Healthcare

27 pages, 1476 KiB

Open AccessArticle

Assessing Occupational Work-Related Stress and Anxiety of Healthcare Staff During COVID-19 Using Fuzzy Natural Language-Based Association Rule Mining

by Abdulaziz S. Alkabaa, Osman Taylan, Hanan S. Alqabbaa and Bulent Guloglu

Healthcare 2025, 13(14), 1745; https://doi.org/10.3390/healthcare13141745 - 18 Jul 2025

Abstract

Background/Objective: Frontline healthcare staff who contend diseases and mitigate their transmission were repeatedly exposed to high-risk conditions during the COVID-19 pandemic. They were at risk of mental health issues, in particular, psychological stress, depression, anxiety, financial stress, and/or burnout. This study aimed to [...] Read more.

Background/Objective: Frontline healthcare staff who contend diseases and mitigate their transmission were repeatedly exposed to high-risk conditions during the COVID-19 pandemic. They were at risk of mental health issues, in particular, psychological stress, depression, anxiety, financial stress, and/or burnout. This study aimed to investigate and evaluate the occupational stress of medical doctors, nurses, pharmacists, physiotherapists, and other hospital support crew during the COVID-19 pandemic in Saudi Arabia. Methods: We collected both qualitative and quantitative data from a survey given to public and private hospitals using methods like correspondence analysis, cluster analysis, and structural equation models to investigate the work-related stress (WRS) and anxiety of the staff. Since health-related factors are unclear and uncertain, a fuzzy association rule mining (FARM) method was created to address these problems and find out the levels of work-related stress (WRS) and anxiety. The statistical results and K-means clustering method were used to find the best number of fuzzy rules and the level of fuzziness in clusters to create the FARM approach and to predict the work-related stress and anxiety of healthcare staff. This innovative approach allows for a more nuanced appraisal of the factors contributing to work-related stress and anxiety, ultimately enabling healthcare organizations to implement targeted interventions. By leveraging these insights, management can foster a healthier work environment that supports staff well-being and enhances overall productivity. This study also aimed to identify the relevant health factors that are the root causes of work-related stress and anxiety to facilitate better preparation and motivation of the staff for reorganizing resources and equipment. Results: The results and findings show that when the financial burden (FIN) of healthcare staff increased, WRS and anxiety increased. Similarly, a rise in psychological stress caused an increase in WRS and anxiety. The psychological impact (PCG) ratio and financial impact (FIN) were the most influential factors for the staff’s anxiety. The FARM results and findings revealed that improving the financial situation of healthcare staff alone was not sufficient during the COVID-19 pandemic. Conclusions: This study found that while the impact of PCG was significant, its combined effect with FIN was more influential on staff’s work-related stress and anxiety. This difference was due to the mutual effects of PCG and FIN on the staff’s motivation. The findings will help healthcare managers make decisions to reduce or eliminate the WRS and anxiety experienced by healthcare staff in the future. Full article

(This article belongs to the Special Issue Depression, Anxiety and Emotional Problems Among Healthcare Workers)

19 pages, 318 KiB

Open AccessArticle

Exploring Ukrainian Refugee Women’s Beliefs and Concerns About Healthcare Systems, with a Focus on HPV Immunization Practices: A Mixed-Methods Study on Forcibly Displaced Populations in Romania

by Teodora Achimaș-Cadariu, Andrei Pașca, Delia Nicoară and Dan Lucian Dumitrașcu

Healthcare 2025, 13(14), 1744; https://doi.org/10.3390/healthcare13141744 - 18 Jul 2025

Abstract

Objectives: Scarce data are available regarding preventive medicine in forcibly displaced populations especially regarding non-communicable diseases like neoplasia, while even more limited data are available on Ukrainian refugees in Romania. To address this research gap, the present analysis was performed to investigate [...] Read more.

Objectives: Scarce data are available regarding preventive medicine in forcibly displaced populations especially regarding non-communicable diseases like neoplasia, while even more limited data are available on Ukrainian refugees in Romania. To address this research gap, the present analysis was performed to investigate Ukrainian refugee women’s beliefs, attitudes, and opinions towards the Romanian and Ukrainian healthcare system in a comparison model while focusing on the HPV immunization rates and factors influencing the uptake for themselves and their children. Methods: Participants were recruited using the snowball sampling method through their General Practitioner (GP) and a health mediator. Results: In total, 105 women completed the online or physical survey. The mean age was 50 years. In total, 40% of women had not been to a gynecological check-up in 3 or more years, and more than 56% had never been screened. Only four were vaccinated against HPV, and none remembered which type of vaccine was dispensed or how many doses were utilized. The primary hindrances to accessing health services or immunization programs were language barriers, financial burdens, and a lack of information. Respondents’ general distrust of health systems and healthcare workforces were recurrent themes. Relationship status, living arrangements, and previous engagement in screening practices influenced immunization rates. Perceiving the healthcare officials as proactive concerning optional vaccination programs such as HPV immunization and actively receiving recommendations drove respondents to pursue vaccination. Conclusions: This analysis offers a foundational insight into the specific needs of refugee women. It can guide the development of effective public health interventions to improve health outcomes and vaccination rates among Ukrainian refugees in Romania. Tailored preventive campaigns with adequate native language information and prompts from medical experts in designated centers should be deployed to ensure inclusive tactics for vulnerable populations. Full article

(This article belongs to the Special Issue Focus on the Sexual and Reproductive Health of Migrant and Refugee Populations)

14 pages, 777 KiB

Open AccessArticle

Turkish Validity and Reliability Study of the Short Version of the Questionnaire for Assessing the Childbirth Experience (QACE)

by Cevriye Emir and Candan Ozturk

Healthcare 2025, 13(14), 1743; https://doi.org/10.3390/healthcare13141743 - 18 Jul 2025

Abstract

Objective: The mother’s birth experience is crucial in identifying her care needs. The “Questionnaire for Assessing the Childbirth Experience” (QACE) consists of four subscales designed to assess a mother’s childbirth experience. However, psychometric evaluations of the QACE have not been conducted in Turkey. [...] Read more.

Objective: The mother’s birth experience is crucial in identifying her care needs. The “Questionnaire for Assessing the Childbirth Experience” (QACE) consists of four subscales designed to assess a mother’s childbirth experience. However, psychometric evaluations of the QACE have not been conducted in Turkey. This study aims to adapt and assess the validity and reliability of the “Questionnaire for Assessing the Childbirth Experience” short version for the Turkish maternal population. Methods: This methodological study included 205 mothers who gave birth in a public hospital. Data were collected using an Introductory Information Form and the Questionnaire for Assessing the Childbirth Experience (QACE). Results: The content validity index (CVI) for Item 9 was calculated as 0.875, while the remaining 12 items obtained a CVI of 1.00. The internal consistency of the scale, as measured by Cronbach’s alpha coefficient (α = 0.758), indicated an acceptable level of reliability across all items. During the Exploratory Factor Analysis (EFA), one item (Item 13) was excluded due to cross-loading. The remaining 12 items were grouped into four distinct subscales. Conclusions: The short version of the QACE demonstrates acceptable psychometric properties and serves as a valid and reliable instrument for assessing childbirth experiences among Turkish women. Full article

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21 pages, 1245 KiB

Open AccessSystematic Review

Application of Conservative Methods Based on Exercise in Reducing the Kyphotic Angle: A Meta-Analysis

by Vanja Dimitrijević, Bojan Rašković, Miroslav P. Popović, Dragan Marinković, Miloš Kojić, Siniša Nikolić, Nikola Jevtić and Borislav Obradović

Healthcare 2025, 13(14), 1742; https://doi.org/10.3390/healthcare13141742 - 18 Jul 2025

Abstract

Background: The aim of this research was to evaluate the size of the effect of conservative methods based on exercises on the reduction in the kyphotic angle through a meta-analysis. Methods: In our research, we followed the Cochrane guidelines and the PRISMA guidelines. [...] Read more.

Background: The aim of this research was to evaluate the size of the effect of conservative methods based on exercises on the reduction in the kyphotic angle through a meta-analysis. Methods: In our research, we followed the Cochrane guidelines and the PRISMA guidelines. In October 2024, we searched the following databases: Scopus, Pub Med, Web of Science, and Cochrane Library. The following keywords were used for the search: (“Kyphosis” OR “Hyperkyphosis” OR “Kyphotic angle” OR “Spinal curve” OR “Sagittal spinal”) AND (“Conservative methods” OR “Conservative treatment” OR “Corrective exercise” OR “Physical exercise” OR “Exercise therapy” OR “Training”). The risk of bias was assessed for each randomized trial using the Cochrane Risk of Bias Tool and the Methodological Index for Non-Randomized Studies (MINORS). The study’s main outcome and estimated effects were the kyphotic angle. R 4.3.2 software with the meta package was used for analyses, and standardized mean difference (SMD) and 95% confidence interval (CI), a randomized model for continuous outcomes, were used as effect size. Results: Twenty-one studies were included in the qualitative analysis, while 19 studies were included in the quantitative analysis. Depending on the analysis, the effect sizes ranged from (SMD = 0.27 to SMD = 0.73). Heterogeneity ranged from 0% to 58%, while the quality of evidence (GRADE) ranged from very low to moderate. Conclusions: Our meta-analysis indicates the positive effects of applying conservative methods based on exercise in subjects without and with osteoporosis diagnosed with hyperkyphosis. Full article

(This article belongs to the Special Issue Physical and Rehabilitation Medicine—2nd Edition)

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17 pages, 787 KiB

Open AccessArticle

Assessing Stress and Shift Quality in Nursing Students: A Pre- and Post-Shift Survey Approach

by Haneen Ali and Yasin Fatemi

Healthcare 2025, 13(14), 1741; https://doi.org/10.3390/healthcare13141741 - 18 Jul 2025

Abstract

Background: Nursing students often experience heightened levels of stress during clinical training due to the dual demands of academic and clinical responsibilities. These stressors, compounded by environmental and organizational factors, can adversely affect students’ well-being, academic performance, and the quality of patient care [...] Read more.

Background: Nursing students often experience heightened levels of stress during clinical training due to the dual demands of academic and clinical responsibilities. These stressors, compounded by environmental and organizational factors, can adversely affect students’ well-being, academic performance, and the quality of patient care they deliver. Aim: This study aimed to identify the key stressors influencing nursing students’ perceptions of single-shift quality (SSQ) during clinical training and to examine how well students can predict the quality of their shift based on pre-shift expectations. Methodology: A cross-sectional survey design was implemented, collecting pre- and post-shift data from 325 nursing students undergoing clinical training in Alabama. The survey measured 13 domains related to workload, environmental conditions, organizational interactions, coping strategies, and overall satisfaction. Paired t tests and linear regressions were used to assess changes in perception and identify key predictors of SSQ. Results: This study found significant discrepancies between students’ pre- and post-shift evaluations across multiple domains, including internal environment, organizational interaction with clinical faculty/preceptors, and coping strategies (p < 0.001). Students also accurately predicted stable factors such as patient characteristics and external environment. Pre-shift expectations did not significantly predict post-shift experiences. Post-shift perceptions revealed that stress-coping strategies and collegiality were the strongest predictors of shift quality. Conclusion: Students enter clinical shifts with optimistic expectations that often do not align with actual experiences, particularly regarding support and stress management. The SSQ framework offers a valuable tool for identifying gaps in clinical training and guiding interventions that foster resilience and better alignment between expectations and real-world practice. Full article

(This article belongs to the Special Issue Health Services, Health Literacy and Nursing Quality)

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13 pages, 325 KiB

Open AccessArticle

“It Can Be Quite Daunting”: Promoting Mental Health Service Use for Vulnerable Young People

by Anne Gu, Michelle Kehoe, Kirsty Pope and Liza Hopkins

Healthcare 2025, 13(14), 1740; https://doi.org/10.3390/healthcare13141740 - 18 Jul 2025

Abstract

Background: Today, young people face a variety of social, environmental and psychological challenges, making them more vulnerable to developing mental health issues. Worldwide 15% of adolescents experience poor mental health, with the majority not seeking help or receiving care. Therefore, it is [...] Read more.

Background: Today, young people face a variety of social, environmental and psychological challenges, making them more vulnerable to developing mental health issues. Worldwide 15% of adolescents experience poor mental health, with the majority not seeking help or receiving care. Therefore, it is critical that youth mental health services become more youth-friendly to encourage help-seeking. This study examines a new pilot volunteer model of care introduced into a youth mental health service in Melbourne, Australia. The aim of the study is to explore staff perspectives of the volunteer model. Methods: A qualitative research design was undertaken using semi-structured one-on-one interviews. Eight staff participated. Data was thematically analysed using an inductive approach. Results: Two main themes, ‘promoting service use’ and ‘implementation to practice’, were generated, along with sub-themes. The themes highlight benefits to staff such as reductions in workload and benefits to volunteers through the gaining of experience and knowledge. However, there was a need to support volunteers through greater training and supervision. Conclusions: Volunteers in youth mental health services can create a welcoming environment which enhances access and engagement for young people seeking help. Volunteers in a youth mental health setting can enhance accessibility, reducing staff workload and fostering meaningful engagement. Full article

(This article belongs to the Special Issue Mental Health Promotion and Illness Prevention in Vulnerable Populations—2nd Edition)

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16 pages, 362 KiB

Open AccessArticle

Inequities in Stroke Recovery: Examining Sociodemographic Predictors of Rehabilitation Success

by Suzana Dedijer Dujović, Olivera Djordjević, Aleksandra Vidaković, Sindi Mitrović, Mirko Grajić, Tijana Dimkić Tomić, Stefan Rosić, Ana Radić and Ljubica Konstantinović

Healthcare 2025, 13(14), 1739; https://doi.org/10.3390/healthcare13141739 - 18 Jul 2025

Abstract

Background: Stroke recovery is influenced not only by clinical but also sociodemographic factors (SDFs). However, data on how variables such as age, sex, marital status, education, and employment status affect rehabilitation outcomes remain limited, particularly in structured inpatient settings. This study aimed to [...] Read more.

Background: Stroke recovery is influenced not only by clinical but also sociodemographic factors (SDFs). However, data on how variables such as age, sex, marital status, education, and employment status affect rehabilitation outcomes remain limited, particularly in structured inpatient settings. This study aimed to analyze the impact of key SDFs on functional recovery after stroke. Methods: A retrospective cohort of 289 stroke patients undergoing structured inpatient rehabilitation was analyzed. Functional status was assessed at admission, after three weeks, and at discharge using five standardized outcomes: gait speed (primary outcome), Barthel Index, Berg Balance Scale, Action Research Arm Test, and Ashworth scale. Repeated measures ANOVA and multivariable logistic regression were used to evaluate within-subject changes and associations with SDFs. Results: The cohort consisted predominantly of middle-aged to older adults (58% female, 62% married, 60% retired, 60% with primary education or less). Most patients (88%) had ischemic strokes of moderate severity. Significant improvements were observed across all functional measures. Employed, married, younger, and male patients achieved better outcomes. Interaction models indicated that older and female patients with moderate stroke severity demonstrated greater improvement than younger and male counterparts with milder strokes. Mean gait speed increased by +0.32 m/s, exceeding the minimal clinically important difference (MCID) of 0.16 m/s. Conclusions: Age, sex, marital status, education, and employment status are relevant predictors of stroke rehabilitation outcomes. These findings emphasize the importance of incorporating sociodemographic profiles into individualized rehabilitation planning to optimize functional recovery and reduce disparities among stroke survivors. Full article

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17 pages, 1437 KiB

Open AccessArticle

Acute Neurochemical, Psychophysiological, and Cognitive Responses to Small-Sided Games vs. Running-Based HIIT in Young, Male Soccer Players

by Yakup Zühtü Birinci, Serkan Pancar, Yusuf Soylu, Hüseyin Topçu, Aygül Koçyiğit, Emre Sarandöl, Hasan Şimşek and Şenay Şahin

Healthcare 2025, 13(14), 1738; https://doi.org/10.3390/healthcare13141738 - 18 Jul 2025

Abstract

Background: This study aimed to compare the immediate effects of small-sided games (SSGs) and running-based high-intensity interval training (HIITrb) on serum brain-derived neurotrophic factor (BDNF) levels, cognitive performance, and enjoyment in young, male soccer players. Methods: Twenty-four soccer players [age: 19.2 ± 0.8 [...] Read more.

Background: This study aimed to compare the immediate effects of small-sided games (SSGs) and running-based high-intensity interval training (HIITrb) on serum brain-derived neurotrophic factor (BDNF) levels, cognitive performance, and enjoyment in young, male soccer players. Methods: Twenty-four soccer players [age: 19.2 ± 0.8 years] completed one session each of four-a-side SSG or HIITrb in a randomized, counterbalanced, and crossover design, with a one-week washout period. Blood samples and Trail Making Tests (TMTs) A and B were measured before and after exercise. Heart rate (HR) was monitored throughout the games, and ratings of perceived exertion (RPE) and enjoyment were collected at the end of the measurements. Results: The results show no significant effects of time (p > 0.775), group (p > 0.276) or time × group interaction (p > 0.199) on BDNF levels. For TMT-A, the time effect (p = 0.866) and group effect (p = 0.057) were not significant; however, the time × group interaction was significant (p < 0.019), indicating a superior performance in the SSG compared to HIITrb. In the TMT-B, significant effects were observed for both time (p < 0.001) and group (p < 0.001), while the time × group interaction effect was not statistically significant (p > 0.061). Furthermore, enjoyment levels did not differ significantly between conditions (p = 0.976). Conclusions: These findings suggest that four-a-side SSG may enhance processing speed compared to HIITrb without changes in serum BDNF levels. Coaches may consider using 4v4 SSG formats in early training sessions or warm-ups to stimulate processing speed and mental readiness in young soccer players. Full article

(This article belongs to the Special Issue Creating Connection Between Physical and Mental Health in Physical Activity, Physical Exercise and Sport Across the Lifespan)

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19 pages, 1633 KiB

Open AccessArticle

Exploring the Integration of Occupational Therapy in Pediatric Oncology Care in Spain: A Descriptive Study

by Sandra León-Herrera, Elisabet Huertas-Hoyas, Raquel Gómez-Bravo, José María Fraile Vicente, Elisa Bullón-Benito and Mª Pilar Rodríguez-Pérez

Healthcare 2025, 13(14), 1737; https://doi.org/10.3390/healthcare13141737 - 18 Jul 2025

Abstract

Background/Objectives: Childhood cancer leads to significant physical, cognitive, and psychosocial consequences that adversely affect the development and quality of life. Occupational Therapy (OT) has the potential to mitigate these effects. However, its integration into pediatric oncology care in Spain remains limited and [...] Read more.

Background/Objectives: Childhood cancer leads to significant physical, cognitive, and psychosocial consequences that adversely affect the development and quality of life. Occupational Therapy (OT) has the potential to mitigate these effects. However, its integration into pediatric oncology care in Spain remains limited and underexplored. This study aims to examine the availability, characteristics, and perceived impact of OT services within pediatric oncology units across Spain and to identify key barriers to their implementation. Methods: A descriptive, cross-sectional study using a mixed-methods approach was conducted. An online questionnaire was distributed to healthcare professionals working in pediatric oncology units nationwide. Quantitative data were analyzed using descriptive statistics, Fisher’s exact test, and odds ratios with 95% confidence intervals to explore associations. Effect sizes were calculated using Cramér’s V where applicable. Qualitative responses underwent inductive thematic analysis. Results: A total of 42 hospital centers from 12 autonomous communities participated. Only 16 reported having OT services in pediatric oncology, with notable regional disparities. A significant proportion of respondents were unaware of the integration of OT in their institutions. Identified barriers included lack of resources, insufficient specialized training, and limited institutional recognition of OT. Nonetheless, professionals familiar with OT interventions reported positive outcomes, particularly in improving patients’ functional autonomy, emotional well-being, and social participation. Conclusions: OT remains insufficiently integrated into pediatric oncology care in Spain. To optimize the quality of care, it is essential to address educational, structural, and institutional challenges and promote OT as a key component of multidisciplinary teams. Full article

(This article belongs to the Special Issue Updates on Oncology Rehabilitation)

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14 pages, 240 KiB

Open AccessArticle

Biopsychosocial Determinants and Comorbid Risks of Obesity Among University Students: A Cross-Sectional Study

by Osama Albasheer, Mohamed Salih Mahfouz, Turki I. Aljezani, Mohammed Hassan Ghasham, Idris Harun Samily, Majid Muhammad Hakami, Naif Muslih Alshamrani, Shaima Abdu Hantul, Haneen A. Almutairi, Amal H. Mohamed, Nagla Abdalghani, Lamyaa A. M. El Hassan, Gassem Gohal, Ali Ali Ahmad Al-Makramani and Abdelkhalig Elhilu

Healthcare 2025, 13(14), 1736; https://doi.org/10.3390/healthcare13141736 - 18 Jul 2025

Abstract

Background/Objectives: Obesity among university students is a growing concern, often influenced by biological, psychological, and social factors. Few studies in Saudi Arabia have addressed this issue using a comprehensive framework. This study aims to examine the prevalence of obesity and its biopsychosocial predictors [...] Read more.

Background/Objectives: Obesity among university students is a growing concern, often influenced by biological, psychological, and social factors. Few studies in Saudi Arabia have addressed this issue using a comprehensive framework. This study aims to examine the prevalence of obesity and its biopsychosocial predictors among university students, as well as their perceptions, behaviors, and comorbidities. Methods: A cross-sectional study was conducted at Jazan University during the 2024–2025 academic year. A total of 819 undergraduate students completed a structured, self-administered Arabic questionnaire. The tool assessed sociodemographic variables, body mass index (BMI) (calculated from self-reported height and weight), biological and psychological factors, social influences, lifestyle behaviors, and comorbidities. Bivariate associations were tested using chi-square analyses, and multivariate logistic regression was used to identify independent predictors of obesity. Results: The prevalence of obesity was 19.6%, and 22.6% of students were overweight. Obesity was significantly more prevalent among males (26.7%) than females (9.6%, p < 0.001) and among students aged 24 years and above (24.0%, p = 0.024). Independent predictors of obesity included being overweight in childhood (AOR = 5.23, 95% CI: 3.47–7.90), belief in a genetic predisposition (AOR = 4.66), emotional eating (AOR = 2.57), academic or personal stress (AOR = 5.36), and social pressures related to body image (AOR = 2.96). Comorbidities significantly associated with obesity included high cholesterol (AOR = 5.40), sleep disorders (AOR = 2.99), and joint pain (AOR = 1.96). More than 80% of students with obesity reported current or past weight loss attempts, and nearly 60% received medical advice to lose weight. Conclusions: Obesity among Jazan University students is significantly associated with male gender, early-life weight history, emotional and academic stress, and social pressures. Students with obesity also experience a higher burden of comorbid conditions, even at a young age. These findings highlight the need for integrated, student-centered interventions that address both the psychological and social dimensions of weight management in university settings. Full article

15 pages, 948 KiB

Open AccessArticle

Older People at Risk of Suicide: A Local Study During the COVID-19 Confinement Period

by Ismael Puig-Amores, Guadalupe Martín-Mora-Parra, Isabel Cuadrado-Gordillo and Jessica Morales-Sanhueza

Healthcare 2025, 13(14), 1735; https://doi.org/10.3390/healthcare13141735 - 18 Jul 2025

Abstract

Background: Suicide in older adults represents an insufficiently addressed public health problem, despite the aging population and the increase in mental disorders in this group. The COVID-19 pandemic and associated measures, such as lockdown, could have exacerbated this phenomenon. This study aimed to [...] Read more.

Background: Suicide in older adults represents an insufficiently addressed public health problem, despite the aging population and the increase in mental disorders in this group. The COVID-19 pandemic and associated measures, such as lockdown, could have exacerbated this phenomenon. This study aimed to analyze the impact of the confinement decreed during the state of alarm in Spain on the incidence of deaths by suicide in people over 70 years of age in Extremadura. Methods: An observational and retrospective study was carried out, using data from the Institutes of Legal Medicine and Forensic Sciences, comparing the figures for 2020 with the years 2019, 2021, along with the average for the period 2015–2019. Statistical analyses included Chi-square tests and calculation of Relative Risk with 95% CI. Results: The results revealed a significant increase in deaths by suicide in the third quarter of 2020 compared to the periods compared, especially among men. Conclusions: It is concluded that confinement may have negatively influenced the mental health of older adults, which underscores the need for specific interventions and attention to regional contextual factors. Full article

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16 pages, 1435 KiB

Open AccessCase Report

Multidimensional Effects of Manual Therapy Combined with Pain Neuroscience-Based Sensorimotor Retraining in a Patient with Chronic Neck Pain: A Case Study Using fNIRS

by Song-ui Bae, Ju-hyeon Jung and Dong-chul Moon

Healthcare 2025, 13(14), 1734; https://doi.org/10.3390/healthcare13141734 - 18 Jul 2025

Abstract

Chronic neck pain is a multifactorial condition involving physical, psychological, and neurological dimensions. This case report describes the clinical course of a 25-year-old female with chronic neck pain and recurrent headaches who underwent a 6-week integrative intervention consisting of manual therapy and pain [...] Read more.

Chronic neck pain is a multifactorial condition involving physical, psychological, and neurological dimensions. This case report describes the clinical course of a 25-year-old female with chronic neck pain and recurrent headaches who underwent a 6-week integrative intervention consisting of manual therapy and pain neuroscience-based sensorimotor retraining, administered three times per week. Outcome measures included the Headache Impact Test-6 (HIT-6), Neck Pain and Disability Scale (NPDS), Pain Catastrophizing Scale (PCS), Fear-Avoidance Beliefs Questionnaire (FABQ), pressure pain threshold (PPT), cervical range of motion (CROM), and functional near-infrared spectroscopy (fNIRS) to assess brain activity. Following the intervention, the patient demonstrated marked reductions in pain and psychological distress: HIT-6 decreased from 63 to 24 (61.9%), NPDS from 31 to 4 (87.1%), FABQ from 24 to 0 (100%), and PCS from 19 to 2 (89.5%). Improvements in PPT and CROM were also observed. fNIRS revealed decreased dorsolateral prefrontal cortex (DLPFC) activation during pain stimulation and movement tasks, suggesting a possible reduction in central sensitization burden. These findings illustrate that an integrative approach targeting biopsychosocial pain mechanisms may be beneficial in managing chronic neck pain, improving function, and modulating cortical responses. This report provides preliminary evidence in support of the clinical relevance of combining manual therapy with neurocognitive retraining in similar patients. Full article

(This article belongs to the Special Issue Spinal Rehabilitation for Health and Performance: A Collection of Case Reports and Series)

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16 pages, 255 KiB

Open AccessArticle

“A Light at the End of the Tunnel”—Post-COVID Condition and the Role of Rehabilitation and Recovery Intervention Delivered in a Football Club Community Trust: A Qualitative Study

by Steven Rimmer, Adam J. Herbert, Adam Leigh Kelly, Irfan Khawaja and Lewis A. Gough

Healthcare 2025, 13(14), 1733; https://doi.org/10.3390/healthcare13141733 - 18 Jul 2025

Abstract

Background and Objectives: This study explored the lived experiences of individuals with post-COVID condition (PCC) who participated in a 12-week exercise rehabilitation and recovery programme (PCCRRP) delivered by a professional football club community trust (FCCT). The aim was to understand the effects [...] Read more.

Background and Objectives: This study explored the lived experiences of individuals with post-COVID condition (PCC) who participated in a 12-week exercise rehabilitation and recovery programme (PCCRRP) delivered by a professional football club community trust (FCCT). The aim was to understand the effects of the programme on physical function and quality of life (QoL). This study aims to address the gap in the literature of a lack of qualitative research exploring the experiences and perspectives of individuals engaging in exercise and physical activity as part of their recovery from PCC. Furthermore, it seeks to provide in-depth participant accounts to better understand outcome-level data. Methods: A qualitative approach was employed, involving semi-structured interviews with seven participants (mean age of 52 ± 8.54 years, with ages ranging from 45 to 60 years) following the 12-week PCCRRP to explore perceived changes in physical function and QoL. Thematic analysis was used to analyse the interview data, including participants’ narratives on their QoL experiences. Results: Participants reported improvements in exercise capacity, fatigue, and breathlessness, leading to enhanced physical function and QoL. They also experienced improvements in emotional well-being, including increased confidence and reduced anxiety. The programme’s focus on tailored exercise plans empowered participants to manage their symptoms and regain control over their lives. Conclusions: The PCCRRP delivered by an FCCT had positive effects on the physical function and QoL of individuals with PCC. This highlights the potential of FCCTs in providing effective rehabilitation and support for individuals with PCC. Full article

12 pages, 925 KiB

Open AccessArticle

Costs and Arising Work Times of Volatile Short-Term Sedation in Intensive Care

by Armin Niklas Flinspach, Michaela Pfaff and Florian Jürgen Raimann

Healthcare 2025, 13(14), 1732; https://doi.org/10.3390/healthcare13141732 - 18 Jul 2025

Abstract

Background: Optimizing critical care sedation is an important and complex task. Although intravenous sedatives are widely used, they do have limitations compared to volatile sedatives, such as faster awakening and minimal accumulation. However, volatiles are still rarely used due to technical barriers [...] Read more.

Background: Optimizing critical care sedation is an important and complex task. Although intravenous sedatives are widely used, they do have limitations compared to volatile sedatives, such as faster awakening and minimal accumulation. However, volatiles are still rarely used due to technical barriers and costs. We intended to conduct an economic evaluation on the workload and efficiency of short-term volatile sedation. Methods: Retrospective secondary data analysis of the cost of 60 min sedation after cardiac valve surgery performed at a tertiary center (n = 94), including assessment of material turnover, substance consumption and personnel expenses combined on a monetary basis. Results: The time required for bedside preparation was extended from almost 18 min (i.v. sedation) to an additional 9–10 min when applying volatile sedatives. We calculated a median sevoflurane consumption of 23 mL using MIRUS^TM and 14 mL using Sedaconda, resulting in an average price of EUR 38.43 for propofol, EUR 13.24 for sevoflurane under Sedaconda, and EUR 15.03 using MIRUS^TM for application in the monetary evaluation. The total prices were calculated based on an additionally optimized scenario of weekly use of a MIRUS^TM reflection device system, at EUR 128.99 versus EUR 119.73 (Sedaconda) versus EUR 48.44 for conventional propofol-based sedation. Conclusions: The use of volatile sedation in intensive care has a higher price in short-term use due to the cost of the single-use reflector of the anesthetic conserving device, which is difficult to offset financially against the pharmacological benefits in terms of faster recovery. However, the additional setup times are relatively short. Clinical benefits such as faster recovery were not included in the cost analysis. Full article

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14 pages, 603 KiB

Open AccessArticle

Health Professionals’ Views on Euthanasia: Impact of Traits, Religiosity, Death Perceptions, and Empathy

by Dimitrios Mimarakis, Maria Moudatsou, Philippa Kolokotroni, Athanasios Alegakis and Sofia Koukouli

Healthcare 2025, 13(14), 1731; https://doi.org/10.3390/healthcare13141731 - 18 Jul 2025

Abstract

Context: A plethora of actors like individual and professional characteristics, religiosity, personality-related factors, personal experience of death, and empathy form the attitude of health professionals in patient care in clinical settings and euthanasia. Objectives: The aim of the study was to measure the [...] Read more.

Context: A plethora of actors like individual and professional characteristics, religiosity, personality-related factors, personal experience of death, and empathy form the attitude of health professionals in patient care in clinical settings and euthanasia. Objectives: The aim of the study was to measure the attitudes of health professionals toward euthanasia. In addition, we examined how individual and professional characteristics, religiosity, death perspectives, and empathy may predict health professionals’ attitudes toward euthanasia. Methods: We collected socio-demographic characteristics and attitudes toward euthanasia and the end of life as well as empathy dimensions from 465 health professionals working in health services in Greece. Multiple linear regression was applied to test the association of the attitudes about euthanasia with (1) demographic and professional variables, (2) perceptions about death, and (3) empathy. Results: Findings of the study revealed that health professionals’ attitudes towards euthanasia are significantly associated with their age, the target group of their patients, religious beliefs, and their attitudes about the end of life. Meanwhile, empathy was an insignificant predictor of ATE (p > 0.05). Conclusions: Working in clinical settings with patients, especially at the end of their lives, will always include ethical issues for health professionals. Training and supporting new generations of health professionals in patient care and bioethics are crucial in order to face these ethical issues during their professional careers. Full article

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38 pages, 1030 KiB

Open AccessSystematic Review

Dynamic Computer-Aided Navigation System in Dentoalveolar Surgery and Maxillary Bone Augmentation in a Dental Setting: A Systematic Review

by Federica Di Spirito, Roberta Gasparro, Maria Pia Di Palo, Alessandra Sessa, Francesco Giordano, Iman Rizki, Gianluca Allegretti and Alessia Bramanti

Healthcare 2025, 13(14), 1730; https://doi.org/10.3390/healthcare13141730 - 17 Jul 2025

Abstract

Background: Dynamic computer-aided navigation systems are a real-time motion tracking technology widely applied in oral implantology and endodontics to enhance precision and reduce complications. However, their reliability, accuracy, and usability in dentoalveolar surgery and maxillary bone augmentation remain underinvestigated. Methods: A [...] Read more.

Background: Dynamic computer-aided navigation systems are a real-time motion tracking technology widely applied in oral implantology and endodontics to enhance precision and reduce complications. However, their reliability, accuracy, and usability in dentoalveolar surgery and maxillary bone augmentation remain underinvestigated. Methods: A systematic review following PRISMA guidelines was conducted and registered on PROSPERO (CRD42024610153). PubMed, Scopus, Web of Science, and Cochrane Library databases were searched until October 2024 to retrieve English eligible studies, without restrictions on the publication year, on dynamic computer-assisted navigation systems in dentoalveolar and bone augmentation surgeries. Exclusion criteria were surgery performed without dynamic computer-assisted navigation systems; dental implant placement; endodontic surgery; and maxillo-facial surgery. The outcomes were reliability, accuracy, post-operative course, surgical duration, complications, patient- and clinician-reported usability, acceptability, and satisfaction. Included studies were qualitatively synthetized and judged using dedicated tools for the different study designs. Results: Twenty-nine studies with 214 patients were included, showing high reliability in dentoalveolar and bone augmentation surgeries comparable to or superior to freehand surgeries, higher accuracy in dentoalveolar surgery compared to maxillary bone augmentation, and reduced complication rates across all surgeries. While overall surgical duration slightly increased due to technology installation, operative time was reduced in third molar extractions. Patient-reported outcomes were poorly investigated. Clinician-reported outcomes were mixed, but difficulties in the differentiation of soft tissue from hard tissue were recorded, especially in sinus floor elevation. Conclusions: Dynamic computer-assisted navigation systems enhance accuracy and safety in dentoalveolar and bone augmentation surgery. Further studies are needed to assess the underinvestigated patient-reported outcomes and standardize protocols. Full article

(This article belongs to the Special Issue Healthcare Goes Digital: Mobile Health and Electronic Health Technology in the 21st Century: Second Edition)

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18 pages, 735 KiB

Open AccessArticle

Assessing the Impact of Potential Confounders on Health-Related Quality of Life and Physical Activity in Patients with Chronic Kidney Disease Treated with Dialysis: A Cross-Sectional Study

by Georgia Paraskeva, Vasiliki Michou, Nikolaos Koutlianos, Dimitra Mameletzi and Evangelia Kouidi

Healthcare 2025, 13(14), 1729; https://doi.org/10.3390/healthcare13141729 - 17 Jul 2025

Abstract

Background: Patients with chronic kidney disease (CKD) G5 treated with dialysis (G5D) often experience reduced physical activity levels and impaired health-related quality of life (HRQoL), which are associated with poor clinical outcomes. Understanding the factors that influence these outcomes is crucial for [...] Read more.

Background: Patients with chronic kidney disease (CKD) G5 treated with dialysis (G5D) often experience reduced physical activity levels and impaired health-related quality of life (HRQoL), which are associated with poor clinical outcomes. Understanding the factors that influence these outcomes is crucial for improving patient care. This study aimed to evaluate the levels of physical activity and HRQoL and investigate the influence of potential confounding factors on these outcomes in patients with CKD G5D. Methods: One hundred and twenty-five patients with CKD G5D and 129 healthy controls completed a template with their general demographic and clinical information, followed by the short version of the International Physical Activity Questionnaire (IPAQ). Moreover, for patients with CKD G5D, the kidney disease-targeted version (KDQOL-SF36) was employed, whereas the healthy controls completed the standard SF-36. Results: A total of 59.2% of patients with CKD G5D demonstrated low physical activity levels, with a mean IPAQ score of 1163.38 MET-min/week, which was significantly lower than that of healthy controls (p = 0.002). Spearman’s rho correlation analysis revealed significant associations between KDQOL subscales and variables including sex, age, Charlson Comorbidity Index (CCI), hemodialysis (HD) vintage, educational level, employment status, and IPAQ activity category (p-values < 0.05). In the regression analyses, physical component summary (PCS) scores were significantly predicted by sex (β = 0.180, p = 0.036), CCI (β = 0.239, p = 0.045), and IPAQ total score (β = 0.316, p < 0.001). IPAQ scores were predicted by age (β = –0.303, p = 0.003), HD vintage (β = 0.275, p = 0.012), and PCS (β = 0.343, p = 0.002). Conclusions: The findings demonstrated a statistically significant association between physical activity and HRQoL, underscoring the importance of promoting physical activity among patients with CKD G5D. Additionally, several underexplored sociodemographic and clinical confounders were identified as significant correlates of these outcome measures. Full article

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17 pages, 820 KiB

Open AccessArticle

Establishing Diagnostic Reference Levels for Paediatric CT Imaging: A Multi-Centre Study

by Yassine Bouchareb, Manar Al Kharusi, Amani Al Maqbali, Amal Al Maimani, Hasina Al Maskari, Srinivasa Rao Sirasanagandla, Amna Al Jabri, Faiza Al Kindi, Saud Al Shabibi and Saleh Baawain

Healthcare 2025, 13(14), 1728; https://doi.org/10.3390/healthcare13141728 - 17 Jul 2025

Abstract

Background: Computed Tomography (CT) imaging is widely recognised for its high capability in assessing multiple organs. However, concerns about patient radiation exposure, particularly in children, pose significant challenges. Objective: This study aimed to establish diagnostic reference levels (DRLs) for paediatric patients in [...] Read more.

Background: Computed Tomography (CT) imaging is widely recognised for its high capability in assessing multiple organs. However, concerns about patient radiation exposure, particularly in children, pose significant challenges. Objective: This study aimed to establish diagnostic reference levels (DRLs) for paediatric patients in the most common CT examinations to monitor and better control radiation doses. Methods: Dosimetry records from 5956 patients’ scans for the four most common CT imaging examinations—Head, Chest, Abdomen Pelvis (AP), and Chest Abdomen Pelvis (CAP)—were considered. The CT dosimetric quantities (CT dose-index volume (CTDI_vol) and dose-length product (DLP)), along with patient demographics (age and weight), were collected from radiology data storage systems. DRLs for CTDI_vol and DLP were determined for each imaging examination, stratified by patient age and weight groups, in accordance with ICRP recommendations. Results: The derived DRLs are presented as [median CTDI_vol (mGy): median DLP (mGy·cm)]. For (<1 yr): Head: 13:187, Chest: 0.4:7, AP: 0.9:19, CAP: 0.4:10. For (1–5 yrs): Head: 16:276, Chest: 1:22, AP: 1.5:58, CAP: 1.6:63. For (6–10 yrs): Head: 19:332, Chest: 1.4:35, AP: 1.9:74, CAP: 2:121. For (11–15 yrs): Head: 21:391, Chest: 3:86, AP: 4.1:191, CAP: 3:165. We observed that both the CTDI_voland DLP DRL values increase with patient age. Weight-based DRLs follow similar trends for CTDI_vol, while DLP values show noticeable variations in Chest and AP examinations. Conclusions: The study findings highlight the need for review and optimisation of certain scanning protocols, particularly for chest and AP examinations. The derived DRLs are consistent with findings from other studies. The study recommends establishing national paediatric DRLs to enhance radiology practice across the country and ensure adherence to international safety standards. Full article

(This article belongs to the Collection Radiology-Driven Projects: Science, Networks, and Healthcare)

18 pages, 2056 KiB

Open AccessSystematic Review

Effectiveness of Nature-Based Interventions in Reducing Agitation Among Older Adults with Dementia: A Systematic Review and Meta-Analysis

by Eun Yeong Choe, Jennifer Yoohyun Lee and Jed Montayre

Healthcare 2025, 13(14), 1727; https://doi.org/10.3390/healthcare13141727 - 17 Jul 2025

Abstract

Background/Objectives: The role of environmental modifications and design in mitigating behavioural symptoms is increasingly being recognised as a way to address the psychosocial needs of individuals with dementia. This study aims to investigate various nature-based interventions for reducing agitation in people with [...] Read more.

Background/Objectives: The role of environmental modifications and design in mitigating behavioural symptoms is increasingly being recognised as a way to address the psychosocial needs of individuals with dementia. This study aims to investigate various nature-based interventions for reducing agitation in people with dementia in long-term residential care environments. Methods: Database searches were conducted on MEDLINE, PsycINFO, Scopus, and Web of Science. A literature search was conducted with the following inclusion criteria: (i) peer-reviewed journal publication written in English; (ii) random controlled trials (RCTs) and quasi-experimental design with results for pre- and post-testing reported; (iii) interventions using natural elements, where the effectiveness of the reduction in agitation was measured using a validated instrument; and (iv) participants aged 65 and older with dementia residing in long-term care facilities. Results: This meta-analysis included 29 studies with 733 participants. The results showed that such interventions had a significant negative mean effect on lowering agitation in this population. Additionally, intervention settings (indoor vs. outdoor) and the presence of social interaction were significant predictors of the effect size for agitation reduction. At the same time, no significant differences in effect size were observed between the types of experiences with nature (indirect vs. direct) or the duration of the interventions. Conclusions: This study demonstrates that, when thoughtfully applied, nature-based interventions can significantly alleviate agitation in patients with dementia residing in long-term residential care facilities. This review lays the groundwork for future research aimed at developing design guidelines and planning strategies to integrate natural elements into dementia-friendly environments effectively. Full article

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