Healthcare

16 pages, 297 KB

Open AccessArticle

Physical Activity and Quality of Life Among Caregivers of Children with Duchenne Muscular Dystrophy

by Sedat Yiğit, İrem Akgün, Kübra Coşkun, Murat Ali Çınar, Serkan Usgu and Peren Perk

Healthcare 2026, 14(10), 1425; https://doi.org/10.3390/healthcare14101425 (registering DOI) - 21 May 2026

Background/Objectives: Duchenne muscular dystrophy (DMD) is a rare progressive neuromuscular disorder associated with increasing care demands. Despite the critical role of caregivers, their physical activity (PA) levels and health-related quality of life (HRQoL) have not been sufficiently investigated. This study aimed to compare [...] Read more.

Background/Objectives: Duchenne muscular dystrophy (DMD) is a rare progressive neuromuscular disorder associated with increasing care demands. Despite the critical role of caregivers, their physical activity (PA) levels and health-related quality of life (HRQoL) have not been sufficiently investigated. This study aimed to compare PA levels and HRQoL between caregivers of children with DMD and caregivers of typically developing children. Methods: This cross-sectional observational study included 44 individuals: caregivers of children with DMD (n = 22) and caregivers of typically developing children (n = 22). The 36-Item Short-Form Health Survey (SF-36) was used for assessing HRQoL and the International Physical Activity Questionnaire—Short Form (IPAQ-SF) for determining PA levels. Results: IPAQ-SF-derived metabolic equivalent of task (MET) values and PA levels were similar between the groups (DMD caregivers: 1744.63 ± 1163.22, controls: 1945.09 ± 1042.12; p > 0.05). Caregivers of children with DMD demonstrated significantly poorer scores in several SF-36 domains, including vitality, social functioning, role limitations due to physical problems, bodily pain, and mental health (p < 0.05), with the largest difference observed in role limitations due to emotional problems (DMD caregivers: 45.27 ± 28.33, controls: 84.83 ± 24.63; p < 0.05). Physical functioning and general health perception scores were comparable (p > 0.05). Conclusions: Caregivers of children with DMD experience substantial impairments in multiple HRQoL domains, particularly those related to psychosocial well-being and pain, despite comparable PA levels and physical functioning. These findings suggest that reduced HRQoL is not directly explained by PA alone and highlight the need for multidisciplinary interventions targeting psychological health, pain management, and social well-being. Full article

15 pages, 275 KB

Open AccessArticle

Social Perception of Natural Background Radiation and Its Implications for Public Health Communication

by Juliánna Szakács, Mihai Ioan Georgescu, Gellért-Gedeon Deák, Eszter Bajkó, Simona Toncean Florentina, Florina Ruta and Călin Avram

Healthcare 2026, 14(10), 1424; https://doi.org/10.3390/healthcare14101424 (registering DOI) - 21 May 2026

Abstract

Background: Public perception of environmental (natural background) radiation represents an important challenge for public health communication, as risk perception is often influenced more by information quality and institutional trust than by objective exposure levels. Methods: A cross-sectional survey was conducted among 481 respondents [...] Read more.

Background: Public perception of environmental (natural background) radiation represents an important challenge for public health communication, as risk perception is often influenced more by information quality and institutional trust than by objective exposure levels. Methods: A cross-sectional survey was conducted among 481 respondents using a structured questionnaire assessing self-perceived knowledge, information sources, perceived radiation risk, institutional trust, and health-related attitudes. Results: Significant gender differences were observed in self-reported knowledge about radioactivity, with men more frequently reporting higher knowledge levels than women (p < 0.001), while no significant differences emerged between urban and rural respondents; logistic regression analysis showed that lower perceived risk was associated with lack of medical information (OR = 0.32, 95% CI: 0.14–0.71) and absence of avoidance behavior (OR = 0.23, 95% CI: 0.11–0.47), whereas low trust in medical institutions was associated with higher odds of perceiving natural background radiation as dangerous (OR = 1.84, 95% CI: 1.21–2.80). Conclusions: Effective radiation risk communication requires more than the dissemination of information; it must also address public concerns, enhance institutional trust, and provide clear, credible, and accessible health-related messages. Tailored communication strategies are essential to bridge the gap between expert knowledge and public perception. Full article

22 pages, 707 KB

Open AccessArticle

From Stress to Burnout: Exploring the Protective and Predictive Factors for Nurses’ Well-Being

by Suad Dukhaykh and Shaikhah Bawzeer

Healthcare 2026, 14(10), 1423; https://doi.org/10.3390/healthcare14101423 (registering DOI) - 21 May 2026

Abstract

Background/Objectives: Occupational stress is a prevalent issue in healthcare settings, particularly among nurses, and is often associated with increased levels of burnout and reduced well-being. This study aims to examine the relationship between occupational stress and burnout among nurses, with a particular focus [...] Read more.

Background/Objectives: Occupational stress is a prevalent issue in healthcare settings, particularly among nurses, and is often associated with increased levels of burnout and reduced well-being. This study aims to examine the relationship between occupational stress and burnout among nurses, with a particular focus on the mediating role of job satisfaction and the moderating role of self-efficacy. Methods: A quantitative research design was employed using data collected from 245 nurses in Saudi Arabia through a bilingual survey instrument incorporating validated psychological measures. Statistical analyses were conducted to test the direct, mediating, and moderating relationships among the study variables. Results: The findings indicate that occupational stress is positively associated with burnout and negatively related to job satisfaction. Job satisfaction was found to partially mediate the relationship between stress and burnout, suggesting that reduced job satisfaction serves as a key mechanism through which stress contributes to burnout. In contrast, self-efficacy did not demonstrate a significant moderating effect in this relationship. Conclusions: This study contributes to the occupational health literature by highlighting the critical role of job satisfaction in mitigating the adverse effects of stress on burnout among nurses. The findings offer practical implications for healthcare leaders and policymakers seeking to design targeted interventions aimed at enhancing job satisfaction, reducing burnout, and improving nurses’ overall well-being. Full article

(This article belongs to the Special Issue Burnout, Perceived Efficacy and Job Satisfaction of Nurses: Leadership, Management and Organizational Perspectives)

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21 pages, 3946 KB

Open AccessArticle

Automated Facial Emotion Recognition System Detects Altered Emotional Processing During Craving Induction in Individuals with Substance Use Disorder

by Joaquin García-Estrada, Diana Emilia Martínez-Fernández, Iris del Socorro Pérez-Alcaraz, Carlos Joel Mondragón-Gomar, Irene G. Aguilar-García, Sonia Luquin and David Fernández-Quezada

Healthcare 2026, 14(10), 1422; https://doi.org/10.3390/healthcare14101422 (registering DOI) - 21 May 2026

Abstract

Background: Substance Use Disorder (SUD) is characterized by recurrent craving episodes frequently associated with emotional dysregulation and altered reward processing. This study aimed to evaluate whether emotional states associated with craving episodes can be detected through automated facial emotion recognition during controlled [...] Read more.

Background: Substance Use Disorder (SUD) is characterized by recurrent craving episodes frequently associated with emotional dysregulation and altered reward processing. This study aimed to evaluate whether emotional states associated with craving episodes can be detected through automated facial emotion recognition during controlled emotional induction. Methods: Forty-one participants completed a 14-day ecological momentary assessment (EMA) monitoring anxiety and craving levels, followed by an emotional induction task using standardized stimuli from the EmoMadrid database and addiction-related images. Facial expressions were recorded and analyzed in real time using a computational facial emotion recognition model trained on the FER-2013 dataset. Results: Participants with SUD exhibited significantly reduced positive emotional valence and emotional activation in response to positive stimuli compared with healthy controls (HC), with large effect sizes observed for emotional valence (Hedges’ g = 1.76) and emotional activation (Hedges’ g = 1.33). Item-level analyses revealed that most between-group differences occurred in stimuli depicting social interactions. Individuals with SUD also showed higher frequencies of fear-related facial expressions and lower frequencies of disgust-related expressions compared with HC, with moderate effect sizes observed for both emotional dimensions (Hedges’ g = 0.72; p = 0.02). Conclusions: These results suggest that people with SUD have changes in how they process emotions, showing less response to positive things and unique facial expressions related to craving. However, given the relatively modest and clinically heterogeneous sample, the findings should be interpreted cautiously and require replication in larger and more homogeneous populations. Full article

(This article belongs to the Special Issue Substance Abuse, Mental Health Disorders, and Intervention Strategies)

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20 pages, 308 KB

Open AccessArticle

Prevalence and Correlates of Mental Health Issues Among University Students in Punjab, Pakistan: Insights into Academic Performance and Psychological Well-Being

by Nauman Ali Chaudhry, Rubeena Zakar, Gulzar H. Shah, Alexander Kraemer and Bushra Shah

Healthcare 2026, 14(10), 1421; https://doi.org/10.3390/healthcare14101421 (registering DOI) - 21 May 2026

Abstract

Background/Objectives: Mental health problems are common among university students and are more consistently associated with dissatisfaction with academic performance than with low grades alone. This study examined the prevalence and determinants of perceived stress, depressive symptoms, and low psychological well-being among university students [...] Read more.

Background/Objectives: Mental health problems are common among university students and are more consistently associated with dissatisfaction with academic performance than with low grades alone. This study examined the prevalence and determinants of perceived stress, depressive symptoms, and low psychological well-being among university students in Punjab, Pakistan, and assessed their association with academic performance. Methods: A cross-sectional survey was conducted among students aged 15 to 29 years at three public universities in Punjab, Pakistan. A total of 1308 questionnaires were completed, yielding a response rate of 91.4%. This study uses data collected in 2015 as a pre-COVID historical baseline, providing valuable insights into student mental health before the global pandemic. This temporal context offers a benchmark for future comparative studies, especially when assessing the mental health impact of COVID-19 on university students. Data were analyzed using SPSS with descriptive statistics, chi-square tests, binary logistic regression, and multinomial logistic regression. Results: The findings revealed that perceived stress and depressive symptoms were prevalent, with 54.9% of students reporting high levels of stress (mean PSS score = 27.6, SD = 8.3), and 44.2% experiencing depressive symptoms (mean M-BDI score = 33.8, SD = 16.2). Female students exhibited higher stress and depressive symptoms compared to male students. Year of study was also a factor, with second- and third-year students experiencing more stress than their final-year counterparts (p < 0.05). Financial strain was associated with poorer mental health outcomes; 62% of students who reported inadequate financial support also reported higher stress levels (p < 0.05). In contrast, students with sufficient financial resources had lower odds of experiencing stress and depressive symptoms (AOR = 0.55, p < 0.05). Additionally, students living in university or private hostels reported better psychological well-being than those living at home (AOR = 0.47, p < 0.01). Mental health issues, particularly high stress and depression, were more strongly linked with academic dissatisfaction than low grades alone, with students in the “low grades and unsatisfied” group exhibiting higher odds of mental health problems (AOR = 2.30, p < 0.05). Conclusions: Mental health problems were common among university students and were associated with poorer academic experiences, particularly dissatisfaction with academic performance. Universities should strengthen accessible mental health support through counseling services, stress-management programs, and stigma-reduction initiatives. Full article

26 pages, 12460 KB

Open AccessArticle

A Pilot Randomized Controlled Trial Examining the Impact of Therapy Dog Visitation on Mood, Anxiety, and Depression in Patients Hospitalized for the Treatment of Mental Illness

by Nancy R. Gee, Lisa Townsend, Erika Friedmann, Sandra B. Barker, Tushar P. Thakre and Megan K. Mueller

Healthcare 2026, 14(10), 1420; https://doi.org/10.3390/healthcare14101420 (registering DOI) - 21 May 2026

Abstract

Background/Objectives: Evidence suggests that AAIs may be useful to support the mental health of individuals with psychiatric diagnoses, but there is limited research on the efficacy of AAIs for patients hospitalized for the treatment of acute mental illness. Methods: A randomized [...] Read more.

Background/Objectives: Evidence suggests that AAIs may be useful to support the mental health of individuals with psychiatric diagnoses, but there is limited research on the efficacy of AAIs for patients hospitalized for the treatment of acute mental illness. Methods: A randomized controlled trial (RCT) design, where patients hospitalized for the treatment of mental illness (N = 60) were randomized into to one of three conditions: dog + handler intervention (AAI), handler only conversational control (CC), or usual care (UC), for 20 min per day for three days. Mood (Smiley Face Assessment Scale), Anxiety (State Trait Anxiety Scales) and Depression (Center for Epidemiological Studies) were the outcome measures. Linear Mixed Models with random intercepts were applied to compare changes in anxiety and mood between conditions pre/post daily intervention session and pre/post three-day intervention phase (days 2–4), and anxiety and depression were assessed from baseline to the day after intervention (days 1–5) (p < 0.01). Results: Mood and anxiety improved more for the AAI than for the CC or UC conditions. Females and people who did not live with a dog experienced similar improvements in mood in the AAI and CC conditions relative to UC, while males and people who live with a dog experienced greater improvement in the AAI condition. Depression decreased similarly in the AAI and CC conditions and both were significantly better than the UC condition. Conclusions: These results indicate that a dog + handler interaction is effective for reducing anxiety and depression and improving mood in adults hospitalized for the treatment of mental illness. Human handler-only visits did not consistently result in similar findings, indicating that there may be something unique and beneficial about the presence of the dog. Full article

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

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30 pages, 7636 KB

Open AccessArticle

Nutrition Label Utilization, Dietary Self-Management, and Health-Related Quality of Life Among Korean Adults: A Two-Part Model Analysis of Nationally Representative Survey Data

by Yoonjin Lee

Healthcare 2026, 14(10), 1419; https://doi.org/10.3390/healthcare14101419 (registering DOI) - 21 May 2026

Abstract

Background: Health-related quality of life (HRQoL) is a central outcome measure in population health research, yet empirical investigations directly linking nutrition label utilization to HRQoL remain limited, particularly in East Asian contexts. This study examines the associations between nutrition label use, dietary control, [...] Read more.

Background: Health-related quality of life (HRQoL) is a central outcome measure in population health research, yet empirical investigations directly linking nutrition label utilization to HRQoL remain limited, particularly in East Asian contexts. This study examines the associations between nutrition label use, dietary control, and HRQoL among Korean adults while accounting for the pronounced ceiling effect inherent in EQ-5D utility scores. Methods: Data were drawn from the Korea National Health and Nutrition Examination Survey (KNHANES) 2024 (N = 5215 adults aged 19–80). HRQoL was measured using the EQ-5D-3L with Korean time trade-off weights. Nutrition label use was operationalized as a composite index (0–3). Given that 48.0% of the weighted sample reported perfect health, a two-part model was employed: Part 1 applied survey-weighted logistic regression predicting perfect health, while Part 2 applied survey-weighted OLS regression restricted to those with imperfect health (n = 2713). Results: In Part 1, nutrition label use was not significantly associated with perfect health (OR = 1.057, p = 0.124), whereas dietary control was negatively associated (OR = 0.819, p = 0.009), suggesting reverse causality. In Part 2, nutrition label use was positively associated with EQ-5D scores (β = 0.0047, p = 0.006). Education, income, and unmet medical need were dominant predictors. Results were robust to an alternative full-sample OLS specification. Conclusions: Nutrition label utilization was modestly and positively associated with HRQoL among Korean adults with imperfect health. Given the cross-sectional design, this association should be interpreted as exploratory and may reflect broader health-oriented characteristics, including health consciousness, self-regulatory behaviors, and health literacy, rather than the independent effect of nutrition label use alone. The findings also underscore the methodological importance of addressing ceiling effects in EQ-5D analyses. Full article

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

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15 pages, 1069 KB

Open AccessArticle

Effects of an Equine-Assisted Riding Program on Motor Performance, Movement Quality, and Well-Being Among Young Inmates

by Milan Dransmann, Martin Koddebusch, Pamela Wicker, Daniela Gröben and Bernd Gröben

Healthcare 2026, 14(10), 1418; https://doi.org/10.3390/healthcare14101418 - 21 May 2026

Abstract

Background: Equine-assisted programs have been shown to promote psychosocial outcomes, but quantitative evidence of motor benefits in correctional settings is scarce. Aim: The present study examined the effects of a one-week equine-assisted riding program on riding performance, movement quality, and well-being among young [...] Read more.

Background: Equine-assisted programs have been shown to promote psychosocial outcomes, but quantitative evidence of motor benefits in correctional settings is scarce. Aim: The present study examined the effects of a one-week equine-assisted riding program on riding performance, movement quality, and well-being among young inmates in an open German prison. Methods: Ten male participants (24.5 ± 0.71 years) completed a five-day program combining practical riding exercises, cooperative activities, and guided reflection. Riding performance was assessed using standardized expert video ratings based on the German performance testing guidelines on a 10-point scale, movement quality using a semantic differential with bipolar adjective pairs assessing telic and autotelic dimensions on a six-point scale, and well-being using the WHO-5 Well-Being Index. A single-group pre–post repeated-measures design without a control group was applied. Results: Significant improvements were found in riding performance for both walk and trot, with large effect sizes (n = 10). Participants also reported a significant enhancement in the autotelic, experience-oriented dimension of movement quality, whereas no significant change occurred in the telic, goal-oriented dimension. Well-being increased significantly from pre- to post-test. Conclusions: Even a short, experience-focused equine-assisted program can produce meaningful improvements in motor performance, positive movement experience, and well-being in a correctional context. Equine-assisted programs may therefore represent a promising complementary approach to rehabilitation by integrating physical, emotional, and social learning processes. Full article

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

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16 pages, 738 KB

Open AccessArticle

Association of Anemia Severity with Distinct Microbial and Inflammatory Signatures in Patients Receiving Vancomycin

by Mohammad A. Alfhili, Sahar A. Alazmi and Jawaher Alsughayyir

Healthcare 2026, 14(10), 1417; https://doi.org/10.3390/healthcare14101417 - 21 May 2026

Abstract

Background: Anemia is a pervasive public health issue that is both a risk factor and a consequence of infection. This study aims to determine the prevalence and correlates of anemia in adults receiving vancomycin (VAN). Methods: A retrospective cross-sectional analysis of clinical data [...] Read more.

Background: Anemia is a pervasive public health issue that is both a risk factor and a consequence of infection. This study aims to determine the prevalence and correlates of anemia in adults receiving vancomycin (VAN). Methods: A retrospective cross-sectional analysis of clinical data was undertaken for 299 patients treated with VAN at a tertiary care hospital from January 2024 to February 2025. Subjects were stratified by anemia severity into non-anemic, mild, moderate, and severe groups. Frequency was examined using the chi-squared test, medians by Kruskal–Wallis test, monotonic relations by Spearman’s correlation, and independent predictors using regression models. Results: Anemia was extremely prevalent in 90% of patients, mostly at a moderate level, and a weak positive correlation was observed between anemia severity and VAN trough levels, ICU admission, kidney disease, abnormal liver markers, and inflammatory indices. Microbial isolates were differentially enriched across anemia categories with K. pneumoniae, E. coli, and MRSA peaking in mild anemia and sharply declining in moderate and severe cases. Anemia severity was differentially correlated with P. aeruginosa, creatinine, hypertension, liver disease, albumin, platelets, and derived indices. In adjusted analysis, albumin, age, gender, platelet–neutrophil ratio, kidney disease, ICU admission, and MATH-1SD were independent predictors of anemia. A diagnostic model for anemia based on multiple markers was developed with an accuracy of 77%. Conclusions: Anemia is alarmingly very common in VAN-treated patients with distinct microbial and inflammatory signatures across severity groups, which highlights the need for experimental and longitudinal studies elucidating its pathophysiological mechanisms and clinical implications. Full article

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23 pages, 1110 KB

Open AccessArticle

Stronger Minds, Better Lives: Exercise Self-Efficacy and Resilience as Serial Mediators in Oncology Nurses

by Gülay Oyur Çelik, Mehmet Behzat Turan, Melih Balyan, Barış Karaoğlu, Osman Pepe, İbrahim Dalbudak, Bilgehan Pepe, Seda Evyapan Aydin, Mustafa Kara and Şıhmehmet Yiğit

Healthcare 2026, 14(10), 1416; https://doi.org/10.3390/healthcare14101416 - 21 May 2026

Abstract

Background: Oncology nurses are highly vulnerable to impaired mental health and reduced quality of life due to the emotionally demanding nature of their work. Although mental health is a well-established determinant of quality of life, the mechanisms underlying this relationship remain insufficiently [...] Read more.

Background: Oncology nurses are highly vulnerable to impaired mental health and reduced quality of life due to the emotionally demanding nature of their work. Although mental health is a well-established determinant of quality of life, the mechanisms underlying this relationship remain insufficiently understood. Objective: This study examined the effect of the mental health continuum on quality of life among oncology nurses and tested the serial mediating roles of exercise self-efficacy and psychological resilience. Methods: A cross-sectional design was conducted with 604 oncology nurses in Türkiye. Data were collected using the Mental Health Continuum—Short Form, the Exercise Self-Efficacy Scale, the Psychological Resilience Scale, and the WHOQOL-BREF. Serial mediation analysis was performed using PROCESS Model 6 with 5000 bootstrap resamples. Results: The mental health continuum had a significant positive effect on exercise self-efficacy (a1 = 0.08, p < 0.001) and psychological resilience (a2 = 0.05, p < 0.001). Exercise self-efficacy significantly predicted psychological resilience (d1 = 0.51, p < 0.001). Both exercise self-efficacy (b1 = 0.88, p < 0.001) and psychological resilience (b2 = 1.60, p < 0.001) were significant predictors of quality of life. The direct effect of the mental health continuum on quality of life remained significant (c′ = 0.65, p < 0.001), indicating partial mediation. Bootstrap results further confirmed that all indirect effects were statistically significant, as their 95% confidence intervals did not include zero. Conclusions: Quality of life is influenced not only by mental health but also by sequential cognitive and adaptive processes. Interventions targeting exercise self-efficacy and psychological resilience may enhance well-being among oncology nurses. Full article

(This article belongs to the Special Issue Psychology of Health, Sport, and Exercise)

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18 pages, 761 KB

Open AccessArticle

The Effect of Ultra-Processed Food Consumption and Physical Activity on Fatty Acid Profiles in Young Muslims in Melilla

by Miriam Mohatar-Barba, María López-Olivares, Emilio González-Jiménez, Ana Rodríguez-Rodríguez, Mario Román-Cabezas, Javier S. Perona and Carmen Enrique-Mirón

Healthcare 2026, 14(10), 1415; https://doi.org/10.3390/healthcare14101415 - 21 May 2026

Abstract

Background: The consumption of ultra-processed foods among adolescents is high due to their widespread availability and accessibility and has been linked to an increased cardiometabolic risk. In the Autonomous City of Melilla, it has been observed that Muslim adolescents consume more of these [...] Read more.

Background: The consumption of ultra-processed foods among adolescents is high due to their widespread availability and accessibility and has been linked to an increased cardiometabolic risk. In the Autonomous City of Melilla, it has been observed that Muslim adolescents consume more of these foods than their Christian peers, which warrants an exploratory analysis of their potential association with fatty acid biomarkers. Methods: A cross-sectional pilot study was conducted among 31 Muslim adolescents aged 15 to 17 years. The NOVA classification was used to identify the ultra-processed foods consumed, and the frequency of consumption, adherence to the Mediterranean diet, and level of physical activity were assessed. Fatty acid composition was determined in serum, VLDL, and erythrocytes. Results: Ultra-processed foods accounted for 49.1% of total daily energy intake, and 71% of the participants showed very low adherence to the Mediterranean diet. Saturated fatty acids predominated in VLDL, n-6 polyunsaturated fatty acids reached their highest levels in serum, and n-3 polyunsaturated fatty acids in erythrocytes. Furthermore, higher consumption of ultra-processed foods was positively correlated with saturated fatty acids in erythrocytes and with n-6 polyunsaturated fatty acids in VLDL and negatively correlated with n-3 polyunsaturated fatty acids in erythrocytes and VLDL. Conclusions: These findings suggest that more frequent consumption of these foods is associated with a less favorable fatty acid profile, which underscores the need for nutritional monitoring and preventive strategies tailored to the sociocultural context. Full article

(This article belongs to the Special Issue Sport and Nutrition: Interventions to Improve the Health of Children and Adolescents)

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23 pages, 426 KB

Open AccessArticle

Using the Socio-Ecological Model to Explore Parents’ Resilience and Perceptions of Adverse Childhood Experiences: A Qualitative Study in the Southeastern United States

by Maribel G. Dominguez, Christine Markham, Andrew E. Springer and Louis D. Brown

Healthcare 2026, 14(10), 1414; https://doi.org/10.3390/healthcare14101414 - 21 May 2026

Abstract

Background: The negative impact of adverse childhood experiences (ACEs) on child development is documented. The parent–child relationship protects against ACEs and improves healthy child development, playing a crucial role in preventing and mitigating ACEs by strengthening parental resilience. However, there is a gap [...] Read more.

Background: The negative impact of adverse childhood experiences (ACEs) on child development is documented. The parent–child relationship protects against ACEs and improves healthy child development, playing a crucial role in preventing and mitigating ACEs by strengthening parental resilience. However, there is a gap in the literature on our understanding of parental resilience’s impact on the parent–child relationship within the social–ecological model (SEM) (i.e., intra- and interpersonal, community, and societal levels). Objective: This study explores parents’ perspectives on parental resilience as a protective factor for preventing and mitigating ACEs at every level of the SEM. Method: This study uses a thematic analysis approach for qualitative research. In-depth individual interviews (n = 21) were conducted with members of a parent support group (PSG) (85% female) based in a community-based organization serving families. Demographic information and ACE scores were collected for each participant to describe the sample. Results: Key findings highlighted parents’ perspectives on improved resilience through self-regulation and social support following participation in PSGs, conceptualized as an inter-level construct within the SEM mechanism due to its influence on parents’ well-being, traversing SEM levels. Under Theme 1: The Many Faces of Parental Resilience, Theme 3: The Power of Close Relationships, Theme 4: Community Resources as a Buffer, and Theme 7: Change Through a Policy Lens: “Anything that protects them,” parents expressed a strong desire for ACE prevention and mitigation strategies and called for systemic policy change to combat ACEs. Conclusions: Parental resilience perceptions are valuable and hold promise to inform the future institutionalization of a multi-level parent resilience-focused framework, which will aid in ACE prevention and mitigation. Full article

(This article belongs to the Special Issue Family Care and Mental Health Delivery to Improve Welfare of Children and Parents: Second Edition)

12 pages, 338 KB

Open AccessArticle

Racial and Geographic Disparities in Automated External Defibrillator Use During EMS Encounters in the United States

by Peter G. Kreysa

Healthcare 2026, 14(10), 1413; https://doi.org/10.3390/healthcare14101413 - 21 May 2026

Abstract

Background: Out-of-hospital cardiac arrest is a major cause of mortality, and survival depends heavily on rapid defibrillation. Automated external defibrillators (AEDs) can significantly improve outcomes when used before emergency medical services (EMS) arrive, yet access to and use of these devices remain uneven [...] Read more.

Background: Out-of-hospital cardiac arrest is a major cause of mortality, and survival depends heavily on rapid defibrillation. Automated external defibrillators (AEDs) can significantly improve outcomes when used before emergency medical services (EMS) arrive, yet access to and use of these devices remain uneven across communities. This study investigates racial and geographic disparities in AED use during EMS encounters in the United States, evaluating differences across racial groups, geographic settings, cardiac arrest status, and patient acuity, irrespective of whether a bystander or EMS personnel applied the device. Methods: This descriptive study used aggregated data from the National Emergency Medical Services Information System (NEMSIS) Public Release Data Cube to compare AED use across racial, geographic, cardiac arrest, and acuity categories. AED use was defined as any documented application during the EMS encounter. Results: The dataset included 106,246 EMS encounters across six racial and ethnic groups. AEDs were applied in 16,688 encounters (15.7%), with substantial variation across demographic and geographic categories. Asian, American Indian or Alaska Native, and Black or African American patients had the highest rates of AED use, while White patients had the lowest rate despite representing the largest share of encounters. Urban areas accounted for most AED deployments, whereas suburban and frontier regions showed markedly lower use, while rural AED use was similar to urban rates. AED application was strongly associated with cardiac arrest and high patient acuity, yet racial differences persisted even within these clinically severe categories. Conclusions: AED use generally aligns with clinical indicators such as cardiac arrest and critical acuity, but meaningful racial and geographic differences were observed, reflecting descriptive patterns rather than confirmed disparities. These patterns should be interpreted cautiously, as the aggregated nature of the dataset limits the ability to determine whether differences reflect inequities, incident characteristics, or EMS system factors. These findings highlight the need for targeted strategies to expand AED access, improve device placement, and strengthen community readiness in underserved areas. Integrating AED availability into broader EMS planning and community outreach may help reduce inequities and create conditions that support improved survival outcomes. Further research using individual-level data and geospatial methods is needed to clarify the drivers of these observed differences and inform equitable prehospital care policies. Full article

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16 pages, 879 KB

Open AccessReview

Nurses’ Roles, Challenges, and Reported Outcomes in Rural and Remote Healthcare: A JBI-Aligned Scoping Review (PRISMA-ScR)

by Muteb Aljuhani, Hanadi Dakhilallah, Norah M. Alyahya, Bandar S. Alharbi, Albandari Almutairi, Waleed M. Alshehri, Thurayya Eid and Abdulaziz M. Alodhailah

Healthcare 2026, 14(10), 1412; https://doi.org/10.3390/healthcare14101412 - 21 May 2026

Abstract

Background: Rural and remote health systems are diverse; while many of these settings face persistent workforce shortages and access gaps, not all are underserved. Nurses play a critical role in improving access, continuity, and quality of care in these contexts. However, evidence on [...] Read more.

Background: Rural and remote health systems are diverse; while many of these settings face persistent workforce shortages and access gaps, not all are underserved. Nurses play a critical role in improving access, continuity, and quality of care in these contexts. However, evidence on their roles, the challenges they face, and the outcomes associated with their contributions remains fragmented. Objective: To map the roles, challenges, and reported outcomes of nurses working in rural and remote healthcare settings, and to examine the quality and scope of the available evidence. Design: This study employed JBI scoping review methodology and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Methods: Eligible studies involved registered nurses (RNs) and nurse practitioners (NPs) providing care in rural or remote settings and reporting at least one outcome related to patients, services, or health systems. Six bibliographic databases (PubMed/MEDLINE, CINAHL, Embase, Scopus, Web of Science, Cochrane Library) plus Google Scholar for supplementary grey literature retrieval and targeted grey literature were searched (from 1 January 2000 to 30 September 2025). The lead author conducted screening and data extraction, supported by a 10% calibration pilot and structured peer debriefing. Design-specific critical appraisal was undertaken descriptively to inform interpretation but did not determine inclusion. Results: From 22 primary empirical studies (plus 2 contextual-only entries; 24 total, nurses’ roles clustered into direct clinical care, care coordination/navigation, telehealth facilitation, and health promotion. Reported outcomes were predominantly in access/utilization (e.g., time-to-care), quality and safety indicators, and patient-reported outcomes/experiences; clinical endpoints were less common. Conclusions: Nurses in rural and remote settings enact broad, adaptive roles that appear to support healthcare access and service continuity. The evidence base is predominantly descriptive, and causal claims about effectiveness cannot be drawn from the available studies. Standardized outcome frameworks, multi-reviewer methodologies, and effectiveness-focused primary research are needed to advance this field. Full article

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41 pages, 3082 KB

Open AccessReview

Periodontitis and Rheumatoid Arthritis: Shared Pathophysiology, Bidirectional Association, and Therapeutic Implications—A Narrative Review

by Neda Najafimakhsoos, Emanuela Pashollari, Nazzarena Malavolta, Francesca Zangari and Claudio Cesari

Healthcare 2026, 14(10), 1411; https://doi.org/10.3390/healthcare14101411 - 20 May 2026

Abstract

Periodontitis (PD) and rheumatoid arthritis (RA) are chronic inflammatory disorders that impose substantial individual and societal burdens worldwide. PD is characterized by progressive destruction of the periodontal ligament and alveolar bone, leading to tooth loss, impaired oral function, and sustained systemic inflammatory burden. [...] Read more.

Periodontitis (PD) and rheumatoid arthritis (RA) are chronic inflammatory disorders that impose substantial individual and societal burdens worldwide. PD is characterized by progressive destruction of the periodontal ligament and alveolar bone, leading to tooth loss, impaired oral function, and sustained systemic inflammatory burden. RA, affecting approximately 0.5–1% of the population, is a chronic autoimmune disease marked by persistent synovial inflammation, progressive joint destruction, disability, and reduced quality of life. Increasing evidence indicates that these conditions are biologically and clinically interconnected. Both diseases share key pathogenic pathways, including microbial dysbiosis, immune dysregulation, chronic inflammation, genetic susceptibility, and aberrant autoantibody responses. Particular attention has focused on keystone periodontal pathogens such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, which may promote protein citrullination and the formation of anti-citrullinated protein antibodies (ACPA), thereby providing a plausible mechanistic bridge between periodontal infection and systemic autoimmunity. Shared genetic risk factors, including HLA-DRB1 susceptibility alleles, further support a common host predisposition. Clinical, epidemiological, and translational studies increasingly support a bidirectional association. Individuals with PD appear to have a higher risk of RA development, whereas patients with RA demonstrate greater prevalence, severity, and progression of periodontal disease. Interventional studies suggest that nonsurgical periodontal therapy may reduce local periodontal inflammation, circulating inflammatory biomarkers, and RA disease activity indices, while effective pharmacological control of RA may also improve periodontal outcomes. This narrative review critically evaluates the PD–RA relationship across four interconnected domains: (i) epidemiological and clinical associations between PD and RA, (ii) key mechanisms underlying RA pathogenesis, (iii) shared biological pathways linking both diseases, and (iv) the extent to which treatment of one condition influences the other. Particular emphasis is placed on major sources of heterogeneity and confounding—including smoking, metabolic comorbidities, disease stage, therapeutic exposure, and variable diagnostic definitions—that may explain inconsistencies across the literature. By integrating current mechanistic and clinical evidence, this review provides a structured synthesis that extends beyond a descriptive overview of association studies. A clearer understanding of the periodontal–rheumatologic axis may facilitate risk stratification, identify novel therapeutic targets, and support integrated multidisciplinary care. Targeting both oral and systemic inflammation may improve outcomes in patients with coexisting PD and RA and may potentially reduce the risk or severity of one condition in individuals already affected by the other. Full article

(This article belongs to the Special Issue Global Health: Focus on Oral Care for People of All Ages)

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17 pages, 272 KB

Open AccessArticle

Awareness of Stroke Symptoms, Risk Factors, and Utilization of Neuroradiology Services Among the General Public in Saudi Arabia

by Basem Hasan Bahakeem

Healthcare 2026, 14(10), 1410; https://doi.org/10.3390/healthcare14101410 - 20 May 2026

Abstract

Background: Stroke is a major global health issue. It is among the leading causes of disability and mortality worldwide. Early stroke detection and treatment are significant in enhancing long-term outcomes. Awareness of neuroimaging is also essential because neuroimaging must be completed urgently within [...] Read more.

Background: Stroke is a major global health issue. It is among the leading causes of disability and mortality worldwide. Early stroke detection and treatment are significant in enhancing long-term outcomes. Awareness of neuroimaging is also essential because neuroimaging must be completed urgently within a limited time to diagnose and treat stroke patients correctly. This study aims to investigate awareness of stroke symptoms, risk factors, and utilization of neuroradiology services among the public in Saudi Arabia. Methods: This is an online survey study that was conducted in Saudi Arabia using social media platforms between January to February 2026. The questionnaire tool for this study was adapted from previous research and examined stroke awareness, symptoms, and risk factors. In addition, it examined neuroradiology awareness and utilization. The multivariable logistic regression analysis was used to identify predictors of better awareness of stroke. Results: A total of 415 participants were involved in this study. Around 46.7% of them were aged 25–34 years. Females formed the majority of the study sample, comprising 76.4%. Bachelor’s degree holders formed 61.4% of the study sample. Around 42.9% of the study sample were unemployed. Married participants contributed 64.3%. Almost half of the study sample (47.2%) reported that their monthly income is less than 5000 SAR. In this study, the participants demonstrated a moderate level of knowledge of stroke. The majority of the participants (70.8%) reported that they are aware of radiology centers near them that they can refer to in case of stroke emergency or follow-up, and 79.0% reported that they think that radiological imaging is important for diagnosing and treating stroke. The majority of the participants (72.3%) reported that they have heard of interventional radiology procedures for stroke. Participants aged 35–44 years and 55–64 years were less likely to have better knowledge of stroke compared to others (aOR: 0.21 (CI: 0.06–0.83); p-value: 0.026) and aOR: 0.17 (CI: 0.04–0.81); p-value: 0.026, respectively). Furthermore, participants who reported that their income level is 5000–9999 SAR and 10,000–14,999 SAR were less likely to have better knowledge of stroke compared to others (aOR: 0.32 (CI: 0.13–0.80); p-value: 0.014 and aOR: 0.21 (CI: 0.09–0.53); p-value: <0.001), respectively). On the other hand, participants who are unemployed were more likely to have better knowledge of stroke compared to others (aOR: 3.63 (CI: 1.09–12.05); p-value: 0.035). Conclusions: The current investigation demonstrated a moderate level of knowledge about strokes among the public in Saudi Arabia. Targeted interventions are mandated to improve the level of awareness about strokes, with a focus on knowledge of the correct emergency response, specifically calling an ambulance. Full article

12 pages, 348 KB

Open AccessArticle

Incontinence Quiz (IQ): Translation, Cross-Cultural Adaptation, and Psychometric Validation of the French Version

by Andrea Ribeiro, João Sousa, João Neves, Carla Macedo and José Lumini

Healthcare 2026, 14(10), 1409; https://doi.org/10.3390/healthcare14101409 - 20 May 2026

Abstract

Background/Objectives: Urinary incontinence (UI) is common among women and is often underreported and undertreated, partly due to limited health literacy and persistent misconceptions regarding its causes and management. Instruments that reliably assess knowledge about UI are important for identifying educational needs and [...] Read more.

Background/Objectives: Urinary incontinence (UI) is common among women and is often underreported and undertreated, partly due to limited health literacy and persistent misconceptions regarding its causes and management. Instruments that reliably assess knowledge about UI are important for identifying educational needs and evaluating the impact of educational interventions. Although the Incontinence Quiz (IQ) has been validated in other languages, no psychometrically tested French version was previously available. This study aimed to translate, culturally adapt, and evaluate the measurement properties of the French version of the Incontinence Quiz (IQ-Fr) in adult women, following internationally recommended procedures for cross-cultural adaptation. Methods: A methodological validation study with a two-sample design was conducted. An extended sample (n = 289) was used to examine internal consistency and convergent validity, while a validation subsample (n = 40) was used to assess divergent validity and reproducibility. The translation process included forward translation, synthesis, back-translation, expert committee review, and pretesting. The internal consistency of the IQ-Fr was assessed using Cronbach’s Alpha. The convergent validity of the IQ-Fr was assessed by both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). The divergent validity of the IQ-Fr was evaluated by Pearson’s correlation IQ-Fr and Ditrovie quality-of-life scores. Finally, the reproducibility of the IQ-Fr was evaluated by Intraclass Correlation (ICC) between the IQ-Fr scores obtained at two different time points (T0 and T1) over a one-week interval. Results: The IQ-Fr showed acceptable internal consistency (Cronbach’s Alpha = 0.654) comparable to other translations/cultural adaptations made for the same instrument. The EFA and CFA suggest the same four-dimension structure (IQ-Fr) found in the original instrument (IQ), although the factorial model fit would benefit from the additional removal of item 6 from the questionnaire, as already suggested by the increase in the instrument’s Cronbach’s Alpha (from 0.646 to 0.659). The IQ-Fr also showed good divergent validity, as assessed by the absence of a statistically significant Pearson correlation between the scores of the IQ-Fr and the scores of a non-related construct—the Ditrovie scale (r_p = 0.097, p-value = 0.552). Lastly, the IQ-Fr showed good reproducibility, as demonstrated by the high ICC coefficient (ICC = 0.752) between the instrument’s overall scores at T0 and T1. Conclusions: The French version of the Incontinence Quiz (IQ-Fr) presents good indicators of internal consistency, convergent validity, divergent validity, and reproducibility for it to be used in research and educational contexts in French-speaking populations. Full article

(This article belongs to the Special Issue Psychometric Properties and Broader Implications of Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs))

12 pages, 578 KB

Open AccessArticle

Building Resilience: How Nurses Adapt and Thrive While Caring for Older Adults with Multimorbidity in Acute Healthcare Settings

by Norah M. Alyahya, Hanadi Dakhilallah, Bandar S. Alharbi, Muteb Aljuhani, Thurayya Eid, Abdulaziz M. Alodhailah, Rayhanah R. Almutairi and Waleed M. Alshehri

Healthcare 2026, 14(10), 1408; https://doi.org/10.3390/healthcare14101408 - 20 May 2026

Abstract

Background: Caring for older adults with multimorbidity represents one of the most challenging aspects of contemporary nursing practice. While research has examined clinical outcomes and care models, limited attention has been given to how nurses develop resilience and adapt their professional practice [...] Read more.

Background: Caring for older adults with multimorbidity represents one of the most challenging aspects of contemporary nursing practice. While research has examined clinical outcomes and care models, limited attention has been given to how nurses develop resilience and adapt their professional practice to meet these complex care demands. This study aimed to examine how nurses build resilience and adapt their professional practice when caring for older adults with multimorbidity in acute care environments. Methods: This qualitative study employed in-depth semi-structured interviews with 15 registered nurses across general and specialized hospital settings. Data were analyzed using interpretive phenomenological analysis to understand the essence of nurses’ adaptation and resilience-building experiences. Results: Three superordinate themes emerged: (1) Professional evolution through complexity navigation, (2) Emotional resilience and meaning-making in challenging care situations, and (3) Collaborative networks as sources of strength and learning. Nurses demonstrated remarkable capacity for professional growth, developing sophisticated coping mechanisms and finding meaning in their challenging work. Conclusions: Nurses caring for older adults with multimorbidity undergo significant professional development, building resilience through experiential learning, peer support, and meaning-making processes, though these gains are accompanied by real emotional costs, including moral distress and exhaustion. Understanding these adaptation mechanisms is crucial for supporting nursing workforce sustainability and optimizing patient care quality. Full article

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13 pages, 827 KB

Open AccessReview

Integrating Artificial Intelligence into Community Health Nursing Education and Practice: Opportunities, Ethical Challenges, and Future Directions

by Bandar Alhumaidi and Talal Ali F. Alharbi

Healthcare 2026, 14(10), 1407; https://doi.org/10.3390/healthcare14101407 - 20 May 2026

Abstract

Background/Objectives: Artificial intelligence (AI) is rapidly transforming healthcare. Its integration into community health nursing—a discipline centered on population-level prevention, health promotion, and primary care in community settings—remains insufficiently explored. This narrative review examines the opportunities, ethical challenges, and future directions for integrating [...] Read more.

Background/Objectives: Artificial intelligence (AI) is rapidly transforming healthcare. Its integration into community health nursing—a discipline centered on population-level prevention, health promotion, and primary care in community settings—remains insufficiently explored. This narrative review examines the opportunities, ethical challenges, and future directions for integrating AI into community health nursing education and practice. Methods: A literature search was conducted across PubMed, CINAHL, Scopus, Web of Science, and IEEE Xplore for publications between January 2017 and March 2026. The initial search yielded 612 records; after the removal of duplicates and screening of titles, abstracts, and full texts against predefined criteria, 58 sources were retained for thematic synthesis, comprising empirical studies, systematic and umbrella reviews, scoping reviews, meta-analyses, and authoritative policy documents. Screening and data extraction were performed by two reviewers, with disagreements resolved by discussion. Results: AI offers opportunities for community health nursing across four interconnected domains: clinical decision support for community-based assessments, predictive analytics for population health management, enhanced disease surveillance and outbreak detection, and personalized health education delivery. Significant challenges persist, including algorithmic bias, data privacy concerns, threats to the therapeutic nurse–client relationship, inadequate AI literacy among nursing faculty, and regulatory gaps. Most empirical evidence originates from hospital or general nursing settings; transferability to community contexts is therefore inferred rather than directly demonstrated. Conclusions: Responsible integration of AI into community health nursing requires curriculum reform, ethical governance frameworks, faculty development, equitable access, and interdisciplinary collaboration. AI should augment, not replace, the relational and culturally sensitive care that defines this discipline. Given the narrative nature of the review and the limited community-specific evidence, conclusions are framed as a vision of the AI–community health nursing interface rather than a definitive synthesis. Full article

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