Healthcare

16 pages, 345 KB

Open AccessArticle

A Pilot Observational Study in Ohio, USA of the Healing of Our Veterans Equine Services Intensive Intervention for Veterans with Trauma Histories

by Amanda Held, Katy Hubbard, Elena Nazarenko and William Marchand

Healthcare 2025, 13(23), 3111; https://doi.org/10.3390/healthcare13233111 (registering DOI) - 28 Nov 2025

Abstract

Background/Objectives: Equine-assisted services are being increasingly utilized as complementary interventions for military veterans who have experienced trauma. However, rigorous research is lacking, and randomized controlled trials are needed. The H.O.O.V.E.S. Intensive intervention was developed for this population. This intensive program is an [...] Read more.

Background/Objectives: Equine-assisted services are being increasingly utilized as complementary interventions for military veterans who have experienced trauma. However, rigorous research is lacking, and randomized controlled trials are needed. The H.O.O.V.E.S. Intensive intervention was developed for this population. This intensive program is an equine-assisted learning approach developed for veteran and active-duty military trauma survivors. The program integrates equine-assisted learning, peer mentorship and experiential learning in a residential retreat format. The primary aim of this pilot study was to determine if more rigorous studies of this intervention are warranted. Secondary aims were to assess preliminary outcomes and explore possible relationships between changes in outcome measures. Methods: This was a pilot prospective study. Inclusion criteria for the program included veteran or active-duty military status and a history of trauma exposure. Data were collected from April–October of 2024 in Ohio, USA. Six psychological instruments were administered to participants before, immediately after and 90 days and 120 days after the intervention. These were the PTSD Checklist for DSM-5 (PCL-5), the Acceptance and Action Questionnaire II (AAQII), the Positive and Negative Affect Scale (PANAS), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI) and the Posttraumatic Growth Inventory (PTGI). Analyses were conducted to assess for significant changes across the study timeframe and for relationships among the changes in psychological instrument scores. Results: Study participants were 32 veterans with trauma histories ranging in age from 30 to 67 years old. There were statistically significant pre- to post-intervention improvements for all instruments except the PTGI, suggesting short-term increased psychological flexibility (AAQII) and positive affect (PANAS-positive) as well as decreased anxiety (STAI), negative affect (PANAS-negative), depression (BDI) and PTSD symptoms (PCL-5). Changes in BDI and PCL-5 scores persisted at 120 days post-intervention whereas changes in the AAQII, PANAS and STAI did not persist. Increased psychological flexibility was correlated with reductions in negative affect, PTSD symptoms and anxiety, as well as with increases in positive affect. Conclusions: Preliminary results reported herein suggest participation is associated with psychological benefits. Further, decreased experiential avoidance/increased psychological flexibility should be explored as an underlying mechanism potentially contributing to the benefits of participation in EAS. A randomized controlled trial of the H.O.O.V.E.S. Intensive program is warranted. Full article

(This article belongs to the Special Issue Human–Animal Interaction: Animal Behaviour and Whole-Person Health in Animal-Assisted Interventions)

13 pages, 313 KB

Open AccessArticle

Assessing Public Awareness and Social Acceptance of Scoliosis Screening and Treatment Options in Saudi Arabia: A Nationwide Cross-Sectional Study

by Abdulmonem Alsiddiky, Abdulaziz S. AlNahari, Abdulmalik A. Alomrani, Mayssar Bassam Alshobaki, Naif Alateeq, Abdullah Nasser Almawash, Maha Emad Aldaijy, Sarah Essa Alsuwaidan, Mohammed Khalid Alqifari, Mohammed N. Aldawsari and Sara Alhomaidhi

Healthcare 2025, 13(23), 3110; https://doi.org/10.3390/healthcare13233110 (registering DOI) - 28 Nov 2025

Abstract

Background: Scoliosis is a common musculoskeletal disorder that remains underrecognized in Saudi Arabia, where limited public awareness may delay early detection and treatment. This study assessed public knowledge, support for school-based screening, and attitudes toward treatment. Methods: A nationwide cross-sectional survey was conducted [...] Read more.

Background: Scoliosis is a common musculoskeletal disorder that remains underrecognized in Saudi Arabia, where limited public awareness may delay early detection and treatment. This study assessed public knowledge, support for school-based screening, and attitudes toward treatment. Methods: A nationwide cross-sectional survey was conducted during the 2025 Saudi National Scoliosis Awareness Campaign through public venues and online platforms. A culturally adapted questionnaire assessed demographics, knowledge, symptom recognition, treatment preferences, barriers, and information sources. A total of 2055 responses were analyzed using descriptive statistics and chi-square tests. Results: While 70.9% of participants had heard of scoliosis, only 18.1% reported good understanding. Symptom recognition was limited, with spinal curvature, back pain, and uneven shoulders most often identified. Most respondents supported school-based screening (88.2%) and early detection (92.1%), with a mean preferred screening age of 8 years. Bracing (64.3%) and surgery (53.5%) were more accepted than observation (30.5%), though concerns about pain, effectiveness, and appearance were frequent. Social media was the most common initial information source (34.6%), while healthcare professionals were the preferred future source (79.2%). Reported barriers included lack of awareness (68.2%), difficulty accessing specialists (19.9%), and cost (8.9%). Conclusions: Public support for school-based screening is strong, but baseline knowledge remains limited, and treatment perceptions are shaped by psychosocial and cultural concerns. National campaigns, school curricula, and healthcare-led education, combined with accessible, low-cost screening, may enhance early detection and improve scoliosis management in Saudi Arabia. Full article

16 pages, 577 KB

Open AccessArticle

Latent Profile Analysis of Occupational Stress and Psychological Capital and the Dual Mechanisms of Psychological Capital in Healthcare Workers’ Sleep Quality

by Sijia Yang, Boya Zhang, Jian Chen, Jiahui Li, Bo Zhang and Zhijun Zhou

Healthcare 2025, 13(23), 3109; https://doi.org/10.3390/healthcare13233109 (registering DOI) - 28 Nov 2025

Abstract

Background: Sleep disorders are highly prevalent among healthcare workers (HCWs) globally, with occupational stress (OS) being a major underlying cause. Psychological capital (PsyCap) may serve as a protective resource, yet its combined relationship with OS and sleep quality remains underexplored. Objectives: [...] Read more.

Background: Sleep disorders are highly prevalent among healthcare workers (HCWs) globally, with occupational stress (OS) being a major underlying cause. Psychological capital (PsyCap) may serve as a protective resource, yet its combined relationship with OS and sleep quality remains underexplored. Objectives: We aimed to identify distinct OS-PsyCap profiles among HCWs, examine their associations with sleep quality, and investigate the mediating and moderating roles of PsyCap. Methods: A cross-sectional study was conducted among 1046 HCWs in Shanghai in December 2024. The Job Content Questionnaire, Psychological Capital Questionnaire, and Pittsburgh Sleep Quality Index were used to measure OS, PsyCap, and sleep quality, respectively. Latent profile analysis (LPA) was conducted to identify OS–PsyCap subgroups. Generalized linear models (GLM) and moderation and mediation analyses were performed to examine associations and to elucidate the role of PsyCap. Results: HCWs were divided into two distinct profiles: Class 1 (low OS and high PsyCap, 45.2%) and Class 2 (high OS and low PsyCap, 54.8%). HCWs in Class 2 had significantly poorer self-rated health and more sleep disturbances. Higher job demands and organizational support were associated with worse sleep outcomes, while higher autonomy and higher PsyCap were protective. In mediation and moderation analyses, PsyCap mediated 16.4–37.8% of OS–sleep relationships but also amplified OS effects on certain sleep outcomes under high stress. Conclusions: High OS with low PsyCap significantly increased sleep disorder risk among HCWs. PsyCap exhibited dual mechanisms, mediating stress effects while exacerbating sleep issues in high-stress contexts. Targeted interventions should address these HCWs in distinct profiles and pathways. Full article

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

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7 pages, 183 KB

Open AccessArticle

Exploring Mental Help-Seeking Behaviors, Health, and Well-Being in Rural Veterans with Chronic Health Conditions: A National Rural Health Study

by Jimena Ortiz, Beatrice Lee, Jeannie Concha, John Barnas, Jim Yates and Emre Umucu

Healthcare 2025, 13(23), 3108; https://doi.org/10.3390/healthcare13233108 (registering DOI) - 28 Nov 2025

Abstract

Background/Objective: Veterans in the United States have increased significantly, with a substantial proportion residing in rural areas. This study aims to examine the relationship between help-seeking behaviors and well-being, controlling demographic variables and service-connected disability status. It also explores mental health–seeking behaviors, health [...] Read more.

Background/Objective: Veterans in the United States have increased significantly, with a substantial proportion residing in rural areas. This study aims to examine the relationship between help-seeking behaviors and well-being, controlling demographic variables and service-connected disability status. It also explores mental health–seeking behaviors, health outcomes, and overall well-being among rural Veterans with existing health conditions. Methods: Data was collected through surveys distributed across multiple channels, including social media platforms. Results: Results indicated that willingness to seek psychological help was positively associated with the well-being of rural Veterans. Conclusions: These findings underscore the critical importance of both willingness to seek mental health support and access to mental health and substance use care services for rural Veterans. Full article

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

39 pages, 1170 KB

Open AccessReview

Bridging Distance, Delivering Care: Pediatric Tele-Nutrition in the Digital Health Era—A Narrative Review

by Motti Haimi and Liron Inchi

Healthcare 2025, 13(23), 3107; https://doi.org/10.3390/healthcare13233107 (registering DOI) - 28 Nov 2025

Abstract

Background: The emergence of telehealth has transformed healthcare delivery across multiple disciplines, with tele-nutrition representing a rapidly evolving field that addresses nutritional assessment, counseling, and management through digital platforms. Objective: This narrative review examines the current landscape of pediatric tele-nutrition services, exploring technological [...] Read more.

Background: The emergence of telehealth has transformed healthcare delivery across multiple disciplines, with tele-nutrition representing a rapidly evolving field that addresses nutritional assessment, counseling, and management through digital platforms. Objective: This narrative review examines the current landscape of pediatric tele-nutrition services, exploring technological platforms, clinical applications, evidence for effectiveness, implementation considerations, and future directions. Methods: A comprehensive literature search was conducted across PubMed, CINAHL, Embase, and Web of Science databases from January 2010 to October 2025. A total of 114 relevant sources were selected, encompassing randomized controlled trials, observational studies, systematic reviews, implementation studies, clinical guidelines, and policy documents. Results: This review synthesized 114 sources, predominantly from the United States (54%) and European nations (21%), with evidence expansion accelerating post-COVID-19 pandemic. Evidence suggests pediatric tele-nutrition demonstrates clinical outcomes comparable to traditional in-person care across diverse populations including obesity management, diabetes, gastrointestinal disorders, feeding difficulties, metabolic conditions, and preventive nutrition services. Multiple technology platforms are utilized, with synchronous video consultations most common (60–85% of encounters). Benefits include enhanced access to specialized care, increased frequency of contact, reduced family burden, and high satisfaction rates (>80% across most studies). Challenges include limitations in physical assessment, digital equity concerns affecting vulnerable populations, variable reimbursement policies, and the need for provider training. Hybrid models combining virtual and in-person care appear optimal for many conditions. Conclusions: Pediatric tele-nutrition represents a viable and effective care delivery model with particular advantages for families facing geographic, logistic, or access barriers. Continued attention to digital equity, provider training, regulatory frameworks, sustainable reimbursement policies, and rigorous evidence generation will optimize implementation and outcomes. Future directions include artificial intelligence applications, precision nutrition approaches, and expanded global health applications. Full article

(This article belongs to the Special Issue Telemedicine and eHealth Applications in the Pediatric Population)

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14 pages, 236 KB

Open AccessArticle

Assessing Postoperative Handover Quality Among Nurses Across Surgical and Recovery Units: A Cross-Sectional Study

by Afnan M. Alotaibi, Essmat A. Mansour, Sahar M. Yakout and Amany Anwar Saeed Alabdullah

Healthcare 2025, 13(23), 3106; https://doi.org/10.3390/healthcare13233106 - 28 Nov 2025

Abstract

Background/Objectives: Inefficient postoperative handovers contribute to medical malpractice and care discontinuity by omitting critical patient information and compromising patient health. This study aimed to evaluate and compare the quality of postoperative nurse handovers in ORs, PACUs, ICUs, and wards across four hospitals in [...] Read more.

Background/Objectives: Inefficient postoperative handovers contribute to medical malpractice and care discontinuity by omitting critical patient information and compromising patient health. This study aimed to evaluate and compare the quality of postoperative nurse handovers in ORs, PACUs, ICUs, and wards across four hospitals in Jeddah, Saudi Arabia. Methods: A descriptive, cross-sectional, comparative study was conducted among postoperative care nurses across four hospitals in the second health cluster in Jeddah, Saudi Arabia. Data were collected through an online questionnaire to assess handover quality via a Handover Quality Rating Form and sociodemographic information. Data analysis was performed using SPSS v28. Results: Among the 521 nurse participants (84.1% female, M_age = 34.5 years), the overall postoperative handover quality was 76.8%, with handover conduct and quality scoring the highest (27.9 ± 4.8 and 17.7 ± 3.1, respectively). Female nurses demonstrated significantly higher performance in teamwork and handover circumstances, whereas older nurses demonstrated significantly better teamwork, handover conduct, and quality. Saudi and younger nurses experienced significantly higher handover circumstances. Nurses’ educational level and years of experience in the present ward were significantly correlated with handover circumstances, conduct, and quality. Handovers from the theater to recovery resulted in higher average circumstances than those from recovery to the ward. The study setting was significantly associated with handover quality. Conclusions: These findings highlight the importance of local evaluating the handover quality of nurses in various contexts, specifically considering the circumstances, conduct, and teamwork when planning implementation and developing standardized handover protocols for different departments, specialties, and healthcare settings. These results support the development of targeted training programs and unit-specific handover protocols. Full article

17 pages, 321 KB

Open AccessReview

Attachment Classification, Emotion Regulation, and Defense Mechanisms: An Integrative Narrative Review

by Arielle M. Morris, Emma Freeberg-Powell, Shivani Verma, Mariagrazia Di Giuseppe, Hunter Crespo, Leon Hoffman and Timothy Rice

Healthcare 2025, 13(23), 3105; https://doi.org/10.3390/healthcare13233105 (registering DOI) - 28 Nov 2025

Abstract

Attachment style and emotion regulation (ER) patterns intertwine. Securely attached individuals employ more adaptive ER strategies, while individuals with avoidant, preoccupied, and disorganized styles rely on less adaptive strategies. Defense mechanisms are part of an experience-near, observable construct that parallels implicit ER. The [...] Read more.

Attachment style and emotion regulation (ER) patterns intertwine. Securely attached individuals employ more adaptive ER strategies, while individuals with avoidant, preoccupied, and disorganized styles rely on less adaptive strategies. Defense mechanisms are part of an experience-near, observable construct that parallels implicit ER. The evaluation of a patient’s defense mechanisms may therefore be a means of identifying and understanding the patient’s attachment classification. This article synthesizes recent empirical research and theory to delineate relationships among attachment styles, ER, and defense mechanisms. It then examines how development and culture shape attachment, discusses assessment strategies, and offers clinicians guidance for assessing attachment through a defense mechanism orientation. This clinical technique may assist clinicians in informed assessment and treatment and underscores the benefits of further integration of attachment research with that of defense mechanisms. Full article

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

19 pages, 1386 KB

Open AccessArticle

The Burden of Inflammatory Bowel Disease in Gulf Cooperation Council Countries from 1990 to 2021 with Forecasting Projections to 2030: A Global Burden of Disease Study

by Ahmed K. Alsaif, Jawad S. Alnajjar, Faisal A. Al-Harbi, Ahmed A. Alsirhani, Sultan S. Alruqaie, Abdulaziz T. Alturki, Mohammed A. Basuhail, Abdulrhman K. Alabdulqader, Ahmed A. Albadrani and Ahmed Y. Azzam

Healthcare 2025, 13(23), 3104; https://doi.org/10.3390/healthcare13233104 - 28 Nov 2025

Abstract

Background: Inflammatory bowel disease (IBD) represents a growing health challenge in regions undergoing socioeconomic transition. This study characterized IBD epidemiology across Gulf Cooperation Council (GCC) countries, forecasted future burden, and identified country-specific determinants to inform targeted health policy interventions. Methods: IBD data from [...] Read more.

Background: Inflammatory bowel disease (IBD) represents a growing health challenge in regions undergoing socioeconomic transition. This study characterized IBD epidemiology across Gulf Cooperation Council (GCC) countries, forecasted future burden, and identified country-specific determinants to inform targeted health policy interventions. Methods: IBD data from the Global Burden of Disease study (1990–2021) were analyzed for all six GCC countries using descriptive epidemiology, temporal trend analysis, three forecasting models (Age-Period-Cohort, Joinpoint regression, Bayesian age-standardized rate modeling), and regression analyses to identify socioeconomic, environmental, gender-specific, and healthcare system factors associated with IBD burden variation. Results: Age-standardized IBD prevalence rates varied across GCC countries (28.92–42.93 per 100,000), with Qatar and the United Arab Emirates (UAE) showing the highest rates and fastest increases (967% and 898% since 1990). Kuwait uniquely demonstrated stable or slightly declining trends. Significant female predominance emerged in most countries (male ratio 0.70–0.91) with strong birth cohort effects (1970s cohorts showing 18–48% higher risk than 1950s cohorts). IBD manifested primarily as disability rather than a mortality burden. Projections indicate continued increases through 2030, potentially reaching 55–59 per 100,000 in Qatar and the UAE. Fast food outlet density, processed food imports, antibiotic consumption, and female vitamin D deficiency were the most significant modifiable risk factors. Conclusions: The GCC region faces a growing IBD epidemiological profile characterized by rising burden, female predominance, and generational differences in risk observations. Identification of modifiable determinants provides actionable targets for intervention, while country-specific projections offer a foundation for healthcare planning to address this challenge. Full article

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19 pages, 1551 KB

Open AccessArticle

Effect of a Mobile App-Based Exercise Program on Diastasis Recti Abdominis, Muscle Strength, Anthropometric Measures, and Satisfaction Among Post-Cesarean Primiparous Mothers: A Randomized Controlled Trial

by Gehan A. Abdelsamea, Shimaa Abdelalim Essa, Azza Sayed Abdelrehim Khalil, Hoda M. Zakaria, Rehab S. Mamoon and Mohamed G. Ali

Healthcare 2025, 13(23), 3103; https://doi.org/10.3390/healthcare13233103 - 28 Nov 2025

Abstract

Background: Diastasis rectus abdominis (DRA) is a frequent concern following childbirth, particularly following a cesarean section (CS). Mobile exercise applications offer promising opportunities for enhancing physical therapy services, with potential positive outcomes. Purpose: This study compared the effect of a specific [...] Read more.

Background: Diastasis rectus abdominis (DRA) is a frequent concern following childbirth, particularly following a cesarean section (CS). Mobile exercise applications offer promising opportunities for enhancing physical therapy services, with potential positive outcomes. Purpose: This study compared the effect of a specific DRA-targeted mobile app-based exercise program on inter-recti distance (IRD) and multiple clinical measures to a traditional abdominal exercise program in post-CS mothers with DRA. Methods: This two-armed, parallel-group, randomized controlled trial involved 40 primiparous women undergoing CS; they were classified into two equal groups. Group A participated in Just Fit, a mobile app-based abdominal exercise program, while Group B received a traditional abdominal exercise program. Both exercise programs lasted 30 min, 3 times/week, for 8 weeks as a home program with follow-up sessions once weekly at an outpatient physical therapy clinic. Ultrasonography was used to measure IRD, a manual muscle test assessed abdominal muscle strength, a tape measure gauged circumferences, and a questionnaire evaluated satisfaction. Results: Both programs showed significant improvements in pre- and post-treatment measures of IRD, muscle strength, and girth (p ≤ 0.001 for all comparisons). Women in Group A exhibited significant post-treatment improvements in IRD above the umbilicus, abdominal muscle strength, girth measurements, and satisfaction compared with those in Group B. However, there were non-significant differences in IRD below the umbilicus and hip circumference between the two groups. Conclusions: The mobile app-based exercise program was associated with greater improvements in IRD above the umbilicus, abdominal muscle strength, waist and umbilical circumferences, and patient satisfaction compared with the traditional exercise program for post-CS DRA. These findings suggest that mobile app-guided rehabilitation may serve as an effective and accessible adjunct to traditional post-CS exercise programs, although larger trials are recommended to confirm these results. Full article

(This article belongs to the Special Issue Digital Health Innovations in Rehabilitation: Integrating Clinical, Technological, and Ethical Perspectives)

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11 pages, 320 KB

Open AccessArticle

Exploring Adults’ Experiences with Tirzepatide for Weight Loss: A Mixed-Methods Study

by Shukri Adam, Fatma M. Ibrahim, Eman Abdelaziz Ahmed Dabou, Sneha Pitre, Rania Aiman and Shimaa AbdelSamad

Healthcare 2025, 13(23), 3102; https://doi.org/10.3390/healthcare13233102 - 28 Nov 2025

Abstract

Background: Obesity confers substantial cardiometabolic risk. Tirzepatide, a once-weekly dual GIP/GLP-1 receptor agonist, produces dose-dependent weight loss in trials, but real-world patient-reported experiences are under-described. We evaluated real-world self-efficacy and experiences with tirzepatide in community settings. Methods: Explanatory sequential mixed-methods study of adults [...] Read more.

Background: Obesity confers substantial cardiometabolic risk. Tirzepatide, a once-weekly dual GIP/GLP-1 receptor agonist, produces dose-dependent weight loss in trials, but real-world patient-reported experiences are under-described. We evaluated real-world self-efficacy and experiences with tirzepatide in community settings. Methods: Explanatory sequential mixed-methods study of adults aged 18–59 years using tirzepatide for weight management. We collected a quantitative survey (demographics; medication use; 20-item Weight Efficacy Lifestyle Questionnaire [WEL]) followed by purposive semi-structured interviews. Associations between WEL and participant characteristics were tested a priori (two-tailed α = 0.05). Results: Among 120 participants (50.8% male; mean age 42 ± 13 years), 91.7% reported weight loss and 85.8% had <6 months’ exposure. WEL total was 91 ± 34. Higher WEL was observed in females, employed participants, those with insurance coverage versus self-pay, during early months of therapy, and among those with prior weight-loss attempts (all p < 0.05). Interviews (n = 15) indicated high satisfaction, improved sleep/energy, mood, and confidence; gastrointestinal effects were usually mild/transient. Interpretation: In routine care, tirzepatide use was associated with high eating self-efficacy and positive patient-reported outcomes. Variation by coverage and duration suggests value in pairing pharmacotherapy with behavioral support and addressing affordability to sustain benefits. Full article

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

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12 pages, 830 KB

Open AccessArticle

Comparative Effectiveness of Kyphoplasty and Radiation with or Without Radiofrequency Ablation in Spinal Metastases from Lung Cancer

by Kamal Shaik, Spencer T. Rasmussen, Muhammad Hozien, Rudy Rahme and Michael Karsy

Healthcare 2025, 13(23), 3101; https://doi.org/10.3390/healthcare13233101 - 28 Nov 2025

Abstract

Background/Objectives: Spinal metastases from lung cancer cause substantial pain, instability, and neurologic compromise. Radiotherapy and kyphoplasty are standard treatment modalities, while radiofrequency ablation (RFA) has emerged as a potential adjunct for cytoreduction. The objective of this study was to evaluate whether RFA confers [...] Read more.

Background/Objectives: Spinal metastases from lung cancer cause substantial pain, instability, and neurologic compromise. Radiotherapy and kyphoplasty are standard treatment modalities, while radiofrequency ablation (RFA) has emerged as a potential adjunct for cytoreduction. The objective of this study was to evaluate whether RFA confers additional benefit when combined with kyphoplasty and radiotherapy in patients with lung cancer spinal metastases. Methods: We conducted a retrospective cohort study of adults with lung cancer and spinal metastases from 2012–2024 using the TriNetX database. Patients were identified using International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes and stratified into two groups: kyphoplasty with radiotherapy alone versus kyphoplasty with radiotherapy and RFA. Propensity score matching was applied to balance demographic and clinical covariates. The primary outcome was 1-year all-cause mortality. Secondary outcomes included tumor recurrence, neurologic complications, and pain burden as assessed by opioid prescription rates. Risk ratios (RR) with 95% confidence intervals (CI) were calculated. Results: A total of 703 patients met inclusion criteria. After matching, no significant differences were observed between groups for 1-year mortality (RR 1.021, 95% CI 0.83–1.256), tumor recurrence (RR 0.989, 95% CI 0.789–1.238), neurologic complications (RR 1.052, 95% CI 0.563–1.967), or opioid use as a pain proxy (RR 0.986, 95% CI 0.76–1.28). Conclusions: The addition of RFA to kyphoplasty and radiotherapy did not significantly impact survival, recurrence, neurologic, or pain outcomes in patients with spinal metastases from lung cancer. These findings suggest that the incremental benefit of RFA in this setting is limited and emphasize the need for prospective studies to refine patient selection and treatment strategies. Full article

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16 pages, 241 KB

Open AccessArticle

Interpersonal Communication in Intensive Care Units: A Qualitative Study on Family Members’ Experiences in a Turkish Public Hospital

by Asu Ozgultekin, Elgiz Yilmaz Altuntas and Deniz Birtan

Healthcare 2025, 13(23), 3100; https://doi.org/10.3390/healthcare13233100 - 28 Nov 2025

Abstract

Background/Objectives: Studies on the satisfaction of patients’ relatives in intensive care units are quite limited both in our country and worldwide. In intensive care units, particularly in adult settings, communication is known to be one of the most important factors influencing patient [...] Read more.

Background/Objectives: Studies on the satisfaction of patients’ relatives in intensive care units are quite limited both in our country and worldwide. In intensive care units, particularly in adult settings, communication is known to be one of the most important factors influencing patient and family satisfaction. From a communication theory perspective, there are very few qualitative descriptive studies that reveal how this issue is perceived. This research aims to examine the information needs of relatives of patients receiving treatment in intensive care units and their satisfaction levels with regard to regular information provision practices carried out by healthcare professionals working in intensive care units in Turkey. Methods: Semi-structured interviews were conducted with 23 patients’ family members in two adult ICUs at a university-affiliated training and research hospital in Turkey. In the data collection process, the ‘Critical Care Family Needs Inventory’ was used to establish the family needs, as well as a sociodemographic questionnaire that included: age, gender, educational level, patient relationship and previous ICU experience. The unstructured texts obtained from the interviews were analyzed using the Atlas.ti qualitative data analysis software for the thematic analysis method. Results: The findings revealed that while face-to-face information provided by healthcare professionals is generally perceived as comprehensive, regular, and confidence-building, the experience of obtaining information by telephone varies greatly depending on hospital and family circumstances. Inconsistencies in telephone-based information access can create significant communication barriers for some families, yet in certain situations (e.g., chronic illnesses), it can serve as a vital adaptation and information flow tool. Conclusions: The ‘Uncertainty Management Theory’ and the ‘Information Management Theory’ are critical for understanding the effects of communication quality in the intensive care unit (ICU) environment on the psychological state of family members and their decision-making processes. Healthcare professionals should recognize that their communication serves not only an informative function but also has profound effects on family members’ psychological well-being and participation in the healthcare process. Full article

(This article belongs to the Special Issue Physician–Patient Communication, Nursing and Health Outcomes)

16 pages, 214 KB

Open AccessArticle

Professional Quality and Empathy of Responses Provided by AI and Dentists: A Cross-Sectional Study

by Thekla J. Pfeiffer-Grötz, Luisa Schäfer, Anke Hollinderbäumer, Dominik Haag, Lisa Zöll and James Deschner

Healthcare 2025, 13(23), 3099; https://doi.org/10.3390/healthcare13233099 - 27 Nov 2025

Abstract

Background/Objectives: Artificial intelligence–based language models such as ChatGPT are increasingly used in medical communication, yet their performance compared with human clinicians remains insufficiently explored in dentistry. Because communication quality, including accuracy and empathy, is essential for patient understanding, this study aimed to compare [...] Read more.

Background/Objectives: Artificial intelligence–based language models such as ChatGPT are increasingly used in medical communication, yet their performance compared with human clinicians remains insufficiently explored in dentistry. Because communication quality, including accuracy and empathy, is essential for patient understanding, this study aimed to compare ChatGPT’s responses with those of dentists with different levels of professional experience. Methods: Ten standardized dental patient questions were generated by the authors and answered by ChatGPT and by three dentist groups (<2 years, 2–5 years, >5 years of experience; one respondent per group, randomly selected from five eligible dentists). Subsequently, 30 dentists rated the professional quality of the responses, and 50 patients evaluated perceived empathy on 4-point scales. Group differences were analyzed using the non-parametric Friedman test with exact post hoc comparisons and Bonferroni correction. Results: ChatGPT received higher ratings than all dentist groups in both domains. Mean empathy scores were 3.23 for ChatGPT versus 1.73–2.14 for dentists, and mean quality scores were 3.50 versus 1.79–2.21 (all p < 0.001). Early-career dentists scored moderately higher than the most experienced group but consistently below ChatGPT. Due to the exploratory design and small number of respondents per experience group, these findings should be interpreted cautiously. Conclusions: ChatGPT generated responses rated as more empathetic and of higher professional quality than those of participating dentists. This suggests potential value for supporting routine, text-based dental communication. However, limitations such as lack of genuine empathy, data privacy concerns, and clinical responsibility must be considered. Larger studies are needed to validate these results Full article

21 pages, 595 KB

Open AccessReview

Cardiopulmonary Exercise Testing and HFpEF: Diagnostic and Therapeutic Perspectives

by Francesco Di Spigno, Valeria Dall’Ospedale, Luigi Gerra, Federico Breviario, Andrea Tedeschi, Giancarlo Trimarchi and Daniela Aschieri

Healthcare 2025, 13(23), 3098; https://doi.org/10.3390/healthcare13233098 - 27 Nov 2025

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) is a complex and heterogeneous clinical syndrome that represents an increasing global health challenge due to its high rates of morbidity, hospitalization, and mortality. In this context, cardiopulmonary exercise testing (CPET) has emerged as a [...] Read more.

Background: Heart failure with preserved ejection fraction (HFpEF) is a complex and heterogeneous clinical syndrome that represents an increasing global health challenge due to its high rates of morbidity, hospitalization, and mortality. In this context, cardiopulmonary exercise testing (CPET) has emerged as a valuable diagnostic modality, particularly in patients presenting with unexplained exertional dyspnea and inconclusive resting imaging results. Objectives and Clinical Implications: This narrative review examines current evidence on the clinical relevance and prognostic value of CPET parameters in HFpEF. Peak VO₂, a marker of aerobic capacity and cardiovascular fitness, has established prognostic value in heart failure with reduced ejection fraction (HFrEF). However, its prognostic significance in HFpEF remains less well defined. Oxygen pulse has emerged as another important measure for evaluating functional capacity and predicting response to exercise-based interventions, offering potential prognostic insight into adverse outcomes in HFpEF. Finally, the VE/VCO₂ slope, an index of ventilatory efficiency during exercise, also holds clinical relevance in HFpEF, particularly with concomitant pulmonary hypertension, though evidence remains heterogeneous. Conclusions: CPET-derived variables are valuable parameters for HFpEF assessment. Their systematic integration into clinical evaluation of HFpEF patients could guide individualized management strategies and inform clinicians for improving outcomes in this challenging condition. Full article

(This article belongs to the Special Issue Cardiopulmonary Exercise Testing: A Key Player in Cardiovascular Disease Management)

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13 pages, 823 KB

Open AccessArticle

Effects of Exercise-Based Cardiac Rehabilitation on Risk Factors, Fitness, and Quality of Life in Patients Undergoing Percutaneous Coronary Intervention: Emergency Department Versus Outpatient Routes

by Tong Yang, Yongchul Choi, Jiyoung Lee and Yonghwan Kim

Healthcare 2025, 13(23), 3097; https://doi.org/10.3390/healthcare13233097 - 27 Nov 2025

Abstract

Background/Objectives: Hospital visits for the treatment of coronary heart disease primarily consist of routine outpatient (OP) or unscheduled emergency room (ER) visits. This study compared the effectiveness of cardiac rehabilitation (CR) based on the routes of hospital visits after percutaneous coronary intervention (PCI). [...] Read more.

Background/Objectives: Hospital visits for the treatment of coronary heart disease primarily consist of routine outpatient (OP) or unscheduled emergency room (ER) visits. This study compared the effectiveness of cardiac rehabilitation (CR) based on the routes of hospital visits after percutaneous coronary intervention (PCI). Methods: Only men who completed three CR center visits (baseline, 6 months, 12 months) during the 12 months after PCI were analyzed. A total of 300 male patients were analyzed, with 206 patients in the OP group and 94 in the ER group, and their socioeconomic status, blood lipids, blood pressure, volume of oxygen peak (VO₂ peak), physical activity, and quality of life (QoL) were compared. This study is a retrospective analysis. Results: The ER group was older and had lower economic income than the OP group (p < 0.05). In the OP and ER groups, total cholesterol (OP −10.4%, and ER −8.6%) and low-density lipoprotein cholesterol (OP −10.9% and ER −8.2%) improved in the third visit compared to the first visit (p < 0.05). Additionally, VO2 peak (OP 16.5%, and ER 14.3%), physical activity (OP 25.1%, and ER 4.4%), and body fat (OP −5.8%, and ER −4.5%) ultimately improved in both groups (p < 0.05). The interaction effect by time and group showed that the OP group significantly improved compared to the ER group in terms of high-density lipoprotein cholesterol, VO₂ peak, exercise duration, grip strength, physical activity, body fat, and quality of life (p < 0.05). Conclusions: The 12-month CR program tended to improve outcomes in both groups, but the OP group showed greater improvements in high-density lipoprotein cholesterol, VO₂ peak, and QoL compared to the ER group. Full article

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16 pages, 742 KB

Open AccessArticle

Metabolic Indicators and Emotional Distress Symptoms Related to Overweight in Youth: A Brief Network Analysis

by Lesly Bucio-Palma, Lina García-Mier, Martha Cruz-Soto, Angela Vargas-Rodríguez and Jorge Palacios-Delgado

Healthcare 2025, 13(23), 3096; https://doi.org/10.3390/healthcare13233096 - 27 Nov 2025

Abstract

Overweight and obesity in young people represent a major public health challenge, not only due to their association with metabolic alterations but also because of their impact on emotional well-being. Background/Objectives: The objective of this study was to determine the structure of [...] Read more.

Overweight and obesity in young people represent a major public health challenge, not only due to their association with metabolic alterations but also because of their impact on emotional well-being. Background/Objectives: The objective of this study was to determine the structure of the network between metabolic indicators and emotional symptoms Methods: A sample of 78 university students was assessed through biochemical, anthropometric, and psychometric measures. Results: A total of 37.9% showed risk levels associated with excess weight and moderate emotional distress. There exist significant links between central adiposity and lipid alterations, as well as positive correlations between anxiety, depression an emotional exhaustion and inverse with happiness. Conclusions: The results highlight an interaction between metabolic and emotional factors even among individuals with normal weight, underscoring the value of network models for early risk detection. The findings are useful for implementing preventive strategies in university settings to promote improved health and emotional well-being. Full article

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12 pages, 2347 KB

Open AccessArticle

Evaluation of Constipation and Quality of Life Among Individuals Undergoing Hemodialysis: A Single-Center Cross-Sectional Study

by Asmaa Fatani, Reham W. Shafi, Hanadi Alhozali, Farouq Mohammad A. Alam, Abdulkader Monier Daghistani, Zulfitri Azuan Mat Daud, Bayan Tashkandi and Buthaina Aljehany

Healthcare 2025, 13(23), 3095; https://doi.org/10.3390/healthcare13233095 - 27 Nov 2025

Abstract

Aim: To assess the prevalence of constipation, dietary fiber intake, and their association with QoL among HD patients. Methods: A cross-sectional study was conducted among 35 adults undergoing maintenance HD at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Constipation was assessed using the [...] Read more.

Aim: To assess the prevalence of constipation, dietary fiber intake, and their association with QoL among HD patients. Methods: A cross-sectional study was conducted among 35 adults undergoing maintenance HD at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Constipation was assessed using the Rome IV criteria and Bristol Stool Form Scale (BSFS). QoL was evaluated using the Kidney Disease Quality of Life Short Form (KDQOL-36), and dietary fiber intake was estimated from three 24-h dietary recalls and a validated Dietary Fiber Intake Short Food Frequency Questionnaire (DFI-FFQ). Data were analyzed using Fisher’s exact test, the Mann–Whitney U test, and correlation coefficients (p < 0.05). Results: Constipation prevalence was 32%. Stool frequency was <3 per week in 14% of participants, 3–4 per week in 23%, and 7 per week in 63%. Mean fiber intake was 9.8 ± 4.8 g/day (24-h recall) and 8.6 ± 4.3 g/day (DFI-FFQ), with all participants classified as low fiber consumers. KDQOL-36 domain scores were highest for “effect of kidney disease” (80.4 ± 16.1) and lowest for “physical health” (40.4 ± 12.4). No significant associations were found between constipation, fiber intake, demographic or clinical variables, or any QoL domain (p > 0.05). Conclusions: Constipation is common among Saudi HD patients, yet not significantly linked to fiber intake or QoL in this small cohort. Larger multicenter studies are needed to identify determinants and guide evidence-based interventions. Full article

(This article belongs to the Special Issue Management of the Patient with Kidney Disease)

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10 pages, 393 KB

Open AccessArticle

Acute Pain Service Utilization as a Lens on Inequities in Trauma and Inpatient Management

by Maxwell B. Baker, Rachel Achu-Lopes, Haley Mullins, Dhanesh D. Binda, Erin Dienes, Rose Joachim and Nicole Z. Spence

Healthcare 2025, 13(23), 3094; https://doi.org/10.3390/healthcare13233094 - 27 Nov 2025

Abstract

Background: Inequities in pain management are well documented in chronic pain and outpatient settings, yet little is known about disparities in inpatient Acute Pain Service (APS) care. This study evaluated demographic, clinical, and social factors associated with APS utilization and outcomes in an [...] Read more.

Background: Inequities in pain management are well documented in chronic pain and outpatient settings, yet little is known about disparities in inpatient Acute Pain Service (APS) care. This study evaluated demographic, clinical, and social factors associated with APS utilization and outcomes in an urban safety-net hospital, with a subgroup analysis of trauma patients who presented with at least three rib fractures. Methods: We performed a retrospective cohort study of two patient populations from our institution: (1) all patients receiving APS consultation from 1 January 2020 to 1 November 2022 (n = 1445) and (2) all patients with traumatic rib fractures during this time, stratified by APS consult status (n = 650). Demographics, insurance, comorbidities, opioid prescribing, and discharge outcomes were analyzed using descriptive statistics, multivariable logistic regression, and log-linear models. As APS consultation criteria were not standardized during the study period, referral patterns reflected routine clinical practice rather than predefined eligibility criteria. Results: Across the full APS cohort, patients were disproportionately represented from vulnerable groups: 30.5% were Black, 81.0% had public insurance, and 32.9% had a substance use disorder (SUD). Methadone use was a strong predictor of non-home discharge, including discharges to a medical facility, hospice, or against medical advice (AMA). In the rib fracture cohort, patients receiving APS consults had significantly higher injury severity scores (Injury Severity Score 17.1 vs. 13.0, p < 0.001). Black patients were less likely to receive APS consult (17.3% vs. 28.8%, p = 0.024). However, this association appeared to be attributable to the younger age and male predominance within this subgroup, as both factors were identified as significant predictors of APS consultation. Conclusions: APS utilization at a high-volume safety-net hospital highlights the intersection of medical vulnerability and structural inequities, with greater involvement among patients who were members of racial and ethnic minorities, publicly insured, or diagnosed with SUD. In trauma populations, younger Black men were over-represented, reinforcing the heightened injury risks Black men may face and the downstream effects on patient care. Taken together, these results highlight how APS involvement acts not only as a marker of increased injury severity but also as an intervention to improve care for vulnerable patient populations. As APS teams regularly serve these populations, they are well-positioned to bridge broader gaps through the integration of addiction and social support services, individualized pain management, and seamless coordination of care across specialties. These findings underscore the need for standardized consultation criteria and integration of social and addiction medicine resources into APS care models. Full article

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24 pages, 4161 KB

Open AccessArticle

MetaAcuPoint: MetaHuman-Generated Synthetic Data for Hand Acupoint Localization

by Kasunika Guruge, Prathiksha Padmanabha, H. M. K. K. M. B. Herath, Nuwan Madusanka, Hi-Joon Park, Chang-Su Na, Myunggi Yi and Byeong-il Lee

Healthcare 2025, 13(23), 3093; https://doi.org/10.3390/healthcare13233093 - 27 Nov 2025

Abstract

Background: Precise localization of acupuncture points (acupoints) is crucial for the clinical success of Traditional Korean Medicine (TKM). Traditional methods that rely on visual inspection and palpation are subjective and prone to inter- and intra-observer differences, making standardization challenging. The progress of data-driven [...] Read more.

Background: Precise localization of acupuncture points (acupoints) is crucial for the clinical success of Traditional Korean Medicine (TKM). Traditional methods that rely on visual inspection and palpation are subjective and prone to inter- and intra-observer differences, making standardization challenging. The progress of data-driven localization techniques is also limited by the scarcity of annotated datasets and inconsistent labeling quality. Objective: This study presents MetaAcuPoint, a synthetic dataset created to overcome these limitations by providing high-fidelity, anatomically consistent hand images for acupoint localization. Methods: MetaAcuPoint was generated using MetaHuman avatars within Unreal Engine, resulting in 900 RGB hand images. Anatomically aligned, bone-attached sockets were implemented for five diagnostically relevant hand acupoints, ensuring millimeter-level precision and spatial consistency across various hand poses. Dataset validity was assessed by training a high-resolution network (HRNet-W48) within the MMPose framework and testing its performance on real-world forearm images. Results: The synthetic-trained model achieved a mean distance error (MDE) of 5.67 ± 3.13 pixels, closely aligning with the real-data baseline at 4.81 ± 2.85 pixels. Adding synthetic samples to real data further enhanced performance (MDE: 4.95 pixels). In contrast, manually annotated synthetic images yielded poorer results (MDE: 12.76 pixels), emphasizing the advantages of automated anatomical annotation. Generalization tests across four external datasets confirmed that the synthetic data-trained model outperformed the real-data-trained model, maintaining higher accuracy (MDE: 5.84–6.45 mm vs. 10.63–15.80 mm). Conclusions: MetaAcuPoint demonstrates the first example of synthetic-to-real generalization for hand acupoint localization. By combining photorealistic rendering with anatomically grounded annotation, the dataset offers a reliable resource to promote standardized, data-driven approaches in acupuncture research and practice. Full article

(This article belongs to the Special Issue Virtual Reality Technologies in Health Care)

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