Healthcare

12 pages, 425 KiB

Open AccessArticle

Effects of Physical Activity and Mental Health on Chewing Difficulty in South Korean Adults: A Cross-Sectional Analysis

by Mi-Ra Lee

Healthcare 2025, 13(16), 2004; https://doi.org/10.3390/healthcare13162004 - 14 Aug 2025

Objectives: This study aimed to investigate the effects of physical activity and mental health on chewing difficulty in South Korean adults using data from the seventh Korea National Health and Nutrition Examination Survey (KNHANES VII, 2016–2018). Methods: A total of 8212 participants aged [...] Read more.

Objectives: This study aimed to investigate the effects of physical activity and mental health on chewing difficulty in South Korean adults using data from the seventh Korea National Health and Nutrition Examination Survey (KNHANES VII, 2016–2018). Methods: A total of 8212 participants aged ≥20 years who completed surveys on their physical activity, mental health, and chewing status were included. Chewing difficulty was assessed via a five-point Likert scale based on self-reported discomfort when chewing due to oral problems, and dichotomized for analysis. The participants were divided into two groups: those aged <40 and those aged ≥40 years. Complex sample analyses, including cross-tabulations and logistic regression, were used to examine the associations. Results: Among men aged <40, high perceived stress was associated with 1.71 times higher odds of experiencing chewing difficulty (p < 0.05). For men aged ≥40, high perceived stress (OR of 1.45) and a sleep duration of <7 h (OR of 1.32) were significant risk factors (p < 0.05). In women aged ≥40 years, high Patient Health Questionnaire 9 (PHQ-9) scores (≥10; OR of 2.35) and high perceived stress (OR of 1.64) were significantly associated with chewing difficulty (p < 0.001). Conclusions: Perceived stress, insufficient sleep, and depression are significant mental health factors associated with chewing difficulty in adults. These findings emphasize the necessity of a multifaceted approach, including psychosocial mental health issues, to effectively manage chewing difficulty in this population. Full article

(This article belongs to the Section Healthcare Quality and Patient Safety)

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15 pages, 248 KiB

Open AccessReview

From Blame to Learning: The Evolution of the London Protocol for Patient Safety

by Francesco De Micco, Gianmarco Di Palma, Vittoradolfo Tambone and Roberto Scendoni

Healthcare 2025, 13(16), 2003; https://doi.org/10.3390/healthcare13162003 - 14 Aug 2025

Abstract

Over the past two decades, patient safety and clinical risk management have become strategic priorities for healthcare systems worldwide. In this context, the London Protocol has emerged as one of the most influential methodologies for investigating adverse events through a systemic, non-punitive lens. [...] Read more.

Over the past two decades, patient safety and clinical risk management have become strategic priorities for healthcare systems worldwide. In this context, the London Protocol has emerged as one of the most influential methodologies for investigating adverse events through a systemic, non-punitive lens. The 2024 edition, curated by Vincent, Adams, Bellandi, and colleagues, represents a significant evolution of the original 2004 framework. It integrates recent advancements in safety science, human factors, and digital health, while placing a stronger emphasis on resilience, proactive learning, and stakeholder engagement. This article critically examines the structure, key principles, and innovations of the London Protocol 2024, highlighting its departure from incident-centered analysis toward a broader understanding of both failures and successes. The protocol encourages fewer but more in-depth investigations, producing actionable and sustainable recommendations rather than generic reports. It also underscores the importance of involving patients and families as active partners in safety processes, recognizing their unique perspectives on communication, care pathways, and system failures. Beyond its strengths—holistic analysis, multidisciplinary collaboration, and cultural openness—the systemic approach presents challenges, including methodological complexity, resource requirements, and cultural resistance in blame-oriented environments. This paper discusses these limitations and explores how leadership, staff engagement, and digital technologies (including artificial intelligence) can help overcome them. Ultimately, the London Protocol 2024 emerges not only as a methodological tool but as a catalyst for cultural transformation, fostering healthcare systems that are safer, more resilient, and committed to continuous learning. Full article

(This article belongs to the Special Issue Integrating Forensic Science in Clinical Medicine: Enhancing Diagnosis and Patient Safety)

19 pages, 1119 KiB

Open AccessSystematic Review

Effects of Tibetan Singing Bowl Intervention on Psychological and Physiological Health in Adults: A Systematic Review

by Fei-Wen Lin, Ya-Hui Yang and Jiun-Yi Wang

Healthcare 2025, 13(16), 2002; https://doi.org/10.3390/healthcare13162002 - 14 Aug 2025

Abstract

Background: Anxiety and stress are common mental health issues that affect both psychological and physiological well-being as well as quality of life. The Tibetan Singing Bowl, which combines sound and vibration, is often used in meditation and relaxation and may offer therapeutic [...] Read more.

Background: Anxiety and stress are common mental health issues that affect both psychological and physiological well-being as well as quality of life. The Tibetan Singing Bowl, which combines sound and vibration, is often used in meditation and relaxation and may offer therapeutic benefits. However, current research findings are scattered and lack systematic integration and quantitative validation. Methods: This study is a systematic review that included 14 quantitative studies from the past 16 years investigating the effects of Tibetan Singing Bowl interventions on adult psychological and physiological health. Data were sourced from six major databases and supplemented through citation tracking. Inclusion criteria were adults aged 18 and over, with interventions primarily involving Tibetan Singing Bowls, and reporting quantitative outcomes related to psychological indicators (e.g., anxiety and depressive symptoms) and physiological indicators (e.g., Heart Rate Variability and brainwave activity). Study quality was assessed using Joanna Briggs Institute (JBI) criteria, and findings were synthesized narratively to identify patterns and trends. Results: Study populations included general adults, individuals with emotional distress, and patients with cancer or chronic illnesses. Interventions ranged from single sessions to multiple courses, with some incorporating breathing or other practices. Most studies reported significant reductions in anxiety and depressive symptoms, improvements in well-being and quality of life, increases in Heart Rate Variability, and decreases in heart rate. Some studies also found increased Delta and Theta brainwave activity. Due to heterogeneity in study design and limited articles, no meta-analysis was conducted. Conclusions: Tibetan Singing Bowl interventions demonstrate potential for stress reduction and psychological well-being, offering a non-invasive, low-risk, and widely accepted complementary method supporting therapeutic processes, which can be suitable for clinical and community settings. Future research should focus on rigorously designed controlled trials and consider follow-up assessments to more accurately evaluate the effectiveness of TSB interventions. Full article

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

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21 pages, 655 KiB

Open AccessArticle

Assessing the Effectiveness of a Solution-Focused Brief Therapy-Based Intervention on Exam Anxiety in First-Year Polish University Students: A Pilot Study with a Randomized Controlled Trial

by Natalia Cavour-Więcławek, Aleksandra Różańska and Aleksandra M. Rogowska

Healthcare 2025, 13(16), 2001; https://doi.org/10.3390/healthcare13162001 - 14 Aug 2025

Abstract

Background/Objectives: Exam anxiety is a prevalent issue among university students, affecting both their academic performance and overall subjective well-being. There is an increasing need for efficient psychological interventions to support students. This study aimed to assess the effectiveness of a four-session group [...] Read more.

Background/Objectives: Exam anxiety is a prevalent issue among university students, affecting both their academic performance and overall subjective well-being. There is an increasing need for efficient psychological interventions to support students. This study aimed to assess the effectiveness of a four-session group intervention based on Solution-Focused Brief Therapy (SFBT) in reducing exam anxiety among 1st-year psychology students in Poland. Additionally, it examined the single-session effects of the SFBT on positive and negative emotions and perceived stress. Methods: A pilot study with a randomized controlled trial with a pretest–post-test design was conducted. The 18 participants aged between 19 and 21 years (M = 19.22, SD = 0.55) were assigned to either the intervention group (SFBT) or a waitlist control group. Exam anxiety was evaluated before and after the intervention. In the experimental group, emotional states and perceived stress were measured before and after each session. Results: The two-way analysis of variance ANOVA 2 (therapy: Before, After treatment) x 2 (group: Experimental, Control) showed significant intervention (p < 0.05, η²_p = 0.27) and interaction effects (p < 0.05, η²_p = 0.22). However, the Experimental and Control groups did not differ significantly in exam anxiety (p = 0.32, η²_p = 0.06). Examining changes during each of the four sessions of SFBT in the Experimental group (n = 10), the study showed a significant decrease in stress (p < 0.05, η²_p = 0.47) and negative emotion levels (p < 0.01, η²_p = 0.57) while increasing positive emotions (p < 0.05, η²_p = 0.14), comparing emotional states before and after SFBT sessions. Conclusions: Even a brief, four-session SFBT intervention is effective in reducing exam anxiety in university students. Moreover, single SFBT sessions were linked to immediate improvements in emotional functioning in the experimental sample. Future research should be repeated to investigate the long-term effects of the SFBT on well-being and include a larger and more heterogeneous sample of university students. Full article

(This article belongs to the Special Issue Psychological Diagnosis and Treatment of People with Mental Disorders)

16 pages, 1317 KiB

Open AccessArticle

Effects of an App-Based Intervention to Improve Awareness and Usage of Early Childhood Intervention Services During the COVID-19 Pandemic: Randomized Controlled Trial of the CoronabaBY Study from Germany

by Catherine Buechel, Volker Mall, Ina Nehring and Anna Friedmann

Healthcare 2025, 13(16), 2000; https://doi.org/10.3390/healthcare13162000 - 14 Aug 2025

Abstract

Background/Objectives: Young families experiencing high levels of psychosocial stress should be addressed at an early stage to counteract potential negative effects on the parents’ and child’s wellbeing. This became particularly relevant during the COVID-19 pandemic when especially families have been strained by [...] Read more.

Background/Objectives: Young families experiencing high levels of psychosocial stress should be addressed at an early stage to counteract potential negative effects on the parents’ and child’s wellbeing. This became particularly relevant during the COVID-19 pandemic when especially families have been strained by restriction measures. Early Childhood Intervention services (ECI) can provide low-threshold support, to which access should be encouraged. Methods: The randomized controlled trial of the CoronabaBY study with N = 1384 participants focuses on the effects of a newly developed app-based intervention on the awareness and usage of ECI services by young families with infants and toddlers during the COVID-19 pandemic in Germany. The analysis compares knowledge and usage rates of an intervention group (IG) and a waitlist control group (WCG) at three survey stages (pre-test, post-test and follow-up). Results: There was a significant increase in awareness of ECI services from pre-test to post-test in both the IG (15.2%) and WCG (10.7%) (p < 0.001), but the difference between the two groups was not significant. In contrast, the usage rate of further ECI services at post-test was significantly higher in the IG (12.1%) compared to the WCG (8.2%) (V = 0.060, p = 0.012), especially in a subgroup of highly stressed parents. Conclusions: Digital applications show potential to improve access to ECI services and should be continuously developed and evaluated to appropriately address young families and their needs. Full article

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17 pages, 567 KiB

Open AccessStudy Protocol

Feasibility and Potential Effects of Multidomain Interventions to Improve the Cognitive and Functional Well-Being of Elderly Individuals in Residential Structures: The I-COUNT Pilot Study Protocol

by Zaira Romeo, Eleonora Macchia, Chiara Ceolin, Maria Devita, Alessandro Morandi, Marianna Noale and Stefania Maggi

Healthcare 2025, 13(16), 1999; https://doi.org/10.3390/healthcare13161999 - 14 Aug 2025

Abstract

Background/Objectives: Multidisciplinary approaches spanning the physical, cognitive, and social domains of geriatric evaluation are essential to promote functional well-being and reduce the aversive consequences of aging. The main objective of the pilot study, “Multidomain Interventions to improve the COgnitive and fUNctional well-being [...] Read more.

Background/Objectives: Multidisciplinary approaches spanning the physical, cognitive, and social domains of geriatric evaluation are essential to promote functional well-being and reduce the aversive consequences of aging. The main objective of the pilot study, “Multidomain Interventions to improve the COgnitive and fUNctional well-being of elderly individuals in residential sTructures” (I-COUNT), is to assess the feasibility of a 6-month multidomain intervention performed on older adults in Long-Term Care Facilities (LTCFs), compared with a group of residents following a traditional care approach. Methods: The intervention will involve two LTCFs in Italy and will include physical exercise and cognitive training, administered and monitored using wearable technologies, a nutritional program based on the Mediterranean diet enriched with selected functional foods, and the administration of the vaccinations recommended in the national vaccination plan. The I-COUNT study will assess the feasibility and acceptability of the defined protocol and provide information to determine the sample size for a definitive study. In relation to the potential health impact of multidomain interventions on older people living in LTCFs, the primary outcome will consider the change in microbiota composition assessed 3 months after the start of interventions, while secondary outcomes will include the evaluation of changes in selected biomarkers, physical performance, psychological health, cognitive functioning, and nutritional status at 6- and 9-month follow-up points. Conclusions: The I-COUNT study will allow us to assess the feasibility of delivering a multidomain intervention on elderly people. Exploratory findings on potential health effect will support the development of a larger-scale randomized controlled trial. Trial registration number: ClinicalTrials.gov ID NCT06820710. Full article

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23 pages, 584 KiB

Open AccessReview

The Impact of Polycrisis on Healthcare Systems—Analyzing Challenges and the Role of Social Epidemiology

by Agata Wypych-Ślusarska, Karolina Krupa-Kotara, Jerzy Słowinski, Antoniya Yanakieva and Mateusz Grajek

Healthcare 2025, 13(16), 1998; https://doi.org/10.3390/healthcare13161998 - 14 Aug 2025

Abstract

In response to contemporary challenges such as the COVID-19 pandemic, climate change, armed conflicts, and economic instability, healthcare systems worldwide are increasingly confronted with multifaceted and overlapping crises—collectively referred to as polycrisis. These interconnected threats amplify one another, placing unprecedented strain on healthcare [...] Read more.

In response to contemporary challenges such as the COVID-19 pandemic, climate change, armed conflicts, and economic instability, healthcare systems worldwide are increasingly confronted with multifaceted and overlapping crises—collectively referred to as polycrisis. These interconnected threats amplify one another, placing unprecedented strain on healthcare infrastructure, governance, and equity. The COVID-19 pandemic alone led to an estimated 16.3 million missed hospitalizations in 2020 and 14.7 million in 2021, revealing systemic vulnerabilities and deepening social inequalities. Armed conflicts, such as in Syria and Gaza, have devastated healthcare access. In Gaza, by mid-2024, 85% of the population had been forcibly displaced, with only 17 of 36 hospitals partially functioning and over 885 healthcare workers killed. Climate change further exacerbates health burdens, with over 86% of urban residents globally exposed to harmful air pollution, contributing to 1.8 million deaths annually. This study introduces a novel perspective by applying social epidemiology to the analysis of polycrisis. While the existing literature often emphasizes political or economic dimensions, our approach highlights how overlapping crises affect population health, social vulnerability, and systemic resilience. By integrating sociodemographic and environmental data, social epidemiology supports crisis-resilient care models, targeted interventions, and equitable health policies. We argue for a stronger mandate to invest in data infrastructure, enhance surveillance, and embed social determinants into health system responses. Full article

(This article belongs to the Section Health Assessments)

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19 pages, 287 KiB

Open AccessArticle

Exploring the Involvement of Personal and Emotional Factors and Social Media Body Image-Related Behaviours on Eating Disorder Symptoms and Body Image Concerns in Women and Men

by Celia López-Muñóz, Roberto García-Sánchez, Melany León-Méndez and Rosario J. Marrero

Healthcare 2025, 13(16), 1997; https://doi.org/10.3390/healthcare13161997 - 14 Aug 2025

Abstract

Background: Eating disorder (ED) symptoms and body image (BI) concerns involve serious risks to the physical and mental health of women and men. Social networking sites have amplified the promotion of idealised body images, contributing to this issue. Objectives: This study [...] Read more.

Background: Eating disorder (ED) symptoms and body image (BI) concerns involve serious risks to the physical and mental health of women and men. Social networking sites have amplified the promotion of idealised body images, contributing to this issue. Objectives: This study examines the link between personal and emotional factors, social media body image-related behaviours, BI concerns, and ED symptoms, as well as the differential role of these factors according to gender. Methods: A cross-sectional design was applied. The participants were 201 Spanish adults (mean age = 28.26; 76.6% women) who completed self-reported measures on BI (MBSRQ), ED symptoms (EAT-26), perfectionism (EDI-2), anxiety, depression, stress (DASS-21), emotional dysregulation (DERS), life satisfaction (SWLS), and social media BI-related behaviours. Results: Significant relationships between ED symptoms and BI concerns with personal and emotional factors and social media body image-related behaviours have been found. Women have scored higher in ED symptoms and social media BI-related behaviours than men. Multiple regression analyses showed that the difficulty in accepting emotions and not posting images due to BI dissatisfaction were risk factors for ED symptoms in both men and women. Furthermore, the adverse effect of perfectionism and low life satisfaction on women’s ED symptoms were demonstrated, whereas in men, goal-directed behaviours were associated with ED risk. Conclusions: These results suggest that prevention programmes focusing on emotional regulation and healthier social media use can be effective for ED symptoms and BI concerns. Full article

23 pages, 1045 KiB

Open AccessReview

Building Lay Society Knowledge and Education for Health Technology Assessment and Policy Engagement: Case of CFTR Modulator Access in Brazil

by Verônica Stasiak Bednarczuk de Oliveira, Marise Basso Amaral, Mariana Camargo and Miquéias Lopes-Pacheco

Healthcare 2025, 13(16), 1996; https://doi.org/10.3390/healthcare13161996 - 14 Aug 2025

Abstract

The health technology assessment (HTA) is a multidisciplinary process utilized to determine the clinical, economic, social, and ethical value of new health technologies before they are incorporated into healthcare systems. In the case of rare diseases, such as Cystic Fibrosis (CF), challenges arise [...] Read more.

The health technology assessment (HTA) is a multidisciplinary process utilized to determine the clinical, economic, social, and ethical value of new health technologies before they are incorporated into healthcare systems. In the case of rare diseases, such as Cystic Fibrosis (CF), challenges arise due to limited evidence and high treatment costs. Indeed, although CF transmembrane conductance regulator (CFTR) modulators are breakthrough therapies for CF, their incorporation into public health systems has been complex with considerable challenges, especially in low- and middle-income countries. This article presents a descriptive and exploratory case study of the regulatory and policy journey for CFTR modulators to be approved in Brazil. Based on a narrative review and document analysis, we highlight the importance of building lay society knowledge to shape policy decisions and promote equitable access to innovative therapies. In parallel, we critically reflect on the HTA process and highlight efforts in the training, education, and coordination required to enable meaningful public engagement and landmark achievements. Full article

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

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15 pages, 277 KiB

Open AccessArticle

Clinical Reasoning and Practices in the Osteopathic Management of Visceral Disorders: A Grounded Theory Study in the Italian Context

by Tommaso Camonico, Francesca Lippi, Nicolò Rizzo, Alessio Barusso, Giacomo Rossettini, Jorge Hugo Villafañe, Francesco Cerritelli, Liria Papa and Jorge E. Esteves

Healthcare 2025, 13(16), 1995; https://doi.org/10.3390/healthcare13161995 - 14 Aug 2025

Abstract

Background and Rationale: Visceral disorders, both functional and organic, significantly impact health-related quality of life and pose a challenge for healthcare systems. Osteopathy offers manual, systemic, and patient-centered approaches for their management, yet these remain controversial due to limited scientific support and methodological [...] Read more.

Background and Rationale: Visceral disorders, both functional and organic, significantly impact health-related quality of life and pose a challenge for healthcare systems. Osteopathy offers manual, systemic, and patient-centered approaches for their management, yet these remain controversial due to limited scientific support and methodological inconsistencies. In the evolving landscape of healthcare regulation in Europe, and particularly in Italy, exploring clinical reasoning and operational models in visceral osteopathy is essential. This study aimed to explore the beliefs, clinical reasoning, and management strategies of experienced Italian osteopaths in the treatment of visceral disorders using a Constructivist Grounded Theory approach. Methods: This qualitative study applied a Constructivist Grounded Theory approach to explore the beliefs and clinical practices of 10 experienced Italian osteopaths. Semi-structured interviews were transcribed, coded, and thematically analyzed, integrating literature comparisons to support theory generation. Results: Four core themes emerged: (1) education and professional development, (2) definition and identification of visceral disorders, (3) clinical management strategies, and (4) multidisciplinary collaboration. The findings reveal marked heterogeneity in diagnostic frameworks and treatment rationales, often driven by tradition and subjective interpretation rather than empirical evidence. Palpatory assessments were frequently prioritized over patient-reported outcomes. Conclusion: The study highlights substantial fragmentation in Italian visceral osteopathic practice, echoing challenges across Europe. Promoting a shift towards critical thinking, evidence-based models, shared terminology, and interprofessional integration is essential for contextualising osteopathic contributions to the care of individuals presenting with visceral-related problems. These findings provide insights into the fragmented clinical practices of Italian osteopaths and may contribute to shaping a more critical and evidence-informed approach within Italian osteopathic practice and professional development, which is now more relevant than ever, given the recent integration of osteopathy into the Italian higher education system. Full article

(This article belongs to the Collection Osteopathic and Manual Therapy Healthcare Reconceptualization: Health Needs and New Evidence)

12 pages, 1178 KiB

Open AccessPerspective

‘Finally, in Hands I Can Trust’: Perspectives on Trust in Motor Neurone Disease Care

by Dominika Lisiecka, Neil Dyson, Keith Malpress, Anthea Smith, Ellen McNeice, Peter Shack and Karen Hutchinson

Healthcare 2025, 13(16), 1994; https://doi.org/10.3390/healthcare13161994 - 14 Aug 2025

Abstract

Integrated multidisciplinary care is recognised as essential for people living with motor neurone disease (PlwMND) and their families. The values underpinning integrated care, such as person-centredness, respect, empowerment, and co-production, are central to delivering meaningful and comprehensive support. Trust is an essential yet [...] Read more.

Integrated multidisciplinary care is recognised as essential for people living with motor neurone disease (PlwMND) and their families. The values underpinning integrated care, such as person-centredness, respect, empowerment, and co-production, are central to delivering meaningful and comprehensive support. Trust is an essential yet often overlooked element of effective person- and family-centred integrated care, particularly for PlwMND. While specialist multidisciplinary MND clinics represent the benchmark for evidence-based care, many PlwMND and their families depend significantly on local and community-based support services to maintain quality of life. Trust directly influences their engagement with these services and the continuity of care provided. Trust enables understanding of personal priorities and how they change as the disease progresses, ultimately allowing for person-centred care to happen. Trust is necessary to enable service co-production, which is a strong value of integrated care. Research highlights seven key domains of support essential to PlwMND and their carers: practical, social, informational, psychological, physical, emotional, and spiritual. Effective integrated care requires strong relationships built upon trust, shared decision-making, respect for individuality, and clear communication. Furthermore, due to the rapidly progressive nature of MND, care priorities and perceived symptom burdens may shift significantly over short periods, making flexible, temporally sensitive approaches critical. A dynamic, inclusive model of decision-making that fosters autonomy within and regular co-review of needs is recommended. This perspective paper examines how person- and family-centred integrated care is currently being delivered, what is working well, and how these practices can be further strengthened to enhance the care experiences of PlwMND, their families, and the health and social care providers involved. This paper builds on both theoretical knowledge and clinical experience to offer our perspective on the critical role of trust in co-producing integrated care for PlwMND. It brings together the voices of clinicians and researchers, alongside those with lived experience of MND. We propose a diagram of care that embeds the core values of integrated, person-centred care within the specific context of MND. Our aim is to enhance collaborative practices, strengthen cross-sector partnerships, and ultimately improve the care experiences for professionals, PlwMND, and their families. Full article

(This article belongs to the Special Issue Improving Care for People Living with ALS/MND)

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21 pages, 579 KiB

Open AccessReview

Perils of the PICC: Peripherally Inserted Central Catheter-Associated Complications and Recommendations for Prevention in Clinical Practice—A Narrative Review

by Benjamin Kalma and André van Zundert

Healthcare 2025, 13(16), 1993; https://doi.org/10.3390/healthcare13161993 - 14 Aug 2025

Abstract

Background: Peripherally inserted central catheters (PICCs) are becoming an increasingly utilised alternative to traditional central venous access devices. Their uptake, particularly among oncology patients, is due to their growing ease of access, suitability for medium-term use and perceived safety profile. However, PICCs can [...] Read more.

Background: Peripherally inserted central catheters (PICCs) are becoming an increasingly utilised alternative to traditional central venous access devices. Their uptake, particularly among oncology patients, is due to their growing ease of access, suitability for medium-term use and perceived safety profile. However, PICCs can be a source of severe and life-threatening complications such as central line-associated bloodstream infection (CLABSI), deep vein thrombosis (DVT), pulmonary embolism (PE), malpositioning, dislodgement, and occlusion. Methods: This narrative was constructed from a literature review of the PubMed database, utilising MESH terms for peripherally inserted central catheters, percutaneous central catheters, PICC, and complications. Randomised controlled trials, systematic reviews, and meta-analyses published between 2015 and 2025 were included. Additional articles were obtained through targeted PubMed searches or from references within previous articles. Results: Major periprocedural complications were seen in 1.1% of PICC insertions, CLABSI in 1.4–1.9%, venous thrombosis embolism (including PE) in 2.3–5.9%, and malpositioning in 7.87%. The overall PICC complication incidence was 9.5–38.6%, which is greater than that of centrally inserted central venous access. A higher BMI, diabetes mellitus, chronic renal failure, and malignancy were the most significant predictive factors for PICC-associated complications. Conclusions: PICC complications are common, occurring more frequently than other forms of central venous access, and may lead to significant morbidity and mortality. Appropriate assessment of patient risk factors and optimisation strategies may reduce complication rates. Full article

(This article belongs to the Section Critical Care)

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16 pages, 251 KiB

Open AccessArticle

A Short-Term Comparative Evaluation of Multiple Treatment Modalities for Meibomian Gland Dysfunction: A Prospective Clinical Study

by Mübeccel Bulut, Ali Hakim Reyhan and Gökhan Yüzbaşı

Healthcare 2025, 13(16), 1992; https://doi.org/10.3390/healthcare13161992 - 14 Aug 2025

Abstract

Purpose: The aim of this study was to evaluate the different approaches used in the treatment of meibomian gland dysfunction (MGD). Materials and Methods: This open-label, single-center, prospective pilot study with a parallel-group design was conducted in February 2025. Ninety-two patients presenting to [...] Read more.

Purpose: The aim of this study was to evaluate the different approaches used in the treatment of meibomian gland dysfunction (MGD). Materials and Methods: This open-label, single-center, prospective pilot study with a parallel-group design was conducted in February 2025. Ninety-two patients presenting to our clinic with symptoms and signs of MGD were enrolled and diagnosed according to Japanese MGD diagnostic criteria. Patients were assigned to five treatment groups: conservative management alone, conservative management plus intense pulsed light (IPL) therapy, conservative management plus oral azithromycin, conservative management plus oral doxycycline, and conservative management plus topical cyclosporine. Conservative management consisted of preservative-free artificial tears containing polyvinyl alcohol and povidone, warm compresses, and eyelid hygiene. Primary outcome measures included ocular surface parameters such as the Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), Standard Patient Evaluation of Eye Dryness (SPEED) scores, and meibomian gland parameters evaluated using a slit-lamp examination. All parameters were assessed at baseline and during follow-up examinations after treatment initiation to observe changes in symptoms and signs. Results: A statistically significant increase was determined in meibum grade plugging (grades 0–3; higher = greater obstruction) and Marx line scores with IPL therapy (p < 0.05). The group receiving doxycycline treatment exhibited a significant improvement in OSDI and SPEED scores, plugging, TBUT, and meibum grades. The group receiving cyclosporine registered a significant improvement in OSDI and SPEED scores, plugging, TBUT, and meibum grades. A statistically significant increase was observed in the conservative treatment group in terms of lid margin irregularity, Marx line score, and OSDI and SPEED scores. In the group receiving azithromycin treatment, plugging, lid margin irregularity, TBUT, and OSDI and SPEED scores increased significantly. Compared with conservative care, the doxycycline group exhibited lengthened TBUT and lowered meibomian gland plugging and symptoms (p < 0.05), and the oral azithromycin group achieved a similar TBUT gain with slightly greater symptom relief. The topical cyclosporine group principally registered improved lid vascularity and meibum quality (p < 0.05), while the IPL group achieved the greatest overall improvements, reducing plugging and Marx line scores and adding ≈3 s to TBUT (p < 0.05 for all endpoints). Doxycycline exhibited notable short-term improvements, with 35.26% meibum grade improvement and a 40.48% foaming response, while IPL therapy demonstrated substantial OSDI improvements at 54.06%, with traditional parameters indicating limited treatment responsiveness. Conclusions: Various methods can be used in the treatment of MGD. All the conservative treatment methods used in this study were successful. Full article

(This article belongs to the Section Health Assessments)

13 pages, 452 KiB

Open AccessArticle

The Association Between Physical Activity and Quality of Sleep Among Nursing Students in Saudi Arabia

by Eman Bajamal, Jori Alotaibi, Danah Balamash, Esraa Alsaeedi, Hanan Ali, Joud Alzahrani, Layan Swat, Ajwan Alamri, Raneem Jundi, Renad Alzahrani and Samar Alharbi

Healthcare 2025, 13(16), 1991; https://doi.org/10.3390/healthcare13161991 - 14 Aug 2025

Abstract

Background: Nursing students usually face excessive academic and clinical demands that negatively impact their sleep quality. Physical activity (PA) has been proposed to enhance sleep, yet few investigations have focused on this correlation within the Saudi environment. The purpose of this research was [...] Read more.

Background: Nursing students usually face excessive academic and clinical demands that negatively impact their sleep quality. Physical activity (PA) has been proposed to enhance sleep, yet few investigations have focused on this correlation within the Saudi environment. The purpose of this research was to determine the relationship between PA and sleep quality in Saudi nursing students. Methodology: A cross-sectional study was conducted among a sample of 554 nursing students from different universities in Saudi Arabia. The International Physical Activity Questionnaire–Short Form (IPAQ-SF) and the Pittsburgh Sleep Quality Index (PSQI) were used to collect data. Snowball sampling was used to recruit the participants through social media. Descriptive statistics, Pearson correlation, and inferential tests were employed for the analysis. Results: Most participants were female (85.1%) and aged 18–34 years (95.5%). LPA levels were reported by 59.6% of students, and only 8.2% engaged in VPA. The majority (91%) reported poor sleep duration (<5 h), and 57.4% had poor sleep efficiency. Overall, 86.7% of students experienced poor sleep quality. Gender and GPA were significantly associated with both PA and sleep quality. Female students and those with lower GPAs were more likely to report LPA and poor sleep. Marital status was also associated with higher levels of VPA. No significant associations were found with age, academic year, region, income, or parental education. A statistically significant positive correlation was found between PA and sleep quality (r = 0.192, p < 0.001), suggesting that increased PA is modestly associated with better sleep. Conclusion: The research shows a high rate of poor sleep and low physical activity in nursing students, indicating an alarming health trend. Although PA was linked significantly to better sleep, the modest strength indicates the necessity for multi-component interventions. Structured PA programs and sleep hygiene education should be incorporated into nursing curricula by universities to foster students’ well-being and academic performance. Full article

(This article belongs to the Special Issue Physical Activity and Fitness in the Health Promotion of Children and Adolescents)

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23 pages, 375 KiB

Open AccessArticle

Stakeholders’ Perceptions of the Nature-Based Healing Industry in South Korea: A Q Methodology Study

by Moon Hee Yu, Ji Seong Yi, Seo Jung Shin, Jae Soo Kim, Jeong Hyun Kim, Yu Cheon Kim and Song Yi Lee

Healthcare 2025, 13(16), 1990; https://doi.org/10.3390/healthcare13161990 (registering DOI) - 14 Aug 2025

Abstract

Background/Objectives: This study explores the subjective perceptions of stakeholders in South Korea’s nature-based healing industry and employs Q methodology to classify their viewpoints. As the healing industry continues to evolve across sectors such as forest therapy, marine healing, and healing agriculture, understanding diverse [...] Read more.

Background/Objectives: This study explores the subjective perceptions of stakeholders in South Korea’s nature-based healing industry and employs Q methodology to classify their viewpoints. As the healing industry continues to evolve across sectors such as forest therapy, marine healing, and healing agriculture, understanding diverse stakeholder perspectives is essential for informing coherent and inclusive policy development. Methods: A total of 25 participants—including policymakers, practitioners, and service users—sorted 39 statements derived from academic and media sources. This study analysed the data using Ken-Q software, applying principal component analysis with Varimax rotation. Results: The results revealed four distinct perception types: (1) a comprehensive and service-oriented type emphasising universal access and public benefit, (2) a professionalism-oriented type advocating for systematic administration and regional development, (3) a differentiation-oriented type concerned with conceptual clarity and distinctiveness, and (4) a sustainability-oriented type emphasising long-term impacts and collaborative structures. Conclusions: These findings highlight the multi-dimensional nature of stakeholder perceptions and suggest the need for differentiated governance strategies. By incorporating public choice theory and complementary insights from health economics, this study provides an empirical foundation for understanding stakeholder-driven policy considerations in developing nature-based healing services. Full article

(This article belongs to the Section Community Care)

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23 pages, 1193 KiB

Open AccessArticle

Disability and Factors Associated with Disability in the Discharge Transition Phase After Acquired Brain Injury: An Observational Follow-Up Study

by Helene Honoré, Peter Preben Eggertsen, Asger Roer Pedersen and Jørgen Feldbæk Nielsen

Healthcare 2025, 13(16), 1989; https://doi.org/10.3390/healthcare13161989 - 14 Aug 2025

Abstract

Background/Objectives: Patients with acquired brain injury (ABI) often face complex challenges during the transition from in-hospital rehabilitation to everyday life. This study aimed to investigate disability, health-related quality of life (HRQoL), work, and other aspects of functioning as indicators of a meaningful life [...] Read more.

Background/Objectives: Patients with acquired brain injury (ABI) often face complex challenges during the transition from in-hospital rehabilitation to everyday life. This study aimed to investigate disability, health-related quality of life (HRQoL), work, and other aspects of functioning as indicators of a meaningful life in this transition phase. Additionally, we assessed how disability three months post-discharge correlates with known risk factors. Methods: We conducted a prospective observational follow-up study including patients aged ≥18 years with ABI discharged from a specialized rehabilitation clinic. Patient-reported outcomes, including disability and HRQoL, were collected at discharge and three months later. Associations between disability and known risk factors were analyzed using multiple linear regression. Results: A total of 137 patients were included (mean age 63), with a follow-up completion rate of 59%. At follow-up, 11% reported complete recovery, while a moderate level of disability persisted overall, with no systematic change from discharge. HRQoL improved significantly, reaching a mean score of 0.83. Fatigue, sex, and time from injury to rehabilitation were significantly associated with disability levels. Conclusions: The transition phase after rehabilitation posed challenges for patients with ABI, with 38% experiencing moderate disability. Despite this, HRQoL improved to levels comparable with the general population. Fatigue, sex, and rehabilitation timing emerged as key factors influencing disability outcomes. Full article

(This article belongs to the Special Issue Exercise Therapy: Improving Functionality, Physical Health, and Quality of Life)

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14 pages, 884 KiB

Open AccessArticle

Who Benefits Most from Positive Psychological Interventions? Predictors and Moderators of Well-Being Outcomes in Severe Mental Health Conditions

by Regina Espinosa, Almudena Trucharte, Alba Contreras, Vanesa Peinado and Carmen Valiente

Healthcare 2025, 13(16), 1988; https://doi.org/10.3390/healthcare13161988 - 13 Aug 2025

Abstract

Background/Objectives: Positive psychology interventions (PPIs) may enhance well-being in individuals with severe psychiatric conditions (SPCs), yet little is known about individual differences in treatment response. Methods: We conducted a secondary analysis of a single-blind, parallel-group randomized controlled trial. A total of [...] Read more.

Background/Objectives: Positive psychology interventions (PPIs) may enhance well-being in individuals with severe psychiatric conditions (SPCs), yet little is known about individual differences in treatment response. Methods: We conducted a secondary analysis of a single-blind, parallel-group randomized controlled trial. A total of 119 adults receiving outpatient mental health care were randomized to an 11-week multicomponent PPI plus treatment as usual (PPI + TAU) or TAU alone. A priori demographic and baseline clinical variables (e.g., age, gender, education, diagnosis, symptom severity) were tested as predictors and moderators of six well-being outcomes. Moderation analyses were conducted using the PROCESS macro (version 4.1) for SPSS version 29.0, with simple slopes explored for significant interactions. Analyses followed an intention-to-treat approach. Results: Individuals who were unemployed, had a diagnosis within the psychosis spectrum, or exhibited high interpersonal sensitivity showed improvements in well-being irrespective of the treatment modality received. Older patients, those attending more weekly therapy sessions, and individuals with less somatization, hostility, or life satisfaction levels responded particularly well to the specialized PPI + TAU treatment. While several interactions were significant at p < 0.01, none remained significant after Bonferroni–Holm correction. Nevertheless, the patterns were consistent and theoretically grounded. Conclusions: Individual characteristics may influence the effectiveness of PPIs in SPC populations. Identifying predictors and moderators can inform more personalized interventions. The findings warrant replication. Trial registration: ClinicalTrials.gov, NCT01436331. Full article

(This article belongs to the Special Issue Psychological Diagnosis and Treatment of People with Mental Disorders)

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16 pages, 579 KiB

Open AccessSystematic Review

Addressing the Leadership Gap: A Systematic Review of Asian American Underrepresentation in Orthopaedic Surgery

by Ahmed Nadeem-Tariq, Matthew Michelberger, Christopher J. Fang, Jeffrey Lucas Hii, Sukanta Maitra and Brock T. Wentz

Healthcare 2025, 13(16), 1987; https://doi.org/10.3390/healthcare13161987 - 13 Aug 2025

Abstract

Background: While Asian American individuals are well represented in medical schools in the United States, their advancement to senior positions within the field of orthopaedic surgery is disproportionately low. This underrepresentation not only limits diversity in leadership but also constrains the development [...] Read more.

Background: While Asian American individuals are well represented in medical schools in the United States, their advancement to senior positions within the field of orthopaedic surgery is disproportionately low. This underrepresentation not only limits diversity in leadership but also constrains the development of people-centred systems that reflect the needs of an increasingly diverse patient population. Objectives: This study systematically examines Asian American representation across the orthopaedic surgery professional pipeline, focusing on disparities between training-level representation and advancement into both faculty and leadership positions., and framing these gaps as a health equity concern. Methods: A comprehensive literature search for peer-reviewed original research articles was conducted via PubMed, EBSCO Open Research, Wiley Online Library, Google Scholar, and ScienceDirect. The potential articles were screened against prespecified eligibility criteria, and risk of bias was assessed using the Newcastle–Ottawa Scale (NOS). Data were then systematically extracted and analysed. Results: This analysis included 20 research articles investigating Asian American representation in orthopaedic surgery. The results demonstrated an underrepresentation of Asian Americans in orthopaedic leadership positions despite improvements in training programme representation with subspecialty clustering in adult reconstruction and spine. Asian American surgeons were less likely to occupy academic and leadership roles than their non-Asian American peers. Across studies, underrepresentation was consistently observed, with effect size estimates indicating a substantial disparity (e.g., pooled risk difference = 0.19; 95% CI [0.12, 0.28]) in those studies reporting comparative outcomes. Similarly, while Asian Americans in residency programmes increased, this growth did not translate proportionally to faculty advancement. In contrast, Asian women face compounded barriers, particularly in subspecialties like spine surgery. These inequities undermine workforce inclusivity and may reduce cultural and linguistic concordance with patients. Conclusions: Despite having strong representation in orthopaedic training programmes, Asian Americans are disproportionately absent from leadership positions. This poses a challenge to equity in surgical education and patient-centred care. To promote equity in leadership, focused mentorship, clear promotion processes, and institutional reform are necessary to address structural barriers to career advancement, this will reflect the diversity of both the workforce and populations served. Full article

(This article belongs to the Special Issue Health Equity and People-Centered Systems: Meeting Needs and Creating Opportunities for Diverse Communities)

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19 pages, 473 KiB

Open AccessArticle

Quality of Life, Anxiety, and Depression in Caregivers of Community-Dwelling Heart Failure Patients

by Maria Polikandrioti, Athanasia Tsami, Vasiliki Tsoulou and Andriana Maggita

Healthcare 2025, 13(16), 1986; https://doi.org/10.3390/healthcare13161986 - 13 Aug 2025

Abstract

Background/Objectives: Patients with heart failure (HF) experience increased morbidity, limited daily activities, and diminished quality of life (QoL), thus relying on a family member, widely known as informal caregiver, for support. The objective of this study was to explore (a) QoL, anxiety, and [...] Read more.

Background/Objectives: Patients with heart failure (HF) experience increased morbidity, limited daily activities, and diminished quality of life (QoL), thus relying on a family member, widely known as informal caregiver, for support. The objective of this study was to explore (a) QoL, anxiety, and depression; (b) factors associated with QoL; and (c) the impact of associated factors on QoL among HF caregivers. Materials and methods: Data collection was performed using the 36-Item Short Form Survey (SF-36), the Hospital Anxiety and Depression Scale (HADs), and the European Heart Failure Self-care Behavior Scale (EHFScBS). Also recorded were characteristics of caregivers and patients. Results: In the present study, 110 HF caregivers and the family members they provided care to were enrolled. The majority of caregivers were patients’ spouses (60%) and were female (71.8%). Within a QoL score range of 0–100, caregivers showed moderate to high levels in role-physical, role-emotional, emotional well-being, and pain (median: 75, 66.7, 64, and 67.5, respectively); moderate QoL levels in energy/fatigue, social functioning, and general health (median: 55, 56.3, and 62, respectively); and poor QoL levels in physical functioning (median: 18). Moreover, 64.5% of caregivers had anxiety and 41.8% had depression. Caregivers with HADs scores that indicate anxiety and depression had worse QoL (p = 0.001). No association was detected between caregivers’ QoL and patients’ HADs and self-care. Conclusions: QoL and anxiety/depression merit further research by clinicians, health systems, and policymakers so that evidence-based policies and interventional programs tailored to their needs can be implemented. Full article

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