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24 pages, 676 KB  
Systematic Review
Integrating Mental Health into Diabetes Care: Closing the Treatment Gap for Better Outcomes—A Systematic Review
by Shakila Jahan Shimu, Shamima Akter, Md. Majedur Rahman, Shahida Arbee, Mohammad Sarif Mohiuddin, Sadman Sazzad, Mahjabin Raiqa, Mohammad Mohabbulla Mohib, Afsana R. Munmun and Mohammad Borhan Uddin
Med. Sci. 2025, 13(4), 259; https://doi.org/10.3390/medsci13040259 - 3 Nov 2025
Viewed by 2670
Abstract
Background: Diabetes and mental health conditions frequently co-occur, with depression and anxiety affecting up to 20–30% of people with diabetes. These comorbidities worsen glycemic control, adherence, and quality of life, yet mental health is often neglected in diabetes care. Integrating mental health services [...] Read more.
Background: Diabetes and mental health conditions frequently co-occur, with depression and anxiety affecting up to 20–30% of people with diabetes. These comorbidities worsen glycemic control, adherence, and quality of life, yet mental health is often neglected in diabetes care. Integrating mental health services into diabetes management is recommended by international organizations to improve patient outcomes. Objectives: To systematically review the evidence on integrated mental health interventions in diabetes care, compared to usual diabetes care, in improving patient outcomes (glycemic control, mental health, adherence, quality of life). Methods: We searched PubMed/MEDLINE, Embase, PsycINFO, and Scopus (2000 through July 2024) for studies of diabetes care integrating mental health support (e.g., collaborative care, co-location, stepped care, or digital interventions). Inclusion criteria were controlled trials or cohort studies involving individuals with type 1 or type 2 diabetes receiving an integrated mental health intervention, with outcomes on glycemic control and/or mental health. Two reviewers independently screened titles/abstracts and full texts, with disagreements resolved by consensus. Data on study design, population, intervention components, and outcomes were extracted. Risk of bias was assessed using Cochrane or appropriate tools. Results: Out of records identified, 64 studies met inclusion criteria (primarily randomized controlled trials). Integrated care models consistently improved depression and anxiety outcomes and diabetes-specific distress, and yielded modest but significant reductions in glycated hemoglobin (HbA1c) compared to usual care. Many interventions also enhanced treatment adherence and self-management behaviors. For example, collaborative care trials showed greater depression remission rates and small HbA1c improvements (~0.3–0.5% absolute reduction) relative to standard care. Co-located care in diabetes clinics was associated with reduced diabetes distress, depression scores, and HbA1c over 12 months. Digital health integrations (telepsychiatry, online cognitive-behavioral therapy) improved psychological outcomes and adherence, with some reporting slight improvements in glycemic control. Integrated approaches often increased uptake of mental health services (e.g., higher referral completion rates) and showed high patient satisfaction. A subset of studies reported fewer emergency visits and hospitalizations with integrated care, and one economic analysis found collaborative care cost-effective in primary care settings. Conclusions: Integrating mental health into diabetes care leads to better mental health outcomes and modest improvements in glycemic control, without adverse effects. Heterogeneity across studies is noted, but the overall evidence supports multidisciplinary, patient-centered care models to address the psychosocial needs of people with diabetes. Healthcare systems should prioritize implementing and scaling integrated care, accompanied by provider training and policy support, to improve outcomes and bridge the persistent treatment gap. Future research should focus on long-term effectiveness, cost-effectiveness, and strategies to reach diverse populations. Full article
(This article belongs to the Section Translational Medicine)
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16 pages, 2028 KB  
Article
Acceptability of Patient Portals and Phone Consultations in Hybrid Primary Care: A Slovenian Multi-Centre Pilot Study
by Matic Mihevc, Snežana Đurić and Marija Petek Šter
Healthcare 2025, 13(21), 2662; https://doi.org/10.3390/healthcare13212662 - 22 Oct 2025
Viewed by 505
Abstract
Background/Objectives: With digital transformation, patient portals and phone consultations are increasingly integrated into hybrid primary care workflows that combine in-person and remote services. This study aimed to assess the acceptability of these tools among patients and identify factors associated with acceptability. Methods [...] Read more.
Background/Objectives: With digital transformation, patient portals and phone consultations are increasingly integrated into hybrid primary care workflows that combine in-person and remote services. This study aimed to assess the acceptability of these tools among patients and identify factors associated with acceptability. Methods: Between April and June 2025, a multicenter cross-sectional survey was conducted in four primary healthcare centers in Slovenia. The sample included 214 people who had used both patient portals and phone consultations within the previous 12 months. Data collected covered socio-demographic and clinical profile, digital communication skills, quality of life, and annual use of digital tools. Acceptability was assessed using the Theoretical Framework of Acceptability (TFA) tool. Univariate and multivariable linear regression analyses were performed to identify factors associated with acceptability. Results: Among the 214 participants (mean age 42.9 ± 14.1 years; 61.2% female), both patient portals and phone consultations were generally acceptable, with similar overall TFA scores (3.9/5). Patient portals were considered as significantly less time-consuming and better for communication, whereas phone consultations were preferred for accessibility and reliability. Multivariable analyses showed that higher digital communication skills and better quality of life predicted greater acceptability for both methods, whereas lower education level and more frequent use were associated with higher acceptability of phone consultations. Conclusions: Acceptability of patient portals and phone consultations varies by education, digital communication skills, and quality of life. This highlights the need for personalized hybrid care solutions. Healthcare providers should offer flexible digital options, invest in digital literacy programs, and develop interoperable eHealth infrastructure to enable safe and sustainable integration of advanced tools such as video consultations. Full article
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31 pages, 2308 KB  
Article
Digital Transformation of Medical Services in Romania: Does the Healthcare System Meet the Current Needs of Patients?
by Ioana-Marcela Păcuraru, Ancuța Năstac, Andreea Zamfir, Ștefan Sebastian Busnatu, Octavian Andronic and Andrada-Raluca Artamonov
Healthcare 2025, 13(20), 2549; https://doi.org/10.3390/healthcare13202549 - 10 Oct 2025
Viewed by 2312
Abstract
Background: The digitalization of medical services is promoted as a solution for improving access, quality, and efficiency within healthcare systems. In this context, the study investigates the extent to which digitalization in Romania meets the current needs of patients through a convergent [...] Read more.
Background: The digitalization of medical services is promoted as a solution for improving access, quality, and efficiency within healthcare systems. In this context, the study investigates the extent to which digitalization in Romania meets the current needs of patients through a convergent analysis of user perceptions and managerial perspectives. Based on the specialized literature, the research tests two hypotheses: (H1) the implementation of digital technologies significantly contributes to improving the quality of medical services and operational efficiency; (H2) digitalization has a positive impact on patient satisfaction by facilitating access to care and improving communication with medical personnel. Methods: The study adopted methodology is cross-sectional and mixed, including an online mixed-methods questionnaire for patients, distributed between 6 and 14 May 2025, and a qualitative questionnaire with open-ended questions distributed via e-mail to managers from public hospitals through The Administration of Hospitals and Medical Services of Bucharest, between 3 and 24 March 2025. Results: In total, 125 patients and 15 hospital managers participated in the study. Statistical analysis (χ2, ordinal regression) and data triangulation highlight a predominantly positive, yet heterogeneous, patient perception of digitalization, with Hypothesis H1 only partially supported (weak, inconsistent, and in some cases negative associations between technology use and perceived service quality). By contrast, H2 was robustly validated, with patient satisfaction strongly linked to tangible benefits, particularly easier access and online appointment scheduling. However, use remains limited to administrative functions, while advanced technologies such as telemedicine or electronic health records are poorly adopted. From an institutional perspective, hospitals predominantly use IT systems for internal purposes, without real patient access to their own data, no interoperability between medical units, and marginal implementation of telemedicine. This reveals a significant gap between user perception and organizational realities, emphasizing the lack of a patient-oriented digital infrastructure. Conclusions: The results highlight the potential of digitalization to enhance patient experience and service efficiency, while also pointing out structural limitations that hinder the full realization of this potential. Patient satisfaction is strongly associated with tangible benefits, particularly easier access and online scheduling, whereas the effect on perceived quality is weaker and sometimes inconsistent. There are significant disparities in digitalization levels between healthcare providers, perceived by patients as public–private differences, and gaps among public hospitals are also confirmed by managerial data. These findings suggest that a successful digital transformation of the medical system in Romania must address both technological infrastructure gaps and organizational barriers, within a coordinated national strategy that ensures interoperability, patient-centered design, and sustainable implementation. Full article
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14 pages, 235 KB  
Article
Investing in Resilience: A Comparative Study of Black Church Survival in Underserved Detroit
by Charles Edward Williams
Religions 2025, 16(9), 1182; https://doi.org/10.3390/rel16091182 - 14 Sep 2025
Viewed by 1622
Abstract
This study examines how theological orientation and institutional culture shape the viability of two historically Black churches in Detroit: Historic King Solomon Baptist Church and Greater King Solomon Baptist Church. Against the backdrop of accelerating church closures in underserved Black communities, the research [...] Read more.
This study examines how theological orientation and institutional culture shape the viability of two historically Black churches in Detroit: Historic King Solomon Baptist Church and Greater King Solomon Baptist Church. Against the backdrop of accelerating church closures in underserved Black communities, the research investigates the factors that contribute to a congregation’s continued relevance and vitality. In doing so, it also provides insight into which churches are best positioned to sustain and scale health and interventions, support community development, and offer enduring spiritual leadership. Using a comparative case study approach grounded in W.E.B. Du Bois’s framework of the Black church as a site of “refuge and protest” and Max Weber’s theory of religious institutionalization, the research combines qualitative interviews with pastors, members, and community residents, alongside sermon content analysis from Easter and Christmas services in 2023 and 2024. Findings reveal stark differences: Historic King Solomon exemplifies an outward-facing, justice-centered model rooted in social memory and public service; Greater King Solomon reflects a more inward-facing, survivalist ethic shaped by individual piety and institutional maintenance. These distinctions impact each church’s resilience, as well as its readiness for public health partnerships and social investment. The study concludes that Black churches that are outwardly facing are likely to survive socioeconomic environmental challenges. Concurrently, both churches portray the Black church as two distinct entities culturally and theologically, which suggests an enhanced selection rubric for identifying congregations best positioned to advance social and health community outcomes. Full article
(This article belongs to the Special Issue Breath of Life: Black Spirituality in Everyday Life)
12 pages, 375 KB  
Article
Vaccination Coverage in Adult Patients with Inflammatory Bowel Disease: Impact of a Tailored Vaccination Pathway Including COVID-19 and Herpes Zoster in a University Hospital Vaccination Center
by Roberto Venuto, Caterina Elisabetta Rizzo, Daniela Lo Giudice, Walter Fries, Concetta Ceccio, Francesco Fedele, Raffaele Squeri and Cristina Genovese
Vaccines 2025, 13(9), 961; https://doi.org/10.3390/vaccines13090961 - 11 Sep 2025
Cited by 2 | Viewed by 1066
Abstract
Background/Objectives: Patients with inflammatory bowel disease (IBD) are at increased risk of severe infections, particularly when undergoing immunosuppressive therapy. Vaccination is a key preventive strategy, but coverage in this group is often suboptimal. This study evaluated vaccination coverage among IBD patients at diagnosis/referral [...] Read more.
Background/Objectives: Patients with inflammatory bowel disease (IBD) are at increased risk of severe infections, particularly when undergoing immunosuppressive therapy. Vaccination is a key preventive strategy, but coverage in this group is often suboptimal. This study evaluated vaccination coverage among IBD patients at diagnosis/referral and after admission to a structured hospital-based vaccination pathway. Methods: We conducted an observational study (February 2022–February 2025) at the Vaccination Center (VC) of the University Hospital “G. Martino” in Messina, Italy. Adult IBD patients referred by gastroenterologists were assessed for vaccination status using hospital and regional registries, and personalized schedules were developed based on Italian National Vaccine Prevention Plan guidelines. Descriptive statistics were applied to assess baseline and post-intervention vaccination coverage. Results: Of 154 participants (mean age 64 years; 51.9% male), 55.4% were on immunosuppressive therapy. Baseline coverage was heterogeneous: influenza, 6.5%; PCV13, 25.5%; PPV23, 26.6%; herpes zoster, 62.3%; and COVID-19 primary cycle, 79.6%. After enrollment, substantial improvements were observed: influenza, 89.2%; PCV13, 74.5%; PPV23, 67.0%; herpes zoster, 75.4%; and COVID-19 primary cycle, 96.8%. Coverage for catch-up vaccines also improved (e.g., HBV went from 1.9% to 44.2%). However, uptake of COVID-19 booster doses during the study period remained low (15.6%). No significant differences emerged by sex or treatment subgroup. Conclusions: A structured, collaborative care pathway between gastroenterologists and public health specialists significantly improved vaccination coverage among IBD patients. Despite gains, gaps persist in COVID-19 booster uptake and catch-up vaccinations. Integration of vaccination services into routine IBD management is essential to enhance protection in this high-risk population. Full article
(This article belongs to the Special Issue Epidemiology of Diseases Preventable by Vaccination)
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23 pages, 1946 KB  
Article
A Digital Health Equity Framework for Sustainable e-Health Services in Saudi Arabia
by Fahdah AlShaikh and Rawan Hayan Alwadai
Sustainability 2025, 17(17), 7681; https://doi.org/10.3390/su17177681 - 26 Aug 2025
Viewed by 2564
Abstract
As Saudi Arabia accelerates digital transformation under Vision 2030, the sustainable adoption of Health 4.0 technologies depends on equitable digital health literacy (DHL) and population-level readiness for eHealth engagement. Despite growing interest, empirical data on the behavioral, social, and contextual determinants of digital [...] Read more.
As Saudi Arabia accelerates digital transformation under Vision 2030, the sustainable adoption of Health 4.0 technologies depends on equitable digital health literacy (DHL) and population-level readiness for eHealth engagement. Despite growing interest, empirical data on the behavioral, social, and contextual determinants of digital health adoption remain limited in Middle Eastern settings. This study investigates the readiness of Saudi adults for eHealth services, identifies key behavioral factors influencing digital tool adoption, and proposes an equity-centered, network-aware DHL framework to support inclusive and sustainable Health 4.0 implementation. A multi-phase, cross-sectional study was conducted among 430 Saudi adults using validated instruments including eHEALS, TRI 2.0, UTAUT, and EQ-5D. Quantitative analysis employed multiple linear regression (R2 = 0.79), structural equation modeling (CFI = 0.96; RMSEA = 0.04), social network analysis (centrality scores), and network-based diffusion analysis (s = 0.17). Additionally, a three-round Delphi method (CI ≤ 0.25) ensured expert consensus on framework development. Significant predictors of digital health tool adoption included eHealth readiness (β = 0.18), perceived usability, and system trust. Social network metrics identified central actors who facilitated peer-driven behavioral diffusion, validated through NBDA modeling. Based on these findings, a comprehensive DHL Equity Framework was synthesized, integrating behavioral drivers, network diffusion pathways, and principles from the Triple Bottom Line (TBL) framework to mitigate structural disparities while addressing environmental, economic, and social dimensions of sustainable digital health access. The framework was also systematically mapped to relevant Sustainable Development Goals (SDGs), highlighting its alignment with global health and sustainability targets. This study presents a scalable and policy-relevant model to guide inclusive eHealth strategies in Saudi Arabia and similar developing contexts. The proposed framework advances national digital resilience, reduces inequities, and promotes sustainable Health 4.0 service delivery. Full article
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13 pages, 221 KB  
Article
“There Are Two Healing Processes in Cancer Care—There Is a Physical Healing and a Mental Adaptation Process”: A Pilot Study for Preparing Children and Adolescents with Osteosarcoma for Limb Amputation
by Cynthia Fair, Bria Wurst and Lori Wiener
Cancers 2025, 17(17), 2755; https://doi.org/10.3390/cancers17172755 - 24 Aug 2025
Cited by 1 | Viewed by 1141
Abstract
Background/Objectives: This study assessed how to best prepare pediatric and adolescent cancer patients for amputation and support them afterward. Methods: This pilot qualitative study explored pre- and post-amputation experiences from the perspectives of nine pediatric and adolescent survivors who underwent amputation. Hour-long audio-recorded [...] Read more.
Background/Objectives: This study assessed how to best prepare pediatric and adolescent cancer patients for amputation and support them afterward. Methods: This pilot qualitative study explored pre- and post-amputation experiences from the perspectives of nine pediatric and adolescent survivors who underwent amputation. Hour-long audio-recorded semi-structured interviews were transcribed and analyzed using the Sort and Sift, Think and Shift qualitative approach. Results: Participants described the informational supports they received before surgery, including guidance on what to expect, contact with amputation-related organizations, and exposure to tangible tools, such as a physical model of a knee joint. Emotional support from fellow amputees and healthcare providers, particularly surgeons, was also found to be meaningful. Individuals also identified unmet needs and gaps in emotional care. These included clearer guidance on post-surgical adaptations (e.g., basic self-care and navigating physical limitations) and the need for information tailored to their learning styles. Many emphasized the importance of improved pain management resources, expanded access to mental health services for both them and their families, and support in adjusting to changes in body image and social relationships. Participants also shared advice for future patients, recommending strategies such as personalizing hospital rooms, connecting with other amputees through social media, and using art to process their experience and say goodbye to the lost limb. Conclusions: Interviews with nine cancer survivors provide guidance for improving holistic, patient-centered care throughout the amputation process. Informational and emotional support should be tailored to an individual’s learning style and specific needs, in addition to their age at the time of surgery. Full article
(This article belongs to the Special Issue Advances in Pediatric and Adolescent Psycho-Oncology)
19 pages, 1222 KB  
Review
Telemedicine in Obstetrics and Gynecology: A Scoping Review of Enhancing Access and Outcomes in Modern Healthcare
by Isameldin Elamin Medani, Ahlam Mohammed Hakami, Uma Hemant Chourasia, Babiker Rahamtalla, Naser Mohsen Adawi, Marwa Fadailu, Abeer Salih, Amani Abdelmola, Khalid Nasralla Hashim, Azza Mohamed Dawelbait, Noha Mustafa Yousf, Nazik Mubarak Hassan, Nesreen Alrashid Ali and Asma Ali Rizig
Healthcare 2025, 13(16), 2036; https://doi.org/10.3390/healthcare13162036 - 18 Aug 2025
Cited by 3 | Viewed by 4831
Abstract
Telemedicine has transformed obstetrics and gynecology (OB/GYN), accelerated by the COVID-19 pandemic. This study aims to synthesize evidence on the adoption, effectiveness, barriers, and technological innovations of telemedicine in OB/GYN across diverse healthcare settings. This scoping review synthesized 63 peer-reviewed studies (2010–2023) using [...] Read more.
Telemedicine has transformed obstetrics and gynecology (OB/GYN), accelerated by the COVID-19 pandemic. This study aims to synthesize evidence on the adoption, effectiveness, barriers, and technological innovations of telemedicine in OB/GYN across diverse healthcare settings. This scoping review synthesized 63 peer-reviewed studies (2010–2023) using PRISMA-ScR guidelines to map global applications, outcomes, and challenges. Key modalities included synchronous consultations, remote monitoring, AI-assisted triage, tele-supervision, and asynchronous communication. Results demonstrated improved access to routine care and mental health support, with outcomes for low-risk pregnancies comparable to in-person services. Adoption surged >500% during pandemic peaks, stabilizing at 9–12% of services in high-income countries. However, significant disparities persisted: 43% of rural Sub-Saharan clinics lacked stable internet, while socioeconomic, linguistic, and cultural barriers disproportionately affected vulnerable populations (e.g., non-English-speaking, transgender, and refugee patients). Providers reported utility but also screen fatigue (41–68%) and diagnostic uncertainty. Critical barriers included fragmented policies, reimbursement variability, data privacy concerns, and limited evidence from conflict-affected regions. Sustainable integration requires equity-centered design, robust policy frameworks, rigorous longitudinal evaluation, and ethically validated AI to address clinical complexity and systemic gaps. Full article
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29 pages, 1150 KB  
Review
What Helps or Hinders Annual Wellness Visits for Detection and Management of Cognitive Impairment Among Older Adults? A Scoping Review Guided by the Consolidated Framework for Implementation Research
by Udoka Okpalauwaekwe, Hannah Franks, Yong-Fang Kuo, Mukaila A. Raji, Elise Passy and Huey-Ming Tzeng
Nurs. Rep. 2025, 15(8), 295; https://doi.org/10.3390/nursrep15080295 - 12 Aug 2025
Viewed by 1584
Abstract
Background: The U.S. Medicare Annual Wellness Visit (AWV) offers a structured opportunity for cognitive screening and personalized prevention planning among older adults. Yet, implementation of AWVs, particularly for individuals with cognitive impairment, remains inconsistent across primary care or other diverse care settings. Methods: [...] Read more.
Background: The U.S. Medicare Annual Wellness Visit (AWV) offers a structured opportunity for cognitive screening and personalized prevention planning among older adults. Yet, implementation of AWVs, particularly for individuals with cognitive impairment, remains inconsistent across primary care or other diverse care settings. Methods: We conducted a scoping review using the Consolidated Framework for Implementation Research (CFIR) to explore multilevel factors influencing the implementation of the Medicare AWV’s cognitive screening component, with a focus on how these processes support the detection and management of cognitive impairment among older adults. We searched four databases and screened peer-reviewed studies published between 2011 and March 2025. Searches were conducted in Ovid MEDLINE, PubMed, EBSCOhost, and CINAHL databases. The initial search was completed on 3 January 2024 and updated monthly through 30 March 2025. All retrieved citations were imported into EndNote 21, where duplicates were removed. We screened titles and abstracts for relevance using the predefined inclusion criteria. Full-text articles were then reviewed and scored as either relevant (1) or not relevant (0). Discrepancies were resolved through consensus discussions. To assess the methodological quality of the included studies, we used the Joanna Briggs Institute critical appraisal tools appropriate to each study design. These tools evaluate rigor, trustworthiness, relevance, and risk of bias. We extracted the following data from each included study: Author(s), year, title, and journal; Study type and design; Data collection methods and setting; Sample size and population characteristics; Outcome measures; Intervention details (AWV delivery context); and Reported facilitators, barriers, and outcomes related to AWV implementation. The first two authors independently coded and synthesized all relevant data using a table created in Microsoft Excel. The CFIR guided our data analysis, thematizing our findings into facilitators and barriers across its five domains, viz: (1) Intervention Characteristics, (2) Outer Setting, (3) Inner Setting, (4) Characteristics of Individuals, and (5) Implementation Process. Results: Among 19 included studies, most used quantitative designs and secondary data. Our CFIR-based synthesis revealed that AWV implementation is shaped by interdependent factors across five domains. Key facilitators included AWV adaptability, Electronic Health Record (EHR) integration, team-based workflows, policy alignment (e.g., Accountable Care Organization participation), and provider confidence. Barriers included vague Centers for Medicare and Medicaid Services (CMS) guidance, limited reimbursement, staffing shortages, workflow misalignment, and provider discomfort with cognitive screening. Implementation strategies were often poorly defined or inconsistently applied. Conclusions: Effective AWV delivery for older adults with cognitive impairment requires more than sound policy and intervention design; it demands organizational readiness, structured implementation, and engaged providers. Tailored training, leadership support, and integrated infrastructure are essential. These insights are relevant not only for U.S. Medicare but also for global efforts to integrate dementia-sensitive care into primary health systems. Our study has a few limitations that should be acknowledged. First, our scoping review synthesized findings predominantly from quantitative studies, with only two mixed-method studies and no studies using strictly qualitative methodologies. Second, few studies disaggregated findings by race, ethnicity, or geography, reducing our ability to assess equity-related outcomes. Moreover, few studies provided sufficient detail on the specific cognitive screening instruments used or on the scope and delivery of educational materials for patients and caregivers, limiting generalizability and implementation insights. Third, grey literature and non-peer-reviewed sources were not included. Fourth, although CFIR provided a comprehensive analytic structure, some studies did not explicitly fit in with our implementation frameworks, which required subjective mapping of findings to CFIR domains and may have introduced classification bias. Additionally, although our review did not quantitatively stratify findings by year, we observed that studies from more recent years were more likely to emphasize implementation facilitators (e.g., use of templates, workflow integration), whereas earlier studies often highlighted systemic barriers such as time constraints and provider unfamiliarity with AWV components. Finally, while our review focused specifically on AWV implementation in the United States, we recognize the value of comparative analysis with international contexts. This work was supported by a grant from the National Institute on Aging, National Institutes of Health (Grant No. 1R01AG083102-01; PIs: Tzeng, Kuo, & Raji). Full article
(This article belongs to the Section Nursing Care for Older People)
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19 pages, 302 KB  
Article
Resettlement Workforce Perspectives on Mental Health Care of Refugees
by Bibhuti K. Sar, Lesley M. Harris, Adrian J. Archuleta, Susan H. Rhema, Nicole B. Adams, Eva Nyerges and Doroty Sato
Int. J. Environ. Res. Public Health 2025, 22(8), 1247; https://doi.org/10.3390/ijerph22081247 - 9 Aug 2025
Viewed by 1491
Abstract
Background: To identify the mental health care needs of resettled refugees, researchers have studied the perspectives of mental health service providers but have paid limited attention to the perspectives of individuals who work directly in resettlement agencies or in agencies that exclusively provide [...] Read more.
Background: To identify the mental health care needs of resettled refugees, researchers have studied the perspectives of mental health service providers but have paid limited attention to the perspectives of individuals who work directly in resettlement agencies or in agencies that exclusively provide services to promote refugees’ self-sufficiency and integration—the refugee resettlement workforce—who routinely provide support, make referrals, and coordinate mental health care. To better inform programming and service delivery, this qualitative case study focuses on the perspectives of the resettlement workforce. Methods: Focus group interviews conducted with 48 refugee resettlement workforce members were analyzed for their perspectives on refugee mental health needs and care. Results: Thematic analysis revealed that their perspectives centered on barriers to (i.e., resettlement challenges, notions about mental illness, stigma associated with mental illness, inadequate access to mental health care, and limited technology literacy) and facilitators of (i.e., promoting mental health literacy, addressing stigma, providing specific and targeted training, mental health coordination, allies, and building programming capacity) refugee mental health care. A set of recommendations to minimize barriers and promote facilitators is presented. Conclusions: These findings corroborate previous research and inform the practices, programs, and policies that should be developed and implemented to support refugees’ mental health wellbeing, self-sufficiency, and community integration post-resettlement. Full article
21 pages, 2460 KB  
Article
Enhancing Competencies and Professional Upskilling of Mobile Healthcare Unit Personnel at the Hellenic National Public Health Organization
by Marios Spanakis, Maria Stamou, Sofia Boultadaki, Elias Liantis, Christos Lionis, Georgios Marinos, Anargiros Mariolis, Andreas M. Matthaiou, Constantinos Mihas, Varvara Mouchtouri, Evangelia Nena, Efstathios A. Skliros, Emmanouil Smyrnakis, Athina Tatsioni, Georgios Dellis, Christos Hadjichristodoulou and Emmanouil K. Symvoulakis
Healthcare 2025, 13(14), 1706; https://doi.org/10.3390/healthcare13141706 - 15 Jul 2025
Cited by 1 | Viewed by 2048
Abstract
Background/Objectives: Mobile healthcare units (MHUs) comprise flexible, ambulatory healthcare teams that deliver community care services, particularly in underserved or remote areas. In Greece, MHUs were pivotal in epidemiological surveillance during the COVID-19 pandemic and are now evolving into a sustainable and integrated service [...] Read more.
Background/Objectives: Mobile healthcare units (MHUs) comprise flexible, ambulatory healthcare teams that deliver community care services, particularly in underserved or remote areas. In Greece, MHUs were pivotal in epidemiological surveillance during the COVID-19 pandemic and are now evolving into a sustainable and integrated service for much-needed community-based healthcare. To support this expanded role, targeted, competency-based training is essential; however, this can pose challenges, especially in coordinating synchronous learning across geographically dispersed teams and in ensuring engagement using an online format. Methods: A nationwide, online training program was developed to improve the knowledge of the personnel members of the Hellenic National Public Health Organization’s MHUs. This program was structured focusing on four core themes: (i) prevention–health promotion; (ii) provision of care; (iii) social welfare and solidarity initiatives; and (iv) digital health skill enhancement. The program was implemented by the University of Crete’s Center for Training and Lifelong Learning from 16 January to 24 February 2025. A multidisciplinary team of 64 experts delivered 250 h of live and on-demand educational content, including health screenings, vaccination protocols, biomarker monitoring, chronic disease management, treatment adherence, organ donation awareness, counseling on social violence, and eHealth applications. Knowledge acquisition was assessed through a pre- and post-training multiple-choice test related to the core themes. Trainees’ and trainers’ qualitative feedback was evaluated using a 0–10 numerical rating scale (Likert-type). Results: A total of 873 MHU members participated in the study, including both healthcare professionals and administrative staff. The attendance rate was consistently above 90% on a daily basis. The average assessment score increased from 52.8% (pre-training) to 69.8% (post-training), indicating 17% knowledge acquisition. The paired t-test analysis demonstrated that this improvement was statistically significant (t = −8.52, p < 0.001), confirming the program’s effectiveness in enhancing knowledge. As part of the evaluation of qualitative feedback, the program was positively evaluated, with 75–80% of trainees rating key components such as content, structure, and trainer effectiveness as “Very Good” or “Excellent.” In addition, using a 0–10 scale, trainers rated the program relative to organization (9.4/10), content (8.8), and trainee engagement (8.9), confirming the program’s strength and scalability in primary care education. Conclusions: This initiative highlights the effectiveness of a structured, online training program in enhancing MHU knowledge, ensuring standardized, high-quality education that supports current primary healthcare needs. Future studies evaluating whether the increase in knowledge acquisition may also result in an improvement in the personnel’s competencies, and clinical practice will further contribute to assessing whether additional training programs may be helpful. Full article
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23 pages, 1388 KB  
Article
Machine Learning-Based State-of-Health Estimation of Battery Management Systems Using Experimental and Simulation Data
by Anas Al-Rahamneh, Irene Izco, Adrian Serrano-Hernandez and Javier Faulin
Mathematics 2025, 13(14), 2247; https://doi.org/10.3390/math13142247 - 11 Jul 2025
Cited by 2 | Viewed by 4555
Abstract
In pursuit of zero-emission targets, increasing sustainability concerns have prompted urban centers to adopt more environmentally friendly modes of transportation, notably through the deployment of electric vehicles (EVs). A prominent manifestation of this shift is the transition from conventional fuel-powered buses to electric [...] Read more.
In pursuit of zero-emission targets, increasing sustainability concerns have prompted urban centers to adopt more environmentally friendly modes of transportation, notably through the deployment of electric vehicles (EVs). A prominent manifestation of this shift is the transition from conventional fuel-powered buses to electric buses (e-buses), which, despite their environmental benefits, introduce significant operational challenges—chief among them, the management of battery systems, the most critical and complex component of e-buses. The development of efficient and reliable Battery Management Systems (BMSs) is thus central to ensuring battery longevity, operational safety, and overall vehicle performance. This study examines the potential of intelligent BMSs to improve battery health diagnostics, extend service life, and optimize system performance through the integration of simulation, real-time analytics, and advanced deep learning techniques. Particular emphasis is placed on the estimation of battery state of health (SoH), a key metric for predictive maintenance and operational planning. Two widely recognized deep learning models—Multilayer Perceptron (MLP) and Long Short-Term Memory (LSTM)—are evaluated for their efficacy in predicting SoH. These models are embedded within a unified framework that combines synthetic data generated by a physics-informed battery simulation model with empirical measurements obtained from real-world battery aging datasets. The proposed approach demonstrates a viable pathway for enhancing SoH prediction by leveraging both simulation-based data augmentation and deep learning. Experimental evaluations confirm the effectiveness of the framework in handling diverse data inputs, thereby supporting more robust and scalable battery management solutions for next-generation electric urban transportation systems. Full article
(This article belongs to the Special Issue Operations Research and Intelligent Computing for System Optimization)
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13 pages, 238 KB  
Article
Partnering with Family Organizations in Research: Experiences from the Field
by Jessica Holmes, Tennyson Dahlman, Eric J. Bruns, Misty Woody, Melissa Hendricks, Millie Sweeney and Bruno J. Anthony
Int. J. Environ. Res. Public Health 2025, 22(6), 894; https://doi.org/10.3390/ijerph22060894 - 3 Jun 2025
Viewed by 1043
Abstract
Parent Peer Support (PPS) provided by other caregivers who have lived experience raising a child with mental health conditions (e.g., such as anxiety, depression, attention, and/or behavior disorders) holds promise as a service that can improve outcomes by helping young people and their [...] Read more.
Parent Peer Support (PPS) provided by other caregivers who have lived experience raising a child with mental health conditions (e.g., such as anxiety, depression, attention, and/or behavior disorders) holds promise as a service that can improve outcomes by helping young people and their families overcome system- and individual-level barriers to receiving care. Here, we describe the development of a collaboration of researchers and Family-Run Organizations (FROs) to provide research support for PPS through three phases (1) developing a research agenda and study aims through a Patient-Centered Outcomes Research Institute (PCORI) “Pipeline to Proposal” grant; (2) designing a pilot study, including refining the measurement framework for a successful grant application to the National Institute of Mental Health (NIMH); and (3) implementing the study through the incorporation of research methodology into FRO operations without disrupting the organizations’ missions. This paper summarizes the participatory action research (PAR) strategies employed by this interdisciplinary research team throughout the three phases, covering the benefits and challenges of these unique partnership activities. We focus on how this project was able to increase the relevance of the research to the FROs and the communities they serve and improve dissemination and utilization of the results to support other PPS projects. Full article
24 pages, 1270 KB  
Article
Multi-Criteria Decision-Making for Assessing and Evaluating Health and Wellness Tourism Destination Potential Using the 6AsTD Framework: A Case Study of Nakhon Ratchasima Province, Thailand
by Phongchai Jittamai, Sovann Toek, Kritsada Phengarree, Kingkan Kongkanjana and Natdanai Chanlawong
Sustainability 2025, 17(11), 4995; https://doi.org/10.3390/su17114995 - 29 May 2025
Viewed by 3178
Abstract
Health and wellness tourism is a rapidly expanding segment of the global tourism industry, driven by increasing consumer awareness of well-being and lifestyle enhancement. As the demand for wellness travel grows, destinations are expected to offer high standards of safety, hygiene, rehabilitation, and [...] Read more.
Health and wellness tourism is a rapidly expanding segment of the global tourism industry, driven by increasing consumer awareness of well-being and lifestyle enhancement. As the demand for wellness travel grows, destinations are expected to offer high standards of safety, hygiene, rehabilitation, and holistic experiences. This study aims to identify and evaluate the key attributes and determinants for developing health and wellness tourism destinations by applying the 6As Tourism Development framework: Attractions, Accessibility, Amenities, Activities, Available Packages, and Ancillary Services. A multi-criteria decision-making approach, specifically the TOPSIS, was employed to assess destination potential through a case study of Nakhon Ratchasima Province, Thailand. The results indicate that Attractions, Accessibility, and Amenities are the top three priorities for wellness tourists. Sub-criteria such as natural scenery, cultural significance, accessibility for all, safety, and accommodation quality are particularly influential. Three districts in Nakhon Ratchasima were found to exhibit distinct strengths—Pak Chong is best suited for rehabilitative tourism (e.g., aroma and water therapy), aligning with mind and nutrition wellness components; Wang Nam Khiao is ideal for ecotourism and cultural experiences, supporting environmental and nutritional dimensions; while Mueang Nakhon Ratchasima excels in sports tourism, supporting physical and nutritional well-being. The study offers practical insights for policymakers and tourism stakeholders to design sustainable, visitor-centered wellness destinations. The proposed framework supports strategic planning and resource allocation for health-focused tourism development. Full article
(This article belongs to the Special Issue Health and Sustainable Lifestyle: Balancing Work and Well-Being)
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20 pages, 505 KB  
Article
A University’s Role in Developing a Regional Network of Dementia Friendly Communities
by Laurel Standiford Reyes, M. C. Ehlman, Suzanne Leahy and Reagan Lawrence
Int. J. Environ. Res. Public Health 2025, 22(5), 721; https://doi.org/10.3390/ijerph22050721 - 1 May 2025
Viewed by 1089
Abstract
Introduction: The World Health Organization has identified dementia as a growing global health concern with 10 million new cases diagnosed every year. The growing number of people living with dementia (PLWD) heightens the need for effective interventions that support PLWD and their caregivers. [...] Read more.
Introduction: The World Health Organization has identified dementia as a growing global health concern with 10 million new cases diagnosed every year. The growing number of people living with dementia (PLWD) heightens the need for effective interventions that support PLWD and their caregivers. The most effective interventions supporting PLWD and caregivers combine education, care, and services to increase knowledge, decrease stigma, improve care, heighten empathy, and increase engagement of PLWD in their communities. Dementia Friendly America (DFA), administered by USAging, promotes a Dementia Friendly Community (DFC) initiative designed to engage multiple sectors (e.g., business, healthcare, community services) and engage PLWD in a comprehensive community change process. A center for healthy aging and wellness at a midwestern public university developed a network approach in its regional support of eight DFCs, as a part of its Geriatric Workforce Enhancement Program funded by the U.S. Health Resources and Services Administration. Objective: This article documents a mid-size university’s approach to establishing a regional DFC network of urban and rural communities surrounding the university, describing the support the university provided as well as how communities implemented the four-phase DFC process and emulated guiding principles. Results: A retrospective evaluation found engagement with the DFA guiding principles and varying levels of adherence to DFC phases. Discussion: The project team suggests that there are unique roles that universities can play in supporting the DFC movement and that developing a network of communities is a helpful strategy to use in providing this support. Additionally, the authors propose the integration of a community change model to guide future DFC work. Conclusions: This article helps to fill an existing research gap concerning DFC implementation and explores the unique role academic partners can play in cultivating regional hubs of DFC activity. Full article
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