Healthcare

24 pages, 1116 KB

Open AccessReview

Unveiling the Dark Side of Negative Behaviors Among Nurses and Their Implications in Workforce Well-Being and Patient Care: A Scoping Review

by Nuno Santos, Rita Barahona, Paulo Cruchinho and Elisabete Nunes

Healthcare 2025, 13(16), 2079; https://doi.org/10.3390/healthcare13162079 - 21 Aug 2025

Viewed by 744

Abstract

Introduction: Negative behaviors in nursing undermine well-being, erode team cohesion, and jeopardize patient safety. Rooted in systemic stressors—workload, emotional strain, and power imbalances—they have far-reaching effects on job satisfaction and care quality. Objective: To systematically map the scientific evidence on negative [...] Read more.

Introduction: Negative behaviors in nursing undermine well-being, erode team cohesion, and jeopardize patient safety. Rooted in systemic stressors—workload, emotional strain, and power imbalances—they have far-reaching effects on job satisfaction and care quality. Objective: To systematically map the scientific evidence on negative behaviors among nurses in healthcare organizations. Methods: A scoping review was conducted using five databases: CINAHL, MEDLINE, Scopus, Psychology & Behavioral Sciences Collection, and RCAAP (for grey literature). The review followed the Joanna Briggs Institute methodology and PRISMA-ScR reporting guidelines. Two independent reviewers conducted data extraction and synthesis. Results: Eighteen studies published between 2017 and 2024 met inclusion criteria from an initial pool of 88 references. Eleven thematic domains emerged: (1) the cycle of violence; (2) victims profile; (3) perpetrator profile; (4) negative behaviors spectrum; (5) negative behaviors prevalence; (6) risk predictors; (7) protective predictors; (8) impact of negative behaviors on nurses; (9) impact of negative behaviors on patients; (10) impact of negative behaviors on healthcare organizations; (11) organizational strategies and the role of the nurse managers. Conclusions: The findings highlight the multidimensional nature of negative behaviors and the variability in how they are defined and assessed. This review highlights the need for conceptual clarity and standardized tools to address negative behaviors in nursing. Nurse managers, as key organizational agents, play a critical role in fostering psychological safety, promoting ethical leadership, and ensuring accountability. System-level strategies that align leadership with organizational values are essential to protect workforce well-being and safeguard patient care. 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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19 pages, 862 KB

Open AccessArticle

Child and Adolescent Mental Health Service (CAMHS) in Poland—From the Perspective of the Current State and New Reform

by Monika Serkowska, Marlena Robakowska, Dariusz Aleksander Rystwej and Michał Brzeziński

Healthcare 2025, 13(16), 2078; https://doi.org/10.3390/healthcare13162078 - 21 Aug 2025

Viewed by 600

Abstract

Introduction: The organization of mental health care is undergoing a transformation from an institutionalized model to a community-centered model. Due to the critical specialist workforce shortage, insufficient funding, and the large number of children in crisis, its implementation presents a challenge. The aim [...] Read more.

Introduction: The organization of mental health care is undergoing a transformation from an institutionalized model to a community-centered model. Due to the critical specialist workforce shortage, insufficient funding, and the large number of children in crisis, its implementation presents a challenge. The aim of this study is to analyze the current situation regarding access to system-based care under contracts with the National Health Fund in various provinces in Poland. Materials and Methods: Based on an analysis of data, resources available to patients were assessed—specifically, information was obtained from the National Health Fund website entitled “NFZ Treatment Waiting Times.” From this, the waiting times for appointments in child and adolescent mental health care facilities, the availability of mental health care facilities under contracts with the National Health Fund in Poland, legal acts, and data from the Central Statistical Office were extracted. Then, an analysis of the current accessibility to child and adolescent mental health services was conducted. The inclusion criteria for data sources were as follows: accessibility—the data had to be openly available to researchers without restrictions; credibility—the data had to be verified by individual health care facilities; usefulness—the data had to accurately reflect the actual availability of services and the needs within the child and adolescent psychiatric care system. Results: There are significant differences and deviations from the average number of facilities and waiting times when comparing the 16 provinces. Notably, some of the analyzed facilities are already operating within the framework of Child and Adolescent Mental Health Centers, where the mean waiting period for inpatient care is 105 days, the mean waiting period for day-care units is 61 days, and the mean waiting period for outpatient clinics is 257 days. The number of facilities is increasing under the reform, with new level I reference centers being opened, which ensures prevention and early support is provided by a pedagogue, psychologist, and non-medical staff, providing enhanced accessibility to care without the need for a visit to a child and adolescent psychiatrist, of whom there are only 579 for the entire child population in Poland. This metric primarily refers to first-time appointments in public institutions, with notable disparities between urban and rural areas. Conclusions: The development of the reform offers hope for quicker access to mental health support for children and adolescents. With the consistent implementation of the reform and further support from non-governmental organizations, there is a high chance of building an effective community-based model with a short waiting time for help and reducing ineffective hospitalizations, among other things, in terms of costs. Full article

(This article belongs to the Section Health Policy)

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20 pages, 3252 KB

Open AccessArticle

Global, Regional, and National Burden of Burn Injury by Total Body Surface Area (TBSA) Involvement from 1990 to 2021, with Projections of Prevalence to 2050

by Nara Lee, Youngoh Bae, Suho Jang, Dong Won Lee and Seung Won Lee

Healthcare 2025, 13(16), 2077; https://doi.org/10.3390/healthcare13162077 - 21 Aug 2025

Viewed by 602

Abstract

Background/Objectives: Burn injuries are a major public health concern. This study estimated global, regional, and national burn burdens by total body surface area from 1990 to 2021 and projected trends to 2050. Methods: Utilizing data from the Global Burden of Disease Study 2021, [...] Read more.

Background/Objectives: Burn injuries are a major public health concern. This study estimated global, regional, and national burn burdens by total body surface area from 1990 to 2021 and projected trends to 2050. Methods: Utilizing data from the Global Burden of Disease Study 2021, we examined the prevalence, mortality, and years lived with disability (YLDs) according to age, sex, and region. Future trends were predicted using Bayesian meta-regression models and Das Gupta decomposition analysis. Results: In 2021, global prevalence was 12.99 million for severe burns and 235.34 million for mild burns, with age-standardized rates of 158.75 and 2815.26 per 100,000. Severe burns were highest in Southern Latin America (7836.51 per 100,000) and mild burns in the Caribbean (626.94 per 100,000). The largest declines from 1990 to 2021 were in high-income North America for severe burns (−38.22%) and East Asia for mild burns (−73.03%). Females had higher severe burn prevalence at younger and older ages, while males had higher mild burn prevalence from early adulthood. Leading risk factors were fire, heat, and hot substances (38.22% of severe burn YLDs; 53.87% for mild burns). By 2050, severe burns are projected to rise by 233.4% and mild burns by 142.5%, with Eastern Europe showing the largest growth. Conclusions: Although age-standardized burn rates are declining, absolute cases are projected to rise due to population growth and aging, particularly in low- and middle-income countries, underscoring the need for stronger prevention and improved burn care infrastructure. Full article

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13 pages, 730 KB

Open AccessArticle

Healthcare Spending Before and After Mild Cognitive Impairment Diagnosis: Evidence from the NHIS–NHID in Korea

by Sujin Ma, Huiwon Jeon, Yoohun Noh and Jin-Won Noh

Healthcare 2025, 13(16), 2076; https://doi.org/10.3390/healthcare13162076 - 21 Aug 2025

Viewed by 418

Abstract

Background/Objectives: With rapid population aging, concerns about cognitive health—especially mild cognitive impairment (MCI), a prodromal stage of dementia—are growing. Although MCI prevalence is rising, limited empirical evidence exists on changes in healthcare expenditures associated with its diagnosis. This study aimed to assess shifts [...] Read more.

Background/Objectives: With rapid population aging, concerns about cognitive health—especially mild cognitive impairment (MCI), a prodromal stage of dementia—are growing. Although MCI prevalence is rising, limited empirical evidence exists on changes in healthcare expenditures associated with its diagnosis. This study aimed to assess shifts in medical spending before and after MCI diagnosis and to identify factors influencing healthcare costs among Korean adults. Methods: We used data from the National Health Insurance Service–National Health Information Database (NHIS–NHID) from 2020 to 2022. This study analyzed 4162 Korean adults aged ≤84 who were newly diagnosed with MCI in 2021. Annual healthcare expenditures were tracked from 2020 to 2022. Generalized estimating equations (GEEs) were employed to examine changes over time, adjusting for sociodemographic characteristics, comorbidities, healthcare utilization, and long-term care insurance (LTCI) enrollment. Results: The average annual healthcare expenditure increased from 74,767 KRW before diagnosis to 87,902 KRW after diagnosis, reflecting a 12.51% rise. Regression analysis showed a significant decrease in costs in the year prior to diagnosis (β = −0.117, p < 0.01) and an increase in the year following diagnosis (β = 0.061, p < 0.01). Higher expenditures were associated with greater outpatient visits (β = 0.385, p < 0.01), longer hospital stays (β = 0.039, p < 0.01), LTCI enrollment (non-graded: β = 0.035, p = 0.02; graded: β = 0.027, p = 0.04) and higher comorbidity levels (CCI = 2: β = 0.088, p < 0.01, CCI ≥ 3: β = 0.192, p < 0.01). Conversely, older age (β = −0.003, p = 0.02) and female sex (β = −0.093, p < 0.01) were associated with lower costs. Sex-stratified analyses revealed consistent cost trends but different predictors for male and female patients. Conclusions: Healthcare expenditures rise significantly after MCI diagnosis. Early identification and interventions tailored to patient characteristics—such as age, sex, and comorbidity status—may help manage future costs and support equitable care for older adults. Full article

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11 pages, 348 KB

Open AccessArticle

The Impact of Employment and Economic Perception on Nutrition and Depression Among Cancer Survivors

by Guillermo Laporte-Estela, Manuel Rivera-Vélez, Paulette Ayala-Rodriguez, Gabriela Nichole Marrero-Quiñones, Zindie Rodriguez-Castro, Cynthia Cortes-Castro, Guillermo N. Armaiz-Pena and Eida M. Castro-Figueroa

Healthcare 2025, 13(16), 2075; https://doi.org/10.3390/healthcare13162075 - 21 Aug 2025

Viewed by 403

Abstract

Background: Cancer remains a leading cause of morbidity and mortality worldwide. In Puerto Rico, patients face additional burdens due to the structural inequalities affecting access to employment, nutritious food, and mental health services. This study examined the associations between employment status, perceived economic [...] Read more.

Background: Cancer remains a leading cause of morbidity and mortality worldwide. In Puerto Rico, patients face additional burdens due to the structural inequalities affecting access to employment, nutritious food, and mental health services. This study examined the associations between employment status, perceived economic hardship, dietary behaviors, and depressive symptoms among 334 adult cancer patients in Puerto Rico. Methods: Using a cross-sectional design, participants provided sociodemographic data, dietary patterns, and self-reports of depression. Results: Statistical analyses revealed that full-time employment was associated with a higher consumption of low-nutritional-value foods (ρ = 0.157, p = 0.015) and significant differences in their consumption having a higher mean against unemployment were observed (mean ranks = 146.09 and 177.08, p = 0.010). A higher employment status also served as a protective factor against depression (p = 0.005). A higher body mass index (BMI) was linked to an increased risk of depression (p = 0.002), and perceived economic hardship was significantly associated with depression (OR= 0.54, p = 0.033). Conclusions: The findings underscore the necessity for comprehensive interventions that account for the synergistic effects of economic perception, employment, nutrition, and psychological well-being in cancer treatment in Puerto Rico. Full article

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17 pages, 2237 KB

Open AccessProtocol

Evaluation of the Effectiveness of a Cardiac Telerehabilitation Program in Chronic Heart Failure: Design and Rationale of the TELEREHAB-HF Study

by Marina Garofano, Carmine Vecchione, Mariaconsiglia Calabrese, Maria Rosaria Rusciano, Valeria Visco, Giovanni Granata, Albino Carrizzo, Gennaro Galasso, Placido Bramanti, Francesco Corallo, Lucia Pepe, Luana Budaci, Michele Ciccarelli and Alessia Bramanti

Healthcare 2025, 13(16), 2074; https://doi.org/10.3390/healthcare13162074 - 21 Aug 2025

Viewed by 618

Abstract

Background: Despite strong guideline recommendations, participation in cardiac rehabilitation (CR) among patients with chronic heart failure (CHF) remains low due to logistical, geographical, and psychosocial barriers. Telerehabilitation may help overcome these limitations by offering remote, structured exercise programs supported by digital technologies. Objective: [...] Read more.

Background: Despite strong guideline recommendations, participation in cardiac rehabilitation (CR) among patients with chronic heart failure (CHF) remains low due to logistical, geographical, and psychosocial barriers. Telerehabilitation may help overcome these limitations by offering remote, structured exercise programs supported by digital technologies. Objective: The TELEREHAB-HF study aims to evaluate the efficacy of an 8-week, home-based cardiac telerehabilitation program compared to standard in-person rehabilitation in patients with CHF. Methods: This is a prospective, controlled cohort study involving 220 adult patients with CHF (NYHA class I–III) clinically stable and on optimized therapy. Participants are assigned to either a telerehabilitation group (remote CR via a digital platform with wearable sensors and real-time physiotherapist supervision) or a standard in-person rehabilitation group. The primary outcome is the change in peak oxygen uptake (VO₂max) at 8 weeks. Secondary outcomes include quality of life, functional performance, biochemical and echocardiographic parameters, and cognitive function, assessed at baseline and at 4, 8, 16, and 24 weeks. Expected Results: We hypothesize that telerehabilitation will be non-inferior to standard CR in improving functional capacity and secondary outcomes, with additional benefits in accessibility and adherence. Data from remote monitoring may also support a translational “rehabilomics” approach to exploring exercise-induced biomarker changes. Conclusions: This study seeks to assess the clinical effectiveness, safety, and feasibility of a home-based telerehabilitation model for CHF, with the goal of informing future strategies for broader implementation and personalized rehabilitation. Trial Registration: ClinicalTrials.gov Identifier: NCT07023536 Full article

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

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15 pages, 462 KB

Open AccessArticle

Association Between Different Patterns of Opioid and Benzodiazepine Use and Risks of Emergency Department Visits and Hospitalizations: A Retrospective Cohort Study

by Fang-Yu Su, Ming-Che Tsai, Yee-Yung Ng and Shiao-Chi Wu

Healthcare 2025, 13(16), 2073; https://doi.org/10.3390/healthcare13162073 - 21 Aug 2025

Viewed by 446

Abstract

Background: In 2016, the U.S. FDA warned against concurrent use of opioids and benzodiazepines (BZDs) due to risks of respiratory depression and death. However, limited data exist in Asian populations. Methods: Using the Chang Gung Research Database in Taiwan, we conducted [...] Read more.

Background: In 2016, the U.S. FDA warned against concurrent use of opioids and benzodiazepines (BZDs) due to risks of respiratory depression and death. However, limited data exist in Asian populations. Methods: Using the Chang Gung Research Database in Taiwan, we conducted a retrospective cohort study of 418,549 patients prescribed opioids between 2008 and 2018. Patients were categorized into four groups based on BZD use: opioid-only (PureO), past BZD use (PastB), continuous BZD use (ContiB), and newly initiated BZD use (NewB). Multivariate logistic regression was used to evaluate all-cause emergency department (ED) visits and hospitalizations during the one year follow-up following one year of co-use. Results: Compared with PureO, co-use groups had significantly higher odds of hospitalization (ContiB: aOR = 1.74; PastB: 1.54; NewB: 1.48) and ED visits (ContiB: 2.09; PastB: 2.04; NewB: 1.51). Elevated risks were also observed among older adults, and patients with depression, stroke or transient ischemic attack, chronic obstructive pulmonary disease, chronic kidney disease, as well as those with higher Charlson Comorbidity Index scores. Conclusions: Our findings support the need for cautious prescribing and individualized deprescribing strategies to reduce avoidable acute healthcare utilization. Full article

(This article belongs to the Topic Drug Use and Patient Safety in Primary and Secondary Care Settings)

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20 pages, 696 KB

Open AccessSystematic Review

An Examination of the Relationship Between Social Support Networks and Opioid Misuse Among American Indian/Alaska Native Populations: A Systematic Review

by Samuel Asante, Allen Shamow and Eun-Jun Bang

Healthcare 2025, 13(16), 2072; https://doi.org/10.3390/healthcare13162072 - 21 Aug 2025

Viewed by 382

Abstract

Background/Objectives: This systematic review addresses the disproportionate impact of the opioid epidemic on American Indian and Alaska Native (AI/AN) populations by examining the socio-ecological and social network factors that influence opioid use and misuse. While previous reviews have largely focused on treatment [...] Read more.

Background/Objectives: This systematic review addresses the disproportionate impact of the opioid epidemic on American Indian and Alaska Native (AI/AN) populations by examining the socio-ecological and social network factors that influence opioid use and misuse. While previous reviews have largely focused on treatment modalities or structural determinants such as socioeconomic status and rurality, few studies have explored the role of social networks as risk or protective factors, particularly within AI/AN communities. Methods: Applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, the review synthesized findings from three scholarly databases (PubMed, EBSCOhost, ProQuest), six institutional repositories (e.g., Indigenous Studies Portal), and one academic search engine (Google Scholar). Studies that examined the influence of social network domains on opioid misuse in AI/AN populations in the United States, reported quantitative or qualitative data, and were published between 2010 and 2022 were included in this review. Study quality was assessed with the JBI Checklists for Analytical Cross Sectional Studies and Qualitative Research. Of the 817 articles initially identified, 7 met the inclusion criteria, with most studies focusing on AI/AN adolescents and young adults, a demographic shown to be especially susceptible to opioid misuse. Results: The review identified several social network domains that significantly affect opioid use patterns, including familial relationships, peer associations, community dynamics, educational influences, cultural traditions, social media engagement and the effect of historical and intergenerational trauma. These domains can function either as protective buffers or as contributing factors to opioid misuse. Conclusions: The findings underscore the necessity for future longitudinal research to elucidate the causal pathways between these social network factors and opioid behaviors, particularly concerning trauma and digital media exposure. Furthermore, the study highlights the importance of culturally grounded, evidence-based prevention strategies that address the multifaceted social environments of AI/AN individuals. Such approaches are critical to fostering resilience and mitigating the opioid crisis within these historically marginalized populations. Full article

(This article belongs to the Special Issue Social Capital, Mental Health and Well-Being among Marginalized Communities)

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16 pages, 280 KB

Open AccessArticle

Personal and General Views on Aging, Non-Communicable Diseases, and Their Interaction as Cross-Sectional Correlates of Vigorous Physical Activity in UK Individuals Aged 50+

by Fabrizio Mezza, Daniela Lemmo, Maria Francesca Freda, Victoria Tischler, Blossom C. M. Stephan, Maria Mataró and Serena Sabatini

Healthcare 2025, 13(16), 2071; https://doi.org/10.3390/healthcare13162071 - 21 Aug 2025

Viewed by 404

Abstract

Background: This study investigated the cross-sectional associations of personal and general views on aging, number of non-communicable diseases, and their interactions as cross-sectional predictors of vigorous physical activity. Methods: Participants were 1699 individuals aged 50 years and over (Mean age = [...] Read more.

Background: This study investigated the cross-sectional associations of personal and general views on aging, number of non-communicable diseases, and their interactions as cross-sectional predictors of vigorous physical activity. Methods: Participants were 1699 individuals aged 50 years and over (Mean age = 67.79) and living in the community in the UK; 70.8% were women. Participants completed measures assessing Awareness of Age-Related Gains and Losses (AARC-Gains; AARC-Losses; indicators of personal views on aging), Expectations Regarding Aging (ERA; indicator of general views on aging), vigorous physical activity in the last month, non-communicable disease status, and sociodemographic questions. Linear regression models were used. Results: After having adjusted for age, sex, education, marital status, and working status, higher AARC-Gains, lower AARC-Losses, more positive ERA, and fewer non-communicable diseases were cross-sectionally associated with greater likelihood of engagement with vigorous physical activity (Adjusted models Odds Ratio (OR) of 1.08; 0.86; and 1.06, respectively). The interactions of AARC-Gains and AARC-Losses with number of non-communicable diseases as cross-sectional predictors of likelihood of engagement with vigorous physical activity were not statistically significant. The interaction between ERA (i.e., General Views on Aging) and number of non-communicable diseases was a statistically significant cross-sectional predictor of likelihood of engagement with vigorous physical activity (OR = 0.99; p = 0.044). Conclusions: Having more positive and less negative views on aging may prompt vigorous physical activity engagement. Moreover, positive general views of aging may be particularly important for physical activity among those who have one or more non-communicable diseases. Although we cannot infer causality, promoting positive views on aging and decreasing negative views on aging could help fostering active aging, especially among those with physical health conditions. Full article

10 pages, 201 KB

Open AccessArticle

Benchmarking Cesarean Section Trends: A Case Study from Tu Du Hospital Using Robson’s Model

by Hai Thanh Pham, Thanh Quang Le and Nam Hoang Tran

Healthcare 2025, 13(16), 2070; https://doi.org/10.3390/healthcare13162070 - 21 Aug 2025

Viewed by 416

Abstract

Background: Cesarean section (CS) is a critical surgical procedure in obstetrics but is increasingly overused worldwide. Vietnam has seen rising CS rates, especially in urban tertiary hospitals, with limited standardized analysis to guide interventions. This study assesses CS rates at Tu Du Hospital [...] Read more.

Background: Cesarean section (CS) is a critical surgical procedure in obstetrics but is increasingly overused worldwide. Vietnam has seen rising CS rates, especially in urban tertiary hospitals, with limited standardized analysis to guide interventions. This study assesses CS rates at Tu Du Hospital using the WHO-endorsed Robson 10-Group Classification System. Methods: A cross-sectional descriptive study was conducted over one month in 2017 at Tu Du Hospital, a major obstetrics referral center in southern Vietnam. All women who delivered during this period were classified into Robson’s 10 groups based on parity, gestational age, labor onset, presentation, fetal number, and prior CS. CS rates and group-specific contributions were analyzed. Results: Among 5287 deliveries, the overall CS rate was 42.6%. Group 5 (previous CS) contributed 29.7% of all CSs, followed by Group 2 (nulliparous, induced/pre-labor CS, 26.2%) and Group 1 (nulliparous, spontaneous labor, 12.8%). Failed induction, fetal distress, and cephalopelvic disproportion were common indications. Only 22% of eligible women in Group 5 were offered a trial of labor after cesarean (TOLAC), although the success rate for vaginal birth after cesarean (VBAC) was 67%, indicating underutilization of this option. Conclusions: This study provides rare Robson-based evidence from Vietnam, identifying key target groups for intervention. The findings support expanded use of VBAC and more stringent criteria for induction. Future research should explore behavioral and systemic drivers of high CS rates to guide national policy. Full article

14 pages, 1509 KB

Open AccessArticle

Evaluation of the Effectiveness of Feedback in a Remote Monitoring Home-Based Training System for Workers: A Medium-Scale Randomized Parallel-Group Controlled Trial

by Yasuhiro Suzuki, Hiroaki Kawamoto, Takaaki Matsuda, Hiroaki Suzuki, Hitoshi Shimano and Naoya Yahagi

Healthcare 2025, 13(16), 2069; https://doi.org/10.3390/healthcare13162069 - 21 Aug 2025

Viewed by 504

Abstract

Background: Maintaining long-term exercise adherence in occupational settings remains a challenge, particularly in remote or unsupervised environments. This study aimed to investigate the effect of individualized feedback on exercise adherence, body composition, and physical function during a remote home-based training intervention utilizing the [...] Read more.

Background: Maintaining long-term exercise adherence in occupational settings remains a challenge, particularly in remote or unsupervised environments. This study aimed to investigate the effect of individualized feedback on exercise adherence, body composition, and physical function during a remote home-based training intervention utilizing the video-based exercise system “SUKUBARA^®”. Methods: In total, 66 care facility workers were randomly categorized into either a feedback (FB) group or a non-feedback (NF) group. Both groups performed a combined exercise program comprising low-load resistance training (slow squats) and balance exercises (one-leg standing time of closed eye) for approximately 15 min, thrice weekly over 12 weeks. The FB group received individualized feedback sheets visualizing total video play time (TT), exercise frequency, and interruptions, alongside reminder emails. The primary outcome was TT. Secondary outcomes included body composition measures (body weight, fat-free mass, and body fat mass rate) and one-leg standing time of opened eye. Results: The FB group demonstrated significantly greater TT, approximately 1.5 times that of the NF group, indicating enhanced exercise adherence. Moreover, significant improvements in fat-free mass and body fat mass rate were observed in the FB group. A significant correlation was identified between changes in TT and body composition parameters, suggesting TT as a valid proxy for exercise engagement. Conclusions: Individualized feedback within a remote monitoring home exercise program effectively improved exercise adherence and body composition among care workers. The “SUKUBARA^®” system shows promise as a tool to support exercise continuity in occupational health and long-term care settings. Full article

(This article belongs to the Special Issue Role of Physiotherapy in Promoting Physical Activity and Well-Being)

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10 pages, 257 KB

Open AccessArticle

Primary Care Service Provision Scale for Evaluating the Right to Health Among International Migrant Populations

by Consuelo Cruz-Riveros, Alfonso Urzúa, Carolina Lagos and Evelyn Parada

Healthcare 2025, 13(16), 2068; https://doi.org/10.3390/healthcare13162068 - 21 Aug 2025

Viewed by 367

Abstract

Introduction: This study was conducted from July 2021 to December 2022. We propose a scale to measure the right to health among international migrants in primary care settings. The scale aims to highlight and objectively assess the elements integrated into the delivery of [...] Read more.

Introduction: This study was conducted from July 2021 to December 2022. We propose a scale to measure the right to health among international migrants in primary care settings. The scale aims to highlight and objectively assess the elements integrated into the delivery of healthcare services by health personnel. Objective: Our aim was to develop and evaluate the psychometric properties of a measurement scale assessing the right to health in primary care for migrant populations in Chile, from the perspective of healthcare workers. Methods: An instrumental psychometric study was conducted. The sample comprised 339 primary healthcare workers from the Antofagasta, Biobío, and Metropolitan regions of Chile. The stages of the process included a theoretical review, conceptual definition, item construction, initial qualitative evaluation, and scale administration. Results: The initial 55-item model exhibited unsatisfactory fit indices (χ² = 2608.693; df = 1271; p < 0.001; RMSEA = 0.056; CFI = 0.931; TLI = 0.919; SRMR = 0.054), whereas the refined 19-item model achieved satisfactory fit (χ² = 441.72, df = 146, p < 0.001; RMSEA = 0.07; CFI = 0.95; TLI = 0.94; SRMR = 0.05). Conclusions: The scale demonstrates robust internal consistency and offers a valuable tool for evaluating primary healthcare delivery to international migrants based on the right to health framework. Full article

(This article belongs to the Special Issue Healthcare for Migrants and Minorities)

14 pages, 261 KB

Open AccessArticle

Adaptation and Validation of a Treatment Expectations Scale for Hospitalized Patients-Spanish Patient Version

by Karol Gonzales-Valdivia, Katherine Ñaupa-Tito and Wilter C. Morales-García

Healthcare 2025, 13(16), 2067; https://doi.org/10.3390/healthcare13162067 - 21 Aug 2025

Viewed by 388

Abstract

Background: Hospitalized patients’ expectations about their treatment play a key role in therapeutic adherence, satisfaction with care, and clinical outcomes. However, there is a lack of brief, psychometrically validated instruments in Spanish-speaking contexts that adequately assess this construct. Objective: The objective of [...] Read more.

Background: Hospitalized patients’ expectations about their treatment play a key role in therapeutic adherence, satisfaction with care, and clinical outcomes. However, there is a lack of brief, psychometrically validated instruments in Spanish-speaking contexts that adequately assess this construct. Objective: The objective of this study is to culturally adapt and validate the Hospitalized Patients’ Expectations for Treatment Scale-Patient Version (HOPE-P) in a Peruvian population. Methods: A methodological, cross-sectional study was conducted with 277 hospitalized patients aged 18 to 85 years (M = 45.87; SD = 17.09). The adaptation process included translation, back-translation, expert review, and pilot testing. Confirmatory factor analysis (CFA) was performed to assess the factor structure, and reliability and validity indices were calculated. Results: The bifactorial model showed good fit (CFI = 0.97, TLI = 0.94, RMSEA = 0.06). One item with a low factor loading was removed to improve the model. Convergent and discriminant validity were confirmed through acceptable values of Average Variance Extracted (0.60 and 0.55) and inter-factor correlation (φ² = 0.23). Internal consistency was strong for both dimensions (α = 0.76–0.77; ω = 0.76–0.77). Conclusions: The Spanish version of the HOPE-P is a valid, reliable, and culturally appropriate instrument for evaluating treatment expectations in hospitalized Peruvian patients. Its implementation in clinical settings could enhance physician–patient communication, support shared decision-making, and contribute to better therapeutic outcomes, especially in high-demand healthcare environments. Full article

27 pages, 29012 KB

Open AccessReview

Wearable Devices & Elderly: A Bibliometric Analysis of 2014–2024

by Haojun Zhi and Mariia Zolotova

Healthcare 2025, 13(16), 2066; https://doi.org/10.3390/healthcare13162066 - 20 Aug 2025

Cited by 1 | Viewed by 795

Abstract

Background: The ageing population demands effective health solutions for the elderly. Wearable devices offer real-time monitoring and early alerts, but a comprehensive review of research in this field is lacking. This study uses bibliometric methods to analyse trends and advances in wearable devices [...] Read more.

Background: The ageing population demands effective health solutions for the elderly. Wearable devices offer real-time monitoring and early alerts, but a comprehensive review of research in this field is lacking. This study uses bibliometric methods to analyse trends and advances in wearable devices for the elderly. Methods: Literature from 2014 to 2024 was retrieved from the Web of Science Core Collection using keywords related to the elderly and wearable devices. A total of 1015 English-language papers were analysed using tools including CiteSpace, VOSviewer, and R-Bibliometrix. Results: The annual growth rate of publications was 7.65%, with research increasing from 4 in 2014 to 1015 in 2024. Major contributors were the United States and China, with key authors including Bijan Najafi and Lynn Rochester. Research shifted from fall detection and activity monitoring to heart rate variability, balance, and AI integration. Key themes included “digital health”, “wearable technology”, and “cardiac health monitoring”. Conclusions: Research on wearable devices for the elderly is growing rapidly. Future studies should focus on multimodal sensor fusion, AI-enhanced analytics and personalised health interventions, and long-term, real-world validation of wearable solutions to improve elderly health management. Full article

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23 pages, 853 KB

Open AccessStudy Protocol

Effects of a Multidimensional Exercise and Mindfulness Approach Targeting Physical, Psychological, and Functional Outcomes: Protocol for the BACKFIT Randomized Controlled Trial with an Active Control Group

by Belén Donoso, Gavriella Tsiarleston, Yolanda Castellote-Caballero, Alba Villegas-Fuentes, Yolanda María Gil-Gutiérrez, José Enrique Fernández-Álvarez, Santiago Montes, Manuel Delgado-Fernández, Antonio Manuel Mesa-Ruíz, Pablo Molina-García, Rocío Pozuelo-Calvo, Miguel David Membrilla-Mesa and Víctor Segura-Jiménez

Healthcare 2025, 13(16), 2065; https://doi.org/10.3390/healthcare13162065 - 20 Aug 2025

Viewed by 530

Abstract

Introduction: Chronic primary low back pain (CPLBP) is a prevalent condition in primary care and a leading cause of disability and absenteeism worldwide. Multidimensional approaches may be necessary to achieve physical and mental health benefits in individuals with CPLBP. Objective: The BACKFIT randomized [...] Read more.

Introduction: Chronic primary low back pain (CPLBP) is a prevalent condition in primary care and a leading cause of disability and absenteeism worldwide. Multidimensional approaches may be necessary to achieve physical and mental health benefits in individuals with CPLBP. Objective: The BACKFIT randomized controlled trial aims to evaluate the effectiveness of a multidimensional intervention—combining supervised exercise and mindfulness—on pain, physical fitness, mental health, and functional outcomes in individuals with CPLBP. Hypothesis: Both the supervised exercise program focused on motor control and trunk muscle strength (IG1) and the multidimensional intervention combining supervised exercise with mindfulness training (IG2) are expected to produce significant health improvements in individuals with CPLBP. It is further hypothesized that IG2 will yield greater improvements compared to IG1, both immediately post-intervention and at the two-month follow-up. Design: Randomized controlled trial. Setting: Virgen de las Nieves University Hospital, Granada (Spain). Participants: 105 individuals. Inclusion criteria: Previously diagnosed with CPLBP, aged ≥18 and ≤65 years, able to read and understand the informed consent, and able to walk, move, and communicate without external assistance. Exclusion criteria: serious lumbar structural disorders, acute or terminal illness, physical injury, mental illness, and medical prescriptions that prevent participation in the study. Intervention: Individuals will be randomly assigned to a supervised physical exercise group (2 days per week, 45 min per session), a multidimensional intervention group (same as supervised physical exercise group, and mindfulness 1 day per week, 2.5 h per session) or an active control group (usual care, 2 days per week, 45 min per session). The intervention will last 8 weeks. Main Outcome Measures: Primary outcome: pain threshold, perceived acute pain, and disability due to pain. Secondary measures: body composition, muscular fitness, gait parameters, device-measured physical activity and sedentary behavior, self-reported sedentary behavior, quality of life, pain catastrophizing, mental health, sleep duration and quality, and central sensitization. The groups will undergo pre-intervention, post-intervention, and a 2-month follow-up after a detraining period. Statistical Analysis: Both per-protocol and intention-to-treat approaches (≥70% attendance) will be used. Program effects will be assessed via one-way ANCOVA for between-group changes in primary and secondary outcomes. Conclusions: Given the complex nature of CPLBP, multidimensional approaches are recommended. If effective, this intervention may provide low-cost alternatives for health professionals. Full article

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14 pages, 259 KB

Open AccessArticle

Resilience Protects Nurses from Workplace Gaslighting and Quiet Quitting, and Improves Their Work Engagement: A Cross-Sectional Study in Greece

by Ioannis Moisoglou, Aglaia Katsiroumpa, Olympia Konstantakopoulou, Ioanna V. Papathanasiou, Ioanna Prasini, Maria Rekleiti and Petros Galanis

Healthcare 2025, 13(16), 2064; https://doi.org/10.3390/healthcare13162064 - 20 Aug 2025

Viewed by 478

Abstract

Background: Although gaslighting is an alarming issue, the literature on predictors of this phenomenon is scarce. Objective: To examine the association between resilience and gaslighting in the workplace, quiet quitting, and work engagement among nurses. Methods: We conducted a cross-sectional study in Greece [...] Read more.

Background: Although gaslighting is an alarming issue, the literature on predictors of this phenomenon is scarce. Objective: To examine the association between resilience and gaslighting in the workplace, quiet quitting, and work engagement among nurses. Methods: We conducted a cross-sectional study in Greece during December 2024. We used the Brief Resilience Scale (BRS) to measure levels of resilience in our sample. Moreover, we used the Gaslighting at Work Scale (GWS), the Quiet Quitting Scale, and the Utrecht Work Engagement Scale-3 to measure workplace gaslighting, quiet quitting, and work engagement, respectively. Results: The study population included 462 nurses with a mean age of 36.80 years. We found that resilience protected nurses from workplace gaslighting. After adjusting gender, age, educational level, and work experience, a negative association was found between resilience and GWS score (p < 0.001), loss of self-trust (p < 0.001), and abuse of power (p < 0.001). Moreover, our multivariable analysis identified a negative association between resilience and Quiet Quitting Scale score (p < 0.001), detachment (p < 0.001), lack of initiative (p < 0.001), and lack of motivation (p < 0.001). Additionally, we identified a positive relationship between resilience and work engagement (p < 0.001). Conclusions: Our findings suggested the protective role of resilience against gaslighting in the workplace and quiet quitting in nurses. Moreover, we found that resilience improved nurses’ work engagement. However, the cross-sectional nature of this study cannot imply causality between the study variables, and, thus, further studies are required to clarify the association between resilience, workplace gaslighting, quiet quitting, and work engagement. Full article

(This article belongs to the Special Issue Well-Being of Healthcare Professionals: New Insights After COVID-19)

20 pages, 3523 KB

Open AccessArticle

Telerehabilitation After Surgery in Adolescent Idiopathic Scoliosis: A Randomized Controlled Trial

by İrem Çetinkaya, Tuğba Kuru Çolak, Mehmet Fatih Korkmaz and Mehmet Aydoğan

Healthcare 2025, 13(16), 2063; https://doi.org/10.3390/healthcare13162063 - 20 Aug 2025

Viewed by 607

Abstract

Background: Structured postoperative rehabilitation is not routinely provided for individuals with adolescent idiopathic scoliosis (AIS) after surgery, with physiotherapy typically limited to the immediate inpatient period. Telerehabilitation offers an accessible and supervised option to address persistent functional limitations, pain, and quality-of-life concerns [...] Read more.

Background: Structured postoperative rehabilitation is not routinely provided for individuals with adolescent idiopathic scoliosis (AIS) after surgery, with physiotherapy typically limited to the immediate inpatient period. Telerehabilitation offers an accessible and supervised option to address persistent functional limitations, pain, and quality-of-life concerns in this population. Objectives: This study aimed to evaluate the effects of a synchronous telerehabilitation program—designed to support post-surgical recovery in individuals with adolescent idiopathic scoliosis (AIS)—on trunk muscle endurance, trunk flexibility, functional capacity, pain severity, perception of appearance, and quality of life. Methods: Thirty-two individuals with AIS, who had undergone surgery 6 months to 2 years prior, were randomly assigned to either an intervention group or a control group. The intervention group participated in a supervised telerehabilitation program twice weekly for eight weeks, while the control group received no exercise intervention. All outcome measures were assessed before and after the intervention. Results: The telerehabilitation group demonstrated significant improvements across all outcome measures compared with the control group (p < 0.05). Post-intervention, the telerehabilitation group had superior trunk muscle endurance, flexibility, and quality-of-life scores, as well as reduced pain intensity (p < 0.05). However, no significant differences were observed between the groups in functional capacity or perception of appearance (p > 0.05). Conclusions: A supervised telerehabilitation program initiated six months after surgery can effectively improve trunk muscle endurance, flexibility, pain intensity, and quality of life in individuals with AIS. These findings emphasize the value of structured post-surgical rehabilitation and raise awareness of the potential benefits of remotely delivered exercise programs in this population. Full article

(This article belongs to the Special Issue Scoliosis Deformity—Etiological Aspects, Management and Rehabilitation)

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10 pages, 374 KB

Open AccessArticle

Do Primary Care Providers’ Medicaid Panels Represent the Communities They Serve?

by Anushree Vichare, Qian (Eric) Luo and Mandar Bodas

Healthcare 2025, 13(16), 2062; https://doi.org/10.3390/healthcare13162062 - 20 Aug 2025

Viewed by 393

Abstract

Disparities in primary care access among Medicaid enrollees may be driven by differences in provider acceptance of Medicaid, yet the extent to which primary care provider (PCP) panels reflect the racial and ethnic diversity of local Medicaid populations is unknown. Objectives: To [...] Read more.

Disparities in primary care access among Medicaid enrollees may be driven by differences in provider acceptance of Medicaid, yet the extent to which primary care provider (PCP) panels reflect the racial and ethnic diversity of local Medicaid populations is unknown. Objectives: To quantify the alignment between the racial/ethnic composition of PCP Medicaid panels and the underlying Medicaid population in their service areas. Methods: We conducted a cross-sectional analysis of 2019 Transformed Medicaid Statistical Information System Analytic Files from 44 states focusing on non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic enrollees. We calculated a panel representation ratio (PRR) for each PCP (physicians, nurse practitioners, and physician associates) as the proportion of a racial/ethnic group in their panel divided by that group’s proportion in the county Medicaid population. PRRs > 1 indicate overrepresentation; PRRs < 1, underrepresentation. Analyses were stratified by provider specialty, rurality, and Health Professional Shortage Area (HPSA) status. Results: The study sample included 372,320 PCPs from the following professions: nurse practitioners (NPs) and physician associates (PAs), along with physicians from the following specialties: family physicians (FPs), internal medicine physicians (IM), obstetrician gynecologists (ObGyn), and pediatricians (Peds). In the full sample, PRR was 1.28 for NHW enrollees, but less than one for NHB (0.98) and Hispanic (0.82) enrollees. Across provider specialties and professions, NHW enrollees were overrepresented in both rural and urban areas. In rural areas, NHB enrollees were overrepresented, but Hispanic enrollees remained underrepresented regardless of Health Professional Shortage Area (HPSA) status. In urban areas, both NHB and Hispanic enrollees were underrepresented in provider panels. Conclusions: Medicaid PCP panels do not reflect the racial/ethnic diversity of local Medicaid populations, particularly for NHB and Hispanic enrollees in urban settings. Efforts to improve equitable access to primary care must address these disparities in provider panel composition. Full article

(This article belongs to the Section Health Policy)

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12 pages, 657 KB

Open AccessArticle

Sexual Dysfunction in Breast Cancer Survivors: The Role of Clinical, Hormonal, and Psychosocial Factors

by Pınar Karaçin and İrem Küçükşahin

Healthcare 2025, 13(16), 2061; https://doi.org/10.3390/healthcare13162061 - 20 Aug 2025

Viewed by 510

Abstract

Background and Objectives: This study aims to investigate female sexual dysfunction (FSD) and the clinical, pathological, and social factors affecting it in women diagnosed with non-metastatic breast cancer. Materials and Methods: The study included patients over the age of 18 who were followed [...] Read more.

Background and Objectives: This study aims to investigate female sexual dysfunction (FSD) and the clinical, pathological, and social factors affecting it in women diagnosed with non-metastatic breast cancer. Materials and Methods: The study included patients over the age of 18 who were followed up between January 2020 and December 2024, diagnosed with breast cancer at least 12 months previously, and treated. The Female Sexual Function Index (FSFI) and its six subheadings (desire, arousal, lubrication, orgasm, satisfaction, and pain) were used to assess sexual dysfunction, and the Hospital Anxiety and Depression Scale (HADs) was used to assess depression. Results: FSD was identified in 86.6% of the 217 patients (mean FSFI score: 20.38). Among women undergoing breast cancer treatment, being over 45 years of age (p = 0.003) and the use of luteinizing hormone-releasing hormone (LHRH) agonists (p < 0.001) were significantly associated with reduced sexual desire. Conversely, premenopausal status (p = 0.012) was associated with increased sexual satisfaction. Independent risk factors for FSD included age, menopausal status, use of LHRH agonists, income level, and axillary dissection. Furthermore, depression was found to have a significant negative impact on sexual desire, lubrication, and orgasm. Conclusions: This study demonstrates that sexual dysfunction is common among women undergoing treatment for breast cancer and is influenced by numerous clinical and social factors. These findings highlight the need for strategic interventions to reduce the adverse effects of treatment processes on the sexual health of women with breast cancer. Full article

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11 pages, 212 KB

Open AccessArticle

Impact of Volume Control Biosensors on Blood Pressure During Haemodialysis: A Quasi-Experimental Study

by Veronica Gimeno-Hernan, Carla Perez-Ingidua, Ana Belen Rivas-Paterna, Natividad Codesal-Sanabria, Guillermo Perez-Duque, Ana Ascaso-del-Rio and Ismael Ortuño-Soriano

Healthcare 2025, 13(16), 2060; https://doi.org/10.3390/healthcare13162060 - 20 Aug 2025

Viewed by 378

Abstract

Background: Intradialytic hypotension is a common complication in haemodialysis, affecting up to 30% of sessions. It results from an imbalance between ultrafiltration and compensatory mechanisms, such as vascular tone and plasma refilling. Volume-controlled biosensors allow for the continuous monitoring of the haemoconcentration, enabling [...] Read more.

Background: Intradialytic hypotension is a common complication in haemodialysis, affecting up to 30% of sessions. It results from an imbalance between ultrafiltration and compensatory mechanisms, such as vascular tone and plasma refilling. Volume-controlled biosensors allow for the continuous monitoring of the haemoconcentration, enabling early detection and prevention of hypotension. Methods: A quasi-experimental study was conducted to assess the effectiveness of biosensors in reducing hypotensive episodes. Two biosensors were compared: the Blood Volume Monitor and the Haemomaster system. Data were collected over two four-month periods: before and after biosensor implementation. Nursing staff received specific training, and a protocol for consistent data collection was established. Informed consent was obtained from all eligible participants. The incidence of intradialytic hypotension was compared between sessions with and without biosensor use. Additionally, outcomes were analysed according to biosensor type. Results: A total of 2262 dialysis sessions from 22 patients were analysed. The cohort was 54.5% male, with a mean age of 60 years (SE = 21); 27.3% had diabetes and 81.8% had hypertension. Post-dilution haemodiafiltration was performed in 62.8% of sessions. Intradialysis hypotension occurred in 11.2% of sessions using biosensors compared to 14.0% without (p = 0.021). No significant difference was found between biosensor types (10.8% vs. 11.8%; p = 0.531), although device 1 reached a significantly lower critical blood volume (mean: 10 L; SE = 4 vs. 16 L; SE = 5; p = 0.000). Conclusions: Biosensor use was associated with fewer hypotensive episodes and greater haemodynamic stability. These findings support their integration into routine dialysis practice to improve treatment, safety, and individualised care. Full article

(This article belongs to the Special Issue Bridging the Gap in Nephrology Nursing: Addressing the Growing Burden of Chronic Kidney Disease)

11 pages, 711 KB

Open AccessArticle

Therapeutic Plasma Exchange in Acute Liver Failure: A Real-World Study in Mexico

by Jose Carlos Gasca-Aldama, Jesús Enrique Castrejón-Sánchez, Mario A. Carrasco Flores, Enzo Vásquez-Jiménez, Paulina Carpinteyro-Espin, Juanita Pérez-Escobar, Karlos Dhamian Gutierrez-Toledo, Pablo E. Galindo, Marcos Vidals-Sanchez and Paula Costa-Urrutia

Healthcare 2025, 13(16), 2059; https://doi.org/10.3390/healthcare13162059 - 20 Aug 2025

Viewed by 553

Abstract

Background/Objectives: Acute liver failure (ALF) is a life-threatening condition with high mortality in nontransplant candidates. Therapeutic plasma exchange (TPE) has emerged as a promising intervention for removing inflammatory mediators and toxic metabolites. In Latin America, data on the efficacy of TPE in [...] Read more.

Background/Objectives: Acute liver failure (ALF) is a life-threatening condition with high mortality in nontransplant candidates. Therapeutic plasma exchange (TPE) has emerged as a promising intervention for removing inflammatory mediators and toxic metabolites. In Latin America, data on the efficacy of TPE in ALF patients are limited. This real-world study aimed to compare 30-day survival outcomes between patients receiving standard medical treatment (SMT) and those receiving SMT plus TPE. Methods: We analyzed 25 ALF patients admitted to the tertiary intensive care unit (ICU) of Hospital Juárez of Mexico City, Mexico, from 2018 to 2024. Patients received either standard medical treatment (SMT group, n = 12) or SMT with TPE (TPE group, n = 13), including high-volume TPE (n = 8) and standard-volume TPE (n = 5). Survival analysis was performed via Kaplan–Meier estimates, and binomial regression analysis was run to estimate the mortality probability stratified by the hepatic encephalopathy grade. Results: At 30 days, survival was significantly greater in the TPE group (92%) than in the SMT group (50%) (p = 0.02). The greatest survival benefit was observed in patients with Grade 4 encephalopathy. The ICU stay was longer in the TPE group, reflecting the complexity of ALF management. Conclusions: TPE significantly improves 30-day survival in ALF patients compared with SMT alone, supporting its role as an adjunct therapy. Further studies are needed to refine patient selection and optimize treatment protocols. Full article

(This article belongs to the Section Critical Care)

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13 pages, 238 KB

Open AccessArticle

A Comparative Study of Selected Hospital-Based Health Professionals’ Perceptions of a Learning Organisation in Five South African Districts

by Nombulelo Chitha, Ruth Tshabalala, Onke Mnyaka, Mirabel Nanjoh, Ntiyiso Khosa, Thokoe Makola and Kedibone Maake

Healthcare 2025, 13(16), 2058; https://doi.org/10.3390/healthcare13162058 - 20 Aug 2025

Viewed by 416

Abstract

Background/Objectives: The concept of learning organisations, which rely on research-based evidence and emphasise employees’ continuous learning and professional development, is essential for effectively managing change and enhancing the quality of services. To better understand the effects of implementing learning organisation principles in [...] Read more.

Background/Objectives: The concept of learning organisations, which rely on research-based evidence and emphasise employees’ continuous learning and professional development, is essential for effectively managing change and enhancing the quality of services. To better understand the effects of implementing learning organisation principles in hospital settings, this study aimed to compare the perceptions of selected health professionals regarding learning organisations across five sub-districts in South Africa’s Eastern Cape province. Methods: This study employed a quantitative, cross-sectional survey design to collect data from selected health professionals in 9 hospitals in Eastern Cape province. Results: Overall, the study showed wide variations in how different healthcare professionals perceived the commitment and communication of department leaders regarding the importance of learning. Key findings showed that 90.9% of dentists agreed that department leaders communicate the importance of learning. In comparison, 68.8% of allied health professionals and 56.5% of pharmacists agreed that department leaders communicated the importance of learning; 21.7% of pharmacists and 25% of allied health professionals disagreed. Conclusions: The study has highlighted significant disparities in the perceptions of selected hospital-based health professionals toward introducing a learning organisation in healthcare facilities. This divergence points to the need for tailored approaches in communicating and implementing LO strategies within hospital settings to ensure that all health professionals are equally engaged and that the benefits of continuous learning are fully realised across disciplines. Full article

18 pages, 767 KB

Open AccessArticle

Investigating Nutrition and Supportive Care Needs in Esophageal and Gastric Cancer Survivors: A Cross-Sectional Survey

by Fatemeh Sadeghi, Juliette Hussey and Suzanne L. Doyle

Healthcare 2025, 13(16), 2057; https://doi.org/10.3390/healthcare13162057 - 20 Aug 2025

Viewed by 693

Abstract

Background/Objectives: Advances in cancer diagnosis and treatment improved survivorship rates, but survivors’ long-term quality of life remains a critical concern. Survivors of esophageal and gastric cancer often undergo extensive curative surgery, which can have lasting impacts on nutritional status. This study aimed [...] Read more.

Background/Objectives: Advances in cancer diagnosis and treatment improved survivorship rates, but survivors’ long-term quality of life remains a critical concern. Survivors of esophageal and gastric cancer often undergo extensive curative surgery, which can have lasting impacts on nutritional status. This study aimed to assess the nutritional status, dietary challenges, and supportive care needs of this population of cancer survivors. Methods: In this cross-sectional study, adults diagnosed with esophageal or gastric cancer were invited to complete an anonymous survey to assess their nutritional status, quality of life, and psychological well-being. Results: A total of 114 responses were analyzed. Although over 70% of participants were more than two years post-diagnosis, more than 30% remained at risk of malnutrition. Additionally, over 36% reported ongoing dietary complications such as swallowing difficulties, dumping syndrome, diarrhea, and reflux. Impaired quality of life was observed in 31.7% of respondents, defined as having a global health status score below 66.1 on the EORTC QLQ-C30. Psychological distress was also evident, with over 25% screening positive for anxiety or borderline anxiety, and more than 22% for depression or borderline depression. Conclusions: Malnutrition, gastrointestinal symptoms, impaired quality of life, and psychological distress remain prevalent among esophageal and gastric cancer survivors many years after diagnosis. These findings underscore the need for ongoing monitoring and the provision of targeted supportive care to improve long-term survivorship outcomes. Full article

(This article belongs to the Special Issue Updates on Oncology Rehabilitation)

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17 pages, 2559 KB

Open AccessSystematic Review

Optical Coherence Tomography Angiography (OCTA) Characteristics of Acute Retinal Arterial Occlusion: A Systematic Review

by Saud Aljohani

Healthcare 2025, 13(16), 2056; https://doi.org/10.3390/healthcare13162056 - 20 Aug 2025

Viewed by 558

Abstract

Purpose: To systematically review the evidence regarding the characteristics of Optical Coherence Tomography Angiography (OCTA) in acute retinal arterial occlusion (RAO), with a particular focus on vascular alterations across the superficial and deep capillary plexuses, choroid, and peripapillary regions. Methods: A comprehensive [...] Read more.

Purpose: To systematically review the evidence regarding the characteristics of Optical Coherence Tomography Angiography (OCTA) in acute retinal arterial occlusion (RAO), with a particular focus on vascular alterations across the superficial and deep capillary plexuses, choroid, and peripapillary regions. Methods: A comprehensive literature search was performed across PubMed, Web of Science, Scopus, EMBASE, Google Scholar, and the Cochrane Database up to April 2025. The search terms included “Optical coherence tomography angiography,” “OCTA,” “Retinal arterial occlusion,” “Central retinal artery occlusion,” and “Branch retinal artery occlusion.” Studies were included if they evaluated the role of OCTA in diagnosing or assessing acute RAO. Case reports, conference abstracts, and non-English articles were excluded. Two reviewers independently conducted the study selection and data extraction. The methodological quality of the included studies was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Results: The initial search yielded 457 articles, from which 10 studies were ultimately included in the final analysis after a rigorous screening process excluding duplicates, non-English publications, and ineligible articles based on title, abstract, or full-text review. The included studies consistently demonstrated that OCTA is a valuable, noninvasive modality for evaluating microvascular changes in RAO. Key OCTA findings in acute RAO include significant perfusion deficits and reduced vessel density in both the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Several studies noted more pronounced involvement of the SCP compared to the DCP. OCTA parameters, such as vessel density in the macular region, have been found to correlate with visual acuity, suggesting a prognostic value. While findings regarding the foveal avascular zone (FAZ) were mixed, the peripapillary area frequently showed reduced vessel density. Conclusion: Acute RAO is an ocular emergency that causes microvascular ischemic changes detectable by OCTA. This review establishes OCTA as a significant noninvasive tool for diagnosing, monitoring, and prognosticating RAO. It effectively visualizes perfusion deficits that correlate with clinical outcomes. However, limitations such as susceptibility to motion artifacts, segmentation errors, and the lack of standardized normative data must be considered. Future standardization of OCTA protocols and analysis is essential to enhance its clinical application in managing RAO. Full article

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14 pages, 662 KB

Open AccessArticle

Influence of Teaching Efficacy and Competence on Life Satisfaction in Pre-Service Physical Education Teachers: Is There a Gender Difference?

by Ginés David López-García, María Carrasco-Poyatos, Rut López-Osca and Antonio Granero-Gallegos

Healthcare 2025, 13(16), 2055; https://doi.org/10.3390/healthcare13162055 - 20 Aug 2025

Viewed by 420

Abstract

Purpose: Grounded in Social Cognitive Theory and Self-Determination Theory, this study analyzed gender differences in the relationships between teachers’ sense of efficacy, basic psychological need satisfaction and frustration (competence), and life satisfaction among Physical Education (PE) pre-service teachers. Method: A sample [...] Read more.

Purpose: Grounded in Social Cognitive Theory and Self-Determination Theory, this study analyzed gender differences in the relationships between teachers’ sense of efficacy, basic psychological need satisfaction and frustration (competence), and life satisfaction among Physical Education (PE) pre-service teachers. Method: A sample of 368 PE pre-service teachers (Mage = 23.41 ± 2.37; 48.1% women) participated. A multi-group structural equation modeling approach was used. Results: Male participants reported significantly higher levels of competence satisfaction compared to their female counterparts. Teaching efficacy positively predicted life satisfaction, both directly and indirectly via competence satisfaction. Notably, the indirect effects were stronger among women, while direct effects were observed only in the female group. Conclusions: The findings emphasize the key role of competence satisfaction in explaining how teaching efficacy influences life satisfaction in pre-service teachers. Gender differences suggest that while both men and women benefit from feeling competent, the pathways differ, highlighting the importance of gender sensitive strategies in teacher education programs. Full article

(This article belongs to the Special Issue Bridging Neuroscience and Cognitive Psychology: Implications for Mental Health and Well-Being)

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12 pages, 230 KB

Open AccessArticle

Empathy in Future Nurses: Insights for Healthcare Management from a Greek Student Sample

by Kejsi Ramollari and Nikolaos Kontodimopoulos

Healthcare 2025, 13(16), 2054; https://doi.org/10.3390/healthcare13162054 - 20 Aug 2025

Viewed by 532

Abstract

Background/Objectives: Empathy is a core competency in nursing, contributing to patient care quality and professional resilience. This study investigated empathy levels among Greek undergraduate nursing students at the University of Peloponnese and examined the personal and educational factors that contribute to empathic development. [...] Read more.

Background/Objectives: Empathy is a core competency in nursing, contributing to patient care quality and professional resilience. This study investigated empathy levels among Greek undergraduate nursing students at the University of Peloponnese and examined the personal and educational factors that contribute to empathic development. Methods: A cross-sectional survey was conducted with 144 students from all academic years using the Jefferson Scale of Physician Empathy—Health Professions (JSPE-HP) and the SF-12 Health Survey. Data were analyzed using ANOVA and stepwise multiple linear regression. Results: Mean empathy scores were relatively high (M = 110.31, SD = 10.52). Empathy increased significantly with academic progression (p < 0.001), and higher scores were associated with parental status (p = 0.030) and better mental health (p = 0.044). Conversely, students with a chronically ill close contact reported lower empathy (p = 0.018). Regression analysis identified having children and exposure to chronic illness as significant predictors. Conclusions: Educational progression, life experience, and well-being are key contributors to empathy development. These insights support strategies to enhance empathy through curriculum design, student support, and wellness programs. Integrating empathy training into management policy can foster professional growth, reduce burnout, and improve patient care and workforce sustainability. Full article

14 pages, 604 KB

Open AccessPerspective

International Partnerships in AI-Driven Healthcare: Opportunities and Challenges for Advancing the UN Sustainable Development Goals—A Perspective

by Tao Yun and Le Zhang

Healthcare 2025, 13(16), 2053; https://doi.org/10.3390/healthcare13162053 - 20 Aug 2025

Viewed by 588

Abstract

Artificial Intelligence (AI) is reshaping global healthcare systems by offering innovative solutions to improve diagnostic accuracy, optimize treatment planning, and enhance public health management. This article provides a structured perspective on the role of international partnerships in accelerating the adoption of AI-driven healthcare, [...] Read more.

Artificial Intelligence (AI) is reshaping global healthcare systems by offering innovative solutions to improve diagnostic accuracy, optimize treatment planning, and enhance public health management. This article provides a structured perspective on the role of international partnerships in accelerating the adoption of AI-driven healthcare, with a focus on advancing the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being). Drawing on representative global initiatives, the paper explores best practices in technology transfer, ethical data sharing, and capacity building—key enablers for inclusive and equitable AI healthcare adoption. It further analyzes common challenges such as digital infrastructure gaps, regulatory fragmentation, and global inequities in data and talent. Through a synthesis of recent collaborations and policy frameworks, this article offers actionable insights for fostering global alliances that bridge innovation with healthcare accessibility. Full article

(This article belongs to the Special Issue UN Sustainable Development Goals (SDGs) Beyond 2030 Agenda: The Role of International Partnerships and Alliances Towards Equitable Access to Care)

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16 pages, 438 KB

Open AccessArticle

Psychometric Evaluation of the Validity and Reliability of the Italian Version of the London Measure of Unplanned Pregnancy Amongst Postnatal Women

by Martina Smorti, Paul Christiansen, Geraldine Barrett, Jennifer A. Hall, Chiara Ionio, Giulia Ciuffo, Marta Landoni, Anna Maria Della Vedova, Elana Payne, Mia Richell, Semra Worrall, Giulia Mauri, Victoria Fallon, Alessandra Bramante and Sergio A. Silverio

Healthcare 2025, 13(16), 2052; https://doi.org/10.3390/healthcare13162052 - 20 Aug 2025

Viewed by 503

Abstract

Background: Unplanned pregnancy is a public health issue and understanding women’s decision making aids practitioners in assessing fertility trends, contraception use, and family planning counselling. In Italy, Catholicism reinforces ‘natural reproduction’ and ‘traditional’ contraception, making it an ‘Imperfect Contraceptive Society.’ A valid [...] Read more.

Background: Unplanned pregnancy is a public health issue and understanding women’s decision making aids practitioners in assessing fertility trends, contraception use, and family planning counselling. In Italy, Catholicism reinforces ‘natural reproduction’ and ‘traditional’ contraception, making it an ‘Imperfect Contraceptive Society.’ A valid and reliable measure of pregnancy intentionality is increasingly important, and the London Measure of Unplanned Pregnancy (LMUP) has proved effective. Objectives and Methods: This study comprised four stages: (1) English–Italian translation and back-translation to create the Italian version [LMUP-IT]; (2) online data collection from postnatal women; (3) evaluation of its psychometric properties (targeting, reliability, construct validity via CFA and measurement invariance with a UK sample, ‘known groups’ hypothesis testing); and (4) exploratory analysis of its associations with perinatal mental health. The sample comprised 450 postnatal women (M_age = 33.6 ± 4.5). Results: The LMUP-IT was shown to be reliable (ωT = 0.81, α = 0.76), with acceptable targeting. Measurement invariance testing confirmed consistency with the UK sample in factor structure, loadings, intercepts, and errors. LMUP-IT scores significantly correlated with well-known indicators of perinatal mental health. Conclusions: Overall, the LMUP-IT is a reliable measure of pregnancy intention in Italian for postpartum women. Understanding pregnancy intention will help healthcare professionals tailor interventions to better support women’s mental health during the transition to motherhood. Full article

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22 pages, 1743 KB

Open AccessArticle

Trends in Pediatric Malpractice Claims at a Tertiary Children’s Hospital

by Beatrice Defraia, Simone Faccioli, Emanuele Gori, Barbara Gualco, Rossella Grifoni, Massimo Pacitti, Fortuna Pierro, Ilaria Lombardi, Vilma Pinchi and Martina Focardi

Healthcare 2025, 13(16), 2051; https://doi.org/10.3390/healthcare13162051 - 19 Aug 2025

Viewed by 528

Abstract

Background: Examining medico-legal cases within hospitals aids in identifying care-related problems, facilitating necessary corrections and emphasizing successful preventive measures. The case of Meyer Children’s Hospital is particularly noteworthy as it offers insights into the evolution of litigation in regard to a tertiary [...] Read more.

Background: Examining medico-legal cases within hospitals aids in identifying care-related problems, facilitating necessary corrections and emphasizing successful preventive measures. The case of Meyer Children’s Hospital is particularly noteworthy as it offers insights into the evolution of litigation in regard to a tertiary pediatric hospital. Methods: The study sample comprised 158 malpractice claims received by Meyer Children’s Hospital from 1 January 2010 to 31 December 2023, which were managed by the Claims Management Committee (CMC) responsible for civil liability within the hospital. In this observational retrospective study, the following variables were analyzed: (1) The characteristics of the patients (age–sex) and the manner in which they interacted with the hospital, ultimately resulting in the compensation claim (method of access, area of specialty, outcomes based on the International Classification of Patient Safety (ICPS)). (2) Medico-legal factors: the details of the compensation claim, the significant issues noted in various cases, and the findings of the medico-legal inquiry conducted by the CMC. In cases of ADR (Alternative Dispute Resolution), we evaluated the nature of the procedure, the results, and the amount of compensation awarded. Results: We conducted a descriptive statistical analysis to delineate the trend of claims and identify specific deficiencies within structures or departments over time. Invasive procedures and surgical operations were identified as the leading causes of accidents, resulting in heightened mortality rates and serious injuries. The most common errors observed were diagnostic and therapeutic. Conclusions: The data that emerged highlighted a low rate of claims (11.28/year) and a low claim/service ratio (0.0002%), suggesting a high level of safety of patient care at the hospital. The acceptance rate (32%), the percentage of rejected cases (48/158~30% of total, or 48/99~49% of resolved claims), the average compensation (EUR 68,312), and the percentage of cases (92%) with judicial opinions consistent with those of the CMC indicate a tendency to pursue exploratory compensation requests and the effectiveness of CMC’s activity. Meanwhile, the predominant error types (surgical and diagnostic) are in accordance with national and international data. Finally, the scarcity of disputes concerning informed consent reflects the impressive effectiveness of the communication strategies utilized by the pediatricians at this center. Full article

(This article belongs to the Topic Health Services Optimization, Improvement, and Management: Worldwide Experiences)

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Open AccessArticle

Evaluation of Motor Control Through Functional Movement Patterns of the Lumbar Spine Among Elite Special Forces Operators: A Pilot Study

by Rita Hansdorfer Korzon, Jolanta Szamotulska, Piotr Wąż, Maciej Śliwiński, Jakub Ławnicki and Rafał Studnicki

Healthcare 2025, 13(16), 2050; https://doi.org/10.3390/healthcare13162050 - 19 Aug 2025

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Abstract

Background: A comprehensive physical therapy process includes prevention against musculoskeletal overload syndromes. Monitoring the occurrence of motor control disorders is one of the tools for preventing overload syndromes of the musculoskeletal system and consequent injuries. Assessing motor control and preventive actions can [...] Read more.

Background: A comprehensive physical therapy process includes prevention against musculoskeletal overload syndromes. Monitoring the occurrence of motor control disorders is one of the tools for preventing overload syndromes of the musculoskeletal system and consequent injuries. Assessing motor control and preventive actions can contribute to minimizing the risk of a soldier being removed from duty, reducing the likelihood of injury and thus preventing job loss. The aim of the study was to evaluate directional control of the lumbar spine using the dissociation tests included in the Kinetic Control physiotherapy method. This physiotherapeutic method is used to identify and assess the occurrence and therapy of motor control disorders, including uncontrolled movement in the locomotor system. Methods: Twenty-three soldiers (40.26 ± 4.5 age) from special units of the Polish Armed Forces were qualified for a one-time assessment. The research methods included the evaluation of motor control using dissociation tests based on the physiological method of kinetic control. The control of the lumbar spine in the directions of flexion, extension, and rotation during hip joint movements was evaluated. Uncontrolled movement was understood as the inability to maintain a stationary lumbar spine in a neutral position during specific directions of hip joint movement included in the tests. Results: The survey showed that the area of pain reported by the operators was the lumbar spine in the last three months. 69.57% of the respondents indicated that this area was the site of their complaints. The results of the motor examination showed statistically significant test results (p-value < 0.0001) indicating the presence of motor control disorders in the form of uncontrolled movement of the lumbar spine in control tests for flexion, rotation, and extension. Conclusions: The main results of the present study showed the appearance of interference with the functional movement patterns of the lumbar spine in a group of special unit operators. Impaired control of movement was observed in the direction of flexion, rotation, and lumbar extension, which may be potentially associated with the generation of lumbar spine pain syndromes. Full article

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

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Healthcare, Volume 13, Issue 16 (August-2 2025) – 140 articles

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