Healthcare

13 pages, 600 KB

Open AccessSystematic Review

Durability of Exercise vs. Revascularization in Intermittent Claudication: An Updated Meta-Analysis of Randomized Trials Focusing on Patient-Centered Outcomes

by Mislav Puljevic, Petra Grubic-Rotkvic, Mia Dubravcic-Dosen, Andrija Stajduhar and Majda Vrkic-Kirhmajer

Healthcare 2026, 14(2), 170; https://doi.org/10.3390/healthcare14020170 - 8 Jan 2026

Abstract

Intermittent claudication (IC) is the most frequent symptomatic manifestation of lower-extremity peripheral artery disease (PAD). Supervised exercise therapy (SET) and endovascular revascularization (ER) are established treatments, but their relative and combined effects on health-related quality of life (HRQoL) remain. We conducted a systematic [...] Read more.

Intermittent claudication (IC) is the most frequent symptomatic manifestation of lower-extremity peripheral artery disease (PAD). Supervised exercise therapy (SET) and endovascular revascularization (ER) are established treatments, but their relative and combined effects on health-related quality of life (HRQoL) remain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing SET, ER, and ER+SET, with HRQoL as the primary outcome. Methods: Following PRISMA 2020, PubMed, Embase, and CENTRAL were used in December 2024. Eligible RCTs enrolled with IC (excluding critical limb-threatening ischemia) and reported validated HRQoL outcomes at ≥3 months. Two reviewers independently extracted data and assessed risk of bias using the Cochrane RoB 2.0 tool. Random-effects meta-analyses pooled standardized mean differences (SMDs) for HRQoL and mean differences (MDs) for walking distance. Results: Five RCTs (n = 728) were included. Compared with optimal medical therapy, both SET and ER improved HRQoL and walking distance. At 12 months, no significant effect was observed between SET and ER (SMD 0.02; 95% CI: −0.18 to 0.22). ER+SET was superior to SET alone (SMD 0.35; 95% CI: 0.12–0.57). Beyond 24 months, improvements were sustained with SET but attenuated with ER, accompanied by higher reintervention rates in ER-containing arms (approximately 20–30% by 2 years). Adverse events were rare (<1%). Conclusions: Given moderate-certainty evidence (GRADE), SET should remain the first-line therapy for intermittent claudication because it provides durable improvements in patient-centered outcomes with minimal harm. Endovascular revascularization (ER) can provide faster symptom relief, but its long-term benefits are constrained by restenosis and repeat procedures, particularly in femoropopliteal disease. Full article

(This article belongs to the Section Clinical Care)

14 pages, 325 KB

Open AccessArticle

Exploring Associations Between STEAM-Based Interventions and Executive and Cognitive Skills in Children with ADHD

by María del Mar Bueno-Galán, Carlos Barbosa-Torres, María José Godoy-Merino, Alperen Yandi, Alejandro Arévalo-Martínez, María Pilar Cantillo-Cordero, María Elena García-Baamonde Sánchez and Juan Manuel Moreno-Manso

Healthcare 2026, 14(2), 169; https://doi.org/10.3390/healthcare14020169 - 8 Jan 2026

Abstract

Background: This study examines whether participation in STEAM-based educational activities is associated with improvements in executive functions (EFs) and cognitive skills in children with Attention Deficit Hyperactivity Disorder (ADHD). Methods: A total of 60 children diagnosed with ADHD (mean age = [...] Read more.

Background: This study examines whether participation in STEAM-based educational activities is associated with improvements in executive functions (EFs) and cognitive skills in children with Attention Deficit Hyperactivity Disorder (ADHD). Methods: A total of 60 children diagnosed with ADHD (mean age = 8 years) participated, with 30 following a traditional educational approach and 30 engaged in STEAM-based activities. Executive functions and cognitive abilities were assessed using standardized instruments (BRIEF, WISC-V, CARAS-R), and data were analyzed with IBM SPSS Statistics 25. Results: Children in the STEAM group outperformed the control group across several domains, showing statistically significant gains in inhibition, planning and organization, verbal comprehension, visuospatial skills, processing speed, total IQ, efficiency, and the Impulsivity Control Index (ICI). Conclusions: These findings suggest that STEAM-based educational experiences may support neurodevelopmental growth and enhance cognitive and executive functioning in children with ADHD, although causal inferences cannot be drawn due to the cross-sectional design. Full article

24 pages, 5341 KB

Open AccessArticle

The “Supporting Adolescents with Self Harm” (SASH) Intervention Supporting Young People (And Carers) Presenting to the Emergency Department with Self-Harm: Therapeutic Assessment, Safety Planning, and Solution-Focused Brief Therapy

by Rose McCabe, Sally O’Keeffe and Maria Long

Healthcare 2026, 14(2), 168; https://doi.org/10.3390/healthcare14020168 - 8 Jan 2026

Abstract

Background: Self-harm is a growing public health concern and the strongest predictor of suicide in young people (YP). The “Supporting Adolescents with Self-Harm” (SASH) intervention was developed with YP with lived experience and expert clinicians. It involves rapid follow-up after ED attendance [...] Read more.

Background: Self-harm is a growing public health concern and the strongest predictor of suicide in young people (YP). The “Supporting Adolescents with Self-Harm” (SASH) intervention was developed with YP with lived experience and expert clinicians. It involves rapid follow-up after ED attendance and up to six intervention sessions. The intervention has three components: Therapeutic Assessment (TA) of self-harm; an enhanced safety plan (SP); and Solution-Focused Brief Therapy (SFBT). Depending on the YP’s preference, carers can join sessions. Carers can also receive two individual sessions. The clinical and cost-effectiveness of SASH is being evaluated in a randomised controlled trial across nine emergency departments in three NHS Trusts in London, England. A total of 154 YP were recruited between May 2023 and March 2025 and randomised on a 1:1 ratio to SASH alongside Treatment As Usual (TAU) or TAU. A logic model describes the SASH inputs, activities, mechanisms, outcomes and longer-term impacts. The aim of this paper is to (1) illustrate how TA, SP, and SFBT were implemented in practice by presenting intervention materials and session recordings for four YP cases and one carer case and (2) explore how the case study materials/recordings reflect the intervention mechanisms in the SASH logic model. Methods: Each case focused on a different component of the intervention. Intervention materials (TA self-harm diagram and completed SP) and recorded SFBT sessions with four YP and one carer were analysed using a descriptive case study approach. The TA diagram and SP were extracted from medical records. Audio/video recordings of intervention sessions were identified. Recordings of intervention sessions and qualitative interviews were transcribed. Quotes from qualitative interviews with the same participants were included where relevant. Results: Across the four YP cases, some core themes emerged. The role of friendships for young people, particularly at school, was important in both negative and positive ways. Experiencing difficulties with friends at school led to feelings of sadness and stress, which could become overwhelming, leading to thoughts of self-harm (“I just need to hurt myself”), triggering self-harm behaviour. YP described mood changes and signs that they were becoming stressed, which improved their self-awareness and understanding of the link between their feelings and self-harm behaviour. They reflected on what kept them feeling calm and overcoming their fear of burdening others by sharing how they were feeling, as this helped them not to self-harm. They also described difficult feelings stemming from a need to please everyone or needing validation from others. Overcoming these feelings led to less social anxiety and more confidence. This made it easier to go to school and to be more social with friends/student peers, which in turn improved their mood. Conclusions: These case studies demonstrate how YP improved their self-awareness and understanding of the link between feelings and self-harm behaviour and identified personal strategies for managing difficult feelings and situations. The carer case study demonstrates how sessions with carers can facilitate carers better supporting their YP’s mental health. Supporting YP and carers in this way has the potential to reduce the risk of future self-harm. Full article

(This article belongs to the Special Issue Health Risk Behaviours: Self-Injury and Suicide in Young People)

12 pages, 229 KB

Open AccessArticle

Adaptive Sport as Complementary and Holistic Health Intervention: Outcomes for Participants to Improve Resiliency, Promote Health, and Live in Recovery

by Kaitlin E. Mueller, Derek Whaley and Allie Thomas

Healthcare 2026, 14(2), 167; https://doi.org/10.3390/healthcare14020167 - 8 Jan 2026

Abstract

Background/Objectives: Adaptive sports engagement has been strongly studied for physical and social gains for athletes with disabilities, with much less investigation into adaptive sports encompassing holistic health (i.e., reaching domains of physical, social, cognitive, emotional, and spiritual). Therefore, the purpose of this [...] Read more.

Background/Objectives: Adaptive sports engagement has been strongly studied for physical and social gains for athletes with disabilities, with much less investigation into adaptive sports encompassing holistic health (i.e., reaching domains of physical, social, cognitive, emotional, and spiritual). Therefore, the purpose of this study is to explore adaptive sport participants’ perspectives on their engagement in sport as a complementary and holistic intervention to improve resiliency, promote health, and live in recovery. Methods: This study employed a qualitative, phenomenological, and participatory action research design to explore how individuals with disabilities perceive their engagement in adaptive sports. Data were collected from eligible participants across the United States, aged 12 years and older, who provided open-ended responses via survey detailing their adaptive sport experiences. Results: Adaptive sport participants (n = 47), primarily male (n = 26), and White (n = 37) with a range of ages 12–75, provided qualitative findings that formed three deductive themes with further inductive subthemes: (1) Improving Resiliency highlighting promotive and protective factors supporting resilience development, (2) Promoting Health defined by World Health Organization’s holistic health definition, and (3) Living in Recovery framed by the Health Protection/Health Promotion Model. Conclusions: For this sample of adaptive sport participants across the United States, engagement in adaptive sports is seen as a complementary and holistic health intervention that achieves outcomes beyond just physical and social. Key aspects of adaptive sports were shown to be vital for building resiliency through the disability community environment, improving holistic health, and providing a recovery mindset through new life opportunities. Full article

20 pages, 3184 KB

Open AccessArticle

Predictive Models for Early Infection Detection in Nursing Home Residents: Evaluation of Imputation Techniques and Complementary Data Sources

by Melisa Granda, María Santamera-Lastras, Alberto Garcés-Jiménez, Francisco Javier Bueno-Guillén, Diego María Rodríguez-Puyol and José Manuel Gómez-Pulido

Healthcare 2026, 14(2), 166; https://doi.org/10.3390/healthcare14020166 - 8 Jan 2026

Abstract

Background: Aging in Western societies poses a growing challenge, placing increasing pressure on healthcare costs. Early identification of infections in elderly nursing home residents is crucial to reduce complications, mortality, and the burden on emergency departments. Methods: We performed a comparative analysis of [...] Read more.

Background: Aging in Western societies poses a growing challenge, placing increasing pressure on healthcare costs. Early identification of infections in elderly nursing home residents is crucial to reduce complications, mortality, and the burden on emergency departments. Methods: We performed a comparative analysis of machine learning models using XGBoost classifiers for infection detection, addressing incomplete daily physiological measurements (Heart Rate, Oxygen Saturation, Body Temperature, and Electrodermal Activity) through strict imputation protocols. We evaluated three model variants—Basic (clinical only), Air Pollution-added, and Social Media-integrated—while incorporating a novel Basal Module to personalize physiological baselines for each resident. Results: Results from the binary model indicate that physiological data provides a necessary baseline for immediate screening. Notably, social media integration emerged as a powerful forecasting tool, extending the predictive horizon to a 6-day lead time with an F1-score of 0.97. Complementarily, air pollution data ensured robust immediate detection (“nowcasting”). In the multiclass scenario, external data resolved the “semantic gap” of vital signs, improving sensitivity for specific infections (e.g., acute respiratory and urinary tract infections) to over 90%. Conclusions: These findings highlight that the strategic integration of environmental and digital signals transforms the system from a reactive monitor into a proactive early warning tool for long-term care facilities. Full article

(This article belongs to the Section Artificial Intelligence in Healthcare)

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13 pages, 393 KB

Open AccessArticle

“I Can Remember Thinking, Like Almost Wishing, That the Injuries Would Have Been Worse, Because Then I Wouldn’t Be Questioned”: A Qualitative Study on Women’s Experience of Accessing Healthcare for Intimate Partner Violence-Related Brain Injury

by Eve M. Valera, Isha Sanghvi, Sarah Rose Sitto, Jason Chua, Altaf Saadi and Alice Theadom

Healthcare 2026, 14(2), 165; https://doi.org/10.3390/healthcare14020165 - 8 Jan 2026

Abstract

Background/Objectives: To identify the barriers and facilitators to accessing healthcare following intimate partner violence (IPV)-related brain injury (BI). Methods: Sixteen adult women participated in interviews about their experience of accessing healthcare following IPV-related BI. Interviews were transcribed verbatim and analyzed using [...] Read more.

Background/Objectives: To identify the barriers and facilitators to accessing healthcare following intimate partner violence (IPV)-related brain injury (BI). Methods: Sixteen adult women participated in interviews about their experience of accessing healthcare following IPV-related BI. Interviews were transcribed verbatim and analyzed using the interpretative descriptive (ID) approach to identify themes and subthemes in the data. Results: Two themes, each with six subthemes related to healthcare seeking for IPV-related BI were identified: Theme 1—Deciding to seek and ability to access healthcare, comprising (a) severity of injury; (b) impact of injury; (c) ability to access medical services; (d) self-blame, fear, shame, and guilt; (e) contextual influences on healthcare seeking; and (f) previous negative interactions; and Theme 2—Complexity in identifying IPV-related BI, comprising (a) trauma can affect recall of events; (b) inability to distinguish IPV-related trauma or aging outcomes from BI sequelae; (c) the importance of trust in disclosure; (d) healthcare professionals need to ask the right questions and respond in the right way; (e) the complex nature of disclosure creates challenges for diagnosis; and (f) fear of being dismissed or judged. Conclusions: Many context-related factors influence whether women can seek treatment for IPV-related BIs. These factors need to be understood by first responders and medical professionals to improve the likelihood and speed of treatment seeking. Furthermore, challenges and fears associated with disclosure of IPV prevent women from seeking proper treatment. IPV training could be helpful in ensuring women feel safe with disclosure. Full article

(This article belongs to the Special Issue Accessing Treatment and Rehabilitation for Underserved Survivors of Brain Injury)

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12 pages, 234 KB

Open AccessArticle

A Proactive Health Behavior Framework for Cognitive Impairment in Chinese Older Adults: Based on a Four-Factor and Logistic Regression Analysis

by Shengjiang Wang and Hailun Liang

Healthcare 2026, 14(2), 164; https://doi.org/10.3390/healthcare14020164 - 8 Jan 2026

Abstract

Objective: In the context of an aging population, the prevention and control of cognitive impairment is a key public health priority. This study aims to investigate the association between proactive health behaviors and the risk of AD8 screening positivity in older adults [...] Read more.

Objective: In the context of an aging population, the prevention and control of cognitive impairment is a key public health priority. This study aims to investigate the association between proactive health behaviors and the risk of AD8 screening positivity in older adults in China, providing an empirical basis for developing targeted intervention strategies. Methods: Based on health behavior data from 1110 older adults in China, the chi-square test was used to analyze the differences in proactive health behaviors (such as limiting salt and alcohol intake, smoking cessation, and vaccination) between the low-risk and high-risk groups for AD8 screening. Factor analysis was used to extract the main factors of proactive health behaviors. Firth penalized logistic regression models were used to analyze the impact of the main factors and sociodemographic factors on the risk of cognitive impairment. Results: The chi-square test showed that there were significant differences between the two groups in salt restriction behavior (χ² = 18.063, p < 0.01) and vaccination (χ² = 29.674, p < 0.01), with a higher proportion of salt restriction (34.7%) and vaccination rates (80.4%) in the low-risk group. Factor analysis extracted four main factors (psychological–social support, information–behavior execution, technology–environment promotion, and addictive behavior control), with a cumulative variance contribution rate of 58.45%. Among them, psychological–social support (31.42% explained variance) and information–behavior execution (28.04%) had the strongest explanatory power. Firth penalized logistic regression showed that psychological–social support (Firth-corrected OR = 0.072, 95% CI: 0.035–0.148, p < 0.01) and information–behavior execution (Firth-corrected OR = 0.008, 95% CI: 0.003–0.021, p < 0.01) had significant protective effects on AD8 screening positivity (standardized OR values indicated that each one-standard-deviation increase in these two factors reduced screening-positive risk by 39% and 53%, respectively), and the risk increased by 21.7% for every 5-year increase in age (OR = 1.217, p = 0.001). Technology–environment promotion (OR = 0.417, 95% CI: 0.250–0.691, p = 0.001) and addictive behavior control (OR = 0.709, 95% CI: 0.490–1.026, p = 0.068) showed no significant protective effects. Sensitivity analysis confirmed the robustness of the four-factor structure and core conclusions. Conclusions: Among proactive health behaviors, psychological–social support and information–behavior execution are key protective factors in reducing the risk of AD8 screening positivity in older adults, and age is an important influencing factor. Strengthening psychological support and optimizing access to health information and behavior execution can serve as core strategies for cognitive impairment prevention and control, providing empirical support for the formulation of health policies for older adults. Full article

20 pages, 1081 KB

Open AccessArticle

A 23-Year Comprehensive Analysis of over 4000 Liver Transplants in Türkiye: Integrating Clinical Outcomes with Public Health Insights

by Deniz Yavuz Baskiran and Sezai Yilmaz

Healthcare 2026, 14(2), 163; https://doi.org/10.3390/healthcare14020163 - 8 Jan 2026

Abstract

Background: This study seeks to evaluate the 23 year experience of the İnonu University Liver Transplantation Institute from a public health perspective by examining demographic patterns, etiological factors, and transplantation trends between 2002 and 2025. Aims: This analysis aims to provide insights into [...] Read more.

Background: This study seeks to evaluate the 23 year experience of the İnonu University Liver Transplantation Institute from a public health perspective by examining demographic patterns, etiological factors, and transplantation trends between 2002 and 2025. Aims: This analysis aims to provide insights into the epidemiological landscape of liver transplantation in Türkiye from a public health perspective. Methods: In this retrospective cross sectional study, we analyzed 4011 liver transplant procedures performed between March 2002 and March 2025. Recipient demographics, disease etiologies, donor characteristics, and patients geographic distribution were assessed to delineate regional health needs and service utilization patterns. Results: A total of 4011 patients were included. The cohort comprised 2618 males (65.3%) and 1393 females (34.7%). Recipients were classified as adult (n = 3232, 80.9%) or pediatric (n = 779, 19.1%). Among adults, infectious etiologies were the most prevalent (35.5%), followed by cryptogenic liver cirrhosis (24.7%). In contrast, pediatric patients most commonly presented with toxic etiologies (29.4%), metabolic disorders (22.6%) and bile duct diseases (15.9%). Most liver transplantations were performed using living donors (n = 3481, 86.8%), while deceased donors accounted for 530 procedures (13.2%). Additionally, 244 living donor liver transplantations were performed via liver paired exchange (LPE). Conclusions: These findings may inform resource allocation, health policy development, and the optimization of transplantation services. This center-based model offers a useful framework for characterizing regional health needs and strengthening community health, particularly through prevention, screening, and early intervention strategies for liver diseases. Full article

(This article belongs to the Topic Application of Biostatistics in Medical Sciences and Global Health)

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12 pages, 822 KB

Open AccessArticle

Association Between Floor of Residence and Frailty in Walk-Up Buildings Among Functionally Independent Older Adults: A Cross-Sectional Study

by Masataka Ando, Naoto Kamide and Akie Kawamura

Healthcare 2026, 14(2), 162; https://doi.org/10.3390/healthcare14020162 - 8 Jan 2026

Abstract

Background/Objectives: Frailty has been associated with various physical, psychological, and social factors; however, the influence of the residential environment—particularly walk-up buildings without elevators—remains unclear. This study aimed to examine the association between the floor of residence and frailty among functionally independent older [...] Read more.

Background/Objectives: Frailty has been associated with various physical, psychological, and social factors; however, the influence of the residential environment—particularly walk-up buildings without elevators—remains unclear. This study aimed to examine the association between the floor of residence and frailty among functionally independent older adults. Methods: A total of 793 older adults (mean age: 76.46 ± 6.29 years; 58.83% women) living in walk-up buildings without elevators and not certified as requiring long-term care participated in a questionnaire survey. Frailty was assessed using the Kihon Checklist (KCL) and the FRAIL Scale (FS). Logistic regression analyses were conducted to examine the association between floor of residence and frailty status (non-frail vs. frail), adjusting for potential confounders. Sensitivity analyses were performed using stratified models based on age group, functional status, and living conditions. Results: Frailty prevalence was 23.28% (KCL) and 16.88% (FS). Higher floor of residence was significantly associated with lower odds of frailty (KCL: odds ratio [OR] = 0.82, 95% confidence interval [CI]: 0.69–0.97; FS: OR = 0.80, 95% CI: 0.65–0.97). Stratified analyses showed consistent associations in subgroups including those aged ≥ 75 years, with full Instrumental Activities of Daily Living scores, non-homebound status, poor subjective economic status, and living alone (all p < 0.05). Conclusions: Living on higher floors in walk-up buildings without elevators may be protective against frailty among functionally independent older adults. While barrier-free environments are essential for those with functional decline or disabilities, moderate physical challenges such as stairs may contribute to frailty prevention in populations who maintain independence. Full article

(This article belongs to the Section Public Health and Preventive Medicine)

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16 pages, 295 KB

Open AccessArticle

by Dawid Koźlenia, Rafał Szafraniec, Jakub Jarosz, Leszek Mazur and Jarosław Domaradzki

Healthcare 2026, 14(2), 161; https://doi.org/10.3390/healthcare14020161 - 8 Jan 2026

Abstract

Objectives: This study examined whether integrating an isometric exercise program into physical education (PE) lessons influences functional outcomes and cardiovascular risk markers in adolescents beyond the effects of standard PE alone. Methods: Boys aged 14–15 years were randomly assigned to an experimental group [...] Read more.

Objectives: This study examined whether integrating an isometric exercise program into physical education (PE) lessons influences functional outcomes and cardiovascular risk markers in adolescents beyond the effects of standard PE alone. Methods: Boys aged 14–15 years were randomly assigned to an experimental group (EG, n = 19) or a control group (CG, n = 21). The EG completed a 6-week isometric exercise program integrated into PE lessons, while the CG followed the regular PE curriculum only. The intervention was based on hold isometric muscle actions (HIMA) with progressively increased volume. Anthropometric measures included body height, body mass, and body mass index (BMI). Body composition was assessed using bioelectrical impedance analysis. Functional capacity was evaluated using field-based measures of lower-limb strength and power (isometric mid-thigh pull, standing broad jump, squat jump, and countermovement jump). Systolic and diastolic blood pressure were measured as indicators of cardiovascular health. Results: A mixed model ANOVA showed that no significant group × time interactions were observed for body composition, functional outcomes, or blood pressure (all p > 0.05). Lean body mass increased over time in both groups (p < 0.01). Improvements in isometric mid-thigh pull (p < 0.01) and standing broad jump (p = 0.01) occurred irrespective of group allocation. Blood pressure remained unchanged. Linear regression revealed that biological maturation did not moderate intervention effects; however, more mature participants demonstrated higher absolute strength levels independent of the intervention (p < 0.05). Conclusions: The inclusion of an isometric exercise program within PE lessons did not provide additional benefits for health-related functional outcomes beyond standard PE alone. In its current format, isometric exercise does not appear to add sufficient value to justify its implementation as a stand-alone strategy in school-based PE. Full article

(This article belongs to the Special Issue Educational Practices for Health in Physical Education and Psychomotricity)

12 pages, 1012 KB

Open AccessFeature PaperArticle

Acute Effects of a Mini-Trampoline Training Session for Improving Normalized Symmetry Index in Participants with Higher Baseline Inter-Limb Asymmetry

by Olga Papale, Emanuel Festino, Marianna De Maio, Francesca Di Rocco, Silvia Zema, Cristina Cortis and Andrea Fusco

Healthcare 2026, 14(2), 160; https://doi.org/10.3390/healthcare14020160 - 8 Jan 2026

Abstract

Background: Inter-limb asymmetry has implications for both athletic performance and healthcare practice. High baseline inter-limb asymmetries have been associated with impaired mobility, increased fall risk, and musculoskeletal injuries across the lifespan. Exercise interventions able to stimulate the stretch–shortening cycle (e.g., plyometric training [...] Read more.

Background: Inter-limb asymmetry has implications for both athletic performance and healthcare practice. High baseline inter-limb asymmetries have been associated with impaired mobility, increased fall risk, and musculoskeletal injuries across the lifespan. Exercise interventions able to stimulate the stretch–shortening cycle (e.g., plyometric training and jump training) have been shown to have a good impact on asymmetries. Among these, Mini-Trampoline Training (MTT) has recently emerged as potentially effective in reducing asymmetries. Objectives: The study aimed to evaluate the acute effects of a single MTT session on muscle power and inter-limb asymmetry in young adults. Methods: Twenty-eight recreationally active participants (25.6 ± 2.4 years) completed one MTT session. Before (PRE) and after (POST) the MTT session, single-leg 6 m Timed Hop (6MTH) and countermovement jump (CMJ) tests were administered. Additionally, 6MTH values of the dominant (DOM) and non-dominant (NODOM) limbs were used to stratify participants according to higher (HBIA) or lower (LBIA) baseline inter-limb asymmetry, based on a commonly adopted Normalized Symmetry Index (NSI) threshold (NSI ≥ 10%, n = 12; NSI < 10%, n = 16). Repeated-measures mixed models were used to evaluate the effects of the MTT session on 6MTH, NSI, and CMJ. Results: Regardless of group and limb, significant (p < 0.0001) improvements in 6MTH (PRE: 2.5 ± 0.06 s; POST: 2.3 ± 0.05 s) were found. Interestingly, the MTT session had a significant (p = 0.01) effect on both groups, with a significant (p = 0.003) interaction with NSI values, showing an improvement for HBIA (PRE = 15.4 ± 1.1%, POST = 11.3 ± 2.1%), whereas a decrement in LBIA was recorded (PRE = 5.1 ± 0.6%, POST = 9.6 ± 1.5%). CMJ did not show any changes in HBIA (PRE: 36.2 ± 0.9 cm; POST: 35.1 ± 0.7 cm), while a significant (p = 0.007) decrease was found in LBIA (PRE: 34.8 ± 1.2 cm; POST: 33.2 ± 1.3 cm). Conclusions: A single MTT session induced acute neuromuscular fatigue, reflected by reduced CMJ performance and improved (~8%) inter-limb control during hopping. The HBIA group preserved jump height (~36 cm) and demonstrated a significant reduction in asymmetry (NSI: −4.1%), suggesting more balanced lower-limb recruitment. Conversely, LBIA showed a significant decrease in CMJ and an increased NSI (+4.5%), possibly reflecting fatigue-related compensatory strategies. Overall, a single MTT elicited distinct responses according to baseline asymmetry, supporting its potential as an adaptable modality for enhancing neuromuscular function in HBIA. Full article

(This article belongs to the Special Issue Exercise Biomechanics: Pathways to Improve Health)

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26 pages, 617 KB

Open AccessSystematic Review

Distribution of Candida Species Causing Oral Candidiasis in High-Risk Populations: A Systematic Review

by João Pedro Carvalho, Jéssica Rodrigues, Célia Fortuna Rodrigues, José Carlos Andrade and António Rajão

Healthcare 2026, 14(2), 159; https://doi.org/10.3390/healthcare14020159 - 8 Jan 2026

Abstract

Background: In the last decade, infections caused by Candida species have increased. Although C. albicans remains the most predominant species, fungal infections caused by non-albicans Candida (NAC) species have also been rising. This study aimed to determine which Candida spp. are most [...] Read more.

Background: In the last decade, infections caused by Candida species have increased. Although C. albicans remains the most predominant species, fungal infections caused by non-albicans Candida (NAC) species have also been rising. This study aimed to determine which Candida spp. are most frequently associated with oral candidiasis. Methods: In accordance with PRISMA guidelines, a literature search was conducted in the PubMed, Cochrane Library, and ScienceDirect databases. The search used the keyword combination “candida spp” AND “oral candidiasis” AND “oral isolates” and included articles published between 2013 and 31 October 2025. Results: A total of 658 articles were identified, of which 24 met the inclusion criteria. Across these studies, 12,750 isolates were reported. C. albicans was the most prevalent species, accounting for 81.7% of all isolates. NAC species were detected at lower frequencies, including C. tropicalis (7.2%), C. glabrata (4.5%), C. krusei (4.1%), C. parapsilosis (1.0%), C. dubliniensis (0.8%), C. kefyr (0.2%), C. guilliermondii (0.1%), C. lusitaniae (0.1%), and other rare or unidentified species (0.2%). The increasing prevalence of Candida infections is associated with a growing population of immunocompromised individuals, and treatment remains challenging due to rising antifungal resistance. Conclusions: Although C. albicans remains the most prevalent, the appearance of NAC species is gradually increasing. With the increase of Candida spp. resistant to conventional antifungal agents and with the competitive or synergistic interaction between Candida spp., it is necessary to develop new therapeutic approaches. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Health Care: Third Edition)

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13 pages, 276 KB

Open AccessArticle

Psychological Distress and Health-Related Quality of Life in Romanian Adults with Diabetes Mellitus: A Cross-Sectional Study

by Lucia Bubulac, Carmen Gabriela Dobjanschi, Mirela Zivari, Constantin Erena, Viorica Tudor, Arsenie Dan Spînu, Gabriela Cornelia Muşat, Claudia Florina Bogdan-Andreescu, Emin Cadar and Cristina-Crenguța Albu

Healthcare 2026, 14(2), 158; https://doi.org/10.3390/healthcare14020158 - 8 Jan 2026

Abstract

Background: Psychological distress is increasingly recognized as an important determinant of health-related quality of life (HRQoL) in adults with diabetes mellitus (DM). However, data quantifying this burden in Eastern European populations remains limited. Objectives: This study aimed to assess psychological distress—defined as anxiety, [...] Read more.

Background: Psychological distress is increasingly recognized as an important determinant of health-related quality of life (HRQoL) in adults with diabetes mellitus (DM). However, data quantifying this burden in Eastern European populations remains limited. Objectives: This study aimed to assess psychological distress—defined as anxiety, depressive symptoms, or perceived stress—and HRQoL among Romanian adults with DM compared with healthy controls, and to explore potential differences between diabetes subtypes. Methods: A cross-sectional study was conducted, including 400 adults (201 with DM and 199 healthy controls). Psychological distress was evaluated using the State–Trait Anxiety Inventory (STAI-Y1, STAI-Y2), Beck Depression Inventory (BDI), and Holmes–Rahe Stress Scale, while HRQoL was assessed using the EQ-5D Visual Analogue Scale. Group comparisons were performed using appropriate parametric or non-parametric tests, with additional multivariable analyses adjusting for age, sex, and body mass index. Results: Adults with diabetes exhibited significantly higher levels of anxiety, depressive symptoms, and perceived stress, and lower HRQoL, compared with controls (all p < 0.001). These differences remained statistically significant after adjustment for age, sex, and body mass index. Exploratory analyses revealed no statistically significant differences between diabetes subtypes, although subgroup comparisons were limited by sample size. Conclusions: Psychological distress is highly prevalent among Romanian adults with DM and is associated with poorer self-perceived health-related quality of life. The results support the relevance of incorporating systematic psychosocial assessment into routine diabetes care. Full article

(This article belongs to the Special Issue Psychodiabetology: The Psycho-Social Challenges of Diabetes)

13 pages, 232 KB

Open AccessArticle

Personality Traits and Sociodemographic Correlates in Saudi Arabia: A DSM-5 AMPD Criterion B Study Using the PID-5-BF

by Saleh A. Alghamdi, Renad Khalid Alqahtani, Nawaf Fahad Bin Othaim and Farah Fahad AL-Muqrin

Healthcare 2026, 14(2), 157; https://doi.org/10.3390/healthcare14020157 - 8 Jan 2026

Abstract

Introduction: Personality disorders are enduring, maladaptive patterns that impair social and vocational functioning. The DSM-5 Alternative Model for Personality Disorders (AMPD) distinguishes Criterion A (personality functioning: identity, self-direction, empathy, intimacy) from Criterion B (maladaptive trait domains: negative affectivity, detachment, antagonism, disinhibition, psychoticism). We [...] Read more.

Introduction: Personality disorders are enduring, maladaptive patterns that impair social and vocational functioning. The DSM-5 Alternative Model for Personality Disorders (AMPD) distinguishes Criterion A (personality functioning: identity, self-direction, empathy, intimacy) from Criterion B (maladaptive trait domains: negative affectivity, detachment, antagonism, disinhibition, psychoticism). We frame this study within Criterion B, supporting the use of a dimensional approach that complements (rather than replaces) normative models like the Five-Factor Model (FFM) and addresses cross-cultural gaps amid Saudi Arabia’s rapid sociocultural change such as the reforms associated with Vision 2030. Given Saudi Arabia’s collectivist orientation and evolving sociocultural norms under Vision 2030, the dimensional approach of the AMPD Criterion B offers a culturally sensitive lens for capturing personality pathology beyond Western-centric diagnostic models. Aim: We aimed to examine how PID-5-BF maladaptive trait domains vary across key sociodemographic factors in Saudi adults. Subjects and Methods: This was a quantitative, cross-sectional analytical study conducted among Saudi adults using the PID-5-BF Convenience sampling was performed via the dissemination of an online survey; we aimed for 377 participants and obtained 343 completed responses (~91% of the target sample). For trait assessment, we used the PID-5-BF; analyses compared domains across sociodemographic groups. Results: Females showed a higher negative affect; participants ≤ 30 years exhibited higher psychoticism than those >40; and single individuals reported lower detachment and psychoticism than their married peers. Conclusions: Gender, age, and marital status are associated with differences in maladaptive trait expression, supporting the need for culturally tailored screening and interventions in Saudi mental health services. These findings should be interpreted with caution given the fact that WhatsApp-based convenience sampling was used, which may bias the results as the respondents were more likely to live in urban areas, be educated, and be technologically proficient. Full article

23 pages, 818 KB

Open AccessReview

The Role of Temporality in Virtual Reality Interventions for Depressive Episodes—A Scoping Review

by Volha Saroka, Tomir Jędrejek, Marcin Trybulec and Zuzanna Aleksandra Rucińska

Healthcare 2026, 14(2), 156; https://doi.org/10.3390/healthcare14020156 - 7 Jan 2026

Abstract

Background/Objectives: People living with depression often experience consistent disruptions in their experience of time, which further contributes to their suffering. We present a scoping review on virtual reality (VR)-based interventions for depression, addressing temporal processing and subjective experiences of time. The paper aims [...] Read more.

Background/Objectives: People living with depression often experience consistent disruptions in their experience of time, which further contributes to their suffering. We present a scoping review on virtual reality (VR)-based interventions for depression, addressing temporal processing and subjective experiences of time. The paper aims to explore the extent to which therapeutic interventions using VR target the temporal dimension of patients’ experiences. Methods: We conducted a scoping review using the PRISMA 2020 standard. The literature search was further extended using Research Rabbit and by examining the reference lists of relevant articles. Seventeen papers were selected for final analysis. Results: Our scoping review indicates that temporality in VR-based therapeutic interventions for depression remains underrepresented. Of the seventeen papers reviewed, only two explicitly deal with this issue, while the rest touch upon it briefly or implicitly. The studies suggest that VR’s main advantage in modifying the experience of time in depression is its potential to generate immersion and to scaffold imagination through visualization. The main limitations are methodological: most of the available research is exploratory, reports short-term effects, and utilizes a broad variety of empirical designs and therapeutic approaches. Full article

(This article belongs to the Special Issue New Technologies for Understanding and Enhancing Lived Temporality in Chronic Illness)

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12 pages, 272 KB

Open AccessArticle

Pre-Competition Stress in Female Volleyball Players: The Role of Experience, Sleep, and Coping

by Kamila Litwic-Kaminska

Healthcare 2026, 14(2), 155; https://doi.org/10.3390/healthcare14020155 - 7 Jan 2026

Abstract

Background/Objectives: Athletes face both daily and sport-related stressors while being expected to perform at an optimal level. Effective recovery, particularly adequate sleep, plays a key role in psychophysiological restoration and performance, whereas sleep deprivation may impair functioning and increase perceived stress. This [...] Read more.

Background/Objectives: Athletes face both daily and sport-related stressors while being expected to perform at an optimal level. Effective recovery, particularly adequate sleep, plays a key role in psychophysiological restoration and performance, whereas sleep deprivation may impair functioning and increase perceived stress. This study examined the associations between coping strategies, sleep quality, athletic experience, competitive level, and perceived stress during the pre-competition period among female volleyball players. Methods: Ninety-one athletes (aged 18–35, M = 23.03, SD = 4.37) from three Polish professional leagues—Tauron (n = 31), First League (n = 30), and Second League (n = 30)—completed an online battery including the Stress Coping Strategies in Sport Questionnaire (SR3S), the Perceived Stress Scale (PSS-4), the Pittsburgh Sleep Quality Index (PSQI), and a demographic survey. Results: Based on PSQI scores, approximately 60% of the athletes were classified as poor sleepers. No significant differences in sleep quality or perceived stress were found across leagues. However, athletes competing in higher leagues reported more frequent use of mental coping strategies. Athletic experience, sleep quality, and the coping strategy of seeking social support were significantly associated with perceived stress. Players with less experience, poorer sleep, and a greater tendency to seek social support reported higher stress levels. The positive association between support-seeking and stress likely reflects reactive coping among more stressed athletes rather than a maladaptive effect of social support. Conclusions: These findings underscore the importance of promoting adaptive coping and sleep hygiene in competitive sport, particularly among less experienced female athletes during the pre-competition period. Full article

(This article belongs to the Special Issue Creating Connection Between Physical and Mental Health in Physical Activity, Physical Exercise and Sport Across the Lifespan)

16 pages, 694 KB

Open AccessArticle

Feasibility of Recruiting Psychiatrically Hospitalized Adults for a Randomized Controlled Trial of an Animal-Assisted Intervention

by Lisa Townsend, Nancy R. Gee, Erika Friedmann, Megan K. Mueller, Tushar P. Thakre and Sandra B. Barker

Healthcare 2026, 14(2), 154; https://doi.org/10.3390/healthcare14020154 - 7 Jan 2026

Abstract

Background/Objectives: Evaluating the feasibility of randomized controlled trials (RCTs) represents a critical next step for advancing human–animal interaction (HAI) science and rigorously exploring the role of animal-assisted interventions (AAIs) in psychiatric acute care. This study presents strategies for conducting a pilot RCT [...] Read more.

Background/Objectives: Evaluating the feasibility of randomized controlled trials (RCTs) represents a critical next step for advancing human–animal interaction (HAI) science and rigorously exploring the role of animal-assisted interventions (AAIs) in psychiatric acute care. This study presents strategies for conducting a pilot RCT comparing an animal-assisted intervention involving dogs (AAI) with an active conversational control (CC), which incorporated conversation with a human volunteer, and treatment as usual (TU) for improving mental health outcomes in psychiatrically hospitalized adults. Methods: We recruited participants from an acute-care psychiatric unit at an academic medical center. AAI and CC were delivered by volunteer handlers with and without their registered therapy dogs. Feasibility data included number of recruitment contacts, recruitment rate, and reasons for non-enrollment. We describe recruitment challenges encountered and mitigating strategies for successful study completion. Results: Recruitment occurred over 23 months with a goal of 60 participants participating in at least one intervention day. A total of 264 patients were referred to the study and 72 enrolled. The additional 12 people were recruited to replace participants who did not complete any intervention days and did not provide any intervention data. Study recruitment goals were met with a recruitment rate of 27.30%. Conclusions: Research to improve the lives of patients in acute psychiatric care is a vital public health goal, yet RCTs are difficult to conduct in acute care settings. Studies like this strengthen HAI and psychiatric science by providing a roadmap for implementing successful AAI RCT designs. 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, 2097 KB

Open AccessArticle

Sexual Dysfunction in Individuals with Early-Onset Parkinson’s Disease in Ethiopia: Gender Differences and Correlation with Anti-Parkinson’s Medication, Stigma, and Distress

by Arefayne Alenko, Morankar Sudhakar, Legese Chelkeba and Ines Keygnaert

Healthcare 2026, 14(2), 153; https://doi.org/10.3390/healthcare14020153 - 7 Jan 2026

Abstract

Background: Sexual dysfunction (SD) affects up to two-thirds of individuals with early-onset Parkinson’s disease (PD), yet it remains underexplored in developing countries where stigma, depression, and treatment side effects may worsen its burden. This study investigated the magnitude and correlation of SD [...] Read more.

Background: Sexual dysfunction (SD) affects up to two-thirds of individuals with early-onset Parkinson’s disease (PD), yet it remains underexplored in developing countries where stigma, depression, and treatment side effects may worsen its burden. This study investigated the magnitude and correlation of SD in early-onset PD. Methods: A cross-sectional study included 74 individuals with PD onset at ≤55 years of age. SD was assessed using the Medical Outcomes Study Sexual Functioning Scale, alongside interviews on sexual experiences after initiating PD medication. Prevalence was estimated descriptively, and Spearman’s correlation identified correlates of SD. Results: Half of participants reported SD, including lack of sexual interest (52.7%), difficulty relaxing or enjoying sex (52.7%), and impaired arousal (50%). Among men, 48% experienced erectile problems, while 44% of women reported difficulty achieving orgasm. After starting anti-Parkinson’s medication, 16% noted markedly reduced sexual desire, whereas nearly 10% reported increased desire. In men, SD correlated with levodopa dose (r = 0.411, p < 0.01). In women, SD correlated with stigma (r = 0.389, p < 0.05), depression (r = 0.529, p < 0.01), and anxiety (r = 0.629, p < 0.01). Conclusions: One in two individuals with early-onset PD experiences SD, independent of gender. Findings highlight the need for routine sexual health assessment and careful monitoring of treatment side effects. Interventions targeting stigma, depression, and anxiety are critical to improve sexual well-being in this population. Full article

(This article belongs to the Special Issue Advances in Chronic Disease Management, Rehabilitation, and Health Outcomes)

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20 pages, 594 KB

Open AccessArticle

Cognitive Functioning in Rural Older Adults: The Mediating Role of Perceived Social Support

by Marko Krnjajić, Željko Mudri, Marija Barišić, Ivana Barać, Jasenka Vujanić, Maja Čebohin, Robert Lovrić, Katarina Major Poljak and Nikolina Farčić

Healthcare 2026, 14(2), 152; https://doi.org/10.3390/healthcare14020152 - 7 Jan 2026

Abstract

Background: Aging is a multidimensional process influenced by biological, psychological, and social factors. Social support contributes to cognitive reserve by reducing stress, promoting mental engagement, and reinforcing a sense of belonging. Objective: To examine the association between perceived social support and cognitive functioning [...] Read more.

Background: Aging is a multidimensional process influenced by biological, psychological, and social factors. Social support contributes to cognitive reserve by reducing stress, promoting mental engagement, and reinforcing a sense of belonging. Objective: To examine the association between perceived social support and cognitive functioning among older adults, and to investigate whether social support mediates the relationship between living arrangements and cognitive performance. Methods: The sample included 265 older adults aged 65 years and above, recruited using snowball sampling between March and July 2025 in rural communities. Instruments included the Montreal Cognitive Assessment for cognitive function and the Multidimensional Scale of Perceived Social Support for social support. Results: In this study, higher perceived social support from family, friends, and significant others was associated with better cognitive performance. Multiple regression showed that all three dimensions of social support significantly predicted MoCA scores, with the strongest effect from friends’ support. Mediation analysis revealed that perceived social support mediated the relationship between living arrangements and cognitive functioning, while the direct effect of cohabitation alone was not significant. Conclusions: These results highlight the importance of perceived social support in preserving cognitive health in older adults. Full article

(This article belongs to the Special Issue Aging and Older Adults’ Healthcare)

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16 pages, 367 KB

Open AccessArticle

Translation, Cross-Cultural Adaptation, and Validation of the Croatian Version of the SARC-F Questionnaire for Assessing Sarcopenia in Older Adults

by Edina Pulić, Ivna Kocijan, Mirjana Telebuh, Ivan Jurak, Tatjana Njegovan Zvonarević, Lana Feher Turković, Vlatko Brezac, Želimir Bertić, Miljenko Franić, Klara Turković and Ana Mojsović Ćuić

Healthcare 2026, 14(2), 151; https://doi.org/10.3390/healthcare14020151 - 7 Jan 2026

Abstract

Background/Objectives: Sarcopenia is a growing public health challenge in older adults, being associated with functional decline, frailty, and increased mortality. The SARC-F questionnaire is a widely recommended screening tool for sarcopenia; however, no validated Croatian version has been available so far. This study [...] Read more.

Background/Objectives: Sarcopenia is a growing public health challenge in older adults, being associated with functional decline, frailty, and increased mortality. The SARC-F questionnaire is a widely recommended screening tool for sarcopenia; however, no validated Croatian version has been available so far. This study aimed to translate, culturally adapt, and validate the Croatian version of the SARC-F questionnaire for older adults. Methods: In a cross-sectional design, 153 participants aged ≥ 65 years from Zagreb and Bjelovar were enrolled between March and September 2025. Psychometric evaluation included internal consistency (Cronbach’s α), test–retest reliability (intraclass correlation coefficient, ICC), item–total correlations, and split-half reliability. Convergent validity was assessed via correlations with handgrip strength (HGS), Short Physical Performance Battery (SPPB), and timed up-and-go (TUG) tests. Known groups and construct validity were also examined. Results: The Croatian SARC-F showed good internal consistency (Cronbach’s α = 0.76; 95% CI: 0.70–0.82), with item–total correlations ranging from 0.34 (falls) to 0.80 (stairs) and excellent test–retest reliability (ICC = 0.86). Strong correlations were found with SPPB (ρ = −0.50; p < 0.001), TUG (ρ = 0.50; p < 0.001), and handgrip strength (ρ = −0.42; p < 0.001), supporting convergent validity. An exploratory factor analysis indicated a unidimensional structure explaining 43% of the variance. Conclusions: The Croatian version of SARC-F is a reliable, valid, and clinically feasible tool for identifying older adults who are at risk of sarcopenia. The results support its use in national screening and cross-cultural research across Europe. Full article

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27 pages, 20963 KB

Open AccessArticle

Mitigating Home Environmental Asthma Triggers in Subsidized Housing: Experiences of Caregivers and Healthcare Workers

by Meirong Liu, Jae Eun Chung, Janet Currie, Irene Park, Dharmil Bhavsar, Sarah Ali Carlis, Imani Cabassa-George, Kyaus Washington and Minxuan Lan

Healthcare 2026, 14(2), 150; https://doi.org/10.3390/healthcare14020150 - 7 Jan 2026

Abstract

Background/Objectives: Pediatric asthma remains a pressing public health issue, especially among low-income, minority children living in subsidized housing. Methods: This study employed a community-based participatory research approach to explore barriers and potential solutions for improving asthma management in this vulnerable population. Semi-structured interviews [...] Read more.

Background/Objectives: Pediatric asthma remains a pressing public health issue, especially among low-income, minority children living in subsidized housing. Methods: This study employed a community-based participatory research approach to explore barriers and potential solutions for improving asthma management in this vulnerable population. Semi-structured interviews were conducted with 22 caregivers of children with asthma and 8 community health workers in Washington, DC—a city marked by high childhood asthma rates and concentrated subsidized housing. Results: Thematic analysis identified six core findings: (1) families frequently encountered multiple home environmental asthma triggers, including pests, mold, secondhand smoke, leaks, poor ventilation, and aging infrastructure; (2) healthy housing services were under implemented, often due to unresponsive landlords, inadequate inspections, and poor maintenance; (3) existing services such as pest control, mold remediation, and smoke-free policies were ineffectively implemented; (4) challenges to service delivery included difficulties faced by landlords and structural barriers tied to geography, race, and socioeconomic status; (5) substandard housing conditions contributed to residents’ feelings of powerlessness, frustration, and distrust, with some taking legal action to address persistent hazards; and (6) participants recommended stronger housing code enforcement, sustained funding for home-based environmental interventions, housing-health liaisons, strengthened landlord accountability, support for landlords to facilitate repairs, centering families’ voices, and advocacy. Conclusions: This study underscores the persistent challenges caregivers face in managing asthma triggers in subsidized housing. The findings highlight the critical need for improved housing conditions, greater landlord and housing authority accountability, and policy reforms to ensure consistent, equitable, and sustainable healthy housing services that reduce pediatric asthma disparities. Full article

(This article belongs to the Section Women’s and Children’s Health)

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27 pages, 998 KB

Open AccessReview

Digital Approaches to Pain Assessment Across Older Adults: A Scoping Review

by Leanne McGaffin, Gary Mitchell, Tara Anderson, Arnelle Gillis and Stephanie Craig

Healthcare 2026, 14(2), 149; https://doi.org/10.3390/healthcare14020149 - 7 Jan 2026

Abstract

Background: Effectively managing pain in adults remains challenging, particularly in individuals with cognitive impairment or communication difficulties. Digital technologies, including artificial intelligence (AI)-enabled facial recognition and mobile applications, are emerging as innovative tools to improve the objectivity and consistency of pain evaluation. This [...] Read more.

Background: Effectively managing pain in adults remains challenging, particularly in individuals with cognitive impairment or communication difficulties. Digital technologies, including artificial intelligence (AI)-enabled facial recognition and mobile applications, are emerging as innovative tools to improve the objectivity and consistency of pain evaluation. This scoping review aimed to map the current evidence on digital pain-assessment tools used with adult and older populations, focusing on validity, reliability, usability, and contributions to person-centred care. Methods: The review followed the Joanna Briggs Institute methodology and Arksey and O’Malley framework and was reported in accordance with PRISMA-ScR guidelines. Systematic searches were conducted in PubMed, CINAHL Complete, Medline (ALL), and PsycINFO for English-language studies published from 2010 onwards. Eligible studies included adults (≥18 years) using digital tools for pain assessment. Data extraction and synthesis were performed using Covidence, and findings were analyzed thematically. Results: Of 1160 records screened, ten studies met inclusion criteria. Most research was quantitative and conducted in high-income clinical settings. Five tools were identified: ePAT/PainChek^®, Painimation, PainCAS, Pain Clinical Assessment System, and Active Appearance Model. Four key themes emerged: (1) Validity and Reliability of Digital Pain Assessment Tools; (2) Comprehensive Pain Evaluation Across Contexts (Rest vs. Movement); (3) Usability and Integration into Clinical Practice; (4) Enabling Person-Centred Pain Management and Future Directions. Conclusions: Emerging evidence suggests that facial-recognition-based digital pain-assessment tools may demonstrate acceptable psychometric performance and usability within dementia care settings in high-income countries. However, evidence relating to broader adult populations, diverse care contexts, and low-resource settings remains limited, highlighting important gaps for future research. Full article

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15 pages, 239 KB

Open AccessArticle

Race, Breastfeeding Support, and the U.S. Infant Formula Shortage: An Exploratory Cross-Sectional Study

by John P. Bartkowski, Katherine Klee, Stephen Bartkowski, Ginny Garcia-Alexander, Jacinda B. Roach and Shakeizia (Kezi) Jones

Healthcare 2026, 14(2), 148; https://doi.org/10.3390/healthcare14020148 - 7 Jan 2026

Abstract

Background/Objectives: African American women are less likely to breastfeed in general and to breastfeed exclusively for the first six months of infancy. Racial and ethnic breastfeeding disparities are especially pronounced in the South, particularly in rural communities. These differences are attributed largely to [...] Read more.

Background/Objectives: African American women are less likely to breastfeed in general and to breastfeed exclusively for the first six months of infancy. Racial and ethnic breastfeeding disparities are especially pronounced in the South, particularly in rural communities. These differences are attributed largely to structural lactation impediments that include less breastfeeding support in healthcare settings, workplaces, and communities. While a great deal of research has explored racial differences in breastfeeding, minimal attention has been paid to the social correlates and racial disparities associated with the 2022 U.S. infant formula shortage. Our study explores racial distinctions in the formula shortage’s effect on breastfeeding support among Gulf Coast Mississippians. Methods: We use data from the second wave of the Mississippi REACH (Racial and Ethnic Approaches to Community Health) Social Climate Survey to determine if racial differences are evident in the formula shortage’s influence on breastfeeding support. We predict that the infant formula shortage will have prompted African American respondents to become much more supportive of breastfeeding than their White counterparts, net of sociodemographic controls. This hypothesis is based on the lower prevalence of exclusive breastfeeding among African Americans, thereby indicating a greater reliance on formula. The study uses a general population (random digit dial) sample and purposive (exclusively African American) oversample to analyze validated data from a cross-sectional survey. Sampling took place between September and December 2023, with a sample population of adult male and female Mississippians. A series of binary logistic regression models were employed to measure the association of race with breastfeeding support changes resulting from the infant formula shortage. Results: The study results support the hypothesis, as seen by a positive association between African Americans and increased breastfeeding support directly related to the infant formula shortage. Further, the baseline statistical model reveals African American respondents to be five times more likely than White respondents (p < 0.001) to report that the formula shortage increased their support of breastfeeding. Conclusions: We conclude by discussing this study’s implications and promising directions for future research. Full article

24 pages, 985 KB

Open AccessReview

A Scoping Review of African Health Histories from the Pre-Colonial to SDG Eras: Insights for Future Health Systems

by Humphrey Karamagi, Chinwe Iwu-Jaja, Akhona V. Mazingisa, Abdu A. Adamu, Elizabeth O. Oduwole, Anabay Mamo, Sokona Sy and Charles S. Wiysonge

Healthcare 2026, 14(2), 147; https://doi.org/10.3390/healthcare14020147 - 7 Jan 2026

Abstract

Background: This scoping review aims to systematically examine the extent of the literature on African health histories throughout the pre-colonial, colonial, post-independence, primary health care (PHC), Millennium Development Goals (MDG), and Sustainable Development Goals (SDG) periods. Methods: This scoping review followed the Arksey [...] Read more.

Background: This scoping review aims to systematically examine the extent of the literature on African health histories throughout the pre-colonial, colonial, post-independence, primary health care (PHC), Millennium Development Goals (MDG), and Sustainable Development Goals (SDG) periods. Methods: This scoping review followed the Arksey and O’Malley framework, enhanced by Levac’s updates and adaptations from the Joanna Briggs Institute’s methodology. Data from eligible records were extracted based on inclusion criteria and summarized narratively. Results: We included 83 records, of which the majority (n = 70) were narrative reviews. Eighteen of these provide evidence from Africa as a whole, while country-specific evidence was obtained from 21 countries. South Africa had the most records (n = 17), followed by Ghana (n = 6) and Nigeria (n = 6). The majority of evidence came from the colonial period (n = 13), followed by the PHC and MDG periods (n = 12 each). Health systems in the pre-colonial era were rooted in indigenous practices and community-driven systems; the colonial period introduced Western-style health care systems; the post-independence period focused on health promotion initiatives and infectious disease eradication; the PHC era focused on community-centered health care and equitable service provision; the MDG era expanded on targeted interventions for infectious diseases, and the SDG era aims to build resilient and inclusive health care systems towards universal health coverage. Conclusion: This review revealed diverse influences on health systems from the pre-colonial to SDG eras. However, these records are not exhaustive and require country-specific records, archived documents, and a centralized repository. Addressing these gaps will provide a comprehensive understanding of African health histories and aid in future health interventions. Full article

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8 pages, 207 KB

Open AccessArticle

Sociodemographic and Health-Seeking Factors Associated with First-Trimester Prenatal Care: A Cross-Sectional Study of PRAMS Data

by Melissa B. Eggen, Seyed M. Karimi, Liza Creel, Bertis Little and Bridget Basile

Healthcare 2026, 14(2), 146; https://doi.org/10.3390/healthcare14020146 - 7 Jan 2026

Abstract

Objective: This study assessed sociodemographic, health-seeking and social services related factors associated with first-trimester prenatal care. Study Design: This cross-sectional study used Phase 8 pooled data from the Kentucky Pregnancy Risk Assessment Monitoring System (PRAMS) for 2017 to 2020 and 2022. [...] Read more.

Objective: This study assessed sociodemographic, health-seeking and social services related factors associated with first-trimester prenatal care. Study Design: This cross-sectional study used Phase 8 pooled data from the Kentucky Pregnancy Risk Assessment Monitoring System (PRAMS) for 2017 to 2020 and 2022. A logistic regression model was used to estimate unadjusted and adjusted odds ratios and 95% confidence intervals. Results: Among the 3502 women in the analytic sample, 89.3% had first-trimester prenatal care. Most respondents were White (weighted percentage, 83.3%), between the ages of 25 and 29 (31.2%), had more than a high school education (59.5%), were married (59.8%), lived in an urban area (59.4%), and had public insurance (53.9%). Maternal education was associated with the highest odds of first-trimester prenatal care, relative to other covariates, and was highest among those who completed more than high school (aOR 4.23, 95% CI 2.72–6.59) and high school (aOR 3.09, 95% CI 2.06–4.64) relative to less than high school. Private insurance, having a healthcare visit one year prior to pregnancy, and WIC receipt during pregnancy were associated with higher odds of first-trimester prenatal care. Conclusions: The findings of this study suggest that sociodemographic factors and access to healthcare and social services are important factors in first-trimester prenatal care. Full article

(This article belongs to the Special Issue Nursing in Women’s Health: Contemporary Approaches to Maternal and Gynecological Care)

28 pages, 621 KB

Open AccessArticle

Integrating Artificial Intelligence (AI) in Primary Health Care (PHC) Systems: A Framework-Guided Comparative Qualitative Study

by Farzaneh Yousefi, Reza Dehnavieh, Maude Laberge, AliAkbar Haghdoost, Maxime Sasseville, Somayeh Noori Hekmat, Mohammad Mehdi Ghaemi and Mohsen Nadali

Healthcare 2026, 14(2), 145; https://doi.org/10.3390/healthcare14020145 - 7 Jan 2026

Abstract

Background/Objectives: The integration of artificial intelligence (AI) into primary health care (PHC) holds significant potential to enhance efficiency, equity, and clinical decision-making. However, its implementation remains uneven across contexts. This study aimed to identify the systemic, contextual, and governance-related determinants influencing AI [...] Read more.

Background/Objectives: The integration of artificial intelligence (AI) into primary health care (PHC) holds significant potential to enhance efficiency, equity, and clinical decision-making. However, its implementation remains uneven across contexts. This study aimed to identify the systemic, contextual, and governance-related determinants influencing AI readiness in PHC, comparing two distinct health systems, Quebec (Canada) and Iran. Methods: A qualitative, comparative design was employed. Data were collected through semi-structured interviews and focus group discussions with key informants in both settings. A framework-guided content analysis was conducted based on the four Primary Care Evaluation Tool (PCET): stewardship, financing, resource generation, and service delivery. The analysis explored shared context-specific challenges and requirements for AI implementation in PHC. Results: Analysis revealed that AI readiness is shaped more by systemic coherence rather than technological availability alone. Across both contexts, governance- and financing-related challenges were reported by the majority of participants, alongside limited data interoperability. In Quebec, challenges were more commonly articulated around operational and ethical concerns, including workflow integration, transparency, and professional trust. In contrast, participants in Iran emphasized foundational deficiencies in governance stability, financing mechanisms, and digital infrastructure as primary barriers. Across both settings, adaptive governance, sustainable investment, data standardization, and workforce capacity-building consistently emerged as key requirements for AI integration in PHC. Conclusions: AI readiness in PHC is a multidimensional process, in which implementation priorities must align with system maturity. This comparative analysis underscores that while high-resource systems must prioritize ethical integration and workflow alignment, middle-resource settings require foundational investments in governance and infrastructure. This reinforces that AI readiness is a context-dependent and phased process rather than a one-size-fits-all endeavor. Full article

(This article belongs to the Special Issue Artificial Intelligence in Health Services Research and Organizations)

21 pages, 773 KB

Open AccessArticle

The Associations Between Participation in Leisure Dance Activity, Perceived Health Status, Happiness Level, and Perceptions of Leisure Amidst Selected Demographic Determinants

by Seungok An, Wi-Young So and Jeonga Kwon

Healthcare 2026, 14(2), 144; https://doi.org/10.3390/healthcare14020144 - 6 Jan 2026

Abstract

Objectives/Background: In this study, we aimed to examine the associations of participation in leisure dance activity with perceived health status, happiness level, and perceptions of leisure, and the relevance of demographic characteristics to these associations. Moreover, we sought to explore ways of [...] Read more.

Objectives/Background: In this study, we aimed to examine the associations of participation in leisure dance activity with perceived health status, happiness level, and perceptions of leisure, and the relevance of demographic characteristics to these associations. Moreover, we sought to explore ways of revitalizing leisure dance activity. Methods: We used data from the 2022 Korea National Leisure Activity Survey organized by the Korean Ministry of Culture, Sports, and Tourism. The 2022 Korea National Leisure Activity Survey was conducted from September to November 2022. The survey was conducted among 10,046 Koreans aged ≥15 who lived in 17 cities and provinces across the country. The participants were informed about the survey schedule in advance, and interviews were conducted at the participants’ homes using tablet PCs. Random telephone verification was performed on the recovered questionnaires to ensure the accuracy of responses. Questionnaires that passed the first verification were subjected to secondary verification by a computerized program, and questionnaires that did not pass the verification were supplemented and re-examined. The collected data were entered electronically through an encoding process, and only the data that passed the final test were compiled in the multi-stage verification process. The data were analyzed using frequency analysis, chi-squared tests, and multivariate logistic regression analysis. Results: Of the 1004 participants, 655 (6.5%) participated in leisure dance activity. Women, individuals in their twenties and thirties, college graduates or those with lower-level educational qualifications, and unmarried individuals were more likely to participate in leisure dance activities. In addition, leisure dance activities were found to be likely to increase happiness levels and leisure life satisfaction, and leisure expenses were likely to be low. Conclusions: Schools should provide high-quality dance education and enhance the professionalism of physical education teachers in the management of dance classes. This is because dance-related experiences in childhood can increase the likelihood of engaging in dancing in adulthood. Efforts are also needed to increase men’s awareness of and participation in leisure dance activities and to lower barriers to entry. The convergence of dance, games, and technology can make this possible. Full article

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23 pages, 632 KB

Open AccessReview

“Your Digital Doctor Will Now See You”: A Narrative Review of VR and AI Technology in Chronic Illness Management

by Albert Łukasik, Milena Celebudzka and Arkadiusz Gut

Healthcare 2026, 14(2), 143; https://doi.org/10.3390/healthcare14020143 - 6 Jan 2026

Abstract

This narrative review examines how immersive virtual and mixed-reality (VR/MR) technologies, combined with AI-driven virtual agents, can support the prevention and long-term management of chronic illness. Chronic diseases represent a significant global health burden, and conventional care models often struggle to sustain patient [...] Read more.

This narrative review examines how immersive virtual and mixed-reality (VR/MR) technologies, combined with AI-driven virtual agents, can support the prevention and long-term management of chronic illness. Chronic diseases represent a significant global health burden, and conventional care models often struggle to sustain patient engagement, motivation, and adherence over time. To address this gap, we conducted a narrative review of reviews and meta-analyses. We selected empirical studies published between 2020 and 2025, identified through searches in PubMed, Web of Science, and Google Scholar. The aim was to capture the state of the art in the integrated use of VR/MR and AI in chronic illness care, and to identify key opportunities, challenges, and considerations relevant to clinical practice. The reviewed evidence indicates that VR/MR interventions consistently enhance engagement, motivation, symptom coping, and emotional well-being, particularly in rehabilitation, pain management, and psychoeducation. At the same time, AI-driven conversational agents and virtual therapists add adaptive feedback, personalization, real-time monitoring, and continuity of care between clinical visits. However, persistent challenges are also reported, including technical limitations such as latency and system dependence, ethical concerns related to data privacy and algorithmic bias, as well as psychosocial risks such as emotional overattachment or discomfort arising from avatar design. Overall, the findings suggest that the most significant clinical value emerges when VR/MR and AI are deployed together rather than in isolation. When implemented with patient-centered design, clinician oversight, and transparent governance, these technologies can meaningfully support more engaging, personalized, and sustainable chronic illness management. Full article

(This article belongs to the Special Issue New Technologies for Understanding and Enhancing Lived Temporality in Chronic Illness)

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26 pages, 8268 KB

Open AccessArticle

The Effects of Virtual Immersive Gaming to Optimize Recovery (VIGOR) in Low Back Pain: A Phase II Randomized Controlled Trial

by Susanne M. van der Veen, Alexander Stamenkovic, Christopher R. France, Amanda Robinson, Roy Sabo, Forough Abtahi and James S. Thomas

Healthcare 2026, 14(2), 142; https://doi.org/10.3390/healthcare14020142 - 6 Jan 2026

Abstract

Background: Chronic low back pain (cLBP) with kinesiophobia is difficult to treat, and traditional graded activity approaches often show limited adherence and short-term effects. Virtual reality (VR) may enhance treatment engagement by providing immersive game-based environments that encourage therapeutic movement. This randomized controlled [...] Read more.

Background: Chronic low back pain (cLBP) with kinesiophobia is difficult to treat, and traditional graded activity approaches often show limited adherence and short-term effects. Virtual reality (VR) may enhance treatment engagement by providing immersive game-based environments that encourage therapeutic movement. This randomized controlled trial aimed to examine the effects of VR interventions designed to promote lumbar spine flexion in individuals with cLBP and elevated movement-related fear. Methods: Participants were randomized to one of two nine-week VR game conditions that differed only in the amount of lumbar flexion required. Primary outcomes were changes in pain intensity and disability from baseline to one-week post-treatment. Secondary analyses examined lumbar flexion and expectations of pain/harm as potential mediators. Follow-up assessments were conducted at multiple time points through 48 weeks to assess maintenance of treatment gains. Results: Both VR groups showed significant and clinically meaningful reductions in pain and disability at post-treatment. Improvements were maintained throughout the 48-week follow-up period. Depression symptoms continued to improve during follow-up. Expectations of pain and harm decreased significantly during treatment and remained reduced, whereas objective lumbar flexion did not change appreciably over time. Mediator analyses indicated that improved expectations of pain/harm, rather than increased lumbar flexion, were more closely associated with treatment response. Conclusions: Immersive VR gaming produced sustained reductions in pain, disability, and movement-related fear in individuals with cLBP and kinesiophobia. Findings suggest that VR may enhance rehabilitation outcomes by modifying maladaptive expectations rather than altering lumbar motion. VR-based interventions represent a promising and engaging approach for long-term cLBP management. Full article

(This article belongs to the Special Issue Pain Management in Healthcare Practice)

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26 pages, 1225 KB

Open AccessReview

Global Trends in Adolescent Health Inequalities and Their Social Determinants: A Bibliometric and Scoping Review

by Yang Wu, Xiaojuan Zeng, Zihan Zhou and Shiyou Wu

Healthcare 2026, 14(2), 141; https://doi.org/10.3390/healthcare14020141 - 6 Jan 2026

Abstract

Objective: To conduct a scoping review of the global trends of adolescent health inequities and their social determinants from 2000 to 2024 and establish an evidence base for developing targeted intervention strategies. Methods: Guided by the rainbow model, we conducted a bibliometric analysis [...] Read more.

Objective: To conduct a scoping review of the global trends of adolescent health inequities and their social determinants from 2000 to 2024 and establish an evidence base for developing targeted intervention strategies. Methods: Guided by the rainbow model, we conducted a bibliometric analysis of 171 peer-reviewed articles related to adolescent health inequalities and their social determinants from the Web of Science Core Collection using CiteSpace 6.3.1 to summarize empirical evidence on how social determinants of health (SDOH) influence adolescents’ health behaviors (e.g., drinking) and health outcomes (e.g., overweight). Results: First, results showed a progressive increase in publications addressing social determinants of adolescent health from 2000 to 2024. Journals in public health and preventive medicine accounted for the highest proportion of articles, with the United States contributing the largest national share (21.05% of global output). Second, an analysis of keywords showed that previous studies mostly focused on the effects of socioeconomic status, family affluence on adolescent health (e.g., physical activity, mental health, and overweight). Third, inequalities in adolescent health were prevalent globally. Health behaviors (e.g., diet, oral health, and smoking) have received widespread attention and are influenced by socioeconomic status, family environment, and gender, whereas various indicators of adolescent health outcomes (e.g., obesity, mental health, and suicide) were highly correlated with family socioeconomic status. Conclusions: To reduce adolescent health disparities, it is important to deepen interdisciplinary research, consider the impact of emerging societal (e.g., digital environments) and environmental factors (e.g., climate change), and develop systematic and comprehensive intervention strategies that encompass the individual, family, school, community, and national levels. Full article

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Healthcare, Volume 14, Issue 2 (January-2 2026) – 34 articles

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