Journal Description
Healthcare
Healthcare
is an international, scientific, peer-reviewed, open access journal on health care systems, industry, technology, policy, and regulation, and is published semimonthly online by MDPI. The European Medical Association (EMA), Ocular Wellness & Nutrition Society (OWNS) and Italian Society of Nephrology Nurses (SIAN) are affiliated with Healthcare and their members receive discounts on the article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE and SSCI (Web of Science), PubMed, PMC, and other databases.
- Journal Rank: JCR - Q2 (Health Policy and Services) / CiteScore - Q1 (Leadership and Management)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 22.4 days after submission; acceptance to publication is undertaken in 2.9 days (median values for papers published in this journal in the second half of 2025).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
- Companion journals for Healthcare include: Trauma Care and European Burn Journal.
- Journal Cluster of Healthcare Sciences and Services: Geriatrics, Journal of Ageing and Longevity, Healthcare, Hospitals, Hygiene, International Journal of Environmental Research and Public Health and Nursing Reports.
Impact Factor:
2.7 (2024);
5-Year Impact Factor:
2.8 (2024)
Latest Articles
The Effects of a Cerebellar Transcranial Direct-Current Stimulation-Based Preventive Exercise Program on Physical Function and Fall Reduction Efficacy in Community-Dwelling Older Adults
Healthcare 2026, 14(2), 241; https://doi.org/10.3390/healthcare14020241 (registering DOI) - 18 Jan 2026
Abstract
Background/Objectives: Falls are a major cause of injury in older adults, closely related to declines in muscle strength, balance control, and sensory integration. Although exercise-based fall prevention programs are well supported, evidence on combining such programs with cerebellar transcranial direct-current stimulation (c-tDCS)
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Background/Objectives: Falls are a major cause of injury in older adults, closely related to declines in muscle strength, balance control, and sensory integration. Although exercise-based fall prevention programs are well supported, evidence on combining such programs with cerebellar transcranial direct-current stimulation (c-tDCS) remains limited. This study investigated the effects of c-tDCS applied before a modified Otago Exercise Program (OEP) on lower-extremity strength, balance, and fall efficacy in older adults. Methods: In this randomized controlled study, twenty-six community-dwelling older adults (median age [IQR]: experimental, 74.00 [10] years; control, 71.00 [10] years) were randomly assigned to either a c-tDCS + exercise group (n = 13) or a sham + exercise group (n = 13). The intervention was administered twice weekly for four weeks. The experimental group received 15 min of c-tDCS followed by 30 min of OEP-based exercise; the control group received sham stimulation under identical conditions. The outcome measures included the Five Times Sit to Stand Test (FTSST), Timed Up and Go (TUG), Balancia-based static balance (velocity average), and Falls Efficacy Scale—Korea (FES-K). Assessments were performed pre- and post-intervention. Results: The experimental group demonstrated significantly greater improvements than the control group (p < 0.05) in the Five Times Sit to Stand Test (r = 0.44) and Timed Up and Go test (r = 0.56). No significant changes were observed in static balance or fall efficacy in either group (p > 0.05). Conclusions: The combined use of c-tDCS and an OEP-based fall prevention exercise program effectively improved lower-extremity strength and dynamic balance in older adults. However, short-term intervention did not influence static balance or fall efficacy. Further studies using longer intervention periods and larger samples are warranted to verify these findings and clarify the mechanisms underlying c-tDCS-enhanced motor performance.
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(This article belongs to the Section Clinical Care)
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Open AccessSystematic Review
Effectiveness of Thoracic Spine Manipulation for the Management of Neck Pain: A Systematic Umbrella Review with Risk of Bias and Methodological and Reporting Quality
by
Michael Masaracchio, Kaitlin Kirker, Birendra Dewan and Stephen Caronia
Healthcare 2026, 14(2), 240; https://doi.org/10.3390/healthcare14020240 (registering DOI) - 18 Jan 2026
Abstract
Background/Objectives: The purpose of this umbrella review was to assess the risk of bias and the methodological and reporting quality of systematic reviews that evaluated the effects of thoracic spine manipulation (TSM) on individuals with mechanical neck pain. Methods: To be included, publications
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Background/Objectives: The purpose of this umbrella review was to assess the risk of bias and the methodological and reporting quality of systematic reviews that evaluated the effects of thoracic spine manipulation (TSM) on individuals with mechanical neck pain. Methods: To be included, publications needed to be systematic reviews including studies with participants with neck pain >18 years old; at least two groups where the experimental intervention was TSM; assessed pain and/or function; and were published in English. Reviews limited to narrative, scoping, or retrospective studies, or those with cervical radiculopathy, were excluded. An electronic search was conducted in May 2025 using PubMed, CINAHL (EBSCO Host), and the Cochrane Library to identify relevant articles from inception to May 2025. Quality and risk of bias were assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020), and Risk of Bias in Systematic Reviews (ROBIS). Findings were summarized narratively and graphically. Results: Seven reviews (27 unique studies; 1394 participants, aged 18–62 years) met the inclusion criteria. Some evidence supported TSM for short-term improvement in neck pain, but confidence in results was low to critically low based on the AMSTAR 2 results. Four reviews had a high overall risk of bias, and three had a low risk. Reporting compliance varied widely (0–100%). Conclusions: While all the included systematic reviews suggested that TSM is a viable short-term option for individuals with neck pain, the overall confidence in these results ranged from low to critically low, making it difficult to draw firm conclusions about the true benefit of TSM in clinical practice. Registered prospectively in PROSPERO (CRD420251034330).
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(This article belongs to the Special Issue Joint Manipulation for Rehabilitation of Musculoskeletal Disorders)
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Open AccessSystematic Review
Efficacy of Technology-Based Cognitive Rehabilitation Tools for Cancer-Related Cognitive Impairment in Non-CNS Cancer Patients: A Systematic Review
by
Benedetta Capetti, Serena Sdinami, Jenny Luisi, Lorenzo Conti, Roberto Grasso and Gabriella Pravettoni
Healthcare 2026, 14(2), 239; https://doi.org/10.3390/healthcare14020239 (registering DOI) - 18 Jan 2026
Abstract
Background: Cancer-related cognitive impairment (CRCI) is a significant concern for individuals with non-central nervous system (non-CNS) cancers, affecting memory, attention, executive functions, and processing speed. Non-pharmacological interventions, including digital cognitive rehabilitation, have shown promise in addressing CRCI. This systematic review investigates the
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Background: Cancer-related cognitive impairment (CRCI) is a significant concern for individuals with non-central nervous system (non-CNS) cancers, affecting memory, attention, executive functions, and processing speed. Non-pharmacological interventions, including digital cognitive rehabilitation, have shown promise in addressing CRCI. This systematic review investigates the efficacy of digital and computerized cognitive rehabilitation interventions in improving cognitive outcomes in non-CNS cancer patients. Method: A systematic search of the EMBASE, Scopus, and PubMed databases was conducted to identify studies on digital and computerized cognitive rehabilitation for non-CNS cancer patients. Studies were included if they involved computerized and digital cognitive rehabilitation for oncological patients and assessed the efficacy of the intervention. A total of 11 studies were selected, including randomized controlled trials and quasi-experimental designs. The quality of the studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Data was synthesized using a narrative descriptive approach, and the results were summarized in a descriptive table. Results: The most frequently assessed cognitive domains included working memory, attention, executive functions, and processing speed. The majority of studies (n = 11) demonstrated significant immediate improvements in cognitive functions, particularly in working memory, executive functions, attention, and processing speed. Short-term follow-up (1–5 months) showed partial maintenance of these improvements, while long-term effects (6 months to 1 year) were more variable. Improvements in episodic memory were less consistent, particularly among breast cancer survivors. Discussion: Digital and computerized cognitive rehabilitation appears to be an effective intervention for CRCI, providing immediate cognitive benefits and some lasting improvements, especially in domains such as memory and attention. However, long-term effects remain variable, and further research is needed to explore the optimal duration of interventions and the potential advantages of personalized rehabilitation approaches.
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(This article belongs to the Special Issue Revolutionizing Cognitive Rehabilitation: The Role of Digital Technologies)
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Open AccessArticle
Bridging the Data Divide in Nevada: A Repeated Cross-Sectional Study of Birth Certificate and Medicaid Billing Discrepancies in Gestational Substance Exposure
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Kyra Morgan, Kavita Batra, Stephanie Woodard, Erika Ryst, Paul Devereux and Wei Yang
Healthcare 2026, 14(2), 238; https://doi.org/10.3390/healthcare14020238 (registering DOI) - 18 Jan 2026
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Background/Objectives: Gestational exposure to substances (GES) is associated with adverse developmental outcomes. Early identification is limited by reliance on self-reported data. This study assessed the incidence and predictors of discordance in GES reporting between birth certificates and Medicaid claims among Medicaid-covered births
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Background/Objectives: Gestational exposure to substances (GES) is associated with adverse developmental outcomes. Early identification is limited by reliance on self-reported data. This study assessed the incidence and predictors of discordance in GES reporting between birth certificates and Medicaid claims among Medicaid-covered births in Nevada from 2022 to 2024. Methods: A statewide, hospital-clustered, cross-sectional analysis was conducted using linked Medicaid billing and birth record data. Discordance was defined as GES identified in one source but not the other. Incidence per 1000 live births was stratified by demographic characteristics. Multilevel logistic regression assessed patient- and hospital-level predictors, with random hospital intercepts. Results: Among 50,394 live births, the discordance rate was 95.09 per 1000 (95% Confidence Interval: 92.5–97.7). Substantial disparities were observed by race/ethnicity, socioeconomic status, and geography, with higher discordance among White non-Hispanic mothers, those residing in rural or frontier counties, and individuals with lower educational attainment or living in lower-income areas. Modest but meaningful variation was also observed across hospitals, including differences by hospital size and teaching or research status. Conclusions: Findings highlight substantial discordance in GES reporting and underscore the limitations of single-source surveillance. Findings also have clear policy relevance, indicating that improved cross-system data integration would strengthen statewide surveillance, enhance early detection, and support more equitable resource allocation and intervention strategies.
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Open AccessArticle
Ageing Population and Balance Under Stressful Conditions—A Cross-Sectional Observational Study
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Isabel Rodríguez-Costa, Belén Díaz Pulido, Yolanda Pérez-Martín, Susana Nunez-Nagy, Miguel Ángel Valero-Gil, Alejandra Hernamperez-Cano and Sara Trapero-Asenjo
Healthcare 2026, 14(2), 237; https://doi.org/10.3390/healthcare14020237 (registering DOI) - 18 Jan 2026
Abstract
Background/Objectives: Falls are a major global issue for older adults, and emotional stress may increase the risk due to its effects on postural control and balance. However, the immediate effects of a stressful stimulus on objective measures of balance and fall risk
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Background/Objectives: Falls are a major global issue for older adults, and emotional stress may increase the risk due to its effects on postural control and balance. However, the immediate effects of a stressful stimulus on objective measures of balance and fall risk are unknown. The study aims to explore differences in older adults’ performance on the Timed Up and Go (TUG) test before and after such exposure. Methods: In this cross-sectional study, 31 older adults (71.6 ± 4.98 years) were exposed to an emotionally stressful stimulus using high-arousal images from the International Affective Picture System. Participants performed the TUG before (t1) and after (t2) exposure as the primary outcome measure. To assess the physiological and psychological impact of the stressful stimulus, heart rate variability (HRV) was recorded before and during image viewing. A visual analogue scale (VAS) of unease was completed both before and after the stimulus. Results: During the stressful stimulus, the HRV high-frequency (HF) band decreased significantly (p = 0.001), while the low-frequency (LF) band (p = 0.002) and the LF/HF ratio (p = 0.004) showed a significant increase. Similarly, after stressful stimulus, VAS scores demonstrated a statistically significant increase (p < 0.001). The time to complete the TUG showed a statistically significant increase at t2 (p < 0.001). Conclusions: The stressful stimulus triggered both physiological and subjective stress responses. Subsequently, TUG test performance declined (increased duration), suggesting that emotionally stressful stimuli could deteriorate functional balance performance in older adults, potentially increasing fall risk.
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(This article belongs to the Special Issue New Insights into Understudied Phenomena in Healthcare: Second Edition)
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Open AccessSystematic Review
Sleep, Stress, and Recovery as Predictors of Injury Risk in Soccer Players: A Systematic Review
by
Enrique Cantón, Joel Raga and David Peris-Delcampo
Healthcare 2026, 14(2), 236; https://doi.org/10.3390/healthcare14020236 (registering DOI) - 17 Jan 2026
Abstract
Introduction. Sleep is an essential component in the recovery, performance, and injury prevention processes of soccer players. Associated psychological variables, such as the balance between stress and recovery, have been less explored, despite their potential influence on rest and injury vulnerability. This
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Introduction. Sleep is an essential component in the recovery, performance, and injury prevention processes of soccer players. Associated psychological variables, such as the balance between stress and recovery, have been less explored, despite their potential influence on rest and injury vulnerability. This study aims to examine the relationship between sleep quality, quantity, and chronotype and injury risk in soccer players, also incorporating the modulating role of stress and recovery. Method. A PRISMA systematic review was conducted using searches in ScienceDirect, PubMed, Ovid, EBSCO, MDPI, Springer Nature Link, SPORTDiscuss (full text), and Dialnet. Original studies and reviews on sleep and its relationship with sports injuries in soccer players or comparable athletic populations were included. Eighteen studies were selected that addressed sleep indicators (quality, quantity, chronotype), injury incidence, and, to a lesser extent, measures of stress and recovery using instruments such as the RESTQ-Sport or wellness questionnaires. Results. There is evidence of an association between poor sleep quality or quantity and an increased risk of injury or illness. Chronotype is an emerging variable of interest, although still insufficiently researched. Regarding stress and recovery, direct evidence is limited, although studies that address this issue show that an imbalance between these two dimensions negatively impacts sleep quality and increases susceptibility to injury. Conclusions: Sleep and the stress–recovery balance are key and interdependent factors in the risk of injury in soccer players. Future research should consider including these variables to further understand the mechanisms underlying the injury process and optimize prevention and recovery strategies.
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(This article belongs to the Special Issue The Role of Physical Activity and Sports in Enhancing Psychological Well-Being and Quality of Life)
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Open AccessCase Report
Dysphagia After Cosmetic Submandibular Gland Botulinum Neurotoxin Type A Injection: A Case Report
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Seoyon Yang and You Gyoung Yi
Healthcare 2026, 14(2), 235; https://doi.org/10.3390/healthcare14020235 (registering DOI) - 17 Jan 2026
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Background: Cosmetic injection of botulinum neurotoxin type A (BoNT/A) into the submandibular glands is increasingly performed to enhance jawline contour. Although generally considered safe, unintended diffusion of the toxin can impair pharyngeal musculature and lead to dysphagia. Severe aspiration-prone dysphagia after esthetic
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Background: Cosmetic injection of botulinum neurotoxin type A (BoNT/A) into the submandibular glands is increasingly performed to enhance jawline contour. Although generally considered safe, unintended diffusion of the toxin can impair pharyngeal musculature and lead to dysphagia. Severe aspiration-prone dysphagia after esthetic submandibular gland injection has rarely been described. Case Presentation: A healthy 37-year-old woman developed acute oropharyngeal dysphagia the day after receiving cosmetic contouring injections with incobotulinumtoxinA (Xeomin®), administered to both submandibular glands (20 units per gland, performed without ultrasound guidance). She presented to our rehabilitation medicine clinic 11 days later with severe difficulty swallowing solids and liquids. Her functional oral intake was severely restricted (Functional Oral Intake Scale [FOIS] score 3), and the Eating Assessment Tool-10 (EAT-10) score was 24. Videofluoroscopic swallowing study (VFSS) demonstrated markedly delayed pharyngeal swallow initiation, reduced palatal elevation, poor airway protection, consistent laryngeal penetration, and silent aspiration of thin liquids (Penetration–Aspiration Scale score 8). She underwent diet modification and structured dysphagia rehabilitation. At three months, repeat VFSS showed substantial improvement, with only occasional penetration of large-volume thin liquids, corresponding to FOIS 5 and EAT-10 score 8. By five months, VFSS confirmed complete resolution of penetration and aspiration with normalization of swallowing physiology, reflected by a FOIS score of 7 and EAT-10 score of 1. Conclusions: This case demonstrates that cosmetic incobotulinumtoxinA injection into the submandibular glands, particularly when performed without ultrasound guidance, can lead to significant oropharyngeal dysphagia. Clinicians performing esthetic lower-face procedures should be aware of this potential complication and ensure timely swallowing evaluation and rehabilitation when symptoms arise.
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Open AccessReview
Manual Dexterity Training and Cognitive Function in Adults with Stroke: A Scoping Review
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Gema Moreno-Morente, Verónica Company-Devesa, Cristina Espinosa-Sempere, Paula Peral-Gómez, Vanesa Carrión-Téllez and Laura-María Compañ-Gabucio
Healthcare 2026, 14(2), 234; https://doi.org/10.3390/healthcare14020234 (registering DOI) - 17 Jan 2026
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Background: Acquired brain injury (ABI) affects manual dexterity (MD) and cognitive functions, limiting daily activity performance. Occupational therapy aims to improve functionality and quality of life. Objective: To examine and describe the available evidence on the impact of MD training on cognitive processes
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Background: Acquired brain injury (ABI) affects manual dexterity (MD) and cognitive functions, limiting daily activity performance. Occupational therapy aims to improve functionality and quality of life. Objective: To examine and describe the available evidence on the impact of MD training on cognitive processes and functional performance in adults with stroke, as well as to identify the most commonly used assessment tools and intervention techniques. Methods: Scoping review. A systematic literature search was conducted in PubMed and Scopus to identify experimental studies from the last 10 years involving adults with ABI who participated in interventions targeting upper-limb, MD, and cognitive function. A three-phase screening was carried out by two authors with duplicates removed using Zotero version 7.0. Results: Ten articles published between 2016 and 2023 were included. The most frequent interventions involved robotics and virtual reality. Eight studies were conducted by occupational therapists or included occupational therapy involvement, while two were conducted by physiotherapists. Training MD and upper-limb motor skills led to improvements in attention, memory, and executive functions. Conclusions: Findings support combined motor–cognitive interventions carried out by occupational therapists or physiotherapists to optimize rehabilitation outcomes, although further research is needed to strengthen the evidence.
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Open AccessSystematic Review
Sedentary Behavior and Low Back Pain in Children and Adolescents: A Systematic Review and Meta-Analysis
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Inmaculada Calvo-Muñoz, José Manuel García-Moreno, Antonia Gómez-Conesa and José Antonio López-López
Healthcare 2026, 14(2), 233; https://doi.org/10.3390/healthcare14020233 (registering DOI) - 16 Jan 2026
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Background/Objectives: Low back pain (LBP) is increasingly prevalent among children and adolescents and represents a growing public health concern due to its potential persistence into adulthood. Screen-based sedentary behavior has substantially increased in pediatric populations. However, evidence regarding its association with LBP
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Background/Objectives: Low back pain (LBP) is increasingly prevalent among children and adolescents and represents a growing public health concern due to its potential persistence into adulthood. Screen-based sedentary behavior has substantially increased in pediatric populations. However, evidence regarding its association with LBP remains inconsistent, and the existence of a dose–response relationship is not well established. Methods: A systematic review and meta-analysis of observational studies was conducted in accordance with PRISMA guidelines. Studies examining the association between screen-based sedentary behavior and LBP in children and adolescents aged 6–18 years were included. Random-effects meta-analyses were used to pool continuous exposure estimates, and a multivariate random-effects dose–response meta-analysis was performed to assess changes in LBP risk across increasing levels of daily screen time. Results: A total of 30 studies were included. The pairwise meta-analysis of continuous exposure showed no statistically significant association between screen time and LBP, with OR = 1.02 (95% CI 0.65 to 1.59). In contrast, the dose–response meta-analysis demonstrated a significant positive association, with a 26% (95% CI 8% to 48%) increase in the odds of LBP for each additional hour of daily screen time. High between-study heterogeneity was observed, and most studies relied on self-reported measures of screen exposure and LBP, which may have introduced recall and misclassification bias and warrants cautious interpretation of the findings. Conclusions: Higher levels of screen-based sedentary behavior were associated with an increased risk of LBP in children and adolescents when examined using a dose–response approach, whereas pairwise meta-analyses did not identify a significant association. Nevertheless, substantial between-study heterogeneity and high risk of bias limit causal inference and require cautious interpretation.
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Open AccessReview
Unregulated Substance Abuse and Systemic Inflammation Markers: A Review
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Carmen Lara-Apolinario, Jose Barroso, Jose Carlos Rodríguez-Gallego and Pedro C. Lara
Healthcare 2026, 14(2), 232; https://doi.org/10.3390/healthcare14020232 (registering DOI) - 16 Jan 2026
Abstract
Aim: There is an urgent need for systematic and well-designed studies to clarify the role of systemic inflammatory parameters, especially the neutrophil–lymphocyte-ratio (NLR), in the pathophysiology and clinical management of unregulated substance addiction. This review aims to synthesize current evidence on the relationship
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Aim: There is an urgent need for systematic and well-designed studies to clarify the role of systemic inflammatory parameters, especially the neutrophil–lymphocyte-ratio (NLR), in the pathophysiology and clinical management of unregulated substance addiction. This review aims to synthesize current evidence on the relationship between unregulated substance addiction and systemic inflammatory parameters, focusing specifically on the NLR as a potential biomarker. Methods: To ensure a transparent approach in the collection of evidence, this review was carried out following the recommendations of the PRISMA 2020 guidelines and registered in PROSPERO (CRD420251151136). We searched the PubMed and Scopus databases in July2025 using combinations of MeSH terms and keywords related to unregulated substance use and inflammatory biomarkers. The strategy included terms such as “cocaine,” “cannabis,” “opioids,” “heroin,” “fentanyl,” “methadone,” “buprenorphine” “nitazene”, “MDMA”, and “methamphetamine,” combined with “neutrophil-to-lymphocyte ratio.” Filters were applied to limit results to human studies published between 2015 and 2025 in English. The methodological quality of the studies included was assessed using the STROBE 22-item checklist. Results: Fifteen studies were included in this review. Methamphetamine and opioid users showed higher NLR and MLR values. For cocaine abuse, although the evidence is limited to a single population-based study, a significant increase in NLR was reported. Controversial results were observed for cannabis use. Conclusions: Systemic inflammation markers are related to unregulated substance abuse disorders; however, the sparse available evidence encourages the need for well-designed large, prospective clinical trials.
Full article
(This article belongs to the Special Issue Health Education and Prevention: New Healthcare Perspectives for Emerging Challenges)
Open AccessArticle
Lifestyle, Modifiable Behavioral Factors, and Biomarker Profiles in Uterine Lesions
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Anna Mihaylova, Antoniya Yaneva, Angelina Mollova-Kyosebekirova, Ekaterina Uchikova, Desislava Bakova, Mariya Koleva-Ivanova, Mariana Parahuleva and Nikoleta Parahuleva
Healthcare 2026, 14(2), 231; https://doi.org/10.3390/healthcare14020231 - 16 Jan 2026
Abstract
Background: Precursor endometrial lesions and endometrial cancer are strongly influenced by lifestyle-related risk factors, including obesity, low physical activity, and unfavorable dietary patterns. Identifying these factors is essential for early prevention and for improving health literacy among women. Objective: The objective
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Background: Precursor endometrial lesions and endometrial cancer are strongly influenced by lifestyle-related risk factors, including obesity, low physical activity, and unfavorable dietary patterns. Identifying these factors is essential for early prevention and for improving health literacy among women. Objective: The objective of this study was to evaluate the influence of modifiable lifestyle factors on the likelihood of developing EIN and endometrial cancer in comparison with leiomyoma. Materials and Methods: A cross-sectional analytical study was conducted among 50 women, divided into three groups: leiomyoma (n = 20), EIN (n = 15), and endometrial cancer (n = 15). BMI, physical activity, dietary habits, sleep duration, stress levels, and smoking status were assessed. Statistical analysis included the Kruskal–Wallis test, correlation analysis, and logistic regression. Results: BMI was identified as an independent predictor of EIN/EC (OR = 1.29; p = 0.015). Women with EIN/EC demonstrated significantly lower levels of physical activity (p = 0.018). A clustering of behavioral risks was observed: higher BMI was associated with higher stress and shorter sleep duration. Conclusions: Modifiable lifestyle factors play a key role in the development of precursor and malignant endometrial conditions. Targeted interventions focusing on weight management, increased physical activity, and improved health literacy may reduce risk and improve quality of life among peri- and postmenopausal women.
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Open AccessArticle
Nurses’ Clinical Reasoning Process: A Grounded Theory Study
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Susana Mendonça
Healthcare 2026, 14(2), 230; https://doi.org/10.3390/healthcare14020230 - 16 Jan 2026
Abstract
Background: Nurses’ clinical reasoning is increasingly being recognized as a core competence that enhances the quality and safety of care across diverse healthcare settings. Nurses with refined clinical reasoning skills contribute significantly to improved health outcomes and broader health gains. In emergency
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Background: Nurses’ clinical reasoning is increasingly being recognized as a core competence that enhances the quality and safety of care across diverse healthcare settings. Nurses with refined clinical reasoning skills contribute significantly to improved health outcomes and broader health gains. In emergency departments, this competence is essential to rapidly assessing complex problems, anticipating complications, and preventing the deterioration of patients’ clinical conditions. Such expertise enables nurses to discern the severity of clinical situations quickly and intervene effectively. Objectives: The aims of this study were to analyze the clinical reasoning process of nurses and develop a theory that explains this process in emergency care settings. Methodology: This qualitative study explored the following research question: “How do nurses enact the clinical reasoning process in emergency departments?” The Grounded Theory methodology was used, with a theoretical sample of 20 nurses. Data collection methods included in-depth interviews, participant observation, and field notes. Results: The theoretical analysis identified clinical reasoning as a substantive theory composed of two subprocesses: Diagnostic Nursing Assessment and Therapeutic Nursing Intervention. Nurses’ clinical reasoning determines two levels of patient severity—Level I, life-threatening situations (immediate risk), and Level II, non-life-threatening situations (expressed problems)—according to which nursing interventions are adjusted. Conclusions: The Nursing Clinical Reasoning Model is a dynamic and continuous process that involves both Diagnostic Nursing Assessment and Nursing Therapeutic Intervention. It is deeply rooted in the nurse–patient–family relationship and is shaped by the specific care context, which influences nurses’ assessments and interventions and patients’ responses and behaviors.
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(This article belongs to the Special Issue Clinical Reasoning in Primary Care)
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Open AccessArticle
Improving Mental Health, Self-Efficacy and Social Support in Older People Through Community Intervention Based on Mindfulness: A Quasi-Experimental Study
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Denis Juraga, Darko Roviš, Mihaela Marinović Glavić, Lovorka Bilajac, Maša Antonić, Hein Raat and Vanja Vasiljev
Healthcare 2026, 14(2), 229; https://doi.org/10.3390/healthcare14020229 - 16 Jan 2026
Abstract
Background: Aging is a complex process that involves various biological, psychological and social changes. Moreover, older people (≥65 years) are more susceptible to lower self-efficacy and social support, as well as deteriorating mental health. As the global population ages, there is a growing
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Background: Aging is a complex process that involves various biological, psychological and social changes. Moreover, older people (≥65 years) are more susceptible to lower self-efficacy and social support, as well as deteriorating mental health. As the global population ages, there is a growing demand for evidence-based interventions tailored to address specific mental health problems, enhance social support and improve overall well-being. The aim of this study was to investigate the effectiveness of a seven-week mindfulness-based community intervention on mental health, self-efficacy and social support in older people. Methods: This quasi-experimental nonrandomized study included 257 participants who were divided into an intervention group and a comparison group that did not participate in the seven-week mindfulness-based community intervention and was not part of a waiting list. Assessments were conducted before the intervention began and 6 months after its completion. Results: The results revealed a significant reduction in depression in the intervention group (p < 0.001). Furthermore, the intervention led to a significant improvement in general self-efficacy, chronic disease self-management self-efficacy, physical activity and nutritional self-efficacy compared with the comparison group. Perceived social support increased within the intervention group; however, covariate adjusted between-group effects for social support were not statistically significant. Conclusions: Overall, the mindfulness-based community intervention was associated with improvements in current depressive symptoms and multiple self-efficacy domains at 6-month follow-up in older people in a community setting. Effects on perceived social support were less robust, and no statistically significant between-group differences were observed after adjustment for baseline covariates. The results of the present study show that this program leads to immediate health benefits in terms of mental health and self-efficacy in older people while contributing to the development of effective strategies for chronic disease self-management.
Full article
(This article belongs to the Special Issue Public Health Prevention Through Integrative Medicine: Community-Based and Society-Level Interventions)
Open AccessArticle
IFRA: A Machine Learning-Based Instrumented Fall Risk Assessment Scale Derived from an Instrumented Timed Up and Go Test in Stroke Patients
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Simone Macciò, Alessandro Carfì, Alessio Capitanelli, Peppino Tropea, Massimo Corbo, Fulvio Mastrogiovanni and Michela Picardi
Healthcare 2026, 14(2), 228; https://doi.org/10.3390/healthcare14020228 - 16 Jan 2026
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Background/Objectives: Falls represent a major health concern for stroke survivors, necessitating effective risk assessment tools. This study proposes the Instrumented Fall Risk Assessment (IFRA) scale, a novel screening tool derived from Instrumented Timed Up and Go (ITUG) test data, designed to capture mobility
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Background/Objectives: Falls represent a major health concern for stroke survivors, necessitating effective risk assessment tools. This study proposes the Instrumented Fall Risk Assessment (IFRA) scale, a novel screening tool derived from Instrumented Timed Up and Go (ITUG) test data, designed to capture mobility measures often missed by traditional scales. Methods: We employed a two-step machine learning approach to develop the IFRA scale: first, identifying predictive mobility features from ITUG data and, second, creating a stratification strategy to classify patients into low-, medium-, or high-fall-risk categories. This study included 142 participants, who were divided into training (including synthetic cases), validation, and testing sets (comprising 22 non-fallers and 10 fallers). IFRA’s performance was compared against traditional clinical scales (e.g., standard TUG and Mini-BESTest) using Fisher’s Exact test. Results: Machine learning analysis identified specific features as key predictors, namely vertical and medio-lateral acceleration, and angular velocity during walking and sit-to-walk transitions. IFRA demonstrated a statistically significant association with fall status (Fisher’s Exact test p = 0.004) and was the only scale to assign more than half of the actual fallers to the high-risk category, outperforming the comparative clinical scales in this dataset. Conclusions: This proof-of-concept study demonstrates IFRA’s potential as an automated, complementary approach for fall risk stratification in post-stroke patients. While IFRA shows promising discriminative capability, particularly for identifying high-risk individuals, these preliminary findings require validation in larger cohorts before clinical implementation.
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Open AccessArticle
Perceptions of Individuals/Patients with Temporomandibular Disorders About Their Diagnosis, Information Seeking and Treatment Expectations: A Comparative Qualitative Study of Brazilian and Spanish Individuals
by
Luana Maria Ramos Mendes, María Palacios-Ceña, Domingo Palacios-Ceña, María-Luz Cuadrado, Farzin Falahat, Miguel Alonso-Juarranz, Jene Carolina Silva Marçal, Milena Dietrich Deitos Rosa, Débora Bevilaqua-Grossi and Lidiane Lima Florencio
Healthcare 2026, 14(2), 227; https://doi.org/10.3390/healthcare14020227 - 16 Jan 2026
Abstract
Background: Considering the significant impact on quality of life and the chronic nature of temporomandibular dysfunction (TMD), seeking healthcare is also part of the reality of individuals with this disorder. However, cultural differences and similarities in the experiences of individuals with TMD have
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Background: Considering the significant impact on quality of life and the chronic nature of temporomandibular dysfunction (TMD), seeking healthcare is also part of the reality of individuals with this disorder. However, cultural differences and similarities in the experiences of individuals with TMD have not yet been investigated. This study aimed to describe and compare the experiences, beliefs, and sociocultural factors of Brazilian and Spanish individuals with TMD, focusing on their perceptions of the disorder, diagnostic pathways, information-seeking behaviors, and treatment expectations. Methods: A descriptive qualitative study was conducted. A purposive sample of 50 participants (25 Brazilian, 25 Spanish), aged 18–50 and diagnosed with TMD according to DC/TMD criteria, was recruited. Data were obtained through semi-structured interviews and analyzed using thematic analysis. Results: Six themes emerged, revealing both similarities and differences between the groups. Brazilian participants reported uncertainty about which professional to consult and difficulty accessing specialized care. In contrast, Spanish participants frequently sought physical therapists as their first option and identified them as primary sources of information. Beliefs about TMD etiology varied across samples. Treatment expectations also differed. Brazilians emphasized the difficulty of obtaining effective care, while Spanish participants perceived physiotherapy as being limited to muscular disorders. Perceptions of occlusal splint effectiveness showed variation between the groups. Conclusions: These findings underscore the necessity of culturally sensitive approaches to patient care that address not only clinical aspects, but also the sociocultural context that influences health behaviors.
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(This article belongs to the Special Issue Application of Qualitative Methods and Mixed Designs in Healthcare)
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Open AccessArticle
Relationships Between Fear of Cancer Recurrence, Unmet Healthcare Needs, and Quality of Life Among Thai Breast Cancer Survivors Post-Treatment
by
Patcharaporn Pichetsopon, Piyawan Pokpalagon and Nipaporn Butsing
Healthcare 2026, 14(2), 226; https://doi.org/10.3390/healthcare14020226 - 16 Jan 2026
Abstract
Purpose: This study examined the relationships among fear of cancer recurrence (FCR), unmet healthcare needs, and quality of life (QOL) among breast cancer survivors post-treatment, particularly within the Thai cultural and healthcare context, where limited research has been conducted. Methods: A
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Purpose: This study examined the relationships among fear of cancer recurrence (FCR), unmet healthcare needs, and quality of life (QOL) among breast cancer survivors post-treatment, particularly within the Thai cultural and healthcare context, where limited research has been conducted. Methods: A cross-sectional descriptive correlational design with purposive sampling was used. A total of 122 breast cancer survivors, 1–5 years prior, were recruited from the Breast Clinic and Chemotherapy Unit at the National Cancer Institute. Instruments included a demographic questionnaire, the FCR Inventory Short Form, the Cancer Survivors’ Unmet Needs measure, and the EORTC QOL-C30 with the breast cancer module (QLQ-BR23). Cronbach’s α ranged from 0.82 to 0.92. Data were analyzed using descriptive statistics, Spearman’s rank correlation, and Pearson’s correlation coefficient. Results: Participants reported moderate levels of FCR (M = 13.39, SD = 4.50), low unmet healthcare needs (M = 25.63, SD = 14.82), and moderate overall QOL (M = 54.82, SD = 0.22). FCR was negatively correlated with overall QOL (r = −0.248, p <0.01) and functional QOL (r = −0.242, p < 0.01). Unmet healthcare needs were also negatively correlated with overall QOL (r = −0.261, p < 0.01). Multiple linear regression analysis revealed that both FCR and unmet healthcare needs had a significantly negative relationship with overall QOL (p < 0.05). Conclusions: FCR and unmet healthcare needs independently impair QOL among breast cancer survivors. Early, culturally appropriate survivorship care in Asian contexts is essential to address these needs and improve QOL.
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Open AccessReview
Exploring Gender Differences in Adolescent Psychiatric Disorders: A Decade of Research
by
Lidia Ricci, Pasquale Ricci, Angiola Avallone, Monica Calderaro, Giorgia Cafiero, Leonardo Iovino and Rosaria Ferrara
Healthcare 2026, 14(2), 225; https://doi.org/10.3390/healthcare14020225 - 16 Jan 2026
Abstract
Background: Adolescence is a developmental phase characterised by profound biological, emotional and social changes and these changes make adolescents particularly vulnerable to the emergence of psychiatric disorders. In this context, gender differences in mental health disorders are of increasing clinical interest. Method:
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Background: Adolescence is a developmental phase characterised by profound biological, emotional and social changes and these changes make adolescents particularly vulnerable to the emergence of psychiatric disorders. In this context, gender differences in mental health disorders are of increasing clinical interest. Method: We conducted a scoping review of the literature regarding gender differences in psychiatric disorders during adolescence. Three databases, PubMed, Web of Science and EBSCO, were used to identify articles published in English from 2015 until 2025. Twenty-one studies fulfilled the inclusion criteria. Results: Ten studies deal with mood disorders, with a focus on gender differences in depression and anxiety during adolescence. Two articles analyse eating disorders, highlighting that girls show higher levels of food restriction and body dissatisfaction. Two studies focus on externalising and neurobehavioural disorders, showing a higher prevalence in boys than in girls. Four articles examine self-harm and suicidal behaviour, where girls report higher rates of suicidal ideation and self-harm. Finally, two studies address personality disorders in adolescence, noting a higher incidence of borderline traits and impulsive behaviour among girls. Conclusions: Research has revealed gender differences in the onset, frequency and factors associated with psychiatric disorders in adolescence. Understanding these differences is essential for developing prevention strategies, early diagnosis and specific interventions.
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(This article belongs to the Section Mental Health and Psychosocial Well-being)
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Open AccessArticle
The Impact of Compassion Fatigue on the Psychological Well-Being of Nurses Caring for Patients with Dementia: A Cross-Sectional Post-COVID-19 Data Analysis
by
Maria Topi, Paraskevi Tsioufi, Evangelos C. Fradelos, Foteini Malli, Evmorfia Koukia and Polyxeni Mangoulia
Healthcare 2026, 14(2), 224; https://doi.org/10.3390/healthcare14020224 - 16 Jan 2026
Abstract
Background/Objectives: Nurses are susceptible to compassion fatigue due to the nature of their professional responsibilities. Factors contributing to this vulnerability include daily patient interactions and organizational elements within their work environment, as well as work-related stress and sociodemographic characteristics, including age, marital status,
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Background/Objectives: Nurses are susceptible to compassion fatigue due to the nature of their professional responsibilities. Factors contributing to this vulnerability include daily patient interactions and organizational elements within their work environment, as well as work-related stress and sociodemographic characteristics, including age, marital status, years of professional experience, and, notably, gender. This research investigates the relationship between compassion fatigue and the levels of anxiety and depression, as well as the professional quality of life among nurses providing care to dementia patients in Greece. Methods: A cross-sectional survey was carried out with 115 nurses working in dementia care centers in Greece. The Hospital Anxiety and Depression Scale (HADS), the Professional Quality of Life Scale (ProQOL-5), and the participants’ personal, demographic, and professional information were all included in an electronic questionnaire. Multiple regression analysis was used. Results: A total of 42.6% of nurses rated their working environment as favorable. Additionally, 23.5% of the sample exhibited high levels of compassion satisfaction, whereas 46.1% demonstrated low levels of burnout. Female gender (p = 0.022) and a higher family income (p = 0.046) was positively associated with compassion satisfaction. Regression analysis indicated that elevated symptoms of anxiety and depression were found to correlate with decreased compassion satisfaction, increased burnout, and heightened secondary post-traumatic stress. Conclusions: Engaging in the care of patients with dementia, particularly throughout the pandemic period, has underscored a pronounced susceptibility to compassion fatigue, physical fatigue, pain, psychological stress, and a reduced quality of life. These results highlight the importance for nursing management to adopt specific organizational measures, including proper staffing levels, balancing workloads, and conducting routine mental health assessments.
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(This article belongs to the Section Healthcare Quality, Patient Safety, and Self-care Management)
Open AccessArticle
Mental Health and Alcohol Consumption Among University Students in the Post-Pandemic Context: An Exploratory Cross-Sectional Study in Portugal
by
Maria Teresa Moreira, Maria Inês Guimarães, Augusta Silveira, Beatriz Loibl, Beatriz Guedes, Hugo Ferraz, Inês Castro, Sofia Mira de Almeida, Inês Lopes Cardoso, Sandra Rodrigues and Andreia Lima
Healthcare 2026, 14(2), 223; https://doi.org/10.3390/healthcare14020223 - 16 Jan 2026
Abstract
Introduction: The COVID-19 pandemic had significant effects on mental health and lifestyle behaviours, especially among university students who experienced academic disruptions, social isolation, and fewer social interactions. Alcohol consumption has long been part of student culture. Still, the influence of post-pandemic academic reintegration
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Introduction: The COVID-19 pandemic had significant effects on mental health and lifestyle behaviours, especially among university students who experienced academic disruptions, social isolation, and fewer social interactions. Alcohol consumption has long been part of student culture. Still, the influence of post-pandemic academic reintegration on drinking patterns and psychological distress remains relatively unexplored, particularly in countries like Portugal, where student traditions heavily shape consumption habits. This study aimed to describe the prevalence of alcohol consumption, depression, anxiety, and stress in a sample of Portuguese university students during the post-pandemic academic period, and to explore associations with sociodemographic variables. Methods: A cross-sectional study was conducted in November 2021 with 90 students from a private higher education institution in northern Portugal. Data were collected via an online questionnaire including sociodemographic information, the Alcohol Use Disorders Identification Test (AUDIT), and the Depression, Anxiety and Stress Scale (DASS-21). Result: The majority of the participants were not at risk of alcohol addiction (95.3%). In total, 15.1% of students reported anxiety symptoms ranging from severe to extremely severe. A binomial logistic regression was performed to ascertain the effects of being away from home and psychological distress (DASS-42 score), on the likelihood that participants were at risk of alcohol addiction (Level 3 and 4 in the AUDIT scale). The logistic regression model was statistically significant, χ2(2) = 9.20, p = 0.010. Living away from home was associated with a substantially lower likelihood of high-risk status (B = −2.79, p = 0.034), corresponding to an odds ratio of 0.06, indicating a strong protective effect. DASS-42 total score was positively associated with high-risk status (B = 0.04, p = 0.039), such that higher psychological distress increased the odds of being classified as high risk. Conclusions: The findings reveal a low prevalence of alcohol risk but heightened symptoms of anxiety, depression, and stress. Psychological distress notably increases the likelihood of hazardous alcohol use, emphasising the importance of targeted mental health and alcohol-use interventions among university students.
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Open AccessSystematic Review
Does Paying the Same Sustain Telehealth? A Systematic Review of Payment Parity Laws
by
Alina Doina Tanase, Malina Popa, Bogdan Hoinoiu, Raluca-Mioara Cosoroaba and Emanuela-Lidia Petrescu
Healthcare 2026, 14(2), 222; https://doi.org/10.3390/healthcare14020222 - 16 Jan 2026
Abstract
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Background and Objectives: Payment parity laws require commercial health plans to pay for telehealth on the same basis as in-person care. We systematically reviewed open-access empirical studies to identify and synthesize empirical U.S. studies that explicitly evaluated state telehealth payment parity (distinct
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Background and Objectives: Payment parity laws require commercial health plans to pay for telehealth on the same basis as in-person care. We systematically reviewed open-access empirical studies to identify and synthesize empirical U.S. studies that explicitly evaluated state telehealth payment parity (distinct from coverage-only parity) and to summarize reported effects on telehealth utilization, modality mix, quality/adherence, equity/access, and expenditures. Methods: Following PRISMA 2020, we searched PubMed/MEDLINE, Scopus, and Web of Science for U.S. studies that explicitly modeled state payment parity or stratified results by payment parity vs. coverage-only vs. no parity. We included original quantitative or qualitative studies with a time or geographic comparator and free full-text availability. The primary outcome was telehealth utilization (share or odds of telehealth use); secondary outcomes were modality mix, quality and adherence, equity and access, and spending. Because designs were heterogeneous (interrupted time series [ITS], difference-in-differences [DiD], regression, qualitative), we used structured narrative synthesis. Results: Nine studies met inclusion criteria. In community health centers (CHCs), payment parity was associated with higher telehealth use (42% of visits in parity states vs. 29% without; Δ = +13.0 percentage points; adjusted odds ratio 1.74, 95% CI 1.49–2.03). Among patients with newly diagnosed cancer, adjusted telehealth rates were 23.3% in coverage + payment parity states vs. 19.1% in states without parity, while cross-state practice limits reduced telehealth use (14.9% vs. 17.8%). At the health-system level, parity mandates were linked to a +2.5-percentage-point telemedicine share in 2023, with mental-health (29%) and substance use disorder (SUD) care (21%) showing the highest telemedicine shares. A Medicaid coverage policy bundle increased live-video use by 6.0 points and the proportion “always able to access needed care” by 11.1 points. For hypertension, payment parity improved medication adherence, whereas early emergency department and hospital adoption studies found null associations. Direct spending evidence from open-access sources remained sparse. Conclusions: Across ambulatory settings—especially behavioral health and chronic disease management—state payment parity laws are consistently associated with modest but meaningful increases in telehealth use and some improvements in adherence and perceived access. Effects vary by specialty and are attenuated where cross-state practice limits persist, and the impact of payment parity on overall spending remains understudied.
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