Healthcare doi: 10.3390/healthcare14081082

Authors: Aikaterini Vasiou Servet Altan Eleni Vasilaki Aristea Mavrogianni Georgios Vleioras Marinos Anastasakis Konstantinos Mastrothanasis

Background: Parental practices that support autonomy, provide structure, and foster warm relationships are associated with greater satisfaction of students’ basic psychological needs for autonomy, competence, and relatedness. In minority educational contexts, however, students’ psychological need satisfaction is also shaped by broader sociocultural conditions that may create additional pressures and sources of chronic stress. Within such environments, parental support may function as a protective factor that helps students cope with educational and cultural demands. Objective: The aim of this study was to explore how parental support contributes to the satisfaction of students’ basic psychological needs within a minority educational context where students from the Greek minority attend a bilingual school operating within a Turkish educational framework. Methods: A qualitative design was employed using three focus groups conducted in a minority school located in Gökçeada, Türkiye: one with parents (N = 5), one with lower secondary school students (N = 6), and one with upper secondary school students (N = 6). Interview questions were developed on the basis of Basic Psychological Needs Theory. Data were analyzed thematically by five members of the research team. Results: Findings indicated that parental support influenced students’ need satisfaction through practices related to autonomy (e.g., trust, space for mistakes), competence (e.g., encouragement, comparison), and relatedness (e.g., emotional presence, empathy). However, these practices were not experienced in a uniform way. Rather, their meaning and impact were shaped by contextual conditions associated with minority status, including bilingual educational demands, limited resources, and close-knit community dynamics. Conclusions: The study suggests that in minority school settings, parental support operates not simply as a general interpersonal resource but as a contextually mediated protective process. By showing how sociocultural and institutional conditions shape the enactment and experience of autonomy, competence, and relatedness, the findings extend existing BPNT research beyond majority settings and offer a more context-sensitive understanding of students’ psychological need satisfaction.

Healthcare doi: 10.3390/healthcare14081083

Authors: Se Young Kim Dong Hyun Lim Dae Ho Kim Ok Ran Jeong

Background/Objectives: Postoperative pulmonary complications (PPCs) following abdominal surgery are associated with prolonged hospitalization, delayed recovery, and increased mortality. Because nursing surveillance is essential for early detection and timely intervention, this study aimed to develop a holistic nursing surveillance decision support system integrating PPC risk prediction with structured nursing action recommendations. Methods: In this retrospective cohort study, electronic medical record (EMR) data from approximately 6900 adult patients who underwent abdominal surgery at a single institution between January 2015 and September 2023 were analyzed. The study protocol was approved by the Institutional Review Board, and the requirement for informed consent was waived because of the retrospective study design. PPC risk was predicted using a tabular multilayer perceptron (MLP) encoder with SHapley Additive exPlanations (SHAP)-based feature weighting and a random forest classification head optimized via Optuna. Class imbalance was addressed using weighted sampling, class weighting in BCE(Binary Cross Entropy) With Logits Loss, and decision-threshold optimization. For clinical decision support, a large language model generated structured nursing surveillance recommendations in an action–evidence–rationale JSON format and was aligned through supervised fine-tuning (SFT) using human-evaluated cases. Results: The prediction model achieved an AUROC of 0.810, with an accuracy of 0.811, precision of 0.547, and recall of 0.545. In expert evaluation, the SFT-aligned model improved recommendation quality, reducing incorrect nursing actions from 19.3% to 8.0%. Conclusions: The proposed system demonstrates the feasibility of an end-to-end nursing surveillance decision support framework linking PPC risk prediction with structured clinical recommendations. The findings suggest its potential to support more accurate risk prediction and more actionable nursing surveillance for patients undergoing abdominal surgery.

Healthcare doi: 10.3390/healthcare14081081

Authors: Aoba Kadono Naohiro Hohashi

Background/Objectives: Stress experienced by families of individuals with illnesses or disabilities is shaped through the interaction of multiple complex influencing factors. This study aimed to elucidate the factors influencing stress in families of young/adult children with illnesses or disabilities, using Family System Unit Stress Theory (FSUST) as the guiding theoretical framework. Methods: Semi-structured interviews were conducted with 10 families of young/adult children with illnesses or disabilities. Data were analyzed using qualitative content analysis following the approach of Graneheim and Lundman. In line with FSUST, the identified influencing factors were categorized into negative factors (risk/causal/promoting) and positive factors (preventive/inhibitory/suppressive). Results: A total of six categories and 18 subcategories were extracted for the risk/causal/promoting factors, including “accumulation of unshared burdens within the family leading to role overload” and “concerns about the future of the young/adult child.” For the preventive/inhibitory/suppressive factors, five categories and 13 subcategories were extracted, including “receiving a diagnosis of the young/adult child’s illness or disability” and “family maintaining a positive attitude.” Conclusions: Family stress in families of young/adult children with illnesses or disabilities varies through the interaction of multilayered influencing factors, including persistent emotions carried over from the past, difficulties faced in the present, and anticipatory concerns regarding the future. Therefore, nursing practice requires a life course-oriented understanding of family stress and an integrated approach that concurrently reduces risk/causal/promoting factors while enhancing preventive/inhibitory/suppressive factors.

Healthcare doi: 10.3390/healthcare14081080

Authors: Danica Vangsgaard Misa Noumi K. Alix Hayden Patricia K. Doyle-Baker

Background/Objectives: Masters athletes are adults aged ≥40 who compete in sport, exhibiting superior physical function and healthier aging than their sedentary peers. However, even highly trained masters athletes experience age-related performance declines. Women masters athletes represent a growing yet understudied population who may face unique physiological challenges. This scoping review synthesizes literature from 1984 to 2024, examining the impact of age and menopause on determinants of endurance performance in women masters athletes. Methods: Following JBI scoping review methodology, six databases were searched (Medline, Embase, Central, CINAHL, SPORTdiscus, Scopus). Studies were evaluated for population characteristics, methodological approaches, and physiological determinants of performance (i.e., aerobic capacity, lactate kinetics, and exercise economy). Results: Twenty-nine studies were included. Most (n = 28) assessed aerobic capacity, reporting declines between 0.36 and 0.84 mL·kg−1·min−1·year−1 (0.5–2.4%·year−1). These reductions were primarily associated with decreased cardiac output followed by changes in body composition. Training volume emerged as a predictor of aerobic capacity, but the effects of menopause were unclear. Findings on lactate kinetics and exercise economy were mixed but preliminary research indicated that lactate threshold relative to VO2max generally increased, peak lactate remained stable and energy cost increased with age. Fitness and health characteristics among women athletes differed from sedentary populations, emphasizing the need for athlete-specific data to support training and health decisions. Conclusions: Aging is associated with decreased aerobic capacity and variable changes in lactate kinetics and exercise economy. While training volume may attenuate performance decrements, the impact of menopause remains uncertain, underscoring the need for longitudinal research to better support this growing segment of the population.

Healthcare doi: 10.3390/healthcare14081079

Authors: Jiayi Zheng Tong Hu Shandan Xu Jing Xiao Change Xiong

Aim: The aim of this study was to explore the distribution and driving factors influencing the disparity of health professionals (HPs) at the Centers for Disease Control and Prevention (CDC) in China and to provide a reference for regional health planning and rational allocation of public health resources. Methods: The Gini coefficient was used to measure the equity of HP distribution at CDC sites at the provincial level during 2012–2023 in China. Moran’s I was used to analyze the spatial agglomeration effect, and the geographic detector model was used to explore the factors driving the allocation of HPs at CDC sites in different provinces. Results: The number of HPs at the CDC showed an increasing trend from 2012 to 2023 in China. The average Gini coefficients at the population and geographical areas were 0.16 and 0.58, respectively. The global Moran’s I statistic indicated a notable decline in spatial clustering for the population dimension, decreasing from 0.503 to 0.238; in contrast, spatial clustering for the geographical dimension remained relatively stable, ranging between 0.13 and 0.16. The local Moran’s I statistic revealed that provinces such as Qinghai in the western China consistently exhibited a “low–low” spatial clustering pattern. Six factors were found to explain the variability in the CDC HP distribution based on the 2020 data. In the context of factor interactions, the synergistic effects between education level and health expenditure share (q = 0.9781), and between population aging and per capita GDP (q = 0.9699), substantially exceed the explanatory power attributable to any single factor alone. Conclusions: A significant regional disparity was observed in the distribution of HPs among 31 provinces, with the distribution based on service area being less equitable than that based on population. The shortage of healthcare professionals in the western region is characterized by notably inadequate geographical distribution. Future policy initiatives should prioritize targeted spatial interventions and integrated, multi-factor collaborative strategies.

Healthcare doi: 10.3390/healthcare14081078

Authors: Gunther Alonso Huaytalla Sanchez Juan Marcelo Zanga Céspedes Zembe Alejandro Saito Roncal Jacksaint Saintila

Background: Adventist spirituality has been identified as a relevant psychosocial resource for emotional well-being; however, evidence on its relationship with self-control and perceived stress in specific religious populations remains limited. Objective: The aim of this study was to examine the associations between Adventist spirituality, self-control, and perceived stress in a sample of adults belonging to the Seventh-day Adventist Church and residing in coastal regions of Peru. Methods: A cross-sectional study was conducted between December 2025 and January 2026 with 506 Seventh-day Adventist adults who completed an online questionnaire. Adventist spirituality was assessed using the Mission Commitment Questionnaire, which captures religious–spiritual commitment through three dimensions: personal devotion, participation, and witnessing. Self-control and perceived stress were measured using standardized scales. Data were analyzed using partial least squares structural equation modeling. Results: The constructs showed adequate internal consistency, with Cronbach’s alpha values ranging from 0.875 to 0.951 and composite reliability values ranging from 0.906 to 0.956. Adventist spirituality was positively associated with self-control (β = 0.479, p < 0.001) and negatively associated with perceived stress (β = −0.457, p < 0.001). Personal devotion showed the strongest contribution to the higher-order spirituality construct. The model explained 22.9% of the variance in self-control and 20.9% of the variance in perceived stress. Conclusions: Adventist spirituality, particularly personal devotion, was associated with higher self-control and lower perceived stress. Although the cross-sectional design does not allow causal inference, the findings support the relevance of Adventist spirituality as a psychosocial resource linked to emotional well-being in this religious population and justify future longitudinal studies.

Healthcare doi: 10.3390/healthcare14081077

Authors: Fatmah Ahmed Alamoudi Mahmoud Abdel Hameed Shahin Maryam Abdullah Bayahya Shouq Mubarak Al Zuabi Rasha Essam Bakhurji Wadha Anbar Aldarbi Hanan Alfahd

Background/Objectives: Nurses and dialysis technicians are primarily responsible for cannulation in in-center and satellite dialysis units. Despite being a core component of hemodialysis care, existing clinical guidelines offer limited standardization, resulting in practice variability across facilities. Therefore, clinical expertise and adherence to consistent standards are essential to ensure safe and effective vascular access management. The study aimed to investigate the variables related to patients and nurses that contribute to unsuccessful vascular access cannulations, as well as the actions taken in response to cannulation failure, in a tertiary dialysis center in the Eastern Region of Saudi Arabia. Methods: This retrospective analytic study reviewed the records of 228 adult hemodialysis patients at King Fahad Military Medical Complex from 2020 to 2024, analyzing demographic, clinical, vascular access, and nursing variables associated with cannulation failure using descriptive statistics, the chi-square test, and t-tests. Ethical approval was obtained, and data were de-identified and manually extracted from nursing and dialysis documentation. Results: Most patients had hypertension and diabetes, with significant comorbidity burdens. Infiltration (61%) and clot formation (30.7%) were the primary complications of cannulation failure. Significant associations emerged with recurrent stroke and peripheral vascular disease, but not with nurse or patient demographics, suggesting vascular factors outweigh staff variables in cannulation risk. Cannulation failures were most common in patients with vascular comorbidities, while staff experience and education had no significant impact. Conclusions: Recommendations include implementing tailored protocols, providing ongoing nurse education, conducting systematic vascular assessments, and holding regular team reviews to enhance access outcomes and patient safety.

Healthcare doi: 10.3390/healthcare14081076

Authors: Al-Qerem Khdair Jarab Saleh Al-Rawashdeh Eberhardt Ashran Sawaftah Alasmari Hammad Alsultan

Objectives: We aimed to evaluate the reliability and validity of the Arabic version of the Chronic Heart Failure Health-Related Quality of Life Questionnaire (CHFQOLQ-20) among patients with heart failure in Jordan. Methods: A cross-sectional study was conducted among 399 adults with heart failure recruited from a tertiary hospital in Jordan (median age 68 years; 55.9% male). The CHFQOLQ-20 was translated using forward–backward procedures. Construct validity was examined using confirmatory factor analysis (CFA) and a multidimensional Partial Credit Model. Differential item functioning by sex and internal consistency were assessed. Results: CFA supported the original four-domain structure (physical, cognitive, mental, and general health), with all items showing significant factor loadings. Item-level analyses demonstrated acceptable model fit, ordered response thresholds, and minimal sex-related bias. Physical health scores were lower than other domains. Conclusions: The Arabic CHFQOLQ-20 is a valid, reliable, and multidimensional measure of HRQoL in patients with heart failure, supporting its use in clinical practice and research.

Healthcare doi: 10.3390/healthcare14081075

Authors: Ahmet Depreli Emre Adıgüzel Burcu Çavdar Fatma Coşkun

Background/Objectives: Children and adolescents exposed to criminal victimization are at increased risk for depression; however, the contribution of nutritional status to depressive symptom severity in this vulnerable population remains poorly understood. Therefore, we aimed to examine the associations between depression severity and nutritional parameters in child and adolescent victims of crime. Methods: This cross-sectional study included 72 children and adolescents (aged 10–16 years) referred to a forensic medicine department in Türkiye. Nutritional status was assessed using anthropometric measurements (body weight, body mass index [BMI], BMI-Z score, and body fat percentage), three-day dietary records, and the Mediterranean Diet Quality Index (KIDMED). Depression severity was evaluated using the Kutcher Adolescent Depression Scale (KADS). The associations were analyzed using Pearson’s rho correlation and forward stepwise linear regression. Potential confounding variables, including age, gender, socioeconomic status, and trauma-related characteristics, were recorded and considered during the analysis; however, due to the limited sample size and to avoid model overparameterization, they were not fully adjusted for in the final model. Results: Depression severity was positively correlated with the body weight, BMI, BMI-Z score, body fat percentage, and dietary energy, carbohydrate, protein, and fat intakes (all p < 0.05). In contrast, the vitamin C and dietary fiber intakes, breastfeeding duration, and KIDMED scores were negatively correlated with the KADS scores (p < 0.05). Regression analysis revealed that the lower KIDMED scores, higher body fat percentage, and greater body weight were significantly associated with depression severity, collectively explaining 82.2% of the variance in the KADS scores. Conclusions: Poor diet quality and adverse body composition are strongly associated with depression severity in child and adolescent victims of crime. These findings suggest that nutritional factors may be associated with depression severity in child and adolescent victims of crime; however, the results should be interpreted as preliminary and hypothesis-generating.

Healthcare doi: 10.3390/healthcare14081074

Authors: Tanjila Nawshin Navneet Kaur Baidwan Hui-Ju Young James Rimmer Tapan Mehta

Background/Objectives: To evaluate construct (convergent and divergent) validity and conduct confirmatory factor analysis (CFA) of the National Center on Health, Physical Activity and Disability (NCHPAD) Wellness Assessment (NWA) tool. Methods: A cross-sectional survey validation study utilizing secondary data. We assessed Spearman correlations between NWA and 36-Item Short Form Health Survey (SF-36), NWA and Godin Leisure-Time Exercise Questionnaire (GLTEQ) and NWA and Modified Fatigue Impact Scale (MFIS) scores to determine construct validity. A CFA was conducted to test the appropriateness of a three-factor model for NWA. Results: Data from 149 participants were used to assess construct validity and from 180 participants for CFA. Both correlations between NWA mental wellness domain and SF-36 mental component scores and between NWA emotional/spiritual wellness domain and SF-36 emotional well-being scores were 0.61 (p < 0.001 for both). The correlation between NWA physical wellness domain and SF-36 physical component score was −0.06 (p = 0.45). The correlations of NWA with GLTEQ overall and with health contribution scores were 0.26 and 0.30, respectively (p < 0.001 for both). The correlations of all NWA domain and MFIS subscale scores ranged between −0.42 and −0.25 (p < 0.05). The CFA model’s comparative fit index was 0.90. Conclusions: The NWA physical wellness domain did not demonstrate strong convergent validity, as mental and emotional/spiritual wellness domains did. All domains showed strong divergent validity, and CFA showed evidence supporting a three-factor model. Future efforts will emphasize refining and reevaluating the physical wellness domain until it achieves strong psychometric properties.

Healthcare doi: 10.3390/healthcare14081073

Authors: Vanessa A. Moore Austin Watkins Michael Ting Ben Seibert Justin Dvorak Katie Keyser Nirmal Choradia Ryan D. Nipp

Introduction: The costs associated with ambulance services are varied and poorly understood, which may contribute to financial burden and barriers to care for patients. Methods: We describe differences in ambulance service costs, comparing public versus private companies, by using the Centers for Medicare and Medicaid Services public use files. We determined the two largest public and two largest private ambulance companies in each state and calculated the average miles traveled per ambulance ride, number of trips by company, adjusted cost, and CPT code usage. We compared these variables between 2019 and 2021, across nine geographic divisions of the US. Results: In both 2019 and 2021, the average costs (adjusted for total service) of public companies were higher than the average costs of private companies. In both years, public companies had fewer average miles traveled compared to private companies. The distribution of CPT codes used was significantly different in public and private companies. The CPT code used most frequently by public companies was more expensive than the CPT code used most often by private companies. Conclusions: Differences in ambulance billing practices may contribute to financial uncertainty for patients. This study underscores the need for further investigation into the factors driving these disparities to inform policy decisions and improve cost transparency for patients.

Healthcare doi: 10.3390/healthcare14081072

Authors: Mu-Yeol Cho Je-Hyun Eom Ji-Won Kim Yun-Woo Kim Seung-Jo Yang Jiyoung Hwang Mi-Hwa No Hye-Sung Kim

Background/Objectives: Forest therapy has demonstrated stress-reducing and immune-enhancing effects, yet its simultaneous impact on cognitive function, stress biomarkers, and oral microbiota in older adults remains unexplored. This study aimed to evaluate the effects of an 8-week community-based village forest experience program on cognitive function, salivary cortisol, and oral pathogenic bacteria in community-dwelling older adults. Methods: A total of 125 older adults (mean age 82.2 ± 5.3 years; 87.2% female) from 17 senior centers participated in a single-arm, pre–post intervention study. Cognitive function was assessed using the Cognitive Impairment Screening Test (CIST), salivary cortisol was measured by ELISA, and seven oral bacterial species were quantified by qPCR. Results: CIST scores improved significantly (p = 0.003, d = 0.27), with the suspected cognitive impairment subgroup showing greater improvement (d = 0.66) and 48.8% transitioning to normal classification. Salivary cortisol decreased significantly (p = 0.002), and total bacterial load, Porphyromonas gingivalis, and Tannerella forsythia were significantly reduced. The 80–84-year age group showed the greatest cognitive gain, whereas participants aged 85 and older showed no significant change. Conclusions: An accessible village forest program may simultaneously benefit cognitive function, stress, and oral health in older adults with early-stage cognitive decline. Controlled studies are needed to confirm causality and elucidate the underlying mechanisms.

Healthcare doi: 10.3390/healthcare14081069

Authors: Alice Yip Wai Ping Cecilia Li Tsang Jeff Yip Chi Kong Calvin Yip Man Ho Tim Li Zoe Tsui Ka Man Rachel Yip Ka Wing Gavin Lee Shuk Yu Maria Hung

Background/Objectives: Globally, rheumatoid arthritis (RA) patients struggle to meet the expectation of being active in their daily lives. The burden on these individuals is twofold, including physical limitations and emotional stress, which make looking after themselves a major challenge. Supporting self-management requires more than just offering strategies; it requires fitness. Whether we are proposing new daily habits or creative outlets like ceramic workshops, it is essential to tap into the patient’s perspective to understand exactly what kind of support will resonate with them. This study explored how ceramic workshops can help people with RA to build resilience and improve their well-being. Methods: Using a phenomenological study design, we interviewed 16 patients with RA in Hong Kong who engaged in ceramic workshops. These participants were selected through purposive sampling, and their insights were gathered via semi-structured interviews. We applied Colaizzi’s seven-step method to analyze the findings. Results: Four key themes emerged: (i) embodied manageability; (ii) clear comprehension of body limits; (iii) the meaningfulness of creating art; and (iv) supporting resilience. Conclusions: This study reveals that effective self-management support should prioritize patient-driven needs, particularly peer interaction and high-demand creative pursuits such as ceramic workshops.

Healthcare doi: 10.3390/healthcare14081071

Authors: Jing Xu Na Li Yu Jian Xin Yang Xianwen Li

Background/Objectives: This study aimed to explore the association between internet use and executive function among older adults and the mediating role of social participation and loneliness in internet use and executive function. Methods: A cross-sectional study was conducted among 439 community-dwelling older adults (≥60 years) in Nanjing, China, from September to December 2022. Participants were selected using simple random sampling and assessed with four standardized instruments: the Internet Use Questionnaire, the Social Participation Capacity Assessment, the six-item UCLA Loneliness Scale (ULS-6), and the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A). Data were analyzed with the SPSS 21.0 software for descriptive statistics and correlation analysis and the AMOS 23.0 software for structural equation modeling to test the chain mediation effects. Model fit was evaluated using Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), Tucker–Lewis Index (TLI), and Weighted Root Mean Square (WRMR), with bootstrap resampling for indirect effect estimation. Results: The results showed that internet use was positively correlated with loneliness (r = 0.203, p < 0.01), social participation impairment (r = 0.193, p < 0.01), and executive function (r = 0.420, p < 0.01). Structural equation modeling showed that greater internet use was significantly associated with poorer executive function (β = 0.306, p < 0.01). These associations were partially explained by pathways involving social participation and loneliness through three indirect pathways: internet use via social participation (indirect effect = 0.087, 18.3% of the total effect); internet use via loneliness (indirect effect = 0.049, 10.3%); and internet use via social participation and then loneliness in sequence (indirect effect = 0.035, 7.1%). Conclusions: In community-dwelling older adults, more frequent internet use was associated with greater executive function impairment through mechanisms involving reduced social participation and increased loneliness. Therefore, there is a need to limit excessive internet use while promoting social participation and reducing isolation, which can have the greatest benefits for executive functioning in older adults.

Healthcare doi: 10.3390/healthcare14081070

Authors: Georgios S. Chatzopoulos Larry F. Wolff

Background/Objectives: The aim of this study was to analyze and quantify the independent effects of tooth mobility and furcation involvement on the probability of tooth loss in a large patient cohort, after controlling for patient-level confounding factors. Methods: This retrospective cohort study utilized data from 16,756 patients. Primary predictors were tooth mobility and furcation involvement. The primary outcome was tooth loss. A multivariable logistic regression model, adjusting for confounders (age, gender, smoking, diabetes), was developed to calculate Odds Ratios (OR) and 95% confidence intervals (CI). Results: A significant dose–response relationship was observed between the severity of both mobility and furcation involvement and the rate of tooth loss (p < 0.001). After multivariable adjustment, both remained statistically significant predictors (p < 0.001). Compared to no mobility, the odds of tooth loss for Class 3 mobility were 3.99 times higher (OR = 3.99; 95% CI: 3.58–4.45). Compared to no furcation involvement, the odds for Grade 3 involvement were 2.50 times higher (OR = 2.50; 95% CI: 2.19–2.85). Diabetes, smoking, male gender, and increasing age were also significant risk factors. Conclusions: Tooth mobility and furcation involvement are independent predictors of future tooth loss. These findings highlight the critical importance of thoroughly assessing mobility and furcation defects for patient risk assessment, prognosis, and treatment planning.

Healthcare doi: 10.3390/healthcare14081068

Authors: Pai-Yueh Chen Ying-Hua Chao Yao-Ching Huang Shi-Hao Huang Ren-Jei Chung Pi-Ching Yu Bing-Long Wang Hsiu-Ju Chang Pi-Chen Chang Shu-Min Huang Chao-Hsi Huang

Background: Family caregivers remain closely involved in communication, care planning, and shared decision-making in long-term care (LTC) facilities. In this context, the quality of the relationship between family caregivers and professional staff may influence trust, collaboration, and satisfaction with care. However, few instruments have been specifically adapted to assess caregiver–staff relationship quality in Taiwanese LTC settings. Objectives: This study aimed to culturally adapt and preliminarily validate the Family Caregiver Relationship Quality (FCRQ) Scale for use in Taiwanese LTC facilities. Methods: A cross-sectional psychometric validation study was conducted with 205 primary family caregivers recruited from 20 LTC facilities in Taiwan. The original Relationship Quality Scale was adapted to the LTC context through contextual revision, expert review, bilingual verification, and pilot testing. Psychometric evaluation included confirmatory factor analysis, internal consistency assessment, convergent validity, and structural equation modelling with Bollen–Stine bootstrap correction to address potential non-normality. Results: The initial 16-item model required refinement, and three items with low standardized factor loadings were removed. The revised 13-item model met the prespecified fit criteria and showed acceptable internal consistency and convergent validity. The retained items reflected three conceptually related domains of relationship quality: trust, commitment, and satisfaction. Overall, the findings provided preliminary psychometric support for the adapted scale in Taiwanese LTC settings. Conclusions: The adapted FCRQ Scale may be a useful tool for assessing caregiver–staff relationship quality in Taiwanese long-term care facilities, particularly in the context of shared decision-making and family-centred care. Nevertheless, the findings should be interpreted as preliminary, and further validation in larger and more diverse samples is needed before broader clinical or research application.

Healthcare doi: 10.3390/healthcare14081067

Authors: Hongfei Zhang Wenjun Hu Qing Zhang Man Jiang Jakub Kortas

Virtual reality (VR) has been increasingly adopted as a digital tool in rehabilitation for balance training, coordination improvement, and motor recovery, yet the literature remains dispersed across clinical rehabilitation, exercise-based interventions, and broader motor-related applications. This fragmentation makes it difficult to determine how the field has evolved and where research emphasis has shifted. This study mapped the research landscape and thematic evolution of VR for balance, coordination, and motor rehabilitation using bibliometric analysis and topic modeling. A total of 1258 articles indexed in the Web of Science Core Collection from 2011 to 2025 were analyzed. Only English language articles and reviews relevant to VR-based balance, coordination, or motor rehabilitation research were included, yielding a final dataset of 1258 publications. CiteSpace and VOSviewer were used to examine keyword co-occurrence, clustering patterns, and temporal trends, while Latent Dirichlet Allocation (LDA) was applied to identify latent themes and their temporal dynamics. The field has moved beyond early feasibility testing toward a more differentiated landscape shaped by distinct clinical targets, population groups, and training purposes. Seven recurring themes were identified, including vestibular rehabilitation and immersive training, post-stroke upper-limb rehabilitation, efficacy and adverse-effect assessment, balance and gait training interventions, evidence synthesis and review-based evaluation, elderly exercise and cognitive interventions, and skill-oriented virtual task training with recent expansion toward broader population groups and task-specific applications beyond traditional rehabilitation settings. VR research on balance, coordination, and motor rehabilitation has evolved into a more thematically differentiated field rather than remaining a single rehabilitation-oriented domain. By combining bibliometric mapping with topic modeling, this study clarifies where evidence is concentrated and which thematic directions are gaining visibility, providing a clearer basis for future evidence synthesis and more comparable intervention reporting.

Healthcare doi: 10.3390/healthcare14081066

Authors: Marijus Leketas Inesa Stonkutė Miglė Miškinytė Dominykas Afanasjevas

Background: Magnetic resonance imaging (MRI) is the reference standard for evaluating temporomandibular joint (TMJ) disorders, particularly for assessing disc position, joint effusion, and degenerative changes. With increasing imaging demands and advances in deep learning, artificial intelligence (AI) has emerged as a potential adjunct to expert interpretation. This systematic review aimed to compare the diagnostic performance of AI-based models with that of human experts in TMJ MRI analysis. Methods: This review was conducted in accordance with the PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420251174127). A systematic search of PubMed/MEDLINE, ScienceDirect, Wiley Online Library, and Springer Nature Link was performed for studies published between 2020 and 2026. Eligible studies included human participants undergoing TMJ MRI and evaluated AI, machine learning, or deep learning models against human expert interpretation. Extracted outcomes included sensitivity, specificity, accuracy, area under the receiver operating characteristic curve (AUC), and agreement metrics. Risk of bias was assessed using QUADAS-2. Due to substantial heterogeneity, a narrative synthesis was conducted. Results: Five retrospective diagnostic accuracy studies were included, comprising sample sizes ranging from 118 to 1474 patients. Target conditions included anterior disc displacement, joint effusion, osteoarthritis, and disc perforation. AI models demonstrated strong discriminative performance, with reported AUC values ranging from 0.79 to 0.98. In direct comparisons, AI achieved diagnostic accuracy comparable to experienced radiologists. AI systems frequently demonstrated higher specificity and similar overall accuracy, whereas human experts often showed higher sensitivity. In osteoarthritis assessment, AI performance approached expert level and exceeded that of less experienced readers. All studies were retrospective and predominantly single-center, with heterogeneous reference standards and limited external validation. Conclusions: AI achieves diagnostic performance comparable to experienced clinicians in TMJ MRI interpretation and shows promise as a decision-support tool. Nevertheless, it should be regarded as complementary to, rather than a replacement for, expert radiological assessment pending further rigorous validation.

Healthcare doi: 10.3390/healthcare14081064

Authors: Joseph P. Anlacan Veeda Michelle M. Anlacan Harold Joshua D. de Guzman Beatrice M. Anlacan Roland Dominic G. Jamora

Background: In the Philippines, studies have shown that availability and access to healthcare varies widely. Although the shortage of psychiatrists in the country has been recognized for many years, no published study to date has described their distribution across the regions. This study aimed to describe the distribution of psychiatrists in the country using publicly available data on the Internet. Methods: This was a cross-sectional study, analyzing publicly available data from the Philippine Psychiatric Association (PPA) web directory, the Philippine Health Insurance Corporation (PhilHealth) web database of accredited psychiatrists, and the Philippine Statistics Authority. Information on location of practice, sex, PPA membership, PhilHealth accreditation, regional gross domestic product (GDP), and regional population were collated. Results: Information on 409 psychiatrists was available online, with 68% being female and 53% holding PhilHealth accreditation. There were a total of 417 declared locations of practice, with six psychiatrists practicing in more than one location. The National Capital Region accounted for 53.5% of the declared practice locations, while no psychiatrist declared practicing in the Bangsamoro region. Conclusions: This study highlights the maldistribution of psychiatrists across the Philippines. Policies to incentivize and encourage practice in low-access regions and investment in technology, such as telemedicine, may help reduce the access gap.

Healthcare doi: 10.3390/healthcare14081065

Authors: Negin Mirzaei Damabi Patience Castleton Bridgit McAteer Zohra S. Lassi

Background: Sexual health research with migrant and refugee communities presents unique challenges, shaped by cultural sensitivities, stigma, and the under-representation of these populations in health research. However, lived experiences insights are essential for the development of appropriate and useful research and health initiatives. It is important to learn from researchers’ experiences to expand the representation of migrant and refugee community voices. Method: This paper draws on two qualitative studies conducted in South Australia: one exploring the sexual and reproductive health perspectives of refugee and migrant women, and the other of men. We reflect upon the methodological and ethical considerations in conducting research in this sensitive field and provide recommendations for future researchers and healthcare providers when working with migrant and refugee communities. Results: Both studies encountered difficulties in relation to participant recruitment, cross-cultural communication, and addressing taboos surrounding sexual health. At the same time, they highlighted opportunities for generating meaningful insights through culturally safe, gender-sensitive approaches and collaboration with community stakeholders. Conclusions: By synthesising experiences from both projects, we identify practical strategies for building trust, overcoming linguistic and cultural barriers, and creating supportive environments for discussing sensitive topics. These reflections offer guidance for researchers and clinicians aiming to advance culturally responsive sexual health research and strengthen healthcare provision for migrant and refugee populations.

Healthcare doi: 10.3390/healthcare14081063

Authors: Pedro Ramalho António Nunes Fernanda M. Silva André Ramalho Gonçalo Flores Diogo Monteiro Pedro Duarte-Mendes

Background/Objectives: Radiologic technologists are frequently exposed to occupational stressors that heighten the risk of burnout, compromising well-being and job performance. Workplace exercise programs have been identified as promising strategies to enhance physical and mental health across occupational groups; however, robust experimental evidence among radiologic technologists remains limited. This study aimed to evaluate the effects of a structured workplace exercise program on perceived stress, burnout, and quality of life among radiologic technologists. Methods: A small-scale randomized controlled experimental study was conducted with 19 radiologic technologists from the Local Health Unit of Castelo Branco, Portugal. Participants were randomly assigned to an experimental group (n = 10, age mean = 43.8 ± 9.92 years old) or a control group (n = 9, age mean = 48.2 ± 7.86 years old). The intervention consisted of a six-week workplace exercise program conducted during work hours, comprising sessions three times per week, twice per day. Each session lasted approximately 15–20 min and included balance, stretching, and light resistance exercises. Outcomes were assessed pre- and post-intervention using the Perceived Stress Scale, the Copenhagen Burnout Inventory, and the WHOQOL-BREF. Results: The experimental group showed significant reductions in perceived stress (p = 0.013, d = −0.697 (−1.6–0.206) [moderate]) and in personal (p = 0.004, d = −0.834 (−1.748–0.08) [moderate]) and work-related burnout (p = 0.026, d = −0.756 (−1.664–0.151) [moderate]), as well as improvements in the physical (p = 0.046, d = 0.592 (−0.303–1.488) [small]) and environmental (p = 0.032, d = 0.991 (0.062–1.92) [moderate]) domains of quality of life. No significant changes occurred in the control group. Conclusions: These preliminary findings suggest that a brief, low-cost workplace exercise program may reduce stress and burnout and improve quality of life among radiologic technologists. These findings support the integration of structured physical activity into healthcare work settings as a feasible, preventive, and health-promoting strategy.

Healthcare doi: 10.3390/healthcare14081062

Authors: Seohyeon Cho Keon Woo Yoonsoo Choy

Background: In the context of global population aging, nutritional risk has emerged as an important factor associated with both physical and mental health among older adults. This study aimed to examine the associations between nutritional risk, depression, and cognitive function in older adults and to explore potential variations across residential area, educational attainment, employment status, frailty status, and activities of daily living (ADL). Methods: Data were obtained from 9955 community-dwelling older adults aged 65 years and older who participated in the 2023 National Survey of Older Koreans. Nutritional risk was assessed using the DETERMINE checklist (21-point scale), a multidimensional screening tool reflecting dietary, functional, and social risk factors. Depression was measured using the Short-form Geriatric Depression Scale (15-point scale), and cognitive function was assessed using the Korean version of the Mini-Mental State Examination-2 (K-MMSE-2; 30-point scale). Hierarchical multiple linear regression, correlation, subgroup, and sensitivity analyses were conducted, adjusting for sociodemographic characteristics, health behaviors, and geriatric factors. Results: Correlation analyses showed significant associations between nutritional risk and cognitive function (r = −0.191, p < 0.05), nutritional risk and depression (r = 0.440, p < 0.05), and depression and cognitive function (r = −0.259, p < 0.05). Higher nutritional risk scores were significantly associated with greater depressive symptoms (B = 0.314, p < 0.001) and lower cognitive function (B = −0.051, p < 0.05). While some subgroup differences were observed, not all interaction effects reached statistical significance, and these findings should be interpreted with caution. Conclusions: These findings suggest that nutritional risk is associated with depressive symptoms and cognitive function in older adults. Given that the DETERMINE checklist reflects multidimensional vulnerability, the results should be interpreted as indicating broader risk contexts rather than direct nutritional status alone. These findings highlight the importance of integrated, multidimensional approaches to support older adults at nutritional risk in community settings.

Healthcare doi: 10.3390/healthcare14081061

Authors: Neil G. Barr Glen E. Randall

Background/Objectives: The use of personal smartphones by healthcare professionals in clinical settings has become a growing area of concern as practice may not consistently align with policy guidance. This study enhances our understanding of how and why medical residents are using smartphones to communicate patient healthcare information with other physicians in daily practice and provides insights into the role that institutional governance, policies, and structures play in the use of smartphones. Methods: This study used qualitative techniques to examine medical residents’ use of smartphones to communicate healthcare-related information with colleagues. Additionally, a neo-institutional theory lens was applied to assess the role that regulative (guidelines/policies), normative (what peers/staff are doing), and cultural-cognitive (beliefs/perceptions) factors play in smartphone use by medical residents. Results: The results suggest that behaviour related to smartphone use is based primarily on normative and cultural-cognitive factors rather than regulative factors. Regulative elements around smartphone use play a smaller role in shaping behaviour, particularly when they: (1) lack clarity; (2) are not seen as credible/legitimate; or (3) are viewed as cumbersome and do not align with workflow needs. Conclusions: The implementation of future guidelines/policies should consider the use of mentorships throughout postgraduate medical training whereby staff physicians educate, model, and promote behaviour in accordance with the associated policies/guidelines.

Healthcare doi: 10.3390/healthcare14081060

Authors: Mika Miyaoka Kosuke Muraoka Shuji Awano Wataru Fujii

Background/Objectives: Japan, the world’s first super-aged society, has confronted rapid population aging and increasing healthcare demands earlier than any other country. In this context, dysphagia rehabilitation has become a critical issue affecting quality of life and survival. With nearly 30% of the population aged ≥65 years, Japan has developed a distinctive dysphagia rehabilitation model characterized by interprofessional collaboration and dental involvement. This narrative review describes its historical evolution and structural characteristics. Methods: This narrative review employed a structured literature search of PubMed and Ichushi-Web, supplemented by manual searches of policy documents and professional guidelines. Publications from 1980 to January 2026 were included if they addressed dysphagia rehabilitation systems or dental involvement in Japan. Both English- and Japanese-language sources were analyzed using thematic synthesis. Results: Japan’s dysphagia rehabilitation model evolved alongside population aging and is embedded within the universal health insurance and long-term care insurance systems. A prominent characteristic is the sustained involvement of dental professionals, who contributed to the foundational development of the field and remain actively involved across care settings, particularly within community- and home-based care. The system is further supported by certification frameworks, a triadic model integrating rehabilitation, nutrition, and oral health, and institutionalized interprofessional education. Conclusions: Previous studies have examined specific aspects of dysphagia care in Japan, but few have examined the overall structure of the system. This review maps the fundamental structure of Japan’s dysphagia rehabilitation model within its historical and policy context, offering insights relevant to dysphagia care in other aging societies.

Healthcare doi: 10.3390/healthcare14081059

Authors: Christine Kirby Julie A. Baldwin Kristan Elwell Michelle Anne Parsons

Background: The literature shows inconclusive results from utilizing motivational interviewing (MI) in indigenous populations to address early childhood caries (ECC). Great Beginnings for Healthy Native Smiles (GBHNS) (NIDCR U01DE028508), a community focused oral health (OH) intervention, was utilized alongside adapted MI techniques to promote OH care and education at home. Methods: The intervention was conducted by local Community Health Representatives (CHRs) from the two partnered indigenous communities. Reflecting on the years-long MI training and CHRs’ concerns, GBHNS conducted post-intervention semi-structured interviews with all MI staff regarding their experiences with MI. This paper uses participant observation, semi-structured interviewing, and inductive and deductive qualitative coding and analysis. Results: Thematic analysis was used to explore lessons learned and future research recommendations for interventions considering the use of MI. Generally considered a person-centered approach, MI reinforces Western psychological frameworks and practices which may disrupt local communicative practices and values. Conclusions: Specifically, interdisciplinary pre-intervention community assessments are recommended to ensure acceptability, relevance and appropriateness through attention to local communicative practices.

Healthcare doi: 10.3390/healthcare14081058

Authors: Bernadett Szilágyi János Sándor Zoltán Ónodi-Szűcs Karolina Kósa

Background: Hungary operated a public health-focused primary care model programme with expanded preventive and community-based services between 2013 and 2017 in four disadvantaged regions. This study aimed at assessing the association of this programme in one region with the patterns of emergency ambulance care before (2012) the programme and 3 years later when all services were available (2016). Methods: Patients in the selected region who received emergency ambulance care in the hospital catchment area were included. De-identified demographic data, reason for emergency service, on-site and hospital diagnosis, and treatment outcomes were entered into an electronic database from paper-based records. Diagnoses were assigned separate codes at GBD 1 and 3 levels. Results: The proportion of patients in emergency ambulance care showed a significant, 0.85% increase (p = 0.013) from 2012 to 2016. The proportion of female/male patients was roughly equal, but males needed emergency ambulance care significantly, 7 years younger than females in both years. Among patients with GPs in the model programme, 3.41% fewer needed emergency ambulance care due to non-communicable diseases, and 1.98% fewer were referred to other institutions from the hospital A&ED compared to those whose GPs did not participate (p < 0.001 for all). Conclusions: Utilisation of emergency ambulance services rose in the region in line with global trends suggesting that expanding primary care services alone may not be sufficient to reduce demand for emergency ambulance services. Further research is warranted to identify individual and systemic factors with major influence on emergency care use, including patient-level differences in the use of acute and preventive primary care services, and the availability of primary care after work hours.

Healthcare doi: 10.3390/healthcare14081057

Authors: Massimo Guasconi Federico Dibennardo Chiara Cosentino Giovanna Artioli Angela Andriollo Sara Pressi Michela Rocchi Sarah Santona Galli Giulia Valente Antonio Bonacaro

Background: Healthcare professionals are exposed to high emotional demands, including repeated contact with suffering, death, moral distress, and organizational pressure. These factors are associated with psychological distress, burnout, and secondary traumatic stress. Expressive Writing (EW) has been proposed as a psychological intervention, but evidence of its effectiveness among healthcare professionals remains heterogeneous. Objectives: To examine the effects of EW on psychological health, psychophysical well-being, and professional satisfaction among healthcare professionals. Methods: A systematic review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA 2020 guidelines. Searches were performed in PubMed, CINAHL, CENRAL, CENTRAL Scopus, Embase, and PsycINFO from database inception to January 2025. Quantitative studies involving healthcare professionals and evaluating structured expressive writing interventions were considered for inclusion, including randomized and non-randomized, controlled and uncontrolled designs. Studies reporting psychological, psychophysical, or work-related outcomes were eligible. Only full-text articles published in English or Italian were considered. The review protocol was registered and archived in the Open Science Framework. Methodological quality was assessed using CASP checklists, the RoB 2 tool, and the Newcastle–Ottawa Scale. Results: Seven studies published between 2017 and 2023 were included. EW interventions were associated with reductions in psychological distress, particularly perceived stress, depressive symptoms, and post-traumatic stress symptoms. Findings regarding burnout and compassion fatigue were mixed. Organizational and job-related outcomes, such as job satisfaction and organizational commitment, showed limited and heterogeneous improvements. No consistent effects were observed for resilience or social support. Overall, the methodological quality of the included studies was generally good. Conclusions: EW appears to be a promising, low-cost intervention for reducing psychological distress among healthcare professionals. However, heterogeneity in study designs, intervention protocols, and outcome measures limits the strength of the evidence. Further high-quality, controlled studies using standardized EW protocols are needed.

Healthcare doi: 10.3390/healthcare14081056

Authors: Marian Rybář Gleb Donin Vojtěch Kamenský Martina Holá

Background: Stroke remains a significant health and economic challenge both globally and in the Czech Republic. Although a structured network of specialized stroke centres exists, comparative data on patient outcomes and healthcare costs across hospital types are still lacking in the Czech context. This study analyzed real-world administrative data to assess 90-day mortality and healthcare costs after ischemic stroke, categorized by intervention and provider type. Methods: Claims data from six Czech health insurance companies, covering approximately 44% of the population, were used for the years 2017–2020. Patients aged 18 and older with a primary diagnosis of ischemic stroke (ICD-10 code I63) were included. Interventions were categorized as thrombectomy, thrombolysis, or other treatment, and providers were classified as comprehensive stroke centres (CSCs), primary stroke centres (PSCs), secondary referral hospitals (SRHs), or others. Costs were calculated from the payer perspective using administrative claims data, and standardized 90-day mortality and effective cost per survivor (ECPS) were computed. Funnel plots were used to evaluate provider variability in outcomes and costs. The analysis included 23,568 patients (47% female; mean age 70.6). Results: Thrombectomy was associated with the highest mean costs (€13,385), the highest 90-day mortality (29.3%), and the highest ECPS (€18,880). Patients receiving other treatments had the lowest costs (€2725) and lower mortality (14.4%). CSCs recorded the highest average costs (€5087) and mortality (16.7%), while SRHs had the lowest costs (€2204) and mortality (13.7%). Funnel plots revealed greater variability in costs, mainly driven by primary hospitalization, while mortality rates showed less variation. Conclusions: These findings suggest that while stroke outcomes are relatively consistent across providers, costs differ, possibly reflecting efficiency differences and case-mix severity. The study is limited by the lack of clinical severity data, highlighting the need to link administrative data with clinical registries for more comprehensive future evaluations.

Healthcare doi: 10.3390/healthcare14081055

Authors: Eleni N. Sertaridou Emmanouela Tsouvala Vasilios E. Papaioannou Christina Alexopoulou

Background: The care and management of a pregnant woman suffering from end-stage brain cancer is surrounded by medical, legal, and ethical controversies. When this brain pathology leads to brain death (BD), continuation of life-sustaining treatments has been considered futile and unethical. An exception could be the case of pregnancy, in order to deliver a healthy neonate. Aim: The presentation of a pregnant woman with a terminal stage brain astrocytoma, admitted in the intensive care unit (ICU) to support the pregnancy, until optimal fetal viability, after she had neurological deterioration and confirmed BD, and a brief literature review of previously relevant published cases. Case Presentation: A 36-year-old woman with a medical history of brain astrocytoma in the last 2 years was admitted in ICU for the first time due to status epilepticus, six months after she stopped anticonvulsant therapy. Her epilepsy was controlled, and a pregnancy of 14 weeks was confirmed. Two weeks later, she deteriorated. After a multidisciplinary approach, it was decided to mechanically ventilate the patient and support the pregnancy. Brain death was determined after a couple of days. Results: A cesarean section was performed 11 weeks after BD diagnosis (at 27 weeks of gestational age) resulting in the delivery of a live, premature infant, weighing 549 gr. Conclusions: Maternal corporeal support can maximize the chances for survival in the neonate by prolonging the pregnancy of a brain-dead woman.

Healthcare doi: 10.3390/healthcare14081054

Authors: Mira Naguib Abdelrazek Heba Mahmoud Mahmoud Mohamed Ahmed Hashem El-Monshed Omima Mohamed Ibrahim Morsy Mahmoud Abdelwahab Khedr Wafa Hamad Almegewly Shadaid Alanezi Laila Saad Mahmoud

Background: Preoperative anxiety is a common and clinically significant response among surgical patients, with prevalence estimates ranging from 30% to over 80% depending on measurement method and surgical context. Early maladaptive schemas (EMSs)—deeply rooted, negative cognitive patterns formed in early life—have been theorized to amplify anxiety vulnerability. This study aimed to examine whether EMSs independently predict preoperative anxiety in a surgical population and to explore the role of demographic factors. Methods: A descriptive cross-sectional correlational study was conducted with 310 patients scheduled for elective surgery. Data were collected using a sociodemographic questionnaire, the Amsterdam Preoperative Anxiety and Information Scale (APAIS), and the Young Schema Questionnaire-Short Form, Second Edition (YSQ-S2). Internal consistency of both instruments was computed for this sample. Analyses included Pearson’s correlations and multiple regression. Results: Participants reported preoperative anxiety scores near the clinically meaningful threshold (M = 11.06, SD = 3.80). Small but statistically significant negative bivariate correlations were observed between APAIS scores and several EMS subscales (rs = −0.12 to −0.17). However, in multiple regression analysis, none of the EMS subscales was an independent predictor of preoperative anxiety (all ps > 0.18). Gender was the only significant independent predictor, with females reporting higher anxiety than males (B = 1.27, p = 0.012). The overall model explained 5.6% of variance (R2 = 0.06). Conclusion: This study did not support the hypothesis that EMSs independently predict preoperative anxiety, representing a null result with respect to EMS prediction. The primary finding was a significant gender difference, with females reporting higher preoperative anxiety. Clinicians should prioritize gender-sensitive preoperative screening. Future research should explore potential moderating factors and use prospective, multicenter designs.

Healthcare doi: 10.3390/healthcare14081053

Authors: Yahia Aldhamri Waleed M. Alshehri Sara M. Alahmari Amirah S. Alharbi Abdullah M. Alanazi Layla A. Alqahtani Samya Alshehri Salman Aloufi Raeed Alanazi Ali Kerari

Background: Mental health problems are highly prevalent among university students in Saudi Arabia; however, help-seeking behaviors remain low despite the availability of mental health services. There is limited evidence regarding students’ intentions to seek help and preferred sources of support, especially formal or informal sources. This study examined help-seeking intentions for mental health problems among university students. Methods: This cross-sectional descriptive study was conducted using an online self-administered questionnaire. Participants were 248 undergraduate students from various Riyadh universities. Help-seeking intentions were assessed using the General Help-Seeking Questionnaire. SPSS software was used to perform independent t-tests to assess differences in preferred sources across demographic groups, and Pearson’s correlation analyses were conducted to examine relationships between preferred sources and demographic variables. Multiple linear regression analyses were conducted to examine demographic and academic predictors of intentions to seek help from formal and informal sources. Results: Students demonstrated a low overall propensity to seek help. Online sources were the most preferred help-seeking option, followed by mothers, friends, and general physicians, whereas faculty, relatives, and religious persons were the least preferred. Preferred help-seeking sources differed by gender. Seeking help from mental health specialists was positively correlated with age and grade point average. Additionally, the regression analysis for formal help-seeking was significant, explaining 8.4% of the variance, with gender as the only significant predictor. Conclusions: These findings suggest the need for targeted interventions to improve students’ help-seeking behaviors. Universities should prioritize mental health literacy initiatives, stigma reduction strategies, and accessible support pathways, particularly by integrating digital and hybrid services and enhancing the role of faculty and institutional support systems in promoting timely and appropriate help-seeking.

Healthcare doi: 10.3390/healthcare14081051

Authors: Jin-Hee Na Hyo-Eun Park Seok-Hwan Kim

Background: The incidence and mortality rates of cancer among females aged 65 years or older in the Republic of Korea are increasing; however, the national cancer screening rate (50.4%) remains low. Therefore, this study aimed to identify predictors of participation in the National Cancer Screening Program (NCSP) among women aged 65 years or older using data from the 8th Korea National Health and Nutrition Examination Survey (KNHANES VIII, 2019–2021). Methods: This cross-sectional study utilized data from the 8th Korea National Health and Nutrition Examination Survey (KNHANES VIII, 2019–2021). Study variables were selected based on Andersen’s healthcare utilization model. Participation in the National Cancer Screening Program (NCSP) was defined as the dependent variable, and independent variables included predisposing, enabling, and need factors. Descriptive analyses were conducted to examine participants’ characteristics. Chi-square tests were used to assess differences in NCSP participation according to participant characteristics. Multivariable logistic regression analysis was conducted to identify factors associated with participation, with all independent variables simultaneously included in the model to adjust for potential confounding. A p-value of <0.05 was considered statistically significant. Results: A total of 2105 women aged 65 years or older were included in the analysis. Of the 2105 women aged 65 years or older, 1429 (67.9%) reported participation in cancer screening within the past two years. NCSP participation was significantly associated with being married (OR = 1.540; 95% CI: 1.263–1.879), being a middle school (OR = 1.357; 95% CI: 1.022–1.801) or college graduate or higher (OR = 2.012; 95% CI: 1.199–3.378), having private insurance (OR = 1.930; 95% CI: 1.573–2.368), average subjective health (OR = 1.332; 95% CI: 1.004–1.766), dyslipidemia (OR = 1.347; 95% CI: 1.110–1.636), and physical activity participation (OR = 1.252; 95% CI: 1.029–1.524). In contrast, urban residence, income level, being employed, medical coverage type, hypertension, diabetes, monthly drinking status and current smoking status were not statistically significantly correlated with NCSP participation. Conclusions: These findings highlight the need for tailored outreach strategies and health education programs targeting women aged 65 years and older to enhance participation in the NCSP and ultimately improve public health outcomes.

Healthcare doi: 10.3390/healthcare14081052

Authors: Sieun Park Seung Kyum Kim

Background/Objectives: Down syndrome (DS), the most common chromosomal disorder, is associated with obesity and related metabolic complications. Although physical activity (PA) improves health outcomes in individuals with DS, global research trends in this field have not been systematically synthesized, and evidence regarding the effects of aerobic training (AT) on obesity-related parameters in individuals with DS remains inconsistent. This study incorporated a dual bibliometric and meta-analytical approach. Methods: First, the bibliometric analysis included 321 original research articles published between 2001 and 2024, retrieved from Scopus, Web of Science, and PubMed. Second, a meta-analysis of 15 randomized controlled trials (n = 477) was conducted to examine the effects of AT on obesity-related parameters, including body weight (BW), body mass index (BMI), fat mass (FM), waist circumference (WC), and waist-to-hip ratio (WHR) in individuals with DS. Results: Keyword co-occurrence and collaboration network analyses revealed a notable increase in research output since 2018, with “adolescent,” “obesity,” and “intellectual disability” the most co-occurring keywords associated with DS and PA. “Obesity” emerged as the most prominently growing keyword associated with DS and PA. A meta-analysis concluded that AT reduced FM (standardized mean differences [SMD] = −0.44; p < 0.001) and WC (SMD = −0.39; p < 0.01), while subtle changes in BW, BMI, and WHR were found. These findings suggest that AT improves body composition, particularly reducing central adiposity, even without changes in traditional weight-based metrics. Conclusions: Our findings demonstrate that AT can be an effective non-pharmacological strategy for improving body composition in individuals with DS and obesity and highlight the urgent need to shift clinical and research paradigms toward multidimensional, individualized health strategies that support PA and healthy body composition throughout the lifespan.

Healthcare doi: 10.3390/healthcare14081050

Authors: Neylan Kaya Aslıhan Ersoy Bozcuk Güler Ferhan Ünal Uyar Eylül Türkay Mehtap Türkay

Background/Objectives: The comparative evaluation of health system performance is becoming increasingly critical for policy makers in the context of rising health expenditures, demographic ageing, and the deepening of health inequalities between countries. In the existing literature, a substantial proportion of studies addressing health performance either examine causal relationships based on single health outcomes or rely on a single multi criteria decision making (MCDM) method based on equal or subjective weighting. This situation may lead to limitations in terms of method sensitivity and the reliability of the resulting rankings. This study addresses an important gap in the literature by directly tackling method sensitivity through the integrated use of objective weighting and multiple ranking methods. The aim of this study is to evaluate the health system performance of OECD countries within an integrated MCDM framework based on objective weighting. Methods: The analysis covers 27 OECD countries and is based on key indicators representing health performance, such as life expectancy, avoidable mortality, infant mortality rate, and maternal mortality rate. Criterion weights are determined objectively using the CRITIC method, and country performance rankings are obtained using the MAIRCA and MARCOS methods. Results: The findings indicate that there are substantial differences in health system performance among OECD countries. The high level of consistency between the results obtained from different ranking methods supports the methodological robustness of the findings. Conclusions: In this respect, the study contributes to the literature on health system performance evaluation at both methodological and applied levels and provides policy makers with a more reliable framework for comparative analysis.

Healthcare doi: 10.3390/healthcare14081049

Authors: Ali M. Bahathig Ayedh H. Alghamdi Mohammed A. Aljaffer Mohammed A. Alblowi Metib S. Alotaibi Deena N. AlNouwaiser Asma’a M. Alshehri Abdullah M. Alhejji Wejdan S. Alruwaili Ghassan A. Abuseif Ahmad H. Almadani

Background: Depression and anxiety are prevalent mental health disorders that substantially impact quality of life. The association of incretin mimetics, including glucagon-like peptide-1 (GLP-1) receptor agonists, with symptoms of depression and anxiety remain underexplored in Saudi Arabia. This study was conducted to assess the association between GLP-1 receptor agonist use and symptoms of depression and anxiety and to identify related factors. Methods: A cross-sectional study using convenience sampling was conducted among adults (≥18 years) treated with GLP-1 receptor agonists at King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia. Data were collected using a questionnaire developed by the research team, in addition to the Arabic versions of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7). Results: A total of 235 participants were included, of whom 48.5% used GLP-1 receptor agonists for both glycemic control and weight loss. Only 31.9% had undergone psychiatric evaluation prior to initiating therapy, and 14.9% had a diagnosed psychiatric disorder. The mean anxiety score (GAD-7) was 4.82 ± 5, and the mean depression score (PHQ-9) was 6.13 ± 4.95. Multivariable analysis showed that higher odds of more severe depression were associated with using diabetes medications for weight loss in addition to diabetes treatment, a history of psychiatric disorders, and holding a bachelor’s degree. Exercising for 101–150 min per week was associated with lower odds of depression. Regarding anxiety, participants who exercised 101–150 min per week had significantly lower odds of anxiety compared with those who did not exercise, while a history of psychiatric disorders was associated with higher odds of more severe anxiety. Conclusions: This study’s findings highlight the importance of integrating both routine psychiatric screening and follow-up into diabetes and obesity management to enhance both psychological well-being and metabolic outcomes. They also reflect the benefit of physical activity for mental health, emphasizing the need to encourage exercise among individuals with diabetes or obesity.

Healthcare doi: 10.3390/healthcare14081048

Authors: Adrijana Svenšek Lucija Gosak Tamara Trajbarič Luka Šajher Gregor Štiglic Mateja Lorber

Background/Objectives: Digital health interventions are increasingly used to support person-centered care (PCC) in chronic disease management, yet it remains unclear which PCC components are most consistently enabled by digital tools and how these relate to outcomes. This study synthesized evidence on digitally supported PCC for adults with chronic conditions, examining how interventions operationalize PCC and which clinical, patient-reported, and implementation outcomes are reported. Methods: A structured literature synthesis was conducted according to PRISMA guidelines across a heterogeneous evidence base, including randomized and pragmatic trials, observational studies, qualitative studies, and systematic reviews. The review protocol was pre-registered in the Open Science Framework (OSF) Registries. Results: Across 16 included studies, digital solutions most consistently supported PCC through enhanced situational awareness via self-monitoring, strengthened partnership through two-way communication and coaching, and reinforced shared documentation through co-created health plans. Benefits were reported most consistently for process and experience outcomes, such as perceived access to support, engagement, and empowerment. Evidence for sustained long-term clinical improvements, such as glycemic control, was mixed and frequently limited by short follow-up periods and variation in intervention integration. Conclusions: Digitalization can strengthen PCC when embedded within relational care models and organizational workflows that translate patient-generated data into meaningful action. Future work should utilize clearer PCC operationalization, longer follow-up, and routine reporting of equity outcomes, alongside targeted training for healthcare professionals delivering PCC in digital encounters.

Healthcare doi: 10.3390/healthcare14081047

Authors: Evdoxia Tsigkaropoulou Fragiskos Gonidakis Ioannis Michopoulos

Anorexia nervosa is a clinically complex and ethically challenging psychiatric disorder. Clinicians are frequently confronted with ethical dilemmas arising from conflicts between core ethical principles in everyday clinical practice. Professional codes of ethics and legal frameworks often fail to provide a stable basis for resolving these dilemmas due to the fluctuating medical risk and the ego-syntonic nature of anorexia nervosa. Under conditions of heightened responsibility and medical risk, clinicians’ cognitive and emotional responses may be activated and may mediate ethical decision-making. Although such internal processes have been described in the literature, limited attention has been paid to their role in shaping ethical judgment in routine clinical care. The aim of this article is to conceptualize the decision-making processes that unfold in response to ethical dilemmas in the clinical context of anorexia nervosa and propose a sequential multi-level framework. A focused conceptual literature review was conducted to develop a reflective framework for clinical practice, drawing on selected studies in clinical ethics, healthcare law, anorexia nervosa care, and cognitive theory. Clinicians’ internal cognitive and emotional processes play a significant role in ethical decision-making in complex clinical contexts such as anorexia nervosa and should be explicitly recognized and brought into reflective awareness through supervision and reflective practice. Ethical decision-making is therefore conceptualized as a dynamic process linking clinical events, clinicians’ internal responses, ethical and legal considerations, and reflective clinical judgment. Incorporating structured reflection into clinical, educational, and supervisory settings may support more ethically informed and context-sensitive clinical judgment within multidisciplinary eating disorder services.

Healthcare doi: 10.3390/healthcare14081046

Authors: Azzah S. Alharbi

Objectives: Given the limitations of body mass index (BMI) as a metric and the lack of data on the relationship between various anthropometric indices of obesity and immune fitness (IF), this study aimed at exploring the possible association between various anthropometric indicators and the immune fitness among an adult sample of the Saudi population residing in Makkah. Methods: A structured self-reported questionnaire, with questions covering age, sex, anthropometric and immune fitness assessment data, was distributed online to a convenience sample of target population. The Immune Status Questionnaire (ISQ) was utilized to assess respondents’ IF over the past 12 months, while perceived momentary immune fitness (PMIF) was measured using a single-item scale. A total of 1135 responses were included in the study. Results: Overall, 530 male (46.7%) and 605 female (53.3%) respondents were included in the analysis. Of these, 478 (42.1%) had a normal BMI, and 343 (30.2%) were classified as overweight, 184 (16.2%) as obese, and 130 (11.5%) as underweight. Participants with reduced ISQ score (<6) were more likely to be underweight (p < 0.001), have a high weight-adjusted waist index (WWI) (p = 0.035), and exhibit an increased conicity index (C index) (p = 0.037) compared to those with an ISQ score ≥ 6. After controlling for age and sex, weight (p = 0.003), height (p < 0.001), and WWI (p = 0.01) were found to have significant correlations with past-year IF, while only height (p = 0.004) showed a significant positive correlation with PMIF. A multiple linear regression analysis revealed that sex and height and waist circumference (WC) were significant predictors of IF. Specifically, males and those who were taller had higher IF scores. Whereas individuals with high-risk WC values reported lower IF scores than those with low-risk WC. Conclusions: Sex (male) and anthropometric measures (lower WC, and taller height) were the most informative predictors of higher IF scores. The findings highlight the association between anthropometric measures and IF. A deeper understanding of these associations can inform the development of targeted interventions aimed at improving IF and overall health outcomes.

Healthcare doi: 10.3390/healthcare14081045

Authors: Kulweena Sisayanarane Suchira Chaiviboontham Piyawan Pokpalagon Nutsiri Kittitirapong Chutirat Sonpee

Background: Chronic venous insufficiency (CVI) is characterized by venous dysfunction in the lower extremities, leading to increased venous pressure, edema, and reduced quality of life. Objectives: This study aimed to evaluate the additional effect of a structured home-based calf muscle strengthening exercise program when combined with standard compression therapy, by comparing disease severity, musculoskeletal function, and quality of life over time between patients receiving compression therapy alone and those receiving combined intervention. Methods: A randomized controlled trial was conducted in 50 patients with CVI (CEAP C3–C5), who were assigned to an experimental group (n = 25) and a control group (n = 25). Outcomes were assessed at baseline, week 6, and week 12. Disease severity was measured using the Revised Venous Clinical Severity Score (rVCSS), and swelling, muscle, and joint function were assessed using calf muscle strength and ankle range of motion. Quality of life outcomes were assessed using the chronic venous disease quality of life questionnaire (CIVIQ-20). Data were analyzed using two-way repeated measures ANOVA. This trial was registered retrospectively at the Thai Clinical Trials Registry (registration number: TCTR20260307002). Results: Significant group × time interaction effects were observed for disease severity (right leg: F = 81.562, p < 0.001, η2p = 0.630; left leg: F = 73.765, p < 0.001, η2p = 0.606), indicating greater improvement in the experimental group over time. Calf muscle strength significantly increased in the experimental group (right leg: F = 395.246, p < 0.001, η2p = 0.892; left leg: F = 87.278, p < 0.001, η2p = 0.645). Ankle range of motion also improved significantly (p < 0.001). Quality of life showed significant improvement with a group × time interaction effect (F = 66.104, p < 0.001, η2p = 0.579). Conclusions: A structured home-based calf muscle strengthening exercise program combined with compression therapy produced significant improvements in disease severity, musculoskeletal function, and quality of life over time, demonstrating an additive therapeutic effect in patients with CVI.

Healthcare doi: 10.3390/healthcare14081044

Authors: Marija Burceva Vineta Viktorija Vinogradova Elmars Rancans

Background/Objectives: Previous research has shown that mental disorders are common in the general population in Latvia, while access to specialised psychiatric services is limited, particularly in rural areas. General practitioners, therefore, have a crucial role in the early detection and management of these conditions. Previous studies and national initiatives have highlighted an unmet need for continuing education in psychiatry tailored to the Latvian primary care context. In response, the first Latvian telementoring programme, the “ECHO School of Psychiatry” (Extension for Community Healthcare Outcomes, ECHO), was launched in 2023 to enhance general practitioners’ competencies and decision-making in mental healthcare. This study explored general practitioners’ experiences and perceptions of participation in the programme and its perceived impact on their practice, using a qualitative approach. Methods: Thirteen women general practitioners who had participated in the programme between October 2023 and February 2025 were recruited using voluntary response sampling, via email invitations from programme coordinators. Individual semi-structured interviews were conducted remotely between May and September 2025, audio-recorded, transcribed verbatim, and the resulting transcripts were analysed thematically using an inductive approach, supported by NVivo software. Data collection continued until no new themes emerged. Results: Four main themes emerged from the thematic analysis: (1) participants’ perceptions of the structure and educational value of the programme; (2) perceived impact of the programme on clinical practice and decision-making; (3) programme limitations in addressing professional isolation and fostering collaboration; (4) suggestions for programme improvement. Themes illustrate participants’ perceptions of the programme’s value, its impact on practice, and recommendations for further development. Conclusions: This study provides insights into the strengths and areas for improvement of the “ECHO School of Psychiatry” as perceived by general practitioners. It also acknowledges current challenges in primary care, such as limited access to specialists and professional isolation.

Healthcare doi: 10.3390/healthcare14081043

Authors: Almudena Castaño Reguillo Raquel Sánchez Ruano Jaime Barrio Cortés Elena Polentinos-Castro ESAPD Espronceda Collaborative Group ESAPD Espronceda Collaborative Group

Background: Dying in the preferred place is considered an indicator of the quality of end-of-life care. Advance care planning and home palliative care may increase the likelihood of dying at home, but it remains unclear whether the documentation of these preferences in clinical records is associated with the actual place of death. This study assessed whether the recording of patients’ preferred place of care or death was associated with the actual place of death among patients followed by home palliative care teams. Methods: We conducted a retrospective observational study with an exploratory approach that included adult patients who died in 2022 and were followed by a home palliative care team in Madrid, Spain. Data were extracted from electronic health records and analysed using bivariate tests and multivariable logistic regression. Results: A total of 464 patients were included (53% women; mean age 80.8 years). Overall, 82.5% of the patients died at home. Preferences were recorded for 64% of the patients; 97.6% preferred to die at home, and 89% died there. Documentation of preferences was not significantly associated with the place of death. Conclusions: Documentation alone was not independently associated with the place of death. These findings should be interpreted cautiously given the observational and exploratory design of the study and the limited explanatory power of the regression model. Notably, most patients expressed a preference to die at home, and most deaths also occurred at home. Recording preferences may still support advance care planning and patient-centred decision-making, but documentation should not be interpreted as sufficient in itself to influence place of death.

Healthcare doi: 10.3390/healthcare14081042

Authors: Adolfo Romero-Arana Nerea Romero-Sibajas Juan Gómez-Salgado María Isabel Ruiz-Moreno Víctor Manuel Cotta-Luque Lucía Rojas-Suárez Luis El Khoury-Moreno Julio Torrejón-Martínez Adolfo Romero-Ruiz

Background: In Spain, the number of patients anticoagulated with vitamin K antagonists (VKAs) is high. Among them, poor adherence is common, which may be justified by a low level of knowledge, and could affect their quality of life. We analyzed treatment adherence, health-related quality of life, and knowledge level about treatment, and evaluated the possible influence of these factors on patients’ time in the therapeutic range while also studying potential differences between patients under routine monitoring or self-monitoring. Methodology: A cross-sectional descriptive study was conducted using three validated and cross-culturally adapted questionnaires to study therapeutic adherence, health-related quality of life, and knowledge level about VKA treatment in a sample of anticoagulated patients. Additionally, it was assessed whether they were self-monitoring or not; the Rosendaal Time in Therapeutic Range (TTRr) was also administered for each patient at the time of recruitment. Descriptive analysis of all variables was performed, and a logistic regression model was constructed to evaluate the possible interaction of variables. Results: Ninety-eight patients participated and were selected sequentially from those attending the oral anticoagulation clinic at Hospital Universitario Virgen de la Victoria in Malaga. Of these, 39 were men and 59 were women. The mean age of these participants was 60.62 years (SD 11.67). Sixty-six were under conventional monitoring and thirty-two followed the self-monitoring program. The DecaMIRT had a mean score of 39.22 (SD 8.57), the SF-12 mean score was 31.73 (SD 6.21), and the knowledge questionnaire’s was 14.2 (SD 2.6). The mean TTRr value was 63.88 (SD 22.99). Self-monitored patients showed better results in DECAMirt and knowledge. Discussion: Overall, patients included in the sample presented satisfactory values in these three questionnaires, which seems to indicate that this was a treatment-compliant group with a correct quality of life, and adequately informed about their treatment. Conclusions: The work of nurses responsible for these aspects appears crucial in achieving these results. We aim to extend this study by focusing on groups with poorer results to design specific activities that allow for improvement in care and, as much as possible, homogenize outcomes. For this purpose, we intend to use all available tools, including those derived from the use of health-oriented artificial intelligence.

Healthcare doi: 10.3390/healthcare14081041

Authors: Muhammet Fatih Şahin Ali Erol

Background/Objectives: In-hospital critical outcome among palliative inpatients remains high, often driven by acute physiological instability rather than chronic comorbidities. Although diabetes mellitus (DM) is common in this population, its independent impact on critical outcome is unclear. This study aimed to determine whether acute metabolic and inflammatory markers—specifically glucose, C-reactive protein (CRP), albumin, and oxygen requirement—better predict short-term outcomes, defined as in-hospital critical outcome or ICU transfer during the same hospitalization period, than DM status alone. Methods: This retrospective study included 200 palliative inpatients admitted to the Internal Medicine Clinic of Kestel State Hospital, Bursa, Turkey, between January 2024 and January 2025. Demographic, clinical, and laboratory data were obtained from electronic records. The primary outcome was in-hospital critical outcome or ICU transfer (“critical outcome”). Logistic regression and receiver-operating characteristic (ROC) analyses identified independent predictors. The study was approved by the Bursa Yüksek İhtisas Training and Research Hospital Ethics Committee (ethics approval: protocol code 2024-TBEK 2025/05-12). Results: The mean age was 77.7 ± 12.3 years, and 47% were male. DM was present in 30.5% but did not independently predict critical outcome (p = 0.904). In contrast, oxygen requirement (OR = 4.08, p = 0.002), mean glucose (OR = 1.01, p = 0.001), and cancer (OR = 3.28, p = 0.016) were significant predictors. ROC analysis identified CRP > 64.1 mg/L and albumin < 25 g/L as optimal thresholds, and these two markers formed the basis of the low-, intermediate-, and high-risk stratification, with critical-outcome rates of 39.0%, 45.1%, and 85.4% (p < 0.001). Conclusions: Acute metabolic and inflammatory disturbances—particularly hyperglycemia, elevated CRP, hypoalbuminemia, and oxygen requirement—are stronger prognostic indicators than DM. A simple bedside model incorporating these parameters may improve prognostic accuracy and communication in palliative care.

Healthcare doi: 10.3390/healthcare14081040

Authors: Deepa Fernandes Prabhu Varadraj Gurupur Alexa Stone Elizabeth Trader

Error in Table [...]

Healthcare doi: 10.3390/healthcare14081039

Authors: Evanthia Asimakopoulou Kyriakos Alexandrou Maria Foka Anna Vavlitou Petroula M. Mavrikiou

Background: Delirium is a frequent and serious complication in intensive care units (ICUs), associated with increased mortality, prolonged mechanical ventilation, extended length of stay, and long-term cognitive impairment. This study aimed to assess ICU nurses’ knowledge and practices regarding delirium management in Cyprus and to identify predictors of knowledge. Methods: A cross-sectional study was conducted among nurses working in adult ICUs in Cyprus. Data were collected using a structured self-administered questionnaire that included demographic characteristics, sedation and analgesia practices, and an adapted Delirium Knowledge Questionnaire incorporating ICU-specific items. Results: A total of 70 ICU nurses participated, most of whom were female (60%) with a mean ICU experience of 5.1 years. Only 27.1% reported daily delirium screening, although 65.2% perceived delirium as frequent. Sedation protocols were reported by 34.3%, sedation scales were used by 44.3%, and daily sedation interruption by 61.4%. Only 15.7% had received formal delirium training, while 87.1% expressed the need for further education. Knowledge scores were moderate to high (68.5–84.0%), with higher scores among nurses with prior training and female nurses (p = 0.003). Hospital type was associated with sedation practices, with greater use of sedation scales in public ICUs (p < 0.001) and propofol more commonly used as first-line sedation compared with midazolam in private ICUs (p = 0.018). Conclusions: Although ICU nurses demonstrated moderate knowledge of delirium, systematic screening and protocolized management remain suboptimal. Structured education and standardized implementation strategies are required to strengthen patient safety in critical care settings.

Healthcare doi: 10.3390/healthcare14081038

Authors: Sadia Qazi Hafsa Fayyaz Bilal Ahmad Abdal Ahmad Syeda Sama Bilal Aiman Ajmeer Humna Aziz

Background: Acute lymphoblastic leukemia (ALL) requires intensive induction, but implementation of pediatric-inspired regimens in low- and middle-income countries is constrained by diagnostic gaps, procurement instability, and limited supportive-care capacity. We evaluated the feasibility, safety, and affordability of a pragmatically adapted pediatric-inspired induction regimen for adults with Philadelphia chromosome-negative Ph(−) ALL in a Pakistani tertiary hospital. Methods: In this prospective single-center cohort study at the Pakistan Institute of Medical Sciences (December 2024–June 2025), consecutive adults aged 18–50 years with newly diagnosed Ph(−)ALL received an adapted pediatric-inspired induction regimen. The primary outcome was complete remission (CR) after induction, with or without extended induction. Secondary outcomes were early mortality, treatment abandonment, grade 3–4 toxicities, and service delivery feasibility indicators. Affordability was assessed against household income. Results: Among 200 adults (mean age 30.3 ± 8.8 years; 65.5% male), 39.5% presented with WBC ≥ 30 × 109/L and 88.0% with platelets < 50 × 103/µL. CR was achieved in 83.0% of patients. Early mortality was 2.0%, and treatment abandonment was 1.5%. Grade 3–4 toxicities included febrile neutropenia (15.0%) and sepsis (7.5%). The Day-30 evaluability was high (96.5%). Observed out-of-pocket diagnostic costs were USD 119, whereas a guideline-complete diagnostic package would cost USD 929, equivalent to 3–6 months of income for households in the poorest quintile. Conclusions: This adapted pediatric-inspired induction regimen was operationally deliverable in a resource-restricted hospital and produced favorable induction-phase outcomes. Limited diagnostic capacity and a lack of financial protection for testing remain barriers to risk-adapted care. Expanding subsidies for essential diagnostics and stabilizing the procurement of critical agents may yield the greatest implementation gains.

Healthcare doi: 10.3390/healthcare14081037

Authors: Sabine Pawellek Isabell Estorff Hagen Wulff Thomas Wendeborn

Background/Objectives: Digital obesity therapy requires exercise therapists with adequate digital competences, yet training opportunities remain limited. This study provides the first application of the DigCompThExO questionnaire to assess exercise therapists’ digital competences and their predictors in obesity therapy, addressing digital sovereignty as an educational outcome and informing future training programs. Methods: A cross-sectional online survey assessed self-perceived digital competences among German-speaking exercise therapists in obesity care using the validated DigCompThExO questionnaire (14 items). Descriptive and regression analyses examined personal (age, gender, qualification) and contextual (type of therapy, therapeutic targets) predictors of overall digital competence, with correction for multiple testing. Results: Of 203 therapists (mean age 33.3 ± 5.9 years), ‘Teaching Strategies’ yielded the highest scores, ‘Selection Criteria’ the lowest. Regression analysis (n = 202) accounted for a substantial proportion of variance in overall digital competence (R2 = 0.801, adjusted R2 = 0.790, p < 0.001), with the digitally pursued therapeutic target body awareness emerging as significant predictor (B = 0.18, p_FDR = 0.003). Conclusions: This study provides initial insights into the digital competence profiles of exercise therapists in obesity therapy. In exploratory analysis, the therapeutic target of digitally fostering body awareness was the only predictor that remained significant after correction. The findings suggest that targeted education in data protection, media reflection, and the communication of exercise-related therapeutic targets may be relevant to support digital competence development.

Healthcare doi: 10.3390/healthcare14081036

Authors: Ji-Hun Kang Min-Seok Choi Eun-Kyung Jung Sung-Soo Choi Seong-Ju Kim Yun-Deok Jang

Background/Objectives: Injury mechanism and intent are key determinants of patient outcomes in the emergency department, yet their combined effects remain insufficiently understood. Emergency department disposition after injury may differ according to mechanism and intent and may be further influenced by specific mechanism–intent combinations. This study aimed to evaluate the associations of injury mechanism, intent, and their interaction with emergency department disposition and injury severity measured using the International Classification of Diseases-based Injury Severity Score (ICISS). Methods: We conducted a retrospective analysis of injury-related emergency department visits recorded between 1 January 2019 and 31 December 2023. Eligible visits included those with valid arrival and departure timestamps and complete disposition data; records with missing key variables or implausible length of stay were excluded. A total of 1,029,875 visits were analyzed. The primary outcome was emergency department disposition, categorized as discharge, admission, or transfer. Multinomial logistic regression was used to estimate relative risk ratios, with discharge as the reference category, and to derive predicted probabilities for selected mechanism–intent combinations. Injury severity was assessed using ICISS and modeled with injury mechanism, intent, their interaction, and prespecified covariates. Results: Of all visits, 69.9% resulted in discharge, 24.3% in admission, and 5.8% in transfer. Compared with traffic accidents, the highest likelihood of admission was observed in suffocation, drowning, and poisoning injuries. Transfer was more frequent in drowning, suffocation, penetrating injuries, and poisoning. Self-harm was associated with increased risks of both admission and transfer compared with unintentional injuries. Interaction analyses showed that certain combinations, particularly poisoning with self-harm and suffocation with self-harm, were associated with substantially higher risks than either factor alone. Predicted probabilities further highlighted high-risk combinations, including markedly elevated admission probabilities in self-harm-related poisoning and suffocation, and increased transfer probability in unintentional drowning. Injury mechanism, intent, and selected interactions were also significantly associated with ICISS-based injury severity. Conclusions: Injury mechanism and intent are independently associated with emergency department disposition and injury severity, with additional risk amplification observed for specific combinations. These findings suggest that mechanism–intent combinations may serve as clinically useful risk indicators in emergency department triage and decision-making, supporting improved risk stratification and system-level coordination.

Healthcare doi: 10.3390/healthcare14081035

Authors: Wenjing Luo Haishan Wei Kaili Zhang Dehui Wang Hong Lu Yinchu Hu Chunying Li Junrong Zhang Xiu Zhu

Background: While combined diet and physical activity interventions are recommended, evidence specific to low-risk pregnant women remains limited. As responses to combined interventions may vary by pre-pregnancy BMI, maternal health status and pregnancy outcomes, targeted evaluation in low-risk pregnant women is needed. Inconsistencies across studies, along with the lack of a comprehensive synthesis of both effects and intervention components, further limit their implementation. Objective: Our aims were to assess the effects of combined diet and physical activity interventions on gestational weight gain among low-risk women and to systematically characterize the intervention components. Design: We conducted a systematic review and meta-analysis following the Cochrane Handbook guidelines and PRISMA 2020. Methods: Eight databases and trial registries were searched from inception to 16 March 2026. Two reviewers independently conducted study selection, data extraction and risk of bias assessment. Intervention components were coded using the TIDieR checklist. The quality of included studies was assessed using the updated Cochrane risk of bias 2.0 tool. Meta-analyses were performed using Review Manager 5.4, and certainty of evidence was assessed using the GRADEpro online tool. Results: A total of 10 studies involving 3977 pregnant women were included. Combined diet and physical activity interventions significantly reduced total gestational weight gain (GWG) (MD = −0.78 kg, 95% CI: −1.12 to −0.44, p < 0.00001) and the risk of excessive gestational weight gain (EGWG) (OR = 0.63, 95% CI: 0.49–0.81, p = 0.0003). Additionally, individually delivered physical activity components and those implemented in healthcare facilities appeared to be associated with lower total GWG (MD = −0.76 kg, 95% CI: −0.98 to −0.53, p < 0.00001). For EGWG, lower risk was observed in interventions using combined face-to-face and remote formats (OR = 0.54, 95% CI: 0.41–0.72, p < 0.0001) and moderate frequency (diet: OR = 0.64, 95% CI: 0.51–0.81, p = 0.0002, physical activity: OR = 0.65, 95% CI: 0.52–0.83, p = 0.0004). Conclusions: Combined diet and physical activity interventions were associated with reduced total GWG and lower EGWG risk in low-risk pregnant women. Intervention characteristics, such as individual delivery formats, combined face-to-face and remote formats, moderate frequency and implementation in healthcare facilities, may be related to intervention effectiveness. Registration number: CRD420251013116 (PROSPERO).

Healthcare doi: 10.3390/healthcare14081034

Authors: Atta Ur Rehman Rubeena Zakar Gulzar H. Shah Ume Hani Muhammad Zakria Zakar Tran Nguyen

Introduction: Health literacy enables refugees to assess, understand, and utilize health information effectively. This investigation aims to identify factors influencing health literacy levels among Afghan refugees in Pakistan. Methods: A cross-sectional survey using a multistage sampling approach was conducted to collect data from 1185 refugees. Health literacy levels were measured using the pre-validated All Aspects of Health Literacy tool in five districts of Punjab and Khyber Pakhtunkhwa provinces that met the inclusion criteria. We used logistic regression models to analyze the dichotomous dependent variables. Results: A significant proportion of Afghan refugees demonstrated low functional health literacy and required assistance with reading and completing health documentation. Afghan refugees in the younger age group, male gender, higher monthly income, and access to healthcare information and clean water were more functionally literate in health. More than two thirds of the Afghan refugee population had adequate communicative health literacy with health care professionals in Pakistan. Most refugees believed that healthy lifestyles information and encouragement were more crucial for health than housing, employment, education, and local infrastructure. Conclusions: Afghan refugees in Pakistan lacked functional health literacy, critical health literacy, and overall health literacy. However, they have adequate communicative health literacy. This initial survey added new data on Afghans’ health literacy levels, which could help stakeholders strengthen health promotion initiatives within the healthcare system to improve health outcomes.

Healthcare doi: 10.3390/healthcare14081032

Authors: Federico Zoila Daniela Cagnetta Sergio Bellantonio Pasquale Simeone Paola Lanuti Maria Antonietta Panaro Laura Civita Laura Antonucci Chiara Porro

Background: Bikram yoga, a form of hot yoga practiced in heated environments, has been associated with improvements in flexibility, body composition, and overall well-being. However, longitudinal evidence on its effects in adult women remains limited. Obesity/metabolic syndrome (MetS) is highly prevalent among adult women worldwide, with estimates exceeding 40% in middle-aged populations, underscoring the need for low-impact interventions targeting adiposity and age-related metabolic risks. This study evaluated the effects of 6-month Bikram yoga on body fat percentage (%BF) in adult women, with age-stratified analyses. Methods: Twenty-two women (20–65 years) participated in a structured Bikram yoga program consisting of three weekly sessions (90 min, 26 postures + 2 breathing exercises, 40 °C, 40% humidity) over six months. Anthropometric assessments (8 skinfolds, 5 body circumferences, weight, and height) were conducted at T0, T1 (~45 days), T2 (~90 days), and T3 (6 months). %BF was estimated using multiple validated prediction equations integrated into the Exercise Science Toolkit. Results: A significant and progressive reduction in %BF was observed across the sample: −3.71% at T1 (p < 0.0001) and −6.07 at T3 (p < 0.0001) compared to the baseline. Positive outcomes were consistent across all age subgroups: subgroup A (20–35 years, T3 −6.62%), subgroup B (36–50 years, T3 −5.96%), and subgroup C (51–65 years, T3 −5.39%). Decreased inter-subject variability (SD) suggests a similar direction of change among participants. Conclusions: Regular Bikram yoga practice (three sessions per week for six months) was associated with significantly and consistently reduced %BF among adult women aged 20–65, exceeding the clinical threshold (>5%) for metabolic benefits. Effects were evident after six weeks and remained across all age subgroups, suggesting that Bikram yoga may represent an effective, low-impact intervention for health promotion and active aging.

Healthcare doi: 10.3390/healthcare14081033

Authors: Khaled Tareg Hakami Arwa S. Almasaudi Areej Ali Alkhaldy Batool Saad Almsaudi

Background: Probiotics have emerged as an effective therapeutic intervention in critically ill patients receiving enteral nutrition, yet their use remains inconsistent across intensive care units (ICUs). Understanding knowledge, attitudes, and practices (KAP) among healthcare professionals (HCPs) is essential for optimizing evidence-based probiotic administration in enteral nutrition, identifying perceived implementation barriers, and examining associations between KAP scores and study variables. Methods: A multicenter, cross-sectional online survey was administered to ICU physicians, nurses, clinical dietitians, pharmacists, and respiratory therapists. Participants completed a self-reported questionnaire assessing their knowledge of probiotic mechanisms, indications, and safety; attitudes toward probiotic therapy; and current practices in probiotic administration during enteral feeding. Results: A total of 935 ICU HCPs participated. Overall knowledge was insufficient, with only 33.2% achieving high knowledge scores (mean: 12.4/18 points), whereas attitudes were moderately favorable, with 35.5% demonstrating positive attitudes (mean: 23.9/30 points). A majority of respondents (58.7%) reported recommending or prescribing probiotics, most frequently clinical dietitians (84.5%). KAP varied significantly by profession, age group, and years of experience (p < 0.01). The most reported barriers were a lack of information about available probiotic products (73.2%), limited knowledge (41.2%), limited availability of clinically proven products (37.8%), and cost concerns (29.7%). Conclusions: Although ICU HCPs show interest and cautious acceptance of probiotics in enteral feeding, knowledge gaps, attitudinal variability, and practice inconsistencies persist across disciplines. These findings highlight the critical need for targeted, multidisciplinary educational interventions and the development of standardized, evidence-based institutional protocols to optimize probiotic use and improve patient outcomes.

Healthcare doi: 10.3390/healthcare14081031

Authors: Xian Zhang Yuetong Pei Shanshan Dou Chunhui Zhang Yandan Duan Jinling Gao

Objective: This study aimed to identify distinct dyadic coping profiles among infertile couples undergoing assisted reproductive technologies (ARTs) and to examine the associations between these coping profiles, depressive symptoms, and fertility quality of life (FertiQOL). Methods: A total of 271 infertile couples undergoing ARTs were recruited from a reproductive medicine center in Zhengzhou, China, and completed standardized self-report measures. Latent profile analysis was conducted to identify distinct dyadic coping profiles at the couple level. Multinomial logistic regression was used to examine sociodemographic and infertility-related predictors of profile membership. Differences in depressive symptoms and FertiQoL across profiles were analyzed using the Bolck–Croon–Hagenaars method. Results: Four dyadic coping profiles were identified: high-coping wife and low-coping husband (15.4%), low dyadic coping (20.1%), medium dyadic coping (31.5%), and high dyadic coping (33.0%). Couples in the high dyadic coping profile reported the lowest levels of depression and the highest level of FertiQoL. Women in the low dyadic coping profile reported the highest depressive symptoms, while men in the high-coping wife and low-coping husband profile demonstrated the highest depression among male partners. Sociodemographic factors (household registration, family income) and infertility characteristics (type of infertility, infertility duration) were significant predictors of profile membership. Conclusions: Dyadic coping among infertile couples undergoing ARTs is heterogeneous and differentially associated with depression and FertiQoL. Low and asymmetric dyadic coping represent high-risk profiles linked to poorer outcomes in both partners. These findings suggest that dyadic coping may serve as a protective resource for infertile couples to improve their psychological well-being and quality of life, highlighting the importance of incorporating dyadic coping assessment into routine care and providing couple-centered psychosocial interventions in fertility care practice.

Healthcare doi: 10.3390/healthcare14081030

Authors: Nerea de Miguel-Hernando Daniel Pecos-Martín Rubén Cámara-Calmaestra Daniel Rodríguez-Almagro Agustín Aibar-Almazán Samuel Fernández-Carnero Alfonso Javier Ibáñez-Vera Alexander Achalandabaso-Ochoa

Background/Objectives: Non-specific chronic neck pain is one of the biggest problems in the current population, with high levels of pain and disability and a decrease in the quality of life. The aim of this study is to assess possible variables that may be associated with neck pain, such as disability, pain, quality of life, sex, neck muscle endurance, active range of motion (AROM) and frequency of drug use. Methods: We performed a cross-sectional study of non-specific chronic neck pain with a total of 105 subjects. The variables pain-related disability, pain, quality of life, sex, AROM and frequency of drug use were evaluated. Results: A total of 105 patients with chronic neck pain were included (mean age 40.47 ± 12.18 years; 67.6% women). Neck pain–related disability showed significant negative correlations with all cervical AROM variables, particularly left rotation (r = −0.507) and right rotation (r = −0.489) (p < 0.001). Disability was also negatively correlated with health-related quality of life (r = −0.604) and positively correlated with pain intensity (r = 0.414) and frequency of drug consumption (r = 0.546) (p < 0.001). Regression analyses indicated that disability was associated with reduced left rotation mobility and higher drug consumption (R2 = 0.424). Pain intensity was associated with female sex, reduced right rotation mobility, and higher drug consumption (R2 = 0.246). Lower health-related quality of life was associated with higher drug consumption and female sex (R2 = 0.174). Conclusions: Being female, having a reduction in active rotational mobility, and a high frequency of drug consumption are associated with greater pain-related disability and pain intensity, and a lower HRQoL in subjects with non-specific chronic neck pain.

Healthcare doi: 10.3390/healthcare14081029

Authors: Haydee Mercedes Aguilar-Armas Velia Graciela Vera-Calmet Marco Agustín Arbulú Ballesteros Lucy Angélica Yglesias-Alva Hugo Martin Noé Grijalva Milagros del Carmen Quispe Villarreal

Background: Social anxiety in adolescence is a prevalent mental health concern characterized by intense fear of negative evaluation in social situations. The Social Anxiety Questionnaire for Adolescents (CASO-N24) is a Spanish-language instrument requiring validation in Peruvian populations. Objective: This study aimed to validate the CASO-N24 in Peruvian adolescents aged 12–17 years, extending its application beyond the original 9–15-year range, and examine its psychometric properties including factorial structure, measurement invariance, nomological validity, and internal consistency. Methods: A stratified probability sample of 710 adolescents (352 males, 358 females; M = 14.82 years, SD = 1.45) from four northern Peruvian educational centers completed the CASO-N24 and ASQ-14. Exploratory and confirmatory factor analyses, multigroup invariance testing by age and gender, nomological validity assessment, and reliability estimation (Cronbach’s α and McDonald’s ω) were conducted using polychoric correlations and robust estimation methods. Results: The six-factor structure was replicated, explaining 47.13% of variance with factor loadings ranging 0.48–0.78. Model fit indices were excellent (GFI = 0.981, AGFI = 0.976, NFI = 0.971, SRMR = 0.046). Complete measurement invariance was achieved across age groups (12–15 vs. 16–17 years). Partial invariance by gender was observed, with differential item functioning identified in item 17. Nomological validity was confirmed through moderate-to-high correlations with ASQ-14 (males: r = 0.622; females: r = 0.604). Internal consistency was adequate (total scale ω = 0.95; subscales ω = 0.69–0.82). Conclusions: The CASO-N24 demonstrated robust psychometric properties for assessing social anxiety in Peruvian adolescents aged 12–17 years, supporting its multidimensional structure and utility for early detection in school settings while highlighting gender-specific response patterns warranting clinical consideration.

Healthcare doi: 10.3390/healthcare14081028

Authors: Omer Doymus Ela Nur Medetoglu Habip Burak Ozgodek Ozlem Dilara Erguney Pelin Aydın Nasuhi Altay Aslı Turgut Ali Ahiskalioglu

Background/Objectives: Shoulder arthroscopies are commonly conducted in orthopedic practice. The interscalene brachial plexus block (ISB) is regarded as the “gold standard” for postoperative analgesia in shoulder surgeries. The serratus posterior superior intercostal plane block (SPSIPB) was introduced as an innovative treatment for addressing thoracic and shoulder discomfort. This study aims to examine the effects of SPSIPB and ISB techniques on postoperative pain levels, opioid intake, and respiratory function measures in patients having shoulder arthroscopy. Methods: Patients were divided into two groups. In the ISB group, 15 mL of fluid containing 0.25% bupivacaine was applied between interscalene muscles, while in the SPSIPB group, 30 mL of 0.25% bupivacaine was applied in the fascial plane between the serratus posterior superior muscle and the intercostal muscles. Results: There were no statistically significant differences in demographic characteristics (p > 0.05). VAS scores were statistically lower in the ISB group compared to the SPSIPB group at rest at 1, 2, 4, 8, 12, and 24 h postoperatively in the PACU (p < 0.05). VAS scores were also lower in the ISB group compared to the SPSIPB group during active movement at 1, 2, 4, 8, and 12 h postoperatively in the PACU (p < 0.05). Twenty-four-hour fentanyl consumption was lower in the ISB group compared to the SPSIPB group (407.50 ± 169.32 μg and 767.50 ± 178.00 μg, respectively, p < 0.001). The decrease in FEV1 and FVC was higher in the ISB group compared to the SPSIPB group (p < 0.001). Conclusions: ISB effectively relieves pain during shoulder arthroscopic procedures; however, while SPSIPB is considered a more advantageous option in terms of respiratory safety, it may not provide adequate analgesia on its own.

Healthcare doi: 10.3390/healthcare14081027

Authors: Irina Evgenievna Kalabikhina Anton Vasilyevich Kolotusha Vadim Sergeevich Moshkin

Background/Objectives: Patient-Reported Experience Measures (PREMs) help us understand how patients perceive healthcare quality. Yet most studies look at complaints in isolation, without tying them to the structural features of medical practice. This study asks whether the nature of clinical work—shaped by diagnostic pathways, interaction patterns, and professional focus—predicts what patients complain about. Methods: We analyzed 18,492 negative reviews from infodoctor.ru, collected between 2012 and 2023 across 16 Russian cities with populations over one million. We used a mix of methods: machine learning (logistic regression) to classify complaints as medical (M-type) or organizational (O-type), statistical tests (chi-square, proportion analysis), and expert validation by nine independent specialists. We also built a novel multidimensional classification of medical practices based on three criteria: diagnostic pathway length, frequency and duration of patient interaction, and whether the work is mainly technical or communicative. Results: Technical specialties received far more medical complaints than communicative ones (39.8% vs. 29.3%, p < 0.001), while communicative specialties received more organizational complaints (45.7% vs. 35.0%, p < 0.001). Specialties that manage chronic conditions over the long term had the highest share of organizational complaints (41.6%). At the city level, the share of communicative specialists correlated negatively with complaints per capita (r = −0.541, p = 0.0306). We found no meaningful gender differences in complaint patterns. Conclusions: The type of medical practice systematically shapes what patients complain about. Technical specialties draw criticism on clinical quality; communicative specialties draw criticism on how care is organized. Long-term care faces challenges rooted more in administrative friction than in clinical competence. These findings show that PREMs, when analyzed through a practice-based lens, can support targeted quality improvement—moving from simply tracking complaints to acting on them in specialty-specific ways.

Healthcare doi: 10.3390/healthcare14081026

Authors: Inês Soares Ana R. Pinho Liliana Rodrigues Catarina Maria Rêgo-Moreira Conceição Nogueira

Despite growing interest in the sexuality and gender identity of people with disabilities (PWD), this topic remains underexplored in both research and institutional policies, owing to prevailing views that ignore PWD sexual life. This contributes to the invisibility of individuals who identify as lesbian, gay, bisexual, and trans (LGBT) and to inadequate attention to the specific needs of LGBT people with disabilities (LGBT PWD). Background/Objectives: Given the lack of Portuguese studies that examine the intersection of LGBT and disability identities, this study aimed to understand professionals’ attitudes and practices toward PWD regarding sexuality and LGBT belonging. Methods: We conducted qualitative research using semi-structured interviews with eleven professionals (two psychologists, three occupational therapists, and six personal assistants). We analyzed the data using reflexive thematic analysis. Results: Key findings highlight professionals’ limited knowledge, prevailing cis-heteronormative attitudes, and emerging affirmative practices. Conclusions: Training and institutional changes are needed to make services more inclusive and responsive to the needs of LGBT PWD.

Healthcare doi: 10.3390/healthcare14081024

Authors: Kim Lisa Westphal Fiona Mankertz Lukas Rasche Robin Bülow Mark Oliver Wielpütz Marie-Luise Kromrey Carolin Malsch

Objective: Back pain is a multifactorial condition commonly associated with degenerative spinal changes. Spondylophytes are frequent outgrowths of the vertebral bodies that may be influenced by arterial hypertension via a possible increased pulsation of the aorta and its effects on bone remodeling. If it can be demonstrated that an increased pulse pressure in the aorta due to hypertension promotes the growth of spondylophytes and thereby increases the likelihood of back pain, future studies may investigate how the effectiveness of blood pressure management can be improved in order to reduce the prevalence of degenerative changes in the spine and, consequently, prevent back pain. This study investigated the association between arterial hypertension and thoracic spondylophyte formation using whole-body MRI data from the population-based Study of Health in Pomerania (SHIP). Materials and Methods: Spondylophyte presence and area were assessed for their association with hypertension status in 859 SHIP-START-3 participants who underwent whole-body MRI. Right-sided spondylophytes at T8-T11 were measured on axial T2-weighted sequences. Hypertension was defined by self-report or antihypertensive medication use; a sensitivity analysis was conducted using the 2024 European Society of Cardiology definition (systolic blood pressure ≥ 140 mmHg). Multivariate regression models adjusted for age, sex, obesity, and smoking were used to assess associations. Machine learning algorithms were applied for validation. Results: Spondylophytes were present in 87.7% of participants. Hypertension was significantly associated with spondylophyte presence (OR = 2.07, 95% CI: 1.15–3.81) but not consistently associated with spondylophyte size. Spondylophyte size increased from T8 to T11, and was associated with age, male sex, and obesity. Sensitivity analyses widely confirmed robustness of the analysis. Conclusions: This population-based MRI study investigates the still insufficiently studied relationship between arterial hypertension and the formation of thoracic spondylophytes. The findings are consistent with the hypothesis that hypertension may be associated with spinal bone remodelling, though causal inference remains limited by the cross-sectional study design. Further longitudinal studies are needed to clarify causality and clinical relevance for spinal degeneration and back pain.

Healthcare doi: 10.3390/healthcare14081025

Authors: Ga-In Lee Jin-Hyuck Park

Background/Objectives: Police officers are exposed to chronic occupational stress and traumatic events, placing them at increased risk for mental health problems. Previous meta-analyses have been limited by heterogeneous samples and methodological variability. This study evaluated the effectiveness of psychological interventions on mental health and posttraumatic stress disorder (PTSD) symptoms among police officers using randomized controlled trials (RCTs). Methods: A systematic search of PubMed, Embase, Web of Science, PsycINFO, and MEDLINE was conducted for studies published between January 2000 and September 2025. The search strategy utilized key terms including “police officers,” “psychological interventions,” “mental health,” and “randomized controlled trials”. Only RCTs involving police officers were included. Psychological interventions were compared with waitlist, usual-care, or active control conditions. General mental health outcomes (depression, anxiety, and stress) were analyzed as the primary outcome, and PTSD symptoms as a secondary outcome. Effect sizes were calculated as Hedges’s g using random-effects models. Subgroup, meta-regression, sensitivity, and publication bias analyses were conducted when appropriate. Results: Ten RCTs comprising 637 police officers met the inclusion criteria. Psychological interventions demonstrated moderate improvements in overall mental health (Hedges’s g = 0.516, 95% CI = 0.296–0.735, p < 0.001), albeit with substantial heterogeneity. Comparable effects were observed across waitlist and usual-care/active control comparisons. For PTSD symptoms, significant improvements were found only in comparisons with waitlist controls, whereas the overall pooled effect was not statistically significant. Meta-regression showed no dose–response relationship between total intervention hours and treatment effects. Sensitivity analyses confirmed result robustness. The certainty of evidence was rated as moderate for general mental health and low for PTSD symptoms, primarily due to substantial inconsistency and imprecision. Conclusions: These findings suggest that structured psychological programs show potential to confer added benefits for general mental health beyond routine wellness activities, although the certainty of the evidence is moderate to low. In contrast, the evidence for PTSD symptoms remains inconclusive, with effects failing to reach robust statistical significance. This underscores that preliminary individual-level intervention may be insufficient for trauma-specific symptoms, necessitating further research into specialized, trauma-focused approaches and the role of organizational determinants in enhancing intervention efficacy.

Healthcare doi: 10.3390/healthcare14081020

Authors: İsmet Çopur Hüseyin Özçınar Turan Evran

Background: This study aims to conduct an analysis of the literature on low-flow anesthesia published over the past 30 years, identifying the most productive countries, institutions, authors, and journals; uncovering the intellectual structure of the field through the most influential publications, authors, and journals; and visualizing thematic clusters and evolving research trends based on keyword analyses. Methods: This retrospective bibliometric study analyzed scientific publications on low-flow anesthesia indexed in the Science Citation Index Expanded (SCIE) of the Web of Science Core Collection (WoSCC) between 1993 and 2024. Articles were classified by countries, institutions, journals, and researchers, and the number of studies and citations were determined. Co-citation analysis and keyword co-occurrence analysis were performed to map thematic clusters and intellectual structures. Results: A total of 260 articles met the inclusion criteria. The United States led with 39 publications, followed by Turkey (33) and Japan (27). The most productive institution was Northwestern University (USA), and the most published journal was Anesthesia & Analgesia. The most prolific authors were André M. De Wolf and Jan F. A. Hendrickx, while co-citation analysis identified Edmund I. Eger II and Hiromichi Bito as the most influential authors based on centrality metrics. MDS and trend topic analyses revealed prominent keywords including “closed loop”, “remifentanil”, “sevoflurane”, “bispectral index”, “EEG analysis”, “pharmacokinetics”, “absorbent”, “performance”, and “FGF” (fresh gas flow). Conclusions: The United States leads the field of low-flow anesthesia in both publication count and citations. Trending terms such as “closed loop,” “performance,” “remifentanil,” “sevoflurane,” “bispectral index,” “EEG analysis,” “FGF,” and “absorbent” reflect the current research directions in this field.

Healthcare doi: 10.3390/healthcare14081023

Authors: Makwena Midah Sibuyi Siyanda Alex Ngema

Introduction: Chronic kidney disease and kidney failure are associated with a decline in physical abilities resulting in severe health-related complications. Existing systematic reviews and meta-analyses show that exercise interventions in patients on haemodialysis enhance physical functioning, cardiovascular health, muscle strength, and overall quality of life. However, the available literature mostly stem from adult cohorts outside Africa. Thus, this scoping review aims to evaluate existing literature on the impact of exercise programs on paediatric patients undergoing haemodialysis in Africa. Methods: A systematic search of electronic databases, including CINAHL, EBSCO, Medline, PubMed, and Scopus, was conducted following the Arksey and O’Malley methodological framework for scoping reviews and complied with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guidelines. The inclusion criteria was applied to identify peer-reviewed articles published between 2015 and 2025, focusing on the effects, impact, and benefits of exercises and physical activity programs in paediatric patients undergoing haemodialysis aged up to 18 years. The selection process was done by two researchers pertaining to importing search results, removing duplicates, screening titles and abstracts, and analysis the reference lists of selected studies to ensure comprehensive coverage. Results: Two exercise-based intervention studies were eligible in the final review. In both studies, the duration of the intervention was about two months, and they included sample sizes of 60 and 50 participants. The first study, using the Paediatric Quality of Life Inventory (PedsQL-I), reported significant improvements across all dimensions in quality-of-life following muscle stretching and isometric exercises. The second study, employing the Paediatric Quality of Life Multidimensional Fatigue Scale (PedsQL-MFS) and the Depression Anxiety Stress Scale (DASS), found reductions in fatigue and psychological distress, and positive biochemical changes. A notable omission was the lack of detail regarding contraindications and precautionary measures. These are essential for informing clinical decision-making and ensuring exercises are safe. Discussion: The findings underscore the importance of incorporating exercise into the standard care of paediatric patients undergoing haemodialysis to facilitate better health outcomes. The fact that only two relevant studies were found highlights a narrow regional scope within Africa as both studies originated from a single country. Further research is needed to develop and implement effective exercise interventions tailored to other countries in Africa.

Healthcare doi: 10.3390/healthcare14081022

Authors: Feng Jiang Shengtian Hou Qianqian Huang Ruiping Zhao Yi-Lang Tang

Background: Artificial intelligence (AI) is increasingly embedded in routine primary care, yet how the levels of integration might affect its acceptability is unknown, especially in relationship-based service models where patients expect visible human stewardship. Prior experimental studies often treat AI adoption as a binary condition, leaving the “intensity gradient” of automation and the role of model specialization under-explored. We examine whether increasing AI integration in the clinical encounter erodes patients’ intention to seek care from family doctors in China, and whether labeling the AI as a medical-specific model buffers such erosion. Methods: We conducted a nationwide online survey experiment in China (N = 2790). Participants were randomly assigned to vignettes that varied by (i) the level of AI integration (low, medium, high) and (ii) the AI type (general-purpose vs. medical-specific large language model), with a human-only care scenario as a reference. Care-seeking intention from family doctors was assessed immediately after exposure. We estimated treatment effects using OLS regression with heteroskedasticity-robust standard errors, and examined the buffering hypothesis through an interaction term between AI integration intensity and AI type. Results: Care-seeking intention declined steadily as AI integration increased (p < 0.001), with the sharpest drop under high-intensity AI integration where clinical decisions were delegated to the AI system. Across all intensity levels, framing the system as a medical-specific AI consistently resulted in higher care-seeking intention than a general-purpose model. However, the interaction between AI intensity and the AI type was not statistically significant (p = 0.508). Conclusions: Patient acceptance of AI in primary care depends not only on whether AI is involved, but on how deeply AI is positioned in the encounter. Medical-specific AI labeling may enhance acceptance across all AI integration levels. The findings underscore the need to preserve human clinical agency in AI-embedded primary care. The results contribute to research on healthcare systems, digital health, and AI–patient interaction.

Healthcare doi: 10.3390/healthcare14081021

Authors: Laia Blanco-Ratto Montserrat Girabent Farrés Cristina Naranjo Ortiz Stephanie Kauffmann Manuel Del Campo Rodríguez Inés Ramírez-García

Background/Objectives: Non-ablative vaginal Erbium-doped Yttrium Aluminium Garnet (Er:YAG) laser therapy has been proposed as a minimally invasive option for pelvic floor dysfunction (PFD), yet objective anatomical data using standardized measures remain limited. This study evaluated short-term anatomical and functional outcomes in a real-world care setting. Methods: This prospective single-arm interventional cohort study included women with PFD who underwent two sessions of non-ablative vaginal Er:YAG laser therapy. Outcomes were assessed at baseline, first follow-up (FU1), and second follow-up (FU2). Anatomical changes were measured using POP-Q parameters, including vaginal hiatus (Gh), total vaginal length (TVL), and compartmental staging. Sexual function was evaluated using the Female Sexual Function Index (FSFI). Pelvic floor muscle strength was assessed using the Oxford Scale. Non-parametric tests were used for repeated measures, and correlations between delivered laser energy and clinical outcomes were explored. Results: A total of 163 women were enrolled; 136 completed FU1 and 59 completed FU2. Median vaginal hiatus decreased significantly from baseline to FU1 and remained reduced at FU2 (p < 0.001). Improvements in anterior and posterior prolapse staging were observed, with a shift toward lower POP-Q stages at both follow-up visits. FSFI total scores did not change significantly across visits, although small changes were observed in specific domains, including a transient decrease in orgasms at FU1 (Δ = −0.2, p = 0.021) and a modest improvement in pain at FU2 (Δ = −0.4, p = 0.045). The magnitude of anatomical changes was modest, and their clinical relevance remains uncertain. Conclusions: Non-ablative vaginal Er:YAG laser therapy was associated with short-term improvements in vaginal hiatus and POP-Q prolapse staging in women with PFD, while sexual function remained stable. These findings provide objective anatomical data on early treatment effects in routine care, informing future evaluation of minimally invasive care models for pelvic floor dysfunction.

Healthcare doi: 10.3390/healthcare14081019

Authors: Xiaoxiao Chen Gyeong Eon Kim Nam Ah Kim Kwang Joon Kim

Background/Objectives: Continuous glucose monitoring (CGM) has transformed diabetes management by enabling high-resolution assessment of glucose dynamics, with well-established use in type 1 diabetes (T1D) and insulin-treated type 2 diabetes (T2D), and expanding applications across broader populations, including non-insulin-treated T2D and gestational diabetes. However, real-world implementation remains constrained by economic barriers, fragmented reimbursement, workflow challenges, and limited capacity for continuous data interpretation. This review examines key barriers to CGM implementation and synthesizes current evidence on pharmacist-integrated CGM care as an emerging model to support CGM adoption across clinical and community-based settings. Methods: A narrative literature review was conducted to synthesize evidence on pharmacist-integrated CGM services in diabetes care. Literature was identified through structured searches of PubMed, Embase, and the Cochrane Library, supplemented by Google Scholar and citation tracking, covering publications from January 2010 to December 2025. Studies were selected based on predefined criteria, including those reporting clinical outcomes, pharmacist involvement, or health system and implementation factors related to CGM use. Relevant survey-based and real-world studies were also considered to capture healthcare professionals’ perspectives and implementation experiences. Evidence was synthesized thematically across clinical, behavioral, and health system domains. Results: Available evidence suggests that pharmacist-integrated CGM care is associated with improvements in glycemic management, including increased time in range, reduced glycemic variability, and more timely pharmacotherapy optimization. Pharmacist involvement may also support patient education, self-management, and engagement with digital health technologies, and facilitate ongoing data interpretation and treatment adjustment between clinical encounters. However, evidence remains heterogeneous and geographically limited, with predominantly retrospective and pilot studies and few randomized trials, constraining the robustness and external validity of the findings. Further studies are needed to confirm its clinical effectiveness, comparative effectiveness, and economic value. Conclusions: Pharmacist-integrated CGM represents a promising and operationally feasible approach to supporting CGM use in routine diabetes care. While current evidence indicates potential benefits in glycemic management and care delivery processes, further research and implementation efforts are required to support its effective and sustainable adoption across diverse healthcare settings.

Healthcare doi: 10.3390/healthcare14081018

Authors: Naoto Kamide Takeshi Murakami Takuya Sawada Masataka Ando Miki Sakamoto

Background: Although swallowing-related muscle function has been implicated in sarcopenia, the association between swallowing-related cervical muscle function and sarcopenia has not been thoroughly examined. The aim of this study was to investigate this association in community-dwelling older adults. Methods: This cross-sectional study included 390 community-dwelling adults aged ≥65 years. Sarcopenia was defined as the concurrent presence of low handgrip strength and low appendicular skeletal muscle mass. The force generated during the chin-tuck maneuver (chin-tuck force) was measured using a dynamometer to indicate swallowing-related cervical muscle function. Tongue pressure and oral diadochokinesis were measured as indicators of swallowing-related muscle function. Potential confounders included body mass index, comorbidities, number of medications, functional capacity, timed up-and-go test and trail-making test times. Results: In logistic regression analyses adjusted for age and sex, chin-tuck force was found to have a statistically significant association with sarcopenia; greater force correlated inversely with sarcopenia (odds ratio = 0.59, p < 0.001). Receiver operating characteristic curve analysis demonstrated acceptable discriminative ability of chin-tuck force for identifying sarcopenia (area under the curve (AUC) = 0.82, 95% confidence interval (CI): 0.72–0.90), which was significantly higher than that for tongue pressure (AUC = 0.62, 95% CI: 0.50–0.74; p < 0.01). Conclusions: Among swallowing-related muscle functions, reduced chin-tuck force may be associated with sarcopenia in older adults. Future studies should investigate targeted assessments and interventions focused on improving swallowing-related cervical muscle function as a potential strategy for sarcopenia prevention.

Healthcare doi: 10.3390/healthcare14081017

Authors: Evangelos C. Fradelos Konstantinos Skampardonis Pavlos Sarafis Alexios Alexopoulos Aikaterini Toska Maria Saridi Theocharis I. Konstantinidis Maria Lavdaniti Paul Cella Athanasios Kotsakis Filippos Koinis

Background: Chemotherapy-related symptom burden and psychological distress may significantly influence patients’ perceptions of treatment convenience and satisfaction, yet evidence in the Greek oncology population remains limited. Methods: A cross-sectional study was conducted among 150 cancer patients receiving chemotherapy in a tertiary hospital. Data were collected using CCSQ, ESAS-r, PHQ-2, GAD-2, and WHO-5. Pearson correlations and multiple linear regression analyses were performed. Results: Higher levels of depressive symptoms and anxiety were significantly associated with lower chemotherapy convenience and satisfaction (e.g., PHQ-2: r = −0.659 to −0.584, p < 0.001; GAD-2: r = −0.623 to −0.469, p < 0.001). Depressed mood emerged as a significant negative predictor of convenience (β = −0.39, p = 0.015) and concerns (β = −0.39, p = 0.005), while anxiety independently predicted satisfaction (β = 0.45, p = 0.007). Conclusions: Chemotherapy experience is strongly associated with psychological and symptom burden. These findings highlight the importance of integrating psychosocial assessment into routine oncology care.

Healthcare doi: 10.3390/healthcare14081016

Authors: Debra A. Harley Si-Yi Chao

Persons with disabilities experience significant barriers to accessing healthcare, yet the gap between disability studies and healthcare service delivery remains a persistent structural problem [...]

Healthcare doi: 10.3390/healthcare14081015

Authors: Fan Wang Ningshen Wang Weiming Xu Peng Zhang

Background/Objectives: Time-constrained consultations in high-volume settings can crowd out patient-centered communication, while AI-generated advice may face algorithm aversion when it lacks a humanistic dimension. This study examined whether a brief narrative-based prompt could improve coded patient-facing communication features in an LLM relative to both clinicians and an unprompted model on authentic patient queries. Methods: We conducted a three-condition comparative evaluation using a stratified sample of 1000 de-identified MedDialog-CN consultations (2016–2020). For each consultation, the same patient query was used to generate (i) a zero-shot GPT-o3-mini response and (ii) a narrative-prompted GPT-o3-mini response; the original physician reply served as the human baseline. Responses were annotated with a pre-specified schema operationalizing four communication dimensions—Storytelling, Empathy, Personalization, and Clarity—with expert adjudication. Frequency-based indicators were summarized as mean events per consultation, and binary indicators as proportions; secondary checks captured unwarranted certainty and risk-relevant language. Results: Narrative prompting shifted coded patient-facing communication from sparse and selectively deployed (clinicians and zero-shot AI) to more routine and standardized. Across the reported communication measures, the prompted model showed the most favorable overall pattern, with higher narrative-device use, empathic support, contextual tailoring, and terminology explanation, alongside more frequent consideration of patient preferences and markedly higher rates of emotion–symptom linkage and the presence of a patient-centered narrative framework. Conclusions: Narrative prompting may offer a lightweight and potentially scalable strategy for improving patient-facing communication in Chinese asynchronous, text-based online consultations. An important next step is calibration: humanistic cues should be delivered selectively and safely so that responses remain credible, locally feasible, and cognitively manageable.

Healthcare doi: 10.3390/healthcare14081014

Authors: Yui Masui Akemi Yamazaki

Background/Objectives: The coparenting relationship newly formed during the transition to parenthood is a relational system focused on parenting. This study was positioned as an exploratory survey, because it evaluated a preventive intervention program developed for couples expecting their first child with the goal of promoting coparenting, focusing solely on the prenatal period. This self-guided program was primarily composed of brief video for viewing and homework that were provided to couples through the pregnant women. The primary objective of this study was to evaluate the feasibility and acceptability of the intervention, and the secondary objective was to explore its preliminary effects; all assessments were based on data collected from pregnant women. Methods: This was a pilot study employing a mixed-methods approach with intervention and comparison groups. The evaluation utilized self-reported data collected at 22–27 weeks’ and 36 weeks’ gestation, along with data gathered through responses to questions in Microsoft Forms and semi-structured interviews, particularly in the intervention group. Ultimately, 20 couples in each group were included in the analysis. Results: Approximately 80% of couples in both groups agreed to participate, enhancing the feasibility of the intervention that included approaches to couples through pregnant women. The intervention completion rate was high (87%), and many women found the program acceptable. Analysis of covariance for between-group comparisons revealed no significant differences in relationship satisfaction (p = 0.267) or prenatal coparenting (p = 0.239). Conclusions: This program was recognized as feasible and acceptable, but its preliminary effects during pregnancy were not confirmed. Randomizing participants and including outcome assessments after childbirth in future studies could contribute to enhancing the potential for beneficial interventions.

Healthcare doi: 10.3390/healthcare14081012

Authors: Seonyoung Son Suhan Koh Taehyung Kim Minkyo Kim Daniel Newmire Taekyu Kim Doyeon Kim

Background/Objectives: Aging is associated with declines in cognitive function and neurotrophic support. Brain-derived neurotrophic factor (BDNF) and insulin-like growth factor-1 (IGF-1) are peripheral biomarkers discussed in relation to brain health and aging. This study investigated changes in serum BDNF, IGF-1, and cognitive screening scores after a 16-week Hatha Yoga program performed twice or four times per week in older women. Methods: Fifty-one community-dwelling women aged 70–79 years were allocated to a twice-per-week yoga group (2YG; n = 17), a four-times-per-week yoga group (4YG; n = 17), or a non-exercise control group (CON; n = 17) based on availability and participant preference; forty-three participants completed the study. Serum BDNF and IGF-1 were analyzed using enzyme-linked immunosorbent assay and chemiluminescent immunoassay, and cognitive status was evaluated using the Cognitive Impairment Screening Test (CIST). Outcomes were analyzed using two-way repeated-measures ANOVA and additional ANCOVA models adjusting for corresponding baseline values. Exploratory correlations were examined between biomarker changes and CIST changes. Effect sizes and 95% confidence intervals were reported. Results: BDNF showed a significant main effect of time (p < 0.05) without a significant group × time interaction; ANCOVA adjusting for baseline BDNF showed no significant group effect (p = 0.270). IGF-1 showed a significant group × time interaction (p < 0.01) with increases in both yoga groups; ANCOVA adjusting for baseline IGF-1 showed a significant group effect (p = 0.001). CIST showed a significant main effect of time (p < 0.01), but changes were small and the group × time interaction was not significant; ANCOVA adjusting for baseline CIST showed no significant group effect (p = 0.114). Biomarker changes were not clearly correlated with CIST changes (ΔBDNF–ΔCIST: r = −0.244, p = 0.115; ΔIGF-1–ΔCIST: r = −0.050, p = 0.750). Conclusions: In this quasi-experimental study with non-random allocation and limited covariate information, changes in peripheral neurotrophic factors and only small changes in cognitive screening scores were observed after participation in a 16-week Hatha Yoga program. However, frequency-dependent conclusions are limited, and findings should be interpreted cautiously as screening-level, hypothesis-generating reference data. Nevertheless, the program is considered a feasible, low-risk health promotion activity for older women and may inform future randomized or well-controlled studies.

Healthcare doi: 10.3390/healthcare14081013

Authors: María Ángeles Portillo-Gil Giancarlo Lucchetti Rocío De Diego-Cordero

Background/Objectives: Spirituality is a key component of coping and well-being in chronic and advanced illness, yet its assessment remains inconsistent across clinical settings. To identify, classify, and critically analyze the most commonly used and validated instruments for measuring spirituality in clinical contexts, focusing on their ability to assess the current spiritual state from a multidimensional perspective (cognitive, behavioral, and affective expressions). Methods: A systematic literature review was conducted using PubMed, Scopus, and Web of Science (2011–2024). Inclusion criteria targeted validation studies of instruments assessing spirituality in adults with chronic or advanced illnesses or in palliative care. A dual conceptual–functional classification was applied, and a custom scoring system was developed to evaluate psychometric quality. Contamination and tautological aspects were also examined. Results: Forty-three instruments were identified across 42 studies. Of these, 93.02% included cognitive, affective, and behavioral dimensions. Most were validated in oncology or chronic disease populations. Content validity and internal consistency were the most reported psychometric properties; responsiveness was rarely evaluated. Conclusions: The available instruments reflect several conceptual and functional approaches. The classification proposed in this review provides practical guidance for selecting scales according to specific clinical goals and settings, supporting the evaluation of the current spiritual state and the integration of spirituality into healthcare practice. Further research is recommended to develop culturally sensitive and responsive instruments suitable for diverse clinical contexts.

Healthcare doi: 10.3390/healthcare14081011

Authors: Asrar Salem Almutairi Antonia Marsden Owen Price Abdullah Hassan Alqahtani Abdullelah Waleed Almulhim Saleh Alsaidan Modhi Alanazi Karina Lovell

Background/Objectives: The use of physical and mechanical restraints and seclusion in psychiatric facilities to manage violent and aggressive behaviours has long been a contentious issue, balancing patient safety with ethical considerations. With advancements in psychiatry and increased understanding of mental illness, there have been expectations that such interventions would no longer be required; however, their use persists in clinical practice. Management policies differ across countries and are largely influenced by legal frameworks. This study aimed to identify the factors influencing the incidence of these interventions across two psychiatric facilities in Saudi Arabia and to examine associations among inpatient variables. Methods: A prospective cohort study was conducted over six months (September 2021–March 2022) across two psychiatric facilities in Saudi Arabia (Eradah Complex, n = 1120; King Fahd University Hospital (KFUH), n = 268). Data from 333 restriction events were analysed using descriptive statistics, chi-square tests, and negative binomial regression to calculate incidence rates and explore associated factors. Results: The findings revealed a complex interplay of factors related to patient characteristics and clinical and environmental conditions within the facilities. Key contributing variables included symptom deterioration and the duration of observation required. Longer observation periods were associated with certain diagnoses, particularly schizophrenia and mood disorders. Conclusions: Restraints and seclusion remain influenced by multiple interacting factors within psychiatric settings. These findings highlight the need to reduce their use and ensure they are applied cautiously, with greater emphasis on minimising patient trauma and promoting safer, person-centred care.

Healthcare doi: 10.3390/healthcare14081010

Authors: Nahla Mohammed Bawazeer Abeer Salman Alzaben Huny M. Bakry Raseel Mohammed Alrashidi Khulood Sami Hussein

Background/Objectives: Poor diet quality is common among young Saudi adults, characterised by high fast-food intake and low fruit and vegetable consumption. This study investigated the association between diet quality and lifestyle factors using a validated short Healthy Eating Index (sHEI). Methods: This study adopted a cross-sectional design, gathering responses through a self-completed online questionnaire. Demographic data were collected. Diet quality was assessed using the Arabic version of the sHEI, physical activity was evaluated with the Arabic short form of the International Physical Activity Questionnaire (IPAQ), and sleep quality was measured using the Athens Insomnia Scale (AIS). Saudi residents aged 18–25 years were eligible; pregnant or lactating individuals and those with chronic conditions affecting dietary intake were excluded. Results: Among 478 participants (mean age 21.1 ± 1.9 years), 88.1% were female, 24.7% were overweight or obese, and half reported poor diet quality. Moderation scores were slightly higher (54.2% high), whereas adequacy scores were nearly equal (49.8% high and 50.2% low). Most participants reported low physical-activity levels (78.5%) and poor sleep quality (55.2%). Sleep quality was significantly associated with all diet quality measures, increasing the odds of good total sHEI (OR = 1.74, p = 0.003), adequacy (OR = 1.49, p = 0.034), and moderation (OR = 1.54, p = 0.021). Conclusions: Sleep quality is significantly associated with diet quality among young Saudi adults. While body mass index and physical activity showed no significant associations, improving sleep quality may promote healthier dietary behaviours. Future studies should explore pathways linking sleep and diet.

Healthcare doi: 10.3390/healthcare14081008

Authors: Fernando Gomes de Jesus Alice Pereira Duque Grazielle Vilas Bôas Huguenin Mauro Felippe Felix Mediano Maicon Teixeira de Almeida Carla Christina Ade Caldas Silvio Rodrigues Marques-Neto Luiz Fernando Rodrigues Junior

Background: Normal-weight obesity (NWO) is a nutritional status in which individuals have a normal body mass index (BMI) with a high percentage of body fat (%BF). However, the impact of elevated %BF on cardiometabolic risk remains unclear. This study aimed to evaluate whether NWO is associated with worse cardiometabolic risk markers and scores. Methods: We conducted a cross-sectional study using a convenience sample of employees from a public hospital. Participants aged ≥18 years with a BMI between 18.5–24.9 kg/m2 were included in the study. %BF was categorized according to sex and age (InBody720). Normal weight and normal %BF (NWNB) and NWO were defined using cutoff points. Body composition, serum biochemical and inflammatory markers, hemodynamics, and autonomic function were considered cardiometabolic risk markers. The visceral fat area (VFA), atherogenic coefficient (AC), atherogenic index of plasma (AIP), body shape index (ABSI), and Framingham Risk (FR) score were considered cardiometabolic risk scores. Statistical significance was set at p < 0.05. Results: Of the 228 eligible participants, 52 met the inclusion criteria (NWNB, N = 29 and NWO, N = 23). Participants with NWO presented worse values of lipid profiles, anthropometric measurements, hemodynamic parameters, and autonomic function indices. After adjustment for age and sex, NWO remained associated with selected cardiometabolic markers, particularly LDL-c, triglycerides, and autonomic indices, whereas body composition findings should be interpreted as confirmatory of the phenotype. Conclusions: In this cross-sectional secondary analysis, NWO was associated with worse cardiometabolic markers and selected risk scores compared with NWNB. These findings support an unfavorable cardiometabolic profile in individuals with NWO, but do not allow inferences about future cardiometabolic events or causal relationships. Longitudinal studies are needed to clarify its prognostic significance.

Healthcare doi: 10.3390/healthcare14081009

Authors: Hüseyin Gazi Sönmez Murat Ergin Çalık Veli Koçak Berkan Bozdağ Ömer Kılınç Ebru Turan Umut Canlı Monira I. Aldhahi

Background and Objectives: While the effectiveness of video modeling (VM) in teaching academic, daily living, and social skills to individuals with Autism Spectrum Disorder (ASD) is frequently investigated, studies examining the use of VM in teaching gymnastics-based motor skills are limited. This study aimed to examine the effects of VM on the acquisition and maintenance of a gymnastics-based motor skills in preschool children with ASD. Methods: The study employed a multiple-probe method across participants in a single-subject research design. Three preschool children diagnosed with mild ASD participated in this study. Baseline, intervention, and follow-up data were systematically collected and analyzed. Social validity data were obtained through semi-structured interviews with parents and special education teachers. Results: The percentage of correct responses increased throughout the VM intervention sessions, and all participants reached the proficiency criterion. Follow-up data collected after the intervention showed that the acquired skill was maintained, and the percentages of correct responses ranged from 80% to 100%. Social validity findings revealed that both teachers and parents perceived VM as an effective and feasible teaching approach for teaching motor skills to children with ASD. Conclusions: The research findings demonstrate that VM is an effective and socially valid teaching method for teaching and maintaining gymnastics-based motor skills in preschool children with ASD. These results contribute to the existing literature by demonstrating the applicability of video modeling in the context of gymnastics-based training.

Healthcare doi: 10.3390/healthcare14081007

Authors: Rayan A. Siraj Maryam M. Almulhem Ibrahim A. Elshaer

Background: Intensive care units (ICUs) are high-acuity environments that require respiratory therapists (RTs) to maintain vigilance, manage emotions, and make rapid clinical decisions. In such settings, performance stability is critical for patient safety. Although emotional intelligence (EI) and work–life balance (WLB) have been linked to professional outcomes in health care, their independent and direction-specific associations with job performance among ICU respiratory therapists remain underexamined. Methods: A national cross-sectional survey was conducted among respiratory therapists working in ICUs across Saudi Arabia (June 2025–January 2026). EI was measured using the Wong and Law Emotional Intelligence Scale. WLB was assessed using the work interference with personal life (WIPL), personal life interference with work (PLIW), and work–personal life enhancement (WPLE) scales. Job performance was evaluated using the Individual Work Performance Questionnaire. Correlation and multivariable linear regression analyses were performed to estimate independent associations. Results: A total of 392 RTs were included in the final analysis. Higher EI was independently associated with greater task performance (B = 0.21, p < 0.01) and contextual performance (B = 0.30, p < 0.001), and with lower counterproductive work behaviours (B = −0.24, p < 0.001). Among WLB dimensions, PLIW showed the strongest adverse association, predicting lower task performance (B = −0.20, p < 0.05) and higher counterproductive behaviours (B = 0.39, p < 0.001), but was not significantly associated with contextual performance in the fully adjusted model. WPLE demonstrated modest positive associations with performance, whereas WIPL was not significant in adjusted models. Conclusions: Job performance among ICU respiratory therapists is shaped by both emotional regulatory capacity and cross-domain strain. Personal life interference with work emerged as the most influential adverse predictor, whereas EI was associated with constructive performance patterns. Findings should be interpreted in light of the cross-sectional design and self-reported data. Sustaining performance in high-acuity settings requires attention to emotional competencies and structural sources of role conflict alongside clinical expertise. These findings inform workforce strategies to support performance and sustainability in critical care settings.

Healthcare doi: 10.3390/healthcare14081005

Authors: Laura J. Wilson Emma V. Ward Luke W. Oates

Background: Older adults are particularly vulnerable to heat related illness due to impaired thermoregulatory responses. Heat acclimation (HA) strategies can mitigate the negative impacts of high environmental temperatures on physiological and perceptual responses. Whilst active HA strategies may prove problematic for older adults, passive approaches such as hot water immersion (HWI) may be more feasible. Methods: This study investigated the effects of four consecutive days of HWI on physiological and perceptual markers in individuals aged over 65 years during moderate exercise. Nine healthy, recreationally active participants (76 ± 5 years) completed two 30 min cycling bouts at 75–80% age predicted HRmax pre- and post-four days of HWI at 40 °C. Measures of average HR, gastrointestinal temperature, skin temperature, thermal sensation, thermal comfort, rate of perceived exertion, power output, and distance covered were recorded during both exercise bouts. Results: Results showed a significant increase in exercise capacity as measured by power output (p < 0.05, 7.45 W) post-intervention, despite no change in ratings of perceived exertion, and reductions in average heart rate (112 ± 3 vs. 109 ± 4 bpm). There were no alterations in gastrointestinal or skin temperature, and ratings of thermal comfort and sensation remained unchanged post-intervention. Conclusions: These preliminary findings provide important new evidence that four days of passive HWI may be a practical and effective method of inducing physiological adaptations in older individuals, which may be of use in interventions to mitigate the negative impact of high environmental temperatures in this population.

Healthcare doi: 10.3390/healthcare14081006

Authors: Supansa Srikong Patcharin Phooncharoen Suranun Klinsrisuk Jakarin Thapsaeng Wichai Eungpinichpong Le Ke Nghiep Kukiat Tudpor

Objective: Village Health Volunteers (VHVs) are vital to Thailand’s primary healthcare, yet many face high risks for non-communicable diseases (NCDs). This preliminary study aimed to implement health empowerment theory-based personalized health promotion for individuals in the NCD-risk group. Methods: The preliminary mixed-methods study implemented a 6-month empowerment-based health promotion program for 21 VHV leaders (mean age 62.43 ± 7.28 years) at risk for NCDs. The intervention integrated laboratory data, behavioral and qualitative focus-group insights, and quantitative anthropometric data obtained via bioelectrical impedance analysis (BIA). Results: Participants’ exercise adequacy significantly improved after the intervention, increasing from 8.3% to 61.9% (p = 0.03). BIA revealed a physiological shift toward improved energy homeostasis, including decreased body weight, reduced visceral fat area, and increased muscle hydration. While biochemical markers did not reach statistical significance, clinically favorable downward trends were observed in median HbA1c (8.0% to 7.3%) and LDL cholesterol (141.8 to 119.0 mg/dL), alongside stable renal and liver function. Qualitative thematic analysis identified four primary domains of impact: sustainability and systemic advocacy, personal transformation, broad competence acquisition, and enhanced social capital. Participants reported a marked increase in self-efficacy, transitioning from inactive beneficiaries to active health advocates. This change was largely driven by mastery experiences, such as visible improvements in body composition and functional health literacy. Conclusions: The empowerment program significantly improved physical activity and body composition while fostering the social capital and health literacy necessary for community leadership, suggesting that personal health mastery is a critical precursor to effective systemic advocacy and long-term sustainability in community-led health programs.

Healthcare doi: 10.3390/healthcare14081004

Authors: Chiara Orlandi Micaela Fredi Cesare Tomasi Martina Salvi Cecilia Nalli Chiara Bazzani Liala Moschetti Ilaria Cavazzana Franco Franceschini

Objective: Clinical remission is a major therapeutic goal in systemic lupus erythematosus (SLE) because of its association with improved long-term outcomes. However, its relationship with patient-reported burden, quality of life, and disease perception remains incompletely understood. This study aimed to evaluate patient-reported outcomes (PROs) in patients with SLE in clinical remission, identify factors associated with impaired health-related quality of life (HRQoL), and assess physician–patient discordance in disease activity perception. Methods: A total of 106 adult patients with SLE in clinical remission according to the definition proposed by Zen et al. were enrolled at a single rheumatology center. Patients were classified into complete remission, clinical remission off corticosteroids, or clinical remission on corticosteroids. Demographic, clinical, and treatment-related data were collected, including organ damage (SLICC-SDI) and disease activity (SLEDAI-2K). Patients completed PRO measures including SF-36, Global Health (GH), pain VAS, STAI-Y1 and STAI-Y2, Zung Depression Scale, Insomnia Severity Index, and HAQ. Disease activity was assessed by both the patient (PGA) and the physician (PhGA); a PGA–PhGA difference >25 mm was considered clinically relevant discordance. Results: Among patients in clinical remission, mild anxiety was observed in 17.1% according to STAI-Y1 and in 27.9% according to STAI-Y2, mild-to-moderate depressive symptoms in 47.1%, and mild insomnia in 25.5%. Of the 106 patients, 24 (22.6%) were in complete remission, 27 (25.5%) in clinical remission off corticosteroids, and 55 (51.9%) in clinical remission on corticosteroids. Patients in clinical remission on corticosteroids showed worse patient-reported outcomes than those in complete remission or clinical remission off corticosteroids. In multivariable analyses, poorer physical HRQoL was independently associated with functional disability, pain intensity, and depressive symptoms, whereas poorer mental HRQoL was independently associated with trait and state anxiety. Clinically relevant physician–patient discordance was observed in 22.6% of the cohort and was almost exclusively driven by higher patient than physician scores. Pain intensity emerged as the most robust independent correlate of discordance. Conclusions: A substantial patient-reported burden may persist in patients with SLE despite clinical remission. Pain, psychological distress, insomnia, and functional disability contribute to impaired HRQoL, while physician–patient discordance appears to reflect a broader mismatch between inflammatory disease control and the patient’s lived experience of illness. These findings support a more comprehensive and patient-centered approach to remission assessment in SLE.

Healthcare doi: 10.3390/healthcare14081003

Authors: Mikie Ebihara Tatsuya Tamura Neteru Masukawa Tomoko Omiya Kumiko Ando

Background/Objectives: Japan’s mental healthcare system is characterized by the world’s highest number of psychiatric beds, widespread “social hospitalization,” and a structurally entrenched managerial support model that frequently undermines patient autonomy. Joint Crisis Plans (JCPs)—collaboratively developed crisis management documents—have been increasingly adopted as a care coordination tool; however, their role in transforming professional practice towards recovery-oriented support remains underexplored. This study aimed to elucidate the experiences of professionals utilizing JCPs across diverse facility types and to develop a theoretical understanding of the process by which they redefine their role from ‘manager’ to ‘recovery companion’. Methods: A qualitative design using the Modified Grounded Theory Approach (M-GTA), grounded in symbolic interactionism, was employed. Semi-structured interviews were conducted with 13 professionals (7 nurses, 6 mental health and welfare workers) across nine facilities (psychiatric hospitals, 24-h residential facilities, outpatient facilities) in the Kanto region of Japan. Theoretical sampling continued until saturation. Data were analyzed using the constant comparative method, with validity ensured through team checking. Results: Nine categories and 23 subcategories were extracted. A three-stage support transformation process emerged: (1) Initial Stage and Motivation, in which professionals confronted the limitations of managerial practice; (2) Role Redefinition and Practice through Collaboration, involving joint crisis management, strength-based support, and network building; and (3) Stage of Integration of Perspectives and Implementation of Recovery-Oriented Practice, in which professionals witnessed individual recovery and integrated new support values into their practice. Negative cases revealed that JCP effectiveness is contingent on the co-construction of shared meaning rather than procedural compliance. Conclusions: JCP was suggested to function as a potential tool to facilitate navigating and reframing structural managerial barriers in Japanese mental healthcare. The creation of a shared language through JCP was associated with supporting conditions for individual self-determination, alleviating professional conflicts, and contributing to shifts in organizational culture.

Healthcare doi: 10.3390/healthcare14081002

Authors: Oscar Araque Luz Adriana Sánchez-Echeverri Ivonne X. Cerón

Objectives: Cardiovascular diseases (CVDs) represent the main global burden of morbidity and mortality, with an accelerated epidemiological transition in regions such as Latin America. The university environment constitutes a period of critical vulnerability due to increased sedentary lifestyles and cardiometabolic risk factors. The objective of this study was to evaluate the cardiovascular risk profile in a university community in the central Andean region of Colombia using anthropometric, haemodynamic and biochemical indicators. Methods: A cross-sectional, observational, and analytical study was conducted on a sample of n = 143 participants (students, teachers, and administrators) aged between 18 and 80 years. Haemodynamic parameters (SBP, DBP, MAP), anthropometric parameters (BMI, % body fat, waist-to-height ratio [WC/W]) and lipid profile were evaluated. Statistical analysis included multiple linear regression models to determine predictors of systolic blood pressure (SBP). Results: Significantly higher levels of SBP were found in the older age groups compared with the younger age groups, reaching stage 1 hypertension levels in the sixth decade. The biochemical profile revealed metabolic deterioration with an atherogenic index (TC/HDL) consistently above the clinical threshold (>4.5) in all groups. The regression model BMI was identified as the statistical predictor with the strongest association with SBP variability in the sample (β = 1.18), followed by age (β = 0.28). A marked sexual dimorphism was observed, with men presenting early haemodynamic risk, while women experienced an accelerated post-menopausal tension and metabolic crisis. Conclusions: The university community presents latent cardiometabolic vulnerability closely linked to modifiable anthropometric factors. These findings underscore the urgency of implementing institutional preventive health policies and weight control intervention programmes to mitigate the future burden of chronic diseases on campus.

Healthcare doi: 10.3390/healthcare14081001

Authors: Yelson Alejandro Picón-Jaimes Judit Mauri Juliachs Iván Arrufat Martin Milena Lopez-Castaño

Background: Hyperparathyroidism is a common endocrine disorder, and its diagnosis can be complex. Various indices based on blood biomarkers have been proposed to improve diagnostic accuracy. The objective of this systematic review was to analyze the diagnostic utility of different indices in primary hyperparathyroidism. Methods: A systematic review was performed with searches up to January 2026. Risk of bias was assessed, and a meta-analysis was conducted for indices with two or more studies, calculating sensitivity, specificity, and other accuracy measures. The certainty of the evidence was evaluated using the GRADE system. Results: Twelve studies were included. The calcium–phosphorus ratio demonstrated a sensitivity of 91.6%, specificity of 89.3%, and an area under the curve of 0.957. The parathyroid function index showed a sensitivity of 94.4% and specificity of 94.2%; however, this finding is based on only two studies and requires validation in larger cohorts. The Wisconsin index also showed good performance. Other indices, including the Ca × Cl/P ratio (evaluated in a single study), yielded promising results but with very limited evidence that precludes firm conclusions. All indices performed poorly in cases with normal calcium. Certainty assessment indicated moderate evidence for the main indices and low or very low evidence for the others. Conclusions: The calcium–phosphorus ratio and the parathyroid function index are valid and useful tools for the diagnosis of primary hyperparathyroidism, with excellent performance. The calcium–phosphorus ratio is especially valuable due to its simplicity and accessibility for screening. No index should be used in isolation; integration with clinical evaluation remains essential.

Healthcare doi: 10.3390/healthcare14081000

Authors: Yuting Hu Liangyu Mi Xinyi Yang Jinfang Gao Ke Xu

Background: Frailty is a fluctuating health state that may worsen or improve over time and is linked to adverse outcomes, including musculoskeletal disorders such as arthritis. However, evidence on whether frailty changes predict arthritis onset remains limited. This study examined the relationship between changes in frailty status and incident arthritis among Chinese adults aged 45 years and older. Methods: We performed a longitudinal cohort analysis using data from the China Health and Retirement Longitudinal Study (CHARLS). Frailty was quantified with a 30-item Frailty Index (FI) and categorized as robust, pre-frail, or frail. Frailty transitions were defined by changes in FI-based categories across survey waves. Incident arthritis was identified as self-reported physician-diagnosed arthritis during follow-up. Associations between frailty transitions and arthritis onset were evaluated using Cox regression, reporting hazard ratios (HRs) and 95% confidence intervals (CIs). Models were adjusted for demographic characteristics, health behaviors, and biochemical indicators, and sensitivity analyses were conducted to verify result stability. Results: Among 4982 participants (mean age 58.97 years; 45.58% female). Relative to robust individuals, baseline pre-frailty (HR 1.67, 95% CI 1.41–1.97) and frailty (HR 2.76, 95% CI 1.97–3.85) were associated with higher arthritis risk. Participants whose frailty status worsened from robust to pre-frail or frail also showed higher arthritis risk (HR 1.68, 95% CI 1.34–2.10). In contrast, transitions from frail to pre-frail or robust were associated with lower risk (HR 0.44, 95% CI 0.21–0.92). Higher cumulative frailty burden and greater frailty progression were also associated with increased arthritis risk. Conclusions: Frailty transitions are strongly associated with incident self-reported physician-diagnosed arthritis. Monitoring frailty trajectories may improve arthritis risk stratification and support prevention strategies.

Healthcare doi: 10.3390/healthcare14080999

Authors: Yuhan Zhang Alba Carrió Julia Sevilla-Llewellyn-Jones Enrique Gutiérrez Ana Calvo Jose-Blas Navarro Ana Barajas

Background/Objectives: In recent years, research on psychosis has increasingly focused on prevention, aiming to implement early interventions that mitigate or reduce its impact. Within this framework, the analysis of linguistic markers in individuals with at-risk mental states (ARMS) has proven valuable for identifying those at risk and predicting psychosis onset. Artificial intelligence tools, particularly natural language processing (NLP), have emerged as effective resources for detecting these language-based indicators. This study aims to synthesize the existing scientific evidence on linguistic markers analyzed through NLP techniques in individuals with ARMS. Methods: A systematic review following the PRISMA 2020 protocol was conducted. Three databases (PubMed, PsycInfo, and Scopus) were searched for published articles from their inception to October 2025. Rayyan software was used to manage references and article downloads. Out of ninety initial search results, fifteen studies involving 1313 participants from diverse groups were included in the review. Results: The findings indicated that alterations in semantic coherence, syntactic complexity, referential cohesion, and speech/content poverty differentiated ARMS individuals from healthy controls. Several of these markers, analyzed with NLP methods, predicted the onset of psychosis with accuracy levels ranging from 79% to 100%, although these findings should be interpreted with caution due to the significant methodological heterogeneity and variability in sample sizes across the included studies. Conclusions: NLP techniques offer a powerful approach for detecting language alterations that distinguish ARMS individuals and provide meaningful predictions of psychosis onset, highlighting their potential as a complement to traditional clinical assessments for early identification and prevention.

Healthcare doi: 10.3390/healthcare14080998

Authors: Josiane Nicolle Pereira Francisco A. Ferreira Vinícius Costa Lima

Background/Objectives: Type 2 Diabetes Mellitus (T2DM) is a prevalent metabolic disorder associated with major cardiovascular and metabolic complications. Regular physical activity is recommended for glycaemic management, but barriers such as obesity, joint pain, and impaired mobility may limit participation in land-based exercise. Aquatic exercise may provide a feasible alternative as water buoyancy reduces joint loading while allowing aerobic and resistance training. This systematic review and meta-analysis evaluated the effects of aquatic exercise interventions on glycaemic control in adults with T2DM. Methods: The review followed the PRISMA 2020 guidelines. MEDLINE, Cochrane CENTRAL, Scopus, Web of Science, and IEEE Xplore databases were searched. Randomised and non-randomised longitudinal studies involving adults aged ≥35 years with T2DM participating in structured aquatic exercise programmes were eligible. The primary outcome was glycated haemoglobin (HbA1c). Risk of bias was assessed using RoB 2 and RoBANS 2, and certainty of evidence was evaluated using GRADE. Random-effects meta-analysis calculated mean differences (MDs) with 95% confidence intervals. Results: Eleven randomised controlled trials involving 335 participants were included. Aquatic exercise significantly reduced HbA1c compared with passive control conditions (MD = −0.76%; 95% CI −1.21 to −0.32), although heterogeneity was high. No significant differences were observed between aquatic and land-based exercise interventions. Eight studies used wearable heart-rate monitors to regulate exercise intensity. Conclusions: Aquatic exercise may improve glycaemic control compared with sedentary conditions and yields effects comparable to those of land-based exercise in adults with T2DM. Further high-quality trials are needed to clarify optimal exercise dose–response and evaluate more advanced wearable technologies.

Healthcare doi: 10.3390/healthcare14080997

Authors: Emily Chisholm Tori N. Stranges

2S/LGBTQIA+ survivors of intimate partner violence (IPV) face multiple, intersecting barriers to accessing care, yet little is known about how these barriers are shaped by IPV-caused brain injury (IPV-BI). Background/Objectives: This study aimed to explore how stigma and institutional trust influence 2S/LGBTQIA+ survivors’ experiences of help-seeking following IPV-BI. Guided by a Community Advisory Board, four semi-structured focus groups were conducted with 29 2S/LGBTQIA+ IPV-BI survivors. Methods: Reflexive thematic analysis was used to examine participants’ help-seeking accounts, with attention to minority stress and intersecting stigmas related to IPV, BI, and 2S/LGBTQIA+ identity. Results: The findings indicate that survivors navigated compounded stigmas that limited access to safe, affirming services and heightened vulnerability during help-seeking. Institutional trust was central to participants’ decisions to disclose sensitive information and engage in care, with confidentiality emerging as a critical determinant of perceived safety. Participants described negotiating disclosure, anticipating discrimination, and avoiding services when systems were perceived as unsafe or unresponsive. Conclusions: These findings highlight the need for service systems to integrate IPV-BI into screening and support protocols, provide training on the intersections of IPV, BI, and 2S/LGBTQIA+ identities, and centre confidentiality as a condition for trust and access, ultimately fostering safer, more responsive systems of care.

Healthcare doi: 10.3390/healthcare14080996

Authors: Emilia Clej Adelina Mavrea Camelia Fizedean Alina Doina Tănase Adrian Cosmin Ilie Alina Tischer

Background: Digitalization and artificial intelligence-supported clinical decision support systems (AI-DSS), defined here as tools that generate patient-specific alerts, risk estimates, prioritization prompts, documentation suggestions, or related recommendation outputs intended to support rather than replace professional nursing judgment, can improve clinical decision-making, yet they may also amplify technostress and burnout, with downstream effects on missed nursing care and implementation readiness. Methods: We surveyed 239 registered nurses from a tertiary-care hospital in Timișoara, Romania (January–March 2025), including critical care (n = 60) and general wards (n = 179). Measures included a 15-item technostress scale, eHEALS, Maslach Burnout Inventory–Human Services Survey (MBI-HSS), Safety Attitudes Questionnaire (SAQ) teamwork and safety climate subscales, a 10-item missed nursing care inventory, and a six-item AI-DSS acceptance scale reflecting perceived usefulness, trust, and stated willingness to use such tools if available as an attitudinal readiness outcome rather than as routine observed use. Multivariable regression, exploratory mediation models, cluster analysis, and exploratory ROC analysis were performed. Results: Higher technostress was associated with higher emotional exhaustion (r = 0.52) and more missed care (r = 0.41), whereas eHealth literacy correlated with higher AI-DSS acceptance (r = 0.35) and lower technostress (r = −0.34). In adjusted models, technostress (per 10 points) was associated with higher missed care (β = 0.28, p < 0.001) (equivalent to 0.14 points per 5-point increase) and higher odds of low AI-DSS acceptance (OR = 1.38, p = 0.001), while eHealth literacy was associated with lower odds of low acceptance (OR = 0.71 per 5 points, p < 0.001). Burnout and the safety climate statistically accounted for approximately 35% of the technostress–missed care association. Three workflow phenotypes were identified, with the high-strain/low-literacy cluster showing the most missed care (3.5 ± 1.8) and the lowest AI acceptance (19.7 ± 5.2). An exploratory in-sample ROC model for intention to leave achieved an AUC of 0.82. Conclusions: Higher technostress clustered with worse nurse well-being, more care omissions, and lower AI-DSS acceptance, whereas eHealth literacy appeared protective. Interventions combining digital skills support, usability-focused redesign, and a stronger safety climate may reduce missed care and support safer AI implementation.

Healthcare doi: 10.3390/healthcare14080995

Authors: Vera Bártolo Miguel Jacinto Nuno Amaro Raúl Antunes Rui Matos Nuno Couto Luís Cid Pedro Duarte-Mendes Filipe Rodrigues Diogo Monteiro

Background/Objectives: Grounded in Self-Determination Theory, this study aimed to translate and validate the Basic Psychological Need Satisfaction and Frustration Scale (BPNSFS), including the Novelty dimension, within the Portuguese exercise context. Given the emerging evidence of novelty as a potential candidate for a basic psychological need, this research examined the psychometric properties and temporal stability. Furthermore, this study explored the nomological validity of these constructs regarding exercise enjoyment and satisfaction with life. Methods: The sample comprised 500 gym-goers (263 females; 237 males), aged between 18 and 65 years (M = 33.76; SD = 12.94). Confirmatory Factor Analysis and Exploratory Structural Equation Modeling were employed to compare the factor structure. Temporal stability was assessed through a test–retest procedure with a four-week interval (n = 50). Results: Exploratory Structural Equation Modeling provided a superior fit to the data (CFI = 0.98; TLI = 0.97; RMSEA = 0.04) compared to Confirmatory factor Analysis, supporting the distinctiveness of the eight dimensions. The instrument demonstrated strong internal consistency (composite reliability ranging from 0.78 to 0.90) and adequate discriminant validity. Path analysis revealed that novelty satisfaction was significantly associated with enjoyment and satisfaction with life. In reverse, novelty frustration was negatively associated with these well-being indicators. Intraclass correlation coefficients (0.75 to 0.83) confirmed robust temporal stability. Conclusions: These findings provide evidence that the Portuguese version of the BPNSFS, including the novelty dimension, is a psychometrically comprehensive instrument for the exercise context. The results support the inclusion of novelty as a relevant psychological need within Self-Determination Theory.

Healthcare doi: 10.3390/healthcare14080994

Authors: Paulo Lino Kidayi Christina Chuck Mtuya Eva-Christina Risa Jane Januarius Rogathi

Background: Evidence shows that simulation-based education for nurses and midwives contributes to strengthening patient safety and quality of care in healthcare settings. Nevertheless, it is implemented to a limited degree in Sub-Saharan African (SSA) higher education institutions, including Tanzania. This demands that Tanzania shift from a traditional model of teaching to incorporate simulation-based education to produce a skilled workforce. Objective: To explore perceptions and experiences of nurse educators (lecturers) and midwives on simulation-based education in Tanzania. Methods: The study employed a generic qualitative descriptive study design with purposive sampling. The data were collected through individual semi-structured interview guides with nurse educators and midwives (nine nurse educators and 11 midwife graduates) from two selected universities in the School of Nursing and their respective teaching hospitals. Qualitative inductive content analysis was used to analyze the data. Results: The data analysis revealed three themes and nine sub-themes: 1. Knowledge and skills in simulation-based education. 2. Challenges in the implementation of simulation-based education. 3. Ensuring patients’ safety. Conclusions: Students were indeed experienced, but not trained in how to use simulation-based education, and nurse educators had inadequate skills. A high number of students with inadequate infrastructure and resources is the major challenge experienced by participants. Simulation-based education is at an early stage of adoption in Tanzania and will require ongoing development, support and resources to fulfilll its potential in promoting patient safety.

Healthcare doi: 10.3390/healthcare14080993

Authors: Antonios Siargkas Alexandra Arvanitaki Areti Faka Efstratios Karagiannidis Barbara Fyntanidou Apostolos Mamopoulos Antonios P. Antoniadis Nikolaos Fragakis Themistoklis Dagklis Ioannis Tsakiridis

Introduction: The prevalence of maternal arrhythmias is increasing with advanced maternal age. Current evidence regarding the association between maternal arrhythmias and pregnancy outcomes remains inconsistent. This meta-analysis aimed to define the associations between adverse pregnancy outcomes and specific maternal arrhythmias. Methods: We conducted a systematic review and meta-analysis using the PRISMA guidelines. We searched MEDLINE, Scopus, and Cochrane on the 4th of November 2025 for cohort and case–control studies comparing pregnant women with cardiac arrhythmias to those without. Primary outcomes included preeclampsia, stillbirth, preterm delivery, and small-for-gestational-age (SGA) neonates. Data were pooled using random-effects models with subgroup analyses by arrhythmia type. Results: Nineteen studies were included. Maternal arrhythmias were associated with a significantly increased risk of preeclampsia (RR = 1.46, 95% CI [1.10, 1.93]), preterm delivery (RR = 1.39, 95% CI [1.12, 1.72]), and stillbirth (RR = 2.09, 95% CI [1.11, 3.91]). Ventricular tachycardia/fibrillation was linked to the most severe outcomes, including a four-fold increase in stillbirth (RR = 4.20, 95% CI [3.75, 4.71]) and a fifteen-fold increase in neonatal death (RR = 15.47, 95% CI [3.45, 69.45]). Supraventricular tachycardia was independently associated with preeclampsia (aRR = 1.14, 95% CI [1.04, 1.24]), preterm delivery (aRR = 1.76, 95% CI [1.39, 2.23]), and SGA neonates (aRR = 5.93, 95% CI [1.23, 28.55]). Risks were notably higher in the general population compared to women with known heart disease, supporting an “unmasking” of occult vulnerability. Conclusions: Maternal arrhythmias are associated with distinct fetal risks beyond maternal hemodynamics. Ventricular tachycardia was associated with severe outcomes, likely reflecting acute compromise, while supraventricular tachycardia was linked to signs of chronic vascular dysfunction. These findings suggest arrhythmias as possible sentinels for placental insufficiency, necessitating enhanced surveillance.

Healthcare doi: 10.3390/healthcare14080992

Authors: Hacer Demirkol Şeyda Dülgerler

Background/Objectives: Intimate partner abuse (IPA) is common among university students, including nursing students, and is linked to posttraumatic stress symptoms. Accessible online psychosocial interventions are needed to reduce trauma-related symptoms and support posttraumatic growth (PTG). This study examined the effects of an online psychosocial intervention grounded in social learning theory and cognitive behavioral therapy on posttraumatic stress symptoms and PTG among nursing students who experienced IPA in Türkiye. Methods: A randomized controlled trial was conducted among nursing students in Türkiye reporting IPA exposure. Participants were randomly assigned to an intervention group (n = 17) or a control group (n = 18). The intervention group received an eight-session online psychosocial program delivered individually. Assessments were conducted at pre-intervention, post-intervention, and at 1-, 3-, and 6-month follow-ups. Repeated-measures ANOVA was used, and partial eta-squared (ηp2) values were calculated. Results: The intervention group showed significant reductions in posttraumatic stress symptoms compared with the control group, with large effect sizes (p < 0.001; ηp2 = 0.402–0.676). Furthermore, significant increases were observed in posttraumatic growth, indicating large and sustained effects over time (p < 0.001; ηp2 = 0.515–0.773). Conclusions: The online psychosocial intervention effectively reduced posttraumatic stress symptoms and enhanced posttraumatic growth among nursing students who experienced IPA. However, results should be interpreted with caution due to the small sample size, and future studies with larger samples are warranted.

Healthcare doi: 10.3390/healthcare14080991

Authors: Cristobal Merino-Meza María José Cáceres-Titos Angela María Ortega-Galán María Dolores Ruiz-Fernández Jose Miguel Robles-Romero E. Begoña Garcia-Navarro

Background/Objectives: The death of a parent due to illness during adolescence constitutes a highly disruptive experience that compounds the developmental losses inherent to this stage of life. Distinguishing between the emotional and behavioural changes characteristic of adolescent development and those specific to grief can be complex, which may hinder the support provided by health, social care, and educational professionals. The aim of this study was to understand the grieving process and associated suffering in young university students who had lost a parent during adolescence. Methods: An exploratory qualitative design with a phenomenological approach was employed. Nine semi-structured interviews were conducted to examine in depth the experiences of suffering and grief associated with the loss of a family member among university students. The study adhered to the COREQ guidelines (Consolidated Criteria for Reporting Qualitative Research). Results: Among the main findings, the quality of the bond with the deceased parent emerged as particularly significant, as it influences the adolescent’s identity formation process. The loss of this parent may hinder processes of differentiation and independence, affecting the decisions young people must make as they transition into adulthood. This proves especially important in key life choices that shape their life project, such as vocational decisions and intimate partner relationships. Conclusions: Parental death during adolescence has long-lasting repercussions on identity construction and the shaping of one’s life project. It is necessary to strengthen psychosocial support within both clinical and educational contexts in order to address the specific needs of adolescents and young people undergoing this experience.

Healthcare doi: 10.3390/healthcare14080990

Authors: Miseon Kwak Eunju Bae Wonjae Choi Myung Ho Lim

Background/Objectives: Research comprehensively analyzing the psychological characteristics and factors related to smartphone addiction in Korean children and adolescents at risk for depression remains scarce. This study utilized large-scale cohort data to examine the differences in psychological characteristics between an at-risk group for depression and a control group, and to identify the specific factors influencing smartphone addiction within the at-risk group. Methods: Data were obtained from the school-based cohort of internet and smartphone users conducted by the National Center for Mental Health (NCMH), involving a total of 2294 children and adolescents (1009 in the at-risk for depression group and 1285 in the control group). Assessment tools included the Children’s Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC/TAIC), Self-Esteem Scale (SES), Self-Control Scale, Aggression Questionnaire (K-AQ), School Bullying (SB) scale, and the Smartphone Addiction Scale-Short Form (SAS-SV). Results: Analysis of Covariance (ANCOVA) revealed that the at-risk group exhibited significantly higher levels of anxiety, aggression, involvement in school bullying, and smartphone addiction compared to the control group, while showing lower levels of self-esteem and self-control. Furthermore, multiple regression analysis indicated that higher anxiety and lower self-control were significant predictors of increased smartphone addiction levels. Conclusions: These findings support the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, which posits that emotional vulnerability and deficits in executive functions lead to addictive behaviors. The results suggest that reducing anxiety and enhancing self-control are critical factors in the prevention of smartphone addiction among children and adolescents.

Healthcare doi: 10.3390/healthcare14080989

Authors: Mauro Lorusso Michele Tepedino Gianvittorio Ferritto Elena D’Angelo Fariba Esperouz Lucio Lo Russo Domenico Ciavarella

Objectives: Class II malocclusion is a frequent orthodontic problem in growing patients, and understanding the dentoskeletal effects of different treatment approaches is essential for selecting the most appropriate therapeutic strategy. This study aimed to compare the skeletal and dentoalveolar effects of the Carriere Motion appliance (CMA) and the Rapid Maxillary Expander II (RME II) system in growing patients with Class II malocclusion, using an untreated control group. Methods: This study included 86 growing patients with skeletal Class II Division 1 malocclusion, divided into three groups: RME II (n = 28), CMA (n = 28), and untreated controls (n = 30). Lateral cephalograms were obtained at baseline (T0) and after Class II correction (T1). Skeletal and dentoalveolar variables were assessed, and intergroup differences in treatment changes were analyzed using appropriate statistical tests with correction for multiple comparisons. Results: Both treatment groups showed significantly greater reductions in overjet than the control group, with no significant difference between the two appliances. The CMA group showed a greater reduction in overbite, whereas the RME II group showed greater reductions in the A point–Nasion–B point (ANB) angle and greater increases in mandibular length (Condylion–Gnathion; Co-Gn) compared with both the control and CMA groups. Conclusions: Both appliances were effective in correcting Class II malocclusion during growth. However, the CMA was mainly associated with dentoalveolar correction and vertical changes, whereas the RME II system induced more evident skeletal modifications.

Healthcare doi: 10.3390/healthcare14080988

Authors: Martins Nweke Julian Pillay

Background: Hypertension remains one of the leading causes of cardiovascular morbidity and mortality in South Africa. Although extensive evidence exists on modifiable risk factors, the translation of this evidence into strategic and equitable health investments remains limited. Current models such as the Global Burden of Disease (GBD) and WHO “Best Buys” identify key exposures, but lack operational mechanisms for context-specific prioritisation and dynamic resource allocation. The aim of this study is to develop and validate an integrated decision-support model that links evidence-based risk factor prioritisation with dynamic budget allocation to improve hypertension prevention and control in South Africa. Methods: This study adopts a two-phase mixed-methods design. Phase 1 develops a Risk Factor Prioritisation Model that ranks modifiable exposures using composite indices for the causality strength, implementation feasibility, policy integration, and equity. Phase 2 constructs a Dynamic Resource Allocation Model that distributes health budgets across interventions to maximise Disability-Adjusted Life Years (DALYs) averted, subject to budget and equity constraints. The model integrates data from systematic reviews, GBD 2019 estimates, WHO-CHOICE cost data, and national health expenditure databases. A validated quantitative Risk Priority Score (RPS) for major hypertension risk factors, an optimisation model for resource allocation, and an interactive dashboard that visualises efficiency and equity trade-offs under varying budget scenarios are expected. Conclusions: This study will provide a reproducible model for transforming epidemiological and economic evidence into actionable policy guidance. It bridges the gap between evidence generation and health planning, supporting more equitable and data-driven decision making in noncommunicable disease control.

Healthcare doi: 10.3390/healthcare14080987

Authors: Nadia O. Elamin Hala E. Danish Razan O. Bawazir Renad F. Alharthy Renad I. Katib Joud M. Alharthy Maryam N. Alotibi Turki A. Banamah

Background: Cardiovascular disease (CVD) represents the second leading cause of death among kidney transplant recipients (KTRs). CVD risks post-transplantation increase with aging, obesity, dyslipidemia, diabetes, hypertension, inactivity, sleep disturbances, immunosuppressant medications use, and graft dysfunction. This study assessed CVD prevalence and risk factors among KTRs. Methods: A cross-sectional study was conducted at National Guard Hospital, Jeddah between 2012–2022. Information was collected from the patients’ medical records. Physical activity, sleep, and adherence to immunosuppressant therapy were evaluated via interviews with adult KTRs using the International Physical Activity Scale, Jenkins Sleep Scale, and Immunosuppressant Therapy Barrier Adherence Scale, respectively. Results: Sixty-four KTRs were included: 67% were males, and the median age was 44.7 years. Eighteen patients (28.1%) had CVD, and 61.1% of them developed ischemic heart disease. KTRs with CVD were older, had lower estimated glomerular filtration rate (eGFR), and higher Hemoglobin A1c (HbA1c), but these differences were not statistically significant (p > 0.05). Patients with CVD had significantly lower LDL (p = 0.02) and more aspirin and statin use (p < 0.05). Forty-five patients (70.3%) completed the interview; most of them had few sleep disturbances and good adherence to immunosuppressant therapy. Low physical activity was reported by KTRs with CVD. Conclusions: CVD was present in over one-quarter of KTRs. Patients with CVD were older, less active, had lower GFR, higher HbA1c, and significantly lower LDL. More use of aspirin and statin improved the glycemic control, physical activity, and medication adherence, and may help in reducing CVD burden among KTRs.

Healthcare doi: 10.3390/healthcare14080986

Authors: Roberta Matković Lucija Vejmelka

Background: Problematic Internet use (PIU) among adolescents has emerged as a significant public health concern, associated with the types of online activities and underlying psychological processes rather than screen time alone. Methods: This cross-sectional study included 750 adolescents (46.4% female) with a mean age of 15.39 years (SD = 1.76; range = 13–19) recruited from 7th and 8th grade primary school students and secondary school students in Split-Dalmatia County (Croatia). The study investigated the associations between specific online activities, psychological variables, and PIU using hierarchical regression and multiple mediation analyses. Results: Results revealed that time spent online remains the most strongly associated with PIU. While streaming and online shopping showed significant associations with problematic use, reading and browsing for information did not. Stress and loneliness were identified as variables associated with higher that significantly statistically mediate the relationships between online engagement and PIU, whereas emotional competence functioned as a protective factor, particularly in relation to social media use. These findings support theoretical models that conceptualize PIU as a maladaptive coping strategy for psychological distress. Conclusions: Based on these findings, prevention efforts should move beyond simple screen-time reduction and focus on strengthening adolescents’ emotional competence, stress management, and self-regulatory skills to promote healthier and more adaptive patterns of digital engagement.

Healthcare doi: 10.3390/healthcare14080983

Authors: Effie Simou Dimitrios Tseronis Konstantina Zoupidou Dimitrios Boumpas

Background: Shared decision-making (SDM) is particularly relevant in rheumatoid arthritis (RA), where multiple treatment options with distinct benefit–risk profiles require alignment with patient values and preferences. This study describes the development of a web-based PtDA to support treatment decision-making in RA and represents the first structured, standards-aligned PtDA in the Greek healthcare context. Methods: Guided by the Ottawa Decision Support Framework and the International Patient Decision Aid Standards, a multistage, user-centered methodology was applied, including evidence synthesis, iterative prototyping, and alpha and beta testing. Qualitative methods, including focus group discussions, semi-structured interviews, and think-aloud protocols, were used, while usability was assessed with the System Usability Scale (SUS). Methodological quality was evaluated using IPDASi v3 and UCD-11 criteria. Results: The final PtDA provides a three-step pathway supporting values clarification, comparison of medication options, and reflection on decisional confidence. It was developed as a publicly accessible, web-based tool compatible with multiple devices, with core elements also available in printable format. The tool showed good usability (mean SUS: 75.93) and strong alignment with IPDASi (83.3/100), and user-centered design criteria (11/11). Conclusions: Developing digital PtDAs is inherently complex, underscoring the importance of established methodological frameworks. The findings demonstrate acceptable usability and alignment with established standards within this early-stage development study. Further research is required to examine the tool’s impact on decision-making processes, value–choice concordance, and longer-term clinical outcomes.

Healthcare doi: 10.3390/healthcare14080985

Authors: Jianhua Li Jian Wang Renxiu Bian

Background: Stroke-related impairments in balance and gait are among the most common and disabling sequelae, significantly limiting functional independence and increasing fall risk. This study investigated the effects of short-term dynamic balance training on balance and gait in post-stroke hemiplegic patients. Methods: In this randomized controlled pilot trial, 16 post-stroke hemiplegic patients (intervention group, n = 8; control group, n = 8; mean age ≈ 58 years; predominantly male) were assigned to either a control group receiving conventional rehabilitation or an intervention group receiving additional daily dynamic balance training using the Prokin-252 system (30 min/day, 5 days/week, 3 weeks). Primary outcome measures included balance performance (Berg Balance Scale, mini-BESTest, single-leg stance), center-of-pressure (COP) parameters, gait performance (Timed Up and Go Test), and surface electromyography (sEMG) activity. Results: Following the intervention, both groups demonstrated improvements; however, the intervention group showed significantly greater gains in balance and gait outcomes. Specifically, Berg Balance Scale scores improved significantly (p = 0.012), as did mini-BESTest scores (p = 0.004). Eyes-closed single-leg stance time increased significantly on both sides (p < 0.05). COP analysis revealed reductions in sway area and trajectory length under challenging conditions. sEMG analysis indicated increased activation of the affected-side gluteus medius. In terms of gait performance, the intervention group demonstrated greater improvements in Timed Up and Go Test performance (p = 0.002), dual-task walking, and gait phase symmetry. Conclusions: Supplementing conventional rehabilitation with dynamic balance training effectively enhances balance and gait function in post-stroke patients, potentially through improved neuromuscular control. The integration of sensor-based COP analysis and sEMG provides additional mechanistic insight into rehabilitation outcomes.