Healthcare

16 pages, 499 KB

Open AccessArticle

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

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

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

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

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

► Show Figures

Figure 1

12 pages, 541 KB

Open AccessArticle

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

by Filip Waligóra, Anastazja Tobolewska-Kielar and Maciej Kielar

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

Abstract

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

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

► Show Figures

Figure 1

5 pages, 188 KB

Open AccessEditorial

Management of Chronic Health Situations

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

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

Abstract

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

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

12 pages, 587 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

20 pages, 1187 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

14 pages, 2101 KB

Open AccessArticle

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

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

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

Abstract

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

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

► Show Figures

Figure 1

21 pages, 286 KB

Open AccessArticle

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

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

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

Abstract

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

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

12 pages, 314 KB

Open AccessArticle

Determinants of Menstrual Hygiene Practices Among Adolescent Schoolgirls in Saudi Arabia: Implications for Adolescent Health Promotion

by Aziza Ibrahim Mohamed, Amani Mahmoud Fadul, Ohood Ali Alkaabi, Mohammed Hassan Moreljwab, Eltayeb Abdelazeem Idress, Thuria Edrees Alhassan, Eman Elsayed Hussien Mohammad, Shereen Ahmed Elwasefy, Rabab Gad Abd El-Kader, Basma Maher Ragheb and Ramya Shine Aneesh

Healthcare 2026, 14(2), 171; https://doi.org/10.3390/healthcare14020171 - 9 Jan 2026

Abstract

Background: Menstrual hygiene management (MHM) is a vital aspect of adolescent girls’ health and well-being. However, in many Gulf countries, including Saudi Arabia, this issue has received less attention because of cultural taboos, misconceptions, and a lack of knowledge about factors affecting [...] Read more.

Background: Menstrual hygiene management (MHM) is a vital aspect of adolescent girls’ health and well-being. However, in many Gulf countries, including Saudi Arabia, this issue has received less attention because of cultural taboos, misconceptions, and a lack of knowledge about factors affecting menstrual hygiene practices. Thus, it is crucial to promote adolescent health and develop effective school-based interventions. Aim of the Study: Our aim was to assess menstrual hygiene practices and their determinants among adolescent girls in secondary schools in Bisha, Saudi Arabia. Methods: A cross-sectional descriptive approach was used to study 320 female secondary school students in Bisha City, southwestern Saudi Arabia. Sample: The subjects were selected by using a stratified random sampling procedure. Information was obtained using a previously validated and culturally sensitive self-administered questionnaire on knowledge and menstrual hygiene. Descriptive statistics, chi-square tests, and binary logistic regression analyses were conducted to determine factors associated with good menstrual hygiene practices. Results: A total of 320 adolescent girls participated, of whom 53.8% demonstrated good menstrual hygiene practices. In the multivariable analysis, independent predictors of good practices were increased age (AOR = 2.69, 95% CI:1.59–4.56), urban residency (AOR = 2.62, 95% CI: 1.46–4.69), and good menstrual knowledge (AOR = 2.13, 95%CI: 1.24–3.67). Maternal primary education (AOR = 8.033, CI: 1.44–44.99) and maternal employment in the government sector (AOR = 7.346, CI: 2.29–23.54) also showed strong positive associations with good menstrual hygiene practices. Conversely, experiencing menarche after age 12 was associated with lower odds of good menstrual hygiene (AOR = 0.49). Conclusions: Although a good proportion of girls practiced adequate menstrual hygiene, major knowledge and behavior gaps persist. Providing strong menstrual education in schools and through community-based efforts is critical for supporting the health of adolescent girls and promoting menstrual equity in Saudi Arabia. Full article

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

► Show Figures

Figure 1

13 pages, 731 KB

Open AccessSystematic Review

Durability of Exercise vs. Revascularization in Intermittent Claudication: An Updated Meta-Analysis of Randomized Trials Focusing on Patient-Centered Outcomes

by Mislav Puljevic, Petra Grubic-Rotkvic, Mia Dubravcic-Dosen, Andrija Stajduhar and Majda Vrkic-Kirhmajer

Healthcare 2026, 14(2), 170; https://doi.org/10.3390/healthcare14020170 - 8 Jan 2026

Abstract

Intermittent claudication (IC) is the most frequent symptomatic manifestation of lower-extremity peripheral artery disease (PAD). Supervised exercise therapy (SET) and endovascular revascularization (ER) are established treatments, but their relative and combined effects on health-related quality of life (HRQoL) remain. We conducted a systematic [...] Read more.

Intermittent claudication (IC) is the most frequent symptomatic manifestation of lower-extremity peripheral artery disease (PAD). Supervised exercise therapy (SET) and endovascular revascularization (ER) are established treatments, but their relative and combined effects on health-related quality of life (HRQoL) remain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing SET, ER, and ER+SET, with HRQoL as the primary outcome. Methods: Following PRISMA 2020, PubMed, Embase, and CENTRAL were used in December 2024. Eligible RCTs enrolled with IC (excluding critical limb-threatening ischemia) and reported validated HRQoL outcomes at ≥3 months. Two reviewers independently extracted data and assessed risk of bias using the Cochrane RoB 2.0 tool. Random-effects meta-analyses pooled standardized mean differences (SMDs) for HRQoL and mean differences (MDs) for walking distance. Results: Five RCTs (n = 728) were included. Compared with optimal medical therapy, both SET and ER improved HRQoL and walking distance. At 12 months, no significant effect was observed between SET and ER (SMD 0.02; 95% CI: −0.18 to 0.22). ER+SET was superior to SET alone (SMD 0.35; 95% CI: 0.12–0.57). Beyond 24 months, improvements were sustained with SET but attenuated with ER, accompanied by higher reintervention rates in ER-containing arms (approximately 20–30% by 2 years). Adverse events were rare (<1%). Conclusions: Given moderate-certainty evidence (GRADE), SET should remain the first-line therapy for intermittent claudication because it provides durable improvements in patient-centered outcomes with minimal harm. Endovascular revascularization (ER) can provide faster symptom relief, but its long-term benefits are constrained by restenosis and repeat procedures, particularly in femoropopliteal disease. Full article

(This article belongs to the Section Clinical Care)

► Show Figures

Figure 1

14 pages, 325 KB

Open AccessArticle

Exploring Associations Between STEAM-Based Interventions and Executive and Cognitive Skills in Children with ADHD

by María del Mar Bueno-Galán, Carlos Barbosa-Torres, María José Godoy-Merino, Alperen Yandi, Alejandro Arévalo-Martínez, María Pilar Cantillo-Cordero, María Elena García-Baamonde Sánchez and Juan Manuel Moreno-Manso

Healthcare 2026, 14(2), 169; https://doi.org/10.3390/healthcare14020169 - 8 Jan 2026

Abstract

Background: This study examines whether participation in STEAM-based educational activities is associated with improvements in executive functions (EFs) and cognitive skills in children with Attention Deficit Hyperactivity Disorder (ADHD). Methods: A total of 60 children diagnosed with ADHD (mean age = [...] Read more.

Background: This study examines whether participation in STEAM-based educational activities is associated with improvements in executive functions (EFs) and cognitive skills in children with Attention Deficit Hyperactivity Disorder (ADHD). Methods: A total of 60 children diagnosed with ADHD (mean age = 8 years) participated, with 30 following a traditional educational approach and 30 engaged in STEAM-based activities. Executive functions and cognitive abilities were assessed using standardized instruments (BRIEF, WISC-V, CARAS-R), and data were analyzed with IBM SPSS Statistics 25. Results: Children in the STEAM group outperformed the control group across several domains, showing statistically significant gains in inhibition, planning and organization, verbal comprehension, visuospatial skills, processing speed, total IQ, efficiency, and the Impulsivity Control Index (ICI). Conclusions: These findings suggest that STEAM-based educational experiences may support neurodevelopmental growth and enhance cognitive and executive functioning in children with ADHD, although causal inferences cannot be drawn due to the cross-sectional design. Full article

24 pages, 2616 KB

Open AccessArticle

The “Supporting Adolescents with Self Harm” (SASH) Intervention Supporting Young People (And Carers) Presenting to the Emergency Department with Self-Harm: Therapeutic Assessment, Safety Planning, and Solution-Focused Brief Therapy

by Rose McCabe, Sally O’Keeffe and Maria Long

Healthcare 2026, 14(2), 168; https://doi.org/10.3390/healthcare14020168 - 8 Jan 2026

Abstract

Background: Self-harm is a growing public health concern and the strongest predictor of suicide in young people (YP). The “Supporting Adolescents with Self-Harm” (SASH) intervention was developed with YP with lived experience and expert clinicians. It involves rapid follow-up after ED attendance [...] Read more.

Background: Self-harm is a growing public health concern and the strongest predictor of suicide in young people (YP). The “Supporting Adolescents with Self-Harm” (SASH) intervention was developed with YP with lived experience and expert clinicians. It involves rapid follow-up after ED attendance and up to six intervention sessions. The intervention has three components: Therapeutic Assessment (TA) of self-harm; an enhanced safety plan (SP); and Solution-Focused Brief Therapy (SFBT). Depending on the YP’s preference, carers can join sessions. Carers can also receive two individual sessions. The clinical and cost-effectiveness of SASH is being evaluated in a randomised controlled trial across nine emergency departments in three NHS Trusts in London, England. A total of 154 YP were recruited between May 2023 and March 2025 and randomised on a 1:1 ratio to SASH alongside Treatment As Usual (TAU) or TAU. A logic model describes the SASH inputs, activities, mechanisms, outcomes and longer-term impacts. The aim of this paper is to (1) illustrate how TA, SP, and SFBT were implemented in practice by presenting intervention materials and session recordings for four YP cases and one carer case and (2) explore how the case study materials/recordings reflect the intervention mechanisms in the SASH logic model. Methods: Each case focused on a different component of the intervention. Intervention materials (TA self-harm diagram and completed SP) and recorded SFBT sessions with four YP and one carer were analysed using a descriptive case study approach. The TA diagram and SP were extracted from medical records. Audio/video recordings of intervention sessions were identified. Recordings of intervention sessions and qualitative interviews were transcribed. Quotes from qualitative interviews with the same participants were included where relevant. Results: Across the four YP cases, some core themes emerged. The role of friendships for young people, particularly at school, was important in both negative and positive ways. Experiencing difficulties with friends at school led to feelings of sadness and stress, which could become overwhelming, leading to thoughts of self-harm (“I just need to hurt myself”), triggering self-harm behaviour. YP described mood changes and signs that they were becoming stressed, which improved their self-awareness and understanding of the link between their feelings and self-harm behaviour. They reflected on what kept them feeling calm and overcoming their fear of burdening others by sharing how they were feeling, as this helped them not to self-harm. They also described difficult feelings stemming from a need to please everyone or needing validation from others. Overcoming these feelings led to less social anxiety and more confidence. This made it easier to go to school and to be more social with friends/student peers, which in turn improved their mood. Conclusions: These case studies demonstrate how YP improved their self-awareness and understanding of the link between feelings and self-harm behaviour and identified personal strategies for managing difficult feelings and situations. The carer case study demonstrates how sessions with carers can facilitate carers better supporting their YP’s mental health. Supporting YP and carers in this way has the potential to reduce the risk of future self-harm. Full article

(This article belongs to the Special Issue Health Risk Behaviours: Self-Injury and Suicide in Young People)

► Show Figures

Figure 1

12 pages, 229 KB

Open AccessArticle

Adaptive Sport as Complementary and Holistic Health Intervention: Outcomes for Participants to Improve Resiliency, Promote Health, and Live in Recovery

by Kaitlin E. Mueller, Derek Whaley and Allie Thomas

Healthcare 2026, 14(2), 167; https://doi.org/10.3390/healthcare14020167 - 8 Jan 2026

Abstract

Background/Objectives: Adaptive sports engagement has been strongly studied for physical and social gains for athletes with disabilities, with much less investigation into adaptive sports encompassing holistic health (i.e., reaching domains of physical, social, cognitive, emotional, and spiritual). Therefore, the purpose of this [...] Read more.

Background/Objectives: Adaptive sports engagement has been strongly studied for physical and social gains for athletes with disabilities, with much less investigation into adaptive sports encompassing holistic health (i.e., reaching domains of physical, social, cognitive, emotional, and spiritual). Therefore, the purpose of this study is to explore adaptive sport participants’ perspectives on their engagement in sport as a complementary and holistic intervention to improve resiliency, promote health, and live in recovery. Methods: This study employed a qualitative, phenomenological, and participatory action research design to explore how individuals with disabilities perceive their engagement in adaptive sports. Data were collected from eligible participants across the United States, aged 12 years and older, who provided open-ended responses via survey detailing their adaptive sport experiences. Results: Adaptive sport participants (n = 47), primarily male (n = 26), and White (n = 37) with a range of ages 12–75, provided qualitative findings that formed three deductive themes with further inductive subthemes: (1) Improving Resiliency highlighting promotive and protective factors supporting resilience development, (2) Promoting Health defined by World Health Organization’s holistic health definition, and (3) Living in Recovery framed by the Health Protection/Health Promotion Model. Conclusions: For this sample of adaptive sport participants across the United States, engagement in adaptive sports is seen as a complementary and holistic health intervention that achieves outcomes beyond just physical and social. Key aspects of adaptive sports were shown to be vital for building resiliency through the disability community environment, improving holistic health, and providing a recovery mindset through new life opportunities. Full article

20 pages, 3184 KB

Open AccessArticle

Predictive Models for Early Infection Detection in Nursing Home Residents: Evaluation of Imputation Techniques and Complementary Data Sources

by Melisa Granda, María Santamera-Lastras, Alberto Garcés-Jiménez, Francisco Javier Bueno-Guillén, Diego María Rodríguez-Puyol and José Manuel Gómez-Pulido

Healthcare 2026, 14(2), 166; https://doi.org/10.3390/healthcare14020166 - 8 Jan 2026

Abstract

Background: Aging in Western societies poses a growing challenge, placing increasing pressure on healthcare costs. Early identification of infections in elderly nursing home residents is crucial to reduce complications, mortality, and the burden on emergency departments. Methods: We performed a comparative analysis of [...] Read more.

Background: Aging in Western societies poses a growing challenge, placing increasing pressure on healthcare costs. Early identification of infections in elderly nursing home residents is crucial to reduce complications, mortality, and the burden on emergency departments. Methods: We performed a comparative analysis of machine learning models using XGBoost classifiers for infection detection, addressing incomplete daily physiological measurements (Heart Rate, Oxygen Saturation, Body Temperature, and Electrodermal Activity) through strict imputation protocols. We evaluated three model variants—Basic (clinical only), Air Pollution-added, and Social Media-integrated—while incorporating a novel Basal Module to personalize physiological baselines for each resident. Results: Results from the binary model indicate that physiological data provides a necessary baseline for immediate screening. Notably, social media integration emerged as a powerful forecasting tool, extending the predictive horizon to a 6-day lead time with an F1-score of 0.97. Complementarily, air pollution data ensured robust immediate detection (“nowcasting”). In the multiclass scenario, external data resolved the “semantic gap” of vital signs, improving sensitivity for specific infections (e.g., acute respiratory and urinary tract infections) to over 90%. Conclusions: These findings highlight that the strategic integration of environmental and digital signals transforms the system from a reactive monitor into a proactive early warning tool for long-term care facilities. Full article

(This article belongs to the Section Artificial Intelligence in Healthcare)

► Show Figures

Figure 1

13 pages, 393 KB

Open AccessArticle

“I Can Remember Thinking, Like Almost Wishing, That the Injuries Would Have Been Worse, Because Then I Wouldn’t Be Questioned”: A Qualitative Study on Women’s Experience of Accessing Healthcare for Intimate Partner Violence-Related Brain Injury

by Eve M. Valera, Isha Sanghvi, Sarah Rose Sitto, Jason Chua, Altaf Saadi and Alice Theadom

Healthcare 2026, 14(2), 165; https://doi.org/10.3390/healthcare14020165 - 8 Jan 2026

Abstract

Background/Objectives: To identify the barriers and facilitators to accessing healthcare following intimate partner violence (IPV)-related brain injury (BI). Methods: Sixteen adult women participated in interviews about their experience of accessing healthcare following IPV-related BI. Interviews were transcribed verbatim and analyzed using [...] Read more.

Background/Objectives: To identify the barriers and facilitators to accessing healthcare following intimate partner violence (IPV)-related brain injury (BI). Methods: Sixteen adult women participated in interviews about their experience of accessing healthcare following IPV-related BI. Interviews were transcribed verbatim and analyzed using the interpretative descriptive (ID) approach to identify themes and subthemes in the data. Results: Two themes, each with six subthemes related to healthcare seeking for IPV-related BI were identified: Theme 1—Deciding to seek and ability to access healthcare, comprising (a) severity of injury; (b) impact of injury; (c) ability to access medical services; (d) self-blame, fear, shame, and guilt; (e) contextual influences on healthcare seeking; and (f) previous negative interactions; and Theme 2—Complexity in identifying IPV-related BI, comprising (a) trauma can affect recall of events; (b) inability to distinguish IPV-related trauma or aging outcomes from BI sequelae; (c) the importance of trust in disclosure; (d) healthcare professionals need to ask the right questions and respond in the right way; (e) the complex nature of disclosure creates challenges for diagnosis; and (f) fear of being dismissed or judged. Conclusions: Many context-related factors influence whether women can seek treatment for IPV-related BIs. These factors need to be understood by first responders and medical professionals to improve the likelihood and speed of treatment seeking. Furthermore, challenges and fears associated with disclosure of IPV prevent women from seeking proper treatment. IPV training could be helpful in ensuring women feel safe with disclosure. Full article

(This article belongs to the Special Issue Accessing Treatment and Rehabilitation for Underserved Survivors of Brain Injury)

► Show Figures

Figure 1

12 pages, 234 KB

Open AccessArticle

A Proactive Health Behavior Framework for Cognitive Impairment in Chinese Older Adults: Based on a Four-Factor and Logistic Regression Analysis

by Shengjiang Wang and Hailun Liang

Healthcare 2026, 14(2), 164; https://doi.org/10.3390/healthcare14020164 - 8 Jan 2026

Abstract

Objective: In the context of an aging population, the prevention and control of cognitive impairment is a key public health priority. This study aims to investigate the association between proactive health behaviors and the risk of AD8 screening positivity in older adults [...] Read more.

Objective: In the context of an aging population, the prevention and control of cognitive impairment is a key public health priority. This study aims to investigate the association between proactive health behaviors and the risk of AD8 screening positivity in older adults in China, providing an empirical basis for developing targeted intervention strategies. Methods: Based on health behavior data from 1110 older adults in China, the chi-square test was used to analyze the differences in proactive health behaviors (such as limiting salt and alcohol intake, smoking cessation, and vaccination) between the low-risk and high-risk groups for AD8 screening. Factor analysis was used to extract the main factors of proactive health behaviors. Firth penalized logistic regression models were used to analyze the impact of the main factors and sociodemographic factors on the risk of cognitive impairment. Results: The chi-square test showed that there were significant differences between the two groups in salt restriction behavior (χ² = 18.063, p < 0.01) and vaccination (χ² = 29.674, p < 0.01), with a higher proportion of salt restriction (34.7%) and vaccination rates (80.4%) in the low-risk group. Factor analysis extracted four main factors (psychological–social support, information–behavior execution, technology–environment promotion, and addictive behavior control), with a cumulative variance contribution rate of 58.45%. Among them, psychological–social support (31.42% explained variance) and information–behavior execution (28.04%) had the strongest explanatory power. Firth penalized logistic regression showed that psychological–social support (Firth-corrected OR = 0.072, 95% CI: 0.035–0.148, p < 0.01) and information–behavior execution (Firth-corrected OR = 0.008, 95% CI: 0.003–0.021, p < 0.01) had significant protective effects on AD8 screening positivity (standardized OR values indicated that each one-standard-deviation increase in these two factors reduced screening-positive risk by 39% and 53%, respectively), and the risk increased by 21.7% for every 5-year increase in age (OR = 1.217, p = 0.001). Technology–environment promotion (OR = 0.417, 95% CI: 0.250–0.691, p = 0.001) and addictive behavior control (OR = 0.709, 95% CI: 0.490–1.026, p = 0.068) showed no significant protective effects. Sensitivity analysis confirmed the robustness of the four-factor structure and core conclusions. Conclusions: Among proactive health behaviors, psychological–social support and information–behavior execution are key protective factors in reducing the risk of AD8 screening positivity in older adults, and age is an important influencing factor. Strengthening psychological support and optimizing access to health information and behavior execution can serve as core strategies for cognitive impairment prevention and control, providing empirical support for the formulation of health policies for older adults. Full article

20 pages, 1081 KB

Open AccessArticle

A 23-Year Comprehensive Analysis of over 4000 Liver Transplants in Türkiye: Integrating Clinical Outcomes with Public Health Insights

by Deniz Yavuz Baskiran and Sezai Yilmaz

Healthcare 2026, 14(2), 163; https://doi.org/10.3390/healthcare14020163 - 8 Jan 2026

Abstract

Background: This study seeks to evaluate the 23 year experience of the İnonu University Liver Transplantation Institute from a public health perspective by examining demographic patterns, etiological factors, and transplantation trends between 2002 and 2025. Aims: This analysis aims to provide insights into [...] Read more.

Background: This study seeks to evaluate the 23 year experience of the İnonu University Liver Transplantation Institute from a public health perspective by examining demographic patterns, etiological factors, and transplantation trends between 2002 and 2025. Aims: This analysis aims to provide insights into the epidemiological landscape of liver transplantation in Türkiye from a public health perspective. Methods: In this retrospective cross sectional study, we analyzed 4011 liver transplant procedures performed between March 2002 and March 2025. Recipient demographics, disease etiologies, donor characteristics, and patients geographic distribution were assessed to delineate regional health needs and service utilization patterns. Results: A total of 4011 patients were included. The cohort comprised 2618 males (65.3%) and 1393 females (34.7%). Recipients were classified as adult (n = 3232, 80.9%) or pediatric (n = 779, 19.1%). Among adults, infectious etiologies were the most prevalent (35.5%), followed by cryptogenic liver cirrhosis (24.7%). In contrast, pediatric patients most commonly presented with toxic etiologies (29.4%), metabolic disorders (22.6%) and bile duct diseases (15.9%). Most liver transplantations were performed using living donors (n = 3481, 86.8%), while deceased donors accounted for 530 procedures (13.2%). Additionally, 244 living donor liver transplantations were performed via liver paired exchange (LPE). Conclusions: These findings may inform resource allocation, health policy development, and the optimization of transplantation services. This center-based model offers a useful framework for characterizing regional health needs and strengthening community health, particularly through prevention, screening, and early intervention strategies for liver diseases. Full article

(This article belongs to the Topic Application of Biostatistics in Medical Sciences and Global Health)

► Show Figures

Figure 1

12 pages, 822 KB

Open AccessArticle

Association Between Floor of Residence and Frailty in Walk-Up Buildings Among Functionally Independent Older Adults: A Cross-Sectional Study

by Masataka Ando, Naoto Kamide and Akie Kawamura

Healthcare 2026, 14(2), 162; https://doi.org/10.3390/healthcare14020162 - 8 Jan 2026

Abstract

Background/Objectives: Frailty has been associated with various physical, psychological, and social factors; however, the influence of the residential environment—particularly walk-up buildings without elevators—remains unclear. This study aimed to examine the association between the floor of residence and frailty among functionally independent older [...] Read more.

Background/Objectives: Frailty has been associated with various physical, psychological, and social factors; however, the influence of the residential environment—particularly walk-up buildings without elevators—remains unclear. This study aimed to examine the association between the floor of residence and frailty among functionally independent older adults. Methods: A total of 793 older adults (mean age: 76.46 ± 6.29 years; 58.83% women) living in walk-up buildings without elevators and not certified as requiring long-term care participated in a questionnaire survey. Frailty was assessed using the Kihon Checklist (KCL) and the FRAIL Scale (FS). Logistic regression analyses were conducted to examine the association between floor of residence and frailty status (non-frail vs. frail), adjusting for potential confounders. Sensitivity analyses were performed using stratified models based on age group, functional status, and living conditions. Results: Frailty prevalence was 23.28% (KCL) and 16.88% (FS). Higher floor of residence was significantly associated with lower odds of frailty (KCL: odds ratio [OR] = 0.82, 95% confidence interval [CI]: 0.69–0.97; FS: OR = 0.80, 95% CI: 0.65–0.97). Stratified analyses showed consistent associations in subgroups including those aged ≥ 75 years, with full Instrumental Activities of Daily Living scores, non-homebound status, poor subjective economic status, and living alone (all p < 0.05). Conclusions: Living on higher floors in walk-up buildings without elevators may be protective against frailty among functionally independent older adults. While barrier-free environments are essential for those with functional decline or disabilities, moderate physical challenges such as stairs may contribute to frailty prevention in populations who maintain independence. Full article

(This article belongs to the Section Public Health and Preventive Medicine)

► Show Figures

Figure 1

16 pages, 295 KB

Open AccessArticle

by Dawid Koźlenia, Rafał Szafraniec, Jakub Jarosz, Leszek Mazur and Jarosław Domaradzki

Healthcare 2026, 14(2), 161; https://doi.org/10.3390/healthcare14020161 - 8 Jan 2026

Abstract

Objectives: This study examined whether integrating an isometric exercise program into physical education (PE) lessons influences functional outcomes and cardiovascular risk markers in adolescents beyond the effects of standard PE alone. Methods: Boys aged 14–15 years were randomly assigned to an experimental group [...] Read more.

Objectives: This study examined whether integrating an isometric exercise program into physical education (PE) lessons influences functional outcomes and cardiovascular risk markers in adolescents beyond the effects of standard PE alone. Methods: Boys aged 14–15 years were randomly assigned to an experimental group (EG, n = 19) or a control group (CG, n = 21). The EG completed a 6-week isometric exercise program integrated into PE lessons, while the CG followed the regular PE curriculum only. The intervention was based on hold isometric muscle actions (HIMA) with progressively increased volume. Anthropometric measures included body height, body mass, and body mass index (BMI). Body composition was assessed using bioelectrical impedance analysis. Functional capacity was evaluated using field-based measures of lower-limb strength and power (isometric mid-thigh pull, standing broad jump, squat jump, and countermovement jump). Systolic and diastolic blood pressure were measured as indicators of cardiovascular health. Results: A mixed model ANOVA showed that no significant group × time interactions were observed for body composition, functional outcomes, or blood pressure (all p > 0.05). Lean body mass increased over time in both groups (p < 0.01). Improvements in isometric mid-thigh pull (p < 0.01) and standing broad jump (p = 0.01) occurred irrespective of group allocation. Blood pressure remained unchanged. Linear regression revealed that biological maturation did not moderate intervention effects; however, more mature participants demonstrated higher absolute strength levels independent of the intervention (p < 0.05). Conclusions: The inclusion of an isometric exercise program within PE lessons did not provide additional benefits for health-related functional outcomes beyond standard PE alone. In its current format, isometric exercise does not appear to add sufficient value to justify its implementation as a stand-alone strategy in school-based PE. Full article

(This article belongs to the Special Issue Educational Practices for Health in Physical Education and Psychomotricity)

12 pages, 1012 KB

Open AccessFeature PaperArticle

Acute Effects of a Mini-Trampoline Training Session for Improving Normalized Symmetry Index in Participants with Higher Baseline Inter-Limb Asymmetry

by Olga Papale, Emanuel Festino, Marianna De Maio, Francesca Di Rocco, Silvia Zema, Cristina Cortis and Andrea Fusco

Healthcare 2026, 14(2), 160; https://doi.org/10.3390/healthcare14020160 - 8 Jan 2026

Abstract

Background: Inter-limb asymmetry has implications for both athletic performance and healthcare practice. High baseline inter-limb asymmetries have been associated with impaired mobility, increased fall risk, and musculoskeletal injuries across the lifespan. Exercise interventions able to stimulate the stretch–shortening cycle (e.g., plyometric training [...] Read more.

Background: Inter-limb asymmetry has implications for both athletic performance and healthcare practice. High baseline inter-limb asymmetries have been associated with impaired mobility, increased fall risk, and musculoskeletal injuries across the lifespan. Exercise interventions able to stimulate the stretch–shortening cycle (e.g., plyometric training and jump training) have been shown to have a good impact on asymmetries. Among these, Mini-Trampoline Training (MTT) has recently emerged as potentially effective in reducing asymmetries. Objectives: The study aimed to evaluate the acute effects of a single MTT session on muscle power and inter-limb asymmetry in young adults. Methods: Twenty-eight recreationally active participants (25.6 ± 2.4 years) completed one MTT session. Before (PRE) and after (POST) the MTT session, single-leg 6 m Timed Hop (6MTH) and countermovement jump (CMJ) tests were administered. Additionally, 6MTH values of the dominant (DOM) and non-dominant (NODOM) limbs were used to stratify participants according to higher (HBIA) or lower (LBIA) baseline inter-limb asymmetry, based on a commonly adopted Normalized Symmetry Index (NSI) threshold (NSI ≥ 10%, n = 12; NSI < 10%, n = 16). Repeated-measures mixed models were used to evaluate the effects of the MTT session on 6MTH, NSI, and CMJ. Results: Regardless of group and limb, significant (p < 0.0001) improvements in 6MTH (PRE: 2.5 ± 0.06 s; POST: 2.3 ± 0.05 s) were found. Interestingly, the MTT session had a significant (p = 0.01) effect on both groups, with a significant (p = 0.003) interaction with NSI values, showing an improvement for HBIA (PRE = 15.4 ± 1.1%, POST = 11.3 ± 2.1%), whereas a decrement in LBIA was recorded (PRE = 5.1 ± 0.6%, POST = 9.6 ± 1.5%). CMJ did not show any changes in HBIA (PRE: 36.2 ± 0.9 cm; POST: 35.1 ± 0.7 cm), while a significant (p = 0.007) decrease was found in LBIA (PRE: 34.8 ± 1.2 cm; POST: 33.2 ± 1.3 cm). Conclusions: A single MTT session induced acute neuromuscular fatigue, reflected by reduced CMJ performance and improved (~8%) inter-limb control during hopping. The HBIA group preserved jump height (~36 cm) and demonstrated a significant reduction in asymmetry (NSI: −4.1%), suggesting more balanced lower-limb recruitment. Conversely, LBIA showed a significant decrease in CMJ and an increased NSI (+4.5%), possibly reflecting fatigue-related compensatory strategies. Overall, a single MTT elicited distinct responses according to baseline asymmetry, supporting its potential as an adaptable modality for enhancing neuromuscular function in HBIA. Full article

(This article belongs to the Special Issue Exercise Biomechanics: Pathways to Improve 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