Healthcare

14 pages, 345 KB

Open AccessArticle

Psychological and Physiological Assessment of Distress Among Public Healthcare Workers During Pandemic Control Efforts

by Dinko Martinovic, Anamarija Jurcev Savicevic, Majda Gotovac, Zeljko Kljucevic, Magda Pletikosa Pavic, Marko Kumric, Zeljka Karin, Slavica Kozina, Daniela Supe Domic, Manuel Colome-Hidalgo and Josko Bozic

Healthcare 2026, 14(2), 212; https://doi.org/10.3390/healthcare14020212 - 14 Jan 2026

Abstract

Background/Objectives: Public healthcare workers face significant occupational stress during crisis situations, yet research on this particular population remains limited compared to other healthcare workers. The aim of this study was to investigate the impact of the COVID-19 pandemic on distress levels and the [...] Read more.

Background/Objectives: Public healthcare workers face significant occupational stress during crisis situations, yet research on this particular population remains limited compared to other healthcare workers. The aim of this study was to investigate the impact of the COVID-19 pandemic on distress levels and the sense of coherence among public health workers by integrating psychological assessments with physiological markers of stress to identify protective factors against pandemic-related occupational stress. Methods: This longitudinal study was conducted at the Teaching Public Health Institute of Split and Dalmatia County from July 2021 to February 2022 at two time points: the latency phase (between COVID-19 waves) and hyperarousal phase (during an active wave). Fifty-four public health workers participated in the study. There were three questionnaires assessing psychological distress: Kessler Psychological Distress Scale, Impact of Events Scale—Revised and Sense of Coherence Scale-29. Salivary and blood samples were collected at both time points to measure cortisol levels, cortisol awakening response, and interleukin-6 concentrations. Results: The cortisol area under the curve with respect to ground (AUCg) was significantly elevated during the stress phase compared to the latency phase (234.8 vs. 201.8; p = 0.023), indicating heightened physiological stress responses. Epidemiologists demonstrated significantly lower sense of coherence scores compared to non-epidemiologists (117.9 ± 9.1 vs. 125.6 ± 10.5; p = 0.029). A lower sense of coherence was significantly associated with higher psychological distress and post-traumatic stress symptoms. Multiple linear regression analysis revealed that sense of coherence and interleukin-6 levels were significant independent predictors of cortisol changes. Conclusions: The findings demonstrate that public health workers experience measurable physiological stress responses during pandemic peaks, with sense of coherence emerging as a protective psychological factor. Interventions targeting sense of coherence and organizational support may possibly enhance resilience and reduce mental health morbidity in this vulnerable workforce during crisis situations. Full article

14 pages, 282 KB

Open AccessReview

Digital Mental Health Through an Intersectional Lens: A Narrative Review

by Rose Yesha, Max C. E. Orezzoli, Kimberly Sims and Aviv Y. Landau

Healthcare 2026, 14(2), 211; https://doi.org/10.3390/healthcare14020211 - 14 Jan 2026

Abstract

For individuals with mental illness who experience multidimensional marginalization, the risks of encountering discrimination and receiving inadequate care are compounded. Artificial intelligence (AI) systems have propelled the provision of mental healthcare through the creation of digital mental health applications (DMHAs). DMHAs can be [...] Read more.

For individuals with mental illness who experience multidimensional marginalization, the risks of encountering discrimination and receiving inadequate care are compounded. Artificial intelligence (AI) systems have propelled the provision of mental healthcare through the creation of digital mental health applications (DMHAs). DMHAs can be trained to identify specific markers of distress and resilience by incorporating community knowledge in machine learning algorithms. However, DMHAs that use rule-based systems and large language models (LLMs) may generate algorithmic bias. At-risk populations face challenges in accessing culturally and linguistically competent care, often exacerbating existing inequities. Creating equitable solutions in digital mental health requires AI training models that adequately represent the complex realities of marginalized people. This narrative review analyzes the current literature on digital mental health through an intersectional framework. Using an intersectional framework considers the nuanced experiences of individuals whose identities lie at the intersection of multiple stigmatized social groups. By assessing the disproportionate mental health challenges faced by these individuals, we highlight several culturally responsive strategies to improve community outcomes. Culturally responsive strategies include digital mental health technologies that incorporate the lived experience of individuals with intersecting identities while reducing the incidence of bias, harm, and exclusion. Full article

(This article belongs to the Special Issue Advancing Mental Well-Being and Health Equity in Marginalized Communities)

11 pages, 233 KB

Open AccessArticle

Health Education Modalities and Influencing Factors in Rural Philippine Communities: A Mixed-Methods Study

by Andrew Thomas Reyes, Carol Manilay-Robles, Reimund Serafica, Marysol C. Cacciata, Jennifer Kawi and Lorraine S. Evangelista

Healthcare 2026, 14(2), 210; https://doi.org/10.3390/healthcare14020210 - 14 Jan 2026

Abstract

Background: Health education is a vital component of preventative care; however, rural Filipino adults often face structural, linguistic, and access barriers to obtaining reliable health information. Designing equitable and culturally relevant health education programs requires understanding which sources are most significant and how [...] Read more.

Background: Health education is a vital component of preventative care; however, rural Filipino adults often face structural, linguistic, and access barriers to obtaining reliable health information. Designing equitable and culturally relevant health education programs requires understanding which sources are most significant and how context affects them. Objective: To identify preferred sources of health education among adults in rural Philippine communities and investigate the contextual factors that influence these preferences. Methods: A cross-sectional mixed-methods study included 1203 adults from disadvantaged Luzon and Visayas barangays. Participants completed a self-administered survey on the importance of neighborhood health fairs, native-language instructional tools, and social media. Descriptive statistics (mean ± standard deviation) were used to aggregate importance ratings, and exploratory comparisons were made using paired and independent-samples t-tests. A subsample of 60 semi-structured interviews was analyzed using thematic analysis to interpret qualitative data. Results: Community health fairs were identified as the primary source of health education, with a mean rating of 8.5 ± 1.6, followed by native-language educational materials, which received a mean rating of 5.5 ± 2.4. In contrast, social media was rated the lowest, with a mean of 3.5 ± 2.3. Preference patterns were consistent across regions and sociodemographic groups, with only slight variation in rating magnitudes. Qualitative analysis revealed four themes influencing source preferences: accessibility and proximity, cultural and linguistic relevance, confidence in local health providers, and structural obstacles to digital access. Conclusions: In rural Philippine communities, intimacy, confidence, and cultural congruence influence health education preferences more than online platforms do. Strengthening community-based, locally integrated health education strategies may enhance the reach and contextual relevance of preventive health communication in underserved settings. Full article

18 pages, 798 KB

Open AccessArticle

A Qualitative Study on the Experiences of Adult Females with Late Diagnosis of ASD and ADHD in the UK

by Victoria Wills and Rhyddhi Chakraborty

Healthcare 2026, 14(2), 209; https://doi.org/10.3390/healthcare14020209 - 14 Jan 2026

Abstract

Background: Adult females with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are frequently underdiagnosed due to gender bias, overlapping symptoms, and limited awareness among healthcare professionals. The scarcity of research on this subject—particularly in the UK context—underscores the need for [...] Read more.

Background: Adult females with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are frequently underdiagnosed due to gender bias, overlapping symptoms, and limited awareness among healthcare professionals. The scarcity of research on this subject—particularly in the UK context—underscores the need for further investigation. Accordingly, the aim of this study was to explore the lived experiences of adult females receiving a late diagnosis of ASD and/or ADHD and to identify key barriers within the UK diagnostic pathway. This study addresses a critical knowledge gap by examining the factors contributing to delayed diagnosis within the United Kingdom. Study Design and Method: The study employed a qualitative approach, utilising an anonymous online questionnaire survey comprising nine open-ended questions. Responses were obtained from 52 UK-based females aged 35–65 years who had either received or were awaiting a diagnosis of ASD and/or ADHD. Data were analysed thematically within a constructivist framework. Findings: The analysis revealed three overarching themes: (i) limited understanding and lack of empathy among healthcare professionals, (ii) insufficient post-diagnostic support, with most participants reporting no follow-up care, and (iii) a complex, protracted diagnostic process, often involving waiting periods exceeding three years. Gender bias and frequent misdiagnosis were recurrent issues, contributing to significant psychological distress. These findings underscore the need for systemic reforms and align closely with gaps identified in the existing literature. Conclusions: The findings emphasise the urgent need for gender-sensitive diagnostic frameworks, enhanced professional training, and a person-centred approach to care. Key recommendations include shortening diagnostic waiting times, strengthening healthcare professionals’ knowledge base, and ensuring equitable and consistent post-diagnostic support. Full article

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

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15 pages, 205 KB

Open AccessConference Report

Preparing Health Professionals for Environmental Health and Climate Change: A Challenge for Europe

by Guglielmo M. Trovato, Camille A. Huser, Lynn Wilson and Giovanni S. Leonardi

Healthcare 2026, 14(2), 208; https://doi.org/10.3390/healthcare14020208 - 14 Jan 2026

Abstract

Even though environmental health and climate change are rapidly intensifying the severity of determinants of disease and inequity, training for health professionals in these areas remains fragmented across Europe. To address this gap, the European Medical Association (EMA), in collaboration with the European [...] Read more.

Even though environmental health and climate change are rapidly intensifying the severity of determinants of disease and inequity, training for health professionals in these areas remains fragmented across Europe. To address this gap, the European Medical Association (EMA), in collaboration with the European Network on Climate and Health Education (ENCHE), the International Network on Public Health and Environment Tracking (INPHET) and University College London, convened a one-day hybrid roundtable in London on 17 September 2025, focused on “Preparing Health Professionals for Environmental Health and Climate Change: A Challenge for Europe”. The programme combined keynote presentations on global and European policy, health economics and curriculum design with three disease-focused roundtables (respiratory, cardiovascular and neurological conditions), each examining the following topics: (A) climate and environment as preventable causes of disease; (B) healthcare as a source of environmental harm; and (C) capacity building through education and training. Contributors highlighted how environmental epidemiology, community-based prevention programmes and sustainable clinical practice can be integrated into teaching, illustrating models from respiratory, cardiovascular, surgical and neurological care. EU-level speakers outlined the policy framework (European Green Deal, Zero Pollution Action Plan and forthcoming global health programme) and tools through which professional and scientific societies can both inform and benefit from European action on environment and health. Discussions converged on persistent obstacles, including patchy national commitments to decarbonising healthcare, isolated innovations that are not scaled and curricula that do not yet embed sustainability in examinable clinical competencies. The conference concluded with proposals to develop an operational education package on environmental and climate health; map and harmonise core competencies across undergraduate, postgraduate and Continuing -professional-development pathways; and establish a permanent EMA-led working group to co-produce a broader position paper with professional and scientific societies. This conference report summarises the main messages and is intended as a bridge between practice-based experience and a formal EMA position on environmental-health training in Europe. Full article

(This article belongs to the Section Healthcare and Sustainability)

12 pages, 516 KB

Open AccessArticle

Migraine Characteristics Among Smokers and Non-Smokers: A Cross-Sectional Survey in Saudi Arabia

by Abdullah Alsabaani, Mona Hussain Aldukain, Ali Hussain Aldukain, Roaa Al Murayyi, Shahad Ali Alshehri, Shuruq Abdullah M. Alqahtani, Omair Mohammed O. Alshahrani, Abdulmohsin Mohammed S. Alzuhairi and Syed Esam Mahmood

Healthcare 2026, 14(2), 207; https://doi.org/10.3390/healthcare14020207 - 14 Jan 2026

Abstract

Background: Migraine is a prevalent neurological disorder associated with significant morbidity and social burden. Although various triggers for migraine have been identified, the relationship between smoking and migraine remains unclear. This study aimed to compare migraine characteristics between people with and without smoking [...] Read more.

Background: Migraine is a prevalent neurological disorder associated with significant morbidity and social burden. Although various triggers for migraine have been identified, the relationship between smoking and migraine remains unclear. This study aimed to compare migraine characteristics between people with and without smoking in Saudi Arabia. Methods: A cross-sectional study using an online survey tool had been conducted in Saudi Arabia. The survey assessed migraine characteristics, smoking behaviour, demographics, and comorbidities. Statistical analyzes were performed to investigate the occurrence of migraine, smoking behaviour, and demographic factors. Descriptive statistics summarized the data, with various statistical tests employed to compare variables between groups. Results: A total of 229 participants were included in the study, with a majority being young adults (48.47%), predominantly females (66.81%), and holding a bachelor’s degree (63.32%). The study found that 19.2% of individuals with migraine were current smokers, with an average smoking duration of 9.7 years. While some reported relief from migraine pain, others experienced increased pain intensity or frequency. No significant differences were found in migraine characteristics between smokers and non-smokers, but younger individuals and males with migraine were more likely to smoke. The study highlights the complex relationship between smoking and migraine, with varying effects on individuals. Conclusions: The study underscores the lack of significant differences in migraine characteristics between smokers and non-smokers, suggesting that smoking does not play a pivotal role in the clinical presentation of migraines. This insight prompts a shift in research focus towards other potential contributors to migraines, such as genetic predispositions, environmental factors, and comorbidities. Understanding these associations can inform public health strategies aimed at alleviating migraine-related burdens. Full article

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6 pages, 168 KB

Open AccessEditorial

New Advances in Palliative Care—State of the Field, Its Challenges and Advances at the End of the Year 2025

by Georg Bollig and Erika Zelko

Healthcare 2026, 14(2), 206; https://doi.org/10.3390/healthcare14020206 - 14 Jan 2026

Abstract

In recent decades, palliative care has become an essential component of modern healthcare systems [...] Full article

(This article belongs to the Special Issue New Advances in Palliative Care)

18 pages, 260 KB

Open AccessArticle

Untold Stories of Black and Racialized Immigrants with Disabilities During COVID-19 in the Greater Toronto and Hamilton Area

by Chavon Niles, Karen Yoshida, Kelsey Vickers, Jheanelle Anderson, Yahya El-Lahib, Rana Hamdy and Nadeen Al Awamry

Healthcare 2026, 14(2), 205; https://doi.org/10.3390/healthcare14020205 - 14 Jan 2026

Abstract

Background: Black and racialized immigrants with disabilities in Canada face overlapping systems of exclusion rooted in racism, ableism, and migration status. Yet, their experiences within health and rehabilitation services during the COVID-19 pandemic remain largely undocumented. This study explores how structural inequities [...] Read more.

Background: Black and racialized immigrants with disabilities in Canada face overlapping systems of exclusion rooted in racism, ableism, and migration status. Yet, their experiences within health and rehabilitation services during the COVID-19 pandemic remain largely undocumented. This study explores how structural inequities shaped access to healthcare, rehabilitation, information, and community supports in the Greater Toronto and Hamilton Area (GTHA). Methods: Using narrative inquiry, ten in-depth interviews were conducted with participants who identified as Black or racialized, disabled, and having immigrated to Canada within the last 10 years. Narratives were analyzed through reflexive thematic analysis to identify how systems, relationships, and policies interacted to shape daily life, health and rehabilitation navigation during the pandemic. Results: Participants described systemic barriers in health and rehabilitation systems, experiences of “othering” and conditional belonging, and the critical role of informal and faith-based networks in navigating inaccessible services. Pandemic policies often intensified existing inequities. Conclusions: Findings underscore the need for intersectional health and rehabilitation planning that centers the voices of Black and racialized disabled immigrants. Addressing systemic racism and ableism is essential for equitable preparedness in future public health emergencies. Full article

(This article belongs to the Special Issue Health Equity and People-Centered Systems: Meeting Needs and Creating Opportunities for Diverse Communities)

13 pages, 472 KB

Open AccessArticle

Patient Activation Among Individuals with Chronic Illness: A Cross-Sectional Study from Jordan

by Mohammad B. Nusair, Rawand Khasawneh, Fahad H. Baali, Ahmed B. Alkhalil, Samer A. Aldehoun and Sayer Al-Azzam

Healthcare 2026, 14(2), 204; https://doi.org/10.3390/healthcare14020204 - 13 Jan 2026

Abstract

Background: Managing chronic conditions can overwhelm patients and reduce their confidence in self-management. Patient activation (PA) is a concept that reflects patients’ knowledge, skills, and confidence in managing their health and self-care. In Jordan, PA has not been explicitly studied, particularly among patients [...] Read more.

Background: Managing chronic conditions can overwhelm patients and reduce their confidence in self-management. Patient activation (PA) is a concept that reflects patients’ knowledge, skills, and confidence in managing their health and self-care. In Jordan, PA has not been explicitly studied, particularly among patients with chronic conditions. Therefore, this study explores PA and its determinants in individuals with chronic conditions in Jordan. Methods: A cross-sectional study was conducted using a convenience sample of outpatients recruited from a tertiary hospital in Jordan. Participants completed a questionnaire including sociodemographic and clinical data, the Single Item Literacy Screener, and the 13-item Patient Activation Measure (PAM). Bivariate and regression analyses were conducted to explore the factors associated with PAM scores. Results: Among a total of 666 participants, the mean PAM score was 57.1 ± 9.17, indicating a moderate activation level overall. Regression analysis revealed that being female (p = 0.14), adequate health literacy (p = 0.002), and post-secondary education (p = 0.004) were significantly associated with higher PAM scores, and older age (p = 0.004) and polypharmacy (p = 0.010) with lower scores. An additional regression model showed that the negative association between polypharmacy and PA scores did not differ by health literacy level, with no significant interaction between polypharmacy and health literacy (p = 0.555). Conclusions: This study showed that individuals with chronic illnesses in Jordan had moderate to high patient activation levels. Several sociodemographic and clinical factors were significantly associated with patient activation. Polypharmacy was independently associated with lower patient activation scores, regardless of health literacy levels. However, given the study’s exploratory nature, the results should be interpreted as preliminary evidence warranting further research. Full article

16 pages, 600 KB

Open AccessArticle

Mapping Competence in Gastrointestinal Endoscopy Nursing Practice: An Item Response Theory Analysis of Perceived Skill Acquisition and Maintenance in Italy

by Mattia Bozzetti, Gennaro Pascale, Ilaria Marcomini, Alessio Lo Cascio, Fabio Grilli, Caterina Sclapari, Grazia Multari, Nicoletta Orgiana, Mirko Gaggiotti, Giorgio Iori, Luciana Nicola Giordano, Stefano Mancin, Fabio Petrelli, Giovanni Cangelosi, Loris Riccardo Lopetuso and Daniele Napolitano

Healthcare 2026, 14(2), 203; https://doi.org/10.3390/healthcare14020203 - 13 Jan 2026

Abstract

Objective. The aim of this study was to define a structured competence model for nurses working in gastrointestinal endoscopy in Italy and to assess nurses’ perceptions of the number of procedural repetitions required to acquire and maintain competence across different endoscopic procedures. [...] Read more.

Objective. The aim of this study was to define a structured competence model for nurses working in gastrointestinal endoscopy in Italy and to assess nurses’ perceptions of the number of procedural repetitions required to acquire and maintain competence across different endoscopic procedures. Methods. A cross-sectional online survey targeted registered nurses working in Italian gastrointestinal endoscopy units. The questionnaire, developed from guidelines and expert consensus, covered demographics, organizational context, and perceived repetition thresholds for 30 procedures. Partial Credit Models (PCMs) estimated acquisition and maintenance thresholds; Differential Item Functioning (DIF) tested differences by self-reported experience level. Results. A total of 332 nurses participated (68.4% female; mean age 47.1 years; mean endoscopy experience 10.1 years). For competence acquisition, most procedures were placed in the 11–30 or 31–50 repetition range, with higher values for complex techniques. Competence maintenance generally required fewer repetitions, but thresholds varied by procedure. Advanced or infrequently performed techniques were perceived as more demanding. More experienced nurses reported higher thresholds, reflecting stricter internal standards. Conclusions. Acquisition and maintenance of gastrointestinal endoscopy competences differ in intensity and frequency requirements, supporting the need for tailored, modular training pathways. Findings highlight the importance of national competence standards, adaptive learning technologies, and structured mentorship to enhance skill development, reduce variability, and promote consistent, high-quality patient care across Italy. Full article

(This article belongs to the Special Issue Advances in Public Health and Healthcare Management for Chronic Care)

19 pages, 1127 KB

Open AccessArticle

Mind the Motion: Feasibility and Effects of a Qigong Intervention on Interoception and Well-Being in Young Adults

by Rebecca Ciacchini, Alessandro Lazzarelli, Giorgia Papini, Aleandra Viti, Francesca Scafuto, Graziella Orrù, Angelo Gemignani and Ciro Conversano

Healthcare 2026, 14(2), 202; https://doi.org/10.3390/healthcare14020202 - 13 Jan 2026

Abstract

Background/Objectives: The present exploratory study evaluates the feasibility and psychological effects of a structured Qigong intervention implemented in an Italian university setting. Qigong is a traditional Chinese mind–body practice combining gentle movements, breathwork, and mindful attention, aimed at enhancing mind–body integration and [...] Read more.

Background/Objectives: The present exploratory study evaluates the feasibility and psychological effects of a structured Qigong intervention implemented in an Italian university setting. Qigong is a traditional Chinese mind–body practice combining gentle movements, breathwork, and mindful attention, aimed at enhancing mind–body integration and interoceptive awareness. Methods: A total of 332 undergraduate students voluntarily enrolled in a 12-week Qigong program. The intervention was based on Neidan Qigong and integrated both static and dynamic exercises. Psychological functioning was assessed through several self-report measures evaluating a range of constructs, including mindfulness (FFMQ), interoceptive ability (MAIA), perceived stress (PSS), depression, anxiety, and stress (BDI; DASS-21; STAI Y), emotion regulation (DERS), alexithymia (TAS), and sleep quality (PSQI). Results: A total of 114 students completed the intervention. The protocol was well received by participants and demonstrated high feasibility in the academic context, with good attendance rates and overall engagement. Preliminary findings indicate consistent improvements across several psychological domains. Conclusions: The results suggest that Qigong may be associated with improvements in mental health and well-being in young adults and may represent a promising, low-cost intervention. The findings should be interpreted as preliminary. Further research using controlled and methodologically rigorous designs is needed to assess the stability of these effects over time, incorporate physiological measures, and clarify the specific therapeutic contribution of spontaneous movement within Qigong practice. Full article

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16 pages, 878 KB

Open AccessCase Report

Late Cervical Recurrence of Invasive Lobular Carcinoma Ten Years After Primary Breast Cancer: A Case Report and Review of the Literature

by Giulia Pellecchia, Stefano Restaino, Matteo Alfarè Lovo, Martina Arcieri, Monica Della Martina, Marco Petrillo, Giampiero Capobianco, Lorenza Driul, Giuseppe Vizzielli and The Gynecological Oncological Tumor Board Group

Healthcare 2026, 14(2), 201; https://doi.org/10.3390/healthcare14020201 - 13 Jan 2026

Abstract

Invasive lobular carcinoma (ILC) accounts for approximately 15% of breast cancers and the most common neoplasm in the female population. Cervical involvement is exceptionally rare and often underrecognized. This relationship is well-defined in the context of breast and ovarian cancer syndrome related to [...] Read more.

Invasive lobular carcinoma (ILC) accounts for approximately 15% of breast cancers and the most common neoplasm in the female population. Cervical involvement is exceptionally rare and often underrecognized. This relationship is well-defined in the context of breast and ovarian cancer syndrome related to BRCA gene mutations. However, it is also observed in rare but underreported cases of cervical metastases originating from breast cancer. The objective of this manuscript is to describe a rare case of cervical recurrence of invasive lobular carcinoma and summarize comparable case to guide future gynecologic follow-up strategies. Therefore, we report the case of a 60-year-old woman who developed a late cervical recurrence of ILC ten years after her initial breast cancer diagnosis. The patient had previously undergone mastectomy for ER-positive, PR-positive, HER2-negative ILC, followed by five years of adjuvant endocrine therapy. She remained disease-free until presenting with post-menopausal bleeding, urinary symptoms, and acute renal failure. Pelvic examination and ultrasonography revealed an enlarged, indurated cervix with bilateral hydroureteronephrosis. Biopsy demonstrated a discohesive infiltrate consistent with metastatic lobular carcinoma, confirmed by immunohistochemistry (GATA3+, CK7+, ER/PR+, E-cadherin−, CK20−, CDX2−). Staging PET-CT showed additional metastases involving bone, peritoneum, and lymph nodes. The patient began systemic therapy with ribociclib plus letrozole, achieving radiologic improvement of the cervical lesion and abdominal disease. After a follow-up of several months, she maintains stable disease but has persistent chronic renal impairment secondary to obstructive uropathy. This case highlights the ability of ILC to recur after long latency and to metastasize to unusual gynecologic sites such as the cervix. We also review the literature on cervical recurrence from lobular carcinoma to emphasize the importance of gynecologic surveillance in breast cancer survivors and to identify areas that require further investigation. Full article

(This article belongs to the Special Issue Progress in Female Reproductive Health)

16 pages, 285 KB

Open AccessArticle

Relationships Between Hematological Variables and Bone Metabolism in Elite Female Trail Runners

by Marta Carrasco-Marginet, Silvia Puigarnau, Javier Espasa-Labrador, Álex Cebrián-Ponce, Fabrizio Gravina-Cognetti, Nil Piñol-Granadino and Alfredo Irurtia

Healthcare 2026, 14(2), 200; https://doi.org/10.3390/healthcare14020200 - 13 Jan 2026

Abstract

Background: This study investigated the relationships between hematological and bone metabolism variables in 35 elite female trail runners, focusing on identifying key hematological correlates of bone health. Methods: Forty-four hematological variables, including biochemical, hormonal, metabolic, liver enzyme, and iron profiles, as well as [...] Read more.

Background: This study investigated the relationships between hematological and bone metabolism variables in 35 elite female trail runners, focusing on identifying key hematological correlates of bone health. Methods: Forty-four hematological variables, including biochemical, hormonal, metabolic, liver enzyme, and iron profiles, as well as complete blood count and platelet indices, were analyzed. Bone mineral density (BMD) and bone mineral content (BMC) were assessed at multiple skeletal regions via dual-energy X-ray absorptiometry (DXA). A cross-sectional design was employed, utilizing descriptive statistics, correlation analyses, and multiple linear regression to analyze the associations between hematological markers and BMC and BMD. Results: Significant but moderate associations were identified: magnesium consistently emerged as a negatively associated factor, particularly associated with BMC and BMD in the lumbar spine (L1–L4) and whole-body, potentially reflecting hypothesized mineral mobilization during chronic physical stress. Follicle-stimulating hormone showed positive associations with BMD, suggesting a potential protective association in bone turnover regulation. Additionally, calcium and thyroid hormones were linked to regional bone properties, highlighting site-specific skeletal vulnerabilities. Conclusions: These findings suggest a complex interplay between mineral homeostasis and hormonal balance that may be related to skeletal integrity in elite female trail runners. This work provides a foundation for developing evidence-based guidelines to support the health and performance of female endurance athletes. Further research is warranted to confirm these results through longitudinal evaluations. Full article

(This article belongs to the Special Issue From Prevention to Recovery in Sports Injury Management)

15 pages, 288 KB

Open AccessArticle

Qualitative Evaluation of a Clinical Decision-Support Tool for Improving Anticoagulation Control in Non-Valvular Atrial Fibrillation in Primary Care

by Maria Rosa Dalmau Llorca, Elisabet Castro Blanco, Zojaina Hernández Rojas, Noèlia Carrasco-Querol, Laura Medina-Perucha, Alessandra Queiroga Gonçalves, Anna Espuny Cid, José Fernández Sáez and Carina Aguilar Martín

Healthcare 2026, 14(2), 199; https://doi.org/10.3390/healthcare14020199 - 13 Jan 2026

Abstract

Objectives: Clinical decision-support systems are computer-based tools to improve healthcare decision-making. However, their effectiveness depends on being positively perceived and well understood by healthcare professionals. Qualitative research is particularly valuable for exploring related behaviors and attitudes. This study aims to explore experiences [...] Read more.

Objectives: Clinical decision-support systems are computer-based tools to improve healthcare decision-making. However, their effectiveness depends on being positively perceived and well understood by healthcare professionals. Qualitative research is particularly valuable for exploring related behaviors and attitudes. This study aims to explore experiences of family physicians and nurses concerning the visualization, utility and understanding of the non-valvular atrial fibrillation clinical decision-support system (CDS-NVAF) tool in primary care in Catalonia, Spain. Methods: We performed a qualitative study, taking a pragmatic utilitarian approach, comprising focus groups with healthcare professionals from primary care centers in the intervention arm of the CDS-NVAF tool randomized clinical trial. A thematic content analysis was performed. Results: Thirty-three healthcare professionals participated in three focus groups. We identified three key themes: (1) barriers to tool adherence, encompassing problems related to understanding the CDS-NVAF tool, alert fatigue, and workload; (2) using the CDS-NVAF tool: differences in interpretations of Time in Therapeutic Range (TTR) assessments, and the value of TTR for assessing patient risk; (3) participants’ suggestions: improvements in workflow, technical aspects, and training in non-valvular atrial fibrillation management. Conclusions: Healthcare professionals endorsed a clinical decision-support system for managing oral anticoagulation in non-valvular atrial fibrillation patients in primary care. However, they emphasized the view that the CDS-NVAF requires technical changes related to its visualization and better integration in their workflow, as well as continuing training to reinforce their theoretical and practical knowledge for better TTR interpretation. Full article

(This article belongs to the Section Digital Health Technologies)

11 pages, 245 KB

Open AccessArticle

Emotional Well-Being and Glycemic Control in People with Diabetes After a Multidisciplinary Hybrid Education

by Carmen Amelia Ruiz-Trillo, Ana Pérez-Morales, Ana Cortés-Lerena, Pilar Santa Cruz-Álvarez, Mónica Enríquez-Macias, Manuel Pabón-Carrasco, Miguel Garrido-Bueno, Rocío Romero-Castillo and Virginia Bellido

Healthcare 2026, 14(2), 198; https://doi.org/10.3390/healthcare14020198 - 13 Jan 2026

Abstract

Background/Objectives: Multidisciplinary hybrid educational programs combined with continuous glucose monitoring may contribute to improved self-management in adults with type 1 diabetes mellitus (T1DM); however, real-world evidence remains limited. This study assessed the effects of an educational intervention integrated with continuous glucose monitoring on [...] Read more.

Background/Objectives: Multidisciplinary hybrid educational programs combined with continuous glucose monitoring may contribute to improved self-management in adults with type 1 diabetes mellitus (T1DM); however, real-world evidence remains limited. This study assessed the effects of an educational intervention integrated with continuous glucose monitoring on glycemic control and patient-reported outcomes in adults with T1DM. Methods: We conducted a single-group quasi-experimental study including 210 adults with T1DM from a public hospital. The nurse-led hybrid intervention consisted of a 2-h in-person group educational session followed by an individual telematic follow-up session. All participants used continuous glucose monitoring. The primary outcome was the change in HbA1c at 9 months. Secondary outcomes included continuous glucose monitoring metrics, diabetes-related quality of life, treatment satisfaction, and hypoglycemia awareness. Results: HbA1c showed a statistically significant but modest reduction from 7.70 ± 1.10% to 7.45 ± 0.91% following the intervention (p = 0.003). No statistically significant changes were observed in continuous glucose monitoring metrics, including time in range, time below and above range, mean glucose, glycemic variability, or sensor wear time. In terms of emotional well-being, treatment satisfaction increased significantly (8.17 ± 7.86 vs. 12.73 ± 5.49; p < 0.001), and the Clarke score showed a statistically significant but modest decrease (2.49 ± 1.90 vs. 2.12 ± 1.88; p = 0.017). Although the overall quality of life score did not change significantly, statistically significant differences were observed in several subscales, including satisfaction, impact, and diabetes-related concern. Conclusions: A multidisciplinary hybrid educational intervention integrated with continuous glucose monitoring was associated with modest improvements in HbA1c and statistically significant, though limited, enhancements in quality of life, treatment satisfaction, and hypoglycemia awareness in adults with T1DM. These findings suggest that similar educational models may have a supportive role in routine care. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches to Chronic Disease Management)

14 pages, 263 KB

Open AccessArticle

Experiences of a Mindfulness-Based Telehealth Program Modified for Adults with Cerebral Palsy—A Qualitative Study

by Georgina Henry, Ingrid Honan, Emma Waight, Katherine Swinburn, Fiona Given, Sarah McIntyre and Hayley Smithers-Sheedy

Healthcare 2026, 14(2), 197; https://doi.org/10.3390/healthcare14020197 - 13 Jan 2026

Abstract

Backgrounds/Objectives: Mindfulness-based stress reduction (MBSR) programs may have applications for adults with cerebral palsy (CP), particularly as this population is at increased risk of mental health challenges relative to the general population. However, little is known about the experiences of adults with CP [...] Read more.

Backgrounds/Objectives: Mindfulness-based stress reduction (MBSR) programs may have applications for adults with cerebral palsy (CP), particularly as this population is at increased risk of mental health challenges relative to the general population. However, little is known about the experiences of adults with CP participating in these programs. The aim of this study was to explore the experiences of adults with CP, and a facilitator, who participated in a 9-week MBSR telehealth program. Methods: Adults who attended an MBSR telehealth program were invited to participate in focus groups. If a participant was unable to attend a focus group, they were offered a semi-structured interview. The facilitator participated in a semi-structured interview. Focus groups and interviews were recorded, transcribed verbatim, and inductively thematically analyzed using Framework Analysis. Results: Ten adults with CP and one facilitator participated. Feedback on the program spanned across three themes: (i) learning and creating my mindfulness toolbox; (ii) applying mindfulness to everyday life; and (iii) online together with expert facilitation. Participants appreciated having access to a variety of mindfulness techniques to accommodate individual preferences. Peer-learning in a facilitated, online group context was also valued. Participants recalled implementing mindfulness strategies in everyday life and provided recommendations of how to improve the program. These included incorporating a group orientation, shortening group sessions to reduce fatigue, and follow-up sessions to maintain mindfulness skills after program completion. Conclusions: This study provides new knowledge about the perspectives of adults with CP regarding MBSR delivered via telehealth. Participant recommendations should inform future implementation of group mindfulness telehealth programs for adults with CP. Full article

(This article belongs to the Special Issue Yoga and Mindfulness Interventions for Health and Well-Being in Different Populations)

16 pages, 499 KB

Open AccessReview

Mindfulness Components and Their Clinical Efficacy: A Critical Review of an Ongoing Debate

by Andrea Lizama-Lefno, Krystel Mojica, Mayte Serrat, Carla Olivari, Ángel Roco-Videla and Sergio V. Flores

Healthcare 2026, 14(2), 196; https://doi.org/10.3390/healthcare14020196 - 13 Jan 2026

Abstract

The rapid expansion of mindfulness research has generated both enthusiasm and controversy regarding its actual clinical value. While meditation is often regarded as the central mechanism of mindfulness-based interventions, other components such as psychoeducation and informal practice may play an equally significant role [...] Read more.

The rapid expansion of mindfulness research has generated both enthusiasm and controversy regarding its actual clinical value. While meditation is often regarded as the central mechanism of mindfulness-based interventions, other components such as psychoeducation and informal practice may play an equally significant role in improving mental health outcomes. This critical review examines the relative contributions of these elements to the therapeutic impact of mindfulness and clarifies the extent to which its effects are comparable to established treatments, particularly Cognitive Behavioral Therapy (CBT). Evidence from meta-analyses and high-quality trials indicates that mindfulness programs achieve moderate efficacy in reducing symptoms of anxiety, depression, and stress, but effect sizes are frequently inflated by methodological limitations. Importantly, cognitive and emotional regulation skills, especially acceptance and non-judgment, appear to sustain long-term benefits more consistently than meditation alone. These findings highlight the need for rigorous longitudinal studies and component-focused designs to identify the mechanisms that drive clinical change. By distinguishing between evidence-based applications and overstated claims, this review contributes to a more balanced understanding of mindfulness and its appropriate integration into healthcare. Full article

(This article belongs to the Special Issue Yoga and Mindfulness Interventions for Health and Well-Being in Different Populations)

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13 pages, 406 KB

Open AccessArticle

Resilience and Burnout Among Healthcare Staff During COVID-19: Lessons for Pandemic Preparedness

by Daniela Bellicoso, Teresa J. Valenzano, Cecilia Santiago, Donna Romano, Sonya Canzian and Jane Topolovec-Vranic

Healthcare 2026, 14(2), 195; https://doi.org/10.3390/healthcare14020195 - 13 Jan 2026

Abstract

Background/Objectives: Healthcare workers at the frontline of managing pandemics are at increased risk for adverse physical and mental health outcomes, which has been shown to result in burnout. The relationship between personal resilience and burnout among clinical and non-clinical healthcare staff working [...] Read more.

Background/Objectives: Healthcare workers at the frontline of managing pandemics are at increased risk for adverse physical and mental health outcomes, which has been shown to result in burnout. The relationship between personal resilience and burnout among clinical and non-clinical healthcare staff working in an acute care setting was assessed at the start of the COVID-19 pandemic. Methods: A prospective cross-sectional survey design with electronic questionnaires was used to measure resilience (Connor-Davidson Resilience Scale,) and burnout (Maslach Burnout Inventory—Human Services Survey). Linear regression analyses were conducted to examine the relationship between resilience and emotional exhaustion, depersonalization, and personal accomplishment. Results: A significant inverse relationship between resilience and both emotional exhaustion and depersonalization, and a positive relationship between resilience and personal accomplishment were identified. Higher resilience scores were significantly associated with lower emotional exhaustion and depersonalization and higher personal accomplishment under pandemic conditions. Conclusions: Strategies to boost resilience organization-wide amongst healthcare staff providing patient care are critical for providing skills to reduce the onset of burnout and support employee mental health. From a pandemic preparedness lens, organizational-level emergency management should consider the importance of resilience-building among staff to proactively prevent burnout and its subsequent effects on patient-care and general hospital functioning. 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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14 pages, 291 KB

Open AccessArticle

Suicidality in the Criminal Justice System: The Role of Cumulative Adversity and Protective Factors

by Guilherme Welter Wendt, Kauê Furquim Depieri, Dalila Moter Benvegnú, Iara Teixeira, Patricia Silva and Felipe Alckmin-Carvalho

Healthcare 2026, 14(2), 194; https://doi.org/10.3390/healthcare14020194 - 13 Jan 2026

Abstract

Background: Incarcerated men experience disproportionately high levels of health inequities shaped by social determinants, including poverty, violence, family adversity, trauma, and limited access to healthcare. These long-standing disadvantages, added to the adverse conditions experienced in prisons, may be associated with elevated rates of [...] Read more.

Background: Incarcerated men experience disproportionately high levels of health inequities shaped by social determinants, including poverty, violence, family adversity, trauma, and limited access to healthcare. These long-standing disadvantages, added to the adverse conditions experienced in prisons, may be associated with elevated rates of suicidality in this population. This study examined the prevalence of suicidal ideation and lifetime suicide attempts among men deprived of liberty in Southern Brazil and investigated the role of cumulative adversities and current protective factors in these outcomes. Methods: A cross-sectional study was conducted with 496 incarcerated men. Participants completed a sociodemographic and background questionnaire assessing lifetime adversity (e.g., hunger, homelessness, sexual abuse, domestic violence, family substance dependence) and current protective factors in prison (e.g., family visits, education, leisure, physical activity, religion, positive self-perception). Cumulative adversity and protective factors were operationalized as composite indices. Logistic regression models tested whether cumulative adversities and protective factors were independently associated with suicidal ideation and suicide attempts. Results: Lifetime prevalence was 9.6% for suicidal ideation and 10.8% for suicide attempts. Cumulative adversities were associated with higher odds of both suicidal ideation (OR = 1.43; 95% CI = 1.11–1.84; p = 0.006) and suicide attempts (OR = 1.94; 95% CI = 1.50–2.52; p < 0.001). Protective factors were associated with lower likelihood of suicidal ideation (OR = 0.74; 95% CI = 0.58–0.96; p = 0.020) but were not significantly associated with suicide attempts. No significant interaction effects were observed, indicating that protective factors did not moderate the impact of adversity. Conclusions: Suicidal tendencies among incarcerated men were associated with cumulative structural and psychosocial adversities. Protective factors in prison were associated with lower odds of ideation but not attempts. These associations may inform person-centered and equity-oriented approaches and are consistent with the relevance of social determinants to mental health, although causal inferences are not supported by this project. Full article

(This article belongs to the Special Issue Health Equity and People-Centered Systems: Meeting Needs and Creating Opportunities for Diverse Communities)

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