Healthcare

33 pages, 544 KB

Open AccessArticle

The Impact of Comorbidities on Health-Related Quality of Life Among Patients with Rheumatoid Arthritis

by Adriana Liliana Vlad, Corina Risca Popazu, Alina-Maria Lescai, Daniela-Ioanina Prisacaru, Doina Carina Voinescu and Alexia Anastasia Stefania Baltă

Healthcare 2026, 14(2), 256; https://doi.org/10.3390/healthcare14020256 - 20 Jan 2026

Abstract

Background. Rheumatoid arthritis (RA) is a chronic autoimmune disease frequently accompanied by cardiovascular, respiratory, skeletal, psychiatric, and neoplastic comorbidities that are associated with higher morbidity and poorer health-related quality of life (HRQoL). This study evaluated the associations between comorbidities and patient-reported physical health, [...] Read more.

Background. Rheumatoid arthritis (RA) is a chronic autoimmune disease frequently accompanied by cardiovascular, respiratory, skeletal, psychiatric, and neoplastic comorbidities that are associated with higher morbidity and poorer health-related quality of life (HRQoL). This study evaluated the associations between comorbidities and patient-reported physical health, emotional distress, daily functioning, and social relationships in adults with RA and explored patient-reported unmet needs relevant to integrated care. Methods. We conducted a cross-sectional survey among 286 adults with physician-confirmed RA, using a structured questionnaire (ICRA-Q) administered between June and July 2025 via online platforms and in-hospital supervised completion. The survey captured demographics, patient-reported physician-diagnosed comorbidities (current and/or past), perceived disease impact, functional limitations, emotional and social consequences, access to treatment, financial burden, and support needs. Analyses included descriptive statistics, χ² tests, t-tests/ANOVA, effect sizes (Cramer’s V and standardized mean differences), and multivariable logistic regression to explore predictors of high HRQoL impact and high difficulty in disease management. An exploratory classification into high-risk phenotypes was performed using predefined clinical, psychological, and socioeconomic criteria. Results. Most participants (98.6%) reported at least one comorbidity, most commonly hypertension, osteoporosis, and cardiovascular disease. Higher comorbidity burden and depression/anxiety were strongly associated with higher pain, reduced mobility, emotional distress, and financial strain. Exploratory high-risk phenotypes (severe somatic multimorbidity, high psychological vulnerability, high socioeconomic burden, and a composite very high-risk profile) were associated with poorer HRQoL indicators. Younger age, shorter disease duration, and higher perceived social support were associated with lower perceived burden. Conclusions. In this cross-sectional, patient-reported study, comorbidity burden—particularly psychological comorbidity—was strongly associated with poorer HRQoL and greater management difficulty in RA. These findings support the need for multidisciplinary, integrated care pathways; however, subgroup phenotypes should be considered exploratory and require external validation. Full article

11 pages, 214 KB

Open AccessCommentary

Persistent Traumatic Stress Exposure: Rethinking PTSD for Frontline Workers

by Nicola Cogan

Healthcare 2026, 14(2), 255; https://doi.org/10.3390/healthcare14020255 - 20 Jan 2026

Abstract

Frontline workers across health, emergency, and social care sectors are repeatedly exposed to distressing events and chronic stressors as part of their occupational roles. Unlike single-event trauma, these cumulative exposures accrue over time, generating persistent psychological and physiological strain. Traditional diagnostic frameworks, particularly [...] Read more.

Frontline workers across health, emergency, and social care sectors are repeatedly exposed to distressing events and chronic stressors as part of their occupational roles. Unlike single-event trauma, these cumulative exposures accrue over time, generating persistent psychological and physiological strain. Traditional diagnostic frameworks, particularly post-traumatic stress disorder (PTSD), were not designed to capture the layered and ongoing nature of this occupational trauma. This commentary introduces the concept of Persistent Traumatic Stress Exposure (PTSE), a framework that reframes trauma among frontline workers as an exposure arising from organisational and systemic conditions rather than solely an individual disorder. It aims to reorient understanding, responsibility, and intervention from a purely clinical lens toward systems, cultures, and organisational duties of care. PTSE is presented as an integrative paradigm informed by contemporary theory and evidence on trauma, moral injury, organisational stress, and trauma-informed systems. The framework synthesises findings from health, emergency, and social care settings, illustrating how repeated exposure, ethical conflict, and institutional pressures contribute to cumulative psychological harm. PTSE highlights that psychological injury may build across shifts, careers, and lifetimes, requiring preventive, real-time, and sustained responses. The framework emphasises that effective support is dependent on both organisational readiness, the structural conditions that enable trauma-informed work, and organisational preparedness, the practical capability to enact safe, predictable, and stigma-free responses to trauma exposure. PTSE challenges prevailing stigma by framing trauma as a predictable occupational hazard rather than a personal weakness. It aligns with modern occupational health perspectives by advocating for systems that strengthen psychological safety, leadership capability and access to support. By adopting PTSE, organisations can shift from reactive treatment models toward proactive cultural and structural protection, honouring the lived realities of frontline workers and promoting long-term wellbeing and resilience. Full article

(This article belongs to the Special Issue Improving the Health and Well-Being of Groups of Workers Experiencing Work Disparities)

10 pages, 557 KB

Open AccessArticle

Effect of the Transradial Approach on Wrist Function in Diagnostic Cerebral Angiography

by Julian Kifmann, Michael Braun, Johannes Steinhart, Nico Sollmann, Christopher Kloth, Maria Pedro, Jens Dreyhaupt, Meinrad Beer, Bernd Schmitz and Johannes Rosskopf

Healthcare 2026, 14(2), 254; https://doi.org/10.3390/healthcare14020254 - 20 Jan 2026

Abstract

Background: With increasing demand for ambulatory catheter angiography, interest in the transradial approach for diagnostic cerebral procedures has grown markedly. This study aimed to evaluate the effect of the transradial approach for catheter-based diagnostic cerebral procedures on wrist function. Methods: Wrist [...] Read more.

Background: With increasing demand for ambulatory catheter angiography, interest in the transradial approach for diagnostic cerebral procedures has grown markedly. This study aimed to evaluate the effect of the transradial approach for catheter-based diagnostic cerebral procedures on wrist function. Methods: Wrist function was quantified by the Patient-Rated Wrist Evaluation (PRWE) questionnaire. The PRWE score ranged from 0 to 100, with 0 indicating no functional impairment. Association analyses with demographic and clinical parameters were performed using univariate logistic regression models. Results: A total of 88 patients underwent ambulatory diagnostic cerebral angiography during the 15-month observation period; of these, 40 (45%) participated in a telephone interview. Overall, 47.5% (n = 19) of patients reported no wrist impairment (PRWE = 0) after the transradial approach. The remaining 52.5% (n= 21) showed a mean PRWE score of 21.3 ± 22.5 (standard deviation), with a median value of 11.0 and a range from 1.0 to 87.0. Interestingly, univariate logistic regression models revealed a trend towards association between the dichotomized PRWE score and body mass index (p = 0.051). No associations were found with age, sex, prior neurosurgical status, total procedure duration, dose area product, fluoroscopy time, or dominant hand (p > 0.05). Conclusions: Following transradial cerebral catheter angiography, 52.5% of patients reported some degree of wrist impairment at follow-up; whether this represents procedure-related deterioration cannot be determined without baseline values. Full article

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20 pages, 1226 KB

Open AccessReview

Enhancing Performance and Quality of Life in Lower Limb Amputees: Physical Activity, a Valuable Tool—A Scoping Review

by Federica Delbello, Leonardo Zullo, Andrea Giacomini and Emiliana Bizzarini

Healthcare 2026, 14(2), 253; https://doi.org/10.3390/healthcare14020253 - 20 Jan 2026

Abstract

Background/Objectives: Lower limb amputation (LLA) negatively affects the physical and psychological health of individuals, leading to a lower quality of life and sedentary lifestyle. The objective of this scoping review is to search for evidence regarding physical activity interventions in individuals with LLA, [...] Read more.

Background/Objectives: Lower limb amputation (LLA) negatively affects the physical and psychological health of individuals, leading to a lower quality of life and sedentary lifestyle. The objective of this scoping review is to search for evidence regarding physical activity interventions in individuals with LLA, investigating improvements in specific outcomes related to quality of life and performance. Methods: PRISMA guidelines—extension for scoping reviews—were used to structure the study. The research was conducted between 26 July 2023 and 30 September 2023; it was structured by defining two PICO questions (P = amputation, I = physical exercise, O1 = quality of life, and O2 = performance) through Pubmed, Cochrane, and Pedro databases. The study included subjects with LLA of any etiology, in prosthetic or pre-prosthetic phase, practicing non-competitive physical activity. The results were then subjected to both qualitative and quantitative analysis. Results: Of the 615 studies identified, 18 were included in the review. They consisted of 6 systematic reviews (SR), 5 RCTs, 4 case–control studies, 1 case report (CR), and 2 cross-sectional (CS). Physical activity (PA) interventions were extremely heterogeneous and were, therefore, categorized into 6 modalities: surveys were the most reported strategies (57%), followed by personalized training (23%), strength training (13%), endurance training (13%), combined training (2%), and gait training (5%). Due to the heterogeneity of the studies, the variety of interventions proposed and the different outcomes registered, there is no evidence that one approach is more effective than another, while each group showed benefits on different specific outcomes. In total, five outcome categories were identified: quality of life was the most frequently analysed (42%), followed by cardiovascular fitness (20%), muscular fitness (14%), gait parameters (13%), functionality and disability (11%). Conclusions: PA represents a valuable strategy for improving performance and quality of life in individuals with LLA, offering a variety of interventions. Although there is no evidence that one strategy is better than the others, each activity has proven to be effective on specific outcomes, therefore, the choice must depend on the patient’s necessities. The preferred option should be the personalization of the training according to individual needs, coupled with long-term planning and remote monitoring. Creating meeting places and supporting occasions for sports activities could be a valid option. Further research could help to clarify the benefits of such interventions and enhance the understanding of how to optimize the management of LLA patients. Full article

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13 pages, 232 KB

Open AccessArticle

Delay in Accessing and Receiving Primary Health Care and Associated Factors Among Nepalese Immigrant Patients in Canada

by Bishnu B. Bajgain, Mohammad Z. I. Chowdhury, Rudra Dahal, Kalpana Thapa Bajgain, Kamala Adhikari, Nashit Chowdhury and Tanvir C. Turin

Healthcare 2026, 14(2), 252; https://doi.org/10.3390/healthcare14020252 - 20 Jan 2026

Abstract

Introduction: Timely access to healthcare is essential for improving population health and reducing inequities. Immigrants often experience unique cultural, linguistic, and systemic barriers that delay care-seeking and service utilization. Despite the rapid growth of the Nepalese community in Canada, there is limited [...] Read more.

Introduction: Timely access to healthcare is essential for improving population health and reducing inequities. Immigrants often experience unique cultural, linguistic, and systemic barriers that delay care-seeking and service utilization. Despite the rapid growth of the Nepalese community in Canada, there is limited empirical evidence examining their healthcare access. This study aimed to assess the prevalence and determinants of delays in accessing healthcare among Nepalese immigrants. Methods: A community-based participatory research (CBPR) framework guided a cross-sectional survey conducted between January and June 2019. The research process was co-led by academic investigators, community scholars, and local Nepalese organizations to ensure cultural and contextual relevance. A snowball sampling strategy was used to recruit 401 Nepalese adults. Data were analyzed using descriptive statistics and multivariable logistic regression to examine sociodemographic and health-related factors associated with delayed healthcare access. Results: Of the 401 respondents, 66.3% (n = 266) reported experiencing a delay in accessing healthcare within the preceding 12 months. Delays were more common among participants aged 26–45 years, those who were married, employed, or had an undergraduate degree or lower. After adjusting for covariates, older age, lower education, having a family doctor, higher income (≥$26,000), and one or more chronic conditions were associated with increased odds of delay. Family size and the number of years living in Canada have had little effect on care delay. Conclusions: Delays in accessing healthcare are common among Nepalese immigrants in Calgary, reflecting the intersection of individual, cultural, and systemic determinants. These findings underscore the importance of community-engaged, culturally responsive strategies to address barriers and promote equitable healthcare access for immigrant populations. Strengthening partnerships between health systems and immigrant communities may enhance trust, navigation, and continuity of care. Full article

15 pages, 239 KB

Open AccessArticle

Family Dialogues on Sexuality: A Contingential Analysis of Gender, Care, and Mother–Adolescent Children Communication

by Angel de Jesús Angulo Moreno, Abner Daniel Ramírez Arzate and María Dolores Aragón Robles Linares

Healthcare 2026, 14(2), 251; https://doi.org/10.3390/healthcare14020251 - 20 Jan 2026

Abstract

From an interbehavioral and contingential perspective, family dialogues about sexuality are understood as patterns of verbal interaction regulated by social, gender, and caregiving contingencies rather than as individual attitudes or intentions. Background: This study analyzes the functional conditions under which family dialogues about [...] Read more.

From an interbehavioral and contingential perspective, family dialogues about sexuality are understood as patterns of verbal interaction regulated by social, gender, and caregiving contingencies rather than as individual attitudes or intentions. Background: This study analyzes the functional conditions under which family dialogues about sexuality occur between mothers and their adolescent sons and daughters, considering caregiving roles and gender norms that regulate these interactions. The research aimed to identify the functional relations between communicative practices and the social contingencies that maintain or inhibit them. Methods: A qualitative approach grounded in interbehavioral psychology was employed, using semistructured interviews with 40 mothers of students from a public middle school in Puebla, Mexico. Data were analyzed through contingency analysis, distinguishing micro- and macrocontingential systems related to family sexual education. Results: Results show that, although patterns of avoidance and discourse displacement toward schools or peers persist, families exhibit increasing openness toward comprehensive sexuality education and recognize its preventive value against violence, adolescent pregnancy, and misinformation. Functional delegation and adolescent mediation of dialogue were identified, along with emerging inclusive macrocontingencies linked to the acceptance of diverse families and LGBTIQ+ themes. Conclusions: It is concluded that households function as self-regulated interbehavioral systems in which historical and gender contingencies restrict sexual dialogue, yet gradual functional changes toward respect, inclusion, and shared educational responsibility are observed. Full article

(This article belongs to the Special Issue Family Care and Mental Health Delivery to Improve Welfare of Children and Parents)

14 pages, 342 KB

Open AccessArticle

Impact of Psychiatric Rehabilitation on Chronicity and Health Outcomes in Mental Disorders: A Quasi-Experimental Study

by Marta Llorente-Alonso, Marta Tello Villamayor, Estela Marco Sainz, Pilar Barrio Íñigo, Lourdes Serrano Matamoros, Irais Esther García Villalobos, Irene Cuesta Matía, Andrea Martínez Abella, María José Velasco Gamarra, María Nélida Castillo Antón and María Concepción Sanz García

Healthcare 2026, 14(2), 250; https://doi.org/10.3390/healthcare14020250 - 20 Jan 2026

Abstract

Background/Objectives: People suffering from mental illnesses are more likely to experience adverse social and health outcomes. Various interventions have been shown to help people with mental illness achieve better results in terms of symptom reduction, functional status, and quality of life. Psychiatric [...] Read more.

Background/Objectives: People suffering from mental illnesses are more likely to experience adverse social and health outcomes. Various interventions have been shown to help people with mental illness achieve better results in terms of symptom reduction, functional status, and quality of life. Psychiatric rehabilitation interventions integrate evidence-based practices, promising approaches, and emerging methods that can be effectively implemented to enhance health outcomes in this population. This study aims to examine whether the rehabilitative treatment provided to a group of patients with mental illness leads to improvements in health outcomes and psychiatric symptomatology. Methods: This study employed a retrospective quasi-experimental design. Data were collected between 2023 and 2025 within the Partial Hospitalization Program of the Psychiatry and Mental Health Service of Soria (Spain). The sample consisted of 58 participants who received rehabilitative treatment in this setting. Data were collected at the time of patients’ admission and at discharge. Gender, age, psychiatric diagnosis according to ICD-10, and the average length of stay in the rehabilitation program were assessed. The questionnaires administered were psychometrically validated scales related to heteroaggressiveness, perceived quality of life, global functioning, attitudes toward medication, and the risk of suicide. Results: A significant improvement was observed in the Global Assessment of Functioning (GAF) Scale (t = −7.1, p < 0.001), with mean scores increasing from 42.17 at admission to 69.13 at discharge. Additionally, reductions in suicidal risk and hetero-aggressive behavior were noted, alongside improvements in quality of life and treatment adherence. Conclusions: The findings highlight the effectiveness of implementing activities and programs focused on psychiatric rehabilitation processes to promote positive health outcomes. Future research directions and practical implications are discussed to support the continued development and optimization of psychiatric rehabilitation programs. Full article

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

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17 pages, 566 KB

Open AccessArticle

Short-Term Inspiratory Muscle Training Enhances Functional and Metabolic Health in Older Adults

by Erkan Konca, Coşkun Yılmaz, Serdar Bayrakdaroğlu, Halil İbrahim Ceylan, Ayla Arslan, Hakan Ocak, İzzet Karakulak, Rifat Sarı, Recep Nur Uzun, Hakan Hüseyin Soylu, Levent Ceylan and Raul Ioan Muntean

Healthcare 2026, 14(2), 249; https://doi.org/10.3390/healthcare14020249 - 19 Jan 2026

Abstract

Background: Age-related declines in respiratory muscle strength and ventilatory efficiency can impair functional capacity and metabolic health in older adults. Inspiratory muscle training (IMT) has been proposed as a practical intervention to counteract these changes, yet its systemic effects remain unclear. This [...] Read more.

Background: Age-related declines in respiratory muscle strength and ventilatory efficiency can impair functional capacity and metabolic health in older adults. Inspiratory muscle training (IMT) has been proposed as a practical intervention to counteract these changes, yet its systemic effects remain unclear. This study aimed to examine the effects of short-term IMT on functional capacity, diaphragm thickness, and liver tissue characteristics in healthy elderly men. Methods: Thirty community-dwelling men aged 60–80 years were randomly assigned to an IMT or control group. The IMT group performed four weeks of breathing exercises using a POWERbreathe^® device at 40% of maximal inspiratory pressure, with a weekly 10% increase in pressure. Pre- and post-intervention assessments included the six-minute walk test (6MWT), diaphragm thickness and liver density via computed tomography, and quality of life (QoL; SF-12). Results: Four weeks of inspiratory muscle training significantly improved diaphragm thickness (11.7%), fatty liver density (FLD) (+16.7%), and six-minute walk performance (+5.3%), with large time × group effects favoring the IMT group. While the physical quality of life showed modest, comparable improvements, mental health outcomes demonstrated a moderate, time-dependent improvement without a significant group-by-time interaction. Conclusions: Short-term IMT improved diaphragmatic function and functional capacity in older men and was associated with favorable changes in a liver-related biomarker; however, given that only a single liver-related metric was assessed, these findings should not be interpreted as evidence of overall improvements in liver health. Full article

20 pages, 520 KB

Open AccessArticle

AI-Enhanced Qualitative Analysis in Healthcare: Unlocking Insight from Interviews of Leadership at Top-Performing Academic Medical Centers

by Triss Ashton and Seth Chatfield

Healthcare 2026, 14(2), 248; https://doi.org/10.3390/healthcare14020248 - 19 Jan 2026

Abstract

Background/Objectives: Vast amounts of textual data are generated by healthcare organizations every year. Traditional content analysis is time-intensive, error-prone, and potentially biased. This study demonstrates how freely available large language model (LLM) artificial intelligence (AI) tools can efficiently and effectively analyze qualitative [...] Read more.

Background/Objectives: Vast amounts of textual data are generated by healthcare organizations every year. Traditional content analysis is time-intensive, error-prone, and potentially biased. This study demonstrates how freely available large language model (LLM) artificial intelligence (AI) tools can efficiently and effectively analyze qualitative healthcare data and uncover insights missed by traditional manual analysis. Interview data from chief nursing officers (CNOs) at top-performing academic medical centers were analyzed to identify factors contributing to their operational and patient quality success. Methods: Semi-structured interviews were conducted with CNOs from top-performing academic medical centers that achieved top-decile quality measures while using resources most efficiently. Interview transcripts were analyzed using a mix of traditional text mining in LSA and Gemini 2.5. The capability of four freely available AI platforms—Gemini 2.5, Scholar AI 5.1, Copilot’s Chat, and Claude’s Sonnet 4.5—was also reviewed. Results: LLM AI analysis identified ten primary factors, comprising twenty-four subtopics, that characterized successful hospital performance. Notably, AI analysis identified a theoretical connection that manual analysis had missed, revealing how the identified framework aligned with Donabedian’s seminal structure, process, outcomes quality model. The AI analysis reduced the required time from weeks to nearly instantaneous. Conclusions: LLM AI tools offer a transformative approach to unlocking insight from the analysis of qualitative textual data in healthcare settings. These tools can provide rapid insight that is accessible to personnel with minimal text-mining expertise and offer a practical solution for healthcare organizations to unlock insight hidden in the vast amounts of textual data they hold. Full article

(This article belongs to the Special Issue AI-Driven Healthcare Insights)

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41 pages, 3681 KB

Open AccessArticle

Proof-of-Concept Machine Learning Framework for Arboviral Disease Classification Using Literature-Derived Synthetic Data: Methodological Development Preceding Clinical Validation

by Elí Cruz-Parada, Guillermina Vivar-Estudillo, Laura Pérez-Campos Mayoral, María Teresa Hernández-Huerta, Alma Dolores Pérez-Santiago, Carlos Romero-Diaz, Eduardo Pérez-Campos Mayoral, Iván A. García Montalvo, Lucia Martínez-Martínez, Héctor Martínez-Ruiz, Idarh Matadamas, Miriam Emily Avendaño-Villegas, Margarito Martínez Cruz, Hector Alejandro Cabrera-Fuentes, Aldo-Eleazar Pérez-Ramos, Eduardo Lorenzo Pérez-Campos and Carlos Mauricio Lastre-Domínguez

Healthcare 2026, 14(2), 247; https://doi.org/10.3390/healthcare14020247 - 19 Jan 2026

Abstract

Background/Objectives: Arboviral diseases share common vectors, geographic distribution, and symptoms. Developing Machine Learning diagnostic tools for co-circulating arboviral diseases faces data-scarcity challenges. This study aimed to demonstrate that proof of concept using synthetic data can establish computational feasibility and guide future real-world [...] Read more.

Background/Objectives: Arboviral diseases share common vectors, geographic distribution, and symptoms. Developing Machine Learning diagnostic tools for co-circulating arboviral diseases faces data-scarcity challenges. This study aimed to demonstrate that proof of concept using synthetic data can establish computational feasibility and guide future real-world validation efforts. Methods: We assembled a synthetic dataset of 28,000 records, with 7000 for each disease—Dengue, Zika, and Chikungunya—plus Influenza as a negative control. These records were obtained from the existing literature. A binary matrix with 67 symptoms was created for detailed statistical analysis using Odds Ratios, Chi-Square, and symptom-specific conditional prevalence to validate the clinical relevance of the simulated data. This dataset was used to train and evaluate various algorithms, including Multi-Layer Perceptron (MLP), Narrow Neural Network (NN), Quadratic Support Vector Machine (QSVM), and Bagged Tree (BT), employing multiple performance metrics: accuracy, precision, sensitivity, specificity, F1-score, AUC-ROC, and Cohen’s kappa coefficient. Results: The dataset aligns with the PAHO guidelines. Similar findings are observed in other arboviral databases, confirming the validity of the synthetic dataset. A notable performance across all evaluated metrics was observed. The NN model achieved an overall accuracy of 0.92 and an AUC above 0.98, with precision, sensitivity, and specificity values exceeding 0.85, and an average Uniform Cohen’s Kappa of 0.89, highlighting its ability to reliably distinguish between Dengue and Influenza, with a slight decrease between Zika and Chikungunya. Conclusions: These models could accelerate early diagnosis of arboviral diseases by leveraging encoded symptom features for Machine Learning and Deep Learning approaches, serving as a support tool in regions with limited healthcare access without replacing clinical medical expertise. Full article

(This article belongs to the Special Issue Machine Learning in Medicine and Health: Data, Methods and Applications)

13 pages, 212 KB

Open AccessArticle

Enhancing Multidimensional Health Benefits Through the Use of Mobile Leisure Application

by Jae Hyung Park, Chul Won Lee and Chanwook Do

Healthcare 2026, 14(2), 246; https://doi.org/10.3390/healthcare14020246 - 19 Jan 2026

Abstract

Background/Objectives: Smartphone-based leisure reservation platforms increasingly shape how individuals participate in leisure, yet little is known about how such technology-mediated engagement influences users’ awareness of multidimensional health benefits. The purpose of this study is to investigate how regular users of smartphone-based leisure [...] Read more.

Background/Objectives: Smartphone-based leisure reservation platforms increasingly shape how individuals participate in leisure, yet little is known about how such technology-mediated engagement influences users’ awareness of multidimensional health benefits. The purpose of this study is to investigate how regular users of smartphone-based leisure reservation platforms perceive multidimensional health benefits associated with their leisure activities. Methods: Based on a constructivist/interpretivist approach, this study applied Interpretative Phenomenological Analysis (IPA). Ten participants with at least one year of platform use completed semi-structured interviews. Data were analyzed through iterative coding and theme development, with trustworthiness ensured through member checking, peer debriefing, and triangulation. Results: Participants reported three dimensions of health awareness. (1) App-enabled accessibility as a catalyst for physical health awareness (i.e., physical health benefits) included improved vitality and increased motivation to maintain exercise routines. (2) App-based planning and anticipation in supporting mental well-being (i.e., mental health benefits) involved stress reduction, emotional recovery, enjoyment, and heightened self-care awareness. (3) Platform-mediated social encounters and the construction of social health (i.e., social health benefits) reflected expanded social networks, strengthened interpersonal relationships, and a greater sense of belonging fostered through shared leisure experiences. Conclusions: Smartphone-based leisure platforms play a meaningful role in enhancing users’ awareness of multidimensional health benefits. By improving accessibility, diversifying leisure options, and facilitating social interaction, these platforms support holistic well-being. The findings contribute to understanding technology-mediated leisure and offer practical implications for designing digital leisure services that promote physical, mental, and social health. Full article

(This article belongs to the Special Issue Promoting Health and Well-Being Through Lifestyle and Physical Activity)

15 pages, 780 KB

Open AccessArticle

Exploring the Role of Appraised Support in Mitigating Reverse Culture Shock Among Cross-Border Retirement Migrants

by Zenan Wu, Sai-fu Fung, Tianjian Pi, Zhai Wang and Yu Tian

Healthcare 2026, 14(2), 245; https://doi.org/10.3390/healthcare14020245 - 19 Jan 2026

Abstract

Background/Objectives: Cross-border retirement migration has become a global trend. However, this population from Hong Kong, with a unique status, offers valuable opportunities for multidimensional empirical research. This paper aims to apply a Stress and Coping Theory–based model to verify the presence of reverse [...] Read more.

Background/Objectives: Cross-border retirement migration has become a global trend. However, this population from Hong Kong, with a unique status, offers valuable opportunities for multidimensional empirical research. This paper aims to apply a Stress and Coping Theory–based model to verify the presence of reverse culture shock (RCS) among them and explore how social support and its appraisal are associated with loneliness. It further examines indirect associations involving secondary appraisal within the appraisal structure. Methods: We recruited 210 Hong Kong seniors (aged ≥65) who had relocated to mainland China and had ever returned and surveyed them using validated scales. Results: Robust regression results revealed that higher levels of RCS were associated with higher levels of loneliness. Compared to social support (β = −0.04, p = 0.278), its appraisal had a significant negative association with loneliness (β = −0.09, p < 0.05). Mediation analysis demonstrated a significant indirect association involving social support appraisal, with variation across duration since the last return. Conclusions: With the resumption of normal cross-border travel after COVID-19, RCS is associated with subjective well-being among older returnees. Support appraisal shows a stronger association with loneliness, although this association varies by temporal context. We further propose that within the appraisal structure, secondary appraisal may be implicated in indirect associations linking primary appraisal to emotional outcomes, and that these associations vary by temporal context. Full article

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16 pages, 3098 KB

Open AccessArticle

Physical Activity and Bidirectional Stage Transitions in Cardiovascular-Kidney-Metabolic Syndrome: A Cohort Study

by Chuan Mou, Xinrui Miao and Zhihua Wang

Healthcare 2026, 14(2), 244; https://doi.org/10.3390/healthcare14020244 - 19 Jan 2026

Abstract

Background: Cardiovascular-Kidney-Metabolic (CKM) syndrome involves interconnected cardiovascular, renal, and metabolic conditions. The dose–response relationship between physical activity and bidirectional CKM stage transitions remains unclear. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS), cross-sectional analysis pooled 14,310 observations from 10,868 [...] Read more.

Background: Cardiovascular-Kidney-Metabolic (CKM) syndrome involves interconnected cardiovascular, renal, and metabolic conditions. The dose–response relationship between physical activity and bidirectional CKM stage transitions remains unclear. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS), cross-sectional analysis pooled 14,310 observations from 10,868 participants. Logistic regression with clustered robust standard errors accounted for intra-individual correlation. Longitudinal analysis (n = 3442) employed continuous-time multi-state Markov models with a 5-state structure (Stages 0–4). To evaluate physical activity effects, stages were regrouped into low-risk (Stages 0–2) and high-risk states (Stages 3–4) using a 2 × 2 transition intensity matrix. Physical activity was measured in MET-min/week and categorized into quartiles (Q1–Q4). Results: Compared with Q1, Q2, Q3, and Q4 were associated with 43.1%, 52.5%, and 53.1% lower risk of high-risk CKM stages, respectively. RCS analysis demonstrated nonlinear dose–response relationships between physical activity and CKM stage progression. Subgroup analyses showed more pronounced protective effects in older adults and single individuals. During 4-year follow-up, 31.6% experienced progression and 6.8% showed improvement. Stage 4 acted as a complete absorbing state without any reversal. Transition intensity analysis revealed that transitions between adjacent stages were notably higher than cross-stage transitions. The Q4 physical activity level significantly reduced transitions from low-risk to high-risk states (HR = 0.598, 95% CI: 0.459–0.777) and promoted transitions from high-risk to low-risk states (HR = 2.995, 95% CI: 1.257–7.134). Conclusions: Moderate-to-high physical activity effectively reduces CKM progression risk and promotes improvement, providing evidence for CKM prevention and management. Full article

(This article belongs to the Special Issue Association Between Physical Activity and Chronic Condition)

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13 pages, 258 KB

Open AccessArticle

A Cross-Sectional Assessment of Quality of Life Among Healthcare Professionals in North-Central Saudi Arabia: Implications for Workforce Well-Being and Policy Development

by Ahmad Homoud Al-Hazmi, Fahad Tulayhan M. Alshammari, Ibtisam Qazi, Bashayer Farhan ALruwaili, Doaa Mazen Abdel-Salam and Ashokkumar Thirunavukkarasu

Healthcare 2026, 14(2), 243; https://doi.org/10.3390/healthcare14020243 - 19 Jan 2026

Abstract

Background and Objectives: Quality of life (QoL) among healthcare professionals (HCPs) is a critical determinant of workforce performance and patient care. Therefore, the present study aimed to assess QoL and its determinants among HCPs in the Hail region, Saudi Arabia. Methods: In this [...] Read more.

Background and Objectives: Quality of life (QoL) among healthcare professionals (HCPs) is a critical determinant of workforce performance and patient care. Therefore, the present study aimed to assess QoL and its determinants among HCPs in the Hail region, Saudi Arabia. Methods: In this cross-sectional study, data were collected from 388 HCPs from multiple healthcare facilities using the WHOQOL-BREF questionnaire. The survey was conducted from August 2025 to October 2025. Convenience sampling was used, and QoL domain scores were calculated according to WHO guidelines. We applied Spearman’s correlation test to assess correlations across domains and logistic regression to identify factors associated with individual and overall QoL. Results: Among the HCPs studied, overall QoL had a median score of 80, while the physical, psychological, social, and environmental domains showed moderate scores with considerable variability. We found a significant positive correlation between the various QoL domains (p = 0.001). Non-Saudi nationals (p = 0.010) and participants with chronic diseases (p = 0.032) reported significantly lower overall QoL. Furthermore, age group, work experience, HCPs category, work setting, nationality, and the presence of chronic disease were significant predictors across multiple QoL domains. Conclusions: The findings highlight the need for targeted workplace and health support interventions to manage the mental and physical health of HCPs, particularly for non-Saudi HCPs and those with chronic conditions, through tailored training, education, and lifestyle-based support programs. Full article

23 pages, 1557 KB

Open AccessSystematic Review

Effectiveness of Negative Pressure Wound Therapy in Burns in Pediatric and Adolescent Patients: A Systematic Review and Meta-Analysis

by Celia Villalba-Aguilar, Juan Manuel Carmona-Torres, Lucía Villalba-Aguilar, Matilde Isabel Castillo-Hermoso, Rosa María Molina-Madueño and José Alberto Laredo-Aguilera

Healthcare 2026, 14(2), 242; https://doi.org/10.3390/healthcare14020242 - 19 Jan 2026

Abstract

Background: Burns represent a public health problem because they generate both physical and psychological damage, especially in the child and adolescent population, and high costs, especially due to the management of scars. Advances in burn care have improved survival and quality of life [...] Read more.

Background: Burns represent a public health problem because they generate both physical and psychological damage, especially in the child and adolescent population, and high costs, especially due to the management of scars. Advances in burn care have improved survival and quality of life for this population. New clinical trials have been conducted on the benefits of negative pressure wound therapy (NPWT), showing that it improves the healing of burns and the appearance of scars. Therefore, this study aims to analyze the efficacy of NPWT both alone and as an adjunct to conventional dressings in pediatric and adolescent patients compared with conventional treatments. Methodology: A systematic search was carried out between December 2023 and the last quarter of 2025 in databases such as PubMed, Scopus, CINAHL, and the Cochrane Library. This meta-analysis was performed following the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and was registered in PROSPERO with registration number CRD42024597293. The risk of bias 2 (RoB2) tool was used to assess the risk of bias in the studies. Quantitative meta-analyses using random-model effects were performed only for variables with sufficient comparable data among studies. For other outcomes, where meta-analysis was not feasible due to lack of comparable data or control groups, results were synthesized qualitatively. Results: A total of seven articles (three clinical trials and four retrospective studies), in which a total of 323 subjects participated, were included. The main results demonstrate the efficacy of NPWT, as it decreases the re-epithelialization time, improves the appearance of scars (MD = −1.25 (95% CI between −1.80 and −0.70)), reduces the probability of skin grafts (OR = 0.17 (95% CI between 0.06 and 0.46)), and therefore, as there is less need for surgery and fewer dressing changes, reduces costs. Conclusions: NPWT offers significant clinical benefits in the treatment of burns in children and adolescents. Although a meta-analysis could not be performed due to the lack of a control group in some studies, studies with larger samples and multicenter designs will be necessary to better assess the relevant clinical outcomes. However, the results of this study show that NPWT is effective in treating burns in children and adolescents and that its use in clinical practice may represent a promising adjunctive therapy. Full article

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15 pages, 613 KB

Open AccessArticle

The Effects of a Cerebellar Transcranial Direct-Current Stimulation-Based Preventive Exercise Program on Physical Function and Fall Reduction Efficacy in Community-Dwelling Older Adults

by Deone Kang and JongEun Yim

Healthcare 2026, 14(2), 241; https://doi.org/10.3390/healthcare14020241 - 18 Jan 2026

Abstract

Background/Objectives: Falls are a major cause of injury in older adults, closely related to declines in muscle strength, balance control, and sensory integration. Although exercise-based fall prevention programs are well supported, evidence on combining such programs with cerebellar transcranial direct-current stimulation (c-tDCS) [...] Read more.

Background/Objectives: Falls are a major cause of injury in older adults, closely related to declines in muscle strength, balance control, and sensory integration. Although exercise-based fall prevention programs are well supported, evidence on combining such programs with cerebellar transcranial direct-current stimulation (c-tDCS) remains limited. This study investigated the effects of c-tDCS applied before a modified Otago Exercise Program (OEP) on lower-extremity strength, balance, and fall efficacy in older adults. Methods: In this randomized controlled study, twenty-six community-dwelling older adults (median age [IQR]: experimental, 74.00 [10] years; control, 71.00 [10] years) were randomly assigned to either a c-tDCS + exercise group (n = 13) or a sham + exercise group (n = 13). The intervention was administered twice weekly for four weeks. The experimental group received 15 min of c-tDCS followed by 30 min of OEP-based exercise; the control group received sham stimulation under identical conditions. The outcome measures included the Five Times Sit to Stand Test (FTSST), Timed Up and Go (TUG), Balancia-based static balance (velocity average), and Falls Efficacy Scale—Korea (FES-K). Assessments were performed pre- and post-intervention. Results: The experimental group demonstrated significantly greater improvements than the control group (p < 0.05) in the Five Times Sit to Stand Test (r = 0.44) and Timed Up and Go test (r = 0.56). No significant changes were observed in static balance or fall efficacy in either group (p > 0.05). Conclusions: The combined use of c-tDCS and an OEP-based fall prevention exercise program effectively improved lower-extremity strength and dynamic balance in older adults. However, short-term intervention did not influence static balance or fall efficacy. Further studies using longer intervention periods and larger samples are warranted to verify these findings and clarify the mechanisms underlying c-tDCS-enhanced motor performance. Full article

(This article belongs to the Section Clinical Care)

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17 pages, 1887 KB

Open AccessSystematic Review

Effectiveness of Thoracic Spine Manipulation for the Management of Neck Pain: A Systematic Umbrella Review with Risk of Bias and Methodological and Reporting Quality

by Michael Masaracchio, Kaitlin Kirker, Birendra Dewan and Stephen Caronia

Healthcare 2026, 14(2), 240; https://doi.org/10.3390/healthcare14020240 - 18 Jan 2026

Abstract

Background/Objectives: The purpose of this umbrella review was to assess the risk of bias and the methodological and reporting quality of systematic reviews that evaluated the effects of thoracic spine manipulation (TSM) on individuals with mechanical neck pain. Methods: To be included, publications [...] Read more.

Background/Objectives: The purpose of this umbrella review was to assess the risk of bias and the methodological and reporting quality of systematic reviews that evaluated the effects of thoracic spine manipulation (TSM) on individuals with mechanical neck pain. Methods: To be included, publications needed to be systematic reviews including studies with participants with neck pain >18 years old; at least two groups where the experimental intervention was TSM; assessed pain and/or function; and were published in English. Reviews limited to narrative, scoping, or retrospective studies, or those with cervical radiculopathy, were excluded. An electronic search was conducted in May 2025 using PubMed, CINAHL (EBSCO Host), and the Cochrane Library to identify relevant articles from inception to May 2025. Quality and risk of bias were assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020), and Risk of Bias in Systematic Reviews (ROBIS). Findings were summarized narratively and graphically. Results: Seven reviews (27 unique studies; 1394 participants, aged 18–62 years) met the inclusion criteria. Some evidence supported TSM for short-term improvement in neck pain, but confidence in results was low to critically low based on the AMSTAR 2 results. Four reviews had a high overall risk of bias, and three had a low risk. Reporting compliance varied widely (0–100%). Conclusions: While all the included systematic reviews suggested that TSM is a viable short-term option for individuals with neck pain, the overall confidence in these results ranged from low to critically low, making it difficult to draw firm conclusions about the true benefit of TSM in clinical practice. Registered prospectively in PROSPERO (CRD420251034330). Full article

(This article belongs to the Special Issue Joint Manipulation for Rehabilitation of Musculoskeletal Disorders)

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26 pages, 586 KB

Open AccessSystematic Review

Efficacy of Technology-Based Cognitive Rehabilitation Tools for Cancer-Related Cognitive Impairment in Non-CNS Cancer Patients: A Systematic Review

by Benedetta Capetti, Serena Sdinami, Jenny Luisi, Lorenzo Conti, Roberto Grasso and Gabriella Pravettoni

Healthcare 2026, 14(2), 239; https://doi.org/10.3390/healthcare14020239 - 18 Jan 2026

Abstract

Background: Cancer-related cognitive impairment (CRCI) is a significant concern for individuals with non-central nervous system (non-CNS) cancers, affecting memory, attention, executive functions, and processing speed. Non-pharmacological interventions, including digital cognitive rehabilitation, have shown promise in addressing CRCI. This systematic review investigates the [...] Read more.

Background: Cancer-related cognitive impairment (CRCI) is a significant concern for individuals with non-central nervous system (non-CNS) cancers, affecting memory, attention, executive functions, and processing speed. Non-pharmacological interventions, including digital cognitive rehabilitation, have shown promise in addressing CRCI. This systematic review investigates the efficacy of digital and computerized cognitive rehabilitation interventions in improving cognitive outcomes in non-CNS cancer patients. Method: A systematic search of the EMBASE, Scopus, and PubMed databases was conducted to identify studies on digital and computerized cognitive rehabilitation for non-CNS cancer patients. Studies were included if they involved computerized and digital cognitive rehabilitation for oncological patients and assessed the efficacy of the intervention. A total of 11 studies were selected, including randomized controlled trials and quasi-experimental designs. The quality of the studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Data was synthesized using a narrative descriptive approach, and the results were summarized in a descriptive table. Results: The most frequently assessed cognitive domains included working memory, attention, executive functions, and processing speed. The majority of studies (n = 11) demonstrated significant immediate improvements in cognitive functions, particularly in working memory, executive functions, attention, and processing speed. Short-term follow-up (1–5 months) showed partial maintenance of these improvements, while long-term effects (6 months to 1 year) were more variable. Improvements in episodic memory were less consistent, particularly among breast cancer survivors. Discussion: Digital and computerized cognitive rehabilitation appears to be an effective intervention for CRCI, providing immediate cognitive benefits and some lasting improvements, especially in domains such as memory and attention. However, long-term effects remain variable, and further research is needed to explore the optimal duration of interventions and the potential advantages of personalized rehabilitation approaches. Full article

(This article belongs to the Special Issue Revolutionizing Cognitive Rehabilitation: The Role of Digital Technologies)

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20 pages, 400 KB

Open AccessArticle

Bridging the Data Divide in Nevada: A Repeated Cross-Sectional Study of Birth Certificate and Medicaid Billing Discrepancies in Gestational Substance Exposure

by Kyra Morgan, Kavita Batra, Stephanie Woodard, Erika Ryst, Paul Devereux and Wei Yang

Healthcare 2026, 14(2), 238; https://doi.org/10.3390/healthcare14020238 - 18 Jan 2026

Abstract

Background/Objectives: Gestational exposure to substances (GES) is associated with adverse developmental outcomes. Early identification is limited by reliance on self-reported data. This study assessed the incidence and predictors of discordance in GES reporting between birth certificates and Medicaid claims among Medicaid-covered births [...] Read more.

Background/Objectives: Gestational exposure to substances (GES) is associated with adverse developmental outcomes. Early identification is limited by reliance on self-reported data. This study assessed the incidence and predictors of discordance in GES reporting between birth certificates and Medicaid claims among Medicaid-covered births in Nevada from 2022 to 2024. Methods: A statewide, hospital-clustered, cross-sectional analysis was conducted using linked Medicaid billing and birth record data. Discordance was defined as GES identified in one source but not the other. Incidence per 1000 live births was stratified by demographic characteristics. Multilevel logistic regression assessed patient- and hospital-level predictors, with random hospital intercepts. Results: Among 50,394 live births, the discordance rate was 95.09 per 1000 (95% Confidence Interval: 92.5–97.7). Substantial disparities were observed by race/ethnicity, socioeconomic status, and geography, with higher discordance among White non-Hispanic mothers, those residing in rural or frontier counties, and individuals with lower educational attainment or living in lower-income areas. Modest but meaningful variation was also observed across hospitals, including differences by hospital size and teaching or research status. Conclusions: Findings highlight substantial discordance in GES reporting and underscore the limitations of single-source surveillance. Findings also have clear policy relevance, indicating that improved cross-system data integration would strengthen statewide surveillance, enhance early detection, and support more equitable resource allocation and intervention strategies. Full article

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