Journal Description
Healthcare
Healthcare
is an international, scientific, peer-reviewed, open access journal on health care systems, industry, technology, policy, and regulation, and is published semimonthly online by MDPI. European Medical Association (EMA) and Ocular Wellness & Nutrition Society (OWNS) are affiliated with Healthcare and their members receive discounts on the article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE and SSCI (Web of Science), PubMed, PMC, and other databases.
- Journal Rank: JCR - Q2 (Health Care Sciences and Services) / CiteScore - Q2 (Leadership and Management)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 20.3 days after submission; acceptance to publication is undertaken in 2.6 days (median values for papers published in this journal in the second half of 2024).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
- Companion journals for Healthcare include: Trauma Care and European Burn Journal.
Impact Factor:
2.4 (2023);
5-Year Impact Factor:
2.5 (2023)
Latest Articles
Serbian Healthcare Students’ Perceptions of and Readiness to Care for People with Intellectual Disabilities: A Cross-Sectional Study
Healthcare 2025, 13(11), 1315; https://doi.org/10.3390/healthcare13111315 (registering DOI) - 1 Jun 2025
Abstract
Background/Objectives: The perspective from which future healthcare professionals view intellectual disabilities affects how people with intellectual disabilities (PWIDs) are perceived and informs care policies and practices. This study aimed to assess healthcare science students’ perceptions of the rights of PWIDs, the students’ social
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Background/Objectives: The perspective from which future healthcare professionals view intellectual disabilities affects how people with intellectual disabilities (PWIDs) are perceived and informs care policies and practices. This study aimed to assess healthcare science students’ perceptions of the rights of PWIDs, the students’ social distances toward PWIDs in healthcare, and the students’ competence in providing care, exploring differences by study programs and demographics and examining correlations between them. Methods: The convenience sample comprised 221 medical and 120 nursing students. A general questionnaire for obtaining sociodemographic data, the scale of beliefs about the rights of PWIDs in healthcare (BS), the scale of social distance toward PWIDs (SD), and the “self-assessment of competency (CS) to provide care for PWIDs” scale were used as students’ report measures. Results: The students’ scores on the BS, SD, and CS scales revealed that they generally recognized the rights of PWIDs in healthcare but expressed a moderate level of social distance and limited self-perceived competence in providing care. Medical students demonstrated slightly more progressive beliefs regarding the rights of PWIDs than nursing students (r = 0.12), while nursing students reported higher self-assessed competence levels (r = 0.19). A small gender-related difference was observed in social distance, with female students showing more favorable attitudes. Significant positive correlations were found between beliefs about the rights of PWIDs and social distance (p = 0.435; p < 0.01) and between social distance and self-assessed competence (p = 0.234, p < 0.01), suggesting that students who felt more competent tended to report less social distance. Conclusions: This study provides new data for understanding healthcare science students’ perceptions and readiness to care for PWIDs in the healthcare sector in Serbia. Namely, our students had moderately positive beliefs and a moderate social distance toward PWIDs and reported low competence in providing care.
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Open AccessArticle
Pilot Study About the Importance of the Active Role of Roma Students: Improving the Health of Bulgarian Children from the Roma Minority Group Through Nutrition and Probiotics
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Bozhidarka Radoslavova Hadzhieva, Marin Kostadinov Baltov, Daniela Ivova Taneva, Atanas Denev Luizov, Milen Ventsislavov Dimitrov and Valentina Boyanova Petkova-Dimitrova
Healthcare 2025, 13(11), 1314; https://doi.org/10.3390/healthcare13111314 (registering DOI) - 1 Jun 2025
Abstract
Background/Objective: The priority task of each country is to ensure the protection of and improvement in its people’s health. One of the key aspects of health is related to food culture, consuming foods that ensure growth and normal development in a person and
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Background/Objective: The priority task of each country is to ensure the protection of and improvement in its people’s health. One of the key aspects of health is related to food culture, consuming foods that ensure growth and normal development in a person and also prevent diseases. The consumption of foods that contain essential nutrients and functional foods, which include those containing probiotics, is the basis of a healthy diet. Methods: A structured anonymous interview was conducted with 90 parents from the Roma minority group to assess the nutritional culture of children from these families. The knowledge of Roma parents about probiotics, as well as their attitudes to apply them to their children, was examined. The survey was based on a questionnaire that was distributed among the respondents, Roma students, under the guidance of a mentor. Roma students study health specialties and are also participants in a Scholarship Programme. Results: We have established that the daily diet of children from this minority group consists of foods containing hydrogenated fats and sugar, which was indicated by 53.3% of respondents, and only 28.9% of respondents noted that their children consume fresh fruit every day. We have established that less than half of the children (35.6%) consume yoghurt daily as a source of valuable probiotics. We applied a nonparametric Kruskal–Wallis test and found statistically significant differences in the respondents’ knowledge of probiotics (χ2 = 16.186, p = 0.001): those receiving secondary specialized education were better informed, but education has not affected their knowledge of the health benefits of probiotics (χ2 = 5.462, p = 0.141). Children from minority groups tend to eat unhealthy foods. Conclusions: The role of Roma students studying health specialties as participants in the Scholarship Programme is to assist parents in forming a nutritional culture in their children. Roma students, due to their ethnic and cultural proximity and potential to be health professionals, contribute to sustainable health improvements among the Roma community as a whole.
Full article
(This article belongs to the Section Healthcare Quality and Patient Safety)
Open AccessArticle
Cultivating Self-Compassion to Improve Social Workers’ Professional Quality of Life in Primary Healthcare
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Polyxeni Mangoulia, Nektarios Tsokas, Evmorfia Koukia, Foteini Malli, Evdokia Missouridou, Chrysoula Dafogianni, Maria Kyranou and Evangelos C. Fradelos
Healthcare 2025, 13(11), 1313; https://doi.org/10.3390/healthcare13111313 (registering DOI) - 1 Jun 2025
Abstract
Background/Objectives: Although self-compassion practice has been increasingly popular in the literature in recent years, the area of social work knows very little about it. To be self-compassionate is to treat oneself with love and respect. The aim of this study was to investigate
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Background/Objectives: Although self-compassion practice has been increasingly popular in the literature in recent years, the area of social work knows very little about it. To be self-compassionate is to treat oneself with love and respect. The aim of this study was to investigate the relationship between social workers’ professional quality of life (compassion satisfaction, secondary traumatic stress, and burnout) and self-compassion. Methods: This cross-sectional descriptive study consisted of 177 social workers in primary healthcare (PHC) in Greece. The Self-Compassion Scale (SCS), the Professional Quality of Life Scale (ProQOL-5), and the participants’ personal, demographic, and professional information were all included in an electronic questionnaire that they had to fill out. Results: This study’s findings show that, although 43.2% of participants exhibited high levels of self-compassion, burnout and secondary traumatic stress were at low-to-moderate levels among the participants. Apart from the secondary traumatic stress and humanity dimensions, both the dimensions and the overall self-compassion scale showed a strong relationship with the aspects of professional quality of life. Burnout and secondary traumatic stress were significantly reduced, and compassion fulfilment were increased in environments that were supportive, socially supportive, work-related, hobby-filled, and religious. Conclusions: The integration of self-compassion into a comprehensive and methodical approach to employee wellness has the potential to enhance the physical and mental health of workers in healthcare environments.
Full article
(This article belongs to the Special Issue Health Risks in the Work Environment: Assessment and Improvement)
Open AccessSystematic Review
Effects of Exercise on Balance Function in People with Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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Xingyue Wang, Zhuying Chen, Yin Liang, Hao Su, Tongling Wang, Yuanyuan Lv and Laikang Yu
Healthcare 2025, 13(11), 1312; https://doi.org/10.3390/healthcare13111312 (registering DOI) - 1 Jun 2025
Abstract
Objectives: This study sought to evaluate the impact of exercise on balance function in individuals with knee osteoarthritis (KOA) and determine the most effective exercise protocols for balance enhancement. Methods: A systematic literature search was performed across five major electronic databases
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Objectives: This study sought to evaluate the impact of exercise on balance function in individuals with knee osteoarthritis (KOA) and determine the most effective exercise protocols for balance enhancement. Methods: A systematic literature search was performed across five major electronic databases (PubMed, Web of Science, EBSCO, Cochrane, Scopus) until 13 September 2024. Statistical synthesis was conducted using weighted mean differences (WMDs) with 95% confidence intervals under a random-effects model. Results: Analysis of 22 studies revealed significant improvements in balance function following exercise interventions. Outcomes measured by the Berg balance scale (BBS, WMD, 2.65, p < 0.00001) and timed up and go test (TUG, WMD, −0.59, p < 0.0001) demonstrated clinically relevant enhancements in KOA populations. Subgroup analyses revealed that multicomponent training (WMD, 6.25, p = 0.003), interventions lasting ≥ 8 weeks (WMD, 4.92, p = 0.002), sessions ≥ 60 min (WMD, 7.42, p = 0.002), frequency ≥ 3 times per week (WMD, 2.83, p = 0.0005), weekly time ≥ 180 min per week (WMD, 7.42, p = 0.002), and patients < 60 years (WMD, 6.71, p = 0.002) were associated with greater improvement in BBS. Conclusions: Exercise significantly improved balance function in KOA patients, with multicomponent training emerging as the most effective intervention. Based on the findings of this meta-analysis, clinicians should recommend that KOA patients engage in exercise at least three times per week, with each session lasting at least 60 min, to achieve a total weekly time of 180 min. These recommendations are particularly relevant for patients less than 60 years, who may experience greater benefits from exercise interventions.
Full article
(This article belongs to the Special Issue Exercise Interventions and Testing for Effective Health Promotion)
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Open AccessArticle
Association Between Sarcopenia and Buttock Pain Among Middle-Aged and Older Chinese People: Evidence from the China Health and Retirement Longitudinal Study
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Jian Jin, Huibin Long, Huiwen Zhang, Chuanhui Zhang and Jianhao Lin
Healthcare 2025, 13(11), 1311; https://doi.org/10.3390/healthcare13111311 (registering DOI) - 31 May 2025
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Background: Sarcopenia and buttock pain are highly prevalent in older adults and exert profound negative effects on quality of life. Little is known about the association between sarcopenia and buttock pain. Methods: This study performed cross-sectional and longitudinal analyses based on prospective cohort
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Background: Sarcopenia and buttock pain are highly prevalent in older adults and exert profound negative effects on quality of life. Little is known about the association between sarcopenia and buttock pain. Methods: This study performed cross-sectional and longitudinal analyses based on prospective cohort study data from the 2015 and 2020 waves of the China Health and Retirement Longitudinal Study (CHARLS). A total of 12,884 community-dwelling adults aged ≥45 years were included in the cross-sectional analysis, and 10,511 of these participants, free of buttock pain at baseline, were further investigated to assess incident buttock pain. Sarcopenia status was categorized as non-sarcopenia, possible sarcopenia, and sarcopenia according to the 2019 Asian Working Group for Sarcopenia and the 2021 Chinese consensus criteria. Logistic regression models adjusted for sociodemographic and health-related covariates were performed to estimate associations between sarcopenia status and buttock pain. Results: After adjusting for covariates, possible sarcopenia, but not sarcopenia, was associated with prevalent buttock pain (OR 1.23, 95% CI 1.03–1.48). After 5 years of follow-up, participants with sarcopenia were more likely to develop incident buttock pain (OR 1.37, 95% CI 1.03–1.81). Among sarcopenia components, poor physical performance was linked to prevalent pain (OR 1.25, 95% CI 1.05–1.50) and low handgrip strength predicted incident pain in males (OR 1.31, 95% CI 1.07–1.60). Appendicular muscle mass was not independently associated with either prevalent or incident buttock pain. Conclusions: In middle-aged and older Chinese adults, sarcopenia is an independent risk factor for incident buttock pain. Early screening and interventions of sarcopenia may help to mitigate the burden of buttock pain and its associated disability.
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Open AccessArticle
Comparison of Frontal Sinus Dimensions with Different Skeletal Classes and Vertical Patterns: A Retrospective Study
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Alessandro Nota, Iuliia Kashtelianska, Francesco Manfredi Monticciolo, Laura Pittari, Simona Tecco and Attilio Castaldo
Healthcare 2025, 13(11), 1310; https://doi.org/10.3390/healthcare13111310 (registering DOI) - 31 May 2025
Abstract
Background: The aim of this work is to compare the size of the frontal sinus and the different skeletal classes and divergence patterns of the subjects. Methods: This study retrospectively includes lateral radiographs performed on a total of 200 adults (78 M, 122
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Background: The aim of this work is to compare the size of the frontal sinus and the different skeletal classes and divergence patterns of the subjects. Methods: This study retrospectively includes lateral radiographs performed on a total of 200 adults (78 M, 122 F; mean age 29.2 ± 8.0 years). Subject inclusion criteria were an age of 18–45 years, presence of both frontal sinuses, and good general health with no hormonal system disorders that may affect the growth and pneumatization of the frontal sinuses. Four different parameters of the frontal sinus were evaluated: length, width, perimeter, and area. In order to calculate the variables inherent to the sagittal and vertical skeletal pattern, two independent nominal variables were considered: skeletal class (ANB°) and mandibular divergence (SN^MP°). Results: The statistical analysis showed that there is a statistically significant difference between the frontal sinus dimension and the three skeletal classes. Subjects in group 3 presented significantly higher mean dimensional values. In the analysis of sinus size variables with skeletal divergence, significant results were found for the width value, which resulted in higher average values in group c. Conclusions: The present study shows a statistically significant difference in frontal sinus size among different skeletal classes and divergence patterns. This result suggests that, in future studies, it should be analyzed whether the dimensional analysis of the frontal sinus could be associated with skeletal class III malocclusion.
Full article
(This article belongs to the Special Issue Therapeutic Advances in Craniofacial Disorders and Orthodontics in Growing and Adult Population)
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Open AccessArticle
Eliciting Distributive Preferences in Health Care Resource Allocation: A Person Trade-Off Study
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Nan Fang, Chang Su and Jing Wu
Healthcare 2025, 13(11), 1309; https://doi.org/10.3390/healthcare13111309 (registering DOI) - 30 May 2025
Abstract
Background/Objectives: While a preference for an equal distribution of health gains is common, there are situations where individuals may opt to concentrate health gains for a select few. This study investigates how distributive preferences, defined as societal valuations of alternative allocations of fixed
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Background/Objectives: While a preference for an equal distribution of health gains is common, there are situations where individuals may opt to concentrate health gains for a select few. This study investigates how distributive preferences, defined as societal valuations of alternative allocations of fixed total health benefits, vary with the magnitude of individual health gains. Methods: Using the person trade-off (PTO) method, we conducted an online survey with a nationally representative sample of Chinese adults (N = 500). The respondents evaluated five allocation programs differing in both individual health gain magnitude and number of beneficiaries. Distributive preferences are classified into five distinct types: diffusion, concentration, maximization, extreme egalitarianism and extreme inequality seeking. Threshold regression analysis identified critical transition points in preference patterns. Results: Non-maximizing tendencies were dominant (79% of the respondents). The health gain threshold was estimated to be 4.6 years (95% CI: [4.28, 4.85]): below this threshold, respondents tend to allocate smaller benefits to more patients (diffusion preference); above the threshold, people are inclined to allocate larger benefits to fewer patients (concentration preference). The income level and self-reported health status of the participants were identified as potential factors influencing distributive preferences. Conclusions: This study provides the first quantitative evidence from China that distributive preferences exhibit a non-linear shift based on the magnitude of health benefits. The identified 4.6-year threshold provides policymakers with an empirically based instrument to strike a balance between efficiency and the reduction in inequality in resource allocation. These findings advocate for incorporating social value weights into health technology assessments, especially for interventions that offer substantial individual benefits.
Full article
(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)
Open AccessReview
Hypersensitivity Reactions to Iodinated Contrast Media: A Narrative Review of Current Evidence and Clinical Challenges
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Francesca Losa, Giovanni Paoletti, Linda Borgonovo, Federica Buta, Stefania Merli, Serena Nannipieri, Marta Piantanida, Carlo Maria Rossi, Giada Sambugaro, Mona-Rita Yacoub, Vincenzo Patella, Giorgio Walter Canonica, Enrico Heffler and Maria Teresa Costantino
Healthcare 2025, 13(11), 1308; https://doi.org/10.3390/healthcare13111308 (registering DOI) - 30 May 2025
Abstract
Background/Objectives: Hypersensitivity reactions (HSRs) to iodinated contrast media (ICM), both immediate and non-immediate, pose clinical challenges despite using low-osmolality agents. This review aims to summarize current diagnostic approaches, cross-reactivity patterns, and the debated role of premedication. Methods: A narrative review was conducted using
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Background/Objectives: Hypersensitivity reactions (HSRs) to iodinated contrast media (ICM), both immediate and non-immediate, pose clinical challenges despite using low-osmolality agents. This review aims to summarize current diagnostic approaches, cross-reactivity patterns, and the debated role of premedication. Methods: A narrative review was conducted using PubMed (2014–2024), selecting studies on ICM-related HSRs, focusing on skin and in vitro testing, drug provocation tests (DPTs), cross-reactivity, and premedication. Results: Skin tests show limited sensitivity, especially for non-immediate reactions. Cross-reactivity among ICMs is common but unpredictable. DPTs are the diagnostic gold standard but lack standardized protocols. Premedication is frequently used, though its efficacy remains uncertain. Conclusions: The management of ICM hypersensitivity is limited by diagnostic gaps and insufficient evidence on premedication. Standardized protocols and prospective studies are needed to improve patient safety and guide clinical decisions.
Full article
(This article belongs to the Special Issue Allergy and Immunology in Healthcare)
Open AccessSystematic Review
Objective and Subjective Factors Influencing Breast Reconstruction Decision-Making After Breast Cancer Surgery: A Systematic Review
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Valentini Bochtsou, Eleni I. Effraimidou, Maria Samakouri, Spyridon Plakias and Aikaterini Arvaniti
Healthcare 2025, 13(11), 1307; https://doi.org/10.3390/healthcare13111307 (registering DOI) - 30 May 2025
Abstract
Background/Objectives:Breast reconstruction (BR) following mastectomy plays a critical role in post-cancer care by offering both physical and psychological benefits. Despite advancements in techniques and shared decision-making (SDM), BR uptake remains inconsistent. This systematic review aims to synthesize evidence on objective (medical and
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Background/Objectives:Breast reconstruction (BR) following mastectomy plays a critical role in post-cancer care by offering both physical and psychological benefits. Despite advancements in techniques and shared decision-making (SDM), BR uptake remains inconsistent. This systematic review aims to synthesize evidence on objective (medical and socioeconomic) and subjective (psychological and personal) factors influencing BR decision-making among women undergoing mastectomy for breast cancer. Methods: A systematic search was conducted across PubMed, ScienceDirect, OVID, and Google Scholar, identifying peer-reviewed studies published between January 2013 and 25 July 2024. Eligible studies examined determinants of BR decisions in women undergoing therapeutic mastectomy, excluding perspectives of non-patient stakeholders and post-decision outcomes. The risk of bias and study quality were assessed using the Quality Appraisal for Diverse Studies (QuADS) tool. This review was registered in PROSPERO (CRD42023456198) and followed PRISMA guidelines. Results: Twenty-seven studies comprising 994,528 participants across 16 countries met the inclusion criteria. The objective factors included age, comorbidities, insurance coverage, physician recommendations, and healthcare access. The subjective factors encompassed body image concerns, self-esteem, fear of recurrence, and emotional readiness. Younger age, private insurance, and active physician counseling were associated with increased BR uptake, while older age, lack of information, and financial or logistical barriers reduced uptake. Regional disparities were noted across healthcare systems. Conclusions: BR decisions are influenced by complex, interrelated clinical, psychological, and systemic factors. Integrating SDM tools, enhancing patient education, and addressing healthcare inequities are essential for supporting informed and equitable BR decision-making. Future research should prioritize longitudinal studies and policy interventions to improve access to and patient satisfaction with BR outcomes.
Full article
(This article belongs to the Section Women's Health Care)
Open AccessArticle
Selected Moral Issues and the Stress Experienced by Paediatric Nurses
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Anna Stefanowicz-Bielska, Magdalena Słomion, Agnieszka Olińska, Małgorzata Rąpała, Julia Behling and Joanna Stefanowicz
Healthcare 2025, 13(11), 1306; https://doi.org/10.3390/healthcare13111306 - 30 May 2025
Abstract
Background/Objectives: The high sensitivity of paediatric nurses directly influences the quality of nursing care provided to patients. The purpose of this study is to present the most frequent issues faced by paediatric nurses in their everyday work and their responses to difficult
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Background/Objectives: The high sensitivity of paediatric nurses directly influences the quality of nursing care provided to patients. The purpose of this study is to present the most frequent issues faced by paediatric nurses in their everyday work and their responses to difficult situations at work, define the actions applied when a difficult situation occurs, and assess the level of stress and other factors influencing the level of stress experienced by paediatric nurses. Methods: This study was conducted using an original survey form and a standardised psychological questionnaire based on the Perceived Stress Scale (PSS-10) for paediatric nurses. Results: The study involved 416 paediatric nurses and indicated a medium level of stress among the nurses. The median stress level, calculated as the sum of answers to questions based on the PSS-10, was 18 (16.0 ÷ 20.0), and the mean was 17.9 (min–max = 1–30). The median Sten score was 6 (5.0 ÷ 7.0), and the mean Sten score was 5.94 (min–max = 2–9). Nurses aged 21–30 years, who live in a city, have a Bachelor of Science in Nursing or a Master of Science in Nursing, and work ≥ 61 h a week and 161–250 h a month experience a higher level of stress. Factors such as choosing which child to help first, spending a great deal of time filling out medical documentation, obtaining a sick child’s consent to perform nursing procedures which the child does not understand, involving the minor in decision-making, impolite or offensive behaviour from a sick child or their parents, ineffective nursing and treatment methods, providing care against the opinion/views of a sick child or their parents, difficulties in or a lack of understanding of the situation of a sick child and their family, performing nursing procedures that can cause the child pain, and the inability to fulfil a sick child’s request increase the level of stress experienced by paediatric nurses. When a difficult situation occurs at work occurs, the nurses usually meet and talk about the situation with someone close (72.4%) or engage in other activities to avoid thinking about the situation (66.6%). They consult a psychologist/psychotherapist very rarely (9.6%) and a psychiatrist extremely rarely (4.6%). Conclusions: Polish paediatric nurses were found to experience a medium level of stress. Since paediatric nurses are exposed to stress, providing them with psychological care is important. The level of perceived stress is dependent on the nurse’s age, place of residence, and education, as well as weekly and monthly working durations. Paediatric nurses experience many difficult situations in their everyday work that influence their stress levels. Management should pay special attention to difficult workplace situations faced by paediatric nurses and implement regular actions to reduce the levels of stress experienced.
Full article
Open AccessReview
Unraveling Rising Mortality: Statistical Insights from Japan and International Comparisons
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Hiroshi Kusunoki
Healthcare 2025, 13(11), 1305; https://doi.org/10.3390/healthcare13111305 - 30 May 2025
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Since the onset of the COVID-19 pandemic, Japan has experienced a significant rise in mortality, with excess deaths surpassing historical projections. Statistical data indicate a sharp increase in mortality rates from 2021 onward, attributed to COVID-19, aging demographics, cardiovascular diseases, and malignancies. Preliminary
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Since the onset of the COVID-19 pandemic, Japan has experienced a significant rise in mortality, with excess deaths surpassing historical projections. Statistical data indicate a sharp increase in mortality rates from 2021 onward, attributed to COVID-19, aging demographics, cardiovascular diseases, and malignancies. Preliminary 2024 data suggest continued excess mortality, fueling public debate. This review analyzes national and municipal mortality trends using official Japanese statistics and comparative data from South Korea, the U.S., and the EU. Findings reveal a sharp mortality rise post-2021 in Japan and South Korea, while Western nations experienced peak deaths in 2020, followed by declines. The review explores contributing factors, including potential vaccine-related adverse effects, declining healthcare access, pandemic-induced stress, and demographic shifts. Notably, older adults’ reluctance to seek medical care led to delayed diagnoses, treatment interruptions, and preventable deaths. Although some argue that declining COVID-19 vaccination rates in 2023 may have contributed to rising mortality in 2024, available data suggest a multifactorial causation. Japan’s rapidly aging population, coupled with increasing mortality and declining birth rates, presents profound social and economic challenges. A nuanced approach, avoiding simplistic causal claims, is crucial for understanding these trends. This review highlights the need for a sustainable societal framework to address demographic shifts and improve healthcare resilience. Future pandemic strategies must balance infection control measures with mitigating unintended health consequences to ensure a more adaptive and effective public health response.
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Open AccessArticle
Expert Guidelines on the Use of Cariprazine in Bipolar I Disorder: Consensus from Southeast Asia
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Ahmad Hatim Sulaiman, Mustafa M. Amin, Jin Kiat Ang, Roger Ho, Nik Ruzyanei Nik Jaafar, Chong Guan Ng, Adhi Wibowo Nurhidayat, Pongsatorn Paholpak, Pornjira Pariwatcharakul, Thitima Sanguanvichaikul, Eng Khean Ung, Natalia Dewi Wardani and Brian Yeo
Healthcare 2025, 13(11), 1304; https://doi.org/10.3390/healthcare13111304 - 30 May 2025
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Background/Objectives: Cariprazine, a D3/D2 partial agonist, is one of the few recommended treatment options for bipolar 1 disorder (BP1D) in Southeast Asia. This study aims to generate insights from leading experts on the safe and effective use of cariprazine for BP1D, specifically
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Background/Objectives: Cariprazine, a D3/D2 partial agonist, is one of the few recommended treatment options for bipolar 1 disorder (BP1D) in Southeast Asia. This study aims to generate insights from leading experts on the safe and effective use of cariprazine for BP1D, specifically by formulating practical recommendations not thoroughly covered in the existing literature. Methods: A formal consensus methodology using the modified RAND/UCLA Appropriateness Method was employed to develop consensus recommendations. The methodology included a targeted literature search, creation of clinical scenarios, two rounds of rating of the appropriateness of each scenario on a nine-point Likert scale by an expert panel of psychiatrists from Southeast Asia (n = 13), and a face-to-face discussion among the expert panel between the two rounds of rating. In the absence of disagreement, scenarios were classified as appropriate (7–9), equivocal (4–6), or inappropriate (1–3) based on median scores. Clinical scenarios were subsequently converted to consensus recommendations upon approval by the expert panel. Results: Most experts recommended a 4–8-week trial of cariprazine for bipolar depression (85%) and 3–4 weeks for acute mania/mixed (71%). For longer treatment, 61.5% and 69% recommended >1 year for acute mania/mixed and bipolar depression, respectively. Cariprazine was also considered suitable as first-line therapy, including for first-episode bipolar depression (Mdn: 8, IQR: 7–9) and first-episode mania (Mdn: 8; IQR: 8–9). Conclusions: The consensus recommendations may serve as practical guidance for clinicians to make informed decisions regarding the management of adult patients with BP1D, while considering the preferences and circumstances of individual patients.
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Open AccessCase Report
Injury Patterns and Conservative Management in Elite Handball: A Multidisciplinary Approach to Diagnosis and Rehabilitation
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Cătălin-Adrian Miu, Mihai Hurmuz, Luminița-Oana Miu, Daniel Ceachir, Alexandru Catalin Motofelea and Romulus-Fabian Tatu
Healthcare 2025, 13(11), 1303; https://doi.org/10.3390/healthcare13111303 - 30 May 2025
Abstract
Background: Musculoskeletal injuries are frequent in handball players due to the high-impact nature of the sport. Accurate diagnosis and tailored treatment are essential for recovery. Magnetic resonance imaging (MRI) has become the gold standard for evaluating complex sports-related injuries. This case report aims
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Background: Musculoskeletal injuries are frequent in handball players due to the high-impact nature of the sport. Accurate diagnosis and tailored treatment are essential for recovery. Magnetic resonance imaging (MRI) has become the gold standard for evaluating complex sports-related injuries. This case report aims to assess the role of MRI in diagnosing trauma in professional handball players and the effectiveness of individualized treatment approaches. Methods: Four male members of the “Politehnica” Timișoara first team who sustained match- or training-related injuries between January 2023 and December 2024 underwent an 1.5 T MRI. Individualized conservative protocols included rest, NSAIDs, physiotherapy, and graded kinesitherapy. Results: The first case involved a right back with a knee hematoma and a vastus lateralis tear. Conservative treatment led to recovery. The second case was a left back with peripheral neuropathy caused by hamstring avulsion at the ischial tuberosity. Conservative therapy alleviated symptoms. The third case involved a left winger with adductor muscle tears, which recovered with conservative management. The fourth case, a goalkeeper, had a type III navicular fracture misdiagnosed on radiography, correctly identified via MRI and treated conservatively. Conclusions: MRI is invaluable in diagnosing handball-related injuries, enabling accurate assessments and effective individualized treatment, resulting in early recovery.
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(This article belongs to the Special Issue Physical Fitness—Effects on Muscle Function and Sports Performance)
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Open AccessArticle
Survey-Based Insights into Romania’s Pathology Services: Charting the Path for Future Progress
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Maria Magdalena Köteles, Ovidiu Țica and Gheorghe Emilian Olteanu
Healthcare 2025, 13(11), 1302; https://doi.org/10.3390/healthcare13111302 - 30 May 2025
Abstract
Background: Pathology is essential for cancer diagnosis, bridging clinical and surgical fields, and requires adequate infrastructure, technology, and skilled staff to meet standards of care. In Romania, healthcare underfunding limits pathology laboratories’ capacity to provide timely and accurate diagnoses, leading to delays that
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Background: Pathology is essential for cancer diagnosis, bridging clinical and surgical fields, and requires adequate infrastructure, technology, and skilled staff to meet standards of care. In Romania, healthcare underfunding limits pathology laboratories’ capacity to provide timely and accurate diagnoses, leading to delays that could negatively impact treatment and patient outcomes. Our study aimed to assess the status of publicly funded pathology laboratories in Romania and identify key areas for improvement. Methods: We analyzed public hospitals in Romania, excluding specialized and non-general care institutions, to evaluate pathology laboratories. A 10-item survey was distributed over 12 months via email, phone, administrative offices, and professional networks to pathologists working in these laboratories, regardless of their hierarchical position. A total of 154 pathology services were represented. The questionnaire assessed technical capabilities, diagnostic techniques, automation, staffing, infrastructure, and satisfaction with funding and resources. Responses were gathered with both predefined and open-text fields to capture comprehensive insights. Results: The findings revealed that many pathology laboratories faced significant challenges, including a lack of automation, limited integration of modern technologies, and barriers to digitalization. Despite these issues, pathologists reported higher-than-expected levels of satisfaction with their laboratories. Conclusions: A comprehensive understanding of existing practices is necessary to drive the modernization of pathology services, establish national standards, and improve collaboration both within and across specialties. Without such foundational insight, efforts to enhance the integration and effectiveness of pathology services are likely to remain constrained.
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(This article belongs to the Section Healthcare Quality and Patient Safety)
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Open AccessSystematic Review
New Perspectives on the Efficacy of Catgut Embedment in Acupoint Combined with Rehabilitation Training for Pediatric-Cerebral-Palsy Motor Function Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
by
Zhe-Hao Hu, Xin-Yue Zhang, Hong-Zhan Jiang, Xue-Jing Li and Yu-Fang Hao
Healthcare 2025, 13(11), 1301; https://doi.org/10.3390/healthcare13111301 - 30 May 2025
Abstract
Background: Motor Function Disorders (MFDs) are common conditions in children with cerebral palsy and closely related to muscle spasticity. Catgut Embedment in Acupoint (CEA) has shown promise as an important adjunctive therapy but current evidence remains insufficient. The aim of this study
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Background: Motor Function Disorders (MFDs) are common conditions in children with cerebral palsy and closely related to muscle spasticity. Catgut Embedment in Acupoint (CEA) has shown promise as an important adjunctive therapy but current evidence remains insufficient. The aim of this study was to evaluate the efficacy and safety of CEA in Pediatric-Cerebral-Palsy Motor Function Disorders (PCPMFDs). Methods: PubMed, Cochrane Library, Embase, Web of Science, four Chinese databases and a clinical trial registry were searched to include randomized controlled trials of patients with PCPMFDs treated with CEA combined with conventional rehabilitation. Meta-analysis was performed using Review Manager 5.4, Stata 18 and R Studio software 2025, and risk of bias was assessed for the included studies using the Cochrane Collaboration Network tool. Results: A total of 17 papers were included, including 1106 PCPMFD patients with a wide range of conditions, age ≤ 9 years, and rehabilitation training mostly using Bobath/Vojta therapy. Meta-analysis showed that CEA was effective in improving MFD with the Gross Motor Function Measure Scale (SMD, 0.90 [95% CI, 0.57 to 1.23], p < 0.0001) and the modified Ashworth Scale (MD, −0.40 [95% CI, −0.58 to −0.23], p < 0.0001). Preliminary results suggested that a treatment regimen, which consisted of three monthly sessions and lasted for one to two months, was most effective. Conclusions: CEA is an effective complementary treatment for patients with PCPMFDs with mild adverse effects. However, due to the relatively new perspective of this study, only a small number of researchers have focused on this area and conducted studies, resulting in fewer included studies meeting requirements, which is a direct result of the fact that this study, although informative, still requires a significant amount of research before clear evidence-based recommendations can be developed.
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(This article belongs to the Special Issue Neurological and Developmental Disorders in Children: Rehabilitation and Care)
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Open AccessArticle
Knowledge, Attitude, and Motivation Regarding Transcranial Direct Current Stimulation (tDCS) Among Rehabilitation Specialists in Saudi Arabia: A Cross-Sectional Study
by
Alaa M. Albishi, Ahmed O. Alokaily, Madhawi K. Altaib, Mohammed F. Alharbi and Ahmed A. Aldohbeyb
Healthcare 2025, 13(11), 1300; https://doi.org/10.3390/healthcare13111300 (registering DOI) - 29 May 2025
Abstract
Background: Transcranial direct current stimulation (tDCS) has exhibited potential in augmenting motor functions, neuroplasticity, and cognitive abilities within neurological rehabilitation contexts. Despite these promising outcomes, the utilization of tDCS in both research and clinical environments in Saudi Arabia remains relatively unexplored. Objective: This
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Background: Transcranial direct current stimulation (tDCS) has exhibited potential in augmenting motor functions, neuroplasticity, and cognitive abilities within neurological rehabilitation contexts. Despite these promising outcomes, the utilization of tDCS in both research and clinical environments in Saudi Arabia remains relatively unexplored. Objective: This study aims to evaluate the knowledge, attitudes, and motivations of rehabilitation specialists in Saudi Arabia concerning tDCS. Methods: A cross-sectional observational study was conducted through an online questionnaire, involving 112 registered rehabilitation professionals. Results: While 58% of respondents acknowledged tDCS as a therapeutic tool, the overall knowledge level was modest, with a mean score of 3.0 ± 2.7 out of 9. Enhanced levels of knowledge were associated with individuals holding doctoral degrees (p = 0.02) and those with international training exposure (p = 0.03). Despite the limited knowledge base, an overwhelming 94.64% of participants displayed a neutral to positive attitude towards tDCS, with 52.7% recognizing its potential efficacy in neurological recovery. Principal obstacles to implementation included safety-related concerns (21.4%) and the need for specialized training (23.3%). Conclusions: Rehabilitation specialists in Saudi Arabia generally hold a favorable view of tDCS and demonstrate an eagerness to pursue further training. The results underscore the imperative for enhanced educational initiatives and practical training to address knowledge deficiencies and facilitate the seamless integration of tDCS into clinical routines. The implementation of structured training programs could not only reinforce adoption rates but also optimize the role of tDCS within rehabilitation.
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(This article belongs to the Special Issue Physical Therapy and Rehabilitation of Neurological Disorders)
Open AccessArticle
Clinical Characteristics and Risk Factors of Geographic Tongue: A Retrospective Analysis of 100 Polish Patients
by
Zuzanna Ślebioda, Julia Drożdżyńska, Aleksandra Karpińska, Aleksandra Krzyżaniak, Marianna Kasperczak, Natalia Tomoń, Paulina Wiśniewska and Marzena Liliana Wyganowska
Healthcare 2025, 13(11), 1299; https://doi.org/10.3390/healthcare13111299 - 29 May 2025
Abstract
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Background/Objectives: We aimed to evaluate the clinical course, demographic characteristics, and risk factors in Polish patients with geographic tongue (GT). Methods: The analysis was based on medical records of 100 patients with GT referred to the outpatient clinic of Poznań University of Medical
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Background/Objectives: We aimed to evaluate the clinical course, demographic characteristics, and risk factors in Polish patients with geographic tongue (GT). Methods: The analysis was based on medical records of 100 patients with GT referred to the outpatient clinic of Poznań University of Medical Sciences (PUMS) from 2013 to 2023. Data regarding age, gender, medical history, habits, subjective complaints, clinical features, localization, histology, and treatment were considered. Results: Patients with GT constituted 11.3% of 887 individuals admitted to the outpatient clinic in the analyzed period. The female-to-male ratio was 52:48. The average age at diagnosis was 51.6 years. Thirteen patients reported smoking, and 2.0% admitted to consuming alcohol excessively. Subjective complaints were reported by 85.0% of patients and mainly included a burning sensation (57.0%), pain (39.0%), xerostomia (22.0%), bleeding (4.0%), and taste disturbance (3.0%), while 15.0% of GT patients were asymptomatic. Comorbidities were found in 76.0% of subjects with GT, and included cardiovascular disorders (37.0%), gastrointestinal and thyroid gland diseases (24.0% and 18.0%), and type II diabetes (15.0%). Psoriasis was observed in one case only. Conclusions: The frequency of GT in a Polish cohort of patients was high and comparable in both genders. The majority of participants reported subjective complaints, and most of the patients were non-smokers. Comorbidities were found in 76.0% of subjects with GT and mainly included cardiovascular and gastrointestinal diseases. GT was often accompanied by other oral conditions, like candidiasis, recurrent aphthous stomatitis, and lichen planus. GT screening should include cardiovascular and gastrointestinal evaluation.
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Open AccessArticle
The Development and Evaluation of the Nursing Leadership Excellence in Practice Program (L-EPP)
by
Mitchell Dwyer, Kylie Chilcott, Samantha Sargent, Kylie Sih, Jennifer Codee, Andrea Middleton and Pieter Jan Van Dam
Healthcare 2025, 13(11), 1298; https://doi.org/10.3390/healthcare13111298 - 29 May 2025
Abstract
Background: Nursing leadership is associated with a host of benefits for patient outcomes and health services. Pressures relating to the COVID-19 pandemic saw many relatively inexperienced nurses thrust into leadership roles, often with little notice. In response to this situation, The Tasmanian
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Background: Nursing leadership is associated with a host of benefits for patient outcomes and health services. Pressures relating to the COVID-19 pandemic saw many relatively inexperienced nurses thrust into leadership roles, often with little notice. In response to this situation, The Tasmanian Health Service—Hospitals South created the Leadership Excellence in Practice Program (L-EPP) as a way of developing the leadership skills of its nurses and midwives. This study aimed to describe the development of the L-EPP and to evaluate it from the perspective of its participants and their peers. Methods: A longitudinal mixed-methods study was conducted using data from the first two offerings of the L-EPP. The L-EPP employs a blended learning model comprised of e-learning, work-integrated learning and face-to-face workshops. Surveys targeting the participants’ leadership abilities were completed at numerous time points by participants themselves, their peers, and their managers. Results: A total of 57 participants completed the program. Workshop surveys indicated that these sessions were generally well-received by participants. Significant improvements were observed in several domains of leadership, from the perspective of the participants themselves and their peers and managers. Conclusions: The program was well-received by its participants, and would serve as a useful template for other organisations seeking to build the leadership capacity of their nurses and midwives. This may be particularly useful to organisations seeking to upskill their existing staff and prevent further attrition of nurses and midwives in the wake of the pandemic.
Full article
(This article belongs to the Special Issue Health Service Improvement, Nursing Management and Simulation)
Open AccessArticle
Factors Associated with Family Caregivers’ Intentions to Complete an Advance Directive for Individuals with Dementia: A Cross-Sectional Descriptive Study
by
Hyeseon Park, Sujin Kang and Youngji Kim
Healthcare 2025, 13(11), 1297; https://doi.org/10.3390/healthcare13111297 - 29 May 2025
Abstract
Background/Objectives:As dementia progresses, patients often lose decision-making capacity, leaving family members responsible for making critical end-of-life (EOL) care decisions. This cross-sectional descriptive study explored the factors associated with the intention to complete an advance directive (AD) among family caregivers of older adults
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Background/Objectives:As dementia progresses, patients often lose decision-making capacity, leaving family members responsible for making critical end-of-life (EOL) care decisions. This cross-sectional descriptive study explored the factors associated with the intention to complete an advance directive (AD) among family caregivers of older adults with dementia in South Korea. Methods: This study surveyed 140 caregivers aged 20 years or older to assess their knowledge of advance directives (ADs), preferences for EOL care, and attitudes toward withdrawing life-sustaining treatment (LST). Data were collected from 1 August to 14 August 2024, and analyzed using descriptive statistics, the Chi-squared test, Fisher’s exact test, Spearman’s correlation, and logistic regression, with SPSS/WIN 28.0. Results: The intention to complete an AD significantly differed by religion (p = 0.004) and the functional status of the patient with dementia (p = 0.012). There was a positive correlation between intention to complete an AD and knowledge of ADs (r = 0.23, p = 0.007). Factors associated with intention to complete an AD included religion (OR = 4.36, p = 0.028) and knowledge of ADs (OR = 1.16, p = 0.033), explaining 22.2% of the variance, which is considered meaningful in studies dealing with complex psychosocial and behavioral variables. Conclusions: These findings suggest that religious affiliation and knowledge of ADs may contribute to greater emphasis on EOL preparedness and self-determination. To promote informed decision making, it is essential to implement targeted educational interventions—such as community-based workshops, telehealth counseling, and in-clinic guidance—that enhance caregivers’ understanding of ADs and empower them in their caregiving roles.
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Open AccessArticle
Effects of Core Stability Training on Balance, Standing, and Gait in Children with Mild Cerebral Palsy: A Randomized Controlled Trial
by
Nancy Mohamed, Mohamed B. Ibrahim, Osama A. El-Agamy, Monira I. Aldhahi and Sara Y. Elsebahy
Healthcare 2025, 13(11), 1296; https://doi.org/10.3390/healthcare13111296 - 29 May 2025
Abstract
Background/Objectives: Children with diplegic spastic cerebral palsy (CP) often present with impaired postural control, poor balance, and gait abnormalities that negatively affect their functional mobility and independence. Core stability, which is the ability to control the position and movement of the trunk,
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Background/Objectives: Children with diplegic spastic cerebral palsy (CP) often present with impaired postural control, poor balance, and gait abnormalities that negatively affect their functional mobility and independence. Core stability, which is the ability to control the position and movement of the trunk, is considered a critical component in maintaining postural alignment and improving gross motor function. This study aimed to investigate the impact of a structured core stability exercise program on the standing ability, functional balance, and gait parameters of children diagnosed with diplegic spastic CP. Methods: Forty children (28 males, 12 females) aged 4–10 years with a clinical diagnosis of diplegic spastic cerebral palsy were randomly allocated into two groups (n = 20 each). The study group underwent a 12-week core stability exercise program in addition to a standardized physiotherapy regimen, which was conducted three times per week. The control group received the physiotherapy program alone. Functional outcomes were assessed pre- and post-intervention using the Gross Motor Function Classification System (GMFCS), Pediatric Balance Scale, and Kinovea software for gait analysis. Results: Both groups demonstrated statistically significant improvements in all measured variables after the intervention. However, the study group showed significantly greater improvements in standing ability (9%), balance (9%), and gait parameters (p < 0.05), particularly in knee flexion, ankle dorsiflexion, and plantar flexion, during gait cycles. Conclusions: Core stability training resulted in superior enhancements in balance, standing, and gait performance compared with physiotherapy alone in children with diplegic spastic cerebral palsy.
Full article
(This article belongs to the Special Issue New Insights into Children’s Orthopedic Health)
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