Healthcare

16 pages, 363 KB

Open AccessSystematic Review

Training Nurses for Disasters: A Systematic Review on Self-Efficacy and Preparedness

by Monica Nikitara, Amarachi Kalu, Evangelos Latzourakis, Costas S. Constantinou and Venetia Sofia Velonaki

Healthcare 2025, 13(24), 3323; https://doi.org/10.3390/healthcare13243323 (registering DOI) - 18 Dec 2025

Abstract

Background: The rising frequency and complexity of disasters underscores the urgent need for robust preparedness in healthcare. Nurses and nursing students, as key frontline responders, often lack sufficient training to respond effectively to emergencies and recovery efforts. Aim: This review evaluates the effectiveness [...] Read more.

Background: The rising frequency and complexity of disasters underscores the urgent need for robust preparedness in healthcare. Nurses and nursing students, as key frontline responders, often lack sufficient training to respond effectively to emergencies and recovery efforts. Aim: This review evaluates the effectiveness of disaster preparedness training in terms of nurses’ and nursing students’ self-efficacy in providing disaster care and determines which training approaches are most effective. Method: A systematic review was conducted of peer-reviewed articles published in English between 2014 and 2025 across Medline, PubMed, ProQuest, and Health & Medical Col. Search terms included nurses, nursing students, self-efficacy, disaster training, emergency preparedness, training, simulation and scenario-based learning. Results: Nineteen peer-reviewed studies met the inclusion criteria. Overall, disaster preparedness training was found to enhance nurses’ and nursing students’ self-efficacy, knowledge and skills, with simulation-based and scenario-driven approaches producing the most consistent gains. These methods provided realistic and immersive experiences that fostered confidence and strengthened preparedness. Traditional lectures and workshops also improved outcomes but were generally less effective in sustaining self-efficacy over time. Reported challenges included limited faculty expertise, insufficient institutional support, and psychological barriers that may reduce engagement and impact. Conclusion: Integrating disaster preparedness into nursing curricula and professional training is vital for strengthening nurses’ and nursing students’ self-efficacy in crisis response. Evidence shows that simulation-based education, particularly when combined with traditional approaches, is especially effective in building knowledge and skills. Embedding these methods into training frameworks offers a sustainable strategy to ensure a more competent and resilient nursing workforce. Full article

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15 pages, 506 KB

Open AccessArticle

Bridging the Knowledge Gap: A National Survey on MASLD Awareness and Management Barriers in the Saudi Population

by Abdulrahman Alwhaibi, Wael Mansy, Wajid Syed, Salmeen D. Babelghaith and Mohamed N-Alarifi

Healthcare 2025, 13(24), 3322; https://doi.org/10.3390/healthcare13243322 (registering DOI) - 18 Dec 2025

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide. It greatly increases hepatic cirrhosis and cancer, cardiovascular disease, and chronic kidney disease. Despite the rising frequency of MASLD in Saudi Arabia, public understanding of its management [...] Read more.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide. It greatly increases hepatic cirrhosis and cancer, cardiovascular disease, and chronic kidney disease. Despite the rising frequency of MASLD in Saudi Arabia, public understanding of its management is lacking. Objective: This study seeks to evaluate public knowledge, attitudes, and management barriers related to MASLD, thereby informing future educational and preventive strategies. Methods: A cross-sectional study was conducted from November 2023 to October 2024, involving 502 participants across Saudi Arabia, employing a modified self-administered online questionnaire. Data was analyzed using SPSS 25. Descriptive statistics and Chi-square tests were used to investigate correlations between knowledge or attitude levels and demographics, with a significance threshold of p < 0.05. Results: Less than half of the respondents who took part (47.2%) had heard of MASLD. Of them, 24.9% had good knowledge, 38.2% had fair knowledge, and 36.9% had low understanding. There were strong links between knowledge and age, education, and job status, but not between knowledge and gender (p = 0.514). People were somewhat aware that being overweight (48.4%) and having high cholesterol (51.8%) were risk factors, but they often had wrong ideas regarding diabetes and high blood pressure. Only 7.8% of those surveyed said they had been formally diagnosed, and 74.4% of those who had been were given advice on how to change their lifestyle. Barriers to management included the idea that lifestyle change alone suffices (46.7%), the absence of medical advice (46.7%), and insufficient disease awareness (33.3%). Conclusions: The research shows that many Saudis are unaware of MASLD and have misconceptions about it. Targeted health education programs, greater provider–patient communication, and primary care MASLD knowledge are needed to close these gaps and promote disease prevention and management. Full article

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

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13 pages, 304 KB

Open AccessReview

Narrative Medicine, Dementia, and Alzheimer’s Disease: A Scoping Review

by Venusia Covelli, Marina Angela Visco, Martino Feyles, Angelica Cristal Sirotich and Alessandra Marelli

Healthcare 2025, 13(24), 3321; https://doi.org/10.3390/healthcare13243321 (registering DOI) - 18 Dec 2025

Abstract

Background/Objectives: In recent years, Narrative Medicine (NM) has gained prominence in the context of neurodegenerative diseases, such as dementia, offering tools to understand the subjective experience of illness and to improve the care relationship. Methods: This scoping review, conducted following the [...] Read more.

Background/Objectives: In recent years, Narrative Medicine (NM) has gained prominence in the context of neurodegenerative diseases, such as dementia, offering tools to understand the subjective experience of illness and to improve the care relationship. Methods: This scoping review, conducted following the PRISMA guidelines, analyzed the scientific literature from PubMed, PsycInfo, Web of Science, and Medline, encompassing 10 contributions focused on NM and patients with dementia or Alzheimer’s disease. Results: The analysis identified three main themes: 1) narrative, memory, and personal identity, highlighting the role of narrative in preserving a sense of self; 2) personalization of care, oriented towards person-centeredness; 3) the use of narrative in a formative and reflective function as a tool to promote empathy, clinical awareness, and observation skills in the training of health professionals. Conclusions: NM confirms itself as a relational and reflexive paradigm, capable of humanizing care and promoting therapeutic pathways that are more inclusive and sensitive to the patient’s subjectivity. Full article

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11 pages, 560 KB

Open AccessArticle

When Sound Fades: Depression and Anxiety in Adults with Hearing Loss—A Cross-Sectional Study

by Serkan Dedeoglu, Serdar Ferit Toprak, Enes Sırma and Süleyman Dönmezdil

Healthcare 2025, 13(24), 3320; https://doi.org/10.3390/healthcare13243320 - 18 Dec 2025

Abstract

Background: Hearing loss is a prevalent sensory impairment with substantial psychosocial consequences. This cross-sectional study investigated the relationship between audiometric hearing loss and mood disturbances in adults aged 18–65 years who reported hearing difficulties for at least six months. Methods: Objective hearing level [...] Read more.

Background: Hearing loss is a prevalent sensory impairment with substantial psychosocial consequences. This cross-sectional study investigated the relationship between audiometric hearing loss and mood disturbances in adults aged 18–65 years who reported hearing difficulties for at least six months. Methods: Objective hearing level was assessed using the better-ear pure-tone average (PTA), and subjective hearing handicap was measured with the Hearing Handicap Inventory for Adults (HHIA). Standardized mood assessments included the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). Results: The study found that higher HHIA scores, indicating greater perceived hearing handicap, were strongly correlated with more severe depression and anxiety (ρ ≈ 0.45 and 0.38, respectively; p < 0.001). In contrast, objective PTA showed weaker associations with mood scores. Regression analyses, adjusted for age and gender, confirmed that perceived hearing handicap (HHIA) was the strongest independent predictor of both depression (standardized β ≈ 0.37, p < 0.001) and anxiety (β ≈ 0.33, p < 0.01), accounting for about 30% of the variance in mood scores. Nearly one-third of participants had clinically significant depression (BDI-II ≥ 20), which is substantially higher than community norms. The cross-sectional design and potential selection bias are limitations. Conclusions: Even mild-to-moderate hearing loss can result in significant depressive and anxious symptoms when individuals perceive themselves as handicapped. Early identification of hearing problems, routine psychosocial screening (e.g., a simple two-question survey), and integrated care are essential for improving quality of life. Full article

(This article belongs to the Section Mental Health and Psychosocial Well-being)

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16 pages, 1650 KB

Open AccessSystematic Review

A Systematic Review and Meta-Analysis of the Effects of Various Physical Activity Interventions in Pregnant Women with Overweight or Obesity

by Mingmao Li, Hongli Yu, Guoping Qian, Anna Szumilewicz and Zbigniew Ossowski

Healthcare 2025, 13(24), 3319; https://doi.org/10.3390/healthcare13243319 - 18 Dec 2025

Abstract

Background: Obesity during pregnancy increases the risk of adverse maternal and neonatal outcomes, and excessive gestational weight gain (GWG) remains highly prevalent worldwide. Although physical activity (PA) interventions have shown potential benefits, evidence on the optimal type, intensity, and duration of exercise [...] Read more.

Background: Obesity during pregnancy increases the risk of adverse maternal and neonatal outcomes, and excessive gestational weight gain (GWG) remains highly prevalent worldwide. Although physical activity (PA) interventions have shown potential benefits, evidence on the optimal type, intensity, and duration of exercise for overweight or obese pregnant women remains limited. Methods: Electronic searches of EBSCOhost, Embase, PubMed and Web of Science were performed through August 2025 to identify randomized controlled trials comparing PA interventions versus usual prenatal care in overweight or obese pregnant women. Two reviewers independently screened studies, extracted data, and assessed risk of bias using Cochrane ROB domains. Continuous outcomes were pooled using inverse-variance meta-analytic methods and heterogeneity was quantified by I². Results: Ten randomized trials (twelve intervention arms) comprising 1150 participants met the inclusion criteria. In the domain of blinding of participants and personnel, three studies (30%) were judged as low risk, while seven (70%) were unclear. PA interventions varied in modality (aerobic, resistance, endurance, walking), setting (clinic, community, home/mHealth), and the intervention period ranges from 10 to 34 weeks. Most interventions (80%) employed moderate intensity, and 30% combined aerobic and resistance training. Results of the meta-analysis showed that the pooled mean GWG was 9.93 ± 5.48 kg in the treatment group and 10.65 ± 5.70 kg in the control group. Overall, PA interventions produced a modest but statistically significant reduction in GWG compared with controls, with negligible between-study heterogeneity (I² = 0%). Conclusions: Tailored, moderate-intensity PA may have the potential to modestly reduce GWG. Although 30% included trials employed combined aerobic and resistance training, current evidence is insufficient to establish whether combined modalities are more effective than aerobic-only or resistance-only interventions. However, the current evidence is limited by small trial sizes, methodological variability and geographic concentration in higher-income settings. Larger, rigorously designed RCTs, including evaluations of digital delivery platforms and carefully supervised higher-intensity protocols, are needed to refine exercise prescriptions and inform clinical guidelines. Full article

(This article belongs to the Special Issue Obesity and Overweight: Prevention, Causes and Treatment)

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22 pages, 404 KB

Open AccessArticle

Community-for-Care: An Integrated Response to Informal Post-Caregivers

by Catarina Inês Costa Afonso, Ana Spínola Madeira, Alcinda Reis and Susana Magalhães

Healthcare 2025, 13(24), 3318; https://doi.org/10.3390/healthcare13243318 - 18 Dec 2025

Abstract

Background/Objectives: Informal caregivers play a crucial role in healthcare, but when caregiving ends the “post-caregivers” often remain invisible and unsupported. Post-caregivers face needs such as reconstructing their identity and finding space and time to grieve. This study aimed to design a support network [...] Read more.

Background/Objectives: Informal caregivers play a crucial role in healthcare, but when caregiving ends the “post-caregivers” often remain invisible and unsupported. Post-caregivers face needs such as reconstructing their identity and finding space and time to grieve. This study aimed to design a support network for informal post-caregivers by exploring perceptions of diverse stakeholders. Methods: A qualitative inductive study was conducted using three focus groups (n = 15; ages 35–70; 12 women, 3 men) held online between June and July 2023. Participants included palliative care team members, home support professionals, general practitioners, informal caregivers, post-caregivers, and members of civil society. A semi-structured guide was used, and narratives were analyzed with a Narrative Medicine-informed approach and thematic analysis. Results: Community-For-Care emerged as an overarching and distinctive concept that, while aligned with the ethos of Compassionate Communities, specifically addresses the transition after caregiving ends, a phase largely absent from existing models. It symbolizes the “living forces of the community” mobilized to accompany informal post-caregivers through identity reconstruction, bereavement, and reintegration. Three interrelated thematic axes structure this concept: (1) Compassion Axis—emphasizing a compassionate community that values caregiving; (2) Coordinated Action Axis—highlighting coordinated, continuous support across healthcare and community services; and (3) Care Literacy Axis—underscoring education and training for caregivers, post-caregivers, and professionals. These axes dynamically interact to empower post-caregivers and stitch the holes in the support network. Conclusions: A community-centered, post-caregiver-focused framework such as Community-For-Care offers a novel extension of compassionate communities by directly addressing the loneliness, identity rupture, and invisibility that often characterize the transition after caregiving. Reinforcing compassion, coordinated action, and care literacy can enable communities to better acknowledge the contributions and ongoing needs of post-caregivers, supporting their emotional recovery, social reintegration, and reconstruction of daily life. By integrating these three axes into community practice, the model introduces a post-care-specific structure that can enhance well-being, reduce preventable health decline, and relieve pressure on formal services by mobilizing local, civic, and relational assets. Full article

(This article belongs to the Special Issue Mental Health and Well-Being in Informal Caregiving: Challenges, Transitions, and Support Mechanisms)

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23 pages, 2694 KB

Open AccessSystematic Review

by Ama Johal, Brian Dunne, Honieh Bolooki and Cara Sandler

Healthcare 2025, 13(24), 3317; https://doi.org/10.3390/healthcare13243317 - 18 Dec 2025

Abstract

Background: The present study aimed to identify the differences between experiences, in terms of oral health-related quality of life, pain, side effects and/or other complications, of adults undergoing orthodontic treatment using removable aligners and fixed labial or lingual appliances. Methods: The [...] Read more.

Background: The present study aimed to identify the differences between experiences, in terms of oral health-related quality of life, pain, side effects and/or other complications, of adults undergoing orthodontic treatment using removable aligners and fixed labial or lingual appliances. Methods: The review was registered with PROSPERO, and a comprehensive electronic search was undertaken without language or date restrictions. Randomised and non-randomised trials and prospective cohort and cross-sectional studies along with case series were included. The Cochrane Collaboration’s Risk of Bias 2 Tool, Newcastle–Ottawa Scale and The Risk Of Bias In Non-Randomized Studies—of Interventions tools were used to assess quality. Data were grouped in terms of oral health-related quality of life, pain side effects and/or other complications. Results: Data from 35 studies were included; 9 were eligible for meta-analysis. Thus 2611 participants were included related to removable aligners (n = 513), fixed labial (n = 1816) and lingual (n = 218) appliances or a combination (n = 64) of appliances. The standardised mean differences in visual analogue scale pain reports between 24 h and 7 days were −10.02 (95% CI: −11.13, −8.91) for aligners and −6.40 (95%CI: −10.42, −2.38) for labial appliances (p = 0.09). There was a significant improvement in dental self-confidence following fixed labial appliance treatment (p = 0.001). Conclusions: No difference was detected in short-term pain with aligners and labial appliances. Aligners may have less impact on oral health-related quality of life measures compared to labial appliances. Lingual appliances have a persistent impact on speech, despite some adaptability. Any deterioration in oral health-related quality of life measures during treatment appears temporary. Further randomised trials using validated assessment tools and comparing aligners and labial and lingual appliances are required. Full article

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18 pages, 311 KB

Open AccessArticle

Sensory Processing in People Experiencing Homelessness in Spain: A Pilot Study

by Alicia Cal-Herrera, Berta Gándara-Gafo, Ariadna Corbella-González, Pablo A. Cantero-Garlito, Sonia Panadero-Herrero, Olga I. Fernández-Rodríguez and Begoña Polonio-López

Healthcare 2025, 13(24), 3316; https://doi.org/10.3390/healthcare13243316 (registering DOI) - 18 Dec 2025

Abstract

Introduction: People experiencing homelessness (PEH) often live in adverse and changing environments and have high rates of mental illness and social exclusion, factors that could influence information processing. However, it is unknown whether these conditions could be related to sensory processing problems. Objectives: [...] Read more.

Introduction: People experiencing homelessness (PEH) often live in adverse and changing environments and have high rates of mental illness and social exclusion, factors that could influence information processing. However, it is unknown whether these conditions could be related to sensory processing problems. Objectives: Analyse sensory processing in PEH. Methodology: A descriptive cross-sectional study was conducted with 150 participants (mean age of 47.43 ± 10.94 years), using the Adult/Adolescent Sensory Profile and a sociodemographic questionnaire. Results. PEH aged 18–64 showed significantly higher scores in low registration (M = 36.9), sensory sensitivity (M = 41.1) and sensation avoiding (M = 45.5) compared to the control group (p < 0.001), suggesting a distinct form of sensory processing in this population. Discussion: These results may be linked to factors such as chronic exposure to unpredictable and stressful situations, as well as to the presence of diverse mental health issues. Conclusion: It is important to consider the sensory characteristics of this population when designing person-centered interventions, in order to reduce social isolation and promote self-regulation strategies, environmental adaptation and greater occupational participation. Full article

(This article belongs to the Section Mental Health and Psychosocial Well-being)

14 pages, 596 KB

Open AccessProtocol

Medical Physics Adaptive Radiotherapy (MPART) Fellowship: Bridging the Training Gap in Online Adaptive Radiotherapy

by Bin Cai, David Parsons, Mu-Han Lin, Dan Nguyen, Andrew R. Godley, Arnold Pompos, Kajal Desai, Shahed Badiyan, David Sher, Robert Timmerman and Steve Jiang

Healthcare 2025, 13(24), 3315; https://doi.org/10.3390/healthcare13243315 - 18 Dec 2025

Abstract

Online adaptive radiotherapy (ART) is rapidly transforming clinical radiation oncology by enabling adaptation of treatment plans based on patient-specific anatomical and biological changes. However, most medical physics training programs lack structured education in ART. To address this critical gap, the Medical Physics Adaptive [...] Read more.

Online adaptive radiotherapy (ART) is rapidly transforming clinical radiation oncology by enabling adaptation of treatment plans based on patient-specific anatomical and biological changes. However, most medical physics training programs lack structured education in ART. To address this critical gap, the Medical Physics Adaptive Radiotherapy (MPART) Fellowship was established at our center to train post-residency or practicing physicists in advanced adaptive technologies and workflows. The MPART Fellowship is a two-year program that provides immersive, platform-specific training in CBCT-guided (Varian Ethos), MR-guided (Elekta Unity), and PET-guided (RefleXion X1) radiotherapy. Fellows undergo modular clinical rotations, hands-on training, and dedicated research projects. The curriculum incorporates competencies in imaging, contouring, online planning, quality assurance, and team-based decision-making. Evaluation is based on the Accreditation Council for Graduate Medical Education competency domains and includes milestone tracking, mentor reviews, and structured presentations. The fellowship attracted applicants from both domestic and international institutions, reflecting strong demand for formal ART training. Out of 22 applications, two fellows have been successfully recruited into the program since 2024. Fellows actively participate in all phases of adaptive workflows and are expected to function at near-attending levels by the second year of their training. Each fellow also leads at least one translational or operational research project aimed at improving ART delivery. Fellows contribute to clinical coverage and lead developmental projects, resulting in presentations and publications at the national and international levels. The MPART Fellowship addresses a vital educational need by equipping medical physicists with the advanced competencies necessary for implementing and leading ART. This program offers a replicable framework for other institutions seeking to advance precision radiation therapy through structured post-residency training in adaptive radiotherapy. As this fellowship program is still in its early phase of establishment, the primary goal of this paper is to introduce the structure, framework, and implementation model of the program. Comprehensive outcome analyses—such as quantitative assessments, fellow feedback, and longitudinal competency evaluations—will be incorporated in future work as additional cohorts complete training. Full article

(This article belongs to the Section Healthcare Quality, Patient Safety, and Self-care Management)

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12 pages, 212 KB

Open AccessArticle

Patient Satisfaction with the Expanded Nurses Service in Primary Health Care: Evidence from Kazakhstan

by Indira Abdikadirova, Lyudmila Yermukhanova, Aurelija Blaževičiene, Zhanar Dostanova, Zaure Baigozhina, Maiya Taushanova, Gulnar Sultanova and Kauysheva Almagul

Healthcare 2025, 13(24), 3314; https://doi.org/10.3390/healthcare13243314 - 18 Dec 2025

Abstract

Background/Objectives: The implementation of advanced practice nursing in Kazakhstan is aimed at improving the accessibility and quality of primary healthcare. One of the key indicators of the effectiveness of this model is patient satisfaction, which reflects the perceived quality of care and directly [...] Read more.

Background/Objectives: The implementation of advanced practice nursing in Kazakhstan is aimed at improving the accessibility and quality of primary healthcare. One of the key indicators of the effectiveness of this model is patient satisfaction, which reflects the perceived quality of care and directly influences treatment adherence. The aim of the study was to assess patient satisfaction with nurse-led consultations in primary healthcare institutions in Kazakhstan. Methods: A cross-sectional study was conducted using a questionnaire developed on the basis of Karin Bergman’s instrument and adapted to the Kazakhstani context. A total of 621 patients who attended independent nursing consultations in polyclinics in Aktobe, Almaty, Astana, and the village of Merke participated in the survey. Descriptive statistics and Pearson’s χ² test were applied, with statistical significance set at p < 0.05. Results: The majority of respondents were women, with a median age of 61 years. Awareness of independent consultations was higher among patients who regularly visited nurses (97.1% vs. 86.9%; p < 0.006). High satisfaction levels were associated with service accessibility, quality of examination, and clarity of recommendations. Among regular visitors, 99.2% reported satisfaction with the nurse’s work, and 76.6% rated the service as “excellent”. In contrast, patients with irregular visits more often reported dissatisfaction due to insufficient attention and limited knowledge of nurses. Conclusions: The findings confirm a high level of patient satisfaction with advanced practice nursing services and highlight the importance of this model in strengthening primary healthcare in Kazakhstan. Full article

(This article belongs to the Special Issue Patient Experience and the Quality of Health Care)

11 pages, 212 KB

Open AccessStudy Protocol

Leadership Succession Planning for Professional Nurses in a Selected Public Hospital in Mangaung District, Free State Province: A Study Protocol

by Lebogang G. Motlhaole, Aluwani D. Mudzweda and Takalani R. Luhalima

Healthcare 2025, 13(24), 3313; https://doi.org/10.3390/healthcare13243313 - 18 Dec 2025

Abstract

Lack of leadership succession planning in South African public hospitals places nursing leadership at great risk instead of improving healthcare. There is a significant demand for nurse managers in the Free State Province; therefore, leadership succession planning is important. The re-advertising of unfilled [...] Read more.

Lack of leadership succession planning in South African public hospitals places nursing leadership at great risk instead of improving healthcare. There is a significant demand for nurse managers in the Free State Province; therefore, leadership succession planning is important. The re-advertising of unfilled leadership roles, the projected volume of nurse managers who will be retiring, and the number of professional nurses opting for better international opportunities indicate the need for effective succession planning. The study aims to determine leadership succession planning for professional nurses in a selected public hospital in the Mangaung District, Free State Province. A qualitative, explorative, and descriptive research design will be used. Non-probability purposive sampling will be adopted to explore the leadership succession planning. The research participants will consist of professional nurses who are currently permanently employed within the Mangaung district, Free State Province. The sample size will be determined by data saturation. An estimated sample size of ±20 participants will be expected. Data collection will be performed through in-depth, unstructured interviews to answer the research question. A central place for interviews will be organised, and appointments will be made with participants as per their schedule or availability. Data will be analysed using Braun and Clarke’s thematic method. The conclusion and the recommendations will be based on the findings of the study. Full article

22 pages, 304 KB

Open AccessArticle

Household Tobacco Expenditure and Child Health Outcomes: Causal Evidence from a Transitional Economy

by Kim-Anh Tran, Mai-Trang Le, Yung-Fu Huang and Manh-Hoang Do

Healthcare 2025, 13(24), 3312; https://doi.org/10.3390/healthcare13243312 - 17 Dec 2025

Abstract

Background/Objectives: The relationship between household tobacco expenditure and child health has attracted considerable attention from both academic and policy communities, as tobacco expenditure can influence children’s health, nutrition, and overall well-being in multiple ways, particularly in rural and low-income settings. This study [...] Read more.

Background/Objectives: The relationship between household tobacco expenditure and child health has attracted considerable attention from both academic and policy communities, as tobacco expenditure can influence children’s health, nutrition, and overall well-being in multiple ways, particularly in rural and low-income settings. This study examines the causal impact of household tobacco expenditure on child health outcomes in a transitional economy. Methods: Using nationally representative microdata from the most recent Household Living Standards Survey, the authors employ Ordinary Least Squares (OLS), Random Effects (RE), and Instrumental Variable (IV) estimations to identify the effects of tobacco spending on children’s healthcare utilization and health status. Results: The results consistently show that higher household tobacco expenditure significantly increases the likelihood of hospitalization among Vietnamese children, with the effects being most pronounced for those under six years of age. Moreover, the authors uncover substantial heterogeneity across gender, maternal age at childbirth, and regional contexts, highlighting persistent socioeconomic inequalities in health outcomes. Conclusions: This study provides compelling evidence of the adverse effects of household tobacco expenditure on children’s health in Vietnam. Theoretically, the study contributes to the literature on the economics of health and intra-household resource allocation by providing micro-level causal evidence from a transitional setting. From a policy perspective, the findings underscore the need for targeted fiscal and public health interventions to mitigate tobacco-related welfare losses and to promote equitable access to healthcare among vulnerable populations. Full article

(This article belongs to the Special Issue Promoting Healthcare and Well-Being in Rural and Vulnerable Communities)

11 pages, 227 KB

Open AccessArticle

The Relation Between Imposter Phenomenon and Self-Critical, Narcissistic, and Rigid Perfectionism: An Observational Study from a Women’s Medical College in Saudi Arabia

by Nasser M. AbuDujain, Rauof A. Almebki, Rakan M. Alghonaim, Mohammed A. Aldkhyyal, Norah A. Alshehri, Saud Alomar, Ahmed S. Almujil, Joud S. Almutairi, Msaad A. Altulihee and Turky H. Almigbal

Healthcare 2025, 13(24), 3311; https://doi.org/10.3390/healthcare13243311 - 17 Dec 2025

Abstract

Background/aim: Medical students often face intense pressure to excel, which can lead to imposterism, characterized by persistent self-doubt and fear of being exposed as inadequate, alongside high levels of perfectionism. This study aims to assess the prevalence of imposterism and perfectionism among medical [...] Read more.

Background/aim: Medical students often face intense pressure to excel, which can lead to imposterism, characterized by persistent self-doubt and fear of being exposed as inadequate, alongside high levels of perfectionism. This study aims to assess the prevalence of imposterism and perfectionism among medical students in Saudi Arabia and explore their potential implications for student well-being. Methods: A cross-sectional analytical study was conducted between October and December 2024 among female medical students in Saudi Arabia. Data were collected via an online survey, which included demographic questions, the validated Arabic versions of the Clance Impostor Phenomenon Scale (Ar-CIPS), the short form of the Big Three Perfectionism Scale (BTPS-SF), and the General Self-Efficacy Scale (GSES). Results: A total of 265 medical students (mean age 20.96 ± 1.44 years) participated. Most reported a monthly income of less than 2000 SR, and the majority had a GPA above 4.5. A 74.3% expressed moderate impostor experiences. The BTPS-SF revealed the highest scores in self-critical perfectionism, followed by narcissistic and rigid perfectionism. Higher impostor scores were significantly associated with greater perfectionism and lower self-efficacy (p < 0.05). In multivariable analysis, BTPS-SF scores positively predicted CIPS scores (β = 0.52, p < 0.001), whereas GSE scores predicted lower CIPS scores (β = −0.47, p = 0.001). Conclusions: This study revealed a high prevalence of impostor phenomenon and perfectionism among female medical students, with self-critical perfectionism being the most prominent. Imposterism was significantly associated with higher perfectionism and lower self-efficacy. Full article

17 pages, 976 KB

Open AccessSystematic Review

Effectiveness of the Internet of Things for Improving Health of Non-Pregnant Women Living in High-Income Countries: A Systematic Review

by Olukunmi Omobolanle Balogun, Etsuko Nishimura, Noyuri Yamaji, Kiriko Sasayama, Md. Obaidur Rahman, Katharina da Silva Lopes, Citra Gabriella Mamahit, Mika Ninohei, Phyu Phyu Tun, Rina Shoki, Daichi Suzuki, Aya Nitamizu, Windy Mariane Virenia Wariki, Daisuke Yoneoka, Eiko Saito and Erika Ota

Healthcare 2025, 13(24), 3310; https://doi.org/10.3390/healthcare13243310 - 17 Dec 2025

Abstract

Background/Objectives: There is increased advocacy for the potential for digital applications (apps) and the Internet of Things (IoT) to improve women’s health. We conducted a systematic review to assess and synthesise the role of Apps and the IoT in improving the health [...] Read more.

Background/Objectives: There is increased advocacy for the potential for digital applications (apps) and the Internet of Things (IoT) to improve women’s health. We conducted a systematic review to assess and synthesise the role of Apps and the IoT in improving the health of non-pregnant women. Methods: Six databases were searched from inception to 13 February 2023. We included randomised controlled trials that assessed the effects of various Apps and the IoT with regard to improving the health of non-pregnant women in high-income countries. Our primary outcomes were health status and well-being or quality of life, and we assessed behaviour change as the secondary outcome. Screening, data extraction, and quality assessment were performed in duplicate. Study quality was assessed using the Cochrane Risk of Bias 2.0 tool. Narrative methods were used to synthesise study outcomes. Results: The search retrieved 18,433 publications and seven publications from six studies met the inclusion criteria. Participants included overweight or obese women, postmenopausal women, or women with stage I–III breast cancer. Intervention types varied across included studies but broadly included wearable or sensor-based personal health tracking digital technologies. The most commonly assessed intervention effect was on behaviour change outcomes related to promoting physical activity. Interventions administered yielded positive effects on health outcomes and well-being or quality of life in one study each, while three of the four studies that assessed behaviour change reported significant positive effects. Most included studies had methodological concerns, while study designs and methodologies lacked comparability. Conclusions: Based on our findings, the use of apps and the IoT may be promising for facilitating behaviour change to promote physical activity. However, more evidence is needed to assess the effectiveness of the IoT for improving health status, well-being and quality of life among non-pregnant women. Full article

(This article belongs to the Special Issue Digital Health Innovations for Sustainable and Equitable Care Delivery)

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18 pages, 325 KB

Open AccessArticle

Breast Milk Donation After Perinatal Loss: A Qualitative Exploration of Maternal Grief and Healing Among Israeli Arab Women and the Islamic Legal-Ethical Perspectives: A Qualitative Research Study

by Mahdi Tarabeih, Orsan Yahya, Mohammad Sabbah and Khaled Awawdi

Healthcare 2025, 13(24), 3309; https://doi.org/10.3390/healthcare13243309 - 17 Dec 2025

Abstract

Background/Objectives: After perinatal loss, namely stillbirth and neonatal death, many bereaved mothers continue to produce breast milk, facing the decision as to whether to suppress lactation or donate their milk. Our aims were to explore the experiences and views of Muslim mothers [...] Read more.

Background/Objectives: After perinatal loss, namely stillbirth and neonatal death, many bereaved mothers continue to produce breast milk, facing the decision as to whether to suppress lactation or donate their milk. Our aims were to explore the experiences and views of Muslim mothers who had donated their breast milk following perinatal loss and examine the Islamic legal-ethical perspectives relating to milk donation. This research explores how milk donation serves as a coping mechanism and how Islamic teachings frame its permissibility and ethical considerations. Methods: A qualitative research methodology was employed, using a Interpretative Phenomenological Analysis (IPA). Nine bereaved Muslim mothers who had donated their breast milk and three Islamic religious scholars (an Imam, a Mufti, and a Muslim jurist) participated in in-depth interviews. Thematic analysis identified recurring patterns and insights. Results: Our findings revealed that mothers experienced milk donation as a coping mechanism, allowing them to maintain a symbolic connection with their lost child while contributing to other infants’ survival. Religious scholars who we interviewed agreed that milk donation is permissible in Islam, provided that milk kinship (rida’a) regulations are observed. Mothers reported a strong need for structured support from healthcare providers and religious leaders in order to assist in the informed decision-making process. Conclusions: Breast milk donation after perinatal loss aids in grief management for bereaved mothers while benefiting vulnerable infants. Healthcare providers should offer comprehensive lactation counseling for bereaved mothers, including milk donation options. Milk banks should implement processes in alignment with rida’a guidelines. Improving support systems for bereaved mothers can alleviate their grieving process while ensuring alignment with cultural and religious norms. Full article

17 pages, 538 KB

Open AccessFeature PaperArticle

The Experience of Goals and Rewards in Young People Who Self-Harm: A Qualitative Exploration

by Martina Di Simplicio, Ruksana Begum-Meades, Emily Gaardner-Bougard, Charis Eleftheriou, Oyinlola Akinsanya, Rachel Rodrigues, Lavanya Thana and Lindsay H. Dewa

Healthcare 2025, 13(24), 3308; https://doi.org/10.3390/healthcare13243308 - 17 Dec 2025

Abstract

Background/Objectives. Self-harm is a heterogeneous behaviour with a lifetime prevalence of around 20% in young people aged 16–25 years old. Recent neurocognitive evidence suggests that, for some individuals, self-harm is associated with motivational processes similar to addiction, including maladaptive mental imagery, reward anticipation, [...] Read more.

Background/Objectives. Self-harm is a heterogeneous behaviour with a lifetime prevalence of around 20% in young people aged 16–25 years old. Recent neurocognitive evidence suggests that, for some individuals, self-harm is associated with motivational processes similar to addiction, including maladaptive mental imagery, reward anticipation, and goal pursuit. However, our knowledge of young people’s subjective experiences of rewards and goals in relation to self-harm behaviour remains limited. Our study aimed to investigate how young people who self-harm experience enjoying and wanting rewards and pursuing goals in daily life and whether this experience changes during periods of self-harm. We also explored their use of mental imagery as a key cognitive process to support motivation. Methods. We conducted two parallel focus groups online (total of N = 12) with young people (mean age = 12.2, SD = 3; nine women, two men, and one non-binary) with a past-year history of self-harm behaviour. Qualitative data was analysed using inductive thematic analysis. Two young people with lived experience of self-harm informed the topic guide and data interpretation. Examples of questions were “Do you think your experiences of enjoying and/or looking forward to pleasant things are related in any way to self-harm, or not?” and “Do you visualise things you enjoy or may look forward to? If you do, how is that experience?”. Results. There were six themes: rewards need deserving, high self-standards, keeping control, trapped into long-term goals, unhelpful mental imagery, and self-harm alters the experience and anticipation of rewards and goal attainment. Most young people reported enjoying conditional rewards and working towards long-term goals that tend to be unattainable and beyond their control. Imagining these goals was experienced as unhelpful by most. For all young people, periods of self-harm thwarted enjoyment and goal achievement, shifted the preference to short-term immediate gratification, including from self-harm behaviour, and devalued long-term goals. However, our data cannot determine if these experiences are specific to young people who self-harm. Conclusions. Our findings indicate that the reciprocal relationship between motivational processes and self-harm behaviour in young people warrants further investigation. Helping individuals develop more adaptive rewards and goals, including appreciation of short-term goals and use of motivational mental imagery, could represent valued support for young people with self-harm. Full article

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

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24 pages, 1025 KB

Open AccessArticle

A Community Advisory Board’s Role in Disseminating Tai Chi Prime in African American and Latinx Communities: A Pragmatic Application of the Consolidated Framework for Implementation Research

by Ejura Yetunde Salihu, Kristine Hallisy, Jéssica S. Malta, Deborah Tolani Joseph, Cheryl Ferrill, Patricia Corrigan Culotti, Rebeca Heaton Juarez and Betty Chewning

Healthcare 2025, 13(24), 3307; https://doi.org/10.3390/healthcare13243307 - 17 Dec 2025

Abstract

Background: Community-Based Participatory Research (CBPR) has proven effective in promoting health research in hard-to-recruit and underserved populations. Tai Chi Prime is a National Council on Aging-certified fall prevention program. However, it has not been widely disseminated in African American (AA)/Black and Latinx communities. [...] Read more.

Background: Community-Based Participatory Research (CBPR) has proven effective in promoting health research in hard-to-recruit and underserved populations. Tai Chi Prime is a National Council on Aging-certified fall prevention program. However, it has not been widely disseminated in African American (AA)/Black and Latinx communities. Guided by the Consolidated Framework for Implementation Research (CFIR), this study examined the process of working with a community advisory board (CAB) to adapt and disseminate Tai Chi Prime within these communities, as well as facilitators and barriers to CAB success. Methods: Eight CAB members met with researchers monthly virtually over a two-year period. Meetings focused on reviewing Tai Chi Prime materials, discussing cultural adaptations, and identifying dissemination strategies relevant to AA/Black and Latinx communities. Detailed notes from 24 meetings were compiled. In addition, semi-structured interviews were conducted with five CAB members and two researchers to capture individual reflections on their experiences, roles, and perceived impact. Data was analyzed using directed content analysis. Results: CFIR constructs helped illuminate how CAB members’ embedded community expertise, organizational partnerships, available resources, shared vision and transparent communication influenced the cultural adaptation and dissemination of Tai Chi Prime. Study findings also highlight important areas that extend beyond CFIR, particularly the cultural knowledge and power-sharing responsibilities undertaken by CAB members as co-researchers. These insights underscore the need to integrate equity-focused and community-engaged research principles into implementation frameworks when working with communities of color. Conclusions: Findings highlight the value of leveraging existing academic–community partnerships. Community-engaged researchers can use the lessons learned from this CAB to build a replicable model of sustainable partnerships with their AA/Black and Latinx community partners, as can others involved in health services research and policy. Full article

(This article belongs to the Special Issue Advancing Cultural Competence in Health Care)

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15 pages, 382 KB

Open AccessArticle

Physical Performance and Mental Health in Institutionalized Older Adults: A Multicenter, Cross-Sectional Observational Study

by Jorge L. Zambrano, Daniela Zurita-Pinto and Laura Hermo-Rebollido

Healthcare 2025, 13(24), 3306; https://doi.org/10.3390/healthcare13243306 - 17 Dec 2025

Abstract

Aging and institutionalization, associated with functional and psychological decline, justify studying how physical performance is linked to mental health in older adults. Objectives: To analyze the relationship between physical performance and anxiety, depression, sleep quality, and perceived stress in institutionalized older adults. [...] Read more.

Aging and institutionalization, associated with functional and psychological decline, justify studying how physical performance is linked to mental health in older adults. Objectives: To analyze the relationship between physical performance and anxiety, depression, sleep quality, and perceived stress in institutionalized older adults. Methods: Multicenter, observational, cross-sectional study in eight nursing homes (N = 105; ≥65 years, M = 80.78 SD ± 7.91). Instruments: SPPB, HADS, PSQI, PSS-10. Descriptives and exploratory bivariate tests. Primary analysis: single multivariable linear regression with SPPB as outcome and HADS-A, HADS-D, PSQI, PSS-10 entered simultaneously, adjusted for age and sex. Robustness: GLM with robust SEs, influence sensitivity excluding Cook’s D > 4/n or leverage > 2 p/n, and a proportional-odds model for SPPB. All statistical tests were two-sided, with α set at 0.05. Results: Mean SPPB was 6.94 ± 3.17; 77.1% of participants showed poor physical performance. Bivariate: All mental health constructs showed significant associations with physical performance. Multivariable model: adjusted R² = 0.198; F (6,98) = 5.28, p < 0.001. Depression B = −0.230 (95% CI −0.398 to −0.061), p = 0.008; sleep quality (higher = worse) B = −0.187 (95% CI −0.351 to −0.024), p = 0.025; age B = −0.087 (95% CI −0.158 to −0.017), p = 0.016. Anxiety showed a positive adjusted association B = +0.224 (95% CI 0.038 to 0.410), p = 0.019 (consistent with suppression); perceived stress B = −0.062, p = 0.275; sex B = −0.144, p = 0.812. Robust SEs left inferences unchanged. Influence sensitivity (n = 97) preserved directions with the PSQI association attenuating to non-significance. Ordinal results were directionally consistent. Conclusions: After adjusting for age and sex, depression and sleep quality independently relate to physical function, while age is inversely associated; anxiety and perceived stress show no independent effects. Full article

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25 pages, 1404 KB

Open AccessReview

Complex Care Needs of People with Technology Dependence in Disaster Situations: A Scoping Review

by Anita Prasser, Joachim Beckert, Michael Köhler and Michael Ewers

Healthcare 2025, 13(24), 3305; https://doi.org/10.3390/healthcare13243305 - 16 Dec 2025

Abstract

Background: Providing complex care and support for people with technology dependence (PwTD) is challenging, even under routine conditions. During disasters, when health and power infrastructure are disrupted, the complex care of PwTD must be maintained under extreme conditions. This research aims to summarize [...] Read more.

Background: Providing complex care and support for people with technology dependence (PwTD) is challenging, even under routine conditions. During disasters, when health and power infrastructure are disrupted, the complex care of PwTD must be maintained under extreme conditions. This research aims to summarize the specific needs of PwTD in disasters and to describe how these needs are addressed in real-life events. Methods: We conducted a scoping review, searching four databases (CINAHL, MEDLINE, PsycInfo, SocINDEX) and the websites of relevant disaster relief organizations. A total of 43 of 2625 screened records were included. Content analysis was used to identify and cluster the needs of PwTD and the response to these needs. Results: Case reports were the most reported types of literature. It was repeatedly stated that PwTD have complex care needs that are often difficult to meet in disaster situations. The review identified three interdependent clusters of needs: clinical and supportive care needs, aids and supply needs, and access needs. The needs of patients and relatives were, as far as the situation allowed, met in accordance with existing plans and guidelines and, where these were found to be inadequate, through creative solutions devised by frontline nurses. Conclusions: We conclude that addressing the complex care needs of PwTD in disasters requires a strategy integrating structural preparedness, professional adaptability, and user participation. Nurses could play a key role in developing and implementing such strategies. This review provides a starting point to develop a more practice-oriented research agenda to achieve inclusive disaster risk management. Full article

(This article belongs to the Special Issue The Role of Healthcare in Public Health Risk and Disaster Management: Strategies for Mitigation and Response)

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