Healthcare

13 pages, 235 KiB

Open AccessArticle

Living with Hypertension: An Investigation of Illness Perception from a Primary Care Perspective

by Handan Duman and Latife Merve Yildiz

Healthcare 2025, 13(16), 2032; https://doi.org/10.3390/healthcare13162032 (registering DOI) - 17 Aug 2025

Background: This study aimed to assess the illness perceptions of patients diagnosed with hypertension from a primary care perspective. It also sought to identify the sociodemographic and clinical factors associated with illness perception. Methods: A cross-sectional descriptive study was conducted between February and [...] Read more.

Background: This study aimed to assess the illness perceptions of patients diagnosed with hypertension from a primary care perspective. It also sought to identify the sociodemographic and clinical factors associated with illness perception. Methods: A cross-sectional descriptive study was conducted between February and March 2025, involving 116 hypertensive patients who attended family medicine outpatient clinics at Rize Training and Research Hospital, Turkey. Data were collected using a sociodemographic questionnaire and the Brief Illness Perception Questionnaire (BIPQ). Nonparametric tests, including the Mann–Whitney U test, Kruskal–Wallis H test with Dunn’s post hoc analysis, and Spearman’s correlation analysis, were employed to evaluate the data. Results: The mean age of the participants was 69.01 ± 6.07 years, with 76.7% of the participants aged over 65 years. The median total BIPQ score was 47.0, indicating a moderate illness perception. A significant negative correlation was observed between age and the total BIPQ score (Rho = −0.443, p < 0.001). Higher illness perception levels were significantly associated with lower educational attainment, shorter duration of antihypertensive treatment, and attribution of hypertension to stress, genetic predisposition, diet, and occupational factors (p < 0.05). Conclusions: Illness perceptions among patients with hypertension are shaped by various sociodemographic and clinical determinants. Enhancing awareness of these perceptions in primary care may support improved treatment adherence and better health outcomes. Interventions that strengthen health literacy and offer psychosocial support may contribute to more effective hypertension management. Full article

16 pages, 687 KiB

Open AccessReview

A Global Perspective of Color Vision Deficiency: Awareness, Diagnosis, and Lived Experiences

by Ali Almustanyir

Healthcare 2025, 13(16), 2031; https://doi.org/10.3390/healthcare13162031 (registering DOI) - 17 Aug 2025

Abstract

Color vision deficiency (CVD), commonly referred to as color blindness, affects a significant portion of the global population, particularly among males. This narrative review synthesizes findings from peer-reviewed articles and published large-scale epidemiological studies identified through database searches using terms such as “color [...] Read more.

Color vision deficiency (CVD), commonly referred to as color blindness, affects a significant portion of the global population, particularly among males. This narrative review synthesizes findings from peer-reviewed articles and published large-scale epidemiological studies identified through database searches using terms such as “color vision deficiency,” “color blindness,” “awareness,” and “diagnosis.” Studies were included if they addressed prevalence, awareness, diagnosis, or lived experiences of individuals with CVD. The prevalence of CVD varies by population, with red–green CVD affecting up to 8% of males and 0.5% of females of Northern European descent and lower rates reported in Asian and African populations. Although CVD is congenital in most cases, diagnosis is often delayed until school age or later due to limited routine screening, with many individuals remaining unaware of their condition until adolescence or adulthood. This delay can result in significant educational, occupational, and psychosocial challenges. This review synthesizes the current literature on the prevalence of CVD, levels of awareness, the age and process of diagnosis, and the lived experiences of individuals affected by this condition. Recommendations are provided for early detection, educational adaptations, and societal support. Full article

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

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17 pages, 840 KiB

Open AccessCase Report

Integration of External Vagus Nerve Stimulation in the Physiotherapeutic Management of Chronic Cervicogenic Headache: A Case Report

by Rob Sillevis, Nicola Khalaf, Valerie Weiss and Eleuterio A. Sanchez Romero

Healthcare 2025, 13(16), 2030; https://doi.org/10.3390/healthcare13162030 (registering DOI) - 17 Aug 2025

Abstract

Background: Cervicogenic headache (CGH) is a prevalent secondary headache disorder associated with upper cervical spine dysfunction, often involving nociceptive convergence at the trigeminocervical complex. While manual therapy and exercise have demonstrated benefit, autonomic dysregulation may contribute to persistent symptoms. This case report explores [...] Read more.

Background: Cervicogenic headache (CGH) is a prevalent secondary headache disorder associated with upper cervical spine dysfunction, often involving nociceptive convergence at the trigeminocervical complex. While manual therapy and exercise have demonstrated benefit, autonomic dysregulation may contribute to persistent symptoms. This case report explores the integration of external vagus nerve stimulation (eVNS) into a multimodal physical therapy approach targeting both mechanical and neurophysiological contributors to CGH. Case Description: A 63-year-old female presented with chronic CGH characterized by right-sided suboccipital and supraorbital pain, impaired sleep, and postural dysfunction. Examination revealed a right rotational atlas positional fault, restricted left atlantoaxial (AA) mobility, suboccipital hypertonicity, and reduced deep neck flexor endurance. Initial treatment emphasized manual therapy to restore AA mobility and atlas symmetry, combined with postural correction and neuromuscular training. Intervention: After initial symptom improvement plateaued, eVNS targeting the auricular branch of the vagus nerve was introduced to modulate autonomic tone. The patient used a handheld eVNS device nightly over three weeks. Outcomes: Substantial improvements were observed in the Neck Disability Index (↓77%), Headache Disability Inventory (↓72%), and pain scores (↓100%). Cervical mobility, atlas symmetry, and deep neck flexor endurance improved markedly. The patient reported reduced anxiety, improved sleep, and sustained headache relief at one-month follow-up. Conclusions: This case highlights the potential synergistic benefits of integrating eVNS within a physiotherapy-led CGH management plan. Further research is warranted to explore its role in targeting autonomic imbalance and enhancing conservative treatment outcomes. Full article

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18 pages, 379 KiB

Open AccessArticle

Occupational Stress and Sleep Quality Among Hungarian Nurses in the Post-COVID Era: A Cross-Sectional Study

by Nóra Rozmann, Katalin Fusz, John M. Macharia, Dávid Sipos, Zsuzsanna Kivés, Orsolya Kövesdi and Bence Raposa

Healthcare 2025, 13(16), 2029; https://doi.org/10.3390/healthcare13162029 (registering DOI) - 17 Aug 2025

Abstract

Background and Objectives: The COVID-19 pandemic placed substantial mental and physical burdens on healthcare workers, particularly nurses. In the post-pandemic period, sustained stress, elevated mental workload and disturbed sleep may continue to affect well-being and job performance. This study aimed to assess perceived [...] Read more.

Background and Objectives: The COVID-19 pandemic placed substantial mental and physical burdens on healthcare workers, particularly nurses. In the post-pandemic period, sustained stress, elevated mental workload and disturbed sleep may continue to affect well-being and job performance. This study aimed to assess perceived stress levels, occupational stress, and sleep quality among Hungarian nurses, while identifying key demographic, occupational, and behavioral predictors. Materials and Methods: A cross-sectional, quantitative study was conducted from April to July 2022 among nurses employed in Hungarian general hospitals (N = 418). Data were collected via an online self-administered questionnaire. Stress and sleep quality were measured using the Perceived Stress Scale (PSS-14), Expanded Nursing Stress Scale (ENSS), and Groningen Sleep Quality Scale (GSQS). Statistical analysis included descriptive statistics, ANOVA, post hoc tests, t-tests, and Pearson’s correlation (p < 0.05). Results: The mean PSS-14 score was 27.82 (SD = 7.82), indicating moderate stress. Sleep quality was poor (mean GSQS = 7.29, SD = 4.28), with significant positive correlation with perceived stress (r = 0.442, p < 0.001). Low income, lower education, and high coffee or alcohol consumption, and multiple night shifts were significantly associated with higher stress and poorer sleep quality. Occupational stress and mental workload, as measured by ENSS, was highest in internal medicine (mean = 122.16, SD = 37.09; p = 0.033). The most burdensome ENSS subscale was “workload” (mean = 2.30, SD = 0.92), with “not enough staff to adequately cover the unit” identified as the most stressful item. Additional cognitive and emotional workload components included dealing with violent patients and a lack of emotional preparedness in supporting families. Conclusions: Post-COVID nurses in Hungary experience moderate stress and impaired sleep. Excessive workload, emotional demands, and shift patterns significantly contribute to psychological and cognitive strain. Institutional and policy-level interventions are needed to reduce occupational stress and promote workforce resilience. Full article

13 pages, 271 KiB

Open AccessArticle

Association Between Physical Activity, Quality of Life, Barriers to Physical Activity, and Mental Health in Chilean Adolescents: The MOV-ES Study

by Eugenio Merellano-Navarro, Pablo Pasten-Hernández, Juan Aristegui-Mondaca, Antonia Morán-Toloza, Marcelo Nuñez-Galaz, Frano Giakoni-Ramírez, Daniel Duclos-Bastías and Andrés Godoy-Cumillaf

Healthcare 2025, 13(16), 2028; https://doi.org/10.3390/healthcare13162028 (registering DOI) - 17 Aug 2025

Abstract

Objective: To analyze the association between physical activity, health-related quality of life (HRQoL), and perceived barriers to physical activity with the risk of symptoms of depression, anxiety, and stress in Chilean adolescents. Method: A quantitative, cross-sectional, descriptive-correlational study was conducted with a sample [...] Read more.

Objective: To analyze the association between physical activity, health-related quality of life (HRQoL), and perceived barriers to physical activity with the risk of symptoms of depression, anxiety, and stress in Chilean adolescents. Method: A quantitative, cross-sectional, descriptive-correlational study was conducted with a sample of 351 secondary school students (mean age = 15.75 ± 1.47 years) from several educational institutions in the south-central region of Chile. Validated instruments were used to assess physical activity (PAQ-A), symptoms of mental health (DASS-21), HRQoL (Kidscreen-52), and the short scale of barriers to physical activity. For exploratory purposes, mental health outcomes were dichotomized based on standard cut-off scores, and binary logistic regression models were estimated to identify associated factors. Results: Based on the binary categorization, a substantial proportion of students exceeded the risk thresholds for depressive (54.4%), anxiety (63%), and stress symptoms (42.2%). Across models, lower physical activity levels, reduced autonomy and weaker relationships with parents, and barriers related to self-concept and motivation were consistently associated with higher mental health risk. Additionally, passive commuting and the perceived school environment emerged as specific predictors of stress and depression risk, respectively. Conclusions: These findings suggest that individual and contextual factors linked to lifestyle behaviors and perceived social support may play a critical role in adolescent mental health, and could represent key targets for school-based interventions. Full article

(This article belongs to the Special Issue Advances in Physical Exercise-Based Interventions: Short- and Long-Term Benefits for Disease Prevention and Improvement)

10 pages, 234 KiB

Open AccessArticle

The Effects of Operating Room Nurses’ Experiences of Verbal Violence, Resilience, and Social Support on Post-Traumatic Stress

by Do Kyun Kim and Sung Hee Shin

Healthcare 2025, 13(16), 2027; https://doi.org/10.3390/healthcare13162027 (registering DOI) - 17 Aug 2025

Abstract

Background/Objectives: Operating room (OR) nurses are frequently exposed to high-stress environments, including verbal violence, which may induce post-traumatic stress (PTS). This study investigated the effects of verbal violence, resilience, and social support on PTS among OR nurses. Methods: A cross-sectional descriptive correlational [...] Read more.

Background/Objectives: Operating room (OR) nurses are frequently exposed to high-stress environments, including verbal violence, which may induce post-traumatic stress (PTS). This study investigated the effects of verbal violence, resilience, and social support on PTS among OR nurses. Methods: A cross-sectional descriptive correlational study was conducted with 150 OR nurses who had at least one year of work experience. Data were collected via a mobile-based questionnaire and analyzed using SPSS Statistics 25. The main variables included experiences of verbal violence (from doctors and nurses), resilience, social support, and OR work satisfaction. Results: Exposure to verbal violence from doctors and nurses, as well as having 10 or more years of clinical experience, were significantly associated with higher PTS levels. In contrast, greater OR work satisfaction was associated with lower PTS. These variables collectively explained 36.6% of PTS variance (F = 8.64, p < 0.001). Conclusions: Verbal violence significantly contributes to PTS among OR nurses. Enhancing resilience and social support may mitigate the impact of PTS. Therefore, interventions such as structured peer-support systems, resilience training, and violence-prevention policies are recommended to reduce PTS risk. In addition, interventions to prevent verbal violence, and strengthen resilience and social support, and OR work satisfaction are crucial to protect nurses’ mental health and ensure patient safety. Full article

25 pages, 2912 KiB

Open AccessArticle

Looking Back After the First Year of the COVID-19 Pandemic: Parents’ View on Screen Media Use, Psychopathology, and Psychological Burden in a Clinical Sample of Children and Adolescents

by Anna Maria Werling, Susanne Walitza and Renate Drechsler

Healthcare 2025, 13(16), 2026; https://doi.org/10.3390/healthcare13162026 (registering DOI) - 17 Aug 2025

Abstract

Objectives. The aim of this study was to examine screen media use and the development and alteration of pre-existing mental health problems over the first year of the COVID-19 pandemic in a clinical sample of children and adolescents. Methods. A survey was conducted [...] Read more.

Objectives. The aim of this study was to examine screen media use and the development and alteration of pre-existing mental health problems over the first year of the COVID-19 pandemic in a clinical sample of children and adolescents. Methods. A survey was conducted with over 650 parents of patients referred to child and adolescent psychiatry. Results. A worsening of the main mental health problem during the first year of the pandemic was reported more often (38%) by parents than an improvement (25%), a tendency even more pronounced for comorbid/secondary problems (worsening in 48%, improvement in 16% of cases). Girls in general, but especially between 14 and 18 years, more often showed a persistent deterioration of mental problems than boys. A negative impact of screen media use on their child’s mental health was reported most frequently by parents of a child affected by depression (50%), with acute crisis (52%), eating disorders (45%), and conduct disorder/aggression (40%). Patients with multiple/comorbid mental health problems presented significantly higher mean screen media times (5.53 h/day) than patients with a single mental problem (3.97 h/day), and their parents more frequently reported increased concerns about their child’s media use since the pandemic. Critical periods such as the lockdown or the “second wave” outbreak were characterized by higher media consumption in all patients, but with higher peaks in patients with multiple mental health problems. Conclusions. Particularly vulnerable patients, i.e., those with multiple mental problems and adolescent girls, have become more vulnerable in the course of the pandemic. From the perspective of most parents, screen media use has contributed to this development. Full article

(This article belongs to the Special Issue The Impact of COVID-19 on Mental Health Across Diverse Populations)

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23 pages, 327 KiB

Open AccessArticle

Caregiver and Birth Parent Influences on Depression and Anxiety in African American Children in Kinship Care

by Tyreasa Washington, Sheryl L. Coley, Joan M. Blakey, Quenette L. Walton, Jeff Labban, Helen B. Tadese, Dominique N. Martinez and Sonya J. Leathers

Healthcare 2025, 13(16), 2025; https://doi.org/10.3390/healthcare13162025 (registering DOI) - 17 Aug 2025

Abstract

Background/Objectives: Depression and anxiety in children pose a significant public health concern, with long-term implications for well-being. Over 10% of children and adolescents are affected by emotional disorders such as depression and anxiety. African American youth face disproportionate exposure to mental health [...] Read more.

Background/Objectives: Depression and anxiety in children pose a significant public health concern, with long-term implications for well-being. Over 10% of children and adolescents are affected by emotional disorders such as depression and anxiety. African American youth face disproportionate exposure to mental health risk factors, including poverty, adverse childhood events, community violence, and racial discrimination, which elevate their vulnerability to these disorders. A particularly at-risk subgroup includes African American children in kinship care arrangements (e.g., grandparents raising grandchildren), who may face additional factors such as family disruption and separation from birth parents. Methods: This mixed-methods sequential study examined how caregiver stress and birth mother–child relationship quality relate to depression and anxiety symptoms in African American children in kinship care. Phase I included survey data from 58 caregivers of children aged 5 to 12; Phase II involved interviews with 16 of these caregivers. Results: Results indicated that lower caregiver stress was associated with reduced child depression and anxiety symptoms. Furthermore, findings suggest that a high quality of the birth mother–child relationship serves as a promotive factor, particularly for depressive symptoms. Qualitative findings highlighted two themes: (1) the weight of kinship care, marked by factors such as ongoing grief and financial strain; and (2) birth parent relationships, defined by a mix of connection, conflict, and loss that affects children’s mental health. Conclusions: These findings underscore the need for greater understanding of the strengths and resources within kinship families that support positive mental health outcomes and highlight the importance of targeted interventions to reduce caregiver stress and foster supportive parent–child relationships. Full article

27 pages, 2440 KiB

Open AccessArticle

From MINI to Meaningful Change—A German Pilot Study to Improve Patient Outcomes in End-of-Life Care

by Jana Sophie Grimm, Alina Kasdorf, Raymond Voltz and Julia Strupp

Healthcare 2025, 13(16), 2024; https://doi.org/10.3390/healthcare13162024 (registering DOI) - 16 Aug 2025

Abstract

Background/Objectives: Early identification of terminally ill patients is crucial for enhancing care, patient and care partner satisfaction, and healthcare staff confidence in discussing disease trajectories. Yet, timely recognition remains challenging. To address this, we developed a minimally invasive intervention (MINI) for general [...] Read more.

Background/Objectives: Early identification of terminally ill patients is crucial for enhancing care, patient and care partner satisfaction, and healthcare staff confidence in discussing disease trajectories. Yet, timely recognition remains challenging. To address this, we developed a minimally invasive intervention (MINI) for general hospital wards. We aimed to evaluate the MINI’s feasibility in facilitating an earlier identification of terminally ill patients and improving patient reported outcomes in a hospital setting. Methods: This prospective, two-arm pre-post intervention study at a university hospital evaluated the MINI alongside usual care. Patient-reported outcomes, including quality of life (SF-12), palliative care needs (IPOS), and functional status (ECOG), were collected at baseline and every three months over 12 months. Participants were allocated to a control or intervention group. Results: Of 188 patients identified using the Surprise Question, 58 completed the baseline assessment. While physical functioning (SF-12 PCS) remained comparable, the intervention group experienced clinically meaningful improvements in mental health (SF-12 MCS) at three months, with positive trends at six months. This group also showed a decline in palliative care needs, reduced emotional symptoms, and improved performance status, evidenced by significant differences in non-parametric analyses. These findings underscore the MINI’s potential to significantly improve patient well-being. Conclusions: This pilot study demonstrated the feasibility of the MINI and suggests it may foster meaningful system-wide change in patient-centred care within acute hospital settings, leading to improved patient outcomes and more confident healthcare staff in identifying terminally ill patients. However, given the small sample size, these findings should be interpreted with caution. Future research with larger cohorts and extended intervention periods is warranted to fully elucidate the MINI’s impact and refine strategies for improving care for terminally ill patients. Full article

(This article belongs to the Special Issue New Advances in Palliative Care)

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13 pages, 203 KiB

Open AccessArticle

Invisible Warriors in the Struggle Against Cancer: Social Support and Spiritual Care—A Phenomenological Study on Patient Experiences

by Esma Özmaya and Sevda Uzun

Healthcare 2025, 13(16), 2023; https://doi.org/10.3390/healthcare13162023 (registering DOI) - 16 Aug 2025

Abstract

Objective: The aim of this study is to examine the effect of social support on the mental state of cancer patients using a phenomenological approach. Materials–Methods: In this study, a phenomenological research orientation was used, and semi-structured in-depth interviews were conducted with 14 [...] Read more.

Objective: The aim of this study is to examine the effect of social support on the mental state of cancer patients using a phenomenological approach. Materials–Methods: In this study, a phenomenological research orientation was used, and semi-structured in-depth interviews were conducted with 14 people diagnosed with cancer living in a province in central Turkey. The criterion sampling method, one of the purposeful sampling methods, was used for the sample group. The interviews continued until data saturation was achieved, and all interviews were recorded and later transcribed verbatim. The data were analyzed using thematic analysis, and the study was conducted and reported according to the COREQ checklist. Results: Two categories (effects of cancer and needs of the cancer patient (invisible components)) and five themes (psychological effects, social effects, physical effects, social support, and spiritual care) were identified in the analysis of the data. Conclusions: It has been determined that individuals are affected by cancer mentally, physically, and socially, and have difficulty coping. In particular, it has been found that social support and thinking about the purpose of life, supporting hope, and self-acceptance are quite important in increasing individuals’ spirituality. Full article

16 pages, 435 KiB

Open AccessArticle

Psychometric Properties of the Arabic Version of the Pictorial Empathy Test for Assessing Affective Empathic Reactions in Patients with Schizophrenia

by Georges Kerbage, Camille Akkari, Nagham Hachem, Michelle El Murr, Rita El Mir, Cyril Abou Atme, Georges Haddad, Rony Abou Khalil, Elissar El Hayek, Frederic Harb, Souheil Hallit and Feten Fekih-Romdhane

Healthcare 2025, 13(16), 2022; https://doi.org/10.3390/healthcare13162022 (registering DOI) - 16 Aug 2025

Abstract

Background/Objectives: Although people with schizophrenia appear to experience emotions like healthy individuals, previous studies suggest that their ability to engage in empathic emotional responses might be impaired. As per our knowledge, no studies in the Arab world have investigated empathy in patients [...] Read more.

Background/Objectives: Although people with schizophrenia appear to experience emotions like healthy individuals, previous studies suggest that their ability to engage in empathic emotional responses might be impaired. As per our knowledge, no studies in the Arab world have investigated empathy in patients with schizophrenia, which is likely due to the lack of valid and reliable measures to assess the empathy construct among Arabic-speaking people. The aim of this research is to validate the Arabic version of the Pictorial Empathy Test (PET) in patients with schizophrenia from Lebanon. Methods: A two-month cross-sectional study was carried out at the Psychiatric Hospital of the Cross during January and February of 2024. The average age of the 113 participants in this study was 57.52 ± 10.35 years and 63.5% of them were men. Data were collected through in-person interviews. A confirmatory factor analysis (CFA) was conducted using SPSS AMOS version 29. Parameter estimation utilized the maximum likelihood approach. In order to examine sex invariance in PET scores, a multi-group CFA was conducted. Measurement invariance was assessed across configural, metric, and scalar levels. Evidence of invariance was determined based on the criteria: ΔCFI ≤ 0.010, ΔRMSEA ≤ 0.015, or ΔSRMR ≤ 0.010. Results: CFA revealed that the Arabic PET exhibited a unidimensional factor structure. The PET demonstrated solid internal consistency (ω = 0.93, α = 0.93). Measurement invariance testing confirmed that the scale performed equally well across sexes. A linear regression analysis found that female sex and higher levels of alexithymia were significantly correlated with lower levels of affective empathy. Conclusions: The findings indicate that the Arabic version of the PET is a reliable and valid tool for measuring affective empathy in Arabic-speaking patients with schizophrenia. The culturally adapted and validated Arabic PET would help detect affective empathy deficits, design and implement context-tailored interventions, and encourage future research in this area in the Arab region. Future research should aim to validate the PET against behavioral tasks like the Empathic Accuracy Task to improve its ecological validity. Full article

(This article belongs to the Special Issue Psychological Diagnosis and Treatment of People with Mental Disorders)

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14 pages, 257 KiB

Open AccessArticle

Artificial Intelligence Anxiety and Patient Safety Attitudes Among Operating Room Professionals: A Descriptive Cross-Sectional Study

by Pinar Ongun, Burcak Sahin Koze and Yasemin Altinbas

Healthcare 2025, 13(16), 2021; https://doi.org/10.3390/healthcare13162021 (registering DOI) - 16 Aug 2025

Abstract

Background/Objectives: The adoption of artificial intelligence (AI) in healthcare, particularly in high-stakes environments such as operating rooms (ORs), is expanding rapidly. While AI has the potential to enhance patient safety and clinical efficiency, it may also trigger anxiety among healthcare professionals due to [...] Read more.

Background/Objectives: The adoption of artificial intelligence (AI) in healthcare, particularly in high-stakes environments such as operating rooms (ORs), is expanding rapidly. While AI has the potential to enhance patient safety and clinical efficiency, it may also trigger anxiety among healthcare professionals due to uncertainties around job displacement, ethical concerns, and system reliability. This study aimed to examine the relationship between AI-related anxiety and patient safety attitudes among OR professionals. Methods: A descriptive, cross-sectional research design was employed. The sample included 155 OR professionals from a university and a city hospital in Turkey. Data were collected using a demographic questionnaire, the Artificial Intelligence Anxiety Scale (AIAS), and the Safety Attitudes Questionnaire–Operating Room version (SAQ-OR). Statistical analyses included t-tests, ANOVA, Pearson correlation, and multiple regression. Results: The mean AIAS score was 3.25 ± 0.8, and the mean SAQ score was 43.2 ± 10.5. Higher AI anxiety was reported by males and those with postgraduate education. Participants who believed AI could improve patient safety scored significantly higher on AIAS subscales related to learning, job change, and AI configuration. No significant correlation was found between AI anxiety and safety attitudes (r = −0.064, p > 0.05). Conclusions: Although no direct association was found between AI anxiety and patient safety attitudes, belief in AI’s potential was linked to greater openness to change. These findings suggest a need for targeted training and policy support to promote safe and confident AI adoption in surgical practice. Full article

(This article belongs to the Section Perioperative Care)

11 pages, 327 KiB

Open AccessArticle

Pulmonary Function Changes in Fighter Pilots with Positive Pressure Ventilation

by Alexander Lengersdorf, Janina Post, Norbert Guettler and Stefan Sammito

Healthcare 2025, 13(16), 2020; https://doi.org/10.3390/healthcare13162020 (registering DOI) - 16 Aug 2025

Abstract

Background/Objectives: The advancing technological developments of recent decades have also changed the stress profile of pilots of high-performance aircraft (HPA) immensely. Pilots are exposed to different gravitational (G)-forces and are only able to fly with anti-G suits that compensate for the physiological [...] Read more.

Background/Objectives: The advancing technological developments of recent decades have also changed the stress profile of pilots of high-performance aircraft (HPA) immensely. Pilots are exposed to different gravitational (G)-forces and are only able to fly with anti-G suits that compensate for the physiological loss of cerebral perfusion by applying external pressure to the body, and positive pressure breathing during G [PBG]. The present study therefore aims to investigate long-term effects of PBG on the lung capacity of fighter pilots. Methods: In a retrospective data analysis (1972–2024), the clinical findings of all German military pilots were analyzed. In total, 1838 subjects were included in the analysis, divided into three groups: HPA with PBG, HPA without PBG, and fixed-wing aircraft. Results: Lung function analysis showed that no significant decrease in FVC was found in the HPA group with PBG, but a decrease was found in the HPA group without PBG. FEV1 and FEV1/FVC decreased significantly in all groups. Multiple regression analyses indicated that the variables age and aircraft type were significant predictors of the changes in FVC and FEV1, but not for the Tiffeneau index. Conclusions: Our study showed that the lung function of HPA pilots who were exposed to both PBG and repeated increased G-forces did not deteriorate to a significantly greater extent compared with other pilots without these conditions; in some cases, it even deteriorated to a lesser extent. Overall, age has primarily been shown to be the predisposing factor for a deterioration in lung function parameters over time. Full article

(This article belongs to the Special Issue Occupational Health and Workers’ Well-Being: From Research to Practice)

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12 pages, 555 KiB

Open AccessArticle

Euthanasia in Mental Disorders: Clinical and Ethical Issues in the Cases of Two Women Suffering from Depression

by Giuseppe Bersani, Angela Iannitelli, Pascual Pimpinella, Francesco Sessa, Monica Salerno, Mario Chisari and Raffaella Rinaldi

Healthcare 2025, 13(16), 2019; https://doi.org/10.3390/healthcare13162019 (registering DOI) - 16 Aug 2025

Abstract

Background/Objectives: The extension of euthanasia and physician-assisted suicide to individuals with mental disorders presents a profound ethical, clinical, and legal challenge. While increasingly accepted in some jurisdictions, their application in psychiatric contexts—particularly in cases of depression—raises concerns about diagnostic precision, therapeutic adequacy, and [...] Read more.

Background/Objectives: The extension of euthanasia and physician-assisted suicide to individuals with mental disorders presents a profound ethical, clinical, and legal challenge. While increasingly accepted in some jurisdictions, their application in psychiatric contexts—particularly in cases of depression—raises concerns about diagnostic precision, therapeutic adequacy, and the validity of informed consent. This study examines two controversial Belgian cases to explore the complexities of euthanasia for psychological suffering. Methods: A qualitative case analysis was conducted through a qualitative analysis of publicly available media sources. The cases were examined through clinical, psychoanalytic, and medico-legal lenses to assess diagnostic clarity, treatment history, and ethical considerations. No access to official medical records was available. Case Presentation: The first case involved a young woman whose depressive symptoms were reportedly linked to trauma from a terrorist attack. The second concerned a middle-aged woman convicted of infanticide and later diagnosed with Major Depression. Discussion: In both cases, euthanasia was granted on the grounds of “irreversible psychological suffering.” However, the absence of detailed clinical documentation, potential unresolved trauma, and lack of psychodynamic assessment raised doubts about the robustness of the evaluations and the validity of informed consent. Conclusions: These findings highlight the need for a more rigorous, multidisciplinary, and ethically grounded approach to psychiatric euthanasia. This study underscores the importance of precise diagnostic criteria, comprehensive treatment histories, and deeper exploration of unconscious and existential motivations. Safeguarding clinical integrity and ethical standards is essential in end-of-life decisions involving mental illness. Full article

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14 pages, 1413 KiB

Open AccessArticle

Beyond the Growth: A Registry-Based Analysis of Global Imbalances in Artificial Intelligence Clinical Trials

by Chan-Young Kwon

Healthcare 2025, 13(16), 2018; https://doi.org/10.3390/healthcare13162018 (registering DOI) - 16 Aug 2025

Abstract

Background/Objectives: While the integration of artificial intelligence (AI) into clinical research is rapidly accelerating, a comprehensive analysis of the global AI clinical trial landscape has been limited. This study presents the first systematic characterization of AI-related clinical trials registered in the World [...] Read more.

Background/Objectives: While the integration of artificial intelligence (AI) into clinical research is rapidly accelerating, a comprehensive analysis of the global AI clinical trial landscape has been limited. This study presents the first systematic characterization of AI-related clinical trials registered in the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). It aims to map global trends, identify patterns of concentration, and analyze the structure of international collaboration. Methods: A search of the WHO ICTRP was conducted on 20 June 2025. Following a two-stage screening process, the dataset was analyzed for temporal trends, geographic distribution, disease and technology categories, and international collaboration patterns using descriptive statistics and network analysis. Results: We identified 596 AI clinical trials across 62 countries, with registrations growing exponentially since 2020. The landscape is defined by extreme geographic concentration, with China accounting for the largest share of trial participations (35.6%), followed by the USA (8.5%). Research is thematically concentrated in Gastroenterology (22.8%) and Oncology (20.1%), with Diagnostic Support (45.6%) being the most common technology application. Formal international collaboration is critically low, with only 8.7% of trials involving multiple countries, revealing a fragmented collaboration landscape. Conclusions: The global AI clinical trial landscape is characterized by rapid but deeply imbalanced growth. This concentration and minimal international collaboration undermine global health equity and the generalizability of AI technologies. Our findings underscore the urgent need for a fundamental shift toward more inclusive, transparent, and collaborative research models to ensure the benefits of AI are realized equitably for all of humanity. Full article

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

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28 pages, 3569 KiB

Open AccessSystematic Review

Physical Training and Pulmonary Rehabilitation in Patients with Cystic Fibrosis: A Systematic Review and Meta-Analysis of Clinical Trials

by Saray Ríos Murillo, Angie Melissa Hinestroza Mancilla, Lina Manuela Pérez Ordoñez, Naudy Yulisa Ararat Carabalí, Freiser Eceomo Cruz Mosquera and Yamil Liscano

Healthcare 2025, 13(16), 2017; https://doi.org/10.3390/healthcare13162017 - 15 Aug 2025

Abstract

Background/Objectives: Physical training and Pulmonary Rehabilitation in Patients with Cystic Fibrosis: A Systematic Review and Meta-Analysis of Clinical Trials. Pulmonary rehabilitation and physical training are essential components of the comprehensive management of patients with cystic fibrosis. Despite documented benefits for some clinical outcomes, [...] Read more.

Background/Objectives: Physical training and Pulmonary Rehabilitation in Patients with Cystic Fibrosis: A Systematic Review and Meta-Analysis of Clinical Trials. Pulmonary rehabilitation and physical training are essential components of the comprehensive management of patients with cystic fibrosis. Despite documented benefits for some clinical outcomes, uncertainty exists regarding their overall effects. Therefore, the objective of the present meta-analysis is to determine the effectiveness of physical training and pulmonary rehabilitation in patients with CF. Methods: This systematic review and meta-analysis of randomized controlled trials published between 1990 and 2025 was conducted using the PubMed, Cochrane Clinical Trial, SCOPUS, Science Direct, Web of Science, Scielo, and LILAC databases. The risk of bias was evaluated using the RoB 2 tool, the quality of the evidence with the Jadad scale, and the certainty of the evidence for each outcome was assessed according to GRADE guidelines. This meta-analysis was developed using the statistical packages RevMan 5.4^® and Jamovi 2.3.28^®. Results: Twenty-three studies with a total of 800 patients with CF were included. This meta-analysis showed that pulmonary rehabilitation and physical training did not affect pulmonary function, as observed in FEV1 (SMD: 0.05; 95% CI: −0.09 to 0.20; p = 0.46) and FVC (SMD: 0.11; 95% CI: −0.04 to 0.27; p = 0.14). However, it has a discrete impact on exercise capacity, producing an increase in VO₂ max (MD: 2.74; 95% CI: 0.43 to 5.04; p = 0.02). Subgroup analyses did not yield relevant findings, and sensitivity analyses did not produce modifications in the direction or magnitude of the effect. Conclusions: The intervention evaluated in this meta-analysis does not have effects on pulmonary function but may influence exercise capacity, particularly VO₂ max. It is recommended to interpret the findings with caution due to the limited certainty of the available evidence. Full article

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17 pages, 278 KiB

Open AccessArticle

Association Between 24-Hour Movement Behaviors and Noncommunicable Chronic Diseases Among Adult and Older Adult Users of the Brazilian Community Health Promotion Program

by Yuri Silva de Souza, Carlos Alencar Souza Alves Junior and Diego Augusto Santos Silva

Healthcare 2025, 13(16), 2016; https://doi.org/10.3390/healthcare13162016 - 15 Aug 2025

Abstract

Background/Objectives: Noncommunicable diseases (NCDs) are the leading causes of global mortality among adults. The aim of this study was to examine the association between adherence to 24 h movement behavior guidelines and the diagnosis of NCDs. Methods: This cross-sectional study was conducted with [...] Read more.

Background/Objectives: Noncommunicable diseases (NCDs) are the leading causes of global mortality among adults. The aim of this study was to examine the association between adherence to 24 h movement behavior guidelines and the diagnosis of NCDs. Methods: This cross-sectional study was conducted with users of the Health Academy Program in Brazil. The sample consisted of 1212 individuals (92.9% female), aged 18 years or older. Dependent variables included self-reported hypertension, diabetes, hypercholesterolemia, and cardiovascular disease based on previous medical diagnosis. Independent variables (physical activity, screen time, and sleep) were self-reported. Binary and multinomial logistic regressions were performed and adjusted for sex, age, educational level, body mass index, and marital status. Results: Participants who did not meet any of the 24 h movement behavior recommendations had higher odds of hypertension (OR: 1.35; 95% CI: 1.15–1.77), diabetes (OR: 1.07; 95% CI: 1.03–2.01), and having two (OR: 1.29; 95% CI: 1.09–2.91) or three or more NCDs (OR: 1.40; 95% CI: 1.11–2.13). Not meeting the physical activity recommendation was associated with higher odds of hypercholesterolemia (OR: 1.37; 95% CI: 1.06–1.76). In contrast, meeting the physical activity guideline alone (OR: 0.32; 95% CI: 0.11–0.85) or in combination with adequate sleep (OR: 0.32; 95% CI: 0.11–0.90) was associated with lower odds of cardiovascular disease. All of these results remained significant after adjustments for multiple comparisons. Conclusions: Not meeting any of the 24 h movement behavior guidelines, especially those related to physical activity, was associated with a higher occurrence of NCDs. Full article

(This article belongs to the Special Issue Understanding Lifestyle Indicators Throughout the Life Course: Determinants, Correlates and Paths to Intervention)

14 pages, 470 KiB

Open AccessArticle

Effects of an mHealth Occupational Therapy Intervention on Functional Performance: A Pilot Study

by Irene Pérez-Díaz, Mario Arnáiz-González and Estíbaliz Jiménez-Arberas

Healthcare 2025, 13(16), 2015; https://doi.org/10.3390/healthcare13162015 - 15 Aug 2025

Abstract

Neurodevelopmental disorders are one of the most prevalent conditions today, and among the limitations in activity and restrictions in the participation of children and their families, we find intervention in activities of daily living; therefore, research focused on outcome measurement is one of [...] Read more.

Neurodevelopmental disorders are one of the most prevalent conditions today, and among the limitations in activity and restrictions in the participation of children and their families, we find intervention in activities of daily living; therefore, research focused on outcome measurement is one of the most active lines, and after COVID-19, telerehabilitation has garnered special interest. Background/Objectives: The study objective was to evaluate the effectiveness of a mobile health (mHealth) application in improving the performance of activities of daily living in children with neurodevelopmental disorders. Methods: The study employed a quasi-experimental design with a control group, using a fully remote mHealth-based intervention. The instruments used were a sociodemographic ad hoc, Pediatric Evaluation of Disability Inventory Computer, Family Outcomes Survey, Family Confidence Scale, and System Usability Scale. The final sample consisted of 13 participants. Results: The mHealth intervention showed significant improvements in occupational performance in the experimental group, especially in the global score and in the Responsibility dimension of the PEDI-CAT. No relevant differences were observed in the CON-FAN and FOS scales between groups, although the latter showed improvements over time. The usability of the app was rated positively (SUS = 69.75). Conclusions: The developed application presents good usability for families of children with neurodevelopmental disorders, but to obtain better outcome measures, the intervention should combine face-to-face sessions and the use of mHealth, as well as employing the family-centered model. Full article

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

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14 pages, 1110 KiB

Open AccessArticle

Effectiveness of Equine-Assisted Intervention as a Therapeutic Strategy for Improving Adaptive Behaviour in Children with Autism Spectrum Disorder

by Carmen María Martínez Moreno, José Manuel Hernández Garre, Paloma Echevarría Pérez, Isabel Morales Moreno, Eva Vegue Parra and Eloína Valero Merlos

Healthcare 2025, 13(16), 2014; https://doi.org/10.3390/healthcare13162014 - 15 Aug 2025

Abstract

Background/Objectives: This study examines the effectiveness of equine-assisted intervention (EAI) in improving adaptive behaviour and motor skills in children with autism spectrum disorder (ASD). Methods: To that effect, a self-controlled experimental analytical study has been designed, which is longitudinal and prospective [...] Read more.

Background/Objectives: This study examines the effectiveness of equine-assisted intervention (EAI) in improving adaptive behaviour and motor skills in children with autism spectrum disorder (ASD). Methods: To that effect, a self-controlled experimental analytical study has been designed, which is longitudinal and prospective in nature, with pre- and post-intervention measures, using the Vineland Adaptive Behavior Scale II (VABS-II) as the assessment instrument. The sample consists of 19 children who participated in weekly therapeutic sessions involving horses for eight months; these sessions included horseback riding, groundwork, hygiene, and preparation of the horse. Results: The results show significant improvements both in the overall score of the VABS-II test (

\bar{x}

pre: 65.84 ± 10.38–

\bar{x}

post: 72.47 ± 16.21, p = 0.003) and in the areas of communication (

\bar{x}

pre: 64.84 ± 15.50 ~

\bar{x}

post: 72.26 ± 21.93, p = 0.010), social skills (

\bar{x}

pre: 61.26 ± 8.99 ~

\bar{x}

post: 66.53 ± 13.79, p = 0.008) and daily living skills (DLS) (

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pre: 66.21 ± 11.15 ~

\bar{x}

post: 69.95 ± 12.32, p = 0.0004), as well as a non-significant slight improvement in motor skills (

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pre: 72.50 ± 8.83 ~

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post: 75.17 ± 7.88, p = 0.363). In addition, these gains were greater in those children attending standard classroom settings and receiving early stimulation. Conclusions: This study suggests equine-assisted intervention (EAI) may contribute to improvements in adaptive behaviour, including communication, social skills, and daily living skills, in children with autism spectrum disorder (ASD). Benefits were notably enhanced in children receiving early stimulation within standard classroom settings. Full article

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23 pages, 525 KiB

Open AccessSystematic Review

Virtual and Augmented Reality Games in Dementia Care: Systematic and Bibliographic Review

by Martin Eckert, Varsha Radhakrishnan, Thomas Ostermann, Jan Peter Ehlers and Gregor Hohenberg

Healthcare 2025, 13(16), 2013; https://doi.org/10.3390/healthcare13162013 - 15 Aug 2025

Viewed by 18

Abstract

Background: This review investigates the use of virtual and augmented reality games in dementia care. It provides an insight into the last 13 years of research, including the earliest publications on this topic, and takes a systematic and bibliographic approach. Methods: We sourced [...] Read more.

Background: This review investigates the use of virtual and augmented reality games in dementia care. It provides an insight into the last 13 years of research, including the earliest publications on this topic, and takes a systematic and bibliographic approach. Methods: We sourced research publications from three different scientific databases (PubMed, Scopus, and APA PsycInfo) for this publication. We chose the PRISMA approach and categorized the studies according to the publisher. A set of 12 variables was defined across three categories (bibliographic, medical, and technical). Results: Of the 389 identified articles, 36 met the inclusion and exclusion criteria. After a phase of pilot studies mainly being conducted, the number of publications increased by four times but decreased again in 2023. Dominating were pilot and feasibility studies; 8 out of the 36 trials were RCTs. The median trial population was 24, and the protocols were performed for an average of 10 weeks, with two 40-min sessions a week. Simulator sickness was reported but not by the majority of participants. A total of 59% of the studies used fully immersive 3D-VR systems. We identified only three publications that provided high immersion quality. These findings indicate the positive effects of using virtual and augmented reality systems on participants’ cognitive function and mood. Conclusions: This publication focuses on the technical aspects of the applied technologies and immersion levels of the patients. Using augmented and virtual reality methods to improve the quality of life and physical interaction of dementia patients shows the potential to enhance cognitive functioning in this population, but further investigation and multicenter RCTs are needed. There are strong indications that this research branch has high potential to benefit both caretakers and patients. Full article

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14 pages, 252 KiB

Open AccessArticle

The Current Attitude Toward Death and Hospice Care Among Medical Students in Mainland China

by Luo Gan, Yuxin Wan and Yanwei Su

Healthcare 2025, 13(16), 2012; https://doi.org/10.3390/healthcare13162012 - 15 Aug 2025

Viewed by 28

Abstract

Background: This study stems from the perceived need to update skills and training in the process of educating healthcare professionals in light of the needs of individuals and their families. Objectives: This study aimed to assess the prevailing attitudes toward death and hospice [...] Read more.

Background: This study stems from the perceived need to update skills and training in the process of educating healthcare professionals in light of the needs of individuals and their families. Objectives: This study aimed to assess the prevailing attitudes toward death and hospice care among medical students in China, providing a foundation for implementing hospice care and death education within these institutions. Methods: We conducted an online survey questionnaire with 568 medical students. Results: The results indicate that the overall attitude toward death was more inclined to accepting death neutrally. Gender, place of origin, educational background, willingness to care for terminally ill patients, experience in caring for terminally ill patients, and more will affect the attitude toward death of medical students. Compared to their rural counterparts, medical students in urban areas are more likely to view death as neutral. Instead of reducing fear, death and hospice education made people more likely to avoid situations. All five dimensions of death attitude exhibit a substantial positive connection with attitudes toward hospice care. In comparison to earlier research, medical students exhibit increasingly favorable attitudes regarding hospice care, and their overall perspective on death remains one of natural approval, suggesting that the integration of death and hospice care teaching is progressing effectively in mainland China. Conclusions: Simultaneously, it was discovered that numerous deficiencies required enhancement, including the need for timely feedback and optimization in hospice care instruction and death education, as well as insufficient attention and educational guidance regarding the individual differences and psychological conditions of medical personnel in the future. Full article

16 pages, 643 KiB

Open AccessArticle

A Short-Term Cost-Effectiveness Analysis of Tirzepatide Versus Semaglutide for the Treatment of Obesity in Greece

by Panagiotis Papantoniou and Nikolaos Maniadakis

Healthcare 2025, 13(16), 2011; https://doi.org/10.3390/healthcare13162011 - 15 Aug 2025

Viewed by 37

Abstract

Background/Objectives: Obesity is a global health issue with profound humanistic and financial implications. Novel pharmacological treatments, such as tirzepatide and semaglutide, offer promising options for sustained weight management; however, their cost-effectiveness warrants assessment. This study investigates the short-term cost-effectiveness of tirzepatide compared [...] Read more.

Background/Objectives: Obesity is a global health issue with profound humanistic and financial implications. Novel pharmacological treatments, such as tirzepatide and semaglutide, offer promising options for sustained weight management; however, their cost-effectiveness warrants assessment. This study investigates the short-term cost-effectiveness of tirzepatide compared to semaglutide in achieving weight loss targets over 72 weeks in Greece. Methods: A short-term cost-effectiveness analysis was conducted from the perspective of the Greek third-party payer (EOPYY), comparing treatment costs and clinical outcomes for semaglutide and tirzepatide over a 72-week horizon. Clinical efficacy was assessed by the proportion of patients achieving weight loss targets of ≥10%, ≥15%, ≥20%, ≥25%, and ≥30%, using data from the SURMOUNT-5—a 72-week, phase 3b, head-to-head study among overweight adults or those with obesity without diabetes. Only direct medical costs were included, and no discount was employed due to the short time horizon. Price scenario, deterministic, and probabilistic sensitivity analyses were performed. Results: Over 72 weeks, the deterministic analysis found the total treatment cost was EUR 5645.70 for tirzepatide and EUR 3201.68 for semaglutide. These base-case results indicated the cost per responder for tirzepatide at higher weight loss targets (e.g., EUR 28,658 and EUR 46,401 at ≥30%) and lower costs for semaglutide at lower targets (e.g., EUR 1627 lower at ≥10%). However, probabilistic sensitivity analysis revealed overlapping 95% confidence intervals at all thresholds, indicating no statistically significant difference in the cost of control between the treatments. Conclusions: Semaglutide showed a numerically lower cost of control at lower weight loss targets, while tirzepatide was favoured at higher targets; however, these differences were not statistically significant. Full article

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14 pages, 265 KiB

Open AccessArticle

Exploring Vulnerable, Ethnic Minority, and Low Socioeconomic Children’s Knowledge, Beliefs, and Attitudes Regarding HPV Vaccination in Romania

by Teodora Achimaș-Cadariu, Andrei Pașca, Delia Nicoară and Dan Lucian Dumitrașcu

Healthcare 2025, 13(16), 2010; https://doi.org/10.3390/healthcare13162010 - 15 Aug 2025

Viewed by 38

Abstract

Background/Objective: To assess vulnerable Romanian children’s knowledge, attitudes, and beliefs regarding the HPV vaccination. Methods: Vulnerable children (ethnic minorities, high social vulnerability index, or low socioeconomic status) from three schools in Cluj County, Romania, were enrolled in a short educational presentation regarding HPV [...] Read more.

Background/Objective: To assess vulnerable Romanian children’s knowledge, attitudes, and beliefs regarding the HPV vaccination. Methods: Vulnerable children (ethnic minorities, high social vulnerability index, or low socioeconomic status) from three schools in Cluj County, Romania, were enrolled in a short educational presentation regarding HPV and were delivered a physical questionnaire consisting of 26 items. Results: 199 vulnerable school students concluded the questionnaire with a mean age of 14.62. Most participants were unaware of the HPV infection or the HPV vaccine. Following the educational program, most participants exhibited a reasonably elevated level of knowledge, which positively correlated with the intention to vaccinate. Fifty-three per cent of respondents would vaccinate in school if the vaccine were available, fifty-four per cent would vaccinate if the product were free of charge or at minimal cost, and over sixty-four per cent would vaccinate at their doctor’s recommendation. Several knowledge items, beliefs, and attitudes towards vaccination were disclosed to influence children’s preference to participate in vaccination campaigns. Conclusions: This analysis unveiled the pivotal role of knowledge about HPV in the immunization uptake within underserved, vulnerable populations of Romanian children. An intricate interplay between vulnerability, knowledge, accessibility, and the willingness to vaccinate was impacted by several beliefs and attitudes towards HPV vaccination. Most children were willing to participate in HPV immunization campaigns, whether school-based, reimbursed, or at the doctor’s recommendation. These findings act as pillars for assembling future educational campaigns in vulnerable Romanian communities of children, aiming to enhance awareness and coverage of HPV vaccination and ensure inclusive health policies. Full article

(This article belongs to the Special Issue HPV Vaccine and Cervical Cancer Prevention)

19 pages, 247 KiB

Open AccessArticle

Enduring Effects of the COVID-19 Pandemic on the Mental Health of Physicians in Pakistan: A Mixed-Methods Study

by Syed Ahmed Shahzaeem Hussain, Syed Ahmed Shahzain Hussain, Muhammad Hasnain Haider, Mustafa Sohail Butt, Anas Zahid and Umair Majid

Healthcare 2025, 13(16), 2009; https://doi.org/10.3390/healthcare13162009 - 15 Aug 2025

Viewed by 43

Abstract

Background: The COVID-19 pandemic caused lasting disruption to healthcare systems and the mental health of frontline workers. Though the acute crisis has passed, many healthcare workers (HCWs) continue to experience long-term psychological effects, including anxiety, grief, and burnout. This mixed-methods study investigates [...] Read more.

Background: The COVID-19 pandemic caused lasting disruption to healthcare systems and the mental health of frontline workers. Though the acute crisis has passed, many healthcare workers (HCWs) continue to experience long-term psychological effects, including anxiety, grief, and burnout. This mixed-methods study investigates the enduring effects of the COVID-19 pandemic on the mental health of physicians in a low-resource country. Methods: Drawing on data from the ear, nose, and throat (ENT) or otolaryngology department at a tertiary care hospital in Pakistan, the study employed an explanatory mixed-methods design, combining structured surveys and semi-structured interviews. The Hospital Anxiety and Depression Scale, the Perceived Stress Scale, and the Brief COPE Inventory were administered to 42 ENT specialists, trainees, and house officers, alongside semi-structured interviews with eight ENT physicians. Results: Survey results revealed moderate to high levels of anxiety, depression, and stress that persisted beyond the acute crisis phase of the pandemic. Interviews provided nuanced insights into the emotional burden experienced by physicians, including persistent concerns about contagion risk, professional isolation, and increased workload. Physicians described maladaptive responses and employed active coping strategies, such as seeking peer support and utilizing adaptive problem solving. Conclusions: The COVID-19 pandemic has had enduring effects on the mental well-being of physicians. Targeted interventions and policy reforms that address the ongoing pressures frontline physicians face in resource-constrained environments may help mitigate these burdens, support healthcare professionals more effectively, and improve their mental health. Full article

(This article belongs to the Special Issue Strategies and Interventions for Supporting the Holistic Well-Being of Clinicians and Nurses)

31 pages, 3101 KiB

Open AccessArticle

Harnessing Digital Phenotyping for Early Self-Detection of Psychological Distress

by Jana G. Zakai and Sultan A. Alharthi

Healthcare 2025, 13(16), 2008; https://doi.org/10.3390/healthcare13162008 - 15 Aug 2025

Viewed by 37

Abstract

Psychological distress remains a significant public health concern, particularly among youth. With the growing integration of mobile and wearable technologies into daily life, digital phenotyping has emerged as a promising approach for early self-detection and intervention in psychological distress. Objectives: The study aims [...] Read more.

Psychological distress remains a significant public health concern, particularly among youth. With the growing integration of mobile and wearable technologies into daily life, digital phenotyping has emerged as a promising approach for early self-detection and intervention in psychological distress. Objectives: The study aims to determine how behavioral and device-derived data can be used to identify early signs of emotional distress and to develop and evaluate a prototype system that enables users to self-detect these early warning signs, ultimately supporting early intervention and improved mental health outcomes. Method: To achieve this, this study involved a multi-phase, mixed-method approach, combining literature review, system design, and user evaluation. It started with a scoping review to guide system design, followed by the design and development of a prototype system (ESFY) and a mixed-method evaluation to assess its feasibility and utility in detecting early signs of psychological distress through digital phenotyping. Results: The results demonstrate the potential of digital phenotyping to support early self-detection for psychological distress while highlighting practical considerations for future deployment. Conclusions: The findings highlight the value of integrating active and passive data streams, prioritizing transparency and user empowerment, and designing adaptable systems that respond to the diverse needs and concerns of end users. The recommendations outlined in this study serve as a foundation for the continued development of scalable, trustworthy, and effective digital mental health solutions. Full article

(This article belongs to the Special Issue The Impact of Digital Technology Use on the Mental and Physical Health)

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26 pages, 561 KiB

Open AccessSystematic Review

Type 2 Diabetes Prediction Model in China: A Five-Year Systematic Review

by Juncheng Duan and Norshita Mat Nayan

Healthcare 2025, 13(16), 2007; https://doi.org/10.3390/healthcare13162007 - 15 Aug 2025

Viewed by 38

Abstract

Background: China has the largest number of patients with type 2 diabetes (T2D) worldwide, and the chronic complications and economic burden associated with T2D are becoming increasingly severe. Developing accurate and widely applicable risk prediction models is of great significance for the early [...] Read more.

Background: China has the largest number of patients with type 2 diabetes (T2D) worldwide, and the chronic complications and economic burden associated with T2D are becoming increasingly severe. Developing accurate and widely applicable risk prediction models is of great significance for the early identification of and intervention in high-risk populations. However, current Chinese models still have many shortcomings in terms of methodological design and clinical application. Objective: This study conducts a systematic review and narrative synthesis of existing risk prediction models for type 2 diabetes in China, aiming to identify issues with existing models and provide references with which Chinese scholars can develop higher-quality risk prediction models. Methods: This study followed the PRISMA guidelines to conduct a systematic search of the literature related to T2D risk prediction models in China published in English journals from October 2019 to October 2024. The databases included PubMed, CNKI and Web of Science. Included studies had to meet criteria such as clear modeling objectives, detailed model development and validation processes, and a focus on non-diabetic populations in China. A total of 20 studies were ultimately selected and comprehensively analyzed based on model type, variable selection, validation methods, and performance metrics. Results: The 20 included studies employed various modeling methods, including statistical and machine learning approaches. The AUC values of the models ranged from 0.728 to 0.977, indicating overall good predictive capability. However, only one study conducted external validation, and 45% (9/20) of the studies binned continuous variables, which may have reduced the models’ generalization ability and predictive performance. Additionally, most models did not include key variables such as lifestyle, socioeconomic factors, and cultural background, resulting in limited data representativeness and adaptability. Conclusions: Chinese T2DM risk prediction models remain in the developmental stage, with issues such as insufficient validation, inconsistent variable handling, and incomplete coverage of key influencing factors. Future research should focus on strengthening multicenter external validation, standardizing modeling processes, and incorporating multidimensional social and behavioral variables to enhance the clinical utility and cross-population applicability of these models. Registration ID: CRD420251072143. Full article

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12 pages, 1227 KiB

Open AccessArticle

PAPIMI Short Effect on Pain Perception and Heart Rate Variability in Chronic Musculoskeletal Pain: A Pilot Study

by Antonio Viti, Manuel Amore, Susanna Garfagnini, Diego Minciacchi and Riccardo Bravi

Healthcare 2025, 13(16), 2006; https://doi.org/10.3390/healthcare13162006 - 15 Aug 2025

Viewed by 67

Abstract

Background: Chronic musculoskeletal pain (CMP) is a multidimensional condition involving both peripheral and central mechanisms, with increasing evidence supporting an interplay between subjective pain perception and autonomic nervous system (ANS) function. However, few studies have explored whether a single non-invasive intervention can [...] Read more.

Background: Chronic musculoskeletal pain (CMP) is a multidimensional condition involving both peripheral and central mechanisms, with increasing evidence supporting an interplay between subjective pain perception and autonomic nervous system (ANS) function. However, few studies have explored whether a single non-invasive intervention can concurrently modulate both domains. Objectives: To evaluate the short-term effects of a single session of Pulsed Electromagnetic Field (PEMF) therapy—administered via the PAP Ion Magnetic Induction (PAPIMI™) device—on subjective pain intensity and heart rate variability (HRV) parameters in individuals with CMP. The relationship between perceived pain relief and physiological autonomic adaptations was also explored. Methods: Thirty adults with CMP underwent a single PAPIMI™ session. Subjective pain intensity was measured using the Numeric Pain Rating Scale (NPRS), while autonomic function was assessed via HRV. Pre- to post-intervention changes were analyzed using the Wilcoxon Signed-Rank test, while Spearman’s correlation was computed to assess associations between post-intervention changes in subjective perceived pain and HRV parameters. Results: A significant reduction in NPRS scores (p < 0.001) was found after PAPIMI intervention. Also, a significant increase in specific parasympathetic-related HRV indices, namely, RMSSD (p = 0.015) and HF power (p = 0.029), was observed. No significant correlations were found between post-intervention changes in pain perception and HRV metrics. Conclusions: A single PAPIMI session induced both analgesic effects and improvements in autonomic balance in individuals with CMP. These findings underscore the potential of PAPIMI as a non-pharmacological approach for rapid pain modulation and systemic rebalancing. Full article

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12 pages, 249 KiB

Open AccessArticle

An Effect of Smelled Breast Milk During and After Venous Blood Drawing on Newborn Infants’ Pain and Comfort Level

by Feyza Kübra Albayram, Selver Guler and Melike Yavas Celik

Healthcare 2025, 13(16), 2005; https://doi.org/10.3390/healthcare13162005 - 14 Aug 2025

Viewed by 106

Abstract

Background/Objectives: This study was conducted as a randomized controlled trial to evaluate the effect of breast milk odor on pain and stress levels during venous blood sampling. Method: Data were collected from 60 newborn infants consisting of a total of 30 infants in [...] Read more.

Background/Objectives: This study was conducted as a randomized controlled trial to evaluate the effect of breast milk odor on pain and stress levels during venous blood sampling. Method: Data were collected from 60 newborn infants consisting of a total of 30 infants in the experimental group and 30 in the control group who were hospitalized in the Intensive Care Unit between 7 December 2022 and 25 September 2023. The data were collected using the Newborn Infant Pain Scale and Premature Infant Comfort Scale forms. Results: It was observed that there was a statistically significant difference between the groups in terms of the Newborn Infant Pain Scale and Premature Infant Comfort Scale when comparing the measurements taken during the procedure and 5 min after the procedure. A strong correlation was found between the Newborn Infant Pain Scale and Premature Infant Comfort Scale scores measured 5 min after the venous blood collection procedure (r = 0.86, p = 0.01). Conclusions: Based on the results of this study, it was determined that smelling breast milk, which is one of the non-pharmacological methods that can be used in invasive or non-invasive painful procedures on newborn infants, positively affects the pain and comfort level of babies. Full article

(This article belongs to the Special Issue Nursing Care in the ICU—2nd Edition)

11 pages, 425 KiB

Open AccessArticle

Effects of Physical Activity and Mental Health on Chewing Difficulty in South Korean Adults: A Cross-Sectional Analysis

by Mi-Ra Lee

Healthcare 2025, 13(16), 2004; https://doi.org/10.3390/healthcare13162004 - 14 Aug 2025

Viewed by 75

Abstract

Objectives: This study aimed to investigate the effects of physical activity and mental health on chewing difficulty in South Korean adults using data from the seventh Korea National Health and Nutrition Examination Survey (KNHANES VII, 2016–2018). Methods: A total of 8212 participants aged [...] Read more.

Objectives: This study aimed to investigate the effects of physical activity and mental health on chewing difficulty in South Korean adults using data from the seventh Korea National Health and Nutrition Examination Survey (KNHANES VII, 2016–2018). Methods: A total of 8212 participants aged ≥20 years who completed surveys on their physical activity, mental health, and chewing status were included. Chewing difficulty was assessed via a five-point Likert scale based on self-reported discomfort when chewing due to oral problems, and dichotomized for analysis. The participants were divided into two groups: those aged <40 and those aged ≥40 years. Complex sample analyses, including cross-tabulations and logistic regression, were used to examine the associations. Results: Among men aged <40, high perceived stress was associated with 1.71 times higher odds of experiencing chewing difficulty (p < 0.05). For men aged ≥40, high perceived stress (OR of 1.45) and a sleep duration of <7 h (OR of 1.32) were significant risk factors (p < 0.05). In women aged ≥40 years, high Patient Health Questionnaire 9 (PHQ-9) scores (≥10; OR of 2.35) and high perceived stress (OR of 1.64) were significantly associated with chewing difficulty (p < 0.001). Conclusions: Perceived stress, insufficient sleep, and depression are significant mental health factors associated with chewing difficulty in adults. These findings emphasize the necessity of a multifaceted approach, including psychosocial mental health issues, to effectively manage chewing difficulty in this population. Full article

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

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15 pages, 248 KiB

Open AccessReview

From Blame to Learning: The Evolution of the London Protocol for Patient Safety

by Francesco De Micco, Gianmarco Di Palma, Vittoradolfo Tambone and Roberto Scendoni

Healthcare 2025, 13(16), 2003; https://doi.org/10.3390/healthcare13162003 - 14 Aug 2025

Viewed by 117

Abstract

Over the past two decades, patient safety and clinical risk management have become strategic priorities for healthcare systems worldwide. In this context, the London Protocol has emerged as one of the most influential methodologies for investigating adverse events through a systemic, non-punitive lens. [...] Read more.

Over the past two decades, patient safety and clinical risk management have become strategic priorities for healthcare systems worldwide. In this context, the London Protocol has emerged as one of the most influential methodologies for investigating adverse events through a systemic, non-punitive lens. The 2024 edition, curated by Vincent, Adams, Bellandi, and colleagues, represents a significant evolution of the original 2004 framework. It integrates recent advancements in safety science, human factors, and digital health, while placing a stronger emphasis on resilience, proactive learning, and stakeholder engagement. This article critically examines the structure, key principles, and innovations of the London Protocol 2024, highlighting its departure from incident-centered analysis toward a broader understanding of both failures and successes. The protocol encourages fewer but more in-depth investigations, producing actionable and sustainable recommendations rather than generic reports. It also underscores the importance of involving patients and families as active partners in safety processes, recognizing their unique perspectives on communication, care pathways, and system failures. Beyond its strengths—holistic analysis, multidisciplinary collaboration, and cultural openness—the systemic approach presents challenges, including methodological complexity, resource requirements, and cultural resistance in blame-oriented environments. This paper discusses these limitations and explores how leadership, staff engagement, and digital technologies (including artificial intelligence) can help overcome them. Ultimately, the London Protocol 2024 emerges not only as a methodological tool but as a catalyst for cultural transformation, fostering healthcare systems that are safer, more resilient, and committed to continuous learning. Full article

(This article belongs to the Special Issue Integrating Forensic Science in Clinical Medicine: Enhancing Diagnosis and Patient Safety)

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