Healthcare

14 pages, 385 KB

Open AccessArticle

The Psychometric Properties of the Moberg Pick-Up Test (MPUT) to Assess Fine Motor Skills in Adults with Haemophilia

by Arnika Lorenz, Fabian Tomschi, Alexander Schmidt, Holger Stephan, Joschua Wiese and Thomas Hilberg

Healthcare 2026, 14(3), 368; https://doi.org/10.3390/healthcare14030368 (registering DOI) - 31 Jan 2026

Abstract

Background/Objectives: Haemophilia-related bleedings primarily affect the musculoskeletal system, and functional tests are used in clinical management. Yet, fine motor skills of the upper extremities have not been evaluated in adult persons with haemophilia (PwH). The Moberg Pick-Up Test (MPUT) assesses fine motor [...] Read more.

Background/Objectives: Haemophilia-related bleedings primarily affect the musculoskeletal system, and functional tests are used in clinical management. Yet, fine motor skills of the upper extremities have not been evaluated in adult persons with haemophilia (PwH). The Moberg Pick-Up Test (MPUT) assesses fine motor skills but has only been psychometrically evaluated in other cohorts. This study aims to examine its psychometric properties in PwH. Methods: A total of 40 moderate or severe PwH A or B were included. The MPUT, consisting of three trials, was conducted twice by rater A and once by rater B. The best performance per hand of each MPUT was used. Subjective hand function (Duruöz Hand Index (DHI) and numeric rating scale (NRS)), elbow joint status (Haemophilia Joint Health Score (HJHS)), pain (NRS), and wrist range of motion (ROM) were utilised for convergent validity evaluation. Inter-rater and test–retest reliability were determined through intraclass correlation coefficients (ICCs) for raw and log10-transformed data. Results: Inter-rater and test–retest reliability demonstrated moderate-to-excellent ICCs for both data types (ICC range: 0.624–0.918). The DHI correlated moderately with the average MPUT score of both hands (r = 0.410; p = 0.016). Left-hand MPUT scores did not correlate with left elbow HJHS scores, whereas right-hand MPUT scores correlated with right elbow HJHS scores (r = 0.396, p = 0.018). Subjective left-hand function (NRS) correlated with the results of the MPUT (r = 0.433; p = 0.009). Conclusions: The MPUT is a reliable and partially valid tool and can be useful to assess fine motor skills in PwH. Full article

(This article belongs to the Special Issue Physical Exercise in Chronic Diseases: Assessment, Implementation and Effectiveness)

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12 pages, 260 KB

Open AccessArticle

Ethical Conflicts and Knowledge of the Code of Ethics Among Occupational Therapists in Spain

by Daniel Emeric-Méaulle, Pablo A. Cantero-Garlito and Ana A. Laborda-Soriano

Healthcare 2026, 14(3), 367; https://doi.org/10.3390/healthcare14030367 (registering DOI) - 31 Jan 2026

Abstract

Objective: This study characterized Spanish occupational therapists’ knowledge of the national Code of Ethics and perceptions of professional ethics and examined associations with sociodemographic and educational variables. It quantified knowledge of key Code elements (approving body and professional values), described ethics education and [...] Read more.

Objective: This study characterized Spanish occupational therapists’ knowledge of the national Code of Ethics and perceptions of professional ethics and examined associations with sociodemographic and educational variables. It quantified knowledge of key Code elements (approving body and professional values), described ethics education and participation in formal ethical support structures, and identified resources used to manage ethical conflicts in routine practice. Methods: A descriptive cross-sectional online survey was administered between March and September 2022. The analytical sample included 596 occupational therapists practicing in Spain. The questionnaire assessed participant characteristics, ethics education, knowledge and perceived importance of the Code, participation in ethics committees or similar structures, experience of ethical conflicts, and conflict-management strategies. Descriptive and bivariate analyses were conducted (p < 0.05). Results: Respondents were mostly women (86.6%) and aged 20–40 years. Although 65.3% reported university ethics education and 73.2% rated the Code as important/very important, 11.4% were unaware of its existence. Only 28.2% identified the approving body, and 16.3% correctly identified the professional values included in the Code. Ethical conflicts were reported by 43.1%. When conflicts occurred, respondents most often consulted the interdisciplinary team (25.5%) or occupational therapy colleagues (24.3%), whereas few consulted the Code (4.5%) or an ethics committee (2.7%). Ethics education and greater professional experience were associated with higher Code knowledge. Conclusions: Occupational therapists in Spain endorse professional ethics, yet actionable knowledge and use of the Code and engagement with formal support structures remain limited. Strengthening practice-oriented ethics education and accessible deliberation mechanisms may improve ethical decision-making. Full article

(This article belongs to the Special Issue Ethical Challenges in Healthcare Professions: Decision-Making in Uncertain Scenarios)

11 pages, 253 KB

Open AccessArticle

Determinants of Severe Financial Distress in U.S. Acute Care Hospitals: A National Longitudinal Study

by James R. Langabeer, Francine R. Vega, Audrey Sarah Cohen, Tiffany Champagne-Langabeer, Andrea J. Yatsco and Karima Lalani

Healthcare 2026, 14(3), 366; https://doi.org/10.3390/healthcare14030366 (registering DOI) - 31 Jan 2026

Abstract

Background: Financial sustainability remains a central challenge for U.S. hospitals as rising operating costs, shifting federal reimbursement, and policy uncertainty intensify economic pressures. This study estimates the prevalence and recent changes in financial distress among U.S. short-term acute care hospitals. Methods: [...] Read more.

Background: Financial sustainability remains a central challenge for U.S. hospitals as rising operating costs, shifting federal reimbursement, and policy uncertainty intensify economic pressures. This study estimates the prevalence and recent changes in financial distress among U.S. short-term acute care hospitals. Methods: We conducted a national longitudinal analysis of all U.S. short-term acute care hospitals from 2021 to 2023 using financial and operational data from Medicare cost reports linked with community-level data from the American Community Survey. Financial distress was measured using the Altman Z-score, with severe distress defined as Z ≤ 1.8. Logistic regression models were used to identify organizational, operational, and market characteristics associated with distress. Results: The proportion of hospitals classified as severely financially distressed increased from 18.6% in 2021 to 22.0% in 2023. Operating margins and returns on assets declined significantly over the study period, while mean Z-scores showed a modest but non-significant downward trend. In adjusted models, urban hospitals had higher odds of distress (OR 1.27, 95% CI 1.15–1.40, p < 0.001), as did hospitals with longer average lengths of stay (OR 1.07 per day, 95% CI 1.04–1.09, p < 0.001) and higher debt-to-equity ratios (OR 1.05 per unit, 95% CI 1.05–1.06, p < 0.001). Higher occupancy rates were protective (OR 0.31, 95% CI 0.25–0.40, p < 0.001). Larger market population was also associated with increased distress risk (OR 1.61, 95% CI 1.21–2.14, p = 0.001), while other market characteristics were not significant. Conclusions: Financial distress remains widespread and appears to be increasing among U.S. acute care hospitals. Operational efficiency, capital structure, and local market scale are key drivers of financial vulnerability, highlighting the need for targeted strategies to strengthen hospital resilience and preserve access to essential acute care services. Full article

(This article belongs to the Section Healthcare Organizations, Systems, and Providers)

16 pages, 705 KB

Open AccessReview

Exploring the Relationship Between Caring and Missed Nursing Care: A Scoping Review

by Gregor Romih, Majda Pajnkihar and Dominika Vrbnjak

Healthcare 2026, 14(3), 365; https://doi.org/10.3390/healthcare14030365 (registering DOI) - 31 Jan 2026

Abstract

Background/Objectives: Missed nursing care is a recognized indicator of nursing quality and safety, while caring is a foundational concept in nursing practice. Few studies have empirically examined their relationship. This scoping review aimed to map and synthesize existing evidence on the conceptualisation, [...] Read more.

Background/Objectives: Missed nursing care is a recognized indicator of nursing quality and safety, while caring is a foundational concept in nursing practice. Few studies have empirically examined their relationship. This scoping review aimed to map and synthesize existing evidence on the conceptualisation, measurement approaches, and empirical relationships between caring and missed nursing care. Methods: The review was conducted using JBI methodology, reported according to PRISMA-ScR guidelines, and was registered in the Open Science Framework. Literature was searched in PubMed, CINAHL Ultimate (EBSCOhost), MEDLINE (EBSCOhost), and Web of Science, with additional grey literature searches in ProQuest Dissertations & Theses and Google Scholar. The review included studies examining caring in relation to missed nursing care across any healthcare setting. All study designs were considered. Data were extracted using an extraction tool, developed based on JBI guidelines, and piloted. Data were analyzed descriptively, tabulated, and summarized narratively. Results: Five quantitative cross-sectional studies met the inclusion criteria, conducted between 2012 and 2024 in the Philippines and Slovenia. Caring was assessed using the Caring Behaviors Inventory, Caring Ability Inventory, or CARE-Q, while missed nursing care was measured using the MISSCARE Survey or the Missed Nursing Care Scale. Most studies used Watson’s Theory of Human Caring, Duffy’s Quality Caring Model, or the Missed Nursing Care Model as theoretical frameworks. Across studies, caring behaviours and caring ability were negatively associated with missed nursing care. Conclusions: Caring can function as a moral and relational ideal and as a measurable and actionable factor related to patient outcomes. However, the evidence base remains limited, with inconsistent theoretical foundations and a lack of experimental studies. Future research should adopt theory-based, experimental approaches with diverse samples to explore causal mechanisms and evaluate strategies that strengthen caring competence and caring organizational cultures. Full article

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

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15 pages, 912 KB

Open AccessArticle

Healthcare Costs and Mortality Trends of Elderly ICU Patients: Evidence from an Eight-Year Cohort Study in China

by Xiaohui Zhu, Meiping Wang, Yawei Guo and Li Jiang

Healthcare 2026, 14(3), 364; https://doi.org/10.3390/healthcare14030364 (registering DOI) - 31 Jan 2026

Abstract

Background/Objectives: Elderly patients represent a growing proportion of ICU admissions, raising concerns about outcomes and healthcare costs. Evidence from China remains limited, yet understanding cost and mortality patterns is critical for optimizing care in aging populations. Methods: We retrospectively analyzed 31,535 ICU patients [...] Read more.

Background/Objectives: Elderly patients represent a growing proportion of ICU admissions, raising concerns about outcomes and healthcare costs. Evidence from China remains limited, yet understanding cost and mortality patterns is critical for optimizing care in aging populations. Methods: We retrospectively analyzed 31,535 ICU patients admitted from 2014 to 2021. After 1:1:1 matching on severity, comorbidities, sex, and admission type, three groups were formed: elderly (≥80 years), older (65–79 years), and younger (16–64 years), with 3398 patients each. Costs were inflation-adjusted, and outcomes compared across groups with appropriate statistical models. Results: Elderly patients accounted for 11.5% of admissions, had the longest ICU stay (4.5 vs. 3.8 vs. 3.1 days, p < 0.001), and the highest ICU (11.5%) and hospital (13.5%) mortality. Among non-surgical patients, elderly incurred the lowest costs; however, surgery reversed this pattern, producing a 124% increase. Expenditures were mainly driven by drugs and consumables. From 2014 to 2021, consumables rose from 32.0% to 42.0% of total costs, whereas drug costs declined. Inflation-adjusted hospital costs remained stable over time, while mortality among elderly patients decreased significantly (19.5% in 2014 vs. 8.8% in 2021; OR 0.86 per year, p < 0.001). Conclusions: Elderly ICU patients demonstrate unique cost and outcome profiles. While non-surgical elderly patients are less costly, surgery substantially increases expenses. Mortality declined over time without a rise in real costs, suggesting improved efficiency of critical care. These findings support tailored resource allocation and policy planning for aging ICU populations. Full article

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21 pages, 746 KB

Open AccessArticle

Improving Hand Hygiene Compliance in a Resource-Limited ICU Using a Low-Cost Multimodal Quality Improvement Intervention

by Sadia Qazi, Muhammad Amir Khan, Athar Ud Din, Naimat Saleem, Eshal Atif and Muhammad Atif Mazhar

Healthcare 2026, 14(3), 363; https://doi.org/10.3390/healthcare14030363 - 30 Jan 2026

Abstract

Background/Objective: Hand hygiene is a cornerstone of infection prevention; however, compliance is inconsistent in intensive care units (ICUs), particularly in resource-constrained settings. This study evaluated whether a low-cost, multimodal quality improvement intervention could improve process-level hand hygiene compliance using routine, episode-based audits embedded [...] Read more.

Background/Objective: Hand hygiene is a cornerstone of infection prevention; however, compliance is inconsistent in intensive care units (ICUs), particularly in resource-constrained settings. This study evaluated whether a low-cost, multimodal quality improvement intervention could improve process-level hand hygiene compliance using routine, episode-based audits embedded in the ICU practice. Methods: We conducted a single-cycle Plan-Do-Study-Act quality improvement project in a 12-bed mixed medical–surgical ICU in Pakistan (December 2023–January 2024). Hand hygiene performance was assessed using the unit’s routine weekly episode-based audit protocol, aligned with the WHO Five Moments framework. A targeted multimodal intervention comprising education, point-of-care visual reminders, audit feedback, and leadership engagement was implemented between the pre- and post-intervention phases (four weeks each). Non-applicable moments were scored as “compliant by default” according to the institutional protocol. A sensitivity analysis was performed excluding these moments to calculate pure adherence. Compliance proportions were summarized using exact 95% Clopper–Pearson confidence intervals without inferential testing. Results: A total of 942 audit episodes (471 per phase) generated 4710 moment-level assessments were generated. Composite hand hygiene compliance increased from 63.1% pre-intervention to 82.0% post-intervention [absolute increase: 18.9 percentage points (pp)]. Sensitivity analysis excluding non-applicable moments demonstrated pure adherence improvement from 54.2% to 82.5% (+28.3 pp), confirming a genuine behavioral change rather than a measurement artifact. Compliance improved across all five WHO moments, with the largest gains in awareness-dependent moments targeted by the intervention: before touching the patient (+27.0 pp) and after touching patient surroundings (+40.0 pp). Week-by-week compliance remained stable within both phases, without immediate post-intervention decay. Conclusions: A pragmatic, low-cost multimodal intervention embedded in routine ICU workflows was associated with substantial short-term improvements in hand hygiene compliance over a four-week observation period, particularly for awareness-dependent behaviors. Episode-based audit systems can support directional process monitoring in resource-limited critical care settings without the need for electronic surveillance. However, its long-term sustainability beyond one month and generalizability to other settings remain unknown. Sensitivity analyses are essential when using “compliant by default” scoring to distinguish adherence patterns from measurement artifacts. Full article

(This article belongs to the Special Issue Innovative Approaches in Preventing and Controlling Healthcare-Associated Infections: Emerging Challenges in Nursing Care)

16 pages, 380 KB

Open AccessArticle

Comparative Analysis of Oral Bacterial Profiles in Parkinson’s Disease According to Periodontal Status: A Clinical Case Series

by Dragoș Nicolae Ciongaru, Silviu Mirel Piţuru, Stana Păunică, Marina Cristina Giurgiu, Ioana Bujdei-Tebeică and Anca-Silvia Dumitriu

Healthcare 2026, 14(3), 362; https://doi.org/10.3390/healthcare14030362 - 30 Jan 2026

Abstract

Introduction: Parkinson’s disease can influence oral health by impairing motor function and altering salivary composition, potentially affecting the oral microbiome. Materials and Methods: The objectives of this study are fourfold: (a) to compare the prevalence of bacterial species associated with periodontal disease in [...] Read more.

Introduction: Parkinson’s disease can influence oral health by impairing motor function and altering salivary composition, potentially affecting the oral microbiome. Materials and Methods: The objectives of this study are fourfold: (a) to compare the prevalence of bacterial species associated with periodontal disease in patients with and without Parkinson’s disease (PD), (b) to assess whether the coexistence of periodontal disease in PD patients contributes to an imbalance in the oral microbiome, (c) to evaluate the correlation between periodontal clinical indices (plaque index, tartar index, bleeding index, and probing depth) and the concentrations of specific periodontopathogenic bacterial species, and (d) to explore the potential implications of these evidences for clinical management and preventive strategies in Parkinson’s patients. The main objective of this study is to compare periodontal clinical indices (plaque index, tartar index, bleeding index, and probing depth) and the bacterial profile of patients with periodontal and Parknson’s disease. Two groups were included: 15 patients with periodontal disease (control group) and 16 patients with both periodontal and Parkinson’s disease (study group). Microbial samples were collected from the periodontal pockets at baseline and analyzed using the Polymerase Chain Reaction (PCR) Perio-Ident 12 kit to detect major periodontal pathogens. Results: Periodontal indices showed no statistically significant differences between groups, although the study group presented lower mean tartar index (49.31% vs. 67.4%, p = 0.069), bleeding on probing (44.31% vs. 56.67%, p = 0.137), and plaque index (66% vs. 68.93%, p = 0.754). Median bacterial loads were generally higher in control group, with Tannerella forsythia, but without statistically significant difference (p = 0.072). Significant correlations between plaque index and multiple pathogens occurred only in control gorup, suggesting disrupted plaque–pathogen dynamics (p < 0.05). Conclusions: The results highlight the potential value of integrating clinical and microbiological assessment when managing periodontal disease in patients with Parkinson’s disease. Full article

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

14 pages, 699 KB

Open AccessArticle

The Influence of Preoperative Oral Carbohydrate Administration on the Perioperative Period in Children and Adolescents After Orthopedic Procedures—A Pilot Study

by Iwona Zaporowska-Bugajewska, Tomasz Mazurek, Szymon Wałejko, Justyna Napora and Wioletta Mędrzycka-Dąbrowska

Healthcare 2026, 14(3), 361; https://doi.org/10.3390/healthcare14030361 - 30 Jan 2026

Abstract

Background: Preoperative fasting is one of the most difficult stages of hospitalization for children and their caregivers. The popularization of preoperative oral polycarbohydrate preparations is an important element influencing the comfort of hospitalized children. The aim of the study was to assess the [...] Read more.

Background: Preoperative fasting is one of the most difficult stages of hospitalization for children and their caregivers. The popularization of preoperative oral polycarbohydrate preparations is an important element influencing the comfort of hospitalized children. The aim of the study was to assess the effect of carbohydrate administration on perioperative blood glucose (PBG), the occurrence of complications in the pre- and postoperative periods, and satisfaction in children and adolescents. Material and methods The study was a comparative-observational one, and the following research methods were used: an author’s diagnostic questionnaire, observation, and analysis of medical documentation. The research group consisted of 50 patients from the Pediatric Orthopedic Department who received an oral polycarbohydrate solution up to 2 h before anesthesia. The control group consisted of 50 patients who fasted for more than 6 h before anesthesia. The study was conducted between February and May 2024. Results: The patients were assessed using a measurement of venous blood glucose taken immediately before the administration of premedication. Parents completed a questionnaire regarding their child’s perioperative period. Conclusions: The glucose level in patients who received a polycarbohydrate preparation is higher than in children who did not. The administration of polycarbohydrate preparations influences the feeling of thirst and hunger in the postoperative period in children and adolescents. Oral administration of a polycarbohydrate preparation up to 2 h before anesthesia does not cause regurgitation in children and adolescents. Patients who received an oral polycarbohydrate preparation tolerated the waiting period before anesthesia better. Preoperative fasting is, apart from the insertion of venous access, the most stressful situation for children and adolescents during hospitalization. The supply of oral polycarbohydrate preparations has a positive effect on pediatric patients in the perioperative period. Full article

16 pages, 530 KB

Open AccessArticle

Associations Between 24 h Movement Behaviours and Cognitive Abilities in Slovak Adolescents: A Cross-Sectional Study

by Beata Ruzbarska, Lenka Hnidkova, Mojmir Trebunak, Erika Chovanova, Dalibor Dzugas and Peter Kacur

Healthcare 2026, 14(3), 360; https://doi.org/10.3390/healthcare14030360 - 30 Jan 2026

Abstract

Background: Twenty-four-hour movement behaviours (physical activity, sedentary time, and sleep) may be associated with adolescent cognitive performance, but evidence from Central/Eastern Europe is limited. Methods: A total of 82 Slovak adolescents (15–19 years) completed tests of IQ, attention, and visual memory. Participants wore [...] Read more.

Background: Twenty-four-hour movement behaviours (physical activity, sedentary time, and sleep) may be associated with adolescent cognitive performance, but evidence from Central/Eastern Europe is limited. Methods: A total of 82 Slovak adolescents (15–19 years) completed tests of IQ, attention, and visual memory. Participants wore a wrist accelerometer 24/7 for seven consecutive days (processed in GGIR v3.0–3). Moderate-to-vigorous physical activity (MVPA), total sedentary time, and sleep duration were derived from accelerometry; physical activity was also self-reported using the Physical Activity Questionnaire for Adolescents (PAQ-A). Non-parametric tests and Spearman correlations were applied; sleep × MVPA interaction models (robust HC3 standard errors) were adjusted for age and sex. Results: MVPA was low (median 32.9 min/day; 11% met ≥60 min/day), while sedentary time was high (median 652.6 min/day). Associations between movement behaviours and cognition were generally small, and no sleep × MVPA interaction effects were observed. The PAQ-A overestimated device-based MVPA (mean bias +1.68 units; 95% limits of agreement +1.10 to +2.25), with greater overestimation in girls and older adolescents. Conclusions: In this convenience sample, 24 h movement patterns were suboptimal, and their associations with cognition were modest and exploratory. Larger longitudinal studies are needed to confirm these findings. Full article

(This article belongs to the Special Issue Physical Activity in Childhood and Adolescence: Preventing Health Risks Through Sport and Diagnosis)

21 pages, 525 KB

Open AccessReview

Care as a Central Concept: Dimensions, Inequalities and Challenges in Chronic Care in Contemporary Societies: A Narrative Review

by Dolores Torres-Enamorado and Rosa Casado-Mejía

Healthcare 2026, 14(3), 359; https://doi.org/10.3390/healthcare14030359 - 30 Jan 2026

Abstract

Background/Objective: Feminist theories and feminist economics have contributed to making visible the structural relevance of care work in sustaining capitalist societies and social reproduction, arguing that care must be addressed as a political phenomenon rather than a merely domestic issue. This perspective [...] Read more.

Background/Objective: Feminist theories and feminist economics have contributed to making visible the structural relevance of care work in sustaining capitalist societies and social reproduction, arguing that care must be addressed as a political phenomenon rather than a merely domestic issue. This perspective is particularly pertinent in contemporary healthcare, where chronic care represents one of the major public health challenges in a context of population ageing and increasing prevalence of chronic diseases. The aim is to contribute to a critical understanding that can support the development of public policies recognizing care as a fundamental pillar of socio-healthcare provision and as a matter of collective responsibility. Methods: A narrative literature review with a critical feminist approach was conducted using PubMed/MEDLINE, Scopus, and Web of Science. Results: A total of 299 records were identified, of which 30 studies were included following screening and eligibility assessment. Care is an essential element for sustaining life, although it has historically been rendered invisible, feminized, and relegated to the private sphere. Chronicity requires simultaneous consideration of the material dimension of care (as work), the subjective dimension (including emotional bonds and moral responsibility), and the political dimension (shaped by power relations). Global care chains reveal persistent inequalities related to gender, class, and race. Conclusions: Care is a structural, political, and transnational category that sustains life and healthcare systems. In the field of chronic care, the recognition, redistribution, and socialization of care are essential for achieving social justice and for safeguarding the dignity of both caregivers—predominantly women—and care recipients. Full article

(This article belongs to the Section Chronic Care)

12 pages, 1298 KB

Open AccessArticle

Risk-Adjusted Inpatient Falls as Indicators of Health System Performance During the COVID-19 Pandemic

by Masae Satoh, Toko Nakahori and Tomoko Shimada

Healthcare 2026, 14(3), 358; https://doi.org/10.3390/healthcare14030358 - 30 Jan 2026

Abstract

Background/Objectives: Inpatient falls are widely used patient safety indicators, yet their behavior under periods of large-scale health system stress remains insufficiently understood. This study aimed to evaluate whether risk-adjusted inpatient fall indicators can capture changes in hospital safety performance during such periods, using [...] Read more.

Background/Objectives: Inpatient falls are widely used patient safety indicators, yet their behavior under periods of large-scale health system stress remains insufficiently understood. This study aimed to evaluate whether risk-adjusted inpatient fall indicators can capture changes in hospital safety performance during such periods, using a prolonged system disruption as an empirical context. The study period was a priori divided into three phases (pre-pandemic, initial pandemic, and later pandemic) according to changes in COVID-19 admission burden and system stress intensity. Methods: We conducted a retrospective observational time-series analysis using daily inpatient fall events and census data from a Japanese acute care hospital between December 2018 and March 2023 (50,140 inpatients; 962 falls). Expected fall rates were estimated using a validated pre-disruption prediction model, and observed/expected (O/E) ratios were calculated to assess risk-adjusted safety performance. Ordinary least squares regression models adjusted for calendar month and seasonal Fourier terms were used to examine temporal associations between fall outcomes and indicators of hospital-level system burden. Results: Both observed and expected fall rates increased during the study period, whereas O/E ratios declined only in the later phase, indicating improvement in risk-adjusted safety performance despite rising intrinsic patient risk. Seasonal patterns in fall outcomes were disrupted during the early phase of system stress but re-emerged over time. Associations between system burden indicators and fall outcomes were most pronounced in the early phase and attenuated in later phases. Conclusions: Risk-adjusted monitoring of inpatient falls provides insight into dynamic changes in hospital safety performance during periods of large-scale system stress and subsequent adaptation. This indicator can also be interpreted as a benchmarking scale for future month-to-month and seasonal safety surveillance beyond crisis contexts. Full article

(This article belongs to the Special Issue Fall Prevention and Geriatric Nursing)

14 pages, 623 KB

Open AccessArticle

Demographic and Clinical Correlates of Quality of Life Domains in Spinal Cord Injury

by Monika Zackova, Paola Rucci, Golcin Maknouni, Simona Udriste, Emanuele Salvatori and Maria Cristina Pirazzoli

Healthcare 2026, 14(3), 357; https://doi.org/10.3390/healthcare14030357 - 30 Jan 2026

Abstract

Background/Objectives: In patients with spinal cord injury (SCI), quality of life (QoL) is increasingly recognized as an important indicator of their ability to sustain both the rehabilitation process and post-rehabilitation community reintegration, and it plays a crucial role in prognosis. The primary purpose [...] Read more.

Background/Objectives: In patients with spinal cord injury (SCI), quality of life (QoL) is increasingly recognized as an important indicator of their ability to sustain both the rehabilitation process and post-rehabilitation community reintegration, and it plays a crucial role in prognosis. The primary purpose of this study was to identify the demographic and clinical correlates of different QoL domains as perceived by patients hospitalized after SCI. Methods: We conducted a cross-sectional study on a single day in the units of the Montecatone Rehabilitation Institute (MRI), the largest Italian center for intensive rehabilitation of individuals with SCI. We administered the World Health Organization Quality of Life–Short Version (WHOQOL-BREF), which consists of 26 items rated on a five-point Likert scale. Study participants included 88 adults with SCI; a total of 74% were male, with a mean age of 53.3 years (SD = 15.05). The lesion was traumatic in 74% of cases and complete in 59%. Physical health showed a weak negative association with age (r = −0.213, p = 0.05), whereas social QoL demonstrated a significant positive association with age (r = 0.215, p = 0.046). Psychological QoL was significantly lower in females compared with males (46.9 vs. 55.1, p < 0.05) and in patients living alone compared with those not living alone (46.1 vs. 54.6, p < 0.05). Conclusions: Clinicians should consider routine assessment of QoL to personalize post-discharge therapeutic plans and to implement targeted interventions aimed at improving outcomes in patients with SCI. Full article

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

24 pages, 2979 KB

Open AccessArticle

Machine Learning Prediction of ICU Mortality and Length of Stay in Atrial Fibrillation: A MIMIC-IV/MIMIC-III Study

by Victoria Nguyen and Rahul Mittal

Healthcare 2026, 14(3), 356; https://doi.org/10.3390/healthcare14030356 - 30 Jan 2026

Abstract

Background: Atrial fibrillation (AF) is common among intensive care unit (ICU) patients and is associated with increased mortality, prolonged length of stay (LOS), and greater resource utilization. Widely used AF risk scores were developed for stable outpatient populations and have limited applicability [...] Read more.

Background: Atrial fibrillation (AF) is common among intensive care unit (ICU) patients and is associated with increased mortality, prolonged length of stay (LOS), and greater resource utilization. Widely used AF risk scores were developed for stable outpatient populations and have limited applicability in critically ill patients. This study aimed to (1) characterize ICU patients with AF, (2) develop and temporally externally validate machine learning models to predict ICU mortality and ICU LOS, and (3) identify early clinical factors associated with these outcomes using interpretable methods. Methods: Adult ICU patients with AF from MIMIC-IV (n = 20,058) were used for model development with grouped cross-validation, and MIMIC-III (n = 11,475) served as a temporal external validation cohort. Predictors included demographics, admission characteristics, vital signs, laboratory values, vasoactive support, and AF-related medications available within the first 24 h of ICU admission. Eight classification algorithms were evaluated for ICU mortality, and six regression algorithms were evaluated for ICU LOS. Discrimination was primarily assessed using the area under the receiver operating characteristic curve (AUC) and average precision (AP), with additional threshold-dependent metrics reported to characterize operating-point behavior under low event prevalence. Probability-threshold optimization using out-of-fold predictions was applied to the primary mortality model. LOS performance was evaluated using mean absolute error (MAE), root mean squared error (RMSE), and the coefficient of determination (R²). Model interpretability was assessed using SHapley Additive exPlanations (SHAP). Results: The median age was 75 years, and ICU mortality was 8.9%. For mortality prediction, the XGBoost model demonstrated preserved discrimination on temporal external validation (MIMIC-III) (AUC = 0.743; AP = 0.226). At the default probability threshold (0.50), recall and F1 scores were low due to low event prevalence; applying a prespecified F1-optimized threshold derived from the development cohort improved sensitivity while maintaining overall discrimination. For ICU LOS, models explained little variance on temporal validation; LightGBM performed best, but the explained variance was low (MAE = 88.9 h; RMSE = 163.9 h; R² = 0.038), indicating that the first 24-h structured data provide an insufficient signal to accurately predict ICU LOS, likely due to downstream clinical and operational factors. SHAP analysis identified clinically plausible predictors of mortality and prolonged ICU stay, including reduced urine output, renal dysfunction, metabolic derangement, hypoxemia, early vasopressor use, advanced age, and admission pathways. Full article

(This article belongs to the Section Artificial Intelligence in Healthcare)

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17 pages, 512 KB

Open AccessReview

Research Trends and Gaps in Human Papillomavirus Vaccination Intention in South Korea: A Scoping Review

by Jiyeon Bark, Haejin Kim and Soyoung Seo

Healthcare 2026, 14(3), 355; https://doi.org/10.3390/healthcare14030355 - 30 Jan 2026

Abstract

Background/Objectives: Human papillomavirus (HPV) is a major cause of cervical, penile, anal, and oropharyngeal cancers. HPV vaccination is the most effective public health strategy for its prevention. Understanding the factors influencing vaccination intentions is critical for developing effective public health policies and improving [...] Read more.

Background/Objectives: Human papillomavirus (HPV) is a major cause of cervical, penile, anal, and oropharyngeal cancers. HPV vaccination is the most effective public health strategy for its prevention. Understanding the factors influencing vaccination intentions is critical for developing effective public health policies and improving population-level vaccine uptake. Therefore, in this scoping review, we aimed to examine HPV vaccination research conducted in Korea, identify common trends and gaps in study populations and influencing factors, and provide evidence-based recommendations for public health policies. Methods: We systematically searched four Korean databases—Research Information Sharing Service (RISS), DBpia, Korean Studies Information Service System (KISS), and National Digital Science Library (NDSL)—for studies published from their respective inception dates to January 2025, using “human papillomavirus,” “HPV,” “vaccination,” and “intention” as keywords. Thirty-six studies were ultimately included. Study characteristics, populations, theoretical frameworks, and key variables were extracted and analyzed using descriptive statistics and content analysis. Results: Of the included studies, 61.1% and 38.9% targeted vaccination-eligible individuals (adolescents and adults) and parents/guardians, respectively, with 50% focusing exclusively on women. The major factors influencing HPV vaccination intention were attitude (47.2%), subjective norms (38.9%), and perceived behavioral control (30.9%). Attitude and knowledge were critical for vaccination-eligible individuals (Direct group), whereas subjective norms were key for parents/guardians (Indirect group). Conclusions: Korean HPV vaccination intention research has predominantly focused on women and parents, with insufficient attention to adolescents and men. Public health strategies must employ multilevel interventions tailored to each group’s decision-making structures, including school-based programs for adolescents, gender-inclusive policies for men, and community-based approaches to address social norms among parents. These findings provide evidence for policy development aligned with the WHO cervical cancer elimination goals. Full article

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

19 pages, 301 KB

Open AccessArticle

Exploring the Immigrant Health Paradox Among the Vietnamese Population in the United States

by Tran Nguyen, Gia-Thien Nguyen, Raymond Chong and Yoon-Ho Seol

Healthcare 2026, 14(3), 354; https://doi.org/10.3390/healthcare14030354 - 30 Jan 2026

Abstract

Background: The term immigrant health paradox describes how immigrants often have better health outcomes than their American-born counterparts. While existing literature treats this phenomenon as broadly generalizable, emerging research indicates that its expression varies across cultural and migration contexts. Understanding how the [...] Read more.

Background: The term immigrant health paradox describes how immigrants often have better health outcomes than their American-born counterparts. While existing literature treats this phenomenon as broadly generalizable, emerging research indicates that its expression varies across cultural and migration contexts. Understanding how the immigrant health paradox may appear across specific ethnic groups requires research that maps variation rather than assumes uniformity. Objectives: This study seeks to describe patterns, explore variation by nativity, and identify factors associated with well-being among the Vietnamese population in the United States (US). By focusing on descriptive trends and contextual influences, the study aims to generate new insights into how the paradox may manifest—or diverge—in the Vietnamese context. Methods: We conducted an online survey asking participants about their depressive disorders, physical and mental health status, demographics, socioeconomic status, social networks, and experiences with daily discrimination. Descriptive statistics were used to describe the study sample. Linear regression and ordinal logistic regression were performed to explore the relationships. Results: In this exploratory analysis, we did not observe indications of the Vietnamese immigrant health paradox. Material factors, especially perceptions of financial needs, as well as psychological factors, were somewhat associated with how Vietnamese people living in the US assess their health. Conclusions: The absence of the Vietnamese immigrant health paradox in the US underscores the need for nuanced health models that reflect diversity within immigrant groups. Their experiences reveal how migration histories, structural barriers, and racialization shape health outcomes in ways that differ from expectations. Full article

(This article belongs to the Special Issue Healthcare for Migrants and Minorities)

20 pages, 3191 KB

Open AccessArticle

Investigating the Feasibility, Usability, and Efficacy of a Mobile App to Reduce Anxiety and Depression in Families of Critical Care Cancer Patients: A Quasi-Experimental Pilot Study

by Anthony Faiola, Saira Soroya, Reinhold Munker, Zhonglin Hao and Joshua Lambert

Healthcare 2026, 14(3), 353; https://doi.org/10.3390/healthcare14030353 - 30 Jan 2026

Abstract

Background: Cancer patients admitted to the bone marrow transplant (BMT) unit face life-threatening medical conditions. Consequently, their family members experience uncertainty, resulting in high levels of anxiety and depression (AD). Limited updates and communication from medical staff exacerbate these emotional burdens. To [...] Read more.

Background: Cancer patients admitted to the bone marrow transplant (BMT) unit face life-threatening medical conditions. Consequently, their family members experience uncertainty, resulting in high levels of anxiety and depression (AD). Limited updates and communication from medical staff exacerbate these emotional burdens. To address these challenges, we developed a mobile health (mHealth) intervention, FamCarePlus, and evaluated its feasibility, usability, and efficacy. We hypothesized that the FamCarePlus application would demonstrate a high degree of feasibility and usability and would reduce AD compared to a control group relying solely on traditional communication through the nurses’ station. Methods: We employed a quasi-experimental pretest/posttest non-randomized, non-blinded self-report design over 3 weeks, with an experimental group (n = 10) using FamCarePlus and a control group (n = 9). We selected participants via convenience sampling using the electronic medical record to identify eligible patients and families, guided by inclusion and exclusion criteria. We used descriptive statistics and the Hospital Anxiety and Depression Scale (HADS) guidelines to analyze the data. Feasibility was defined by a retention rate > 80%, with usability testing using the System Usability Scale (SUS) and NASA Task Load Index (NASA-TLX) surveys. The HADS measured AD, comparing baseline to Week 3. Results: We met our feasibility criteria of >80%. All SUS and NASA scores were in the higher index, suggesting a significant degree of usability and low workload demand on participants. For efficacy, we compared baseline mean scores, with the experimental group reporting lower AD levels at Week 1 (41.9% and 27.8%, respectively) than the control group (55.2% and 34.2%, respectively). From Week 1 to Week 3, the percentage change showed an 8.6% decrease in anxiety in the experimental group, compared to a 12.8% decrease in anxiety in the control group. These results were consistent when analyzed according to HADS guidelines. Conclusions: The findings of this study provide preliminary evidence that the FamCarePlus intervention is feasible and usable, while also demonstrating that its use may be associated with a sustained reduction in AD levels among family members of patients admitted to the BMT unit. These outcomes underscore the potential of digital interventions to address disparities in patient health information access and psychosocial support. Full article

(This article belongs to the Topic Digital Patient Care: Bridging Technology and Clinical Practice)

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17 pages, 9887 KB

Open AccessArticle

Implementation of an Intervention Program Based on Virtual Walking and Therapeutic Exercise in Cuba: A Feasibility Study

by Noemí Moreno-Segura, Sara Mollà-Casanova, Elena Muñoz-Gómez, Héctor González-Pons and Marta Inglés

Healthcare 2026, 14(3), 352; https://doi.org/10.3390/healthcare14030352 - 30 Jan 2026

Abstract

Background/Objectives: This article presents the feasibility and preliminary outcomes of an international cooperation project between the University of Valencia (Spain) and the University and health authorities of Pinar del Río (Cuba), designed to implement and evaluate an innovative rehabilitation protocol. Aligned with [...] Read more.

Background/Objectives: This article presents the feasibility and preliminary outcomes of an international cooperation project between the University of Valencia (Spain) and the University and health authorities of Pinar del Río (Cuba), designed to implement and evaluate an innovative rehabilitation protocol. Aligned with the United Nations Sustainable Development Goals (SDGs 3, 4, and 10), the initiative aims to implement a low-cost, evidence-based rehabilitation program combining mirror-neuron stimulation via Virtual Walking and therapeutic exercise. Methods: The program included multidisciplinary meetings and both digital and on-site training for healthcare professionals, caregivers, and educators, aimed at strengthening local capacities in evidence-based practice. The transferred protocol consisted of Virtual Walking (10 min) and therapeutic exercise (30 min), implemented three times per week, for eight weeks. Outcomes assessed included gait speed and endurance (10-Minute Walking Test, 6-Minute Walking Test), lower limb function (Timed Up and Go Test), frailty status (Fried criteria), pain (Visual Analog Scale), and satisfaction with the training program. Pre-post comparisons were conducted using the Wilcoxon signed-rank test for continuous data. Results: The program was successfully implemented in two polyclinics with high levels of participant satisfaction. Eleven patients completed the program, showing significant improvements in gait endurance (p < 0.05), while lower limb function and pain did not change significantly. Noteworthily, severe infrastructural and connectivity limitations were found. Overall, results demonstrate the feasibility, adaptability, and acceptability of the proposed protocol, which integrates technological innovation, clinical training, and community engagement to promote health quality and equity. Conclusions: This project provides a replicable framework for rehabilitation initiatives in low-resource settings and demonstrates the potential to achieve meaningful clinical results. Full article

(This article belongs to the Section Healthcare and Sustainability)

23 pages, 495 KB

Open AccessSystematic Review

Psychosocial Aspects of Cystic Fibrosis: A Mixed-Methods Systematic Review

by Maria Inês Griff, Rita Santos, Carmen Trumello and Tânia Brandão

Healthcare 2026, 14(3), 351; https://doi.org/10.3390/healthcare14030351 - 30 Jan 2026

Abstract

Background/Objectives: Cystic fibrosis (CF) is a genetic condition with an increasing life expectancy in recent years. As a result, addressing psychosocial aspects in this population has become an increasingly important concern. This mixed-methods systematic review aimed to update the current knowledge on [...] Read more.

Background/Objectives: Cystic fibrosis (CF) is a genetic condition with an increasing life expectancy in recent years. As a result, addressing psychosocial aspects in this population has become an increasingly important concern. This mixed-methods systematic review aimed to update the current knowledge on the psychosocial aspects of living with CF in adults. Methods: Following PRISMA guidelines, a literature search was conducted in November 2024 across several databases, including Scopus, ScienceDirect, Academic Search Complete, MEDLINE, Supplemental Index, Complementary Index, APA PsycInfo, Business Source Complete, SciELO, and the Directory of Open Access Journals via EBSCO. Results: Of the 701 articles retrieved, 24 were analyzed, including a total of 2023 participants (mean age: 31.2 years; 57.2% female). Quantitative findings identified optimistic coping as the most frequent strategy associated with improved survival. High social support and gratitude emerged as key factors for treatment adherence and quality of life, while depression remained the primary mental health concern. Qualitatively, the findings highlighted concerns with adult life transitions and financial stressors. Participants described experiences of social stigma and embarrassment linked to chronic symptoms, often leading to selective disclosure to avoid discrimination. Conclusions: This review confirms that psychosocial factors are central to the adult CF experience, shifting the focus beyond biological survival and highlighting areas that require clinical intervention. As life expectancy increases, clinical care must evolve to incorporate interventions that address these factors to improve mental health and overall quality of life (QoL), ensuring that patients are supported through the unique challenges of extended adulthood. Full article

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

17 pages, 2212 KB

Open AccessProject Report

Implementing a Community-Centered Approach to Gestational Diabetes Screening in Rural Guatemala: A Process Report

by Victoria Rabello Kras, Sasha Hernandez, Concepción Damián Chicajau, Josefa Damián Coquix, Rachel Siretskiy and Jessica Oliveira

Healthcare 2026, 14(3), 350; https://doi.org/10.3390/healthcare14030350 - 30 Jan 2026

Abstract

Introduction: Gestational diabetes (GD) screening remains limited in many low- and middle-income countries (LMICs) due to resource constraints, limited training, and low community awareness. Although community-centered approaches may improve access to screening in rural and Indigenous settings, the implementation processes through which such [...] Read more.

Introduction: Gestational diabetes (GD) screening remains limited in many low- and middle-income countries (LMICs) due to resource constraints, limited training, and low community awareness. Although community-centered approaches may improve access to screening in rural and Indigenous settings, the implementation processes through which such approaches are designed and operationalized are rarely documented. Methods: This study presents a community-based implementation process report describing the development, adaptation, and early implementation of a GD screening program in rural Guatemala, guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation science framework. Using a participatory approach, international screening guidelines were systematically adapted to the local context through iterative protocol refinement, structured stakeholder engagement, and ongoing feedback from community health educators and partner institutions. Aggregate program data were used descriptively to characterize early screening uptake and feasibility. Results: Key implementation challenges included patient no-shows, community skepticism, and difficulties among health educators in interpreting screening procedures. Iterative adaptations were introduced to simplify protocols, reduce loss to follow-up, and strengthen community engagement. Over time, the program expanded from point-of-care screening to more comprehensive prenatal services and increased collaboration with the Ministry of Health and local community outlets. A total of 103 Indigenous Mayan Tz’utujil women were screened (mean age: 26.9 years; range: 15–46), of whom, 12 were diagnosed with GD. Conclusions: This implementation process report demonstrates the scientific value of systematically documenting real-world adaptation, feasibility, and stakeholder engagement when introducing GD screening in rural Indigenous LMIC settings. The implementation lessons described may inform similar maternal health initiatives in comparable contexts. Full article

(This article belongs to the Section Healthcare Organizations, Systems, and Providers)

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