Healthcare

11 pages, 801 KiB

Open AccessArticle

Clinical Trial Awareness, Perceptions, and Participation Among Cancer Patients in Saudi Arabia

by Maryam Alotaibi, Laila Alsolami, Sarah AlHarbi, Amal Alagha, Lina Alqurashi, Rahaf Badr, Nouf Almatrafi, Ghada Aladwani, Amal Alotaibi, Alaa Shahbar and Mohammed Alnuhait

Healthcare 2025, 13(9), 1044; https://doi.org/10.3390/healthcare13091044 - 1 May 2025

Abstract

Background: Clinical trials are essential tools for advancing cancer treatment, improving survival rates, and introducing innovative therapies. However, patient participation in clinical trials remains low in the Middle East, including Saudi Arabia. This study explores Saudi cancer patients’ awareness, perceptions, and willingness to [...] Read more.

Background: Clinical trials are essential tools for advancing cancer treatment, improving survival rates, and introducing innovative therapies. However, patient participation in clinical trials remains low in the Middle East, including Saudi Arabia. This study explores Saudi cancer patients’ awareness, perceptions, and willingness to participate in clinical trials while identifying key barriers to enrollment. Methods: A cross-sectional survey was conducted using a self-administered questionnaire distributed via email and social media. Saudi cancer patients aged 14 and older, fluent in Arabic or English, and with a confirmed cancer diagnosis were eligible. Ethical approval was obtained, and participation was voluntary with ensured data confidentiality. The survey assessed awareness of clinical trials, perceived benefits, willingness to enroll, and barriers to participation. Data were analyzed using SPSS version 23, with chi-square tests used to examine associations. Results: A total of 201 participants completed the survey. Most were female (69.2%), with a mean age of 39.5 years. Awareness of clinical trials was moderate (51.2%), with social media and healthcare providers being primary information sources. While 57.2% recognized the benefits of clinical trials, 44.8% expressed concerns about risks. Trust in healthcare providers influenced willingness to participate, with 49.8% confident in their physician’s recommendations. The most common barriers were fear of side effects (82.6%) and lack of information (42.8%). Only 5.5% had prior experience with clinical trials, but 35.3% expressed willingness to enroll if recommended by a healthcare provider. Gender and income were significantly associated with perceptions and willingness to participate. Conclusions: Findings highlight the need for targeted educational initiatives to improve awareness and trust in clinical trials among Saudi cancer patients. Addressing key barriers, particularly concerns about side effects and limited information, could enhance participation, ultimately advancing cancer research and treatment in the region. Full article

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15 pages, 253 KiB

Open AccessArticle

Association Between Depression and the Short Sleep Duration on Weekdays and Weekends in South Korean Adults: A Cross-Sectional Study Using the 2016 and 2018 Korea National Health and Nutrition Examination Survey

by Mi-Jung Eum and Euna Si

Healthcare 2025, 13(9), 1043; https://doi.org/10.3390/healthcare13091043 - 1 May 2025

Abstract

Objective: This study aimed to examine the association between sleep duration on weekdays and weekends and depression among Korean adults. Design: Cross-sectional study. Setting: South Korea, utilizing data from 2016 and 2018 Korea National Health and Nutrition Examination Survey (KNHANES). Participants: A total [...] Read more.

Objective: This study aimed to examine the association between sleep duration on weekdays and weekends and depression among Korean adults. Design: Cross-sectional study. Setting: South Korea, utilizing data from 2016 and 2018 Korea National Health and Nutrition Examination Survey (KNHANES). Participants: A total of 7669 South Korean adults aged 19−64 years. Measures: Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Sleep duration was classified separately for weekdays and weekends and categorized into three groups: <7, 7–9, and ≥9 h. Multiple logistic regression analysis was performed, adjusting for socioeconomic, lifestyle, and health-related variables. Results: Among the participants, 3.6% were identified as having depression. On weekdays, 40.5% of respondents reported an average sleep duration of less than 7 h per day, whereas only 20.3% did so on weekends. Compared to those who averaged 7 to less than 9 h of sleep per day, individuals with short sleep duration (<7 h) on weekdays had significantly higher odds of depression (OR: 1.65; 95% CI: 1.16–2.35), as did those with short sleep on weekends (OR: 1.62; 95% CI: 1.10–2.38). Notably, participants who consistently averaged less than 7 h of sleep per day across both weekdays and weekends demonstrated the highest odds of depression (OR: 1.76; 95% CI: 1.13–2.75). Conclusions: Short sleep duration on both weekdays and weekends was found to be associated with depression. These findings suggest that sleep duration should be considered an important factor in the prevention of depression. Full article

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

20 pages, 781 KiB

Open AccessArticle

The Impact of Maladaptive Coping Styles on Psychological Outcomes in Tuberculosis Patients

by Ion Papava, Ana-Maria Cristina Daescu, Liana Dehelean, Ana-Cristina Bredicean, Adrian Cosmin Ilie, Sorin Ursoniu, Mariana Bondrescu, Ion Radu, Andrei Daescu, Alexandru-Ioan Gaitoane and Cristian Oancea

Healthcare 2025, 13(9), 1042; https://doi.org/10.3390/healthcare13091042 - 1 May 2025

Abstract

Background/Objective: Tuberculosis (TB) is associated with significant psychological distress, including anxiety and depression, which may be influenced by coping styles. This study aimed to evaluate the relationship between coping mechanisms, psychological outcomes, and sociodemographic factors in TB patients. Methods: A total of 100 [...] Read more.

Background/Objective: Tuberculosis (TB) is associated with significant psychological distress, including anxiety and depression, which may be influenced by coping styles. This study aimed to evaluate the relationship between coping mechanisms, psychological outcomes, and sociodemographic factors in TB patients. Methods: A total of 100 TB patients admitted to the Victor Babeș Clinical Hospital of Infectious Diseases and Pneumophtisiology, Timișoara, were assessed using the COPE questionnaire for coping styles and the GAD7 and PHQ9 scales for anxiety and depression. The Wilcoxon signed-rank test analyzed the changes in the psychological scores between admission and discharge. Results: Multinomial and linear regression analyses identified the predictors of coping styles based on psychological and sociodemographic factors. Anxiety and depression significantly improved during hospitalization (PHQ9: p < 0.001, GAD7: p < 0.001). Social-support-focused coping showed the largest depression reduction (PHQ9: from 13 to 4), while avoidant coping had the lowest residual distress (PHQ9 = 0.5, GAD7 = 0). Age and marital status were significant predictors of problem-focused coping, with older and married patients being more likely to adopt this strategy (β = 0.08, p = 0.008). Coping styles significantly influence psychological outcomes in TB patients. Problem-focused coping was associated with better psychological recovery, while social-support-focused coping was linked to persistent distress. Conclusions: Integrating mental health screening into TB care and tailoring interventions to coping styles may enhance psychological resilience and potentially support treatment adherence, a relationship that should be further explored in future research. Full article

(This article belongs to the Special Issue Coping with Emotional Distress)

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20 pages, 580 KiB

Open AccessArticle

Severe COVID-19 in Non-Smokers: Predictive Factors and Outcomes

by Marko Djuric, Irina Nenadic, Nina Radisavljevic, Dusan Todorovic, Nemanja Dimic, Marina Bobos, Suzana Bojic, Predrag Savic, Tamara Nikolic Turnic, Predrag Stevanovic and Vladimir Djukic

Healthcare 2025, 13(9), 1041; https://doi.org/10.3390/healthcare13091041 - 1 May 2025

Abstract

Background: The COVID-19 pandemic revealed an unexpected pattern known as the “smoker’s paradox”, with lower rates of severe disease among smokers compared to non-smokers, highlighting the need for the specific investigation of disease progression in non-smoking populations. Objective: To identify early mortality predictors [...] Read more.

Background: The COVID-19 pandemic revealed an unexpected pattern known as the “smoker’s paradox”, with lower rates of severe disease among smokers compared to non-smokers, highlighting the need for the specific investigation of disease progression in non-smoking populations. Objective: To identify early mortality predictors in non-smoking patients with severe COVID-19 through the evaluation of clinical, laboratory, and oxygenation parameters. Methods: This retrospective observational cohort study included 59 non-smokers hospitalized with COVID-19 between November and December 2020. Clinical parameters, laboratory findings, and respiratory support requirements were analyzed on Days 1 and 7 of hospitalization. ROC curves were constructed to assess the predictive value of the parameters. Results: The overall mortality rate was 54.2%. The seventh-day SOFA score showed the strongest predictive value (AUC = 0.902, p = 0.004), followed by pCO₂ (AUC = 0.853, p = 0.012). Significant differences between survivors and non-survivors were observed in acid–base parameters, oxygenation indices, and hematological markers. Mortality rates varied significantly with ventilation type: 84.6% for IMV and 50% for NIMV, with no deaths in HFNC patients. Conclusions: Multiple parameters measured on Day 7 of hospitalization demonstrate significant predictive value for mortality in non-smoking COVID-19 patients, with the SOFA score being the strongest predictor. The type of respiratory support significantly influences outcomes, suggesting the importance of careful ventilation strategy selection. Full article

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12 pages, 751 KiB

Open AccessArticle

Modulation Effect of Physical Activity on Sleep Quality and Mental Hyperactivity in Higher-Education Students

by Rubén Fernández-García, Cristina González-Forte, José Granero-Molina and Eduardo Melguizo-Ibáñez

Healthcare 2025, 13(9), 1040; https://doi.org/10.3390/healthcare13091040 - 1 May 2025

Abstract

Objectives: The present study seeks to analyze the relationships between the intensity of physical activity, mental hyperactivity and sleep quality. A comparative, descriptive and exploratory study was carried out. Methods: A sample of 1907 university students belonging to the degree of Physiotherapy and [...] Read more.

Objectives: The present study seeks to analyze the relationships between the intensity of physical activity, mental hyperactivity and sleep quality. A comparative, descriptive and exploratory study was carried out. Methods: A sample of 1907 university students belonging to the degree of Physiotherapy and Physical Activity and Sport Sciences was used. The International Physical Activity and Mental Hyperactivity Questionnaires were used. The scale used was the Pittsburgh sleep quality index. The proposed model analyzes the relationships of physical activity with mental hyperactivity and various sleep-related factors. Results: The following fit indices were evaluated: Chi-Square = 80.242; Degrees of Freedom = 3; Incremental Fit Index = 0.951, Comparative Fit Index = 0.977; Normed Fit Index = 0.946; Root Mean Square Error of Approximation = 0.071. The values obtained show the good fit of the theoretical model. Statistically significant differences are observed (p < 0.05) in the causal relationship of mental hyperactivity with the personal assessment of sleep as a function of the intensity of physical activity. A greater effect of light (β = 0.671) compared to moderate- (β = 0.428) or vigorous-intensity (β = 0.343) physical activity in personal sleep assessment is evident. Statistically significant differences were also observed in the causal relationship of mental hyperactivity with the time to fall asleep (p < 0.05). Light physical activity (β = 0.479) has a greater causal relationship with time to fall asleep than moderate- (β = 0.302) or vigorous-intensity (β = 0.413) physical activity. Conclusions: Based on the results obtained, it is concluded that the intensity with which physical activity is performed has a modulating effect on sleep quality and mental hyperactivity. Full article

(This article belongs to the Special Issue New Insights into Understudied Phenomena in Healthcare: Second Edition)

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16 pages, 1426 KiB

Open AccessSystematic Review

Mental Health and Suicide Attempts in Adolescents: A Systematic Review

by Virginia Morcillo, Maria Ferrer-Ribot, Bartomeu Mut-Amengual, Sara Bagur and Maria Rosa Rosselló

Healthcare 2025, 13(9), 1039; https://doi.org/10.3390/healthcare13091039 - 1 May 2025

Abstract

Suicide has become one of the leading causes of mortality among the adolescent population. This worrisome fact demands an exhaustive analysis of this social phenomenon’s reality. Objective: This paper aims to carry out a systematic review of the existing scientific literature in recent [...] Read more.

Suicide has become one of the leading causes of mortality among the adolescent population. This worrisome fact demands an exhaustive analysis of this social phenomenon’s reality. Objective: This paper aims to carry out a systematic review of the existing scientific literature in recent years on suicide among minors and adolescents. Method: To achieve this purpose, central databases, WoS, Scopus, and Dialnet, were analyzed, obtaining 34 articles. Results: The results are structured into three main categories. (1) Risk factors: psychological and mental health factors, family and context factors, and, finally, school factors. (2) Prevention: School as prevention, emotional education programs, and tools to deal with this situation. And, finally, the third block, (3) family experiences in the face of suicidal behavior. Conclusions: The studies reviewed highlight the enormous complexity of this problem and show a worrying situation regarding suicide, considering multifactorial aspects such as depression, psychosocial issues, and mood disorders, as well as causes related to the school environment, such as bullying and lack of connection with school. In addition, they denote the importance of family factors in this aspect. Finally, the results highlight the importance of prevention and early detection, underlining the need to develop concrete actions to alleviate this growing situation among adolescents. Full article

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10 pages, 497 KiB

Open AccessArticle

Assessing the Roles and Responsibilities of Informal Caregivers from the Perspective of Adult Patients in Saudi Arabia: A Cross-Sectional Study

by Saja H. Almazrou, Shiekha S. Alaujan and Nouf F. AlSaad

Healthcare 2025, 13(9), 1038; https://doi.org/10.3390/healthcare13091038 - 1 May 2025

Abstract

Objectives: This study aim to determine the characteristics, roles, responsibilities, and challenges of informal caregivers for adult patients in Saudi Arabia. Methods: Adult patients who have informal caregivers were invited to participate in a cross-sectional study. The inclusion criteria were patients who [...] Read more.

Objectives: This study aim to determine the characteristics, roles, responsibilities, and challenges of informal caregivers for adult patients in Saudi Arabia. Methods: Adult patients who have informal caregivers were invited to participate in a cross-sectional study. The inclusion criteria were patients who were 18 years old or older and permanent Saudi residents. A self-administered online questionnaire was used to identify patients’ demographics, roles, responsibilities, and care challenges. Data collection lasted four months. Percentages, means, and standard deviations were reported in the analysis. Results: The study included 276 participants, mostly female (68.8%), with a mean age of 55.21 years (SD = 20.3). Over half were married (56.2%) and not employed (81.9%). Common chronic diseases were diabetes and hypertension, with 55.8% using up to five medications. Caregivers were mainly sons or daughters (62%) living with the patient (84.1%). The top caregiver tasks were escorting patients to appointments (63.4%), scheduling doctor appointments (60.1%), and tracking medication refills (59.4%). Common challenges included caregivers lacking time (45.3%), inconsistent care (35.9%), financial constraints (27.5%), and caregivers missing doses (27.9%). The top not encountered challenges were inappropriate medication storage (78.3%), communication barriers (74.3%), improper disposal of injections (72.5%), medication management errors (71.4%), and lack of empathy (70.3%). Conclusion: This study highlights the vital role of informal caregivers in managing chronic illnesses in Saudi Arabia. Informal caregivers face challenges such as time constraints and financial limitations. The findings emphasize the need for better support systems, including training programs and improved access to healthcare resources, to enhance care quality for patients. Full article

(This article belongs to the Special Issue Health, Social Problems and Well-Being of Patients with Chronic Diseases, Quality of Life, and the Need for Emotional and Social Support)

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19 pages, 1092 KiB

Open AccessSystematic Review

Effectiveness of Web-Based Interventions on Clinical Outcomes and Lifestyle Modifications in Women Planning to Conceive: A Systematic Review

by Hitomi Suzuki, Phyu Phyu Tun, Shuxian Liu, Erika Ota and Naoko Arata

Healthcare 2025, 13(9), 1037; https://doi.org/10.3390/healthcare13091037 - 1 May 2025

Abstract

Purpose: to identify evidence on the effectiveness of web-based interventions for lifestyle modification among women or couples of reproductive ages wishing to conceive. Methods: A systematic search was conducted in February 2023 across CENTRAL, PubMed, Web of Science, Embase, Emcare, ClinicalTrials.gov, and WHO [...] Read more.

Purpose: to identify evidence on the effectiveness of web-based interventions for lifestyle modification among women or couples of reproductive ages wishing to conceive. Methods: A systematic search was conducted in February 2023 across CENTRAL, PubMed, Web of Science, Embase, Emcare, ClinicalTrials.gov, and WHO ICTRP. Data from four randomized controlled trials involving 1965 preconception women were narratively synthesized following risk of bias assessment. Interventions included a web-based conversational agent system, an email-based mobile service, and a mobile app providing lifestyle-related information. Results: Despite diverse assessment tools, benefits were observed for systolic blood pressure, serum folate levels, and physical activity. However, no significant effects were found for intake of vegetables and fruit, folic acid supplementation, smoking, alcohol consumption, waist circumference, weight, BMI, overweight status, HbA1c, total cholesterol, HDL, stress, depression, anxiety, or pregnancy outcomes. Conclusions: Web-based interventions show potential in improving certain health behaviors among preconception women. Further high-quality studies are needed to assess their effectiveness on a broader range of outcomes, including dietary habits, physical activity, and substance use, and to inform their integration into preconception care strategies. Registration: We registered the study protocol with PROSPERO (CRD42023488277). Full article

(This article belongs to the Section Women's Health Care)

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15 pages, 450 KiB

Open AccessArticle

Analysis of the Status and Influencing Factors of Depression in Chinese Middle-Aged and Older Cancer Patients—Based on Empirical Evidence from the 2020 CHARLS Database

by Yantong Zhou and Ying Bian

Healthcare 2025, 13(9), 1036; https://doi.org/10.3390/healthcare13091036 - 30 Apr 2025

Abstract

Background/Objectives: With the gradual acceleration of population aging in China, the health problems among middle-aged and older adults have become a key social topic. Among this segment of the population, symptoms of depression are common, and cancer has the potential to aggravate [...] Read more.

Background/Objectives: With the gradual acceleration of population aging in China, the health problems among middle-aged and older adults have become a key social topic. Among this segment of the population, symptoms of depression are common, and cancer has the potential to aggravate such psychological diseases. Under this background, the present study investigates depression in middle-aged and older cancer patients and the various factors that influence depression. Methods: Data from 356 participants (aged ≥ 45, cancer-diagnosed, CES-D score ≥ 10) were extracted from CHARLS 2020. Depressive symptoms were assessed using CES-D, with SPSS 29.0 employed for ANOVA and binary logistic regression to identify associations between cancer, covariates, and depression. Results: The number of depressive symptoms was 161 (45.2%). Binary logistic regression showed that “gender”, “retired status”, “social status”, “life satisfaction”, “self-rated health”, and “sleep duration” were the main factors. “Female”, “not retired”, “unsocialized”, “satisfied”, “very poor self-rated health”, and “sleep < 6 h” were found to exacerbate depressive symptoms in middle-aged and older cancer patients. Conclusions: Depressive symptoms are more severe in middle-aged and older cancer patients than in other groups and are influenced by various factors. Consequently, greater attention should be paid to the mental health of these patients in their daily lives, and targeted measures should be taken to improve their mental health considering all aspects of family and society. These measures may alleviate the psychological harm that these patients suffer in the process of cancer and its treatment. Full article

16 pages, 321 KiB

Open AccessArticle

Promoting Women’s Mental Health and Resilience in Times of Health Crisis and Adversity via Personal Development Groups

by Maria Moudatsou, Areti Stavropoulou, Michael Rovithis, Dimitrios Mimarakis and Sofia Koukouli

Healthcare 2025, 13(9), 1035; https://doi.org/10.3390/healthcare13091035 - 30 Apr 2025

Abstract

Background: Women carry out an array of demanding tasks due to their multiple roles as mothers, workers, spouses, and caregivers. Their responsibilities to the family and society are essential throughout life, but they become even more important at times of crisis and unanticipated [...] Read more.

Background: Women carry out an array of demanding tasks due to their multiple roles as mothers, workers, spouses, and caregivers. Their responsibilities to the family and society are essential throughout life, but they become even more important at times of crisis and unanticipated events. All these obligations may have a detrimental effect on their mental health and general well-being. According to the social model of health, through personal development groups, women improve their health because they can transform their personalities, enhance their social and personal abilities, and strengthen their resilience to unforeseen occurrences, health crises, and adversity. Aim of the study: This follow-up study examined the viewpoints of women regarding the durability and efficacy of group therapy’s positive impact on their resilience and mental health, especially through unforeseen circumstances and crises. This group of women had taken part in group therapy six years ago to strengthen their resilience and improve their mental health. Methods: Data collection was implemented through semi-structured in-person interviews conducted from December 2020 to March 2021. Five topics emerged from the framework analysis: (a) personal development and mental health; (b) reinforcement of their resilience; (c) group therapy and women’s health during the COVID-19 pandemic; (d) an assessment of group therapy on women’s health through imagery; (e) future recommendations. Results: Most of the women stated that group treatment had a beneficial impact in terms of improving their individual abilities. The group experience was described as a bridge that allowed them to recognize and accept their emotions. Since COVID-19, women have developed helpful coping strategies to deal with daily tension, loneliness, and work-related stress. Conclusions: Our research results indicate that group therapy is a useful tool for women’s empowerment and mental health in times of crises and adversity. Social policy should take it into account in order to meet women’s highly demanding roles and personal needs. Full article

(This article belongs to the Special Issue Health and Social Care Policy—2nd Edition)

12 pages, 267 KiB

Open AccessArticle

Effectiveness of Virtual and Augmented Reality for Emergency Healthcare Training: A Randomized Controlled Trial

by Jose Manuel Castillo-Rodríguez, Jose Luis Gómez-Urquiza, Sofía García-Oliva and Nora Suleiman-Martos

Healthcare 2025, 13(9), 1034; https://doi.org/10.3390/healthcare13091034 - 30 Apr 2025

Abstract

Background: Appropriate clinical training for emergencies is a key factor in the quality of healthcare. Advances in technology facilitate the creation of new forms of training, fostering student interaction and engagement. In this respect, augmented and virtual reality approaches in healthcare training are [...] Read more.

Background: Appropriate clinical training for emergencies is a key factor in the quality of healthcare. Advances in technology facilitate the creation of new forms of training, fostering student interaction and engagement. In this respect, augmented and virtual reality approaches in healthcare training are generating great interest. Objectives: to evaluate the effectiveness of virtual and augmented reality in emergency healthcare training. Methods: A randomized controlled trial was conducted with two intervention groups. Intervention group No. 1 (n = 30) received in-class instruction followed by practice with a cardiopulmonary resuscitation (CPR) manikin and using virtual reality with the Meta Quest model (using the VR applications Heart, Lung, and School of CPR). Intervention group No. 2 (n = 31) received the same in-class training but followed by an augmented reality session. In this intervention, the Heart and Lung AR applications were used on an iPhone 15 ProMax. The control group (n = 32) only received in-class instruction and practice with the CPR manikin. Results: The virtual reality and augmented reality interventions improved learning effectiveness and user satisfaction. These results were statistically significant (p < 0.05) for knowledge post-intervention between groups, VR being the highest. However, the results were not significant for satisfaction. Conclusions: VR procedures can be effective for increasing learning effectiveness in emergency training. Full article

(This article belongs to the Section Nursing)

12 pages, 756 KiB

Open AccessArticle

Comparative Outcomes of Bilateral Versus Unilateral Total Knee Arthroplasty: A Big Data Analysis

by David Maman, Daniel Dumov, Maneesh Nandakumar, Batia Litmanowicz, Daniel Shpigelman, Linor Fournier, Yaniv Steinfeld, Yaniv Yonai and Yaron Berkovich

Healthcare 2025, 13(9), 1033; https://doi.org/10.3390/healthcare13091033 - 30 Apr 2025

Abstract

Background: Bilateral total knee arthroplasty (B-TKA) is a surgical option for patients with bilateral osteoarthritis, offering potential efficiency and cost advantages but with increased perioperative risk. Methods: We conducted a retrospective analysis of 2,299,979 elective TKA cases from the Nationwide Inpatient Sample (2016–2019). [...] Read more.

Background: Bilateral total knee arthroplasty (B-TKA) is a surgical option for patients with bilateral osteoarthritis, offering potential efficiency and cost advantages but with increased perioperative risk. Methods: We conducted a retrospective analysis of 2,299,979 elective TKA cases from the Nationwide Inpatient Sample (2016–2019). Propensity score matching (PSM) was used to compare 83,980 B-TKA patients with matched unilateral TKA (U-TKA) patients. Outcomes included in-hospital mortality, complications, length of stay, and hospital charges. Results: B-TKA patients had higher rates of complications such as deep vein thrombosis (OR 1.798) and pulmonary embolism (OR 1.883), longer hospital stays (3.03 vs. 2.49 days), and higher charges (USD 83,639 vs. USD 59,215; all p < 0.001). Conclusions: Although B-TKA is associated with increased perioperative risk, it may offer logistical and economic advantages in well-selected patients. These findings support the need for risk stratification in surgical decision-making. Full article

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9 pages, 5439 KiB

Open AccessBrief Report

Relationship of Reduced Pain Intensity and Improved Quality-of-Life with Menstrual Migraine with Aspirin, Acetaminophen, and Caffeine Combination

by Ashoke Mitra, Mako Araga, Abhay Aher, Jay Xu, Gilbert Shanga, Billy Franks and Richard Petruschke

Healthcare 2025, 13(9), 1032; https://doi.org/10.3390/healthcare13091032 - 30 Apr 2025

Abstract

Objective: The objective of the current post hoc analysis is to evaluate whether the combination of acetaminophen, aspirin, and caffeine (AAC) is more effective than placebo in relieving the pain intensity for and improving the quality-of-life (QoL) of subjects with menstrual migraine (MM). [...] Read more.

Objective: The objective of the current post hoc analysis is to evaluate whether the combination of acetaminophen, aspirin, and caffeine (AAC) is more effective than placebo in relieving the pain intensity for and improving the quality-of-life (QoL) of subjects with menstrual migraine (MM). Methods: This analysis evaluated the impact of AAC (n = 85) versus placebo (n = 100) in relieving the pain intensity for and improving the QoL of subjects with MM during baseline and at 0.5, 1, 2, 3, 4, and 6 h post treatment. Subjects reported their pain intensity using a 4-point scale and QoL using a 5-point scale. A lower score indicates reduced pain intensity and improved QoL. Results: A statistically significant difference between the AAC and placebo groups (p ≤ 0.001) was observed in pain relief after 1 h (40% vs. 14%), 2 h (56.5% vs. 24%), 3 h (63.5% vs. 31%), 4 h (65.9% vs. 34%), and 6 h (64.7% vs. 31%) post treatment. Similarly, a significantly higher proportion of subjects reported improved QoL at 1 h (48.2% vs. 28.0%; p ≤ 0.005), 2 h (61.2% vs. 40.0%; p ≤ 0.005), 3 h (68.2% vs. 44.0%; p ≤ 0.001), 4 h (67.9% vs. 39.0%; p ≤ 0.001), and 6 h (64.3% vs. 37.0%; p ≤ 0.001) post treatment. The mean pain intensity and QoL scores reduced, while the relative pain intensity and QoL (difference between the AAC and placebo groups) increased with time and was sustained for 6 h. Conclusions: The rapid onset and sustained effect of AAC make it a potential option for managing headaches and other symptoms, and to improve the QoL of subjects with MM. Full article

(This article belongs to the Section Women's Health Care)

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24 pages, 1798 KiB

Open AccessArticle

HEalthcare Robotics’ ONtology (HERON): An Upper Ontology for Communication, Collaboration and Safety in Healthcare Robotics

by Penelope Ioannidou, Ioannis Vezakis, Maria Haritou, Rania Petropoulou, Stavros T. Miloulis, Ioannis Kouris, Konstantinos Bromis, George K. Matsopoulos and Dimitrios D. Koutsouris

Healthcare 2025, 13(9), 1031; https://doi.org/10.3390/healthcare13091031 - 30 Apr 2025

Abstract

Background: Healthcare robotics needs context-aware policy-compliant reasoning to achieve safe human–agent collaboration. The current ontologies fail to provide healthcare-relevant information and flexible semantic enforcement systems. Methods: HERON represents a modular upper ontology which enables healthcare robotic systems to communicate and collaborate while ensuring [...] Read more.

Background: Healthcare robotics needs context-aware policy-compliant reasoning to achieve safe human–agent collaboration. The current ontologies fail to provide healthcare-relevant information and flexible semantic enforcement systems. Methods: HERON represents a modular upper ontology which enables healthcare robotic systems to communicate and collaborate while ensuring safety during operations. The system enables domain-specific instantiations through SPARQL queries and SHACL-based constraint validation to perform context-driven logic. The system models robotic task interactions through simulated eldercare and diagnostic and surgical support scenarios which follow ethical and regulatory standards. Results: The validation tests demonstrated HERON’s capacity to enable safe and explainable autonomous operations in changing environments. The semantic constraints enforced proper eligibility for roles and privacy conditions and policy override functionality during agent task execution. The HERON system demonstrated compatibility with healthcare IT systems and demonstrated adaptability to the GDPR and other policy frameworks. Conclusions: The semantically rich framework of HERON establishes an interoperable foundation for healthcare robotics. The system architecture maintains an open design which enables HL7/FHIR standard integration and robotic middleware compatibility. HERON demonstrates superior healthcare-specific capabilities through its evaluation against SUMO HL7 and MIMO. The future research will focus on optimizing HERON for low-resource clinical environments while extending its applications to remote care emergency triage and adaptive human–robot collaboration. Full article

(This article belongs to the Section TeleHealth and Digital Healthcare)

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21 pages, 334 KiB

Open AccessArticle

Perceived Homonegativity and Psychological Distress in Gay Men in Brazil: Does Skin Color Matter?

by Felipe Alckmin-Carvalho, Renata Della Torre, Iara Teixeira, Jóni Ledo, António Oliveira, Lúcia Yasuko Izumi Nichiata and Henrique Pereira

Healthcare 2025, 13(9), 1030; https://doi.org/10.3390/healthcare13091030 - 30 Apr 2025

Abstract

Homonegativity is associated with several adverse physical and mental health outcomes in gay men. However, the intersection between homonegativity and racism remains little investigated in Brazil. The aim of this study was to assess, in a sample of cisgender Brazilian gay men, associations [...] Read more.

Homonegativity is associated with several adverse physical and mental health outcomes in gay men. However, the intersection between homonegativity and racism remains little investigated in Brazil. The aim of this study was to assess, in a sample of cisgender Brazilian gay men, associations between skin color, homonegativity, psychological distress, and socioeconomic variables. Method: A cohort of 229 Brazilian gay men, 151 (66%) white and 78 (34%) black or brown were assessed. Participants completed the Internalized Homophobia Scale, the Beck Depression Inventory-II, and the State–Trait Anxiety Inventory. Results: In the general sample, high levels of homonegativity, symptoms of depression, and trait and state anxiety were found, particularly among young and low-income individuals. Black and brown participants reported significantly higher levels of trait and state anxiety, but not depression or homonegativity. Black and brown skin color were a predictor of trait and state anxiety, but not of homonegativity or depression. Conclusions: The high levels of psychological distress and homonegativity found in the general sample indicate the importance of developing preventive interventions of racial discrimination and sexual prejudice for the general community and psychoeducational and therapeutic interventions for Brazilian gay men, regardless of skin color. They also suggest the relevance of customizing these interventions to meet the specificities of black/brown Brazilian gay men, a population doubly exposed to the burden of stigma, considering the intersection between racial and sexual stigma in the Brazilian sociocultural reality. Full article

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

18 pages, 928 KiB

Open AccessArticle

The Impact of Rural Community Elderly Care Services on the Subjective Well-Being of Older Adults: The Mediating Role of Late-Life Stress

by Linjing Wan, Yixin Zhu, Dan Chen and Xiuliang Dai

Healthcare 2025, 13(9), 1029; https://doi.org/10.3390/healthcare13091029 - 30 Apr 2025

Abstract

Background/Objectives: This study aims to investigate whether rural community elderly care services can enhance older adults’ subjective well-being, with a specific focus on examining whether late-life stress mediates this association. Methods: Subjective well-being is operationalized through three dimensions: life satisfaction, positive life attitude, [...] Read more.

Background/Objectives: This study aims to investigate whether rural community elderly care services can enhance older adults’ subjective well-being, with a specific focus on examining whether late-life stress mediates this association. Methods: Subjective well-being is operationalized through three dimensions: life satisfaction, positive life attitude, and depression levels. Data were collected from a sample of 796 rural Chinese adults aged 60 years and older. Regression analysis was used to assess the direct effects of rural community elderly care services on subjective well-being outcomes, while an instrumental variable two-stage least squares model was employed to test the robustness of these findings. A mediation analysis further explored the underlying mechanisms through which these services influence well-being. Results: Results indicate that rural community elderly care services exert significant direct and indirect effects on all three dimensions of subjective well-being. The indirect effects arise because these services provide social support that mitigates late-life stressors and buffers the negative impacts of adverse life events, thereby enhancing psychological well-being. Conclusions: These findings clarify the mediating role of stress in the relationship between community care services and subjective well-being among rural older adults, highlighting the importance of addressing age-related stressors in gerontological interventions. This study contributes to the literature by providing empirical evidence for the efficacy of rural community elderly care programs and offering actionable insights for developing contextually appropriate service models to meet the needs of aging rural populations. This study elucidates how rural older adults perceive community elderly care services, providing empirical evidence for government agencies to evaluate the effectiveness of policy-driven services. It further identifies key entry points for enhancing rural care service quality and promoting elderly well-being, bridging research insights with actionable strategies for policy improvement. Full article

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16 pages, 255 KiB

Open AccessArticle

Sociodemographic Factors Associated with Physical Functioning in Elderly Males and Females from Serbia: Population-Based Modeling Study

by Milena Kostadinovic, Dejan Nikolic, Ardak Nurbakyt, Dinara Sukenova, Bojana Matejic, Ivana Sotirovic, Natasa Mujovic, Filip Milanovic, Ljubica Nikcevic and Milena Santric-Milicevic

Healthcare 2025, 13(9), 1028; https://doi.org/10.3390/healthcare13091028 - 30 Apr 2025

Abstract

Background and aim: During the past few decades, the aging population has increased. With aging, there is an increase in functional limitations. The aim of this study was to analyze sociodemographic factors associated with physical functioning impairment in elderly males and females. Methods [...] Read more.

Background and aim: During the past few decades, the aging population has increased. With aging, there is an increase in functional limitations. The aim of this study was to analyze sociodemographic factors associated with physical functioning impairment in elderly males and females. Methods: This population-based modeling study based on a data from a third national study of health of Serbian inhabitants from 2013 in Serbia included 3540 elderly participants 65 years of age and above from Serbia. Physical functioning for both genders was categorized as follows: PF1—walking half a kilometer on level ground without the assistance of any mobility aids and PF2—walking up or down 12 steps. Modeling of physical functioning for both genders was categorized as follows: Model 1: inability to perform PF1, Model 2: some/a lot of difficulty in performing PF1, Model 3: inability to perform PF2, and Model 4: some/a lot of difficulty in performing PF2. Further variables were evaluated: age, education level, marital status, body mass index (BMI), wealth index, and place of residence. Logistic regression was performed to identify the variables that are factors associated with PF1 and PF2 in elderly males and females. Results: Statistically significant factors were as follows: age (Model 1 (male OR: 2.591; female OR: 4.708); Model 2 (male OR: 1.791; female OR: 2.354); Model 3 (male OR: 2.386; female OR: 4.985); Model 4 (male OR: 1.883; female OR: 2.772)); BMI (Model 2 (female OR: 1.348); Model 4 (female OR: 1.329)), marital status (Model 2 (female OR: 0.713); Model 4 (male OR: 0.688)); education level (Model 1 (male OR: 0.626; female OR: 0.537); Model 2 (male OR: 0.811; female OR: 0.653); Model 3 (male OR: 0.697; female OR: 0.494); Model 4 (male OR: 0.784; female OR: 0.639)); wealth index (Model 2 (male OR: 0.823; female OR: 0.740); Model 3 (male OR: 0.724); Model 4 (male OR: 0.787; female OR: 0.731)); and place of residence (Model 1 (female OR: 1.704); Model 3 (female OR: 1.575)). Conclusions: Increased age, being single, a lower education level, and a lower wealth index were factors associated with functional disability in the elderly of both genders, while an increased BMI and living in another place than a city were factors associated with functional disability in elderly females. Specific social strategies bearing in mind possible gender differences should be created and implemented in order to optimize the physical functioning, mobility, and participation of the elderly. Full article

27 pages, 885 KiB

Open AccessArticle

Preliminary Study and Pre-Validation in Portugal of New Farmers’ Mindfulness and Life Satisfaction Scale (FMLSS)

by Artur Morais, Raquel P. F. Guiné, Cristina A. Costa and Cátia Magalhães

Healthcare 2025, 13(9), 1027; https://doi.org/10.3390/healthcare13091027 - 29 Apr 2025

Abstract

Background/Objective: Besides the common risks associated with agriculture, recently, there has been growing concern about the impact of agriculture on farmers’ mental health, due to high stress levels, depression, anxiety, and increasing rates of suicide, especially complex considering that many of these farmers [...] Read more.

Background/Objective: Besides the common risks associated with agriculture, recently, there has been growing concern about the impact of agriculture on farmers’ mental health, due to high stress levels, depression, anxiety, and increasing rates of suicide, especially complex considering that many of these farmers are older people. The potential of the practice of mindfulness to minimize mental health problems and improve people’s sense of well-being has been studied in recent decades, although there is a dearth of literature related to farmer populations. This study aimed to correlate the presence of mindfulness traits with general life quality and well-being and assess the levels of mindfulness and life satisfaction among family farmers, as well as to evaluate which characteristics might be associated with them. Method: The sample was composed of 30 farmers from the region of Viseu—Portugal, who were randomly selected for a survey consisting of an adaptation of the Mindful Attention Awareness Scale (MAAS) and the Satisfaction with Life Scale (SWLS), with some new items specific to the context of agriculture. A proposed Farmers’ Mindfulness and Life Satisfaction Scale (FMLSS) was validated through factor analysis and internal reliability analysis. Result: The results showed a relatively high average score for the 10 items of the mindfulness scale (4.23 ± 0.56) and the global sum of scores for the 5 items of the life satisfaction scale (26.67 ± 4.76). Factor analysis revealed six factors, globally explaining 77% of the variance, with values of alpha varying from 0.640 to 0.874. The FMLSS was validated with 19 items of the 20 initially considered (α = 0.672). Cluster analysis revealed two typologies of participants, “Pleased” and “Accommodated” family farmers. These two clusters had global values for the FMLSS of 5.19 ± 0.51 and 4.37 ± 0.59, with the higher value obtained for the “Pleased” family farmers, who were mostly of male gender and worked more hours per week and whose agricultural activities had higher significance for their family income. Conclusions: Overall, we observed a relatively high level of mindfulness and satisfaction with life among family farmers. This suggests the importance of future research on mental health among family farmers. Full article

(This article belongs to the Special Issue Psychological Health and Social Wellbeing Among Older Adults)

21 pages, 5116 KiB

Open AccessArticle

Patient Perspectives on Coordinated Care: Preliminary Results from the Implementation Stage Using Patient-Reported Experience Measures (PREMs)

by Beata Wieczorek-Wójcik, Anna Justyna Milewska, Dorota Kilańska, Aneta Kulma-Pytlak, Peter Iltchev, Aleksandra Gaworska-Krzemińska and Remigiusz Kozlowski

Healthcare 2025, 13(9), 1026; https://doi.org/10.3390/healthcare13091026 - 29 Apr 2025

Abstract

Background and Objectives: Integrated health services are health services that are managed and delivered in a way that ensures patients receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation, and palliative care services at different levels and sites of [...] Read more.

Background and Objectives: Integrated health services are health services that are managed and delivered in a way that ensures patients receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation, and palliative care services at different levels and sites of care within the health system, and according to their needs, throughout their life course. Assessing the effectiveness of their implementation, the perspective of the process participant—the patient—is examined. There are three main types of patient-reported measures: PROM, PREM and HLS. PREM (patient-reported experience measure) is a tool that allows the objective measurement of the patient’s experience related to healthcare services, for instance, the timeliness of visits or receiving recommendations. The aim of this study was to evaluate the coordinated care experienced by patients (PREMs) before and after the introduction of coordinated care, using the JOP-POP tool as a key measure. Materials and Methods: This longitudinal study was conducted in two stages. The first stage concerned the joining of the coordinated care program by the entity in which the study was conducted; the study was repeated six months after joining coordinated care (CC). At each stage of the study, the study group included 40 patients. The Shapiro–Wilk test was used to verify the normality of the distribution of quantitative variables. For statistical analysis, the Wilcoxon test for paired samples was used to compare two ordinal dependent variables. For independent variables, the Mann–Whitney and the Kruskal–Wallis ANOVA by ranks tests were used, with a post hoc test of multiple comparisons of mean ranks. Results: A statistically significant relationship (p = 0.00157) was observed between the number of chronic diseases and health status assessment before inclusion in coordinated care. The patients’ responses showed statistically significant improvement 6 months after the introduction of coordinated care (CC). The improvement in assessment was related to the time physicians spent with patients. The greatest improvement over 6 months was achieved in coordination of care and the smallest improvement was noted in the approach to the patient. Conclusions: The JOP-POP tool may be useful in future studies to assess patients’ experiences with implementing coordinated care. Full article

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