Healthcare

23 pages, 650 KB

Open AccessSystematic Review

Understanding the Relationship Between Alcohol Consumption and HIV Risk Behaviors in U.S. Adolescents: A Systematic Review of Youth Risk Behavior Survey Findings (2005–2021)

by Shahin Davoudpour, Madeline Kerr and Gregory L. Phillips II

Healthcare 2025, 13(18), 2370; https://doi.org/10.3390/healthcare13182370 (registering DOI) - 21 Sep 2025

Abstract

Background/Objectives: Alcohol use is a significant public health concern for adolescents, not only for its direct health impacts but also for its association with other health risk behaviors. In particular, alcohol use has been linked to sexual behaviors that may increase the [...] Read more.

Background/Objectives: Alcohol use is a significant public health concern for adolescents, not only for its direct health impacts but also for its association with other health risk behaviors. In particular, alcohol use has been linked to sexual behaviors that may increase the risk of HIV transmission. This systematic review aims to provide a deeper understanding of the relationships between various alcohol- and HIV-related risk behaviors among adolescents by synthesizing existing literature that exclusively uses Youth Risk Behavior Survey (YRBS) data. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted in PubMed, Web of Science, and PsycINFO. Eligible studies were peer-reviewed, published in English, and analyzed associations between alcohol use (age at first drink, alcohol use, binge drinking) and HIV risk behaviors (number of sexual partners, condom use, HIV testing) using YRBS data from the 2005–2021 collection years. Two authors independently screened 1133 records for eligibility, with 17 studies included in the final review. Results: The included studies consistently found a significant positive association between the frequency of alcohol use and binge drinking and a greater number of sexual partners. However, the evidence for an association between alcohol use and condom non-use was mixed. Limited evidence suggests that age of first alcohol use is not correlated with condom non-use. A key finding was the wide variation in study methodology, including the use of lifetime versus recent and dichotomized versus ordinal measures. Additionally, few studies were guided by a theoretical framework. Conclusions: The findings support a consistent link between alcohol use and having a greater number of sexual partners but highlight mixed evidence regarding condom use and little evidence for an association with HIV testing. This review demonstrates a need for more nuanced, theory-driven analyses that better utilize the multidimensional data available in the YRBS to capture the complex nature of risk behaviors. Full article

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22 pages, 6026 KB

Open AccessArticle

Spatio-Temporal Modelling and Forecasting of the Prolonged Measles Outbreak in Romania: Insights and Challenges

by Valerian-Ionuț Stoian, Aurora Stănescu, Mihaela Debita, Mariana Daniela Ignat, Raisa Eloise Barbu, Mădălina Nicoleta Matei, Alexia Anastasia Ștefania Baltă, Valentin Bulza, Liliana Baroiu and Cătălin Pleșea Condratovici

Healthcare 2025, 13(18), 2364; https://doi.org/10.3390/healthcare13182364 (registering DOI) - 21 Sep 2025

Abstract

Background/Objectives: Measles is a highly contagious viral disease that continues to have a profound effect on morbidity in Romania. Identifying temporal and spatial trends in how the disease spreads among the country’s counties and regions, both in the same disease generation as well [...] Read more.

Background/Objectives: Measles is a highly contagious viral disease that continues to have a profound effect on morbidity in Romania. Identifying temporal and spatial trends in how the disease spreads among the country’s counties and regions, both in the same disease generation as well as one generation apart (2-week case lag), aided by forecasting tools, could provide valuable insights into tailoring public health interventions. Methods: A big data analysis has been performed on notified measles cases from January 2020 to December 2024 using Python v3.13 grouping cases based on location (using the Nomenclature of territorial units for statistics) and time of the onset of the disease. Results: Feedback loops among both counties and macroregions have been identified (for example Centru-Brașov and București-Ilfov with a correlation factor of 0.77) while monthly forecasting for 2025 and 2026, explored using both the SARIMA and the Holt-Winters models (MAE 1616.74 and 1281.99, respectively), shows the measles might continue to be a burden, with the Holt–Winters models exhibiting slightly more reliable monthly forecast data nationwide, helping to define a solid basis for future predictions and decisions. Conclusions: The spatial feedback loops, both interregional or within the same region, coupled with the trend of lowering vaccination rates, contribute to the persistent emergence of new measles cases which might continue throughout 2025 and 2026 based on the forecasting, distinct from previous outbreaks which followed a specific cadence. Full article

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25 pages, 1022 KB

Open AccessArticle

From Research to Practice: Implementing an Evidence-Based Intervention for Nurse Well-Being in a Healthcare System

by Amanda K. Bailey, Hong Tao and Amanda T. Sawyer

Healthcare 2025, 13(18), 2369; https://doi.org/10.3390/healthcare13182369 (registering DOI) - 20 Sep 2025

Abstract

Background: In response to the high prevalence of burnout in nursing, a hospital research team developed, studied, and implemented RISE (Resilience, Insight, Self-Compassion, Empowerment), a novel psychoeducational group program designed to reduce distress and promote well-being among professional caregivers, specifically nurses and nurse [...] Read more.

Background: In response to the high prevalence of burnout in nursing, a hospital research team developed, studied, and implemented RISE (Resilience, Insight, Self-Compassion, Empowerment), a novel psychoeducational group program designed to reduce distress and promote well-being among professional caregivers, specifically nurses and nurse leaders. Pilot studies and randomized controlled trials showed positive results, and thus, the program was operationalized. Methods: This quality improvement/quality assurance (QI/QA) project involved scaling the program and gathering data to evaluate implementation and impact on well-being indicators. The intervention involves structured weekly (8–9 weeks) 90-min group sessions integrating mindfulness, cognitive-behavioral techniques, and acceptance and commitment therapy. Eight licensed mental health providers were trained and delivered the program. Implementation outcomes included adoption/stakeholder engagement, fidelity, provider satisfaction, participant engagement, and sustainability. Participant outcomes were measured through validated scales and participant feedback forms. The implementation process was examined at the participant, provider, and organizational levels to identify barriers and enabling factors. Results: The program was implemented in seven acute care hospitals. From January 2023 to December 2024, 160 participants completed the program. Effective implementation strategies included intensive training and supervision of qualified providers, multi-departmental collaborations, and rigorous fidelity monitoring. Quality improvement processes addressed challenges such as early attrition and administrative burden. Evaluation data from pre- and post-intervention surveys demonstrated statistically significant improvements in psychological outcomes, with high satisfaction reported by both participants and providers. Conclusion: The findings support the effective implementation of the program as part of a broader organizational strategy to address nurse burnout and workforce mental health. Lessons, implications, and future directions for healthcare leaders are discussed. Full article

(This article belongs to the Special Issue Promoting the Health of Caregivers: Addressing Physical, Psychosocial, and Spiritual Well-Being Across Acute and Chronic Care Settings)

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15 pages, 267 KB

Open AccessArticle

Factors Affecting Return to Work of Patients with Chronic Coronary Syndrome: A Prospective Study

by Corina Oancea, Despina Mihaela Gherman, Rodica Simona Capraru, Sorina Maria Aurelian, Mirela Maria Nedelescu and Florina Georgeta Popescu

Healthcare 2025, 13(18), 2368; https://doi.org/10.3390/healthcare13182368 (registering DOI) - 20 Sep 2025

Abstract

Background/Objectives: Return to work is an important goal of cardiac rehabilitation, yet individuals recovering from cardiovascular disease often face significant challenges in achieving it. As a result, a significant proportion of individuals with coronary artery disease experience work disability, negatively impacting both [...] Read more.

Background/Objectives: Return to work is an important goal of cardiac rehabilitation, yet individuals recovering from cardiovascular disease often face significant challenges in achieving it. As a result, a significant proportion of individuals with coronary artery disease experience work disability, negatively impacting both their economic well-being and quality of life while imposing a substantial financial burden on society. This less-studied issue is often treated as a secondary outcome in research, resulting in return to work findings that are frequently underreported. As such, this study aimed to identify the factors associated with adequate levels of functional capacity enabling the engagement in professional work and to develop a model for predicting the potential return to work of patients with coronary artery disease. Methods: During 2024, we enrolled 250 consecutive patients with chronic coronary syndrome less than 65 years of age who were referred to the National Institute for Medical Assessment and Work Capacity Rehabilitation (INEMRCM) for medical evaluation to establish eligibility-to-work disability benefits. Patients underwent a revascularization procedure either using PTCA or CABG, with a few having had no revascularization until the moment of assessment. Detailed demographic, socioeconomic, and clinical data were collected via interviews. Logistic regression was used to develop a multivariable model for predicting return to work. Results: Six months after discharge from the INEMRCM, around 20% of participants had returned to work. A better functional status was determinant for individuals’ re-employment (p = 0.026) along with an absence of cardiovascular comorbidities (p = 0.045) and holding a higher-skilled occupation (p = 0.037). The multivariate analysis identified professional specialization and the absence of cardiovascular comorbidities as the strongest predictors of return to work. Conclusions: Cardiac patients with coexisting cardiovascular conditions engaged in less-specialized types of work tend to experience poorer return to work outcomes. As such, individuals in this category should be carefully assessed and prioritized in the development of targeted rehabilitation programs. Full article

7 pages, 176 KB

Open AccessCommentary

Commentary on Sources of Attention-Deficit/Hyperactivity Overdiagnosis Among U.S. Adults

by Samuel R. Weber

Healthcare 2025, 13(18), 2367; https://doi.org/10.3390/healthcare13182367 (registering DOI) - 20 Sep 2025

Abstract

Diagnosis of adult attention-deficit/hyperactivity disorder (ADHD) has risen precipitously in recent years in the United States. This has been accompanied by a corresponding increase in rates of stimulant medication prescriptions, resulting in prescription drug shortages. These data raise concern that adult ADHD may [...] Read more.

Diagnosis of adult attention-deficit/hyperactivity disorder (ADHD) has risen precipitously in recent years in the United States. This has been accompanied by a corresponding increase in rates of stimulant medication prescriptions, resulting in prescription drug shortages. These data raise concern that adult ADHD may be overdiagnosed. This article examines factors that can contribute to adult ADHD overdiagnosis. Sources of overdiagnosis include lack of adherence to DSM-5-TR diagnostic criteria, poor diagnostic practices, malingering, electronic distractions, cultural shifts in how the term “ADHD” has been used, and other health conditions that impair attention. More rigorous diagnostic practices are necessary to ensure appropriate diagnoses and treatments are offered. Adopting such practices will help optimize patient outcomes. Such practices include ruling out other conditions that impair attention, taking a careful developmental history, gathering information from collateral sources, and evaluating the patient for functional impairments. Full article

27 pages, 1256 KB

Open AccessArticle

Perceptions of Stress, Well-Being, and Intervention Preferences Among Parents Affected by Major Stressors

by Nada M. Goodrum, Julie K. Nguyen, Diamonde McCollum, E. Rebekah Siceloff, Brianna Tennie, Sara delMas and Ronald J. Prinz

Healthcare 2025, 13(18), 2366; https://doi.org/10.3390/healthcare13182366 (registering DOI) - 20 Sep 2025

Abstract

Background/Objectives: Children’s social–emotional difficulties and unhealthy lifestyle behaviors co-occur but are rarely addressed concurrently in parent-based interventions. These problems are exacerbated by family stressors (e.g., parental trauma, mental health, substance misuse, illness, financial strain, racism), which further compound existing health and healthcare [...] Read more.

Background/Objectives: Children’s social–emotional difficulties and unhealthy lifestyle behaviors co-occur but are rarely addressed concurrently in parent-based interventions. These problems are exacerbated by family stressors (e.g., parental trauma, mental health, substance misuse, illness, financial strain, racism), which further compound existing health and healthcare inequities for families experiencing marginalization who are more likely to face major stressors. Yet, most parent-based interventions do not sufficiently address parents’ own stress and self-regulation. To inform prevention efforts to address these gaps, this mixed methods formative needs assessment explored strengths, challenges, and intervention preferences of parents dealing with major stressors, informing parent-based prevention to improve child social–emotional and physical health. Method: A sociodemographically diverse sample of parents/caregivers (N = 46) who had a child aged 3–9 years and ≥ two major stressors completed surveys assessing child well-being, parenting, parental stress, self-regulation, and intervention preferences. A subsample (n = 24) completed qualitative interviews further exploring these areas. Results: Parents expressed high interest in programming on emotion regulation, mindfulness, dealing with trauma, and reducing stress while strengthening children’s social–emotional and physical health. Conclusions: Results underscore the need to address caregivers’ own emotion-related skills to promote children’s well-being. Findings inform implementation and evaluation of a preventive program to improve child health, promote positive parenting, and address parental stress through self-regulation and coping. By aligning with community needs and preferences, parenting interventions that simultaneously address parental well-being and stress may be a promising avenue for improving equitable access to and quality of healthcare for families experiencing marginalization and stress. Full article

(This article belongs to the Special Issue Increasing Access to and Quality of Healthcare Services to Promote Community Health Equity)

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15 pages, 1242 KB

Open AccessArticle

Multidisciplinary Professionals’ Perceptions of Home-Visit Oral Care for Older Adults in Integrated Community Care: A Focus Group Interview Study

by Se-Rim Jo, Bo-Ram Shin and Jong-Hwa Jang

Healthcare 2025, 13(18), 2365; https://doi.org/10.3390/healthcare13182365 (registering DOI) - 20 Sep 2025

Abstract

Background/Objectives: With the acceleration of population ageing the need for integrated support in healthcare and caregiving is increasing, and the societal demand for improved service quality is also increasing. This study aims to explore how multidisciplinary professionals perceive the implementation of home-visit [...] Read more.

Background/Objectives: With the acceleration of population ageing the need for integrated support in healthcare and caregiving is increasing, and the societal demand for improved service quality is also increasing. This study aims to explore how multidisciplinary professionals perceive the implementation of home-visit oral care (HVOC) within the Integrated Community Care in Older Adults model, in order to inform the design of future integrated oral health programs. Methods: The study participants comprised 16 individuals: eight dental hygienists with experience in HVOC and eight multidisciplinary healthcare providers. Focus group interviews were conducted with these participants, and the data were analysed using Colaizzi’s phenomenological method to derive key themes and categories. Results: The analysis revealed four main thematic categories: (1) cognitive aspects (understanding of geriatric diseases and families); (2) technical aspects (effective communication and competence in oral care); (3) value-based aspects (empathy, patient-centredness, professional pride); (4) multidisciplinary organisational efforts (establishing interprofessional collaboration systems and integrated platforms). Conclusions: HVOC services provided by dental hygienists were found to promote oral health among older adults. To ensure the sustainability and effectiveness of such services, a customised integrated care model based on multidisciplinary collaboration should be established. Full article

(This article belongs to the Special Issue Oral Health Care and Services for Patients)

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27 pages, 829 KB

Open AccessReview

Psychiatric Risk Governance Across Jurisdictions: A Comparative Analysis of Involuntary Treatment, Community Treatment Orders, and Forensic Mental Health Services

by Matteo Lippi, Laura Leondina Campanozzi, Giuseppe D’Andrea, Donato Morena, Francesca Orsini, Felice Marco Damato, Giuseppe Fanelli, Yasin Hasan Balcioglu, Howard Ryland, Thomas Fovet, Birgit Völlm, Javier Vicente-Alba, Charles L. Scott, Paola Frati, Vittoradolfo Tambone and Raffaella Rinaldi

Healthcare 2025, 13(18), 2363; https://doi.org/10.3390/healthcare13182363 (registering DOI) - 20 Sep 2025

Abstract

Background: This article presents an international comparative review of involuntary psychiatric care, Community Treatment Orders (CTOs), and forensic mental health services, with operational implications for Italy. Italy has a community-based model inspired by the “Basaglia Law” (Law No. 180/1978), emphasizing deinstitutionalization and [...] Read more.

Background: This article presents an international comparative review of involuntary psychiatric care, Community Treatment Orders (CTOs), and forensic mental health services, with operational implications for Italy. Italy has a community-based model inspired by the “Basaglia Law” (Law No. 180/1978), emphasizing deinstitutionalization and continuity of care. Nevertheless, risk governance gaps persist for high-complexity patients, imposing a disproportionate legal and clinical burden on mental health professionals. This group includes individuals who refuse treatment despite meeting criteria for compulsory admission, patients at elevated risk with substantial management complexity, and offenders with a current or suspected psychiatric disorder. Methods: We conducted a comparative legal and policy review across seven jurisdictions (Italy, England and Wales (UK), France, Germany, Spain, the United States, and Canada) to map frameworks for involuntary treatment, forensic services, CTOs (or equivalents), and community-based risk management. We also extracted procedural safeguards, duration and renewal limits, and interfaces with forensic services. Results: CTOs are available in five of the seven jurisdictions (England and Wales, France, Spain, the United States, and Canada) but are absent in Italy and Germany. We propose a three-pillar framework: (1) enforceable outpatient measures, including CTOs; (2) Forensic Psychiatry Units within Local Health Authorities; and (3) oversight boards with judicial, clinical, and social representatives. These components aim to redistribute responsibility, ensure continuity of care, and provide proportional oversight within a least restrictive, graduated system. Conclusions: When narrowly targeted, time limited, and paired with robust safeguards and service-quality standards, CTOs can support adherence and continuity for patients who repeatedly disengage from care. For Italy, integrating this instrument within the three-pillar framework and under independent oversight could strengthen patient rights and public safety, reduce revolving-door admissions, and improve outcomes. Full article

(This article belongs to the Section Healthcare Quality, Patient Safety, and Self-care Management)

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15 pages, 512 KB

Open AccessStudy Protocol

Using Participatory Action Research to Enhance Physical Education Interventions for Promoting Active Lifestyles in Schools: A Study Design and Protocol

by Jorge Lizandra, Alexandra Valencia-Peris, Roberto Ferriz and Carmen Peiró-Velert

Healthcare 2025, 13(18), 2362; https://doi.org/10.3390/healthcare13182362 - 19 Sep 2025

Abstract

Promoting active lifestyles among adolescents is essential due to their short-, medium-, and long-term contributions to young people’s holistic development and overall health. Beyond physical well-being, Physical Education foster physical activity, autonomy, social connectedness, motivation and emotional well-being, thus constituting a key dimension [...] Read more.

Promoting active lifestyles among adolescents is essential due to their short-, medium-, and long-term contributions to young people’s holistic development and overall health. Beyond physical well-being, Physical Education foster physical activity, autonomy, social connectedness, motivation and emotional well-being, thus constituting a key dimension of quality education. Background/Objectives: The “Estilos de Vida Activos (EVA)” project is a school-based intervention designed to foster adolescent agency and motivation in adopting active habits. Grounded in the salutogenic model, self-determination theory, and the health-based Physical Education pedagogical model, this protocol describes the design and implementation strategies of a participatory intervention in secondary schools. Methods: A variety of research methods will be used to collect quantitative and qualitative data before, during, and after the intervention. Validated questionnaires will assess active commuting, socioeconomic status, satisfaction of basic psychological needs, motivation, levels and intention to engage in physical activity. Qualitative data include interviews with teachers, Photovoice sessions with students, observation notes, and programme materials. Intervention: The EVA intervention is collaboratively developed by students, teachers, and researchers using participatory action research. It includes needs analysis, participatory activities, and co-design of tailored physical activity programmes. The intervention is described using the Template for Intervention Description and Replication checklist (TIDieR) to enhance transparency and replicability. Conclusions: This protocol presents a theoretically grounded and participatory approach to school-based health promotion. By integrating educational and collaborative strategies, it offers a replicable model that promotes adolescent active lifestyles, from contextual relevance, and pedagogical coherence, serving as a guide for inclusive and sustainable interventions in school settings. Full article

(This article belongs to the Special Issue Future Trends of Physical Activity in Health Promotion)

28 pages, 1208 KB

Open AccessArticle

Down the Digital Delta: Health Information Inequities Among Rural Mississippi Caregivers

by Danielle K. Nadorff, Sujan Anreddy, Katerina Sergi, Zaccheus J. Ahonle, Colleen Stouffer, Tockie Hemphill and David R. Buys

Healthcare 2025, 13(18), 2361; https://doi.org/10.3390/healthcare13182361 - 19 Sep 2025

Abstract

Background/Objectives: As healthcare increasingly utilizes digital delivery systems, equitable access and engagement are critical, particularly for caregivers of older adults in rural regions. This study examines how education levels and geographic rurality influence health information-seeking in Mississippi, a state with persistent structural [...] Read more.

Background/Objectives: As healthcare increasingly utilizes digital delivery systems, equitable access and engagement are critical, particularly for caregivers of older adults in rural regions. This study examines how education levels and geographic rurality influence health information-seeking in Mississippi, a state with persistent structural inequities, through the theoretical lenses of Digital Divide Theory and Theory of Planned Behavior. Methods: A statewide survey was conducted among caregivers in Mississippi (N = 452) who support adults aged 50+. The survey assessed rurality level, educational attainment, attitudes toward various health information sources, perceived digital accessibility, and reported challenges in obtaining necessary health guidance. Results: Findings challenged conventional assumptions regarding rural digital engagement. Rural caregivers reported higher trust in both internet and interpersonal health information sources. Rurality did not significantly predict internet use or reported difficulty finding information. However, a significant interaction between education and rurality revealed an “Outcome Divide”: while higher education correlated with more positive attitudes toward online health information in urban areas, this association weakened and reversed in highly rural contexts. Conclusions: These results underscore the need for strategies beyond merely improving access to bridge digital health equity gaps. Policy and interventions must address contextual barriers, such as digital health literacy and relevance, limiting the effectiveness of digital tools, even when internet access is available. Promoting digital health literacy, integrating trusted local interpersonal networks, and adapting educational initiatives to rural realities are essential for advancing equitable and effective digital health engagement. Full article

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14 pages, 397 KB

Open AccessArticle

Antibiotic Prescribing Patterns of Family Medicine Pediatric Visits: A Pharmacoepidemiological Study

by Reem S. AlOmar, Nouf A. AlShamlan, Ahmed M. Al-Turki, Ahmed A. Al Yateem, Abdulrahman A. Al-Abdulazeem, Najla A. Alhamed, Sameerah Motabgani, Assim M. AlAbdulkader, Abdulelah H. Almansour and Malak A. Al Shammari

Healthcare 2025, 13(18), 2360; https://doi.org/10.3390/healthcare13182360 - 19 Sep 2025

Abstract

Background/Objectives: Understanding the medication prescribing patterns in pediatric primary care is essential for informing policy and clinical practice. In the Kingdom of Saudi Arabia (KSA), and following the 2018 antibiotic restriction policy, limited data exist on the patterns, types, and regimens of [...] Read more.

Background/Objectives: Understanding the medication prescribing patterns in pediatric primary care is essential for informing policy and clinical practice. In the Kingdom of Saudi Arabia (KSA), and following the 2018 antibiotic restriction policy, limited data exist on the patterns, types, and regimens of antibiotics prescribed during routine family medicine visits for children. This pharmacoepidemiological study aimed to describe the antibiotic prescribing patterns in a university-affiliated model primary healthcare center. Methods: A retrospective chart review was conducted for all the pediatric visits (<14 years) to general family medicine clinics between January and December 2024. Demographic characteristics, visit type, diagnosis, and antibiotic prescription details such as medication class, route, frequency, and duration were extracted from electronic medical records and analyzed descriptively. Results: Among the 2036 pediatric visits, 705 (34.63%) resulted in at least one prescription. Of these, 87 visits (12.34%) included an antibiotic. The most frequently prescribed antibiotic classes were nitroimidazoles (39.29%), penicillins (36.90%), and macrolides (10.71%). Penicillins were typically prescribed for 7 days twice daily as suspensions. Among the non-antibiotic prescriptions, vaccines, nutritional supplements, and analgesics were the most common. Follow-up consultations accounted for 34.09% of all the visits. Conclusions: A lower proportion of antibiotic prescriptions was found when compared to regional and international reports, which may reflect the impact of the antibiotic restriction policy in the country. The findings suggest a shift toward more cautious prescribing in primary care and align with the national efforts to regulate antimicrobial use. Ongoing surveillance of the prescribing trends is essential to evaluate the long-term effectiveness of these measures. Full article

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

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17 pages, 543 KB

Open AccessReview

The Application of Biologic and Synthetic Bone Grafts in Scoliosis Surgery: A Scoping Review of Emerging Technologies

by Nikolaos Trygonis, Ioannis I. Daskalakis and Christos Tsagkaris

Healthcare 2025, 13(18), 2359; https://doi.org/10.3390/healthcare13182359 - 19 Sep 2025

Abstract

Background: Spinal deformity correction surgery, particularly in scoliosis, often necessitates long fusion constructs and complex osteotomies that create significant structural bone defects. These defects threaten the integrity of spinal fusion, potentially compromising surgical outcomes. Bone grafting remains the cornerstone of addressing these [...] Read more.

Background: Spinal deformity correction surgery, particularly in scoliosis, often necessitates long fusion constructs and complex osteotomies that create significant structural bone defects. These defects threaten the integrity of spinal fusion, potentially compromising surgical outcomes. Bone grafting remains the cornerstone of addressing these defects, traditionally relying on autologous bone. However, limitations such as donor site morbidity and insufficient graft volume have made urgent the development and adoption of biologic substitutes and synthetic alternatives. Additionally, innovations in three-dimensional (3D) printing offer emerging solutions for graft customization and improved osseointegration. Objective: This scoping review maps the evidence of the effectiveness of the use of biologic and synthetic bone grafts in scoliosis surgery. It focusses on the role of novel technologies, particularly osteobiologics in combination with 3D-printed scaffolds, in enhancing graft performance and surgical outcomes. Methods: A comprehensive literature search was conducted using PubMed, Scopus, and the Cochrane Library to identify studies published within the last 15 years. Inclusion criteria focused on clinical and preclinical research involving biologic grafts (e.g., allografts, demineralized bone matrix-DBM, bone morphogenetic proteins-BMPs), synthetic substitutes (e.g., ceramics, polymers), and 3D-printed grafts in the context of scoliosis surgery. Data were extracted on graft type, clinical application, outcome measures, and complications. The review followed PRISMA-ScR guidelines and employed the Arksey and O’Malley methodological framework. Results: The included studies revealed diverse grafting strategies across pediatric and adult populations, with varying degrees of fusion success, incorporation rates, and complication profiles. It also included some anime studies. Emerging 3D technologies demonstrated promising preliminary results but require further validation. Conclusions: Osteobiologic and synthetic bone grafts, including those enhanced with 3D technologies, represent a growing area of interest in scoliosis surgery. Despite promising outcomes, more high-quality comparative clinical studies are needed to guide clinical decision-making and standardize practice. Full article

(This article belongs to the Special Issue Scoliosis Deformity—Etiological Aspects, Management and Rehabilitation)

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16 pages, 958 KB

Open AccessArticle

Access to Services Within the Entrusted Budgets in Primary Healthcare in Poland from 2022 to 2025

by Magdalena Mrożek-Gąsiorowska

Healthcare 2025, 13(18), 2358; https://doi.org/10.3390/healthcare13182358 - 19 Sep 2025

Abstract

Background: Entrusted budgets were introduced as part of the primary healthcare (PHC) system in Poland in July 2022. This initiative aimed to increase the role of PHC and enhance the accessibility of diagnostic services and specialist consultations/advice for patients. Methods: Data [...] Read more.

Background: Entrusted budgets were introduced as part of the primary healthcare (PHC) system in Poland in July 2022. This initiative aimed to increase the role of PHC and enhance the accessibility of diagnostic services and specialist consultations/advice for patients. Methods: Data from the National Health Fund (NHF) databases regarding contracts between the NHF and healthcare providers in the field of PHC from 2022 to 2025 were analyzed. The share of contracts with entrusted budgets in the total number of PHC physician contracts was estimated in individual voivodships, as well as in counties, using the example of the Małopolskie Voivodship. It was assessed whether there were significant differences between voivodships and counties as well as the pace of implementation of the new solution. Results: Only 43.1% of PHC physicians have signed contracts with the NHF for coordinated care services for 2025, with this percentage varying significantly between voivodships, ranging from 24.8% in Opolskie Voivodship to 66.3% in Lubelskie Voivodship (p < 0.0001). For the vast majority of voivodships, no statistically significant increase in the share of service providers was demonstrated in the period from 2022 to 2025. Access to services between counties is also highly varied (from 10.0% to 76.5%), although the differences were not statistically significant (p = 0.217). Conclusions: The results indicate regional and local inequalities in access to services. It is necessary to implement incentive mechanisms within the contracting of health services between the NHF and providers that will ensure equal access to PHC services within entrusted budgets for all patients. The range of available services should be equal regardless of at which PHC facility a patient is registered. The current regulations concerning entrusted budgets, including the voluntary involvement of service providers, are not sufficient. Full article

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18 pages, 2375 KB

Open AccessSystematic Review

Effectiveness of Arm Swing Exercise on Comprehensive Health Outcomes: A Systematic Review and Meta-Analysis

by Phatcharaphon Whaikid and Noppawan Piaseu

Healthcare 2025, 13(18), 2357; https://doi.org/10.3390/healthcare13182357 - 19 Sep 2025

Abstract

Background: Arm swing exercise (ASE) is a simple and accessible form of physical activity that has been reported to reduce disease risk and enhance overall health across various populations. In alignment with the World Health Organization’s recommendations for promoting physical activity, ASE requires [...] Read more.

Background: Arm swing exercise (ASE) is a simple and accessible form of physical activity that has been reported to reduce disease risk and enhance overall health across various populations. In alignment with the World Health Organization’s recommendations for promoting physical activity, ASE requires no specialized equipment or professional supervision. However, systematic evidence on its health benefits remains limited. Objective: This systematic review and meta-analysis aimed to assess the effects of ASE on body composition, glycemic control, cardiovascular health, and musculoskeletal outcomes. Methods: A comprehensive systematic search was conducted in four major databases, including PubMed, Embase, Scopus, and the Thai-Journal Citation Index Center, covering studies published from inception to October 2024. Articles published in both English and Thai were included. Two independent reviewers screened and selected eligible randomized controlled trials and quasi-experimental studies. Methodological quality was assessed using the JBI critical appraisal tool, and meta-analyses were performed using Stata software (version 18), presenting mean differences (MD) with 95% confidence intervals (CI). Results: Thirteen studies were included, comprising eight randomized controlled trials and five quasi-experimental studies, with intervention durations ranging from 5 to 24 weeks. The ASE significantly reduced waist circumference (MD = −4.76; 95% CI: −8.36 to −1.17; and p < 0.05), hemoglobin A1C (MD= −0.80%; 95% CI: −1.19 to −0.40; and p < 0.001), fasting blood glucose (MD = −17.62 mg/dL; 95% CI: −25.93 to −9.32; and p < 0.05), and diastolic blood pressure (MD = −9.74 mmHg; 95% CI: −17.84 to −1.65; and p < 0.05). The ASE showed a non-significant reduction in systolic blood pressure (MD = −3.65 mmHg; 95% CI: −10.37 to 3.08; and p = 0.29). Additionally, the ASE significantly increased high-density lipoprotein cholesterol (HDL-C) levels (MD = 6.96 mg/dL; 95% CI: 2.20 to 11.71; and p < 0.05). Conclusions: This study, representing the first systematic review and meta-analysis focusing on ASE, demonstrates that ASE is an effective intervention for improving body composition, glycemic control, and cardiovascular health. Given its simplicity, low cost, and broad applicability, ASE could serve as a practical public health strategy to promote health and prevent chronic diseases across diverse populations. Full article

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11 pages, 253 KB

Open AccessArticle

Suicidal Ideation, Depression, Anxiety, Impulsivity, Self-Esteem, Emotional Regulation, Child Trauma and Hopelessness in Korean Military Soldiers

by Yeon Seo Lee, Youngil Lee and Myung Ho Lim

Healthcare 2025, 13(18), 2356; https://doi.org/10.3390/healthcare13182356 - 18 Sep 2025

Abstract

Background/Objectives: Suicide is the leading cause of death among South Korean military soldiers, accounting for more than 70% of all deaths. This issue is particularly relevant in the military context due to the nature of living in groups in a controlled environment. [...] Read more.

Background/Objectives: Suicide is the leading cause of death among South Korean military soldiers, accounting for more than 70% of all deaths. This issue is particularly relevant in the military context due to the nature of living in groups in a controlled environment. This study was conducted active-duty south Korean male soldiers aged 18 to 28 who were performing mandatory military service for one year and six months. Additionally, it compares and analyzes the differences in suicidal ideation and risk factors between military soldiers and a comparison group consisting of males in their 20s without military experience. Methods: This study included 248 Korean soldiers and 292 general controls, totaling 540 participants. The research instruments used for evaluation included the Beck Scale of Suicide Ideation (BSI), the Childhood Trauma Questionnaire (CTQ-SF), the Perceived Stress Scale (PSS), the Difficulties in Emotion Regulation Scale (DERS-16), the Barratt Impulsiveness Scale Version 11 (BIS-11), the Rosenberg Self-Esteem Scale (RSES), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item scale (GAD-7), the UCLA Loneliness Scale (UCLAS), and the State-Beck Hopelessness Scale (S-BHS). Results: The results of this study showed that suicidal ideation, depression, anxiety, impulsivity, and self-esteem were significantly higher in the military group compared to the comparison group. Conversely, emotional dysregulation was considerably lower in the soldiers than in the comparison group. No significant differences were found in childhood trauma, stress, loneliness, and hopelessness between the two groups. Multiple regression analysis within the military group revealed that childhood trauma, hopelessness, and depression were major factors influencing suicidal ideation. Conclusions: These findings will help identify risk factors for suicide among soldiers and develop effective intervention strategies to prevent it. Full article

(This article belongs to the Special Issue Social Determinants of Health/Mental Health Among Youth and Young Adults)

13 pages, 337 KB

Open AccessArticle

Exploring the Social Network Structure of Dementia-Friendly Communities in Rural Taiwan: A Qualitative Study

by Hsien-Ting Pan, Shu-Ting Chang and Shofang Chang

Healthcare 2025, 13(18), 2355; https://doi.org/10.3390/healthcare13182355 - 18 Sep 2025

Abstract

Background/Objectives: The rising prevalence of dementia presents significant emotional, psychological, and economic challenges for families. Dementia-friendly communities (DFCs) aim to alleviate these burdens by fostering social inclusion and mutual support for people with dementia (PWD) and their caregivers. This study explores the [...] Read more.

Background/Objectives: The rising prevalence of dementia presents significant emotional, psychological, and economic challenges for families. Dementia-friendly communities (DFCs) aim to alleviate these burdens by fostering social inclusion and mutual support for people with dementia (PWD) and their caregivers. This study explores the social network structures within DFCs in rural Taiwan, utilizing social network theory as its framework. Methods: A qualitative design was employed, involving semi-structured interviews with eleven participants, including eight caregivers and three case managers. Data were analyzed using grounded theory. Results: The results indicate that the DFC social network is grounded in reciprocal relationships and mutual support between families, workplaces, and neighborhoods. Durability depends on stable relationships, sustained support systems, and the preservation of local culture. Cultural alignment and engagement reduce stigma and foster understanding, while diverse activities strengthen social bonds and participation. Conclusions: The study highlights the importance of government policy, infrastructure, and public awareness in sustaining dementia-friendly environments. The results offer valuable insights for enhancing community design and policy to better support PWD and their families. Full article

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15 pages, 343 KB

Open AccessSystematic Review

Mental Health Exploration and Variables Associated with Young Health Professionals in Early Childhood Care Centers: A Systematic Review

by Sofía Gómez-Herrera, María Auxiliadora Robles-Bello and David Sánchez-Teruel

Healthcare 2025, 13(18), 2354; https://doi.org/10.3390/healthcare13182354 - 18 Sep 2025

Abstract

Early childhood care (ECC) represents a vital service for the families two supports; however, research on the experiences of young professionals working in this field is lacking. The nature of the work is inherently difficult due to lengthy bureaucratic procedures, limited flexibility to [...] Read more.

Early childhood care (ECC) represents a vital service for the families two supports; however, research on the experiences of young professionals working in this field is lacking. The nature of the work is inherently difficult due to lengthy bureaucratic procedures, limited flexibility to adapt services to individual needs, and a lack of financial and human resources. Background/Objectives: This systematic review is to analyze the existence of scientific literature related to mental health and protective and risk factors in these young professionals. Methods: The PRISMA methodology and a comparative analysis of the selected articles were used, incorporating sources from major scientific databases, such as Scopus, Web of Science, and PsycInfo. Results: A total of 19,943 articles were identified, with a striking 0% specifically addressing early childhood intervention. Only 13 of the articles were selected for the analysis of mental health among young healthcare professionals. Conclusions: The literature reviewed highlights risk factors such as depression, anxiety, and stress among health professionals, as well as protective factors like resilience, social support, empathy and the working conditions themselves (working method, working hours, pay, professional value of the workers themselves, administrative workload and opportunities for teamwork). This study is valuable for establishing a scientific foundation for this population and for enhancing its positive characteristics. Full article

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

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20 pages, 273 KB

Open AccessArticle

Facilitators and Barriers to Self-Volume Management in Older Patients with Chronic Heart Failure and Multimorbidity: A Qualitative Study

by Xin Xu, Yu Chen, Jiaxin Zhou, Shuying Li, Xinyue Dong and Zhiyun Shen

Healthcare 2025, 13(18), 2353; https://doi.org/10.3390/healthcare13182353 - 18 Sep 2025

Abstract

Background: Effective volume management can significantly improve patients’ health outcomes, but the current situation of volume management in older patients with chronic heart failure (CHF) and multimorbidity is not optimistic. This study aimed to explore the facilitators and barriers of self-volume management in [...] Read more.

Background: Effective volume management can significantly improve patients’ health outcomes, but the current situation of volume management in older patients with chronic heart failure (CHF) and multimorbidity is not optimistic. This study aimed to explore the facilitators and barriers of self-volume management in patients and to provide a basis for the development of self-volume management strategies. Methods: A descriptive qualitative research method was used. Semi-structured interviews were conducted with older patients with CHF and multimorbidity between January and April 2025 in two tertiary hospitals in Shanghai, China. Data were analyzed using content analysis. Results: Eight facilitators emerged, including the hospital–community collaboration mechanism, Medicare and long-term care insurance coverage, diverse social support, the doctor–patient trust relationship, results-oriented incentives, digital health management, high self-efficacy, and strong motivation for health. Nine barriers were identified; these were insufficient adaptability of self-volume management programs, limited access to community resources, lack of standardized self-volume management tools, inadequate multidisciplinary team communication, one-way doctor–patient communication, lack of knowledge of self-volume management, physical limitations, management negligence caused by work constraints, and behavioral habits’ consolidation. Conclusions: Self-volume management was affected by various factors. The study suggests strengthening health insurance coverage to reduce financial burden, taking advantage of family support and providing digital health management tools. In addition, healthcare providers should provide patient-centered care, enhance multidisciplinary collaboration, and address individual barriers with precise intervention strategies. Full article

(This article belongs to the Special Issue Nursing for Older Adults with Multimorbidities)

10 pages, 225 KB

Open AccessArticle

Table Tennis for Health: A Multidimensional Perspective on Its Physical, Emotional, and Social Advantages

by Pilar Aparicio-Chueca and Noa Muñoz-Vila

Healthcare 2025, 13(18), 2352; https://doi.org/10.3390/healthcare13182352 - 18 Sep 2025

Abstract

Background/Objectives: Table tennis is commonly perceived as a recreational or competitive sport; however, growing evidence highlights its potential as a multidimensional tool for health promotion. This study investigates the perceived physical, cognitive, emotional, and social benefits of regular table tennis practice, emphasizing [...] Read more.

Background/Objectives: Table tennis is commonly perceived as a recreational or competitive sport; however, growing evidence highlights its potential as a multidimensional tool for health promotion. This study investigates the perceived physical, cognitive, emotional, and social benefits of regular table tennis practice, emphasizing its contribution to health beyond the purely sporting dimension. Methods: A mixed-method design with a predominantly quantitative approach was employed. A structured questionnaire was administered to 329 table tennis players in Catalonia. Descriptive statistics, exploratory factor analysis (EFA), multiple linear regression, Pearson correlations, and hierarchical cluster analysis (Ward’s method) were conducted to examine perceived benefits and identify user profiles. Factor analysis revealed two dimensions: physical–cognitive and emotional–social benefits. Results: The EFA produced a robust two-factor structure, explaining 76.6% of the variance (KMO = 0.941; Bartlett’s test, p < 0.001). Both dimensions showed excellent internal consistency (Cronbach’s α > 0.91). Regression analysis demonstrated that both factors significantly predicted the overall perception of table tennis as a health-enhancing activity (R² = 0.199), with physical–cognitive benefits exerting the strongest effect (β = 0.375; p < 0.001). Cluster analysis identified three distinct profiles: Skeptical, Functional, and Integrative—with significant differences in perceived benefits (η² = 0.710 for the emotional–social factor). Conclusions: Table tennis emerges as an inclusive, low-impact activity with strong potential to foster physical, emotional, and social well-being. Its accessibility and adaptability make it appropriate for diverse populations. These findings support its inclusion in public health strategies and community programs promoting holistic wellness. Future research should further explore motivational drivers across profiles and extend analyses to underrepresented populations. Full article

(This article belongs to the Special Issue Future Trends of Physical Activity in Health Promotion)

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