Healthcare

18 pages, 919 KiB

Open AccessCase Report

Family-Centered Care in Adolescent Intensive Outpatient Mental Health Treatment in the United States: A Case Study

by Henry W. Kietzman, Willem L. Styles, Liese Franklin-Zitzkat, Maria Del Vecchio Valerian and Eunice Y. Yuen

Healthcare 2025, 13(9), 1079; https://doi.org/10.3390/healthcare13091079 (registering DOI) - 6 May 2025

Abstract

Background: Social isolation, national turmoil, and an adolescent mental health crisis in the wake of the COVID-19 pandemic have resulted in a significant uptick in inpatient admissions and re-admissions for high-risk patients. This trend persists even as the pandemic wanes. Intensive outpatient programs [...] Read more.

Background: Social isolation, national turmoil, and an adolescent mental health crisis in the wake of the COVID-19 pandemic have resulted in a significant uptick in inpatient admissions and re-admissions for high-risk patients. This trend persists even as the pandemic wanes. Intensive outpatient programs (IOPs) serve as a critical steppingstone between the community and inpatient mental health services, providing comprehensive psychiatric care for at-risk youth. Significant research has identified family engagement as a key element of successful collaborative care in adolescents. Objectives: This article provides models of family-centered care in the adolescent IOP through a case study detailing the six-week course of care of an adolescent struggling with increased emotionality and distress intolerance in the context of family conflicts. Methods: This case highlights five family engagement components, including (1) family-centered psychiatric medication management, (2) individualized case management, parental education, and peer support, (3) Measurement Based Care (MBC) family assessment and feedback sessions, (4) Dialectical Behavior Therapy (DBT) multi-family skill groups, and (5) Compassionate Home Action Together (CHATogether) family intervention to address teen–parent relational health and communication. Results: This case showed improvement in depressive and anxiety symptoms, family conflict behaviors, self-reported suicide risk, and help-seeking attitudes towards parents/adults. The case family, along with others (n = 26), endorsed the parent peer support groups’ acceptability and feasibility implemented in the adolescent IOP. Conclusions: This article emphasizes the importance of family engagement during clinical care and provides a practical guide to implement collaborative family-centered therapeutic interventions in intensive outpatient services. Full article

(This article belongs to the Section Family Medicine)

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22 pages, 692 KiB

Open AccessSystematic Review

Cognitive Interventions for the Treatment of Insomnia or Poor-Quality Sleep in Community-Dwelling Older People: A Systematic Review and Meta-Analysis

by Laura Pilar de Paz-Montón, José Alberto Laredo-Aguilera and Juan Manuel Carmona-Torres

Healthcare 2025, 13(9), 1078; https://doi.org/10.3390/healthcare13091078 (registering DOI) - 6 May 2025

Abstract

Background: Aging and its pathologies, particularly sleep problems, are increasingly affecting industrialized societies. This study aims to determine the effectiveness of different cognitive interventions for the treatment of insomnia or poor sleep quality in community-dwelling older people. Methodology: A systematic review was [...] Read more.

Background: Aging and its pathologies, particularly sleep problems, are increasingly affecting industrialized societies. This study aims to determine the effectiveness of different cognitive interventions for the treatment of insomnia or poor sleep quality in community-dwelling older people. Methodology: A systematic review was carried out from November 2023–July 2024 according to the standards of the Preferred Reporting Items for Systematic Review and Meta-Analyses in the databases. The following databases were consulted: Pubmed, Web of Science, and ClinicalTrials.gov. The studies included patients with sleep problems or insomnia over 60 years of age. To evaluate the quality of the studies, the Critical Appraisal Skills Program Spanish (CASPe) guide was used. Results: Nine clinical trials with intervention groups and control groups belonging to the last 10 years were selected. They were analyzed, and the results were verified via questionnaires, scales, sleep diaries, and objective measures. In general, the implementation of the interventions improved the quality of sleep and symptoms of insomnia. Conclusions: Cognitive interventions have been found to be safe and useful for the treatment of insomnia and poor sleep quality in older people. Furthermore, they are feasible in terms of cost effectiveness and can be easily implemented by primary care teams. Full article

(This article belongs to the Section Chronic Care)

13 pages, 280 KiB

Open AccessArticle

Biliary Complications After Surgery for Hydatid Disease: A Five-Year Experience in a Tertiary Care Center

by Sebastian Vâlcea, Bogdan Cristian Dumitriu, Mircea Beuran and Catalin Vladut Ionut Feier

Healthcare 2025, 13(9), 1077; https://doi.org/10.3390/healthcare13091077 (registering DOI) - 6 May 2025

Abstract

Background and Objectives: Cystic echinococcosis (CE) remains a significant health concern in endemic areas, including Romania, where hepatic hydatid cysts frequently require surgical treatment. Surgery represents the cornerstone of therapy, particularly in large, complicated, or symptomatic cysts, where medical or minimally invasive options [...] Read more.

Background and Objectives: Cystic echinococcosis (CE) remains a significant health concern in endemic areas, including Romania, where hepatic hydatid cysts frequently require surgical treatment. Surgery represents the cornerstone of therapy, particularly in large, complicated, or symptomatic cysts, where medical or minimally invasive options may be insufficient. This study aims to investigate the clinical characteristics, risk factors, and postoperative evolution of patients undergoing surgical intervention for hepatic CE in a tertiary care center over a five-year period. Materials and Methods: This retrospective study examined data from 62 patients who underwent surgical procedures for hepatic CE during a 5-year period. The analysis focused on demographic parameters, cyst morphology, surgical techniques employed, and postoperative complications, with particular attention to the frequency, management, and outcomes of biliary fistulas. Results: The study cohort had an average age of 44.1 years, with a slight predominance of female patients (51.6%). The majority of cysts (62.9%) were located in the right hepatic lobe, with an average diameter of 10.9 cm. Postoperative complications were recorded in 25.8% of cases, with biliary fistulas being the most frequent (12.9%). Patients who developed biliary fistulas presented significantly larger cysts (152.13 ± 105.68 mm vs. 102.20 ± 37.86 mm, p = 0.012) and required an extended length of hospitalization, particularly in high-output cases (29 vs. 9.3 days, p = 0.045). Hospital stays and treatment expenses were notably higher among patients with biliary fistulas. Conclusions: Biliary fistulas were observed exclusively in patients who underwent partial cystectomy. This finding highlights the need for increased caution when performing partial cystectomy, especially in cases involving large or recurrent cysts, where the risk of postoperative biliary fistulas is higher. Tailoring the surgical technique based on cyst characteristics and incorporating intraoperative strategies to manage or prevent biliary leakage may help reduce morbidity. Early identification and multidisciplinary management of high-risk cases are key to improving outcomes in hepatic CE. Full article

(This article belongs to the Special Issue One World, One Health: Zoonotic Diseases, Parasitic Diseases and Infectious Diseases)

19 pages, 1617 KiB

Open AccessSystematic Review

The Impact of Prenatal Care on the Prevention of Neonatal Outcomes: A Systematic Review and Meta-Analysis of Global Health Interventions

by Mohammed Nasser Albarqi

Healthcare 2025, 13(9), 1076; https://doi.org/10.3390/healthcare13091076 - 6 May 2025

Abstract

Background/Objectives: Neonatal outcomes, including low birth weight, preterm birth, and neonatal mortality, pose significant global health challenges, particularly in low- and middle-income countries. Prenatal care has emerged as a critical intervention in mitigating these risks through medical, nutritional, and psychosocial support. This study [...] Read more.

Background/Objectives: Neonatal outcomes, including low birth weight, preterm birth, and neonatal mortality, pose significant global health challenges, particularly in low- and middle-income countries. Prenatal care has emerged as a critical intervention in mitigating these risks through medical, nutritional, and psychosocial support. This study aimed to systematically assess the effectiveness of prenatal care interventions in preventing neonatal outcomes across diverse settings. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines, with the protocol registered in PROSPERO (CRD42024601066). Fourteen peer-reviewed studies were included following a comprehensive search across five major databases. Eligible studies reported quantitative neonatal outcomes associated with prenatal care interventions, including nutritional supplementation, mental health services, telehealth, and routine antenatal care. Random-effects models were used for meta-analysis, and the risk of bias was assessed using RoB 2 and the Newcastle–Ottawa Scale. Results: Nutritional interventions, especially folic acid and iron supplementation, significantly reduced neonatal mortality by up to 40% (RR = 0.60, 95% CI: 0.54–0.68). High-quality prenatal care was associated with a 41% reduction in neonatal mortality. Psychosocial support reduced the risk of low birth weight and preterm birth, while telehealth interventions lowered NICU admissions in low-risk populations (RR = 0.88, 95% CI: 0.75–1.03). Heterogeneity was substantial (I² = 70%), and publication bias was suggested. Conclusions: Comprehensive prenatal care, integrating medical, nutritional, and mental health interventions, significantly improves neonatal outcomes. The global implementation of accessible, high-quality prenatal services is essential, particularly in underserved populations, to reduce neonatal morbidity and mortality. Full article

(This article belongs to the Special Issue Maternal Diseases and Treatment for Mothers and Children)

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11 pages, 435 KiB

Open AccessArticle

Prevalence of Stroke in Spain and Its Impact on Quality of Life: Socioeconomic Inequalities and Access to Rehabilitation

by Ismael García-Campanario and Maria Jesus Vinolo-Gil

Healthcare 2025, 13(9), 1075; https://doi.org/10.3390/healthcare13091075 - 6 May 2025

Abstract

Stroke is a cerebrovascular syndrome due to a sudden interruption of blood flow to the brain that causes transient or permanent damage. Despite advances in the field of medical science, stroke is still common and continues to have a significant effect on quality [...] Read more.

Stroke is a cerebrovascular syndrome due to a sudden interruption of blood flow to the brain that causes transient or permanent damage. Despite advances in the field of medical science, stroke is still common and continues to have a significant effect on quality of life. Objective: The objective of the study was to analyze the prevalence of strokes in Spain, considering differences in sociodemographic factors, functional limitations, and access to rehabilitation, with special attention to sex-related disparities. Methodology: A cross-sectional study was conducted using data from the latest European Health Survey in Spain carried out between 2019 and 2020 on a total of 22,072 people. Individuals over 16 years of age with a medical diagnosis of stroke were selected for this study. Sociodemographic variables, self-perception of health, limitations in daily activities, level of physical activity, and access to rehabilitation treatment were analyzed. Descriptive measures and inferential tests were applied for statistical analysis. Results: The prevalence of strokes occurring in Spain was estimated at 2.02%, which is lower than European figures. Men tend to have strokes at younger ages (50% between 36 and 73 years), while women report a poorer quality of life after the incident. Most patients had not received rehabilitation services in the last year. Conclusions: Given the aging population, it is essential to reinforce prevention, early detection and rehabilitation therapies to improve quality of life and reduce the burden of care. Full article

(This article belongs to the Special Issue Physical Therapy and Rehabilitation of Neurological Disorders)

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20 pages, 6560 KiB

Open AccessArticle

How Stable Are Individual Preferences for Health Expenditure in Germany?

by Bodo Vogt and Andreas Uphaus

Healthcare 2025, 13(9), 1074; https://doi.org/10.3390/healthcare13091074 - 6 May 2025

Abstract

Background/Objectives: This study analyzed the stability of individual preferences for the allocation of expenditure in the healthcare system using an experimental setting. Understanding these preferences can support policy decisions aimed at achieving a more needs-based allocation of scarce resources in healthcare systems. Stability [...] Read more.

Background/Objectives: This study analyzed the stability of individual preferences for the allocation of expenditure in the healthcare system using an experimental setting. Understanding these preferences can support policy decisions aimed at achieving a more needs-based allocation of scarce resources in healthcare systems. Stability in preferences might be essential in order to avoid frequent legislative changes and can potentially enhance public satisfaction with the healthcare system. Methods: Individual preferences were assessed through two questionnaire-based experimental studies conducted before and after the COVID-19 pandemic, each with about 160 participants, in the context of a healthcare seminar in the MaxLab of the Otto-von-Guericke-University Magdeburg, Germany. This study was intended as a preliminary study for a larger follow-up panel study. In particular, the questionnaire contained questions regarding satisfaction with the healthcare system, optimization options, possible maximum contributions, and preferences for the allocation of notional healthcare budget and research funds in order to provide initial evidence regarding the stability of such preferences. As the data were collected both before and after the COVID-19 pandemic, this significant change in the situation helps to provide clear indications of stability. The preferences collected were compared to the actual allocation of expenditure derived from official statistics in order to identify potential areas for policy adjustment. Results: Preferences for the allocation of healthcare expenditure appear to be relatively stable despite the effects of the pandemic. However, noticeable discrepancies exist between individual preferences and actual healthcare spending. Satisfaction with the healthcare system also remains relatively stable at a high level. Conclusions: Overall, the scientific measurement of public preferences could support more informed political decision-making and contribute to sustained satisfaction with the healthcare system. In particular, the distribution of funds to different disease categories should be adjusted on the basis of such preferences, taking into account the respective medical indications after representative regular surveys have been carried out. Full article

(This article belongs to the Section Health Policy)

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Graphical abstract

15 pages, 890 KiB

Open AccessArticle

Piloting an In Situ Training Program in Video Consultations in a Gynaecological Outpatient Clinic at a University Hospital: A Qualitative Study of the Healthcare Professionals’ Perspectives

by Christina Louise Lindhardt, Maria Monberg Feenstra, Heidi Faurholt, Louise Rosenlund Andersen and Marianne Kirstine Thygesen

Healthcare 2025, 13(9), 1073; https://doi.org/10.3390/healthcare13091073 - 6 May 2025

Abstract

Background/Objectives: The successful integration of video consultations in routine hospital care requires further research. This study explores how healthcare professionals experienced and engaged with a pilot training program in video consultations (VCs), focusing on patient-centred communication and technical skills. Methods: A qualitative study [...] Read more.

Background/Objectives: The successful integration of video consultations in routine hospital care requires further research. This study explores how healthcare professionals experienced and engaged with a pilot training program in video consultations (VCs), focusing on patient-centred communication and technical skills. Methods: A qualitative study was conducted at a gynaecological outpatient clinic in a Danish university hospital. In October 2022, healthcare professionals (n = 8) piloted a training program in VCs with patients suffering from gynaecological disorders, followed by semi-structured interviews. Our data analysis was inductive and inspired by thematic analysis, as proposed by Braun and Clarke. Results: Our analysis resulted in an overall theme, namely feasible, with context-dependent considerations, and followed by four other themes:, namely that (1) pre in situ training presents benefits and challenges, (2) consultation via video can be an advantage to consultations via phone or in-clinic, (3) individual planning and organising is a must, and (4) video consultation calls for new competencies. Conclusions: Our study indicates that a training program focusing on patient-centred communication, technical skills and in situ training with peer feedback is relevant when implementing VCs. Visual contact was an advantage of VC versus phone; however, patient triage was identified as essential when planning VCs. Overall, VCs are feasible in a gynaecological outpatient setting when their implementation is supported by an in situ training program and with ongoing technical support available. Full article

(This article belongs to the Section TeleHealth and Digital Healthcare)

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18 pages, 870 KiB

Open AccessArticle

Social Media Addiction and Procrastination in Peruvian University Students: Exploring the Role of Emotional Regulation and Age Moderation

by Sandra Elizabeth Fuentes Chavez, Velia Graciela Vera-Calmet, Haydee Mercedes Aguilar-Armas, Lucy Angélica Yglesias Alva, Marco Agustín Arbulú Ballesteros and Cristian Edgardo Alegria Silva

Healthcare 2025, 13(9), 1072; https://doi.org/10.3390/healthcare13091072 - 6 May 2025

Abstract

Objectives: This study examines the mediating role of emotional regulation in the relationship between social media addiction and irrational procrastination among university students in Trujillo, Peru. Methods: The research employed a non-experimental, explanatory design with latent variables using measurement scales involving 342 [...] Read more.

Objectives: This study examines the mediating role of emotional regulation in the relationship between social media addiction and irrational procrastination among university students in Trujillo, Peru. Methods: The research employed a non-experimental, explanatory design with latent variables using measurement scales involving 342 university students aged 18 to 36 years. Data collection was carried out using quota sampling using institutional email lists. The findings reveal that social media addiction significantly influences both irrational procrastination and emotional regulation, with age moderating the relationship between emotional regulation and procrastination. Results: The results indicated that social media addiction explained 9.5% of the variance in procrastination and 12% of the variance in emotional regulation. Interestingly, although age alone did not directly predict procrastination, it demonstrated a significant moderating effect when combined with emotional regulation. The study did not find a significant mediating effect of emotional regulation between social media addiction and procrastination. Conclusions: These findings contribute to understanding the complex dynamics between digital behavior, emotional regulation, and academic procrastination, suggesting the need for targeted interventions that consider age-specific approaches to emotional regulation and social media use in the academic setting. Full article

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24 pages, 31663 KiB

Open AccessReview

The Many Faces of Intestinal Tumors in Adults, Including the Primary Role of CT Imaging in Emergencies and the Important Role of Cross-Sectional Imaging: A Pictorial Review

by Barbara Brogna, Francesca Maccioni, Dolores Sgambato, Fabiana Capuano, Lorenzo Iovine, Salvatore Guarino, Lorenzo Di Libero, Alfonso Amendola, Lorenzo Faggioni and Dania Cioni

Healthcare 2025, 13(9), 1071; https://doi.org/10.3390/healthcare13091071 - 6 May 2025

Abstract

Background/Objectives: Small bowel tumors (SBTs) encompass a diverse range of tumor types, with benign tumors being the most prevalent. However, the incidence of malignant SBTs is increasing, particularly small bowel adenocarcinoma; this poses a diagnostic challenge for clinicians and radiologists due to the [...] Read more.

Background/Objectives: Small bowel tumors (SBTs) encompass a diverse range of tumor types, with benign tumors being the most prevalent. However, the incidence of malignant SBTs is increasing, particularly small bowel adenocarcinoma; this poses a diagnostic challenge for clinicians and radiologists due to the varied and nonspecific clinical and radiological presentations associated with SBTs. In fact, SBTs can present differently in emergencies, often mimicking inflammatory diseases or manifesting as complications such as intussusception, small bowel obstruction (SBO), intestinal ischemia, perforation, gastrointestinal bleeding, or metastatic disease. These tumors can remain asymptomatic for extended periods. Methods: We present a pictorial review on the role of imaging in evaluating SBTs, focusing on the emergency setting where diagnosis can be incidental. We also include some representative cases that may be useful for radiologists and residents in clinical practice. Results: Despite these challenges, contrast-enhanced computed tomography (CECT) is usually the best modality to use in emergencies for evaluating SBTs, and in some cases, a diagnosis can be made incidentally. However, when possible, multimodal imaging through cross-sectional imaging remains crucial for the non-invasive diagnosis of SBTs in stable patients, as endoscopic procedures may also be impractical. A complementary CT study with distension using negative oral contrast media, such as water, polyethylene glycol, or mannitol solutions, can improve the characterization of SBTs and rule out multiple SBT locations, particularly in small bowel neuroendocrine tumor (NET) and gastrointestinal tumor (GIST) localization. Positive water-soluble iodine-based oral contrast, such as Gastrografin (GGF), can be used to evaluate and monitor the intestinal lumen during the nonsurgical management of small bowel obstruction (SBO) or in suspected cases of small bowel perforations or the presence of fistulas. Magnetic resonance enterography (MRE) can aid in improving the characterization of SBTs through a multiplanar and multisequence study. Positron emission tomography combined with CT is generally an essential modality in evaluating metastatic disease and staging and assessing tumor prognosis, but it has limitations for indolent lymphoma and small NETs. Conclusions: Therefore, the integration of multiple imaging modalities can improve patient management and provide a preoperative risk assessment with prognostic and predictive indicators. In the future, radiomics could potentially serve as a “virtual biopsy” for SBTs, allowing for better diagnosis and more personalized management in precision medicine. Full article

(This article belongs to the Special Issue Digital Healthcare Innovation in Medical Imaging: The Past, the Present and the Future)

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12 pages, 2834 KiB

Open AccessReview

Adult Triage in the Emergency Department: Introducing a Multi-Layer Triage System

by Dimitrios Tsiftsis, Andreas Tasioulis and Dimitrios Bampalis

Healthcare 2025, 13(9), 1070; https://doi.org/10.3390/healthcare13091070 - 6 May 2025

Abstract

Emergency department (ED) triage is the cornerstone of ED operations. Many different triage systems have been proposed and implemented globally. To date, an ideal triage system has not yet been identified. As the burden on EDs rises, with overcrowding being recognized as a [...] Read more.

Emergency department (ED) triage is the cornerstone of ED operations. Many different triage systems have been proposed and implemented globally. To date, an ideal triage system has not yet been identified. As the burden on EDs rises, with overcrowding being recognized as a universal problem, ED triage needs to be restructured to address this reality. Extensive and critical literature research over the years has identified the strengths and weaknesses of current ED triage implementations. A novel multi-layer triage system was introduced and implemented in Greek Eds, combining the strengths of various triage and early warning systems and scores to minimize under-triage and the adverse downstream effects it creates on patient outcomes. Acknowledging that no triage system can be universally adapted in different settings, the structural concepts of this triage system address most of the triage problems currently reported in the literature. Full article

(This article belongs to the Special Issue A Needle in a Haystack: Looking for Gaps in Treatment and Education in Emergency Medicine)

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15 pages, 1321 KiB

Open AccessArticle

Adolescent Refugee Potential Traumatic Experience and Mental Health in Gambella Region in Ethiopia: A Model Examining Mediating Effects of Coping and Resilience

by Solomon D. Danga, Babatope O. Adebiyi, Erica Koegler, Conran Joseph and Nicolette V. Roman

Healthcare 2025, 13(9), 1069; https://doi.org/10.3390/healthcare13091069 - 6 May 2025

Abstract

Background: Refugees often experience multiple traumatic events due to persecution, conflict, and displacement, which can result in poor mental health outcomes. Objective: The current study examined whether coping and resilience mediate the relationship between traumatic experience(s) and mental health outcomes and whether [...] Read more.

Background: Refugees often experience multiple traumatic events due to persecution, conflict, and displacement, which can result in poor mental health outcomes. Objective: The current study examined whether coping and resilience mediate the relationship between traumatic experience(s) and mental health outcomes and whether these indirect effects were moderated by age, gender, and refugee camp duration. Method: A cross-sectional, correlational study design was employed. Data were collected from 14 July 2019 to 28 August 2019. A sample of 414 adolescent refugees from two refugee camps in the Gambella regional state of Ethiopia were selected using proportional stratified sampling and simple random sampling techniques. Participants completed a self-reported questionnaire. Data were analysed using Structural Equation Modelling for hypotheses testing causal models. Results: Coping and resilience fully mediated the relationship between traumatic experience and mental health among adolescent refugees. Refugee camp duration as a moderator factor weakens the positive relationship between traumatic experiences and mental health outcomes. Conclusions: This study highlights the critical importance of comprehensive intervention strategies that strengthen adolescent refugee personal, family, social, and community level coping and resilience abilities within refugee camps setting. The findings also strongly suggested that early intervention in refugee camps could protect adolescent refugees from possible psychological distress and maintain adolescents’ mental health and well-being within refugee camps. Full article

(This article belongs to the Special Issue Healthcare for Immigrants and Refugees)

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15 pages, 4784 KiB

Open AccessCase Report

Use of a Resorbable Magnesium Membrane for Bone Regeneration After Large Radicular Cyst Removal: A Clinical Case Report

by Gabi Chaushu, Vadim Reiser, Eli Rosenfeld, Daya Masri, Liat Chaushu, Marija Čandrlić, Patrick Rider and Željka Perić Kačarević

Healthcare 2025, 13(9), 1068; https://doi.org/10.3390/healthcare13091068 - 6 May 2025

Abstract

Background: Periapical cysts are the most common odontogenic cysts, often resulting in large bone defects. Guided tissue regeneration techniques support tissue healing by means of membranes and bone grafts. The present case report evaluates for the first time clinical application of a resorbable [...] Read more.

Background: Periapical cysts are the most common odontogenic cysts, often resulting in large bone defects. Guided tissue regeneration techniques support tissue healing by means of membranes and bone grafts. The present case report evaluates for the first time clinical application of a resorbable magnesium membrane in guided bone regeneration (GBR) following cystectomy. Case report: A 35-year-old male patient presented with a large periapical cystic lesion in the maxillary anterior region. Treatment involved marsupialization followed by cyst enucleation and GBR using a resorbable magnesium membrane and bovine xenograft. The magnesium membrane served as a structural support to bridge the bony discontinuity in the palatal bone. Cone-beam computed tomography (CBCT) was used for diagnosis, treatment planning, and follow-up assessments. At 16 months post-treatment, CBCT imaging revealed significant bone regeneration, with restoration of the palatal contour and cortication of the palatal wall. Clinical examination showed asymptomatic teeth with normal mobility and optimal soft tissue healing. Conclusions: This case demonstrates the potential of resorbable magnesium membranes in managing large periapical defects, offering a promising alternative to traditional GBR materials by combining mechanical strength with complete resorption, therefore eliminating the need for membrane removal surgery. However, future studies on larger patient samples should focus on confirming the long-term outcomes of this approach and investigating patient-specific factors that are important in choosing effective treatment options. Full article

(This article belongs to the Collection Dentistry, Oral Health and Maxillofacial Surgery)

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16 pages, 3941 KiB

Open AccessArticle

Bibliometric Analysis of Cross-Sectional Studies on Early Childhood Caries

by Rana A. Alamoudi

Healthcare 2025, 13(9), 1067; https://doi.org/10.3390/healthcare13091067 - 6 May 2025

Abstract

Background/Objectives: Early childhood caries (ECC) is a significant global public health issue with economic and psychosocial consequences, impacting families and pediatric dentists. It affects children’s quality of life, causing pain and infection. Despite increasing research on ECC cross-sectional studies worldwide, inconsistencies and gaps [...] Read more.

Background/Objectives: Early childhood caries (ECC) is a significant global public health issue with economic and psychosocial consequences, impacting families and pediatric dentists. It affects children’s quality of life, causing pain and infection. Despite increasing research on ECC cross-sectional studies worldwide, inconsistencies and gaps remain in terms of geographical disparities. This study aimed to conduct a bibliometric analysis of cross-sectional surveys on ECC by examining the co-authorship, citation analysis, co-citation networks, and keyword co-occurrence. Methods: An advanced search was performed using relevant terms in the Dimensions database from 2005 to 2024. Bibliometric parameters were retrieved through the database’s analytical view tool and VOSviewer software. Results: A total of 571 documents were identified, with the highest output between 2019 and 2023 (355 records). Saul Martins Paiva authored the most articles (10), with 294 citations and a total link strength of 19. Brazil and the U.S. had the highest numbers of publications (56 and 52) and total link strengths, i.e., a measure of collaborative ties (21 and 50). The Universidade Federal de Minas Gerais in Brazil had the most published documents (15). BMC Oral Health led in terms of citations (44 articles, 899 citations, average 20.43%). The frequently co-occurring terms included ECC (1147 occurrences), oral health (417), and preschool child (301). Conclusions: This bibliometric analysis highlights the global interest in cross-sectional ECC studies beyond pediatric dentistry, helping researchers understand the field’s scope and progress. Full article

(This article belongs to the Special Issue Prevention and Management of Oral Diseases Among Children)

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12 pages, 387 KiB

Open AccessArticle

Effect of Diabetes Self-Efficacy on Coping Strategy: Self-Stigma’s Mediating Effect

by Hyunjin Lee, Seyeon Park and Kawoun Seo

Healthcare 2025, 13(9), 1066; https://doi.org/10.3390/healthcare13091066 - 5 May 2025

Abstract

Objectives: This descriptive study aimed to explore self-stigma’s mediating effect on the association between self-efficacy and coping strategy among Korean patients with type 2 diabetes. Methods: This study included 189 participants with type 2 diabetes diagnosed by an endocrinologist. Data were collected from [...] Read more.

Objectives: This descriptive study aimed to explore self-stigma’s mediating effect on the association between self-efficacy and coping strategy among Korean patients with type 2 diabetes. Methods: This study included 189 participants with type 2 diabetes diagnosed by an endocrinologist. Data were collected from 1 November to 28 December 2023, using a self-report questionnaire focusing on self-efficacy, coping strategy, and self-stigma. The collected data were analyzed using descriptive statistics, independent sample t-test, one-way analysis of variance, Pearson’s correlation coefficient, and multiple regression analysis using SPSS; the mediating effect was examined using SPSS PROCESS Macro. Results: The mean self-efficacy, coping strategy, and self-stigma scores were 6.29 (±10.80), 2.84 (±0.54), and 2.72 (±0.82), respectively. Self-efficacy was negatively correlated with coping strategy (r = −0.52, p < 0.001) and self-stigma (r = −0.45, p < 0.001). Coping strategy was positively correlated with self-stigma (r = 0.78, p < 0.001). Further, self-stigma partially mediated the relationship between self-efficacy and coping strategy, accounting for 64.0% of the variance. Conclusions: These results suggest the importance of tailoring self-stigma reduction strategies to enable patients with diabetes to develop positive coping strategies. Moreover, incremental and tailored programs for reducing self-stigma must be developed. Full article

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12 pages, 506 KiB

Open AccessArticle

Differentiating Nontuberculous Mycobacterial Pulmonary Disease from Pulmonary Tuberculosis in Resource-Limited Settings: A Pragmatic Model for Reducing Misguided Antitubercular Treatment

by Wei Zhang, Jun Chen, Zhenhua Chen, Jun Quan and Zebing Huang

Healthcare 2025, 13(9), 1065; https://doi.org/10.3390/healthcare13091065 - 5 May 2025

Abstract

Background: Differentiating nontuberculous mycobacterial pulmonary disease (NTM-PD) from pulmonary tuberculosis (PTB) remains challenging due to overlapping clinical features, particularly in resource-limited settings where diagnostic errors are frequent. This retrospective case–control study (January 2023–June 2024) aimed to identify key clinical predictors and develop [...] Read more.

Background: Differentiating nontuberculous mycobacterial pulmonary disease (NTM-PD) from pulmonary tuberculosis (PTB) remains challenging due to overlapping clinical features, particularly in resource-limited settings where diagnostic errors are frequent. This retrospective case–control study (January 2023–June 2024) aimed to identify key clinical predictors and develop a diagnostic model to distinguish NTM-PD from PTB. Methods: Patients initially presumed to have PTB (meeting clinical–radiological criteria but lacking bacteriological confirmation at admission) at a tertiary tuberculosis hospital were enrolled. Final diagnoses of NTM-PD (n = 105) and PTB (n = 105) were confirmed by mycobacterial culture identification. Clinical, laboratory, and radiological data were compared using univariate analysis. Variables showing significant differences (p < 0.05) were entered into multivariable logistic regression. Diagnostic performance was evaluated via receiver operating characteristic (ROC) curve analysis. Results: Female sex (odds ratio [OR] = 2.51, 95% confidence interval [CI] 1.12–5.60), hemoptysis (OR = 2.20, 1.05–4.62), bronchiectasis (OR = 5.92, 2.56–13.71), and emphysema/pulmonary bullae (OR = 2.69, 1.16–6.24) emerged as independent predictors of NTM-PD, while systemic symptoms favored PTB (OR = 0.45, 0.20–0.99). The model demonstrated 91.4% specificity and 68.6% sensitivity with an area under the curve [AUC] of 0.871. Conclusions: This high-specificity model helps prioritize NTM-PD confirmation in females with hemoptysis and structural lung changes (computed tomography evidence of bronchiectasis and/or emphysema) while maintaining PTB suspicion when systemic symptoms (fever, night sweats, weight loss) dominate. The approach may reduce misguided antitubercular therapy in resource-limited settings awaiting culture results. Full article

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13 pages, 236 KiB

Open AccessArticle

Building Resilience Through Symphony and Poetry for COVID-19-Encumbered Healthcare Workers: A Taiwanese Qualitative Study

by Hui-Yueh Liu, Chun-Kai Fang, Jung-En Peng, Sung-Yuan Cheng and Te-Yu Wu

Healthcare 2025, 13(9), 1064; https://doi.org/10.3390/healthcare13091064 - 5 May 2025

Abstract

Background: In 2021, Taiwan’s healthcare workers faced significant stress due to the coronavirus disease 2019 (COVID-19) pandemic. This study aims to enhance healthcare workers’ self-awareness of their stress and improve their work efficiency by using symphonic poetry to inspire resilience. Methods: This qualitative [...] Read more.

Background: In 2021, Taiwan’s healthcare workers faced significant stress due to the coronavirus disease 2019 (COVID-19) pandemic. This study aims to enhance healthcare workers’ self-awareness of their stress and improve their work efficiency by using symphonic poetry to inspire resilience. Methods: This qualitative study involved in-depth interviews with a panel of physicians, nurses, and specialist nurses. The interviews were conducted using ATLAS—ti 7.5 qualitative analysis software for content analysis. Participants must have attended the “Meeting Mahler, Meeting Myself” concert organized by the medical center. The concert was based on the poetry from the fifth movement of Mahler’s Symphony No. 2, “Resurrection”, and included symphonic poetry and a manual. The manual combined pictures and a complementary interview guide to facilitate participants sharing their pandemic experiences and health. Results: A total of 19 healthcare workers participated in the interviews. All participants had attended the institute’s symphonic poetry concert “Meeting Mahler, Meeting Myself”. The average age of the participants was 44.1 ± 11.4 years, and their average working experience was 19.1 ± 13.1 years. The group included nine physicians (47.4%), eight nurses (42.1%), and two specialist nurses (10.5%). The results were categorized into three major themes: “Pandemic-Induced Physical and Mental Exhaustion”, “Symphonic Poetry as a Tool for Building Resilience”, and “Enhancing Mental Toughness to Overcome Adversity”. Conclusions: Healthcare workers experienced stress and exhaustion during the pandemic. Symphonic poetry can serve as a supportive tool to inspire resilience and enhance mental toughness among healthcare professionals facing pandemic-related challenges. Full article

(This article belongs to the Topic Employee Quality of Life, Well-Being and Wellness: A Pathway to Organizational Performance, Efficiency, and Sustainability)

29 pages, 982 KiB

Open AccessArticle

Exploring the Gender Preferences for Healthcare Providers and Their Influence on Patient Satisfaction

by Felician Andrew Kitole, Zaiba Ali, Jiayi Song, Muhammad Ali, Mochammad Fahlevi, Mohammed Aljuaid, Petra Heidler, Muhammad Ali Yahya and Muhammad Shahid

Healthcare 2025, 13(9), 1063; https://doi.org/10.3390/healthcare13091063 - 5 May 2025

Abstract

Background: Patient satisfaction is a key indicator for improving healthcare delivery, yet the influence of gender preferences on healthcare providers remains underexplored. Cultural norms and gender perceptions often shape the patient preferences, affecting access to care, patient–provider relationships, and overall satisfaction. Thus, this [...] Read more.

Background: Patient satisfaction is a key indicator for improving healthcare delivery, yet the influence of gender preferences on healthcare providers remains underexplored. Cultural norms and gender perceptions often shape the patient preferences, affecting access to care, patient–provider relationships, and overall satisfaction. Thus, this study investigates the patients’ gender preferences and their impact on satisfaction in Tanzania. Methods: The study utilized a cross-sectional design, collecting data from five health centres: Mikongeni, Konga, Mzumbe, Tangeni, and Mlali. A total of 240 randomly selected respondents participated in the study. Gender preferences were categorized as male, female, and both, and determinants were analyzed using a multivariate probit model (MPM), while satisfaction was analyzed using an ordered logit model (OLM). Results: Results reveal that female providers were preferred for empathy (58.30%), intimate care (50.00%), and receptionist roles (50.00%), while males were favored for surgery (50.00%), professionalism (0.86), and IT roles (41.70%). Professionalism (0.75) and communication (0.70) had the strongest positive effects on very high satisfaction. Male provider preference was strongly linked to higher satisfaction (0.84), while female preference showed a mild effect (0.23). Insurance (0.32) and care at Tangeni Health Centre (0.70) boosted satisfaction, while consultation fees (−0.26) reduced it. Conclusions: The study recommends that healthcare systems address gender stereotypes by equipping all providers with both technical and relational care skills, regardless of gender. It also highlights the need for culturally and religiously sensitive care practices that acknowledge how societal norms shape patient preferences and satisfaction. To enhance patient-centered care, policies should promote affordability, broaden insurance coverage, and integrate patient feedback on gender preferences into healthcare delivery models. Full article

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18 pages, 955 KiB

Open AccessArticle

Menopause and Diabetes Risk Along with Trajectory of β-Cell Function and Insulin Sensitivity: A Community-Based Cohort Study

by Mi Jin Choi and Juyoun Yu

Healthcare 2025, 13(9), 1062; https://doi.org/10.3390/healthcare13091062 - 5 May 2025

Abstract

Background: The relationship between menopause and diabetes risk is unclear, with some studies indicating a weak association. This study examined changes in diabetes risk, β-cell function, and insulin sensitivity in relation to menopause. Methods: In this community-based cohort study, data from 6684 visits [...] Read more.

Background: The relationship between menopause and diabetes risk is unclear, with some studies indicating a weak association. This study examined changes in diabetes risk, β-cell function, and insulin sensitivity in relation to menopause. Methods: In this community-based cohort study, data from 6684 visits to 1224 women over a 16-year follow-up were analyzed. Diabetes risk changes were assessed in relation to the different menopausal phases: premenopausal (≥3 years before menopause), perimenopausal (2 years before to 1 year after menopause), and postmenopausal (≥2 years after menopause). Changes in β-cell function and insulin sensitivity indices were tracked, and their relationship with diabetes risk was assessed. Generalized estimating equations and linear mixed models were used, adjusting for covariates including age at menopause and obesity. Results: Diabetes incidence was 18.6% among participants. The odds ratio (OR) of diabetes increased by 1.03 times annually during the premenopausal period (OR 1.03; 95% CI 1.02–1.04) and decreased during the postmenopausal period (OR 0.96; 95% CI 0.95–0.97). The incident diabetes groups showed a decline in insulin sensitivity and β-cell function, resulting in a decrease in the disposition indices over time. A large change in insulin sensitivity, especially during the period immediately before the onset of diabetes, increased the risk of diabetes (OR 1.88; 95% CI 1.33–2.67). Conclusions: This study indicates an increased diabetes risk during the premenopausal periods, compared with that in the postmenopausal period, independent of age at menopause and obesity. Additionally, a decrease in insulin sensitivity followed by a subsequent decrease in β-cell function depending on the time of onset was related to the risk of diabetes. These findings enhance the understanding of diabetes risk and associated changes in insulin indices in relation to menopause, emphasizing the importance of health management and diabetes prevention for women in menopausal transition. Full article

(This article belongs to the Section Women's Health Care)

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19 pages, 3069 KiB

Open AccessSystematic Review

Dropout Rate of Participants in Randomized Controlled Trials Using Different Exercise-Based Interventions in Patients with Migraine. A Systematic Review with Meta-Analysis

by Sahar Taghipourazam, Maria-Dolores Cortés-Vega and Cristina García-Muñoz

Healthcare 2025, 13(9), 1061; https://doi.org/10.3390/healthcare13091061 - 5 May 2025

Abstract

Background/Objectives: Exercise has gained attention as a potentially beneficial non-pharmacological intervention, but whether this type of intervention presents a higher dropout rate compared to other interventions is still unknown. This systematic review, with a meta-analysis of randomized controlled trials, aims to determine whether [...] Read more.

Background/Objectives: Exercise has gained attention as a potentially beneficial non-pharmacological intervention, but whether this type of intervention presents a higher dropout rate compared to other interventions is still unknown. This systematic review, with a meta-analysis of randomized controlled trials, aims to determine whether exercise or comparators present lower or higher attrition in patients with migraine. Methods: A search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library until March 2025. The methodological quality was evaluated using the JBI scale for randomized trials. Proportion meta-analysis calculated the dropout rate. Results: Odds ratio meta-analysis under 1 indicated lower attrition in experimental participants. Subgroup meta-analyses sorted by type of exercise, control, and migraine were conducted to explore variability in results based on the mentioned moderators. The overall pooled dropout rate was 6.7%, 11.6% for the exercise groups, and 10.1% for the comparators. No statistical difference was found between groups of studies, type of migraine, type of exercise, and type of comparator (p ≥ 0.05). Only the odds ratio results for migraine with auras showed a lower pooled dropout rate in favor of control participants, OR = 1.18. Conclusions: Although there is no statistically significant difference, the meta-analysis of proportions shows a higher loss rate in exercise-based interventions. However, the high heterogeneity found in the included studies prevents us from drawing firm conclusions. Furthermore, adequate adherence to the CONSORT guidelines in reporting losses and their reasons could help design appropriate retention strategies for studies and interventions based on exercise in patients with migraines. Full article

(This article belongs to the Special Issue Management and Nursing Strategy for Patients with Pain)

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22 pages, 1121 KiB

Open AccessReview

Integrating Digital Health Innovations to Achieve Universal Health Coverage: Promoting Health Outcomes and Quality Through Global Public Health Equity

by Mohamed Mustaf Ahmed, Olalekan John Okesanya, Noah Olabode Olaleke, Olaniyi Abideen Adigun, Uthman Okikiola Adebayo, Tolutope Adebimpe Oso, Gilbert Eshun and Don Eliseo Lucero-Prisno III

Healthcare 2025, 13(9), 1060; https://doi.org/10.3390/healthcare13091060 - 5 May 2025

Abstract

Digital health innovations are reshaping global healthcare systems by enhancing access, efficiency, and quality of care. Technologies such as artificial intelligence, telemedicine, mobile health applications, and big data analytics have been widely applied to support disease surveillance, enable remote care, and improve clinical [...] Read more.

Digital health innovations are reshaping global healthcare systems by enhancing access, efficiency, and quality of care. Technologies such as artificial intelligence, telemedicine, mobile health applications, and big data analytics have been widely applied to support disease surveillance, enable remote care, and improve clinical decision making. This review critically identifies persistent implementation challenges that hinder the equitable adoption of digital health solutions, such as the digital divide, limited infrastructure, and weak data governance, particularly in low- and middle-income countries (LMICs). It aims to propose strategic pathways for integrating digital innovations to strengthen universal health coverage (UHC) and bridge health disparities in the region. By analyzing the best global practices and emerging innovations, this study contributes to the ongoing dialogue on leveraging digital health for inclusive, scalable, and sustainable healthcare delivery in underserved regions. Full article

(This article belongs to the Special Issue Health Promotion to Improve Health Outcomes and Health Quality)

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12 pages, 210 KiB

Open AccessArticle

Perception of Social Support and Disease Acceptance Among Patients Undergoing Cardiac Rehabilitation—Cross-Sectional Study

by Patryk Szlacheta, Marika Wlazło, Mateusz Grajek, Magdalena Kłoda-Suchoń, Beata Choromańska-Matera, Antoniya Yanakieva and Ilona Korzonek-Szlacheta

Healthcare 2025, 13(9), 1059; https://doi.org/10.3390/healthcare13091059 - 4 May 2025

Viewed by 80

Abstract

Background: Cardiovascular diseases (CVD), the leading cause of mortality worldwide, require a multidisciplinary approach, with cardiac rehabilitation being a recommended component. The rehabilitation process may be directly influenced by social support, which enhances motivation to cope with the disease and fosters its acceptance. [...] Read more.

Background: Cardiovascular diseases (CVD), the leading cause of mortality worldwide, require a multidisciplinary approach, with cardiac rehabilitation being a recommended component. The rehabilitation process may be directly influenced by social support, which enhances motivation to cope with the disease and fosters its acceptance. Aims: This study aims to assess the level of social support among patients undergoing cardiac rehabilitation and its impact on disease acceptance. Methods: The study included a sample of 150 patients currently participating in cardiac rehabilitation. Data were collected through direct contact using the validated, anonymous Acceptance of Illness Scale questionnaire, supplemented with a demographic section addressing social support. Results: The majority of respondents reported receiving strong family support (51.3%) and good institutional support (47.3%) during treatment. The mean score for illness acceptance was 29.6 ± 6.9, indicating a high acceptance level observed in most patients (57.3%). The p-values for the association between illness acceptance and support from family and institutions were p = 0.43 and p = 0.82, respectively, suggesting no statistically significant relationship. Conclusions: Patients undergoing cardiac rehabilitation generally experience strong family support, good institutional support, and a high level of disease acceptance. No statistically significant relationship was observed between family or institutional support and the level of disease acceptance. Full article

18 pages, 617 KiB

Open AccessArticle

Assessing COVID-19-Related Psychological Distress: Validation of the AMICO Scale in Spanish Nursing University Students

by Nadine Badillo-Sánchez, Cristina Morgado-Toscano, Regina Allande-Cussó, Juan Gómez-Salgado, Murat Yıldırım, Krzysztof Goniewicz, Israel Macías-Toronjo and Javier Fagundo-Rivera

Healthcare 2025, 13(9), 1058; https://doi.org/10.3390/healthcare13091058 - 4 May 2025

Viewed by 102

Abstract

Background: The COVID-19 pandemic had a significant impact on nursing students by intertwining academic demands with health concerns, a situation that had effects on their emotional well-being and academic engagement. Factors such as sociodemographic characteristics and health status determined their experiences. Understanding [...] Read more.

Background: The COVID-19 pandemic had a significant impact on nursing students by intertwining academic demands with health concerns, a situation that had effects on their emotional well-being and academic engagement. Factors such as sociodemographic characteristics and health status determined their experiences. Understanding these dynamics is crucial, especially in the context of the Spanish health and education systems. The present study aimed to adapt and assess the psychometric properties of the AMICO scale in the context of nursing students in Spain. Methods: Cross-sectional descriptive study. The study was carried out in University Nursing Centers in Spain using a non-probabilistic snowball sampling method. The total sample consisted of 1197 nursing students. Sociodemographic variables were included, as well as questions related to general health and some more specific questions about COVID-19. For the reliability study, Cronbach’s alpha was calculated. An exploratory factor analysis using principal components and varimax rotation was applied, excluding items with loadings below 0.05. Results: In this study, 1197 nursing students residing in Spain participated, of whom 85% were female, with a mean age of 22.35 years. Despite 73.9% of the students being isolated due to exposure to COVID-19, they rated their general health positively (7.86). Females reported higher levels of anxiety. The AMICO scale revealed significant differences according to gender, health, and vaccination history, showing high reliability (Cronbach’s alpha = 0.913). Conclusions: The two-factor structure of the AMICO scale was validated, confirming its suitability for assessing anxiety and fear among nursing students in Spain. The study revealed significant emotional distress during the COVID-19 pandemic, particularly among women, high-risk individuals, and those fully vaccinated. These findings accentuate the need for higher education institutions to implement targeted mental health interventions during public health emergencies. Future longitudinal research should examine the evolving psychological impact of such crises and the mitigating roles of quality of life, sleep, and physical activity. Full article

(This article belongs to the Special Issue The Impact of COVID-19 on Mental Health Across Diverse Populations)

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20 pages, 262 KiB

Open AccessArticle

Social Support and Its Influencing Factors Among Perimenopausal Women in Tianjin, China: A Community-Based Study

by Shuang Yuan and Jianping Ren

Healthcare 2025, 13(9), 1057; https://doi.org/10.3390/healthcare13091057 - 4 May 2025

Viewed by 77

Abstract

Objectives: This study aimed to assess the social support level among perimenopausal women and explore its key influencing factors. Methods: From November 2022 to March 2023, a stratified multistage random sampling method was used to recruit 647 perimenopausal women from three communities in [...] Read more.

Objectives: This study aimed to assess the social support level among perimenopausal women and explore its key influencing factors. Methods: From November 2022 to March 2023, a stratified multistage random sampling method was used to recruit 647 perimenopausal women from three communities in Tianjin, China. The participants completed the Social Support Rating Scale (SSRS), the Kupperman Menopausal Index (KMI), and a sociodemographic questionnaire. Nonparametric tests, correlation analysis, and stepwise regression analysis were conducted to explore key factors influencing social support. Robustness checks were performed using hierarchical regression analysis. Results: The overall social support level of perimenopausal women was moderately low (34.190 ± 10.007), with the lowest scores observed in the 46–50 age group (33.000 ± 9.666). Stepwise regression analysis showed that, compared to married women, single women reported significantly lower social support levels (β = −0.242, p < 0.001). Using public sector employees as the reference group, women in all other occupational categories (including self-employed, corporate employees, farmers, freelancers, and other professions) had significantly lower social support scores (β range: −0.196 to −0.232, all p < 0.05). Compared to those with good family relationships, women with average (β = −0.420, p < 0.001) and poor (β = −0.349, p < 0.001) family relationships reported significantly lower social support levels. In terms of menopausal symptoms, greater severity of palpitations (β = −0.140, p < 0.05) and dyspareunia (β = −0.143, p < 0.05) was associated with lower social support, while higher levels of neuroticism (β = 0.102, p < 0.05) and joint/muscle pain (β = 0.158, p < 0.05) were linked to greater social support. Conclusions: Social support levels among perimenopausal women were generally low, particularly among those aged 46–50 years. Marital status, occupational type, and family relationships were key influencing factors, and certain menopausal symptoms were closely related to social support, especially those that are difficult to discuss, such as palpitations and dyspareunia. These findings highlight the necessity of strengthening social support networks for perimenopausal women and provide scientific evidence for the development of targeted interventions and public health policies to enhance their well-being and promote healthy aging. Full article

14 pages, 1540 KiB

Open AccessArticle

Anterior Cruciate Ligament Reconstruction with Modified Transtibial Technique: Outcomes and Return to Sport in Athletes

by Arcangelo Russo, Giuseppe Gianluca Costa, Maria Agata Musumeci, Michele Giancani, Calogero Di Naro, Francesco Pegreffi, Gianluca Testa, Marco Sapienza and Vito Pavone

Healthcare 2025, 13(9), 1056; https://doi.org/10.3390/healthcare13091056 - 4 May 2025

Viewed by 105

Abstract

Background: Anterior cruciate ligament (ACL) injuries are common among athletes and significantly impact their knee stability and performance. Surgical reconstruction is the standard treatment. The modified transtibial technique has emerged as a promising surgical approach for optimal graft positioning and complication reduction. Methods: [...] Read more.

Background: Anterior cruciate ligament (ACL) injuries are common among athletes and significantly impact their knee stability and performance. Surgical reconstruction is the standard treatment. The modified transtibial technique has emerged as a promising surgical approach for optimal graft positioning and complication reduction. Methods: A retrospective study of athletes who underwent primary ACL reconstruction with the modified transtibial technique was conducted. Clinical outcomes were evaluated using the Lysholm and International Knee Documentation Committee (IKDC) subjective scores and objective knee stability assessments. Return-to-sport rates and associated factors were analyzed. Results: Forty-four athletes were included (thirty-seven males, seven females; mean age 21.2 ± 5.0 years). At mean follow-up of 27.0 ± 12.2 months, significant improvements in the Lysholm and IKDC subjective scores were observed. Overall, 88.2% of athletes returned to sports, and 65.9% achieved their pre-injury levels. Return to pre-injury level was defined as regaining the same type, intensity, and frequency of sport participation as before the injury occurred. Professional athletes showed significantly higher return-to-pre-injury-sport rates (79.3%) than recreational athletes (40.0%, p = 0.0091). Concomitant meniscus injuries negatively impacted return-to-sport rates (92.9% versus 66.7%, p = 0.0397). The overall failure rate was 4.6% (2/44; 95% confidence level [CI]: 0.6–15.5%) with two cases of graft insufficiency or re-rupture. Conclusions: ACL reconstruction with the modified transtibial technique provides favorable clinical outcomes, high return-to-sport rates, and low failure rates, particularly among professional athletes. Meniscus preservation is crucial for optimizing post-operative recovery. Future research should focus on long-term outcomes and comparative studies with other ACL reconstruction techniques. Full article

(This article belongs to the Special Issue Sports Trauma: From Prevention to Surgery and Return to Sport)

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28 pages, 3802 KiB

Open AccessArticle

Effects of High-Resistance Elastic Band Training and a Curcumin-Based Formulation on Neuro-Oxidative and Functional Health in Sedentary Older Adults

by Alvaro Juesas, Angel Saez-Berlanga, Javier Gene-Morales, Pablo Jiménez-Martínez, Carlos Alix-Fages, Julio Fernandez-Garrido, Oscar Caballero, Danica Janicijevic, Virginia Zarza and Juan C. Colado

Healthcare 2025, 13(9), 1055; https://doi.org/10.3390/healthcare13091055 - 3 May 2025

Viewed by 146

Abstract

Background/Objectives: Physical exercise and curcumin supplementation can positively influence parameters related to cognition and neuro-oxidative status. However, research on the combined effects of resistance training with elastic bands and supplementation with a curcumin-based formulation is limited. Moreover, different types of contractions (e.g., [...] Read more.

Background/Objectives: Physical exercise and curcumin supplementation can positively influence parameters related to cognition and neuro-oxidative status. However, research on the combined effects of resistance training with elastic bands and supplementation with a curcumin-based formulation is limited. Moreover, different types of contractions (e.g., concentric and eccentric) may elicit distinct neurophysiological effects. This study evaluated the effectiveness of two high-resistance training (high-RT) programs using elastic bands in improving neuro-oxidative markers (brain-derived neurotrophic factor [BDNF] and F2-isoprostanes), cognitive function, physical performance, and quality of life, and examined the additional benefits of curcumin supplementation. Methods: Eighty-one sedentary older adults were randomly assigned to one of the following groups: accentuated eccentric training with either a bio-optimized curcumin formulation (Aecc-Cur) or placebo (Aecc-Pla); maximum strength training with either curcumin (Max-Cur) or placebo (Max-Pla); or a control group receiving curcumin (C-Cur) or placebo (C-Pla) without training. The training groups participated in a 16-week full-body high-RT program using elastic bands. Results: BDNF significantly increased in Aecc-Cur and Aecc-Pla (both p ≤ 0.020) but showed no changes after Max-Cur or Max-Pla (both p ≥ 0.256). All other dependent variables improved similarly across training groups (all p ≤ 0.50). Curcumin supplementation combined with exercise significantly reduced F2-isoprostanes in the Max-Cur group compared to Aecc-Pla, and enhanced 6-Minute Walk Test performance in Aecc-Cur and Max-Cur compared to their placebo counterparts. C-Cur showed nonsignificant changes in BDNF, F2-isoprostanes, social functioning, and vitality, while C-Pla worsened these parameters. Notably, at least half of the participants in the experimental groups exhibited clinically significant improvements in 11 of 14 dependent variables. Conclusions: Both high-RT protocols led to improvements in almost all dependent variables, with the Aecc program demonstrating greater effectiveness in boosting BDNF, a key neuroprotection marker. Curcumin supplementation alone and with exercise positively influenced neuro-oxidative markers and quality of life. Full article

(This article belongs to the Special Issue Innovative Exercise-Based Approaches for Chronic Condition Management)

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12 pages, 1077 KiB

Open AccessArticle

Exploring the Relationship Between Low Back Pain, Physical Activity, Posture, and Body Composition in Older Women

by Barbara Rosolek, Dan Iulian Alexe, Krystyna Gawlik, Elena Adelina Panaet, Ilie Mihai, Bogdan Alexandru Antohe and Anna Zwierzchowska

Healthcare 2025, 13(9), 1054; https://doi.org/10.3390/healthcare13091054 - 3 May 2025

Viewed by 87

Abstract

Background: Low back pain (LBP) is a widespread and disabling condition affecting many older adults. Methods: This study aimed to establish correlations between LBP, physical activity, body composition, and posture in 114 women (mean age: 67.6 ± 5.68 years). Using a cross-sectional study [...] Read more.

Background: Low back pain (LBP) is a widespread and disabling condition affecting many older adults. Methods: This study aimed to establish correlations between LBP, physical activity, body composition, and posture in 114 women (mean age: 67.6 ± 5.68 years). Using a cross-sectional study design, LBP was assessed using the Oswestry Disability Index (ODI). Physical activity (PA) was measured using a pedometer to count the steps taken. Spinal curvatures in the sagittal plane were examined with a Rippstein Plurimeter. Results: Significant correlations were found between ODI and waist circumference (WC) (F(1, 113) = 7.574, p = 0.007), body mass index (BMI) (F(1, 113) = 11.660, p = 0.001), total fat (TF) (F(1, 113) = 8.806, p = 0.004, R² = 0.072), and total steps (F(1, 113) = 4.446, p = 0.037). No associations were found between ODI and hip circumference (HC) (F(1, 113) = 6.257, p = 0.014, R² = 0.52), waist-to-hip ratio (WHR) (F(1, 113) = 6.342, p = 0.013, R² = 0.053), thoracic kyphosis (THK) (F(1, 113) = 0.290, p = 0.591, R² = 0.003), or lumbar lordosis angle (LLA) (F(1, 113) = 0.290, p = 0.591, R² = 0.003). Conclusion: These results of the study findings reveal the multifactorial nature of LBP syndrome and highlight the connection between LBP and ODI, BMI, WC, and TF in older women. Additionally, we emphasize the importance of implementing further prevention and intervention strategies to manage the clinical manifestation of LBP in the geriatric population. Healthcare providers can better support this population’s well-being by focusing on targeted interventions. Full article

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22 pages, 1852 KiB

Open AccessArticle

The Benefits of Practicing Physical Activity in the Aquatic Environment on Health and Quality of Life

by Gabriela Tomescu, Valeria Bălan, Kamer-Ainur Aivaz and Mihaela Zahiu

Healthcare 2025, 13(9), 1053; https://doi.org/10.3390/healthcare13091053 - 3 May 2025

Viewed by 124

Abstract

Background/Objectives: Aquagym is a form of practicing aerobic gymnastics to stay fit, which is constantly progressing in line with the dynamics of market growth and the fitness industry, bringing benefits to physical and mental health. The purpose of the study was to [...] Read more.

Background/Objectives: Aquagym is a form of practicing aerobic gymnastics to stay fit, which is constantly progressing in line with the dynamics of market growth and the fitness industry, bringing benefits to physical and mental health. The purpose of the study was to identify the level of popularity of this sport among people aged 20–65 years and to highlight the benefits of practicing aquagym. Methods: This quantitative research study was designed to use a structured questionnaire to collect data from 150 participants. The sample was chosen to reflect various age groups and to ensure representativeness for the general population interested in physical activity. Participants were divided by gender into two age categories, under 45 and over 45, in order to examine differences in preferences and perceptions between these age segments. For the analysis of between-group differences, we used the Chi-Square and Cramer’s V tests, and for the profile of respondents, a Two-Step Cluster Analysis was applied. Results: Regarding knowledge of the aquagym concept, there is a notable discrepancy between females and males, with significantly more women (54%) than men (18%) stating that they are familiar with this concept. Among the perceived benefits of water gymnastics, most responses indicate maintaining muscle tone (25% women and 14% men) and a fun way to stay fit (20% women and 11% men). Young people under 45 years of age tend to attach more importance to the social and entertaining aspects of aquagym. As for the improvement in quality of life by practicing water gymnastics, a large number of respondents (82%) rated this contribution with a score of 4 or 5 on a 5-point scale, meaning that the positive impact of this activity was highly appreciated. Conclusions: Aquagym lessons are perceived as both an effective form of exercise for health improvement and a means of socialization. The outcomes of the study highlight the opportunity to continuously promote and develop gymnastics in the aquatic environment as an accessible and enjoyable form of physical activity for all ages. Full article

(This article belongs to the Special Issue The Impact of Exercise on the Mental Health and Quality of Life of People—the Second Edition)

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12 pages, 242 KiB

Open AccessArticle

The Effects of CenteringPregnancy: A Quasi-Experimental Evaluation

by Chul Hyun Park, Nichola Driver, Robert C. Richards, Jr. and Penny Ward

Healthcare 2025, 13(9), 1052; https://doi.org/10.3390/healthcare13091052 - 3 May 2025

Viewed by 116

Abstract

Background/Objectives: CenteringPregnancy (CP) is a group prenatal care model that empowers pregnant women through risk assessment, education, and social support. CP participants have more contact time with providers compared to those in traditional prenatal care. Despite contradictory findings in the literature, this [...] Read more.

Background/Objectives: CenteringPregnancy (CP) is a group prenatal care model that empowers pregnant women through risk assessment, education, and social support. CP participants have more contact time with providers compared to those in traditional prenatal care. Despite contradictory findings in the literature, this study aimed to determine if CP leads to better health outcomes for women and their infants. Methods: A quasi-experimental design was used. Data were collected from hospital birth records of both CP participants and those receiving traditional prenatal care from 2018 to 2020. Various treatment effect models for observational data were used to assess CP’s effectiveness. Results: CP improved women’s access to prenatal care and reduced rates of preterm birth and perinatal death compared to traditional prenatal care. It also resulted in longer gestation periods and better infant birth weight outcomes. However, no significant differences were found in delivery type (vaginal or C-section) or breastfeeding initiation and continuation between the two groups. Conclusions: These findings provide compelling evidence that CenteringPregnancy can lead to significantly improved maternal and infant health outcomes by demonstrating its effectiveness in a real-world clinical setting. Full article

15 pages, 884 KiB

Open AccessArticle

The Effects of a Home-Based Cardiac Rehabilitation Program via the Line Application on Functional Capacity and Quality of Life Among Open-Heart Surgery Patients: A Quasi-Experimental Study

by Suteetida Saensoda, Piyawan Pokpalagon and Suchira Chaiviboontham

Healthcare 2025, 13(9), 1051; https://doi.org/10.3390/healthcare13091051 - 3 May 2025

Viewed by 188

Abstract

Background/Objectives: This study aims to investigate the effects of a home-based cardiac rehabilitation (HBCR) program via a LINE application on functional capacity and quality of life (QOL) in open-heart surgery patients. Methods: This study involved 54 open-heart surgery patients divided into [...] Read more.

Background/Objectives: This study aims to investigate the effects of a home-based cardiac rehabilitation (HBCR) program via a LINE application on functional capacity and quality of life (QOL) in open-heart surgery patients. Methods: This study involved 54 open-heart surgery patients divided into a control group and an experimental group (27 intervention, 27 control) using pair matching. Participants in the intervention group participated in the HBCR program, while the control group received standard care. Orem’s self-care theory was used as the conceptual framework. Functional capacity was measured via a six-minute walk test and the Duke Activity Status Index, while QOL was measured via the Thai version of the Short Form-36 Survey. Results: The findings from the study reveal that the patients who underwent open-heart surgery in the experimental group had significantly higher functional capacity compared to those in the control group (p < 0.05). Additionally, the overall QOL of the open-heart surgery patients in the experimental group was significantly better than that of the control group, alongside physical functioning, emotional roles, vitality, mental health, social functioning, and general health (p < 0.05). However, there were no significant differences between the two groups in terms of physical roles and bodily pain (p > 0.05). Conclusions: Using an HBCR program via the LINE application has the potential to enhance the at-home self-care ability of post-open-heart surgery patients, thus improving their functional capacity and QOL. Full article

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17 pages, 251 KiB

Open AccessArticle

Coping Strategies in Patients with Bipolar Disorder (BD) and Major Depressive Disorder (MDD) and Their Correlation with Clusters of Psychiatric Symptoms

by Bianca-Oana Bucatoş, Laura Gaita, Ana-Maria Romoşan, Ion Papava, Miruna Popovici, Radu-Ştefan Romoşan, Mariana Bondrescu, Ana-Maria Cristina Daescu and Liana Dehelean

Healthcare 2025, 13(9), 1050; https://doi.org/10.3390/healthcare13091050 - 2 May 2025

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Abstract

Background: Adjustment to stress requires the involvement of coping strategies. Using maladaptive coping strategies may precipitate the onset or recurrence of psychiatric disorders. On the other hand, the illness itself may alter the coping mechanisms of an individual. This study aims to identify [...] Read more.

Background: Adjustment to stress requires the involvement of coping strategies. Using maladaptive coping strategies may precipitate the onset or recurrence of psychiatric disorders. On the other hand, the illness itself may alter the coping mechanisms of an individual. This study aims to identify the coping strategies in patients with bipolar disorder (BD) and major depressive disorder (MDD) and determine the correlation between coping strategies and clusters of psychiatric symptoms. Material and Methods: Socio-demographic and clinical data were analyzed for 30 inpatients with BD and 30 inpatients with MDD. The SCL-90 questionnaire and COPE inventory were filled in by the participants. Results: Compared to the general population, the patients with BD had lower scores for functional coping strategies and higher scores for one dysfunctional coping strategy. The patients with MDD had lower scores for all active functional and two passive functional coping strategies. By contrast, they presented higher scores on one passive functional and one dysfunctional coping strategy. Positive reinterpretation and growth were negatively correlated with somatization, depression, anxiety, interpersonal sensitivity, hostility, and psychoticism. Behavioral disengagement was positively correlated with depression, anxiety, somatization, interpersonal sensitivity, and psychoticism. Substance use was positively correlated with the number of episodes. Distinct coping mechanisms were associated with certain symptom clusters. Conclusions: Although dysfunctional coping strategies may predispose to psychiatric disorders, in our study, they appear to be state-dependent rather than trait-dependent. Full article

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Healthcare, Volume 13, Issue 9 (May-1 2025) – 121 articles

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