Healthcare

19 pages, 892 KB

Open AccessSystematic Review

Exploring the Impact of Health Literacy on Fertility Awareness and Reproductive Health in University Students—A Systematic Review

by Viktória Prémusz, Melese Dereje Mesfin, Leman Atmaca, Shalini Chauhan, Zoltán Tándor, Lili Andrea Bodor, Ákos Várnagy and Dahabo Adi Galgalo

Healthcare 2025, 13(18), 2342; https://doi.org/10.3390/healthcare13182342 (registering DOI) - 17 Sep 2025

Abstract

Background/Objectives: Health literacy has an impact on students’ reproductive health. Therefore, the objective of our study is to systematically examine, identify, and summarize all research on the role of health literacy in fertility awareness and reproductive health among university students in order to [...] Read more.

Background/Objectives: Health literacy has an impact on students’ reproductive health. Therefore, the objective of our study is to systematically examine, identify, and summarize all research on the role of health literacy in fertility awareness and reproductive health among university students in order to understand how health literacy influences reproductive health outcomes in this population. Methods: Using the PRISMA guidelines, a comprehensive systematic search was conducted using electronic databases, such as PubMed, EMBASE, CINAHL, Scopus, and Google Scholar. The protocol was registered in the Prospective Register for Systematic Reviews (PROSPERO, CRD 42024566268). All studies were imported into EndNote software and screened using a two-level title/abstract screening process. The included studies were narratively summarized. Results: The database search identified 1360 articles; 116 duplicates were removed, and thus, 1244 were initially screened, leading to 1133 exclusions. A total of 111 articles underwent full screening, and 94 were then excluded. A total of 14 articles were included for data extraction. Health literacy impacts university students’ behaviour, fertility awareness, and reproductive health knowledge. Students with higher health literacy show more understanding of critical topics such as fertility and emergency contraception. Socioeconomic factors play a crucial role in shaping health literacy and reproductive choices, while gender disparities highlight the need for targeted educational interventions, particularly for male students. Effective educational programs have been shown to enhance health literacy. Additionally, technology integration serves as a valuable tool for disseminating reproductive health information. Cultural context also plays a vital role in influencing health literacy. Conclusions: The findings of this study emphasize the importance of comprehensive strategies to enhance health literacy among university students, and future research should focus on developing and evaluating targeted educational programs that address gender disparities and socioeconomic factors influencing health literacy. Full article

(This article belongs to the Special Issue Reproductive and Sexual Health: Addressing Understudied Areas in Public Health and Primary Care)

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26 pages, 658 KB

Open AccessReview

The Impact of Toxic Leadership on Nurse Retention: A Scoping Review

by Eleni Tsapnidou, Maria Moudatsou, George Katharakis, Sofia Koukouli, Michael Rovithis, Martha Kelesi and Areti Stavropoulou

Healthcare 2025, 13(18), 2341; https://doi.org/10.3390/healthcare13182341 - 17 Sep 2025

Abstract

Background/Objectives: Toxic leadership has arisen as a matter of serious concern within the nursing profession, with growing evidence linking it to diminished job satisfaction, ineffective conflict management, and weakened organizational commitment. These effects not only compromise nurse retention but also threaten the quality [...] Read more.

Background/Objectives: Toxic leadership has arisen as a matter of serious concern within the nursing profession, with growing evidence linking it to diminished job satisfaction, ineffective conflict management, and weakened organizational commitment. These effects not only compromise nurse retention but also threaten the quality of patient care and overall healthcare outcomes. This scoping review aimed to examine the impact of toxic nursing leadership on staff retention by synthesizing evidence from existing literature and a broad range of published studies. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed/MEDLINE, Scopus, CINAHL and Science Direct databases yielding 1356 articles. Of these, 18 met the predefined inclusion criteria. The scoping review followed the six-stage methodological framework proposed by Arksey and O’Malley. Thematic analysis identified two core categories: (a) key dimensions shaping perceptions of toxic leadership and (b) the impact of toxic leadership on nursing staff retention. Results: The findings reveal that toxic leadership contributes to organizational silence, emotional exhaustion, diminished psychological safety, and low professional commitment. Such behaviors not only jeopardize nurse engagement and productivity but also negatively affect patient safety and care quality. In contrast, leadership styles such as transformational and transactional leadership are associated with higher job satisfaction, reduced burnout, and improved retention outcomes. Conclusions: This review underscores the need for healthcare organizations to identify and address toxic leadership behaviors promptly. By promoting supportive and ethical leadership styles, institutions can foster a healthier workplace, improve nurse retention, and ultimately enhance the quality of care. The study offers practical implications for healthcare administrators, emphasizing leadership development. Full article

20 pages, 393 KB

Open AccessReview

How Could Artificial Intelligence Change the Doctor–Patient Relationship? A Medical Ethics Perspective

by Gianluca Montanari Vergallo, Laura Leondina Campanozzi, Matteo Gulino, Lorena Bassis, Pasquale Ricci, Simona Zaami, Susanna Marinelli, Vittoradolfo Tambone and Paola Frati

Healthcare 2025, 13(18), 2340; https://doi.org/10.3390/healthcare13182340 - 17 Sep 2025

Abstract

Background: This paper aims to outline an ethical overview of the potential challenges related to AI technologies in the doctor–patient relationship. Methods: This study is structured as a narrative review of the literature (2015–2025), based on searches conducted in the main scientific databases [...] Read more.

Background: This paper aims to outline an ethical overview of the potential challenges related to AI technologies in the doctor–patient relationship. Methods: This study is structured as a narrative review of the literature (2015–2025), based on searches conducted in the main scientific databases (PubMed, Scopus, Web of Science, Google Scholar), supplemented by official documents issued by the following international organizations: World Health Organization (WHO), United Nations Educational, Scientific and Cultural Organization (UNESCO), and the World Medical Association (WMA), as well as key regulatory frameworks of the European Union, China, and the United States. The selection included academic contributions, guidelines, and institutional reports relevant to the clinical applications of AI and their ethical and regulatory implications. Specifically, the analysis herein presented is grounded on four key aspects: the rationale for AI in patient care, informed consent about AI use, confidentiality, and the impact on the therapeutic alliance and medical professionalism. Results and Conclusions: Depending on their application, AI systems may offer benefits regarding the management of administrative burdens and in supporting clinical decisions. However, their applications in diagnostics, particularly in fields as radiology and dermatology, may also adversely impact the patient–doctor relationship and professional autonomy. Specifically, the implementation of these systems, including generative AI, may lead to increased healthcare costs and jeopardise the patient–doctor relationships by exposing patients’ confidentiality to new risks and reducing space for healthcare empathy and personalisation. The future of the medical profession and the doctor–patient relationship will largely depend on the types of artificial intelligence that are integrated into clinical practice and how effectively such additions are reconciled with core ethical values on which healthcare rests within our systems and societies. Full article

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

15 pages, 1685 KB

Open AccessArticle

Patterns of Prescription Switching in a Uniform-Pricing System for Multi-Source Drugs: A Retrospective Population-Based Cohort Study

by Dong Han Kim and Song Hee Hong

Healthcare 2025, 13(18), 2339; https://doi.org/10.3390/healthcare13182339 - 17 Sep 2025

Abstract

Background: Generic drugs account for approximately 40% of the Korean prescription drug market, despite limited generic substitution at the point of dispensing. This suggests that switching between originator and generic drugs often occurs at the point of prescription. Physicians, in fact, have opposed [...] Read more.

Background: Generic drugs account for approximately 40% of the Korean prescription drug market, despite limited generic substitution at the point of dispensing. This suggests that switching between originator and generic drugs often occurs at the point of prescription. Physicians, in fact, have opposed pharmacy-level substitution due to concerns about the clinical equivalence of generics, despite the regulatory confirmation of their bioequivalence. Importantly, multi-source prescription switching (MSPS) may reflect discretionary prescribing behavior, underscoring the need for targeted benefit policies to enhance substitutability and promote effective competition among multi-source drugs. This study aimed to quantify the extent of physician-initiated MSPS among adults with hypertension or diabetes and to identify factors associated with these switching behaviors. Methods: We conducted a retrospective cohort study using Korean National Health Insurance claims data. The studied cohort consisted of patients newly initiated, between January and June 2014, on a pharmaceutically equivalent and bioequivalent antihypertensive or antidiabetic drug. Patients were followed for up to 24 months to identify MSPS episodes occurring during drug therapy courses, which were defined as 12 ± 3 consecutive visits resulting in prescriptions for pharmaceutically equivalent, bioequivalent multi-source drugs. An MSPS episode was defined as a change in product code—uniquely identifying a multi-source drug—within the same pharmaceutically equivalent drug code between any two consecutive prescriptions within the course. We estimated the mean MSPS rate and assessed variation by patient characteristics, drug types, physician practices, and geographic regions. Results: Among 1,325,334 identified drug therapy courses, 17.06% involved at least one MSPS. Switching rates varied substantially (coefficient of variation = 227%) by physician practice setting (e.g., public health center branches: 26%; tertiary hospitals: 15%) and by drug market size (e.g., glimepiride: 29%; cilnidipine: 1%). In contrast, patient age and gender were not associated with switching behavior. Conclusions: In Korea, physicians frequently switch prescriptions between originator and generic drugs, even as generic substitution at the pharmacy level remains uncommon. The substantial variation in MSPS across provider settings and drug markets—but not by patient characteristics—underscores the need for targeted pharmacy benefit policies to promote effective substitutability and competition among multi-source drugs. Full article

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35 pages, 696 KB

Open AccessArticle

An Optimization-Based Framework to Dynamically Schedule Hospital Beds in a Pandemic

by Marwan Shams Eddin and Hussein El Hajj

Healthcare 2025, 13(18), 2338; https://doi.org/10.3390/healthcare13182338 - 17 Sep 2025

Abstract

Background: Emerging pandemics can rapidly overwhelm hospital capacity, leading to increased mortality and healthcare costs. Objective: We develop an optimization-based framework that dynamically schedules hospital beds across multiple facilities to minimize total healthcare costs, including patient rejections and logistical expenses, under resource constraints. [...] Read more.

Background: Emerging pandemics can rapidly overwhelm hospital capacity, leading to increased mortality and healthcare costs. Objective: We develop an optimization-based framework that dynamically schedules hospital beds across multiple facilities to minimize total healthcare costs, including patient rejections and logistical expenses, under resource constraints. Methods: The model integrates several real-world flexibilities: standard hospital beds, buffer capacity from non-pandemic wards, in situ field hospitals, and inter-hospital patient transfers. To capture demand uncertainty, we link the model with an SEIRD epidemic forecasting approach and further extend it with a robust optimization variant that safeguards against worst-case surges. Recognizing computational challenges, we reformulate the problem to significantly reduce solution times and derive structural properties that provide guidance on when to open field hospitals, allocate buffer beds, and prioritize patients across facilities. Results: A case study based on COVID-19 data from Northern Virginia shows that the proposed framework reduces healthcare costs by more than 50% compared with current practice, mainly by lowering patient rejection rates. Conclusions: These results highlight the value of combining epidemic forecasting with prescriptive optimization to improve resilience and inform healthcare policy during crises. Full article

21 pages, 1431 KB

Open AccessArticle

Implementing a Mixed Health Service Model as an Informed Modality to Enhance Prevention and Promote Workplace Health in the Greek Regional Public Sector: A Pilot Study in Crete

by Nikos Frantzeskakis, Maria Tziraki, Marios Spanakis, Spyridoula D. Katsarou, Nikolaos Papadopoulos, Manolis Linardakis, Charikleia Vova-Chatzi, Apostolos Kamekis, George Pitsoulis, Antonios Papadakis and Emmanouil K. Symvoulakis

Healthcare 2025, 13(18), 2337; https://doi.org/10.3390/healthcare13182337 - 17 Sep 2025

Abstract

Background/Objectives: Preventive care in Greece remains underdeveloped, especially in workplace settings. To address this, a mixed service model was piloted to integrate preventive and occupational health for public sector employees in Region of Crete. Methods: Between January and July 2025, 180 [...] Read more.

Background/Objectives: Preventive care in Greece remains underdeveloped, especially in workplace settings. To address this, a mixed service model was piloted to integrate preventive and occupational health for public sector employees in Region of Crete. Methods: Between January and July 2025, 180 employees enrolled for a 30 min consultation including medical history review, lifestyle assessment, and evaluation of vaccination and screening status according to age, risk factors, and national guidelines. Standardized tools (PSS-14, PHQ-9) assessed perceived stress and mental well-being. Participants rated satisfaction and perceived care quality on a 10-point Likert scale. Results: Of 180 enrolled, 154 completed the evaluation. The majority of participants were female (68.8%), with a mean age of 54 years, and 42.9% held a higher education degree. Common lifestyle characteristics included current smoking (24.7%), regular alcohol consumption (9.8%), and insufficient sleep (mean 6.5 h/night). Overweight (40.3%) and obesity (29.2%) were prevalent. Chronic conditions were reported in 87.0% of participants, with dyslipidemia (54.5%), allergies (35.8%), and hypertension (26.9%) being the most frequent. Criteria for metabolic syndrome were found in 33.1% of participants with a higher prevalence in men (50.0% vs. 25.0%; p = 0.029). Mental health assessments revealed moderate stress levels (mean PSS-14: 23.7) and mostly minimal depressive symptoms (mean PHQ-9: 4.3). Preventive screening was variable, with higher adherence for mammography (79.2%) and lower for colonoscopy (40.2%). Service satisfaction was high, with significant increases in perceived usefulness (8.96 to 9.80, p < 0.001) and satisfaction (9.08 to 9.87, p < 0.001) after the intervention. Conclusions: This pilot revealed critical gaps in vaccination, cardiometabolic risk, and stress management among public employees. It was also shown that integrated workplace-based health models are both feasible and acceptable. These models can effectively deliver preventive actions on a scale and represent a promising strategy for strengthening occupational health in employed adult population. Full article

(This article belongs to the Special Issue Healthcare Management: Improving Patient Outcomes and Service Quality)

16 pages, 888 KB

Open AccessArticle

Understanding the Impact of Personal Resources on Emotional Exhaustion Among Emergency Healthcare Workers: A Structural Equation Modeling Approach

by Alicia Arenas, Valeria Terán-Tinedo, Esther Cuadrado, Rosario Castillo-Mayén, Bárbara Luque and Carmen Tabernero

Healthcare 2025, 13(18), 2336; https://doi.org/10.3390/healthcare13182336 - 17 Sep 2025

Abstract

Background/Objectives: The COVID-19 pandemic was associated with an increase in burnout vulnerability in healthcare workers, which often translated into higher potential risks for their personal safety and that of their patients. This study was based on the JD-R model and explored emotional [...] Read more.

Background/Objectives: The COVID-19 pandemic was associated with an increase in burnout vulnerability in healthcare workers, which often translated into higher potential risks for their personal safety and that of their patients. This study was based on the JD-R model and explored emotional exhaustion and stress, as a result of a lack of personal resources such as self-efficacy to cope with stress and poor emotion regulation, and work demands, with the buffering effect of a healthy lifestyle. Methods: The sample was composed of 189 emergency healthcare workers from Spain, aged between 26 and 59 years old. A cross-sectional and correlational study was carried out through an online platform. Results: The mediation, moderation, and Structural Equation Modeling analyses supported the proposed model, demonstrating good fit to the data. Work demands showed both a positive direct effect and an indirect effect on emotional exhaustion through emotion regulation and stress. In turn, self-efficacy to cope with stress and healthy lifestyle showed indirect effects on emotional exhaustion, also through emotion regulation and stress. Further, healthy lifestyle moderated the relationship between stress and emotional exhaustion, by mitigating the negative influence of stress on emotional exhaustion. Conclusions: The study highlights the importance of incorporating self-care in coping with stress and preventing burnout and should be considered when designing interventions in the context of emergency healthcare to improve well-being in its workers. Full article

(This article belongs to the Special Issue Job Stress, Physical and Mental Well-Being Among Workers)

17 pages, 432 KB

Open AccessArticle

Psychosocial Correlates of Fatigue in Young Adults with Multiple Sclerosis: Exploring the Roles of Resilience, Mindfulness, and Illness Perception

by Silvia Poli, Valeria Donisi, Roshan das Nair, Maria Angela Mazzi, Alberto Gajofatto and Michela Rimondini

Healthcare 2025, 13(18), 2335; https://doi.org/10.3390/healthcare13182335 - 17 Sep 2025

Abstract

Background and Objectives: Fatigue, despite being one of the most common and disabling symptoms in multiple sclerosis (MS), is far from being fully understood. The aim of the present study was to explore the association between fatigue and resilience, illness perception, and [...] Read more.

Background and Objectives: Fatigue, despite being one of the most common and disabling symptoms in multiple sclerosis (MS), is far from being fully understood. The aim of the present study was to explore the association between fatigue and resilience, illness perception, and mindfulness traits, accounting for the impact of anxiety and depression in young adults with MS (YawMS). Methods: For this cross-sectional exploratory analysis, the following inclusion criteria applied: age 18–45 years, MS diagnosis, Expanded Disability Status Scale <3.5. Fifty-one YAwMS (mean age: 33.5 ± 6.7 years; 76% women, 24% men; 96% relapsing-remitting MS) completed validated questionnaires. Student’s t-tests and Spearman correlations, with partial correlations controlling for anxiety and depression, were performed. Finally, a preliminary multivariate model (seemingly unrelated regression) was applied. Results: Despite low disability levels, 69% experienced moderate to severe fatigue (average fatigue score 61.9 ± 17.9). Higher total fatigue was associated with negative illness perception, particularly regarding identity and consequences (p = 0.66 and p = 0.67, respectively), and lower levels of non-judgment and non-reactivity (p = −0.48 and p = −0.54, respectively), and these relationships persisted after controlling for anxiety and depression. Although resilience was negatively correlated with fatigue, its impact was not maintained. Conclusions: Our findings emphasize the relevance of fatigue in YawMS with low disability levels. Cognitive and emotional processing might be associated with fatigue, beyond and beside disease severity itself. Full article

(This article belongs to the Section Chronic Care)

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13 pages, 370 KB

Open AccessArticle

Pokémon GO, Went, Gone…—Physical Activity Level, Health Behaviours, and Mental Well-Being of Game Users: A Cross-Sectional Study

by Michał Giller, Tomasz Kowal, Wirginia Likus and Anna Brzęk

Healthcare 2025, 13(18), 2334; https://doi.org/10.3390/healthcare13182334 - 17 Sep 2025

Abstract

Background/Objectives: Pokémon GO has had a substantial global impact, emerging as one of the most prominent smartphone game releases of the 21st century. Beyond its entertainment value, this game has the potential to encourage physical activity alongside recreational engagement. Consequently, it may facilitate [...] Read more.

Background/Objectives: Pokémon GO has had a substantial global impact, emerging as one of the most prominent smartphone game releases of the 21st century. Beyond its entertainment value, this game has the potential to encourage physical activity alongside recreational engagement. Consequently, it may facilitate the integration of augmented reality into daily routines within the context of advancing mobile device technology. This study aimed to assess the impact of Pokémon GO on users’ physical activity levels, as well as to identify other implicit health outcomes and potential risks. Methods: A cross-sectional study was conducted using the International Physical Activity Questionnaire (IPAQ-long form) and a custom-designed survey (including demographic characteristics) administered to a cohort of 243 Pokémon GO players (112 females and 131 males, mean age 27 ± 7 years). Results: According to IPAQ-long form data, 68% of Pokémon GO users demonstrated high physical activity levels, 29% moderate, and 2.5% insufficient activity. More than 80% of participants reported increased walking distances, and 39% indicated that playing the game had improved their overall mood, while 13% reported enhanced social interactions. However, some findings are concerning, with 27% of respondents admitting to sacrificing sleep, 20% considering themselves addicted, and more than half exceeding the World Health Organization (WHO) screen time guidelines based solely on the time spent playing Pokémon GO. Conclusions: Pokémon GO has a positive impact on users’ physical activity levels, particularly in terms of low-intensity physical activities such as walking. This observational study suggests that the application may be associated with a healthy lifestyle and enhanced interpersonal contact. Prudent and safe usage is advised, as the game has the potential to be addictive and may pose risks when misused. Full article

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17 pages, 2526 KB

Open AccessArticle

Effectiveness of Adapted Physical Activity on Quality of Life of Patients with Knee and Hip Replacement: A Randomized Pilot Study

by Raffaele Zinno, Erika Pinelli, Giuseppe Barone, Dante Dallari, Maria Scoppolini Massini and Laura Bragonzoni

Healthcare 2025, 13(18), 2333; https://doi.org/10.3390/healthcare13182333 - 17 Sep 2025

Abstract

Background: Total hip (THR) and knee replacement (TKR) effectively treat end-stage osteoarthritis, but many patients continue to experience functional limitations and reduced quality of life (QoL) after rehabilitation. The aim of this pilot study was to assess the changes in terms of QoL [...] Read more.

Background: Total hip (THR) and knee replacement (TKR) effectively treat end-stage osteoarthritis, but many patients continue to experience functional limitations and reduced quality of life (QoL) after rehabilitation. The aim of this pilot study was to assess the changes in terms of QoL in people with THR and TKR after a specifically designed PA intervention. The secondary aim was to evaluate changes in physical function through strength and mobility tests. Methods: Eighteen participants (mean age 65.8 ± 7.1 years) were enrolled at the Rizzoli Orthopedic Institute and were randomly assigned to an intervention group (IG), which completed a six-month supervised PA program (6 months after surgery), or a control group (CG), which received standard care. Assessments were conducted at four time points: before surgery, after rehabilitation, and at 9- and 12-month post-surgery. Repeated measures ANOVA was used to assess within- and between-group differences over time, with post hoc pairwise comparisons conducted using independent t-tests with Sidak correction. The level of statistical significance was set at p < 0.05 for all analyses. Results: Both groups showed significant improvements in QoL over time, with greater gains in physical functioning observed in the IG. Lower limb strength increased more in the IG; however, the differences between groups were not statistically significant. The Timed Up and Go and 30-Second Chair Stand Test improved in both groups. No adverse events were reported. Conclusions: These findings support the feasibility and potential benefits of adapted PA programs after rehabilitation. Although no significant differences emerged between groups, clinically relevant improvements were observed in the IG. Larger studies are warranted to confirm these results and explore long-term outcomes across multiple domains. Full article

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14 pages, 451 KB

Open AccessArticle

A Mediation Analysis of Trauma Symptoms on the Well-Being in Caregivers of Children with Medical Complexity

by Courtney M. Holmes, Kanako Iwanaga, Tiffany Kimbrough, Simran Singh, Marcia A. Winter, Ayomide Popoola, Genevive Heymann, Makayla Burton and Heather A. Jones

Healthcare 2025, 13(18), 2332; https://doi.org/10.3390/healthcare13182332 - 17 Sep 2025

Abstract

Background/Objectives: Parent caregivers of children with medical complexity experience high levels of chronic stress and trauma symptoms. Despite ongoing and continuous involvement with the healthcare system, parents often do not seek support for their own mental health concerns. Parent mental wellness is [...] Read more.

Background/Objectives: Parent caregivers of children with medical complexity experience high levels of chronic stress and trauma symptoms. Despite ongoing and continuous involvement with the healthcare system, parents often do not seek support for their own mental health concerns. Parent mental wellness is a critical component of reducing family distress. This study aimed to explore how various factors such as resilience, coping, and support impacted well-being and trauma symptom severity. Methods: Parents/caregivers from a complex care clinic in a mid-Atlantic children’s hospital were recruited for this study. A total of 125 participants completed the study which included a battery of measures focused on trauma symptoms, well-being, coping, and resilience. Results: PTSD symptom severity was significantly negatively related to resilience and subjective well-being. Significant mediators included informational support, indicating that collaboration between healthcare providers and caregivers/parents is critical. Conclusions: This study highlights potential target intervention areas to promote well-being and reduce trauma symptom severity, such as resiliency promotion and enhancement and increasing informational support provided by healthcare professionals. Full article

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15 pages, 585 KB

Open AccessReview

Exploring the Various Sources of Mortality Estimation in Ghana: A Scoping Review of Data Sources, Challenges, and Opportunities

by Regina Titi-Ofei, Hillary Kipruto, Dominic Atweam, Anthony Adofo Ofosu and Clementine Rossier

Healthcare 2025, 13(18), 2331; https://doi.org/10.3390/healthcare13182331 - 17 Sep 2025

Abstract

Background: Accurate estimation of mortality is essential for effective public health planning, policymaking, and monitoring of health interventions. In Ghana, multiple data sources are used to estimate mortality, including civil registration systems, household surveys, census data, and health and demographic surveillance systems. This [...] Read more.

Background: Accurate estimation of mortality is essential for effective public health planning, policymaking, and monitoring of health interventions. In Ghana, multiple data sources are used to estimate mortality, including civil registration systems, household surveys, census data, and health and demographic surveillance systems. This scoping review explores the existing sources of mortality data in Ghana, examining their challenges and opportunities. Methods: Using Arksey and O’Malley’s framework, we identified peer-reviewed and grey literature from Ghana Health Service, Ministry of Health, Ghana Statistical Service, WHO, and the United Nations. We selected studies published between 2000 and 2024 that focused on mortality estimation in Ghana. Data was extracted and synthesized into key themes: data sources, challenges, and opportunities. Results: Six major data sources on mortality were identified: Civil Registration and Vital Statistics (CRVS), census data, Demographic and Health Surveys (DHS), Health and Demographic Surveillance Systems (HDSS), Facility-Based Health Information Systems (HMIS), modeled estimates from the Global Burden of Disease (GBD) and from the United Nations Department of Economic and Social Affairs (UN DESA). Key challenges include under-registration of deaths (CRVS and HMIS), recall bias (DHS, census), limited geographic coverage (HDSS), inconsistencies in cause-of-death classification (HMIS, HDSS), and lack of local geographic coverage (GBD, UN DESA, DHS). Nonetheless, benefits include longitudinal follow-up (HDSS), local coverage and ownership (CRVS, HMIS) and international comparability (GBD, UN DESA, DHS). Conclusions: Mortality estimation in Ghana is supported by diverse but fragmented data sources. Strengthening the CRVS and HMIS systems, integrating multiple data streams, standardizing methodologies, and enhancing institutional partnership are essential steps toward improving data quality and coverage. This review provides recommendations for improvement towards better quality estimations of mortality in Ghana. Full article

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20 pages, 311 KB

Open AccessArticle

Survivors of Oncological Disease: Experience and Satisfaction with National Health Care and Service

by Tânia Gaspar, Joana Ferreira and Anabela Coelho

Healthcare 2025, 13(18), 2330; https://doi.org/10.3390/healthcare13182330 - 17 Sep 2025

Abstract

Background/Objectives: The relationship between patients, health professionals, and healthcare organizations is a key factor in patient satisfaction and adherence to care. Organizations, professionals, and patients would benefit from the implementation of organizational measures to promote health literacy and post-discharge psychological counseling. This [...] Read more.

Background/Objectives: The relationship between patients, health professionals, and healthcare organizations is a key factor in patient satisfaction and adherence to care. Organizations, professionals, and patients would benefit from the implementation of organizational measures to promote health literacy and post-discharge psychological counseling. This study aims to explore cancer survivors’ experiences and satisfaction with care, along with identifying their primary needs and barriers. Methods: This is a cross-sectional, mixed study with a random and representative sample of the three Portuguese Institutes of Oncology. The patient sample consists of 768 participants, 463 of whom are female (60.3%), aged between 18 and 68 years. Results: Most patients reported a positive healthcare experience, particularly regarding staff attention and clarification of doubts, comfort, and ease of access. However, less positive aspects included long waiting times, limited involvement in decision-making, and difficulties understanding medical information. No significant differences were found by gender or age. Overall satisfaction was influenced by the patient’s health status, with those in better health reporting more favorable experiences. Conclusions: Patients shared suggestions and complaints about healthcare organization functioning, especially regarding long waiting lists and inadequate conditions during prolonged hospital stays. Overall, their view of the National Health System, particularly Primary Health Care, was less positive compared to the satisfaction with the health organizations under study. This study highlights the importance of follow-up for cancer survivors, with many patients valuing post-discharge contact as a space to share experiences and challenges. The psychological monitoring of patients and families surviving cancer should be clinical practice in health organizations. Full article

17 pages, 239 KB

Open AccessArticle

Stakeholder Roles and Views in the Implementation of the Differentiated HIV Treatment Service Delivery Model Among Female Sex Workers in Gauteng Province, South Africa

by Lifutso Motsieloa, Edith Phalane and Refilwe N. Phaswana-Mafuya

Healthcare 2025, 13(18), 2329; https://doi.org/10.3390/healthcare13182329 - 17 Sep 2025

Abstract

Background: Key populations (KPs), particularly female sex workers (FSWs), continue to face significant barriers in accessing HIV-related healthcare services in South Africa. Structural challenges have historically hindered equitable HIV treatment access, worsened by the COVID-19 pandemic. Overburdened clinics, staff shortages, and travel constraints [...] Read more.

Background: Key populations (KPs), particularly female sex workers (FSWs), continue to face significant barriers in accessing HIV-related healthcare services in South Africa. Structural challenges have historically hindered equitable HIV treatment access, worsened by the COVID-19 pandemic. Overburdened clinics, staff shortages, and travel constraints disrupted HIV services and ART adherence. In response, the Differentiated Service Delivery (DSD) model was rapidly scaled up to decentralise care and improve treatment continuity. Objective: To solicit the views of stakeholders regarding their interests, roles and experiences in the implementation of the HIV treatment DSD model among FSWs in South Africa, as well as associated successes and barriers thereof. Methods: We purposively selected and interviewed eight stakeholders, comprising government officials, implementers and sex workers’ advocacy organizations. Thematic analysis was used to explore the perceived impact of DSD models and associated successes and barriers in the current service delivery landscape. Results: The study found that decentralization of DSD models improved access to services for FSWs. However, the criminalization of sex work perpetuates fear and marginalization, while stigma and discrimination within healthcare settings remain significant deterrents to HIV treatment uptake. High mobility among FSWs also disrupts continuity of care, contributing to treatment interruptions and lack of data on loss to follow-up. Participants highlighted the need for legal reform, increased healthcare provider sensitization, and the integration of mental health and psychosocial support in HIV services. Peer-led interventions and digital health innovations, such as biometric systems and electronic medical records, emerged as promising strategies for enhancing patient tracking and retention. Nonetheless, the sustainability of DSD models is threatened by an overreliance on external donor funding and insufficient government ownership. Conclusions: To achieve equitable healthcare access and improved HIV outcomes for KPs, especially FSWs, a multi-pronged, rights-based approach is essential. This must include community engagement, structural and legal reforms, integrated support services, and sustainable financing mechanisms to ensure the long-term impact and scalability of DSD models. Full article

13 pages, 263 KB

Open AccessReview

Conservative and Pharmacological Strategies for Preventing Osteoporotic Stress Fractures in Older Recreational Competitors

by Lana Ružić, Marija Rakovac, Ines Bilić-Ćurčić, Domagoj Jakovac and Maja Cigrovski Berković

Healthcare 2025, 13(18), 2328; https://doi.org/10.3390/healthcare13182328 - 17 Sep 2025

Abstract

Exercise and bone health are crucial for overall cardiovascular and metabolic well-being. However, certain types of activities can increase the risk of osteoporotic fractures. Preventing injuries while remaining active can be challenging, particularly for older competitive recreational athletes whose training volumes can be [...] Read more.

Exercise and bone health are crucial for overall cardiovascular and metabolic well-being. However, certain types of activities can increase the risk of osteoporotic fractures. Preventing injuries while remaining active can be challenging, particularly for older competitive recreational athletes whose training volumes can be comparable to those of professional athletes. While high levels of physical activity in older adults typically lead to thicker cortical bone and improved physical fitness, age-related bone loss, hormonal changes, nutrition, and a history of fractures can significantly raise the risk of osteoporosis. This narrative review provides a descriptive summary of the current understanding of the paradox between exercise and bone fragility, particularly in recreational athletes. Many older athletes may be unaware of their declining bone mineral density, believing that their activity levels are sufficient. Ironically, high-impact activities like running and jumping, which are generally recommended for the prevention of osteoporosis, can also increase the risk of stress fractures. Early detection of osteoporosis is crucial, and this can be achieved through DEXA scans and regular bone density tests, allowing for timely intervention before fractures occur. Alongside medications, strength training, as well as balance and stability exercises, can be very beneficial. It is also important to maintain healthy lifestyle choices, ensure adequate energy levels, and consume sufficient amounts of calcium and vitamin D. Furthermore, monitoring training volume and allowing for proper recovery can help reduce the risk of osteoporotic stress fractures in athletes. Full article

(This article belongs to the Special Issue Sports Injury Prevention)

11 pages, 839 KB

Open AccessArticle

Quantification of Thoracic Volume and Spinal Length of Pediatric Scoliosis Patients on Chest MRI Using a 3D U-Net Segmentation

by Romy E. Buijs, Dingina M. Cornelissen, Dimo Devetzis, Peter P. G. Lafranca, Daniel Le, Jiaxin Zhang, Mitko Veta, Koen L. Vincken and Tom P. C. Schlösser

Healthcare 2025, 13(18), 2327; https://doi.org/10.3390/healthcare13182327 - 17 Sep 2025

Abstract

Background/Objectives: Adolescent idiopathic scoliosis (AIS) can lead to significant chest deformations. The quantification of chest deformity and spinal length could provide additional insights for monitoring during follow-up and treatment. This study proposes a 3D U-Net convolutional neural network (CNN) for automatic thoracic and [...] Read more.

Background/Objectives: Adolescent idiopathic scoliosis (AIS) can lead to significant chest deformations. The quantification of chest deformity and spinal length could provide additional insights for monitoring during follow-up and treatment. This study proposes a 3D U-Net convolutional neural network (CNN) for automatic thoracic and spinal segmentations of chest MRI scans. Methods: In this proof-of-concept study, axial chest MRI scans from 19 girls aged 8–10 years at risk for AIS development and 19 asymptomatic young adults were acquired (n = 38). The thoracic volume and spine were manually segmented as the ground truth (GT). A 3D U-Net CNN was trained on 31 MRI scans. The seven remaining MRI scans were used for validation, reported by the Dice similarity coefficient (DSC), the Hausdorff distance (HD), precision, and recall. From these segmentations, the thoracic volume and 3D spinal length were calculated. Results: Automatic chest segmentation was possible for all chest MRIs. For the chest volume segmentations, the average DSC was 0.91, HD was 51.89, precision was 0.90, and recall 0.99. For the spinal segmentation, the average DSC was 0.85, HD was 25.98, precision was 0.74, and recall 0.99. Chest volumes and 3D spinal lengths differed by on average 11% and 12% between automatic and GT, respectively. Qualitative analysis showed agreement between the automatic and manual segmentations in most cases. Conclusions: The proposed 3D U-Net CNN shows a high accuracy and good predictions in terms of HD, DSC, precision, and recall. This suggested 3D U-Net CNN could potentially be used to monitor the progression of chest deformation in scoliosis patients in a radiation-free manner. Improvement can be made by training the 3D U-net with more data and improving the GT data. Full article

(This article belongs to the Special Issue Scoliosis Deformity—Etiological Aspects, Management and Rehabilitation)

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10 pages, 227 KB

Open AccessArticle

Young Smokers’ Therapy Preferences: App-Based vs. Face-to-Face Treatment in the Context of Co-Addictions

by Francisca López-Torrecillas, María del Mar Arcos-Rueda, Beatriz Cobo-Rodríguez and Lucas Muñoz-López

Healthcare 2025, 13(18), 2326; https://doi.org/10.3390/healthcare13182326 - 17 Sep 2025

Abstract

Background: Tobacco use remains a major public health concern among young adults and is often complicated by co-occurring addictive behaviors. Objective: This study analyzed motivation for change, assessed with the decisional balance framework, in relation to multiple addictions among young smokers seeking treatment. [...] Read more.

Background: Tobacco use remains a major public health concern among young adults and is often complicated by co-occurring addictive behaviors. Objective: This study analyzed motivation for change, assessed with the decisional balance framework, in relation to multiple addictions among young smokers seeking treatment. Methods: Ninety-eight participants from the University of Granada enrolled in either an app-based cognitive–behavioral therapy (CBT) program (n = 35) or a traditional face-to-face CBT program (n = 63). Recruitment relied on self-identification and voluntary participation. Standardized instruments were applied to measure nicotine dependence (FTND), behavioral and substance-related addictions (MULTICAGE CAD-4), cannabis dependence (SDS), and motivation for change (DBQ). Logistic and stepwise regression analyses were conducted to identify predictors of treatment choice and motivational outcomes. Results: Younger participants and students were more likely to choose the app-based program. Compulsive buying was linked to perceiving more disadvantages of smoking, whereas sex addiction, cannabis dependence, and other substance addictions were associated with perceiving fewer disadvantages. Conclusions: Treatment preferences and motivational profiles differ according to age, academic status, and co-occurring addictions. These findings highlight the need to tailor smoking cessation strategies to individual profiles and support the role of mobile health tools in engaging digitally oriented populations. Full article

(This article belongs to the Special Issue Mental Health, Innovative Therapies and Assessment in Adolescents and Young Adults and Related Contexts)

12 pages, 4740 KB

Open AccessArticle

Intraoperative Surgeon-Performed Ultrasound in Complex Partial Nephrectomy: Insights from Challenging Renal Tumors

by Stelian Ianiotescu, Constantin Gingu, Nicoleta Sanda, Alexandru Iordache, Alexandru Dick and Ioanel Sinescu

Healthcare 2025, 13(18), 2325; https://doi.org/10.3390/healthcare13182325 - 17 Sep 2025

Abstract

Introduction: Intraoperative ultrasound (IOUS) is increasingly utilized in nephron-sparing surgery for its ability to provide real-time, high-resolution imaging that enhances tumor localization and resection accuracy. Its role becomes particularly important in anatomically complex cases such as endophytic, multifocal, or recurrent renal tumors, as [...] Read more.

Introduction: Intraoperative ultrasound (IOUS) is increasingly utilized in nephron-sparing surgery for its ability to provide real-time, high-resolution imaging that enhances tumor localization and resection accuracy. Its role becomes particularly important in anatomically complex cases such as endophytic, multifocal, or recurrent renal tumors, as well as in patients with a solitary kidney. Methods: We conducted a retrospective analysis of 152 patients who underwent partial nephrectomy for localized renal tumors between January 2019 and December 2024. Patients were divided into two groups: Group A (n = 24) included patients with a solitary surgical kidney or tumor recurrence; Group B (n = 128) included patients with a contralateral functional kidney. IOUS was used in 31 cases (20%). Demographic, perioperative, and oncological outcomes were compared, with specific attention to the use and impact of IOUS. Results: IOUS was significantly more common in Group A (75%) than in Group B (10%) (p < 0.001), reflecting its preferential use in higher-complexity surgeries. The rate of positive surgical margins was low overall, with no significant difference between the IOUS and non-IOUS groups (3.2% vs. 1.7%; p = 0.54). IOUS was more frequently employed in cases involving medium/high RENAL nephrometry scores and multifocal tumors, contributing to improved intraoperative tumor delineation without increasing complication rates. Conclusions: IOUS enhances surgical precision and supports oncologic safety in both robotic and open partial nephrectomies, particularly in complex scenarios. Its use should be encouraged as a standard adjunct in conservative renal surgery, especially in patients with a solitary kidney, recurrent disease, or multifocal tumors. Full article

(This article belongs to the Special Issue Correlations Between Diagnostic Imaging and Morphology in Personalized Medicine)

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19 pages, 685 KB

Open AccessSystematic Review

Bridging Gaps in Holistic Rehabilitation After Critical Illness: A Systematic Review

by Anna Korompeli, Kalliopi Kydonaki and Pavlos Myrianthefs

Healthcare 2025, 13(18), 2324; https://doi.org/10.3390/healthcare13182324 - 16 Sep 2025

Abstract

Background: Holistic care in the Intensive Care Unit (ICU) addresses the full spectrum of patient needs—physical, emotional, psychological, social, spiritual, and environmental—to support recovery and improve long-term outcomes after critical illness. Objective: This systematic review aimed to synthesize evidence on the effectiveness of [...] Read more.

Background: Holistic care in the Intensive Care Unit (ICU) addresses the full spectrum of patient needs—physical, emotional, psychological, social, spiritual, and environmental—to support recovery and improve long-term outcomes after critical illness. Objective: This systematic review aimed to synthesize evidence on the effectiveness of holistic care interventions across these six dimensions of wellness in adult ICU patients. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted following PRISMA guidelines. The SPICE framework was used to define the scope (Setting: ICU; Perspective: patients; Intervention: holistic care; Comparison: standard care; Evaluation: multi-dimensional outcomes). Studies published in English between 1999 and 2024 were included. Methodological quality was appraised using Joanna Briggs Institute (JBI) tools. Results: Seven studies, comprising randomized controlled trials, observational, and mixed-methods designs, met the inclusion criteria. The interventions were diverse, encompassing corporeal rehabilitation, spiritual care toolkits, reflexology, early physical therapy, patient diaries, and family involvement. A narrative synthesis of these heterogeneous studies suggested potential benefits and high acceptability for various patient-centered outcomes. Conclusions: The limited but promising evidence indicates that holistic care interventions may contribute positively to ICU patient recovery. The findings underscore the need for more robust, high-quality research to conclusively determine their efficacy and support their integration into standard critical care practice. Full article

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