Healthcare

20 pages, 1635 KiB

Open AccessReview

Inclusive Healthcare System for Children with Disabilities: A Bibliometric Analysis and Visualization

by Erkan Gulgosteren, Yavuz Onturk, Abdullah Cuhadar, Mihaela Zahiu, Monica Stanescu and Rares Stanescu

Healthcare 2025, 13(17), 2106; https://doi.org/10.3390/healthcare13172106 (registering DOI) - 24 Aug 2025

Abstract

Background: Children with disabilities face complex, systemic health access barriers rooted in societal, institutional, and structural inequities, requiring urgent global policy attention. Publications on access to health services for this population category have been found to have a significant growth in both quantity [...] Read more.

Background: Children with disabilities face complex, systemic health access barriers rooted in societal, institutional, and structural inequities, requiring urgent global policy attention. Publications on access to health services for this population category have been found to have a significant growth in both quantity and content. The article aims to examine the structure and evolution of scientific literature in analyzing the healthcare system through the lens of inclusive services. Methods: We present the bibliometric profile of the global literature on access to health services for children with disabilities, the publication trends, the structure of research in this field concerning geographical distribution, methodological approaches, and interdisciplinary collaborations, and the core research topics, conceptual clusters, and future research directions in the field. The publications were screened from Web of Science databases, using PRISMA methodology. Finally, 1100 academic publications published between 1984 and 2025, obtained from a total of 432 different sources, the majority of which were peer-reviewed journals, were screened. Results: The calculated annual publication growth rate of 8.37% and the distinct upward trend observed, especially after 2015. The highest level was reached in 2023, with over 90 publications showing that the topic has become a focus of international academic interest. The USA (33.5%), the United Kingdom (15.7%), Australia (9.5%), and Canada (9.5%) stood out in publications, and there were strong collaborative networks among European nations (8.2%). Conclusions: Although high-income countries still appear to play a dominant role in research production, expanding international collaborations and distributing resources more equitably will contribute to the development of more inclusive solutions on a global scale. Temporal trends show an evolution toward diagnostic processes, family-centered approaches, and psychosocial dimensions. The results draw a clear picture of the current research landscape regarding access to health services for pediatric disability populations and identify potential directions for future research. Full article

(This article belongs to the Special Issue Disability Studies and Disability Evaluation)

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13 pages, 1701 KiB

Open AccessArticle

Modeling the Impact of Tele-Health on Accessibility and Equity of Medical Resources in Metropolitan Cities in China

by Qing Wang, Leqi Weng and Jingshan Li

Healthcare 2025, 13(17), 2105; https://doi.org/10.3390/healthcare13172105 (registering DOI) - 24 Aug 2025

Abstract

Background: Although the expansion of medical resources has largely alleviated challenges of “more diseases but fewer medicines”, the growing urbanization and rapid aging in China have led to increasing demands of healthcare services in metropolitan cities. The uneven distribution of medical facilities makes [...] Read more.

Background: Although the expansion of medical resources has largely alleviated challenges of “more diseases but fewer medicines”, the growing urbanization and rapid aging in China have led to increasing demands of healthcare services in metropolitan cities. The uneven distribution of medical facilities makes services unequal for residents in the city. To achieve fair and rapid access to medical services, healthcare accessibility and equity have become key concerns. The introduction of tele-health, i.e., online visits or digital health, can help balance the distribution of medical resources to improve accessibility and equity, particularly for elderly patients with chronic diseases. Methods: To quantitatively assess the spatial accessibility of healthcare facilities, an improved two-step floating catchment area method with tele-health (i2SFCA-TH) is proposed to study the demand–supply ratio by considering traveling time, chronic diseases, and online visits based on services provided by community and tertiary hospitals. An optimization model using mixed-integer programming to maximize average accessibility under resource constraints could help improve overall accessibility and reduce differences in access among all residential divisions to achieve better equity in the region. Results: By applying the method in a metropolitan city in China, it is observed that the overall spatial accessibility of residential divisions in the city is 0.72, but the gap between the highest and the lowest reaches 2.36; i.e., significant differences exhibit due to uneven allocation of medical resources. By introducing tele-health, the gaps of access among different divisions can be decreased, with the largest gap reduced to 1.49, and the accessibility in divisions with poor medical resource allocation can be increased. Finally, the mean healthcare accessibility and equity in the study region can be improved to 0.75. In addition, it is shown that proper management of medical resources and patients’ willingness to accept online visits could help improve accessibility and equity, which can provide insights for hospital management and urban planning. Conclusions: An integrated framework to quantitatively assess and optimally improve healthcare accessibility and equity of medical resource allocation through tele-health is presented in this paper. An i2SFCA-TH method and an optimization model are used in the framework, which provides hospital management and urban planners a quantitative tool to improve accessibility and equity in metropolitan cities in China and other countries. Full article

(This article belongs to the Section TeleHealth and Digital Healthcare)

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15 pages, 622 KiB

Open AccessArticle

A Cohort of Sociodemographic and Health-Related Risk Factors for All-Cause Mortality in Middle-Aged and Older Adults in China

by Wenhu Xu, Hang Zhu, Yutian Chen, Qianyi Zhang, Zhinan Liu and Gong Chen

Healthcare 2025, 13(17), 2104; https://doi.org/10.3390/healthcare13172104 (registering DOI) - 24 Aug 2025

Abstract

Background: Physical inactivity is a major contributor to increased mortality among aging populations, especially in middle-aged and older adults. Methods: Data were derived from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020). Participants self-reported their physical activity frequency, categorized as low (≤1 [...] Read more.

Background: Physical inactivity is a major contributor to increased mortality among aging populations, especially in middle-aged and older adults. Methods: Data were derived from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020). Participants self-reported their physical activity frequency, categorized as low (≤1 day/week), medium (2–4 days/week), or high (≥5 days/week). All-cause mortality was tracked through verified records. Cox proportional hazards models were used to estimate hazard ratios (HRs), with adjustments for demographics, lifestyle factors, and baseline health conditions. Results: A total of 2092 participants (mean age = 63.7 ± 10.4 years) were included in the final analytic sample. Higher physical activity frequency was significantly associated with lower mortality in unadjusted models. Participants engaging in activity ≥5 days/week had a 67% reduced mortality risk compared to the low-frequency group (HR = 0.33, p < 0.001). However, after adjusting for health-related covariates, the protective effect was attenuated and no longer statistically significant. In the fully adjusted model, advanced age, current smoking, and ADL limitations emerged as the strongest independent risk factors for mortality, while being married and residing in a rural area were significantly protective effects. Conclusions: The association between frequent physical activity and reduced mortality risk among Chinese older adults is profoundly mediated by baseline health status and functional capacity. These findings highlight the importance of integrated, multifactorial public health interventions that address chronic disease management and functional rehabilitation alongside physical activity promotion. Full article

(This article belongs to the Special Issue Healthy Ageing and Lifestyle Medicine: Current Knowledge and Future Direction)

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24 pages, 636 KiB

Open AccessSystematic Review

Effectiveness of the Internet of Things for Improving Pregnancy and Postpartum Women’s Health in High-Income Countries: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Etsuko Nishimura, Noyuri Yamaji, Kiriko Sasayama, Md. Obaidur Rahman, Katharina da Silva Lopes, Citra Gabriella Mamahit, Mika Ninohei, Phyu Phyu Tun, Rina Shoki, Daichi Suzuki, Aya Nitamizu, Daisuke Yoneoka, Eiko Saito and Erika Ota

Healthcare 2025, 13(17), 2103; https://doi.org/10.3390/healthcare13172103 (registering DOI) - 23 Aug 2025

Abstract

Background/Objectives: The Internet of Things (IoT), integrated with application software, has increasingly been used to support health management through monitoring indicators like physical activity, sleep, and heart rate, in pregnant and postpartum women. However, limited evidence exists regarding its effectiveness in improving [...] Read more.

Background/Objectives: The Internet of Things (IoT), integrated with application software, has increasingly been used to support health management through monitoring indicators like physical activity, sleep, and heart rate, in pregnant and postpartum women. However, limited evidence exists regarding its effectiveness in improving health outcomes for pregnant and postpartum women. The objective of this systematic review and meta-analysis was to evaluate and synthesize the role of IoT in enhancing the health outcomes of pregnant and postpartum women. Methods: A systematic search was conducted on 13 February 2023, across CENTRAL, CINAHL, ClinicalTrials.gov, Embase, MEDLINE, PsycINFO, PubMed, and WHO ICTRP to identify all randomized controlled trials. Studies were included if they involved pregnant or postpartum women in high-income countries and used sensor-based data collection via smartphones or wearable devices. Two reviewers independently selected the studies, extracted data, and assessed the risk of bias using the Cochrane Collaboration’s risk of bias assessment tool 2.0. We performed a pairwise meta-analysis using a random effects model. The findings were reported according to PRISMA guidelines. Results: Seven studies with 1638 pregnant and postpartum women were included in this review. Of the seven included studies, half targeted women with gestational diabetes and the other half targeted obese women. A meta-analysis revealed that IoT interventions may reduce gestational weight gain in women with obesity with a mean difference of −3.35 kg (95% confidence interval (CI): −5.23 to−1.46; I² = 36%; two studies; 242 women; moderate certainty of evidence). Conclusions: This review suggested that IoT interventions may limit gestational weight gain in pregnant women with obesity. Future studies should evaluate the long-term effects of IoT-based interventions on maternal and neonatal health outcomes. Full article

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

17 pages, 1471 KiB

Open AccessArticle

Social Determinants of Health and 30-Day Readmission for Heart Failure Patients in U.S. Hospitals: Evidence from ICD-10 Z-Code Data

by Yong Cai, Liu Yanping and Qiang Liu

Healthcare 2025, 13(17), 2102; https://doi.org/10.3390/healthcare13172102 (registering DOI) - 23 Aug 2025

Abstract

Background/Objectives: There has been growing interest in understanding the impact of social determinants of health (SDoHs) on health outcomes. Since 2015, healthcare providers have begun to document patients’ SDoH systematically using ICD-10 Z-codes. Methods: We extracted claims data from a nationally representative hospital [...] Read more.

Background/Objectives: There has been growing interest in understanding the impact of social determinants of health (SDoHs) on health outcomes. Since 2015, healthcare providers have begun to document patients’ SDoH systematically using ICD-10 Z-codes. Methods: We extracted claims data from a nationally representative hospital chargemaster database for 586,929 eligible HF patients between January 2019 and December 2021. We investigated the association between SDoH Z-codes and 30-day hospital readmission for heart failure (HF) patients in U.S. hospitals using a Chi square test and adjusted odds ratios from logistic regression models. Results: We found that four major SDoH Z-code categories and five specific sub-Z-code factors within the major categories are significantly associated with 30-day readmission for HF patients. We also found that patients with two or more SDoH Z-codes have a higher risk of readmission than those with one. Conclusions: Our study indicates that ICD-10 Z-codes are useful in identifying SDoH risk factors for hospital readmission among HF patients. Policymakers and healthcare providers should consider Z-codes when assessing HF readmission risk and developing interventions to lower HF readmission rates. Full article

(This article belongs to the Section Health Policy)

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16 pages, 251 KiB

Open AccessArticle

Should I Stay at Home Alone? Lived Experiences of Loneliness Among Older Adults: A Qualitative Study

by Maria Shuk Yu Hung, Michael Man Ho Li and Ken Hok Man Ho

Healthcare 2025, 13(17), 2101; https://doi.org/10.3390/healthcare13172101 (registering DOI) - 23 Aug 2025

Abstract

Background: Loneliness and social isolation among older people are currently widespread and recognized as the foremost public health problems globally and locally. Hong Kong, which exhibits a rapid aging trend and an expanding elderly population, is inevitably facing these issues. This study explored [...] Read more.

Background: Loneliness and social isolation among older people are currently widespread and recognized as the foremost public health problems globally and locally. Hong Kong, which exhibits a rapid aging trend and an expanding elderly population, is inevitably facing these issues. This study explored the lived experiences of loneliness among older adults in Hong Kong. Methods: Qualitative interviews were conducted among older adults in the community aged 60 or above who were cared for by migrant domestic workers and presented varying levels of loneliness. Purposive sampling was used to select subjects for face-to-face, semi-structured individual interviews, with consent for audio recording, which led to the inclusion of 19 older adults, among whom five were male, nine lived with a spouse, and three lived with their children. Interpretative phenomenological analysis was adopted. Results: We identified a core theme, “Should I stay at home alone?”, and the following four interrelated themes: (1) experience of inadequate social support and networks, (2) altered family dynamics and support, (3) deterioration in physical functions and mobility limitations, and (4) experience of negative and complex emotions. Conclusions: Based on our investigation into the lived experience of loneliness among older adults locally, we recommend that the government, non-governmental organizations, and healthcare institutions establish appropriate strategies and integrated services to address the social, physical, familial, and emotional issues in this population to foster healthy aging, improve their quality of life, and encourage support from families and communities. Full article

(This article belongs to the Special Issue Research on Health-Related Quality of Life and Well-Being Among Older People)

20 pages, 1797 KiB

Open AccessArticle

The Effects of Moderate- to High-Intensity Physical Exercise on Emotion Regulation and Subsequent Cognitive Control in Highly Psychologically Stressed College Students

by Baole Tao, Tianci Lu, Hanwen Chen and Jun Yan

Healthcare 2025, 13(17), 2100; https://doi.org/10.3390/healthcare13172100 (registering DOI) - 23 Aug 2025

Abstract

Objectives: Chronic psychological stress among college students increases sensitivity to negative emotional stimuli. Emotion regulation, a critical coping mechanism, draws upon cognitive resources and may impair subsequent cognitive control. Physical exercise has been proposed as an effective intervention to enhance both emotional and [...] Read more.

Objectives: Chronic psychological stress among college students increases sensitivity to negative emotional stimuli. Emotion regulation, a critical coping mechanism, draws upon cognitive resources and may impair subsequent cognitive control. Physical exercise has been proposed as an effective intervention to enhance both emotional and cognitive functioning. This study investigated whether a 12-week structured exercise intervention could modulate emotion regulation outcomes and improve cognitive control in college students experiencing high psychological stress. Methods: Forty-seven college students, identified as highly stressed via the Chinese College Students Psychological Stress Scale, were randomly assigned to either an exercise group (n = 25) or a control group (n = 22). The exercise group participated in supervised rope-jumping sessions three times per week for 40 min, following ACSM guidelines, over 12 weeks. Before and after the intervention, participants completed tasks measuring two emotion regulation strategies—expressive suppression and cognitive reappraisal—and tasks assessing cognitive control. Results: A significant group × time × strategy interaction emerged for subjective emotional valence: following the intervention, the exercise group reported attenuated negative valence under expressive suppression. For subjective arousal, post-intervention ratings decreased under suppression but increased under reappraisal in the exercise group, suggesting strategy-specific modulation by physical activity. Regarding cognitive control, electrophysiological measures revealed that the P3 component showed a significant interaction: the exercise group exhibited enhanced P3 amplitudes in congruent versus incongruent conditions after the intervention. Moreover, P3 interference scores were significantly reduced post-intervention in the exercise group compared to both its pre-intervention baseline and the control group. Conclusions: A 12-week aerobic exercise intervention enhanced emotion regulation outcomes and improved cognitive control under high psychological stress. These findings underscore the utility of physical exercise as a non-pharmacological approach to bolster cognitive–affective resilience in young adults. Full article

(This article belongs to the Section School Health)

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11 pages, 327 KiB

Open AccessCommentary

Preventive Healthcare and Disability: Challenges and Opportunities

by Giovanni Emanuele Ricciardi, Rita Cuciniello, Veronica Raimondi, Francesco Vaia, Carlo Signorelli and Cristina Renzi

Healthcare 2025, 13(17), 2099; https://doi.org/10.3390/healthcare13172099 (registering DOI) - 23 Aug 2025

Abstract

Despite global commitments to universal health coverage, persons with disabilities (PwD) continue to face significant barriers in accessing appropriate healthcare, including diagnostics, treatments and preventive healthcare, with lower participation in cancer screening and vaccination programs. These disparities are driven by diverse, intersecting obstacles [...] Read more.

Despite global commitments to universal health coverage, persons with disabilities (PwD) continue to face significant barriers in accessing appropriate healthcare, including diagnostics, treatments and preventive healthcare, with lower participation in cancer screening and vaccination programs. These disparities are driven by diverse, intersecting obstacles (structural, financial, communicative, and social) that vary by disability type and context. Inclusive approaches, co-designed with PwD and supported by standardized assessment tools, are urgently needed to address persistent inequities in healthcare access and outcomes. Full article

(This article belongs to the Special Issue Collaborative Approaches to Risk Management and Infection Control: A Patient Perspective)

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13 pages, 231 KiB

Open AccessArticle

Family History of Diabetes: Neighborhood and Familial Risks in African American Youth Living in Public Housing

by Ngozi V. Enelamah, Andrew Foell, Melissa L. Villodas, Chrisann Newransky, Margaret Lombe, Von Nebbitt and Mansoo Yu

Healthcare 2025, 13(17), 2098; https://doi.org/10.3390/healthcare13172098 (registering DOI) - 23 Aug 2025

Abstract

Background/Objectives: Recent data shows increasing diabetes prevalence among African Americans. Youth with a family history of diabetes are at high risk for diabetes. This study explores the multilevel risk factors associated with a family history of diabetes among African American youth in [...] Read more.

Background/Objectives: Recent data shows increasing diabetes prevalence among African Americans. Youth with a family history of diabetes are at high risk for diabetes. This study explores the multilevel risk factors associated with a family history of diabetes among African American youth in public housing. Methods: This study used a cross-sectional, quantitative, and community-based participatory research (CBPR) approach. The research team, comprising community stakeholders and academic researchers, employed respondent-driven sampling (RDS) for data collection (survey) and used univariate and bivariate analyses to examine variable relationships. A sequential logistic regression highlighted factors influencing the likelihood of having a family history of diabetes. Results: The final sample (n = 190, mean age 18.5 years, 58% female) included 35% of youth with a family history of diabetes. Forty-six percent reported medium to severe household hardships. Results suggest that reporting a family history of diabetes is correlated with maternal substance use (tau-b = 0.27 **) and alcohol problems (tau-b = 0.16 ***), paternal substance use (tau-b = 0.17 *), and eating fewer fruits (tau-b = 0.17 *). With an odds ratio (OR) of 1.70 [0.68, 4.13] and attributable fraction among the exposed at 41.3%, the final model (3) was not significant [χ² = 11.19(8)]. Thus, we fail to reject the null hypothesis that the model fits the data well. Fewer vegetable consumption (OR = 15.08, p < 0.001), higher soda consumption (OR = 0.06, p < 0.001), severe household hardships (OR = 5.82, p < 0.01), and maternal substance use problems (OR = 6.81, p < 0.05) predicted a higher likelihood of a history of diabetes. Conclusions: Our study calls attention to the need to reevaluate interventions for hardships and substance use in diabetes management, particularly in poor neighborhoods and among minority families. Full article

19 pages, 575 KiB

Open AccessArticle

PromoACTIVA-SC: A Tool Aiming at Identifying Health Promotion Practice of Civil Society Organizations

by Olga Lopez-Dicastillo, Andrea Iriarte-Roteta, Elena Antoñanzas-Baztán, Sara Sola-Cia, Agurtzane Mujika, Naia Hernantes, Isabel Antón-Solanas, María Anunciación Jiménez-Marcos, Edurne Zabaleta-del-Olmo, Dolors Juvinyà-Canal and María Jesús Pumar-Méndez

Healthcare 2025, 13(17), 2097; https://doi.org/10.3390/healthcare13172097 (registering DOI) - 23 Aug 2025

Abstract

Background: The World Health Organization (WHO) defines health promotion as the process of enabling individuals to gain control over and improve their health. This shifts the focus from lifestyle choices to broader social determinants of health, requiring involvement from healthcare, authorities, industry, civil [...] Read more.

Background: The World Health Organization (WHO) defines health promotion as the process of enabling individuals to gain control over and improve their health. This shifts the focus from lifestyle choices to broader social determinants of health, requiring involvement from healthcare, authorities, industry, civil society, and the media. Civil society engagement in health initiatives offers benefits such as empowerment, service delivery, flexibility, policy participation, and credibility. However, identifying specific health promotion actions for civil society organizations (CSOs) is challenging. The lack of assessment tools for CSOs hinders evaluation and improvement. Objective: To develop a tool, ‘PromoACTIVA-SC’, to assess CSOs’ health promotion practice by identifying essential actions that constitute the health promotion process. Methods: ‘PromoACTIVA-SC’ was developed through documentary analysis and validated by experts. CSOs’ members participated in cognitive interviews for comprehensibility, and the tool was pilot tested for administration and Likert scale evaluation. Results: The final questionnaire, consisting of 8 phases and 40 items, demonstrated good content validity. Its use can help to map CSOs’ practices and identify areas needing improvement. CSOs can use it for self-assessment and in collaborative health promotion and disease prevention efforts. Conclusions: ‘PromoACTIVA-SC’ is the first tool designed to assess civil society’s role in the health promotion process. Its future use will reveal the extent to which civil society organizations actively participate in health promotion. It can also be used to promote CSOs’ involvement in health policy and administration, enhancing public health outcomes through collaborative, cross-sectoral efforts. Full article

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20 pages, 4323 KiB

Open AccessArticle

Adapting a Positive Psychological Intervention for Employees with and Without Intellectual Disabilities

by Ari Gomez-Borges, Isabel M. Martínez and Marisa Salanova

Healthcare 2025, 13(17), 2096; https://doi.org/10.3390/healthcare13172096 (registering DOI) - 23 Aug 2025

Abstract

Background/Objectives: This study explores the adaptation and implementation of a positive psychological intervention based on the Emotional Styles model to improve well-being and reduce stress in employees with and without intellectual disabilities (IDs). Methods: A longitudinal intervention was conducted in a social foundation [...] Read more.

Background/Objectives: This study explores the adaptation and implementation of a positive psychological intervention based on the Emotional Styles model to improve well-being and reduce stress in employees with and without intellectual disabilities (IDs). Methods: A longitudinal intervention was conducted in a social foundation with 45 participants (12 with ID). The program, based on Davidson’s six emotional dimensions, included six weekly sessions adapted through Easy Read strategies and COVID-19 adjustments. Data were collected at pre-test, post-test, and six-month follow-up using the Emotional Styles Questionnaire, PERMA Profiler, and UWES-3. Results: Significant improvements were found in outlook, resilience, engagement, relationships, and reduction in negative emotions, with stronger effects for non-ID participants, although context sensibility improved in the ID group. High satisfaction (93% very satisfied) confirmed the program’s acceptability. Conclusions: The adapted intervention effectively enhances emotional well-being in heterogeneous workplaces, supporting inclusive positive psychology practices. Full article

(This article belongs to the Section Community Care)

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18 pages, 629 KiB

Open AccessArticle

Assessing the Impact of Telemedicine on Patient Satisfaction Before and During the COVID-19 Pandemic

by Ashiat Adeogun and Misa Faezipour

Healthcare 2025, 13(17), 2095; https://doi.org/10.3390/healthcare13172095 (registering DOI) - 23 Aug 2025

Abstract

Objectives: The adoption of telemedicine, which is the delivery of healthcare services through digital platforms, exploded during the COVID-19 pandemic as a means to ensure the continuity of care while minimizing infection risks. While this modality improved access and convenience for many, disparities [...] Read more.

Objectives: The adoption of telemedicine, which is the delivery of healthcare services through digital platforms, exploded during the COVID-19 pandemic as a means to ensure the continuity of care while minimizing infection risks. While this modality improved access and convenience for many, disparities in adoption have emerged, particularly in rural and underserved populations. This study aims to evaluate the impact of telemedicine on patient satisfaction before and during the pandemic, with a focus on chronic disease management—notably hypertension—and to identify factors influencing the equitable adoption of telehealth. Methods and Procedures: This study used a mixed method approach, combining quantitative survey data and causal loop modeling to analyze patient satisfaction levels and the interplay between telehealth adoption, healthcare access, and demographic disparities. Patient-reported satisfaction data were collected in two time periods—before and during the pandemic. Causal modeling was used to explore systemic relationships between provider support, technology access, patient engagement, and health equity. Results: The findings revealed that telemedicine significantly enhanced healthcare access during the pandemic, with a notable increase in patient satisfaction scores. Patients with chronic conditions, especially those diagnosed with hypertension, reported the improved continuity of care and reduced geographic barriers. However, disparities in telehealth access were more pronounced in non-metropolitan areas and among older adults and minority populations. Causal analysis highlighted key enablers of telehealth success, i.e., provider support, digital literacy, and access to reliable internet and devices. Conclusions: Telemedicine presents a transformative solution for equitable healthcare delivery, especially in chronic disease management. Strategic efforts are needed to address adoption disparities and ensure the sustained and inclusive integration of telehealth after the pandemic. Full article

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20 pages, 1043 KiB

Open AccessSystematic Review

Home Physical Exercise Interventions in Chronic Non-Specific Low Back Pain: Systematic Review and Multivariate Meta-Analysis

by Diego Lapuente-Hernández, Marina Gil-Calvo, Juan Nicolás Cuenca-Zaldívar, Alberto Carcasona-Otal, Pablo Herrero and Ángel Matute-Llorente

Healthcare 2025, 13(17), 2094; https://doi.org/10.3390/healthcare13172094 - 22 Aug 2025

Abstract

Background/Objectives: Low back pain is considered one of the leading causes of disability. Up to 90% of cases are classified as non-specific, which, if prolonged for at least 12 weeks, is considered non-specific chronic low back pain (NSCLBP). Physical exercise is one [...] Read more.

Background/Objectives: Low back pain is considered one of the leading causes of disability. Up to 90% of cases are classified as non-specific, which, if prolonged for at least 12 weeks, is considered non-specific chronic low back pain (NSCLBP). Physical exercise is one of the selected treatments for NSCLBP. Interest in the use of remote interventions has recently emerged. The main objective was to analyze the effect of home exercise interventions to reduce pain intensity and functional disability in individuals with NSCLBP. Methods: A systematic review was conducted in April 2024. Both multivariate and univariate meta-analysis was performed with the difference before and after treatment, adjusting both models with a meta-regression that included the covariates age and body mass index (BMI). Heterogeneity was analyzed with Cochran’s Q test as well as with the I² estimator, and effect size was calculated with Hedges’G. Results: A total of six studies, with moderate–high methodological quality and a heterogeneous risk of bias, were included. There was a statistically significant pre-/post-treatment effect on functional disability (moderate effect: Hedge’s g = 0.69, p = 0.018) and pain intensity (large effect: Hedge’s g = 1.11, p = 0.007) in both univariate and multivariate (moderate effect: Hedge’s g = 0.77) meta-analyses when comparing unsupervised home exercise with supervised in-person exercise, in favor of the latter. This effect was significantly moderated by BMI (p = 0.003 for both outcomes) negatively. Conclusions: Unsupervised home exercise appears to be less effective than supervised in-person exercise in effectively reducing pain intensity and functional disability in the short term in individuals with NSCLBP. Full article

(This article belongs to the Section TeleHealth and Digital Healthcare)

16 pages, 668 KiB

Open AccessArticle

Strengthening Clinical Governance and Public Health Interventions to Improve Drug-Resistant Tuberculosis Outcomes in Rural South Africa

by Mojisola Clara Hosu, Urgent Tsuro, Ntandazo Dlatu, Lindiwe Modest Faye and Teke Apalata

Healthcare 2025, 13(17), 2093; https://doi.org/10.3390/healthcare13172093 - 22 Aug 2025

Abstract

Background/Objectives: Drug-resistant tuberculosis (DR-TB) presents significant challenges to public health, particularly in rural South Africa, where limited infrastructure, high HIV co-infection rates, and weak clinical governance contribute to poor treatment outcomes. This study evaluates treatment trajectories and the impact of clinical governance and [...] Read more.

Background/Objectives: Drug-resistant tuberculosis (DR-TB) presents significant challenges to public health, particularly in rural South Africa, where limited infrastructure, high HIV co-infection rates, and weak clinical governance contribute to poor treatment outcomes. This study evaluates treatment trajectories and the impact of clinical governance and public health interventions on DR-TB outcomes in the rural Eastern Cape. Methods: A retrospective cohort study was conducted among 323 laboratory-confirmed DR-TB patients treated between 2018 and 2021. Kaplan–Meier curves and Cox proportional hazards analysis identified predictors of unfavorable outcomes. Logistic regression analysis simulated the impact of enhanced clinical governance scenarios on treatment success. Results: Treatment outcomes included cure (36.2%), completion (26.0%), loss to follow up (LTFU) (9.0%), death (9.3%), failure (2.2%), and transfer (9.3%). The median treatment duration was 10 months (IQR: 9–11). Survival analysis indicates the highest risk of death and LTFU occurred in the first 6–8 months of treatment. Multivariate Cox regression revealed that primary (HR = 0.39; 95% CI: 0.23–0.68; p = 0.0017) and secondary education (HR = 0.50; 95% CI: 0.31–0.85; p = 0.0103) were significantly protective. Paradoxically, patients with pre-XDR (HR = 0.13; p = 0.034) and XDR TB (HR = 0.16; p = 0.043) showed lower hazard of poor outcomes, likely due to early mortality or referral. HIV-negative status was associated with higher risk of poor outcomes (HR = 1.74; p = 0.010). Simulations suggested that improved clinical governance via better follow-up, TB/HIV integration, and adherence support could improve treatment success by up to 20 percentage points in high-impact scenarios. Conclusions: Strengthening clinical governance through targeted interventions could substantially reduce LTFU and mortality, especially in vulnerable subgroups. A coordinated, patient-centered approach is critical for improving DR-TB outcomes in rural, high-burden settings. Full article

17 pages, 1324 KiB

Open AccessArticle

Workforce Allocation in Urban Community Mental Health Services: GIS-Based Analytical Insights for Policy and Planning

by Somayyeh Azimi and Nasir Uddin

Healthcare 2025, 13(17), 2092; https://doi.org/10.3390/healthcare13172092 - 22 Aug 2025

Abstract

Background/Objectives: This study aims to provide a comprehensive understanding of the current mental health workforce and the factors influencing its distribution within adult community mental health services in Western Australia’s North Metropolitan Health Service. Methods: Mental health workforce supply across North Metropolitan Statistical [...] Read more.

Background/Objectives: This study aims to provide a comprehensive understanding of the current mental health workforce and the factors influencing its distribution within adult community mental health services in Western Australia’s North Metropolitan Health Service. Methods: Mental health workforce supply across North Metropolitan Statistical Area Level 2 (SA2-Australian Statistical Geography Standard) was estimated using the Geographically-adjusted Index of Relative Supply (GIRS) and categorised as low (0–3) or moderate-to-high (4–8) for analysis and testing associations with multiple covariates. Population, clinic, and individual-level data were analysed using principal component analysis and logistic regression to identify the factors associated with workforce distribution. Results: Of the 68 SA2s analysed, 25 SA2s (representing 45 suburbs) were identified as having a low workforce supply, defined by a GIRS score of ≤3. These areas were compared to those with a moderate-to-high supply (GIRS > 3) to assess the differences in service performance. A principal component analysis identified three key components within the data: service usage, health service providers, and service efficiency. A logistic regression analysis revealed that areas with a low workforce supply were significantly more likely to experience reduced service usage (OR = 3.3, p = 0.037, CI [0.09–0.92]), indicating fewer patient interactions and lower engagement with mental health services. In addition, these areas demonstrated a lower service efficiency as evidenced by longer wait times (OR = 3.7, p = 0.002, CI [1.62–8.50]), suggesting that workforce shortages directly impact timely access to health care. Conclusions: The findings revealed disparities in workforce supply across different urban locations, with low-supply areas facing tangible challenges in service accessibility and operational efficiency. These findings highlight the need for targeted mental health workforce planning. Developing and implementing best practice guidelines is essential for effectively managing service demands and reducing waitlists. Full article

(This article belongs to the Special Issue Implementation of GIS (Geographic Information Systems) in Health Care)

13 pages, 1077 KiB

Open AccessArticle

Feasibility and Acceptability of a Deep-Learning-Based Nipple Trauma Assessment System for Postpartum Breastfeeding Support

by Maya Nakamura, Hiroyuki Sugimori and Yasuhiko Ebina

Healthcare 2025, 13(17), 2091; https://doi.org/10.3390/healthcare13172091 - 22 Aug 2025

Abstract

Background/Objectives: Nipple trauma is a common challenge during the early postpartum period, often undermining maternal confidence and breastfeeding success. Although deep-learning-based image analysis offers the potential for objective and remote assessments, its feasibility in clinical practice has not been well examined. This [...] Read more.

Background/Objectives: Nipple trauma is a common challenge during the early postpartum period, often undermining maternal confidence and breastfeeding success. Although deep-learning-based image analysis offers the potential for objective and remote assessments, its feasibility in clinical practice has not been well examined. This study aimed to evaluate the feasibility and acceptability of a deep-learning-based nipple trauma assessment system and explore maternal perceptions of the intervention. Methods: A quasi-experimental study was conducted at a maternity hospital in Japan. Participants were assigned to intervention or control groups based on their delivery month. Mothers in the intervention group used a dedicated offline smartphone to photograph their nipples during hospitalization. Images were analyzed using a pretrained deep-learning model, and individualized feedback was delivered via a secure messaging platform. Self-administered questionnaires were collected at three points: late pregnancy, during hospitalization, and one month postpartum. Maternal experiences and satisfaction with breastfeeding were also assessed. Results: A total of 23 participants (intervention = 8 and control = 15) completed the study. The system functioned without technical errors, and no adverse events were reported. Most participants found the AI results useful, with 75% receiving high-confidence outputs (predicted class probability ≥ 60%). Participants expressed interest in real-time feedback and post-discharge use. Breastfeeding self-efficacy scores (BSES-SF) improved more in the intervention group (+9.8) than in the control group (+7.8). Conclusions: This study confirmed the feasibility and acceptability of a deep-learning-based nipple trauma assessment system during postpartum hospitalization. The system operated safely and was well received by participants. Future developments should prioritize real-time, remote functionality to support diverse maternal needs. Full article

(This article belongs to the Special Issue Women’s Health Care: State of the Art and New Challenges)

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14 pages, 256 KiB

Open AccessArticle

Health Profiles of Inmates: A Cross-Sectional Study of Prevalent Diseases in a Central Italian Prison

by Massimo Lancia, Luca Tomassini, Roberto Scendoni, Elisa Fanella, Alessio Gili, Angela Gambelunghe, Mauro Bacci, Kyriaki Aroni, Virginia Goracci and Cristiana Gambelunghe

Healthcare 2025, 13(17), 2090; https://doi.org/10.3390/healthcare13172090 - 22 Aug 2025

Abstract

Background: Article 32 of the Italian Constitution guarantees the right to health for all citizens, including detainees. Prison populations face unique health challenges due to high-risk lifestyles, psychosocial stressors, and limited access to care. This study aimed to investigate the burden of chronic [...] Read more.

Background: Article 32 of the Italian Constitution guarantees the right to health for all citizens, including detainees. Prison populations face unique health challenges due to high-risk lifestyles, psychosocial stressors, and limited access to care. This study aimed to investigate the burden of chronic diseases and associated risk factors among male inmates in a central Italian prison. Methods: This cross-sectional study was conducted in accordance with STROBE guidelines at Giuseppe Pagliei Prison in Frosinone, Central Italy, from May 2022 to May 2023. A total of 477 adult male inmates underwent systematic clinical evaluations and medical record reviews. Demographic and health data were analyzed to determine the prevalence of chronic conditions and related risk factors. Results: Participants (mean age 47.3 ± 13.1 years; 69.6% Italian, 30.4% international, mainly Eastern European and African) presented on average 1.8 chronic conditions. The most frequent diagnoses were psychiatric disorders (19.9%), cardiovascular diseases (17.2%), and osteoarticular disorders (14.5%). Disease burden correlated with aging, unhealthy lifestyles, and incarceration-related stressors. Tobacco smoking was highly prevalent. Conclusions: Male inmates show a considerable and partly preventable burden of chronic disease. Broader policy measures, including alternative sentencing and community-based rehabilitation, may mitigate the health impact of imprisonment while ensuring public safety. Adequate prison healthcare remains a public health priority and a constitutional and human rights obligation. Full article

(This article belongs to the Special Issue Prisoner Health)

14 pages, 224 KiB

Open AccessArticle

Health Professionals’ Perceptions of Pacific Co-Designed Resources for Pacific Gout Patients

by Samuela ‘Ofanoa, Malakai ‘Ofanoa, Siobhan Tu’akoi, Melenaite Tohi, Maryann Heather, Hinamaha Lutui, Rose Lamont and Felicity Goodyear-Smith

Healthcare 2025, 13(17), 2089; https://doi.org/10.3390/healthcare13172089 - 22 Aug 2025

Abstract

Background/Objectives: Pacific peoples in Aotearoa, New Zealand experience the highest burden of gout globally, yet there is still a lack of awareness and understanding of the disease. A Pacific community group and Pacific health professional network co-designed Pacific gout resources to improve understanding. [...] Read more.

Background/Objectives: Pacific peoples in Aotearoa, New Zealand experience the highest burden of gout globally, yet there is still a lack of awareness and understanding of the disease. A Pacific community group and Pacific health professional network co-designed Pacific gout resources to improve understanding. The aim of this study is to identify and discuss the current state and perceptions of Pacific gout education, and explore health professionals’ views on Pacific co-designed resources and their usefulness in clinical settings. Methods: The Fa’afaletui model was utilised to conduct semi-structured Talanga interviews with 14 health professionals in Auckland, New Zealand who work in primary care clinics. The interview explored their views on providing gout education and on the feasibility of the Pacific co-designed gout resources. Talanga interviews were audio recorded and thematically analysed. Results: Overall, health professionals responded positively to the co-designed resources, identifying the benefits of supporting primary care consultations and improving Pacific patients’ understanding of gout. The key findings were summarised in five main themes: (1) health system barriers to gout education, (2) misleading information, (3) health professionals’ experiences of providing health education, (4) general impressions of Pacific co-designed resources, and (5) the feasibility of Pacific co-designed educational resources in a clinical setting. Conclusions: This study presents the views of health professionals in providing health education related to gout and on the feasibility of Pacific co-designed educational resources. It reinforces the significance of involving communities in the design and implementation of interventions to ensure they are culturally safe, relevant, and have long-term impacts on gout management. Full article

13 pages, 796 KiB

Open AccessArticle

Effects of Web-Based Education Program for Self-Urination Management of Patients with Spinal Cord Injuries in Community: Preliminary Study

by Hyeon Jeong Jin, Minkyung Gu, Nam Kyung Oh and Sohyune Sok

Healthcare 2025, 13(17), 2088; https://doi.org/10.3390/healthcare13172088 - 22 Aug 2025

Viewed by 39

Abstract

Background/Objective: Community-dwelling spinal cord injury patients have many difficulties and disabilities in self-care of urination based on pathological mechanisms. This study aimed to examine the effects of a web-based education program for self-urination management on knowledge and compliance of self-urination management, self-efficacy, and [...] Read more.

Background/Objective: Community-dwelling spinal cord injury patients have many difficulties and disabilities in self-care of urination based on pathological mechanisms. This study aimed to examine the effects of a web-based education program for self-urination management on knowledge and compliance of self-urination management, self-efficacy, and psychological well-being of patients with spinal cord injury in the community. Methods: A quasi-experimental study design using a non-equivalent control group was employed. There was a total of 36 participants, including 18 of each intervention group and control group. Web-based education program for self-urination management as an intervention was applied to intervention group duration four weeks. Measures included self-urination management knowledge, compliance of self-urination management, self-efficacy, and psychological well-being. The self-urination management knowledge, compliance of self-urination management, self-efficacy, and psychological well-being were significantly improved in the intervention group applied to web-based education program for self-urination management. Result: The results show that the web-based education program for self-urination management was effective in improving self-urination management knowledge, compliance of self-urination management, self-efficacy, and psychological well-being of patients with spinal cord injury in the community. Conclusions: Health professionals can utilize the web-based education program for self-urination management to help people with spinal cord injury live healthy, independent lives in the community. Full article

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21 pages, 2578 KiB

Open AccessReview

Exercise Interventions for Metabolic Diseases: An Analysis of the Evolution of Aerobic Exercise Bibliometrics in the Field of Type 2 Diabetes Mellitus

by Yang Li, Amin Ullah, Shuhao Fang, Donglin Liu, Zhenwei Cui and Guangning Kou

Healthcare 2025, 13(17), 2087; https://doi.org/10.3390/healthcare13172087 - 22 Aug 2025

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Abstract

Background: Type 2 diabetes mellitus (T2DM) is a major global public health challenge. Aerobic exercise (AE) can be a key strategy for non-pharmacological intervention in T2DM through multi-targeted modulation of glucose and lipid metabolism, inhibition of chronic inflammation, and reduction of oxidative [...] Read more.

Background: Type 2 diabetes mellitus (T2DM) is a major global public health challenge. Aerobic exercise (AE) can be a key strategy for non-pharmacological intervention in T2DM through multi-targeted modulation of glucose and lipid metabolism, inhibition of chronic inflammation, and reduction of oxidative stress. This study aims to investigate the current status of AE intervention in T2DM research and analyze its future evolution. Methods: Using the R-based bibliometric software package and the Java-based visualization software CiteSpace and VOSviewer, we analyzed the literature and cited references related to AE intervention in T2DM research included in the Web of Science Core Collection (WOSCC) and China National Knowledge Infrastructure (CNKI) from 2014 to 2024. Results: This study included a total of 882 relevant literature sources (488 of which were indexed in WOSCC and 394 in CNKI). From the perspective of research trends, the number of literature sources on AE interventions for T2DM has shown fluctuating changes over time. In terms of research output, the United States, China, and Canada are at the forefront. It is worth noting that, although China has a relatively high number of published papers, there is still a significant gap in terms of the depth of international collaboration and the presentation of results in top-tier journals. Among researchers, Dai Xia (China) and Riddell MC (Canada) are the scholars with the highest number of published articles in this field. Keyword analysis indicates that mechanisms such as oxidative stress, insulin resistance, inflammatory responses, and glucose metabolism disorders remain core research hotspots. Time-series analysis reveals that the research paradigm in this field has evolved from single exercise methods to comprehensive exercise prescription studies, and multi-dimensional intervention studies combining exercise, diet, and pharmacological interventions are emerging as new research frontiers. Conclusions: This study uses bibliometric methods to visualize and analyze the progress of AE in T2DM intervention research from a broader perspective, providing a scientific overview and macro-level predictions for the research landscape in this field. Full article

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15 pages, 1133 KiB

Open AccessArticle

Mediating Role of Basic Psychological Needs in the Association Between Exercise Goal Content and Subjective Well-Being in Portuguese Older Adults

by Nuno Couto, Raul Antunes, Teresa Bento, Anabela Vitorino, Diogo Monteiro and Luís Cid

Healthcare 2025, 13(17), 2086; https://doi.org/10.3390/healthcare13172086 - 22 Aug 2025

Viewed by 34

Abstract

Background: This study aimed to examine the association between different exercise goals and their impact on subjective well-being (SWB) variables, namely, positive affect (PA), negative affect (NA), and satisfaction with life (SWL), as well as to explore the mediating role of basic [...] Read more.

Background: This study aimed to examine the association between different exercise goals and their impact on subjective well-being (SWB) variables, namely, positive affect (PA), negative affect (NA), and satisfaction with life (SWL), as well as to explore the mediating role of basic psychological needs (BPNs) in this relationship within a sample of Portuguese older adults. Objectives: The present study aimed to analyze the association between extrinsic and intrinsic motivation for exercise, basic psychological needs (BPNs), and subjective well-being (SWB) in older Portuguese people. Methods: The sample study constituted 298 individuals (233 females, 65 males), aged between 60 and 90 years (M = 68.43; SD = 6.48). Through model four of the Process macro for SPSS version 3.5, a simple mediation analysis was carried out. Results: The results show that BPNs mediated the relationship between goal content for exercise health management and positive affect (PA) and satisfaction with life (SWL); goal content for exercise skill development and PA; goal content for exercise image, PA, and SWL; and goal content for exercise social affiliation and PA. Conclusions: Thus, we can conclude that BPNs stand out as a relevant mediator in the relationship between goal content for exercise and SWB variables, which reinforces the importance of BPNs in SWB promotion in the older population. Full article

(This article belongs to the Special Issue Physical Activity and Body Composition in Healthy Aging)

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15 pages, 301 KiB

Open AccessReview

by Joshua R. Sparks and Xuewen Wang

Healthcare 2025, 13(17), 2085; https://doi.org/10.3390/healthcare13172085 - 22 Aug 2025

Viewed by 36

Abstract

This narrative review examines the complex relationship between sleep changes during the menopausal transition and cardiometabolic risks. The most common complaint about sleep is increased awakenings during sleep. Other complaints include having trouble falling asleep, waking up too early, insufficient and non-restorative sleep, [...] Read more.

This narrative review examines the complex relationship between sleep changes during the menopausal transition and cardiometabolic risks. The most common complaint about sleep is increased awakenings during sleep. Other complaints include having trouble falling asleep, waking up too early, insufficient and non-restorative sleep, and overall poor quality. Sleep determined using objective methods also indicates that greater awakenings after sleep onset are associated with the period of menopausal transition. Polysomnography recordings suggest physiological hyperarousal during sleep. Changes in other sleep metrics, such as sleep latency and sleep duration, are less consistent, and some studies suggest they may not worsen during the menopausal transition. These sleep issues are influenced by multiple factors, such as hormonal fluctuations, vasomotor symptoms, and psychosocial factors, and evidence suggests that hypothalamic kisspeptin/neurokinin B/dynorphin (KNDy) neurons are key underlying mechanisms for these associations. The menopausal transition is also associated with increases in cardiometabolic risk factors, such as body fat, altered lipid profiles, blood pressure, and vascular health. Emerging evidence suggests that poor sleep health during this period is associated with increased cardiometabolic risks and adverse cardiovascular outcomes. Thus, addressing sleep disturbances is crucial for comprehensive healthcare during the menopausal transition to safeguard long-term cardiometabolic health. Future research is needed to investigate interventions that can improve sleep and their impact on cardiometabolic health in this population experiencing increases in cardiometabolic risk. Full article

(This article belongs to the Special Issue Menopause Transition and Postmenopausal Health)

11 pages, 418 KiB

Open AccessArticle

Healthcare Expenditures and Reimbursement Patterns in Idiopathic Pulmonary Fibrosis: A 10-Year Single-Center Retrospective Cohort Study in Turkey

by Kerem Ensarioğlu, Berna Akıncı Özyürek, Metin Dinçer, Tuğçe Şahin Özdemirel and Hızır Ali Gümüşler

Healthcare 2025, 13(17), 2084; https://doi.org/10.3390/healthcare13172084 - 22 Aug 2025

Viewed by 58

Abstract

Background/Objectives: Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive fibrosing interstitial disease that incurs significant healthcare costs due to diagnostic and treatment needs. This study aimed to estimate healthcare expenses related to IPF diagnosis, treatment, and follow-up, including factors affecting overall expenditure. [...] Read more.

Background/Objectives: Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive fibrosing interstitial disease that incurs significant healthcare costs due to diagnostic and treatment needs. This study aimed to estimate healthcare expenses related to IPF diagnosis, treatment, and follow-up, including factors affecting overall expenditure. Methods: This retrospective cohort study included 276 IPF patients from a tertiary hospital (2013–2022). Diagnostic and treatment costs were analyzed, including antifibrotic medications (pirfenidone and nintedanib), diagnostic tests (pulmonary function tests and performance evaluation tests), and interventions (fiberoptic bronchoscopy, imaging modalities). Costs in Turkish Lira were converted to United States dollars. Statistical analysis was performed using non-parametric tests to evaluate expenditure correlations with demographic, clinical, and treatment parameters, which included the Mann–Whitney and Spearman Rank Correlation tests when appropriate. Results: The median healthcare expenditure was USD 429.1 (9.13–21,024.57). Inpatient costs (USD 582.67; USD 250.22 to USD 1751, 25th and 75th percentile, respectively) were higher than outpatient costs (USD 192.36; USD 85.75 to USD 407.47, 25th and 75th percentile, respectively). Antifibrotic regimens did not differ significantly in cost or duration (Z = 0.657; p = 0.511) (mean pirfenidone duration: 1.1 ± 1.0 years; mean nintedanib duration: 0.6 ± 0.9 years). Diagnostic tests, particularly pulmonary function tests (PFT) (p: 0.001, Rho: 0.337), diffusing capacity of the lungs for carbon monoxide (DLCO) (p: 0.001, Rho: 0.516), and high-resolution computed tomography (HRCT) (p: 0.001, Rho: 0.327), were the primary drivers of costs. Longer treatment duration was positively correlated with expenditure (Rho: 0.264, p: 0.001 and Rho: 0.247, p: 0.006 for pirfenidone and nintedanib, respectively) while age showed a weak negative correlation (Rho = −0.184, p = 0.002). Gender and type of antifibrotic regimen did not show any significant effect on costs. Discussion: Diagnostic and follow-up testing were the main contributors to costs, driven by reimbursement requirements and the progressive nature of IPF. Antifibrotic medications, although expensive, provided clinical stability, potentially reducing hospitalization needs but increasing long-term care expenses. Variations in healthcare systems affect expenditures, with Turkey’s universal coverage lowering costs compared to Western countries. The study’s main limitations include being a single-center, retrospective study and its inability to include comorbidities and disease severity in the statistical analysis. Conclusions: IPF management is resource-intensive, with diagnostic tests and follow-up driving costs independent of demographics and treatment modality. Anticipating higher expenditures with prolonged survival and evolving treatment options is crucial for healthcare budget planning. Preparation of healthcare policies accordingly to these observations, which must include an overall increase in cost due to treatment duration and survival, remains a crucial aspect of budget control. Full article

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13 pages, 249 KiB

Open AccessReview

Psychological Violence in Image-Based Sexual Abuse (IBSA): The Role of Psychological Traits and Social Communications—A Narrative Review

by Carmela Mento, Martina Praticò, Maria Catena Silvestri, Clara Lombardo and Francesco Pira

Healthcare 2025, 13(17), 2083; https://doi.org/10.3390/healthcare13172083 - 22 Aug 2025

Viewed by 83

Abstract

This narrative review has examined the psychological and emotional effects of non-consensual distribution of intimate images, a phenomenon known as Image-Based Sexual Abuse (IBSA). It is an increasingly frequent phenomenon, and in detail, it consists of when a person uploads nude/semi-nude photos of [...] Read more.

This narrative review has examined the psychological and emotional effects of non-consensual distribution of intimate images, a phenomenon known as Image-Based Sexual Abuse (IBSA). It is an increasingly frequent phenomenon, and in detail, it consists of when a person uploads nude/semi-nude photos of someone online; therefore, it is similar to nonconsensual pornography. According to the scientific literature, this phenomenon has caused victims to experience trust issues, anxiety, depression, suicidal thoughts, social withdrawal, public shame and humiliation, depression, fear, anxiety, stress, inability to find new romantic partners, and several other mental health effects. The aim of this study was to study the psychological consequences of Image-Based Sexual Abuse on victims. This study is a narrative review conducted in accordance with the SANRA guidelines. Findings have shown that revenge pornography and non-consensual intimate images have had devastating impacts on victims’ mental health. Full article

(This article belongs to the Section Medication Management)

20 pages, 747 KiB

Open AccessArticle

Perceptions and Attitudes of Informal Caregivers of Stroke Patients Regarding the Stroke-CareApp: A Phenomenological Study

by Ismael Andrades-González, Neiva Rodríguez-Estrabot, Rocío Magdaleno-Moya and Jesús Molina-Mula

Healthcare 2025, 13(17), 2082; https://doi.org/10.3390/healthcare13172082 - 22 Aug 2025

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Abstract

Introduction: The application of information and communication tools in healthcare is becoming increasingly widespread and is obtaining promising results. However, their use by informal caregivers is not adequately elucidated. Objective: The aim was to analyze the opinions, perceptions, and attitudes of [...] Read more.

Introduction: The application of information and communication tools in healthcare is becoming increasingly widespread and is obtaining promising results. However, their use by informal caregivers is not adequately elucidated. Objective: The aim was to analyze the opinions, perceptions, and attitudes of informal caregivers of stroke patients concerning the use of Stroke-CareApp (Version 1), a smartphone application (app) designed exclusively for this population. Methods: A qualitative study was conducted using a phenomenological approach. Five caregivers used Stroke-CareApp, an app designed as a meeting place for peers, with information about the disease and access to healthcare professionals. Results: The discourses obtained from the interviews were analyzed, and the resulting codes were divided into eight categories: impact on the caregiver, coping with caregiving, involvement in caregiving, steps toward recovery in the absence of the caregiver, relevance for the caregiver, facilitating factors for the use of the app, source of consultation when in doubt and reliability of the information, and limitations in the use of the app. Conclusions: Although caregivers consider the app a beneficial intervention for them, it is important to note that it is a complementary alternative to other interventions, and one must be patient and perseverant during the initial months to achieve optimal adherence. Full article

(This article belongs to the Special Issue Health and Education in Synergy: Strengthening Healthcare Through Educational Innovation and the Excellence of Professional Training)

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11 pages, 222 KiB

Open AccessArticle

Defining Skill in Manual and Manipulative Therapy: Perspectives from Physical Therapists

by William J. Hanney, Rachel A. Brown, Emily Lufsey, Georgia Newsome, Payne Sewnarine, Morey J. Kolber and Abigail W. Anderson

Healthcare 2025, 13(17), 2081; https://doi.org/10.3390/healthcare13172081 - 22 Aug 2025

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Abstract

Background/Objectives: A state-wide survey was conducted in Florida to evaluate skill in manual and manipulative therapy as a therapeutic intervention, explore its use in the field of physical therapy, and understand how physical therapists quantify skill to aid in creating a definition [...] Read more.

Background/Objectives: A state-wide survey was conducted in Florida to evaluate skill in manual and manipulative therapy as a therapeutic intervention, explore its use in the field of physical therapy, and understand how physical therapists quantify skill to aid in creating a definition of what comprises manual and manipulative skills. A survey was developed utilizing the Delphi approach, which was entered into an electronic survey platform and distributed via email to physical therapists licensed in the state of Florida. Questions of the survey addressed the physical therapists’ demographics, education, training, use of MT, and Likert scales to quantify physical therapists’ perspectives on characteristics contributing to MT skills and how various characteristics contribute to skills in manual and manipulative therapies. Results: The response rate was 1.6% (307/19,523). Ninety-four percent of participants had more than 10 years of experience in physical therapy, and all respondents had at least 1 year of experience. Participants were 59.3% female and 40.7% male, with a mean age of 48 years (SD = 12.7). No association between gender and use of manual therapy was found (p = 0.44). Of respondents, 33.3% said they use manual and manipulative therapy on every patient, and 38.1% said they use it at least once a day. The most common specialty board certification that respondents held was in orthopedics. Among participants who believe that skill in manual and manipulative therapy is measurable, a Pearson’s correlation showed the following factors as key contributors of “skill” in manual therapy: therapeutic alliance, therapeutic touch, the ability to differentiate subtle nuances between grades I–IV, and adherence to evidence-based practice. Conclusions: The definition of skill found in this study could be used in future studies to determine how skilled MT interventions can influence patient outcomes. Future research should be conducted to discover how these aspects of manual and manipulative therapy can impact intervention results in patient care and how these definitions may influence physical therapy education. Full article

12 pages, 355 KiB

Open AccessArticle

Mediating Effect of Team Effectiveness of the Nursing Unit on the Nursing Work Environment and Patient-Centered Nursing: A Cross-Sectional Study

by Se Young Kim and Young Ko

Healthcare 2025, 13(17), 2080; https://doi.org/10.3390/healthcare13172080 - 22 Aug 2025

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Abstract

Background/Objectives: This study aimed to examine the mediating role of the team effectiveness of the nursing unit on the relationship between the nursing work environment and patient-centered nursing. Methods: This cross-sectional design enrolled 327 nurses working in general hospitals across South Korea. Data [...] Read more.

Background/Objectives: This study aimed to examine the mediating role of the team effectiveness of the nursing unit on the relationship between the nursing work environment and patient-centered nursing. Methods: This cross-sectional design enrolled 327 nurses working in general hospitals across South Korea. Data were collected using a structured questionnaire between July and October 2022. Mediation analysis was conducted using PROCESS Macro v3.5 for SPSS (Model 4), with bootstrap resampling (5000 samples) to assess the direct and indirect effects of the nursing work environment on patient-centered nursing. Results: The mean score for patient-centered nursing was 3.96 (maximum scored 5). Clinical experience, position, and hospital type were found to be significant general characteristics influencing patient-centered nursing. Both the nursing work environment (r = 0.522, p < 0.001) and the team effectiveness of the nursing unit (r = 0.569, p < 0.001) showed significant positive correlations with patient-centered nursing. Moreover, team effectiveness was found to mediate the relationship between the nursing work environment and patient-centered nursing (R² = 0.39, F = 35.35, p < 0.001). Conclusions: These findings highlight the importance of organization-level strategies to enhance the nursing work environment and foster a team-based culture to improve patient-centered nursing. Full article

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