Healthcare

26 pages, 502 KB

Open AccessSystematic Review

Mental Health and Mental Health Care in Iran: Addressing Social Inequalities

by Saeid Zandi, Farnoosh Oghani-Esfahani, Fereshteh Ahmadi, Roqayyeh Sabbaghi-Dehkalani and Sharareh Akhavan

Healthcare 2025, 13(23), 3131; https://doi.org/10.3390/healthcare13233131 (registering DOI) - 1 Dec 2025

Abstract

Background/Objectives: Iran carries a significant burden of mental health disorders. This study aimed to describe the status of mental health and mental health care in Iran between 2012 and 2023, addressing inequalities and mapping existing challenges in the mental health care system. [...] Read more.

Background/Objectives: Iran carries a significant burden of mental health disorders. This study aimed to describe the status of mental health and mental health care in Iran between 2012 and 2023, addressing inequalities and mapping existing challenges in the mental health care system. Methods: A systematic literature review was conducted. Databases including Medline, CINAHL, APA PsycINFO, Scopus, Web of Science, and the Cochrane Library, as well as local databases such as SID, Magiran, and Noormags, were searched to identify studies related to mental health care in Iran. A total of 59 studies met the inclusion criteria. An inductive approach and thematic analysis were used to synthesize themes from the data. Results: Lower socioeconomic status (SES) was associated with higher rates of mental disorders due to poverty-related stressors and limited access to quality care. Gender disparities revealed that women are more vulnerable to mental health problems, exacerbated by perceived gender inequality. Ethnic minorities and undocumented migrant populations faced inadequate healthcare services, resulting in poorer mental health outcomes. Children and older adults also experienced mental health challenges influenced by sociodemographic factors. The main challenge for mental health care is establishing mechanisms to ensure more equitable access for all citizens. Additional challenges include limited awareness among policymakers, insufficient budget allocation, weak prevention programs, and poor intra- and inter-sectoral coordination and collaboration. A shortage of mental health care providers, as well as deficiencies in structure, system processes, and resources, further hinder progress. Conclusions: Socioeconomic factors exacerbate the challenges of Iran’s under-resourced mental health system. To address these issues, equity considerations must be integrated into mental health policies. Key interventions include the routine monitoring of mental health indicators, expanding insurance coverage for mental health services, and establishing dedicated services for children. Full article

(This article belongs to the Special Issue Mental Health Syndemics Among Underserved Communities)

22 pages, 614 KB

Open AccessReview

Parental/Guardian–Child Physical Activity in Relation to Racial/Ethnic Inequities in the Americas: A Scoping Review

by Melquesedek Ferreira da Silva Almeida, João Antônio Chula de Castro, Andressa Ferreira da Silva and Diego Augusto Santos Silva

Healthcare 2025, 13(23), 3130; https://doi.org/10.3390/healthcare13233130 (registering DOI) - 1 Dec 2025

Abstract

Background/Objectives:This study mapped parent/guardian–child physical activity (PA) inequities across racial and ethnic groups in the Americas. Method: A systematic scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) and the Joanna [...] Read more.

Background/Objectives:This study mapped parent/guardian–child physical activity (PA) inequities across racial and ethnic groups in the Americas. Method: A systematic scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs Institute guidelines. Searches were carried out in January 2025 in the following databases: SciELO, LILACS, Web of Science, MEDLINE, EMBASE, Scopus, Web of Science, SPORTDiscus, and PsycINFO. Eligible studies were original articles that jointly assessed parents/guardians and children from diverse racial and ethnic backgrounds. Results: 4195 articles were found, and a total of 25 studies were included (cross-sectional design n = 20). Among these, 18 studies reported that higher parental/guardian PA was associated with greater child PA, regardless of race and ethnic background. Only seven studies provided explicit race and ethnic comparisons (six cross-sectional and one cohort). In four studies Black/African American parents/guardians and children were less physically active than their White counterparts; one study of Latino families showed lower participation in sports compared with African Americans; in one study Hispanic, African American, and Asian families had lower odds of engaging in PA compared with White peers; and one study of African American and Mexican American families reported lower participation in non-competitive individual sports than Anglo families. Conclusions: This review demonstrates consistent associations between parental/guardian and child PA, although a few studies reported null or inverse findings. Moreover, racial and ethnic inequalities in intergenerational PA reflect broader structural health inequities, where access to time, space, and resources for movement remains unevenly distributed. Full article

29 pages, 1530 KB

Open AccessArticle

High-Velocity, Accentuated Eccentric, or Maximal Elastic Band Resistance Training? Effects of Resistance Training Modalities on Bone Health, Isokinetic Strength, and Systemic Biomarkers in Sedentary Older Adults: A Comparative Study

by Angel Saez-Berlanga, Javier Gene-Morales, Ana María Teixeira, Ruth Jiménez-Castuera, Andrés Gené-Sampedro, Alvaro Juesas, Pedro Gargallo, Oscar Caballero, Julio Fernandez-Garrido, Carlos Alix-Fages, Pablo Jiménez-Martínez and Juan C. Colado

Healthcare 2025, 13(23), 3129; https://doi.org/10.3390/healthcare13233129 (registering DOI) - 1 Dec 2025

Abstract

Objectives: To examine three elastic band resistance training (EB-RT) modalities—high-velocity (HVRT), accentuated eccentric (Aecc), and maximal strength (Max)—on bone health, strength, redox-inflammatory profile, and neuroplasticity in sedentary older adults. Methods: Sixty-one participants (69.41 ± 4.61 years) were randomly assigned to HVRT [...] Read more.

Objectives: To examine three elastic band resistance training (EB-RT) modalities—high-velocity (HVRT), accentuated eccentric (Aecc), and maximal strength (Max)—on bone health, strength, redox-inflammatory profile, and neuroplasticity in sedentary older adults. Methods: Sixty-one participants (69.41 ± 4.61 years) were randomly assigned to HVRT (n = 21), Aecc (n = 13), Max (n = 10), or passive controls (n = 17). Training was conducted three times a week for 16 weeks. Sessions included four sets of alternating upper- and lower-limb EB exercises, with intensity guided by the OMNI–RES EB scale. HVRT emphasized explosive concentric actions [~70% one-repetition maximum (1RM); 3–4 rating of perceived exertion in the first repetition (RPE-1)]. Aecc performed 5 s eccentric overload [>100% 1RM; 7–8 RPE-1]. Max employed controlled 2 s concentric/eccentric actions [~80–85% 1RM; 7–8 RPE-1]. Results: All training groups improved isokinetic strength (p < 0.01, g = 0.91–2.40). HVRT increased brain-derived neurotrophic factor (BDNF) (p = 0.019, g = 0.42) and glutathione peroxidase (GPx) (p < 0.001, g = 0.31). Aecc elicited the strongest osteoanabolic and antioxidant effects (P1NP, p = 0.001, g = 1.21; β-CTX, p < 0.001, g = 1.82; F2-isoprostanes, p = 0.007, g = 0.94). Max induced moderate bone turnover benefits (P1NP, p = 0.005, g = 1.08; β-CTX, p < 0.001, g = 1.12), but no GPx or BDNF gains. Controls maintained or declined all variables. Conclusions: EB-RT over 16 weeks improved most outcomes overall, showing modality-specific trends: HVRT favored neuroplasticity, Aecc enhanced redox-inflammatory and bone remodeling responses, and Max improved strength and bone health. These findings support elastic band resistance training as a safe and individualized strategy for healthy aging. Full article

(This article belongs to the Special Issue Exercise Therapy: Improving Functionality, Physical Health, and Quality of Life)

19 pages, 1745 KB

Open AccessArticle

Paths of Suicidal Ideation Identification and Suicidal Behavior Intervention: A Qualitative Comparative Analysis of Chinese Young People

by Yaping Xin, Xuanyuan Chen and Dan Li

Healthcare 2025, 13(23), 3128; https://doi.org/10.3390/healthcare13233128 (registering DOI) - 1 Dec 2025

Abstract

Objective: This study examines pathways for suicide ideation identification and suicidal behavior intervention among Chinese young adults. Methods: It used qualitative comparative analysis (QCA) to analyze the cases of 47 Chinese young people (aged 18–28) with suicidal experiences. The outcome variables are suicide [...] Read more.

Objective: This study examines pathways for suicide ideation identification and suicidal behavior intervention among Chinese young adults. Methods: It used qualitative comparative analysis (QCA) to analyze the cases of 47 Chinese young people (aged 18–28) with suicidal experiences. The outcome variables are suicide ideation identification and suicidal behavior intervention, and condition variables include psychological disorders, suicidal history, suicidal communication, suicidal time, suicidal location, suicidal methods, family support, peer support, and school support. Results: There are two successful identification pathways and five effective intervention pathways, contrasted with four failed identification pathways and one failed intervention pattern. These results reveal that continuous supervision of individuals with psychological disorders and multi-group participation in intervention are important to decrease the suicide risk of Chinese young people. Meanwhile, a lack of proactive identification of individuals without warning signals, insufficient attention from families and communities to young people with psychological disorders, and inadequate physical limitations on fatal suicidal behaviors are major risk factors. Conclusions: This study highlights the measures of strengthening continuous attention to suicide signals among high-risk youth groups, limiting lethal suicide methods, promoting network monitoring and suicide risk warning, increasing psychological services in the community, and improving the collaborative synergy of peers, families, and schools. Full article

(This article belongs to the Special Issue Promoting Mental Health in School and Community Settings)

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16 pages, 1302 KB

Open AccessProtocol

Lion Hearts: Using the Intervention Mapping Framework to Develop a Family-Based CrossFit Program for Health Behavior Change

by Janette Watkins, Janelle Goss, Kelton Mehls, Deirdre Dlugonski and Danielle Symons Downs

Healthcare 2025, 13(23), 3127; https://doi.org/10.3390/healthcare13233127 (registering DOI) - 1 Dec 2025

Abstract

Background/Objectives: Physical inactivity and sedentary lifestyles remain leading behavioral risk factors for chronic disease across generations. Mothers with young children face unique barriers to exercise, including time constraints, fatigue, and limited access to supportive environments. Lion Hearts was developed to address these barriers [...] Read more.

Background/Objectives: Physical inactivity and sedentary lifestyles remain leading behavioral risk factors for chronic disease across generations. Mothers with young children face unique barriers to exercise, including time constraints, fatigue, and limited access to supportive environments. Lion Hearts was developed to address these barriers through a family-centered, community-based approach that integrates physical activity, strength training, and health education. This protocol describes the systematic application of the Intervention Mapping (IM) framework to develop Lion Hearts, a multigenerational CrossFit-based program for mothers and children. Methods: Following the first four steps of the IM framework—needs assessment, matrices, intervention design, and program creation—behavioral determinants were identified through literature review, national data, and community input. The resulting 12-week program integrates twice-weekly family CrossFit sessions, monthly cardiovascular health workshops, and weekly home-based challenges delivered through local affiliates using a train-the-trainer model. Results: IM produced a theoretically grounded and evidence-based intervention targeting individual (self-efficacy, outcome expectations), interpersonal (modeling, relatedness), and environmental (access, social support) determinants. The process resulted in detailed logic models, behavior change matrices, and implementation materials, including family handbooks and coach guides. Conclusions:Lion Hearts represents a scalable, multigenerational approach to CVD prevention that leverages existing community fitness infrastructure. By embedding prevention within family systems and CrossFit affiliates, the program offers a sustainable, replicable model to enhance physical activity, strengthen family health behaviors, and reduce intergenerational CVD risk. Full article

(This article belongs to the Special Issue Innovative Exercise-Based Approaches for Chronic Condition Management)

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39 pages, 1291 KB

Open AccessArticle

Multivariate Patterns in Mental Health Burden and Psychiatric Resource Allocation in Europe: A Principal Component Analysis

by Andrian Țîbîrnă, Floris Petru Iliuta, Mihnea Costin Manea and Mirela Manea

Healthcare 2025, 13(23), 3126; https://doi.org/10.3390/healthcare13233126 (registering DOI) - 1 Dec 2025

Abstract

Introduction: In recent decades, the burden of mental disorders has become a major determinant of population health in the European Union, generating profound clinical, socioeconomic, and institutional consequences. Despite political recognition of this silent crisis, substantial methodological challenges persist in the transnational monitoring [...] Read more.

Introduction: In recent decades, the burden of mental disorders has become a major determinant of population health in the European Union, generating profound clinical, socioeconomic, and institutional consequences. Despite political recognition of this silent crisis, substantial methodological challenges persist in the transnational monitoring of mental health and in linking disease burden with the resources allocated to address it. The present analysis develops a multivariate taxonomy of EU Member States from a psychosocial perspective, using an integrative quantitative approach. Methods: This cross-sectional, comparative study follows international standards for transparent and reproducible quantitative reporting and is based on 18 harmonized clinical, epidemiological, and institutional indicators collected for 27 EU Member States over the period 2014–2023. The indicators used in this study were grouped according to their position along the care continuum. Hospital-based indicators refer to inpatient activity and institutional capacity, including total hospital discharges, psychiatric admissions (affective disorders, schizophrenia, dementia, alcohol- and drug-related disorders), and hospital bed availability. Outpatient and community-level indicators reflect the capacity of systems to provide non-hospital psychiatric care and consist primarily of psychiatrist density and total specialist medical workforce. Finally, subjective perception indicators capture population-level self-assessed health status, complementing clinical and institutional measures by integrating a psychosocial perspective. After harmonization and standardization, Principal Component Analysis (PCA) with Varimax rotation was applied to identify latent dimensions of mental health. Model adequacy was confirmed using the Kaiser–Meyer–Olkin coefficient (0.747) and Bartlett’s test of sphericity (p < 0.001). Results: Three latent dimensions explaining 77.7% of the total variance were identified: (1) institutionalized psychiatric burden, (2) functional capacity of the health care system, and (3) suicidal vulnerability associated with problematic substance use. Standardized factor scores allowed for the classification of Member States, revealing distinct patterns of psychosocial risk. For example, Germany and France display profiles marked by high levels of institutionalized psychiatric activity, while the Baltic and Southeast European countries exhibit elevated suicidal vulnerability in the context of limited medical resources. These results highlight the deep heterogeneity of psychiatric configurations in Europe and reveal persistent gaps between population needs and institutional response capacity. Conclusions: The analysis provides an empirical foundation for differentiated public policies aimed at prevention, early intervention, and stigma reduction. It also supports the case for institutionalizing a European mental health monitoring system based on harmonized indicators and common assessment standards. Overall, the findings clarify the underlying structure of mental health across the European Union and underscore the need for coherent, evidence-based strategies to reduce inequalities and strengthen system performance at the continental level. Full article

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

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20 pages, 312 KB

Open AccessArticle

Addressing Sexual Violence Against Persons with Disabilities in Belgium

by Elizaveta Fomenko, Lotte De Schrijver, Anne Nobels and Ines Keygnaert

Healthcare 2025, 13(23), 3125; https://doi.org/10.3390/healthcare13233125 (registering DOI) - 1 Dec 2025

Abstract

Background/Objectives: This study examined the specific vulnerabilities and experiences of persons with disabilities (PwDs) regarding sexual violence (SV) in Belgium. Methods: Data were drawn from the nationally representative UN-MENAMAIS survey (n = 4944), which included adults aged 16–99 years. SV was [...] Read more.

Background/Objectives: This study examined the specific vulnerabilities and experiences of persons with disabilities (PwDs) regarding sexual violence (SV) in Belgium. Methods: Data were drawn from the nationally representative UN-MENAMAIS survey (n = 4944), which included adults aged 16–99 years. SV was assessed using behaviourally specific questions based on validated international instruments. Logistic regression analyses examined associations between SV, disability status, sociodemographic, and mental health indicators. Results: PwDs reported a significantly higher lifetime prevalence of hands-on SV (37.8%) compared with those without disabilities (29.4%; p < 0.001, V = 0.065). PwDs also reported lower quality of life (p < 0.001, V = 0.273), and higher rates of depression (p < 0.001, V = 0.214), anxiety (p < 0.001, V = 0.145), PTSD (p < 0.001, V = 0.101), sedative use (p < 0.001, V = 0.237), and suicide attempts (p < 0.001, V = 0.124), though they reported less hazardous alcohol use (p < 0.001, V = 0.103) and cannabis use (p < 0.001, V = 0.080). Regression analyses showed that individuals assigned female at birth (p < 0.001) and those identifying as LGB+ (p < 0.001) were at a higher risk of both hands-off and hands-on SV. Among mental health correlates, depression, anxiety, PTSD, substance use, self-harm, and suicide attempts were significantly (all p < 0.001) associated with increased odds of SV. Conclusions: The findings highlight the need for targeted, inclusive prevention and support strategies addressing structural inequalities, ableism, and barriers to care to effectively prevent SV and revictimization among PwDs. Full article

(This article belongs to the Special Issue Research on Health Disparities in the Global Population)

18 pages, 581 KB

Open AccessArticle

Gender and Social Stratification in Active Aging: Inequalities in Sport Participation and Subjective Health Among Older Adults in South Korea

by Su Yeon Roh and Ik Young Chang

Healthcare 2025, 13(23), 3124; https://doi.org/10.3390/healthcare13233124 (registering DOI) - 1 Dec 2025

Abstract

Background: As South Korea transitions into a super-aged society, promoting sport participation among older adults is increasingly vital for physical health, emotional well-being, and social inclusion. Objective: This study examines how the interplay between gender and social stratification influence sport participation [...] Read more.

Background: As South Korea transitions into a super-aged society, promoting sport participation among older adults is increasingly vital for physical health, emotional well-being, and social inclusion. Objective: This study examines how the interplay between gender and social stratification influence sport participation and health among South Koreans aged 60 and above. Methods: Using data from the 2024 Korea National Sports Participation Survey (n = 1779), this study employed Multiple Correspondence Analysis (MCA), cross-tabulation, and one-way ANOVA with Scheffé’s post hoc tests to examine differences in sport participation and health by gender and social stratification such as income, education, and occupation. Results: The analysis revealed significant differences in sport participation and subjective health outcomes by gender and social stratification. Among older men, sport participation varied strongly by socioeconomic status: higher-status men participated in golf, cycling, and bodybuilding, whereas those from lower strata mainly engaged in walking and gateball. In contrast, older women’s participation types were less stratified and more influenced by gender norms, with consistent involvement in walking, aerobics, yoga, and stretching. One-way ANOVA showed statistically significant differences (p < 0.001) in subjective health status and physical fitness by all socioeconomic variables for both genders. Conclusions: Older adults’ sport participation and health in South Korea are constrained by both socioeconomic inequality and entrenched gender norms. Promoting equitable active aging requires policies that both reduce socioeconomic barriers and challenge restrictive gender norms. Full article

(This article belongs to the Special Issue Exercise Science and Health Promotion)

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18 pages, 2125 KB

Open AccessArticle

Anthropometric and Metabolic Determinants of Multi-Organ Stress in Adults with Obesity: Application of the CaRaMeL-O Score

by Timea Claudia Ghitea, Mihaela Simona Popoviciu, Andrada Moldovan, Florica Ramona Dorobantu, Petru Cornel Domocos, Daniela Florina Trifan and Felicia Manole

Healthcare 2025, 13(23), 3123; https://doi.org/10.3390/healthcare13233123 (registering DOI) - 1 Dec 2025

Abstract

Background: Obesity represents a multisystemic disorder that extends beyond metabolic dysfunction, involving hepatic, renal, and cardiovascular axes. This study introduces the Cardio–Reno–Metabolic–Liver–Obesity (CaRaMeL-O) framework as an integrated tool to assess multi-organ metabolic stress in adults with obesity. Methods: In this cross-sectional study, 287 [...] Read more.

Background: Obesity represents a multisystemic disorder that extends beyond metabolic dysfunction, involving hepatic, renal, and cardiovascular axes. This study introduces the Cardio–Reno–Metabolic–Liver–Obesity (CaRaMeL-O) framework as an integrated tool to assess multi-organ metabolic stress in adults with obesity. Methods: In this cross-sectional study, 287 adults with obesity (mean BMI 35.1 ± 4.6 kg/m²) were evaluated. The CaRaMeL-O score (0–13 points) incorporated metabolic (TyG index), hepatic (FIB-4, transaminases), and renal (eGFR, UACR) parameters, as well as classical and lifestyle risk factors. Participants were stratified into low, moderate, and high risk categories. Group comparisons were conducted using ANOVA and Kruskal–Wallis tests, while multivariate regressions identified independent predictors of FIB-4 and eGFR. Distributional characteristics were further analyzed using Weibull modeling. Results: Higher CaRaMeL-O scores were associated with a progressive increase in TyG (p < 0.001) and FIB-4 (p < 0.001), while eGFR showed a mild, nonsignificant downward trend. In multivariate models, age was the strongest predictor of FIB-4 (β_std = 0.33), whereas age, FIB-4, BMI, blood pressure, and UACR independently predicted eGFR. TyG did not remain significant after full adjustment. Weibull analysis revealed distinct distributional profiles, with TyG showing a narrow, homogeneous curve and FIB-4 and eGFR broader, right-skewed patterns. Conclusions: The CaRaMeL-O framework effectively captures inter-organ metabolic stress, demonstrating that hepatic and metabolic alterations precede overt renal decline. This integrated score may support early stratification and targeted prevention in obesity-related cardio-metabolic risk. Full article

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12 pages, 231 KB

Open AccessArticle

Body Positivity and Eating Behaviors Among Women Attending Fitness Classes: Associations with Body Mass Index

by Martyna Kłoda, Monika Marszołek, Wiktoria Staśkiewicz-Bartecka, Sylwia Jaruga-Sękowska and Małgorzata Magdalena Michalczyk

Healthcare 2025, 13(23), 3122; https://doi.org/10.3390/healthcare13233122 (registering DOI) - 1 Dec 2025

Abstract

Background: Body positivity is a social movement aimed at promoting acceptance and appreciation of diverse body types. Despite its growing popularity, its relationship with eating behaviors and body mass index (BMI) remains unclear. This study aimed to investigate the opinions of women [...] Read more.

Background: Body positivity is a social movement aimed at promoting acceptance and appreciation of diverse body types. Despite its growing popularity, its relationship with eating behaviors and body mass index (BMI) remains unclear. This study aimed to investigate the opinions of women attending fitness classes on the body positivity movement and to assess the association between these attitudes, eating behaviors, and BMI. Methods: A total of 118 women aged 18–65 years participated in the study. Data were collected using a self-developed body positivity questionnaire and the validated Polish version of the Three-Factor Eating Questionnaire (TFEQ-13). Participants were stratified into two groups based on BMI (<25 and ≥25 kg/m²). Results: No significant association was found between general attitudes toward body positivity and either eating behaviors or BMI. However, a positive correlation was observed between BMI and emotional eating as well as cognitive restraint. Women with higher BMI demonstrated greater cognitive restraint and tendencies toward emotional eating. Body acceptance was significantly lower in women with BMIs ≥ 25. Conclusions: While general attitudes toward the body positivity movement do not appear to influence eating behaviors directly, body weight is linked to both emotional eating and cognitive restraint. These findings underscore the complex relationship between psychological factors, eating patterns, and body image, suggesting the need for further research and tailored interventions promoting both health and self-acceptance. Full article

(This article belongs to the Special Issue The Relationship Between Diet Quality, Physical Activity, and Mental and Physical Health Status)

16 pages, 251 KB

Open AccessArticle

AI-Based Assessment of Non-Technical Skills in Prehospital Simulations: A Comparative Validation Study

by Masanori Mitsuhashi, Yumika Akiba, Misato Saitou, Kensuke Suzuki, Satoo Ogawa and Tomohiko Masuno

Healthcare 2025, 13(23), 3121; https://doi.org/10.3390/healthcare13233121 (registering DOI) - 1 Dec 2025

Abstract

Background/Objectives: Assessing non-technical skills (NTSs) in prehospital care is susceptible to rater subjectivity. While Artificial Intelligence (AI) can be used to score conversation transcripts, it emphasizes formal linguistic features, whereas humans integrate scene context, leading to potentially divergent evaluations. We examined the [...] Read more.

Background/Objectives: Assessing non-technical skills (NTSs) in prehospital care is susceptible to rater subjectivity. While Artificial Intelligence (AI) can be used to score conversation transcripts, it emphasizes formal linguistic features, whereas humans integrate scene context, leading to potentially divergent evaluations. We examined the validity of NTS assessments generated by AI (ChatGPT-4o) from prehospital simulation data by comparing them with ratings from paramedic faculty. We hypothesized that AI-based ratings would provide evaluations of team NTSs that are comparable to faculty ratings and would enable us to describe the direction and magnitude of score differences between AI and faculty across the five NTS domains. Methods: Sixty-four first-year paramedic students performed 5 min prehospital scenarios. Five NTS domains were scored independently by AI and faculty using a three-level rubric (5, 3, or 1 point per domain): (i) communication and interpersonal manner, (ii) order and completeness of information gathering, (iii) detail of follow-up questioning, (iv) context-appropriate actions, and (v) time management. Score differences were analyzed with Wilcoxon signed-rank tests with Holm correction and Bayes factors (BF10). Agreement was quantified with weighted Gwet’s agreement coefficient 2 (AC2). Results: Three domains—communication, context-appropriate actions, and time management—showed significant differences (p < 0.001), with strong evidence for differences (BF10 > 22); median differences favored AI. Evidence of a difference was insufficient for the other two domains. Across all domains, agreement remained below the prespecified substantial threshold (AC2 ≥ 0.60). The primary hypothesis was not supported. Conclusions: In prehospital simulations, AI-only NTS assessment is not yet an adequate substitute for human raters. Although AI evaluates linguistic aspects, its agreement with expert ratings was insufficient. Future work should evaluate hybrid approaches leveraging the strengths of both AI and human judgment. Full article

23 pages, 372 KB

Open AccessSystematic Review

Therapeutic Benefits of Robotics and Exoskeletons for Gait and Postural Balance Among Children and Adolescents with Cerebral Palsy: An Overview of Systematic Reviews

by Amal Alharbi, Shouq S. Alhosaini, Shahad S. Alrakebeh and Saleh M. Aloraini

Healthcare 2025, 13(23), 3120; https://doi.org/10.3390/healthcare13233120 (registering DOI) - 1 Dec 2025

Abstract

Background/Objectives: Robotic therapies are emerging as a potential management strategy for individuals with cerebral palsy (CP). These devices apply mechanical and electrical forces to regulate neural excitability and promote motor learning. This review aimed to systematically assess and synthesize evidence from published systematic [...] Read more.

Background/Objectives: Robotic therapies are emerging as a potential management strategy for individuals with cerebral palsy (CP). These devices apply mechanical and electrical forces to regulate neural excitability and promote motor learning. This review aimed to systematically assess and synthesize evidence from published systematic reviews and meta-analyses on the therapeutic benefits of robotics and exoskeletons for gait and postural balance in pediatric CP. Methods: A comprehensive search of PubMed, CINAHL, Scopus, and The Cochrane Library was conducted. Two independent reviewers screened records to identify studies that were: (1) written in English and published in peer-reviewed journals; (2) included participants <18 years with a diagnosis of CP; and (3) examined robotic therapies or exoskeletons targeting gait or postural balance. Methodological quality of included reviews was appraised with the Assessment of Multiple Systematic Reviews (AMSTAR) tool, and certainty of evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework. Results: 18 systematic reviews met the inclusion criteria, encompassing 256 primary studies and 5092 participants. Overall methodological quality of the included reviews was rated as moderate to good. A variety of robotic and exoskeleton systems were noted across studies, with heterogeneous protocols and outcomes. Several reviews reported modest improvements in gait and postural balance; however, the findings were inconsistent, and pooled effects, where available, did not yield definitive conclusions regarding efficacy. Conclusions: Robotic and exoskeleton interventions may offer benefits for gait and postural balance in children and adolescents with CP, but the current evidence base remains inconclusive. Additional high-quality research is required to determine effectiveness more definitively. Full article

(This article belongs to the Special Issue Assistive Technologies, Robotics, and Automated Machines in the Health Domain: Third Edition)

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26 pages, 349 KB

Open AccessArticle

Homophobic Bullying Among Adolescents: Prevalence, Associations with Emotional Factors, Psychopathological Symptoms, and Predictors

by Maite Garaigordobil, Juan Pablo Mollo-Torrico and Mónica Rodríguez-Enríquez

Healthcare 2025, 13(23), 3119; https://doi.org/10.3390/healthcare13233119 (registering DOI) - 1 Dec 2025

Abstract

Background/Objectives: Despite progress in recognizing sexual diversity, homophobic bullying persists. This study had four objectives: (1) to identify the prevalence of homophobic bullying (victims, perpetrators, and bystanders); (2) to explore whether differences exist between victims and perpetrators as a function of sexual [...] Read more.

Background/Objectives: Despite progress in recognizing sexual diversity, homophobic bullying persists. This study had four objectives: (1) to identify the prevalence of homophobic bullying (victims, perpetrators, and bystanders); (2) to explore whether differences exist between victims and perpetrators as a function of sexual orientation with respect to emotional factors and psychopathological symptoms; (3) to analyze whether victims and perpetrators of homophobic bullying have sought psychological assistance significantly more often; and (4) to identify predictive variables of victimization and perpetration of homophobic bullying. Methods: The sample comprised 1558 Bolivian students aged 13 to 17 years (M = 14.64; SD = 0.96), who completed six standardized assessment instruments. Results: (1) A substantial percentage of students reported homophobic bullying behaviors. Victims: 76.6% reported experiencing homophobic behaviors, with significantly higher rates among non-heterosexual students (χ² = 7.40, p < 0.01) and no gender differences (χ² = 0.013, p > 0.05). Perpetrators: 11.8% admitted engaging in homophobic aggressive behaviors, with no differences by sexual orientation (χ² = 0.306, p > 0.05) but significantly higher rates among males (χ² = 8.49, p < 0.01). Bystanders: 51.9% reported witnessing homophobic behaviors, with significantly higher prevalence among non-heterosexual students (χ² = 7.03, p < 0.01) and females (χ² = 4.98, p < 0.05). (2) Analyses of variance showed that non-heterosexual victims scored significantly lower on emotional regulation, empathic joy, overall empathy, and happiness, and significantly higher on fear of negative social evaluation, overall social anxiety, all psychopathological symptom dimensions assessed (somatization, obsession–compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism), and the global severity index. Non-heterosexual perpetrators also displayed significantly higher scores on several psychopathological symptoms (depression, anxiety, hostility, paranoid ideation, psychoticism) and on the global severity index. Effect sizes were moderate for psychopathological symptoms and small for emotional variables. (3) Victims (OR = 1.392, 95% CI [1.04, 1.86], p = 0.024) and perpetrators (OR = 1.507, 95% CI [1.07, 2.10], p = 0.017) of homophobic bullying reported significantly higher rates of seeking psychological assistance in the past year compared to those uninvolved in bullying. (4) Hierarchical regression analyses identified significant predictors of victimization (R² = 18.6%): non-heterosexual orientation, male gender, higher somatization, paranoid ideation, fear of negative evaluation, and lower happiness. For perpetration, only being male and higher levels of phobic anxiety emerged as significant predictors in the final model, explaining 5.1% of the variance. Conclusions: The findings underscore the urgency of implementing school-based psychoeducational anti-bullying prevention programs that include activities designed to foster tolerance toward sexual diversity. Full article

(This article belongs to the Special Issue Bias-Based Bullying and Child and Adolescent Health)

15 pages, 1611 KB

Open AccessArticle

Perception Versus Actual Weight: Body Image Dissatisfaction as a Stronger Correlate of Anxiety and Depression than BMI Among Romanian Health Sciences Students

by Catalin Pleșea-Condratovici, Vlad Dionisie, Lavina-Alexandra Moroianu, Petrut-Stefan Serban, Victor Plesea-Condratovici and Manuela Arbune

Healthcare 2025, 13(23), 3118; https://doi.org/10.3390/healthcare13233118 (registering DOI) - 1 Dec 2025

Abstract

Background: The high prevalence of anxiety and depression among young adults constitutes a significant public health concern, with body image identified as a key psychological factor. However, the interplay between subjective metrics (perceived body image) and objective measures (Body Mass Index) remains [...] Read more.

Background: The high prevalence of anxiety and depression among young adults constitutes a significant public health concern, with body image identified as a key psychological factor. However, the interplay between subjective metrics (perceived body image) and objective measures (Body Mass Index) remains insufficiently explored within specific populations, such as health sciences students in Eastern Europe. Methods: An observational, cross-sectional study was conducted on a sample of 137 medical and nursing students from a Romanian university. Validated instruments were employed: the Hospital Anxiety and Depression Scale (HADS) and the Eating Disorder Examination Questionnaire (EDE-Q). BMI was calculated from self-reported height and weight. Spearman’s correlation analyses and Mann–Whitney U tests were performed. Results: Subjective body image concerns, particularly those related to shape, weight, and eating, were found to be positively and significantly correlated with symptoms of anxiety and depression (all p < 0.05). In contrast, BMI exhibited no significant correlation with either of the HADS subscales. Although nursing students presented a higher mean BMI, no significant differences were recorded between the student groups with respect to psychological symptoms or body image concerns. Conclusions: Subjective dissatisfaction with body image is a more salient correlate of emotional distress than objective body mass in this cohort. Although the sample size was moderate, the observed associations were robust and statistically significant, underscoring the importance of subjective body image over objective metrics such as BMI in this academic population. These findings underscore the necessity for mental health interventions within university settings to focus on the perceptual and cognitive-affective aspects of body image, rather than exclusively on weight management. Full article

(This article belongs to the Special Issue Body Image, Dissatisfaction and Eating Disorders: A Healthcare Perspective)

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17 pages, 473 KB

Open AccessArticle

Psychometric Validation of the Arabic FRAIL Scale for Frailty Assessment Among Older Adults with Colorectal Cancer

by Mohammed T. A. Omar, Bader Nasser M. Alamri, Ahmed Mohammed Mesfer, Majed Hassan Al-Malki, Ahmed Allehebi, Zizi M. Ibrahim and Rehab F. M. Gwada

Healthcare 2025, 13(23), 3117; https://doi.org/10.3390/healthcare13233117 (registering DOI) - 1 Dec 2025

Abstract

Background/Objective: Culturally adapted frailty screening tools are essential for improving health outcomes, facilitating clinical decision-making, promoting effective care planning, and ensuring accurate frailty assessment across diverse cultural contexts; their use among clinicians and academics is therefore supported. The purpose of this study was [...] Read more.

Background/Objective: Culturally adapted frailty screening tools are essential for improving health outcomes, facilitating clinical decision-making, promoting effective care planning, and ensuring accurate frailty assessment across diverse cultural contexts; their use among clinicians and academics is therefore supported. The purpose of this study was to assess internal consistency, test–retest reliability, and validity of the Arabic FRAIL scale (FRAIL-AR scale) for Arabic-speaking populations with colorectal cancer (CRC). Methods: This cross-sectional study included 137 participants diagnosed with CRC who completed the FRAIL-AR scale, the EORTC QLQ-C30 physical function subscale, and functional performance-based Timed Up and Go (TUG) and Five Times Sit-to-Stand (5xSTS) tasks. Internal consistency was assessed using Kuder–Richardson formula 20 (KR-20), and test–retest reliability was determined using the two-way random intraclass correlation coefficient ICC _(2.1). Convergent validity was evaluated by assessing the correlation between the FRAIL-AR scale against the EORTC QLQ-C30 physical function scale, TUG, and 5xSTS. Results: The FRAIL-AR scale exhibited good internal consistency (KR-20 = 0.80) and test–retest reliability (ICC _(2.1) = 0.89, 95% CI 0.77–0.94). Correlation analysis showed a weak negative correlation between the overall FRAIL-AR scale scores and EORTC QLQ-C30 physical function scale scores (r = −0.38, p < 0.05), while it exhibited a moderate positive correlation with TUG (r = 0.75, p < 0.01) and 5xSTS (r = 0.63, p < 0.01) scores. FRAIL-AR scores showed significant known-groups validity with higher frailty scores in older-age individuals (p < 0.01), females (p < 0.05), and those with comorbid conditions (≥5) (p < 0.05). Conclusion: The FRAIL-AR scale’s validity and reliability make it an appropriate tool for geriatricians, oncologists, and healthcare providers to evaluate and monitor frailty among Arabic-speaking colorectal cancer patients. Full article

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10 pages, 196 KB

Open AccessArticle

Do Patient-Important Outcomes Differ by Care Setting? Findings from Semi-Structured Interviews with Individuals with Diabetes

by Amy T. Cunningham, Alexzandra T. Gentsch, Pouya Arefi, Judd E. Hollander, Marianna D. LaNoue, Amanda M. B. Doty, Geoffrey D. Mills, Brendan Carr and Kristin L. Rising

Healthcare 2025, 13(23), 3116; https://doi.org/10.3390/healthcare13233116 (registering DOI) - 1 Dec 2025

Abstract

Background: Patient-important outcomes (PIOs) reflect patient values and preferences. Prior studies have elicited a variety of PIOs for diabetes. However, no studies have examined whether, or how, PIOs differ across diabetes care settings. The purpose of this study was to compare the frequencies [...] Read more.

Background: Patient-important outcomes (PIOs) reflect patient values and preferences. Prior studies have elicited a variety of PIOs for diabetes. However, no studies have examined whether, or how, PIOs differ across diabetes care settings. The purpose of this study was to compare the frequencies of PIOs derived from patients with diabetes in primary care (PC), acute care (emergency department (ED)), and post-acute care (post-hospital discharge (PHD)) settings within a large delivery system. Methods: This study was an analysis of 89 interviews with patients in PC, ED, and PHD settings. Participants had moderately to poorly controlled diabetes, defined as follows: presented to the ED with a diabetes-related problem, admitted to the hospital for a diabetes-related problem, or had at least two primary care measurements of hemoglobin A1c (HbA1c) > 7.5 in the prior year. A matrix analysis compared the frequencies of participants’ PIOs across the three settings. Results: Overall PIO frequencies were similar across care settings. PIOs fell into seven domains; all seven domains and 21 of the 26 PIOs were represented within each of the care settings. The most common PIOs included “be healthy”, “eat right”, and “reduce or get off medicines”. Conclusions: Participants identified similar PIOs in all care settings, indicating that recruitment from one or two care settings may often be sufficient for achieving saturation of PIOs. Furthermore, the results inform our understanding of patient priorities across the care continuum. Full article

18 pages, 279 KB

Open AccessArticle

Exploring African Community Attitudes Towards Mental Illness in Australia: A Cross-Sectional Study

by Gihane Endrawes and Olayide Ogunsiji

Healthcare 2025, 13(23), 3115; https://doi.org/10.3390/healthcare13233115 (registering DOI) - 1 Dec 2025

Abstract

Background: Mental illness is often stigmatized across various cultural groups, yet there is limited understanding of African communities’ perceptions and beliefs regarding mental health. One reason for this disparity could be the lack of culturally appropriate tools to assess attitudes towards mental illness [...] Read more.

Background: Mental illness is often stigmatized across various cultural groups, yet there is limited understanding of African communities’ perceptions and beliefs regarding mental health. One reason for this disparity could be the lack of culturally appropriate tools to assess attitudes towards mental illness in African populations. This study aimed to evaluate the psychometric properties of the 40-item Community Attitudes towards the Mentally Ill (CAMI) scale within African communities in Australia. Design: This study employed a quantitative, cross-sectional, and descriptive approach, using a self-administered survey to assess the psychometric properties of the CAMI scale among African Australian individuals. Cronbach’s alpha was used to evaluate internal consistency. Method: A convenience sample of 110 individuals from various African community organizations in Australia was recruited. The original English version of the CAMI scale was used to assess attitudes towards mental illness. Results: Cronbach’s alpha for the overall scale was 0.717, indicating acceptable consistency. The Authoritarianism sub-scale had a lower reliability of 0.424, which is below the acceptable threshold of 0.70. The other sub-scales had a better internal consistency, with 0.730 for Benevolence, 0.724 for Ideology, and 0.627 for Social Restrictiveness, though the latter still lacked the ideal 0.70. Conclusions: The CAMI scale has been demonstrated to be a reliable and culturally appropriate tool for assessing African communities’ attitudes towards mental illness in Australia. By identifying negative attitudes, this tool can be used to inform health education and awareness programs that address misconceptions about mental illness. Such programs could encourage early health-seeking behaviors among migrants, facilitating early identification and intervention, and ultimately improving health outcomes by reducing the burden of mental illness. This study is significant as it provides a culturally appropriate tool to assess mental health attitudes in African communities, informing the development of appropriate strategies to promote early help-seeking behaviors and reduce stigma, thus improving mental health outcomes. Full article

11 pages, 2578 KB

Open AccessCase Report

Finger Joints Reconstructive Coverage with Cross-Arm (Colson) Flaps After Burn Injury: A Literature Review and Our Experience

by Ziyad Alharbi, Maysaa Alghamdi, Johannes Hertelendy, Khalid Khatib and Norbert Pallua

Healthcare 2025, 13(23), 3114; https://doi.org/10.3390/healthcare13233114 (registering DOI) - 1 Dec 2025

Abstract

Background: Random pattern flaps are widely used in reconstructive surgery when inadequate vascularity precludes skin graft survival or when regional pedicled flaps are unavailable due to local burn injury. Here, thin tissue from the upper arm was utilized to cover exposed cartilage over [...] Read more.

Background: Random pattern flaps are widely used in reconstructive surgery when inadequate vascularity precludes skin graft survival or when regional pedicled flaps are unavailable due to local burn injury. Here, thin tissue from the upper arm was utilized to cover exposed cartilage over the proximal interphalangeal (PIP) joints of the contralateral hand. Methods/Technical Note: We report the uncommon application of multiple cross-arm (Colson) flaps to reconstruct dorsal skin defects over the PIP joints of the index, middle, and ring fingers following a high-voltage burn injury, in conjunction with a comprehensive literature review. Results: Three separate random-pattern flaps were harvested from the upper arm and transferred to the contralateral hand. All flaps demonstrated good perfusion, durable coverage, and a clean wound bed postoperatively, with preservation of joint mobility. Conclusions: To our knowledge, this represents one of the first reported reconstructions of multiple adjacent PIP joints using individual cross-arm flaps. This technique remains a dependable salvage option that should be considered in complex reconstructive scenarios when local or microsurgical options are not feasible. Full article

(This article belongs to the Special Issue Dermatological Health and Skin Integrity: Multidisciplinary Rehabilitation Strategies for Optimal Care)

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13 pages, 655 KB

Open AccessArticle

Effect of Moderate-to-High-Intensity Interval Aerobic Exercise on Clinical Symptoms During the Menstrual Cycle: A Pilot Randomized Controlled Trial

by Alejandra Pio-Soria, Doaa Zahran and Alberto Roldán-Ruiz

Healthcare 2025, 13(23), 3113; https://doi.org/10.3390/healthcare13233113 (registering DOI) - 30 Nov 2025

Abstract

Introduction: Primary dysmenorrhea is one of the most prevalent gynecological disorders. It has been shown to negatively impact quality of life and overall wellbeing, as recent studies have associated stress and physical inactivity with both the onset and severity of menstrual pain. Objective: [...] Read more.

Introduction: Primary dysmenorrhea is one of the most prevalent gynecological disorders. It has been shown to negatively impact quality of life and overall wellbeing, as recent studies have associated stress and physical inactivity with both the onset and severity of menstrual pain. Objective: To analyze the effectiveness of a moderate-to-high-intensity interval aerobic exercise on menstrual pain intensity, menstrual-related quality of life, general health-related quality of life, sleep quality, stress and anxiety, and drug intake in young women with primary dysmenorrhea. Methodology: A total of 20 women were randomly allocated to either the exercise (N = 10) or control group (N = 10). Primary outcomes were menstrual pain intensity and menstrual-related quality of life. Secondary outcomes included general health-related quality of life, sleep quality, stress and anxiety, and drug intake. A supervised moderate-to-high-intensity interval aerobic exercise program on a stationary bicycle was carried out twice a week, for eight weeks, in young women with regular cycles and no diagnosed medical conditions. Patients were assessed at baseline, and at 1- and 2-month follow-ups. Results: At 8 weeks, 17 women completed the follow-up. Analyses showed statistically significant differences in favor of moderate-to-high-intensity interval aerobic exercise at 2-month follow-up for menstrual pain intensity, with a large size effect. Significant changes were also found in menstrual-related quality of life at both follow-ups in the exercise group, but they were not superior to the control group. No significant changes were observed for the rest of the variables in either group. Conclusions: The results from this pilot study suggest that the moderate-to-high-intensity interval aerobic exercise program is effective in reducing menstrual pain intensity at 2-month follow-ups. Future randomized controlled trials with larger samples are required to confirm the results. Full article

(This article belongs to the Special Issue Advancing Health Through a Multidisciplinary Lens: Integrating Exercise, Nutrition and Pain Management)

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