Healthcare

1 pages, 126 KiB

Open AccessCorrection

Correction: Lee et al. Smartwatch-Derived VO2max Prediction Model for Korean Adults: Utilizing Heart Rate and GPS Data from the 12-Minute Cooper Test. Healthcare 2025, 13, 722

by Kihyuk Lee, Dohee Kim, Sungeun Shin, Hongjun Choi, Ahyun Jang and Jinwook Chung

Healthcare 2025, 13(10), 1100; https://doi.org/10.3390/healthcare13101100 (registering DOI) - 9 May 2025

Abstract

There was an error in the original publication [...] Full article

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

25 pages, 930 KiB

Open AccessArticle

From “Eating for Two” to Food Insecurity: Understanding Weight Gain Perspective During Pregnancy Among Malaysian Women

by Shahrir Nurul-Farehah, Abdul Jalil Rohana, Noor Aman Hamid, Zaiton Daud and Siti Harirotul Hamrok Asis

Healthcare 2025, 13(10), 1099; https://doi.org/10.3390/healthcare13101099 - 8 May 2025

Abstract

Background/Objectives: Gestational weight gain (GWG) is a critical determinant of pregnancy outcomes; however, studies on factors contributing to suboptimal GWG in developing countries, including Malaysia, remain limited. Methods: This study employed an explanatory sequential mixed-methods design, with the quantitative phase conducted between January [...] Read more.

Background/Objectives: Gestational weight gain (GWG) is a critical determinant of pregnancy outcomes; however, studies on factors contributing to suboptimal GWG in developing countries, including Malaysia, remain limited. Methods: This study employed an explanatory sequential mixed-methods design, with the quantitative phase conducted between January and March 2020, followed by the qualitative phase from July 2020 to March 2021 in Selangor. The qualitative phase aimed to explain the factors influencing suboptimal (inadequate and excessive) GWG identified in the quantitative phase. Inclusion criteria included Malaysian women aged 18 and above who had suboptimal GWG (either inadequate or excessive) from the quantitative phase. Exclusion criteria included women who refused participation. Of the 475 participants from the quantitative phase, 20 with suboptimal GWG were purposively selected for in-depth telephone interviews using a semi-structured interview protocol. Data were analysed using thematic analysis. Results: Three key themes emerged: (1) the impact of pre-pregnancy overweight and obesity, shaped by unhealthy lifestyles, social influences, and limited access to nutritious food and physical activity; (2) the management of diabetes during pregnancy, contributing to inadequate GWG due to psychological responses, restrictive behaviours, and barriers to dietary guidance; and (3) financial constraints in middle- and low-income households, leading to income vulnerability, financial crises, and food insecurity. Conclusions: This finding highlights the urgent need for targeted interventions to optimize GWG, emphasizing pre-pregnancy health optimization, enhanced diabetes management, and strategies to mitigate financial constraints and food insecurity among pregnant women. Full article

(This article belongs to the Section Preventive Medicine)

14 pages, 459 KiB

Open AccessArticle

Association Between Sedentary Behavior and Primary Dysmenorrhea in Young Korean Women: A Cross-Sectional Online Survey

by Myongsook Hyun and Jaehee Kim

Healthcare 2025, 13(10), 1098; https://doi.org/10.3390/healthcare13101098 - 8 May 2025

Abstract

Background/Objectives: Sedentary behavior is an independent risk factor for various health conditions, but its association with dysmenorrhea has been little investigated. This study aimed to examine whether sedentary behavior is independently associated with primary dysmenorrhea in young women, controlling for moderate-to-vigorous physical activity [...] Read more.

Background/Objectives: Sedentary behavior is an independent risk factor for various health conditions, but its association with dysmenorrhea has been little investigated. This study aimed to examine whether sedentary behavior is independently associated with primary dysmenorrhea in young women, controlling for moderate-to-vigorous physical activity and other known risk factors. Methods: An online survey was conducted in 603 young women in South Korea in 2023. Menstrual pain intensity was measured using a numeric rating scale, and symptoms were assessed with the Cox Menstrual Symptom Scale. Sedentary behavior and physical activity were assessed using the Global Physical Activity Questionnaire. Known risk factors for dysmenorrhea included menstrual and lifestyle characteristics, sleep quality, and stress. Results: Longer sedentary time (hours/day) was correlated with more frequent (r = 0.144; p < 0.001) and severe (r = 0.123; p < 0.01) menstrual symptoms but not with pain intensity. Multiple linear regression analysis showed that sedentary time was independently associated with the frequency (β = 0.10; p < 0.01) and severity (β = 0.09; p < 0.05) of menstrual symptoms after adjusting for physical activity and other risk factors for dysmenorrhea. Multiple logistic regression analysis showed that women with higher levels of sedentary time had 1.05 times greater odds (95% CI, 1.00–1.10; p < 0.05) of experiencing severe pain compared to those with less sedentary time, even after adjusting for physical activity and other risk factors. Conclusions: Prolonged sedentary behavior in young women is associated with more frequent and severe menstrual symptoms, including more intense menstrual pain. These findings highlight the need for public health strategies that reduce sedentary behavior to alleviate dysmenorrhea. Full article

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18 pages, 2174 KiB

Open AccessReview

A Narrative Review on Shifting Practice and Policy Around Social Determinants of Health (SDOH) Screenings: Expanding the Role of Social Workers in Healthcare Settings in the U.S.

by Shetal Vohra-Gupta, Liana Petruzzi, Amulya Cherian, Cheng Chow, Monica Unzueta and Rachel Joachimi

Healthcare 2025, 13(10), 1097; https://doi.org/10.3390/healthcare13101097 - 8 May 2025

Abstract

Introduction: Social workers play a critical role in healthcare settings by addressing both medical and nonmedical needs. Trained in human behavior and social environments, they are best suited to screen for social determinants of health (SDOH) and connect patients with resources paving the [...] Read more.

Introduction: Social workers play a critical role in healthcare settings by addressing both medical and nonmedical needs. Trained in human behavior and social environments, they are best suited to screen for social determinants of health (SDOH) and connect patients with resources paving the way for optimal health and well-being. Methods: This narrative review synthesizes the existing literature on SDOH screening practices within healthcare settings, emphasizing the role of social workers. A systematic search was conducted across multiple databases. A total of 26 studies met the inclusion criteria and were analyzed using a qualitative narrative synthesis approach. Results: This review reveals variability in SDOH screening domains, tools, and implementation strategies across healthcare settings. Facilitators and barriers to implementation were identified, including workflow integration, interprofessional collaboration, and contextual readiness. Social workers emerged as key professionals in addressing health-related social risks, leveraging their expertise in patient engagement, assessment, and system navigation. We further introduced the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to suggest the effective integration of SDOH screenings, emphasizing innovation, recipient engagement, contextual readiness, and facilitation. Conclusion: The effective integration of SDOH screenings requires structured workflows, interdisciplinary collaboration, and policy support. The review provides practice models of workflows for SDOH screenings and implications within two different healthcare settings: hospitals and outpatient clinics, offering insights into best practices and areas for future research. Strengthening the role of social workers in SDOH screenings can improve patient outcomes and promote health equity. Full article

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14 pages, 2335 KiB

Open AccessArticle

Age-Period-Cohort Analysis on the Burden of Gastrointestinal Cancers in China: Trends, Risk Factors, and Predictions

by Yongbo Lu, Jingya Zhang, Zongyang Zhou, Ning Zhang, Wei Ning and Ying Mao

Healthcare 2025, 13(10), 1096; https://doi.org/10.3390/healthcare13101096 - 8 May 2025

Abstract

Background: Gastrointestinal cancer imposes a heavy public health burden worldwide. The six major subtypes of GI cancer cases accounted for over a quarter of the total cancer cases in China. We examined and predicted the amount and trend of the burden of gastrointestinal [...] Read more.

Background: Gastrointestinal cancer imposes a heavy public health burden worldwide. The six major subtypes of GI cancer cases accounted for over a quarter of the total cancer cases in China. We examined and predicted the amount and trend of the burden of gastrointestinal cancer in China. Methods: We collected the crude incidence rate (CIR), age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), crude DALY rate, age-standardized DALY rate, crude death rate (CDR), and age-standardized death rate (ASDR) by gender, age, and risk factors from the Global Burden of Disease 2021 database, covering the period from 1990 to 2021. We used an age–period–cohort (APC) model to calculate the age, period, and cohort effects separately and a Bayesian APC model to predict the epidemiological trends and the age-specific incidence. Results: In 2021, 1,957,948 incidence cases of gastrointestinal cancers were estimated in China, with an incidence rate of 137.62 per 100,000. The burden was notably higher for males, with tobacco use accounting for 26.48% of male GI cancer DALYs versus dietary risks (13.22%) being predominant in females. Metabolic risk factors showed concerning growth trends, with high fasting plasma glucose increasing by 166.06% in males and 275.72% in females. The age–period–cohort analysis revealed peak incidence at advanced ages (>80 years) for most GI cancers. By 2050, China’s gastrointestinal cancer burden is projected to increase substantially, with total cases reaching 2.92 (95% CI: 2.27, 3.77) million (49.06% increase) and crude incidence rate rising to 230.51 (95% CI: 178.98, 298.03) per 100,000 (a 67.49% increase), predominantly driven by colorectal cancer (41.74%) and stomach cancer (21.47%). While crude incidence rates show consistent increases across all GI cancers, particularly in males, age-standardized incidence rates are predicted to decrease for most cancer types except for male colorectal and biliary tract cancers. Conclusions: The burden of gastrointestinal cancer in China is growing rapidly and will continue to increase. The performance of ASIR indicated that population aging is a potential driver of the increasing burden. Cancer control policies should focus on older people. It is critical to distinguish prevention strategies by gender and age according to the major risk factors. Full article

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14 pages, 1545 KiB

Open AccessArticle

Depressive Symptoms and Risk Factors During the COVID-19 Pandemic Among People with/Without Mental Disorders

by Yuko Fukase, Kanako Ichikura, Hidenori Inaoka and Hirokuni Tagaya

Healthcare 2025, 13(10), 1095; https://doi.org/10.3390/healthcare13101095 - 8 May 2025

Abstract

Background/Objectives: The present study aimed to reveal the differences in changes in and risk factors for depressive symptoms between people with and without various psychiatric disorders during the pandemic. Methods: Longitudinal web-based surveys were conducted from 2020 to 2022. The diagnosis [...] Read more.

Background/Objectives: The present study aimed to reveal the differences in changes in and risk factors for depressive symptoms between people with and without various psychiatric disorders during the pandemic. Methods: Longitudinal web-based surveys were conducted from 2020 to 2022. The diagnosis of mental disorders was based on self-reports by participants. Depressive symptoms were measured via the Patient Health Questionnaire-9 (PHQ-9), and coping was measured via the Brief Coping Orientation to Problems Experienced Inventory. A linear mixed model of PHQ-9, two-sample t-tests on Brief-COPE, and multiple linear regression for with and without mental disorders were conducted. Results: A total of 1443 participants were analyzed, of whom 9.3% had mental disorders. Depressive symptoms significantly decreased from January 2021 to January 2022, regardless of mental disorder status. Participants with mental disorders used certain coping styles more frequently than those without mental disorders. In a multiple linear regression analysis, no coping strategy was significantly effective for PHQ-9 scores among participants with mental disorders. However, being single was a risk factor, and emotional support use was associated with PHQ-9 scores. Additionally, behavioral disengagement was linked to PHQ-9 scores, regardless of mental disorder status. Conclusions: These results showed depressive symptoms might decrease in the long term regardless of the presence of mental disorders. Although there was no evidence of coping strategies effectively reducing depressive symptoms in people with mental disorders, the presence of a spousal relationship may play an important protective role for people with mental disorders and behavioral guidelines regardless of the presence of mental disorders. Full article

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17 pages, 1456 KiB

Open AccessSystematic Review

The Mechanism by 18 RCTs Psychosocial Interventions Affect the Personality, Emotions, and Behaviours of Paediatric and Young Adult Cancer Patients: A Systematic Review

by Xiao Liu, Honglin Chen, Natalie Joubert and Heli Tiirola

Healthcare 2025, 13(10), 1094; https://doi.org/10.3390/healthcare13101094 - 8 May 2025

Abstract

Background/Objectives: Psychosocial interventions bring mental and social benefits to paediatric and young adult patients. Gaining insight into the optimal psychosocial intervention strategies and their process mechanisms can contribute to the deepening of practice in this field. Methods: This systematic review evaluates [...] Read more.

Background/Objectives: Psychosocial interventions bring mental and social benefits to paediatric and young adult patients. Gaining insight into the optimal psychosocial intervention strategies and their process mechanisms can contribute to the deepening of practice in this field. Methods: This systematic review evaluates the psychosocial interventions that promote adaptability, resilience, and positive changes among paediatric and young adult patients. Following the Cochrane guidelines, the literature from 2000 to 2024 was reviewed, focusing on randomised controlled trials (RCTs). Results: Eighteen studies were included and analysed using a logic model framework. Therapeutic interventions that involved the reframing of cognition activities shaped personality changes, including resilience and adaptation, requiring significant investment, and they were influenced by individual characteristics and background. Process-oriented activities, such as art-, play-, and music-based therapies, improved emotional well-being and were affected by pain, cognitive abilities, and language skills. Behavioural changes are best achieved through interactive interventions, particularly group-based and parent-involved approaches, which improve social integration and physical abilities. Conclusions: Psychosocial interventions lead to positive changes in paediatric and young adult patients in terms of personality, emotion, and behaviour. Although the sample size for the behavioural changes is insufficient, understanding the mechanisms underlying these interventions benefits practice. Full article

(This article belongs to the Special Issue Health Promotion and Chronic Illness: Future Challenges and Opportunities)

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17 pages, 246 KiB

Open AccessArticle

Does Food Habits and Malnutrition Affect Health Perception Among Diabetic Patients? A Mediation and Moderation Analysis

by Sufyan Habib, Nawaf N. Hamadneh, Asif Hasan, Ahmed S. M. Almamy and Bandar N. Hamadneh

Healthcare 2025, 13(10), 1093; https://doi.org/10.3390/healthcare13101093 - 8 May 2025

Abstract

Background: The prevalence of diabetes among young individuals has reached concerning levels, posing significant public health risks and exacerbating the economic burden on healthcare systems. The health outcomes of individuals with diabetes are heavily influenced by malnutrition and unhealthy dietary habits, which not [...] Read more.

Background: The prevalence of diabetes among young individuals has reached concerning levels, posing significant public health risks and exacerbating the economic burden on healthcare systems. The health outcomes of individuals with diabetes are heavily influenced by malnutrition and unhealthy dietary habits, which not only hamper effective blood glucose management but also negatively affect overall health perceptions. Introduction: This study analyzes the factors influencing malnutrition, food habits, and health perceptions among diabetic patients. Methods: A well-structured questionnaire was designed to collect data. A cross-sectional survey of 503 diabetic patients across various regions in India was conducted. Additionally, structural equation modeling, as well as mediation and moderation analyses, were performed. Results: The study findings revealed that dietary knowledge, dietitian-led interventions, and economic factors significantly influenced malnutrition and health outcomes. Conversely, nutritional quality did not emerge as a significant predictor. Discussions: The study will help pharmaceutical companies, governments, and healthcare practitioners in marketing dietary supplements, design focused dietary programs, and develop health education campaigns to improve diabetes patients’ quality of life. The findings illuminated the critical roles of dietary knowledge, dietitian-led interventions, economic factors, and lifestyle modifications in managing malnutrition and enhancing health outcomes. Conclusions: The study demonstrated significant mediation and moderation effects, emphasizing the complex interplay between food habits and malnutrition on health perceptions. However, nutritional quality was not a significant predictor, and the research underscored the necessity of holistic, personalized interventions. This will also help medical marketers in devising their marketing strategies. Full article

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

11 pages, 818 KiB

Open AccessCase Report

Using the Trauma Reintegration Process to Treat Posttraumatic Stress Disorder with Dissociation and Somatic Features: A Case Series

by Mary T. Sise

Healthcare 2025, 13(10), 1092; https://doi.org/10.3390/healthcare13101092 - 8 May 2025

Abstract

Given the suboptimal responses to medication and cognitive behavioral therapies in the treatment of post-traumatic stress disorder (PTSD), new approaches are needed. Background/Objectives: Therapies that include a somatic component such as Emotional Freedom Techniques (EFT) and Eye Movement Desensitization and Reprocessing (EMDR) [...] Read more.

Given the suboptimal responses to medication and cognitive behavioral therapies in the treatment of post-traumatic stress disorder (PTSD), new approaches are needed. Background/Objectives: Therapies that include a somatic component such as Emotional Freedom Techniques (EFT) and Eye Movement Desensitization and Reprocessing (EMDR) have demonstrated efficacy in the treatment of PTSD in numerous clinical trials. This case series introduces the Trauma Reintegration Process (TRP), a psychotherapeutic process developed by the author that can be combined with somatic therapies to enhance their effectiveness, especially in patients with dissociation. Methods: This case series describes the use of TRP in combination with EFT, an energy-based somatic treatment that engages the meridian system of the body through gentle tapping on acupressure points. TRP uses EFT in combination with a focused guided imagery sequence. This case series describes the treatment of two patients: a 20-year-old woman who experienced PTSD and somatic symptoms following a serious motor vehicle accident (MVA) and a 45-year-old woman with a history of severe abuse as a child as well as adult trauma who had also been in a serious MVA. The cases contrast the way TRP can be applied in patients with single versus multiple traumas and who experience dissociation. Results: In both cases, EFT treatment stalled when the patient dissociated. After TRP was introduced, however, the EFT treatment regained momentum, leading to significant improvement in PTSD symptoms including a reduction of nightmares and flashbacks and resolution of other somatic symptoms. Conclusions: The trauma reintegration process (TRP) in combination with EFT has the potential to assist in the memory processing of patients with dissociation and complicated trauma presentation without retraumatizing the client and causing further distress or dissociation. In addition, it provides the patient with a self-empowering method to alleviate any additional traumatic sequelae. Full article

(This article belongs to the Special Issue Beyond Words: Somatic Approaches for Treating PTSD and Trauma)

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8 pages, 199 KiB

Open AccessOpinion

Legislation on Medical Assistance in Dying (MAID): Preliminary Consideration on the First Regional Law in Italy

by Lorenzo Blandi, Russell Tolentino, Giuseppe Basile, Livio Pietro Tronconi, Carlo Signorelli and Vittorio Bolcato

Healthcare 2025, 13(9), 1091; https://doi.org/10.3390/healthcare13091091 - 7 May 2025

Abstract

Medical assistance in dying (MAID) remains a sensitive and evolving issue in Europe, frequently linked with discussions about human freedom, life dignity, and healthcare policy. While national consensus in Italy is absent, the Region of Tuscany has enacted Law No. 16/2025, which establishes [...] Read more.

Medical assistance in dying (MAID) remains a sensitive and evolving issue in Europe, frequently linked with discussions about human freedom, life dignity, and healthcare policy. While national consensus in Italy is absent, the Region of Tuscany has enacted Law No. 16/2025, which establishes a MAID procedure based on recent Constitutional Court rulings. The commentary aims to provide a preliminary analysis of the new law, addressing ethical, medico-legal, and social issues that emerge in relation to the Italian and global debate on the topic. The law establishes a three-stage process based on four eligibility criteria: irreversible disease, psycho-physical suffering, life-support dependence, and informed consent. However, Tuscany’s model poses medico-legal and ethical concerns, particularly about the boundaries of regional legislative competence, the duties of healthcare professionals, and the possibility of intra-national inequity or “health migration.” In addition, critical organisational implications derived from informed consent and lethal drug self-administration impede clinical implementation in some individuals with mental or neurological disorders. The lack of clarity in the different steps of the procedure, the uncertain supervision system, and the potential consequences for specific categories of vulnerable people underline the need for comprehensive national regulation. A future regulatory framework must balance procedural clarity with individual autonomy and equitable access, bringing Italy in line with larger European context for end-of-life care. Full article

(This article belongs to the Special Issue Ethical Dilemmas and Moral Distress in Healthcare)

21 pages, 5023 KiB

Open AccessArticle

Implementation of a Family Skills Programme in Internally Displaced People Camps in Kachin State, Myanmar

by Karin Haar, Aala El-Khani, Hkawng Hawng, Tun Tun Brang, Win Mar, Zin Ko Ko Lynn and Wadih Maalouf

Healthcare 2025, 13(9), 1090; https://doi.org/10.3390/healthcare13091090 - 7 May 2025

Abstract

Background/Objectives: Children that are forcibly displaced are more likely to experience mental health and behavioural challenges than non-displaced populations, including increased risk of anxiety, depression and post-traumatic stress disorder. Building appropriate parenting skills to strengthen the relationships between caregivers and their children in [...] Read more.

Background/Objectives: Children that are forcibly displaced are more likely to experience mental health and behavioural challenges than non-displaced populations, including increased risk of anxiety, depression and post-traumatic stress disorder. Building appropriate parenting skills to strengthen the relationships between caregivers and their children in times of war is key to building resilience in children. There is a lack of research on the role of family skill interventions in internally displaced people (IDP). The aim of this study was to assess the potential change in parenting skills, child mental health, and resilience capacity in families living in IDP camps in Kachin State, Myanmar, after taking part in a brief family skill intervention, Strong Families. Methods: An open, multi-site pilot feasibility and acceptability trial was conducted with 100 families. Outcome data were collected prospectively, assessing changes in parenting skills and family adjustment in caregivers, children’s behaviour, and children’s resilience capacities. Families were assessed using three scales, Parenting and Family Adjustment Scales (PAFAS), the Strengths and Difficulties Questionnaire (SDQ), and the Child and Youth Resilience Measure (CYRM-R). Results: Despite being a light intervention, Strong Families produced improvements in the child mental health, parenting practices, and parent and family adjustment skills scales. Improvements were observed in scores particularly for caregivers and children with greater challenges at baseline. Conclusions: The results positively value the importance and feasibility of family skill interventions being integrated into the routine care of IDP families. This advocates for the prioritisation of using such tools for supporting better family functioning and mental health in humanitarian contexts. Full article

(This article belongs to the Special Issue Factors That Affect the Physical and Mental Health of Vulnerable Groups)

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16 pages, 252 KiB

Open AccessArticle

Nursing Students’ Perceptions of AI-Driven Mental Health Support and Its Relationship with Anxiety, Depression, and Seeking Professional Psychological Help: Transitioning from Traditional Counseling to Digital Support

by Zainab Albikawi, Mohammad Abuadas and Ahmad M. Rayani

Healthcare 2025, 13(9), 1089; https://doi.org/10.3390/healthcare13091089 - 7 May 2025

Abstract

Background: The integration of artificial intelligence (AI) into mental health care is reshaping psychological support systems, particularly for digitally literate populations such as nursing students. Given the high prevalence of anxiety and depression in this group, understanding their perceptions of AI-driven mental [...] Read more.

Background: The integration of artificial intelligence (AI) into mental health care is reshaping psychological support systems, particularly for digitally literate populations such as nursing students. Given the high prevalence of anxiety and depression in this group, understanding their perceptions of AI-driven mental health support is critical for effective implementation. Objectives: to evaluate nursing students’ perceptions toward AI-driven mental health support and examine its relationship with anxiety, depression, and their attitudes to seeking professional psychological help. Methods: A cross-sectional survey was conducted among 176 undergraduate nursing students in northern Jordan. Results: Students reported moderately positive perceptions toward AI-driven mental health support (mean score: 36.70 ± 4.80). Multiple linear regression revealed that prior use of AI tools (β = 0.44, p < 0.0001), positive help-seeking attitudes (β = 0.41, p < 0.0001), and higher levels of psychological distress encompassing both anxiety (β = 0.29, p = 0.005) and depression (β = 0.24, p = 0.007) significantly predicted more positive perceptions. Daily AI usage was not a significant predictor (β = 0.15, p = 0.174). Logistic regression analysis further indicated that psychological distress, reflected by elevated anxiety (OR = 1.42, p = 0.002) and depression scores (OR = 1.32, p = 0.003), along with stronger help-seeking attitudes (OR = 1.35, p = 0.011), significantly increased the likelihood of using AI-based mental health support. Conclusions: AI-driven mental health tools hold promises as adjuncts to traditional counseling, particularly for nursing students experiencing psychological distress. Despite growing acceptance, concerns regarding data privacy, bias, and lack of human empathy remain. Ethical integration and blended care models are essential for effective mental health support. Full article

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

14 pages, 717 KiB

Open AccessArticle

Prevalence of Erectile Dysfunction and Help-Seeking Behavior Among Patients Attending Primary Healthcare Centers for Non-Urological Complaints

by Mansour Alnazari, Sulaiman Abdullah, Abdullah K. Aljohani, Emad S. Rajih, Ghadi S. Alghamdi, Faris S. Sebaa, Ali A. Alraddadi, Wesam Khan and Adel Moalwi

Healthcare 2025, 13(9), 1088; https://doi.org/10.3390/healthcare13091088 - 7 May 2025

Abstract

Background/Objectives: Erectile dysfunction (ED) is a prevalent condition worldwide that significantly affects men’s sexual health and overall quality of life. ED is often associated with both psychological and organic factors and may serve as an early indicator of underlying health conditions such [...] Read more.

Background/Objectives: Erectile dysfunction (ED) is a prevalent condition worldwide that significantly affects men’s sexual health and overall quality of life. ED is often associated with both psychological and organic factors and may serve as an early indicator of underlying health conditions such as diabetes mellitus, hypertension, and cardiovascular diseases. This study aimed to assess the attitudes and help-seeking behaviors of patients with ED who attended primary healthcare centers for non-urological reasons. Methods: A cross-sectional survey was conducted among 384 men aged 18 years and older who attended primary care clinics. Erectile dysfunction was evaluated using a structured questionnaire designed to assess patients’ attitudes toward ED, help-seeking behaviors, and treatment preferences. Results: Approximately half of the participants (49.5%) acknowledged the necessity of seeking treatment. However, the majority (53.1%) had not consulted specialized clinics, primarily due to social stigma and a preference for self-medication. Concerning sources of information on ED treatment, 30.7% of participants relied on their partners and healthcare providers. Conclusions: The study underscores critical barriers to ED management, including social stigma and reliance on self-medication, which may impede optimal treatment engagement and access to specialized care. Full article

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33 pages, 1724 KiB

Open AccessSystematic Review

A Systematic Literature Review for Blockchain-Based Healthcare Implementations

by Mutiullah Shaikh, Shafique Ahmed Memon, Ali Ebrahimi and Uffe Kock Wiil

Healthcare 2025, 13(9), 1087; https://doi.org/10.3390/healthcare13091087 - 7 May 2025

Abstract

Background: Healthcare information systems are hindered by delayed data sharing, privacy breaches, and lack of patient control over data. The growing need for secure, privacy-preserved access control interoperable in health informatics technology (HIT) systems appeals to solutions such as Blockchain (BC), which offers [...] Read more.

Background: Healthcare information systems are hindered by delayed data sharing, privacy breaches, and lack of patient control over data. The growing need for secure, privacy-preserved access control interoperable in health informatics technology (HIT) systems appeals to solutions such as Blockchain (BC), which offers a decentralized, transparent, and immutable ledger architecture. However, its current adoption remains limited to conceptual or proofs-of-concept (PoCs), often relying on simulated datasets rather than validated real-world data or scenarios, necessitating further research into its pragmatic applications and their benchmarking. Objective: This systematic literature review (SLR) aims to analyze BC-based healthcare implementations by benchmarking peer-reviewed studies and turning PoCs or production insights into real-world applications and their evaluation metrics. Unlike prior SLRs focusing on proposed or conceptual models, simulations, or limited-scale deployments, this review focuses on validating practical BC real-world applications in healthcare settings beyond conceptual studies and PoCs. Methods: Adhering to PRISMA-2020 guidelines, we systematically searched five major databases (Scopus, Web of Science, PubMed, IEEE Xplore, and ScienceDirect) for high-precision relevant studies using MeSH terms related to BC in healthcare. The designed review protocol was registered with OSF, ensuring transparency in the review process, including study screening by independent reviewers, eligibility, quality assessment, and data extraction and synthesis. Results: In total, 82 original studies fully met the eligibility criteria and narratively reported BC-based healthcare implementations with validated evaluation outcomes. These studies highlight the current challenges addressed by BC in healthcare settings, providing both qualitative and quantitative data synthesis on its effectiveness. Conclusions: BC-based healthcare implementations show both qualitative and quantitative effectiveness, with advancements in areas such as drug traceability (up to 100%) and fraud prevention (95% reduction). We also discussed the recent challenges of focusing more attention in this area, along with a discussion on the mythological consideration of our own work. Our future research should focus on addressing scalability, privacy-preservation, security, integration, and ethical frameworks for widespread BC adoption for data-driven healthcare. Full article

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19 pages, 254 KiB

Open AccessArticle

Study on the Influencing Factors of the Demand of Rural Older Adults in China for Elderly Care Services

by Linjing Wan and Xiaodong Di

Healthcare 2025, 13(9), 1086; https://doi.org/10.3390/healthcare13091086 - 7 May 2025

Abstract

Background/Objectives: Population aging has become a common concern worldwide. At present, the aging rate of China far exceeds the international standard, and the rural population in China faces a more obvious aging problem. With the increasing number of the older population, the demand [...] Read more.

Background/Objectives: Population aging has become a common concern worldwide. At present, the aging rate of China far exceeds the international standard, and the rural population in China faces a more obvious aging problem. With the increasing number of the older population, the demand for elderly care services is constantly diversified, and the homogenized service supply in rural areas fails to effectively meet the service needs of older adults. Methods: This study employs a multi-stage stratified sampling method to survey rural older adults in Shaanxi, Hebei and Jiangsu provinces (n = 803, effective response rate > 95%). The dependent variable is categorized into four levels: no, mild, moderate and severe demands. Independent variables include demographic characteristics (age and gender), predisposing factors (education and marital status), enabling resources (income and family support) and need factors (health status). In the survey, the questionnaire survey method is adopted, and a multinomial logistic regression model is used to analyze the factors influencing the demand degree for elderly care services in rural areas. Results: Regression analysis indicates that pension level exerts a significant influence on the demand intensity for medical care, entertainment and spiritual comfort services. Family support is significantly associated with the demand intensity for medical care and spiritual comfort services. This study reveals that the pension level of elderly adults in rural areas is a key factor affecting the demand degree for elderly care services. The influence of family support on the demand for elderly care services should not be underestimated. Older adults in rural areas have a high demand for medical care services. Conclusions: A gap remains between elderly care service resources and the needs of older adults in rural areas of China. The government should pay attention to allocating and optimizing elderly care service resources to meet the needs of older adults. Full article

15 pages, 1592 KiB

Open AccessArticle

Causal Associations Between Pre-Pregnancy Diabetes Mellitus and Pre-Eclampsia Risk: Insights from a Mendelian Randomization Study

by Xiang Ying, Quanfeng Wu, Xiaohan Li, Yan Bi, Li Gao, Shushu Yu, Xiaona Xu, Xiaotian Li, Yanlin Wang and Renyi Hua

Healthcare 2025, 13(9), 1085; https://doi.org/10.3390/healthcare13091085 - 7 May 2025

Abstract

Background and Objectives: Pre-eclampsia (PE) is a serious pregnancy complication defined by the onset of hypertension and multi-organ dysfunction occurring after 20 weeks of gestation. Studies have indicated the correlation between diabetes mellitus (DM) and PE, but the causal relationship remains unclear. Materials [...] Read more.

Background and Objectives: Pre-eclampsia (PE) is a serious pregnancy complication defined by the onset of hypertension and multi-organ dysfunction occurring after 20 weeks of gestation. Studies have indicated the correlation between diabetes mellitus (DM) and PE, but the causal relationship remains unclear. Materials and Methods: The two-sample Mendelian randomization (MR) approach, including the inverse variance weighted random effects (IVW-RE) model and the traditional sensitivity model, was employed to assess the causal effects of pre-pregnancy type 1 diabetes (T1D) and type 2 diabetes (T2D) on PE using summary-level data obtained from genome-wide association studies. Additionally, diabetes-related factors, such as glycated hemoglobin (HbA1c) levels, fasting insulin levels, and body mass index (BMI), were evaluated for their potential causal effects on the risk of PE. Pleiotropy-robust and multivariable Mendelian randomization (MVMR) methods were further used because of the intricate associations among the traits. Insulin and metformin use was also assessed for their causal role in PE risk. Results: Our findings show that genetically predicted T1D (OR = 1.06, 95% CI: 1.03–1.09, p < 0.001), T2D (OR = 1.09, 95% CI: 1.04–1.14, p < 0.001), and BMI (OR = 1.64, 95% CI 1.49 to 1.80, p < 0.001) had causal effects on the incidence of PE, while the effects of HbA1c (OR = 0.77, 95% CI 0.59 to 1.02, p = 0.064) and fasting insulin levels (OR = 1.35, 95% CI 0.89 to 2.05, p = 0.153) on the occurrence of PE were not significant. The results were verified by MVMR analysis. Additionally, insulin use increased the risk of pre-eclampsia (OR = 1.11, 95% CI 1.05–1.17, p < 0.001). Conclusions: Our findings demonstrate a causal relationship between pre-pregnancy diabetes (DM) and obesity and the risk of PE from a genetic epidemiological perspective. Adverse maternal factors, including DM and obesity prior to pregnancy, should be considered in mechanistic studies of PE. In addition, comprehensive interventions for risk factors such as pre-pregnancy DM and obesity should be emphasized in clinical practice. Full article

(This article belongs to the Section Perinatal and Neonatal Medicine)

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14 pages, 800 KiB

Open AccessSystematic Review

The Role of Psychological Interventions in Enhancing Quality of Life for Patients with Cystic Fibrosis—A Systematic Review

by Lavinia Hogea, Brenda Bernad, Iuliana Costea, Codrina Mihaela Levai, Amalia Marinca, Ion Papava and Teodora Anghel

Healthcare 2025, 13(9), 1084; https://doi.org/10.3390/healthcare13091084 - 7 May 2025

Abstract

Background/Objectives: Cystic fibrosis (CF) is a chronic genetic disease that impacts both physical and psychological health, increasing vulnerability to anxiety, depression, and reduced quality of life (QoL). Psychological interventions, particularly cognitive behavioral therapy (CBT), have demonstrated promising results in enhancing emotional resilience, treatment [...] Read more.

Background/Objectives: Cystic fibrosis (CF) is a chronic genetic disease that impacts both physical and psychological health, increasing vulnerability to anxiety, depression, and reduced quality of life (QoL). Psychological interventions, particularly cognitive behavioral therapy (CBT), have demonstrated promising results in enhancing emotional resilience, treatment adherence, and QoL. This systematic review aims to evaluate the role and effectiveness of psychological interventions in improving the QoL among individuals with CF. Methods: A comprehensive literature search was conducted across the PubMed, Scopus, and PsycINFO databases for studies published between 2014 and 2024, in line with PRISMA guidelines and a registered PROSPERO protocol. Out of 162 initially identified articles, six clinical studies met the inclusion criteria. Intervention included cognitive behavioral therapy-based interventions, employing several digital or telehealth formats such as fibrosis-specific cognitive behavioral therapy (CF-CBT) and the coping and learning to manage stress (CALM) program, often delivered via telehealth. Results: Most interventions demonstrated significant reductions in depression, anxiety, and perceived stress, alongside improvements in coping self-efficacy and vitality. Cohen’s d-effect sizes ranged from moderate to large for core psychological outcomes. QoL measures, particularly vitality and emotional functioning, were significantly enhanced in most studies. Conclusions: Psychological interventions, particularly CBT and ACT, significantly improve mental health and QoL in individuals with CF, supporting their integration into routine care. Full article

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16 pages, 647 KiB

Open AccessArticle

Multimodal Prehabilitation in Colorectal Cancer: Improving Fitness, Lifestyle, and Post-Surgery Outcomes

by María-Pilar Suárez-Alcázar, Ana Folch Ayora, María Muriach, Paula Recacha-Ponce, M.-Elena Garcia-Roca, Alba Coret-Franco, Juan Carlos Pastor-Mora, Pablo Salas-Medina and Eladio J. Collado-Boira

Healthcare 2025, 13(9), 1083; https://doi.org/10.3390/healthcare13091083 - 7 May 2025

Abstract

Objectives: This study aimed to analyze the effect of a multimodal prehabilitation program for colorectal cancer patients in body composition, physical and cardiorespiratory fitness as well as its ability to reduce postoperative complications. Methods: A longitudinal observational study evaluated the efficacy [...] Read more.

Objectives: This study aimed to analyze the effect of a multimodal prehabilitation program for colorectal cancer patients in body composition, physical and cardiorespiratory fitness as well as its ability to reduce postoperative complications. Methods: A longitudinal observational study evaluated the efficacy of a prehabilitation intervention based on four components: (a) health education and self-care, (b) nutritional counseling, (c) psychological support, and (d) supervised physical exercise. Body composition was determined through bioelectrical impedance analysis; physical fitness variables such as strength was measured by a handgrip dynamometer for upper limbs, and a squat–jump test, countermovement jump test using a contact platform, and a chair–stand test for lower limbs. Flexibility was assessed with the sit-and-reach test. Cardiorespiratory fitness was assessed with the 6 min walking test (6MWT). Moreover, we measured lifestyles related to the amount of physical exercise by accelerometry. Results: The final cohort included 30 patients. Patients completed an average of 9.90 ± 5.26 exercise sessions. Statistically significant changes with varying effect sizes were observed in the following outcomes: SJ values in cm and W for both sexes (p = 0.021/d = 0.14 and p = 0.043/d = 0.10, respectively), SJ in W for women (p = 0.023/d = 0.21), all chair-stand test values (p = 0.021/d = 0.65 for men, p = 0.004/d = 2.08 for women, and p = 0.000/d = 0.84 for both sexes), and sit-and-reach for both sexes (p = 0.005/d = 0.12) and for men (p = 0.044/d = 0.08). All 6MWT values had statistically significant changes (p = 0.001/0.46). Women reduced the weekly minutes spent in sedentary behavior (p = 0.037/d = 0.65) and increased the minutes spent performing light physical activity (p = 0.037/d = 0.63). With regard to surgical outcomes, there was a tendency towards a decrease in postoperative complications and hospitalization days, as well as minutes in postoperative REA (p = 0.009/d = 0.69) in relation to the control group. Conclusions: Participation in a multimodal prehabilitation program improves several aspects of physical condition and lifestyles related to the amount of physical exercise and reduces both days of hospitalization and several complications post-surgery. Full article

(This article belongs to the Special Issue Exercise Therapy: Improving Functionality, Physical Health, and Quality of Life)

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15 pages, 2353 KiB

Open AccessArticle

Pilot Randomized Controlled Study on the Effectiveness of a Virtual Reality-Based Dementia Prevention Program Using Self-Regulated Learning Strategies Among Older Adults with Mild Cognitive Impairment

by Ching-Hao Chang, Kuei-Yu Huang, Lou-Hui Kuo, Ya-Wen Cheng, Su-Fei Huang, Tien-Hsi Chuang, Chiu-Mieh Huang and Jong-Long Guo

Healthcare 2025, 13(9), 1082; https://doi.org/10.3390/healthcare13091082 - 7 May 2025

Abstract

Background/Objectives: Dementia is a growing public health issue, especially in rapidly aging societies like Taiwan, where nearly 10% of adults over 65 show signs of cognitive decline. Given that mild cognitive impairment (MCI) serves as a critical stage for early intervention, this study [...] Read more.

Background/Objectives: Dementia is a growing public health issue, especially in rapidly aging societies like Taiwan, where nearly 10% of adults over 65 show signs of cognitive decline. Given that mild cognitive impairment (MCI) serves as a critical stage for early intervention, this study examined the feasibility and preliminary effectiveness of a virtual reality (VR)-based dementia prevention program, specifically designed based on self-regulated learning (SRL) principles to enhance dementia knowledge, health literacy, and self-efficacy among older adults with MCI. Methods: A pilot randomized controlled trial (RCT) was conducted with 60 older adults aged 65 and above with MCI. Participants were randomly assigned to either an experimental group, which received a VR-based dementia prevention program, or a comparison group, which received routine paper-based educational materials. Results: The experimental group demonstrated significant improvements in overall dementia knowledge and all subdomains. Significant gains were also observed in critical health literacy and self-efficacy, though no significant changes were found in overall health literacy. Conclusions: The preliminary findings suggest that the SRL-informed VR program showed initial effectiveness in enhancing dementia knowledge, critical health literacy, and self-efficacy among older adults with MCI, highlighting its potential as an innovative approach to dementia prevention education. Full article

(This article belongs to the Topic Applied System on Biomedical Engineering, Healthcare and Sustainability 2024)

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