Healthcare

21 pages, 971 KB

Open AccessArticle

Evaluating Cardiovascular Patient Support Groups: A Cross-Sectional Control-Group Questionnaire Study of Patients and Healthcare Providers

by Dana Stefanovic, Julia Pantoglou, Lisa Voggenberger, Fabian Bekelaer, Markus Mader and Erika Zelko

Healthcare 2025, 13(21), 2692; https://doi.org/10.3390/healthcare13212692 (registering DOI) - 24 Oct 2025

Abstract

Background/Objectives: Participation in patient support groups (PSGs) for long-term cardiac rehabilitation (CR) enables sustainable, cardioprotective lifestyle modification, which can reduce morbidity and cardiovascular mortality. This study evaluates a nationwide network of cardiovascular PSGs in Austria in the holistic management of patients with [...] Read more.

Background/Objectives: Participation in patient support groups (PSGs) for long-term cardiac rehabilitation (CR) enables sustainable, cardioprotective lifestyle modification, which can reduce morbidity and cardiovascular mortality. This study evaluates a nationwide network of cardiovascular PSGs in Austria in the holistic management of patients with cardiovascular disease (CVD). Methods: Between December 2023 and March 2024, we evaluated PSGs by surveying members about their knowledge of CVD and self-assessed health status, comparing them with non-member CVD patients. Members’ and healthcare providers’ perceptions of the program were also assessed. Results: PSG members rated their own health literacy regarding CVD higher than non-members (median score: 7.00 vs. 6.00, range 1–10; U = 7088.00, p = 0.014). These results were not confirmed by an objective assessment of participant knowledge, and members did not exhibit better health data. However, members appreciated the association’s services in providing an important social network, enabling them to feel empowered in managing their condition (52.2%), and stated that it “improved their quality of life” (69.6%), while rating detrimental effects of participation as low. Healthcare providers also viewed the program rather positively, though only 5% reported prior contact with it. Conclusions: Cardiovascular PSGs offering long-term CR provide valuable support and are appreciated as important social networks. While further research is needed to confirm improvements in health literacy or health status, participation addresses patients’ psychosocial needs and may particularly benefit those at risk of social isolation and depression, therefore offering a useful addition to comprehensive CVD care. Full article

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10 pages, 208 KB

Open AccessArticle

Green Triage: A Curtain in Front of Possible Serious Injuries

by Gülşen Akçay, Bedriye Müge Sönmez, Hacer Demirdelen, Emre Çakar, Mert Şahin, Murat Özdemir and Mehmet Emin Arayıcı

Healthcare 2025, 13(21), 2691; https://doi.org/10.3390/healthcare13212691 - 24 Oct 2025

Abstract

Objective: The human body cannot withstand intense mechanical forces generated by an earthquake. The shaking effect of an earthquake, as the human body absorbs it, produces both visible and invisible injuries. Therefore, it is essential to provide accurate triage in the process of [...] Read more.

Objective: The human body cannot withstand intense mechanical forces generated by an earthquake. The shaking effect of an earthquake, as the human body absorbs it, produces both visible and invisible injuries. Therefore, it is essential to provide accurate triage in the process of mass casualties. Hence, this study aims to characterize green triage patients of the 2023 Kahramanmaraş, Turkey, earthquake and emphasize the need to reconsider mass casualty triage. Methods: A retrospective cross-sectional study was conducted on green triage patients who did not receive first-aid medical attention and attended the emergency department (ED) of a tertiary care hospital. The development of crush syndrome (CS), the receipt of renal replacement therapy (RRT), and associated injuries were considered. Results: Among 295 individuals, CS occurred in 32.2%, and RRT was required in 7.1% of cases. In addition to the traditional markers of CS, non-trapped green triage patients developed both CS and required RRT, as well as sustained injuries. Whether trapped or not, CK levels emerged as a significant predictor of CS. Conclusions: Green triage patients may acquire CS even in the absence of obvious injuries or entrapment. Accurate triage can be life-saving even in the absence of obvious injuries. Full article

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

19 pages, 693 KB

Open AccessReview

by Matthew N. Berger, Chenoa Cassidy-Matthews, Marian W. A. Farag, Cristyn Davies, Rohan I. Bopage and Shailendra Sawleshwarkar

Healthcare 2025, 13(21), 2690; https://doi.org/10.3390/healthcare13212690 - 23 Oct 2025

Abstract

Introduction: Mpox emerged as a multi-country outbreak in 2022 and disproportionately affected gay, bisexual, and other men who have sex with men (GBMSM). Stigma is known to exacerbate health crises by discouraging testing, treatment, and vaccination. This review aimed to explore stigma associated [...] Read more.

Introduction: Mpox emerged as a multi-country outbreak in 2022 and disproportionately affected gay, bisexual, and other men who have sex with men (GBMSM). Stigma is known to exacerbate health crises by discouraging testing, treatment, and vaccination. This review aimed to explore stigma associated with Mpox among GBMSM from July 2022, when mpox was declared a public health emergency of international concern. Methods: The PICO framework guided this narrative review. A search was conducted across the following databases from inception to June 2025: PubMed/MEDLINE, Embase, CINAHL, and Web of Science. The literature had to be empirical, peer-reviewed research that focused on mpox-related stigma in GBMSM. Results: Forty-seven studies were included in this review. The following themes were derived: (1) healthcare experiences, (2) media influence, (3) internalised and anticipated stigma, (4) public health messaging, (5) community responses, and (6) psychosocial impact. Healthcare experiences were marked by anticipated discrimination; many GBMSM delayed testing or vaccination for fear of being disclosed or labelled promiscuous. This was especially apparent in contexts where same-sex relationships are criminalised, leading some men to self-medicate or seek clandestine services. Media analyses revealed that social and traditional platforms often amplified blame and homophobia, though community-led counter-messaging helped shift narratives. Internalised and anticipated stigma resulted in shame, concealment of symptoms, avoidance of care, and heightened anxiety. Public health messaging that framed mpox as a behaviour-linked rather than identity-linked risk was more acceptable, and flexible vaccination strategies (e.g., offering less conspicuous injection sites) increased uptake. Stigma contributed to psychosocial distress and may have impeded outbreak control. Conclusions: Mpox-related stigma among GBMSM operates at individual, community, and structural levels, echoing patterns from the HIV era. Effective mitigation requires rights-based, destigmatising communication, culturally competent care, and collaboration. Addressing stigma is vital to controlling future outbreaks and ensuring equitable healthcare access. Full article

(This article belongs to the Special Issue Mental Health and Stigma of Sexual Minorities)

17 pages, 1328 KB

Open AccessArticle

Endoscopic and Pathological Examinations of Early-Signet-Ring Carcinoma in the Stomach

by Zhao Liang, Liang Zheng and Jia Cao

Healthcare 2025, 13(21), 2689; https://doi.org/10.3390/healthcare13212689 - 23 Oct 2025

Abstract

Objective: Early-signet-ring cell carcinoma has a low malignancy and good prognosis, while advanced signet-ring cell carcinoma has high malignancy and high mortality. So, we need to understand the risk factors of early-signet-ring cell carcinoma, analyze the relationship between early gastric signet-ring cell carcinoma [...] Read more.

Objective: Early-signet-ring cell carcinoma has a low malignancy and good prognosis, while advanced signet-ring cell carcinoma has high malignancy and high mortality. So, we need to understand the risk factors of early-signet-ring cell carcinoma, analyze the relationship between early gastric signet-ring cell carcinoma and non-Signet-ring cell carcinoma, and between pure signet-ring cell carcinoma and mixed signet-ring cell carcinoma, in order to provide the basis for the early diagnosis and treatment of signet-ring cell carcinoma. Methods: In this study, a retrospective analysis of 424 cases of early gastric cancer that underwent endoscopic submucosal dissection and surgical treatment between March 2019 and March 2023 in Shanghai Oriental Hospital was carried out. Among the cases, the two groups, namely, the signet-ring cell carcinoma and non-signet-ring cell carcinoma group, and the pure signet-ring cell carcinoma and mixed signet-ring cell carcinoma group, were compared and analyzed. With the help of logistic regression analysis, gender, age, smoking history, alcohol consumption history, tumor site, pathological characteristics, disease progression, tumor size, infiltration depth, and H. pylori infection were investigated between the two groups. Result: The results of the univariate regression analyses in the signet-ring cell carcinoma and non-signet-ring cell carcinoma groups showed that being female (p = 0.001), age < 60 years (p = 0.001), with cancer foci in the middle part of the stomach (p = 0.001), and with a mixed type of cancer foci (p = 0.007) were the risk factors for signet-ring cell carcinoma. In the multifactorial regression analysis, age < 60 years (OR = 1.037, CL = 1.008–1.067, p = 0.012), cancer foci in the middle part of the stomach (OR = 2.094, CL = 1.488–2.948, p = 0.001), mixed-type patients (OR = 0.702, CL = 0.519–0.951, p = 0.022), and women (OR = 0.421, CL = 0.254–0.698, p = 0.001) were the risk factors for signet-ring cell cancer. These are independent risk factors for signet-ring cell carcinoids. Univariate regression analysis on the pure and mixed signet-ring cell carcinoma groups showed that Helicobacter pylori infection (p = 0.001), Kimura–Takemoto classification O1–O3 (p = 0.013), flat and concave types (p = 0.004), and age < 60 years (p = 0.013) were risk factors affecting the development of pure signet-ring cell carcinoma. In the multifactorial regression analysis, age (OR = 0.233, CL = 0.059–0.930, p = 0.039) was the main independent risk factor for pure signet-ring cell carcinoma. Conclusions: Age < 60 years, cancer foci located in the middle of the stomach, mixed type, and female are associated with the development of early gastric signet-ring cell carcinoma; age < 60 years is related to the development of pure signet-ring cell carcinoma, so we need to pay attention to these clinical and pathological factors to prevent the growth of ring cell carcinoma. Full article

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17 pages, 256 KB

Open AccessArticle

Implementation Barriers to Effective Nursing Interventions in Oncology Nursing Care in Saudi Arabia: A CMO Realist Evaluation

by Fatmah Jabr Alsolami

Healthcare 2025, 13(21), 2688; https://doi.org/10.3390/healthcare13212688 - 23 Oct 2025

Abstract

Background: Nursing interventions are important in improving patient outcomes, especially in acute care units where patients encounter severe and complicated health problems. However, multiple barriers can hinder the accurate assessment of the effectiveness of such interventions. Aim: The aim of this study was [...] Read more.

Background: Nursing interventions are important in improving patient outcomes, especially in acute care units where patients encounter severe and complicated health problems. However, multiple barriers can hinder the accurate assessment of the effectiveness of such interventions. Aim: The aim of this study was to explore the barriers to evaluating the impact of nursing interventions on patient outcomes in acute care settings. Methods: This study employed a qualitative exploratory research design. This study was carried out in the acute care departments of a governmental tertiary hospital in the Western Region, Saudi Arabia. A purposive sample of 20 nurses was considered. Data were collected using a semi-structured interview guide. Thematic analysis was employed for data analysis. Results: The thematic analysis results identified five major themes: a lack of a standardised evaluation tool, time constraints, resource limitations, patient variability, and a lack of interdisciplinary collaboration. Conclusions: The results reveal that there are obstacles to evaluating nursing interventions in acute care. Such obstacles hinder the introduction of evidence-based changes in nursing practice and, consequently, affect the quality of care provided to patients. Healthcare settings should therefore focus on addressing the identified barriers and enabling nurses to effectively evaluate their care interventions. Full article

(This article belongs to the Section Healthcare Quality, Patient Safety, and Self-care Management)

16 pages, 2800 KB

Open AccessArticle

The Multimorbidity Knowledge Domain: A Bibliometric Analysis of Web of Science Literature from 2004 to 2024

by Xiao Zheng, Lingli Yang, Xinyi Zhang, Chengyu Chen, Ting Zheng, Yuyang Li, Xiyan Li, Yanan Wang, Lijun Ma and Chichen Zhang

Healthcare 2025, 13(21), 2687; https://doi.org/10.3390/healthcare13212687 - 23 Oct 2025

Abstract

Aim: With the intensification of population aging, the public health challenges posed by multimorbidity have become increasingly severe. This study employs bibliometric analysis to elucidate research hotspots and trends in the field of multimorbidity against the backdrop of global aging. The immediate aim [...] Read more.

Aim: With the intensification of population aging, the public health challenges posed by multimorbidity have become increasingly severe. This study employs bibliometric analysis to elucidate research hotspots and trends in the field of multimorbidity against the backdrop of global aging. The immediate aim is to systematically map the intellectual landscape and evolving patterns in multimorbidity research. The ultimate long-term aim is to provide a scientific basis for optimizing chronic disease prevention systems and guiding future research directions. Methods: The study adopted the descriptive research method and employed a bibliometric approach, analyzing 8129 publications related to multimorbidity from the Web of Science Core Collection. Using CiteSpace, we constructed and visualized several knowledge structures, including collaboration networks, keyword co-occurrence networks, burst detection maps, and co-citation networks within the multimorbidity research domain. Results: The analysis included 8129 articles from 2004 to 2024, published across 1042 journals, with contributions from 740 countries/regions, 33,931 institutions, and 40,788 authors. The five most frequently occurring keywords were prevalence, health, older adult, mortality, and risk. The top five contributing countries globally were the United States, the United Kingdom, Germany, China, and Spain. Five pivotal research trajectories delineate the intellectual architecture of this field: ① Evolution of Disease Cluster Management: Initial investigations (2013–2014) prioritized disease cluster coordination within general practice settings, particularly cardiovascular comorbidity management through primary care protocols and self-management strategies. ② Paradigm Shifts in Health Impact Assessment: Multimorbidity outcome research demonstrated sequential transitions—from physical disability evaluation (2013) to mental health consequences like depression (2016), culminating in current emphasis on holistic health indicators including frailty syndromes (2015–2019). ③ Expansion of Risk Factor Exploration: Analytical frameworks evolved from singular physical activity metrics (2014) toward comprehensive lifestyle-related determinants encompassing behavioral and environmental dimensions (2021). ④ Emergence of Polypharmacy Scholarship: Medication optimization studies emerged as a distinct research stream since 2016, addressing therapeutic complexities in multimorbidity management. ⑤ Frontier Investigations: Cutting-edge directions (2019–2021) feature cardiometabolic multimorbidity patterns and their dementia correlations, signaling novel interdisciplinary interfaces. Conclusions: The prevalence of multimorbidity is on the rise globally, particularly in older populations. Therefore, it is essential to prioritize the prevention of cardiometabolic conditions in older adults and to provide them with appropriate and effective health services, including disease risk monitoring and community-based chronic disease care. Full article

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17 pages, 645 KB

Open AccessArticle

Hemodynamic Heterogeneity in Community-Acquired Sepsis at Intermediate Care Admission: A Prospective Pilot Study Using Impedance Cardiography

by Gianni Turcato, Arian Zaboli, Lucia Filippi, Fabrizio Lucente, Michael Maggi, Alessandro Cipriano, Massimo Marchetti, Daniela Milazzo, Christian J. Wiedermann and Lorenzo Ghiadoni

Healthcare 2025, 13(21), 2686; https://doi.org/10.3390/healthcare13212686 - 23 Oct 2025

Abstract

Background: Sepsis is a heterogeneous syndrome in which patients with similar clinical presentations at admission may exhibit markedly different treatment responses and outcomes, suggesting that comparable macroscopic features can conceal profoundly distinct perfusion and hemodynamic states. Aim: This study aimed to characterize the [...] Read more.

Background: Sepsis is a heterogeneous syndrome in which patients with similar clinical presentations at admission may exhibit markedly different treatment responses and outcomes, suggesting that comparable macroscopic features can conceal profoundly distinct perfusion and hemodynamic states. Aim: This study aimed to characterize the hemodynamic profile of patients with community-acquired sepsis, assess its correlation with macro-hemodynamic indices, compare fluid responders with non-responders, and explore the prognostic value of early identification of a feature consistent with distributive shock. Methods: A prospective observational pilot study was conducted in the Intermediate Medical Care Unit (IMCU) of Ospedale Alto Vicentino (Santorso, Italy), September 2024–May 2025. 115 consecutive adults with community-acquired sepsis underwent NICaS^® bioimpedance assessment at IMCU admission. Sepsis was diagnosed at IMCU admission as suspected/confirmed infection plus an acute increase in total Sequential Organ Failure Assessment (SOFA) ≥ 2 points. Hemodynamic indices were analyzed in relation to the Sequential Organ Failure Assessment (SOFA) score and mean arterial pressure (MAP), fluid responsiveness, and 30-day mortality. Results: Hemodynamics were heterogeneous across patients and within SOFA strata. SOFA showed no correlation with SV, SI, CO, or CI; weak inverse associations for TPR (r = −0.198, p = 0.034) and TPRI (r = −0.241, p = 0.009) were observed. MAP did not correlate with SV, SI, CO, or CI, but correlated positively with TPR (r = 0.461) and TPRI (r = 0.547) and with CPI (ρ = 0.550), all p < 0.001. A distributive profile was present in 21.7% (25/115), increasing with higher SOFA (p = 0.033); only 20% of those with this profile had MAP < 65 mmHg at admission. Fluid non-responders (27.8%) had lower resistance and higher CI (4.1 vs. 3.4 L/min/m^²; p = 0.015). The distributive profile was not associated with 30-day mortality (log-rank p = 0.808). Conclusions: In IMCU patients with community-acquired sepsis, macro-indices (SOFA, MAP) correlate poorly with the underlying hemodynamic state. Early noninvasive profiling reveals within-SOFA circulatory heterogeneity and may support operational, individualized resuscitation strategies; these pilot findings are hypothesis-generating and warrant prospective interventional testing. Full article

(This article belongs to the Special Issue New Tools and Technologies in Emergency Medicine and Critical Care)

12 pages, 507 KB

Open AccessArticle

Cultivating Digital Wellness: Embracing Mobile Mental Health Apps in Saudi Arabia

by Arwa Alumran, Nouf Al-Kahtani, Kifah Alsadah, Amjad Alhanfoosh, Saja A. Alrayes and Mona Aljuwair

Healthcare 2025, 13(21), 2685; https://doi.org/10.3390/healthcare13212685 - 23 Oct 2025

Abstract

Background: Mental health is increasingly prioritized in Saudi Arabia, with growing interest in digital solutions. Objectives: The study’s objective was to assess awareness, acceptance, and use of mobile mental health applications among Saudis. Methods: A cross-sectional online survey, based on the UTAUT model, [...] Read more.

Background: Mental health is increasingly prioritized in Saudi Arabia, with growing interest in digital solutions. Objectives: The study’s objective was to assess awareness, acceptance, and use of mobile mental health applications among Saudis. Methods: A cross-sectional online survey, based on the UTAUT model, explored performance expectancy, effort expectancy, social influence, and privacy concerns among 1613 participants. Results: While 68.9% were aware of at least one mental health app, only 20% actively used them. Awareness was influenced by gender, age, employment, marital status, and region, whereas utilization depended on gender, age, education, region, and acceptance. Performance expectancy strongly predicted usage. Conclusions: Despite high awareness, usage of mobile mental health applications remains low in Saudi Arabia. Demographic factors affect awareness, and acceptance drives utilization. App developers should consider these factors to enhance engagement and effectiveness. Full article

(This article belongs to the Topic Mental Health and the 2030 Sustainable Development Agenda: Old Problems and New Perspectives)

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35 pages, 773 KB

Open AccessArticle

Access to and Use of Health Services by Older Men and Women Experiencing Frailty and Ageing in Place Alone in Italy

by Maria Gabriella Melchiorre, Marco Socci, Giovanni Lamura and Sabrina Quattrini

Healthcare 2025, 13(21), 2684; https://doi.org/10.3390/healthcare13212684 - 23 Oct 2025

Abstract

Background: Access to and use of health services represent crucial issues/challenges for older people experiencing frailty with functional limitations and chronic diseases, especially when they age in place alone. Both access to and use of health services are also characterised by gender [...] Read more.

Background: Access to and use of health services represent crucial issues/challenges for older people experiencing frailty with functional limitations and chronic diseases, especially when they age in place alone. Both access to and use of health services are also characterised by gender differences. The present study analysed these factors in three Italian regions (Lombardy, North; Marche, Centre; and Calabria, South), where in 2019, the “Inclusive Ageing in Place” (IN-AGE) project was carried out, involving 120 senior people aged 65 years and of both genders. Methods: In this mixed-methods study, both qualitative (predominant section) and some quantitative data (e.g., socio-demographic aspects and functional limitations) were collected through semi-structured interviews. In addition to basic quantitative analyses, content analysis and the quantification of statements were performed to process the qualitative data. The results for both men and women are presented. Possible barriers to accessing health services were also considered. Results: Women reported more cases of chronic diseases than men, especially arthritis/osteoporosis, and a greater use of drugs than men. Both genders used services provided by the general practitioner (GP) and medical specialist (MS), the latter being mostly private. More women than men used rehabilitation, especially in the private sector, and reported the issue of cost for private healthcare and the travel distance to reach medical units as barriers to access. The long waiting lists/times were complained about by both males and females. Conclusions: This study, despite its simple/descriptive qualitative approach with a limited sample, could provide, however, some insights for policymakers and healthcare professionals to plan prevention policies and deliver appropriate and timely health services to older people experiencing frailty and ageing in place alone, devoting attention to gender-related issues in the design and provision of such services. Full article

(This article belongs to the Special Issue Aging Population and Healthcare Utilization)

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18 pages, 392 KB

Open AccessArticle

Advancing Pediatric Cognitive Health: Psychometric Evaluation and IRT- and Regression-Based Norms for Two Neuropsychological Measures in Colombian Children and Adolescents

by Eliana María Fuentes Mendoza, Laiene Olabarrieta-Landa, Clara Sancho-Domingo, Oscar Teijido, Juan Carlos Arango-Lasprilla and Diego Rivera

Healthcare 2025, 13(21), 2683; https://doi.org/10.3390/healthcare13212683 - 23 Oct 2025

Abstract

Objective: To evaluate the psychometric properties of the short version of the Token Test (SVTT) and the Rey–Osterrieth Complex Figure (ROCF) using an item response theory (IRT) framework and to establish normative data for Colombian children and adolescents based on ability scores. Methods: [...] Read more.

Objective: To evaluate the psychometric properties of the short version of the Token Test (SVTT) and the Rey–Osterrieth Complex Figure (ROCF) using an item response theory (IRT) framework and to establish normative data for Colombian children and adolescents based on ability scores. Methods: A total of 668 healthy participants aged 6–17 years took part in this study. Factorial structure was assessed through confirmatory factor analysis (CFA). Item parameters were estimated using a two-parameter logistic (2PL) model for the SVTT, which accounts for both item difficulty and discrimination in dichotomous responses, and a graded response model (GRM) for the ROCF, suitable for items scored on ordered categories reflecting increasing levels of performance accuracy and Differential Item Functioning (DIF) analysis was conducted to assess potential bias related to sex. Reliability was examined using the Test Information Function (TIF), internal consistency throughout Cronbach’s alpha, and the influence of sociodemographic variables was analyzed through regression models. Results: CFA confirmed unidimensionality for all measures. For most items, moderate-to-low ability was sufficient to achieve the highest scores in the ROCF, and low ability in the SVTT. DIF analysis indicated no meaningful sex-related bias in any of the subtests. Both tests showed excellent reliability and internal consistency. Copy scores were influenced by polynomial age and parents’ mean years of education (MPE), while both immediate recall in the ROCF and SVTT were affected by MPE and the interaction of logarithmic age. Conclusions: This study provides strong psychometric evidence and, together with the integration of digital tools for generating normative data, represents a meaningful advancement in neuropsychological assessment. Full article

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

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13 pages, 540 KB

Open AccessArticle

Evaluation of Static Balance in Children with Cerebral Palsy Using an Innovative Image Processing Software

by Zekiye Başaran, Halil İbrahim Çelik, Önder Polat and Bülent Elbasan

Healthcare 2025, 13(21), 2682; https://doi.org/10.3390/healthcare13212682 - 23 Oct 2025

Abstract

Background: Impaired balance is one of the most common and functionally limiting problems in children with cerebral palsy (CP), significantly affecting their motor abilities and quality of life. Although force platforms are considered the gold standard for evaluating postural stability, they are often [...] Read more.

Background: Impaired balance is one of the most common and functionally limiting problems in children with cerebral palsy (CP), significantly affecting their motor abilities and quality of life. Although force platforms are considered the gold standard for evaluating postural stability, they are often costly, non-portable, and require specialized laboratory environments, limiting their accessibility in routine clinical settings. Objective: This study aimed to develop a novel software program based on image processing techniques to assess static balance in children with CP and to evaluate its validity against traditional force platform measurements. Methods: A total of 83 children aged 5–15 years (63 with CP, GMFCS levels I–II; 20 healthy controls) participated. Static balance was assessed under four different standing conditions using both a force platform and a newly developed video-based software tool. The software utilized the frame difference method to detect center of mass movements, and parameters such as velocity and total displacement were calculated. Correlation analyses were conducted between the image processing and force platform data. Results: The software demonstrated moderate to strong positive correlations with force platform parameters in the majority of test conditions, particularly when participants stood with eyes open. In more challenging balance scenarios (e.g., eyes closed, feet together), correlations were weaker but still significant. Conclusions: The findings suggest that this image-based software is a valid, low-cost, and portable alternative for static balance assessment in children with CP. It has the potential for use in diverse clinical or home settings, supporting individualized rehabilitation strategies. Full article

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15 pages, 767 KB

Open AccessArticle

Dyadic Mental Health in Paediatric Congenital Heart Disease: Actor–Partner Associations Between Child HRQoL/Depression and Caregiver Stress Across Lesion Severity

by Andrada Ioana Dumitru, Adrian Cosmin Ilie, Andrei-Cristian Bondar, Naresh Reddy Mudireddy, Arpan Turimula, Adelina Mavrea and Marioara Boia

Healthcare 2025, 13(21), 2681; https://doi.org/10.3390/healthcare13212681 - 23 Oct 2025

Abstract

Background and Objectives: We examined how health-related quality of life (HRQoL) in children with congenital heart disease (CHD) and caregiver stress/burnout relate in terms of lesion severity. Methods: We enrolled 72 child–caregiver dyads at a tertiary centre (May 2023–April 2025). Children completed PedsQL [...] Read more.

Background and Objectives: We examined how health-related quality of life (HRQoL) in children with congenital heart disease (CHD) and caregiver stress/burnout relate in terms of lesion severity. Methods: We enrolled 72 child–caregiver dyads at a tertiary centre (May 2023–April 2025). Children completed PedsQL and CDI (anxiety assessment via SCARED-C was descriptive and not modelled in APIM); caregivers completed SF-36, PSS-10, and the Parental Burnout Assessment (PBA). Lesion severity (mild n = 22, moderate n = 34, severe n = 16) and LVEF were abstracted. Pearson correlations and actor–partner interdependence models (APIM) estimated within- and cross-partner effects. Results: Child PedsQL decreased with severity (mild 81.2 ± 7.4; moderate 70.9 ± 8.1; severe 63.3 ± 5.1; p < 0.001); caregiver SF-36 Mental Component Summary (MCS) showed a parallel gradient (66.8 ± 9.2; 59.7 ± 8.5; 54.1 ± 7.9; p < 0.001). Child HRQoL correlated with caregiver MCS (r = 0.46) and inversely with caregiver stress (PSS r = −0.42) and burnout (PBA r = −0.39). In APIM, caregiver stress predicted a caregiver’s own MCS (actor β = −0.38, p < 0.001) and the child’s PedsQL (partner β = −0.26, p = 0.002); higher child depressive symptoms predicted lower caregiver MCS (partner β = −0.22, p = 0.006). Each step up in lesion severity independently reduced child PedsQL by 7.9 points and caregiver MCS by 5.3 points (both p < 0.001). Dyads with unscheduled hospitalizations (n = 43) had poorer scores in both members. Conclusions: Psychological wellbeing in CHD dyads is strongly interdependent; caregiver stress relates to lower child HRQoL and child mood to caregiver mental health. Brief dyadic screening (PedsQL/SF-36 with PSS/CDI) and integrated, family-focused interventions may better target high-risk families, particularly with severe lesions or recent hospitalizations. Full article

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40 pages, 967 KB

Open AccessReview

Implementation of Telehealth Among Older People: A Challenge and Opportunity for Latin America and the Caribbean—A Literature Review

by Rafael Pizarro-Mena, Elena S. Rotarou, Hendrik Adrián Baracaldo-Campo, Samuel Duran-Aguero, Solange Parra-Soto, Felipe Retamal-Walter, Patrick Alexander Wachholz, Silvia Maranzano, Victoria Tirro, Sara Aguilar-Navarro, Isabel Barrientos-Calvo, Valeria Carpio-Arias, Clarissa Botello, María Fernanda López, Roni Mukamal, Alessandra Tieppo, Igor Cigarroa, Fausto Medola and Gloria Riveros-Basoalto

Healthcare 2025, 13(21), 2680; https://doi.org/10.3390/healthcare13212680 - 23 Oct 2025

Abstract

Although the COVID-19 pandemic negatively affected the health and quality of life of older people (OP), it provided an opportunity for the implementation of telehealth in the areas of Gerontology and Geriatrics, globally and in the countries of Latin America and the Caribbean, [...] Read more.

Although the COVID-19 pandemic negatively affected the health and quality of life of older people (OP), it provided an opportunity for the implementation of telehealth in the areas of Gerontology and Geriatrics, globally and in the countries of Latin America and the Caribbean, which enabled the continuity of healthcare interventions. Therefore, this literature review aimed to (a) conceptualize telehealth in OP through the lens of Gerontology and Geriatrics; (b) analyze the implementation, facilitators, and barriers of telehealth for OP during the COVID-19 pandemic at both global and Latin American and Caribbean regional levels; (c) identify lessons learned and considerations for improving implementation and reducing barriers to telehealth for OP; and (d) discuss challenges related to the integration of telehealth for OP in the region. The databases consulted were PubMed, Scopus, and Scielo; scientific articles in both English and Spanish were considered, including research conducted globally and in Latin American and Caribbean countries that contributed to the objectives of the literature review; the search was conducted from the year 2020 onwards. In addition, government documents and non-governmental technical guidelines from countries in the region were included, whether they focused specifically on older populations or the general population; the search was not limited to a specific time period. Initially, in our search strategy, 1631 scientific articles and 20 governmental and non-governmental documents were identified for the literature review. After eliminating duplicate and applying the inclusion and exclusion criteria, 84 documents were selected for the literature review (46 analyzed the implementation, barriers, and facilitators of telehealth during the COVID-19 pandemic). This literature review presents a conceptual analysis of the implementation and facilitators of, as well as barriers to, telehealth among OP during the COVID-19 pandemic from the perspective of healthcare providers and OP themselves. The paper synthesizes a number of international and Latin American experiences and proposes several recommendations for the implementation of telehealth for OP in the Latin American and Caribbean region. Despite the ongoing challenges regarding telehealth research and training, this review describes telehealth for OP as an intervention approach that improves the provision of holistic care, favoring OP autonomy, functionality, and overall quality of life. This review also proposes telehealth as a regular intervention approach to clinical practice in Gerontology and Geriatrics in the region. Collaborative endeavors are needed to further regulate and promote public policy on telehealth, telemedicine and telerehabilitation for OP. Full article

(This article belongs to the Special Issue The Role of Telemedicine in Transforming Healthcare Delivery—Capabilities and Barriers)

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11 pages, 426 KB

Open AccessArticle

Positive Association of the Dietary n-6/n-3 PUFA Ratio with Fatty Liver in Mexican Adults

by Cristina Gutierrez-Osorio and Omar Ramos-Lopez

Healthcare 2025, 13(21), 2679; https://doi.org/10.3390/healthcare13212679 - 23 Oct 2025

Abstract

Background: The increase in obesity rates and related liver diseases has risen in recent years in Mexico. Dietary factors, such as the imbalance between n-6 and n-3 polyunsaturated fatty acids, have been associated with a higher risk of developing conditions such as fatty [...] Read more.

Background: The increase in obesity rates and related liver diseases has risen in recent years in Mexico. Dietary factors, such as the imbalance between n-6 and n-3 polyunsaturated fatty acids, have been associated with a higher risk of developing conditions such as fatty liver. The objective of this study was to analyse the influence of the dietary n-6/n-3 ratio on fatty liver in Mexican adults. Methods: This analytical cross-sectional study included 213 Mexican adults aged 18 to 65 years, of both genders. The dietary n-6/n-3 ratio was calculated using the Nutritionist Pro software. Participants were divided into two groups according to the median of their dietary n-6/n-3 intake ratio: “low” (<10.2:1) and “high” (≥10.2:1). Anthropometric and biochemical markers were evaluated using standardised methods. The hepatic steatosis index (HSI) was used as a surrogate marker of fatty liver. Multivariate logistic regression analyses were conducted to predict fatty liver based on HSI. Results: Overall, the mean dietary n-6/n-3 ratio was 12.75 in the general population. Higher HSI values were found in participants with a high n-6/n-3 ratio (p = 0.038). In the multivariate model, the n-6/n-3 ratio was positively associated with high HSI (OR = 1.48, 95% CI, 1.02, 1.99). Conclusions: This study concludes that a high n-6/n-3 ratio may contribute to the development of fatty liver in Mexican adults. These results highlight the importance of a balanced intake of fatty acids to prevent metabolic complications and improve public health. Full article

(This article belongs to the Special Issue The Role of Nutrition in Metabolic Dysfunction-Associated Steatotic Liver Disease)

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14 pages, 502 KB

Open AccessArticle

Effects of Sex, Smoking, and Physical Activity on Metabolic Syndrome Among Current Smokers: A Cross-Sectional Study from Taiwan

by Ke-Ting Pan, Fan-Min Lin, Ta-Wei Chu, Ming-Tsung Chen, Yuan-Chieh Chuang, Dee Pei and Chih-Hao Shen

Healthcare 2025, 13(21), 2678; https://doi.org/10.3390/healthcare13212678 - 23 Oct 2025

Abstract

Background: Metabolic syndrome (MetS) is a growing global health concern. Although sex, smoking, and physical activity are recognized risk factors, their combined effects remain insufficiently studied, particularly among Asian populations. This study aimed to examine the associations of sex, cumulative smoking exposure, [...] Read more.

Background: Metabolic syndrome (MetS) is a growing global health concern. Although sex, smoking, and physical activity are recognized risk factors, their combined effects remain insufficiently studied, particularly among Asian populations. This study aimed to examine the associations of sex, cumulative smoking exposure, and physical activity with MetS among current smokers in Taiwan. Methods: Data were drawn from 15,385 participants recruited between 2013 and 2017 from a health screening center. Demographic characteristics, smoking status, physical activity levels, and biochemical data were analyzed. Mann–Whitney U tests, chi-square tests, and multiple logistic regression were used to identify variables associated with MetS. Results: MetS prevalence differed significantly by sex, with rates of 13.6% in men and 5.1% in women. Women had a lower chance of developing MetS compared to men (OR = 0.607, 95% CI 0.488–0.754). Older age, higher body mass index, and greater cumulative smoking exposure (quantified using a composite ‘smoke area’ index derived from questionnaire data on smoking duration, frequency, and daily amount) were positively associated with MetS risk. Among smokers younger than 45 years, women also had significantly lower odds of MetS than men (OR = 0.590, 95% CI 0.451–0.771). Higher levels of physical activity were linked to reduced MetS risk in both sexes. Conclusions: Among current smokers, being female was inversely associated with the risk of MetS. Greater physical activity and lower smoking exposure were also associated with reduced risk. Future research should use longitudinal designs and comorbidities to clarify mechanisms and inform tailored prevention strategies. Full article

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15 pages, 648 KB

Open AccessArticle

Evaluating a 30-Hour Training Program for Community Health Workers on 4Ms Implementation in FQHCs Using the Kirkpatrick Model

by Sweta Tewary, Cherell Cottrell-Daniels, Kevin Espinoza, Katherine Chung-Bridges, Diego I. Shmuels, Deborah Gracia and Joycelyn J Lawrence

Healthcare 2025, 13(21), 2677; https://doi.org/10.3390/healthcare13212677 - 23 Oct 2025

Abstract

Objective: To evaluate a 30 h educational program delivered to community health care workers (CHWs) involved in geriatric care within a primary care clinic, measure increase in knowledge, likelihood of using the education, and baseline results of geriatric screenings for patients 65 and [...] Read more.

Objective: To evaluate a 30 h educational program delivered to community health care workers (CHWs) involved in geriatric care within a primary care clinic, measure increase in knowledge, likelihood of using the education, and baseline results of geriatric screenings for patients 65 and older conducted by CHWs in their clinics. Methods: Design, Setting and Participants: This is an evaluation with a two-center, pre–post design study of a 30 h in-person educational program. The program used the Kirkpatrick model to evaluate the educational program. The study used quantitative and qualitative data collection with surveys measuring knowledge, feedback, content, and demographics of the participants and chart reviews to measure clinical implementation of 4Ms discussion. Qualitative data collection included a focus group and open-ended questions in the survey. Thematic analysis from focus groups explored the feedback from the educational program. Results: Twelve community health care workers (average age 40, 90% female) from two federally qualified health centers (FQHC) participated in the 30 h training program. Perceived knowledge improved after the completion of the training. Final exam scores after the training were also significant, indicating an improvement in content retention. Overall, 98% of participants described the training as “Excellent” and 96% rated excellent for the speakers who provided the training. Additionally, 83% suggested they would apply the training in their practice. Approximately 40% of chart reviews indicated the completion of the 4Ms (What Matters, Mentation, Medication, and Mobility) discussion with patients. Thematic analysis yielded two new practice dimensions: care provision and clinical documentation. The training resulted in organizational adaptation with the development of an intake form in the Electronic Health Record (EHR) to document the 4Ms. Conclusion: Results indicate improvement in all dimensions of the training with an emphasis on level 4, indicating wider organization adaptation of 4Ms discussion. Full article

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12 pages, 969 KB

Open AccessCase Report

Complementary Therapies of Diabetic Peripheral Neuropathy and Intermittent Claudication

by Shu Yan Ng

Healthcare 2025, 13(21), 2676; https://doi.org/10.3390/healthcare13212676 - 23 Oct 2025

Abstract

Epidemiological studies have shown that the prevalence of diabetic peripheral neuropathy (DPN) will increase. Currently, DPN is treated medically. In many instances, the outcome is less than satisfactory, and the treatment is associated with side effects. We report a case of severe DPN [...] Read more.

Epidemiological studies have shown that the prevalence of diabetic peripheral neuropathy (DPN) will increase. Currently, DPN is treated medically. In many instances, the outcome is less than satisfactory, and the treatment is associated with side effects. We report a case of severe DPN and peripheral artery disease that are refractory to medical treatment. The patient was treated by external counterpulsation (ECP), electrical neuromuscular stimulation, a footbath in CO₂-enriched water, and hydrogen inhalation, all of which are considered off-label. The patients also took L α-lipoic acid and vitamin B12 and were advised on lifestyle modification. The combination of treatments significantly improved the patient’s pain and claudication distance, increasing it from 16 m to 300–400 m. Additionally, as a result of the decrease in nocturnal pain, the patient experienced restful sleep. The reasons for the improvement in subjective symptoms are unclear, as changes in objective vascular and neurological measurements were inconsistent with the subjective improvement. This dissociation highlights the need for further research. Given the symptomatic relief observed, however, such alternative therapies could be considered on a case-by-case basis for patients with DPN who have limited treatment options. Full article

(This article belongs to the Special Issue Integrative Strategies in Exercise, Nutrition, and Health: Preventing Diseases and Promoting Well-Being)

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17 pages, 819 KB

Open AccessArticle

Physicians’ Perceptions of AI and Extended Reality in Telemedicine: A Multi-Specialty Cross-Sectional Survey in Romania

by Florina Onetiu, Melania Lavinia Bratu, Felix Bratosin and Tiberiu Bratu

Healthcare 2025, 13(21), 2675; https://doi.org/10.3390/healthcare13212675 - 23 Oct 2025

Abstract

Background and Objectives: Artificial intelligence (AI) and extended reality (XR) are reshaping telemedicine, yet physician-level adoption depends on perceived value, training needs, and specialty context. We quantified attitudes toward AI/XR, identified barriers/benefits, and tested advanced relationships (moderation and mediation). Methods: Cross-sectional survey of [...] Read more.

Background and Objectives: Artificial intelligence (AI) and extended reality (XR) are reshaping telemedicine, yet physician-level adoption depends on perceived value, training needs, and specialty context. We quantified attitudes toward AI/XR, identified barriers/benefits, and tested advanced relationships (moderation and mediation). Methods: Cross-sectional survey of Romanian physicians (n = 43) across anesthesiology and ICU, surgical, medical, and dentistry. Items were translated into English and mapped to 5-point scales. A 10-item Telemedicine Acceptance Index (TAI; α = 0.86) and a 2-item XR Utility Index (XUI) were computed. Moderation by specialty (Training Priority × Specialty) and bootstrap mediation (2000 resamples) of Future Potential → XUI → TAI were performed. Results: Overall acceptance and perceived utility of XR were moderate to high across specialties; participants most frequently identified technical and financial constraints as barriers and time efficiency and improved access as key benefits. Acceptance patterns were similar across specialties and aligned most strongly with beliefs about future system-level potential and the priority assigned to hands-on training. Conclusions: Physicians reported favorable acceptance of AI/XR-enabled telemedicine. Perceived future system-level value and prioritization of hands-on training were the most consistent correlates of acceptance across specialties. Technical and financial constraints remained the primary barriers, while time efficiency and access emerged as leading perceived benefits. Acceptance appears to be driven more by beliefs about system-level potential and practical upskilling than by specialty identity. Full article

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14 pages, 516 KB

Open AccessArticle

Mental and Behavioral Health Disparities Among Pain-Reliever Misusers: A Cross-Sectional Analysis by Race and Ethnicity

by James P. D’Etienne, Sam Abduganiev, Ryan Warrior and Hao Wang

Healthcare 2025, 13(21), 2674; https://doi.org/10.3390/healthcare13212674 - 23 Oct 2025

Abstract

Objectives: The misuse of pain relievers has been linked to mental and behavioral disorders. This study aims to determine the associations between pain-reliever misuse, severe psychological distress (SPD), suicidal ideation, and difficulties in performing daily activities. Additionally, it seeks to identify the [...] Read more.

Objectives: The misuse of pain relievers has been linked to mental and behavioral disorders. This study aims to determine the associations between pain-reliever misuse, severe psychological distress (SPD), suicidal ideation, and difficulties in performing daily activities. Additionally, it seeks to identify the socio-demographic factors associated with pain-reliever misuse across different racial and ethnic groups. Methods: This cross-sectional study utilizes data from the 2022 United States National Survey on Drug Use and Health (NSDUH). Participants were categorized into four groups: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic/Latino (Hispanic), and Other (American Indian, Alaska Native, Asian, Native Hawaiian or other Pacific Islanders, and two or more races) groups. Comparisons were made between individuals regarding pain-reliever misuse, socio-demographic characteristics, SPD, suicidal thoughts, and World Health Organization Disability Assessment Schedule (WHODAS) scores, using Rao–Scott Chi-square tests. Stepwise multivariable logistic regression analyses were conducted to identify socio-demographic factors associated with pain-reliever misuse. Results: The study included 45,451 participants, with 27,551 (62.00 wt%) identified as NHW, 5186 (11.98 wt%) as NHB, 7795 (17.15 wt%) as Hispanic, and 4919 (8.87 wt%) as other racial and ethnic groups. The rate of pain-reliever misuse was 2.90% among NHWs, 3.40% among NHBs, 3.61% among Hispanics, and 2.05% among individuals of other races and ethnicities (p = 0.043). Among those who misused pain relievers, a significantly higher proportion experienced SPD (36.00% vs. 14.05%), suicidal thoughts (15.51% vs. 4.91%), and difficulties in performing daily activities (73.77% vs. 52.84%) compared to those who did not misuse pain relievers (p < 0.001). Socio-demographic factors associated with a lower risk of misuse included being female (AOR = 0.80, 95% CI 0.67–0.95, p = 0.013), being employed (AOR = 0.66, 95% CI 0.48–0.90, p = 0.010), and having a college or higher education (AOR = 0.54, 95% CI 0.37–0.79, p = 0.002). Conclusions: The prevalence of pain-reliever misuse varies across racial and ethnic groups, with Hispanic individuals demonstrating the highest rates of misuse. Pain-reliever misuse is strongly associated with SPD, suicidal thoughts, and impaired daily functioning. Socio-demographic factors are crucial in predicting the likelihood of pain-reliever misuse. These findings highlight the importance of culturally tailored prevention strategies and public health policies aimed at mitigating misuse, especially among vulnerable populations. Full article

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