Healthcare

18 pages, 6840 KiB

Open AccessArticle

Exploring New Tools in Upper Limb Rehabilitation After Stroke Using an Exoskeletal Aid: A Pilot Randomized Control Study

by Pantelis Syringas, Vassiliki Potsika, Nikolaos Tachos, Athanasios Pardalis, Christoforos Papaioannou, Alexandros Mitsis, Emilios E. Pakos, Orestis N. Zestas, Georgios Papagiannis, Athanasios Triantafyllou, Nikolaos D. Tselikas, Konstantina G. Yiannopoulou, George Papathanasiou, George Georgoudis, Daphne Bakalidou, Maria Kyriakidou, Panagiotis Gkrilias, Ioannis Kakkos, George K. Matsopoulos and Dimitrios I. Fotiadis

Healthcare 2025, 13(1), 91; https://doi.org/10.3390/healthcare13010091 - 6 Jan 2025

Viewed by 761

Abstract

Background/Objectives: Spasticity commonly occurs in individuals after experiencing a stroke, impairing their hand function and limiting activities of daily living (ADLs). In this paper, we introduce an exoskeletal aid, combined with a set of augmented reality (AR) games consisting of the Rehabotics rehabilitation [...] Read more.

Background/Objectives: Spasticity commonly occurs in individuals after experiencing a stroke, impairing their hand function and limiting activities of daily living (ADLs). In this paper, we introduce an exoskeletal aid, combined with a set of augmented reality (AR) games consisting of the Rehabotics rehabilitation solution, designed for individuals with upper limb spasticity following stroke. Methods: Our study, involving 60 post-stroke patients (mean ± SD age: 70.97 ± 4.89 years), demonstrates significant improvements in Ashworth Scale (AS) scores and Box and Block test (BBT) scores when the Rehabotics solution is employed. Results: The intervention group showed slightly greater improvement compared to the control group in terms of the AS (−0.23, with a confidence interval of −0.53 to 0.07) and BBT (1.67, with a confidence interval of 1.18 to 2.16). Additionally, the Rehabotics solution was particularly effective for patients with more severe deficits. Patients with an AS score of 3 showed more substantial improvements, with their AS scores increasing by −1.17 ± 0.39 and BBT scores increasing by −4.83 ± 0.72. Conclusions: These findings underscore the potential of wearable hand robotics in enhancing stroke survivors’ hand rehabilitation, emphasizing the need for further investigations into its broader applications. Full article

(This article belongs to the Special Issue Applications of Digital Technology in Comprehensive Healthcare)

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35 pages, 4544 KiB

Open AccessReview

Synchronous Home-Based Telerehabilitation of the Upper Extremity Following Stroke—A Pyramid Review

by Kirsten Stangenberg-Gliss, Christian Kopkow and Bernhard Borgetto

Healthcare 2025, 13(1), 90; https://doi.org/10.3390/healthcare13010090 - 6 Jan 2025

Viewed by 642

Abstract

Background: Stroke is a leading cause of long-term disability, often resulting in upper extremity impairment. Telerehabilitation offers a promising approach to deliver therapy in home settings. This review aimed to evaluate the effects of home-based telerehabilitation interventions delivered to address upper extremity function [...] Read more.

Background: Stroke is a leading cause of long-term disability, often resulting in upper extremity impairment. Telerehabilitation offers a promising approach to deliver therapy in home settings. This review aimed to evaluate the effects of home-based telerehabilitation interventions delivered to address upper extremity function in stroke patients. Methods: A systematic review was conducted following the Pyramid Review methodology. Quantitative and qualitative studies examining home-based telerehabilitation for upper extremity function in stroke patients were included. Data were synthesized using meta-analysis where possible and narrative synthesis. Results: Thirty studies (24 quantitative, four qualitative, and two mixed-methods studies) were included. Telerehabilitation interventions demonstrated improvements in upper extremity function for both subacute and chronic stroke patients, with varying effect sizes across intervention types. Constraint-induced movement therapy adaptations and some sensor-based approaches showed consistently positive results. Qualitative findings revealed generally positive effects, with convenience, gamification, and social support as key motivators for adherence. Conclusions: Home-based telerehabilitation shows promise for improving upper extremity function in stroke patients. However, heterogeneity in intervention designs and outcomes limits definitive conclusions. Future research should focus on larger trials, observational studies, standardized outcome measures, and long-term follow-up as well as qualitative studies with focus on perceived effectiveness to optimize telerehabilitation approaches for stroke recovery. Full article

(This article belongs to the Special Issue Advances in Telerehabilitation for Optimising Recovery)

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19 pages, 464 KiB

Open AccessSystematic Review

The Effects of Social Feedback Through the “Like” Feature on Brain Activity: A Systematic Review

by Artemisa R. Dores, Miguel Peixoto, Carina Fernandes, António Marques and Fernando Barbosa

Healthcare 2025, 13(1), 89; https://doi.org/10.3390/healthcare13010089 - 6 Jan 2025

Viewed by 954

Abstract

Background: Problematic social media (SM) use is a growing concern, particularly among adolescents who are drawn to these platforms for social interactions important to their age group. SM dependence is characterized by excessive, uncontrolled usage that impairs personal, social, and professional aspects. Despite [...] Read more.

Background: Problematic social media (SM) use is a growing concern, particularly among adolescents who are drawn to these platforms for social interactions important to their age group. SM dependence is characterized by excessive, uncontrolled usage that impairs personal, social, and professional aspects. Despite the ongoing debate over recognizing SM addiction as a distinct diagnostic category, the impact of social feedback, particularly through the “like” button, on brain activity remains under scrutiny. Objective: This systematic review aims to study the neural correlates of online social feedback, focusing on the effects of the “like” feedback on brain activity using fMRI and EEG. Methods: The review followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA). Results: The review included 11 studies with 504 participants, identifying key brain structures such as the amygdala, ventromedial prefrontal cortex (vmPFC), and ventral striatum involved in reward processing. Positive feedback (“likes”) activates areas like the nucleus accumbens (NACC), vmPFC, and amygdala, with NACC correlating with increased SM use intensity. Negative feedback activates the ventrolateral prefrontal cortex (vlPFC) and left medial prefrontal cortex (mPFC). Behavioral data indicates that positive feedback influences subsequent social interactions. Conclusions: The review highlights disparities in the literature regarding the neural response to social feedback, emphasizing the need for further research to clarify the roles of sex, personality traits, and the person giving feedback. Overall, understanding the neurobiological underpinnings of SM engagement is essential for developing effective interventions to prevent or address the negative effects of excessive SM use. Full article

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13 pages, 564 KiB

Open AccessArticle

Impact of Nurse Staffing Levels on Patient Fall Rates: A Retrospective Cross-Sectional Study in General Wards in Japan

by Mutsuko Moriwaki, Masayuki Kakehashi, Kenshi Hayashida, Masato Koizumi and Hiromasa Horiguchi

Healthcare 2025, 13(1), 88; https://doi.org/10.3390/healthcare13010088 - 6 Jan 2025

Viewed by 685

Abstract

Background: Falls are common adverse events among hospitalized patients, affecting outcomes and placing a financial burden on patients and hospitals. This study investigated the relationship between nurse staffing/workload and patient falls during hospitalization. Methods: The patients studied were hospitalized in the [...] Read more.

Background: Falls are common adverse events among hospitalized patients, affecting outcomes and placing a financial burden on patients and hospitals. This study investigated the relationship between nurse staffing/workload and patient falls during hospitalization. Methods: The patients studied were hospitalized in the general wards (excluding pediatrics and obstetrics/gynecology) of 11 National Hospital Organization institutions between April 2019 and March 2020. The data were obtained from the Diagnosis Procedure Combination Work Record and institutional fall reports. The variables used in the analyses included patient conditions, number of hospitalization cases, emergency hospitalizations, surgeries/examinations, disease composition ratio, patient attributes, hospital stay duration, hospital bed size, and nursing time per patient (day and night) on a ward-day basis. Multivariate analysis was performed to determine the effects of these factors on fall events. Results: A total of 36,209 ward days were analyzed, with falls reported on 2866 days (fall event rate of 9.0%). The mean nursing times per patient were 1.99 h (day) and 1.47 h (night). The nursing time per patient in the fall group compared to the non-fall group showed an odds ratio of 1.19 (p < 0.01) during day shifts and 0.17 (p < 0.02) during night shifts. An increase in nursing time per patient during the night was associated with fewer fall events, whereas during the day, increased nursing time appeared to contribute to more falls. Common background factors that increased nurse staffing and patient falls simultaneously could be suggested to exist during the day. Conclusions: Increased nursing time was correlated with reduced fall incidence, indicating the need for policy improvements in nurse staffing practices in Japan to enhance patient safety and outcomes. Further research is needed to accumulate evidence reflecting policies regarding nurse staffing. Full article

(This article belongs to the Section Healthcare Quality and Patient Safety)

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11 pages, 445 KiB

Open AccessArticle

Likelihood of Preterm Birth in Patients After Antenatal Corticosteroid Administration in Relation to Diagnosis and Confounding Risk Factors: A Retrospective Cohort Study

by Jan Pauluschke-Fröhlich, Richard Berger, Harald Abele, Claudia F. Plappert and Joachim Graf

Healthcare 2025, 13(1), 87; https://doi.org/10.3390/healthcare13010087 - 6 Jan 2025

Viewed by 579

Abstract

Background: In the case of threatened preterm birth (PTB) before the 34th week of pregnancy, the application of antenatal corticosteroids (ACSs) for the maturation of the fetal lung is a standard procedure in perinatal medicine. Common diagnoses for ACS use in pregnancy [...] Read more.

Background: In the case of threatened preterm birth (PTB) before the 34th week of pregnancy, the application of antenatal corticosteroids (ACSs) for the maturation of the fetal lung is a standard procedure in perinatal medicine. Common diagnoses for ACS use in pregnancy are the preterm rupture of membranes (PPROMs), placental bleeding, premature labor, preeclampsia, oligohydramnios, amniotic infection syndrome (AIS), and cervical insufficiency. The aim of this study was to investigate whether the current diagnosis, which results in ACS, and the patient’s risk factors influence the risk of PTB events. Methods: The data of all affected women were extracted, who were hospitalized in 2016 due to a threatening PTB and administered corticosteroids in the German federal state Rhineland-Palatinate (n = 1544), so the study was conducted as a retrospective cohort trial. Frequency analyses, Friedman tests, Chi square tests, logistic regressions, Spearman correlation, and moderation analysis were performed to determine the Odds ratio (OR) for PTB in ACS patients in relation to diagnosis and risk factors. Results: Only 60% of all patients with PTB risk delivered prematurely, whereby patients with different diagnoses differ in terms of the PTB risk; the highest risk could be found in AIS (OR = 16.12) or preeclampsia (OR = 5.46). For prior PTB, stillbirth, or abortion, there is a moderation effect (based on the confounders), while multiple pregnancies influence the PTB risk irrespective of diagnosis (OR = 6.45). In the whole collective, the OR for PTB was 6.6 in relation to all pregnant women in Germany. Conclusions: A higher risk of PTB could be found in patients with a diagnosis of AIS, preeclampsia, as well as in multiple pregnancies. Prior PTB, stillbirth, or abortion act as a relevant confounder. Full article

(This article belongs to the Special Issue Global Care of Preterm Children: The Role of Individual, Family and Environmental Factors)

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18 pages, 404 KiB

Open AccessSystematic Review

Identifying Access Barriers to PrEP Among Cisgender Black/African American Women in the United States: A Systematic Review of the Literature

by JoAnna Boudreaux, Cristobal Mario Valdebenito and Latrice C. Pichon

Healthcare 2025, 13(1), 86; https://doi.org/10.3390/healthcare13010086 - 6 Jan 2025

Viewed by 888

Abstract

Background/Objectives: Cisgender Black women in the U.S. face disproportionately high HIV rates due to systemic inequities rooted in institutional racism, not individual behaviors. These disparities are particularly severe in the southern U.S., driven by limited access to healthcare, economic instability, and unsafe social [...] Read more.

Background/Objectives: Cisgender Black women in the U.S. face disproportionately high HIV rates due to systemic inequities rooted in institutional racism, not individual behaviors. These disparities are particularly severe in the southern U.S., driven by limited access to healthcare, economic instability, and unsafe social environments. Despite its proven effectiveness, PrEP remains significantly underutilized in this population. Methods: This systematic review followed PRISMA guidelines to identify and select relevant studies and used the CASP checklist to appraise the quality of the selected qualitative studies. The review focuses on individual and systemic barriers to PrEP access for cisgender Black women, aiming to guide equitable health interventions and improve HIV prevention efforts. Results: Key barriers include limited PrEP awareness, medical mistrust, and stigma. Financial, structural, and social determinants also hinder access. Facilitators, such as PrEP education, social normalization, trust building, and affordability, were identified as critical to improving uptake. Conclusions: The findings emphasize the need for culturally tailored strategies that build trust, provide education, and empower cisgender Black women to overcome barriers to PrEP access. Full article

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18 pages, 2127 KiB

Open AccessSystematic Review

Prevalence of Depression Among People Living with HIV on Antiretroviral Therapy in Africa: A Systematic Review and Meta-Analysis

by Dimakatso M. Molapo, Kabelo Mokgalaboni and Wendy N. Phoswa

Healthcare 2025, 13(1), 85; https://doi.org/10.3390/healthcare13010085 - 6 Jan 2025

Viewed by 781

Abstract

Background: HIV is a global health issue, with the highest number of infected individuals found in sub-Saharan Africa. The coexistence of HIV with depression is a huge challenge. This study aimed to investigate the prevalence of depression in people living with HIV (PLWHIV) [...] Read more.

Background: HIV is a global health issue, with the highest number of infected individuals found in sub-Saharan Africa. The coexistence of HIV with depression is a huge challenge. This study aimed to investigate the prevalence of depression in people living with HIV (PLWHIV) who are on antiretroviral therapy (ART) in Africa. Method: PubMed, Scopus, and bibliographic screening were used to identify suitable literature. The study adhered to guidelines outlined by Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The Newcastle–Ottawa guideline was used to assess the quality of the included cross-sectional studies. Subgroup analysis and meta-regression were subsequently conducted following the meta-analyses, based on heterogeneity. A meta-analysis software online tool and Jamovi software (version 2.4.8.0) were used to analyse the data, and the results were presented as prevalence and 95% confidence intervals. Results: Thirty-four cross-sectional studies identified from the databases were deemed relevant. The overall sample size was 21,143 PLWHIV on ART in African countries. The analysed data showed the prevalence of depression to be 36%, with 95% CI (27% to 40%), p < 0.01, in Africa. However, the subgroup showed that the highest prevalence was in Northern Africa, with a prevalence of 41% with 95% CI (20% to 50%), p < 0.01, followed by those in Southern and Eastern Africa, with a prevalence of 38% with 95% CI (27% to 49%) and 39% with 95% CI (26% to 50%), p < 0.01, respectively. The lowest prevalence was observed in Western Africa, with a prevalence of 20% with 95% CI (14% to 27%), p < 0.01. Conclusions: Our findings show that there is a higher prevalence of depression among PLWHIV who are on ART in Africa. It is crucial to correctly recognise and provide proper care for depression to optimise HIV treatment and enhance treatment adherence in this population. Full article

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13 pages, 249 KiB

Open AccessArticle

Impact of COVID-19 on Substance Use Disorder Treatment: Examining the Influence of In-Person and Telehealth Intervention on Outcomes Using Real-World Data

by Cinta Mancheño-Velasco, Marta Narváez-Camargo, Daniel Dacosta-Sánchez, Ana de la Rosa-Cáceres and Óscar M. Lozano

Healthcare 2025, 13(1), 84; https://doi.org/10.3390/healthcare13010084 - 6 Jan 2025

Viewed by 716

Abstract

Background: The COVID-19 health crisis challenged healthcare systems around the world, leading to restrictions in access to face-to-face healthcare services, and forcing rapid adaptation to telehealth services. At present, there is a gap in the functioning of this adaptation in drug-dependence centres. [...] Read more.

Background: The COVID-19 health crisis challenged healthcare systems around the world, leading to restrictions in access to face-to-face healthcare services, and forcing rapid adaptation to telehealth services. At present, there is a gap in the functioning of this adaptation in drug-dependence centres. The present study analyses, over four years, care indicators on the care modality (face-to-face vs. hybrid), the patient profile and the impact on retention in treatment. Methods: Retrospective observational study with data collected between 14 March 2019 and 21 June 2023. The electronic health records of 44,930 patients were analysed according to different moments and selected based on the different health measures imposed by the COVID-19 pandemic. Patients were classified according to whether they received an in-person or hybrid intervention. Bivariate statistics and logistic regression analysis were applied. Results: The trend over time shows an increase in the number of patients seen in addiction centres. However, no notable changes within the in-person care modality and a modest increase in telehealth services are observed. Telehealth is primarily used among patients with opiate addiction, as well as with those with comorbid mental disorders. Logistic regression analysis shows that patients in a hybrid modality are more likely to remain in treatment. Conclusions: Results show that hybrid care is associated with higher patient retention rates. Despite this, different profiles are mostly treated with in-person interventions rather than hybrid modalities. Future studies should explore how to generalise personalised hybrid care among SUD patients considering factors such as patients’ educational level, employment status or accessibility to mental health services. Full article

(This article belongs to the Special Issue Human Health Before, During, and After COVID-19)

18 pages, 839 KiB

Open AccessArticle

Ergonomics and Occupational Health: Knowledge, Attitudes and Practices of Nurses in a Tertiary Hospital in Botswana

by Kagiso Kgakge, Paul Kiprono Chelule and Themba Geoffrey Ginindza

Healthcare 2025, 13(1), 83; https://doi.org/10.3390/healthcare13010083 - 6 Jan 2025

Viewed by 944

Abstract

Background: Musculoskeletal disorders (MSD) are, to this day, considered one of the major occupational health risks, especially among healthcare workers. Poor working conditions, such as awkward postures, are associated with the development of MSD. This study aimed to evaluate the knowledge, attitudes, [...] Read more.

Background: Musculoskeletal disorders (MSD) are, to this day, considered one of the major occupational health risks, especially among healthcare workers. Poor working conditions, such as awkward postures, are associated with the development of MSD. This study aimed to evaluate the knowledge, attitudes, and practices (KAP) of nurses at a public tertiary hospital in Botswana relating to ergonomic principles. Methods: The researchers conducted a cross-sectional survey, using a self-administered questionnaire to collect the data. The researchers employed Stata v18 (StataCorp, USA) to perform descriptive and inferential statistics. The chi-square test was used to determine the association between knowledge levels and sociodemographic variables. p-values ≤ 0.05 were deemed statistically significant. Results: In total, 306 nurses participated in the study, and a response rate of 88.4% was achieved. The mean age was 35.5 (SD± 8.79) years. Most (69%) participants were female nurses. About 99.3% (95%CI: 97.7–99.9) of the participants were familiar with the concept of ergonomics. Only a small proportion of participants (26%) possessed high levels of knowledge, exhibited positive attitudes, and demonstrated good practices in relation to ergonomic principles, following the composite analysis. A statistically significant relationship was found to exist between sex and practice (p = 0.030) and between length of work and practice (p = 0.013). Conclusions: The KAP analysis indicated that most nurses had poor practices regarding essential ergonomic principles. These findings could inform policy development and enable employers to design prevention strategies, especially those aimed at preventing lower back pain (LBP). Full article

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21 pages, 1147 KiB

Open AccessReview

Healthcare Application of Failure Mode and Effect Analysis (FMEA): Is There Room in the Infectious Disease Setting? A Scoping Review

by Marco Vecchia, Paolo Sacchi, Lea Nadia Marvulli, Luca Ragazzoni, Alba Muzzi, Lorenzo Polo, Raffaele Bruno and Flavio Salio

Healthcare 2025, 13(1), 82; https://doi.org/10.3390/healthcare13010082 - 4 Jan 2025

Viewed by 1388

Abstract

Background: Failure mode and effect analysis (FMEA) is a valuable risk analysis tool aimed at predicting the potential failures of a system and preventing them from occurring. Since its initial use, it has also recently been applied to the healthcare setting, which [...] Read more.

Background: Failure mode and effect analysis (FMEA) is a valuable risk analysis tool aimed at predicting the potential failures of a system and preventing them from occurring. Since its initial use, it has also recently been applied to the healthcare setting, which has been made progressively more complex by technological developments and new challenges. Infection prevention and control (IPC) is an area that requires effective strategies. The aim of this study is to review the literature on the employment of FMEA in the healthcare environment, with special consideration for its application in the infectious disease setting. Methods: An extensive search was carried out in two international and public databases, PUBMED and EMBASE; we included all studies regarding the use of FMEA in hospital settings and human patient care processes. Results: A total of 163 studies published over the period from 2003 to 2023 were included for data extraction. These studies were analyzed regarding bibliometric data (publication year and country of origin), the healthcare issues to be addressed, the application fields, and the utilized FMEA methods. Among these, 13 studies were found that took an interest in infectious diseases. Conclusions: FMEA can be effectively used for healthcare risk assessment. Its implementation as a standard tool in healthcare settings, though demanding, may serve as an important tool for preventing the risk of biohazard incidents, epidemics, and environmental contamination, thereby improving safety for both patients and healthcare workers. Full article

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9 pages, 259 KiB

Open AccessArticle

Predictive Factors of Resilience in Early Childhood Care Professionals

by Sofía Gómez-Herrera, Maria Auxiliadora Robles-Bello, David Sánchez-Teruel and Aziz Sarhani-Robles

Healthcare 2025, 13(1), 81; https://doi.org/10.3390/healthcare13010081 - 4 Jan 2025

Viewed by 528

Abstract

Background/Objectives: Early childhood intervention professionals have higher rates of work-related stress and burnout compared to other health professionals. Furthermore, this is exacerbated by exposure to negative emotions, the stigma associated with mental health, and even the stress experienced by families due to the [...] Read more.

Background/Objectives: Early childhood intervention professionals have higher rates of work-related stress and burnout compared to other health professionals. Furthermore, this is exacerbated by exposure to negative emotions, the stigma associated with mental health, and even the stress experienced by families due to the impact of having a child with a developmental disability. The aim of this study was to determine whether emotional intelligence and empathy were able to predict resilience in early childhood care professionals. Methods: The total sample consisted of 139 people (128 women and 11 men, with a mean age of 32.69 and SD 9.72) who were divided into two groups: high resilience (M = 35.85; SD = 3.64) and low resilience (M = 20.74; SD = 3.84). Results: The results showed significant differences between the two groups in self and others’ emotional appraisal, use and regulation of emotion, perspective taking, and personal distress, with a positive relationship between resilience and all sub-dimensions of emotional intelligence and perspective taking and a negative relationship with personal distress. In addition, a predictive model of resilience in early childhood professionals was found with empathic concern, personal distress, and use of emotion. Conclusions: This study is useful to start investigating psychological aspects related to early intervention and its professionals in order to consolidate a resilient workforce. Full article

(This article belongs to the Special Issue Social Capital, Mental Health and Well-Being among Marginalized Communities)

11 pages, 725 KiB

Open AccessArticle

Increased Risk of End-Stage Kidney Disease After Traumatic Amputation: Nationwide Cohort Study

by Jung Eun Yoo, Bongseong Kim, Won Hyuk Chang, Kyungho Lee, Hye Ryoun Jang, Kyungdo Han and Dong Wook Shin

Healthcare 2025, 13(1), 80; https://doi.org/10.3390/healthcare13010080 - 4 Jan 2025

Viewed by 525

Abstract

Background: Amputation confers disabilities upon patients and is associated with substantial cardiovascular and metabolic morbidity and mortality. We aimed to compare the incidence of end-stage kidney disease (ESKD) between individuals with amputation and the general population. Methods: A population-based retrospective cohort study was [...] Read more.

Background: Amputation confers disabilities upon patients and is associated with substantial cardiovascular and metabolic morbidity and mortality. We aimed to compare the incidence of end-stage kidney disease (ESKD) between individuals with amputation and the general population. Methods: A population-based retrospective cohort study was performed using the Nationwide Health Insurance Service database for the period between 2010 and 2018. A total of 24,925 individuals with amputation were included with a ratio of 1:3 age- and sex-matched controls. A Cox proportional hazards regression analysis was used to calculate the risk of ESKD among amputees. Results: During a mean follow-up period of 4.3 years, there were 40 incident ESKD cases (0.4 per 1000 person-years) among individuals with amputation. Individuals with amputation showed a higher risk of ESKD (adjusted HR [aHR] of 1.75, 95% confidence interval [CI] of 1.20–2.54) compared with matched controls. The risk was further increased in those with mild disability (aHR of 1.41, 95% CI of 0.51–3.87) and severe disability (aHR of 8.22, 95% CI of 2.99–22.61). When considering the levels of amputation, the association was apparently more prominent in proximal than distal amputation, in particular for proximal upper limb amputation (aHR of 17.90, 95% CI of 4.37–73.40). Conclusions: Individuals with amputation were at a significantly greater risk of ESKD than the general population, particularly subjects with severe disability and proximal amputation. Our data suggest that amputations should be added to the list of risk factors for the development of chronic kidney disease. Full article

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22 pages, 431 KiB

Open AccessReview

Parkinson’s Disease and Caregiving Roles, Demands, and Support Needs and Experiences: A Scoping Review

by Margaret L. Longacre, Lacey Roche, George C. Kueppers and Bart Buurman

Healthcare 2025, 13(1), 79; https://doi.org/10.3390/healthcare13010079 - 4 Jan 2025

Viewed by 744

Abstract

Background and Objectives: A public health priority is the increasing number of persons with Parkinson’s disease (PwP), and the need to provide them with support. We sought to synthesize the experiences of relatives or friends—family caregivers—who provide such support. Eligibility Criteria: This study [...] Read more.

Background and Objectives: A public health priority is the increasing number of persons with Parkinson’s disease (PwP), and the need to provide them with support. We sought to synthesize the experiences of relatives or friends—family caregivers—who provide such support. Eligibility Criteria: This study was a scoping literature review modeled by the PRISMA guidelines. The articles for this review fit the following inclusion criteria: (1) studies including the perspective of caregivers of PwP, (2) studies conducted in the United States, and (3) studies conducted between January 2019 to January 2024. Sources of Evidence: Articles were identified by searching the PubMed, EBSCO, and Ovid databases between January 2019 and January 2024. The search terms included the following: (Parkinson’s disease) AND (caregiver OR caregiving OR carer). Results: A total of 31 articles were included. Most of the included articles are descriptive (n = 26), including quantitative (n = 17), qualitative (n = 7), and mixed-methods studies (n = 2). Gender, race, and ethnicity were not consistently reported. Findings across studies demonstrated common roles of caregiving (e.g., assistance with personal care), extensive physical and mental health strains, social isolation, and work and financial strain. Benefit-finding was also evident among caregivers including a goal of securing the PwP dignity and comfort as the disease progressed. The studies of this review provide perspectives on benefits and challenges of caregiving in this context and caregiver resources. Conclusions: Future studies need to improve racial and gender-related diversity and address caregiver strain and health. Full article

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9 pages, 723 KiB

Open AccessArticle

The Effect of Home-Based Robotic Rehabilitation on Individuals with Disabilities in Community Settings: A Pilot Study

by Joonhwan Lee, Eunyoung Lee, Seokjoon Hong, Sunyi Shin and Byungju Ryu

Healthcare 2025, 13(1), 78; https://doi.org/10.3390/healthcare13010078 - 4 Jan 2025

Viewed by 605

Abstract

Background: With South Korea’s growing aging population, the demand for accessible rehabilitation solutions is increasing. Home-based robotic rehabilitation presents a feasible alternative to conventional in-clinic rehabilitation. This study explores the impact of the Rebless robotic rehabilitation device in a home-based setting for people [...] Read more.

Background: With South Korea’s growing aging population, the demand for accessible rehabilitation solutions is increasing. Home-based robotic rehabilitation presents a feasible alternative to conventional in-clinic rehabilitation. This study explores the impact of the Rebless robotic rehabilitation device in a home-based setting for people with physical disabilities and their caregivers. Methods: We prospectively collected data from individuals with brain disorders or physical disabilities living in Dongdaemun-gu, from August 2023 to March 2024. Participants completed an 8-week rehabilitation program using the Rebless robotic device. Assessments were conducted at baseline and after the eight-week program, measuring motor function, caregiver burden, and quality of life. Exercises were performed three times weekly for at least 90 min total. Results: We conducted an intervention with 26 adults with physical or neurological disabilities, of which 20 completed the program. Significant improvements were observed in upper limb function within the elbow exercise group (Fugl–Meyer assessment for upper extremity, p = 0.043) and a reduction in caregiver burden across the total groups (Zarit Burden Interview, p = 0.003). However, no statistically significant changes were found in balance and mobility measures (Berg balance scale, timed up-and-go, 10 m walk test). Conclusions: Home-based robotic rehabilitation demonstrates potential for improving upper limb function and reducing caregiver burden and mental health, proving beneficial to both patients and caregivers. Full article

(This article belongs to the Special Issue Rehabilitation Program for Orthopedic and Neurological Patients)

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15 pages, 1061 KiB

Open AccessArticle

The Role of Eustachian Tube Dysfunction in Recurrent Chronic Otitis Media: A Cross-Sectional Study of Anatomical and Functional Variations

by Sarah Alshehri and Abdullah Musleh

Healthcare 2025, 13(1), 77; https://doi.org/10.3390/healthcare13010077 - 3 Jan 2025

Viewed by 714

Abstract

Background/Objectives: Recurrent chronic otitis media (rCOM) is a major cause of hearing impairment, often linked to Eustachian tube (ET) dysfunction. Anatomical abnormalities, such as ET narrowing and obstructions, and functional impairments, including poor pressure regulation, play significant roles in rCOM recurrence. This [...] Read more.

Background/Objectives: Recurrent chronic otitis media (rCOM) is a major cause of hearing impairment, often linked to Eustachian tube (ET) dysfunction. Anatomical abnormalities, such as ET narrowing and obstructions, and functional impairments, including poor pressure regulation, play significant roles in rCOM recurrence. This study aimed to (1) identify anatomical variations of the ET in patients with rCOM using high-resolution imaging; (2) evaluate ET functional status using tympanometry, tubomanometry, and ET function tests; and (3) assess the correlation between anatomical variations and functional impairments in predicting rCOM recurrence. Methods: A cross-sectional study was conducted on 212 patients with rCOM and 212 controls. High-resolution CT and MRI were used to assess ET anatomy, while functional status was evaluated using tympanometry, tubomanometry, and Valsalva maneuver tests. Statistical analyses, including t-tests, Pearson correlation, and Cox proportional hazards models, were applied to examine the relationship between anatomical and functional impairments and rCOM recurrence. Results: Significant anatomical differences were observed in the rCOM group, including ET narrowing (24.53% vs. 11.32%, p = 0.014) and curvature (32.08% vs. 14.15%, p < 0.001). Functional impairments were also more prominent in rCOM patients, with higher ET opening pressure (120.56 ± 14.34 dPa vs. 85.78 ± 12.98 dPa, p < 0.001) and lower Valsalva maneuver success rates (62.32% vs. 89.56%, p < 0.001). Cox regression indicated that anatomical and functional impairments significantly predicted faster recurrence (HR for tympanometry peak pressure = 1.56, p < 0.001). Conclusions: The ETs anatomical and functional impairments are significant predictors of rCOM recurrence. A combined assessment of these factors can improve diagnostic accuracy and guide more targeted interventions to prevent recurrence. Full article

(This article belongs to the Special Issue Care and Treatment of Ear, Nose, and Throat)

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21 pages, 369 KiB

Open AccessReview

Cultural Determinants of Body Image: What About the Menopausal Transition?

by Coralie Vincent, Alixe Ménard and Isabelle Giroux

Healthcare 2025, 13(1), 76; https://doi.org/10.3390/healthcare13010076 - 3 Jan 2025

Viewed by 908

Abstract

Body image is an important aspect of psychological well-being that is influenced by several biological and psychosocial risk factors. Cultural determinants of body image include the patterns of shared beliefs, values, practices, and social norms within a group that can act as a [...] Read more.

Body image is an important aspect of psychological well-being that is influenced by several biological and psychosocial risk factors. Cultural determinants of body image include the patterns of shared beliefs, values, practices, and social norms within a group that can act as a lens through which a person perceives, compares, and evaluates their body. Women tend to experience higher rates of body dissatisfaction than men, with reproductive milestones such as puberty, pregnancy, and postpartum being windows of vulnerability for body image concerns. The menopausal transition is another reproductive stage of women’s lives that involves major physical changes, psychological challenges, and social pressures that can impact body image negatively. However, the literature on the influence of cultural determinants on the body image of menopausal women is limited. Therefore, this perspective review paper aims to discuss the potential role of cultural determinants in influencing body image satisfaction in women undergoing the menopausal transition. To this end, the relationships between different cultural perspectives and body image around the world are first discussed. Sociocultural influences on body image throughout women’s lifespan and reproductive stages are then presented. Finally, cultural perspectives on menopause and aging and their potential influence on the body image of menopausal women are explored. This paper underscores the importance of considering culture and sociocultural factors when studying body image and highlights the need for further research on the cultural determinants of body image during the menopausal transition. Full article

(This article belongs to the Special Issue Body Image, Dissatisfaction and Eating Disorders: A Healthcare Perspective)

20 pages, 455 KiB

Open AccessArticle

Measurement of Dehumanization, Self-Dehumanization, and Empathy as Mediating Factors Among Healthcare Professionals

by Aikaterini Roupa, Athina Patelarou, Konstantinos Giakoumidakis, Kyriaki Fousiani, Marianna Miliaraki, Eirini Stratidaki and Evridiki Patelarou

Healthcare 2025, 13(1), 75; https://doi.org/10.3390/healthcare13010075 - 3 Jan 2025

Viewed by 681

Abstract

Background: Dehumanization refers to the tendency of individuals or groups to attribute fewer human characteristics to other individuals or groups (referred to as hetero-dehumanization) or to themselves (referred to as self-dehumanization). This phenomenon currently seems to predominate in the medical and nursing professions. [...] Read more.

Background: Dehumanization refers to the tendency of individuals or groups to attribute fewer human characteristics to other individuals or groups (referred to as hetero-dehumanization) or to themselves (referred to as self-dehumanization). This phenomenon currently seems to predominate in the medical and nursing professions. Indeed, healthcare environments facilitate latent forms of dehumanization due to their structure, organization, and inherent professional demands. This study aimed to investigate the association between hetero- or self-dehumanization and personality traits of healthcare professionals, as well as the possible key mediating role of empathy in this relationship. Methods: A total of 1150 healthcare employees were recruited for the current study with a mean age of 45.13 years. Data were collected through a questionnaire completed by health professionals. Results: Statistically significant relationships were found between self- and hetero-dehumanization and most personality traits (extraversion, agreeableness, conscientiousness). A mediation analysis revealed that empathy mediates the effects of personality traits on hetero- and self-dehumanization. Conclusions: The present study addresses the vital role of personality traits of healthcare professionals on dehumanizing oneself or patients, offering insights into improving therapeutic relationships through the cultivation of empathy. Full article

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17 pages, 1718 KiB

Open AccessSystematic Review

The Beneficial Effects of Lactobacillus Strains on Gut Microbiome in Alzheimer’s Disease: A Systematic Review

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

Healthcare 2025, 13(1), 74; https://doi.org/10.3390/healthcare13010074 - 3 Jan 2025

Viewed by 937

Abstract

Background/Objectives: Growing evidence suggests that the gut–brain axis influences brain function, particularly the role of intestinal microbiota in modulating cognitive processes. Probiotics may alter brain function and behavior by modulating gut microbiota, with implications for neurodegenerative diseases like Alzheimer’s disease (AD). The purpose [...] Read more.

Background/Objectives: Growing evidence suggests that the gut–brain axis influences brain function, particularly the role of intestinal microbiota in modulating cognitive processes. Probiotics may alter brain function and behavior by modulating gut microbiota, with implications for neurodegenerative diseases like Alzheimer’s disease (AD). The purpose of this review is to systematically review the current literature exploring the effects of probiotic supplementation on gut microbiota and cognitive function in AD and mild cognitive impairment (MCI). Methods: A comprehensive literature search was conducted across PubMed/Medline, Embase, and Scopus to identify relevant randomized controlled trials (RCTs) from inception to 20 August 2024. The search focused on comparing outcomes between intervention and control/placebo groups. Data searches, article selection, data extraction, and risk of bias assessment were performed in accordance with Cochrane guidelines. Systematic Review Registration: PROSPERO registration no: CRD42023446796. Results: Data from four RCTs involving 293 Individuals (AD and MCI patients) receiving mainly Lactobacillus and Bifidobacterium strains showed some beneficial effects on cognitive function, altered gut microbiota composition, and positively affected metabolic biomarkers. However, variability in microbiota assessment across studies limits the interpretation of results. The limited number and quality of the existing studies make it difficult to draw definitive conclusions from the data. Additional high-quality research is clearly needed. Conclusions: Probiotics show promise as an adjunctive intervention for cognitive decline, but larger, long-term trials are needed to confirm their efficacy and clinical applicability in neurodegenerative diseases like AD. Full article

(This article belongs to the Special Issue Health Promotion and Disease Prevention Strategies for Older Populations to Ensure Healthy Lifespans)

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13 pages, 2954 KiB

Open AccessArticle

The Protective Role of the FIFA 11+ Training Program on the Valgus Loading of the Knee in Academy Soccer Players Across a Season

by Michele Mercurio, Giovanni Carlisi, Marko Ostojic, Alessandro Imbrogno, Olimpio Galasso and Giorgio Gasparini

Healthcare 2025, 13(1), 73; https://doi.org/10.3390/healthcare13010073 - 3 Jan 2025

Viewed by 700

Abstract

Background: Improper neuromuscular control with excessive dynamic valgus loading of the knee has been identified as one of the main anterior cruciate ligament injury risk factors. This study aimed to analyze the impact of the FIFA 11+ training program on the valgus [...] Read more.

Background: Improper neuromuscular control with excessive dynamic valgus loading of the knee has been identified as one of the main anterior cruciate ligament injury risk factors. This study aimed to analyze the impact of the FIFA 11+ training program on the valgus loading of the knee in academy soccer players over a competitive season. Methods: A prospective study was conducted on 85 players. The drop vertical jump test was carried out before the match and at the end of the same match at the beginning and at the end of the season over a period of 11 months. Results: An increase of the varus angle on the right limb was noted between the start and the end of the season at the beginning of the match (−4.7 ± 8.9 versus −6.9 ± 6, p = 0.003) and between the start and the end of the match in values measured at the beginning of the season (−4.7 ± 8.9 versus −7.7 ± 9, p < 0.001). An increase of the flexion angle of both limbs was noted between the start and the end of the season in values measured at the start of the match (left limb 76.8 ± 32.8 versus 98.6 ± 17.2, p < 0.001; right limb 76.4 ± 32.8 versus 96.1 ± 16.1, p < 0.001) and between the start and the end of the season in values measured at the end of the match (left limb 92.8 ± 19.1 versus 98.5 ± 16.3, p = 0.002; right limb 92.6 ± 19.2 versus 96.7 ± 14.5, p = 0.013). Conclusions: A decrease in dynamic valgus angle and an increase in knee flexion angle measured with the DVJ test were noted between the start and the end of the season, suggesting a protective role of the FIFA 11+ training program. Full article

(This article belongs to the Special Issue Sports Trauma: From Prevention to Surgery and Return to Sport)

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18 pages, 271 KiB

Open AccessArticle

Impact of Digitalization in Dentistry on Technostress, Mental Health, and Job Satisfaction: A Quantitative Study

by Monika Bernburg, Julia Sofie Gebhardt, David A. Groneberg and Stefanie Mache

Healthcare 2025, 13(1), 72; https://doi.org/10.3390/healthcare13010072 - 3 Jan 2025

Viewed by 657

Abstract

Background: The utilization of digital technologies in the field of dentistry is becoming increasingly prevalent. Such technologies facilitate more precise and efficient dental treatment while also enhancing the overall quality of care. The advent of digitalization has brought with it a plethora of [...] Read more.

Background: The utilization of digital technologies in the field of dentistry is becoming increasingly prevalent. Such technologies facilitate more precise and efficient dental treatment while also enhancing the overall quality of care. The advent of digitalization has brought with it a plethora of advantages, yet it has also given rise to a number of potential challenges. These have the potential to give rise to a variety of negative consequences, including an increase in stress perception. Objectives: This study identifies the digital demands and resources as well as the prevalence of digital stress perception among German dentists. Furthermore, the study examines the relationship between digital stress perception and work- and health-related outcomes, and it identifies potential preventive measures. Methods: The quantitative cross-sectional study involved a total of 325 German dentists. Data collection took place between January and April 2024. The questionnaire was validated using several established scales, including the Technostress Scale and the Copenhagen Psychosocial Questionnaire (COPSOQ). Multiple correlation and regression analyses were conducted to ascertain the reliability and validity of the data collected. Results: The study results demonstrated that the participating dentists exhibited a moderate level of digital stress (M = 3.73 (SD = 0.71). Regarding the individual technostress creators, the highest mean was observed for the constructs of techno-overload (M = 3.91; SD = 0.76), techno-complexity (M = 3.63; SD = 0.71), and techno-uncertainty (M = 2.01; SD = 0.75). The participants reported an average level of exhaustion symptoms (M = 3.21; SD = 0.91) and job satisfaction (M = 4.52; SD = 0.78). The association between technostress and emotional exhaustion (as a burnout symptom) showed a significant positive correlation (r = 0.38; CI: 0.07, 0.52; p < 0.05). A significant negative correlation was observed between the variables of technostress and job satisfaction, with a correlation coefficient of r = −0.33 (CI: −0.25, 0.07; p < 0.05). Conclusions: This study presents preliminary findings on the digital stress experience in dentistry and relevant associations. In the context of ongoing digitalization, there is a need for support and preventive measures to reduce technology-related stress. An optimized design of digital applications and the working environment are of crucial importance to improve the health of dentists and the quality of patient care. Full article

(This article belongs to the Section TeleHealth and Digital Healthcare)

12 pages, 1431 KiB

Open AccessArticle

Exploring Patient Activation and Compliance in Patients with Different Rheumatological Disorders

by Haya M. Almalag, Nora Alosaimi, Reem Alqahtani, Rahaf Alharbi, Abdulrahman S. Alarfaj, Mohammed A. Omair, Mohamed Bedaiwi, Iman Qurtas, Ibrahim Almaghlouth, Jawza F. Alsabhan, Bashayr Alsuwayni and Lobna Al Juffali

Healthcare 2025, 13(1), 71; https://doi.org/10.3390/healthcare13010071 - 2 Jan 2025

Viewed by 757

Abstract

Purpose: This study aimed to assess patient activation using patient activation measure 13 (PAM-13) in systemic lupus erythematosus (SLE), psoriatic arthritis (PsA), and axial spondyloarthritis (axSPA). Patients and methods: A cross-sectional study was conducted involving patients with three rheumatological conditions (SLE, PsA, and [...] Read more.

Purpose: This study aimed to assess patient activation using patient activation measure 13 (PAM-13) in systemic lupus erythematosus (SLE), psoriatic arthritis (PsA), and axial spondyloarthritis (axSPA). Patients and methods: A cross-sectional study was conducted involving patients with three rheumatological conditions (SLE, PsA, and axSPA). Patients were contacted either at the clinic or through social media platforms. Data, including demographics, PAM 13, Arabic compliance questionnaire for rheumatology (ACQR), and disease-related activity scores, were collected electronically. The analyses included Chi-squared tests, linear regression, and binary logistic regression. Results: Overall, 418 patients were recruited (SLE = 323, PsA = 65, and axSPA = 30), with a mean (±SD) age of 42 ± 11 years and a female predominance (88%). PAM-13 scores did not significantly differ between the rheumatological disorders. Patients with axSPA showed significantly higher compliance than those with SLE or PsA (p = 0.012). In regression models, patients with PsA were more likely to be in activation level 1, with an OR of 2.890 (95% CI: 1.044–8.000, p = 0.0041), whereas patients with axSPA were more likely to be in activation level 4, with an OR of 2.460 (95% CI: 1.122–5.393, p = 0.025). The SLEDAI score was inversely related to the PAM-13 score (Pearson’s correlation coefficient = −0.221, p < 0.001). Conclusions: This study explored the levels of activation and medication compliance in different rheumatological conditions. Larger studies are needed to confirm these findings and explore the challenges and opportunities for improving compliance and activation. Full article

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16 pages, 608 KiB

Open AccessArticle

Changes in Subjective Cognitive and Social Functioning in Parkinson’s Disease from Before to During the COVID-19 Pandemic

by Nishaat Mukadam, Shraddha B. Kinger, Sandy Neargarder, Robert D. Salazar, Celina Pluim McDowell, Juliana Wall, Rini I. Kaplan and Alice Cronin-Golomb

Healthcare 2025, 13(1), 70; https://doi.org/10.3390/healthcare13010070 - 2 Jan 2025

Viewed by 1004

Abstract

Background/Objectives: Social isolation and health-related consequences of the COVID-19 pandemic may have significantly impacted quality of life in people with Parkinson’s disease (PwPD). The effect of the COVID-19 pandemic specifically on subjective cognition and social functioning in PwPD is poorly understood. We conducted [...] Read more.

Background/Objectives: Social isolation and health-related consequences of the COVID-19 pandemic may have significantly impacted quality of life in people with Parkinson’s disease (PwPD). The effect of the COVID-19 pandemic specifically on subjective cognition and social functioning in PwPD is poorly understood. We conducted a longitudinal analysis of changes in subjective cognitive and social functioning in PwPD before (T1, 2017–2019) and during (T2, 2021) the COVID-19 pandemic. Methods: At T1, 347 PwPD completed online surveys. At T2, 123 of them (54 males, 69 females) responded to follow-up questionnaires including Quality of Life in Neurological Disorders (Neuro-QoL) subscales, Beck Depression Inventory-II, Parkinson’s Anxiety Scale, motor and non-motor experiences of daily living from the MDS-Unified Parkinson’s Disease Rating Scale, and the Coronavirus Impact Scale. Results: T1–T2 declines in subjective cognition and social functioning both were correlated with more anxiety, fatigue, and motor symptoms. Additionally, declines in subjective cognition correlated with depression, and with decline in social functioning. Women reported greater COVID-19 impact than men, unrelated to cognition and social functioning; in men, personal experience with COVID-19 was associated with decline in subjective cognition. Conclusions: Our finding that subjective cognition and social functioning are associated with different motor and non-motor symptoms of PD suggests that the impacts of PD on subjective cognition and social functioning are complex, which has important implications for treatment. Full article

(This article belongs to the Special Issue Human Health Before, During, and After COVID-19)

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17 pages, 808 KiB

Open AccessArticle

The Role of Social Integration in Chronic Disease Prevalences Among the Internal Migrant Populations in China: Evidence from a National Survey

by Xiao Yang, Yixuan Zhang, Siyu Zou, Yihang Chen, Ziqing Cai, Ying Zhu and Kun Tang

Healthcare 2025, 13(1), 69; https://doi.org/10.3390/healthcare13010069 - 2 Jan 2025

Viewed by 894

Abstract

Background: China has the world’s largest internal migrant population, yet chronic disease prevalence among this group remains largely overlooked. The integration of the internal migrant population into the local society may affect their noncommunicable disease prevalences and become a challenge for the [...] Read more.

Background: China has the world’s largest internal migrant population, yet chronic disease prevalence among this group remains largely overlooked. The integration of the internal migrant population into the local society may affect their noncommunicable disease prevalences and become a challenge for the public health system. This study aimed to explore the association between the social integration of China’s internal migrant population and the prevalences of chronic diseases, including hypertension and diabetes. Methods: This study used data from the 2017 China Migration Dynamic Survey. Social integration status was assessed using an 8-item Likert scale and categorized into four quartiles, with higher points indicating higher levels of social integration. Multivariate logistic regression was conducted to examine the association between social integration level and the prevalences of hypertension, diabetes and combined chronic diseases. Disaggregated analysis was performed to explore the potential effect modification by age, sex, income, and migration duration. Results: A medium level of social integration was associated with lower prevalences of chronic diseases, while the lowest and highest levels of social integration were both associated with enhanced prevalence. Further disaggregation demonstrated the relationship between social integration and chronic disease prevalences were modified by various factors, including age, sex, income, and migration duration. Conclusions: This study demonstrated that both the lowest and highest levels of social integration can significantly affect chronic disease outcomes of China’s internal migrants. These findings emphasize the necessity to formulate tailored public health policies to effectively prevent and manage chronic diseases among the internal migrant population in China. Full article

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25 pages, 1178 KiB

Open AccessArticle

Community Vulnerability: Measuring the Health Situation of a Population After COVID-19 Through Electronic Health Record Indicators

by Andrea Sierra-Ortega, Alexandra González-Aguña, Marta Fernández-Batalla, Enrique Monsalvo-San Macario, Blanca Gonzalo de Diego, Lourdes Jiménez-Rodríguez and José María Santamaría-García

Healthcare 2025, 13(1), 68; https://doi.org/10.3390/healthcare13010068 - 2 Jan 2025

Viewed by 740

Abstract

Background: The COVID-19 pandemic made people face the fact that we are all vulnerable. This vulnerability can be measured through the Basic Variables of Care (BVC) using the Care Vulnerability Index (CVI). Health systems work with indicators that nurses can consult to understand [...] Read more.

Background: The COVID-19 pandemic made people face the fact that we are all vulnerable. This vulnerability can be measured through the Basic Variables of Care (BVC) using the Care Vulnerability Index (CVI). Health systems work with indicators that nurses can consult to understand the care and health situation of their population. These indicators provide valuable information on the vulnerability of the population. Objective: to determine the level of community vulnerability of a population group using health indicators from the computerized clinical records of Primary Care. Methods: observational, retrospective study from March 2023 to January 2024, with a sample of 2106 people assigned to a nurse at the Meco Health Centre (Madrid, Spain). Phases: selection of dashboard indicators, linkage to BVC, score assignment, population adjustment and calculation of the CVI. Results: The sample of indicators selects 18 out of 376 included in the Specific Dashboard; each indicator is related to 6 to 10 BCVs, with different rank values. Each score is adjusted by a Vulnerability Correction Factor according to the number of people included in the indicator. Finally, the population-adjusted CVI scores 1.95 points (percentile 37.90). Conclusions: community vulnerability is an essential tool in community health diagnostics and can be measured through health indicators that reflect the care situation of a population group at a given time, including changes in the situation in the face of health crises such as the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Human Health Before, During, and After COVID-19)

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11 pages, 725 KiB

Open AccessArticle

Functional and Lateral Asymmetry of the Knee Joint Muscles Measured Using Tensiomyography (TMG) in Professional Football Players of Different Playing Positions

by Lazar Pajović, Lazar Toskić, Aleksandar Joksimović, Adem Preljević, Dina Joksimović, Slavko Dragosavljević, Djordje Stanić, Ljubiša Lilić, Veroljub Stanković and Borislav Cicović

Healthcare 2025, 13(1), 67; https://doi.org/10.3390/healthcare13010067 - 2 Jan 2025

Viewed by 1090

Abstract

Background/Objectives: The aim of this study is to determine whether different playing positions in football influence muscle asymmetry, which is a common cause of injuries in football. This study aimed to determine the difference in the functional and lateral asymmetry of the [...] Read more.

Background/Objectives: The aim of this study is to determine whether different playing positions in football influence muscle asymmetry, which is a common cause of injuries in football. This study aimed to determine the difference in the functional and lateral asymmetry of the knee joint muscles measured using tensiomyography (TMG) between football players of different playing positions. Methods: This study included 52 professional football players (25.1 ± 4.7 years) divided into three groups according to their playing position: defenders—DF (N = 18), midfielders—MF (N = 15), and forwards—FW (N = 19). Functional and lateral symmetry were investigated by applying TMG on the knee joint muscles Rectus femoris, Vastus medialis, Vastus lateralis, Biceps femoris, and Semitendinosus of the right and left leg, and using the algorithm proposed by the manufacturer and previous studies. Results: The results of one and two-way ANOVA revealed no significant differences in functional (F = 0.596, p = 0.555, on average) and lateral asymmetry (F = 0.888, p = 0.497, on average) from the aspect of muscle contraction velocity and muscle stiffness between football players of different playing positions. Conclusions: The study results show that the specificity of the playing position in football does not influence the functional and lateral asymmetry of the knee joint muscles. However, it has been shown that there is a high percentage of players with lateral (n = 14.5, 39.6%, on average) and specifically functional asymmetry (n = 27, 51.9%, on average). Full article

(This article belongs to the Special Issue Sports Injury Prevention)

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15 pages, 674 KiB

Open AccessArticle

A Complex Intervention to Minimize Medication Error by Nurses in Intensive Care: A Case Study

by Fábio Coelho, Luís Furtado, Márcio Tavares and Joana Pereira Sousa

Healthcare 2025, 13(1), 66; https://doi.org/10.3390/healthcare13010066 - 2 Jan 2025

Viewed by 845

Abstract

Background/Objectives: Medication errors are the most frequent and critical issues in healthcare settings, often leading to worsened clinical outcomes, increased treatment costs, extended hospital stays, and heightened mortality and morbidity rates. These errors are particularly prevalent in intensive care units (ICUs), where the [...] Read more.

Background/Objectives: Medication errors are the most frequent and critical issues in healthcare settings, often leading to worsened clinical outcomes, increased treatment costs, extended hospital stays, and heightened mortality and morbidity rates. These errors are particularly prevalent in intensive care units (ICUs), where the complexity and critical nature of the care elevate the risks. Nurses play a pivotal role in preventing medication errors and require strategies and methods to enhance patient safety. This study aims to develop a comprehensive and evidence-based intervention to minimize medication errors by nurses in ICUs. Methods: This qualitative case study forms a part of a broader research project that commenced with a scoping review. Building on the review findings, a complex intervention was designed to address nurses’ medication errors. A focus group of experts was conducted to validate the intervention designed, evaluating its contextual feasibility and relevance. Results: This study led to the development of a complex intervention whose relevance lies in its potential implementation within the studied context. The resulting intervention was structured around four main components—educational interventions, verification and safety methods, organizational and functional modifications, and an error reporting system—meticulously designed to leverage the ICU’s existing resources. Conclusions: In conclusion, the proposed intervention has the potential to positively impact healthcare quality by reducing errors and promoting a culture of safety. Furthermore, this study’s findings provide a relevant foundation for future research and practical applications, driving advancements in healthcare service excellence. Full article

(This article belongs to the Section Nursing)

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14 pages, 248 KiB

Open AccessArticle

Knowledge in the Area of Prevention and Treatment of Pressure Injuries Among Nurses: Report from the Study

by Joanna Przybek-Mita, Dariusz Bazaliński, Ewelina Małek, Jan Kachaniuk, Dorota Kozieł, Maria Kózka and Maria Teresa Szewczyk

Healthcare 2025, 13(1), 65; https://doi.org/10.3390/healthcare13010065 - 2 Jan 2025

Viewed by 841

Abstract

Introduction: Pressure injuries represent a significant issue in nursing care, with prevalence rates ranging from 5 to 27% among hospitalized patients and 3–32% in long-term care settings. Nurses’ knowledge of pressure injury prevention and treatment plays a crucial role in reducing their [...] Read more.

Introduction: Pressure injuries represent a significant issue in nursing care, with prevalence rates ranging from 5 to 27% among hospitalized patients and 3–32% in long-term care settings. Nurses’ knowledge of pressure injury prevention and treatment plays a crucial role in reducing their incidence. Objective: The aim of this study was to assess nurses’ knowledge of pressure injury prevention and treatment, taking into account their professional and postgraduate education, self-directed learning activities, and interest in wound care. Materials and Methods: This study included 500 nurses working in hospital wards and primary healthcare settings who participated in specialized nursing training programs. The Pieper–Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT), in its 2021 version and adapted into Polish was used to assess the nurses’ knowledge. The main study was conducted over five months, from March to July 2024. Results: This study revealed that nurses’ knowledge of pressure injury prevention and treatment was above average, with a mean score of 49.6 ± 5.2. Conclusions: The level of knowledge among the nurses assessed using the Polish version of the PZ-PUKT was above average. The PZ-PUKT test can be a useful tool for evaluating pressure injury knowledge among both nursing students and employed nurses and may serve as a means for identifying knowledge gaps in pressure injury prevention and treatment. Full article

11 pages, 229 KiB

Open AccessArticle

Low Vision Rehabilitation Referral Characteristics for Patients with Neovascular Age-Related Macular Degeneration

by Simon D. Archambault, Courtney Sweeny, Mahesh Bhardwaj and David J. Ramsey

Healthcare 2025, 13(1), 64; https://doi.org/10.3390/healthcare13010064 - 1 Jan 2025

Viewed by 884

Abstract

Background: Despite evidence that low vision rehabilitation (LVR) services can improve visual function in patients with neovascular age-related macular degeneration (nAMD), many patients are not directed to access these resources. This study was conducted to determine factors associated with LVR referral and [...] Read more.

Background: Despite evidence that low vision rehabilitation (LVR) services can improve visual function in patients with neovascular age-related macular degeneration (nAMD), many patients are not directed to access these resources. This study was conducted to determine factors associated with LVR referral and to assess the visual outcomes from completed evaluations. Methods: The study comprised a retrospective, cross-sectional analysis of patients with nAMD. Referrals for LVR services were extracted from the electronic health record (EHR). The effectiveness of each evaluation was determined by assessing the change in best corrected visual acuity (BCVA) achieved after distance refraction. Costs, quality-adjusted life years (QALYs), and incremental costs per-QALY-gained were calculated based upon the better-seeing eye by using a willingness-to-pay threshold of $50,000/QALY. Results: Out of 560 eligible patients with nAMD, 110 were referred for LVR (19.6%). Referral was more common for individuals who qualified as having low vision, based upon the visual acuity of the better-seeing eye (adjusted odds ratio [aOR], 3.214; 95% confidence interval [CI], 1.920–5.380, p < 0.001), had bilateral nAMD (aOR, 1.592; 95% CI, 1.017–2.492, p = 0.042), or had commercial health insurance compared to those who had Medicare (aOR, 2.887; 95% CI, 1.041–8.009, p = 0.042). Most patients referred completed LVR appointments (86%). More than half of the patients achieved improved BCVA for their better-seeing eye (53%) yielding an average gain of 0.04 QALYs/patient at a cost of $3504/QALY. The estimated net monetary benefit was $1704 per evaluation completed. Conclusions: Most patients with nAMD achieved improvements in visual function after low vision evaluation, yielding improvements in vision-related quality of life at a reasonable cost. Full article

(This article belongs to the Special Issue New Developments in Optometry and Vision)

14 pages, 1244 KiB

Open AccessArticle

Acoustic Characteristics of Voice and Speech in Post-COVID-19

by Larissa Cristina Berti, Marcelo Gauy, Luana Cristina Santos da Silva, Julia Vasquez Valenci Rios, Viviam Batista Morais, Tatiane Cristina de Almeida, Leisi Silva Sossolete, José Henrique de Moura Quirino, Carolina Fernanda Pentean Martins, Flaviane R. Fernandes-Svartman, Beatriz Raposo de Medeiros, Marcelo Queiroz, Murilo Gazzola and Marcelo Finger

Healthcare 2025, 13(1), 63; https://doi.org/10.3390/healthcare13010063 - 1 Jan 2025

Viewed by 824

Abstract

Background/Objectives: The aim of this paper was to compare voice and speech characteristics between post-COVID-19 and control subjects. The hypothesis was that acoustic parameters of voice and speech may differentiate subjects infected by COVID-19 from control subjects. Additionally, we expected to observe the [...] Read more.

Background/Objectives: The aim of this paper was to compare voice and speech characteristics between post-COVID-19 and control subjects. The hypothesis was that acoustic parameters of voice and speech may differentiate subjects infected by COVID-19 from control subjects. Additionally, we expected to observe the persistence of symptoms in women. Methods: In total, 134 subjects participated in the study, were selected for convenience and divided into two groups: 70 control subjects and 64 post-COVID-19 subjects, with an average time of 8.7 months after infection. The recordings were made using the SPIRA software (v.1.0.) on cell phones, based on three verbal tasks: sustained production of the vowel/a/, reading a sentence, and producing a rhyme. Acoustic analyses of speech and voice were carried out with the PRAAT software (v.4.3.18), based on the following parameters: total sentence duration, number of pauses, pause duration, f₀, f₀SD, jitter, shimmer, and harmonics-to-noise ratio (HNR). Results: Regarding the acoustic characteristics of speech, there were no differences between the groups or between the sexes. Regarding the acoustic characteristics of voice, jitter, shimmer, and HNR, significant differences between the groups were found. Differences between sexes were observed in the following frequency-related parameters: f₀, f₀SD, and jitter. Conclusions: Some acoustic characteristics of the patients’ voice may show a deteriorated condition even after exacerbation of the disease. These characteristics are compatible with some of the symptoms reported by post-COVID-19 subjects, such as the presence of tension and fatigue. These voice acoustic parameters could be used as biomarkers to screen voice disorders in long-COVID, using artificial intelligence (AI), accelerating the search for diagnosis by specialists. Full article

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20 pages, 274 KiB

Open AccessArticle

Perceived Telehealth Usability for Personalized Healthcare Among the Adult Population in Saudi Arabia: A Cross-Sectional Study in the Post-COVID-19 Era

by Samiha Hamdi Sayed, Danyah Abdulrahman Aldailami, Maha Mahmoud Abd El Aziz and Ebtesam Abbas Elsayed

Healthcare 2025, 13(1), 62; https://doi.org/10.3390/healthcare13010062 - 1 Jan 2025

Viewed by 815

Abstract

Background: Due to technological advancements, the demand for easily accessible and convenient healthcare services is rising globally. Thus, telehealth is gaining momentum that was previously unheard of. The Kingdom of Saudi Arabia (KSA) actively embraces digital innovation in the healthcare industry through [...] Read more.

Background: Due to technological advancements, the demand for easily accessible and convenient healthcare services is rising globally. Thus, telehealth is gaining momentum that was previously unheard of. The Kingdom of Saudi Arabia (KSA) actively embraces digital innovation in the healthcare industry through its ambitious Vision 2030 initiative. This study aimed to assess the perceived usability of telehealth for personalized healthcare among the KSA adult population in the post-COVID-19 era. Methods: This cross-sectional study used a convenience sample of 975 adults from the general population in KSA. A digital survey was used for data collection through Survey Monkey software. It contained two sections: personal and health data and the Telehealth Usability Questionnaire (TUQ). The data was collected over three months (July–September 2024) and investigated using the multinomial logistic regression analysis. Results: This study showed that 59.8% of the participants have initiated telehealth service use before the COVID-19 pandemic, and the most frequently used services are the issuance of sick leave (30.6%), tele-prescription (29.0%), virtual consultation (20.0%), tele-mental health services (19.4%), telemonitoring (18.6), and tele-referral (18.2%). A high total telehealth usability score was observed among 60.4% of the participants: 72.7% perceive telehealth as highly useful, 76.4% perceive it as easy to use, 60.1% have high satisfaction and intention for future use, 57.4% perceive high interface quality, and 51.8% perceive a high interaction quality. Conversely, 45.8% perceive low reliability of the telehealth system. Multinomial logistic regression showed that low education (AOR = 2.04; 95% CI = 1.16–4.85) and using virtual consultation (AOR = 0.98; 95% CI = 0.38–0.99) were predictors of low telehealth usability. However, being female (AOR = 1.67; 95% CI = 1.27–2.55), being in higher education (AOR = 1.47; 95% CI = 1.02–2.34), and living in the central KSA region (AOR = 1.37; 95% CI = 1.10–2.23) were predictors of high telehealth usability. Working status, income, and presence of chronic disease were not statistically significant predictors. Conclusions: Telehealth services have been highly usable in KSA even before the COVID-19 pandemic, with commonly used asynchronous services. Many social, technological, and system-related factors could affect the user experience and system reliability. Hence, telehealth developments are recommended to overcome such barriers, with future initiatives focusing on the flexibility and convenience of telehealth systems. Full article

(This article belongs to the Special Issue Application of Digital Services to Improve Patient-Centered Care)

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Healthcare, Volume 13, Issue 1 (January-1 2025) – 91 articles

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