Healthcare

21 pages, 507 KB

Open AccessReview

Cardiopulmonary Exercise Testing and HFpEF: Diagnostic and Therapeutic Perspectives

by Francesco Di Spigno, Valeria Dall’Ospedale, Luigi Gerra, Federico Breviario, Andrea Tedeschi, Giancarlo Trimarchi and Daniela Aschieri

Healthcare 2025, 13(23), 3098; https://doi.org/10.3390/healthcare13233098 - 27 Nov 2025

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) is a complex and heterogeneous clinical syndrome that represents an increasing global health challenge due to its high rates of morbidity, hospitalization, and mortality. In this context, cardiopulmonary exercise testing (CPET) has emerged as a [...] Read more.

Background: Heart failure with preserved ejection fraction (HFpEF) is a complex and heterogeneous clinical syndrome that represents an increasing global health challenge due to its high rates of morbidity, hospitalization, and mortality. In this context, cardiopulmonary exercise testing (CPET) has emerged as a valuable diagnostic modality, particularly in patients presenting with unexplained exertional dyspnea and inconclusive resting imaging results. Objectives and Clinical Implications: This narrative review examines current evidence on the clinical relevance and prognostic value of CPET parameters in HFpEF. Peak VO₂, a marker of aerobic capacity and cardiovascular fitness, has established prognostic value in heart failure with reduced ejection fraction (HFrEF). However, its prognostic significance in HFpEF remains less well defined. Oxygen pulse has emerged as another important measure for evaluating functional capacity and predicting response to exercise-based interventions, offering potential prognostic insight into adverse outcomes in HFpEF. Finally, the VE/VCO₂ slope, an index of ventilatory efficiency during exercise, also holds clinical relevance in HFpEF, particularly with concomitant pulmonary hypertension, though evidence remains heterogeneous. Conclusions: CPET-derived variables are valuable parameters for HFpEF assessment. Their systematic integration into clinical evaluation of HFpEF patients could guide individualized management strategies and inform clinicians for improving outcomes in this challenging condition. Full article

(This article belongs to the Special Issue Cardiopulmonary Exercise Testing: A Key Player in Cardiovascular Disease Management)

13 pages, 823 KB

Open AccessArticle

Effects of Exercise-Based Cardiac Rehabilitation on Risk Factors, Fitness, and Quality of Life in Patients Undergoing Percutaneous Coronary Intervention: Emergency Department Versus Outpatient Routes

by Tong Yang, Yongchul Choi, Jiyoung Lee and Yonghwan Kim

Healthcare 2025, 13(23), 3097; https://doi.org/10.3390/healthcare13233097 - 27 Nov 2025

Abstract

Background/Objectives: Hospital visits for the treatment of coronary heart disease primarily consist of routine outpatient (OP) or unscheduled emergency room (ER) visits. This study compared the effectiveness of cardiac rehabilitation (CR) based on the routes of hospital visits after percutaneous coronary intervention (PCI). [...] Read more.

Background/Objectives: Hospital visits for the treatment of coronary heart disease primarily consist of routine outpatient (OP) or unscheduled emergency room (ER) visits. This study compared the effectiveness of cardiac rehabilitation (CR) based on the routes of hospital visits after percutaneous coronary intervention (PCI). Methods: Only men who completed three CR center visits (baseline, 6 months, 12 months) during the 12 months after PCI were analyzed. A total of 300 male patients were analyzed, with 206 patients in the OP group and 94 in the ER group, and their socioeconomic status, blood lipids, blood pressure, volume of oxygen peak (VO₂ peak), physical activity, and quality of life (QoL) were compared. This study is a retrospective analysis. Results: The ER group was older and had lower economic income than the OP group (p < 0.05). In the OP and ER groups, total cholesterol (OP −10.4%, and ER −8.6%) and low-density lipoprotein cholesterol (OP −10.9% and ER −8.2%) improved in the third visit compared to the first visit (p < 0.05). Additionally, VO2 peak (OP 16.5%, and ER 14.3%), physical activity (OP 25.1%, and ER 4.4%), and body fat (OP −5.8%, and ER −4.5%) ultimately improved in both groups (p < 0.05). The interaction effect by time and group showed that the OP group significantly improved compared to the ER group in terms of high-density lipoprotein cholesterol, VO₂ peak, exercise duration, grip strength, physical activity, body fat, and quality of life (p < 0.05). Conclusions: The 12-month CR program tended to improve outcomes in both groups, but the OP group showed greater improvements in high-density lipoprotein cholesterol, VO₂ peak, and QoL compared to the ER group. Full article

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16 pages, 742 KB

Open AccessArticle

Metabolic Indicators and Emotional Distress Symptoms Related to Overweight in Youth: A Brief Network Analysis

by Lesly Bucio-Palma, Lina García-Mier, Martha Cruz-Soto, Angela Vargas-Rodríguez and Jorge Palacios-Delgado

Healthcare 2025, 13(23), 3096; https://doi.org/10.3390/healthcare13233096 - 27 Nov 2025

Abstract

Overweight and obesity in young people represent a major public health challenge, not only due to their association with metabolic alterations but also because of their impact on emotional well-being. Background/Objectives: The objective of this study was to determine the structure of [...] Read more.

Overweight and obesity in young people represent a major public health challenge, not only due to their association with metabolic alterations but also because of their impact on emotional well-being. Background/Objectives: The objective of this study was to determine the structure of the network between metabolic indicators and emotional symptoms Methods: A sample of 78 university students was assessed through biochemical, anthropometric, and psychometric measures. Results: A total of 37.9% showed risk levels associated with excess weight and moderate emotional distress. There exist significant links between central adiposity and lipid alterations, as well as positive correlations between anxiety, depression an emotional exhaustion and inverse with happiness. Conclusions: The results highlight an interaction between metabolic and emotional factors even among individuals with normal weight, underscoring the value of network models for early risk detection. The findings are useful for implementing preventive strategies in university settings to promote improved health and emotional well-being. Full article

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12 pages, 2347 KB

Open AccessArticle

Evaluation of Constipation and Quality of Life Among Individuals Undergoing Hemodialysis: A Single-Center Cross-Sectional Study

by Asmaa Fatani, Reham W. Shafi, Hanadi Alhozali, Farouq Mohammad A. Alam, Abdulkader Monier Daghistani, Zulfitri Azuan Mat Daud, Bayan Tashkandi and Buthaina Aljehany

Healthcare 2025, 13(23), 3095; https://doi.org/10.3390/healthcare13233095 - 27 Nov 2025

Abstract

Aim: To assess the prevalence of constipation, dietary fiber intake, and their association with QoL among HD patients. Methods: A cross-sectional study was conducted among 35 adults undergoing maintenance HD at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Constipation was assessed using the [...] Read more.

Aim: To assess the prevalence of constipation, dietary fiber intake, and their association with QoL among HD patients. Methods: A cross-sectional study was conducted among 35 adults undergoing maintenance HD at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Constipation was assessed using the Rome IV criteria and Bristol Stool Form Scale (BSFS). QoL was evaluated using the Kidney Disease Quality of Life Short Form (KDQOL-36), and dietary fiber intake was estimated from three 24-h dietary recalls and a validated Dietary Fiber Intake Short Food Frequency Questionnaire (DFI-FFQ). Data were analyzed using Fisher’s exact test, the Mann–Whitney U test, and correlation coefficients (p < 0.05). Results: Constipation prevalence was 32%. Stool frequency was <3 per week in 14% of participants, 3–4 per week in 23%, and 7 per week in 63%. Mean fiber intake was 9.8 ± 4.8 g/day (24-h recall) and 8.6 ± 4.3 g/day (DFI-FFQ), with all participants classified as low fiber consumers. KDQOL-36 domain scores were highest for “effect of kidney disease” (80.4 ± 16.1) and lowest for “physical health” (40.4 ± 12.4). No significant associations were found between constipation, fiber intake, demographic or clinical variables, or any QoL domain (p > 0.05). Conclusions: Constipation is common among Saudi HD patients, yet not significantly linked to fiber intake or QoL in this small cohort. Larger multicenter studies are needed to identify determinants and guide evidence-based interventions. Full article

(This article belongs to the Special Issue Management of the Patient with Kidney Disease)

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10 pages, 393 KB

Open AccessArticle

Acute Pain Service Utilization as a Lens on Inequities in Trauma and Inpatient Management

by Maxwell B. Baker, Rachel Achu-Lopes, Haley Mullins, Dhanesh D. Binda, Erin Dienes, Rose Joachim and Nicole Z. Spence

Healthcare 2025, 13(23), 3094; https://doi.org/10.3390/healthcare13233094 - 27 Nov 2025

Abstract

Background: Inequities in pain management are well documented in chronic pain and outpatient settings, yet little is known about disparities in inpatient Acute Pain Service (APS) care. This study evaluated demographic, clinical, and social factors associated with APS utilization and outcomes in an [...] Read more.

Background: Inequities in pain management are well documented in chronic pain and outpatient settings, yet little is known about disparities in inpatient Acute Pain Service (APS) care. This study evaluated demographic, clinical, and social factors associated with APS utilization and outcomes in an urban safety-net hospital, with a subgroup analysis of trauma patients who presented with at least three rib fractures. Methods: We performed a retrospective cohort study of two patient populations from our institution: (1) all patients receiving APS consultation from 1 January 2020 to 1 November 2022 (n = 1445) and (2) all patients with traumatic rib fractures during this time, stratified by APS consult status (n = 650). Demographics, insurance, comorbidities, opioid prescribing, and discharge outcomes were analyzed using descriptive statistics, multivariable logistic regression, and log-linear models. As APS consultation criteria were not standardized during the study period, referral patterns reflected routine clinical practice rather than predefined eligibility criteria. Results: Across the full APS cohort, patients were disproportionately represented from vulnerable groups: 30.5% were Black, 81.0% had public insurance, and 32.9% had a substance use disorder (SUD). Methadone use was a strong predictor of non-home discharge, including discharges to a medical facility, hospice, or against medical advice (AMA). In the rib fracture cohort, patients receiving APS consults had significantly higher injury severity scores (Injury Severity Score 17.1 vs. 13.0, p < 0.001). Black patients were less likely to receive APS consult (17.3% vs. 28.8%, p = 0.024). However, this association appeared to be attributable to the younger age and male predominance within this subgroup, as both factors were identified as significant predictors of APS consultation. Conclusions: APS utilization at a high-volume safety-net hospital highlights the intersection of medical vulnerability and structural inequities, with greater involvement among patients who were members of racial and ethnic minorities, publicly insured, or diagnosed with SUD. In trauma populations, younger Black men were over-represented, reinforcing the heightened injury risks Black men may face and the downstream effects on patient care. Taken together, these results highlight how APS involvement acts not only as a marker of increased injury severity but also as an intervention to improve care for vulnerable patient populations. As APS teams regularly serve these populations, they are well-positioned to bridge broader gaps through the integration of addiction and social support services, individualized pain management, and seamless coordination of care across specialties. These findings underscore the need for standardized consultation criteria and integration of social and addiction medicine resources into APS care models. Full article

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24 pages, 4161 KB

Open AccessArticle

MetaAcuPoint: MetaHuman-Generated Synthetic Data for Hand Acupoint Localization

by Kasunika Guruge, Prathiksha Padmanabha, H. M. K. K. M. B. Herath, Nuwan Madusanka, Hi-Joon Park, Chang-Su Na, Myunggi Yi and Byeong-il Lee

Healthcare 2025, 13(23), 3093; https://doi.org/10.3390/healthcare13233093 - 27 Nov 2025

Abstract

Background: Precise localization of acupuncture points (acupoints) is crucial for the clinical success of Traditional Korean Medicine (TKM). Traditional methods that rely on visual inspection and palpation are subjective and prone to inter- and intra-observer differences, making standardization challenging. The progress of data-driven [...] Read more.

Background: Precise localization of acupuncture points (acupoints) is crucial for the clinical success of Traditional Korean Medicine (TKM). Traditional methods that rely on visual inspection and palpation are subjective and prone to inter- and intra-observer differences, making standardization challenging. The progress of data-driven localization techniques is also limited by the scarcity of annotated datasets and inconsistent labeling quality. Objective: This study presents MetaAcuPoint, a synthetic dataset created to overcome these limitations by providing high-fidelity, anatomically consistent hand images for acupoint localization. Methods: MetaAcuPoint was generated using MetaHuman avatars within Unreal Engine, resulting in 900 RGB hand images. Anatomically aligned, bone-attached sockets were implemented for five diagnostically relevant hand acupoints, ensuring millimeter-level precision and spatial consistency across various hand poses. Dataset validity was assessed by training a high-resolution network (HRNet-W48) within the MMPose framework and testing its performance on real-world forearm images. Results: The synthetic-trained model achieved a mean distance error (MDE) of 5.67 ± 3.13 pixels, closely aligning with the real-data baseline at 4.81 ± 2.85 pixels. Adding synthetic samples to real data further enhanced performance (MDE: 4.95 pixels). In contrast, manually annotated synthetic images yielded poorer results (MDE: 12.76 pixels), emphasizing the advantages of automated anatomical annotation. Generalization tests across four external datasets confirmed that the synthetic data-trained model outperformed the real-data-trained model, maintaining higher accuracy (MDE: 5.84–6.45 mm vs. 10.63–15.80 mm). Conclusions: MetaAcuPoint demonstrates the first example of synthetic-to-real generalization for hand acupoint localization. By combining photorealistic rendering with anatomically grounded annotation, the dataset offers a reliable resource to promote standardized, data-driven approaches in acupuncture research and practice. Full article

(This article belongs to the Special Issue Virtual Reality Technologies in Health Care)

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14 pages, 1144 KB

Open AccessArticle

Comparative Outcomes Between Classic and Silent ICU Models During COVID-19 Surge in Taiwan: A Real-World Cohort Analysis from a Dual-Campus Medical Center

by Wei-Hung Chang, Ting-Yu Hu and Li-Kuo Kuo

Healthcare 2025, 13(23), 3092; https://doi.org/10.3390/healthcare13233092 - 27 Nov 2025

Abstract

Background: During Taiwan’s May 2021 COVID-19 surge, hospitals expanded ICU capacity using both conventional and ward-converted (“silent”) ICUs. Methods: We retrospectively compared adults with severe COVID-19 admitted to three ICUs (two classic and one ward-based) between May and August 2021. The [...] Read more.

Background: During Taiwan’s May 2021 COVID-19 surge, hospitals expanded ICU capacity using both conventional and ward-converted (“silent”) ICUs. Methods: We retrospectively compared adults with severe COVID-19 admitted to three ICUs (two classic and one ward-based) between May and August 2021. The primary outcome was ICU mortality; secondary outcomes included ventilator-weaning success and complications. Results: Sixty-four patients were included (28 classic, 36 silent ICU). Baseline severity was comparable (median APACHE II 21 vs. 20). ICU mortality was 29% vs. 36% (risk difference 7.5%, 95% CI –18.6 to 33.1). No difference was found in weaning success or complication rates. No staff infections occurred. Conclusions: Outcomes in the ward-converted silent ICU were comparable to those in classic ICUs. With appropriate infection control and staffing, silent ICUs can safely expand surge capacity. Full article

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12 pages, 412 KB

Open AccessArticle

Effects of Online Supervised Slow-Movement Bodyweight Resistance Training Followed by Self-Directed Exercise on Physical Function in Older Adults: A Pilot Study

by Zhenyue Liu, Shuji Sawada, Hisashi Naito and Shuichi Machida

Healthcare 2025, 13(23), 3091; https://doi.org/10.3390/healthcare13233091 - 27 Nov 2025

Abstract

Background/Objectives: The development of safe and effective online exercise interventions is essential for enhancing physical activity among older adults and supporting healthy aging. However, the effects of online slow-movement bodyweight resistance training (SBRT) programs and exercise continuation after such interventions remain unclear. [...] Read more.

Background/Objectives: The development of safe and effective online exercise interventions is essential for enhancing physical activity among older adults and supporting healthy aging. However, the effects of online slow-movement bodyweight resistance training (SBRT) programs and exercise continuation after such interventions remain unclear. This pilot study examined the effects of a seven-week online exercise class (OEC) using SBRT on physical function in community-dwelling older adults and further explored exercise continuation and its effects on physical function during a subsequent seven-week self-directed exercise (SDE) period. Methods: Eight community-dwelling older adults (age: 70.0 ± 7.7 years) participated in a seven-week OEC (twice per week), followed by a seven-week SDE. Their physical function was assessed remotely using the 30-second chair stand test (CS-30) at baseline, after the OEC, and following the SDE. Training frequencies and volumes were recorded throughout the periods to evaluate exercise adherence and continuation. Results: The participants’ CS-30 performance significantly improved after the OEC (21.3 ± 2.7 vs. 24.0 ± 3.2 times; p = 0.004) and even more following the SDE (24.0 ± 3.2 vs. 27.8 ± 3.8 times; p = 0.002). The training frequency during the SDE period was comparable to that during the OEC period (2.5 ± 1.2 vs. 2.1 ± 1.0 days/week; p = 0.916), with there being no significant difference in lower limbs training volume between the two periods (1313.1 ± 376.4 vs. 1421.3 ± 673.2 repetitions; p = 0.698). Conclusions: A seven-week SBRT-based OEC may be a feasible remote exercise intervention that effectively improves physical function in older adults and encourages post-intervention exercise continuation. Full article

(This article belongs to the Section Digital Health Technologies)

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15 pages, 258 KB

Open AccessArticle

Influences of Experience of Violence and Cognitive-Emotion Regulation Strategies on Psychiatric Nurses’ Post-Traumatic Stress

by Hyun Jae Park, Seung Hyun Hong, Nam Hee Kim and Sung Hee Shin

Healthcare 2025, 13(23), 3090; https://doi.org/10.3390/healthcare13233090 - 27 Nov 2025

Abstract

Background/Objectives: Psychiatric nurses are constantly exposed to physical and verbal violence from patients with mental illnesses, which can lead to post-traumatic stress (PTS). This study investigated the correlations among psychiatric nurses’ experiences of violence, cognitive-emotion regulation strategies, and PTS and sought to [...] Read more.

Background/Objectives: Psychiatric nurses are constantly exposed to physical and verbal violence from patients with mental illnesses, which can lead to post-traumatic stress (PTS). This study investigated the correlations among psychiatric nurses’ experiences of violence, cognitive-emotion regulation strategies, and PTS and sought to identify factors associated with PTS. Although workplace violence and its psychological effects have been examined among nurses, little is known about how cognitive-emotion regulation influences PTS in psychiatric nurses who are frequently exposed to violence. Understanding these mechanisms is crucial for developing interventions to support their mental health. Methods: This was a cross-sectional, descriptive correlational study. Participants were 140 psychiatric nurses with more than one year of clinical experience working in psychiatric wards at university, general, and psychiatric hospitals in South Korea. Collected data were analyzed using SPSS/WIN 25.0. A hierarchical regression analysis was performed to identify factors influencing the nurses’ PTS. Hierarchical regression analysis was performed in three steps: demographic variables were entered first, followed by violence experience, and finally cognitive-emotion regulation strategies. All assumptions of linearity, normality, and homoscedasticity were satisfied. Results: In Model 3, after controlling for demographic and work-related variables, maladaptive emotion regulation strategies, experiences of violence, and education level emerged as significant predictors of PTS among psychiatric nurses. These variables together explained a substantial proportion of the variance in PTS. Conclusions: To reduce PTS among psychiatric nurses, it is necessary to develop and implement violence prevention and coping programs, stress and mental health management initiatives, and educational programs. Based on the findings, hospitals should strengthen organizational systems by establishing structured mechanisms for reporting and debriefing after violent incidents. In addition, hospitals should provide regular training on cognitive-emotion regulation and enhance institutional support to help nurses manage the psychological impact of workplace violence. Such interventions may not only minimize violent incidents but also reduce reliance on maladaptive cognitive-emotion regulation strategies. While the findings provide important insight, the cross-sectional design limits causal inference. Further longitudinal research is recommended to verify these relationships. Full article

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

18 pages, 1546 KB

Open AccessReview

The Impact of Social Determinants of Health on Ocular Diseases in Western New York: A Comparative Ecological Study of Two U.S. Counties

by Abdullah Virk, Henry Qin, Mohammed Mehdi Shahid, Honghong Liu, Changyong Feng and Karen Allison

Healthcare 2025, 13(23), 3089; https://doi.org/10.3390/healthcare13233089 - 27 Nov 2025

Abstract

Background/Objectives: As the world becomes more connected, it is becoming critical for clinicians to understand other cultures, races, and ethnicities to provide the most effective therapy. A comprehensive understanding of all communities necessitates an examination of the social determinants of health (SDH). Eye [...] Read more.

Background/Objectives: As the world becomes more connected, it is becoming critical for clinicians to understand other cultures, races, and ethnicities to provide the most effective therapy. A comprehensive understanding of all communities necessitates an examination of the social determinants of health (SDH). Eye diseases and many other conditions are influenced by SDH. To elucidate the impact of SDH on eye health, a comparative ecological analysis of Monroe and Erie Counties in New York State was conducted to identify any differences in SDH and glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy prevalence. Methods: The CDC Vision and Eye Health Surveillance System (VEHSS) was utilized to collect glaucoma, AMD, and diabetic retinopathy data in Monroe and Erie Counties, New York State, and the USA for 2019. The American Community Survey, County Health Rankings, and Neighborhood Atlas data portals were used to collect the county socioeconomic demographics, along with other health statistics. Results: Overall, Erie County had a higher prevalence of AMD (9.56% vs. 6.61%, p < 0.0001) and glaucoma (13.05% vs. 11.71%, p < 0.0001) compared to Monroe County. Erie County also had a higher prevalence of AMD and glaucoma across all races, aside from North American Natives. Erie County also had a greater primary care shortage, with only 1 primary care physician for every 1230 individuals. Although income inequality and poverty were similar between Erie and Monroe Counties, Erie County also has more racial segregation regarding the residential layout (ranked 74 on a scale of 0 to 100, with 100 being the most segregated). Conclusions: The results indicate that Erie County had an increased prevalence of AMD and glaucoma compared to Monroe County in 2019, along with a greater primary care shortage. Although this analysis targeted Western New York, disparities such as lack of primary care access and segregation are prevalent across the US, necessitating widespread action to address these problems. Full article

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13 pages, 547 KB

Open AccessArticle

Parental Satisfaction After Pediatric Inguinal Hernia Repair: Day Surgery Versus Conventional Hospitalization

by Zenon Pogorelić, Nikola Ljubić, Marijana Rađa, Ivana Mrklić and Stipe Vidović

Healthcare 2025, 13(23), 3088; https://doi.org/10.3390/healthcare13233088 - 27 Nov 2025

Abstract

Objectives: This study aimed to evaluate differences in parental satisfaction with healthcare provided to children undergoing inguinal hernia repair, comparing two organizational models of treatment: conventional hospitalization (CH) and day surgery (DS). Secondary objectives were to examine demographic characteristics, postoperative pain intensity, hospital [...] Read more.

Objectives: This study aimed to evaluate differences in parental satisfaction with healthcare provided to children undergoing inguinal hernia repair, comparing two organizational models of treatment: conventional hospitalization (CH) and day surgery (DS). Secondary objectives were to examine demographic characteristics, postoperative pain intensity, hospital stay duration, and clinical outcomes across groups. Methods: A prospective cohort study was conducted at the Department of Pediatric Surgery, University Hospital of Split, between 1 May 2024 and 1 May 2025. A total of 133 parents of children who underwent primary inguinal hernia repair completed the study questionnaire. The sample included 105 boys and 28 girls, with a median age of 5 years (IQR 3–7). Participants were assigned to either CH (n = 65) or DS (n = 68). Pain intensity was measured using a Visual Analogue Scale (VAS), while parental satisfaction was assessed using the Croatian version of the PedsQL™ 3.0 Healthcare Satisfaction–Parent Report instrument. Results: Postoperative pain levels did not differ significantly between the CH and DS groups (p = 0.439). Parental satisfaction scores were high in both settings. However, CH was associated with significantly greater satisfaction in the domains of information provision (p = 0.042), family participation (p = 0.012), communication (p = 0.017), and emotional support (p = 0.031). No significant differences were observed in general satisfaction (p = 0.945), technical skills (p = 0.054), or total satisfaction scores (p = 0.055). Conclusions: Day surgery represents a safe and efficient treatment model for pediatric inguinal hernia, with comparable pain outcomes to conventional hospitalization. Although overall parental satisfaction was high in both groups, lower ratings in the DS group for communication, emotional support, and information provision highlight areas for targeted organizational and educational improvements to enhance the family experience in ambulatory pediatric surgical care. Full article

(This article belongs to the Special Issue Patient Experience and the Quality of Health Care)

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17 pages, 620 KB

Open AccessArticle

The Impact of Smartphone Addiction on PTSD Symptoms Among South African University Students: Resilience as a Protective Factor

by Anita Padmanabhanunni and Tyrone B. Pretorius

Healthcare 2025, 13(23), 3087; https://doi.org/10.3390/healthcare13233087 - 27 Nov 2025

Abstract

Background: Problematic smartphone use has emerged as a growing concern among young adults and has been linked to adverse mental health outcomes. However, limited research has examined how protective factors such as resilience may buffer the relationship between smartphone addiction and post-traumatic [...] Read more.

Background: Problematic smartphone use has emerged as a growing concern among young adults and has been linked to adverse mental health outcomes. However, limited research has examined how protective factors such as resilience may buffer the relationship between smartphone addiction and post-traumatic stress disorder (PTSD). Methods: Participants (n = 491,

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age = 21.22 years) were students enrolled at a university in the Western Cape province of South Africa. They completed three standardized measures: the Smartphone Application-Based Addiction Scale, the Connor–Davidson Resilience Scale-10, and the Posttraumatic Stress Disorder Checklist for DSM-5. Moderation analyses were conducted using the PROCESS macro for SPSS to examine whether resilience moderated the association between smartphone addiction and post-traumatic stress symptoms. Results: Higher levels of smartphone addiction were significantly associated with elevated PTSD symptoms across all clusters. Resilience emerged as a significant protective factor, exerting direct effects on several PTSD symptom clusters and moderating the association between smartphone addiction and the avoidance and negative alterations in cognition and mood clusters. However, resilience did not significantly moderate the relationship between smartphone addiction and the re-experiencing or hyperarousal clusters, suggesting that these physiologically driven aspects of post-traumatic distress are less amenable to cognitive or emotional coping resources. Conclusions: These findings highlight resilience as a key buffer in the relationship between problematic smartphone use and trauma-related distress. While strengthening resilience may mitigate certain cognitive and affective dimensions of PTSD associated with excessive smartphone use, interventions may need to incorporate strategies to effectively address hyperarousal and intrusive re-experiencing symptoms among trauma-exposed students. Full article

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12 pages, 327 KB

Open AccessArticle

Enhancing Advance Directive Completion Among Older Adults in the Geriatrics Clinic in Indiana, USA: A Quality Improvement Initiative

by Anna Geraldina Pendrey Guillen, Triccia Aparicio Recarte, Miguel Paz Castillo, Mariel Esther Zelaya Ramirez and Javier F. Sevilla Mártir

Healthcare 2025, 13(23), 3086; https://doi.org/10.3390/healthcare13233086 - 27 Nov 2025

Abstract

Background/Objective: Death is an inevitable part of life, and ensuring high-quality end-of-life care is a critical concern. Planning for a “good death” aligns care with patients’ preferences, and advance directive (AD) discussions should begin early between patients, physicians, and families. This project aimed [...] Read more.

Background/Objective: Death is an inevitable part of life, and ensuring high-quality end-of-life care is a critical concern. Planning for a “good death” aligns care with patients’ preferences, and advance directive (AD) discussions should begin early between patients, physicians, and families. This project aimed to increase AD completion among older adults in the Indiana University Health Primary Care (IUHPC) Geriatrics Clinic, with the goal of meeting or exceeding the national average of 46%. Methods: An intervention was implemented from September to November 2024 and from January to June 2025, focusing on patient education and strengthening patient–provider communication. Results: The initiative significantly increased AD completion, demonstrating that older adults are receptive to advance care planning once informed of its benefits. Potential influencing factors included knowledge of life-sustaining care, demographic variables, health status, awareness of dying well, and attitudes toward ADs. Conclusions: Education and communication are key to increasing AD completion rates. These findings underscore the importance of ongoing efforts to raise awareness and ensure that end-of-life care respects patients’ wishes and values. Full article

(This article belongs to the Section Healthcare Quality, Patient Safety, and Self-care Management)

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13 pages, 514 KB

Open AccessArticle

Cultural Perceptions and Emotional Well-Being Among Married Women with Polycystic Ovary Syndrome Experiencing Fertility Difficulties in Southern Punjab, Pakistan: A Cross-Sectional Study

by Muhammad Muneeb Hassan, Kah Boon Lim, Sook Fern Yeo and Muhammad Ameeq

Healthcare 2025, 13(23), 3085; https://doi.org/10.3390/healthcare13233085 - 27 Nov 2025

Abstract

Background: Polycystic ovary syndrome (PCOS) commonly causes fertility difficulties and is associated with substantial psychological distress, particularly in collectivist societies where motherhood is central to female identity and social status. This cross-sectional study examined the association between specific cultural perceptions of fertility difficulties [...] Read more.

Background: Polycystic ovary syndrome (PCOS) commonly causes fertility difficulties and is associated with substantial psychological distress, particularly in collectivist societies where motherhood is central to female identity and social status. This cross-sectional study examined the association between specific cultural perceptions of fertility difficulties and emotional well-being among married women with PCOS in rural Southern Punjab, Pakistan. Methodology: From July to September 2025, we recruited 583 married women aged 18–48 years with confirmed PCOS using systematic random sampling from the Gynecology Outpatient Department of DHQ Hospital Muzaffargarh. Data were collected using a structured questionnaire comprising validated scales for cultural perceptions of fertility difficulties (10 items, Cronbach’s α = 0.87) and emotional well-being (Urdu DASS-21 Depression and Anxiety subscales plus selected Fertility Problem Inventory items, Cronbach’s α = 0.84–0.91). Multiple linear regression models with robust standard errors were used in this study. Results: A higher perceived cultural importance of childbearing (β = 0.39, 95% CI 0.30–0.48, p < 0.001) and societal pressure to conceive soon after marriage (β = 0.36, 95% CI 0.27–0.45, p < 0.001) were significantly associated with increased depression and anxiety. Perceived stigma showed an unexpected negative association with depression (β = −0.15, 95% CI −0.24 to −0.06, p = 0.001), possibly reflecting resilience or the mobilization of social support. Conclusions: Cultural perceptions of fertility difficulties are strongly associated with emotional distress in rural populations. Therefore, culturally sensitive psychological screening and support integrated into reproductive health services are recommended. Full article

(This article belongs to the Topic The Imperative of Patient Safety and Safety Culture in Contemporary Healthcare)

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10 pages, 224 KB

Open AccessReview

Trauma, Power, and Psychological Safety: Understanding the Mental Health Impact of Workplace Bullying

by Jason Walker

Healthcare 2025, 13(23), 3084; https://doi.org/10.3390/healthcare13233084 - 27 Nov 2025

Abstract

Background: Workplace bullying, harassment and sexual abuse cause psychological harm, and can pose a significant threat to the success of an organization as well. This type of violence in the workplace, comprising negative actions and often abuse of power, can lead to trauma, [...] Read more.

Background: Workplace bullying, harassment and sexual abuse cause psychological harm, and can pose a significant threat to the success of an organization as well. This type of violence in the workplace, comprising negative actions and often abuse of power, can lead to trauma, anxiety, depression, PTSD and in severe cases, suicide. These acts impact workplace performance, negatively impact psychological safety and lead to high turnover and loss of productivity in an organization. Objectives: This narrative review outlines the key concepts of bullying, its impact on the individual, and the ways an organization can obstruct and manage it, using recent works (2018–2025) and some highlighted literature on trauma, power, and psychological safety. Methodology: Research conducted on leadership, safety climate, psychological safety and trauma-informed- as well as meta-analyses and relevant gray literature, journal articles, and other studies on bullying that A narrative synthesis of peer-reviewed and selected gray literature was conducted across PsycINFO, MEDLINE, Scopus, and Web of Science were integrated to this review. Results: Exposure to bullying was connected to anxiety, depression, burnout, post-traumatic stress disorders, cardiovascular problems, absenteeism, and turnover. Diminished psychological safety, as well as disordered leadership, increases the damaging effect. In contrast, ethical trauma-informed leadership and a strong psychosocial safety climate promote recovery and decrease the incidence of bullying. Conclusions: Recognizing workplace bullying, harassment, and sexual abuse as forms of violence—and as both occupational and public health hazards—underscores the urgency of prevention. Embedding psychological safety as a core organizational value at every level is essential to fostering healthier, more resilient workplaces. Full article

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

14 pages, 468 KB

Open AccessArticle

Assessment of Food Insecurity, Diet Quality, and Mental Health Status Among Syrian Refugee Mothers with Young Children

by Sedat Coşkunsu and Müge Yılmaz

Healthcare 2025, 13(23), 3083; https://doi.org/10.3390/healthcare13233083 - 27 Nov 2025

Abstract

Background: Although Türkiye hosts the largest population of Syrian refugees in the world, research on the vulnerability factors contributing to food insecurity among Syrian refugee mothers remains scarce. The aim of this study was to investigate the relationships between maternal food insecurity, diet [...] Read more.

Background: Although Türkiye hosts the largest population of Syrian refugees in the world, research on the vulnerability factors contributing to food insecurity among Syrian refugee mothers remains scarce. The aim of this study was to investigate the relationships between maternal food insecurity, diet quality, and mental health outcomes among Syrian refugee mothers with young children living in Türkiye. Methods: This cross-sectional study involved 285 Syrian mothers living in Türkiye with children under five years of age. Maternal food insecurity was assessed via the Food Insecurity Experience Scale (FIES), diet quality was evaluated via the Healthy Eating Index-2020 (HEI-2020), and the Patient Health Questionnaire-9 (PHQ-9) was used to evaluate mental health conditions. Data were collected through face-to-face surveys conducted by two native Arabic translators, and the analyses included sociodemographic characteristics, anthropometric measurements, diet quality, food insecurity status, and mental health status. Results: The prevalence of moderate/severe food insecurity and poor diet quality among refugee mothers amounted to 30% and 59.3%, respectively. Mothers experiencing food insecurity presented significantly lower levels of mental health and diet quality (p < 0.05). A one-unit increase in the food insecurity score was associated with an increase of 1.031 units in the total Patient Health Questionnaire-9 (PHQ-9) score. The model demonstrated that food insecurity accounted for 30.2% of the variance in PHQ scores (R² = 0.302). Low income, lack of institutional aid, short length of stay, and number of children significantly increase the likelihood of poor dietary quality among refugee mothers. Conclusions: Food insecurity was found to be a widespread problem for mothers who are refugees from Syria. It was significantly associated with poorer nutritional quality and mental health issues in mothers. These findings suggest the need for expanding social support programs, implementing effective public health interventions for food security, and securing an overall improvement of maternal health. Full article

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26 pages, 6455 KB

Open AccessArticle

Kidney, Prostate, and Bladder Cancer Burden Attributable to Tobacco Smoke Exposure in BRICS Countries from 1990 to 2021: A Systematic Analysis Based on the Global Burden of Disease Study

by Yushi Hou, Qian Zhang and Binglei Ma

Healthcare 2025, 13(23), 3082; https://doi.org/10.3390/healthcare13233082 - 26 Nov 2025

Abstract

Background: While tobacco smoke remains a leading modifiable risk factor for urologic cancers, comprehensive assessments in BRICS countries are scarce. We aimed to quantify the burden of kidney, prostate, and bladder cancers attributable to tobacco exposure from 1990 to 2021 in BRICS countries. [...] Read more.

Background: While tobacco smoke remains a leading modifiable risk factor for urologic cancers, comprehensive assessments in BRICS countries are scarce. We aimed to quantify the burden of kidney, prostate, and bladder cancers attributable to tobacco exposure from 1990 to 2021 in BRICS countries. Methods: We estimated tobacco-attributable deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) for kidney, prostate, and bladder cancers in BRICS nations using data from the Global Burden of Disease Study 2021. The data were stratified by sex, age, and sociodemographic index (SDI) and analyzed for temporal trends using the estimated annual percentage change (EAPC). Forecasts until 2050 were produced using autoregressive integrated moving average (ARIMA) modeling. Results: In 2021, tobacco-related genitourinary cancers caused approximately 85,000 deaths and 1.8 million DALYs in BRICS countries. While age-standardized DALY rates declined in most countries, absolute burdens rose due to aging and population growth. Bladder cancer contributed the greatest burden, with notable sex disparities: males experienced significantly higher rates across all three cancers. Russia and South Africa had the highest age-standardized rates, while China and India bore the largest absolute burdens. YLLs dominated the total burden, but YLDs increased faster over time, indicating a growing need for survivorship care. Conclusion: Despite some progress in reducing age-standardized rates, tobacco-attributable urologic cancer burdens continue to rise in BRICS countries. Targeted tobacco control, early detection, and long-term survivorship care are essential to mitigate future impacts. Full article

(This article belongs to the Section Public Health and Preventive Medicine)

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17 pages, 506 KB

Open AccessArticle

Cross-Cultural Adaptation, Validity and Reliability of the European Portuguese Version of the Kerlan-Jobe Orthopaedic Clinic Shoulder & Elbow Score (KJOC)

by Gonçalo Almeida, Luísa Amaral, Rui Vilarinho, Bárbara Magalhães, Fátima Silva, Verónica Abreu, André Magalhães, Mário Esteves and Mariana Cervaens

Healthcare 2025, 13(23), 3081; https://doi.org/10.3390/healthcare13233081 - 26 Nov 2025

Abstract

Background/Objectives: The Kerlan-Jobe Orthopaedic Clinic Shoulder & Elbow Score (KJOC) is used to identify dysfunctions and estimate injury risk in overhead sports athletes. Although it has been validated in several countries, a European Portuguese version is currently unavailable. This study aimed to [...] Read more.

Background/Objectives: The Kerlan-Jobe Orthopaedic Clinic Shoulder & Elbow Score (KJOC) is used to identify dysfunctions and estimate injury risk in overhead sports athletes. Although it has been validated in several countries, a European Portuguese version is currently unavailable. This study aimed to translate, culturally adapt and assess psychometric properties (validity and reliability) of the European Portuguese KJOC (KJOC-PT). Methods: The KJOC-PT was translated and culturally adapted according to international guidelines. One hundred athletes were selected (median age 24 [IQR 17] years, 72% male) and divided into two groups: asymptomatic and symptomatic athletes. The convergent validity was assessed by correlating the KJOC-PT with the Disabilities of the Arm, Shoulder and Hand (DASH) and DASH-Sports. 31 athletes from the initial sample were considered to assess between-day reliability and agreement (Bland-Altman analysis). Floor and ceiling effects were also calculated. Sampling adequacy was assessed using the Kaiser Meyer-Olkin (KMO) test. Results: Minor cultural and linguistic changes were made in the KJOC-PT. This version demonstrated excellent internal consistency (Cronbach’s α = 0.91 to 0.97) and moderate negative correlations for validity (KJOC-PT with DASH, rho = −0.595; with DASH-Sports, rho = −0.533, both p < 0.001). Good reliability (ICC_2,1 = 0.77 to 0.89 [95%CI 0.36 to 0.96]), measurement error (SEM = 4.11 to 6.90; MDC = 11.39 to 19.13) and mean difference ranging from −0.08 ± 6.14 to 3 ± 9.17 were found. No floor effect (0%) and ceiling effects of 24.2% for the total sample (50% for asymptomatic and 5.1% for symptomatic athletes) were found. Conclusions: KJOC-PT is now available and is a valid and reliable instrument for use by athletes in overhead sports. Full article

(This article belongs to the Special Issue Psychometric Properties and Broader Implications of Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs))

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16 pages, 297 KB

Open AccessArticle

Lifestyle Habits and Adherence to Cancer Screening Programs Among Italian Teachers: A Cross-Sectional Study

by Giovanna Paduano, Silvia Angelillo, Vincenza Sansone, Concetta Paola Pelullo, Francesco Napolitano and Gabriella Di Giuseppe

Healthcare 2025, 13(23), 3080; https://doi.org/10.3390/healthcare13233080 - 26 Nov 2025

Abstract

Objectives: This study aims to evaluate teachers’ lifestyle habits and to investigate their knowledge and behaviors related to cancer screening. Methods: This cross-sectional survey was performed among teachers randomly selected from schools located in the Campania region, Italy. Results: Only 17% of the [...] Read more.

Objectives: This study aims to evaluate teachers’ lifestyle habits and to investigate their knowledge and behaviors related to cancer screening. Methods: This cross-sectional survey was performed among teachers randomly selected from schools located in the Campania region, Italy. Results: Only 17% of the teachers were current smokers, while 72.1% consumed alcohol. Female teachers, those who were married/cohabitant, and those who discussed with students about alcohol consumption were more likely to have never smoked or drunk alcohol. Female and older teachers, those with a university or a master/PhD degree, and those who had a moderate/high level of physical activity (PA) were more likely to sufficiently consume fruits and vegetables. Only 20.9% of teachers had a moderate/high level of PA. Those who had at least one child, who taught humanistic and support disciplines, and who needed additional information on healthy lifestyle habits were less likely to have a moderate/high level of PA. Among participants, 42.3% had ever undergone mammography for screening and 37.5% a Pap test and a fecal occult blood test. Conclusions: This survey describes a worrying prevalence of unhealthy behaviors and low adherence to screening programs among Italian teachers, suggesting the need for education and screening campaigns to improve preventive strategies in this population. 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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