Healthcare

12 pages, 778 KB

Open AccessArticle

A Structural Equation Modeling Approach to the Moderating Effect of Psychological Well-Being on Burnout and Depressive Symptoms Among Mental Health Professionals

by Fatih Bal, Hale A. Kahyaoğlu Çakmakci, İpek Okkay, Gülşen Filazoğlu Çokluk and Melek Süler

Healthcare 2026, 14(2), 284; https://doi.org/10.3390/healthcare14020284 - 22 Jan 2026

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Abstract

Background/Objectives: This study investigates whether psychological well-being moderates the relationship between burnout and depressive symptoms among mental health professionals, who are frequently exposed to high emotional labor. Methods: A sample of 607 professionals—including psychologists, guidance counselors, social workers, and psychiatrists—working in public and [...] Read more.

Background/Objectives: This study investigates whether psychological well-being moderates the relationship between burnout and depressive symptoms among mental health professionals, who are frequently exposed to high emotional labor. Methods: A sample of 607 professionals—including psychologists, guidance counselors, social workers, and psychiatrists—working in public and private institutions in Turkey participated in the study. Data were collected online using the Maslach Burnout Inventory, the Psychological Well-Being Scale, and the Beck Depression Inventory–II. A latent interaction term between burnout and psychological well-being was tested using Structural Equation Modeling (SEM). Results: Burnout was positively associated with depressive symptoms (β = 0.37, p < 0.001), and psychological well-being showed a significant main effect on depressive symptoms (β = 0.26, p < 0.001). Importantly, the interaction between burnout and psychological well-being was significant (β = 0.20, p < 0.001), indicating that psychological well-being significantly moderates the relationship between burnout and depressive symptoms. Specifically, the positive interaction suggests that the association between burnout and depressive symptoms becomes stronger at higher levels of psychological well-being. The model explained 27% of the variance in depressive symptoms. Conclusions: These findings highlight the protective role of psychological well-being and suggest that interventions aimed at enhancing well-being may help reduce depressive symptoms among mental health professionals in high-stress environments. Full article

(This article belongs to the Special Issue Psychological Well-Being and Coping in Healthcare Workplace Environments)

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27 pages, 624 KB

Open AccessReview

Nutrition in Perinatal Midwifery Care: A Narrative Review of RCTs, Current Practices, and Future Directions

by Artemisia Kokkinari, Maria Dagla, Kleanthi Gourounti, Evangelia Antoniou, Nikoleta Tsinisizeli, Evangelos Tzamakos and Georgios Iatrakis

Healthcare 2026, 14(2), 283; https://doi.org/10.3390/healthcare14020283 - 22 Jan 2026

Viewed by 224

Abstract

Background: Nutrition during the perinatal period, including pregnancy, childbirth, postpartum, and lactation, is a critical determinant of maternal and neonatal health. While the importance of balanced nutrition is well established, the integration of nutritional counseling into midwifery care remains inconsistent across settings. Evidence [...] Read more.

Background: Nutrition during the perinatal period, including pregnancy, childbirth, postpartum, and lactation, is a critical determinant of maternal and neonatal health. While the importance of balanced nutrition is well established, the integration of nutritional counseling into midwifery care remains inconsistent across settings. Evidence suggests that midwives are uniquely positioned to deliver nutrition-related support, yet gaps persist in their formal training and in the availability of structured guidance. These gaps are particularly evident in certain regions, such as Greece, where dedicated national guidelines for perinatal nutrition are lacking. Methods: This systematized narrative review synthesises evidence from studies published between 2010 and 2025, retrieved through PubMed, CINAHL, Scopus, and relevant national guidelines. Although the synthesis draws on diverse study designs to provide contextual depth, randomized controlled trials (RCTs) were prioritized and synthesized separately to evaluate the effectiveness of midwife-led interventions. In total, ten randomized controlled trials were included in the evidence synthesis, alongside additional observational and qualitative studies that informed the narrative analysis. Both international and Greek literature were examined to capture current practices, challenges, and knowledge gaps in the nutritional dimension of midwifery care. Results: Findings indicate that adequate intake of macronutrients and micronutrients, including iron, folic acid, vitamin D, iodine, calcium, and omega-3 fatty acids, is essential for optimal maternal and neonatal outcomes. Despite this, studies consistently report insufficient nutritional knowledge among midwives, limited confidence in providing counseling, and variability in clinical practice. Socio-cultural factors, such as dietary traditions and migration-related challenges, further influence nutritional behaviors and access to guidance. Emerging approaches, including e-health tools, group counseling models, and continuity-of-care frameworks, show promise in enhancing midwives’ capacity to integrate nutrition into perinatal care. Conclusion: Nutrition is a cornerstone of perinatal health, and midwives are strategically placed to address it. However, gaps in training, inconsistent guidelines, and cultural barriers limit the effectiveness of current practices. Strengthening midwifery education in nutrition, developing context-specific tools, and fostering interdisciplinary collaboration are essential steps toward more comprehensive and culturally sensitive perinatal care. Future research should focus on longitudinal and intervention studies that assess the impact of midwife-led nutritional counseling on maternal and neonatal outcomes. Full article

(This article belongs to the Section Healthcare and Sustainability)

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25 pages, 681 KB

Open AccessSystematic Review

A Systematic Review of Topic Modeling Techniques for Electronic Health Records

by Iqra Mehmood, Zoya Zahra, Sarah Iqbal, Ayman Qahmash and Ijaz Hussain

Healthcare 2026, 14(2), 282; https://doi.org/10.3390/healthcare14020282 - 22 Jan 2026

Viewed by 266

Abstract

Background: Electronic Health Records (EHRs) are a rich source of clinical information used for patient monitoring, disease progression analysis, and treatment outcome assessment. However, their large-scale, heterogeneity, and temporal characteristics make them difficult to analyze. Topic modeling has emerged as an effective [...] Read more.

Background: Electronic Health Records (EHRs) are a rich source of clinical information used for patient monitoring, disease progression analysis, and treatment outcome assessment. However, their large-scale, heterogeneity, and temporal characteristics make them difficult to analyze. Topic modeling has emerged as an effective method to extract latent structures, detect disease characteristics, and trace patient trajectories in EHRs. Recent neural and transformer-based approaches such as BERTopic has significantly improved coherence, scalability, and domain adaptability compared to earlier probabilistic models. Methods: This Systematic Literature Review (SLR) examines topic modeling and its variants applied to EHR data over the past decade. We follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework to identify, screen, and select relevant studies. The reviewed techniques span traditional probabilistic models, neural embedding-based methods, and temporal extensions designed for pathway and sequence modeling in clinical data. Results: The synthesis covers trends in publication patterns, dataset usage, application domains, and methodological contributions. The reviewed literature demonstrates strengths across different modeling families, while also highlighting challenges related to scalability, interpretability, temporal complexity, and privacy when analyzing large-scale EHRs. Conclusions: Topic modeling continues to play a central role in understanding temporal patterns and latent structures in EHRs. This review also outlines future possibilities for integrating topic modeling with Agentic AI and large language models to enhance clinical decision-making. Overall, this SLR provides researchers and practitioners with a consolidated foundation on temporal topic modeling in EHRs and its potential to advance data-driven healthcare. Full article

(This article belongs to the Special Issue AI-Driven Healthcare Insights)

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11 pages, 562 KB

Open AccessArticle

Symptomatic Outcomes After Autologous Fat Grafting in Irradiated Postmastectomy Chest Wall

by Razvan George Bogdan, Mara Nicolau, Alina Helgiu and Zorin Petrisor Crainiceanu

Healthcare 2026, 14(2), 281; https://doi.org/10.3390/healthcare14020281 - 22 Jan 2026

Viewed by 144

Abstract

Background/Objectives: Radiotherapy of the chest wall after mastectomy frequently leads to fibrosis, reduced tissue elasticity, erythema, pain and chronic skin-related symptoms that complicate reconstructive strategies. Autologous fat grafting has been proposed as a regenerative option for radiation induced soft tissue damage, but clinical [...] Read more.

Background/Objectives: Radiotherapy of the chest wall after mastectomy frequently leads to fibrosis, reduced tissue elasticity, erythema, pain and chronic skin-related symptoms that complicate reconstructive strategies. Autologous fat grafting has been proposed as a regenerative option for radiation induced soft tissue damage, but clinical data focused on patient-reported symptoms remain limited. The objective of this study was to describe symptomatic and clinical changes after autologous fat grafting in irradiated postmastectomy chest wall tissue. Methods: This pilot observational study included five female patients with a history of mastectomy followed by adjuvant chest wall radiotherapy. All patients underwent a single session of standard autologous fat grafting without adipose derived stem cell enrichment. Patient-reported symptoms, including pruritus, local discomfort, burning sensation and erythema, were recorded preoperatively and at six months using a standardized 0 to 5 scale. Scar pliability was assessed by two experienced physicians using the same scale. Only descriptive statistical analysis was performed. Results: All patients demonstrated lower postoperative symptom scores at six months. Mean reductions were observed for erythema (71.4 percent), burning sensation (61.1 percent) and pruritus (57.1 percent). Local discomfort decreased by 33.3 percent. Mean scar pliability scores increased from 2.2 to 3.2. No postoperative complications, such as infection, fat necrosis or oil cyst formation, were recorded. All patients completed the six month follow up. Conclusions: In this small pilot observational study, autologous fat grafting was well tolerated and associated with descriptive improvement of patient-reported symptoms and scar pliability in irradiated postmastectomy chest wall tissue. These findings suggest a potential symptomatic benefit of fat grafting, while larger studies with objective imaging and histological correlation are required to confirm efficacy and durability. Full article

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16 pages, 861 KB

Open AccessReview

Mirror Neurons and Pain: A Scoping Review of Experimental, Social, and Clinical Evidence

by Marco Cascella, Pierluigi Manchiaro, Franco Marinangeli, Cecilia Di Fabio, Giacomo Sollecchia, Alessandro Vittori and Valentina Cerrone

Healthcare 2026, 14(2), 280; https://doi.org/10.3390/healthcare14020280 - 22 Jan 2026

Viewed by 279

Abstract

Background: The mirror neuron system (MNS) has been proposed as a key neural mechanism linking action perception, motor representation, and social cognition. This framework has increasingly been applied to pain research, encompassing pain empathy, observational learning of pain, and rehabilitative interventions such as [...] Read more.

Background: The mirror neuron system (MNS) has been proposed as a key neural mechanism linking action perception, motor representation, and social cognition. This framework has increasingly been applied to pain research, encompassing pain empathy, observational learning of pain, and rehabilitative interventions such as mirror therapy. However, the literature is conceptually heterogeneous, methodologically diverse, and spans experimental, social, and clinical domains. Objective: This scoping review aims to map the extent, nature, and characteristics of the available evidence on the relationship between the MNS and pain, clarifying how MNS-related mechanisms are defined, investigated, and applied across different contexts. Methods: A scoping review was conducted using the methodological framework proposed by the Joanna Briggs Institute and reported in accordance with PRISMA-ScR guidelines. We searched PubMed/MEDLINE, Scopus, Web of Science, and PsycINFO. Studies were included if they addressed MNS-related mechanisms in pain processing, pain empathy, pain modulation, or pain rehabilitation. Eligible studies were charted and synthesized descriptively and thematically. Results: Twenty-one studies met the inclusion criteria. The evidence was predominantly derived from clinical and rehabilitative settings, with most studies focusing on mirror therapy or mirror visual feedback interventions. The majority of included populations consisting of adults with chronic pain conditions, particularly phantom limb pain and complex regional pain syndrome. Pain intensity, assessed mainly through self-reported clinical scales, was the most frequently reported outcome. A smaller number of studies investigated action observation or motor imagery paradigms, primarily in chronic musculoskeletal pain, showing short-term hypoalgesic effects. Across studies, substantial heterogeneity was observed in the conceptualization of MNS-related constructs, intervention protocols, outcome measures, and follow-up duration. Conclusions: Despite extensive theoretical discussion of the MNS, empirical applications are largely confined to clinical mirror-based interventions, with limited use of direct neurophysiological or neuroimaging markers. Since crucial conceptual and methodological gaps constrain comparability and translation into clinical practice, there is a need for clearer operational definitions and more integrated experimental and clinical research approaches. Full article

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

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16 pages, 367 KB

Open AccessArticle

COVID-19’s Impact on Health Professionals’ Quality of Professional Life: A Single-Site Cross-Sectional Study

by Michael Rovithis, Sofia Koukouli, Anastasia Konstantinou, Maria Moudatsou, Nikos Rikos, Manolis Linardakis, Konstantinos Piliotis and Areti Stavropoulou

Healthcare 2026, 14(2), 279; https://doi.org/10.3390/healthcare14020279 - 22 Jan 2026

Viewed by 305

Abstract

Background/Objectives: Professional quality of life influences patient care, staff well-being, and organizational efficacy. The COVID-19 pandemic placed pressure on healthcare professionals, disrupting their professional quality of life and imposing a psychological burden. In Greece, these issues were intensified by a decade of economic [...] Read more.

Background/Objectives: Professional quality of life influences patient care, staff well-being, and organizational efficacy. The COVID-19 pandemic placed pressure on healthcare professionals, disrupting their professional quality of life and imposing a psychological burden. In Greece, these issues were intensified by a decade of economic crisis, marked by constrained healthcare budget, personnel shortages, and insufficient resources. This study investigates the pandemic’s impact on the professional quality of life of Greek healthcare professionals to support targeted interventions. Methods: A cross-sectional study was conducted using descriptive statistics. The participants were a convenience sample of 246 healthcare professionals from a Greek regional university hospital with at least one year of experience and who had worked with COVID-19-positive or potentially exposed but asymptomatic patients. Data were collected between March and June 2021 using the Professional Quality of Life Scale (version 5). Results: Of the 246 participants, 81.3% were women and 33.8% were aged 50 or older. Moderate concern and fear regarding COVID-19 were reported, with 34.6% extremely afraid of transmitting the virus to family or friends and 22.8% to patients or their families. Overall professional quality of life was moderate: compassion satisfaction was moderate to high, while burnout and secondary traumatic stress were moderate to low. Higher compassion satisfaction was linked to holding a position of responsibility. Burnout was associated with having children, permanent employment, years of experience, and increased pandemic-related fear. Higher secondary traumatic stress was associated with older age, more years of experience, and greater pandemic-related fear. Conclusions: These findings support international research and highlight that the moderate levels observed indicate intrinsic motivation based on professionalism in patient care, providing evidence of resilience and coping mechanisms that reduce psychological consequences on well-being due to the pandemic. 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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15 pages, 506 KB

Open AccessArticle

Legislative Debate-Attributed Suicidality Among LGBTQ+ Adults: The Buffering Effect of Community Belongingness

by Keith J. Watts, Shawndaya S. Thrasher, Laneshia R. Conner, Nicole Campbell, Louis G. Baser, DeKeitra Griffin, Sydney P. Howard, Missy Spears and Justin X. Moore

Healthcare 2026, 14(2), 278; https://doi.org/10.3390/healthcare14020278 - 22 Jan 2026

Viewed by 162

Abstract

Background: In recent years, the sociopolitical landscape in the United States has shifted due to an increase in state-level legislation regarding LGBTQ+ rights, a trend that has been particularly pronounced in the Commonwealth of Kentucky. While the mental health impacts of enacted laws [...] Read more.

Background: In recent years, the sociopolitical landscape in the United States has shifted due to an increase in state-level legislation regarding LGBTQ+ rights, a trend that has been particularly pronounced in the Commonwealth of Kentucky. While the mental health impacts of enacted laws are increasingly documented, a critical gap remains in understanding the psychological toll of the legislative debates themselves—the prolonged periods of public discourse surrounding the restriction of rights. Methods: Utilizing data from the 2025 Queer Kentucky Survey (N = 817), this exploratory study examined the association between LGBTQ+ community belongingness and acute suicidality attributed specifically to anti-LGBTQ+ legislative debates. Data were derived from a non-probability snowball sample. Binary logistic regression models that adjusted for age, race, gender identity, education, and income were utilized. Results: Prevalence of debate-attributed suicidality was alarmingly high: 59.7% of the sample attributed increased suicidal thoughts, and 44.1% attributed a suicide attempt, specifically to the legislative debates. LGBTQ+ belongingness was a robust protective correlate, associated with significantly lower odds of both suicidal thoughts (OR = 0.61, p < 0.001) and attempts (OR = 0.41, p < 0.001). Analyses further revealed divergent risk for suicidality across demographic characteristics. Conclusions: Findings are consistent with the interpretation that legislative debates may function as distinct structural stressors associated with suicidal thoughts and suicide attempts. While community belongingness may offer a critical buffer, the elevated risks among Transgender and Black, Indigenous, and People of Color (BIPOC) populations highlight the need for intersectional, structural interventions beyond individual resilience. Full article

(This article belongs to the Special Issue Gender, Sexuality and Mental Health)

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19 pages, 1191 KB

Open AccessReview

Effects of Social Support Interventions on Medical Patient Survival: A Meta-Analysis of Non-Randomized Clinical Trials

by Ksenia Illinykh-Bair and Timothy B. Smith

Healthcare 2026, 14(2), 277; https://doi.org/10.3390/healthcare14020277 - 21 Jan 2026

Viewed by 199

Abstract

Background: Prior research confirms that social support promotes resilience among medical patients with chronic illness. Beyond emotional benefits, research has increasingly shown the importance of social support on physical health outcomes. Therefore, identifying and evaluating interventions that increase social support among medical [...] Read more.

Background: Prior research confirms that social support promotes resilience among medical patients with chronic illness. Beyond emotional benefits, research has increasingly shown the importance of social support on physical health outcomes. Therefore, identifying and evaluating interventions that increase social support among medical patients with chronic conditions is a priority for healthcare. Methods: This meta-analysis summarized data from 39,493 medical patients across 14 non-randomized trials that had been identified by a prior review of the survival benefits of social support interventions. Results: Across four studies reporting hazard ratio data, the results failed to reach statistical significance (HR = 2.10, 95% CI = 0.99 to 4.48, p = 0.0546), and the results of ten studies reporting odds ratio data were of smaller magnitude (OR = 1.27, 95% CI [0.72, 2.23], p > 0.05). Heterogeneity characterized both the odds ratio data (I² = 53%; Q = 18.1, p = 0.03) and hazard ratio data (I² = 89%, Q = 23, p < 0.001). A notable finding was that studies with longer periods of data collection showed longer survival among medical patients receiving social support. Conclusions: Long-term observations may be necessary for the survival benefits of social support interventions to become apparent. Further research with a larger pool of data from long-term follow-up studies will be needed to establish firm conclusions. Full article

(This article belongs to the Section Chronic Care)

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16 pages, 226 KB

Open AccessArticle

“The Window of Opportunity”: A Qualitative Exploration of Individual Reminiscence in Care Home Settings

by Aoife Conway, Rosemary Bradley, Assumpta Ryan, Claire McCauley, Brighide Lynch, Deirdre Harkin and Sarah Penney

Healthcare 2026, 14(2), 276; https://doi.org/10.3390/healthcare14020276 - 21 Jan 2026

Viewed by 194

Abstract

Background: Care homes are complex care environments where supporting residents’ identity, wellbeing, and sense of personhood is central to person-centred care. Reminiscence is widely recognised as a psychosocial approach that can support these outcomes. However, existing evidence has largely focused on group-based interventions, [...] Read more.

Background: Care homes are complex care environments where supporting residents’ identity, wellbeing, and sense of personhood is central to person-centred care. Reminiscence is widely recognised as a psychosocial approach that can support these outcomes. However, existing evidence has largely focused on group-based interventions, with comparatively limited attention given to how individual reminiscence is implemented and sustained within care home practice. Methods: This study was an implementation-focused qualitative exploration of staff experiences of introducing and embedding individualised reminiscence in care home practice. Care home staff participated in four monthly workshops that introduced principles of individualised reminiscence and supported them to plan and implement reminiscence with at least one resident. Participants used either the InspireD digital reminiscence app (n = 19) or non-digital approaches such as life story books (n = 2), depending on local preferences and perceived suitability. Three focus groups were conducted with 21 care home staff to explore experiences of implementing individualised reminiscence and perceptions of its impact on residents, staff, and families. Data were analysed using reflexive thematic analysis. Results: Four interrelated themes were identified: (1) reminiscence within pressured systems; (2) resident experience and identity; (3) adapting and sustaining practice; and (4) families as partners in reminiscence. Participants described challenges associated with workload pressures, role expectations, and variability in family involvement, which influenced how reminiscence was adopted in practice. Despite these constraints, participants described perceived benefits for residents, including perceived improvements in mood, engagement, and expressions of identity. Participants also discussed perceived increased staff confidence, strengthened staff–resident relationships, and enhanced awareness of person-centred care practices. Conclusions: Findings highlight the perceived potential of individualised reminiscence to support person-centred and relational care in care homes, while identifying key contextual influences on implementation. Further research is needed to examine sustainability and effectiveness using comparative and mixed-method designs. Full article

(This article belongs to the Special Issue Novel Research and Care Strategies for Older Adults with Stroke and/or Dementia)

13 pages, 234 KB

Open AccessArticle

Exploring the Illness Experience of Patients with Central Nervous System Hemangioblastomas in Von Hippel–Lindau Disease: A Qualitative Study

by Mei-Fang Chuang, Pi-Hua Huang, Jing-Shan Huang and Chii Jeng

Healthcare 2026, 14(2), 275; https://doi.org/10.3390/healthcare14020275 - 21 Jan 2026

Viewed by 185

Abstract

Background/Objectives: Von Hippel–Lindau (VHL) disease is a rare autosomal dominant hereditary disorder. Central nervous system hemangioblastomas are one of the most common tumor types associated with VHL disease. Although these tumors are histologically benign, delayed diagnosis and treatment may result in severe neurological [...] Read more.

Background/Objectives: Von Hippel–Lindau (VHL) disease is a rare autosomal dominant hereditary disorder. Central nervous system hemangioblastomas are one of the most common tumor types associated with VHL disease. Although these tumors are histologically benign, delayed diagnosis and treatment may result in severe neurological dysfunction, permanent disability, and even death. However, little is known about the experiences of patients with VHL disease. The aim of this study was to gain a better understanding of the illness experiences and psychological responses of patients with VHL disease accompanied by central nervous system hemangioblastomas. Methods: A qualitative study based on a semi-structured guide was conducted. Twelve participants were recruited. Data were collected through face-to-face interviews and analyzed using the constant comparative method. Results: Four themes and their subthemes were identified: 1. powerlessness—unpredictable disease progression and uncontrollable continuity; 2. negative emotional experiences—guilt and self-blame, depression, and low self-esteem; 3. compromise—acceptance of fate, positive outlook, and sense of hope; and 4. persistent worry—worries about family members, anxiety regarding finances and employment, and uncertainty regarding the future. Conclusions: This study identified four major themes in the illness experiences of patients with VHL disease accompanied by central nervous system hemangioblastomas, which provided deep insights into the care needs of individuals with VHL disease. Healthcare providers should develop effective measures to enhance patients’ ability to maintain a good quality of life and confront the future with resilience. Full article

32 pages, 448 KB

Open AccessReview

Innovative Assistive Technologies for Tetraplegia: A Narrative Review of Systematic and Emerging Evidence

by Lorenzo Desideri, Regina Gregori Grgič, Antonia Pirrera and Daniele Giansanti

Healthcare 2026, 14(2), 274; https://doi.org/10.3390/healthcare14020274 - 21 Jan 2026

Viewed by 287

Abstract

Background: Assistive technologies (ATs) for individuals with tetraplegia have evolved from mechanical aids to complex neurotechnological, digital, and psychosocial systems. However, the evidence base remains fragmented, with heterogeneous methodologies and limited integration across domains. This review synthesizes recent review-level evidence to clarify current [...] Read more.

Background: Assistive technologies (ATs) for individuals with tetraplegia have evolved from mechanical aids to complex neurotechnological, digital, and psychosocial systems. However, the evidence base remains fragmented, with heterogeneous methodologies and limited integration across domains. This review synthesizes recent review-level evidence to clarify current trends, gaps, and directions in ATs for tetraplegia. Methods: A narrative review of reviews was conducted following the ANDJ checklist. PubMed and Scopus were searched for systematic, scoping, and narrative reviews addressing assistive technologies relevant to tetraplegia. After screening, de-duplication, and quality appraisal, 20 reviews were included and synthesized narratively. Results: The included reviews clustered into four main domains: neural and regenerative interfaces, motor and biomechanical assistive systems, digital and adaptive rehabilitation ecosystems, and psychosocial and integrative frameworks. Across domains, evidence highlights a shift toward personalized, adaptive, and interoperable systems, supported by neurotechnologies, robotics, mobile health, and virtual reality. Common limitations include heterogeneous outcome measures, scarcity of longitudinal evidence, limited system interoperability, and persistent inequities in access and adoption. Emerging applications of artificial intelligence support adaptive control, monitoring, and personalization, though robust clinical validation remains limited. Conclusions: This synthesis provides a structured overview of review-level evidence on assistive technologies for tetraplegia. The findings underscore the need for coordinated, multidisciplinary approaches and more rigorous, longitudinal evaluation to support the development of inclusive, human-centered, and interoperable assistive ecosystems. Full article

(This article belongs to the Special Issue Assistive Technologies, Robotics, and Automated Machines in the Health Domain: Third Edition)

15 pages, 821 KB

Open AccessArticle

Attitudes of Healthcare Service Users in Bulgaria Towards the Application of Teleophthalmology in the Case of Glaucoma

by Stanka Uzunova, Rumyana Stoyanova, Marin Atanassov and Kristina Kilova

Healthcare 2026, 14(2), 273; https://doi.org/10.3390/healthcare14020273 - 21 Jan 2026

Viewed by 177

Abstract

Objectives: The purpose of the current research is to examine and analyze the attitudes of healthcare service users towards the integration of remote medical services into ophthalmology in Bulgaria, including teleglaucoma. Methods: A cross-sectional survey study was conducted among 902 healthcare [...] Read more.

Objectives: The purpose of the current research is to examine and analyze the attitudes of healthcare service users towards the integration of remote medical services into ophthalmology in Bulgaria, including teleglaucoma. Methods: A cross-sectional survey study was conducted among 902 healthcare users during the period from May 2023 until December 2024. Descriptive statistics, parametric, and non-parametric tests for hypothesis testing were used. Results: The present study outlined predominantly positive attitudes towards the use of telemedicine services in ophthalmology, with 69.6% of respondents reporting a positive overall opinion in the final assessment. The greatest support was observed during remote consultations with a familiar doctor (77.4%) and during continuous follow-up of eye conditions (55.2%). Willingness to use such services was lower in emergencies or when contacting an unfamiliar specialist. A significant correlation was established between socio-demographic characteristics and attitudes—respondents with greater education levels (p = 0.006), men, and younger participants were more positive towards telemedicine (p < 0.05). The high level of awareness about glaucoma, particularly among those with university-level education, served as a positive prerequisite for the implementation of teleophthalmology services related to its monitoring. Mobile applications and digital solutions were evaluated as beneficial means of facilitating communication and increasing adherence to treatment. Regarding the use of artificial intelligence, certain skepticism and insufficient awareness levels were observed, which required additional efforts to increase trust and digital literacy among users. Conclusions: The implementation of telemedicine services into ophthalmology has potential but outlines the necessity of considering the individual attitudes of applying coherent quality and safety standards and of directed awareness campaigns, especially towards the groups of lower technological and healthcare literacy. Full article

(This article belongs to the Section Digital Health Technologies)

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17 pages, 916 KB

Open AccessArticle

Treatment Efficacy of Semantic Feature Analysis in Logopenic and Semantic Variants of Primary Progressive Aphasia

by İbrahim Can Yaşa, İlknur Maviş and Tuğba Kaya

Healthcare 2026, 14(2), 272; https://doi.org/10.3390/healthcare14020272 - 21 Jan 2026

Viewed by 184

Abstract

Background/Objectives: Primary Progressive Aphasia (PPA) is a neurodegenerative disorder characterized by gradual and progressive deterioration of speech and language abilities. Speech and language therapy is considered an important intervention to slow decline and support the recovery of linguistic functions in individuals with [...] Read more.

Background/Objectives: Primary Progressive Aphasia (PPA) is a neurodegenerative disorder characterized by gradual and progressive deterioration of speech and language abilities. Speech and language therapy is considered an important intervention to slow decline and support the recovery of linguistic functions in individuals with PPA. This study aims to examine the effectiveness of an elaborated Semantic Feature Analysis (SFA) approach in enhancing naming abilities and semantic networks in individuals with the logopenic and semantic variants of PPA. Methods: Fourteen participants were recruited, including seven individuals with logopenic PPA and seven with semantic PPA. All participants received an elaborated SFA intervention twice weekly for four weeks. The Aphasia Language Assessment Test (ADD), the Turkish Picture Naming Test (T-RAT), and the SAQOL-39 were conducted at the following three time points: prior to treatment (pre-test), immediately after treatment (post-test), and one month post-treatment (follow-up). Results: Significant improvements were observed in ADD, T-RAT, and SAQOL-39 scores in both logopenic and semantic PPA groups following treatment (p < 0.05). Although follow-up scores declined compared to posttest performance (p < 0.05), several follow-up scores remained higher than pretest levels. Between-group comparisons indicated no significant difference in ADD scores; however, logopenic PPA participants demonstrated higher T-RAT scores (p < 0.05), while semantic PPA participants showed higher SAQOL-39 scores, except at follow-up (p < 0.05). Conclusions: Preliminary results suggest that the elaborated SFA intervention is effective in improving naming skills, language functioning, and quality of life in both logopenic and semantic variants of PPA. Although treatment gains partially decreased after one month, many improvements were maintained above baseline, supporting the clinical value of SFA in managing language decline in PPA. Full article

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18 pages, 763 KB

Open AccessArticle

Cyberbullying Victimisation as a Mediator Between Social Media Use and Emotional Problems Among Elementary School Students

by Sanja Radić Bursać, Sabina Mandić, Martina Lotar Rihtarić, Dora Dodig Hundrić and Neven Ricijaš

Healthcare 2026, 14(2), 271; https://doi.org/10.3390/healthcare14020271 - 21 Jan 2026

Viewed by 154

Abstract

Background/Objectives: Adolescence is a developmental period characterised by intensive use of social media and an increased prevalence of emotional problems such as depression and anxiety. Scientific evidence indicates that the modality of social media use (active or passive) can significantly predict these problems, [...] Read more.

Background/Objectives: Adolescence is a developmental period characterised by intensive use of social media and an increased prevalence of emotional problems such as depression and anxiety. Scientific evidence indicates that the modality of social media use (active or passive) can significantly predict these problems, with active use being linked to a higher likelihood of cyberbullying victimisation. As victimisation is associated with more severe emotional problems, social media represents an important context for understanding adolescent mental health. Following this, the main aim of this study was to examine how the modality of social media use (SMU) is related to emotional problems, and whether cyberbullying victimisation mediates this relationship. Methods: This study was conducted on a convenient sample of N = 1822 students (49.0% boys, 51.0% girls; M_age = 13.22 years, SD_age = 0.629) from a total of 64 elementary schools throughout Croatia. A modified Croatian version of the Active and Passive Use of Social Networks Scale, the Anxiety and Depression subscales of the Depression, Anxiety, Stress Scale—Youth Version, and the Cyber-Victimisation subscale of the European Cyberbullying Intervention Project Questionnaire were used. Results: The results indicate that passive SMU among boys is directly related only to anxiety, while that among girls contributes only to the explanation of depression. Regarding cyberbullying victimisation as a mediator, full mediation in the association between active SMU and emotional problems was found for both girls and boys. Conclusions: This represents a significant theoretical contribution, as well as a contribution to the development of psychosocial interventions. Full article

(This article belongs to the Special Issue Addressing Behavioral Addictions and Promoting Emotional Well-Being: Insight, Challenges, and Solutions)

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14 pages, 328 KB

Open AccessArticle

Patient Safety and Quality Improvement in Nursing Practice: Associations Among Workload, Occupational Coping Self-Efficacy and Medical Device-Related Pressure Injury Prevention

by Hyun Suk Gwag and Jin Ah Kim

Healthcare 2026, 14(2), 270; https://doi.org/10.3390/healthcare14020270 - 21 Jan 2026

Viewed by 162

Abstract

Background/Objectives: Medical device-related pressure injury (MDRPI) is a significant patient safety issue associated with increased morbidity, prolonged hospitalization, and healthcare costs. Although evidence-based guidelines for MDRPI prevention exist, nurses’ prevention performance remains suboptimal, and the mechanisms linking workload to preventive practice remain [...] Read more.

Background/Objectives: Medical device-related pressure injury (MDRPI) is a significant patient safety issue associated with increased morbidity, prolonged hospitalization, and healthcare costs. Although evidence-based guidelines for MDRPI prevention exist, nurses’ prevention performance remains suboptimal, and the mechanisms linking workload to preventive practice remain insufficiently elucidated. Within a patient safety and quality improvement framework, this study aimed to examine whether occupational coping self-efficacy (OCSE) is statistically consistent with an indirect association linking nurses’ workload and MDRPI prevention performance across the nursing practice continuum. Methods: This descriptive correlational study used a mediation model with data from 181 registered nurses working in intensive care units, general wards, and integrated nursing care wards in South Korea. Workload, OCSE, and MDRPI prevention performance were measured using validated instruments. Mediation was tested using hierarchical regression and bootstrapped analysis (PROCESS macro Model 4, 5000 resamples), controlling for demographic and work-related variables. Results: Higher workload was associated with lower OCSE, while higher OCSE was associated with better MDRPI prevention performance. When OCSE was included in the model, the direct association between workload and prevention performance was no longer significant. Bootstrapping confirmed a significant indirect association through OCSE, consistent with a full mediation pattern. Conclusions: Nurses’ workload appears to be indirectly associated with MDRPI prevention performance through OCSE. These findings suggest that strengthening nurses’ coping self-efficacy, alongside organizational strategies, may be essential for sustainable MDRPI prevention and patient safety improvement. Full article

(This article belongs to the Special Issue Patient Safety and Quality Improvement Across the Nursing Practice Continuum)

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14 pages, 257 KB

Open AccessArticle

Role Clarity Among Patient Care Technicians in Saudi Arabia: Outcomes of a Structured Educational Program

by Nashi Masnad Alreshidi, Afaf Mufadhi Alrimali, Wadida Darwiesh Alshammari, Kristine Angeles Gonzales, Maram Nasser Alawad, Eida Habeeb Alshammari, Mohmmad Khalf Al-Shammari, Ohoud Awadh Alreshidi, Fawziah Nasser Alrashedi, Asrar Eid Alrashidi and Lueife Ali Alrashedi

Healthcare 2026, 14(2), 269; https://doi.org/10.3390/healthcare14020269 - 21 Jan 2026

Viewed by 314

Abstract

Background: Role clarity is a persistent challenge among Patient Care Technicians (PCTs), contributing to inconsistent task performance and safety risks. In Saudi Arabia, little is known about PCTs’ understanding of their responsibilities. This study evaluated the impact of a targeted educational program designed [...] Read more.

Background: Role clarity is a persistent challenge among Patient Care Technicians (PCTs), contributing to inconsistent task performance and safety risks. In Saudi Arabia, little is known about PCTs’ understanding of their responsibilities. This study evaluated the impact of a targeted educational program designed to improve PCTs’ role clarity, safety practices, and communication. Methods: A quasi-experimental pre-post study was conducted in September 2025 with 35 PCTs from the Hail Health Cluster. The one-day intervention included lectures, discussions, role-play, and case scenarios. Outcomes were measured using a validated instrument across four domains: role clarity; core clinical tasks and safety; communication and ethics; and objective knowledge. Pre-post changes were analyzed using paired t-tests (Cohen’s d), and subgroup differences in change scores were examined using one-way ANOVA (η²) in SPSS v29. Results: Baseline scores were lowest in objective knowledge (41.4%) and role clarity (62.8%). Post-training, total composite scores improved significantly (+10.88%, p < 0.001, d = 1.63), with the most significant gain in objective knowledge (+19.8%, p < 0.001, d = 0.99). Role clarity showed only a modest, non-significant increase (+3.98%, p = 0.088, d = 0.30). No demographic differences were found. Conclusions: Targeted training was effective in reducing knowledge gaps; however, improving role clarity may require organizational reinforcement beyond brief training. Full article

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

18 pages, 797 KB

Open AccessArticle

Facilitators and Barriers of Using an Artificial Intelligence Agent in Chronic Disease Management: A Normalization Process Theory-Guided Qualitative Study of Older Patients with COPD

by Shiya Cui, Shilei Wang, Jingyi Deng, Ruiyang Jia and Yuyu Jiang

Healthcare 2026, 14(2), 268; https://doi.org/10.3390/healthcare14020268 - 21 Jan 2026

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Abstract

Objectives: This study aims to explore the facilitators and barriers in the process of using AI agents for disease management in older COPD patients. Methods: Based on the normalization process theory, a descriptive qualitative study was used to conduct semi-structured interviews with 28 [...] Read more.

Objectives: This study aims to explore the facilitators and barriers in the process of using AI agents for disease management in older COPD patients. Methods: Based on the normalization process theory, a descriptive qualitative study was used to conduct semi-structured interviews with 28 older patients with COPD recruited from June to August 2025 in a Class A tertiary hospital in Wuxi, Jiangsu Province. Results: A total of 28 interviews were conducted. Four themes (Coherence, Cognitive Participation, Collective Action, Reflexive Monitoring), nine subthemes (recognition of intelligent technology;supported by policy discourse and the background of national-level projects; the creation of a family atmosphere; recommendations from HCPs; relief and social connection; new “doctor”–patient relationship and communication; eliminate the burden and return to life; benefit and value perception; right self-decision by AI) in facilitators and nine subthemes (privacy conflicts and trust deficiency; blurred boundaries of human–machine responsibility and authority; non-high-quality services are chosen reluctantly; technical anxiety; lack of motivation for continued engagement; extra burden; limitations of the physical environment; human–machine dialogue frustration; a sense of uncertainty about the future of AI) in barriers were extracted. Conclusions: This study identified key factors influencing the use of AI agents in chronic disease management in older patients with COPD. The results provide directions for improving the implementation and sustainable use of AI health technologies. Full article

(This article belongs to the Special Issue Artificial Intelligence in Healthcare: Opportunities and Challenges)

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9 pages, 365 KB

Open AccessArticle

Regional Differences in Medicare Reimbursements and Gastroenterology Workforce Dynamics: Implications for Access to Care

by Jason N. Chen, Eric C. H. Leung, Jacob Evans, Cassidy Swain, Arham Siddiqui, Duke Appiah and Sameer Islam

Healthcare 2026, 14(2), 267; https://doi.org/10.3390/healthcare14020267 - 21 Jan 2026

Viewed by 187

Abstract

Background: As the U.S. population ages, the need for gastrointestinal (GI) care and procedures grows. Medicare is a significant payer for these procedures, but declining reimbursements raise concerns about the availability of GIs and thus equitable access to care. This study examines the [...] Read more.

Background: As the U.S. population ages, the need for gastrointestinal (GI) care and procedures grows. Medicare is a significant payer for these procedures, but declining reimbursements raise concerns about the availability of GIs and thus equitable access to care. This study examines the relationship between Medicare reimbursements for GI procedures and the regional supply and demand of GI physicians. Methods: This study analyzed the Medicare facility and non-facility setting physician reimbursements for the top 10 GI procedures for 2003, 2013, and 2023. Facility reimbursements were compared across four regions (Northeast, Midwest, South, and West) and compared to regional GI physician supply and demand data for 2013 and 2025 projections. Linear regression and mixed-effects models were used to evaluate relationships between reimbursements, physician supply, and demand. Results: The national average adjusted facility setting physician reimbursements for the top 10 GI procedures declined by 45.6% from 2003 to 2023. In 2013 and projected for 2025, the South had the highest GI physician supply and demand, but consistently lower facility setting physician reimbursements compared to the Northeast and West. Associations between supply, demand, and reimbursements were observed, though regional patterns showed paradoxical trends, such as similar low reimbursements in the South and Midwest despite differing supply levels. Conclusions: Regional inconsistencies between physician supply and reimbursements highlight the complexity of economic and healthcare dynamics. Declining Medicare reimbursements for GI procedures are multifactorial and, as the aging population grows, these reductions may widen disparities. Further investigation is needed to address barriers and ensure equitable access to GI care. Full article

(This article belongs to the Special Issue Enhancing Healthcare Services for Vulnerable Groups)

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13 pages, 843 KB

Open AccessProtocol

Integrating Immersive Virtual Reality Meditation into Palliative Oncology: A Randomized Trial Protocol for Evaluating Pain Relief and Quality of Life

by Emily Santos Montarroyos, Sara Lima, Raimundo Barreto, Rosana Moysés and Letícia Zumpano Cardenas

Healthcare 2026, 14(2), 266; https://doi.org/10.3390/healthcare14020266 - 21 Jan 2026

Viewed by 216

Abstract

Background/Objectives: Cancer is a disabling, challenging, and growing global disease. Although early diagnosis and adequate treatment of cancer are developing rapidly, a large part of the population remains without access to specialized services and routinely progresses to uncontrolled pain, poorer quality of [...] Read more.

Background/Objectives: Cancer is a disabling, challenging, and growing global disease. Although early diagnosis and adequate treatment of cancer are developing rapidly, a large part of the population remains without access to specialized services and routinely progresses to uncontrolled pain, poorer quality of life, and suffering. Complementary therapies for pain management and the well-being of patients under palliative care are fundamental tools of integrative oncological medicine. This first version of the protocol was created in August 2023 to structure the aim of this study to investigate the effectiveness of the experimental protocol which uses immersive virtual reality as a meditation tool in patients followed at the Pain Therapy and Palliative Care Service of the CECON Foundation. Methods: This randomized clinical trial, conducted at the Pain Therapy and Palliative Care Service (STDCP) of the FCECON, explores the use of immersive virtual reality to promote regular meditation practice among cancer patients as an effective means of managing pain and improving quality of life. Discussion: The present study has the potential to evaluate the effectiveness of immersive virtual reality as a meditation tool for patients undergoing palliative care, in addition to contributing scientific evidence that supports better decisions in healthcare for the management of cancer pain. Trial registration: Brazilian Registry of Clinical Trials (ReBEC) and ClinicalTrials.gov/NCT06328751/Universal Trial Number (UTN) U1111-1304-3752. Full article

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13 pages, 619 KB

Open AccessReview

Psychometric Evidence of Instruments for Assessing Mental Health in Older Adults from Latin America and the Caribbean: A Scoping Review

by Claudia Miranda-Castillo, Stella-Maria Paddick, María O. León-Campos, Pedro Molleda, Javiera Rosell and Margarita Valenzuela

Healthcare 2026, 14(2), 265; https://doi.org/10.3390/healthcare14020265 - 21 Jan 2026

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Abstract

Background/Objectives: Screening instruments are relevant for assessing the mental health of older adults, favoring clinical practice and research. However, there is a need for instruments with sufficient evidence of validity for use in Latin America and the Caribbean (LAC), where they are growing. [...] Read more.

Background/Objectives: Screening instruments are relevant for assessing the mental health of older adults, favoring clinical practice and research. However, there is a need for instruments with sufficient evidence of validity for use in Latin America and the Caribbean (LAC), where they are growing. This scoping review aims to evaluate the existing evidence regarding the psychometric properties of mental health measurement instruments used with older adults from LAC. Methods: Eight databases (PubMed, CINAHL, Medline, Embase, Scielo, Scopus, Web of Science, PsycINFO) were searched to extract relevant articles about instruments to measure mental health outcomes in older adults in English, Spanish, and Portuguese. After the first screening and duplicate removal, 6307 were retrieved. Results: The full-text screening identified 312 articles for inclusion in the review. Most of the articles were from Brazil (49.04%). One hundred eighty instruments (52.79%) assessed cognition, mainly using the Mini-Mental State Examination (MMSE), followed by 11.14% for depression, most commonly with the Yesavage Depression Scale (GDS). The assessment of validity was predominantly based on two criteria (34%), and 56% of the evidence was published in the last 10 years. To improve usability, we have provided a practical guide to help LAC clinicians and researchers identify and select robustly validated and contextually appropriate assessment instruments. Conclusions: There is still little evidence of the validity of instruments that measure other aspects of mental health beyond cognitive functioning. There seems to be no unified set of criteria in Latin America for determining whether an instrument has sufficient valid evidence. More work is needed on cross-cultural validity evidence within the region. Full article

(This article belongs to the Special Issue Mental Health in Older People)

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13 pages, 269 KB

Open AccessArticle

Organizational Climate, Ethical Work Environment, and Turnover Intentions Among Healthcare Workers in a Romanian Chronic Care Hospital: A Multidimensional Analysis

by Sorina Enășoni, Diana Szekely, Flavia Zara, Cristina Stefania Dumitru, Alexia Manole, Catalin Dumitru, Raul Patrascu and Alexandra Enache

Healthcare 2026, 14(2), 264; https://doi.org/10.3390/healthcare14020264 - 21 Jan 2026

Viewed by 122

Abstract

Background: Turnover intention among healthcare workers represents a growing challenge for chronic care institutions, particularly in resource-constrained healthcare systems. Organizational and ethical factors have been increasingly recognized as relevant correlates of workforce retention. Methods: This exploratory cross-sectional study was conducted in a Romanian [...] Read more.

Background: Turnover intention among healthcare workers represents a growing challenge for chronic care institutions, particularly in resource-constrained healthcare systems. Organizational and ethical factors have been increasingly recognized as relevant correlates of workforce retention. Methods: This exploratory cross-sectional study was conducted in a Romanian chronic care hospital between January 2023 and September 2024. A total of 62 healthcare workers were included using a census-based recruitment approach. Organizational climate, ethical work environment, job satisfaction, and turnover intention were assessed using adapted and composite self-report measures. Correlation, multivariate regression, and exploratory mediation analyses were performed. Results: Job satisfaction and ethical work environment were inversely associated with turnover intention in both correlation and multivariate analyses. Organizational climate did not retain an independent association with turnover intention after adjustment. Exploratory mediation analysis suggested that job satisfaction may partially account for the association between an ethical work environment and turnover intention. Higher turnover intention and less favorable organizational perceptions were observed among nursing and auxiliary healthcare staff compared to physicians. Conclusions: The findings suggest that organizational and ethical conditions, particularly those influencing job satisfaction, are relevant correlates of turnover intention in chronic care settings. Given the exploratory design and limited sample size, these results should be interpreted cautiously. Organizational strategies targeting ethical practices and everyday work satisfaction may represent feasible approaches to workforce retention in similar healthcare contexts. Full article

(This article belongs to the Special Issue Organizational Approaches That Support Nurses and Healthcare Workers to Thrive: Moving Beyond Burnout)

19 pages, 694 KB

Open AccessArticle

Relationship Between Perceived Stress and Anxiety in High School Senior Students: The Mediating Role of Social Support and the Moderating Influence of Lifestyle

by Vilija Malinauskiene and Romualdas Malinauskas

Healthcare 2026, 14(2), 263; https://doi.org/10.3390/healthcare14020263 - 21 Jan 2026

Viewed by 229

Abstract

(1) Background: The purpose of this study was to investigate the associations between perceived stress and anxiety in high school senior students, taking into account the possible influence from lifestyle (physical activity, nicotine dependence, and alcohol use) and social support. (2) Methods: A [...] Read more.

(1) Background: The purpose of this study was to investigate the associations between perceived stress and anxiety in high school senior students, taking into account the possible influence from lifestyle (physical activity, nicotine dependence, and alcohol use) and social support. (2) Methods: A representative sample of high school senior students (N = 405; mean age: 18.2 ± 0.4), reflecting the overall geographic distribution of Lithuania’s student population, was investigated using anonymous questionnaires on perceived stress (Perceived Stress Scale, PSS-10), anxiety (Generalized Anxiety Disorder Scale, GAD-7), perceived social support (Multidimensional Scale of Perceived Social Support, MSPSS), lifestyle (Fagerström Test for Nicotine Dependence), alcohol use (Alcohol Use Disorders Identification Test, AUDIT), and physical activity (International Physical Activity Questionnaire, IPAQ). Hierarchical multiple regression analysis was employed, investigating mediating and moderating effects. (3) Results: The direct effect of perceived stress on anxiety was significant (B = 0.364; SE = 0.0486; 95% CI [0.268, 0.459]; p < 0.001). Furthermore, the analysis revealed a significant indirect effect via social support (B = 0.387; SE = 0.0525; 95% CI [0.284, 0.490]), indicating that a portion of the relationship between perceived stress and anxiety was mediated by social support. Physical inactivity, alcohol use, and nicotine dependence served as moderators. Our findings confirmed that all three moderators showed significant interaction effects, with standardized β = −0.124, p = 0.002, for physical inactivity, β = 0.073, p = 0.016, for alcohol dependence, and β = 0.119, p = 0.001, for nicotine dependence, in the relationship between perceived stress and anxiety among high school senior students. (4) Conclusions: These findings have practical insights for educators who implement physical activity and alcohol and nicotine usage programs for high school senior students to help reduce their stress and anxiety. Full article

(This article belongs to the Special Issue A Multi-Perspective Study on the Psychological Health of Children and Adolescents)

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18 pages, 1461 KB

Open AccessArticle

Experiencing Violence from Animal Owners in Veterinary Medicine: Results of a Nationwide Survey

by Irina Böckelmann and Beatrice Thielmann

Healthcare 2026, 14(2), 262; https://doi.org/10.3390/healthcare14020262 - 21 Jan 2026

Viewed by 236

Abstract

Background/Objectives: Veterinarians are among the most stressed of all professional groups. Their work is characterised by long working hours, high emotional demands and an increased risk of anxiety, depression, suicide and burnout. The aim of this cross-sectional study that examines retrospective records [...] Read more.

Background/Objectives: Veterinarians are among the most stressed of all professional groups. Their work is characterised by long working hours, high emotional demands and an increased risk of anxiety, depression, suicide and burnout. The aim of this cross-sectional study that examines retrospective records of experienced violence was to analyse the frequency of violent acts and their connection to certain factors (age, gender, place of work, and specialist area according to animal species). Methods: This nationwide, cross-sectional, online survey of veterinarians in Germany was conducted between July 2021 and February 2023. A total of 1053 veterinarians were included in the analysis, which was conducted according to the respondents’ age, (<35 years, 35–45 years and >45 years), gender, workplace and veterinary specialisation. Sociodemographic and work-related data were collected, as were responses to questions regarding experiences of violence, which were differentiated between verbal abuse and physical violence. The data were analysed using descriptive statistics and non-parametric group comparisons (Kruskal–Wallis test with Bonferroni correction, Mann–Whitney U test and Pearson’s chi-squared test). Results: Overall, 52.7% of veterinarians reported experiencing verbal abuse or physical violence at the hands of animal owners. Verbal abuse occurred, on average, more than three times per month, whereas physical violence was rare. Physical violence occurred significantly more frequently among middle-aged veterinarians (p < 0.001). The highest prevalence of verbal abuse or violence (72.5%, p < 0.001) was reported by veterinarians working in public authorities, while the lowest was reported by those working in laboratories. Conclusions: Workplace violence against veterinarians is a frequent occupational burden in Germany and highlights the urgent need for targeted prevention, de-escalation training and organisational support across veterinary settings. Full article

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13 pages, 2357 KB

Open AccessArticle

A Prevention-Focused Geospatial Epidemiology Framework for Identifying Multilevel Vulnerability Across Diverse Settings

by Cindy Ogolla Jean-Baptiste

Healthcare 2026, 14(2), 261; https://doi.org/10.3390/healthcare14020261 - 21 Jan 2026

Viewed by 136

Abstract

Background/Objectives: Geographic Information Systems (GIS) offer essential capabilities for identifying spatial concentrations of vulnerability and strengthening context-aware prevention strategies. This manuscript describes a geospatial architecture designed to generate anticipatory, place-based risk identification applicable across diverse community and institutional environments. Interpersonal Violence (IPV), [...] Read more.

Background/Objectives: Geographic Information Systems (GIS) offer essential capabilities for identifying spatial concentrations of vulnerability and strengthening context-aware prevention strategies. This manuscript describes a geospatial architecture designed to generate anticipatory, place-based risk identification applicable across diverse community and institutional environments. Interpersonal Violence (IPV), one of several preventable harms that benefit from this spatially informed analysis, remains a critical public health challenge shaped by structural, ecological, and situational factors. Methods: The conceptual framework presented integrates de-identified surveillance data, ecological indicators, environmental and temporal dynamics into a unified spatial epidemiological model. Multilevel data layers are geocoded, spatially matched, and analyzed using clustering (e.g., Getis-Ord Gi*), spatial dependence metrics (e.g., Moran’s I), and contextual modeling to support anticipatory identification of elevated vulnerability. Framework Outputs: The model is designed to identify spatial clustering, mobility-linked risk patterns, and emerging escalation zones using neighborhood disadvantage, built-environment factors, and situational markers. Outputs are intended to support both clinical decision-making (e.g., geocoded trauma screening, and context-aware discharge planning), and community-level prevention (e.g., targeted environmental interventions and cross-sector resource coordination). Conclusions: This framework synthesizes behavioral theory, spatial epidemiology, and prevention science into an integrative architecture for coordinated public health response. As a conceptual foundation for future empirical research, it advances the development of more dynamic, spatially informed, and equity-focused prevention systems. Full article

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18 pages, 436 KB

Open AccessSystematic Review

Animal-Assisted Therapy for Reducing Anxiety in Vulnerable Clinical Populations: A Systematic Review

by Nazaret Hernández-Espeso, Laura Durbán Bronchud and Gloria Bernabé-Valero

Healthcare 2026, 14(2), 260; https://doi.org/10.3390/healthcare14020260 - 21 Jan 2026

Viewed by 289

Abstract

Background: Anxiety is highly prevalent among individuals living with disability, chronic illness, or hospitalisation, yet it often remains insufficiently addressed in healthcare settings. Animal-assisted therapy (AAT) has been proposed as a complementary intervention to reduce anxiety; however, existing evidence is fragmented across [...] Read more.

Background: Anxiety is highly prevalent among individuals living with disability, chronic illness, or hospitalisation, yet it often remains insufficiently addressed in healthcare settings. Animal-assisted therapy (AAT) has been proposed as a complementary intervention to reduce anxiety; however, existing evidence is fragmented across populations and methodologies. Methods: A systematic review was conducted following PRISMA 2020 guidelines. The review protocol was registered in PROSPERO (CRD42024494109); no amendments were made to the protocol after registration. Four databases (Scopus, APA PsycInfo, Web of Science, and PubMed) were searched for empirical studies (2013–2023) evaluating AAT delivered by trained professionals using domesticated species and reporting anxiety outcomes in individuals with disability, illness, or hospitalisation. Results: Thirty-one studies met eligibility criteria and were included in the review. Across heterogeneous designs, most interventions—primarily using dogs or horses—reported significant post-intervention reductions in anxiety. Randomised clinical trials consistently showed superior results compared with control conditions. AAT demonstrated beneficial effects across populations including PTSD, paediatric hospitalisation, chronic illness, disability, acute care, and trauma exposure. Long-term outcomes were mixed, and methodological variability limited comparability across studies. Conclusions: AAT appears to be a promising complementary intervention for anxiety management within clinical, psychosocial, and healthcare settings. Evidence supports short-term anxiolytic effects across diverse populations, although standardisation and long-term evaluations remain insufficient. Future research should establish optimal intervention parameters, mechanisms of action, and strategies for integrating AAT into multidisciplinary mental healthcare. Full article

(This article belongs to the Special Issue Human–Animal Interaction: Animal Behaviour and Whole-Person Health in Animal-Assisted Interventions)

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14 pages, 257 KB

Open AccessArticle

Let Them Talk: Coping with PrEP-Related Stigma and Sustaining PrEP Persistence Among Men Who Have Sex with Men in Tanga, Tanzania

by Faithness Kiondo, Emmy Metta, Elia John Mmbaga, Kåre Moen, Calvin Swai and Melkzedeck Leshabari

Healthcare 2026, 14(2), 259; https://doi.org/10.3390/healthcare14020259 - 21 Jan 2026

Viewed by 212

Abstract

Background: Pre-exposure prophylaxis (PrEP) offers over 99% protection against HIV when used consistently, but stigma continues to undermine persistence in care. While much research has described the external manifestations of PrEP-related stigma, less is known about how individuals cope with these stigmas and [...] Read more.

Background: Pre-exposure prophylaxis (PrEP) offers over 99% protection against HIV when used consistently, but stigma continues to undermine persistence in care. While much research has described the external manifestations of PrEP-related stigma, less is known about how individuals cope with these stigmas and how such coping processes influence persistence. Guided by Social Cognitive Theory, this study examined the psychosocial strategies men who have sex with men (MSM) in Tanzania use to cope with PrEP-related stigma and sustain persistence in care. Methods: Thirty-two in-depth interviews were conducted with purposefully selected MSM aged 18–38 years at Ngamiani Health Centre in Tanga region. The sampling included both persistent and non-persistent PrEP users with variation in age and sexual position preferences. Participants were sampled for variation in persistence status (persistent and non-persistent), age, and sexual position preference to capture heterogeneity in stigma experiences and coping processes. Interviews were conducted in Kiswahili, audio-recorded, transcribed, translated, and analyzed using reflexive thematic analysis. Results: Participants described PrEP-related stigma as socially constructed through narratives that equated PrEP with HIV treatment, labeled it a “gay pill,” associated it with promiscuity, or linked it to bodily harm or increased HIV risk. These stigmas impact persistence in care through discouraging clinic visits and daily pill taking. However, some participants remained persistent in care despite stigma by using protective mental strategies such as personal agency, mental time travel, and affirmation from supportive social connections, which buffered emotional impacts and sustained persistence. Conclusions: Persistence in PrEP care is shaped not only by stigma in the social environment but also by how individuals interpret and respond to it. Interventions should therefore combine structural stigma-reduction efforts with mental health-informed strategies that strengthen agency and supportive social relationships to sustain PrEP engagement among MSM. Full article

21 pages, 288 KB

Open AccessFeature PaperArticle

Functional and Neurological Outcomes After Spine Surgery and Neurorehabilitation for Chronic Discogenic Low Back Pain: A Prospective Observational Pre–Post Study

by Monika Michalak, Adam Druszcz, Maciej Miś, Marcin Miś, Małgorzata Paprocka-Borowicz and Joanna Rosińczuk

Healthcare 2026, 14(2), 258; https://doi.org/10.3390/healthcare14020258 - 21 Jan 2026

Viewed by 256

Abstract

Background: Discogenic low back pain (LBP) is a significant therapeutic and social problem. Discopathy is associated with neurological symptoms that severely disrupt the patient’s functional status. Regardless of the choice of neurosurgical procedure for discopathy, its effectiveness highly varies. Aims: This study aimed [...] Read more.

Background: Discogenic low back pain (LBP) is a significant therapeutic and social problem. Discopathy is associated with neurological symptoms that severely disrupt the patient’s functional status. Regardless of the choice of neurosurgical procedure for discopathy, its effectiveness highly varies. Aims: This study aimed to assess the effectiveness of neurosurgical treatment and neurorehabilitation procedures based on a comprehensive analysis of a number of neurological symptoms and the functional status of patients with chronic discogenic LBP. Material and Methods: This study involved 110 patients (56 women and 54 men) who underwent first-ever lumbar spine surgery. Before the surgery and 3 months after the hospital discharge, all patients were subjected to neurological examination and comprehensive assessment of neurological symptoms. Results: After the procedure, improvement was shown in sensory disturbance (p < 0.0001), pain (p < 0.0001), and sexual dysfunction (p < 0.0001). The results of lower limb paresis, monoplegia, and sphincter complications remained non-significant. A reduction in scoliosis (p = 0.0040) and lumbar pain (p < 0.0001) was observed. There was a reduction in pain in the lower leg (p = 0.0136) and foot (p = 0.0122) during movements. Improvement in passive and active mobility as well as pain reduction in the lumbar spine area were demonstrated (p < 0.0001). There was significant improvement in the knee and ankle reflexes (p < 0.0001). There were no significant changes in the superficial sensation. In the functional assessment, an improvement in the toe-to-floor test of 13.3 cm was confirmed (p < 0.0001), while there was no difference in the Lasègue’s test. Conclusions: The general and neurological condition of patients with LBP significantly improved after the spine surgery. The improvement included mainly a reduction in pain and sensory disturbances, return of deep reflexes, and increased mobility of the lower limbs and spine. Full article

(This article belongs to the Special Issue The Physical and Mental Well-Being of Individuals with Chronic Diseases)

17 pages, 245 KB

Open AccessArticle

Lived Experiences of Social Isolation and Meaningful Relationships Among Older Adults Living with HIV with a Concurrent Mental Health Diagnosis: A Heideggerian Phenomenological Approach

by Kristina M. Kokorelias, Dean Valentine, Andrew D. Eaton, Sarah E. P. Munce, Christine L. Sheppard, Sander L. Hitzig, Marina B. Wasilewski, Alice Zhabokritsky, Reham Abdelhalim, Laura Jamieson, Maurita T. Harris and Luxey Sirisegaram

Healthcare 2026, 14(2), 257; https://doi.org/10.3390/healthcare14020257 - 20 Jan 2026

Viewed by 177

Abstract

Background/Objectives: Meaningful social connections are critical for well-being in later life, yet older adults living with HIV frequently experience social isolation and loneliness, compounded by stigma, mental health conditions, and systemic inequities. This study aimed to explore how older adults living with HIV [...] Read more.

Background/Objectives: Meaningful social connections are critical for well-being in later life, yet older adults living with HIV frequently experience social isolation and loneliness, compounded by stigma, mental health conditions, and systemic inequities. This study aimed to explore how older adults living with HIV and a concurrent mental health diagnosis experience social isolation and cultivate meaningful relationships, situating these experiences within Social Convoy Theory. Methods: Using a Heideggerian phenomenological approach, we conducted in-depth, semi-structured interviews with 33 adults aged 50 and older in Ontario, Canada, who self-identified as living with HIV and a diagnosed mental health condition. Participants were recruited through community-engaged strategies and snowball sampling. Data were analyzed iteratively, combining descriptive and interpretive coding to identify patterns in social isolation, relational meaning, and the influence of intersecting social, structural, and health determinants. Results: Participants described social isolation as both a physical and existential experience, influenced by stigma, mental health challenges, and contextual factors such as urban versus rural settings. Meaningful relationships were characterized by authenticity, trust, emotional safety, and reciprocity, often formed within peer networks sharing similar lived experiences. Community engagement and virtual platforms facilitated connection, while rural or suburban environments often intensified isolation. Relationships providing validation, agency, and continuity of experience were particularly impactful on participants’ well-being. Conclusions: Social isolation among older adults living with HIV and mental health conditions extends beyond objective network measures to include emotional and identity-related dimensions. Interventions should prioritize affirming, context-sensitive spaces that support disclosure, trust, and reciprocal relationships, recognizing the nuanced needs of this population for both social and existential connectedness. Full article

(This article belongs to the Special Issue Impact of Social Connections on Well-Being of Older Adults)

34 pages, 416 KB

Open AccessArticle

The Impact of Comorbidities on Health-Related Quality of Life Among Patients with Rheumatoid Arthritis

by Adriana Liliana Vlad, Corina Risca Popazu, Alina-Maria Lescai, Daniela-Ioanina Prisacaru, Doina Carina Voinescu and Alexia Anastasia Stefania Baltă

Healthcare 2026, 14(2), 256; https://doi.org/10.3390/healthcare14020256 - 20 Jan 2026

Viewed by 185

Abstract

Background. Rheumatoid arthritis (RA) is a chronic autoimmune disease frequently accompanied by cardiovascular, respiratory, skeletal, psychiatric, and neoplastic comorbidities that are associated with higher morbidity and poorer health-related quality of life (HRQoL). This study evaluated the associations between comorbidities and patient-reported physical health, [...] Read more.

Background. Rheumatoid arthritis (RA) is a chronic autoimmune disease frequently accompanied by cardiovascular, respiratory, skeletal, psychiatric, and neoplastic comorbidities that are associated with higher morbidity and poorer health-related quality of life (HRQoL). This study evaluated the associations between comorbidities and patient-reported physical health, emotional distress, daily functioning, and social relationships in adults with RA and explored patient-reported unmet needs relevant to integrated care. Methods. We conducted a cross-sectional survey among 286 adults with physician-confirmed RA, using a structured questionnaire (ICRA-Q) administered between June and July 2025 via online platforms and in-hospital supervised completion. The survey captured demographics, patient-reported physician-diagnosed comorbidities (current and/or past), perceived disease impact, functional limitations, emotional and social consequences, access to treatment, financial burden, and support needs. Analyses included descriptive statistics, χ² tests, t-tests/ANOVA, effect sizes (Cramer’s V and standardized mean differences), and multivariable logistic regression to explore predictors of high HRQoL impact and high difficulty in disease management. An exploratory classification into high-risk phenotypes was performed using predefined clinical, psychological, and socioeconomic criteria. Results. Most participants (98.6%) reported at least one comorbidity, most commonly hypertension, osteoporosis, and cardiovascular disease. Higher comorbidity burden and depression/anxiety were strongly associated with higher pain, reduced mobility, emotional distress, and financial strain. Exploratory high-risk phenotypes (severe somatic multimorbidity, high psychological vulnerability, high socioeconomic burden, and a composite very high-risk profile) were associated with poorer HRQoL indicators. Younger age, shorter disease duration, and higher perceived social support were associated with lower perceived burden. Conclusions. In this cross-sectional, patient-reported study, comorbidity burden—particularly psychological comorbidity—was strongly associated with poorer HRQoL and greater management difficulty in RA. These findings support the need for multidisciplinary, integrated care pathways; however, subgroup phenotypes should be considered exploratory and require external validation. Full article

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Open AccessCommentary

Persistent Traumatic Stress Exposure: Rethinking PTSD for Frontline Workers

by Nicola Cogan

Healthcare 2026, 14(2), 255; https://doi.org/10.3390/healthcare14020255 - 20 Jan 2026

Viewed by 237

Abstract

Frontline workers across health, emergency, and social care sectors are repeatedly exposed to distressing events and chronic stressors as part of their occupational roles. Unlike single-event trauma, these cumulative exposures accrue over time, generating persistent psychological and physiological strain. Traditional diagnostic frameworks, particularly [...] Read more.

Frontline workers across health, emergency, and social care sectors are repeatedly exposed to distressing events and chronic stressors as part of their occupational roles. Unlike single-event trauma, these cumulative exposures accrue over time, generating persistent psychological and physiological strain. Traditional diagnostic frameworks, particularly post-traumatic stress disorder (PTSD), were not designed to capture the layered and ongoing nature of this occupational trauma. This commentary introduces the concept of Persistent Traumatic Stress Exposure (PTSE), a framework that reframes trauma among frontline workers as an exposure arising from organisational and systemic conditions rather than solely an individual disorder. It aims to reorient understanding, responsibility, and intervention from a purely clinical lens toward systems, cultures, and organisational duties of care. PTSE is presented as an integrative paradigm informed by contemporary theory and evidence on trauma, moral injury, organisational stress, and trauma-informed systems. The framework synthesises findings from health, emergency, and social care settings, illustrating how repeated exposure, ethical conflict, and institutional pressures contribute to cumulative psychological harm. PTSE highlights that psychological injury may build across shifts, careers, and lifetimes, requiring preventive, real-time, and sustained responses. The framework emphasises that effective support is dependent on both organisational readiness, the structural conditions that enable trauma-informed work, and organisational preparedness, the practical capability to enact safe, predictable, and stigma-free responses to trauma exposure. PTSE challenges prevailing stigma by framing trauma as a predictable occupational hazard rather than a personal weakness. It aligns with modern occupational health perspectives by advocating for systems that strengthen psychological safety, leadership capability and access to support. By adopting PTSE, organisations can shift from reactive treatment models toward proactive cultural and structural protection, honouring the lived realities of frontline workers and promoting long-term wellbeing and resilience. Full article

(This article belongs to the Special Issue Improving the Health and Well-Being of Groups of Workers Experiencing Work Disparities)

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Healthcare, Volume 14, Issue 2 (January-2 2026) – 148 articles

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