Healthcare

14 pages, 515 KiB

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 (registering DOI) - 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 [...] Read more.

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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18 pages, 554 KiB

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 (registering DOI) - 10 Aug 2025

Abstract

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 [...] Read more.

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. Full article

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7 pages, 499 KiB

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 (registering DOI) - 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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Yoga and Mindfulness Interventions for Health and Well-Being in Different Populations)

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14 pages, 1026 KiB

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 (registering DOI) - 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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Data Driven Insights in Healthcare)

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16 pages, 394 KiB

Open AccessArticle

Knowledge of Vaginal Microbiota and Its Association with Perceptions of Vulvovaginal Aesthetic Procedures Among Saudi Women

by Esraa Aldawood, Lama Alzamil, Layla Faqih and Sarah Almuhayya

Healthcare 2025, 13(16), 1955; https://doi.org/10.3390/healthcare13161955 (registering DOI) - 9 Aug 2025

Abstract

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 [...] Read more.

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. Full article

19 pages, 1159 KiB

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 (registering DOI) - 9 Aug 2025

Abstract

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) [...] Read more.

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. Full article

19 pages, 754 KiB

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 (registering DOI) - 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 [...] Read more.

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. Full article

(This article belongs to the Section Chronic Care)

21 pages, 526 KiB

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 (registering DOI) - 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 [...] Read more.

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. Full article

(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)

20 pages, 458 KiB

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 (registering DOI) - 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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Mental Health in Older People)

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14 pages, 590 KiB

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 (registering DOI) - 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 [...] Read more.

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. Full article

(This article belongs to the Section Environmental Factors and Global Health)

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16 pages, 348 KiB

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 (registering DOI) - 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 [...] Read more.

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. Full article

20 pages, 622 KiB

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 (registering DOI) - 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 [...] Read more.

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. Full article

16 pages, 278 KiB

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 [...] Read more.

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. Full article

19 pages, 1336 KiB

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 [...] Read more.

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 (η_p²) 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. Full article

(This article belongs to the Special Issue Health and Readiness of Tactical Populations)

18 pages, 1006 KiB

Open AccessArticle

Saudi Medical Appointments and Referrals Center (SMARC) Performance Dynamic: A Comparative National Analysis of 2023–2024 Against Baseline Metrics

by Abdullah A. Alharbi, Ahmad Y. Alqassim, Meshary S. Binhotan, Mohammed A. Muaddi, Ali K. Alsultan, Mohammed S. Arafat, Abdulrahman Aldhabib, Yasser A. Alaska, Eid B. Alwahbi, Aidrous M. Ali, Mohammed K. Alabdulaali and Nawfal A. Aljerian

Healthcare 2025, 13(16), 1945; https://doi.org/10.3390/healthcare13161945 - 8 Aug 2025

Abstract

Background/Objectives: Saudi Arabia implemented the Saudi Medical Appointments and Referrals Centre (SMARC) e-referral system to coordinate patient transfers and enhance healthcare access across the country. This nationwide system was established to improve coordination between healthcare facilities and provide timely access to specialized services. [...] Read more.

Background/Objectives: Saudi Arabia implemented the Saudi Medical Appointments and Referrals Centre (SMARC) e-referral system to coordinate patient transfers and enhance healthcare access across the country. This nationwide system was established to improve coordination between healthcare facilities and provide timely access to specialized services. SMARC operates as a centralized coordination hub connecting secondary and tertiary care facilities across all specialties nationwide. This study evaluates SMARC’s evolution since 2020–2021 and efficiency improvements through 2023–2024 after major expansion efforts. Methods: This retrospective analysis examined 755,145 e-referrals across all 13 administrative regions of Saudi Arabia during 2023–2024. The study analyzed data extracted from the SMARC database covering two consecutive years. Outcomes assessed included acceptance rates, referral destinations (internal within the same region vs. external to other regions), and factors associated with system performance. Results: The total volume of e-referrals through SMARC increased substantially by 19.34% to 755,145 in 2023–2024. Acceptance rates for referrals improved markedly from 74.13% to 90.19% over this period. The proportion of internal referrals increased from 80.13% of total referrals to 87.52%. In contrast, external referrals to other regions declined from 19.87% to 12.48% of the total. Critical care referrals (ICU, CCU, NICU, PICU) decreased from 12.39% to 9.91%. Referrals for life-saving emergency conditions showed a noticeable decrease from 6.65% to 2.18%. Referrals to hospital outpatient departments (OPD) also showed an increase from 48.07% to 66.66% of total referrals. Conclusions: SMARC demonstrated considerable improvements in key metrics including referral acceptance rates and growth in regional self-sufficiency. This progress is associated with the Kingdom’s goals for advancing its healthcare system under Vision 2030 initiatives. The system has enabled more effective care coordination and access to specialized services across regions. These achievements were observed during a period of significant healthcare infrastructure expansion documented during this period, including growth in specialized centers, increased ICU bed capacity following governmental regulation after the COVID-19 pandemic, and expansion of trained medical subspecialists. Full article

13 pages, 341 KiB

Open AccessReview

Period Poverty in Brazil: A Public Health Emergency

by Maurício Fonseca Ribeiro Carvalho de Moraes, Rui Nunes and Ivone Duarte

Healthcare 2025, 13(16), 1944; https://doi.org/10.3390/healthcare13161944 - 8 Aug 2025

Abstract

Period poverty is a broad and complex issue that intersects with various areas, including health, education, infrastructure, and human rights, among others, affecting countless women and girls around the world. Despite remarkable technological, social, and economic advances this century, menstruation remains a taboo [...] Read more.

Period poverty is a broad and complex issue that intersects with various areas, including health, education, infrastructure, and human rights, among others, affecting countless women and girls around the world. Despite remarkable technological, social, and economic advances this century, menstruation remains a taboo subject, which leads to widespread misinformation and stigma. Prejudice and a lack of access to knowledge and essential sanitation resources, such as clean water, hygiene products, and safe private spaces, heighten the vulnerability of those affected. Integrated and multisectoral approaches that involve legislature, health, education, and sanitation are necessary to face this public health issue effectively. These efforts involve developing and implementing comprehensive plans that unite government, society, and the private sector. Some examples of these actions include making information about menstruation and menstrual health available in schools, cutting taxes on feminine hygiene products, improving basic sanitation, building decent public restrooms, and providing free sanitary pads in schools and workplaces. These initiatives have the potential to promote menstrual health and dignity, ensuring that people who menstruate can manage their periods in healthy, safe, and supportive environments. This review aims to shed light on menstrual poverty in Brazil as a global issue and a human rights violation, especially when it comes to the rights to health, education, and dignity. It stresses that efforts to end this social stigma and align with the 2030 Agenda, which seeks to eliminate poverty and inequality worldwide, and provides a plan of action to tackle this stigma. Full article

29 pages, 1001 KiB

Open AccessReview

Loneliness and Isolation in the Era of Telework: A Comprehensive Review of Challenges for Organizational Success

by Elisabeth Figueiredo, Clara Margaça and José Carlos Sánchez-García

Healthcare 2025, 13(16), 1943; https://doi.org/10.3390/healthcare13161943 - 8 Aug 2025

Abstract

Purpose: As remote work becomes increasingly prevalent, scholarly and organizational attention has largely centered on stress and workload. However, emerging evidence highlights loneliness and isolation as critical yet underexplored factors with profound implications for employees’ mental health and organizational performance. Method: This study [...] Read more.

Purpose: As remote work becomes increasingly prevalent, scholarly and organizational attention has largely centered on stress and workload. However, emerging evidence highlights loneliness and isolation as critical yet underexplored factors with profound implications for employees’ mental health and organizational performance. Method: This study conducts a bibliometric review of 65 peer-reviewed articles indexed in the Scopus database, following PRISMA guidelines and employing VOSviewer for data analysis and visualization. The objective is to examine how loneliness and isolation in remote work settings affect psychological well-being and productivity. Findings: The findings reveal that the absence of physical interaction and structured social environments exacerbates feelings of detachment, contributing to emotional strain and reduced job performance. Despite the growing importance of remote work, the literature remains fragmented in addressing its broader psychological and organizational consequences. Originality/Value: This study offers theoretical insights and practical recommendations for managers and policymakers, emphasizing the need for preventive strategies and inclusive management practices to support employee well-being, foster engagement, and sustain organizational effectiveness in remote work contexts. Full article

(This article belongs to the Special Issue Improving the Health and Well-Being of Groups of Workers Experiencing Work Disparities)

18 pages, 2263 KiB

Open AccessReview

Inflammatory Joint Pathologies and the Oral–Gut Microbiota: A Reason for Origin

by Mario Salazar-Páramo, Fabiola de Santos Ávila, Genaro E. Ortiz-Velázquez, Ian Ramirez-Jaramillo, Daniela L. C. Delgado-Lara, Erandis Dheni Torres-Sánchez and Genaro Gabriel Ortiz

Healthcare 2025, 13(16), 1942; https://doi.org/10.3390/healthcare13161942 - 8 Aug 2025

Abstract

The human gut microbiota, which can weigh as much as 2 kg and harbor 100 trillion bacteria, is specific to each individual. In healthy adults, a balanced microbiota—a state known as eubiosis—can be altered by various factors such as diet and lifestyle. Microbiota [...] Read more.

The human gut microbiota, which can weigh as much as 2 kg and harbor 100 trillion bacteria, is specific to each individual. In healthy adults, a balanced microbiota—a state known as eubiosis—can be altered by various factors such as diet and lifestyle. Microbiota imbalance—or dysbiosis—can have consequences for host health. Given that 80% of the human immune system is located in the gut, studies have investigated the role of the microbiota in immune system diseases, including joint and inflammatory pathologies such as rheumatoid arthritis. A better understanding of this pathology might enable the development of new treatments in the future. The microbiota includes all unicellular organisms in the digestive tract, including bacteria, viruses, fungi, and archaea. This complex ecosystem is unique to each individual. Associations between the human body and the microorganisms that it hosts can be considered mutualistic, symbiotic, or parasitic. These microorganisms are responsible for essential functions in maintaining health; the microbiota can even be considered another organ of the body. Microbiota composition varies considerably between early life and older age but remains relatively stable for most of a lifespan. Full article

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14 pages, 1210 KiB

Open AccessArticle

Effect of Computerized Physician Order Entry Reminders on HLA-B*15:02 Screening Rates: A Retrospective Study in a Taiwanese Hospital

by Xiao Chen, Jason Jiunshiou Lee, Mei-Hsiouh Guan, Su-Han Hsu and Shu-Chuan Wu

Healthcare 2025, 13(16), 1941; https://doi.org/10.3390/healthcare13161941 - 8 Aug 2025

Abstract

Background: Carbamazepine (CBZ) is associated with severe cutaneous adverse reactions in individuals carrying the HLA-B*15:02 allele, which is prevalent in Asian populations. Genetic screening before the initiation of CBZ is recommended, yet screening is not always undertaken. Objectives: To determine the effect of [...] Read more.

Background: Carbamazepine (CBZ) is associated with severe cutaneous adverse reactions in individuals carrying the HLA-B*15:02 allele, which is prevalent in Asian populations. Genetic screening before the initiation of CBZ is recommended, yet screening is not always undertaken. Objectives: To determine the effect of implementing computerized physician order entry (CPOE) reminders on the screening rates of HLA-B*15:02 before CBZ prescription. Methods: We conducted a retrospective analysis of 1611 patients who were prescribed CBZ between 2012 and 2023 in a regional hospital in Taiwan. The intervention involved integrating automated HLA-B*15:02 screening reminders into the CPOE system in outpatient settings. Patients were divided into an outpatient (intervention) group and an inpatient (control) group, and their data were analyzed before and after the intervention. Screening rates were compared using Fisher’s exact test, and subgroup analyses were conducted on the basis of age group and physician specialty. Results: After the intervention, the outpatient group exhibited an increase in screening rate from 23.7% to 55.6% (p < 0.001). However, no significant change was observed in the inpatient group. Subgroup analysis revealed major improvements among neurologists and patients aged 41–80 years in outpatient settings. Conclusions: Implementing CPOE reminders substantially improves rates of screening for HLA-B*15:02 in outpatient settings, indicating the effectiveness of informatic interventions in enhancing adherence to pharmacogenomic guidelines. Extending such interventions to inpatient settings may further mitigate the risk of CBZ-induced severe cutaneous adverse reactions. Full article

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