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17 pages, 298 KB  
Article
Vaccination Uptake and Pandemic-Related Healthcare Experiences Among People Living with HIV in Romania: A Cross-Sectional Study
by Adrian Gabriel Marinescu, Aida-Isabela Adamescu, Cătălin Tilișcan, Daniela Pițigoi, Sebastian Ciobanu, Laurențiu Mihăița Stratan, Carmen Cristina Vasile, Victor Daniel Miron, Mariana Mardarescu, Dalila Toma, Andreea Iuliana Ciobanu, Victoria Aramă and Ștefan Sorin Aramă
Vaccines 2026, 14(9), 751; https://doi.org/10.3390/vaccines14090751 (registering DOI) - 28 Aug 2026
Abstract
Background: The COVID-19 pandemic exposed major vulnerabilities in healthcare accessibility and may have influenced preventive attitudes among people living with HIV (PLWH). However, the relationship between pandemic-related healthcare experiences and vaccination uptake remains insufficiently understood. Materials: A cross-sectional survey was conducted among 203 [...] Read more.
Background: The COVID-19 pandemic exposed major vulnerabilities in healthcare accessibility and may have influenced preventive attitudes among people living with HIV (PLWH). However, the relationship between pandemic-related healthcare experiences and vaccination uptake remains insufficiently understood. Materials: A cross-sectional survey was conducted among 203 adults living with HIV receiving follow-up care in Romania between October 2025 and March 2026. The questionnaire evaluated vaccination uptake, vaccine-related perceptions, healthcare information sources, and pandemic-related experiences. Multivariable logistic regression analysis was performed to identify factors independently associated with vaccination uptake. Results: Only 38.9% of participants reported receiving at least one vaccine within the previous three years. The main barriers to vaccination were perceived lack of necessity, lack of physician recommendation, fear of adverse effects, and lack of trust. Multivariable logistic regression identified positive vaccine-related beliefs (OR = 0.454, 95% CI: 0.235–0.876, p = 0.019) and CD4+ T-cell count above 500 cells/mm3 (OR = 0.448, 95% CI: 0.232–0.867, p = 0.017) as independently associated with lower odds of being non-vaccinated. More than half of participants (52.7%) reported at least one pandemic-related disruption or negative health impact. The pandemic-related negative impact composite was not significantly associated with vaccination status (p = 0.209), whereas confirmed COVID-19 infection was more frequent among vaccinated participants than among non-vaccinated participants (43.0% vs. 28.2%, p = 0.030). Pandemic-related negative impact was associated with a greater demand for physician-provided information (p = 0.011). Conclusions: Pandemic-related healthcare experiences were associated with greater demand for physician-provided preventive information, while confirmed COVID-19 infection was more frequent among vaccinated participants. Positive vaccine-related beliefs and higher CD4+ T-cell counts were independently associated with vaccination uptake, while lack of physician recommendation remained a major barrier to vaccination. These findings emphasize the critical role of physicians in improving vaccination coverage among people living with HIV in the post-pandemic era. Full article
18 pages, 2232 KB  
Article
Parental Reports of Oral Health Behaviours and Dental Caries in Romanian Children and Adolescents: A Cross-Sectional Study
by Darius Dacian Macavei, Raluca Iurcov, Abel Emanuel Moca, Rebeca Daniela Marton, Gabriela Ciavoi and Ligia Luminița Vaida
Children 2026, 13(9), 1154; https://doi.org/10.3390/children13091154 - 27 Aug 2026
Viewed by 328
Abstract
Background/Objectives: Dental caries remains one of the most prevalent chronic diseases in childhood, influenced by a combination of hygiene, dietary, and access-related behaviours that are largely shaped by parental involvement. This study aimed to evaluate oral hygiene habits, dietary risk factors, access [...] Read more.
Background/Objectives: Dental caries remains one of the most prevalent chronic diseases in childhood, influenced by a combination of hygiene, dietary, and access-related behaviours that are largely shaped by parental involvement. This study aimed to evaluate oral hygiene habits, dietary risk factors, access to dental services, awareness of caries prevention, and the impact of oral health on the child, in relation to parent-reported dental caries in Romanian children and adolescents. Methods: A cross-sectional study was conducted using a structured online questionnaire completed by parents or legal guardians of 508 children and adolescents aged under 18 years. Associations between categorical variables and reported caries were assessed using chi-square tests and Cramér’s V. Ordinal variables were compared using the Mann–Whitney U test. A multivariable logistic regression identified independent predictors of reported caries, with robustness examined through sensitivity analyses. Results: Parent-reported caries was present in 61.2% of children. The strongest associations with caries were the absence of parental supervision during brushing (Cramér’s V = 0.364), the age at which children began brushing unsupervised (V = 0.354), and the reason for the last dental visit (V = 0.426). In the multivariable model, older age, absence of brushing supervision, sweets before bedtime, less frequent dental visits, and rural residence were independent predictors (all p < 0.05; Nagelkerke R2 = 0.361). All six assessed dimensions of oral-health impact on the child were significantly associated with caries, with physical discomfort showing the largest effect (V = 0.349). Conclusions: Parent-reported caries risk in this population clustered around a small number of modifiable behaviours rather than any single dominant factor, while reported caries was associated with a substantial burden on children’s daily functioning. These findings point to sustained parental supervision and routine, non-symptomatic dental care as priority targets for future prevention efforts, although intervention studies are needed to confirm their effectiveness. Full article
(This article belongs to the Special Issue Dental Status and Oral Health in Children and Adolescents)
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15 pages, 631 KB  
Article
Communication as Mediator: Interprofessional Deprescribing and the RCC (Roles–Collaboration–Communication) Framework
by Alina Cernasev, Devin Scott, Laura Reed, Amy Hall and Bruce L. Keisling
Healthcare 2026, 14(17), 2739; https://doi.org/10.3390/healthcare14172739 - 27 Aug 2026
Viewed by 127
Abstract
Background: Polypharmacy remains a significant challenge, often leading to adverse drug events and increased healthcare costs. One effective strategy to mitigate these risks is deprescribing, the systematic and intentional discontinuation or reduction of medications. Despite growing recognition of deprescribing’s importance, limited research has [...] Read more.
Background: Polypharmacy remains a significant challenge, often leading to adverse drug events and increased healthcare costs. One effective strategy to mitigate these risks is deprescribing, the systematic and intentional discontinuation or reduction of medications. Despite growing recognition of deprescribing’s importance, limited research has examined the impact of interprofessional education interventions on developing deprescribing competencies among healthcare professional students. This study aims to examine the perspectives of healthcare students, including student pharmacists, medical students, and nurse practitioner students, regarding their roles and responsibilities in the deprescribing process. Methods: Following completion of a Deprescribing Interprofessional Education Simulation activity (DIPE-SA), participants were invited to join focus groups. The study included students from the University of Tennessee Health Science Center (UTHSC) Colleges of Medicine, Nursing, and Pharmacy. Constructivist Grounded Theory (CGT) underpinned the qualitative research approach, informing the development of the study framework. Each focus group was facilitated by two researchers and recorded. Recruitment continued until saturation was achieved. Data were transcribed verbatim and analyzed for themes using Dedoose, qualitative analysis software. Results: A total of 19 participants attended four focus groups. Three major themes emerged and guided the development of the Roles–Collaboration–Communication (RCC) interprofessional framework. The first theme, roles, focuses on the unique responsibilities and functions healthcare professionals assume within the team and throughout the deprescribing process. The second theme, collaboration, emphasizes coordinated efforts and shared decision-making among members of the interprofessional healthcare team in deprescribing. Finally, the third theme, communication, highlights the importance of effective information and intention exchange, serving as both a mediator and connector, linking roles and collaboration, and ultimately enabling successful deprescribing. Conclusions: This study’s findings, together with the RCC interprofessional framework, demonstrate the interplay of roles, collaboration, and communication in medication management. The RCC framework highlights the value of dynamic team processes for achieving safe and effective deprescribing, which in turn improves patient care and health outcomes. Full article
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27 pages, 337 KB  
Review
Beyond Efficacy: Policy, Delivery, and Equity Determinants of Long-Acting Monoclonal Antibody Uptake for Infant RSV Prevention—A WAidid Consensus Document
by Susanna Esposito, Bahaa Abu-Raya, Brian Eley, Natasha Halasa, Federico Martinon-Torres, Asuncion Mejias, Vana Spoulou, Tobias Tenenbaum, Juan Pablo Torres, Albert Osterhaus, Octavio Ramilo and Nicola Principi
Vaccines 2026, 14(9), 739; https://doi.org/10.3390/vaccines14090739 - 26 Aug 2026
Viewed by 220
Abstract
Background: Long-acting monoclonal antibodies have become an important strategy for preventing respiratory syncytial virus (RSV) disease in infants. Nirsevimab is the first product for which substantial post-licensure implementation data are available, whereas real-world evidence on clesrovimab remains limited. Although nirsevimab has demonstrated high [...] Read more.
Background: Long-acting monoclonal antibodies have become an important strategy for preventing respiratory syncytial virus (RSV) disease in infants. Nirsevimab is the first product for which substantial post-licensure implementation data are available, whereas real-world evidence on clesrovimab remains limited. Although nirsevimab has demonstrated high efficacy, its uptake varies considerably across countries, healthcare systems, delivery settings, and population subgroups. This World Association for Infectious Diseases and Immunological Disorders (WAidid) consensus document examines the policy, organizational, economic, and equity-related determinants that shape real-world implementation of long-acting monoclonal antibodies for infant RSV prevention. Methods: This study was conducted as a structured narrative review and WAidid expert consensus document. A structured literature search was performed in PubMed and Embase for English-language publications relevant to nirsevimab uptake and implementation, complemented by targeted review of surveillance reports, policy documents, and public health guidance from the ECDC, UKHSA, and CDC, as well as reference lists of selected publications. Eligible sources included observational and real-world implementation studies, systematic reviews and meta-analyses, economic evaluations, guidelines, policy statements, surveillance reports, and relevant narrative reviews. Evidence was synthesized qualitatively according to policy frameworks, financing and reimbursement, delivery pathways, demographic and socioeconomic determinants, and healthcare-system factors influencing uptake. No statistical software was used because no quantitative re-analysis or meta-analysis was performed. Results: Nirsevimab uptake was strongly influenced by national RSV prevention policies, particularly whether countries adopted universal infant monoclonal antibody programs, maternal RSV vaccination strategies, dual maternal–infant approaches, or targeted risk-based models. Universal, publicly funded programs integrated into neonatal care achieved the highest and most homogeneous coverage, especially when administration occurred before hospital discharge and was supported by registry-based recall systems for infants born outside the RSV season. In contrast, fragmented, outpatient-only, insurance-dependent, or partially reimbursed models were associated with lower, delayed, or more variable uptake. Additional determinants included product cost, reimbursement pathways, provider practices, caregiver awareness and health literacy, insurance status, income, race and ethnicity, geographic deprivation, and access to primary pediatric care. Most available evidence comes from high-income countries, limiting generalizability to low- and middle-income settings, where RSV burden is greatest and implementation constraints may differ. Conclusions: Successful implementation of long-acting monoclonal antibodies for infant RSV prevention requires more than regulatory approval and demonstrated efficacy. Equitable uptake depends on clear national recommendations, sustainable public financing, reliable product supply, integration into neonatal and primary pediatric care, proactive identification and recall of eligible infants, and targeted strategies to reduce socioeconomic and geographic disparities. Although many determinants identified in high-income settings are likely relevant globally, their feasibility, relative importance, and impact require dedicated evaluation in low- and middle-income countries. Full article
(This article belongs to the Special Issue Recent Progress of Vaccines for Respiratory Syncytial Virus (RSV))
23 pages, 2723 KB  
Review
Transparency Through Testing: Rethinking Certification and Safety in Personal Care Products
by Johanna R. Rochester, Kim Schultz, Michael Kupec Lathrop, Kristin Favela, Gay C. Timmons, Jarod Grossman, Martin J. Mulvihill and Jenna Hua
Standards 2026, 6(3), 32; https://doi.org/10.3390/standards6030032 - 26 Aug 2026
Viewed by 192
Abstract
The personal care product market has expanded rapidly in recent years, along with growing consumer awareness of chemical exposures and increasing demand for “clean” products. Consumer perceptions of product safety and potential health impacts are commonly based on ingredient labels, intended use, and [...] Read more.
The personal care product market has expanded rapidly in recent years, along with growing consumer awareness of chemical exposures and increasing demand for “clean” products. Consumer perceptions of product safety and potential health impacts are commonly based on ingredient labels, intended use, and certifications, rather than the full chemical composition of finished products. In this study, we conducted a targeted review of certification and ingredient-evaluation programs in the United States and European markets. Eighteen programs were identified and characterized based on their evaluation approaches, data sources, and whether they incorporate analytical measurement of finished products. We also evaluated the current U.S. and EU regulatory frameworks. Across both certification and regulatory systems, evaluation was found to rely primarily on ingredient-based approaches and supporting documentation, with limited incorporation of analytical measurement. As a result, contaminants, impurities, and incidentals/non-intentionally added substances (which have previously been identified in many consumer products) may not be consistently identified or evaluated for safety. These findings highlight a fundamental gap between intended formulation and actual product composition. Incorporating analytical measurement, particularly non-targeted approaches, provides a complementary groundwork for identifying previously unrecognized chemical exposures and improving the accuracy of product safety certification programs and hazard assessments. Aligning evaluation with measured chemical composition may enhance transparency and better reflect real-world exposure, support more credible sustainability claims, enhance consumer trust, support growing market demand, support consumer safety, and contribute to more effective regulation in the personal care industry. Full article
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13 pages, 249 KB  
Article
Nurse–Patient Mutuality and Health-Related Quality of Life Among Nurses Caring for People with Chronic Illness: A Multicentre Cross-Sectional Study
by Camilla Ripari, Silvia Cilluffo, Barbara Bassola, Rosario Caruso, Stefano Terzoni and Maura Lusignani
Nurs. Rep. 2026, 16(9), 300; https://doi.org/10.3390/nursrep16090300 - 25 Aug 2026
Viewed by 148
Abstract
Background: Although nurses’ health-related quality of life (HRQoL) is critical for mitigating the growing intention to leave the profession, the association between nurse–patient mutuality and nurses’ HRQoL remains unexplored. Therefore, this study aims to examine the association between nurse–patient mutuality and nurses’ [...] Read more.
Background: Although nurses’ health-related quality of life (HRQoL) is critical for mitigating the growing intention to leave the profession, the association between nurse–patient mutuality and nurses’ HRQoL remains unexplored. Therefore, this study aims to examine the association between nurse–patient mutuality and nurses’ HRQoL. Methods: A cross-sectional, multicentre study was conducted across four tertiary hospitals in Italy. Data were collected from a sample of 726 nurses working in medical and surgical inpatient and outpatient wards. Mutuality was measured using the Nurse–patient Mutuality in Chronic Illness scale, comprising three dimensions: developing and going beyond, being a point of reference, deciding and sharing care; HRQoL was assessed via the Short Form-12 Health Status Questionnaire (SF-12), providing Physical (PCS) and Mental (MCS) Component Summaries. Two multiple linear regression models were conducted to evaluate the impact of mutuality dimensions on HRQoL components. Results: Among the 726 participants, none of the three mutuality dimensions were significantly associated with physical HRQoL (PCS). Conversely, two mutuality dimensions were significantly and positively associated with higher MCS scores: developing and going beyond (B = 0.54, 95% CI [0.14, 0.95], p = 0.009) and being a point of reference (B = 0.38, 95% CI [0.09, 0.68], p = 0.010). However, the overall regression model demonstrated a modest explanatory value for MCS (R2 = 0.075). Among covariates, female sex (ref: male; B = −2.29, 95% CI [−4.10, −0.49], p = 0.013) and taking care of relatives (B = −2.07, 95% CI [−3.55, −0.60], p = 0.006) were associated with lower MCS, whereas older age (B = 0.17, 95% CI [0.01, 0.34], p = 0.039) was related to higher MCS. Regarding physical health (R2 = 0.261), having chronic conditions (B = −5.08, 95% CI [−6.48, −3.69], p < 0.001), previous experience as a patient (B = −1.88, 95% CI [−3.07, −0.69], p = 0.002), and taking care of relatives (B = −1.49, 95% CI [−2.62, −0.36], p = 0.010) were significantly associated with lower PCS scores. Conclusions: The reciprocal nature of mutuality could be a potential relational resource for nurses’ mental HRQoL. Healthcare organizations should prioritize structural frameworks and interventions that allow nurses the time and resources to cultivate these essential clinical connections. Full article
16 pages, 480 KB  
Article
How Experiences of Displacement and Resettlement Impact Health and Health Care Access for Resettled Rohingya Refugees: An Emic Perspective
by Diane Barker Mitschke, Katherine Kitchens and Mohamad Faizal
Soc. Sci. 2026, 15(9), 575; https://doi.org/10.3390/socsci15090575 - 25 Aug 2026
Viewed by 164
Abstract
This qualitative descriptive study uses an emic perspective to examine how displacement, statelessness, and resettlement shape health and health care access among 21 Rohingya people with refugee backgrounds living in the United States. Semi-structured interviews were conducted by a Rohingya member of the [...] Read more.
This qualitative descriptive study uses an emic perspective to examine how displacement, statelessness, and resettlement shape health and health care access among 21 Rohingya people with refugee backgrounds living in the United States. Semi-structured interviews were conducted by a Rohingya member of the research team and analyzed using a taxonomic approach. Findings show that participants’ health concerns were not limited to general barriers commonly reported across refugee populations; rather, chronic pain, somaticized distress, comorbid conditions, and difficulties communicating health concepts emerged within a specific context of protracted statelessness, trauma exposure, limited Rohingya-language medical interpretation, and post-resettlement stress pile-up. Participants also described financial, transportation, and language barriers to health care access, alongside instances of positive, respectful care experiences. The study contributes to the literature by demonstrating how Rohingya participants describe health and care access through culturally and historically situated narratives, highlighting the need for trauma-informed, language-accessible, and culturally responsive health systems that attend to both structural barriers and embodied expressions of displacement. Full article
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18 pages, 3317 KB  
Article
Impacts of the ‘Cost-of-Living Crisis’ on UK-Based Owners of Pandemic Puppies
by Claire L. Brand, Zoe Belshaw, Dan G. O’Neill, Gina T. Bryson and Rowena M. A. Packer
Animals 2026, 16(17), 2656; https://doi.org/10.3390/ani16172656 - 24 Aug 2026
Viewed by 276
Abstract
Since 2021, United Kingdom (UK) residents have faced a decline in disposable income termed the Cost-of-Living Crisis (COLC). For pet owners, this has been compounded by the costs of veterinary care rising faster than the rate of inflation. Animal welfare charities have reported [...] Read more.
Since 2021, United Kingdom (UK) residents have faced a decline in disposable income termed the Cost-of-Living Crisis (COLC). For pet owners, this has been compounded by the costs of veterinary care rising faster than the rate of inflation. Animal welfare charities have reported increased rates of relinquishment and owners making cost-reducing savings on multiple aspects of their dogs’ care. This study aimed to quantitatively assess the nature and prevalence of impacts of the COLC on a cohort of dogs acquired in 2020 and their owners. A cross-sectional survey collected data between 2022 and 2024 from n = 770 owners of “Pandemic Puppies” as their dogs reached 36 months of age. Questions focused on the impacts of COLC on household income and expenditure, as well as on specific aspects of dog management. Results identified our owner cohort to have a modal household income which was three times higher than the average household income. Despite this, 36% reported that their household income had been negatively impacted by COLC. Over one in ten (12.4%) owners reported having made COLC-driven negative changes to their dogs’ care, with 10.8% anticipating making changes in the future. The most common changes were reduction in or cessation of pet insurance cover, reduced use of professional dog trainers, groomer and daycare services and delays to seeking veterinary attention for potential health problems. Given the relative affluence of our respondents and the specific features of this “Pandemic Puppy” cohort, these results may not be widely generalisable and may substantially underestimate the negative impacts of the COLC on canine welfare in the wider UK population. Full article
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12 pages, 857 KB  
Article
Impact of the Korean Medical–Political Conflict on Septic Shock Care in the Emergency Department: A Retrospective Single-Center Clinical Analysis
by Seongmun Kang, Jae Hwan Kim, Chiwon Ahn, Young Taeck Oh and Sojune Hwang
Medicina 2026, 62(8), 1604; https://doi.org/10.3390/medicina62081604 - 21 Aug 2026
Viewed by 213
Abstract
Background and Objectives: The 2024 Korean medical–political conflict caused the mass resignation of trainee physicians, raising concerns about the quality of care for time-critical emergencies. This study aimed to assess the impact of workforce disruptions on the management and outcomes of adults [...] Read more.
Background and Objectives: The 2024 Korean medical–political conflict caused the mass resignation of trainee physicians, raising concerns about the quality of care for time-critical emergencies. This study aimed to assess the impact of workforce disruptions on the management and outcomes of adults presenting to the emergency department (ED) with septic shock. Materials and Methods: This retrospective single-center cohort study was conducted at a tertiary care ED and included adults with septic shock between September 2022 and August 2025. This study compared the pre-conflict period, operating under a resident-supported model, with the conflict period characterized by a specialist-led staffing model. The primary outcome was the all-cause in-hospital mortality. The secondary outcomes included process-related time intervals and clinical course measurements. Multivariate logistic regression was used to identify the independent predictors of mortality. Results: Altogether, 343 patients were included (159 pre-conflict, 184 conflict). During the conflict, ED crowding significantly decreased (average concurrent ED patients: 14.9 vs. 7.6, p < 0.001). Key diagnostic process metrics, including time to blood gas analysis, blood sampling, blood culture, computed tomography, and total ED length of stay, were significantly shortened. Time-critical therapeutic intervals, such as time to empirical antibiotics, remained unchanged. In-hospital mortality did not differ significantly between the pre- and conflict periods. Multivariate analysis demonstrated that the conflict period was not independently associated with mortality; only initial serum lactate levels and Acute Physiology and Chronic Health Evaluation II scores remained significant predictors. Conclusions: The 2024 Korean medical–political conflict was not associated with increased in-hospital mortality among patients with septic shock. Process-related metrics improved, while key therapeutic intervals and overall clinical outcomes remained stable. These findings may reflect reduced ED crowding, organizational adaptation, and continued adherence to established septic shock management practices. Reduced ED volume likely contributed substantially to improvements in diagnostic and throughput-related processes. Full article
(This article belongs to the Special Issue Emergency Medicine: Current Status)
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20 pages, 482 KB  
Article
Facing Dementia in Primary Care: A Process Evaluation of a Multicomponent Practice Change Intervention to Improve Dementia Diagnosis in General Practice
by Mark Yates, Caroline Gibson, Constance Dimity Pond, Stephanie Daly, Jessica Jebramek, Sharon Daniel, Lyn Phillipson, Kate Laver, Meredith Gresham, Edwin Tan, Henry Brodaty, Jamie Swann, Shahana Ferdousi, Annica Barcenilla-Wong, Nora Wong and Lee-Fay Low
Int. J. Environ. Res. Public Health 2026, 23(8), 1086; https://doi.org/10.3390/ijerph23081086 - 20 Aug 2026
Viewed by 211
Abstract
Dementia is a leading cause of disability and death worldwide, yet diagnosis in primary care remains substantially lower than expected, delaying access to treatment, support and future care planning. The Facing Dementia Together Practice Change Program was developed as a co-designed, multicomponent intervention [...] Read more.
Dementia is a leading cause of disability and death worldwide, yet diagnosis in primary care remains substantially lower than expected, delaying access to treatment, support and future care planning. The Facing Dementia Together Practice Change Program was developed as a co-designed, multicomponent intervention to improve dementia diagnosis in Australian general practice. A mixed-methods process evaluation used the RE-AIM framework with the addition of Appropriateness. The intervention included Primary Health Network (PHN) engagement, GP education, clinical resources, audit and benchmarking reports, specialist support, and a dementia risk-alert tool. Data were collected through surveys, stakeholder interviews, website analytics and program documentation. Clinicians who participated reported increased confidence and changes in dementia-related clinical behaviours, while education, resources and benchmarking were perceived as valuable. However, overall reach was limited by competing clinical priorities, workforce pressures, lack of financial incentives, and PHN implementation challenges. The dementia risk-alert tool was feasible but achieved limited uptake because of software compatibility, usability concerns and incomplete electronic medical record data. Although the program was acceptable to participating clinicians, limited reach constrained its potential impact. These findings highlight organizational, workforce, digital infrastructure and policy factors that influenced implementation of multicomponent interventions in routine primary care. Full article
(This article belongs to the Special Issue Interventions to Improve the Care of People Living with Dementia)
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22 pages, 1762 KB  
Review
Enhancing Type 2 Diabetes Management Involving Healthcare Professionals in Primary Care
by Mengyao Li and Lijian Wang
Healthcare 2026, 14(16), 2633; https://doi.org/10.3390/healthcare14162633 - 20 Aug 2026
Viewed by 310
Abstract
Background: Current evidence on diabetes care interventions is either fragmented or focused on specific interventions targeting healthcare professionals or patients. This study aims to categorize diabetes care interventions involving physicians or nurses and their impact on health outcomes for individuals with diabetes. Additionally, [...] Read more.
Background: Current evidence on diabetes care interventions is either fragmented or focused on specific interventions targeting healthcare professionals or patients. This study aims to categorize diabetes care interventions involving physicians or nurses and their impact on health outcomes for individuals with diabetes. Additionally, it aimed to determine the proportion of favorable findings across healthcare intervention categories. Methods: This scoping review was conducted in primary care settings and guided by a health system framework. We searched articles from inception to June 2022 in databases including CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL. The classification of healthcare interventions was guided by the Cochrane Effective Practice and Organization of Care taxonomy and health system framework. Results: Results were reported following the PRISMA Extension for Scoping Reviews. From the initial pool of 13,406 articles, 116 met the eligibility criteria and reported interventions conducted across 119 countries or regions, of which 94 were high-level economies. Five healthcare intervention categories were identified: transforming the workforce; service content; re-designing the service delivery system; information and communication technology; and multifaceted. Patient health outcomes were classified into 3 overarching categories with 11 subcategories: clinical outcomes, behavioral outcomes, and psychosocial outcomes. The proportion of statistically significant favorable findings differed across intervention categories and outcome domains. Multifaceted interventions showed relatively higher proportions of favorable findings for clinical outcomes, whereas re-designing the service delivery system interventions showed relatively higher proportions for behavioral outcomes. ICT interventions frequently reported favorable findings related to blood glucose indicators. Conclusions: This study provides a comprehensive overview of healthcare interventions and health outcomes for diabetes in primary care settings. It emphasizes the importance of tailored interventions, delivery methods, and technology integration for effective diabetes management, advocating for a comprehensive approach from individual to societal levels. Full article
(This article belongs to the Section Chronic Care)
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19 pages, 939 KB  
Article
Desired but Unattained Breastfeeding: A Qualitative Exploration of Maternal Perceptions in a Cultural–Religious Context
by Eva Carolina Rodríguez-Huamán, María Angustias Sánchez-Ojeda, Providencia Juana Trujillo-Muñoz, Karima Mezyani-Haddu, Irene Hoyo-Guillot and Silvia Navarro-Prado
Nurs. Rep. 2026, 16(8), 291; https://doi.org/10.3390/nursrep16080291 - 20 Aug 2026
Viewed by 236
Abstract
Background: The World Health Organization recommends exclusive breastfeeding for the first six months of life, with continued breastfeeding alongside complementary feeding up to two years or beyond. However, many mothers are unable to meet their breastfeeding expectations, resulting in a significant emotional [...] Read more.
Background: The World Health Organization recommends exclusive breastfeeding for the first six months of life, with continued breastfeeding alongside complementary feeding up to two years or beyond. However, many mothers are unable to meet their breastfeeding expectations, resulting in a significant emotional impact shaped by social, cultural, and occupational factors. Objective: The aim of this study was to explore mothers’ perceptions and experiences of desired but unattained breastfeeding, with particular attention to its cultural–religious dimension. Methods: A qualitative descriptive study within an interpretivist paradigm was conducted between September 2024 and February 2025. Thirty women (15 Christian and 15 Muslim) receiving care from a primary care midwife in a Spanish city in North Africa participated. Data were collected through semi-structured interviews and analysed using inductive thematic analysis following Braun and Clarke’s approach. Results: Four main themes were identified: (1) emotional experiences and feelings, (2) reasons for breastfeeding discontinuation, (3) contextual and structural barriers, and (4) the influence of the social environment and support networks. Although both groups shared emotions such as guilt, frustration, and sadness, some differences were observed in how breastfeeding discontinuation was interpreted and experienced within this sample. Several Muslim participants expressed distress in relation to maternal identity and perceived maternal inadequacy, whereas several Christian participants more frequently emphasised contextual factors such as perceived lack of support or social pressure. Conclusions: The experience of desired but unattained breastfeeding is complex and may be shaped by cultural–religious context alongside individual, social, and structural factors. Integrating a transcultural approach into healthcare provision may improve emotional support and help reduce the burden of guilt and distress associated with breastfeeding discontinuation. Full article
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16 pages, 4143 KB  
Article
An Integrated Decentralised–Centralised Oncology Care Model to Improve Cancer Screening, Access, and Continuity of Care in Rural Eastern Cape, South Africa: Implementation Study at Nelson Mandela Academic Hospital
by Zukiswa Jafta, Muamabangu Jean Paul Milambo, Eric Maimela, Constance Rufaro Sewani-Rusike and Wilson Wezile Chitha
Int. J. Environ. Res. Public Health 2026, 23(8), 1079; https://doi.org/10.3390/ijerph23081079 - 19 Aug 2026
Viewed by 410
Abstract
Background: Rural and resource-constrained settings face major barriers to timely cancer screening, diagnosis, and treatment due to limited specialist availability and centralised service-delivery models. In the Eastern Cape, a largely rural province with a constrained oncology workforce, a decentralised–centralised hybrid model was introduced [...] Read more.
Background: Rural and resource-constrained settings face major barriers to timely cancer screening, diagnosis, and treatment due to limited specialist availability and centralised service-delivery models. In the Eastern Cape, a largely rural province with a constrained oncology workforce, a decentralised–centralised hybrid model was introduced to improve access to cancer care. Nelson Mandela Academic Hospital serves as the central referral hub within this model. This study evaluates the implementation process and impact of this decentralised cancer care model on service utilisation, access, and continuity of care. Methods: A quantitative quasi-experimental pre–post implementation and quality improvement evaluation was conducted using retrospectively collected routine service utilisation and programme data from April 2023 to February 2025. The study assessed the impact of a decentralised oncology care model on access, service integration, and utilisation outcomes. Data from facility registers and district health information systems were managed using Microsoft Excel and analysed using Stata and IBM SPSS Statistics. Descriptive statistics, correlation analysis, and linear regression were used to compare pre- and post-implementation changes in patient volumes, screening coverage, referral completion, workforce capacity, gender distribution, and service uptake. The intervention decentralised screening, diagnosis, follow-up, and patient navigation services to district and satellite facilities while centralising specialised oncology care at referral centres to improve accessibility, efficiency, and continuity of care. Results: Cancer patient attendance increased substantially over the study period, from 355 patients in April 2023 to a peak of 1039 in April 2024, with a sustained upward trend (B = 18.03, p = 0.005), reflecting an average monthly increase of 18 patients. Female patients accounted for most visits, while male attendance showed a significant increasing trend (B = 8.03, p < 0.001). Service integration improved, with strong positive correlations between new patient registrations, follow-up care, palliative services, and inpatient admissions, indicating an expanding continuum of care. Breast and cervical cancers contributed the highest service burden, while cervical and lung cancers showed significant upward trends. Seasonal variation in attendance was observed, particularly during festive periods. From an implementation perspective, screening coverage for priority cancers increased by 18%, while 732,349 individuals were reached through community awareness initiatives. Access improved substantially, evidenced by a reduction of 56,400 km in cumulative patient travel distance over one year. Workforce capacity was strengthened through the training of 517 healthcare workers, and 1943 patients received structured navigation support. Referral efficiency and continuity of care improved, although persistent bottlenecks were observed in diagnostic and referral pathways. Conclusions: The decentralised–centralised oncology care model demonstrated improved cancer service utilisation, access, and continuity of care in a rural, resource-limited setting. However, increasing patient volumes and interconnected service demands place additional pressure on health system capacity. Sustained investment in workforce development, screening—particularly for cervical cancer—and system efficiency is required. This model provides a scalable and context-appropriate framework for strengthening oncology services in similar low-resource settings. Full article
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21 pages, 828 KB  
Article
Cost-Effectiveness Analysis of Older Adult Vaccination with the Bivalent Respiratory Syncytial Virus Prefusion F (RSVpreF) Vaccine in Mexico
by Veronica Guajardo, Ali Shajarizadeh, Nishu Gaind, Luka Ivkovic, Rengina Kefalogianni and Diana Mendes
Vaccines 2026, 14(8), 713; https://doi.org/10.3390/vaccines14080713 - 19 Aug 2026
Viewed by 297
Abstract
Background/Objectives: Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults, and in Mexico’s rapidly growing older-adult population it may place increasing pressure on hospital-based care; however, Mexico-specific evidence to inform adult RSV immunization policy remains limited. This study estimated the [...] Read more.
Background/Objectives: Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults, and in Mexico’s rapidly growing older-adult population it may place increasing pressure on hospital-based care; however, Mexico-specific evidence to inform adult RSV immunization policy remains limited. This study estimated the long-term clinical and economic burden of medically attended RSV among adults aged 60–99 years in Mexico and evaluated the health impact and cost-effectiveness of a year-round RSVpreF vaccination program. Methods: A population-based Markov cohort model compared the RSVpreF vaccination with no vaccination in a hypothetical Mexican cohort aged 60–99 years over a lifetime horizon. Outcomes included RSV-related hospitalizations, emergency department (ED) and physician office (PO) encounters, in-hospital deaths, life-years (LYs), and quality-adjusted life-years (QALYs). Analyses were conducted from Mexican healthcare system and societal perspectives in 2025 Mexican pesos (MXN$) and US dollars (US$), with costs and outcomes discounted at 5% annually. One-way and probabilistic sensitivity analyses and scenario analyses assessed the robustness of the findings. Results: With 58% uptake, RSVpreF reduced hospitalizations by 187,825, ED encounters by 178,278, PO encounters by 465,976, and RSV-related deaths by 15,384. In the first 5 years, hospitalizations, ED encounters, and deaths declined by 31% each, and PO encounters by 14%. Over the lifetime horizon, vaccination generated an additional 96,227 discounted LYs and 71,526 discounted QALYs, while avoiding MXN$ 19,484 million (US$ 1061 million) in direct medical costs and MXN$ 3324 million (US$ 181 million) in indirect costs. Conclusions: Year-round RSVpreF vaccination in Mexico among adults aged 60–99 years could substantially reduce medically attended RSV cases and RSV-related mortality and is projected to be cost-effective, thereby supporting the adoption of preventive strategies to address the growing clinical and economic burden of RSV in Mexico’s aging population. Full article
(This article belongs to the Section Vaccines and Public Health)
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26 pages, 19028 KB  
Systematic Review
Applications of Artificial Intelligence in the Health Sector: A PRISMA-Based Systematic Review
by Zakir Hossen Shaikh, Sarita Yadav, Bibhu Prasad Sahoo, Jay Shankar Sharma and Abdelrhman Meero
Healthcare 2026, 14(16), 2604; https://doi.org/10.3390/healthcare14162604 - 19 Aug 2026
Viewed by 166
Abstract
Background: The health sector is getting transformed with the usage of AI, be it diagnosis, treatment planning, disease prediction, and or health system management. Research in this field has picked up in the last few years, which was made possible with the emergence [...] Read more.
Background: The health sector is getting transformed with the usage of AI, be it diagnosis, treatment planning, disease prediction, and or health system management. Research in this field has picked up in the last few years, which was made possible with the emergence of machine learning, natural language processing and the increasing number of e-health records. Objectives: The study aims to investigate the current trends in the implementation of artificial intelligence (AI) applications in medical settings by investigating the global scientific output/landscape on this theme, such as the annual publication trends, country-wise contributions, and publishing patterns. Methods: The current study is based on systematic review by combining bibliometric analysis and cluster analysis using VOSviewer version 1.6.20, R software version 4.5.0, and Biblioshiny (Bibliometrix package in R) along with preferred reporting items for systematic reviews and meta analyses (PRISMA), 2020 which provides transparency and rigorous visualization to examine the articles published in English on the use of AI in healthcare, after the onset of COVID-19 till date i.e., from 2020 to 2026 on the Scopus database. Results: Using the relevant search string, 5940 documents were identified between 2020 and 2026, 1434 were included for analysis after screening and relevant filters. The publications have increased remarkably after 2020 on this theme and more than half of the publications have their roots in the discipline of Medicine. The USA, China, and the United Kingdom have contributed the most to the volume of research. Natural language processing and diagnosis are the emerging themes. The Journal of Medical Internet Research, BMC Medical Informatics and Decision Making, Computers in Biology and Medicine, IEEE Journal of Biomedical and Health Informatics, Frontiers in Public Health, and Digital Health are some of the most influential sources in the field. Li J and Liu X are among the authors with remarkable local impact. Conclusions: The work aims to assist investigators, health care professionals, and policymakers to learn about modern trends and focus on critical areas of future research and collaboration in AI-enhanced health care. The limitation of the study is that it considered only the Scopus database but it has opened up opportunities for researchers for analysis using other databases such as Dimensions, Lens, and PubMed. Also, this review is considering the publication record since the onset of COVID-19 but a comparative analysis of pre and post-pandemic studies can also be conducted to get a holistic view of drastic collaboration of research in this field. Discussions: The findings suggest that the role of artificial intelligence in health care has paramount over recent years, with other supporting technologies but a technologically hesitant population as well as low acceptance of AI due to ethical issues, cannot be ignored for ensuring efficiency in the health sector. Full article
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