Healthcare

17 pages, 902 KiB

Open AccessArticle

Long-Term Trends in Laryngeal Cancer Incidence and Mortality in Central Serbia (1999–2023): A Joinpoint Regression Analysis

by Vladimir Nešić, Dragana Krstić Nešić, Sandra Šipetić Grujičić, Bojana Bukurov, Dragan Miljuš, Snežana Živković Perišić and Aleksandra Nikolić

Healthcare 2025, 13(13), 1633; https://doi.org/10.3390/healthcare13131633 - 7 Jul 2025

Viewed by 331

Abstract

Background/Objectives: Laryngeal cancer (LC) accounts for 1–3% of all malignant neoplasms. The aim of this study was to analyze temporal trends in the incidence and mortality of LC in Central Serbia over a 25-year period (1999–2023). Methods: Data on newly diagnosed cases and [...] Read more.

Background/Objectives: Laryngeal cancer (LC) accounts for 1–3% of all malignant neoplasms. The aim of this study was to analyze temporal trends in the incidence and mortality of LC in Central Serbia over a 25-year period (1999–2023). Methods: Data on newly diagnosed cases and deaths, stratified by sex and age group, were obtained from the Serbian Cancer Registry. Crude, age-specific, and age-standardized incidence and mortality rates were calculated. Joinpoint regression analysis was used to estimate average annual percent changes (AAPCs) and assess their statistical significance. Results: The average annual age-standardized incidence rate (ASR-W) was 11.1 per 100,000 in men and 1.4 in women, with corresponding mortality rates of 5.4 and 0.5, respectively. The highest incidence was observed in the 60–69 age group for both sexes (61.1/100,000 in men; 7.4/100,000 in women), while the highest mortality was recorded in individuals aged ≥70 (35.7/100,000 in men; 3.8/100,000 in women). A statistically significant annual decline among men was observed in both incidence (ASR-W: −0.7%) and mortality (ASR-W: −2.0%). In contrast, trends among women were not statistically significant, indicating overall stability. Conclusions: Although the Cancer Registry in Serbia faces limitations primarily due to data quality issues, it is a key tool for understanding LC trends, guiding health policies, and effectively allocating resources. Given the substantially higher burden among men, it is essential to strengthen tobacco and alcohol control, improve occupational safety, and promote early detection and timely treatment to reduce the disease burden. Full article

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16 pages, 462 KiB

Open AccessArticle

Prevalence and Determinants of Suicidal Ideation Among Physicians in Saudi Arabia

by Ayedh H. Alghamdi, Mohammed A. Aljaffer, Ahmad H. Almadani, Saleh A. Alghamdi, Hasan R. Alshehri, Akeel A. Alyateem, Refan T. Hashim and Fahad D. Alosaimi

Healthcare 2025, 13(13), 1632; https://doi.org/10.3390/healthcare13131632 - 7 Jul 2025

Viewed by 352

Abstract

Background: The mental health of physicians has become a pressing global concern. High rates of depression, anxiety, and burnout are reported in the literature, with each condition linked to reduced job satisfaction, increased medical errors, and ultimately suicidal ideation (SI). Although research on [...] Read more.

Background: The mental health of physicians has become a pressing global concern. High rates of depression, anxiety, and burnout are reported in the literature, with each condition linked to reduced job satisfaction, increased medical errors, and ultimately suicidal ideation (SI). Although research on physicians’ mental health is emerging in Saudi Arabia, data on suicidality remain scarce. Objective: This study aims to determine the prevalence of SI and its determinants among physicians in Saudi Arabia. Methods: A cross-sectional study was conducted with 423 physicians across all medical specialties of all ranks, who were recruited using a convenience sampling technique. The study tool comprised three main sections. The first section included questions regarding sociodemographic factors, lifestyle, and work-related factors. The second section included items on suicidality and the Patient Health Questionnaire-9 to screen for depressive symptoms. The third section included the Brief Resilient Coping Scale (BRCS) to measure the coping mechanisms of the participants. Results: SI was disclosed by 9.7% of the respondents, with 0.5% reporting previous suicide attempts. Suicidal ideation was independently associated with low income (OR = 3.94, 95% CI 1.32–11.76, p = 0.014) and higher depression scores (OR = 1.09 per point, 95% CI 1.02–1.16, p = 0.008). Moreover, knowing a colleague with suicidal behavior (i.e., knowing a colleague who had contemplated suicide or had attempted suicide/died by suicide) was significantly associated with SI among our participants (p < 0.001 and p < 0.006, respectively). Higher scores on the BRCS, specifically with respect to growing from adversity and actively replacing losses, were linked to lower odds of SI (p < 0.001 and p < 0.045, respectively). Conclusions: Physicians in Saudi Arabia experience an alarming level of SI that is associated with low income and depression. The results of this study underscore the importance of additional research to evaluate the effectiveness of intervention programs designed to enhance mental health support for physicians, encourage adaptive coping mechanisms, foster peer support networks, and combat stigma associated with mental illnesses. Full article

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18 pages, 324 KiB

Open AccessArticle

Integrated Dental Practice Management in Romania: A Cross-Sectional Case–Control Study on the Perceived Impact of Managerial Training on Efficiency, Collaboration, and Care Quality Dental

by Georgiana Ioana Potra Cicalău, Liana Todor, Roxana Alexandra Cristea, Ramona Hodișan, Olivia Andreea Marcu, Ioan Andrei Țig, Lucia Georgeta Daina and Gabriela Ciavoi

Healthcare 2025, 13(13), 1631; https://doi.org/10.3390/healthcare13131631 - 7 Jul 2025

Viewed by 204

Abstract

Background/Objectives: The effective management of dental practices is increasingly recognized as a key factor in ensuring high-quality care, efficient operations, and interdisciplinary collaboration. While many dentists assume managerial responsibilities, formal training in healthcare or dental practice management may influence the quality of these [...] Read more.

Background/Objectives: The effective management of dental practices is increasingly recognized as a key factor in ensuring high-quality care, efficient operations, and interdisciplinary collaboration. While many dentists assume managerial responsibilities, formal training in healthcare or dental practice management may influence the quality of these practices. This study aims to evaluate the differences in organization, efficiency, and quality of care between dental clinics managed by dentists who have completed management training and those who have not. It also explores dentists’ knowledge and attitudes regarding dental practice management. Methods: A cross-sectional, observational, case–control study was conducted between 14 April and 14 May 2023, using an online questionnaire distributed to licensed dental practitioners in Romania. A total of 136 dentists participated, divided into a study group (n = 60), who had completed management courses and a control group (n = 76) who had not. Descriptive statistics and comparative analyses (t-tests, Chi-square tests) were performed using SPSS version 24, with significance set at p < 0.05. Results: Dentists with managerial training demonstrated greater implementation of strategic planning, financial performance monitoring, quality management, and use of digital tools. They also reported higher collaboration with interdisciplinary professionals—orthodontist 76.7% in the study group vs. 63.2% in the control group, medical assistant 78.3% in the study group vs. 47.4% in the control group, front desk 43.3% in the study group vs. 18.4% in the control group; better delegation of tasks—61.7% in the study group vs. 27.6% in the control group; and greater concern for team development—95% in the study group vs. 71% in the control group; and patient rights—81.7% in the study group vs. 75% in the control group. Significant differences (p < 0.05) were noted in management practices, opinions about the optimal manager for a dental practice, and the use of software tools. Conclusions: Managerial training equips dentists with critical skills for enhancing operational efficiency and care quality. Integrating management education into dental curricula and continuing professional development can substantially improve the sustainability and performance of dental practices. Full article

(This article belongs to the Special Issue Health Service Improvement, Nursing Management and Simulation)

10 pages, 723 KiB

Open AccessCommentary

Advancing Gender Equity in International Eyecare: A Roadmap in Creating the Women Leaders in Eye Health (WLEH) Initiative

by Clare Szalay Timbo, Armaan Jaffer, Maria Jose Montero Romero, Gabriela Cubias, Heidi Chase, Sara T. Wester, Femida Kherani and Erin M. Shriver

Healthcare 2025, 13(13), 1630; https://doi.org/10.3390/healthcare13131630 - 7 Jul 2025

Viewed by 607

Abstract

Gender inequality remains a persistent issue in healthcare, especially in ophthalmology, where women face systemic barriers such as pay gaps, limited surgical opportunities, harassment, and unequal family expectations. Despite increasing entry into the field, women remain underrepresented in leadership, affecting career advancement and [...] Read more.

Gender inequality remains a persistent issue in healthcare, especially in ophthalmology, where women face systemic barriers such as pay gaps, limited surgical opportunities, harassment, and unequal family expectations. Despite increasing entry into the field, women remain underrepresented in leadership, affecting career advancement and patient care. This study examines how virtual platforms, and co-led initiatives can address gender disparities in eye health. In 2021, Women in Ophthalmology, Seva Foundation, and Orbis International launched the Women’s Leaders in Eye Health (WLEH) initiative—a global community promoting mentorship, networking, and leadership development. Starting with virtual webinars and informal networking, the initiative expanded to in-person events in 2023 due to strong global engagement and demand. Early virtual programming, including webinars and “Coffee Hour” sessions, proved effective and laid the groundwork for broader offerings such as mentorship and professional development grants. WLEH’s success underscores the power of collaboration in promoting gender equity. By fostering connections and leadership pathways, WLEH offers a scalable model to break down gender challenges and uplift the next generation of women leaders to deliver more accessible eyecare globally. Full article

(This article belongs to the Special Issue Bullying in the Workplace, Gender Inequality: Challenges for the Quality and Safety of Health Care)

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15 pages, 878 KiB

Open AccessReview

Machine Learning in Primary Health Care: The Research Landscape

by Jernej Završnik, Peter Kokol, Bojan Žlahtič and Helena Blažun Vošner

Healthcare 2025, 13(13), 1629; https://doi.org/10.3390/healthcare13131629 - 7 Jul 2025

Viewed by 460

Abstract

Background: Artificial intelligence and machine learning are playing crucial roles in digital transformation, aiming to improve the efficiency, effectiveness, equity, and responsiveness of primary health systems and their services. Method: Using synthetic knowledge synthesis and bibliometric and thematic analysis triangulation, we identified the [...] Read more.

Background: Artificial intelligence and machine learning are playing crucial roles in digital transformation, aiming to improve the efficiency, effectiveness, equity, and responsiveness of primary health systems and their services. Method: Using synthetic knowledge synthesis and bibliometric and thematic analysis triangulation, we identified the most productive and prolific countries, institutions, funding sponsors, source titles, publications productivity trends, and principal research categories and themes. Results: The United States and the United Kingdom were the most productive countries; Plos One and BJM Open were the most prolific journals; and the National Institutes of Health, USA, and the National Natural Science Foundation of China were the most productive funding sponsors. The publication productivity trend is positive and exponential. The main themes are related to natural language processing in clinical decision-making, primary health care optimization focusing on early diagnosis and screening, improving health-based social determinants, and using chatbots to optimize communications with patients and between health professionals. Conclusions: The use of machine learning in primary health care aims to address the significant global burden of so-called “missed diagnostic opportunities” while minimizing possible adverse effects on patients. Full article

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

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34 pages, 11268 KiB

Open AccessArticle

Advancements and Innovation Trends of Information Technology Empowering Elderly Care Community Services Based on CiteSpace and VOSViewer

by Yanxiu Wang, Zichun Shao, Zhen Tian and Junming Chen

Healthcare 2025, 13(13), 1628; https://doi.org/10.3390/healthcare13131628 - 7 Jul 2025

Viewed by 437

Abstract

Background: In elderly community services, information technology is reshaping the daily lives of older adults in unprecedented ways. It effectively addresses the issue of frailty in the community by strengthening support networks and dynamic risk management. Despite its vast potential, there remains [...] Read more.

Background: In elderly community services, information technology is reshaping the daily lives of older adults in unprecedented ways. It effectively addresses the issue of frailty in the community by strengthening support networks and dynamic risk management. Despite its vast potential, there remains a need to explore further enabling methods in the realm of elderly community services. Objectives: This study aims to provide a significant theoretical and practical foundation for information technology in this field by systematically analyzing the progress and trends of digital transformation facilitated by information technology. Materials and method: To map the advancements and emerging trends in this evolving field, this study conducts a bibliometric analysis of 461 relevant publications from the Web of Science Core Collection (2004–2024). The research employs bibliometric methods and utilizes tools such as CiteSpace and VOSViewer to analyze collaborations, keywords, and citations, as well as to perform data visualization. Results: The findings indicate that current research hotspots mainly focus on “community care”, “access to care”, “technology”, and “older adults”.Potential development trends include (1) further exploration of information technology in elderly care to provide more precise health management solutions; (2) systematically building community elderly service systems to offer more detailed elderly care services; (3) strengthening interdisciplinary information sharing and research collaboration to drive innovation in community elderly care models; and (4) introducing targeted policy and financial support to improve the specific implementation framework of information technology in elderly community services. Conclusions: This study provides empirical support for the development of relevant theories and practices. Furthermore, the research outcomes offer valuable insights into business opportunities for practitioners and provide important recommendations for formulating elderly service policies. Full article

(This article belongs to the Special Issue Frailty and Resilience Across Aging: A Holistic Approach to Elderly Care)

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22 pages, 557 KiB

Open AccessReview

Advancing Cardiovascular Risk Stratification and Functional Assessment: A Narrative Review of CPET and ESE Applications

by Valerio Di Fiore, Lavinia Del Punta, Nicolò De Biase, Stefano Masi, Stefano Taddei, Javier Rosada, Michele Emdin, Claudio Passino, Iacopo Fabiani and Nicola Riccardo Pugliese

Healthcare 2025, 13(13), 1627; https://doi.org/10.3390/healthcare13131627 - 7 Jul 2025

Viewed by 409

Abstract

Cardiopulmonary exercise testing combined with exercise stress Echocardiography (CPET-ESE) is an advanced diagnostic modality for evaluating cardiovascular disease and tailoring patient-specific treatment strategies. By integrating metabolic, ventilatory, and hemodynamic data with real-time imaging, CPET-ESE offers a comprehensive assessment of cardiovascular function under physiological [...] Read more.

Cardiopulmonary exercise testing combined with exercise stress Echocardiography (CPET-ESE) is an advanced diagnostic modality for evaluating cardiovascular disease and tailoring patient-specific treatment strategies. By integrating metabolic, ventilatory, and hemodynamic data with real-time imaging, CPET-ESE offers a comprehensive assessment of cardiovascular function under physiological stress. CPET provides detailed insights into metabolic and ventilatory performance, while ESE allows for the dynamic visualisation of cardiac structure and function during exercise. This review outlines the physiological foundations and core parameters of CPET and ESE, emphasising their complementary roles in cardiovascular diagnostics and prognostication and exploring their clinical value for evaluating unexplained dyspnoea and exercise-induced hemodynamic abnormalities. CPET-ESE plays a pivotal role in detecting subtle hemodynamic abnormalities, assessing functional capacity, and contributing to earlier diagnosis, targeted interventions, and improved clinical outcomes. Full article

(This article belongs to the Special Issue Cardiopulmonary Exercise Testing: A Key Player in Cardiovascular Disease Management)

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14 pages, 677 KiB

Open AccessArticle

Pathways Linking ICT Use to Chronic Disease Self-Management Among Older Adults with Comorbidities in Shanghai, China

by Qingru Chen, Ke Gong, Zhijun Bao, Yuanfang Yin, Lirong Zhao and Yan-Yan Chen

Healthcare 2025, 13(13), 1626; https://doi.org/10.3390/healthcare13131626 - 7 Jul 2025

Viewed by 280

Abstract

Background: The mechanisms through which information and communication technology (ICT) use influences chronic disease self-management remain unclear. Method: This cross-sectional investigation examined the mediating effects of health literacy, social support, and self-efficacy on the association between ICT use and self-management behaviors among older [...] Read more.

Background: The mechanisms through which information and communication technology (ICT) use influences chronic disease self-management remain unclear. Method: This cross-sectional investigation examined the mediating effects of health literacy, social support, and self-efficacy on the association between ICT use and self-management behaviors among older adults (≥60 years) with comorbidities in China (n = 520). The participants were recruited from a tertiary hospital in Shanghai (July 2023–June 2024), and data on sociodemographics, self-management, health literacy, social support, self-efficacy, and ICT use were collected via structured questionnaires. Results: Pearson’s correlation analysis revealed a significant association between ICT use, health literacy, social support, self-efficacy, and chronic disease self-management (p < 0.001). Multiple mediation modeling revealed a direct positive effect of ICT use on self-management (b = 1.3314, 95% CI = 0.6629, 2.0002). Furthermore, significant indirect effects were observed, mediated independently by both health literacy and social support. Additional serial mediation pathways included health literacy → social support, health literacy → self-efficacy, social support → self-efficacy, and a comprehensive pathway from health literacy through social support to self-efficacy. Conclusions: These findings collectively indicate that ICT use directly enhances chronic disease self-management among older adults with comorbidities. Moreover, ICT use indirectly improves self-management by enhancing health literacy, augmenting social support, and bolstering self-efficacy. Full article

(This article belongs to the Special Issue Smart Medicine for Older Adults)

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16 pages, 893 KiB

Open AccessArticle

Efficacy of Myofascial Techniques and Proprioceptive Neuromuscular Facilitation in the Treatment of Patients with Systemic Lupus Erythematosus—Randomized Crossover Clinical Study

by José-María Torres-Quiles, Rubén Cuesta-Barriuso and Raúl Pérez-Llanes

Healthcare 2025, 13(13), 1625; https://doi.org/10.3390/healthcare13131625 - 7 Jul 2025

Viewed by 375

Abstract

Background/Objectives: Systemic lupus erythematosus is an autoimmune disease. The musculoskeletal system is affected in 90% of patients. The most common symptoms are myalgia, arthralgia, and arthritis. The objective was to analyze the efficacy of an intervention using myofascial techniques and proprioceptive neuromuscular [...] Read more.

Background/Objectives: Systemic lupus erythematosus is an autoimmune disease. The musculoskeletal system is affected in 90% of patients. The most common symptoms are myalgia, arthralgia, and arthritis. The objective was to analyze the efficacy of an intervention using myofascial techniques and proprioceptive neuromuscular facilitation in patients with systemic lupus erythematosus. Methods: A randomized, single-blind, crossover clinical trial. Seventeen patients with systemic lupus erythematosus were randomly assigned to two sequences: Sequence A–B (intervention phase first, then control phase) and Sequence B–A (control phase first, then intervention phase). The intervention lasted for four weeks, with two weekly sessions lasting 50 min each. The intervention consisted of myofascial and proprioceptive neuromuscular facilitation techniques. The variables were: pain intensity (Visual Analog Scale), functional capacity of lower limbs (2-Minute Walk Test), physical function (Timed Up and Go Test), and fatigue (Fatigue Assessment Scale). After a 2-week follow-up and a 2-week washout period, the patients switched groups, and the methodology was replicated. Results: None of the patients developed injury or adverse effects as a direct consequence of the intervention. There were statistically significant differences between groups (p < 0.001) in the intensity of ankle (η²_p = 0.38) and knee (η² = 0.37) pain, functional capacity (η² = 0.33), and physical function (η² = 0.56). There were also intergroup changes in fatigue (η² = 0.52), and the relevant mental (η² = 0.26) and physical (η² = 0.45) components. Conclusions: Proprioceptive myofascial and neuromuscular facilitation techniques are safe in patients with systemic lupus erythematosus. This physical therapy protocol can improve the intensity of knee and ankle joint pain in these patients. This intervention can improve functional capacity, physical function, and fatigue in people with systemic lupus erythematosus. Full article

(This article belongs to the Special Issue Advances in Manual Therapy: Diagnostics, Prevention and Treatment)

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15 pages, 659 KiB

Open AccessArticle

Sex Differences in Strength, Self-Estimation, and Pain Perception Based on Physical Activity After Rotator Cuff Repair

by Zebin Wen, Yonghwan Kim, Yongchul Choi and Moonyoung Choi

Healthcare 2025, 13(13), 1624; https://doi.org/10.3390/healthcare13131624 - 7 Jul 2025

Viewed by 288

Abstract

Background: The role of physical activity in early recovery following arthroscopic rotator cuff repair (ARCR) remains unclear, particularly regarding potential sex differences. This study examined the effects of physical activity on pain, self-estimation, and strength recovery after ARCR in middle-aged and older adults. [...] Read more.

Background: The role of physical activity in early recovery following arthroscopic rotator cuff repair (ARCR) remains unclear, particularly regarding potential sex differences. This study examined the effects of physical activity on pain, self-estimation, and strength recovery after ARCR in middle-aged and older adults. Methods: Patients who underwent ARCR were classified into high physical activity (HPA, n = 94) and low physical activity (LPA, n = 99) groups based on the International Physical Activity Questionnaire. The Visual Analog Scale (VAS) for pain and the American Shoulder and Elbow Surgeons (ASESs) score for self-estimation were assessed preoperatively and at 6, 12, and 24 weeks postoperatively. Isokinetic shoulder strength was measured at the same intervals except for the 6-week assessment. Results: All groups demonstrated significant improvements in pain reduction and self-estimation over time (p < 0.05). At 6 and 12 weeks, the HPA group showed significantly lower VAS scores and higher ASES scores than the LPA group (p < 0.05). Notably, at 12 weeks, men in the LPA group exhibited pain levels comparable to the HPA group, whereas women in the LPA group continued to report significantly higher pain levels (p < 0.05). Isokinetic strength assessment revealed greater flexion and external rotation strength in the HPA group at 12 weeks (p < 0.05), though no significant between-group differences were observed at 24 weeks. Conclusions: Higher physical activity levels were associated with better early pain relief and self-estimation after ARCR, particularly within the first 12 weeks. These findings suggest that structured physical activity may enhance postoperative outcomes, with potential sex-based differences in pain perception. Full article

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17 pages, 760 KiB

Open AccessArticle

Evidence-Based Weight Management for Fertility Preservation in Endometrial Cancer Patients: Developing a Complex Intervention Based on the Medical Research Council Framework

by Jingjing Gong, Yiqian Chen, Yongli Wang, Yuanyuan Gong, Dandan Yang and Xiaodan Li

Healthcare 2025, 13(13), 1623; https://doi.org/10.3390/healthcare13131623 - 7 Jul 2025

Viewed by 273

Abstract

Background/Objectives: This study aims to develop a standardized weight management intervention program for patients with endometrial cancer (EC) undergoing fertility preservation treatment and to provide a scientific foundation for midwives to implement weight management initiatives in the domains of oncology and reproduction. [...] Read more.

Background/Objectives: This study aims to develop a standardized weight management intervention program for patients with endometrial cancer (EC) undergoing fertility preservation treatment and to provide a scientific foundation for midwives to implement weight management initiatives in the domains of oncology and reproduction. Methods: The weight management intervention program for patients with EC undergoing fertility preservation treatment was crafted following the directives of the Medical Research Council framework for developing and assessing complex interventions and the World Health Organization handbook for guideline development. The development process encompassed four distinct stages: (1) establishing the intervention development group, (2) identifying a theoretical basis and forming a content framework, (3) gathering and synthesizing evidence, and (4) refining and modeling the practice program. Results: The ultimate weight management program consisted of 6 primary, 18 secondary, and 53 tertiary items. Through two rounds of Delphi consultation, a response rate of 100% was attained, with an expert authority coefficient of 0.83. Conclusions: The developed intervention demonstrates scientific robustness and clinical feasibility, presenting a structured methodology for weight management for EC patients undergoing fertility preservation therapy. Full article

(This article belongs to the Special Issue Ensuring the Well-Being of Mothers and Infants by Strengthening Midwifery Services: From Evidence to Practice)

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16 pages, 380 KiB

Open AccessSystematic Review

The Value of Interventions Aimed at Improving the Patient Experience: Systematic Review of Economic Impacts and Provider Well-Being Outcomes

by Tiago S. Jesus, Dongwook Lee, Brocha Z. Stern, Manrui Zhang, Jan Struhar, Allen W. Heinemann, Anne Deutsch and Neil Jordan

Healthcare 2025, 13(13), 1622; https://doi.org/10.3390/healthcare13131622 - 7 Jul 2025

Viewed by 357

Abstract

Background: Although improving the patient experience with care is being framed as part of value-based care, the economic and provider well-being impact of interventions for improving the patient experience has not been established. We aimed to synthesize the contemporary (2015–2024) empirical literature on [...] Read more.

Background: Although improving the patient experience with care is being framed as part of value-based care, the economic and provider well-being impact of interventions for improving the patient experience has not been established. We aimed to synthesize the contemporary (2015–2024) empirical literature on the economic (e.g., costs, revenue) and other value-based impacts (e.g., provider well-being) of patient-experience improvement interventions. Methods: Systematic review using six databases of scientific literature (PubMed, EconLit, CINAHL, PsycINFO, DOAJ, and Scopus) supplemented by journal-specific and snowball searches following a registered study protocol (PROSPERO: CRD42022358337). Two independent reviewers performed eligibility decisions and quality appraisals of the study methods and economic assessments, when applicable; the latter was conducted using the Joanna Briggs Institute’s checklist for economic evaluations. Results: Out of 1317 unique references, nine were included. Four studies assessed the effectiveness of patient experience improvement interventions (e.g., provider communication training, discharge or transitional support) coupled with economic evaluations; these found statistically significant positive outcomes for both patient experience and economic dimensions—including reduced costs, improved revenue, or additional costs offset by increased revenue. Three additional studies on provider communication training also found statistically significant positive impacts on provider well-being (i.e., reduced burnout) and patient experience improvements. Conclusion: These findings shed light on the overall synergistic value of and business case for investments into developing patient experience improvement programs or activities. However, there is room for strengthening this body of knowledge in scope, volume, and method quality, including the need to study the impact on patient experience, provider well-being, health outcomes, and costs (i.e., the quadruple aim) in tandem. Full article

(This article belongs to the Special Issue Patient Experience and the Quality of Health Care)

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14 pages, 742 KiB

Open AccessArticle

Impact of Sarcopenia, Dynapenia, and Obesity on Muscle Strength and Quality in Chronic Kidney Disease Patients: A Sex-Specific Study

by Marcio Bacci, Fernanda Rico Angelotto, Thiago Dos Santos Rosa, Thaís Branquinho De Araújo, Hugo De Luca Corrêa, Lysleine Alves De Deus, Rodrigo Vanerson Passos Neves, Andrea Lucena Reis, Rafael Lavarini dos Santos, Jéssica Mycaelle Da Silva Barbosa, Vitória Marra Da Motta Vilalva Mestrinho, Carmen Tzanno-Martins, Whitley J. Stone, Ivo Vieira De Sousa Neto, Wilson Max Almeida Monteiro de Moraes, Guilherme Borges Pereira and Jonato Prestes

Healthcare 2025, 13(13), 1621; https://doi.org/10.3390/healthcare13131621 - 7 Jul 2025

Viewed by 401

Abstract

Sex-specific differences in the prevalence of sarcopenia, dynapenia, and the impact of obesity on muscle strength and quality in patients with chronic kidney disease (CKD) remain underexplored. Background/Objectives: In this cross-sectional study, 78 adults with stage 5 CKD undergoing thrice-weekly maintenance hemodialysis [...] Read more.

Sex-specific differences in the prevalence of sarcopenia, dynapenia, and the impact of obesity on muscle strength and quality in patients with chronic kidney disease (CKD) remain underexplored. Background/Objectives: In this cross-sectional study, 78 adults with stage 5 CKD undergoing thrice-weekly maintenance hemodialysis in Brazil (44 men, 34 women; mean ± SD age = 57.55 ± 4.06 years) were assessed. Anthropometry (BMI, waist circumference, waist-to-height ratio), dual-energy X-ray absorptiometry, circulating IL-6, Timed Up and Go, handgrip strength (Jamar ^® dynamometer), and muscle quality index (MQI = handgrip/BMI) were obtained. Dynapenia (handgrip < 27 kg men and < 16 kg women) and sarcopenia (1.0 kg/kg for men and 0.56 kg/kg for women) were classified using EWGSOP2-2018 and FNIH thresholds. Results: Compared with reference values, men showed markedly reduced muscle strength and muscle quality (men: handgrip 21.3 ± 5.1 kg; MQI 0.80 ± 0.23 AU) than women. Also, men were 5.1 times more likely to present with dynapenia (88.6%; 95% CI 2.28–11.60) and 3.15 times more likely to present with sarcopenia (75.0%; 95% CI 1.88–5.30) than women. Waist circumference, waist-to-height ratio, BMI, and body fat % correlated inversely with MQI in both sexes (p ≤ 0.01) and with handgrip strength in men (p ≤ 0.01) but not in women. Conclusions: Among hemodialysis patients, men exhibit a substantially higher burden of dynapenia and sarcopenia than women and excess adiposity is independently associated with poorer muscle quality in both sexes. These findings highlight the need for sex-specific screening cut-offs and integrated strategies targeting both muscle dysfunction and central obesity in CKD management. Full article

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15 pages, 1439 KiB

Open AccessArticle

The Knowledge, Attitudes, and Experiences of Traditional Korean Medicine Doctors in the Spontaneous Reporting of Adverse Drug Events: A Cross-Sectional Survey

by Mikyung Kim, Hyunkyung Sung, Jiyun Jung and Dongjun Choi

Healthcare 2025, 13(13), 1620; https://doi.org/10.3390/healthcare13131620 - 7 Jul 2025

Viewed by 301

Abstract

Background and Objectives: The spontaneous reporting (SR) of adverse drug events (ADEs) is a cornerstone of pharmacovigilance and a critical mechanism for safeguarding patient safety. However, underreporting remains a persistent global challenge. In Korea, despite the widespread use of herbal medicines (HMs), adverse [...] Read more.

Background and Objectives: The spontaneous reporting (SR) of adverse drug events (ADEs) is a cornerstone of pharmacovigilance and a critical mechanism for safeguarding patient safety. However, underreporting remains a persistent global challenge. In Korea, despite the widespread use of herbal medicines (HMs), adverse event reports from traditional Korean medicine doctors (KMDs) are remarkably scarce. This study aimed to assess the knowledge, attitudes, and experiences of KMDs regarding SR, identify key barriers, and suggest strategies to strengthen the safety culture within traditional Korean medicine. Materials and Methods: A cross-sectional, anonymous online survey was distributed to licensed KMDs registered with the Association of Korean Medicine. The questionnaire collected information on respondents’ sociodemographic characteristics and assessed their knowledge, attitudes, and experiences related to ADE reporting. Descriptive statistics and multivariate logistic regression were used to analyze the associations between the variables. Results: Of the 1021 KMDs who completed the survey, the vast majority acknowledged the importance of SR and recognized their role in pharmacovigilance. Nevertheless, only 5% had ever submitted an ADE report. A widespread lack of awareness about the national spontaneous reporting system (SRS), particularly its inclusion of licensed HMs, was evident. Although many respondents expressed support for expanding the scope of SR to cover all HMs, significant gaps in pharmacovigilance knowledge and limited access to relevant training were major barriers. KMDs affiliated with academic institutions or specialist groups showed higher levels of awareness, education, and reporting behavior. Conclusions: While KMDs exhibit positive attitudes toward patient safety and understand the importance of SR, their participation in it remains low due to knowledge deficits and insufficient training. Addressing these gaps through targeted education and expanding the national SRS to comprehensively include herbal medicines are essential steps toward enhancing pharmacovigilance and cultivating a proactive safety culture in Korean medicine. Full article

(This article belongs to the Topic The Imperative of Patient Safety and Safety Culture in Contemporary Healthcare)

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37 pages, 4065 KiB

Open AccessArticle

Cost Utility Modeling of Reducing Waiting Times for Elective Surgical Interventions: Case Study of Egyptian Initiative

by Ahmad Nader Fasseeh, Amany Ahmed Salem, Ahmed Yehia Khalifa, Asmaa Khairy ElBerri, Nada Abaza, Baher Elezbawy, Naeema Al Qasseer, Balázs Nagy, Zoltán Kaló, Bertalan Németh and Rok Hren

Healthcare 2025, 13(13), 1619; https://doi.org/10.3390/healthcare13131619 - 7 Jul 2025

Viewed by 466

Abstract

Background/Objectives: Reducing waiting times for elective surgeries remains a critical global healthcare challenge that negatively impacts patient outcomes and economic productivity. This study develops an adaptable cost-utility modeling framework for assessing the cost-effectiveness (CE) of reducing waiting time for elective surgeries in data-limited [...] Read more.

Background/Objectives: Reducing waiting times for elective surgeries remains a critical global healthcare challenge that negatively impacts patient outcomes and economic productivity. This study develops an adaptable cost-utility modeling framework for assessing the cost-effectiveness (CE) of reducing waiting time for elective surgeries in data-limited environments. Methods: We evaluated the economic and health impacts of Egypt’s recent initiative aimed at decreasing surgical waiting lists. The study conducts a CE analysis of the initiative by estimating incremental costs (expressed in Egyptian Pounds—EGP) and outcomes (expressed in quality-adjusted life years—QALYs) before and after its implementation, performs a benefit–cost analysis to quantify the initiative’s return on investment, and employs a budget share method to evaluate catastrophic health expenditure (CHE). The analysis included five elective surgical interventions: open-heart surgery, cardiac catheterization, cochlear implantation, ophthalmic surgery, and orthopedic (joint replacement) surgery. Results: The main research outcomes of the study are as follows. The initiative resulted in incremental cost-effectiveness ratios of EGP 46,795 (societal perspective) and EGP 56,094 (payer perspective) per QALY, both within acceptable CE thresholds. Most of the evaluated interventions demonstrated substantial returns on the investment. Without public funding, more than 90% of patients faced CHE, indicating considerable financial barriers to elective surgeries. Conclusions: Egypt’s initiative to reduce waiting times was deemed cost-effective. Our adaptable modeling framework could be practical for similar evaluations in low/middle-income countries, especially where data is limited. Scaling up the initiative to include additional curative and preventive services and integrating it with broader health system reforms in Egypt is strongly recommended. Full article

(This article belongs to the Section Health Assessments)

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13 pages, 938 KiB

Open AccessArticle

Psychometric Properties of the Brazilian Version of Environmental Protectors Against Hospital Work Stress

by Silmara Meneguin, Paula Astudillo-Díaz, José Fausto de Morais, Camila Fernandes Pollo, Juliana Pierami de Freitas, Cesar de Oliveira and Aniele Fernanda Deplácido De Léo

Healthcare 2025, 13(13), 1618; https://doi.org/10.3390/healthcare13131618 - 7 Jul 2025

Viewed by 250

Abstract

Objective: To analyse the psychometric properties of the Brazilian version of the Environmental Protectors Against Hospital Work Stress (ENPROS). Methods: A cross-sectional methodological study was conducted in two public hospitals in São Paulo state, Brazil, involving 431 doctors and nursing staff. [...] Read more.

Objective: To analyse the psychometric properties of the Brazilian version of the Environmental Protectors Against Hospital Work Stress (ENPROS). Methods: A cross-sectional methodological study was conducted in two public hospitals in São Paulo state, Brazil, involving 431 doctors and nursing staff. Exploratory and confirmatory factor analyses were performed to assess the construct validity of the instrument. To evaluate internal consistency and measurement stability, Cronbach’s alpha and the intraclass correlation coefficient (ICC) were used. Convergent validity was tested by comparison with the Job Stress Scale. Results: Exploratory factor analysis indicated a structure comprising four factors, with satisfactory factor loadings and commonalities ranging from 0.26 to 0.75. Confirmatory factor analysis suggested a model with good fit (CFI = 0.988; TLI = 0.988; RMSEA = 0.064; SRMR = 0.067). Cronbach’s alpha was 0.95, and the intraclass correlation coefficient (ICC) was 0.45. Convergent validity showed significant correlations between the ENPROS domains and the Job Stress Scale factors, particularly in the social support domain. Conclusions: The Brazilian Portuguese version of the Environmental Protectors Against Hospital Work Stress scale has a four-dimensional structure, adequate reliability, and a good fit to the proposed factorial model. Full article

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11 pages, 201 KiB

Open AccessArticle

Adverse Effects and Precautionary Measures for Isotretinoin Use in Patients with Acne Vulgaris: A Single-Center Study

by Mohammed Saif Anaam, Dalia A. AlShibl, Saeed Alfadly, Munirah Yousef Aloyuni, Fawaz Hamdan Al Harbi, Hussam Alhmoud, Ibrahim S. Alhomoud and Waleed Mohammad Altowayan

Healthcare 2025, 13(13), 1617; https://doi.org/10.3390/healthcare13131617 - 7 Jul 2025

Viewed by 445

Abstract

Background: Oral isotretinoin is an effective treatment for refractory and moderate acne unresponsive to conventional therapies, considered the most effective option for such cases. Objective: This study aimed to evaluate the knowledge, concerns, and experiences of acne patients undergoing isotretinoin treatment in Qassim, [...] Read more.

Background: Oral isotretinoin is an effective treatment for refractory and moderate acne unresponsive to conventional therapies, considered the most effective option for such cases. Objective: This study aimed to evaluate the knowledge, concerns, and experiences of acne patients undergoing isotretinoin treatment in Qassim, Saudi Arabia, with a focus on commonly reported adverse effects. Methods: A cross-sectional study was conducted from December 2023 to February 2024 using a self-administered questionnaire. This study targeted male and female acne vulgaris patients from the Qassim region attending the outpatient dermatology clinic at King Saud Hospital (KSH). Results: A total of 131 acne patients participated. Of these, 97.7% had heard of isotretinoin, and 92.4% were aware of its side effects. The most common sources of information were colleagues, friends, or family (37.4%), followed by previous use (26%) and healthcare professionals (24%). The most frequently reported side effect was dryness (51.9%), followed by liver function changes (24.4%) and fetal abnormalities (13%). There was a significant association between educational level and knowledge of isotretinoin’s side effects (p = 0.003) and awareness of specific side effects (p < 0.001). Conclusion: Most acne patients had sufficient knowledge of isotretinoin and its adverse effects, with dryness being the most commonly reported side effect. The primary sources of information were non-medical, highlighting the need for health education to ensure informed and safe isotretinoin use. Full article

27 pages, 1098 KiB

Open AccessArticle

Enhancing Healthcare for People with Disabilities Through Artificial Intelligence: Evidence from Saudi Arabia

by Adel Saber Alanazi, Abdullah Salah Alanazi and Houcine Benlaria

Healthcare 2025, 13(13), 1616; https://doi.org/10.3390/healthcare13131616 - 6 Jul 2025

Viewed by 446

Abstract

Background/Objectives: Artificial intelligence (AI) offers opportunities to enhance healthcare accessibility for people with disabilities (PwDs). However, their application in Saudi Arabia remains limited. This study explores PwDs’ experiences with AI technologies within the Kingdom’s Vision 2030 digital health framework to inform inclusive healthcare [...] Read more.

Background/Objectives: Artificial intelligence (AI) offers opportunities to enhance healthcare accessibility for people with disabilities (PwDs). However, their application in Saudi Arabia remains limited. This study explores PwDs’ experiences with AI technologies within the Kingdom’s Vision 2030 digital health framework to inform inclusive healthcare innovation strategies. Methods: Semi-structured interviews were conducted with nine PwDs across Riyadh, Al-Jouf, and the Northern Border region between January and February 2025. Participants used various AI-enabled technologies, including smart home assistants, mobile health applications, communication aids, and automated scheduling systems. Thematic analysis following Braun and Clarke’s six-phase framework was employed to identify key themes and patterns. Results: Four major themes emerged: (1) accessibility and usability challenges, including voice recognition difficulties and interface barriers; (2) personalization and autonomy through AI-assisted daily living tasks and medication management; (3) technological barriers such as connectivity issues and maintenance gaps; and (4) psychological acceptance influenced by family support and cultural integration. Participants noted infrastructure gaps in rural areas, financial constraints, limited disability-specific design, and digital literacy barriers while expressing optimism regarding AI’s potential to enhance independence and health outcomes. Conclusions: Realizing the benefits of AI for disability healthcare in Saudi Arabia requires culturally adapted designs, improved infrastructure investment in rural regions, inclusive policymaking, and targeted digital literacy programs. These findings support inclusive healthcare innovation aligned with Saudi Vision 2030 goals and provide evidence-based recommendations for implementing AI healthcare technologies for PwDs in similar cultural contexts. Full article

(This article belongs to the Topic Artificial Intelligence in Public Health: Current Trends and Future Possibilities, 2nd Edition)

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20 pages, 1879 KiB

Open AccessSystematic Review

The Effectiveness and Safety of Tai Chi on Knee Pain: A Systematic Review and Meta-Analysis

by Hyunggon Lee, Soo-Hyun Sung and Sangnam Lee

Healthcare 2025, 13(13), 1615; https://doi.org/10.3390/healthcare13131615 - 6 Jul 2025

Viewed by 418

Abstract

Background/Objectives: Although Tai Chi has shown potential benefits for managing chronic pain, its clinical effectiveness specifically for knee pain remains inconclusive. Methods: We systematically searched ten electronic databases for randomized controlled trials (RCTs) investigating the effects of Tai Chi on knee pain. Results: [...] Read more.

Background/Objectives: Although Tai Chi has shown potential benefits for managing chronic pain, its clinical effectiveness specifically for knee pain remains inconclusive. Methods: We systematically searched ten electronic databases for randomized controlled trials (RCTs) investigating the effects of Tai Chi on knee pain. Results: This systematic review and meta-analysis included 11 RCTs involving 706 participants; among them, three studies (n = 169) were eligible for meta-analysis. A comprehensive search of ten electronic databases was conducted up to March 2025. The included RCTs were conducted in the United States (n = 5), China (n = 3), South Korea (n = 2), and Turkey (n = 1). Compared to health education, Tai Chi significantly improved knee pain, as measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score (mean difference (MD) = −0.60; 95% CI: −6.52 to −3.28; p < 0.00001) and the Visual Analogue Scale (VAS) (MD = −1.44; 95% CI: −1.95 to −0.93; p < 0.00001). Tai Chi also significantly improved knee function compared to health education (WOMAC function score—MD = −13.49; 95% CI: −17.11 to −9.87; p < 0.00001). Four RCTs comparing Tai Chi with no intervention reported favorable effects on knee pain and function; however, a meta-analysis was not possible due to limited data. In contrast, two studies comparing Tai Chi with active controls, such as physical therapy and resistance training, found no significant differences in pain or functional outcomes. Two studies reported increased knee pain during initial Tai Chi sessions, but no adverse events occurred after postural corrections. Conclusions: While Tai Chi appears promising for knee pain management, further large-scale, high-quality RCTs with rigorous methodology are needed to establish definitive evidence. Full article

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16 pages, 236 KiB

Open AccessArticle

Quality of Life for Patients with Down Syndrome and Their Caregivers: A Cross-Sectional Study from a Parental Perspective in Saudi Arabia

by Amal Khaleel AbuAlhommos, Maitham Abdullah Al Hawaj, Ashwaq Ali Alanazi, Hanadi Hwthael Alrashidi, Maha Faleh Aldawsari and Rasan Ali Alajmi

Healthcare 2025, 13(13), 1614; https://doi.org/10.3390/healthcare13131614 - 6 Jul 2025

Viewed by 308

Abstract

Background: Patients with Down syndrome (DS) commonly experience psychological and mental problems. Studying the quality of life (QoL) of children with DS is important because it increases knowledge related to understanding the challenges that this group may face. This study aims to examine [...] Read more.

Background: Patients with Down syndrome (DS) commonly experience psychological and mental problems. Studying the quality of life (QoL) of children with DS is important because it increases knowledge related to understanding the challenges that this group may face. This study aims to examine the QoL of children with DS from a parental perspective in terms of physical, emotional, social, and school domains, depending on several factors, and identify demographic characteristics of their parents that may affect their QoL. Methods: This online survey study was conducted in Saudi Arabia between November 2024 and March 2025. The inclusion criteria targeted parents of children with confirmed DS diagnoses aged between 8 and 18 years. Results: The findings of this study showed that children with DS aged between 0 and 2 years had significantly lower QoL scores (10.18 ± 3.83) compared to other age groups (p = 0.02). In addition, gender differences were significant in the emotional (p = 0.03), social (p = 0.01), and school (p = 0.01) domains, with females scoring lower QoL scores in all areas compared to males. Moreover, educational level showed significant results across all domains, particularly for children with no education, who had the lowest QoL scores in the physical domain (22.34 ± 7.53, p = 0.004), emotional domain (10.41 ± 3.79, p = 0.003), social domain (11.22 ± 4.06, p = 0.001), and school domain (8.75 ± 5.09, p = 0.001). The findings of this study showed that children with DS who are in primary school (odds ratio (OR) = 5.90, 95% confidence interval (CI): 1.85–18.78, p = 0.003) and middle school (OR = 5.27, 95% CI: 1.44–19.31, p = 0.012) had significantly higher odds of better QoL compared to children with no formal education. Additionally, children cared for by their fathers had significantly lower odds compared to those cared for by their mothers (OR = 0.07, 95% CI: 0.01–0.90, p = 0.041). None of the demographic characteristics of caregivers reached a statistical significance level to have influence on caregivers QoL (p > 0.05). Conclusions: The findings of this study demonstrated a low level of QoL, affecting the emotional, social, and school domains, especially among female children with DS aged between 0 and 2 years with no formal education and cared for by their fathers. Governments should develop a comprehensive plan to care for these children and families in order to enhance their rights and quality of life, thereby placing emphasis on those who exhibit parameters related to a lower QoL. Full article

12 pages, 226 KiB

Open AccessArticle

Factors Associated with Asthma Medication Adherence in Parents with Asthmatic Children: Theory of Planned Behaviour

by Ahmed M. Alshehri, Yasser S. Almogbel, Saud M. Alsahali, Yousif A. Alosaily, Ghada M. Almohaimeed, Lamis I. Alotayk and Abdulrahman A. Alqunaisy

Healthcare 2025, 13(13), 1613; https://doi.org/10.3390/healthcare13131613 - 5 Jul 2025

Viewed by 277

Abstract

Background/Objectives: Asthma is a prevalent chronic condition affecting approximately 300 million people globally. Despite advancements in treatment protocols, poor adherence to asthma medication remains a significant issue, often leading to severe complications, especially in children. This study aimed to identify factors influencing medication [...] Read more.

Background/Objectives: Asthma is a prevalent chronic condition affecting approximately 300 million people globally. Despite advancements in treatment protocols, poor adherence to asthma medication remains a significant issue, often leading to severe complications, especially in children. This study aimed to identify factors influencing medication adherence among parents of children with asthma, using constructs from the theory of planned behaviour to better understand and improve adherence. Methods: This cross-sectional study employed a survey incorporating constructs from the theory of planned behaviour, demographic variables, and other adherence-related factors. Descriptive statistics and logistic regression analyses were applied to explore the relationship between these factors and adherence to asthma medications. Results: Out of 152 parents who visited the survey link, 150 were eligible. The average age was 35.58 ± 9.913 years; most participants were married (82%) and female (62.6%). Multivariate linear regression analysis of the parents’ factor showed parental attitude (β = 0.38, p < 0.001) and subjective norms (β = 0.34, p < 0.002) were significantly associated with parents’ intention to adhere to asthma medications. Conclusion: The study found that parental attitudes and subjective norms significantly impact the intention to adhere to asthma medication. Improving adherence is crucial for effective disease management, reducing healthcare costs, and enhancing the quality of life for children and their families. Interventions should focus on educating parents about the importance of adherence and engaging more family members to positively influence adherence through strengthened subjective norms. Full article

(This article belongs to the Special Issue Family Influences on Child and Adolescent Health)

25 pages, 595 KiB

Open AccessSystematic Review

Effect of Exercise on Chronic Tension-Type Headache and Chronic Migraine: A Systematic Review

by Cindy Johana Palacio-Del Río, Sofía Monti-Ballano, María Orosia Lucha-López, César Hidalgo-García and José Miguel Tricás-Moreno

Healthcare 2025, 13(13), 1612; https://doi.org/10.3390/healthcare13131612 - 4 Jul 2025

Viewed by 477

Abstract

Objectives: This study aims to identify the effectiveness of exercise in chronic tension-type headache and chronic migraine. Methods: The PICOS (Population, Intervention, Comparator, Outcomes, Study design) strategy was followed, where P—patients with chronic tension-type headache or chronic migraine; I—exercise; C—conventional treatment; O—pain reduction; [...] Read more.

Objectives: This study aims to identify the effectiveness of exercise in chronic tension-type headache and chronic migraine. Methods: The PICOS (Population, Intervention, Comparator, Outcomes, Study design) strategy was followed, where P—patients with chronic tension-type headache or chronic migraine; I—exercise; C—conventional treatment; O—pain reduction; and S—RCTs (randomized controlled trials) and quasi-experimental trials. Studies with a high risk of bias according to the RoB 2 (Risk of Bias) scale and with a score < 6 according to the PEDro (Physiotherapy Evidence Database) scale were excluded. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement was followed. The databases Pubmed, Web of Science, and Scopus were searched in November 2024. The PEDro and RoB2 scales were used to assess the risk of bias and internal validity of the studies. The results were synthesized qualitatively. Results: Ten studies with a total sample of 848 subjects were analyzed, comparing therapeutic interventions with an exercise versus conventional treatment. In most of the studies, the exercise group significantly outperformed the control group in pain reduction. Discussion: The findings suggest that exercise improves central pain modulation and reinforces the potential of body strategies such as postural integration. The main limitations found were the limited evidence on exercise’s role in chronic tension-type headache or migraine and the risk of bias due to the difficulty of blinding patients, therapists, and evaluators. Conclusions: The studies analyzed have shown that exercise could be an effective strategy to support the management of chronic tension-type headache and migraine. Full article

(This article belongs to the Special Issue Future Trends of Physical Activity in Health Promotion)

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9 pages, 202 KiB

Open AccessArticle

Beyond Physical Disability: The Social Cognition Challenges in Quality of Life Among Multiple Sclerosis Patients

by Triantafyllos Doskas, Kanellos C. Spiliopoulos, Constantinos Kormas, Christos Kokkotis, Liberis Dekavallas, Anna Tsiakiri, Foteini Christidi, George D. Vavougios, Dimitrios Tsiptsios, Aspasia Serdari, Nikolaos Grigoriadis, Ioannis Iliopoulos and Konstantinos Vadikolias

Healthcare 2025, 13(13), 1611; https://doi.org/10.3390/healthcare13131611 - 4 Jul 2025

Viewed by 248

Abstract

Background/Objectives: Social cognition impairment is common in multiple sclerosis (MS) and could implicate the well-being of patients by promoting difficulties in social interactions. This study investigated the relationship between social cognition and quality of life (QoL) in patients with MS (PwMSs). Methods: In [...] Read more.

Background/Objectives: Social cognition impairment is common in multiple sclerosis (MS) and could implicate the well-being of patients by promoting difficulties in social interactions. This study investigated the relationship between social cognition and quality of life (QoL) in patients with MS (PwMSs). Methods: In total, 100 PwMSs, enrolled as per distinct criteria, underwent neuropsychological assessment using validated questionnaires and scales. To assess QoL, Multiple Sclerosis Quality of Life-54 (MSQOL-54) questionnaires, both physical and mental, were utilized. The components of social cognition were evaluated using the Reading the Mind in the Eyes Test (RMET) and the Faux Pas task. The type of MS and years since diagnosis were also recorded. Results: The RMET score (β = 0.336; p = 0.001) and years since diagnosis (β = −0.225; p = 0.017) emerged as significant predictors of physical QoL, whereas the Faux Pas score did not significantly predict MSQOL-54_PHYSICAL scores (p = 0.451). Both Faux Pas (β = 0.247; p = 0.015) and RMET scores (β = 0.221; p = 0.028) showed a positive association with MSQOL-54_MENTAL scores. The years since diagnosis did not significantly predict the mental component of QoL (p = 0.635). Conclusions: Social cognition deficits are crucial for the social functioning of patients with MS, inevitably affecting both physical and mental aspects of QoL. Full article

(This article belongs to the Section Chronic Care)

17 pages, 532 KiB

Open AccessArticle

The Six-Minute Walk Test in Community-Dwelling Older Adult Women: The Influence of Physical Activity Levels and Age-Related Factors

by Rocío Cogollos-de-la-Peña, Gemma Victoria Espí-López, Laura Fuentes-Aparicio, Lucas Monzani, Dagmar Pavlu and Anna Arnal-Gómez

Healthcare 2025, 13(13), 1610; https://doi.org/10.3390/healthcare13131610 - 4 Jul 2025

Viewed by 307

Abstract

Background/Objectives: In the context of active ageing, functional assessment is key to preserving autonomy in older women. The six-minute walk test (6MWT) is a practical tool for estimating general health, but its results can be influenced by various factors. This study analysed [...] Read more.

Background/Objectives: In the context of active ageing, functional assessment is key to preserving autonomy in older women. The six-minute walk test (6MWT) is a practical tool for estimating general health, but its results can be influenced by various factors. This study analysed cardiorespiratory variations during the 6MWT in older women according to their physical activity level and age-related variables such as pain, sarcopenia, frailty, and motivation to exercise. Methods: A total of 163 older women with musculoskeletal pain, but without cardiac or respiratory conditions, were classified into groups with high (HPA), moderate (MPA), and low (LPA) physical activity. During the 6MWT, heart rate (HR), dyspnoea, and oxygen saturation (SpO₂) were recorded. Pain, sarcopenia, frailty, and motivation to exercise were also assessed. A repeated-measures multivariate analysis of (co)variance (RM-MANCOVA) was performed. Results: The results showed differences in HR depending on the level of physical activity, conditioned by sarcopenia (p < 0.05) and walked distance (p < 0.001), and in dyspnoea conditioned by pain perception (p < 0.01) and social (p < 0.001) and psychological (p < 0.05) motivation to exercise. There were also differences in SpO₂ depending on the level of physical activity (p < 0.0001). There were differences between the HPA group and both the MPA and LPA group, which had higher HR, higher dyspnoea, and lower SpO₂ when undergoing the 6MWT test. Conclusions: To accurately interpret 6MWT results in older adult women, it is essential to consider physical activity level, perceived pain, sarcopenia, and motivation to exercise, as these factors influence HR, dyspnoea, and SpO₂. These variables should guide physical activity recommendations for healthy ageing. Full article

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

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14 pages, 204 KiB

Open AccessArticle

A Study on Optometrists’ Knowledge, Awareness, and Management of Traumatic Brain Injury-Related Visual Disorders in Saudi Arabia

by Nawaf M. Almutairi, Abdulaziz Alharbi, Abdulelah Alharbi and Mohammed M. Alnawmasi

Healthcare 2025, 13(13), 1609; https://doi.org/10.3390/healthcare13131609 - 4 Jul 2025

Viewed by 274

Abstract

Background: Traumatic brain injury frequently leads to visual dysfunction, affecting up to 75% of patients. These visual issues, if unrecognized, can significantly impair daily functioning. Optometrists are well-positioned to identify and manage such conditions, yet their level of preparedness is not well understood. [...] Read more.

Background: Traumatic brain injury frequently leads to visual dysfunction, affecting up to 75% of patients. These visual issues, if unrecognized, can significantly impair daily functioning. Optometrists are well-positioned to identify and manage such conditions, yet their level of preparedness is not well understood. Objective: This study aimed to assess optometrists’ knowledge, awareness, and management practices regarding TBI-related visual disorders in Saudi Arabia. Methods: A cross-sectional survey was distributed online to 411 licensed optometrists in Saudi Arabia. The 16-item questionnaire assessed demographics, awareness, confidence, knowledge, and management practices related to TBI-associated visual disorders. Results: Only 26.3% of the respondents reported receiving formal education on TBI-related visual disorders. While most recognized common symptoms, such as blurred vision and light sensitivity, comprehensive knowledge of complex visual disorders was limited. A majority (82.5%) recommended referral to other healthcare providers; however, only 16.8% demonstrated high management competency, and 31.5% fell into the low-competency category. Referral patterns and clinical decision-making were significantly associated with experience and formal training. Conclusion: The findings reveal notable gaps in optometrists’ knowledge and preparedness to manage TBI-related visual dysfunctions. Structured educational initiatives and standardized clinical protocols are essential to improve optometric care for individuals with TBI. Full article

16 pages, 214 KiB

Open AccessArticle

Lived Experience of Caregivers of Lung Transplant Recipients in Korea

by Haeng-Mi Son, Kyoungok Min and Younghui Hwang

Healthcare 2025, 13(13), 1608; https://doi.org/10.3390/healthcare13131608 - 4 Jul 2025

Viewed by 264

Abstract

Background/Objectives: This study aimed to explore the underlying meaning and structure of the experiences of caregivers with lung transplant recipients using phenomenological research methods. Methods: Data were collected between February 2020 and December 2021 via in-depth individual interviews with nine caregivers of [...] Read more.

Background/Objectives: This study aimed to explore the underlying meaning and structure of the experiences of caregivers with lung transplant recipients using phenomenological research methods. Methods: Data were collected between February 2020 and December 2021 via in-depth individual interviews with nine caregivers of lung transplant recipients. The meaning of the participants’ experiences was analyzed using Colaizzi’s phenomenological analysis to ensure methodological rigor. Researchers minimized bias through reflexivity and member checking, and the study adhered to ethical standards to ensure trustworthiness. Results: Participants cared for patients who had not fully crossed the threshold of death without giving up hope for a cure. They did not avoid caregiving as a responsibility to their families but accepted it as their responsibility. The lives of the participants became increasingly immersed as they witnessed the process of the patient’s illness and gained insights into patience and gratitude through the caregiving experience. Conclusions: This study’s findings can help assess the needs of lung transplant recipients and their caregivers and guide interventions that address their reciprocal relationship. It also emphasizes the importance of ongoing education and expanded social care services to reduce caregiver stress and burden. Full article

10 pages, 220 KiB

Open AccessBrief Report

Financial Capacity Assessment in Female Euthymic Bipolar Patients: Catching Up on a Long Neglected Vulnerable Group

by Vaitsa Giannouli

Healthcare 2025, 13(13), 1607; https://doi.org/10.3390/healthcare13131607 - 4 Jul 2025

Viewed by 263

Abstract

Background: Patients with bipolar disorder (BD) face many challenges as many basic cognitive and non-cognitive domains can be affected by their disease. Financial capacity requires complex cognitive functioning and is little investigated in BD, especially in the Greek cultural context. Objectives: [...] Read more.

Background: Patients with bipolar disorder (BD) face many challenges as many basic cognitive and non-cognitive domains can be affected by their disease. Financial capacity requires complex cognitive functioning and is little investigated in BD, especially in the Greek cultural context. Objectives: This study, for the first time, is focusing on whether financial capacity shows deficits in female euthymic BD patients compared to controls and what the self-estimations of the patients for their performance are. Materials and Methods: Patients and a sample of one-to-one matched healthy controls were examined with a detailed neuropsychological battery and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). Before their neuropsychological assessment, participants responded to a single-item five-point Likert scale about their financial capacity. Results: Findings extend earlier work in other groups of older patients and indicate that euthymic BD patients’ performance is lower than that of the control group in various subdomains and total score of LCPLTAS (p < 0.001), resembling the performance of patients with a diagnosis of Mild Cognitive Impairment (MCI). However, euthymic BD patients are not aware of their cognitive deficits compared to healthy controls and overestimate their financial capacities as they have more positive estimations regarding their financial capacity than controls (χ²(1) = 8.315, p = 0.004) despite their lower real performance. In addition, from a number of classic neuropsychological tests administered, only Trail Making Part B correlates with LCPLTAS scores for the group of euthymic BD patients (rho = −0.561, p = 0.005). Conclusions: The results support that special care must be provided for euthymic BD individuals, so we can prevent financial exploitation. Full article

(This article belongs to the Special Issue Mental Health Promotion and Illness Prevention in Vulnerable Populations—2nd Edition)

9 pages, 206 KiB

Open AccessArticle

Why Functioning Should Be Used as a Population Health Indicator? A Discussion of a Chilean Population Study

by Marina Carvalho Arruda Barreto, Ricardo Cartes-Velásquez, Valeria Campos, Luciana Castaneda and Shamyr Sulyvan Castro

Healthcare 2025, 13(13), 1606; https://doi.org/10.3390/healthcare13131606 - 4 Jul 2025

Viewed by 228

Abstract

Background/Objectives: Population health problems are among the world’s main concerns. However, mortality and morbidity alone do not fully encompass the health experience of populations. International efforts are underway to verify health experiences using functioning as the third health indicator. The aim of the [...] Read more.

Background/Objectives: Population health problems are among the world’s main concerns. However, mortality and morbidity alone do not fully encompass the health experience of populations. International efforts are underway to verify health experiences using functioning as the third health indicator. The aim of the study was to compare the functioning profile of the Chilean population with mortality and morbidity rates due to neurological, circulatory, respiratory, and musculoskeletal diseases at the regional level. Methods: An ecological study was conducted with the secondary dataset II Estudio Nacional de la Discapacidad (ENDISC) and mortality and hospitalization rates from the Departamento de Estadísticas e Información en Salud. The II-ENDISC was a national household survey, based on the Model Disability Survey, carried out in 2015. Results: The correlation of functioning with morbidity and mortality rates was determined by Spearman’s correlation. The correlation values of the mortality and morbidity coefficients with the performance and disability data were not relevant and significant (p < 0.35; p > 0.05). This suggests a lack of a linear relationship between these indicators at the regional level. Conclusions: The analysis of the Chilean population revealed that performance values, as an expression of functioning, do not correlate with morbidity or mortality rates. This discrepancy underscores the limitations of relying solely on traditional health indicators to capture the complexity of population health. Our findings support the conceptual value of functioning as a complementary and distinct health indicator, rather than a proxy for morbidity or mortality. Full article

(This article belongs to the Special Issue Health Risks, Health Service, and Healthcare Supports for Vulnerable Populations)

18 pages, 929 KiB

Open AccessSystematic Review

Factors Determining Women’s Attitudes and Knowledge Toward Breast Cancer Screening: A Systematic Review

by Dimitra Georga, Afroditi Zartaloudi, Maria Saridi, Evangelos C. Fradelos, Erasmia Rouka, Pavlos Sarafis, Dimos Mastrogiannis and Aikaterini Toska

Healthcare 2025, 13(13), 1605; https://doi.org/10.3390/healthcare13131605 - 4 Jul 2025

Viewed by 340

Abstract

Background/Objectives: Breast cancer (BCA) is one of the most common cancers affecting women worldwide. Screening has been linked to up to a 33% reduction in breast cancer-related deaths by helping detect tumors at an early stage. The successful implementation of community-based breast [...] Read more.

Background/Objectives: Breast cancer (BCA) is one of the most common cancers affecting women worldwide. Screening has been linked to up to a 33% reduction in breast cancer-related deaths by helping detect tumors at an early stage. The successful implementation of community-based breast cancer screening programs depends on understanding the attitudes of women within the target community. This study aims to systematically review the literature to assess the association between women’s attitudes toward breast cancer screening and their life satisfaction and general attitudes toward life. We also aimed to examine women’s attitudes toward breast cancer screening recommendations and the factors that influence these attitudes. Methods: A systematic review of English-language literature was carried out. PubMed and Scopus were searched up to November 2024 for studies that met the predefined inclusion criteria. Methodologic quality was assessed using the adapted Newcastle–Ottawa Scale for cross-sectional studies and the corresponding scale for cohort studies. Results: Eleven studies met the inclusion criteria. The percentage of women who had undergone at least one breast cancer screening ranged from 8.3% to 94.5%. Women’s attitudes toward and participation in breast cancer screening were linked to psychological, social, and demographic factors. Lower levels of life satisfaction, self-efficacy, and perceived control or mastery in life, along with higher levels of non-work-related stress, and higher levels of optimism, were associated with a lower likelihood of participating in breast cancer screening. Full article

(This article belongs to the Special Issue Promotion of Women's Health through Exercise-Based and Educational Programs: A Multidisciplinary Approach)

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Open AccessArticle

The Impact of Automation and Digitalization in Hospital Medication Management: Economic Analysis in the European Countries

by Federico Filippo Orsini, Daniele Bellavia, Fabrizio Schettini and Emanuela Foglia

Healthcare 2025, 13(13), 1604; https://doi.org/10.3390/healthcare13131604 - 4 Jul 2025

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Abstract

Background/Objectives: European healthcare systems are increasingly adopting automation technologies to improve efficiency. This study evaluates the economic viability of hospital automation and medication management digitalization. Methods: An economic evaluation was based on a standardized hospital model comprising 561 beds, representative of an average [...] Read more.

Background/Objectives: European healthcare systems are increasingly adopting automation technologies to improve efficiency. This study evaluates the economic viability of hospital automation and medication management digitalization. Methods: An economic evaluation was based on a standardized hospital model comprising 561 beds, representative of an average acute care hospital across EU27 + UK. For each technology, several cost items were estimated using country-specific parameters such as labor costs, medication error rates, healthcare expenditure, and money discount rate. The financial metrics (Return On Investment—ROI, Net Present Value—NPV, Payback Time—PBT) were first calculated at the hospital level. These results were then extrapolated to the national level by scaling the per-hospital estimates according to the total number of hospital beds reported in each country. Finally, national results were aggregated to derive the overall European impact. Results: The analysis estimated a total European investment of EUR 3.55 billion, with an average PBT of 4.46 years and annual savings of 1,96 billion. ROI averaged 167%, and the total NPV was 8.21 billion. A major saving driver was the reduction in Medication Administration Errors that has an impact of 37.2% on the total savings. Payback times ranged from 3 years in high-GDP countries, to 7 years in lower-GDP nations. Conclusions: These findings demonstrate how providing structured data on hospital automation benefits could support decision-making processes, highlighting the organizational and economic feasibility of the investment across different European national contexts. Full article

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Healthcare, Volume 13, Issue 13 (July-1 2025) – 157 articles

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