Journal Description
Healthcare
Healthcare
is an international, scientific, peer-reviewed, open access journal on health care systems, industry, technology, policy, and regulation, and is published semimonthly online by MDPI. European Medical Association (EMA) and Ocular Wellness & Nutrition Society (OWNS) are affiliated with Healthcare and their members receive discounts on the article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE and SSCI (Web of Science), PubMed, PMC, and other databases.
- Journal Rank: JCR - Q2 (Health Policy and Services) / CiteScore - Q1 (Leadership and Management)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 21.5 days after submission; acceptance to publication is undertaken in 2.6 days (median values for papers published in this journal in the first half of 2025).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
- Companion journals for Healthcare include: Trauma Care and European Burn Journal.
- Journal Cluster of Healthcare Sciences and Services: Geriatrics, Journal of Ageing and Longevity, Healthcare, Hospitals, Hygiene, International Journal of Environmental Research and Public Health and Nursing Reports.
Impact Factor:
2.7 (2024);
5-Year Impact Factor:
2.8 (2024)
Latest Articles
Living with Hypertension: An Investigation of Illness Perception from a Primary Care Perspective
Healthcare 2025, 13(16), 2032; https://doi.org/10.3390/healthcare13162032 (registering DOI) - 17 Aug 2025
Abstract
Background: This study aimed to assess the illness perceptions of patients diagnosed with hypertension from a primary care perspective. It also sought to identify the sociodemographic and clinical factors associated with illness perception. Methods: A cross-sectional descriptive study was conducted between February and
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Background: This study aimed to assess the illness perceptions of patients diagnosed with hypertension from a primary care perspective. It also sought to identify the sociodemographic and clinical factors associated with illness perception. Methods: A cross-sectional descriptive study was conducted between February and March 2025, involving 116 hypertensive patients who attended family medicine outpatient clinics at Rize Training and Research Hospital, Turkey. Data were collected using a sociodemographic questionnaire and the Brief Illness Perception Questionnaire (BIPQ). Nonparametric tests, including the Mann–Whitney U test, Kruskal–Wallis H test with Dunn’s post hoc analysis, and Spearman’s correlation analysis, were employed to evaluate the data. Results: The mean age of the participants was 69.01 ± 6.07 years, with 76.7% of the participants aged over 65 years. The median total BIPQ score was 47.0, indicating a moderate illness perception. A significant negative correlation was observed between age and the total BIPQ score (Rho = −0.443, p < 0.001). Higher illness perception levels were significantly associated with lower educational attainment, shorter duration of antihypertensive treatment, and attribution of hypertension to stress, genetic predisposition, diet, and occupational factors (p < 0.05). Conclusions: Illness perceptions among patients with hypertension are shaped by various sociodemographic and clinical determinants. Enhancing awareness of these perceptions in primary care may support improved treatment adherence and better health outcomes. Interventions that strengthen health literacy and offer psychosocial support may contribute to more effective hypertension management.
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Open AccessReview
A Global Perspective of Color Vision Deficiency: Awareness, Diagnosis, and Lived Experiences
by
Ali Almustanyir
Healthcare 2025, 13(16), 2031; https://doi.org/10.3390/healthcare13162031 (registering DOI) - 17 Aug 2025
Abstract
Color vision deficiency (CVD), commonly referred to as color blindness, affects a significant portion of the global population, particularly among males. This narrative review synthesizes findings from peer-reviewed articles and published large-scale epidemiological studies identified through database searches using terms such as “color
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Color vision deficiency (CVD), commonly referred to as color blindness, affects a significant portion of the global population, particularly among males. This narrative review synthesizes findings from peer-reviewed articles and published large-scale epidemiological studies identified through database searches using terms such as “color vision deficiency,” “color blindness,” “awareness,” and “diagnosis.” Studies were included if they addressed prevalence, awareness, diagnosis, or lived experiences of individuals with CVD. The prevalence of CVD varies by population, with red–green CVD affecting up to 8% of males and 0.5% of females of Northern European descent and lower rates reported in Asian and African populations. Although CVD is congenital in most cases, diagnosis is often delayed until school age or later due to limited routine screening, with many individuals remaining unaware of their condition until adolescence or adulthood. This delay can result in significant educational, occupational, and psychosocial challenges. This review synthesizes the current literature on the prevalence of CVD, levels of awareness, the age and process of diagnosis, and the lived experiences of individuals affected by this condition. Recommendations are provided for early detection, educational adaptations, and societal support.
Full article
(This article belongs to the Section Artificial Intelligence in Medicine)
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Open AccessCase Report
Integration of External Vagus Nerve Stimulation in the Physiotherapeutic Management of Chronic Cervicogenic Headache: A Case Report
by
Rob Sillevis, Nicola Khalaf, Valerie Weiss and Eleuterio A. Sanchez Romero
Healthcare 2025, 13(16), 2030; https://doi.org/10.3390/healthcare13162030 (registering DOI) - 17 Aug 2025
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Background: Cervicogenic headache (CGH) is a prevalent secondary headache disorder associated with upper cervical spine dysfunction, often involving nociceptive convergence at the trigeminocervical complex. While manual therapy and exercise have demonstrated benefit, autonomic dysregulation may contribute to persistent symptoms. This case report explores
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Background: Cervicogenic headache (CGH) is a prevalent secondary headache disorder associated with upper cervical spine dysfunction, often involving nociceptive convergence at the trigeminocervical complex. While manual therapy and exercise have demonstrated benefit, autonomic dysregulation may contribute to persistent symptoms. This case report explores the integration of external vagus nerve stimulation (eVNS) into a multimodal physical therapy approach targeting both mechanical and neurophysiological contributors to CGH. Case Description: A 63-year-old female presented with chronic CGH characterized by right-sided suboccipital and supraorbital pain, impaired sleep, and postural dysfunction. Examination revealed a right rotational atlas positional fault, restricted left atlantoaxial (AA) mobility, suboccipital hypertonicity, and reduced deep neck flexor endurance. Initial treatment emphasized manual therapy to restore AA mobility and atlas symmetry, combined with postural correction and neuromuscular training. Intervention: After initial symptom improvement plateaued, eVNS targeting the auricular branch of the vagus nerve was introduced to modulate autonomic tone. The patient used a handheld eVNS device nightly over three weeks. Outcomes: Substantial improvements were observed in the Neck Disability Index (↓77%), Headache Disability Inventory (↓72%), and pain scores (↓100%). Cervical mobility, atlas symmetry, and deep neck flexor endurance improved markedly. The patient reported reduced anxiety, improved sleep, and sustained headache relief at one-month follow-up. Conclusions: This case highlights the potential synergistic benefits of integrating eVNS within a physiotherapy-led CGH management plan. Further research is warranted to explore its role in targeting autonomic imbalance and enhancing conservative treatment outcomes.
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Open AccessArticle
Occupational Stress and Sleep Quality Among Hungarian Nurses in the Post-COVID Era: A Cross-Sectional Study
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Nóra Rozmann, Katalin Fusz, John M. Macharia, Dávid Sipos, Zsuzsanna Kivés, Orsolya Kövesdi and Bence Raposa
Healthcare 2025, 13(16), 2029; https://doi.org/10.3390/healthcare13162029 (registering DOI) - 17 Aug 2025
Abstract
Background and Objectives: The COVID-19 pandemic placed substantial mental and physical burdens on healthcare workers, particularly nurses. In the post-pandemic period, sustained stress, elevated mental workload and disturbed sleep may continue to affect well-being and job performance. This study aimed to assess perceived
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Background and Objectives: The COVID-19 pandemic placed substantial mental and physical burdens on healthcare workers, particularly nurses. In the post-pandemic period, sustained stress, elevated mental workload and disturbed sleep may continue to affect well-being and job performance. This study aimed to assess perceived stress levels, occupational stress, and sleep quality among Hungarian nurses, while identifying key demographic, occupational, and behavioral predictors. Materials and Methods: A cross-sectional, quantitative study was conducted from April to July 2022 among nurses employed in Hungarian general hospitals (N = 418). Data were collected via an online self-administered questionnaire. Stress and sleep quality were measured using the Perceived Stress Scale (PSS-14), Expanded Nursing Stress Scale (ENSS), and Groningen Sleep Quality Scale (GSQS). Statistical analysis included descriptive statistics, ANOVA, post hoc tests, t-tests, and Pearson’s correlation (p < 0.05). Results: The mean PSS-14 score was 27.82 (SD = 7.82), indicating moderate stress. Sleep quality was poor (mean GSQS = 7.29, SD = 4.28), with significant positive correlation with perceived stress (r = 0.442, p < 0.001). Low income, lower education, and high coffee or alcohol consumption, and multiple night shifts were significantly associated with higher stress and poorer sleep quality. Occupational stress and mental workload, as measured by ENSS, was highest in internal medicine (mean = 122.16, SD = 37.09; p = 0.033). The most burdensome ENSS subscale was “workload” (mean = 2.30, SD = 0.92), with “not enough staff to adequately cover the unit” identified as the most stressful item. Additional cognitive and emotional workload components included dealing with violent patients and a lack of emotional preparedness in supporting families. Conclusions: Post-COVID nurses in Hungary experience moderate stress and impaired sleep. Excessive workload, emotional demands, and shift patterns significantly contribute to psychological and cognitive strain. Institutional and policy-level interventions are needed to reduce occupational stress and promote workforce resilience.
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Open AccessArticle
Association Between Physical Activity, Quality of Life, Barriers to Physical Activity, and Mental Health in Chilean Adolescents: The MOV-ES Study
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Eugenio Merellano-Navarro, Pablo Pasten-Hernández, Juan Aristegui-Mondaca, Antonia Morán-Toloza, Marcelo Nuñez-Galaz, Frano Giakoni-Ramírez, Daniel Duclos-Bastías and Andrés Godoy-Cumillaf
Healthcare 2025, 13(16), 2028; https://doi.org/10.3390/healthcare13162028 (registering DOI) - 17 Aug 2025
Abstract
Objective: To analyze the association between physical activity, health-related quality of life (HRQoL), and perceived barriers to physical activity with the risk of symptoms of depression, anxiety, and stress in Chilean adolescents. Method: A quantitative, cross-sectional, descriptive-correlational study was conducted with a sample
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Objective: To analyze the association between physical activity, health-related quality of life (HRQoL), and perceived barriers to physical activity with the risk of symptoms of depression, anxiety, and stress in Chilean adolescents. Method: A quantitative, cross-sectional, descriptive-correlational study was conducted with a sample of 351 secondary school students (mean age = 15.75 ± 1.47 years) from several educational institutions in the south-central region of Chile. Validated instruments were used to assess physical activity (PAQ-A), symptoms of mental health (DASS-21), HRQoL (Kidscreen-52), and the short scale of barriers to physical activity. For exploratory purposes, mental health outcomes were dichotomized based on standard cut-off scores, and binary logistic regression models were estimated to identify associated factors. Results: Based on the binary categorization, a substantial proportion of students exceeded the risk thresholds for depressive (54.4%), anxiety (63%), and stress symptoms (42.2%). Across models, lower physical activity levels, reduced autonomy and weaker relationships with parents, and barriers related to self-concept and motivation were consistently associated with higher mental health risk. Additionally, passive commuting and the perceived school environment emerged as specific predictors of stress and depression risk, respectively. Conclusions: These findings suggest that individual and contextual factors linked to lifestyle behaviors and perceived social support may play a critical role in adolescent mental health, and could represent key targets for school-based interventions.
Full article
(This article belongs to the Special Issue Advances in Physical Exercise-Based Interventions: Short- and Long-Term Benefits for Disease Prevention and Improvement)
Open AccessArticle
The Effects of Operating Room Nurses’ Experiences of Verbal Violence, Resilience, and Social Support on Post-Traumatic Stress
by
Do Kyun Kim and Sung Hee Shin
Healthcare 2025, 13(16), 2027; https://doi.org/10.3390/healthcare13162027 (registering DOI) - 17 Aug 2025
Abstract
Background/Objectives: Operating room (OR) nurses are frequently exposed to high-stress environments, including verbal violence, which may induce post-traumatic stress (PTS). This study investigated the effects of verbal violence, resilience, and social support on PTS among OR nurses. Methods: A cross-sectional descriptive correlational
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Background/Objectives: Operating room (OR) nurses are frequently exposed to high-stress environments, including verbal violence, which may induce post-traumatic stress (PTS). This study investigated the effects of verbal violence, resilience, and social support on PTS among OR nurses. Methods: A cross-sectional descriptive correlational study was conducted with 150 OR nurses who had at least one year of work experience. Data were collected via a mobile-based questionnaire and analyzed using SPSS Statistics 25. The main variables included experiences of verbal violence (from doctors and nurses), resilience, social support, and OR work satisfaction. Results: Exposure to verbal violence from doctors and nurses, as well as having 10 or more years of clinical experience, were significantly associated with higher PTS levels. In contrast, greater OR work satisfaction was associated with lower PTS. These variables collectively explained 36.6% of PTS variance (F = 8.64, p < 0.001). Conclusions: Verbal violence significantly contributes to PTS among OR nurses. Enhancing resilience and social support may mitigate the impact of PTS. Therefore, interventions such as structured peer-support systems, resilience training, and violence-prevention policies are recommended to reduce PTS risk. In addition, interventions to prevent verbal violence, and strengthen resilience and social support, and OR work satisfaction are crucial to protect nurses’ mental health and ensure patient safety.
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Open AccessArticle
Looking Back After the First Year of the COVID-19 Pandemic: Parents’ View on Screen Media Use, Psychopathology, and Psychological Burden in a Clinical Sample of Children and Adolescents
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Anna Maria Werling, Susanne Walitza and Renate Drechsler
Healthcare 2025, 13(16), 2026; https://doi.org/10.3390/healthcare13162026 (registering DOI) - 17 Aug 2025
Abstract
Objectives. The aim of this study was to examine screen media use and the development and alteration of pre-existing mental health problems over the first year of the COVID-19 pandemic in a clinical sample of children and adolescents. Methods. A survey was conducted
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Objectives. The aim of this study was to examine screen media use and the development and alteration of pre-existing mental health problems over the first year of the COVID-19 pandemic in a clinical sample of children and adolescents. Methods. A survey was conducted with over 650 parents of patients referred to child and adolescent psychiatry. Results. A worsening of the main mental health problem during the first year of the pandemic was reported more often (38%) by parents than an improvement (25%), a tendency even more pronounced for comorbid/secondary problems (worsening in 48%, improvement in 16% of cases). Girls in general, but especially between 14 and 18 years, more often showed a persistent deterioration of mental problems than boys. A negative impact of screen media use on their child’s mental health was reported most frequently by parents of a child affected by depression (50%), with acute crisis (52%), eating disorders (45%), and conduct disorder/aggression (40%). Patients with multiple/comorbid mental health problems presented significantly higher mean screen media times (5.53 h/day) than patients with a single mental problem (3.97 h/day), and their parents more frequently reported increased concerns about their child’s media use since the pandemic. Critical periods such as the lockdown or the “second wave” outbreak were characterized by higher media consumption in all patients, but with higher peaks in patients with multiple mental health problems. Conclusions. Particularly vulnerable patients, i.e., those with multiple mental problems and adolescent girls, have become more vulnerable in the course of the pandemic. From the perspective of most parents, screen media use has contributed to this development.
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(This article belongs to the Special Issue The Impact of COVID-19 on Mental Health Across Diverse Populations)
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Caregiver and Birth Parent Influences on Depression and Anxiety in African American Children in Kinship Care
by
Tyreasa Washington, Sheryl L. Coley, Joan M. Blakey, Quenette L. Walton, Jeff Labban, Helen B. Tadese, Dominique N. Martinez and Sonya J. Leathers
Healthcare 2025, 13(16), 2025; https://doi.org/10.3390/healthcare13162025 (registering DOI) - 17 Aug 2025
Abstract
Background/Objectives: Depression and anxiety in children pose a significant public health concern, with long-term implications for well-being. Over 10% of children and adolescents are affected by emotional disorders such as depression and anxiety. African American youth face disproportionate exposure to mental health
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Background/Objectives: Depression and anxiety in children pose a significant public health concern, with long-term implications for well-being. Over 10% of children and adolescents are affected by emotional disorders such as depression and anxiety. African American youth face disproportionate exposure to mental health risk factors, including poverty, adverse childhood events, community violence, and racial discrimination, which elevate their vulnerability to these disorders. A particularly at-risk subgroup includes African American children in kinship care arrangements (e.g., grandparents raising grandchildren), who may face additional factors such as family disruption and separation from birth parents. Methods: This mixed-methods sequential study examined how caregiver stress and birth mother–child relationship quality relate to depression and anxiety symptoms in African American children in kinship care. Phase I included survey data from 58 caregivers of children aged 5 to 12; Phase II involved interviews with 16 of these caregivers. Results: Results indicated that lower caregiver stress was associated with reduced child depression and anxiety symptoms. Furthermore, findings suggest that a high quality of the birth mother–child relationship serves as a promotive factor, particularly for depressive symptoms. Qualitative findings highlighted two themes: (1) the weight of kinship care, marked by factors such as ongoing grief and financial strain; and (2) birth parent relationships, defined by a mix of connection, conflict, and loss that affects children’s mental health. Conclusions: These findings underscore the need for greater understanding of the strengths and resources within kinship families that support positive mental health outcomes and highlight the importance of targeted interventions to reduce caregiver stress and foster supportive parent–child relationships.
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Open AccessArticle
From MINI to Meaningful Change—A German Pilot Study to Improve Patient Outcomes in End-of-Life Care
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Jana Sophie Grimm, Alina Kasdorf, Raymond Voltz and Julia Strupp
Healthcare 2025, 13(16), 2024; https://doi.org/10.3390/healthcare13162024 (registering DOI) - 16 Aug 2025
Abstract
Background/Objectives: Early identification of terminally ill patients is crucial for enhancing care, patient and care partner satisfaction, and healthcare staff confidence in discussing disease trajectories. Yet, timely recognition remains challenging. To address this, we developed a minimally invasive intervention (MINI) for general
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Background/Objectives: Early identification of terminally ill patients is crucial for enhancing care, patient and care partner satisfaction, and healthcare staff confidence in discussing disease trajectories. Yet, timely recognition remains challenging. To address this, we developed a minimally invasive intervention (MINI) for general hospital wards. We aimed to evaluate the MINI’s feasibility in facilitating an earlier identification of terminally ill patients and improving patient reported outcomes in a hospital setting. Methods: This prospective, two-arm pre-post intervention study at a university hospital evaluated the MINI alongside usual care. Patient-reported outcomes, including quality of life (SF-12), palliative care needs (IPOS), and functional status (ECOG), were collected at baseline and every three months over 12 months. Participants were allocated to a control or intervention group. Results: Of 188 patients identified using the Surprise Question, 58 completed the baseline assessment. While physical functioning (SF-12 PCS) remained comparable, the intervention group experienced clinically meaningful improvements in mental health (SF-12 MCS) at three months, with positive trends at six months. This group also showed a decline in palliative care needs, reduced emotional symptoms, and improved performance status, evidenced by significant differences in non-parametric analyses. These findings underscore the MINI’s potential to significantly improve patient well-being. Conclusions: This pilot study demonstrated the feasibility of the MINI and suggests it may foster meaningful system-wide change in patient-centred care within acute hospital settings, leading to improved patient outcomes and more confident healthcare staff in identifying terminally ill patients. However, given the small sample size, these findings should be interpreted with caution. Future research with larger cohorts and extended intervention periods is warranted to fully elucidate the MINI’s impact and refine strategies for improving care for terminally ill patients.
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(This article belongs to the Special Issue New Advances in Palliative Care)
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Invisible Warriors in the Struggle Against Cancer: Social Support and Spiritual Care—A Phenomenological Study on Patient Experiences
by
Esma Özmaya and Sevda Uzun
Healthcare 2025, 13(16), 2023; https://doi.org/10.3390/healthcare13162023 (registering DOI) - 16 Aug 2025
Abstract
Objective: The aim of this study is to examine the effect of social support on the mental state of cancer patients using a phenomenological approach. Materials–Methods: In this study, a phenomenological research orientation was used, and semi-structured in-depth interviews were conducted with 14
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Objective: The aim of this study is to examine the effect of social support on the mental state of cancer patients using a phenomenological approach. Materials–Methods: In this study, a phenomenological research orientation was used, and semi-structured in-depth interviews were conducted with 14 people diagnosed with cancer living in a province in central Turkey. The criterion sampling method, one of the purposeful sampling methods, was used for the sample group. The interviews continued until data saturation was achieved, and all interviews were recorded and later transcribed verbatim. The data were analyzed using thematic analysis, and the study was conducted and reported according to the COREQ checklist. Results: Two categories (effects of cancer and needs of the cancer patient (invisible components)) and five themes (psychological effects, social effects, physical effects, social support, and spiritual care) were identified in the analysis of the data. Conclusions: It has been determined that individuals are affected by cancer mentally, physically, and socially, and have difficulty coping. In particular, it has been found that social support and thinking about the purpose of life, supporting hope, and self-acceptance are quite important in increasing individuals’ spirituality.
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Open AccessArticle
Psychometric Properties of the Arabic Version of the Pictorial Empathy Test for Assessing Affective Empathic Reactions in Patients with Schizophrenia
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Georges Kerbage, Camille Akkari, Nagham Hachem, Michelle El Murr, Rita El Mir, Cyril Abou Atme, Georges Haddad, Rony Abou Khalil, Elissar El Hayek, Frederic Harb, Souheil Hallit and Feten Fekih-Romdhane
Healthcare 2025, 13(16), 2022; https://doi.org/10.3390/healthcare13162022 (registering DOI) - 16 Aug 2025
Abstract
Background/Objectives: Although people with schizophrenia appear to experience emotions like healthy individuals, previous studies suggest that their ability to engage in empathic emotional responses might be impaired. As per our knowledge, no studies in the Arab world have investigated empathy in patients
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Background/Objectives: Although people with schizophrenia appear to experience emotions like healthy individuals, previous studies suggest that their ability to engage in empathic emotional responses might be impaired. As per our knowledge, no studies in the Arab world have investigated empathy in patients with schizophrenia, which is likely due to the lack of valid and reliable measures to assess the empathy construct among Arabic-speaking people. The aim of this research is to validate the Arabic version of the Pictorial Empathy Test (PET) in patients with schizophrenia from Lebanon. Methods: A two-month cross-sectional study was carried out at the Psychiatric Hospital of the Cross during January and February of 2024. The average age of the 113 participants in this study was 57.52 ± 10.35 years and 63.5% of them were men. Data were collected through in-person interviews. A confirmatory factor analysis (CFA) was conducted using SPSS AMOS version 29. Parameter estimation utilized the maximum likelihood approach. In order to examine sex invariance in PET scores, a multi-group CFA was conducted. Measurement invariance was assessed across configural, metric, and scalar levels. Evidence of invariance was determined based on the criteria: ΔCFI ≤ 0.010, ΔRMSEA ≤ 0.015, or ΔSRMR ≤ 0.010. Results: CFA revealed that the Arabic PET exhibited a unidimensional factor structure. The PET demonstrated solid internal consistency (ω = 0.93, α = 0.93). Measurement invariance testing confirmed that the scale performed equally well across sexes. A linear regression analysis found that female sex and higher levels of alexithymia were significantly correlated with lower levels of affective empathy. Conclusions: The findings indicate that the Arabic version of the PET is a reliable and valid tool for measuring affective empathy in Arabic-speaking patients with schizophrenia. The culturally adapted and validated Arabic PET would help detect affective empathy deficits, design and implement context-tailored interventions, and encourage future research in this area in the Arab region. Future research should aim to validate the PET against behavioral tasks like the Empathic Accuracy Task to improve its ecological validity.
Full article
(This article belongs to the Special Issue Psychological Diagnosis and Treatment of People with Mental Disorders)
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Open AccessArticle
Artificial Intelligence Anxiety and Patient Safety Attitudes Among Operating Room Professionals: A Descriptive Cross-Sectional Study
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Pinar Ongun, Burcak Sahin Koze and Yasemin Altinbas
Healthcare 2025, 13(16), 2021; https://doi.org/10.3390/healthcare13162021 (registering DOI) - 16 Aug 2025
Abstract
Background/Objectives: The adoption of artificial intelligence (AI) in healthcare, particularly in high-stakes environments such as operating rooms (ORs), is expanding rapidly. While AI has the potential to enhance patient safety and clinical efficiency, it may also trigger anxiety among healthcare professionals due to
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Background/Objectives: The adoption of artificial intelligence (AI) in healthcare, particularly in high-stakes environments such as operating rooms (ORs), is expanding rapidly. While AI has the potential to enhance patient safety and clinical efficiency, it may also trigger anxiety among healthcare professionals due to uncertainties around job displacement, ethical concerns, and system reliability. This study aimed to examine the relationship between AI-related anxiety and patient safety attitudes among OR professionals. Methods: A descriptive, cross-sectional research design was employed. The sample included 155 OR professionals from a university and a city hospital in Turkey. Data were collected using a demographic questionnaire, the Artificial Intelligence Anxiety Scale (AIAS), and the Safety Attitudes Questionnaire–Operating Room version (SAQ-OR). Statistical analyses included t-tests, ANOVA, Pearson correlation, and multiple regression. Results: The mean AIAS score was 3.25 ± 0.8, and the mean SAQ score was 43.2 ± 10.5. Higher AI anxiety was reported by males and those with postgraduate education. Participants who believed AI could improve patient safety scored significantly higher on AIAS subscales related to learning, job change, and AI configuration. No significant correlation was found between AI anxiety and safety attitudes (r = −0.064, p > 0.05). Conclusions: Although no direct association was found between AI anxiety and patient safety attitudes, belief in AI’s potential was linked to greater openness to change. These findings suggest a need for targeted training and policy support to promote safe and confident AI adoption in surgical practice.
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(This article belongs to the Section Perioperative Care)
Open AccessArticle
Pulmonary Function Changes in Fighter Pilots with Positive Pressure Ventilation
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Alexander Lengersdorf, Janina Post, Norbert Guettler and Stefan Sammito
Healthcare 2025, 13(16), 2020; https://doi.org/10.3390/healthcare13162020 (registering DOI) - 16 Aug 2025
Abstract
Background/Objectives: The advancing technological developments of recent decades have also changed the stress profile of pilots of high-performance aircraft (HPA) immensely. Pilots are exposed to different gravitational (G)-forces and are only able to fly with anti-G suits that compensate for the physiological
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Background/Objectives: The advancing technological developments of recent decades have also changed the stress profile of pilots of high-performance aircraft (HPA) immensely. Pilots are exposed to different gravitational (G)-forces and are only able to fly with anti-G suits that compensate for the physiological loss of cerebral perfusion by applying external pressure to the body, and positive pressure breathing during G [PBG]. The present study therefore aims to investigate long-term effects of PBG on the lung capacity of fighter pilots. Methods: In a retrospective data analysis (1972–2024), the clinical findings of all German military pilots were analyzed. In total, 1838 subjects were included in the analysis, divided into three groups: HPA with PBG, HPA without PBG, and fixed-wing aircraft. Results: Lung function analysis showed that no significant decrease in FVC was found in the HPA group with PBG, but a decrease was found in the HPA group without PBG. FEV1 and FEV1/FVC decreased significantly in all groups. Multiple regression analyses indicated that the variables age and aircraft type were significant predictors of the changes in FVC and FEV1, but not for the Tiffeneau index. Conclusions: Our study showed that the lung function of HPA pilots who were exposed to both PBG and repeated increased G-forces did not deteriorate to a significantly greater extent compared with other pilots without these conditions; in some cases, it even deteriorated to a lesser extent. Overall, age has primarily been shown to be the predisposing factor for a deterioration in lung function parameters over time.
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(This article belongs to the Special Issue Occupational Health and Workers’ Well-Being: From Research to Practice)
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Euthanasia in Mental Disorders: Clinical and Ethical Issues in the Cases of Two Women Suffering from Depression
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Giuseppe Bersani, Angela Iannitelli, Pascual Pimpinella, Francesco Sessa, Monica Salerno, Mario Chisari and Raffaella Rinaldi
Healthcare 2025, 13(16), 2019; https://doi.org/10.3390/healthcare13162019 (registering DOI) - 16 Aug 2025
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Background/Objectives: The extension of euthanasia and physician-assisted suicide to individuals with mental disorders presents a profound ethical, clinical, and legal challenge. While increasingly accepted in some jurisdictions, their application in psychiatric contexts—particularly in cases of depression—raises concerns about diagnostic precision, therapeutic adequacy, and
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Background/Objectives: The extension of euthanasia and physician-assisted suicide to individuals with mental disorders presents a profound ethical, clinical, and legal challenge. While increasingly accepted in some jurisdictions, their application in psychiatric contexts—particularly in cases of depression—raises concerns about diagnostic precision, therapeutic adequacy, and the validity of informed consent. This study examines two controversial Belgian cases to explore the complexities of euthanasia for psychological suffering. Methods: A qualitative case analysis was conducted through a qualitative analysis of publicly available media sources. The cases were examined through clinical, psychoanalytic, and medico-legal lenses to assess diagnostic clarity, treatment history, and ethical considerations. No access to official medical records was available. Case Presentation: The first case involved a young woman whose depressive symptoms were reportedly linked to trauma from a terrorist attack. The second concerned a middle-aged woman convicted of infanticide and later diagnosed with Major Depression. Discussion: In both cases, euthanasia was granted on the grounds of “irreversible psychological suffering.” However, the absence of detailed clinical documentation, potential unresolved trauma, and lack of psychodynamic assessment raised doubts about the robustness of the evaluations and the validity of informed consent. Conclusions: These findings highlight the need for a more rigorous, multidisciplinary, and ethically grounded approach to psychiatric euthanasia. This study underscores the importance of precise diagnostic criteria, comprehensive treatment histories, and deeper exploration of unconscious and existential motivations. Safeguarding clinical integrity and ethical standards is essential in end-of-life decisions involving mental illness.
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Open AccessArticle
Beyond the Growth: A Registry-Based Analysis of Global Imbalances in Artificial Intelligence Clinical Trials
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Chan-Young Kwon
Healthcare 2025, 13(16), 2018; https://doi.org/10.3390/healthcare13162018 (registering DOI) - 16 Aug 2025
Abstract
Background/Objectives: While the integration of artificial intelligence (AI) into clinical research is rapidly accelerating, a comprehensive analysis of the global AI clinical trial landscape has been limited. This study presents the first systematic characterization of AI-related clinical trials registered in the World
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Background/Objectives: While the integration of artificial intelligence (AI) into clinical research is rapidly accelerating, a comprehensive analysis of the global AI clinical trial landscape has been limited. This study presents the first systematic characterization of AI-related clinical trials registered in the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). It aims to map global trends, identify patterns of concentration, and analyze the structure of international collaboration. Methods: A search of the WHO ICTRP was conducted on 20 June 2025. Following a two-stage screening process, the dataset was analyzed for temporal trends, geographic distribution, disease and technology categories, and international collaboration patterns using descriptive statistics and network analysis. Results: We identified 596 AI clinical trials across 62 countries, with registrations growing exponentially since 2020. The landscape is defined by extreme geographic concentration, with China accounting for the largest share of trial participations (35.6%), followed by the USA (8.5%). Research is thematically concentrated in Gastroenterology (22.8%) and Oncology (20.1%), with Diagnostic Support (45.6%) being the most common technology application. Formal international collaboration is critically low, with only 8.7% of trials involving multiple countries, revealing a fragmented collaboration landscape. Conclusions: The global AI clinical trial landscape is characterized by rapid but deeply imbalanced growth. This concentration and minimal international collaboration undermine global health equity and the generalizability of AI technologies. Our findings underscore the urgent need for a fundamental shift toward more inclusive, transparent, and collaborative research models to ensure the benefits of AI are realized equitably for all of humanity.
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(This article belongs to the Special Issue Artificial Intelligence in Healthcare: Opportunities and Challenges)
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Open AccessSystematic Review
Physical Training and Pulmonary Rehabilitation in Patients with Cystic Fibrosis: A Systematic Review and Meta-Analysis of Clinical Trials
by
Saray Ríos Murillo, Angie Melissa Hinestroza Mancilla, Lina Manuela Pérez Ordoñez, Naudy Yulisa Ararat Carabalí, Freiser Eceomo Cruz Mosquera and Yamil Liscano
Healthcare 2025, 13(16), 2017; https://doi.org/10.3390/healthcare13162017 - 15 Aug 2025
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Background/Objectives: Physical training and Pulmonary Rehabilitation in Patients with Cystic Fibrosis: A Systematic Review and Meta-Analysis of Clinical Trials. Pulmonary rehabilitation and physical training are essential components of the comprehensive management of patients with cystic fibrosis. Despite documented benefits for some clinical outcomes,
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Background/Objectives: Physical training and Pulmonary Rehabilitation in Patients with Cystic Fibrosis: A Systematic Review and Meta-Analysis of Clinical Trials. Pulmonary rehabilitation and physical training are essential components of the comprehensive management of patients with cystic fibrosis. Despite documented benefits for some clinical outcomes, uncertainty exists regarding their overall effects. Therefore, the objective of the present meta-analysis is to determine the effectiveness of physical training and pulmonary rehabilitation in patients with CF. Methods: This systematic review and meta-analysis of randomized controlled trials published between 1990 and 2025 was conducted using the PubMed, Cochrane Clinical Trial, SCOPUS, Science Direct, Web of Science, Scielo, and LILAC databases. The risk of bias was evaluated using the RoB 2 tool, the quality of the evidence with the Jadad scale, and the certainty of the evidence for each outcome was assessed according to GRADE guidelines. This meta-analysis was developed using the statistical packages RevMan 5.4® and Jamovi 2.3.28®. Results: Twenty-three studies with a total of 800 patients with CF were included. This meta-analysis showed that pulmonary rehabilitation and physical training did not affect pulmonary function, as observed in FEV1 (SMD: 0.05; 95% CI: −0.09 to 0.20; p = 0.46) and FVC (SMD: 0.11; 95% CI: −0.04 to 0.27; p = 0.14). However, it has a discrete impact on exercise capacity, producing an increase in VO2 max (MD: 2.74; 95% CI: 0.43 to 5.04; p = 0.02). Subgroup analyses did not yield relevant findings, and sensitivity analyses did not produce modifications in the direction or magnitude of the effect. Conclusions: The intervention evaluated in this meta-analysis does not have effects on pulmonary function but may influence exercise capacity, particularly VO2 max. It is recommended to interpret the findings with caution due to the limited certainty of the available evidence.
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Open AccessArticle
Association Between 24-Hour Movement Behaviors and Noncommunicable Chronic Diseases Among Adult and Older Adult Users of the Brazilian Community Health Promotion Program
by
Yuri Silva de Souza, Carlos Alencar Souza Alves Junior and Diego Augusto Santos Silva
Healthcare 2025, 13(16), 2016; https://doi.org/10.3390/healthcare13162016 - 15 Aug 2025
Abstract
Background/Objectives: Noncommunicable diseases (NCDs) are the leading causes of global mortality among adults. The aim of this study was to examine the association between adherence to 24 h movement behavior guidelines and the diagnosis of NCDs. Methods: This cross-sectional study was conducted with
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Background/Objectives: Noncommunicable diseases (NCDs) are the leading causes of global mortality among adults. The aim of this study was to examine the association between adherence to 24 h movement behavior guidelines and the diagnosis of NCDs. Methods: This cross-sectional study was conducted with users of the Health Academy Program in Brazil. The sample consisted of 1212 individuals (92.9% female), aged 18 years or older. Dependent variables included self-reported hypertension, diabetes, hypercholesterolemia, and cardiovascular disease based on previous medical diagnosis. Independent variables (physical activity, screen time, and sleep) were self-reported. Binary and multinomial logistic regressions were performed and adjusted for sex, age, educational level, body mass index, and marital status. Results: Participants who did not meet any of the 24 h movement behavior recommendations had higher odds of hypertension (OR: 1.35; 95% CI: 1.15–1.77), diabetes (OR: 1.07; 95% CI: 1.03–2.01), and having two (OR: 1.29; 95% CI: 1.09–2.91) or three or more NCDs (OR: 1.40; 95% CI: 1.11–2.13). Not meeting the physical activity recommendation was associated with higher odds of hypercholesterolemia (OR: 1.37; 95% CI: 1.06–1.76). In contrast, meeting the physical activity guideline alone (OR: 0.32; 95% CI: 0.11–0.85) or in combination with adequate sleep (OR: 0.32; 95% CI: 0.11–0.90) was associated with lower odds of cardiovascular disease. All of these results remained significant after adjustments for multiple comparisons. Conclusions: Not meeting any of the 24 h movement behavior guidelines, especially those related to physical activity, was associated with a higher occurrence of NCDs.
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(This article belongs to the Special Issue Understanding Lifestyle Indicators Throughout the Life Course: Determinants, Correlates and Paths to Intervention)
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Effects of an mHealth Occupational Therapy Intervention on Functional Performance: A Pilot Study
by
Irene Pérez-Díaz, Mario Arnáiz-González and Estíbaliz Jiménez-Arberas
Healthcare 2025, 13(16), 2015; https://doi.org/10.3390/healthcare13162015 - 15 Aug 2025
Abstract
Neurodevelopmental disorders are one of the most prevalent conditions today, and among the limitations in activity and restrictions in the participation of children and their families, we find intervention in activities of daily living; therefore, research focused on outcome measurement is one of
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Neurodevelopmental disorders are one of the most prevalent conditions today, and among the limitations in activity and restrictions in the participation of children and their families, we find intervention in activities of daily living; therefore, research focused on outcome measurement is one of the most active lines, and after COVID-19, telerehabilitation has garnered special interest. Background/Objectives: The study objective was to evaluate the effectiveness of a mobile health (mHealth) application in improving the performance of activities of daily living in children with neurodevelopmental disorders. Methods: The study employed a quasi-experimental design with a control group, using a fully remote mHealth-based intervention. The instruments used were a sociodemographic ad hoc, Pediatric Evaluation of Disability Inventory Computer, Family Outcomes Survey, Family Confidence Scale, and System Usability Scale. The final sample consisted of 13 participants. Results: The mHealth intervention showed significant improvements in occupational performance in the experimental group, especially in the global score and in the Responsibility dimension of the PEDI-CAT. No relevant differences were observed in the CON-FAN and FOS scales between groups, although the latter showed improvements over time. The usability of the app was rated positively (SUS = 69.75). Conclusions: The developed application presents good usability for families of children with neurodevelopmental disorders, but to obtain better outcome measures, the intervention should combine face-to-face sessions and the use of mHealth, as well as employing the family-centered model.
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(This article belongs to the Special Issue Healthcare Goes Digital: Mobile Health and Electronic Health Technology in the 21st Century: Second Edition)
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Effectiveness of Equine-Assisted Intervention as a Therapeutic Strategy for Improving Adaptive Behaviour in Children with Autism Spectrum Disorder
by
Carmen María Martínez Moreno, José Manuel Hernández Garre, Paloma Echevarría Pérez, Isabel Morales Moreno, Eva Vegue Parra and Eloína Valero Merlos
Healthcare 2025, 13(16), 2014; https://doi.org/10.3390/healthcare13162014 - 15 Aug 2025
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Background/Objectives: This study examines the effectiveness of equine-assisted intervention (EAI) in improving adaptive behaviour and motor skills in children with autism spectrum disorder (ASD). Methods: To that effect, a self-controlled experimental analytical study has been designed, which is longitudinal and prospective
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Background/Objectives: This study examines the effectiveness of equine-assisted intervention (EAI) in improving adaptive behaviour and motor skills in children with autism spectrum disorder (ASD). Methods: To that effect, a self-controlled experimental analytical study has been designed, which is longitudinal and prospective in nature, with pre- and post-intervention measures, using the Vineland Adaptive Behavior Scale II (VABS-II) as the assessment instrument. The sample consists of 19 children who participated in weekly therapeutic sessions involving horses for eight months; these sessions included horseback riding, groundwork, hygiene, and preparation of the horse. Results: The results show significant improvements both in the overall score of the VABS-II test ( pre: 65.84 ± 10.38– post: 72.47 ± 16.21, p = 0.003) and in the areas of communication ( pre: 64.84 ± 15.50 ~ post: 72.26 ± 21.93, p = 0.010), social skills ( pre: 61.26 ± 8.99 ~ post: 66.53 ± 13.79, p = 0.008) and daily living skills (DLS) ( pre: 66.21 ± 11.15 ~ post: 69.95 ± 12.32, p = 0.0004), as well as a non-significant slight improvement in motor skills ( pre: 72.50 ± 8.83 ~ post: 75.17 ± 7.88, p = 0.363). In addition, these gains were greater in those children attending standard classroom settings and receiving early stimulation. Conclusions: This study suggests equine-assisted intervention (EAI) may contribute to improvements in adaptive behaviour, including communication, social skills, and daily living skills, in children with autism spectrum disorder (ASD). Benefits were notably enhanced in children receiving early stimulation within standard classroom settings.
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Open AccessSystematic Review
Virtual and Augmented Reality Games in Dementia Care: Systematic and Bibliographic Review
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Martin Eckert, Varsha Radhakrishnan, Thomas Ostermann, Jan Peter Ehlers and Gregor Hohenberg
Healthcare 2025, 13(16), 2013; https://doi.org/10.3390/healthcare13162013 - 15 Aug 2025
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Background: This review investigates the use of virtual and augmented reality games in dementia care. It provides an insight into the last 13 years of research, including the earliest publications on this topic, and takes a systematic and bibliographic approach. Methods: We sourced
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Background: This review investigates the use of virtual and augmented reality games in dementia care. It provides an insight into the last 13 years of research, including the earliest publications on this topic, and takes a systematic and bibliographic approach. Methods: We sourced research publications from three different scientific databases (PubMed, Scopus, and APA PsycInfo) for this publication. We chose the PRISMA approach and categorized the studies according to the publisher. A set of 12 variables was defined across three categories (bibliographic, medical, and technical). Results: Of the 389 identified articles, 36 met the inclusion and exclusion criteria. After a phase of pilot studies mainly being conducted, the number of publications increased by four times but decreased again in 2023. Dominating were pilot and feasibility studies; 8 out of the 36 trials were RCTs. The median trial population was 24, and the protocols were performed for an average of 10 weeks, with two 40-min sessions a week. Simulator sickness was reported but not by the majority of participants. A total of 59% of the studies used fully immersive 3D-VR systems. We identified only three publications that provided high immersion quality. These findings indicate the positive effects of using virtual and augmented reality systems on participants’ cognitive function and mood. Conclusions: This publication focuses on the technical aspects of the applied technologies and immersion levels of the patients. Using augmented and virtual reality methods to improve the quality of life and physical interaction of dementia patients shows the potential to enhance cognitive functioning in this population, but further investigation and multicenter RCTs are needed. There are strong indications that this research branch has high potential to benefit both caretakers and patients.
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