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

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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.

Healthcare doi: 10.3390/healthcare14080982

Authors: Amélie Rosière Sebastian Riemann Olfa Guaddoudi Stéphanie Pochet Guy Brusselle Carine De Vriese

Background/Objectives: Therapeutic adherence to asthma and COPD medications remains worryingly low and varies widely across patient groups, underscoring persistent challenges in chronic respiratory care. The aim of this nationwide study is to quantify real-world adherence and to identify its demographic and clinical determinants using the Belgian health care claims database of the National Institute for Health and Disability Insurance (NIHDI). Methods: Adherence was assessed using the Continuous Multiple Interval Measure of Medication Availability (CMA) among patients treated between 2020 and 2023. Mixed-effects logistic regression was applied to identify determinants of adherence. Results: Only 30.5% of patients achieved good adherence (CMA ≥ 0.8). Adherence varied substantially across pharmacological classes, ranging from 8.1% for inhaled corticosteroids to 66.4% for triple therapy. Age emerged as a major determinant, with adherence increasing steadily across age groups: only 4.0% of children and 15.7% of adolescents reached good adherence, compared with progressively higher rates in adults. Mixed-effects logistic regression confirmed age, sex, and pharmacological class as robust predictors of adherence. Conclusions: These findings highlight the magnitude of the therapeutic adherence gap in chronic respiratory diseases and clearly identify children, adolescents, and ICS or LABA + ICS users as the highest-risk groups. Recognizing these profiles has direct implications for clinical practice, as it provides concrete targets for future patient-centered interventions and guideline-concordant adherence-enhancing strategies.

Healthcare doi: 10.3390/healthcare14080984

Authors: Rossella Procaccia Giulia Segre Cristina Liviana Caldiroli

Background: Exposure to intimate partner violence (IPV) represents a major risk factor for both maternal psychological well-being and child development. Maternal psychopathology—particularly depression and post-traumatic stress disorder (PTSD)—has been shown to impair parenting functioning and increase children’s vulnerability to emotional and behavioral difficulties. Objectives: This study examined the associations between maternal depression and PTSD symptoms and children’s internalizing and externalizing problems, and explored whether parenting stress and maternal mentalization capacities mediate these relationships. Methods: The sample included 42 mothers (mean age = 43.38, SD = 10.56) and their preschool- and school-aged children (n = 42; mean age = 8.30, SD = 2.53) exposed to IPV. Mothers completed self-report measures assessing depressive and PTSD symptoms, parenting stress, and mentalization (uncertainty and certainty about mental states). Children’s internalizing and externalizing problems were assessed through maternal report. Mediation analyses with bootstrapping procedures were conducted to examine indirect effects. Results: Maternal depressive symptoms emerged as the strongest predictor of children’s internalizing problems. Parenting stress was associated with stronger relationships between maternal symptoms and children’s internalizing problems, while polarized mentalization—particularly uncertainty and, to a lesser extent, excessive certainty about mental states—partially mediated the relationship. Maternal PTSD symptoms predicted both internalizing and externalizing problems. Parenting stress fully mediated the association between PTSD symptoms and children’s externalizing behaviors, whereas excessive certainty and uncertainty about mental states showed partial mediation effects. Conclusions: These findings suggest that maternal psychopathology may influence child adjustment both directly and indirectly through increased parenting stress and dysregulated mentalization. The results highlight the importance of trauma-informed, dyadic interventions targeting maternal mental health, parenting stress, and reflective functioning to prevent the intergenerational transmission of trauma and support resilience in families exposed to IPV.

Healthcare doi: 10.3390/healthcare14080981

Authors: Daniela Pereira Filipe Rodrigues

Background/Objectives: Institutionalized aging is associated with severe physical deconditioning, a high risk of falls, and a pervasive fear of falling. Physical exercise mitigates these factors, but the comparative efficacy of different training methodologies in this specific population remains unclear. The objective of this study was to compare the impact of a multicomponent exercise program versus a dual-task (cognitive-motor) training program on reducing fall risk, decreasing the fear of falling, and improving physical performance in institutionalized older adults. Methods: A randomized, parallel group controlled trial involving 21 older adults residing in a nursing home (Mean age = 83.67 ± 6.17 years). Participants were allocated to either a Multicomponent Group (n = 11) or a Dual-Task Group (n = 10) for a 12-week intervention (2 sessions/week). Fall risk, fear of falling, and global physical performance were assessed at baseline and post-intervention. Results: No significant improvements were observed in fall risk assessment execution time for either group. The Multicomponent Group showed a significant reduction in the fear of falling (−29.1%; 95% CI [−17.27, −1.27], p = 0.025) and a clinically significant improvement in physical performance (+40.9%; 95% CI [1.11, 3.43], p < 0.001), supported by large time effects (FES-I: F(1, 19) = 4.52, η2p = 0.192; SPPB: F(1, 19) = 13.68, η2p = 0.419). The Dual-Task Group achieved no significant changes in these dimensions. Furthermore, a marginally significant time-by-group interaction was observed for physical performance, favoring the multicomponent approach (F(1, 19) = 3.83, p = 0.065, η2p = 0.168 [large effect]). Conclusions: Multicomponent training proved superior in improving physical performance and reducing the fear of falling. In a frail, institutionalized population, the attentional cost demanded by dual-task training appears to limit the physical and psychological benefits of exercise.

Healthcare doi: 10.3390/healthcare14080980

Authors: Jui-Ying Hung

Background: As Taiwan transitions into a super-aging society, the government has launched “Long-term Care (LTC) 3.0,” a policy initiative that marks a strategic shift from service expansion to integrated quality verification, digital oversight, and social resilience. This transition demands a robust quality verification mechanism. Ensuring perceptual consistency between service providers and external evaluators is critical for systemic fairness and sustainable service quality. Objective: This study utilized a two-dimensional gap analysis to examine the discrepancy in service quality benchmarks between home-based LTC center managers and assessment committee members, identifying critical divergence zones for institutional improvement. Methods: A cross-sectional evaluative study was conducted, involving center managers (evaluatees, n = 50) and external experts (evaluators, n = 28). The data were collected via a structured instrument covering 20 consensus benchmarks. Results: Significant perceptual gaps were identified across all dimensions (p < 0.001), with “Professional Care Quality” exhibiting the largest effect size (Cohen’s d > 1.5). Benchmarks with low external scores but high internal ratings were categorized into the “Overestimation (Management Blind Spot)” quadrant, signaling a systemic overestimation bias in administrative and clinical risk management. Conclusions: This study provides empirical evidence for the refinement of LTC 3.0 assessment systems. The results offer a strategic roadmap for policymakers to enhance organizational resilience by transitioning from subjective self-perception to objective, data-driven quality management through the two-dimensional gap model.

Healthcare doi: 10.3390/healthcare14080979

Authors: Valérie Szönyi Brigitte Grosgogeat Franck Decup Jean-Noël Vergnes Anne-Margaux Collignon

Background/Objectives: Dental Practice-Based Research Networks (DPBRNs) bridge the gap between academic research and private dental practice, addressing questions relevant to everyday medical care. Despite their growing scientific output, little research has explored the experiences of practitioners engaged in these networks. Our study therefore aims to investigate these practitioners’ perspectives in order to identify strategies for improving investigator recruitment, training and data quality in future DPBRN studies. Methods: The qualitative methodology was chosen, and our study adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines. Semi-structured interviews were conducted with dentists who had participated in a DPBRNs study and transcribed before being thematically analysed using Braun and Clarke’s framework. MaxQDA 2022 software was used to facilitate coding of the verbatim quotes. Results: Three major themes emerged: (1) obstacles to participation, including time constraints, difficulties in patient recruitment, and a perceived disconnect between academia and private practice; (2) facilitators of engagement, such as strong leadership, logistical support, and a collaborative research environment; and (3) personal benefits, such as skill development, breaking professional routines, and counteracting stereotypes about private practitioners’ involvement in research. Conclusions: The findings align with existing literature on medical Practice-Based Research Networks (PBRNs), highlighting logistical and motivational barriers while also emphasizing the importance of social and professional benefits. Notably, although financial compensation or credits for continuing professional development are frequently cited as motivators for research participation, these were not significant concerns for our participants. This study sheds light on the experiences of health practitioners in PBRNs, offering recommendations to overcome challenges through strategies such as accessible training, practical incentives and collaboration opportunities.

Healthcare doi: 10.3390/healthcare14080978

Authors: Gabriela Cristina Chelu Cătălina Raluca Nuță Ovidiu Lucian Băjenaru Lidia Băjenaru Gabriel Ioan Prada

Background/Objectives: Autonomy and the ability to live independently are priority goals for older adults and are closely linked to healthy aging and quality of life (QoL). However, nutrition, although a crucial and modifiable determinant, remains undervalued. Cardiovascular diseases are highly prevalent in middle-aged and older adults and increase the risk of functional impairment, burdening the economy and limiting the patient’s autonomy. This study aimed to analyse the quality of life in older adults and its relationship with functional impairment and nutritional status. Methods: This was a cross-sectional study that included 359 patients with a mean age of 71.52 years who were admitted to the National Institute of Gerontology and Geriatrics “Ana Aslan”, between January 2024 and April 2025. Data were collected through interviews, medical records, and standardized instruments, including the Up and Go Test, Tinetti Test, Downton Fall Risk Index, and handgrip strength assessment. Quality of life was assessed using the EQ-5D-5L and the visual analog scale (VAS). Results: Nutritional status assessed using MNA showed significant moderate-to-strong correlations with EQ-5D-5L mobility (r = −0.326, p = 0.007 in the ≥80 years’ group), anxiety/depression (r = −0.544, p < 0.001 in the ≥80 years’ group), self-care (r = −0.271 to −0.311, p < 0.05 in patients over 65), and usual activities (r = −0.294, p = 0.016 in the ≥80 years’ group). In contrast, BMI showed moderate positive correlations with EQ-5D-5L pain/discomfort across all age groups (r = 0.365 to 0.524, p < 0.002). Functional assessment revealed strong negative correlations between EQ-5D-5L mobility and the Tinetti Test (r = −0.583 to −0.728, p < 0.001), with weaker correlations for pain/discomfort and anxiety/depression dimensions. While BMI-EQ-5D-5L pain/discomfort correlations were consistent across age groups, a stronger correlation was observed in the ≥80 years’ group for MNA-EQ-5D-5L anxiety/depression. Conclusions: In this exploratory cross-sectional study, MNA and BMI were associated with different quality of life domains. Lower MNA scores were more frequently associated with anxiety/depression and certain functional domains, particularly in the ≥80 years’ group, whereas higher BMI was more consistently associated with pain/discomfort across age groups.

Healthcare doi: 10.3390/healthcare14080977

Authors: Sylwia Jakubowska Jan Kowalski

Background: The aim of the present narrative review is to synthesize the available scientific evidence comparing periodontal endoscopy-assisted therapy with established surgical regenerative procedures for the treatment of intrabony periodontal defects. While regenerative surgery—including papilla-preserving techniques—remains the standard approach for achieving predictable clinical attachment gain, these procedures may potentially compromise papillary integrity and healing dynamics. Periodontal endoscopy enables enhanced visualization and debridement without surgical access. This review evaluates available studies and discusses whether endoscopy-assisted therapy can achieve outcomes comparable to surgical regeneration while reducing tissue trauma and preserving interdental anatomy. Methods: A comprehensive literature search was conducted using the electronic databases PubMed, Web of Science, The Cochrane Library, and Scopus, supplemented by manual searching. The search was performed up to 1 November 2025. Results: Two studies were included. Overall, there is a substantial lack of RCTs directly comparing periodontal endoscopy-assisted therapy with surgical regenerative procedures. However, EASD (Endoscopic- assisted subgingival debridement) was found not to be inferior to papilla-preservation surgery (PPFS) for treating residual pockets in intrabony defects. Both PPFS and EASD were effective, although PPFS showed more consistent microbial modulation. Conclusions: Periodontal endoscopy-assisted therapy may be considered a promising minimally invasive approach for selected intrabony defects, potentially reducing surgical morbidity and preserving interdental tissues. Although early data suggest that endoscopy-guided approaches may offer comparable clinical improvements with less invasiveness, the evidence base is too small to support definitive recommendations. Robust, well-designed randomized trials are needed to define its clinical indications and compare it directly with established regenerative procedures.

Healthcare doi: 10.3390/healthcare14080976

Authors: ShinYoung Kim Jinhyung Lee

Background/Objectives: This study examines gender differences in healthcare utilization and financial burden across family structures under Korea’s near-universal health insurance system. Methods: Using 2010–2018 Korea Health Panel data, we applied a two-part model to estimate initiation of care, conditional utilization, and expected out-of-pocket expenditures. Results: Single fathers were less likely to initiate care, whereas single mothers had higher unmet needs and substantially greater conditional and expected out-of-pocket spending, with expected expenditures approximately 46% higher than those of two-parent households. Conclusions: We document stage-specific disparities in healthcare utilization and financial burden across family structures even under near-universal coverage, indicating the need for policies that strengthen both access and financial protection for single-parent households.

Healthcare doi: 10.3390/healthcare14080975

Authors: Julia Nike Sturm Mark Berneburg Bernadett Kurz Dennis Niebel

Background: In 2022, the German healthcare system generated 400,000 tons of waste. Reducing this number could lower greenhouse gas emissions. The waste management plan at the University Medical Center Regensburg, and those of other comparable German facilities, require that glass, cardboard/paper, residual waste, and other non-hazardous materials are collected separately. Objectives: To assess the personal interest, proficiency, opinion, and awareness of waste management among German dermatology staff to develop customized, resource-saving process optimization and training programs. Methods: An online cross-sectional survey was conducted among German dermatology healthcare professionals between 27 February and 4 October 2024. Out of the 100 responses, 84 were complete and subsequently analyzed. Respondents included staff at dermatology wards, outpatient units, and private practices. Data were analyzed descriptively; comparisons were made between clinics and outpatient units, and correlations were identified among the items. Results: Most respondents perceived the amount of waste generated during wound dressing changes as high; more than 60% expressed an interest in receiving further training on sustainability and waste reduction. Although many respondents reported having a good understanding of waste separation, they identified time pressure and stress as the two main obstacles to consistent implementation. Higher self-reported knowledge did not correspond with greater confidence in recycling as an effective waste reduction measure. Conclusions: The findings suggest a discrepancy between awareness and practice regarding sustainable waste management in dermatology. Combining structural and organizational measures with targeted training and workflow optimization could promote more sustainable clinical practices.

Healthcare doi: 10.3390/healthcare14080974

Authors: Michael Quansah Monique Antoinette David Ralph Martins Emad El-Omar Silvana Mirella Aliberti Mario Capunzo Slade O. Jensen Mourad Tayebi

In the original publication [...]

Healthcare doi: 10.3390/healthcare14080973

Authors: Jessica J. Lucchini-Paredes Alcides Flores-Paredes Josue Pilco-Pezo Gutember Peralta-Eugenio Liset Z. Sairitupa-Sanchez Sandra B. Morales-García Oriana Rivera-Lozada Patricia Soto-Casquero Wilter C. Morales-García

Background: Adolescent insomnia is a public health concern associated with affective disturbances, poor academic performance, and cardiometabolic risk. In Peru, nighttime screen use, psychosocial stressors, and social inequalities intensify its impact; however, brief, validated screening instruments remain limited. Objective: To translate, culturally adapt, and evaluate the psychometric properties of the Youth Self-rated Insomnia Scale (YSIS) in Peruvian adolescents, examining its internal structure, reliability, and invariance across sex. Methods: An instrumental study was conducted with 300 students aged 13 to 17 years (M = 15.02; SD = 1.07). Descriptive statistics were calculated, and confirmatory factor analysis (CFA) was performed using a robust estimator. Reliability was assessed through Cronbach’s alpha (α), McDonald’s omega (ω), and average variance extracted (AVE). Factorial invariance by sex was examined at the configural, metric, scalar, and strict levels. Results: The unidimensional model demonstrated adequate fit (χ2 = 44.55, df = 18, p < 0.001; CFI = 0.97; TLI = 0.95; RMSEA = 0.07; SRMR = 0.04), with factor loadings ranging from 0.47 to 0.76, high internal consistency (α = 0.86; ω = 0.81), and AVE = 0.51. Although the two-factor model showed acceptable global fit indices, it revealed insufficient AVE in one factor (AVE = 0.40) and a high inter-factor correlation (r = 0.93), suggesting a lack of discriminant validity. Factorial invariance across sex was supported at all evaluated levels. Conclusions: The Spanish version of the YSIS demonstrates a unidimensional structure, adequate internal consistency, and factorial invariance across sex, supporting its use as a brief screening tool in clinical and school settings, as well as in epidemiological studies among Peruvian and Latin American adolescents.

Healthcare doi: 10.3390/healthcare14070972

Authors: Fatma Kılıç Hamzaoğlu Betül Dik Emine Türen Demir Hasan Energin

Background/Objections: One of the most common surgical procedures performed internationally is the cesarean section. It is known to be associated with intense postoperative pain and a slow recovery process. Focusing on surgical techniques, especially the type of fascial closure, is an area that has received very little attention when it comes to postoperative pain and rapid recovery. Using a mixed-methods approach, the primary objective of this study was to assess the impact of guide-suture-assisted modified fascial closure on postoperative pain and early mobilization after cesarean sections. Methods: Women undergoing elective cesarean sections with Pfannenstiel’s incision were the study participants of this prospective, single-center, randomized mixed-methods study. Participants were enrolled in the study and randomized to either classical continuous fascial closure or guide-suture-assisted modified fascial closure, which was carried out in a 1:1 ratio. Quantitative data assessed postoperative pain through the Visual Analog Scale (VAS), a Numeric Rating Scale (NRS), and the Short-Form McGill Pain Questionnaire (SF-MPQ), and functional recovery was assessed through walking distances at postoperative 6, 12, 24, and 48 h. Qualitative data were collected via semi-structured interviews and analyzed through conventional content analysis to understand the patients’ perceptions of pain and recovery experiences. Results: The first 24 h postoperative period pain levels were significantly lower for the modified fascial closure group versus the classical closure group (p < 0.05). Moreover, the modified closure group had a significantly better functional recovery, evidenced by walking greater distances at 12, 24, and 48 h postoperative. Qualitative results indicated improved comfort and stronger early mobilization confidence, in addition to less movement apprehension, consistent with the above results, among those with the modified technique. Conclusions: The modified fascial closure technique with guide suture was linked to less pain in the early postoperative period and better functional recovery after cesarean section. This technique is a good candidate for addition to standard obstetric procedures since it is cost effective, easily added, and surgical practice will improve comfort for mothers and assist with early mobilization.

Healthcare doi: 10.3390/healthcare14070971

Authors: Soyeon Noh Hyungmin Kim Hyeonkyeong Choi Wonseuk Jang

Background/Objectives: Non-invasive hemodynamic monitoring technologies are being developed to support clinical decisions while reducing risks from invasive procedures. Usability evaluation is essential to assess safety and effectiveness before commercial release. This study examined the usability of a novel patch-type ultrasound-based system (CW10) designed for continuous monitoring in perioperative settings. Methods: A summative evaluation was conducted following IEC 62366-1 with 15 anesthesiologists. Potential hazards were identified via the FDA MAUDE database (Code: DQK) to inform test scenarios. Participants were stratified by clinical experience (1–<5, 5–<10, and ≥10 years) to observe potential variations in operation. In a simulated operating room, users performed 9 clinical scenarios (49 tasks). Metrics included task success rates, subjective satisfaction (5-point Likert scale), and the System Usability Scale (SUS). Results: The overall task success rate was 98.2%. No statistically significant differences were observed across groups in performance, subjective ratings, or SUS scores (p > 0.05). The mean SUS score was 78.5, corresponding to a “Good” usability level. While some use errors occurred in tasks like probe orientation, root cause analysis suggested these were likely due to negative transfer from prior device experience rather than interface complexity. Conclusions: The results suggest the system demonstrates acceptable usability and consistent operation across experience levels. Integrated automated features and the patch design may contribute to reducing inter-user variability for continuous monitoring. This study provides usability evidence that may inform the development of similar non-invasive technologies.

Healthcare doi: 10.3390/healthcare14070970

Authors: Magdalena Królikowska-Jerużalska Magdalena Kurkiewicz Aleksandra Moździerz Anna Rzepecka-Stojko Jerzy Stojko

Introduction: Lung cancer remains the leading cause of cancer-related mortality among men in Poland. Prognosis is generally poor, largely due to late diagnosis at advanced stages and the aggressive biological nature of the disease. Aim: This study aimed to evaluate the effectiveness of various treatment modalities and determine their impact on overall survival in male patients diagnosed with small-cell (SCLC) and non-small-cell lung cancer (NSCLC). Methods: This retrospective cohort study analyzed 1431 men (mean age: 61.5 years) treated at the Katowice Oncology Center in Poland between 2002 and 2012. Overall survival was assessed using the Kaplan–Meier method and multivariable Cox proportional hazards regression. Evaluated prognostic factors included clinical stage, surgical intervention (partial or total lung resection), first-line treatment regimen, and the number of treatment cycles. Results: Survival probabilities declined progressively with advancing clinical stage for both SCLC and NSCLC. Patients who underwent surgical resection demonstrated significantly longer survival compared to non-surgically treated patients (p < 0.001). Furthermore, combined radiochemotherapy yielded superior therapeutic outcomes compared to chemotherapy alone. In the non-surgical NSCLC cohort, first-line treatment with platinum derivatives combined with gemcitabine resulted in the highest 1-year survival rate compared to other pharmacological schemes. Discussion: The high mortality observed within the first 12 months post diagnosis reflects the late-stage presentation common during the study period. The findings align with established oncological principles, confirming that surgical resection and multimodal therapies offer the greatest survival advantages for eligible patients. Conclusions: Survival rates for both SCLC and NSCLC are overwhelmingly dictated by early diagnosis and the feasibility of surgical resection. Improving long-term outcomes depends heavily on implementing effective lung cancer screening programs to detect the disease at operable stages and utilizing optimized combined treatment protocols.

Healthcare doi: 10.3390/healthcare14070969

Authors: Ali A. Asseri Ebtesam Elgezawy Sarah Ibrahim Summan Abdullah A. Alamoudi Ashwag Asiri

Background: CD8A-related CD8α deficiency (Immunodeficiency 116) is a rare autosomal recessive primary immunodeficiency disease characterized by absent CD8+ T cells and variable sinopulmonary disease. Case Presentation: A seven-year-old boy from a consanguineous family was referred for chronic wet cough and “uncontrolled asthma” despite being prescribed high-dose inhaled corticosteroids and montelukast. He was hospitalized seven times over a two-year period for presumed asthma exacerbations complicated by pneumonia. An examination revealed bilateral crackles without wheezing. Throat culture tested positive for Haemophilus influenzae. CT imaging showed signs of chronic rhinosinusitis (maxillary mucosal thickening) and chronic airway disease with bronchiectatic changes. The patient’s immunoglobulin levels were within normal ranges for his age group. Flow cytometry revealed profound CD8+ T-cell lymphopenia (CD8+ 0.21%; 11 cells/µL; near-absent after excluding dual-positive cells) with expansion of CD3+CD4−CD8− T cells (29.5%). CD8A gene sequencing identified a novel homozygous nonsense variant NM_001768.7:c.319C>T (p.Arg107Ter; GRCh38: chr2:86790412G>A), consistent with loss of CD8α and secondary loss of CD8β surface expression. A literature review identified three previously reported symptomatic patients (and two asymptomatic sisters in the first family), all with recurrent respiratory infections and variable structural lung disease. Conclusions: This case highlights CD8A deficiency as a rare mimic of pediatric asthma and expands the genotype spectrum with a truncating CD8A variant. Early lymphocyte immunophenotyping in children with recurrent sinopulmonary infections may prevent delayed diagnosis and progressive airway damage.

Healthcare doi: 10.3390/healthcare14070968

Authors: Min Seok Choi Su Il Kim Yun Deok Jang Seong Ju Kim In Hye Kang Woong Bin Jeong

Background/Objectives: Rapid and accurate electrocardiogram (ECG) interpretation is essential for timely recognition of ST-elevation myocardial infarction (STEMI) and initiation of reperfusion therapy in the emergency department (ED). We evaluated the diagnostic performance of a real-time artificial intelligence (AI) ECG interpretation system and its pragmatic impact when integrated into routine ED workflows. Methods: This prospective, single-center pragmatic observational study was conducted in a regional emergency medical center ED in Busan, Republic of Korea (1 January–31 December 2024). Consecutive adults (≥18 years) undergoing 12-lead ECG for cardiovascular-related symptoms were enrolled (N = 1524). A predefined alternating-day protocol allocated visits to physician-only interpretation days (physician-days, N = 763) or AI output disclosure days (AI-days, N = 761). Diagnostic performance for STEMI was assessed using paired ECG-level comparisons between physician-alone interpretation and AI output against a blinded expert-panel reference standard; clinical impact outcomes included reperfusion-related time metrics, hospital length of stay (LOS), and in-hospital mortality. Results: Against the expert reference standard, AI showed higher STEMI sensitivity than physician-alone interpretation (96.7% vs. 68.3%; McNemar p = 0.027), while specificity was lower (75.9% vs. 84.5%; p = 0.018). In pragmatic day-level comparisons, door-to-balloon time was shorter on AI-days (40.0 ± 19.81 vs. 47.34 ± 21.90 min; p = 0.001), and time to PCI was significantly reduced among patients with atypical presentations (42.3 ± 18.21 vs. 57.1 ± 20.11 min; p = 0.013). Among admitted patients, hospital LOS was shorter on AI-days (13 ± 9.21 vs. 17 ± 10.31 days; p = 0.010), whereas in-hospital mortality did not differ significantly between groups (17.0% vs. 16.77%; p = 0.191). Conclusions: Real-time AI-ECG integration in the ED was associated with improved STEMI detection sensitivity and shorter reperfusion-related time metrics, particularly in atypical presentations, and with reduced hospital LOS among admitted patients. Short-term mortality was comparable between groups. Further multicenter studies are warranted to confirm generalizability and to balance benefits against potential false-positive-related operational impacts.

Healthcare doi: 10.3390/healthcare14070967

Authors: Mariana Cristina Palermo Ferreira Érica Cesário Defilipo Lélia Cápua Nunes Pedro Henrique Berbert de Carvalho

Background/Objectives: Cerebral palsy (CP) is the most prevalent physical disability in the pediatric population, resulting in functional limitations and restrictions in participation, with higher prevalence rates in low- and middle-income countries. Caregivers of children and adolescents with CP face both physical and emotional challenges, and their perceptions of the body may act as contextual and cultural indicators shaping children’s participation, care practices, and well-being within the family environment. This study aimed to understand the perceptions, values, and cultural beliefs of family caregivers about the bodies of children and adolescents with CP. Methods: A qualitative study was conducted using six focus groups with 22 mothers and grandmothers of children and adolescents with CP. Participants were recruited from rehabilitation services. Discussions were audio-recorded, transcribed verbatim, and analyzed using content analysis. The analytical process involved systematic coding, categorization, and thematic interpretation to identify recurring meanings and patterns across narratives. Results: Three thematic categories emerged: (1) perceptions of the body within social interactions; (2) viewing the body as capable of performing activities independently when stimulated/taught; and (3) viewing the body as dependent, requiring constant supervision and support. Conclusions: The findings highlight the need to expand family caregivers’ knowledge about CP to promote children’s participation and mitigate beliefs related to limitations, dependence, fragility, and vulnerability.

Healthcare doi: 10.3390/healthcare14070966

Authors: Yuan Li Takayuki Noma Long Liang Wenhao Weng

Background/Objective: Sex-based disparities in cancer outcomes have gained increasing attention in women’s health research. We examined the relationship between sex and overall survival (OS) among patients with non-small-cell lung cancer (NSCLC), with particular emphasis on the survival advantage observed in women across different clinical stages and treatment settings. Sex-related differences in cancer outcomes have become an important focus in oncology and women’s health research. This study aimed to investigate the association between sex and overall survival (OS) in patients with non-small-cell lung cancer (NSCLC), with particular attention to the observed survival advantage in women across clinical stages and treatment contexts. Methods: A total of 129,864 patients diagnosed with NSCLC were identified, including 78,460 men and 51,404 women. Demographic characteristics, socioeconomic status, tumor features, treatment modalities, and survival outcomes were compared between sexes. Kaplan–Meier survival analyses and stage-stratified Cox proportional hazards models were used to evaluate overall survival differences between female and male patients. Results: Women demonstrated significantly superior OS compared with men across all stages of NSCLC (all p < 0.001). This survival advantage persisted regardless of receipt of chemotherapy. Among patients receiving chemotherapy, survival improvements were observed in both sexes; however, women consistently exhibited longer median OS at each stage. From stage IB to IV, median OS in women was 52.0, 30.0, 13.0, and 5.0 months, respectively, compared with 33.0, 23.0, 11.0, and 4.0 months in men. Notably, the magnitude of sex-related survival differences was more pronounced in earlier stages (IB/II) than in advanced stages (III/IV), suggesting potential biological or treatment response differences favoring women. Age-stratified analyses further demonstrated that women older than 45 years experienced a consistent survival advantage across all stages. Multivariable Cox regression confirmed that female sex was independently associated with reduced mortality risk at every stage (HRs ranging from 0.766 to 0.857; all p < 0.001). Conclusions: Women with NSCLC exhibit a significant and independent survival advantage over men across clinical stages, regardless of chemotherapy status, particularly among patients older than 45 years. These findings highlight the importance of considering sex in prognostic assessment and support further investigation into factors contributing to survival differences in NSCLC.

Healthcare doi: 10.3390/healthcare14070965

Authors: Xiaofan Wang Linlin Su Xiao Yang Ruofan Qiao Jixuan Zheng Chunhui Zhang Xian Zhang Lixia Qu Beilei Lin

Objectives: We aimed to investigate the medication experience of older adults with multiple chronic conditions in rural areas and to analyze its associated factors, so as to provide evidence for developing targeted medication management interventions. Design: This was a single-center cross-sectional study. Methods: From June to July 2025, a convenience sample of 539 older adults with multiple chronic conditions was recruited from a county hospital in Henan Province, China. The survey utilized a general information questionnaire, the Chinese version of the Medication Experience Scale, the Safe Medication Knowledge Scale, the Perceived Social Support Scale, the Chinese version of the Chronic Disease Self-Efficacy Scale, and the Chinese version of the Medication Errors Scale. Results: The medication experience score among rural older adults with multiple chronic conditions was (117.14 ± 17.19). Multivariate hierarchical regression analysis revealed that age, marriage status, source of income, medical insurance schemes, duration of medication use, safe medication knowledge, perceived social support, self-efficacy for chronic disease management, and medication errors were significant factors associated with medication experience (all p < 0.05). Conclusions: The medication experience among older adults with multiple chronic conditions in our study sample was at a moderate level. Age, marriage status, source of income, medical insurance schemes, duration of medication use, safe medication knowledge, perceived social support, self-efficacy for chronic disease management, and medication errors were associated factors of medication experience for older adults with multiple chronic conditions. Countermeasures should be implemented to improve medication experience in this population.

Healthcare doi: 10.3390/healthcare14070964

Authors: Yuexing Wang Xin Ma

Background/Objectives: Digital health ecosystems increasingly integrate content, behavioral interventions, and commercial offerings across multiple platforms. While design consistency is established as critical for trust in commercial contexts, its associations with health behavior change and objective health outcomes remain underexplored. This study examined how cross-platform design consistency and aesthetic experience are associated with behavioral adoption through psychological pathways and investigated relationships between design-driven adoption and objective health outcomes. Methods: A convergent mixed-method design comprised five integrated studies: systematic content analysis of short-form videos (N = 200), expert evaluation and user testing (N = 33), a cross-sectional survey (N = 186), semi-structured interviews (N = 15), and a 3-month longitudinal health outcome analysis (N = 143). Structural equation modeling tested pathways from design features through psychological mediators and COM-B components (capability, opportunity, motivation) to behavioral adoption and health outcomes. Results: Design consistency was significantly associated with trust (β = 0.52), perceived value (β = 0.68), and reduced perceived risk (β = −0.41; all p < 0.001). Aesthetic experience predicted emotional resonance (β = 0.71, p < 0.001) and moderated design–trust associations. COM-B components mediated 75% of the intention-to-adoption pathway (total indirect effect = 0.51, p < 0.001). High-adoption users showed clinically meaningful improvements in weight (−2.8 kg, d = 0.89), HbA1c (−0.7%, d = 0.65), fasting glucose (−0.9 mmol/L, d = 0.72), and LDL-C (−0.4 mmol/L, d = 0.51) over three months. Conclusions: Within a single, influencer-centered Chinese digital health ecosystem, design consistency and aesthetic experience were significantly associated with trust, psychological readiness, and behavioral adoption. These findings are observational; randomized controlled trials and multi-site replication are required to establish causal mechanisms and assess generalizability.

Healthcare doi: 10.3390/healthcare14070963

Authors: Ana Reis Vítor Silva João José Joaquim Cristiano Matos Carolina Valeiro Cristiana Freitas Olívia R. Pereira Ramona Mateos-Campos Fernando Moreira

Background: Occupational exposure to cytotoxic drugs remains a major concern for pharmacy personnel, due to their well-established, carcinogenic, mutagenic and organ-specific effects. Despite the existence of robust international guidelines, evidence suggests substantial variability in compliance, training quality and operational conditions across healthcare settings. Objective: This study aimed to characterise current handling practices, assess working conditions, training, safety procedures, exposure patterns, and perceived risk factors among pharmacy technicians involved in the preparation of cytotoxic drugs in Portugal. Methods: A cross-sectional descriptive study was conducted using a structured questionnaire grounded in international standards (ISOPP, NIOSH, ASHP, USP <800>). The instrument was developed through literature review, expert panel validation (n = 42), and pre-testing. Data were collected electronically between April and May 2025 from pharmacy technicians actively handling cytotoxic drugs in Portugal. Results: A total of 124 valid responses were analysed. Most participants were female (78%) and under 50 years, with nearly one-third having less than one year of experience. Prolonged daily exposure (31.5% participants worked ≥ 5 h/day) extended uninterrupted handling periods (28.2% worked > 120 min), and high preparation workloads were common. While adherence to core protective measures—such as reinforced gowns, double gloves, and Class II B2 biological safety cabinets—was high, important gaps were identified, including incomplete use of closed system transfer devices, inconsistent respiratory and foot protection, limited automation, and insufficient environmental monitoring. Structured competency assessment, periodic training, and formal documentation were frequently absent. Institutional policies on reproductive risk showed strong protection for women but less clarity for male workers. Conclusions: Cytotoxic drug handling practices in Portugal demonstrate satisfactory adherence to fundamental protective measures but reveal significant structural and organisational gaps related to workload management, environmental monitoring, and continuous training. The absence of unified national guidance contributes to variability across institutions. These findings highlight the need for greater standardisation of occupational safety practices.

Healthcare doi: 10.3390/healthcare14070962

Authors: Murat Baloğlu

Background: Meniscal tears are a common cause of knee pain and functional limitation, yet determinants of pain recovery following rehabilitation remain incompletely understood. Structural imaging findings often show limited correlation with clinical symptoms. This study aimed to evaluate longitudinal pain trajectories after rehabilitation in patients with meniscal tears and to investigate whether synovial fluid characteristics and structural joint degeneration are associated with pain improvement. Methods: This retrospective cohort study included 59 patients with meniscal tears who underwent structured rehabilitation. Structural degeneration was assessed using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Synovial fluid cytology evaluated neutrophil predominance (PNL) and erythrocyte positivity. Pain intensity was measured using the Visual Analog Scale (VAS) at 3 months, 6 months, and 1 year. Longitudinal changes were analyzed using the Friedman test, and predictors of pain improvement (ΔVAS from 3 months to 1 year) were evaluated using multivariable linear regression. Results: VAS scores decreased significantly over time (p < 0.001), indicating sustained pain reduction during follow-up. In the multivariable regression model (F(4, 54) = 2.80, p = 0.035), 17% of the variance in pain improvement was explained (R2 = 0.17). Synovial erythrocyte positivity was modestly associated with greater longitudinal pain reduction (β = 0.75, 95% CI 0.15–1.36, p = 0.016). Age was also a significant predictor (β = 0.025, p = 0.043), whereas WORMS score and PNL positivity were not significantly associated with pain improvement. Conclusions: Pain recovery following rehabilitation in patients with meniscal tears appears to be influenced more by intra-articular biological characteristics than by structural imaging severity alone. Synovial erythrocyte positivity may indicate a potentially reversible inflammatory phenotype associated with higher early pain but greater subsequent improvement. These findings support a multidimensional model of knee pain and suggest that synovial characteristics may help improve clinical risk stratification during rehabilitation planning.

Healthcare doi: 10.3390/healthcare14070960

Authors: Francisco Javier Roldán-Ramos Juan de Dios Benítez-Sillero Ana Rodríguez-Cano Javier Raya-González

Background/Objectives: Mental fatigue in adolescents is a growing concern in educational contexts, positioning physical education (PE) teachers as key agents in designing effective mitigation strategies. This study examined the perceptions of Spanish high school PE teachers regarding the causes, consequences, and potential countermeasures for students’ mental fatigue. Methods: A total of 116 in-service teachers (81 males and 35 females; mean teaching experience 7.8 ± 5.3 years) from 12 autonomous communities throughout Spain completed a comprehensive 34-item electronic questionnaire. The instrument assessed the perceived existence, etiology, and outcomes of mental fatigue through multiple-choice, dichotomous (yes/no), and five-point Likert scale questions, with particular attention given to the role of physical activity (PA) in symptom alleviation. A quantitative frequency analysis was conducted to examine the data. Results: The main findings reveal a strong consensus among the teachers (77.6% to 87.9%) on the prevalence of mental fatigue, with its primary causes attributed to academic pressure and sedentarism. The consequences were identified as increased irritability and reduced cognitive performance. The teachers overwhelmingly endorsed moderate intensity PA as the most effective countermeasure. However, a significant gap was identified between this theoretical awareness and the systematic implementation of targeted strategies within schools. Conclusions: These results underscore the critical need for professional development programs and structural support to translate teacher knowledge into practical intervention, suggesting important directions for future research.

Healthcare doi: 10.3390/healthcare14070961

Authors: Koba Kamashidze Tina Beruchashvili Tamar Peshkova Irina Nakashidze Liana Jashi Sarfraz Ahmad

Background/Objectives: Cervical cancer is widely recognized as a preventable disease; however, participation in screening programs remains insufficient in many transitional health systems. In the Georgia, organized screening services are available, yet utilisation remains low, indicating barriers to screening extend beyond access alone. This study, therefore, examined physician-level factors influencing the promotion of cervical cancer screening in the Adjara region of Georgia, with focus on routine clinical practice and organizational conditions. Methods: A cross-sectional survey was carried out among physicians providing outpatient and preventive services in six municipalities of the Adjara region. The analysis was guided by a socio-ecological framework and examined individual, inter-personal, and organizational factors in relation to physicians’ recent cervical cancer screening recommendation practices. Multivariable logistic and ordinal regression analyses were used to identify factors associated with screening promotion. Results: Despite a generally high level of support for cervical cancer screening among physicians, regular screening recommendations were not consistently reported. Limited consultation time, uncertainty regarding screening-related harms, and rural practice settings were independently associated with a lower probability of having recently recommended screening. In contrast, favourable attitudes toward screening on their own were not sufficient to translate into routine preventive practice. Conclusions: These findings indicate that gaps between physician attitudes and screening promotion are largely driven by structural and organizational factors rather than a lack of professional support. Efforts to reduce workflow constraints, improve clarity around screening guidance, and integrate preventive counselling into routine clinical practice may be essential for improving screening uptake in similar healthcare system contexts.

Healthcare doi: 10.3390/healthcare14070959

Authors: Samiah Alqabbani Maha F. Algabbani Abeer A. Alazmi Samiha M. I. Abdelkader Mai Aldera Lolwah AlRashed AlHumaid Rehab F. M. Gwada Munera M. Almurdi Wafa Alahmari Afrah Almuwais Madawi Alotaibi Jawahr Alagil Afaf A. M. Shaheen

Background: Low back pain is a common musculoskeletal complaint among postpartum women due to physical changes that occur during pregnancy and delivery, which can lead to different disability levels. Therefore, the aim of this study was to evaluate the disability levels and associated factors of postpartum women within the first year after childbirth. Methods: A descriptive cross-sectional study design was used to gather data from post-partum women between 6 weeks and 12 months after childbirth using an online self-administered questionnaire. This questionnaire included demographic variables, the Nordic Musculoskeletal Symptoms Questionnaire, the Pain Intensity Numeric Rating Scale, and a back disability questionnaire. Results: Among 400 postpartum mothers, 71% reported low back pain, with 51.1% experiencing mild disability. Logistic regression showed significant predictors of disability, including cesarean delivery (6.49 times higher likelihood), having 4–5 children (1.98 times), and more than six children (3.45 times). Breastfeeding increased disability risk (2.44 times), while mixed feeding reduced it (0.52 times). The model explained 49.8% of disability variance (p < 0.001). Conclusions: Disability is a common problem among postpartum women, highlighting the importance of healthcare providers addressing these challenges.

Healthcare doi: 10.3390/healthcare14070958

Authors: Danijela Ilic Jovana Milosevic Jovana Todorovic Zorica Terzic-Supic Ilija Dragojevic Mirjana Stojanovic-Tasic Emilija Novakovic Tijana Spasojevic Svetozar Memarovic Milivoje Galjak Kristina Rakic Mirijana Virijevic Kristina Stevanovic Jelena Stefanovic Biljana Trajkovic Andrija Milovic Momcilo Mirkovic

Introduction: The aim of this study was to examine the prevalence of scores indicating depression, anxiety and stress (<95th percentile of the score on each of the domains) among students at the University of Pristina-Kosovska Mitrovica and social and lifestyle characteristics associated with scores indicative of depression, anxiety and stress in this population studying in a post-conflict area. Methods: The cross-sectional study applying the non-probabilistic convenience sampling that included a total of 656 students of nine faculties who were present in the classes during the day of this study at the University of Pristina-Kosovska Mitrovica was conducted during the 2024/2025 school year. Results: A total of 9.3% had a score on the DASS-D scale, indicating severe or extremely severe depression, 19.6% had a score indicating severe or extremely severe anxiety, and 13.9% had a score indicative of severe or extremely severe stress. Our study showed the association of scores indicating depression with living in rural areas, average self-rated health, use of anti-anxiety medications, and mobile phone addiction. Our study showed the association of scores indicating anxiety and average self-rated health, use of anti-anxiety medications, score on social support scale, and score on state impulsivity scale. Our study showed the association of scores indicating stress with female sex, age in years, poor self-rated financial status, average self-rated health, use of anti-anxiety medications, and score on the state impulsivity scale. Conclusions: This study has shown a significant burden of psychological distress among students at the University of Pristina-Kosovska Mitrovica.

Healthcare doi: 10.3390/healthcare14070957

Authors: Akef Obeidat Athar Ud Din Muhammad Amir Khan Amara Asad Khan Eshal Atif Muhammad Atif Mazhar Muhammad Zain Khan Sadia Qazi

Background/Objectives: Accurate drug allergy documentation is essential for patient safety; however, documentation quality remains poor worldwide. In resource-limited settings that rely on paper records, allergy information may become fragmented across multiple forms, and evidence on concordance between paper-based documentation systems is limited. This audit assessed concordance between clinical notes and drug Kardex records, and completeness of drug allergy documentation entries, in a manual hospital system. Methods: This retrospective clinical audit, reported in accordance with SQUIRE 2.0 guidelines, examined 88 randomly selected patient records from 525 consecutive admissions to a general medicine ward in Pakistan during June–July 2024, retrospectively reviewed in August 2024. The audit assessed allergy status documentation in clinical notes and the drug Kardex, evaluated completeness against five internationally recommended elements (drug name, reaction description, severity, date, and treatment), and measured inter-system concordance using McNemar’s test and Cohen’s kappa. Results: Drug allergy status was documented in 25.0% of clinical notes (95% CI: 16.5–35.4%) versus 94.3% of drug Kardex records (95% CI: 87.2–98.1%), representing a 69.3 percentage-point gap (McNemar χ2 = 59.06, p < 0.001). Inter-system agreement was poor (κ = 0.0079; 95% CI: −0.046 to 0.062), with an overall concordance of 28.4%. Discordant pairs showed that undocumented allergy status was far more likely in clinical notes than in the drug Kardex (OR = 62.00). Kardex-only documentation occurred in 62 of 88 patients (70.5%). Among nine patients with documented allergy history in at least one source, none met the five-element completeness standards (0%; 95% CI: 0.0–33.6%). Recorded entries were generic statements such as “drug allergy” or “allergic to antibiotics” without clinically actionable details. Conclusions: Drug allergy documentation showed two major quality failures: poor concordance between parallel paper records and lack of actionable detail in recorded entries. The two systems functioned independently rather than as complementary safety checks, with allergy information often present in the drug Kardex but absent from clinical notes. This Kardex-only failure mode may be a practical target for quality improvement through structured five-element templates, prompts for clinicians to review the drug Kardex, and interdisciplinary allergy-reconciliation workflows. These strategies require prospective evaluation in this setting.

Healthcare doi: 10.3390/healthcare14070956

Authors: Yi Chen Chunqi Wu Jianping Ye

Background: Housing affordability is one of the most pressing social and political challenges in urban China, yet empirical evidence on its impact on residents’ mental health remains limited. Methods: Guided by the Social Determinants of Health (SDOH) framework, this study examines its relationship with mental health using nationally representative longitudinal data from the China Family Panel Studies (CFPS) across the 2016, 2018, and 2020 waves. We employ two-way fixed effects models and further incorporate an instrumental variable strategy to address potential endogeneity. Results: There is a significant association between housing affordability and mental health; greater affordability is associated with a lower likelihood of experiencing depressive symptoms. Heterogeneity analyses further reveal that these benefits vary by housing asset status and educational attainment. Conclusions: From an SDOH perspective, this study provides empirical evidence on how housing affordability contributes to mental health inequities in the Chinese context. Housing affordability should be recognized as a public health concern requiring coordinated policy responses. Targeted interventions are necessary to protect vulnerable populations that are most exposed to affordability shocks.

Healthcare doi: 10.3390/healthcare14070955

Authors: Dragan Glavaš Marija Šakić Velić Patrik Grubor

Background/Objectives: In an effort to clarify the mechanisms underlying the relationship between physical activity (PA) and mental well-being, emerging evidence points to a potentially important role of beliefs about PA’s impact on mental health. Nevertheless, research in this area remains scarce. This cross-sectional study examined whether belief in the mental health benefits of PA mediates the relationship between PA level and mental well-being among university students. Methods: A total of 339 university students, aged 18–28, completed the Godin–Shephard Leisure-Time Physical Activity Questionnaire, the Warwick–Edinburgh Mental Wellbeing Scale, and a newly developed Belief in the Mental Health Benefits of Physical Activity Scale. Results: Structural equation modelling indicated a non-significant direct effect of PA level on mental well-being. However, a significant indirect effect was observed, with higher PA level being associated with stronger belief in the mental health benefits of one’s own PA, which in turn was related to better mental well-being. Conclusions: The findings suggest that PA level is indirectly associated with mental well-being through belief in the mental health benefits of PA among university students. These findings highlight the potential importance of PA-related beliefs in mental health promotion and point to indirect psychological pathways that may link PA and mental well-being, warranting further longitudinal examination.

Healthcare doi: 10.3390/healthcare14070954

Authors: Ilie Cirstea Ada Radu Andrei-Flavius Radu Delia Mirela Tit Gabriela S. Bungau Daniela Gitea Bogdan Uivaraseanu

Surgical wards constitute a significant contributor to global medical waste (MW), accounting for over one-third of total healthcare sector trash. Medical interventions produce hazardous, infectious, and potentially toxic byproducts, making effective MW management crucial, especially where current mechanisms are insufficient. Substantial disparities persist between high-income and low- and middle-income countries regarding MW infrastructure, enforcement, and adoption of safe, sustainable treatment technologies. Proper segregation, recycling, treatment, and disposal are key to protecting public health, environmental integrity, and promoting healthcare sustainability. Waste treatment technologies divide into thermal and physico-chemical processes, requiring thorough evaluation of advantages, disadvantages, and suitability for each waste type. This narrative review updates MW knowledge by synthesizing data from scientific literature, institutional documents, and regulatory sources. Key quantitative data indicate operating rooms generate up to 30% of total hospital waste, with recyclable materials representing over 40% of that volume. Improper segregation rates remain high, and incineration remains dominant despite sustainability concerns. The Romanian case study highlights progressive EU alignment, enforcing standardized MW classification, color-coded segregation, and specialized disposal protocols in surgical wards. Despite legal compliance, Romania is advancing incrementally, with systematic audits, digital tracking, and national outcome-based evaluations yet to be fully established. The Plastic Surgery Unit at Oradea County Emergency Clinical Hospital demonstrates good protocol adherence; however, strengthening data feedback mechanisms would enhance hospital-wide performance optimization and strategic waste reduction. Training and monitoring represent important areas for continued development. Coordinated professional engagement, modernized infrastructure, and enforceable audits are identified as critical priorities for improving MW handling in surgical environments. Future research should emphasize management innovation, evidence-based policy formulation, and a systematic strategy to achieve sustainable MW.

Healthcare doi: 10.3390/healthcare14070953

Authors: Giorgio Zappalà Michelangelo Delmedico Davide Ciclamini Nicholas Trapella Carlo Pasquali Camilla Crespi Mario Ronga

Background: Acute posterior cruciate ligament (PCL) injuries are uncommon and often challenging to treat. While conservative treatment is frequently proposed in the acute phase, conventional rigid bracing may lead to complications such as joint stiffness and quadriceps atrophy. Dynamic braces applying posterior to anterior force during flexion have been proposed as a more functional alternative. Purpose: To evaluate the biomechanical efficacy of a dynamic PCL brace in reducing posterior tibial translation during the acute post-traumatic phase using standardized stress radiographs. Methods: The study was conducted on 11 patients with acute PCL injuries (four isolated, seven multiligamentous) treated within 15 days from trauma. Posterior tibial translation was measured with X-rays at 90° of flexion under four conditions: static (resting), stress (150 N), brace unloaded, and brace loaded (50 N posterior force). Three blinded orthopedic surgeons performed all measurements independently. Results: The dynamic brace significantly reduced posterior tibial translation across all conditions. Translation under stress was reduced from a mean of 7.1 mm to 2.68 mm with the loaded brace (p < 0.001). Conclusions: The study demonstrates that dynamic bracing provides effective biomechanical control of posterior tibial translation in the acute PCL injury. These findings support the potential role of dynamic bracing in conservative treatment protocols.

Healthcare doi: 10.3390/healthcare14070952

Authors: Janice Hill Tina Werringloer Ulrike Keim Maria Meisl Claudia F. Plappert

Background: Maternity care for vulnerable pregnant women presents a particular challenge within midwifery practice. In Germany, maternity services lack standardized frameworks to adequately address the specific needs of individuals who have experienced, among other factors, sexualized violence, poverty, female genital mutilation/cutting (FGM/C), or discrimination. Limited access to healthcare among these populations contributes to increased maternal and neonatal morbidity and mortality. Emerging evidence indicates that comprehensive medical and psychosocial support provided by midwives can substantially improve obstetric outcomes for marginalized pregnant women. Methods: An elective course, Antenatal Care for Vulnerable Women, was offered in the sixth semester of the Bachelor’s program in Midwifery Science at the University of Tübingen in 2025. The course provided insights into the psychosocial challenges faced by vulnerable pregnant women and prepared students for these specific aspects of midwifery practice. The curriculum incorporated foundational lectures and innovative teaching formats aimed at cultivating constructivist approaches to problem-solving. All sixth-semester midwifery students were asked to assess their knowledge and skills across five vulnerability categories: asylum-seeking, FGM/C, intimate partner violence, trauma, and racism. A pilot pre–posttest analysis using a 6-point Likert scale (1 = very good, 6 = poor) was conducted as hypothesis-generating and curriculum-guiding. The pretest included 38 respondents. The posttest included 11 respondents who attended the course. Results: Students who attended the course demonstrated observable gains in knowledge and skills across all categories, with the greatest improvements in asylum-seeking, median of 5 (IQR 4–5) vs. 2 (2–3); FGM/C, 5 (4–5) vs. 2 (2–3); and racism, 5 (3–5) vs. 2 (2–3). Conclusions: Innovative teaching methods may contribute to preparing midwifery students for targeted care of vulnerable pregnant women. Findings from the pre- and posttests provide preliminary insight into the potential value of experiential learning and may inform the further development of practice-oriented teaching methods.