Healthcare

12 pages, 220 KB

Open AccessArticle

Reliability, Validity, and Optimal Cut-Off Scores of Action Research Arm Test and Jebsen–Taylor Hand Function Test in People with Parkinson’s Disease

by Sefa Eldemir and Burhanettin Cigdem

Healthcare 2025, 13(24), 3280; https://doi.org/10.3390/healthcare13243280 (registering DOI) - 13 Dec 2025

Abstract

Background/Objectives: Although upper extremity dexterity problems are frequently reported in people with Parkinson’s disease (PwPD), valid and reliable scales for assessing upper extremity function and dexterity are limited. The objective of this study was to investigate the reliability and validity of the [...] Read more.

Background/Objectives: Although upper extremity dexterity problems are frequently reported in people with Parkinson’s disease (PwPD), valid and reliable scales for assessing upper extremity function and dexterity are limited. The objective of this study was to investigate the reliability and validity of the Action Research Arm Test (ARAT) and the Jebsen–Taylor Hand Function Test (JTHFT) in PwPD. Methods: Seventy PwPD and thirty HC were recruited. The test–retest reliability was evaluated by determining the intraclass correlation coefficient (ICC). MDC₉₅ was calculated by using ICC results. The concurrent validities of JTHFT and ARAT were determined by investigating their relationship with the Nine-Hole Peg Test (9-HPT), Hoehn and Yahr scale (H & Y), Unified Parkinson’s Disease Rating Scale (UPDRS), and motor symptoms (UPDRS-III). The cut-off times that best discriminated between PwPD and HC were investigated by plotting receiver operating characteristic (ROC) curves. Results: The ARAT and JTHFT showed excellent test–retest reliability (ICC = 0.937 to 0.995). The MDC₉₅ values for the ARAT were 0.38 for the dominant hand and 0.58 for the non-dominant hand. MDC₉₅ values for the JTHFT subtests and total scores ranged from 0.38 to 4.71. The ARAT, JTHFT subtests, and total scores demonstrated a fair-to-strong correlation with other outcomes (p < 0.05). The cut-off times that best differentiated JTHFT subtests and total scores ranged from 3.56 to 64.23. Conclusions: The JTHFT is a reliable and valid measurement tool for the assessment of manual dexterity in PwPD, while the ARAT is a reliable assessment tool in PwPD but does not have discriminant validity. Full article

(This article belongs to the Section Clinical Care)

18 pages, 301 KB

Open AccessArticle

The Effects of Health Literacy, Social Support, and Health-Promoting Behaviors on Metabolic Syndrome Among Middle-Aged and Older Women Living in Rural Areas of Republic of Korea

by Eun-Kyung Lee and Yong-Sook Eo

Healthcare 2025, 13(24), 3279; https://doi.org/10.3390/healthcare13243279 (registering DOI) - 13 Dec 2025

Abstract

Background/Objectives: This study examined how health literacy, social support, and health-promoting behaviors influence the prevalence of metabolic syndrome among middle-aged and older women living in rural Republic of Korea. Methods: The participants were 300 women residing in three rural regions. Data were collected [...] Read more.

Background/Objectives: This study examined how health literacy, social support, and health-promoting behaviors influence the prevalence of metabolic syndrome among middle-aged and older women living in rural Republic of Korea. Methods: The participants were 300 women residing in three rural regions. Data were collected from 1 August to 15 September 2025, in cooperation with the Lifestyle Improvement Association. Results: Descriptive and multiple regression analyses were conducted using the collected data. The prevalence of metabolic syndrome was 46.3%, and 36.7% of the participants had one or two risk factors. Factors that significantly influenced metabolic syndrome included obesity (β = 0.36, p < 0.001), health literacy (β = −0.25, p = 0.015), health responsibility (β = 0.25, p < 0.001), subjective health status (β = −0.25, p < 0.001), and menopause (β = 0.16, p = 0.005), which explained 36.3% of the variance (F = 8.59, p < 0.001). Conclusions: Enhancing health literacy and promoting a stronger sense of health responsibility may help reduce the prevalence of metabolic syndrome among middle-aged and older women in rural Republic of Korea. Full article

16 pages, 253 KB

Open AccessArticle

Factors Influencing the Quality of Women’s Sexual Life: A Study of Polish Female Students

by Maciej Stokłosa, Iga Florczyk, Gniewko Więckiewicz, Karolina Kiersten, Magdalena Piegza and Robert Pudlo

Healthcare 2025, 13(24), 3278; https://doi.org/10.3390/healthcare13243278 (registering DOI) - 13 Dec 2025

Abstract

Background/Objectives: Women’s sexual quality of life is a multidimensional construct shaped by individual, psychological, relational, and health-related factors. This exploratory cross-sectional study aimed to identify selected determinants of sexual functioning in young women, with a particular focus on partner relationships and sexual dysfunction [...] Read more.

Background/Objectives: Women’s sexual quality of life is a multidimensional construct shaped by individual, psychological, relational, and health-related factors. This exploratory cross-sectional study aimed to identify selected determinants of sexual functioning in young women, with a particular focus on partner relationships and sexual dysfunction symptoms within the couple. Methods: Data from 199 female university students aged 18–30 years, recruited via Facebook, were analyzed. Participants completed the Female Sexual Function Index (FSFI) and an author-designed questionnaire assessing sociodemographic variables, relationship characteristics, and self-perceived sexual difficulties in themselves and their partners. Descriptive statistics, bivariate analyses, and multivariable linear regression models were used to examine factors associated with the FSFI total and domain scores. Results: In this self-selected, non-representative sample, over 75% of women reported at least one self-perceived sexual difficulty, while 35.2% obtained FSFI scores at or below the established cutoff, indicating an increased risk of female sexual dysfunction rather than a confirmed diagnosis. In multivariable analysis, higher intercourse frequency, greater overall sexual satisfaction in the last 12 months, and fewer self-reported dysfunction symptoms emerged as the strongest independent predictors of higher FSFI total scores. Women who perceived premature ejaculation in their male partners tended to report lower orgasm and satisfaction domain scores, although this perception was not independently associated with the FSFI total score after adjustment for individual and relationship factors. Conclusions: These findings underline the role of both individual and relational factors in young women’s sexual functioning and support a holistic, couple-centred perspective in sexual health assessment. Full article

18 pages, 386 KB

Open AccessArticle

Competency Profile for Primary Health Care Managers in Chile: Mixed-Methods Validation Through Expert Judgment

by Katherine Soto-Schulz, Raúl Herrera-Echenique and Nuria Pérez-Romero

Healthcare 2025, 13(24), 3277; https://doi.org/10.3390/healthcare13243277 (registering DOI) - 13 Dec 2025

Abstract

Background/Objectives: Strengthening management competencies are essential to ensure effective and equitable Primary Health Care (PHC) systems. Emerging perspectives suggest that effective leadership in PHC could benefit from integrating cognitive, emotional, and social competencies. Although there is existing evidence on the required competencies [...] Read more.

Background/Objectives: Strengthening management competencies are essential to ensure effective and equitable Primary Health Care (PHC) systems. Emerging perspectives suggest that effective leadership in PHC could benefit from integrating cognitive, emotional, and social competencies. Although there is existing evidence on the required competencies worldwide and the characterization of PHC managers in Chile, no study has yet developed or validated a specific competency profile for these positions. This study developed and validated a competency profile for PHC managers to provide an evidence-based and context-specific tool for leadership, training, and evaluation. Methods: A mixed-method observational study based on expert judgment was conducted across three Chilean macrozones (northern, central, and southern), involving 36 professionals with recognized experience in PHC management identified through direct contact and snowball sampling. Quantitative validation through the Content Validity Index (CVI) confirmed high expert agreement (CVI ≥ 0.90), while thematic analysis of qualitative responses led to the inclusion of new areas. Results: The final profile comprises 47 competencies organized into knowledge, skills, and attitudes, emphasizing executive functions and social cognition and incorporating emerging domains such as emotional intelligence and institutional support. Beyond managerial relevance, the profile offers a structured framework for designing, implementing, and evaluating competency-based education and training in health sciences. Conclusions: These results also support leadership development and performance assessment, providing an evidence-based reference for professional training initiatives in PHC. This profile emphasizes that leadership development should not be limited to technical competencies, but also encompasses emotional, cognitive, and social dimensions essential for effective performance. Full article

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18 pages, 816 KB

Open AccessReview

Non-Invasive Methods for Early Diagnosis of Endometriosis—A Comprehensive Narrative Literature Review

by Adriana Ioana Gaia-Oltean, Dan Boitor, Laura-Ancuta Pop, Geanina Galea, Teodora Telecan and Romeo Micu

Healthcare 2025, 13(24), 3276; https://doi.org/10.3390/healthcare13243276 (registering DOI) - 13 Dec 2025

Abstract

Endometriosis is a common gynecological pathology, with an incidence of nearly 10% in patients of reproductive age, and is still underdiagnosed. A thorough and well-spread diagnostic study of endometriosis based on epigenetic factor dysregulation can highlight potential areas for improvement. To quantify the [...] Read more.

Endometriosis is a common gynecological pathology, with an incidence of nearly 10% in patients of reproductive age, and is still underdiagnosed. A thorough and well-spread diagnostic study of endometriosis based on epigenetic factor dysregulation can highlight potential areas for improvement. To quantify the potential and utility of non-invasive tools in the early diagnosis of endometriosis, an overview of current knowledge on epigenetic factors, based on DNA and RNA, is presented. Among these tools, it is important to highlight the role of miRNAs (microRNAs), cfDNA (cell-free DNA), and rRNAs (ribosomal RNAs), which are small molecules involved in endometriosis and numerous other pathologies. To evaluate their potential and utility in endometriosis, a salivary miRNA diagnostic test was conducted, the cfDNA methylation patterns of fragmented DNA circulating in bodily fluids (e.g., plasma) were analyzed, and cervical and uterine microbiomes were profiled for bacterial rRNA in patients with clinical suspicion of incipient endometriosis. Specific molecular profiles associated with endometriosis were analyzed. The first profile, a 109-miRNA saliva signature, was validated as a product of miRNA biomarkers and artificial intelligence modeling. In addition, peripheral blood cfDNA methylation biomarkers were identified by investigating nine genes in a molecular signature that requires validation. A profile was also obtained from cervical swabs and uterine washes, including molecular analysis of 16S rRNA amplicon sequencing to evaluate alterations in the cervical bacterial community. This review aims to optimize the integration of a non-invasive diagnostic tool for early endometriosis diagnosis. Genetic biomarkers can be correlated with clinical factors to improve diagnostic accuracy. Of the assessed diagnostic tools, salivary miRNA tests, a peripheral blood cfDNA methylation biomarker, and a microbiome rRNA signature may be useful for early diagnosis of endometriosis, as well as, implicitly, therapeutic attitude and follow-up. Full article

(This article belongs to the Special Issue Diagnosis and Therapeutic Advances in Endometriosis)

17 pages, 1017 KB

Open AccessArticle

Frailty Syndrome and Cardiovascular Diseases in Older People

by Gabriela Cristina Chelu, Ovidiu Lucian Băjenaru, Cătălina Raluca Nuță, Lidia Băjenaru and Gabriel Ioan Prada

Healthcare 2025, 13(24), 3275; https://doi.org/10.3390/healthcare13243275 (registering DOI) - 13 Dec 2025

Abstract

Objective: Cardiovascular diseases have a high prevalence among the elderly, together with frailty syndrome, and both conditions negatively affect quality of life and limit patient autonomy. This study aimed to explore potential relationships between cardiovascular and metabolic parameters, renal function, and frailty domains [...] Read more.

Objective: Cardiovascular diseases have a high prevalence among the elderly, together with frailty syndrome, and both conditions negatively affect quality of life and limit patient autonomy. This study aimed to explore potential relationships between cardiovascular and metabolic parameters, renal function, and frailty domains to identify potential intervention targets. Methods: A cross-sectional study was conducted between January 2024 and April 2025 at the National Institute of Gerontology and Geriatrics “Ana Aslan”, including 359 patients aged over 40 years. Demographic, anthropometric, and clinical data were collected through interviews, medical records, and standardized assessments of frailty components (weakness, exhaustion, slow gait, balance impairment, reduced activity, cognitive decline, and weight loss), as well as cardiovascular diseases and comorbidities. Results: Most participants were aged 65–79 years. ROC curve identified triglycerides as a good indicator of both alcohol consumption (AUC = 0.631, p= 0.042) and smoking status (AUC = 0.676, p = 0.004), while HDL cholesterol showed an inverse association with smoking status (AUC = 0.356, p= 0.019). Reduced renal function was significantly associated with smoking status, balance, gait impairment, and reduced functional mobility. The Up and Go Test indicated a good discriminatory ability for renal function decline (AUC = 0.656, p < 0.001). Muscle strength, MMSE, and Tinetti scores showed inverse associations with renal function. Conclusions: Renal impairment appears to be a reliable indicator across multiple frailty domains, acting as an accelerator of frailty progression. Triglycerides reflect lifestyle-related factors, while the Up and Go Test may serve as a practical screening tool for renal dysfunction in frail older adults. These findings suggest the need to adapt traditional cardiovascular risk management to the frail geriatric population. Full article

(This article belongs to the Special Issue Progress in Prevention and Care for Cardiovascular Diseases: Second Edition)

11 pages, 231 KB

Open AccessArticle

The Relationship Between Physical Activity, Sedentary Behavior, and Subjective Well-Being: Gender Differences Among Slovak University Students

by Alena Buková, Justyna Krzepota, Dorota Sadowska, Tatiana Kimáková and Petra Melicharová

Healthcare 2025, 13(24), 3274; https://doi.org/10.3390/healthcare13243274 (registering DOI) - 13 Dec 2025

Abstract

Background/Objectives: University students are a population vulnerable to psychological distress due to academic and lifestyle transitions. This study examined the relationships between physical activity (PA), sedentary behavior, and subjective well-being among Slovak university students, with attention to gender-specific and non-linear patterns. Methods: A [...] Read more.

Background/Objectives: University students are a population vulnerable to psychological distress due to academic and lifestyle transitions. This study examined the relationships between physical activity (PA), sedentary behavior, and subjective well-being among Slovak university students, with attention to gender-specific and non-linear patterns. Methods: A total of 1314 first-year students (69.5% women; mean age = 20.7 ± 1.4 years) completed the IPAQ-Short Form and the Bern Questionnaire on Subjective Well-Being (BSW/A). PA levels were categorized as low, moderate, or high according to standard MET thresholds. Group differences were analyzed using nonparametric tests with Benjamini–Hochberg FDR correction. Results: Higher PA levels were associated with more favorable well-being outcomes, particularly higher self-esteem and joy of life and lower depressed mood and somatic complaints. Effect sizes ranged from small to moderate. Gender-specific patterns emerged: among men, well-being indicators tended to plateau beyond moderate PA, whereas among women, moderate PA showed an inverse association with self-esteem despite slightly higher median scores in the moderate-activity group. Sedentary time showed weak and mostly non-significant associations after FDR correction. Conclusions: Physical activity was positively associated with subjective well-being in a non-linear, gender-dependent manner. These findings suggest that approaches to supporting student well-being may benefit from considering gender differences, individual activity patterns, and motivational context. Full article

(This article belongs to the Section Mental Health and Psychosocial Well-being)

20 pages, 364 KB

Open AccessSystematic Review

Passion, Motivation, and Well-Being in Young Footballers: A Systematic Review

by Diogo Braz, Cátia Maia, Élvio Gouveia, Diogo Monteiro, Nuno Couto and Hugo Sarmento

Healthcare 2025, 13(24), 3273; https://doi.org/10.3390/healthcare13243273 (registering DOI) - 13 Dec 2025

Abstract

Background: Psychological well-being is crucial for the development and performance of young athletes. This systematic review aims to synthesize the available scientific evidence on the relationship between passion (harmonious and obsessive), basic psychological needs (BPNs), motivation, affect (positive and negative), and life satisfaction [...] Read more.

Background: Psychological well-being is crucial for the development and performance of young athletes. This systematic review aims to synthesize the available scientific evidence on the relationship between passion (harmonious and obsessive), basic psychological needs (BPNs), motivation, affect (positive and negative), and life satisfaction in young football (soccer) players. Methods: A systematic literature review was performed, following the PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was conducted in the Web of Science, Scopus, ERIC, and SportDiscus databases, using a comprehensive strategy that combined keywords related to football, youth, passion, motivation, and well-being. Two independent reviewers performed article screening, eligibility assessment, and data extraction. The methodological quality of the included studies was determined using two different tools. Results: Nine studies met the inclusion criteria and were analyzed in detail. The results consistently indicate that harmonious passion is associated with greater fulfillment of BPNs, positive affect, and overall life satisfaction. In contrast, obsessive passion was linked to negative outcomes such as burnout and emotional dysregulation. The available evidence suggests a positive association of harmonious passion with motivation and well-being, and an association of obsessive passion with psychological distress. Conclusions: Within the delimited scope, the evidence suggests that harmonious passion is an important construct positively associated with the well-being and motivation of young footballers, while obsessive passion is associated with adverse outcomes. Research in this area is scarce, showing methodological diversity and heterogeneous samples, which limits the generalizability of the findings. Future research should prioritize longitudinal designs and interventions to promote harmonious passion and the satisfaction of BPNs. Full article

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

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17 pages, 517 KB

Open AccessArticle

Tracking Chronic Diseases via Mobile Health Applications: Which User Experience Aspects Are Key?

by Anouk S. Huberts, Preston Long, Ann-Kristin Porth, Liselotte Fierens, Nicholas C. Carney, Linetta Koppert, Alexandra Kautzky-Willer, Belle H. de Rooij and Tanja Stamm

Healthcare 2025, 13(24), 3272; https://doi.org/10.3390/healthcare13243272 - 12 Dec 2025

Abstract

Background: A key barrier to realizing the full potential and long-term collection of patient-reported outcomes (PROs) is the limited understanding of user experience (UX) factors that influence sustained patient engagement with digital PRO tools. Most existing research focuses on disease-specific or country-specific solutions, [...] Read more.

Background: A key barrier to realizing the full potential and long-term collection of patient-reported outcomes (PROs) is the limited understanding of user experience (UX) factors that influence sustained patient engagement with digital PRO tools. Most existing research focuses on disease-specific or country-specific solutions, leaving a gap in identifying shared UX determinants that could inform scalable, cross-disease European digital health frameworks. This fragmentation hinders interoperability and increases development costs by requiring separate tools for each context. This case study aims to address this gap by identifying key UX features that optimize PRO collection across diverse chronic conditions in Europe within the Health Outcomes Observatory project, enhancing continuous (primary use) and large-scale (secondary use) data collection. Objective: This study aimed to identify and analyze key UX factors that support adoption and sustained use of PRO collection tools among patients with chronic diseases across multiple European countries. Methods: Patient focus groups were conducted in four chronic disease areas: cancer, inflammatory bowel disease (IBD), and diabetes (type I and II) across six European countries. Participants were recruited purposively through national patient advisory boards to ensure diversity in age, gender, and disease type. Sessions were moderated by trained qualitative researchers following a standardized guide, and discussions were transcribed verbatim and coded in researcher pairs to ensure intercoder reliability through iterative consensus. A modified thematic analysis, guided deductively by the UX Honeycomb model and inductively by emergent themes, was used to identify cross-disease UX determinants. Results: In total, 17 patients and patient representatives participated (76% female; 4 diabetes, 6 IBD and 7 cancer). We identified six core UX factors driving patient engagement for all disease groups: compatibility with other technologies, direct communication with the care team, personalization, ability to share data, the need for educational material and data protection were identified as key aspects of PRO technologies. However, the customizability of the app is crucial. Not all disease groups had the same needs, and participants specifically requested that the app provide information relevant to their own condition. Disease-specific needs, like T1D patients desiring glucose monitoring integration, were identified. IBD patients highlighted flare detection abilities and cancer patients especially sought side-effect comparisons. Conclusions: Our findings indicate that a unified yet customizable PRO platform can address shared UX needs across diseases, improving patient engagement and data quality. Incorporating features such as seamless data transfer, personalization, feedback, and strong privacy measures can foster trust and long-term adoption across European contexts. In addition to some disease-specific issues, most needs for the backbone of the app were shared among the disease areas. This shows that a shared app between diseases might be preferable and, in case of comorbidities, could ease self-management for patients. Last, to ensure full potential for every user and every disease, customization is crucial. Full article

15 pages, 267 KB

Open AccessArticle

Challenges and Social Implications of Informal Caregiving for People with Alzheimer’s: A Qualitative Study

by Andrea Alcaraz-Córdoba, María López-Cano, Olivia Ibáñez-Masero, María Isabel Ventura-Miranda, María Dolores Ruiz-Fernández and Angela María Ortega-Galán

Healthcare 2025, 13(24), 3271; https://doi.org/10.3390/healthcare13243271 - 12 Dec 2025

Abstract

Aim: The aim of this study was to explore the experiences and challenges faced by informal caregivers of people with Alzheimer’s, including the social and emotional aspects of their caregiving role. Methods: A descriptive qualitative study was conducted using one focus [...] Read more.

Aim: The aim of this study was to explore the experiences and challenges faced by informal caregivers of people with Alzheimer’s, including the social and emotional aspects of their caregiving role. Methods: A descriptive qualitative study was conducted using one focus group discussion and eleven semi-structured interviews with informal caregivers of individuals diagnosed with Alzheimer’s disease. The data collected were analyzed through thematic analysis using ATLAS.ti qualitative software version 23. Results: The results reveal two themes: (1) “Life centred on compassionate care for the other person”, which reflects the role performed from a perspective of emotional and compassionate commitment to those in need of care, and (2) “Abandonment by caregivers”, which expresses the emotional cost associated with caregiving. Conclusions: Informal caregivers of people with Alzheimer’s disease undertake their roles guided by compassion, which involves substantial personal sacrifice. This commitment often leads to self-abandonment, impacting their emotional and physical health, social relationships, and personal aspirations. It is therefore crucial to implement psychosocial interventions grounded in compassion and to strengthen both formal and informal social support systems for caregivers. Full article

(This article belongs to the Special Issue Enhancing Healthcare Services for Vulnerable Groups)

26 pages, 580 KB

Open AccessSystematic Review

Patient-Reported Outcome Measures for Evaluating Body Awareness: A Systematic Review Using the COSMIN Methodology

by Cristina Bravo, Manuel Trinidad-Fernández, David Barranco-i-Reixachs, Sandy Arias-Matiz, Pedro Malagon-Santos and Daniel Catalán-Matamoros

Healthcare 2025, 13(24), 3270; https://doi.org/10.3390/healthcare13243270 - 12 Dec 2025

Abstract

Objective: Body awareness is the conscious, subjective multimodal integration of body-related sensitivity from bodily signals—detecting states and subtle reactions to internal and environmental conditions—modifiable by attention, interpretation, appraisal, beliefs, memories, conditioning, attitudes, and affect. The aim of our study is to identify [...] Read more.

Objective: Body awareness is the conscious, subjective multimodal integration of body-related sensitivity from bodily signals—detecting states and subtle reactions to internal and environmental conditions—modifiable by attention, interpretation, appraisal, beliefs, memories, conditioning, attitudes, and affect. The aim of our study is to identify patient-reported outcome measures (PROMs) of BA and evaluate their psychometric properties and cross-cultural adaptation processes. Literature Survey: We searched PubMed, Scopus, and PsycINFO; the last search was conducted on 1 July 2025. Methodology: We included studies that psychometrically evaluated PROMs regarding BA in the general adult population and their translations into other languages, with no time-range restrictions. Study selection was performed independently by two reviewers in a blind manner. Evaluation followed COSMIN guidance for systematic reviews of PROMs: (1) risk of bias assessment, (2) application of quality criteria for measurement properties, and (3) GRADE rating of the certainty of evidence. Synthesis: We identified 12 BA questionnaires and more than 30 cross-cultural adaptations, from a total of 50 studies. In summary, the Revised Body Awareness Rating Questionnaire and the Multidimensional Assessment of Interoceptive Awareness (MAIA 1 and 2) showed good results for structural validity and internal consistency, which were the most frequently assessed psychometric properties. In contrast, construct validity was highly variable, and the findings on reliability were far from optimal. MAIA-2 was one of the most studied and showed stronger evidence and better pooled results (4 out of 5 properties) than other instruments. Conclusions: The psychometric quality of BA PROMs varies widely, reflecting challenges in operationalizing the construct of body awareness and related domains. While MAIA-2 currently presents the most acceptable—though still imperfect—evidence, further high-quality studies are needed to strengthen their measurement properties and clarify construct coverage. Full article

(This article belongs to the Special Issue Physical Therapy in Mental Health)

23 pages, 1023 KB

Open AccessArticle

Development and Validation of the Artificial Intelligence in Mental Health Scale: Application for AI Mental Health Chatbots

by Aglaia Katsiroumpa, Olympia Konstantakopoulou, Ioannis Moisoglou, Parisis Gallos, Olga Galani, Paschalina Lialiou, Maria Tsiachri and Petros Galanis

Healthcare 2025, 13(24), 3269; https://doi.org/10.3390/healthcare13243269 - 12 Dec 2025

Abstract

Background/Objectives: Artificial intelligence (AI)-based chatbots present a viable approach to overcoming several challenges associated with conventional psychotherapy, such as high financial costs, limited access to mental health professionals, and geographical or logistical barriers. Thus, these chatbots are increasingly employed as complementary tools [...] Read more.

Background/Objectives: Artificial intelligence (AI)-based chatbots present a viable approach to overcoming several challenges associated with conventional psychotherapy, such as high financial costs, limited access to mental health professionals, and geographical or logistical barriers. Thus, these chatbots are increasingly employed as complementary tools to traditional therapeutic practices in mental health care. Our aim was to develop and validate a scale to measure attitudes toward the use of AI-based chatbots for mental health support, i.e., the Artificial Intelligence in Mental Health Scale (AIMHS). Methods: A multidisciplinary panel of experts assessed the content validity. To confirm face validity, we carried out cognitive interviews and calculated the item-level face validity index. We applied factor analysis to verify the construct structure. We assessed measurement invariance across demographic subgroups. Concurrent validity was evaluated using three valid instruments. Reliability was tested through Cronbach’s alpha, Cohen’s kappa, and the intraclass correlation coefficient. Results: Factor analysis supported a two-factor five-item model. The two factors were technical and personal advantages, and explained 81.28% of the variance. The AIMHS demonstrated adequate concurrent validity, evidenced by statistically significant correlations with Artificial Intelligence Attitude Scale (r = 0.405, p-value < 0.001), Attitudes Towards Artificial Intelligence Scale (acceptance subscale; r = 0.401, p-value < 0.001, fear subscale; r = −0.151, p-value = 0.002), and Short Trust in Automation Scale (r = 0.450, p-value < 0.001). Configural, metric and scalar invariance were supported by our findings. Cronbach’s alpha was 0.798, and intraclass correlation coefficient was 0.938. Cohen’s kappa for the five items ranged from 0.760 to 0.848. Conclusions: The AIMHS is a five-item psychometrically sound and user-friendly instrument capturing two dimensions; technical and personal advantages. Future research should be undertaken to further evaluate the psychometric properties of the AIMHS across diverse populations and contexts. Full article

(This article belongs to the Special Issue Artificial Intelligence Chatbots and Mental Health)

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19 pages, 926 KB

Open AccessSystematic Review

Efficacy of Massage Therapy for Symptom Management in Cancer Patients: A Systematic Review and Meta-Analysis

by Arda Uzunoglu, Paula Matta-Diaz, Valeria Bustos-Gajardo, Javiera Obreque-González, Gloria Cifuentes-Suazo, Guinevere Granite, Mathias Orellana Donoso, Pablo Nova Baeza, Gustavo Oyanedel-Amaro, Alvaro Becerra Farfan, Juan Sanchis-Gimeno, Juan José Valenzuela-Fuenzalida, Jessica Paola Loaiza Giraldo and Jose E. León-Rojas

Healthcare 2025, 13(24), 3268; https://doi.org/10.3390/healthcare13243268 - 12 Dec 2025

Abstract

Background: Cancer and its treatments frequently lead to physical and psychological symptoms that negatively affect quality of life. Massage therapy has been proposed as a complementary intervention to reduce symptom burden through its effects on stress regulation and autonomic balance. This systematic review [...] Read more.

Background: Cancer and its treatments frequently lead to physical and psychological symptoms that negatively affect quality of life. Massage therapy has been proposed as a complementary intervention to reduce symptom burden through its effects on stress regulation and autonomic balance. This systematic review and meta-analysis evaluated the effectiveness of massage therapy in patients with cancer. Methods: A systematic search was conducted in MEDLINE, Web of Science, Scopus, Embase, Google Scholar, and CINAHL. Search terms included “massage therapy,” “reflexology,” “massage,” and “cancer.” Randomized controlled trials comparing massage therapy with placebo or standard care and reporting quantitative outcomes were eligible. Seven studies met inclusion criteria for the meta-analysis. Results: Compared with control conditions, massage therapy was associated with significant improvements in several outcomes: Behavioral Symptoms Frequency (BSF) (MD = −12.54; 95% CI: −18.70 to −6.38; p < 0.0001), Quality of Life Questionnaire (QLQ) scores (SMD = 10.10; 95% CI: 1.21 to 19.00; p = 0.03), Spielberger State–Trait Anxiety Inventory (STAI) scores (MD = −3.97; 95% CI: −4.63 to −3.31; p = 0.0001), and Visual Analog Scale (VAS) symptom intensity (MD = −1.09; 95% CI: −2.11 to −0.07; p = 0.04). Overall certainty of evidence was limited by methodological heterogeneity and risk of bias. Conclusions: Massage therapy may provide short-term improvements in selected physical and psychological symptoms in cancer patients and may serve as a supportive complementary intervention. However, the evidence remains limited, and well-designed trials with standardized protocols are needed to strengthen the reliability of these findings. Full article

(This article belongs to the Collection Integrative, Complementary and Alternative Medicine (CAM) in Healthcare)

13 pages, 851 KB

Open AccessArticle

Cost-Effectiveness Analysis of Recombinant Tumor Necrosis Factor Receptor: Fc Fusion Protein as First-Line Treatment for Active Rheumatoid Arthritis in China

by Rui Zhang and Aixia Ma

Healthcare 2025, 13(24), 3267; https://doi.org/10.3390/healthcare13243267 - 12 Dec 2025

Abstract

Background/Objectives: To evaluate the cost-effectiveness of recombinant tumor necrosis factor receptor Fc fusion protein compared with methotrexate as first-line therapy for active rheumatoid arthritis in China using evidence from a Chinese head-to-head randomized trial. Methods: A Markov model with 6 months [...] Read more.

Background/Objectives: To evaluate the cost-effectiveness of recombinant tumor necrosis factor receptor Fc fusion protein compared with methotrexate as first-line therapy for active rheumatoid arthritis in China using evidence from a Chinese head-to-head randomized trial. Methods: A Markov model with 6 months per cycle was developed to estimate costs and health utilization in the lifetime of patients with RA from the Chinese healthcare system. The analysis data were derived from the randomized clinical trial in China. The primary cost includes drug and other medical costs. The health utilities quality-adjusted life years (QALYs) were derived using EQ-5D-5L mapping from disease-specific health assessment questionnaire (HAQ) scores obtained in clinical trials. The cost-effectiveness analysis was conducted by calculating the incremental cost-effectiveness ratio (ICER) values for rhTNFR:Fc and MTX. One-way and probabilistic sensitivity analyses were conducted to test the robustness of the base-case result. Results: In the base case, rhTNFR:Fc yielded 8.20 QALYs versus 7.46 with methotrexate, resulting in an ICER of CNY 12,783.56 per QALY. Scenario ICERs for bDMARD group combination treatment were 11,776.31 per QALY. Scenario ICERs were CNY 8079.04 per QALY for the patient perspective and CNY 7630.34 per QALY for the medical insurance perspective. One-way analysis highlighted utility inputs as the main drivers, and probabilistic analysis indicated a high probability of cost-effectiveness across common willingness-to-pay thresholds. Conclusions: The fusion protein strategy achieved an incremental cost-effectiveness ratio far below the 2024 China per capita gross domestic product threshold of CNY 95,749 per quality-adjusted life year. As first-line therapy for active rheumatoid arthritis, it is cost-effective relative to methotrexate in the Chinese setting. Full article

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13 pages, 916 KB

Open AccessArticle

The Prognostic Implications of the Geriatric Nutritional Risk Index in Patients with Prostate Cancer: A Single-Center Retrospective Cohort Study

by Rong Zhou, Yanqiong Zhou, Xiao Yue, Mei Wang, Yucong Zhang and Chang Liu

Healthcare 2025, 13(24), 3266; https://doi.org/10.3390/healthcare13243266 - 12 Dec 2025

Abstract

Background and Aims: Nutritional risk is a significant yet often overlooked factor influencing postoperative outcomes in older patients with prostate cancer. This study aimed to evaluate the impact of the Geriatric Nutritional Risk Index (GNRI) on postoperative complications in older patients undergoing radical [...] Read more.

Background and Aims: Nutritional risk is a significant yet often overlooked factor influencing postoperative outcomes in older patients with prostate cancer. This study aimed to evaluate the impact of the Geriatric Nutritional Risk Index (GNRI) on postoperative complications in older patients undergoing radical prostatectomy. Secondary objectives included examining the association between the GNRI and healthcare resource utilization, specifically the length of hospital stay and hospitalization costs. Methods: This retrospective cohort study included patients aged ≥ 65 years who underwent laparoscopic radical prostatectomy at a single tertiary center between 2022 and 2024. Patients were stratified into a malnutrition group (GNRI ≤ 98) and a normal nutrition group (GNRI > 98). Clinical outcomes were compared using chi-square and t tests. Binary logistic regression was performed to identify independent predictors of complications, hospital stay, and costs. Results: Of the 264 patients included, 34.8% were classified as being at nutritional risk. The malnutrition group had a significantly higher incidence of postoperative complications (OR = 2.859, p = 0.007), longer hospital stays (OR = 4.678, p < 0.001), and greater hospitalization costs (OR = 4.867, p < 0.001). Nutritional risk remained a significant predictor after adjusting for confounders. Conclusions: GNRI-defined nutritional risk is independently associated with increased postoperative complications and higher healthcare resource utilization in older prostate cancer patients. The GNRI may serve as a practical and accessible tool for perioperative risk stratification in this population. Full article

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12 pages, 663 KB

Open AccessArticle

The Effect of Chronic Graft-Versus-Host Disease and Its Therapy on Salivary Caries Risk Factors—An Exploratory Cross-Sectional Pilot Study

by Nina Vovk, Manca Urek, Ksenija Cankar and Lidija Nemeth

Healthcare 2025, 13(24), 3265; https://doi.org/10.3390/healthcare13243265 - 12 Dec 2025

Abstract

Background: The aim of this study was to investigate the effects of chronic graft-versus-host disease (cGVHD) and its treatment with cyclosporine and extracorporeal photopheresis (ECP) on salivary caries risk factors. Methods: In this exploratory single-centre cross-sectional pilot study, saliva samples from [...] Read more.

Background: The aim of this study was to investigate the effects of chronic graft-versus-host disease (cGVHD) and its treatment with cyclosporine and extracorporeal photopheresis (ECP) on salivary caries risk factors. Methods: In this exploratory single-centre cross-sectional pilot study, saliva samples from 22 cGVHD patients were analysed for flow rate, pH, buffering capacity, and counts of Streptococcus mutans and Lactobacillus. A detailed dental examination assessed plaque, carious lesions, and their progression. Caries risk was determined based on general health and diet questionnaires and clinical findings. Results: Patients receiving a combination of cyclosporine and ECP had significantly fewer carious teeth, affected tooth surfaces, and non-cavitated carious lesions compared with those treated with ECP alone (Bonferroni test, p = 0.004, p = 0.002, and p < 0.001, respectively). Patients treated with ECP had more carious teeth and affected surfaces than those who did not receive either ECP or cyclosporine (p = 0.008 and p = 0.002), whereas patients treated with cyclosporine only had more non-cavitated lesions than those receiving both cyclosporine and ECP (p < 0.001). A negative correlation was observed between cyclosporine dose and stimulated salivary flow (R = −0.672, p = 0.0486), and a positive correlation between cyclosporine dose and caries risk (R = 0.640, p = 0.0461). Conclusions: The disease and its treatment were associated with reduced salivary flow and increased caries risk. Patients’ oral health should be monitored regularly and managed with care to prevent further deterioration. Full article

(This article belongs to the Special Issue Novel Therapeutic and Diagnostic Strategies for Oral Diseases)

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21 pages, 780 KB

Open AccessArticle

Beyond Pain Relief: A Cross-Sectional Study on NSAID Prescribing, Polypharmacy, and Drug Interaction Risks in Community Pharmacies

by Javedh Shareef, Sathvik Belagodu Sridhar, Saeed Humaid Al Naqbi and Adyan Iftekhar Bakshi

Healthcare 2025, 13(24), 3264; https://doi.org/10.3390/healthcare13243264 - 12 Dec 2025

Abstract

Background/Objectives: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used globally to manage pain and inflammation. The rising prevalence of polypharmacy and potential drug–drug interactions (pDDIs) magnified by the prolonged and irrational use of NSAIDs may jeopardize patient medication safety. This study aims to [...] Read more.

Background/Objectives: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used globally to manage pain and inflammation. The rising prevalence of polypharmacy and potential drug–drug interactions (pDDIs) magnified by the prolonged and irrational use of NSAIDs may jeopardize patient medication safety. This study aims to analyze the pattern in prescribing NSAIDs and assess the extent of polypharmacy and pDDIs in community pharmacies located in Ras Al Khaimah. Methods: A quantitative cross-sectional study was conducted in randomly selected community pharmacies over six months (July 2024 to December 2024). Prescriptions pertaining to NSAIDs were assessed for prescribing patterns; incidence of polypharmacy and pDDIs were identified using Lexicomp’s drug interaction database. Chi-square tests assessed associations between treatment variables and polypharmacy, while logistic regression explored predictors of pDDIs. Results: In a total of 600 prescriptions, 1865 drugs were prescribed, including 908 NSAIDs. Celecoxib (28.2%) and ketoprofen (27.6%) remained the most predominant oral and topical NSAIDs prescribed. Aspirin and celecoxib were most commonly linked with pDDIs. A total of 357 pDDIs were identified, averaging 1.87 ± 1.39 per prescription. Most were of minor severity (60.22%), risk category C (43.97%), and fair reliability (59.38%). Gender, nationality, and comorbidities were significantly associated with polypharmacy (p < 0.001). Logistic regression showed nationality (p = 0.016), comorbidities (p < 0.001), and drug count (p = 0.007) as key predictors of pDDIs. Conclusions: Frequent NSAIDs prescribing, incidence of polypharmacy, and pDDIs underscore the attention for more cautious, evidence-based prescribing practice. Enforcing a robust regulatory framework, coupled with strengthening medication-use policies and pharmacist-led thorough medication history review and ongoing monitoring is paramount to improve patient safety and clinical outcomes. Full article

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

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25 pages, 362 KB

Open AccessArticle

Assisted Suicide and Suicide Prevention: Ethical Perspectives, Attitudes and Challenges for Nurses in Long-Term Care—A Qualitative Focus Group Study

by Karen Klotz, Pia Madeleine Haug, Thomas Heidenreich, Eva-Maria Stratmann, Erik Jacob and Annette Riedel

Healthcare 2025, 13(24), 3263; https://doi.org/10.3390/healthcare13243263 - 12 Dec 2025

Abstract

Background/Objectives: Assisted suicide and suicide prevention remain subjects of intense societal, political, and professional-ethical debate in Germany. Nurses working in residential and home-based long-term care (LTC) play a pivotal role in responding to requests for assisted suicide and in supporting suicide prevention. [...] Read more.

Background/Objectives: Assisted suicide and suicide prevention remain subjects of intense societal, political, and professional-ethical debate in Germany. Nurses working in residential and home-based long-term care (LTC) play a pivotal role in responding to requests for assisted suicide and in supporting suicide prevention. While international research has explored diverse ethical perspectives and challenges related to these issues, little is known about how LTC nurses in Germany experience and navigate them. This study examines German LTC nurses’ ethical perspectives on assisted suicide and suicide prevention and explores the associated ethical challenges. Methods: A qualitative design employing both in-person and online focus groups was used. Data were analyzed following Mayring’s qualitative content analysis. Results: Twelve focus groups with a total of 96 nurses working in residential and home-based LTC were conducted between February and September 2025. Findings show that nurses perceive assisted suicide and suicide prevention as ethically complex and emotionally demanding. Three overarching themes emerged: (1) Intuitive and Emotional Reactions, (2) Ethical Perception and Ethical Reflection, and (3) Ethical Challenges. Conclusions: This study offers new insights into the diverse ethical perspectives of German LTC nurses on assisted suicide and suicide prevention. It extends existing knowledge through its explicit focus on the ethical issues and implications involved, both in residential and home-based LTC. The ethical challenges identified may enhance understanding of the factors underlying the development of moral distress in Germany and other countries where assisted suicide is a legal option. To help nurses navigate these ethically demanding situations, strategies at multiple levels are required. These include continuous ethics education, an open ethical culture, role definitions and clear professional guidance, alongside societal support for equitable access to general healthcare and suicide prevention services. Full article

23 pages, 602 KB

Open AccessReview

Artificial Intelligence in Obesity Prevention

by Golbarg Shabani Jafarabadi and Luca Busetto

Healthcare 2025, 13(24), 3262; https://doi.org/10.3390/healthcare13243262 - 12 Dec 2025

Abstract

Background/Objectives: Obesity is a complex disorder that causes further health issues linked to several chronic diseases, such as cancer, diabetes, metabolic syndrome, and cardiovascular diseases; thus, it is critical to identify and diagnose obesity as soon as possible. Traditional methods, such as anthropometric [...] Read more.

Background/Objectives: Obesity is a complex disorder that causes further health issues linked to several chronic diseases, such as cancer, diabetes, metabolic syndrome, and cardiovascular diseases; thus, it is critical to identify and diagnose obesity as soon as possible. Traditional methods, such as anthropometric measures, were popular, although recent advances in artificial intelligence (AI) offer new opportunities for prediction models; as a result, AI has become an essential tool in obesity research. This study provides a comprehensive analysis of the research on the impact of AI on obesity prevention. Methods: In this study, the researchers performed a scoping study using AI to assess and predict obesity in PubMed, Scopus, Web of Science, and Google Scholar from February 2009 to July 2025. The researchers compiled and arranged the employed AI approaches to find connections, patterns, and trends that could guide further research and the application of machine learning algorithms for advanced data analytics. Results: Clinical professionals in obesity medicine may find chatbots valuable as a source of clinical and scientific knowledge, and for creating standard operating procedures, policies, and procedures. According to the findings, AI models can be used to identify clinically significant patterns of obesity or the connections between specific factors and weight outcomes. Moreover, the application of deep learning and machine learning approaches, such as logistic regression, decision trees, and artificial neural networks, appears to have yielded new insight into data, particularly in terms of obesity prediction. Conclusions: This work aims to contribute to a better understanding of obesity detection. While more studies are needed, AI offers solutions to modern challenges in obesity prediction. Full article

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