Journal Description
Healthcare
Healthcare
is an international, scientific, peer-reviewed, open access journal on health care systems, industry, technology, policy, and regulation, and is published semimonthly online by MDPI. European Medical Association (EMA) and Ocular Wellness & Nutrition Society (OWNS) are affiliated with Healthcare and their members receive discounts on the article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE and SSCI (Web of Science), PubMed, PMC, and other databases.
- Journal Rank: JCR - Q2 (Health Care Sciences and Services) / CiteScore - Q2 (Leadership and Management)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 20.3 days after submission; acceptance to publication is undertaken in 2.6 days (median values for papers published in this journal in the second half of 2024).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
- Companion journals for Healthcare include: Trauma Care and European Burn Journal.
Impact Factor:
2.4 (2023);
5-Year Impact Factor:
2.5 (2023)
Latest Articles
Smartwatch-Derived VO2max Prediction Model for Korean Adults: Utilizing Heart Rate and GPS Data from the 12-Minute Cooper Test
Healthcare 2025, 13(7), 722; https://doi.org/10.3390/healthcare13070722 (registering DOI) - 25 Mar 2025
Abstract
Background/Objectives: Recent technological advancements enable smartwatches to measure running distance and heart rate using wearable sensors. This study aimed to analyze the validity of the 12 min Cooper test using a smartwatch and to develop an accurate VO2max prediction model for Korean
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Background/Objectives: Recent technological advancements enable smartwatches to measure running distance and heart rate using wearable sensors. This study aimed to analyze the validity of the 12 min Cooper test using a smartwatch and to develop an accurate VO2max prediction model for Korean adults. Methods: A total of 104 adults (53 males: age 35.00 ± 6.1 years, BMI 24.71 ± 3.13; 51 females: age 34.82 ± 6.07 years, BMI 22.24 ± 2.66) participated. VO2max was measured using a maximal graded treadmill test. Participants performed the Cooper test while wearing a smartwatch, which collected average heart rate, peak heart rate, and running distance. Sex, height, and weight were also included as predictor variables. Multiple regression analysis was conducted to develop a VO2max prediction equation. Model accuracy was assessed using R2 and the standard error of the estimate (SEE). Results: The developed VO2max prediction equation was VO2max = 27.620 + 6.358 (sex; male = 1, female = 0) − 0.012 (height) − 0.202 (weight) − 0.036 (mean HR) + 0.039 (peak HR) + 0.012 (distance) (R2 = 0.853, SEE = 3.176 mL/kg/min, p < 0.001). The intra-class correlation coefficient (ICC) between measured and predicted VO2max using the smartwatch was 0.961, compared to 0.925 for traditional methods. The explanatory power was 86.0% (SEE = 3.024 mL/kg/min) versus 81.0% (SEE = 3.516 mL/kg/min). Conclusions: The smartwatch-based VO2max prediction model demonstrated higher accuracy than traditional methods. This equation is recommended for more precise VO2max estimation in Korean adults.
Full article
(This article belongs to the Special Issue Cardiopulmonary Exercise Testing: A Key Player in Cardiovascular Disease Management)
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Open AccessArticle
Experiences in Accessing Treatment Among Females with Schizophrenia: A Qualitative Study from Turkey
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Mehmet Cihad Aktaş and Cemile Hürrem Ayhan
Healthcare 2025, 13(7), 721; https://doi.org/10.3390/healthcare13070721 (registering DOI) - 25 Mar 2025
Abstract
Background/Objectives: The experiences of women with schizophrenia in accessing treatment are multifaceted and influenced by a variety of biological, psychological, and social factors. The goal of this study was to explore the experiences of women with schizophrenia in accessing treatment in Turkey.
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Background/Objectives: The experiences of women with schizophrenia in accessing treatment are multifaceted and influenced by a variety of biological, psychological, and social factors. The goal of this study was to explore the experiences of women with schizophrenia in accessing treatment in Turkey. Methods: The study was conducted using the phenomenological method, one of the qualitative study methods. In-depth individual interviews were conducted with females with schizophrenia (>18 years) (n = 10). The study data were collected using a personal information form and an open-ended structured interview form in which participants were asked about their views and experiences of accessing treatment. Voice recordings were transcribed, and categories, subthemes and themes were formed. Results: Five themes emerged: (1) shadows of obstacles; (2) resistance and adaptation (3) connection and solidarity; (4) unmet needs; and (5) alternative paths. Conclusions: This qualitative study on the experiences of accessing treatment among females with schizophrenia in Turkey reveals significant insights into the multifaceted challenges and barriers these women face. The findings indicate that gender-specific factors play a crucial role in shaping treatment experiences and outcomes. Female patients often encounter unique societal pressures, including stigma and domestic coercion, which can influence their treatment adherence and overall mental health outcomes. By addressing the specific barriers faced by women and implementing gender-responsive care strategies, healthcare systems can significantly improve treatment accessibility and outcomes for female patients with schizophrenia in eastern Turkey and beyond.
Full article
(This article belongs to the Section Women's Health Care)
Open AccessArticle
The Feasibility and Safety of Robot-Assisted Vaginal Natural Orifice Transluminal Endoscopic Surgery (RA-vNOTES) for Gynecologic Disease: 298-Case Series
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Qiannan Yang, Daniel Y. Lovell, Yingchun Ma, Chunhua Zhang and Xiaoming Guan
Healthcare 2025, 13(7), 720; https://doi.org/10.3390/healthcare13070720 (registering DOI) - 25 Mar 2025
Abstract
Objectives: To explore the feasibility and surgical outcomes of robot-assisted vaginal natural orifice transluminal endoscopic surgery (RA-vNOTES) for women suffering from gynecologic disease. Methods: We performed an observational study reporting and analyzing the perioperative outcomes of 298 patients with gynecologic disease who underwent
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Objectives: To explore the feasibility and surgical outcomes of robot-assisted vaginal natural orifice transluminal endoscopic surgery (RA-vNOTES) for women suffering from gynecologic disease. Methods: We performed an observational study reporting and analyzing the perioperative outcomes of 298 patients with gynecologic disease who underwent RA-vNOTES in a single institution from June 2019 to August 2024. Results: A total of 298 patients with a median age of 41 years and median body mass index of 29 kg/m2 underwent RA-vNOTES. The primary indications for surgery were endometriosis (43.62%), chronic pelvic pain (11.07%), abnormal uterine bleeding (20.81%), and uterine leiomyomata (14.77%). A total of 286 of 298 (95.97%) patients had a hysterectomy. The median total operating time was 138 min, with a port placement time of 5 min, dock time of 3 min, and robot console time of 63 min. The median estimated blood loss was 50 milliliters. Endometriosis resection of all stages was performed in 192 of 298 (64.43%) patients. Three cases (1.01%) were converted to laparoscopic surgery. One case was converted to robot-assisted single incision plus one port laparoscopic surgery (SILS plus one) and two cases were converted to robot-assisted multi-port surgery. The total complication rate was 17.45% (52 cases), of which 2.1% (6 cases) were intraoperative complications and 15.44% (46 cases) were postoperative complications. Conclusions: Our findings indicate that RA-vNOTES is a feasible and less invasive option for various gynecologic procedures, including complex endometriosis excision and sacrocolpopexy.
Full article
(This article belongs to the Special Issue Contemporary Surgical Trends and Management)
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Open AccessArticle
Mental Health and Drug Use Patterns Among Men Who Have Sex with Men (MSM) Engaging in Chemsex in the UK
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Lukasz Lagojda, Deberson Ferreira de Jesus, Daniel Kinnair and Marc Chrysanthou
Healthcare 2025, 13(7), 719; https://doi.org/10.3390/healthcare13070719 (registering DOI) - 24 Mar 2025
Abstract
Background: Chemsex is a subtype of sexualized drug use which is increasingly more prevalent amongst gay, bisexual, and other men who have sex with men (MSM). This use of psychoactive substances in sexual contexts poses an emerging public health concern, since it has
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Background: Chemsex is a subtype of sexualized drug use which is increasingly more prevalent amongst gay, bisexual, and other men who have sex with men (MSM). This use of psychoactive substances in sexual contexts poses an emerging public health concern, since it has been associated with an array of health risks, including mental health risks. Objective: As Chemsex appears to be increasing in the UK, this study aimed to explore Chemsex patterns and mental health amongst Chemsex users in the UK. Methods: Chemsex/drug use patterns and the prevalence of coexisting depression and anxiety, based on the Hospital Anxiety and Depression Scale (HADS), were assessed in an MSM sample via an anonymous online survey between December 2023 and February 2024. Results: A total of 141 UK adults participated in the survey (age range: 26–41 years). High overall use of the three common Chemsex-related substances was reported, including γ-hydroxybutyrate/γ-butyrolactone (GHB/GBL) (77.3%), synthetic cathinones (64.5%), and methamphetamine (47.5%). Injecting (“slamming”) was less prevalent (17.0%), although this practice was the most common amongst weekly Chemsex users (54.2%). Based on provided HADS responses, a high incidence of anxiety (49.9%) was reported among the study population, with the highest (abnormal) anxiety scores observed among weekly Chemsex users (44.4%). The incidence of depression was lower overall (27.0%), whilst the highest (abnormal) scores were also observed in weekly Chemsex users (61.5%). Conclusions: As relevant UK data remain limited, this study offers novel insight into Chemsex patterns and mental health challenges among MSM in the UK, suggesting unmet needs for targeted interventions on mental health issues among this population. Further large-scale and prospective studies are necessary to explore the nuanced interplay between the frequency of Chemsex use and its impact on mental health.
Full article
(This article belongs to the Special Issue Sexuality, Health, and Gender)
Open AccessArticle
Exploring Predictors of Self-Perceived Cardiorespiratory Fitness ≥ 5 Years Beyond Breast Cancer Diagnosis: A Cross-Sectional Study
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Francisco Álvarez-Salvago, Maria Figueroa-Mayordomo, Cristina Molina-García, Sandra Atienzar-Aroca, Clara Pujol-Fuentes, José Daniel Jiménez-García, Palmira Gutiérrez-García, Rosario Ching-López and Jose Medina-Luque
Healthcare 2025, 13(7), 718; https://doi.org/10.3390/healthcare13070718 (registering DOI) - 24 Mar 2025
Abstract
Background/Objectives: This study aimed to examine the association between self-perceived cardiorespiratory fitness and health outcomes in long-term breast cancer survivors (LTBCSs) and identify possible predictors in women at least 5 years post-diagnosis. Methods: A cross-sectional study was carried out involving 80
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Background/Objectives: This study aimed to examine the association between self-perceived cardiorespiratory fitness and health outcomes in long-term breast cancer survivors (LTBCSs) and identify possible predictors in women at least 5 years post-diagnosis. Methods: A cross-sectional study was carried out involving 80 LTBCSs, divided into three groups according to their self-reported cardiorespiratory fitness levels: very poor/poor (1–2), average (3), and good/very good (4–5). Sociodemographic and clinical data were collected, and this study analyzed variables measured at least five years after diagnosis, focusing on various factors including physical fitness, physical activity (PA) levels, cancer-related fatigue (CRF), mood, pain, and health-related quality of life (HRQoL). ANOVA, Mann–Whitney U, and chi-square tests were performed, along with correlation and multiple regression analyses. Cohen’s d was used to calculate effect sizes. Results: Among the 80 LTBCSs, 35% reported very poor/poor self-perceived cardiorespiratory fitness, 35% reported average levels, and 30% reported good/very good levels. Individuals with lower self-perceived cardiorespiratory fitness levels showed significant declines in physical fitness, greater physical inactivity, increased CRF, higher pain levels, and a poorer HRQoL (p < 0.05). Regression analysis identified “self-perceived muscle strength” (β = 0.40; p < 0.01) and “nausea and vomiting” (β = −0.37; p < 0.01) as significant predictors of higher self-perceived cardiorespiratory fitness (adjusted r2 = 0.472). Conclusions: These findings highlight the importance of self-perceived cardiorespiratory fitness as a relevant indicator of health outcomes in LTBCSs. Given its association with physical fitness, sedentary behavior, CRF, pain, and HRQoL, assessing patients’ perceptions may provide valuable insights for developing tailored rehabilitation strategies. Future interventions should consider both subjective and objective measures to optimize the long-term health and quality of life in this population.
Full article
Open AccessArticle
The Impact of Polycystic Ovary Syndrome on Gestational Diabetes Mellitus, Disease Knowledge, and Health Behaviors
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Hye Jin Kim, Eui Hyeok Kim, Eungil Ko, Sojung Park and Yaelim Lee
Healthcare 2025, 13(7), 717; https://doi.org/10.3390/healthcare13070717 (registering DOI) - 24 Mar 2025
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Background/Objectives: Polycystic ovary syndrome (PCOS) is a common endocrine disorder that increases the risk of gestational diabetes mellitus (GDM). This study aims to assess the correlation between PCOS and GDM and to identify associated healthcare needs. Methods: A mixed-methods approach was used. The
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Background/Objectives: Polycystic ovary syndrome (PCOS) is a common endocrine disorder that increases the risk of gestational diabetes mellitus (GDM). This study aims to assess the correlation between PCOS and GDM and to identify associated healthcare needs. Methods: A mixed-methods approach was used. The retrospective study analyzed 2635 medical records of women aged 19–45 who underwent fertility treatments (2020–2023). The prospective study (2023–2024) assessed PCOS and GDM knowledge, nutrition, and physical activity among three groups: PCOS, GDM, and normal pregnancies. Results: Women with PCOS had a significantly higher BMI (p < 0.001) and an increased risk of GDM (28.1% vs. 10.6%, p < 0.001), with a 2.94-fold higher likelihood (95% CI: 2.22–3.90). Preterm birth (p = 0.029) and multiple pregnancies (p = 0.014) were also more common. The GDM group demonstrated better nutritional habits (p = 0.017), while the PCOS group showed higher physical activity levels (p < 0.001). Greater disease knowledge correlated with healthier behaviors. Conclusions: PCOS is a strong risk factor for GDM and adverse pregnancy outcomes. Targeted education and lifestyle interventions are crucial for improving maternal and neonatal health. Future research should focus on long-term metabolic management in women with PCOS.
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Open AccessReview
Sexual Health in Women with Inflammatory Bowel Diseases: A Narrative Review
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Caterina Mercuri, Vincenzo Bosco, Raúl Juárez-Vela, Assunta Guillari, Silvio Simeone and Patrizia Doldo
Healthcare 2025, 13(7), 716; https://doi.org/10.3390/healthcare13070716 (registering DOI) - 24 Mar 2025
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Background/Objectives: Inflammatory bowel diseases (IBDs), such as Crohn’s disease and ulcerative colitis, have a significant impact on overall well-being. Sexual health, a critical component of overall well-being, is often compromised in individuals with IBD, especially in women, owing to physical, psychological, and social
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Background/Objectives: Inflammatory bowel diseases (IBDs), such as Crohn’s disease and ulcerative colitis, have a significant impact on overall well-being. Sexual health, a critical component of overall well-being, is often compromised in individuals with IBD, especially in women, owing to physical, psychological, and social factors. This narrative review aims to synthesize the fragmented existing evidence on the impact of IBD on women’s sexual health by examining clinical manifestations along with patients’ perceptions and lived experiences. Methods: Five databases (CINAHL Complete, Medline, APA PsycInfo, APA PsycArticles, and Psychology and Behavioral Sciences Collection) were searched using keywords related to IBD, sexual health, and women’s experiences. Fifteen studies that met the predefined inclusion and exclusion criteria were analyzed. Results: Women with IBD often perceive their bodies as “damaged” or “mutilated,” which profoundly affects their self-esteem and sexual satisfaction. Physically, debilitating symptoms such as abdominal pain, diarrhea, and chronic fatigue limit sexual desire and intimacy. Psychological factors, including anxiety, depression, and negative body image, exacerbate these challenges, and compromise emotional well-being and intimate relationships. Social stigma further isolates patients, making it more difficult for them to communicate their sexual needs to both partners and healthcare providers. Strategies such as psychological support, health education, and promoting open communication with partners emerge as promising avenues to improve sexual health and quality of life. Conclusions: IBD profoundly affects women’s sexual health by intertwining physical, psychological, and social challenges. A holistic and personalized clinical approach that incorporates sexual well-being into routine care is essential to improve patients’ quality of life.
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Open AccessArticle
Moderating Effect of Muscular Strength in the Association Between Cancer and Depressive Symptomatology
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Diogo Veiga, Marcelo de Maio Nascimento, Miguel Peralta, Élvio R. Gouveia and Adilson Marques
Healthcare 2025, 13(7), 715; https://doi.org/10.3390/healthcare13070715 (registering DOI) - 24 Mar 2025
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Background/Objectives: Depression, as one of the leading causes of disease burden, frequently co-occurs with other diseases. Cancer seems to be strongly associated with depression more than any other disease. As an outcome of physical fitness, muscular strength seems to have a protective effect
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Background/Objectives: Depression, as one of the leading causes of disease burden, frequently co-occurs with other diseases. Cancer seems to be strongly associated with depression more than any other disease. As an outcome of physical fitness, muscular strength seems to have a protective effect on depression. This study aimed to analyze how muscular strength moderates the relationship between cancer and depressive symptomatology among older European adults. Methods: Cross-sectional data from wave 8 (2019/2020), including 41,666 participants (17,986 males) of the population-based Survey of Health, Aging, and Retirement in Europe, were analyzed. Grip strength, used as the moderator, was measured twice on each hand using a dynamometer. The EURO-D 12-item scale was used to measure depressive symptomatology. Results: Grip strength had a significant effect as a moderator in the association between cancer and depressive symptoms (male: B = −0.025, 95% CI = −0.04, −0.01; female: B = −0.02, 95% CI = −0.04, 0.00). Also, the grip strength moderation values are below 55.3 kg for males and 39.4 kg for females. Conclusions: Muscular strength, as measured by grip strength, moderated the relationship between cancer and depressive symptomatology. This supports the theory that recovery programs could include physical activity, namely muscle-strengthening exercises, to prevent depression.
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Open AccessArticle
Internet Use and Self-Rated Health: The Mediating Role of Physical Exercise
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Fangmei Zhu, Bowen Tan and Yi Jang
Healthcare 2025, 13(7), 714; https://doi.org/10.3390/healthcare13070714 (registering DOI) - 24 Mar 2025
Abstract
Background: The rise in digital engagement has positioned self-rated health (SRH) among Chinese adults as a pressing public health challenge. This study employs cross-sectional data to analyze the mechanisms by which Internet use impacts SRH outcomes, with particular emphasis on elucidating physical exercise’s
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Background: The rise in digital engagement has positioned self-rated health (SRH) among Chinese adults as a pressing public health challenge. This study employs cross-sectional data to analyze the mechanisms by which Internet use impacts SRH outcomes, with particular emphasis on elucidating physical exercise’s moderating role within this dynamic relationship. Methods: The data were obtained from the 2021 China General Social Survey (2021CGSS). The analytical sample comprised 7582 participants. An ordered probit model was used to analyze the relationship between Internet use, physical exercise, and self-rated health. To assess the robustness of the results, an alternative model and a substitute independent variable were employed. The Karlson–Holm–Breen (KHB) method was applied to examine the mediating role of physical exercise. Results: Significant correlations were found between Internet use, physical exercise, and self-rated health (p < 0.01). Physical exercise partially mediated the positive effect of Internet use on self-rated health, accounting for 9% of the total effect. Conclusions: This study suggests a positive relationship between Internet use and self-rated health, with physical exercise playing a mediating role. Expanding Internet access and reducing the digital divide across regions and age groups may contribute to better public health outcomes.
Full article
(This article belongs to the Topic Public Health and Healthcare in the Context of Big Data)
Open AccessArticle
The Neurosurgical Immigrant Experience in Italy: Analysis of a Northeast Tertiary Center
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Andrea Valenti, Elisabetta Marton, Giuseppe Canova and Enrico Giordan
Healthcare 2025, 13(7), 713; https://doi.org/10.3390/healthcare13070713 (registering DOI) - 24 Mar 2025
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Italy’s immigrant population has risen in the last two decades. Integration into society, including access to healthcare, is critical for the well-being of this population. Objectives: We compared regular immigrants and Italians to determine whether the groups received different care. Methods:
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Italy’s immigrant population has risen in the last two decades. Integration into society, including access to healthcare, is critical for the well-being of this population. Objectives: We compared regular immigrants and Italians to determine whether the groups received different care. Methods: Inpatient and outpatient medical records were collected from January 2017 to December 2021. We abstracted the identification code, nationality, sex, age, ICD-9 codes, date of the first and additional visits, and surgical intervention. Pathologies were categorized with ICD-9 codes. Patients were grouped according to geographical origin: European Union (EU), Central and Eastern Europe, Asia, North Africa, Central and South Africa, North America, and Central and South America. Results: More patients from Asia and Africa presented to inpatient than outpatient clinics (p-value: 0.001). The median age was lower for patients from Asia and Eastern Europe than from the EU. More patients presented with acute spine pain (26.4% versus 19.6%, p-value: 0.001) as inpatients, while patients presented as outpatients more for degenerative spine issues (77.1% versus 69.0%, p-value: <0.001) but less for brain neoplasms (p-value: 0.009). Additional visit rates were higher for immigrants than for Italians (IRR 1.32 visits/year, 95% CI 0.99–1.77 visits/year, p-value: 0.06), especially for patients with spinal issues (spinal versus cranial: 1.27 visits/year, 95% CI 1.14–1.43 visits/year, p-value: <0.001) and younger patients (<65 years old: 1.52 visits/year, 95% CI 1.39–1.71 visits per year, p-value: <0.001). There was no difference in the incidence of new visits when stratified by sex. Conclusions: Access to emergency care and additional visits were more prevalent in the recent immigrant population, especially from Asia, reflecting unconsolidated health habits. Immigrants from Central and Eastern Europe or North Africa seemed fully integrated. A healthcare policy tailored to the needs of immigrants—taking into account their cultural and social backgrounds and ensuring effective communication—can be highly beneficial. Specifically, it is essential to reintegrate general practitioners and guide individuals toward the most appropriate services.
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Open AccessArticle
Rehabilitation of Visually Impaired People: Experiences and Relevance According to the Perception of Family Members and Patients
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Ana Cláudia Fernandes, Yara de Moraes, Pedro Henrique Silva Carvalho, Rita de Cassia Ietto Montilha, Florencia Carmine, Cristian Sandoval, Síbila Floriano Landim, Nicolás Márquez Álvarez and Dolors Rodriguez-Martin
Healthcare 2025, 13(7), 712; https://doi.org/10.3390/healthcare13070712 (registering DOI) - 24 Mar 2025
Abstract
Background: This study aims to explore the perceptions of visually impaired patients and their families regarding rehabilitation. Methods: A qualitative, descriptive, and cross-sectional design was employed, incorporating data from semi-structured interviews conducted with patients and their families as part of a
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Background: This study aims to explore the perceptions of visually impaired patients and their families regarding rehabilitation. Methods: A qualitative, descriptive, and cross-sectional design was employed, incorporating data from semi-structured interviews conducted with patients and their families as part of a broader project. Data were analyzed using a content analysis approach to address the study’s objectives. Results: The findings identified three primary categories based on interviews with nine patients and six family members: (A) the impact of rehabilitation on autonomy and identity formation; (B) the significance of professional training, experience, and assistive technology in rehabilitation; and (C) the effects of rehabilitation on patients and their families. Conclusions: Patients and their families deemed rehabilitation essential for fostering autonomy and independence in daily activities. A multidisciplinary approach, emphasizing professional training that integrates health, rehabilitation, and education, was found to be vital.
Full article
(This article belongs to the Section Health Informatics and Big Data)
Open AccessSystematic Review
A Systematic Review and Meta-Analysis of Virtual and Traditional Physical Activity Programs: Effects on Physical, Health, and Cognitive Outcomes
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Đorđe Hajder, Bojan Bjelica, Saša Bubanj, Nikola Aksović, Milan Marković, Radenko Arsenijević, Gabriel-Stănică Lupu, Tomislav Gašić, Constantin Sufaru, Lazar Toskić, Daniel-Lucian Dobreci, Tatiana Dobrescu and Mihai Adrian Sava
Healthcare 2025, 13(7), 711; https://doi.org/10.3390/healthcare13070711 (registering DOI) - 24 Mar 2025
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(1) Background: The aim of this study was to conduct a systematic literature review and meta-analysis on the effects of virtual reality (VR) and traditional (TR) physical activity programs, analyzing their impact on the physical, health, and cognitive aspects of participants. The
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(1) Background: The aim of this study was to conduct a systematic literature review and meta-analysis on the effects of virtual reality (VR) and traditional (TR) physical activity programs, analyzing their impact on the physical, health, and cognitive aspects of participants. The study sought to identify the advantages and limitations of both methods, taking into account previous research and potential areas for future studies. (2) Methods: The study protocol for this systematic review was registered at the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY202530015). The review followed PRISMA guidelines, and studies were selected based on their relevance to the research objectives using the PICOS model criteria. The authors applied a meta-analysis in addition to a systematic review to further ensure the accuracy of the results. Primary outcomes included physical and cognitive performance, while secondary outcomes encompassed participant perceptions and psychological effects. (3) Results: The findings indicate that VR training significantly enhances flexibility, motivation, and cognitive abilities, particularly in populations with limited access to traditional exercise methods. The most pronounced effects were observed in programs lasting 8 to 12 weeks with a moderate to high intensity. In contrast, TR showed superiority in developing strength, endurance, and cardiorespiratory functions. (4) Conclusions: VR offers significant benefits as an adjunct or alternative to TR, especially for individuals with limited resources or physical accessibility. However, variations in methodological approaches, short program durations, and sample heterogeneity highlight the need for further longitudinal research. Standardizing VR training duration and intensity is essential to ensure consistent and reliable outcomes.
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Open AccessArticle
The Effects of Cervical Manipulation Compared with a Conventional Physiotherapy Program for Patients with Acute Whiplash Injury: A Randomized Controlled Trial
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Joan Parera-Turull, Maite Garolera, Jose-Blas Navarro, Dolors Esteve Bech-Decareda, Josep Gual-Beltran, Jose-Vicente Toledo-Marhuenda and Emilio-Jose Poveda-Pagan
Healthcare 2025, 13(7), 710; https://doi.org/10.3390/healthcare13070710 (registering DOI) - 24 Mar 2025
Abstract
Whiplash injuries (WLs) are the most frequent cause of emergency room visits after motor vehicle collisions. In clinical practice, massage, electrotherapy, mobilization, or therapeutic exercise are used. As part of manual therapy, high-velocity, low-amplitude manipulative techniques can also be used. Objectives: To
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Whiplash injuries (WLs) are the most frequent cause of emergency room visits after motor vehicle collisions. In clinical practice, massage, electrotherapy, mobilization, or therapeutic exercise are used. As part of manual therapy, high-velocity, low-amplitude manipulative techniques can also be used. Objectives: To evaluate the effect of the cervical Specific Adjustment Technique (SAT) in adults affected by whiplash on pain, functionality, cervical mobility, and radiological changes in cervical curvature through a prospective, single-blind, randomized clinical trial. Methods: One hundred and nineteen patients with grade II acute WL were randomly assigned to either the manipulation group (MAN group = 59) or the rehabilitation group (RHB group = 60) to receive 3 or 20 sessions of treatment, respectively. Both groups were measured at baseline and 15, 30, and 120 days after starting treatment. Results: Statistically significant differences were found in the MAN group in flexion (p = 0.041) and left-side bending (p = 0.022); similar statistical values were found in the other measures. According to the interaction treatment-time effect, statistical significance for the Cobb angle was obtained in the MAN group (p = 0.047). Conclusions: the effects of SAT were comparable in terms of pain, functionality, and mobility of the cervical spine. Although further research is needed on its effects in the acute phase, due to its effectiveness and lower associated cost, SAT could be considered a useful technique, at least during the first 3 months after a traffic collision.
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(This article belongs to the Special Issue Advances in Manual Therapy: Diagnostics, Prevention and Treatment)
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Open AccessArticle
Body-Weight Fluctuations and the Association Between the Consumption of Protein-Rich Foods and the Incidence of Metabolic Syndrome Among Middle-Aged Women in Korea
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Hyejin Chun, Jung-Heun Ha, Jongchul Oh and Miae Doo
Healthcare 2025, 13(7), 709; https://doi.org/10.3390/healthcare13070709 (registering DOI) - 24 Mar 2025
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Background/Objectives: Metabolic syndrome (MetS) is a growing global health concern, driven in part by increasing rates of overweight and obesity. In Korea, MetS incidence escalates particularly among middle-aged women, eventually surpassing that of men. While protein-rich diets have been associated with improved metabolic
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Background/Objectives: Metabolic syndrome (MetS) is a growing global health concern, driven in part by increasing rates of overweight and obesity. In Korea, MetS incidence escalates particularly among middle-aged women, eventually surpassing that of men. While protein-rich diets have been associated with improved metabolic health, the impact of protein intake on body weight fluctuations (BWFs) and MetS risk has received limited attention, especially in Korean populations. Methods: Using data from the Korean Genome and Epidemiology Study (KoGES), this study examined whether a higher intake of protein-rich foods is linked to smaller BWF and lower MetS incidence in middle-aged Korean women. Dietary intake was assessed through validated questionnaires, and BWF was calculated based on repeated anthropometric measurements over a long-term follow-up. MetS was defined according to established clinical criteria. Results: Preliminary findings indicated that participants who consumed higher amounts of protein-rich foods, particularly animal-based proteins (e.g., fish, low-fat dairy), tended to exhibit smaller BWFs. Additionally, lower BWF was associated with a reduced risk of MetS, suggesting that stable weight regulation may play a protective role against metabolic dysfunction. Potential mechanisms include the preservation of lean mass, enhanced energy expenditure, and reduced carbohydrate intake when protein consumption is increased. These findings highlight the importance of dietary strategies that optimize protein intake to help minimize BWF and potentially lower MetS risk in middle-aged Korean women. Future research should investigate the specific sources and quality of protein and their long-term effects on metabolic health outcomes in diverse populations.
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Open AccessArticle
Clinical Application Research on Stroke Situational Intelligent Rehabilitation Training System Based on Wearable Devices: A Randomized Controlled Trial
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Ying Lu, Kangjia Ding, Yayuan Dai, Jie Yin, Jianjun Yao, Liquan Guo, Jiping Wang and Xiaojun Wang
Healthcare 2025, 13(7), 708; https://doi.org/10.3390/healthcare13070708 (registering DOI) - 23 Mar 2025
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Background/Objectives: With the advancement of intelligent sensing technology, rehabilitation systems based on wearable devices have a positive impact on the functional recovery and quality of life of stroke patients. This study aims to evaluate the application value of a contextualized intelligent rehabilitation training
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Background/Objectives: With the advancement of intelligent sensing technology, rehabilitation systems based on wearable devices have a positive impact on the functional recovery and quality of life of stroke patients. This study aims to evaluate the application value of a contextualized intelligent rehabilitation training system for stroke survivors, which is based on wearable devices, in the rehabilitation of motor function impairments following stroke. Methods: A randomized controlled trial design was employed, in which 100 stroke patients were randomly divided into a control group (n = 50, receiving standard physical therapy rehabilitation interventions) and an experimental group (n = 50). The experimental group additionally underwent motor function rehabilitation interventions and intelligent assessments through a wearable device-based contextual intelligent rehabilitation training system, with sessions conducted twice daily for 30 min each, five days a week, over a duration of eight weeks. Both groups of patients underwent clinical scale evaluations and data collection before and after the treatment, with primary outcome measures including motor ability (Fugl–Meyer Assessment, FMA), activities of daily living (Modified Barthel Index, MBI), and participation in rehabilitation therapy. The intervention effects of both groups were compared after eight weeks of rehabilitation. Results: Prior to the intervention, there were no significant differences in Fugl–Meyer Assessment (FMA) and Modified Barthel Index (MBI) scores between the experimental group and the control group (p > 0.05). After eight weeks of rehabilitation, the experimental group demonstrated significantly superior performance in motor function (FMA scores) and activities of daily living (MBI scores) compared to the control group (p < 0.01). Conclusions: The intelligent rehabilitation system significantly enhances motor function and activities of daily living in stroke survivors. Compared to traditional rehabilitation methods, it improves patient adherence to rehabilitation training and overall outcomes.
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Open AccessArticle
Understanding the Impact of COVID-19 on the Utilization of Community Health Services: Evidence from Beijing in China
by
Yuqing Zhang, Lele Li, Qiao Yu and Qi Li
Healthcare 2025, 13(7), 707; https://doi.org/10.3390/healthcare13070707 (registering DOI) - 23 Mar 2025
Abstract
Background: Primary healthcare (PHC) at the community level is essential to improving access to health services and reducing healthcare costs. However, compared to developed countries where PHC is well developed, PHC in developing countries is not as well developed. The worldwide prevalence of
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Background: Primary healthcare (PHC) at the community level is essential to improving access to health services and reducing healthcare costs. However, compared to developed countries where PHC is well developed, PHC in developing countries is not as well developed. The worldwide prevalence of COVID-19 has put a tremendous strain on the healthcare systems of all countries. Interestingly, we found that the impact of COVID-19 on the global healthcare system has brought about a new opportunity for PHC in developing countries. Methods: Based on community-scale panel data from Beijing, China, in the period from 1 January 2018 to 30 June 2021, this paper employed the Anderson model to reveal the impact of COVID-19 on community health service utilization. Two-way fixed effects models and double-difference models were used to analyze the data for robustness. Results: The results show that COVID-19 significantly reduced visits to the Community Health Center, but meanwhile, it raised the cost of single visits. While the costs of treatment, together with medical materials, were significantly lower during the pandemic, COVID-19 has affected the cost control of family physicians, resulting in the cost of contracted patients being significantly lower than that of non-contracted patients. Conclusions: While the COVID-19 pandemic significantly reduced routine visits to established medical centers, it served as a catalyst for the increased utilization of community health services. If appropriate measures to contain COVID-19 were taken, it would be possible to extend the scope of community health services and strengthen the PHC system.
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(This article belongs to the Section Health Policy)
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Open AccessArticle
Gender Differential Morbidity in Quality of Life and Coping Among People Diagnosed with Depression and Anxiety Disorders
by
Elisabet Torrubia-Pérez, Maria-Antonia Martorell-Poveda, José Fernández-Sáez, Mónica Mulet Barberà and Silvia Reverté-Villarroya
Healthcare 2025, 13(7), 706; https://doi.org/10.3390/healthcare13070706 (registering DOI) - 23 Mar 2025
Abstract
Background/Objectives: Psychosocial and cultural determinants have a special influence on the development, manifestation and prognosis of common mental disorders such as anxiety and depression. The objectives of this study were to define the psychosocial profile of the people most vulnerable to the development
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Background/Objectives: Psychosocial and cultural determinants have a special influence on the development, manifestation and prognosis of common mental disorders such as anxiety and depression. The objectives of this study were to define the psychosocial profile of the people most vulnerable to the development of these health problems, analyse the symptomatology and health determinants that may influence these from a gender perspective, and evaluate the quality of life and coping strategies among the adult population with this diagnosis in a rural area of Catalonia (Spain). Methods: An observational, cross-sectional, and analytical study was conducted on 180 people diagnosed with anxiety or depression. Patients completed an ad hoc sociodemographic questionnaire, the Brief Symptom Checklist (LSB-50), the Quality of Life Scale (EQ-5D-5L) and the Brief Cope Inventory (COPE-28). Results: Women aged 45–64 with a low socioeconomic profile may be more vulnerable to common mental disorders, although psychiatric symptomatology was more pronounced in men. Women were more likely to have problems with mobility (aOR= 2.93, p = 0.039) and daily activities (aOR = 2.75, p = 0.033), as well as lower self-perceived health scores (p = 0.002). Women used active coping, venting and seeking social support as coping strategies, while men used behavioural disengagement. Conclusions: It has been observed that the people most susceptible to developing depression and anxiety disorders may have a specific profile. Although a greater number of women have these common mental disorders, men tend to have more noticeable symptomatology. The coping strategies most used also differ according to gender.
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(This article belongs to the Special Issue Women’s Health Care: State of the Art and New Challenges)
Open AccessSystematic Review
A Critical Advantage of Hypnobirthing to Ameliorate Antenatal Depression: A Systematic Review and Meta-Analysis
by
Feni Betriana, Sunarno Sunarno, Wiwit Nurwidyaningtyas and Amelia Ganefianty
Healthcare 2025, 13(7), 705; https://doi.org/10.3390/healthcare13070705 (registering DOI) - 23 Mar 2025
Abstract
Background: Pregnant women are likely to experience depression due to various factors. Hypnobirthing is a non-invasive therapy that can be used to treat depression during pregnancy. This study aims to systematically review the effect of hypnobirthing on antenatal depression. Methods: This study employs
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Background: Pregnant women are likely to experience depression due to various factors. Hypnobirthing is a non-invasive therapy that can be used to treat depression during pregnancy. This study aims to systematically review the effect of hypnobirthing on antenatal depression. Methods: This study employs a systematic review following PRISMA guidelines. Articles were retrieved from PubMed, ScienceDirect, the Cochrane Library, Google Scholar, and hand searches. Articles were included for review if they met the following inclusion criteria: (1) published in the last ten years (2014–2024); (2) the articles published in English; (3) article types are original research articles and reviews; (4) the full text can be retrieved; and (5) the findings of the selected articles should discuss the effect of hypnobirthing or hypnosis for birth. Articles were critically appraised using Joanna Briggs Institute tools. Results: The initial search yielded 7603 records; nine studies met the inclusion criteria for systematic review, and four studies for meta-analysis. The articles were analyzed, and findings were presented in narrative ways and categorized into three themes: the effect of therapy, the administration of the therapy, and the mechanism of the therapy. The therapy was performed by different methods, involving hypnosis, daily relaxation, progressive muscle relaxation, breathing exercises, the J-breathing technique, meditation, visualization, and ego strengthening. Additionally, participants were encouraged to do self-practice at home and were followed up by personal visits, phone calls, or text messages. Conclusions: The majority of the studies found that hypnobirthing ameliorated antenatal depression, despite the variation in initial administration and the duration of therapy. Further research is needed to standardize therapy protocols and explore long-term outcomes.
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(This article belongs to the Special Issue Women’s Health Care: State of the Art and New Challenges)
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Open AccessArticle
Mediation Role of Behavioral Decision-Making Between Self-Efficacy and Self-Management Among Elderly Stroke Survivors in China: Cross-Sectional Study
by
Xiaoxuan Wang, Hu Jiang, Zhixin Zhao, Noubessi Tchekwagep Kevine, Baoxia An, Zhiguang Ping, Beilei Lin and Zhenxiang Zhang
Healthcare 2025, 13(7), 704; https://doi.org/10.3390/healthcare13070704 (registering DOI) - 23 Mar 2025
Abstract
Background: Identifying the factors that impact self-management is crucial, as elderly stroke survivors frequently face challenges in self-management. Self-efficacy and behavioral decision-making are reported as influencing factors of self-management, but their relationship within the elderly population remains unconfirmed. This study aimed to explore
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Background: Identifying the factors that impact self-management is crucial, as elderly stroke survivors frequently face challenges in self-management. Self-efficacy and behavioral decision-making are reported as influencing factors of self-management, but their relationship within the elderly population remains unconfirmed. This study aimed to explore whether self-efficacy impacts self-management through the mediating role of behavioral decision-making among elderly stroke survivors. Methods: A cross-sectional design and convenience sampling method were used in this study. A total of 291 elderly stroke survivors were recruited from a tertiary hospital in Henan Province, China, between March and July of 2024. Questionnaires were distributed to collect sociodemographic, self-efficacy, behavioral decision-making, and self-management data. A path analysis and correlation analysis were used to analyze the data. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: Elderly stroke survivors reported having a moderate level of self-management. There was a positive correlation between self-efficacy, behavioral decision-making, and self-management (all p < 0.01). The mediation model indicated that behavioral decision-making mediated the association of self-efficacy and self-management in the regression model (95% CI 0.03 to 0.14), and the effect value was 0.08. It was also confirmed that behavioral decision-making mediated the impact of self-efficacy and self-management, accounting for 25.81% of the total effect. Conclusion: Self-efficacy is not solely a key factor influencing self-management in elderly stroke survivors, but it also improves their self-management behaviors by facilitating behavioral decision-making. As a result, healthcare professionals should consider self-efficacy and behavioral decision-making as crucial elements for assessing elderly stroke survivors during discharge and follow-up.
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(This article belongs to the Special Issue Stroke and Ageing)
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Open AccessArticle
Associations of Dietary Zinc Supplementation and Sleep Patterns with Chronic Kidney Disease Risk: A Prospective Cohort Study
by
Xiaofeng Zhang, Shuai Zhang, Jiali Lv, Xiaoyan Ma, Xia Lin, Lin Yang, Shengxu Li and Tao Zhang
Healthcare 2025, 13(7), 703; https://doi.org/10.3390/healthcare13070703 (registering DOI) - 23 Mar 2025
Abstract
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Background: Previous studies have indicated that both dietary zinc supplementation and sleep patterns may influence the development of chronic kidney disease (CKD). Additionally, it is established that dietary zinc can enhance sleep quality. Despite these insights, the interplay between zinc supplementation and sleep
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Background: Previous studies have indicated that both dietary zinc supplementation and sleep patterns may influence the development of chronic kidney disease (CKD). Additionally, it is established that dietary zinc can enhance sleep quality. Despite these insights, the interplay between zinc supplementation and sleep patterns, and their combined effect on CKD progression, is still not fully understood. Methods: This population-based cohort study used UK Biobank data (2006–2010) and employed cox regression models to assess the associations between dietary zinc supplementation, sleep patterns, and their combined effects on CKD. Results: Over a median follow-up of 14.8 years, 22,384 new CKD cases were identified. Zinc supplementation reduced CKD risk in individuals with poor (HR: 0.70, 95% CI: 0.50–0.98) and moderate (HR: 0.89, 95% CI: 0.81–0.98) sleep patterns but not in those with healthy sleep (HR: 1.00, 95% CI: 0.89–1.14). A significant interaction between zinc supplementation and sleep patterns was observed (p = 0.017), with sensitivity analyses confirming the results. Conclusions: These findings indicate a significant association between dietary zinc supplementation and reduced CKD risk, especially in individuals with poor sleep patterns. Further studies are needed to explore zinc supplementation as a targeted intervention for those at higher CKD risk due to poor sleep.
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