Healthcare

15 pages, 647 KB

Open AccessArticle

Investigating Physical Activity as a Predictor of Psychological Distress in UAE Nursing Students

by Eman Abdelaziz Ahmed Dabou, Shukri Adam, Mona Gamal Mohamed, Mary Grace Carezon Bedolido and Kim Ashley Militar

Healthcare 2025, 13(17), 2112; https://doi.org/10.3390/healthcare13172112 (registering DOI) - 25 Aug 2025

Abstract

Background: Psychological distress is one of the leading causes of ill health in the United Arab Emirates (UAE). Nursing students often report higher levels of stress than the general population. Identifying the determinants of mental distress is essential to raise awareness and enable [...] Read more.

Background: Psychological distress is one of the leading causes of ill health in the United Arab Emirates (UAE). Nursing students often report higher levels of stress than the general population. Identifying the determinants of mental distress is essential to raise awareness and enable universities to implement preventive interventions. Aim: To examine the relationship between physical activity and psychological distress among nursing students at RAK Medical and Health Sciences University. Methods: A descriptive cross-sectional design was employed. A total of 187 students completed a three-part survey: (I) sociodemographic characteristics, (II) the International Physical Activity Questionnaire-Short Form (IPAQ-SF), and (III) the Depression Anxiety Stress Scale-21 (DASS-21). Results: Among participants, 28.3% were inactive, 36.9% engaged in moderate activity, and 34.8% engaged in vigorous activity. Significant associations were observed between physical activity and gender (χ² = 9.64, p < 0.001), nationality (χ² = 8.09, p = 0.01), anxiety (FET = 99.34, p < 0.001), and stress levels (χ² = 12.41, p = 0.05). Regression analysis showed that gender, nationality, anxiety, and stress significantly predicted physical activity levels (F(3,183) = 62.47, p < 0.001), explaining 51% of the variance (R² = 0.506, adjusted R² = 0.498). Conclusion: Physical activity among nursing students was significantly associated with gender, nationality, anxiety, and stress. Programs that promote physical activity may help reduce psychological distress and improve students’ health and well-being. Failure to address high levels of stress and anxiety may increase the risk of burnout in future professional practice. Full article

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17 pages, 526 KB

Open AccessStudy Protocol

Effects of a Twelve-Week Complementary Sports Program to Athletics Training on Motor Competence in Children Aged 6 to 10 Years Old—A Study Protocol

by Nataniel Lopes, Miguel Jacinto, Diogo Monteiro, Rui Matos and Sérgio J. Ibáñez

Healthcare 2025, 13(17), 2111; https://doi.org/10.3390/healthcare13172111 (registering DOI) - 25 Aug 2025

Abstract

Motor competence (MC) is defined as a global term that describes a person’s ability to be proficient in a wide range of motor acts. Based on this principle, we have created a training program that aims to determine the effect of 12 weeks [...] Read more.

Motor competence (MC) is defined as a global term that describes a person’s ability to be proficient in a wide range of motor acts. Based on this principle, we have created a training program that aims to determine the effect of 12 weeks of enriched athletics sports training with complementary motor activities on MC in children aged between 6 and 10 years old. The subjects will be divided into two groups: (i) the athletics training group (IG_A) that will participate in athletics training three times a week for 12 weeks, with 60 min sessions; and (ii) the athletics training + other activities group (IG_B) that will participate in athletics training twice a week and will have another activity training (gymnastics, handball, swimming, and motor games) for 12 weeks, with 60 min sessions. The two groups will be assessed at baseline and 12 weeks later. The KTK3+ will be used to assess MC. A between–within ANOVA-RM (2 [groups] × 2 [time points]) will be conducted. The results and conclusions of the implementation program will be presented in another study. Full article

(This article belongs to the Special Issue Physical Activity, Healthy Lifestyle and Well-Being Across the Lifespan: Second Edition)

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23 pages, 790 KB

Open AccessArticle

The Role of Physical Activity Opportunities and Local Authority Engagement in Promoting Healthy Living and Increasing Life Expectancy

by Mădălina Giorgiana Mangra, Gabriel Ioan Mangra, Claudiu George Bocean, Anca Antoaneta Vărzaru, Cristina Claudia Rotea and Constantin-Cristian Văduva

Healthcare 2025, 13(17), 2110; https://doi.org/10.3390/healthcare13172110 (registering DOI) - 25 Aug 2025

Abstract

Background: Physical activity is essential for public health, yet disparities in access to exercise opportunities and institutional support remain significant across European regions. Objectives: This study examines how locally available physical activity options and support from local authorities relate to exercise [...] Read more.

Background: Physical activity is essential for public health, yet disparities in access to exercise opportunities and institutional support remain significant across European regions. Objectives: This study examines how locally available physical activity options and support from local authorities relate to exercise participation, life expectancy, and healthy life years within the European Union. Methods: Using artificial neural networks and cluster analysis, the research identifies patterns across EU countries and explores associations between exercise behaviors and public health outcomes. Results: The MLP analysis showed that moderate regular physical activity had the most decisive influence on predicting healthy life years (100%), followed by regular activity (44.7%). In comparison, inactivity had a notable negative impact (40.5%). Life expectancy was most closely associated with the model’s strongest predictive pathway (weight = 2.395). Access to physical activity opportunities (100%) and the presence of supportive community providers (90.8%) were the most influential factors in encouraging active lifestyles. Conclusions: Populations with greater access and engagement in physical activity tend to enjoy longer life expectancies and more years of good health. While the study’s observational nature limits causal interpretations, the findings highlight the potential of community-level strategies and infrastructural investment to foster active lifestyles and enhance population health across varied local contexts. Full article

(This article belongs to the Special Issue The Impact of Exercise and Physical Activity on Quality of Life)

18 pages, 254 KB

Open AccessArticle

Migratory Experience as a Factor of Vulnerability: Navigating Loss, Gratitude, and Meaning

by María José Cáceres-Titos, E. Begoña García-Navarro and Mayckel da Silva Barreto

Healthcare 2025, 13(17), 2109; https://doi.org/10.3390/healthcare13172109 (registering DOI) - 25 Aug 2025

Abstract

Background/Objectives: Involuntary migration exposes individuals to multiple losses and ruptures that profoundly affect their physical, emotional, and social well-being. This study aimed to explore the vital losses experienced by Latin American women seeking international protection, identifying key dimensions of these losses and the [...] Read more.

Background/Objectives: Involuntary migration exposes individuals to multiple losses and ruptures that profoundly affect their physical, emotional, and social well-being. This study aimed to explore the vital losses experienced by Latin American women seeking international protection, identifying key dimensions of these losses and the coping strategies they employ to support their health and well-being. Methods: The study employed a qualitative phenomenological approach, with 17 international migrant women comprising the study subjects. Data were analysed using an inductive approach and interpretative phenomenological analysis, facilitated by Atlas.ti 23.0 software. The COREQ criteria were followed. Results: The analysis revealed two central themes: the multiplicity of losses associated with migration, including loss of identity, emotional deterioration, disruption of family and community ties, economic instability, and loss of sense of belonging; and hidden gains, encompassing processes of gratitude, spiritual strength, and personal transformation. Conclusions: The findings highlight the complexity of both the losses and the hidden gains associated with the migration experience, underscoring the need for compassionate and culturally competent healthcare. This study provides relevant evidence to improve professional support strategies for refugee women from a comprehensive and humanised perspective. Full article

(This article belongs to the Special Issue Advancing Cultural Competence in Health Care)

17 pages, 439 KB

Open AccessArticle

Developing a Concept on Ethical, Legal and Social Implications (ELSI) for Data Literacy in Health Professions: A Learning Objective-Based Approach

by Vivian Lüdorf, Sven Meister, Anne Mainz, Jan P. Ehlers, Julia Nitsche and Theresa Sophie Busse

Healthcare 2025, 13(17), 2108; https://doi.org/10.3390/healthcare13172108 - 25 Aug 2025

Abstract

(1) Background: Data literacy is becoming increasingly important for healthcare professionals in both outpatient care and research. Since healthcare data and the possibilities for its use and misuse are increasing in these areas, healthcare professionals need diverse knowledge regarding the collection, use and [...] Read more.

(1) Background: Data literacy is becoming increasingly important for healthcare professionals in both outpatient care and research. Since healthcare data and the possibilities for its use and misuse are increasing in these areas, healthcare professionals need diverse knowledge regarding the collection, use and evaluation of data. A core component of this is an understanding of the ethical, legal, and social implications (ELSI) of working with health data. (2) Methods: Within the DIM.RUHR project (Data Competence Center for Interprofessional use of Health Data in the Ruhr Metropolis), the challenge of training in data literacy for different healthcare professionals is addressed. Based on a learning objectives matrix for interprofessional data literacy education, an ELSI concept was developed through collaboration with interprofessional project partners. The study was conducted between December 2024 and April 2025. (3) Results: The foundational structure of the ELSI concept was based on the learning objectives matrix and an unstructured literacy search for ELSI concepts in similar contexts. Using an iterative design-based research approach, a group of experts from different fields (didactics, applied ethics, health sciences, law, sociology, informatics, and psychology) developed an ELSI concept for healthcare professionals. The following categories were identified as crucial: 1. philosophy of science: a basic understanding of science and the hurdles and opportunities; 2. ethics: an overview of the biomedical principles and a technological assessment; 3. law: an overview of the reservation of permission and self-determination; 4. social aspects: an overview of health inequalities and different forms of power relations and imbalances. (4) Conclusions: The ELSI concept can be used in the orientation of healthcare professionals in outpatient care and research—regardless of their profession—to develop data competencies, with the aim of providing a holistic view of the challenges and potential in the collection, use, and evaluation of healthcare data. The DIM.RUHR project’s approach is to develop open educational resources that build on the ELSI concept to teach specific skills at different competence levels. Full article

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18 pages, 282 KB

Open AccessArticle

What a SMART Pharmacist Can Discover in Only One Day: A Public Health Initiative Focused on Diabetes in North Macedonia

by Vesna Stavrova, Maja Simonoska Crcarevska, Zorica Naumovska, Biljana Bozhinovska, Joana Andonoska, Katarina Stavric, Viktorija Maksimova, Arijana Meštrović and Michael John Rouse

Healthcare 2025, 13(17), 2107; https://doi.org/10.3390/healthcare13172107 - 25 Aug 2025

Abstract

Background/Objectives: Pharmacists’ roles are shifting from dispensing medications to managing chronic diseases and prevention. Diabetes is a growing public health issue requiring early detection and management, where pharmacists can play a key role. The SMART Pharmacist Program promotes continuing education and expanded care, [...] Read more.

Background/Objectives: Pharmacists’ roles are shifting from dispensing medications to managing chronic diseases and prevention. Diabetes is a growing public health issue requiring early detection and management, where pharmacists can play a key role. The SMART Pharmacist Program promotes continuing education and expanded care, and a nationwide blood sugar screening campaign in North Macedonia was conducted to evaluate the impact of pharmacists in detecting undiagnosed diabetes and supporting glycemic control. Methods: This descriptive observational cross-sectional study was conducted mainly on 14 November 2024, in 98 community pharmacies across 14 cities. Participants over 18 years old were recruited via voluntary sampling. A total of 998 measurements were performed on the campaign day, with additional screening extending to 24 January 2025, totaling 1085 participants. Blood glucose was measured by finger prick testing and classified according to national and NICE guidelines. A structured questionnaire collected demographic, medical, and lifestyle data. Results: Among 1085 participants (65.1% female, mean age 57.6 ± 14.5 years), 258 (23.8%) had diagnosed diabetes, mostly Type 2 (226; 20.8%), while 827 (76.2%) were undiagnosed. Males had 1.7 times higher odds of diabetes. Diabetes prevalence correlated with physical inactivity, higher BMI, smoking, and chronic diseases. Among the undiagnosed, 17.8% were prediabetic and 4.3% diabetic. Of diagnosed patients, 57% had well-controlled and 42% poorly controlled diabetes. Metformin-based therapies were most common for Type 2 diabetes. Conclusions: Community pharmacists can effectively support early detection of diabetes and identify patients with suboptimal glycemic control, enhancing diabetes management in the community. Full article

20 pages, 1635 KB

Open AccessReview

Inclusive Healthcare System for Children with Disabilities: A Bibliometric Analysis and Visualization

by Erkan Gulgosteren, Yavuz Onturk, Abdullah Cuhadar, Mihaela Zahiu, Monica Stanescu and Rares Stanescu

Healthcare 2025, 13(17), 2106; https://doi.org/10.3390/healthcare13172106 - 24 Aug 2025

Abstract

Background: Children with disabilities face complex, systemic health access barriers rooted in societal, institutional, and structural inequities, requiring urgent global policy attention. Publications on access to health services for this population category have been found to have a significant growth in both quantity [...] Read more.

Background: Children with disabilities face complex, systemic health access barriers rooted in societal, institutional, and structural inequities, requiring urgent global policy attention. Publications on access to health services for this population category have been found to have a significant growth in both quantity and content. The article aims to examine the structure and evolution of scientific literature in analyzing the healthcare system through the lens of inclusive services. Methods: We present the bibliometric profile of the global literature on access to health services for children with disabilities, the publication trends, the structure of research in this field concerning geographical distribution, methodological approaches, and interdisciplinary collaborations, and the core research topics, conceptual clusters, and future research directions in the field. The publications were screened from Web of Science databases, using PRISMA methodology. Finally, 1100 academic publications published between 1984 and 2025, obtained from a total of 432 different sources, the majority of which were peer-reviewed journals, were screened. Results: The calculated annual publication growth rate of 8.37% and the distinct upward trend observed, especially after 2015. The highest level was reached in 2023, with over 90 publications showing that the topic has become a focus of international academic interest. The USA (33.5%), the United Kingdom (15.7%), Australia (9.5%), and Canada (9.5%) stood out in publications, and there were strong collaborative networks among European nations (8.2%). Conclusions: Although high-income countries still appear to play a dominant role in research production, expanding international collaborations and distributing resources more equitably will contribute to the development of more inclusive solutions on a global scale. Temporal trends show an evolution toward diagnostic processes, family-centered approaches, and psychosocial dimensions. The results draw a clear picture of the current research landscape regarding access to health services for pediatric disability populations and identify potential directions for future research. Full article

(This article belongs to the Special Issue Disability Studies and Disability Evaluation)

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13 pages, 1701 KB

Open AccessArticle

Modeling the Impact of Tele-Health on Accessibility and Equity of Medical Resources in Metropolitan Cities in China

by Qing Wang, Leqi Weng and Jingshan Li

Healthcare 2025, 13(17), 2105; https://doi.org/10.3390/healthcare13172105 - 24 Aug 2025

Abstract

Background: Although the expansion of medical resources has largely alleviated challenges of “more diseases but fewer medicines”, the growing urbanization and rapid aging in China have led to increasing demands of healthcare services in metropolitan cities. The uneven distribution of medical facilities makes [...] Read more.

Background: Although the expansion of medical resources has largely alleviated challenges of “more diseases but fewer medicines”, the growing urbanization and rapid aging in China have led to increasing demands of healthcare services in metropolitan cities. The uneven distribution of medical facilities makes services unequal for residents in the city. To achieve fair and rapid access to medical services, healthcare accessibility and equity have become key concerns. The introduction of tele-health, i.e., online visits or digital health, can help balance the distribution of medical resources to improve accessibility and equity, particularly for elderly patients with chronic diseases. Methods: To quantitatively assess the spatial accessibility of healthcare facilities, an improved two-step floating catchment area method with tele-health (i2SFCA-TH) is proposed to study the demand–supply ratio by considering traveling time, chronic diseases, and online visits based on services provided by community and tertiary hospitals. An optimization model using mixed-integer programming to maximize average accessibility under resource constraints could help improve overall accessibility and reduce differences in access among all residential divisions to achieve better equity in the region. Results: By applying the method in a metropolitan city in China, it is observed that the overall spatial accessibility of residential divisions in the city is 0.72, but the gap between the highest and the lowest reaches 2.36; i.e., significant differences exhibit due to uneven allocation of medical resources. By introducing tele-health, the gaps of access among different divisions can be decreased, with the largest gap reduced to 1.49, and the accessibility in divisions with poor medical resource allocation can be increased. Finally, the mean healthcare accessibility and equity in the study region can be improved to 0.75. In addition, it is shown that proper management of medical resources and patients’ willingness to accept online visits could help improve accessibility and equity, which can provide insights for hospital management and urban planning. Conclusions: An integrated framework to quantitatively assess and optimally improve healthcare accessibility and equity of medical resource allocation through tele-health is presented in this paper. An i2SFCA-TH method and an optimization model are used in the framework, which provides hospital management and urban planners a quantitative tool to improve accessibility and equity in metropolitan cities in China and other countries. Full article

(This article belongs to the Section TeleHealth and Digital Healthcare)

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15 pages, 622 KB

Open AccessArticle

A Cohort of Sociodemographic and Health-Related Risk Factors for All-Cause Mortality in Middle-Aged and Older Adults in China

by Wenhu Xu, Hang Zhu, Yutian Chen, Qianyi Zhang, Zhinan Liu and Gong Chen

Healthcare 2025, 13(17), 2104; https://doi.org/10.3390/healthcare13172104 - 24 Aug 2025

Abstract

Background: Physical inactivity is a major contributor to increased mortality among aging populations, especially in middle-aged and older adults. Methods: Data were derived from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020). Participants self-reported their physical activity frequency, categorized as low (≤1 [...] Read more.

Background: Physical inactivity is a major contributor to increased mortality among aging populations, especially in middle-aged and older adults. Methods: Data were derived from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020). Participants self-reported their physical activity frequency, categorized as low (≤1 day/week), medium (2–4 days/week), or high (≥5 days/week). All-cause mortality was tracked through verified records. Cox proportional hazards models were used to estimate hazard ratios (HRs), with adjustments for demographics, lifestyle factors, and baseline health conditions. Results: A total of 2092 participants (mean age = 63.7 ± 10.4 years) were included in the final analytic sample. Higher physical activity frequency was significantly associated with lower mortality in unadjusted models. Participants engaging in activity ≥5 days/week had a 67% reduced mortality risk compared to the low-frequency group (HR = 0.33, p < 0.001). However, after adjusting for health-related covariates, the protective effect was attenuated and no longer statistically significant. In the fully adjusted model, advanced age, current smoking, and ADL limitations emerged as the strongest independent risk factors for mortality, while being married and residing in a rural area were significantly protective effects. Conclusions: The association between frequent physical activity and reduced mortality risk among Chinese older adults is profoundly mediated by baseline health status and functional capacity. These findings highlight the importance of integrated, multifactorial public health interventions that address chronic disease management and functional rehabilitation alongside physical activity promotion. Full article

(This article belongs to the Special Issue Healthy Ageing and Lifestyle Medicine: Current Knowledge and Future Direction)

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24 pages, 615 KB

Open AccessSystematic Review

Effectiveness of the Internet of Things for Improving Pregnancy and Postpartum Women’s Health in High-Income Countries: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Etsuko Nishimura, Noyuri Yamaji, Kiriko Sasayama, Md. Obaidur Rahman, Katharina da Silva Lopes, Citra Gabriella Mamahit, Mika Ninohei, Phyu Phyu Tun, Rina Shoki, Daichi Suzuki, Aya Nitamizu, Daisuke Yoneoka, Eiko Saito and Erika Ota

Healthcare 2025, 13(17), 2103; https://doi.org/10.3390/healthcare13172103 - 23 Aug 2025

Abstract

Background/Objectives: The Internet of Things (IoT), integrated with application software, has increasingly been used to support health management through monitoring indicators like physical activity, sleep, and heart rate, in pregnant and postpartum women. However, limited evidence exists regarding its effectiveness in improving [...] Read more.

Background/Objectives: The Internet of Things (IoT), integrated with application software, has increasingly been used to support health management through monitoring indicators like physical activity, sleep, and heart rate, in pregnant and postpartum women. However, limited evidence exists regarding its effectiveness in improving health outcomes for pregnant and postpartum women. The objective of this systematic review and meta-analysis was to evaluate and synthesize the role of IoT in enhancing the health outcomes of pregnant and postpartum women. Methods: A systematic search was conducted on 13 February 2023, across CENTRAL, CINAHL, ClinicalTrials.gov, Embase, MEDLINE, PsycINFO, PubMed, and WHO ICTRP to identify all randomized controlled trials. Studies were included if they involved pregnant or postpartum women in high-income countries and used sensor-based data collection via smartphones or wearable devices. Two reviewers independently selected the studies, extracted data, and assessed the risk of bias using the Cochrane Collaboration’s risk of bias assessment tool 2.0. We performed a pairwise meta-analysis using a random effects model. The findings were reported according to PRISMA guidelines. Results: Seven studies with 1638 pregnant and postpartum women were included in this review. Of the seven included studies, half targeted women with gestational diabetes and the other half targeted obese women. A meta-analysis revealed that IoT interventions may reduce gestational weight gain in women with obesity with a mean difference of −3.35 kg (95% confidence interval (CI): −5.23 to−1.46; I² = 36%; two studies; 242 women; moderate certainty of evidence). Conclusions: This review suggested that IoT interventions may limit gestational weight gain in pregnant women with obesity. Future studies should evaluate the long-term effects of IoT-based interventions on maternal and neonatal health outcomes. Full article

(This article belongs to the Special Issue Health Risks, Health Service, and Healthcare Supports for Vulnerable Populations)

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17 pages, 1471 KB

Open AccessArticle

Social Determinants of Health and 30-Day Readmission for Heart Failure Patients in U.S. Hospitals: Evidence from ICD-10 Z-Code Data

by Yong Cai, Liu Yanping and Qiang Liu

Healthcare 2025, 13(17), 2102; https://doi.org/10.3390/healthcare13172102 - 23 Aug 2025

Abstract

Background/Objectives: There has been growing interest in understanding the impact of social determinants of health (SDoHs) on health outcomes. Since 2015, healthcare providers have begun to document patients’ SDoH systematically using ICD-10 Z-codes. Methods: We extracted claims data from a nationally representative hospital [...] Read more.

Background/Objectives: There has been growing interest in understanding the impact of social determinants of health (SDoHs) on health outcomes. Since 2015, healthcare providers have begun to document patients’ SDoH systematically using ICD-10 Z-codes. Methods: We extracted claims data from a nationally representative hospital chargemaster database for 586,929 eligible HF patients between January 2019 and December 2021. We investigated the association between SDoH Z-codes and 30-day hospital readmission for heart failure (HF) patients in U.S. hospitals using a Chi square test and adjusted odds ratios from logistic regression models. Results: We found that four major SDoH Z-code categories and five specific sub-Z-code factors within the major categories are significantly associated with 30-day readmission for HF patients. We also found that patients with two or more SDoH Z-codes have a higher risk of readmission than those with one. Conclusions: Our study indicates that ICD-10 Z-codes are useful in identifying SDoH risk factors for hospital readmission among HF patients. Policymakers and healthcare providers should consider Z-codes when assessing HF readmission risk and developing interventions to lower HF readmission rates. Full article

(This article belongs to the Section Health Policy)

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16 pages, 251 KB

Open AccessArticle

Should I Stay at Home Alone? Lived Experiences of Loneliness Among Older Adults: A Qualitative Study

by Maria Shuk Yu Hung, Michael Man Ho Li and Ken Hok Man Ho

Healthcare 2025, 13(17), 2101; https://doi.org/10.3390/healthcare13172101 - 23 Aug 2025

Abstract

Background: Loneliness and social isolation among older people are currently widespread and recognized as the foremost public health problems globally and locally. Hong Kong, which exhibits a rapid aging trend and an expanding elderly population, is inevitably facing these issues. This study explored [...] Read more.

Background: Loneliness and social isolation among older people are currently widespread and recognized as the foremost public health problems globally and locally. Hong Kong, which exhibits a rapid aging trend and an expanding elderly population, is inevitably facing these issues. This study explored the lived experiences of loneliness among older adults in Hong Kong. Methods: Qualitative interviews were conducted among older adults in the community aged 60 or above who were cared for by migrant domestic workers and presented varying levels of loneliness. Purposive sampling was used to select subjects for face-to-face, semi-structured individual interviews, with consent for audio recording, which led to the inclusion of 19 older adults, among whom five were male, nine lived with a spouse, and three lived with their children. Interpretative phenomenological analysis was adopted. Results: We identified a core theme, “Should I stay at home alone?”, and the following four interrelated themes: (1) experience of inadequate social support and networks, (2) altered family dynamics and support, (3) deterioration in physical functions and mobility limitations, and (4) experience of negative and complex emotions. Conclusions: Based on our investigation into the lived experience of loneliness among older adults locally, we recommend that the government, non-governmental organizations, and healthcare institutions establish appropriate strategies and integrated services to address the social, physical, familial, and emotional issues in this population to foster healthy aging, improve their quality of life, and encourage support from families and communities. Full article

(This article belongs to the Special Issue Research on Health-Related Quality of Life and Well-Being Among Older People)

20 pages, 1797 KB

Open AccessArticle

The Effects of Moderate- to High-Intensity Physical Exercise on Emotion Regulation and Subsequent Cognitive Control in Highly Psychologically Stressed College Students

by Baole Tao, Tianci Lu, Hanwen Chen and Jun Yan

Healthcare 2025, 13(17), 2100; https://doi.org/10.3390/healthcare13172100 - 23 Aug 2025

Abstract

Objectives: Chronic psychological stress among college students increases sensitivity to negative emotional stimuli. Emotion regulation, a critical coping mechanism, draws upon cognitive resources and may impair subsequent cognitive control. Physical exercise has been proposed as an effective intervention to enhance both emotional and [...] Read more.

Objectives: Chronic psychological stress among college students increases sensitivity to negative emotional stimuli. Emotion regulation, a critical coping mechanism, draws upon cognitive resources and may impair subsequent cognitive control. Physical exercise has been proposed as an effective intervention to enhance both emotional and cognitive functioning. This study investigated whether a 12-week structured exercise intervention could modulate emotion regulation outcomes and improve cognitive control in college students experiencing high psychological stress. Methods: Forty-seven college students, identified as highly stressed via the Chinese College Students Psychological Stress Scale, were randomly assigned to either an exercise group (n = 25) or a control group (n = 22). The exercise group participated in supervised rope-jumping sessions three times per week for 40 min, following ACSM guidelines, over 12 weeks. Before and after the intervention, participants completed tasks measuring two emotion regulation strategies—expressive suppression and cognitive reappraisal—and tasks assessing cognitive control. Results: A significant group × time × strategy interaction emerged for subjective emotional valence: following the intervention, the exercise group reported attenuated negative valence under expressive suppression. For subjective arousal, post-intervention ratings decreased under suppression but increased under reappraisal in the exercise group, suggesting strategy-specific modulation by physical activity. Regarding cognitive control, electrophysiological measures revealed that the P3 component showed a significant interaction: the exercise group exhibited enhanced P3 amplitudes in congruent versus incongruent conditions after the intervention. Moreover, P3 interference scores were significantly reduced post-intervention in the exercise group compared to both its pre-intervention baseline and the control group. Conclusions: A 12-week aerobic exercise intervention enhanced emotion regulation outcomes and improved cognitive control under high psychological stress. These findings underscore the utility of physical exercise as a non-pharmacological approach to bolster cognitive–affective resilience in young adults. Full article

(This article belongs to the Section School Health)

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11 pages, 327 KB

Open AccessCommentary

Preventive Healthcare and Disability: Challenges and Opportunities

by Giovanni Emanuele Ricciardi, Rita Cuciniello, Veronica Raimondi, Francesco Vaia, Carlo Signorelli and Cristina Renzi

Healthcare 2025, 13(17), 2099; https://doi.org/10.3390/healthcare13172099 (registering DOI) - 23 Aug 2025

Abstract

Despite global commitments to universal health coverage, persons with disabilities (PwD) continue to face significant barriers in accessing appropriate healthcare, including diagnostics, treatments and preventive healthcare, with lower participation in cancer screening and vaccination programs. These disparities are driven by diverse, intersecting obstacles [...] Read more.

Despite global commitments to universal health coverage, persons with disabilities (PwD) continue to face significant barriers in accessing appropriate healthcare, including diagnostics, treatments and preventive healthcare, with lower participation in cancer screening and vaccination programs. These disparities are driven by diverse, intersecting obstacles (structural, financial, communicative, and social) that vary by disability type and context. Inclusive approaches, co-designed with PwD and supported by standardized assessment tools, are urgently needed to address persistent inequities in healthcare access and outcomes. Full article

(This article belongs to the Special Issue Collaborative Approaches to Risk Management and Infection Control: A Patient Perspective)

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13 pages, 231 KB

Open AccessArticle

Family History of Diabetes: Neighborhood and Familial Risks in African American Youth Living in Public Housing

by Ngozi V. Enelamah, Andrew Foell, Melissa L. Villodas, Chrisann Newransky, Margaret Lombe, Von Nebbitt and Mansoo Yu

Healthcare 2025, 13(17), 2098; https://doi.org/10.3390/healthcare13172098 - 23 Aug 2025

Abstract

Background/Objectives: Recent data shows increasing diabetes prevalence among African Americans. Youth with a family history of diabetes are at high risk for diabetes. This study explores the multilevel risk factors associated with a family history of diabetes among African American youth in [...] Read more.

Background/Objectives: Recent data shows increasing diabetes prevalence among African Americans. Youth with a family history of diabetes are at high risk for diabetes. This study explores the multilevel risk factors associated with a family history of diabetes among African American youth in public housing. Methods: This study used a cross-sectional, quantitative, and community-based participatory research (CBPR) approach. The research team, comprising community stakeholders and academic researchers, employed respondent-driven sampling (RDS) for data collection (survey) and used univariate and bivariate analyses to examine variable relationships. A sequential logistic regression highlighted factors influencing the likelihood of having a family history of diabetes. Results: The final sample (n = 190, mean age 18.5 years, 58% female) included 35% of youth with a family history of diabetes. Forty-six percent reported medium to severe household hardships. Results suggest that reporting a family history of diabetes is correlated with maternal substance use (tau-b = 0.27 **) and alcohol problems (tau-b = 0.16 ***), paternal substance use (tau-b = 0.17 *), and eating fewer fruits (tau-b = 0.17 *). With an odds ratio (OR) of 1.70 [0.68, 4.13] and attributable fraction among the exposed at 41.3%, the final model (3) was not significant [χ² = 11.19(8)]. Thus, we fail to reject the null hypothesis that the model fits the data well. Fewer vegetable consumption (OR = 15.08, p < 0.001), higher soda consumption (OR = 0.06, p < 0.001), severe household hardships (OR = 5.82, p < 0.01), and maternal substance use problems (OR = 6.81, p < 0.05) predicted a higher likelihood of a history of diabetes. Conclusions: Our study calls attention to the need to reevaluate interventions for hardships and substance use in diabetes management, particularly in poor neighborhoods and among minority families. Full article

19 pages, 575 KB

Open AccessArticle

PromoACTIVA-SC: A Tool Aiming at Identifying Health Promotion Practice of Civil Society Organizations

by Olga Lopez-Dicastillo, Andrea Iriarte-Roteta, Elena Antoñanzas-Baztán, Sara Sola-Cia, Agurtzane Mujika, Naia Hernantes, Isabel Antón-Solanas, María Anunciación Jiménez-Marcos, Edurne Zabaleta-del-Olmo, Dolors Juvinyà-Canal and María Jesús Pumar-Méndez

Healthcare 2025, 13(17), 2097; https://doi.org/10.3390/healthcare13172097 - 23 Aug 2025

Abstract

Background: The World Health Organization (WHO) defines health promotion as the process of enabling individuals to gain control over and improve their health. This shifts the focus from lifestyle choices to broader social determinants of health, requiring involvement from healthcare, authorities, industry, civil [...] Read more.

Background: The World Health Organization (WHO) defines health promotion as the process of enabling individuals to gain control over and improve their health. This shifts the focus from lifestyle choices to broader social determinants of health, requiring involvement from healthcare, authorities, industry, civil society, and the media. Civil society engagement in health initiatives offers benefits such as empowerment, service delivery, flexibility, policy participation, and credibility. However, identifying specific health promotion actions for civil society organizations (CSOs) is challenging. The lack of assessment tools for CSOs hinders evaluation and improvement. Objective: To develop a tool, ‘PromoACTIVA-SC’, to assess CSOs’ health promotion practice by identifying essential actions that constitute the health promotion process. Methods: ‘PromoACTIVA-SC’ was developed through documentary analysis and validated by experts. CSOs’ members participated in cognitive interviews for comprehensibility, and the tool was pilot tested for administration and Likert scale evaluation. Results: The final questionnaire, consisting of 8 phases and 40 items, demonstrated good content validity. Its use can help to map CSOs’ practices and identify areas needing improvement. CSOs can use it for self-assessment and in collaborative health promotion and disease prevention efforts. Conclusions: ‘PromoACTIVA-SC’ is the first tool designed to assess civil society’s role in the health promotion process. Its future use will reveal the extent to which civil society organizations actively participate in health promotion. It can also be used to promote CSOs’ involvement in health policy and administration, enhancing public health outcomes through collaborative, cross-sectoral efforts. Full article

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20 pages, 4323 KB

Open AccessArticle

Adapting a Positive Psychological Intervention for Employees with and Without Intellectual Disabilities

by Ari Gomez-Borges, Isabel M. Martínez and Marisa Salanova

Healthcare 2025, 13(17), 2096; https://doi.org/10.3390/healthcare13172096 - 23 Aug 2025

Abstract

Background/Objectives: This study explores the adaptation and implementation of a positive psychological intervention based on the Emotional Styles model to improve well-being and reduce stress in employees with and without intellectual disabilities (IDs). Methods: A longitudinal intervention was conducted in a social foundation [...] Read more.

Background/Objectives: This study explores the adaptation and implementation of a positive psychological intervention based on the Emotional Styles model to improve well-being and reduce stress in employees with and without intellectual disabilities (IDs). Methods: A longitudinal intervention was conducted in a social foundation with 45 participants (12 with ID). The program, based on Davidson’s six emotional dimensions, included six weekly sessions adapted through Easy Read strategies and COVID-19 adjustments. Data were collected at pre-test, post-test, and six-month follow-up using the Emotional Styles Questionnaire, PERMA Profiler, and UWES-3. Results: Significant improvements were found in outlook, resilience, engagement, relationships, and reduction in negative emotions, with stronger effects for non-ID participants, although context sensibility improved in the ID group. High satisfaction (93% very satisfied) confirmed the program’s acceptability. Conclusions: The adapted intervention effectively enhances emotional well-being in heterogeneous workplaces, supporting inclusive positive psychology practices. Full article

(This article belongs to the Section Community Care)

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18 pages, 629 KB

Open AccessArticle

Assessing the Impact of Telemedicine on Patient Satisfaction Before and During the COVID-19 Pandemic

by Ashiat Adeogun and Misa Faezipour

Healthcare 2025, 13(17), 2095; https://doi.org/10.3390/healthcare13172095 - 23 Aug 2025

Abstract

Objectives: The adoption of telemedicine, which is the delivery of healthcare services through digital platforms, exploded during the COVID-19 pandemic as a means to ensure the continuity of care while minimizing infection risks. While this modality improved access and convenience for many, disparities [...] Read more.

Objectives: The adoption of telemedicine, which is the delivery of healthcare services through digital platforms, exploded during the COVID-19 pandemic as a means to ensure the continuity of care while minimizing infection risks. While this modality improved access and convenience for many, disparities in adoption have emerged, particularly in rural and underserved populations. This study aims to evaluate the impact of telemedicine on patient satisfaction before and during the pandemic, with a focus on chronic disease management—notably hypertension—and to identify factors influencing the equitable adoption of telehealth. Methods and Procedures: This study used a mixed method approach, combining quantitative survey data and causal loop modeling to analyze patient satisfaction levels and the interplay between telehealth adoption, healthcare access, and demographic disparities. Patient-reported satisfaction data were collected in two time periods—before and during the pandemic. Causal modeling was used to explore systemic relationships between provider support, technology access, patient engagement, and health equity. Results: The findings revealed that telemedicine significantly enhanced healthcare access during the pandemic, with a notable increase in patient satisfaction scores. Patients with chronic conditions, especially those diagnosed with hypertension, reported the improved continuity of care and reduced geographic barriers. However, disparities in telehealth access were more pronounced in non-metropolitan areas and among older adults and minority populations. Causal analysis highlighted key enablers of telehealth success, i.e., provider support, digital literacy, and access to reliable internet and devices. Conclusions: Telemedicine presents a transformative solution for equitable healthcare delivery, especially in chronic disease management. Strategic efforts are needed to address adoption disparities and ensure the sustained and inclusive integration of telehealth after the pandemic. Full article

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20 pages, 982 KB

Open AccessSystematic Review

Home Physical Exercise Interventions in Chronic Non-Specific Low Back Pain: Systematic Review and Multivariate Meta-Analysis

by Diego Lapuente-Hernández, Marina Gil-Calvo, Juan Nicolás Cuenca-Zaldívar, Alberto Carcasona-Otal, Pablo Herrero and Ángel Matute-Llorente

Healthcare 2025, 13(17), 2094; https://doi.org/10.3390/healthcare13172094 - 22 Aug 2025

Abstract

Background/Objectives: Low back pain is considered one of the leading causes of disability. Up to 90% of cases are classified as non-specific, which, if prolonged for at least 12 weeks, is considered non-specific chronic low back pain (NSCLBP). Physical exercise is one [...] Read more.

Background/Objectives: Low back pain is considered one of the leading causes of disability. Up to 90% of cases are classified as non-specific, which, if prolonged for at least 12 weeks, is considered non-specific chronic low back pain (NSCLBP). Physical exercise is one of the selected treatments for NSCLBP. Interest in the use of remote interventions has recently emerged. The main objective was to analyze the effect of home exercise interventions to reduce pain intensity and functional disability in individuals with NSCLBP. Methods: A systematic review was conducted in April 2024. Both multivariate and univariate meta-analysis was performed with the difference before and after treatment, adjusting both models with a meta-regression that included the covariates age and body mass index (BMI). Heterogeneity was analyzed with Cochran’s Q test as well as with the I² estimator, and effect size was calculated with Hedges’G. Results: A total of six studies, with moderate–high methodological quality and a heterogeneous risk of bias, were included. There was a statistically significant pre-/post-treatment effect on functional disability (moderate effect: Hedge’s g = 0.69, p = 0.018) and pain intensity (large effect: Hedge’s g = 1.11, p = 0.007) in both univariate and multivariate (moderate effect: Hedge’s g = 0.77) meta-analyses when comparing unsupervised home exercise with supervised in-person exercise, in favor of the latter. This effect was significantly moderated by BMI (p = 0.003 for both outcomes) negatively. Conclusions: Unsupervised home exercise appears to be less effective than supervised in-person exercise in effectively reducing pain intensity and functional disability in the short term in individuals with NSCLBP. Full article

(This article belongs to the Section TeleHealth and Digital Healthcare)

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