Healthcare

18 pages, 581 KB

Open AccessArticle

Gender and Social Stratification in Active Aging: Inequalities in Sport Participation and Subjective Health Among Older Adults in South Korea

by Su Yeon Roh and Ik Young Chang

Healthcare 2025, 13(23), 3124; https://doi.org/10.3390/healthcare13233124 (registering DOI) - 1 Dec 2025

Abstract

Background: As South Korea transitions into a super-aged society, promoting sport participation among older adults is increasingly vital for physical health, emotional well-being, and social inclusion. Objective: This study examines how the interplay between gender and social stratification influence sport participation [...] Read more.

Background: As South Korea transitions into a super-aged society, promoting sport participation among older adults is increasingly vital for physical health, emotional well-being, and social inclusion. Objective: This study examines how the interplay between gender and social stratification influence sport participation and health among South Koreans aged 60 and above. Methods: Using data from the 2024 Korea National Sports Participation Survey (n = 1779), this study employed Multiple Correspondence Analysis (MCA), cross-tabulation, and one-way ANOVA with Scheffé’s post hoc tests to examine differences in sport participation and health by gender and social stratification such as income, education, and occupation. Results: The analysis revealed significant differences in sport participation and subjective health outcomes by gender and social stratification. Among older men, sport participation varied strongly by socioeconomic status: higher-status men participated in golf, cycling, and bodybuilding, whereas those from lower strata mainly engaged in walking and gateball. In contrast, older women’s participation types were less stratified and more influenced by gender norms, with consistent involvement in walking, aerobics, yoga, and stretching. One-way ANOVA showed statistically significant differences (p < 0.001) in subjective health status and physical fitness by all socioeconomic variables for both genders. Conclusions: Older adults’ sport participation and health in South Korea are constrained by both socioeconomic inequality and entrenched gender norms. Promoting equitable active aging requires policies that both reduce socioeconomic barriers and challenge restrictive gender norms. Full article

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

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18 pages, 2125 KB

Open AccessArticle

Anthropometric and Metabolic Determinants of Multi-Organ Stress in Adults with Obesity: Application of the CaRaMeL-O Score

by Timea Claudia Ghitea, Mihaela Simona Popoviciu, Andrada Moldovan, Florica Ramona Dorobantu, Petru Cornel Domocos, Daniela Florina Trifan and Felicia Manole

Healthcare 2025, 13(23), 3123; https://doi.org/10.3390/healthcare13233123 (registering DOI) - 1 Dec 2025

Abstract

Background: Obesity represents a multisystemic disorder that extends beyond metabolic dysfunction, involving hepatic, renal, and cardiovascular axes. This study introduces the Cardio–Reno–Metabolic–Liver–Obesity (CaRaMeL-O) framework as an integrated tool to assess multi-organ metabolic stress in adults with obesity. Methods: In this cross-sectional study, 287 [...] Read more.

Background: Obesity represents a multisystemic disorder that extends beyond metabolic dysfunction, involving hepatic, renal, and cardiovascular axes. This study introduces the Cardio–Reno–Metabolic–Liver–Obesity (CaRaMeL-O) framework as an integrated tool to assess multi-organ metabolic stress in adults with obesity. Methods: In this cross-sectional study, 287 adults with obesity (mean BMI 35.1 ± 4.6 kg/m²) were evaluated. The CaRaMeL-O score (0–13 points) incorporated metabolic (TyG index), hepatic (FIB-4, transaminases), and renal (eGFR, UACR) parameters, as well as classical and lifestyle risk factors. Participants were stratified into low, moderate, and high risk categories. Group comparisons were conducted using ANOVA and Kruskal–Wallis tests, while multivariate regressions identified independent predictors of FIB-4 and eGFR. Distributional characteristics were further analyzed using Weibull modeling. Results: Higher CaRaMeL-O scores were associated with a progressive increase in TyG (p < 0.001) and FIB-4 (p < 0.001), while eGFR showed a mild, nonsignificant downward trend. In multivariate models, age was the strongest predictor of FIB-4 (β_std = 0.33), whereas age, FIB-4, BMI, blood pressure, and UACR independently predicted eGFR. TyG did not remain significant after full adjustment. Weibull analysis revealed distinct distributional profiles, with TyG showing a narrow, homogeneous curve and FIB-4 and eGFR broader, right-skewed patterns. Conclusions: The CaRaMeL-O framework effectively captures inter-organ metabolic stress, demonstrating that hepatic and metabolic alterations precede overt renal decline. This integrated score may support early stratification and targeted prevention in obesity-related cardio-metabolic risk. Full article

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12 pages, 231 KB

Open AccessArticle

Body Positivity and Eating Behaviors Among Women Attending Fitness Classes: Associations with Body Mass Index

by Martyna Kłoda, Monika Marszołek, Wiktoria Staśkiewicz-Bartecka, Sylwia Jaruga-Sękowska and Małgorzata Magdalena Michalczyk

Healthcare 2025, 13(23), 3122; https://doi.org/10.3390/healthcare13233122 (registering DOI) - 1 Dec 2025

Abstract

Background: Body positivity is a social movement aimed at promoting acceptance and appreciation of diverse body types. Despite its growing popularity, its relationship with eating behaviors and body mass index (BMI) remains unclear. This study aimed to investigate the opinions of women [...] Read more.

Background: Body positivity is a social movement aimed at promoting acceptance and appreciation of diverse body types. Despite its growing popularity, its relationship with eating behaviors and body mass index (BMI) remains unclear. This study aimed to investigate the opinions of women attending fitness classes on the body positivity movement and to assess the association between these attitudes, eating behaviors, and BMI. Methods: A total of 118 women aged 18–65 years participated in the study. Data were collected using a self-developed body positivity questionnaire and the validated Polish version of the Three-Factor Eating Questionnaire (TFEQ-13). Participants were stratified into two groups based on BMI (<25 and ≥25 kg/m²). Results: No significant association was found between general attitudes toward body positivity and either eating behaviors or BMI. However, a positive correlation was observed between BMI and emotional eating as well as cognitive restraint. Women with higher BMI demonstrated greater cognitive restraint and tendencies toward emotional eating. Body acceptance was significantly lower in women with BMIs ≥ 25. Conclusions: While general attitudes toward the body positivity movement do not appear to influence eating behaviors directly, body weight is linked to both emotional eating and cognitive restraint. These findings underscore the complex relationship between psychological factors, eating patterns, and body image, suggesting the need for further research and tailored interventions promoting both health and self-acceptance. Full article

(This article belongs to the Special Issue The Relationship Between Diet Quality, Physical Activity, and Mental and Physical Health Status)

16 pages, 251 KB

Open AccessArticle

AI-Based Assessment of Non-Technical Skills in Prehospital Simulations: A Comparative Validation Study

by Masanori Mitsuhashi, Yumika Akiba, Misato Saitou, Kensuke Suzuki, Satoo Ogawa and Tomohiko Masuno

Healthcare 2025, 13(23), 3121; https://doi.org/10.3390/healthcare13233121 (registering DOI) - 1 Dec 2025

Abstract

Background/Objectives: Assessing non-technical skills (NTSs) in prehospital care is susceptible to rater subjectivity. While Artificial Intelligence (AI) can be used to score conversation transcripts, it emphasizes formal linguistic features, whereas humans integrate scene context, leading to potentially divergent evaluations. We examined the [...] Read more.

Background/Objectives: Assessing non-technical skills (NTSs) in prehospital care is susceptible to rater subjectivity. While Artificial Intelligence (AI) can be used to score conversation transcripts, it emphasizes formal linguistic features, whereas humans integrate scene context, leading to potentially divergent evaluations. We examined the validity of NTS assessments generated by AI (ChatGPT-4o) from prehospital simulation data by comparing them with ratings from paramedic faculty. We hypothesized that AI-based ratings would provide evaluations of team NTSs that are comparable to faculty ratings and would enable us to describe the direction and magnitude of score differences between AI and faculty across the five NTS domains. Methods: Sixty-four first-year paramedic students performed 5 min prehospital scenarios. Five NTS domains were scored independently by AI and faculty using a three-level rubric (5, 3, or 1 point per domain): (i) communication and interpersonal manner, (ii) order and completeness of information gathering, (iii) detail of follow-up questioning, (iv) context-appropriate actions, and (v) time management. Score differences were analyzed with Wilcoxon signed-rank tests with Holm correction and Bayes factors (BF10). Agreement was quantified with weighted Gwet’s agreement coefficient 2 (AC2). Results: Three domains—communication, context-appropriate actions, and time management—showed significant differences (p < 0.001), with strong evidence for differences (BF10 > 22); median differences favored AI. Evidence of a difference was insufficient for the other two domains. Across all domains, agreement remained below the prespecified substantial threshold (AC2 ≥ 0.60). The primary hypothesis was not supported. Conclusions: In prehospital simulations, AI-only NTS assessment is not yet an adequate substitute for human raters. Although AI evaluates linguistic aspects, its agreement with expert ratings was insufficient. Future work should evaluate hybrid approaches leveraging the strengths of both AI and human judgment. Full article

23 pages, 372 KB

Open AccessSystematic Review

Therapeutic Benefits of Robotics and Exoskeletons for Gait and Postural Balance Among Children and Adolescents with Cerebral Palsy: An Overview of Systematic Reviews

by Amal Alharbi, Shouq S. Alhosaini, Shahad S. Alrakebeh and Saleh M. Aloraini

Healthcare 2025, 13(23), 3120; https://doi.org/10.3390/healthcare13233120 (registering DOI) - 1 Dec 2025

Abstract

Background/Objectives: Robotic therapies are emerging as a potential management strategy for individuals with cerebral palsy (CP). These devices apply mechanical and electrical forces to regulate neural excitability and promote motor learning. This review aimed to systematically assess and synthesize evidence from published systematic [...] Read more.

Background/Objectives: Robotic therapies are emerging as a potential management strategy for individuals with cerebral palsy (CP). These devices apply mechanical and electrical forces to regulate neural excitability and promote motor learning. This review aimed to systematically assess and synthesize evidence from published systematic reviews and meta-analyses on the therapeutic benefits of robotics and exoskeletons for gait and postural balance in pediatric CP. Methods: A comprehensive search of PubMed, CINAHL, Scopus, and The Cochrane Library was conducted. Two independent reviewers screened records to identify studies that were: (1) written in English and published in peer-reviewed journals; (2) included participants <18 years with a diagnosis of CP; and (3) examined robotic therapies or exoskeletons targeting gait or postural balance. Methodological quality of included reviews was appraised with the Assessment of Multiple Systematic Reviews (AMSTAR) tool, and certainty of evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework. Results: 18 systematic reviews met the inclusion criteria, encompassing 256 primary studies and 5092 participants. Overall methodological quality of the included reviews was rated as moderate to good. A variety of robotic and exoskeleton systems were noted across studies, with heterogeneous protocols and outcomes. Several reviews reported modest improvements in gait and postural balance; however, the findings were inconsistent, and pooled effects, where available, did not yield definitive conclusions regarding efficacy. Conclusions: Robotic and exoskeleton interventions may offer benefits for gait and postural balance in children and adolescents with CP, but the current evidence base remains inconclusive. Additional high-quality research is required to determine effectiveness more definitively. Full article

(This article belongs to the Special Issue Assistive Technologies, Robotics, and Automated Machines in the Health Domain: Third Edition)

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26 pages, 349 KB

Open AccessArticle

Homophobic Bullying Among Adolescents: Prevalence, Associations with Emotional Factors, Psychopathological Symptoms, and Predictors

by Maite Garaigordobil, Juan Pablo Mollo-Torrico and Mónica Rodríguez-Enríquez

Healthcare 2025, 13(23), 3119; https://doi.org/10.3390/healthcare13233119 (registering DOI) - 1 Dec 2025

Abstract

Background/Objectives: Despite progress in recognizing sexual diversity, homophobic bullying persists. This study had four objectives: (1) to identify the prevalence of homophobic bullying (victims, perpetrators, and bystanders); (2) to explore whether differences exist between victims and perpetrators as a function of sexual [...] Read more.

Background/Objectives: Despite progress in recognizing sexual diversity, homophobic bullying persists. This study had four objectives: (1) to identify the prevalence of homophobic bullying (victims, perpetrators, and bystanders); (2) to explore whether differences exist between victims and perpetrators as a function of sexual orientation with respect to emotional factors and psychopathological symptoms; (3) to analyze whether victims and perpetrators of homophobic bullying have sought psychological assistance significantly more often; and (4) to identify predictive variables of victimization and perpetration of homophobic bullying. Methods: The sample comprised 1558 Bolivian students aged 13 to 17 years (M = 14.64; SD = 0.96), who completed six standardized assessment instruments. Results: (1) A substantial percentage of students reported homophobic bullying behaviors. Victims: 76.6% reported experiencing homophobic behaviors, with significantly higher rates among non-heterosexual students (χ² = 7.40, p < 0.01) and no gender differences (χ² = 0.013, p > 0.05). Perpetrators: 11.8% admitted engaging in homophobic aggressive behaviors, with no differences by sexual orientation (χ² = 0.306, p > 0.05) but significantly higher rates among males (χ² = 8.49, p < 0.01). Bystanders: 51.9% reported witnessing homophobic behaviors, with significantly higher prevalence among non-heterosexual students (χ² = 7.03, p < 0.01) and females (χ² = 4.98, p < 0.05). (2) Analyses of variance showed that non-heterosexual victims scored significantly lower on emotional regulation, empathic joy, overall empathy, and happiness, and significantly higher on fear of negative social evaluation, overall social anxiety, all psychopathological symptom dimensions assessed (somatization, obsession–compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism), and the global severity index. Non-heterosexual perpetrators also displayed significantly higher scores on several psychopathological symptoms (depression, anxiety, hostility, paranoid ideation, psychoticism) and on the global severity index. Effect sizes were moderate for psychopathological symptoms and small for emotional variables. (3) Victims (OR = 1.392, 95% CI [1.04, 1.86], p = 0.024) and perpetrators (OR = 1.507, 95% CI [1.07, 2.10], p = 0.017) of homophobic bullying reported significantly higher rates of seeking psychological assistance in the past year compared to those uninvolved in bullying. (4) Hierarchical regression analyses identified significant predictors of victimization (R² = 18.6%): non-heterosexual orientation, male gender, higher somatization, paranoid ideation, fear of negative evaluation, and lower happiness. For perpetration, only being male and higher levels of phobic anxiety emerged as significant predictors in the final model, explaining 5.1% of the variance. Conclusions: The findings underscore the urgency of implementing school-based psychoeducational anti-bullying prevention programs that include activities designed to foster tolerance toward sexual diversity. Full article

(This article belongs to the Special Issue Bias-Based Bullying and Child and Adolescent Health)

15 pages, 1611 KB

Open AccessArticle

Perception Versus Actual Weight: Body Image Dissatisfaction as a Stronger Correlate of Anxiety and Depression than BMI Among Romanian Health Sciences Students

by Catalin Pleșea-Condratovici, Vlad Dionisie, Lavina-Alexandra Moroianu, Petrut-Stefan Serban, Victor Plesea-Condratovici and Manuela Arbune

Healthcare 2025, 13(23), 3118; https://doi.org/10.3390/healthcare13233118 (registering DOI) - 1 Dec 2025

Abstract

Background: The high prevalence of anxiety and depression among young adults constitutes a significant public health concern, with body image identified as a key psychological factor. However, the interplay between subjective metrics (perceived body image) and objective measures (Body Mass Index) remains [...] Read more.

Background: The high prevalence of anxiety and depression among young adults constitutes a significant public health concern, with body image identified as a key psychological factor. However, the interplay between subjective metrics (perceived body image) and objective measures (Body Mass Index) remains insufficiently explored within specific populations, such as health sciences students in Eastern Europe. Methods: An observational, cross-sectional study was conducted on a sample of 137 medical and nursing students from a Romanian university. Validated instruments were employed: the Hospital Anxiety and Depression Scale (HADS) and the Eating Disorder Examination Questionnaire (EDE-Q). BMI was calculated from self-reported height and weight. Spearman’s correlation analyses and Mann–Whitney U tests were performed. Results: Subjective body image concerns, particularly those related to shape, weight, and eating, were found to be positively and significantly correlated with symptoms of anxiety and depression (all p < 0.05). In contrast, BMI exhibited no significant correlation with either of the HADS subscales. Although nursing students presented a higher mean BMI, no significant differences were recorded between the student groups with respect to psychological symptoms or body image concerns. Conclusions: Subjective dissatisfaction with body image is a more salient correlate of emotional distress than objective body mass in this cohort. Although the sample size was moderate, the observed associations were robust and statistically significant, underscoring the importance of subjective body image over objective metrics such as BMI in this academic population. These findings underscore the necessity for mental health interventions within university settings to focus on the perceptual and cognitive-affective aspects of body image, rather than exclusively on weight management. Full article

(This article belongs to the Special Issue Body Image, Dissatisfaction and Eating Disorders: A Healthcare Perspective)

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17 pages, 473 KB

Open AccessArticle

Psychometric Validation of the Arabic FRAIL Scale for Frailty Assessment Among Older Adults with Colorectal Cancer

by Mohammed T. A. Omar, Bader Nasser M. Alamri, Ahmed Mohammed Mesfer, Majed Hassan Al-Malki, Ahmed Allehebi, Zizi M. Ibrahim and Rehab F. M. Gwada

Healthcare 2025, 13(23), 3117; https://doi.org/10.3390/healthcare13233117 (registering DOI) - 1 Dec 2025

Abstract

Background/Objective: Culturally adapted frailty screening tools are essential for improving health outcomes, facilitating clinical decision-making, promoting effective care planning, and ensuring accurate frailty assessment across diverse cultural contexts; their use among clinicians and academics is therefore supported. The purpose of this study was [...] Read more.

Background/Objective: Culturally adapted frailty screening tools are essential for improving health outcomes, facilitating clinical decision-making, promoting effective care planning, and ensuring accurate frailty assessment across diverse cultural contexts; their use among clinicians and academics is therefore supported. The purpose of this study was to assess internal consistency, test–retest reliability, and validity of the Arabic FRAIL scale (FRAIL-AR scale) for Arabic-speaking populations with colorectal cancer (CRC). Methods: This cross-sectional study included 137 participants diagnosed with CRC who completed the FRAIL-AR scale, the EORTC QLQ-C30 physical function subscale, and functional performance-based Timed Up and Go (TUG) and Five Times Sit-to-Stand (5xSTS) tasks. Internal consistency was assessed using Kuder–Richardson formula 20 (KR-20), and test–retest reliability was determined using the two-way random intraclass correlation coefficient ICC _(2.1). Convergent validity was evaluated by assessing the correlation between the FRAIL-AR scale against the EORTC QLQ-C30 physical function scale, TUG, and 5xSTS. Results: The FRAIL-AR scale exhibited good internal consistency (KR-20 = 0.80) and test–retest reliability (ICC _(2.1) = 0.89, 95% CI 0.77–0.94). Correlation analysis showed a weak negative correlation between the overall FRAIL-AR scale scores and EORTC QLQ-C30 physical function scale scores (r = −0.38, p < 0.05), while it exhibited a moderate positive correlation with TUG (r = 0.75, p < 0.01) and 5xSTS (r = 0.63, p < 0.01) scores. FRAIL-AR scores showed significant known-groups validity with higher frailty scores in older-age individuals (p < 0.01), females (p < 0.05), and those with comorbid conditions (≥5) (p < 0.05). Conclusion: The FRAIL-AR scale’s validity and reliability make it an appropriate tool for geriatricians, oncologists, and healthcare providers to evaluate and monitor frailty among Arabic-speaking colorectal cancer patients. Full article

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10 pages, 196 KB

Open AccessArticle

Do Patient-Important Outcomes Differ by Care Setting? Findings from Semi-Structured Interviews with Individuals with Diabetes

by Amy T. Cunningham, Alexzandra T. Gentsch, Pouya Arefi, Judd E. Hollander, Marianna D. LaNoue, Amanda M. B. Doty, Geoffrey D. Mills, Brendan Carr and Kristin L. Rising

Healthcare 2025, 13(23), 3116; https://doi.org/10.3390/healthcare13233116 (registering DOI) - 1 Dec 2025

Abstract

Background: Patient-important outcomes (PIOs) reflect patient values and preferences. Prior studies have elicited a variety of PIOs for diabetes. However, no studies have examined whether, or how, PIOs differ across diabetes care settings. The purpose of this study was to compare the frequencies [...] Read more.

Background: Patient-important outcomes (PIOs) reflect patient values and preferences. Prior studies have elicited a variety of PIOs for diabetes. However, no studies have examined whether, or how, PIOs differ across diabetes care settings. The purpose of this study was to compare the frequencies of PIOs derived from patients with diabetes in primary care (PC), acute care (emergency department (ED)), and post-acute care (post-hospital discharge (PHD)) settings within a large delivery system. Methods: This study was an analysis of 89 interviews with patients in PC, ED, and PHD settings. Participants had moderately to poorly controlled diabetes, defined as follows: presented to the ED with a diabetes-related problem, admitted to the hospital for a diabetes-related problem, or had at least two primary care measurements of hemoglobin A1c (HbA1c) > 7.5 in the prior year. A matrix analysis compared the frequencies of participants’ PIOs across the three settings. Results: Overall PIO frequencies were similar across care settings. PIOs fell into seven domains; all seven domains and 21 of the 26 PIOs were represented within each of the care settings. The most common PIOs included “be healthy”, “eat right”, and “reduce or get off medicines”. Conclusions: Participants identified similar PIOs in all care settings, indicating that recruitment from one or two care settings may often be sufficient for achieving saturation of PIOs. Furthermore, the results inform our understanding of patient priorities across the care continuum. Full article

18 pages, 279 KB

Open AccessArticle

Exploring African Community Attitudes Towards Mental Illness in Australia: A Cross-Sectional Study

by Gihane Endrawes and Olayide Ogunsiji

Healthcare 2025, 13(23), 3115; https://doi.org/10.3390/healthcare13233115 (registering DOI) - 1 Dec 2025

Abstract

Background: Mental illness is often stigmatized across various cultural groups, yet there is limited understanding of African communities’ perceptions and beliefs regarding mental health. One reason for this disparity could be the lack of culturally appropriate tools to assess attitudes towards mental illness [...] Read more.

Background: Mental illness is often stigmatized across various cultural groups, yet there is limited understanding of African communities’ perceptions and beliefs regarding mental health. One reason for this disparity could be the lack of culturally appropriate tools to assess attitudes towards mental illness in African populations. This study aimed to evaluate the psychometric properties of the 40-item Community Attitudes towards the Mentally Ill (CAMI) scale within African communities in Australia. Design: This study employed a quantitative, cross-sectional, and descriptive approach, using a self-administered survey to assess the psychometric properties of the CAMI scale among African Australian individuals. Cronbach’s alpha was used to evaluate internal consistency. Method: A convenience sample of 110 individuals from various African community organizations in Australia was recruited. The original English version of the CAMI scale was used to assess attitudes towards mental illness. Results: Cronbach’s alpha for the overall scale was 0.717, indicating acceptable consistency. The Authoritarianism sub-scale had a lower reliability of 0.424, which is below the acceptable threshold of 0.70. The other sub-scales had a better internal consistency, with 0.730 for Benevolence, 0.724 for Ideology, and 0.627 for Social Restrictiveness, though the latter still lacked the ideal 0.70. Conclusions: The CAMI scale has been demonstrated to be a reliable and culturally appropriate tool for assessing African communities’ attitudes towards mental illness in Australia. By identifying negative attitudes, this tool can be used to inform health education and awareness programs that address misconceptions about mental illness. Such programs could encourage early health-seeking behaviors among migrants, facilitating early identification and intervention, and ultimately improving health outcomes by reducing the burden of mental illness. This study is significant as it provides a culturally appropriate tool to assess mental health attitudes in African communities, informing the development of appropriate strategies to promote early help-seeking behaviors and reduce stigma, thus improving mental health outcomes. Full article

11 pages, 2578 KB

Open AccessCase Report

Finger Joints Reconstructive Coverage with Cross-Arm (Colson) Flaps After Burn Injury: A Literature Review and Our Experience

by Ziyad Alharbi, Maysaa Alghamdi, Johannes Hertelendy, Khalid Khatib and Norbert Pallua

Healthcare 2025, 13(23), 3114; https://doi.org/10.3390/healthcare13233114 (registering DOI) - 1 Dec 2025

Abstract

Background: Random pattern flaps are widely used in reconstructive surgery when inadequate vascularity precludes skin graft survival or when regional pedicled flaps are unavailable due to local burn injury. Here, thin tissue from the upper arm was utilized to cover exposed cartilage over [...] Read more.

Background: Random pattern flaps are widely used in reconstructive surgery when inadequate vascularity precludes skin graft survival or when regional pedicled flaps are unavailable due to local burn injury. Here, thin tissue from the upper arm was utilized to cover exposed cartilage over the proximal interphalangeal (PIP) joints of the contralateral hand. Methods/Technical Note: We report the uncommon application of multiple cross-arm (Colson) flaps to reconstruct dorsal skin defects over the PIP joints of the index, middle, and ring fingers following a high-voltage burn injury, in conjunction with a comprehensive literature review. Results: Three separate random-pattern flaps were harvested from the upper arm and transferred to the contralateral hand. All flaps demonstrated good perfusion, durable coverage, and a clean wound bed postoperatively, with preservation of joint mobility. Conclusions: To our knowledge, this represents one of the first reported reconstructions of multiple adjacent PIP joints using individual cross-arm flaps. This technique remains a dependable salvage option that should be considered in complex reconstructive scenarios when local or microsurgical options are not feasible. Full article

(This article belongs to the Special Issue Dermatological Health and Skin Integrity: Multidisciplinary Rehabilitation Strategies for Optimal Care)

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13 pages, 655 KB

Open AccessArticle

Effect of Moderate-to-High-Intensity Interval Aerobic Exercise on Clinical Symptoms During the Menstrual Cycle: A Pilot Randomized Controlled Trial

by Alejandra Pio-Soria, Doaa Zahran and Alberto Roldán-Ruiz

Healthcare 2025, 13(23), 3113; https://doi.org/10.3390/healthcare13233113 (registering DOI) - 30 Nov 2025

Abstract

Introduction: Primary dysmenorrhea is one of the most prevalent gynecological disorders. It has been shown to negatively impact quality of life and overall wellbeing, as recent studies have associated stress and physical inactivity with both the onset and severity of menstrual pain. Objective: [...] Read more.

Introduction: Primary dysmenorrhea is one of the most prevalent gynecological disorders. It has been shown to negatively impact quality of life and overall wellbeing, as recent studies have associated stress and physical inactivity with both the onset and severity of menstrual pain. Objective: To analyze the effectiveness of a moderate-to-high-intensity interval aerobic exercise on menstrual pain intensity, menstrual-related quality of life, general health-related quality of life, sleep quality, stress and anxiety, and drug intake in young women with primary dysmenorrhea. Methodology: A total of 20 women were randomly allocated to either the exercise (N = 10) or control group (N = 10). Primary outcomes were menstrual pain intensity and menstrual-related quality of life. Secondary outcomes included general health-related quality of life, sleep quality, stress and anxiety, and drug intake. A supervised moderate-to-high-intensity interval aerobic exercise program on a stationary bicycle was carried out twice a week, for eight weeks, in young women with regular cycles and no diagnosed medical conditions. Patients were assessed at baseline, and at 1- and 2-month follow-ups. Results: At 8 weeks, 17 women completed the follow-up. Analyses showed statistically significant differences in favor of moderate-to-high-intensity interval aerobic exercise at 2-month follow-up for menstrual pain intensity, with a large size effect. Significant changes were also found in menstrual-related quality of life at both follow-ups in the exercise group, but they were not superior to the control group. No significant changes were observed for the rest of the variables in either group. Conclusions: The results from this pilot study suggest that the moderate-to-high-intensity interval aerobic exercise program is effective in reducing menstrual pain intensity at 2-month follow-ups. Future randomized controlled trials with larger samples are required to confirm the results. Full article

(This article belongs to the Special Issue Advancing Health Through a Multidisciplinary Lens: Integrating Exercise, Nutrition and Pain Management)

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20 pages, 872 KB

Open AccessReview

Processes Associated with the Development of Depression in Autistic Individuals: A Narrative Review

by Yaerin H. Wallenberger, Mirko Uljarevic, Lacey Chetcuti and Samuel P. Putnam

Healthcare 2025, 13(23), 3112; https://doi.org/10.3390/healthcare13233112 (registering DOI) - 28 Nov 2025

Abstract

Autistic individuals are disproportionately likely to experience mental health challenges during their lifetime, with depressive disorders being particularly common. High rates of depression among autistic individuals are a particular matter of clinical and policy concern, given the well-established links between depression and a [...] Read more.

Autistic individuals are disproportionately likely to experience mental health challenges during their lifetime, with depressive disorders being particularly common. High rates of depression among autistic individuals are a particular matter of clinical and policy concern, given the well-established links between depression and a range of negative outcomes, including suicidality. By proposing a novel integrative model, we aim to synthesize existing knowledge and prompt innovation in previously under-explored areas. In this narrative review, we first briefly discuss the prevalence of depression in autism, potential differences in how depression may present in autistic vs. non-autistic populations, and conceptual considerations for research on co-occurring autism and mental health challenges. We then provide a summary of cognitive, developmental, and clinical factors that have been identified through previous studies as important contributors to elevated rates and severity of depression in autistic individuals. Several, often closely interrelated, factors may affect the development and maintenance of depression in this population, including core autism features as well as cognitive and emotional experiences that are common in autistic individuals but not part of the diagnostic criteria for autism. Further, we propose a conceptual integration of the noted factors, specifying potential patterns of their interrelatedness. Finally, we put forward conceptual and empirical strategies for formally testing and refining our proposed model, and describe its implications for research, clinical practice, and societal reform. Full article

(This article belongs to the Special Issue Social Functioning Determinants of the Clinical Course and Outcomes of Autism Spectrum Disorder)

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16 pages, 345 KB

Open AccessArticle

A Pilot Observational Study in Ohio, USA of the Healing of Our Veterans Equine Services Intensive Intervention for Veterans with Trauma Histories

by Amanda Held, Katy Hubbard, Elena Nazarenko and William Marchand

Healthcare 2025, 13(23), 3111; https://doi.org/10.3390/healthcare13233111 (registering DOI) - 28 Nov 2025

Abstract

Background/Objectives: Equine-assisted services are being increasingly utilized as complementary interventions for military veterans who have experienced trauma. However, rigorous research is lacking, and randomized controlled trials are needed. The H.O.O.V.E.S. Intensive intervention was developed for this population. This intensive program is an [...] Read more.

Background/Objectives: Equine-assisted services are being increasingly utilized as complementary interventions for military veterans who have experienced trauma. However, rigorous research is lacking, and randomized controlled trials are needed. The H.O.O.V.E.S. Intensive intervention was developed for this population. This intensive program is an equine-assisted learning approach developed for veteran and active-duty military trauma survivors. The program integrates equine-assisted learning, peer mentorship and experiential learning in a residential retreat format. The primary aim of this pilot study was to determine if more rigorous studies of this intervention are warranted. Secondary aims were to assess preliminary outcomes and explore possible relationships between changes in outcome measures. Methods: This was a pilot prospective study. Inclusion criteria for the program included veteran or active-duty military status and a history of trauma exposure. Data were collected from April–October of 2024 in Ohio, USA. Six psychological instruments were administered to participants before, immediately after and 90 days and 120 days after the intervention. These were the PTSD Checklist for DSM-5 (PCL-5), the Acceptance and Action Questionnaire II (AAQII), the Positive and Negative Affect Scale (PANAS), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI) and the Posttraumatic Growth Inventory (PTGI). Analyses were conducted to assess for significant changes across the study timeframe and for relationships among the changes in psychological instrument scores. Results: Study participants were 32 veterans with trauma histories ranging in age from 30 to 67 years old. There were statistically significant pre- to post-intervention improvements for all instruments except the PTGI, suggesting short-term increased psychological flexibility (AAQII) and positive affect (PANAS-positive) as well as decreased anxiety (STAI), negative affect (PANAS-negative), depression (BDI) and PTSD symptoms (PCL-5). Changes in BDI and PCL-5 scores persisted at 120 days post-intervention whereas changes in the AAQII, PANAS and STAI did not persist. Increased psychological flexibility was correlated with reductions in negative affect, PTSD symptoms and anxiety, as well as with increases in positive affect. Conclusions: Preliminary results reported herein suggest participation is associated with psychological benefits. Further, decreased experiential avoidance/increased psychological flexibility should be explored as an underlying mechanism potentially contributing to the benefits of participation in EAS. A randomized controlled trial of the H.O.O.V.E.S. Intensive program is warranted. Full article

(This article belongs to the Special Issue Human–Animal Interaction: Animal Behaviour and Whole-Person Health in Animal-Assisted Interventions)

13 pages, 313 KB

Open AccessArticle

Assessing Public Awareness and Social Acceptance of Scoliosis Screening and Treatment Options in Saudi Arabia: A Nationwide Cross-Sectional Study

by Abdulmonem Alsiddiky, Abdulaziz S. AlNahari, Abdulmalik A. Alomrani, Mayssar Bassam Alshobaki, Naif Alateeq, Abdullah Nasser Almawash, Maha Emad Aldaijy, Sarah Essa Alsuwaidan, Mohammed Khalid Alqifari, Mohammed N. Aldawsari and Sara Alhomaidhi

Healthcare 2025, 13(23), 3110; https://doi.org/10.3390/healthcare13233110 (registering DOI) - 28 Nov 2025

Abstract

Background: Scoliosis is a common musculoskeletal disorder that remains underrecognized in Saudi Arabia, where limited public awareness may delay early detection and treatment. This study assessed public knowledge, support for school-based screening, and attitudes toward treatment. Methods: A nationwide cross-sectional survey was conducted [...] Read more.

Background: Scoliosis is a common musculoskeletal disorder that remains underrecognized in Saudi Arabia, where limited public awareness may delay early detection and treatment. This study assessed public knowledge, support for school-based screening, and attitudes toward treatment. Methods: A nationwide cross-sectional survey was conducted during the 2025 Saudi National Scoliosis Awareness Campaign through public venues and online platforms. A culturally adapted questionnaire assessed demographics, knowledge, symptom recognition, treatment preferences, barriers, and information sources. A total of 2055 responses were analyzed using descriptive statistics and chi-square tests. Results: While 70.9% of participants had heard of scoliosis, only 18.1% reported good understanding. Symptom recognition was limited, with spinal curvature, back pain, and uneven shoulders most often identified. Most respondents supported school-based screening (88.2%) and early detection (92.1%), with a mean preferred screening age of 8 years. Bracing (64.3%) and surgery (53.5%) were more accepted than observation (30.5%), though concerns about pain, effectiveness, and appearance were frequent. Social media was the most common initial information source (34.6%), while healthcare professionals were the preferred future source (79.2%). Reported barriers included lack of awareness (68.2%), difficulty accessing specialists (19.9%), and cost (8.9%). Conclusions: Public support for school-based screening is strong, but baseline knowledge remains limited, and treatment perceptions are shaped by psychosocial and cultural concerns. National campaigns, school curricula, and healthcare-led education, combined with accessible, low-cost screening, may enhance early detection and improve scoliosis management in Saudi Arabia. Full article

16 pages, 614 KB

Open AccessArticle

Latent Profile Analysis of Occupational Stress and Psychological Capital and the Dual Mechanisms of Psychological Capital in Healthcare Workers’ Sleep Quality

by Sijia Yang, Boya Zhang, Jian Chen, Jiahui Li, Bo Zhang and Zhijun Zhou

Healthcare 2025, 13(23), 3109; https://doi.org/10.3390/healthcare13233109 (registering DOI) - 28 Nov 2025

Abstract

Background: Sleep disorders are highly prevalent among healthcare workers (HCWs) globally, with occupational stress (OS) being a major underlying cause. Psychological capital (PsyCap) may serve as a protective resource, yet its combined relationship with OS and sleep quality remains underexplored. Objectives: [...] Read more.

Background: Sleep disorders are highly prevalent among healthcare workers (HCWs) globally, with occupational stress (OS) being a major underlying cause. Psychological capital (PsyCap) may serve as a protective resource, yet its combined relationship with OS and sleep quality remains underexplored. Objectives: We aimed to identify distinct OS-PsyCap profiles among HCWs, examine their associations with sleep quality, and investigate the mediating and moderating roles of PsyCap. Methods: A cross-sectional study was conducted among 1046 HCWs in Shanghai in December 2024. The Job Content Questionnaire, Psychological Capital Questionnaire, and Pittsburgh Sleep Quality Index were used to measure OS, PsyCap, and sleep quality, respectively. Latent profile analysis (LPA) was conducted to identify OS–PsyCap subgroups. Generalized linear models (GLM) and moderation and mediation analyses were performed to examine associations and to elucidate the role of PsyCap. Results: HCWs were divided into two distinct profiles: Class 1 (low OS and high PsyCap, 45.2%) and Class 2 (high OS and low PsyCap, 54.8%). HCWs in Class 2 had significantly poorer self-rated health and more sleep disturbances. Higher job demands and organizational support were associated with worse sleep outcomes, while higher autonomy and higher PsyCap were protective. In mediation and moderation analyses, PsyCap mediated 16.4–37.8% of OS–sleep relationships but also amplified OS effects on certain sleep outcomes under high stress. Conclusions: High OS with low PsyCap significantly increased sleep disorder risk among HCWs. PsyCap exhibited dual mechanisms, mediating stress effects while exacerbating sleep issues in high-stress contexts. Targeted interventions should address these HCWs in distinct profiles and pathways. Full article

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

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7 pages, 183 KB

Open AccessArticle

Exploring Mental Help-Seeking Behaviors, Health, and Well-Being in Rural Veterans with Chronic Health Conditions: A National Rural Health Study

by Jimena Ortiz, Beatrice Lee, Jeannie Concha, John Barnas, Jim Yates and Emre Umucu

Healthcare 2025, 13(23), 3108; https://doi.org/10.3390/healthcare13233108 (registering DOI) - 28 Nov 2025

Abstract

Background/Objective: Veterans in the United States have increased significantly, with a substantial proportion residing in rural areas. This study aims to examine the relationship between help-seeking behaviors and well-being, controlling demographic variables and service-connected disability status. It also explores mental health–seeking behaviors, health [...] Read more.

Background/Objective: Veterans in the United States have increased significantly, with a substantial proportion residing in rural areas. This study aims to examine the relationship between help-seeking behaviors and well-being, controlling demographic variables and service-connected disability status. It also explores mental health–seeking behaviors, health outcomes, and overall well-being among rural Veterans with existing health conditions. Methods: Data was collected through surveys distributed across multiple channels, including social media platforms. Results: Results indicated that willingness to seek psychological help was positively associated with the well-being of rural Veterans. Conclusions: These findings underscore the critical importance of both willingness to seek mental health support and access to mental health and substance use care services for rural Veterans. Full article

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

39 pages, 1170 KB

Open AccessReview

Bridging Distance, Delivering Care: Pediatric Tele-Nutrition in the Digital Health Era—A Narrative Review

by Motti Haimi and Liron Inchi

Healthcare 2025, 13(23), 3107; https://doi.org/10.3390/healthcare13233107 (registering DOI) - 28 Nov 2025

Abstract

Background: The emergence of telehealth has transformed healthcare delivery across multiple disciplines, with tele-nutrition representing a rapidly evolving field that addresses nutritional assessment, counseling, and management through digital platforms. Objective: This narrative review examines the current landscape of pediatric tele-nutrition services, exploring technological [...] Read more.

Background: The emergence of telehealth has transformed healthcare delivery across multiple disciplines, with tele-nutrition representing a rapidly evolving field that addresses nutritional assessment, counseling, and management through digital platforms. Objective: This narrative review examines the current landscape of pediatric tele-nutrition services, exploring technological platforms, clinical applications, evidence for effectiveness, implementation considerations, and future directions. Methods: A comprehensive literature search was conducted across PubMed, CINAHL, Embase, and Web of Science databases from January 2010 to October 2025. A total of 114 relevant sources were selected, encompassing randomized controlled trials, observational studies, systematic reviews, implementation studies, clinical guidelines, and policy documents. Results: This review synthesized 114 sources, predominantly from the United States (54%) and European nations (21%), with evidence expansion accelerating post-COVID-19 pandemic. Evidence suggests pediatric tele-nutrition demonstrates clinical outcomes comparable to traditional in-person care across diverse populations including obesity management, diabetes, gastrointestinal disorders, feeding difficulties, metabolic conditions, and preventive nutrition services. Multiple technology platforms are utilized, with synchronous video consultations most common (60–85% of encounters). Benefits include enhanced access to specialized care, increased frequency of contact, reduced family burden, and high satisfaction rates (>80% across most studies). Challenges include limitations in physical assessment, digital equity concerns affecting vulnerable populations, variable reimbursement policies, and the need for provider training. Hybrid models combining virtual and in-person care appear optimal for many conditions. Conclusions: Pediatric tele-nutrition represents a viable and effective care delivery model with particular advantages for families facing geographic, logistic, or access barriers. Continued attention to digital equity, provider training, regulatory frameworks, sustainable reimbursement policies, and rigorous evidence generation will optimize implementation and outcomes. Future directions include artificial intelligence applications, precision nutrition approaches, and expanded global health applications. Full article

(This article belongs to the Special Issue Telemedicine and eHealth Applications in the Pediatric Population)

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14 pages, 236 KB

Open AccessArticle

Assessing Postoperative Handover Quality Among Nurses Across Surgical and Recovery Units: A Cross-Sectional Study

by Afnan M. Alotaibi, Essmat A. Mansour, Sahar M. Yakout and Amany Anwar Saeed Alabdullah

Healthcare 2025, 13(23), 3106; https://doi.org/10.3390/healthcare13233106 - 28 Nov 2025

Abstract

Background/Objectives: Inefficient postoperative handovers contribute to medical malpractice and care discontinuity by omitting critical patient information and compromising patient health. This study aimed to evaluate and compare the quality of postoperative nurse handovers in ORs, PACUs, ICUs, and wards across four hospitals in [...] Read more.

Background/Objectives: Inefficient postoperative handovers contribute to medical malpractice and care discontinuity by omitting critical patient information and compromising patient health. This study aimed to evaluate and compare the quality of postoperative nurse handovers in ORs, PACUs, ICUs, and wards across four hospitals in Jeddah, Saudi Arabia. Methods: A descriptive, cross-sectional, comparative study was conducted among postoperative care nurses across four hospitals in the second health cluster in Jeddah, Saudi Arabia. Data were collected through an online questionnaire to assess handover quality via a Handover Quality Rating Form and sociodemographic information. Data analysis was performed using SPSS v28. Results: Among the 521 nurse participants (84.1% female, M_age = 34.5 years), the overall postoperative handover quality was 76.8%, with handover conduct and quality scoring the highest (27.9 ± 4.8 and 17.7 ± 3.1, respectively). Female nurses demonstrated significantly higher performance in teamwork and handover circumstances, whereas older nurses demonstrated significantly better teamwork, handover conduct, and quality. Saudi and younger nurses experienced significantly higher handover circumstances. Nurses’ educational level and years of experience in the present ward were significantly correlated with handover circumstances, conduct, and quality. Handovers from the theater to recovery resulted in higher average circumstances than those from recovery to the ward. The study setting was significantly associated with handover quality. Conclusions: These findings highlight the importance of local evaluating the handover quality of nurses in various contexts, specifically considering the circumstances, conduct, and teamwork when planning implementation and developing standardized handover protocols for different departments, specialties, and healthcare settings. These results support the development of targeted training programs and unit-specific handover protocols. Full article

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