Healthcare

17 pages, 601 KB

Open AccessArticle

Regional Variations in Health Behavior Structures: A Social Determinants of Health Approach

by Seungman Lee, Sungho Yoon and Hanbeom Kim

Healthcare 2025, 13(20), 2557; https://doi.org/10.3390/healthcare13202557 (registering DOI) - 10 Oct 2025

Background/Objectives: This study analyzes how Health and Fitness Awareness influences quality of life (QOL), mediated by Health Behavior Action and Safety Behavior Practice, within the Social Determinants of Health (SDH) framework. Methods: Accordingly, a multi-group structural equation modeling (SEM) analysis was conducted on [...] Read more.

Background/Objectives: This study analyzes how Health and Fitness Awareness influences quality of life (QOL), mediated by Health Behavior Action and Safety Behavior Practice, within the Social Determinants of Health (SDH) framework. Methods: Accordingly, a multi-group structural equation modeling (SEM) analysis was conducted on the data obtained from 6601 respondents selected from the 2024 National Sports for All Survey, jointly administered by the Ministry of Culture, Sports and Tourism and Korea Sports Promotion Foundation. Nationally representative survey data was collected across metropolitan, mid-sized, and rural areas in South Korea. The analysis further examined whether the structural pathways differed by regional size. Outcome measures included path coefficients and latent mean differences among Health and Fitness Awareness, Health Behavior Action, Safety Behavior Practice, and Improvement in QOL. Results: The analysis revealed that Health and Fitness Awareness significantly influenced both Health Behavior Action and Safety Behavior Practice; these, in turn, had positive effects on Improvement in QOL. Moreover, the structural pathways differed by region: whereas Health Behavior Action played a more significant mediating role in large cities, Safety Behavior Practice was more prominent in mid-sized ones. Conclusions: These findings are expected to provide a theoretical and policy-based foundation for region-specific health promotion strategy development and health equity advancement. Full article

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14 pages, 457 KB

Open AccessArticle

Preparedness for the Digital Transition in Healthcare: Insights from an Italian Sample of Professionals

by Valentina Elisabetta Di Mattei, Gaia Perego, Francesca Milano, Federica Cugnata, Chiara Brombin, Antonio Catarinella, Francesca Gatti, Lavinia Bellamore Dettori, Jennifer Tuzii and Elena Bottinelli

Healthcare 2025, 13(20), 2556; https://doi.org/10.3390/healthcare13202556 (registering DOI) - 10 Oct 2025

Abstract

Background: The digital transition is reshaping healthcare systems through the adoption of telemedicine and electronic health records (EHRs). While these innovations enhance efficiency and access, their implementation unfolds within overstretched organizational settings characterized by workforce shortages, bureaucratic demands, and heightened psychosocial risks. Burnout, [...] Read more.

Background: The digital transition is reshaping healthcare systems through the adoption of telemedicine and electronic health records (EHRs). While these innovations enhance efficiency and access, their implementation unfolds within overstretched organizational settings characterized by workforce shortages, bureaucratic demands, and heightened psychosocial risks. Burnout, impostor syndrome, and the quality of organizational support have thus become pivotal constructs in understanding healthcare professionals’ digital preparedness. Methods: A cross-sectional online survey was conducted among 111 professionals employed at two San Donato Group facilities in Bologna, Italy. The battery included socio-demographic and occupational data, perceptions of digitalization, and validated instruments: the Maslach Burnout Inventory (MBI), the Clance Impostor Phenomenon Scale (CIPS), and the Work Organization Assessment Questionnaire (WOAQ). Descriptive analyses were complemented by Classification and Regression Trees (CART) to identify predictors of perceived digital preparedness. Results: Most respondents (88%) acknowledged the relevance of digitalization, yet 18% felt unprepared, especially women and administrative staff. Burnout levels were high, with 51% reporting emotional exhaustion, most notably among nurses and female participants. Impostor syndrome affected 43% of the sample, with nurses exhibiting the highest prevalence. CART analysis identified emotional exhaustion, impostor syndrome, and age as principal discriminators of digital preparedness. Conclusions: Our findings highlight the role of emotional exhaustion, impostor syndrome, and age in shaping perceived digital preparedness, underscoring the need for tailored training and supportive practices to ensure a sustainable digital transition. Full article

12 pages, 345 KB

Open AccessArticle

Gambling Behaviour, Motivations, and Gender Differences Among Medical Students in Poland: Survey-Based Study

by Dominik Krupka, Jerzy Brzoza, Olgierd Cugier, Maciej Szwajkowski, Jagoda Szwach, Magdalena Raczkowska, Adam Chełmoński and Julia Drewniowska

Healthcare 2025, 13(20), 2555; https://doi.org/10.3390/healthcare13202555 (registering DOI) - 10 Oct 2025

Abstract

Background: In psychiatry, gambling is classified as an addiction-related disorder and is characterized by a persistent, problematic pattern of behaviour that leads to significant distress and functional impairment. This study aims to explore the prevalence, underlying motivations, and potential academic impact of gambling [...] Read more.

Background: In psychiatry, gambling is classified as an addiction-related disorder and is characterized by a persistent, problematic pattern of behaviour that leads to significant distress and functional impairment. This study aims to explore the prevalence, underlying motivations, and potential academic impact of gambling behaviours among medical students in Poland. Methods: An anonymous online survey was conducted among students from multiple medical universities across Poland. Participants completed a sociodemographic questionnaire and the South Oaks Gambling Screen (SOGS). Respondents who reported any past or current gambling activity were additionally asked about their motivations and potential academic consequences. Results: The study included 281 participants. Active or past gambling was reported by 55% of respondents, with men significantly more likely to gamble currently. Women were predominantly non-problem gamblers, whereas men more often scored within the “some problems” range on the SOGS. Motivations also differed: women emphasised financial gain, while men cited fun, socializing, and competition. Lottery and scratch cards were most popular overall, though men preferred skill-based and casino activities. Conclusions: Although participants showed relatively low levels of gambling involvement, their risk of developing pathological gambling was comparable to that of the general population. Gender influenced involvement in different gambling patterns. Full article

(This article belongs to the Special Issue Psychological Diagnosis and Treatment of People with Mental Disorders)

18 pages, 597 KB

Open AccessArticle

Upper Cervical Manipulation and Manual Massage Do Not Modulate Sympatho-Vagal Balance or Blood Pressure in Women: A Randomized, Placebo-Controlled Clinical Trial

by Estêvão Rios Monteiro, Linda S. Pescatello, Gustavo Henrique Garcia, Alexandre Gonçalves de Meirelles, Francine de Oliveira, Rafael Cotta de Souza, Leandro Alberto Calazans Nogueira, Agnaldo José Lopes and Daniel Moreira-Gonçalves

Healthcare 2025, 13(20), 2554; https://doi.org/10.3390/healthcare13202554 (registering DOI) - 10 Oct 2025

Abstract

Objectives: To compare the acute effects of upper cervical manipulation (CM) and manual massage (MM) to simulated CM (Sham) and Control conditions (Control) on heart rate variability (HRV) and blood pressure (BP) responses in women with non-elevated BP. Methods: A single-blind, [...] Read more.

Objectives: To compare the acute effects of upper cervical manipulation (CM) and manual massage (MM) to simulated CM (Sham) and Control conditions (Control) on heart rate variability (HRV) and blood pressure (BP) responses in women with non-elevated BP. Methods: A single-blind, four-arm, parallel-group, randomized, crossover, placebo-controlled trial recruited 15 apparently healthy women with non-elevated BP who visited the lab on four occasions with 48 h intervals to ensure adequate washout between interventions. A Latin square randomization approach was employed to assign participants to one of four experimental conditions: (1) Control: Rest without intervention; (2) CM: Bilateral high-velocity, low-amplitude manipulation of the upper cervical spine (C0–C2); (3) MM: A single 120 s session of MM release applied unilaterally to the anterior and posterior thigh, posterior lower leg, and lumbar musculature; or (4) Sham: Mimicking the positioning used in CM without the application of thrust manipulation. In each experiment, HRV, systolic and diastolic BP were measured at rest (Baseline) and every 15 min for 60 min after each intervention. All procedures were performed in the morning to avoid any confounding circadian rhythm effect on HRV and BP. Results: We found significant increases within conditions for RMSSDms (Control: Post-0 (p = 0.032), Post-15 (p = 0.023); Sham: Post-15 (p = 0.014); CM: Post-15 (p = 0.027)); SDNNms (Control: Post-45 (p = 0.037); CM: Post-45 (p = 0.014) and Post-60 (p = 0.019)); PNN50% (CM: Post-0 (p = 0.044), Post-15 (p = 0.044) and Post-45 (p = 0.019)); LF Power (ms2) (CM: Post-60 (p = 0.001)), and LF/HF ratio (MM: Post-60 (p = 0.022). Conclusions: Although no statistically significant between-condition differences were detected, within-condition changes with moderate-to-large effect sizes suggest potential clinical relevance of CM and MM. These preliminary findings emphasize the importance of effect sizes and may indicate greater translational significance in populations with non-elevated cardiovascular risk. Full article

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32 pages, 1237 KB

Open AccessReview

Healthcare 5.0-Driven Clinical Intelligence: The Learn-Predict-Monitor-Detect-Correct Framework for Systematic Artificial Intelligence Integration in Critical Care

by Hanene Boussi Rahmouni, Nesrine Ben El Hadj Hassine, Mariem Chouchen, Halil İbrahim Ceylan, Raul Ioan Muntean, Nicola Luigi Bragazzi and Ismail Dergaa

Healthcare 2025, 13(20), 2553; https://doi.org/10.3390/healthcare13202553 - 10 Oct 2025

Abstract

Background: Healthcare 5.0 represents a shift toward intelligent, human-centric care systems. Intensive care units generate vast amounts of data that require real-time decisions, but current decision support systems lack comprehensive frameworks for safe integration of artificial intelligence. Objective: We developed and validated the [...] Read more.

Background: Healthcare 5.0 represents a shift toward intelligent, human-centric care systems. Intensive care units generate vast amounts of data that require real-time decisions, but current decision support systems lack comprehensive frameworks for safe integration of artificial intelligence. Objective: We developed and validated the Learn–Predict–Monitor–Detect–Correct (LPMDC) framework as a methodology for systematic artificial intelligence integration across the critical care workflow. The framework improves predictive analytics, continuous patient monitoring, intelligent alerting, and therapeutic decision support while maintaining essential human clinical oversight. Methods: Framework development employed systematic theoretical modeling integrating Healthcare 5.0 principles, comprehensive literature synthesis covering 2020–2024, clinical workflow analysis across 15 international ICU sites, technology assessment of mature and emerging AI applications, and multi-round expert validation by 24 intensive care physicians and medical informaticists. Each LPMDC phase was designed with specific integration requirements, performance metrics, and safety protocols. Results: LPMDC implementation and aggregated evidence from prior studies demonstrated significant clinical improvements: 30% mortality reduction, 18% ICU length-of-stay decrease (7.5 to 6.1 days), 45% clinician cognitive load reduction, and 85% sepsis bundle compliance improvement. Machine learning algorithms achieved an 80% sensitivity for sepsis prediction three hours before clinical onset, with false-positive rates below 15%. Additional applications demonstrated effectiveness in predicting respiratory failure, preventing cardiovascular crises, and automating ventilator management. Digital twins technology enabled personalized treatment simulations, while the integration of the Internet of Medical Things provided comprehensive patient and environmental surveillance. Implementation challenges were systematically addressed through phased deployment strategies, staff training programs, and regulatory compliance frameworks. Conclusions: The Healthcare 5.0-enabled LPMDC framework provides the first comprehensive theoretical foundation for systematic AI integration in critical care while preserving human oversight and clinical safety. The cyclical five-phase architecture enables processing beyond traditional cognitive limits through continuous feedback loops and system optimization. Clinical validation demonstrates measurable improvements in patient outcomes, operational efficiency, and clinician satisfaction. Future developments incorporating quantum computing, federated learning, and explainable AI technologies offer additional advancement opportunities for next-generation critical care systems. Full article

(This article belongs to the Section Artificial Intelligence in Healthcare)

21 pages, 5367 KB

Open AccessArticle

Spinal Cord Injury Epidemiology and Causes: A Worldwide Analysis with 2050 Projections

by Minyoung Kim, Woonyoung Jeong, Suho Jang, Jin Hoon Park, Youngoh Bae and Seung Won Lee

Healthcare 2025, 13(20), 2552; https://doi.org/10.3390/healthcare13202552 - 10 Oct 2025

Abstract

Background/Objectives: The global burden of spinal cord injury (SCI) is increasing due to aging populations and persistent regional disparities, highlighting an urgent need for updated epidemiological data. This study quantifies the global, regional, and national burden of SCI from 1990 to 2021 [...] Read more.

Background/Objectives: The global burden of spinal cord injury (SCI) is increasing due to aging populations and persistent regional disparities, highlighting an urgent need for updated epidemiological data. This study quantifies the global, regional, and national burden of SCI from 1990 to 2021 and projects its prevalence to 2050. Methods: Using data from the Global Burden of Disease (GBD) 2021 study, we estimated age-, sex-, and location-specific prevalence and years lived with disability (YLDs). Projections were developed using sociodemographic modeling, with analyses including Bayesian meta-regression (DisMod-MR 2.1) and Das Gupta decomposition. Results: In 2021, approximately 14.5 million people worldwide were living with SCI, including 7.30 million with neck-level and 7.22 million with below-neck-level injuries. The age-standardized prevalence per 100,000 people was 88 for neck-level SCI and 95 for below-neck-level SCI. Although age-standardized rates declined slightly from 1990 (−0.17% for neck-level and −0.18% for below-neck-level), the absolute burden increased substantially. This increase was particularly prominent in East Asia and low- and middle-income countries. The highest prevalence was observed in men aged 50–64 years. Projections indicate that global SCI cases will exceed 14.5 million by 2050. Conclusions: These findings underscore the growing absolute burden of SCI. Targeted prevention strategies, enhanced rehabilitation services, and equitable healthcare access are crucial to mitigate long-term disability and improve the quality of life for affected populations worldwide. Full article

(This article belongs to the Topic Public Health and Healthcare in the Context of Big Data)

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13 pages, 250 KB

Open AccessArticle

Job Satisfaction, Quality of Life, and Turnover Intention Among Nurses: A Comparative Study of Pattern-Based and Rotating Shift Schedules

by Yu Jin Jung and Haejin Kim

Healthcare 2025, 13(20), 2551; https://doi.org/10.3390/healthcare13202551 - 10 Oct 2025

Abstract

Background/Objectives: Shift work among nurses is associated with adverse outcomes, such as low job satisfaction, reduced quality of life, and high turnover intention. A pattern-based shift system has recently been introduced to provide more predictable and regular schedules. However, empirical research directly comparing [...] Read more.

Background/Objectives: Shift work among nurses is associated with adverse outcomes, such as low job satisfaction, reduced quality of life, and high turnover intention. A pattern-based shift system has recently been introduced to provide more predictable and regular schedules. However, empirical research directly comparing the pattern-based shift system with traditional rotating shifts is lacking. Therefore, this study compared job satisfaction, quality of life, and turnover intention between nurses working under a pattern-based shift system and those working under a traditional rotating shift system. Methods: In total, 112 nurses (56 on a rotating shift and 56 on a pattern-based shift) were surveyed in this cross-sectional study. Job satisfaction was assessed using the Job Satisfaction Scale for Clinical Nurses, specifically developed for Korean nurses. Quality of life was measured using the Scale for Korean Adults’ Quality of Life. The Turnover Intention Measurement Tool, developed for Korean nurses, was used to evaluate turnover intention. Results: Nurses working under a pattern-based shift system reported significantly higher job satisfaction and quality of life than those in a traditional rotating shift system. No significant difference in turnover intention was observed between the two groups. Conclusions: Pattern-based shift systems were associated with higher job satisfaction and quality of life than traditional rotating shift systems; however, their impact on turnover intention was not significant. These findings highlight the need for comprehensive strategies in scheduling reform, as schedule predictability may improve nurses’ job satisfaction and quality of life but appears insufficient to reduce turnover intention, which is likely shaped by broader organizational and psychosocial factors. Full article

18 pages, 270 KB

Open AccessArticle

Understanding the Support Needs of Family Caregivers Living with Severe Developmental Disability: An Interpretive Phenomenological Analysis

by Anna McStravick and Rosanna Cousins

Healthcare 2025, 13(20), 2550; https://doi.org/10.3390/healthcare13202550 - 10 Oct 2025

Abstract

Background/Objectives: Living with a disabled family member has extensive implications for the whole family involved in their care, and there is dependency on healthcare support for maintaining quality of life. This qualitative study, conducted in Northern Ireland, investigated the support needs of different [...] Read more.

Background/Objectives: Living with a disabled family member has extensive implications for the whole family involved in their care, and there is dependency on healthcare support for maintaining quality of life. This qualitative study, conducted in Northern Ireland, investigated the support needs of different family members living with a severely impaired individual across the lifespan. A key objective was to identify support needs for intervention. Methods: In-depth semi-structured interviews were conducted to obtain data from eight mothers, fathers, sisters and brothers of a profoundly disabled child or sibling. Data was analyzed using Interpretive Phenomenological Analysis, allowing for the application of double hermeneutic in which the researchers derived meaning from the lived experiences of participants. Results: The analysis yielded five themes in total. Three themes were related to gaps in healthcare systems: Support Needs in Childhood, Support in Transition into Adult Services, and Worry for the Future; and two themes were linked with support needs: Associative Disability in Family Members; and Stigma. All family members had caregiving roles, and these had similarities and differences according to the relationship with the care-receiver. Participants recognized their families were survivors, however maintained a family tragedy rather than positive change outlook. Conclusions: Recommendations derived from the findings to alleviate the stressors of the situation for family members include increasing community support and age-related respite facilities. Additionally, improving and enhancing education of disabilities in schools, and immersing and further integrating individuals with disability into society, will alleviate the alienation, isolation and loneliness experienced by family members. Full article

(This article belongs to the Special Issue Healthcare Practice in Community)

31 pages, 2308 KB

Open AccessArticle

Digital Transformation of Medical Services in Romania: Does the Healthcare System Meet the Current Needs of Patients?

by Ioana-Marcela Păcuraru, Ancuța Năstac, Andreea Zamfir, Ștefan Sebastian Busnatu, Octavian Andronic and Andrada-Raluca Artamonov

Healthcare 2025, 13(20), 2549; https://doi.org/10.3390/healthcare13202549 - 10 Oct 2025

Abstract

Background: The digitalization of medical services is promoted as a solution for improving access, quality, and efficiency within healthcare systems. In this context, the study investigates the extent to which digitalization in Romania meets the current needs of patients through a convergent [...] Read more.

Background: The digitalization of medical services is promoted as a solution for improving access, quality, and efficiency within healthcare systems. In this context, the study investigates the extent to which digitalization in Romania meets the current needs of patients through a convergent analysis of user perceptions and managerial perspectives. Based on the specialized literature, the research tests two hypotheses: (H1) the implementation of digital technologies significantly contributes to improving the quality of medical services and operational efficiency; (H2) digitalization has a positive impact on patient satisfaction by facilitating access to care and improving communication with medical personnel. Methods: The study adopted methodology is cross-sectional and mixed, including an online mixed-methods questionnaire for patients, distributed between 6 and 14 May 2025, and a qualitative questionnaire with open-ended questions distributed via e-mail to managers from public hospitals through The Administration of Hospitals and Medical Services of Bucharest, between 3 and 24 March 2025. Results: In total, 125 patients and 15 hospital managers participated in the study. Statistical analysis (χ², ordinal regression) and data triangulation highlight a predominantly positive, yet heterogeneous, patient perception of digitalization, with Hypothesis H1 only partially supported (weak, inconsistent, and in some cases negative associations between technology use and perceived service quality). By contrast, H2 was robustly validated, with patient satisfaction strongly linked to tangible benefits, particularly easier access and online appointment scheduling. However, use remains limited to administrative functions, while advanced technologies such as telemedicine or electronic health records are poorly adopted. From an institutional perspective, hospitals predominantly use IT systems for internal purposes, without real patient access to their own data, no interoperability between medical units, and marginal implementation of telemedicine. This reveals a significant gap between user perception and organizational realities, emphasizing the lack of a patient-oriented digital infrastructure. Conclusions: The results highlight the potential of digitalization to enhance patient experience and service efficiency, while also pointing out structural limitations that hinder the full realization of this potential. Patient satisfaction is strongly associated with tangible benefits, particularly easier access and online scheduling, whereas the effect on perceived quality is weaker and sometimes inconsistent. There are significant disparities in digitalization levels between healthcare providers, perceived by patients as public–private differences, and gaps among public hospitals are also confirmed by managerial data. These findings suggest that a successful digital transformation of the medical system in Romania must address both technological infrastructure gaps and organizational barriers, within a coordinated national strategy that ensures interoperability, patient-centered design, and sustainable implementation. Full article

(This article belongs to the Special Issue The Role of Digitalization in Healthcare Within the National Health System: Opportunities and Challenges for a More Efficient System)

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20 pages, 2127 KB

Open AccessSystematic Review

The Diagnostic Performance of Transvaginal Ultrasound for Posterior Compartment Endometriosis Compared to Laparoscopic and Histopathological Findings: A Systematic Review

by Roxana-Denisa Capraș, Iulia Clara Badea, Mădălina Moldovan, Adriana Ioana Gaia-Oltean, Alexandru-Florin Badea and Teodora Telecan

Healthcare 2025, 13(20), 2548; https://doi.org/10.3390/healthcare13202548 - 10 Oct 2025

Abstract

Background: Deep infiltrating endometriosis (DIE) frequently affects the posterior pelvic compartment, where accurate non-invasive imaging is essential for diagnosis and surgical planning. Aim: This systematic review evaluates the diagnostic performance of transvaginal ultrasound (TVUS) in detecting posterior compartment DIE, specifically rectosigmoid lesions, uterosacral [...] Read more.

Background: Deep infiltrating endometriosis (DIE) frequently affects the posterior pelvic compartment, where accurate non-invasive imaging is essential for diagnosis and surgical planning. Aim: This systematic review evaluates the diagnostic performance of transvaginal ultrasound (TVUS) in detecting posterior compartment DIE, specifically rectosigmoid lesions, uterosacral ligament involvement, and pouch of Douglas obliteration. Material and Methods: A comprehensive literature search of PubMed, Scopus, and Web of Science was performed for studies published between 2015 and 2025. Eligible studies assessed the accuracy of TVUS for posterior compartment DIE using laparoscopy and histology as reference standards. Data on sensitivity, specificity, and overall diagnostic accuracy were extracted or derived. The study’s quality was evaluated using the QUADAS-2 tool. Results: Thirty eligible studies were included. The mean sensitivities and specificities reported in the included studies reached 83.05% and 90.53% for rectosigmoid disease, 78.07% and 90.49% for uterosacral ligament involvement, and 79.58% and 89.75% for pouch of Douglas obliteration, respectively. Adjunctive techniques such as gel sonovaginography, rectal water contrast, or saline instillation into the pouch of Douglas were described, but their use was inconsistent. Marked heterogeneity in patient preparation, scanning protocols, and reporting limited comparability across studies. Despite this, TVUS demonstrated diagnostic performance within a similar range to that reported for MRI in prior systematic reviews, with the advantages of lower cost, accessibility, and integration into routine gynecological practice. Conclusions: TVUS is consistently reported as a reliable and cost-effective imaging modality and, in line with international guidelines, should be considered the first-line option for posterior compartment DIE, though further standardization of scanning and reporting protocols is needed to optimize reproducibility and clinical utility. Full article

(This article belongs to the Special Issue Diagnosis and Therapeutic Advances in Endometriosis)

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12 pages, 237 KB

Open AccessArticle

Moral Distress in Ethical Dilemmas: A Comparative Study of Medical Students and Physicians

by George-Dumitru Constantin, Bogdan Hoinoiu, Ioana Veja, Crisanta-Alina Mazilescu, Teodora Hoinoiu, Ruxandra Elena Luca, Ioana Roxana Munteanu and Roxana Oancea

Healthcare 2025, 13(19), 2547; https://doi.org/10.3390/healthcare13192547 - 9 Oct 2025

Abstract

Background: Ethical dilemmas and the moral distress they generate are central challenges in healthcare practice and professional identity formation. While moral reasoning has been widely studied, comparative evidence on how medical students and practicing physicians approach ethical dilemmas remains scarce in Eastern [...] Read more.

Background: Ethical dilemmas and the moral distress they generate are central challenges in healthcare practice and professional identity formation. While moral reasoning has been widely studied, comparative evidence on how medical students and practicing physicians approach ethical dilemmas remains scarce in Eastern Europe. Methods: A total of 244 participants (51 senior medical students and 193 physicians) completed an adapted version of the Defining Issues Test, version 2 (DIT-2). Three classical dilemmas were assessed: end-of-life decision-making, access to life-saving medication, and the reintegration of a fugitive. Responses were analyzed through descriptive statistics and chi-square tests to identify differences in decision choices and underlying reasoning. Results: Physicians consistently endorsed conventional, law-based reasoning, emphasizing legality and professional codes, while medical students demonstrated greater variability, indecision, and openness to compassion-driven justifications. In the “Jan and the Drug” and “Fugitive” dilemmas, significant between-group differences highlighted tensions between legality, empathy, and justice (p < 0.01). These differences in reasoning indicate differing vulnerabilities to moral distress, especially when legal and compassionate perspectives conflict. Conclusions: The findings reveal distinct patterns of moral reasoning that reflect different levels of vulnerability to moral distress in healthcare contexts. Integrating structured ethics training and reflective dialogue into both undergraduate and continuing medical education could mitigate moral distress by fostering a balance between justice, compassion, and professional responsibility. Full article

(This article belongs to the Special Issue Ethical Dilemmas and Moral Distress in Healthcare)

12 pages, 246 KB

Open AccessArticle

Applying the WHO ICF Framework to Fetal Alcohol Spectrum Disorder (FASD): A Forensic and Clinical Perspective on Disability Assessment and Patient Support

by Davide Ferorelli, Francesco Calò, Gianmarco Sirago, Dania Comparcini, Filippo Gibelli, Francesco Sessa, Marco Carotenuto, Biagio Solarino and Monica Salerno

Healthcare 2025, 13(19), 2546; https://doi.org/10.3390/healthcare13192546 - 9 Oct 2025

Abstract

Background/Objectives: This article aims to investigate the multifaceted effects of alcohol on neurophysiopathological development from gestational stages through adult life and the consequent dynamic-relational challenges in individuals with Fetal Alcohol Spectrum Disorder (FASD). FASD, resulting from prenatal alcohol exposure (PAE), is characterized [...] Read more.

Background/Objectives: This article aims to investigate the multifaceted effects of alcohol on neurophysiopathological development from gestational stages through adult life and the consequent dynamic-relational challenges in individuals with Fetal Alcohol Spectrum Disorder (FASD). FASD, resulting from prenatal alcohol exposure (PAE), is characterized by a range of neurological, cognitive, behavioral, and sometimes physical impairments. This article explores how alcohol and its toxic metabolites cross the placenta, inducing direct cellular toxicity and epigenetic alterations that disrupt critical neurodevelopmental processes such as neurogenesis and brain circuit formation. Clinically, individuals with FASD exhibit diverse deficits in executive functioning, learning, memory, social skills, and sensory-motor abilities, leading to significant lifelong disabilities. A central focus is the application of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) criteria to comprehensively frame these disabilities. The ICF’s biopsychosocial model allows for a multidimensional assessment of impairments in body functions and structures, limitations in activities, and restrictions in participation, while also considering the crucial role of environmental factors. Methods: PubMed and Semantic Scholar databases were searched for relevant papers published in English. Results: This article highlights the utility of the ICF in creating individualized functioning profiles to guide interventions and support services, addressing the limitations of traditional assessment methods. Conclusions: While the ICF framework offers a robust approach for understanding and managing FASD, further research is essential to develop and validate FASD-specific ICF-based assessment tools to enhance support and social participation for affected individuals. Full article

14 pages, 419 KB

Open AccessArticle

Effects of a Standing Program for Ambulatory Children with Myelomeningocele: A Single-Subject Design

by Marianne Hanover, Elizabeth M. Ardolino and Megan B. Flores

Healthcare 2025, 13(19), 2545; https://doi.org/10.3390/healthcare13192545 - 9 Oct 2025

Abstract

Background/Objectives: Children with myelomeningocele (MMC) often experience lower extremity muscular contractures, which can impact their functional mobility. While standing programs have demonstrated benefits for children with other neuromuscular conditions, there is limited evidence on their use in ambulatory children with MMC who have [...] Read more.

Background/Objectives: Children with myelomeningocele (MMC) often experience lower extremity muscular contractures, which can impact their functional mobility. While standing programs have demonstrated benefits for children with other neuromuscular conditions, there is limited evidence on their use in ambulatory children with MMC who have joint deformities. This single-subject design study examined the impact of a home-based standing program on two ambulatory children with MMC, focusing on lower extremity muscle flexibility, functional movement quality, gait velocity, and participation in daily activities. Methods: Two children participated in a multi-phase single-subject (ABABA) withdrawal design beginning with the baseline phase and then alternating between the intervention and withdrawal phases. The intervention consisted of 60-minute standing sessions, five days a week, using a sit-to-stand stander (STSS) with support and supervision from a physical therapist (PT) and the parent. Primary outcomes included goniometric passive range of motion (PROM) and 10-Meter Walk Test (10 MWT). Secondary outcomes included the Pediatric Neuromuscular Recovery Scale (Peds NRS) and the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT). Results: Improvements in hip and knee muscle flexibility were observed during the intervention phases, with some loss during the withdrawal phase. Functional movement quality improved in both children. Gait velocity and participation in daily activity scores remained stable during intervention phases. Parental feedback reflected increased independence and high engagement with the home program. One child discontinued due to a heel injury, highlighting the need for individualized support. Conclusions: Personalized standing programs may improve muscle flexibility and functional movement quality in ambulatory children with MMC. Further research is warranted to determine the optimal dosing regimen, ensure safety, and assess long-term functional outcomes. Full article

(This article belongs to the Section Chronic Care)

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18 pages, 454 KB

Open AccessArticle

Associations Between Sedentary Behaviors and Sedentary Patterns with Metabolic Syndrome in Children and Adolescents: The UP&DOWN Longitudinal Study

by Alejandro Sánchez-Delgado, Alejandro Perez-Bey, Julio Conde-Caveda, Rocío Izquierdo-Gómez, Sonia Gómez-Martínez, Oscar L. Veiga, Ascensión Marcos and José Castro-Piñero

Healthcare 2025, 13(19), 2544; https://doi.org/10.3390/healthcare13192544 - 9 Oct 2025

Abstract

Background/Objectives: The longitudinal associations between different modalities of sedentary behaviors (SBs) and sedentary patterns (SPs) with metabolic syndrome (MetS) in children and adolescents are unclear. We aimed to analyze the cross-sectional and longitudinal (2-year follow-up) association between SB and SP with the MetS [...] Read more.

Background/Objectives: The longitudinal associations between different modalities of sedentary behaviors (SBs) and sedentary patterns (SPs) with metabolic syndrome (MetS) in children and adolescents are unclear. We aimed to analyze the cross-sectional and longitudinal (2-year follow-up) association between SB and SP with the MetS score in Spanish children and adolescents. Methods: 76 children (34 females) and 186 adolescents (94 females) were included for SB analyses, and 175 children (82 females) and 188 adolescents (95 females) for SP. Children and adolescents were aged 6–11.9 years and 12–17.9 years, respectively. SB were assessed by a self-reported questionnaire and SP were determined by accelerometry. The MetS score was computed from the waist circumference, systolic blood pressure, triglycerides, high-density lipoprotein cholesterol, and glucose levels. Different linear regression models were implemented to examine cross-sectional, longitudinal, and change associations of SB and SP with MetS. Results: Total daily SB, educative daily SB, and mean SB were longitudinal and inversely associated with MetS (β = −0.001, all p < 0.05) in male adolescents, while other daily SB was longitudinal and inversely associated with MetS (β = −0.002, all p < 0.05) in female adolescents. Changes in screen and other daily SB were directly associated with MetS in female adolescents (β = 0.001 to 0.002, all p < 0.05). In contrast, changes in educative daily SB were inversely associated with MetS in female adolescents (β = −0.001, all p < 0.05). Conclusions: Few associations between SB modalities and the MetS score were found, mainly in adolescents and often in unexpected directions. In male adolescents, total and educative daily SB were negatively associated with MetS. In female adolescents, other daily SB and changes in educative daily SB showed negative associations, while changes in screen-based and other daily SB were positively associated with MetS. No associations were found between SP and MetS. Given the low evidence available to date, more longitudinal studies analyzing SB and SP simultaneously are needed to reach solid conclusions. Full article

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

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13 pages, 857 KB

Open AccessArticle

Patterns of Psychiatric Comorbidity Among Drug Users: A Prospective Observational Study in a Romanian Psychiatric Hospital

by Andreea Atena Zaha, Antonia Lucia Comșa, Dana Carmen Zaha and Cosmin Mihai Vesa

Healthcare 2025, 13(19), 2543; https://doi.org/10.3390/healthcare13192543 - 9 Oct 2025

Abstract

Background: A large number of substance use disorders are increasingly associated with complex clinical presentations and unknown mental and medical risks, presenting a growing challenge for mental health worldwide. Research exploring the interplay between substance use and psychiatric disorders remains limited in Eastern [...] Read more.

Background: A large number of substance use disorders are increasingly associated with complex clinical presentations and unknown mental and medical risks, presenting a growing challenge for mental health worldwide. Research exploring the interplay between substance use and psychiatric disorders remains limited in Eastern Europe. Objectives: We investigated the demographic and clinical features of 203 patients admitted to a major Romanian psychiatric hospital, aiming to clarify the patterns of dual diagnosis and symptomatology within this vulnerable population. Results: Cannabis, novel psychoactive substances and unknown substances were the most commonly used drugs. Psychiatric comorbidity was rather the rule than the exception within our group. Cluster analysis revealed three distinct symptom profiles: manic/psychotic, negative affective and disorganized. While individual drug type did not independently predict symptom severity or readmission risk, a significant interaction effect between drug use and psychiatric comorbidity influenced symptom cluster membership. Conclusions: These findings highlight the complexity and heterogeneity of dual diagnoses and underline the importance of an integrated, multidisciplinary approach in addiction medicine. Full article

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10 pages, 342 KB

Open AccessArticle

A VR-Based Trauma Nursing Education Program for Clinical Nurses: Integrating Jeffries’ Model and the 5E Learning Cycle

by Heeyeon Kim, Gyuli Baek and Eunju Lee

Healthcare 2025, 13(19), 2542; https://doi.org/10.3390/healthcare13192542 - 9 Oct 2025

Abstract

Background/Objectives: Nurses’ professional competencies are critical in trauma patient care, and educational programs that strengthen these competencies contribute to improved patient safety and higher-quality care. This study aimed to develop and evaluate the effectiveness of a virtual reality (VR)-based trauma nursing education program [...] Read more.

Background/Objectives: Nurses’ professional competencies are critical in trauma patient care, and educational programs that strengthen these competencies contribute to improved patient safety and higher-quality care. This study aimed to develop and evaluate the effectiveness of a virtual reality (VR)-based trauma nursing education program by applying Jeffries’ simulation model and the 5E Learning Cycle. Methods: A quasi-experimental, non-equivalent control group pretest–post-test design was employed. Participants were 34 nurses with more than one year of clinical experience, recruited from three university hospitals in Daegu, Korea, each with over 800 beds. Participants were allocated to either the experimental group (n = 17) or the control group (n = 17). The experimental group received the VR-based program, while the control group received standard training. Effectiveness was assessed using validated questionnaires measuring trauma-related knowledge, confidence in trauma care, and emergency nursing competency. Data were analyzed with repeated-measures ANOVA. Results: The experimental group demonstrated significant improvements in trauma-related knowledge and confidence in trauma care compared with the control group. Emergency nursing competency also increased significantly in both groups over time, but the degree of improvement did not differ between groups. Conclusions: The VR-based trauma nursing education program, designed using Jeffries’ simulation model and the 5E Learning Cycle, enhanced trauma-related knowledge and confidence among clinical nurses. Although no between-group difference was found for emergency nursing competency, the findings provide foundational evidence supporting the use of VR-based interventions to advance emergency and critical care nursing education. Full article

(This article belongs to the Topic The Use of New Technologies for Health and Clinical Practice)

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11 pages, 216 KB

Open AccessArticle

Emotional Health: Improving Emotional Intelligence Through Physical Education

by Karen Troncoso-Ulloa, Izaskun Luis-de-Cos, Saioa Urrutia-Gutierrez, Gurutze Luis-de-Cos and Silvia Arribas-Galarraga

Healthcare 2025, 13(19), 2540; https://doi.org/10.3390/healthcare13192540 - 9 Oct 2025

Abstract

Background/Objectives: Difficulties in emotional regulation are recognized as a risk factor for a variety of emotion-based psychopathologies, including anxiety and depression. In this context, movement and physical activity have been identified as a key element in preventing these health issues, particularly during [...] Read more.

Background/Objectives: Difficulties in emotional regulation are recognized as a risk factor for a variety of emotion-based psychopathologies, including anxiety and depression. In this context, movement and physical activity have been identified as a key element in preventing these health issues, particularly during the initial teacher training. This study aimed to analyze the impact of an emotional health physical education program on the Emotional Intelligence of university students studying physical education in Chile. Methods: A quasi-experimental design with experimental and control groups and repeated measures (pre test-post test) was employed. A total of 214 male and female students from two Chilean universities participated and completed the Spanish version of the Trait Meta-Mood Scale (TMMS-24). Results: Results confirmed the program’s effectiveness in fostering Emotional Intelligence, revealing statistically significant improvements (p < 0.05) in the dimensions of emotional attention and clarity. Conclusions: These findings suggest that emotional physical education programs can be effective in promoting emotional skills essential for the learning and mental well-being of university students who will later become primary and secondary school teachers. Full article

(This article belongs to the Special Issue Physical Activity and Fitness in the Health Promotion of Children and Adolescents)

22 pages, 3295 KB

Open AccessBrief Report

The Greek Versions of the HLS₁₉ Health Literacy Instruments (HLS₁₉-NAV-GR, HLS₁₉-COM-GR, and HLS₁₉-VAC-GR): Translation, Cultural Adaptation, and Descriptive Pilot Evaluation

by Angeliki Flokou, Panagiotis Theodorou, Dimitris A. Niakas and Petros Kostagiolas

Healthcare 2025, 13(19), 2541; https://doi.org/10.3390/healthcare13192541 - 8 Oct 2025

Abstract

Background: Health literacy (HL) is a key determinant of health outcomes and equity. The European Health Literacy Survey 2019 (HLS₁₉) introduced three domain-specific instruments—HLS₁₉-NAV, HLS₁₉-COM-P-Q11, and HLS₁₉-VAC. We present the translation, cultural adaptation, field [...] Read more.

Background: Health literacy (HL) is a key determinant of health outcomes and equity. The European Health Literacy Survey 2019 (HLS₁₉) introduced three domain-specific instruments—HLS₁₉-NAV, HLS₁₉-COM-P-Q11, and HLS₁₉-VAC. We present the translation, cultural adaptation, field testing, and descriptive pilot evaluation of their Greek versions (HLS₁₉-NAV-GR, HLS₁₉-COM-GR, HLS₁₉-VAC-GR). Methods: Dual forward/back-translation and expert review (11 health professionals/academics) produced the final versions. A purposive, quota-guided field test (N = 71) approximated population distributions by sex, age, education, and geographical region. Test–retest stability (n = 16; ~12 days) was summarized primarily with intraclass correlation ICC (2,1), with Pearson/Spearman correlations reported secondarily. Internal consistency was assessed using ordinal alpha computed from polychoric (polytomous) and tetrachoric (dichotomous) correlations. We report item- and scale-level descriptive statistics for both the original polytomous (four-category, 1–4) responses and a dichotomous difficulty–ease scheme (1–2 vs. 3–4). Given the non-probability sampling in this pilot, the results are descriptive, not statistically representative. Results: Instruments were well accepted, requiring only minor revisions. Scales demonstrated high short-term stability and good internal consistency; inter-scale correlations were moderate, interpreted as associations among related but distinct constructs. Item distributions skewed toward Easy/Very Easy; several HLS₁₉-VAC-GR items showed a clear ceiling, suggesting the need to consider harder items or a larger item pool in future validation. By scale, scores followed the descending order NAV, COM, and VAC. Distributions and ranking patterns broadly mirrored population-level findings from other countries. Conclusions: The adapted HLS₁₉-NAV/COM/VAC-GR instruments are linguistically and culturally appropriate and prepared for large-scale validation, while items NAV9, COM4, and the VAC ceiling are flagged for further assessment. Full article

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14 pages, 1917 KB

Open AccessArticle

Health Information Seeking and Behavior in the Korean Population During the COVID-19 Pandemic

by Hanna Choi, Meiling Jin and Byungsun Park

Healthcare 2025, 13(19), 2539; https://doi.org/10.3390/healthcare13192539 - 8 Oct 2025

Abstract

Background: Online health information seeking emerged as a critical form of public health behavior during the COVID-19 pandemic, generating substantial research interest. However, empirical studies examining health information-seeking patterns among Korean populations and their behavioral outcomes during the pandemic remain limited. Grounded in [...] Read more.

Background: Online health information seeking emerged as a critical form of public health behavior during the COVID-19 pandemic, generating substantial research interest. However, empirical studies examining health information-seeking patterns among Korean populations and their behavioral outcomes during the pandemic remain limited. Grounded in the information–motivation–behavior skills model, this study investigates online health information-seeking behaviors, including information sources, search terms, and engagement patterns, while also exploring their association with actual health behaviors during the COVID-19 pandemic. Methods: A structured survey was developed based on 1014 adults aged 19 years or older using the 2021 Korean version of the Health Information National Trends Survey (K-HINTS) to obtain nationally representative data. We adopted a structural equation model and analyzed the data using SPSS 25.0 and the WordArt site. Results: Of the respondents, 74.2% sought health information online, with vaccine details being the most widely searched topic. Mobile phones were the most commonly used devices (75.8%), and 98% searched for health information online via mobile devices at least once a week. Information (β = 0.230, p < 0.001), motivation (β = 0.117, p < 0.01), and behavior skills (β = 0.117, p < 0.01) positively influenced consumers’ behavioral changes regarding health. Behavioral skills also mediated the influences that information seeking and motivation had on behavioral changes. Conclusions: This study examines four aspects of online health information seeking through nationally representative COVID-19 data in South Korea. Exploring the relationship between information-seeking and actual health behaviors provides crucial insights for predicting post-pandemic consumer behavior and developing effective public health communication strategies for future crises. Full article

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