Healthcare

16 pages, 1253 KB

Open AccessArticle

Co-Designing a Web-Based, Gamified, Auditory–Cognitive Dual-Task Training System for Older Adults with Hearing Loss

by Ivy Yan Zhao, Tsz Wai Lau, Chen Li, Janet Ho-Yee Ng, Eleanor Holroyd, Robert Sweetow, Engle Angela Chan and Angela Y. M. Leung

Healthcare 2025, 13(22), 2926; https://doi.org/10.3390/healthcare13222926 (registering DOI) - 15 Nov 2025

Abstract

Background: Age-related hearing loss (ARHL) is associated with decreased communication, reduced social engagement, cognitive decline and an increased risk of dementia globally. Although increasing studies report the benefits of combing auditory and cognitive training for older adults with ARHL, more evidence is needed [...] Read more.

Background: Age-related hearing loss (ARHL) is associated with decreased communication, reduced social engagement, cognitive decline and an increased risk of dementia globally. Although increasing studies report the benefits of combing auditory and cognitive training for older adults with ARHL, more evidence is needed to examine its effects. Moreover, existing training programs have been developed with minimal end-user involvement leading to low adherence rates. This study aimed to investigate the role of co-design in the development of an auditory–cognitive training system for older adults with ARHL. Methods: A co-design methodology was employed. Digital recordings of the co-design workshops were transcribed verbatim. An established reflexive thematic analysis methodology was used. Results: Fifteen older adults with ARHL, referred to as “co-researchers”, participated in three co-design workshops until data saturation was achieved. Consultations were held with two key service providers. Three key themes emerged: (1) older adults with ARHL prefer a user-friendly auditory–cognitive training system; (2) clear, localized and colloquial instructions for the training tasks are necessary; and (3) diversified, tailor-made and dual-task training tasks, performed in an interactive and game-like mode, can motivate and sustain usage of the training system. As a result, a prototype of a web-based, gamified, and adaptive auditory–cognitive dual-task training system was co-designed. Conclusions: Our findings affirmed the importance of genuinely listening to the voices of end-users and creating a system that is responsive to their needs and preferences. Future study is recommended to examine the effects of this system on older adults with ARHL. Full article

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12 pages, 315 KB

Open AccessArticle

The Questions, Challenges, and Possibilities When Joining Critical Disabilities Studies and Healthcare Research

by Madelyn Toman, Meredith Atanasio and Pamela B. Teaster

Healthcare 2025, 13(22), 2925; https://doi.org/10.3390/healthcare13222925 (registering DOI) - 15 Nov 2025

Abstract

Background/Objectives: Interdisciplinary research teams that include critical disability studies (CDS) scholars and Healthcare and Medical Researchers have the potential to investigate complex lived experiences and explore new opportunities to best serve disabled communities. However, individuals in these fields typically approach disability research in [...] Read more.

Background/Objectives: Interdisciplinary research teams that include critical disability studies (CDS) scholars and Healthcare and Medical Researchers have the potential to investigate complex lived experiences and explore new opportunities to best serve disabled communities. However, individuals in these fields typically approach disability research in different ways. Throughout this manuscript, we refer to a hypothetical interdisciplinary research team as an example of how to integrate the questions, challenges, and possibilities into practice when joining CDS and Healthcare and Medical Research. Discussion: First, we raise three large and complex questions that researchers must address (and discuss) when conducting disability research: (a) what is (a) disability, (b) what does it mean to live with a disability, and (c) who is included in research samples/as research participants for disability research? Then, we discuss the colliding and harmful relationship history between CDS and Healthcare and Medical Research fields, and the continued oppositional training of professionals in both fields. Finally, we offer insights into how collaborative efforts and methods of interdisciplinary research teams can optimize success when tackling complex research questions to serve disabled communities. Conclusions: We suggest approaches for projects at the intersection of CDS and Healthcare and Medical Research: holistic, person-centered research, treating individuals in the disability community as experts, and collaborating with the community while conducting research. This manuscript serves as a starting point for researcher teams looking to conduct ethical, rigorous, and trustworthy research at the intersection of health, medicine, and disability. Full article

(This article belongs to the Special Issue Disability Studies and Disability Evaluation)

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14 pages, 502 KB

Open AccessArticle

“It Can Hurt Your Heart”: A Co-Designed Cross-Sectional Survey Exploring Pacific People’s Understanding of Rheumatic Fever in Auckland, New Zealand

by Siobhan Tu’akoi, Malakai ‘Ofanoa, Samuela ‘Ofanoa, Melenaite Tohi, Maryann Heather, Hinamaha Lutui, Rose Lamont, Elizabeth Fanueli and Felicity Goodyear-Smith

Healthcare 2025, 13(22), 2924; https://doi.org/10.3390/healthcare13222924 (registering DOI) - 15 Nov 2025

Abstract

Background/Objectives: Rheumatic fever is preventable and can be treated successfully; however, a lack of understanding of the disease and barriers to timely healthcare can impact outcomes. Pacific people in Aotearoa New Zealand experience inequitable burdens, and a Pacific community group and health [...] Read more.

Background/Objectives: Rheumatic fever is preventable and can be treated successfully; however, a lack of understanding of the disease and barriers to timely healthcare can impact outcomes. Pacific people in Aotearoa New Zealand experience inequitable burdens, and a Pacific community group and health professional network are working together to co-design education initiatives. This descriptive, mixed-methods study aimed to (1) explore Pacific people’s awareness and understanding of rheumatic fever, (2) describe where Pacific people access health information. Methods: An online survey co-developed with Pacific community members was run from December 2024 to February 2025. Questions related to sore throats, rheumatic fever, medication adherence, long-term outcomes and where Pacific people access health information. Quantitative data was analyzed descriptively using SPSS version 28 and open-ended qualitative responses were analyzed using an inductive content analysis approach. Results: A total of 400 Pacific respondents were included: 34% were aged 16–24 years and 66% were female. Based on the analysis, 71% of Pacific participants knew that a sore throat should always be checked by a health professional and 65.3% had heard of rheumatic fever. Fever and sore throats were commonly identified as symptoms of rheumatic fever, with joint pain, body aches and chest pain mentioned less. Barriers to health services such as cost, long waiting times and cultural factors were discussed as reasons why many Pacific people often utilize social media and online forums for health information. Conclusions: This study highlights gaps in rheumatic fever knowledge and thus opportunities for health education initiatives for Pacific communities, potentially utilizing social media and online platforms. Full article

(This article belongs to the Special Issue Community-Based Strategies to Tackle Health Disparities and Promote Equity)

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9 pages, 468 KB

Open AccessReview

Nursing Patient Classification Systems to Assess Pediatric Patients’ Nursing Complexity: An Empty Narrative Literature Review

by Roberta Da Rin Della Mora, Silvia Rossi, Ilaria Artuso, Simona Calza, Roberta Tirone, Stefano Parodi, Giulia Ottonello, Nicoletta Dasso and Silvia Scelsi

Healthcare 2025, 13(22), 2923; https://doi.org/10.3390/healthcare13222923 (registering DOI) - 15 Nov 2025

Abstract

Background/Objectives: In recent years, some hospitals have shifted from traditional to intensity-of-care-based organizational models, where patients allocation is based on the care they require. In this context, Nursing Patient Classification Systems (NPCSs) can lead to the identification of the appropriate nursing care setting [...] Read more.

Background/Objectives: In recent years, some hospitals have shifted from traditional to intensity-of-care-based organizational models, where patients allocation is based on the care they require. In this context, Nursing Patient Classification Systems (NPCSs) can lead to the identification of the appropriate nursing care setting based on patient nursing needs; this also applies to pediatrics. In this scenario, the concept of patient nursing complexity has emerged. This narrative literature review aims to provide an overview on validated NPCSs that assess the nursing complexity of pediatric patients. Methods: PubMed, CINAHL, and the Cochrane Library were searched, and inclusion and exclusion criteria were applied to the retrieved papers. Two authors independently screened n = 498 papers, of which n = 7 were read in full and subsequently excluded. Results: No paper met the inclusion criteria. However, papers read in full were analyzed, and their main characteristics were described. They were excluded because they did not concern validated NPCSs that assess pediatric patients’ nursing complexity or did not assess pediatric patients’ nursing complexity as defined in this literature review. Conclusions: This narrative literature review highlighted a critical gap in the field of validated NPCSs that assess the nursing complexity of pediatric patients. The lack of a shared definition of “nursing complexity of the patient” is the primary barrier identified. This constitutes a crucial take-home message. Therefore, future studies should prioritize in-depth exploration of the differences among all the published definitions and concepts related to “complexity” and harmonizing existing conceptual analysis to guide future research and the development of shared NPCSs. Full article

(This article belongs to the Special Issue From Evidence-Based Practice to Knowledge Translation in Nursing Care)

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15 pages, 560 KB

Open AccessReview

Semaglutide in Diabetic Kidney Disease: Integrating Clinical Evidence with Mechanistic Insights

by Faten F. Bin Dayel

Healthcare 2025, 13(22), 2922; https://doi.org/10.3390/healthcare13222922 - 14 Nov 2025

Abstract

Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), has demonstrated substantial efficacy in managing type 2 diabetes mellitus (T2DM). It provides glycemic control, promotes weight loss, and offers cardiovascular protection. Evidence also supports its role in diabetic kidney disease (DKD), a leading global cause [...] Read more.

Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), has demonstrated substantial efficacy in managing type 2 diabetes mellitus (T2DM). It provides glycemic control, promotes weight loss, and offers cardiovascular protection. Evidence also supports its role in diabetic kidney disease (DKD), a leading global cause of end-stage renal disease. DKD arises from a multifactorial interaction involving hyperglycemia, hypertension, and inflammation, which leads to cumulative nephron loss. Beyond glycemic control, semaglutide’s mechanisms of action target metabolic and hemodynamic pathways that contribute to renal damage. This review evaluates the preclinical and clinical evidence of semaglutide’s role in preventing DKD, focusing on its renal effects and the mechanistic basis for renoprotection. We also position semaglutide within the broader DKD therapeutic landscape by reviewing clinical trial findings, translational studies, real-world evidence, and its effectiveness compared to other drug classes. The expanded actions of semaglutide make it a promising agent in patients with T2DM and DKD and encourage further mechanistic research and long-term evaluation. Full article

20 pages, 891 KB

Open AccessArticle

Pharmacovigilance Signal Detection of Drug-Induced Hospitalizations and Mortality: A 5-Year Nationwide Study

by Jeongah Min, Jeong Eon Lee, Eunah Cho, Jayoung Im and Yeo Jin Choi

Healthcare 2025, 13(22), 2921; https://doi.org/10.3390/healthcare13222921 - 14 Nov 2025

Abstract

Background/Objectives: This study aimed to comprehensively characterize the prevalence and patterns of drug-induced hospitalizations and death and to identify predictors strongly associated with drug-induced death. Methods: This study analyzed 29,438 serious adverse event (SAE) reports submitted to the Korea Adverse Event Reporting System [...] Read more.

Background/Objectives: This study aimed to comprehensively characterize the prevalence and patterns of drug-induced hospitalizations and death and to identify predictors strongly associated with drug-induced death. Methods: This study analyzed 29,438 serious adverse event (SAE) reports submitted to the Korea Adverse Event Reporting System (KIDS KAERS DB) database between January 2019 and December 2023. Disproportionality analysis was conducted to detect drug–event associations, and multiple logistic regression was performed to identify independent predictors of mortality. Results: Mortality accounted for 7.53% (n = 2217) and hospitalization for 93.53% (n = 27,532). The strong signals for drug-induced death were observed with steroids (ROR 3.81, 95% CI 3.39–4.27), antidotes (ROR 3.65, 95% CI 2.15–6.18), and anticoagulants (ROR 2.01, 95% CI 1.73–2.34). Immunosuppressants (ROR 9.17, 95% CI 4.75–17.70), diuretics (ROR 3.83, 95% CI 1.42–10.31), and antihyperlipidemics (ROR 3.65, 95% CI 1.72-7.69) were strongly associated with hospitalizations. In multivariate regression, men, aging (OR 1.02, 95% CI 1.02–1.03), use of antidotes (OR 11.37, 95% CI 6.59–19.62), steroids (OR 5.78, 95% CI 4.71–7.08), and anticoagulants (OR 3.60, 95% CI 2.90–4.46) were independent predictors of drug-induced mortality. Conclusions: This study emphasizes the need for targeted surveillance and risk-mitigation strategies focusing on anticoagulants, steroids and immunosuppressants, particularly among elderly and multimorbid populations. Full article

16 pages, 895 KB

Open AccessSystematic Review

Clinical Efficacy of Different Therapies for Painful Shoulder Conditions: A Network Meta-Analysis of Randomized Controlled Trials

by Kuan-Han Chen, Sih-Yu Guo, Hung-Cheng Chen and Chiu-Yueh Yang

Healthcare 2025, 13(22), 2920; https://doi.org/10.3390/healthcare13222920 - 14 Nov 2025

Abstract

Objective: This study aimed to evaluate, through a network meta-analysis, the short- and long-term efficacy of both Western medical therapies and traditional Chinese medical therapy (acupuncture) in improving symptoms of shoulder pain. Methods: A comprehensive computer-based search was conducted in Embase, Cochrane Library, [...] Read more.

Objective: This study aimed to evaluate, through a network meta-analysis, the short- and long-term efficacy of both Western medical therapies and traditional Chinese medical therapy (acupuncture) in improving symptoms of shoulder pain. Methods: A comprehensive computer-based search was conducted in Embase, Cochrane Library, Web of Science, and PubMed databases for randomized controlled trials (RCTs) related to Western and Chinese medical treatments for shoulder pain measured by visual analogue scale (VAS) scores. All researchers independently screened and selected studies, extracted data, and assessed the risk of bias. Studies that met quality standards were analyzed using Stata 16.0 and Review Manager 5.4 software. Results: A total of 269 articles were retrieved, and 15 were ultimately included in the network meta-analysis, covering nine types of Western and Chinese medical therapies. The total sample size was 1114 cases, with 557 in an experimental group and 557 in a control group. In terms of reducing VAS scores at 4 weeks after treatment, sham acupuncture was significantly less effective than acupuncture (MD: 19.39; 95% CI: 0.66–38.12), indicating that acupuncture had a better short-term effect on pain relief at 4 weeks. In terms of reducing VAS scores at 12 weeks after treatment, sodium hyaluronate (hyaluronate) was more effective than physical therapy (PT) in reducing long-term pain (MD: −19.57; 95% CI: −37.23–−1.90); suprascapular nerve block (SSNB) (MD: −9.11; 95% CI: −16.02–−2.20) and arthroscopic capsular release (MD: −16.07; 95% CI: −30.16–−1.97) were also more effective than PT. The top three treatments in terms of clinical efficacy for painful shoulder conditions were hyaluronate, SSNB, and arthroscopic capsular release. Conclusions: For the treatment of shoulder pain, hyaluronate, SSNB, and arthroscopic capsular release showed greater potential long-term efficacy in pain reduction than PT, with hyaluronate showing the best effect. Full article

15 pages, 331 KB

Open AccessArticle

Relationship Between Quality of Life and Sports Performance Among Athletes with Disabilities: A Focus on Individual Sports

by Fatemeh Ahmadi, Mohammad Mehdi Khaleghi, Abdosaleh Zar, Josyula Tejaswi, Karuppasamy Govindasamy, Viorel Petru Ardelean, Vasile Emil Ursu and Vlad Adrian Geantă

Healthcare 2025, 13(22), 2919; https://doi.org/10.3390/healthcare13222919 - 14 Nov 2025

Abstract

Background/Objectives: Physical activity and sports participation are widely recognized as effective strategies for enhancing quality of life (QoL) in individuals with disabilities. This study aimed to examine the relationship between QoL and athletic performance among male and female athletes with physical disabilities [...] Read more.

Background/Objectives: Physical activity and sports participation are widely recognized as effective strategies for enhancing quality of life (QoL) in individuals with disabilities. This study aimed to examine the relationship between QoL and athletic performance among male and female athletes with physical disabilities who participate in individual sports. Methods: This descriptive–correlational study involved 338 Iranian athletes with physical disabilities competing at various levels of competition. QoL was measured using the SF-36 questionnaire, and sports performance was assessed based on official competition records. Data were analyzed using SPSS v21, applying descriptive statistics and Pearson correlations. Results: Both male and female athletes reported high levels of overall QoL. No statistically significant differences were found between genders in terms of physical health, psychological well-being, or total QoL scores (p > 0.05). Furthermore, there were no significant correlations between QoL and sports performance at the provincial, national, or international levels (p > 0.05). Conclusions: The findings indicate that athletes with physical disabilities report relatively high levels of QoL, irrespective of their competitive achievements or medal standings. Although no statistically significant correlations were observed, participation in individual sports may be linked to better physical functioning and psychological resilience. These associations should be interpreted with caution and do not imply causality. Nonetheless, encouraging such participation could be beneficial in supporting various dimensions of health and promoting social inclusion among individuals with disabilities. Full article

(This article belongs to the Special Issue Active and Included: People with Disabilities in Sport, Physical Activity and Physical Education)

18 pages, 1147 KB

Open AccessArticle

Validity of Online Patient Medication Reviews and Ratings (PMRRs) for Treatment Satisfaction with Medication Therapy Among Older Adults with Antihypertensive Medications

by Dong Han Kim, Taehyun Yang, Youran Noh and Song Hee Hong

Healthcare 2025, 13(22), 2918; https://doi.org/10.3390/healthcare13222918 - 14 Nov 2025

Abstract

Background/objective: Online platforms for sharing prescription drug experiences are becoming increasingly available, yet their validity as measures of patient satisfaction remains unclear. This study aimed to evaluate the potential of an online drug review system, WePharm, as a proxy for treatment satisfaction [...] Read more.

Background/objective: Online platforms for sharing prescription drug experiences are becoming increasingly available, yet their validity as measures of patient satisfaction remains unclear. This study aimed to evaluate the potential of an online drug review system, WePharm, as a proxy for treatment satisfaction among older adults taking antihypertensive medications. Methods: A cross-sectional survey using a convenience sample was conducted from February to July 2018 among patients aged 50–80 years recruited from four senior welfare centers and one community pharmacy in Seoul. Participants completed both an online review via WePharm and a paper-based Treatment Satisfaction Questionnaire for Medication (TSQM). Satisfaction attributes included drug efficacy, side effects, convenience, affordability, and willingness to recommend. Pearson correlation coefficients and ANOVA were used to examine concordance and associated factors. Results: A total of 313 participants were included. Online review scores were significantly correlated with TSQM scores across all domains as follows: effectiveness (r = 0.451), side effects (r = 0.363), convenience (r = 0.285), and overall satisfaction (r = 0.256), all p < 0.0001. Key factors associated with satisfaction included region, stage of hypertension, income, duration of antihypertensive use, and comorbidity count. Conclusions: Online patient medication reviews, as implemented in WePharm, demonstrated moderate correlation with validated treatment satisfaction measures. These findings support the potential utility of online drug review systems as complementary tools for capturing real-world patient experience and informing shared decision-making in clinical practice, and as these findings were from a convenience sample, further research is expected with the aim of improving generalizability. Full article

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20 pages, 851 KB

Open AccessArticle

Development and Psychometric Validation of the Health Professionals’ Job Satisfaction Scale

by Ana Lúcia João, Paula Chaves, Ana Prata Massano, Fátima Diogo, Rita Paulos, António Portelada and João Alves

Healthcare 2025, 13(22), 2917; https://doi.org/10.3390/healthcare13222917 - 14 Nov 2025

Abstract

Background/Objective: Job satisfaction is a key determinant of healthcare professionals’ well-being, quality of care, and organisational performance. In Portugal, although validated tools exist for nurses, there is no comprehensive instrument for different professional groups. This study aimed to develop and validate the [...] Read more.

Background/Objective: Job satisfaction is a key determinant of healthcare professionals’ well-being, quality of care, and organisational performance. In Portugal, although validated tools exist for nurses, there is no comprehensive instrument for different professional groups. This study aimed to develop and validate the Health Professionals’ Job Satisfaction Scale (ESPST—Escala de Satisfação dos Profissionais de Saúde no Trabalho), designed to assess job satisfaction across diverse healthcare categories. Methods: A quantitative, descriptive, cross-sectional study was conducted with 549 professionals from a Portuguese hospital. The ESPST was developed from literature review and expert focus groups, comprising 50 Likert-scale items. Construct validity was examined using exploratory factor analysis (EFA), and reliability was assessed via Cronbach’s alpha. Results: The EFA revealed an eight-factor structure, explaining 70.3% of total variance. The KMO value was 0.963, and Bartlett’s test of sphericity was significant (p < 0.001). The factors were: leadership and management, nature of work, colleagues, recognition by service users, career progression, human resources, institutional protocols, and peer recognition. Cronbach’s alpha was 0.973 for the total scale, with subscales above 0.84, indicating excellent reliability. Conclusions: The ESPST is a valid and reliable instrument for assessing job satisfaction among healthcare professionals across different categories. Its multidimensional scope allows clinical and research applications, supporting organisational strategies to improve professional well-being and quality of care. Future studies should include confirmatory analyses to strengthen its psychometric robustness. Full article

16 pages, 320 KB

Open AccessArticle

by Alejandro Oliva-Muñoz, Manuel Fernández-Alcántara, Nicolás Ruiz-Robledillo, Borja García-Sousa, Hortensia Ballester-Galiana and Silvia Delgado-García

Healthcare 2025, 13(22), 2916; https://doi.org/10.3390/healthcare13222916 - 14 Nov 2025

Abstract

Background/Objectives: Breast cancer is the most common cancer among Spanish women. Carriers of certain genetic variants are at increased risk, which can significantly impact their quality of life. The main objective of the present research was to describe the health-related quality of [...] Read more.

Background/Objectives: Breast cancer is the most common cancer among Spanish women. Carriers of certain genetic variants are at increased risk, which can significantly impact their quality of life. The main objective of the present research was to describe the health-related quality of life in women with breast cancer-associated genetic risk variants, distinguishing between those who had already developed cancer and those who did not. Additionally, we aimed to identify the variables influencing the decision to undergo risk-reducing surgery. Methods: Descriptive using the questionnaires BREAST-Q, SF-12 and DASS-21. Results: A total of 63 women participated, with a mean age of 43.38 years. In the 38.1% the genetic variant was identified during the diagnosis of breast cancer, while the rest did not have cancer. We found significantly lower scores for women with breast cancer in the BREAST-Q modules Satisfaction with breasts (p = 0.035) and Physical well-being: chest (p = 0.007), as well as in the physical component of SF-12 questionnaire (p = 0.005). Anxiety scores with DASS-21 were significantly higher in breast cancer patients (p = 0.017). A total of 55.6% of the patients decided to undergo bilateral prophylactic mastectomy, while 60.31% bilateral adnexectomy. These rates were significantly higher in breast cancer patients (p = 0.003), older women (p = 0.001), those with at least one child (p = 0.002) and those who were already menopausal (p = 0.0021). Women who underwent bilateral prophylactic mastectomy reported significantly lower scores in the BREAST-Q modules Satisfaction with breasts (p = 0.033) and Physical well-being: chest (p = 0.025), compared to the ones who decided to undergo a follow-up. Conclusions: Health-related quality of life is significantly lower in women with pathogenic genetic variants who have developed breast cancer. This may contribute to a higher rate of risk-reducing surgeries in this group. Full article

(This article belongs to the Special Issue Mental Health and Health Care in Vulnerable Contexts)

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18 pages, 605 KB

Open AccessArticle

Exploring the Relationship Between Conspiracy Theory Beliefs and Adherence to Government Guidelines During the COVID-19 Pandemic: The Role of Perceived Control and Trust in Social Media and Traditional Sources of Information

by Maria Stella Epifanio, Vittoria Spicuzza, Martina Riolo, Emanuele Cusumano, Marco Andrea Piombo and Sabina La Grutta

Healthcare 2025, 13(22), 2915; https://doi.org/10.3390/healthcare13222915 - 14 Nov 2025

Abstract

Background: The COVID-19 pandemic, declared to be over by the World Health Organization (WHO) on May 5, 2023, significantly impacted global physical, mental, economic, social, and political conditions. Since the onset of the pandemic, conspiracy theories have surged globally, facilitated by the [...] Read more.

Background: The COVID-19 pandemic, declared to be over by the World Health Organization (WHO) on May 5, 2023, significantly impacted global physical, mental, economic, social, and political conditions. Since the onset of the pandemic, conspiracy theories have surged globally, facilitated by the Internet and social media. Conspiracy thinking is associated with mistrust in traditional sources of information, such as newspapers and news/TV programs, and lower adherence to public health guidance. However, there is limited understanding of how these beliefs are reflected in specific health-related behaviors and the mediating variables involved. Objective: The study aims to analyze the relationship between the belief in conspiracy theories, perceived personal control, and psychological well-being during the COVID-19 pandemic in Italy to understand how belief in conspiracy theories may contribute to less adherence to government guidelines and the role of factors such as personal control, trust in social media, and traditional sources of information in this relationship. Methods: In total, 437 Italian adults (296 women, 140 men, 1 non-binary; M_age = 31.41, SD = 13.32) completed measures of well-being, perceived control, use/trust of traditional vs. social-media sources, conspiracy beliefs, and adherence. Results: Well-being correlated positively with perceived control and social-media trust. Perceived control correlated positively with social-media trust and negatively with traditional-source trust. Adherence correlated positively with traditional-source trust and negatively with all conspiracy measures. Mediation showed an indirect effect of conspiracy beliefs on lower adherence only via reduced trust in traditional sources. In contrast, no indirect effects were found via social-media trust or perceived control. Conclusion: Conspiracy beliefs undermine adherence primarily by eroding trust in traditional information. Risk communication should rebuild institutional trust and tailor messaging across both social and traditional channels, taking into account psychological factors. Full article

(This article belongs to the Special Issue Misinformation: A Major Threat to Public Health, Healthcare Services, and Patient Outcomes)

15 pages, 1032 KB

Open AccessArticle

Effect of Motion-Controlled Video Games-Based Virtual Reality Exercise on Patients with Post-COVID-19 Condition: A Randomized Controlled Trial

by Musa Polat, Pınar Oba and Ahmet Karadağ

Healthcare 2025, 13(22), 2914; https://doi.org/10.3390/healthcare13222914 - 14 Nov 2025

Abstract

Objective: Virtual reality (VR) exercises may offer a comprehensive rehabilitation approach for many conditions. This study primarily aimed to evaluate the effectiveness of VR exercises compared with conventional exercise in reducing pain intensity in individuals with post-COVID-19 condition (PCC). Secondary analyses explored [...] Read more.

Objective: Virtual reality (VR) exercises may offer a comprehensive rehabilitation approach for many conditions. This study primarily aimed to evaluate the effectiveness of VR exercises compared with conventional exercise in reducing pain intensity in individuals with post-COVID-19 condition (PCC). Secondary analyses explored their effects on fatigue, functional capacity, mood, and quality of life. Materials and Methods: A single-center, randomized, assessor-blinded intervention study was conducted with 79 individuals between July 2021 and February 2022. The primary outcome was pain intensity measured using the Visual Analog Scale (VAS). Secondary outcomes included mood (Hospital Anxiety and Depression Scale, HADS), fatigue (Fatigue Severity Scale, FSS), quality of life (SF-12), and functional exercise capacity (6-Minute Walk Test, 6 MWT). Participants completed supervised exercise sessions 3 times weekly for 30–45 min over 8 weeks. The conventional exercise program involved moderate-intensity aerobic, strength, stretching, and neuromuscular exercises. VR exercises were delivered semi-immersively using motion-controlled video games. Time × group interactions were analyzed using linear mixed-effects model. Results: In both groups, 6MWT, SF-12 physical and mental components increased, while VAS, FSS and HADS anxiety and depression scores decreased. Time-group interaction was observed in favor of VRG for VAS [F(1, 59.4) = 56.3, p = 0.001], as well as HADS-D [F(1, 54.6) = 7.40, p = 0.008] and FSS [F(1, 61.4) = 8.96, p = 0.004]. Conclusions: While structured exercise improves the physical and psychological conditions of individuals with PCC, virtual reality exercises stand out in pain, also fatigue, and depression. Full article

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

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9 pages, 227 KB

Open AccessArticle

Dementia Is Associated with In-Hospital Mortality and Prolonged Length of Stay: A Propensity Score Matched Analysis on Administrative Data

by Giuseppe Di Martino, Pamela Di Giovanni, Federica Vaccaro, Livia Tognaccini, Edoardo Trebbi, Teresa Aita, Ferdinando Romano and Tommaso Staniscia

Healthcare 2025, 13(22), 2913; https://doi.org/10.3390/healthcare13222913 - 14 Nov 2025

Abstract

Background/Objectives: To investigate the relationship between dementia and hospital outcomes (in-hospital mortality and prolonged length of stay). Methods: A retrospective study was conducted considering all hospital admissions performed between 1st January 2018 and 31st December 2023 in the Abruzzo region, Italy. [...] Read more.

Background/Objectives: To investigate the relationship between dementia and hospital outcomes (in-hospital mortality and prolonged length of stay). Methods: A retrospective study was conducted considering all hospital admissions performed between 1st January 2018 and 31st December 2023 in the Abruzzo region, Italy. The study was conducted on a large sample including all elderly patients admitted to hospital in a Southern Italian region during a six year period. To compare outcomes between patients with and without dementia, a propensity score matching procedure was performed using a multivariable logistic model adjusted for age and gender and comorbidities. Odds ratios for primary and secondary outcomes were computed using logistic regression models. Results: After the matching procedure, 25,476 patients were included in the analyses: 12,738 with dementia and 12,738 controls. Logistic regression models showed that dementia was associated with in-hospital mortality (OR: 2.02; 95% CI 1.91–2.18; p < 0.001) and prolonged length of stay (OR: 1.44; 95% CI 1.29–1.58; p < 0.001). Conclusions: In a large cohort of Italian patients, dementia was associated with in-hospital mortality and prolonged length of stay. Full article

(This article belongs to the Topic Health Services Optimization, Improvement, and Management: Worldwide Experiences)

14 pages, 228 KB

Open AccessArticle

Professional Involvement in Health Policy Development: A Cross-Sectional Study on Nurse Managers in Saudi Arabia

by Ahmad E. Aboshaiqah, Ahmed S. Alsadoun, Ahmad M. Rayani and Regie Buenafe Tumala

Healthcare 2025, 13(22), 2912; https://doi.org/10.3390/healthcare13222912 - 14 Nov 2025

Abstract

Background/Objective: Despite the vital role of nurses in health policy development, their involvement and influence in such development remain challenging. The involvement of nurse managers in health policy development in the Kingdom of Saudi Arabia (KSA) is not well examined. This study examined [...] Read more.

Background/Objective: Despite the vital role of nurses in health policy development, their involvement and influence in such development remain challenging. The involvement of nurse managers in health policy development in the Kingdom of Saudi Arabia (KSA) is not well examined. This study examined the extent of involvement of nurse managers in health policy development in the KSA and identified related barriers, benefits, confidence, and perceived impacts. Methods: A descriptive correlational cross-sectional design was used to achieve the study aim and objectives. An electronic self-administered questionnaire (Registered Nurses Involvement in Health Policy) was distributed to nurse managers working in the KSA. A total convenience sample of 238 nurse managers willingly and voluntarily agreed to participate. Data were collected from 10 February 2022 to 30 April 2022. Descriptive statistics and the Spearman rho correlation coefficient were used to analyze the data. Results: Among 238 nurse managers surveyed, 58% had received policy-related training, 73% reported high involvement as professionals, and 43% rated their confidence as high. Findings show the high level of involvement in health policy development of the nurse managers and their increased interest in influencing health policies. The policy activity most frequently chosen by the nurse managers is “provided health policy-related information to consumers or other professionals.” Moreover, the participants reported “lack of time, support, and resources” as their most perceived barrier and “improving public health” as their most perceived benefit. The majority of the nurse managers reported receiving information or training on health policies, and more than half of the participants rated their skills as “very good” or “excellent.” Our findings show the participants’ moderate level of confidence in performing health policy activities and moderate level of their perceived impact of their involvement in health policy activities on health outcomes. The results indicate a positive relationship between health outcomes and the ability of the nurse managers to influence health policy activities. Conclusions: The study findings suggest that Saudi nurse managers are increasingly engaged in policy development, but greater institutional support and targeted training are needed to strengthen their policy impact. Full article

14 pages, 616 KB

Open AccessArticle

Oman Vision 2040: A Transformative Blueprint for a Leading Healthcare System with International Standards

by Mohammed Al Ghafari, Badar Al Alawi, Idris Aal Jumaa and Salah Al Awaidy

Healthcare 2025, 13(22), 2911; https://doi.org/10.3390/healthcare13222911 - 14 Nov 2025

Abstract

Background/Objectives: Oman Vision 2040, the national blueprint for socio-economic transformation, aims to elevate the Sultanate to developed nation status, with the “Health” priority committed to building a “Leading Healthcare System with International Standards” via a Health in All Policies (HiAP) approach. This paper [...] Read more.

Background/Objectives: Oman Vision 2040, the national blueprint for socio-economic transformation, aims to elevate the Sultanate to developed nation status, with the “Health” priority committed to building a “Leading Healthcare System with International Standards” via a Health in All Policies (HiAP) approach. This paper critically reviews Oman’s strategic health directions and implementation frameworks under Vision 2040, assessing their alignment with global Sustainable Development Goals (SDGs) and serving as a case model for health system transformation. Methods: This study employs a critical narrative synthesis based on a comprehensive literature search that included academic, official government reports, and international organization sources. The analysis is guided by the World Health Organization’s (WHO) Health Systems Framework, providing a structured interpretation of progress across its six building blocks. Results: Key interventions implemented include integrated governance (e.g., Committee for Managing and Regulating Healthcare), diversified health financing (e.g., public private partnership (PPPs), Health Endowment Foundation), and strategic digital transformation (e.g., Al-Shifa system, AI diagnostics). Performance metrics show progress, with a rise in the Legatum Prosperity Index ranking and an increase in the Community Satisfaction Rate. However, critical challenges persist, including resistance to change during governance restructuring, cybersecurity risks from digital adoption, and system fragmentation that complicates a unified Non-Communicable Disease (NCD) response. Conclusions: Oman’s integrated approach, emphasizing decentralization, quality improvement, and investment in preventive health and human capital, positions it for sustained progress. The transformation offers generalizable insights. Successfully realizing Vision 2040 demands rigorous, evidence-informed policymaking to effectively address equity implications and optimize resource allocation. Full article

(This article belongs to the Special Issue Policy Interventions to Promote Health and Prevent Disease)

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17 pages, 325 KB

Open AccessSystematic Review

Healthcare Professionals’ Cultural Competence in Diabetes Care: A Systematic Review

by Monica Nikitara, Achonwa Esther Mba, Evangelos Latzourakis and Costas S. Constantinou

Healthcare 2025, 13(22), 2910; https://doi.org/10.3390/healthcare13222910 - 14 Nov 2025

Abstract

Background: Culturally diverse patients with diabetes often face barriers that contribute to poor outcomes. Providing culturally sensitive care requires awareness of how cultural beliefs influence management, yet no standard model of cultural competency exists, underscoring the need for further research. Aims: To evaluate [...] Read more.

Background: Culturally diverse patients with diabetes often face barriers that contribute to poor outcomes. Providing culturally sensitive care requires awareness of how cultural beliefs influence management, yet no standard model of cultural competency exists, underscoring the need for further research. Aims: To evaluate the level of cultural competence among healthcare professionals in caring for patients with diabetes, and to assess the impact of cultural competence training on their ability to deliver culturally sensitive, patient-centered care. Methodology: A systematic review was conducted of primary research articles published between 2015 and 2025 that examined the cultural competence of healthcare providers in diabetes care, described relevant training programs, and evaluated their impact. The databases searched included Medline, CINAHL, ProQuest, and the Nursing and Allied Health Database. Result: A total of 15 studies were included in the review. Seven assessed the cultural competence of diabetes care providers, reporting moderate to high levels of awareness and sensitivity but noting gaps in communication and cultural knowledge. Eight studies evaluated training interventions, all of which demonstrated improvements in provider attitudes and self-perceived competence. Some also reported better patient outcomes, particularly among high-risk groups. However, the long-term effects were inconsistent, and no single assessment tool proved universally effective. Conclusion: This systematic review suggests that the cultural competence of healthcare providers in diabetes care remains limited, although some evidence indicates that interventions can enhance competence. The findings may assist researchers in selecting appropriate measures to evaluate cultural competence in diabetes care. Full article

(This article belongs to the Special Issue Chronic Illness, Diversity, and Cultural Competence)

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9 pages, 642 KB

Open AccessArticle

Type-D Personality as a Predictor of Postoperative Pain, Recovery, and Clinical Outcomes After Spine Surgery: Implications for Chronic Pain Management

by Christian Riediger, Mark Ferl, Christoph H. Lohmann, Maria Schönrogge and Agnieszka Halm-Pozniak

Healthcare 2025, 13(22), 2909; https://doi.org/10.3390/healthcare13222909 - 14 Nov 2025

Abstract

Objectives: To investigate the association between Type-D personality and pain-related outcomes in patients undergoing spine surgery, and to discuss implications for the management of chronic pain conditions. Methods: A prospective cohort of 200 patients scheduled for elective spine surgery was assessed for Type-D [...] Read more.

Objectives: To investigate the association between Type-D personality and pain-related outcomes in patients undergoing spine surgery, and to discuss implications for the management of chronic pain conditions. Methods: A prospective cohort of 200 patients scheduled for elective spine surgery was assessed for Type-D personality using the DS14 scale. Postoperative outcomes including pain intensity (VAS), functional recovery (ODI), complication rates, and patient satisfaction (PSI) were measured preoperatively and at 3, 6, and 12 months. Multivariate regression analyses adjusted for age, sex, surgical approach, comorbidities, and baseline health status. Results: Type-D personality was identified in 30% of patients. These individuals reported significantly higher postoperative pain, slower functional recovery, higher complication rates, and lower overall satisfaction compared to non-Type-D patients. Compared with non-Type-D patients, Type-D patients reported higher pain and slower functional recovery at 12 months (VAS β = 0.34, 95% CI 0.18–0.52, p = 0.004, Cohen’s d = 0.61; ODI β = 0.31, 95% CI 0.12–0.48, p = 0.006, d = 0.58), and lower satisfaction (PSI β = −0.36, 95% CI −0.49 to −0.20, p < 0.001, d = 0.66). Conclusions: Type-D personality is associated with worse postoperative pain and recovery. Preoperative psychological assessment and tailored interventions may improve outcomes. These findings highlight the importance of integrating psychosocial screening into pain management strategies for both spine surgery and chronic pain populations. Full article

(This article belongs to the Special Issue Clinical Approaches to Characterization and Treatment of Cancer-Related Pain and Other Chronic Pain Conditions)

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12 pages, 625 KB

Open AccessArticle

Providing Compassionate Care: A Qualitative Study of Compassion Fatigue Among Midwives and Gynecologists

by Sarah Vandekerkhof, Laura Malisse, Stefanie Steegen, Florence D’haenens, Hanne Kindermans and Sarah Van Haeken

Healthcare 2025, 13(22), 2908; https://doi.org/10.3390/healthcare13222908 - 14 Nov 2025

Abstract

Background: Compassion fatigue (CF) is a state of emotional and physical exhaustion in the caregiving relationship, which can negatively impact patient safety and quality of care. Maternity care professionals are particularly vulnerable to CF due to their continuous empathetic engagement with patients [...] Read more.

Background: Compassion fatigue (CF) is a state of emotional and physical exhaustion in the caregiving relationship, which can negatively impact patient safety and quality of care. Maternity care professionals are particularly vulnerable to CF due to their continuous empathetic engagement with patients in an unpredictable, high-stress work environment. Despite its significance, research on CF in maternity care is limited. The aim of this study is to explore experiences of CF among maternity care professionals. Methods: A thematic analysis of semi-structured in-depth interviews was conducted. The sample consisted of seven midwives and three gynecologists from different hospitals and outpatient care in Flanders (Belgium). Results: Experiences, risk factors and protective factors were identified as three organizing themes and further refined into 12 subthemes. Participants showed limited familiarity with the term CF but recognized its symptoms, including emotional exhaustion, reduced empathy, and a diminished ability to provide care, ‘as one normally would’. Key risk factors included high workload, emotional strain from ‘energy-consuming’ patients, fear of errors, and administrative burden. A supportive team environment, compassion satisfaction (CS), job autonomy and personal coping skills were identified as protective factors. Participants emphasized the need to recognize and address signals of CF. Conclusions: CF among maternity care professionals is underrecognized but appears to impact both caregiver well-being and patient care quality. Interventions should target awareness, team communication, psychological safety, and organizational context. A multilevel approach—combining individual, team, and systemic strategies—is needed to sustainably mitigate CF in maternity care. Full article

(This article belongs to the Special Issue Depression, Anxiety and Emotional Problems Among Healthcare Workers)

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