Healthcare

15 pages, 4105 KB

Open AccessArticle

Six-Month Home-Based Telemedicine Program for Heart Failure and Type 2 Diabetes Patients: Applicability, Usability of Telemonitoring Devices and Apps, and Patient Satisfaction

by Palmira Bernocchi, Gloria Fiorini Aloisi, Marilisa Serlini, Elisa Pasotti, Laura Comini and Simonetta Scalvini

Healthcare 2026, 14(1), 90; https://doi.org/10.3390/healthcare14010090 (registering DOI) - 30 Dec 2025

Abstract

Background: Telemedicine can improve early symptom detection using medical devices and applications. It can also help identify barriers to patient adherence and enhance communication with healthcare professionals. This study aimed to evaluate the applicability, usability, and patient satisfaction with telemonitoring devices and apps [...] Read more.

Background: Telemedicine can improve early symptom detection using medical devices and applications. It can also help identify barriers to patient adherence and enhance communication with healthcare professionals. This study aimed to evaluate the applicability, usability, and patient satisfaction with telemonitoring devices and apps for individuals with heart failure and type 2 diabetes. Methods: In a randomized study, patients in the Intervention Group received six months of nursing teleassistance and telemonitoring using a wearable electrocardiograph, a step tracker, and an App for recording clinical information and conducting video calls. Usability was measured using the System Usability Scale (SUS) and satisfaction with a six-item questionnaire. Results: A total of 43 patients (71 ± 8 years) were enrolled in the intervention group. A total of 41 (95%) of patients utilized the App daily, entering 13,048 information, 53 ± 59 per patient. The nurses performed 896 video-calls, 22 ± 21 per patient. The mean number of walking sessions recorded was 6.1 ± 0.9 per week (159 ± 24 per patient). Thirty-five patients (81%) used a 3-lead ECG and recorded 942 traces, 27 ± 14 per patient. At the end, 40 SUS were collected from patients: 15 (38%, 71 ± 7 years) considered the system excellent or good, 20 (50%, 71 ± 8 years) thought it fair, and 5 (13%, 74 ± 7 years) considered the system offered poor. The overall assessment of patient satisfaction with the service was 22 ± 3.3. Conclusions: This study provides evidence that, although technology can be complex for older adults, it is broadly accepted by most patients, especially when the benefits are understood. The support offered by nurses is essential for significantly enhancing the overall patient experience. Full article

(This article belongs to the Special Issue Non-Pharmacological Interventions in Chronic Cardio-Respiratory Diseases)

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15 pages, 594 KB

Open AccessArticle

Nutritional Support via Jejunostomy Placed During Staging Laparoscopy for Esophagogastric Cancer: A Case Series

by Maria Tieri, Claudia Sivieri, Jacopo Viganò, Salvatore Corallo, Andrea Dagnoni, Anna Pagani, Elisa Mattavelli, Anna Uggè, Francesca De Simeis, Alice Tartara, Paolo Pedrazzoli, Riccardo Caccialanza and Valentina Da Prat

Healthcare 2026, 14(1), 89; https://doi.org/10.3390/healthcare14010089 (registering DOI) - 30 Dec 2025

Abstract

Background: Malnutrition is associated with poorer clinical outcomes in esophagogastric cancers (EGCs). Enteral nutrition via feeding jejunostomy (FJ) is feasible and effective, although standardized criteria for its placement during staging laparoscopy (SL) are lacking. Here, we describe a case series with the [...] Read more.

Background: Malnutrition is associated with poorer clinical outcomes in esophagogastric cancers (EGCs). Enteral nutrition via feeding jejunostomy (FJ) is feasible and effective, although standardized criteria for its placement during staging laparoscopy (SL) are lacking. Here, we describe a case series with the aim of generate preliminary evidence in highlighting unmet needs in this setting. Methods: We retrospectively reviewed medical records of EGC patients who underwent FJ placement during SL at the Fondazione IRCCS Policlinico S. Matteo from January 2022 to December 2023. Patients with missing nutritional data or known metastatic disease were excluded. Results: We included 14 Caucasian patients aged 66 years (IQR: 56.3–69.5) with a median Body Mass Index (BMI) of 23.7 kg/m² (IQR: 21.6–26.3). The tumor location was the gastroesophageal junction in eight cases (57%), the body of the stomach in four cases (29%), and the esophagus in two cases (14%). At the time of diagnosis, all patients had experienced weight loss: 13.4% of body weight (IQR: 8.7–16.8) in the last 6 months; with high malnutrition risk scores: NRS-2002 = 3 (IQR: 2–4) and MUST = 2 (IQR: 1–2). Prior to FJ placement only four (29%) patients had tried oral nutrition supplements (ONS) and nine (64%) had been evaluated by dietitians. Home enteral nutrition (HEN) was started in twelve (86%) cases, with three (21%) providing total enteral nutrition and 9 (64%) as supplemental HEN, providing a median of 45.5% of energy needs (IQR: 32.6–68.2). Due to sufficient oral intake, HEN was not started in two cases (14%) and was discontinued in the first month in another two cases. In this series, FJ was in place but unused for a median duration of 11 days (IQR: 3–91). The median duration of HEN was 97 days (IQR: 40–135); with 5 (35%) patients achieving weight stability/gain. FJ-related complications requiring hospitalization occurred in three (21%) cases. Conclusions: In this case series, we observed a suboptimal utilization of the FJ. Several patients had not undergone ONS trials or dietitian assessment prior to FJ placement, while others retained the FJ for months without using it. Given the potential risks of FJ, standardized selection criteria are warranted; routine preoperative nutritional assessments before SL should be implemented to identify high-risk patients and optimize FJ placement. Full article

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11 pages, 224 KB

Open AccessViewpoint

Extending Healthy Ageing Narratives in Sub-Saharan Africa: Expert Viewpoint

by Daniel Katey, Senyo Zanu, Abigail Agyekum and Anthony Kwame Morgan

Healthcare 2026, 14(1), 88; https://doi.org/10.3390/healthcare14010088 (registering DOI) - 30 Dec 2025

Abstract

The nexus of rapid demographic transition and underdeveloped geriatric infrastructure poses a critical, yet understudied challenge in Sub-Saharan Africa (SSA). As global life expectancies rise, SSA’s older population is projected to triple by 2050, intensifying the need for sustainable age-friendly environments (AFEs) and [...] Read more.

The nexus of rapid demographic transition and underdeveloped geriatric infrastructure poses a critical, yet understudied challenge in Sub-Saharan Africa (SSA). As global life expectancies rise, SSA’s older population is projected to triple by 2050, intensifying the need for sustainable age-friendly environments (AFEs) and robust healthy ageing interventions. Informal or family caregiving structures, while vital, are under strain from rapid urbanisation and shifting social dynamics, creating a compelling gap between need and provision. This expert viewpoint draws on the authors’ professional and scholarly experience regarding population ageing, AFEs, and healthy ageing to provide a comprehensive outlook on these issues in SSA. Selective literature searches were conducted in Google Scholar, Scopus and PubMed using targeted keywords and MESH terms, including “ageing in Africa”, “ageing in Sub-Saharan Africa”, “healthy ageing in Africa”, “healthy ageing in Sub-Saharan Africa”, “population ageing in Africa”, “population ageing in Sub-Saharan Africa”, “age-friendly environment in Africa”, and “age-friendly environment in Sub-Saharan Africa.” The authors argue that rapid population ageing in SSA is outpacing existing informal care arrangements, necessitating a strategic shift towards the development of age-friendly environments and more coordinated healthy ageing interventions to bridge the widening gap between demographic change and geriatric support systems. This paper underscores the necessity of proactive, evidence-based policy implementation to secure the well-being of SSA’s burgeoning older population. Full article

20 pages, 1133 KB

Open AccessArticle

Physical Activity Patterns and Behavioral Resilience Among Foggia University Students During the COVID-19 Pandemic: A Public Health Perspective

by Tarek Benameur, Neji Saidi, Maria Antonietta Panaro and Chiara Porro

Healthcare 2026, 14(1), 87; https://doi.org/10.3390/healthcare14010087 (registering DOI) - 30 Dec 2025

Abstract

Background: The (COVID-19) pandemic profoundly disrupted daily routines and physical activity (PA), especially among university students, due to restrictions and limited access to sports facilities. As this group is particularly vulnerable to sedentary lifestyles and mental health issues, understanding their PA patterns [...] Read more.

Background: The (COVID-19) pandemic profoundly disrupted daily routines and physical activity (PA), especially among university students, due to restrictions and limited access to sports facilities. As this group is particularly vulnerable to sedentary lifestyles and mental health issues, understanding their PA patterns is crucial. This study explores overall and domain-specific PA levels and the influence of sociodemographic factors, offering insights for promoting sustainable PA strategies in higher education during and beyond health crises. Methods: A cross-sectional online survey was conducted among University of Foggia students during the pandemic. The participants completed the validated Italian IPAQ-Long to assess PA across various domains. Associations with demographics and perceived barriers were analyzed via t tests, ANOVA, and nonparametric tests. Results: A total of 301 students completed the survey. Despite barriers such as limited living space, low income, and sports facility closures, 66% of the participants reported high PA levels, mainly through work-related and leisure activities. This remains insufficient. PA varied significantly by gender, income, residence, and employment status: males reported higher leisure PA, whereas females engaged more in active transport and domestic activities. Rural residents and those with moderate incomes demonstrated higher overall PA, whereas employed students presented lower activity levels. These findings underscore the complex socioeconomic and environmental factors shaping PA behavior during an unprecedented global health crisis. Conclusions: The findings reveal that students’ resilience in maintaining PA is a coping mechanism despite socioeconomic and environmental barriers. Tailored, accessible PA initiatives integrated into university curricula can enhance student well-being, academic performance, and long-term health during and after public health emergencies. Universities should adopt accessible, equity-oriented PA initiatives to promote physical and mental health and enhance public-health preparedness during future emergencies. Full article

(This article belongs to the Collection COVID-19: Impact on Public Health and Healthcare)

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11 pages, 949 KB

Open AccessArticle

Using Step Trackers Among Older People Receiving Aged Care Services Is Feasible and Acceptable: A Mixed-Methods Study

by Rik Dawson, Judy Kay, Lauren Cameron, Bernard Bucalon, Catherine Sherrington and Abby Haynes

Healthcare 2026, 14(1), 86; https://doi.org/10.3390/healthcare14010086 (registering DOI) - 30 Dec 2025

Abstract

Background: Maintaining physical activity (PA) is vital for older people, particularly those with frailty and mobility limitations. Wearable activity trackers and digital feedback tools show promise for encouraging PA, but their feasibility and acceptability in aged care remain underexplored. This study evaluated the [...] Read more.

Background: Maintaining physical activity (PA) is vital for older people, particularly those with frailty and mobility limitations. Wearable activity trackers and digital feedback tools show promise for encouraging PA, but their feasibility and acceptability in aged care remain underexplored. This study evaluated the feasibility and acceptability of using wearable and mobile devices for step tracking and examined the usability of three interfaces (Fitbit, mobile app, and website) for reviewing PA progress in aged care. Methods: This is a user experience and feasibility study that does not involve objective physical activity quantification or device performance analysis. It is a mixed-methods feasibility study conducted with 14 participants aged ≥65 years from residential and community aged care services in metropolitan and regional New South Wales, Australia. Participants used a Fitbit Inspire 3 linked to a study website and a mobile phone step-counting app to monitor their steps across the three interfaces for four weeks. Feasibility was evaluated through enrolment and retention, and acceptability through a facilitator-led survey. Quantitative items on usability, comfort, motivation and device preference were summarised descriptively; open-ended responses were analysed thematically to identify user experiences, benefits, and barriers. Results: Step tracking was feasible, with 82% enrolment and 93% retention. Participants preferred the Fitbit over the mobile phone or website due to its ease of use, visibility and more enjoyable experience. Step tracking increased awareness of PA and supported confidence to move more. Participants valued reminders, rewards and opportunities for social sharing. Reported barriers included illness, usability challenges and occasional technical issues. Conclusions: Wearable step trackers show promise for supporting PA among older people receiving aged care. Despite the small sample and short follow-up, strong acceptability signals suggest that simple digital tools could enhance the reach and sustainability of mobility-promoting interventions into aged care systems. Future studies should examine long-term adherence, usability across diverse mobility and cognitive needs, and conditions for successful scale-up. Full article

(This article belongs to the Special Issue Health Promotion and Long-Term Care for Older Adults)

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15 pages, 1060 KB

Open AccessArticle

Experiences of Primary Care Nurse Case Managers in Palliative Care Needs Identification and Complex Chronic Patients’ Referral to Advanced Palliative Care Resources

by María Inmaculada Herrera-Gómez, María Luz Iribarne-Duran, María Paz García-Caro, Manuel López-Morales, Ana Alejandra Esteban-Burgos and Rafael Montoya-Juárez

Healthcare 2026, 14(1), 85; https://doi.org/10.3390/healthcare14010085 (registering DOI) - 30 Dec 2025

Abstract

Introduction: Palliative needs assessment and referral to advanced palliative care resources are fundamental aspects of complex chronic patients’ care. Primary care Nurse Case Managers play a key role in the care of these patients. Objective: We aimed to describe the experiences of primary [...] Read more.

Introduction: Palliative needs assessment and referral to advanced palliative care resources are fundamental aspects of complex chronic patients’ care. Primary care Nurse Case Managers play a key role in the care of these patients. Objective: We aimed to describe the experiences of primary care Nurse Case Managers in palliative care needs identification and complex chronic patients’ referral to advanced palliative care resources. Method: This is a qualitative descriptive study with a phenomenological approach. Semi-structured online interviews were conducted with primary care Nurse Case Managers. A thematic analysis was performed using ATLAS.ti software. Results: 20 nurses participated, 16 of whom were women, with a mean age of 52.3 years and an average of 15.9 years of experience in primary care. Regarding “Palliative care Needs Assessment”, four sub-themes have been identified: “What do you understand?”, “How do you assess?”, “Difficulties” and “Alternatives” to current palliative care needs assessment. For the “Palliative Care Referral” theme four sub-themes have been identified: “Criteria”, “Tools”, “Difficulties” and “Alternatives” for referral. Discussion: Palliative needs are identified in patients with incurable diseases when there are no curative treatment options and when quality of life must be prioritized. Symptoms, general condition, progression, and comorbidity are assessed. Open interviews and home visits are essential for assessing the social and family context and the home resources available. Barriers identified include the conspiracy of silence, limited training in non-oncological palliative care, and a lack of staff and caregiver’s understanding of illness situation. The presence of difficult symptoms and a limited life expectancy were identified as key criteria for referral to palliative care. The physician’s assessment, the family’s request, and consultation with specialized teams play a key role in prognosis. Barriers include late referrals, lack of a palliative background, inequity in access to resources, and low visibility of the palliative care needs of non-cancer patients. Conclusions: Significant challenges remain in identifying palliative needs and referral to specialized resources, highlighting the need to optimize resources, strengthen professional training, and improve coordination between levels of care to ensure quality palliative care. Full article

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

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14 pages, 477 KB

Open AccessArticle

Changes in Psychophysical Parameters in Seniors During the COVID-19 Pandemic—A Repeated Observational Study

by Dorota Szydłak, Ewelina Grabska-Klein and Anna Brzęk

Healthcare 2026, 14(1), 84; https://doi.org/10.3390/healthcare14010084 (registering DOI) - 30 Dec 2025

Abstract

Older individuals primarily belong to the group with an increased risk of SARS-CoV-2 infection. Social distancing and other strategies to mitigate the COVID-19 pandemic may negatively impact the psychophysical parameters of seniors. Objective: The main aim of this study is to analyze the [...] Read more.

Older individuals primarily belong to the group with an increased risk of SARS-CoV-2 infection. Social distancing and other strategies to mitigate the COVID-19 pandemic may negatively impact the psychophysical parameters of seniors. Objective: The main aim of this study is to analyze the changes in psychophysical parameters among seniors in the context of the COVID-19 pandemic over a one-year observation. Materials and methods: The observation involved 54 respondents aged 60 and above. The study was conducted three times from March 2020 to April 2021. The selected research method was a diagnostic survey based on a questionnaire. Results: The level of general physical activity in the study groups during the pandemic was determined to be moderate with an upward trend. A downward trend in self-assessment of quality of life was observed, particularly in the area of mental health, along with an increase in symptoms of anxiety, aggression, and insomnia. Conclusions: The pandemic period did not significantly affect the level of physical activity among the surveyed seniors, but an intensification of mental symptoms was noticeable. Full article

(This article belongs to the Collection COVID-19: Impact on Public Health and Healthcare)

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12 pages, 624 KB

Open AccessArticle

Role of Posttraumatic Stress Disorder Symptoms in Life Adaptation of Toxic Humidifier Disinfectant Survivors: A Multi-Group Analysis

by Yubin Chung, Min Joo Lee, Hun-Ju Lee, Soo-Young Kwon, Hye-Sil Ahn, Taksoo Kim and Sang Min Lee

Healthcare 2026, 14(1), 83; https://doi.org/10.3390/healthcare14010083 (registering DOI) - 30 Dec 2025

Abstract

Background: The Republic of Korean humidifier disinfectant disaster, involving toxic chemical exposure, constitutes a major social disaster causing severe trauma. While physical and psychological difficulties are documented, this study investigated the relationship between posttraumatic stress disorder (PTSD) symptoms and survivors’ daily life adaptation [...] Read more.

Background: The Republic of Korean humidifier disinfectant disaster, involving toxic chemical exposure, constitutes a major social disaster causing severe trauma. While physical and psychological difficulties are documented, this study investigated the relationship between posttraumatic stress disorder (PTSD) symptoms and survivors’ daily life adaptation across children, adolescents, and adults, examining PTSD’s mediating role. Methods: The sample included 834 participants (417 exposed survivors and 417 unaffected individuals), divided into three age groups. PTSD symptoms and life adaptation were measured via self-reports. Multigroup Structural Equation Modeling (SEM) was utilized to test the indirect associations among exposure, PTSD symptoms, and life adaptation, and to examine age-group comparisons. Results: Survivors in all age groups reported higher PTSD symptoms and lower adaptive functioning compared to unaffected individuals, with the largest PTSD mean difference found in children and adults. Multigroup SEM confirmed that exposure positively impacted PTSD symptoms, and PTSD symptoms negatively impacted life adaptation across all ages. PTSD symptoms significantly mediated the exposure-life adaptation link in all groups. Critically, the direct effect of exposure on life adaptation was significant only in adults, indicating a full mediation via PTSD symptoms in children and adolescents. Conclusions: Exposure to toxic humidifier disinfectants is linked to life adaptation difficulties through elevated PTSD symptoms. These findings emphasize addressing trauma-related symptoms and suggest the utility of developmentally sensitive psychological interventions. Limitations include reliance on self- and parent-reported measures rather than clinical diagnoses, and the lack of control for external contextual factors (e.g., policy changes, media exposure). Full article

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17 pages, 401 KB

Open AccessArticle

Adapted Judo as a Multidimensional Intervention: Effects on Physical Fitness and Psychosocial Well-Being in Adolescents with Down Syndrome

by Borja Suarez-Villadat, Mario Montero, Sonia Montero, Adrián López-García and Ariel Villagra

Healthcare 2026, 14(1), 81; https://doi.org/10.3390/healthcare14010081 (registering DOI) - 30 Dec 2025

Abstract

Background/Objectives: Adolescents with Down syndrome often present limitations in physical fitness and psychosocial well-being, which can affect their health and social inclusion. Adapted physical activity programs, such as martial arts, may offer multidimensional benefits. This study aimed to analyze the effects of [...] Read more.

Background/Objectives: Adolescents with Down syndrome often present limitations in physical fitness and psychosocial well-being, which can affect their health and social inclusion. Adapted physical activity programs, such as martial arts, may offer multidimensional benefits. This study aimed to analyze the effects of an adapted judo intervention on physical fitness and psychosocial outcomes in adolescents with Down syndrome. Methods: A quasi-experimental design was applied with 43 adolescents diagnosed with Down syndrome, allocated to a control group (n = 19) and an intervention group (n = 24). Participants in the intervention group completed a 24-week adapted judo program. Physical fitness was assessed through standardized tests for strength, balance, and flexibility, while psychosocial well-being was evaluated using validated questionnaires on self-esteem and social interaction. Pre- and post-intervention comparisons were conducted using appropriate statistical analyses. Results: Participants showed significant improvements in physical fitness components, particularly in muscular strength and balance (p < 0.05). Flexibility also increased, although to a lesser extent. Psychosocial measures revealed enhanced self-esteem and greater perceived social interaction, indicating positive effects beyond physical health. Conclusions: Adapted judo appears to be an effective multidimensional intervention for adolescents with Down syndrome, promoting both physical and psychosocial benefits. These findings support the inclusion of adapted martial arts in physical education and therapeutic programs aimed at fostering health and social participation in this population. Full article

(This article belongs to the Special Issue Active and Included: People with Disabilities in Sport, Physical Activity and Physical Education)

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15 pages, 1136 KB

Open AccessArticle

Unmet Healthcare Needs in COPD: A Text Network Analysis and Topic Modeling of Pre/Post-COVID-19 Research Trends

by So Young Yun and Mi Ok Song

Healthcare 2026, 14(1), 82; https://doi.org/10.3390/healthcare14010082 (registering DOI) - 29 Dec 2025

Abstract

Background/Objectives: Unmet healthcare needs, driven by structural and patient-level barriers, are particularly critical in chronic obstructive pulmonary disease (COPD). However, limited research has examined how academic themes on this topic connect and evolve over time. This study analyzed the structure and temporal shifts [...] Read more.

Background/Objectives: Unmet healthcare needs, driven by structural and patient-level barriers, are particularly critical in chronic obstructive pulmonary disease (COPD). However, limited research has examined how academic themes on this topic connect and evolve over time. This study analyzed the structure and temporal shifts in research trends on unmet healthcare needs in COPD to identify key concepts and topics and policy implications. Methods: We systematically searched PubMed, Embase, and CINAHL (12–15 March 2025) to identify English-language abstracts on unmet healthcare needs in COPD. Eligible studies were peer-reviewed articles with an English-language abstract that examined unmet healthcare needs from the patient perspective. In total, 451 abstracts were analyzed using text network analysis and Latent Dirichlet Allocation. Topic distributions before and after the coronavirus disease pandemic were assessed using chi-square tests, and findings were interpreted within Penchansky and Thomas’s 5A healthcare access framework. Results: Six topics emerged: socioeconomic disparities, early diagnosis and symptom management, guideline-based information and technology use, integrated care for advanced COPD, access to pulmonary rehabilitation, and equitable medication availability. These topics mapped onto all five access dimensions, underscoring the multidimensional nature of unmet healthcare needs. Network analysis identified management, diagnosis, symptoms, exacerbation, and other related terms as central hubs in the discourse. Post-pandemic, research shifted toward digital information delivery, technology adoption, and equitable pharmacotherapy. Conclusions: Findings suggest that reducing unmet healthcare needs in COPD requires integrated systems that address both disease complexity and access barriers. Targeted, multidisciplinary, and policy-driven interventions in highly central domains are needed to reduce disparities and improve outcomes. This study also confirmed a post-pandemic shift in research priorities, emphasizing the need for equitable and adaptive healthcare policies. Full article

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19 pages, 557 KB

Open AccessArticle

Mental Health of Psychologists During a Period of Cumulative Crises in Lebanon: The Predictive Role of Self-Esteem

by Rabab Bou Debs, Rudy S. Younes, Stephanie Abboud, Sandra Akoury, Jana Hamzeh, Joya Arab, Christina Mechref and Nadine Zalaket

Healthcare 2026, 14(1), 80; https://doi.org/10.3390/healthcare14010080 (registering DOI) - 29 Dec 2025

Abstract

Background/Objectives: Since October 2019, Lebanon has faced continuous sociopolitical and economic instability. Clinical psychologists have played a central role in responding to rising mental health needs, yet little is known about their own psychological well-being. Methods: This study examined mental health [...] Read more.

Background/Objectives: Since October 2019, Lebanon has faced continuous sociopolitical and economic instability. Clinical psychologists have played a central role in responding to rising mental health needs, yet little is known about their own psychological well-being. Methods: This study examined mental health outcomes among 157 certified psychologists (clinical and educational psychologists) working in Lebanon. A cross-sectional study was conducted with psychologists aged 30–53 years across all Lebanese governorates, who were recruited through snowball and word-of-mouth sampling. Participants completed validated measures of depression (PHQ-9), anxiety (LAS-10), perceived stress (PSS-10), subjective well-being (WHO-5), eating attitudes (EAT-26), and self-esteem (A-SISE). Results: Results showed that 44% of participants reported at least mild depressive symptoms, 14% met criteria for anxiety, and 57% experienced moderate to high perceived stress, while most showed no risk for eating disorders. Bivariate and multivariate analyses identified self-esteem as a predictive factor, negatively associated with depression, anxiety, and stress, and positively associated with subjective well-being. Additional risk factors included younger age, being unmarried, not having children, prior psychological history, health problems, lower income, and working as an educational rather than clinical psychologist. Conclusions: These findings highlight aspects of vulnerability among psychologists and underline the need for targeted interventions for at-risk groups. Strengthening self-esteem may contribute to enhancing clinicians’ mental health. However, these conclusions should be interpreted in light of several limitations, including the small sample size, the non-probability and gender-skewed nature of the sample, partly due to the relatively limited number of practicing psychologists in Lebanon. Full article

(This article belongs to the Special Issue Mental Health of Healthcare Professionals)

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17 pages, 383 KB

Open AccessArticle

Translation, Cultural Adaptation, and Validation of the Arabic Version of the Type 1 Diabetes Distress Scale (T1-DDS) Among Adults with Type 1 Diabetes in Saudi Arabia

by Abdullah M. Alguwaihes and Shuliweeh Alenezi

Healthcare 2026, 14(1), 79; https://doi.org/10.3390/healthcare14010079 (registering DOI) - 29 Dec 2025

Abstract

Background/Objectives: Diabetes distress is a significant, often unaddressed, aspect of type 1 diabetes (T1D) management. The Type 1 Diabetes Distress Scale (T1-DDS) is a key assessment tool, but no validated Arabic version exists for Saudi Arabia’s large T1D population. This study aimed to [...] Read more.

Background/Objectives: Diabetes distress is a significant, often unaddressed, aspect of type 1 diabetes (T1D) management. The Type 1 Diabetes Distress Scale (T1-DDS) is a key assessment tool, but no validated Arabic version exists for Saudi Arabia’s large T1D population. This study aimed to translate, culturally adapt, and validate the Arabic T1-DDS to enable accurate assessment of diabetes-specific distress in Saudi adults with T1D. Methods: A cross-sectional study was conducted among Saudi adults with self-reported T1D. The T1-DDS underwent forward-backward translation, expert panel review, and cognitive debriefing. Participants completed an online survey containing the 28-item Arabic T1-DDS, the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7). Psychometric evaluation included exploratory and confirmatory factor analysis (EFA, CFA), internal consistency (Cronbach’s α), and convergent validity. A multivariable generalized linear model identified predictors of distress. Results: The analysis included 837 participants (73.8% female, mean age 27.22 ± 7.8 years). The Arabic T1-DDS demonstrated excellent reliability (α = 0.934). EFA/CFA supported a robust four-factor structure, confirming model fit (χ²/df = 1.313, CFI = 1.000, RMSEA = 0.019). The mean overall distress score was 2.74 (SD = 1.05), with 72.4% reporting moderate-to-high distress. Distress correlated moderately with depression (r = 0.58) and anxiety (r = 0.52). Multivariable analysis identified higher PHQ-9 (RR = 1.178) and GAD-7 scores (RR = 1.063) as significant predictors of elevated distress, while insulin pump use was protective (RR = 0.938). Conclusions: The Arabic T1-DDS is a valid and reliable tool for Saudi adults with T1D. Its use revealed a high prevalence of diabetes distress, strongly linked to psychological symptoms and mitigated by insulin pump therapy. Integrating this scale into routine clinical care can facilitate timely psychosocial support, potentially improving patient outcomes. Full article

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17 pages, 1467 KB

Open AccessSystematic Review

Efficacy of Early Mobilization in Stroke Patients in Relation to Quality of Life and Level of Dependency: A Systematic Review

by Malena Maffassanti-Reyes, Marta González-Sierra and Alberto Javier-Ormazábal

Healthcare 2026, 14(1), 78; https://doi.org/10.3390/healthcare14010078 - 29 Dec 2025

Abstract

Introduction: Stroke is a severe neurological condition associated with high rates of mortality and disability. Objective: This systematic review aimed to analyze the efficacy of early mobilization (EM) on the quality of life and the dependency levels in stroke patients. Additionally, the impact [...] Read more.

Introduction: Stroke is a severe neurological condition associated with high rates of mortality and disability. Objective: This systematic review aimed to analyze the efficacy of early mobilization (EM) on the quality of life and the dependency levels in stroke patients. Additionally, the impact on anxiety and depression, the occurrence of adverse effects, and length of hospital stay were assessed. Methods: A systematic search was conducted in PubMed, Web of Science, and Scopus databases. The search was restricted to randomized controlled trials published within the last 10 years that included EM as an intervention in the experimental group. The Cochrane tools were used to assess risk of bias, and the PEDro scale was applied to evaluate the methodological quality of the included studies. Results: Nine studies were included in this review. Findings indicated that EM performed within 24–48 h post-stroke reduces dependency levels; however, no significant improvement in quality of life was observed. Evidence regarding anxiety and depression was inconclusive, and no significant differences were reported between groups concerning adverse events or reduction in hospital stay duration. Conclusions: This review demonstrates that EM is beneficial for reducing dependency after stroke, but there is no evidence of a significant improvement in quality of life. Further research is needed to establish clear protocols and appropriate intervention doses. Full article

(This article belongs to the Section Chronic Care)

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28 pages, 3792 KB

Open AccessArticle

Leadership and Burnout in Anatomic Pathology Laboratories: Findings from Greece’s Attica Region

by Angeliki Flokou, Sofia Pappa, Vassilis Aletras and Dimitris A. Niakas

Healthcare 2026, 14(1), 77; https://doi.org/10.3390/healthcare14010077 - 27 Dec 2025

Abstract

Background: Anatomic pathology laboratories operate under conditions requiring high precision, strict documentation, biosafety protocols, and tight turnaround times. Evidence from Greece is limited, and joint assessment of burnout and leadership in this setting is rare. Objective: The aim of this study was to [...] Read more.

Background: Anatomic pathology laboratories operate under conditions requiring high precision, strict documentation, biosafety protocols, and tight turnaround times. Evidence from Greece is limited, and joint assessment of burnout and leadership in this setting is rare. Objective: The aim of this study was to estimate burnout levels among anatomic pathology personnel in Attica and examine their association with perceived leadership style. Methods: A cross-sectional survey of public and private laboratories was carried out. The questionnaire included demographics and work characteristics, the Copenhagen Burnout Inventory (CBI), and the Multifactor Leadership Questionnaire Form 5X (MLQ-5X). Results: Burnout levels were moderate to low overall, with personal burnout highest, work-related intermediate, and colleague-related lowest. Women and employment type were associated with personal burnout (p < 0.05). Passive/avoidant leadership (including management by exception–passive and laissez-faire) showed positive associations with burnout, whereas transformational leadership and favorable leadership outcomes—particularly, perceived effectiveness and satisfaction with the leader—were inversely associated; transactional leadership followed the same direction but less robustly (p < 0.05 where supported). Conclusions: Burnout among anatomic pathology personnel in Attica is non-trivial and varies across domains. Leadership dimensions display differential links with burnout, indicating potentially modifiable organizational targets for intervention. Significance: To our knowledge, this is the first study in Greece and among the first in Europe to jointly apply CBI and MLQ-5X in anatomic pathology laboratories, offering practical evidence to inform leadership-oriented interventions. Full article

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22 pages, 4413 KB

Open AccessArticle

Evaluation of DAid^® Smart Socks for Foot Plantar Center of Pressure Measurements in Football-Specific Tasks: A Preliminary Validation Study

by Anna Davidovica, Guna Semjonova, Aleksejs Kataševs, Aleksandrs Okss, Darja Nesterovica and Signe Tomsone

Healthcare 2026, 14(1), 76; https://doi.org/10.3390/healthcare14010076 - 27 Dec 2025

Abstract

Background/Objectives: Accurate plantar pressure assessment is essential for injury prevention and rehabilitation monitoring in sports. Wearable sensor technologies, such as DAid^® Smart Socks, offer portable, real-time biomechanical feedback and enable data collection in field conditions. However, there is limited evidence on their [...] Read more.

Background/Objectives: Accurate plantar pressure assessment is essential for injury prevention and rehabilitation monitoring in sports. Wearable sensor technologies, such as DAid^® Smart Socks, offer portable, real-time biomechanical feedback and enable data collection in field conditions. However, there is limited evidence on their level of agreement with a gold standard in measuring the foot plantar center of pressure (CoP) in football-specific tasks. This study aimed to determine the preliminary validity of DAid^® Smart Socks compared with a gold-standard force platform in measuring plantar center of pressure (CoP) during functional football FIFA 11+ Part 2 exercises. Methods: Ten male volunteer youth football players (mean age 12.2 ± 0.42 years; height 158.7 ± 7.72 cm; weight 46.46 ± 8.78 kg; shoe size EU 39.8 ± 2.68) from the Latvian Football Federation Youth League participated. Eight players had right-leg dominance, two had left-leg dominance; three reported past lower-limb injuries. Plantar pressure was measured simultaneously using DAid^® Smart Socks and a 1.5 m entry-level force platform with a calibration factor of 3.2. Center of pressure (CoP) data from the force platform were recorded using Footscan software version 9.10.4. Participants performed two selected FIFA 11+ Part 2 exercises—a single-leg squat (unilateral) and a squat with heel raise, performed bilaterally—under standardized conditions. Each exercise was performed twice, with sock removal and reapplication between trials. Agreement between the DAid^® Smart Socks and the force platform was examined using waveform synchronization, root mean square error (RMSE), Bland–Altman analysis, and Lin’s Concordance Correlation Coefficient (CCC) to quantify both relative waveform correspondence and absolute CoP measurement accuracy. Results: Across 160 paired recordings, the DAid^® Smart Socks showed moderate-to-high correlation with the force platform for relative CoP dynamics, with 79% of waveforms demonstrating CCC ≥ 0.60. Absolute agreement was limited, with only 16% of recordings reaching CCC ≥ 0.90, and RMSE values ranging from 2.1 to 18.9 mm (X) and 4.3–34.2 mm (Y). Conclusions: DAid^® Smart Socks showed moderate-to-high correspondence with the force platform in capturing the directional and temporal characteristics of plantar CoP during functional football tasks, with agreement varying across individuals. Full article

(This article belongs to the Special Issue Physical Therapy and Rehabilitation in Sports)

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15 pages, 252 KB

Open AccessArticle

Artificial Intelligence and Emotional Support: A Comparative Study of University Students with and Without Disabilities

by Raquel Suriá-Martínez, Fernando García-Castillo, Carmen López-Sánchez and José A. García del Castillo

Healthcare 2026, 14(1), 75; https://doi.org/10.3390/healthcare14010075 - 27 Dec 2025

Abstract

Background/Objectives: This study explores the perceived usefulness and use of artificial intelligence (AI)-based technologies as informational and emotional support among university students with and without disabilities. Methods: The sample consisted of 358 students from the University of Alicante, aged between 16 and [...] Read more.

Background/Objectives: This study explores the perceived usefulness and use of artificial intelligence (AI)-based technologies as informational and emotional support among university students with and without disabilities. Methods: The sample consisted of 358 students from the University of Alicante, aged between 16 and 30 years; 88 participants identified as having a disability, while 270 reported no disability. The gender distribution was balanced, with 53% women and 47% men. An ad hoc questionnaire was applied to evaluate familiarity, frequency of use, and perceived usefulness of AI as a means of obtaining informational and emotional support. Results: The results of the multivariate analyses indicated that students without disabilities reported greater familiarity with and more frequent use of AI tools compared to students with disabilities. Significant differences were found in perceived usefulness for obtaining both informational and emotional support, with higher ratings among students without disabilities, and a moderate effect size. Moreover, frequency of use was positively associated with perceived usefulness in both groups, suggesting that practical experience influences users’ evaluations. Discussions: The findings suggest that students perceive AI as a useful resource for informational and emotional support. However, as with other technologies, addressing accessibility and perception gaps is crucial to promote effective inclusion in university settings. Full article

(This article belongs to the Special Issue AI, Emotion, and Health: Applying Algorithmic Intelligence to Improve Well-Being)

12 pages, 425 KB

Open AccessArticle

Factors for Returning to Work for Patients with Physical Disabilities and Brain Damage After Industrial Accidents

by Dahyeon Koo, Jun Hwa Choi, Eun Suk Choi and Dougho Park

Healthcare 2026, 14(1), 74; https://doi.org/10.3390/healthcare14010074 - 27 Dec 2025

Abstract

Background/Objectives: Return to work (RTW) after an industrial accident is crucial for an individual’s well-being and socioeconomic recovery. This study investigated factors influencing RTW among workers who sustained physical or brain lesion-related disabilities following industrial accidents. Methods: Using five-year panel data [...] Read more.

Background/Objectives: Return to work (RTW) after an industrial accident is crucial for an individual’s well-being and socioeconomic recovery. This study investigated factors influencing RTW among workers who sustained physical or brain lesion-related disabilities following industrial accidents. Methods: Using five-year panel data (2018–2022) from the Panel Study of Workers’ Compensation Insurance of South Korea, we analyzed 340 individuals with physical or brain lesion-related disabilities sustained from industrial accidents. We used logistic regression models to identify factors associated with RTW and return to employed (RTE) status. Results: The RTW and non-RTW groups comprised 160 and 180 participants, respectively. Factors associated with non-RTW included female sex (adjusted odds ratio [aOR], 0.33; 95% confidence interval [CI], 0.13–0.86; p = 0.023), injury caused by disease (aOR, 0.18; 95% CI, 0.05–0.66; p = 0.010), long recovery periods (aOR, 0.27; 95% CI, 0.10–0.72; p = 0.009), low self-confidence (aOR, 0.16; 95% CI, 0.07–0.35; p < 0.001), and older age (aOR, 0.08; 95% CI, 0.02–0.34; p = 0.001). Workers with no blood pressure problems (aOR, 2.21; 95% CI, 1.11–4.38; p = 0.024) and longer employment durations (aOR, 3.84; 95% CI, 1.15–12.81; p = 0.029) had a higher chance of RTW. Similar factors were associated with RTE, with more emphasis on older age, long recovery periods, low self-confidence, and injury caused by disease. Conclusions: Our findings contribute to developing targeted support services and informing policy decisions to improve RTW for workers with physical or brain lesion-related disabilities caused by industrial accidents. Full article

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15 pages, 567 KB

Open AccessSystematic Review

Impact of Social Media on HPV Vaccine Knowledge and Attitudes Among Adolescents and Young Adults: A Systematic Literature Review

by Blessing Oluwatofunmi Apata, Anagha Hemant Tupe, Oluwabusayomi Akeju and Kelly L. Wilson

Healthcare 2026, 14(1), 73; https://doi.org/10.3390/healthcare14010073 - 27 Dec 2025

Abstract

Objective: Human Papillomavirus (HPV), a leading cause of sexually transmitted infections (STIs) and various cancers, including cervical cancer, remains prevalent in the US. Despite the HPV vaccine’s effectiveness in preventing persistent HPV infections, vaccination rates remain low. Given the significant role of [...] Read more.

Objective: Human Papillomavirus (HPV), a leading cause of sexually transmitted infections (STIs) and various cancers, including cervical cancer, remains prevalent in the US. Despite the HPV vaccine’s effectiveness in preventing persistent HPV infections, vaccination rates remain low. Given the significant role of social media in reaching younger populations, this systematic review examines its influence on adolescents’ and young adults (AYAs) awareness, knowledge, and attitudes toward HPV vaccination. Methods: Following the PRISMA guidelines, we conducted a comprehensive search across six electronic databases (ERIC, APA PsycInfo, Child Development & Adolescent Studies, CINAHL Ultimate, MEDLINE Ultimate, and PubMed) from 2011 to 2024. Empirical studies that examined the association between social media use and HPV were included. Data extraction captured the study’s purpose, design, population, outcome measures, and key results. Results: Seven studies satisfied the review’s inclusion criteria. Our findings reveal mixed effects of social media on AYAs’ knowledge and vaccination intentions. Some studies indicated positive associations between social media interventions and increased vaccination knowledge and intentions, while others found no significant impact. Additionally, exposure to anti-vaccine content was linked to lower vaccination intentions, especially among individuals with lower knowledge who were more vulnerable to misinformation. Interventions incorporating interactive content and loss-framed messaging were more effective in increasing vaccine intentions. Conclusions: This review underscores the potential of social media to influence AYAs knowledge and perceptions regarding HPV vaccination, while also highlighting the challenges posed by misinformation. Further research is needed to optimize social media interventions and combat misinformation to improve vaccination uptake. Full article

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23 pages, 352 KB

Open AccessArticle

by Merve Berika Kadıoğlu, Meyra Durmaz and Mahmut Kadıoğlu

Healthcare 2026, 14(1), 72; https://doi.org/10.3390/healthcare14010072 - 27 Dec 2025

Abstract

Background/Objectives: Dental training is known for its demanding academic pace, early clinical exposure, and constant performance pressure. These stressors may contribute to behavioral and physical manifestations, including bruxism and temporomandibular disorder (TMD). This study aimed to better understand the multidimensional burden experienced in [...] Read more.

Background/Objectives: Dental training is known for its demanding academic pace, early clinical exposure, and constant performance pressure. These stressors may contribute to behavioral and physical manifestations, including bruxism and temporomandibular disorder (TMD). This study aimed to better understand the multidimensional burden experienced in this educational setting by investigating the relationship between education-related stress, bruxism patterns, and temporomandibular symptoms (TMD-related symptoms) in dental students. Methods: A cross-sectional survey was conducted at the Ankara University Faculty of Dentistry in 2025 and completed by 287 undergraduate dental students. The questionnaire collected sociodemographic information, self-reported bruxism status, TMD-related symptoms via the Fonseca Anamnestic Index (FAI), and education-related stressors using the Dental Environment Stress (DES) scale. Descriptive statistics, group comparisons, and Spearman correlation analyses were conducted. Results: Bruxism was reported by 76% of students and was significantly more common among females (p < 0.05). Students with bruxism demonstrated higher DES (3.34 ± 0.84) and FAI (41.81 ± 20.32) scores compared with those without bruxism (p < 0.001). DES and FAI scores showed a significant positive correlation (r = 0.229, p < 0.001). Stressors related to workload, examinations, limited rest time, clinical uncertainty, patient responsibility, and financial concerns were strongly associated with bruxism, while inconsistent academic feedback emerged as a key distinguishing factor. Conclusions: Education-related stress is closely linked to bruxism and TMD-related symptoms among dental students. Beyond overall stress intensity, the nature of experienced stressors plays a critical role. These findings highlight the importance of supportive learning structures, targeted stress-management strategies, and curriculum-level improvements to promote student wellbeing and resilience. Full article

(This article belongs to the Special Issue Promoting Wellness and Excellence in Health Education for Medical Students and Healthcare Professionals)

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