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Search Results (152)

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19 pages, 428 KB  
Article
Empowering Patients: A Multicomponent Workshop Improves Self-Management and Quality of Life in Chronic Pain
by María Victoria Ruiz-Romero, María Begoña Gómez-Hernández, Ana Porrúa-Del Saz, María Blanca Martínez-Monrobé, Natalia Gutiérrez-Fernández, Almudena Arroyo-Rodríguez, Rosa Anastasia Garrido-Alfaro, Néstor Canal-Diez, María Dolores Guerra-Martín and Consuelo Pereira-Delgado
Med. Sci. 2025, 13(4), 319; https://doi.org/10.3390/medsci13040319 - 15 Dec 2025
Cited by 1 | Viewed by 569
Abstract
Background: Chronic pain is a prevalent and disabling condition, affecting 20–30% of the global population, which requires multidisciplinary approaches integrating non-pharmacological therapies and promoting patient engagement in self-management. Objective: To describe the structure, content, outcomes, and lessons learned from multicomponent workshops for chronic [...] Read more.
Background: Chronic pain is a prevalent and disabling condition, affecting 20–30% of the global population, which requires multidisciplinary approaches integrating non-pharmacological therapies and promoting patient engagement in self-management. Objective: To describe the structure, content, outcomes, and lessons learned from multicomponent workshops for chronic non-cancer pain using non-pharmacological therapies. Methods: A quasi-experimental before–after study was conducted in patients attending a chronic pain workshop at San Juan de Dios Hospital (Bormujos, Seville, Spain) between November 2021 and May 2024, with a 3-month follow-up, Validated scales and an ad hoc patient survey were administered at baseline, immediately post-workshop, and at 3-month follow-up. Furthermore, comparative analysis was conducted 4 months before and after the intervention for emergency visits and consultations, medication consumption, and employment status. Analyses employed Chi-square or Fisher’s exact tests (categorical variables); student’s t-tests or Mann–Whitney U (between-group); paired t-tests or Wilcoxon (within-group pre–post); and effect sizes (Cohen’s d, Rosenthal’s r). Significance was set at p < 0.05. Results: 197 patients completed the workshop; 178 (90.4%) were women, mean age: 55.0; 114 (57.9%) had fibromyalgia. Reductions were observed in: pain (scale 0–10) (baseline: 7.0; end of workshop: 5.0; 3 months: 5.0; p < 0.001); anxiety (13.0; 9.0; 11.0; p < 0.001); and depression (11.4; 7.2; 6.8; p < 0.001) (scales 0–21). Increases were noted in: well-being (scale 0–10) (4.0; 6.0; 5.0; p < 0.001); quality of life (scale 0–1) (0.399; 0.581; 0.556; p < 0.001); health status (scale 0–100) (40.0; 60.0; 60.0; p < 0.001); self-esteem (scale 9–36) (23.5; 27.1; 26.6; p < 0.001); and resilience (scale 6–30) (17.0; 18.0; 18.0; p = 0.002, p < 0.001). PROMs were completed by 189 patients at the end of the workshop and 110 at 3 months: pain decreased (end of workshop: 76.7%; 3 months: 80.7%); medication decreased (80.5%; 78.1%); and habits improved (87.2%; 87.6%). 40 patients (37.4%) reduced emergency visits and scheduled consultations. Overall satisfaction: 9.7. Conclusions: The workshop enhanced patients’ self-management and produced improvements in pain, quality of life, emotional well-being, and self-esteem, with effects maintained at 3 months. Full article
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10 pages, 633 KB  
Article
Impact of an Interdisciplinary Care Program on Health Outcomes in Older Patients with Multimorbidity
by Pilar Cubo-Romano, Pilar García-de-la-Torre, Carolina Medina-de-Campos, Irene Casado-López, María de-Castro-García, Alejandro Estrada-Santiago, Yolanda Majo-Carbajo, Sara Núñez-Palomares and José Manuel Casas-Rojo
J. Clin. Med. 2025, 14(24), 8856; https://doi.org/10.3390/jcm14248856 - 15 Dec 2025
Viewed by 465
Abstract
Background/Objectives: Evidence on the optimal components and effectiveness of care programs for patients with multimorbidity is limited. This study aimed to evaluate the impact of a structured interdisciplinary program on the incidence of emergency visits, hospitalizations, and avoidable outpatient consultations following an [...] Read more.
Background/Objectives: Evidence on the optimal components and effectiveness of care programs for patients with multimorbidity is limited. This study aimed to evaluate the impact of a structured interdisciplinary program on the incidence of emergency visits, hospitalizations, and avoidable outpatient consultations following an admission or emergency visit. Methods: This retrospective observational study included 200 patients enrolled in the Multimorbidity Care Program at Hospital Universitario Infanta Cristina. Event rates were compared during the year before and after program inclusion. Multiple-event survival analysis was performed using the counting process method. Results: After program inclusion, patients showed a significant reduction in emergency visits (HR 0.74, 95% CI 0.60–0.92, p = 0.006), in conventional hospitalizations (HR 0.54, 95% CI 0.44–0.68, p = 0.001), and in avoidable outpatient visits (HR 0.66, 95% CI 0.51–0.86, p = 0.005). Conclusions: An interdisciplinary care model for patients over 65 with multimorbidity, integrating comprehensive multidimensional assessment, structured patient education, early management of decompensations in a day hospital, and systematic medication review, significantly reduces healthcare utilization. These findings support implementing integrated care programs for complex patients, though multicenter studies and cost-effectiveness analyses are needed to confirm generalizability and sustainability. Full article
(This article belongs to the Special Issue Chronic Disease Management and Rehabilitation in Older Adults)
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13 pages, 830 KB  
Article
Comparison Between In-Office Versus Remote Follow-Up Costs in Patients with Pacemakers and Reimbursed Transportation in a Portuguese District Hospital
by João Oliveira, Sandra Oliveira, Vítor Martins, Cristina Reis, Patrícia Branco, Helena Pedrosa, Luís Casalta and Tânia Parreira
Healthcare 2025, 13(24), 3257; https://doi.org/10.3390/healthcare13243257 - 12 Dec 2025
Viewed by 269
Abstract
Background: Digital technologies can contribute to healthcare democratization in an ethical, safe, and sustainable context. The remote monitoring of implantable cardiac devices enables the follow-up of patients from a distance. Patients with anti-bradycardia pacemakers represent the largest group and have the least access [...] Read more.
Background: Digital technologies can contribute to healthcare democratization in an ethical, safe, and sustainable context. The remote monitoring of implantable cardiac devices enables the follow-up of patients from a distance. Patients with anti-bradycardia pacemakers represent the largest group and have the least access to this technology due to the controversial cost–benefit ratio and barriers to its widespread implementation, such as equipment costs and organizational challenges. In contrast, reimbursed transportation in Portugal reached approximately 82 million euros in 2024. Objectives: The aim of the present study was to assess the financial viability of remote pacemaker follow-up in a Portuguese district hospital, comparing the non-urgent transportation costs and the investment in remote monitoring equipment while measuring user acceptance and satisfaction. Methods: A total of 41 surveys were conducted with patients who received a pacemaker and used publicly reimbursed transportation. The projected costs were calculated for two simulated protocols: the first involved in-person visits every six months, while the second involved in-person visits every two years with remote consultations every six months, over the expected lifespan of the devices. EZR, version 1.61, was used. Results: Our data showed a 74% overall reduction in face-to-face visits. The implementation of remote follow-up would result in a cost saving of EUR 373/patient (21.2%), with total reimbursement (p = 0.01151). The savings increased to 33.3%, reaching EUR 764/patient (p = 0.0002742) for distances greater than 60 km (round trip) for ambulance users with total reimbursement. Acceptance and satisfaction achieved 88%. Conclusions: Remote monitoring of pacemakers can be a financially viable alternative with high acceptance and satisfaction. Full article
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19 pages, 1495 KB  
Article
Evaluating Wireless Vital Parameter Continuous Monitoring for Critically Ill Patients Hospitalized in Internal Medicine Units: A Pilot Randomized Controlled Trial
by Filomena Pietrantonio, Alessandro Signorini, Anna Rosa Bussi, Francesco Rosiello, Fabio Vinci, Michela Delli Castelli, Matteo Pascucci, Elena Alessi, Luca Moriconi, Antonio Vinci, Andrea Moriconi and Roberto D’Amico
J. Sens. Actuator Netw. 2025, 14(6), 116; https://doi.org/10.3390/jsan14060116 - 5 Dec 2025
Viewed by 739
Abstract
Background: Wireless Vital Parameter Continuous Monitoring (WVPCM) allows the continuous tracking of patient physiological parameters, facilitating the earlier detection of clinical deterioration, especially in low-intensity care settings. The aim of this study is to evaluate the effectiveness of using WVPCM compared to the [...] Read more.
Background: Wireless Vital Parameter Continuous Monitoring (WVPCM) allows the continuous tracking of patient physiological parameters, facilitating the earlier detection of clinical deterioration, especially in low-intensity care settings. The aim of this study is to evaluate the effectiveness of using WVPCM compared to the usual monitoring of critically ill patients hospitalized in Internal Medicine wards. An investigation of the attitude of health professionals towards the use of new technologies in daily practice to improve patient management was also carried out. Methods: The LIght Monitor Study (LIMS) is a prospective, open-label, randomized, multi-center pilot trial comparing WVPCM and conventional nurse monitoring during the first 72 h of hospitalization. A central randomization unit used computer-generated tables to allocate patients to two different types of monitoring. The main outcome was the occurrence of major complications. The study planned to enroll 296 critically ill patients with a Modified Early Warning Score (MEWS) ≥ 3 and/or National Early Warning Score (NEWS) ≥ 5 across two Internal Medicine (IM) Units in Italy. The investigation of the attitude of nurses towards the use of WVPCM was carried out by using a questionnaire and a qualitative survey. Results: Due to the COVID-19 outbreak, the study was interrupted early and only 135 patients (WVPCM = 68; standard care = 67) were randomized. One patient in the control group was excluded from analysis because of drop-out, leaving 134 patients for intention to treat analysis. No statistically significant differences between standard care and WVPCM were observed in terms of major complications (37.5%, vs. 31.2% p = 0.475), in-hospital mortality (17.5% vs. 11.1%, p = 0.309), and median hospital length of stay (9 vs. 10 days, p = 0.463). WVPCM decreased nursing workload compared to the control, as the average time spent by nurses on the detection of vital signs per patient was 0 min per patient per day compared to 24.4 min (p < 0.001) observed in the control group. Twenty-two percent of patients in the WVPCM group (15/68) experienced discomfort with the device, resulting in its removal. The investigation of nurses involved 16 out of 18 people participating in the study. Opinions on the wireless device for patient monitoring were particularly favorable; most of them considered remote monitoring clearly superior to traditional in-person visits and easy to use after a brief practice period. All participants recognized the safety benefits of the system. Conclusions: The reduced sample size of this pilot study does not allow us to draw any conclusions on the superiority of WVPCM compared to standard care in terms of clinical outcomes. However, we observed a positive trend in the reduction of major complications. Full article
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12 pages, 1380 KB  
Article
Unsupervised Clustering of 41,728 Emergency Department Visits: Insights into Patient Profiles and KTAS Reliability
by Jongsun Kim, EunChul Jang, SoonChan Kwon and MyoungJe Song
Healthcare 2025, 13(23), 3073; https://doi.org/10.3390/healthcare13233073 - 26 Nov 2025
Viewed by 401
Abstract
Introduction: In the emergency room, it is essential to quickly and accurately classify the patients’ various severities. However, existing five-stage classification systems, such as the Korean Emergency Patient Classification Tool (KTAS), do not sufficiently reflect the physiological and clinical heterogeneity of all patients, [...] Read more.
Introduction: In the emergency room, it is essential to quickly and accurately classify the patients’ various severities. However, existing five-stage classification systems, such as the Korean Emergency Patient Classification Tool (KTAS), do not sufficiently reflect the physiological and clinical heterogeneity of all patients, so there is a possibility of under-classification in some age groups or specific symptom groups. Methods: A retrospective cross-sectional study was conducted using KTAS and the physiological and clinical data of 41,728 patients who visited the emergency room of a university hospital in Incheon in 2022. K-prototypes unsupervised cluster analysis incorporating demographic, physiological, and clinical variables was applied, and the number of clusters was determined as the optimal value through the Silhouette, Dunn, and Davies–Bouldin indicators. Dimension reduction was performed by UMAP, and differences between clusters were compared by t-test, Mann–Whitney U, and chi-square test. Results: Two different clusters were identified. Cluster 0 was a stable patient group with a mean age of 58 years and an average arterial pressure of 104 mmHg. On the other hand, Cluster 1 was a young but physiologically unstable patient group with an average age of 46 years and an average arterial pressure of 90 mmHg. There were significant differences in age, MAP, heart rate, respiratory rate, body temperature, and pain scores between clusters (p < 0.001), and a moderate association was observed between KTAS classification and clusters (Cramer’s V = 0.208). Discussion: This study suggested the possibility of early identification of high-risk groups in the emergency room and efficient resource allocation by identifying potential patient heterogeneity that KTAS cannot detect through unsupervised learning. This approach can be used as a basis for precision triage and patient-centered emergency medical policy establishment by supplementing rather than replacing the existing classification system. Full article
(This article belongs to the Special Issue New Tools and Technologies in Emergency Medicine and Critical Care)
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19 pages, 1186 KB  
Systematic Review
The Role of the Family and Community Nurse in Improving Quality of Life and Optimizing Home Care Post-COVID: A Systematic Review with Meta-Analysis
by Angelo Cianciulli, Emanuela Santoro, Nicole Bruno, Savino Quagliarella, Salvatore Esposito, Roberta Manente, Biagio Santella, Rosaria Flora Ferrara, Antonietta Pacifico, Gianluigi Franci and Giovanni Boccia
Nurs. Rep. 2025, 15(12), 415; https://doi.org/10.3390/nursrep15120415 - 26 Nov 2025
Viewed by 1208
Abstract
Background/Objectives: The COVID-19 pandemic accelerated the shift toward community- and home-based care models. Within this transformation, Family and Community Nurses (FCNs) have become key in bridging hospital and primary care, supporting continuity, self-care, and quality of life (QoL). Despite increasing recognition, evidence [...] Read more.
Background/Objectives: The COVID-19 pandemic accelerated the shift toward community- and home-based care models. Within this transformation, Family and Community Nurses (FCNs) have become key in bridging hospital and primary care, supporting continuity, self-care, and quality of life (QoL). Despite increasing recognition, evidence on FCN-led interventions remains fragmented. This systematic review and meta-analysis aimed to synthesize evidence on the impact of FCN interventions on QoL and clinical outcomes in post-COVID and people living with chronic conditions managed in community and home settings. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, CINAHL, PsycINFO, Embase, and Cochrane Library (January 2020–November 2024). Eligible studies were randomized controlled trials evaluating FCN-led interventions. Primary outcomes were QoL (measured with validated tools) and glycemic control (HbA1c). Secondary outcomes included hospital readmissions, anxiety, depression, and self-care abilities. Risk of bias was assessed using the Cochrane RoB2 tool for randomized controlled trials. Random-effects meta-analyses were performed, with heterogeneity evaluated by I2. The protocol was prospectively registered in PROSPERO (CRD42024567890) before data extraction. Results: Seventy-one studies (n = 19,390) were included. Interventions comprised home visits, telehealth, patient education, and case management. Pooled analyses demonstrated significant improvement in QoL (SMD 0.34, 95% CI 0.18–0.50) and reduction in HbA1c (−0.47%, 95% CI −0.69 to −0.25). FCN interventions also reduced hospital readmissions (RR 0.74, 95% CI 0.62–0.89) and improved mental health outcomes. Most studies were judged at low to moderate risk of bias. Conclusions: FCN-led interventions significantly enhance QoL, mental health, and clinical outcomes while reducing hospital readmissions. These findings highlight the strategic importance of integrating FCNs into community-based healthcare models. Full article
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15 pages, 1746 KB  
Article
Clinical Outcomes of Repeated Sodium Polynucleotide Injections in Knee Osteoarthritis: Large-Scale, Retrospective Cohort Study
by Jiyon Bok, Bongseong Kim, Kyungdo Han, Dongwook Shin and Hasuk Bae
J. Clin. Med. 2025, 14(23), 8358; https://doi.org/10.3390/jcm14238358 - 25 Nov 2025
Viewed by 1032
Abstract
Background/Objectives: Sodium polynucleotide (PN) injection has recently been considered as a potential intra-articular therapy for knee osteoarthritis (OA); however, there is limited evidence regarding the long-term consistency of repeated PN cycles. To evaluate the clinical effectiveness of repeated intra-articular PN injections after [...] Read more.
Background/Objectives: Sodium polynucleotide (PN) injection has recently been considered as a potential intra-articular therapy for knee osteoarthritis (OA); however, there is limited evidence regarding the long-term consistency of repeated PN cycles. To evaluate the clinical effectiveness of repeated intra-articular PN injections after the initial 6 months of therapy in patients with knee OA, using nationwide claims data. Methods: We conducted a retrospective cohort study using data from the Korea Health Insurance Review and Assessment Service collected between 2020 and 2023. Patients who received PN injections for knee OA were classified into two groups based on the treatment cycle: Group 1 (single cycle) and Group 2 (re-administration). Surgical outcomes and symptomatic indicators, including pain-related hospital visits, arthrocentesis, nonsteroidal anti-inflammatory drug prescriptions, and antidepressant prescriptions, were analyzed. Results: A total of 142,322 patients were included in this study. Readministration of PN was associated with significantly lower rates of total knee arthroplasty (2.31% vs. 4.92%, p < 0.0001) and delayed time to surgery (252.0 vs. 176.6 days, p < 0.0001). Similar trends were observed for hemiarthroplasty, with a lower incidence (0.28% vs. 0.55%, p < 0.0001) and longer time to surgery (240.7 vs. 162.2 days, p < 0.0001) in the readministration group. All groups showed a timewise reduction in pain-related hospital visits and instances of arthrocentesis. Safety outcomes were not assessed in this claim-based dataset. Conclusions: Repeated cycles of PN injections provide sustained clinical benefits and may effectively delay the need for surgical intervention in patients with knee OA, supporting their possible role as a long-term conservative treatment option. Radiographic severity and safety outcomes were unavailable in this claims dataset, limiting the adjustment for baseline OA severity and restricting causal interpretation. Full article
(This article belongs to the Special Issue Knee Osteoarthritis: Clinical Updates and Perspectives)
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12 pages, 459 KB  
Article
Preventable Hospitalization and Primary Healthcare Visits Among Hypertensive Patients in Makkah City
by Turky Arbaein
Healthcare 2025, 13(23), 3039; https://doi.org/10.3390/healthcare13233039 - 25 Nov 2025
Viewed by 550
Abstract
Background: Hypertension-preventable hospitalizations are used internationally as indicators of primary healthcare centers (PHCs) performance. The Ministry of Health (MoH) in Saudi Arabia has recently implemented several programs to strengthen PHCs and reduce avoidable admissions. This study aimed to observe recent trends in healthcare [...] Read more.
Background: Hypertension-preventable hospitalizations are used internationally as indicators of primary healthcare centers (PHCs) performance. The Ministry of Health (MoH) in Saudi Arabia has recently implemented several programs to strengthen PHCs and reduce avoidable admissions. This study aimed to observe recent trends in healthcare utilization among hypertensive patients in Makkah City. Methods: A retrospective comparative time-trend analysis was conducted using aggregated monthly counts from individual-level records collected by the Makkah Health Cluster between January 2023 and May 2024. Data from 43 PHCs and all public hospitals were analyzed using segmented Poisson regression based on the AHRQ Prevention Quality Indicator #07 (PQI-07) for hypertension. Models included demographic covariates (age, sex, nationality) and a dummy variable to adjust for the Eid holiday period. Rates were calculated per 100,000 adults. Results: A total of 42,743 hypertension-related encounters were identified, including 2895 preventable hospitalizations and 39,848 PHC visits. Monthly analyses showed a 5.7% decline in preventable hospitalizations (IRR = 0.943; p < 0.001) and a 1.5% increase in PHC visits (IRR = 1.015; p < 0.001). Reductions were most pronounced among adults ≥ 65 years. Non-Saudis were significantly less likely to attend PHCs, reflecting public-sector eligibility differences. Conclusions: After controlling for Eid-related seasonal variation, the results indicate a favorable shift toward outpatient hypertension management in Makkah City. These findings align with Saudi Vision 2030 objectives of strengthening PHC and reducing preventable hospital burden. Further multi-regional studies integrating private-sector data are warranted to confirm national trends. Full article
(This article belongs to the Section Chronic Care)
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13 pages, 346 KB  
Review
Medically Tailored Meals: A Case for Federal Policy Action
by Catherine Macpherson, William H. Frist and Emily Gillen
Healthcare 2025, 13(22), 2899; https://doi.org/10.3390/healthcare13222899 - 13 Nov 2025
Viewed by 2814
Abstract
Background: Poor nutrition drives chronic disease, health disparities, and rising health care costs in the United States. Medically tailored meals (MTMs), designed by registered dietitians, are a Food-as-Medicine intervention with potential to improve outcomes and reduce costs. This review synthesizes evidence on the [...] Read more.
Background: Poor nutrition drives chronic disease, health disparities, and rising health care costs in the United States. Medically tailored meals (MTMs), designed by registered dietitians, are a Food-as-Medicine intervention with potential to improve outcomes and reduce costs. This review synthesizes evidence on the clinical, economic, and policy implications of MTMs. Methods: We conducted a narrative review of peer-reviewed studies, real-world program evaluations, and policy analyses. Sources included PubMed, Google Scholar, and grey literature from government, nonprofit, and industry organizations. Articles and reports were included if they examined MTMs in Medicare, Medicaid, or other high-risk populations. Results: Evidence demonstrates that MTMs improve health outcomes, reduce hospitalizations, and lower total cost of care. Case studies from Medicaid and Medicare Advantage plans, including those administered by Mom’s Meals®, report reductions in emergency department visits, hospital readmissions, and total cost of care, alongside sustained high member satisfaction. Despite these findings, gaps in coverage and limited stakeholder awareness hinder broader access and adoption. Conclusions: Federal policy action can expand MTM availability and maximize utilization of existing benefits. Opportunities include establishing a Medicare Fee-for-Service demonstration, expanding and encouraging use in Medicare Advantage, and leveraging MTMs within Center for Medicare and Medicaid Innovation models. Broader implementation and utilization could reduce the nation’s chronic disease burden, advance health equity, and promote value-based care. Full article
(This article belongs to the Special Issue Policy Interventions to Promote Health and Prevent Disease)
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13 pages, 379 KB  
Article
Cost-Effectiveness Analysis of Universal Rotavirus Vaccination Schedules in Syria
by Mania Mershed, Razan Altarabishi, Rasha Mohamed, Lamia Abu ajaj, Dima Alrashee, Manar Kamel and Salah Al Awaidy
Vaccines 2025, 13(11), 1157; https://doi.org/10.3390/vaccines13111157 - 12 Nov 2025
Viewed by 861
Abstract
Background: Rotavirus (RV) continues to be the leading cause of acute gastroenteritis (AGE) globally among children under five. National RV vaccination efforts have lowered morbidity and mortality. Vaccination is a key public health tool to alleviate this substantial burden of RV in middle- [...] Read more.
Background: Rotavirus (RV) continues to be the leading cause of acute gastroenteritis (AGE) globally among children under five. National RV vaccination efforts have lowered morbidity and mortality. Vaccination is a key public health tool to alleviate this substantial burden of RV in middle- and low-income countries. In Syria, RV morbidity accounts for 27% of severe GE. We conducted a cost-effectiveness analysis of introducing rotavirus vaccinations (RVV) into Syria’s National Immunization Program. Methods: A decision tree model was developed to assess the cost-saving of two-dose rotavirus vaccinations (Rotarix®) compared to no vaccination. A birth cohort of 573,944 newborns was simulated throughout a 5-year time frame to capture the near-term health and economic effects. The analysis adopted an incremental cost-saving approach, evaluating a hypothetical 2023 birth cohort from the government’s perspective. Outcomes included the cost per disability-adjusted life year (DALY) prevented and the cost per death averted. Model inputs were derived from local data, specifically including healthcare and vaccination costs and deaths attributable to RVGE, the scientific literature, and national/international databases. The incremental cost-effectiveness ratio (ICER) measures the cost of avoiding one disability-adjusted life year (DALY) adopted. Results: Over five years, the two-dose RV strategy would avert 77,500 RVGE cases, reduce outpatient visits by 59%, and reduce severe RV hospitalizations by 41%. The vaccination program would cost $21,817,918 USD and avert $3,239,907 USD in healthcare costs, resulting in a net cost of $18,578,011 USD. The incremental cost-effectiveness ratio (ICER) was $2098 USD per DALY averted, which is below three times Syria’s GDP per capita ($753.6 USD), indicating high cost-effectiveness according to WHO benchmarks. Conclusions: Introducing rotavirus vaccination is highly cost-saving and will result in a substantial reduction in healthcare burdens and lives lost. Policy planners must ensure its inclusion in the National Immunization Programs, ensuring sustainable financing and equitable access. Full article
(This article belongs to the Special Issue Childhood Immunization and Public Health)
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12 pages, 245 KB  
Article
Impact of an Early Discharge Hospital-at-Home Program on Length of Stay and Clinical Outcomes in Preterm Infants: A Case–Control Study
by María Ángeles García-Ortega, José Miguel García-Piñero, Alberto José Gómez-González, Rosana Medina-López, Marta González-García, Antonio Jesús Montero-García and Isabel María Morales-Gil
Children 2025, 12(11), 1504; https://doi.org/10.3390/children12111504 - 6 Nov 2025
Viewed by 780
Abstract
Background/Objectives: Prolonged hospitalization of clinically stable preterm infants may lead to nosocomial infections, interfere with breastfeeding, and hinder parent-infant bonding. We evaluated the impact of an early discharge program with hospital-at-home (HaH) on hospital stay and clinical outcomes among preterm infants. Methods [...] Read more.
Background/Objectives: Prolonged hospitalization of clinically stable preterm infants may lead to nosocomial infections, interfere with breastfeeding, and hinder parent-infant bonding. We evaluated the impact of an early discharge program with hospital-at-home (HaH) on hospital stay and clinical outcomes among preterm infants. Methods: A retrospective case–control study was conducted in a tertiary neonatal unit (Spain). Fifty infants managed with HaH (2016–2020) were compared with ninety-six controls receiving conventional in-hospital care. Baseline characteristics, growth, and clinical events up to 12 months were collected. Analyses included bivariate comparisons and multiple linear regression for length of stay, adjusted for gestational age, birth weight, sex, and parental factors. Results: Baseline characteristics were comparable between groups. Discharge weight was lower in HaH infants (1865 vs. 2130 g; p < 0.001), but no differences were observed at 6 or 12 months. Length of stay was shorter in HaH infants (26.3 vs. 33.8 days; p = 0.081), and the multivariable model showed an independent 5.5-day reduction (β −5.53; 95% CI −10.96 to −0.11; p = 0.046). Exclusive breastfeeding was more frequent (74% vs. 59%; p = 0.08) and significantly longer in HaH infants (141.9 vs. 81.1 days; p = 0.024). No increases were found in complications at discharge, emergency visits (28% vs. 32%; p = 0.7), or readmissions (18% vs. 31%; p = 0.2). Conclusions: Among clinically stable preterm infants, early discharge with HaH was associated with a shorter hospital stay and longer exclusive breastfeeding duration, without evidence of increased morbidity or healthcare use; however, causal inference cannot be established due to the observational design. These findings support the implementation of nurse-led HaH programs as a safe, family-centered strategy for neonatal care. Full article
(This article belongs to the Section Pediatric Nursing)
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 2771
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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14 pages, 1028 KB  
Article
Tobacco Smoke Exposure Biomarker Profiles and Healthcare Utilization Patterns Among U.S. Children
by Ashley L. Merianos, Georg E. Matt, Roman A. Jandarov and E. Melinda Mahabee-Gittens
Toxics 2025, 13(11), 909; https://doi.org/10.3390/toxics13110909 - 23 Oct 2025
Viewed by 741
Abstract
This study aimed to examine the associations between distinct tobacco smoke exposure (TSE) biomarkers and healthcare utilization patterns in U.S. children ages 3–11 years with and without current asthma. Secondary data from the 2013–2016 National Health and Nutrition Examination Survey were analyzed (N [...] Read more.
This study aimed to examine the associations between distinct tobacco smoke exposure (TSE) biomarkers and healthcare utilization patterns in U.S. children ages 3–11 years with and without current asthma. Secondary data from the 2013–2016 National Health and Nutrition Examination Survey were analyzed (N = 2838). TSE biomarkers included serum cotinine, urinary total nicotine equivalents (TNE2), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), the NNAL/TNE2 ratio, and the N-acetyl-S-(2-cyanoethyl)-L-cysteine (2CyEMA)/TNE2 ratio. We conducted Poisson regression analyses to examine the associations between each biomarker and healthcare visits and hospitalizations within the past 12 months, adjusting for sociodemographic and home TSE covariates. Children without asthma who had higher urinary TNE2 levels (adjusted incidence rate ratio [aIRR] = 1.03, 95% confidence interval [CI] = 1.02–1.04) and children with asthma who had higher urinary 2CyEMA/TNE2 ratio levels (aIRR = 1.05, 95%CI = 1.03–1.07) were at an increased risk of having more healthcare visits. Children without asthma who had higher serum cotinine (aIRR = 1.21, 95%CI = 1.07–1.37) and higher 2CyEMA/TNE2 ratio levels (aIRR = 1.25, 95%CI = 1.14–1.37) were at an increased risk of hospitalizations. Children with asthma who had higher NNAL/TNE2 ratio levels (aIRR = 1.52, 95%CI = 1.11–2.09) were at increased risk of hospitalizations. It is important to consider comprehensive biomarkers of TSE in children, such as TNE, tobacco-specific nitrosamines, and volatile organic compounds, along with healthcare utilization patterns. Child TSE reduction policies are urgently needed. Full article
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10 pages, 1615 KB  
Article
Virtual Clinics in Cardiology: Do They Provide Equivalent Care and Reduce Travel?
by Matthew Farrier, Brian Wood, Zoubaida Yahia and Martin Farrier
J. Clin. Med. 2025, 14(20), 7363; https://doi.org/10.3390/jcm14207363 - 17 Oct 2025
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Abstract
Objective: To evaluate whether virtual clinic appointments in cardiology are equivalent to face-to-face appointments in terms of investigations as a consequence of the appointment and a reduction in travel for the whole care episode. Design: Retrospective observational cohort study of 9445 patients. Setting: [...] Read more.
Objective: To evaluate whether virtual clinic appointments in cardiology are equivalent to face-to-face appointments in terms of investigations as a consequence of the appointment and a reduction in travel for the whole care episode. Design: Retrospective observational cohort study of 9445 patients. Setting: Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, a medium-sized NHS trust in the north-west of England. Participants: 9445 patients referred for new cardiology appointments between 2023 and 2025. Methods: Data were extracted from electronic records and test ordering systems and appointments with corresponding investigations were retrieved. The data was validated using random samples, and the extraction was modified until accuracy was achieved. Principle component analysis was used to compare groups, and Welch t-test was used to statistically analyse the results. Distance travelled was calculated using postcodes and the number of visits was calculated using investigations conducted on separate days. Results: Patients who had virtual appointments showed no statistical difference in the number of investigations or visits for investigations. The care provided via virtual and face-to-face appointments was found to be comparable in terms of clinical effectiveness and quality of care. The distance travelled for both types of appointment is therefore not different, but if the initial appointment is taken into consideration where there was no travel for the virtual appointment patients, then the reduction in miles travelled is 5002 km, resulting in a carbon saving of 784 kgCO2eq. Conclusions: Virtual Clinics in Cardiology offer an equitable service but only a small reduction in travel. Full article
(This article belongs to the Section Cardiovascular Medicine)
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16 pages, 956 KB  
Article
Low-Tech Telemedicine Reduces Caregiver Burden and Improves Outcomes in Older Adults with Chronic Diseases: Results from a Prospective Study in Romania
by Angelica Gherman, Emil Robert Stoicescu, Codrina Mihaela Levai, Călin Marius Popoiu and Ovidiu Alin Haţegan
Healthcare 2025, 13(19), 2442; https://doi.org/10.3390/healthcare13192442 - 26 Sep 2025
Cited by 2 | Viewed by 2038
Abstract
Background: Family caregivers of patients with chronic diseases face high levels of burden, anxiety, and burnout, which may negatively affect both their well-being and patient outcomes. Low-cost, accessible telemedicine approaches may provide practical support in resource-limited settings. Methods: We conducted a [...] Read more.
Background: Family caregivers of patients with chronic diseases face high levels of burden, anxiety, and burnout, which may negatively affect both their well-being and patient outcomes. Low-cost, accessible telemedicine approaches may provide practical support in resource-limited settings. Methods: We conducted a prospective, parallel-group controlled study in Timisoara, Romania, between April 2024 and March 2025 and included 161 caregivers of older adults with chronic diseases, allocated 1:1 to receive either structured low-cost telemedicine support (weekly phone calls and SMS reminders; n = 82) or usual care (n = 79). Data were collected at baseline, three months, and six months through structured interviews. The primary outcome was caregiver burden measured by the Zarit Burden Interview (ZBI). Secondary outcomes included caregiver anxiety, burnout, satisfaction, and patient-related outcomes such as emergency room (ER) visits, hospital readmissions, and medication adherence. Analyses were performed using ANCOVA and logistic regression, adjusting for baseline values and relevant covariates. Results: At three months, caregivers in the intervention group had significantly lower burden scores compared to controls (adjusted mean difference −2.9; 95% CI −4.7 to −1.1; p = 0.002). Reductions in anxiety (−1.4; p = 0.02) and burnout (−1.6; p = 0.01) were also observed. These effects persisted at six months, though slightly attenuated. Patient outcomes favored the intervention: ER visits were lower at six months (27.50% vs. 41.02%; aOR 0.55, 95% CI 0.30–0.99; p = 0.047), while medication adherence and readmissions showed consistent but non-significant improvements. No adverse effects were reported. Conclusions: A simple, low-tech telemedicine program reduced caregiver burden, anxiety, and burnout and decreased ER visits. Improvements in medication adherence and readmissions were observed, but did not reach statistical significance. This pragmatic intervention can easily be integrated into primary care follow-up or community-based caregiver support programs, providing an affordable and low-cost technique to promote chronic disease management and caregiver well-being, especially in resource-limited health systems. Full article
(This article belongs to the Special Issue Prevention and Management of Chronic Diseases)
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