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Volume 14
Issue 12
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Healthcare, Volume 14, Issue 12 (June-2 2026) – 210 articles

Cover Story (view full-size image): As Parkinson’s disease becomes one of the fastest-growing neurological conditions, more men are stepping into caregiving roles long assumed by women, yet their experiences remain largely invisible in research. This qualitative study gives voice to seven male caregivers supporting loved ones with Parkinson’s. Researchers found that caregiving was shaped by financial stability, personal beliefs, and the ability to adapt to changing roles. Participants described internalized doubts about whether men are naturally suited to care, the strain of balancing work and costs, and the quiet grief of watching normalcy fade. Over time, many renegotiated their roles and sought information that felt both empowering and anxiety-provoking. These findings underscore the need to recognize male caregivers and provide support that reflects their realities. View this paper
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19 pages, 565 KB  
Article
Macro Responsibility in the Microvascular World: Nurse Experiences in Flap Care, a Phenomenological Study
by Dilay Hacıdursunoğlu Erbaş and Evin Korkmaz
Healthcare 2026, 14(12), 1808; https://doi.org/10.3390/healthcare14121808 - 22 Jun 2026
Viewed by 347
Abstract
Background/Objectives: Postoperative monitoring of microvascular free flaps is critical for early detection of vascular complications and flap survival. Nurses play a central role in this process; however, qualitative evidence on their experiences and challenges remains limited. This study explored nurses’ experiences in [...] Read more.
Background/Objectives: Postoperative monitoring of microvascular free flaps is critical for early detection of vascular complications and flap survival. Nurses play a central role in this process; however, qualitative evidence on their experiences and challenges remains limited. This study explored nurses’ experiences in free tissue flap care to identify clinical practices, challenges, and improvement needs. Methods: A phenomenological qualitative design was used. Data were collected through semi-structured interviews with nine nurses experienced in free tissue flap care, recruited via purposive and snowball sampling. Interviews were conducted online and lasted 30–45 min. Data were analyzed using content analysis with MAXQDA 2025. Inter-researcher reliability was 97%. Results: The findings were categorized into four main themes and seventeen subthemes: (1) clinical monitoring and evaluation in the care process, (2) challenges and difficulties, (3) emotional and professional reflections, and (4) suggestions for improving care. Nurses reported that flap care requires intensive monitoring, rapid decision-making, and close collaboration with physicians, especially within the first 24–48 h. Monitoring was largely based on observation and experience due to the lack of standardized protocols. Major challenges included high workload, frequent assessments, and donor site management. Emotional burden, stress, and responsibility were also prominent. Conclusions: Free flap care is a complex and demanding process for nurses. The lack of standardized monitoring tools and protocols is a key gap. Developing structured tools, improving training, and strengthening multidisciplinary collaboration may enhance patient safety and care quality. Full article
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21 pages, 840 KB  
Article
Agreement Between Standing Eight-Point Multifrequency Bioelectrical Impedance Analysis and Dual-Energy X-Ray Absorptiometry for Body Composition Assessment in Apparently Healthy Greek Adults
by Dimitrios Balampanos, Theodoros Stampoulis, Alexandra Avloniti, Anastasia Gkachtsou, Dimitrios Pantazis, Maria Protopapa, Nikolaos-Orestis Retzepis, Christos Kokkotis, Danai Kelaraki, Nikolaos Zaras, Dimitrios Ioannou, Stelios Kyriazidis, Maria Michalopoulou and Athanasios Chatzinikolaou
Healthcare 2026, 14(12), 1807; https://doi.org/10.3390/healthcare14121807 - 22 Jun 2026
Cited by 1 | Viewed by 410
Abstract
Background/Objectives: Multifrequency bioelectrical impedance analysis (MF-BIA) is increasingly used for practical body composition assessment when dual-energy X-ray absorptiometry (DXA) is unavailable or impractical. However, MF-BIA estimates are device-, population-, and outcome-specific, and therefore require validation against reference methods under standardized conditions. This study [...] Read more.
Background/Objectives: Multifrequency bioelectrical impedance analysis (MF-BIA) is increasingly used for practical body composition assessment when dual-energy X-ray absorptiometry (DXA) is unavailable or impractical. However, MF-BIA estimates are device-, population-, and outcome-specific, and therefore require validation against reference methods under standardized conditions. This study examined the agreement, concordance, and systematic bias between a standing 8-point MF-BIA device and DXA-derived body composition estimates in apparently healthy Greek adults. Methods: A total of 1250 adults aged 18 to 80 years completed same-day DXA and MF-BIA (Charder MA801) assessments. Fat mass (FM), fat-free mass (FFM), body fat percentage (BF%), and appendicular skeletal muscle mass estimate (ASM) were compared between methods. Analyses were performed by sex and BMI category. Pearson correlations described association, whereas Bland–Altman analysis, Lin’s concordance correlation coefficient (CCC), mean absolute error (MAE), root mean square error (RMSE), and proportional bias testing evaluated agreement and error magnitude. Results: MF-BIA showed strong associations with DXA-derived outcomes, but systematic bias was observed. When BMI categories were considered collectively, MF-BIA underestimated BF% by 3.59 percentage points in men and 4.25 percentage points in women, underestimated FM by 2.89 kg and 2.58 kg, and overestimated FFM by 3.09 kg and 3.29 kg, respectively. CCC was highest for FM (men: 0.913; women: 0.949) and lower for FFM and ASM in women (0.642 and 0.714, respectively). Proportional bias was observed for BF%, FM, and ASM in both sexes, and for FFM in women. Conclusions: The MA801 showed strong associations and outcome-specific concordance with DXA, but systematic bias and individual-level error limit interchangeability. Under standardized conditions, MF-BIA may support group-level or repeated same-device assessments but not precise individual-level assessment, clinical classification, or monitoring of small longitudinal changes. Full article
(This article belongs to the Special Issue Exercise Interventions and Testing for Effective Health Promotion)
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13 pages, 552 KB  
Article
‘It’s Not About the Food’—Understanding the Lived Experience of Patients Who Developed Hospital-Acquired Malnutrition (HAM) and That of Their Carers
by Michelle Palmer, Angela Vivanti, Breanne Hosking, Fiona Naumann, Sally Courtice, Amanda Henderson, Hazel Harden, Shoni Philpot, Anne Smyth and Lynda Ross
Healthcare 2026, 14(12), 1806; https://doi.org/10.3390/healthcare14121806 - 22 Jun 2026
Viewed by 421
Abstract
Background/Objectives: Given the limited evidence internationally, this qualitative study employed discovery interviews to explore the lived experience of patients who developed Hospital-Acquired Malnutrition (HAM) and that of their carers. Methods: Seven (two patients [(n = 1 female] and five carers [n [...] Read more.
Background/Objectives: Given the limited evidence internationally, this qualitative study employed discovery interviews to explore the lived experience of patients who developed Hospital-Acquired Malnutrition (HAM) and that of their carers. Methods: Seven (two patients [(n = 1 female] and five carers [n = 3 female]) completed discovery interviews with an experienced independent interviewer. Carers were either spouses or parents. Responses were thematically analyzed using a constant comparative approach. Results: A key theme was ‘It’s not about the food, it’s the hospital system’ with the needs of the system dominating, including when patients were feeling at their worst. Subthemes were ‘integration of care’ and ‘patient acuity’, including symptoms that impacted food intake. Another theme was ‘Who is looking out for the patient?’, exploring ‘reliance on carer advocacy’, and ‘variation in staff involvement’. One carer said, “… the girl that delivered the meal tray was the only one in our hospital stay who actually said to [the patient], ‘I’m so glad you’re sitting up. I was worried about you because you hadn’t eaten for so long?” A persistent but comparatively less strong theme was ‘When it is about the food’ which explored ‘the quality of the food’ and ‘receiving information on eating and drinking’. Conclusions: The three key themes identified from carers and patients were hospital system impacts, care co-ordination and, less strongly, experiences with food quality and information. The key opportunities to prevent, or better support the nutritional care of patients with, HAM may be through improving systems and care co-ordination. Full article
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22 pages, 538 KB  
Review
Unveiling the Humanizing and Therapeutic Values of Live Music in Healthcare Settings: A Scoping Review
by Conrado Carrascosa-Lopez, Miriam Serrano-Soliva, María De-Miguel-Molina, Blanca De-Miguel-Molina and Daniel Catala-Perez
Healthcare 2026, 14(12), 1805; https://doi.org/10.3390/healthcare14121805 - 22 Jun 2026
Viewed by 509
Abstract
Background: Live music, understood as real-time musical performance delivered in the physical presence of patients or other participants, is increasingly incorporated into healthcare settings as an arts-based, non-pharmacological practice intended to support well-being and humanize care. While previous reviews have examined a broad [...] Read more.
Background: Live music, understood as real-time musical performance delivered in the physical presence of patients or other participants, is increasingly incorporated into healthcare settings as an arts-based, non-pharmacological practice intended to support well-being and humanize care. While previous reviews have examined a broad range of music-based interventions in healthcare, limited attention has been given specifically to live music, its contextual characteristics, and the values attributed to its use within hospital environments. Objectives: This scoping review aims to map and synthesize the literature on live music in healthcare settings, focusing on clinical contexts, populations involved, and the therapeutic, psychosocial, and environmental values reported. Methods: A scoping review was conducted following the framework of Arksey and O’Malley. Searches were performed in Web of Science, Scopus and Pubmed using terms related to live music and healthcare settings. Studies published in English or Spanish over the past 20 years were considered. After screening titles, abstracts, and full texts, 81 studies met the inclusion criteria. Results: The studies covered diverse hospital units and patient groups, particularly oncology, neonatal and intensive care, palliative care, and haemodialysis. Reported outcomes were mainly psychological and emotional, including reductions in anxiety, stress, and distress, alongside improvements in mood, well-being, and quality of life. Cognitive, physiological, and environmental benefits were also identified, emphasizing the role of live music in creating supportive and humanized care environments. Most studies were conducted in Europe and North America. Conclusions: Live music is widely implemented in healthcare settings and is associated with benefits extending beyond symptom reduction to experiential and humanizing dimensions of care. This scoping review provides an overview of the existing evidence base and identifies directions for future research in arts and health. Full article
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28 pages, 1509 KB  
Review
Respiratory Rehabilitation and Decannulation in Adults with Prolonged Mechanical Ventilation After Tracheostomy: A Narrative Review
by Jun Zhang, Xi Zhao, Ming Fen Tao, Hong Mei Zeng, Li Ping Yuan, Emmanuel Mensah, Shuoshuo Wei, Lingling Pan and Lei Zha
Healthcare 2026, 14(12), 1804; https://doi.org/10.3390/healthcare14121804 - 22 Jun 2026
Viewed by 846
Abstract
Background: Patients with prolonged mechanical ventilation (PMV) frequently require tracheostomy due to failure to wean, yet the pathway from ventilator dependence to successful decannulation remains complex and poorly standardised. Comprehensive respiratory rehabilitation is recognised as a core strategy for improving decannulation outcomes, [...] Read more.
Background: Patients with prolonged mechanical ventilation (PMV) frequently require tracheostomy due to failure to wean, yet the pathway from ventilator dependence to successful decannulation remains complex and poorly standardised. Comprehensive respiratory rehabilitation is recognised as a core strategy for improving decannulation outcomes, but no unified, evidence-based guidelines currently exist for this population. This review addresses that gap by synthesising current evidence on respiratory rehabilitation and decannulation strategies for tracheostomized PMV patients. Methods: A narrative review was conducted through a systematic search of PubMed/MEDLINE covering publications indexed from May 2019 to February 2026, supplemented by targeted searches of Embase and the Cochrane Library. The search combined free-text keywords and Medical Subject Headings (MeSH) terms across eight search string combinations. Following title and abstract screening of 830 deduplicated records, 51 studies met eligibility criteria and were included in the final narrative synthesis. Results: Six core rehabilitation intervention domains were identified: respiratory muscle training, physical rehabilitation and nutritional optimisation, sedation and delirium management, speaking valve use, airway complication management, and ventilator mode optimisation. High-intensity inspiratory muscle training at no less than 50% of maximal inspiratory pressure is currently supported by the strongest available evidence among the interventions reviewed, although this threshold derives primarily from general ICU populations and has not been specifically validated in heterogeneous tracheostomized PMV cohorts. Decannulation readiness assessment may benefit from evaluating five core domains—neurological readiness, secretion management capacity (suctioning ≤ 4 times/24 h), cough efficacy (peak cough flow > 160 L/min), safe swallowing confirmed by instrumental assessment, and upper airway patency confirmed by fiberoptic bronchoscopy—using a structured multidisciplinary framework. Conclusions: Successful decannulation in tracheostomized PMV patients requires integration of evidence-based rehabilitation interventions, structured multidisciplinary assessment, and a patient-centred outcome framework that extends beyond physiological endpoints to encompass voice restoration, psychological well-being, and social reintegration. Significant evidence gaps remain—particularly for expiratory muscle training, population-specific decannulation protocols, and adapted rehabilitation models for resource-limited settings—representing priority areas for future research. Full article
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18 pages, 267 KB  
Article
Barriers and Facilitators of Exercise Participation Among Community-Dwelling Older Adults with Chronic Conditions: A Qualitative Study Using the COM-B Model and Theoretical Domains Framework
by Xiaoxiao Huang, Guochun Liu, Xiaoqian Xu, Xiaojing Li, Xiaofeng Yan, Wen Li, Huilin Shi, Xing Ming, Yuqing Xia, Shiqi Lu, Haolin Wei, Zhannuo Su, Shuqi Xin and Haobo Li
Healthcare 2026, 14(12), 1803; https://doi.org/10.3390/healthcare14121803 - 22 Jun 2026
Viewed by 484
Abstract
Background: In the context of population aging and the growing burden of chronic conditions, promoting exercise participation has become an important strategy for supporting healthy aging. However, older adults with chronic conditions often face multiple constraints related to symptom burden, risk perception, and [...] Read more.
Background: In the context of population aging and the growing burden of chronic conditions, promoting exercise participation has become an important strategy for supporting healthy aging. However, older adults with chronic conditions often face multiple constraints related to symptom burden, risk perception, and everyday life. A theory-informed understanding of the determinants of exercise participation in this population is therefore needed. Methods: This study adopted a theory-informed qualitative descriptive design and conducted face-to-face semi-structured interviews with 30 community-dwelling older adults with chronic conditions. Purposive sampling was used to ensure variation in age, sex, chronic condition type, and exercise participation. Data were analyzed using the framework method guided by the Theoretical Domains Framework (TDF), and the resulting themes were subsequently mapped onto the Capability, Opportunity, Motivation–Behavior (COM-B) model. Results: Participants were aged 60–86 years, and most were women, had low educational attainment, came from rural backgrounds, and lived with multimorbidity. Participants described exercise participation as a day-to-day process of negotiating symptoms, risk, functional boundaries, and everyday responsibilities rather than as a simple matter of willingness. Although most participants recognized the value of exercise, many lacked disease-specific knowledge about suitable exercise types, safe intensity, progression, and warning signs. Symptom burden and functional limitations constrained exercise, but many participants used symptom-based self-regulation strategies, such as resting, slowing down, or modifying activity when discomfort occurred. Family members, peers, health professionals, and community resources could either facilitate exercise or restrict it, depending on their accessibility, continuity, specificity, and practical relevance. Continued participation was closely linked to perceived benefits, controllable risk, self-efficacy, positive emotional experience, and immediate bodily feedback. Conclusions: Exercise promotion for older adults with chronic conditions should move beyond general advice and provide disease-adapted exercise education, symptom-based self-regulation strategies, family and peer support, professional guidance, age-friendly community resources, and feedback mechanisms that support long-term maintenance. Full article
(This article belongs to the Special Issue Barriers to Activity in Older Adults: Societal, Environmental, and Individual Factors)
18 pages, 630 KB  
Article
Determinants of Patients’ Intention to Use Remote Monitoring Service for Cardiac Implantable Electronic Devices: An Extended Technology Acceptance Model Study in Taiwan
by Teh-Kuang Sun and Shu-Hui Chuang
Healthcare 2026, 14(12), 1802; https://doi.org/10.3390/healthcare14121802 - 22 Jun 2026
Viewed by 292
Abstract
Background/Objectives: Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has been associated with potential clinical and economic benefits; however, its adoption among patients remains limited in some healthcare settings. This study examined patients’ intention to use RM services by applying an [...] Read more.
Background/Objectives: Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has been associated with potential clinical and economic benefits; however, its adoption among patients remains limited in some healthcare settings. This study examined patients’ intention to use RM services by applying an extended Technology Acceptance Model (TAM) that incorporates perceived effectiveness (PE), perceived barriers (PB), perceived threat (PT), and economic considerations, as well as the influence of socioeconomic factors. Methods: A cross-sectional survey was conducted among 104 patients with CIEDs in Taiwan using validated questionnaires. Structural equation modeling (SEM) was employed to examine the relationships among the proposed constructs. The association between intention to use and actual service utilization was explored. The correlations between sociodemographic factors and the constructs were analyzed using analysis of variance (ANOVA). Results: SEM showed that perceived effectiveness (PE), perceived usefulness (PU) and perceived ease of use (PEOU) were significantly associated with intention to use RM services, with economic considerations also having a significant contribution. Intention to use RM services further predicted actual adoption. However, PB and PT did not moderate these relationships. Sociodemographic factors influenced RM acceptance, with younger, more educated, employed, higher-income, and professionally employed patients reporting stronger perceptions and greater intention to use RM. Conclusions: This study reinforces the TAM framework in the context of health-related technology adoption. Overall, the adoption of RM services is complex and shaped by psychological, economic, and demographic factors, highlighting the need for user-friendly design, targeted education on clinical benefits, and flexible pricing and reimbursement strategies to improve equitable and sustained use. Full article
(This article belongs to the Section Digital Health Technologies)
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12 pages, 1148 KB  
Article
Exploring Healthcare Professionals’ Approaches to Promoting Physical Activity and Reducing Sedentary Behaviour in Clinical Paediatric Populations in South Wales
by Amie B. Richards, Rachel L. Knight, Kelly A. Mackintosh, Joanne Hudson, Sarah Denford and Melitta A. McNarry
Healthcare 2026, 14(12), 1801; https://doi.org/10.3390/healthcare14121801 - 22 Jun 2026
Viewed by 356
Abstract
Background/Objectives: Physical inactivity is a significant public health challenge among children and young people (CYP), particularly within clinical populations. Whilst healthcare professionals (HCPs) are uniquely positioned to implement behaviour change strategies, there is little evidence of implementation in practice. This study examined [...] Read more.
Background/Objectives: Physical inactivity is a significant public health challenge among children and young people (CYP), particularly within clinical populations. Whilst healthcare professionals (HCPs) are uniquely positioned to implement behaviour change strategies, there is little evidence of implementation in practice. This study examined the practices of, as well as barriers and facilitators experienced by, HCPs in South Wales, United Kingdom (UK), when promoting physical activity (PA) and reducing sedentary behaviour (SED) in clinical paediatric populations, together with their perceptions and proficiencies in delivering this support. Methods: A 32-item questionnaire was completed by 41 HCPs, recruited through professional and clinical networks to generate an opportunistic sample from physiotherapists (n = 22), doctors (n = 7), occupational therapists (n = 4), therapy technical instructors (n = 2), and others (n = 1 each). Quantitative responses were analysed using descriptive statistics; free-text responses underwent qualitative content analysis. Results: The findings revealed that 95% of HCPs discussed PA at some or all appointments, with similar figures reported for SED (90%) and exercise (88%). However, only 63% of participants felt PA was adequately addressed within their services. Barriers included time constraints, resource limitations, and knowledge gaps. Key facilitators included training, toolkit availability, and multidisciplinary collaboration. Conclusions: This study highlights the need for system-level changes to enable HCPs to deliver consistent, effective messaging that promotes PA and reduces SED, ultimately improving health outcomes for CYP receiving clinical input. Facilitating this approach requires embedding PA promotion into HCP training, expanding referral pathways to CYP, and strengthening multidisciplinary working. Full article
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16 pages, 287 KB  
Article
Patient Experience and Caregiver Involvement in COVID-19 Care Pathways: Revealing System Blind Spots Through a Life-Events Calendar Approach
by Romain Lutaud, Juliette Mirouse, Manon Borg, Lucie Cattaneo, Jean Constance, Christian Pradier, Sebastien Cortaredona, Irit Touitou, Patrick Peretti-Watel, Philippe Brouqui, Michel Carles and Stéphanie Gentile
Healthcare 2026, 14(12), 1800; https://doi.org/10.3390/healthcare14121800 - 22 Jun 2026
Viewed by 357
Abstract
Background/Objectives: Patient experience is increasingly recognised as a key dimension of healthcare quality, yet most tools fail to capture its temporal and processual nature, limiting its contribution to system improvement. This study aimed to demonstrate how a biographical approach to patient experience can [...] Read more.
Background/Objectives: Patient experience is increasingly recognised as a key dimension of healthcare quality, yet most tools fail to capture its temporal and processual nature, limiting its contribution to system improvement. This study aimed to demonstrate how a biographical approach to patient experience can generate actionable insights for improving care pathways. Specifically, we sought to: (i) identify and characterise distinct types of prehospital care pathways among patients hospitalised for COVID-19; (ii) identify patient-perceived significant events and safety issues; and (iii) generate structured variables to inform a subsequent quantitative phase. Methods: We conducted semi-structured biographical interviews with 31 patients hospitalised for COVID-19 in two French university hospitals. Data were collected using a life-events calendar (LEC), enabling day-by-day reconstruction of symptoms, healthcare contacts, and decision-making processes. Thematic analysis was performed with multidisciplinary triangulation. The qualitative phase identified three pathway types and the key mechanisms underlying each; these patterns were subsequently confirmed in a separate quantitative follow-up study (n = 312) using state sequence analysis. Results: Three distinct pathway types emerged: short (≤3 days), intermediate (4–9 days), and long (≥10 days). Delayed pathways were associated with repeated false-negative tests, underestimation of severity, and silent hypoxaemia. Across all pathways, patient experience suggested critical system-level failures, including diagnostic delays and inadequate escalation of care. Notably, in many cases, hospitalisation was triggered by a relative rather than a healthcare professional. These findings highlight the role of patient and social context as key components of care pathways. Conclusions: When captured longitudinally, patient experience may provide actionable insights into healthcare system functioning, suggesting structural mismatches between clinical trajectories and care responses. The life-events calendar method offers a replicable framework for transforming patient experience data into clinically and organisationally relevant knowledge. Integrating such approaches into healthcare evaluation could enhance patient safety, improve care coordination, and support more responsive care systems beyond COVID-19. Full article
(This article belongs to the Special Issue How Patient Experience Contributes to Improving Healthcare)
13 pages, 3926 KB  
Article
Structural Mapping of Disease-Level Community-Based Care Patterns in Rural Clinics on Remote Islands in Japan: A Questionnaire Survey
by Daisuke Matsubara and Kazuhiko Kotani
Healthcare 2026, 14(12), 1799; https://doi.org/10.3390/healthcare14121799 - 22 Jun 2026
Viewed by 292
Abstract
Background/Objectives: Remote islands in Japan constitute a unique medical environment in which physicians often manage a broad spectrum of clinical conditions. However, physicians practicing on remote islands have diverse medical backgrounds, and disease-level community-based care patterns in these settings have not been [...] Read more.
Background/Objectives: Remote islands in Japan constitute a unique medical environment in which physicians often manage a broad spectrum of clinical conditions. However, physicians practicing on remote islands have diverse medical backgrounds, and disease-level community-based care patterns in these settings have not been systematically described. This study aimed to characterize community-based care patterns across diseases in clinics on remote islands in Japan using an exploratory conceptual framework and to examine whether facility- and physician-related attributes were associated with these patterns. Methods: We conducted a questionnaire survey in February 2023 involving rural clinics on remote islands in Japan. For each disease, respondents reported community involvement at three clinical stages—initial consultation, follow-up, and completion of care—yielding eight possible care patterns (000–111). Primary community completeness was defined as the proportion of clinics reporting community-based involvement in initial consultation and completion of care (P111 + P101). Diseases were ranked according to this metric and stratified into three predefined conceptual zones (upper, middle, and lower). Subgroup analyses examined differences in primary community completeness according to facility- and physician-related attributes, including deployment duration, prior rural practice experience, career length, and specialty composition. Results: We analyzed data from 23 clinics covering 167 diseases. Diseases formed a continuous gradient ranging from community-completable to specialist-dependent conditions. Differences in community-based care patterns were most pronounced in the middle zone. Deployment duration was associated with directional differences in community-based care patterns, whereas specialty composition was associated with larger subgroup differences. In contrast, diseases in the lower zone demonstrated relatively stable specialist-dependent patterns regardless of facility- or physician-related attributes. Conclusions: This exploratory study proposed a conceptual framework for characterizing community-based care patterns across diseases in clinics on remote islands in Japan. The findings suggest that community-based care patterns on remote islands may reflect differences in disease-related care structures as well as contextual factors. The proposed framework may support future discussions regarding education, workforce planning, and healthcare systems in remote island settings in Japan. Full article
(This article belongs to the Special Issue Promoting Healthcare and Well-Being in Rural and Vulnerable Communities)
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16 pages, 627 KB  
Article
Home Environmental Factors and Functional Ability as Determinants of Falls Among Community-Dwelling Older Adults: Implications for Primary Health Care
by Fatemeh Mehravar, Maryam Chehregosha, Shannon Freeman, Haidar Nadrian, Courtney Genge, Farzaneh Barati, Hamideh Mancheri, Leila Jouybari, Azadeh Dehrooyeh, Hadi Savari, Mahdi Farzadmehr and Elham Lotfalinezhad
Healthcare 2026, 14(12), 1798; https://doi.org/10.3390/healthcare14121798 - 22 Jun 2026
Viewed by 501
Abstract
Background: Falls among older adults are a major public health concern associated with injury, disability, reduced mobility, and loss of independence. Functional impairment, chronic diseases, and unsafe home environments may increase the risk of falls. This study examined environmental, functional, and health-related [...] Read more.
Background: Falls among older adults are a major public health concern associated with injury, disability, reduced mobility, and loss of independence. Functional impairment, chronic diseases, and unsafe home environments may increase the risk of falls. This study examined environmental, functional, and health-related factors linked to falls among community-dwelling older adults in Iran. Methods: A comparative cross-sectional study was conducted among 329 community-dwelling older adults. Data were collected using standardized assessments of functional ability, home safety, health status, and fall history. Conventional regression and Elastic Net analyses were applied to identify significant predictors of falls. Results: Overall, 28.6% of participants reported at least one fall during the previous 12 months. Falls were significantly more common among females, adults aged ≥85 years, individuals without a spouse, and those with lower educational levels. Fallers showed poorer mobility, balance, and functional independence, greater fear of falling, and a higher risk of home accidents (all p < 0.001). Elastic Net analysis identified use of movement aids as the strongest risk factor, whereas better Performance-Oriented Mobility Assessment (POMA) scores were the main protective factor. Conclusions: Falls among community-dwelling older adults appear to result from the interaction of physical, medical, socioeconomic, and environmental factors. These findings highlight the need for multidimensional fall-prevention strategies in primary care settings. Full article
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17 pages, 1887 KB  
Article
Salivary RANKL/OPG and Periodontal Status Among Users of Heated Tobacco and Electronic Cigarettes Versus Non-Smokers: A Prospective Observational Study
by Alexandra Cornelia Teodorescu, Elena-Raluca Baciu, Irina-Georgeta Sufaru, Bogdan-Constantin Vasiliu, Alice Murariu and Sorina Mihaela Solomon
Healthcare 2026, 14(12), 1797; https://doi.org/10.3390/healthcare14121797 - 22 Jun 2026
Viewed by 419
Abstract
Background/Objectives: This prospective observational cohort study aimed to evaluate the influence of heated tobacco (HT) and electronic cigarettes (ECs) on bone remodeling markers such as receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG), and periodontal status, at baseline and at [...] Read more.
Background/Objectives: This prospective observational cohort study aimed to evaluate the influence of heated tobacco (HT) and electronic cigarettes (ECs) on bone remodeling markers such as receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG), and periodontal status, at baseline and at 3 months after initial periodontal therapy. Methods: The sample comprised 236 participants (130 women, 106 men; mean age 38.96 ± 7.69 years), distributed across non-smokers (n = 72), heated tobacco/HT product users (n = 83), and electronic cigarette/EC users (n = 81). For each patient, the periodontal charting included periodontal probing depth (PPD), bleeding on probing (BOP), and clinical attachment loss (CAL). Unstimulated saliva samples were analyzed for RANKL and OPG levels. All patients underwent nonsurgical periodontal therapy (scaling and root planing). Between-group comparisons were performed using the Kruskal–Wallis test followed by Bonferroni-adjusted pairwise comparisons, while within-group changes over time were assessed using the Wilcoxon signed-rank test. To complement the primary nonparametric analyses, two-way mixed-design ANOVA and ANCOVA models adjusted for baseline values and periodontitis stage were performed as sensitivity analyses. Statistical significance was set at p < 0.05. Results: At baseline, both product user groups exhibited significantly higher PPD (p = 0.005) and CAL (p = 0.001) compared with non-smokers, with no differences between HT and EC users. Salivary RANKL levels were significantly higher in HT and EC users than in non-smokers, and OPG levels did not differ significantly. Following non-surgical periodontal therapy, all parameters improved significantly across groups (p < 0.001). At the 3-month follow-up, both product user groups maintained higher PPD (p = 0.008), CAL (p = 0.001), and salivary RANKL levels, compared with non-smoking individuals (p < 0.001). The RANKL/OPG ratio remained significantly different only for EC users compared with non-smokers (p < 0.001). Conclusions: HT and EC use were associated with differences in periodontal parameters and higher RANKL levels, while differences in the RANKL/OPG ratio were observed in EC users compared with non-smokers. Non-surgical periodontal therapy improved clinical parameters and reduced the RANKL/OPG ratio, highlighting the importance of biofilm control. Full article
(This article belongs to the Special Issue Oral Healthcare: Diagnosis, Prevention and Treatment—2nd Edition)
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23 pages, 1200 KB  
Review
Evolution of Exercise Training in Patients with Pulmonary Hypertension—A Comprehensive Review
by Ioannis Beis, Konstantina Dipla, Afroditi Boutou, Athanasios Zacharias, Athanasia Pataka, Evdokia Sourla, Andreas Zafeiridis and Georgia Pitsiou
Healthcare 2026, 14(12), 1796; https://doi.org/10.3390/healthcare14121796 - 22 Jun 2026
Viewed by 639
Abstract
Pulmonary hypertension (PH) is a progressive, multifactorial syndrome characterized by elevated pulmonary arterial pressure and right heart dysfunction, associated with significant morbidity, impaired quality of life, and poor prognosis. Advances in classification, hemodynamic definitions, and targeted pharmacotherapies have improved understanding and management, yet [...] Read more.
Pulmonary hypertension (PH) is a progressive, multifactorial syndrome characterized by elevated pulmonary arterial pressure and right heart dysfunction, associated with significant morbidity, impaired quality of life, and poor prognosis. Advances in classification, hemodynamic definitions, and targeted pharmacotherapies have improved understanding and management, yet therapeutic challenges persist across the five World Health Organization groups of PH. Historically, exercise was discouraged due to concerns about adverse hemodynamic effects, but growing evidence has suggested that structured, supervised training is safe and beneficial. Randomized trials and meta-analyses show improvements in six-minute walk distance, peak oxygen uptake, right ventricular function, ventilatory efficiency, and health-related quality of life, with a low incidence of adverse events. Physiological adaptations include favorable cardiac remodeling, enhanced endothelial function, improved skeletal and respiratory muscle performance, and improved neurohormonal activity. Despite this evidence, barriers such as patient fears, limited clinical expertise, and restricted access to specialized rehabilitation programs hinder widespread implementation. Current guidelines recommend supervised exercise as part of pulmonary rehabilitation for patients with stable PH, supporting its role as an adjunct to pharmacotherapy. This descriptive review briefly summarizes the pathophysiology of PH, phenotype-related differences and current therapeutic approaches, and the beneficial adaptations to exercise training, with the aim of informing exercise specialists and supporting safer, more effective integration of exercise-based rehabilitation into patient care. Full article
(This article belongs to the Special Issue Psychophysiological Responses to Physical Activity, Exercise and/or Nutrition Interventions in Individuals with Cardiometabolic Health Impairments)
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14 pages, 403 KB  
Article
The Mediating Role of Rumination in the Relationship Between Mindful Awareness and Athlete Burnout
by Selin Biçer Baikoğlu, Suzan Dal, Sinan Avcı, Sevim Güllü, Meltem Özağır, Yunus Şahinler, Renas Zaman and Orkun Akkoç
Healthcare 2026, 14(12), 1795; https://doi.org/10.3390/healthcare14121795 - 22 Jun 2026
Cited by 1 | Viewed by 376
Abstract
Background/Objectives: This study aimed to examine whether rumination statistically accounts for the indirect association between mindfulness and burnout among athletes using a quantitative, cross-sectional, and non-interventional research design. Methods: The sample consisted of 484 licensed athletes (157 females, 32.4%; 327 males, 67.6%) actively [...] Read more.
Background/Objectives: This study aimed to examine whether rumination statistically accounts for the indirect association between mindfulness and burnout among athletes using a quantitative, cross-sectional, and non-interventional research design. Methods: The sample consisted of 484 licensed athletes (157 females, 32.4%; 327 males, 67.6%) actively involved in team sports, individual sports, and e-sports in Istanbul during the 2024–2025 period. Data were collected using the Athlete Mindfulness Questionnaire, the Sport Competition Rumination Scale, and the Athlete Burnout Questionnaire. Statistical analyses were conducted using IBM SPSS 25 and Hayes’ PROCESS Macro (Model 4), and mediation effects were tested using a bootstrap procedure with 5000 resamples and 95% confidence intervals. Results: The findings revealed significant relationships among mindfulness, rumination, and burnout. Mindfulness was positively associated with rumination, and rumination was significantly associated with athlete burnout. Furthermore, when rumination was included in the model, the direct relationship between mindfulness and burnout became non-significant. Given the cross-sectional nature of the study, the findings should be interpreted as relational rather than causal. Conclusions: In conclusion, the findings suggest that the relationship between mindfulness and burnout may be indirectly shaped through ruminative cognitive processes depending on contextual and cognitive-regulatory factors. The results further suggest that the associations between mindfulness, rumination, and burnout may vary according to competitive context and individual cognitive processing patterns. Full article
(This article belongs to the Collection Advances in Integrative Medicine: Complementary Approaches and Therapies in Global Healthcare)
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14 pages, 809 KB  
Article
Workplace Violence Exposure and Job Burnout Among Korean Paramedics: The Moderating Roles of Family, Coworker, and Organizational Support
by Nayoon Lee and Daye Lee
Healthcare 2026, 14(12), 1794; https://doi.org/10.3390/healthcare14121794 - 22 Jun 2026
Viewed by 357
Abstract
Background/Objectives: This study sought to investigate the relationship between workplace violence exposure and job burnout among Korean paramedics and the moderating roles of different sources of social support, including family, coworker, and organizational support, on this relationship. Methods: Participants were 175 [...] Read more.
Background/Objectives: This study sought to investigate the relationship between workplace violence exposure and job burnout among Korean paramedics and the moderating roles of different sources of social support, including family, coworker, and organizational support, on this relationship. Methods: Participants were 175 paramedics working in B city, South Korea. Data were collected through an online survey conducted from 15 July to 30 July 2025. Workplace violence exposure, family support, coworker support, organizational support, and job burnout were assessed using validated self-report questionnaires. Descriptive statistics, correlation analyses, and three-step hierarchical regression analyses were performed using the SPSS program. Results: Workplace violence exposure was positively associated with job burnout among paramedics. Among the three sources of social support, organizational support was associated with lower levels of job burnout. Family support moderated the association between workplace violence exposure and job burnout, whereas the moderating effects of coworker support and organizational support were not statistically significant. Conclusions: The findings suggest that organizational support and family-based support strategies may be important resources for addressing job burnout among paramedics exposed to workplace violence. These findings may contribute to a better understanding of support mechanisms associated with job burnout among paramedics and inform future intervention development and organizational support strategies. Full article
(This article belongs to the Special Issue Occupational Wellbeing and Burnout in Healthcare: Challenges, Prevention and Strategies)
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16 pages, 276 KB  
Article
Cross-Cultural Adaptation and Psychometric Testing of the Italian Barriers to Nursing Research Participation (I-BNPRQ)
by Mattia Bozzetti, Alessio Lo Cascio, Michela Colalelli, Piergiorgio Martella, Roberta Pendoni, Michela Piredda, Joseph Hagan, Monica Guberti and Daniele Napolitano
Healthcare 2026, 14(12), 1793; https://doi.org/10.3390/healthcare14121793 - 22 Jun 2026
Viewed by 446
Abstract
Background/Objectives: Nurses’ engagement in research is essential to strengthen evidence-based practice, knowledge translation, and quality of care. However, individual, organisational, and cultural barriers may limit nurses’ participation in research activities. This study aimed to cross-culturally adapt and psychometrically test the Italian version [...] Read more.
Background/Objectives: Nurses’ engagement in research is essential to strengthen evidence-based practice, knowledge translation, and quality of care. However, individual, organisational, and cultural barriers may limit nurses’ participation in research activities. This study aimed to cross-culturally adapt and psychometrically test the Italian version of the Barriers to Nurses’ Participation in Research Questionnaire within the Italian cultural and healthcare organisational context, and to explore perceived obstacles to research engagement among nurses in Italy. Methods: A cross-sectional methodological study was conducted. The instrument was translated, back-translated, reviewed by the original instrument developer and an expert panel, and evaluated for content validity by 12 clinical research professionals. Data were collected online between September and October 2024 from 196 nurses working across Italian healthcare settings, including hospitals, university hospitals, IRCCS, primary care, and private hospitals. Exploratory Structural Equation Modelling was used to examine the factor structure. Results: A total of 196 nurses were enrolled in the study. A two-factor structure was identified, comprising Research Resources and Personal Relevance of Research, which explained 35.37% and 25.14% of the variance, respectively. Both factors demonstrated good reliability. The most prominent barrier was the lack of incentive or reward for nurses to engage in research, whereas the least relevant barrier was the perception that research was not interesting or valuable. Greater barriers were reported by younger nurses, those with fewer years of experience, and those without specific research training. Lack of time to conduct research emerged as a pervasive obstacle across the sample. Conclusions: The Italian version of the Barriers to Nurses’ Participation in Research Questionnaire provides preliminary evidence of validity and reliability for assessing perceived barriers to research participation among Italian nurses. Owing to the structural modifications introduced during adaptation, the instrument should be interpreted as a culturally adapted and modified Italian version rather than as a direct replication of the original structure. Its use may support organisational diagnosis, research mentorship, training planning, and future research-capacity-building initiatives, although further validation in larger and more heterogeneous samples is warranted. Full article
(This article belongs to the Special Issue New Trends in Evidence-Based Practice in Health)
23 pages, 770 KB  
Article
Investigation of the Effectiveness of Mindfulness-Based Yoga Training in Individuals with Fibromyalgia: A Randomized Controlled Trial
by Ebru Durusoy, Abdülhakim İbrahim Ulusoy, Özge Önürmen Zeyrek, Sebahat Yaprak Çetin, Sevil Bilgin and Edibe Ünal
Healthcare 2026, 14(12), 1792; https://doi.org/10.3390/healthcare14121792 - 21 Jun 2026
Viewed by 639
Abstract
Background: Fibromyalgia is a chronic condition characterised by widespread pain, fatigue, sleep disturbances, and psychological symptoms. Mindfulness-based approaches are increasingly used as complementary interventions for symptom management. This study aimed to investigate the effectiveness of mindfulness-based yoga (MBY) delivered via telerehabilitation in individuals [...] Read more.
Background: Fibromyalgia is a chronic condition characterised by widespread pain, fatigue, sleep disturbances, and psychological symptoms. Mindfulness-based approaches are increasingly used as complementary interventions for symptom management. This study aimed to investigate the effectiveness of mindfulness-based yoga (MBY) delivered via telerehabilitation in individuals with fibromyalgia. Methods: This trial included 64 women with fibromyalgia who were randomly assigned to an 8-week mindfulness-based yoga program delivered via telerehabilitation or active control group including walking and physiotherapy modalities. Both groups received patient education at the outset. Assessments were conducted before and after the intervention. Outcome measures included fatigue, anxiety, depression, sleep quality, symptoms associated with central sensitization, kinesiophobia, pain intensity, mindfulness level, impact of fibromyalgia on life, biopsychosocial status, and pain catastrophising. Data were analyzed using mixed-design analysis of variance (ANOVA), with additional t-tests and analysis of covariance (ANCOVA) conducted for post hoc analyses. Results: Compared to the control group, the mindfulness-based yoga (MBY) group showed more pronounced improvements in terms of fatigue, anxiety, symptoms associated with central sensitization, biopsychosocial status, symptom severity, catastrophising about pain, ruminative thoughts about pain, and cognitive dimensions of pain. Although no significant differences were found between groups for other variables, intra-group improvements were observed in the MBY group. Conclusions: It was concluded that the MBY intervention administered via telerehabilitation is a viable complementary approach to traditional treatments in reducing the symptom burden of fibromyalgia. It was thought that the effectiveness of the research could be increased by conducting studies involving long-term follow-up assessments and investigating the integration of different mindfulness-based telerehabilitation interventions into the clinical setting. Full article
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25 pages, 2415 KB  
Review
Gestational Diabetes Mellitus Across the Perinatal Continuum: A Narrative Review of Woman-Centered, Holistic Care Models
by Eleftheria Lazarou, Dimitra Metallinou, Ourania Kolokotroni, Ekaterini Lambrinou, Panagiota Miltiadous, Georgios Papaetis, Andri Evripidou, Konstantinos Mikellidis, Charilaos Kontos, Spyridakis Chrysostomou, Michalis Chrysostomou, Charalambos Neocleous, Elli Parpa, Constantina Constantinou and Eleni Hadjigeorgiou
Healthcare 2026, 14(12), 1791; https://doi.org/10.3390/healthcare14121791 - 21 Jun 2026
Viewed by 781
Abstract
Gestational Diabetes Mellitus (GDM) represents a significant public health concern due to its association with adverse maternal and neonatal outcomes, as well as elevated long-term metabolic risks. Its prevalence varies substantially depending on the diagnostic criteria used and the population studied. Women with [...] Read more.
Gestational Diabetes Mellitus (GDM) represents a significant public health concern due to its association with adverse maternal and neonatal outcomes, as well as elevated long-term metabolic risks. Its prevalence varies substantially depending on the diagnostic criteria used and the population studied. Women with GDM frequently experience heightened stress, anxiety, and uncertainty, underscoring the need for accessible information, counseling, and ongoing support to navigate glucose monitoring, dietary adjustments, and treatment regimens. Although clinical management has been extensively studied, research has largely focused on metabolic monitoring and therapeutic interventions, often underemphasizing prevention strategies, women’s informational needs, and maternal psychological well-being. Emerging evidence and international guidelines increasingly advocate for integrating these components into structured, woman-centered GDM care plans that actively involve families. Such approaches empower women to engage in self-management, enhance health literacy, support adherence to lifestyle and pharmacological interventions, and promote sustainable behavioral changes. This narrative review presents a comprehensive, holistic model of care across the perinatal continuum, emphasizing early risk identification, preventive strategies, and multidisciplinary coordination. Core elements include individualized antenatal education, empathetic communication, and family engagement, fostering self-efficacy, continuity of care, and integration of medical, educational, and psychosocial interventions. Equipping healthcare professionals with the competencies to deliver this holistic, woman-centered framework is essential to optimize maternal and neonatal outcomes and mitigate the long-term health consequences of GDM. Full article
(This article belongs to the Special Issue Innovations in Maternal Healthcare: From Prenatal to Postpartum Interventions)
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20 pages, 569 KB  
Review
Hidden Communication Needs in Higher Education: A Scoping Review of Developmental Communication Disorders, Mental Health, and Academic Participation
by Xiaowen Qi and Yang Zhao
Healthcare 2026, 14(12), 1790; https://doi.org/10.3390/healthcare14121790 - 21 Jun 2026
Viewed by 526
Abstract
Background/Objectives: Higher education requires students to communicate in complex academic and social contexts, including oral presentations, group work, help-seeking, assessment, and peer interaction. For students with developmental communication disorders, and communication-related developmental profiles, these demands may create hidden participation vulnerabilities that affect mental [...] Read more.
Background/Objectives: Higher education requires students to communicate in complex academic and social contexts, including oral presentations, group work, help-seeking, assessment, and peer interaction. For students with developmental communication disorders, and communication-related developmental profiles, these demands may create hidden participation vulnerabilities that affect mental health, academic engagement, and belonging. This scoping review mapped empirical evidence among tertiary students, focusing on mental health, academic participation, social belonging, institutional support, and contextual influences. Methods: A scoping review was conducted in accordance with PRISMA-ScR guidance. Five databases, PubMed, PsycINFO, CINAHL, Scopus, and Web of Science, were searched for English-language, peer-reviewed empirical studies published from 2000 onwards. Eligible studies involved university, college, or tertiary students with developmental speech, language, fluency, pragmatic communication, or communication-related developmental profiles, who reported at least one mental health, academic, or social participation outcome. Data were charted and synthesised thematically, with methodological quality appraised using CASP-informed criteria. Results: Twenty-one studies were included. Evidence was strongest for stuttering and fluency-related participation, while research on developmental language disorder, speech sound disorder, pragmatic language impairment, cluttering, and mixed communication profiles was limited. Across studies, communication needs intersected with anxiety, depression, stress, self-efficacy, oral assessment, help-seeking, disclosure, stigma, accommodation access, and belonging. Key limitations included reliance on self-report, cross-sectional or retrospective designs, inconsistent diagnostic confirmation, and limited evidence for intervention. Conclusions: The available evidence suggests that developmental communication disorders and communication-related developmental profiles can function as hidden participation vulnerabilities in higher education. These vulnerabilities are shaped by students’ communication profiles and by communication-intensive university environments. Universities may therefore need communication-accessible teaching, flexible assessment, visible support pathways, and coordinated support across disability services, counselling, academic support, and speech–language pathology. Full article
(This article belongs to the Special Issue Speech and Language Disorders and Mental Health: Interdisciplinary Perspectives on Risk, Resilience, and Support)
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17 pages, 264 KB  
Article
Self-Compassion of Nurses Working in Pediatric Hospitals
by Dimitra Tsoutsoura, Ioannis Koutelekos, Afroditi Zartaloudi, Areti Stavropoulou and Maria Polikandrioti
Healthcare 2026, 14(12), 1789; https://doi.org/10.3390/healthcare14121789 - 21 Jun 2026
Viewed by 481
Abstract
Introduction: Compassion is defined as the emotional response that arises when an individual perceives another’s suffering and is motivated to alleviate it. Purpose: To explore levels of self-compassion among nurses working in pediatric hospitals and examine their associations with nurses’ characteristics. Materials and [...] Read more.
Introduction: Compassion is defined as the emotional response that arises when an individual perceives another’s suffering and is motivated to alleviate it. Purpose: To explore levels of self-compassion among nurses working in pediatric hospitals and examine their associations with nurses’ characteristics. Materials and Methods: This cross-sectional study included a convenience sample of 208 nurses from a public pediatric hospital. Data were collected through interviews using the Neff Self-Compassion Scale (SCS) which includes the following subscales: Self-Kindness, Common Humanity, Mindfulness, Self-Judgment, Isolation, and Over-Identification. The Greek-validated version of the instrument was used with acceptable internal consistency in the present sample (Cronbach’s alpha = 0.849). Data analysis included descriptive statistics and inferential tests (non-parametric comparisons and multiple linear regression), with statistical significance defined as p < 0.05. Results: The mean total Self-Compassion score was 83.24 ± 12.6 (range: 26–130). Regarding family-related factors, total Self-Compassion (p = 0.029), Common Humanity (p = 0.033), and Over-Identification (p = 0.041) were associated with the number of children. In relation to age, Self-Kindness (p = 0.033), Isolation (p = 0.005), and Over-Identification (p = 0.005) showed significant associations. Professional factors were also relevant, as Isolation was associated with total years of nursing experience (p = 0.032) and choice of nursing as a profession (p = 0.004), while Over-Identification was associated with years of experience in pediatric settings (p = 0.004) and choice of nursing as a profession (p = 0.049). Additionally, marital status was associated with Over-Identification (p = 0.045). Conclusions: Demographic and professional characteristics appear to influence the expression of Self-compassion. Healthcare organizations should implement targeted training programs to individualize professional development. Future research should explore work-related and personal factors influencing self-compassion to improve care quality and outcomes. Full article
(This article belongs to the Special Issue Psychosocial Aspects of Childhood and Adolescent Health)
18 pages, 639 KB  
Article
Effects of Nordic Walking on Prenatal Health: A Focus on Gait Kinematics, Musculoskeletal Pain, and Quality of Life—A Randomized Controlled Trial
by Nadia L. Radwan, Olfat Ibrahim Ali, Walaa E. Morsy, Marim Ali M. Slimani, Omkalthoom Sahagi, Sahar Mahmoud Hassan, Zizi M. Ibrahim and Wafaa Mahmoud Amin
Healthcare 2026, 14(12), 1788; https://doi.org/10.3390/healthcare14121788 - 21 Jun 2026
Viewed by 657
Abstract
Background/Objectives: Given the growing need for prenatal care, Nordic Walking (NW) is a promising intervention for maintaining maternal physical activity and quality of life (QoL). We aimed to investigate the influence of NW on gait kinematics, pelvic girdle pain, low back pain (LBP), [...] Read more.
Background/Objectives: Given the growing need for prenatal care, Nordic Walking (NW) is a promising intervention for maintaining maternal physical activity and quality of life (QoL). We aimed to investigate the influence of NW on gait kinematics, pelvic girdle pain, low back pain (LBP), and QoL during pregnancy. Methods: This is a single-blind randomized controlled trial. A total of 44 pregnant women aged 20 to 40 years with 13–28 weeks of gestation and mild to moderate musculoskeletal pain were included. Participants were randomly assigned to either the study (NW) group or the control group. The study group received the NW program for 12 weeks, three sessions per week, each lasting 45 min. The control group received standard prenatal care plus 30 min of moderate walking three days a week. The GAITRite system was used to measure gait kinematics, and the Visual Analog Scale (VAS) for pain and the SF-36 for QoL were administered at baseline, the fourth week, and the twelfth week. Results: NW significantly improved gait kinematics and reduced musculoskeletal pain (p < 0.001) with improvements in pain and gait speed exceeding the previous reported MCID thresholds. QoL improved across all SF-36 domains in the NW group (p < 0.001) compared with the control group, with large effect sizes observed for the primary outcomes. Conversely, the control group experienced declines in several QoL domains, including energy/fatigue and emotional well-being, despite moderate walking exercise and standard prenatal care over 12 weeks. Conclusions: NW may represent an effective prenatal exercise regimen associated with improved gait, reduced pain, and better overall QoL compared with moderate exercise, consistent with standard prenatal care. Full article
(This article belongs to the Special Issue Healthy Lifestyle for Pregnant and Postpartum Women)
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16 pages, 304 KB  
Article
Probable Post-Traumatic Stress Disorder and Associated Factors Among Children Exposed to the 2023 Al Haouz Earthquake in Morocco
by Meriyam Hannoun, El Mahjoub El Harsi, Abdelhafid Benkssim and Mohamed Cherkaoui
Healthcare 2026, 14(12), 1787; https://doi.org/10.3390/healthcare14121787 - 21 Jun 2026
Viewed by 435
Abstract
Background/Objectives: The Al Haouz earthquake that struck Morocco on 8 September 2023, resulted in substantial material, human, and psychological impacts. Children are at increased risk of psychological disorders, notably post-traumatic stress disorder (PTSD). This study aims to assess probable PTSD and its [...] Read more.
Background/Objectives: The Al Haouz earthquake that struck Morocco on 8 September 2023, resulted in substantial material, human, and psychological impacts. Children are at increased risk of psychological disorders, notably post-traumatic stress disorder (PTSD). This study aims to assess probable PTSD and its associated factors among children exposed to the Al Haouz earthquake. Methods: This cross-sectional study, conducted between December 2024 and January 2025, included 536 children from the affected areas. Probable PTSD was assessed using the 20 item Child and Adolescent Trauma Screen (CATS). Sociodemographic and exposure-related data, including post-earthquake conditions, were collected using a structured questionnaire. Data analysis was performed using SPSS software, version 25. Results: Analysis revealed that 47.6% of the children presented with probable PTSD. Multivariable analysis identified several factors independently associated with probable PTSD among children exposed to the earthquake, including age between 11 and 15 years (AOR = 2.02; p < 0.001), female gender (AOR = 1.82; p = 0.001), advanced level of education (AOR = 1.87; p = 0.006), housing damage (AOR = 2.08; p = 0.015), physical injury (AOR = 1.86; p = 0.012), proximity to the epicenter (AOR = 2.22; p = 0.006), temporary shelter in tents (AOR = 1.75; p = 0.02), difficulty of evacuation (OR = 1.97; p = 0.01), and loss of a family member (AOR = 1.98; p = 0.013). Conclusions: This study revealed a high frequency of probable PTSD in children exposed to the Al Haouz earthquake and identifies several associated factors, highlighting the need to targeted, multidimensional interventions. Full article
15 pages, 904 KB  
Article
Discharge Practices After Hospitalization for COPD Exacerbations: A Physician Survey and SWOT Analysis
by Sanja Dimic-Janjic, Mihailo Stjepanovic, Ivan Cekerevac, Sanja Hromis, Ivana Buha, Vojislav Cupurdija, Ivan Kopitovic, Rade Milic, Biljana Zvezdin, Ivana Stankovic, Jelena Jankovic, Nikola Trboljevac, Maja Omcikus, Lidija Isovic, Nikola Kostadinovic, Nikola Subotic and Marija Vukoja
Healthcare 2026, 14(12), 1786; https://doi.org/10.3390/healthcare14121786 - 20 Jun 2026
Viewed by 570
Abstract
Background/Objectives: Discharging patients after hospitalization for an acute exacerbation of chronic obstructive pulmonary disease (COPD) is a critical transition in care associated with a high risk of early readmission. This survey aimed to describe physician-reported discharge practices following COPD exacerbations, identify perceived gaps [...] Read more.
Background/Objectives: Discharging patients after hospitalization for an acute exacerbation of chronic obstructive pulmonary disease (COPD) is a critical transition in care associated with a high risk of early readmission. This survey aimed to describe physician-reported discharge practices following COPD exacerbations, identify perceived gaps and organizational barriers, explore attitudes toward structured COPD discharge summaries, and use a SWOT analysis as an interpretative framework. Methods: In this cross-sectional observational survey, 100 physicians involved in COPD care were recruited from the official mailing list of the Respiratory Society of Serbia, which represents approximately 71% of the Society’s members. The survey assessed discharge procedures, multidisciplinary practices, patient education, comorbidity management, perceived causes of readmission, and barriers to structured discharge summaries. Data were analyzed descriptively and complemented with a structured SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis. Results: Most respondents worked in tertiary care settings and were involved in managing patients hospitalized for COPD exacerbations. Although 24% of physicians routinely used structured discharge summaries, 45% reported never using them. The most frequently perceived contributors to 30-day readmissions were active smoking (90%), poor treatment adherence (81%), comorbidities (77%), and incorrect inhaler technique (72%). Major barriers to implementing structured discharge summaries included the lack of standardized templates, time constraints, poor coordination across healthcare levels, and technical limitations. Willingness to implement structured discharge tools was high (mean score 8.86/10). SWOT analysis identified strong professional support for discharge standardization alongside organizational and system-level barriers to implementation. Conclusions: This exploratory survey identified important gaps between recommended and routine COPD discharge practices and highlighted organizational barriers to implementation. The findings may inform future evaluation and development of structured discharge tools in this healthcare setting. Full article
(This article belongs to the Special Issue Health Care Professionals' Role in Developing Quality and Patient Safety)
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26 pages, 1339 KB  
Article
Data-Informed and Accessibility-Oriented Motion Graphics for Depression-Related Health Communication in Aging Populations
by Cong Mo, Khachakrit Liamthaisong and Jantima Polpinij
Healthcare 2026, 14(12), 1785; https://doi.org/10.3390/healthcare14121785 - 20 Jun 2026
Viewed by 416
Abstract
Background/Objectives: Short-form motion graphics are increasingly used in digital health communication. However, limited research has examined their accessibility, interaction quality, and usability for older adults. This study explores the design and evaluation of short-form motion graphics as human–computer interaction systems for depression-related [...] Read more.
Background/Objectives: Short-form motion graphics are increasingly used in digital health communication. However, limited research has examined their accessibility, interaction quality, and usability for older adults. This study explores the design and evaluation of short-form motion graphics as human–computer interaction systems for depression-related health communication in aging populations. Methods: A data-informed and human-centered approach was adopted, integrating clustering-based analysis, expert evaluation, and user-based assessment. Short-form motion graphics videos and user-generated comments were analyzed to identify design-related themes associated with accessible digital health communication. These insights informed the development of motion graphics prototypes. The evaluation involved independent expert groups and 200 older adult participants. Cognitive load and usability were assessed using a structured questionnaire. Results: The clustering analysis showed moderate cluster separation and provided an exploratory source of design insights. Expert evaluation highlighted the importance of visual clarity, structured content organization, and appropriate motion pacing. User evaluation yielded a mean usability score of 3.95 and a mean cognitive load score of 3.72, indicating generally positive perceptions of the developed motion graphics among participants. Conclusions: The findings suggest that combining data-informed analysis, expert review, and user evaluation may be useful for designing and assessing digital health communication systems for older adults. As this study was exploratory and did not include a control group, the findings should be interpreted within the context of the study and should not be considered evidence of causal relationships. Full article
(This article belongs to the Topic Communications Challenges in Health and Well-Being, 2nd Edition)
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18 pages, 574 KB  
Article
Patients’ Perspective of Medication Safety in a Structurally Burdened Healthcare System: A Netnography-Based Qualitative Analysis
by Barbara Báldy, Zoltán Cserháti and Judit Lám
Healthcare 2026, 14(12), 1784; https://doi.org/10.3390/healthcare14121784 - 20 Jun 2026
Viewed by 416
Abstract
Background/Objectives: Medication-related harm is a leading global patient safety challenge, yet patients’ lived experiences of medication safety remain underexplored in Central and Eastern European healthcare systems, where structural constraints significantly shape everyday medication use. Methods: This study provides an in-depth qualitative [...] Read more.
Background/Objectives: Medication-related harm is a leading global patient safety challenge, yet patients’ lived experiences of medication safety remain underexplored in Central and Eastern European healthcare systems, where structural constraints significantly shape everyday medication use. Methods: This study provides an in-depth qualitative analysis of Hungarian patients’ online narratives, building on a prior netnographic mixed-methods study. Using grounded theory-informed principles and a patient-centred medication safety framework, we inductively analysed 5174 publicly accessible Hungarian-language comments posted on health forums and social media platforms between August 2020 and August 2023. The COM-B model was applied as a secondary lens to map findings onto modifiable behavioural determinants. Results: Access to services and communication emerged as the dominant medication safety concerns. Patients reported long waiting times, limited rural emergency services, and brief consultations leading to delayed or inadequate treatment. Communication gaps included insufficient information on medication duration, side effects, and follow-up, as well as conflicting advice from multiple sources, all of which eroded trust and prompted treatment discontinuation or reliance on informal online communities. Community pharmacists were largely absent from patients’ mental models of care, representing a significant missed opportunity given their accessibility. Less frequently mentioned were medication shortages, healthcare professional workload, and systemic safety culture. Conclusions: Clear, respectful communication and timely access to care are central to medication safety from the patient perspective. Netnography combined with a grounded theory-informed methodology offers a valuable approach for capturing authentic patient perspectives in structurally burdened healthcare systems, with findings relevant beyond the Hungarian context. Full article
(This article belongs to the Section Healthcare Quality, Patient Safety, and Self-care Management)
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17 pages, 998 KB  
Article
The Mediation Role of Relatedness and Competence for Patient Activation: A Longitudinal Study of Older Adults with Chronic Illness
by Monica Kaltenbrunner, Maria Flink, Amanda Hellström and Mirjam Ekstedt
Healthcare 2026, 14(12), 1783; https://doi.org/10.3390/healthcare14121783 - 20 Jun 2026
Viewed by 458
Abstract
Background: Patient activation is associated with both health outcomes and the utilization of healthcare resources. Since various factors influence activation levels among older ill adults, further exploration of this topic is needed. Specifically, we aim to examine the extent to which changes [...] Read more.
Background: Patient activation is associated with both health outcomes and the utilization of healthcare resources. Since various factors influence activation levels among older ill adults, further exploration of this topic is needed. Specifically, we aim to examine the extent to which changes over time in self-rated symptoms of depression are associated with changes in patient activation and to what extent self-rated health status and satisfaction of basic psychological needs (autonomy, relatedness, and competence) have a mediation effect. Methods: A longitudinal and correlational design was employed in which two hundred and seven participants with heart failure or chronic obstructive pulmonary disease were recruited from two hospitals in the middle of Sweden. The sample used in this study is the same as that used in a randomized controlled trial. A questionnaire was administered at baseline, and at 30-, 90-, and 180 days post-discharge, involving ratings of depression, patient activation, self-rated health, and satisfaction of basic psychological needs (autonomy, relatedness, and competence). As the results from the original study showed no difference between the two randomized groups in patient activation, the analysis in this study was conducted using a combined sample in which the intervention and control groups were merged. For estimation of the direct effects and the components of indirect effects, we employed multilevel modeling using a linear mixed model, and to test mediation, the stand-alone program RMediation was used. Results: Over time, increases in depressive symptoms were associated with reduced patient activation, with this relationship mediated by declines in relatedness and competence. No evidence was found showing that autonomy or self-rated health had a mediation effect. Conclusions: The results indicate that older chronically ill individuals may benefit from interventions targeting psychological mediators to improve and sustain activation. Full article
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11 pages, 382 KB  
Article
Core High-Risk Foot Profiles and Surgery-Coded Care-Intensity Indicators Among Hajj Pilgrims Presenting with Foot and Ankle Conditions: A Presentation-Level Analysis
by Mohammed F. AlGabgab, Naif Alqurashi, Majed Alqahtani, Moharmis M. Alolyani and Osama A. Samarkandi
Healthcare 2026, 14(12), 1782; https://doi.org/10.3390/healthcare14121782 - 20 Jun 2026
Cited by 1 | Viewed by 516
Abstract
Background/Objectives: Foot and ankle presentations during Hajj occur in a dense mass-gathering environment where prolonged walking, heat exposure, crowding, variable footwear, and limited self-care can interact with chronic disease and wound vulnerability. Previous Hajj studies have described foot injuries and diabetes-related complications, but [...] Read more.
Background/Objectives: Foot and ankle presentations during Hajj occur in a dense mass-gathering environment where prolonged walking, heat exposure, crowding, variable footwear, and limited self-care can interact with chronic disease and wound vulnerability. Previous Hajj studies have described foot injuries and diabetes-related complications, but less is known about whether simple high-risk foot documentation flags identify presentation records with higher care-pathway intensity. The primary objective was to estimate the presentation-level burden of core high-risk foot profiles among pilgrims presenting with foot and ankle conditions during Hajj 2025. Secondary objectives were to evaluate associations with a surgery-coded care-intensity indicator, hospital referral, and component heterogeneity. Methods: This observational presentation-level analysis included 3957 foot and ankle presentation records. The unit of analysis was the presentation/case record, not a unique individual pilgrim. A core high-risk foot profile was defined as diabetes, neuropathy, diabetic foot ulcer, foot ulcer, complications of open wound, or osteomyelitis. The primary outcome was a surgery-coded care-intensity indicator, defined solely from treatment documentation containing “Surgery” and interpreted as a care-pathway proxy rather than confirmed operating-room surgery. Logistic regression estimated crude and adjusted odds ratios (ORs); exploratory risk-category analyses assessed heterogeneity within the composite profile. Results: Core high-risk foot profiles were identified in 1793/3957 presentations (45.3%). The primary outcome occurred in 239/1793 high-risk presentations (13.3%) and 201/2164 non-high-risk presentations (9.3%), an absolute difference of 4.0 percentage points. The crude OR was 1.50 (95% CI 1.23–1.83; p < 0.001). The association persisted in the primary adjusted model (adjusted OR 1.47; 95% CI 1.20–1.79; p < 0.001) and in the extended clinical sensitivity model (adjusted OR 1.47; 95% CI 1.20–1.80; p < 0.001). Care pathways and secondary outcomes are summarized was also more frequent in high-risk presentations (12.2% vs. 9.8%; crude OR 1.28; 95% CI 1.05–1.57; p = 0.017). Exploratory category analysis showed that chronic-risk-only presentations had a primary outcome rate similar to non-high-risk presentations (9.0% vs. 9.3%), whereas ulcer/wound/deep-infection presentations had a higher rate (17.3%; crude OR 2.04; 95% CI 1.63–2.55; p < 0.001). Model discrimination was modest (C-statistics 0.55–0.64). Conclusions: Core high-risk foot flags were common among Hajj foot and ankle presentation records and were associated with surgery-coded care-intensity and referral documentation. However, the composite was clinically heterogeneous, the outcome was not a validated surgery endpoint, and the models were not prediction tools. These findings support cautious use of high-risk foot flags as operational prompts for assessment and pathway planning rather than as standalone clinical risk estimates. Full article
(This article belongs to the Special Issue Association Between Physical Activity and Chronic Condition)
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12 pages, 1134 KB  
Article
A Multilevel Analysis of HIV Care Outcomes Across Age, Race, and Housing Among United States Women Veterans
by Giselle Day, Amber B. Amspoker, Alan Z. Sheinfil, Liang Chen, Emmanuel Guajardo, Maria E. Fernandez, Cici Bauer, Irene Tamí-Maury and Jan Lindsay
Healthcare 2026, 14(12), 1781; https://doi.org/10.3390/healthcare14121781 - 20 Jun 2026
Viewed by 397
Abstract
Background: Women veterans with HIV represent a growing, diverse population within the Veterans Health Administration (VHA). This study examined HIV care continuum outcomes among women veterans using a multilevel intersectional approach. Methods: We conducted a retrospective analysis of 1154 women veterans with HIV [...] Read more.
Background: Women veterans with HIV represent a growing, diverse population within the Veterans Health Administration (VHA). This study examined HIV care continuum outcomes among women veterans using a multilevel intersectional approach. Methods: We conducted a retrospective analysis of 1154 women veterans with HIV in VHA care in fiscal year 2022, with outcomes assessed in fiscal year 2023. We applied Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to evaluate how combinations of social positions (age, race/ethnicity, housing status) were associated with HIV outcomes. Results: MAIHDA models showed that younger age (<45 years) and being unhoused were consistently associated with lower odds of care engagement and viral suppression than midlife (45–64) and older (65+) housed women veterans. Additionally, predicted probability analyses revealed distinct clustering patterns. Younger non-Hispanic White women consistently ranked among the lowest performing strata across all outcomes, while midlife and older Hispanic and non-Hispanic Black women veterans clustered among the highest. Variance Partition Coefficients from null models were modest (1.8–3.0%). Fully adjusted models showed no remaining between-stratum variance, suggesting that the included social positions explained the observed differences in our dataset. Conclusions: These findings highlight disparities in HIV care engagement concentrated among specific groups and reinforce the importance of addressing individual- and system-level barriers to engagement and continuity of care among women Veterans in VHA care. Full article
(This article belongs to the Section Chronic Care)
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22 pages, 3603 KB  
Article
Financial Relief and Health Effects of Urban–Rural Health Insurance Integration on Older Rural Adults: A Causal Analysis of Age-Based Heterogeneity
by Sirui Li, Xiangdong Liu, Xi Wang and Shufang Zhao
Healthcare 2026, 14(12), 1780; https://doi.org/10.3390/healthcare14121780 - 19 Jun 2026
Cited by 1 | Viewed by 700
Abstract
Objective: To evaluate the impact of urban–rural health insurance integration on the health outcomes and financial burden of rural older adults. Methods: Utilizing panel data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2013 to 2018, we employed a staggered difference-in-differences [...] Read more.
Objective: To evaluate the impact of urban–rural health insurance integration on the health outcomes and financial burden of rural older adults. Methods: Utilizing panel data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2013 to 2018, we employed a staggered difference-in-differences model coupled with propensity score matching (PSM-DID) for rigorous causal identification. Results: The policy significantly reduced out-of-pocket medical expenditures for rural households by approximately 5.6% (p = 0.034). Concurrently, significant improvements were observed in both physical health (a 0.092-point reduction in ADL impairment scores) and mental health (a 0.725-point reduction in CES-D depression scores). Mechanism analyses revealed that the integration did not significantly increase the probability of outpatient or inpatient visits—thereby ruling out supplier-induced demand and moral hazard—while effectively reducing the incidence of catastrophic health expenditure by 1.9% (p = 0.004). Heterogeneity analyses indicated that while the financial relief was universally distributed across varying educational levels, the policy dividends were predominantly captured by the younger-old demographic. Notably, the reduction in financial burden was not statistically significant for the oldest-old cohort (aged 75 and older). Conclusions: The urban–rural health insurance integration has achieved a dual dividend of financial protection and health enhancement without triggering the overutilization of medical services. Nevertheless, the unmet care expenses for older adults with severe disabilities underscore the urgent necessity for a secondary safety net, such as long-term care insurance. Full article
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27 pages, 942 KB  
Article
The Role of Advanced Practice Nurses in the Care of Multimorbid and Complex Chronically Ill Young and Middle-Aged Adults in Hospital Settings—Perspectives on Experience of APNs: A Qualitative Study
by Gabriele Bales, Birgit Schönfelder, Reto W. Kressig and Hanna Mayer
Healthcare 2026, 14(12), 1779; https://doi.org/10.3390/healthcare14121779 - 19 Jun 2026
Viewed by 589
Abstract
Background/Objectives: The rising prevalence of multimorbid and complex chronically ill young and middle-aged adults necessitates the implementation of innovative care models and the creation of roles that can meet the complex healthcare needs of this patient group. Advanced Practice Nurses (APNs) can play [...] Read more.
Background/Objectives: The rising prevalence of multimorbid and complex chronically ill young and middle-aged adults necessitates the implementation of innovative care models and the creation of roles that can meet the complex healthcare needs of this patient group. Advanced Practice Nurses (APNs) can play a crucial role in the care of multimorbid and complex chronically ill young and middle-aged adults in APN-led clinics; however, in Switzerland, these roles are still evolving. The aim of this study was to explore APNs’ perspectives on the planned development of their roles in an APN-led clinic. Methods: To gain insights into the experiences of APNs in caring for this patient group, a qualitative study design was chosen. Data were collected through interviews with APNs from Switzerland, the USA, and Canada. In total, 19 APNs (12 from Switzerland and 7 from the United States and Canada) participated in the study. The data were collected through semi-structured online interviews. These data were analyzed using reflective thematic analysis in accordance with the approach presented by Braun and Clarke. Results: The analysis identified 10 themes that describe the competencies, components, and framework conditions required for the work of APNs in an APN-led clinic for multimorbid and complex chronically ill young and middle-aged adults within the Swiss clinical context. Required competencies include direct clinical practice, guidance and coaching, collaboration, and psychosocial support. Essential components include person-centered care, transitional care, and continuity of care. Key framework conditions include regulations of the legal and regulatory framework and eligibility for reimbursement of services, resources, and extended competencies and scope of practice. Conclusions: The perspectives of the APNs involved in this study show that multimorbid and complexly chronically ill young and middle-aged adults require complex and long-term care that extends beyond the hospital setting. The findings of this study show that Swiss APNs may be well positioned to contribute to this role. Full article
(This article belongs to the Topic Advances in Chronic Disease Management)
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