Healthcare

20 pages, 1879 KiB

Open AccessSystematic Review

The Effectiveness and Safety of Tai Chi on Knee Pain: A Systematic Review and Meta-Analysis

by Hyunggon Lee, Soo-Hyun Sung and Sangnam Lee

Healthcare 2025, 13(13), 1615; https://doi.org/10.3390/healthcare13131615 (registering DOI) - 6 Jul 2025

Background/Objectives: Although Tai Chi has shown potential benefits for managing chronic pain, its clinical effectiveness specifically for knee pain remains inconclusive. Methods: We systematically searched ten electronic databases for randomized controlled trials (RCTs) investigating the effects of Tai Chi on knee pain. Results: [...] Read more.

Background/Objectives: Although Tai Chi has shown potential benefits for managing chronic pain, its clinical effectiveness specifically for knee pain remains inconclusive. Methods: We systematically searched ten electronic databases for randomized controlled trials (RCTs) investigating the effects of Tai Chi on knee pain. Results: This systematic review and meta-analysis included 11 RCTs involving 706 participants; among them, three studies (n = 169) were eligible for meta-analysis. A comprehensive search of ten electronic databases was conducted up to March 2025. The included RCTs were conducted in the United States (n = 5), China (n = 3), South Korea (n = 2), and Turkey (n = 1). Compared to health education, Tai Chi significantly improved knee pain, as measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score (mean difference (MD) = −0.60; 95% CI: −6.52 to −3.28; p < 0.00001) and the Visual Analogue Scale (VAS) (MD = −1.44; 95% CI: −1.95 to −0.93; p < 0.00001). Tai Chi also significantly improved knee function compared to health education (WOMAC function score—MD = −13.49; 95% CI: −17.11 to −9.87; p < 0.00001). Four RCTs comparing Tai Chi with no intervention reported favorable effects on knee pain and function; however, a meta-analysis was not possible due to limited data. In contrast, two studies comparing Tai Chi with active controls, such as physical therapy and resistance training, found no significant differences in pain or functional outcomes. Two studies reported increased knee pain during initial Tai Chi sessions, but no adverse events occurred after postural corrections. Conclusions: While Tai Chi appears promising for knee pain management, further large-scale, high-quality RCTs with rigorous methodology are needed to establish definitive evidence. Full article

► Show Figures

Figure 1

16 pages, 236 KiB

Open AccessArticle

Quality of Life for Patients with Down Syndrome and Their Caregivers: A Cross-Sectional Study from a Parental Perspective in Saudi Arabia

by Amal Khaleel AbuAlhommos, Maitham Abdullah Al Hawaj, Ashwaq Ali Alanazi, Hanadi Hwthael Alrashidi, Maha Faleh Aldawsari and Rasan Ali Alajmi

Healthcare 2025, 13(13), 1614; https://doi.org/10.3390/healthcare13131614 (registering DOI) - 6 Jul 2025

Abstract

Background: Patients with Down syndrome (DS) commonly experience psychological and mental problems. Studying the quality of life (QoL) of children with DS is important because it increases knowledge related to understanding the challenges that this group may face. This study aims to examine [...] Read more.

Background: Patients with Down syndrome (DS) commonly experience psychological and mental problems. Studying the quality of life (QoL) of children with DS is important because it increases knowledge related to understanding the challenges that this group may face. This study aims to examine the QoL of children with DS from a parental perspective in terms of physical, emotional, social, and school domains, depending on several factors, and identify demographic characteristics of their parents that may affect their QoL. Methods: This online survey study was conducted in Saudi Arabia between November 2024 and March 2025. The inclusion criteria targeted parents of children with confirmed DS diagnoses aged between 8 and 18 years. Results: The findings of this study showed that children with DS aged between 0 and 2 years had significantly lower QoL scores (10.18 ± 3.83) compared to other age groups (p = 0.02). In addition, gender differences were significant in the emotional (p = 0.03), social (p = 0.01), and school (p = 0.01) domains, with females scoring lower QoL scores in all areas compared to males. Moreover, educational level showed significant results across all domains, particularly for children with no education, who had the lowest QoL scores in the physical domain (22.34 ± 7.53, p = 0.004), emotional domain (10.41 ± 3.79, p = 0.003), social domain (11.22 ± 4.06, p = 0.001), and school domain (8.75 ± 5.09, p = 0.001). The findings of this study showed that children with DS who are in primary school (odds ratio (OR) = 5.90, 95% confidence interval (CI): 1.85–18.78, p = 0.003) and middle school (OR = 5.27, 95% CI: 1.44–19.31, p = 0.012) had significantly higher odds of better QoL compared to children with no formal education. Additionally, children cared for by their fathers had significantly lower odds compared to those cared for by their mothers (OR = 0.07, 95% CI: 0.01–0.90, p = 0.041). None of the demographic characteristics of caregivers reached a statistical significance level to have influence on caregivers QoL (p > 0.05). Conclusions: The findings of this study demonstrated a low level of QoL, affecting the emotional, social, and school domains, especially among female children with DS aged between 0 and 2 years with no formal education and cared for by their fathers. Governments should develop a comprehensive plan to care for these children and families in order to enhance their rights and quality of life, thereby placing emphasis on those who exhibit parameters related to a lower QoL. Full article

12 pages, 226 KiB

Open AccessArticle

Factors Associated with Asthma Medication Adherence in Parents with Asthmatic Children: Theory of Planned Behaviour

by Ahmed M. Alshehri, Yasser S. Almogbel, Saud M. Alsahali, Yousif A. Alosaily, Ghada M. Almohaimeed, Lamis I. Alotayk and Abdulrahman A. Alqunaisy

Healthcare 2025, 13(13), 1613; https://doi.org/10.3390/healthcare13131613 (registering DOI) - 5 Jul 2025

Abstract

Background/Objectives: Asthma is a prevalent chronic condition affecting approximately 300 million people globally. Despite advancements in treatment protocols, poor adherence to asthma medication remains a significant issue, often leading to severe complications, especially in children. This study aimed to identify factors influencing medication [...] Read more.

Background/Objectives: Asthma is a prevalent chronic condition affecting approximately 300 million people globally. Despite advancements in treatment protocols, poor adherence to asthma medication remains a significant issue, often leading to severe complications, especially in children. This study aimed to identify factors influencing medication adherence among parents of children with asthma, using constructs from the theory of planned behaviour to better understand and improve adherence. Methods: This cross-sectional study employed a survey incorporating constructs from the theory of planned behaviour, demographic variables, and other adherence-related factors. Descriptive statistics and logistic regression analyses were applied to explore the relationship between these factors and adherence to asthma medications. Results: Out of 152 parents who visited the survey link, 150 were eligible. The average age was 35.58 ± 9.913 years; most participants were married (82%) and female (62.6%). Multivariate linear regression analysis of the parents’ factor showed parental attitude (β = 0.38, p < 0.001) and subjective norms (β = 0.34, p < 0.002) were significantly associated with parents’ intention to adhere to asthma medications. Conclusion: The study found that parental attitudes and subjective norms significantly impact the intention to adhere to asthma medication. Improving adherence is crucial for effective disease management, reducing healthcare costs, and enhancing the quality of life for children and their families. Interventions should focus on educating parents about the importance of adherence and engaging more family members to positively influence adherence through strengthened subjective norms. Full article

(This article belongs to the Special Issue Family Influences on Child and Adolescent Health)

24 pages, 620 KiB

Open AccessSystematic Review

Effect of Exercise on Chronic Tension-Type Headache and Chronic Migraine: A Systematic Review

by Cindy Johana Palacio-Del Río, Sofía Monti-Ballano, María Orosia Lucha-López, César Hidalgo-García and José Miguel Tricás-Moreno

Healthcare 2025, 13(13), 1612; https://doi.org/10.3390/healthcare13131612 (registering DOI) - 4 Jul 2025

Abstract

Objectives: This study aims to identify the effectiveness of exercise in chronic tension-type headache and chronic migraine. Methods: The PICOS (Population, Intervention, Comparator, Outcomes, Study design) strategy was followed, where P—patients with chronic tension-type headache or chronic migraine; I—exercise; C—conventional treatment; O—pain reduction; [...] Read more.

Objectives: This study aims to identify the effectiveness of exercise in chronic tension-type headache and chronic migraine. Methods: The PICOS (Population, Intervention, Comparator, Outcomes, Study design) strategy was followed, where P—patients with chronic tension-type headache or chronic migraine; I—exercise; C—conventional treatment; O—pain reduction; and S—RCTs (randomized controlled trials) and quasi-experimental trials. Studies with a high risk of bias according to the RoB 2 (Risk of Bias) scale and with a score < 6 according to the PEDro (Physiotherapy Evidence Database) scale were excluded. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement was followed. The databases Pubmed, Web of Science, and Scopus were searched in November 2024. The PEDro and RoB2 scales were used to assess the risk of bias and internal validity of the studies. The results were synthesized qualitatively. Results: Ten studies with a total sample of 848 subjects were analyzed, comparing therapeutic interventions with an exercise versus conventional treatment. In most of the studies, the exercise group significantly outperformed the control group in pain reduction. Discussion: The findings suggest that exercise improves central pain modulation and reinforces the potential of body strategies such as postural integration. The main limitations found were the limited evidence on exercise’s role in chronic tension-type headache or migraine and the risk of bias due to the difficulty of blinding patients, therapists, and evaluators. Conclusions: The studies analyzed have shown that exercise could be an effective strategy to support the management of chronic tension-type headache and migraine. Full article

(This article belongs to the Special Issue Future Trends of Physical Activity in Health Promotion)

9 pages, 202 KiB

Open AccessArticle

Beyond Physical Disability: The Social Cognition Challenges in Quality of Life Among Multiple Sclerosis Patients

by Triantafyllos Doskas, Kanellos C. Spiliopoulos, Constantinos Kormas, Christos Kokkotis, Liberis Dekavallas, Anna Tsiakiri, Foteini Christidi, George D. Vavougios, Dimitrios Tsiptsios, Aspasia Serdari, Nikolaos Grigoriadis, Ioannis Iliopoulos and Konstantinos Vadikolias

Healthcare 2025, 13(13), 1611; https://doi.org/10.3390/healthcare13131611 - 4 Jul 2025

Abstract

Background/Objectives: Social cognition impairment is common in multiple sclerosis (MS) and could implicate the well-being of patients by promoting difficulties in social interactions. This study investigated the relationship between social cognition and quality of life (QoL) in patients with MS (PwMSs). Methods: In [...] Read more.

Background/Objectives: Social cognition impairment is common in multiple sclerosis (MS) and could implicate the well-being of patients by promoting difficulties in social interactions. This study investigated the relationship between social cognition and quality of life (QoL) in patients with MS (PwMSs). Methods: In total, 100 PwMSs, enrolled as per distinct criteria, underwent neuropsychological assessment using validated questionnaires and scales. To assess QoL, Multiple Sclerosis Quality of Life-54 (MSQOL-54) questionnaires, both physical and mental, were utilized. The components of social cognition were evaluated using the Reading the Mind in the Eyes Test (RMET) and the Faux Pas task. The type of MS and years since diagnosis were also recorded. Results: The RMET score (β = 0.336; p = 0.001) and years since diagnosis (β = −0.225; p = 0.017) emerged as significant predictors of physical QoL, whereas the Faux Pas score did not significantly predict MSQOL-54_PHYSICAL scores (p = 0.451). Both Faux Pas (β = 0.247; p = 0.015) and RMET scores (β = 0.221; p = 0.028) showed a positive association with MSQOL-54_MENTAL scores. The years since diagnosis did not significantly predict the mental component of QoL (p = 0.635). Conclusions: Social cognition deficits are crucial for the social functioning of patients with MS, inevitably affecting both physical and mental aspects of QoL. Full article

(This article belongs to the Section Chronic Care)

17 pages, 532 KiB

Open AccessArticle

The Six-Minute Walk Test in Community-Dwelling Older Adult Women: The Influence of Physical Activity Levels and Age-Related Factors

by Rocío Cogollos-de-la-Peña, Gemma Victoria Espí-López, Laura Fuentes-Aparicio, Lucas Monzani, Dagmar Pavlu and Anna Arnal-Gómez

Healthcare 2025, 13(13), 1610; https://doi.org/10.3390/healthcare13131610 - 4 Jul 2025

Abstract

Background/Objectives: In the context of active ageing, functional assessment is key to preserving autonomy in older women. The six-minute walk test (6MWT) is a practical tool for estimating general health, but its results can be influenced by various factors. This study analysed [...] Read more.

Background/Objectives: In the context of active ageing, functional assessment is key to preserving autonomy in older women. The six-minute walk test (6MWT) is a practical tool for estimating general health, but its results can be influenced by various factors. This study analysed cardiorespiratory variations during the 6MWT in older women according to their physical activity level and age-related variables such as pain, sarcopenia, frailty, and motivation to exercise. Methods: A total of 163 older women with musculoskeletal pain, but without cardiac or respiratory conditions, were classified into groups with high (HPA), moderate (MPA), and low (LPA) physical activity. During the 6MWT, heart rate (HR), dyspnoea, and oxygen saturation (SpO₂) were recorded. Pain, sarcopenia, frailty, and motivation to exercise were also assessed. A repeated-measures multivariate analysis of (co)variance (RM-MANCOVA) was performed. Results: The results showed differences in HR depending on the level of physical activity, conditioned by sarcopenia (p < 0.05) and walked distance (p < 0.001), and in dyspnoea conditioned by pain perception (p < 0.01) and social (p < 0.001) and psychological (p < 0.05) motivation to exercise. There were also differences in SpO₂ depending on the level of physical activity (p < 0.0001). There were differences between the HPA group and both the MPA and LPA group, which had higher HR, higher dyspnoea, and lower SpO₂ when undergoing the 6MWT test. Conclusions: To accurately interpret 6MWT results in older adult women, it is essential to consider physical activity level, perceived pain, sarcopenia, and motivation to exercise, as these factors influence HR, dyspnoea, and SpO₂. These variables should guide physical activity recommendations for healthy ageing. Full article

(This article belongs to the Special Issue Exercise Therapy: Improving Functionality, Physical Health, and Quality of Life)

► Show Figures

Figure 1

14 pages, 204 KiB

Open AccessArticle

A Study on Optometrists’ Knowledge, Awareness, and Management of Traumatic Brain Injury-Related Visual Disorders in Saudi Arabia

by Nawaf M. Almutairi, Abdulaziz Alharbi, Abdulelah Alharbi and Mohammed M. Alnawmasi

Healthcare 2025, 13(13), 1609; https://doi.org/10.3390/healthcare13131609 - 4 Jul 2025

Abstract

Background: Traumatic brain injury frequently leads to visual dysfunction, affecting up to 75% of patients. These visual issues, if unrecognized, can significantly impair daily functioning. Optometrists are well-positioned to identify and manage such conditions, yet their level of preparedness is not well understood. [...] Read more.

Background: Traumatic brain injury frequently leads to visual dysfunction, affecting up to 75% of patients. These visual issues, if unrecognized, can significantly impair daily functioning. Optometrists are well-positioned to identify and manage such conditions, yet their level of preparedness is not well understood. Objective: This study aimed to assess optometrists’ knowledge, awareness, and management practices regarding TBI-related visual disorders in Saudi Arabia. Methods: A cross-sectional survey was distributed online to 411 licensed optometrists in Saudi Arabia. The 16-item questionnaire assessed demographics, awareness, confidence, knowledge, and management practices related to TBI-associated visual disorders. Results: Only 26.3% of the respondents reported receiving formal education on TBI-related visual disorders. While most recognized common symptoms, such as blurred vision and light sensitivity, comprehensive knowledge of complex visual disorders was limited. A majority (82.5%) recommended referral to other healthcare providers; however, only 16.8% demonstrated high management competency, and 31.5% fell into the low-competency category. Referral patterns and clinical decision-making were significantly associated with experience and formal training. Conclusion: The findings reveal notable gaps in optometrists’ knowledge and preparedness to manage TBI-related visual dysfunctions. Structured educational initiatives and standardized clinical protocols are essential to improve optometric care for individuals with TBI. Full article

16 pages, 214 KiB

Open AccessArticle

Lived Experience of Caregivers of Lung Transplant Recipients in Korea

by Haeng-Mi Son, Kyoungok Min and Younghui Hwang

Healthcare 2025, 13(13), 1608; https://doi.org/10.3390/healthcare13131608 - 4 Jul 2025

Abstract

Background/Objectives: This study aimed to explore the underlying meaning and structure of the experiences of caregivers with lung transplant recipients using phenomenological research methods. Methods: Data were collected between February 2020 and December 2021 via in-depth individual interviews with nine caregivers of [...] Read more.

Background/Objectives: This study aimed to explore the underlying meaning and structure of the experiences of caregivers with lung transplant recipients using phenomenological research methods. Methods: Data were collected between February 2020 and December 2021 via in-depth individual interviews with nine caregivers of lung transplant recipients. The meaning of the participants’ experiences was analyzed using Colaizzi’s phenomenological analysis to ensure methodological rigor. Researchers minimized bias through reflexivity and member checking, and the study adhered to ethical standards to ensure trustworthiness. Results: Participants cared for patients who had not fully crossed the threshold of death without giving up hope for a cure. They did not avoid caregiving as a responsibility to their families but accepted it as their responsibility. The lives of the participants became increasingly immersed as they witnessed the process of the patient’s illness and gained insights into patience and gratitude through the caregiving experience. Conclusions: This study’s findings can help assess the needs of lung transplant recipients and their caregivers and guide interventions that address their reciprocal relationship. It also emphasizes the importance of ongoing education and expanded social care services to reduce caregiver stress and burden. Full article

10 pages, 220 KiB

Open AccessBrief Report

Financial Capacity Assessment in Female Euthymic Bipolar Patients: Catching Up on a Long Neglected Vulnerable Group

by Vaitsa Giannouli

Healthcare 2025, 13(13), 1607; https://doi.org/10.3390/healthcare13131607 - 4 Jul 2025

Abstract

Background: Patients with bipolar disorder (BD) face many challenges as many basic cognitive and non-cognitive domains can be affected by their disease. Financial capacity requires complex cognitive functioning and is little investigated in BD, especially in the Greek cultural context. Objectives: [...] Read more.

Background: Patients with bipolar disorder (BD) face many challenges as many basic cognitive and non-cognitive domains can be affected by their disease. Financial capacity requires complex cognitive functioning and is little investigated in BD, especially in the Greek cultural context. Objectives: This study, for the first time, is focusing on whether financial capacity shows deficits in female euthymic BD patients compared to controls and what the self-estimations of the patients for their performance are. Materials and Methods: Patients and a sample of one-to-one matched healthy controls were examined with a detailed neuropsychological battery and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). Before their neuropsychological assessment, participants responded to a single-item five-point Likert scale about their financial capacity. Results: Findings extend earlier work in other groups of older patients and indicate that euthymic BD patients’ performance is lower than that of the control group in various subdomains and total score of LCPLTAS (p < 0.001), resembling the performance of patients with a diagnosis of Mild Cognitive Impairment (MCI). However, euthymic BD patients are not aware of their cognitive deficits compared to healthy controls and overestimate their financial capacities as they have more positive estimations regarding their financial capacity than controls (χ²(1) = 8.315, p = 0.004) despite their lower real performance. In addition, from a number of classic neuropsychological tests administered, only Trail Making Part B correlates with LCPLTAS scores for the group of euthymic BD patients (rho = −0.561, p = 0.005). Conclusions: The results support that special care must be provided for euthymic BD individuals, so we can prevent financial exploitation. Full article

(This article belongs to the Special Issue Mental Health Promotion and Illness Prevention in Vulnerable Populations—2nd Edition)

9 pages, 206 KiB

Open AccessArticle

Why Functioning Should Be Used as a Population Health Indicator? A Discussion of a Chilean Population Study

by Marina Carvalho Arruda Barreto, Ricardo Cartes-Velásquez, Valeria Campos, Luciana Castaneda and Shamyr Sulyvan Castro

Healthcare 2025, 13(13), 1606; https://doi.org/10.3390/healthcare13131606 - 4 Jul 2025

Abstract

Background/Objectives: Population health problems are among the world’s main concerns. However, mortality and morbidity alone do not fully encompass the health experience of populations. International efforts are underway to verify health experiences using functioning as the third health indicator. The aim of the [...] Read more.

Background/Objectives: Population health problems are among the world’s main concerns. However, mortality and morbidity alone do not fully encompass the health experience of populations. International efforts are underway to verify health experiences using functioning as the third health indicator. The aim of the study was to compare the functioning profile of the Chilean population with mortality and morbidity rates due to neurological, circulatory, respiratory, and musculoskeletal diseases at the regional level. Methods: An ecological study was conducted with the secondary dataset II Estudio Nacional de la Discapacidad (ENDISC) and mortality and hospitalization rates from the Departamento de Estadísticas e Información en Salud. The II-ENDISC was a national household survey, based on the Model Disability Survey, carried out in 2015. Results: The correlation of functioning with morbidity and mortality rates was determined by Spearman’s correlation. The correlation values of the mortality and morbidity coefficients with the performance and disability data were not relevant and significant (p < 0.35; p > 0.05). This suggests a lack of a linear relationship between these indicators at the regional level. Conclusions: The analysis of the Chilean population revealed that performance values, as an expression of functioning, do not correlate with morbidity or mortality rates. This discrepancy underscores the limitations of relying solely on traditional health indicators to capture the complexity of population health. Our findings support the conceptual value of functioning as a complementary and distinct health indicator, rather than a proxy for morbidity or mortality. Full article

(This article belongs to the Special Issue Health Risks, Health Service, and Healthcare Supports for Vulnerable Populations)

18 pages, 929 KiB

Open AccessSystematic Review

Factors Determining Women’s Attitudes and Knowledge Toward Breast Cancer Screening: A Systematic Review

by Dimitra Georga, Afroditi Zartaloudi, Maria Saridi, Evangelos C. Fradelos, Erasmia Rouka, Pavlos Sarafis, Dimos Mastrogiannis and Aikaterini Toska

Healthcare 2025, 13(13), 1605; https://doi.org/10.3390/healthcare13131605 - 4 Jul 2025

Abstract

Background/Objectives: Breast cancer (BCA) is one of the most common cancers affecting women worldwide. Screening has been linked to up to a 33% reduction in breast cancer-related deaths by helping detect tumors at an early stage. The successful implementation of community-based breast [...] Read more.

Background/Objectives: Breast cancer (BCA) is one of the most common cancers affecting women worldwide. Screening has been linked to up to a 33% reduction in breast cancer-related deaths by helping detect tumors at an early stage. The successful implementation of community-based breast cancer screening programs depends on understanding the attitudes of women within the target community. This study aims to systematically review the literature to assess the association between women’s attitudes toward breast cancer screening and their life satisfaction and general attitudes toward life. We also aimed to examine women’s attitudes toward breast cancer screening recommendations and the factors that influence these attitudes. Methods: A systematic review of English-language literature was carried out. PubMed and Scopus were searched up to November 2024 for studies that met the predefined inclusion criteria. Methodologic quality was assessed using the adapted Newcastle–Ottawa Scale for cross-sectional studies and the corresponding scale for cohort studies. Results: Eleven studies met the inclusion criteria. The percentage of women who had undergone at least one breast cancer screening ranged from 8.3% to 94.5%. Women’s attitudes toward and participation in breast cancer screening were linked to psychological, social, and demographic factors. Lower levels of life satisfaction, self-efficacy, and perceived control or mastery in life, along with higher levels of non-work-related stress, and higher levels of optimism, were associated with a lower likelihood of participating in breast cancer screening. Full article

(This article belongs to the Special Issue Promotion of Women's Health through Exercise-Based and Educational Programs: A Multidisciplinary Approach)

► Show Figures

Figure 1

19 pages, 273 KiB

Open AccessArticle

The Impact of Automation and Digitalization in Hospital Medication Management: Economic Analysis in the European Countries

by Federico Filippo Orsini, Daniele Bellavia, Fabrizio Schettini and Emanuela Foglia

Healthcare 2025, 13(13), 1604; https://doi.org/10.3390/healthcare13131604 - 4 Jul 2025

Abstract

Background/Objectives: European healthcare systems are increasingly adopting automation technologies to improve efficiency. This study evaluates the economic viability of hospital automation and medication management digitalization. Methods: An economic evaluation was based on a standardized hospital model comprising 561 beds, representative of an average [...] Read more.

Background/Objectives: European healthcare systems are increasingly adopting automation technologies to improve efficiency. This study evaluates the economic viability of hospital automation and medication management digitalization. Methods: An economic evaluation was based on a standardized hospital model comprising 561 beds, representative of an average acute care hospital across EU27 + UK. For each technology, several cost items were estimated using country-specific parameters such as labor costs, medication error rates, healthcare expenditure, and money discount rate. The financial metrics (Return On Investment—ROI, Net Present Value—NPV, Payback Time—PBT) were first calculated at the hospital level. These results were then extrapolated to the national level by scaling the per-hospital estimates according to the total number of hospital beds reported in each country. Finally, national results were aggregated to derive the overall European impact. Results: The analysis estimated a total European investment of EUR 3.55 billion, with an average PBT of 4.46 years and annual savings of 1,96 billion. ROI averaged 167%, and the total NPV was 8.21 billion. A major saving driver was the reduction in Medication Administration Errors that has an impact of 37.2% on the total savings. Payback times ranged from 3 years in high-GDP countries, to 7 years in lower-GDP nations. Conclusions: These findings demonstrate how providing structured data on hospital automation benefits could support decision-making processes, highlighting the organizational and economic feasibility of the investment across different European national contexts. Full article

15 pages, 268 KiB

Open AccessReview

Parental Burnout: A Progressive Condition Potentially Compromising Family Well-Being—A Narrative Review

by Patrik M. Bogdán, Katalin Varga, Lívia Tóth, Kristóf Gróf and Annamária Pakai

Healthcare 2025, 13(13), 1603; https://doi.org/10.3390/healthcare13131603 - 4 Jul 2025

Abstract

Background: Parental burnout is one of today’s significant challenges, increasingly manifesting as a problem in our fast-paced world. The aim of this review is to create an exploratory, descriptive summary of parental burnout through the analysis of available international publications, providing a clearer [...] Read more.

Background: Parental burnout is one of today’s significant challenges, increasingly manifesting as a problem in our fast-paced world. The aim of this review is to create an exploratory, descriptive summary of parental burnout through the analysis of available international publications, providing a clearer and more accurate understanding of the psychological condition, severity, manifestations, and treatment options. Methods: Our narrative literature review includes publications from 2010 onwards, focusing on those that directly address the topic of parental burnout syndrome and contain epidemiological data, risk factors, symptoms, diagnostic possibilities, and treatment strategies. We excluded publications that examined the condition within narrow societal groups, such as parents caring for children with somatic mental disorders. Results: Based on our review, it appears that parental burnout may potentially affect both women and men. Factors such as low emotional intelligence, workplace stress, and lack of supportive family background render parents vulnerable to this condition. Significant differences in the prevalence of parental burnout can be measured between countries, due to cultural differences. Parental burnout has extremely detrimental effects on family dynamics and the emotional development of children, and it can negatively impact the willingness to have more children at the family level, which has dire consequences considering the low birth rates characteristic of European countries. Full article

(This article belongs to the Section Family Medicine)

10 pages, 213 KiB

Open AccessArticle

Burnout and Associated Factors Among Dental Students, Interns, and Dental Practitioners in Saudi Arabia: A Cross-Sectional Study

by Abdulrahman Mohammed Algethami, Sakeenabi Basha, Roshan Noor Mohamed, Ali Alqarni, Azzah O. Alhazmi, Thani Alsharari, Fahad Saeed Algahtani, Hassan Talat Shawli, Abdullah Amjad Alzamil, Ahmed Sulayyih Alosaimi and Abdulaziz Abdullah Alharbi

Healthcare 2025, 13(13), 1602; https://doi.org/10.3390/healthcare13131602 - 3 Jul 2025

Abstract

Background/Objectives: The present study aims to assess the prevalence of burnout and associated factors among dental students, interns, and dental practitioners in Saudi Arabia. Methods: A descriptive cross-sectional study was conducted among dental students, interns, and practitioners at Makkah Province, KSA. [...] Read more.

Background/Objectives: The present study aims to assess the prevalence of burnout and associated factors among dental students, interns, and dental practitioners in Saudi Arabia. Methods: A descriptive cross-sectional study was conducted among dental students, interns, and practitioners at Makkah Province, KSA. The Maslach Burnout Inventory (MBI) scale was used to assess burnout. The difference in mean scores was tested using a t-test and analysis of variance (ANOVA). Multivariate logistic regression analysis was carried out for the independent variables and outcome variable of burnout syndrome. Results: The total number of participants was 302 (female = 25, male = 277). The mean age of study participants was 30.2 ± 10.1. A total of 66.2% of study participants presented with high emotional exhaustion, 48.7% with high depersonalization, and 38.7% with low personal achievement. Burnout level was 1.78 times (CI = 1.52–3.53, p = 0.032) higher among female participants than male participants. Burnout level was 1.53 times (C = 1.31–3.17, p = 0.043) higher among student participants compared to practitioners. Burnout level was 2.41 times (CI = 1.72–3.79, p = 0.023) higher among participants who worked more than 5 days per week compared to participants who worked ≤ 5 days per week. Conclusions: This study’s results showed burnout syndrome was high among dental students compared to interns and dental practitioners. A significant association was seen between increased working hours per week and burnout syndrome. There is a need for a proactive step to highlight the importance of burnout management, especially among dental students. Full article

45 pages, 435 KiB

Open AccessArticle

Factors Affecting Cypriot Nurses’ Roles in the Care and Education of Patients with CKD: An Interpretive Phenomenological Study

by Evangelos Latzourakis, Panayiotis Angelides, Marianna Diomidous, Monica Nikitara and Costas S. Constantinou

Healthcare 2025, 13(13), 1601; https://doi.org/10.3390/healthcare13131601 - 3 Jul 2025

Abstract

Background: Chronic kidney disease (CKD) affects over 10% of the global population and imposes a growing burden on healthcare systems. Aim: To explore nurses’ perceptions of their roles in CKD care and identify factors influencing role implementation. Methods: An Interpretative [...] Read more.

Background: Chronic kidney disease (CKD) affects over 10% of the global population and imposes a growing burden on healthcare systems. Aim: To explore nurses’ perceptions of their roles in CKD care and identify factors influencing role implementation. Methods: An Interpretative Phenomenological Approach (IPA) was employed, involving semi-structured interviews with 16 purposively selected nurses from all district hospitals in the Republic of Cyprus. Thematic analysis was conducted on the transcribed data. Findings: Nurses identified five core roles in CKD care: machine operator, holistic caregiver, bureaucratic coordinator, patient educator, and emotional supporter. These roles varied by setting. Key influencing factors included nurse training, organizational challenges, barriers to patient education, patient behavior, and nurses’ coping strategies. Conclusions: Nurses are essential to quality CKD care, particularly in patient education. A framework was developed to address barriers and support nurses, healthcare organizations, and patients in improving care delivery. Full article

17 pages, 734 KiB

Open AccessArticle

Occupational Stress, Burnout, and Fatigue Among Healthcare Workers in Shanghai, China: A Questionnaire-Based Cross-Sectional Survey

by Qiaochu Wang, Jiayun Ding, Yiming Dai, Sijia Yang and Zhijun Zhou

Healthcare 2025, 13(13), 1600; https://doi.org/10.3390/healthcare13131600 - 3 Jul 2025

Abstract

Background: Occupational burnout and fatigue are critical issues affecting the health and performance of healthcare workers (HCWs) globally. These outcomes are often driven by complex and overlapping work-related stressors, which remain insufficiently understood in combination. Objective: To investigate the associations of [...] Read more.

Background: Occupational burnout and fatigue are critical issues affecting the health and performance of healthcare workers (HCWs) globally. These outcomes are often driven by complex and overlapping work-related stressors, which remain insufficiently understood in combination. Objective: To investigate the associations of multiple work-related stressors with occupational burnout and fatigue, and to identify distinct stress patterns and critical stressors among HCWs. Method: A cross-sectional survey was conducted using a self-administered electronic questionnaire among 2695 HCWs in Shanghai, China. Validated questionnaire scales were used to assess work-related stress (self-developed occupational stress scale for medical staff, CSSM), occupational burnout (Maslach Burnout Inventory–General Survey, MBI-GS), and fatigue (Fatigue Scale-14, FS-14). Latent profile analysis (LPA) was employed to identify distinct work-related stress patterns. Generalized linear models (GLMs) were used to explore the associations between individual stressors, stress patterns, and occupational burnout and fatigue. Additionally, weighted quantile sum (WQS) models were utilized to evaluate the combined effects of multiple stressors and identify the main contributors. Results: In this study, 77.0% and 71.2% of participants were classified as experiencing occupational burnout and fatigue, respectively. A strained doctor–patient relationship was the highest-rated work-related stressor. All work-related stressors, including career development, interpersonal relationships, work–life imbalance, physical environment, doctor–patient relationship, social environment, and workload, were significantly associated with burnout (β: 0.444~0.956, p < 0.001) and fatigue (β: 1.384~3.404, p < 0.001). WQS assigned higher weights to career development and workload for burnout, and to workload and work–life imbalance for fatigue. LPA identified two distinct occupational stress patterns. HCWs characterized by higher stress levels in physical environment, career development, workload, and interpersonal relationships exhibited significantly higher burnout scores (β = 0.325, 95% CI: 0.122, 0.528), particularly in the reduced personal accomplishment (PA) dimension (β = 1.003, 95% CI: 0.746, 1.259). Conclusions: This study highlighted the high prevalence of occupational burnout and fatigue among HCWs in Shanghai, China. Occupational stressors were associated with both burnout and fatigue, with higher workload, work–life imbalance, and poorer career development showing particularly significant contributions. These findings emphasized the urgent need for targeted interventions, including workload management, career development programs, and mental health support, to reduce occupational stress and mitigate its adverse effects on HCWs. Full article

► Show Figures

Figure 1

15 pages, 248 KiB

Open AccessArticle

General Practitioners’ Perceptions on Prescribing Coastal Visits for Mental Health in Flanders (Belgium)

by Alexander Hooyberg, Luka De Wever Van der Heyden, Marine I. Severin, Stefaan De Henauw and Gert Everaert

Healthcare 2025, 13(13), 1599; https://doi.org/10.3390/healthcare13131599 - 3 Jul 2025

Abstract

Background: Increasing evidence suggests that visiting the coast benefits mental health and that coastal prescribing is a promising societal endpoint. General practitioners (GPs) are the pivotal access point for patients to receive diagnosis and treatment, but little is known about their perspective on [...] Read more.

Background: Increasing evidence suggests that visiting the coast benefits mental health and that coastal prescribing is a promising societal endpoint. General practitioners (GPs) are the pivotal access point for patients to receive diagnosis and treatment, but little is known about their perspective on recommending patients to visit the coast. Methods: This study applied qualitative semi-structured interviews to explore GPs’ perspectives on coastal prescribing in Flanders. We interviewed eleven GPs (aged 32–69 years) and inspected their responses using inductive thematic analysis. Results: Results show that the interviewed GPs generally believed in the therapeutic benefits of the coast, but also acknowledged risks associated with crowding and patient-specific effects. Six barriers were identified for coastal prescribing: feasibility concerns, lack of awareness, prioritizing physical exercise or visiting nearby green nature, anticipating low motivation of the patient, feeling pressure to prescribe medication, and needing more scientific evidence. As solutions, they proposed gathering more scientific evidence and raising awareness. Finally, the GPs regarded their field expertise as valuable in helping to recruit patients for follow-up research on the health effects of the coast. Conclusions: Our findings highlight the importance of engaging GPs, patients, and other stakeholders to identify key knowledge gaps before co-creating coastal prescribing in healthcare. Full article

► Show Figures

Graphical abstract

13 pages, 1519 KiB

Open AccessArticle

ChatGPT Performance Deteriorated in Patients with Comorbidities When Providing Cardiological Therapeutic Consultations

by Wen-Rui Hao, Chun-Chao Chen, Kuan Chen, Long-Chen Li, Chun-Chih Chiu, Tsung-Yeh Yang, Hung-Chang Jong, Hsuan-Chia Yang, Chih-Wei Huang, Ju-Chi Liu and Yu-Chuan (Jack) Li

Healthcare 2025, 13(13), 1598; https://doi.org/10.3390/healthcare13131598 - 3 Jul 2025

Abstract

Background: Large language models (LLMs) like ChatGPT are increasingly being explored for medical applications. However, their reliability in providing medication advice for patients with complex clinical situations, particularly those with multiple comorbidities, remains uncertain and under-investigated. This study aimed to systematically evaluate [...] Read more.

Background: Large language models (LLMs) like ChatGPT are increasingly being explored for medical applications. However, their reliability in providing medication advice for patients with complex clinical situations, particularly those with multiple comorbidities, remains uncertain and under-investigated. This study aimed to systematically evaluate the performance, consistency, and safety of ChatGPT in generating medication recommendations for complex cardiovascular disease (CVD) scenarios. Methods: In this simulation-based study (21 January–1 February 2024), ChatGPT 3.5 and 4.0 were prompted 10 times for each of 25 scenarios, representing five common CVDs paired with five major comorbidities. A panel of five cardiologists independently classified each unique drug recommendation as “high priority” or “low priority”. Key metrics included physician approval rates, the proportion of high-priority recommendations, response consistency (Jaccard similarity index), and error pattern analysis. Statistical comparisons were made using Z-tests, chi-square tests, and Wilcoxon Signed-Rank tests. Results: The overall physician approval rate for GPT-4 (86.90%) was modestly but significantly higher than that for GPT-3.5 (85.06%; p = 0.0476) based on aggregated data. However, a more rigorous paired-scenario analysis of high-priority recommendations revealed no statistically significant difference between the models (p = 0.407), indicating the advantage is not systematic. A chi-square test confirmed significant differences in error patterns (p < 0.001); notably, GPT-4 more frequently recommended contraindicated drugs in high-risk scenarios. Inter-model consistency was low (mean Jaccard index = 0.42), showing the models often provide different advice. Conclusions: While demonstrating high overall physician approval rates, current LLMs exhibit inconsistent performance and pose significant safety risks when providing medication advice for complex CVD cases. Their reliability does not yet meet the standards for autonomous clinical application. Future work must focus on leveraging real-world data for validation and developing domain-specific, fine-tuned models to enhance safety and accuracy. Until then, vigilant professional oversight is indispensable. Full article

► Show Figures

Figure 1

14 pages, 427 KiB

Open AccessArticle

Factors Associated with Decisional Regret After Shared Decision Making for Patients Undergoing Total Knee Arthroplasty

by Yu-Chieh Lo, Yu-Pin Chen, Hui En Lin, Wei-Chun Chang, Wei-Pin Ho, Jia-Pei Jang and Yi-Jie Kuo

Healthcare 2025, 13(13), 1597; https://doi.org/10.3390/healthcare13131597 - 3 Jul 2025

Abstract

Introduction: Total knee arthroplasty (TKA) is a treatment for knee pain, but some patients are not satisfied with their outcomes. Utilizing shared decision making (SDM) can lead to better decisions, satisfaction, and fewer regrets. However, healthcare professionals have little knowledge of risk factors [...] Read more.

Introduction: Total knee arthroplasty (TKA) is a treatment for knee pain, but some patients are not satisfied with their outcomes. Utilizing shared decision making (SDM) can lead to better decisions, satisfaction, and fewer regrets. However, healthcare professionals have little knowledge of risk factors for regret. The aim of this study is to evaluate decisional regret using the Decision Regret Scale (DRS) after primary TKA among patients who engaged in SDM. Method: A total of 118 patients who underwent TKA surgery between March 2020 and May 2022 participated in this study, and they were able to reflect on their outcomes. The primary outcome was decisional regret assessed using the DRS, and the secondary outcome was post-operative pain at a three-month follow-up, measured using the Lequesne Index. Result: The study found that 49% of the patients reported no regret, 25% reported mild regret, and 26% reported moderate-to-severe regret. There was a significant correlation between greater levels of decision regret and a higher three-month Lequesne Index. Post-operative pain and post-operative mobility status and the range of motion of the knee joint were also strongly correlated. Conclusion: The study found that more than half of the patients undergoing primary TKAs experienced regret even following SDM counseling. Regret levels were associated with higher post-operative pain and poorer mobility. This underscores the importance of informing patients about potential adverse effects of TKA to manage their expectations and reduce regret in future SDM interviews. Practice implications: This study incorporated patient perspectives through their direct engagement in the SDM process prior to surgery. Patients participated in the design of the SDM framework, which included educational pamphlets and structured interviews to assess their values and preferences. Their involvement ensured that the SDM procedure was tailored to patient-centered outcomes. Furthermore, the follow-up assessments were conducted with patients to evaluate decisional regret and post-operative outcomes, providing valuable insights into the effectiveness of the SDM process. By actively participating in the research through decision making and outcome reflection, the patients contributed to the understanding of factors influencing decisional regret after undergoing TKA. Full article

(This article belongs to the Special Issue Patient-Centered Care for Enhancing Health-Related Quality of Life: Integrating Clinical, Behavioral, and Social Determinants of Health)

► Show Figures

Figure 1

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