Healthcare

17 pages, 314 KiB

Open AccessArticle

Can the Components of Physical Fitness Be Linked to Creative Thinking and Fluid Intelligence in Spanish Schoolchildren?

by Karina Elizabeth Andrade-Lara, Pedro Ángel Latorre Román, Eva Atero Mata, José Carlos Cabrera-Linares and Juan Antonio Párraga Montilla

Healthcare 2025, 13(14), 1682; https://doi.org/10.3390/healthcare13141682 (registering DOI) - 12 Jul 2025

Abstract

Objective: The aim of this study was to determine the relationship between the components of physical fitness (PF), creativity and fluid intelligence, as well as to determine which components of PF are predictors of the analysed cognitive potential. Material and Methods: A total [...] Read more.

Objective: The aim of this study was to determine the relationship between the components of physical fitness (PF), creativity and fluid intelligence, as well as to determine which components of PF are predictors of the analysed cognitive potential. Material and Methods: A total of 584 Spanish schoolchildren (6−11 years old; age = 8.62 ± 1.77 years) took part in this study. Creativity was assessed using the Torrance Tests of Creative Thinking (TTCT) and fluid intelligence through TEA-1. Moreover, PF components were evaluated using a 25 m sprint, handgrip strength, standing long jump and 20 m SRT. Results: Boys exhibited a better PF performance than girls (p range from = < 0.001 to 0.05), as well as higher creativity score (p < 0.001), the fluid intelligence score and QI score (p < 0.05, respectively). Moreover, PF components (CRF, strength and speed) were positively associated with creativity (p range from = < 0.001 to 0.001) and fluid intelligence (p range from = < 0.001 to 0.015). Regression analysis showed that the creativity model explained between 31.4% and 36.6% of the variance (R² = 0.314−0.366, p < 0.001), while the fluid intelligence model accounted for 25.5% to 33.1% of the variance (R² = 0.255−0.331, p < 0.001 to 0.001). Conclusions: A positive relationship was found between creativity, fluid intelligence, and PF components. Children with higher PF levels scored better in creativity, with notable differences between boys and girls. These findings highlight the educational value of incorporating structured physical activity into school settings to support both cognitive and physical development. Full article

(This article belongs to the Special Issue Promoting Children’s Health Through Movement Behavior)

15 pages, 463 KiB

Open AccessArticle

Impaired Quality of Life in Croatian IBD Patients in the Era of Advanced Treatment Options

by Alen Bišćanin, Leon Palac, Zdravko Dorosulić, Dominik Kralj, Petra Ćaćić, Filip Babić, Doris Ogresta, Davor Hrabar and Vedran Tomašić

Healthcare 2025, 13(14), 1681; https://doi.org/10.3390/healthcare13141681 (registering DOI) - 12 Jul 2025

Abstract

Background/Objectives: Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder marked by relapsing episodes of gastrointestinal inflammation, potentially causing severe symptoms. These unpredictable acute episodes, paired with chronic disabilities, such as fatigue and malabsorption, and extensive pharmacological and surgical treatments, can severely impact [...] Read more.

Background/Objectives: Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder marked by relapsing episodes of gastrointestinal inflammation, potentially causing severe symptoms. These unpredictable acute episodes, paired with chronic disabilities, such as fatigue and malabsorption, and extensive pharmacological and surgical treatments, can severely impact patients’ quality of life. This study aimed to assess which aspects of the patients’ lives IBD impacts, and how IBD patients perceive their disease. Methods: All IBD patients who had an appointment in our tertiary centre from 10 October 2022 to 21 February 2023, were invited to complete anonymous questionnaires. The questionnaires used were IBDQ-32, WPAI, and IBD Disk, all designed specifically to assess the IBD patients’ quality of life. Results: The questionnaires were completed by a total of 159 participants, 51% of whom were males, 47.9% who had UC, and 49.4% who had been or were currently treated with biologics. There was no statistically significant difference in the answers from patients with CD compared to UC, as well as those treated with conventional therapies compared to those with advanced options. Most of them considered their health to be good, but only a few (12.8%) claimed, with absolute certainty, that their health was at the level of healthy individuals, and only 13 (8.3%) claimed their health was excellent. A total of 95 (60.1%) participants expressed at least minor limitations when performing strenuous activities, but lighter forms of activities were not affected as much by the disease. A significant portion (48.7%) of the participants believed they were exposed to more stress than others, and their current pharmacological therapy was the cause of fear in 26.5%. A total of 119 (75.3%) participants believed that the disease affected their lives at least mildly during remission. Conclusions: Our study showed that IBD patients have diminished quality of life, not only in the periods of active disease but also during clinical remission. The decline in quality of life was not solely attributed to physical symptoms, as previously thought. Other factors, such as mental health issues, were found to impact quality of life as well. We firmly believe that restoring quality of life should be emphasised in guidelines as one of the most important therapeutic goals. Full article

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17 pages, 290 KiB

Open AccessArticle

Attitudes Toward Coercion Among Mental Healthcare Workers in Italy: A Cross-Sectional Study

by Calogero Gugliotta, Antonino Amato, Giuliano Anastasi, Teresa Rea, Roberto Latina, Pasquale Iozzo and Stefano Bambi

Healthcare 2025, 13(14), 1680; https://doi.org/10.3390/healthcare13141680 (registering DOI) - 12 Jul 2025

Abstract

Background/Objectives: Coercive measures remain a common practice in mental health, despite ethical concerns, potential risks, and uncertain efficacy. Mental healthcare workers’ (MHCWs) attitudes toward coercion can influence their use. However, research in Italy is limited. This study aimed to investigate Italian MHCWs’ [...] Read more.

Background/Objectives: Coercive measures remain a common practice in mental health, despite ethical concerns, potential risks, and uncertain efficacy. Mental healthcare workers’ (MHCWs) attitudes toward coercion can influence their use. However, research in Italy is limited. This study aimed to investigate Italian MHCWs’ attitudes toward coercion and their associations with sociodemographic and professional characteristics. Methods: A cross-sectional study was conducted on 356 MHCWs from a mental health department in Southern Italy. Participants completed the Staff Attitude to Coercion Scale (SACS), which assesses negative, pragmatic, and positive attitudes toward coercion. Descriptive statistics (i.e., frequencies, percentages, means) and bivariate analyses (i.e., one-way ANOVA) were used to explore the associations between variables. Results: The majority of participants were male (56.7%), nurses (50.3%), and worked in acute psychiatric settings (52%), with a mean age of 51.08 years (±10.59) and 13.74 years (±12.14) of experience in mental health. Attitudes differed significantly according to age, sex, professional role, and work setting. More negative attitudes were found among staff in residential settings and non-caring roles (p < 0.001). Pragmatic attitudes were lower among older staff (p = 0.012) and among those in residential settings and non-caring roles (p < 0.001). Positive attitudes were higher among males (p = 0.001), nursing staff (p < 0.001), and staff in acute settings (p = 0.049). Conclusions: Italian MHCWs reported different attitudes toward coercion, which was influenced by personal and professional factors. These findings highlight the need for targeted interventions and policy strategies to promote attitudinal change, particularly in settings where positive attitudes are prevalent. Full article

19 pages, 4761 KiB

Open AccessArticle

Physical Activity and Psychonutritional Correlates of Eating Disorder Risk in Female Health Science Students

by Patricia Ruiz-Bravo, Germán Díaz Ureña, Bárbara Rodríguez-Rodríguez, Nuria Mendoza Laiz and Sonia García-Merino

Healthcare 2025, 13(14), 1679; https://doi.org/10.3390/healthcare13141679 - 11 Jul 2025

Abstract

Objective: This study sought to examine the correlation between physical activity levels and various psychological and nutritional factors associated with the risk of developing eating disorders among female university students in the Health Sciences discipline. Method: The study assessed body image, self-esteem, nutritional [...] Read more.

Objective: This study sought to examine the correlation between physical activity levels and various psychological and nutritional factors associated with the risk of developing eating disorders among female university students in the Health Sciences discipline. Method: The study assessed body image, self-esteem, nutritional status, adherence to the Mediterranean diet, and attitudes toward food in a sample of 96 women, categorized into two groups based on their level of physical activity. Results: Significant differences in skeletal muscle mass were identified between the groups, alongside associations between body dissatisfaction, low self-esteem, and elevated EAT-26 scores. Furthermore, students with higher levels of physical activity exhibited a significantly increased prevalence of eating disorder risk. Logistic regression analysis identified body dissatisfaction as a significant predictor of eating disorder risk, while membership in the group with the highest physical activity levels enhanced model fit and increased eating disorder risk. Conclusions: These findings indicate that, while physical activity is associated with certain benefits related to body composition and eating habits, it may also be linked to a heightened risk of disordered eating behaviors, contingent upon the underlying motivations and body perceptions involved. This study highlights the necessity for comprehensive preventive strategies that address both the physical and psychological dimensions of physical activity in female university students. Full article

(This article belongs to the Special Issue The Relationship Between Physical Activity, Dietary Habits and Health Status)

17 pages, 488 KiB

Open AccessArticle

Pain Intensity and Health Service Utilization in United States Adults with Pain: A Cross-Sectional Database Analysis

by David R. Axon, Blair Jensen, Jordanne Koulong Kuemene, Mason Leech and Estabraq Mahmood

Healthcare 2025, 13(14), 1678; https://doi.org/10.3390/healthcare13141678 - 11 Jul 2025

Abstract

Background: Pain is a common, often debilitating ailment that may necessitate considerable health service utilization. However, there is a need to assess the associations of pain intensity and other variables with health service utilization among United States adults who have pain. Methods: This [...] Read more.

Background: Pain is a common, often debilitating ailment that may necessitate considerable health service utilization. However, there is a need to assess the associations of pain intensity and other variables with health service utilization among United States adults who have pain. Methods: This cross-sectional database analysis made use of the Medical Expenditure Panel Survey full-year consolidated data file and included United States adults (≥18 years) who have pain. The dependent variables consisted of four health service utilization variables, which included the number of emergency room visits, inpatient discharges, office visits, and outpatient visits in 2021. The number of visits or discharges were categorized as either ≥1 or 0. The independent variable was pain intensity (extreme, quite a bit, moderate, or little pain). Other variables analyzed included age, race, ethnicity, sex, marriage, education, employment, income, insurance, chronic conditions, limitations, exercise, smoking, physical health, and mental health. Chi-squared tests compared differences between pain intensity groups, and multivariable logistic regression models assessed the associations of pain intensity and other variables with each of the four health service utilization variables. The analysis was weighted for national estimates. The significance (alpha) level was 0.05. Results: This analysis included 6280 adults, representing 89,314,769 United States adults with pain. In the multivariable analyses, there were statistically significant associations for extreme pain (odds ratio = 1.72, 95% confidence interval = 1.27–2.33), quite a bit of pain (odds ratio = 1.75, 95% confidence interval=1.37–2.24), and moderate pain (odds ratio = 1.28, 95% confidence interval = 1.02–1.60) versus little pain with emergency room visits, extreme pain (odds ratio = 2.10, 95% confidence interval = 1.44–3.08) and quite a bit of pain (odds ratio = 1.66, 95% confidence interval = 1.21–2.28) versus little pain with inpatient discharges, and quite a bit of pain (odds ratio = 1.47, 95% confidence interval = 1.03–2.11) versus little pain with office visits. There was no correlation between pain intensity levels and outpatient visits. In addition, several other variables were associated with various health service utilization variables. Conclusions: This database analysis discovered greater pain intensity levels were often correlated with increased health service utilization, including more emergency room, inpatient, and office visits. These findings may inform the development of targeted interventions for people with specific characteristics. Further work is needed to implement initiatives that optimize health service utilization and ultimately improve health outcomes for United States adults who have pain. Full article

17 pages, 929 KiB

Open AccessArticle

Assessing an Outdoor Office Work Intervention: Exploring the Relevance of Measuring Frequency, Perceived Stress, Quality of Life and Connectedness to Nature

by Dorthe Djernis, Charlotte Petersson Troije, Victoria Linn Lygum, Peter Bentsen, Sidse Grangaard, Yun Ladegaard, Helle Haahr Nielsen, Katia Dupret and Christian Gaden Jensen

Healthcare 2025, 13(14), 1677; https://doi.org/10.3390/healthcare13141677 - 11 Jul 2025

Abstract

Background/Objectives: Outdoor office work (OOW) has been shown to promote health and well-being and to reduce stress. However, few empirical studies have examined research-based, simple approaches to implementing OOW. In preparation for a larger study, we conducted a feasibility study focusing on limited [...] Read more.

Background/Objectives: Outdoor office work (OOW) has been shown to promote health and well-being and to reduce stress. However, few empirical studies have examined research-based, simple approaches to implementing OOW. In preparation for a larger study, we conducted a feasibility study focusing on limited efficacy testing of potentially relevant outcomes for future OOW research. Methods: The simple Pop Out OOW programme consists of three workshops and access to online tutorials designed to support employees in transitioning relevant everyday office tasks outdoors. Before and after a 12-week intervention, employees from five small- and medium-sized Danish companies (N = 70) reported their weekly number of days including OOW, connectedness to nature (CNS and INS), Perceived Stress Scale (PSS), and well-being (WHO-5) scores. Results: At baseline, higher CNS scores were associated with a greater number of days including OOW per week (r = 0.25, p = 0.020). Following the intervention, participants reported a significant increase in the number of days per week with OOW (p < 0.01, d = 0.65). CNS scores also increased significantly (p = 0.019, d = 0.32). No significant changes were observed in stress or well-being scores across the entire sample. However, participants with PSS scores exceeding a national Danish criterion for high stress (n = 11) exhibited a significant and substantial reduction in perceived stress (p < 0.01, d = 1.00). Conclusions: Days including OOW, along with PSS and CNS scores, may serve as relevant outcome measures in future studies evaluating interventions aimed at promoting OOW. These outcomes should be assessed in larger and more diverse and controlled samples to establish generalisability. Full article

(This article belongs to the Special Issue Outdoor and Nature Therapy)

18 pages, 2569 KiB

Open AccessArticle

Enhancing Pediatric Outpatient Medical Services Through the Implementation of the Smart Well Child Center Application

by Naporn Uengarporn, Teerapat Saengthongpitag, Poonyanuch Chongjaroenjai, Atcha Pongpitakdamrong, Wutthipong Sriratthnarak, Phonpimon Rianteerasak, Kanyarat Mongkolkul, Paninun Srinuchasart, Panuwat Srichaisawat, Nicharee Mungklang, Raiwada Sanguantrakul, Pattama Tongdee, Wichulada Kiatmongkol, Boonyanulak Sihaklang, Piraporn Putrakul, Niwatchai Namvichaisirikul and Patrapon Saritshasombat

Healthcare 2025, 13(14), 1676; https://doi.org/10.3390/healthcare13141676 - 11 Jul 2025

Abstract

Background: Caregivers of children often encounter barriers when accessing pediatric healthcare services. These challenges highlight the need for digital innovations to improve accessibility and efficiency in pediatric outpatient care. Objectives: This study aimed to design, implement, and pilot evaluate the Smart Well Child [...] Read more.

Background: Caregivers of children often encounter barriers when accessing pediatric healthcare services. These challenges highlight the need for digital innovations to improve accessibility and efficiency in pediatric outpatient care. Objectives: This study aimed to design, implement, and pilot evaluate the Smart Well Child Center application in conjunction with enhancements to the Pediatric Outpatient Department. Methods: This study employs a mixed-methods research approach. The application was developed following the system development life cycle (SDLC) process, and its performance was subsequently evaluated. Additionally, its effectiveness in real-world settings was assessed through a satisfaction survey completed by 85 child caregivers. The results were summarized using the mean and standard deviation, and satisfaction levels were compared using paired t-test and repeated measures ANOVA. Results: The findings reveal that caregivers face significant challenges, including financial burdens related to travel, prolonged wait times, and difficulties accessing healthcare services. In response, the application was designed to incorporate key functionalities. Within the pre-consultation self-assessment module, caregivers can complete evaluations and receive recommendations directly through the application. Furthermore, the service procedure flowchart was restructured to seamlessly integrate these digital innovations, thereby enhancing the overall healthcare experience. The evaluation results indicate that the application achieved high performance ratings across all assessed dimensions (4.06 ± 0.77). Additionally, caregivers reported a substantial increase in satisfaction levels both immediately after implementation (4.58 ± 0.57) and one month afterward (4.59 ± 0.33). Conclusions: Given these findings, it is recommended that the hospital fully adopt the Smart Well Child Center application to improve healthcare accessibility and reduce patient wait times. Future research should assess the long-term impact of the intervention on both caregiver outcomes and healthcare professional workflow, satisfaction, and system usability, to inform broader implementation strategies. Full article

11 pages, 1159 KiB

Open AccessArticle

Pressure Ulcers and Nursing-Led Mobilization Protocols in ICU Patients: A Retrospective Observational Cohort Study

by Anna Korompeli, Eleni Karakike, Petros Galanis and Pavlos Myrianthefs

Healthcare 2025, 13(14), 1675; https://doi.org/10.3390/healthcare13141675 - 11 Jul 2025

Abstract

Background: Pressure ulcers (PUs) remain a prevalent complication in intensive care unit (ICU) settings, especially among immobilized patients. The impact of structured, nursing-led mobilization protocols on PU prevention and recovery remains underexplored. Objective: To evaluate the impact of nursing-led mobilization protocols on the [...] Read more.

Background: Pressure ulcers (PUs) remain a prevalent complication in intensive care unit (ICU) settings, especially among immobilized patients. The impact of structured, nursing-led mobilization protocols on PU prevention and recovery remains underexplored. Objective: To evaluate the impact of nursing-led mobilization protocols on the incidence and progression of PUs in critically ill patients. Methods: In this retrospective observational cohort study, 188 ICU patients were admitted during one of two consecutive periods of care: conventional care (6-hourly repositioning) and an advanced nursing-led protocol (3-hourly repositioning with support surfaces and specialized nurse training), which replaced conventional care as standard in our institution. The primary outcome included new PU development for patients with no pre-existing ulcers or worsening/non-progression of pre-existing ulcers at discharge; ICU mortality was evaluated as a secondary outcome. Results: Among patients without pre-existing ulcers (n = 155), new PU incidence did not significantly differ between groups, even after adjusting for SOFA score (OR 0.40, 95% CI: 0.05 TO 3.17; p = 0.374). However, in patients with pre-existing ulcers (n = 33), the advanced care group showed improvement (53.3% versus 0% in the conventional group, OR 0.07, 95% CI: 0.01–0.64; p = 0.012); this effect was independent of initial SOFA score. Mortality was associated with the SOFA score, but not with the type of care. Conclusions: While advanced nursing-led mobilization did not reduce PU incidence, it significantly improved existing ulcer outcomes. Findings support the integration of structured protocols for high-risk ICU patients, especially those with existing ulcers. Full article

(This article belongs to the Special Issue Nursing Care in the ICU—2nd Edition)

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16 pages, 610 KiB

Open AccessArticle

The Mediating Role of Active Coping Strategies in the Relationship Between Academic Stressors and Stress Responses Among University Students

by Cristina Ruiz-Camacho, Margarita Gozalo and Inmaculada Sánchez Casado

Healthcare 2025, 13(14), 1674; https://doi.org/10.3390/healthcare13141674 - 11 Jul 2025

Abstract

Background/Objectives: Academic stress is a major factor affecting university students’ psychological well-being and overall functioning. This study examined whether three active coping strategies—positive reappraisal, social support seeking, and strategic planning—mediate the relationship between academic stressors and self-reported stress responses. Methods: A [...] Read more.

Background/Objectives: Academic stress is a major factor affecting university students’ psychological well-being and overall functioning. This study examined whether three active coping strategies—positive reappraisal, social support seeking, and strategic planning—mediate the relationship between academic stressors and self-reported stress responses. Methods: A quantitative, cross-sectional, non-experimental design was employed. The sample comprised 1014 students from the University of Extremadura (M_age = 20.56, SD = 3.50). Three subscales of the Academic Stress Questionnaire (CEA) were administered: Academic Stressors (E-CEA), Stress Responses (R-CEA), and Coping Strategies (A-CEA). Descriptive statistics, correlation analyses, and a multiple mediation model using structural equation modeling (SEM) tested direct and indirect effects, controlling for gender, study year, and academic field. Results: (1) Academic stressors were inversely related to positive reappraisal (β = −0.34, p < 0.001), planning (β = −0.12, p < 0.001), and social support seeking (β = −0.09, p < 0.01). (2) All three coping strategies were significantly associated with fewer stress symptoms, with positive reappraisal showing the strongest effect (β = −0.13, p < 0.001), followed by social support seeking (β = −0.06, p < 0.05) and planning (β = −0.03, p < 0.05). (3) Stressors had a strong positive direct effect on stress responses (β = 0.54, p < 0.001). (4) Coping strategies partially mediated the stressor–symptom link (total indirect effect: β = 0.12, p < 0.001, 95% CI [0.08, 0.16]). Conclusions: Active coping partially buffers the negative effects of academic stressors on perceived distress. Findings underscore the importance of enhancing students’ coping skills and implementing institutional policies that reduce structural stress and support psychological well-being. Full article

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

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17 pages, 638 KiB

Open AccessArticle

The Impact of Environmental Quality Dimensions and Green Practices on Patient Satisfaction from Students’ Perspective—Managerial and Financial Implications

by Nikola Milicevic, Nenad Djokic, Ines Djokic, Jelena Radic, Nemanja Berber and Branimir Kalas

Healthcare 2025, 13(14), 1673; https://doi.org/10.3390/healthcare13141673 - 11 Jul 2025

Abstract

Background/Objectives: Healthcare institutions, similar to other service providers, should prioritize their clients—in this case, patients—to effectively meet their needs. However, fulfilling this objective becomes increasingly challenging due to numerous factors. Therefore, this study explores student patient satisfaction by examining the effects of [...] Read more.

Background/Objectives: Healthcare institutions, similar to other service providers, should prioritize their clients—in this case, patients—to effectively meet their needs. However, fulfilling this objective becomes increasingly challenging due to numerous factors. Therefore, this study explores student patient satisfaction by examining the effects of environmental quality dimensions (Internal Spaces, External Spaces, And Social Environment) and green practices, as well as investigating how environmental knowledge moderates the relationship between green practices and patient satisfaction. Methods: Given the latent nature of the variables investigated, structural equation modeling (SEM) was employed. Some variables were conceptualized as hierarchical constructs comprising higher-order and lower-order components. Before testing the relationships among variables, reliability and validity assessments were performed. For this purpose, the SmartPLS 4 software was used. Since the focus of the research was on students’ health in general, the sample consisted of 280 students from the University of Novi Sad (Republic of Serbia). Results: Among the three environmental quality dimensions, only the Social Environment had a significant and positive influence on patient satisfaction. Furthermore, the green practices emerged as a significant determinant of patient satisfaction. However, the moderating effect of environmental knowledge on this relationship was found to be non-significant. Conclusions: This research underscores the significance of patient satisfaction as a critical objective for healthcare institutions. Special attention should be directed toward enhancing positive interactions between medical staff and patients and adopting green practices. Consequently, certain managerial aspects related to human resource management (such as adequate staffing and organization of personnel) should be considered. In addition, issues concerning financial challenges and benefits regarding the implementation of green practices in healthcare were presented. Full article

(This article belongs to the Special Issue Patient Experience and the Quality of Health Care)

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14 pages, 333 KiB

Open AccessArticle

Physician and Patient Dissatisfaction with Outpatient Pre-Screening Triage in Public Dental Hospitals: Scope and Strategies for Improvement

by Siwei Ma, Li Zhang, Wenzhi Du, Gaofeng Fang, Peng Zhang, Fangfang Xu, Xingke Hao, Xiaojing Fan and Ang Li

Healthcare 2025, 13(14), 1672; https://doi.org/10.3390/healthcare13141672 - 11 Jul 2025

Abstract

Objectives: While pre-screening triage (PST) enhances healthcare efficiency in emergency and pediatric settings, its application in dental healthcare remains undervalued. This novel study implemented PST in dental services, identifying determinants of physician–patient dissatisfaction to optimize triage systems and promote dental health outcomes. Methods: [...] Read more.

Objectives: While pre-screening triage (PST) enhances healthcare efficiency in emergency and pediatric settings, its application in dental healthcare remains undervalued. This novel study implemented PST in dental services, identifying determinants of physician–patient dissatisfaction to optimize triage systems and promote dental health outcomes. Methods: A cross-sectional survey (July–September 2024) recruited 113 physicians and 206 patients via convenience sampling. Dissatisfaction levels were quantified using validated questionnaires and analyzed through t-tests, ANOVA, and regression models. Results: In total, 37.17% of physicians with prior PST experience demonstrated significantly higher dissatisfaction scores (37.67 ± 9.08 vs. 32.51 ± 10.08, p = 0.006). Multivariate analysis revealed that experienced physicians rated PST services 5.63 points higher than less experienced counterparts (95% CI: 0.75–10.51). Dental patients expressed dissatisfaction with nurse attitudes (β = 1.04, 95% CI: 0.07–2.01) and triage process inefficiencies. Conclusions: Key dissatisfaction drivers include a lack of physician PST exposure and nurse–patient interaction quality in dental settings. These findings advocate for the development of a specialized triage system to enhance clinical workflow efficiency and service effectiveness in dental healthcare. Full article

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12 pages, 236 KiB

Open AccessArticle

Associations Between Metabolic Risk Factors and Lung Function Among Adults in Northern Thailand: A Cross-Sectional Study

by Anurak Wongta, Nan Ei Moh Moh Kyi, Muhammad Samar, Nyan Lin Thu, Tipsuda Pintakham and Surat Hongsibsong

Healthcare 2025, 13(14), 1671; https://doi.org/10.3390/healthcare13141671 - 10 Jul 2025

Abstract

Background/Objectives: Lung function decline is influenced by metabolic risk factors (e.g., obesity, hyperglycemia, dyslipidemia) and environmental exposures (e.g., PM2.5), which may jointly contribute to airway inflammation and lung function impairment. This study aimed to investigate these associations in northern Thai adults and identify [...] Read more.

Background/Objectives: Lung function decline is influenced by metabolic risk factors (e.g., obesity, hyperglycemia, dyslipidemia) and environmental exposures (e.g., PM2.5), which may jointly contribute to airway inflammation and lung function impairment. This study aimed to investigate these associations in northern Thai adults and identify factors linked to lung function impairment. Methods: A cross-sectional study was conducted in San Pa Thong, Chiang Mai, Thailand, involving 137 adults. Data on metabolic indicators and spirometry were collected. Statistical analyses included Spearman’s correlation, multivariable linear regression, and logistic regression. Results: Higher triglyceride levels and shorter 6-min walk test (6MWT) distances were associated with reduced forced expiratory volume in one second (FEV₁) and forced vital capacity (FVC). Only 6MWT distance remained a significant factor for lung function impairment in logistic regression (adjusted OR = 0.763, 95% CI: 0.588–0.990, p = 0.042). Conclusions: Combining metabolic and respiratory assessments may improve early detection of lung function impairment in high-risk populations, particularly given the dual burden of metabolic disorders and air pollution in northern Thailand. These findings support the integration of metabolic and respiratory screening in community health programs to enhance preventive strategies. Full article

(This article belongs to the Special Issue Screening, Prevention and Response Strategies for Chronic Cardiopulmonary and Metabolic Diseases)

15 pages, 1368 KiB

Open AccessArticle

The Epidemiology of Emergency Calls in a Tertiary Emergency Department for Admitted Patients: A TECOR Study

by Viet Tran, Toni Dunbabin, Simone Page, Lauren Thurlow and Giles Barrington

Healthcare 2025, 13(14), 1670; https://doi.org/10.3390/healthcare13141670 - 10 Jul 2025

Abstract

Emergency calls, including medical emergency team and code blue calls, aim to respond to and assess patients at an earlier stage of clinical deterioration (to potentially avoid cardiac arrest and death). With an increasing prevalence of hospital access block, more admitted patients are [...] Read more.

Emergency calls, including medical emergency team and code blue calls, aim to respond to and assess patients at an earlier stage of clinical deterioration (to potentially avoid cardiac arrest and death). With an increasing prevalence of hospital access block, more admitted patients are boarding in the Emergency Department (ED). Although emergency calls were traditionally a ward-based system, they are now occurring more often in the ED. Large variations exist in the staffing mix and specialist skill sets between ED- and ward-based care. There is a paucity of evidence describing the epidemiology of patients that require emergency calls in the ED setting. Objectives: We aim to evaluate the population of adult patients that require emergency calls in our tertiary ED. Methods: This study utilised the Tasmanian Emergency Care Outcomes registry (TECOR) to perform a retrospective cohort study of emergency calls occurring over a 13-month period. Descriptive statistics are used to summarize the data. Categorical variables are presented as frequencies and their percentages and continuous variables are depicted as means and standard deviations (SDs) or medians and interquartile ranges (IQRs), as appropriate. Results: There were 600 emergency calls in the ED, involving 423 unique patients and 596 (99.33%) MET calls. The mean patient age was 68.68 years (SD 17.87). The mean ED length of stay for patients with an emergency call was 18.28 h (SD 8.96). Calls made were predominantly for systolic blood pressure < 90 mmHg (310, 51.67%). The mean duration of an emergency call was 40.89 min (SD 20.48). Most patients had a single emergency call (311, 73.18%). For our cohort, goals of care remained unchanged following 341 (56.83%) emergency calls. Conclusions: Emergency calls in the ED are uncommon, representing 2.08% of all admissions from the ED. Patients in the ED requiring an emergency call have a mean length of stay twice that of all ED presentations. Recognising and responding early to address the concerns that trigger a call may help to mitigate this additional burden. More research is required to explore the factors that will lead to effective and appropriate care before, during, and after an ED emergency call is made. Full article

(This article belongs to the Section Healthcare Quality and Patient Safety)

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22 pages, 665 KiB

Open AccessReview

The Relationship Between Socioeconomic Status and Health Behaviors in Older Adults: A Narrative Review

by Hidetaka Hamasaki

Healthcare 2025, 13(14), 1669; https://doi.org/10.3390/healthcare13141669 - 10 Jul 2025

Abstract

Background: In rapidly aging societies like Japan, socioeconomic status (SES) plays a critical role in shaping older adults’ health behaviors. Disparities in SES influence access to healthcare, engagement in health-promoting activities, and the adoption of digital health technologies. This narrative review synthesizes [...] Read more.

Background: In rapidly aging societies like Japan, socioeconomic status (SES) plays a critical role in shaping older adults’ health behaviors. Disparities in SES influence access to healthcare, engagement in health-promoting activities, and the adoption of digital health technologies. This narrative review synthesizes current evidence on how SES affects health behaviors among older adults and highlights challenges in promoting equitable and sustainable healthcare in aging populations. Methods: A PubMed search was conducted for English-language articles published up to May 2025 using the keywords “socioeconomic status”, “older adults”, and terms related to health behaviors. Studies were included if they focused on individuals aged 65 or older and examined associations between SES and healthcare use, digital health, complementary and alternative medicine (CAM), supplements, or lifestyle behaviors. Results: A total of 24 articles were identified. Higher SES—typically measured by income, education, and occupation—was consistently associated with an increased use of preventive services, digital health tools, CAM, and healthier lifestyle behaviors such as diet, physical activity, and sleep. In contrast, lower SES was linked to healthcare underuse or overuse, digital exclusion, and less healthy behaviors. Structural and regional disparities often reinforce individual-level SES effects. Comorbidity burden and shifting health perceptions with age may also modify these associations. Conclusions: SES is a key determinant of health behavior in older adults. Policies should focus on redistributive support, digital inclusion, and SES-sensitive health system strategies to reduce disparities and promote healthy aging in super-aged societies. Full article

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9 pages, 191 KiB

Open AccessPerspective

Clozapine and Regulatory Inertia: Revisiting Evidence, Risks, and Reform

by Carlos De las Cuevas

Healthcare 2025, 13(14), 1668; https://doi.org/10.3390/healthcare13141668 - 10 Jul 2025

Abstract

In the United States, the Clozapine Risk Evaluation and Mitigation Strategy (REMS) program was implemented to ensure safe prescription and monitoring; however, its administrative complexity has often resulted in unintended barriers to access. Clozapine remains the most effective antipsychotic for treatment-resistant schizophrenia (TRS), [...] Read more.

In the United States, the Clozapine Risk Evaluation and Mitigation Strategy (REMS) program was implemented to ensure safe prescription and monitoring; however, its administrative complexity has often resulted in unintended barriers to access. Clozapine remains the most effective antipsychotic for treatment-resistant schizophrenia (TRS), yet its use continues to be constrained by outdated regulatory frameworks, cultural inertia, and clinical hesitancy. This perspective article revisits the pharmacokinetic foundations of clozapine, re-examines its association with fatal outcomes, and critiques the persistence of obsolete monitoring systems such as the U.S. REMS program. Drawing on recent consensus publications endorsed by over 120 international clozapine experts, this article outlines the proposed changes to the U.S. prescription information and contextualizes them within broader global practices. This article argues that many barriers to clozapine use stem not from evidence, but from regulatory conservatism and the perpetuation of clinical myths. The dismantling of the REMS program in early 2025 represents a pivotal moment, yet further reforms are urgently needed to align regulatory guidance with contemporary science. Ultimately, this article is a call to rediscover the clinical value of clozapine and to translate decades of knowledge into regulatory and clinical action. Full article

39 pages, 1706 KiB

Open AccessSystematic Review

Improving Vaccine Coverage Among Older Adults and High-Risk Patients: A Systematic Review and Meta-Analysis of Hospital-Based Strategies

by Flavia Pennisi, Stefania Borlini, Rita Cuciniello, Anna Carole D’Amelio, Rosaria Calabretta, Antonio Pinto and Carlo Signorelli

Healthcare 2025, 13(14), 1667; https://doi.org/10.3390/healthcare13141667 - 10 Jul 2025

Abstract

Background/Objectives: Adult vaccination remains suboptimal, particularly among older adults and individuals with chronic conditions. Hospitals represent a strategic setting for improving vaccination coverage among these high-risk populations. This systematic review and meta-analysis evaluated hospital-based interventions aimed at enhancing vaccine uptake in adults aged [...] Read more.

Background/Objectives: Adult vaccination remains suboptimal, particularly among older adults and individuals with chronic conditions. Hospitals represent a strategic setting for improving vaccination coverage among these high-risk populations. This systematic review and meta-analysis evaluated hospital-based interventions aimed at enhancing vaccine uptake in adults aged ≥60 years or 18–64 years with at-risk medical conditions. Methods: We conducted a systematic review and meta-analysis following PRISMA and MOOSE guidelines. Searches in PubMed, EMBASE, and Scopus identified studies published in the last 10 years evaluating hospital-based interventions reporting vaccination uptake. The risk of bias was assessed using validated tools (NOS, RoB 2, ROBINS-I, QI-MQCS). A meta-analysis was conducted for categories with ≥3 eligible studies reporting pre- and post-intervention vaccination coverage in the same population. Results: We included 44 studies. Multi-component strategies (n = 21) showed the most consistent results (e.g., pneumococcal uptake from 2.2% to 43.4%, p < 0.001). Reminder-based interventions (n = 4) achieved influenza coverage increases from 31.0% to 68.0% and a COVID-19 booster uptake boost of +38% after SMS reminders. Educational strategies (n = 11) varied in effectiveness, with one study reporting influenza coverage rising from 1.6% to 12.2% (+662.5%, OR 8.86, p < 0.01). Standing order protocols increased pneumococcal vaccination from 10% to 60% in high-risk adults. Hospital-based catch-up programs improved DTaP-IPV uptake from 56.2% to 80.8% (p < 0.001). For patient education, the pooled OR was 2.11 (95% CI: 1.96–2.27; p < 0.001, I² = 97.2%) under a fixed-effects model, and 2.47 (95% CI: 1.53–3.98; p < 0.001) under a random-effects model. For multi-component strategies, the OR was 2.39 (95% CI: 2.33–2.44; p < 0.001, I² = 98.0%) with fixed effects, and 3.12 (95% CI: 2.49–3.92; p < 0.001) with random effects. No publication bias was detected. Conclusions: Hospital-based interventions, particularly those using multi-component approaches, effectively improve vaccine coverage in older and high-risk adults. Embedding vaccination into routine hospital care offers a scalable opportunity to reduce disparities and enhance population-level protection. Future policies should prioritize the institutional integration of such strategies to support healthy aging and vaccine equity. Full article

(This article belongs to the Special Issue Collaborative Approaches to Risk Management and Infection Control: A Patient Perspective)

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15 pages, 324 KiB

Open AccessArticle

Determinants of Public Knowledge, Attitude, and Practice on Antibiotic Use in Saudi Arabia: A Regional Cross-Sectional Study

by Wadia S. Alruqayb, Fahad H. Baali, Manar Althbiany, Alanoud Alharthi, Sara Alnefaie, Raghad Alhaji, Reem Alshehri, Wael Y. Khawagi, Monther A. Alshahrani, Hassan Arida and Abdullah A. Alshehri

Healthcare 2025, 13(14), 1666; https://doi.org/10.3390/healthcare13141666 - 10 Jul 2025

Abstract

Background: Antibiotic resistance (AMR) is a critical global and national health challenge, largely driven by the misuse and overuse of antibiotics. Understanding the public′s knowledge and practices regarding antibiotic use is essential for informing effective interventions. This study aimed to assess the levels [...] Read more.

Background: Antibiotic resistance (AMR) is a critical global and national health challenge, largely driven by the misuse and overuse of antibiotics. Understanding the public′s knowledge and practices regarding antibiotic use is essential for informing effective interventions. This study aimed to assess the levels of knowledge, attitude, and practice (KAP) related to antibiotic use among adults in Saudi Arabia’s Western Region and to identify the demographic and behavioral determinants of these outcomes. Methods: A regional cross-sectional survey was conducted from March to June 2025 using a 40-item self-administered online questionnaire. Adults aged ≥ 18 years residing in the Western Region of Saudi Arabia were recruited via social media using snowball sampling. Descriptive statistics and Chi-square tests were used to examine associations, while multivariate logistic regression was employed to identify determinants of high knowledge and good practices, presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results: A total of 891 participants were included; most were female (63.6%) and aged 18–30 years (56.2%). Moderate knowledge of antibiotic use was observed in 54.0% of participants, while 30.8% had high knowledge. In terms of attitude and practice, 55.6% demonstrated good performance and 42.8% average performance. High knowledge was significantly associated with the female gender (aOR = 1.90; 95% CI: 1.34–2.70), age of 41–50 years (aOR = 2.22; 95% CI: 1.42–3.48), and a postgraduate education (aOR = 15.37; 95% CI: 1.84–128.13). Good practices were associated with the female gender (aOR = 2.32; 95% CI: 1.66–3.24) and being married (aOR = 1.99; 95% CI: 1.43–2.77). A moderate positive correlation was found between knowledge and practice scores (r = 0.406, p < 0.001). Conclusions: Significant variability in public KAP regarding antibiotic use was identified. Female gender, older age, and higher education were key determinants of better KAP. These findings emphasize the need for targeted educational strategies focusing on high-risk groups to support rational antibiotic use and mitigate antimicrobial resistance. Full article

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14 pages, 236 KiB

Open AccessCommunication

Technological Advances in Healthcare and Medical Deontology: Towards a Hybrid Clinical Methodology

by Vittoradolfo Tambone, Laura Leondina Campanozzi, Lucio Di Mauro, Fabio Fenato, Guido Travaini, Francesco De Micco, Alberto Blandino, Giuseppe Vetrugno, Giulia Mercuri, Mario Picozzi, Raffaella Rinaldi and Francesco Introna

Healthcare 2025, 13(14), 1665; https://doi.org/10.3390/healthcare13141665 - 10 Jul 2025

Abstract

The rapid advancements in healthcare technologies are reshaping the medical landscape, prompting a reconsideration of clinical methodologies and their ethical foundations. This article explores the need for an updated approach to medical deontology, emphasizing the transition from traditional practices to a hybrid clinical [...] Read more.

The rapid advancements in healthcare technologies are reshaping the medical landscape, prompting a reconsideration of clinical methodologies and their ethical foundations. This article explores the need for an updated approach to medical deontology, emphasizing the transition from traditional practices to a hybrid clinical methodology that integrates both human expertise and technological innovations. With the increasing use of Artificial Intelligence, data analytics, and advanced medical tools, healthcare professionals are presented with new ethical and professional challenges. These challenges demand a reevaluation of professional responsibility, highlighting the importance of scientific evidence in decision-making while mitigating the influence of economic and ideological factors. By framing medical practice within a systemic and integrated perspective, this article proposes a model that moves beyond the reductionist and anti-reductionist dualism, fostering a more realistic understanding of healthcare. This new paradigm necessitates the evolution of the Medical Code of Ethics, integrating the concept of “medical intelligence” to address the complexities of data management and its ethical implications. The article ultimately advocates for a dynamic and adaptive approach that aligns medical practice with emerging technologies, ensuring that patient care remains person-centered and ethically grounded in a rapidly changing healthcare environment. Full article

(This article belongs to the Section Health Policy)

13 pages, 1071 KiB

Open AccessReview

Listening Until the End: Best Practices and Guidelines for Auditory Care in Palliative Sedation in Europe

by Ismael Rodríguez-Castellanos, María Isabel Ortega González-Gallego, Alberto Bermejo-Cantarero, Raúl Expósito-González, Julián Rodríguez-Almagro, Sandra Martínez-Rodríguez and Andrés Redondo-Tébar

Healthcare 2025, 13(14), 1664; https://doi.org/10.3390/healthcare13141664 - 10 Jul 2025

Abstract

Background/Objectives: Auditory capacity plays a fundamental role in human emotional development from prenatal stages and persists as the last sensory modality to fade during terminal phases. In palliative sedation, uncertainty about preserved hearing—despite potential unconsciousness—underscores the need to evaluate current care recommendations [...] Read more.

Background/Objectives: Auditory capacity plays a fundamental role in human emotional development from prenatal stages and persists as the last sensory modality to fade during terminal phases. In palliative sedation, uncertainty about preserved hearing—despite potential unconsciousness—underscores the need to evaluate current care recommendations for this critical sensory dimension. This review examines European guidelines to (i) assess auditory care integration in palliative sedation protocols and (ii) propose humanization strategies for sensory-preserving end-of-life care. Methods: Narrative review of evidence from the European Palliative Sedation Repository and the European Association for Palliative Care (EAPC). Results: Three key findings emerged: (i) lack of explicit protocols for auditory care despite acknowledging environmental sound management (e.g., music, family communication); (ii) limited consensus exists regarding hearing preservation during unconsciousness. Conclusions: Although auditory perception during palliative sedation remains scientifically uncertain, the precautionary principle warrants integrating auditory care into palliative sedation through (i) family education on potential hearing preservation; (ii) therapeutic sound protocols; and (iii) staff training in sensory-inclusive practices. This approach addresses current gaps in the guidelines while enhancing patient dignity and family support during end-of-life care. Further research should clarify auditory perception thresholds during sedation. Full article

(This article belongs to the Special Issue Improving the Quality of Nursing: Focus on Palliative Care and End-of-Life Care)

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