Healthcare

17 pages, 443 KiB

Open AccessArticle

Understanding Disclosure Decisions and Communication About HPV-Related Cancer: A Qualitative Exploration of Stigma and Social Support

by Seiichi Villalona, Julian Sanchez, Preeyapat Mangkalard and Alicia L. Best

Healthcare 2025, 13(9), 966; https://doi.org/10.3390/healthcare13090966 (registering DOI) - 22 Apr 2025

Abstract

Background/Objectives: This study aimed to explore the barriers and facilitators influencing initial self-disclosure among individuals diagnosed with human papillomavirus (HPV)-related cancers, as well as examine the post-disclosure experiences of affected individuals. Emphasis was placed on understanding the roles of perceived and internalized [...] Read more.

Background/Objectives: This study aimed to explore the barriers and facilitators influencing initial self-disclosure among individuals diagnosed with human papillomavirus (HPV)-related cancers, as well as examine the post-disclosure experiences of affected individuals. Emphasis was placed on understanding the roles of perceived and internalized stigma in these interpersonal communication encounters. Methods: Semi-structured interviews were conducted with 27 participants diagnosed with an HPV-related cancer. MAXQDA was used for qualitative analysis with themes grounded in Attribution Theory and the Disclosure Model. Results: Barriers to disclosure identified among participants included privacy concerns, hesitancy to burden others, and discomfort discussing the anatomic location of their cancer. In contrast, seeking support, instances of misunderstanding HPV’s relation to cancer, and the proactive detailing of their diagnosis to avoid judgment emerged as facilitators of disclosure. While many recounted positive post-disclosure experiences, some participants expressed feelings of guilt and internalized stigma, suggesting a deeper emotional struggle in communicating about their diagnosis to others in their social support networks. Nuances in the internalized stigma were observed in specific subgroups among this patient population, such as those who identify as a sexual/gender minority. Conclusions: This study underscores the multifaceted challenges experienced among individuals diagnosed with HPV-related cancers when disclosing their diagnoses and seeking social support. This study highlights the imperative role of identifying psychosocial distress in the post-diagnosis period among individuals with HPV-related cancer. Future research should explore ways to enhance social support for this patient population by improving healthcare providers’ screening measures and providing integrated support services earlier to better address their psychosocial needs. Full article

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12 pages, 618 KiB

Open AccessArticle

Integrating Case Management in Cystic Fibrosis Units: A Key to Enhancing Patient-Centered Care

by Alessandra Russo Krauss, Andrea Lastrucci, Valentina Petrini, Nicola Gualtieri, Renzo Ricci, Matteo Tomaiuolo, Daniele Giansanti, Alessandro Bartoloni and Silvia Bresci

Healthcare 2025, 13(9), 965; https://doi.org/10.3390/healthcare13090965 (registering DOI) - 22 Apr 2025

Abstract

Introduction: Cystic fibrosis (CF) is a chronic genetic disease affecting the respiratory and digestive systems. Multidisciplinary care is vital for managing CF’s complex complications. This study investigates the potential role of a Case Manager (CM) in improving care coordination and patient outcomes [...] Read more.

Introduction: Cystic fibrosis (CF) is a chronic genetic disease affecting the respiratory and digestive systems. Multidisciplinary care is vital for managing CF’s complex complications. This study investigates the potential role of a Case Manager (CM) in improving care coordination and patient outcomes at the CF Unit of Careggi University Hospital. Methods: A survey among 34 CF Unit healthcare professionals assessed the perceptions of integrating a CM. The survey included demographic questions and 12 Likert scale items on the CM’s role in care continuity, team collaboration, and treatment adherence. Responses were collected anonymously and analyzed using descriptive statistics. Results: The response rate was 100%, with strong support for the CM role, averaging 4.5/5 across Likert scales. Respondents highlighted the CM’s value in coordinating care, managing time-sensitive tasks, and improving communication with external care providers. Telemedicine was positively rated, particularly for reducing hospital visits and supporting the remote monitoring of CF patients treated. Discussion: Findings indicate that integrating a CM could enhance multidisciplinary CF care by improving communication and treatment adherence. Challenges, including team readiness and training, were noted. Future studies will focus on patient satisfaction and clinical outcomes following the integration of CM, with special attention to the role of telemedicine in CF care. Full article

(This article belongs to the Special Issue Moving Forward: Implementing Patient-Centered Care in Hospitals)

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16 pages, 1434 KiB

Open AccessArticle

Mediation of Ethnic Disparity in the 5-Year Mortality of Cervical Cancer Patients in the US, 2001–2019

by Shi-Hao Zhou, Yong-Qiao He, Hua Diao, Da-Wei Yang, Tong-Min Wang, Ying Liao, Wei-Hua Jia and Wen-Qiong Xue

Healthcare 2025, 13(9), 964; https://doi.org/10.3390/healthcare13090964 (registering DOI) - 22 Apr 2025

Abstract

Objectives: This study aims to investigate the potential mediators for ethnic disparity in cervical cancer 5-year mortality and identify potential patients affected by ethnic disparities. Methods: The cohort study analyzed 56,374 cervical cancer patients from the Surveillance, Epidemiology, and End Results (SEER) 17 [...] Read more.

Objectives: This study aims to investigate the potential mediators for ethnic disparity in cervical cancer 5-year mortality and identify potential patients affected by ethnic disparities. Methods: The cohort study analyzed 56,374 cervical cancer patients from the Surveillance, Epidemiology, and End Results (SEER) 17 database (2000–2019). The primary and secondary outcome were the 5-year mortality of cervical cancer patients for all causes and cervical cancer-specific death, respectively. Cox and competing risks models were applied to identifying prognostic factors for 5-year cervical cancer all-cause mortality and specific death, respectively. Potential mediators for ethnic disparity were analyzed using multiple mediation analyses. Results: NHB patients had a 49% higher risk of 5-year mortality than NHW patients, while Hispanic and API patients showed a 19% and 12% decreased risk, respectively. Mediation analyses revealed that clinical stage and surgery predominately contributed to NHW-NHB prognosis disparities, with an indirect effect proportion of 29.6% and 26.7% for all-cause mortality and 34.2% and 26.7% for disease-specific death, respectively. No significant mediation effect was observed for other ethnic disparities. Compared to NHW patients, the inferior prognosis of NHB patients was observed mainly for localized and regional cancer, receiving hysterectomy, and, especially, adenocarcinomas. Conversely, the superior prognosis of Hispanic and API patients was observed in the no surgery subgroup and mainly for squamous cell carcinomas. Conclusions: Delayed diagnosis and a lack of surgery are key contributors to the prognosis discrepancy between NHB and NHW patients. More attention should be paid to NHB patients with cervical adenocarcinoma to narrow the disparity. Full article

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21 pages, 959 KiB

Open AccessReview

A Scoping Review of Arabic Natural Language Processing for Mental Health

by Ashwag Alasmari

Healthcare 2025, 13(9), 963; https://doi.org/10.3390/healthcare13090963 (registering DOI) - 22 Apr 2025

Abstract

Mental health disorders represent a substantial global health concern, impacting millions and placing a significant burden on public health systems. Natural Language Processing (NLP) has emerged as a promising tool for analyzing large textual datasets to identify and predict mental health challenges. The [...] Read more.

Mental health disorders represent a substantial global health concern, impacting millions and placing a significant burden on public health systems. Natural Language Processing (NLP) has emerged as a promising tool for analyzing large textual datasets to identify and predict mental health challenges. The aim of this scoping review is to identify the Arabic NLP techniques employed in mental health research, the specific mental health conditions addressed, and the effectiveness of these techniques in detecting and predicting such conditions. This scoping review was conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) framework. Studies were included if they focused on the application of NLP techniques, addressed mental health issues (e.g., depression, anxiety, suicidal ideation) within Arabic text data, were published in peer-reviewed journals or conference proceedings, and were written in English or Arabic. The relevant literature was identified through a systematic search of four databases: PubMed, ScienceDirect, IEEE Xplore, and Google Scholar. The results of the included studies revealed a variety of NLP techniques used to address specific mental health issues among Arabic-speaking populations. Commonly utilized techniques included Support Vector Machine (SVM), Random Forest (RF), Decision Tree (DT), Recurrent Neural Network (RNN), and advanced transformer-based models such as AraBERT and MARBERT. The studies predominantly focused on detecting and predicting symptoms of depression and suicidality from Arabic social media data. The effectiveness of these techniques varied, with trans-former-based models like AraBERT and MARBERT demonstrating superior performance, achieving accuracy rates of up to 99.3% and 98.3%, respectively. Traditional machine learning models and RNNs also showed promise but generally lagged in accuracy and depth of insight compared to transformer models. This scoping review highlights the significant potential of NLP techniques, particularly advanced transformer-based models, in addressing mental health issues among Arabic-speaking populations. Ongoing research is essential to keep pace with the rapidly evolving field and to validate current findings. Full article

(This article belongs to the Special Issue Data Driven Insights in Healthcare)

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18 pages, 2537 KiB

Open AccessArticle

A Nationwide Survey to Investigate Burnout and Quality of Life Among Thoracic Surgery Residents in Italy

by Giovanni Mattioni, Federico Raveglia, Andrea Onofri, Andrea Anastasi, Graziana Carleo, Diletta Mongiello, Doroty Sampietro, Cinzia Scala, Luigi Paladini, Giuseppe Cardillo, Franca Melfi, Mohsen Ibrahim, Carmelina Cristina Zirafa, Riccardo Orlandi and on behalf of the SIET Residents’ Committee Collaborative Group

Healthcare 2025, 13(9), 962; https://doi.org/10.3390/healthcare13090962 (registering DOI) - 22 Apr 2025

Abstract

Background: Surgical residents are a high-risk population for burnout, yet no studies have assessed its prevalence among thoracic surgery residents in Europe or Italy. Methods: A nationwide cross-sectional survey was conducted among Italian thoracic surgery residents to assess burnout and quality [...] Read more.

Background: Surgical residents are a high-risk population for burnout, yet no studies have assessed its prevalence among thoracic surgery residents in Europe or Italy. Methods: A nationwide cross-sectional survey was conducted among Italian thoracic surgery residents to assess burnout and quality of life. The Maslach Burnout Inventory measured burnout risk, while tailored questions evaluated quality of life. Univariate and multivariable analyses identified burnout risk factors, and χ² tests explored relevant associations between variables. Results: Of 193 eligible residents, 98 (50.8%) completed the survey. High burnout risk was identified in 60.2% of respondents. Independent risk factor associations between burnout risk and low perceived inclusion and aggregation, low colleague quality, low residency program rating, low personal life satisfaction, perceived lack of valorization, and exposure to sexual harassment were not significant in multivariable models. No differences in burnout risk were found across gender, geographic location, or training year. Conclusions: Burnout among Italian thoracic surgery residents underscores systemic challenges such as excessive administrative demands, insufficient mentorship, limitations to self-care, and gaps in theoretical training. Addressing these issues requires comprehensive reforms, including curriculum enhancement, strengthened mentorship, improved administrative support, and accessible mental health resources. A multi-level intervention strategy is essential to enhance resident well-being and training quality. Full article

(This article belongs to the Section Medics)

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12 pages, 465 KiB

Open AccessReview

Dental Caries Status of Children and Adolescents in West Africa—A Literature Review

by Wai-Lam Chan, Hei-Yu Wong, Rowenna Yue, Duangporn Duangthip and Phoebe Lam

Healthcare 2025, 13(9), 961; https://doi.org/10.3390/healthcare13090961 - 22 Apr 2025

Abstract

Objectives: Dental caries is one of the most prevalent oral diseases worldwide, including in Africa. The aim of this article was to provide a comprehensive review of dental caries status of children and adolescents living in the West African region. Methods: Articles that [...] Read more.

Objectives: Dental caries is one of the most prevalent oral diseases worldwide, including in Africa. The aim of this article was to provide a comprehensive review of dental caries status of children and adolescents living in the West African region. Methods: Articles that fulfilled the study selection criteria were identified through systematic search in electronic databases (EMBASE and MEDLINE). Titles and abstracts were examined manually to screen for articles that study the caries prevalence and experience of children under the age of 18, and only English publications published from the years 2015 to 2024 were included. Publications that include participants with special healthcare needs were excluded. Relevant data related to caries prevalence and severity of participants below 18 were extracted with a standardized spreadsheet. Results: Out of 1288 studies, a total of 18 studies were included. Among the 16 countries in West Africa, only 3 countries (19%) including Ghana, Nigeria, and Senegal met the inclusion criteria, with a majority (15/18, 78.9%) focusing on Nigerian children and adolescents. The dmft scores of the included studies ranged from 0.06 to 3.04, and the DMFT scores ranged from 0.02 to 2.65. It is worth noting that dmft/DMFT scores across different countries were collected with a high heterogeneity in study design, and were thereby not directly comparable. Conclusions: The majority of the included studies were conducted in Nigeria. There are significant variations in caries prevalence and caries experience among children and adolescent in West Africa. Further research on oral health surveillance in West Africa is needed. Full article

(This article belongs to the Special Issue Prevention and Management of Oral Diseases Among Children)

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20 pages, 2744 KiB

Open AccessSystematic Review

Pain and Disability Therapy with Stabilization Exercises in Patients with Chronic Low Back Pain: A Meta-Analysis

by Vanja Dimitrijević, Bojan Rašković, Nikola Jevtić, Siniša Nikolić, Dejan Viduka and Borislav Obradović

Healthcare 2025, 13(9), 960; https://doi.org/10.3390/healthcare13090960 - 22 Apr 2025

Abstract

Background: Chronic low back pain is a leading cause of disability worldwide, necessitating effective interventions to alleviate pain and improve function. This meta-analysis aimed to evaluate the effectiveness of stabilization exercises for pain relief and disability reduction in patients with chronic low back [...] Read more.

Background: Chronic low back pain is a leading cause of disability worldwide, necessitating effective interventions to alleviate pain and improve function. This meta-analysis aimed to evaluate the effectiveness of stabilization exercises for pain relief and disability reduction in patients with chronic low back pain. Methods: A meta-analysis was conducted following PRISMA and Cochrane guidelines. Randomized controlled trials evaluating stabilization exercises for chronic low back pain were included. Subgroup analyses were performed based on treatment duration, type of pain (specific vs. non-specific), study quality, and exercise type. Effect sizes were calculated using standardized mean differences (SMD), and evidence quality was assessed using the GRADE tool. Results: A total of 23 studies involving 1132 participants were included. The meta-analysis revealed that longer treatment durations (8–12 weeks) showed the strongest effects on pain reduction (SMD = −0.88) and disability improvement (SMD = −0.85). For pain type, non-specific low back pain responded better (SMD = −0.81 for pain, −0.73 for disability) compared to specific LBP (SMD = −0.61 and −0.42, respectively). The 6-week duration also demonstrated moderate effects (SMD = −0.72 for pain). Core stability exercises had superior pain reduction (SMD = −0.90, large effect) compared to spinal stability exercises (SMD = −0.57), while spinal stability exercises showed higher-quality evidence for disability improvement (SMD = −0.56, high-quality) versus core stability (SMD = −0.62, low-quality). Conclusion: Stabilization exercises are a highly effective intervention for chronic low back pain, offering significant pain relief and functional improvement. They outperform other common interventions and should be prioritized in clinical practice, particularly in longer-duration, supervised programs. These findings provide strong evidence to guide treatment protocols and improve outcomes for patients with chronic low back pain. Full article

(This article belongs to the Special Issue Physical and Rehabilitation Medicine—2nd Edition)

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23 pages, 2481 KiB

Open AccessArticle

Does Government Trust Matter? The Effectiveness of Policy Responses in the Health-Disaster Era

by Jaesun Wang

Healthcare 2025, 13(9), 959; https://doi.org/10.3390/healthcare13090959 - 22 Apr 2025

Abstract

Background: The COVID-19 pandemic has sparked the need for appropriate government responses in health-disaster situations worldwide. This study analyzes the impact of governments’ non-pharmaceutical measures on the number of deaths from COVID-19. In particular, it further analyzes how trust in government moderates government [...] Read more.

Background: The COVID-19 pandemic has sparked the need for appropriate government responses in health-disaster situations worldwide. This study analyzes the impact of governments’ non-pharmaceutical measures on the number of deaths from COVID-19. In particular, it further analyzes how trust in government moderates government measures. Through this analysis, this study aims to explore the government’s appropriate role in overcoming future health disasters by understanding the effectiveness of government measures in response to the COVID-19 pandemic. Methods: This study collected and analyzed national data provided by various international organizations for countries of the Organization for Economic Co-operation and Development (OECD). To estimate the relationship between various policy measures and COVID-19 related deaths, it employed panel data analysis using random effects, since only three years of data, ranging from 2020 to 2022, were utilized. Results: The main findings of this study are as follows. First, suppression measures which include measures that place relatively stronger restrictions on people’s behavior were directly related to decreases in the number of total deaths. However, mitigation measures which consisted of weak-intensity measures were directly related to increases in the number of deaths. Second, higher levels of trust in government were directly related to decreased numbers of deaths. Finally, the moderating effect of government trust on suppression measures was not tested, but the moderating effect on mitigation measures was confirmed. Conclusions: This study presents the following implications. First, governments’ non-pharmaceutical measures in times of pandemic need to consider various environmental factors of the country. Second, trust in government can be an important environmental condition in overcoming health-disaster situations. In particular, trust in government weakens the side effects that can be caused by government measures. Third, suppression methods that directly affect people’s movement and daily life had a positive association with decreases in the number of total deaths, and the correlations of these measures in overcoming the health-disaster situation were confirmed. Full article

(This article belongs to the Section Health Policy)

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533 KiB

Open AccessArticle

Knowledge and Awareness of Ionizing Radiation Harms Among Hospital Employees at a Large Tertiary Medical Center: Findings from a First-of-Its-Kind Study in Israel

by Ghassan Makhoul, Saritte Perlman, Tomer Ziv-Baran and Gil Fire

Healthcare 2025, 13(8), 958; https://doi.org/10.3390/healthcare13080958 (registering DOI) - 21 Apr 2025

Abstract

Background: Medical imaging and therapeutic tools are used on a daily basis. Some of these technologies bear potential risk of harm due to exposure to ionizing radiation. Previous research has shown a lack of knowledge and awareness surrounding ionizing radiation among a [...] Read more.

Background: Medical imaging and therapeutic tools are used on a daily basis. Some of these technologies bear potential risk of harm due to exposure to ionizing radiation. Previous research has shown a lack of knowledge and awareness surrounding ionizing radiation among a wide range of medical staff. Objectives: This study aimed to evaluate the knowledge and awareness of ionizing radiation in a large tertiary medical center and compare the knowledge and awareness among types of hospital employees. Methods: A cross-sectional study based on an anonymous 32-question questionnaire was conducted. Participants were categorized by employee type, including physicians, nurses, allied health professionals, and ancillary and administrative staff. The questionnaire was divided into demographic profile, professional characteristics related to ionizing radiation, and knowledge and awareness. Knowledge and awareness scores were analyzed as standard scores (Z-scores). Univariate and multivariable analyses were performed. Results: The study included 479 participants. Physicians received the highest scores compared to other employee types, participants who had received ionizing radiation training received higher scores, and similar trends were observed for employees working in departments with higher potential for radiation exposure. Conclusions: This research underscores the need to enhance ionizing radiation knowledge and awareness among hospital staff. Achieving this may involve training sessions, workshops, and academic courses. Full article

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Open AccessArticle

Curative-Intention Surgery with Lobe-Specific Versus Systematic Lymph Node Dissection in Clinical Stage IA–IB Non-Small Cell Lung Cancer: Our Experience and Literature Review

by Bogdan Cosmin Tanase, Teodor Horvat, Mihnea Davidescu, Claudiu Eduard Nistor, Calin Muntean, Gabriel Veniamin Cozma, Alin Nicola, Felix Bratosin, Sorina Maria Denisa Laitin and Alin Burlacu

Healthcare 2025, 13(8), 957; https://doi.org/10.3390/healthcare13080957 - 21 Apr 2025

Abstract

Background and Objectives: The benefit of lobe-specific lymph node dissection (LS-LND) in non-small cell lung cancer (NSCLC) remains debated, especially in early-stage disease. Previous reviews often included all stages, leaving a gap in focused evaluations of clinical stage IA–IB NSCLC. This systematic review, [...] Read more.

Background and Objectives: The benefit of lobe-specific lymph node dissection (LS-LND) in non-small cell lung cancer (NSCLC) remains debated, especially in early-stage disease. Previous reviews often included all stages, leaving a gap in focused evaluations of clinical stage IA–IB NSCLC. This systematic review, supplemented by our institutional experience, aimed to compare overall survival (OS), recurrence-free survival (RFS), and postoperative complications between LS-LND and systematic lymph node dissection (S-LND) in clinical stage IA–IB NSCLC. Methods: We retrospectively reviewed 24 patients treated at our institution (14 S-LND vs. 10 LS-LND). Data on patient demographics, operative details, OS, RFS, and postoperative complications were collected. Risk of bias was assessed using established methodological tools. A targeted literature search was conducted in PubMed, EMBASE, and Web of Science from inception to 14 April 2022. Only three articles (total n = 1101 patients) met inclusion criteria focusing on clinical stage IA–IB NSCLC who underwent curative-intent resection. Results: LS-LND demonstrated comparable or slightly improved 5-year OS (range: 69.7–96.7%) versus S-LND (64.9–92.0%), and similar or slightly higher RFS (66.0–95.6% in LS-LND vs. 60.8–88.8% in S-LND). In our cohort, the 5-year OS was 78.6% in S-LND vs. 80.0% in LS-LND, and the 5-year RFS was 71.4% vs. 70.0%, respectively. Postoperative complications such as arrhythmias were less frequent in LS-LND groups overall. Our data showed a low rate of pneumonia in S-LND compared to LS-LND (7.1% vs. 10.0%); however, arrhythmias accounted for 14.3% in S-LND vs. 10.0% in LS-LND). Conclusions: For clinical stage IA–IB NSCLC, LS-LND offers oncologic outcomes that are comparable to S-LND, with a potential for reduced postoperative complications. The findings from our institution align with these trends observed in the literature. While these results suggest potential advantages of lobe-specific approaches, definitive conclusions require further validation through larger, prospective randomized studies to confirm the clinical benefits of LS-LND in early-stage NSCLC. Full article

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10 pages, 1113 KiB

Open AccessSystematic Review

The Role of Lactic Acid in Episiotomy Wound Healing: A Systematic Review

by Dragos Brezeanu, Ana-Maria Brezeanu, Sergiu Chirilă and Vlad Tica

Healthcare 2025, 13(8), 956; https://doi.org/10.3390/healthcare13080956 - 21 Apr 2025

Abstract

Episiotomy is a common obstetric intervention aimed at facilitating childbirth and reducing severe perineal trauma. Lactic acid, a naturally occurring alpha-hydroxy acid (AHA), has emerged as a promising alternative to conventional wound-care methods due to its antimicrobial, anti-inflammatory, and regenerative properties. Objective: This [...] Read more.

Episiotomy is a common obstetric intervention aimed at facilitating childbirth and reducing severe perineal trauma. Lactic acid, a naturally occurring alpha-hydroxy acid (AHA), has emerged as a promising alternative to conventional wound-care methods due to its antimicrobial, anti-inflammatory, and regenerative properties. Objective: This systematic review evaluates the effectiveness of lactic acid in episiotomy wound healing compared to conventional wound-care methods, focusing on healing time, infection rates, and patient-reported outcomes. Methods: A systematic search was conducted in PubMed, Cochrane Library, Embase, Web of Science, and Scopus using the keywords “lactic acid”, “episiotomy wound healing”, “perineal wound care”, and “infection prevention”. Inclusion criteria covered randomized controlled trials (RCTs), observational studies, and systematic reviews. The Cochrane Risk of Bias 2 (RoB 2) tool and the Newcastle–Ottawa Scale were used for quality assessment. Results: Eight studies met the inclusion criteria. Lactic acid-treated wounds demonstrated 30% faster healing rates, 50% lower infection rates, and reduced pain scores compared with standard wound-care methods (e.g., povidone-iodine or saline). A meta-analysis of five RCTs found a significant reduction in post-episiotomy infections (RR = 0.68, 95% CI: 0.52–0.85). Conclusions: Lactic acid shows promise in episiotomy wound care by improving healing outcomes and reducing infection and discomfort. However, further large-scale RCTs are needed to confirm its safety and long-term efficacy. Full article

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12 pages, 990 KiB

Open AccessArticle

The Impact of a Structured Contraceptive Counseling Program on Reproductive Health Knowledge, Sexual Autonomy, and Mental Well-Being Among Romanian College Women

by Denisa Hinoveanu, Adrian Gluhovschi, Ileana Enatescu, Oana Belei, Lavinia Stelea, Catalin Dumitru, Felix Bratosin and Sorina Maria Denisa Laitin

Healthcare 2025, 13(8), 955; https://doi.org/10.3390/healthcare13080955 - 21 Apr 2025

Abstract

Background and Objectives: Contraceptive education may influence reproductive health outcomes, foster greater sexual autonomy, and improve mental well-being. The current study investigated the efficacy of a structured contraceptive counseling program on reproductive health knowledge, sexual autonomy, anxiety, and depressive symptoms among Romanian college [...] Read more.

Background and Objectives: Contraceptive education may influence reproductive health outcomes, foster greater sexual autonomy, and improve mental well-being. The current study investigated the efficacy of a structured contraceptive counseling program on reproductive health knowledge, sexual autonomy, anxiety, and depressive symptoms among Romanian college women. Materials and Methods: A prospective study was conducted during the 2021–2024 academic years, enrolling 240 female students aged 18–26 from the “Victor Babes” University of Medicine and Pharmacy in Timisoara. The participants were divided into two arms: (1) Intervention Group (IG, n = 115), which was provided counseling materials, and (2) Control Group (CG, n = 116), which received no additional counseling. Baseline and post-intervention data were collected using a contraceptive knowledge quiz (CKQ), a sexual autonomy scale (SAS), the WHOQOL-BREF, GAD-7, and PHQ-9. Results: After the 12-week intervention, the IG demonstrated significant improvements in contraceptive knowledge (mean CKQ score: 25.5 ± 3.1 vs. 20.1 ± 4.3 in CG, p < 0.001), sexual autonomy (SAS: 82.6 ± 9.2 vs. 75.7 ± 10.1, p < 0.001), and psychological well-being indicators: lower anxiety (GAD-7: 3.1 ± 2.0 vs. 5.2 ± 2.3, p < 0.001) and depression scores (PHQ-9: 4.8 ± 2.0 vs. 7.1 ± 2.2, p < 0.001). Multiple regression analysis showed that membership in the IG was the most significant predictor of improved post-intervention contraceptive knowledge and reduced mental distress, even after adjusting for confounders such as age, socioeconomic status, and relationship status. Conclusions: A structured contraceptive counseling program can significantly enhance reproductive health knowledge, strengthen sexual autonomy, and reduce depressive and anxiety symptoms among Romanian college women. The findings emphasize the importance of developing systematic, multi-faceted interventions for improving students’ reproductive well-being and mental health outcomes within university settings. Full article

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17 pages, 259 KiB

Open AccessArticle

The Role of Disgust Emotion in Eating Disorders and Its Relationship with Dissociative Symptoms

by María F. Rabito-Alcón, Anabel González-Vázquez and José I. Baile

Healthcare 2025, 13(8), 954; https://doi.org/10.3390/healthcare13080954 - 21 Apr 2025

Abstract

Background: Disgust is a central emotion in eating disorders, influencing both their development and maintenance. High sensitivity to disgust has been associated with restrictive and purgative behaviors, as well as with greater severity of eating disorder symptoms. Despite its importance, the different [...] Read more.

Background: Disgust is a central emotion in eating disorders, influencing both their development and maintenance. High sensitivity to disgust has been associated with restrictive and purgative behaviors, as well as with greater severity of eating disorder symptoms. Despite its importance, the different aspects of disgust are rarely examined in depth, limiting the understanding of its role in these disorders. Since the emotion of disgust is more closely linked to the body and food than other emotions, the aim of this paper is to understand its possible role in eating disorders and obesity. Method: In a case–control study, 313 women (155 with eating disorders and obesity in the clinical group and 158 in the control group) were assessed using various questionnaires, including measures of disgust, dissociation, and symptom severity. Results: The results showed that the clinical group reported greater symptom severity, more dissociative symptoms, and higher sensitivity to disgust than the control group. It is noteworthy that there were significant differences between subtypes of the clinical group, particularly in disgust related to hygiene, sexual content and deterioration and disease. Conclusions: These findings highlight the importance of considering disgust in the evaluation and treatment of eating disorders, emphasizing the need for further research on this emotion to develop more effective therapeutic interventions that address this complex emotion in the context of eating disorders and obesity. Full article

36 pages, 1787 KiB

Open AccessSystematic Review

Effectiveness and Adherence of Pharmacological vs. Non-Pharmacological Technology-Supported Smoking Cessation Interventions: An Umbrella Review

by Federica Di Spirito, Maria Pia Di Palo, Marina Garofano, Rosaria Del Sorbo, Gianluca Allegretti, Iman Rizki, Marianna Bartolomeo, Massimo Giordano, Massimo Amato and Alessia Bramanti

Healthcare 2025, 13(8), 953; https://doi.org/10.3390/healthcare13080953 - 21 Apr 2025

Abstract

Background: Smoking cessation has a crucial public health role. To overcome non-technological and technology-based smoking cessation intervention limitations, technology-supported programs were developed. Objectives: The present umbrella review aimed to evaluate the long-term effectiveness (≥6 months) of pharmacological vs. non-pharmacological technology-supported smoking [...] Read more.

Background: Smoking cessation has a crucial public health role. To overcome non-technological and technology-based smoking cessation intervention limitations, technology-supported programs were developed. Objectives: The present umbrella review aimed to evaluate the long-term effectiveness (≥6 months) of pharmacological vs. non-pharmacological technology-supported smoking cessation interventions on adult daily smokers and the related human health benefits. Methods: Following PRISMA guidelines, the protocol was registered on PROSPERO (CRD42024601824). Fifty systematic reviews were included, evaluated through AMSTAR-2, and qualitatively synthesized. Results: A total of 69,269 smokers underwent pharmacological (39,367) and non-pharmacological (29,902) technology-supported interventions. The biochemically-verified effectiveness assessed as continuous abstinence rates (CARs) and seven-day point prevalence abstinence (PPA) of pharmacological vs. non-pharmacological at 6 and 12 months were, respectively, CARs 9.06% vs. 14.85%, 7-day PPA 17.37% vs. 17.15%; CARs 8.51% vs. 9.08%, 7-day PPA 14.00% vs. 5.63%. The 6-month adherence rates were higher in the non-pharmacological group (41.37% vs. 83.43%). Conclusions: Non-pharmacological technology-supported interventions showed similar effectiveness and higher adherence at 6 months. At 12 months, the CARs were similar despite lower adherence. Adherence quality and consistency may be important for sustained success, probably due to the “reverse causality”. Non-pharmacological interventions showed similar effectiveness, lower costs, and shorter durations than pharmacological interventions. Full article

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26 pages, 1872 KiB

Open AccessSystematic Review

Effects of Mind–Body Interventions on Immune and Neuroendocrine Functions: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Shih-Ching Lee, Ping-Han Tsai, Kuang-Hui Yu and Tien-Ming Chan

Healthcare 2025, 13(8), 952; https://doi.org/10.3390/healthcare13080952 - 21 Apr 2025

Abstract

Objective: Chronic stress affects the immune system via the hypothalamic–pituitary–adrenal (HPA) axis and autonomic system. Chronic inflammation is a risk factor for cardiovascular diseases, cancer onset and progression, susceptibility to infection, and cognitive impairment. Mind–body interventions (MBIs) could affect the immune and [...] Read more.

Objective: Chronic stress affects the immune system via the hypothalamic–pituitary–adrenal (HPA) axis and autonomic system. Chronic inflammation is a risk factor for cardiovascular diseases, cancer onset and progression, susceptibility to infection, and cognitive impairment. Mind–body interventions (MBIs) could affect the immune and neuroendocrine systems, and we aimed to assess the correlations among these systems through a meta-analysis. Methods: RCTs were identified by searching three databases: PubMed, Embase, and Scopus. Of the 1697 studies identified, 89 were included in this study. Risk of bias was examined using the Cochrane risk-of-bias assessment tool. Data were pooled using a random-effects model, and SMDs were calculated. I² statistics and Egger’s test were used to assess the significance of the asymmetry. Influence diagnostics were used to assess whether pooled effects were disproportionately dependent on any single study. The trim-and-fill method was applied to all identified asymmetric instances. Meta-regression was used to examine the moderating effect of MBI efficacy on biomarkers. Results: MBIs generally decreased the levels of inflammatory factors, such as the CRP, IL-6, TNF-α, IL-1, IL-8, IL-17, ESR, and cortisol, and increased IL-10, IFN-γ, IL-1ra, BDNF, and secretory IgA. In a subgroup analysis of the CNS and cancer, qigong and yoga showed increased BDNF and IL-6, respectively. Notably, IL-10 was increased in inflammatory diseases, and IFN-γ was increased in viral infections. Conclusions: This study revealed MBIs decrease inflammatory cytokine and increase anti-inflammatory, antiviral, and immune-activating factors. These results suggest the MBIs including gentle physical exercise may be beneficial for neuropsychiatric disorders or tumors. Prospero registration number: CRD42024507646. Full article

(This article belongs to the Collection Integrative, Complementary and Alternative Medicine (CAM) in Healthcare)

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11 pages, 2383 KiB

Open AccessArticle

Maternal Mortality Due to Abortion in Brazil: A Temporal, Regional, and Sociodemographic Analysis over the Last Three Decades

by Pedro Omar Batista Pereira, Mateus Pinheiro de Souza, Laura Beatriz Argôlo Moreira, Eumar Soares Silva Filho, Edjan da Silva Santos, Amanda Vitória Rodrigues dos Santos, Ana Clara Ferreira Asbeque, Mauro José de Deus Morais, Júlio Eduardo Gomes Pereira and Francisco Naildo Cardoso Leitão

Healthcare 2025, 13(8), 951; https://doi.org/10.3390/healthcare13080951 - 21 Apr 2025

Abstract

Background/Objectives: Maternal mortality due to abortion in Brazil has shown a significant decline of 47.37% between 1996 and 2022. This study aims to analyze temporal trends in maternal mortality due to abortion across regions and sociodemographic groups, highlighting disparities and their implications for [...] Read more.

Background/Objectives: Maternal mortality due to abortion in Brazil has shown a significant decline of 47.37% between 1996 and 2022. This study aims to analyze temporal trends in maternal mortality due to abortion across regions and sociodemographic groups, highlighting disparities and their implications for public health. Methods: Trends were assessed using Prais–Winsten regression models to estimate the annual percentage change (APC). Data were stratified by region and sociodemographic characteristics to identify vulnerable groups. Results: The findings reveal notable regional disparities, with some regions experiencing more pronounced declines than others. Vulnerable sociodemographic groups, including women with lower levels of education and younger age groups, exhibited persistently higher mortality rates. Conclusions: Despite a significant overall reduction in maternal mortality due to abortion, disparities remain among regions and sociodemographic groups. These findings underscore the need for targeted public health policies aimed at reducing inequalities and addressing the needs of the most affected populations. Full article

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15 pages, 637 KiB

Open AccessReview

Artificial Intelligence as a Tool for Self-Care in Patients with Type 1 and Type 2 Diabetes—An Integrative Literature Review

by Vera Persson and Ulrica Lovén Wickman

Healthcare 2025, 13(8), 950; https://doi.org/10.3390/healthcare13080950 - 21 Apr 2025

Abstract

Background/Objectives: Diabetes is a common public health disease that affects patients mentally, physically, and economically. It requires lifestyle changes such as blood sugar control and regular contact with healthcare services. Artificial intelligence has developed rapidly in many different areas in recent years, [...] Read more.

Background/Objectives: Diabetes is a common public health disease that affects patients mentally, physically, and economically. It requires lifestyle changes such as blood sugar control and regular contact with healthcare services. Artificial intelligence has developed rapidly in many different areas in recent years, including healthcare and nursing. The aim of this study is to explore how artificial intelligence can be used as a tool for patients with diabetes mellitus. Methods: An integrative literature review design was chosen according to Whittemore and Knafl (2005). Electronic searches in databases were conducted across Pub-Med, CINAHL Complete (EBSCO), and ACM Digital Library until September 2024. A total set of quantitative and qualitative articles (n = 15) was selected and reviewed using a Mixed Method Appraisal Tool. Results: Artificial intelligence is an effective tool for patients with diabetes mellitus, and various models are used. Three themes emerged: artificial intelligence as a tool for blood sugar monitoring for patients with diabetes mellitus, artificial intelligence as a decision support for diabetic wounds and complications, and patients’ requests for artificial intelligence capabilities in relation to tools. Artificial intelligence can create better conditions for patient self-care. Conclusions: Artificial intelligence is a valuable tool for patients with diabetes mellitus and enables the district nurse to focus more on person-centered care. The technology facilitates the patient’s blood sugar monitoring. However, more research is needed to ensure the safety of AI technology, the protection of patient privacy, and clarification of laws and regulations within diabetes care. Full article

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17 pages, 1045 KiB

Open AccessReview

Exploring the Science of Shape: How Physical Activity, Sleep, and Stress Affect Body Composition

by Krystian Maruszczak, Wojciech Kasperek, Konrad Kustra, Joanna Baran and Maciej Kochman

Healthcare 2025, 13(8), 949; https://doi.org/10.3390/healthcare13080949 - 20 Apr 2025

Abstract

In the contemporary context of health challenges, the focus on physical health has become a social and individual priority. Within this framework, body composition emerges as one of the key determinants of physical health, with deviations from normal body composition being associated with [...] Read more.

In the contemporary context of health challenges, the focus on physical health has become a social and individual priority. Within this framework, body composition emerges as one of the key determinants of physical health, with deviations from normal body composition being associated with numerous pathological conditions that can lead to serious health issues. Consequently, there is an urgent need to synthesize the available knowledge and increase awareness regarding healthy body composition and the factors that shape its components. This narrative review aims to summarize the knowledge regarding the main components of body composition and the key factors that influence their development. The fundamental morphological characteristics and functions of the primary components of body composition—including adipose tissue, muscle mass, and bone tissue—are addressed. Furthermore, the available methods for assessing body composition are outlined. The role of three key factors that influence body composition is outlined, including, but not limited to, physical activity, sleep quality, and stress levels. Additionally, hormonal fluctuations that determine body composition in relation to the variability of these factors are discussed. The review provides evidence-based information that will be valuable both for disease prevention related to non-communicable diseases and for the promotion of health strategies aimed at long-term physical well-being. Full article

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10 pages, 240 KiB

Open AccessArticle

Ovarian Tissue Removed with Endometrioma May Reflect the Quality of the Adjacent Ovary

by Francesco G. Martire, Veronica Yacoub, Eliana Fuggetta, Valerio Carletti, Lucia Lazzeri, Gabriele Centini, Claudia D’Abate, Giuseppe Sorrenti, Errico Zupi and Francesco Maneschi

Healthcare 2025, 13(8), 948; https://doi.org/10.3390/healthcare13080948 - 20 Apr 2025

Abstract

Background/Objectives: Endometriosis is commonly associated with infertility due to multiple factors. In this paper, we investigated the histopathological factors underlying these effects by comparing microscopic samples obtained during laparoscopic stripping. Methods: Morpho-functional examination through the follicular Score (FS) of ovarian tissue [...] Read more.

Background/Objectives: Endometriosis is commonly associated with infertility due to multiple factors. In this paper, we investigated the histopathological factors underlying these effects by comparing microscopic samples obtained during laparoscopic stripping. Methods: Morpho-functional examination through the follicular Score (FS) of ovarian tissue adjacent to the cystic wall (Specimen 1) was compared with the FS of ovarian tissue inadvertently harvested during cystectomy (Specimen 2). The follicular score was compared with clinical factors such as age, parity, BMI, and CA-125 levels. Results: Cohen’s kappa analysis revealed a 77.8% concordance between the follicular score of the ovarian tissue alongside the endometrioma (S1) and the ovarian tissue inadvertently removed (S2), reflecting a moderate level of concordance between the two samples. A statistically significant positive correlation was observed between the FS of Specimen 1 and the preoperative CA-125 value (p = 0.01); in contrast, a negative correlation was found between the FS and both the patient’s age (p = 0.006) and parity (p = 0.03). Additionally, a statistically significant negative correlation was demonstrated between the FS of Specimen 2 and patient age (p = 0.04). Conclusions: The functional quality of the remaining ovary after endometrioma stripping may be assessed by evaluating the follicular score of the pericystic ovarian tissue. Full article

(This article belongs to the Special Issue Fertility-Sparing Gynaecological Surgery)

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