Healthcare

15 pages, 503 KB

Open AccessArticle

The Relationship Between Stress of Conscience and Quiet Quitting in Nurses: The Mediating Role of Compassion Fatigue

by Esra Danacı, Esra Özbudak Arıca and Tuğba Kavalalı Erdoğan

Healthcare 2026, 14(3), 316; https://doi.org/10.3390/healthcare14030316 (registering DOI) - 27 Jan 2026

Background/Objectives: In recent years, quiet quitting has attracted increasing attention in nursing research and is conceptualized as a phenomenon in which nurses perform their professional duties at a minimal level without physically leaving their jobs. This study aimed to adapt the Quiet Quitting [...] Read more.

Background/Objectives: In recent years, quiet quitting has attracted increasing attention in nursing research and is conceptualized as a phenomenon in which nurses perform their professional duties at a minimal level without physically leaving their jobs. This study aimed to adapt the Quiet Quitting Scale into Turkish, evaluate its psychometric properties, and examine the relationships between stress of conscience, compassion fatigue, and quiet quitting among nurses. Methods: This is a descriptive, correlational, and methodological study. This study was conducted between 20 February and March 2025 with the participation of 205 nurses working in a university hospital in Turkey. The data were collected using the Nurse Descriptive Information Form, Stress of Conscience Questionnaire, Compassion Fatigue-Short Scale, and Quiet Quitting Scale. Results: The results indicated positive associations between stress of conscience, compassion fatigue, and quiet quitting. Mediation analysis revealed that compassion fatigue had a significant indirect effect on the association between stress of conscience and quiet quitting, while the direct relationship remained significant, suggesting partial mediation. Conclusions: These findings highlight the importance of supportive work environments where nurses can address ethical concerns and access interventions aimed at preventing compassion fatigue. Organizational strategies that promote psychological well-being may help sustain nurses’ work engagement and reduce quiet quitting. Full article

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13 pages, 245 KB

Open AccessArticle

Factors Influencing Retention at Their First Hospital Among New Graduate Nurses in South Korea

by Yujin Jeong and Hyo-Jeong Yoon

Healthcare 2026, 14(3), 314; https://doi.org/10.3390/healthcare14030314 (registering DOI) - 27 Jan 2026

Abstract

Background/Objectives: Early turnover among new graduate nurses remains challenging in South Korea. This study examined how socialisation factors—based on Scott et al.’s transition model and Herzberg’s motivation-hygiene theory—are associated with early retention at the first hospital of employment among new graduate nurses. Methods: [...] Read more.

Background/Objectives: Early turnover among new graduate nurses remains challenging in South Korea. This study examined how socialisation factors—based on Scott et al.’s transition model and Herzberg’s motivation-hygiene theory—are associated with early retention at the first hospital of employment among new graduate nurses. Methods: This retrospective cross-sectional study analysed secondary data from the Graduate Occupational Mobility Survey (GOMS), a nationally representative dataset of college and university graduates in Korea, collected using a stratified multi-stage sampling method. The study included 602 new graduate nurses from the 2017–2019 datasets who had worked as nurses at their first hospital of employment. Anticipatory socialisation factors included personal and educational characteristics. Organisational socialisation factors referred to workplace-related characteristics of the first hospital, including motivational factors and hygiene factors. The outcome variable was early retention. Multiple logistic regression analyses were performed to identify factors associated with early retention. Results: A total of 68.6% of nurses remained in their first hospital employment. Retention was more likely among nurses whose high school, nursing school, and first hospital were in the same region (p = 0.019), those employed in Seoul (p < 0.001), and those working in larger hospitals (p < 0.001). Retention was also associated with satisfaction with autonomy and authority (p = 0.013). Conversely, lower retention was observed among nurses who were dissatisfied with interpersonal relationships (p < 0.001) and those who reported satisfaction with growth opportunities (p < 0.001). Conclusions: Targeted strategies that support new graduate nurses during their transition are essential. Aligning education-to-employment regions and strengthening workplace conditions may enhance early retention. Full article

(This article belongs to the Section Healthcare Organizations, Systems, and Providers)

19 pages, 579 KB

Open AccessArticle

Comparing Thriving at Work Among Trans-Tasman Early-Career Nurses: A Multinational Cross-Sectional Study

by Willoughby Moloney, Daniel Terry, Stephen Cavanagh and Stephen Jacobs

Healthcare 2026, 14(3), 313; https://doi.org/10.3390/healthcare14030313 (registering DOI) - 27 Jan 2026

Abstract

Background/Objectives: The Thriving at Work model proposes that organisations have a responsibility to provide supportive work environments that identify individual health outcomes, which organisations can use to determine where workforce support is needed. The aims of this study are to (1) identify [...] Read more.

Background/Objectives: The Thriving at Work model proposes that organisations have a responsibility to provide supportive work environments that identify individual health outcomes, which organisations can use to determine where workforce support is needed. The aims of this study are to (1) identify and compare the predictors of early-career nurses’ thriving at work in New Zealand and Australia and (2) provide innovative and theory-informed recommendations to improve organisational support of early-career nurses to increase retention in the profession. Design: A multinational cross-sectional study design was followed. Methods: The methods include a sub-study of an international action research programme to support the thriving of early-career nurses, which evaluates and compares results from surveys of nurses at approximately three months post-registration in 2024 and 2025. A theory-informed survey assesses predictors and outcomes of thriving at work. Results: Early-career nurses (N = 320) from New Zealand (n = 277) and Australia (n = 43) completed the survey. New Zealand early-career nurses experience greater quality of care and authenticity at work; however, they also report greater burnout. For Australian early-career nurses, authenticity at work is the greatest predictor of thriving. In New Zealand, thriving is linked to burnout and colleague support. Conclusions: New Zealand must focus on reducing burnout and fostering workplaces that value social connection if it wants to mitigate early-career nurse attrition to Australia for better working conditions. In Australia, the value of authenticity at work highlights the importance of organisational cultures that enable nurses to express their true selves and professional identity. The findings highlight the need for tailored approaches in each country to strengthen workforce sustainability and improve nurse wellbeing. Implications for the Profession: In New Zealand, additional funding to bolster the recruitment and retention of the nursing workforce is crucial to improve patient ratios and reduce workloads. The remuneration of nurses must also remain competitive with Australia. Additionally, workplaces should incorporate Māori values and practices into workplace policies to strengthen social connections. Australian organisations should include authentic management training, psychological safety initiatives, and policies that value diversity and encourage open communication. Full article

(This article belongs to the Special Issue Organizational Approaches That Support Nurses and Healthcare Workers to Thrive: Moving Beyond Burnout)

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11 pages, 241 KB

Open AccessArticle

Determinants of Functional Dependency and Long-Term Care Needs Among Older Mexican Adults

by Sandra Luz Valdez-Avila, Myo Nyein Aung and Motoyuki Yuasa

Healthcare 2026, 14(3), 312; https://doi.org/10.3390/healthcare14030312 (registering DOI) - 27 Jan 2026

Abstract

Background: Low and middle-income countries (LMICs) such as Mexico are experiencing rapid population aging, accompanied by increasing levels of functional dependency and growing long-term care (LTC) needs. Objectives: We aimed to identify the factors associated with varying levels of functional dependency in order [...] Read more.

Background: Low and middle-income countries (LMICs) such as Mexico are experiencing rapid population aging, accompanied by increasing levels of functional dependency and growing long-term care (LTC) needs. Objectives: We aimed to identify the factors associated with varying levels of functional dependency in order to assist population health planning and LTC policy in aging populations in Mexico. Methods: This cross-sectional study analyzed data from the 2021 wave of the Mexican Health and Aging Study (MHAS). Functional dependency was assessed through a modified Autonomie Gérontologie Groupes Iso-Ressources (AGGIR) scale, adapted to incorporate cognitive and physical assessments suitable for the Mexican context. Socioeconomic, health-related, and psychological variables were examined using ordinal logistic regression models. Results: Among 8049 participants included in the analysis, 87.08% were classified with non-to-mild dependency, 9.13% with moderate dependency, and 3.79% with severe dependency. More severe levels of functional dependency were associated with older age, lower educational attainment, not having a partner (being single, widowed, separated or divorced), and the presence of chronic conditions such as hypertension and cardiovascular disease. Conclusions: In contrast, higher educational attainment and regular physical activity were associated with less severe levels of dependency. These associations highlight the multifactorial nature of dependency in later life. The application of a graded, multidimensional dependency classification provides a more comprehensive and differentiated understanding of care needs than binary functional measures. This population-level perspective may support the prioritization of healthy aging strategies and long-term care planning in rapidly aging middle-income settings such as Mexico. Full article

18 pages, 256 KB

Open AccessArticle

Sri Lankan School Student and Teacher Perspectives of Adolescent Mental Health and Its Determinants: A Qualitative Exploration

by Chethana Mudunna, Miyuru Chandradasa, Kavidi Amanda Epasinghe, Josefine Antoniades, Medhavi Weerasinghe, Thach Tran, Sivunadipathige Sumanasiri and Jane Fisher

Healthcare 2026, 14(3), 311; https://doi.org/10.3390/healthcare14030311 - 26 Jan 2026

Abstract

Background/Objectives: Across geographical and cultural contexts, how individuals identify, communicate and help-seek for distress is often shaped by how mental health itself is understood. Insight into how adolescents and adults in their routine environment, such as teachers, understand mental health is crucial [...] Read more.

Background/Objectives: Across geographical and cultural contexts, how individuals identify, communicate and help-seek for distress is often shaped by how mental health itself is understood. Insight into how adolescents and adults in their routine environment, such as teachers, understand mental health is crucial for developing context-specific mental health promotion strategies to young people. Sri Lanka, a country that navigates the dual legacies of pre-and-post-colonial mental health frameworks, has this need. The aim was to explore Sri Lankan school-going adolescents’ and their teachers’ perspectives of mental health and its determinants. Methods: Semi-structured interviews were conducted with 28 school-going adolescents in grades 10–12/13 and 14 of their school teachers, from seven secondary schools in Gampaha District, Sri Lanka. Interviews were transcribed, translated, coded inductively and analysed thematically. Results: All participants drew on culturally meaningful language that is rooted in Buddhist perspectives to conceptualise mental health. Causes and risk factors of poor mental health were attributed to individual, immediate environmental and structural factors. School environment played a central role in exacerbating other risk factors. Adolescents exhibited more knowledge of informal care avenues for mental health-related concerns. Conclusions: Findings highlight several implications including opportunities to leverage culturally contextualised language/frameworks when promoting mental health to Sri Lankan adolescents, diversifying mental health research and initiating school-based mental health programmes that integrate mental health promotion into routine educational practice to transform learning institutions across Sri Lanka to become mental health-promoting schools. Full article

(This article belongs to the Special Issue Global Health and Health Care Services: Social Psychological Determinants of Health and Well-Being)

17 pages, 1089 KB

Open AccessArticle

Abortion on Request, Contraceptive Access Barriers, and Mental Health-Related Quality of Life Among Women Attending a Romanian Tertiary Center

by Bogdan Dumitriu, Flavius George Socol, Ioana Denisa Socol, Lavinia Stelea, Alina Dumitriu and Adrian Gluhovschi

Healthcare 2026, 14(3), 310; https://doi.org/10.3390/healthcare14030310 - 26 Jan 2026

Abstract

Background and Objectives: Abortion on request, contraceptive access barriers, and mental health may jointly shape women’s quality of life (QoL). We examined how abortion history, structural barriers, and psychosocial factors relate to modern contraceptive use, depressive and anxiety symptoms, and QoL among [...] Read more.

Background and Objectives: Abortion on request, contraceptive access barriers, and mental health may jointly shape women’s quality of life (QoL). We examined how abortion history, structural barriers, and psychosocial factors relate to modern contraceptive use, depressive and anxiety symptoms, and QoL among women attending a Romanian tertiary center. Methods: We conducted a single-center observational study combining retrospective chart review with an online survey of 200 women aged 18–45 years. Validated instruments (Patient Health Questionnaire-9 [PHQ-9], Generalized Anxiety Disorder-7 [GAD-7], World Health Organization Five-Item Well-Being Index [WHO-5], and World Health Organization Quality of Life–BREF [WHOQOL-BREF]) and indices of access barriers, perceived stigma, and social support were used. Analyses included multivariable regression, structural equation modelling, latent class analysis, and moderation analysis. Results: Overall, 55.0% of women reported ≥1 abortion on request. Compared with those without abortion history, they were older (31.2 ± 4.9 vs. 26.8 ± 4.8 years, p < 0.001), more often had lower levels of education (51.8% vs. 33.3%, p = 0.013), and were less likely to use modern contraception at last intercourse (52.7% vs. 71.1%, p = 0.012). PHQ-9 (8.8 ± 4.0 vs. 7.3 ± 4.3) and GAD-7 (7.0 ± 3.2 vs. 5.7 ± 3.4) scores were higher (both p = 0.010), while QoL was lower (55.4 ± 8.1 vs. 59.5 ± 7.8, p < 0.001). In adjusted models, access barriers (OR per point = 1.3, 95% CI 1.1–1.6), but not abortion history, predicted non-use of modern contraception. QoL correlated strongly with PHQ-9 (r = −0.6) and WHO-5 (r = 0.5; both p < 0.001). Latent class analysis identified a “high-barrier, distressed, abortion-experienced” profile with the poorest mental health and QoL. Conclusions: Structural access barriers and current depressive and anxiety symptoms, rather than abortion history alone, were key correlates of contraceptive gaps and reduced QoL, underscoring the need for integrated reproductive and mental health care. Full article

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28 pages, 2596 KB

Open AccessReview

The Role of Pharmacies in Providing Point-of-Care Services in the Era of Digital Health and Artificial Intelligence: An Updated Review of Technologies, Regulation and Socioeconomic Considerations

by Maria Daoutakou and Spyridon Kintzios

Healthcare 2026, 14(3), 309; https://doi.org/10.3390/healthcare14030309 - 26 Jan 2026

Abstract

Pharmacy-based point-of-care (POC) services have evolved from pilot initiatives to an essential component of decentralized healthcare delivery. These services—ranging from rapid infectious-disease screening to chronic-disease monitoring—improve access, reduce diagnostic delays and empower pharmacists as front-line healthcare providers. The present paper is an updated, [...] Read more.

Pharmacy-based point-of-care (POC) services have evolved from pilot initiatives to an essential component of decentralized healthcare delivery. These services—ranging from rapid infectious-disease screening to chronic-disease monitoring—improve access, reduce diagnostic delays and empower pharmacists as front-line healthcare providers. The present paper is an updated, in-depth review of the evolution of pharmacy POC services worldwide, combined with the analysis of the regulatory and educational frameworks supporting implementation, technological drivers such as biosensors, mobile health and artificial intelligence and in-depth socioeconomic considerations. Benefits for patients, pharmacies and healthcare systems are contrasted with challenges including variable reimbursement, uneven regulatory oversight and workforce preparedness. Full article

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Graphical abstract

19 pages, 9109 KB

Open AccessSystematic Review

Influence of Self-Care on the Quality of Life of Elderly People with Chronic Non-Communicable Diseases: A Systematic Review

by Poliana Martins Ferreira, Jonas Paulo Batista Dias, Monica Barbosa, Teresa Martins, Rui Pedro Gomes Pereira, Murilo César do Nascimento and Namie Okino Sawada

Healthcare 2026, 14(3), 308; https://doi.org/10.3390/healthcare14030308 - 26 Jan 2026

Abstract

Background/Objectives: Self-care is a cornerstone of healthy aging and chronic disease management; however, evidence on the most effective intervention models for improving quality of life in older adults with chronic non-communicable diseases (NCDs) remains fragmented. This review aimed to evaluate the effectiveness of [...] Read more.

Background/Objectives: Self-care is a cornerstone of healthy aging and chronic disease management; however, evidence on the most effective intervention models for improving quality of life in older adults with chronic non-communicable diseases (NCDs) remains fragmented. This review aimed to evaluate the effectiveness of self-care interventions in promoting quality of life and health outcomes in older adults with NCDs. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251040613). Randomized and non-randomized clinical trials published between 2019 and 2024 were retrieved from Scopus, Web of Science, and EBSCOhost. Eligible studies included adults aged ≥60 years with NCDs receiving self-care interventions. Data extraction and risk of bias assessment were independently performed using Joanna Briggs Institute tools. Results: Twenty-nine studies involving 7241 older adults were included. Self-care interventions comprised nurse-led educational programs, digital health strategies, community- and peer-based approaches, and person-centered care models. Multicomponent and continuous interventions demonstrated consistent improvements in physical and psychological domains of quality of life, self-efficacy, autonomy, symptom management, and treatment adherence. Digital interventions enhanced monitoring and engagement, although their effectiveness varied according to sensory and health literacy limitations. Conclusions: Structured, person-centered, and nurse-led self-care interventions are effective in improving quality of life and autonomy among older adults with NCDs. These findings support their integration into primary and community-based care, reinforcing their relevance for clinical practice, care planning, and the development of assistive and educational strategies in aging care. Full article

(This article belongs to the Special Issue Advances in Public Health and Healthcare Management for Chronic Care)

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11 pages, 632 KB

Open AccessArticle

Psychometric Evaluation of the 15-Item Five Facet Mindfulness Questionnaire: A Cross-Cultural Comparison Study Among English- and Chinese-Speaking Adult Mental Health Service Users

by Ming Yu Claudia Wong, Guangzhe Frank Yuan, Shan-yan Huang, Amos En Zhe Lian, Görkem Derin, Aslı Dila Akiş, Peejay D. Bengwasan and Hong Wang Fung

Healthcare 2026, 14(3), 307; https://doi.org/10.3390/healthcare14030307 - 26 Jan 2026

Abstract

Objectives: Mindfulness has been proposed as an important health outcome and an indicator of mental well-being. This study aimed to evaluate the psychometric properties of the Five Facet Mindfulness Questionnaire (FFMQ-15) in two samples of mental health service users with diverse cultural [...] Read more.

Objectives: Mindfulness has been proposed as an important health outcome and an indicator of mental well-being. This study aimed to evaluate the psychometric properties of the Five Facet Mindfulness Questionnaire (FFMQ-15) in two samples of mental health service users with diverse cultural and linguistic backgrounds (English- and Chinese-speaking). The study addresses the conceptual gap regarding the limited validation of the FFMQ-15 in Chinese-speaking clinical populations and examines the implications of measurement invariance. This study aimed at (1) confirming the reliability and validity of the FFMQ-15 in mental health service users; (2) assessing the validity of the FFMQ-15 in Chinese-speaking populations, where evidence is limited; and (3) examining measurement invariance across English- and Chinese-speaking groups to ensure cross-cultural applicability and comparable score interpretation. Methods: Participants were recruited using snowball sampling and social media advertising, targeting adults aged 18 or older who could read and write English or Chinese and had received mental health services. The English-speaking sample comprised 115 adults, and the Chinese-speaking sample included 118 adults. Exploratory factor analysis was used to identify structural dimensions, while confirmatory factor analysis was conducted for both samples to evaluate the five-factor structure of the FFMQ-15. Results: The EFA showed literature-aligned results supporting the 5-factor structure model, while the CFA model demonstrated acceptable fit: χ²/df = 159.50/80 = 1.99, p < 0.001; CFI = 0.927; TLI = 0.904; RMSEA = 0.065 (90% CI [0.050, 0.080]); SRMR = 0.060, BIC = 10,843.067, meeting established thresholds, and the non-significant measurement variance indicated the measurement model’s consistency among clinical patients and across different cultural contexts. Conclusions: The FFMQ-15 shows strong psychometric properties for measuring mindfulness in English- and Chinese-speaking mental health service users, supporting its value in clinical research and practice. Full article

(This article belongs to the Special Issue Development, Validation, and Application of Measures Assessing Mental Health and Functional Outcomes)

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20 pages, 733 KB

Open AccessSystematic Review

Federated Learning in Healthcare Ethics: A Systematic Review of Privacy-Preserving and Equitable Medical AI

by Bilal Ahmad Mir, Syed Raza Abbas and Seung Won Lee

Healthcare 2026, 14(3), 306; https://doi.org/10.3390/healthcare14030306 - 26 Jan 2026

Abstract

Background/Objectives: Federated learning (FL) offers a way for healthcare institutions to collaboratively train machine learning models without sharing sensitive patient data. This systematic review aims to comprehensively synthesize the ethical dimensions of FL in healthcare, integrating privacy preservation, algorithmic fairness, governance, and [...] Read more.

Background/Objectives: Federated learning (FL) offers a way for healthcare institutions to collaboratively train machine learning models without sharing sensitive patient data. This systematic review aims to comprehensively synthesize the ethical dimensions of FL in healthcare, integrating privacy preservation, algorithmic fairness, governance, and equitable access into a unified analytical framework. The application of FL in healthcare between January 2020 and December 2024 is examined, with a focus on ethical issues such as algorithmic fairness, privacy preservation, governance, and equitable access. Methods: Following PRISMA guidelines, six databases (PubMed, IEEE Xplore, Web of Science, Scopus, ACM Digital Library, and arXiv) were searched. The PROSPERO registration is CRD420251274110. Studies were selected if they described FL implementations in healthcare settings and explicitly discussed ethical considerations. Key data extracted included FL architectures, privacy-preserving mechanisms, such as differential privacy, secure multiparty computation, and encryption, as well as fairness metrics, governance models, and clinical application domains. Results: Out of 3047 records, 38 met the inclusion criteria. The most popular applications were found in medical imaging and electronic health records, especially in radiology and oncology. Through thematic analysis, four key ethical themes emerged: algorithmic fairness, which addresses differences between clients and attributes; privacy protection through formal guarantees and cryptographic techniques; governance models, which emphasize accountability, transparency, and stakeholder engagement; and equitable distribution of computing resources for institutions with limited resources. Considerable variation was observed in how fairness and privacy trade-offs were evaluated, and only a few studies reported real-world clinical deployment. Conclusions: FL has significant potential to promote ethical AI in healthcare, but advancement will require the development of common fairness standards, workable governance plans, and systems to guarantee fair benefit sharing. Future studies should develop standardized fairness metrics, implement multi-stakeholder governance frameworks, and prioritize real-world clinical validation beyond proof-of-concept implementations. Full article

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14 pages, 923 KB

Open AccessArticle

Study of Behaviors Related to Over-the-Counter Medications, in Particular Nonsteroidal Anti-Inflammatory Drugs, in the General Polish Population

by Kaja Kiedrowska, Agata Pawlicka, Kacper Malinoś, Emilia Sokołowska, Wojciech Marlicz, Anastasios Koulaouzidis, Norbert Czapla and Karolina Skonieczna-Żydecka

Healthcare 2026, 14(3), 305; https://doi.org/10.3390/healthcare14030305 - 26 Jan 2026

Abstract

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used analgesics. However, their inappropriate or excessive use may lead to serious adverse effects. The aim of the study was to analyze behavioral patterns and attitudes toward the use of over-the-counter (OTC) [...] Read more.

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used analgesics. However, their inappropriate or excessive use may lead to serious adverse effects. The aim of the study was to analyze behavioral patterns and attitudes toward the use of over-the-counter (OTC) NSAIDs, as well as the perception of risks associated with their use. Methods: A cross-sectional survey was conducted among 567 respondents. An anonymous questionnaire consisting of 26 items was used, addressing sociodemographic characteristics, frequency of reading drug information leaflets, frequency of NSAID use, and awareness of potential adverse effects associated with these medications. Results: The demographic factors significantly influenced NSAID-related behaviors. Women were significantly more likely than men to read drug information leaflets and reported more frequent use of OTC NSAIDs. Older respondents exhibited greater adherence to the principles of responsible NSAID use. Higher educational attainment was associated with more frequent and attentive reading of drug information leaflets. Urban residents reported higher median frequencies of NSAID use, whereas students demonstrated greater awareness of potential NSAID adverse effects compared with non-students. Conclusions: The results reveal complex patterns of NSAID consumption and underscore the need for implementing targeted public health interventions. Full article

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13 pages, 632 KB

Open AccessSystematic Review

A Systematic Review of Stress-Related Work and Missed Nursing Care Among Clinical Nurses

by Yetty Mardelima Uli Pakpahan, Maria Komariah and Hana Rizmadewi Agustina

Healthcare 2026, 14(3), 304; https://doi.org/10.3390/healthcare14030304 - 26 Jan 2026

Abstract

Background: Missed nursing care (MNCs) is a global issue with the potential to threaten patient safety and is often associated with a stressful work environment. Although stress-related work among clinical nurses is associated with MNCs, the correlation remains limited. Objective: This systematic review [...] Read more.

Background: Missed nursing care (MNCs) is a global issue with the potential to threaten patient safety and is often associated with a stressful work environment. Although stress-related work among clinical nurses is associated with MNCs, the correlation remains limited. Objective: This systematic review aimed to assess and synthesize available scientific evidence regarding the correlation between stress-related work among clinical nurses and the incidence of MNCs in hospital settings. Methods: This review was conducted according to the PRISMA guidelines. The PubMed, Scopus, and EBSCO databases were systematically searched for articles published between January 2014 and June 2025. Primary studies with quantitative, qualitative, or mixed-methods designs that examined the relationship between stress-related work and MNCs among hospital nurses were included. The data obtained were extracted and analyzed using thematic approaches. Results: A total of 244 articles were identified from the three databases. Seven studies, conducted in different countries met the inclusion criteria. All studies used cross-sectional designs. The results showed that most study reported stress-related work, emotional fatigue, and burnout were significantly positively related to the frequency of MNCs (p < 0.05). The most frequently missed types of nursing care include monitoring vital signs, skin/wound care, and oral care. Conclusions: The evidence suggests that stress-related work among nurses has significant potential to predict MNCs. Interventions that focus on mitigating work stress by improving the work environment and optimizing workload are crucial for improving quality of care and patient safety. Full article

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17 pages, 1217 KB

Open AccessArticle

Comparison of Strength Training Interventions on Functional Performance in Frail Nursing Home Residents

by Helena Vila, Carmen Ferragut, Luis Javier Chirosa, Virginia Serrano-Gómez, Óscar García-García, Daniel Jerez-Mayorga, Ángela Rodríguez-Perea and José María Cancela

Healthcare 2026, 14(3), 303; https://doi.org/10.3390/healthcare14030303 - 26 Jan 2026

Abstract

Background/Objectives: Frailty and functional decline represent major challenges for aging populations, particularly among institutionalized older adults. Preserving functional capacity is essential to maintain autonomy, mobility, and quality of life. This study aimed to compare the effects of two strength training interventions—functional electromechanical dynamometer [...] Read more.

Background/Objectives: Frailty and functional decline represent major challenges for aging populations, particularly among institutionalized older adults. Preserving functional capacity is essential to maintain autonomy, mobility, and quality of life. This study aimed to compare the effects of two strength training interventions—functional electromechanical dynamometer (FEMD) training and weighted vest training—on peak concentric and eccentric force during the sit-to-stand task, as well as on functional performance and body composition in frail nursing home residents. Methods: A pilot quasi-experimental study with a non-randomized control group was conducted in 19 older adults (mean age: 86.3 ± 5.8 years). Participants were allocated to FEMD training (EG1, n = 6), weighted vest training (EG2, n = 6), or a control group (CG, n = 7). Training was performed twice weekly for eight weeks. Assessments included body composition, handgrip strength, 30 s chair stand test, 3 m walking speed, and peak concentric and eccentric force during the sit-to-stand movement. Data were analyzed using mixed-model ANOVA and complementary within-group analyses. Results: No significant group × moment interactions were observed. However, EG1 demonstrated significant within-group improvements in chair stand performance (+4.8 repetitions, p = 0.006), walking speed (+0.1 m·s⁻¹, p = 0.030), concentric peak force (+46.5%, p = 0.008), and eccentric peak force (+34%, p = 0.047). EG2 showed a smaller but significant increase in eccentric peak force (+6.1%, p = 0.019), without functional improvements. Body composition changes were modest, with EG1 showing increases in weight and BMI without concomitant fat mass gains. Conclusions: In this pilot quasi-experimental study, functional electromechanical dynamometer-based training was associated with improvements in neuromuscular performance, particularly concentric peak force. However, no significant group × moment interactions were observed, indicating that differential effects between interventions cannot be established. Functional improvements should be interpreted cautiously. The present results should therefore be considered exploratory and hypothesis-generating. These findings suggest that FEMD-based training may be a feasible and potentially beneficial functional strength training strategy for frail institutionalized older adults, which should be confirmed in adequately powered randomized controlled trials. Full article

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

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14 pages, 387 KB

Open AccessArticle

Effects of Catastrophic Coverage Expansion on Out-of-Pocket Spending for Non-Covered Services and Financial Equity: Evidence from South Korea’s National Health Insurance

by Minjeong Kim, Donggyo Shin, Hyunwoung Shin and Jangho Yoon

Healthcare 2026, 14(3), 302; https://doi.org/10.3390/healthcare14030302 - 26 Jan 2026

Abstract

Background: Patients with catastrophic health conditions have continuously faced substantial out-of-pocket (OOP) costs for non-covered services despite universal health coverage in South Korea. In 2013, the National Health Insurance Service (NHIS) expanded coverage for four major catastrophic conditions—cancers, cardiovascular diseases, cerebrovascular diseases, and [...] Read more.

Background: Patients with catastrophic health conditions have continuously faced substantial out-of-pocket (OOP) costs for non-covered services despite universal health coverage in South Korea. In 2013, the National Health Insurance Service (NHIS) expanded coverage for four major catastrophic conditions—cancers, cardiovascular diseases, cerebrovascular diseases, and rare illnesses—aiming to strengthen financial protection for patients with catastrophic conditions. However, concerns remain that providers may respond by inducing more use of non-covered services, potentially offsetting reductions in patients’ financial burden. Methods: We evaluated the impact of the 2013 catastrophic coverage expansion on patients’ OOP spending for non-covered services using a quasi-experimental difference-in-differences design. Using nationally representative longitudinal healthcare expenditure data, the Korean Health Panel Survey (KHPS), from 2011 to 2016, we compared patients with the four targeted conditions to a control group with clinically comparable conditions. A two-part model was applied to separately estimate changes in the probability of incurring any non-covered OOP spending and changes in spending levels conditional on positive expenditures. We further examined whether effects differed by supplemental private health insurance (PHI) status. Results: We found that 7.3-, 5.2-, and 7.7-percentage-point decreases in annual probability of incurring any non-covered OOP spending for total, inpatient, and outpatient services, respectively, after policy implementation. Among patients with positive spending, OOP spending for total and inpatient non-covered services decreased by approximately 164 USD and 254 USD per year, while outpatient spending showed no statistically significant change. No statistically significant differential effects were also observed by PHI status. Conclusion: The catastrophic coverage expansion reduced patients’ exposure to and burden of non-covered OOP spending, indicating improved financial protection without evidence of compensatory increases in non-covered service use. These findings suggest that targeted benefit expansions for high-cost conditions can enhance financial equity within universal health systems. Full article

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11 pages, 473 KB

Open AccessReview

Integrating Evidence on Dynapenia and Dynapenic Obesity: An Umbrella Review of Health Outcomes Among Community-Dwelling Older Adults

by Shih-Sen Lin, Sung-Yun Chen, Hsiao-Chi Tsai and Shu-Fang Chang

Healthcare 2026, 14(3), 301; https://doi.org/10.3390/healthcare14030301 - 26 Jan 2026

Abstract

Background: Dynapenia refers to the age-related decline in muscle strength that occurs even when muscle mass is preserved. It has become an important issue in older adults because reduced strength is strongly linked to many negative health outcomes. When dynapenia occurs together with [...] Read more.

Background: Dynapenia refers to the age-related decline in muscle strength that occurs even when muscle mass is preserved. It has become an important issue in older adults because reduced strength is strongly linked to many negative health outcomes. When dynapenia occurs together with obesity—referred to as dynapenic obesity or dynapenic abdominal obesity—the risks, including mortality, falls, and the development of multiple chronic conditions, appear to increase even further. This umbrella review aimed to bring together and summarize existing systematic reviews and meta-analyses that examined how dynapenia and its obesity-related subtypes are associated with mortality, falls, and multimorbidity among community-dwelling older adults. Methods: Following PRISMA 2020 and JBI guidelines, six major databases and search engines (PubMed, Embase, Cochrane Library, Scopus, CINAHL, and Airiti Library) were searched from their inception to October 2025. Systematic reviews and meta-analyses involving adults aged 60 years and older and reporting quantitative results on the relationships between dynapenia-related conditions and adverse health outcomes were included. The methodological quality of each review was evaluated using AMSTAR 2, and the certainty of evidence was assessed with the GRADE approach. This umbrella review followed the PRIOR framework and was reported according to PRISMA 2020. The protocol for this review was registered in PROSPERO (ID: CRD 42023415232). Results: A total of four systematic reviews and meta-analyses were included, covering more than 73,000 community-dwelling older adults. The pooled data showed that dynapenic obesity significantly increased the risk of all-cause mortality, with hazard ratios ranging from 1.50 (95% CI 1.14–1.96) to 1.73 (95% CI 1.38–2.16). Dynapenic abdominal obesity was also strongly linked to falls, with pooled estimates ranging from HR = 1.82 (95% CI 1.04–3.17) to RR = 6.91 (95% CI 5.42–8.80). For multimorbidity, older adults with dynapenia had 1.38 times higher odds of having two or more chronic diseases than those without dynapenia (OR = 1.38, 95% CI 1.10–1.72). Based on the GRADE evaluation, the certainty of evidence was moderate for mortality and falls and low for multimorbidity. Conclusions: Overall, the findings indicate that dynapenia and its obesity-related forms meaningfully increase the risks of mortality, falls, and multimorbidity among community-dwelling older adults. Importantly, these results position dynapenia not merely as a musculoskeletal condition, but as a clinically relevant marker of aging-related vulnerability. This underscores the need for early screening of muscle strength alongside obesity-related indicators, as well as the development of integrated preventive strategies that combine strength-oriented interventions with obesity management in older populations. Full article

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12 pages, 530 KB

Open AccessArticle

Results and Future Perspectives of the Sustainable Anesthesia Project: A Large-Scale, Real-World Implementation Study at the Largest Spanish Private Healthcare Provider

by Juan Acha-Ganderias, María del Pino Henríquez-de Armas, Luis Enrique Muñoz-Alameda, Ion Cristóbal, Cristina Caramés and Leticia Moral-Iglesias

Healthcare 2026, 14(3), 300; https://doi.org/10.3390/healthcare14030300 - 25 Jan 2026

Abstract

Background: Climate change is a serious threat to global health. The healthcare sector contributes substantially to greenhouse gas (GHG) emissions, with anaesthetic gases being a major source of Scope 1 emissions. We aimed to evaluate the 2024 impact of the Sustainable Anesthesia [...] Read more.

Background: Climate change is a serious threat to global health. The healthcare sector contributes substantially to greenhouse gas (GHG) emissions, with anaesthetic gases being a major source of Scope 1 emissions. We aimed to evaluate the 2024 impact of the Sustainable Anesthesia Project, designed to reduce the environmental footprint of anaesthetic gases by eliminating and/or replacing the most polluting agents (nitrous oxide and desflurane) with more sustainable alternatives (sevoflurane, total intravenous anaesthesia, and regional/local anaesthesia). Methods: We conducted a descriptive analysis of anaesthetic gas consumption in 2023 and 2024, as well as a comparison of emissions in tons of CO₂, the impact on the carbon footprint, and the potential future emissions savings that full implementation of the project would entail. Results: In the first year, nitrous oxide consumption decreased by 64% and desflurane by 63%. Overall anaesthetic-gas emissions fell by 8386 tCO₂e versus 2023, a 54% relative reduction. Furthermore, the contribution of these gases to the total Scope 1 emissions markedly declined from 35.18% in 2023 to 21.22% in 2024. An additional reduction potential of around 4800 tCO₂e was identified for consolidation by 2025 with full implementation. Conclusions: The results observed in this study demonstrate the success of the Sustainable Anesthesia Project, whose strategy represents an extensible and applicable option to other centers and companies in the health sector to reduce their environmental impact. Full article

(This article belongs to the Section Healthcare and Sustainability)

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12 pages, 250 KB

Open AccessArticle

Quality of Prison Life and Physical Environment: What Is Predictive of Prisoners’ Overall Satisfaction with the Prison?

by Hilde Pape and Berit Johnsen

Healthcare 2026, 14(3), 299; https://doi.org/10.3390/healthcare14030299 - 24 Jan 2026

Abstract

Background/Objectives: This study examines prisoners’ quality of life by investigating which aspects of imprisonment conditions—including perceptions of the physical environment—best predict overall satisfaction with the prison (OSP). A key question is whether the staff–prisoner relationship is the single most important dimension, which [...] Read more.

Background/Objectives: This study examines prisoners’ quality of life by investigating which aspects of imprisonment conditions—including perceptions of the physical environment—best predict overall satisfaction with the prison (OSP). A key question is whether the staff–prisoner relationship is the single most important dimension, which is frequently emphasized in the literature but has scarcely been tested quantitatively. Methods: Data stemmed from a survey conducted in three closed prisons in Norway in 2022 (response rate: 63%, n = 163). The dependent variable was assessed by asking: “Generally speaking, on a scale from 1 to 10, how satisfied are you with this prison?” This outcome was regressed on seven subscales from the Prison Climate Questionnaire and four single-item measures of the physical environment that have been shown to influence health and well-being. Results: As expected, the quality of staff–prisoner relationships had a unique statistical impact on OSP. Ratings of the outdoor areas and the view from the cell were about equally strong predictors. No statistically independent effects were observed for perceived quality of relationships with fellow prisoners, reintegration measures, receiving visits, personal safety, autonomy, access to natural light and a global rating of the prison building (noise, temperature, layout, etc.). Conclusions: This study further emphasizes the importance of staff–prisoner relationships in shaping prisoners’ experiences and perceptions of imprisonment. Moreover, it provides new insights into the significance of the physical environment for prisoners’ overall perceptions of prison quality, which is likely to affect their mental health and well-being. These findings have potential implications for the design and siting of new correctional facilities and for improving the quality of existing ones. Full article

(This article belongs to the Special Issue Prisoner Health)

14 pages, 798 KB

Open AccessArticle

Seaweed-Derived Iodine Intake During the Korean Postpartum Period: A 1-Year Follow-Up Study

by Jihee Choi, Se-A Lee, Na Young Yoon and Hae-Jeung Lee

Healthcare 2026, 14(3), 298; https://doi.org/10.3390/healthcare14030298 - 24 Jan 2026

Abstract

Background: Seaweed consumption is a major source of dietary iodine in Korea, particularly among lactating women during the postpartum period. This practice raises concerns regarding short-term iodine excess and its potential effects on thyroid function. We examined the prevalence of thyroid disease and [...] Read more.

Background: Seaweed consumption is a major source of dietary iodine in Korea, particularly among lactating women during the postpartum period. This practice raises concerns regarding short-term iodine excess and its potential effects on thyroid function. We examined the prevalence of thyroid disease and hormone abnormalities 1 year after childbirth among postpartum women with varying levels of seaweed-derived iodine intake. Methods: Between 17 July 2021 and 10 December 2021, 147 postpartum women were enrolled within two weeks after childbirth at postpartum care centers in Korea, which provide structured residential maternal and infant care, including standardized meals, during the early postpartum period. Participants provided informed consent and completed baseline questionnaires and dietary assessments. Iodine intake, including seaweed soup consumption during the 8-week postpartum period, and infant growth indicators were evaluated. A total of 81 participants completed the 1-year follow-up. At follow-up, dietary records, thyroid disease prevalence, hormone levels, urinary iodine concentration, and infant growth indicators were assessed. Results: At 1 year, none of the 81 participants had thyroid disease. The prevalence of abnormal triiodothyronine (T3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) was analyzed by iodine-intake quartiles, revealing no significant differences (T3: p = 0.4175; FT4: p = 0.1591; TSH: p = 0.9344). Conclusions: These findings suggest that the evidence regarding an association between short-term postpartum iodine intake and thyroid outcomes one year after childbirth remains inconclusive. Owing to the limited sample size, high attrition, and observational design, the study may have been underpowered to detect clinically meaningful differences, and potential effects cannot be excluded. Therefore, these results should be interpreted cautiously, and larger, well-designed longitudinal studies with repeated thyroid assessments are needed to better clarify the long-term implications of postpartum iodine exposure. Full article

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16 pages, 729 KB

Open AccessArticle

Assessment the Level of Comorbid Depression, Quality of Life and Associated Factors Among Patients with Heart Failure: An Outpatient-Based Study

by Zekiye Yılmaz, Anmar Al-Taie and İrem Bayol

Healthcare 2026, 14(3), 297; https://doi.org/10.3390/healthcare14030297 - 24 Jan 2026

Abstract

Background: Heart failure (HF) affects not only the cardiovascular system but also mental health. The majority of patients with HF experience symptoms of mental disorders, such as depression, which are proportionally related to the severity of HF. This results in a significant [...] Read more.

Background: Heart failure (HF) affects not only the cardiovascular system but also mental health. The majority of patients with HF experience symptoms of mental disorders, such as depression, which are proportionally related to the severity of HF. This results in a significant comorbidity of HF, which might be associated with poor clinical outcomes, including decreased health-related quality of life (HRQOL). In Türkiye, data concerning the extent of this complication among outpatients with HF are limited. Therefore, the aim of this study was to assess the prevalence of depression in outpatients with HF and consequently the HRQOL; the secondary aim was to identify the related factors contributing to the incidence of depression and HRQOL in patients with HF in Bursa, Türkiye. Methods: An outpatient, descriptive, observational, cross-sectional study was conducted in a cardiology outpatient clinic in Bursa Province, Türkiye, between September and December 2022. The study was conducted via a validated questionnaire consisting of four sections. Depression was measured using the Beck Depression Inventory (BDI) scale, and the HRQOL of HF patients was evaluated using the Turkish version of the Minnesota Living with HF Questionnaire (MLHFQ). Simple linear regression and multiple linear regression analyses were used to determine the effects of variables. Limitations of the study include its design as a descriptive, observational, cross-sectional study from a single center that relies on self-reported data. Results: A total of 166 patients were enrolled, with a mean age of 64.96 ± 11.33 years. Nearly half of the participants had moderate or severe depression (33.1% and 15.7%, respectively). The mean MLHFQ score of the study participants was 54.15 ± 18.20. Patients suffering from severe depression had the lowest HRQOL (71.46 ± 12.4). There was a significant increase in depression level, and a decrease in HRQOL in patients with a duration of HF diagnosis of more than 3 years (p = 0.001), a number of HF hospitalizations (p = 0.001), and those diagnosed with NYHA class IV (p = 0.001). Multiple linear regression analysis revealed a significant relationship between the duration of HF disease, number of comorbidities, number of medications used, and BDI [(0.30 < r: 0.31/0.43/0.43 ≤ 0.70), respectively]. The simple linear regression analysis revealed that the BDI has positive and significant explanatory power for the MLHFQ (F: 168.29; R²: 0.51; t: 12.97; p < 0.001), and 51% of the change in the MLHFQ score is recorded by the BDI (R²: 0.51). Conclusions: The results of this study revealed that comorbid depression and HRQOL are closely related. This was observed in nearly half of the patients with HF, who had comorbid moderate and severe depression, which is associated with poor HRQOL. The factors associated with high depression and poor HRQOL were the duration of HF diagnosis of more than 3 years, an increased number of HF hospitalizations, polypharmacy, and NYHA class IV diagnoses. Full article

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