Healthcare

14 pages, 798 KB

Open AccessArticle

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

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

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

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

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

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16 pages, 729 KB

Open AccessArticle

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

by Zekiye Yılmaz, Anmar Al-Taie and İrem Bayol

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

Abstract

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

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

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19 pages, 618 KB

Open AccessFeature PaperArticle

Quality of Life as a Predictor of Successful Aging in Urban and Rural Older Adults: A Cross-Sectional Study in Eastern Croatia–Slavonia

by Marija Barišić, Ivana Barać, Jasenka Vujanić, Nikolina Farčić, Štefica Mikšić, Maja Čebohin, Robert Lovrić, Dunja Degmečić, Marko Krnjajić, Željka Dujmić and Željko Mudri

Healthcare 2026, 14(3), 296; https://doi.org/10.3390/healthcare14030296 (registering DOI) - 24 Jan 2026

Abstract

Background: Population aging has increased attention on the quality of life and successful aging of older adults. Objective: To examine urban–rural differences in subjective quality of life and self-rated successful aging, explore associations with psychosocial factors, and identify predictors of successful aging, including [...] Read more.

Background: Population aging has increased attention on the quality of life and successful aging of older adults. Objective: To examine urban–rural differences in subjective quality of life and self-rated successful aging, explore associations with psychosocial factors, and identify predictors of successful aging, including potential moderating effects of place of residence and chronic illness. Methods: A cross-sectional study was conducted among 403 adults aged ≥ 60 years in Eastern Croatia. Measures included a sociodemographic questionnaire, the Self-assessment of Successful Aging Scale (SSAS), and the Personal Wellbeing Index (PWI). Data were analyzed using nonparametric tests (Mann–Whitney U, Spearman’s correlation), linear regression, and moderation analyses. Significance was set at p < 0.05. Ethical approval was obtained (Class: 602-01/24-12/02; IRB: 2158/97-97-10-24-36). Results: Rural participants reported lower PWI scores (p = 0.005) and self-rated successful aging (p < 0.001) than urban participants. Active community involvement was positively associated with quality of life (Rho = 0.46; p < 0.001), whereas regret about missed opportunities and past actions was negatively associated (Rho = −0.20; p < 0.01). Regression analyses explained 48.3% of the variance in SSAS, with higher PWI scores being strongly associated with higher SSAS scores, and rural residence and chronic illness being associated with lower SSAS scores. Moderation analyses indicated that the association between PWI and SSAS was consistent across different environmental contexts and in the presence of illness. Conclusions: Older adults living in rural areas reported lower quality of life and self-rated successful aging compared with those in urban and suburban areas, with subjective wellbeing emerging as a key predictor. Promoting social engagement and addressing psychosocial barriers may enhance successful aging, particularly in rural populations. Findings suggest that social engagement and psychosocial support are associated with higher level of perceived successful aging, indicating potential areas for future community-based or healthcare interventions. Full article

(This article belongs to the Special Issue Aging and Older Adults’ Healthcare)

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13 pages, 259 KB

Open AccessArticle

Posttraumatic Stress Symptoms and Anger Among Police Officers Following a Fatal Knife Attack on a Team Member

by Anna Koch-Scharwatt and Ulrich Wesemann

Healthcare 2026, 14(3), 295; https://doi.org/10.3390/healthcare14030295 (registering DOI) - 24 Jan 2026

Abstract

Mental disorders and impairments are part of the occupational risk for emergency personnel. This study examines the impact of a deadly knife attack on police officers’ mental health. Aims: We hypothesized that police officers who knew the deceased team member would report [...] Read more.

Mental disorders and impairments are part of the occupational risk for emergency personnel. This study examines the impact of a deadly knife attack on police officers’ mental health. Aims: We hypothesized that police officers who knew the deceased team member would report higher levels of psychological distress compared to those who did not, regardless of the deployment status. Methods: Six months after a fatal knife attack in which a police officer was killed, a total of N = 254 officers participated in the study. Of these, n = 115 reported knowing the victim personally, n = 126 did not (n = 78 deployed; n = 176 not deployed), while n = five did not provide any information. Posttraumatic stress disorder (PTSD), posttraumatic stress symptoms (PTSS), anger and adverse childhood experiences (ACEs) were assessed using questionnaires. Chi-square tests examined group differences in probable PTSD prevalence; t-tests assessed differences in anger and Posttraumatic Stress Disorder Checklist for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; DSM-5; PCL-5) symptom scores. Linear regression analyses tested deployment, acquaintance with the victim, gender, and childhood emotional neglect as predictors. Results: Police officers who personally knew the deceased colleague exhibited significantly higher PTSS scores. In addition, the deployed group showed significantly higher trait anger than the non-deployed. Acquaintance with the victim and emotional neglect in childhood were significantly related to negative cognitions, whereas deployment to the knife attack or gender were not. Discussion: Police officers with a personal connection to the deceased showed significantly higher mental health impact than those with direct exposure alone, placing them in a higher-risk group due to increased exposure to feelings of guilt and shame due to their professional role. Police officers who were emotionally neglected in their childhood may be more prone to negative cognitions in adulthood, when faced with critical events. These results underline the importance of addressing risk factors in both pre-deployment training and post-event debriefing, especially with regard to anger management after major critical incidents. Full article

20 pages, 316 KB

Open AccessArticle

Assessing the Critical Thinking and Training Needs of Healthcare Professionals, and Patient Experiences: An Exploratory Cross-Sectional Study in Primary Care of Crete, Greece

by Antonios Christodoulakis, Anna Sergaki, Dimitrios Vavoulas, Izolde Bouloukaki, Michail Zografakis-Sfakianakis, Aristea Mavrogianni, Emmanouil K. Symvoulakis and Ioanna Tsiligianni

Healthcare 2026, 14(3), 294; https://doi.org/10.3390/healthcare14030294 - 23 Jan 2026

Abstract

Background/Objectives: Primary health care (PHC) is the cornerstone of any high-quality healthcare system. For PHC to work well, healthcare professionals need to be skilled in critical thinking, self-reflection, and patient-centered care. However, few studies have explored the potential interplays between these factors. [...] Read more.

Background/Objectives: Primary health care (PHC) is the cornerstone of any high-quality healthcare system. For PHC to work well, healthcare professionals need to be skilled in critical thinking, self-reflection, and patient-centered care. However, few studies have explored the potential interplays between these factors. Therefore, this cross-sectional study evaluated the critical thinking disposition and training needs of PHC professionals, alongside patient experiences and satisfaction with PHC services. Methods: The study involved 54 PHC professionals and 100 patients from sixteen PHC facilities in Crete, Greece. Professionals completed the Critical Thinking Disposition Scale (CTDS) and Training Needs Assessment (TNA) questionnaires, while patients filled out the Quality-of-Life Instrument of Chronic Conditions in Primary Health Care (QUALICOPC) questionnaire. Results: Our findings indicated that PHC professionals exhibited high critical thinking levels (CTDS, mean score of 46.46 ± 4.24). However, TNA scores suggested moderate training needs, particularly in relationships/investigations [median: 0.50 (0, 1.50)], communication/patient-centered [median: 0.30 (0, 1.1)], and flexibility and application of knowledge [median: 0.40 (0, 1.0)]. Nevertheless, no significant correlation was found between CTDS and TNA (ρ = 0.08, p > 0.05). Patients mostly rated their health as poor (40%), and 26% lacked a family physician. Although patients were highly satisfied with communication and patient-centered care (>95% reporting positive experiences), continuity and empowerment had room for improvement. Only 37% felt their GP knew their living conditions, and 26% lacked a personal physician. Patients with chronic conditions reported significantly different experiences. Specifically, patients with chronic conditions had better continuity of care (84% vs. 59%, p = 0.01) and more comprehensive care (70% vs. 43%, p = 0.01) compared to controls. Conclusions: Our findings suggest that targeted training is needed for PHC professionals to address skill gaps. These initial findings could guide the creation of customized professional development initiatives and point to areas where PHC services could be structurally improved. Additional studies, including longitudinal ones, are required to further validate these associations. Full article

12 pages, 232 KB

Open AccessArticle

Prevalence and Characteristics of Patients with Pressure Ulcers at a Tertiary Hospital in the Eastern Cape, South Africa

by Emma Muendo Loko, Nongiwe Linette Mhlanga, Wezile Wilson Chitha, Sibusiso Cyprian Nomatshila and Sikhumbuzo Advisor Mabunda

Healthcare 2026, 14(3), 293; https://doi.org/10.3390/healthcare14030293 - 23 Jan 2026

Abstract

Background/Objectives: Pressure ulcers in hospitals reflect the nature of care provided. This study sought to describe the prevalence of pressure ulcers and patient characteristics at a large tertiary hospital in South Africa. Methods: A descriptive retrospective record review was conducted, and all records [...] Read more.

Background/Objectives: Pressure ulcers in hospitals reflect the nature of care provided. This study sought to describe the prevalence of pressure ulcers and patient characteristics at a large tertiary hospital in South Africa. Methods: A descriptive retrospective record review was conducted, and all records of patients with pressure ulcers were included from 1 August 2019 to 31 July 2020. A data abstraction instrument was used to collect data on sociodemographic characteristics, clinical conditions, and pressure ulcer characteristics. Data were analysed using descriptive statistics using the Statistical Package for Social Sciences version 26. Results: A total of 12,777 patients were admitted, and 85 records were of adults aged 15 years and above with pressure ulcers. The prevalence of pressure ulcers was 0.7%; of these, 42.4% were hospital-acquired pressure ulcers, while 57.6% had a pressure ulcer on admission. The age group most affected by pressure ulcers was 30–49 years. Most (68.2%) patients had a pressure ulcer on the sacrum, and the majority (34.1%) were admitted to surgical units. Patients who had a hospital-acquired pressure ulcer were three times more likely to be deceased than those who had a pressure ulcer on admission. Conclusions: The prevalence of pressure ulcers was lower compared to global and regional prevalences and prevention measures should continue to be implemented at the tertiary hospital. Full article

14 pages, 1371 KB

Open AccessArticle

AI-Based Electromyographic Analysis of Single-Leg Landing for Injury Risk Prediction in Taekwondo Athletes

by Jun-Sik Kim, Fatima Faridoon, Jaeyeop Choi, Junghwan Oh, Juhyun Kang and Hae Gyun Lim

Healthcare 2026, 14(3), 292; https://doi.org/10.3390/healthcare14030292 - 23 Jan 2026

Abstract

Background/Objectives: Improper landing mechanics in Taekwondo can lead to non-contact injuries such as ankle sprains and knee ligament tears, highlighting the necessity for objective methods to evaluate landing stability and injury risk. Electromyography (EMG) enables the examination of muscle activation patterns; however, conventional [...] Read more.

Background/Objectives: Improper landing mechanics in Taekwondo can lead to non-contact injuries such as ankle sprains and knee ligament tears, highlighting the necessity for objective methods to evaluate landing stability and injury risk. Electromyography (EMG) enables the examination of muscle activation patterns; however, conventional analyses based on simple averages have limited predictive value. Methods: This study analyzed EMG signals recorded during single-leg landings (45 cm height) in 30 elite male Taekwondo athletes. Participants were divided into regular exercise groups (REG, n = 15) and non-exercise groups (NEG, n = 15). Signals were segmented into two phases. Eight features were extracted per muscle per phase. Classification models (Random Forest, XGBoost, Logistic Regression, Voting Classifier) were used to classify between groups, while regression models (Ridge, Random Forest, XGBoost) predicted continuous muscle activation changes as injury risk indicators. Results: The Random Forest Classifier achieved an accuracy of 0.8365 and an F1-score of 0.8547. For regression, Ridge Regression indicated high performance (R² = 0.9974, MAE = 0.2620, RMSE = 0.4284, 5-fold CV MAE: 0.2459 ± 0.0270), demonstrating strong linear correlations between EMG features and outcomes. Conclusions: The AI-enabled EMG analysis can be used as an objective measure of the study of the individual landing stability and risk of injury in Taekwondo athletes, but its clinical application has to be validated in the future by biomechanical injury indicators and prospective cohort studies. Full article

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

14 pages, 265 KB

Open AccessArticle

Understanding Alignment to the Mediterranean-Style and DASH Eating Patterns and Assessing Associations with Cardiometabolic Clinical Outcomes Among Hispanic/Latine Adults in the United States: An NHANES Analysis

by Ambria Crusan and Francine Overcash

Healthcare 2026, 14(3), 291; https://doi.org/10.3390/healthcare14030291 - 23 Jan 2026

Abstract

Background/Objectives: The Mediterranean (Med)-style and Dietary Approaches to Stop Hypertension (DASH) eating patterns are evidence-based nutrition interventions given their protective effects from cardiometabolic diseases. Little is known about adherence to each eating pattern among the Hispanic/Latine population. The objective of this [...] Read more.

Background/Objectives: The Mediterranean (Med)-style and Dietary Approaches to Stop Hypertension (DASH) eating patterns are evidence-based nutrition interventions given their protective effects from cardiometabolic diseases. Little is known about adherence to each eating pattern among the Hispanic/Latine population. The objective of this cross-sectional analysis is to assess the alignment of reported dietary intakes of Hispanic/Latine adults to Med-style and DASH eating patterns and associations with clinical outcomes for diabetes mellitus and cardiovascular diseases. Methods: A sample of 5406 Hispanic/Latine adults from the National Health and Nutrition Examination Survey (2007–2018) was utilized. Alignment to the Med-style and DASH eating patterns was calculated by scoring indices tailored for overconsumption in the United States. Multiple linear regression determined associations between each respective eating pattern and clinical outcomes. Results: Hispanic/Latine adults in the United States have a mean DASH score of 11.2 and a Med-style score of 8.4 (out of 100), indicating poor alignment. Adjusted regression analysis showed increased alignment of both eating patterns was associated with a decrease in average blood pressure (DASH ꞵ = −0.095, p = <0.0001; Med-style: ꞵ = −0.128, p = 0.0002). Greater adherence to a Med-style eating pattern score was also associated with improved average hemoglobin A1c (ꞵ −0.007, p = 0.017). Neither diet pattern score was associated with total cholesterol. Conclusions: Evidence of low alignment to the Med-style and DASH eating patterns among Hispanic/Latine populations exacerbates the need for future work to understand cultural tailoring of evidence-based eating patterns to increase adherence and support improved cardiometabolic outcomes. Full article

(This article belongs to the Special Issue Nutrition Interventions for Chronic Disease Management)

23 pages, 959 KB

Open AccessReview

Therapeutic Patient Education in Adults with Chronic Lower Limb Musculoskeletal Pain: A Scoping Review

by Carla Vanti, Michael Bianchini, Alessio Mantineo, Francesco Ballardin and Paolo Pillastrini

Healthcare 2026, 14(3), 290; https://doi.org/10.3390/healthcare14030290 - 23 Jan 2026

Abstract

Background: Conservative treatment of chronic musculoskeletal pain includes exercise, manual therapy, medications, physical agents/modalities, and Therapeutic Patient Education (TPE). Research on TPE has predominantly focused on spinal pain, so we do not know the extent and scope of clinical research in other [...] Read more.

Background: Conservative treatment of chronic musculoskeletal pain includes exercise, manual therapy, medications, physical agents/modalities, and Therapeutic Patient Education (TPE). Research on TPE has predominantly focused on spinal pain, so we do not know the extent and scope of clinical research in other areas, particularly lower extremities. This review aimed to map current research on this topic. Methods: We searched PubMed, PEDro, CINAHL, PsycINFO, and Cochrane Library up to 1 April 2024. We included RCTs on adults with chronic lower limb musculoskeletal pain, written in English, French, Spanish, or Italian. Results: Fifty-two records concerning knee osteoarthritis (n.33), hip and knee osteoarthritis (n.8), hip osteoarthritis (n.3), chronic knee pain (n.3), patellofemoral pain (n.3), and gluteal tendinopathy (n.2) were included. TPE was delivered through self-management, disease-specific information, pain education, and the management of physical activity, load, diet, stress, and sleep. Interventions were both individual- and group-based; delivery methods included in-person intervention, telephone/video calls, and web tools/apps. TPE combined with exercise seemed to be more effective than exercise alone, information/little education, or usual care. The effects of TPE as a stand-alone intervention appeared uncertain. Conclusions: There is considerable variability in TPE in terms of teaching topics, providers, administration methods, and dosage of interventions. Future studies should investigate the effects of TPE in young adult populations and in ankle conditions. They should also investigate the effects of TPE on pain intensity versus pain interference with activities, by deepening TPE effects on disability and quality of life. Full article

(This article belongs to the Special Issue Dysfunctions or Approaches of the Musculoskeletal System)

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15 pages, 258 KB

Open AccessArticle

Exploring Professionals’ Perceptions of the Potential of Digital Twins in Homecare—A Focus Group Study in Sweden

by Sandra Saade, Susanna Nordin and Johan Borg

Healthcare 2026, 14(3), 289; https://doi.org/10.3390/healthcare14030289 - 23 Jan 2026

Abstract

Background/Objectives: The growing number of older adults with complex healthcare needs increases demand for homecare services, while a shrinking workforce often lacks skills for advanced tasks. Digital health is seen as a promising tool to address these challenges. This study explored Swedish [...] Read more.

Background/Objectives: The growing number of older adults with complex healthcare needs increases demand for homecare services, while a shrinking workforce often lacks skills for advanced tasks. Digital health is seen as a promising tool to address these challenges. This study explored Swedish homecare professionals’ perceptions of the potential use of digital twins in daily work. Methods: Four focus group discussions were conducted with 31 homecare professionals; two groups each in one urban/rural and one rural municipality. Data were analyzed using inductive content analysis. Results: Three main themes emerged: (i) Perceptions of digital twins as support for older adults, including needs-based, individualized care and proactive support enabling preventive measures; (ii) Perceptions of digital twins as support for professionals, including a better work environment through streamlined tasks and flows and enhanced planning and assessment; and (iii) Concerns about digital twins, focusing on ethical and social issues and limited understanding, which were related to monitoring aspects, the importance of physical visits, and how the technology works. Conclusions: Digital twins are perceived by professionals to have the potential to improve homecare services by supporting both older adults and professionals; however, further research is needed to address concerns and practical implications. Full article

(This article belongs to the Special Issue Holistic Approaches to Aging in Place: Health, Safety, and Community)

17 pages, 533 KB

Open AccessArticle

The Lived Experience of Older Adults with Monitoring Technologies: An Interpretive Phenomenology Study

by Alisha Harvey Johnson, Chang-Chun Chen, K. Melinda Fauss and Shu-Fen Wung

Healthcare 2026, 14(3), 288; https://doi.org/10.3390/healthcare14030288 - 23 Jan 2026

Abstract

Background: Most older adults prefer to age in place. Technology-assisted monitoring can enhance safety while maintaining independence. However, there is limited understanding of older adult end users’ preferences and experiences. Methods: In this interpretive phenomenological study, we interviewed eight older adults, with and [...] Read more.

Background: Most older adults prefer to age in place. Technology-assisted monitoring can enhance safety while maintaining independence. However, there is limited understanding of older adult end users’ preferences and experiences. Methods: In this interpretive phenomenological study, we interviewed eight older adults, with and without dementia, to understand their lived experiences with monitoring technology and its impact on self-identity, independence, and aging-in-place. Results: We found that older adults use pragmatic strategies to process the meaning of life as “monitored” individuals, reflected in four themes: (1) freedom to age in place, (2) the need for active and integrated intervention, (3) individualized approaches to technology based on temperament, usefulness, and worldview, and (4) a sense of changing situations while remaining unchanged. Adaptive techniques for older adults with dementia successfully elicited complex thoughts and desires when participants were given sufficient time and space. Conclusions: As technology-assisted monitoring becomes more common, it is imperative to understand the perspectives of older adult end users. Focusing on lived experiences offers valuable insights to ensure technology-assisted monitoring interventions are effective and accepted as older adults navigate changes in their capabilities and endeavor to age in place. Full article

(This article belongs to the Special Issue Health Promotion and Long-Term Care for Older Adults)

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29 pages, 1072 KB

Open AccessSystematic Review

Ethical Responsibility in Medical AI: A Semi-Systematic Thematic Review and Multilevel Governance Model

by Domingos Martinho, Pedro Sobreiro, Andreia Domingues, Filipa Martinho and Nuno Nogueira

Healthcare 2026, 14(3), 287; https://doi.org/10.3390/healthcare14030287 - 23 Jan 2026

Abstract

Background: Artificial intelligence (AI) is transforming medical practice, enhancing diagnostic accuracy, personalisation, and clinical efficiency. However, this transition raises complex ethical challenges related to transparency, accountability, fairness, and human oversight. This study examines how the literature conceptualises and distributes ethical responsibility in [...] Read more.

Background: Artificial intelligence (AI) is transforming medical practice, enhancing diagnostic accuracy, personalisation, and clinical efficiency. However, this transition raises complex ethical challenges related to transparency, accountability, fairness, and human oversight. This study examines how the literature conceptualises and distributes ethical responsibility in AI-assisted healthcare. Methods: This semi-systematic, theory-informed thematic review was conducted in accordance with the PRISMA 2020 guidelines. Publications from 2020 to 2025 were retrieved from PubMed, ScienceDirect, IEEE Xplore databases, and MDPI journals. A semi-quantitative keyword-based scoring model was applied to titles and abstracts to determine their relevance. High-relevance studies (n = 187) were analysed using an eight-category ethical framework: transparency and explainability, regulatory challenges, accountability, justice and equity, patient autonomy, beneficence–non-maleficence, data privacy, and the impact on the medical profession. Results: The analysis revealed a fragmented ethical landscape in which technological innovation frequently outperforms regulatory harmonisation and shared accountability structures. Transparency and explainability were the dominant concerns (34.8%). Significant gaps in organisational responsibility, equitable data practices, patient autonomy, and professional redefinition were reported. A multilevel ethical responsibility model was developed, integrating micro (clinical), meso (institutional), and macro (regulatory) dimensions, articulated through both ex ante and ex post perspectives. Conclusions: AI requires governance frameworks that integrate ethical principles, regulatory alignment, and epistemic justice in medicine. This review proposes a multidimensional model that bridges normative ethics and operational governance. Future research should explore empirical, longitudinal, and interdisciplinary approaches to assess the real impact of AI on clinical practice, equity, and trust. Full article

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13 pages, 1767 KB

Open AccessArticle

Nicotine Negatively Affects Its Users’ Health and Psychology in Saudi Arabia: A Cross-Sectional Study

by Jehad A. Aldali

Healthcare 2026, 14(3), 286; https://doi.org/10.3390/healthcare14030286 - 23 Jan 2026

Abstract

Background: Recently introduced nicotine pouches (NPs) are smokeless nicotine products. They are held between the lips and gums for 30 min to absorb nicotine into the bloodstream through the oral mucosa. Attractiveness may increase nicotine use, especially among young people and teens. [...] Read more.

Background: Recently introduced nicotine pouches (NPs) are smokeless nicotine products. They are held between the lips and gums for 30 min to absorb nicotine into the bloodstream through the oral mucosa. Attractiveness may increase nicotine use, especially among young people and teens. The objective of this study is to investigate the health issues and psychological effects associated with nicotine pouch use among individuals in Saudi Arabia. Methods: A cross-sectional online survey using Google Forms. It was conducted between 13 February and 4 November 2025, in the Riyadh province of Saudi Arabia, restricted to users of nicotine pouches willing to answer a questionnaire on the occasion of buying them (at regional tobacco stores/supermarkets) or online via WhatsApp or the Telegram platform. Statistical analysis was conducted using SPSS Version 27, with a p < 0.05 indicating significance. Results: The current study included data of 489 participants, with a total of 395 participants using nicotine pouches. The most commonly reported symptoms were difficulty breathing and shortness of breath (both 40.5%), changes in taste or smell (36.7%), headache and stomach ulcers (33.4% each), and rapid or irregular heartbeat (28.4%). Most common psychological symptoms at any severity level (slightly to extremely) were appetite changes (78.7%), difficulty concentrating or focusing (75.4%), difficulty sleeping (74.9%), and increased anxiety or irritability (73.4%). Depression (72.2%), anger management (71.1%), and stress (70.4%) were also common. Regression analyses revealed that educational attainment was a significant predictor of both physical and psychological health outcomes. Conclusions: The findings show the most common physical symptoms were difficulty breathing and shortness of breath, followed by taste or smell changes, headaches, stomach ulcers, and rapid or irregular heartbeat. Appetite changes, concentration issues, sleep disturbances, and anxiety or irritability were common across all severity levels. Depression, anger issues, and stress were common. Full article

(This article belongs to the Special Issue Advancing Population Health for Disease Prevention and Early Intervention)

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18 pages, 498 KB

Open AccessArticle

Translation, Cross-Cultural Adaptation, and Psychometric Properties of the Arabic Version of the MOS Pain Effect Scale in Individuals with Multiple Sclerosis

by Alaa M. Albishi, Zainab S. Alshammari, Sarah S. Almhawas, Dalia M. Alimam, Manal H. Alosaimi and Salman Aljarallah

Healthcare 2026, 14(3), 285; https://doi.org/10.3390/healthcare14030285 - 23 Jan 2026

Abstract

Purpose: This study aimed to translate the Pain Effects Scale (PES) into Arabic, evaluate its cultural adaptation, and assess its psychometric properties (validity and reliability) among patients with Multiple Sclerosis (MS). Method: The translation and cultural adaptation followed published guidelines. A [...] Read more.

Purpose: This study aimed to translate the Pain Effects Scale (PES) into Arabic, evaluate its cultural adaptation, and assess its psychometric properties (validity and reliability) among patients with Multiple Sclerosis (MS). Method: The translation and cultural adaptation followed published guidelines. A total of 121 patients with MS completed the PES and several other assessments: the Short-Form McGill Pain Questionnaire (SF-MPQ), the Patient Health Questionnaire-9 (PHQ-9), the Modified Fatigue Impact Scale (MFIS), and the Multiple Sclerosis Impact Scale (MSIS-29), to evaluate construct validity. Reliability was assessed after two weeks using the intraclass correlation coefficient (ICC) and internal consistency (Cronbach’s α). Results: The Arabic version of Pain Effects Scale PES-Ar demonstrated good internal consistency (Cronbach’s α = 0.910) and strong test–retest reliability (ICC (2,1) = 0.88; 95% CI: 0.85–0.92). The corrected item–total correlations for all six items ranged from 0.591 to 0.840. No floor or ceiling effects were observed. Content validity indices were high (I-CVI and S-CVI = 1.00). Construct validity was supported by moderate correlations with PHQ-9 (r = 0.677), MFIS (r = 0.66), and SF-MPQ (r = 0.586), and a weak correlation with the MSIS-29. Conclusions: The PES-Ar showed strong validity and reliability for assessing the impact of pain in Arabic-speaking individuals with MS in Saudi Arabia. Full article

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12 pages, 549 KB

Open AccessArticle

A Structural Equation Modeling Approach to the Moderating Effect of Psychological Well-Being on Burnout and Depressive Symptoms Among Mental Health Professionals

by Fatih Bal, Hale A. Kahyaoğlu Çakmakci, İpek Okkay, Gülşen Filazoğlu Çokluk and Melek Süler

Healthcare 2026, 14(2), 284; https://doi.org/10.3390/healthcare14020284 - 22 Jan 2026

Abstract

Background/Objectives: This study investigates whether psychological well-being moderates the relationship between burnout and depressive symptoms among mental health professionals, who are frequently exposed to high emotional labor. Methods: A sample of 607 professionals—including psychologists, guidance counselors, social workers, and psychiatrists—working in public and [...] Read more.

Background/Objectives: This study investigates whether psychological well-being moderates the relationship between burnout and depressive symptoms among mental health professionals, who are frequently exposed to high emotional labor. Methods: A sample of 607 professionals—including psychologists, guidance counselors, social workers, and psychiatrists—working in public and private institutions in Turkey participated in the study. Data were collected online using the Maslach Burnout Inventory, the Psychological Well-Being Scale, and the Beck Depression Inventory–II. A latent interaction term between burnout and psychological well-being was tested using Structural Equation Modeling (SEM). Results: Burnout was positively associated with depressive symptoms (β = 0.37, p < 0.001), and psychological well-being showed a significant main effect on depressive symptoms (β = 0.26, p < 0.001). Importantly, the interaction between burnout and psychological well-being was significant (β = 0.20, p < 0.001), indicating that psychological well-being significantly moderates the relationship between burnout and depressive symptoms. Specifically, the positive interaction suggests that the association between burnout and depressive symptoms becomes stronger at higher levels of psychological well-being. The model explained 27% of the variance in depressive symptoms. Conclusions: These findings highlight the protective role of psychological well-being and suggest that interventions aimed at enhancing well-being may help reduce depressive symptoms among mental health professionals in high-stress environments. Full article

(This article belongs to the Special Issue Psychological Well-Being and Coping in Healthcare Workplace Environments)

27 pages, 624 KB

Open AccessReview

Nutrition in Perinatal Midwifery Care: A Narrative Review of RCTs, Current Practices, and Future Directions

by Artemisia Kokkinari, Maria Dagla, Kleanthi Gourounti, Evangelia Antoniou, Nikoleta Tsinisizeli, Evangelos Tzamakos and Georgios Iatrakis

Healthcare 2026, 14(2), 283; https://doi.org/10.3390/healthcare14020283 - 22 Jan 2026

Abstract

Background: Nutrition during the perinatal period, including pregnancy, childbirth, postpartum, and lactation, is a critical determinant of maternal and neonatal health. While the importance of balanced nutrition is well established, the integration of nutritional counseling into midwifery care remains inconsistent across settings. Evidence [...] Read more.

Background: Nutrition during the perinatal period, including pregnancy, childbirth, postpartum, and lactation, is a critical determinant of maternal and neonatal health. While the importance of balanced nutrition is well established, the integration of nutritional counseling into midwifery care remains inconsistent across settings. Evidence suggests that midwives are uniquely positioned to deliver nutrition-related support, yet gaps persist in their formal training and in the availability of structured guidance. These gaps are particularly evident in certain regions, such as Greece, where dedicated national guidelines for perinatal nutrition are lacking. Methods: This systematized narrative review synthesises evidence from studies published between 2010 and 2025, retrieved through PubMed, CINAHL, Scopus, and relevant national guidelines. Although the synthesis draws on diverse study designs to provide contextual depth, randomized controlled trials (RCTs) were prioritized and synthesized separately to evaluate the effectiveness of midwife-led interventions. In total, ten randomized controlled trials were included in the evidence synthesis, alongside additional observational and qualitative studies that informed the narrative analysis. Both international and Greek literature were examined to capture current practices, challenges, and knowledge gaps in the nutritional dimension of midwifery care. Results: Findings indicate that adequate intake of macronutrients and micronutrients, including iron, folic acid, vitamin D, iodine, calcium, and omega-3 fatty acids, is essential for optimal maternal and neonatal outcomes. Despite this, studies consistently report insufficient nutritional knowledge among midwives, limited confidence in providing counseling, and variability in clinical practice. Socio-cultural factors, such as dietary traditions and migration-related challenges, further influence nutritional behaviors and access to guidance. Emerging approaches, including e-health tools, group counseling models, and continuity-of-care frameworks, show promise in enhancing midwives’ capacity to integrate nutrition into perinatal care. Conclusion: Nutrition is a cornerstone of perinatal health, and midwives are strategically placed to address it. However, gaps in training, inconsistent guidelines, and cultural barriers limit the effectiveness of current practices. Strengthening midwifery education in nutrition, developing context-specific tools, and fostering interdisciplinary collaboration are essential steps toward more comprehensive and culturally sensitive perinatal care. Future research should focus on longitudinal and intervention studies that assess the impact of midwife-led nutritional counseling on maternal and neonatal outcomes. Full article

(This article belongs to the Section Healthcare and Sustainability)

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25 pages, 681 KB

Open AccessSystematic Review

A Systematic Review of Topic Modeling Techniques for Electronic Health Records

by Iqra Mehmood, Zoya Zahra, Sarah Iqbal, Ayman Qahmash and Ijaz Hussain

Healthcare 2026, 14(2), 282; https://doi.org/10.3390/healthcare14020282 - 22 Jan 2026

Abstract

Background: Electronic Health Records (EHRs) are a rich source of clinical information used for patient monitoring, disease progression analysis, and treatment outcome assessment. However, their large-scale, heterogeneity, and temporal characteristics make them difficult to analyze. Topic modeling has emerged as an effective [...] Read more.

Background: Electronic Health Records (EHRs) are a rich source of clinical information used for patient monitoring, disease progression analysis, and treatment outcome assessment. However, their large-scale, heterogeneity, and temporal characteristics make them difficult to analyze. Topic modeling has emerged as an effective method to extract latent structures, detect disease characteristics, and trace patient trajectories in EHRs. Recent neural and transformer-based approaches such as BERTopic has significantly improved coherence, scalability, and domain adaptability compared to earlier probabilistic models. Methods: This Systematic Literature Review (SLR) examines topic modeling and its variants applied to EHR data over the past decade. We follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework to identify, screen, and select relevant studies. The reviewed techniques span traditional probabilistic models, neural embedding-based methods, and temporal extensions designed for pathway and sequence modeling in clinical data. Results: The synthesis covers trends in publication patterns, dataset usage, application domains, and methodological contributions. The reviewed literature demonstrates strengths across different modeling families, while also highlighting challenges related to scalability, interpretability, temporal complexity, and privacy when analyzing large-scale EHRs. Conclusions: Topic modeling continues to play a central role in understanding temporal patterns and latent structures in EHRs. This review also outlines future possibilities for integrating topic modeling with Agentic AI and large language models to enhance clinical decision-making. Overall, this SLR provides researchers and practitioners with a consolidated foundation on temporal topic modeling in EHRs and its potential to advance data-driven healthcare. Full article

(This article belongs to the Special Issue AI-Driven Healthcare Insights)

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12 pages, 548 KB

Open AccessArticle

Symptomatic Outcomes After Autologous Fat Grafting in Irradiated Postmastectomy Chest Wall

by Razvan George Bogdan, Mara Nicolau, Alina Helgiu and Zorin Petrisor Crainiceanu

Healthcare 2026, 14(2), 281; https://doi.org/10.3390/healthcare14020281 - 22 Jan 2026

Abstract

Background/Objectives: Radiotherapy of the chest wall after mastectomy frequently leads to fibrosis, reduced tissue elasticity, erythema, pain and chronic skin-related symptoms that complicate reconstructive strategies. Autologous fat grafting has been proposed as a regenerative option for radiation induced soft tissue damage, but clinical [...] Read more.

Background/Objectives: Radiotherapy of the chest wall after mastectomy frequently leads to fibrosis, reduced tissue elasticity, erythema, pain and chronic skin-related symptoms that complicate reconstructive strategies. Autologous fat grafting has been proposed as a regenerative option for radiation induced soft tissue damage, but clinical data focused on patient-reported symptoms remain limited. The objective of this study was to describe symptomatic and clinical changes after autologous fat grafting in irradiated postmastectomy chest wall tissue. Methods: This pilot observational study included five female patients with a history of mastectomy followed by adjuvant chest wall radiotherapy. All patients underwent a single session of standard autologous fat grafting without adipose derived stem cell enrichment. Patient-reported symptoms, including pruritus, local discomfort, burning sensation and erythema, were recorded preoperatively and at six months using a standardized 0 to 5 scale. Scar pliability was assessed by two experienced physicians using the same scale. Only descriptive statistical analysis was performed. Results: All patients demonstrated lower postoperative symptom scores at six months. Mean reductions were observed for erythema (71.4 percent), burning sensation (61.1 percent) and pruritus (57.1 percent). Local discomfort decreased by 33.3 percent. Mean scar pliability scores increased from 2.2 to 3.2. No postoperative complications, such as infection, fat necrosis or oil cyst formation, were recorded. All patients completed the six month follow up. Conclusions: In this small pilot observational study, autologous fat grafting was well tolerated and associated with descriptive improvement of patient-reported symptoms and scar pliability in irradiated postmastectomy chest wall tissue. These findings suggest a potential symptomatic benefit of fat grafting, while larger studies with objective imaging and histological correlation are required to confirm efficacy and durability. Full article

16 pages, 861 KB

Open AccessReview

Mirror Neurons and Pain: A Scoping Review of Experimental, Social, and Clinical Evidence

by Marco Cascella, Pierluigi Manchiaro, Franco Marinangeli, Cecilia Di Fabio, Giacomo Sollecchia, Alessandro Vittori and Valentina Cerrone

Healthcare 2026, 14(2), 280; https://doi.org/10.3390/healthcare14020280 - 22 Jan 2026

Abstract

Background: The mirror neuron system (MNS) has been proposed as a key neural mechanism linking action perception, motor representation, and social cognition. This framework has increasingly been applied to pain research, encompassing pain empathy, observational learning of pain, and rehabilitative interventions such as [...] Read more.

Background: The mirror neuron system (MNS) has been proposed as a key neural mechanism linking action perception, motor representation, and social cognition. This framework has increasingly been applied to pain research, encompassing pain empathy, observational learning of pain, and rehabilitative interventions such as mirror therapy. However, the literature is conceptually heterogeneous, methodologically diverse, and spans experimental, social, and clinical domains. Objective: This scoping review aims to map the extent, nature, and characteristics of the available evidence on the relationship between the MNS and pain, clarifying how MNS-related mechanisms are defined, investigated, and applied across different contexts. Methods: A scoping review was conducted using the methodological framework proposed by the Joanna Briggs Institute and reported in accordance with PRISMA-ScR guidelines. We searched PubMed/MEDLINE, Scopus, Web of Science, and PsycINFO. Studies were included if they addressed MNS-related mechanisms in pain processing, pain empathy, pain modulation, or pain rehabilitation. Eligible studies were charted and synthesized descriptively and thematically. Results: Twenty-one studies met the inclusion criteria. The evidence was predominantly derived from clinical and rehabilitative settings, with most studies focusing on mirror therapy or mirror visual feedback interventions. The majority of included populations consisting of adults with chronic pain conditions, particularly phantom limb pain and complex regional pain syndrome. Pain intensity, assessed mainly through self-reported clinical scales, was the most frequently reported outcome. A smaller number of studies investigated action observation or motor imagery paradigms, primarily in chronic musculoskeletal pain, showing short-term hypoalgesic effects. Across studies, substantial heterogeneity was observed in the conceptualization of MNS-related constructs, intervention protocols, outcome measures, and follow-up duration. Conclusions: Despite extensive theoretical discussion of the MNS, empirical applications are largely confined to clinical mirror-based interventions, with limited use of direct neurophysiological or neuroimaging markers. Since crucial conceptual and methodological gaps constrain comparability and translation into clinical practice, there is a need for clearer operational definitions and more integrated experimental and clinical research approaches. Full article

(This article belongs to the Special Issue Management and Nursing Strategy for Patients with Pain)

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