Healthcare

22 pages, 2148 KB

Open AccessSystematic Review

Antipsychotic Medications in Parkinson’s Disease Psychosis; A Systematic Review of Double-Blind, Randomised, Placebo-Controlled Trials

by Christopher John McKeown and Alberto Salmoiraghi

Healthcare 2026, 14(5), 698; https://doi.org/10.3390/healthcare14050698 - 9 Mar 2026

Viewed by 801

Abstract

Background: Psychosis is a common neuropsychiatric symptom associated with Parkinson’s disease (PD), with prevalence rates of up to 75% over the course of the disease. Parkinson’s disease psychosis (PDP) is associated with increased morbidity, caregiver burden, depression, poorer quality of life and progression [...] Read more.

Background: Psychosis is a common neuropsychiatric symptom associated with Parkinson’s disease (PD), with prevalence rates of up to 75% over the course of the disease. Parkinson’s disease psychosis (PDP) is associated with increased morbidity, caregiver burden, depression, poorer quality of life and progression of dementia. It has also been shown to be a strong predictive factor for long-term care placement, and results in up to 71% increase in risk of mortality compared with PD patients free from psychotic symptoms. Use of APs for PDP is common, with up to 35% of PD patients prescribed at least one AP within 7 years of PD diagnosis. Methods: Four electronic databases (Ovid MEDLINE, Embase, PsycINFO, PubMed) were systematically searched for double-blind, randomised, placebo-controlled clinical trials for the use of APs in the treatment of PDP and their effects on PD motor symptoms, according to PRISMA guidelines. Results: Eleven studies from ten publications were identified and included in this review. Four studies investigated quetiapine, three investigated olanzapine, two investigated clozapine and a further two investigated pimavanserin. Quetiapine showed no significant improvement for PDP over placebo in three of the four studies, with both olanzapine studies also showing no improvement. Olanzapine studies also showed significant motor worsening compared to placebo. Clozapine significantly improved psychosis compared with placebo in both studies, with large effect sizes in primary outcome measures; (−0.82, 95% CI −1.37 to −0.26), −0.89 (95% CI −1.42 to −0.36). Pimavanserin also showed significant improvement (−0.48, 95% CI −0.77 to −0.18). Quetiapine, clozapine and pimavanserin showed no significant worsening in motor scores compared with placebo groups. Conclusions: Data from the studies included in this review suggest that the use of quetiapine for the management of PDP may not be evidence based. Clozapine may improve PDP symptoms with low doses however significant side-effects may limit usability. The findings from this review support the use of clozapine as an alternative AP for the management of PDP when clinically appropriate. Full article

(This article belongs to the Special Issue New Research on Psychosis in Older Adults)

► Show Figures

Figure 1

13 pages, 222 KB

Open AccessArticle

Patient Perceptions of Vascular Access and Quality of Life in Maintenance Hemodialysis: A Multicenter Study on Patient-Centered Outcomes

by Eirini Eftychia Kokkinidi, Angeliki Chandrinou, Konstantinos Exarchos, Alexios Alexopoulos, Evangelos Fradelos, Aikaterini Toska, Maria Saridi, Maria Malliarou and Pavlos Sarafis

Healthcare 2026, 14(5), 697; https://doi.org/10.3390/healthcare14050697 - 9 Mar 2026

Viewed by 987

Abstract

Background: Vascular access is a core component of hemodialysis and may influence both clinical outcomes and patient-reported quality of life. This study examined the association between vascular access type and quality of life among patients receiving maintenance hemodialysis in multiple nephrology centers. Methods: [...] Read more.

Background: Vascular access is a core component of hemodialysis and may influence both clinical outcomes and patient-reported quality of life. This study examined the association between vascular access type and quality of life among patients receiving maintenance hemodialysis in multiple nephrology centers. Methods: We conducted a multicenter, cross-sectional observational study of 152 adults with end-stage kidney disease undergoing hemodialysis in public and private dialysis units in the Attica region, Greece (January–May 2022). Data were collected using a demographic/clinical questionnaire, the 36-Item Short Form Health Survey (SF-36), the Dialysis Patient Satisfaction Questionnaire (SDIALOR), and the Missoula VITAS Quality of Life Index (MVQOLI). Multivariable linear regression models were fitted for SF-36 and MVQOLI domain scores. Results: Most participants reported being very (40.8%) or quite (53.3%) satisfied with their current vascular access, and 69.5% considered an arteriovenous fistula (AVF) the most appropriate option. SF-36 scores were generally lower than those reported for the general population, except for the mental health domain. Compared with AVF, permanent catheter use was associated with lower SF-36 physical functioning scores, and graft use was associated with lower vitality scores. Lower vascular access satisfaction was consistently associated with lower HRQoL: compared with being “very” satisfied, being “quite” satisfied was associated with lower general health, vitality, social functioning, mental health, and lower PCS/MCS scores, while being “a little/not at all” satisfied was associated with lower general health and worse bodily pain scores. On MVQOLI, living alone and lower access satisfaction were associated with lower interpersonal relationships, transcendence/spirituality, and overall quality-of-life scores, while obesity was associated with lower function scores. Conclusions: Vascular access type, particularly AVF versus catheter, is associated with meaningful differences in quality of life among hemodialysis patients. Patient satisfaction with access and sociodemographic characteristics should be considered in patient-centered access planning and follow-up. Full article

(This article belongs to the Special Issue Patient-Centered Care and Well-Being: Health Communication and Patient Engagement)

18 pages, 1313 KB

Open AccessReview

Association Between Hyperchloremia and Neurological Outcomes in Traumatic Brain Injury: A Narrative Review

by Philippa McIlroy, Mahesh Ramanan, Kyle C. White, Kevin B. Laupland, Mark J. Hackett, Gaewyn Ellison and Robert McNamara

Healthcare 2026, 14(5), 696; https://doi.org/10.3390/healthcare14050696 - 9 Mar 2026

Cited by 1 | Viewed by 714

Abstract

Background/Objectives: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality worldwide. Electrolyte disturbances are common in this patient cohort, with serum chloride frequently elevated. Chloride dysregulation may be associated with poor neurological outcomes through mechanisms including paradoxical gamma amino [...] Read more.

Background/Objectives: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality worldwide. Electrolyte disturbances are common in this patient cohort, with serum chloride frequently elevated. Chloride dysregulation may be associated with poor neurological outcomes through mechanisms including paradoxical gamma amino butyric acid receptor excitation, cytotoxic edema, and ferroptosis. The aim of this review was to evaluate the relationship between serum chloride levels and outcomes in patients with TBI. Methods: A literature review was performed to identify all potential studies that reported on serum chloride levels and TBI. All study types and patient groups were included. Studies were included if they reported on serum chloride measurements as well as outcomes such as mortality, surgical intervention, intracranial pressure, and neurological/functional outcome scores in patients with TBI. References and citations were also reviewed. Results: A small number of mostly retrospective studies with modest patient numbers demonstrate an association between high chloride levels and increased mortality in patients with TBI, with this relationship persisting independent of hypernatremia. Recent large, randomized trials showed that balanced crystalloid solutions, despite lower chloride content, may be associated with worse outcomes in TBI patients compared to saline. No studies directly correlated chloride levels with intracranial pressure measurements. Chloride level rather than total chloride load appears more strongly associated with adverse outcomes, with non-hypertonic saline sources contributing substantially to chloride burden. Mechanistic evidence links chloride channel dysregulation to ferroptosis and cytotoxic edema, with sex-specific patterns of transporter expression. Conclusions: Limited available evidence suggests that hyperchloremia is independently associated with increased mortality in TBI though causality remains unestablished. The findings regarding balanced solutions challenge conventional fluid management assumptions and highlight the complexity of chloride’s role in TBI pathophysiology. The absence of studies directly correlating chloride with intracranial pressure represents a critical evidence gap. Future studies with larger patient numbers, prospective designs, and multimodal neuromonitoring should further define these relationships to inform evidence-based chloride management strategies. Full article

(This article belongs to the Section Clinical Care)

► Show Figures

Figure 1

20 pages, 978 KB

Open AccessArticle

Physical Literacy-Focused Education Improves Fitness Markers in Preadolescents: Implications for School-Based Health Promotion

by Petra Rajkovic Vuletic, Tomislav Pranjic, Barbara Gilic Skugor, Blaž Lešnik, Damir Sekulic and Dorica Šajber

Healthcare 2026, 14(5), 695; https://doi.org/10.3390/healthcare14050695 - 9 Mar 2026

Cited by 1 | Viewed by 599

Abstract

Background/Objectives: Physical literacy (PL) is globally recognized as a foundational determinant of health status in children, but the effects of interventions based on PL were rarely studied in preadolescent children. The aim of this quasi-experimental, school-based study was to evaluate the potential effects [...] Read more.

Background/Objectives: Physical literacy (PL) is globally recognized as a foundational determinant of health status in children, but the effects of interventions based on PL were rarely studied in preadolescent children. The aim of this quasi-experimental, school-based study was to evaluate the potential effects of a PL intervention delivered during regular school hours on physical fitness (PF), physical literacy (PL), and physical activity (PA) in children aged 9 to 11 years from southern Croatia. Methods: Participants were 125 preadolescents (57 girls), and were grouped into a control group (C = 70), and an experimental group (E, n = 55). The E group participated in a specific PL-focused education, integrated into regular physical education (PE) lessons as a 5–6 min substitute for standard PE content, over 12 weeks (36 PE classes in total). The C group participated in the standard PE curriculum. A pre–post–retention design was used, and the observed variables included anthropometrics (height, weight, BMI), PF (jumping power, abdominal strength, upper body strength, flexibility, mobility, and cardiovascular endurance), PL (evaluated by the PLAYself questionnaire), and indirectly measured PA (estimated via the PAQ-C questionnaire). Multivariate (MANOVA and univariate (ANOVA) analyses of variance for repeated measurements were used with time, gender, and group as the main effects, including their interactions. Results: MANOVA calculated for a set of PF variables revealed significant main effects for time (F = 1361, p < 0.001) and a significant time × group interaction (F = 2.98, p < 0.05). Univariate ANOVA indicated specific intervention effects for jumping power and abdominal strength, favoring the E group. No significant differential effects were observed for PL or PA. Conclusions: The study demonstrated small, but statistically significant, improvements in PF indicators among children exposed to the PL-based intervention. Notably, the intervention was conducted in authentic school settings using standard resources, supporting the ecological validity and real-world applicability of the findings. Full article

(This article belongs to the Special Issue Advancing Physical Activity and Well-Being in Children and Adolescents)

► Show Figures

Figure 1

16 pages, 253 KB

Open AccessArticle

Physical Restraint Use in Acute Care Hospitals: A Diagnostic Study on Knowledge, Documentation, and Patient Safety from a Humanization Perspective

by Alicia Albalat-Rodríguez, Ana Fernández-García, Violeta Hernández-De Arribas, Nuria Pérez-Panizo, Patricia Nieto-Alcantud, Sara Guillén-Tolbaños, Jesús De Cabo-Calvo, Marina De la Matta-Canto, Natalia Mudarra-García and Francisco Javier García-Sánchez

Healthcare 2026, 14(5), 694; https://doi.org/10.3390/healthcare14050694 - 9 Mar 2026

Cited by 1 | Viewed by 793

Abstract

Background: The use of physical restraints in hospital settings remains a controversial practice due to its ethical, legal, and safety implications. Although restraints are intended to prevent falls or manage agitation, their inappropriate use may compromise patient dignity, autonomy, and quality of care. [...] Read more.

Background: The use of physical restraints in hospital settings remains a controversial practice due to its ethical, legal, and safety implications. Although restraints are intended to prevent falls or manage agitation, their inappropriate use may compromise patient dignity, autonomy, and quality of care. Current healthcare policies emphasize restraint reduction, appropriate documentation, and professional training as key elements of humanized and safe care. Methods: A descriptive cross-sectional study based on an anonymous self-administered survey was conducted in a tertiary university hospital as the diagnostic phase of a quality improvement project aimed at evaluating healthcare professionals’ knowledge, perceptions, and documentation practices related to physical restraint use. A structured ad hoc questionnaire was distributed to registered nurses and nursing assistants working in adult inpatient units using a non-probabilistic convenience sampling strategy. The survey explored training, clinical decision-making, communication with patients and families, awareness of institutional protocols, and use of the electronic health record (EHR). Descriptive analyses and Pearson’s chi-square tests were performed using IBM SPSS Statistics. Results: A total of 241 professionals participated. More than half of respondents (54.8%) reported no formal training in physical restraint use, and only 27.4% considered their training sufficient. Although 86.3% stated they were familiar with restraint indications, only 53.5% were aware of the existence of a structured EHR restraint registry, and just 31.0% consistently completed it. Documentation of restraint removal was particularly low (32.9%). Furthermore, significant discrepancies were observed between regulatory definitions of restraints and professionals’ perceptions regarding practices requiring formal documentation. Statistically significant associations were identified between professional category, perceived training adequacy, and knowledge of physical restraint indications. Conclusions: This diagnostic phase identified substantial gaps between regulatory requirements, professional knowledge, and real-world documentation practices related to physical restraint use. The findings highlight the need for competency-based training strategies, standardized documentation processes, and strengthened institutional leadership to promote patient safety, regulatory compliance, and the humanization of hospital care. Full article

► Show Figures

Figure 1

18 pages, 268 KB

Open AccessArticle

Reconstruction of Identity and Meaning in the Postpartum Period: Women’s Experiences of Social Vulnerability and Existential Transition—A Phenomenological Study

by Aycan Şahin, Fatih Şahin and Leyla Sezgin

Healthcare 2026, 14(5), 693; https://doi.org/10.3390/healthcare14050693 - 9 Mar 2026

Viewed by 804

Abstract

Background: The postpartum period represents a critical transitional phase in which women experience profound changes in identity, meaning, and social roles. This process is often shaped by social vulnerability and existential transformation, yet remains insufficiently explored from a phenomenological perspective. This study aimed [...] Read more.

Background: The postpartum period represents a critical transitional phase in which women experience profound changes in identity, meaning, and social roles. This process is often shaped by social vulnerability and existential transformation, yet remains insufficiently explored from a phenomenological perspective. This study aimed to explore how women reconstruct identity and meaning during the postpartum period within the context of social vulnerability and existential transition. Methods: This qualitative study em-ployed an descriptive phenomenological approach in accordance with the COREQ guidelines. Data saturation was achieved with 20 mothers of infants aged 0–12 months who were purposively selected from a province in eastern Türkiye. Data were collected through semi-structured face-to-face interviews and analyzed using Colaizzi’s phenomenological method. Credibility was ensured through participant validation, reflexivity, and team-based analysis. Results: Four themes emerged. Fracturing of Existence indicated an ontological shift from “I” to “we,” reflecting a metaphorical rebirth of the self. Invisible Burdens revealed that societal expectations and insufficient social support intensify psychosocial vulnerability. Re-Tailoring the Self demonstrated that maternal identity is dynamic and continuously negotiated between the past and emerging self. Construction of Silent Resilience showed that women develop strength alongside vulnerability through internal resources, spirituality, and everyday practices of hope. Conclusions: The postpartum period involves a multilayered reconstruction of identity and meaning beyond role adaptation. During this existential transition, women not only give birth to a child but also reconstruct their own existence, metaphorically giving birth to themselves. Full article

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

19 pages, 1187 KB

Open AccessArticle

Long-Term Effects of Positive Psychotherapy Compared to Cognitive Behavior Therapy in Clinical Depression: An 18-Month Follow-Up Randomized Controlled Trial

by Elena Fischer, Linda Maria Furchtlehner, Raphael Schuster and Anton-Rupert Laireiter

Healthcare 2026, 14(5), 692; https://doi.org/10.3390/healthcare14050692 - 9 Mar 2026

Cited by 1 | Viewed by 883

Abstract

Background/Objectives: Positive Psychotherapy (PPT) is an empirically supported treatment that directly targets positive resources and personal strengths as its primary logic. PPT is effective in amplifying happiness and well-being as an additional way to enhance positive mental health while also ameliorating symptoms [...] Read more.

Background/Objectives: Positive Psychotherapy (PPT) is an empirically supported treatment that directly targets positive resources and personal strengths as its primary logic. PPT is effective in amplifying happiness and well-being as an additional way to enhance positive mental health while also ameliorating symptoms of negative affect, especially in depression, anxiety disorders, and stress disorders. However, few studies have been conducted to investigate these effects in the long run. This study extends our previously published findings on the short-term efficacy of PPT by extending the follow-up period to 18 months and comparing its long-term effects with those of Cognitive Behavioral Therapy (CBT) within the same randomized controlled trial. Methods: Forty-nine out-patient participants with a DSM-IV diagnosis for depressive disorder (MDD, Dysthymia) were treated with 14 sessions of manualized PPT (n = 23) or CBT (n = 26) group therapy. In a randomized controlled two-center-study, questionnaires on depressive symptoms (BDI-II, MADRS, DHS), psychological distress (BSI), and well-being related outcomes (FS, PPTI, SWLS) were administered at baseline and 18-month follow-up. Results: Analyses using linear mixed models indicated significant differences in long-term treatment outcome for depressive symptoms (BDI-II, DHS, MADRS) and satisfaction with life (SWLS), depicting better outcomes for the PPT group. Between group effect sizes at 18-month follow-up were primarily in the middle range for all outcome measures, in favor of PPT. Conclusions: This study provides support for the long-term efficacy of PPT in the treatment of depression and improvement of positive resources. Full article

(This article belongs to the Special Issue Positive Psychology in Healthcare: Interdisciplinary and Intercultural Perspectives)

► Show Figures

Figure 1

11 pages, 392 KB

Open AccessArticle

Aspects of Religious Life as Determinants of the Subjective Health Assessment of Religious Sisters: The Role of Prayer, Community, and Daily Practices

by Paulina Teodorczyk, Paweł Najechalski, Maciej Walędziak and Anna Różańska-Walędziak

Healthcare 2026, 14(5), 691; https://doi.org/10.3390/healthcare14050691 - 9 Mar 2026

Viewed by 408

Abstract

Introduction: Religious practices can shape lifestyles, influence health choices, and help individuals cope with illness and suffering. Understanding which aspects of religiosity support health-promoting attitudes is particularly important. This study explores how belonging to a religious community affects health and well-being among religious [...] Read more.

Introduction: Religious practices can shape lifestyles, influence health choices, and help individuals cope with illness and suffering. Understanding which aspects of religiosity support health-promoting attitudes is particularly important. This study explores how belonging to a religious community affects health and well-being among religious sisters. Materials and Methods: An anonymous survey was conducted among 463 women from international, apostolic Catholic congregations in Poland and 33 other countries. The questionnaire included questions on lifestyle, physical health (including diet, physical activity, sleep, chronic conditions, and medication use), and perceptions of how community life influences health and encourages health-conscious behaviors. Results: Overall, 57% of participants reported following a healthy lifestyle, most commonly sisters aged 65 and older (73%). Non-Polish sisters and those living outside Poland were more likely to report healthy habits. Among sisters who saw their community as beneficial for health, 69% led a healthy lifestyle. Retreats, a sense of belonging, communal prayers, and vacations were consistently rated as having the most positive impact on well-being, particularly among older sisters and missionaries. Conclusions: Life in a religious community appears to support health both directly, through structured daily routines and shared responsibilities, and indirectly, by providing social support and fostering a sense of purpose. Spiritual practices, rest, and close interpersonal relationships emerge as the most influential factors for well-being, while formal obligations such as wearing religious attire or attending formation meetings were rated as less impactful. These findings highlight the important role of communal life in promoting both physical and spiritual health among religious sisters. Full article

► Show Figures

Figure 1

13 pages, 407 KB

Open AccessArticle

Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting—Clinical, Demographic, and Intraoperative Predictors: A Multicenter Observational Study

by Kyriakos Alexandrou, Nicos Middleton, Maria Kyranou and Pavlos Sarafis

Healthcare 2026, 14(5), 690; https://doi.org/10.3390/healthcare14050690 - 9 Mar 2026

Cited by 1 | Viewed by 691

Abstract

Background: Postoperative arrhythmias, especially atrial fibrillation (AF), are common complications of coronary artery bypass grafting (CABG) associated with prolonged hospitalization and adverse outcomes. This study aimed to assess the incidence of postoperative AF and identify demographic, clinical, and intraoperative predictors in CABG patients [...] Read more.

Background: Postoperative arrhythmias, especially atrial fibrillation (AF), are common complications of coronary artery bypass grafting (CABG) associated with prolonged hospitalization and adverse outcomes. This study aimed to assess the incidence of postoperative AF and identify demographic, clinical, and intraoperative predictors in CABG patients in Cyprus. Methods: This prospective, multicenter observational study was conducted in three cardiac surgery centers in Cyprus between September 2022 and April 2023. Adult elective CABG patients in preoperative sinus rhythm were included; emergency cases and those with prior arrhythmias or conduction disturbances were excluded. Data on demographic, clinical, intraoperative, and postoperative variables, including norepinephrine infusion duration, were collected daily. Postoperative arrhythmias were systematically recorded during hospitalization. Statistical analyses included descriptive statistics, bivariate tests, and multivariable logistic regression to identify independent predictors of postoperative atrial fibrillation. Results: Among 102 patients (mean age 66.8 years, 78.4% male), postoperative arrhythmias occurred in 26.5%. AF was most frequent (20.6%), followed by ventricular tachycardia (2.9%), atrial tachycardia (1.0%), atrioventricular block (1.0%), and one fatal asystole. Key independent predictors of AF were increasing age, atrial enlargement, severely reduced left ventricular ejection fraction (<30%), and prolonged norepinephrine infusion. Conclusions: Postoperative AF remains a prevalent and clinically significant complication after CABG. The association with norepinephrine duration underscores the importance of careful hemodynamic management. Further studies and AI-based prediction models may enhance individualized prevention strategies. Full article

► Show Figures

Figure 1

24 pages, 6598 KB

Open AccessSystematic Review

Exercise Interventions for Cognitive and Functional Outcomes in Dementia: A Systematic Review and Meta-Analysis Exploring Dose Metrics, Heterogeneity, and Implementation-Relevant Factors

by Chun-Wei Lu, Tsz-Ching Ng, Yi-Chen Cheng and Chun-Hsien Su

Healthcare 2026, 14(5), 689; https://doi.org/10.3390/healthcare14050689 - 9 Mar 2026

Viewed by 944

Abstract

Background: Exercise interventions are commonly considered as non-pharmacological approaches to support cognitive and functional outcomes in older adults with dementia. However, the effects reported in the literature remain heterogeneous, and commonly used time-based dose markers may be insufficient to explain variability across [...] Read more.

Background: Exercise interventions are commonly considered as non-pharmacological approaches to support cognitive and functional outcomes in older adults with dementia. However, the effects reported in the literature remain heterogeneous, and commonly used time-based dose markers may be insufficient to explain variability across trials. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted in accordance with PRISMA 2020 guidelines. Eligible trials described benefits with cognitive, functional or behavioral changes associated with structured exercise interventions in older adults with dementia. Random-effects meta-analysis and meta-regression models were used to derive pooled effects and assess if linear dose indicators (e.g., duration of intervention, session length, frequency and total cumulative dose) reflected heterogeneity. Results: Twenty-two studies were analyzed. Based on our pooled analyses, a small but statistically significant improvement was observed under the fixed-effects model (g = 0.106, 95% CI 0.015–0.197; p = 0.023), but this was not significant for random-effects models (g = 0.117, 95% CI −0.021–0.254; p = 0.097), while suggesting moderate between-study heterogeneity (Q(21) = 43.530, p = 0.003; I² = 51.757%; τ² = 0.052). For the main random-effects meta-regression, standard linear dose indicators did not significantly explain between-study heterogeneity (Qm(3) = 1.06, p = 0.7867; R²_analog ≈ 0), while significant residual heterogeneity remained (I² ≈ 56.03%). Conclusions: In the literature so far, there are limited and heterogeneous effects of exercise interventions on cognition and functions in older adults with dementia. These findings in all literature suggest that the current evidence does not support a consistent linear dose–response relationship but rather will likely depend to some extent on feasibility and supervision (again, quality of the interventions), thus emphasizing that exercise strategies must be contextually sensitive rather than dose-dependent. Full article

(This article belongs to the Special Issue Health, Behavioral, and Functional Outcomes of Exercise Interventions for Aging and Longevity)

► Show Figures

Figure 1

30 pages, 1596 KB

Open AccessReview

From Legislative Harmonization to Real-World Access: A Scoping Review of Pharmaceutical Regulation and Access to Medicines in Romania

by Corina Daniela Negrila, Luana-Maria Gherasie, Sebastian Mihai Armean and Petru Armean

Healthcare 2026, 14(5), 688; https://doi.org/10.3390/healthcare14050688 - 9 Mar 2026

Viewed by 1054

Abstract

Objectives: This scoping review aimed to map European and Romanian pharmaceutical legislation and policy-related evidence and to examine how legislative harmonization translates into access outcomes in Romania. Eligibility criteria: Legislative documents, institutional reports, market analyses, and peer-reviewed studies addressing pharmaceutical regulation, pricing, reimbursement, [...] Read more.

Objectives: This scoping review aimed to map European and Romanian pharmaceutical legislation and policy-related evidence and to examine how legislative harmonization translates into access outcomes in Romania. Eligibility criteria: Legislative documents, institutional reports, market analyses, and peer-reviewed studies addressing pharmaceutical regulation, pricing, reimbursement, and access to medicines (2000–2024). Sources of evidence: EUR-Lex, the Romanian Legislative Portal, PubMed, Scopus, Google Scholar, and institutional sources (European Commission, OECD, WHO, EFPIA, NAMMDR, CNAS). Charting methods: Data were extracted using a standardized charting form and synthesized narratively across thematic domains (regulatory harmonization, pricing and reimbursement, medicine shortages, comparative EU indicators, and health system implications). Results: Fifty sources were included. The mapped evidence consistently identified three dominant patterns: (1) prolonged time-to-availability for centrally authorized medicines, with mean delays exceeding 800 days in Romania compared with approximately 578 days at EU level; (2) limited availability of innovative therapies, particularly in oncology (approximately 20% availability in Romania versus around 50% EU average); and (3) recurrent medicine shortages associated with low-price regulation and parallel export dynamics. Evidence gaps include limited Romania-specific empirical evaluation of the causal effects of individual policy levers (e.g., external reference pricing, reimbursement timelines, clawback mechanisms). Conclusions: Legislative harmonization alone has not ensured equitable or timely access to medicines in Romania. The evidence suggests that national pricing, reimbursement, and supply governance mechanisms mediate the relationship between EU regulation and real-world patient access, highlighting the need for targeted policy reforms and further empirical investigation. Full article

(This article belongs to the Section Healthcare and Sustainability)

► Show Figures

Graphical abstract

12 pages, 779 KB

Open AccessArticle

An Action-Based Psychosocial Group Intervention in Psychiatric Inpatient Care: A Pragmatic Add-On Study to Talk-Based Psychotherapy

by Jyu-Ming Hu, I-Fei Chen, Chun-Chu Lin, Li-Ting Huang, Nien-Hwa Lai and Ming-Wei Lin

Healthcare 2026, 14(5), 687; https://doi.org/10.3390/healthcare14050687 - 9 Mar 2026

Viewed by 574

Abstract

Background/Objectives: Psychiatric inpatient care emphasizes pharmacological stabilization, yet psychosocial interventions remain essential for addressing complex emotional, interpersonal, and behavioral needs. While talk-based psychotherapy (TBP) is standard inpatient psychosocial care, some patients face barriers to exclusively verbal engagement during acute crises. This study examined [...] Read more.

Background/Objectives: Psychiatric inpatient care emphasizes pharmacological stabilization, yet psychosocial interventions remain essential for addressing complex emotional, interpersonal, and behavioral needs. While talk-based psychotherapy (TBP) is standard inpatient psychosocial care, some patients face barriers to exclusively verbal engagement during acute crises. This study examined the feasibility and implementation of psychodrama as a pragmatic add-on to routine inpatient TBP under real-world ward conditions. Methods: A quasi-experimental pragmatic add-on design was used (N = 84). All participants received routine TBP; the experimental group (n = 47) additionally participated in psychodrama co-facilitated by a multidisciplinary team (MDT). Outcomes were assessed using the ASEBA-ASR. Non-parametric tests with effect sizes and 95% confidence intervals were used to evaluate pre–post symptom changes over four weeks, and between-group differences were assessed using change-score comparisons. Results: Both groups demonstrated significant within-group symptom reductions following the intervention. However, between-group comparisons of change scores showed no statistically significant differences (all p > 0.05), with small effect sizes and confidence intervals including zero. Conclusions: Psychodrama appears feasible to implement as an action-based psychosocial add-on in acute inpatient settings. Although statistical superiority over TBP alone was not demonstrated, the intervention allowed for the characterization of symptom trajectories under real-world constraints, suggesting that psychodrama may represent an action-based option to diversify psychosocial pathways within MDT-delivered care. Future adequately powered studies are needed to examine how action-based modalities may fit within multidimensional, complexity-informed inpatient care pathways. Full article

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

► Show Figures

Figure 1

1 pages, 158 KB

Open AccessCorrection

Correction: Afonso et al. Community-for-Care: An Integrated Response to Informal Post-Caregivers. Healthcare 2025, 13, 3318

by Catarina Inês Costa Afonso, Ana Spínola Madeira, Alcinda Reis and Susana Magalhães

Healthcare 2026, 14(5), 686; https://doi.org/10.3390/healthcare14050686 - 9 Mar 2026

Viewed by 279

Abstract

In the original publication [...] Full article

13 pages, 271 KB

Open AccessArticle

Effects of a Structured Physical Activity Program on Quality of Life in Older Adults: A Quasi-Experimental Study

by Evgenia Kouli, Evangelos Bebetsos, Maria Michalopoulou and Filippos Filippou

Healthcare 2026, 14(5), 685; https://doi.org/10.3390/healthcare14050685 - 9 Mar 2026

Viewed by 1033

Abstract

Background/Objectives: Quality of life is conceptualized as a multidimensional construct encompassing subjective well-being, health, and social functioning. Evidence suggests that engagement in physical activity contributes to higher quality of life scores among older adults, indicating that structured exercise programs can positively influence both [...] Read more.

Background/Objectives: Quality of life is conceptualized as a multidimensional construct encompassing subjective well-being, health, and social functioning. Evidence suggests that engagement in physical activity contributes to higher quality of life scores among older adults, indicating that structured exercise programs can positively influence both physical and psychological domains in this population. The present study examined the impact of an 18-week structured physical exercise program on the quality of life of older adults, assessed through the World Health Organization Quality of Life-BREF (WHOQOL-BREF) instrument, which consists of four domains: physical health, psychological, social relationships and environment. A total of 86 participants were allocated to three groups: individual exercise (n = 31), collaborative exercise (n = 32), and a control group (n = 23). Quality of life was evaluated before and after the intervention using the WHOQOL-BREF. Results: Correlation analysis indicated strong relationships among the WHOQOL-BREF domains, both before and after the program. Repeated-measures analysis revealed no significant Group × Time interaction effects for any WHOQOL-BREF domain. A significant main effect of Time was observed for the Environment domain, indicating a small overall decrease across all groups during the study period. Conclusions: The structured exercise protocol did not lead to greater changes in quality of life compared to the control condition. Perceived environmental quality of life showed a small overall decrease over time across participants. Full article

(This article belongs to the Special Issue Promoting Health and Well-Being Through Lifestyle and Physical Activity)

22 pages, 357 KB

Open AccessArticle

Medicaid Expansion and Medication Use Among U.S. Children with ASD or ADHD: A Repeated Cross-Sectional Analysis Comparing Before and During the COVID-19 Periods

by Florida Uzoaru, Michael A. Preston, Travis Loux and Levi Ross

Healthcare 2026, 14(5), 684; https://doi.org/10.3390/healthcare14050684 - 9 Mar 2026

Viewed by 607

Abstract

Background/Objectives: Children with Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) frequently rely on pharmacological treatment to manage core symptoms. This study examined how Medicaid expansion and the COVID-19 pandemic influenced medication use among children with ASD or ADHD, including those with comorbid [...] Read more.

Background/Objectives: Children with Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) frequently rely on pharmacological treatment to manage core symptoms. This study examined how Medicaid expansion and the COVID-19 pandemic influenced medication use among children with ASD or ADHD, including those with comorbid diagnoses. Methods: We analyzed 2016–2023 data from the National Survey of Children’s Health (NSCH) for children aged 3–17 years with caregiver-reported diagnoses. Logistic regression models assessed the association between Medicaid expansion, the pandemic period, and current medication use, including an interaction between expansion and pandemic period. Analyses were conducted for the full sample (N = 35,198) and a subgroup with comorbid ASD and ADHD (N = 4298). Results: Current Medicaid expansion was associated with significantly lower odds of medication use in the full sample (aOR = 0.68, p < 0.001) but not the comorbid group (aOR = 0.98, p = 0.9). Medication use showed no significant change during the COVID-19 period in either the full sample (aOR = 0.99; p > 0.90) or the comorbid subgroup (aOR = 1.22; p = 0.4). A significant interaction indicating increased odds of medication use during the pandemic in expansion states was observed only in the full sample, although a similar but non-significant pattern appeared in the comorbid group. Age, race, and insurance-related differences were significant across groups, with coverage consistency playing a larger role in the full sample. Sensitivity analyses, excluding the 2020 survey year and modeling pre/post pandemic periods, supported the robustness of findings. Conclusions: Medicaid expansion was associated with patterns consistent with buffering pandemic-related disruptions in medication use among children with ASD or ADHD overall, but those with co-occurring conditions remain especially vulnerable. Full article

(This article belongs to the Special Issue Shaping Futures: Health Policy Innovations for Neurodevelopmental Disorders in Children)

17 pages, 245 KB

Open AccessArticle

Healthcare Professionals’ Perceptions of Medicine Shortages in Public Health Facilities of the Eastern Cape, South Africa

by Mmabatho Miriam Ndwandwe, Mygirl Pearl Lowane, Thembi Simbeni and Mathildah Mpata Mokgatle

Healthcare 2026, 14(5), 683; https://doi.org/10.3390/healthcare14050683 - 8 Mar 2026

Viewed by 695

Abstract

Background: Medicine shortages present a critical challenge for health systems worldwide, impacting patient care and health outcomes. This study investigated healthcare professionals’ perceptions of the impact of medicine shortages in public health facilities of the Eastern Cape, South Africa. Methods: A quantitative, cross-sectional [...] Read more.

Background: Medicine shortages present a critical challenge for health systems worldwide, impacting patient care and health outcomes. This study investigated healthcare professionals’ perceptions of the impact of medicine shortages in public health facilities of the Eastern Cape, South Africa. Methods: A quantitative, cross-sectional design was employed, using a self-administered questionnaire distributed to 394 healthcare professionals (professional nurses, pharmacists, and medical officers). Results: The findings revealed a strong consensus that shortages negatively affect all stakeholders, with 96.7% of respondents agreeing that they increase provider stress and reduce patient trust. A significant majority also reported that shortages lead to delayed treatment (70.6%) and compromised health outcomes (67%). However, perceptions varied significantly by profession. Pharmacists were significantly more likely than nurses and medical officers to perceive that shortages result in increased out-of-pocket costs for patients, treatment errors, and compromised health outcomes. Conclusions: The study concludes that medicine shortages severely impact patient safety, clinical outcomes, and healthcare providers’ well-being in this setting. The pronounced concerns among pharmacists highlight their strained role in managing the crisis and underscore the urgent need for strengthened pharmaceutical supply chain governance, interprofessional collaboration, and targeted policies to mitigate the effects of shortages and protect patients from financial hardship. Full article

(This article belongs to the Section Healthcare Organizations, Systems, and Providers)

20 pages, 590 KB

Open AccessArticle

Paving the Way for ERAS in German Gynecologic and Gynecologic Oncology Departments: Insights into Barriers, Facilitators and Practical Strategies

by Cara Thiel, Helena Schorling, Lina Judit Schiestl, Mona Wanda Schmidt, Anne-Sophie Heimes, Kathrin Stewen, Gilbert Georg Klamminger, Lea Omogbehin, Katharina Delfs, Konstantin Hofmann, Evangelos Papanikolaou, Georgios Tagarakis, Ioannis Boutas, Annette Hasenburg and Roxana Schwab

Healthcare 2026, 14(5), 682; https://doi.org/10.3390/healthcare14050682 - 8 Mar 2026

Cited by 1 | Viewed by 478

Abstract

Background: Enhanced Recovery After Surgery (ERAS) protocols improve postoperative outcomes and promote multidisciplinary, evidence-based perioperative care. However, ERAS adoption in gynecological departments remains inconsistent, and the underlying implementation challenges are poorly understood. Objective: To identify key barriers, facilitators, and preferred implementation strategies influencing [...] Read more.

Background: Enhanced Recovery After Surgery (ERAS) protocols improve postoperative outcomes and promote multidisciplinary, evidence-based perioperative care. However, ERAS adoption in gynecological departments remains inconsistent, and the underlying implementation challenges are poorly understood. Objective: To identify key barriers, facilitators, and preferred implementation strategies influencing ERAS adoption in German gynecological departments, and to assess whether clinicians’ ERAS knowledge or institutional certification shapes these perceptions. Methods: We conducted a nationwide, web-based cross-sectional survey of gynecologic clinicians in Germany. The questionnaire assessed ERAS-related knowledge, current implementation status, and perceived barriers, facilitators, and strategies. Statistical analyses included equality of proportions tests, logistic regression, and internal consistency measurement. Results: A total of 116 clinicians participated; 66 provided data on barriers and 64 on facilitators and strategies. Only 37.9% reported routine ERAS use. The most frequently identified barriers were limited ERAS knowledge (40.9% “very important”) and insufficient personnel resources (40.9%). The strongest facilitators were improved patient well-being, reduced morbidity, and higher patient satisfaction (each >60% “very important”). High-impact implementation strategies included informational materials, workshops, and online training. Well-informed clinicians had significantly higher odds of reporting a positive professional impact of ERAS (OR = 9.0, p = 0.001). Conclusions: ERAS implementation in gynecological settings remains restricted by staff knowledge gaps and personnel limitations. Patient-centered benefits and interactive educational strategies serve as powerful facilitators. Enhanced staff education and multidisciplinary support structures may substantially improve ERAS uptake and contribute to greater professional satisfaction among clinicians. Full article

(This article belongs to the Section Clinical Care)

► Show Figures

Figure 1

21 pages, 765 KB

Open AccessArticle

Feasibility and Acceptability of a Mindfulness App Intervention for Healthcare Worker Families Under Stress: A Pilot Micro-Randomized Trial

by Sun-Kyung Lee, Sydni A. J. Basha, Qiyue Cai and Abigail H. Gewirtz

Healthcare 2026, 14(5), 681; https://doi.org/10.3390/healthcare14050681 - 7 Mar 2026

Viewed by 594

Abstract

Background: This pilot study examined the feasibility, acceptability, usability, and preliminary outcomes of apt.mind, a mobile app-based mindfulness intervention with an exploratory smartwatch component, among healthcare worker families during the COVID-19 pandemic. Methods: Using a micro-randomized trial (MRT) design, 102 healthcare workers [...] Read more.

Background: This pilot study examined the feasibility, acceptability, usability, and preliminary outcomes of apt.mind, a mobile app-based mindfulness intervention with an exploratory smartwatch component, among healthcare worker families during the COVID-19 pandemic. Methods: Using a micro-randomized trial (MRT) design, 102 healthcare workers and co-parents of children aged 4–13 years were randomized once per day over 30 days to one of three conditions: (1) an audio-guided mindfulness exercise delivered via the apt.mind mobile app, (2) an in-app push notification prompting a brief mindfulness activity, or (3) no intervention. Feasibility was assessed through participant enrollment, retention, and daily engagement rates, while acceptability and usability were evaluated through qualitative and quantitative feedback. Exploratory multilevel analyses examined proximal effects of intervention conditions on momentary stress. Results: Retention was high, with all participants completing the 30-day protocol, and 80% of participants completed at least one daily survey. Participants reported moderate-to-high acceptability and usability. However, smartwatch battery life and sensor reliability limited the collection of usable physiological data. Multilevel analyses did not identify any significant main effects of intervention condition on momentary stress, but age moderated the association between the audio exercise condition and stress, benefiting older participants. Conclusions: Mobile-based mindfulness interventions appear feasible and acceptable for healthcare worker families in high-stress contexts. Although proximal stress effects were limited and exploratory, the findings inform future optimization of just-in-time adaptive interventions. Improvements in wearable technology and MRT implementation strategies are needed to enhance physiological data quality and reduce assessment-related anxiety. Full article

(This article belongs to the Section Digital Health Technologies)

► Show Figures

Figure 1

13 pages, 1493 KB

Open AccessArticle

Clinical Profiles, Interventions, and Outcomes of Sepsis and Septic Shock in a Saudi Arabian Tertiary ICU: A Five-Year Retrospective Analysis

by Amer Asiri, Khaled Abdulwahab Amer, Mushary Alqahtani, Lena A. Almathami, Osama Ayed Asiri, Sultan Saad Alnasser, Ahmed Ali Khuzayyim, Bander Abdullah Alqahtani, Fatimah Mohammed Asiri and Hatem Mostafa Asiri

Healthcare 2026, 14(5), 680; https://doi.org/10.3390/healthcare14050680 - 7 Mar 2026

Viewed by 703

Abstract

Background and Objectives: Sepsis and septic shock remain leading causes of morbidity and mortality in intensive care settings worldwide. While substantial epidemiological data exist from Western countries, the clinical profile of sepsis in regions with exceptionally high diabetes prevalence remains inadequately characterized. [...] Read more.

Background and Objectives: Sepsis and septic shock remain leading causes of morbidity and mortality in intensive care settings worldwide. While substantial epidemiological data exist from Western countries, the clinical profile of sepsis in regions with exceptionally high diabetes prevalence remains inadequately characterized. Saudi Arabia, with one of the highest diabetes mellitus prevalence rates globally, may exhibit distinct sepsis epidemiology, infection patterns, and outcomes. This study aimed to characterize the clinical profiles, antimicrobial management, and outcomes of sepsis and septic shock in a tertiary intensive care unit (ICU) in the Aseer region of southwestern Saudi Arabia. Materials and Methods: A retrospective observational study was conducted including 263 adults meeting Sepsis-3 criteria (232 sepsis, 31 septic shock) admitted to a tertiary ICU between January 2020 and December 2024. Demographics, comorbidities, laboratory parameters, microbiological data, antibiotic timing, interventions, and in-hospital mortality were analyzed. Logistic regression identified independent mortality predictors. This study adhered to the STROBE reporting guidelines. Results: The median age was 73 years with male predominance (58.4%). Diabetes mellitus (71.5%) and hypertension (65.8%) were highly prevalent. Urinary tract infections (UTIs) predominated (79.8%), with Escherichia coli as the most common pathogen (26.2%). The median time to antibiotic administration was 1.8 h; piperacillin–tazobactam was the most frequent empiric regimen (43.7%). Septic shock patients exhibited higher creatinine (1.65 vs. 1.08 mg/dL, p = 0.026) and lower platelets (194 vs. 271 × 10³/μL, p = 0.030). Mortality was 38.7% in septic shock versus 8.2% in sepsis (p < 0.001). Multivariate analysis confirmed septic shock (aOR: 5.23; 95% CI: 1.89–14.48) and mechanical ventilation (aOR: 15.42; 95% CI: 5.67–41.95) as independent mortality predictors. Conclusions: High diabetes prevalence shapes regional sepsis epidemiology with UTI predominance. Early antibiotic administration and recognition of septic shock remain critical for improving outcomes in this population. Full article

(This article belongs to the Section Clinical Care)

► Show Figures

Figure 1

23 pages, 2363 KB

Open AccessArticle

Limited Feasibility Study of Holographic Display Technology for Interprofessional Team Training

by Maria Bajwa, Melissa Morris, Wajeeha Brar Ghias and Adam Linzels

Healthcare 2026, 14(5), 679; https://doi.org/10.3390/healthcare14050679 - 7 Mar 2026

Viewed by 569

Abstract

Background: Immersive technologies are increasingly used to support interprofessional education and team training in healthcare. Holographic display technology (HDT) offers a novel approach for delivering distributed, simulation-based TeamSTEPPS training; however, evidence regarding its short-term feasibility remains limited. Methods: This mixed-methods pilot [...] Read more.

Background: Immersive technologies are increasingly used to support interprofessional education and team training in healthcare. Holographic display technology (HDT) offers a novel approach for delivering distributed, simulation-based TeamSTEPPS training; however, evidence regarding its short-term feasibility remains limited. Methods: This mixed-methods pilot feasibility study examined the acceptability and limited efficacy (defined as learning satisfaction and self-reported gains) of HDT for interprofessional TeamSTEPPS-based team training across two geographically distributed campuses. Quantitative measures assessed changes in UTAUT-informed constructs, including attitude toward technology use (ATU) and behavioral intention (BI), while qualitative focus groups explored learner experiences and perceptions. Results: Of 64 participants, 47 consented to analysis. Quantitative analyses demonstrated post-training improvements in key technology-acceptance constructs, including significant gains in ATU and strengthened alignment between BI and UTAUT predictors. Qualitative findings reflected high learner engagement and perceived educational value, alongside practical considerations related to technical and instructional coordination. Conclusions: HDT was feasible for assessment of short-term foci of acceptability and perceived limited efficacy through the delivery of interprofessional TeamSTEPPS training, with observed gains in ATU and BI. These findings inform future assessment of long-term feasibility foci, including implementation studies examining the role of holographic simulation in advancing interprofessional education, healthcare workforce development, and the quality of healthcare delivery. Full article

(This article belongs to the Special Issue Advancing Healthcare Delivery and Patient Quality of Care Through Healthcare Professionals’ Development)

► Show Figures

Figure 1

17 pages, 479 KB

Open AccessArticle

Pregnant Women’s Experiences and Perceptions of the Impact of Exercise on Mental Health During Pregnancy—A Qualitative Study

by Manuela Filipec, Marko Bodrožić and Sania Almousa

Healthcare 2026, 14(5), 678; https://doi.org/10.3390/healthcare14050678 - 7 Mar 2026

Viewed by 642

Abstract

Background: Exercise during pregnancy is known to benefit physical and mental health. However, pregnant women’s lived experiences of its psychological impact remain insufficiently explored. This study aimed to explore pregnant women’s experiences and perceptions of how exercise influences mental health during pregnancy. Methods: [...] Read more.

Background: Exercise during pregnancy is known to benefit physical and mental health. However, pregnant women’s lived experiences of its psychological impact remain insufficiently explored. This study aimed to explore pregnant women’s experiences and perceptions of how exercise influences mental health during pregnancy. Methods: A qualitative study design was employed. Pregnant women were recruited using purposive sampling from a clinical hospital setting between March and September 2025. Eligible participants met predefined inclusion and exclusion criteria. Data saturation guided sample size (N = 38). Data were collected through semi-structured online interviews. Interviews were audio-recorded, transcribed verbatim, and analysed using inductive thematic analysis. Results: Four major participant-derived themes emerged: emotional regulation and mood stabilization, reduction of anxiety and depressive symptoms, enhanced self-confidence and body acceptance, and increased self-efficacy and sense of control. These themes illustrate the range of psychological benefits associated with maintaining exercise during pregnancy. Conclusions: This study highlights the psychological meanings pregnant women attribute to exercise, extending beyond its established physical benefits. These insights underscore the importance of integrating mental health perspective into prenatal physical activity counselling and support the development of more individualized, patient-centered prenatal care strategies. Full article

(This article belongs to the Special Issue Benefits of Exercise on Reproductive Health)

► Show Figures

Figure 1

15 pages, 303 KB

Open AccessArticle

Physical Activity Enjoyment and Orthorexic Eating Behaviours in Turkish Adults: A Cross-Sectional Study

by Bekir Erhan Orhan, Hussain Yasin, Aydın Karaçam, Umut Canlı and Mehdi Ben Brahim

Healthcare 2026, 14(5), 677; https://doi.org/10.3390/healthcare14050677 - 7 Mar 2026

Viewed by 434

Abstract

Background: Orthorexic eating reflects a rigid preoccupation with healthy eating that often co-occurs with health-oriented lifestyles, yet the affective experience of physical activity has received little attention. This study examined whether enjoyment of physical activity is associated with orthorexic tendencies in adults [...] Read more.

Background: Orthorexic eating reflects a rigid preoccupation with healthy eating that often co-occurs with health-oriented lifestyles, yet the affective experience of physical activity has received little attention. This study examined whether enjoyment of physical activity is associated with orthorexic tendencies in adults and whether it explains variance beyond age, body mass index (BMI), physical activity status, and self-rated diet. Methods: Adults (N = 434; M_age = 27.55) recruited online in Türkiye completed a survey including the Physical Activity Enjoyment Scale (PACES), the Orthorexia Nervosa Inventory (ONI), and sociodemographic, BMI, physical activity, and diet items. Pearson correlations and one-way ANOVAs assessed bivariate associations, and hierarchical regressions tested whether PACES added incremental variance to ONI total and domain scores beyond covariates. Results: PACES scores showed a near-zero correlation with ONI total (r ≈ 0.02) and did not add variance in regression models (ΔR² ≈ 0.00). Higher BMI and identifying one’s diet as “healthy and balanced” were linked to modestly higher ONI total and Impairments/Emotions scores, while differences in physical activity status were small and mainly limited to the Behavioural domain. Conclusions: In this non-clinical sample of Turkish adults, enjoyment of physical activity was not meaningfully associated with orthorexic tendencies. These findings suggest that enjoyment-focused physical activity promotion can be encouraged without increasing orthorexic symptoms, while replication in clinical/high-risk groups (e.g., elite/professional athletes and clinical eating disorder patients) and longitudinal designs is warranted. Full article

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

14 pages, 1170 KB

Open AccessArticle

Health Insurance and Neighborhood Deprivation as Determinants of Diagnostic Delays and Survival in Breast Cancer

by Axel Gierbolini-Bermúdez, Maira A. Castañeda-Avila, Marjorie Vázquez-Roldán, Tonatiuh Suárez-Ramos, Carlos R. Torres-Cintrón, Rosa Román-Oyola and Karen J. Ortiz-Ortiz

Healthcare 2026, 14(5), 676; https://doi.org/10.3390/healthcare14050676 - 7 Mar 2026

Viewed by 404

Abstract

Background/Objectives: Breast cancer (BC) represents a major public health problem that is influenced by social and systemic factors. This study evaluates disparities in the BC care continuum based on health insurance type and determines whether these patterns differ according to neighborhood-level deprivation. [...] Read more.

Background/Objectives: Breast cancer (BC) represents a major public health problem that is influenced by social and systemic factors. This study evaluates disparities in the BC care continuum based on health insurance type and determines whether these patterns differ according to neighborhood-level deprivation. Methods: Using the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database, we conducted a retrospective cohort study of women aged ≥18 years and diagnosed with BC in Puerto Rico between 2012 and 2016. The main outcomes were diagnostic delay (>60 days) and six-year mortality. Insurance type (private, Medicare, Medicaid, and dual enrollment in Medicare and Medicaid) was the main predictor, with neighborhood deprivation as a modifier. Logistic and Cox models assessed delay and survival, adjusting for key covariates. Results: Disparities in diagnostic delays and risk of death across insurance types were most evident in areas with low to average deprivation, whereas, in neighborhoods with above-average to highest deprivation, these differences diminished for diagnostic delay and disappeared for risk of death. Conclusions: These findings reveal that neighborhood environment, an intermediary social determinant of health, may affect the timeliness and quality of care provided to women diagnosed with BC. Full article

► Show Figures

Figure 1

19 pages, 2876 KB

Open AccessSystematic Review

Table Tennis as a Sustainable Health Intervention: A Meta-Analysis of Its Effects on Balance and Cognitive Functions

by He Li, Hyunkyun Ahn and Minhye Shin

Healthcare 2026, 14(5), 675; https://doi.org/10.3390/healthcare14050675 - 6 Mar 2026

Viewed by 648

Abstract

Background: Physical inactivity is linked to falls, cognitive decline, and reduced independence, underscoring the need for accessible interventions that enhance balance and cognitive functions. In this context, sustainability refers to affordability, accessibility, feasibility, and potential for long-term adherence. Table tennis, an open-skill sport [...] Read more.

Background: Physical inactivity is linked to falls, cognitive decline, and reduced independence, underscoring the need for accessible interventions that enhance balance and cognitive functions. In this context, sustainability refers to affordability, accessibility, feasibility, and potential for long-term adherence. Table tennis, an open-skill sport requiring motor coordination and cognitive engagement, may help improve balance and cognitive functions. This meta-analysis synthesized available evidence to investigate the effects of table tennis interventions on balance and cognitive functions. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and PROSPERO registration, six electronic databases were searched. A meta-analysis was conducted with 14 randomized controlled trials comprising 1565 participants in total. Additionally, subgroup analyses were conducted based on intervention participants, health status, intervention duration, and session length. Results: Pooled analyses showed that individuals who received table tennis interventions demonstrated significantly improved balance (standardized mean difference [SMD] = 0.78, 95% confidence interval [CI] [0.57, 0.98]) and cognitive (SMD = 2.05, 95% CI [1.27, 2.83]) functions than those who did not. Subgroup analyses indicated consistent benefits across different age groups and health statuses, along with larger cognitive function effects with longer interventions. Despite considerable heterogeneity across studies and limited evidence for some subgroups, sensitivity analyses supported the robustness of the results. Conclusions: Table tennis appears to be a feasible and low-cost intervention that can effectively enhance balance and cognition functions, with potential applicability in community, educational, and rehabilitation settings. However, considering the observed heterogeneity and methodological limitations, the findings should be interpreted with caution. Full article

► Show Figures

Figure 1

17 pages, 1093 KB

Open AccessArticle

Assessing the Early Economic Feasibility of a Curative Gene Therapy for Multiple Sclerosis Using a Risk-Adjusted Valuation Framework

by Attila Imre, Balázs Nagy and Rok Hren

Healthcare 2026, 14(5), 674; https://doi.org/10.3390/healthcare14050674 - 6 Mar 2026

Viewed by 572

Abstract

Background/Objectives: Multiple sclerosis (MS) imposes a substantial clinical, humanistic, and economic burden, and current disease-modifying therapies require lifelong administration without restoring immune tolerance. IMMUTOL, a tolerogenic gene therapy under development within an EU-funded programme, aims to induce durable remission. Methods: This [...] Read more.

Background/Objectives: Multiple sclerosis (MS) imposes a substantial clinical, humanistic, and economic burden, and current disease-modifying therapies require lifelong administration without restoring immune tolerance. IMMUTOL, a tolerogenic gene therapy under development within an EU-funded programme, aims to induce durable remission. Methods: This study assessed the early financial feasibility of IMMUTOL using a structured risk-adjusted net present value (rNPV) model, incorporating development and operating costs, probabilities of clinical and regulatory success, manufacturing expenditure, market dynamics, and revenue projections. Uncertainty was examined through one-way, probabilistic, and scenario analyses. Results: Under base-case assumptions, IMMUTOL generated a deterministic rNPV of −$223.8 million with an internal rate of return of 3.4%. Probabilistic analysis yielded a mean rNPV of −$99.4 million and a mean internal rate of return of 10.5%, with 70.2% of simulations producing negative values. Only scenarios combining higher treatment prices with lower manufacturing costs produced consistently positive rNPVs; a price of $1.5 million with a $200,000 production cost resulted in an rNPV of $711.2 million and an internal rate of return of 20.7%. Neither increased market size, reduced time to approval, nor modest cost reductions altered the conclusion. Conclusions: These findings emphasise a structural gap between value-based pricing and the pricing required for commercial viability. Without external support or reductions in cost structures, commercial development may be economically unattractive. Full article

(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)

► Show Figures

Figure 1

41 pages, 1265 KB

Open AccessReview

Mindfulness-Based Interventions for Bereavement: A Systematized Narrative Review

by Fabio D’Antoni, Fabio Mattiussi and Cristiano Crescentini

Healthcare 2026, 14(5), 673; https://doi.org/10.3390/healthcare14050673 - 6 Mar 2026

Viewed by 1181

Abstract

Background/Objectives: Mindfulness-based interventions (MBIs) have shown promising effects across diverse areas of psychiatry, yet their specific role in bereavement remains insufficiently synthesized. Bereavement is a universal but heterogeneous process, with a minority of individuals at risk of developing prolonged grief disorder (PGD). Understanding [...] Read more.

Background/Objectives: Mindfulness-based interventions (MBIs) have shown promising effects across diverse areas of psychiatry, yet their specific role in bereavement remains insufficiently synthesized. Bereavement is a universal but heterogeneous process, with a minority of individuals at risk of developing prolonged grief disorder (PGD). Understanding the potential benefits of MBIs in this context is crucial for informing clinical practice. Methods: Following the methodological framework of systematized narrative reviews, a comprehensive literature search was conducted across major databases. Eligible studies included empirical investigations of MBIs applied to bereavement, without restrictions on type of loss, population, or intervention format. Data were narratively synthesized and summarized in tables; no meta-analysis was performed. Results: Seventeen studies met inclusion criteria. The strongest evidence was found for Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), which demonstrated improvements in grief-related distress, depressive symptoms, and psychological well-being. Across interventions, MBIs were associated with reductions in rumination and experiential avoidance, increased self-compassion, and enhanced emotion regulation. However, most studies were limited by small sample sizes, heterogeneous outcome measures, and a lack of long-term follow-up. Conclusions: MBIs show promise as adjunctive interventions in bereavement care, targeting mechanisms central to grief adaptation, including acceptance, decentering, and self-compassion. Nevertheless, the evidence remains preliminary and methodologically constrained. Future high-quality randomized controlled trials are needed to establish efficacy, clarify mechanisms of action, and define the role of MBIs alongside established grief therapies. Full article

(This article belongs to the Special Issue Yoga and Mindfulness Interventions for Health and Well-Being in Different Populations)

► Show Figures

Figure 1

19 pages, 881 KB

Open AccessArticle

Deep Brain Stimulation for Movement Disorders in Spain: Temporal Trends, Complications, and Sex-Related Disparities (2002–2019)

by Víctor Gómez-Mayordomo, Jose J. Zamorano-León, David Carabantes-Alarcon, Valentín Hernández-Barrera, Ana Lopez-de-Andrés, Natividad Cuadrado-Corrales, Fernando Alonso-Frech, Ana Jiménez-Sierra and Rodrigo Jiménez-García

Healthcare 2026, 14(5), 672; https://doi.org/10.3390/healthcare14050672 - 6 Mar 2026

Viewed by 446

Abstract

Background/Objectives: This study aimed to describe temporal trends in deep brain stimulation (DBS) use for Parkinson’s disease (PD), essential tremor (ET), and dystonia; characterize patient age and sex distribution and comorbidity; assess postoperative complications and in-hospital mortality (IHM) after implantation and explantation; and [...] Read more.

Background/Objectives: This study aimed to describe temporal trends in deep brain stimulation (DBS) use for Parkinson’s disease (PD), essential tremor (ET), and dystonia; characterize patient age and sex distribution and comorbidity; assess postoperative complications and in-hospital mortality (IHM) after implantation and explantation; and explore sex-specific differences in utilization and outcomes. Methods: We conducted a retrospective nationwide population-based study using the Spanish National Hospital Discharge Database (RAE-CMBD) from 2002 to 2019. All hospital admissions with DBS implantation or explantation/revision and a diagnosis of PD, ET, or dystonia were identified. Sociodemographic variables, the Charlson Comorbidity Index (CCI), length of hospital stay (LOHS), postoperative complications, and IHM were analyzed across three calendar periods and stratified by diagnosis and sex. Results: A total of 4883 admissions for DBS electrode implantations and 497 admissions for DBS explantation/revision were recorded. PD accounted for 82.6% of implantations, followed by ET (11.2%) and dystonia (6.3%). DBS activity increased significantly over time, while median LOHS declined from 12 to 6 days for implantations and from 13 to 5 days for explantations. Overall IHM after implantation was 0.27%, decreasing to 0.05% in 2014–2019; IHM after explantation was 0.6%. Most hospitalizations had low comorbidity (CCI = 0 in 87.8%), although comorbidity increased over time. Men represented approximately 60% of procedures in PD and ET. Women with PD underwent DBS at older ages, despite similar LOHS and IHM. Postoperative complications were recorded in 14.6% of implantations, mainly hardware-related issues (5–6%) and infections (1–2%), whereas infections (33%) and mechanical problems (27%) predominated among explantations. Conclusions: DBS use in Spain has expanded substantially, with shorter hospital stays and very low in-hospital mortality. Sex-related differences in utilization are increasing, and hardware complications and infections remain the most frequent conditions associated with explantation. As complications were identified only during the same hospitalization as the DBS procedure, late post-discharge events are not captured and could be underestimated; patient-level risks cannot be derived. Full article

► Show Figures

Figure 1

2 pages, 132 KB

Open AccessCorrection

Correction: Zhang et al. Obesity and Occupational Disparities in Urban China: Evidence from a Large-Scale Cross-Sectional Study. Healthcare 2025, 13, 2225

by Guoxi Zhang, Huyang Zhang, Gordon G. Liu and Leiyu Shi

Healthcare 2026, 14(5), 671; https://doi.org/10.3390/healthcare14050671 - 6 Mar 2026

Viewed by 318

Abstract

Error in Figure/Table [...] Full article

26 pages, 473 KB

Open AccessArticle

Findings from the Process Evaluation of a Mobile Health Clinic Designed to Improve Equity of Access to Primary Healthcare for People with Substance Use Disorders and/or Homelessness in One Region in the North East of England, UK

by Emma-Joy Holland, Eleanor Ash, Elizabeth Titchener, Sarah Schonewald, Amy O’Donnell, Sedighe Hosseini-Jebeli, Emma A. Adams, Sarah Lonbay, Floor Christie-de Jong, Sarah Norman and Katherine Jackson

Healthcare 2026, 14(5), 670; https://doi.org/10.3390/healthcare14050670 - 6 Mar 2026

Viewed by 697

Abstract

Background/Objectives: New models of care are needed to address the barriers people who use substances (PWUS) and/or experience homelessness face when accessing primary healthcare. This study reports findings from the evaluation of a six-month pilot of a mobile health clinic (MHC) co-delivered [...] Read more.

Background/Objectives: New models of care are needed to address the barriers people who use substances (PWUS) and/or experience homelessness face when accessing primary healthcare. This study reports findings from the evaluation of a six-month pilot of a mobile health clinic (MHC) co-delivered by primary healthcare, local government, and lived-experience recovery organisations in the North East of England, UK. Methods: Pragmatic mixed-methods process evaluation with data sources including a patient survey, overt observations, qualitative interviews, and routine patient data. Qualitative data were analysed using inductive and deductive thematic analysis; quantitative data were analysed descriptively. RE-AIM framework dimensions were applied to inform interpretation. Results: N = 164 patients accessed the bus between 1 April and 31 October 2025, with survey data indicating that most patients were PWUS (n = 96, 84%), with experience of homelessness (n = 67, 61%) and/or lived in the most deprived neighbourhoods, with complex physical and mental health needs (Reach). Patients expressed satisfaction with the service, valuing the compassionate and comprehensive support provided. There was qualitative evidence of further re-engagement with statutory healthcare following attendance on the bus (Effectiveness). Local organisations were mostly keen to be involved in the pilot, with participation benefiting from existing local relationships and infrastructure (Adoption). The flexible yet consistent approach of those involved in service delivery was viewed as positive. There was some uncertainty around the functions of the bus and the role of some delivery staff (Implementation). Limited funding was perceived as a barrier to sustaining the bus, alongside lack of capacity within local organisations (Maintenance). Conclusions: The study highlighted the positive impact that an MHC can have on this marginalised population and provides further evidence for the need for clinical care that provides relational support and attends to the social determinants of health. The study indicates the potential for interdisciplinary working to improve access to healthcare for PWUS, and underlines that delivering healthcare at a neighbourhood level is reliant on strong community networks. Wider system change is still needed to further support the population. Full article

(This article belongs to the Special Issue Increasing Access to and Quality of Healthcare Services to Promote Community Health Equity)

► Show Figures

Figure 1

21 pages, 640 KB

Open AccessArticle

Archetypes of Family Health Climates for Nutrition and Physical Activity Among Families in Singapore: A Cross-Sectional Study

by Dhiya Mahirah, Yi-Ching Lynn Ho, Zi Hsuan Chia, Mary Su-Lynn Chew, Xuan Han Koh, Jin-Jin Lim, Julian Thumboo and Kinjal Doshi

Healthcare 2026, 14(5), 669; https://doi.org/10.3390/healthcare14050669 - 6 Mar 2026

Viewed by 535

Abstract

Background: Poor lifestyle choices contribute significantly to non-communicable chronic diseases. Given the family’s influence on health behaviours, this study aimed to identify distinct family archetypes based on family health climates for physical activity and nutrition to inform targeted family-based health promotion strategies. Methods: [...] Read more.

Background: Poor lifestyle choices contribute significantly to non-communicable chronic diseases. Given the family’s influence on health behaviours, this study aimed to identify distinct family archetypes based on family health climates for physical activity and nutrition to inform targeted family-based health promotion strategies. Methods: Two hundred family dyads (≥15 years old, cohabiting) in Singapore completed a survey assessing family health climates (physical activity and nutrition), together with individual behaviours, and family lifestyle behaviours. Based on family health climate scores, K-means clustering identified family archetypes. Random Forest analysis determined key contributing constructs to the clusters. Chi-square and ANOVA tests compared socio-demographics, family and individual behaviours, and sleep quality across archetypes. Results: Four family health climate archetypes were identified: Survivors (16%) had poor health climate scores for both physical activity and nutrition, lower socioeconomic status, infrequent family meals, and poorer diet and sleep quality. Nourished Sedentary (16%) had a poor climate for physical activity but a positive climate for nutrition, higher socioeconomic status, frequent family meals, and limited physical activity. Satisficers (41%) had moderate health climates for both, with average socioeconomic status and engagement in healthy behaviours. Flourishers (27%) had positive health climates for both higher socioeconomic status, frequent family meals, healthy food choices, and greater physical activity engagement. Conclusions: The identification of four distinct family health climate archetypes demonstrates that health-related behaviours cluster at the family level rather than solely at the individual level. These findings underscore the importance of targeting family systems in health promotion and support the development of tailored, family-specific strategies. Full article

(This article belongs to the Special Issue Enhancing Family and Community Health Through Salutogenic Approach)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Healthcare, Volume 14, Issue 5 (March-1 2026) – 145 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI