Healthcare

15 pages, 603 KB

Open AccessArticle

Loneliness and Its Association with Depression, Aspiration Risk, and Conversation in Japanese Older Adults

by Naoki Maki, Hitomi Matsuda, Sachie Eto, Akihiro Araki, Toshifumi Takao and Thomas Mayers

Healthcare 2026, 14(2), 190; https://doi.org/10.3390/healthcare14020190 - 12 Jan 2026

Background/Objectives: Loneliness is a critical public health concern associated with adverse mental and physical health outcomes in later life. However, few large-scale studies have examined loneliness in relation to depression, aspiration risk, frailty, and social participation among Japanese older adults. This study examined [...] Read more.

Background/Objectives: Loneliness is a critical public health concern associated with adverse mental and physical health outcomes in later life. However, few large-scale studies have examined loneliness in relation to depression, aspiration risk, frailty, and social participation among Japanese older adults. This study examined associations between loneliness and psychosocial and health-related factors among older adults. Methods: This cross-sectional study involved a secondary analysis of data obtained from online surveys conducted in 2018 and 2021 among 1000 community-dwelling Japanese adults (≥65 years). Loneliness was assessed using the UCLA Loneliness Scale Version 3 and dichotomized at the median to define a high-loneliness group. Depressive symptoms, aspiration risk, frailty, conversation frequency, and volunteering participation were assessed using validated scales. Multivariable logistic regression was used to identify factors associated with loneliness and interaction terms were examined to assess effect modification. Results: High loneliness was observed in 52.2% of participants. Greater loneliness was significantly associated with depressive symptoms (GDS ≥ 5; OR = 4.69, 95% CI: 2.84–7.76), higher dysphagia risk (DRACE score; OR = 1.08, 95% CI: 1.00–1.16), and lower daily conversation frequency (OR = 0.76, 95% CI: 0.67–0.86); however, volunteering (OR = 0.475, 95% CI: 0.23–0.87) was a protective factor. Conclusions: Loneliness among Japanese older adults is closely linked to depressive symptoms and aspiration risk, while frequent conversations and volunteer participation appear to be protective. Community-based interventions promoting social engagement and oral health may mitigate loneliness and its health consequences and improve quality of life for older adults. Given the cross-sectional design, the observed associations should not be interpreted as causal. Full article

(This article belongs to the Special Issue Preventing Frailty and Improving Quality of Life in Older Adults: Perspectives on Exercise and Nutrition Medicine)

► Show Figures

Figure 1

24 pages, 1950 KB

Open AccessArticle

Lifestyle and Chronic Comorbidity in Relation to Healthy Ageing in Community-Dwelling People Aged 80 and over: Preliminary Study from a Primary Health Care Service in Southern Spain

by Alberto Jesús García-Zayas, María del Carmen Márquez-Tejero, Juan Luis González-Caballero and Carmen Gómez-Gómez

Healthcare 2026, 14(2), 189; https://doi.org/10.3390/healthcare14020189 - 12 Jan 2026

Abstract

Background/Objectives: Healthy ageing, focused on maintaining daily autonomy and cognitive function despite chronic comorbidities, poses a challenge for public health systems, especially for those aged ≥80, given the expected increase in this population. Promoting a healthy lifestyle in this group is essential [...] Read more.

Background/Objectives: Healthy ageing, focused on maintaining daily autonomy and cognitive function despite chronic comorbidities, poses a challenge for public health systems, especially for those aged ≥80, given the expected increase in this population. Promoting a healthy lifestyle in this group is essential to achieving this goal, with primary care services playing a key role in this effort. Therefore, our objective was to profile the participants based on these characteristics. Methods: The study included 222 non-institutionalized, dementia-free individuals (mean age 84.58 ± 3.72 years, 56.3% women) recruited from a primary healthcare service. Data were collected from medical records and interviews, including the cognitive Pfeiffer test, the functional Barthel index (BI), and ad hoc questionnaires (for lifestyle variables). Latent profiling analysis (LPA) was used to classify the participants. Results: The participants reported social support (97.7%), low-risk alcohol consumption (94.6%), adherence to the Mediterranean diet (85.1%), physical activity (74.8%), and never smoking (72.5%). Hypertension (86.5%), cataracts (74.3%), and osteoarticular diseases (68.5%) were the most frequent chronic conditions. Women showed a significantly different distribution of certain variables and a higher number of comorbidities (6.34 ± 2.38) than men (5.58 ± 2.44) (p = 0.019). After LPA, we found that 38.29% of individuals met characteristics compatible with healthy ageing, predominantly male (60%); the association of a high probability of cognitive impairment with a high degree (severe or total), exhibited by the profiles likely >85% women (18.5% of individuals); physical activity, smoking, osteoporosis, anxiety, COPD, chronic kidney disease (CKD), and creatinine blood levels exhibited statistical differences between profiles; and the probability of dependence severity was associated with an increase in age, although cognitive status conservation was associated being male. Conclusions: The studied +80 group seems to follow a healthy lifestyle, as self-reported. Women fare worse than men in resilient ageing. While common factors related to dysfunctionality did not differentiate between profiles, CKD, an increasingly common age-related condition, did. Full article

(This article belongs to the Special Issue Impact of Lifestyle, Health Conditions and Medical and Family Care on the Quality of Life of the 80+)

► Show Figures

Figure 1

20 pages, 1018 KB

Open AccessStudy Protocol

Feasibility and Acceptability of a Novel Algorithm for Physicians to Prescribe Personalized Exercise Prescriptions to Patients with Cardiovascular Disease Risk Factors: Study Protocol for an Exploratory Randomized Controlled Crossover Trial

by Alexander J. Wright, Gregory A. Panza, Antonio B. Fernandez, Peter F. Robinson, Victoria R. DeScenza, Ming-Hui Chen, Elaine C. Lee, Margaux A. Guidry and Linda S. Pescatello

Healthcare 2026, 14(2), 188; https://doi.org/10.3390/healthcare14020188 - 12 Jan 2026

Abstract

Background: Approximately half of U.S. adults have ≥1 cardiovascular disease (CVD) risk factors. Exercise is universally recommended as a first-line lifestyle therapy to prevent and treat CVD. Objective: We will conduct a feasibility and pilot efficacy randomized controlled trial to test the usability [...] Read more.

Background: Approximately half of U.S. adults have ≥1 cardiovascular disease (CVD) risk factors. Exercise is universally recommended as a first-line lifestyle therapy to prevent and treat CVD. Objective: We will conduct a feasibility and pilot efficacy randomized controlled trial to test the usability and user satisfaction of an evidence-based digital health tool we developed for physicians—the Prioritizes Personalizes Prescribes EXercise algorithm (P3-EX)—to treat patients with CVD risk factors (ClinicalTrials.gov: NCT07238556). Methods: We will recruit 24 physicians who do not prescribe written exercise prescriptions (ExRx) from two local CT hospitals. Physicians will recruit two patients each (N = 48); both patients must have CVD risk factors. Each physician will deliver a P3-EX ExRx to one patient (n = 24) and the Physical Activity Vital Sign ExRx to the other patient (n = 24) in a random sequence crossover design. Physicians and patients will rate the feasibility and acceptability of each ExRx method using validated questionnaires. Patients will perform their ExRx for 12 weeks and complete an exercise diary to monitor exercise adherence with weekly virtual oversight by Research Assistants. Before and after the exercise intervention, we will measure patient CVD risk factors and physical activity levels via accelerometry. Results: This trial has received Institutional Review Board approval (E-HHC-2025-0198) and will begin in January 2026, with findings published in 2027. Conclusions: This protocol provides the scientific rationale and methodology to test P3-EX within a real-world clinical setting, to inform the feasibility of using P3-EX as a digital health support tool by physicians, and preliminary efficacy of P3-EX to improve patient cardiovascular health and physical activity levels. Full article

► Show Figures

Figure 1

13 pages, 1168 KB

Open AccessArticle

Translation and Population-Based Validation of the Arabic Version of the Fullerton Advanced Balance Scale

by Fayaz Khan

Healthcare 2026, 14(2), 187; https://doi.org/10.3390/healthcare14020187 - 12 Jan 2026

Abstract

Background/Objective: This study aimed to translate the Fullerton Advanced Balance Scale (FAB) into Arabic and assess the instrument’s reliability and validity. Methods: The study was carried out in two distinct stages: (i) the translation and adaptation process utilizing the ‘forward-back’ translation method and [...] Read more.

Background/Objective: This study aimed to translate the Fullerton Advanced Balance Scale (FAB) into Arabic and assess the instrument’s reliability and validity. Methods: The study was carried out in two distinct stages: (i) the translation and adaptation process utilizing the ‘forward-back’ translation method and (ii) the psychometric evaluation of the Arabic version of the FAB-A among a sample of 68 older persons residing in the community. Results: The internal consistency of the FAB-A was excellent (Cronbach’s alpha = 0.86). The Intraclass Correlation Coefficient (ICC) for the inter-rater tests (ICC = 0.96, p ≤ 0.001) and the intra-rater tests (ICC = 0.95, p ≤ 0.001) were excellent and significant. The scale showed a strong correlation with the Berg Balance Scale (r = 0.75). The sampling adequacy for factor analysis was proven by a Kaiser–Meyer–Olkin value of 0.84. The goodness of fit (GFI) statistics for the model were in the acceptable range (Chi-square/Degree of freedom (CMIN/DF) = 1.38, Goodness-of-Fit Index (GFI) = 0.88, Comparative Fit Index (CFI) = 0.95, Root Mean Square Error of Approximation (RMSEA) = 0.07). Conclusions: The FAB-A has demonstrated excellent psychometric qualities for measuring balance in older adults. Full article

(This article belongs to the Special Issue Integrative Approaches to Musculoskeletal Disorders, Health-Related Issues and Physical Fitness: From Diagnosis to Management)

► Show Figures

Figure 1

17 pages, 388 KB

Open AccessArticle

Considering Glucagon-like Peptide-1 Receptor Agonists (GLP-1RAs) for Weight Loss: Insights from a Pragmatic Mixed-Methods Study of Patient Beliefs and Barriers

by Regina DePietro, Isabella Bertarelli, Chloe M. Zink, Shannon M. Canfield, Jamie Smith and Jane A. McElroy

Healthcare 2026, 14(2), 186; https://doi.org/10.3390/healthcare14020186 - 12 Jan 2026

Abstract

Background/Objective: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have received widespread attention as effective obesity treatments. However, limited research has examined the perspectives of patients contemplating GLP-1RAs. This study explored perceptions, motivations, and barriers among individuals considering GLP-1RA therapy for obesity treatment, with the [...] Read more.

Background/Objective: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have received widespread attention as effective obesity treatments. However, limited research has examined the perspectives of patients contemplating GLP-1RAs. This study explored perceptions, motivations, and barriers among individuals considering GLP-1RA therapy for obesity treatment, with the goal of informing patient-centered care and enhancing clinician engagement. Methods: Adults completed surveys and interviews between June and November 2025. In this pragmatic mixed-methods study, both survey and interview questions explored perceived benefits, barriers, and decision-making processes. Qualitative data, describing themes based on the Health Belief Model, were analyzed using Dedoose (version 9.0.107), and quantitative data were analyzed using SAS (version 9.4). Participant characteristics included marital status, income, educational attainment, employment status, insurance status, age, race/ethnicity, and sex. Anticipated length on GLP-1RA medication and selected self-reported health conditions (depression, anxiety, hypertension, heart disease, back pain, joint pain), reported physical activity level, and perceived weight loss competency were also recorded. Results: Among the 31 non-diabetic participants who were considering GLP-1RA medication for weight loss, cost emerged as the most significant barrier. Life course events, particularly (peri)menopause among women over 44, were commonly cited as contributors to weight gain. Participants expressed uncertainty about eligibility, long-term safety, and treatment expectations. Communication gaps were evident, as few participants initiated discussions and clinician outreach was rare, reflecting limited awareness and discomfort around the topic. Conclusions: Findings highlight that individuals considering GLP-1RA therapy face multifaceted emotional, financial, and informational barriers. Proactive, empathetic clinician engagement, through validation of prior efforts, clear communication of risks and benefits, and correction of misconceptions, can support informed decision-making and align treatment with patient goals. Full article

(This article belongs to the Special Issue Health Education and Prevention: New Healthcare Perspectives for Emerging Challenges)

► Show Figures

Figure 1

16 pages, 425 KB

Open AccessArticle

The Link Between Physical Fitness and Cognitive Function in Vulnerable Low-Income Older Adults from Amazonas, Brazil

by Duarte Henriques-Neto, Alex Barreto de Lima, Miguel Peralta, Adilson Marques, Marcelo de Maio Nascimento and Andreas Ihle

Healthcare 2026, 14(2), 185; https://doi.org/10.3390/healthcare14020185 - 12 Jan 2026

Abstract

Background: Studies on the association between cognitive and physical fitness in older adults from particularly vulnerable settings are scarce. This study aims to analyse the relationship between different protocols for assessing physical fitness and the cognitive function of low-income older adults. Methods [...] Read more.

Background: Studies on the association between cognitive and physical fitness in older adults from particularly vulnerable settings are scarce. This study aims to analyse the relationship between different protocols for assessing physical fitness and the cognitive function of low-income older adults. Methods: A total of 312 adults aged 60–96 years (M age = 72.63, SD= 7.81) living in the urban area of Amazonas, Brazil, participated in the study. The following measures of physical fitness were assessed: body composition, handgrip strength, the Five Times Sit-to-Stand Test and Senior Fitness Tests. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Linear regression models were used to analyse the relationship between physical function measures and cognitive function. Results: For men, only the 30-chair stand test power (β = 0.33, p < 0.001) presented favourable association with cognitive function. For women, significant associations between MMSE score were observed for every fitness test, except for the chair sit-and-reach test. Conclusions: Physical fitness is differently associated with cognitive function among low-income older men and women from Amazonas. Muscular fitness particularly seems to be an important indicator of cognitive function. It should be considered for monitoring, promoting, and managing health-ageing of low-income elderly populations of both sexes. Full article

► Show Figures

Figure 1

14 pages, 884 KB

Open AccessArticle

Multidomain Predictors of Four-Year Risk for Dementia and Mild Cognitive Impairment Among Community-Dwelling Korean Older Adults

by Jinhee Shin, Hyebeen Sim, Kennedy Diema Konlan and Chang Gi Park

Healthcare 2026, 14(2), 184; https://doi.org/10.3390/healthcare14020184 - 12 Jan 2026

Abstract

Background: Dementia and mild cognitive impairment (MCI) are major public health concerns in rapidly aging societies. However, evidence from non-Western populations with self- or proxy-reported physician-diagnosed cognitive outcomes remains limited. Methods: This study investigated the four-year (2018–2022) incidence of self- or proxy-reported dementia [...] Read more.

Background: Dementia and mild cognitive impairment (MCI) are major public health concerns in rapidly aging societies. However, evidence from non-Western populations with self- or proxy-reported physician-diagnosed cognitive outcomes remains limited. Methods: This study investigated the four-year (2018–2022) incidence of self- or proxy-reported dementia and MCI, and their multidomain risk markers in a nationally representative sample of 3432 Korean adults aged ≥ 65 years from the Korean Longitudinal Study of Aging. Weighted descriptive analyses and multinomial logistic regression accounting for the complex survey design (sampling weights, strata, and clusters) were used to identify demographic, functional, mental health, and social factors associated with the incidence of cognitive impairment. Adjusted predicted probabilities were estimated for age, depressive symptoms, and instrumental activities of daily living (IADL). Results: Over the four-year follow-up period, among 3432 initially cognitively normal community-dwelling older adults, 34 participants developed MCI and 70 developed dementia. Older age, increased IADL impairment, depressive symptoms, and multimorbidity were significantly associated with a higher likelihood of incident cognitive impairment, while living with family was associated with a lower likelihood. Frequent social interaction showed a protective association against dementia. Predicted probabilities demonstrated overall increasing trends across age, depressive symptoms, and IADL, reflecting general risk patterns. Conclusions: These findings emphasize the importance of multidomain assessments for early detection and community-based prevention strategies. By identifying key clinical and social markers, this study provides culturally relevant evidence to support dementia risk management in rapidly aging populations, highlighting the protective roles of family co-residence and frequent social interaction among Korean older adults. Full article

(This article belongs to the Special Issue Advances in Chronic Disease Management, Rehabilitation, and Health Outcomes)

► Show Figures

Figure 1

18 pages, 2138 KB

Open AccessReview

Integrating Ophthalmology, Endocrinology, and Digital Health: A Bibliometric Analysis of Telemedicine for Diabetic Retinopathy

by Theofilos Kanavos and Effrosyni Birbas

Healthcare 2026, 14(2), 183; https://doi.org/10.3390/healthcare14020183 - 12 Jan 2026

Abstract

Background/Objectives: Telemedicine has emerged as a pivotal approach to improving access to diabetic retinopathy (DR) screening, diagnosis, management, and monitoring. Over the past two decades, rapid advancements in digital imaging, mobile health technologies, and artificial intelligence have substantially expanded the role of teleophthalmology [...] Read more.

Background/Objectives: Telemedicine has emerged as a pivotal approach to improving access to diabetic retinopathy (DR) screening, diagnosis, management, and monitoring. Over the past two decades, rapid advancements in digital imaging, mobile health technologies, and artificial intelligence have substantially expanded the role of teleophthalmology in DR, resulting in a large volume of pertinent publications. This study aimed to provide a scientific overview of telemedicine applied to DR through bibliometric analysis. Methods: A search of the Web of Science Core Collection was conducted on 15 November 2025 to identify English-language original research and review articles regarding telemedicine for DR. Bibliographic data from relevant publications were extracted and underwent quantitative analysis and visualization using the tools Bibliometrix and VOSviewer. Results: A total of 515 articles published between 1998 and 2025 were included in our analysis. During this period, the research field of telemedicine for DR exhibited an annual growth rate of 13.14%, with publication activity markedly increasing after 2010 and peaking in 2020–2021. Based on the number of publications, United States, China, and Australia were the most productive countries, while Telemedicine and e-Health, Journal of Telemedicine and Telecare, and British Journal of Ophthalmology were the most relevant journals in the field. Keyword co-occurrence analysis revealed three major thematic clusters within the broader topic of telemedicine and DR, namely, public health-oriented work, telehealth service models, and applications of artificial intelligence technologies. Conclusions: The role of telemedicine in DR detection and care represents an expanding multidisciplinary field of research supported by contributions from multiple authors and institutions worldwide. As technological capabilities continue to evolve, ongoing innovation and cross-domain collaboration could further advance the applications of teleophthalmology for DR, promoting more accessible, efficient, and equitable identification and management of this condition. Full article

► Show Figures

Figure 1

18 pages, 495 KB

Open AccessArticle

Environmental Dynamics and Digital Transformation in Lower-Middle-Class Hospitals: Evidence from Indonesia

by Faisal Binsar, Mohammad Hamsal, Mohammad Ichsan, Sri Bramantoro Abdinagoro and Diena Dwidienawati

Healthcare 2026, 14(2), 182; https://doi.org/10.3390/healthcare14020182 - 12 Jan 2026

Abstract

Background/Objectives: Digital transformation is increasingly essential for healthcare organizations to improve operational efficiency and service quality. However, in developing countries such as Indonesia, many lower-middle-class hospitals lag due to limited financial, human, and infrastructural resources. This study examines how environmental dynamism—comprising regulatory [...] Read more.

Background/Objectives: Digital transformation is increasingly essential for healthcare organizations to improve operational efficiency and service quality. However, in developing countries such as Indonesia, many lower-middle-class hospitals lag due to limited financial, human, and infrastructural resources. This study examines how environmental dynamism—comprising regulatory changes, market pressures, and technological shifts—affects the digital capabilities of these hospitals. Methods: A quantitative, cross-sectional survey was conducted in Class C and D hospitals across Indonesia. Respondents included hospital directors, deputy directors, and IT heads. Data were collected through structured questionnaires measuring environmental dynamism and digital capability using a six-point Likert scale. Reliability testing yielded Cronbach’s alpha values above 0.96 for both constructs. Correlation analysis was performed to examine the relationship between environmental dynamism and digital capability. Results: Findings reveal a weak positive correlation (r = 0.1816) between environmental dynamism and digital capability. Although external factors such as policy regulations and technological competition encourage digital adoption, hospitals with limited internal resources struggle to translate these pressures into sustainable transformation. Key challenges include low ICT budgets, inconsistent staff training, and insufficient infrastructure. Conclusions: The results suggest that environmental change alone cannot drive digital readiness without internal capacity development. To foster resilient digital healthcare ecosystems, policy interventions should integrate regulatory frameworks with practical support programs that strengthen resources, leadership, and human capital in lower-middle-class hospitals. Full article

► Show Figures

Figure 1

15 pages, 270 KB

Open AccessArticle

Ethical Decision-Making and Clinical Ethics Support in Italian Neonatal Intensive Care Units: Results from a National Survey

by Clara Todini, Barbara Corsano, Simona Giardina, Simone S. Masilla, Costanza Raimondi, Pietro Refolo, Dario Sacchini and Antonio G. Spagnolo

Healthcare 2026, 14(2), 181; https://doi.org/10.3390/healthcare14020181 - 11 Jan 2026

Abstract

Background/Objectives: Neonatal Intensive Care Units (NICUs) constitute a highly complex clinical environment characterized by patient fragility and frequent ethically sensitive decisions. To date, systematic studies investigating how Italian NICUs address these challenges and what forms of ethics support are effectively available are lacking. [...] Read more.

Background/Objectives: Neonatal Intensive Care Units (NICUs) constitute a highly complex clinical environment characterized by patient fragility and frequent ethically sensitive decisions. To date, systematic studies investigating how Italian NICUs address these challenges and what forms of ethics support are effectively available are lacking. The aim of this study is therefore to assess how ethical issues are managed in Italian NICUs, with particular attention to the availability, use, and perceived usefulness of clinical ethics support in everyday practice. Methods: A 25-item questionnaire was developed by adapting an existing tool for investigating clinical ethics activities to the neonatal context. Following expert review by the GIBCE (Gruppo Interdisciplinare di Bioetica Clinica e Consulenza Etica in ambito sanitario), the final instrument covered four areas (general data, experience with ethical dilemmas, tools and procedures, opinions and training needs). A manual web search identified all Italian NICUs and their clinical directors, who were asked to disseminate the survey among staff. Participation was voluntary and anonymous. Data collection was conducted via Google Forms and analyzed through qualitative thematic analysis. Results: A total of 217 questionnaires were collected. The most frequent ethical dilemmas concern quality of life with anticipated multiple or severe disabilities (72.4%) and decisions to withdraw or withhold life-sustaining treatments (64.5%). Major challenges include fear of medico-legal repercussions (57.6%) and communication divergences between physicians and nurses (49,8%). More than half of respondents (52.1%) reported no formal training in clinical ethics, and 68.7% had never developed a Shared Care Plan (Shared Document for healthcare ethics planning) as defined by the Italian Law 219/2017. Conclusions: Findings highlight marked fragmentation in ethical practices across Italian NICUs. On this basis, establishing structured and accessible CEC services could help promote consistency, reinforce shared ethical standards, and support transparent and equitable decision-making in critical neonatal care. Full article

(This article belongs to the Special Issue ETHICA—ETHICs in Action: Values, Dilemmas, and Decision-Making in Contemporary Healthcare)

15 pages, 402 KB

Open AccessArticle

Exploring Parental Perceptions and Barriers to Early Orthodontic Treatment in Children: A Mixed-Methods Study

by Guna Shekhar Madiraju

Healthcare 2026, 14(2), 180; https://doi.org/10.3390/healthcare14020180 - 11 Jan 2026

Abstract

Parents’ awareness, attitudes, and perceptions of barriers to orthodontic care for children significantly influence decisions regarding early orthodontic interventions. This mixed-methods study explored parents’ perceptions of their child’s orthodontic needs and examined their experiences and perceived barriers to accessing early orthodontic treatment (EOT) [...] Read more.

Parents’ awareness, attitudes, and perceptions of barriers to orthodontic care for children significantly influence decisions regarding early orthodontic interventions. This mixed-methods study explored parents’ perceptions of their child’s orthodontic needs and examined their experiences and perceived barriers to accessing early orthodontic treatment (EOT) among children aged 6–12 years. Methods: Quantitative data were collected using a 12-item validated questionnaire, while qualitative insights were obtained through structured interviews and analyzed thematically. Results: Parents’ perception of their child’s orthodontic needs was significantly associated with their attitude toward seeking consultation or treatment (p < 0.001). Among parents who sought consultation, only 38.7% had initiated the required orthodontic treatment. The most frequently reported barriers were high cost (32.1%), long appointment wait times (30.6%), and lack of insurance coverage (22.5%). Thematic analysis revealed four major barriers: financial, structural, cognitive, and psychological. Conclusions: These findings highlight critical challenges to accessing EOT for children, including affordability, long waiting times, limited parental awareness, and inadequate, timely referrals. Addressing these challenges through combined efforts at both the individual and community levels could significantly enhance the uptake of early orthodontic services in children. Full article

(This article belongs to the Special Issue Global Health: Focus on Oral Care for People of All Ages)

► Show Figures

Figure 1

19 pages, 2840 KB

Open AccessArticle

Evolution of Computerized Provider Order Entry Documentation at a Leading Tertiary Care Referral Center in Riyadh

by Hanan Sabet Alanazi and Yazed Alruthia

Healthcare 2026, 14(2), 179; https://doi.org/10.3390/healthcare14020179 - 10 Jan 2026

Abstract

Background: Computerized Provider Order Entry (CPOE) systems are critical for medication safety, but their effectiveness relies heavily on the completeness of entered data. Incomplete clinical and anthropometric information can disable Clinical Decision Support Systems (CDSSs), compromising patient safety. Objective: This study [...] Read more.

Background: Computerized Provider Order Entry (CPOE) systems are critical for medication safety, but their effectiveness relies heavily on the completeness of entered data. Incomplete clinical and anthropometric information can disable Clinical Decision Support Systems (CDSSs), compromising patient safety. Objective: This study aimed to assess the longitudinal evolution of CPOE data completeness, specifically focusing on “Breadth Completeness” (the presence of essential clinical variables), and to identify factors predicting data integrity in a tertiary care setting. Methods: A retrospective cross-sectional study was conducted at a 500-bed tertiary referral center in Riyadh. Data were extracted from the Cerner Millennium CPOE system for three “steady-state” years (2015, 2017, and 2019); years involving major system overhauls (2016 and 2018) were excluded to avoid structural bias. A total of 600 unique patient encounters (200 per year) were selected using systematic random sampling from a chronologically ordered sampling frame to minimize temporal bias. The primary outcome was “Breadth Completeness,” defined as the presence of eight key variables: age, gender, marital status, weight, height, diagnosis, vital signs, and allergies. Secondary outcomes included documentation consistency (daily notes). Multivariable logistic regression, adjusted for potential confounders, was used to determine predictors of completeness. Results: The rate of primary data completeness (Breadth) improved significantly over the study period, rising from 5.5% in 2015 to 26% in 2017 and 49.5% in 2019. In the multivariable analysis, the year of documentation (OR = 17.47 for 2019 vs. 2015, p < 0.0001) and length of hospitalization (OR = 1.04, p = 0.045) were significant predictors of completeness. Pharmacist-led medication reconciliation was associated with a 2.5-fold increase in data completeness in bivariate analysis (p < 0.0001). Conclusions: While system maturity has driven substantial improvements in CPOE documentation, critical gaps persist, particularly in anthropometric data required for safety alerts. The study underscores the necessity of mandating “hard stops” for core variables and formalizing pharmacist involvement in data reconciliation to ensure patient safety. Full article

► Show Figures

Figure 1

16 pages, 499 KB

Open AccessArticle

Intention to Use Digital Health Among COPD Patients in Europe: A Cluster Analysis

by Solomon Getachew Alem, Le Nguyen, Nadia Hipólito, Maelle Spiller and Esther Metting

Healthcare 2026, 14(2), 178; https://doi.org/10.3390/healthcare14020178 - 9 Jan 2026

Abstract

Background: Chronic obstructive pulmonary disease (COPD) increasingly strains European health systems amid population ageing. Digital health interventions (DHIs) can reduce hospitalizations and support self-management, yet older patients hesitate to adopt them. Tailored interventions require understanding patient profiles. This study aimed to identify clusters [...] Read more.

Background: Chronic obstructive pulmonary disease (COPD) increasingly strains European health systems amid population ageing. Digital health interventions (DHIs) can reduce hospitalizations and support self-management, yet older patients hesitate to adopt them. Tailored interventions require understanding patient profiles. This study aimed to identify clusters by intention to use DHIs. Methods: Between July 2024 and February 2025, 232 COPD patients (mean age 65; 61% female) across seven European countries completed surveys covering sociodemographic and Unified Theory of Technology Acceptance (UTAUT) constructs. Intention to use DHIs was categorized as positive, neutral, or negative. Weighted UTAUT scores were clustered using Gower distance and Partitioning Around Medoids. Associations were visualized with multiple correspondence analysis and heat maps; differences were tested with the chi-square test. Results: Intention to adopt DHIs varied across countries, with the highest in the Netherlands. Two clusters emerged. Cluster 1, the ‘balanced hesitant’ group (n = 104), showed mixed intentions (38% positive, 40% neutral, 21% negative). Barriers included low performance expectancy and limited digital skills (both p < 0.05). Cluster 2, the ‘enthusiastic’ group (n = 128), demonstrated strong adoption intentions, with 84% positive intention. Enablers included low effort expectancy and complex disease (p < 0.01). Across both clusters, performance expectancy predicted intention. Conclusions: Digital health adoption among COPD patients is shaped by psychosocial and digital skill profiles. Hesitant users benefit from expectation-based information about DHIs, digital literacy training and peer support. Enthusiasts require ease of integration. Performance expectancy is a consistent driver of adoption, whereas country-specific factors should guide strategies. Full article

► Show Figures

Figure 1

12 pages, 541 KB

Open AccessArticle

Changes in Alcohol-Based Handrub Usage Among Hospital Staff Four Years After the COVID-19 Pandemic: A Single-Centre Observational Time-Series Study

by Filip Waligóra, Anastazja Tobolewska-Kielar and Maciej Kielar

Healthcare 2026, 14(2), 177; https://doi.org/10.3390/healthcare14020177 - 9 Jan 2026

Abstract

Background/Objectives: Alcohol-based handrub (ABHR) consumption is commonly used as an indirect proxy for hand hygiene practices. Hand hygiene compliance increased significantly during COVID-19, but sustainability remains uncertain. This study assessed ABHR consumption trends from 2022 to 2024 and compared them with pre-pandemic [...] Read more.

Background/Objectives: Alcohol-based handrub (ABHR) consumption is commonly used as an indirect proxy for hand hygiene practices. Hand hygiene compliance increased significantly during COVID-19, but sustainability remains uncertain. This study assessed ABHR consumption trends from 2022 to 2024 and compared them with pre-pandemic and pandemic-era rates. Methods: We conducted a follow-up observational study tracking quarterly ABHR consumption in a surgical department and hospital-wide (2022–2024). Consumption was normalized as mL per patient-day and compared with 2019–2020 data. Time-series regression with Newey–West standard errors assessed temporal trends. Results: Surgical department consumption declined 27.5% (55.9 to 40.5 mL/patient-day), returning to 2019 pre-pandemic levels. Hospital-wide consumption increased 36% (36.4 to 49.6 mL/patient-day). Neither trend reached statistical significance (p > 0.05). The 2024 surgical rate remained substantially below the 2020 pandemic peak (320 mL/patient-day). Conclusions: Pandemic-era ABHR consumption gains were not sustained in the surgical department despite maintained educational infrastructure, accessible dispensers, and consistent staffing. The critical missing element was systematic monitoring and feedback. Institutions relying solely on passive education may experience erosion of hand hygiene compliance post-crisis, highlighting the need for active surveillance programs to maintain behavioral gains. Full article

► Show Figures

Figure 1

5 pages, 188 KB

Open AccessEditorial

Management of Chronic Health Situations

by Luís Sousa, Christoph Käppler, Fabiana Faleiros, Geyslane Alburquerque and Helena José

Healthcare 2026, 14(2), 176; https://doi.org/10.3390/healthcare14020176 - 9 Jan 2026

Abstract

Chronic diseases are one of the greatest current global health challenges, not only because of their direct clinical impacts, but above all because of the functional, emotional, and social repercussions that profoundly affect the lives of patients and their families [...] Full article

(This article belongs to the Special Issue Management of Chronic Health Situations)

12 pages, 587 KB

Open AccessArticle

Riverine Women’s Perceptions of the Pap Smear Test in Light of Health Literacy

by Thaynara Cordeiro Mendes, Letícia Calandrine Chagas, Marcio Yrochy Saldanha dos Santos, Ingrid Bentes Lima, Breno Augusto Silva Duarte, Ivaneide Leal Ataíde Rodrigues, Evelin Lorena Sousa do Espírito Santo, Paula Gisely Costa Silva and Laura Maria Vidal Nogueira

Healthcare 2026, 14(2), 175; https://doi.org/10.3390/healthcare14020175 - 9 Jan 2026

Abstract

Background: Women living in riverine communities are affected by factors such as geographical and cultural distance that hinder access to and use of health services. In this context, access to the Pap smear is crucial for the early detection of cellular changes that [...] Read more.

Background: Women living in riverine communities are affected by factors such as geographical and cultural distance that hinder access to and use of health services. In this context, access to the Pap smear is crucial for the early detection of cellular changes that may progress to cervical cancer, which underlines the importance of understanding riverine women’s subjective perceptions of this exam. Objectives: To analyze the perceptions of riverine women regarding cervical cancer screening through the lens of health literacy. Methods: Descriptive qualitative study conducted with 42 riverine women residents of the Brazilian Amazon who were registered at the Basic Health Unit on Cotijuba Island, Pará, Brazil. Data were collected through semi-structured individual interviews from January to May 2024 and analyzed using IRaMuTeQ software version 0.7 alpha 2. Results: Data were grouped into similar classes, yielding the following thematic axes: knowledge, feelings and perceptions about the Pap smear test; how health literacy and access to information affect self-care; access to health services. The study showed that limited participant knowledge about the Pap smear was reflected in low health literacy, which directly affected adherence to the exam. Conclusions: The study demonstrated that the riverine woman’s limited knowledge regarding the Pap smear was reflected in their poorly developed health literacy, which directly contributed to non-adherence to the exam. Full article

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

► Show Figures

Figure 1

20 pages, 1187 KB

Open AccessArticle

Physiological and Psychological Predictors of Functional Performance Related to Injury Risk in Female Athletes: A Cross-Sectional Study

by Monira I. Aldhahi, Hadeel R. Bakhsh, Bodor H. Bin sheeha, Mohanad S. Aljabiri and Rehab Alhasani

Healthcare 2026, 14(2), 174; https://doi.org/10.3390/healthcare14020174 - 9 Jan 2026

Abstract

Background and Objectives: Lower-extremity injuries are common among female athletes; however, their multifactorial predictors remain insufficiently understood. Given the interplay between physiological and psychological readiness in athletic performance, identifying the factors that influence lower limb performance is crucial for effective injury prevention. This [...] Read more.

Background and Objectives: Lower-extremity injuries are common among female athletes; however, their multifactorial predictors remain insufficiently understood. Given the interplay between physiological and psychological readiness in athletic performance, identifying the factors that influence lower limb performance is crucial for effective injury prevention. This study aimed to evaluate the predictive effects of physiological (VO₂peak, anaerobic power, agility, and isokinetic strength) and psychological (resilience and self-efficacy) variables on functional performance related to risk of injury. Materials and Methods: This cross-sectional study included 60 athletes with a mean age of 24.5 ± 6.90 years and mean body mass index of 23.12 ± 3.6 kg/m² (range: 16–30 kg/m²). The testing protocol included anthropometric measurements, the Lower Extremity Functional Test (LEFT), Wingate anaerobic cycling test, assessments of aerobic capacity, isokinetic muscle strength, and jumping performance (Single-Leg Hop [SLH] and Standing Long Jump [SLJ] tests). Psychological assessments included the General Self-Efficacy Scale (GSES) and a resilience questionnaire. A hierarchical regression analysis was performed. Results: The participants trained 5 ± 2 days per week and had 42 ± 39 months of sports experience. The mean VO_2peak was 40.82 ± 5.8 mL·kg⁻¹·min⁻¹, relative anaerobic peak power was 7.53 ± 1.92 W/kg, and fatigue index was 60.63 ± 15.41%. The mean isokinetic knee extension and flexion torque were 184.55 ± 44.60 N·m and 95.08 ± 21.44 N·m, respectively, with a flexion-to-extension ratio of 53.5%. The mean LEFT completion time was 160 ± 22 s. The participants demonstrated moderate resilience (BRS = 21 ± 4) and good self-efficacy (GSES = 33 ± 7.5). Among the psychological variables, GSES exhibited a modest negative correlation with LEFT (r = −0.28, p = 0.02). No significant associations were found between LEFT and psychological resilience. Longer LEFT completion times were associated with lower VO_2peak, mean power, and jump distance (p < 0.01). In the final model (R² = 0.58, p = 0.02), SLH (β = −0.54), VO_2peak (β = −10.32), and GSES (β = −0.70) were the strongest independent predictors of LEFT performance. Conclusions: SLH distance, VO_2peak, and general self-efficacy are key predictors of functional performance on the LEFT among female athletes. These factors may serve as practical indicators for identifying athletes who could benefit from targeted injury prevention programs. Full article

(This article belongs to the Special Issue The Role of Physical Activity and Sports in Enhancing Psychological Well-Being and Quality of Life)

► Show Figures

Figure 1

14 pages, 2101 KB

Open AccessArticle

Age-Specific Responses to Immersive Virtual Reality During Pediatric Venipuncture: Evidence from Routine Clinical Practice

by Domonkos Tinka, Mohammad Milad Shafaie, Péter Prukner and Márta Kovács

Healthcare 2026, 14(2), 173; https://doi.org/10.3390/healthcare14020173 - 9 Jan 2026

Abstract

Background/Objectives: Virtual reality (VR) is increasingly used to reduce pain during pediatric needle procedures, but its effectiveness may vary by developmental stage and gender. This study evaluated whether immersive VR reduces venipuncture pain in children and adolescents and examined parent–patient agreement and [...] Read more.

Background/Objectives: Virtual reality (VR) is increasingly used to reduce pain during pediatric needle procedures, but its effectiveness may vary by developmental stage and gender. This study evaluated whether immersive VR reduces venipuncture pain in children and adolescents and examined parent–patient agreement and gender-specific response patterns. Methods: A prospective nonrandomized clinical study was conducted within a hospital-based pediatric venipuncture service using an alternating 1:1 allocation sequence. Participants aged 4–18 years underwent venipuncture with either VR (n = 49) or standard care (n = 29). Procedural pain was measured using the Faces Pain Scale–Revised (FPS-R) with independent parent ratings. Analysis of covariance (ANCOVA) compared post-procedural FPS-R scores while adjusting for baseline pain. Exploratory age and gender-specific analyses were also performed. Results: VR led to a clear reduction in pain for children, even after adjusting for baseline scores (3.55 vs. 4.73; p = 0.003). Adolescents, however, reported similarly low pain in both groups (2.81 vs. 2.79; p = 0.60), and several mentioned that the PEGI 3 content felt too young for them, which likely limited how engaged they were. Among children, girls showed the most noticeable drop in pain, which matches the subgroup’s adjusted significance (p = 0.011). Parent–patient agreement was stronger in children (r ≈ 0.7–0.8) than in adolescents (r ≈ 0.4–0.5), and VR did not change this pattern. Most participants said they would choose VR again for future procedures. Conclusions: Immersive VR helped reduce venipuncture pain in children but had little effect in adolescents, underscoring the need for age-appropriate or more interactive VR content for older patients. Overall, these findings support using VR selectively as a distraction tool that fits the developmental needs of pediatric groups. Full article

► Show Figures

Figure 1

21 pages, 286 KB

Open AccessArticle

Psychosocial Perceptions and Health Behaviors Related to Lifestyle During Pregnancy: A Cross-Sectional Study in a Local Community of Albania

by Saemira Durmishi, Rezarta Lalo, Fatjona Kamberi, Shkelqim Hidri and Mitilda Gugu

Healthcare 2026, 14(2), 172; https://doi.org/10.3390/healthcare14020172 - 9 Jan 2026

Abstract

Background: Maternal health behaviors during pregnancy are crucial for maternal and fetal outcomes. While global research has explored that demographic, clinical, and psychosocial determinants significantly influence these behaviors, evidence from low- and middle-income countries (LMICs), including Albania, remains limited. This study aims to [...] Read more.

Background: Maternal health behaviors during pregnancy are crucial for maternal and fetal outcomes. While global research has explored that demographic, clinical, and psychosocial determinants significantly influence these behaviors, evidence from low- and middle-income countries (LMICs), including Albania, remains limited. This study aims to evaluate psychosocial perceptions and health behaviors related to lifestyle among pregnant women in a local Albanian community in order to identify which are higher risk subgroups that need targeted and tailored antenatal care interventions. Methods: This multicenter cross-sectional study included 200 pregnant women attending antenatal clinics from May to August 2024 in Vlora city, Albania. Participants were selected using consecutive sampling based on inclusion criteria. Data were collected through a validated questionnaire composed of five sections: demographic/obstetric data; maternal health behaviors; dietary diversity; physical activity, perceived stress; and social support. Clinical and anthropometric measurements were assessed by trained health professionals during antenatal visits. SPSS version 23.0 and binary logistic regression with p-value ≤ 0.05 statistically significant were used for data analysis. Results: Mean age was 28.3 ± 6.4 years, 71% employed and 83.5% urban residents. Key unhealthy behaviors included tobacco use (25.5%), alcohol consumption (10.5%), exposure to toxins (15%), and low dietary diversity (32%). We found significant correlations between low dietary diversity and rural residence (Adj OR = 2.48), hypertension (Adj OR = 6.88), and overweight/obesity (Adj OR = 2.33). Tobacco use was associated with unemployment and alcohol use with unemployment and hypertension variables. Low/moderate social support and high perceived stress were significantly related with multiple unhealthy behaviors, such as low dietary diversity, inadequate physical activity and antenatal care. Conclusions: Unhealthy nutritional behaviors, tobacco and alcohol use and low physical activity are more prevalent risk factors among pregnant women in Vlora city. Priority should be given to vulnerable groups, including rural residents, pregnant women with low social support, high perceived stress and those with hypertension and obesity. Interventions that integrate psychosocial support and health education into antenatal care services are urgently needed to enhance pregnancy outcomes in Albanian communities. Full article

Journal Description

Healthcare

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Topical Collections

Further Information

Guidelines

MDPI Initiatives

Follow MDPI