Healthcare

8 pages, 199 KiB

Open AccessOpinion

Legislation on Medical Assistance in Dying (MAID): Preliminary Consideration on the First Regional Law in Italy

by Lorenzo Blandi, Russell Tolentino, Giuseppe Basile, Livio Pietro Tronconi, Carlo Signorelli and Vittorio Bolcato

Healthcare 2025, 13(9), 1091; https://doi.org/10.3390/healthcare13091091 - 7 May 2025

Viewed by 324

Abstract

Medical assistance in dying (MAID) remains a sensitive and evolving issue in Europe, frequently linked with discussions about human freedom, life dignity, and healthcare policy. While national consensus in Italy is absent, the Region of Tuscany has enacted Law No. 16/2025, which establishes [...] Read more.

Medical assistance in dying (MAID) remains a sensitive and evolving issue in Europe, frequently linked with discussions about human freedom, life dignity, and healthcare policy. While national consensus in Italy is absent, the Region of Tuscany has enacted Law No. 16/2025, which establishes a MAID procedure based on recent Constitutional Court rulings. The commentary aims to provide a preliminary analysis of the new law, addressing ethical, medico-legal, and social issues that emerge in relation to the Italian and global debate on the topic. The law establishes a three-stage process based on four eligibility criteria: irreversible disease, psycho-physical suffering, life-support dependence, and informed consent. However, Tuscany’s model poses medico-legal and ethical concerns, particularly about the boundaries of regional legislative competence, the duties of healthcare professionals, and the possibility of intra-national inequity or “health migration.” In addition, critical organisational implications derived from informed consent and lethal drug self-administration impede clinical implementation in some individuals with mental or neurological disorders. The lack of clarity in the different steps of the procedure, the uncertain supervision system, and the potential consequences for specific categories of vulnerable people underline the need for comprehensive national regulation. A future regulatory framework must balance procedural clarity with individual autonomy and equitable access, bringing Italy in line with larger European context for end-of-life care. Full article

(This article belongs to the Special Issue Ethical Dilemmas and Moral Distress in Healthcare)

21 pages, 5023 KiB

Open AccessArticle

Implementation of a Family Skills Programme in Internally Displaced People Camps in Kachin State, Myanmar

by Karin Haar, Aala El-Khani, Hkawng Hawng, Tun Tun Brang, Win Mar, Zin Ko Ko Lynn and Wadih Maalouf

Healthcare 2025, 13(9), 1090; https://doi.org/10.3390/healthcare13091090 - 7 May 2025

Viewed by 253

Abstract

Background/Objectives: Children that are forcibly displaced are more likely to experience mental health and behavioural challenges than non-displaced populations, including increased risk of anxiety, depression and post-traumatic stress disorder. Building appropriate parenting skills to strengthen the relationships between caregivers and their children in [...] Read more.

Background/Objectives: Children that are forcibly displaced are more likely to experience mental health and behavioural challenges than non-displaced populations, including increased risk of anxiety, depression and post-traumatic stress disorder. Building appropriate parenting skills to strengthen the relationships between caregivers and their children in times of war is key to building resilience in children. There is a lack of research on the role of family skill interventions in internally displaced people (IDP). The aim of this study was to assess the potential change in parenting skills, child mental health, and resilience capacity in families living in IDP camps in Kachin State, Myanmar, after taking part in a brief family skill intervention, Strong Families. Methods: An open, multi-site pilot feasibility and acceptability trial was conducted with 100 families. Outcome data were collected prospectively, assessing changes in parenting skills and family adjustment in caregivers, children’s behaviour, and children’s resilience capacities. Families were assessed using three scales, Parenting and Family Adjustment Scales (PAFAS), the Strengths and Difficulties Questionnaire (SDQ), and the Child and Youth Resilience Measure (CYRM-R). Results: Despite being a light intervention, Strong Families produced improvements in the child mental health, parenting practices, and parent and family adjustment skills scales. Improvements were observed in scores particularly for caregivers and children with greater challenges at baseline. Conclusions: The results positively value the importance and feasibility of family skill interventions being integrated into the routine care of IDP families. This advocates for the prioritisation of using such tools for supporting better family functioning and mental health in humanitarian contexts. Full article

(This article belongs to the Special Issue Factors That Affect the Physical and Mental Health of Vulnerable Groups)

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16 pages, 252 KiB

Open AccessArticle

Nursing Students’ Perceptions of AI-Driven Mental Health Support and Its Relationship with Anxiety, Depression, and Seeking Professional Psychological Help: Transitioning from Traditional Counseling to Digital Support

by Zainab Albikawi, Mohammad Abuadas and Ahmad M. Rayani

Healthcare 2025, 13(9), 1089; https://doi.org/10.3390/healthcare13091089 - 7 May 2025

Viewed by 450

Abstract

Background: The integration of artificial intelligence (AI) into mental health care is reshaping psychological support systems, particularly for digitally literate populations such as nursing students. Given the high prevalence of anxiety and depression in this group, understanding their perceptions of AI-driven mental [...] Read more.

Background: The integration of artificial intelligence (AI) into mental health care is reshaping psychological support systems, particularly for digitally literate populations such as nursing students. Given the high prevalence of anxiety and depression in this group, understanding their perceptions of AI-driven mental health support is critical for effective implementation. Objectives: to evaluate nursing students’ perceptions toward AI-driven mental health support and examine its relationship with anxiety, depression, and their attitudes to seeking professional psychological help. Methods: A cross-sectional survey was conducted among 176 undergraduate nursing students in northern Jordan. Results: Students reported moderately positive perceptions toward AI-driven mental health support (mean score: 36.70 ± 4.80). Multiple linear regression revealed that prior use of AI tools (β = 0.44, p < 0.0001), positive help-seeking attitudes (β = 0.41, p < 0.0001), and higher levels of psychological distress encompassing both anxiety (β = 0.29, p = 0.005) and depression (β = 0.24, p = 0.007) significantly predicted more positive perceptions. Daily AI usage was not a significant predictor (β = 0.15, p = 0.174). Logistic regression analysis further indicated that psychological distress, reflected by elevated anxiety (OR = 1.42, p = 0.002) and depression scores (OR = 1.32, p = 0.003), along with stronger help-seeking attitudes (OR = 1.35, p = 0.011), significantly increased the likelihood of using AI-based mental health support. Conclusions: AI-driven mental health tools hold promises as adjuncts to traditional counseling, particularly for nursing students experiencing psychological distress. Despite growing acceptance, concerns regarding data privacy, bias, and lack of human empathy remain. Ethical integration and blended care models are essential for effective mental health support. Full article

(This article belongs to the Special Issue Mental Health, Innovative Therapies and Assessment in Adolescents and Young Adults and Related Contexts)

14 pages, 717 KiB

Open AccessArticle

Prevalence of Erectile Dysfunction and Help-Seeking Behavior Among Patients Attending Primary Healthcare Centers for Non-Urological Complaints

by Mansour Alnazari, Sulaiman Abdullah, Abdullah K. Aljohani, Emad S. Rajih, Ghadi S. Alghamdi, Faris S. Sebaa, Ali A. Alraddadi, Wesam Khan and Adel Moalwi

Healthcare 2025, 13(9), 1088; https://doi.org/10.3390/healthcare13091088 - 7 May 2025

Viewed by 257

Abstract

Background/Objectives: Erectile dysfunction (ED) is a prevalent condition worldwide that significantly affects men’s sexual health and overall quality of life. ED is often associated with both psychological and organic factors and may serve as an early indicator of underlying health conditions such [...] Read more.

Background/Objectives: Erectile dysfunction (ED) is a prevalent condition worldwide that significantly affects men’s sexual health and overall quality of life. ED is often associated with both psychological and organic factors and may serve as an early indicator of underlying health conditions such as diabetes mellitus, hypertension, and cardiovascular diseases. This study aimed to assess the attitudes and help-seeking behaviors of patients with ED who attended primary healthcare centers for non-urological reasons. Methods: A cross-sectional survey was conducted among 384 men aged 18 years and older who attended primary care clinics. Erectile dysfunction was evaluated using a structured questionnaire designed to assess patients’ attitudes toward ED, help-seeking behaviors, and treatment preferences. Results: Approximately half of the participants (49.5%) acknowledged the necessity of seeking treatment. However, the majority (53.1%) had not consulted specialized clinics, primarily due to social stigma and a preference for self-medication. Concerning sources of information on ED treatment, 30.7% of participants relied on their partners and healthcare providers. Conclusions: The study underscores critical barriers to ED management, including social stigma and reliance on self-medication, which may impede optimal treatment engagement and access to specialized care. Full article

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33 pages, 1724 KiB

Open AccessSystematic Review

A Systematic Literature Review for Blockchain-Based Healthcare Implementations

by Mutiullah Shaikh, Shafique Ahmed Memon, Ali Ebrahimi and Uffe Kock Wiil

Healthcare 2025, 13(9), 1087; https://doi.org/10.3390/healthcare13091087 - 7 May 2025

Viewed by 435

Abstract

Background: Healthcare information systems are hindered by delayed data sharing, privacy breaches, and lack of patient control over data. The growing need for secure, privacy-preserved access control interoperable in health informatics technology (HIT) systems appeals to solutions such as Blockchain (BC), which offers [...] Read more.

Background: Healthcare information systems are hindered by delayed data sharing, privacy breaches, and lack of patient control over data. The growing need for secure, privacy-preserved access control interoperable in health informatics technology (HIT) systems appeals to solutions such as Blockchain (BC), which offers a decentralized, transparent, and immutable ledger architecture. However, its current adoption remains limited to conceptual or proofs-of-concept (PoCs), often relying on simulated datasets rather than validated real-world data or scenarios, necessitating further research into its pragmatic applications and their benchmarking. Objective: This systematic literature review (SLR) aims to analyze BC-based healthcare implementations by benchmarking peer-reviewed studies and turning PoCs or production insights into real-world applications and their evaluation metrics. Unlike prior SLRs focusing on proposed or conceptual models, simulations, or limited-scale deployments, this review focuses on validating practical BC real-world applications in healthcare settings beyond conceptual studies and PoCs. Methods: Adhering to PRISMA-2020 guidelines, we systematically searched five major databases (Scopus, Web of Science, PubMed, IEEE Xplore, and ScienceDirect) for high-precision relevant studies using MeSH terms related to BC in healthcare. The designed review protocol was registered with OSF, ensuring transparency in the review process, including study screening by independent reviewers, eligibility, quality assessment, and data extraction and synthesis. Results: In total, 82 original studies fully met the eligibility criteria and narratively reported BC-based healthcare implementations with validated evaluation outcomes. These studies highlight the current challenges addressed by BC in healthcare settings, providing both qualitative and quantitative data synthesis on its effectiveness. Conclusions: BC-based healthcare implementations show both qualitative and quantitative effectiveness, with advancements in areas such as drug traceability (up to 100%) and fraud prevention (95% reduction). We also discussed the recent challenges of focusing more attention in this area, along with a discussion on the mythological consideration of our own work. Our future research should focus on addressing scalability, privacy-preservation, security, integration, and ethical frameworks for widespread BC adoption for data-driven healthcare. Full article

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19 pages, 254 KiB

Open AccessArticle

Study on the Influencing Factors of the Demand of Rural Older Adults in China for Elderly Care Services

by Linjing Wan and Xiaodong Di

Healthcare 2025, 13(9), 1086; https://doi.org/10.3390/healthcare13091086 - 7 May 2025

Viewed by 231

Abstract

Background/Objectives: Population aging has become a common concern worldwide. At present, the aging rate of China far exceeds the international standard, and the rural population in China faces a more obvious aging problem. With the increasing number of the older population, the demand [...] Read more.

Background/Objectives: Population aging has become a common concern worldwide. At present, the aging rate of China far exceeds the international standard, and the rural population in China faces a more obvious aging problem. With the increasing number of the older population, the demand for elderly care services is constantly diversified, and the homogenized service supply in rural areas fails to effectively meet the service needs of older adults. Methods: This study employs a multi-stage stratified sampling method to survey rural older adults in Shaanxi, Hebei and Jiangsu provinces (n = 803, effective response rate > 95%). The dependent variable is categorized into four levels: no, mild, moderate and severe demands. Independent variables include demographic characteristics (age and gender), predisposing factors (education and marital status), enabling resources (income and family support) and need factors (health status). In the survey, the questionnaire survey method is adopted, and a multinomial logistic regression model is used to analyze the factors influencing the demand degree for elderly care services in rural areas. Results: Regression analysis indicates that pension level exerts a significant influence on the demand intensity for medical care, entertainment and spiritual comfort services. Family support is significantly associated with the demand intensity for medical care and spiritual comfort services. This study reveals that the pension level of elderly adults in rural areas is a key factor affecting the demand degree for elderly care services. The influence of family support on the demand for elderly care services should not be underestimated. Older adults in rural areas have a high demand for medical care services. Conclusions: A gap remains between elderly care service resources and the needs of older adults in rural areas of China. The government should pay attention to allocating and optimizing elderly care service resources to meet the needs of older adults. Full article

15 pages, 1592 KiB

Open AccessArticle

Causal Associations Between Pre-Pregnancy Diabetes Mellitus and Pre-Eclampsia Risk: Insights from a Mendelian Randomization Study

by Xiang Ying, Quanfeng Wu, Xiaohan Li, Yan Bi, Li Gao, Shushu Yu, Xiaona Xu, Xiaotian Li, Yanlin Wang and Renyi Hua

Healthcare 2025, 13(9), 1085; https://doi.org/10.3390/healthcare13091085 - 7 May 2025

Viewed by 329

Abstract

Background and Objectives: Pre-eclampsia (PE) is a serious pregnancy complication defined by the onset of hypertension and multi-organ dysfunction occurring after 20 weeks of gestation. Studies have indicated the correlation between diabetes mellitus (DM) and PE, but the causal relationship remains unclear. Materials [...] Read more.

Background and Objectives: Pre-eclampsia (PE) is a serious pregnancy complication defined by the onset of hypertension and multi-organ dysfunction occurring after 20 weeks of gestation. Studies have indicated the correlation between diabetes mellitus (DM) and PE, but the causal relationship remains unclear. Materials and Methods: The two-sample Mendelian randomization (MR) approach, including the inverse variance weighted random effects (IVW-RE) model and the traditional sensitivity model, was employed to assess the causal effects of pre-pregnancy type 1 diabetes (T1D) and type 2 diabetes (T2D) on PE using summary-level data obtained from genome-wide association studies. Additionally, diabetes-related factors, such as glycated hemoglobin (HbA1c) levels, fasting insulin levels, and body mass index (BMI), were evaluated for their potential causal effects on the risk of PE. Pleiotropy-robust and multivariable Mendelian randomization (MVMR) methods were further used because of the intricate associations among the traits. Insulin and metformin use was also assessed for their causal role in PE risk. Results: Our findings show that genetically predicted T1D (OR = 1.06, 95% CI: 1.03–1.09, p < 0.001), T2D (OR = 1.09, 95% CI: 1.04–1.14, p < 0.001), and BMI (OR = 1.64, 95% CI 1.49 to 1.80, p < 0.001) had causal effects on the incidence of PE, while the effects of HbA1c (OR = 0.77, 95% CI 0.59 to 1.02, p = 0.064) and fasting insulin levels (OR = 1.35, 95% CI 0.89 to 2.05, p = 0.153) on the occurrence of PE were not significant. The results were verified by MVMR analysis. Additionally, insulin use increased the risk of pre-eclampsia (OR = 1.11, 95% CI 1.05–1.17, p < 0.001). Conclusions: Our findings demonstrate a causal relationship between pre-pregnancy diabetes (DM) and obesity and the risk of PE from a genetic epidemiological perspective. Adverse maternal factors, including DM and obesity prior to pregnancy, should be considered in mechanistic studies of PE. In addition, comprehensive interventions for risk factors such as pre-pregnancy DM and obesity should be emphasized in clinical practice. Full article

(This article belongs to the Section Perinatal and Neonatal Medicine)

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14 pages, 800 KiB

Open AccessSystematic Review

The Role of Psychological Interventions in Enhancing Quality of Life for Patients with Cystic Fibrosis—A Systematic Review

by Lavinia Hogea, Brenda Bernad, Iuliana Costea, Codrina Mihaela Levai, Amalia Marinca, Ion Papava and Teodora Anghel

Healthcare 2025, 13(9), 1084; https://doi.org/10.3390/healthcare13091084 - 7 May 2025

Viewed by 264

Abstract

Background/Objectives: Cystic fibrosis (CF) is a chronic genetic disease that impacts both physical and psychological health, increasing vulnerability to anxiety, depression, and reduced quality of life (QoL). Psychological interventions, particularly cognitive behavioral therapy (CBT), have demonstrated promising results in enhancing emotional resilience, treatment [...] Read more.

Background/Objectives: Cystic fibrosis (CF) is a chronic genetic disease that impacts both physical and psychological health, increasing vulnerability to anxiety, depression, and reduced quality of life (QoL). Psychological interventions, particularly cognitive behavioral therapy (CBT), have demonstrated promising results in enhancing emotional resilience, treatment adherence, and QoL. This systematic review aims to evaluate the role and effectiveness of psychological interventions in improving the QoL among individuals with CF. Methods: A comprehensive literature search was conducted across the PubMed, Scopus, and PsycINFO databases for studies published between 2014 and 2024, in line with PRISMA guidelines and a registered PROSPERO protocol. Out of 162 initially identified articles, six clinical studies met the inclusion criteria. Intervention included cognitive behavioral therapy-based interventions, employing several digital or telehealth formats such as fibrosis-specific cognitive behavioral therapy (CF-CBT) and the coping and learning to manage stress (CALM) program, often delivered via telehealth. Results: Most interventions demonstrated significant reductions in depression, anxiety, and perceived stress, alongside improvements in coping self-efficacy and vitality. Cohen’s d-effect sizes ranged from moderate to large for core psychological outcomes. QoL measures, particularly vitality and emotional functioning, were significantly enhanced in most studies. Conclusions: Psychological interventions, particularly CBT and ACT, significantly improve mental health and QoL in individuals with CF, supporting their integration into routine care. Full article

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16 pages, 647 KiB

Open AccessArticle

Multimodal Prehabilitation in Colorectal Cancer: Improving Fitness, Lifestyle, and Post-Surgery Outcomes

by María-Pilar Suárez-Alcázar, Ana Folch Ayora, María Muriach, Paula Recacha-Ponce, M.-Elena Garcia-Roca, Alba Coret-Franco, Juan Carlos Pastor-Mora, Pablo Salas-Medina and Eladio J. Collado-Boira

Healthcare 2025, 13(9), 1083; https://doi.org/10.3390/healthcare13091083 - 7 May 2025

Viewed by 178

Abstract

Objectives: This study aimed to analyze the effect of a multimodal prehabilitation program for colorectal cancer patients in body composition, physical and cardiorespiratory fitness as well as its ability to reduce postoperative complications. Methods: A longitudinal observational study evaluated the efficacy [...] Read more.

Objectives: This study aimed to analyze the effect of a multimodal prehabilitation program for colorectal cancer patients in body composition, physical and cardiorespiratory fitness as well as its ability to reduce postoperative complications. Methods: A longitudinal observational study evaluated the efficacy of a prehabilitation intervention based on four components: (a) health education and self-care, (b) nutritional counseling, (c) psychological support, and (d) supervised physical exercise. Body composition was determined through bioelectrical impedance analysis; physical fitness variables such as strength was measured by a handgrip dynamometer for upper limbs, and a squat–jump test, countermovement jump test using a contact platform, and a chair–stand test for lower limbs. Flexibility was assessed with the sit-and-reach test. Cardiorespiratory fitness was assessed with the 6 min walking test (6MWT). Moreover, we measured lifestyles related to the amount of physical exercise by accelerometry. Results: The final cohort included 30 patients. Patients completed an average of 9.90 ± 5.26 exercise sessions. Statistically significant changes with varying effect sizes were observed in the following outcomes: SJ values in cm and W for both sexes (p = 0.021/d = 0.14 and p = 0.043/d = 0.10, respectively), SJ in W for women (p = 0.023/d = 0.21), all chair-stand test values (p = 0.021/d = 0.65 for men, p = 0.004/d = 2.08 for women, and p = 0.000/d = 0.84 for both sexes), and sit-and-reach for both sexes (p = 0.005/d = 0.12) and for men (p = 0.044/d = 0.08). All 6MWT values had statistically significant changes (p = 0.001/0.46). Women reduced the weekly minutes spent in sedentary behavior (p = 0.037/d = 0.65) and increased the minutes spent performing light physical activity (p = 0.037/d = 0.63). With regard to surgical outcomes, there was a tendency towards a decrease in postoperative complications and hospitalization days, as well as minutes in postoperative REA (p = 0.009/d = 0.69) in relation to the control group. Conclusions: Participation in a multimodal prehabilitation program improves several aspects of physical condition and lifestyles related to the amount of physical exercise and reduces both days of hospitalization and several complications post-surgery. Full article

(This article belongs to the Special Issue Exercise Therapy: Improving Functionality, Physical Health, and Quality of Life)

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15 pages, 2353 KiB

Open AccessArticle

Pilot Randomized Controlled Study on the Effectiveness of a Virtual Reality-Based Dementia Prevention Program Using Self-Regulated Learning Strategies Among Older Adults with Mild Cognitive Impairment

by Ching-Hao Chang, Kuei-Yu Huang, Lou-Hui Kuo, Ya-Wen Cheng, Su-Fei Huang, Tien-Hsi Chuang, Chiu-Mieh Huang and Jong-Long Guo

Healthcare 2025, 13(9), 1082; https://doi.org/10.3390/healthcare13091082 - 7 May 2025

Viewed by 221

Abstract

Background/Objectives: Dementia is a growing public health issue, especially in rapidly aging societies like Taiwan, where nearly 10% of adults over 65 show signs of cognitive decline. Given that mild cognitive impairment (MCI) serves as a critical stage for early intervention, this study [...] Read more.

Background/Objectives: Dementia is a growing public health issue, especially in rapidly aging societies like Taiwan, where nearly 10% of adults over 65 show signs of cognitive decline. Given that mild cognitive impairment (MCI) serves as a critical stage for early intervention, this study examined the feasibility and preliminary effectiveness of a virtual reality (VR)-based dementia prevention program, specifically designed based on self-regulated learning (SRL) principles to enhance dementia knowledge, health literacy, and self-efficacy among older adults with MCI. Methods: A pilot randomized controlled trial (RCT) was conducted with 60 older adults aged 65 and above with MCI. Participants were randomly assigned to either an experimental group, which received a VR-based dementia prevention program, or a comparison group, which received routine paper-based educational materials. Results: The experimental group demonstrated significant improvements in overall dementia knowledge and all subdomains. Significant gains were also observed in critical health literacy and self-efficacy, though no significant changes were found in overall health literacy. Conclusions: The preliminary findings suggest that the SRL-informed VR program showed initial effectiveness in enhancing dementia knowledge, critical health literacy, and self-efficacy among older adults with MCI, highlighting its potential as an innovative approach to dementia prevention education. Full article

(This article belongs to the Topic Applied System on Biomedical Engineering, Healthcare and Sustainability 2024)

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12 pages, 454 KiB

Open AccessArticle

The Socio-Ecological Factors of Physical Activity Participation in Preschool-Aged Children with Disabilities

by Ming-Chih Sung, Mohammadreza Mahmoudkhani and Byungmo Ku

Healthcare 2025, 13(9), 1081; https://doi.org/10.3390/healthcare13091081 - 7 May 2025

Viewed by 145

Abstract

Background: To effectively promote physical activity (PA) participation in preschool-aged children with disabilities (PACD), a comprehensive understanding of the associated factors is necessary. Consequently, this study aims to examine the factors influencing PA participation in PACD using the socio-ecological model. Methods: The Disability [...] Read more.

Background: To effectively promote physical activity (PA) participation in preschool-aged children with disabilities (PACD), a comprehensive understanding of the associated factors is necessary. Consequently, this study aims to examine the factors influencing PA participation in PACD using the socio-ecological model. Methods: The Disability Status Survey 2020 in South Korea has been used for the current study. PACD aged below five years were selected, resulting in 5825 children. Variables were selected across each level of the socio-ecological model: (1) intrapersonal level (child’s sex, chronic condition, disability level, perceived health), (2) interpersonal level (siblings’ status, grandparents’ status, satisfaction with number of friends), (3) organizational level (enrollment in physical therapy, enrollment in occupational therapy), and (4) environmental level (residential area, government support). The decision tree analysis was conducted using chi-square automatic interaction detection to examine multi-level associated factors of PA participation in PACD. Results: The decision tree analysis produced a three-level model with six terminal nodes. In the study sample, 48.4% of participants reported participating in PA. The most common location for PA was at home, with balance exercises being the most frequent type of activity, followed by stretching. Frequent barriers to regular PA participation included a lack of professionals who are knowledgeable about disabilities and the absence of disability-specific programs. The decision tree analysis identified living with grandparents, the child’s sex, having a sibling, and enrollment in physical therapy as common predictors of PA participation in PACD. Conclusions: This study’s strength lies in its thorough examination of the socio-ecological factors influencing PA participation in PACD. The associated factors span both intrapersonal and interpersonal levels. To enhance PA participation among PACD, interventions should target these levels. Full article

(This article belongs to the Special Issue Physical Activity Intervention for Non-Communicable Diseases)

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10 pages, 400 KiB

Open AccessArticle

The Association Between Doctor–Patient Conflict and Uncertainty Stress During Clinical Internships Among Medical Students: A Panel Study

by Huihui Wang, Xinxin Ying, Lujin Zhang, Tingzhong Yang and Weifang Zhang

Healthcare 2025, 13(9), 1080; https://doi.org/10.3390/healthcare13091080 - 6 May 2025

Viewed by 290

Abstract

Background/Objectives: Medical students experience significant mental stress during clinical internships. This study aimed to assess the levels of uncertainty stress among medical interns, evaluate its temporal changes and associations with doctor–patient conflict and reference norm, and provide insights for stress-alleviating policies and educational [...] Read more.

Background/Objectives: Medical students experience significant mental stress during clinical internships. This study aimed to assess the levels of uncertainty stress among medical interns, evaluate its temporal changes and associations with doctor–patient conflict and reference norm, and provide insights for stress-alleviating policies and educational initiatives. Methods: A prospective longitudinal panel study was conducted; 131 medical students preparing for clinical internships were recruited via WeChat social media groups from June 2023 to June 2024. Data were collected at three time points using an online survey on Wenjuanxing: before the internship, three months into the internship, and after the internship. Variables such as uncertainty stress, doctor–patient conflict, and reference norm were measured, and data were analyzed using GEE and the GLMM program. Results: A total of 122 students completed all three waves of the study. Uncertainty stress decreased over the internship period (W = 7.25, p < 0.05), while doctor–patient conflict increased (W = 6.65, p < 0.05). Uncertainty stress was positively associated with the reference norm from teachers (β = 0.856, p < 0.05) and doctor–patient conflict (β = 1.068, p < 0.05). Conclusions: Although uncertainty stress reduces as internships progress, doctor–patient conflict rises. A supportive learning environment, especially from teachers, is crucial for mitigating stress. Medical schools and hospitals should implement comprehensive strategies to address individual stressors and institutional factors, considering the associations between uncertainty stress, doctor–patient conflict, and reference norm. However, the study has limitations such as a small sample size and reliance on self-reported measures, indicating a need for further research. Full article

(This article belongs to the Special Issue Health Promotion, Disease Prevention, and Chronic Illness Experience: A Health Psychology Perspective)

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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 - 6 May 2025

Viewed by 687

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, 3358 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 - 6 May 2025

Viewed by 272

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)

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13 pages, 269 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 - 6 May 2025

Viewed by 198

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

Viewed by 388

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

Viewed by 435

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

Viewed by 274

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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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

Viewed by 201

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

Viewed by 373

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

Viewed by 383

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

Viewed by 223

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

Viewed by 234

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

Viewed by 614

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

Viewed by 282

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

Viewed by 284

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

Viewed by 309

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

Viewed by 241

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

Viewed by 429

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

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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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Healthcare, Volume 13, Issue 9 (May-1 2025) – 133 articles

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