Healthcare

16 pages, 1971 KB

Open AccessArticle

Multidisciplinary Management of Women Suffering from Migraine: Rationale, Design and Results of a National Delphi Consensus

by Piero Barbanti, Rossella E. Nappi, Sabina Cevoli, Patrizio Pasqualetti, Pasquale Perrone Filardi, Innocenzo Rainero, Alessandro Rossi, Vito Trojano and Annamaria Colao

Healthcare 2026, 14(13), 2014; https://doi.org/10.3390/healthcare14132014 (registering DOI) - 6 Jul 2026

Abstract

Background/Objectives: Migraine is a common, disabling neurological disorder disproportionately affecting women during hormonally sensitive phases like menarche, pregnancy, and menopause. Despite awareness of sex-specific risk factors, management remains fragmented and predominantly neurologist-led, with limited coordination. To address these gaps, this project aimed [...] Read more.

Background/Objectives: Migraine is a common, disabling neurological disorder disproportionately affecting women during hormonally sensitive phases like menarche, pregnancy, and menopause. Despite awareness of sex-specific risk factors, management remains fragmented and predominantly neurologist-led, with limited coordination. To address these gaps, this project aimed to develop a national expert consensus, endorsed by scientific societies, on multidisciplinary migraine management in women across the lifespan, integrating perspectives from neurology, gynecology, endocrinology, cardiology, and general medicine. Methods: A two-round Delphi survey was conducted among 145 Italian clinicians representing the five specialties. The Scientific Board formulated 50 questions, each consisting of a variable number of statements, covering diagnostic approaches, hormonal therapies, comorbidities, and organizational care pathways. Statements were rated on a nine-point Likert scale, and consensus was defined using pre-specified criteria based on median scores and agreement. Results: Overall, 79 of 145 statements (54%) achieved consensus. High-level agreement emerged on sex-informed diagnostic strategies, including systematic gynecological and endocrinological evaluation and hormonal profiling in women with migraine. Round 2 facilitated consensus on contentious issues, such as avoiding estrogen-containing contraceptives in migraine with aura, individualized thrombotic risk assessment during menopause, and structured interdisciplinary coordination—particularly among neurologists, gynecologists, and general practitioners—during fertility planning and assisted reproduction. Qualitative feedback emphasized the need to update clinical pathways, implement standardized referral models, and strengthen interprofessional communication. However, persistent divergence remained on selected topics, particularly the role of hormonal contraceptives as a first-line approach to migraine management in women of reproductive age, reflecting different priorities between gynecologists and neurologists. Conclusions: This Delphi initiative provides the first national multidisciplinary consensus on migraine management in women in Italy. The findings support the development of sex- and life-stage-specific clinical guidance and integrated care models tailored to the complex needs of women with migraine. Full article

(This article belongs to the Section Women’s and Children’s Health)

13 pages, 1502 KB

Open AccessArticle

Effect of a Nursing Process Training Program on Nurses’ Knowledge and Skills in Primary Healthcare in Albania: A Quasi-Experimental Study

by Sonila Qirko, Florin Leasu, Maria Elena Cocuz, Vasilika Prifti, Emirjona Kiçaj, Rudina Çerçizaj and Liliana Marcela Rogozea

Healthcare 2026, 14(13), 2013; https://doi.org/10.3390/healthcare14132013 - 6 Jul 2026

Abstract

Background: The nursing process provides a structured framework for delivering safe, holistic, and patient-centered care; however, its implementation in primary healthcare settings, particularly in low-resource systems, remains inconsistent due to limited training and institutional support. Objectives: This study aimed to evaluate the effectiveness [...] Read more.

Background: The nursing process provides a structured framework for delivering safe, holistic, and patient-centered care; however, its implementation in primary healthcare settings, particularly in low-resource systems, remains inconsistent due to limited training and institutional support. Objectives: This study aimed to evaluate the effectiveness of a structured educational intervention in improving nurses’ knowledge and practical competencies in applying the nursing process in primary healthcare centers in Vlora, Albania. Methods: A quasi-experimental study was conducted with 32 nurses from five public primary healthcare centers. Sixteen nurses received a structured training program consisting of theoretical instruction and case-based practice, while sixteen nurses served as a control group. Pre- and post-intervention assessments were performed using standardized questionnaires and skill evaluation tools, and differences were analyzed using nonparametric statistical tests. Results: The results showed clear improvements in the intervention group across all domains, after the training. The reported use of the nursing process increased from 62.5% to 100%, while the use of Gordon’s Functional Health Patterns increased from 6.3% to 93.7%. The use of NANDA nursing diagnosis increased from 62.5% to 100%. The proportion of nurses reporting written nursing care plans increased from 62.5% to 93.7%, and the implementation and evaluation of care plans increased from 62.5% to 100%. The control group showed no comparable progress. Nurses who participated in the training also reported increased confidence and consistency in applying the nursing process in daily practice. Conclusions: These findings suggest that structured, competency-based training programs may improve immediate nurses’ theoretical knowledge and practical skills. Such training may contribute to improving the quality of nursing care, but further studies and longer follow-up and patient-related results are needed. Full article

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12 pages, 264 KB

Open AccessArticle

Patients’ Readiness to Exercise After Cardiac Surgery: A Single-Center Observational Study

by Eleni Anagnostopoulou, Konstantinos Giakoumidakis, Anastasia A. Chatziefstratiou, Nikolaos V. Fotos, Athina Patelarou, Evridiki Patelarou and Hero Brokalaki

Healthcare 2026, 14(13), 2012; https://doi.org/10.3390/healthcare14132012 - 6 Jul 2026

Abstract

Background/Objectives: The prolonged bed rest of patients after cardiac thoracic surgery is associated with many deteriorations in their lives. This study examined patients’ readiness to exercise after cardiac surgery in Greece. Methods: This study employs a cross-sectional observational design. Data collection [...] Read more.

Background/Objectives: The prolonged bed rest of patients after cardiac thoracic surgery is associated with many deteriorations in their lives. This study examined patients’ readiness to exercise after cardiac surgery in Greece. Methods: This study employs a cross-sectional observational design. Data collection occurred from April to August 2024, and 98 patients who underwent cardiac surgery were enrolled in the study. Patient readiness was assessed via the Greek version of the “Readiness to Change Exercise Questionnaire,” which contains 13 questions divided into four subscales: pre-contemplation, contemplation, preparation, and action. Demographic and clinical data were obtained from medical records, while readiness for exercise was assessed by telephone interview three months after surgery. Data analysis was performed using IBM SPSS 21.0. Results: The mean age (standard deviation) was 64.2 (±10.7 years), while the majority were men (72.4%). In the “pre-contemplation “, “contemplation”, “preparation”, and “action” subscales, 11.2%, 11.2%, 24.5%, and 53.1% of the patients were allocated, respectively. Male patients (OR = 3.3, 95% CI 1.0–10.4, p = 0.042) were more likely to be ready for exercise than female patients. Compared with patients with low levels of preoperative physical activity, those with moderate and high levels of physical activity were more likely to be ready for exercise (OR = 5.2, 95% CI 1.4–18.7, p = 0.012 and OR = 7.4, 95% CI 2.1–26.0, p = 0.002, respectively). Conclusions: About half of the patients who have undergone cardiac surgery appear to have a good intention of exercising. Parameters such as sex, marital status, and preoperative exercise levels were significantly associated with these patients’ readiness to exercise. Full article

(This article belongs to the Section Chronic Care)

21 pages, 874 KB

Open AccessArticle

Positive Self-Perception of Aging and Quality of Life in People Living with HIV: The Role of Cultural Stereotype Internalization

by Ana Laguía, Antonio Bustillos, Cristina Moreno, Inmaculada Jarrín and María José Fuster-RuizdeApodaca

Healthcare 2026, 14(13), 2011; https://doi.org/10.3390/healthcare14132011 - 6 Jul 2026

Abstract

Introduction: Individuals aging with HIV face significant challenges that can negatively impact their long-term health, including biomedical complications, premature aging, and the influential role of aging-related stereotypes. Our study aimed to investigate whether a more positive self-perception of aging is associated with [...] Read more.

Introduction: Individuals aging with HIV face significant challenges that can negatively impact their long-term health, including biomedical complications, premature aging, and the influential role of aging-related stereotypes. Our study aimed to investigate whether a more positive self-perception of aging is associated with better health-related quality of life and less adverse impacts of premature aging on people living with HIV. Methods: We conducted a multicenter study combining a cross-sectional survey with a 2-year retrospective extraction of clinical data from medical records, involving 285 participants aged ≥ 50 years (77.9% male) living with HIV in Spain. Participants reported their health-related quality of life, self-perception of aging, and cultural age-related stereotypes. Additionally, two years of retrospective clinical health data were collected for eight areas: Metabolic, Neurological, Neoplastic, Bone, Hepatic, Renal, Cardiovascular, and Others. Results: As expected, worse physical health over the past two years had a negative impact on the self-perception of aging. Cultural age-related stereotypes of warmth and competence were found to predict their internalization into the self-concept. However, only self-perceived competence mediated the influence of the cultural age-related stereotype of the competence dimension on a more positive self-perception of aging. Furthermore, a positive self-perception of aging positively predicts all dimensions of health-related quality of life. Conclusions: Our data suggest two interrelated pathways that may influence the aging process: a clinical pathway, characterized by the negative impact of pre-existing comorbidities, and a psychosocial pathway, related to the internalization of cultural stereotypes. This study highlights the impact of cultural stereotypes on the self-perception of aging through their internalization in a sample of individuals experiencing premature aging. Full article

(This article belongs to the Special Issue HIV and Aging)

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20 pages, 800 KB

Open AccessArticle

Acute Cognitive Effects of Brief Physical Activity Breaks After Lecture-Based Academic Activity in Undergraduate University Students: A Randomized Crossover Study

by Ilaria Pepe, Alessandro Petrelli, Luca Poli, Francesco Fischetti, Stefania Cataldi and Gianpiero Greco

Healthcare 2026, 14(13), 2010; https://doi.org/10.3390/healthcare14132010 - 6 Jul 2026

Abstract

Background: Prolonged sitting during lecture-based academic activities may be accompanied by sustained attentional engagement and cognitive fatigue, with potential consequences for cognitive efficiency and broader psychological functioning. Physical activity breaks (PABs) represent a feasible strategy to interrupt sitting time within university timetables, [...] Read more.

Background: Prolonged sitting during lecture-based academic activities may be accompanied by sustained attentional engagement and cognitive fatigue, with potential consequences for cognitive efficiency and broader psychological functioning. Physical activity breaks (PABs) represent a feasible strategy to interrupt sitting time within university timetables, yet evidence in higher-education settings remains limited, particularly regarding modality-specific effects. This randomized crossover study examined the acute effects of a 10 min PAB on attentional and executive functioning in undergraduate students and compared an outdoor physical activity break (OPAB) with an exergame-based PAB (PABEx) versus a no-break control (NPAB). Methods: Forty-two undergraduate students (26 males, 16 females; mean age = 22.78 ± 5.84 years) completed three weekly conditions in randomized order following two consecutive hours of seated lectures: NPAB (seated rest), OPAB (2 min warm-up, 6 min light-to-moderate walking, 2 min cool-down), and PABEx (2 min warm-up, 6 min Fruit Ninja Kinect, 2 min cool-down). Cognitive performance was assessed immediately after each condition using the Trail Making Test A-B (TMT A-B) and the Stroop Color-Word Test (SCWT). Results: Significant condition effects were found for TMT-A (χ² = 53.976, p < 0.001), TMT-B (χ² = 44.635, p < 0.001), TMT B-A (χ² = 10.841, p = 0.004), SCWT interference time (χ² = 44.714, p < 0.001), and SCWT interference errors (χ² = 23.211, p < 0.001). Post-hoc tests showed that both OPAB and PABEx were associated with better performance on TMT-A, TMT-B, and SCWT interference time versus NPAB (all Benjamini–Hochberg-adjusted p < 0.001); PABEx was associated with better TMT-A performance than OPAB (Benjamini–Hochberg-adjusted p = 0.047). TMT B-A decreased only for OPAB versus NPAB (Benjamini–Hochberg-adjusted p = 0.009). SCWT interference errors were lower for OPAB versus NPAB (Benjamini–Hochberg-adjusted p < 0.001) and for PABEx versus NPAB (Benjamini–Hochberg-adjusted p = 0.012). Conclusions: A 10 min PAB implemented immediately after a lecture-based academic activity was associated with more favorable post-condition attentional and executive performance in undergraduate students compared with a passive no-break condition. OPAB and PABEx yielded broadly comparable benefits across executive outcomes, whereas PABEx showed an additional advantage for TMT-A, suggesting a possible modality-specific effect on processing speed and visuoperceptual tracking. These findings support the integration of brief active breaks into university schedules as a pragmatic strategy to promote post-lecture cognitive efficiency during academically demanding periods. Trial registration: ClinicalTrials.gov, NCT07624084; retrospectively registered on 28 May 2026. Full article

(This article belongs to the Topic Physical Activity, Exercise, and Psychological Well-Being Across the Lifespan)

11 pages, 732 KB

Open AccessArticle

Genital Warts and Male Sexual Dysfunction: An IIEF-15-Based Cross-Sectional Study

by Orhan Şen and Emre Kıraç

Healthcare 2026, 14(13), 2009; https://doi.org/10.3390/healthcare14132009 - 6 Jul 2026

Abstract

Background/Objective: The psychosexual burden of human papillomavirus (HPV)-induced genital warts (GWs) in men remains underexplored. This study aimed to determine the prevalence of sexual dysfunction in men with GWs and to evaluate the effects of disease duration and condom use on the sexual [...] Read more.

Background/Objective: The psychosexual burden of human papillomavirus (HPV)-induced genital warts (GWs) in men remains underexplored. This study aimed to determine the prevalence of sexual dysfunction in men with GWs and to evaluate the effects of disease duration and condom use on the sexual cycle using the International Index of Erectile Function (IIEF-15). Methods: This single-center, cross-sectional study was conducted in the dermatology outpatient clinic of Kayseri City Education and Research Hospital between May and June 2026 and enrolled 150 sexually active male patients with clinically diagnosed, currently present genital wart lesions. To minimize reading comprehension and social desirability biases, a two-stage protocol was implemented. First, a clinician explained each IIEF-15 item face-to-face. Patients then completed the questionnaire independently and submitted it in a sealed envelope. Associations were analyzed using Spearman’s rank correlation, and group comparisons used the Mann–Whitney U and Kruskal–Wallis tests. Results: The median age was 30.0 years (IQR 25.0–36.0) and the median disease duration was 18.0 months (IQR 8.0–35.8). Erectile dysfunction (ED) of varying severity was detected in 84.7% (n = 127) of patients. In unadjusted analysis, longer disease duration was associated with lower sexual function scores; however, these associations did not remain significant after adjustment for age. As ED severity increased, all other sexual function domains declined concurrently and strongly (Spearman rho ranging from −0.679 to −0.821; p < 0.0001). Condom users exhibited higher total sexual function scores than non-users (median 55.5, IQR 43.2–61.0 vs. median 49.5, IQR 37.0–60.0); however, this difference did not reach statistical significance (p = 0.076). Conclusions: Genital warts in men constitute a major psychosexual condition that disrupts multiple phases of the sexual response cycle, not merely a dermatological lesion. Our cross-sectional findings suggest that lesion-directed treatment alone may not fully address this psychosexual burden: whether the proactive integration of multidisciplinary sexual counseling improves outcomes should be tested in controlled, longitudinal studies. Full article

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

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17 pages, 1011 KB

Open AccessArticle

Telerehabilitation with Web-Based Exercises for Individuals with Postural Problems: Digital Touch to Posture Disorders—A Randomized Controlled Study on Telerehabilitation for Postural Problems

by Duygu Korkem Yorulmaz, Alperen Yazıtaş, Mehmet Furkan Cantürk and Tezel Yıldırım Şahan

Healthcare 2026, 14(13), 2008; https://doi.org/10.3390/healthcare14132008 - 6 Jul 2026

Abstract

Background: Postural problems such as head forward posture, thoracic hyperkyphosis, and lumbar hyperlordosis, when seen together, further complicate postural control, increasing the importance of comprehensive approaches in treatment. This study aims to examine the effect of 6 weeks of telerehabilitation with web-based exercises [...] Read more.

Background: Postural problems such as head forward posture, thoracic hyperkyphosis, and lumbar hyperlordosis, when seen together, further complicate postural control, increasing the importance of comprehensive approaches in treatment. This study aims to examine the effect of 6 weeks of telerehabilitation with web-based exercises and compare the home-based exercises in individuals with postural problems. Trial Design: A Randomized Controlled Study. Methods: A total of 34 volunteers with postural deformity among young adults were randomly divided into telerehabilitation (n = 17) and control (n = 17) groups. Craniovertebral, thoracic kyphosis, and lumbar lordosis angles of all individuals were evaluated with a smartphone application (Clinometer+ Bubble), hamstring and pectoral muscle shortness with a goniometer, and trunk muscle endurance with endurance tests created by McGill and Sorenson. Whilst the tele-rehabilitation group was provided with a video-based exercise program, the control group was advised to follow the same exercise program at home. Exercises were performed 3 days a week for 6 weeks, as 1-h sessions. Participants in the telerehabilitation group were followed up with a synchronized video conference. Results: A significant difference was observed in the telerehabilitation group in muscle shortness and the endurance tests (p < 0.05). Only a significant difference in left (p = 0.03) and right (p = 0.04) muscle shortness was observed in the home exercise group. Significant differences were observed in Craniovertebral and lumbar lordosis angles between groups (p < 0.05), with the telerehabilitation group showing better outcomes. The kyphosis angle, muscle shortness, and endurance test results between groups were found to be similar (p > 0.05). Conclusions: Six weeks of telerehabilitation can improve muscle shortness and trunk endurance in young adults with postural deformities. Both the exercise program using telerehabilitation and the home exercise program were beneficial for individuals with postural problems, with more favorable effects observed in the telerehabilitation group. Full article

(This article belongs to the Section Digital Health Technologies)

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23 pages, 1364 KB

Open AccessArticle

Future Inpatient Cost Burden of Laryngeal Cancer in Romania: Aging, Residence, and Prevention Scenarios in a Nationwide Ecological Study

by Andreea-Mihaela Banța, Livia Stanga, Ingrid-Denisa Barcan, Anda-Ioana Morgovan, Alexandru Orasan, Bogdan Hîrtie, Nicolae-Constantin Balica, Karina-Cristina Marin, Mihaela-Cristina Negru, Delia Ioana Horhat and Marius Papurica

Healthcare 2026, 14(13), 2007; https://doi.org/10.3390/healthcare14132007 - 6 Jul 2026

Abstract

Background and Objectives: Laryngeal cancer imposes substantial inpatient costs in middle-income health systems. We described recent trends in laryngeal cancer hospitalizations in Romania, estimated hospital expenditure, and modeled the impact of prevention scenarios to 2035. Methods: We conducted an ecological analysis of 20,056 [...] Read more.

Background and Objectives: Laryngeal cancer imposes substantial inpatient costs in middle-income health systems. We described recent trends in laryngeal cancer hospitalizations in Romania, estimated hospital expenditure, and modeled the impact of prevention scenarios to 2035. Methods: We conducted an ecological analysis of 20,056 discharges diagnosed as laryngeal cancer (ICD-10 C32.x) between 2019 and 2023. Each episode was assigned a mean unit cost of 1100 USD, with age- and residence-specific adjustments, and re-priced using EU (3900 USD) and US (30,000 USD) tariffs. We derived annual costs and projected 2035 expenditure under three prevention scenarios. Results: Annual discharges fell from 5408 in 2019 to 3151–3212 in 2020–2021, then rose to 4409 in 2023, while inpatient spending ranged from 3.47 to 5.95 million USD, reaching 4.85 million USD in 2023 (22,200 USD/100,000 population). Re-pricing 2023 activity at EU and US unit costs yielded counterfactual totals of 17.20 and 132.27 million USD. Older adults (≥65 years) generated 47.6% of discharges and 49.1% of spending in 2023, and urban residence increased the odds of age ≥65 by 48% (OR 1.48, 95% CI 1.40–1.57). Without new prevention, costs are projected to reach 12.60 million USD by 2035; a 30% smoking reduction and a combined package including radon mitigation and dysphonia screening would lower 2035 costs to 10.33 and 9.07 million USD. Conclusions: Demographic aging and sustained case volume will markedly increase hospital costs, while prevention scenarios are associated with lower projected inpatient expenditure. Full article

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16 pages, 2544 KB

Open AccessReview

Assessment of Mental Health in Healthcare Personnel: A Review of DASS, MBI, and Zung Scales

by Tanja Lupieri, Martina Hrvačić, Dubravka Švob Štrac, Suzana Uzun and Dunja Degmečić

Healthcare 2026, 14(13), 2006; https://doi.org/10.3390/healthcare14132006 - 6 Jul 2026

Abstract

Background/Objectives: Healthcare professionals face high occupational stress, emotional burden, and demanding conditions that increase the risk of burnout, depression, and anxiety, with recent post-pandemic evidence indicating a high and rising global prevalence. Early identification of distress is therefore essential. This review compared three [...] Read more.

Background/Objectives: Healthcare professionals face high occupational stress, emotional burden, and demanding conditions that increase the risk of burnout, depression, and anxiety, with recent post-pandemic evidence indicating a high and rising global prevalence. Early identification of distress is therefore essential. This review compared three widely used instruments—the Depression, Anxiety and Stress Scales (DASS), the Maslach Burnout Inventory (MBI), and the Zung Self-Rating Depression Scale (SDS)—selected because they jointly cover depression, anxiety, stress, and burnout, unlike unidimensional tools (PHQ-9, GAD-7, PSS, CBI) that would need combining for comparable coverage. Methods: A narrative integrative review searched PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar for peer-reviewed articles (English/Croatian) published up to December 2025 (final search: 26 June 2026). Two reviewers independently screened records, resolving disagreements by consensus; quality was appraised narratively. Of 55 records, 35 were included. Results: The DASS showed a replicated three-factor structure and strong reliability, with shortened forms (DASS-8, DASS-12) enabling rapid screening at reduced domain coverage. The MBI remained the most widely used burnout measure but was limited by its emotional-exhaustion focus, proprietary licensing, and scoring heterogeneity. The Zung SDS offered a brief depression screen, though dated wording and context-dependent cut-offs favor initial-screen use. Notably, much evidence is derived from non-healthcare populations—the principal limitation. Conclusions: The instruments appear complementary rather than interchangeable; their combined use is proposed—as a reasonable suggestion from the literature, not an empirically demonstrated finding—as a multidimensional approach, contingent on context, objective, and appropriate cultural validation. Full article

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

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14 pages, 1592 KB

Open AccessSystematic Review

The Role of Hydrotherapy in Enhancing Recovery After Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Saja Nashmi Alrashedi, Eslam K. Fahmy, Hadaya Mosaad Eladl, Maha Ata Alshammari, Safya E. Esmaeel, Mustafa Shukry, Olfat Ibrahim Ali and Mohamed Abdelaziz Emam

Healthcare 2026, 14(13), 2005; https://doi.org/10.3390/healthcare14132005 - 6 Jul 2026

Abstract

Background: Total knee arthroplasty (TKA) is a common procedure to relieve pain and restore function in osteoarthritis patients. Postoperative rehabilitation is essential to address pain, swelling, reduced range of motion, and functional limitations. Hydrotherapy, using water buoyancy and resistance, may enhance recovery, but [...] Read more.

Background: Total knee arthroplasty (TKA) is a common procedure to relieve pain and restore function in osteoarthritis patients. Postoperative rehabilitation is essential to address pain, swelling, reduced range of motion, and functional limitations. Hydrotherapy, using water buoyancy and resistance, may enhance recovery, but evidence on its effectiveness after these surgeries remains limited. Methods: A systematic literature search was conducted across six databases: PubMed, ProQuest, Science Direct, Google Scholar, Scopus, the Cochrane Library, and PEDro, covering studies published up to 30 November 2025. Only prospective randomized controlled trials were considered for inclusion. Studies such as case reports, uncontrolled case series, and those focused on outcomes other than postoperative pain and decreased muscle strength in patients undergoing total knee arthroplasty were excluded. This review was registered in PROSPERO (CRD420251164054). Results: Pooled analysis showed no statistically significant difference between hydrotherapy and land-based or usual-care rehabilitation in Visual Analogue Scale (VAS)-measured pain (MD ≈ −0.35; 95% CI

[- 1.06, 0.36]

;

p = 0.34

) or in WOMAC pain (MD ≈ −0.46; 95% CI

[- 8.50, 7.58]

;

p = 0.89

). In contrast, hydrotherapy produced a moderate, statistically significant improvement in lower-limb muscle strength (Hedges’

g = 0.46

; 95% CI

[0.23, 0.69]

), particularly in knee extensor and hip abductor strength. Heterogeneity was low for VAS pain and muscle strength but substantial for WOMAC pain (

I^{2} \approx 71 %

), and no evidence of publication bias was identified. Conclusions: Hydrotherapy did not reduce postoperative pain more than land-based exercise or usual care; pain relief was comparable between approaches, whereas hydrotherapy yielded greater gains in muscle strength. Heterogeneity in treatment parameters and the limited number of high-quality trials preclude definitive conclusions; future research should standardize hydrotherapy protocols and investigate long-term outcomes. Full article

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14 pages, 469 KB

Open AccessArticle

Billing Disparities in Home Sleep Testing: The Role of Sleep Medicine Board Certification and Practice Setting

by Umesh Ghimire, Heather L. Taylor, Scott R. Houle, Snigdha Pusalavidyasagar and Wajahat Khalil

Healthcare 2026, 14(13), 2004; https://doi.org/10.3390/healthcare14132004 - 6 Jul 2026

Abstract

Background: The financial burden of diagnostic testing for obstructive sleep apnea (OSA) represents a substantial barrier to treatment initiation, with cost-related access disparities disproportionately affecting the low-income and underinsured population. Home sleep testing (HST) offers a cost-effective diagnostic alternative, yet economic patterns [...] Read more.

Background: The financial burden of diagnostic testing for obstructive sleep apnea (OSA) represents a substantial barrier to treatment initiation, with cost-related access disparities disproportionately affecting the low-income and underinsured population. Home sleep testing (HST) offers a cost-effective diagnostic alternative, yet economic patterns across provider types remain unclear. This study assessed whether board-certified sleep medicine provider (BCSMP) status is associated with differences in provider-billed HST charges and evaluated how organizational and payment contexts influence these charges. Methods: A retrospective cross-sectional analysis was conducted using 2019 data from Optum’s de-identified Clinformatics^® Data Mart Database (N = 61,531 adult HST claims). The main exposure was provider status (BCSMP vs. non-BCSMP). The outcome was total provider-requested charge per HST procedure. Generalized Linear Models with a gamma distribution estimated adjusted charge differences, controlling for organizational context, place of service, and payer type. Results: BCSMP encounters had significantly lower adjusted mean HST charges than non-BCSMPs (mean difference: −$78.04; 95% CI: −$89.06 to −$67.02; p < 0.001). Individual practitioners charged $168.48 less than hospital-affiliated providers, while group practices and other facilities charged more (all p < 0.001). Fee-for-service arrangements were associated with lower charges than commercial and Medicare Advantage plans (p < 0.001). Conclusions: Board-certified sleep medicine providers and individual practice settings were associated with lower billed charges for home sleep testing; however, these findings do not necessarily reflect actual cost reduction. To translate these baseline charge differences into equitable clinical protocols and healthcare policies, future research must analyze negotiated reimbursement rates, billing structures, and practice environments to determine how these cost parameters impact the overall cost of an OSA diagnosis. Full article

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18 pages, 300 KB

Open AccessArticle

Knowledge, Attitudes, and Practices Regarding Breast Cancer Screening Among Females in Saudi Arabia

by Nawaf W. Alruwaili, Abdullah Mohammed Alfehaid, Khaled Abdullah Shafi Al-Toum, Aljazi Bin Zarah and Nora Alafif

Healthcare 2026, 14(13), 2003; https://doi.org/10.3390/healthcare14132003 - 6 Jul 2026

Abstract

Background: Breast cancer comprises 31.4% of all female cancers in Saudi Arabia (2020 Cancer Registry). Despite free national screening services existing since 2005, mammography utilization remains critically low. This study assessed breast cancer knowledge, attitudes, and practices (KAP) among females in Saudi Arabia [...] Read more.

Background: Breast cancer comprises 31.4% of all female cancers in Saudi Arabia (2020 Cancer Registry). Despite free national screening services existing since 2005, mammography utilization remains critically low. This study assessed breast cancer knowledge, attitudes, and practices (KAP) among females in Saudi Arabia and identified independent predictors of screening behavior. Methods: A cross-sectional study (December 2024–February 2025) enrolled 426 females aged ≥20 years from all 13 Saudi administrative regions using a quota-based design combining facility-based and online recruitment. Attitude and barrier domains were adapted from Champion’s Health Belief Model Scale (CHBMS), validated in Arabic; knowledge items used validated regional instruments. Knowledge-score reliability: KR-20 = 0.45; attitude subscale: α = 0.74. Binary logistic regression identified independent predictors of screening uptake (outcome: any screening in the preceding five years, coded as screened = 1; not screened = 0). Results: Mean composite knowledge score: 4.51 ± 1.52/7 (KR-20 = 0.45); 54.0% achieved high knowledge (≥5). Mammography uptake was 30.5% overall and 52.2% among women aged ≥40 (n = 136; the recommended target group). Predominant barriers: Fear of diagnosis (83.6%), belief in incurability (76.3%), radiation concern (73.2%), and pain anxiety (72.3%). Logistic regression (χ²(8) = 188.96, p < 0.001; McFadden’s pseudo R² = 0.323) identified older age (OR = 1.52; 95% CI: 1.21–1.92), higher income (OR = 1.57; 95% CI: 1.25–1.99), transportation barriers (OR = 3.39; 95% CI: 1.95–5.89), and family discouragement (OR = 3.03; 95% CI: 1.72–5.34) as significant predictors (all p < 0.001). Conclusions: A significant knowledge–practice gap persists across all 13 Saudi regions. These findings suggest several implications for a multi-level public health response to be evaluated through future intervention research; multi-level strategies targeting CHBMS Barriers are needed. Full article

15 pages, 260 KB

Open AccessArticle

Knowledge of Cardiovascular Disease Risk Factors and Warning Signs Among Adults in the Jazan Region, Saudi Arabia: A Cross-Sectional Study

by Hossam Shaabi, Hassan Jaafari, Naif Gharwi, Raghad Bajawi, Raneem Zakri and Taif Hakami

Healthcare 2026, 14(13), 2002; https://doi.org/10.3390/healthcare14132002 - 6 Jul 2026

Abstract

Background: Cardiovascular diseases (CVDs) are the leading cause of death in Saudi Arabia, and public knowledge of risk factors and warning signs supports early detection and prevention. This study aimed to assess CVD knowledge and its demographic predictors among adults in the Jazan [...] Read more.

Background: Cardiovascular diseases (CVDs) are the leading cause of death in Saudi Arabia, and public knowledge of risk factors and warning signs supports early detection and prevention. This study aimed to assess CVD knowledge and its demographic predictors among adults in the Jazan region. Methods: A cross-sectional study was conducted among 382 adults (≥18 years) between February and April 2025. A questionnaire adapted from prior validated instruments assessed CVD awareness, knowledge of 11 risk factors and 10 warning signs, perceptions, and practices. Total knowledge scores (0–21) were dichotomized as adequate (≥8) versus inadequate (<8). Mann–Whitney U and Kruskal–Wallis tests were used for bivariate analysis, followed by binary logistic regression. Results: Most participants (89.5%) had heard of CVD, yet 53.7% had inadequate knowledge, and only 9.9% demonstrated good knowledge (≥15). The median total knowledge score was 7 (IQR 2–11) out of 21, with warning-sign knowledge (2.96/10) lower than risk-factor knowledge (3.95/11). Overweight/obesity (52.6%), hypertension (51.3%), and smoking (49.5%) were the most recognized risk factors; chest pain (47.6%) and shortness of breath (46.1%) were the most recognized warning signs. University education (aOR = 2.44, 95% CI 1.23–4.85, p = 0.011) and family history of chronic disease (aOR = 2.26, 95% CI 1.32–3.85, p = 0.003) were the only independent predictors of adequate knowledge. Conclusions: More than half of the surveyed adults in the Jazan region had inadequate CVD knowledge despite high general awareness. These findings suggest that targeted education using digital platforms and primary care providers may help improve knowledge of risk factors and warning signs in the region. Full article

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

10 pages, 6574 KB

Open AccessCase Report

Structured Differential Diagnosis of Orofacial Pain Associated with an Enamel Crack Using ICOP and ICHD-3: A Case Report

by Kohei Shimizu, Takuya Yasukawa, Masayuki Okano, Aki Kawamoto, Noboru Noma, Makoto Hayashi and Osamu Takeichi

Healthcare 2026, 14(13), 2001; https://doi.org/10.3390/healthcare14132001 - 6 Jul 2026

Abstract

Background: Cracked teeth may present with variable and atypical symptoms, sometimes mimicking non-odontogenic orofacial pain conditions, making diagnosis challenging, particularly when cracks appear limited to enamel. Case presentation: A 36-year-old woman presented with intermittent pain in a mandibular molar radiating to the ipsilateral [...] Read more.

Background: Cracked teeth may present with variable and atypical symptoms, sometimes mimicking non-odontogenic orofacial pain conditions, making diagnosis challenging, particularly when cracks appear limited to enamel. Case presentation: A 36-year-old woman presented with intermittent pain in a mandibular molar radiating to the ipsilateral temporal region. Clinical examination identified a crack line on the lingual surface of the mandibular first molar. Pulp sensibility testing (cold test and electric pulp test), occlusal loading tests, and cone-beam computed tomography (CBCT) were performed. CBCT was used primarily to exclude vertical root fracture and periapical pathology, and no radiographic abnormalities were identified. Differential diagnosis was conducted using structured diagnostic frameworks, including the International Classification of Orofacial Pain and the International Classification of Headache Disorders (3rd edition). Diagnostic local anaesthesia eliminated both biting pain and referred pain, supporting an odontogenic source. Collectively, the findings suggested that the enamel crack was the most likely source of odontogenic pain, although a definitive causal relationship could not be established. Because pulp sensibility remained normal, conservative management was selected. Crack sealing with a methyl methacrylate-based adhesive resin resulted in complete symptom resolution that was maintained throughout a 3-year follow-up period without the need for root canal treatment. Conclusions: Although the diagnosis remained probabilistic, the structured diagnostic approach, together with the favourable clinical response after crack sealing, supported the enamel crack as the most likely source of odontogenic pain. Full article

(This article belongs to the Special Issue Contemporary Clinical Advances in Endodontics)

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14 pages, 612 KB

Open AccessReview

Behavioral Determinants Potentially Relevant to First-Witness Responses in Prehospital Stroke Care: A COM-B-Based Scoping Review

by Keying Xu, Chengxia Wei, Hui Ni, Xinhao Chen and Gendi Lu

Healthcare 2026, 14(13), 2000; https://doi.org/10.3390/healthcare14132000 - 6 Jul 2026

Abstract

Objective: Delays in prehospital stroke care are often influenced by the actions of first witnesses (e.g., family, bystanders). However, evidence on what shapes their responses remains fragmented. This scoping review synthesizes these factors and maps them onto the Capability–Opportunity–Motivation–Behavior (COM-B) model. Methods: Following [...] Read more.

Objective: Delays in prehospital stroke care are often influenced by the actions of first witnesses (e.g., family, bystanders). However, evidence on what shapes their responses remains fragmented. This scoping review synthesizes these factors and maps them onto the Capability–Opportunity–Motivation–Behavior (COM-B) model. Methods: Following the PRISMA-ScR guidelines, eight international and Chinese databases were searched for studies published between 2019 and 2024. Two reviewers independently screened records and charted data. Because no eligible study directly recruited first witnesses, all included studies focused on stroke patients or the general public. We therefore adopted a conservative interpretive approach: we extracted factors occurring at the stroke scene before professional contact and, where a logical low-inference link existed, interpreted their potential relevance to first-witness behavior. These interpreted determinants were then mapped onto the COM-B framework. Results: Forty-eight studies involving approximately 257,000 participants from more than 20 countries were included. Factors identified across the literature covered all domains of the COM-B framework. Physical opportunity was the most frequently coded domain (33/134 codings, 24.6%), followed by psychological capability (26/134, 19.4%) and reflective motivation (22/134, 16.4%). Key barriers included insufficient stroke knowledge, limited access to emergency services, and delayed decision-making due to weak urgency perception. Conclusions: This scoping review identified behavioral factors potentially relevant to first-witness response, as interpreted from patient and public evidence. The findings suggest that prehospital stroke delays may be associated with the co-occurrence of limited capability, constrained opportunity, and insufficient motivation. These barriers often coexist and may interact with one another, highlighting the potential value of behavior-informed strategies for improving prehospital stroke response and reducing delay. Full article

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

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13 pages, 251 KB

Open AccessArticle

Beyond Cancer: Differences in Psychosocial Burden Between Patients with Chronic Non-Cancer Diagnoses Assessed Using the Integrated Palliative Outcome Scale

by Monika Grochowicka, Monika Pyszczorska, Grzegorz Kowalski, Małgorzata Reysner, Tomasz Reysner, Wojciech Leppert and Katarzyna Wieczorowska-Tobis

Healthcare 2026, 14(13), 1999; https://doi.org/10.3390/healthcare14131999 - 6 Jul 2026

Abstract

Background/Objectives: The Integrated Palliative Outcome Scale (IPOS) was developed for use in patients with advanced, life-limiting conditions. This study aimed to apply the IPOS in an inpatient hospice setting in Poland, incorporating both patient- and healthcare staff-reported perspectives in cancer and non-cancer [...] Read more.

Background/Objectives: The Integrated Palliative Outcome Scale (IPOS) was developed for use in patients with advanced, life-limiting conditions. This study aimed to apply the IPOS in an inpatient hospice setting in Poland, incorporating both patient- and healthcare staff-reported perspectives in cancer and non-cancer populations. Methods: Patients’ needs were assessed in 112 individuals (86 patients with cancer [C] and 26 with non-cancer diagnoses [nC]) using the Polish version of the IPOS. Assessments were conducted twice: within 24 h of admission (A1) and after 7 days (A2). Results: The mean age of the study population was 73.9 ± 11.9 years, and 63 patients (56.2%) were male. At A1, the total IPOS score reported by staff was significantly lower than that reported by patients (p < 0.01), primarily due to lower scores in the psychosocial domain (p < 0.001), while somatic domain scores were comparable. At A2, no significant changes were observed in total IPOS scores or in any domain in either patient- or staff-reported assessments. At A1, total IPOS scores did not differ significantly between C and nC groups. However, psychosocial domain scores were higher in the nC group (p < 0.01). Patients with non-cancer conditions reported higher levels of anxiety (p < 0.05), as well as greater needs related to feeling at peace (p < 0.01), sharing feelings (p < 0.05), and access to information (p < 0.05). Conclusions: Our findings underscore the multidimensional nature of suffering and highlight the need for more comprehensive recognition and assessment of psychosocial needs in palliative care patients, particularly those with non-cancer diagnoses. Full article

(This article belongs to the Special Issue Innovative Approaches to Chronic Disease Patient Care)

20 pages, 1344 KB

Open AccessSystematic Review

Association Between Physical Activity and Mortality in Men with or at Risk of Prostate Cancer: A Systematic Review

by Nacho García-Miralles, Irene Martínez-García, Irene Marcilla-Toribio, Andrea Herreros-Solano, Jaime Fernández-Bravo-Rodrigo, Silvana Patiño-Cardona, Elena Moreno-Charco, Amparo María Ortega-Armiñana, María Gregori-Navarro and Carlos Pascual-Morena

Healthcare 2026, 14(13), 1998; https://doi.org/10.3390/healthcare14131998 - 5 Jul 2026

Abstract

Introduction: Prostate cancer (PC) is a highly prevalent malignant tumour associated with significant morbidity and mortality. While physical activity has been linked to a lower risk of PC and exercise has been shown to reduce mortality, the evidence for the association between physical [...] Read more.

Introduction: Prostate cancer (PC) is a highly prevalent malignant tumour associated with significant morbidity and mortality. While physical activity has been linked to a lower risk of PC and exercise has been shown to reduce mortality, the evidence for the association between physical activity and mortality is limited. Objective: This study aimed to assess the association between physical activity and mortality risk in men with or at risk of PC. Methods: A systematic search was conducted in Medline, Scopus and Web of Science from inception until April 2026. Observational studies analysing physical activity and all-cause and PC-specific mortality were included. The data were synthesised and interpreted using a synthesis without meta-analysis (SWiM) approach. The quality of the studies was assessed using the NHLBI tool. The certainty of the evidence was assessed using the GRADE framework. Results: Fifteen observational studies were included. The hazard ratio (HR) was the predominant effect measure. Physical activity was associated with a reduction in all-cause mortality (HRs: 0.40–0.88; highest versus lowest categories), and a dose–response gradient was observed within two cohorts. Associations with PC-specific mortality were less consistent, with significant inverse findings concentrated in post-diagnosis assessments. The quality of the studies was generally poor, and the certainty of the evidence was very low for both outcomes. Conclusions: Physical activity was associated with lower all-cause mortality risk in men with or at risk of PC, and the most consistent inverse estimates were observed in post-diagnostic assessments. These findings are observational and should not be interpreted as a clinical recommendation. A dose–response pattern was noted within individual studies, although the certainty of evidence was very low for this outcome. Additionally, evidence for PC-specific mortality was inconsistent and of very low certainty. Prospective studies with standardised, objective measures of physical activity are required. Full article

(This article belongs to the Special Issue Exercise Science and Health Promotion)

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28 pages, 607 KB

Open AccessReview

Effects of Non-Pharmacological Interventions on the Biopsychosocial Health of Community-Dwelling Older Adults with Chronic Heart Failure: An Integrative Review

by Miguel Gerez-De-Paco, Dulcenombre de María García-López, Anabel Chica-Pérez, Cayetano Fernández-Sola, Adrián Martínez-Ortigosa and María del Mar Jiménez-Lasserrotte

Healthcare 2026, 14(13), 1997; https://doi.org/10.3390/healthcare14131997 - 5 Jul 2026

Abstract

Background/Objectives: Chronic heart failure (CHF) is a leading cause of global morbidity and mortality, particularly among older adults, significantly impacting their quality of life and imposing a substantial economic burden. While pharmacological and surgical treatments remain essential, non-pharmacological interventions led by nurses [...] Read more.

Background/Objectives: Chronic heart failure (CHF) is a leading cause of global morbidity and mortality, particularly among older adults, significantly impacting their quality of life and imposing a substantial economic burden. While pharmacological and surgical treatments remain essential, non-pharmacological interventions led by nurses are gaining prominence due to their comprehensive approach and biopsychosocial impact. The objective of this study was to synthesise and integrate such interventions for community-dwelling older adults with CHF. Methods: An integrative review was conducted in accordance with the Joanna Briggs Institute protocols and the PRISMA statement, utilising a systematic search across databases including PubMed and Cochrane. Qualitative, quantitative, and mixed-methods studies evaluating non-pharmacological interventions in the home setting were included, whilst those targeting non-specific populations were excluded. Following a rigorous screening process, 12 studies were selected, and their methodological quality was appraised based on study design. Results: The 12 included studies involved a total of 2466 participants and addressed interventions across the domains of education, physical activity, telehealth, and nutrition, with programme durations ranging from 4 weeks to 16 months. Notable improvements were observed in physical capacity, cognitive function, quality of life, and self-care capabilities, alongside potential reductions in hospitalisations reported in some studies. However, considerable methodological variability was identified across the literature. Conclusions: This review synthesises non-pharmacological nursing interventions for older adults with CHF, demonstrating varied benefits across multiple biopsychosocial domains. The findings emphasise the critical need for further research to evaluate the economic viability of these programmes and to adapt interventions to enhance the delivery of community-based care. Full article

(This article belongs to the Special Issue Healthcare Strategies for Patients with Chronic Diseases in an Ageing Society: Second Edition)

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11 pages, 872 KB

Open AccessArticle

Perinatal and Parental Predictors of Wheezing in the First Year of Life: A Saudi Arabian Birth Cohort Study

by Nasser S. Alharbi, Lana A. Shaiba, Mona Philby, Ebtesam Almutairi, Fahad Alsohime and Mohamad-Hani Temsah

Healthcare 2026, 14(13), 1996; https://doi.org/10.3390/healthcare14131996 - 5 Jul 2026

Abstract

Background: Infant wheezing is a common respiratory condition with a significant healthcare burden, yet data from the Middle East remain limited. This study aimed to identify predictors of any wheezing and recurrent wheezing during the first year of life in a Saudi Arabian [...] Read more.

Background: Infant wheezing is a common respiratory condition with a significant healthcare burden, yet data from the Middle East remain limited. This study aimed to identify predictors of any wheezing and recurrent wheezing during the first year of life in a Saudi Arabian birth cohort. Methods: This retrospective birth cohort study included infants born at King Saud University Medical City, Riyadh, in 2020. Data were collected from electronic medical records and a structured parental questionnaire administered via WhatsApp at 12 months of age, assessing wheezing episodes, parental atopy, household smoking, pets, home humidity, and nearby pollution sources. Any wheezing was defined as ≥1 wheezing episode during the first year, and recurrent wheezing as ≥3 episodes. Variables with p < 0.25 in univariable logistic regression were entered into multivariable models; adjusted odds ratios (aOR) with 95% confidence intervals are reported. Results: Of 594 infants, 135 (22.7%) experienced any wheezing and 85 (14.3%) had recurrent wheezing. NICU admission was independently associated with both any wheezing (aOR 2.65, 95% CI 1.49–4.73; p < 0.001) and recurrent wheezing (aOR 2.34, 95% CI 1.21–4.56; p = 0.012). Parental allergic rhinitis was independently associated with both outcomes (any wheezing: aOR 1.55, 95% CI 1.01–2.37; recurrent wheezing: aOR 1.67, 95% CI 1.00–2.78), while parental eczema was specifically associated with recurrent wheezing (aOR 1.74, 95% CI 1.00–3.03). Conclusions: NICU admission and parental atopy were associated with infant wheezing in this cohort. These findings provide region-specific data from Saudi Arabia but should be regarded as hypothesis-generating and require confirmation in prospective multicentre studies before informing clinical follow-up strategies. Full article

(This article belongs to the Section Women’s and Children’s Health)

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