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Search Results (868)

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10 pages, 216 KiB  
Article
Prevalence, Causes, and Risk Factors of Visual Impairment: Evidence from Duhknah, a Rural Community in Saudi Arabia
by Sulaiman Aldakhil
Healthcare 2025, 13(15), 1927; https://doi.org/10.3390/healthcare13151927 (registering DOI) - 7 Aug 2025
Abstract
Background: Visual impairment (VI) continues to be a significant global public health concern, especially in underserved rural communities. Objectives: This study aims to assess the prevalence of VI and refractive errors, as well as to identify the causes and risk factors associated [...] Read more.
Background: Visual impairment (VI) continues to be a significant global public health concern, especially in underserved rural communities. Objectives: This study aims to assess the prevalence of VI and refractive errors, as well as to identify the causes and risk factors associated with VI in Duhknah, a rural area in Qassim Province, Saudi Arabia. Methods: This cross-sectional study, conducted in May 2024, included 929 participants aged 6–90 years from Duhknah, a rural area in Qassim Province, Saudi Arabia. Refractive errors (REs) were measured using a non-cycloplegic autorefractometer. Anterior and posterior eye examinations were performed using slit lamp biomicroscopy, direct ophthalmoscopy, and 90 D fundus biomicroscopy. VI was classified based on the International Classification of Diseases 11th revision (ICD-11), 2018. Results: The findings revealed that 671 (72.2%) participants had never undergone an eye examination. The overall prevalence of presenting VI was 370 (39.8%), comprising 21.6% with mild VI, 11.0% moderate, 4.1% severe, and 3.1% classified as blind. The prevalence of hyperopia, myopia, and astigmatism was 20.6%, 36.9%, and 13.2%, respectively. Uncorrected REs were the most common cause of VI (81.4%), followed by amblyopia (13.5%) and cataracts (3.2%). Regression analysis showed that women had 1.58 times higher odds of VI (p = 0.001). Participants with eye examinations for one year or more had 3.64 times higher odds (p < 0.001). Additionally, the risk of VI was significantly lower among older participants (ages 18–90) compared to younger ones (ages 6–17), (p < 0.001). Conclusions: This study found most participants had never had an eye exam, and VI was highly prevalent in the rural community. These findings underscore the need to strengthen primary eye care in rural Saudi Arabia. Regular vision screening, particularly for children, and better access to refractive services could significantly reduce VI and support the goals of Saudi Vision 2030. Full article
10 pages, 483 KiB  
Article
The Lack of Impact of Primary Care Units on Screening Services in Thailand and the Transition to Local Administrative Organization Policy
by Noppcha Singweratham, Jiruth Sriratanaban, Daoroong Komwong, Mano Maneechay and Pallop Siewchaisakul
Healthcare 2025, 13(15), 1884; https://doi.org/10.3390/healthcare13151884 - 1 Aug 2025
Viewed by 192
Abstract
Background/Objectives: In Thailand, the transition of primary care units (PCUs) to Local Administrative Organizations (LAOs) has raised concerns regarding the potential impact on healthcare service delivery. This study aimed to compare health services between PCUs that have been transferred to LAOs and [...] Read more.
Background/Objectives: In Thailand, the transition of primary care units (PCUs) to Local Administrative Organizations (LAOs) has raised concerns regarding the potential impact on healthcare service delivery. This study aimed to compare health services between PCUs that have been transferred to LAOs and those that have not. Methods: A total of 15 transferred PCUs (T-PCUs) and 45 non-transferred PCUs (NT-PCUs), matched by population within the same provinces, were purposively sampled. The study population consisted of the cumulative number of diabetes (DM) and hypertension (HTN) screenings retrieved from the National Health Security Office (NHSO) database from 2017 to 2023. The impact of the LAO transfer policy on health service delivery was assessed using generalized estimating equation (GEE) models. All analyses were performed using Stata version 15. Results: The result showed no significant difference in the population and size of PCUs. DM screening was non-significantly lower by 18.9% (AdjRR: 0.811), and HTN screening was lower by 18.6% (AdjRR: 0.814), when comparing T-PCU with NT-PCU. Similarly, the DM and HTN screening in T-PCU was non-significantly lower than NT-PCU when interacting with time. Both T-PCU and NT-PCU show decreases over time; however, the decrease was not statistically significant. Conclusions: Our results show a non-significant difference in DM and HTN screening between T-PCU and NT-PCU. Therefore, decentralization did not clearly demonstrate a negative impact on the delivery of these health services. Further research is needed to consider other confounding and covariate factors for DM and HTN screening. Full article
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20 pages, 1376 KiB  
Article
Comienzo Saludable Puerto Rico: A Community-Based Network of Care to Improve Maternal, Newborn, and Child Health Outcomes
by Edna Acosta-Pérez, Cristina Díaz, Atisha Gómez-Reyes, Samaris Vega, Carlamarie Noboa Ramos, Rosario Justinianes-Pérez, Glamarie Ferran, Jessica Carnivali-García, Fabiola J. Grau, Lili M. Sardiñas, Maribel Campos and Marizaida Sánchez Cesareo
Int. J. Environ. Res. Public Health 2025, 22(8), 1204; https://doi.org/10.3390/ijerph22081204 - 31 Jul 2025
Viewed by 192
Abstract
Background: Maternal and newborn health disparities remain a challenge in Puerto Rico, especially in underserved communities. Comienzo Saludable Puerto Rico, sponsored by the U.S. Department of Health and Human Services’ Healthy Start Initiative (HRSA), addresses these gaps through an integrated Networks of Care [...] Read more.
Background: Maternal and newborn health disparities remain a challenge in Puerto Rico, especially in underserved communities. Comienzo Saludable Puerto Rico, sponsored by the U.S. Department of Health and Human Services’ Healthy Start Initiative (HRSA), addresses these gaps through an integrated Networks of Care model known as Cuidado Compartido. Comienzo Saludable Puerto Rico is a maternal, paternal, and child health program aimed at improving the health and well-being of pregnant women, mothers, fathers, newborns, and children in Puerto Rico, particularly those from disadvantaged communities. Methods: This paper presents the Comienzo Saludable Puerto Rico program’s Cuidado Compartido model to integrate a network of healthcare providers and services across hospitals, community organizations, and families. This model aims to improve maternal and newborn/child health outcomes by focusing on the importance of integrated, hospital-community-based care networks. Results: Participants experienced significant improvements in key birth outcomes: low birth weight prevalence declined by 27.2% compared to the community baseline, premature birth rates decreased by 30.9%, and infant mortality dropped by 75%, reaching 0% by 2021 and remaining there through 2023. These results were complemented by increases in maternal mental health screening, paternal involvement, and breastfeeding practices. Conclusions: The Cuidado Compartido model demonstrates a scalable, culturally responsive strategy to improve maternal, newborn, and child health outcomes. It offers critical insights for implementation in other high-need contexts. Full article
(This article belongs to the Special Issue Community Interventions in Health Disparities)
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19 pages, 1239 KiB  
Article
Effect of Nudge Interventions in Real-World Kiosks on Consumer Beverage Choices to Promote Non-Sugar-Sweetened Beverage Consumption
by Suah Moon, Seo-jin Chung and Jieun Oh
Nutrients 2025, 17(15), 2524; https://doi.org/10.3390/nu17152524 - 31 Jul 2025
Viewed by 285
Abstract
Background/Objectives: Excessive sugar intake through sugar-sweetened beverages (SSBs) has raised global concerns due to its association with various health risks. This study evaluates the effectiveness of nudges—in the form of order placement, variety expansion, and a combination of both—in promoting non-SSB purchases [...] Read more.
Background/Objectives: Excessive sugar intake through sugar-sweetened beverages (SSBs) has raised global concerns due to its association with various health risks. This study evaluates the effectiveness of nudges—in the form of order placement, variety expansion, and a combination of both—in promoting non-SSB purchases at self-service kiosks, a key environment for SSB consumption. Methods: This study was conducted using a real-world kiosk at food and beverage outlets in South Korea from 28 May to 12 July, 2024. A total of 183 consumers aged 19 to 29 participated in this study. A single kiosk device was used with four screen layouts, each reflecting a different nudge strategy. Participants were unaware of these manipulations when making their purchases. After their purchases, participants completed a survey. All data were analyzed using IBM SPSS Statistics for Windows, Version 29.0. Results: Females reported significantly higher positive attitudes, preferences, and perceived necessity regarding nudges compared to males. In particular, both the single (variety) and combination (order and variety) nudges received positive responses from females (p < 0.001). The combination nudge significantly increased non-SSB purchases compared to the control (p < 0.05) and single (order) nudge groups (p < 0.01), which suggests that combination nudge is effective in promoting healthier beverage choices. Females were also more likely to purchase non-SSBs than males (p < 0.05). Conclusions: The findings suggest that the combination nudge strategy effectively promotes healthier beverage choices in real kiosk settings. Notably, females demonstrate significantly higher positive attitudes, preferences, and perceived necessity regarding nudges compared to males, and are also more likely to purchase non-SSBs. These findings offer valuable insights for real-world applications aimed at encouraging healthier consumption behaviors. Full article
(This article belongs to the Special Issue Policies of Promoting Healthy Eating)
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51 pages, 1047 KiB  
Review
Healthy Food Service Guidelines for Worksites and Institutions: A Scoping Review
by Jane Dai, Reena Oza-Frank, Amy Lowry-Warnock, Bethany D. Williams, Meghan Murphy, Alla Hill and Jessi Silverman
Int. J. Environ. Res. Public Health 2025, 22(8), 1194; https://doi.org/10.3390/ijerph22081194 - 30 Jul 2025
Viewed by 271
Abstract
Healthy food service guidelines (HFSG) comprise food, nutrition, behavioral design, and other standards to guide the purchasing, preparation, and offering of foods and beverages in worksites and institutional food service. To date, there have been few attempts to synthesize evidence for HFSG effectiveness [...] Read more.
Healthy food service guidelines (HFSG) comprise food, nutrition, behavioral design, and other standards to guide the purchasing, preparation, and offering of foods and beverages in worksites and institutional food service. To date, there have been few attempts to synthesize evidence for HFSG effectiveness in non-K-12 or early childhood education sectors, particularly at worksites and institutional food services. We conducted a scoping review to achieve the following: (1) characterize the existing literature on the effectiveness of HFSG for improving the institution’s food environment, financial outcomes, and consumers’ diet quality and health, and (2) identify gaps in the literature. The initial search in PubMed and Web of Science retrieved 10,358 articles; after screening and snowball searching, 68 articles were included for analysis. Studies varied in terms of HFSG implementation settings, venues, and outcomes in both U.S. (n = 34) and non-U.S. (n = 34) contexts. The majority of HFSG interventions occurred in venues where food is sold (e.g., worksite cafeterias, vending machines). A diversity of HFSG terminology and measurement tools demonstrates the literature’s breadth. Literature gaps include quasi-experimental study designs, as well as interventions in settings that serve dependent populations (e.g., universities, elderly feeding programs, and prisons). Full article
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14 pages, 2017 KiB  
Article
Prevalence of Depression and Anxiety Symptoms Among Parents of Hospitalized Children in 14 Countries
by Linda S. Franck, Renée Mehra, Christine R. Hodgson, Caryl Gay, Jennifer Rienks, Amy Jo Lisanti, Michelle Pavlik, Sufiya Manju, Nitya Turaga, Michael Clay and Thomas J. Hoffmann
Children 2025, 12(8), 1001; https://doi.org/10.3390/children12081001 - 30 Jul 2025
Viewed by 325
Abstract
Background/Objectives: Despite the importance of parent mental health for child health, there are no global prevalence data on parental mental health symptoms when children are hospitalized. We aimed to describe depression and anxiety symptom prevalence and associated factors among parents of hospitalized [...] Read more.
Background/Objectives: Despite the importance of parent mental health for child health, there are no global prevalence data on parental mental health symptoms when children are hospitalized. We aimed to describe depression and anxiety symptom prevalence and associated factors among parents of hospitalized children. Methods: We conducted this 14-country prospective cohort survey with parents/primary caregivers staying at a nearby Ronald McDonald House® during their child’s hospital treatment. We used the Hospital Anxiety and Depression Scale to measure depression and anxiety symptoms and validated scales and theory-based questions to measure parent, family, and child covariates. We calculated the prevalence of clinically significant or concerning symptoms of depression and anxiety, and used multivariable regression analyses to examine associations between covariates and outcomes. Results: Among 3350 participants, 1789 (49.7%) reported depression symptoms and 2286 (69.0%) reported anxiety symptoms. Worry about housing and poorer ratings of their child’s health were associated with increased risk of depression symptoms. Poorer rating of the child’s health, living with a partner, and discrimination in daily life were associated with increased risk of anxiety symptoms. Higher levels of self-care, hospital family-centered care, and social support were associated with reduced risk of depression symptoms. Higher levels of self-care and social support were associated with reduced risk of anxiety symptoms. Conclusions: Clinically significant or concerning depression and anxiety symptoms are common among parents of hospitalized children globally. Hospitals should consider offering routine mental health symptom screening and preventative mental health and support services to all parents. Full article
(This article belongs to the Section Pediatric Mental Health)
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17 pages, 515 KiB  
Review
The Epidemiology of Syphilis Worldwide in the Last Decade
by Francois Rosset, Valentina Celoria, Sergio Delmonte, Luca Mastorino, Nadia Sciamarrelli, Sara Boskovic, Simone Ribero and Pietro Quaglino
J. Clin. Med. 2025, 14(15), 5308; https://doi.org/10.3390/jcm14155308 - 28 Jul 2025
Viewed by 595
Abstract
Background/Objectives: Syphilis, a re-emerging global public health issue, has shown increasing incidence over the past decade, particularly among key populations such as men who have sex with men (MSM), people living with HIV, and pregnant women. This narrative review aimed to synthesize global [...] Read more.
Background/Objectives: Syphilis, a re-emerging global public health issue, has shown increasing incidence over the past decade, particularly among key populations such as men who have sex with men (MSM), people living with HIV, and pregnant women. This narrative review aimed to synthesize global epidemiological trends of syphilis from 2015 to 2025, with a focus on surveillance gaps, regional disparities, and structural determinants. Methods: A broad narrative approach was used to collect and analyze epidemiological data from 2015 to 2025. The literature was retrieved from databases (PubMed, Scopus) and official reports from the WHO, CDC, and ECDC. Included materials span observational studies, surveillance reports, and modeling data relevant to global trends and public health responses. Results: Globally, syphilis incidence has increased, with notable surges in North America, Europe, and Asia. MSM remain disproportionately affected, while congenital syphilis is resurging even in high-income countries. Low- and middle-income countries report persistent burdens, especially among women of reproductive age, often exacerbated by limited screening and surveillance infrastructure. The COVID-19 pandemic disrupted syphilis-related services and further exacerbated underreporting, hindering timely detection and response efforts. Surveillance systems vary widely in their completeness and quality, which significantly hinders global data comparability and coordinated public health responses. Conclusions: Despite its curability, syphilis continues to spread due to fragmented prevention strategies, inequities in access to care, and insufficient surveillance. Strengthening diagnostic access, integrating prevention efforts into broader health systems, and addressing social determinants are essential. Improved surveillance, equitable access, and innovation—including diagnostics and potential vaccine research—are critical to controlling the global syphilis epidemic. Full article
(This article belongs to the Section Epidemiology & Public Health)
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23 pages, 1118 KiB  
Systematic Review
Management of Preoperative Anxiety via Virtual Reality Technology: A Systematic Review
by Elina Christiana Alimonaki, Anastasia Bothou, Athina Diamanti, Anna Deltsidou, Styliani Paliatsiou, Grigorios Karampas and Giannoula Kyrkou
Nurs. Rep. 2025, 15(8), 268; https://doi.org/10.3390/nursrep15080268 - 25 Jul 2025
Viewed by 244
Abstract
Background: Perioperative care is an integral part of the procedure of a surgical operation, with strictly defined rules. The need to upgrade and improve some individual long-term processes aims at optimal patient care and the provision of high-level health services. Therefore, preoperative care [...] Read more.
Background: Perioperative care is an integral part of the procedure of a surgical operation, with strictly defined rules. The need to upgrade and improve some individual long-term processes aims at optimal patient care and the provision of high-level health services. Therefore, preoperative care is drawn up with new data resulting from the evolution of technology to upgrade the procedures that need improvement. According to the international literature, a factor considered to be of major importance is high preoperative anxiety and its effects on the patient’s postoperative course. High preoperative anxiety is postoperatively responsible for prolonged hospital stays, increased postoperative pain, decreased effect of anesthetic agents, increased amounts of analgesics, delayed healing of surgical wounds, and increased risk of infections. The use of Virtual Reality technology appears as a new method of managing preoperative anxiety. Objective: This study investigates the effect and effectiveness of Virtual Reality (VR) technology in managing preoperative anxiety in adult patients. Methods: A literature review was performed on 193 articles, published between 2017 and 2024, sourced from the scientific databases PubMed and Cochrane, as well as the trial registry ClinicalTrials, with a screening and exclusion process to meet the criterion of investigating VR technology’s effectiveness in managing preoperative anxiety in adult patients. This systematic review was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Results: Out of the 193 articles, 29 were selected. All articles examined the efficacy of VR in adult patients (≥18) undergoing various types of surgery. The studies represent a total of 2.354 participants from 15 countries. There are two types of VR applications: distraction therapy and patient education. From the studies, 14 (48%) used the distraction VR intervention, 14 (48%) used the training VR intervention, and 1 (4%) used both VR interventions, using a range of validated anxiety scales such as the STAI, VAS-A, APAIS, and HADS. Among the 29 studies reviewed, 25 (86%) demonstrated statistically significant reductions in preoperative anxiety levels following the implementation of VR interventions. VR technology appears to manage preoperative anxiety effectively. It is a non-invasive and non-pharmacological intervention with minimal side effects. Conclusions: Based on the review, the management of preoperative anxiety with VR technology shows good levels of effectiveness. Further investigation of the efficacy by more studies and randomized controlled trials, with a larger patient population, is recommended to establish and universally apply VR technology in the preoperative care process as an effective method of managing preoperative anxiety. Full article
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21 pages, 1322 KiB  
Article
Patterns of Distress and Supportive Resource Use by Healthcare Workers During the COVID-19 Pandemic
by Mahiya Habib, Aaron Palachi, Melissa B. Korman, Rosalie Steinberg, Claudia Cocco, Catherine Martin-Doto, Andrea Tuka, Xingshan Cao, Mark Sinyor and Janet Ellis
Healthcare 2025, 13(15), 1785; https://doi.org/10.3390/healthcare13151785 - 23 Jul 2025
Viewed by 289
Abstract
Background/Objectives: Healthcare workers (HCW) have increased the risk of occupational stress injuries and adverse mental health outcomes, which were exacerbated during the COVID-19 pandemic. Understanding HCW psychological distress patterns and help-seeking behaviors can inform responsive resource development that may mitigate negative outcomes in [...] Read more.
Background/Objectives: Healthcare workers (HCW) have increased the risk of occupational stress injuries and adverse mental health outcomes, which were exacerbated during the COVID-19 pandemic. Understanding HCW psychological distress patterns and help-seeking behaviors can inform responsive resource development that may mitigate negative outcomes in future crises. This paper provides insights on monthly trends in HCW distress and support utilization at a large Canadian hospital over a 14-month period. Methods: As part of a hospital-wide wellness initiative during COVID-19, the STEADY program emailed monthly confidential wellness assessments to hospital staff from April 2020 to May 2021. The assessments included screens for burnout, anxiety, depression and posttraumatic stress, types of support accessed, and demographic information. Repeated cross-sectional data were summarized as monthly proportions and examined alongside longitudinal COVID-19 data. Results: A total of 2498 wellness assessments were submitted (M = ~168 monthly, range: 17–945). Overall, 67% of assessments had at least one positive screen for distress. Average positive screens were 44% for anxiety, 29% for depression, 31% for posttraumatic stress, and 53% for burnout. Despite high distress, most respondents used informal supports (e.g., family/friends), highlighting limited formal support use. Conclusions: HCWs experienced sustained high levels of psychological distress during the COVID-19 pandemic, with burnout remaining a predominant and persistent concern. The limited use of formal support services may indicate barriers to accessing these types of supports. Our findings underscore the need for accessible and acceptable mental health supports for HCW during prolonged crises. Full article
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11 pages, 778 KiB  
Article
Gut and Other Differences Between Female and Male Veterans—Vive La Différence? Bringing It All Together
by Martin Tobi, Donald Bradley, Fadi Antaki, MaryAnn Rambus, Noreen F. Rossi, James Hatfield, Suzanne Fligiel and Benita McVicker
Gastrointest. Disord. 2025, 7(3), 48; https://doi.org/10.3390/gidisord7030048 - 22 Jul 2025
Viewed by 264
Abstract
Background: The number of women veterans has been rising steadily since the Gulf War and many assume the functions of their male counterparts. Women face unique obstacles in their service, and it is imperative that differences in physiology not be overlooked so [...] Read more.
Background: The number of women veterans has been rising steadily since the Gulf War and many assume the functions of their male counterparts. Women face unique obstacles in their service, and it is imperative that differences in physiology not be overlooked so as to provide better and appropriate care to our women in uniform. Despite this influx and incorporation of female talent, dedicated reports contrasting female and male veterans are rare, outside of specific psychological studies. We therefore attempt to contrast gut constituents, absorption, innate immune system, and nutritional differences to provide a comprehensive account of similarities and differences between female and male veterans, from our single-center perspective, as this has not been carried out previously. Herein, we obtained a detailed roster of commonly used biomedical tests and some novel entities to detect differences between female and male veterans. The objective of this study was to detect differences in the innate immune system and other ancillary test results to seek differences that may impact the health of female and male veterans differently. Methods: To contrast biochemical and sociomedical parameters in female and male veterans, we studied the data collected on 450 female veterans and contrasted them to a group of approximately 1642 males, sequentially from 1995 to 2022, all selected because of above-average risk for CRC. As part of this colorectal cancer (CRC) screening cross-sectional and longitudinal study, we also collected stool, urine, saliva, and serum specimens. We used ELISA testing to detect stool p87 shedding by the Adnab-9 monoclonal and urinary organ-specific antigen using the BAC18.1 monoclonal. We used the FERAD ratio (blood ferritin/fecal p87), a measure of the innate immune system to gauge the activity of the innate immune system (InImS) by dividing the denominator p87 (10% N-linked glycoprotein detected by ELISA) into the ferritin level (the enumerator, a common lab test to assess anemia). FERAD ratios have not been performed elsewhere despite past Adnab-9 commercial availability so we have had to auto-cite our published data where appropriate. Results: Many differences between female and males were detected. The most impressive differences were those of the InImS where males clearly had the higher numbers (54,957 ± 120,095) in contrast to a much lower level in females (28,621 ± 66,869), which was highly significantly different (p < 0.004). Mortality was higher in males than females (49.4% vs. 24.1%; OR 3.08 [2.40–3.94]; p < 0.0001). Stool p87, which is secreted by Paneth cells and may have a protective function, was lower in males (0.044 ± 0.083) but higher in females (0.063 ± 0.116; p < 0.031). Immunohistochemistry of the Paneth cell-fixed p87 antigen was also higher in females (in the descending colon and rectum). In contrast, male ferritin levels were significantly higher (206.3 ± 255.9 vs. 141.1 ± 211.00 ng/mL; p < 0.0006). Females were less likely to be diabetic (29.4 vs. 37.3%; OR 0.7 [0.55–0.90]; p < 0.006). Females were also more likely to use NSAIDs (14.7 vs. 10.7%, OR 1.08 [1.08–2.00]; p < 0.015). Females also had borderline less GI bleeding by fecal immune tests (FITs), with 13.2% as opposed to 18.2% in males (OR 0.68 [0.46–1.01]; p = 0.057), but were less inclined to have available flexible sigmoidoscopy (OR 0.68 [0.53–0.89]; p < 0.004). Females also had more GI symptomatology, a higher rate of smoking, and were significantly younger than their male counterparts. Conclusions: This study shows significant differences with multiple parameters in female and male veterans. Full article
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17 pages, 258 KiB  
Article
Exploring Staff Perspectives on Implementing an Intervention Package for Post-Stroke Psychological Support: A Qualitative Study
by Kulsum Patel, Emma-Joy Holland, Caroline Leigh Watkins, Audrey Bowen, Jessica Read, Shirley Thomas, Temitayo Roberts and Catherine Elizabeth Lightbody
Psychol. Int. 2025, 7(3), 65; https://doi.org/10.3390/psycholint7030065 - 21 Jul 2025
Viewed by 183
Abstract
Background: Psychological problems post-stroke can negatively impact stroke survivors. Although general psychological services exist (e.g., NHS Talking Therapies), access remains limited, particularly for individuals with post-stroke communication and cognitive impairments. Stroke service staff report low confidence in managing psychological distress. This study is [...] Read more.
Background: Psychological problems post-stroke can negatively impact stroke survivors. Although general psychological services exist (e.g., NHS Talking Therapies), access remains limited, particularly for individuals with post-stroke communication and cognitive impairments. Stroke service staff report low confidence in managing psychological distress. This study is the first to explore the barriers and facilitators to implementing a novel intervention package comprising a cross-service care pathway and staff training to enhance post-stroke psychological provision. Methods: Staff from stroke and mental health services in four UK regions, recruited through purposive sampling to ensure diversity of services and professional roles, participated in semi-structured interviews or focus groups, guided by the Theoretical Domains Framework (TDF), before and after implementation of the intervention package. Pre-implementation interviews/groups identified anticipated barriers and facilitators to implementation and training needs, informing the development of site-specific intervention packages; post-implementation interviews/groups explored experienced barriers, facilitators and perceptions of the intervention. Interviews underwent thematic analysis using the TDF. Results: Fifty-five staff participated pre-implementation and seventeen post-implementation, representing stroke (e.g., nurse, physiotherapist, consultant) and psychology (e.g., counsellor, psychological therapist) roles across acute, rehabilitation, community, and voluntary services. Challenges anticipated pre-implementation included: limited specialist post-stroke psychological support; low staff confidence; and fragmented service pathways. Post-implementation findings indicated increased staff knowledge and confidence, enhanced screening and referral processes, and stronger inter-service collaboration. Implementation success varied across sites (with some sites showing greater ownership and sustainability of the intervention) and across staff roles (with therapy staff more likely than nursing staff to have received training). Conclusions: Effective implementation of an intervention package to increase psychological provision post-stroke requires staff engagement at all levels across all services. Staff investment influenced ownership of the intervention package, beliefs about priorities and overall enhancement of service capability. Full article
(This article belongs to the Section Neuropsychology, Clinical Psychology, and Mental Health)
12 pages, 1258 KiB  
Article
Epidemiologic Characteristics of Chronic Hepatitis B and Coinfections with Hepatitis C Virus or Human Immunodeficiency Virus in South Korea: A Nationwide Claims-Based Study Using the Korean Health Insurance Review and Assessment Service Database
by Hyunwoo Oh, Won Sohn, Na Ryung Choi, Hyo Young Lee, Yeonjae Kim, Seung Woo Nam and Jae Yoon Jeong
Pathogens 2025, 14(7), 715; https://doi.org/10.3390/pathogens14070715 - 19 Jul 2025
Viewed by 359
Abstract
Coinfections with hepatitis C virus (HCV) or human immunodeficiency virus (HIV) among individuals with chronic hepatitis B (CHB) are associated with worse clinical outcomes but remain understudied due to their low prevalence and the sensitivity of associated data. This nationwide, cross-sectional study utilized [...] Read more.
Coinfections with hepatitis C virus (HCV) or human immunodeficiency virus (HIV) among individuals with chronic hepatitis B (CHB) are associated with worse clinical outcomes but remain understudied due to their low prevalence and the sensitivity of associated data. This nationwide, cross-sectional study utilized claims data from the Korean Health Insurance Review and Assessment Service (2014–2021) to investigate the prevalence, comorbidities, treatment patterns, and liver-related complications among patients with HBV monoinfection, HBV/HIV, HBV/HCV, or triple coinfection. Among over 4.5 million patients with chronic hepatitis B, the prevalence of HIV and HCV coinfection ranged from 0.05 to 0.07% and 0.77 to 1.00%, respectively. Patients with HBV/HCV coinfection were older and had significantly higher rates of hypertension, diabetes, dyslipidemia, and major adverse liver outcomes, including hepatocellular carcinoma and liver transplantation, compared to other groups. HBV/HIV coinfection was more common in younger males and was associated with higher dyslipidemia. The use of HBV antivirals increased over time across all groups. These findings highlight the distinct clinical characteristics and unmet needs of coinfected populations, underscoring the importance of tailored screening and management strategies in HBV-endemic settings. Full article
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19 pages, 318 KiB  
Article
Exploring Ukrainian Refugee Women’s Beliefs and Concerns About Healthcare Systems, with a Focus on HPV Immunization Practices: A Mixed-Methods Study on Forcibly Displaced Populations in Romania
by Teodora Achimaș-Cadariu, Andrei Pașca, Delia Nicoară and Dan Lucian Dumitrașcu
Healthcare 2025, 13(14), 1744; https://doi.org/10.3390/healthcare13141744 - 18 Jul 2025
Viewed by 405
Abstract
Objectives: Scarce data are available regarding preventive medicine in forcibly displaced populations especially regarding non-communicable diseases like neoplasia, while even more limited data are available on Ukrainian refugees in Romania. To address this research gap, the present analysis was performed to investigate [...] Read more.
Objectives: Scarce data are available regarding preventive medicine in forcibly displaced populations especially regarding non-communicable diseases like neoplasia, while even more limited data are available on Ukrainian refugees in Romania. To address this research gap, the present analysis was performed to investigate Ukrainian refugee women’s beliefs, attitudes, and opinions towards the Romanian and Ukrainian healthcare system in a comparison model while focusing on the HPV immunization rates and factors influencing the uptake for themselves and their children. Methods: Participants were recruited using the snowball sampling method through their General Practitioner (GP) and a health mediator. Results: In total, 105 women completed the online or physical survey. The mean age was 50 years. In total, 40% of women had not been to a gynecological check-up in 3 or more years, and more than 56% had never been screened. Only four were vaccinated against HPV, and none remembered which type of vaccine was dispensed or how many doses were utilized. The primary hindrances to accessing health services or immunization programs were language barriers, financial burdens, and a lack of information. Respondents’ general distrust of health systems and healthcare workforces were recurrent themes. Relationship status, living arrangements, and previous engagement in screening practices influenced immunization rates. Perceiving the healthcare officials as proactive concerning optional vaccination programs such as HPV immunization and actively receiving recommendations drove respondents to pursue vaccination. Conclusions: This analysis offers a foundational insight into the specific needs of refugee women. It can guide the development of effective public health interventions to improve health outcomes and vaccination rates among Ukrainian refugees in Romania. Tailored preventive campaigns with adequate native language information and prompts from medical experts in designated centers should be deployed to ensure inclusive tactics for vulnerable populations. Full article
16 pages, 856 KiB  
Systematic Review
Assessing Grief in Cancer Care: A Systematic Review of Observational Studies Using Psychometric Instruments
by Rebecca Mattson, Margaret Henderson and Savitri Singh Carlson
Healthcare 2025, 13(14), 1722; https://doi.org/10.3390/healthcare13141722 - 17 Jul 2025
Viewed by 379
Abstract
Background/Objectives: Grief in cancer patients represents a multidimensional psychological response encompassing anticipatory, existential, and identity-related distress. While the recent literature has examined grief in caregivers, family members, and even healthcare professionals, the psychological grief experienced by patients themselves following a cancer diagnosis [...] Read more.
Background/Objectives: Grief in cancer patients represents a multidimensional psychological response encompassing anticipatory, existential, and identity-related distress. While the recent literature has examined grief in caregivers, family members, and even healthcare professionals, the psychological grief experienced by patients themselves following a cancer diagnosis remains comparatively understudied and insufficiently characterized in empirical research. This systematic review aims to evaluate observational studies that used validated psychometric instruments to measure grief in adult cancer patients and to synthesize findings on the significance of grief in this population. Methods: Following PRISMA 2020 guidelines, a systematic search of PubMed, CINAHL, and PsycINFO was conducted to identify observational studies that employed validated tools to assess grief among adult cancer patients. The inclusion criteria required the use of psychometrically validated grief instruments and the collection of quantitative data. Fifteen studies met eligibility criteria and were included in the final analysis. Results: Grief symptoms were consistently present at moderate to high levels across diverse cancer types, care settings, and geographic regions. Preparatory Grief in Advanced Cancer (PGAC) scores often exceeded thresholds associated with clinical concern, with correlations observed between grief and psychological variables such as anxiety (r = 0.63), depression (r = 0.637), hopelessness (r = 0.63), and dignity (r = 0.654). Demographic factors (e.g., younger age, female gender) and illness perceptions (e.g., identity centrality, stigma) further intensified grief. Grief was a predominant psychological concern even when general distress measures failed to capture its presence. Conclusions: Future research is essential to identify an effective public health strategy for addressing grief through structured screening conducted in primary care and outpatient medical settings, coupled with accessible referral pathways to community-based support groups and coordinated follow-up services to facilitate grief management. Full article
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16 pages, 1441 KiB  
Article
Adherence Barriers, Patient Satisfaction, and Depression in Albanian Ambulatory Patients
by Sonila Qirko, Vasilika Prifti, Emirjona Kicaj, Rudina Cercizaj and Liliana Rogozea
Healthcare 2025, 13(14), 1707; https://doi.org/10.3390/healthcare13141707 - 15 Jul 2025
Viewed by 434
Abstract
Background: Medication adherence is essential for managing chronic conditions, while non-adherence remains a widespread issue, leading to poorer health outcomes and higher healthcare costs. This study aimed to identify key adherence barriers, explore their relationship with patient satisfaction, and assess their impact on [...] Read more.
Background: Medication adherence is essential for managing chronic conditions, while non-adherence remains a widespread issue, leading to poorer health outcomes and higher healthcare costs. This study aimed to identify key adherence barriers, explore their relationship with patient satisfaction, and assess their impact on overall well-being among ambulatory patients in Albania. Methods: A cross-sectional study was conducted in three public urban health centers in Vlora, Albania, between November 2024 and January 2025. A total of 80 ambulatory patients were recruited using convenience sampling. Data were collected through face-to-face interviews using validated questionnaires, including the Adherence Barriers Questionnaire (ABQ), the Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), and the Patient Health Questionnaire (PHQ-9) for depression screening. Results: The study included 80 ambulatory patients (mean age 66.7 years; 48.7% female), predominantly diagnosed with diabetes (42.5%) and rheumatic diseases (36.3%). All participants reported at least one adherence barrier, with 92.5% experiencing multiple barriers. The most common were financial burden (91.3%) and fear of side effects (77.5%). A significant positive correlation was found between adherence barriers and depression severity (ρ = 0.518, p < 0.0001), while patient satisfaction did not significantly influence adherence barriers (ρ = −0.217, p = 0.053) or depression severity (ρ = −0.004, p = 0.969). Multiple regression analysis showed that higher depression severity (p = 0.0049) was significantly associated with greater adherence barriers, while postgraduate education was associated with fewer barriers (p = 0.0175). Conclusions: Financial burden, fear of side effects, and psychological distress are key barriers to adherence among Albanian ambulatory patients. Although there are limitations inherent to the cross-sectional design and modest sample size, our findings highlight the potential benefit of routine mental health screening, targeted financial support, and improved patient education on medication management within primary care. These insights may help inform future research and interventions aimed at enhancing adherence and overall well-being. Patient satisfaction did not significantly impact adherence or depression. Targeted interventions focusing on financial support, mental health care, and patient education are needed to improve adherence and patient well-being. These findings underscore the need for integrated mental health and adherence support strategies within routine primary care services. Full article
(This article belongs to the Special Issue Medication Therapy Management in Healthcare)
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