Journal Description
Healthcare
Healthcare
is an international, scientific, peer-reviewed, open access journal on health care systems, industry, technology, policy, and regulation, and is published semimonthly online by MDPI. European Medical Association (EMA) and Ocular Wellness & Nutrition Society (OWNS) are affiliated with Healthcare and their members receive discounts on the article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE and SSCI (Web of Science), PubMed, PMC, and other databases.
- Journal Rank: JCR - Q2 (Health Policy and Services) / CiteScore - Q1 (Leadership and Management)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 21.5 days after submission; acceptance to publication is undertaken in 2.6 days (median values for papers published in this journal in the first half of 2025).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
- Companion journals for Healthcare include: Trauma Care and European Burn Journal.
- Journal Cluster of Healthcare Sciences and Services: Geriatrics, Journal of Ageing and Longevity, Healthcare, Hospitals, Hygiene, International Journal of Environmental Research and Public Health and Nursing Reports.
Impact Factor:
2.7 (2024);
5-Year Impact Factor:
2.8 (2024)
Latest Articles
Psychopathological Symptomatology and Sleep Quality in Chronic Primary Musculoskeletal Pain: A Comparison with Healthy Controls
Healthcare 2025, 13(16), 1965; https://doi.org/10.3390/healthcare13161965 (registering DOI) - 11 Aug 2025
Abstract
Background/Objectives: Chronic musculoskeletal pain without a clearly identifiable medical cause is characterised by significant emotional distress and/or functional disability. Given the relatively limited research specifically addressing chronic primary musculoskeletal pain (CPMP), as defined in the latest revision of the International Classification of Diseases
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Background/Objectives: Chronic musculoskeletal pain without a clearly identifiable medical cause is characterised by significant emotional distress and/or functional disability. Given the relatively limited research specifically addressing chronic primary musculoskeletal pain (CPMP), as defined in the latest revision of the International Classification of Diseases (ICD-11), the present study aimed to examine its psychopathological and sleep-related implications, and to explore whether pain intensity is associated with psychological distress and poor sleep quality. Methods: This observational study included 60 adult participants, comprising 30 patients diagnosed with CPMP and 30 healthy controls without any diagnosis. Participants completed the Numeric Pain Rating Scale (NPRS), the Symptom Checklist-90-R (SCL-90-R), and the Pittsburgh Sleep Quality Index (PSQI). Results: Patients with CPMP exhibited significantly higher levels of psychopathological symptomatology on the SCL-90-R and poorer sleep quality on the PSQI compared to controls (p < 0.05 for most dimensions). Greater pain intensity on the NPRS was strongly associated with psychological distress (e.g., GSI: r = 0.838, p < 0.01) and poor sleep quality (r = 0.785, p < 0.01). Hierarchical regression analyses revealed that pain intensity may play a meaningful role in both psychological distress and sleep quality (p < 0.05 across all models), even after statistically controlling for sex, age, and pain duration. Conclusions: These findings suggest that pain intensity is not only a key physical symptom, but also a relevant factor in understanding the broader psychological vulnerability in patients with CPMP. The present study contributes to a deeper understanding of the psychopathological and functional impact of CPMP and underscores the need for tailored psychological interventions to address the comorbid symptoms associated with this condition.
Full article
(This article belongs to the Special Issue Mental Health and Health Care in Vulnerable Contexts)
Open AccessArticle
Prevalence of Hearing Impairment in Saudi Arabia: Pathways to Early Diagnosis, Intervention, and National Policy
by
Ahmed Alduais, Hind Alfadda and Hessah Saad Alarifi
Healthcare 2025, 13(16), 1964; https://doi.org/10.3390/healthcare13161964 (registering DOI) - 11 Aug 2025
Abstract
Background: Hearing impairment is a significant public health issue globally, yet national data for Saudi Arabia remain sparse. Methods: Using data from the 2017 Disability Survey, we analysed 12 hearing-related indicators across 13 administrative regions. Descriptive statistics, logistic regression, cluster analysis, and residual
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Background: Hearing impairment is a significant public health issue globally, yet national data for Saudi Arabia remain sparse. Methods: Using data from the 2017 Disability Survey, we analysed 12 hearing-related indicators across 13 administrative regions. Descriptive statistics, logistic regression, cluster analysis, and residual mapping were applied to identify socio-demographic disparities and service gaps. Findings: Among 20,408,362 Saudi nationals, about 1,445,723 (7.1%) reported at least one functional difficulty. Of these, 289,355 individuals (1.4%) had hearing impairment, either alone or with other difficulties—229,541 (1.1%) had hearing impairment combined with other disabilities, while 59,814 (0.3%) had only hearing impairment. Females and males were equally affected. Notably, educational attainment and marital status significantly influenced device uptake; less-educated and divorced individuals were particularly underserved. Regionally, southern provinces (Al-Baha, Jazan, and Najran) demonstrated the highest unmet need due to geographic barriers, limited audiological resources, and socioeconomic constraints, reflecting compounded risks from consanguinity and rural isolation. Cluster analyses identified provinces requiring urgent attention, recommending mobile audiology units, tele-audiology services, and means-tested vouchers to enhance coverage. Conclusions: Despite Saudi Arabia’s existing public audiology services and a National Newborn Hearing Screening programme achieving 96% coverage, substantial gaps remain in follow-up care and specialist distribution, underscoring the necessity for systematic workforce tracking and enhanced rural incentives. International evidence from India and Brazil underscores the feasibility and cost-effectiveness (approximately USD 5200/QALY) of these recommended interventions. Implementing targeted provincial strategies, integrating audiological screening into routine healthcare visits, and aligning resource allocation with the WHO and Vision 2030 benchmarks will significantly mitigate hearing impairment’s health, social, and economic impacts, enhancing the quality of life and societal inclusion for affected individuals.
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(This article belongs to the Section Health Informatics and Big Data)
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Open AccessArticle
An Association Between Possible Sarcopenia as an Early Marker and Mild Cognitive Impairment: A Cross-Sectional Study
by
Junga Lee and Guang-Lei Zhang
Healthcare 2025, 13(16), 1963; https://doi.org/10.3390/healthcare13161963 (registering DOI) - 11 Aug 2025
Abstract
Background/Objectives: The purpose of this study is to investigate the association between possible sarcopenia, considered as an early marker before its diagnosis, and mild cognitive impairment. Methods: A cross-sectional study was conducted involving 60 physically inactive participants aged 40–69. Assessments included
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Background/Objectives: The purpose of this study is to investigate the association between possible sarcopenia, considered as an early marker before its diagnosis, and mild cognitive impairment. Methods: A cross-sectional study was conducted involving 60 physically inactive participants aged 40–69. Assessments included body composition, physical activity, and cognitive evaluations. The association between sarcopenia and mild cognitive impairment was examined using binary logistic regression, with odds ratios (ORs) and 95% confidence intervals (CIs) reported. Results: Participants with possible sarcopenia were found to have a 12.25 times higher risk of developing mild cognitive impairment (OR: 12.250; 95% CI: 1.692–88.711; p = 0.013). Conclusions: The findings highlight the critical role of early diagnosis of and intervention in sarcopenia to prevent cognitive decline. Future longitudinal studies are necessary to clarify causal relationships and optimize preventive strategies.
Full article
Open AccessArticle
Public Awareness and Knowledge of Prostate Cancer Screening: A Community Study in Saudi Arabia
by
Geetha Kandasamy, Khalid Orayj, Yahya I. Asiri, Eman Shorog, Asma M. Alshahrani and Hebah Abdullah Alenazi
Healthcare 2025, 13(16), 1962; https://doi.org/10.3390/healthcare13161962 - 11 Aug 2025
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Background: Prostate cancer (PCa) is one of the most common malignancies among men in Saudi Arabia and contributes significantly to cancer-related morbidity and mortality. The objective of this survey was to evaluate community awareness and screening practices related to PCa among men
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Background: Prostate cancer (PCa) is one of the most common malignancies among men in Saudi Arabia and contributes significantly to cancer-related morbidity and mortality. The objective of this survey was to evaluate community awareness and screening practices related to PCa among men in the Asir region of Saudi Arabia. Method: A cross-sectional study was conducted from 5 October to 25 December 2024 among men aged 40 and above in the Asir region, excluding those with a prior PCa diagnosis. Using convenience sampling, 399 participants were recruited via social media and community outreach. Data were collected through a self-administered online questionnaire covering demographics, medical history, PCa knowledge, information sources, prevention, screening awareness, and barriers. Informed consent was obtained from all participants. Results: The study comprised 399 male participants, with 37.09% aged 40–50, 36.34% aged 51–60, and 26.56% over 60. Most participants (363; 90.97%) were married, 245 (61.4%) had a university education, 282 (70.67%) lived in urban areas, and 180 (45.11%) were employed. Over half of the participants, 222 (55.63%), had a personal history of prostate problems. Additionally, 272 (68.17%) had health insurance, and 153 (38.34%) reported a monthly income between 10,000 and 14,999 SAR. The study found that 329 (82.5%) participants had good knowledge of PCa but only 197 (49.4%) had good awareness of screening methods. Key predictors of good awareness of PCa screening included a personal history of prostate problems (odds ratio—OR = 4.791, p = 0.000, confidence interval—CI 2.727–8.418) and health insurance (OR = 0.359, p = 0.000, CI 0.203–0.636). Common barriers to screening were affordability, n = 116 (29.07%), and perceived good health, n = 201 (50.37%). Additionally, 154 participants (38.59%) found screening uncomfortable, while 156 (39.59%) believed the Digital Rectal Exam (DRE) was harmful or embarrassing. Significant differences in perceived barriers were found based on age (F = 11.449, p < 0.001), education (F = 2.608, p = 0.051), occupation (F = 3.668, p = 0.026), family history (F = 17.407, p < 0.001), and income (F = 5.148, p = 0.006). Conclusions: The study highlights a significant gap between general knowledge and specific awareness of prostate cancer (PCa) screening among men in the Asir region. Although 82.5% demonstrated good overall knowledge, only 49.4% were aware of screening methods, and just 44.36% had undergone PSA testing. Common barriers included perceived good health, fear of diagnosis, embarrassment, and financial concerns. However, due to the use of convenience sampling, online distribution, and geographic restriction to the Asir region, the findings may not be generalizable to the broader male population in Saudi Arabia, particularly older men and those in rural areas. Addressing these gaps requires targeted education, empowerment of healthcare providers, and coordinated public health strategies to enhance early detection and reduce the PCa burden.
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Open AccessArticle
Work–Care Reconciliation Strategies for a Variety of Informal Carers: What Works and What Does Not?
by
Tjaša Potočnik and Valentina Hlebec
Healthcare 2025, 13(16), 1961; https://doi.org/10.3390/healthcare13161961 - 11 Aug 2025
Abstract
Objectives: The aim of this study is to describe and examine reconciliation strategies for reconciling work and informal care that are aimed at different types of working carers (carers of the following: family members with dementia; partners; children under 18; adult children;
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Objectives: The aim of this study is to describe and examine reconciliation strategies for reconciling work and informal care that are aimed at different types of working carers (carers of the following: family members with dementia; partners; children under 18; adult children; parents; other family members). Methods: We conducted a cross-sectional survey to examine structural strategies for a work–care balance throughout the caregiving period, followed by the frequency of the use of strategies in the last 12 months to better understand what is an effective work–care balance strategy for different working carer types. Hierarchical cluster analysis was conducted in February 2025 on 299 working carers drawn from a representative sample of adult Slovenian residents in an online probability panel. Results: The results show five clusters of carers that clearly indicate their use of reconciliation strategies depends on the national context, the work organisation and employees, the family structure, the value orientation of informal carers, and the type of care recipient. Conclusions: A variety of policy measures are needed to enable informal carers to remain active in the labour market while they care for dependent family members and relatives.
Full article
Open AccessReview
The Inner Road to Happiness: A Narrative Review Exploring the Interoceptive Benefits of Exercise for Well-Being
by
Laura Barca
Healthcare 2025, 13(16), 1960; https://doi.org/10.3390/healthcare13161960 - 10 Aug 2025
Abstract
Background: Interoception, the multifaceted perception of internal bodily signals, is crucial for homeostasis, emotional regulation, and overall well-being. Physical exercise significantly influences interoceptive mechanisms through its varied physiological, neurobiological, and psychological impacts. Despite its potential to enhance this internal sensing across its dimensions
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Background: Interoception, the multifaceted perception of internal bodily signals, is crucial for homeostasis, emotional regulation, and overall well-being. Physical exercise significantly influences interoceptive mechanisms through its varied physiological, neurobiological, and psychological impacts. Despite its potential to enhance this internal sensing across its dimensions and foster adaptive behaviors like self-regulation, exercise remains an underutilized therapeutic approach. Objective: This narrative review explores the current understanding of the interplay between exercise and interoception, examining its resulting impact on both mental and physical health. Method: A comprehensive literature search was conducted on PubMed using keywords such as “interoception,” “exercise,” and “well-being.” Article selection prioritized empirical studies, reviews, and influential theoretical papers. The synthesis of the literature was performed through a thematic analysis, structured around three primary mechanisms: physiological changes, neurobiological adaptations, and psychological benefits. Key Findings: Engaging in exercise improves interoceptive function by inducing physiological changes, fostering neurobiological adaptations, and yielding psychological advantages such as reduced stress. This enhancement in internal bodily sensing, encompassing its various dimensions, and promotion of adaptive behaviors has notable consequences for well-being. Conclusions and Future Directions: Exercise presents a valuable and readily available means to enhance interoceptive processing and encourage adaptive behaviors, with substantial positive implications for well-being throughout life. Future studies should focus on identifying the most effective exercise approaches tailored to individual requirements and exploring their specific impact on different interoceptive dimensions. Integrating exercise into clinical treatment plans and public health strategies offers a promising path to substantially boost well-being.
Full article
(This article belongs to the Topic Physical Exercise Impacts on Human Physical and Psychological Health)
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Open AccessArticle
Interventions to Improve Compliance to Surgical Safety Checklist Use: Before-and-After Study at a Tertiary Public Hospital in Croatia
by
Jure Krstulović, Zrinka Hrgović, Ante Krešo, Ante Tavra, Ljubo Znaor and Ana Marušić
Healthcare 2025, 13(16), 1959; https://doi.org/10.3390/healthcare13161959 - 10 Aug 2025
Abstract
Background/Objectives: The World Health Organization’s Surgical Safety Checklist (WHO SSC) is known to reduce surgical complications and mortality, yet its implementation remains inconsistent across institutions. This study evaluated compliance with a modified SSC and assessed the impact of structured interventions to improve adherence
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Background/Objectives: The World Health Organization’s Surgical Safety Checklist (WHO SSC) is known to reduce surgical complications and mortality, yet its implementation remains inconsistent across institutions. This study evaluated compliance with a modified SSC and assessed the impact of structured interventions to improve adherence at the University Hospital of Split, Croatia. Methods: A before-and-after study analyzed a sample of 1437 completed SSCs over four time points between April 2024 and May 2025: the baseline and after three successive interventions (an official letter from the hospital director emphasizing mandatory SSC use, individual meetings with department heads and head nurses reinforcing its importance, and a quality audit review of SSC completeness with leadership). Checklist completeness was assessed across five SSC sections: General Information, Sign In, Time Out, Sign Out, and Staff Info. Results: Overall checklist completeness increased from 78.3 ± 8.5% at baseline to 86.3 ± 2.5%, 92.0 ± 3.8%, and 94.7 ± 4.8% after the first, second, and third interventions, respectively (p < 0.001). All checklist sections improved significantly: General Info rose from 91.1 ± 6.0% to 98.6 ± 2.6% (p < 0.001); Sign In from 85.0 ± 11.4% to 97.0 ± 3.5% (p = 0.002); Time Out from 79.0 ± 14.6% to 96.4 ± 6.5% (p < 0.001); Sign Out from 70.2 ± 11.2% to 87.7 ± 11.0% (p = 0.003); and Staff Info from 70.7 ± 12.9% to 100.0 ± 0.0% (p < 0.001). Post hoc testing confirmed significant gains versus baseline for all three interventions (Dunnett’s test), with a further significant improvement between the first and third interventions (Tukey’s HSD, p = 0.011). Conclusions: Structured, low-cost interventions emphasizing administrative support, education, and communication significantly improved SSC adherence across a large tertiary hospital. This initiative represents a pioneering effort in Croatia and offers a scalable model for similar public healthcare systems aiming to enhance patient safety.
Full article
(This article belongs to the Special Issue Health Care Professionals' Role in Developing Quality and Patient Safety)
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Open AccessArticle
Semantic Processing Deficits and Their Use as Early Biomarkers in Schizophrenia
by
Alfonso Martínez-Cano, Begoña Polonio-López, Juan José Bernal-Jiménez, José L. Martín-Conty, Laura Mordillo-Mateos and Manuela Martinez-Lorca
Healthcare 2025, 13(16), 1958; https://doi.org/10.3390/healthcare13161958 - 10 Aug 2025
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Background: Schizophrenia is a serious mental health condition that usually begins in adolescence and often progresses to become a chronic and disabling illness. Difficulties in communication and anomalous language are considered core elements of the disorder. Several studies have demonstrated the presence
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Background: Schizophrenia is a serious mental health condition that usually begins in adolescence and often progresses to become a chronic and disabling illness. Difficulties in communication and anomalous language are considered core elements of the disorder. Several studies have demonstrated the presence of semantic deficits in individuals with schizophrenia, suggesting that these deficits may constitute a core feature of the disorder. However, research in this area remains limited, particularly among individuals at high risk of developing the disorder. The central hypothesis of this study is that individuals with schizophrenia exhibit semantic processing deficits, even when cognitive function, psychopathology, and medication are controlled for. We also hypothesize that similar, albeit milder, deficits can be observed in individuals at high risk of developing the condition. Methods: This cross-sectional study included 155 participants divided into three groups: 46 with schizophrenia, 42 at high risk due to factors like substance use and high psychopathology, and 67 controls matched by sex, age, and education. Semantic processing was assessed using the semantic relations subtest from the BETA, controlling for medication and cognitive performance as possible confounding factors. Results: the results revealed significant differences among the three groups (F = 28.543; p < 0.001); the schizophrenia group performed poorly, followed by the high-risk group, and then the control group, which showed no deficits. Error patterns were also analyzed to assess group differences, revealing that the schizophrenia group had the lowest scores and the most specific deficits. These findings highlight the relevance of semantic evaluation in schizophrenia and, more importantly, in individuals at high risk of developing the disorder, as such deficits may serve as early biomarkers. Additionally, significant correlations were found between semantic performance and variables such as medication (r = −0.342; p = 0.020), cognition (r = −0.259; p = 0.001), and psychopathology (r = −0.566; p < 0.001). Conclusions: This emphasizes the need to control these factors to avoid misinterpreting semantic deficits in both schizophrenia and high-risk groups. The present research is not without limitations; for example, the study design does not allow for conclusions of causality but rather of correlation.
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Open AccessOpinion
Unlocking the Power of Sankalpa in Yoga Nidra Practice: Cognitive Restructuring Processes and Suggestions for Athletes’ Health
by
Selenia di Fronso
Healthcare 2025, 13(16), 1957; https://doi.org/10.3390/healthcare13161957 - 10 Aug 2025
Abstract
This opinion article aims to highlight the potential mechanisms behind a specific stage of Yoga Nidra (YN) practice, i.e., the formulation and repetition of Sankalpa, encouraging scholars to further study it and providing athletes with suggestions on how to use it for their
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This opinion article aims to highlight the potential mechanisms behind a specific stage of Yoga Nidra (YN) practice, i.e., the formulation and repetition of Sankalpa, encouraging scholars to further study it and providing athletes with suggestions on how to use it for their sport and health. YN can be defined as a meditation practice encompassing a sequence of breathing, guided body awareness, visualization and cognitive restructuring process exercises. According to preliminary results, YN stimulates a hypnagogic state generally associated with improvements in sleep parameters, thus enhancing recovery and health in different populations including athletes. Cognitive restructuring processes can be stimulated by the formulation of Sankalpa, a YN element comparable to positive self-instructions used to counteract dysfunctional cognitions. From a practical standpoint, the formulation of Sankalpa involves expressing an intention that could positively influence body, mind and emotions. For example, Sankalpa might stop or reverse unhealthy thought patterns, resulting in greater mental health. It might also foster intrinsic motivation and enhance emotional intelligence by strengthening mental resilience. In particular, athletes could use Sankalpa as an affirmation to awaken any strength they may feel is necessary to provide them with stress–recovery balance and mental health. However, additional research on this topic is needed to better elucidate Sankalpa’s mechanisms/effects and better integrate its formulation into sport programs.
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(This article belongs to the Special Issue Yoga and Mindfulness Interventions for Health and Well-Being in Different Populations)
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Open AccessArticle
From Mandate to Choice: How Voluntary Mask Wearing Shapes Interpersonal Distance Among University Students After COVID-19
by
Yi-Lang Chen, Che-Wei Hsu and Andi Rahman
Healthcare 2025, 13(16), 1956; https://doi.org/10.3390/healthcare13161956 - 9 Aug 2025
Abstract
Background/Objectives: As COVID-19 policies shift from government mandates to individual responsibility, understanding how voluntary protective behaviors shape social interactions remains a public health priority. This study examines the association between voluntary mask wearing and interpersonal distance (IPD) preferences in a post-mandate context, focusing
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Background/Objectives: As COVID-19 policies shift from government mandates to individual responsibility, understanding how voluntary protective behaviors shape social interactions remains a public health priority. This study examines the association between voluntary mask wearing and interpersonal distance (IPD) preferences in a post-mandate context, focusing on Taiwan, where mask wearing continues to be culturally prevalent. Methods: One hundred university students (50 males, 50 females) in Taiwan completed an online IPD simulation task. Participants adjusted the distance of a virtual avatar in response to targets that varied by gender and mask status. Mask-wearing status upon arrival was recorded naturally, without manipulation. A four-way ANOVA tested the effects of participant gender, participant mask wearing, target gender, and target mask wearing on the preferred IPD. Results: Voluntary mask wearing was more common among female participants (72%) than males (44%). Mask-wearing individuals maintained significantly greater IPDs, suggesting heightened risk perception, whereas masked targets elicited smaller IPDs, possibly due to social signaling of safety. Gender differences emerged in both protective behavior and spatial preferences, with females showing stronger associations between mask use and distancing behavior. Conclusions: These findings offer actionable insights into how voluntary behavioral adaptations continue to shape spatial interaction norms after mandates are lifted. The integration of real-time simulation and statistical modeling highlights the potential of digital behavioral tools to support culturally adaptive, person-centered public health strategies.
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(This article belongs to the Special Issue Data Driven Insights in Healthcare)
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Open AccessArticle
Knowledge of Vaginal Microbiota and Its Association with Perceptions of Vulvovaginal Aesthetic Procedures Among Saudi Women
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Esraa Aldawood, Lama Alzamil, Layla Faqih and Sarah Almuhayya
Healthcare 2025, 13(16), 1955; https://doi.org/10.3390/healthcare13161955 - 9 Aug 2025
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Background: The human microbiome includes trillions of microorganisms, with the vaginal microbiota playing a vital role in women’s reproductive health. Concurrently, interest in vulvovaginal esthetic procedures (VVEP) is increasing. This study aimed to compare single and married or previously married women in terms
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Background: The human microbiome includes trillions of microorganisms, with the vaginal microbiota playing a vital role in women’s reproductive health. Concurrently, interest in vulvovaginal esthetic procedures (VVEP) is increasing. This study aimed to compare single and married or previously married women in terms of their knowledge of the human microbiome, particularly the vaginal microbiota, and their perceptions of VVEP. It also examined associations between microbiota awareness, attitudes toward VVEP, and sociodemographic factors. Methods: A cross-sectional, online survey was distributed to women aged 18 years and older in Saudi Arabia. A total of 1019 responses were collected. Chi-square tests compared knowledge responses between marital groups, while linear regression was used to explore associations between microbiota knowledge and participant characteristics. Results: Single women showed greater awareness of general microbiome concepts, with 42% correctly identifying the term “microbiome” compared to 29.89% of married or previously married women. In contrast, married or previously married women demonstrated better knowledge of vaginal microbiota and the effects of antibiotic misuse. Of the participants, 6.6% had undergone one or more VVEP. Furthermore, 19.7% of single women and 18.3% of married or previously married women expressed future interest in undergoing such procedures. Marital status influenced perceptions of specific procedures, with married or previously married women more likely to justify interventions such as augmentation of the labia minora/“G-spot” augmentation and vaginal rejuvenation. Justification for augmentation of the labia minora/“G-spot” augmentation in this group was associated with lower vaginal microbiota knowledge. Healthcare professionals exhibited significantly higher microbiota awareness. Conclusion: Enhancing women’s knowledge of vaginal microbiota can enhance informed decision-making and reduce unnecessary esthetic interventions among Saudi women, thereby supporting better reproductive health outcomes.
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Open AccessArticle
Pain Neuroscience Education Versus Biomedical Pain Education with Exercise in Primary Dysmenorrhea: A Randomized Controlled Trial
by
Büşra N. Erol, Ceren Gürşen, Sezcan Mümüşoğlu and Serap Özgül
Healthcare 2025, 13(16), 1954; https://doi.org/10.3390/healthcare13161954 - 9 Aug 2025
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Background/Objectives: Although pain education is a very important component of chronic pain management, its effects on primary dysmenorrhea (PD) have not been investigated. The aim of this study was to compare the effects of pain neuroscience education (PNE) or biomedical pain education (BPE)
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Background/Objectives: Although pain education is a very important component of chronic pain management, its effects on primary dysmenorrhea (PD) have not been investigated. The aim of this study was to compare the effects of pain neuroscience education (PNE) or biomedical pain education (BPE) combined with exercise training (ET) in PD. Methods: Individuals with PD were randomly assigned to PNE or BPE combined with ET (stretching and relaxation exercises) for two menstrual cycles. The PNE focused on pain neurobiology, central sensitization, and brain pain-modulation mechanisms, while the BPE included anatomical and biomechanical explanations of pain. Assessments were conducted at the start of the study, after the intervention period, and at the one-month follow-up after the intervention. The primary outcome measure was menstrual pain (mean and maximum pain) intensity, while the secondary outcome measures included menstrual stress, central sensitization symptoms, and pain catastrophizing. Results: All the individuals assigned to the PNE+ET (n = 19) and BPE+ET (n = 19; control) groups were included in the analysis. PNE or BPE with ET led to improvements in all outcome measures (p < 0.05). Furthermore, PNE was found to reduce menstrual pain, central sensitization symptoms, and pain catastrophizing more after the intervention and at follow-up compared to BPE (p < 0.05, Cohen’s d = 0.683–1.174). However, menstrual stress decreased at similar levels in both groups (p > 0.05). Conclusions: The combination of PNE or BPE with ET was demonstrated to be an effective approach for the management of menstrual pain and stress in PD. Furthermore, PNE appears to be more efficacious in addressing menstrual pain, symptoms of central sensitization, and pain cognition compared with BPE. Further studies could investigate the combination of PNE with different education parameters and physiotherapy methods to manage PD.
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Open AccessReview
Impact of Direct-Acting Antivirals on Extrahepatic Manifestations in Chronic Hepatitis C: A Narrative Review with a Hermeneutic Approach
by
Alexia Anastasia Stefania Balta, Mariana Daniela Ignat, Raisa Eloise Barbu, Caterina Dumitru, Diana Sabina Radaschin, Valentin Bulza, Silvia Aura Mateescu Costin, Catalin Pleșea-Condratovici and Liliana Baroiu
Healthcare 2025, 13(16), 1953; https://doi.org/10.3390/healthcare13161953 - 9 Aug 2025
Abstract
Background/Objectives: Chronic hepatitis C virus (HCV) infection is associated with a wide spectrum of extrahepatic manifestations, involving the immune, dermatologic, endocrine, vascular, and neuropsychiatric systems. Among these, mixed cryoglobulinemic vasculitis (CryoVas) remains one of the most clinically relevant complications. This work aims
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Background/Objectives: Chronic hepatitis C virus (HCV) infection is associated with a wide spectrum of extrahepatic manifestations, involving the immune, dermatologic, endocrine, vascular, and neuropsychiatric systems. Among these, mixed cryoglobulinemic vasculitis (CryoVas) remains one of the most clinically relevant complications. This work aims to provide a structured overview of HCV-related extrahepatic conditions and to analyze the clinical and virological outcomes of direct-acting antivirals (DAAs) in CryoVas patients. Methods: We first categorized and reviewed extrahepatic manifestations of HCV across five major domains: immune, inflammatory/metabolic/vascular, dermatological, thyroid, and neuropsychiatric. Subsequently, we conducted a comparative analysis of five clinical studies evaluating the impact of DAA therapy in patients with CryoVas. Data on demographics, clinical symptoms, treatment regimens, sustained virological response, and clinical response were extracted and summarized. Results: HCV was found to be associated with numerous extrahepatic conditions, including mixed cryoglobulinemia, non-Hodgkin lymphoma, autoimmune thyroiditis, insulin resistance, and neurocognitive symptoms. In the CryoVas subgroup analysis, virological response rates were uniformly high (88.9–100%), but clinical remission varied significantly. Complete response ranged from 39% to 90%, highlighting a discrepancy between viral eradication and extrahepatic symptom resolution. These findings underscore the need for individualized follow-up and further investigation into persistent immunological dysfunction post-sustained virological response (SVR). However, clinical outcomes were more variable: complete response (CR) varied between 39% and 90%, partial response (PR) ranged from 4% to 42%, and no response (NR) was reported in 0% to 40% of cases. Although significant improvement in key manifestations such as purpura, arthralgia, and neuropathy was frequently observed, a subset of patients continued to exhibit residual or refractory symptoms despite achieving SVR. Conclusions: HCV infection exerts multisystemic effects that extend beyond liver pathology. While DAAs offer near-universal virological clearance, the heterogeneous clinical response in CryoVas underscores the need for closer monitoring of extrahepatic outcomes. Future research should assess whether combining DAAs with immunomodulatory strategies can improve symptom control and long-term outcomes in patients with severe or refractory CryoVas.
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(This article belongs to the Section Chronic Care)
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Open AccessReview
Standardized Nursing Terminologies and Electronic Health Records: A Secondary Analysis of a Systematic Review
by
Luca Bertocchi, Cristina Petrucci, Vittorio Masotta, Alessia Marcotullio, Dorothy Jones, Loreto Lancia and Angelo Dante
Healthcare 2025, 13(16), 1952; https://doi.org/10.3390/healthcare13161952 - 9 Aug 2025
Abstract
Background/Objectives: Standardized nursing terminologies (SNTs) have been associated with improved patient and organizational outcomes. This secondary analysis aims to examine how structured nursing assessment data and documentation are integrated into electronic health records (EHRs) in studies that report on the impact of American
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Background/Objectives: Standardized nursing terminologies (SNTs) have been associated with improved patient and organizational outcomes. This secondary analysis aims to examine how structured nursing assessment data and documentation are integrated into electronic health records (EHRs) in studies that report on the impact of American Nurses Association–recognized SNTs. Methods: Data were extracted from all 53 primary studies included in a previously published systematic review. The original literature search was conducted in PubMed, Scopus, CINAHL, and OpenGrey. Extracted data focused on nursing assessment tools, use of EHRs, inter-rater reliability, and methodological characteristics. Results: Gordon’s Eleven Functional Health Patterns was the most frequently used nursing assessment framework, often in combination with NANDA-I diagnoses. However, details regarding assessment tools and their application in EHRs were inconsistently reported. Only about one-third of the studies explicitly indicated the use of EHRs, though an upward trend in their use has been observed over the last decade. Inter-rater reliability was reported in a limited number of studies, with considerable variation. An overall increasing trend in the use of nursing assessment data in electronic health records was observed over the past decade. Conclusions: The integration of SNTs with structured assessment frameworks into EHRs is increasing but remains inconsistently reported. Standardized documentation practices could strengthen nursing visibility, support quality improvement, and enhance outcome measurement in both clinical and research contexts.
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(This article belongs to the Special Issue Transforming Care Through Clinical Nursing Information Systems and Standardized Nursing Terminologies: Optimizing Data-Driven Care in Hospital and Community Settings)
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Open AccessArticle
Depressive Symptoms and Associated Factors Among Middle-Aged and Older Patients with Chronic Kidney Disease: Gender Differences Based on a Health Ecological Model
by
Yu Zhang, Yingqi Huang, Wenhui Zhang, Ya Shi, Youtao Mou, Yuanyuan Lan, Manoj Sharma, Lei Zhang and Yong Zhao
Healthcare 2025, 13(16), 1951; https://doi.org/10.3390/healthcare13161951 - 9 Aug 2025
Abstract
Objectives: Depressive symptoms are highly prevalent among individuals with chronic kidney disease (CKD). This study explores their associated factors and gender differences among middle-aged and older CKD patients in China. Methods: Based on the health ecology model (HEM), this study utilized
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Objectives: Depressive symptoms are highly prevalent among individuals with chronic kidney disease (CKD). This study explores their associated factors and gender differences among middle-aged and older CKD patients in China. Methods: Based on the health ecology model (HEM), this study utilized the 2018 cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS) to examine gender differences in CKD patients across demographic groups. A multivariate logistic regression identified factors associated with depressive symptoms and gender differences among middle-aged and older patients with CKD in China. Additionally, a random forest model was constructed to rank the importance of key predictors based on the Gini index. Results: Among 1422 CKD patients, 50.35% reported depressive symptoms (42.97% of males and 59.56% of females). Factors significantly associated with higher depressive symptoms included female gender, rural residence, poor self-reported health, sleep duration < 7 h, and limitations in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The association of smoking and ADLs on depressive symptoms in CKD patients varied considerably between genders. Self-reported health and life satisfaction were the two variables most strongly associated with depressive symptoms among CKD patients. Conclusions: The study shows that female CKD patients have a higher prevalence of depressive symptoms than males. Several factors are significantly associated with depressive symptoms in patients with CKD. These findings provide valuable insights that potentially inform the development of targeted prevention and management strategies for depressive symptoms in middle-aged and older CKD patients in China.
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(This article belongs to the Special Issue Mental Health in Older People)
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Open AccessArticle
Association Between Lifestyle Parameters, Quality of Life, and Satisfaction with Life in Chilean University Students
by
Felipe Caamaño-Navarrete, Carlos Arriagada-Hernández, Gerardo Fuentes-Vilugrón, Iris Paola Guzmán-Guzmán, Lorena Jara-Tomckowiack, Daniel Jerez-Mayorga, Indya del-Cuerpo, Guido Contreras-Díaz, Claudio Hernández-Mosqueira, Claudia Andrea Vargas and Pedro Delgado-Floody
Healthcare 2025, 13(16), 1950; https://doi.org/10.3390/healthcare13161950 - 9 Aug 2025
Abstract
Background: A negative lifestyle has been reported to be associated with poor quality of life (QoL). However, there is limited information regarding the relationship between satisfaction with life (SWL) and lifestyle factors in university students. Objective: The aim of the present study was
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Background: A negative lifestyle has been reported to be associated with poor quality of life (QoL). However, there is limited information regarding the relationship between satisfaction with life (SWL) and lifestyle factors in university students. Objective: The aim of the present study was to determine the association between lifestyle parameters, quality of life (i.e., physical, psychological, social, and environmental dimensions), and categories of satisfaction with life (i.e., extremely satisfied, satisfied, slightly satisfied, dissatisfied, extremely dissatisfied) in Chilean university students. Methods: This cross-sectional study included a total of 212 university students (128 females and 83 males), aged between 18 and 28 years. Physical activity (PA), screen time (ST), dietary habits, sleep quality, QoL, and SWL were assessed using validated questionnaires. Results: SWL presented inverse association with unhealthy diet (β = −0.18, 95%CI; −0.28 to −0.09, p < 0.001), sleep < 6 h (β = −0.21, 95%CI; −0.31 to −0.11, <0.001), ST > 4 h (β = −0.10, 95%CI; −0.18 to −0.01, 0.015) and non-PA (β = −0.10, 95%CI; −0.19 to −0.01, p = 0.027). Regarding the association between lifestyle parameters and QoL, unhealthy diet was inversely associated with the physical (β; 0.18, 95%CI; −0.27 to −0.09, <0.001), psychological (β = −0.18, 95%CI; −0.27 to 0.09, p < 0.001), and environmental (β = −0.14, 95%CI; −0.23 to −0.06, 0.001) dimensions, and overall QoL score (β = −0.06, 95%CI; −0.09 to −0.03, p < 0.001). Sleep duration < 6 h showed inverse associations with the physical (β = −0.21, 95%Ci; −0.30 to −0.11, <0.001), psychological (β = −0.20, 95%CI; −0.30 to −0.10, <0.001), social (β = −0.30, 95%CI; −0.47 to −0.14, p < 0.001), and environmental (β = −0.13, 95CI; −0.21 to −0.04, p = 0.004) dimensions, and overall QoL score (β = −0.07, 95%CI; −0.10 to −0.04, p < 0.001). Non-PA was associated with physical dimensions (β = −0.09, 95%CI; −0.17 to −0.01, p = 0.019). Non-PA reported association with physical (β = −0.16, 95%CI; −0.25 to −0.07, p < 0.001), psychological (β = −0.20, 95%CI; −0.30 to −0.10, p < 0.001), social (β = −0.25, 95%CI; −0.41 to −0.09, p = 0.002), and environmental (β = −0.11, 95%CI; −0.19 to −0.02, p = 0.010) dimensions, and QoL overall score (β = −0.06, 95%CI; −0.09 to −0.03, p < 0.001). Conclusions: Poor diet, inadequate sleep, excessive ST, and non-PA are all associated with negative impacts on SWL and QoL in Chilean university students.
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(This article belongs to the Section Environmental Factors and Global Health)
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Open AccessArticle
Patterns and Factors Associated with E-Cigarette Initiation and Transition Among University Students in Al-Madinah City, Saudi Arabia: A Cross-Sectional Study
by
Shahad Mubarak Alahmadi and Abdulmohsen Hamdan Al-Zalabani
Healthcare 2025, 13(16), 1949; https://doi.org/10.3390/healthcare13161949 - 9 Aug 2025
Abstract
Background/Objectives: Electronic cigarettes (e-cigarettes) have gained popularity among young adults globally, but only limited research exists on usage patterns in Saudi Arabia. This study investigated the prevalence, patterns, and factors associated with e-cigarette use initiation and transition to cigarette smoking among university
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Background/Objectives: Electronic cigarettes (e-cigarettes) have gained popularity among young adults globally, but only limited research exists on usage patterns in Saudi Arabia. This study investigated the prevalence, patterns, and factors associated with e-cigarette use initiation and transition to cigarette smoking among university students in Saudi Arabia. Methods: A cross-sectional survey was conducted among 537 university students in Al-Madinah city during the 2024–2025 academic year. Data were collected using a self-administered online questionnaire assessing e-cigarette use patterns, motivations, susceptibility to future cigarette smoking, and demographic characteristics. Multivariable logistic regression analysis was used to identify factors associated with e-cigarette use. Results: E-cigarette prevalence was substantial: 11.7% of participants were current users, 5.4% were former users, and 27.9% were ever-users, compared with 5.8% current cigarette smokers. Males had significantly higher use rates than females (20.9% vs. 4.6%; p < 0.001). Senior students showed the highest current use (21.1%). Among ever-users, the primary motivations were enjoyment (29.3%), the possibility of use where smoking is banned (26.1%), and social acceptability (21.7%). Most users (73.0%) used high-nicotine liquids (≥20 mg/mL), and 55.4% vaped daily. Multivariable logistic regression revealed that e-cigarette use was independently associated with male gender (adjusted OR = 4.0), higher academic year (OR = 1.24), current smoking (adjusted OR = 3.45; 95 CI: 1.54–7.82), and lower harm perception (adjusted OR = 1.69; 95 CI: 1.16–2.51). Susceptibility to future cigarette smoking was 18.9% overall but much higher among current e-cigarette smokers (59.5%; p < 0.001). Conclusions: E-cigarette use was prevalent among Saudi university students, particularly males and senior students, with patterns suggestive of nicotine dependence. Strong associations with cigarette smoking and high-concentration nicotine use raise concerns about dual use and addiction potential.
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Open AccessReview
Stress, Anxiety, and Depression as Psychological Distress Among College and Undergraduate Students: A Scoping Review of Reviews Guided by the Socio-Ecological Model
by
Sharmistha Roy, Ashis Kumar Biswas and Manoj Sharma
Healthcare 2025, 13(16), 1948; https://doi.org/10.3390/healthcare13161948 - 9 Aug 2025
Abstract
Background/Objectives: College and undergraduate students around the world struggle with stress, anxiety, and depression, which have a significant negative influence on their academic performance, social interactions, and general well-being. Creating successful preventative and intervention plans requires an understanding of the many, multi-level
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Background/Objectives: College and undergraduate students around the world struggle with stress, anxiety, and depression, which have a significant negative influence on their academic performance, social interactions, and general well-being. Creating successful preventative and intervention plans requires an understanding of the many, multi-level factors that contribute to psychological discomfort. The objective of this scoping review was to use the Socio-Ecological Model (SEM) to map the determinants of psychological distress among college students in a comprehensive manner. Methods: A total of 15 review publications published between 2015 and 2024, including narrative reviews, systematic reviews, meta-analyses, and umbrella reviews, were analyzed under the guidance of PRISMA ScR. These studies synthesized evidence across various countries, including China, Iran, India, Canada, Egypt, Nigeria, Saudi Arabia, and the United States. Results: Academic pressure, financial stress, poor sleep, unhealthy coping mechanisms, and pre-existing mental health issues were all individual-level concerns, with female and minority students being more vulnerable. Strong familial ties and friendships served as protective interpersonal support. Heavy academic workloads, strict grading guidelines, a lack of mental health resources, and unwelcoming campus environments were among the institutional factors. Stigma and socioeconomic disparities are examples of community-level variables that make mental health issues worse. Conclusions: Student mental health is shaped by interrelated factors across all SEM levels. Integrated, multi-level strategies are essential to fostering supportive campuses, strengthening community networks, and implementing inclusive policies that promote mental health equity.
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Open AccessReview
Violence Against Healers in Italy: A Medico-Legal Inquiry into Patient Aggression
by
Paolo Bailo, Filippo Gibelli, Marilyn Cennamo, Giuliano Pesel, Emerenziana Basello, Tommaso Spasari and Giovanna Ricci
Healthcare 2025, 13(16), 1947; https://doi.org/10.3390/healthcare13161947 - 8 Aug 2025
Abstract
In recent years, Italy has experienced a significant increase in violence against healthcare workers, mirroring a global trend. Manifesting as verbal, physical, psychological, and material aggression, this phenomenon endangers both personnel safety and the foundational principles of the National Health Service (SSN) as
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In recent years, Italy has experienced a significant increase in violence against healthcare workers, mirroring a global trend. Manifesting as verbal, physical, psychological, and material aggression, this phenomenon endangers both personnel safety and the foundational principles of the National Health Service (SSN) as outlined in Article 32 of the Italian Constitution. The escalation—most acute in emergency departments, psychiatric units, inpatient wards, and community services—affects a broad spectrum of professionals, compromising care quality and institutional integrity. Data from the FNOMCeO-CENSIS Report 2023–2024 reveal over 18,000 reported incidents in 2024, with verbal assaults disproportionately affecting female nursing staff. The COVID-19 pandemic further exacerbated systemic vulnerabilities, heightening user dissatisfaction and psychological strain among healthcare providers. In response, legislative actions—such as Law No. 113/2020 and Decree-Law No. 137/2024—aim to strengthen prevention, monitoring, and penal measures. This article examines legal, institutional, and organizational responses, including on-the-ground and hospital-based strategies to mitigate violence. Adopting a multidisciplinary perspective, it analyzes recent policy developments, regional dynamics, and victim-perpetrator profiles, arguing that safeguarding healthcare environments is both a public security priority and an ethical imperative essential to preserving the dignity of care work and the resilience of the health system.
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Open AccessArticle
Impact of Age and Years in the Fire Service on Firefighter Health and Physical Performance Outcomes
by
Jisun Chun, Michael J. Conner, Jacob A. Mota, Brian Newman, J. Jay Dawes, Steven E. Martin and Drew Edward Gonzalez
Healthcare 2025, 13(16), 1946; https://doi.org/10.3390/healthcare13161946 - 8 Aug 2025
Abstract
Background: Age is considered an independent cardiovascular disease (CVD) risk factor, but limited data exist concerning the impact of age and years in the fire service on firefighter health and physical performance. Objectives: We assessed the impact of age and years
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Background: Age is considered an independent cardiovascular disease (CVD) risk factor, but limited data exist concerning the impact of age and years in the fire service on firefighter health and physical performance. Objectives: We assessed the impact of age and years in the fire service on structural firefighter health and physical performance. Methods: 142 firefighters completed an annual clinical assessment. General linear model (GLM) multivariate and univariate analyses were performed across age groups, with years of fire service experience as a covariate. Partial Eta squared (ηp2) values for the GLM statics and Cohen’s d for pairwise comparisons were used to assess effect size. Results: GLM analyses revealed statistically significant differences (p < 0.05) for several demographic, body composition, blood biomarker, and physical performance parameters. Pairwise comparisons revealed that younger firefighters displayed more favorable health and fitness profiles than their older counterparts. Interestingly, when accounting for years of fire service experience, differences for only the following variables remained: body mass index, waist circumference, lean mass, visceral adipose tissue, triglycerides, cardiopulmonary exercise test time-to-exhaustion, and VO2max. Conclusions: These findings suggest differences in CVD risk biomarkers, physical fitness levels, and body composition metrics across age groups. However, years of fire service experience appears to have a greater impact on these variables, suggesting that firefighters’ time in the fire service may accelerate the effects of aging on these outcomes. While age-specific health interventions are recommended to manage and mitigate CVD risk effectively, there also should be consideration for the years of fire service.
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(This article belongs to the Special Issue Health and Readiness of Tactical Populations)
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