Healthcare

11 pages, 757 KiB

Open AccessArticle

Effect of a Practice-Oriented Electronic Medical Record Education Program for New Nurses

by Jae-Kyun Ju and Hye-Won Jeong

Healthcare 2025, 13(4), 365; https://doi.org/10.3390/healthcare13040365 (registering DOI) - 8 Feb 2025

Background/Objectives: New nurses often face challenges in adapting to clinical environments, particularly in mastering electronic medical record (EMR) systems, which are critical for effective patient care and communication. This study aimed to evaluate the effectiveness of a practice-oriented EMR education program designed [...] Read more.

Background/Objectives: New nurses often face challenges in adapting to clinical environments, particularly in mastering electronic medical record (EMR) systems, which are critical for effective patient care and communication. This study aimed to evaluate the effectiveness of a practice-oriented EMR education program designed to improve new nurses’ EMR competencies. Methods: A quasi-experimental pretest–post-test design with a non-equivalent control group was employed. Fifty-four new nurses employed for less than a year participated, with 25 in the intervention group and 29 in the comparison group. The intervention group underwent five weekly sessions focused on core EMR tasks, including admission nursing, operation/procedure documentation, patient transfer/discharge, night duties, and SBAR handovers. The program, led by clinical nurse educators, incorporated lectures, practical exercises, and Q&A sessions. EMR competencies were assessed using a validated 5-point Likert scale. Results: The intervention group showed significant improvements across all assessed domains, with post-program scores significantly higher than those of the comparison group. The most notable improvements were in operation/procedure documentation and patient transfer/discharge tasks. The comparison group’s gains were limited, likely reflecting natural skill acquisition through clinical experience. Conclusions: The practice-oriented EMR education program effectively enhanced new nurses’ EMR competencies. The program’s structured approach, which combined theoretical instruction with extensive hands-on practice and department-specific adaptations, proved particularly effective in improving complex documentation tasks. The integration of comprehensive EMR training into nursing curricula and the expansion of such programs to other institutions are recommended for broader implementation. Full article

(This article belongs to the Section Nursing)

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11 pages, 262 KiB

Open AccessArticle

Comparison of Readmission, Discharge Location and Mortality over Three Years Post-Discharge Between Patients Diagnosed with Hospital-Acquired Malnutrition and Those Malnourished on Admission—A Retrospective Matched Case–Control Study in Five Facilities

by Breanne Hosking, Lynda Ross, Angela Vivanti, Sally Courtice, Amanda Henderson, Fiona Naumann, Rachel Stoney and Michelle Palmer

Healthcare 2025, 13(4), 364; https://doi.org/10.3390/healthcare13040364 (registering DOI) - 8 Feb 2025

Abstract

Background/Objectives: Increased mortality and poor post-discharge outcomes are common in malnourished inpatients. It is unknown whether post-discharge outcomes differ between patients with hospital-acquired malnutrition (HAM) or malnutrition present on admission (MPOA), which could impact nutrition processes within healthcare systems and hospital-acquired-complication policy. This [...] Read more.

Background/Objectives: Increased mortality and poor post-discharge outcomes are common in malnourished inpatients. It is unknown whether post-discharge outcomes differ between patients with hospital-acquired malnutrition (HAM) or malnutrition present on admission (MPOA), which could impact nutrition processes within healthcare systems and hospital-acquired-complication policy. This retrospective matched case–control study compared mortality, discharge location and readmission at 3-, 12- and 36-months post-discharge between HAM and MPOA patients. Methods: The eligible patients were ≥18 years, malnourished and stayed in hospital for >14 days between 2015 and 2019. HAM patients were 1:1 matched with MPOA patients for age (±3 years), sex, facility and year of admission and further categorised by age group (18 < 65, ≥65 years). The data were obtained from medical records included demographics, mortality, discharge location and readmissions. Statistical tests were used to compare the groups. Results: There were 350 eligible patients (n = 175 HAM, 65 ± 18 years, 37%F, 88% moderately malnourished, 71% from hospitals with >500 beds). HAM and MPOA patients had similar post-discharge mortality (n = 51/175 (29%) vs. n = 64/175 (37%), p > 0.172) and discharge locations (n = 101/111 (81%) vs. n = 91/124 (82%) resided at home, p = 1.00) at 36 months. Of those readmitted to hospital (n= 268/350, 77%), days hospitalised post-discharge (HAM:17(6–40) vs. MPOA:19(8–39)) and number of readmissions (HAM:2(1–4) vs. MPOA:2(1–5)) were similar at 36 months (p > 0.05). However, older MPOA patients were more likely to readmit within 30 days (p = 0.007). Conclusions: Mortality was high but similar between MPOA and HAM patients up to 36 months post-discharge. Discharge location and readmissions were also similar between the groups, except that older MPOA patients were more likely to readmit to hospital within 30 days than older HAM patients. Mechanisms, such as nutrition policies and procedures, implementation of post-discharge nutrition interventions or allocation of post-discharge resources, should be explored further and should consider all long-stay malnourished patients, particularly those aged ≥65 years, to reduce preventable patient harm associated with malnutrition. Full article

(This article belongs to the Special Issue Clinical Nutrition Management in Healthcare)

23 pages, 612 KiB

Open AccessSystematic Review

Interactive Conversational Agents for Perinatal Health: A Mixed Methods Systematic Review

by Samira Amil, Sié-Mathieu-Aymar-Romaric Da, James Plaisimond, Geneviève Roch, Maxime Sasseville, Frédéric Bergeron and Marie-Pierre Gagnon

Healthcare 2025, 13(4), 363; https://doi.org/10.3390/healthcare13040363 (registering DOI) - 8 Feb 2025

Abstract

Background: Interactive conversational agents (chatbots) simulate human conversation using natural language processing and artificial intelligence. They enable dynamic interactions and are used in various fields, including education and healthcare. Objective: This systematic review aims to identify and synthesize studies on chatbots for women [...] Read more.

Background: Interactive conversational agents (chatbots) simulate human conversation using natural language processing and artificial intelligence. They enable dynamic interactions and are used in various fields, including education and healthcare. Objective: This systematic review aims to identify and synthesize studies on chatbots for women and expectant parents in the preconception, pregnancy, and postnatal period through 12 months postpartum. Methods: We searched in six electronic bibliographic databases (MEDLINE (Ovid), CINAHL (EBSCO), Embase, Web of Science, Inspec, and IEEE Xplore) using a pre-defined search strategy. We included sources if they focused on women in the preconception period, pregnant women and their partners, mothers, and fathers/coparents of babies up to 12 months old. Two reviewers independently screened studies and all disagreements were resolved by a third reviewer. Two reviewers independently extracted and validated data from the included studies into a standardized form and conducted quality appraisal. Results: Twelve studies met the inclusion criteria. Seven were from the USA, with others from Brazil, South Korea, Singapore, and Japan. The studies reported high user satisfaction, improved health intentions and behaviors, increased knowledge, and better prevention of preconception risks. Chatbots also facilitated access to health information and interactions with health professionals. Conclusion: We provide an overview of interactive conversational agents used in the perinatal period and their applications. Digital interventions using interactive conversational agents have a positive impact on knowledge, behaviors, attitudes, and the use of health services. Interventions using interactive conversational agents may be more effective than those using methods such as individual or group face-to-face delivery. Full article

(This article belongs to the Special Issue Healthcare Goes Digital: Mobile Health and Electronic Health Technology in the 21st Century)

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18 pages, 254 KiB

Open AccessArticle

The Use of Narratives as a Therapeutic Tool Among Latin American Immigrant Women: Processes of Reconstruction and Empowerment in Contexts of Vulnerability

by Mª Dolores Pereñíguez, José Palacios, Paloma Echevarría, Isabel Morales-Moreno and Aarón Muñoz

Healthcare 2025, 13(4), 362; https://doi.org/10.3390/healthcare13040362 (registering DOI) - 8 Feb 2025

Abstract

Background/Objectives: This study explores how narratives can act as therapeutic tools for Latin American immigrant women residing in the Region of Murcia, Spain. The objective is to analyse how the act of narrating their migratory experiences contributes to emotional relief, the re-signification of [...] Read more.

Background/Objectives: This study explores how narratives can act as therapeutic tools for Latin American immigrant women residing in the Region of Murcia, Spain. The objective is to analyse how the act of narrating their migratory experiences contributes to emotional relief, the re-signification of their trajectories, and the construction of resilience, while strengthening identity and fostering a sense of belonging in contexts marked by exclusion and inequalities in gender and class. Methods: A qualitative methodology was used with a narrative and gender approach. The field work was carried out between 2022 and 2023, with a sample of 20 women selected through snowball sampling. Data were collected through in-depth interviews and analysed through an inductive approach using MAXQDA 24.5 software. The emerging categories reflected the emotional experience and meanings constructed during the migration process. Results: The narratives revealed five key categories: emotional relief of social suffering through expression, reconstruction of identity and re-signification of experiences, emotional validation and strengthening of identity, empowerment and symbolic resistance, and sense of belonging and connection. Likewise, it was observed that the interviews created therapeutic spaces that strengthened the bond between researcher and participant. Conclusions: The narratives contribute to processing emotions and redefining traumatic experiences, while also allowing greater agency in the participating women. This approach highlights the transformative potential of narrative research to generate situated knowledge and promote inclusive practices in contexts of vulnerability. Full article

(This article belongs to the Section Women's Health Care)

11 pages, 451 KiB

Open AccessArticle

Associations of Mentally Active Versus Passive Sedentary Behavior with Overweight/Obesity in Adults: Role of Patterns and Sex

by Daliya S. Alobaid and Abdullah B. Alansare

Healthcare 2025, 13(4), 361; https://doi.org/10.3390/healthcare13040361 (registering DOI) - 8 Feb 2025

Abstract

Objectives: This study assessed associations of total and mental-activity-based sedentary behavior (SB) with the risk of being overweight or obese in adults. The role of sex and SB patterns and the effects of statistically exchanging different mental-activity-based SBs on body mass index [...] Read more.

Objectives: This study assessed associations of total and mental-activity-based sedentary behavior (SB) with the risk of being overweight or obese in adults. The role of sex and SB patterns and the effects of statistically exchanging different mental-activity-based SBs on body mass index (BMI) were explored. Methods: Participants (n = 1154) from the Saudi Post-COVID-19 Sedentary Behavior Survey self-reported demographics, health-related variables, and last-measured body height and weight. BMI was calculated to classify adults as normal weight or overweight/obese. The Sedentary Behavior Questionnaire estimated total and mentally active and passive SB per day, during weekdays, and on weekends. Adjusted logistic regression and isotemporal substitution models assessed the associations of SBs with the risk of being overweight or obese and the effects of displacing mental-activity-based SBs on BMI, respectively. Results: No significant relationships were observed in the overall sample (p > 0.05). Once sex was considered, the risk of being overweight or obese increased between 5.2% and 10.7% for each hour increase in total and mentally active SBs per day and on weekends in men only (p < 0.05 for all). Replacing one hour of mentally active SB with mentally passive SB resulted in non-significant effects on BMI (p > 0.05). Conclusions: These findings reveal the importance of distinguishing between SBs based on mental activity for more optimal obesity outcomes, particularly in men. Importantly, exchanging mental-activity-based SBs does not appear to be an effective behavioral strategy to reduce obesity. Obesity prevention and management plans should target reducing total and mentally active SBs daily and on weekends. Full article

(This article belongs to the Special Issue Obesity and Overweight: Prevention, Causes and Treatment)

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15 pages, 253 KiB

Open AccessArticle

Self-Reported Medical Errors and Primary Care Physicians’ Performance and Confidence in Delivering Care: A Multilevel Empirical Study in China

by Xueshan Sun, Zhongliang Zhou and Wenhua Wang

Healthcare 2025, 13(4), 360; https://doi.org/10.3390/healthcare13040360 (registering DOI) - 8 Feb 2025

Abstract

Background/Objectives: Patient safety is fundamental to primary healthcare, and medical errors impose a considerable burden on patients globally. However, the impact of medical errors on primary healthcare physicians remains understudied, especially in developing countries. This study aimed to examine the associations between self-reported [...] Read more.

Background/Objectives: Patient safety is fundamental to primary healthcare, and medical errors impose a considerable burden on patients globally. However, the impact of medical errors on primary healthcare physicians remains understudied, especially in developing countries. This study aimed to examine the associations between self-reported medical errors and physicians’ performance and confidence in Chinese primary care practice. Methods: A cross-sectional survey was conducted from November 2021 to May 2022 with 224 primary care physicians from 38 community health centers (CHCs) across four large cities in China. The quality of clinical and preventative care, and confidence in managing commonly occurring diseases, multimorbidity, and common mental health disorders served as indicators of performance and confidence, respectively. Hierarchical linear regression and linear regression with cluster-robust standard errors were employed. Results: Clinical care quality (β = −0.159, SE = 0.075, p < 0.05), preventive care quality (β = −0.165, SE = 0.068, p < 0.05), confidence in managing multimorbidity (β = −0.175, SE = 0.074, p < 0.05), and confidence in managing common mental health disorders (β = −0.189, SE = 0.076, p < 0.05) were negatively associated with self-reported medical errors, with scores of 4.08 (SD 0.95), 3.59 (SD 0.87), 3.63 (SD 1.04), and 3.10 (SD 1.21) out of 5 (where 5 represents the best possible score), respectively. The association between self-reported medical errors and confidence in managing commonly occurring diseases (β = −0.063, SE = 0.075, p > 0.05) was not statistically significant, with a score of 3.81 (SD 1.00) out of 5 (where 5 represents the best possible score). Conclusions: This study offers new insight into the associations between self-reported medical errors and primary healthcare physicians’ performance and confidence. It is crucial for CHCs to be aware of the impact of self-reported medical errors on physicians’ performance in delivering clinic and preventative care, and confidence in managing multimorbidity and common mental health disorders. Strategies such as strengthening organizational support should be developed to maintain performance and rebuild confidence in delivering care for physicians who were involved in medical errors. Full article

10 pages, 201 KiB

Open AccessArticle

Stress and Anxiety Are Associated with Increased Metabolic Syndrome Risk Among Young Adults Living in the Deep South

by Megan E. Renna, Faith N. Wilbourne, Sonal Johal, Ava K. Fergerson, Kylee F. Behringer, Caleb F. Brandner, Jon Stavres and Austin J. Graybeal

Healthcare 2025, 13(4), 359; https://doi.org/10.3390/healthcare13040359 (registering DOI) - 8 Feb 2025

Abstract

Background/Objectives: This study assessed the association among perceived stress, anxiety, and depression with both the metabolic syndrome (MetS) risk and diagnostic status among young adults in the Deep South. Methods: Participants included 132 young adults aged 18–39 (M_age = 27.73, [...] Read more.

Background/Objectives: This study assessed the association among perceived stress, anxiety, and depression with both the metabolic syndrome (MetS) risk and diagnostic status among young adults in the Deep South. Methods: Participants included 132 young adults aged 18–39 (M_age = 27.73, SD = 11.11; M_BMI = 27.6, SD = 6.8; 56.5% female; 55.7% White) living in Mississippi. In addition to completing self-report measures of perceived stress, anxiety, and depression, all of the participants underwent anthropometric, blood pressure, and fasting blood glucose and lipid assessments to ascertain the MetS status. The participants were provided with both a MetS diagnosis (defined as a dichotomous yes/no variable) as well as a continuous MetS risk severity score determined using existing equations. The risk scores ranged from −1 to +1, with positive scores indicating an increased risk for MetS. Results: After controlling for age, biological sex, race, medication use, and education level, multiple regression models revealed significant positive relationships between perceived stress (b = 0.03; p = 0.017) and anxiety symptoms (b = 0.01; p = 0.039) with the MetS severity. Perceived stress (p = 0.017) and anxiety symptoms (p = 0.043) were also significantly higher among participants with MetS compared to those without. There were no significant associations between the MetS severity and depressive symptoms, and no differences in depressive symptoms in participants with versus without MetS. Conclusions: The results highlight the role of stress and anxiety not only in MetS but in the overall metabolic risk among young adults living in the Deep South. The results highlight the importance of intervening on stress and anxiety early in adulthood to help mitigate cardiometabolic health risk. Full article

(This article belongs to the Special Issue The Impact and Relationship of Lifestyle Behaviors and Mental Health)

13 pages, 1073 KiB

Open AccessArticle

Turkish Adaptation and Validation of Patient Participation Questionnaire (PPQ)

by Adil Aydoğdu and Mehmet Yorulmaz

Healthcare 2025, 13(4), 358; https://doi.org/10.3390/healthcare13040358 (registering DOI) - 8 Feb 2025

Abstract

Background/Objectives: The concept of patient participation is increasingly recognized as an important component in many areas, such as redesigning healthcare processes, improving patient safety, increasing satisfaction, and managing chronic diseases. In this context, measuring the level of patient participation in healthcare services [...] Read more.

Background/Objectives: The concept of patient participation is increasingly recognized as an important component in many areas, such as redesigning healthcare processes, improving patient safety, increasing satisfaction, and managing chronic diseases. In this context, measuring the level of patient participation in healthcare services is an important factor. The “Patient Participation Questionnaire” is a tool used to assess patients’ evaluations of their participation in their in-hospital care. The absence of a scale in the Turkish literature that measures this concept reveals the importance of this research. Methods: In this study conducted in a tertiary public hospital in Turkey, the final scale translated into Turkish was applied to 355 people using the convenience sampling method. In addition to the “Patient Participation Scale”, the “Patient Satisfaction Scale” was used for context validity in the study. Data were analyzed with SPSS 27 and AMOS programs. Results: As a result of the confirmatory factor analysis, the scale, which originally consisted of 16 questions and four dimensions, was adapted to Turkish as 14 questions and four dimensions. As a result of confirmatory factor analysis, the goodness of fit values of the scale were found to be x²/sd = 2.53, GFI = 0.93, AGFI = 0.90, CFI = 0.93, RMSEA = 0.066, RMR = 0.041, and NFI = 0.90. These values are within the acceptable and good fit level ranges. As a result of the correlation analysis performed for context validity, it was determined that there was a positive significant relationship between the adapted patient participation scale and the patient satisfaction scale (r = 0.692, p < 0.001). In addition, the internal consistency coefficient of the scale was examined to determine the reliability of the scale, and it was revealed that the scale was reliable at a good level (α = 0.86). Conclusions: Based on the findings, it was revealed that the “Patient Participation Scale” developed in English is a valid and reliable measurement tool in Turkish culture. Full article

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

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15 pages, 608 KiB

Open AccessReview

Fall Risk Assessment and Prevention Strategies in Nursing Homes: A Narrative Review

by Takeshi Miura and Yuka Kanoya

Healthcare 2025, 13(4), 357; https://doi.org/10.3390/healthcare13040357 (registering DOI) - 7 Feb 2025

Abstract

Background/Objectives: Falls in nursing homes significantly affect residents’ health and quality of life. Although considerable progress has been made in fall prevention strategies in acute care settings and community environments, research on fall risk assessment methods and prevention strategies in nursing homes remains [...] Read more.

Background/Objectives: Falls in nursing homes significantly affect residents’ health and quality of life. Although considerable progress has been made in fall prevention strategies in acute care settings and community environments, research on fall risk assessment methods and prevention strategies in nursing homes remains scarce. Nursing homes provide long-term care for residents with high levels of dependency, presenting unique challenges in managing fall risks. Nevertheless, unlike hospitals, nursing homes face operational constraints, such as limited resources and staffing. These factors necessitate a tailored approach to fall risk management. This study aimed to summarize the current knowledge of fall risk assessment and prevention methods in nursing homes, clarify practical insights for implementation, and identify research gaps based on studies published over the past five years. Methods: This narrative review targeted studies published between 2019 and 2024 on fall risk assessment and prevention methods in nursing homes. A literature search was conducted using the PubMed and CINAHL databases, combining keywords such as “Accident Prevention”, “Fall Risk Assessment”, “Nursing Homes”, “Long-Term Care”, and “Aged”. The inclusion criteria allowed the inclusion of peer-reviewed academic articles on fall risk assessment or prevention interventions in long-term care facilities published in English within the past five years. Studies focusing on community-dwelling older adults, hospitalized older adults, and review articles were excluded. Results: This review analyzed 55 studies; among them, 27 studies focused on fall risk assessment and 28 focused on fall prevention. Regarding fall risk assessment, widely used tools, such as the Morse Fall Scale, which is also utilized in medical settings, have been extensively examined. In addition, new predictive methods utilizing electronic health records (EHR) and wearable devices have been introduced. However, the limited number of reports highlights the potential challenges in developing indicators that consider the unique characteristics and feasibility of LTC facilities. Regarding fall prevention, studies have examined indirect approaches, such as environmental modifications, and direct interventions, such as exercise programs. Furthermore, staff education and organizational initiatives are crucial in implementing preventive measures. However, most studies have been conducted in experimental settings, with limited empirical research available to assess the practical applications of these strategies in real-world nursing home environments. Conclusions: Fall risk assessments in nursing homes lack practical indicators tailored to the specific characteristics of long-term care facilities. Although various digital technologies have been explored for fall prevention, empirical studies that validate their real-world applicability are lacking. Full article

(This article belongs to the Special Issue Fall Prevention and Geriatric Nursing)

11 pages, 705 KiB

Open AccessArticle

Association Between Calcium Level, Bone Mineral Density, and Hip Fracture: Analysis Based on NHANES Data

by Xiao Wang and Zisheng Ai

Healthcare 2025, 13(4), 356; https://doi.org/10.3390/healthcare13040356 (registering DOI) - 7 Feb 2025

Abstract

Introduction: The relationships between calcium, bone mineral density, and hip fracture have been studied for a long time, but there are still different opinions on the matter. The aim of this study was to decipher the relationship between these factors from National Health [...] Read more.

Introduction: The relationships between calcium, bone mineral density, and hip fracture have been studied for a long time, but there are still different opinions on the matter. The aim of this study was to decipher the relationship between these factors from National Health and Nutrition Examination Survey (NHANES) data. Methods: After we performed data cleaning for the obtained NHANES data, we used multiple imputation to obtain the complete data and conducted an analysis for different variables. First, by using multivariate linear regression models, we confirmed the association between calcium and bone mineral density, and then we confirmed the association between bone mineral density and hip fracture by using multivariate logistic regression models. A mediation analysis of these variables was performed. Results: The analysis in this study included data on 18,003 participants from the NHANES, and we were able to find a strong association between calcium and bone mineral density (p < 0.001). The association between bone mineral density and hip fracture was also significant (p < 0.001). One augmented gram of daily calcium intake was associated with a 0.04 unit increase in BMD level, and a one unit increase in BMD level could downgrade the occurrence of hip fracture for 5.4 times. The mediation analysis showed that the femur BMD level and total BMD level have a mediating relationship with hip fracture, and no clear relationship among calcium, BMD, and hip fracture could be established. Conclusions: Although it is difficult to draw strict conclusions from the mediation analysis in this study, we can observe a clear association between calcium and BMD as well as an association between BMD and hip fracture. Full article

20 pages, 655 KiB

Open AccessArticle

The Role of Short-Form Video Apps in Mitigating Occupational Burnout and Enhancing Life Satisfaction Among Healthcare Workers: A Serial Multiple Mediation Model

by Donghwa Chung, Yanfang Meng and Jiaqi Wang

Healthcare 2025, 13(4), 355; https://doi.org/10.3390/healthcare13040355 - 7 Feb 2025

Abstract

Background: The intersection of occupational burnout and digital leisure activities has garnered increasing scholarly attention in recent years. However, limited research has examined how Chinese healthcare workers engage with short-form video apps as a stress management tool. Objectives: This study employs [...] Read more.

Background: The intersection of occupational burnout and digital leisure activities has garnered increasing scholarly attention in recent years. However, limited research has examined how Chinese healthcare workers engage with short-form video apps as a stress management tool. Objectives: This study employs a serial multiple mediation model to explore the impact of occupational burnout on the use of short-form video apps and its subsequent effects on a sense of community, intrinsic rewards, and life satisfaction among Chinese healthcare workers aged 18–34. Methods: Data were collected through an online survey, with 362 valid responses, and analyzed using descriptive statistics, hierarchical regression, and mediation analyses, including serial mediation via SPSS 25.0. Results: The results demonstrate a positive direct association between occupational burnout and the use of short-form video apps. Furthermore, the relationship between the use of short-form video apps and life satisfaction was mediated through two distinct pathways, namely, a sense of community and intrinsic rewards. Conclusions: These findings contribute to the expanding body of literature on the role of digital media in stress management and well-being among healthcare workers, as well as highlighting evidence-based digital interventions to support healthcare workers’ well-being in high-stress settings. Full article

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

14 pages, 496 KiB

Open AccessArticle

Tele-Exercise for Fitness: Physical and Psychological Outcomes in Athletes and Non-Athletes’ Trainees

by Enzo Iuliano, Giovanna Zimatore, Antonio Fabbrizio, Andrea De Giorgio, Martina Sausa, Barbara Maria Matteo, Sonia Angilletta, Victor Machado Reis, Nuno D. Garrido, José Vilaça-Alves, Rafael Peixoto, Paulina Perusina, Aleksandra Aristova, Carlo Baldari, Filippo Macaluso, Alberto Fucarino and Manuela Cantoia

Healthcare 2025, 13(4), 354; https://doi.org/10.3390/healthcare13040354 - 7 Feb 2025

Abstract

Background: This research explored how tele-exercise influenced physical fitness and mental well-being in individuals with and without disabilities and with different training habits. Methods: One hundred and ninety-three participants were categorized into two groups: athletes and non-athletes. Participants were involved in [...] Read more.

Background: This research explored how tele-exercise influenced physical fitness and mental well-being in individuals with and without disabilities and with different training habits. Methods: One hundred and ninety-three participants were categorized into two groups: athletes and non-athletes. Participants were involved in either synchronous or asynchronous tele-exercise programs of two or three sessions of workouts per week, lasting eight weeks. Psychological well-being was evaluated pre- vs. post-intervention by the WHO-Five Well-Being Index (WHO-5), Psychological General Well-Being Index (PGWBI), and Perceived Stress Scale (PSS-10). Fitness assessment tools included the 2-minute step test, curl-up test, forward bending test, and squat test. Body weight was also assessed pre- and post-intervention. Results: The analysis showed a significant increment in all fitness scores (p-value ranged from <0.001 to 0.015) with no change in body weight. Psychological tests indicated an overall increment in the participants’ well-being measured by the WHO-5 and unexpectedly, also in the stress level assessed through PSS-10. Conclusions: Enabled by technology, tele-exercise provides a flexible and convenient complementary approach to conventional workouts, helping individuals maintain an active lifestyle and improve their well-being. Positive effects on the sedentary population’s lifestyles are discussed. Full article

(This article belongs to the Special Issue Exercise Therapy: Improving Functionality, Physical Health, and Quality of Life)

35 pages, 1635 KiB

Open AccessArticle

Towards Best-Practice Healthcare for Transgender Patients: Quality Improvement in United Kingdom General Practice

by Carine Silver, Rebecca Calvey, Alexandra Martin and Joanne Butterworth

Healthcare 2025, 13(4), 353; https://doi.org/10.3390/healthcare13040353 - 7 Feb 2025

Abstract

Introduction: The ongoing care of transgender patients in United Kingdom (UK) general practice (GP) is hampered by a lack of UK primary care guidelines regarding the monitoring of treatments, despite the key role that general practice has in holistic lifelong care. This quality [...] Read more.

Introduction: The ongoing care of transgender patients in United Kingdom (UK) general practice (GP) is hampered by a lack of UK primary care guidelines regarding the monitoring of treatments, despite the key role that general practice has in holistic lifelong care. This quality improvement project aimed to audit the monitoring of treatments and health screening in a GP practice population, across two large practices in southwest England, in order to drive local improvement and to identify gaps in wider healthcare support for this population. Mothods: This project updated a previously published audit instrument, incorporating a novel, pragmatic standard, based on up-to-date UK gender clinic guidelines and the UK population screening programmes. National Health Service (NHS) Health Research Authority and Medical Research Council processes were used to confirm that this quality improvement project did not require formal ethics committee approval. An audit against this standard was performed for 176 transgender and gender-minority patients, to provide data on the consistency of the monitoring of gender hormonal treatments and reminders for appropriate population health screening programmes. Results: A total of 16% of those undergoing hormonal treatments had received optimal monitoring; 20% were missing the most basic hormone level monitoring. Reminders regarding appropriate health screening were rare in patients who had changed the gender markers on their electronic record. Long waiting lists, the use of private clinics, confusion around responsibilities shared between primary and secondary care and growing complex co-morbidity were demonstrated. Conclusion: This project supports previous calls for consistent evidence-based guidelines, improved data systems and adequately resourced primary and secondary care services to support the safe and effective lifelong care of transgender patients. Full article

(This article belongs to the Section Family Medicine)

26 pages, 2864 KiB

Open AccessArticle

Assessing the Relationships of Expenditure and Health Outcomes in Healthcare Systems: A System Design Approach

by Anca Antoaneta Vărzaru

Healthcare 2025, 13(4), 352; https://doi.org/10.3390/healthcare13040352 - 7 Feb 2025

Abstract

Background/Objectives: The COVID-19 pandemic has significantly altered healthcare systems worldwide, highlighting healthcare expenditure’s critical role in fostering population resilience and wellness. This extraordinary situation has brought to light the delicate balance that governments must maintain between the need to protect public health [...] Read more.

Background/Objectives: The COVID-19 pandemic has significantly altered healthcare systems worldwide, highlighting healthcare expenditure’s critical role in fostering population resilience and wellness. This extraordinary situation has brought to light the delicate balance that governments must maintain between the need to protect public health and budgetary restraints. The relationship between healthcare expenditure and outcomes, such as healthy life years, health expectancy, and standardized death rate, has become a central point in understanding the dynamics of healthcare systems and their capacity to adapt to emerging challenges. Methods: Using extensive datasets and predictive approaches such as artificial neural networks, exponential smoothing models, and ARIMA techniques, this study explores these connections in the context of the European Union. Results: The study better explains how healthcare financing schemes influence important health outcomes by examining past trends and forecasting future developments. The results show that household healthcare expenditures correlate negatively with standardized death rates and substantially benefit healthy life years and health expectancy. These findings underline the significance of household contributions in influencing health outcomes across various healthcare systems. Long-term and strategic investments in health services are essential, as the pandemic has demonstrated the proactive capacity of well-designed healthcare systems to reduce risks and enhance overall resilience. The results suggest that focused investments can raise life expectancy and lower death rates, supporting the development of robust, adaptable healthcare systems in the post-pandemic era. Conclusions: The main contribution of this research is demonstrating the significant role of healthcare expenditure, particularly household contributions, in improving key health outcomes and fostering healthcare system resilience in the EU context. Full article

(This article belongs to the Special Issue Efficiency, Innovation, and Sustainability in Healthcare Systems)

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15 pages, 2004 KiB

Open AccessArticle

YouTube as a Source of Information for Dietary Guidance and Advisory Content in the Management of Non-Alcoholic Fatty Liver Disease

by Kagan Tur

Healthcare 2025, 13(4), 351; https://doi.org/10.3390/healthcare13040351 - 7 Feb 2025

Abstract

Background/Objectives: Fatty liver disease (FLD), particularly non-alcoholic fatty liver disease (NAFLD), is a growing global health concern that underscores the need for effective dietary management strategies. With over 25% of patients seeking dietary advice through platforms like YouTube, the quality and reliability [...] Read more.

Background/Objectives: Fatty liver disease (FLD), particularly non-alcoholic fatty liver disease (NAFLD), is a growing global health concern that underscores the need for effective dietary management strategies. With over 25% of patients seeking dietary advice through platforms like YouTube, the quality and reliability of this information remain critical. However, the disparity in educational value and engagement metrics between professional and non-professional content remains underexplored. This study evaluates YouTube’s role in disseminating dietary advice for FLD management, focusing on content reliability, engagement metrics, and the educational value of videos. Methods: This cross-sectional study systematically analyzed 183 YouTube videos on FLD and dietary advice. Videos were selected based on relevance, English language, and non-promotional content. Scoring systems, including DISCERN, Global Quality Score (GQS), and the Video Information and Quality Index (VIQI), were employed to assess reliability, quality, and educational value. Engagement metrics such as views, likes, dislikes, and interaction rates were analyzed across uploader categories, including healthcare professionals, patients, and undefined sources. Results: Videos uploaded by healthcare professionals demonstrated significantly higher DISCERN scores (4.2 ± 0.8) and GQS ratings (4.1 ± 0.6) compared to patient-generated content (DISCERN: 2.8 ± 0.9; GQS: 3.0 ± 0.7). However, patient-generated videos achieved higher engagement rates, with median views reaching 340,000 (IQR: 15,000–1,000,000) compared to 450,050 (IQR: 23,000–1,800,000) for professional videos. Nutritional recommendations spanned diverse approaches, including low-carb diets, Mediterranean diets, and guidance to avoid processed foods and sugars. A significant proportion of videos lacked evidence-based content, particularly among non-professional uploads. Conclusions: YouTube represents a widely accessed but inconsistent source of dietary advice for FLD. While healthcare professional videos exhibit higher reliability and educational value, patient-generated content achieves broader engagement, revealing a critical gap in trusted, accessible dietary guidance. These findings highlight the need for clinicians and content creators to collaborate in curating and disseminating evidence-based content, ensuring patients receive accurate, actionable advice for managing FLD. Full article

(This article belongs to the Special Issue Update on the Nutritional Management for Chronic and Communicable Diseases)

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17 pages, 1640 KiB

Open AccessArticle

Adoption of Artificial Intelligence in Rehabilitation: Perceptions, Knowledge, and Challenges Among Healthcare Providers

by Monira I. Aldhahi, Amal I. Alorainy, Mohamed M. Abuzaid, Awadia Gareeballah, Naifah F. Alsubaie, Anwar S. Alshamary and Zuhal Y. Hamd

Healthcare 2025, 13(4), 350; https://doi.org/10.3390/healthcare13040350 - 7 Feb 2025

Abstract

Background/Objectives: The current literature reveals a gap in understanding how rehabilitation professionals, such as physical and occupational therapists, perceive and prepare to implement artificial intelligence (AI) in their practices. Therefore, we conducted a cross-sectional observational study to assess the perceptions, knowledge, and willingness [...] Read more.

Background/Objectives: The current literature reveals a gap in understanding how rehabilitation professionals, such as physical and occupational therapists, perceive and prepare to implement artificial intelligence (AI) in their practices. Therefore, we conducted a cross-sectional observational study to assess the perceptions, knowledge, and willingness of rehabilitation healthcare providers to implement AI in practice. Methods: This study was conducted in Saudi Arabia, with data collected from 430 physical therapy professionals via an online SurveyMonkey questionnaire between January and March 2024. The survey assessed demographics, AI knowledge and skills, and perceived challenges. Data were analyzed using Statistical Package for the Social Science (SPSS 27) and DATAtab (version 2025), with frequencies, percentages, and nonparametric tests used to examine the relationships between the variables. Results: The majority of respondents (80.9%) believed that AI would be integrated into physical therapy in future, with 78.6% seeing AI as significantly impacting their work. While 61.4% thought that AI would reduce workload and enhance productivity, only 30% expressed concerns about AI endangering their profession. A lack of formal AI training was commonly been reported, with social media platforms being respondents’ primary source of AI knowledge. Despite these challenges, 85.1% expressed an eagerness to learn and use AI. Organizational preparedness was a significant barrier, with 45.6% of respondents reporting that their organizations lacked AI strategies. There were insignificant differences in the mean rank of AI perceptions or knowledge based on the gender, years of experience, and qualification degree of the respondents. Conclusions: The results demonstrated a strong interest in AI implementation in physical therapy. The majority of respondents expressed confidence in AI’s future utility and readiness to incorporate it into their practice. However, challenges, such as a lack of formal training and organizational preparedness, were identified. Overall, the findings highlight AI’s potential to revolutionize physical therapy while underscoring the necessity to address training and readiness to fully realize this potential. Full article

(This article belongs to the Special Issue Artificial Intelligence in Healthcare: Opportunities and Challenges)

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17 pages, 1097 KiB

Open AccessSystematic Review

by Alexandra Titopoulou, Eleftherios Vavoulidis, Chrysoula Margioula-Siarkou, Georgia Margioula-Siarkou, Aristarchos Almperis, Stamatios Petousis, Georgios Mavromatidis, Theodoros Dardavesis and Konstantinos Dinas

Healthcare 2025, 13(4), 349; https://doi.org/10.3390/healthcare13040349 - 7 Feb 2025

Abstract

Background/Objectives: Diagnosis-related group (DRG)-based financing, a subcategory of case-based payment models, has been established as the primary reimbursement scheme in most high-income countries. Almost 40 years thereafter, the impact of the reform on gynecologic oncology funding and recompensation has not been clearly [...] Read more.

Background/Objectives: Diagnosis-related group (DRG)-based financing, a subcategory of case-based payment models, has been established as the primary reimbursement scheme in most high-income countries. Almost 40 years thereafter, the impact of the reform on gynecologic oncology funding and recompensation has not been clearly elucidated. This systematic review aims to address the scarce bibliographic data, consolidate the information regarding DRG-based systems in gynecologic oncology, evaluate the advantages and challenges of its implementation worldwide, and examine alternative and complementary recompensation schemes in this context. Methods: A stringent and comprehensive literature review of original articles using online databases (Google Scholar and Pubmed) yielded 173 potential results. Results: These were further assessed for relevance and eligibility and, finally, an in-depth investigation of 15 articles was conducted. We concluded that, despite the fact that DRG-based financing may be beneficial in most healthcare scenarios, the reimbursement scheme is challenged in the context of gynecologic oncology. Conclusions: An innovative approach comprising a combination of the values of case-based and value-based payment models would extend healthcare services beyond acute treatments and propose new perspectives in holistic healthcare provision in a financially sustainable environment. Full article

(This article belongs to the Section Health Policy)

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15 pages, 239 KiB

Open AccessArticle

Associations Between Domains and Patterns of Sedentary Behavior with Sleep Quality and Duration in Pregnant Women

by Nada Khojah, Bethany Barone Gibbs, Saja Abdullah Alghamdi, Alawyah Alsalman, Om Kalthom Sowadi, Hadeel Saad, Ghareeb Omar Alshuwaier and Abdullah Bandar Alansare

Healthcare 2025, 13(3), 348; https://doi.org/10.3390/healthcare13030348 - 6 Feb 2025

Abstract

Objectives: To assess the associations of sedentary behavior (SB) with sleep quality and duration in pregnant women by trimesters and to consider SB domains and patterns. Methods: This investigation included 935 participants (age = 30.0 ± 5.6 years; first trimester = 24.1%, second [...] Read more.

Objectives: To assess the associations of sedentary behavior (SB) with sleep quality and duration in pregnant women by trimesters and to consider SB domains and patterns. Methods: This investigation included 935 participants (age = 30.0 ± 5.6 years; first trimester = 24.1%, second trimester = 33.9%, third trimester = 42.0%). The total, domains (leisure, occupational, commuting), and patterns (weekdays, weekends) of SB, as well as sleep quality and duration, were self-reported. Adjusted logistic regression models examined the associations of different SBs with the risk of poor sleep quality, not adhering to sleep duration guidelines (7–9 h/day), or being a short- or long-sleeper. Results: The odds of poor sleep quality were significantly higher by 14.2% and 7.4% for each hour increase in total and leisure SB on weekends, respectively. The odds of not adhering to sleep duration guidelines were significantly higher by 5.5% and 11.4% for each hour increase in total and leisure SB during weekdays, respectively; paradoxically, the odds of not complying with the sleep duration guidelines were significantly lower, ranging between 6.6% and 34.4% for each hour increase in total, leisure, or commuting SB on weekends. Further, when analyzed separately, the likelihood of being a short- or long-sleeper was highly variable across SB domains, with associations being more apparent in the first and third trimesters. Conclusions: The relationship between SB and healthy sleep during pregnancy was complex. These variable findings underscore the importance of considering domains and patterns of SB beyond simple total durations in future research to inform interventions and guidelines to improve sleep health during pregnancy. Full article

(This article belongs to the Special Issue Healthy Lifestyle for Pregnant and Postpartum Women)

16 pages, 787 KiB

Open AccessArticle

A Cross-Sectional Survey on the Management of Medication Adherence Among Healthcare Professionals in Saudi Arabia

by Wael Y. Khawagi, Fahad H. Baali, Norah M. Alnefaie, Shatha A. Albishi, Alla H. Al-swat, Dinan A. Alshahrani, Ragad A. Alshemaimri and Abdullah A. Alshehri

Healthcare 2025, 13(3), 347; https://doi.org/10.3390/healthcare13030347 - 6 Feb 2025

Abstract

Background/Objectives: Medication adherence is essential for effective healthcare, significantly influencing treatment success and overall health outcomes. However, there is limited understanding of how healthcare professionals in Saudi Arabia manage and support medication adherence. This study aims to examine physicians’ and pharmacists’ approaches to [...] Read more.

Background/Objectives: Medication adherence is essential for effective healthcare, significantly influencing treatment success and overall health outcomes. However, there is limited understanding of how healthcare professionals in Saudi Arabia manage and support medication adherence. This study aims to examine physicians’ and pharmacists’ approaches to managing medication adherence in Saudi Arabia by examining the methods used for adherence assessment, interventions to enhance adherence, and the challenges faced. Methods: A cross-sectional study was conducted over nine months using a self-administered online questionnaire. The study targeted physicians and pharmacists actively working in Saudi Arabia. The questionnaire was distributed through professional networks to ensure a broad and representative sample. Results: A total of 397 healthcare professionals met the inclusion criteria, comprising 81.1% pharmacists and 18.9% physicians. Direct patient inquiry was the most common assessment method, frequently or always used by 81.3% of physicians and 57.1% of pharmacists. Treatment response evaluation was similarly frequent (89.3% of physicians and 56.2% of pharmacists). Standardized tools, such as the Morisky Medication Adherence Scale, were underutilized (14.7%). Adherence-enhancing interventions focused on patient education, and their use was reported by 89.3% of physicians and 74.2% of pharmacists as frequent or always. Written information was more commonly used by pharmacists (65.8%) than physicians (45.3%). Barriers included excessive workloads and short consultation times (59.9%), absence of effective systems for tracking adherence (51.9%), lack of reliable tools for assessing adherence (48.9%), and insufficient training in behavioral interventions (48.1%). Conclusions: This study reveals significant differences in medication adherence management practices between physicians and pharmacists in Saudi Arabia, emphasizing their distinct roles. Key barriers, including excessive workload, limited consultation time, and inadequate tracking systems, hinder the adoption of evidence-based tools. Tailored interventions, enhanced interprofessional collaboration, and systemic support are essential to address these challenges and improve adherence management, ultimately enhancing patient outcomes. Full article

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