Healthcare

21 pages, 5116 KiB

Open AccessArticle

Patient Perspectives on Coordinated Care: Preliminary Results from the Implementation Stage Using Patient-Reported Experience Measures (PREMs)

by Beata Wieczorek-Wójcik, Anna Justyna Milewska, Dorota Kilańska, Aneta Kulma-Pytlak, Peter Iltchev, Aleksandra Gaworska-Krzemińska and Remigiusz Kozlowski

Healthcare 2025, 13(9), 1026; https://doi.org/10.3390/healthcare13091026 - 29 Apr 2025

Abstract

Background and Objectives: Integrated health services are health services that are managed and delivered in a way that ensures patients receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation, and palliative care services at different levels and sites of [...] Read more.

Background and Objectives: Integrated health services are health services that are managed and delivered in a way that ensures patients receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation, and palliative care services at different levels and sites of care within the health system, and according to their needs, throughout their life course. Assessing the effectiveness of their implementation, the perspective of the process participant—the patient—is examined. There are three main types of patient-reported measures: PROM, PREM and HLS. PREM (patient-reported experience measure) is a tool that allows the objective measurement of the patient’s experience related to healthcare services, for instance, the timeliness of visits or receiving recommendations. The aim of this study was to evaluate the coordinated care experienced by patients (PREMs) before and after the introduction of coordinated care, using the JOP-POP tool as a key measure. Materials and Methods: This longitudinal study was conducted in two stages. The first stage concerned the joining of the coordinated care program by the entity in which the study was conducted; the study was repeated six months after joining coordinated care (CC). At each stage of the study, the study group included 40 patients. The Shapiro–Wilk test was used to verify the normality of the distribution of quantitative variables. For statistical analysis, the Wilcoxon test for paired samples was used to compare two ordinal dependent variables. For independent variables, the Mann–Whitney and the Kruskal–Wallis ANOVA by ranks tests were used, with a post hoc test of multiple comparisons of mean ranks. Results: A statistically significant relationship (p = 0.00157) was observed between the number of chronic diseases and health status assessment before inclusion in coordinated care. The patients’ responses showed statistically significant improvement 6 months after the introduction of coordinated care (CC). The improvement in assessment was related to the time physicians spent with patients. The greatest improvement over 6 months was achieved in coordination of care and the smallest improvement was noted in the approach to the patient. Conclusions: The JOP-POP tool may be useful in future studies to assess patients’ experiences with implementing coordinated care. Full article

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21 pages, 305 KiB

Open AccessArticle

Burnout and Professional Quality of Life Amongst Crisis Hotline Responders: A Cross-Sectional Survey in Canada During COVID-19

by Stephen Lee-Cheong, Mariam Alaverdashvili, Mackenzie Jardine, Vidhi Shivani Maharaj and Nathan Kolla

Healthcare 2025, 13(9), 1025; https://doi.org/10.3390/healthcare13091025 - 29 Apr 2025

Abstract

Background/Objectives: There is a significant gap in accessibility to mental healthcare in Canada. This study aims to examine the population of Canadian crisis hotline responders and investigate the variables that contributed to burnout and professional quality of life during COVID-19. Crisis hotline responders [...] Read more.

Background/Objectives: There is a significant gap in accessibility to mental healthcare in Canada. This study aims to examine the population of Canadian crisis hotline responders and investigate the variables that contributed to burnout and professional quality of life during COVID-19. Crisis hotline responders are hypothesized to be affected by burnout and poor professional quality of life, due to the inherent nature of the job and the widespread negative mental health effects of COVID-19, which are expected to continue even after the pandemic. Methods: An online, cross-sectional, mixed-methods survey assessed sociodemographic information, shift-related variables, burnout and related factors, and current support methods utilized by crisis hotline responders across Canada. The open-ended questions helped to more personally reflect participants’ experiences. Data were analyzed using chi-square tests, an analysis of variance, and a regression analysis. Results: The survey was completed by 136 participants (78.7% female) with an average age of 39.68. Participants reported relatively high levels of burnout/stress on both the Copenhagen Burnout Inventory and professional quality of life survey. Younger age, less work experience, and working overnight shifts emerged as possible predictors of worse mental wellbeing. Conclusions: Findings suggest that Canadian crisis hotline responders require greater support to manage workplace burnout/stress. Nevertheless, conducting comprehensive studies during times when there are no public health emergencies are warranted to understand the full scope of burnout in this population. We offer five recommendations to support the mental wellbeing of responders and improve access to this important public health resource. Full article

(This article belongs to the Special Issue Mental Health in Times of Crisis: New Trends in Diagnosis and Treatment)

13 pages, 454 KiB

Open AccessArticle

A Robust ORMS Framework for Taiwanese Healthcare: Taguchi’s Dynamic Method in Action

by Hung-Chang Liao and Ya-Huei Wang

Healthcare 2025, 13(9), 1024; https://doi.org/10.3390/healthcare13091024 - 29 Apr 2025

Abstract

The study focused on the design of an ORMS in a medical center in central Taiwan, which also functions as a teaching hospital. Background/Objectives: The research objectives were to design an ORMS simulation system based on the status quo of the operating [...] Read more.

The study focused on the design of an ORMS in a medical center in central Taiwan, which also functions as a teaching hospital. Background/Objectives: The research objectives were to design an ORMS simulation system based on the status quo of the operating room planning and scheduling in the medical center, obtain the optimal parameter setting in the ORMS, and find improvement strategies according to the sensitivity analysis based on the optimal parameter setting for total performance. Methods: Taguchi’s dynamic method was adopted to design the ORMS under human and material resource constraints. The scope of the study was internal medicine patients of the ORMS. A neural network was used to construct a relationship between parameters and performances. A genetic algorithm was used to obtain the optimal parameter setting for optimal performance. Results: This study successfully established a robust operating room management system (ORMS) to help hospital manager to plan and schedule operating rooms and take the ORMS into account to meet patient needs. Decision-makers can use the insights from the sensitivity analysis to refine their strategies effectively. The sensitivity analysis showed that the impact power (the percentage change in d) of the “number of circulating nurses (−0.15 to −1.25; −0.25 to −1.85)” factor was less than (<) that of the “number of holding nurses (−0.85 to −2.04; −0.91 to −2.07)” factor < that of the “number of preoperative beds (−2.57 to −4.53; −2.23 to −4.10)” factor < that of the “number of anesthetists (−3.13 to −7.50)” factor. Conclusions: In the optimal parameter setting obtained, the number of holding nurses was 18, the number of circulating nurses was 20, the number of anesthetists was 15, and the number of preoperative beds was 12. The optimal performance was 0.91. Full article

(This article belongs to the Special Issue Evaluation and Potential of Effective Decision-Making in Healthcare)

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18 pages, 1218 KiB

Open AccessArticle

Pre- and Postoperative Care for Bariatric Surgery Patients: The Impact of a Designed Reference Guide on Nurses’ Awareness and Patient Satisfaction

by Samar Khattab Mohammed, Mahmoud Abdel Hameed Shahin, Fatmah Ahmed Alamoudi, Mosaad M. Morshed, Wafaa Gameel Mohammed Ali and Amal Eid Abdelmonaem Shaaban

Healthcare 2025, 13(9), 1023; https://doi.org/10.3390/healthcare13091023 - 29 Apr 2025

Abstract

Background/Objectives: Bariatric surgery is a crucial intervention for the treatment of morbid obesity, necessitating that nursing staff possess a thorough understanding of expected outcomes to ensure successful patient care and promote healthier lifestyles. Recognizing this need, the present study aimed to develop and [...] Read more.

Background/Objectives: Bariatric surgery is a crucial intervention for the treatment of morbid obesity, necessitating that nursing staff possess a thorough understanding of expected outcomes to ensure successful patient care and promote healthier lifestyles. Recognizing this need, the present study aimed to develop and implement a reference guide tailored to nursing staff providing bariatric surgery care. Methods: A quasi-experimental design was employed, utilizing a convenience sample of 78 nurses and 156 patients—comprising 78 participants before the administration of the reference guide and another 78 participants after its provision—from the general surgery units at Mansoura University Hospital. Four tools were employed for data collection: a sociodemographic datasheet, a knowledge questionnaire assessing nurses’ understanding of care for bariatric surgery patients, a self-reported practice questionnaire, and a patients’ satisfaction measurement tool. A reference guide for bariatric surgery care was constructed. Descriptive and inferential statistics were conducted with adherence to all ethical considerations. Results: After implementing the reference guide, the percentage of nurses who exhibited good knowledge of bariatric surgery increased from 10.3% to 80.8%. Additionally, the proportion of nurses reporting poor self-reported practices related to necessary procedures decreased from 80.8% to 5.1%. Surprisingly, the improvement in knowledge and self-reported practices was sustained for a long time, though reduced. Furthermore, patient satisfaction levels showed a marked improvement following the intervention. Conclusion: Implementing a reference guide significantly improved nurses’ knowledge, self-reported practices, and patient satisfaction. To sustain these improvements, it is recommended that the reference guide be made available and educational programs be provided to nursing staff. Full article

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20 pages, 2006 KiB

Open AccessReview

Emergency Department Clinical Quality Registries: A Scoping Review

by Viet Tran, Giles Barrington and Simone Page

Healthcare 2025, 13(9), 1022; https://doi.org/10.3390/healthcare13091022 - 29 Apr 2025

Abstract

Background: Emergency departments (ED) are vital within the health system, often representing the first hospital contact for patients who are undifferentiated and may be critically ill. Although advancements in digital technology and increasing use of electronic medical records in health systems have led [...] Read more.

Background: Emergency departments (ED) are vital within the health system, often representing the first hospital contact for patients who are undifferentiated and may be critically ill. Although advancements in digital technology and increasing use of electronic medical records in health systems have led to the dramatic growth of large data sets, the presence of ED clinical registries to measure quality of care in the literature is currently unknown. Objectives: Our scoping review aims to investigate the extent of emergency department clinical registries reported in peer-reviewed literature. Methods: We conducted a scoping review of ED registries in accordance with the PRISMA-ScR checklist. Searches were undertaken in PUBMED, EMBASE, and SCOPUS. Studies were included if they described a clinical registry with a focus on the ED. Results: We identified 60 manuscripts with 27 identified as primary registries (6 had a general scope, 21 were condition or population specific). The remaining 33 papers were investigational reports sourced from the identified primary registries. Funding sources were identified for some registries: three by research grants, two by medical colleges, five by government organizations or initiatives, two by pharmaceutical companies, and three by research institutes. No funding information was provided in 12 studies. The reported registry periods ranged from 31 days to 4018 days (median 365 days, IQR 181–1309 days). A grey literature search revealed that six registries were ongoing. Conclusions: Internationally, there appears to be a wide degree of heterogeneity with primary ED registry publications and secondary publications. Having a standardized approach to ED registries is needed. Integrating ED registries with a learning health system model will enable clinicians to serve their community proactively and with a focus on quality, rather than the current safety-focused approach. Full article

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15 pages, 3752 KiB

Open AccessArticle

Dentophobia and the Interaction Between Child Patients and Dentists: Anxiety Triggers in the Dental Office

by Roxana Alexandra Cristea, Mariana Ganea, Georgiana Ioana Potra Cicalău and Gabriela Ciavoi

Healthcare 2025, 13(9), 1021; https://doi.org/10.3390/healthcare13091021 - 29 Apr 2025

Abstract

Dental anxiety is an intense and irrational fear of visiting the dentist or of undergoing dental procedures. Background/Objectives: The aim of this study was to investigate the prevalence of dental anxiety in children aged 6–11 years and to identify the importance of communication [...] Read more.

Dental anxiety is an intense and irrational fear of visiting the dentist or of undergoing dental procedures. Background/Objectives: The aim of this study was to investigate the prevalence of dental anxiety in children aged 6–11 years and to identify the importance of communication in reducing anxiety in pediatric patients. Methods: The research was conducted through a questionnaire administered to 101 students (55.4% girls and 44.6% boys), aged 6–11 years, from the North-West Region of Romania. The data collected included the age and gender of the subjects, their previous experiences with the dentist, the identification of factors that trigger anxiety, and the way in which patients perceive future dental visits. Results: This study found that for the majority of participants, a visit to the dentist does not represent a source of fear. Moreover, most children are eager to visit the dentist again. Gender and age did not have a significant effect on the prevalence of anxiety. Elements such as sitting in the dental chair, observing dental instruments, having the teeth examined with a mirror, and hearing the sounds produced by the instruments were identified as factors that may cause anxiety in pediatric patients. Conclusions: It was found that pediatric patients who have good communication with the practitioner display lower anxiety levels compared to those of others. Full article

(This article belongs to the Section Nursing)

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18 pages, 1878 KiB

Open AccessArticle

COVID-19 Vaccine Uptake Inequality Among Children: A Multidimensional Demographic Analysis

by Seyed M. Karimi, Mana Moghadami, Md Yasin Ali Parh, Shaminul H. Shakib, Hamid Zarei, Venetia Aranha, Sepideh Poursafargholi, Trey Allen, Bert B. Little, Demetra Antimisiaris, W. Paul McKinney, Yu-Ting Chen, Taylor Ingram and Angela Graham

Healthcare 2025, 13(9), 1019; https://doi.org/10.3390/healthcare13091019 - 29 Apr 2025

Abstract

Background: Although children can contract COVID-19, their typically lower immune reactivity appears to shield them from the intense hyperinflammatory response observed in other age groups, leading to milder disease symptoms. Nonetheless, children’s infection raises the possibility of unwanted transmission of the coronavirus to [...] Read more.

Background: Although children can contract COVID-19, their typically lower immune reactivity appears to shield them from the intense hyperinflammatory response observed in other age groups, leading to milder disease symptoms. Nonetheless, children’s infection raises the possibility of unwanted transmission of the coronavirus to others, especially because most infected children are asymptomatic. Objectives: This study examines the uptake of the first and second doses of the COVID-19 vaccine among children by combinations of age, race, ethnicity, and sex. Methods: Data from the immunization registry were utilized to assess changes over time in COVID-19 vaccine uptake among children in Jefferson County, Kentucky’s most populous county. The analysis examined trends by age, race, ethnicity, and combinations of age-race, age-ethnicity, age-race-sex, and age-ethnicity-sex during the first six quarters of the COVID-19 vaccination rollout. Results: By May 2022, in 16–17-year-olds, the highest and lowest COVID-19 vaccination rates were observed among White and Black children (64.8% versus 41.2%, respectively, for dose two). The highest two-dose vaccination rate at ages 12–15 years was among Multiracial and White children (63.3% and 62.9%, respectively), the lowest among Black children (38.8%). The highest two-dose vaccination rate at ages 5–11 years was among children of Some Other Races, Asian, and White children (37.0%, 36.7%, and 35.5%, respectively), and the lowest among Black children (17.2%). Conclusions: Inequalities in COVID-19 vaccination based on race, ethnicity, and sex persisted throughout the study period. Efforts in vaccine distribution and promotional initiatives should focus on increasing vaccination rates among children from racial and ethnic minority groups and males. Full article

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20 pages, 298 KiB

Open AccessArticle

Prevalence of Self-Reported Musculoskeletal Disorders in Dentists—A Cross-Sectional Study in Portugal and Italy

by Alessandro Bracciale, Maria Conceição Manso, Francesca Bracciale and Liliana Gavinha Costa

Healthcare 2025, 13(9), 1020; https://doi.org/10.3390/healthcare13091020 - 28 Apr 2025

Abstract

Objectives: A dentist may assume incorrect working positions throughout their professional career, which can lead to musculoskeletal disorders (MSDs). This study aimed to quantify the prevalence of self-reported MSDs in dentists and the body region most affected, as well as to evaluate [...] Read more.

Objectives: A dentist may assume incorrect working positions throughout their professional career, which can lead to musculoskeletal disorders (MSDs). This study aimed to quantify the prevalence of self-reported MSDs in dentists and the body region most affected, as well as to evaluate the most frequent working position, the area of work and the age group most frequently associated with MSDs. Methods: This is a cross-sectional observational study adhering to the STROBE and CHERRIES guidelines, approved by the local Ethics Committee. An online questionnaire (including the Nordic Musculoskeletal Symptoms Questionnaire) was applied to a convenience sample of Portuguese and Italian dentists. Data analysis was conducted with non-parametric comparisons (IBM© SPSS^® Statistics vs. 28.0, p < 0.05). Results: A total of 341 dentists (170 Portuguese, 171 Italian) aged 18–75 years participated. The prevalence of self-reported MSDs in Portugal and Italy was 78.8% and 81.9%, respectively. The most affected self-reported MSD body regions were the neck (65.3% Portuguese and 61.4% Italian dentists), shoulder (49.4% Portuguese and 39.2% Italian) and lumbar region (52.4% and 39.2%, respectively). The neck region was the one reported to cause the highest work absenteeism. The higher age group (41–50 years and higher) has a higher risk for self-reported MSD. Multivariate analysis highlighted increased practice time as a significant risk factor for MSDs in the previous year in both countries. Age group, practice duration and work position relative to the patient were significantly linked to MSD occurrence and work avoidance. Conclusions: Dentists showed a high prevalence of self-reported MSD despite performing clinical activity mostly seated. It was concluded that dentists older than 40 years and those who have been working for more than 20 years have a higher risk of MSD, and that endodontics is the area where they report feeling more discomfort. Dentists should be encouraged to take more breaks between appointments and regular exercise to prevent the development/progression of MSDs. Full article

(This article belongs to the Special Issue Advances in Musculoskeletal Rehabilitation and Therapy: Second Edition)

16 pages, 2305 KiB

Open AccessArticle

Associations Between Physical Capability Markers and Risk of Coronary Artery Disease: A Prospective Study of 439,295 UK Biobank Participants

by Duqiu Liu, Chenxing Yang, Tianyu Guo, Yi Guo, Jinjie Xiong, Ru Chen and Shan Deng

Healthcare 2025, 13(9), 1018; https://doi.org/10.3390/healthcare13091018 - 28 Apr 2025

Abstract

Background: The relationship between sarcopenia and the incidence of coronary artery disease (CAD) is not well understood. This study aimed to investigate this relationship and the modifying effect of potential risk factors. Methods: We conducted a prospective study including 439,295 individuals [...] Read more.

Background: The relationship between sarcopenia and the incidence of coronary artery disease (CAD) is not well understood. This study aimed to investigate this relationship and the modifying effect of potential risk factors. Methods: We conducted a prospective study including 439,295 individuals from the UK Biobank. The primary outcome was the incidence of CAD. The main physical capability markers for sarcopenia, grip strength and muscle mass, were investigated as risk factors of interest. Grip strength was measured using a Jamar J00105 (Lafayette, IN, USA) hydraulic hand dynamometer, while muscle mass was estimated through bioelectrical impedance. Cox proportional hazard models were employed to analyze the associations between the exposures and the risk of CAD. Results: A total of 41,564 incident cases of CAD were identified after a median follow-up of 13.15 years (IQR 12.29–13.88 years). Compared with the lowest quintile of grip strength, the adjusted HRs for incidences of CAD from the second to the fifth quintile were 0.81 (95% CI: 0.79–0.83), 0.71 (95% CI: 0.69–0.73), 0.61 (95% CI: 0.60–0.63), and 0.49 (95% CI: 0.48–0.51). The association remained significant in subgroup analysis and interactions were observed between the two exposures and sex, age, smoking status, inflammatory diseases, metabolic syndrome, and genetic predisposition (all p for interactions < 0.05). Conclusions: Physical capability markers of sarcopenia, grip strength and muscle mass, were independently associated with a dose–response decreased risk for CAD incidence, regardless of genetic predisposition and potential modifying risk factors. Full article

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13 pages, 789 KiB

Open AccessArticle

Communication and Therapy Planning for Patients of Reproductive Age Under Immunomodulatory Treatments for Psoriasis or Psoriatic Arthritis—Survey of the German National Psoriasis Registry PsoBest

by Brigitte Stephan, Christina Sorbe, Birgit-Christiane Zyriax, Janne Schmittinger, Matthias Augustin, Rachel Sommer, Neuza Maria Bernardino da Silva Burger, Ansgar Weyergraf, Ralph von Kiedrowski and Laura Kühl

Healthcare 2025, 13(9), 1017; https://doi.org/10.3390/healthcare13091017 - 28 Apr 2025

Abstract

Background/Objective: During the systemic treatment of moderate to severe psoriasis in patients of reproductive age, contraindications and therapeutic peculiarities must be taken into account. Doctor–patient communication is crucial for therapy conduct and compliance. Methods: This survey among male and female patients from the [...] Read more.

Background/Objective: During the systemic treatment of moderate to severe psoriasis in patients of reproductive age, contraindications and therapeutic peculiarities must be taken into account. Doctor–patient communication is crucial for therapy conduct and compliance. Methods: This survey among male and female patients from the German psoriasis registry, PsoBest, aims to provide real-world evidence on communication and patient needs for those of reproductive age (18–55). Result: In total, 404 patients were eligible for the analysis (254 m, 150 f), including 39 patients currently wishing to conceive (20 m, 19 f). Patients with and without the desire to have children received similar systemic therapy. In most cases, treatment was not adapted when patients expressed a desire to have children (85.9% m, 79.5% f). Only 38.3% of men and 49.9% of women had been informed about options for conception during or before systemic therapy, mainly by dermatologists (77.4% m, 84.6% f). The majority of patients retrieved additional information about the wish to conceive and medications from the internet and other media. This survey emphasizes the importance of open communication between patients and physicians regarding family planning and therapy options. Conclusions: Physicians need to broach the topic of family planning, conception and pregnancy with patients and support with evidence-based information to enable comprehensive medical decision making and safe therapy choices. Full article

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13 pages, 247 KiB

Open AccessArticle

Low Back Pain in Italian Nurses: A Statistical Analysis of Disability and Work Productivity Impairment—An Observational Study

by Roberto Lupo, Elsa Vitale, Luana Conte, Andrea Bernetti, Francesco Ciccarese, Marcella Orgiu, Salvatore Latina, Ludovica Panzanaro, Alessia Lezzi, Alessandra Puglia, Giorgio De Nunzio, Donato Cascio, Gianandrea Pasquinelli and Ivan Rubbi

Healthcare 2025, 13(9), 1016; https://doi.org/10.3390/healthcare13091016 - 28 Apr 2025

Abstract

Background: Low back pain (LBP) is a common occupational health issue among nurses, significantly affecting quality of life and work productivity. Despite awareness, it remains a major cause of absenteeism and presenteeism, highlighting the need for targeted interventions. This study aimed to [...] Read more.

Background: Low back pain (LBP) is a common occupational health issue among nurses, significantly affecting quality of life and work productivity. Despite awareness, it remains a major cause of absenteeism and presenteeism, highlighting the need for targeted interventions. This study aimed to assess the prevalence of LBP among Italian nurses and its impact on quality of life and work productivity. Methods: A cross-sectional, multicenter observational study was conducted from May to October 2024 using an online questionnaire distributed to members of the Provincial Orders of Nursing Professions across Italy. The questionnaire included sociodemographic variables and three validated instruments: the Quebec Back Pain Disability Scale (QBPDS), the Oswestry Disability Index (ODI), and the Work Productivity and Activity Impairment Questionnaire (WPAI). Results: A total of 318 nurses participated, with the majority from Southern Italy (57.1%) and female (74.6%). LBP was reported by 57.5% of respondents. Nurses working in Critical Care and those with 30–40 years of experience had significantly higher QBPDS and ODI scores, indicating moderate disability. Nurses working 12 h shifts and those with job restrictions or medical prescriptions reported significantly higher disability levels (ODI > 29, p < 0.001). Nurses on pharmacological therapy reported moderate pain levels, while those engaging in regular physical activity had significantly lower pain symptoms (<20, p < 0.001). The WPAI results showed that 67.0% of nurses reported impaired work productivity due to LBP. Conclusions: LBP is extremely prevalent among Italian nurses, especially affecting physical well-being and, accordingly, the health care quality provided by them. Factors exacerbating this problem are wrong manual handling of loads, not exercising, poor nutrition, and smoking, as well as wrong posture. Fundamental in order to avoid the occurrence of this problem are preventive programs and ergonomic training. Full article

14 pages, 231 KiB

Open AccessArticle

Effectiveness of Case Management for High-Frequency Outpatients and Long-Term Inpatients Among South Korean Medical Aid Beneficiaries

by Young-kyoon Na, Daho Lee and Kyounga Lee

Healthcare 2025, 13(9), 1015; https://doi.org/10.3390/healthcare13091015 - 28 Apr 2025

Abstract

Background/Objectives: South Korea implemented a case management program for Medical Aid (MA) beneficiaries in 2003. This study evaluates the effect of case management on healthcare utilization among MA beneficiaries, with a focus on both outpatients and inpatients. Methods: This retrospective comparative study was [...] Read more.

Background/Objectives: South Korea implemented a case management program for Medical Aid (MA) beneficiaries in 2003. This study evaluates the effect of case management on healthcare utilization among MA beneficiaries, with a focus on both outpatients and inpatients. Methods: This retrospective comparative study was conducted using the 2023 full dataset of MA beneficiaries. The propensity score matching method was used to match the case management group with the non-case management group, and differences in healthcare utilization were analyzed using a difference-in-differences analysis. Results: The case management group exhibited characteristics of a medically vulnerable population, with greater healthcare needs than those of the non-case management group. Case management interventions reduced outpatient days by 4.7 and outpatient medical costs by USD 327 per person annually. For long-term inpatients, it reduced inpatient days by 13.6 and medical costs by USD 2261 per person annually (p < 0.001). Conclusions: MA case management effectively reduced both outpatient/inpatient days and medical costs. As the effects may vary depending on the type of case management, developing diverse and detailed case management programs is necessary. Full article

11 pages, 1681 KiB

Open AccessOpinion

The Contribution of the Double Rib Contour Sign and the Rib Index to the Study of Scoliogeny, Thoracic Deformity, Progression, Outcome of Treatments and Costoplasty for Idiopathic Scoliosis

by Theodoros B. Grivas, Anastasios G. Christodoulou, Evangelos A. Christodoulou, Galateia Katzouraki, Marios G. Lykissas, Panayiotis J. Papagelopoulos, Elias C. Papadopoulos, Sotirios Papastefanou, Nikolaos Sekouris, Panayotis N. Soucacos, Konstantinos C. Soultanis and Elias Vasiliadis

Healthcare 2025, 13(9), 1014; https://doi.org/10.3390/healthcare13091014 - 28 Apr 2025

Abstract

This opinion article refers to the “double rib contour sign” and to the rib index (DRCS and RI), to their reliability study results in the chest radiographs of a control group and to their validity study results. These two parameters were introduced by [...] Read more.

This opinion article refers to the “double rib contour sign” and to the rib index (DRCS and RI), to their reliability study results in the chest radiographs of a control group and to their validity study results. These two parameters were introduced by the first author in this report. The introduction of the Segmental Rib Index (SRI) and its relation to spinal deformity is also discussed. The RI has been confirmed to be a strong surrogate for scoliometric readings in idiopathic scoliosis (IS). The clinical applications of the RI are analyzed for the following: (a) the documentation of deformity; (b) the assessment of physiotherapy outcomes (PSSEs); (c) the documentation of the outcomes of brace treatment; (d) the documentation of the pre- and post-operative assessment of thoracic deformity correction in different types of instrumentation; (e) its usage in prognosticating accelerated deterioration in skeletally mature adolescent idiopathic scoliosis (AIS) curves of 40–50 degrees; and (f) its usage in the recognition of the proper rib level for thoracoplasty/costoplasty. The emerging etiological–scoliogenic implications from the use of the DRCS and RI are described. The rotation of the trunk and vertebral bodies as interrelated, but distinct parameters are finally analyzed. Full article

(This article belongs to the Special Issue Scoliosis Deformity—Etiological Aspects, Management and Rehabilitation)

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15 pages, 2204 KiB

Open AccessArticle

HIV Stigma and Discrimination in Colombian Healthcare: Insights from a National Cross-Sectional Analysis of General Practitioners

by Valentina Loaiza-Guevara, Juliana Paola Martinez Rivera, Juan Sebastian Castillo, Widad Dalel Gomez, Elisabet Deig Comerma and Juan S. Izquierdo-Condoy

Healthcare 2025, 13(9), 1013; https://doi.org/10.3390/healthcare13091013 - 28 Apr 2025

Abstract

Background/Objectives: HIV-related stigma and fear among healthcare professionals represent significant barriers to effective patient care, contributing to delayed diagnosis and suboptimal treatment for people living with HIV (PLHIV). Although these issues have been studied in various settings, there is a lack of [...] Read more.

Background/Objectives: HIV-related stigma and fear among healthcare professionals represent significant barriers to effective patient care, contributing to delayed diagnosis and suboptimal treatment for people living with HIV (PLHIV). Although these issues have been studied in various settings, there is a lack of evidence on how they manifest among general practitionersin Colombia—a key group in the healthcare system. This study investigated the prevalence of stigma and fear among Colombian general practitioners and identified associated factors. Methods: A cross-sectional, observational study was conducted between February and May 2024, using a self-administered online survey targeting general practitioners. A validated 28-question instrument adapted from the Health Policy Project assessed fear, stigma, and related factors. Results: Among 579 participants, 68.6% exhibited low fear levels; however, specific clinical tasks, such as taking blood samples, elicited greater concern. Stigmatizing beliefs—such as associating HIV with irresponsible behavior—were reported by 25% of participants. Prior training in HIV care was inversely associated with stigma (OR = 0.681; 95% CI: 0.489–0.949), while older age and heterosexual orientation correlated with higher stigma levels. Conclusions: Despite generally low levels of fear and stigma, gaps in HIV-related training among physicians highlight the need for targeted educational initiatives. Promoting comprehensive HIV education in medical curricula and continuing professional development can reduce stigma, enhance confidence in care, and foster a more inclusive healthcare environment. Full article

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23 pages, 3283 KiB

Open AccessArticle

A Pilates Exercise Program as a Therapeutic Strategy in Older Adults with Type 2 Diabetes: Effects on Functional Capacity and Blood Glucose

by Beatriz Ruiz-Ariza, Fidel Hita-Contreras, Agustín Aibar-Almazán, María Del Carmen Carcelén-Fraile and Yolanda Castellote-Caballero

Healthcare 2025, 13(9), 1012; https://doi.org/10.3390/healthcare13091012 - 28 Apr 2025

Abstract

Background/Objectives: Older adults with type 2 diabetes mellitus (T2DM) often experience impaired physical function and metabolic control. This study aimed to evaluate the effectiveness of a 12-week Pilates-based intervention on blood glucose concentration and physical function in this population. Methods: A randomized controlled [...] Read more.

Background/Objectives: Older adults with type 2 diabetes mellitus (T2DM) often experience impaired physical function and metabolic control. This study aimed to evaluate the effectiveness of a 12-week Pilates-based intervention on blood glucose concentration and physical function in this population. Methods: A randomized controlled trial was conducted with 104 older adults (mean age: 70.6 ± 3.15 years; 70.2% women), all diagnosed with T2DM. The participants were assigned to a control group (CG, n = 52) or a Pilates training group (PG, n = 52). The intervention included 24 Pilates sessions over 12 weeks (2 sessions/week, 60 min each). Outcomes were assessed pre- and post-intervention and included capillary blood glucose, handgrip strength, functional mobility (Timed Up and Go), balance (Berg Balance Scale), and flexibility (Chair Sit-and-Reach Test and Back Scratch Test). Results: Compared to the control group, the Pilates group showed statistically significant improvements in blood glucose levels (−4.06 mg/dL (p < 0.001; d = 0.68)), handgrip strength (+1.76 kg (p < 0.001; d = 0.48)), gait speed (p < 0.001; d = 0.53), balance (Berg score) (+2.37 points (p < 0.001; d = 0.66)), and flexibility (improvements in upper limbs (BST, d = 0.78–0.98) and lower limbs (CSRT, d = 1.07 right; d = 0.63 left)). Conclusions: A 12-week Pilates program led to significant improvements in glycemic control, muscular strength, gait speed, balance, and flexibility in older adults with T2DM. These findings support Pilates as a safe, effective, and adaptable non-pharmacological intervention to promote functional and metabolic health in this population. Full article

(This article belongs to the Section Nursing)

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26 pages, 3259 KiB

Open AccessArticle

The Effects of Motor Imagery on Trapeziometacarpal Osteoarthritis in Women During the Post-Surgical Immobilization Period: A Randomized Clinical Trial

by Eva Prado-Robles, Jose Ángel Delgado-Gil and Jesús Seco-Calvo

Healthcare 2025, 13(9), 1011; https://doi.org/10.3390/healthcare13091011 - 28 Apr 2025

Abstract

Trapeziometacarpal osteoarthritis is the second most frequent degenerative hand disease, and it presents in 66% of women over the age of 55. Post-surgery immobilization results in functional losses that could be attenuated by motor imagery training. Objectives: The aim of this study [...] Read more.

Trapeziometacarpal osteoarthritis is the second most frequent degenerative hand disease, and it presents in 66% of women over the age of 55. Post-surgery immobilization results in functional losses that could be attenuated by motor imagery training. Objectives: The aim of this study is to evaluate the efficacy of motor imagery training during the post-surgical immobilization period in women who underwent surgery for trapeziometacarpal osteoarthritis. Methods: A randomized controlled trial was performed. A total of 40 patients satisfied the eligibility criteria, agreed to participate, and were randomized into an experimental group (n = 20) or control group (n = 20). Motor imagery was applied to the experimental group during the 3 weeks of post-surgical immobilization and to the control group with the conventional protocol. Measurement outcomes were assessed four times throughout the study using the Disabilities of the Arm, Shoulder, and Hand questionnaire, the Cochin Hand Function Scale questionnaire, the Visual Analogue Scale, goniometry, a baseline pinch gauge, circumferential measurement, and the modified Kapandji Index. Results: There were significant improvements in the motor imagery group compared with the control group in post-motor imagery, pre- and post-rehabilitation measurements, functional pain (p < 0.001), rest pain (p < 0.01), hand mobility (p < 0.001), range of motion (p < 0.05), and wrist edema (p < 0.04); there were also improvements in pre- and post-rehabilitation measurements, quality of life in relation to upper limb function problems (p < 0.04), the post-rehabilitation measurement of hand functionality (p = 0.02), and post-motor imaging in finger-to-finger pinch strength. There were no statistically significant differences in the rest of the variables. Conclusions: Early intervention with motor imagery could be effective for resting and functional pain, quality of life in relation to upper limb problems, functional capacity, mobility, range of motion, strength, and edema. Full article

(This article belongs to the Special Issue New Challenges in Health Care Services among Patients with Musculoskeletal Pain)

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13 pages, 427 KiB

Open AccessArticle

A Mediating Effect of Psychological Distress in the Relationship Between Performance Status and Health-Related Quality of Life of Patients with Female Cancer

by Eunha Yeo, JinShil Kim, Jisun Yang, Eun Young Park, Kwang-Hi Park, KyungAh Cho and Seongkum Heo

Healthcare 2025, 13(9), 1010; https://doi.org/10.3390/healthcare13091010 - 28 Apr 2025

Abstract

Objective: This study aimed to examine whether anxiety and depressive symptoms mediate the relationship between performance status and health-related quality of life (HRQL) in patients with female cancer. A poor performance status is known to adversely affect HRQL and psychological distress—particularly anxiety and [...] Read more.

Objective: This study aimed to examine whether anxiety and depressive symptoms mediate the relationship between performance status and health-related quality of life (HRQL) in patients with female cancer. A poor performance status is known to adversely affect HRQL and psychological distress—particularly anxiety and depressive symptoms—which may play a key role in this relationship. Identifying the mediating role of these symptoms may offer valuable insights into the mechanisms linking the performance status and HRQL. Methods: In a cross-sectional, correlational study, data on the HRQL (EORTC QLQ Version 3), performance status (Eastern Cooperative Oncology Group), and anxiety and depressive symptoms (Hospital Anxiety Depression Scale) were collected between February 2019 and June 2021. Process v4.1 for SPSS was used to analyze the data. Results: Sixty-five patients with female cancer participated (breast cancer = 44; gynecologic cancer = 21; mean age = 55.03 ± 8.65 years). Anxiety (p = 0.002), but not depressive symptoms (p = 0.525), mediated the relationship between the performance status and HRQL, explaining 41% of the variance in the HRQL (R² = 0.41, F = 14.06, p < 0.001). A better performance status was only indirectly associated with a better HROL through the effect on anxiety. The total effect of the performance status on the HRQL was 15.972 (confidence interval [CI] = 6.095, 25.849): direct effect = 7.226 (CI = −1.936, 16.389) and indirect effect = 6.878 (standardized indirect effect = 0.374) (CI = 1.195, 15.395). Conclusions: The findings of this study only supported the mediating role of anxiety in the relationship between the performance status and HRQL in patients with female cancer. To improve the HRQL in patients with female cancer, improvements in the performance status and reductions in anxiety are critical. Full article

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16 pages, 2406 KiB

Open AccessArticle

Analysis of Drainage Volume in External Ventricular Drainage Based on Intracranial Pressure and Drainage Catheter Size for Clinical Nurses

by Hanna Lee, Boeun Yang, Kyeongeun Lee and Jeongwon Han

Healthcare 2025, 13(9), 1009; https://doi.org/10.3390/healthcare13091009 - 27 Apr 2025

Abstract

Introduction: The purpose of this study is to provide foundational data for nursing care in patients with external ventricular drainage (EVD) by comparatively analyzing drainage volume in relation to intracranial pressure (ICP) and drainage catheter size. Methods: In this study, we conducted a [...] Read more.

Introduction: The purpose of this study is to provide foundational data for nursing care in patients with external ventricular drainage (EVD) by comparatively analyzing drainage volume in relation to intracranial pressure (ICP) and drainage catheter size. Methods: In this study, we conducted a volumetric analysis using the continuity and Bernoulli equations, considering friction forces under predefined conditions. In adults in the supine position with 37 °C CSF, the ventricular drainage volume was assessed based on the height of the EVD system, ICP levels, and EVD catheter sizes. Results: The results indicated that the CSF flow rate increased with larger catheter diameters and when the EVD system was positioned lower than the reference point (foramen of Monro). Across all catheter sizes, the minimum CSF flow occurred when the EVD system was 15 cm above the reference point, while the maximum flow was observed when it was 15 cm below the reference point. This multidisciplinary study, utilizing fluid dynamics, quantitatively estimates the drainage volume in EVD systems based on ICP and catheter size, contributing to the nursing care of EVD systems. The findings underscore the importance of developing specific nursing guidelines to improve patient safety in external ventricular drainage management and incorporating them into clinical education. Conclusions: A limitation of this study is that it does not compare with patients in clinical settings for clinical empirical validity. Therefore, a stepwise validation process is necessary. So, future studies will need to compare medical record data with the results of this study to confirm the validity of the equations presented. Full article

(This article belongs to the Special Issue Advancing Neurodevelopmental and Neurological Care: Innovations and Emerging Technologies)

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9 pages, 203 KiB

Open AccessArticle

Ego-Resiliency, Life Satisfaction and Symptoms of Anxiety and Depression Among Students of Pro-Health Faculties During COVID-19 Pandemic

by Karina Badura-Brzoza, Patryk Główczyński, Paweł Dębski and Małgorzata Dębska-Janus

Healthcare 2025, 13(9), 1008; https://doi.org/10.3390/healthcare13091008 - 27 Apr 2025

Abstract

Background: Ego-resiliency could play a protective role, especially in stressful situations. Such a situation is certainly the period of the COVID-19 pandemic. The beginning of the pandemic period was a source of significant stress for many people. Students, especially of medical faculties, [...] Read more.

Background: Ego-resiliency could play a protective role, especially in stressful situations. Such a situation is certainly the period of the COVID-19 pandemic. The beginning of the pandemic period was a source of significant stress for many people. Students, especially of medical faculties, were one of the social groups that could be particularly affected by the reorganization of everyday functioning. Effective coping with stress during this period could have been important for minimizing its negative effects. Aim: The aim of this study was to assess ego-resiliency as a factor enhancing life satisfaction and a protective factor against symptoms of anxiety and depression in a group of health students during the COVID-19 pandemic. Methods and Material: This study was conducted in the period from October 2020 to June 2021. The study group included 362 students of the medical faculty and 249 students of the Academy of Physical Education (APhE). The Ego Resiliency Scale (ER89-R12), the Life Satisfaction Scale (SWLS) and the Anxiety and Depression Scale (HADS) were used in this study. Among the statistical methods, the Mann–Whitney U test and Spearman’s rank correlation coefficient were used. Results: In the study group, medical students obtained an average score of 34.96 ± 5.19 points and APhE students obtained 36.49 ± 5.22 points on the ER-89-R12; the difference was statistically significant (p = 0.003). On the SWLS, the mean score was 23.65 ± 5.9 points for medical students and 22.35 ± 5.67 points for students of the APhE; the difference was also statistically significant (p = 0.005). In the assessment of anxiety, medical students obtained an average of 8.43 ± 4.34 points and students of the APhE 7.60 ± 4.27 points; the difference was statistically significant (p = 0.012). In the assessment of depression, medical students achieved 5.10 ± 3.77 points and students of APhE obtained about 4.77 ± 3.26 points; the difference was not statistically significant. There were significant, negative correlations in the scope of the results obtained on the ER-89-R12 with the results of anxiety and depression, and positive correlations with the results obtained on the SWLS scale for both groups. Conclusions: Life during the pandemic was assessed by students of pro-health faculties as moderately satisfactory. The severity of symptoms of anxiety and depression correlated negatively with life satisfaction. Ego-resiliency may be a factor enhancing life satisfaction and may be a protective factor against anxiety and depression symptoms. Full article

(This article belongs to the Special Issue Human Health Before, During, and After COVID-19)

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