Healthcare

41 pages, 1153 KB

Open AccessArticle

Evaluating the Effectiveness of a School-Based Mental Health Training Programme: The Transformative, Resilient, Youth-Led (TRY) Gym

by Wai-Chung Chung, Fan Jiang, Yin Ling Beryl Fok, Cheung Ying Chiu, Winnie Wing Yan Yuen, Josephine Wing-Fun Fung, Anson Chui Yan Tang, Po Fai Jonah Li, Raymond Chi-Fai Chui and Chi-Keung Chan

Healthcare 2026, 14(1), 9; https://doi.org/10.3390/healthcare14010009 - 19 Dec 2025

Abstract

Background: The Transformative, Resilient, and Youth-Led/Driven (TRY) Gym, a school-based co-creative mental health training programme, is grounded in the Positive Youth Development (PYD) approach. It seeks to improve adolescents’ mental health and well-being by strengthening their resilience and competence. Additionally, it prepares [...] Read more.

Background: The Transformative, Resilient, and Youth-Led/Driven (TRY) Gym, a school-based co-creative mental health training programme, is grounded in the Positive Youth Development (PYD) approach. It seeks to improve adolescents’ mental health and well-being by strengthening their resilience and competence. Additionally, it prepares them to deliver peer-led mental health activities, promoting mental wellness and fostering a stigma-free, supportive environment. Methods: This study evaluated the programme using a mixed-method design. In total, 94 students from eight secondary schools in Hong Kong were recruited, with 80 participating in the evaluation. Results: Five outcomes showed significant improvements from baseline to the post-implementation phase, including social competence, cognitive competence, emotional competence, resilience, and mental well-being. Common features were identified across interviews, which may possibly account for the significant results and participants’ improved mental health. Conclusions: The TRY Gym programme’s fidelity was demonstrated by its completion, which included high participant responsiveness, and a co-creative and youth-driven approach in the project. In addition, the positive outcomes of the programme underscore its effectiveness in improving mental health among adolescents by imparting mental health knowledge and providing opportunities for participants to apply learnt techniques in everyday life situations. Full article

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

27 pages, 1946 KB

Open AccessArticle

Psychological Needs and Problematic Social Media Use in Adolescents: A Gender-Moderated Mediation via Sensation Seeking and Cognitive Flexibility

by Kübra Dombak, İbrahim Erdoğan Yayla, Samet Makas, Eyüp Çelik, Ümit Sahranç and Mehmet Kaya

Healthcare 2026, 14(1), 8; https://doi.org/10.3390/healthcare14010008 - 19 Dec 2025

Abstract

Background: The purpose of this study is to examine the mediating roles of cognitive flexibility and sensation seeking in the relationship between basic psychological needs and problematic social media use. Furthermore, the moderating effect of gender on indirect effects has been examined. [...] Read more.

Background: The purpose of this study is to examine the mediating roles of cognitive flexibility and sensation seeking in the relationship between basic psychological needs and problematic social media use. Furthermore, the moderating effect of gender on indirect effects has been examined. Method: The sample of the study consisted of 838 Turkish adolescents aged between 14 and 18 (46.2% female; Mean = 15.6, SD = 1.71). Participants completed the Bergen Social Media Addiction Scale, the Basic Psychological Needs Scale, the Cognitive Flexibility Scale, and the Brief Sensation Seeking Scale. Data were analyzed using structural equation modeling (SEM) with the AMOS 26.0 program. Results: A significant relationship was found between basic psychological needs and problematic social media use (r = 0.43, p < 0.001). Both cognitive flexibility and sensation seeking partially mediated this relationship in girls (β = −0.23, p < 0.001), while fully mediating it in boys (β = 0.03, p = 0.675). Conclusions: The findings suggest that problematic social media use in adolescents may be associated with cognitive flexibility and increased sensation-seeking tendencies stemming from unmet psychological needs, and that gender plays an important role in this relationship. Full article

(This article belongs to the Special Issue The Influence of Social Media on Health Behavior)

18 pages, 589 KB

Open AccessArticle

Towards Differentiated Management: The Role of Organizational Type and Work Position in Shaping Employee Engagement Among Slovak Healthcare Professionals

by Veronika Juran, Stela Kolesárová and Viktória Ali Taha

Healthcare 2026, 14(1), 7; https://doi.org/10.3390/healthcare14010007 - 19 Dec 2025

Abstract

Background/Objectives: Employee engagement is fundamental for the quality and sustainability of the Slovak healthcare sector. While the concept is critical, its operational challenges lie in the differentiated perception of its drivers across the highly heterogeneous workforce. This study aimed to empirically identify [...] Read more.

Background/Objectives: Employee engagement is fundamental for the quality and sustainability of the Slovak healthcare sector. While the concept is critical, its operational challenges lie in the differentiated perception of its drivers across the highly heterogeneous workforce. This study aimed to empirically identify and structure the key antecedent factors of engagement and examine their perception based on structural and sociodemographic characteristics among healthcare workers in Slovakia. Methods: This research employed a quantitative, cross-sectional design, utilizing a self-administered questionnaire distributed widely among healthcare providers throughout Slovakia. To achieve the study’s objectives, several advanced mathematical and statistical methods were applied: the Kaiser-Meyer-Olkin (KMO) Measure and Bartlett’s Test for sample adequacy, Principal Component Analysis (PCA) for empirical factor structuring and Analysis of Variance (ANOVA). Results: Three common antecedent factors for healthcare workers’ engagement and well-being were identified: Factor 1—Organizational Commitment and Identity; Factor 2—Meaningful Involvement and Job Satisfaction; and Factor 3—Organizational Citizenship and Retention Intent. Factor 1 was evaluated positively in public (state-owned) and mixed organizations but negatively in private healthcare providers, confirming a statistically significant difference. Factor 2 also exhibited significant differences based on work position: it was negatively rated by management, physicians, and nurses, but positively by other staff categories. Conclusions: The contribution of this study lies in the empirical confirmation that a universal managerial approach to increasing employee engagement in Slovak healthcare is ineffective. A differentiated managerial approach based on organizational type and work position directly supports the transition from blanket, expensive, and ineffective HR policies to strategic and targeted engagement management, which is essential for the long-term sustainability and improvement of care quality in Slovak healthcare. Full article

(This article belongs to the Special Issue Job Satisfaction and Mental Health of Workers: Second Edition)

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17 pages, 523 KB

Open AccessArticle

Otologic Axis and Sleep-Disordered Breathing in Achondroplasia: Age-Structured Cohort Findings

by Cristina Popescu, Rebecca-Cristiana Serban, Andreea Mituț-Velișcu, Andrei Costache, Raluca-Ioana Teleanu, Diana Ionescu, Cristian Arsenie, Renata-Maria Varut, Ion-Dorin Pluta, Virginia Maria Radulescu and Ioana Streață

Healthcare 2026, 14(1), 6; https://doi.org/10.3390/healthcare14010006 - 19 Dec 2025

Abstract

Background/Objectives: Achondroplasia is linked to distinctive ear–nose–throat (ENT) morbidity, yet quantitative age-structured profiles and actionable correlates remain incompletely defined. This study mapped ENT phenotypes in a consecutive cohort and examined the achondroplasia subset for prevalence, co-occurrence, age dynamics, and parsimonious risk models. [...] Read more.

Background/Objectives: Achondroplasia is linked to distinctive ear–nose–throat (ENT) morbidity, yet quantitative age-structured profiles and actionable correlates remain incompletely defined. This study mapped ENT phenotypes in a consecutive cohort and examined the achondroplasia subset for prevalence, co-occurrence, age dynamics, and parsimonious risk models. Methods: Retrospective observational analysis (1 February 2023–31 January 2025). Narrative “ENT complications” were dictionary-mapped to five non-exclusive categories: otitis media, adenotonsillar/apnea—obstructive sleep apnea (OSA), audiologic/Eustachian-tube dysfunction (ETD), nasopharyngeal/upper-respiratory (URT), and extra-ENT. Proportions used Wilson 95% confidence intervals (CIs). Pairwise associations used Fisher’s exact tests with Benjamini–Hochberg false discovery rate (BH-FDR). Age was summarized by a four-level age-class schema (AC-4: 0–2, 3–5, 6–12, ≥13 years) and a two-level sensitivity contrast (AC-2: ≤5 vs. >5 years). Results: Of 83 patients, 64 (77.1%) had achondroplasia. In achondroplasia, otitis media occurred in 51.6% and OSA in 28.1%; versus non-achondroplasia, ARDs were +35.8 and +28.1 percentage points (BH-FDR adjusted). Within achondroplasia, otitis media co-occurred with OSA (odds ratio [OR] 4.97; q = 0.012) and with ETD (OR 7.25; q = 0.012). OSA increased across AC-4 to school age (p-trend = 0.0548). In parsimonious models, otitis media independently predicted ETD and OSA. A five-item ENT-burden score discriminated otologic and adeno-tonsillar interventions (AUC 0.83–0.93). Conclusions: Achondroplasia shows a concentrated ENT burden dominated by otitis media and OSA, with large adjusted absolute differences versus non-achondroplasia. Otitis media functions as a practical clinical marker for both OSA and ETD, while a compact burden score may assist intervention triage. Full article

(This article belongs to the Special Issue Care and Treatment of Ear, Nose, and Throat)

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14 pages, 1748 KB

Open AccessSystematic Review

Filgotinib in Moderate-to-Severe Crohn’s Disease: A Network Meta-Analysis of Efficacy and Adverse Events

by Yasser Ali Khoshaim, Yahya Z. Habis, Afnan Ghazi Daqnah, Razan Khalid Alqurashi, Yazeed Shaker Abdulrahim, Abdullah Sakkat, Sultan Ali Alsubhi, Deema Tawfeq Almuwlad, Halah Samer Bukhari, Abdulrhman J. Shogdar, Omar Ashraf Amir and Mohamed Sayed Zaazouee

Healthcare 2026, 14(1), 5; https://doi.org/10.3390/healthcare14010005 - 19 Dec 2025

Abstract

Background: Filgotinib is an emerging Janus kinase 1 (JAK1) inhibitor being investigated for inflammatory bowel disease. This systematic review and network meta-analysis (NMA) evaluated the efficacy and safety of filgotinib in adult patients with moderate-to-severe crohn’s disease. Methods: We systematically searched PubMed, EMBASE, [...] Read more.

Background: Filgotinib is an emerging Janus kinase 1 (JAK1) inhibitor being investigated for inflammatory bowel disease. This systematic review and network meta-analysis (NMA) evaluated the efficacy and safety of filgotinib in adult patients with moderate-to-severe crohn’s disease. Methods: We systematically searched PubMed, EMBASE, and Scopus through April 2025. Randomized controlled trials evaluating filgotinib versus placebo in adults with moderate-to-severe Crohn’s disease were included. Primary outcomes were clinical remission and endoscopic response. Study quality was assessed using the Cochrane Risk of Bias 2.0 tool. A network meta-analysis was performed to integrate direct and indirect evidence, reporting risk ratios (RRs) with 95% confidence intervals (CIs). Results: Five randomized controlled trials (from 4 publications) met the inclusion criteria. Filgotinib 200 mg significantly improved clinical remission compared with placebo (RR: 1.75 [1.40–2.19]) and 100 mg (RR: 1.38 [1.11–1.71]), while 100 mg showed no significant difference versus placebo (RR: 1.27 [0.99–1.63]). For endoscopic response, both 200 mg (RR: 1.72 [1.09–2.69]) and 100 mg (RR: 1.65 [1.02–2.69]) demonstrated significant benefit over placebo, though no difference was observed between active doses (RR: 1.04 [0.64–1.68]; I² = 57%). In the two-item patient-reported outcome, 200 mg showed significant improvement versus placebo (RR: 1.47 [1.20–1.80]) and 100 mg (RR: 1.26 [1.02–1.55]), while 100 mg remained insignificant versus placebo (RR: 1.17 [0.93–1.46]). Neither dose increased the risk of treatment-emergent adverse events, serious adverse events, or infections compared with placebo, with consistent homogeneity across analyses. Conclusions: Filgotinib 200 mg demonstrated superior efficacy across clinical, endoscopic, and patient-reported outcomes compared with 100 mg and placebo, with a favorable safety profile. The 100 mg dose showed limited efficacy and no advantage over placebo. Filgotinib represents a promising oral therapeutic option, particularly for biologic-naïve patients and in maintenance therapy, while also showing potential benefit in perianal fistulising crohn’s disease. Future trials should explore long-term safety and head-to-head comparisons with established biologics. Full article

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13 pages, 1396 KB

Open AccessArticle

The Power of Belief: Investigating the Placebo Effect in Post-Exercise Recovery Strategies for Football Players

by Marco Pernigoni, Andrius Osvaldo Alfieri, Audinga Kniubaitė, Sigitas Kamandulis, Daniele Conte and Inga Lukonaitienė

Healthcare 2026, 14(1), 4; https://doi.org/10.3390/healthcare14010004 - 19 Dec 2025

Abstract

Objectives: The objective is assessing whether the placebo effect can influence the time course of recovery following a football match. Methods: Using a randomized crossover design, eighteen youth male players (age: 15.3 ± 0.5 years, stature: 178.7 ± 6.4 cm, body [...] Read more.

Objectives: The objective is assessing whether the placebo effect can influence the time course of recovery following a football match. Methods: Using a randomized crossover design, eighteen youth male players (age: 15.3 ± 0.5 years, stature: 178.7 ± 6.4 cm, body mass: 65.3 ± 7.6 kg, playing experience: 8.6 ± 1.5 years) completed two friendly matches, followed by placebo (PLA; sham vagus nerve stimulation) or passive rest (CON). To assess the impact of PLA, countermovement jump height (CMJ), 10 and 20 m sprint times, heart rate variability (Ln-rMSSD), static and dynamic muscle soreness, and perceived fatigue were measured at pre-match, post-match, post-recovery, and 24 h post-match. Results: Our findings indicate that match play induced substantial fatigue, with significant deteriorations [p ≤ 0.002, small-to-large effect sizes (ES)] in CMJ, 10 and 20 m sprint performance, Ln-rMSSD, muscle soreness, and perceived fatigue at post-match and post-recovery compared to pre-match (except Ln-rMSSD between pre-match and post-recovery: p = 0.151, small ES). Although no significant between-intervention differences were found for any variable at any time point (p > 0.05), effect size analysis showed moderately lower perceived fatigue (r = 0.40) and dynamic soreness (r = 0.32) in PLA compared to CON at post-recovery. Conclusions: These findings suggest that while placebo stimulation did not affect performance or heart rate variability, it may support perceptual recovery. This holds relevance for both research and practice, as including placebo conditions can help isolate psychological effects from true treatment responses, while promoting positive expectations may enhance the perceived effectiveness of recovery strategies. Full article

(This article belongs to the Special Issue Advances in Physical Therapy for Sports-Related Injuries and Pain)

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16 pages, 253 KB

Open AccessArticle

Life History, Identity, and Recovery in People with Mental Health Conditions: A Phenomenological Study Using OPHI-II

by Olga I. Fernández-Rodríguez, Alicia Cal-Herrera, María Fernández-Blanco, Paloma Guillén-Rogel, Beatriz Fernández-Díez and Raquel Martínez-Sinovas

Healthcare 2026, 14(1), 3; https://doi.org/10.3390/healthcare14010003 - 19 Dec 2025

Abstract

Background and Objectives: Mental health recovery is conceived as a personal process going beyond symptom remission and thus involving identity reconstruction, search for meaning and active participation in everyday life. This study aimed to analyze the influence of life history, identity, competence [...] Read more.

Background and Objectives: Mental health recovery is conceived as a personal process going beyond symptom remission and thus involving identity reconstruction, search for meaning and active participation in everyday life. This study aimed to analyze the influence of life history, identity, competence and context on the recovery process of people with mental illness. Methods: A qualitative phenomenological study was conducted and registered in the Open Science Framework. Participants were 159 individuals diagnosed with mental disorders who attended a community mental health association. Data were collected using the standardized Occupational Performance History Interview-II (OPHI-II) and analyzed through an inductive phenomenological approach with researcher triangulation. Results: Findings showed that life history is central to recovery, as it helps rebuild identity, recognize personal capacities and restore a sense of continuity. Daily occupations and social support emerged as key factors for inclusion and participation. Conclusions: Results highlight the importance of integrating biographical narratives and occupational perspective into mental health interventions through a standardized tool that surpasses traditional diagnosis-based or methodologically weak approaches. This perspective fosters practices aligned with individuals’ values, goals and contexts, promoting autonomy, empowerment, and social inclusion. These findings may inform person-centered recovery programs in community services. Full article

(This article belongs to the Special Issue Application of Qualitative Methods and Mixed Designs in Healthcare)

10 pages, 201 KB

Open AccessArticle

What Do Older Adults with Frailty and Their Caregivers Want from Advance Care Planning Discussions? A Descriptive Qualitative Study

by Robin Urquhart, Cynthia Kendell, Jessica Vickery and Elias Hirsch

Healthcare 2026, 14(1), 2; https://doi.org/10.3390/healthcare14010002 - 19 Dec 2025

Abstract

Introduction: Advance care planning (ACP) may facilitate person-centered, goal-concordant care for this population. However, we know little about what older adults expect from ACP discussions (that is, the outcomes they expect or desire). We sought to explore patient and family views on the [...] Read more.

Introduction: Advance care planning (ACP) may facilitate person-centered, goal-concordant care for this population. However, we know little about what older adults expect from ACP discussions (that is, the outcomes they expect or desire). We sought to explore patient and family views on the outcomes they consider most pertinent to ACP discussions for older adults living with frailty. Methods: This qualitative descriptive study used semi-structured telephone/video-conferencing interviews with older persons with frailty (65+ years) and their family/friend caregivers from across Canada. All interviews took place in person or via telephone or Zoom with healthcare professionals, depending on the participant’s preference, and were conducted by a researcher with experience in qualitative methods. Data analysis involved coding, grouping, detailing, and comparing the data, using techniques commonly employed in descriptive qualitative research. Results: Nine participants took part in this study: two were individuals living with frailty, and seven were caregivers of persons with frailty. They described three desired outcomes of ACP: (1) maximizing comfort and quality-of-life; (2) enhancing confidence in decision-making, which would heighten families’ level of reassurance as their loved one’s function and health status declines; and (3) maintaining autonomy so that people can live and die on their own terms. Conclusions: Ultimately, research and clinical care should tailor their ACP initiatives and evaluation metrics to align with what patients and families deem most important. The outcomes described by participants of this study should be further investigated and refined in future research. Full article

16 pages, 1091 KB

Open AccessArticle

Association Between Dietary Magnesium Intake and Low Muscle Mass: The Mediating Role of Inflammatory Indicators

by Zhu Zhu, Wenji Wang, Feng Ding and Yue Shen

Healthcare 2026, 14(1), 1; https://doi.org/10.3390/healthcare14010001 - 19 Dec 2025

Abstract

Background: Magnesium is essential for mitochondrial function and muscle regeneration, potentially protecting against low muscle mass (LMM). We examined the association of dietary magnesium intake with LMM risk and skeletal muscle index (SMI), and whether inflammatory indicators mediate this relationship. Methods: A total [...] Read more.

Background: Magnesium is essential for mitochondrial function and muscle regeneration, potentially protecting against low muscle mass (LMM). We examined the association of dietary magnesium intake with LMM risk and skeletal muscle index (SMI), and whether inflammatory indicators mediate this relationship. Methods: A total of 5793 participants aged 20–59 years were included in this study from the National Health and Nutrition Examination Survey (NHANES) conducted from 2011 to 2018. To investigate the association of dietary magnesium intake with LMM and SMI, we applied weighted logistic regression model, linear regression model, restricted cubic spline analysis, subgroup analysis and sensitivity analysis. Inflammatory indicators were assessed using mediation analysis, including the C-reactive protein–albumin–lymphocyte (CALLY) index, neutrophil–platelet score (NP), platelet-to-albumin ratio (PAR) and red blood cell distribution width-to-albumin ratio (RAR) mediation. Results: In the fully adjusted model, participants in the highest magnesium quartile had a reduced risk of LMM, with OR of 0.33 (95% CI: 0.18, 0.60), and increased levels of SMI, with β values of 0.05 (95% CI: 0.04, 0.07). Mediation analysis showed that NP, PAR, and RAR mediated 18%, 13%, and 21% of the association between magnesium and LMM, respectively, and also acted as mediators of the relationship between magnesium and SMI, with mediation ratios of 32%, 24%, and 25%, respectively. Conclusion: Higher dietary magnesium intake was associated with lower LMM risk and higher SMI, partly mediated through inflammatory indicators involving NP, PAR, and RAR. This finding may provide a new perspective on the prevention and management of LMM. Full article

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

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22 pages, 893 KB

Open AccessArticle

Enhancing Diagnostic Infrastructure Through Innovation-Driven Technological Capacity in Healthcare

by Nicoleta Mihaela Doran

Healthcare 2025, 13(24), 3328; https://doi.org/10.3390/healthcare13243328 - 18 Dec 2025

Abstract

Background: This study examines how national innovation performance shapes the diffusion of advanced diagnostic technologies across European healthcare systems. Strengthening technological capacity through innovation is increasingly essential for resilient and efficient health services. The analysis quantifies the influence of innovation capacity on the [...] Read more.

Background: This study examines how national innovation performance shapes the diffusion of advanced diagnostic technologies across European healthcare systems. Strengthening technological capacity through innovation is increasingly essential for resilient and efficient health services. The analysis quantifies the influence of innovation capacity on the availability of medical imaging technologies in 26 EU Member States between 2018 and 2024. Methods: A balanced panel dataset was assembled from Eurostat, the European Innovation Scoreboard, and World Bank indicators. Dynamic relationships between innovation performance and the adoption of CT, MRI, gamma cameras, and PET scanners were estimated using a two-step approach combining General-to-Specific (GETS) outlier detection with Robust Least Squares regression to address heterogeneity and specification uncertainty. Results: Higher innovation scores significantly increase the diffusion of R&D-intensive technologies such as MRI and PET, while CT availability shows limited responsiveness due to market maturity. Public health expenditure supports frontier technologies when strategically targeted, whereas GDP growth has no significant effect. Population size consistently enhances technological capacity through scale and system-integration effects. Conclusions: The findings show that innovation ecosystems, rather than economic growth alone, drive the modernization of diagnostic infrastructure in the EU. Integrating innovation metrics into health-technology assessments offers a more accurate basis for designing innovation-oriented investment policies in European healthcare. Full article

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12 pages, 914 KB

Open AccessReview

Artificial Intelligence and Innovation in Oral Health Care Sciences: A Conceptual Review

by Marco Dettori, Demetrio Lamloum, Peter Lingström and Guglielmo Campus

Healthcare 2025, 13(24), 3327; https://doi.org/10.3390/healthcare13243327 - 18 Dec 2025

Abstract

Background/Objectives: Artificial intelligence (AI) has rapidly evolved from experimental algorithms to transformative tools in clinical dentistry. Between 2020 and 2025, advances in machine learning (ML) and deep learning (DL) have reshaped diagnostic imaging, caries detection, prosthodontic design, and teledentistry, while raising new [...] Read more.

Background/Objectives: Artificial intelligence (AI) has rapidly evolved from experimental algorithms to transformative tools in clinical dentistry. Between 2020 and 2025, advances in machine learning (ML) and deep learning (DL) have reshaped diagnostic imaging, caries detection, prosthodontic design, and teledentistry, while raising new ethical and regulatory challenges. This study aimed to provide a comprehensive bibliometric and conceptual review of AI applications in dental care, highlighting research trends, thematic clusters, and future directions for equitable and responsible integration of AI technologies. In addition, the review further considers the implications of AI adoption for patient-centered care, including its potential role in supporting shared decision-making processes in oral healthcare. Methods: A comprehensive search was conducted in PubMed, Scopus and Embase for articles published between January 2020 and October 2025 using AI-related keywords in dentistry. Eligible records were analyzed using VOSviewer (v.1.6.20) to map co-occurrence networks of keywords, authors, and citations. A narrative synthesis complemented the bibliometric mapping, emphasizing conceptual and ethical dimensions of AI adoption in oral health care. Results: A total of 50 documents met the inclusion criteria. Bibliometric network visualization identified that the largest and most interconnected clusters were centered around the keywords “artificial intelligence,” “machine learning,” and “deep learning,” reflecting the technological backbone of AI-based applications in dentistry. Thematic evolution analysis indicated increasing interest in generative and multimodal AI models, explainability, and fairness in clinical deployment. Conclusions: AI has become a core driver of innovation in dentistry, enabling precision diagnostics and personalized care. However, responsible translation requires robust validation, transparency, and ethical oversight. Future research should integrate interdisciplinary approaches linking AI performance, patient outcomes, and equity in oral health. Full article

(This article belongs to the Special Issue The Future of Patient-Centered Care: Digital Tools and Strategies for Shared Decision-Making)

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18 pages, 667 KB

Open AccessArticle

Cross-Cultural Adaptation and Validation of the Beck Depression Inventory (BDI-II) in the Community Otomi of the Mezquital Valley, Mexico

by Irene López-Hernández, Claudia Lerma, Rebeca María Elena Guzmán-Saldaña, Itzel Moreno Vite, María Luisa Escamilla Gutiérrez, Cristina J. González-Flores and Abel Lerma

Healthcare 2025, 13(24), 3326; https://doi.org/10.3390/healthcare13243326 - 18 Dec 2025

Abstract

Background: The Beck Depression Inventory Second Edition (BDI-II) is used to assess depression worldwide. In Mexico, the BDI-II Spanish translation is widely used. Despite more than 23 million people being identified as indigenous, there is no empirical evidence on the BDI-II psychometric properties [...] Read more.

Background: The Beck Depression Inventory Second Edition (BDI-II) is used to assess depression worldwide. In Mexico, the BDI-II Spanish translation is widely used. Despite more than 23 million people being identified as indigenous, there is no empirical evidence on the BDI-II psychometric properties among indigenous languages, including Otomi. Therefore, this study aimed to cross-culturally adapt the BDI-II for the Otomi population and evaluate its psychometric properties. Methods: This cross-sectional instrumental study with non-probability sampling was conducted with 228 participants from the Otomi community. The cross-cultural adaptation of the BDI-II followed Beaton’s guidelines for self-report measures: (i) translation, (ii) synthesis, (iii) back translation, (iv) expert committee review, (v) pretesting, and (vi) submission of documentation to the developers. Reliability was assessed using Cronbach’s alpha. Exploratory and confirmatory factor analyses were used to determine structural and construct validity. Results: The cross-culturally adapted instrument showed adequate reliability, with a total Cronbach’s α of 0.756, comprising 14 items and four factors (with alpha coefficients ranging from 0.505 to 0.633). These factors included three cognitive–affective dimensions and one somatic dimension, which conceptually align with Beck’s original model. Confirmatory factor analysis (CFA) presented adequate indices: Comparative Fit Index (CFI) = 0.901, Root Mean Square Error of Approximation (RMSEA) = 0.056, IC_90% [0.028–0.079], and Goodness-of-Fit Index = 0.908, which indicate a balanced and parsimonious fit of the model. Conclusions: The BDI-II is a reliable and culturally valid instrument for measuring depressive symptoms among the Otomi people of the Mezquital Valley. Full article

(This article belongs to the Special Issue Depression: Recognizing and Addressing Mental Health Challenges)

15 pages, 273 KB

Open AccessArticle

Comparative Assessment of Out-of-Pocket Health Expenditure in Haemodialysis and Peritoneal Dialysis Patients

by Suhaila Saad, Nurulhuda Mohd Satar and Roza Hazli Zakaria

Healthcare 2025, 13(24), 3325; https://doi.org/10.3390/healthcare13243325 - 18 Dec 2025

Abstract

Background: Dialysis is a life-sustaining treatment for patients with end-stage renal disease (ESRD), but it requires high financial costs due to the need for continuous treatment and the associated expenses of medical supplies, equipment, and related care. Objective: This study aims to compare [...] Read more.

Background: Dialysis is a life-sustaining treatment for patients with end-stage renal disease (ESRD), but it requires high financial costs due to the need for continuous treatment and the associated expenses of medical supplies, equipment, and related care. Objective: This study aims to compare the out-of-pocket (OOP) health expenditure incurred by patients undergoing haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). Methods: The data for this observational cross-sectional study were obtained through a survey at two public hospitals, comprising a sample of 220 ESRD patients. In order to compare the OOP health expenditure between two modalities, the Mann–Whitney U test and the chi-square test were employed. Multiple linear-regression analysis was then used to identify the contributing factors associated with the aforementioned OOP expenses. Results: The estimated median monthly OOP health expenditure for HD patients was MYR 388 (interquartile range [IQR: 224–519]), significantly higher than CAPD (MYR 160 [IQR: 100–231]; p < 0.001). Our findings confirm that the choice of dialysis modality significantly affects the OOP health expenditures for dialysis patients

(M Y R 145.73; 95 % C I : 75.51 - 218.15; p < 0.05; 0.001) .

Additional determinants of OOP health expenditure identified in this study include the interaction between the modality choice and the distance from home to the dialysis centre (MYR 3.39; 95% CI: 0.27–6.66; p < 0.05; 0.022), comorbidity status (MYR 49.51; 95% CI: 9.09–90.77; p < 0.05; 0.031), duration of illness (MYR 4.01; 95% CI: 0.71–7.63; p < 0.05; 0.041), and household income MYR 67.43 (95% CI: 1.71–134.81; p < 0.05; 0.021). Conclusions: This study emphasises the need to improve the training and awareness of CAPD to increase its use, as it requires less travel and lowers OOP expenses. In addition, introducing a travel reimbursement scheme is also recommended to reduce the transportation costs for HD patients. Full article

21 pages, 1503 KB

Open AccessSystematic Review

Nutritional Interventions in Head and Neck Cancer Patients Undergoing Chemoradiotherapy: A Systematic Review and Meta-Analysis

by Sneha Patnaik, Jiun-Yi Wang, Fawziyyah Usman Sadiq and Khemraj Sharma

Healthcare 2025, 13(24), 3324; https://doi.org/10.3390/healthcare13243324 - 18 Dec 2025

Abstract

Background: Head and neck cancer patients frequently encounter nutritional deterioration, culminating in poor clinical and treatment-related outcomes and reduced quality of life. This systematic review and meta-analysis aim to examine the effects of non-invasive nutritional interventions on nutritional status and clinical, biochemical, and [...] Read more.

Background: Head and neck cancer patients frequently encounter nutritional deterioration, culminating in poor clinical and treatment-related outcomes and reduced quality of life. This systematic review and meta-analysis aim to examine the effects of non-invasive nutritional interventions on nutritional status and clinical, biochemical, and patient-reported outcomes. Methods: A comprehensive literature search across five databases (PubMed, CINAHL, ProQuest, Medline, and Scopus) was carried out to identify potentially relevant randomized control trials published in English between 2019 and 2024. Screening, extraction of data, and quality check were carried out separately by two reviewers. The Joanna Briggs Critical Appraisal tools assessed the quality of the included studies and evidence certainty was appraised using the GRADE framework. Depending on the amount of heterogeneity present, a random or fixed-effects model was used to conduct the meta-analysis. Results: Eleven studies were included, involving 1000 participants. Pooled estimates showed significant effects on weight (SMD = 0.171, 95%CI: 0.008, 0.335, p = 0.04), serum albumin (SMD = 0.539, 95%CI: 0.150, 0.927, p= 0.007), and patient-generated subjective global assessment score (SMD = −0.518, 95%CI: −0.931, −0.106, p = 0.014) in the intervention group compared to controls. Bias concerns were observed in some studies, largely stemming from inadequate blinding and deviations from intention-to-treat analysis. Evidence certainty ranged from moderate to very low. Conclusions: Non-invasive, patient-directed nutritional interventions may lead to clinically meaningful benefits in patients with head and neck cancer receiving chemoradiotherapy, particularly for the maintenance of body weight and nutritional status. However, robust, adequately powered trials with standardized reporting of intervention components and outcome measures are needed in the future to strengthen the evidence base for clinical application. Full article

(This article belongs to the Special Issue Nutrition in Patient Care: Second Edition)

16 pages, 363 KB

Open AccessSystematic Review

Training Nurses for Disasters: A Systematic Review on Self-Efficacy and Preparedness

by Monica Nikitara, Amarachi Kalu, Evangelos Latzourakis, Costas S. Constantinou and Venetia Sofia Velonaki

Healthcare 2025, 13(24), 3323; https://doi.org/10.3390/healthcare13243323 - 18 Dec 2025

Abstract

Background: The rising frequency and complexity of disasters underscores the urgent need for robust preparedness in healthcare. Nurses and nursing students, as key frontline responders, often lack sufficient training to respond effectively to emergencies and recovery efforts. Aim: This review evaluates the effectiveness [...] Read more.

Background: The rising frequency and complexity of disasters underscores the urgent need for robust preparedness in healthcare. Nurses and nursing students, as key frontline responders, often lack sufficient training to respond effectively to emergencies and recovery efforts. Aim: This review evaluates the effectiveness of disaster preparedness training in terms of nurses’ and nursing students’ self-efficacy in providing disaster care and determines which training approaches are most effective. Method: A systematic review was conducted of peer-reviewed articles published in English between 2014 and 2025 across Medline, PubMed, ProQuest, and Health & Medical Col. Search terms included nurses, nursing students, self-efficacy, disaster training, emergency preparedness, training, simulation and scenario-based learning. Results: Nineteen peer-reviewed studies met the inclusion criteria. Overall, disaster preparedness training was found to enhance nurses’ and nursing students’ self-efficacy, knowledge and skills, with simulation-based and scenario-driven approaches producing the most consistent gains. These methods provided realistic and immersive experiences that fostered confidence and strengthened preparedness. Traditional lectures and workshops also improved outcomes but were generally less effective in sustaining self-efficacy over time. Reported challenges included limited faculty expertise, insufficient institutional support, and psychological barriers that may reduce engagement and impact. Conclusion: Integrating disaster preparedness into nursing curricula and professional training is vital for strengthening nurses’ and nursing students’ self-efficacy in crisis response. Evidence shows that simulation-based education, particularly when combined with traditional approaches, is especially effective in building knowledge and skills. Embedding these methods into training frameworks offers a sustainable strategy to ensure a more competent and resilient nursing workforce. Full article

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15 pages, 506 KB

Open AccessArticle

Bridging the Knowledge Gap: A National Survey on MASLD Awareness and Management Barriers in the Saudi Population

by Abdulrahman Alwhaibi, Wael Mansy, Wajid Syed, Salmeen D. Babelghaith and Mohamed N-Alarifi

Healthcare 2025, 13(24), 3322; https://doi.org/10.3390/healthcare13243322 - 18 Dec 2025

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide. It greatly increases hepatic cirrhosis and cancer, cardiovascular disease, and chronic kidney disease. Despite the rising frequency of MASLD in Saudi Arabia, public understanding of its management [...] Read more.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide. It greatly increases hepatic cirrhosis and cancer, cardiovascular disease, and chronic kidney disease. Despite the rising frequency of MASLD in Saudi Arabia, public understanding of its management is lacking. Objective: This study seeks to evaluate public knowledge, attitudes, and management barriers related to MASLD, thereby informing future educational and preventive strategies. Methods: A cross-sectional study was conducted from November 2023 to October 2024, involving 502 participants across Saudi Arabia, employing a modified self-administered online questionnaire. Data was analyzed using SPSS 25. Descriptive statistics and Chi-square tests were used to investigate correlations between knowledge or attitude levels and demographics, with a significance threshold of p < 0.05. Results: Less than half of the respondents who took part (47.2%) had heard of MASLD. Of them, 24.9% had good knowledge, 38.2% had fair knowledge, and 36.9% had low understanding. There were strong links between knowledge and age, education, and job status, but not between knowledge and gender (p = 0.514). People were somewhat aware that being overweight (48.4%) and having high cholesterol (51.8%) were risk factors, but they often had wrong ideas regarding diabetes and high blood pressure. Only 7.8% of those surveyed said they had been formally diagnosed, and 74.4% of those who had been were given advice on how to change their lifestyle. Barriers to management included the idea that lifestyle change alone suffices (46.7%), the absence of medical advice (46.7%), and insufficient disease awareness (33.3%). Conclusions: The research shows that many Saudis are unaware of MASLD and have misconceptions about it. Targeted health education programs, greater provider–patient communication, and primary care MASLD knowledge are needed to close these gaps and promote disease prevention and management. Full article

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

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13 pages, 304 KB

Open AccessReview

Narrative Medicine, Dementia, and Alzheimer’s Disease: A Scoping Review

by Venusia Covelli, Marina Angela Visco, Martino Feyles, Angelica Cristal Sirotich and Alessandra Marelli

Healthcare 2025, 13(24), 3321; https://doi.org/10.3390/healthcare13243321 - 18 Dec 2025

Abstract

Background/Objectives: In recent years, Narrative Medicine (NM) has gained prominence in the context of neurodegenerative diseases, such as dementia, offering tools to understand the subjective experience of illness and to improve the care relationship. Methods: This scoping review, conducted following the [...] Read more.

Background/Objectives: In recent years, Narrative Medicine (NM) has gained prominence in the context of neurodegenerative diseases, such as dementia, offering tools to understand the subjective experience of illness and to improve the care relationship. Methods: This scoping review, conducted following the PRISMA guidelines, analyzed the scientific literature from PubMed, PsycInfo, Web of Science, and Medline, encompassing 10 contributions focused on NM and patients with dementia or Alzheimer’s disease. Results: The analysis identified three main themes: 1) narrative, memory, and personal identity, highlighting the role of narrative in preserving a sense of self; 2) personalization of care, oriented towards person-centeredness; 3) the use of narrative in a formative and reflective function as a tool to promote empathy, clinical awareness, and observation skills in the training of health professionals. Conclusions: NM confirms itself as a relational and reflexive paradigm, capable of humanizing care and promoting therapeutic pathways that are more inclusive and sensitive to the patient’s subjectivity. Full article

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11 pages, 560 KB

Open AccessArticle

When Sound Fades: Depression and Anxiety in Adults with Hearing Loss—A Cross-Sectional Study

by Serkan Dedeoglu, Serdar Ferit Toprak, Enes Sırma and Süleyman Dönmezdil

Healthcare 2025, 13(24), 3320; https://doi.org/10.3390/healthcare13243320 - 18 Dec 2025

Abstract

Background: Hearing loss is a prevalent sensory impairment with substantial psychosocial consequences. This cross-sectional study investigated the relationship between audiometric hearing loss and mood disturbances in adults aged 18–65 years who reported hearing difficulties for at least six months. Methods: Objective hearing level [...] Read more.

Background: Hearing loss is a prevalent sensory impairment with substantial psychosocial consequences. This cross-sectional study investigated the relationship between audiometric hearing loss and mood disturbances in adults aged 18–65 years who reported hearing difficulties for at least six months. Methods: Objective hearing level was assessed using the better-ear pure-tone average (PTA), and subjective hearing handicap was measured with the Hearing Handicap Inventory for Adults (HHIA). Standardized mood assessments included the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). Results: The study found that higher HHIA scores, indicating greater perceived hearing handicap, were strongly correlated with more severe depression and anxiety (ρ ≈ 0.45 and 0.38, respectively; p < 0.001). In contrast, objective PTA showed weaker associations with mood scores. Regression analyses, adjusted for age and gender, confirmed that perceived hearing handicap (HHIA) was the strongest independent predictor of both depression (standardized β ≈ 0.37, p < 0.001) and anxiety (β ≈ 0.33, p < 0.01), accounting for about 30% of the variance in mood scores. Nearly one-third of participants had clinically significant depression (BDI-II ≥ 20), which is substantially higher than community norms. The cross-sectional design and potential selection bias are limitations. Conclusions: Even mild-to-moderate hearing loss can result in significant depressive and anxious symptoms when individuals perceive themselves as handicapped. Early identification of hearing problems, routine psychosocial screening (e.g., a simple two-question survey), and integrated care are essential for improving quality of life. Full article

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

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16 pages, 1650 KB

Open AccessSystematic Review

A Systematic Review and Meta-Analysis of the Effects of Various Physical Activity Interventions in Pregnant Women with Overweight or Obesity

by Mingmao Li, Hongli Yu, Guoping Qian, Anna Szumilewicz and Zbigniew Ossowski

Healthcare 2025, 13(24), 3319; https://doi.org/10.3390/healthcare13243319 - 18 Dec 2025

Abstract

Background: Obesity during pregnancy increases the risk of adverse maternal and neonatal outcomes, and excessive gestational weight gain (GWG) remains highly prevalent worldwide. Although physical activity (PA) interventions have shown potential benefits, evidence on the optimal type, intensity, and duration of exercise [...] Read more.

Background: Obesity during pregnancy increases the risk of adverse maternal and neonatal outcomes, and excessive gestational weight gain (GWG) remains highly prevalent worldwide. Although physical activity (PA) interventions have shown potential benefits, evidence on the optimal type, intensity, and duration of exercise for overweight or obese pregnant women remains limited. Methods: Electronic searches of EBSCOhost, Embase, PubMed and Web of Science were performed through August 2025 to identify randomized controlled trials comparing PA interventions versus usual prenatal care in overweight or obese pregnant women. Two reviewers independently screened studies, extracted data, and assessed risk of bias using Cochrane ROB domains. Continuous outcomes were pooled using inverse-variance meta-analytic methods and heterogeneity was quantified by I². Results: Ten randomized trials (twelve intervention arms) comprising 1150 participants met the inclusion criteria. In the domain of blinding of participants and personnel, three studies (30%) were judged as low risk, while seven (70%) were unclear. PA interventions varied in modality (aerobic, resistance, endurance, walking), setting (clinic, community, home/mHealth), and the intervention period ranges from 10 to 34 weeks. Most interventions (80%) employed moderate intensity, and 30% combined aerobic and resistance training. Results of the meta-analysis showed that the pooled mean GWG was 9.93 ± 5.48 kg in the treatment group and 10.65 ± 5.70 kg in the control group. Overall, PA interventions produced a modest but statistically significant reduction in GWG compared with controls, with negligible between-study heterogeneity (I² = 0%). Conclusions: Tailored, moderate-intensity PA may have the potential to modestly reduce GWG. Although 30% included trials employed combined aerobic and resistance training, current evidence is insufficient to establish whether combined modalities are more effective than aerobic-only or resistance-only interventions. However, the current evidence is limited by small trial sizes, methodological variability and geographic concentration in higher-income settings. Larger, rigorously designed RCTs, including evaluations of digital delivery platforms and carefully supervised higher-intensity protocols, are needed to refine exercise prescriptions and inform clinical guidelines. Full article

(This article belongs to the Special Issue Obesity and Overweight: Prevention, Causes and Treatment)

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