Healthcare

24 pages, 1128 KB

Open AccessArticle

The Role of Telemedicine Centers and Digital Health Applications in Home Care: Challenges and Opportunities for Family Caregivers

by Kevin-Justin Schwedler, Jan Ehlers, Thomas Ostermann and Gregor Hohenberg

Healthcare 2026, 14(1), 136; https://doi.org/10.3390/healthcare14010136 - 5 Jan 2026

Viewed by 596

Abstract

Background/Objectives: Home care plays a crucial role in contemporary healthcare systems, particularly in the long-term care of people with chronic and progressive illnesses. Family caregivers often experience substantial physical, emotional, and organizational burden. Telemedicine and digital health applications have the potential to support [...] Read more.

Background/Objectives: Home care plays a crucial role in contemporary healthcare systems, particularly in the long-term care of people with chronic and progressive illnesses. Family caregivers often experience substantial physical, emotional, and organizational burden. Telemedicine and digital health applications have the potential to support home care by improving health monitoring, communication, and care coordination. However, their use among family caregivers remains inconsistent, and little is known about how organizational support structures such as telemedicine centers influence acceptance and everyday use. This study aims to examine the benefits of telemedicine in home care and to evaluate the role of telemedicine centers as supportive infrastructures for family caregivers. Methods: A mixed-methods design was applied. Quantitative data were collected through an online survey of 58 family caregivers to assess the use of telemedicine and digital health applications, perceived benefits, barriers, and support needs. This was complemented by an in-depth qualitative case study exploring everyday caregiving experiences with telemedicine technologies and telemedicine center support. A systematic literature review informed the theoretical framework and the development of the empirical instruments. Results: Most respondents reported not using telemedicine or digital health applications in home care. Among users, telemedicine was associated with perceived improvements in quality of care, particularly through enhanced health monitoring, improved communication with healthcare professionals, and increased feelings of safety and control. Key barriers to adoption included technical complexity, data protection concerns, and limited digital literacy. Both quantitative findings and the qualitative case study highlighted the importance of structured support. Telemedicine centers were perceived as highly beneficial, providing technical assistance, training, coordination, and ongoing guidance that facilitated technology acceptance and sustained use. Conclusions: Telemedicine and digital health applications can meaningfully support home care and reduce caregiver burden when they are embedded in supportive socio-technical structures. Telemedicine centers can function as central points of contact that enhance usability, trust, and continuity of care. The findings suggest that successful implementation of telemedicine in home care requires not only technological solutions but also accessible organizational support and targeted training for family caregivers. Full article

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15 pages, 1214 KB

Open AccessArticle

Work Complexity and Musculoskeletal Symptoms in Healthcare Workers

by Elamara Marama de Araujo Vieira, Jonhatan Magno Norte da Silva, Wilza Karla dos Santos Leite and Gilvane de Lima Araújo

Healthcare 2026, 14(1), 135; https://doi.org/10.3390/healthcare14010135 - 5 Jan 2026

Viewed by 358

Abstract

Background/Objectives: To investigate whether healthcare workers present different characteristics of musculoskeletal symptoms depending on the level of complexity in which these professionals work in the Brazilian Unified Health System. Methods: Health professionals were recruited from 24 health institutions, using probabilistic stratified sampling. Data [...] Read more.

Background/Objectives: To investigate whether healthcare workers present different characteristics of musculoskeletal symptoms depending on the level of complexity in which these professionals work in the Brazilian Unified Health System. Methods: Health professionals were recruited from 24 health institutions, using probabilistic stratified sampling. Data were collected using the Nordic Musculoskeletal Questionnaire. We obtained the questionnaire scores through exploratory factor analysis. Based on the scores, individuals could be grouped into symptom configurations using a non-hierarchical clustering algorithm (K-means). Results: The created groups differed in symptom intensity and location but did not differ by level of work complexity, as defined by Brazil’s healthcare sector division. Therefore, regardless of the level of complexity at which professionals perform their activities in the Brazilian Unified Health System, the burden of musculoskeletal symptoms related to the factor under analysis is similar. We developed distinct symptom profiles for each group, accompanied by targeted occupational intervention recommendations. Conclusions: This study challenges conventional assumptions by demonstrating that musculoskeletal symptom burden remains consistent across varying levels of work complexity, while providing a practical framework for developing targeted interventions based on symptom profiles. Full article

(This article belongs to the Special Issue Job Stress, Physical and Mental Well-Being Among Workers)

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27 pages, 2268 KB

Open AccessArticle

A Six-Month Observational Study of Nursing Workload in 14 Latvian Intensive Care Units Using the Nursing Activities Score

by Olga Cerela-Boltunova and Inga Millere

Healthcare 2026, 14(1), 134; https://doi.org/10.3390/healthcare14010134 - 5 Jan 2026

Viewed by 579

Abstract

Objectives: Intensive care units (ICUs) are characterised by high care complexity and nursing workload, which directly affects patient safety and staff sustainability. Latvia faces a chronic shortage of nurses, particularly in intensive care, yet systematic national data on nursing workload have been lacking. [...] Read more.

Objectives: Intensive care units (ICUs) are characterised by high care complexity and nursing workload, which directly affects patient safety and staff sustainability. Latvia faces a chronic shortage of nurses, particularly in intensive care, yet systematic national data on nursing workload have been lacking. This study aimed to quantitatively assess nursing workload in Latvian ICUs using the Nursing Activities Score (NAS) and to evaluate its relationship with staffing adequacy. Methods: A prospective, multicentre observational study was conducted over six months (May–November 2025) in 14 Latvian ICUs representing all three levels of intensive care. Nursing workload was measured using the NAS during each 12 h shift. A total of 28,079 complete NAS observations were analysed using descriptive statistics, inferential tests (t-tests, ANOVA), mixed-effects modelling, regression analysis, and time-series forecasting. Results: The mean NAS was 65.45 (SD = 25.76), equivalent to an average of 15.71 nursing care hours per patient per day. Workload remained similarly high during day and night shifts. Significant differences were observed between ICUs and care levels, with level 2 units showing the highest workload. The average nursing shortage rate was 42.6% and was strongly predicted by NAS values (R² = 0.115), whereas shift type and unit level had minimal explanatory power. Conclusions: ICU nursing workload in Latvia is persistently high and unevenly distributed across units. Staffing levels are not adequately adjusted to actual care demands. Integrating NAS-based workload monitoring into staffing models is essential for evidence-based workforce planning, improving patient safety, and reducing nurse overburdening. Full article

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16 pages, 441 KB

Open AccessArticle

Effectiveness of a Mobile-Based Self-Regulation Training on Youths’ Affect

by Anouk Aleva, Annemiek Karreman, Loes H. C. Janssen, Anouk Vroegindeweij, Marcel A. G. van Aken, Christel J. Hessels and Odilia M. Laceulle

Healthcare 2026, 14(1), 133; https://doi.org/10.3390/healthcare14010133 - 5 Jan 2026

Viewed by 625

Abstract

Background: The rising prevalence and enduring impact of mental health problems in youth have intensified the call for population-level prevention. Low positive and high negative affect in childhood are vulnerability factors for mental health problems in adolescence. Supporting youth in managing affect during [...] Read more.

Background: The rising prevalence and enduring impact of mental health problems in youth have intensified the call for population-level prevention. Low positive and high negative affect in childhood are vulnerability factors for mental health problems in adolescence. Supporting youth in managing affect during early adolescence may foster mental health preventively. Self-regulation training has shown promise in this regard. Moreover, its parallels with Behavioral Activation (BA) align with the recommendation to adapt evidence-based clinical interventions into scalable, accessible formats for prevention. Methods: This study examined whether a 12-day mobile-based self-regulation training, consistent with BA principles and delivered in an innovative digital format, could increase positive and decrease negative affect in a sample of 156 youths (M_age = 10.0). Results: No significant group differences emerged in affect change over time, and neither baseline levels of self-control nor emotion regulation strategies moderated the effects. Conclusions: The findings suggest that low-intensity mobile-based interventions may be insufficient to produce meaningful affect change in youth. The potential need to shift from universal prevention strategies to more selective approaches targeting at-risk youth is discussed. Full article

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

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17 pages, 280 KB

Open AccessArticle

Effects of an Agro-Healing Horticultural Intervention on Stress, Self-Esteem, and PANSS Scores in Inpatients with Schizophrenia: A Quasi-Experimental Study

by Sang-Mi Lee, Eun-Ju Song, Sun-Jin Jeong and Jiwon Moon

Healthcare 2026, 14(1), 132; https://doi.org/10.3390/healthcare14010132 - 5 Jan 2026

Viewed by 420

Abstract

Background: Developing and implementing diverse interventions is imperative for addressing schizophrenia in the context of deinstitutionalization policies. This study evaluates the effectiveness of an agro-healing horticultural therapy as a psychosocial rehabilitation program for inpatients with schizophrenia. Methods: This quasi-experimental study utilizes a non-equivalent [...] Read more.

Background: Developing and implementing diverse interventions is imperative for addressing schizophrenia in the context of deinstitutionalization policies. This study evaluates the effectiveness of an agro-healing horticultural therapy as a psychosocial rehabilitation program for inpatients with schizophrenia. Methods: This quasi-experimental study utilizes a non-equivalent control group pre–post design to assess the efficacy of a therapeutic horticulture program for patients diagnosed with schizophrenia. Results: This study’s findings supported the initial hypothesis, as the experimental group exhibited a statistically significant reduction in perceived stress, with post-test scores differing significantly between groups (Z = −2.11, p = 0.035). Hypothesis 2, which examined self-esteem, was rejected because no statistically significant differences were found between groups (Z = −0.57, p = 0.566). Hypothesis 3 was supported, as the experimental group’s Positive and Negative Symptom Scale (PANSS) scores decreased following treatment, with significant post-treatment differences between groups (Z = −3.43, p < 0. 001). Conclusions: The agro-healing horticultural therapy program in this study effectively reduced stress and PANSS scores among inpatients with schizophrenia. Combining this intervention with medication may enhance rehabilitation outcomes and quality of life for patients afflicted with schizophrenia. Full article

(This article belongs to the Section Mental Health and Psychosocial Well-being)

15 pages, 2732 KB

Open AccessArticle

One-Year Impact of Scleral Lens Wear on Corneal Morphology in Keratoconus with and Without Intracorneal Ring Segment

by María Serramito, Ana Privado-Aroco and Gonzalo Carracedo

Healthcare 2026, 14(1), 131; https://doi.org/10.3390/healthcare14010131 - 4 Jan 2026

Viewed by 444

Abstract

Purpose: The purpose of this study is to evaluate changes in corneal thickness and anterior and posterior corneal curvature after one year of scleral lens wear in keratoconus eyes and to determine their impact on visual performance. Methods: Sixty-five keratoconus subjects were divided [...] Read more.

Purpose: The purpose of this study is to evaluate changes in corneal thickness and anterior and posterior corneal curvature after one year of scleral lens wear in keratoconus eyes and to determine their impact on visual performance. Methods: Sixty-five keratoconus subjects were divided into two groups: with intrastromal corneal ring segments (KC-ICRS) and without ICRS (KC). All participants wore 16.5 mm scleral lenses for 8 h daily over 1 year. Measurements included corneal thickness, anterior and posterior curvature, and high-contrast visual acuity assessed before and after lens wear. Results: Corneal thicknesses increased significantly in the superior region of the KC-ICRS group. In curvature analysis, the KC group showed inferior steepening and superior flattening, while the KC-ICRS group exhibited central and superior-nasal anterior flattening. Posterior curvature changes included central flattening and peripheral steepening. Visual acuity remained stable across all visits and groups. Conclusions: Long-term scleral lens wear induced measurable morphological changes, including increased superior corneal thickness and region-specific curvature alterations, which varied by ICRS presence. These changes did not compromise visual acuity, supporting scleral lenses as a safe and effective option for sustained vision correction in keratoconus. The findings highlight the importance of personalized fitting and monitoring strategies in clinical practice. Full article

(This article belongs to the Special Issue The Latest Advances in Visual Health)

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47 pages, 1558 KB

Open AccessReview

Mindfulness-Based Interventions to Implement the Psychological Well-Being of Nursing Students: A Scoping Review

by Milena Consorte, Elena Morotti, Fabio Nanni, Alessandro Giannandrea, Stefano Benini and Monica Martoni

Healthcare 2026, 14(1), 130; https://doi.org/10.3390/healthcare14010130 - 4 Jan 2026

Viewed by 789

Abstract

Background/Objectives: Mindfulness is a meditative practice that increases levels of awareness and attention. Introducing this practice into the curricula of nursing students could improve the relationship with patients and promote students’ well-being. This scoping review aims to map the literature on mindfulness-based [...] Read more.

Background/Objectives: Mindfulness is a meditative practice that increases levels of awareness and attention. Introducing this practice into the curricula of nursing students could improve the relationship with patients and promote students’ well-being. This scoping review aims to map the literature on mindfulness-based interventions (MBIs) administered to nursing students to promote their psychological well-being. Methods: The review was conducted according to Peters’ framework. PCC eligibility criteria were used. The PCC mnemonic stands for Population (nursing students), Concept (mindfulness-based interventions applied with positive and negative outcomes for psychological well-being), and Context (undergraduate, pre-licensure). The search was conducted in March 2024 by consulting PubMed, ERIC (Ovid), CINAHL (EBSCOhost), PsycINFO (Ovid), and ProQuest databases. Additional sources have been identified from Google Scholar. Results: Of the 763 articles that emerged, 55 were included in the scoping review. The interventions depicted are heterogeneous in terms of content and timing. The most investigated outcomes remain stress and anxiety; self-efficacy and empathy emerge as positive indicators of psychological well-being. In the post-COVID period, there is an increase in the online delivery method. Conclusions: In order to provide guidance for practice and institutional policies, future research could focus on a systematic review that identifies the most appropriate MBIs for the well-being of nursing students. In addition, it would be useful to conduct feasibility studies to introduce structured mindfulness-based practices into the nursing degree programmes, with standardized and adaptable pathways tailored to the needs of different academic realities. Full article

(This article belongs to the Special Issue Strategies and Interventions for Supporting the Holistic Well-Being of Clinicians and Nurses)

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13 pages, 382 KB

Open AccessArticle

Group Telerehabilitation to Improve Balance and Mobility in Patients After Stroke Performed at Home: A Feasibility and Pilot Study

by Metka Močilar, Nataša Bizovičar and Urška Puh

Healthcare 2026, 14(1), 129; https://doi.org/10.3390/healthcare14010129 - 4 Jan 2026

Viewed by 594

Abstract

Background/Objectives: Telerehabilitation is intended for remote treatment, but studies on group training after stroke performed in the patient’s home have not yet been conducted. The purpose of this study was to evaluate adherence rates, safety, usability and enjoyment and preliminary clinical effects [...] Read more.

Background/Objectives: Telerehabilitation is intended for remote treatment, but studies on group training after stroke performed in the patient’s home have not yet been conducted. The purpose of this study was to evaluate adherence rates, safety, usability and enjoyment and preliminary clinical effects of home-based remote group training for balance and mobility in chronic stage after stroke. Methods: Community-dwelling patients in chronic stage after stroke who walked independently and had mild balance deficits participated. Over a 6-week period, they completed 60-min sessions of balance and mobility training twice a week in a group from their home. Adherence rates, adverse events and technical problems were recorded. Participants’ satisfaction was assessed using Modified Physical Activity Enjoyment Scale. The primary outcomes were Mini-Balance Evaluation Systems Test (mini-BESTest), 5TSTS and 10MWT and secondary outcomes were limits of stability, weight-bearing symmetry and Activities-Specific Balance Confidence Scale (ABC Scale), measured before, immediately after and six weeks after remote group training. Results: Participants expressed a very high level of satisfaction with training. There were no adverse events and dropouts, but some minor technical challenges. Results showed significant improvements in primary outcomes (mini-BESTest, 10MWT fast walking speed, 5TSTS; all p < 0.001), however there were no significant improvements in secondary outcomes (weight-bearing symmetry, limits of stability and ABC Scale). All improvements persisted six weeks after training. Conclusions: Remote group training at home is feasible, safe and efficient to improve balance and mobility in patients in the chronic phase after stroke. Full article

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13 pages, 617 KB

Open AccessArticle

Psychometric Validation of the Depression, Anxiety and Stress Scale (DASS-21) in Portuguese Youth Transitioning to Higher Education

by Luís Loureiro, Ana Teresa Pedreiro, Rosa Simões, Inês Batista, Amorim Rosa and Tânia Morgado

Healthcare 2026, 14(1), 128; https://doi.org/10.3390/healthcare14010128 - 4 Jan 2026

Viewed by 1533

Abstract

Background/Objectives: The transition to higher education is a critical phase of human development that makes adolescents and young adults particularly vulnerable to mental health problems, such as depression, anxiety, and stress. This study aimed to evaluate the psychometric properties of the Portuguese [...] Read more.

Background/Objectives: The transition to higher education is a critical phase of human development that makes adolescents and young adults particularly vulnerable to mental health problems, such as depression, anxiety, and stress. This study aimed to evaluate the psychometric properties of the Portuguese version of the Depression, Anxiety and Stress Scale-21 Items (DASS-21) among first-year undergraduate nursing students. Methods: A methodological study was conducted with 225 undergraduate nursing students, aged 17 to 18 years, from a higher education institution in central Portugal. Data were collected using the Google Forms platform. Confirmatory factor analysis was conducted to test three competing models: a single-factor model, a three-factor correlated model, and a second-order factor model. Reliability was assessed using composite reliability, and validity was evaluated using average variance extracted and the Fornell–Larcker criterion for discriminant validity. Results: Factor analyses revealed that the three-factor correlated model fit the data best overall, showing superior fit indices compared to the competing models (χ²/df = 2.37; CFI = 0.90; and RMSEA = 0.08; TLI = 0.88 and SRMR = 0.04). Composite reliability was high across all tested models, ranging from 0.84 to 0.94. The analysis of score distributions by category revealed a high prevalence of severe or extremely severe symptoms of anxiety, stress, and, to a lesser extent, depression. A statistically significant association was found between higher symptom severity and prior familiarity with mental illness. Conclusions: The DASS-21 proved to be a valid and reliable instrument for assessing psychological distress in higher education students. These findings underscore the urgent need for mental health programs in higher education institutions that focus on early detection and intervention, particularly for students initiating their studies and those with a history of mental health problems. Full article

(This article belongs to the Special Issue Research and Survey on the Mental Health of Children and Adolescents: Second Edition)

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18 pages, 723 KB

Open AccessArticle

Changes in Hedonic Hunger and Problematic Eating Behaviors Following Bariatric Surgery: A Comparative Study of Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy

by Can Selim Yilmaz and Perim Fatma Turker

Healthcare 2026, 14(1), 127; https://doi.org/10.3390/healthcare14010127 - 4 Jan 2026

Viewed by 495

Abstract

Background/Objective: This study aims to examine changes in hedonic hunger and problematic eating behaviors over a 24-week follow-up period after sleeve gastrectomy and Roux-en-Y gastric bypass and to compare differences between the two surgical procedures. Methods: This prospective observational study included [...] Read more.

Background/Objective: This study aims to examine changes in hedonic hunger and problematic eating behaviors over a 24-week follow-up period after sleeve gastrectomy and Roux-en-Y gastric bypass and to compare differences between the two surgical procedures. Methods: This prospective observational study included 144 adults who underwent sleeve gastrectomy (n = 74) or Roux-en-Y gastric bypass (n = 70). Hedonic hunger was assessed using the Power of Food Scale, and problematic eating behaviors were evaluated with the Eating Disorder Examination Questionnaire. Data was collected one week before surgery and 24 weeks postoperatively through face-to-face interviews. Results: At the 24-week follow-up, participants who underwent gastric bypass had higher total Power of Food Scale scores than those who underwent sleeve gastrectomy (2.42 vs. 2.15), although reductions from baseline were not significantly different (−1.31 vs. −1.16, p = 0.136). Both procedures resulted in significant decreases in total Eating Disorder Examination Questionnaire scores (sleeve gastrectomy: 2.37 to 1.00, p < 0.01; gastric bypass: 2.41 to 1.36, p < 0.01), as well as in Eating Concern, Shape Concern, and Weight Concern subgroups. Reductions in Eating Disorder Examination Questionnaire total score and in Shape Concern and Weight Concern subgroups score were greater after sleeve gastrectomy (−1.37 vs. −1.05, p = 0.030). Total weight loss percentage was positively correlated with decreases in Eating Disorder Examination Questionnaire scores in both groups (p = 0.010) and was significantly associated with Power of Food Scale reductions only in sleeve gastrectomy (r = 0.163, p = 0.014). Conclusions: Both procedures reduce hedonic hunger and problematic eating behaviors, but the magnitude of change and its effect on weight loss may vary by surgical method. Full article

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12 pages, 448 KB

Open AccessArticle

Perceived Impact of Wearable Fitness Trackers on Health Behaviours in Saudi Adults

by Asma A. Abahussin

Healthcare 2026, 14(1), 126; https://doi.org/10.3390/healthcare14010126 - 4 Jan 2026

Viewed by 623

Abstract

Background/Objectives: Wearable fitness trackers (WFTs) are growing in popularity as tools to motivate physical activity and support healthier lifestyles. Evidence suggests that they can have both positive and negative effects on user behaviour and well-being. However, little is known about their impact [...] Read more.

Background/Objectives: Wearable fitness trackers (WFTs) are growing in popularity as tools to motivate physical activity and support healthier lifestyles. Evidence suggests that they can have both positive and negative effects on user behaviour and well-being. However, little is known about their impact in Saudi settings, considering its unique cultural context. This study aims to investigate the perceived positive and negative impacts of WFTs on adults’ health behaviours and well-being in Saudi Arabia. Methods: A cross-sectional survey was conducted among Saudi adults aged 18 years or older who currently use or have previously used WFTs, using an online questionnaire distributed via social media platforms in May 2025. The survey was developed based on evidence from the literature. It included demographic items, five-point Likert-scale questions assessing positive (9 items) and negative (10 items) effects of WFTs, and an open-ended question. Responses were analysed using descriptive statistics, independent samples t-tests, and one-way ANOVA. Results: A total of 154 adults participated. The mean composite score for positive effects was 3.26 (SD = 0.73), indicating general agreement on the benefits of WFTs, while the negative effects score was 2.15 (SD = 0.66), showing low endorsement of adverse outcomes. No significant differences appeared between gender (positive: p = 0.34; negative: p = 0.24) or age groups (positive: p = 0.56; negative: p = 0.19). However, users of over two months had higher positive scores (M = 3.43, SD = 0.66) than newer or former users (p = 0.01). Open responses showed 62% positive experiences; 27% reported stress, guilt, or obsessive monitoring. Conclusions: This study provides initial insights into WFT use and perceptions in Saudi Arabia. However, its cross-sectional nature limits the ability to draw causal conclusions. While most users experienced beneficial health outcomes, a significant proportion reported negative psychological experiences. These findings highlight WFT users’ dual experiences and the need for further longitudinal research and diverse recruitment strategies to better understand sustained engagement and psychological effects. Full article

(This article belongs to the Section Digital Health Technologies)

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10 pages, 212 KB

Open AccessArticle

A Retrospective Analysis of Blood Component Utilization and Transfusion-Related Factors in a Diverse Patient Population

by Yazeed Abdulaziz Almujali, Nancy Mohamed Darwish, Abdulqader Ali Ba Abbad, Hani Tamim, Muhammad Raihan Sajid, Rimah Abdullah Saleem, Abdulwahab Binjomah and Kamel Aldosari

Healthcare 2026, 14(1), 125; https://doi.org/10.3390/healthcare14010125 - 4 Jan 2026

Viewed by 476

Abstract

Background/Objectives: This retrospective observational study aimed to analyze blood component utilization patterns and investigate associations between patient demographics, clinical parameters, and transfusion requirements at a major tertiary care center. Methods: The study analyzed data from 2867 patients at King Saud Medical City, Riyadh. [...] Read more.

Background/Objectives: This retrospective observational study aimed to analyze blood component utilization patterns and investigate associations between patient demographics, clinical parameters, and transfusion requirements at a major tertiary care center. Methods: The study analyzed data from 2867 patients at King Saud Medical City, Riyadh. Utilization patterns and correlations were assessed for packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and cryoprecipitate. Results: Significant correlations were found between age, hemoglobin levels, platelet counts, ferritin levels, and transfusion of specific components. Elderly patients received more PRBCs, FFP, and platelets, while younger patients received more cryoprecipitate. Hemoglobin < 7 g/dL was the most common trigger for PRBC transfusion. Platelet transfusions correlated strongly with thrombocytopenia, and elevated ferritin levels correlated with higher platelet transfusion volumes. Patients with hematologic malignancies, β-thalassemia, and sickle cell disease demonstrated distinct transfusion profiles. Conclusions: These findings underscore the importance of tailored, evidence-based transfusion strategies to optimize blood use and minimize risk. Full article

16 pages, 1885 KB

Open AccessArticle

Geographic and Behavioral Determinants of Typhoid and Antimicrobial Resistance in Children Across Urban, Rural, and Nomadic Populations of Punjab, Pakistan

by Atifa Ambreen, Muhammad Asif Zahoor, Muhammad Hidayat Rasool and Mohsin Khurshid

Healthcare 2026, 14(1), 124; https://doi.org/10.3390/healthcare14010124 - 4 Jan 2026

Viewed by 561

Abstract

Background/Objectives: This study aimed to determine the antimicrobial susceptibility patterns of multidrug resistant (MDR) and extensively resistant (XDR) Salmonella enterica serovar Typhi (S. Typhi) strains among children, along with the associated behavioral and environmental risk factors across different population groups [...] Read more.

Background/Objectives: This study aimed to determine the antimicrobial susceptibility patterns of multidrug resistant (MDR) and extensively resistant (XDR) Salmonella enterica serovar Typhi (S. Typhi) strains among children, along with the associated behavioral and environmental risk factors across different population groups in multiple districts of Punjab, Pakistan. Methods: A cross-sectional study was conducted across 20 districts in Punjab, Pakistan. Structured questionnaires were used to assess sociodemographic and behavioral determinants. Blood cultures from febrile children were obtained for the isolation and identification of S. Typhi, followed by antimicrobial susceptibility testing and screening for the resistance genes. Results: A total of 900 blood samples were collected and 41.5% were positive for S. Typhi. The proportion of culture-positive cases were higher among children aged 6–12 years (34.8%). Sociodemographic and behavioral analysis revealed that children from low-income households (PKR < 20,000 showed significantly higher infection rate (67.1%, p < 0.001). Antimicrobial susceptibility testing revealed high resistance rates against several antibiotics: Ciprofloxacin (88.8%), Trimethoprim/sulfamethoxazole (83.7%), Ampicillin (73.8%) and Chloramphenicol (72.7%). However, all isolates remained susceptible to carbapenems and azithromycin. The prevalence of MDR and XDR S. Typhi in urban areas was 28.1% and 60.8%, respectively, while rural areas showed 22.6% MDR and 20.6% XDR. In contrast, nomadic populations exhibited a higher rate of MDR (49.3%) but a lower XDR prevalence of 18.6% with significant geographic variations in resistance patterns. Molecular analysis revealed a high prevalence of resistance genes, including sul1 (83.7%), sul2 (79.7%), followed by dfrA7 (81.3%), catA1 (64.9%) and bla_TEM (60.5%), bla_CTX-M-1 (12.5%), bla_CTX-M-15 (25.9%) and qnrS (88.8%), respectively. Conclusions: The study underscores a persistent typhoid burden and widespread antimicrobial resistance among children in Punjab. Targeted vaccination, antibiotic stewardship, public health education are urgently needed, especially among the nomadic population, where healthcare access and hygiene awareness are limited. Full article

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16 pages, 272 KB

Open AccessArticle

Maritime Response and Emergency Care for Irregular Migrants: Experiences of Spanish Rescue Professionals

by María del Mar Jiménez-Lasserrotte, Andrés Pomares Rodríguez, Dulcenombre de María García-López, Verónica Díaz-Sotero, Anabel Chica-Pérez and José Granero-Molina

Healthcare 2026, 14(1), 123; https://doi.org/10.3390/healthcare14010123 - 4 Jan 2026

Viewed by 506

Abstract

Background/Objectives: Irregular maritime migration is a global health challenge as it combines exposure to extreme physical risks with profound psychosocial vulnerability. Understanding the role of maritime rescue professionals is essential for designing effective public health strategies that respond to these realities. The [...] Read more.

Background/Objectives: Irregular maritime migration is a global health challenge as it combines exposure to extreme physical risks with profound psychosocial vulnerability. Understanding the role of maritime rescue professionals is essential for designing effective public health strategies that respond to these realities. The objective of this study was to explore and describe the experiences of SASEMAR professionals involved in the emergency care and rescue of irregular migrants arriving by small boat to the Spanish coast. Methods: Using a qualitative descriptive design, we conducted in-depth interviews and focus groups with 12 SASEMAR professionals. Thematic analysis was performed using Braun and Clarke’s approach with ATLAS.ti software. Results: The findings were grouped into three overarching themes: (1) Innovative Emergency Response Systems for Vulnerable Populations; (2) Holistic Health Approaches in Maritime Emergency Care; and (3) Integrated Approaches to Resource Use and Migrant Care Policies. Conclusions: Rescuing irregular migrants at sea requires coordinated, flexible, and multidisciplinary strategies to address diverse profiles and challenging conditions. Strengthening rescue capacity and policies is essential to ensure effective, human care during maritime emergencies. Full article

(This article belongs to the Special Issue New Insights into Understudied Phenomena in Healthcare: Second Edition)

13 pages, 239 KB

Open AccessReview

Recommendations for Lifestyle Physical Activity and Exercise During the Perinatal Period: A Narrative Review

by Józef Opara, Krzysztof Mehlich and Jarosław Szczygieł

Healthcare 2026, 14(1), 122; https://doi.org/10.3390/healthcare14010122 - 4 Jan 2026

Viewed by 1112

Abstract

Background: The World Health Organization (WHO) has recently focused much attention on physical activity recommendations. Regular physical activity offers broad health benefits, reducing the risk of some chronic diseases and improving bone structure and muscle strength. Although the scientific literature provides numerous recommendations [...] Read more.

Background: The World Health Organization (WHO) has recently focused much attention on physical activity recommendations. Regular physical activity offers broad health benefits, reducing the risk of some chronic diseases and improving bone structure and muscle strength. Although the scientific literature provides numerous recommendations for physical activity during pregnancy and the postpartum period, there are no official recommendations for lifestyle-related physical activity. Objectives: This narrative review aimed to review the current knowledge on physical activity during pregnancy and the postpartum period, specifically focusing on lifestyle-related physical activity. The review was based on the definition of lifestyle-related physical activity proposed by Dunn et al. in 1998, which is at least 30 min of self-selected activity per day, encompassing all recreational, occupational, or household activities, as well as planned and unplanned activities that are part of daily life. Methods: A number of databases were analyzed, including PubMed, the Cochrane Library, Embase, and Web of Science. Results: The most valuable reports and recommendations regarding physical activity during the perinatal period were identified. Conclusions: Moderate physical activity during pregnancy is safe and offers benefits, such as reducing the risk of gestational diabetes, preeclampsia, and excessive weight gain, as well as improving mental health. The most common benefits of continuing physical activity after delivery include weight control, reduced risk of depression, and improved quality of life. Lifestyle-based physical activity is easier to implement and more achievable than structured exercise. Further research is needed to establish recommendations regarding lifestyle-based physical activity during the perinatal period. Full article

(This article belongs to the Special Issue Healthy Lifestyle for Pregnant and Postpartum Women)

16 pages, 250 KB

Open AccessArticle

Nurses’ Perceptions of Communication in an Oncology Hospital Care: A Qualitative Study

by Lara Guariglia, Maria Condoleo, Giovanna D’antonio, Simona Molinaro, Tatiana Bolgeo, Francesca Gambalunga, Fabrizio Petrone, Anita Caruso and Laura Iacorossi

Healthcare 2026, 14(1), 121; https://doi.org/10.3390/healthcare14010121 - 4 Jan 2026

Viewed by 502

Abstract

Background/Objectives: In the context of evolving healthcare systems, effective communication represents a fundamental skill for ensuring quality care and addressing the psychosocial needs of oncology patients. In line with the new challenges of nursing education, this study explores communication between nurses and [...] Read more.

Background/Objectives: In the context of evolving healthcare systems, effective communication represents a fundamental skill for ensuring quality care and addressing the psychosocial needs of oncology patients. In line with the new challenges of nursing education, this study explores communication between nurses and oncology patients, analyzing facilitating and hindering factors from the nurses’ perspective within the hospital setting. Methods: A descriptive qualitative study was conducted using one-on-one semi-structured interviews. The interviews lasted from 15 to 30 min. The study population consisted of nurses working in the Medical Oncology units of the Regina Elena Institute in Rome (IRE). Data were analyzed using the Framework Analysis method by Ritchie and Spencer. Results: The sample consisted of 20 nurses with an average age of 33.5 years. Six main themes emerged: communication as the pillar of the care relationship between technical and human aspects, the need for a balance between closeness and personal protection, the influence of language and personalized approaches on communication, the stimulation of specific training needs, and barriers to nursing communication. Conclusions: Nurses recognize communication as an integral part of the care process and as a key competency for addressing the complex needs of oncology patients. However, inadequate training, time constraints, and staff shortages represent significant barriers, highlighting the need to invest in specific training programs and organizational strategies to improve the quality of care. Full article

(This article belongs to the Special Issue Nursing Competencies: New Advances in Nursing Care—2nd Edition)

18 pages, 1122 KB

Open AccessArticle

Brief Mindfulness Meditation Protects Chinese Young Women’s Body Image from Appearance-Focused Social Media Exposure: An Online Randomized Controlled Trial

by Xiaoxiao Zhang and Zixuan Zhang

Healthcare 2026, 14(1), 120; https://doi.org/10.3390/healthcare14010120 - 4 Jan 2026

Viewed by 612

Abstract

Objectives: Exposure to appearance-focused social media often leads to body image disturbance among young women. One promising intervention to lessen this negative impact is mindfulness meditation. This study aimed to determine whether a brief mindfulness meditation intervention could mitigate the adverse effects [...] Read more.

Objectives: Exposure to appearance-focused social media often leads to body image disturbance among young women. One promising intervention to lessen this negative impact is mindfulness meditation. This study aimed to determine whether a brief mindfulness meditation intervention could mitigate the adverse effects of exposure to appearance-focused social media content on body image and mood in young Chinese women. Methods: In an online randomized controlled trial, 168 women aged 18–35 years were randomly assigned to either an intervention group (n = 86) that listened to a ten-minute mindfulness meditation audio or to a control group (n = 82) that listened to a ten-minute recorded natural history text. After listening to the audio, participants viewed idealized body images on Xiaohongshu and compared themselves to these images. Outcome measures included state body dissatisfaction and negative mood. Data were collected at baseline (T0), post-intervention (T1), and post-exposure to images (T2). Results: At T0, groups did not differ in age, BMI, education, body dissatisfaction, or negative mood (all p > 0.05). From T0 to T1, both groups showed significant improvements in body dissatisfaction and mood. The intervention group’s scores decreased significantly (p = 0.008; p < 0.01), and the control group also showed significant improvements on both outcome measures (both p < 0.001). However, when exposed to the idealized images, only the intervention group maintained its improvements, with no significant change in body dissatisfaction or mood (p = 0.178 and p = 0.310, respectively) from T1 to T2, whereas the control group’s scores worsened significantly on both outcome measures (p < 0.001 for both). Conclusions: These findings suggest that even a brief mindfulness meditation intervention may buffer against the negative effects of idealized social media content on body image and mood. Full article

(This article belongs to the Special Issue Body Image, Dissatisfaction and Eating Disorders: A Healthcare Perspective)

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11 pages, 226 KB

Open AccessPerspective

Corporate Profits and the Health of Americans

by Anthony Biglan, Ronald J. Prinz and Diana H. Fishbein

Healthcare 2026, 14(1), 119; https://doi.org/10.3390/healthcare14010119 - 4 Jan 2026

Viewed by 1132

Abstract

A large and growing empirical literature documents that privatization, deregulation, financialization, and under-regulation of harmful industries are associated with adverse health outcomes in the United States. However, this evidence remains fragmented across sectors and rarely articulates a unifying causal framework. This paper advances [...] Read more.

A large and growing empirical literature documents that privatization, deregulation, financialization, and under-regulation of harmful industries are associated with adverse health outcomes in the United States. However, this evidence remains fragmented across sectors and rarely articulates a unifying causal framework. This paper advances the literature by integrating findings across health care, harmful-product industries, and economic and social policy to demonstrate that corporate profit maximization functions as a cross-cutting driver of health disparities and premature mortality in the United States. We synthesize evidence showing that profit-driven incentives shape insurance markets, hospital and physician practice ownership, pharmaceutical marketing, and the aggressive promotion of tobacco, alcohol, ultra-processed foods, opioids, firearms, and fossil fuels—together contributing to more than one million deaths annually. We further document how corporate influence over public policy has increased poverty, economic inequality, and discrimination, all of which are powerful social determinants of health. In contrast to sector-specific analyses, this paper presents a unified, systems-level account of how profit-first governance undermines population health. We conclude by describing how a social movement to achieve a single payer system that provides Medicare for All would not only vastly improve public health, it would be a catalyst for numerous other reforms that enhance the general wellbeing. Full article

14 pages, 671 KB

Open AccessArticle

Explainable Artificial Intelligence for Rehospitalization and Financial Burden of Fertile Women in Orthopedic Care

by Kwang-Sig Lee, Jaehwan Kim and Seung Beom Han

Healthcare 2026, 14(1), 118; https://doi.org/10.3390/healthcare14010118 - 3 Jan 2026

Viewed by 367

Abstract

Background: Fertile women represent a socially and medically significant patient group, yet little research has examined their rehospitalization behavior and financial burden in clinical settings. This study develops predictive and explainable artificial intelligence for rehospitalization and medical costs among reproductive-age orthopedic patients. Methods: [...] Read more.

Background: Fertile women represent a socially and medically significant patient group, yet little research has examined their rehospitalization behavior and financial burden in clinical settings. This study develops predictive and explainable artificial intelligence for rehospitalization and medical costs among reproductive-age orthopedic patients. Methods: Electronic health records of 83 women (aged 15–49) at a major university hospital in Korea were analyzed. Six machine learning models were developed, and model performance was assessed using accuracy, the area under the curve, the root mean square error and its scaling invariant divided by the interquartile range (RMSE/IQR). Shapley Additive Explanations were applied to interpret predictors of rehospitalization. Additional analyses explored determinants of patients’ total and uncovered medical costs. Results: The random forest outperformed other models in predicting rehospitalization (area under the curve 0.92 vs. 0.73 for logistic regression). Key predictors included major disease, systolic blood pressure, platelet count, age, and treatment costs. The random forest also yielded lower error rates than linear regression in forecasting patients’ costs (e.g., RMSE/IQR for total cost: 1.05 vs. 1.14). Several factors—such as blood pressure, pulse, and hematocrit—were influential for both rehospitalization and costs. Conclusions: Predictive and explainable artificial intelligence can support medical centers in anticipating the rehospitalization and financial burden of fertile women. By integrating medical and socioeconomic determinants, hospitals may design strategies that enhance patient rehospitalization while addressing broader societal priorities in women’s health. Full article

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11 pages, 451 KB

Open AccessArticle

Effect of Maternal Table Tilt During Cesarean Delivery Under Spinal Anesthesia on Norepinephrine Requirements: A Prospective Observational Comparative Study

by Jakub Vallo, Jana Morávková, Matúš Paulíny and Peter Sabaka

Healthcare 2026, 14(1), 117; https://doi.org/10.3390/healthcare14010117 - 3 Jan 2026

Viewed by 431

Abstract

Background: Left lateral tilt is traditionally recommended during cesarean delivery to reduce aortocaval compression and maintain maternal hemodynamic stability; however, with the widespread adoption of prophylactic vasopressor strategies recommended by current guidelines, the incremental benefit of routine tilt remains uncertain. Methods: We conducted [...] Read more.

Background: Left lateral tilt is traditionally recommended during cesarean delivery to reduce aortocaval compression and maintain maternal hemodynamic stability; however, with the widespread adoption of prophylactic vasopressor strategies recommended by current guidelines, the incremental benefit of routine tilt remains uncertain. Methods: We conducted a prospective, nonrandomized observational comparative study at the University Hospital Bratislava including 99 women undergoing elective cesarean delivery under spinal anesthesia. Participants were managed either with a standard ~15° left lateral tilt (n = 41) or in a flat supine position without tilt (n = 58), according to the day of surgery and routine anesthesiologist practice; all other anesthetic and surgical procedures were identical. A prophylactic norepinephrine infusion was initiated at 0.05 µg/kg/min and titrated to maintain systolic arterial pressure at 90–100% of baseline. The primary outcome was the average norepinephrine infusion rate (µg/kg/min) from induction of spinal anesthesia to neonatal delivery. Secondary outcomes included total norepinephrine dose to delivery, dose normalized per kilogram, and neonatal outcomes (Apgar scores and umbilical arterial blood gas parameters). Results: The median norepinephrine infusion rate was 0.03 µg/kg/min in both groups (tilt: IQR 0.01–0.04 vs. no-tilt: IQR 0.02–0.04; p = 0.325). Total norepinephrine dose to delivery (20 [15–35] µg; p = 0.89) and dose per kilogram (0.25 [0.15–0.33] µg/kg vs. 0.34 [0.17–0.44] µg/kg; p = 0.10) were also comparable. Neonatal outcomes, including Apgar scores and umbilical arterial blood gas parameters, did not differ significantly between groups. In a multivariable regression sensitivity analysis adjusting for maternal and procedural covariates, table tilt was not independently associated with norepinephrine requirements. Conclusions: In parturients undergoing cesarean delivery under spinal anesthesia with prophylactic norepinephrine infusion, a 15° left lateral tilt did not reduce vasopressor requirements or improve neonatal outcomes. Routine maternal tilt therefore appears unnecessary for hemodynamic optimization in this setting, and patient positioning can be individualized without compromising maternal or neonatal safety. Full article

(This article belongs to the Section Clinical Care)

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30 pages, 1728 KB

Open AccessArticle

Composition of Diagnostic Assessment Sheet Items for Developing a Personalized Forest Therapy Program for Patients with Depression: Application of the Delphi Technique

by Gayeon Kim, Sinae Kang, Kyungsook Paek, Youngeun Seo, Hyoju Choi, Seyeon Park and Pyeongsik Yeon

Healthcare 2026, 14(1), 116; https://doi.org/10.3390/healthcare14010116 - 3 Jan 2026

Viewed by 363

Abstract

Background/Objectives: Depression is a serious mental illness worldwide, with a continuously increasing prevalence. As evidence supporting forest therapy as a non-pharmacological intervention has accumulated, the need for collaboration between the medical and forest therapy sectors has emerged; however, practical tools applicable in real-world [...] Read more.

Background/Objectives: Depression is a serious mental illness worldwide, with a continuously increasing prevalence. As evidence supporting forest therapy as a non-pharmacological intervention has accumulated, the need for collaboration between the medical and forest therapy sectors has emerged; however, practical tools applicable in real-world clinical settings remain limited. This study aimed to derive components of a diagnostic assessment sheet to support clinicians in developing personalized forest therapy programs for patients with depression. Methods: Program-related literature and case materials from diverse disciplines were systematically analyzed to identify transferable program development elements and therapeutic activities. Based on these findings, a two-round Delphi survey was conducted with 17 experts in forest therapy and medicine. Results: Through the Delphi process, 26 therapeutic activities were identified and classified into six final activity types. Assessment items were developed to support clinicians in selecting appropriate activity types, and nine key precaution items were identified to enhance safety and appropriateness during program design and implementation. Conclusions: This study provides a structured framework to guide clinicians and forest therapy instructors in composing individualized forest therapy programs for patients with depression, supporting practical medical–forest therapy integration. Future research should validate the diagnostic assessment sheet through empirical field testing. Full article

(This article belongs to the Section Mental Health and Psychosocial Well-being)

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11 pages, 703 KB

Open AccessArticle

The Incidence of Contrast-Induced Nephropathy Among Low-Risk Cancer Patients with Preserved Renal Function on Active Treatment Undergoing Contrast-Enhanced Computed Tomography: A Single-Site Experience

by Ahmad Subahi, Nada Alhazmi, Maryam Lardi, Fatimah Alkathiri, Layan Bokhari, Sultanah Alqahtani, Nesreen Abourokba and Khalid Alshamrani

Healthcare 2026, 14(1), 115; https://doi.org/10.3390/healthcare14010115 - 3 Jan 2026

Viewed by 494

Abstract

Background/Objectives: Contrast-induced nephropathy (CIN) is a common iatrogenic or medically induced condition among patients who receive intravenous infusion of iodinated contrast media that can cause renal insufficiency, raise the cost of care, and increase mortality risk. This study evaluated the incidence of [...] Read more.

Background/Objectives: Contrast-induced nephropathy (CIN) is a common iatrogenic or medically induced condition among patients who receive intravenous infusion of iodinated contrast media that can cause renal insufficiency, raise the cost of care, and increase mortality risk. This study evaluated the incidence of CIN and predictors of renal function among cancer patients receiving contrast-enhanced computed tomography (CECT). Methods: A prospective, single-center longitudinal study was conducted at King Abdul-Aziz Medical City’s (Jeddah) medical imaging department from December 2021 to December 2023. Convenience sampling was used to select patients who were exposed to CECT based on data filled in the electronic medical record during the study period. Results: The final sample constituted 80 patients (47.71% attrition, mean age = 55.5 years, 58.75% male). The high attrition rate was associated with participants with incomplete records, those who were lost to follow-up, and those whose follow-up Scr was collected after 72 h from CECT administration. There was no statistically significant change in Scr following contrast exposure (mean increase 0.9 µmol/L; paired t = 1.41, p = 0.162; Wilcoxon p = 0.326). The incidence of CIN was 3.75% (3 of 80 patients; 95% confidence intervals (CI), 1.28–10.39%). Regression analysis showed no statistically significant associations between the percentage change in Scr and age, sex, baseline creatinine, or eGFR category (model R² = 0.07). No clinically meaningful predictors of CIN were identified. Conclusions: The incidence of CIN in this study’s cohort of low-risk cancer patients undergoing CECT was low, and contrast exposure did not produce significant short-term changes in renal function. These findings support the safety of modern contrast agents in oncology imaging, but multi-center studies with larger samples and more robust methods are warranted to refine CIN risk assessment in cancer patients undergoing CECT. Full article

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18 pages, 756 KB

Open AccessReview

Bias at the Bedside: A Comprehensive Review of Racial, Sexual, and Gender Minority Experiences and Provider Attitudes in Healthcare

by Emily J. R. Carter, Roberto Sagaribay, Aditi Singh, Lorraine S. Evangelista, Deborah A. Kuhls, Jennifer R. Pharr and Kavita Batra

Healthcare 2026, 14(1), 114; https://doi.org/10.3390/healthcare14010114 - 3 Jan 2026

Viewed by 621

Abstract

Background/Objectives: Persistent inequities in healthcare experiences and outcomes among marginalized racial/ethnic groups and sexual and gender minority (SGM) populations have been well documented. However, disparities in perceptions of discrimination and bias between patients and health providers remain insufficiently understood. This review synthesizes the [...] Read more.

Background/Objectives: Persistent inequities in healthcare experiences and outcomes among marginalized racial/ethnic groups and sexual and gender minority (SGM) populations have been well documented. However, disparities in perceptions of discrimination and bias between patients and health providers remain insufficiently understood. This review synthesizes the current evidence on how these groups differently perceive discrimination, how bias manifests in clinical encounters, and how intersecting identities shape healthcare experiences. Methods: A comprehensive review using SANRA guidelines examined racial/ethnic discrimination, SGM-related bias, provider implicit attitudes, minority stress processes, and structural determinants of inequity in healthcare settings. Articles were identified through systematic search strategies across major databases, and their conceptual, methodological, and theoretical contributions were analyzed. Results: Across studies, marginalized patients consistently reported discrimination, stigma, and mistrust in healthcare, whereas providers often underestimated the prevalence and impact of these experiences. Evidence indicates that implicit pro-White biases among providers influence communication quality, clinical decision-making, and patient comfort. Structural racism and intersecting minority statuses further compound disparities, contributing to delayed care, unmet health needs, and poorer outcomes. Limited alignment between patient and provider perceptions suggests a gap in recognition of inequitable treatment and its drivers. Conclusions: Healthcare inequities arise from interconnected, interpersonal, and structural mechanisms. Addressing these disparities requires multilevel interventions targeting provider training, institutional policy reform, and system-level barriers. Integrating both patient and provider perspectives is essential for developing equitable, affirming models of care and improving health outcomes for racial/ethnic and SGM populations. Full article

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16 pages, 1093 KB

Open AccessArticle

Rural General Practitioners’ Perceptions of the Barriers and Facilitators of Chronic Disease and Cardiometabolic Risk Factor Care Through Lifestyle Management—A Western Australian Qualitative Study

by Aniruddha Sheth, Sandra C. Thompson and Nahal Mavaddat

Healthcare 2026, 14(1), 113; https://doi.org/10.3390/healthcare14010113 - 2 Jan 2026

Viewed by 389

Abstract

Background: Chronic diseases such as type 2 diabetes mellitus and cardiovascular disease and their cardiometabolic risk factors require management, which includes lifestyle interventions. Rural and remote residents are disproportionately affected by these conditions compared to their urban counterparts. Studies have examined barriers to [...] Read more.

Background: Chronic diseases such as type 2 diabetes mellitus and cardiovascular disease and their cardiometabolic risk factors require management, which includes lifestyle interventions. Rural and remote residents are disproportionately affected by these conditions compared to their urban counterparts. Studies have examined barriers to chronic disease and cardiometabolic risk factor management in urban environments, but rural perspectives remain underexplored, especially in Western Australia (WA) with its vast geography. This study examined rural general practitioners’ (GPs) views on barriers and facilitators to chronic disease and cardiometabolic care in rural WA through lifestyle management. Methods: This qualitative study used semi-structured interviews with 15 rural WA GPs recruited via rural networks using convenience and snowball sampling. Braun and Clarke’s reflexive thematic analysis was used to identify patterns and themes within the qualitative data that addressed the study questions. Results: According to rural general practitioners, major barriers to chronic disease and cardiometabolic risk care included geographic isolation, socioeconomic disadvantage and an obesogenic food environment in rural areas, as well as severe time and financial constraints for GPs and workforce shortages with a high turnover and lack of accessible allied health professionals. Facilitators included co-located multidisciplinary teams, case management/health coaching, better remuneration for complex consultations involving preventive care and upstream policy measures, such as improving healthy food affordability and availability. Conclusion: Rural patients face systemic, geographic and socioeconomic barriers that are substantially greater than those in urban settings; these barriers impact GPs caring for their patients with chronic disease and cardiometabolic risk factors. Targeted solutions to these barriers such as attention to workforce issues, investment in lifestyle coaching approaches and having dedicated case managers, could reduce rural–urban inequities in chronic disease outcomes. Full article

(This article belongs to the Section Chronic Care)

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12 pages, 262 KB

Open AccessArticle

Clinical Outcomes of Hearing Aid Use in Moderate to Severe Sensorineural Hearing Loss: A Cross-Sectional Study from Romania

by Liviu Lucian Padurean, Horatiu Eugen Ștefanescu, Calin Muntean, Vasile Gaborean and Ioana Delia Horhat

Healthcare 2026, 14(1), 112; https://doi.org/10.3390/healthcare14010112 - 2 Jan 2026

Viewed by 536

Abstract

Background/Objectives: This study aims to explore both the psychosocial outcomes of hearing aid use and the factors that differentiate users from non-users among older adults with sensorineural hearing loss (SNHL) in Romania. Methods: We conducted a cross-sectional, comparative study with follow-up, [...] Read more.

Background/Objectives: This study aims to explore both the psychosocial outcomes of hearing aid use and the factors that differentiate users from non-users among older adults with sensorineural hearing loss (SNHL) in Romania. Methods: We conducted a cross-sectional, comparative study with follow-up, including 201 patients aged between 49 and 92 years (mean age 70.76 ± 11.86 years), diagnosed with moderate to severe SNHL, evaluated between 1 November 2023, and 30 November 2024, at the Municipal Clinical Hospital Orăștie, Romania. Audiological assessment involved pure-tone audiometry and speech testing. Outcome measures included the Word Recognition Score (WRS), International Outcome Inventory for Hearing Aids (IOI-HA), Hearing Handicap Inventory for Adults (HHIA), Tinnitus Handicap Inventory (THI), and the Self-Esteem Scale (SES). Results: Of the 201 patients, 105 (52.2%) accepted hearing aid (HA) fitting and 96 (47.8%) declined. No significant differences were found in age (p = 0.565) or sex (p = 0.476) between groups. HA users reported significantly lower perceived handicap (HHIA: 46.48 ± 24.83 vs. 77.74 ± 28.02, p = 0.015) and higher self-esteem scores (SES: 35.68 ± 4.88 vs. 23.03 ± 4.90, p < 0.001), while tinnitus-related distress (THI) did not differ significantly (p = 0.785). Word recognition scores improved significantly post-fitting across all degrees of hearing loss: moderate (48.52% → 86.13%), moderately severe (47.47% → 85.31%), and severe (47.55% → 85.46%), all p < 0.001. Conclusions: Hearing aid use in older adults with SNHL was associated with significant improvements in speech perception and reduced perceived hearing handicap. These benefits were consistent across all severity levels and were independent of unilateral or bilateral device use. The difference in self-esteem observed between users and non-users may reflect pre-existing psychological factors influencing HA adoption, underlining the importance of personalized counseling in hearing rehabilitation. Full article

(This article belongs to the Special Issue Care and Treatment of Ear, Nose, and Throat)

14 pages, 1292 KB

Open AccessArticle

Neighborhood Deprivation Associated with Impaired Sit-to-Stand Performance in Middle-Aged and Older Adults: A Cross-Sectional Analysis with Clinical Implications

by Kenneth Harrison, Silvia Campos-Vargas, Brandon M. Peoples, Keven G. Santamaria-Guzman, David T. Redden, Michael A. Samaan and Jaimie A. Roper

Healthcare 2026, 14(1), 111; https://doi.org/10.3390/healthcare14010111 - 2 Jan 2026

Viewed by 407

Abstract

Background: Socioeconomic factors significantly influence health outcomes in older adults, yet their impact on specific aspects of mobility remains unclear. This study investigates the relationship between area-level socioeconomic disadvantage and mobility health in older adults. Methods: We conducted a cross-sectional study [...] Read more.

Background: Socioeconomic factors significantly influence health outcomes in older adults, yet their impact on specific aspects of mobility remains unclear. This study investigates the relationship between area-level socioeconomic disadvantage and mobility health in older adults. Methods: We conducted a cross-sectional study of 110 community-dwelling older adults recruited and collected using voluntary response sampling at eight health fairs across rural Southeast Alabama in 2022–2024 (60 ± 16 years, 80% female). Area-level socioeconomic status was measured using the Area Deprivation Index (ADI), a validated composite measure of neighborhood disadvantage. Mobility was assessed using the Instrumented Timed Up and Go (iTUG) test and the Instrumented Five Times Sit-to-Stand (i5TSTS) test. Kruskal–Wallis tests and general linear models in SAS 9.4 analyzed the relationship between ADI and mobility measures. Results: Higher ADI scores were significantly associated with poorer performance on the i5TSTS test (p = 0.0004). While overall iTUG duration did not differ significantly across ADI groups, the sit-to-stand phase of the iTUG showed a significant relationship with ADI (p = 0.0026). These associations remained significant after adjusting for age, weight, race, and education level. Conclusions: These findings suggest that neighborhood context plays a crucial role in mobility health, particularly in functions related to postural transitions. Clinicians should consider area-level disadvantage when screening for mobility limitations and may need to prioritize sit-to-stand interventions for patients living in high-deprivation areas. Full article

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17 pages, 288 KB

Open AccessArticle

Impact of a Playful Relaxation Intervention on Children’s Well-Being: A Mixed-Methods Study in Primary School in Portugal

by Sara Sarroeira, Beatriz Pereira, Guida Veiga, Wanderlei Abadio de Oliveira and José Eugenio Rodríguez-Fernández

Healthcare 2026, 14(1), 110; https://doi.org/10.3390/healthcare14010110 - 2 Jan 2026

Viewed by 577

Abstract

Background/Objectives: Considering that current research highlights the role of well-being and play in children’s development and learning, and that the few publications reflecting research into relaxation methods suggest that these create conditions for well-being, the main objective of this research was to [...] Read more.

Background/Objectives: Considering that current research highlights the role of well-being and play in children’s development and learning, and that the few publications reflecting research into relaxation methods suggest that these create conditions for well-being, the main objective of this research was to evaluate the effects of a playful intervention based on relaxation methods on the well-being of children in the first cycle of schooling. Methods: It is a mixed study, using quantitative and qualitative methods, with a quasi-experimental design, with an intervention group (a total of 24 sessions, based on Boski and Choque’s relaxation proposals for children) and a control group, with pre- and post-intervention assessment in both groups. Semi-structured interviews were conducted with teachers, and focus group techniques were used with children. Sixty-three children participated in this study, with an average age of 8.79 years (M = 8.79; SD = 0.676), 55.6% (35) of whom were female and 44.4% (28) male. Results: The results of the study indicate that the children developed passive limb relaxation and proprioceptive function, without altering their life satisfaction or aspects of emotional development. However, according to the children and teachers, the intervention developed positive emotions, bringing benefits to the classroom. Conclusions: This research contributes to the understanding of the effects, possibilities and potential of relaxation for children in school settings. Full article

15 pages, 1408 KB

Open AccessArticle

Medical Service Utilization for Carpal Tunnel Syndrome in Korea (2010–2017): A Retrospective, Cross-Sectional Study Using a Nationally Representative Sample from the HIRA-National Patient Sample Database

by Ji Won Kim, Soo Jin Kim, Ye-Seul Lee, Yoon Jae Lee, In-Hyuk Ha, Ju Yeon Kim and Doori Kim

Healthcare 2026, 14(1), 109; https://doi.org/10.3390/healthcare14010109 - 2 Jan 2026

Viewed by 404

Abstract

Background: Carpal tunnel syndrome (CTS) is a common peripheral neuropathy with increasing prevalence and economic burden. This study aimed to analyze recent trends in CTS treatment patterns, healthcare utilization, and costs within the dualized healthcare system in Korea, using nationwide claim data. [...] Read more.

Background: Carpal tunnel syndrome (CTS) is a common peripheral neuropathy with increasing prevalence and economic burden. This study aimed to analyze recent trends in CTS treatment patterns, healthcare utilization, and costs within the dualized healthcare system in Korea, using nationwide claim data. Methods: This cross-sectional study used data from the Korean Health Insurance Review and Assessment Service National Patient Sample (HIRA-NPS) between 2010 and 2017. Patients with a primary diagnosis of CTS (KCD-10: G56.0) were included. Descriptive analyses were performed to examine trends in patient characteristics, healthcare utilization, treatment patterns, and medical costs in Western and Korean medicine. Results: A total of 29,112 patients with CTS were analyzed. In Western medicine, diagnostic tests accounted for the highest expenditure, particularly X-ray, nerve conduction studies, and electromyography. Over time, X-ray utilization increased, while nerve conduction and electromyography tests decreased. The proportion of surgical treatment declined from 11.28% in 2010 to 8.55% in 2017, whereas Korean medicine use increased from 9.41% to 15.08%, mainly consisting of acupuncture and related procedures. Conclusions: Korea exhibited a lower CTS surgery rate than other countries, alongside a rising trend in Korean medicine utilization. These findings underscore the distinctive dual healthcare system in Korea and highlight the need for prospective studies to assess the long-term effectiveness of Korean medicine-based conservative treatments. Additionally, the results may inform national health policy decisions, including insurance coverage and resource allocation for CTS management. Full article

(This article belongs to the Collection Advances in Integrative Medicine: Complementary Approaches and Therapies in Global Healthcare)

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17 pages, 276 KB

Open AccessArticle

“Transforming Pain”: Evaluation of a Multicomponent Workshop for the Treatment of Chronic Pain—A Quasi-Experimental Design with Control Group

by María Victoria Ruiz-Romero, María Begoña Gómez-Hernández, Ana Porrúa-Del Saz, María Blanca Martínez-Monrobé, Natalia Gutiérrez-Fernández, Almudena Arroyo-Rodríguez, Rosa Anastasia Garrido-Alfaro, Ángela C. López-Tarrida, Néstor Canal-Diez, María Dolores Guerra-Martín and Consuelo Pereira-Delgado

Healthcare 2026, 14(1), 108; https://doi.org/10.3390/healthcare14010108 - 2 Jan 2026

Viewed by 536

Abstract

Background/Objectives: Between 20 and 30% of the global population experiences Chronic Pain (CP). A comprehensive, interdisciplinary approach incorporating non-pharmacological interventions and active patient participation is recommended. This study evaluated the short- and medium-term effectiveness of a multicomponent workshop compared with a control group. [...] Read more.

Background/Objectives: Between 20 and 30% of the global population experiences Chronic Pain (CP). A comprehensive, interdisciplinary approach incorporating non-pharmacological interventions and active patient participation is recommended. This study evaluated the short- and medium-term effectiveness of a multicomponent workshop compared with a control group. Methods: A detailed description of the workshop and a single-group before–after evaluation in 197 patients were recently published. The present study used a quasi-experimental before–after design with a three-month follow-up, comparing an intervention group (n = 64) with a contemporaneous control group that continued with usual care (n = 64). Validated scales were used to measure pain, well-being, quality of life (QoL), self-esteem, resilience, anxiety, and depression. Two ad hoc surveys assessed satisfaction and perceived impact on pain, medication use, habits, and mood. Results: A total of 128 patients participated (64 per group). The intervention group showed statistically significant improvements in all indicators at both short-term (end of workshop) and medium-term (three months) follow-up. Pain decreased by −1.3 (−3.0–0) [3 months: −1.0 (−3.0–−1.0)], anxiety by −3.0 (−5.0–−1.0) [3 months: −3.0 (−5.0–1.0)], and depression by −4.0 (−7.0–−2.0) [3 months: −3.0 (−6.0–0)]. Well-being increased by 3.0 (1.0–4.0) [3 months: 1.0 (0–4.0)]; QoL by 0.213 (0.072–0.388) [3 months: 0.185 (0.013–0.337)]; perceived health by 13.5 (0–30.0) [3 months: 10.0 (0–30.0)]; self-esteem by 4.5 (1.0–7.3) [3 months: 3.0 (−1.0–6.0)], and resilience by 1.0 (−1.0–5.0) [3 months: 1.0 (0.0–5.0)]. In the control group, resilience worsened (−1.0 [−5.0–1.0], p = 0.002) and depression increased (1.0 [−1.0–3.0], p = 0.037). Pain decreased in 47 participants (74.6%) at the end of the workshop [3 months: 34 (65.4%)]. Of 55 who used medication, 48 (81.4%) reduced their intake [3 months: 34; 68.0%]. Healthy habits improved in 58 (92.1%) [3 months: 40; 78.4%]. Mood improved: 26 (41.3%) described themselves as “cheerful” and 24 (38.1%) as “neutral” [3 months: 23; 44.2% and 14; 26.9%]. Overall satisfaction: 9.7 (scale 0–10). Conclusions: The workshop enabled patients to mitigate pain, actively participate in self-care, and improve quality of life, self-esteem, and emotional well-being. These effects persisted three months post-intervention. Full article

(This article belongs to the Special Issue Health, Social Problems and Well-Being of Patients with Chronic Diseases, Quality of Life, and the Need for Emotional and Social Support: Second Edition)

12 pages, 714 KB

Open AccessArticle

Psychometric Evaluation of the Arabic Version of the Swedish National Diabetes Registers Instrument for Patient-Reported Experience and Outcome Measures

by Nizar Alsubahi, Ahmed Alzahrani, Fahad Alhazmi, Roba Alhaifani and Mohannad Alkhateeb

Healthcare 2026, 14(1), 107; https://doi.org/10.3390/healthcare14010107 - 1 Jan 2026

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Abstract

Background: Healthcare quality is increasingly dependent on the patients’ perspective to ensure care aligns with patients’ needs and experiences, especially for those living with chronic conditions such as diabetes. The Swedish National Diabetes Register instrument (NDR) combines patient-reported experiences and outcomes to evaluate [...] Read more.

Background: Healthcare quality is increasingly dependent on the patients’ perspective to ensure care aligns with patients’ needs and experiences, especially for those living with chronic conditions such as diabetes. The Swedish National Diabetes Register instrument (NDR) combines patient-reported experiences and outcomes to evaluate patient-centered diabetes care, but it has not yet been accessible in Arabic. This study aimed to assess the validity and reliability of the Arabic version of the Swedish National Diabetes Register questionnaire among patients with diabetes. Methods: A cross-sectional study was carried out from July to August 2023 at 47 primary healthcare centers in Saudi Arabia, involving 594 adult patients with diabetes. Reliability was measured with Cronbach’s alpha and composite reliability. Construct validity was tested using confirmatory factor analysis, and discriminant validity was assessed through the Heterotrait–Monotrait Ratio. Data analysis was performed using SPSS (version 28) and the lavaan package in R (version 4.3.2). Results: The Arabic version showed high internal consistency, with Cronbach’s α ranging from 0.716 to 0.886 and CR between 0.663 and 0.855. It also exhibited good model fit indices, including χ²/df of 2.72, RMSEA of 0.054, SRMR of 0.073, and a CFI above 0.90. All item loadings were statistically significant (p < 0.01). The HTMT values were below 0.85, confirming adequate discriminant validity. Conclusions: The Arabic version of the NDR instrument is a valid and reliable tool for measuring patient-reported experiences and outcomes among Arabic-speaking patients with diabetes, which supports its application in diabetic care across the Arab region. Health policymakers in the region are recommended to incorporate this validated Arabic tool into their national diabetes initiatives. Full article

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Healthcare, Volume 14, Issue 1 (January-1 2026) – 136 articles

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