Healthcare

13 pages, 1493 KB

Open AccessArticle

Clinical Profiles, Interventions, and Outcomes of Sepsis and Septic Shock in a Saudi Arabian Tertiary ICU: A Five-Year Retrospective Analysis

by Amer Asiri, Khaled Abdulwahab Amer, Mushary Alqahtani, Lena A. Almathami, Osama Ayed Asiri, Sultan Saad Alnasser, Ahmed Ali Khuzayyim, Bander Abdullah Alqahtani, Fatimah Mohammed Asiri and Hatem Mostafa Asiri

Healthcare 2026, 14(5), 680; https://doi.org/10.3390/healthcare14050680 (registering DOI) - 7 Mar 2026

Abstract

Background and Objectives: Sepsis and septic shock remain leading causes of morbidity and mortality in intensive care settings worldwide. While substantial epidemiological data exist from Western countries, the clinical profile of sepsis in regions with exceptionally high diabetes prevalence remains inadequately characterized. [...] Read more.

Background and Objectives: Sepsis and septic shock remain leading causes of morbidity and mortality in intensive care settings worldwide. While substantial epidemiological data exist from Western countries, the clinical profile of sepsis in regions with exceptionally high diabetes prevalence remains inadequately characterized. Saudi Arabia, with one of the highest diabetes mellitus prevalence rates globally, may exhibit distinct sepsis epidemiology, infection patterns, and outcomes. This study aimed to characterize the clinical profiles, antimicrobial management, and outcomes of sepsis and septic shock in a tertiary intensive care unit (ICU) in the Aseer region of southwestern Saudi Arabia. Materials and Methods: A retrospective observational study was conducted including 263 adults meeting Sepsis-3 criteria (232 sepsis, 31 septic shock) admitted to a tertiary ICU between January 2020 and December 2024. Demographics, comorbidities, laboratory parameters, microbiological data, antibiotic timing, interventions, and in-hospital mortality were analyzed. Logistic regression identified independent mortality predictors. This study adhered to the STROBE reporting guidelines. Results: The median age was 73 years with male predominance (58.4%). Diabetes mellitus (71.5%) and hypertension (65.8%) were highly prevalent. Urinary tract infections (UTIs) predominated (79.8%), with Escherichia coli as the most common pathogen (26.2%). The median time to antibiotic administration was 1.8 h; piperacillin–tazobactam was the most frequent empiric regimen (43.7%). Septic shock patients exhibited higher creatinine (1.65 vs. 1.08 mg/dL, p = 0.026) and lower platelets (194 vs. 271 × 10³/μL, p = 0.030). Mortality was 38.7% in septic shock versus 8.2% in sepsis (p < 0.001). Multivariate analysis confirmed septic shock (aOR: 5.23; 95% CI: 1.89–14.48) and mechanical ventilation (aOR: 15.42; 95% CI: 5.67–41.95) as independent mortality predictors. Conclusions: High diabetes prevalence shapes regional sepsis epidemiology with UTI predominance. Early antibiotic administration and recognition of septic shock remain critical for improving outcomes in this population. Full article

(This article belongs to the Section Clinical Care)

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23 pages, 2363 KB

Open AccessArticle

Limited Feasibility Study of Holographic Display Technology for Interprofessional Team Training

by Maria Bajwa, Melissa Morris, Wajeeha Brar Ghias and Adam Linzels

Healthcare 2026, 14(5), 679; https://doi.org/10.3390/healthcare14050679 (registering DOI) - 7 Mar 2026

Abstract

Background: Immersive technologies are increasingly used to support interprofessional education and team training in healthcare. Holographic display technology (HDT) offers a novel approach for delivering distributed, simulation-based TeamSTEPPS training; however, evidence regarding its short-term feasibility remains limited. Methods: This mixed-methods pilot [...] Read more.

Background: Immersive technologies are increasingly used to support interprofessional education and team training in healthcare. Holographic display technology (HDT) offers a novel approach for delivering distributed, simulation-based TeamSTEPPS training; however, evidence regarding its short-term feasibility remains limited. Methods: This mixed-methods pilot feasibility study examined the acceptability and limited efficacy (defined as learning satisfaction and self-reported gains) of HDT for interprofessional TeamSTEPPS-based team training across two geographically distributed campuses. Quantitative measures assessed changes in UTAUT-informed constructs, including attitude toward technology use (ATU) and behavioral intention (BI), while qualitative focus groups explored learner experiences and perceptions. Results: Of 64 participants, 47 consented to analysis. Quantitative analyses demonstrated post-training improvements in key technology-acceptance constructs, including significant gains in ATU and strengthened alignment between BI and UTAUT predictors. Qualitative findings reflected high learner engagement and perceived educational value, alongside practical considerations related to technical and instructional coordination. Conclusions: HDT was feasible for assessment of short-term foci of acceptability and perceived limited efficacy through the delivery of interprofessional TeamSTEPPS training, with observed gains in ATU and BI. These findings inform future assessment of long-term feasibility foci, including implementation studies examining the role of holographic simulation in advancing interprofessional education, healthcare workforce development, and the quality of healthcare delivery. Full article

(This article belongs to the Special Issue Advancing Healthcare Delivery and Patient Quality of Care Through Healthcare Professionals’ Development)

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17 pages, 479 KB

Open AccessArticle

Pregnant Women’s Experiences and Perceptions of the Impact of Exercise on Mental Health During Pregnancy—A Qualitative Study

by Manuela Filipec, Marko Bodrožić and Sania Almousa

Healthcare 2026, 14(5), 678; https://doi.org/10.3390/healthcare14050678 (registering DOI) - 7 Mar 2026

Abstract

Background: Exercise during pregnancy is known to benefit physical and mental health. However, pregnant women’s lived experiences of its psychological impact remain insufficiently explored. This study aimed to explore pregnant women’s experiences and perceptions of how exercise influences mental health during pregnancy. Methods: [...] Read more.

Background: Exercise during pregnancy is known to benefit physical and mental health. However, pregnant women’s lived experiences of its psychological impact remain insufficiently explored. This study aimed to explore pregnant women’s experiences and perceptions of how exercise influences mental health during pregnancy. Methods: A qualitative study design was employed. Pregnant women were recruited using purposive sampling from a clinical hospital setting between March and September 2025. Eligible participants met predefined inclusion and exclusion criteria. Data saturation guided sample size (N = 38). Data were collected through semi-structured online interviews. Interviews were audio-recorded, transcribed verbatim, and analysed using inductive thematic analysis. Results: Four major participant-derived themes emerged: emotional regulation and mood stabilization, reduction of anxiety and depressive symptoms, enhanced self-confidence and body acceptance, and increased self-efficacy and sense of control. These themes illustrate the range of psychological benefits associated with maintaining exercise during pregnancy. Conclusions: This study highlights the psychological meanings pregnant women attribute to exercise, extending beyond its established physical benefits. These insights underscore the importance of integrating mental health perspective into prenatal physical activity counselling and support the development of more individualized, patient-centered prenatal care strategies. Full article

(This article belongs to the Special Issue Benefits of Exercise on Reproductive Health)

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15 pages, 303 KB

Open AccessArticle

Physical Activity Enjoyment and Orthorexic Eating Behaviours in Turkish Adults: A Cross-Sectional Study

by Bekir Erhan Orhan, Hussain Yasin, Aydın Karaçam, Umut Canlı and Mehdi Ben Brahim

Healthcare 2026, 14(5), 677; https://doi.org/10.3390/healthcare14050677 (registering DOI) - 7 Mar 2026

Abstract

Background: Orthorexic eating reflects a rigid preoccupation with healthy eating that often co-occurs with health-oriented lifestyles, yet the affective experience of physical activity has received little attention. This study examined whether enjoyment of physical activity is associated with orthorexic tendencies in adults [...] Read more.

Background: Orthorexic eating reflects a rigid preoccupation with healthy eating that often co-occurs with health-oriented lifestyles, yet the affective experience of physical activity has received little attention. This study examined whether enjoyment of physical activity is associated with orthorexic tendencies in adults and whether it explains variance beyond age, body mass index (BMI), physical activity status, and self-rated diet. Methods: Adults (N = 434; M_age = 27.55) recruited online in Türkiye completed a survey including the Physical Activity Enjoyment Scale (PACES), the Orthorexia Nervosa Inventory (ONI), and sociodemographic, BMI, physical activity, and diet items. Pearson correlations and one-way ANOVAs assessed bivariate associations, and hierarchical regressions tested whether PACES added incremental variance to ONI total and domain scores beyond covariates. Results: PACES scores showed a near-zero correlation with ONI total (r ≈ 0.02) and did not add variance in regression models (ΔR² ≈ 0.00). Higher BMI and identifying one’s diet as “healthy and balanced” were linked to modestly higher ONI total and Impairments/Emotions scores, while differences in physical activity status were small and mainly limited to the Behavioural domain. Conclusions: In this non-clinical sample of Turkish adults, enjoyment of physical activity was not meaningfully associated with orthorexic tendencies. These findings suggest that enjoyment-focused physical activity promotion can be encouraged without increasing orthorexic symptoms, while replication in clinical/high-risk groups (e.g., elite/professional athletes and clinical eating disorder patients) and longitudinal designs is warranted. Full article

(This article belongs to the Special Issue Body Image, Dissatisfaction and Eating Disorders: A Healthcare Perspective)

14 pages, 1170 KB

Open AccessArticle

Health Insurance and Neighborhood Deprivation as Determinants of Diagnostic Delays and Survival in Breast Cancer

by Axel Gierbolini-Bermúdez, Maira A. Castañeda-Avila, Marjorie Vázquez-Roldán, Tonatiuh Suárez-Ramos, Carlos R. Torres-Cintrón, Rosa Román-Oyola and Karen J. Ortiz-Ortiz

Healthcare 2026, 14(5), 676; https://doi.org/10.3390/healthcare14050676 (registering DOI) - 7 Mar 2026

Abstract

Background/Objectives: Breast cancer (BC) represents a major public health problem that is influenced by social and systemic factors. This study evaluates disparities in the BC care continuum based on health insurance type and determines whether these patterns differ according to neighborhood-level deprivation. [...] Read more.

Background/Objectives: Breast cancer (BC) represents a major public health problem that is influenced by social and systemic factors. This study evaluates disparities in the BC care continuum based on health insurance type and determines whether these patterns differ according to neighborhood-level deprivation. Methods: Using the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database, we conducted a retrospective cohort study of women aged ≥18 years and diagnosed with BC in Puerto Rico between 2012 and 2016. The main outcomes were diagnostic delay (>60 days) and six-year mortality. Insurance type (private, Medicare, Medicaid, and dual enrollment in Medicare and Medicaid) was the main predictor, with neighborhood deprivation as a modifier. Logistic and Cox models assessed delay and survival, adjusting for key covariates. Results: Disparities in diagnostic delays and risk of death across insurance types were most evident in areas with low to average deprivation, whereas, in neighborhoods with above-average to highest deprivation, these differences diminished for diagnostic delay and disappeared for risk of death. Conclusions: These findings reveal that neighborhood environment, an intermediary social determinant of health, may affect the timeliness and quality of care provided to women diagnosed with BC. Full article

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20 pages, 2582 KB

Open AccessSystematic Review

Table Tennis as a Sustainable Health Intervention: A Meta-Analysis of Its Effects on Balance and Cognitive Functions

by He Li, Hyunkyun Ahn and Minhye Shin

Healthcare 2026, 14(5), 675; https://doi.org/10.3390/healthcare14050675 - 6 Mar 2026

Abstract

Background: Physical inactivity is linked to falls, cognitive decline, and reduced independence, underscoring the need for accessible interventions that enhance balance and cognitive functions. In this context, sustainability refers to affordability, accessibility, feasibility, and potential for long-term adherence. Table tennis, an open-skill sport [...] Read more.

Background: Physical inactivity is linked to falls, cognitive decline, and reduced independence, underscoring the need for accessible interventions that enhance balance and cognitive functions. In this context, sustainability refers to affordability, accessibility, feasibility, and potential for long-term adherence. Table tennis, an open-skill sport requiring motor coordination and cognitive engagement, may help improve balance and cognitive functions. This meta-analysis synthesized available evidence to investigate the effects of table tennis interventions on balance and cognitive functions. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and PROSPERO registration, six electronic databases were searched. A meta-analysis was conducted with 14 randomized controlled trials comprising 1565 participants in total. Additionally, subgroup analyses were conducted based on intervention participants, health status, intervention duration, and session length. Results: Pooled analyses showed that individuals who received table tennis interventions demonstrated significantly improved balance (standardized mean difference [SMD] = 0.78, 95% confidence interval [CI] [0.57, 0.98]) and cognitive (SMD = 2.05, 95% CI [1.27, 2.83]) functions than those who did not. Subgroup analyses indicated consistent benefits across different age groups and health statuses, along with larger cognitive function effects with longer interventions. Despite considerable heterogeneity across studies and limited evidence for some subgroups, sensitivity analyses supported the robustness of the results. Conclusions: Table tennis appears to be a feasible and low-cost intervention that can effectively enhance balance and cognition functions, with potential applicability in community, educational, and rehabilitation settings. However, considering the observed heterogeneity and methodological limitations, the findings should be interpreted with caution. Full article

18 pages, 876 KB

Open AccessArticle

Assessing the Early Economic Feasibility of a Curative Gene Therapy for Multiple Sclerosis Using a Risk-Adjusted Valuation Framework

by Attila Imre, Balázs Nagy and Rok Hren

Healthcare 2026, 14(5), 674; https://doi.org/10.3390/healthcare14050674 - 6 Mar 2026

Abstract

Background/Objectives: Multiple sclerosis (MS) imposes a substantial clinical, humanistic, and economic burden, and current disease-modifying therapies require lifelong administration without restoring immune tolerance. IMMUTOL, a tolerogenic gene therapy under development within an EU-funded programme, aims to induce durable remission. Methods: This [...] Read more.

Background/Objectives: Multiple sclerosis (MS) imposes a substantial clinical, humanistic, and economic burden, and current disease-modifying therapies require lifelong administration without restoring immune tolerance. IMMUTOL, a tolerogenic gene therapy under development within an EU-funded programme, aims to induce durable remission. Methods: This study assessed the early financial feasibility of IMMUTOL using a structured risk-adjusted net present value (rNPV) model, incorporating development and operating costs, probabilities of clinical and regulatory success, manufacturing expenditure, market dynamics, and revenue projections. Uncertainty was examined through one-way, probabilistic, and scenario analyses. Results: Under base-case assumptions, IMMUTOL generated a deterministic rNPV of −$223.8 million with an internal rate of return of 3.4%. Probabilistic analysis yielded a mean rNPV of −$99.4 million and a mean internal rate of return of 10.5%, with 70.2% of simulations producing negative values. Only scenarios combining higher treatment prices with lower manufacturing costs produced consistently positive rNPVs; a price of $1.5 million with a $200,000 production cost resulted in an rNPV of $711.2 million and an internal rate of return of 20.7%. Neither increased market size, reduced time to approval, nor modest cost reductions altered the conclusion. Conclusions: These findings emphasise a structural gap between value-based pricing and the pricing required for commercial viability. Without external support or reductions in cost structures, commercial development may be economically unattractive. Full article

(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)

45 pages, 4934 KB

Open AccessReview

Mindfulness-Based Interventions for Bereavement: A Systematized Narrative Review

by Fabio D’Antoni, Fabio Mattiussi and Cristiano Crescentini

Healthcare 2026, 14(5), 673; https://doi.org/10.3390/healthcare14050673 - 6 Mar 2026

Abstract

Background/Objectives: Mindfulness-based interventions (MBIs) have shown promising effects across diverse areas of psychiatry, yet their specific role in bereavement remains insufficiently synthesized. Bereavement is a universal but heterogeneous process, with a minority of individuals at risk of developing prolonged grief disorder (PGD). Understanding [...] Read more.

Background/Objectives: Mindfulness-based interventions (MBIs) have shown promising effects across diverse areas of psychiatry, yet their specific role in bereavement remains insufficiently synthesized. Bereavement is a universal but heterogeneous process, with a minority of individuals at risk of developing prolonged grief disorder (PGD). Understanding the potential benefits of MBIs in this context is crucial for informing clinical practice. Methods: Following the methodological framework of systematized narrative reviews, a comprehensive literature search was conducted across major databases. Eligible studies included empirical investigations of MBIs applied to bereavement, without restrictions on type of loss, population, or intervention format. Data were narratively synthesized and summarized in tables; no meta-analysis was performed. Results: Seventeen studies met inclusion criteria. The strongest evidence was found for Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), which demonstrated improvements in grief-related distress, depressive symptoms, and psychological well-being. Across interventions, MBIs were associated with reductions in rumination and experiential avoidance, increased self-compassion, and enhanced emotion regulation. However, most studies were limited by small sample sizes, heterogeneous outcome measures, and a lack of long-term follow-up. Conclusions: MBIs show promise as adjunctive interventions in bereavement care, targeting mechanisms central to grief adaptation, including acceptance, decentering, and self-compassion. Nevertheless, the evidence remains preliminary and methodologically constrained. Future high-quality randomized controlled trials are needed to establish efficacy, clarify mechanisms of action, and define the role of MBIs alongside established grief therapies. Full article

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

20 pages, 740 KB

Open AccessArticle

Deep Brain Stimulation for Movement Disorders in Spain: Temporal Trends, Complications, and Sex-Related Disparities (2002–2019)

by Víctor Gómez-Mayordomo, Jose J. Zamorano-León, David Carabantes-Alarcon, Valentín Hernández-Barrera, Ana Lopez-de-Andrés, Natividad Cuadrado-Corrales, Fernando Alonso-Frech, Ana Jiménez-Sierra and Rodrigo Jiménez-García

Healthcare 2026, 14(5), 672; https://doi.org/10.3390/healthcare14050672 - 6 Mar 2026

Abstract

Background/Objectives: This study aimed to describe temporal trends in deep brain stimulation (DBS) use for Parkinson’s disease (PD), essential tremor (ET), and dystonia; characterize patient age and sex distribution and comorbidity; assess postoperative complications and in-hospital mortality (IHM) after implantation and explantation; and [...] Read more.

Background/Objectives: This study aimed to describe temporal trends in deep brain stimulation (DBS) use for Parkinson’s disease (PD), essential tremor (ET), and dystonia; characterize patient age and sex distribution and comorbidity; assess postoperative complications and in-hospital mortality (IHM) after implantation and explantation; and explore sex-specific differences in utilization and outcomes. Methods: We conducted a retrospective nationwide population-based study using the Spanish National Hospital Discharge Database (RAE-CMBD) from 2002 to 2019. All hospital admissions with DBS implantation or explantation/revision and a diagnosis of PD, ET, or dystonia were identified. Sociodemographic variables, the Charlson Comorbidity Index (CCI), length of hospital stay (LOHS), postoperative complications, and IHM were analyzed across three calendar periods and stratified by diagnosis and sex. Results: A total of 4883 admissions for DBS electrode implantations and 497 admissions for DBS explantation/revision were recorded. PD accounted for 82.6% of implantations, followed by ET (11.2%) and dystonia (6.3%). DBS activity increased significantly over time, while median LOHS declined from 12 to 6 days for implantations and from 13 to 5 days for explantations. Overall IHM after implantation was 0.27%, decreasing to 0.05% in 2014–2019; IHM after explantation was 0.6%. Most hospitalizations had low comorbidity (CCI = 0 in 87.8%), although comorbidity increased over time. Men represented approximately 60% of procedures in PD and ET. Women with PD underwent DBS at older ages, despite similar LOHS and IHM. Postoperative complications were recorded in 14.6% of implantations, mainly hardware-related issues (5–6%) and infections (1–2%), whereas infections (33%) and mechanical problems (27%) predominated among explantations. Conclusions: DBS use in Spain has expanded substantially, with shorter hospital stays and very low in-hospital mortality. Sex-related differences in utilization are increasing, and hardware complications and infections remain the most frequent conditions associated with explantation. As complications were identified only during the same hospitalization as the DBS procedure, late post-discharge events are not captured and could be underestimated; patient-level risks cannot be derived. Full article

2 pages, 132 KB

Open AccessCorrection

Correction: Zhang et al. Obesity and Occupational Disparities in Urban China: Evidence from a Large-Scale Cross-Sectional Study. Healthcare 2025, 13, 2225

by Guoxi Zhang, Huyang Zhang, Gordon G. Liu and Leiyu Shi

Healthcare 2026, 14(5), 671; https://doi.org/10.3390/healthcare14050671 - 6 Mar 2026

Abstract

Error in Figure/Table [...] Full article

26 pages, 473 KB

Open AccessArticle

Findings from the Process Evaluation of a Mobile Health Clinic Designed to Improve Equity of Access to Primary Healthcare for People with Substance Use Disorders and/or Homelessness in One Region in the North East of England, UK

by Emma-Joy Holland, Eleanor Ash, Elizabeth Titchener, Sarah Schonewald, Amy O’Donnell, Sedighe Hosseini-Jebeli, Emma A. Adams, Sarah Lonbay, Floor Christie-de Jong, Sarah Norman and Katherine Jackson

Healthcare 2026, 14(5), 670; https://doi.org/10.3390/healthcare14050670 - 6 Mar 2026

Abstract

Background/Objectives: New models of care are needed to address the barriers people who use substances (PWUS) and/or experience homelessness face when accessing primary healthcare. This study reports findings from the evaluation of a six-month pilot of a mobile health clinic (MHC) co-delivered [...] Read more.

Background/Objectives: New models of care are needed to address the barriers people who use substances (PWUS) and/or experience homelessness face when accessing primary healthcare. This study reports findings from the evaluation of a six-month pilot of a mobile health clinic (MHC) co-delivered by primary healthcare, local government, and lived-experience recovery organisations in the North East of England, UK. Methods: Pragmatic mixed-methods process evaluation with data sources including a patient survey, overt observations, qualitative interviews, and routine patient data. Qualitative data were analysed using inductive and deductive thematic analysis; quantitative data were analysed descriptively. RE-AIM framework dimensions were applied to inform interpretation. Results: N = 164 patients accessed the bus between 1 April and 31 October 2025, with survey data indicating that most patients were PWUS (n = 96, 84%), with experience of homelessness (n = 67, 61%) and/or lived in the most deprived neighbourhoods, with complex physical and mental health needs (Reach). Patients expressed satisfaction with the service, valuing the compassionate and comprehensive support provided. There was qualitative evidence of further re-engagement with statutory healthcare following attendance on the bus (Effectiveness). Local organisations were mostly keen to be involved in the pilot, with participation benefiting from existing local relationships and infrastructure (Adoption). The flexible yet consistent approach of those involved in service delivery was viewed as positive. There was some uncertainty around the functions of the bus and the role of some delivery staff (Implementation). Limited funding was perceived as a barrier to sustaining the bus, alongside lack of capacity within local organisations (Maintenance). Conclusions: The study highlighted the positive impact that an MHC can have on this marginalised population and provides further evidence for the need for clinical care that provides relational support and attends to the social determinants of health. The study indicates the potential for interdisciplinary working to improve access to healthcare for PWUS, and underlines that delivering healthcare at a neighbourhood level is reliant on strong community networks. Wider system change is still needed to further support the population. Full article

(This article belongs to the Special Issue Increasing Access to and Quality of Healthcare Services to Promote Community Health Equity)

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21 pages, 640 KB

Open AccessArticle

Archetypes of Family Health Climates for Nutrition and Physical Activity Among Families in Singapore: A Cross-Sectional Study

by Dhiya Mahirah, Yi-Ching Lynn Ho, Zi Hsuan Chia, Mary Su-Lynn Chew, Xuan Han Koh, Jin-Jin Lim, Julian Thumboo and Kinjal Doshi

Healthcare 2026, 14(5), 669; https://doi.org/10.3390/healthcare14050669 - 6 Mar 2026

Abstract

Background: Poor lifestyle choices contribute significantly to non-communicable chronic diseases. Given the family’s influence on health behaviours, this study aimed to identify distinct family archetypes based on family health climates for physical activity and nutrition to inform targeted family-based health promotion strategies. Methods: [...] Read more.

Background: Poor lifestyle choices contribute significantly to non-communicable chronic diseases. Given the family’s influence on health behaviours, this study aimed to identify distinct family archetypes based on family health climates for physical activity and nutrition to inform targeted family-based health promotion strategies. Methods: Two hundred family dyads (≥15 years old, cohabiting) in Singapore completed a survey assessing family health climates (physical activity and nutrition), together with individual behaviours, and family lifestyle behaviours. Based on family health climate scores, K-means clustering identified family archetypes. Random Forest analysis determined key contributing constructs to the clusters. Chi-square and ANOVA tests compared socio-demographics, family and individual behaviours, and sleep quality across archetypes. Results: Four family health climate archetypes were identified: Survivors (16%) had poor health climate scores for both physical activity and nutrition, lower socioeconomic status, infrequent family meals, and poorer diet and sleep quality. Nourished Sedentary (16%) had a poor climate for physical activity but a positive climate for nutrition, higher socioeconomic status, frequent family meals, and limited physical activity. Satisficers (41%) had moderate health climates for both, with average socioeconomic status and engagement in healthy behaviours. Flourishers (27%) had positive health climates for both higher socioeconomic status, frequent family meals, healthy food choices, and greater physical activity engagement. Conclusions: The identification of four distinct family health climate archetypes demonstrates that health-related behaviours cluster at the family level rather than solely at the individual level. These findings underscore the importance of targeting family systems in health promotion and support the development of tailored, family-specific strategies. Full article

(This article belongs to the Special Issue Enhancing Family and Community Health Through Salutogenic Approach)

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29 pages, 780 KB

Open AccessSystematic Review

Postpartum Health in Mothers of Preterm Infants in the NICU: Needs, Service Utilization, and Care Gaps—A Systematic Review

by Tabea Mina Stein, Marie-Jeannine Riefert, Harald Abele, Cornelia Wiechers and Claudia F. Plappert

Healthcare 2026, 14(5), 668; https://doi.org/10.3390/healthcare14050668 - 6 Mar 2026

Abstract

Background/Objectives: Mothers of preterm infants face complex postpartum challenges, yet their needs are often overlooked in neonatal care. This review synthesizes evidence on maternal health needs, service utilization, perceived adequacy, and barriers to care. Methods: A systematic search of PubMed, CINAHL, and PsycINFO [...] Read more.

Background/Objectives: Mothers of preterm infants face complex postpartum challenges, yet their needs are often overlooked in neonatal care. This review synthesizes evidence on maternal health needs, service utilization, perceived adequacy, and barriers to care. Methods: A systematic search of PubMed, CINAHL, and PsycINFO identified 16 peer-reviewed studies published between 2007 and 2025 on mothers of preterm infants. A narrative synthesis integrated quantitative and qualitative findings from NICU settings. Results: Across 16 included studies, all reported psychological and emotional needs, with anxiety, distress, and fear for infant survival frequently highlighted. Informational needs were identified in 11 studies, particularly regarding infant care and postpartum guidance. Physical needs were reported in 10 studies, including fatigue and pain affecting NICU engagement. Nursing support and lactation services were consistently accessed, whereas psychosocial services and postpartum follow-up were reported in fewer than half of the studies. Perceived adequacy depended on empathetic, individualized communication, while structural and contextual barriers, such as transportation, financial burden, and NICU policies, limited maternal engagement. Despite available services, gaps in emotional, informational, and practical support persisted. Conclusions: Mothers of preterm infants experience substantial postpartum health needs that are insufficiently addressed within current NICU-centered care structures. Integrating maternal-focused, continuous, and psychosocially informed postpartum care into neonatal services is essential to reduce care gaps and support maternal well-being during NICU hospitalization. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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15 pages, 243 KB

Open AccessArticle

Association of Social Determinants of Health and Health Equity with Adverse Childhood Experiences in Georgia, USA

by Gulzar H. Shah, Adverlyn Ivey-Waters, Tobi Oloyede and Shams Rahman

Healthcare 2026, 14(5), 667; https://doi.org/10.3390/healthcare14050667 - 6 Mar 2026

Abstract

Background/Objectives: Adverse childhood experiences (ACEs), including physical and sexual abuse, are significantly associated with long-term health issues, particularly among socially disadvantaged populations. The study examines the social determinants of health, such as poverty, racial inequities, and limited access to care, to assess their [...] Read more.

Background/Objectives: Adverse childhood experiences (ACEs), including physical and sexual abuse, are significantly associated with long-term health issues, particularly among socially disadvantaged populations. The study examines the social determinants of health, such as poverty, racial inequities, and limited access to care, to assess their association with adverse childhood experiences, including exposure to physical violence and sexual abuse. Methods: We performed multivariable logistic regression analyses using data from the 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) (n = 8227) to examine associations between selected ACEs and key social determinants of health (SDOH). Results: Our results indicated that a lack of emotional and social support was associated with increased odds of witnessing parental violence (AOR = 2.00) and physical abuse (AOR = 1.90). Absence of food insecurity was associated with lower odds of witnessing parental violence (AOR = 0.65), unwanted sexual touching (AOR = 0.77), and forced sex (AOR = 0.63). Similarly, not reporting transportation barriers was associated with lower odds across ACE outcomes (AORs ranging from 0.54 to 0.65). Sexual and gender minority individuals exhibited substantially higher odds of childhood sexual abuse (AORs = 3.64–5.56). Hispanic ethnicity was associated with increased odds of physical abuse (AOR = 1.47), and older adults (ages 45–64) had greater odds of experiencing forced sex (AORs = 2.08–2.48). These findings highlight complex relationships between SDOH and early trauma. Conclusions: Trauma-informed public health strategies must address structural inequities and strengthen emotional and material support for vulnerable populations. Full article

(This article belongs to the Special Issue Psychosocial Aspects of Childhood and Adolescent Health)

17 pages, 406 KB

Open AccessArticle

Social Media and High-Risk Eating Behaviors in Adults: A Cross-Sectional Study

by Eman Khalid Alqadheeb, Peter M. B. Cahusac, Narmeen Shaikh and Noara Alhusseini

Healthcare 2026, 14(5), 666; https://doi.org/10.3390/healthcare14050666 - 6 Mar 2026

Abstract

Introduction: Eating disorders and disordered eating behaviours are crucial mental health concerns, yet evidence linking social media use to eating-related outcomes in adult populations, particularly in Saudi Arabia, remains limited and primarily focused on female or student samples. This study examined the [...] Read more.

Introduction: Eating disorders and disordered eating behaviours are crucial mental health concerns, yet evidence linking social media use to eating-related outcomes in adult populations, particularly in Saudi Arabia, remains limited and primarily focused on female or student samples. This study examined the prevalence of disordered eating risk among Saudi adults and its association with social media engagement, body mass index (BMI), and sociodemographic factors. Method: A cross-sectional survey was conducted among adults residing in Saudi Arabia. Disordered eating risk was assessed using the Eating Attitudes Test (EAT-26), and social media engagement was measured as frequency of use across multiple daily routines using the Social Media Engagement Questionnaire (SMEQ). BMI and sociodemographic variables were self-reported. Descriptive statistics, bivariate analyses, and multivariable linear regression were performed to examine associations between study variables. Results: Approximately 43% of respondents were at high risk of disordered eating behaviors. Social media engagement was prevalent; however, its association with disordered eating risk was weak and inverse (Spearman’s Rho = −0.1243, p < 0.01). BMI showed domain-specific associations across eating-related domains, while most sociodemographic factors were not strongly associated with disordered eating outcomes. Conclusions: Disordered eating behaviors were present among adults in Saudi Arabia and extend beyond traditionally studied high-risk groups. The weak inverse association indicates that frequency of social media use alone may not be a reliable indicator of eating-related risk in adults and likely does not capture content- and comparison-specific mechanisms. Findings highlight the need for broader screening and prevention efforts, as well as for longitudinal research using content- and behavior-specific measures of social media exposure to clarify mechanisms in adult populations. Full article

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

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15 pages, 257 KB

Open AccessArticle

Community Prevalence and Predictors of Pelvic Floor-Related Symptoms in Saudi Men: Implications for Physiotherapy-Led Care

by Wael Alghamdi

Healthcare 2026, 14(5), 665; https://doi.org/10.3390/healthcare14050665 - 6 Mar 2026

Abstract

Background: Research in pelvic floor muscle-related symptoms (PFM-related symptoms) in Saudi Arabia remains limited. Clearer identification of symptom burden and its predictors is needed to guide physiotherapy strategies for prevention and management. Objective: We aimed to determine the prevalence of PFM-related symptoms among [...] Read more.

Background: Research in pelvic floor muscle-related symptoms (PFM-related symptoms) in Saudi Arabia remains limited. Clearer identification of symptom burden and its predictors is needed to guide physiotherapy strategies for prevention and management. Objective: We aimed to determine the prevalence of PFM-related symptoms among adult Saudi men and identify behavioral and lifestyle predictors associated with symptom burden. Methods: A community-based cross-sectional survey was conducted among 458 men aged >18 years from the Al-Baha region of Saudi Arabia. PFM-related symptoms were assessed using five items adapted from the Pelvic Floor Distress Inventory-20 (PFDI-20), their impact using five items from the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and urinary incontinence using the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF). Data were analyzed with descriptive statistics, correlation analysis, one-way ANOVA, and binary logistic regression. Results: Urinary incontinence was reported by 14% (86% reported none), but 19% disclosed regular “preventive” voiding. Symptom incidence increased with age (p < 0.001). Logistic regression identified smoking (OR = 1.34, p = 0.029) and preventive voiding (OR = 1.54, p = 0.002) as significant predictors of greater symptom burden. Conclusions: These results highlight the need for physiotherapy-led strategies in primary care, prioritizing smoking-cessation support and structured bladder training, with escalation when required. Prospective studies are needed to confirm temporality and to develop a practical rehabilitation pathway for men. Full article

19 pages, 646 KB

Open AccessArticle

Bridging Clinical Care and Self-Management: Impact of Nursing Module Based on WHO’s Universal Self-Care Framework in Women with Endometriosis

by Hajer I. Motakef, Niven Basyouni, Salam Bani Hani, Emran A. Abu Aqoulah, Bahia Galal Abd Elrazik Siam, Soha Kamel Mosbah Mahmoud, Layla Salem Alshammari, Elham Saeed Abdo Moqbel, Isis Emile Gohar, Zainh I. Motakef, Fatima Diab, Mokhtar A. Almoliky, Bushra Alshammari and Awatif Alrasheeday

Healthcare 2026, 14(5), 664; https://doi.org/10.3390/healthcare14050664 - 6 Mar 2026

Abstract

Aims: This study aims to assess the effect of a structured universal self-care practices module on improving self-care compliance and health maintenance behaviors among women with endometriosis, and to determine if it reduces pain severity. Design: A quasi-experimental design was used. Methods: A [...] Read more.

Aims: This study aims to assess the effect of a structured universal self-care practices module on improving self-care compliance and health maintenance behaviors among women with endometriosis, and to determine if it reduces pain severity. Design: A quasi-experimental design was used. Methods: A total of 90 women confirmed a diagnosis of endometriosis, who were free from any chronic medical or gynecological comorbidities, and who had not received any pain relief pharmacological interventions. Results: The study and control groups were comparable at baseline regarding socio-demographic and clinical characteristics (p > 0.05). Following the intervention, the study group demonstrated significant improvements in universal self-care practices compared to the control group at one month (M = 69.2 ± 11.6 vs. 58.3 ± 8.83; t = −4.93, p = 0.001) and three months (M = 76.4 ± 16.5 vs. 61.5 ± 12.2; t = −4.89, p = 0.001). A strong negative correlation was found between self-care and symptom severity at one month (r = −0.70, p < 0.001) and three months (r = −0.83, p < 0.001), indicating that improved self-care was associated with reduced symptoms. Conclusions: This study highlights the vital role of nursing-led, WHO-based self-care interventions in improving compliance and reducing pain among women with endometriosis. Integrating such programs into routine care can enhance self-management and overall quality of life. Patient or Public Contribution: Integrating individualized, nursing-led self-care programs into routine endometriosis management can improve symptom control through ongoing education and follow-up. Nurses play a pivotal role in empowering women’s self-management, while adopting the WHO Universal Self-Care Framework can strengthen gynecological care policies and practices. Full article

(This article belongs to the Section Women’s and Children’s Health)

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18 pages, 785 KB

Open AccessArticle

Effect of Tai Chi vs. Strength Training on Body Composition, Physical Performance, and Well-Being in Community-Dwelling Older Mexican Women

by Cristina Flores-Bello, Elsa Correa-Muñoz, Martha A. Sánchez-Rodríguez, Juana Rosado-Pérez, Nayeli Vaquero-Barbosa and Víctor Manuel Mendoza-Núñez

Healthcare 2026, 14(5), 663; https://doi.org/10.3390/healthcare14050663 - 5 Mar 2026

Abstract

Background/Objectives: Tai Chi (TC) practice has been shown to positively affect the physical, psychological, and cognitive health of older adults. However, discrepancies persist regarding its effectiveness compared to strength training (ST). This study aimed to determine the effect of TC training compared [...] Read more.

Background/Objectives: Tai Chi (TC) practice has been shown to positively affect the physical, psychological, and cognitive health of older adults. However, discrepancies persist regarding its effectiveness compared to strength training (ST). This study aimed to determine the effect of TC training compared to ST on body composition, physical performance, cognitive function, and psychological well-being in older adults. Methods: A quasi-experimental study was conducted with a convenience sample of 68 women 60 years or older, divided into three groups: (i) Tai Chi Group (TCG) n = 26; (ii) Strength Training Group (STG) n = 21; and (iii) Control Group (CG) n = 21. TCG and STG performed physical training four days a week, 60 min/day, for six months. All participants were assessed for body composition (BFP, body fat percentage; SMM, skeletal muscle mass; SMMI, skeletal muscle mass index); physical performance (4MWT, 4 m walk test; STST, sit-to-stand test; OPP, overall physical performance; HGS, handgrip strength) and Wellbeing (PWBS, psychological well-being scale of Ryff, validated for the Mexican population). The data were analyzed per protocol using repeated-measures ANOVA (TCG & STG vs. CG; TCG vs. STG), and the mean difference (MD) was calculated. Results: TCG showed statistically significant changes in body composition, BFP (MD, −3.4 ± 8.2, p < 0.05), SMM (MD, 1.6 ± 1.4, p < 0.001), and SMMI (MD, 0.72 ± 0.61, p < 0.001) after the intervention compared to CG. However, no differences were observed between TCG and STG (p > 0.05). Regarding physical performance, TCG showed significant changes in 4MWT (MD, −1.0 ± 1.8, p < 0.01) and STST (MD, −3.7 ± 4.8, p < 0.05) compared to CG. Differences were also observed in STST between TCG and STG (MD, −3.7 ± 4.8 vs. 0.45 ± 3, p < 0.05). In addition, TCG showed a significant increase in HGS (MD, 1.1 ± 1.9, p < 0.05) compared to CG, although no differences were observed with STG (p > 0.05). Conclusions: Our findings suggest that TC is more effective than strength training for improving body composition, physical performance, and handgrip strength in older adults living in the community. Full article

(This article belongs to the Special Issue Research on Health-Related Quality of Life and Well-Being Among Older People)

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17 pages, 1119 KB

Open AccessReview

The Vicious Cycle of Diabetic Kidney Disease, Vitamin D Deficiency, and Arterial Hypertension

by Barbara Kurzyna, Patrycja Czebreszuk, Wiktoria Szczerbińska, Bartłomiej Michalak, Maciej Walędziak and Anna Różańska-Walędziak

Healthcare 2026, 14(5), 662; https://doi.org/10.3390/healthcare14050662 - 5 Mar 2026

Abstract

Diabetic kidney disease (DKD) is a major complication of diabetes mellitus that contributes substantially to chronic kidney failure and increased cardiovascular risk. Beyond progressive deterioration of renal function, DKD is associated with disturbances in endocrine and vascular regulation. Among these, alterations in vitamin [...] Read more.

Diabetic kidney disease (DKD) is a major complication of diabetes mellitus that contributes substantially to chronic kidney failure and increased cardiovascular risk. Beyond progressive deterioration of renal function, DKD is associated with disturbances in endocrine and vascular regulation. Among these, alterations in vitamin D homeostasis and blood pressure (BP) control represent clinically relevant, yet incompletely integrated aspects of DKD pathophysiology. This narrative review synthesizes current evidence on the multidirectional relationships between DKD, vitamin D deficiency, and arterial hypertension (AH). Attention is given to renal mechanisms responsible for reduced vitamin D availability in DKD, including proteinuria-related loss of vitamin D-binding proteins, impaired proximal tubular reabsorption, decreased renal activation of vitamin D, and hormonal regulators such as fibroblast growth factor-23. It further discusses how insufficient vitamin D signaling may influence renal and vascular pathways involved in BP regulation. Mechanistic links between vitamin D deficiency and AH in DKD are discussed, with emphasis on maladaptive activation of the renin–angiotensin–aldosterone system (RAAS), persistent inflammation, oxidative stress, endothelial dysfunction, and insulin resistance. These interdependent processes promote both renal injury progression and sustained elevations in BP, forming a self-reinforcing pathogenic loop. Finally, available data on vitamin D-based therapeutic strategies in DKD are reviewed, including native vitamin D supplementation, active vitamin D metabolites, and vitamin D receptor agonists. Although experimental and observational studies suggest potential nephroprotective and vasculoprotective effects, evidence from randomized clinical trials remains heterogeneous. Further well-designed prospective studies are required to clarify the clinical utility of vitamin D interventions in patients with DKD and coexisting AH. Full article

(This article belongs to the Section Chronic Care)

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