Healthcare

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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16 pages, 367 KB

Open AccessArticle

COVID-19’s Impact on Health Professionals’ Quality of Professional Life: A Single-Site Cross-Sectional Study

by Michael Rovithis, Sofia Koukouli, Anastasia Konstantinou, Maria Moudatsou, Nikos Rikos, Manolis Linardakis, Konstantinos Piliotis and Areti Stavropoulou

Healthcare 2026, 14(2), 279; https://doi.org/10.3390/healthcare14020279 - 22 Jan 2026

Abstract

Background/Objectives: Professional quality of life influences patient care, staff well-being, and organizational efficacy. The COVID-19 pandemic placed pressure on healthcare professionals, disrupting their professional quality of life and imposing a psychological burden. In Greece, these issues were intensified by a decade of economic [...] Read more.

Background/Objectives: Professional quality of life influences patient care, staff well-being, and organizational efficacy. The COVID-19 pandemic placed pressure on healthcare professionals, disrupting their professional quality of life and imposing a psychological burden. In Greece, these issues were intensified by a decade of economic crisis, marked by constrained healthcare budget, personnel shortages, and insufficient resources. This study investigates the pandemic’s impact on the professional quality of life of Greek healthcare professionals to support targeted interventions. Methods: A cross-sectional study was conducted using descriptive statistics. The participants were a convenience sample of 246 healthcare professionals from a Greek regional university hospital with at least one year of experience and who had worked with COVID-19-positive or potentially exposed but asymptomatic patients. Data were collected between March and June 2021 using the Professional Quality of Life Scale (version 5). Results: Of the 246 participants, 81.3% were women and 33.8% were aged 50 or older. Moderate concern and fear regarding COVID-19 were reported, with 34.6% extremely afraid of transmitting the virus to family or friends and 22.8% to patients or their families. Overall professional quality of life was moderate: compassion satisfaction was moderate to high, while burnout and secondary traumatic stress were moderate to low. Higher compassion satisfaction was linked to holding a position of responsibility. Burnout was associated with having children, permanent employment, years of experience, and increased pandemic-related fear. Higher secondary traumatic stress was associated with older age, more years of experience, and greater pandemic-related fear. Conclusions: These findings support international research and highlight that the moderate levels observed indicate intrinsic motivation based on professionalism in patient care, providing evidence of resilience and coping mechanisms that reduce psychological consequences on well-being due to the pandemic. Full article

(This article belongs to the Special Issue Strategies and Interventions for Supporting the Holistic Well-Being of Clinicians and Nurses)

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15 pages, 506 KB

Open AccessArticle

Legislative Debate-Attributed Suicidality Among LGBTQ+ Adults: The Buffering Effect of Community Belongingness

by Keith J. Watts, Shawndaya S. Thrasher, Laneshia R. Conner, Nicole Campbell, Louis G. Baser, DeKeitra Griffin, Sydney P. Howard, Missy Spears and Justin X. Moore

Healthcare 2026, 14(2), 278; https://doi.org/10.3390/healthcare14020278 - 22 Jan 2026

Abstract

Background: In recent years, the sociopolitical landscape in the United States has shifted due to an increase in state-level legislation regarding LGBTQ+ rights, a trend that has been particularly pronounced in the Commonwealth of Kentucky. While the mental health impacts of enacted laws [...] Read more.

Background: In recent years, the sociopolitical landscape in the United States has shifted due to an increase in state-level legislation regarding LGBTQ+ rights, a trend that has been particularly pronounced in the Commonwealth of Kentucky. While the mental health impacts of enacted laws are increasingly documented, a critical gap remains in understanding the psychological toll of the legislative debates themselves—the prolonged periods of public discourse surrounding the restriction of rights. Methods: Utilizing data from the 2025 Queer Kentucky Survey (N = 817), this exploratory study examined the association between LGBTQ+ community belongingness and acute suicidality attributed specifically to anti-LGBTQ+ legislative debates. Data were derived from a non-probability snowball sample. Binary logistic regression models that adjusted for age, race, gender identity, education, and income were utilized. Results: Prevalence of debate-attributed suicidality was alarmingly high: 59.7% of the sample attributed increased suicidal thoughts, and 44.1% attributed a suicide attempt, specifically to the legislative debates. LGBTQ+ belongingness was a robust protective correlate, associated with significantly lower odds of both suicidal thoughts (OR = 0.61, p < 0.001) and attempts (OR = 0.41, p < 0.001). Analyses further revealed divergent risk for suicidality across demographic characteristics. Conclusions: Findings are consistent with the interpretation that legislative debates may function as distinct structural stressors associated with suicidal thoughts and suicide attempts. While community belongingness may offer a critical buffer, the elevated risks among Transgender and Black, Indigenous, and People of Color (BIPOC) populations highlight the need for intersectional, structural interventions beyond individual resilience. Full article

(This article belongs to the Special Issue Gender, Sexuality and Mental Health)

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19 pages, 1191 KB

Open AccessReview

Effects of Social Support Interventions on Medical Patient Survival: A Meta-Analysis of Non-Randomized Clinical Trials

by Ksenia Illinykh-Bair and Timothy B. Smith

Healthcare 2026, 14(2), 277; https://doi.org/10.3390/healthcare14020277 - 21 Jan 2026

Abstract

Background: Prior research confirms that social support promotes resilience among medical patients with chronic illness. Beyond emotional benefits, research has increasingly shown the importance of social support on physical health outcomes. Therefore, identifying and evaluating interventions that increase social support among medical [...] Read more.

Background: Prior research confirms that social support promotes resilience among medical patients with chronic illness. Beyond emotional benefits, research has increasingly shown the importance of social support on physical health outcomes. Therefore, identifying and evaluating interventions that increase social support among medical patients with chronic conditions is a priority for healthcare. Methods: This meta-analysis summarized data from 39,493 medical patients across 14 non-randomized trials that had been identified by a prior review of the survival benefits of social support interventions. Results: Across four studies reporting hazard ratio data, the results failed to reach statistical significance (HR = 2.10, 95% CI = 0.99 to 4.48, p = 0.0546), and the results of ten studies reporting odds ratio data were of smaller magnitude (OR = 1.27, 95% CI [0.72, 2.23], p > 0.05). Heterogeneity characterized both the odds ratio data (I² = 53%; Q = 18.1, p = 0.03) and hazard ratio data (I² = 89%, Q = 23, p < 0.001). A notable finding was that studies with longer periods of data collection showed longer survival among medical patients receiving social support. Conclusions: Long-term observations may be necessary for the survival benefits of social support interventions to become apparent. Further research with a larger pool of data from long-term follow-up studies will be needed to establish firm conclusions. Full article

(This article belongs to the Section Chronic Care)

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16 pages, 226 KB

Open AccessArticle

“The Window of Opportunity”: A Qualitative Exploration of Individual Reminiscence in Care Home Settings

by Aoife Conway, Rosemary Bradley, Assumpta Ryan, Claire McCauley, Brighide Lynch, Deirdre Harkin and Sarah Penney

Healthcare 2026, 14(2), 276; https://doi.org/10.3390/healthcare14020276 - 21 Jan 2026

Abstract

Background: Care homes are complex care environments where supporting residents’ identity, wellbeing, and sense of personhood is central to person-centred care. Reminiscence is widely recognised as a psychosocial approach that can support these outcomes. However, existing evidence has largely focused on group-based interventions, [...] Read more.

Background: Care homes are complex care environments where supporting residents’ identity, wellbeing, and sense of personhood is central to person-centred care. Reminiscence is widely recognised as a psychosocial approach that can support these outcomes. However, existing evidence has largely focused on group-based interventions, with comparatively limited attention given to how individual reminiscence is implemented and sustained within care home practice. Methods: This study was an implementation-focused qualitative exploration of staff experiences of introducing and embedding individualised reminiscence in care home practice. Care home staff participated in four monthly workshops that introduced principles of individualised reminiscence and supported them to plan and implement reminiscence with at least one resident. Participants used either the InspireD digital reminiscence app (n = 19) or non-digital approaches such as life story books (n = 2), depending on local preferences and perceived suitability. Three focus groups were conducted with 21 care home staff to explore experiences of implementing individualised reminiscence and perceptions of its impact on residents, staff, and families. Data were analysed using reflexive thematic analysis. Results: Four interrelated themes were identified: (1) reminiscence within pressured systems; (2) resident experience and identity; (3) adapting and sustaining practice; and (4) families as partners in reminiscence. Participants described challenges associated with workload pressures, role expectations, and variability in family involvement, which influenced how reminiscence was adopted in practice. Despite these constraints, participants described perceived benefits for residents, including perceived improvements in mood, engagement, and expressions of identity. Participants also discussed perceived increased staff confidence, strengthened staff–resident relationships, and enhanced awareness of person-centred care practices. Conclusions: Findings highlight the perceived potential of individualised reminiscence to support person-centred and relational care in care homes, while identifying key contextual influences on implementation. Further research is needed to examine sustainability and effectiveness using comparative and mixed-method designs. Full article

(This article belongs to the Special Issue Novel Research and Care Strategies for Older Adults with Stroke and/or Dementia)

13 pages, 234 KB

Open AccessArticle

Exploring the Illness Experience of Patients with Central Nervous System Hemangioblastomas in Von Hippel–Lindau Disease: A Qualitative Study

by Mei-Fang Chuang, Pi-Hua Huang, Jing-Shan Huang and Chii Jeng

Healthcare 2026, 14(2), 275; https://doi.org/10.3390/healthcare14020275 - 21 Jan 2026

Abstract

Background/Objectives: Von Hippel–Lindau (VHL) disease is a rare autosomal dominant hereditary disorder. Central nervous system hemangioblastomas are one of the most common tumor types associated with VHL disease. Although these tumors are histologically benign, delayed diagnosis and treatment may result in severe neurological [...] Read more.

Background/Objectives: Von Hippel–Lindau (VHL) disease is a rare autosomal dominant hereditary disorder. Central nervous system hemangioblastomas are one of the most common tumor types associated with VHL disease. Although these tumors are histologically benign, delayed diagnosis and treatment may result in severe neurological dysfunction, permanent disability, and even death. However, little is known about the experiences of patients with VHL disease. The aim of this study was to gain a better understanding of the illness experiences and psychological responses of patients with VHL disease accompanied by central nervous system hemangioblastomas. Methods: A qualitative study based on a semi-structured guide was conducted. Twelve participants were recruited. Data were collected through face-to-face interviews and analyzed using the constant comparative method. Results: Four themes and their subthemes were identified: 1. powerlessness—unpredictable disease progression and uncontrollable continuity; 2. negative emotional experiences—guilt and self-blame, depression, and low self-esteem; 3. compromise—acceptance of fate, positive outlook, and sense of hope; and 4. persistent worry—worries about family members, anxiety regarding finances and employment, and uncertainty regarding the future. Conclusions: This study identified four major themes in the illness experiences of patients with VHL disease accompanied by central nervous system hemangioblastomas, which provided deep insights into the care needs of individuals with VHL disease. Healthcare providers should develop effective measures to enhance patients’ ability to maintain a good quality of life and confront the future with resilience. Full article

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