Healthcare

14 pages, 500 KiB

Open AccessSystematic Review

Arthroscopic Management of Medial or Rotational Ankle Instability: A Comprehensive Review of Current Evidence

by Chiara Barbieri, Guido Bocchino, Daniele Grassa, Doriana Di Costa, Elena Gabrielli, Fabrizio Forconi, Giulio Maccauro and Raffaele Vitiello

Healthcare 2025, 13(12), 1398; https://doi.org/10.3390/healthcare13121398 - 11 Jun 2025

Abstract

Introduction: Rotational ankle instability (RAI), involving combined medial and lateral ligament insufficiency, is an increasingly recognized clinical entity. While open surgery has traditionally been the mainstay for treating deltoid ligament injuries, recent developments in arthroscopic techniques offer a minimally invasive alternative. This systematic [...] Read more.

Introduction: Rotational ankle instability (RAI), involving combined medial and lateral ligament insufficiency, is an increasingly recognized clinical entity. While open surgery has traditionally been the mainstay for treating deltoid ligament injuries, recent developments in arthroscopic techniques offer a minimally invasive alternative. This systematic review aimed to evaluate the current evidence on the arthroscopic management of medial and rotational ankle instability, focusing on surgical techniques, clinical outcomes, and complications. Methods: A systematic literature search was conducted following PRISMA guidelines using the PubMed, Scopus, and Web of Science databases. The search strategy included the following terms: ((rotation instability) OR (deltoid) OR (medial ankle instability)) AND (ankle arthrosc*). Eligible studies included adult patients undergoing arthroscopic repair of medial ankle instability with a mean 26.4 months follow-up and reported clinical outcomes. Ten studies met the inclusion criteria, encompassing 336 patients and 346 ankles. Results: The mean patient age was 32.6 ± 5.0 years, with 80.6% being male. MRI was the primary diagnostic tool across most studies. Ankle sprains were the most common cause of instability. Lateral ligament insufficiency was frequently associated with medial injuries, reported in all studies evaluating this parameter. All patients underwent prior conservative treatment (mean duration: 5.6 months). Surgical management involved all-inside arthroscopic repair using knotless suture anchors. Additional procedures were performed in 90% of studies, including osteophyte resection (33.3%) and microfracture (22.2%). The mean follow-up period was 26.4 months. The mean postoperative AOFAS score was 95.3, with return to sport generally achieved between 3 and 5 months. Complications were minimal, primarily consisting of superficial wound issues and transient nerve irritation; no major complications or revision surgeries were reported. Discussion: Arthroscopic management of medial and rotational ankle instability is associated with excellent functional outcomes, low complication rates, and early return to sport. Compared to open procedures, arthroscopic techniques offer advantages including reduced soft tissue trauma, fewer wound complications, and the ability to address concomitant intra-articular lesions in a single session. Although technically demanding, this approach is particularly beneficial in athletic populations. However, high-quality prospective studies are still needed to validate these findings and establish long-term comparative outcomes with open reconstruction techniques. Full article

(This article belongs to the Special Issue Sports Trauma: From Prevention to Surgery and Return to Sport)

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57 pages, 689 KiB

Open AccessReview

Multilevel Interventions Demonstrate Mixed Effectiveness for Improving Blood Pressure Outcomes: A Rapid Review

by Briana N. Sprague and Anna K. Forster

Healthcare 2025, 13(12), 1397; https://doi.org/10.3390/healthcare13121397 - 11 Jun 2025

Abstract

Objective: What types of multilevel interventions exist to improve blood pressure among community-dwelling adults aged 18+ in the United States? What is the treatment efficacy? Data Source: Peer-reviewed articles from Cochrane Library, EMBASE, PsycINFO, and PubMed. The search strategy was pre-registered on Open [...] Read more.

Objective: What types of multilevel interventions exist to improve blood pressure among community-dwelling adults aged 18+ in the United States? What is the treatment efficacy? Data Source: Peer-reviewed articles from Cochrane Library, EMBASE, PsycINFO, and PubMed. The search strategy was pre-registered on Open Science Framework. Study Inclusion and Exclusion Criteria: Inclusion criteria were community-dwelling adults in the United States aged 18 or older; interventions involving at least two levels; at least one blood pressure outcome measured; and published in a peer-reviewed journal. Data Extraction: Intervention activities, blood pressure outcomes, and moderation/subgroup analyses, when available, were extracted. Data Synthesis: Qualitative synthesis and summary statistics. Results: Ninety-five papers covering 89 RCTs were included. Multilevel interventions involving the individual and healthcare team (without health policies = 49 studies; with health policies = 15 studies) tended to show the most consistent saltatory effects on blood pressure (systolic: 46% of studies showed statistical improvement; diastolic: 47% of studies showed statistical improvement). Interventions involving families or communities outside of healthcare settings were promising but were less frequently reported (19% of studies). Conclusions: There was mixed evidence that multilevel interventions targeting cardiovascular health improved blood pressure among U.S.-based adults. Future research should continue evaluating interventions that improve the individual as well as the environments in which individuals work and play, especially those levels outside of traditional healthcare settings. Full article

(This article belongs to the Section Community Care)

31 pages, 388 KiB

Open AccessArticle

Chronic Illnesses: Varied Health Patterns and Mental Health Challenges

by Ângela Leite

Healthcare 2025, 13(12), 1396; https://doi.org/10.3390/healthcare13121396 - 11 Jun 2025

Abstract

Background/Objectives: Hypertension, diabetes, and cancer are three prevalent chronic conditions with distinct etiologies and significant global health impacts. This study aimed to explore the diverse impacts of different chronic illnesses on health behaviors and psychological well-being, with a focus on identifying and addressing [...] Read more.

Background/Objectives: Hypertension, diabetes, and cancer are three prevalent chronic conditions with distinct etiologies and significant global health impacts. This study aimed to explore the diverse impacts of different chronic illnesses on health behaviors and psychological well-being, with a focus on identifying and addressing the unique challenges faced by individuals with hypertension, diabetes, and cancer. It was hypothesized that health behaviors and psychological well-being would differ significantly among individuals with hypertension, diabetes, and cancer, reflecting the distinct demands and psychosocial impacts of each condition. Methods: The database of Americans’ Changing Lives, Wave 6, including 767 participants, was used (56.1% hypertension, 20.8% diabetes, and 19.9% cancer cases). Variables concerning physical and mental health issues were chosen. Descriptive statistics summarized the data. Chi-squared and t-tests assessed associations and group differences, with effect sizes reported. Logistic regression examined predictors of hypertension, diabetes, and cancer. Sensitivity analyses excluded outliers. Results: Hypertensive individuals are more likely to show cognitive impairment and unhealthy behaviors, including poor self-rated health, higher BMI, lower physical activity, and altered alcohol use. Risk increases with age, widowhood, retirement, hospital admissions, and poor mental health, while more emergency room or doctor visits slightly reduce it. People with diabetes experience greater depressive symptoms, hopelessness, and financial stress. They also tend to have poorer self-rated health, higher BMI, and less physical activity. Risk is higher for separated individuals and lower for females. Psychological distress is a key factor, while age, employment, and healthcare use show minimal influence. Cancer is linked to chronic stress, poorer perceived health, and mental health challenges. Risk is higher among older adults and those who keep house. Poor self-rated health, high BMI, low fruit and vegetable intake, and psychological distress increase risk, but healthcare use is not a strong predictor. Conclusions: While different chronic illnesses present distinct challenges to health behaviors and psychological well-being, they also share common features-such as increased stress and lifestyle disruptions-underscoring the importance of both tailored and cross-cutting interventions to effectively support individuals across conditions. Full article

(This article belongs to the Special Issue One Life, One Health: Advances in Therapeutic Strategies for Chronic Patients)

16 pages, 3104 KiB

Open AccessArticle

Outcomes of the Transsphenoidal Approach for ACTH-Secreting Pituitary Tumours and the Role of Postoperative ACTH in Predicting the Late Recurrence of Cushing’s Disease: A Retrospective Analysis of 50 Cases

by Athanasios Saratziotis, Maria Baldovin, Claudia Zanotti, Sara Munari, Luca Denaro, Jiannis Hajiioannou and Enzo Emanuelli

Healthcare 2025, 13(12), 1395; https://doi.org/10.3390/healthcare13121395 - 11 Jun 2025

Abstract

Background/Objectives: The endoscopic transsphenoidal approach constitutes an excellent technique for adrenocorticotropin hormone (ACTH)-producing pituitary tumours. It is associated with subnormal postoperative serum cortisol levels, which may guide decisions regarding immediate re-operation. Methods: The authors retrospectively reviewed patients with Cushing’s disease who [...] Read more.

Background/Objectives: The endoscopic transsphenoidal approach constitutes an excellent technique for adrenocorticotropin hormone (ACTH)-producing pituitary tumours. It is associated with subnormal postoperative serum cortisol levels, which may guide decisions regarding immediate re-operation. Methods: The authors retrospectively reviewed patients with Cushing’s disease who had undergone endoscopic transsphenoidal surgery between 2013 and 2023. All operations were performed by neurosurgeons and skull-base otolaryngologists. Surgical outcomes were evaluated in combination with prognostic factors such as cortisol and ACTH levels in terms of long-term remission and late recurrence rates of Cushing’s disease. Results: Fifty patients aged between 15 and 69 (average 37.8) years were evaluated, having undergone 50 operations. The median follow-up was 76.5 months (range: 23–122 months). Major complications with a transient CSF leak resulting from the surgical approach occurred in three patients. Two patients in the series experienced minor complications, developing a deep vein thrombosis, and thirteen patients developed transient diabetes insipidus. The initial remission rate was 84% (n = 42/50). Initial non-remission occurred in eight (8) patients (16%), with three macro- and five microadenomas. A total of 3 of the 42 patients with initial remission had a late recurrence after 50 months follow-up and required repeat transsphenoidal surgery. Seven patients (16.6%) who did not exhibit early postoperative cortisol reduction subsequently achieved remission. Male gender was the only factor that was significantly associated with lower remission rates in either short- or long-term follow-up (p = 0.003 and 0.038, respectively). An immediate postoperative ACTH nadir of ≤5 pg/mL was significantly related to long-term remission (p = 0.004). In our study, a significant correlation was confirmed between remission of the disease and 24 h urinary cortisol values, both early and late (p = 0.019), and serum cortisol <138 nmol/L. In this retrospective study from a single institution specialising in pituitary tumour management, the endoscopic transsphenoidal approach was shown to be both safe and effective. Additionally, we found that the risk of relapse in patients with Cushing’s disease persisting for more than 5 years after surgery is real but low. Moreover, failure to achieve an early postoperative cortisol reduction does not preclude a subsequent remission. Conclusions: Our findings demonstrate that ACTH, postoperative serum cortisol, and urinary free cortisol are valuable predictors of relapse over a five-year period and are closely correlated to each other. Full article

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20 pages, 1015 KiB

Open AccessArticle

Gender Differences in the Use of ChatGPT as Generative Artificial Intelligence for Clinical Research and Decision-Making in Occupational Medicine

by Patricia Mashburn, Felix A. Weuthen, Nelly Otte, Hanif Krabbe, Gerardo M. Fernandez, Thomas Kraus and Julia Krabbe

Healthcare 2025, 13(12), 1394; https://doi.org/10.3390/healthcare13121394 - 11 Jun 2025

Abstract

Background/Objectives: Artificial intelligence (AI) has evolved from early diagnostic expert systems to advanced generative models, such as GPT-4, which are increasingly being used in healthcare. Concerns persist regarding inaccuracies and input dependency. This study aimed to deliver initial insights into whether gender influences [...] Read more.

Background/Objectives: Artificial intelligence (AI) has evolved from early diagnostic expert systems to advanced generative models, such as GPT-4, which are increasingly being used in healthcare. Concerns persist regarding inaccuracies and input dependency. This study aimed to deliver initial insights into whether gender influences the interaction of medical professionals with generative AI. Methods: This analysis investigated gender differences in medical students’ and physicians’ interactions with ChatGPT-4 while researching occupational medicine cases in a randomized controlled study. Participants assessed cases involving asbestos-related disease, metal sulfate allergy, and berylliosis using ChatGPT. Inputs and outputs were evaluated for accuracy, confabulations, communication styles, and user satisfaction. Demographic data and self-assessments of occupational medicine knowledge before and after the tasks were also collected. Results: Among 27 participants (63% women, 37% men), women showed greater knowledge improvement after using ChatGPT, particularly in asbestos-related cancer identification. No significant gender differences emerged in diagnostic accuracy, reporting procedures, or satisfaction with ChatGPT. Women exhibited significantly higher self-rated competence after using the ChatGPT application, while men only showed minimal change. Input from the female participants led to more confabulations, although response accuracy remained comparable. Conclusions: This study offers the first real-world insights into the use of generative AI in occupational medicine, highlighting the importance of understanding user-dependent variability in AI-supported clinical practice and decision-making. These findings underscore the need for gender-sensitive AI literacy training in medical education, accommodating diverse interaction styles and strategies to mitigate AI-generated misinformation. Future research with larger and more diverse cohorts could provide deeper insights into the influence of gender, age, and experience on AI utilization in healthcare. Integrating gender-based interaction differences into AI training and applications may improve clinical performance and promote more equitable healthcare practices. Full article

(This article belongs to the Special Issue Occupational Health and Workers’ Well-Being: From Research to Practice)

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13 pages, 898 KiB

Open AccessArticle

Does Knowledge About Physical Activity Translate into More Active Populations?

by Roger O’Sullivan, Aideen Sheehan, Ruth D. Neill and Toby Finch

Healthcare 2025, 13(12), 1393; https://doi.org/10.3390/healthcare13121393 - 11 Jun 2025

Abstract

Background: Physical activity has a number of benefits; however, the consequences of inactivity can have a negative impact on individuals and health and social care services. Increasing knowledge can play an important role in helping sustain behaviours that can lead to health benefits, [...] Read more.

Background: Physical activity has a number of benefits; however, the consequences of inactivity can have a negative impact on individuals and health and social care services. Increasing knowledge can play an important role in helping sustain behaviours that can lead to health benefits, reduce barriers and increase participation in physical activity while having a greater impact on public health policy. The aim of this study is to explore knowledge about physical activity benefits, levels of activity, awareness of risks of inactivity, sources of information about the benefits and the relationship between knowledge about physical activity recommendations and activity levels. Methods: A cross-sectional survey involving adults over 18 years old in Northern Ireland (weighted sample n = 2201) and Ireland (weighted sample n = 1279) was commissioned by the Institute of Public Health in 2021 to explore knowledge about health benefits and the association between knowledge and physical activity levels. Descriptive statistics in percentages were used to demonstrate the findings, while chi square tests of independence were used to examine if a significant relationship between activity and knowledge existed. Results: Only 4 out of 10 respondents knew the recommendations of at least 150 min weekly of physical activity. A chi square test of independence showed that the relationship between knowledge about recommendations and activity was significant (χ2(1, n = 3506) = 20.25, p < 0.001, not weighted). There was a sex difference in the association of knowledge about the recommended guidelines and activity levels. Women were more knowledgeable about many of the health benefits of physical activity but were less active than men. Conclusions: Overall, getting the adult population more active remains a challenge in public health promotion; however, knowledge alone does not equate to action. Therefore, it is essential to understand and address the range of challenges to increasing physical activity to ensure the needs of the whole population are met. Full article

(This article belongs to the Special Issue Association Between Physical Activity and Chronic Condition)

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16 pages, 1787 KiB

Open AccessArticle

mHealth Applications in Saudi Arabia: Current Features and Future Opportunities

by Sultan A. Alharthi

Healthcare 2025, 13(12), 1392; https://doi.org/10.3390/healthcare13121392 - 11 Jun 2025

Abstract

Introduction: The rapid growth of mobile health (mHealth) applications has revolutionized healthcare delivery worldwide. These digital tools encompass a broad array of functionalities, including telemedicine, appointment scheduling, medication management, and health data tracking, all of which contribute to enhanced healthcare accessibility, increased patient [...] Read more.

Introduction: The rapid growth of mobile health (mHealth) applications has revolutionized healthcare delivery worldwide. These digital tools encompass a broad array of functionalities, including telemedicine, appointment scheduling, medication management, and health data tracking, all of which contribute to enhanced healthcare accessibility, increased patient engagement, and improved operational efficiency. However, despite their increasing prominence, the design, deployment, and use of mHealth applications continue to face several challenges, such as usability issues and overall sustained adoption. Objectives: This study aims to evaluate mHealth applications in Saudi Arabia, focusing on their design characteristics, usability features, and current feature gaps. Method: A total of 21 mHealth applications were selected and analyzed using a thematic analysis approach. The apps were selected based on usage popularity in the Saudi market and relevance to national digital health strategies. Data were drawn from publicly available app store information, official app documentation, and expert evaluations. Results: The findings reveal that while mHealth applications excel in areas such as telemedicine, appointment booking, and health education, there are notable gaps in features such as behavior modification, patient monitoring, and health management. Conclusions: This study contributes to the growing body of research on mHealth by offering grounded insights into the functional landscape of digital health tools in Saudi Arabia. It also outlines practical recommendations to enhance usability, feature diversity, and alignment with evolving healthcare needs in Saudi Arabia and beyond. Full article

(This article belongs to the Special Issue Application of Digital Services to Improve Patient-Centered Care)

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13 pages, 476 KiB

Open AccessSystematic Review

Effects of Vibration Foam Rolling on Pain, Fatigue, and Range of Motion in Individuals with Muscle Fatigue: A Systematic Review

by Seju Park and Byeonggeun Kim

Healthcare 2025, 13(12), 1391; https://doi.org/10.3390/healthcare13121391 - 11 Jun 2025

Abstract

Background/Objectives: Vibration foam rolling (VFR) has emerged as a popular intervention in sports and rehabilitation settings to enhance recovery and flexibility. This systematic review aimed to evaluate the effects of VFR on pain, fatigue, and range of motion (ROM) in individuals experiencing exercise-induced [...] Read more.

Background/Objectives: Vibration foam rolling (VFR) has emerged as a popular intervention in sports and rehabilitation settings to enhance recovery and flexibility. This systematic review aimed to evaluate the effects of VFR on pain, fatigue, and range of motion (ROM) in individuals experiencing exercise-induced muscle fatigue and to assess its clinical applicability. Methods: A systematic literature search was conducted across five databases: PubMed, Cochrane Library, Embase, Web of Science, and CINAHL. Studies were included if they involved participants with muscle fatigue, applied VFR as an intervention, and measured outcomes related to pain, fatigue, or ROM. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. Results: Eight studies published between 2019 and 2024 met the inclusion criteria. VFR showed beneficial effects in reducing delayed onset muscle soreness, improving pressure pain threshold, and lowering subjective fatigue. Several studies also reported increased ROM in specific joints, including the hip and knee. However, findings across studies were inconsistent, particularly in physiological markers such as muscle oxygen saturation and blood flow parameters, where statistically significant differences were not always observed. Conclusions: VFR may offer potential benefits for pain relief, fatigue recovery, and ROM improvement in fatigued individuals. Nonetheless, its effects remain difficult to isolate from those of mechanical pressure and friction associated with foam rolling. Future studies with standardized intervention protocols and long-term follow-up are needed to clarify the independent role of vibration in recovery outcomes. Full article

(This article belongs to the Special Issue Physical Fitness—Effects on Muscle Function and Sports Performance)

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12 pages, 679 KiB

Open AccessArticle

Performance of Real and Virtual Object Handling Task Between Post-Surgery Wrist Fracture Patients and Healthy Adults

by Chun Wei Yew, Kai Way Li, Wen Pei, Mei-Hsuan Wu, Pei Syuan Wu and Lu Peng

Healthcare 2025, 13(12), 1390; https://doi.org/10.3390/healthcare13121390 - 11 Jun 2025

Abstract

Background: Humans interacting with virtual objects is becoming common due to the popularity of the devices adopting the mixed reality (MR) techniques. Assessing hand functions using these devices for medical purposes provides alternatives in addition to the traditional hand function assessment techniques. Objectives: [...] Read more.

Background: Humans interacting with virtual objects is becoming common due to the popularity of the devices adopting the mixed reality (MR) techniques. Assessing hand functions using these devices for medical purposes provides alternatives in addition to the traditional hand function assessment techniques. Objectives: The objectives were to compare the movement time (MT) of handing a real and a virtual object between post-surgery wrist fracture patients and healthy adults and to determine the correlation between the MT and commonly adopted hand function indicators. Methods: An experiment was performed. A total of 29 participants, including 17 patients and 12 healthy adults, joined. All the participants moved a real or a virtual tube from an origin to a destination. A set of MR device was adopted to generate the virtual object. The MTs were analyzed to compare differences between the patients and the healthy adults. Regression models were developed to predict the MT under experimental conditions. Results: The MT of the surgical hand was significantly longer than that of the nonsurgical hand of the patients and was significantly longer than that of the left hand of the healthy adults. The MT was negatively correlated with the commonly adopted hand function indicators, including grip strength, range of motion, hand dexterity score, and Modified Mayo Wrist Score. Conclusions: The anticipation that the MT of interacting with virtual objects for patients may reveal hand function characteristics for post-surgery patients was supported. The regression models developed could reveal the progression of hand function recovery for these patients. Having patients interact with virtual objects could be a supplemental approach in assessing their hand functions. Full article

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18 pages, 778 KiB

Open AccessArticle

Assessing Postnatal Immunisation Services in a Low-Resource Setting: A Cross-Sectional Survey

by Alhassan Sibdow Abukari, Rejoice Gaddah, Emmanuella Vincentia Ayivor, Ibrahim Sadik Haruna and Emmanuel Kwame Korsah

Healthcare 2025, 13(12), 1389; https://doi.org/10.3390/healthcare13121389 - 11 Jun 2025

Abstract

Background/Objectives: Postnatal immunisation is critical for maternal and child health, particularly in low-income countries. Despite international efforts, maternal awareness and access to care remain limited. Understanding the drivers behind postnatal immunisation services is critical for improving neonatal and maternal healthcare interventions. Methods: A [...] Read more.

Background/Objectives: Postnatal immunisation is critical for maternal and child health, particularly in low-income countries. Despite international efforts, maternal awareness and access to care remain limited. Understanding the drivers behind postnatal immunisation services is critical for improving neonatal and maternal healthcare interventions. Methods: A tertiary healthcare facility’s postpartum mothers who were seeking immunisation services participated in a prospective cross-sectional electronic survey. Convenience sampling was used to select respondents, who then answered a structured electronic questionnaire intended to obtain information on immunisation practices. To evaluate important trends and correlations, data was analysed using both descriptive and inferential statistics. A factor analysis was performed using the principal component analysis method, eigenvalue criteria, communalities, and confirmatory factor analysis. The study adhered to the STROBE guidelines. Results: We found that postnatal mothers’ good immunisation practices were influenced by their adherence to immunisation schedules (% variance: 56.407; Eigenvalue: 7.33), and significant satisfaction with communication (% variance: 8.338; Eigenvalue: 1.084); giving a cumulative variance explained of 64.745% of the total variance of variables under study. However, suboptimal practices include limited resource availability, poor record maintenance, insufficient support for side effects, a lack of support from healthcare providers, and a decline in immunisation recommendations, all of which had Eigenvalue <1 and insignificant percentage of variance contribution to the total variance explained. We developed a two-factor model of postnatal immunisation practices, focusing on adherence and effective communication. The model showed high loadings and adequate fit indices (χ²(34) = 91.333, p < 0.001; CFI = 0.945; TLI = 0.927; RMSEA = 0.071; SRMR = 0.042), good evidence of internal consistency (α = 0.823–0.877), and composite reliability (ω = 0.832–0.877). Conclusions: The study recommends a comprehensive approach to increasing newborn vaccine coverage, which includes health education, improved service delivery, and culturally sensitive communication strategies. Future research should focus on digital health interventions, community-based initiatives, and policy-driven postnatal care. Full article

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16 pages, 1249 KiB

Open AccessArticle

Effect of Postural Stabilization Exercises in Combination with Cervical Stabilization Exercises on Craniovertebral Angle, Pain, Disability, and Quality of Life in Patients with Chronic Neck Pain: A Randomized Controlled Trial

by Gölgem Mehmetoğlu and İnci Yüksel

Healthcare 2025, 13(12), 1388; https://doi.org/10.3390/healthcare13121388 - 11 Jun 2025

Abstract

Objective: The aim of the study was to evaluate the effect of postural stabilization exercises, in addition to cervical stabilization (CS), on the craniovertebral angle (CVA), pain, neck disability index (NDI), and quality of life in people with chronic neck pain. Methods: This [...] Read more.

Objective: The aim of the study was to evaluate the effect of postural stabilization exercises, in addition to cervical stabilization (CS), on the craniovertebral angle (CVA), pain, neck disability index (NDI), and quality of life in people with chronic neck pain. Methods: This study was performed on 60 women with chronic neck pain, aged 20–60 years, who were randomly divided into two groups. Individuals in the first group underwent CS exercises, in addition to scapular and lumbopelvic stabilization (SLPS) exercises, three times a week for 6 weeks. The individuals in the second group underwent only CS exercises for the same period. Moreover, stretching exercises and a 20 min hot pack were applied to the muscles around the neck of all patients. The CVA was measured using photogrammetry. The visual analog scale (VAS) was used to assess pain. The disability level was measured using the NDI. The Turkish version of the 36-Item Short-Form Health Survey (SF-36) was used to assess quality of life. The assessments were conducted before treatment, after treatment, and at the 2-month follow-up. To assess changes over time and between groups, a two-way repeated measures analysis of variance (ANOVA) was conducted. Results: Post-treatment measurements revealed significant differences favoring the SLPS group. The VAS and NDI scores were markedly lower in the SLPS group than in the CS group, both post-treatment (p < 0.001) and at follow-up (p < 0.001). The CVA was significantly greater in the SLPS group at both the post-treatment (p < 0.001) and follow-up (p < 0.001) assessments. However, in all sub-parameters except the SF-36 general health subscale, the SLPS group reported higher scores than the CS group post-treatment and at follow-up. Effect sizes for between-group comparisons ranged from moderate to very large (Cohen’s d = 0.65 to 2.31), and partial eta-squared (η²) values indicated moderate to large effect magnitudes (η² = 0.09 to 0.48), supporting the clinical relevance of the findings. Conclusion: In individuals with neck pain, including SLPS exercises in the treatment program, rather than just exercises for the cervical region, provides more positive results in terms of reducing disability and pain and increasing functionality. Clinical Trial Registration Number: NCT06578481. Full article

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16 pages, 1066 KiB

Open AccessArticle

Patient Participation in Patient Safety Practices Scale: Development and Psychometric Evaluation of a Scale

by Meltem Dursun Engin and Şeyda Seren İntepeler

Healthcare 2025, 13(12), 1387; https://doi.org/10.3390/healthcare13121387 - 11 Jun 2025

Abstract

Introduction: Patient participation is a critical element in enhancing patient safety. Involving patients in safety practices improves communication, reduces errors, and optimizes treatment outcomes. However, there is no standardized instrument that measures patient participation in safety practices. Methods: This study was designed as [...] Read more.

Introduction: Patient participation is a critical element in enhancing patient safety. Involving patients in safety practices improves communication, reduces errors, and optimizes treatment outcomes. However, there is no standardized instrument that measures patient participation in safety practices. Methods: This study was designed as a scale development and psychometric validation study to create the Patient Participation in Patient Safety Practices Scale (PPPSPS). The methodological research was conducted with 424 inpatients in a Turkish public hospital between June 2021 and February 2022. The scale development process included item generation, expert review, a pilot study, and statistical validation. Content validity was assessed using Lawshe’s content validity ratio (CVR). Structural validity was tested through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency reliability was evaluated using Cronbach’s alpha and item–total correlations. Results: The final version of the scale included 32 items under 4 subscales (general, infection, falls, and drugs). Cronbach’s alpha coefficient was 0.90 for the whole scale, 0.90 for the general subscale (11 items), 0.90 for the infection subscale (10 items), 0.81 for the fall subscale (6 items), and 0.80 for the drug subscale (5 items). EFA revealed four factors explaining 70.61% of the total variance. CFA confirmed a good model fit: χ² (457) = 1053.15; p < 0.001; χ²/df = 2.3; GFI = 0.930; AGFI = 0.920; CFI = 1.000; TLI = 0.981; RMSEA = 0.079; SRMR = 0.079. Cronbach’s alpha was 0.922 for the total scale and ranged between 0.799 and 0.932 for the subscales. Conclusions: The Patient Participation in Patient Safety Practices Scale is a valid and reliable tool for assessing patient participation in safety practices. It is recommended for use in clinical settings and further testing in different patient populations and healthcare systems. Full article

(This article belongs to the Special Issue Review Research on Healthcare Quality and Patient Safety)

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20 pages, 675 KiB

Open AccessArticle

Assessment of Endometriosis Knowledge and Its Determinants Among Nurses in Al-Jouf Region, Saudi Arabia

by Nadia Bassuoni Elsharkawy, Afrah Madyan Alshammari, Osama Mohamed Elsayed Ramadan, Enas Mahrous Abdelaziz, Mohamed E. H. Elzeky, Alaa Hussain Hafiz, Mary Faleh Alrowily, Sultan Muharib Alruwaili and Lareen Magdi El-Sayed Abo-Seif

Healthcare 2025, 13(12), 1386; https://doi.org/10.3390/healthcare13121386 - 11 Jun 2025

Abstract

Background/Objectives: Endometriosis, a chronic and debilitating gynecological disorder, exacts a heavy clinical and socioeconomic toll on women’s lives. Despite its prevalence, its timely diagnosis and effective management are hindered by pervasive knowledge gaps among frontline nursing professionals, and these are especially pronounced [...] Read more.

Background/Objectives: Endometriosis, a chronic and debilitating gynecological disorder, exacts a heavy clinical and socioeconomic toll on women’s lives. Despite its prevalence, its timely diagnosis and effective management are hindered by pervasive knowledge gaps among frontline nursing professionals, and these are especially pronounced in under-researched regions such as Al-Jouf, Saudi Arabia. Aim: Guided by the Knowledge–Attitude–Practice model, this study aimed to assess the level of endometriosis-related knowledge among nurses in the Al-Jouf region of Saudi Arabia and to identify the sociodemographic and professional determinants of knowledge levels. Methods: A cross-sectional, descriptive-analytical design was employed between January and July 2024, enrolling 215 nurses from a principal maternity and children’s hospital and two primary healthcare centers in Sakaka. A rigorously validated, bilingual 20-item questionnaire assessing four domains (definition, risk factors, clinical manifestations, and treatment goals) was administered. Data were analyzed using descriptive statistics, multiple linear regression, and binary logistic regression to elucidate predictors of knowledge. Results: A concerning picture emerged: 61% of participants scored below 60% (indicative of low knowledge), with only 6% achieving high scores. Higher educational attainment proved the strongest predictor (β = 0.415, p < 0.001), followed by age (β = 0.232, p < 0.001), years of experience (β = 0.149, p = 0.041), and direct patient care exposure (β = 0.168, p = 0.021). Collectively, these factors explained 37.6% of the variance in knowledge scores, underscoring a critical deficit in endometriosis management preparedness. Conclusions: The stark deficiencies in endometriosis knowledge among nurses in Al-Jouf call for immediate, tailored educational and policy interventions. Strengthening clinical competencies is essential for fostering early diagnosis and improving care outcomes for women burdened by this complex condition. Full article

(This article belongs to the Special Issue From Evidence-Based Practice to Knowledge Translation in Nursing Care)

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13 pages, 393 KiB

Open AccessArticle

Health Information Mistrust Is Directly Associated with Poor Sleep Quality: Evidence from a Population-Based Study

by Dietmar Ausserhofer, Christian J. Wiedermann, Verena Barbieri, Stefano Lombardo, Timon Gärtner, Klaus Eisendle, Giuliano Piccoliori and Adolf Engl

Healthcare 2025, 13(12), 1385; https://doi.org/10.3390/healthcare13121385 - 10 Jun 2025

Abstract

Background: Mistrust in professional health information may undermine population health by reducing engagement in preventive care and contributing to poorer health outcomes. Although sleep quality is a sensitive indicator of both psychosocial stress and health behavior, little is known about how mistrust influences [...] Read more.

Background: Mistrust in professional health information may undermine population health by reducing engagement in preventive care and contributing to poorer health outcomes. Although sleep quality is a sensitive indicator of both psychosocial stress and health behavior, little is known about how mistrust influences sleep at the population level, and whether preventive health behavior mediates this relationship. Methods: A weighted cross-sectional analysis of a representative adult sample (n = 2090) from South Tyrol, Italy was conducted. Survey data included mistrust toward professional health information (Mistrust Index), five preventive health behaviors (Health Behavior Checklist, HBC), and sleep quality (Brief Pittsburgh Sleep Quality Index, B-PSQI). Associations between mistrust, behavior, and sleep were examined using multivariable linear regression, robust regression (Huber’s M-estimator), and nonparametric correlation. Results: Sociodemographic characteristics were not significantly associated with mistrust when weighted data were applied. Higher mistrust was associated with poorer sleep quality (β = 0.09, p = 0.003). Preventive health behaviors varied significantly across mistrust levels, with high-mistrust individuals less likely to report regular engagement (all p < 0.01). Regression analyses confirmed that mistrust was independently associated with poorer sleep quality, while preventive behaviors showed no significant relationship with sleep. Conclusions: Mistrust in professional health information is independently associated with poorer sleep quality and lower engagement in preventive behaviors. However, preventive behavior does not appear to mediate this relationship. These findings highlight mistrust as a direct and potentially modifiable risk factor for sleep disturbance at the population level. Full article

(This article belongs to the Special Issue Recent Advances in Sleep Disorder)

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15 pages, 801 KiB

Open AccessArticle

Association Between Physical Activity Timing and Metabolic Syndrome in Korea: A Functional Principal Component Approach

by Suah Park and Hee-Jung Jee

Healthcare 2025, 13(12), 1384; https://doi.org/10.3390/healthcare13121384 - 10 Jun 2025

Abstract

Background: Metabolic syndrome (MetS), characterized by the co-occurrence of obesity, hypertension, hyperglycemia, and dyslipidemia, substantially increases the risk of cardiovascular disease and type 2 diabetes. In South Korea, the prevalence of MetS is steadily increasing. While physical activity is known to mitigate [...] Read more.

Background: Metabolic syndrome (MetS), characterized by the co-occurrence of obesity, hypertension, hyperglycemia, and dyslipidemia, substantially increases the risk of cardiovascular disease and type 2 diabetes. In South Korea, the prevalence of MetS is steadily increasing. While physical activity is known to mitigate this risk, recent evidence suggests that the timing of activity, not just its volume, may also be important. Methods: We analyzed accelerometer data from Korean adults who participated in the 2014–2016 Korea National Health and Nutrition Examination Survey (KNHANES). Functional principal component analysis (FPCA) was applied to minute-level physical activity trajectories to extract key temporal patterns. Logistic regression models assessed associations between the resulting principal component (PC) scores and MetS, adjusting for demographic, behavioral, and occupational factors, as well as total moderate-to-vigorous physical activity (MVPA). Results: Among the four extracted components, the third principal component (PC3)—reflecting higher morning and evening activity with reduced afternoon variability—was significantly associated with increased risk of MetS in the fully adjusted model (adjusted OR = 1.117; 95% CI: 1.003–1.244). Conclusions: These findings suggest that temporal patterns of physical activity, particularly reduced variability in the afternoon, may be linked to adverse metabolic outcomes. Beyond overall activity volume, the timing and distribution of daily physical activity should be considered in metabolic health research and interventions. Full article

(This article belongs to the Section Health Informatics and Big Data)

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16 pages, 455 KiB

Open AccessArticle

What Drives Trust and Satisfaction in Health Welfare Social Cooperatives?

by Hyeon Jo, Enoch Kang and Bum Suk Lee

Healthcare 2025, 13(12), 1383; https://doi.org/10.3390/healthcare13121383 - 10 Jun 2025

Abstract

Background/Objectives: Patient trust and satisfaction are critical components of effective healthcare delivery, particularly within health welfare social cooperatives. This study investigates the impacts of administrative procedures, courtesy, physical accessibility, collaborative management, and community health relations on patient trust and satisfaction. Methods: [...] Read more.

Background/Objectives: Patient trust and satisfaction are critical components of effective healthcare delivery, particularly within health welfare social cooperatives. This study investigates the impacts of administrative procedures, courtesy, physical accessibility, collaborative management, and community health relations on patient trust and satisfaction. Methods: Using Partial Least Squares Structural Equation Modeling (PLS-SEM), we analyzed survey data collected from 658 members of a health welfare social cooperative to assess the hypothesized relationships. Results: The findings reveal that administrative procedures significantly enhance trust but do not directly affect satisfaction. Courtesy and community health relations positively influence both trust and satisfaction. Physical accessibility, collaborative management, and trust also significantly enhance patient satisfaction. Conclusions: These results highlight the multifaceted nature of patient trust and satisfaction, emphasizing the importance of efficient administrative practices, respectful treatment, collaborative decision-making, and strong community engagement. For practitioners, the study underscores the need for a comprehensive approach to healthcare management that integrates operational efficiency with patient-centered care. Full article

(This article belongs to the Special Issue Advances in Primary Health Care and Community Health)

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16 pages, 608 KiB

Open AccessArticle

The Complex Interplay Between Dental Anxiety, Generalized Anxiety, and Dental Neglect and Oral Health Quality of Life in the General Public

by Abdullah S. Bin Rahmah, Mohammed I. Alsaif and Abdallah Y. Naser

Healthcare 2025, 13(12), 1382; https://doi.org/10.3390/healthcare13121382 - 10 Jun 2025

Abstract

Background: Dental anxiety and generalized anxiety are common psychological conditions and can lead to poor oral health and avoidance behavior. This research aims to study the complex interplay between dental anxiety, generalized anxiety, dental neglect, and oral health-related quality of life (OHRQoL) in [...] Read more.

Background: Dental anxiety and generalized anxiety are common psychological conditions and can lead to poor oral health and avoidance behavior. This research aims to study the complex interplay between dental anxiety, generalized anxiety, dental neglect, and oral health-related quality of life (OHRQoL) in the general public. Methods: This is an online survey study that was conducted between August to September 2024 in Saudi Arabia and Jordan. Four previously validated instruments were used in this study. This study made use of the Modified Dental Anxiety Scale, the General Anxiety Disorder-7, dental neglect scale, and the Oral Health Impact Profile-14. Mediation analysis was conducted using the PROCESS macro (Model 4) to explore whether dental anxiety and dental neglect mediates the relationship between generalized anxiety and OHRQoL. Results: This study had 2704 participants in total. Higher anxiety levels were associated with slightly lower dental neglect and significantly poorer OHRQoL. Generalized anxiety significantly predicted dental anxiety, with a coefficient of b = 0.275 (p < 0.001). Both generalized anxiety and dental anxiety were significant predictors of OHRQoL, with generalized anxiety showing stronger effect. Dental anxiety partially mediates the impact of generalized anxiety on oral health-related quality of life, while a strong direct effect remains. Conclusions: Dental neglect served as a minor mediator, and the primary relationship between anxiety and oral health-related quality of life is direct. Moreover, dental anxiety partially mediates the impact of generalized anxiety on oral health-related quality of life, while a strong direct effect remains. Full article

(This article belongs to the Special Issue Contemporary Oral and Dental Health Care: Issues and Challenges)

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18 pages, 871 KiB

Open AccessSystematic Review

The Effectiveness and Harms of PSA-Based Prostate Cancer Screening: A Systematic Review

by Chung-uk Oh and Hyekyung Kang

Healthcare 2025, 13(12), 1381; https://doi.org/10.3390/healthcare13121381 - 9 Jun 2025

Abstract

Objectives: Prostate cancer’s prevalence is rapidly increasing in Korea, with incidence rates rising by over 13% annually since 2017 according to the Korea Central Cancer Registry, highlighting the need for effective early detection strategies. This study systematically reviews the benefits and harms of [...] Read more.

Objectives: Prostate cancer’s prevalence is rapidly increasing in Korea, with incidence rates rising by over 13% annually since 2017 according to the Korea Central Cancer Registry, highlighting the need for effective early detection strategies. This study systematically reviews the benefits and harms of PSA-based prostate cancer screening, focusing on its clinical effectiveness and public health implications. Methods: Following PRISMA 2020 guidelines, we searched five databases (PubMed, Embase, Cochrane Library, Google Scholar, and KMbase) for studies from 2014 to 2024. The eligible studies included RCTs, cohort studies, meta-analyses, and guidelines. Risk of bias was assessed using the Cochrane tool. We synthesized our findings narratively due to their methodological heterogeneity. Results: Sixteen studies were included. PSA screening reduced prostate-cancer-specific mortality by 20–31%, as reported in multiple randomized controlled trials, such as ERSPC and ProScreen, among men aged 55–69, but showed minimal impact on all-cause mortality. Advanced tools such as MRI and multi-biomarker models, which were implemented in several included studies, enhanced diagnostic accuracy. The potential harms included overdiagnosis, overtreatment, and psychological distress. Community-based education and shared decision-making, inferred from observational and implementation studies, improved participation and equity in screening. Conclusions: PSA-based screening offers modest mortality benefits but carries the risk of overdiagnosis. Precision diagnostics and risk-stratified strategies improve screening outcomes. Public health approaches, particularly those led by nurses and community health workers, are essential to promoting informed, equitable screening decisions. Full article

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15 pages, 229 KiB

Open AccessArticle

Adapting and Accepting Type 1 Diabetes: A Qualitative Exploration of the Perspectives from People with Type 1 Diabetes from 13 Countries

by Elsa Gaillard and David Beran

Healthcare 2025, 13(12), 1380; https://doi.org/10.3390/healthcare13121380 - 9 Jun 2025

Abstract

Introduction: Divergent theories exist concerning the constructs of adaptation and acceptance for chronic conditions. Understanding these processes is essential to improving care. The aim of this study is to describe these concepts from the perspective of people living with type 1 diabetes. Methods: [...] Read more.

Introduction: Divergent theories exist concerning the constructs of adaptation and acceptance for chronic conditions. Understanding these processes is essential to improving care. The aim of this study is to describe these concepts from the perspective of people living with type 1 diabetes. Methods: A secondary analysis was conducted on data from a qualitative study, including interviews with 101 people in 13 countries across all continents, with participants of varying ages, genders, and diabetes durations as well as participants who were parents with children with type 1 diabetes. The initial study included a topic guide with open questions and interviews were analyzed using grounded theory resulting in a pyramid of needs for type 1 diabetes. This pyramid included the concepts of adaptation and acceptance. This study explores these themes in more depth. Results: Adaptation and acceptance processes vary from one person to another. Adaptation includes both adjustment to daily care and a change in perspective. Acceptance is explained as a process relying on adaptation, with no defined standardized stages. Diabetes acceptance positively impacts health, daily life, and relationships. The study identifies several factors that help acceptance, such as medical supplies, a caring healthcare environment, family and peer support, parental acceptance of diabetes, and diabetes camps. Discussion: Some of the elements required for adaptation and acceptance can be provided directly by the healthcare system, such as medical supplies, while others outside the healthcare system still need to be considered by caregivers, such as the individual’s social environment. The psychological well-being of people with type 1 diabetes and parents should be investigated as often as possible with the provision of adaptative, integrated, and holistic care. Full article

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