Healthcare

17 pages, 517 KB

Open AccessArticle

Tracking Chronic Diseases via Mobile Health Applications: Which User Experience Aspects Are Key?

by Anouk S. Huberts, Preston Long, Ann-Kristin Porth, Liselotte Fierens, Nicholas C. Carney, Linetta Koppert, Alexandra Kautzky-Willer, Belle H. de Rooij and Tanja Stamm

Healthcare 2025, 13(24), 3272; https://doi.org/10.3390/healthcare13243272 - 12 Dec 2025

Abstract

Background: A key barrier to realizing the full potential and long-term collection of patient-reported outcomes (PROs) is the limited understanding of user experience (UX) factors that influence sustained patient engagement with digital PRO tools. Most existing research focuses on disease-specific or country-specific solutions, [...] Read more.

Background: A key barrier to realizing the full potential and long-term collection of patient-reported outcomes (PROs) is the limited understanding of user experience (UX) factors that influence sustained patient engagement with digital PRO tools. Most existing research focuses on disease-specific or country-specific solutions, leaving a gap in identifying shared UX determinants that could inform scalable, cross-disease European digital health frameworks. This fragmentation hinders interoperability and increases development costs by requiring separate tools for each context. This case study aims to address this gap by identifying key UX features that optimize PRO collection across diverse chronic conditions in Europe within the Health Outcomes Observatory project, enhancing continuous (primary use) and large-scale (secondary use) data collection. Objective: This study aimed to identify and analyze key UX factors that support adoption and sustained use of PRO collection tools among patients with chronic diseases across multiple European countries. Methods: Patient focus groups were conducted in four chronic disease areas: cancer, inflammatory bowel disease (IBD), and diabetes (type I and II) across six European countries. Participants were recruited purposively through national patient advisory boards to ensure diversity in age, gender, and disease type. Sessions were moderated by trained qualitative researchers following a standardized guide, and discussions were transcribed verbatim and coded in researcher pairs to ensure intercoder reliability through iterative consensus. A modified thematic analysis, guided deductively by the UX Honeycomb model and inductively by emergent themes, was used to identify cross-disease UX determinants. Results: In total, 17 patients and patient representatives participated (76% female; 4 diabetes, 6 IBD and 7 cancer). We identified six core UX factors driving patient engagement for all disease groups: compatibility with other technologies, direct communication with the care team, personalization, ability to share data, the need for educational material and data protection were identified as key aspects of PRO technologies. However, the customizability of the app is crucial. Not all disease groups had the same needs, and participants specifically requested that the app provide information relevant to their own condition. Disease-specific needs, like T1D patients desiring glucose monitoring integration, were identified. IBD patients highlighted flare detection abilities and cancer patients especially sought side-effect comparisons. Conclusions: Our findings indicate that a unified yet customizable PRO platform can address shared UX needs across diseases, improving patient engagement and data quality. Incorporating features such as seamless data transfer, personalization, feedback, and strong privacy measures can foster trust and long-term adoption across European contexts. In addition to some disease-specific issues, most needs for the backbone of the app were shared among the disease areas. This shows that a shared app between diseases might be preferable and, in case of comorbidities, could ease self-management for patients. Last, to ensure full potential for every user and every disease, customization is crucial. Full article

15 pages, 267 KB

Open AccessArticle

Challenges and Social Implications of Informal Caregiving for People with Alzheimer’s: A Qualitative Study

by Andrea Alcaraz-Córdoba, María López-Cano, Olivia Ibáñez-Masero, María Isabel Ventura-Miranda, María Dolores Ruiz-Fernández and Angela María Ortega-Galán

Healthcare 2025, 13(24), 3271; https://doi.org/10.3390/healthcare13243271 - 12 Dec 2025

Abstract

Aim: The aim of this study was to explore the experiences and challenges faced by informal caregivers of people with Alzheimer’s, including the social and emotional aspects of their caregiving role. Methods: A descriptive qualitative study was conducted using one focus [...] Read more.

Aim: The aim of this study was to explore the experiences and challenges faced by informal caregivers of people with Alzheimer’s, including the social and emotional aspects of their caregiving role. Methods: A descriptive qualitative study was conducted using one focus group discussion and eleven semi-structured interviews with informal caregivers of individuals diagnosed with Alzheimer’s disease. The data collected were analyzed through thematic analysis using ATLAS.ti qualitative software version 23. Results: The results reveal two themes: (1) “Life centred on compassionate care for the other person”, which reflects the role performed from a perspective of emotional and compassionate commitment to those in need of care, and (2) “Abandonment by caregivers”, which expresses the emotional cost associated with caregiving. Conclusions: Informal caregivers of people with Alzheimer’s disease undertake their roles guided by compassion, which involves substantial personal sacrifice. This commitment often leads to self-abandonment, impacting their emotional and physical health, social relationships, and personal aspirations. It is therefore crucial to implement psychosocial interventions grounded in compassion and to strengthen both formal and informal social support systems for caregivers. Full article

(This article belongs to the Special Issue Enhancing Healthcare Services for Vulnerable Groups)

26 pages, 580 KB

Open AccessSystematic Review

Patient-Reported Outcome Measures for Evaluating Body Awareness: A Systematic Review Using the COSMIN Methodology

by Cristina Bravo, Manuel Trinidad-Fernández, David Barranco-i-Reixachs, Sandy Arias-Matiz, Pedro Malagon-Santos and Daniel Catalán-Matamoros

Healthcare 2025, 13(24), 3270; https://doi.org/10.3390/healthcare13243270 - 12 Dec 2025

Abstract

Objective: Body awareness is the conscious, subjective multimodal integration of body-related sensitivity from bodily signals—detecting states and subtle reactions to internal and environmental conditions—modifiable by attention, interpretation, appraisal, beliefs, memories, conditioning, attitudes, and affect. The aim of our study is to identify [...] Read more.

Objective: Body awareness is the conscious, subjective multimodal integration of body-related sensitivity from bodily signals—detecting states and subtle reactions to internal and environmental conditions—modifiable by attention, interpretation, appraisal, beliefs, memories, conditioning, attitudes, and affect. The aim of our study is to identify patient-reported outcome measures (PROMs) of BA and evaluate their psychometric properties and cross-cultural adaptation processes. Literature Survey: We searched PubMed, Scopus, and PsycINFO; the last search was conducted on 1 July 2025. Methodology: We included studies that psychometrically evaluated PROMs regarding BA in the general adult population and their translations into other languages, with no time-range restrictions. Study selection was performed independently by two reviewers in a blind manner. Evaluation followed COSMIN guidance for systematic reviews of PROMs: (1) risk of bias assessment, (2) application of quality criteria for measurement properties, and (3) GRADE rating of the certainty of evidence. Synthesis: We identified 12 BA questionnaires and more than 30 cross-cultural adaptations, from a total of 50 studies. In summary, the Revised Body Awareness Rating Questionnaire and the Multidimensional Assessment of Interoceptive Awareness (MAIA 1 and 2) showed good results for structural validity and internal consistency, which were the most frequently assessed psychometric properties. In contrast, construct validity was highly variable, and the findings on reliability were far from optimal. MAIA-2 was one of the most studied and showed stronger evidence and better pooled results (4 out of 5 properties) than other instruments. Conclusions: The psychometric quality of BA PROMs varies widely, reflecting challenges in operationalizing the construct of body awareness and related domains. While MAIA-2 currently presents the most acceptable—though still imperfect—evidence, further high-quality studies are needed to strengthen their measurement properties and clarify construct coverage. Full article

(This article belongs to the Special Issue Physical Therapy in Mental Health)

23 pages, 1023 KB

Open AccessArticle

Development and Validation of the Artificial Intelligence in Mental Health Scale: Application for AI Mental Health Chatbots

by Aglaia Katsiroumpa, Olympia Konstantakopoulou, Ioannis Moisoglou, Parisis Gallos, Olga Galani, Paschalina Lialiou, Maria Tsiachri and Petros Galanis

Healthcare 2025, 13(24), 3269; https://doi.org/10.3390/healthcare13243269 - 12 Dec 2025

Abstract

Background/Objectives: Artificial intelligence (AI)-based chatbots present a viable approach to overcoming several challenges associated with conventional psychotherapy, such as high financial costs, limited access to mental health professionals, and geographical or logistical barriers. Thus, these chatbots are increasingly employed as complementary tools [...] Read more.

Background/Objectives: Artificial intelligence (AI)-based chatbots present a viable approach to overcoming several challenges associated with conventional psychotherapy, such as high financial costs, limited access to mental health professionals, and geographical or logistical barriers. Thus, these chatbots are increasingly employed as complementary tools to traditional therapeutic practices in mental health care. Our aim was to develop and validate a scale to measure attitudes toward the use of AI-based chatbots for mental health support, i.e., the Artificial Intelligence in Mental Health Scale (AIMHS). Methods: A multidisciplinary panel of experts assessed the content validity. To confirm face validity, we carried out cognitive interviews and calculated the item-level face validity index. We applied factor analysis to verify the construct structure. We assessed measurement invariance across demographic subgroups. Concurrent validity was evaluated using three valid instruments. Reliability was tested through Cronbach’s alpha, Cohen’s kappa, and the intraclass correlation coefficient. Results: Factor analysis supported a two-factor five-item model. The two factors were technical and personal advantages, and explained 81.28% of the variance. The AIMHS demonstrated adequate concurrent validity, evidenced by statistically significant correlations with Artificial Intelligence Attitude Scale (r = 0.405, p-value < 0.001), Attitudes Towards Artificial Intelligence Scale (acceptance subscale; r = 0.401, p-value < 0.001, fear subscale; r = −0.151, p-value = 0.002), and Short Trust in Automation Scale (r = 0.450, p-value < 0.001). Configural, metric and scalar invariance were supported by our findings. Cronbach’s alpha was 0.798, and intraclass correlation coefficient was 0.938. Cohen’s kappa for the five items ranged from 0.760 to 0.848. Conclusions: The AIMHS is a five-item psychometrically sound and user-friendly instrument capturing two dimensions; technical and personal advantages. Future research should be undertaken to further evaluate the psychometric properties of the AIMHS across diverse populations and contexts. Full article

(This article belongs to the Special Issue Artificial Intelligence Chatbots and Mental Health)

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19 pages, 926 KB

Open AccessSystematic Review

Efficacy of Massage Therapy for Symptom Management in Cancer Patients: A Systematic Review and Meta-Analysis

by Arda Uzunoglu, Paula Matta-Diaz, Valeria Bustos-Gajardo, Javiera Obreque-González, Gloria Cifuentes-Suazo, Guinevere Granite, Mathias Orellana Donoso, Pablo Nova Baeza, Gustavo Oyanedel-Amaro, Alvaro Becerra Farfan, Juan Sanchis-Gimeno, Juan José Valenzuela-Fuenzalida, Jessica Paola Loaiza Giraldo and Jose E. León-Rojas

Healthcare 2025, 13(24), 3268; https://doi.org/10.3390/healthcare13243268 - 12 Dec 2025

Abstract

Background: Cancer and its treatments frequently lead to physical and psychological symptoms that negatively affect quality of life. Massage therapy has been proposed as a complementary intervention to reduce symptom burden through its effects on stress regulation and autonomic balance. This systematic review [...] Read more.

Background: Cancer and its treatments frequently lead to physical and psychological symptoms that negatively affect quality of life. Massage therapy has been proposed as a complementary intervention to reduce symptom burden through its effects on stress regulation and autonomic balance. This systematic review and meta-analysis evaluated the effectiveness of massage therapy in patients with cancer. Methods: A systematic search was conducted in MEDLINE, Web of Science, Scopus, Embase, Google Scholar, and CINAHL. Search terms included “massage therapy,” “reflexology,” “massage,” and “cancer.” Randomized controlled trials comparing massage therapy with placebo or standard care and reporting quantitative outcomes were eligible. Seven studies met inclusion criteria for the meta-analysis. Results: Compared with control conditions, massage therapy was associated with significant improvements in several outcomes: Behavioral Symptoms Frequency (BSF) (MD = −12.54; 95% CI: −18.70 to −6.38; p < 0.0001), Quality of Life Questionnaire (QLQ) scores (SMD = 10.10; 95% CI: 1.21 to 19.00; p = 0.03), Spielberger State–Trait Anxiety Inventory (STAI) scores (MD = −3.97; 95% CI: −4.63 to −3.31; p = 0.0001), and Visual Analog Scale (VAS) symptom intensity (MD = −1.09; 95% CI: −2.11 to −0.07; p = 0.04). Overall certainty of evidence was limited by methodological heterogeneity and risk of bias. Conclusions: Massage therapy may provide short-term improvements in selected physical and psychological symptoms in cancer patients and may serve as a supportive complementary intervention. However, the evidence remains limited, and well-designed trials with standardized protocols are needed to strengthen the reliability of these findings. Full article

(This article belongs to the Collection Integrative, Complementary and Alternative Medicine (CAM) in Healthcare)

13 pages, 851 KB

Open AccessArticle

Cost-Effectiveness Analysis of Recombinant Tumor Necrosis Factor Receptor: Fc Fusion Protein as First-Line Treatment for Active Rheumatoid Arthritis in China

by Rui Zhang and Aixia Ma

Healthcare 2025, 13(24), 3267; https://doi.org/10.3390/healthcare13243267 - 12 Dec 2025

Abstract

Background/Objectives: To evaluate the cost-effectiveness of recombinant tumor necrosis factor receptor Fc fusion protein compared with methotrexate as first-line therapy for active rheumatoid arthritis in China using evidence from a Chinese head-to-head randomized trial. Methods: A Markov model with 6 months [...] Read more.

Background/Objectives: To evaluate the cost-effectiveness of recombinant tumor necrosis factor receptor Fc fusion protein compared with methotrexate as first-line therapy for active rheumatoid arthritis in China using evidence from a Chinese head-to-head randomized trial. Methods: A Markov model with 6 months per cycle was developed to estimate costs and health utilization in the lifetime of patients with RA from the Chinese healthcare system. The analysis data were derived from the randomized clinical trial in China. The primary cost includes drug and other medical costs. The health utilities quality-adjusted life years (QALYs) were derived using EQ-5D-5L mapping from disease-specific health assessment questionnaire (HAQ) scores obtained in clinical trials. The cost-effectiveness analysis was conducted by calculating the incremental cost-effectiveness ratio (ICER) values for rhTNFR:Fc and MTX. One-way and probabilistic sensitivity analyses were conducted to test the robustness of the base-case result. Results: In the base case, rhTNFR:Fc yielded 8.20 QALYs versus 7.46 with methotrexate, resulting in an ICER of CNY 12,783.56 per QALY. Scenario ICERs for bDMARD group combination treatment were 11,776.31 per QALY. Scenario ICERs were CNY 8079.04 per QALY for the patient perspective and CNY 7630.34 per QALY for the medical insurance perspective. One-way analysis highlighted utility inputs as the main drivers, and probabilistic analysis indicated a high probability of cost-effectiveness across common willingness-to-pay thresholds. Conclusions: The fusion protein strategy achieved an incremental cost-effectiveness ratio far below the 2024 China per capita gross domestic product threshold of CNY 95,749 per quality-adjusted life year. As first-line therapy for active rheumatoid arthritis, it is cost-effective relative to methotrexate in the Chinese setting. Full article

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13 pages, 916 KB

Open AccessArticle

The Prognostic Implications of the Geriatric Nutritional Risk Index in Patients with Prostate Cancer: A Single-Center Retrospective Cohort Study

by Rong Zhou, Yanqiong Zhou, Xiao Yue, Mei Wang, Yucong Zhang and Chang Liu

Healthcare 2025, 13(24), 3266; https://doi.org/10.3390/healthcare13243266 - 12 Dec 2025

Abstract

Background and Aims: Nutritional risk is a significant yet often overlooked factor influencing postoperative outcomes in older patients with prostate cancer. This study aimed to evaluate the impact of the Geriatric Nutritional Risk Index (GNRI) on postoperative complications in older patients undergoing radical [...] Read more.

Background and Aims: Nutritional risk is a significant yet often overlooked factor influencing postoperative outcomes in older patients with prostate cancer. This study aimed to evaluate the impact of the Geriatric Nutritional Risk Index (GNRI) on postoperative complications in older patients undergoing radical prostatectomy. Secondary objectives included examining the association between the GNRI and healthcare resource utilization, specifically the length of hospital stay and hospitalization costs. Methods: This retrospective cohort study included patients aged ≥ 65 years who underwent laparoscopic radical prostatectomy at a single tertiary center between 2022 and 2024. Patients were stratified into a malnutrition group (GNRI ≤ 98) and a normal nutrition group (GNRI > 98). Clinical outcomes were compared using chi-square and t tests. Binary logistic regression was performed to identify independent predictors of complications, hospital stay, and costs. Results: Of the 264 patients included, 34.8% were classified as being at nutritional risk. The malnutrition group had a significantly higher incidence of postoperative complications (OR = 2.859, p = 0.007), longer hospital stays (OR = 4.678, p < 0.001), and greater hospitalization costs (OR = 4.867, p < 0.001). Nutritional risk remained a significant predictor after adjusting for confounders. Conclusions: GNRI-defined nutritional risk is independently associated with increased postoperative complications and higher healthcare resource utilization in older prostate cancer patients. The GNRI may serve as a practical and accessible tool for perioperative risk stratification in this population. Full article

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12 pages, 663 KB

Open AccessArticle

The Effect of Chronic Graft-Versus-Host Disease and Its Therapy on Salivary Caries Risk Factors—An Exploratory Cross-Sectional Pilot Study

by Nina Vovk, Manca Urek, Ksenija Cankar and Lidija Nemeth

Healthcare 2025, 13(24), 3265; https://doi.org/10.3390/healthcare13243265 - 12 Dec 2025

Abstract

Background: The aim of this study was to investigate the effects of chronic graft-versus-host disease (cGVHD) and its treatment with cyclosporine and extracorporeal photopheresis (ECP) on salivary caries risk factors. Methods: In this exploratory single-centre cross-sectional pilot study, saliva samples from [...] Read more.

Background: The aim of this study was to investigate the effects of chronic graft-versus-host disease (cGVHD) and its treatment with cyclosporine and extracorporeal photopheresis (ECP) on salivary caries risk factors. Methods: In this exploratory single-centre cross-sectional pilot study, saliva samples from 22 cGVHD patients were analysed for flow rate, pH, buffering capacity, and counts of Streptococcus mutans and Lactobacillus. A detailed dental examination assessed plaque, carious lesions, and their progression. Caries risk was determined based on general health and diet questionnaires and clinical findings. Results: Patients receiving a combination of cyclosporine and ECP had significantly fewer carious teeth, affected tooth surfaces, and non-cavitated carious lesions compared with those treated with ECP alone (Bonferroni test, p = 0.004, p = 0.002, and p < 0.001, respectively). Patients treated with ECP had more carious teeth and affected surfaces than those who did not receive either ECP or cyclosporine (p = 0.008 and p = 0.002), whereas patients treated with cyclosporine only had more non-cavitated lesions than those receiving both cyclosporine and ECP (p < 0.001). A negative correlation was observed between cyclosporine dose and stimulated salivary flow (R = −0.672, p = 0.0486), and a positive correlation between cyclosporine dose and caries risk (R = 0.640, p = 0.0461). Conclusions: The disease and its treatment were associated with reduced salivary flow and increased caries risk. Patients’ oral health should be monitored regularly and managed with care to prevent further deterioration. Full article

(This article belongs to the Special Issue Novel Therapeutic and Diagnostic Strategies for Oral Diseases)

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21 pages, 780 KB

Open AccessArticle

Beyond Pain Relief: A Cross-Sectional Study on NSAID Prescribing, Polypharmacy, and Drug Interaction Risks in Community Pharmacies

by Javedh Shareef, Sathvik Belagodu Sridhar, Saeed Humaid Al Naqbi and Adyan Iftekhar Bakshi

Healthcare 2025, 13(24), 3264; https://doi.org/10.3390/healthcare13243264 - 12 Dec 2025

Abstract

Background/Objectives: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used globally to manage pain and inflammation. The rising prevalence of polypharmacy and potential drug–drug interactions (pDDIs) magnified by the prolonged and irrational use of NSAIDs may jeopardize patient medication safety. This study aims to [...] Read more.

Background/Objectives: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used globally to manage pain and inflammation. The rising prevalence of polypharmacy and potential drug–drug interactions (pDDIs) magnified by the prolonged and irrational use of NSAIDs may jeopardize patient medication safety. This study aims to analyze the pattern in prescribing NSAIDs and assess the extent of polypharmacy and pDDIs in community pharmacies located in Ras Al Khaimah. Methods: A quantitative cross-sectional study was conducted in randomly selected community pharmacies over six months (July 2024 to December 2024). Prescriptions pertaining to NSAIDs were assessed for prescribing patterns; incidence of polypharmacy and pDDIs were identified using Lexicomp’s drug interaction database. Chi-square tests assessed associations between treatment variables and polypharmacy, while logistic regression explored predictors of pDDIs. Results: In a total of 600 prescriptions, 1865 drugs were prescribed, including 908 NSAIDs. Celecoxib (28.2%) and ketoprofen (27.6%) remained the most predominant oral and topical NSAIDs prescribed. Aspirin and celecoxib were most commonly linked with pDDIs. A total of 357 pDDIs were identified, averaging 1.87 ± 1.39 per prescription. Most were of minor severity (60.22%), risk category C (43.97%), and fair reliability (59.38%). Gender, nationality, and comorbidities were significantly associated with polypharmacy (p < 0.001). Logistic regression showed nationality (p = 0.016), comorbidities (p < 0.001), and drug count (p = 0.007) as key predictors of pDDIs. Conclusions: Frequent NSAIDs prescribing, incidence of polypharmacy, and pDDIs underscore the attention for more cautious, evidence-based prescribing practice. Enforcing a robust regulatory framework, coupled with strengthening medication-use policies and pharmacist-led thorough medication history review and ongoing monitoring is paramount to improve patient safety and clinical outcomes. Full article

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

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25 pages, 362 KB

Open AccessArticle

Assisted Suicide and Suicide Prevention: Ethical Perspectives, Attitudes and Challenges for Nurses in Long-Term Care—A Qualitative Focus Group Study

by Karen Klotz, Pia Madeleine Haug, Thomas Heidenreich, Eva-Maria Stratmann, Erik Jacob and Annette Riedel

Healthcare 2025, 13(24), 3263; https://doi.org/10.3390/healthcare13243263 - 12 Dec 2025

Abstract

Background/Objectives: Assisted suicide and suicide prevention remain subjects of intense societal, political, and professional-ethical debate in Germany. Nurses working in residential and home-based long-term care (LTC) play a pivotal role in responding to requests for assisted suicide and in supporting suicide prevention. [...] Read more.

Background/Objectives: Assisted suicide and suicide prevention remain subjects of intense societal, political, and professional-ethical debate in Germany. Nurses working in residential and home-based long-term care (LTC) play a pivotal role in responding to requests for assisted suicide and in supporting suicide prevention. While international research has explored diverse ethical perspectives and challenges related to these issues, little is known about how LTC nurses in Germany experience and navigate them. This study examines German LTC nurses’ ethical perspectives on assisted suicide and suicide prevention and explores the associated ethical challenges. Methods: A qualitative design employing both in-person and online focus groups was used. Data were analyzed following Mayring’s qualitative content analysis. Results: Twelve focus groups with a total of 96 nurses working in residential and home-based LTC were conducted between February and September 2025. Findings show that nurses perceive assisted suicide and suicide prevention as ethically complex and emotionally demanding. Three overarching themes emerged: (1) Intuitive and Emotional Reactions, (2) Ethical Perception and Ethical Reflection, and (3) Ethical Challenges. Conclusions: This study offers new insights into the diverse ethical perspectives of German LTC nurses on assisted suicide and suicide prevention. It extends existing knowledge through its explicit focus on the ethical issues and implications involved, both in residential and home-based LTC. The ethical challenges identified may enhance understanding of the factors underlying the development of moral distress in Germany and other countries where assisted suicide is a legal option. To help nurses navigate these ethically demanding situations, strategies at multiple levels are required. These include continuous ethics education, an open ethical culture, role definitions and clear professional guidance, alongside societal support for equitable access to general healthcare and suicide prevention services. Full article

23 pages, 602 KB

Open AccessReview

Artificial Intelligence in Obesity Prevention

by Golbarg Shabani Jafarabadi and Luca Busetto

Healthcare 2025, 13(24), 3262; https://doi.org/10.3390/healthcare13243262 - 12 Dec 2025

Abstract

Background/Objectives: Obesity is a complex disorder that causes further health issues linked to several chronic diseases, such as cancer, diabetes, metabolic syndrome, and cardiovascular diseases; thus, it is critical to identify and diagnose obesity as soon as possible. Traditional methods, such as anthropometric [...] Read more.

Background/Objectives: Obesity is a complex disorder that causes further health issues linked to several chronic diseases, such as cancer, diabetes, metabolic syndrome, and cardiovascular diseases; thus, it is critical to identify and diagnose obesity as soon as possible. Traditional methods, such as anthropometric measures, were popular, although recent advances in artificial intelligence (AI) offer new opportunities for prediction models; as a result, AI has become an essential tool in obesity research. This study provides a comprehensive analysis of the research on the impact of AI on obesity prevention. Methods: In this study, the researchers performed a scoping study using AI to assess and predict obesity in PubMed, Scopus, Web of Science, and Google Scholar from February 2009 to July 2025. The researchers compiled and arranged the employed AI approaches to find connections, patterns, and trends that could guide further research and the application of machine learning algorithms for advanced data analytics. Results: Clinical professionals in obesity medicine may find chatbots valuable as a source of clinical and scientific knowledge, and for creating standard operating procedures, policies, and procedures. According to the findings, AI models can be used to identify clinically significant patterns of obesity or the connections between specific factors and weight outcomes. Moreover, the application of deep learning and machine learning approaches, such as logistic regression, decision trees, and artificial neural networks, appears to have yielded new insight into data, particularly in terms of obesity prediction. Conclusions: This work aims to contribute to a better understanding of obesity detection. While more studies are needed, AI offers solutions to modern challenges in obesity prediction. Full article

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10 pages, 209 KB

Open AccessArticle

Public Knowledge, Attitudes, and Preventive Practices Toward G6PD Deficiency in Al-Kharj, Saudi Arabia: A Community-Based Cross-Sectional Study

by Noura Al-Dayan

Healthcare 2025, 13(24), 3261; https://doi.org/10.3390/healthcare13243261 - 12 Dec 2025

Abstract

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the world’s most prevalent X-linked enzymopathy, yet public literacy regarding its inheritance, haemolytic triggers, and preventive actions remains inadequate in many high-risk populations. This study assessed public knowledge, attitudes, and preventive practices toward G6PD deficiency among adults [...] Read more.

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the world’s most prevalent X-linked enzymopathy, yet public literacy regarding its inheritance, haemolytic triggers, and preventive actions remains inadequate in many high-risk populations. This study assessed public knowledge, attitudes, and preventive practices toward G6PD deficiency among adults in Al-Kharj, Saudi Arabia, a region reporting haemoglobinopathy burden and a recent expansion of national newborn screening. Materials and Methods: A community-based cross-sectional survey was administered between May and September 2025 using a bilingual, self-administered questionnaire. A total of 1104 adults (≥18 years) were recruited through convenience and snowball sampling. Knowledge was scored using 13 dichotomous factual items, and findings are reported as proportions with corresponding 95% confidence intervals. Results: Participants were predominantly female (57%) and university-educated (34.2%). Although 58.5% had heard of “fava bean anaemia”, only 38% recognised the X-linked mode of inheritance and 36.1% identified medication-induced haemolysis, despite 61.8% correctly linking fava beans to haemolytic risk. The mean knowledge score across items was 34.4%. Preventive practices were limited: 41.5% reported premarital medical consultation, and only 21.6% had undergone genetic assessment. Conclusions: Despite national advances in newborn screening, substantial public knowledge deficits and low engagement with preventive practices persist. Strengthened community-level education, particularly regarding inheritance, medication safety, and proactive screening, may reduce preventable haemolysis events. Integrating G6PD-targeted messaging within premarital, antenatal, and primary-care services may support long-term preventive health objectives. Full article

24 pages, 991 KB

Open AccessSystematic Review

Barriers and Facilitators in Secondary Stroke Prevention Among Older Adults: An International Systematic Review of Randomized Controlled Trials

by Myrto Pyrrou, Anna Tsiakiri, Konstantinos Vadikolias and Hariklia Proios

Healthcare 2025, 13(24), 3260; https://doi.org/10.3390/healthcare13243260 - 12 Dec 2025

Abstract

Background/Objectives: Secondary stroke prevention is a cornerstone of long-term recovery and healthy aging among older adults, yet adherence to preventive strategies remains suboptimal. This global systematic review aimed to synthesize evidence from randomized controlled trials evaluating interventions that support sustained secondary prevention in [...] Read more.

Background/Objectives: Secondary stroke prevention is a cornerstone of long-term recovery and healthy aging among older adults, yet adherence to preventive strategies remains suboptimal. This global systematic review aimed to synthesize evidence from randomized controlled trials evaluating interventions that support sustained secondary prevention in older adults after stroke. Methods: A systematic search of PubMed and Scopus databases was conducted up to April 2025, following PRISMA 2020 guidelines and registered in PROSPERO (CRD420251177501). Eligible studies included randomized controlled trials targeting adults aged 60 years or older and assessing pharmacological, behavioral, educational, rehabilitative, or technology-assisted interventions for stroke recurrence prevention. Data were narratively synthesized due to study heterogeneity, and methodological quality was appraised using the Cochrane RoB 2 tool. Results: Seventeen randomized trials involving approximately 17,000 participants met the inclusion criteria. Multicomponent programs integrating medication management, behavioral education, exercise, cognitive rehabilitation, and digital support consistently improved adherence, vascular risk control, and quality of life. Pharmacological strategies alone showed limited or transient benefits, underscoring the importance of patient education and sustained follow-up. Common barriers included low motivation, cognitive decline, and technological challenges, while key facilitators were personalized education, multidisciplinary coordination, and culturally adapted implementation. Conclusions: Effective secondary stroke prevention in older adults depends on integrated, person-centered models that combine education, behavioral reinforcement, and technology-assisted monitoring. Structured, continuous educational programs, embedded within rehabilitation and primary care, emerge as the most promising pathway to improve adherence, reduce recurrence, and promote active, autonomous aging. Full article

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17 pages, 944 KB

Open AccessArticle

Dimensions of Hope as Mediators Between Negative Events and Recovery of Well-Being in Adults and Elderly

by Santo Di Nuovo, Caterina Ugolini, Rita Zarbo and Paola Magnano

Healthcare 2025, 13(24), 3259; https://doi.org/10.3390/healthcare13243259 - 12 Dec 2025

Abstract

Background/Objectives: Hope plays an important role in coping with difficulties and is predictive of resilience, improving the skills necessary to sustain life plans and well-being, and overcoming stressful situations in adulthood and especially in older age adults. We hypothesised that the dimensions of [...] Read more.

Background/Objectives: Hope plays an important role in coping with difficulties and is predictive of resilience, improving the skills necessary to sustain life plans and well-being, and overcoming stressful situations in adulthood and especially in older age adults. We hypothesised that the dimensions of hope, including spirituality, are connected to personal, educational, and contextual conditions, and play a mediating role in fostering resilience and well-being after stressful events; this mediating role might differ in adulthood and among the elderly. Methods: The sample consisted of 100 adults without severe pathologies and living in their own homes, aged between 50 and 86 years (M = 66.08; SD = 8.48). They completed an online survey that included the Stress Event scale, the Comprehensive State Hope Scale, the Resilience Scale for Adults, and the Well-being Profile. The data were analysed using SPSS and JAMOVI software, applying the following statistical tests: t-test, ANOVA and mediational model. Results: Stressful events influence resilience and well-being differently in adulthood and old age, with non-significant differences due to gender and living conditions. Hope mediates between stress resulting from negative life events and resilience and well-being, but this mediation involves different hope components for adults (trust) and older adults (self-realisation and perception of social support in interpersonal relationships). Spirituality is a non-significant mediator in both age stages. Conclusions: Appropriate psychological and psychosocial supports are needed to enhance the mediating potential of hope between stressful events and resilience. The results of our study help clarify which components of hope specifically promote resilience in different conditions of normal old age, differentiating them from those more beneficial for adults. Full article

(This article belongs to the Special Issue The Role of Psychological, Environmental, and Social Factors in the Promotion of Older Adults’ Health and Well-Being)

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14 pages, 982 KB

Open AccessArticle

Inadequate Gestational Weight Gain Among Saudi Mothers and Pregnancy Outcomes: Riyadh Mother and Baby Follow-Up Study (RAHMA Explore)

by Hayfaa Wahabi, Samia Esmaeil and Amel Fayed

Healthcare 2025, 13(24), 3258; https://doi.org/10.3390/healthcare13243258 - 12 Dec 2025

Abstract

Background: Gestational weight gain (GWG) is commonly used as an indicator of nutritional adequacy during pregnancy and a marker for pregnancy outcomes. This study aims to report the prevalence and extent of GWG inadequacy among Saudi women and to examine the effects of [...] Read more.

Background: Gestational weight gain (GWG) is commonly used as an indicator of nutritional adequacy during pregnancy and a marker for pregnancy outcomes. This study aims to report the prevalence and extent of GWG inadequacy among Saudi women and to examine the effects of GWG inadequacy on pregnancy outcomes. Methods: This study was conducted as part of the Riyadh Mother and Baby Multicenter Cohort Study; it included 6984 women with singleton pregnancies. Adverse pregnancy outcomes—including hypertension, gestational diabetes (GDM), cesarean section (CS), low birth weight (LBW), Neonatal Intensive Care Unit admission (NICU), and macrosomia—were compared between women with adequate and inadequate GWG, based on the Institute of Medicine (IOM) guidelines. Results: Of the participants, 2221 women (31.8%) had adequate GWG for prepregnancy BMI, 2959 (42.4%) had inadequate GWG, and 1804 (25.8%) had excessive GWG. Women with normal prepregnancy BMI and inadequate GWG had significantly increased odds of delivering LBW infants (adjusted odds ratio (AOR) = 1.61, 95% CI: 1.17–2.20). Inadequate GWG also decreased the odds of emergency cesarean delivery among women with obesity (AOR = 0.75, 95% CI: 0.56–0.97) and lowered the likelihood of NICU admission for infants of obese women (AOR = 0.59, 95% CI: 0.36–0.97). Women with prepregnancy obesity experienced the highest rate of adverse outcomes; however, the prevalence of all adverse outcomes decreased as the degree of weight gain inadequacy increased. Conversely, underweight women had the highest percentage of LBW, with this percentage increasing as weight gain inadequacy increased. Conclusions: The effects of inadequate GWG vary depending on maternal prepregnancy BMI and the specific outcome assessed. For women with obesity, reduced weight gain during pregnancy may be beneficial. In contrast, inadequate GWG is associated with a higher incidence of LBW in women with normal prepregnancy BMI and underweight women. Full article

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13 pages, 830 KB

Open AccessArticle

Comparison Between In-Office Versus Remote Follow-Up Costs in Patients with Pacemakers and Reimbursed Transportation in a Portuguese District Hospital

by João Oliveira, Sandra Oliveira, Vítor Martins, Cristina Reis, Patrícia Branco, Helena Pedrosa, Luís Casalta and Tânia Parreira

Healthcare 2025, 13(24), 3257; https://doi.org/10.3390/healthcare13243257 - 12 Dec 2025

Abstract

Background: Digital technologies can contribute to healthcare democratization in an ethical, safe, and sustainable context. The remote monitoring of implantable cardiac devices enables the follow-up of patients from a distance. Patients with anti-bradycardia pacemakers represent the largest group and have the least access [...] Read more.

Background: Digital technologies can contribute to healthcare democratization in an ethical, safe, and sustainable context. The remote monitoring of implantable cardiac devices enables the follow-up of patients from a distance. Patients with anti-bradycardia pacemakers represent the largest group and have the least access to this technology due to the controversial cost–benefit ratio and barriers to its widespread implementation, such as equipment costs and organizational challenges. In contrast, reimbursed transportation in Portugal reached approximately 82 million euros in 2024. Objectives: The aim of the present study was to assess the financial viability of remote pacemaker follow-up in a Portuguese district hospital, comparing the non-urgent transportation costs and the investment in remote monitoring equipment while measuring user acceptance and satisfaction. Methods: A total of 41 surveys were conducted with patients who received a pacemaker and used publicly reimbursed transportation. The projected costs were calculated for two simulated protocols: the first involved in-person visits every six months, while the second involved in-person visits every two years with remote consultations every six months, over the expected lifespan of the devices. EZR, version 1.61, was used. Results: Our data showed a 74% overall reduction in face-to-face visits. The implementation of remote follow-up would result in a cost saving of EUR 373/patient (21.2%), with total reimbursement (p = 0.01151). The savings increased to 33.3%, reaching EUR 764/patient (p = 0.0002742) for distances greater than 60 km (round trip) for ambulance users with total reimbursement. Acceptance and satisfaction achieved 88%. Conclusions: Remote monitoring of pacemakers can be a financially viable alternative with high acceptance and satisfaction. Full article

(This article belongs to the Topic Digital Patient Care: Bridging Technology and Clinical Practice)

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11 pages, 527 KB

Open AccessArticle

Prevalence and Impact of Contraceptive Misconceptions Among Married Women in Al-Ahsa, Saudi Arabia

by Rasha Ahmed Fouad, Ghadah Abdulaziz AlShaikh-Mubarak, Fai Fahad Alruwaished, Noura Yousef Alrasheed, Raghad Abdullah Alessad, Rawan Nabeel Alabdullah, Norah Adel Alali and Latifah Saleh Aljawf

Healthcare 2025, 13(24), 3256; https://doi.org/10.3390/healthcare13243256 - 12 Dec 2025

Abstract

Background: Family planning is essential for improving maternal and child health. However, misconceptions and cultural beliefs remain significant barriers to contraceptive use in many conservative societies. Purpose: This study aimed to assess the prevalence of contraceptive misconceptions and examine their impact on contraceptive [...] Read more.

Background: Family planning is essential for improving maternal and child health. However, misconceptions and cultural beliefs remain significant barriers to contraceptive use in many conservative societies. Purpose: This study aimed to assess the prevalence of contraceptive misconceptions and examine their impact on contraceptive use among married women in Al-Ahsa, Saudi Arabia. Methods: A cross-sectional study was conducted from January to April 2023, enrolling 379 married women aged 18–49 years from primary healthcare centers in Al-Ahsa. A structured, validated questionnaire was used to collect data on sociodemographic characteristics, contraceptive practices, and the prevalence of common misconceptions. Statistical tests were performed for data analysis using SPSS version 26. Results: Misconceptions were highly prevalent, with 94.7% believing contraceptives affect mood, 92.3% linking them to hormonal disorders, and 63.3% to impaired future pregnancies. Conclusions: The findings indicate that widespread misconceptions about contraceptives persist among married women in Al-Ahsa. These beliefs significantly limit the optimal use of family planning methods, despite relatively high educational attainment in the population. The study highlights an urgent need for targeted, culturally sensitive interventions to correct misinformation and improve women’s reproductive health outcomes. Full article

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10 pages, 233 KB

Open AccessArticle

Workplace Gaslighting: Implications for Employees’ Mental Health and Work Life in Greece

by Ioannis Moisoglou, Aglaia Katsiroumpa, Olympia Konstantakopoulou, Polyxeni Mangoulia, Maria Tsiachri, Aristotelis Koinis, Georgios Marios Kyriakatis and Petros Galanis

Healthcare 2025, 13(24), 3255; https://doi.org/10.3390/healthcare13243255 - 12 Dec 2025

Abstract

Background/Objectives: The present study seeks to address an important empirical gap by examining the associations of workplace gaslighting with symptoms of anxiety and depression, quiet quitting, and work engagement among a sample of Greek employees. Methods: An online cross-sectional study was [...] Read more.

Background/Objectives: The present study seeks to address an important empirical gap by examining the associations of workplace gaslighting with symptoms of anxiety and depression, quiet quitting, and work engagement among a sample of Greek employees. Methods: An online cross-sectional study was conducted in Greece in December 2024, with 291 employees, aged 18 years or older, who reported at least one year of work experience. The validated Greek versions of already published tools were used to measure workplace gaslighting (GWS), anxiety and depression (PHQ-4), quiet quitting (QQS) and work Engagement (UWES-3). Associations between gaslighting and mental health and occupational outcomes were tested using multivariable linear regression, adjusting for demographic and occupational covariates. Results: Higher workplace gaslighting scores were significantly predictive of anxiety (b = 0.565, p < 0.001) and depression (b = 0.571, p < 0.001). Gaslighting was also a significant predictor of both quiet quitting (b = 0.368, p < 0.001) and work engagement (b = −0.373, p < 0.001). Conclusions: These results highlight the negative consequences of gaslighting on the mental health and work engagement of employees. Employees should be encouraged to report instances of supervisory gaslighting, while senior leadership and organizational governance structures ought to implement and enforce a zero-tolerance policy toward such behaviors. Full article

(This article belongs to the Special Issue Employees’ Well-Being: Effective Measures to Cope with Job Stress and Workplace Bullying: Second Edition)

10 pages, 211 KB

Open AccessArticle

Urinary Incontinence and Its Relationship with Obstetric, Age, and Ethnic Factors: A Cross-Sectional Study

by Cristian Santiago Torres, Katherine Geovanna Esparza and Verónica Alexandra Celi

Healthcare 2025, 13(24), 3254; https://doi.org/10.3390/healthcare13243254 - 12 Dec 2025

Abstract

Background/Objectives: To relate types of Urinary Incontinence (UI) with obstetric, age, and ethnic factors of interest—a cross-sectional study Methods, in the northern provinces of Ecuador. Methods: A descriptive, cross-sectional study was conducted with a study population of 2039 women with urinary incontinence (UI), [...] Read more.

Background/Objectives: To relate types of Urinary Incontinence (UI) with obstetric, age, and ethnic factors of interest—a cross-sectional study Methods, in the northern provinces of Ecuador. Methods: A descriptive, cross-sectional study was conducted with a study population of 2039 women with urinary incontinence (UI), recruited between October and November 2022 across different areas of the provinces of Imbabura, Carchi, and Esmeraldas. Data were collected using a characterization questionnaire and the International Consultation on Incontinence Questionnaire–Short Form (ICIQ-IU-SF). The data were analyzed using descriptive and inferential statistics. To quantify the association between risk factors and urinary incontinence, p-values and Odds Ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: A significant association with higher risk was observed between stress urinary incontinence (SUI) and women with a history of cesarean section (13.1%; OR = 1.34; p = 0.021). Likewise, SUI was more frequent among nulliparous women (22.6%; OR = 66.2; p < 0.001), young adults (34.4%; OR = 4.45; p < 0.001), and those of Karanki ethnicity (7.5%; OR = 2.74; p < 0.001). In contrast, urge urinary incontinence (UUI) was associated with vaginal delivery (93.9%; OR = 1.41; p < 0.001), multiparity (75.5%; OR = 1.78; p < 0.001), older age (41%; OR = 2.50; p < 0.001), and Awá ethnicity (12.7%; OR = 1.41; p = 0.009). Finally, mixed urinary incontinence (MUI) showed strong associations with cesarean section (21.8%; OR = 2.09; p < 0.001), grand multiparity (41.3%; OR = 4.54; p < 0.001), advanced age (31.1%; OR = 188.1; p < 0.001), and white women (24%; OR = 2.30; p < 0.001). Conclusions: Urinary incontinence in women is statistically associated with obstetric, age-related, and ethnic risk factors. These findings contribute scientific evidence specific to the Ecuadorian population, supporting the development of prevention and health promotion programs, as well as early interventions aimed at reducing the impact on women’s quality of life, health, and the economic well-being of their families. Full article

(This article belongs to the Section Women’s and Children’s Health)

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