Healthcare

13 pages, 2395 KiB

Open AccessArticle

Research Tendency and Frontiers of Multifocal Lenses in Myopic Control in the Past Two Decades: A Bibliometric Analysis

by Lingli Jiang, Manrong Yu, Jiangxiong Cai, Yingying Wang, Hao Hu and Minjie Chen

Healthcare 2025, 13(2), 204; https://doi.org/10.3390/healthcare13020204 - 20 Jan 2025

Viewed by 627

Background: This study aimed to analyze the research progress on the use of a multifocal lens for myopic control throughout the 21st century, utilizing bibliometric analysis. Methods: Publications related to multifocal lenses from 2001 to 2024 were searched on the Web of Science [...] Read more.

Background: This study aimed to analyze the research progress on the use of a multifocal lens for myopic control throughout the 21st century, utilizing bibliometric analysis. Methods: Publications related to multifocal lenses from 2001 to 2024 were searched on the Web of Science core collection (WoSCC) database. VOSviewer (Version 1.6.19) and Bibliometrix package (Version 4.3.0) were used to perform the bibliometric analysis. Primary information including the publication number per year, country or region, journal, keyword, and title of the literature was extracted and analyzed. Results: A total of 234 articles from 31 countries were retrieved. The number of publications related to multifocal lenses had a rapid growth phase from 2016 to 2024. The United States, Australia, China, and Spain emerged as leading contributors to the research landscape. Ophthalmic and Physiological Optics was the most popular journal in this field, and the most frequently cited article was published in Optometry and Vision Science. Myopic progression was the main topic in this research field as well as the principal keywords of emerging research hotspots. Conclusions: Our bibliometric study provides a pioneering overview of the research trends and evolution in the application of a multifocal lens for myopic control. These findings provide a deep insight into current research frontiers and hot directions, offering a valuable reference for further research. Full article

(This article belongs to the Section School Health)

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12 pages, 239 KiB

Open AccessArticle

Gait Training with Virtual Reality-Based Real-Time Feedback for Chronic Post-Stroke Patients: A Pilot Study

by Sunmin Kim, Yangjin Lee and Kyunghun Kim

Healthcare 2025, 13(2), 203; https://doi.org/10.3390/healthcare13020203 - 20 Jan 2025

Viewed by 518

Abstract

Background: Virtual reality-based training has been widely used for post-stroke patients due to its positive effects on functional aspects by promoting brain plasticity. Objective: This study aimed to investigate the effectiveness of gait training with virtual reality-based real-time feedback on motor function, balance, [...] Read more.

Background: Virtual reality-based training has been widely used for post-stroke patients due to its positive effects on functional aspects by promoting brain plasticity. Objective: This study aimed to investigate the effectiveness of gait training with virtual reality-based real-time feedback on motor function, balance, and spatiotemporal gait parameters in post-stroke patients. Methods: Fifteen patients (n = 15) with chronic stroke were randomly assigned to either the virtual reality-based real-time feedback with treadmill gait training (experimental group n = 8) or the treadmill gait training (control group n = 7). For the experimental group that participated, a treadmill, an Oculus Rift VR device, and smart insoles were used for gait training with VR-based real-time feedback. Regarding gait training with VR-based real-time feedback, the patient wore an Oculus Rift and performed gait training on a treadmill for 30 min a day, three times a week, for 5 weeks. The control group participated in treadmill gait training for 30 min a day, three times a week, for 5 weeks. Motor function was measured using the Fugl-Meyer assessment. Balance was measured using the timed up and go test and Berg balance scale. Gait performance was measured using an Optogait. The normality test was performed using the Shapiro–Wilk test, the Wilcoxon signed-rank test was used for the within-group comparison, and the Mann–Whitney U test was used for the between-group comparison. Results: In the group analyses, both groups showed significant improvements in motor function balance and gait ability. According to the pre- and post-treatment results, greater improvement in the Fugl-Meyer assessment (experimental group: 4.75 vs. control group: 1.57) was observed in the experimental group compared with the control group (p < 0.05). In balance ability, greater improvement in the timed up and go test (experimental group: −3.10 vs. control group: −1.12) and Berg balance scale (experimental group: 3.00 vs. control group: 1.71) (p < 0.05). In the spatiotemporal gait parameters, greater improvement in affected step length (5.35 vs. 2.01), stride length (3.86 vs. 1.75), affected single support (2.61 vs. 1.22), and cadence (0.07 vs. 0.02) was observed in the experimental group compared with the control group (p < 0.05). Conclusions: This study suggested the positive effects of the virtual reality-based real-time feedback with treadmill gait training on motor function, balance, and gait performance. Full article

16 pages, 653 KiB

Open AccessArticle

by Elisabetta Ferrara, Manela Scaramuzzino, Giovanna Murmura, Gianmaria D’Addazio and Bruna Sinjari

Healthcare 2025, 13(2), 202; https://doi.org/10.3390/healthcare13020202 - 20 Jan 2025

Viewed by 430

Abstract

Background: Thermal therapy represents a well-established therapeutic approach for chronic musculoskeletal and respiratory conditions. To date, no studies have investigated the clinical effects of treatment interruption in thermal medicine. We aimed to evaluate the clinical impact of COVID-19 lockdown-induced thermal therapy discontinuation through [...] Read more.

Background: Thermal therapy represents a well-established therapeutic approach for chronic musculoskeletal and respiratory conditions. To date, no studies have investigated the clinical effects of treatment interruption in thermal medicine. We aimed to evaluate the clinical impact of COVID-19 lockdown-induced thermal therapy discontinuation through validated patient-reported outcomes. Methods: This single-center observational, retrospective study (March 2020–June 2024) evaluated 97 patients receiving standardized thermal therapy at Saturnia Thermal Springs. Treatment protocols included balneotherapy, mud therapy, and inhalation treatments in cycles of 12–15 sessions, with maintenance protocols every 4–6 months. Primary outcomes were assessed through VAS and SF-36 PCS, with EQ-5D and PSQI as secondary outcomes. Results: Significant clinical deterioration occurred during treatment interruption (p < 0.001) in 77.7% of patients. Recovery patterns were duration-dependent, with the 6–7-year cohort showing faster recovery (mean time to baseline: 2.8 months) compared to the 3–5-year cohort (4.6 months). Effect sizes were substantial across all outcomes (Cohen’s d > 1.0), with EQ-5D scores showing duration-dependent improvement (mean improvement in 6–7-year cohort: 0.27). Conclusions: Thermal therapy interruption precipitates quantifiable clinical deterioration, with recovery patterns significantly influenced by pre-existing treatment duration. These findings support the essential nature of treatment continuity in thermal therapy protocols. Full article

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

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16 pages, 276 KiB

Open AccessArticle

Psychometric Validation of the Simplified Chinese Version of the Dyspnoea-12 Questionnaire for Patients with Primary Lung Cancer

by Xianliang Liu, Bo Peng, Tao Wang, Alex Molassiotis, Janelle Yorke, Liqun Yao, Silin Zheng, Jing-Yu (Benjamin) Tan and Houqiang Huang

Healthcare 2025, 13(2), 201; https://doi.org/10.3390/healthcare13020201 - 20 Jan 2025

Viewed by 640

Abstract

Purpose: The simplified Chinese version of the Dyspnoea-12 Questionnaire (D-12) has not yet been translated and validated for patients with primary lung cancer. This study aimed to evaluate the psychometric properties of the simplified Chinese version of the D-12 for patients with primary [...] Read more.

Purpose: The simplified Chinese version of the Dyspnoea-12 Questionnaire (D-12) has not yet been translated and validated for patients with primary lung cancer. This study aimed to evaluate the psychometric properties of the simplified Chinese version of the D-12 for patients with primary lung cancer. Methods: This study analysed the baseline data of a randomised controlled trial that used an inspiratory muscle training intervention for patients with thoracic malignancies. The original English version of the D-12 was translated into simplified Chinese according to standard instrument translation and adaptation procedures. The internal consistency reliability of the D-12 was determined by calculating Cronbach’s alpha coefficients. The convergent validity of the D-12 was evaluated by Spearman’s correlation with the Borg CR-10 Scale, Numerical Rating Scale (NRS), Hospital Anxiety and Depression Scale (HADS), and Saint George’s Respiratory Questionnaire (SGRQ). Blood oxygen level, the 6-minute walk test distance, alcohol use, surgery type, cancer stage, exercise level, and educational background were identified to evaluate their discriminating performance. Results: The analysis included 196 participants. The Cronbach’s alpha coefficients for the full D-12 and its physical and emotional function subscales were 0.83, 0.74, and 0.92, respectively. Significantly positive associations were found between the D-12 scores and the Borg CR-10 Scale, the NRS, the HADS, and SGRQ scores (p < 0.01). The participants with insomnia (p < 0.01) and who did not use alcohol (p = 0.019) reported significantly higher D-12 total scores compared with their respective counterparts. The participants at different cancer stages (p < 0.01) and those who had undergone different surgeries (p = 0.033) reported significantly different D-12 total scores. Conclusions: The D-12 simplified Chinese version demonstrated very good psychometric properties and high acceptability in patients with primary lung cancer. Full article

15 pages, 238 KiB

Open AccessArticle

Knowledge, Attitude, and Practice in Dental Trauma Management Among Schoolteachers in Taif, Saudi Arabia

by Muaath H. Alzahrani, Muwffak Alghoraibi, Mohammed A. Alzubaidi, Sakeenabi Basha, Yousef Althomali, Roshan Noor Mohamed, Faisal K. Altalhi, Yazeed A. Alzahrani, Amal Albalooshy, Abdulaziz Alharbi and Ali Alqarni

Healthcare 2025, 13(2), 200; https://doi.org/10.3390/healthcare13020200 - 20 Jan 2025

Viewed by 490

Abstract

Background: In Saudi Arabia, dental trauma is regarded as one of the most important issues affecting schoolchildren. This study evaluated Saudi Arabian schoolteachers’ knowledge, attitude, and practice regarding emergency dental trauma management. Methods: A cross-sectional study was conducted on 263 schoolteachers from 25 [...] Read more.

Background: In Saudi Arabia, dental trauma is regarded as one of the most important issues affecting schoolchildren. This study evaluated Saudi Arabian schoolteachers’ knowledge, attitude, and practice regarding emergency dental trauma management. Methods: A cross-sectional study was conducted on 263 schoolteachers from 25 schools; 50.9% were females. A questionnaire was used to collect respondents’ personal and professional data and information on managing dental injury scenarios and the respondents’ attitudes toward dental injuries. A multivariate logistic regression analysis was carried out for the independent and outcome variable of inadequate knowledge regarding dental trauma management. Results: Male teachers had better knowledge than female teachers regarding emergency management of avulsed teeth. Compared to female teachers, male teachers would scrub a tooth with a toothbrush to replant it back into its socket if it fell onto the ground and was covered with dirt. Males had a significantly higher percentage of believing it is not teachers’ responsibility to care for tooth injuries in schools. Teachers with teaching experience of 5–10 years had a significantly higher percentage of training in dental emergencies. Teachers with bachelor’s degrees agreed on the need for teacher involvement to save the tooth in a timely manner. Compared to general teachers, physical education teachers would put the tooth back in the mouth and send the child to the dentist immediately if they were hit in the face and the upper front tooth fell out of their mouth. Teachers with a diploma level of education and teachers with a general type of teaching qualification were 2.15 times (CI = 0.98–3.11, p = 0.002) and 3.19 times (CI = 1.71–4.22, p = 0.0001) more likely to have a higher level of inadequate knowledge regarding dental trauma management. Conclusions: There is a need to raise teachers’ awareness and improve their dental trauma emergency management training. Full article

(This article belongs to the Collection Dentistry, Oral Health and Maxillofacial Surgery)

10 pages, 1433 KiB

Open AccessArticle

Increasing Serious Illness Conversations in Patients at High Risk of One-Year Mortality Using Improvement Science: A Quality Improvement Study

by Kanishk D. Sharma, Sandip A. Godambe, Prachi P. Chavan, Agatha Parks-Savage and Marissa Galicia-Castillo

Healthcare 2025, 13(2), 199; https://doi.org/10.3390/healthcare13020199 - 20 Jan 2025

Viewed by 597

Abstract

Background: Serious illness conversation (SIC) in an important skillset for clinicians. A review of mortality meetings from an urban academic hospital highlighted the need for early engagement in SICs and advance care planning (ACP) to align medical treatments with patient-centered outcomes. The aim [...] Read more.

Background: Serious illness conversation (SIC) in an important skillset for clinicians. A review of mortality meetings from an urban academic hospital highlighted the need for early engagement in SICs and advance care planning (ACP) to align medical treatments with patient-centered outcomes. The aim of this study was to increase SICs and their documentation in patients with low one-year survival probability identified by updated Charlson Comorbidity Index (CCI) scores. Methods: This was a quality improvement study with data collected pre- and post-intervention at a large urban level one trauma center in Virginia, which also serves as a primary teaching hospital to about 400 residents and fellows. Patient chart reviews were completed to assess medical records and hospitalization data. Chi square tests were used to identify statistical significance with the alpha level set at <0.05. Integrated care managers were trained to identify and discuss high CCI scores during interdisciplinary rounds. Providers were encouraged to document SICs with identified patients in extent of care (EOC) notes within the hospital’s cloud-based electronic health record known as EPIC. Results: Sixty-two patients with high CCI scores were documented, with 16 (25.81%, p = 0.0001) having EOC notes. Patients with documented EOC notes were significantly more likely to change their focus of care, prompting palliative care (63.04% vs. 50%, p = 0.007) and hospice consults (93.48% vs. 68.75%, p = 0.01), compared to those without. Post-intervention surveys revealed that although 50% of providers conducted SICs, fewer used EOC notes for documentation. Conclusion: This initial intervention suggests that the documentation of SICs increases engagement in ACP, palliative care, hospice consultations, and do not resuscitate decisions. Full article

(This article belongs to the Special Issue Health Disparities and Inequalities in Disease Prediction and Treatment)

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12 pages, 597 KiB

Open AccessArticle

Tobacco Use and Second-Hand Smoke Exposure Among Athletes; Assessment by Urine Cotinine Level and Exhaled Carbon Monoxide: A Cross-Sectional Study

by Erdogan Asar, Yunus Emre Bulut, Nermin Dindar Badem, Aydan Orscelik, Cagri Emin Sahin, Gokhan Buyukluoglu, Ismail Kucuk, Tugba Kocahan and Toker Erguder

Healthcare 2025, 13(2), 198; https://doi.org/10.3390/healthcare13020198 - 20 Jan 2025

Viewed by 587

Abstract

Background and Objectives: Tobacco use and exposure to tobacco products remain a major public health challenge, even among athletes. This study aimed to evaluate tobacco use and second-hand smoke exposure in athletes through urinary cotinine levels and exhaled air carbon monoxide (CO) measurements. [...] Read more.

Background and Objectives: Tobacco use and exposure to tobacco products remain a major public health challenge, even among athletes. This study aimed to evaluate tobacco use and second-hand smoke exposure in athletes through urinary cotinine levels and exhaled air carbon monoxide (CO) measurements. Materials and Methods: This cross-sectional study included licensed athletes who visited the sports medicine outpatient clinic of a tertiary hospital. Participants completed an electronic questionnaire on smoking habits and second-hand smoke exposure. Urine samples were analysed for cotinine levels, while CO levels were measured in exhaled breath. Results: A total of 421 athletes participated (57.8% male, median age: 18 years). Tobacco use was reported by 29.9% (n = 126) of participants. Median urinary cotinine levels were 22.9 ng/mL among daily tobacco users and 17.4 ng/mL among athletes exposed daily to second-hand smoke, with a statistically significant difference between exposure levels (p < 0.05). The optimal cut-off value for detecting second-hand smoke exposure was identified as 12.5 ng/mL. Median exhaled air CO levels were 5 ppm in daily tobacco users. Conclusions: This study demonstrates that tobacco use prevalence among athletes mirrors Türkiye’s national rates. Despite legal measures to curb tobacco use, direct use and second-hand smoke exposure remain pressing issues among athletes. Full article

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24 pages, 754 KiB

Open AccessArticle

A Retrospective Observational Study on Post-Pandemic Effects of Endogenous and Exogenous Factors on Prematurity in Pregnant Women Under 18 Years of Age

by Florin Țovîrnac, Alina Mihaela Călin, Eva Maria Elkan, Nicoleta Andreea Țovîrnac, Valentin Marian Antohi and Alexandru Nechifor

Healthcare 2025, 13(2), 197; https://doi.org/10.3390/healthcare13020197 - 19 Jan 2025

Viewed by 807

Abstract

Background/Objectives: This research investigates the impact of exogenous and endogenous factors on fetal health in pregnant women under the age of 18, with a special focus on the influence of educational level, adherence to vices (smoking and alcohol), comorbidities (diabetes and hypertension), and [...] Read more.

Background/Objectives: This research investigates the impact of exogenous and endogenous factors on fetal health in pregnant women under the age of 18, with a special focus on the influence of educational level, adherence to vices (smoking and alcohol), comorbidities (diabetes and hypertension), and poor sanitary conditions. Methods: The study uses retrospective data collected from a medical institution in the Southeast region of Romania, including a sample of 3639 births during the post-pandemic period (2022–2023). This period was considered to be a reference period for the study because, as a result of measures to combat the spread of COVID-19 disease in the pandemic, there was an increase in the birth rate among patients under 18 years of age. The APGAR clinical score was evaluated at 5, 10, and 20 min after birth and measured on an inverted scale to reflect the increased risk to fetal health. Results: The results indicate that lack of education is a significant exogenous factor associated with an increased risk of preterm births and a lower APGAR score. Additionally, adherence to vices is more pronounced among pregnant women with low educational levels and smoking and alcohol consumption negatively impact fetal health. Regarding comorbidities, diabetes did not significantly affect the short-term APGAR score, while hypertension had a complex effect, though medical interventions mitigated the associated risks. Conclusions: The conclusions of the research emphasize the need for appropriate educational and medical interventions to reduce the risks associated with preterm births and newborn health in adolescent pregnancies, especially in disadvantaged environments. The study suggests future research directions to expand the analysis to other geographical regions and for long-term monitoring of newborn health. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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18 pages, 517 KiB

Open AccessArticle

Health Resort Treatment Mitigates Neuropsychiatric Symptoms in Long COVID Patients: A Retrospective Study

by Grzegorz Onik, Katarzyna Knapik, Dariusz Górka and Karolina Sieroń

Healthcare 2025, 13(2), 196; https://doi.org/10.3390/healthcare13020196 - 19 Jan 2025

Viewed by 950

Abstract

Background/Objectives: Among the neuropsychiatric symptoms of long COVID, the following may be listed: sleep disturbances, headaches, anxiety, depression, dizziness, numbness, memory loss, and concentration difficulties. Various therapies have been implemented to mitigate these symptoms; however, health resort treatments that utilize a wide range [...] Read more.

Background/Objectives: Among the neuropsychiatric symptoms of long COVID, the following may be listed: sleep disturbances, headaches, anxiety, depression, dizziness, numbness, memory loss, and concentration difficulties. Various therapies have been implemented to mitigate these symptoms; however, health resort treatments that utilize a wide range of modalities stimulating multidirectional biological reactions may also be effective. The aim of this study was to assess the severity of neuropsychiatric symptoms in long COVID patients who qualified for health resort treatment, evaluate the effectiveness of health resort treatment in this group of patients, and evaluate the effect of balneological factors in the treatment course. Methods: A retrospective analysis of the medical records of 120 people with long COVID (69 women and 51 men) aged 42–79 who underwent health resort treatment in 2021 was performed. People were eligible for treatment at a lowland health resort based on a valid referral from a doctor. The treatment included balneological therapies, physical medicine modalities, exercise programs, health education, and psychological support. Patients assessed the severity of persistent neuropsychiatric symptoms on a 0–10 point scale before and after treatment. Results: After the treatment, the greatest improvement was noted in sleep disorders (2.47 ± 2.23 points vs. 0.86 ± 1.25 points, p < 0.00001) and dizziness (1.39 ± 1.94 points vs. 0.34 ± 0.76 points, p < 0.00001). The lowest improvement was observed in memory disorders (2.68 ± 2.5 points vs. 1 ± 1.4 points, p < 0.00001). Conclusions: Patients with long COVID who qualified for health resort treatment reported mild neuropsychiatric symptoms. Health resort treatment mitigates neuropsychiatric symptoms, as it is a complex approach. Treatment that includes balneological factors improves symptoms to a greater extent. This method of treatment should be integrated into the standard treatment for long COVID. Full article

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

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11 pages, 773 KiB

Open AccessArticle

The New Italian Guidelines for Assisted Reproduction Technologies (ART): Ethical and Medico-Legal Issues

by Costanza Raimondi, Claudia Casella, Emanuele Capasso, Laura L. Campanozzi, Giulia Mercuri, Antonio Oliva, Antonio G. Spagnolo and Pietro Refolo

Healthcare 2025, 13(2), 195; https://doi.org/10.3390/healthcare13020195 - 19 Jan 2025

Viewed by 707

Abstract

Background: On 20 March 2024, the Italian Minister of Health, in collaboration with the Italian National Institute of Health (Istituto Superiore di Sanità) and the National Health Council (Consiglio Superiore di Sanità), issued updated guidelines for assisted reproduction technologies (ART). They introduced two [...] Read more.

Background: On 20 March 2024, the Italian Minister of Health, in collaboration with the Italian National Institute of Health (Istituto Superiore di Sanità) and the National Health Council (Consiglio Superiore di Sanità), issued updated guidelines for assisted reproduction technologies (ART). They introduced two key changes: (1) permitting post-mortem embryo transfers, allowing a woman to proceed with the procedure after her male partner’s death, and (2) permitting embryo transfer even if the male partner is alive but the relationship has ended. Objectives: This study explores the ethical and medico-legal challenges posed by the updated Italian ART Guidelines, with a specific focus on the complexities of informed consent and the ethical dilemmas introduced by these provisions. Methods: This study employs a comprehensive review of legislation, case law, and a comparative analysis of national and international norms. Primary and secondary sources include laws, regulations, court decisions, and key ethical and medico-legal perspectives. Results were organized into two thematic areas: the medico-legal dimension, focusing on informed consent, and the ethical dimension, addressing post-mortem and ex-partner embryo transfers. Results: The new guidelines exacerbate the already intricate ART landscape in Italy. Post-mortem and post-relationship embryo transfers raise significant ethical concerns and amplify legal uncertainties. Conclusions: These updates highlight the pressing need for legislative reform to address unresolved ethical and legal issues in ART. Full article

(This article belongs to the Special Issue Ethics of Well-Done Work and Proposals for a Better Healthcare System)

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25 pages, 816 KiB

Open AccessArticle

Neighborhood Violence Exposure and Alcohol and Tobacco Use Initiation Among Ethnic Minority Adolescents

by Anna Maria Santiago and Iris Margetis

Healthcare 2025, 13(2), 194; https://doi.org/10.3390/healthcare13020194 - 19 Jan 2025

Viewed by 651

Abstract

Background/Objectives: Although the extant literature has recognized the importance of neighborhood contexts for adolescent alcohol and tobacco use, less is known about the effects of exposure to neighborhood violence on the prevalence and timing of initiation across gender and race/ethnic groups. Methods: This [...] Read more.

Background/Objectives: Although the extant literature has recognized the importance of neighborhood contexts for adolescent alcohol and tobacco use, less is known about the effects of exposure to neighborhood violence on the prevalence and timing of initiation across gender and race/ethnic groups. Methods: This secondary analysis of administrative and survey data from a natural experiment in Denver examines the influence of neighborhood contexts on the health and well-being of 1100 Latino/a and African American adolescents. Cox Proportional Hazard models were used to (1) estimate the effects of exposure to neighborhood violence on the prevalence and timing of adolescent alcohol and tobacco use initiation; (2) examine gender and race/ethnic variations in alcohol and tobacco use initiation after controlling for adolescent, caregiver, household, and other neighborhood characteristics; and (3) test for threshold effects. Results: Prevalence rates among all adolescents were 12.9% for alcohol use initiation and 13.7% for tobacco use initiation but were 14.6% and 17.3%, respectively, among adolescents exposed to higher levels of neighborhood violence. The average age of initiation was 16.1 and 15.6 years for alcohol and tobacco use, respectively, but 2–8 months earlier for adolescents exposed to higher levels of neighborhood violence. Heightened exposure to neighborhood violence increased the hazards of alcohol use initiation by 32% for all adolescents and 38% for adolescent males. The hazards of tobacco use initiation were 1.3 to 1.5 times higher for male, Latino/a, and African American adolescents. Exposure to neighborhood violence suggests threshold effects of diminishing returns on adolescent tobacco use initiation. Conclusions: Findings underscore the need to examine gender and race/ethnic group differences in adolescent alcohol and tobacco initiation, the multiple pathways to such use, and interventions aimed at reducing neighborhood violence. Full article

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14 pages, 262 KiB

Open AccessArticle

The Role of Personality in Explaining Burnout, Work Addiction, and Stress-Related Growth in Prehospital Emergency Personnel

by Mihai Alexandru Butoi, Gabriela Vancu, Radiana-Carmen Marcu, Andrei Hermenean, Monica Puticiu and Luciana Teodora Rotaru

Healthcare 2025, 13(2), 193; https://doi.org/10.3390/healthcare13020193 - 19 Jan 2025

Viewed by 607

Abstract

Background/Objectives: This is a cross-sectional study designed to explore the contribution of personality factors (the Alternative Five Factor Model) and lower order characteristics (responsive distress and self-discipline) to burnout, work addiction, and stress-related growth among Romanian prehospital emergency healthcare workers. Methods: A total [...] Read more.

Background/Objectives: This is a cross-sectional study designed to explore the contribution of personality factors (the Alternative Five Factor Model) and lower order characteristics (responsive distress and self-discipline) to burnout, work addiction, and stress-related growth among Romanian prehospital emergency healthcare workers. Methods: A total of 266 prehospital professionals (41 physicians, 74 nurses, and 151 paramedics) participated in the study out of the 728 invited (36.5% response rate). The age of participants ranged between 20 and 57 years and 67.3% were men. The participants completed the Oldenburg Burnout Inventory, the Dutch Work Addiction Scale (the short version), the Stress-Related Growth Scale, the Zuckerman–Kuhlman Personality Inventory, the Responsive Distress Scale, and the Self-Discipline Scale. Results: The results show that burnout was predicted by age, gender, impulsive sensation seeking, responsive distress, and self-discipline; work addiction was predicted by aggression–hostility, sociability, and responsive distress, while stress-related growth was predicted by age, activity, and self-discipline. Additionally, we found that emergency healthcare workers displayed lower impulsive sensation seeking, neuroticism–anxiety, and aggression–hostility, but displayed higher levels of activity and sociability in comparison with the general Romanian population, although these differences must be interpreted with caution as the general Romanian population tend to be significantly younger. Conclusions: This study provides new insights into the role of personality traits as risk factors for burnout and work addiction, and as protective factors for stress-related growth in prehospital emergency personnel. It is also among the few studies in this field to employ the Alternative Five Factor Model of personality. Full article

(This article belongs to the Special Issue Burnout and Mental Health among Health Professionals)

18 pages, 660 KiB

Open AccessPerspective

Advancing Sustainable HIV Services Through Integration in Primary Healthcare in Sub-Saharan Africa: A Perspective on Practical Recommendations

by Tafadzwa Dzinamarira, Gallican Rwibasira, Loveday Mwila, Enos Moyo, Derek Mangoya, Perseverance Moyo, Edward Oladele, Adewale Akinjeji, Munashe Chimene and Claude Mambo Muvunyi

Healthcare 2025, 13(2), 192; https://doi.org/10.3390/healthcare13020192 - 19 Jan 2025

Viewed by 878

Abstract

Sub-Saharan Africa continues to bear a disproportionate burden of the global HIV epidemic. Integrating HIV services into primary healthcare is a crucial strategy to accelerate progress towards ending the epidemic. However, several challenges hinder effective integration, including underfunding, human resource shortages, infrastructure limitations, [...] Read more.

Sub-Saharan Africa continues to bear a disproportionate burden of the global HIV epidemic. Integrating HIV services into primary healthcare is a crucial strategy to accelerate progress towards ending the epidemic. However, several challenges hinder effective integration, including underfunding, human resource shortages, infrastructure limitations, weak health systems, and sociocultural factors. With this perspective, we discuss strategies to address these challenges. A comprehensive, multi-faceted approach is necessary to overcome these barriers. Investing in human resources, improving infrastructure, and strengthening health information systems are essential for strengthening the health system. Implementing patient-centered care, integrated service delivery models, and community engagement can optimize service delivery. Utilizing digital health tools, such as mobile health applications and electronic health records, can enhance service delivery and data management. Mobilizing for an increase in domestic resources, aligning donor funding, and using cost-effective approaches are crucial for effective financing. Finally, robust monitoring and evaluation systems are necessary to track progress, identify challenges, and inform decision-making. With these strategies, among many others, sub-Saharan African countries can significantly improve the integration of HIV services into primary healthcare, leading to better health outcomes for people living with HIV and more sustainable HIV programs. Full article

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27 pages, 1004 KiB

Open AccessArticle

When I Receive Too Much Social Support: The Effect of Social Support Overload on Users’ Life Burnout and Discontinuance in Fitness Apps

by Ruihan Li, Shuang Wang and Tailai Wu

Healthcare 2025, 13(2), 191; https://doi.org/10.3390/healthcare13020191 - 19 Jan 2025

Viewed by 451

Abstract

Background/Objectives: As fitness apps increasingly incorporate social interaction features, users may find themselves overwhelmed by an excess of received support, struggling to effectively manage it. Highlighting a novel recipient-centric perspective, we aim to investigate the impact of social support overload on users’ life [...] Read more.

Background/Objectives: As fitness apps increasingly incorporate social interaction features, users may find themselves overwhelmed by an excess of received support, struggling to effectively manage it. Highlighting a novel recipient-centric perspective, we aim to investigate the impact of social support overload on users’ life burnout and discontinuance within fitness apps. Methods: Utilizing Social Support Theory and Basic Psychological Needs Theory, we develop a model to examine how emotional, network, and informational support overload affect life burnout and discontinuance through the frustration of basic psychological needs: autonomy, competence, and relatedness. A total of 443 fitness app users were included in our study, and we employed Structural Equation Modeling (SEM) to empirically test this model. Results: The results highlight the significant mediating role of the frustration of basic psychological needs between social support overload and life burnout/discontinuance. Network and informational support overload positively correlate with frustration of all needs, whereas emotional support overload shows a complex relationship. All need frustrations are linked to life burnout, but only autonomy and relatedness frustrations significantly lead to discontinuance. Additionally, gender and app use proficiency are significant control variables impacting discontinuance. Conclusions: This study adopts a novel recipient-centric perspective to explore social support overload, examining its effects on life burnout and discontinuance and offering practical implications for both users and app managers. Full article

(This article belongs to the Section Artificial Intelligence in Medicine)

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20 pages, 1461 KiB

Open AccessArticle

Cultural Competence of Obstetricians/Gynecologists and Midwives Providing Midwifery Care to Roma Women in Western Greece

by Chrysoula Chinoporou, Athina Diamanti, Eleni Asimaki, Christina Nanou, Pinelopi Varela, Victoria Vivilaki and Anna Deltsidou

Healthcare 2025, 13(2), 190; https://doi.org/10.3390/healthcare13020190 - 19 Jan 2025

Viewed by 450

Abstract

Background: Providing midwifery care to Roma women is a significant public health issue due to their status as a vulnerable population, often facing unique challenges and discrimination in accessing healthcare. Cultural competence refers to the ability of maternity providers to understand and incorporate [...] Read more.

Background: Providing midwifery care to Roma women is a significant public health issue due to their status as a vulnerable population, often facing unique challenges and discrimination in accessing healthcare. Cultural competence refers to the ability of maternity providers to understand and incorporate cultural factors within the broader healthcare system. Objective: This study aimed to investigate the cultural competence of obstetricians/gynecologists and midwives working in Western Greece who provide midwifery care to Roma women. Methods: A cross-sectional quantitative study was conducted using a questionnaire from the Roma Women’s Empowerment and Fight against discrimination in Access to Health (REACH) project, which focuses on empowering Roma women and combating healthcare access discrimination. The questionnaire covered three areas: the cultural competence of maternity professionals, their knowledge of Roma women’s lifestyle, and participants’ demographics. The sample included 100 maternity professionals from hospitals and health centers in Western Greece. Results: Cultural competence was found to be moderate to high, with a mean score of 6.9 (SD = 2.2) for the ability to provide adequate care. In the past six months, 33% had provided care to 1–5 Roma women with communication issues, and 53% frequently faced challenges in service delivery. Common problems included Roma women not understanding the information provided (72.9%), and not having necessary documents (41.7%). Obstetricians/gynecologists had higher knowledge scores compared to midwives, and higher educational attainment correlated with better knowledge. Older age was associated with higher cultural competence (p = 0.048). Conclusions: Cultural competence was positively correlated with knowledge levels, with obstetricians/gynecologists exhibiting higher competence than midwives. Enhancing cultural competence among perinatal care providers is crucial to addressing health disparities faced by Roma women. The study’s cross-sectional design and reliance on self-reported data may limit the generalizability and introduce bias. Enhancing cultural competence through targeted training programs can help address healthcare disparities faced by Roma women. Full article

(This article belongs to the Special Issue Interdisciplinary Perspectives in Maternal Health: Integrating Theoretical Frameworks and Practical Applications)

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27 pages, 1066 KiB

Open AccessSystematic Review

Physical Exercise Interventions Using Virtual Reality in Children and Adolescents with Cerebral Palsy: Systematic Review

by Javier Velasco Aguado, Mário C. Espada, Jesús Muñoz-Jiménez, Cátia C. Ferreira and Luisa Gámez-Calvo

Healthcare 2025, 13(2), 189; https://doi.org/10.3390/healthcare13020189 - 19 Jan 2025

Viewed by 831

Abstract

Background/Objectives: Cerebral palsy (CP) is a neurological disorder that affects movement and posture. Physical activity (PA) is safe and crucial for healthy development; however, this population faces barriers that hinder its implementation. Virtual reality (VR) is an emerging and promising technology that promotes [...] Read more.

Background/Objectives: Cerebral palsy (CP) is a neurological disorder that affects movement and posture. Physical activity (PA) is safe and crucial for healthy development; however, this population faces barriers that hinder its implementation. Virtual reality (VR) is an emerging and promising technology that promotes PA in young people with CP. This work aims to compile and analyze the current scientific literature on physical exercise (PE) programs using VR in children and adolescents with CP through a PRISMA systematic review. Methods: A systematic review was conducted and reported based on the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analyses) statement. The search was conducted through the Web of Science, PubMed, and Scopus databases on 1st September 2024. Studies based on PA interventions using VR in children and adolescents with CP were selected. Results: A total of 24 experimental research articles were selected for this review. The studies included comprise a total sample of 616 participants between 4 and 18 years old. The studies involved a diverse range of interventions, from brief sessions to intensive training. The results consistently demonstrated improvements in motor control, muscle strength, aerobic capacity, and overall participation in daily activities. Conclusions: The results highlight that the use of VR for PE programs has numerous benefits such as increased enjoyment, facilitation of motor learning, and acquisition of functional skills. PE through VR in children and adolescents with CP represents a promising tool; more scientific and practical evidence is needed to confirm its long-term effectiveness. Full article

(This article belongs to the Special Issue Physical Activity, Exercise, and Sport in People with Disabilities: Strategies for Health Promotion)

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10 pages, 379 KiB

Open AccessArticle

An Overlooked Challenge: A Retrospective Audit of Overnutrition in Hospital Rehabilitation Wards

by Hannah T. Olufson, Jennifer Ellick, Simone McCoy, Sally E. Barrimore, Tracy Knowlman and Adrienne M. Young

Healthcare 2025, 13(2), 188; https://doi.org/10.3390/healthcare13020188 - 18 Jan 2025

Viewed by 711

Abstract

Background/Objective: Research shows that obesity has risen among rehabilitation patients. Despite this, nutrition care in subacute rehabilitation wards focuses primarily on preventing and treating protein-energy malnutrition. The continued provision of energy-dense meals during lengthy rehabilitation admissions may present a risk of overnutrition for [...] Read more.

Background/Objective: Research shows that obesity has risen among rehabilitation patients. Despite this, nutrition care in subacute rehabilitation wards focuses primarily on preventing and treating protein-energy malnutrition. The continued provision of energy-dense meals during lengthy rehabilitation admissions may present a risk of overnutrition for some patients, which can adversely affect functional outcomes. However, overnutrition is not routinely monitored in practice. This study summarizes the initial findings of a multi-site investigation of overnutrition incidence across five rehabilitation wards to scope the need for future research. Methods: A retrospective audit was conducted, including all inpatients admitted over 3 months to the study wards with a complete dataset (total sample n = 199). Data were collected from the medical record and menu management system to determine overnutrition, defined as an average daily energy intake equal to or greater than 1000 kJ above estimated requirements and weight gain of equal to or greater than 1 kg over the admission. Results: The incidence of overnutrition in the total sample was 12.1%. Of those patients deemed at low risk of malnutrition (n = 124), 19.4% developed overnutrition during their rehabilitation admission. Those who developed overnutrition during their admission gained an average of 2.9 kg, with a mean excess energy intake of 2456 kJ/day above estimated requirements. They also consumed a high intake of discretionary items (mean of 3156 kJ/day). Conclusions: The findings suggest that further research is needed to investigate the etiology and impact of the overlooked problem of overnutrition in subacute rehabilitation settings. Future investigation is essential to ensure that the planning and delivery of subacute dietetic and food services meet the nutrition needs of patients in longer-stay inpatient settings. Full article

(This article belongs to the Special Issue Nutrition in Patient Care)

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16 pages, 587 KiB

Open AccessArticle

Exploring Physician and Patient Perspectives on Expectations and Role Models Towards Chronic Pain Treatment in General Practice: A Qualitative Cross-Sectional Study

by Dominik Dupont, Sabrina Brinkmöller, Sarina Carter, Michel Wensing, Cornelia Straßner, Peter Engeser and Regina Poß-Doering

Healthcare 2025, 13(2), 187; https://doi.org/10.3390/healthcare13020187 - 18 Jan 2025

Viewed by 454

Abstract

Background and Objective: Approximately 7.4% of the German population matched the criteria of impeding, chronic non-cancer-related pain in 2014. Guidelines emphasize the importance of a holistic treatment approach. The project RELIEF aims to develop and evaluate a multifaceted case-management intervention to foster the [...] Read more.

Background and Objective: Approximately 7.4% of the German population matched the criteria of impeding, chronic non-cancer-related pain in 2014. Guidelines emphasize the importance of a holistic treatment approach. The project RELIEF aims to develop and evaluate a multifaceted case-management intervention to foster the holistic management of chronic pain in general practice. To inform intervention development, this study explored expectations and perceived role models of general practitioners (GP) and patients regarding chronic non-cancer-related pain management in general practice with a focus on patient expectations of GPs and themselves, as well as GP expectations of patients and their anticipation of patient’s expectations. Methods: Data were collected via semi-structured guide-based interviews with general practitioners and patients. Pseudonymized verbatim transcripts were analyzed using an inductive–deductive approach with a structuring qualitative content analysis. The Theoretical Domains Framework served as an analytical framework to explore behavioral aspects associated with expectations and role perceptions. Results:n = 25 interviews were analyzed (GP: n = 10, patient: n = 15). Findings indicate that patients considered themselves as the main actor in the therapy process yet expected guidance and care coordination from their GP. The essential role GPs play in pain management was emphasized. Role models indicated by GPs and some patients represent a care ideal, which was also reflected in discussed expectations. GPs anticipated that patients would place high relevance on pharmacological options. Patients highlighted their preference of non-pharmacological and alternative treatment options. Conclusions: Our findings demonstrate the importance of holistic, individually tailored chronic pain management in general practice. Systematic, multifaceted case management, as planned in the RELIEF project, may contribute to high-quality primary care for affected individuals. Full article

(This article belongs to the Section Pain Management)

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18 pages, 271 KiB

Open AccessArticle

A Cross-Sectional Multivariable Analysis of the Quality of Hemodialysis Patients’ Life in Lahore City, Pakistan

by Ghosia Islam, Gulzar H. Shah, Nadia Saeed, Jeffery A. Jones and Indira Karibayeva

Healthcare 2025, 13(2), 186; https://doi.org/10.3390/healthcare13020186 - 18 Jan 2025

Viewed by 478

Abstract

Background/Objectives: Chronic kidney disease (CKD) is a severe health problem with dire consequences for the quality of life of millions of individuals and their families around the globe. This quantitative study analyzes the factors associated with hemodialysis patients’ quality of life (QoL) in [...] Read more.

Background/Objectives: Chronic kidney disease (CKD) is a severe health problem with dire consequences for the quality of life of millions of individuals and their families around the globe. This quantitative study analyzes the factors associated with hemodialysis patients’ quality of life (QoL) in Lahore City, Pakistan. Methods: Primary data from a sample of 384 patients were collected through regular visits to the hospital. We employed proportional odds models (POMs) and structural equation models to identify factors associated with the QoL. Results: The results revealed significant associations between various factors and patients’ quality of life. While gender showed no association with quality of life, younger age, single marital status, higher education, higher family income, and employment status were associated with a better QoL. Clinical variables such as the absence of diabetes and hypertension and specific laboratory parameters were protective against deteriorating QoL. Physical symptoms like muscle soreness, cramps, and shortness of breath significantly impacted QoL. Social and environmental factors adversely affected patient well-being, including family distress and financial issues. Psychological variables such as anxiety, depression, and fear of death also influenced QoL. Conclusions: The findings underscore the importance of holistic, patient-centered care approaches in renal failure management, highlighting the need for tailored interventions to address the diverse needs of dialysis patients and enhance their QoL. Further longitudinal research is recommended to validate these findings and guide the development of targeted interventions for improving patient well-being in hemodialysis settings. Full article

(This article belongs to the Special Issue Clinical Healthcare and Quality of Life of Chronically Ill Patients)

16 pages, 419 KiB

Open AccessArticle

The Impact of a Healthy Lifestyle on Lower Urinary Tract Symptoms and Erectile Function: A Prospective Study

by Riccardo Lombardo, Matteo Romagnoli, Chiara Splendore, Luca Sarcinelli, Beatrice Turchi, Giacomo Gallo, Giorgia Tema, Antonio Franco, Antonio Nacchia, Ferdinando Fusco, Yazan Al Salhi, Andrea Fuschi, Antonio Pastore, Antonio Cicione, Andrea Tubaro and Cosimo De Nunzio

Healthcare 2025, 13(2), 185; https://doi.org/10.3390/healthcare13020185 - 18 Jan 2025

Viewed by 400

Abstract

Background and Objectives: The impact of lifestyle on lower urinary tract symptoms has been deeply evaluated in recent years; however, studies in the young population are missing. The aim of this study is to evaluate the impact of alcohol intake, tobacco and [...] Read more.

Background and Objectives: The impact of lifestyle on lower urinary tract symptoms has been deeply evaluated in recent years; however, studies in the young population are missing. The aim of this study is to evaluate the impact of alcohol intake, tobacco and cannabinoid smoking, physical activity, and dietary regime on urinary symptoms and sexual function in young adults under 30 years of age. Methods: A prospectively enrolled population of healthy young adults of both sexes under 30 years of age was selected. Young people with comorbidities were excluded. All participants were assessed by completing an anonymous questionnaire which included questions on medical history, lifestyle, smoking and alcohol intake, urinary symptoms, and sexual function only in male subjects. The questionnaire was postponed in case there was an acute pathology. Results: Overall, 802 young adults were prospectively enrolled, of whom 44% were male and 56% female, with a median age of 26 (23/28) years. In our population, 580/818 (70.9%) subjects presented an IPSS ≥ 3. In the analysis of the association between urinary symptoms and smoking, smokers presented urinary symptoms more frequently than nonsmokers (76% vs. 61%; p < 0.05). No association between urinary symptoms and alcohol intake, cannabinoid smoking, physical activity, and dietary regimen was recorded. On multivariable analysis, smokers had an almost doubled risk of urinary symptoms compared to nonsmokers (OR: 1.78; p = 0.001). Conclusions: In conclusion, we demonstrated how even in the young population there can be a correlation between LUTSs and different lifestyles. Full article

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17 pages, 902 KiB

Open AccessArticle

Cybersecuity Analysis of a Telemedicine Platform

by Martina Nobili, Domenico Raguseo and Roberto Setola

Healthcare 2025, 13(2), 184; https://doi.org/10.3390/healthcare13020184 - 18 Jan 2025

Viewed by 542

Abstract

Background: The global shift toward telemedicine, accelerated by the COVID-19 pandemic, has revolutionized healthcare delivery by enabling remote consultations and treatments. However, this rapid adoption has also introduced critical cybersecurity vulnerabilities, particularly in safeguarding sensitive medical data and ensuring the secure operation of [...] Read more.

Background: The global shift toward telemedicine, accelerated by the COVID-19 pandemic, has revolutionized healthcare delivery by enabling remote consultations and treatments. However, this rapid adoption has also introduced critical cybersecurity vulnerabilities, particularly in safeguarding sensitive medical data and ensuring the secure operation of telemedicine platforms. If not properly addressed, these vulnerabilities can compromise patient safety and the integrity of healthcare systems. As a result, implementing robust cybersecurity measures in telemedicine platforms is essential. Methods: The framework developed in this study allows for the assessment of a telemedicine platform’s cybersecurity posture and provides concrete recommendations for improvement. In this context, the Security Framework for Telemedicine Platforms, developed as part of the study, serves as a valuable tool for evaluating platform security, identifying vulnerabilities, and pinpointing areas for enhancement. Conclusions: This framework empowers organizations to effectively strengthen their cybersecurity strategies, as demonstrated by a case study. Full article

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

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16 pages, 1183 KiB

Open AccessArticle

The Effect of an Improved Environment According to Watson’s Theory of Human Care on Sleep, Anxiety, and Depression in Patients Undergoing Open Heart Surgery: A Randomized Controlled Trial

by Hatice Azizoğlu, Zeynep Gürkan, Yasemin Bozkurt, Canan Demir and Hatice Akaltun

Healthcare 2025, 13(2), 183; https://doi.org/10.3390/healthcare13020183 - 18 Jan 2025

Viewed by 491

Abstract

Background/Objectives: According to Watson’s Human Care Theory, an improved environment influences patients’ care processes. The purpose of this study was to examine the effect of an improved environment, according to Watson’s Human Care Theory, on sleep quality, anxiety, and depression in patients undergoing [...] Read more.

Background/Objectives: According to Watson’s Human Care Theory, an improved environment influences patients’ care processes. The purpose of this study was to examine the effect of an improved environment, according to Watson’s Human Care Theory, on sleep quality, anxiety, and depression in patients undergoing open heart surgery. Methods: Upon admission to the ward from the postoperative intensive care unit, the experimental group underwent environmental remediation for three days. The environmental arrangements ensured that the patient’s room maintained an appropriate temperature range of 18–26 °C and humidity values of 30–50%. Monitoring took place at 21:00, 22:00, and 23:00 on Days 1, 2, and 3, at which times, the brightness of the patient rooms gradually decreased. On the morning of the fourth day, the patients were interviewed face to face, and research questionnaires were filled out (ClinicalTrials.gov identifier of the manuscript: NCT06744023). Results: After the implementation of an improved environment in accordance with Watson’s Human Care Theory, the sleep duration of the patients in the experimental group (5.91 h) was higher than that of the control group (4.1 h). At the same time, the mean sleep quality score was measured as 300 ± 15.33 in the experimental group and 116.33 ± 14.94 in the control group. In addition, anxiety and depression levels were lower in the experimental group (5.63 ± 0.59; 4.53 ± 0.42) compared with the control group (12.03 ± 0.85; 10.03 ± 0.82). Conclusions: We recommend implementing improved environmental arrangements in accordance with Watson’s Human Care Theory to improve sleep quality and reduce anxiety and depression levels in patients undergoing open heart surgery. Full article

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12 pages, 848 KiB

Open AccessArticle

An Integrative Path Model of Healthcare Utilization Determinants in Traditional Korean Medicine and Western Medicine Based on the Anderson Behavioral Model

by Minjung Park

Healthcare 2025, 13(2), 182; https://doi.org/10.3390/healthcare13020182 - 18 Jan 2025

Viewed by 409

Abstract

Background: This study aimed to elucidate the determinants of healthcare utilization in South Korea’s dual healthcare system, encompassing both Western medicine and Korean medicine, through the Andersen Model. An integrative non-recursive path model of healthcare utilization determinants was proposed and analyzed. Methods: A [...] Read more.

Background: This study aimed to elucidate the determinants of healthcare utilization in South Korea’s dual healthcare system, encompassing both Western medicine and Korean medicine, through the Andersen Model. An integrative non-recursive path model of healthcare utilization determinants was proposed and analyzed. Methods: A path analysis using structural equation modeling, followed by mediation analysis, was conducted to determine the magnitude of the effect for each pathway. The 2020 data from the Korea Health Panel were used. Results: Structural equation modeling revealed that need factors, such as chronic diseases, disability, and self-rated health status, were the most significant drivers of both WM and KM utilization, while enabling factors significantly impacted WM utilization. Interestingly, WM and KM utilization were found to positively influence each other, contradicting the assumption of substitutional healthcare use. Mediation analysis further highlighted the interconnected nature of healthcare utilization pathways, with enabling and need factors showing significant indirect effects on utilization via the counterpart system. These findings underscore the importance of considering mutual influences in healthcare policy and resource allocation to enhance accessibility and efficiency. While the cross-sectional nature of the data limits causal inference, this study offers a robust theoretical framework and practical insights for addressing the complexities of healthcare utilization in dual-system contexts. Conclusion: The findings reveal that when traditional medicine functions within the national healthcare system, both Western medicine and traditional medicine are influenced by similar determinants in the same environment. Future research should explore longitudinal data to confirm these findings and investigate potential moderating effects of predisposing and enabling factors on WM and KM interactions. Full article

(This article belongs to the Section Health Policy)

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19 pages, 1208 KiB

Open AccessSystematic Review

Advancements in Obstructive Sleep Apnea Diagnosis and Screening Through Artificial Intelligence: A Systematic Review

by Lucrezia Giorgi, Domiziana Nardelli, Antonio Moffa, Francesco Iafrati, Simone Di Giovanni, Ewa Olszewska, Peter Baptista, Lorenzo Sabatino and Manuele Casale

Healthcare 2025, 13(2), 181; https://doi.org/10.3390/healthcare13020181 - 17 Jan 2025

Viewed by 645

Abstract

Background: Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed condition associated with a major healthcare burden. Current diagnostic tools, such as full-night polysomnography (PSG), pose a limited accessibility to diagnosis due to their elevated costs. Recent advances in Artificial Intelligence (AI), including [...] Read more.

Background: Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed condition associated with a major healthcare burden. Current diagnostic tools, such as full-night polysomnography (PSG), pose a limited accessibility to diagnosis due to their elevated costs. Recent advances in Artificial Intelligence (AI), including Machine Learning (ML) and deep learning (DL) algorithms, offer novel potential tools for an accurate OSA screening and diagnosis. This systematic review evaluates articles employing AI-powered models for OSA screening and diagnosis in the last decade. Methods: A comprehensive electronic search was performed on PubMed/MEDLINE, Google Scholar, and SCOPUS databases. The included studies were original articles written in English, reporting the use of ML algorithms to diagnose and predict OSA in suspected patients. The last search was performed in June 2024. This systematic review is registered in PROSPERO (Registration ID: CRD42024563059). Results: Sixty-five articles, involving data from 109,046 patients, met the inclusion criteria. Due to the heterogeneity of the algorithms, outcomes were analyzed into six sections (anthropometric indexes, imaging, electrocardiographic signals, respiratory signals, and oximetry and miscellaneous signals). AI algorithms demonstrated significant improvements in OSA detection, with accuracy, sensitivity, and specificity often exceeding traditional tools. In particular, anthropometric indexes were most widely used, especially in logistic regression-powered algorithms. Conclusions: The application of AI algorithms to OSA diagnosis and screening has great potential to improve patient outcomes, increase early detection, and lessen the load on healthcare systems. However, rigorous validation and standardization efforts must be made to standardize datasets. Full article

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14 pages, 1251 KiB

Open AccessArticle

The Impact of Relaxation Massage Prior to Bedtime on Sleep Quality and Quantity in People with Symptoms of Chronic Insomnia: A Home-Based Sleep Study

by Ilias Ntoumas, Christina Karatzaferi, Christoforos D. Giannaki, Fotini Papanikolaou, Aggelos Pappas, Efthimios Dardiotis and Giorgos K. Sakkas

Healthcare 2025, 13(2), 180; https://doi.org/10.3390/healthcare13020180 - 17 Jan 2025

Viewed by 667

Abstract

Background/Objectives: Manual massage is an effective treatment approach for reducing general stress and promoting an overall sense of well-being. Relaxation massage aims to alleviate psychophysiological tension, enhance both blood and lymphatic circulation, and promote mental and physical relaxation. It is particularly beneficial for [...] Read more.

Background/Objectives: Manual massage is an effective treatment approach for reducing general stress and promoting an overall sense of well-being. Relaxation massage aims to alleviate psychophysiological tension, enhance both blood and lymphatic circulation, and promote mental and physical relaxation. It is particularly beneficial for those with anxiety-related symptoms (such as generalized anxiety disorder and social anxiety) and sleep disorders, aiming to improve calmness and promote sleepiness. Aims: The purpose of the present study was to assess the effectiveness of a single session of relaxation massage prior to bedtime on sleep quality and quantity indices in individuals with symptoms of chronic insomnia. Methods: In total, 20 (N = 20) healthy individuals (aged 25.5 ± 12.0 years; 6F/14M) with a score on the Athens Insomnia Scale of ≥16 participated under three different conditions over one week apart: (1) a 45 min relaxation massage condition (REL), (2) a 45 min sham massage condition (PLA), and (3) a control condition with no massage. Sleep activity was monitored using a portable polysomnographic system. Results: A statistically significant effect was observed between sleep efficiency across the three sessions (p = 0.034), with a notable effect in the relaxation massage (REL) session (p = 0.045). Additionally, sustained sleep efficiency showed a statistically significant difference among the sessions (p = 0.005). Conclusions: Relaxation massage prior to bedtime could be used as an effective and safe non-pharmacological approach for improving sleep efficiency and potentially restoring the fragmented sleep of individuals with symptoms of insomnia. Trial registration number: The trial was registered at clinicaltrials.gov as NCT06781866. Full article

(This article belongs to the Special Issue Psychophysiological Responses to Physical Activity, Exercise and/or Nutrition Interventions in Individuals with Cardiometabolic Health Impairments)

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16 pages, 570 KiB

Open AccessReview

Do Academic Libraries Contribute to Students’ and Communities’ Wellbeing?: A Scoping Review

by Shivani Suresh, David Lim, Kanchana Ekanayake and Amit Arora

Healthcare 2025, 13(2), 179; https://doi.org/10.3390/healthcare13020179 - 17 Jan 2025

Viewed by 1949

Abstract

Background/Objectives: Academic libraries offer a range of activities and initiatives for their students and community users. However, wellbeing, as a concept in academic libraries, is not very well defined and is poorly understood. The objective of this scoping review was to examine [...] Read more.

Background/Objectives: Academic libraries offer a range of activities and initiatives for their students and community users. However, wellbeing, as a concept in academic libraries, is not very well defined and is poorly understood. The objective of this scoping review was to examine the role of academic libraries in student and community wellbeing, identify the various kinds of activities and initiatives that they carry out to address their wellbeing, and uncover gaps that might require further research. Methods: An extensive search was conducted in the Library Information Sciences Association (LISA), Education Resources Information Centre (ERIC), Medline (OVID), Scopus, and Web of Science (WOS) databases. Grey literature was searched on a selection of library websites and digital repositories. Data were extracted from studies that met the inclusion criteria for the scoping review. Themes were identified by the authors and reported as a narrative summary. Results: Of the 5437 records identified, a total of 40 documents were included in this scoping review. The authors identified 11 different kinds of activities and initiatives carried out in academic libraries that promote student and community wellbeing, i.e., (1) animal-assisted activities; (2) facilitating dialogues about belonging and identity; (3) fun recreational activities; (4) study support; (5) physical activity promotion; (6) meditation, yoga, and mindfulness; (7) book clubs; (8) art exhibitions; (9) technology and digital support; (10) free food and tea; and (11) health awareness. These activities were found to promote the physical, emotional, and social wellbeing of student and community users. Conclusions: This review highlights the need for further systematic research on the long-term effects of wellbeing initiatives and activities on both student and community users, and how they might impact aspects of wellbeing for specific population groups such as senior citizens and LGBTQIA members. This scoping review demonstrates the potential of academic libraries in promoting health and wellbeing for their users. Full article

(This article belongs to the Special Issue Caring for the Mental Health of Higher Education Students: Coping Strategies and Well-Being Support)

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17 pages, 1735 KiB

Open AccessArticle

Trends in Socioeconomic Inequalities in the Prevalence of Chronic Non-Communicable Diseases in China: Evidence from Shaanxi Province During 2003–2013

by Dan Wang, Rashed Nawaz, Xiaojing Fan, Chi Shen, Sha Lai, Zhongliang Zhou and Jianmin Gao

Healthcare 2025, 13(2), 178; https://doi.org/10.3390/healthcare13020178 - 17 Jan 2025

Viewed by 489

Abstract

Background: The link between chronic non-communicable diseases (NCDs) and poverty in underdeveloped countries is debated. This study aims to examine socioeconomic inequalities related to NCDs and assess the contributing factors to these disparities. Methods: The study utilized data from the National [...] Read more.

Background: The link between chronic non-communicable diseases (NCDs) and poverty in underdeveloped countries is debated. This study aims to examine socioeconomic inequalities related to NCDs and assess the contributing factors to these disparities. Methods: The study utilized data from the National Health Services Survey in Shaanxi Province for 2003, 2008, and 2013, having 71,766 respondents. The concentration index (CI) was employed to rigorously quantify the degree of socioeconomic inequality in the prevalence of non-communicable diseases (NCDs). The CI decomposition identified the contribution of each variable, while the horizontal inequity (HI) index was calculated annually to assess changes in inequality. Additionally, a Probit model was employed to examine the significant determinants contributing to the occurrence of NCDs. Results: The results show a significant increase in NCD prevalence with age, particularly for individuals aged 60 and above, who experienced a 286.55% rise from 2003 to 2013. Higher education levels are associated with decreased NCD prevalence, as evidenced by a 74.13% reduction for those with high school education or above. Additionally, wealthier individuals had a 15.31% lower prevalence of NCDs, indicating that higher socioeconomic status correlates with a reduced likelihood of chronic diseases. Conclusions: The study finds that NCD prevalence significantly increases with age, while higher education levels and greater wealth are associated with reduced prevalence. These findings highlight the need to target older populations and lower socioeconomic groups for effective NCD prevention and management. Policies should focus on improving educational opportunities and socioeconomic conditions to reduce the burden of NCDs, particularly among older and economically disadvantaged groups. Full article

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18 pages, 581 KiB

Open AccessReview

Self-Compassion Intervention Programs for Nurses: A Scoping Review

by Jing Bian, Fazhan Chen, Shihan Fang and Yanbo Wang

Healthcare 2025, 13(2), 177; https://doi.org/10.3390/healthcare13020177 - 17 Jan 2025

Viewed by 562

Abstract

Background: Nurses frequently face various sources of stress in the workplace, making self-compassion interventions crucial for promoting their mental well-being. This scoping review aims to: (a) identify self-compassion intervention programs implemented within the nursing population; and (b) analyze the content and outcome [...] Read more.

Background: Nurses frequently face various sources of stress in the workplace, making self-compassion interventions crucial for promoting their mental well-being. This scoping review aims to: (a) identify self-compassion intervention programs implemented within the nursing population; and (b) analyze the content and outcome measures of these interventions. Methods: The study follows Arksey and O’Malley’s scoping review framework and adheres to the PRISMA-ScR guidelines. Relevant literature on self-compassion interventions for nurses published between January 2010 and May 2024 was systematically reviewed. Databases searched included PubMed, Web of Science, Scopus, ProQuest, and the Cochrane Library, using MeSH terms and free-text keywords such as “self-compassion”, “self-kindness”, “self-appreciation”, “self-worth”, “self-forgiveness”, “self-awareness”, “nurses”, and “nursing”. Results: Fifteen studies met the inclusion criteria and were included in the review. Self-compassion interventions were categorized into two types: (1) mindfulness-focused programs, such as Mindfulness-Based Stress Reduction (MBSR) and Mindful Self-Care and Resiliency (MSCR), which treat self-compassion as a potential outcome; and (2) self-compassion-focused programs, including Mindful Self-Compassion (MSC), Compassion Focused Therapy (CFT), and Loving-Kindness Meditation (LKM). Conclusions: The mental health challenges faced by nurses have drawn growing attention, underscoring the importance of self-compassion interventions. This review examines empirical studies within the nursing population, contributing to the development of more targeted and effective strategies to enhance the mental health and well-being of nursing professionals. Full article

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15 pages, 952 KiB

Open AccessStudy Protocol

Dealing with Childhood Externalizing Behavior: Protocol for a Feasibility RCT of the Being a Parent Program

by Laura Maciel, Ana Rita Pires, Miguel Basto-Pereira and Crispin Day

Healthcare 2025, 13(2), 176; https://doi.org/10.3390/healthcare13020176 - 17 Jan 2025

Viewed by 472

Abstract

Concerning numbers of childhood behavior problems have been reported worldwide. Parenting interventions are considered one of the most effective early strategies to intervene with externalizing conduct. This protocol outlines a feasibility RCT that aims to implement a parenting intervention in Portugal and (a) [...] Read more.

Concerning numbers of childhood behavior problems have been reported worldwide. Parenting interventions are considered one of the most effective early strategies to intervene with externalizing conduct. This protocol outlines a feasibility RCT that aims to implement a parenting intervention in Portugal and (a) test key feasibility parameters, (b) assess the fidelity and acceptability of the program, and (c) explore its effectiveness in childhood behavior problems, parenting skills, parental concern, and parental sense of competence. A double-blinded, two-arm feasibility RCT is described. The participants are the primary caregivers of children between the ages of two and eleven years old that identify difficulties in managing their child’s behavior. Families will be randomly assigned to an intervention arm and a waitlist control arm. Parents in the intervention arm will participate in the Being a Parent program (Portuguese version: Ser Pai & Ser Mãe), an eight-week group intervention. Outcomes will be assessed using quantitative and qualitative measures throughout three assessment periods (pre- and post-intervention, and follow-up). This study marks the first feasibility RCT of the Being a Parent program outside the UK. The findings will provide information on the global strength of this program. Challenges and clinical implications are also discussed. Full article

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14 pages, 466 KiB

Open AccessArticle

Effects of Shared Decision-Making, Health Literacy, and Self-Care Knowledge on Self-Care Behavior Among Hemodialysis Patients in Korea: A Cross-Sectional Survey

by Hyohjung Lee and Mi-Kyoung Cho

Healthcare 2025, 13(2), 175; https://doi.org/10.3390/healthcare13020175 - 17 Jan 2025

Viewed by 531

Abstract

Background: Patients undergoing hemodialysis for chronic kidney failure experience various complications and physical and emotional difficulties, leading to decreased quality of life. Self-care behaviors are essential for preventing complications and reducing mortality rates. Effective self-care behaviors significantly depend on shared decision-making, health literacy, [...] Read more.

Background: Patients undergoing hemodialysis for chronic kidney failure experience various complications and physical and emotional difficulties, leading to decreased quality of life. Self-care behaviors are essential for preventing complications and reducing mortality rates. Effective self-care behaviors significantly depend on shared decision-making, health literacy, and self-care knowledge, each critical in patient self-care performance and disease management. This study aimed to determine the importance and relevance of shared decision-making, health literacy, and self-care knowledge. In particular, it enhances self-care behaviors among hemodialysis patients. Methods: Participants were 108 adult hemodialysis patients from the hemodialysis centers of three medical institutions in Cheongju City, Korea. Moreover, the study utilized a descriptive survey research design. Data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, Pearson’s correlation coefficients, and multiple linear regression analyses. Results: The average score for self-care behaviors was 125.28 out of 175 points, with high scores for medication and vascular management. Furthermore, there were low scores for social activities and dietary management. Factors influencing self-care behaviors in hemodialysis patients were identified as sex, age, economic status, health literacy, and self-care knowledge. These factors explained 45.2% of the variance in self-care behaviors. Conclusions: To promote self-care behaviors in hemodialysis patients, it is essential to improve health literacy and self-care knowledge, strengthen tailored educational programs, and promote the explanatory role of nurses and shared decision-making. Additionally, comprehensive interventions, including economic support, are necessary. Full article

(This article belongs to the Section Chronic Care)

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Healthcare, Volume 13, Issue 2 (January-2 2025) – 113 articles

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