Healthcare

12 pages, 1365 KB

Open AccessArticle

Habitual Spectacle-Corrected Distance Visual Acuity and Axial Elongation in School-Based Myopia Screening: A Retrospective Cohort Study

by You-Ruo Zhang, Qiu-Lin Mi, Huan Xiao, Ying-Ying Nie, Yi-Chun Chai, Ting Li and Jun-Guo Duan

Healthcare 2026, 14(14), 2076; https://doi.org/10.3390/healthcare14142076 - 10 Jul 2026

Abstract

Background/Objectives: Progressive axial elongation is a key structural indicator of myopia progression. In school-based screening, repeated ocular biometry may not always be feasible; routinely collected visual-acuity information may support follow-up prioritization. This study examined the association between stable habitual spectacle-corrected distance visual-acuity [...] Read more.

Background/Objectives: Progressive axial elongation is a key structural indicator of myopia progression. In school-based screening, repeated ocular biometry may not always be feasible; routinely collected visual-acuity information may support follow-up prioritization. This study examined the association between stable habitual spectacle-corrected distance visual-acuity profiles and annualized axial length growth. Methods: This retrospective real-world cohort study used the Chengdu school-based myopia screening database. Children aged 7.0–9.9 years with screening—defined as low-to-moderate myopia and three consecutive screening visits—were classified as adequately corrected (ACG), functionally under-corrected (UCG), or uncorrected myopia (UMG) according to stable spectacle-wearing and visual-acuity profiles. The primary outcome was annualized axial length growth from baseline to the second follow-up (ΔAL). The primary analysis used 1:1 propensity-score matching; robustness was assessed using interval-specific outcomes, alternative caliper widths, and full-cohort multivariable regression. Results: The final cohort included 4152 children: 391 ACG, 551 UCG, and 3210 UMG. Matching retained 313 ACG–UCG pairs and 387 UCG–UMG pairs. ΔAL was lower in the ACG than in the UCG groups (0.224 vs. 0.362 mm/year; mean difference, −0.139; 95% CI, −0.165 to −0.112; p < 0.001). No statistically significant ΔAL difference was detected between the UCG and UMG (p = 0.412). Sensitivity analyses yielded consistent findings. Conclusions: Stable habitual spectacle-corrected distance visual-acuity profiles were associated with annualized axial length growth. Achieved visual acuity under habitual spectacle-wearing conditions may provide information beyond spectacle-wearing status alone; however, these observational findings do not establish equivalence, predictive utility, or causality. Full article

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

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16 pages, 1780 KB

Open AccessReview

A Decade of Lung Transplantation in China (2015–2024): Driving Quality Improvement and Scale Expansion Through Management Systems

by Xiao-Shan Li, Chun-Xiao Hu, Gong-Tao Qian, Wei-Wei Xu, Yi Lu and Jing-Yu Chen

Healthcare 2026, 14(14), 2075; https://doi.org/10.3390/healthcare14142075 - 10 Jul 2026

Abstract

Since organ donation after citizen death became the sole legal source in 2015, lung transplantation (LTx) in China has undergone a systematic transformation, shifting from numerical scarcity to scale expansion and from technical exploration to sustained improvement in quality. From a management perspective, [...] Read more.

Since organ donation after citizen death became the sole legal source in 2015, lung transplantation (LTx) in China has undergone a systematic transformation, shifting from numerical scarcity to scale expansion and from technical exploration to sustained improvement in quality. From a management perspective, this article provides a comprehensive review of the development of LTx in China between 2015 and 2024, demonstrating that its central achievement has been the establishment of an integrated management system that combines national top-level policy design, standardized and homogeneous training, multidisciplinary collaboration, standardized clinical pathways, and rigorous quality assessment. Supported by a mechanism based on data-driven decision making, standard-guided implementation, and closed-loop management, this system has effectively ensured quality homogeneity and controllable risk during the dissemination of advanced transplantation techniques. Over the past decade, the number of hospitals performing LTx increased from 9 to 45, annual procedure volume rose from 118 to 925 cases, and the cumulative total of completed LTx was 5483. During the same period, 30-day survival improved from 78.5% to 85.3%. This system-oriented management model provides an important reference for the global community, particularly for developing countries facing challenges related to resource imbalance, by demonstrating how institutional innovation can facilitate the safe and efficient dissemination of highly complex medical technologies. Full article

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19 pages, 891 KB

Open AccessSystematic Review

Developmentally Stratified Integrated Preventive Strategies for Pediatric Oral Health: A Systematic Review with Healthcare Implications

by Ioana Elena Lile, Gianina Tapalagă, Diana Marian, Andra-Alexandra Stăncioiu, Christian Samoilă and Carolina Cojocariu

Healthcare 2026, 14(14), 2074; https://doi.org/10.3390/healthcare14142074 - 10 Jul 2026

Abstract

Background/Objectives: Within pediatric healthcare systems, integrated strategies combining dietary and oral hygiene interventions have been proposed to improve oral health outcomes. In order to evaluate the effects of combined dietary and oral hygiene approaches on behavioral, knowledge-based, and clinical outcomes in pediatric populations, [...] Read more.

Background/Objectives: Within pediatric healthcare systems, integrated strategies combining dietary and oral hygiene interventions have been proposed to improve oral health outcomes. In order to evaluate the effects of combined dietary and oral hygiene approaches on behavioral, knowledge-based, and clinical outcomes in pediatric populations, this systematic review synthesized evidence from intervention studies. Methods: A comprehensive literature search was conducted on 5 September 2025 using PubMed, Scopus, Web of Science, Google Scholar, and arXiv. Children and adolescents (0–18 years old) exposed to dietary and oral hygiene interventions with documented behavioral, clinical, or knowledge-related outcomes were included in eligible studies. Studies were stratified by age groups (0–5, 6–12, and 13–18 years) in order to address developmental heterogeneity. The Cochrane RoB 2 tool for randomized trials and the ROBINS-I tool for non-randomized studies with a comparator were used to evaluate the risk of bias. For single-arm pre–post studies, a narrative risk-of-bias assessment was conducted, as ROBINS-I is not designed for uncontrolled studies. Due to methodological and clinical heterogeneity, a narrative synthesis approach was applied. Results: Out of 1231 records, eight outcome-reporting intervention studies satisfied the inclusion criteria. Improvements in self-reported oral hygiene behaviors, dietary habits, and oral health knowledge were consistently linked to integrated interventions across developmental subgroups. There was little and inconsistent evidence for clinical outcomes, such as caries and periodontal indicators. Conclusions: In pediatric populations, integrated dietary and oral hygiene interventions seem to enhance behavioral and educational oral health outcomes. These findings highlight the need for developmentally tailored preventive strategies integrated within pediatric healthcare frameworks. Full article

(This article belongs to the Special Issue Oral Health Care and Services for Patients)

18 pages, 926 KB

Open AccessArticle

Construction of Customized Personas for Decision-Making Cognition Regarding Oral Microbiota Transplantation in Head and Neck Cancer Patients Undergoing Radiotherapy: A Qualitative Study

by Xue Liu, Hang Wang, Xinyao Yang, Yufei Li, Like Zhang, Lei Cui, Hao Li and Lili Hou

Healthcare 2026, 14(14), 2073; https://doi.org/10.3390/healthcare14142073 - 10 Jul 2026

Abstract

Background: Patients with head and neck cancer who are undergoing radiotherapy frequently suffer from oral mucositis and oral microecological disorders, which severely impair their quality of life. Oral microbiota transplantation is an emerging oral microecological intervention that offers a novel approach for [...] Read more.

Background: Patients with head and neck cancer who are undergoing radiotherapy frequently suffer from oral mucositis and oral microecological disorders, which severely impair their quality of life. Oral microbiota transplantation is an emerging oral microecological intervention that offers a novel approach for reconstructing oral microecological balance and relieving mucositis. However, regarding this innovative therapy, there is a paucity of in-depth research into patients’ decision-making cognition, and existing evidence is insufficient to support individualized clinical decision-making guidance. Methods: A descriptive qualitative research design was employed. From July to December 2025, patients diagnosed with head and neck cancer undergoing radiotherapy were recruited from a tertiary hospital in Shanghai via purposive sampling. The data were collected through semi-structured interviews and analyzed using Colaizzi’s seven-step analysis method. The user label system was refined and summarized to construct user portraits. These portraits were visualized in the form of WordArt word clouds and character labels. Results: A total of 21 eligible patients with head and neck cancer undergoing radiotherapy participated in the study. The construct of decision-making cognition encompasses five dimensions: treatment prioritization, information needs, health literacy, psychological status, and decision quality. The patients were categorized into four types: proactive participation, passive dependence, weigh carefully, and symptom-driven. These classifications reflect the cognitive characteristics and group differences regarding the Oral Microbiota Transplantation decision-making process among different patients. Conclusions: Patients exhibit considerable variability in their decision-making cognition regarding the innovative OMT therapy. This phenomenon can be categorized into four distinct persona types, which, respectively, reflect unique information processing styles, risk assessments, and behavioral coping strategies when patients encounter novel therapeutic interventions. This typology provides a theoretical foundation for individualized clinical decision support, delineates targets for the formulation of targeted communication strategies, and ultimately enhances patient decision quality and treatment adherence. Full article

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19 pages, 567 KB

Open AccessArticle

Comorbidity Burden Is Associated with Claims-Based Muscle Wasting and Atrophy Suggestive of Possible Sarcopenia in Korean Adults: A Propensity Score-Matched Analysis Using the National Health Insurance Service Database

by Hyunseok Jee and Jimi Kim

Healthcare 2026, 14(14), 2072; https://doi.org/10.3390/healthcare14142072 - 10 Jul 2026

Abstract

Background/Objectives: Possible sarcopenia has been proposed as an early clinical category for identifying individuals at risk of adverse muscle-related outcomes before full diagnostic evaluation. This study examined whether comorbidity burden is associated with possible sarcopenia more strongly than routinely available clinical and [...] Read more.

Background/Objectives: Possible sarcopenia has been proposed as an early clinical category for identifying individuals at risk of adverse muscle-related outcomes before full diagnostic evaluation. This study examined whether comorbidity burden is associated with possible sarcopenia more strongly than routinely available clinical and laboratory variables. Methods: We conducted a retrospective propensity score-matched case–control study using the Korean National Health Insurance Service database (2002–2019). Possible sarcopenia was not defined according to guideline-based muscle strength, muscle mass, or physical performance criteria. Instead, we used KCD code M62.5 as a claims-based proxy for clinically suspected muscle wasting or atrophy suggestive of possible sarcopenia. After exclusion of individuals with missing data, 1793 cases were matched 1:1 with 1793 controls according to age, sex, residential area, and insurance type. Anthropometric measures, biochemical parameters, lifestyle factors, and Charlson Comorbidity Index (CCI) scores were compared. Logistic regression and receiver operating characteristic analyses were performed to evaluate associations and discriminatory performance. Results: In the matched population, most anthropometric, biochemical, and lifestyle variables were not significantly different between groups. Fasting blood glucose and gamma-glutamyl transferase were higher in the claims-based possible sarcopenia group, but these associations were not retained in the multivariable model. The CCI score was independently associated with possible sarcopenia (odds ratio: 1.25, 95% confidence interval: 1.20–1.30; p < 0.001). In receiver operating characteristic analysis, the CCI showed the highest discriminatory ability among individual predictors (area under the curve, 0.603). The multivariable model yielded an area under the curve of 0.610. Conclusions: In administrative health data, claims-recorded muscle wasting or atrophy suggestive of possible sarcopenia was more consistently associated with multimorbidity burden than with individual routine clinical or laboratory markers. These findings support cautious, comorbidity-aware interpretation of muscle wasting/atrophy codes, but do not establish diagnostic validity for possible sarcopenia. Full article

(This article belongs to the Section Chronic Care)

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28 pages, 2887 KB

Open AccessArticle

Quality of Life Among End-Stage Renal Disease Patients Undergoing Maintenance Hemodialysis at King Abdulaziz Hospital, Kingdom of Saudi Arabia: A Cross-Sectional Study

by Nuha Eid Alotaibi, Anna Joyce Pitsoane, Felipe G. Martinez, Jr. and Ramy I. Abulikailik

Healthcare 2026, 14(14), 2071; https://doi.org/10.3390/healthcare14142071 - 10 Jul 2026

Abstract

Background/Objectives: End-stage renal disease (ESRD) profoundly affects patients’ daily functioning and well-being, particularly among individuals receiving long-term hemodialysis. Evaluating quality of life (QoL) is therefore essential for understanding the broader impact of ESRD and its treatment. This study aimed to assess QoL and [...] Read more.

Background/Objectives: End-stage renal disease (ESRD) profoundly affects patients’ daily functioning and well-being, particularly among individuals receiving long-term hemodialysis. Evaluating quality of life (QoL) is therefore essential for understanding the broader impact of ESRD and its treatment. This study aimed to assess QoL and identify demographic and treatment-related factors associated with QoL among patients undergoing maintenance hemodialysis at a regional dialysis center in Al Ahsa, Eastern Saudi Arabia. Methods: A cross-sectional study was conducted among 79 adult patients receiving maintenance hemodialysis for at least three months at King Abdulaziz Hospital, Al Ahsa. Quality of life was assessed using the WHOQOL-BREF questionnaire, with domain scores transformed to a 0–100 scale. Statistical analyses included descriptive statistics, independent t-tests, one-way ANOVA, Spearman’s correlation analysis, and multinomial logistic regression. Results: The physical domain demonstrated the lowest QoL score (49.69 ± 18.77), followed by the social domain (48.02 ± 24.92), whereas the psychological (63.83 ± 19.15) and environmental (67.56 ± 19.27) domains showed comparatively higher scores. Female sex, lower educational attainment, and night-shift dialysis were associated with poorer physical QoL. Significant positive correlations were observed among all QoL domains (p < 0.01), indicating strong interrelationships between different aspects of quality of life. Conclusions: Patients undergoing maintenance hemodialysis experienced substantial impairment in the physical and social dimensions of quality of life, while psychological and environmental well-being remained relatively preserved. These findings support the routine assessment of QoL in dialysis care and highlight the need for targeted interventions, including optimized dialysis scheduling, structured physical activity programs, and psychosocial support, to improve overall patient well-being with ESRD. Full article

(This article belongs to the Section Chronic Care)

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20 pages, 1807 KB

Open AccessArticle

Social Vulnerability and Structural Determinants of Child and Adolescent Well-Being in Europe: A Longitudinal Cross-National Analysis Using Eurostat Data (2017–2023)

by David Pérez-Jorge, Miriam Catalina González-Afonso, Iris Alexia Hernández-González and María Carmen Martínez-Murciano

Healthcare 2026, 14(14), 2070; https://doi.org/10.3390/healthcare14142070 - 10 Jul 2026

Abstract

Background/Objectives: Child social vulnerability is a multidimensional phenomenon influenced by poverty, material deprivation, inequality, and institutional protection. This study analysed child and adolescent social vulnerability in Europe between 2017 and 2023 and developed a Child Social Vulnerability Index (CSVI). Methods: A [...] Read more.

Background/Objectives: Child social vulnerability is a multidimensional phenomenon influenced by poverty, material deprivation, inequality, and institutional protection. This study analysed child and adolescent social vulnerability in Europe between 2017 and 2023 and developed a Child Social Vulnerability Index (CSVI). Methods: A longitudinal ecological study was conducted using Eurostat country-year data from European countries. Indicators included severe child poverty, severe material deprivation, income inequality (Gini index), preventive healthcare expenditure, and social protection expenditure. Descriptive, longitudinal, principal component, and cluster analyses were performed. Results: The findings revealed substantial differences in child social vulnerability across European countries. Poverty, material deprivation, and inequality were strongly associated, supporting the multidimensional nature of vulnerability. Principal Component Analysis supported the internal structure of the child Social Vulnerability Index (CSVI), identifying two components that explained 76.35% of the variance. The CSVI showed a very high correlation with the first principal component (r = 0.97, p < 0.001) confirming its structural consistency. Longitudinal analyses revealed a significant decline in child social vulnerability between 2017 and 2023 with an additional reduction during the COVID-19/post-COVID period. Cluster analysis identified three distinct European vulnerability profiles based on the CSVI and institutional protection dimension. Conclusions: Child social vulnerability in Europe is shaped by the interaction of socioeconomic inequalities and institutional protection mechanisms. The CSVI provides a useful tool for monitoring vulnerability and informing policies to reduce inequalities and promote child and adolescent well-being. Full article

(This article belongs to the Special Issue Cross-Disciplinary Approaches to Advancing Child Health and Well-Being)

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41 pages, 1358 KB

Open AccessReview

by Amrit Kooner, Lee Man, Justin Best, Nicholas Litsky, Brianna Yee and Justin Jeffries

Healthcare 2026, 14(14), 2069; https://doi.org/10.3390/healthcare14142069 - 10 Jul 2026

Abstract

Sleep-related breathing disorders (SRBDs) encompasses a spectrum of conditions that disrupt ventilation during sleep, leading to fragmented sleep and impaired gas exchange. Their high prevalence and substantial neurocognitive and mental health outcomes make SRBD clinically significant across multiple medical disciplines. Traditional management includes [...] Read more.

Sleep-related breathing disorders (SRBDs) encompasses a spectrum of conditions that disrupt ventilation during sleep, leading to fragmented sleep and impaired gas exchange. Their high prevalence and substantial neurocognitive and mental health outcomes make SRBD clinically significant across multiple medical disciplines. Traditional management includes lifestyle modifications and positive airway pressure (PAP). When non-surgical measures fail or anatomical factors predominate, a range of surgical approaches may be employed, such as uvulopalatopharyngoplasty (UPPP) or maxillomandibular advancement (MMA). There are many notable emerging surgical advancements, such as hypoglossal nerve stimulation (HNS), transoral robotic surgery (TORS), and minimally invasive radiofrequency technologies (RFA), that have offered improved outcomes for select patients. Advances in diagnostic tools, such as portable home sleep technologies and drug-induced sleep endoscopy (DISE), further support precision-based care. Collectively, the expanding range of therapeutic and diagnostic innovations is enabling clinicians to deliver individualized care and improve long-term outcomes for patients with SRBD. Full article

(This article belongs to the Special Issue Surgical Innovations and New Technologies for Sleep-Related Breathing Disorders)

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14 pages, 2451 KB

Open AccessArticle

Electronic Cigarette Use and Sleep Quality Among Young Adults in Jazan, Saudi Arabia: A Community-Based Cross-Sectional Study

by Majed A. Alotayfi, Sarah Salih, Abdulilah Alqarny, Ahmed M. Hashim, Atheer Homadi, Khalid Humedi, Reema Nharri and Ghada A. Ageeli

Healthcare 2026, 14(14), 2068; https://doi.org/10.3390/healthcare14142068 - 10 Jul 2026

Abstract

Purpose: This study aimed to assess the association between electronic cigarette use and sleep quality among young adults aged 18 to 25 years. Methods: This cross-sectional study was conducted in the Jazan region using a structured, self-administered questionnaire. Sleep quality was [...] Read more.

Purpose: This study aimed to assess the association between electronic cigarette use and sleep quality among young adults aged 18 to 25 years. Methods: This cross-sectional study was conducted in the Jazan region using a structured, self-administered questionnaire. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), with global scores >5 indicating poor sleep quality. Smoking behaviors, including electronic and combustible cigarette use, along with demographic, socioeconomic, and clinical variables, were collected. Multivariable generalized linear modeling was used to identify factors independently associated with PSQI global scores. Results: Among 423 participants (median [IQR] age, 21.0 [20.0–24.0] years), 51.3% were classified as having poor sleep quality (PSQI > 5). In univariate analysis, male, electronic cigarette use, and presence of comorbidity were significantly associated with poor sleep quality. Electronic cigarette users had a higher prevalence of poor sleep compared with nonusers (64.0% vs. 46.6%; p = 0.01). In multivariable logistic regression, electronic cigarette use remained independently associated with increased odds of poor sleep (odds ratio [OR], 2.86; 95% CI, 1.31–6.24; p = 0.008), whereas combustible cigarette use was not significant. Conclusions: In this study of young adults in Jazan, poor sleep quality was common and was associated with electronic cigarette use and comorbidity burden, whereas combustible cigarette use was not associated after adjustment. These findings suggest that vaping may be an important correlate of sleep health in this population. Further longitudinal studies are needed to clarify the temporal relationship between electronic cigarette use and sleep outcomes. Full article

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23 pages, 4444 KB

Open AccessArticle

Mitigating Clinical Confounding in AI Models: A Comparative Analysis of Associative and Causal-Fused AI for ICU Readmissions

by Konstantina Remoundou, Emanuele Koumantakis and Ioanna Roussaki

Healthcare 2026, 14(14), 2067; https://doi.org/10.3390/healthcare14142067 - 10 Jul 2026

Abstract

Introduction: In critical environments, patient discharge decisions present significant challenges, particularly regarding the prevention of readmissions. However, traditional AI systems focus on correlations rather than causation, resulting in issues related to explainability and generalization. This study conducts a comparative evaluation between standard [...] Read more.

Introduction: In critical environments, patient discharge decisions present significant challenges, particularly regarding the prevention of readmissions. However, traditional AI systems focus on correlations rather than causation, resulting in issues related to explainability and generalization. This study conducts a comparative evaluation between standard predictive and causal-fused models to assess their ability to mitigate clinical confounding on predicting readmissions. Methodology: Utilizing the MIMIC-IV dataset, we predicted 30-day ICU readmissions through a comparative analysis of associative models (XGBoost, LSTM) and their causal-fused equivalents. The Fast Causal Inference (FCI) algorithm mapped latent confounding via a Partial Ancestral Graph (PAG), while counterfactuals were computed using Causal Forests to estimate the Average Treatment Effect (ATE), which was integrated into the predictive models. Performance was evaluated via AUROC, AUPRC, calibration metrics, precision, recall, and F1-score while feature extraction was used to monitor feature realignment. Results: The causal-fused LSTM model maintained a stable AUROC (0.7342 to 0.7357), while the XGBoost AUROC improved (0.6517 to 0.6909). Feature importance extraction revealed a structural realignment; whereas standard models relied heavily on non-actionable frailty proxies such as polypharmacy, causal integration elevated the individualized causal effect of length of stay as a primary predictive driver. The estimated ATE for length of stay was calculated at −0.038. Conclusions: The comparison showed that transitioning to causal-fused AI mathematically resolves a clinical Simpson’s Paradox, while also realigning the features based on causal mechanisms without sacrificing predictability. By making this shift, we can mitigate reliance on administrative noise and promote de-confounded interventions rather than passive correlations. Full article

(This article belongs to the Special Issue The Role of AI in Predictive and Prescriptive Healthcare)

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23 pages, 872 KB

Open AccessReview

Beyond the Surgical Bill: Pharmacoeconomics and Real-World Utilization Across the Knee Osteoarthritis Care Pathway—A Critical Narrative Review

by Furkan Yapıcı

Healthcare 2026, 14(14), 2066; https://doi.org/10.3390/healthcare14142066 - 9 Jul 2026

Abstract

Background: Knee osteoarthritis (KOA) is often framed as degenerative knee pain, yet behaves as a decades-long care pathway in which medication, injections, comorbidity, productivity loss, and surgery accumulate into a major economic footprint. This critical narrative review synthesizes pharmacoeconomic and pharmacoepidemiologic evidence across [...] Read more.

Background: Knee osteoarthritis (KOA) is often framed as degenerative knee pain, yet behaves as a decades-long care pathway in which medication, injections, comorbidity, productivity loss, and surgery accumulate into a major economic footprint. This critical narrative review synthesizes pharmacoeconomic and pharmacoepidemiologic evidence across that pathway. Methods: Structured source identification was conducted in PubMed, Web of Science, Scopus, and Google Scholar for publications from 2000 to 2026, with citation tracking. Sources were appraised against predefined critical-interpretation domains and mapped narratively rather than pooled; no meta-analysis was performed. Results: Global Burden of Disease 2019 estimates approximately 364.6 million prevalent KOA cases worldwide. Reported evidence indicates that KOA spending is highly concentrated: in a large U.S. claims analysis, knee arthroplasty was performed in approximately 8.8% of patients yet accounted for 61.5% of KOA-related costs, whereas hyaluronic acid represented 3.0% of overall costs; the remaining pathway burden was distributed across years of outpatient care, analgesics, injections, and other nonsurgical utilization. Medication and injection findings were stage- and phenotype-dependent, and observational studies associated opioid exposure with higher fall risk, healthcare utilization, and cost. Intra-articular hyaluronic acid was repeatedly associated with longer time to arthroplasty, interpreted here as an association limited by confounding and immortal-time bias, not a causal effect; platelet-rich plasma value remained price- and durability-sensitive. Conclusions: KOA economics resembles an iceberg—arthroplasty is the visible peak, while the submerged mass is years of pathway-level care. Value-based policy should measure the full pathway, not the surgical episode, using linked claims, registries, patient-reported outcomes, and productivity data. Full article

(This article belongs to the Section Clinical Care)

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16 pages, 483 KB

Open AccessReview

Meaningful or Marginal: An Integrative Review of Consumer and Community Involvement in Migrant Health Research

by Mehwish Nisar, Muhammad Waqas Nisar Ahmed and Sobia Zafar

Healthcare 2026, 14(14), 2065; https://doi.org/10.3390/healthcare14142065 - 9 Jul 2026

Abstract

Background/Objectives: Consumer and Community Involvement (CCI) is increasingly mandated in health research to promote ethical, relevant, and impactful research outcomes. However, in migrant health research, CCI can sometimes be tokenistic. This review aimed to critically synthesise the empirical and contextual literature on CCI [...] Read more.

Background/Objectives: Consumer and Community Involvement (CCI) is increasingly mandated in health research to promote ethical, relevant, and impactful research outcomes. However, in migrant health research, CCI can sometimes be tokenistic. This review aimed to critically synthesise the empirical and contextual literature on CCI in migrant health research to examine how meaningfully migrant communities are engaged across the research process. Methods: An integrative literature review was conducted. A systematic search of six databases (CINAHL, EMBASE, PubMed, PsycINFO, Scopus, Web of Science) was performed for peer-reviewed literature published up to January 2026, excluding grey literature. Two independent reviewers conducted screening and quality appraisal (using AMSTAR 2, MMAT, and the JBI Critical Appraisal Checklist for Text and Opinion). Data from 20 included studies were synthesised using systematic text condensation. Results: A total of 20 peer reviewed articles were included. Results identified four themes: (1) the meaningfulness gap—between superficial indicators of involvement and impact-driven measures; (2) the burden of representation—few individuals expected to act as authentic representatives for heterogeneous populations; (3) intersectional power dynamics—participation skewed toward English-speaking, high-socioeconomic status migrants; and (4) limited co-design in research governance—insufficient involvement in funding, ethics, or data decisions. Conclusions: CCI in migrant health research appears more marginal than meaningful. Structural conditions, rather than individual failings, appear to constrain authentic community participation particularly at the stages of priority setting and research governance. Procedural compliance alone appears insufficient; reform across research governance, funding, and ethics appears warranted. Full article

(This article belongs to the Special Issue Ensuring Health Equity: Cultural Competence and Social Determinants in Migrant Care)

20 pages, 1888 KB

Open AccessArticle

Participant Perceptions of Continued Mental Health First Aid (MHFA) Engagement, Help-Seeking Behavior, and Stigma Reduction: A Mixed-Methods Pilot Study

by Michael A. D. Smith, Jennifer Marazzo, Lillian D. Williams, Eric Fishon, Josh Muhammad, LaTika Muhammad, Venecia Williams, Ashlee Shands and Arleen Downer-Reid

Healthcare 2026, 14(14), 2064; https://doi.org/10.3390/healthcare14142064 - 9 Jul 2026

Abstract

Background/Objectives: Mental Health First Aid (MHFA) is an internationally recognized training program designed to improve mental health literacy, reduce stigma, and train non-clinicians with supportive skills to assist individuals experiencing psychological distress. Although prior research has demonstrated trainees’ short-term improvements in knowledge and [...] Read more.

Background/Objectives: Mental Health First Aid (MHFA) is an internationally recognized training program designed to improve mental health literacy, reduce stigma, and train non-clinicians with supportive skills to assist individuals experiencing psychological distress. Although prior research has demonstrated trainees’ short-term improvements in knowledge and attitudes, less is known about their post-certification perceptions. Here, we assess the likelihood of trainees’ continued application of MHFA concepts several months after certification. The current study examined the participants’ self-reported perceptions of the behavioral and attitudinal outcomes three to six months following training, including, help-seeking behaviors, self-efficacy, stigma-related attitudes, and functional application of intervention skills. Methods: A mixed-methods, cross-sectional design was employed using a structured web-based survey administered to MHFA-trained participants. The survey included demographic items, Likert-scale measures of confidence, behavioral engagement, and stigma-related attitudes, as well as open-ended qualitative prompts. Quantitative analyses included descriptive statistics, reliability testing using Cronbach’s alpha, exploratory factor analysis, assumption diagnostics, and nonparametric hypothesis testing using Mann–Whitney U tests. Qualitative responses were analyzed using thematic analysis to identify recurring patterns related to long-term training impact. Results: Participants reported increases in self-confidence and behavioral engagement following MHFA training. More than 80% of participants indicated they had recommended professional mental health services to others after certification. Psychometric evaluation demonstrated strong internal consistency for the six-item self-stigma scale (α = 0.90), with a unidimensional factor structure explaining 60.4% of the variance, whereas the public stigma scale showed weaker internal reliability (α = 0.45). Qualitative themes included increased self-awareness, stigma reduction, advocacy behavior, professional empowerment, and institutional validation of mental health priorities. Conclusions: The findings suggest participants perceived continued confidence, reduced internalized stigma, and engagement in supportive mental health behaviors following MHFA training. These findings should be interpreted cautiously given the cross-sectional design, self-reported measures, and highly engaged sample. Full article

(This article belongs to the Section Mental Health and Psychosocial Well-being)

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18 pages, 1735 KB

Open AccessArticle

Why Nurses Intend to Override AI Alerts: How Alert Fatigue, Moral Distress, and Team Psychological Safety Shape Self-Reported Trust Calibration Toward Clinical Decision Support

by Emilia Clej, Camelia Fizedean, Adelina Gherman, Adrian Cosmin Ilie, Melania Lavinia Bratu and Felicia Marc

Healthcare 2026, 14(14), 2063; https://doi.org/10.3390/healthcare14142063 - 9 Jul 2026

Abstract

Background and Objectives: Hospitals increasingly use AI tools that give nurses on-screen alerts and recommendations (AI-supported clinical decision support, AI-DSS). When nurses override these alerts too often, useful guidance can be lost; when they trust them blindly, errors can slip through. We examined [...] Read more.

Background and Objectives: Hospitals increasingly use AI tools that give nurses on-screen alerts and recommendations (AI-supported clinical decision support, AI-DSS). When nurses override these alerts too often, useful guidance can be lost; when they trust them blindly, errors can slip through. We examined which work and wellbeing factors are associated with nurses’ self-reported intention to override AI alerts, rather than observed override behavior. Methods: We surveyed 239 registered nurses (76.6% female; mean age 33.7 years) at a large hospital in Timișoara, Romania, from January to March 2025. Questionnaires measured alert fatigue, moral distress, mental workload, sleep problems, resilience, team psychological safety, and how strongly nurses intended to override AI alerts. Results: Nurses fell into three groups: those who tended to over-trust AI (26.8%), those with balanced trust (41.0%), and those who resisted it (32.2%). The resistant group had the strongest intention to override alerts and the weakest sense of psychological safety. Alert fatigue was the factor most strongly associated with override intention, and this association was partly accounted for by moral distress. The indirect association was weaker among nurses reporting higher team psychological safety. An exploratory model using these factors distinguished nurses with high self-reported override intention with acceptable accuracy. Because all variables were measured at a single time point, findings are associative and hypothesis-generating rather than causal. Conclusions: How nurses respond to AI alerts depends less on the technology than on their workload, ethical strain, and team climate. Cutting unnecessary alerts, easing moral distress, and building psychological safety may help nurses use AI more safely. Full article

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15 pages, 393 KB

Open AccessArticle

Exploring the Priorities for Home Self-Management Among Patients with Interstitial Lung Disease: A Mixed-Methods Approach Using Q-Methodology

by Jiayu Liu, Haibo Ma, Hongyan Lu, Ruijie Gu, Lulu Qi, Yanan Deng and Jianghong Liu

Healthcare 2026, 14(14), 2062; https://doi.org/10.3390/healthcare14142062 - 9 Jul 2026

Abstract

Aim: This study aims to analyze the self-management needs of patients with interstitial lung disease, clarify the types and characteristics of their needs, and provide a scientific basis for nursing staff to formulate personalized continuing care plans. Method: The Q-methodology was adopted in [...] Read more.

Aim: This study aims to analyze the self-management needs of patients with interstitial lung disease, clarify the types and characteristics of their needs, and provide a scientific basis for nursing staff to formulate personalized continuing care plans. Method: The Q-methodology was adopted in this study. Semi-structured interviews with 13 patients with ILD and systematic literature retrieval were performed to qualitatively explore and summarize patients’ authentic home self-management needs. The Q-set of representative statement items was further established based on the integrated results of interviews and literature analysis. Subsequently, another 15 patients with ILD were enrolled as the P-set to complete the Q-sort ranking of all statement items. By-person factor analysis was conducted to extract potential self-management demand patterns and refine the typology and core characteristics of patients’ self-management needs. Result: Factor analysis identified four common factors, representing four types of home self-management needs in interstitial lung disease patients. These types differ in symptom management, information preferences, and psychological rehabilitation needs, while sharing core common needs. Conclusions: Patients with interstitial lung diseases have both common and individual self-management needs, with no universal model. Nurses should develop personalized continuing care plans to improve care precision and adaptability. Full article

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

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22 pages, 8805 KB

Open AccessReview

Mapping Nordic Walking Research in Ageing-Related Populations: A Bibliometric and Topic Modeling Analysis (2006–2025)

by Hao Chen, Man Jiang and Jakub Kortas

Healthcare 2026, 14(14), 2061; https://doi.org/10.3390/healthcare14142061 - 9 Jul 2026

Abstract

Population ageing has increased the need for safe, accessible, and sustainable exercise strategies that support functional capacity, independence, and healthy ageing. Nordic walking has been examined across physiological, functional, clinical, and health-related contexts; however, previous research syntheses have generally focused on specific intervention [...] Read more.

Population ageing has increased the need for safe, accessible, and sustainable exercise strategies that support functional capacity, independence, and healthy ageing. Nordic walking has been examined across physiological, functional, clinical, and health-related contexts; however, previous research syntheses have generally focused on specific intervention effects, populations, or outcome categories, leaving the relationships among these research strands insufficiently understood. This study combined CiteSpace-based bibliometric analysis with Latent Dirichlet Allocation (LDA) topic modeling to examine the knowledge structure and thematic development of Nordic walking research in ageing-related populations from 2006 to 2025. A total of 263 publications indexed in the Web of Science Core Collection were included in the final analysis. The results showed that research activity was geographically concentrated, whereas institutional connections were relatively dispersed. Co-citation patterns linked the field with exercise science, rehabilitation, gerontology, gait analysis, and clinical health research. Keyword and temporal analyses indicated that research attention expanded from the physiological and biomechanical characterization of Nordic walking toward functional rehabilitation, chronic disease-related applications, and broader health outcomes. The seven LDA-derived topics reflected health-outcome evaluation, metabolic and cardiovascular indicators, functional rehabilitation, exercise physiology, cognitive health, body composition and muscle function, and gait-related rehabilitation. Rather than representing isolated research domains, these topics reveal an interconnected knowledge structure linking exercise-related mechanisms, functional and clinical outcomes, and broader ageing-related health concerns. Future research should improve intervention reporting, adopt population-specific outcome selection, and strengthen the linkage between exercise mechanisms and functional or health-related outcomes to support more comparable and cumulative evidence. Full article

(This article belongs to the Topic Physical Activity, Exercise, and Psychological Well-Being Across the Lifespan)

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23 pages, 1137 KB

Open AccessArticle

Secondary Traumatic Stress and Positive Adaptation Among Social Workers: The Roles of Burnout, Compassion Satisfaction, and Perceived Social Support in a Cross-Sectional Study

by Fang Fu, Yumeng Zhu, Mandy Lau and Soon Noi Goh

Healthcare 2026, 14(14), 2060; https://doi.org/10.3390/healthcare14142060 - 9 Jul 2026

Abstract

Objectives: This study aimed to examine the associations of secondary traumatic stress with social workers’ positive psychological outcomes (resilience and post-traumatic growth) and to test the moderating roles of burnout, compassion satisfaction, and perceived social support. Methods: This study adopted a [...] Read more.

Objectives: This study aimed to examine the associations of secondary traumatic stress with social workers’ positive psychological outcomes (resilience and post-traumatic growth) and to test the moderating roles of burnout, compassion satisfaction, and perceived social support. Methods: This study adopted a cross-sectional survey design and recruited practicing social workers from health and social care institutions in Singapore and China. A total of 673 valid questionnaires were obtained, including 354 from Singapore and 319 from China. Hierarchical regression analysis was conducted to test the direct and moderating associations among the core variables. Results: Secondary traumatic stress was positively associated with post-traumatic growth (β = 0.25, p < 0.01) with no significant association with resilience. Burnout negatively moderated the secondary traumatic stress–post-traumatic growth link (β = −0.13, p < 0.01) but not the secondary traumatic stress–resilience relationship. Compassion satisfaction negatively moderated the associations of secondary traumatic stress with both resilience and post-traumatic growth (β = −0.14, −0.15, p < 0.01). Perceived social support showed no significant moderating roles but was positively associated with both adaptation indicators (β = 0.19, 0.14, p < 0.01). Conclusions: This study challenges the conventional “risk-protection” dichotomy by revealing a nuanced stress–adaptation mechanism. Secondary traumatic stress co-occurs with post-traumatic growth (PTG) rather than baseline resilience, while compassion satisfaction exhibits a paradoxical “buffering-ceiling” interaction that attenuates the positive associations between traumatic stress and growth. Practically, organizations must move beyond generic wellness programs to implement dual-track strategies: mitigating burnout to foster social workers’ growth potential while leveraging compassion satisfaction as an early-stage shield rather than a late-stage resilience enhancer. Full article

(This article belongs to the Special Issue Spirituality, Stress, and Well-Being of Healthcare Professionals)

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17 pages, 2955 KB

Open AccessArticle

Takeaway Fast-Food Consumption and Elevated Diastolic Blood Pressure in US Young Adults: An Exploratory Mediation Analysis of Metabolic and Inflammatory Indicators

by Gaozhao Chu, Jun Chen and Lihong Wang

Healthcare 2026, 14(14), 2059; https://doi.org/10.3390/healthcare14142059 - 9 Jul 2026

Abstract

Background: Global takeaway fast-food consumption (TFC) has surged. This study aimed to investigate the association between TFC frequency and diastolic blood pressure (DBP) and to explore the potential mediating roles of metabolic and inflammatory markers. Methods and Results: In this cross-sectional study of [...] Read more.

Background: Global takeaway fast-food consumption (TFC) has surged. This study aimed to investigate the association between TFC frequency and diastolic blood pressure (DBP) and to explore the potential mediating roles of metabolic and inflammatory markers. Methods and Results: In this cross-sectional study of 13,062 adults from the National Health and Nutrition Examination Survey (NHANES), we utilized weighted regression and restricted cubic splines (RCS) to evaluate the association between TFC frequency and DBP. We performed exploratory mediation analyses to explore the roles of body mass index (BMI), visceral adiposity index (VAI), cardiometabolic index (CMI), dietary inflammatory index (DII), and insulin resistance (HOMA-IR). In the overall cohort, the main association between TFC frequency and DBP did not reach statistical significance in fully adjusted models. However, restricted cubic spline analysis revealed a linear dose–response trajectory without an evident threshold effect. In exploratory subgroup analyses, a potentially pronounced positive association was noted among females, although the formal interaction test was not statistically significant. Mediation models indicated that the examined metabolic and inflammatory markers did not significantly mediate this relationship, suggesting that the association with diastolic blood pressure may not operate through these specific pathways. Conclusions: While the overall main categorical association did not reach statistical significance, TFC demonstrated a potential continuous trend with DBP, with potential associations observed among females. Notably, this relationship was not mediated by established metabolic or inflammatory indices, suggesting that the association between TFC and blood pressure elevation may exist independent of overt structural obesity. These findings highlight the potential value of incorporating takeaway fast-food consumption into routine dietary screening for early cardiovascular risk assessment in young adults. Full article

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13 pages, 440 KB

Open AccessArticle

Multiple Chronic Conditions and Multimorbidity Among Older Adults in Southern Albania: Distribution and Impact on Care Needs, Medication Adherence, and Quality of Life

by Brunilda Subashi, Fatjona Kamberi and Erlini Kokalla

Healthcare 2026, 14(14), 2058; https://doi.org/10.3390/healthcare14142058 - 9 Jul 2026

Abstract

Introduction: Multimorbidity, defined as the coexistence of two or more chronic conditions, is a major global public health challenge. It exists on a continuum from non-complex to highly complex forms, with increasing complexity associated with greater instrumental activities of daily living (IADL) [...] Read more.

Introduction: Multimorbidity, defined as the coexistence of two or more chronic conditions, is a major global public health challenge. It exists on a continuum from non-complex to highly complex forms, with increasing complexity associated with greater instrumental activities of daily living (IADL) disability, frailty, and mortality. Objectives: This study aims (1) to assess chronic condition complexity (CCC) by distinguishing multiple chronic conditions (MCCs) from multimorbidity (MM); (2) evaluate their distribution and impact on care needs, medication adherence, and quality of life; and (3) examine associations between MM and sociodemographic factors among older adults in Albania. Methods: A descriptive, cross-sectional, multicenter observational study was conducted among older adults aged 65 years and older with ≥2 chronic conditions. Data were collected from participants attending six primary health care centers in southern Albania between March and December 2024. Medication adherence and quality of life were assessed using the Simplified Medication Adherence Questionnaire (SMAQ) and the Older People’s Quality of Life Questionnaire (OPQOL-35), both validated for the Albanian population. Results: In a sample of 727 older adults with ≥2 chronic conditions, MM was significantly associated with advanced age, polypharmacy, medication non-adherence, and lower educational level (p < 0.05). Additional factors, such as reliance on family care and reduced quality of life, were also linked to higher odds of MM, while gender and secondary education showed non-significant associations. Conclusions: Although multimorbidity represents a smaller subgroup within MCCs, it is associated with greater clinical and functional complexity, particularly among older adults of advanced age and lower educational level, indicating that disease burden alone does not fully capture clinical complexity. Full article

(This article belongs to the Special Issue Challenges and Innovations in Nursing Management Within Modern Healthcare Systems)

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