Healthcare

18 pages, 498 KB

Open AccessArticle

Translation, Cross-Cultural Adaptation, and Psychometric Properties of the Arabic Version of the MOS Pain Effect Scale in Individuals with Multiple Sclerosis

by Alaa M. Albishi, Zainab S. Alshammari, Sarah S. Almhawas, Dalia M. Alimam, Manal H. Alosaimi and Salman Aljarallah

Healthcare 2026, 14(3), 285; https://doi.org/10.3390/healthcare14030285 (registering DOI) - 23 Jan 2026

Abstract

Purpose: This study aimed to translate the Pain Effects Scale (PES) into Arabic, evaluate its cultural adaptation, and assess its psychometric properties (validity and reliability) among patients with Multiple Sclerosis (MS). Method: The translation and cultural adaptation followed published guidelines. A [...] Read more.

Purpose: This study aimed to translate the Pain Effects Scale (PES) into Arabic, evaluate its cultural adaptation, and assess its psychometric properties (validity and reliability) among patients with Multiple Sclerosis (MS). Method: The translation and cultural adaptation followed published guidelines. A total of 121 patients with MS completed the PES and several other assessments: the Short-Form McGill Pain Questionnaire (SF-MPQ), the Patient Health Questionnaire-9 (PHQ-9), the Modified Fatigue Impact Scale (MFIS), and the Multiple Sclerosis Impact Scale (MSIS-29), to evaluate construct validity. Reliability was assessed after two weeks using the intraclass correlation coefficient (ICC) and internal consistency (Cronbach’s α). Results: The Arabic version of Pain Effects Scale PES-Ar demonstrated good internal consistency (Cronbach’s α = 0.910) and strong test–retest reliability (ICC (2,1) = 0.88; 95% CI: 0.85–0.92). The corrected item–total correlations for all six items ranged from 0.591 to 0.840. No floor or ceiling effects were observed. Content validity indices were high (I-CVI and S-CVI = 1.00). Construct validity was supported by moderate correlations with PHQ-9 (r = 0.677), MFIS (r = 0.66), and SF-MPQ (r = 0.586), and a weak correlation with the MSIS-29. Conclusions: The PES-Ar showed strong validity and reliability for assessing the impact of pain in Arabic-speaking individuals with MS in Saudi Arabia. Full article

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12 pages, 549 KB

Open AccessArticle

A Structural Equation Modeling Approach to the Moderating Effect of Psychological Well-Being on Burnout and Depressive Symptoms Among Mental Health Professionals

by Fatih Bal, Hale A. Kahyaoğlu Çakmakci, İpek Okkay, Gülşen Filazoğlu Çokluk and Melek Süler

Healthcare 2026, 14(2), 284; https://doi.org/10.3390/healthcare14020284 (registering DOI) - 22 Jan 2026

Abstract

Background/Objectives: This study investigates whether psychological well-being moderates the relationship between burnout and depressive symptoms among mental health professionals, who are frequently exposed to high emotional labor. Methods: A sample of 607 professionals—including psychologists, guidance counselors, social workers, and psychiatrists—working in public and [...] Read more.

Background/Objectives: This study investigates whether psychological well-being moderates the relationship between burnout and depressive symptoms among mental health professionals, who are frequently exposed to high emotional labor. Methods: A sample of 607 professionals—including psychologists, guidance counselors, social workers, and psychiatrists—working in public and private institutions in Turkey participated in the study. Data were collected online using the Maslach Burnout Inventory, the Psychological Well-Being Scale, and the Beck Depression Inventory–II. A latent interaction term between burnout and psychological well-being was tested using Structural Equation Modeling (SEM). Results: Burnout was positively associated with depressive symptoms (β = 0.37, p < 0.001), and psychological well-being showed a significant main effect on depressive symptoms (β = 0.26, p < 0.001). Importantly, the interaction between burnout and psychological well-being was significant (β = 0.20, p < 0.001), indicating that psychological well-being significantly moderates the relationship between burnout and depressive symptoms. Specifically, the positive interaction suggests that the association between burnout and depressive symptoms becomes stronger at higher levels of psychological well-being. The model explained 27% of the variance in depressive symptoms. Conclusions: These findings highlight the protective role of psychological well-being and suggest that interventions aimed at enhancing well-being may help reduce depressive symptoms among mental health professionals in high-stress environments. Full article

(This article belongs to the Special Issue Psychological Well-Being and Coping in Healthcare Workplace Environments)

27 pages, 624 KB

Open AccessReview

Nutrition in Perinatal Midwifery Care: A Narrative Review of RCTs, Current Practices, and Future Directions

by Artemisia Kokkinari, Maria Dagla, Kleanthi Gourounti, Evangelia Antoniou, Nikoleta Tsinisizeli, Evangelos Tzamakos and Georgios Iatrakis

Healthcare 2026, 14(2), 283; https://doi.org/10.3390/healthcare14020283 (registering DOI) - 22 Jan 2026

Abstract

Background: Nutrition during the perinatal period, including pregnancy, childbirth, postpartum, and lactation, is a critical determinant of maternal and neonatal health. While the importance of balanced nutrition is well established, the integration of nutritional counseling into midwifery care remains inconsistent across settings. Evidence [...] Read more.

Background: Nutrition during the perinatal period, including pregnancy, childbirth, postpartum, and lactation, is a critical determinant of maternal and neonatal health. While the importance of balanced nutrition is well established, the integration of nutritional counseling into midwifery care remains inconsistent across settings. Evidence suggests that midwives are uniquely positioned to deliver nutrition-related support, yet gaps persist in their formal training and in the availability of structured guidance. These gaps are particularly evident in certain regions, such as Greece, where dedicated national guidelines for perinatal nutrition are lacking. Methods: This systematized narrative review synthesises evidence from studies published between 2010 and 2025, retrieved through PubMed, CINAHL, Scopus, and relevant national guidelines. Although the synthesis draws on diverse study designs to provide contextual depth, randomized controlled trials (RCTs) were prioritized and synthesized separately to evaluate the effectiveness of midwife-led interventions. In total, ten randomized controlled trials were included in the evidence synthesis, alongside additional observational and qualitative studies that informed the narrative analysis. Both international and Greek literature were examined to capture current practices, challenges, and knowledge gaps in the nutritional dimension of midwifery care. Results: Findings indicate that adequate intake of macronutrients and micronutrients, including iron, folic acid, vitamin D, iodine, calcium, and omega-3 fatty acids, is essential for optimal maternal and neonatal outcomes. Despite this, studies consistently report insufficient nutritional knowledge among midwives, limited confidence in providing counseling, and variability in clinical practice. Socio-cultural factors, such as dietary traditions and migration-related challenges, further influence nutritional behaviors and access to guidance. Emerging approaches, including e-health tools, group counseling models, and continuity-of-care frameworks, show promise in enhancing midwives’ capacity to integrate nutrition into perinatal care. Conclusion: Nutrition is a cornerstone of perinatal health, and midwives are strategically placed to address it. However, gaps in training, inconsistent guidelines, and cultural barriers limit the effectiveness of current practices. Strengthening midwifery education in nutrition, developing context-specific tools, and fostering interdisciplinary collaboration are essential steps toward more comprehensive and culturally sensitive perinatal care. Future research should focus on longitudinal and intervention studies that assess the impact of midwife-led nutritional counseling on maternal and neonatal outcomes. Full article

(This article belongs to the Section Healthcare and Sustainability)

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25 pages, 680 KB

Open AccessSystematic Review

A Systematic Review of Topic Modeling Techniques for Electronic Health Records

by Iqra Mehmood, Zoya Zahra, Sarah Iqbal, Ayman Qahmash and Ijaz Hussain

Healthcare 2026, 14(2), 282; https://doi.org/10.3390/healthcare14020282 (registering DOI) - 22 Jan 2026

Abstract

Background: Electronic Health Records (EHRs) are a rich source of clinical information used for patient monitoring, disease progression analysis, and treatment outcome assessment. However, their large-scale, heterogeneity, and temporal characteristics make them difficult to analyze. Topic modeling has emerged as an effective [...] Read more.

Background: Electronic Health Records (EHRs) are a rich source of clinical information used for patient monitoring, disease progression analysis, and treatment outcome assessment. However, their large-scale, heterogeneity, and temporal characteristics make them difficult to analyze. Topic modeling has emerged as an effective method to extract latent structures, detect disease characteristics, and trace patient trajectories in EHRs. Recent neural and transformer-based approaches such as BERTopic has significantly improved coherence, scalability, and domain adaptability compared to earlier probabilistic models. Methods: This Systematic Literature Review (SLR) examines topic modeling and its variants applied to EHR data over the past decade. We follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework to identify, screen, and select relevant studies. The reviewed techniques span traditional probabilistic models, neural embedding-based methods, and temporal extensions designed for pathway and sequence modeling in clinical data. Results: The synthesis covers trends in publication patterns, dataset usage, application domains, and methodological contributions. The reviewed literature demonstrates strengths across different modeling families, while also highlighting challenges related to scalability, interpretability, temporal complexity, and privacy when analyzing large-scale EHRs. Conclusions: Topic modeling continues to play a central role in understanding temporal patterns and latent structures in EHRs. This review also outlines future possibilities for integrating topic modeling with Agentic AI and large language models to enhance clinical decision-making. Overall, this SLR provides researchers and practitioners with a consolidated foundation on temporal topic modeling in EHRs and its potential to advance data-driven healthcare. Full article

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

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12 pages, 548 KB

Open AccessArticle

Symptomatic Outcomes After Autologous Fat Grafting in Irradiated Postmastectomy Chest Wall

by Razvan George Bogdan, Mara Nicolau, Alina Helgiu and Zorin Petrisor Crainiceanu

Healthcare 2026, 14(2), 281; https://doi.org/10.3390/healthcare14020281 (registering DOI) - 22 Jan 2026

Abstract

Background/Objectives: Radiotherapy of the chest wall after mastectomy frequently leads to fibrosis, reduced tissue elasticity, erythema, pain and chronic skin-related symptoms that complicate reconstructive strategies. Autologous fat grafting has been proposed as a regenerative option for radiation induced soft tissue damage, but clinical [...] Read more.

Background/Objectives: Radiotherapy of the chest wall after mastectomy frequently leads to fibrosis, reduced tissue elasticity, erythema, pain and chronic skin-related symptoms that complicate reconstructive strategies. Autologous fat grafting has been proposed as a regenerative option for radiation induced soft tissue damage, but clinical data focused on patient-reported symptoms remain limited. The objective of this study was to describe symptomatic and clinical changes after autologous fat grafting in irradiated postmastectomy chest wall tissue. Methods: This pilot observational study included five female patients with a history of mastectomy followed by adjuvant chest wall radiotherapy. All patients underwent a single session of standard autologous fat grafting without adipose derived stem cell enrichment. Patient-reported symptoms, including pruritus, local discomfort, burning sensation and erythema, were recorded preoperatively and at six months using a standardized 0 to 5 scale. Scar pliability was assessed by two experienced physicians using the same scale. Only descriptive statistical analysis was performed. Results: All patients demonstrated lower postoperative symptom scores at six months. Mean reductions were observed for erythema (71.4 percent), burning sensation (61.1 percent) and pruritus (57.1 percent). Local discomfort decreased by 33.3 percent. Mean scar pliability scores increased from 2.2 to 3.2. No postoperative complications, such as infection, fat necrosis or oil cyst formation, were recorded. All patients completed the six month follow up. Conclusions: In this small pilot observational study, autologous fat grafting was well tolerated and associated with descriptive improvement of patient-reported symptoms and scar pliability in irradiated postmastectomy chest wall tissue. These findings suggest a potential symptomatic benefit of fat grafting, while larger studies with objective imaging and histological correlation are required to confirm efficacy and durability. Full article

16 pages, 861 KB

Open AccessReview

Mirror Neurons and Pain: A Scoping Review of Experimental, Social, and Clinical Evidence

by Marco Cascella, Pierluigi Manchiaro, Franco Marinangeli, Cecilia Di Fabio, Giacomo Sollecchia, Alessandro Vittori and Valentina Cerrone

Healthcare 2026, 14(2), 280; https://doi.org/10.3390/healthcare14020280 (registering DOI) - 22 Jan 2026

Abstract

Background: The mirror neuron system (MNS) has been proposed as a key neural mechanism linking action perception, motor representation, and social cognition. This framework has increasingly been applied to pain research, encompassing pain empathy, observational learning of pain, and rehabilitative interventions such as [...] Read more.

Background: The mirror neuron system (MNS) has been proposed as a key neural mechanism linking action perception, motor representation, and social cognition. This framework has increasingly been applied to pain research, encompassing pain empathy, observational learning of pain, and rehabilitative interventions such as mirror therapy. However, the literature is conceptually heterogeneous, methodologically diverse, and spans experimental, social, and clinical domains. Objective: This scoping review aims to map the extent, nature, and characteristics of the available evidence on the relationship between the MNS and pain, clarifying how MNS-related mechanisms are defined, investigated, and applied across different contexts. Methods: A scoping review was conducted using the methodological framework proposed by the Joanna Briggs Institute and reported in accordance with PRISMA-ScR guidelines. We searched PubMed/MEDLINE, Scopus, Web of Science, and PsycINFO. Studies were included if they addressed MNS-related mechanisms in pain processing, pain empathy, pain modulation, or pain rehabilitation. Eligible studies were charted and synthesized descriptively and thematically. Results: Twenty-one studies met the inclusion criteria. The evidence was predominantly derived from clinical and rehabilitative settings, with most studies focusing on mirror therapy or mirror visual feedback interventions. The majority of included populations consisting of adults with chronic pain conditions, particularly phantom limb pain and complex regional pain syndrome. Pain intensity, assessed mainly through self-reported clinical scales, was the most frequently reported outcome. A smaller number of studies investigated action observation or motor imagery paradigms, primarily in chronic musculoskeletal pain, showing short-term hypoalgesic effects. Across studies, substantial heterogeneity was observed in the conceptualization of MNS-related constructs, intervention protocols, outcome measures, and follow-up duration. Conclusions: Despite extensive theoretical discussion of the MNS, empirical applications are largely confined to clinical mirror-based interventions, with limited use of direct neurophysiological or neuroimaging markers. Since crucial conceptual and methodological gaps constrain comparability and translation into clinical practice, there is a need for clearer operational definitions and more integrated experimental and clinical research approaches. Full article

(This article belongs to the Special Issue Management and Nursing Strategy for Patients with Pain)

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16 pages, 367 KB

Open AccessArticle

COVID-19’s Impact on Health Professionals’ Quality of Professional Life: A Single-Site Cross-Sectional Study

by Michael Rovithis, Sofia Koukouli, Anastasia Konstantinou, Maria Moudatsou, Nikos Rikos, Manolis Linardakis, Konstantinos Piliotis and Areti Stavropoulou

Healthcare 2026, 14(2), 279; https://doi.org/10.3390/healthcare14020279 (registering DOI) - 22 Jan 2026

Abstract

Background/Objectives: Professional quality of life influences patient care, staff well-being, and organizational efficacy. The COVID-19 pandemic placed pressure on healthcare professionals, disrupting their professional quality of life and imposing a psychological burden. In Greece, these issues were intensified by a decade of economic [...] Read more.

Background/Objectives: Professional quality of life influences patient care, staff well-being, and organizational efficacy. The COVID-19 pandemic placed pressure on healthcare professionals, disrupting their professional quality of life and imposing a psychological burden. In Greece, these issues were intensified by a decade of economic crisis, marked by constrained healthcare budget, personnel shortages, and insufficient resources. This study investigates the pandemic’s impact on the professional quality of life of Greek healthcare professionals to support targeted interventions. Methods: A cross-sectional study was conducted using descriptive statistics. The participants were a convenience sample of 246 healthcare professionals from a Greek regional university hospital with at least one year of experience and who had worked with COVID-19-positive or potentially exposed but asymptomatic patients. Data were collected between March and June 2021 using the Professional Quality of Life Scale (version 5). Results: Of the 246 participants, 81.3% were women and 33.8% were aged 50 or older. Moderate concern and fear regarding COVID-19 were reported, with 34.6% extremely afraid of transmitting the virus to family or friends and 22.8% to patients or their families. Overall professional quality of life was moderate: compassion satisfaction was moderate to high, while burnout and secondary traumatic stress were moderate to low. Higher compassion satisfaction was linked to holding a position of responsibility. Burnout was associated with having children, permanent employment, years of experience, and increased pandemic-related fear. Higher secondary traumatic stress was associated with older age, more years of experience, and greater pandemic-related fear. Conclusions: These findings support international research and highlight that the moderate levels observed indicate intrinsic motivation based on professionalism in patient care, providing evidence of resilience and coping mechanisms that reduce psychological consequences on well-being due to the pandemic. Full article

(This article belongs to the Special Issue Strategies and Interventions for Supporting the Holistic Well-Being of Clinicians and Nurses)

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15 pages, 506 KB

Open AccessArticle

Legislative Debate-Attributed Suicidality Among LGBTQ+ Adults: The Buffering Effect of Community Belongingness

by Keith J. Watts, Shawndaya S. Thrasher, Laneshia R. Conner, Nicole Campbell, Louis G. Baser, DeKeitra Griffin, Sydney P. Howard, Missy Spears and Justin X. Moore

Healthcare 2026, 14(2), 278; https://doi.org/10.3390/healthcare14020278 (registering DOI) - 22 Jan 2026

Abstract

Background: In recent years, the sociopolitical landscape in the United States has shifted due to an increase in state-level legislation regarding LGBTQ+ rights, a trend that has been particularly pronounced in the Commonwealth of Kentucky. While the mental health impacts of enacted laws [...] Read more.

Background: In recent years, the sociopolitical landscape in the United States has shifted due to an increase in state-level legislation regarding LGBTQ+ rights, a trend that has been particularly pronounced in the Commonwealth of Kentucky. While the mental health impacts of enacted laws are increasingly documented, a critical gap remains in understanding the psychological toll of the legislative debates themselves—the prolonged periods of public discourse surrounding the restriction of rights. Methods: Utilizing data from the 2025 Queer Kentucky Survey (N = 817), this exploratory study examined the association between LGBTQ+ community belongingness and acute suicidality attributed specifically to anti-LGBTQ+ legislative debates. Data were derived from a non-probability snowball sample. Binary logistic regression models that adjusted for age, race, gender identity, education, and income were utilized. Results: Prevalence of debate-attributed suicidality was alarmingly high: 59.7% of the sample attributed increased suicidal thoughts, and 44.1% attributed a suicide attempt, specifically to the legislative debates. LGBTQ+ belongingness was a robust protective correlate, associated with significantly lower odds of both suicidal thoughts (OR = 0.61, p < 0.001) and attempts (OR = 0.41, p < 0.001). Analyses further revealed divergent risk for suicidality across demographic characteristics. Conclusions: Findings are consistent with the interpretation that legislative debates may function as distinct structural stressors associated with suicidal thoughts and suicide attempts. While community belongingness may offer a critical buffer, the elevated risks among Transgender and Black, Indigenous, and People of Color (BIPOC) populations highlight the need for intersectional, structural interventions beyond individual resilience. Full article

(This article belongs to the Special Issue Gender, Sexuality and Mental Health)

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21 pages, 1191 KB

Open AccessReview

Effects of Social Support Interventions on Medical Patient Survival: A Meta-Analysis of Non-Randomized Clinical Trials

by Ksenia Illinykh-Bair and Timothy B. Smith

Healthcare 2026, 14(2), 277; https://doi.org/10.3390/healthcare14020277 (registering DOI) - 21 Jan 2026

Abstract

Background: Prior research confirms that social support promotes resilience among medical patients with chronic illness. Beyond emotional benefits, research has increasingly shown the importance of social support on physical health outcomes. Therefore, identifying and evaluating interventions that increase social support among medical [...] Read more.

Background: Prior research confirms that social support promotes resilience among medical patients with chronic illness. Beyond emotional benefits, research has increasingly shown the importance of social support on physical health outcomes. Therefore, identifying and evaluating interventions that increase social support among medical patients with chronic conditions is a priority for healthcare. Methods: This meta-analysis summarized data from 39,493 medical patients across 14 non-randomized trials that had been identified by a prior review of the survival benefits of social support interventions. Results: Across four studies reporting hazard ratio data, the results failed to reach statistical significance (HR = 2.10, 95% CI = 0.99 to 4.48, p = 0.0546), and the results of ten studies reporting odds ratio data were of smaller magnitude (OR = 1.27, 95% CI [0.72, 2.23], p > 0.05). Heterogeneity characterized both the odds ratio data (I² = 53%; Q = 18.1, p = 0.03) and hazard ratio data (I² = 89%, Q = 23, p < 0.001). A notable finding was that studies with longer periods of data collection showed longer survival among medical patients receiving social support. Conclusions: Long-term observations may be necessary for the survival benefits of social support interventions to become apparent. Further research with a larger pool of data from long-term follow-up studies will be needed to establish firm conclusions. Full article

(This article belongs to the Section Chronic Care)

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16 pages, 226 KB

Open AccessArticle

“The Window of Opportunity”: A Qualitative Exploration of Individual Reminiscence in Care Home Settings

by Aoife Conway, Rosemary Bradley, Assumpta Ryan, Claire McCauley, Brighide Lynch, Deirdre Harkin and Sarah Penney

Healthcare 2026, 14(2), 276; https://doi.org/10.3390/healthcare14020276 (registering DOI) - 21 Jan 2026

Abstract

Background: Care homes are complex care environments where supporting residents’ identity, wellbeing, and sense of personhood is central to person-centred care. Reminiscence is widely recognised as a psychosocial approach that can support these outcomes. However, existing evidence has largely focused on group-based interventions, [...] Read more.

Background: Care homes are complex care environments where supporting residents’ identity, wellbeing, and sense of personhood is central to person-centred care. Reminiscence is widely recognised as a psychosocial approach that can support these outcomes. However, existing evidence has largely focused on group-based interventions, with comparatively limited attention given to how individual reminiscence is implemented and sustained within care home practice. Methods: This study was an implementation-focused qualitative exploration of staff experiences of introducing and embedding individualised reminiscence in care home practice. Care home staff participated in four monthly workshops that introduced principles of individualised reminiscence and supported them to plan and implement reminiscence with at least one resident. Participants used either the InspireD digital reminiscence app (n = 19) or non-digital approaches such as life story books (n = 2), depending on local preferences and perceived suitability. Three focus groups were conducted with 21 care home staff to explore experiences of implementing individualised reminiscence and perceptions of its impact on residents, staff, and families. Data were analysed using reflexive thematic analysis. Results: Four interrelated themes were identified: (1) reminiscence within pressured systems; (2) resident experience and identity; (3) adapting and sustaining practice; and (4) families as partners in reminiscence. Participants described challenges associated with workload pressures, role expectations, and variability in family involvement, which influenced how reminiscence was adopted in practice. Despite these constraints, participants described perceived benefits for residents, including perceived improvements in mood, engagement, and expressions of identity. Participants also discussed perceived increased staff confidence, strengthened staff–resident relationships, and enhanced awareness of person-centred care practices. Conclusions: Findings highlight the perceived potential of individualised reminiscence to support person-centred and relational care in care homes, while identifying key contextual influences on implementation. Further research is needed to examine sustainability and effectiveness using comparative and mixed-method designs. Full article

(This article belongs to the Special Issue Novel Research and Care Strategies for Older Adults with Stroke and/or Dementia)

13 pages, 234 KB

Open AccessArticle

Exploring the Illness Experience of Patients with Central Nervous System Hemangioblastomas in Von Hippel–Lindau Disease: A Qualitative Study

by Mei-Fang Chuang, Pi-Hua Huang, Jing-Shan Huang and Chii Jeng

Healthcare 2026, 14(2), 275; https://doi.org/10.3390/healthcare14020275 (registering DOI) - 21 Jan 2026

Abstract

Background/Objectives: Von Hippel–Lindau (VHL) disease is a rare autosomal dominant hereditary disorder. Central nervous system hemangioblastomas are one of the most common tumor types associated with VHL disease. Although these tumors are histologically benign, delayed diagnosis and treatment may result in severe neurological [...] Read more.

Background/Objectives: Von Hippel–Lindau (VHL) disease is a rare autosomal dominant hereditary disorder. Central nervous system hemangioblastomas are one of the most common tumor types associated with VHL disease. Although these tumors are histologically benign, delayed diagnosis and treatment may result in severe neurological dysfunction, permanent disability, and even death. However, little is known about the experiences of patients with VHL disease. The aim of this study was to gain a better understanding of the illness experiences and psychological responses of patients with VHL disease accompanied by central nervous system hemangioblastomas. Methods: A qualitative study based on a semi-structured guide was conducted. Twelve participants were recruited. Data were collected through face-to-face interviews and analyzed using the constant comparative method. Results: Four themes and their subthemes were identified: 1. powerlessness—unpredictable disease progression and uncontrollable continuity; 2. negative emotional experiences—guilt and self-blame, depression, and low self-esteem; 3. compromise—acceptance of fate, positive outlook, and sense of hope; and 4. persistent worry—worries about family members, anxiety regarding finances and employment, and uncertainty regarding the future. Conclusions: This study identified four major themes in the illness experiences of patients with VHL disease accompanied by central nervous system hemangioblastomas, which provided deep insights into the care needs of individuals with VHL disease. Healthcare providers should develop effective measures to enhance patients’ ability to maintain a good quality of life and confront the future with resilience. Full article

32 pages, 448 KB

Open AccessReview

Innovative Assistive Technologies for Tetraplegia: A Narrative Review of Systematic and Emerging Evidence

by Lorenzo Desideri, Regina Gregori Grgič, Antonia Pirrera and Daniele Giansanti

Healthcare 2026, 14(2), 274; https://doi.org/10.3390/healthcare14020274 - 21 Jan 2026

Abstract

Background: Assistive technologies (ATs) for individuals with tetraplegia have evolved from mechanical aids to complex neurotechnological, digital, and psychosocial systems. However, the evidence base remains fragmented, with heterogeneous methodologies and limited integration across domains. This review synthesizes recent review-level evidence to clarify current [...] Read more.

Background: Assistive technologies (ATs) for individuals with tetraplegia have evolved from mechanical aids to complex neurotechnological, digital, and psychosocial systems. However, the evidence base remains fragmented, with heterogeneous methodologies and limited integration across domains. This review synthesizes recent review-level evidence to clarify current trends, gaps, and directions in ATs for tetraplegia. Methods: A narrative review of reviews was conducted following the ANDJ checklist. PubMed and Scopus were searched for systematic, scoping, and narrative reviews addressing assistive technologies relevant to tetraplegia. After screening, de-duplication, and quality appraisal, 20 reviews were included and synthesized narratively. Results: The included reviews clustered into four main domains: neural and regenerative interfaces, motor and biomechanical assistive systems, digital and adaptive rehabilitation ecosystems, and psychosocial and integrative frameworks. Across domains, evidence highlights a shift toward personalized, adaptive, and interoperable systems, supported by neurotechnologies, robotics, mobile health, and virtual reality. Common limitations include heterogeneous outcome measures, scarcity of longitudinal evidence, limited system interoperability, and persistent inequities in access and adoption. Emerging applications of artificial intelligence support adaptive control, monitoring, and personalization, though robust clinical validation remains limited. Conclusions: This synthesis provides a structured overview of review-level evidence on assistive technologies for tetraplegia. The findings underscore the need for coordinated, multidisciplinary approaches and more rigorous, longitudinal evaluation to support the development of inclusive, human-centered, and interoperable assistive ecosystems. Full article

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

15 pages, 418 KB

Open AccessArticle

Attitudes of Healthcare Service Users in Bulgaria Towards the Application of Teleophthalmology in the Case of Glaucoma

by Stanka Uzunova, Rumyana Stoyanova, Marin Atanassov and Kristina Kilova

Healthcare 2026, 14(2), 273; https://doi.org/10.3390/healthcare14020273 - 21 Jan 2026

Abstract

Objectives: The purpose of the current research is to examine and analyze the attitudes of healthcare service users towards the integration of remote medical services into ophthalmology in Bulgaria, including teleglaucoma. Methods: A cross-sectional survey study was conducted among 902 healthcare [...] Read more.

Objectives: The purpose of the current research is to examine and analyze the attitudes of healthcare service users towards the integration of remote medical services into ophthalmology in Bulgaria, including teleglaucoma. Methods: A cross-sectional survey study was conducted among 902 healthcare users during the period from May 2023 until December 2024. Descriptive statistics, parametric, and non-parametric tests for hypothesis testing were used. Results: The present study outlined predominantly positive attitudes towards the use of telemedicine services in ophthalmology, with 69.6% of respondents reporting a positive overall opinion in the final assessment. The greatest support was observed during remote consultations with a familiar doctor (77.4%) and during continuous follow-up of eye conditions (55.2%). Willingness to use such services was lower in emergencies or when contacting an unfamiliar specialist. A significant correlation was established between socio-demographic characteristics and attitudes—respondents with greater education levels (p = 0.006), men, and younger participants were more positive towards telemedicine (p < 0.05). The high level of awareness about glaucoma, particularly among those with university-level education, served as a positive prerequisite for the implementation of teleophthalmology services related to its monitoring. Mobile applications and digital solutions were evaluated as beneficial means of facilitating communication and increasing adherence to treatment. Regarding the use of artificial intelligence, certain skepticism and insufficient awareness levels were observed, which required additional efforts to increase trust and digital literacy among users. Conclusions: The implementation of telemedicine services into ophthalmology has potential but outlines the necessity of considering the individual attitudes of applying coherent quality and safety standards and of directed awareness campaigns, especially towards the groups of lower technological and healthcare literacy. Full article

(This article belongs to the Section Digital Health Technologies)

18 pages, 775 KB

Open AccessArticle

Treatment Efficacy of Semantic Feature Analysis in Logopenic and Semantic Variants of Primary Progressive Aphasia

by İbrahim Can Yaşa, İlknur Maviş and Tuğba Kaya

Healthcare 2026, 14(2), 272; https://doi.org/10.3390/healthcare14020272 - 21 Jan 2026

Abstract

Background/Objectives: Primary Progressive Aphasia (PPA) is a neurodegenerative disorder characterized by gradual and progressive deterioration of speech and language abilities. Speech and language therapy is considered an important intervention to slow decline and support the recovery of linguistic functions in individuals with [...] Read more.

Background/Objectives: Primary Progressive Aphasia (PPA) is a neurodegenerative disorder characterized by gradual and progressive deterioration of speech and language abilities. Speech and language therapy is considered an important intervention to slow decline and support the recovery of linguistic functions in individuals with PPA. This study aims to examine the effectiveness of an elaborated Semantic Feature Analysis (SFA) approach in enhancing naming abilities and semantic networks in individuals with the logopenic and semantic variants of PPA. Methods: Fourteen participants were recruited, including seven individuals with logopenic PPA and seven with semantic PPA. All participants received an elaborated SFA intervention twice weekly for four weeks. The Aphasia Language Assessment Test (ADD), the Turkish Picture Naming Test (T-RAT), and the SAQOL-39 were conducted at the following three time points: prior to treatment (pre-test), immediately after treatment (post-test), and one month post-treatment (follow-up). Results: Significant improvements were observed in ADD, T-RAT, and SAQOL-39 scores in both logopenic and semantic PPA groups following treatment (p < 0.05). Although follow-up scores declined compared to posttest performance (p < 0.05), several follow-up scores remained higher than pretest levels. Between-group comparisons indicated no significant difference in ADD scores; however, logopenic PPA participants demonstrated higher T-RAT scores (p < 0.05), while semantic PPA participants showed higher SAQOL-39 scores, except at follow-up (p < 0.05). Conclusions: Preliminary results suggest that the elaborated SFA intervention is effective in improving naming skills, language functioning, and quality of life in both logopenic and semantic variants of PPA. Although treatment gains partially decreased after one month, many improvements were maintained above baseline, supporting the clinical value of SFA in managing language decline in PPA. Full article

19 pages, 763 KB

Open AccessArticle

Cyberbullying Victimisation as a Mediator Between Social Media Use and Emotional Problems Among Elementary School Students

by Sanja Radić Bursać, Sabina Mandić, Martina Lotar Rihtarić, Dora Dodig Hundrić and Neven Ricijaš

Healthcare 2026, 14(2), 271; https://doi.org/10.3390/healthcare14020271 - 21 Jan 2026

Abstract

Background/Objectives: Adolescence is a developmental period characterised by intensive use of social media and an increased prevalence of emotional problems such as depression and anxiety. Scientific evidence indicates that the modality of social media use (active or passive) can significantly predict these problems, [...] Read more.

Background/Objectives: Adolescence is a developmental period characterised by intensive use of social media and an increased prevalence of emotional problems such as depression and anxiety. Scientific evidence indicates that the modality of social media use (active or passive) can significantly predict these problems, with active use being linked to a higher likelihood of cyberbullying victimisation. As victimisation is associated with more severe emotional problems, social media represents an important context for understanding adolescent mental health. Following this, the main aim of this study was to examine how the modality of social media use (SMU) is related to emotional problems, and whether cyberbullying victimisation mediates this relationship. Methods: This study was conducted on a convenient sample of N = 1822 students (49.0% boys, 51.0% girls; M_age = 13.22 years, SD_age = 0.629) from a total of 64 elementary schools throughout Croatia. A modified Croatian version of the Active and Passive Use of Social Networks Scale, the Anxiety and Depression subscales of the Depression, Anxiety, Stress Scale—Youth Version, and the Cyber-Victimisation subscale of the European Cyberbullying Intervention Project Questionnaire were used. Results: The results indicate that passive SMU among boys is directly related only to anxiety, while that among girls contributes only to the explanation of depression. Regarding cyberbullying victimisation as a mediator, full mediation in the association between active SMU and emotional problems was found for both girls and boys. Conclusions: This represents a significant theoretical contribution, as well as a contribution to the development of psychosocial interventions. Full article

(This article belongs to the Special Issue Addressing Behavioral Addictions and Promoting Emotional Well-Being: Insight, Challenges, and Solutions)

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15 pages, 328 KB

Open AccessArticle

Patient Safety and Quality Improvement in Nursing Practice: Associations Among Workload, Occupational Coping Self-Efficacy and Medical Device-Related Pressure Injury Prevention

by Hyun Suk Gwag and Jin Ah Kim

Healthcare 2026, 14(2), 270; https://doi.org/10.3390/healthcare14020270 (registering DOI) - 21 Jan 2026

Abstract

Background/Objectives: Medical device-related pressure injury (MDRPI) is a significant patient safety issue associated with increased morbidity, prolonged hospitalization, and healthcare costs. Although evidence-based guidelines for MDRPI prevention exist, nurses’ prevention performance remains suboptimal, and the mechanisms linking workload to preventive practice remain [...] Read more.

Background/Objectives: Medical device-related pressure injury (MDRPI) is a significant patient safety issue associated with increased morbidity, prolonged hospitalization, and healthcare costs. Although evidence-based guidelines for MDRPI prevention exist, nurses’ prevention performance remains suboptimal, and the mechanisms linking workload to preventive practice remain insufficiently elucidated. Within a patient safety and quality improvement framework, this study aimed to examine whether occupational coping self-efficacy (OCSE) is statistically consistent with an indirect association linking nurses’ workload and MDRPI prevention performance across the nursing practice continuum. Methods: This descriptive correlational study used a mediation model with data from 181 registered nurses working in intensive care units, general wards, and integrated nursing care wards in South Korea. Workload, OCSE, and MDRPI prevention performance were measured using validated instruments. Mediation was tested using hierarchical regression and bootstrapped analysis (PROCESS macro Model 4, 5000 resamples), controlling for demographic and work-related variables. Results: Higher workload was associated with lower OCSE, while higher OCSE was associated with better MDRPI prevention performance. When OCSE was included in the model, the direct association between workload and prevention performance was no longer significant. Bootstrapping confirmed a significant indirect association through OCSE, consistent with a full mediation pattern. Conclusions: Nurses’ workload appears to be indirectly associated with MDRPI prevention performance through OCSE. These findings suggest that strengthening nurses’ coping self-efficacy, alongside organizational strategies, may be essential for sustainable MDRPI prevention and patient safety improvement. Full article

(This article belongs to the Special Issue Patient Safety and Quality Improvement Across the Nursing Practice Continuum)

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14 pages, 257 KB

Open AccessArticle

Role Clarity Among Patient Care Technicians in Saudi Arabia: Outcomes of a Structured Educational Program

by Nashi Masnad Alreshidi, Afaf Mufadhi Alrimali, Wadida Darwiesh Alshammari, Kristine Angeles Gonzales, Maram Nasser Alawad, Eida Habeeb Alshammari, Mohmmad Khalf Al-Shammari, Ohoud Awadh Alreshidi, Fawziah Nasser Alrashedi, Asrar Eid Alrashidi and Lueife Ali Alrashedi

Healthcare 2026, 14(2), 269; https://doi.org/10.3390/healthcare14020269 - 21 Jan 2026

Abstract

Background: Role clarity is a persistent challenge among Patient Care Technicians (PCTs), contributing to inconsistent task performance and safety risks. In Saudi Arabia, little is known about PCTs’ understanding of their responsibilities. This study evaluated the impact of a targeted educational program designed [...] Read more.

Background: Role clarity is a persistent challenge among Patient Care Technicians (PCTs), contributing to inconsistent task performance and safety risks. In Saudi Arabia, little is known about PCTs’ understanding of their responsibilities. This study evaluated the impact of a targeted educational program designed to improve PCTs’ role clarity, safety practices, and communication. Methods: A quasi-experimental pre-post study was conducted in September 2025 with 35 PCTs from the Hail Health Cluster. The one-day intervention included lectures, discussions, role-play, and case scenarios. Outcomes were measured using a validated instrument across four domains: role clarity; core clinical tasks and safety; communication and ethics; and objective knowledge. Pre-post changes were analyzed using paired t-tests (Cohen’s d), and subgroup differences in change scores were examined using one-way ANOVA (η²) in SPSS v29. Results: Baseline scores were lowest in objective knowledge (41.4%) and role clarity (62.8%). Post-training, total composite scores improved significantly (+10.88%, p < 0.001, d = 1.63), with the most significant gain in objective knowledge (+19.8%, p < 0.001, d = 0.99). Role clarity showed only a modest, non-significant increase (+3.98%, p = 0.088, d = 0.30). No demographic differences were found. Conclusions: Targeted training was effective in reducing knowledge gaps; however, improving role clarity may require organizational reinforcement beyond brief training. Full article

(This article belongs to the Special Issue Strategies and Interventions for Supporting the Holistic Well-Being of Clinicians and Nurses)

18 pages, 797 KB

Open AccessArticle

Facilitators and Barriers of Using an Artificial Intelligence Agent in Chronic Disease Management: A Normalization Process Theory-Guided Qualitative Study of Older Patients with COPD

by Shiya Cui, Shilei Wang, Jingyi Deng, Ruiyang Jia and Yuyu Jiang

Healthcare 2026, 14(2), 268; https://doi.org/10.3390/healthcare14020268 - 21 Jan 2026

Abstract

Objectives: This study aims to explore the facilitators and barriers in the process of using AI agents for disease management in older COPD patients. Methods: Based on the normalization process theory, a descriptive qualitative study was used to conduct semi-structured interviews with 28 [...] Read more.

Objectives: This study aims to explore the facilitators and barriers in the process of using AI agents for disease management in older COPD patients. Methods: Based on the normalization process theory, a descriptive qualitative study was used to conduct semi-structured interviews with 28 older patients with COPD recruited from June to August 2025 in a Class A tertiary hospital in Wuxi, Jiangsu Province. Results: A total of 28 interviews were conducted. Four themes (Coherence, Cognitive Participation, Collective Action, Reflexive Monitoring), nine subthemes (recognition of intelligent technology;supported by policy discourse and the background of national-level projects; the creation of a family atmosphere; recommendations from HCPs; relief and social connection; new “doctor”–patient relationship and communication; eliminate the burden and return to life; benefit and value perception; right self-decision by AI) in facilitators and nine subthemes (privacy conflicts and trust deficiency; blurred boundaries of human–machine responsibility and authority; non-high-quality services are chosen reluctantly; technical anxiety; lack of motivation for continued engagement; extra burden; limitations of the physical environment; human–machine dialogue frustration; a sense of uncertainty about the future of AI) in barriers were extracted. Conclusions: This study identified key factors influencing the use of AI agents in chronic disease management in older patients with COPD. The results provide directions for improving the implementation and sustainable use of AI health technologies. Full article

(This article belongs to the Special Issue Artificial Intelligence in Healthcare: Opportunities and Challenges)

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9 pages, 365 KB

Open AccessArticle

Regional Differences in Medicare Reimbursements and Gastroenterology Workforce Dynamics: Implications for Access to Care

by Jason N. Chen, Eric C. H. Leung, Jacob Evans, Cassidy Swain, Arham Siddiqui, Duke Appiah and Sameer Islam

Healthcare 2026, 14(2), 267; https://doi.org/10.3390/healthcare14020267 - 21 Jan 2026

Abstract

Background: As the U.S. population ages, the need for gastrointestinal (GI) care and procedures grows. Medicare is a significant payer for these procedures, but declining reimbursements raise concerns about the availability of GIs and thus equitable access to care. This study examines the [...] Read more.

Background: As the U.S. population ages, the need for gastrointestinal (GI) care and procedures grows. Medicare is a significant payer for these procedures, but declining reimbursements raise concerns about the availability of GIs and thus equitable access to care. This study examines the relationship between Medicare reimbursements for GI procedures and the regional supply and demand of GI physicians. Methods: This study analyzed the Medicare facility and non-facility setting physician reimbursements for the top 10 GI procedures for 2003, 2013, and 2023. Facility reimbursements were compared across four regions (Northeast, Midwest, South, and West) and compared to regional GI physician supply and demand data for 2013 and 2025 projections. Linear regression and mixed-effects models were used to evaluate relationships between reimbursements, physician supply, and demand. Results: The national average adjusted facility setting physician reimbursements for the top 10 GI procedures declined by 45.6% from 2003 to 2023. In 2013 and projected for 2025, the South had the highest GI physician supply and demand, but consistently lower facility setting physician reimbursements compared to the Northeast and West. Associations between supply, demand, and reimbursements were observed, though regional patterns showed paradoxical trends, such as similar low reimbursements in the South and Midwest despite differing supply levels. Conclusions: Regional inconsistencies between physician supply and reimbursements highlight the complexity of economic and healthcare dynamics. Declining Medicare reimbursements for GI procedures are multifactorial and, as the aging population grows, these reductions may widen disparities. Further investigation is needed to address barriers and ensure equitable access to GI care. Full article

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

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