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Healthcare

Healthcare is an international, scientific, peer-reviewed, open access journal on health care systems, industry, technology, policy, and regulation, and is published semimonthly online by MDPI.
The European Medical Association (EMA), Ocular Wellness & Nutrition Society (OWNS) and Italian Society of Nephrology Nurses (SIAN) are affiliated with Healthcare and their members receive discounts on the article processing charges.
Indexed in PubMed | Quartile Ranking JCR - Q2 (Health Policy and Services | Health Care Sciences and Services)

All Articles (14,758)

Background/Objectives: Unmet healthcare needs, driven by structural and patient-level barriers, are particularly critical in chronic obstructive pulmonary disease (COPD). However, limited research has examined how academic themes on this topic connect and evolve over time. This study analyzed the structure and temporal shifts in research trends on unmet healthcare needs in COPD to identify key concepts and topics and policy implications. Methods: We systematically searched PubMed, Embase, and CINAHL (12–15 March 2025) to identify English-language abstracts on unmet healthcare needs in COPD. Eligible studies were peer-reviewed articles with an English-language abstract that examined unmet healthcare needs from the patient perspective. In total, 451 abstracts were analyzed using text network analysis and Latent Dirichlet Allocation. Topic distributions before and after the coronavirus disease pandemic were assessed using chi-square tests, and findings were interpreted within Penchansky and Thomas’s 5A healthcare access framework. Results: Six topics emerged: socioeconomic disparities, early diagnosis and symptom management, guideline-based information and technology use, integrated care for advanced COPD, access to pulmonary rehabilitation, and equitable medication availability. These topics mapped onto all five access dimensions, underscoring the multidimensional nature of unmet healthcare needs. Network analysis identified management, diagnosis, symptoms, exacerbation, and other related terms as central hubs in the discourse. Post-pandemic, research shifted toward digital information delivery, technology adoption, and equitable pharmacotherapy. Conclusions: Findings suggest that reducing unmet healthcare needs in COPD requires integrated systems that address both disease complexity and access barriers. Targeted, multidisciplinary, and policy-driven interventions in highly central domains are needed to reduce disparities and improve outcomes. This study also confirmed a post-pandemic shift in research priorities, emphasizing the need for equitable and adaptive healthcare policies.

29 December 2025

Study selection process following the PRISMA 2020 flow diagram guidelines [16].

Background/Objectives: Diabetes distress is a significant, often unaddressed, aspect of type 1 diabetes (T1D) management. The Type 1 Diabetes Distress Scale (T1-DDS) is a key assessment tool, but no validated Arabic version exists for Saudi Arabia’s large T1D population. This study aimed to translate, culturally adapt, and validate the Arabic T1-DDS to enable accurate assessment of diabetes-specific distress in Saudi adults with T1D. Methods: A cross-sectional study was conducted among Saudi adults with self-reported T1D. The T1-DDS underwent forward-backward translation, expert panel review, and cognitive debriefing. Participants completed an online survey containing the 28-item Arabic T1-DDS, the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7). Psychometric evaluation included exploratory and confirmatory factor analysis (EFA, CFA), internal consistency (Cronbach’s α), and convergent validity. A multivariable generalized linear model identified predictors of distress. Results: The analysis included 837 participants (73.8% female, mean age 27.22 ± 7.8 years). The Arabic T1-DDS demonstrated excellent reliability (α = 0.934). EFA/CFA supported a robust four-factor structure, confirming model fit (χ2/df = 1.313, CFI = 1.000, RMSEA = 0.019). The mean overall distress score was 2.74 (SD = 1.05), with 72.4% reporting moderate-to-high distress. Distress correlated moderately with depression (r = 0.58) and anxiety (r = 0.52). Multivariable analysis identified higher PHQ-9 (RR = 1.178) and GAD-7 scores (RR = 1.063) as significant predictors of elevated distress, while insulin pump use was protective (RR = 0.938). Conclusions: The Arabic T1-DDS is a valid and reliable tool for Saudi adults with T1D. Its use revealed a high prevalence of diabetes distress, strongly linked to psychological symptoms and mitigated by insulin pump therapy. Integrating this scale into routine clinical care can facilitate timely psychosocial support, potentially improving patient outcomes.

29 December 2025

Structural Equation Modelling based path model.

Background/Objectives: Since October 2019, Lebanon has faced continuous sociopolitical and economic instability. Clinical psychologists have played a central role in responding to rising mental health needs, yet little is known about their own psychological well-being. Methods: This study examined mental health outcomes among 157 certified psychologists (clinical and educational psychologists) working in Lebanon. A cross-sectional study was conducted with psychologists aged 30–53 years across all Lebanese governorates, who were recruited through snowball and word-of-mouth sampling. Participants completed validated measures of depression (PHQ-9), anxiety (LAS-10), perceived stress (PSS-10), subjective well-being (WHO-5), eating attitudes (EAT-26), and self-esteem (A-SISE). Results: Results showed that 44% of participants reported at least mild depressive symptoms, 14% met criteria for anxiety, and 57% experienced moderate to high perceived stress, while most showed no risk for eating disorders. Bivariate and multivariate analyses identified self-esteem as a predictive factor, negatively associated with depression, anxiety, and stress, and positively associated with subjective well-being. Additional risk factors included younger age, being unmarried, not having children, prior psychological history, health problems, lower income, and working as an educational rather than clinical psychologist. Conclusions: These findings highlight aspects of vulnerability among psychologists and underline the need for targeted interventions for at-risk groups. Strengthening self-esteem may contribute to enhancing clinicians’ mental health. However, these conclusions should be interpreted in light of several limitations, including the small sample size, the non-probability and gender-skewed nature of the sample, partly due to the relatively limited number of practicing psychologists in Lebanon.

29 December 2025

Levels of mental health outcomes (depression, anxiety, stress, and EDs) (N = 157). Note: The thresholds reported for each variable correspond to the established cutoff scores provided by the respective psychometric scales mentioned in Section 2.
  • Systematic Review
  • Open Access

Introduction: Stroke is a severe neurological condition associated with high rates of mortality and disability. Objective: This systematic review aimed to analyze the efficacy of early mobilization (EM) on the quality of life and the dependency levels in stroke patients. Additionally, the impact on anxiety and depression, the occurrence of adverse effects, and length of hospital stay were assessed. Methods: A systematic search was conducted in PubMed, Web of Science, and Scopus databases. The search was restricted to randomized controlled trials published within the last 10 years that included EM as an intervention in the experimental group. The Cochrane tools were used to assess risk of bias, and the PEDro scale was applied to evaluate the methodological quality of the included studies. Results: Nine studies were included in this review. Findings indicated that EM performed within 24–48 h post-stroke reduces dependency levels; however, no significant improvement in quality of life was observed. Evidence regarding anxiety and depression was inconclusive, and no significant differences were reported between groups concerning adverse events or reduction in hospital stay duration. Conclusions: This review demonstrates that EM is beneficial for reducing dependency after stroke, but there is no evidence of a significant improvement in quality of life. Further research is needed to establish clear protocols and appropriate intervention doses.

29 December 2025

Flow Diagram.

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Editors: Klaudiusz Nadolny, Filip Jaśkiewicz

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Healthcare - ISSN 2227-9032