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Volume 13
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Healthcare, Volume 13, Issue 3 (February-1 2025) – 107 articles

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20 pages, 650 KiB  
Article
Exploring a Co-Designed Approach for Healthcare Quality Improvement—Learning Through Developmental Evaluation
by Katharina Kovacs Burns and Marian George
Healthcare 2025, 13(3), 311; https://doi.org/10.3390/healthcare13030311 (registering DOI) - 3 Feb 2025
Abstract
Background: Healthcare setting teams were challenged to understand how and what to measure regarding healthcare quality improvement (HQI), who should be involved, and what approach to apply. We aimed to determine if a generic co-design approach involving patients/families, multi-disciplinary care providers, and other [...] Read more.
Background: Healthcare setting teams were challenged to understand how and what to measure regarding healthcare quality improvement (HQI), who should be involved, and what approach to apply. We aimed to determine if a generic co-design approach involving patients/families, multi-disciplinary care providers, and other staff was feasible to apply for HQI across diverse care settings. Developmental evaluation embedded in the co-design approach would determine its effectiveness, challenges, and other experiences across care settings and teams. Methods: Twenty-two acute and community care settings agreed to participate in applying a phased co-design approach to their HQI initiatives, including developmental evaluation. Each care setting team received co-design orientation and support. Semi-structured interviews and focus groups were conducted with patient/family advisors (PFAs) and care setting staff/care providers to gather their experiences with the co-design approach applied to their phased HQI work. Transcripts were thematically analyzed and triangulated with observation notes of care setting team discussions. Experiences were gathered from 17 PFAs and 68 staff/care providers across the 22 participating healthcare settings. Results: Themes for the orientation and each phase emphasized the importance of participants’ understanding, engagement, and ongoing open communication throughout the HQI co-design process. The orientation was viewed as key to facilitating good outcomes. Participants valued working together, gathering real-time experiences to “make a difference”, and having PFA voices involved in co-designing the HQI initiatives. Challenges were identified, including time commitment. Conclusions: Based on the overall developmental evaluation findings, there was consensus that a generic co-design of HQI initiatives was effective, feasible, and sustainable across care settings. Full article
(This article belongs to the Special Issue Improving Healthcare Quality)
15 pages, 762 KiB  
Article
Assessing Population Well-Being in Saudi Arabia: A Comprehensive National Survey Using the WHO-05 Index and Self-Rated Health Metrics
by Abdulaziz Alahmadi, Yasir Almuzaini, Majed Alosaimi, Ahmed Alahmari, Fahad Alamri, Haytham Sheerah, Mariyyah Alburayh and Anas Khan
Healthcare 2025, 13(3), 310; https://doi.org/10.3390/healthcare13030310 - 3 Feb 2025
Abstract
Introduction: The well-being of populations is crucial for understanding nations’ public health and progress. With its ongoing transformation and development objectives, Saudi Arabia emphasizes its residents’ quality of life and well-being. Recent surveys and health indicators have underlined the nation’s focus on enhancing [...] Read more.
Introduction: The well-being of populations is crucial for understanding nations’ public health and progress. With its ongoing transformation and development objectives, Saudi Arabia emphasizes its residents’ quality of life and well-being. Recent surveys and health indicators have underlined the nation’s focus on enhancing population well-being. Aim: This study aimed to assess the overall level of well-being of the population living in Saudi Arabia using the WHO-5 index and self-rated health (SRH) metrics. Subject and methods: This cross-sectional study was conducted among thirty-nine thousand five hundred and sixty-two people from the general population in Saudi Arabia, citizens and residents, including all adult age groups (>18 years) and both genders. A self-administered questionnaire was sent to the Saudi adult population using an online survey. The questionnaire includes socio-demographic characteristics, the five-item Well-Being Index (WHO-5), and the self-rated health status. Results: Based on SRH, 77.4% were considered a healthy group. Male gender participants who had a better education were more likely to report a favorable SRH. According to WHO-5, poor well-being was seen in 26% of the population, and the rest had good well-being (74%). Independent predictors for good well-being include increasing age and educational level and being unemployed. Interestingly, we found a positive significant correlation between SRH and WHO-5 scores (r = 0.371; p < 0.001). Conclusions: Poor well-being was common among the general population. Independent risk factors for poor well-being include female gender and Saudi nationality, while increasing age, male gender, and higher education were significant predictors of healthy SRH. More longitudinal studies are needed to extract more data on this nation’s growing prevalence of poor self-rated health status. Full article
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11 pages, 1777 KiB  
Article
Work-Related Low Back Pain Among Physical Therapists in the Makkah Region, Saudi Arabia: A Cross-Sectional Study
by Hebah Ameen Takrouni, Gihan Mousa, Khalid Mohammed Yaseen and Mansour Abdullah Alshehri
Healthcare 2025, 13(3), 309; https://doi.org/10.3390/healthcare13030309 - 3 Feb 2025
Viewed by 127
Abstract
Background/Objectives: Low back pain (LBP) is a major work-related musculoskeletal disorder experienced globally, significantly limiting individuals’ daily activities and work performance. This study aimed to assess the prevalence of work-related LBP among physical therapists in the Makkah region of Saudi Arabia. Methods: A [...] Read more.
Background/Objectives: Low back pain (LBP) is a major work-related musculoskeletal disorder experienced globally, significantly limiting individuals’ daily activities and work performance. This study aimed to assess the prevalence of work-related LBP among physical therapists in the Makkah region of Saudi Arabia. Methods: A cross-sectional survey was conducted using an online self-reported questionnaire, which covered three domains: demographic information, history of LBP prior to joining the physical therapy field, and work-related LBP experienced during their current job. The questionnaire was distributed to 300 physical therapists in the Makkah region, yielding 151 responses. Data were analyzed to explore associations between LBP and various categorical and continuous factors. Results: Among the respondents, 78.1% reported experiencing LBP during their work as physical therapists, while 21.9% did not. Of those with LBP, 53.4% reported mild pain, 39.8% reported moderate pain, and smaller proportions reported severe pain (4.2%) or no pain (2.5%). Additionally, 52.5% of respondents with LBP indicated that it negatively affected their daily activities. Conclusions: Work-related LBP is highly prevalent among physical therapists in the Makkah region of Saudi Arabia, significantly impacting both patient care and the therapists’ daily functioning. Full article
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14 pages, 710 KiB  
Article
Prognostic Factors for Responders of Home-Based Pulmonary Rehabilitation—Secondary Analysis of a Randomized Controlled Trial
by Chul Kim, Hee-Eun Choi, Chin Kook Rhee, Jae Ha Lee, Ju Hyun Oh and Jun Hyeong Song
Healthcare 2025, 13(3), 308; https://doi.org/10.3390/healthcare13030308 - 3 Feb 2025
Viewed by 156
Abstract
Background: Home-based pulmonary rehabilitation (PR) is an effective alternative to center-based PR. However, not all participants exhibit sufficient therapeutic improvement, highlighting the need to identify appropriate candidates to maximize cost-effectiveness. This study aimed to identify the factors associated with favorable outcomes in home-based [...] Read more.
Background: Home-based pulmonary rehabilitation (PR) is an effective alternative to center-based PR. However, not all participants exhibit sufficient therapeutic improvement, highlighting the need to identify appropriate candidates to maximize cost-effectiveness. This study aimed to identify the factors associated with favorable outcomes in home-based PR, focusing on the role of digital therapeutics (DTx). Methods: This secondary analysis used data from a randomized controlled trial. Participants with chronic respiratory disease (CRD) were divided into responders and non-responders based on a change in 6 min walk distance (6MWD) and patient-reported outcome measures (PROM) representing dyspnea and health-related quality of life. Factors such as baseline 6MWD, DTx use, and pulmonary function were analyzed for their predictive value in improving 6MWD and PROM scores. Results: Responders, particularly those using DTx, showed significantly greater improvements in 6MWD than non-responders. Participants with a baseline 6MWD under 500 m demonstrated a higher likelihood of exceeding the minimum clinically important difference in 6MWD. DTx use strongly predicted improvements in both 6MWD and PROM scores. The baseline diffusing capacity of the lungs for carbon monoxide was also a significant factor influencing improvements in the modified Medical Research Council scale. Conclusions: Responders to 8-week program of home-based PR exhibited a relatively lower baseline health status. Encouraging participants with poorer baseline health could improve adherence to PR and enhance cost-effectiveness. Additionally, improvements in 6MWD and PROM scores were associated with the use of DTx. Considering the functions of DTx, proper supervision for home-based exercise may be crucial for achieving optimal outcomes. Full article
(This article belongs to the Special Issue Application of Digital Services to Improve Patient-Centered Care)
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17 pages, 1285 KiB  
Article
Validation of a Questionnaire of Motivations for Moderated and Severe Alcohol Consumption Among College Students
by Abel Lerma, Jorge Alberto Soto-Huerta, Cristina J. González-Flores, Rebeca María Elena Guzmán-Saldaña, Diego Aguirre-Villegas and Claudia Lerma
Healthcare 2025, 13(3), 307; https://doi.org/10.3390/healthcare13030307 - 2 Feb 2025
Viewed by 354
Abstract
Objective: This work aimed to develop and validate a scale to assess motivations for alcohol drinking among Mexican college students. Methods: The scale design consisted of applying a stimulus phrase to assess motivations for moderate alcohol drinking (up to three drinks [...] Read more.
Objective: This work aimed to develop and validate a scale to assess motivations for alcohol drinking among Mexican college students. Methods: The scale design consisted of applying a stimulus phrase to assess motivations for moderate alcohol drinking (up to three drinks per occasion) and severe alcohol consumption (four or more drinks) in 130 college students. The semantic network technique was applied to identify 15 defining motivations (with more considerable semantic weight) for each drinking level, constituting the pilot scale. The pilot scale was validated on 307 students from a public university in Mexico (255 with moderate drinking and 82 with severe consumption). Results: The final number of items per level of drinking was 10 (moderate drinking) and 13 (severe consumption). Internal reliability (Cronbach’s alpha) for the first one was 0.886 with three factors that explain 57.5% of the total variance; the second had an alpha of 0.884 with four factors that explain 70.5% of the total variance. All the factors had positive correlations with the risk perception for alcohol drinking, and there was a positive correlation between severe consumption motivation and the risk perception for consumption of other substances. The confirmatory factor analysis showed that the proposed theoretical models adjust to the data with an error of approximately zero (i.e., RMSEA of 0.088 for moderate consumption and 0.074 for severe consumption), which also carefully measures the motivation for moderate and severe alcohol consumption among college students. Conclusions: The new scale is valid and reliable for assessing motivations for moderate and severe alcohol consumption in Mexican college students. This may be a valuable tool to design and evaluate interventions for the prevention of alcohol use among college students. 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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14 pages, 241 KiB  
Article
Personal and Organizational Factors as Predictors of Life Satisfaction Among Older Adults in Long-Term Care Settings
by Xiaoli Li, Cheng Yin, Juliana O. Abude-Aribo, Reagen Conklin and Elias Mpofu
Healthcare 2025, 13(3), 306; https://doi.org/10.3390/healthcare13030306 - 2 Feb 2025
Viewed by 229
Abstract
Background and Aims: Resident satisfaction is a critical indicator of the quality of care in long-term care facilities (LTCFs). Yet, the relative importance quality of care factors in predicting resident satisfaction remains unclear for guiding resident support initiatives. This study aims to identify [...] Read more.
Background and Aims: Resident satisfaction is a critical indicator of the quality of care in long-term care facilities (LTCFs). Yet, the relative importance quality of care factors in predicting resident satisfaction remains unclear for guiding resident support initiatives. This study aims to identify the relative contribution of personal and facility care service factors as predictors of satisfaction LTCF residents. Methods: This cross-sectional study enrolled a convenience sample of 399 older adult residents from LTCFs in Shanghai, Nanjing, and Changsha, China, from June to December 2023. The inclusion criteria were age 65 or older, fluency in speaking and reading simplified Chinese Mandarin, having resided in long-term care facilities for at least one month, and cognitive competence to comprehend the questionnaires. Hierarchical multiple regressions were utilized to examine self-report survey data on ten resident personal variables, and seven care facility service domains were examined for their relative contribution to resident care satisfaction. Moreover, the analysis included the interaction between personal factors and care service attributes. Results: The combined personal and care service factors explained 26.1% of the variance in overall resident satisfaction. Personal factors that predicted resident satisfaction included age, level of independence, and length of stay (ΔR2 = 0.11). Of the care facility factors, the significant predictors of higher resident satisfaction were spending time (β = 0.60, p < 0.01, ΔR2 = 0.09) and environment domains (β = 0.62, p < 0.01, ΔR2 = 0.03). Age moderated the relationship between the spending time domain and overall satisfaction, with a positive effect for residents aged 70–79 compared to those aged 60–69 (β = −1.26, p < 0.05). Conclusions: This study provides evidence to suggest the importance of personal and care facility characteristics to LTFC resident satisfaction. Based on these findings, improved resident satisfaction is likely with LTCF care services that provide tailored care plans using resident characteristics. Full article
(This article belongs to the Section Health Informatics and Big Data)
23 pages, 3514 KiB  
Review
A Bibliometric Analysis of Healthcare Intervention-Related Studies Reporting Patient and Public Involvement and Engagement
by Wenze Lu, Yan Li, Jed Montayre, Mengqi Li, Ka Yan Ho, Jiaying Li and Janelle Yorke
Healthcare 2025, 13(3), 305; https://doi.org/10.3390/healthcare13030305 - 2 Feb 2025
Viewed by 289
Abstract
Background/Objectives: Patient and public involvement and engagement (PPIE) has gained global recognition as an innovative healthcare research practice. PPIE engages end-users throughout the research process, improving intervention effectiveness, resource efficiency, and user satisfaction. Despite its increasing inclusion in studies, comprehensive bibliometric reviews of [...] Read more.
Background/Objectives: Patient and public involvement and engagement (PPIE) has gained global recognition as an innovative healthcare research practice. PPIE engages end-users throughout the research process, improving intervention effectiveness, resource efficiency, and user satisfaction. Despite its increasing inclusion in studies, comprehensive bibliometric reviews of healthcare intervention-related studies reporting PPIE are scarce. This study aims to conduct a bibliometric analysis of healthcare intervention-related studies reporting PPIE in recent decades to identify key worldwide bibliometric features, themes, and trends. Methods: The analysis includes 10,624 relevant English articles published in the Web of Science (WoS) Core Collection up to 26 November 2024. Search terms were selected based on PPIE conceptualization, interventional types, and related healthcare terms. Using WoS descriptive analysis and CiteSpace, we examined bibliometric features and identified major international themes and trends. Results: There has been a significant increase in the number of healthcare intervention-related studies reporting PPIE over the past five years, especially from the United States and the United Kingdom, with a recent rise in Asia. However, cross-national collaboration remains limited. Key research themes identified include “community participation”, “health equity”, “coronary heart disease”, “web-based patient empowerment”, “mental illness”, and “obesity prevention”, with growing interest in “mobile health” and “digital health”. Conclusions: This study provides a comprehensive and up-to-date overview of the bibliometric characteristics and evolving trends in healthcare intervention-related studies reporting PPIE. It highlights global regions with limited PPIE implementation, suggests pathways for further development, and identifies key research themes. The study offers researchers and practitioners valuable insights into tracking PPIE trends in healthcare interventions and fostering collaborations on evidence-based PPIE studies with leading scholars and institutions worldwide. Additionally, the findings drive innovations aimed at improving patient and public healthcare outcomes. Full article
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18 pages, 1139 KiB  
Article
Somatization and Body Composition: Findings from a Cross-Sectional Study on Non-Clinical Young Adults
by Marius Baranauskas, Ingrida Kupčiūnaitė, Jurgita Lieponienė and Rimantas Stukas
Healthcare 2025, 13(3), 304; https://doi.org/10.3390/healthcare13030304 - 2 Feb 2025
Viewed by 255
Abstract
Background/Objectives: Lifestyle is a significant, common, and easily modifiable factor capable of increasing or reducing the risk of acquiring many diseases. Currently, there is a research gap as too little scientific attention has been focused on exploring the relationship between mental health and [...] Read more.
Background/Objectives: Lifestyle is a significant, common, and easily modifiable factor capable of increasing or reducing the risk of acquiring many diseases. Currently, there is a research gap as too little scientific attention has been focused on exploring the relationship between mental health and nutritional status in various populations. Moreover, the association between body composition and somatization has not been fully disclosed. Therefore, this study aimed to assess the associations of body composition with the symptomatology of somatization in an environmentally vulnerable sample of young adults. Methods: A single cross-sectional study included young non-clinical Lithuanian students (n = 1223) aged 21.7 ± 3.9. The body adiposity status of the study participants was estimated using both the body mass index (BMI) and the Body Adiposity Estimator (CUN-BAE) method. Fat-free mass was evaluated via the adjusted fat-free mass index equation (FFMIadj). The Patient Health Questionnaire (PHQ-15) was applied to assess the severity of the perceived symptoms of a somatic symptom disorder (SSD). Results: The CUN-BAE was considered to be a better predictor of adiposity than the BMI because 14.7% of females and 6.2% of males were interpreted as obese using the CUN-BAE, while the BMI equation identified participants as having a normal body weight. The highest rates of somatization were found in 18.6% of the cohort. Young adults with higher amounts of body fat mass (β: 0.050, 95% confidence interval (95% CI): 0.013; 0.084, p = 0.007) and lower FFMI are prone to a higher risk for developing somatization (β: −0.429, 95% CI: −0.597; −0.260, p < 0.001). Conclusions: Our study revealed that body composition is significantly related to multiple somatic complaints throughout a range of measurements. However, in contrast to the CUN-BAE tool, the BMI equation underestimated the relationship between body fat and mental health outcomes in young adults. Even though nutritional status along with targeted physical load, as the mediators, are likely to play a significant role in the maintenance of optimal body composition and mental health outcomes, healthcare providers are recommended to advise individuals to lower their body fat percentage and increase fat-free mass in order to reduce the risk of somatization. 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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21 pages, 1013 KiB  
Article
Environment Disaster: A Cross-Sectional Study of the Determinants for the Preparation of Azorean Nurses
by Eunice Gatinho Pires, Paulo Nogueira, Maria Adriana Henriques, Miguel Arriaga and Andreia Silva Costa
Healthcare 2025, 13(3), 303; https://doi.org/10.3390/healthcare13030303 - 2 Feb 2025
Viewed by 270
Abstract
Background/Objectives: Climate change increases the vulnerability of regions, communities, and individuals, stressing the urgent requirement to prepare health professionals in alignment with the Sustainable Development Goals. To foster sustainable and resilient communities, it is essential to integrate disaster preparedness into health education and [...] Read more.
Background/Objectives: Climate change increases the vulnerability of regions, communities, and individuals, stressing the urgent requirement to prepare health professionals in alignment with the Sustainable Development Goals. To foster sustainable and resilient communities, it is essential to integrate disaster preparedness into health education and practice. By equipping nurses with essential knowledge and skills, healthcare systems can be better prepared to respond to the challenges of climate change and disasters, contributing to safer and more resilient urban environments. This study aims to identify the factors that determine nurses’ preparedness for disaster situations. Methods: A cross-sectional online survey was conducted through digital platforms among 230 nurses across the Azores to assess their preparedness for disaster management. A structured questionnaire, adapted from the validated Disaster Preparedness Evaluation Tool (DPET©), was administered to registered nurses affiliated with the Nursing Council. The sample was chosen for convenience, and data were analyzed using IBM® SPSS Statistics, employing descriptive statistics, Cronbach’s alpha for measuring internal consistency, independent samples t-tests, and one-way ANOVA for comparative analysis. Ethical oversight was obtained from the Ethics Committee of the Azores, ensuring confidentiality and the voluntary nature of participation. Results: The findings revealed concerns about nurses’ disaster response, with 70% of participants indicating low ability. While knowledge was relatively strong (M = 5.50, SD = 1.07), practical competence showed a moderate score (3.51, SD = 1.797). Additional education is necessary in areas such as family preparation (M = 2.58, SD = 1.569), patient management during responses (M = 3.43, SD = 1.312), disaster-specific knowledge (M = 2.95, SD = 1.45), and recovery management (M = 2.53, SD = 1.363). Conclusions: Despite increased knowledge and awareness of climate change and its global impact, there is a need for more meaningful nursing interventions to minimize the impact of climate change on the community. This study highlights that nurses have an in-depth knowledge of communities’ needs, which puts them in a unique position to influence disaster preparation and response. By developing these strategies, nurses contribute significantly to communities’ resilience in climate change, improving society’s ability to respond and adapt to these challenges. Full article
(This article belongs to the Special Issue Health Education and Prevention: New Healthcare Perspectives for Emerging Challenges)
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12 pages, 196 KiB  
Article
Tetanus Vaccine Knowledge, Beliefs, and Attitudes Among Syrian Pregnant Women in Türkiye: A Qualitative Study
by Zeynep Meva Altaş, Bayan Abdulhaq, Mehmet Akif Sezerol and Selma Karabey
Healthcare 2025, 13(3), 302; https://doi.org/10.3390/healthcare13030302 - 2 Feb 2025
Viewed by 224
Abstract
Background: In this qualitative study, we aimed to evaluate the knowledge, beliefs, and attitudes of Syrian pregnant women living in Türkiye toward tetanus vaccination, vaccine hesitations, and the perceived benefits and harms of the tetanus vaccine. Methods: In face-to-face, in-depth interviews, an open-ended, [...] Read more.
Background: In this qualitative study, we aimed to evaluate the knowledge, beliefs, and attitudes of Syrian pregnant women living in Türkiye toward tetanus vaccination, vaccine hesitations, and the perceived benefits and harms of the tetanus vaccine. Methods: In face-to-face, in-depth interviews, an open-ended, semi-structured interview guide was used by an interviewer and translator who spoke Arabic, which is the mother tongue of the participants. Codes, themes, and subthemes were created. Results: In the study, face-to-face in-depth interviews were conducted with a total of 16 pregnant women. The median age of the pregnant women was 26.5 years (18.0–41.0). The median time since they arrived in Türkiye as migrants was 8.5 years (3.0–10.0). The themes were “Beliefs about vaccines”, “Information about vaccines”, “Knowledge, beliefs and attitudes about tetanus vaccine”, “Reasons for vaccination desire”, “Reasons for not being vaccinated”, and “Problems experienced while receiving health services”. Pregnant women mostly mentioned that vaccines have benefits. Most of the women stated that tetanus vaccine is needed to protect from diseases. There were no women thinking that vaccines are harmful. Some of them only mentioned the minor side effects observed after vaccination. Participants mentioned that they get information about vaccines from relatives such as family and friends, health professionals, television, and social media. However, some women talked about the fact that they had no knowledge about vaccines. A lack of knowledge and not visiting the health institution were the reasons for not being vaccinated. Conclusions: Although participants mostly believed that vaccination is necessary and has benefits, some women had no idea about the exact purpose of vaccines. This lack of knowledge may cause vaccine hesitancy and refusal. Full article
(This article belongs to the Special Issue Healthcare for Immigrants and Refugees)
19 pages, 697 KiB  
Article
The Relationship of the Psychological Resilience and Stress Coping Level of Health Personnel Working in Hospitals After Kahramanmaraş-Based Earthquakes with Traumatic Stress
by Mehmet Koca, Serdar Deniz and Feyza İnceoğlu
Healthcare 2025, 13(3), 301; https://doi.org/10.3390/healthcare13030301 - 2 Feb 2025
Viewed by 181
Abstract
Objectives: In this study, we aimed to examine the indirect and direct effects of the stress experienced by health workers after an earthquake on their psychological resilience. Methods: This study was conducted using the Structural Equation Model on 315 employees serving in hospitals [...] Read more.
Objectives: In this study, we aimed to examine the indirect and direct effects of the stress experienced by health workers after an earthquake on their psychological resilience. Methods: This study was conducted using the Structural Equation Model on 315 employees serving in hospitals in Kahramanmaraş, Gaziantep, Şanlıurfa, Diyarbakır, Adana, Adıyaman, Osmaniye, Hatay, Kilis, Malatya, and Elazığ (11 provinces) that were most affected by the earthquake. Results: The study group consisted of 58.4% (n = 184) women and 41.6% (n = 131) men. The mean score on the Psychological Resilience Scale was 71.74, the mean score on the Coping with Stress Scale was 87.17, the mean score on the Traumatic Stress Symptom Scale was 44.04, and the mean score on the Disability Scale was 3.75. Psychological resilience had a statistically significant negative effect on traumatic stress symptoms (β1 = −0.26; p = 0.001 < 0.05). There was a statistically significant positive relationship between coping with stress and psychological resilience (β1 = 0.52; p = 0.001 < 0.05). Conclusions: It was concluded that an increase in an individual’s psychological resilience will increase the level of coping with stress, and the traumatic stress symptoms of individuals with an increased level of coping with stress will decrease. Full article
(This article belongs to the Special Issue Innovative Treatments for Post-traumatic Stress Disorder (PTSD))
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8 pages, 1800 KiB  
Case Report
Prurigo Pigmentosa Associated with a Ketogenic Diet in a Romanian Patient: A Case Report
by Carmen Andrada Iliescu, Cristina Beiu, Tiberiu Tebeică and Liliana Gabriela Popa
Healthcare 2025, 13(3), 300; https://doi.org/10.3390/healthcare13030300 - 2 Feb 2025
Viewed by 211
Abstract
Background/Objectives: Prurigo pigmentosa (PP) is a rare inflammatory dermatosis characterized by recurrent pruritic eruptions resolving with reticulated hyperpigmentation. Initially described in young Asian women, PP is increasingly reported worldwide, often linked to ketosis-inducing factors such as low-carbohydrate diets. This report documents the first [...] Read more.
Background/Objectives: Prurigo pigmentosa (PP) is a rare inflammatory dermatosis characterized by recurrent pruritic eruptions resolving with reticulated hyperpigmentation. Initially described in young Asian women, PP is increasingly reported worldwide, often linked to ketosis-inducing factors such as low-carbohydrate diets. This report documents the first case of PP in a Romanian patient and highlights the importance of recognizing the condition in diverse populations. Methods: We describe a 16-year-old girl with a six-month history of pruritic eruptions on the neck, trunk, shoulders, and thighs. A detailed clinical assessment was conducted, including dietary history, physical examination, laboratory evaluation of urinary ketones, and skin biopsy for histopathological analysis. Results: Clinical examination revealed erythematous papules and plaques with peripheral pustules and post-inflammatory hyperpigmentation. Substantial weight loss and elevated urinary ketone levels suggested dietary-induced ketosis from a strict low-carbohydrate diet. Histopathological findings confirmed the diagnosis of PP. The patient’s skin lesions resolved following carbohydrate reintroduction and doxycycline therapy. Conclusions: This case highlights the association between ketosis and PP, emphasizing the importance of thorough dietary history-taking and histopathological confirmation for accurate diagnosis. As ketogenic diets become more popular globally, heightened awareness of PP is essential to ensure timely diagnosis and effective management. Full article
(This article belongs to the Special Issue Dermatological Health and Skin Integrity: Multidisciplinary Rehabilitation Strategies for Optimal Care)
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22 pages, 1472 KiB  
Systematic Review
A Systematic Review of Community-Based Exercise Interventions for Adults with Intellectual Disabilities
by Teresa Greene, Laurence Taggart and Gavin Breslin
Healthcare 2025, 13(3), 299; https://doi.org/10.3390/healthcare13030299 - 1 Feb 2025
Viewed by 399
Abstract
Background: Adults with intellectual disabilities are a particularly inactive sub-population who experience disproportionally poorer health and social exclusion when compared with the wider general population. This systematic review aimed to identify whether community-based exercise interventions were theoretically underpinned, whether they had an [...] Read more.
Background: Adults with intellectual disabilities are a particularly inactive sub-population who experience disproportionally poorer health and social exclusion when compared with the wider general population. This systematic review aimed to identify whether community-based exercise interventions were theoretically underpinned, whether they had an active single- or multi-exercise component, and how the interventions were objectively and/or subjectively measured, as well as deducing if they improved the health of this population. Method: A systematic search of five databases was conducted up to May 2024. The study was registered in PROSPERO and followed PRISMA reporting guidelines. Study methodological quality was appraised using the Critical Appraisal Skills Programme. Risk of bias was determined using the Cochrane collaboration tools ROB 2 and ROB 2 CRT. Articles were eligible for inclusion if they recruited adults with intellectual disability, were community-based, had an active exercise component and measured physical activity (PA) levels as an outcome measure. Results: In total, 9034 records were identified, with five studies meeting the eligibility criteria. All studies used a feasibility RCT or RCT methodology and all focused on weight loss or PA levels as the primary outcome measure. Two studies focused on walking as a single exercise, two combined walking with nutrition/weight loss, and one combined walking with aerobics. One multi-component walking and aerobics intervention led to statistically significant improvements in PA. Multi-component community-based exercise interventions led to statistically significant improvements in body composition measures. No studies showed statistically significant improvements in quality of life. Risk of bias was rated moderate to high across all included studies. Conclusions: Caution should be taken in drawing firm conclusions due to the small number of included studies, small sample sizes and high risk of bias. Multi-component community-based interventions are more effective at improving PA levels in adults with intellectual disabilities than walking-only studies. Future studies should be theoretically underpinned and explore the use of peer and student models of social support. The use of fitness facilities such as leisure centres and gyms requires further exploration in this population. Full article
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11 pages, 1674 KiB  
Review
Long COVID Research, 2020–2024: A PubMed-Based Bibliometric Analysis
by Cristina Honorato-Cia, Elena Cacho-Asenjo, Antonio Martinez-Simon, Irene Aquerreta and Jorge M. Núñez-Córdoba
Healthcare 2025, 13(3), 298; https://doi.org/10.3390/healthcare13030298 - 1 Feb 2025
Viewed by 255
Abstract
Long COVID is a SARS-CoV-2 infection-associated chronic condition with great potential to impact health and socioeconomic outcomes. The research efforts to face the challenges related to long COVID have resulted in a substantial amount of publications, which warrants the need for bibliometric profiling. [...] Read more.
Long COVID is a SARS-CoV-2 infection-associated chronic condition with great potential to impact health and socioeconomic outcomes. The research efforts to face the challenges related to long COVID have resulted in a substantial amount of publications, which warrants the need for bibliometric profiling. This is a large-scale PubMed-based bibliometric analysis of more than 390,000 COVID-19 publications. The overall aim was to update the profile of long COVID publications in comparison with the rest of the COVID-19 scientific literature through December 2024. The estimated proportion of long COVID publications was relatively low (2.3% of all COVID-19 publications), although the cumulative frequency (n = 8928) continues to pose a challenge for proper information management. Currently, “treatment” and “mechanism” appear to be the most predominant research topics in the long COVID literature. Interestingly, this evaluation revealed a distinctive profile of the long COVID literature, with a clear preponderance of “case report” and “mechanism” research topics when compared with other COVID-19 publications. This evaluation also identified and ranked the most prolific scientific journals in the production of long COVID-related publications. This study may improve the visibility of long COVID research and contribute to the management of the growing scientific knowledge on long COVID. Full article
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11 pages, 766 KiB  
Article
Satisfaction with Social Support and Quality of Life Among Portuguese Patients with Breast Cancer: Mediating Effects of Coping Styles—Cross-Sectional Study
by Joana Carreiro, Susana Cardoso, Pedro Teques, Andreia P. Teques and José Luís Pais-Ribeiro
Healthcare 2025, 13(3), 297; https://doi.org/10.3390/healthcare13030297 - 1 Feb 2025
Viewed by 346
Abstract
Background/Objectives: The purpose of this study was to analyze the mediating effects of coping styles on the relationship between satisfaction with social support (SSS) and quality of life (QoL) in breast cancer patients. Methods: A cross-sectional structural equation modeling (SEM) approach [...] Read more.
Background/Objectives: The purpose of this study was to analyze the mediating effects of coping styles on the relationship between satisfaction with social support (SSS) and quality of life (QoL) in breast cancer patients. Methods: A cross-sectional structural equation modeling (SEM) approach was used to examine the mediating effects. The participants were 311 women who were breast cancer patients, aged between 27 and 86 years (M = 46.61, SD = 9.53). Results: SEM analyses showed that SSS was positively associated with fighting spirit (β = 0.31, p < 0.05), cognitive avoidance (β = 0.19, p > 0.05), and QoL (β = 0.21, p < 0.05), and negatively associated with helplessness–hopelessness (β = −0.28, p < 0.05). Furthermore, fighting spirit and helplessness–hopelessness showed significant relationships with QoL. Anxious preoccupation was negatively related to QoL. Furthermore, fighting spirit and helplessness–hopelessness showed significant relationships with quality of life (β = 0.18, p < 0.05; β = −0.15, p < 0.05, respectively). In addition, the mediation analysis revealed that coping styles (i.e., fighting spirit and helplessness–hopelessness) mediated the relationship between SSS and QoL. Conclusions: The findings suggest that perceptions of SSS from family and friends may promote perceived QoL via adaptive coping, such as fighting spirit and helplessness–hopelessness strategies to deal with the cancer experience. Full article
(This article belongs to the Special Issue Multidisciplinary Approaches in Cancer Healthcare)
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18 pages, 735 KiB  
Review
Mindfulness Meditation for Sleep Disturbances Among Individuals with Cognitive Impairment: A Scoping Review
by Sunny H. W. Chan, Richard Cheston, Charlotte Steward-Anderson, Chong-Ho Yu, Emily Dodd and Elizabeth Coulthard
Healthcare 2025, 13(3), 296; https://doi.org/10.3390/healthcare13030296 - 31 Jan 2025
Viewed by 354
Abstract
Background: This scoping review investigates the effectiveness of mindfulness meditation in alleviating sleep disturbances among individuals with mild cognitive impairment (MCI) and Alzheimer’s disease (AD). With the rising prevalence of dementia and its profound impact on cognitive function and quality of life, [...] Read more.
Background: This scoping review investigates the effectiveness of mindfulness meditation in alleviating sleep disturbances among individuals with mild cognitive impairment (MCI) and Alzheimer’s disease (AD). With the rising prevalence of dementia and its profound impact on cognitive function and quality of life, this review aims to synthesize existing research and identify gaps in the literature. Methods: We systematically searched six electronic databases (CINAHL, Embase, Medline, PsycINFO, PubMed, and Scopus) from 2004 to 2024, yielding 462 potentially relevant articles. Screening was conducted using ASReview, an AI ranking tool, which facilitated the selection of studies. Ultimately, seven studies that met our stringent eligibility criteria were included in the review. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines for reporting. Results: Our findings indicate that mindfulness meditation significantly improves sleep quality, reduces insomnia severity, and enhances overall well-being in this at-risk population. Notably, interventions that combine structured, face-to-face sessions with at-home practice emerged as the most effective. Conclusions: Despite these positive outcomes, methodological limitations, including small sample sizes and reliance on self-reported measures, underscore the need for more rigorous long-term studies. This review highlights the potential of mindfulness meditation as a low-cost, scalable intervention to improve sleep and cognitive health in older adults, paving the way for future research and clinical applications. Full article
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15 pages, 932 KiB  
Article
Evaluation of Social Media Addiction and Its Relationship with Anxiety and Academic Performance Among Medical and Non-Medical Students: A Cross-Sectional Study from Saudi Arabia
by Suhaj Abdulsalim, Mohammed Saif Anaam, Maryam Farooqui, Mohammed S. Alshammari, Saeed Alfadly, Jehad Alolayan, Anas Ahmad Aljarallah and Saud Alsahali
Healthcare 2025, 13(3), 295; https://doi.org/10.3390/healthcare13030295 - 31 Jan 2025
Viewed by 348
Abstract
Background: Social media (SM) use has become an integral aspect of daily life. Overutilization of SM can adversely impact an individual’s physical and emotional well-being, especially that of students. This study evaluated the potential impact of SM addiction on anxiety and academic performance [...] Read more.
Background: Social media (SM) use has become an integral aspect of daily life. Overutilization of SM can adversely impact an individual’s physical and emotional well-being, especially that of students. This study evaluated the potential impact of SM addiction on anxiety and academic performance among university students. Methods: A cross-sectional study was conducted among medical ad non-medical students at Qassim University during September 2022–April 2023 after obtaining the Ethics Committee’s permission. Raosoft was used for calculating the sample size, and participants were selected through convenience sampling. Both descriptive and inferential statistics were used to analyze and interpret the results, using SPSS version 25. Results: A total of 269 students participated in the study. The majority of them were male (52%), with a mean age of 22.28. The main purpose of SM usage was entertainment, followed by communication. More than 30% of them were using SM for 4–6 h per day, accessing SM 1–10 times in a day, with more than half of them feeling that they had SM addiction and that it was affecting their daily activities and sleep. The majority of them agreed that SM can be used for group discussion (78.1% vs. 71.6%) and knowledge sharing (93.7% vs. 90%). However, a statistically significant difference was observed about anxiety level between the two groups. A negative correlation was found between cumulative grade point average (CGPA) and anxiety level. Conclusion: The findings suggest that SM has both positive and negative effects on academic performance and social anxiety. Continuous education and motivation about wise use of SM is warranted among students by parents, university authorities, and policymakers. Full article
(This article belongs to the Topic Diversity, Educational Inclusion, Emotional Intelligence, Coping, and Other Factors That Influence Psychological Health and Well-Being)
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16 pages, 488 KiB  
Article
Investigating the Interplay Between Sleep, Anxiety, and Depression in Chronic Kidney Disease Patients: Implications for Mental Health
by Reynita Saguban, Asmaa Mohamed Ali AlAbd, Evalyn Rondilla, Joyce Buta, Salwa Ali Marzouk, Richard Maestrado, Chandrakala Sankarapandian, Sameer A. Alkubati, Romeo Mostoles Jr., Salman Amish Alshammari, Maha Sanat Alrashidi, Analita Gonzales, Grace Ann Lagura and Ferdinand Gonzales
Healthcare 2025, 13(3), 294; https://doi.org/10.3390/healthcare13030294 - 31 Jan 2025
Viewed by 239
Abstract
Background/Objectives: This study aims to determine the level of anxiety, depression, and sleep disturbances in patients with chronic kidney disease, as well as the interactions between the three comorbidities, and the implications it has for health practitioners. Methods: A descriptive cross-sectional study, following [...] Read more.
Background/Objectives: This study aims to determine the level of anxiety, depression, and sleep disturbances in patients with chronic kidney disease, as well as the interactions between the three comorbidities, and the implications it has for health practitioners. Methods: A descriptive cross-sectional study, following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, was implemented whereby 179 patients with chronic kidney disease attending a government hospital were recruited to this study. Results: Our results showed that 65.9% of the participants had the metrics of severe anxiety while 34.1 percent had moderate anxiety. Further, it was reported that more than half 51.4% of participants had poor sleep quality. The levels of depression reported by the patients were roughly 40.2% minimal depression, 29.6% mild, 21.2% moderate, and 8.9% depression that was severe. There was a significant correlation between mental health disease together with sociodemographic variables such as gender, marital status, educational status, and nationality (p < 0.05). Cut points of those aged 26–35 found younger patients experiencing higher anxiety levels (cut point (AOR = 2.792; p = 0.021)), and they also had poorer sleep quality (AOR = 0.403; p = 0.020). Conclusion: Our findings illustrate the importance of more frequent early mental health measures and strategies that help patients with chronic kidney diseases. The main study limitation was the cross-sectional design, which allows for correlational but not causal statements to be made. We address a gap in the literature with our results by noting specific demographic characteristics that are associated with poor mental health in chronic kidney disease populations and discuss practical and policy recommendations aimed at enhancing the mental well-being of chronic kidney disease patients. Full article
15 pages, 371 KiB  
Article
Examining Risk and Protective Factors for Suicidal Behaviors: A Cross-Sectional Study Among Portuguese Male Inmates
by Catarina Oliveira and Miguel Basto-Pereira
Healthcare 2025, 13(3), 293; https://doi.org/10.3390/healthcare13030293 - 31 Jan 2025
Viewed by 240
Abstract
Background/Objectives: Prison inmates face a significantly higher risk of acting on suicidal thoughts than the general population. However, Portuguese studies distinguishing inmates who think about suicide from those who attempt it remain scarce. Given this ideation-to-action distinction, the current cross-sectional study aimed to [...] Read more.
Background/Objectives: Prison inmates face a significantly higher risk of acting on suicidal thoughts than the general population. However, Portuguese studies distinguishing inmates who think about suicide from those who attempt it remain scarce. Given this ideation-to-action distinction, the current cross-sectional study aimed to examine risk and protective factors for suicidal ideation, suicide attempts, and the transition from one outcome to another. Methods: A total of 411 male inmates (M = 37.94 years, SD = 10.91) from 16 Portuguese prisons participated in the study. Data were collected between 2020 and2024 using four instruments: (1) Sociodemographic Questionnaire; (2) Social and Emotional Competencies Questionnaire (SEC-Q); (3) Predictive Antisocial Spectrum Questionnaire; and (4) Health Risk Behavior Checklist. Results: Among the total sample, 29.1% reported a lifetime history of suicidal ideation, and 19.4% had attempted suicide. Impulsivity/irresponsibility emerged as a key risk factor for suicidal ideation, whereas social and emotional competencies of self-management and motivation were protective factors against suicide attempts. Previous self-harm behavior was the only risk factor for both suicidal ideation and suicide attempts. Conclusions: Our findings provide important insights into risk and protective factors for suicidal behaviors among male inmates, offering key information for policy and practice efforts aimed at reducing mortality in this high-risk population. Full article
14 pages, 224 KiB  
Article
Moments of Care: Perceptions of Young Carers and Day-to-Day Well-Being
by Melinda S. Kavanaugh, Matthew J. Zawadzki, Kayla T. Johnson and Miranda R. Boville
Healthcare 2025, 13(3), 292; https://doi.org/10.3390/healthcare13030292 - 31 Jan 2025
Viewed by 324
Abstract
Background/Objectives: Over 5 million youth under the age of 19 provide daily, hands-on care to an ill or injured family member across the United States. Yet how these young carers perceive the care they deliver in the moment, and how these perceptions relate [...] Read more.
Background/Objectives: Over 5 million youth under the age of 19 provide daily, hands-on care to an ill or injured family member across the United States. Yet how these young carers perceive the care they deliver in the moment, and how these perceptions relate to well-being, is unexplored, particularly in complex neurological conditions. This paper presents initial data on young carers for a family member with amyotrophic lateral sclerosis (ALS). Methods: Ecological momentary assessment (EMA) was used to measure perceptions of care in the moments of care and the cognitive and emotional states of the young carers during those moments. Young carers (n = 15) aged 10–19 were followed for seven days, completing assessments three times per day, which provided 260 total measurements. Young carers reported frequently engaging in caregiving (~39% of assessments). Results: The results indicated that it was not simply performing a caregiving task that related to outcomes, but rather how caregiving moments were perceived that mattered. Caregiving moments perceived as more fulfilling resulted in young carers feeling less discontent and more focused, whereas caregiving moments perceived as lacking resources predicted more discontent and distress. Exploratory analyses highlighted the potential for burden for young carers. They reported high levels of worry when they were not around the care recipient, with this worry predicting feeling more discontent and distressed. Conclusions: Young carers are deeply involved in care and perceive care differently across moments, both positive and negative. These initial data can be used to develop targeting support programs in the moment of care, potentially lessening the negative impacts of care. Full article
(This article belongs to the Special Issue Young Carers: Prevention, Intervention, Services and Outcomes—What Works?)
11 pages, 214 KiB  
Article
The Determinants of Men’s Health Behaviors: A Cross-Sectional Study Among Public Safety Personnel in Kelantan, Malaysia
by Muhammad Iqbal Haji Mukhti and Mohd Ismail Ibrahim
Healthcare 2025, 13(3), 291; https://doi.org/10.3390/healthcare13030291 - 31 Jan 2025
Viewed by 315
Abstract
Background: Men’s health behaviors influence health outcomes but remain understudied in high-risk occupational groups. This study examines determinants of health behaviors among public safety personnel using Andersen’s Behavioral Model. Methods: A cross-sectional study was conducted among 257 male public safety personnel in Kelantan, [...] Read more.
Background: Men’s health behaviors influence health outcomes but remain understudied in high-risk occupational groups. This study examines determinants of health behaviors among public safety personnel using Andersen’s Behavioral Model. Methods: A cross-sectional study was conducted among 257 male public safety personnel in Kelantan, Malaysia. Participants were selected through simple random sampling. Data were collected using proforma and the validated Malay Health Behavior Inventory-Short Form (MHBI-SF). Multiple logistic regression identified factors associated with poor health behaviors. Results: Key risk factors for poor health behaviors included reliance on parental influence (AOR: 5.54; 95% CI: 1.74–17.64) and restricted healthcare access during leisure time (AOR: 4.70; 95% CI: 1.43–15.49). Protective factors included peer influence (AOR: 0.19; 95% CI: 0.05–0.71) and transportation support (AOR: 0.22; 95% CI: 0.06–0.79). Conclusions: Addressing barriers to healthcare access and enhancing social support are critical to promoting healthy behaviors among men in high-risk occupations. Targeted interventions can reduce health disparities and improve outcomes. Full article
26 pages, 661 KiB  
Article
Communication Tapestry: Health Literacy Mediates Public Trust in Physician Health Information in Pakistani Public Hospitals
by Dake Wang, Talib Hussain and Wang Weiying
Healthcare 2025, 13(3), 290; https://doi.org/10.3390/healthcare13030290 - 31 Jan 2025
Viewed by 260
Abstract
Background/Objectives: This study explores the multifaceted factors influencing public trust in healthcare services provided by doctors in public hospitals in Pakistan. The objective is to examine the relationships between various determinants such as doctors' reputation and expertise, patient participation in decision-making, communication clarity, [...] Read more.
Background/Objectives: This study explores the multifaceted factors influencing public trust in healthcare services provided by doctors in public hospitals in Pakistan. The objective is to examine the relationships between various determinants such as doctors' reputation and expertise, patient participation in decision-making, communication clarity, health literacy levels, and trust in prescribed medications to provide actionable insights for improving healthcare trust. Methods: A total of 550 patients from public hospitals were surveyed, and data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). This approach enabled the identification of intricate relationships between the key factors influencing trust in healthcare services. Results: The findings indicate that patient participation in decision-making and transparent communication significantly enhance trust in prescribed medications. Additionally, health literacy emerged as a crucial factor, with higher levels of understanding leading to greater confidence in healthcare services. Conclusions: The study highlights the importance of patient-centered care, clear communication strategies, and health literacy initiatives in strengthening public trust in healthcare systems. Practical recommendations are provided for policymakers, healthcare professionals, and researchers to collaboratively improve healthcare service delivery and foster public confidence. Full article
18 pages, 614 KiB  
Article
Exploring the Pain Situation, Pain Impact, and Educational Preferences of Pain Among Adults in Mainland China, a Cross-Sectional Study
by Jiafan He, Mimi Mun Yee Tse, Tyrone Tai On Kwok, Timothy Chung Ming Wu and Shukkwan Tang
Healthcare 2025, 13(3), 289; https://doi.org/10.3390/healthcare13030289 - 31 Jan 2025
Viewed by 248
Abstract
Objectives: This study aimed to investigate the pain situation, functional limitations, treatment used, care-seeking behaviors, and educational preferences of adults with pain in mainland China. Methods: An online questionnaire was developed through expert validation, and participants were recruited via social media platforms. Inclusion [...] Read more.
Objectives: This study aimed to investigate the pain situation, functional limitations, treatment used, care-seeking behaviors, and educational preferences of adults with pain in mainland China. Methods: An online questionnaire was developed through expert validation, and participants were recruited via social media platforms. Inclusion criteria required having access to the Internet and smartphones, while individuals with significant cognitive impairments or severe mental illness were excluded. Results: 1566 participants, predominantly male (951) with a mean age of 30.24, were included. A total of 80.1% of the respondents reported experiencing pain, with over half suffering from chronic pain. Pain primarily affects the neck, lower back, and upper back, especially chronic low back pain. Pain significantly impacted various aspects of life, including mood, physical activity, work performance, family dynamics, and social relationships, particularly among chronic pain sufferers (p-value:  < 0.001). Analgesics (66.9%) and self-management (80–94.3%) were the most used pain management strategies, with respondents with chronic pain reporting higher usage and effectiveness of medication than those with acute pain (p-value:  < 0.001). Participants also expressed a greater interest in online education and psychotherapy interventions, especially through mobile applications. Conclusions: Chronic pain is highly prevalent in mainland China, leading to emotional distress, decreased work competency, and social isolation, with a strong demand for pain education through smartphone applications. Full article
(This article belongs to the Special Issue Pain Management in Healthcare Practice)
15 pages, 282 KiB  
Review
The Legal and Ethical Dimensions of Hospital Visitation Bans in the COVID-19 Era
by Nicholas Lassi, Su Jiang and Yu Du
Healthcare 2025, 13(3), 288; https://doi.org/10.3390/healthcare13030288 - 31 Jan 2025
Viewed by 332
Abstract
Background/Objectives: The COVID-19 pandemic compelled countries worldwide to implement stringent visitation restrictions across hospitals, nursing homes, and long-term care facilities to mitigate viral transmission. While initially justified by the uncertainty surrounding the virus, these restrictions often lasted well beyond the acute stage of [...] Read more.
Background/Objectives: The COVID-19 pandemic compelled countries worldwide to implement stringent visitation restrictions across hospitals, nursing homes, and long-term care facilities to mitigate viral transmission. While initially justified by the uncertainty surrounding the virus, these restrictions often lasted well beyond the acute stage of the pandemic, leading to substantial psychological and physical harm, particularly for older adults. This study assesses the effects of these controls and offers strategies to balance public health priorities with patients’ rights and psychological well-being during public health crises. Methods: An integrative review and comparative analysis of legislative measures and the psychological effects of visitation restrictions was undertaken. International and national visitation regulations and case studies were reviewed, and ethical frameworks were considered. Results: Our findings indicate that prolonged isolation due to extended visitation restrictions led to higher rates of anxiety, depression, and delirium among patients, creating ethical dilemmas for healthcare providers. Legal responses to this challenge varied globally. International human rights organizations called for policies bridging public health priorities with patients’ rights to family and caregiver support. Some U.S. states enacted proactive legislation to strengthen family visitation rights, while other jurisdictions lack these visitation protections. Conclusions: Prolonged visitation restrictions during the pandemic show the need for legislation integrating public health protections with in-person family and caregiver support. The ethical imperatives of limiting the psychological harm caused by healthcare isolation and the legislative solutions to protect public health and the psychological well-being of patients during health crises are discussed. Full article
(This article belongs to the Special Issue Innovation in Hospital Management: Strategies and Efforts for Patient and Healthcare Workers Safety and Prevention of Claims: 2nd Edition)
17 pages, 883 KiB  
Article
A Computational Framework Analysis of Public Attitudes Toward Male Human Papillomavirus Infection and Its Vaccination in China: Based on Weibo Data
by Xuan Zhou, Hao Gao and Jun Wang
Healthcare 2025, 13(3), 287; https://doi.org/10.3390/healthcare13030287 - 31 Jan 2025
Viewed by 314
Abstract
Background/Aims: The global promotion of HPV vaccines has underscored the importance of vaccination for both males and females in reducing disease transmission and associated complications. Despite robust evidence supporting male HPV vaccination, China has yet to approve it. Public discussions on male HPV [...] Read more.
Background/Aims: The global promotion of HPV vaccines has underscored the importance of vaccination for both males and females in reducing disease transmission and associated complications. Despite robust evidence supporting male HPV vaccination, China has yet to approve it. Public discussions on male HPV vaccination, influenced by policy delays, gender norms, and commercialization, reveal diverse attitudes and significant challenges in achieving equitable health outcomes. This study investigates public perceptions and attitudes toward male HPV vaccination in China by analyzing cognitive frames and the social, cultural, and economic factors shaping these discussions. Methods: This study employs a cross-sectional design to analyze 4997 Sina Weibo posts using the Analysis of Topic Model Networks (ANTMN), identifying five frames: Disease Risk and Prevention, Virus Transmission, Gender Roles and Perceptions, Vaccine Promotion and Acceptance, and Market Dynamics and Consumption. Results: The findings reveal a significant gap between policy implementation and public awareness of male HPV vaccination in China. Despite growing recognition of its benefits, entrenched gender norms and biases hinder equitable health outcomes. Social media, as a pivotal platform for health communication, plays a dual role in facilitating public discourse while also amplifying misinformation. Policy delays and concerns over vaccine commercialization heighten public hesitancy, emphasizing the need for inclusive policies and targeted education. Conclusions: This study highlights the necessity for systemic efforts to address gender biases, enhance public education on male HPV vaccination, and rebuild trust in vaccination programs. A multifaceted approach is required to bridge these gaps, integrating policy reforms, inclusive health communication strategies, and equitable vaccine access. These measures aim to promote awareness and increase vaccination uptake among males in China, ultimately contributing to more comprehensive and equitable public health outcomes. Full article
(This article belongs to the Special Issue HPV Vaccine and Cervical Cancer Prevention)
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14 pages, 430 KiB  
Article
Telehealth Perceived Benefits and Self-Efficacy Do Not Mediate the Effects of Demographic, Health, and Social Determinants on Telehealth Use of Low-Income African American and Latino Residents of Public Housing in Los Angeles
by Sharon Cobb, Attallah Dillard, Ehsan Yaghmaei, Mohsen Bazargan and Shervin Assari
Healthcare 2025, 13(3), 286; https://doi.org/10.3390/healthcare13030286 - 31 Jan 2025
Viewed by 405
Abstract
Background: Marginalized low-income racial and ethnic minority residents of public housing represent an intersectional population with multiple health needs and low healthcare utilization. Telehealth has been proposed as a solution to address healthcare access disparities, yet the role of telehealth attitudes, including perceived [...] Read more.
Background: Marginalized low-income racial and ethnic minority residents of public housing represent an intersectional population with multiple health needs and low healthcare utilization. Telehealth has been proposed as a solution to address healthcare access disparities, yet the role of telehealth attitudes, including perceived benefits and self-efficacy, in influencing telehealth use of this population remains unknown. Objective: This study investigates whether two domains of telehealth attitudes, namely self-efficacy and perceived benefits (expectancy), mediate the relationship between demographic, health, and social determinants of telehealth use among low-income racial and ethnic minority residents of public housing in Los Angeles. Methods: This cross-sectional study analyzed data collected from low-income racial and ethnic minority residents of public housing in Los Angeles. Measures included demographic factors (age and gender), social determinants of health (e.g., education, language, and primacy care provider), health (chronic illnesses and physical mobility), telehealth attitudes (perceived benefits and self-efficacy), and telehealth use frequency. Mediation analysis was conducted to test whether telehealth attitudes explained the association between demographic, social, and health determinants of telehealth use. Results: The findings revealed that neither of the two domains of telehealth attitudes, including perceived benefits and self-efficacy, were significantly associated with telehealth use. As such, these attitude domains did not operate as mediators of the relationship between demographic, health, and social determinants of telehealth use. Conclusion: The study results suggest that structural barriers, rather than individual attitudes, primarily drive telehealth use disparities among this intersectional population. Interventions aimed at increasing telehealth adoption should prioritize addressing systemic inequities rather than focusing solely on changing individual attitudes. These findings underscore the importance of structural solutions to promote equitable telehealth access in marginalized communities. Full article
(This article belongs to the Special Issue The Role of Telemedicine in Transforming Healthcare Delivery—Capabilities and Barriers)
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16 pages, 241 KiB  
Article
International Partnerships in Health Education: Adapting E-Learning Models for Conflict-Affected Myanmar
by Clelia D’Apice and Massimo Guasconi
Healthcare 2025, 13(3), 285; https://doi.org/10.3390/healthcare13030285 - 31 Jan 2025
Viewed by 407
Abstract
Background: In the wake of Myanmar’s 2021 military coup, the University of Parma, in partnership with Myanmar and Brazilian institutions, developed an asynchronous e-learning program to sustain healthcare education amid severe disruptions. The program aimed to address urgent training needs in emergency medicine, [...] Read more.
Background: In the wake of Myanmar’s 2021 military coup, the University of Parma, in partnership with Myanmar and Brazilian institutions, developed an asynchronous e-learning program to sustain healthcare education amid severe disruptions. The program aimed to address urgent training needs in emergency medicine, public health management, and mental health, aligning with Sustainable Development Goals. Methods: An educational needs assessment involving 298 surveys and 10 interviews identified training priorities. Based on these findings, a four-module e-learning course was created, covering basic life support, trauma care, pediatric emergencies, and psychological assistance. The course utilized prerecorded high-fidelity telesimulations with multilingual support to ensure accessibility. Evaluation included participant satisfaction using the MSSE questionnaire and knowledge acquisition through post-module quizzes. Results: Over 750 students participated, with significant knowledge acquisition observed—60% scored 8 or higher across all modules. The MSSE questionnaire, completed by 152 students, revealed high satisfaction, with 88% agreeing that the course enhanced clinical reasoning, decision-making, and self-reflection Conclusions: This program demonstrates the value of international partnerships and e-learning in sustaining medical education during crises. High student engagement and strong learning outcomes affirm its efficacy. Future iterations will aim to improve completion rates, refine feedback mechanisms, and expand accessibility. This scalable model offers a blueprint for addressing healthcare training needs in conflict-affected and resource-limited settings, contributing to global health resilience and the achievement of Universal Health Coverage. Full article
(This article belongs to the Special Issue UN Sustainable Development Goals (SDGs) Beyond 2023 Agenda: The Role of International Partnerships and Alliances Towards Equitable Access to Care)
12 pages, 910 KiB  
Article
Leveraging Machine Learning to Predict and Assess Disparities in Severe Maternal Morbidity in Maryland
by Qingfeng Li, Y. Natalia Alfonso, Carrie Wolfson, Khyzer B. Aziz and Andreea A. Creanga
Healthcare 2025, 13(3), 284; https://doi.org/10.3390/healthcare13030284 - 31 Jan 2025
Viewed by 350
Abstract
Background: Severe maternal morbidity (SMM) is increasing in the United States. The main objective of this study is to test the use of machine learning (ML) techniques to develop models for predicting SMM during delivery hospitalizations in Maryland. Secondarily, we examine disparities in [...] Read more.
Background: Severe maternal morbidity (SMM) is increasing in the United States. The main objective of this study is to test the use of machine learning (ML) techniques to develop models for predicting SMM during delivery hospitalizations in Maryland. Secondarily, we examine disparities in SMM by key sociodemographic characteristics. Methods: We used the linked State Inpatient Database (SID) and the American Hospital Association (AHA) Annual Survey data from Maryland for 2016–2019 (N = 261,226 delivery hospitalizations). We first estimated relative risks for SMM across key sociodemographic factors (e.g., race, income, insurance, and primary language). Then, we fitted LASSO and, for comparison, Logit models with 75 and 18 features. The selection of SMM features was based on clinical expert opinion, a literature review, statistical significance, and computational resource constraints. Various model performance metrics, including the area under the receiver operating characteristic curve (AUC), accuracy, precision, and recall values were computed to compare predictive performance. Results: During 2016–2019, 76 per 10,000 deliveries (1976 of 261,226) were in patients who experienced an SMM event. The Logit model with a full list of 75 features achieved an AUC of 0.71 in the validation dataset, which marginally decreased to 0.69 in the reduced model with 18 features. The LASSO algorithm with the same 18 features demonstrated slightly superior predictive performance and an AUC of 0.80. We found significant disparities in SMM among patients living in low-income areas, with public insurance, and who were non-Hispanic Black or non-English speakers. Conclusion: Our results demonstrate the feasibility of utilizing ML and administrative hospital discharge data for SMM prediction. The low recall score is a limitation across all models we compared, signifying that the algorithms struggle with identifying all SMM cases. This study identified substantial disparities in SMM across various sociodemographic factors. Addressing these disparities requires multifaceted interventions that include improving access to quality care, enhancing cultural competence among healthcare providers, and implementing policies that help mitigate social determinants of health. Full article
(This article belongs to the Special Issue Research into Women's Health and Care Disparities)
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19 pages, 379 KiB  
Systematic Review
Enhancing High Reliability in Oncology Care: The Critical Role of Nurses—A Systematic Review and Thematic Analysis
by Hiroko Komatsu, Akemi Hara, Fumiko Koyama and Yasuhiro Komatsu
Healthcare 2025, 13(3), 283; https://doi.org/10.3390/healthcare13030283 - 31 Jan 2025
Viewed by 370
Abstract
Background/objectives: The oncology setting is complex and recognized as a high-risk area, with an increased potential for errors due to the complexity of therapeutic modalities and different processes. Nurses are pivotal in fostering a culture of patient safety and high reliability and actively [...] Read more.
Background/objectives: The oncology setting is complex and recognized as a high-risk area, with an increased potential for errors due to the complexity of therapeutic modalities and different processes. Nurses are pivotal in fostering a culture of patient safety and high reliability and actively contribute to the enhancement of safety standards in oncology care. This review systematically identified and examined the critical role of nurses in promoting high reliability within oncology organizations to ensure optimal patient outcomes. Methods: A systematic review was performed in the PubMed, CINAHL, and Cochran Library databases in accordance with PRISMA guidelines. Using Tomas and Harden’s three stages, 12 studies were deductively and thematically analyzed to discover themes. Results: We identified eight themes concerning nurses’ roles in achieving high reliability in healthcare within oncology organizations: establishing standardized and safe administration, enhancing situational awareness, promoting effective communication, advocating for patients, building a culture of safety, leading safety culture improvements, engaging staff, and fostering patient engagement. Conclusions: Nurses play a critical role in identifying, communicating, and correcting safety threats, overcoming various organizational barriers to safety concerns, and maintaining and developing a culture of safety for patients and families. Although this review included a relatively limited body of literature, the findings highlight the need for further research that considers the unique characteristics of health and healthcare systems. Protocol registry; UMIN Clinical Trials Registry (UMIN-CTR) Registry No. UMIN000056140. Full article
(This article belongs to the Special Issue Mental Health and Nursing Care of Individuals with Cancer and Their Families—2nd Edition)
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7 pages, 7911 KiB  
Case Report
Successful Management of Calciphylaxis with Sodium Thiosulfate in End-Stage Renal Disease: A Case Report
by Mohamed A. Albekery, Munirah K. Alkulaib, Ahmed A. Alanazi, Lulwah T. Alturki, Muthana A. Al Sahlawi, Ramy I. Abulikailik and Elbadri I. Abdelgadir
Healthcare 2025, 13(3), 282; https://doi.org/10.3390/healthcare13030282 - 31 Jan 2025
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Abstract
Introduction: Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is a rare and potentially fatal condition primarily affecting patients with end-stage renal disease (ESRD) on hemodialysis (HD). It is characterized by calcification in small blood vessels, leading to painful skin ulcers and high [...] Read more.
Introduction: Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is a rare and potentially fatal condition primarily affecting patients with end-stage renal disease (ESRD) on hemodialysis (HD). It is characterized by calcification in small blood vessels, leading to painful skin ulcers and high mortality rates. Case Description: This is a case of a 42-year-old female with ESRD on HD who developed calciphylaxis, presenting with non-healing ulcers on her thighs. Discussion: Despite initial treatments, including wound care and pain management, her condition did not improve. A skin biopsy was inconclusive, highlighting the diagnostic challenges associated with calciphylaxis. Based on clinical judgment, warfarin and calcium-based therapies were discontinued, and the patient’s HD regimen was adjusted. Due to the persistence of symptoms, sodium thiosulfate (STS) therapy was initiated, leading to significant improvement in her ulcers after six months of treatment. Conclusions: This case highlights the importance of clinical judgment in the diagnosis and management of calciphylaxis, particularly when histopathological diagnostic methods yield inconclusive results. Clinical criteria, alongside a thorough assessment of the patient’s history and presentation, are vital for achieving a timely diagnosis in such challenging cases. The successful use of sodium thiosulfate in this patient adds to the growing body of evidence supporting its use as a potential treatment for calciphylaxis, especially in cases that do not respond to conventional therapy. Full article
(This article belongs to the Special Issue Real-Life Advances in Chronic Kidney Disease)
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