Healthcare

14 pages, 262 KiB

Open AccessArticle

The Role of Personality in Explaining Burnout, Work Addiction, and Stress-Related Growth in Prehospital Emergency Personnel

by Mihai Alexandru Butoi, Gabriela Vancu, Radiana-Carmen Marcu, Andrei Hermenean, Monica Puticiu and Luciana Teodora Rotaru

Healthcare 2025, 13(2), 193; https://doi.org/10.3390/healthcare13020193 (registering DOI) - 19 Jan 2025

Abstract

Background/Objectives: This is a cross-sectional study designed to explore the contribution of personality factors (the Alternative Five Factor Model) and lower order characteristics (responsive distress and self-discipline) to burnout, work addiction, and stress-related growth among Romanian prehospital emergency healthcare workers. Methods: A total [...] Read more.

Background/Objectives: This is a cross-sectional study designed to explore the contribution of personality factors (the Alternative Five Factor Model) and lower order characteristics (responsive distress and self-discipline) to burnout, work addiction, and stress-related growth among Romanian prehospital emergency healthcare workers. Methods: A total of 266 prehospital professionals (41 physicians, 74 nurses, and 151 paramedics) participated in the study out of the 728 invited (36.5% response rate). The age of participants ranged between 20 and 57 years and 67.3% were men. The participants completed the Oldenburg Burnout Inventory, the Dutch Work Addiction Scale (the short version), the Stress-Related Growth Scale, the Zuckerman–Kuhlman Personality Inventory, the Responsive Distress Scale, and the Self-Discipline Scale. Results: The results show that burnout was predicted by age, gender, impulsive sensation seeking, responsive distress, and self-discipline; work addiction was predicted by aggression–hostility, sociability, and responsive distress, while stress-related growth was predicted by age, activity, and self-discipline. Additionally, we found that emergency healthcare workers displayed lower impulsive sensation seeking, neuroticism–anxiety, and aggression–hostility, but displayed higher levels of activity and sociability in comparison with the general Romanian population, although these differences must be interpreted with caution as the general Romanian population tend to be significantly younger. Conclusions: This study provides new insights into the role of personality traits as risk factors for burnout and work addiction, and as protective factors for stress-related growth in prehospital emergency personnel. It is also among the few studies in this field to employ the Alternative Five Factor Model of personality. Full article

(This article belongs to the Special Issue Burnout and Mental Health among Health Professionals)

18 pages, 660 KiB

Open AccessPerspective

Advancing Sustainable HIV Services Through Integration in Primary Healthcare in Sub-Saharan Africa: A Perspective on Practical Recommendations

by Tafadzwa Dzinamarira, Gallican Rwibasira, Loveday Mwila, Enos Moyo, Derek Mangoya, Perseverance Moyo, Edward Oladele, Adewale Akinjeji, Munashe Chimene and Claude Mambo Muvunyi

Healthcare 2025, 13(2), 192; https://doi.org/10.3390/healthcare13020192 (registering DOI) - 19 Jan 2025

Abstract

Sub-Saharan Africa continues to bear a disproportionate burden of the global HIV epidemic. Integrating HIV services into primary healthcare is a crucial strategy to accelerate progress towards ending the epidemic. However, several challenges hinder effective integration, including underfunding, human resource shortages, infrastructure limitations, [...] Read more.

Sub-Saharan Africa continues to bear a disproportionate burden of the global HIV epidemic. Integrating HIV services into primary healthcare is a crucial strategy to accelerate progress towards ending the epidemic. However, several challenges hinder effective integration, including underfunding, human resource shortages, infrastructure limitations, weak health systems, and sociocultural factors. With this perspective, we discuss strategies to address these challenges. A comprehensive, multi-faceted approach is necessary to overcome these barriers. Investing in human resources, improving infrastructure, and strengthening health information systems are essential for strengthening the health system. Implementing patient-centered care, integrated service delivery models, and community engagement can optimize service delivery. Utilizing digital health tools, such as mobile health applications and electronic health records, can enhance service delivery and data management. Mobilizing for an increase in domestic resources, aligning donor funding, and using cost-effective approaches are crucial for effective financing. Finally, robust monitoring and evaluation systems are necessary to track progress, identify challenges, and inform decision-making. With these strategies, among many others, sub-Saharan African countries can significantly improve the integration of HIV services into primary healthcare, leading to better health outcomes for people living with HIV and more sustainable HIV programs. Full article

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27 pages, 1004 KiB

Open AccessArticle

When I Receive Too Much Social Support: The Effect of Social Support Overload on Users’ Life Burnout and Discontinuance in Fitness Apps

by Ruihan Li, Shuang Wang and Tailai Wu

Healthcare 2025, 13(2), 191; https://doi.org/10.3390/healthcare13020191 (registering DOI) - 19 Jan 2025

Abstract

Background/Objectives: As fitness apps increasingly incorporate social interaction features, users may find themselves overwhelmed by an excess of received support, struggling to effectively manage it. Highlighting a novel recipient-centric perspective, we aim to investigate the impact of social support overload on users’ life [...] Read more.

Background/Objectives: As fitness apps increasingly incorporate social interaction features, users may find themselves overwhelmed by an excess of received support, struggling to effectively manage it. Highlighting a novel recipient-centric perspective, we aim to investigate the impact of social support overload on users’ life burnout and discontinuance within fitness apps. Methods: Utilizing Social Support Theory and Basic Psychological Needs Theory, we develop a model to examine how emotional, network, and informational support overload affect life burnout and discontinuance through the frustration of basic psychological needs: autonomy, competence, and relatedness. A total of 443 fitness app users were included in our study, and we employed Structural Equation Modeling (SEM) to empirically test this model. Results: The results highlight the significant mediating role of the frustration of basic psychological needs between social support overload and life burnout/discontinuance. Network and informational support overload positively correlate with frustration of all needs, whereas emotional support overload shows a complex relationship. All need frustrations are linked to life burnout, but only autonomy and relatedness frustrations significantly lead to discontinuance. Additionally, gender and app use proficiency are significant control variables impacting discontinuance. Conclusions: This study adopts a novel recipient-centric perspective to explore social support overload, examining its effects on life burnout and discontinuance and offering practical implications for both users and app managers. Full article

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

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20 pages, 1461 KiB

Open AccessArticle

Cultural Competence of Obstetricians/Gynecologists and Midwives Providing Midwifery Care to Roma Women in Western Greece

by Chrysoula Chinoporou, Athina Diamanti, Eleni Asimaki, Christina Nanou, Pinelopi Varela, Victoria Vivilaki and Anna Deltsidou

Healthcare 2025, 13(2), 190; https://doi.org/10.3390/healthcare13020190 (registering DOI) - 19 Jan 2025

Abstract

Background: Providing midwifery care to Roma women is a significant public health issue due to their status as a vulnerable population, often facing unique challenges and discrimination in accessing healthcare. Cultural competence refers to the ability of maternity providers to understand and incorporate [...] Read more.

Background: Providing midwifery care to Roma women is a significant public health issue due to their status as a vulnerable population, often facing unique challenges and discrimination in accessing healthcare. Cultural competence refers to the ability of maternity providers to understand and incorporate cultural factors within the broader healthcare system. Objective: This study aimed to investigate the cultural competence of obstetricians/gynecologists and midwives working in Western Greece who provide midwifery care to Roma women. Methods: A cross-sectional quantitative study was conducted using a questionnaire from the Roma Women’s Empowerment and Fight against discrimination in Access to Health (REACH) project, which focuses on empowering Roma women and combating healthcare access discrimination. The questionnaire covered three areas: the cultural competence of maternity professionals, their knowledge of Roma women’s lifestyle, and participants’ demographics. The sample included 100 maternity professionals from hospitals and health centers in Western Greece. Results: Cultural competence was found to be moderate to high, with a mean score of 6.9 (SD = 2.2) for the ability to provide adequate care. In the past six months, 33% had provided care to 1–5 Roma women with communication issues, and 53% frequently faced challenges in service delivery. Common problems included Roma women not understanding the information provided (72.9%), and not having necessary documents (41.7%). Obstetricians/gynecologists had higher knowledge scores compared to midwives, and higher educational attainment correlated with better knowledge. Older age was associated with higher cultural competence (p = 0.048). Conclusions: Cultural competence was positively correlated with knowledge levels, with obstetricians/gynecologists exhibiting higher competence than midwives. Enhancing cultural competence among perinatal care providers is crucial to addressing health disparities faced by Roma women. The study’s cross-sectional design and reliance on self-reported data may limit the generalizability and introduce bias. Enhancing cultural competence through targeted training programs can help address healthcare disparities faced by Roma women. Full article

(This article belongs to the Special Issue Interdisciplinary Perspectives in Maternal Health: Integrating Theoretical Frameworks and Practical Applications)

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27 pages, 1066 KiB

Open AccessSystematic Review

Physical Exercise Interventions Using Virtual Reality in Children and Adolescents with Cerebral Palsy: Systematic Review

by Javier Velasco Aguado, Mário C. Espada, Jesús Muñoz-Jiménez, Cátia C. Ferreira and Luisa Gámez-Calvo

Healthcare 2025, 13(2), 189; https://doi.org/10.3390/healthcare13020189 (registering DOI) - 19 Jan 2025

Abstract

Background/Objectives: Cerebral palsy (CP) is a neurological disorder that affects movement and posture. Physical activity (PA) is safe and crucial for healthy development; however, this population faces barriers that hinder its implementation. Virtual reality (VR) is an emerging and promising technology that promotes [...] Read more.

Background/Objectives: Cerebral palsy (CP) is a neurological disorder that affects movement and posture. Physical activity (PA) is safe and crucial for healthy development; however, this population faces barriers that hinder its implementation. Virtual reality (VR) is an emerging and promising technology that promotes PA in young people with CP. This work aims to compile and analyze the current scientific literature on physical exercise (PE) programs using VR in children and adolescents with CP through a PRISMA systematic review. Methods: A systematic review was conducted and reported based on the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analyses) statement. The search was conducted through the Web of Science, PubMed, and Scopus databases on 1st September 2024. Studies based on PA interventions using VR in children and adolescents with CP were selected. Results: A total of 24 experimental research articles were selected for this review. The studies included comprise a total sample of 616 participants between 4 and 18 years old. The studies involved a diverse range of interventions, from brief sessions to intensive training. The results consistently demonstrated improvements in motor control, muscle strength, aerobic capacity, and overall participation in daily activities. Conclusions: The results highlight that the use of VR for PE programs has numerous benefits such as increased enjoyment, facilitation of motor learning, and acquisition of functional skills. PE through VR in children and adolescents with CP represents a promising tool; more scientific and practical evidence is needed to confirm its long-term effectiveness. Full article

(This article belongs to the Special Issue Physical Activity, Exercise, and Sport in People with Disabilities: Strategies for Health Promotion)

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10 pages, 297 KiB

Open AccessArticle

An Overlooked Challenge: A Retrospective Audit of Overnutrition in Hospital Rehabilitation Wards

by Hannah T. Olufson, Jennifer Ellick, Simone McCoy, Sally E. Barrimore, Tracy Knowlman and Adrienne M. Young

Healthcare 2025, 13(2), 188; https://doi.org/10.3390/healthcare13020188 (registering DOI) - 18 Jan 2025

Abstract

Background/Objective: Research shows that obesity has risen among rehabilitation patients. Despite this, nutrition care in subacute rehabilitation wards focuses primarily on preventing and treating protein-energy malnutrition. The continued provision of energy-dense meals during lengthy rehabilitation admissions may present a risk of overnutrition for [...] Read more.

Background/Objective: Research shows that obesity has risen among rehabilitation patients. Despite this, nutrition care in subacute rehabilitation wards focuses primarily on preventing and treating protein-energy malnutrition. The continued provision of energy-dense meals during lengthy rehabilitation admissions may present a risk of overnutrition for some patients, which can adversely affect functional outcomes. However, overnutrition is not routinely monitored in practice. This study summarizes the initial findings of a multi-site investigation of overnutrition incidence across five rehabilitation wards to scope the need for future research. Methods: A retrospective audit was conducted, including all inpatients admitted over 3 months to the study wards with a complete dataset (total sample n = 199). Data were collected from the medical record and menu management system to determine overnutrition, defined as an average daily energy intake equal to or greater than 1000 kJ above estimated requirements and weight gain of equal to or greater than 1 kg over the admission. Results: The incidence of overnutrition in the total sample was 12.1%. Of those patients deemed at low risk of malnutrition (n = 124), 19.4% developed overnutrition during their rehabilitation admission. Those who developed overnutrition during their admission gained an average of 2.9 kg, with a mean excess energy intake of 2456 kJ/day above estimated requirements. They also consumed a high intake of discretionary items (mean of 3156 kJ/day). Conclusions: The findings suggest that further research is needed to investigate the etiology and impact of the overlooked problem of overnutrition in subacute rehabilitation settings. Future investigation is essential to ensure that the planning and delivery of subacute dietetic and food services meet the nutrition needs of patients in longer-stay inpatient settings. Full article

(This article belongs to the Special Issue Nutrition in Patient Care)

16 pages, 587 KiB

Open AccessArticle

Exploring Physician and Patient Perspectives on Expectations and Role Models Towards Chronic Pain Treatment in General Practice: A Qualitative Cross-Sectional Study

by Dominik Dupont, Sabrina Brinkmöller, Sarina Carter, Michel Wensing, Cornelia Straßner, Peter Engeser and Regina Poß-Doering

Healthcare 2025, 13(2), 187; https://doi.org/10.3390/healthcare13020187 (registering DOI) - 18 Jan 2025

Abstract

Background and Objective: Approximately 7.4% of the German population matched the criteria of impeding, chronic non-cancer-related pain in 2014. Guidelines emphasize the importance of a holistic treatment approach. The project RELIEF aims to develop and evaluate a multifaceted case-management intervention to foster the [...] Read more.

Background and Objective: Approximately 7.4% of the German population matched the criteria of impeding, chronic non-cancer-related pain in 2014. Guidelines emphasize the importance of a holistic treatment approach. The project RELIEF aims to develop and evaluate a multifaceted case-management intervention to foster the holistic management of chronic pain in general practice. To inform intervention development, this study explored expectations and perceived role models of general practitioners (GP) and patients regarding chronic non-cancer-related pain management in general practice with a focus on patient expectations of GPs and themselves, as well as GP expectations of patients and their anticipation of patient’s expectations. Methods: Data were collected via semi-structured guide-based interviews with general practitioners and patients. Pseudonymized verbatim transcripts were analyzed using an inductive–deductive approach with a structuring qualitative content analysis. The Theoretical Domains Framework served as an analytical framework to explore behavioral aspects associated with expectations and role perceptions. Results:n = 25 interviews were analyzed (GP: n = 10, patient: n = 15). Findings indicate that patients considered themselves as the main actor in the therapy process yet expected guidance and care coordination from their GP. The essential role GPs play in pain management was emphasized. Role models indicated by GPs and some patients represent a care ideal, which was also reflected in discussed expectations. GPs anticipated that patients would place high relevance on pharmacological options. Patients highlighted their preference of non-pharmacological and alternative treatment options. Conclusions: Our findings demonstrate the importance of holistic, individually tailored chronic pain management in general practice. Systematic, multifaceted case management, as planned in the RELIEF project, may contribute to high-quality primary care for affected individuals. Full article

(This article belongs to the Section Pain Management)

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18 pages, 271 KiB

Open AccessArticle

A Cross-Sectional Multivariable Analysis of the Quality of Hemodialysis Patients’ Life in Lahore City, Pakistan

by Ghosia Islam, Gulzar H. Shah, Nadia Saeed, Jeffery A. Jones and Indira Karibayeva

Healthcare 2025, 13(2), 186; https://doi.org/10.3390/healthcare13020186 (registering DOI) - 18 Jan 2025

Abstract

Background/Objectives: Chronic kidney disease (CKD) is a severe health problem with dire consequences for the quality of life of millions of individuals and their families around the globe. This quantitative study analyzes the factors associated with hemodialysis patients’ quality of life (QoL) in [...] Read more.

Background/Objectives: Chronic kidney disease (CKD) is a severe health problem with dire consequences for the quality of life of millions of individuals and their families around the globe. This quantitative study analyzes the factors associated with hemodialysis patients’ quality of life (QoL) in Lahore City, Pakistan. Methods: Primary data from a sample of 384 patients were collected through regular visits to the hospital. We employed proportional odds models (POMs) and structural equation models to identify factors associated with the QoL. Results: The results revealed significant associations between various factors and patients’ quality of life. While gender showed no association with quality of life, younger age, single marital status, higher education, higher family income, and employment status were associated with a better QoL. Clinical variables such as the absence of diabetes and hypertension and specific laboratory parameters were protective against deteriorating QoL. Physical symptoms like muscle soreness, cramps, and shortness of breath significantly impacted QoL. Social and environmental factors adversely affected patient well-being, including family distress and financial issues. Psychological variables such as anxiety, depression, and fear of death also influenced QoL. Conclusions: The findings underscore the importance of holistic, patient-centered care approaches in renal failure management, highlighting the need for tailored interventions to address the diverse needs of dialysis patients and enhance their QoL. Further longitudinal research is recommended to validate these findings and guide the development of targeted interventions for improving patient well-being in hemodialysis settings. Full article

(This article belongs to the Special Issue Clinical Healthcare and Quality of Life of Chronically Ill Patients)

16 pages, 310 KiB

Open AccessArticle

The Impact of a Healthy Lifestyle on Lower Urinary Tract Symptoms and Erectile Function: A Prospective Study

by Riccardo Lombardo, Matteo Romagnoli, Chiara Splendore, Luca Sarcinelli, Beatrice Turchi, Giacomo Gallo, Giorgia Tema, Antonio Franco, Antonio Nacchia, Ferdinando Fusco, Yazan Al Salhi, Andrea Fuschi, Antonio Pastore, Antonio Cicione, Andrea Tubaro and Cosimo De Nunzio

Healthcare 2025, 13(2), 185; https://doi.org/10.3390/healthcare13020185 (registering DOI) - 18 Jan 2025

Abstract

Background and Objectives: The impact of lifestyle on lower urinary tract symptoms has been deeply evaluated in recent years; however, studies in the young population are missing. The aim of this study is to evaluate the impact of alcohol intake, tobacco and [...] Read more.

Background and Objectives: The impact of lifestyle on lower urinary tract symptoms has been deeply evaluated in recent years; however, studies in the young population are missing. The aim of this study is to evaluate the impact of alcohol intake, tobacco and cannabinoid smoking, physical activity, and dietary regime on urinary symptoms and sexual function in young adults under 30 years of age. Methods: A prospectively enrolled population of healthy young adults of both sexes under 30 years of age was selected. Young people with comorbidities were excluded. All participants were assessed by completing an anonymous questionnaire which included questions on medical history, lifestyle, smoking and alcohol intake, urinary symptoms, and sexual function only in male subjects. The questionnaire was postponed in case there was an acute pathology. Results: Overall, 802 young adults were prospectively enrolled, of whom 44% were male and 56% female, with a median age of 26 (23/28) years. In our population, 580/818 (70.9%) subjects presented an IPSS ≥ 3. In the analysis of the association between urinary symptoms and smoking, smokers presented urinary symptoms more frequently than nonsmokers (76% vs. 61%; p < 0.05). No association between urinary symptoms and alcohol intake, cannabinoid smoking, physical activity, and dietary regimen was recorded. On multivariable analysis, smokers had an almost doubled risk of urinary symptoms compared to nonsmokers (OR: 1.78; p = 0.001). Conclusions: In conclusion, we demonstrated how even in the young population there can be a correlation between LUTSs and different lifestyles. Full article

17 pages, 726 KiB

Open AccessArticle

Cybersecuity Analysis of a Telemedicine Platform

by Martina Nobili, Domenico Raguseo and Roberto Setola

Healthcare 2025, 13(2), 184; https://doi.org/10.3390/healthcare13020184 (registering DOI) - 18 Jan 2025

Abstract

Background: The global shift toward telemedicine, accelerated by the COVID-19 pandemic, has revolutionized healthcare delivery by enabling remote consultations and treatments. However, this rapid adoption has also introduced critical cybersecurity vulnerabilities, particularly in safeguarding sensitive medical data and ensuring the secure operation of [...] Read more.

Background: The global shift toward telemedicine, accelerated by the COVID-19 pandemic, has revolutionized healthcare delivery by enabling remote consultations and treatments. However, this rapid adoption has also introduced critical cybersecurity vulnerabilities, particularly in safeguarding sensitive medical data and ensuring the secure operation of telemedicine platforms. If not properly addressed, these vulnerabilities can compromise patient safety and the integrity of healthcare systems. As a result, implementing robust cybersecurity measures in telemedicine platforms is essential. Methods: The framework developed in this study allows for the assessment of a telemedicine platform’s cybersecurity posture and provides concrete recommendations for improvement. In this context, the Security Framework for Telemedicine Platforms, developed as part of the study, serves as a valuable tool for evaluating platform security, identifying vulnerabilities, and pinpointing areas for enhancement. Conclusions: This framework empowers organizations to effectively strengthen their cybersecurity strategies, as demonstrated by a case study. Full article

(This article belongs to the Section TeleHealth and Digital Healthcare)

16 pages, 1183 KiB

Open AccessArticle

The Effect of an Improved Environment According to Watson’s Theory of Human Care on Sleep, Anxiety, and Depression in Patients Undergoing Open Heart Surgery: A Randomized Controlled Trial

by Hatice Azizoğlu, Zeynep Gürkan, Yasemin Bozkurt, Canan Demir and Hatice Akaltun

Healthcare 2025, 13(2), 183; https://doi.org/10.3390/healthcare13020183 (registering DOI) - 18 Jan 2025

Abstract

Background/Objectives: According to Watson’s Human Care Theory, an improved environment influences patients’ care processes. The purpose of this study was to examine the effect of an improved environment, according to Watson’s Human Care Theory, on sleep quality, anxiety, and depression in patients undergoing [...] Read more.

Background/Objectives: According to Watson’s Human Care Theory, an improved environment influences patients’ care processes. The purpose of this study was to examine the effect of an improved environment, according to Watson’s Human Care Theory, on sleep quality, anxiety, and depression in patients undergoing open heart surgery. Methods: Upon admission to the ward from the postoperative intensive care unit, the experimental group underwent environmental remediation for three days. The environmental arrangements ensured that the patient’s room maintained an appropriate temperature range of 18–26 °C and humidity values of 30–50%. Monitoring took place at 21:00, 22:00, and 23:00 on Days 1, 2, and 3, at which times, the brightness of the patient rooms gradually decreased. On the morning of the fourth day, the patients were interviewed face to face, and research questionnaires were filled out (ClinicalTrials.gov identifier of the manuscript: NCT06744023). Results: After the implementation of an improved environment in accordance with Watson’s Human Care Theory, the sleep duration of the patients in the experimental group (5.91 h) was higher than that of the control group (4.1 h). At the same time, the mean sleep quality score was measured as 300 ± 15.33 in the experimental group and 116.33 ± 14.94 in the control group. In addition, anxiety and depression levels were lower in the experimental group (5.63 ± 0.59; 4.53 ± 0.42) compared with the control group (12.03 ± 0.85; 10.03 ± 0.82). Conclusions: We recommend implementing improved environmental arrangements in accordance with Watson’s Human Care Theory to improve sleep quality and reduce anxiety and depression levels in patients undergoing open heart surgery. Full article

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12 pages, 848 KiB

Open AccessArticle

An Integrative Path Model of Healthcare Utilization Determinants in Traditional Korean Medicine and Western Medicine Based on the Anderson Behavioral Model

by Minjung Park

Healthcare 2025, 13(2), 182; https://doi.org/10.3390/healthcare13020182 (registering DOI) - 18 Jan 2025

Abstract

Background: This study aimed to elucidate the determinants of healthcare utilization in South Korea’s dual healthcare system, encompassing both Western medicine and Korean medicine, through the Andersen Model. An integrative non-recursive path model of healthcare utilization determinants was proposed and analyzed. Methods: A [...] Read more.

Background: This study aimed to elucidate the determinants of healthcare utilization in South Korea’s dual healthcare system, encompassing both Western medicine and Korean medicine, through the Andersen Model. An integrative non-recursive path model of healthcare utilization determinants was proposed and analyzed. Methods: A path analysis using structural equation modeling, followed by mediation analysis, was conducted to determine the magnitude of the effect for each pathway. The 2020 data from the Korea Health Panel were used. Results: Structural equation modeling revealed that need factors, such as chronic diseases, disability, and self-rated health status, were the most significant drivers of both WM and KM utilization, while enabling factors significantly impacted WM utilization. Interestingly, WM and KM utilization were found to positively influence each other, contradicting the assumption of substitutional healthcare use. Mediation analysis further highlighted the interconnected nature of healthcare utilization pathways, with enabling and need factors showing significant indirect effects on utilization via the counterpart system. These findings underscore the importance of considering mutual influences in healthcare policy and resource allocation to enhance accessibility and efficiency. While the cross-sectional nature of the data limits causal inference, this study offers a robust theoretical framework and practical insights for addressing the complexities of healthcare utilization in dual-system contexts. Conclusion: The findings reveal that when traditional medicine functions within the national healthcare system, both Western medicine and traditional medicine are influenced by similar determinants in the same environment. Future research should explore longitudinal data to confirm these findings and investigate potential moderating effects of predisposing and enabling factors on WM and KM interactions. Full article

(This article belongs to the Section Health Policy)

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19 pages, 1208 KiB

Open AccessSystematic Review

Advancements in Obstructive Sleep Apnea Diagnosis and Screening Through Artificial Intelligence: A Systematic Review

by Lucrezia Giorgi, Domiziana Nardelli, Antonio Moffa, Francesco Iafrati, Simone Di Giovanni, Ewa Olszewska, Peter Baptista, Lorenzo Sabatino and Manuele Casale

Healthcare 2025, 13(2), 181; https://doi.org/10.3390/healthcare13020181 - 17 Jan 2025

Abstract

Background: Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed condition associated with a major healthcare burden. Current diagnostic tools, such as full-night polysomnography (PSG), pose a limited accessibility to diagnosis due to their elevated costs. Recent advances in Artificial Intelligence (AI), including [...] Read more.

Background: Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed condition associated with a major healthcare burden. Current diagnostic tools, such as full-night polysomnography (PSG), pose a limited accessibility to diagnosis due to their elevated costs. Recent advances in Artificial Intelligence (AI), including Machine Learning (ML) and deep learning (DL) algorithms, offer novel potential tools for an accurate OSA screening and diagnosis. This systematic review evaluates articles employing AI-powered models for OSA screening and diagnosis in the last decade. Methods: A comprehensive electronic search was performed on PubMed/MEDLINE, Google Scholar, and SCOPUS databases. The included studies were original articles written in English, reporting the use of ML algorithms to diagnose and predict OSA in suspected patients. The last search was performed in June 2024. This systematic review is registered in PROSPERO (Registration ID: CRD42024563059). Results: Sixty-five articles, involving data from 109,046 patients, met the inclusion criteria. Due to the heterogeneity of the algorithms, outcomes were analyzed into six sections (anthropometric indexes, imaging, electrocardiographic signals, respiratory signals, and oximetry and miscellaneous signals). AI algorithms demonstrated significant improvements in OSA detection, with accuracy, sensitivity, and specificity often exceeding traditional tools. In particular, anthropometric indexes were most widely used, especially in logistic regression-powered algorithms. Conclusions: The application of AI algorithms to OSA diagnosis and screening has great potential to improve patient outcomes, increase early detection, and lessen the load on healthcare systems. However, rigorous validation and standardization efforts must be made to standardize datasets. Full article

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14 pages, 1251 KiB

Open AccessArticle

The Impact of Relaxation Massage Prior to Bedtime on Sleep Quality and Quantity in People with Symptoms of Chronic Insomnia: A Home-Based Sleep Study

by Ilias Ntoumas, Christina Karatzaferi, Christoforos D. Giannaki, Fotini Papanikolaou, Aggelos Pappas, Efthimios Dardiotis and Giorgos K. Sakkas

Healthcare 2025, 13(2), 180; https://doi.org/10.3390/healthcare13020180 (registering DOI) - 17 Jan 2025

Abstract

Background/Objectives: Manual massage is an effective treatment approach for reducing general stress and promoting an overall sense of well-being. Relaxation massage aims to alleviate psychophysiological tension, enhance both blood and lymphatic circulation, and promote mental and physical relaxation. It is particularly beneficial for [...] Read more.

Background/Objectives: Manual massage is an effective treatment approach for reducing general stress and promoting an overall sense of well-being. Relaxation massage aims to alleviate psychophysiological tension, enhance both blood and lymphatic circulation, and promote mental and physical relaxation. It is particularly beneficial for those with anxiety-related symptoms (such as generalized anxiety disorder and social anxiety) and sleep disorders, aiming to improve calmness and promote sleepiness. Aims: The purpose of the present study was to assess the effectiveness of a single session of relaxation massage prior to bedtime on sleep quality and quantity indices in individuals with symptoms of chronic insomnia. Methods: In total, 20 (N = 20) healthy individuals (aged 25.5 ± 12.0 years; 6F/14M) with a score on the Athens Insomnia Scale of ≥16 participated under three different conditions over one week apart: (1) a 45 min relaxation massage condition (REL), (2) a 45 min sham massage condition (PLA), and (3) a control condition with no massage. Sleep activity was monitored using a portable polysomnographic system. Results: A statistically significant effect was observed between sleep efficiency across the three sessions (p = 0.034), with a notable effect in the relaxation massage (REL) session (p = 0.045). Additionally, sustained sleep efficiency showed a statistically significant difference among the sessions (p = 0.005). Conclusions: Relaxation massage prior to bedtime could be used as an effective and safe non-pharmacological approach for improving sleep efficiency and potentially restoring the fragmented sleep of individuals with symptoms of insomnia. Trial registration number: The trial was registered at clinicaltrials.gov as NCT06781866. Full article

(This article belongs to the Special Issue Psychophysiological Responses to Physical Activity, Exercise and/or Nutrition Interventions in Individuals with Cardiometabolic Health Impairments)

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16 pages, 474 KiB

Open AccessReview

Whether Academic Libraries Contribute to Students’ and Communities’ Wellbeing: A Scoping Review

by Shivani Suresh, David Lim, Kanchana Ekanayake and Amit Arora

Healthcare 2025, 13(2), 179; https://doi.org/10.3390/healthcare13020179 - 17 Jan 2025

Abstract

Background/Objectives: Academic libraries offer a range of activities and initiatives for their students and community users. However, wellbeing, as a concept in academic libraries, is not very well defined and is poorly understood. The objective of this scoping review was to examine [...] Read more.

Background/Objectives: Academic libraries offer a range of activities and initiatives for their students and community users. However, wellbeing, as a concept in academic libraries, is not very well defined and is poorly understood. The objective of this scoping review was to examine the role of academic libraries in student and community wellbeing, identify the various kinds of activities and initiatives that they carry out to address their wellbeing, and uncover gaps that might require further research. Methods: An extensive search was conducted in the Library Information Sciences Association (LISA), Education Resources Information Centre (ERIC), Medline (OVID), Scopus, and Web of Science (WOS) databases. Grey literature was searched on a selection of library websites and digital repositories. Data were extracted from studies that met the inclusion criteria for the scoping review. Themes were identified by the authors and reported as a narrative summary. Results: Of the 5437 records identified, a total of 40 documents were included in this scoping review. The authors identified 11 different kinds of activities and initiatives carried out in academic libraries that promote student and community wellbeing, i.e., (1) animal-assisted activities; (2) facilitating dialogues about belonging and identity; (3) fun recreational activities; (4) study support; (5) physical activity promotion; (6) meditation, yoga, and mindfulness; (7) book clubs; (8) art exhibitions; (9) technology and digital support; (10) free food and tea; and (11) health awareness. These activities were found to promote the physical, emotional, and social wellbeing of student and community users. Conclusions: This review highlights the need for further systematic research on the long-term effects of wellbeing initiatives and activities on both student and community users, and how they might impact aspects of wellbeing for specific population groups such as senior citizens and LGBTQIA members. This scoping review demonstrates the potential of academic libraries in promoting health and wellbeing for their users. Full article

(This article belongs to the Special Issue Caring for the Mental Health of Higher Education Students: Coping Strategies and Well-Being Support)

17 pages, 1735 KiB

Open AccessArticle

Trends in Socioeconomic Inequalities in the Prevalence of Chronic Non-Communicable Diseases in China: Evidence from Shaanxi Province During 2003–2013

by Dan Wang, Rashed Nawaz, Xiaojing Fan, Chi Shen, Sha Lai, Zhongliang Zhou and Jianmin Gao

Healthcare 2025, 13(2), 178; https://doi.org/10.3390/healthcare13020178 - 17 Jan 2025

Abstract

Background: The link between chronic non-communicable diseases (NCDs) and poverty in underdeveloped countries is debated. This study aims to examine socioeconomic inequalities related to NCDs and assess the contributing factors to these disparities. Methods: The study utilized data from the National [...] Read more.

Background: The link between chronic non-communicable diseases (NCDs) and poverty in underdeveloped countries is debated. This study aims to examine socioeconomic inequalities related to NCDs and assess the contributing factors to these disparities. Methods: The study utilized data from the National Health Services Survey in Shaanxi Province for 2003, 2008, and 2013, having 71,766 respondents. The concentration index (CI) was employed to rigorously quantify the degree of socioeconomic inequality in the prevalence of non-communicable diseases (NCDs). The CI decomposition identified the contribution of each variable, while the horizontal inequity (HI) index was calculated annually to assess changes in inequality. Additionally, a Probit model was employed to examine the significant determinants contributing to the occurrence of NCDs. Results: The results show a significant increase in NCD prevalence with age, particularly for individuals aged 60 and above, who experienced a 286.55% rise from 2003 to 2013. Higher education levels are associated with decreased NCD prevalence, as evidenced by a 74.13% reduction for those with high school education or above. Additionally, wealthier individuals had a 15.31% lower prevalence of NCDs, indicating that higher socioeconomic status correlates with a reduced likelihood of chronic diseases. Conclusions: The study finds that NCD prevalence significantly increases with age, while higher education levels and greater wealth are associated with reduced prevalence. These findings highlight the need to target older populations and lower socioeconomic groups for effective NCD prevention and management. Policies should focus on improving educational opportunities and socioeconomic conditions to reduce the burden of NCDs, particularly among older and economically disadvantaged groups. Full article

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18 pages, 581 KiB

Open AccessReview

Self-Compassion Intervention Programs for Nurses: A Scoping Review

by Jing Bian, Fazhan Chen, Shihan Fang and Yanbo Wang

Healthcare 2025, 13(2), 177; https://doi.org/10.3390/healthcare13020177 - 17 Jan 2025

Abstract

Background: Nurses frequently face various sources of stress in the workplace, making self-compassion interventions crucial for promoting their mental well-being. This scoping review aims to: (a) identify self-compassion intervention programs implemented within the nursing population; and (b) analyze the content and outcome [...] Read more.

Background: Nurses frequently face various sources of stress in the workplace, making self-compassion interventions crucial for promoting their mental well-being. This scoping review aims to: (a) identify self-compassion intervention programs implemented within the nursing population; and (b) analyze the content and outcome measures of these interventions. Methods: The study follows Arksey and O’Malley’s scoping review framework and adheres to the PRISMA-ScR guidelines. Relevant literature on self-compassion interventions for nurses published between January 2010 and May 2024 was systematically reviewed. Databases searched included PubMed, Web of Science, Scopus, ProQuest, and the Cochrane Library, using MeSH terms and free-text keywords such as “self-compassion”, “self-kindness”, “self-appreciation”, “self-worth”, “self-forgiveness”, “self-awareness”, “nurses”, and “nursing”. Results: Fifteen studies met the inclusion criteria and were included in the review. Self-compassion interventions were categorized into two types: (1) mindfulness-focused programs, such as Mindfulness-Based Stress Reduction (MBSR) and Mindful Self-Care and Resiliency (MSCR), which treat self-compassion as a potential outcome; and (2) self-compassion-focused programs, including Mindful Self-Compassion (MSC), Compassion Focused Therapy (CFT), and Loving-Kindness Meditation (LKM). Conclusions: The mental health challenges faced by nurses have drawn growing attention, underscoring the importance of self-compassion interventions. This review examines empirical studies within the nursing population, contributing to the development of more targeted and effective strategies to enhance the mental health and well-being of nursing professionals. Full article

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15 pages, 952 KiB

Open AccessStudy Protocol

Dealing with Childhood Externalizing Behavior: Protocol for a Feasibility RCT of the Being a Parent Program

by Laura Maciel, Ana Rita Pires, Miguel Basto-Pereira and Crispin Day

Healthcare 2025, 13(2), 176; https://doi.org/10.3390/healthcare13020176 - 17 Jan 2025

Abstract

Concerning numbers of childhood behavior problems have been reported worldwide. Parenting interventions are considered one of the most effective early strategies to intervene with externalizing conduct. This protocol outlines a feasibility RCT that aims to implement a parenting intervention in Portugal and (a) [...] Read more.

Concerning numbers of childhood behavior problems have been reported worldwide. Parenting interventions are considered one of the most effective early strategies to intervene with externalizing conduct. This protocol outlines a feasibility RCT that aims to implement a parenting intervention in Portugal and (a) test key feasibility parameters, (b) assess the fidelity and acceptability of the program, and (c) explore its effectiveness in childhood behavior problems, parenting skills, parental concern, and parental sense of competence. A double-blinded, two-arm feasibility RCT is described. The participants are the primary caregivers of children between the ages of two and eleven years old that identify difficulties in managing their child’s behavior. Families will be randomly assigned to an intervention arm and a waitlist control arm. Parents in the intervention arm will participate in the Being a Parent program (Portuguese version: Ser Pai & Ser Mãe), an eight-week group intervention. Outcomes will be assessed using quantitative and qualitative measures throughout three assessment periods (pre- and post-intervention, and follow-up). This study marks the first feasibility RCT of the Being a Parent program outside the UK. The findings will provide information on the global strength of this program. Challenges and clinical implications are also discussed. Full article

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14 pages, 466 KiB

Open AccessArticle

Effects of Shared Decision-Making, Health Literacy, and Self-Care Knowledge on Self-Care Behavior Among Hemodialysis Patients in Korea: A Cross-Sectional Survey

by Hyohjung Lee and Mi-Kyoung Cho

Healthcare 2025, 13(2), 175; https://doi.org/10.3390/healthcare13020175 - 17 Jan 2025

Abstract

Background: Patients undergoing hemodialysis for chronic kidney failure experience various complications and physical and emotional difficulties, leading to decreased quality of life. Self-care behaviors are essential for preventing complications and reducing mortality rates. Effective self-care behaviors significantly depend on shared decision-making, health literacy, [...] Read more.

Background: Patients undergoing hemodialysis for chronic kidney failure experience various complications and physical and emotional difficulties, leading to decreased quality of life. Self-care behaviors are essential for preventing complications and reducing mortality rates. Effective self-care behaviors significantly depend on shared decision-making, health literacy, and self-care knowledge, each critical in patient self-care performance and disease management. This study aimed to determine the importance and relevance of shared decision-making, health literacy, and self-care knowledge. In particular, it enhances self-care behaviors among hemodialysis patients. Methods: Participants were 108 adult hemodialysis patients from the hemodialysis centers of three medical institutions in Cheongju City, Korea. Moreover, the study utilized a descriptive survey research design. Data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, Pearson’s correlation coefficients, and multiple linear regression analyses. Results: The average score for self-care behaviors was 125.28 out of 175 points, with high scores for medication and vascular management. Furthermore, there were low scores for social activities and dietary management. Factors influencing self-care behaviors in hemodialysis patients were identified as sex, age, economic status, health literacy, and self-care knowledge. These factors explained 45.2% of the variance in self-care behaviors. Conclusions: To promote self-care behaviors in hemodialysis patients, it is essential to improve health literacy and self-care knowledge, strengthen tailored educational programs, and promote the explanatory role of nurses and shared decision-making. Additionally, comprehensive interventions, including economic support, are necessary. Full article

(This article belongs to the Section Chronic Care)

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