Healthcare

19 pages, 3401 KB

Open AccessSystematic Review

Remote Virtual Interactive Agents for Older Adults: Exploring Its Science via Network Analysis and Systematic Review

by Michael Joseph Dino, Chloe Margalaux Villafuerte, Veronica A. Decker, Janet Lopez, Luis Ezra D. Cruz, Gerald C. Dino, Jenica Ana Rivero, Patrick Tracy Balbin, Eloisa Mallo, Cheryl Briggs, Ladda Thiamwong and Mona Shattell

Healthcare 2025, 13(17), 2253; https://doi.org/10.3390/healthcare13172253 - 8 Sep 2025

Viewed by 268

Abstract

Background: The global rise in the aging population presents significant challenges to healthcare systems, especially with increasing rates of chronic illnesses, mental health issues, and functional decline among older adults. In response, holistic and tech-driven approaches, such as telehealth and remote virtual interactive [...] Read more.

Background: The global rise in the aging population presents significant challenges to healthcare systems, especially with increasing rates of chronic illnesses, mental health issues, and functional decline among older adults. In response, holistic and tech-driven approaches, such as telehealth and remote virtual interactive agents (VIAs), are potential emerging solutions to support the physical, cognitive, and emotional well-being of older adults. VIAs are multimodal digital tools that provide interactive and immersive experiences to users. Despite its promise, gaps still exist in the insights that explore ways of delivering geriatric healthcare remotely. Objective: This systematic review examines the existing literature on remote virtual interventions for older adults, focusing on bibliometrics, study purposes, outcomes, and network analysis of studies extracted from major databases using selected keywords and managed using the Covidence application. Methods and Results: Following five stages, namely, problem identification, a literature search, data evaluation, data analysis, and presentation, the review found that the studies on remote VIAs for older adults (2013–2025) were mostly from a positivist perspective, multi-authored, and U.S.-led, mainly showing positive outcomes for most studies (n = 13/15) conducted in home settings with healthy older participants. The dominance of positivist, US-led studies reflect an epistemological stance that emphasizes objectivity, quantification, and generalizability. VIAs, often pre-programmed and internet-based, supported health promotion and utilized visual humanoid avatars on personal devices. Keyword and network analysis additionally revealed four themes resulting from the review: Health and Clinical, Holistic and Cognitive, Home and Caring, and Hybrid and Connection. Conclusions: The review provides innovative insights and illustrations that may serve as a foundation for future research on VIAs and remote healthcare delivery for older adults. Full article

(This article belongs to the Special Issue Recent Advances and Innovation in Telehealth Use Among Older Adults)

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22 pages, 927 KB

Open AccessArticle

The Online Misinformation Susceptibility Scale: Development and Initial Validation

by Aglaia Katsiroumpa, Ioannis Moisoglou, Polyxeni Mangoulia, Olympia Konstantakopoulou, Parisis Gallos, Maria Tsiachri and Petros Galanis

Healthcare 2025, 13(17), 2252; https://doi.org/10.3390/healthcare13172252 - 8 Sep 2025

Viewed by 408

Abstract

Background/Objectives: Although it is known that widespread online misinformation has negative consequences, there is no scale to measure susceptibility to online misinformation. Thus, our aim was to develop and validate a tool for measuring susceptibility to online misinformation: the Online Misinformation Susceptibility [...] Read more.

Background/Objectives: Although it is known that widespread online misinformation has negative consequences, there is no scale to measure susceptibility to online misinformation. Thus, our aim was to develop and validate a tool for measuring susceptibility to online misinformation: the Online Misinformation Susceptibility Scale (OMISS). Methods: A comprehensive literature review was conducted to generate a preliminary pool of items. Subsequently, a multidisciplinary panel of experts assessed the content validity of these items. To establish face validity, cognitive interviews were performed. Both exploratory and confirmatory factor analyses were performed to verify the underlying construct structure of the OMISS. We examined the concurrent validity of the OMISS by using a fake news detection scale, the Trust in Scientists Scale, a single-item trust in scientists scale, the Conspiracy Mentality Questionnaire, and a single-item conspiracy belief scale. Reliability was rigorously examined using multiple indices, including Cronbach’s alpha, McDonald’s Omega, Cohen’s kappa, and intraclass correlation coefficient. Results: The psychometric evaluation using both exploratory and confirmatory factor analyses supported a one-factor nine-item model for the OMISS. The OMISS demonstrated strong concurrent validity, evidenced by statistically significant correlations with the five scales mentioned above. Cronbach’s alpha and McDonald’s Omega were 0.920 and 0.921, respectively. The intraclass correlation coefficient for the OMISS was 0.994. Conclusions: Our comprehensive psychometric evaluations confirmed the OMISS as a valid tool for measuring online misinformation susceptibility. The OMISS holds promise as an effective tool for identifying susceptibility to misinformation and could support policymakers, health educators, healthcare professionals, and stakeholders in pinpointing high-risk groups. Full article

(This article belongs to the Special Issue Misinformation: A Major Threat to Public Health, Healthcare Services, and Patient Outcomes)

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19 pages, 562 KB

Open AccessReview

An Overview of Instruments to Assess Vulnerability in Healthcare: A Scoping Review

by Filipa Andrade, Ana Resende, Clara Roquette Viana, Amélia Simões Figueiredo and Fernanda Loureiro

Healthcare 2025, 13(17), 2251; https://doi.org/10.3390/healthcare13172251 - 8 Sep 2025

Viewed by 131

Abstract

Background/Objectives: Vulnerability is a multifaceted concept frequently addressed in healthcare, reflecting individuals’ and families’ conditions that may affect health outcomes. The availability of validated instruments to assess vulnerability is essential for supporting healthcare professionals in delivering tailored care. This scoping review aimed [...] Read more.

Background/Objectives: Vulnerability is a multifaceted concept frequently addressed in healthcare, reflecting individuals’ and families’ conditions that may affect health outcomes. The availability of validated instruments to assess vulnerability is essential for supporting healthcare professionals in delivering tailored care. This scoping review aimed to map the available scientific evidence regarding vulnerability assessment instruments in individuals and/or families in the context of healthcare. Methods: We conducted a scoping review following the Joanna Briggs Institute methodology. A comprehensive search was carried out in the databases PubMed, SciELO, CINAHL, Scopus, and Web of Science, as well as in sources of gray literature, using relevant keywords. Results: A total of 38 studies were included, identifying 13 distinct instruments used to assess vulnerability at the individual and/or family level. These instruments varied widely in terms of dimensions, number of items, target populations, and modes of completion. Some instruments focused on specific aspects such as socioeconomic status, health behaviors, or access to services. Conclusions: The results demonstrate the complexity of the concept of vulnerability and the need to create instruments adapted to specific determinants/factors, such as environmental, biological, and social factors, as well as the specificities of target populations and contexts of assessment and intervention. Full article

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17 pages, 726 KB

Open AccessArticle

Physical and Psychological Benefits of a 12-Week Zumba Gold^® Exercise Intervention in Postmenopausal Sedentary Women from Low Socioeconomic Status

by Anne Delextrat, Alba Solera-Sanchez, Emma L. Davies, Sarah E. Hennelly, Clare D. Shaw, Lily Sabir and Adam Bibbey

Healthcare 2025, 13(17), 2250; https://doi.org/10.3390/healthcare13172250 - 8 Sep 2025

Viewed by 171

Abstract

Background: Exercise is known to help with the effects of the menopause, but women from low socioeconomic status (SES) tend to exercise less at this stage of life. Therefore, this study aimed to investigate the physical and psychological effects of a Zumba Gold [...] Read more.

Background: Exercise is known to help with the effects of the menopause, but women from low socioeconomic status (SES) tend to exercise less at this stage of life. Therefore, this study aimed to investigate the physical and psychological effects of a Zumba Gold^® community-based intervention in postmenopausal women from low SES. Methods: Forty-three women were divided into a Zumba Gold^® (ZG) and control (C) group, and participated in pre- and post-testing sessions, separated by a 12-week intervention period. The outcomes measured were: body composition, sit-to-stand (STS), six-minute walk test (6MWT), balance, Short Form Health Survey (SF-12), Multidimensional Fatigue Index (MFI-20), Self-Efficacy for Exercise (SEE), Behavioral Regulations in Exercise (BREQ-2), Hospital Anxiety and Depression Scale (HADS), and Social Connectedness questionnaires. Semi-structured interviews were also performed on 15 ZG participants. Results: The results showed significant improvements in the ZG group only for STS, 6MWT, mental health, fatigue (general, physical, and mental), social connectedness score, and a significantly lower level of amotivation. Zumba Gold^® had positive effects on four main themes: belonging, non-judgmental place, psychological motivational factors, and mind–body connection. Conclusions:This is the first study to show that ZG is beneficial for this population and encourages similar studies on other aspects of the menopause. Full article

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12 pages, 368 KB

Open AccessArticle

Casualties During Marathon Events and Implications for Medical Support

by Juliana Poh and Venkataraman Anantharaman

Healthcare 2025, 13(17), 2249; https://doi.org/10.3390/healthcare13172249 - 8 Sep 2025

Viewed by 150

Abstract

Introduction: Marathon runs conducted in tropical environments can result in high injury rates. This study was conducted to provide information about the burden of injuries in such environments, to aid planning for similar mass events, enhance medical support, and improve participant safety. Methods: [...] Read more.

Introduction: Marathon runs conducted in tropical environments can result in high injury rates. This study was conducted to provide information about the burden of injuries in such environments, to aid planning for similar mass events, enhance medical support, and improve participant safety. Methods: This was a retrospective review of casualty data from the Singapore Marathon races from 2013 to 2016. Patient Presentation Rate (PPR) and Transport to Hospital Rate (THR) were calculated and correlated with heat index, derived from weather information. Injury types were also reviewed. The negative binomial regression was performed to investigate impact of heat index on casualty rates. The medical response plan is briefly described. Results: During the four-year period covered, heat index increased from 29° to 35°. There were more casualties amongst the participants from the full marathon than other race categories. The THR was 0.3 to 0.68 per 1000 participants. Two participants had cardiac arrest. Negative binomial regression showed significant impact of heat index on casualty rate. Incidence rate ratio was 1.22 for severe casualties, which indicated that every 1 unit increase in heat index resulted in 22% rise in severe casualty numbers. Compared with 10 km racers, half marathon racers experienced 1.58 times greater likelihood of all injuries and full marathon racers, a 3.87 times greater risk. Conclusions: Adverse weather conditions with high-heat index can increase injury rates during strenuous physical activities such as the marathon. Applying careful measures to minimise the impact of heat and high humidity may help minimise such injuries. Full article

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19 pages, 825 KB

Open AccessPerspective

A Physician-Driven Patient Safety Paradigm: The “Pitfall Bank” as a Translational Mechanism for Medical Error Prevention

by Gerd Herold, Viktoras Justickis, Vytė Maneikienė, Kazimieras Maneikis, Paulius Trinkauskas and Karina Palkova

Healthcare 2025, 13(17), 2248; https://doi.org/10.3390/healthcare13172248 - 8 Sep 2025

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Abstract

Background: Despite more than 25 years of intensive effort following the landmark “To Err Is Human” report, conventional top-down medical error prevention strategies, grounded in the Safety-I paradigm, have largely failed to reduce patient harm. This persistent shortcoming underscores the need for a [...] Read more.

Background: Despite more than 25 years of intensive effort following the landmark “To Err Is Human” report, conventional top-down medical error prevention strategies, grounded in the Safety-I paradigm, have largely failed to reduce patient harm. This persistent shortcoming underscores the need for a new prevention model. The medical literature contains an extensive yet systematically underutilized body of physician-generated experiential knowledge on “clinical pitfalls”—specific high-risk scenarios in which errors are likely to occur. This resource presents an opportunity for a novel, physician-driven approach to medical error prevention. The present paper proposes and evaluates such a model, grounded in the principles of Safety-II and translational medicine. Methods: The methodology involved a three-part conceptual analysis: (1) a critical review of the literature assessing the effectiveness of established error prevention strategies, (2) a quantitative bibliometric analysis of the PubMed database to determine the volume and temporal trends of publications on “clinical pitfalls”, and (3) a conceptual synthesis to design a novel physician-driven error prevention model. Each method is described in detail at the beginning of its respective section. Results: The literature review confirms the limited effectiveness of existing top-down safety initiatives, particularly in complex domains such as diagnosis and treatment. The bibliometric analysis identified more than 43,000 publications containing the keyword “pitfall,” with a sustained and significant upward trend in annual publications over the past three decades. The conceptual synthesis demonstrates that a physician-driven system—centered on a “Pitfall Bank”—addresses core weaknesses of current strategies, including unreliable data, heterogeneous knowledge, and cognitive biases. Structured as a circular translational mechanism, the proposed system facilitates a continuous cycle of practice-based problem identification and science-informed solution implementation. Conclusions: A physician-driven prevention system, architected as a translational engine, offers a promising and sustainable strategy to overcome the current impasse in medical error reduction and create a more resilient and adaptive healthcare system. Full article

(This article belongs to the Section Healthcare Quality, Patient Safety, and Self-care Management)

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16 pages, 703 KB

Open AccessReview

Self-Management Behaviours in Type 2 Diabetes Across Gulf Cooperation Council Countries: An Updated Narrative Review to Enhance Patient Care

by Ashokkumar Thirunavukkarasu and Aseel Awad Alsaidan

Healthcare 2025, 13(17), 2247; https://doi.org/10.3390/healthcare13172247 - 8 Sep 2025

Viewed by 305

Abstract

Background and Objectives: Type 2 diabetes mellitus (T2DM) remains a significant public health problem across Gulf Cooperation Council (GCC) nations because of advancements in urbanization alongside behavioural lifestyle changes and genetic predispositions. Specific self-management methods are fundamental in T2DM management because they [...] Read more.

Background and Objectives: Type 2 diabetes mellitus (T2DM) remains a significant public health problem across Gulf Cooperation Council (GCC) nations because of advancements in urbanization alongside behavioural lifestyle changes and genetic predispositions. Specific self-management methods are fundamental in T2DM management because they provide better glycaemic control and decrease complications. Achieving a synthesis of updated evidence about self-management strategies and patient perception within GCC nations represents the primary objective of this narrative review. Materials and Methods: The studies included in the present review were retrieved from the Web of Science, Scopus, Medline, Saudi Digital Library, and Embase. We included peer-reviewed studies that were published from January 2020 to March 2025. The selected studies measured the self-management practices of adult T2DM patients by examining medication adherence, dietary patterns, blood glucose monitoring, and treatment barriers. Results: Research data indicate that patients demonstrate different levels of self-care management behaviours, where medication compliance is fair, but dietary patterns and physical activities remain areas of concern. High levels of knowledge deficits, cultural elements, and economic background substantially impact patients’ self-management practices. Patients indicate their need for enhanced and personalized care, better connections with healthcare providers, and interventions that consider their cultural backgrounds. Conclusions: Patients throughout the GCC region encounter ongoing difficulties that prevent them from performing their best at self-management, even though advanced healthcare facilities exist in this region. Therefore, it is critical to develop culturally sensitive patient-centered care, individualized educational programs, and adopt supportive digital solutions to enhance diabetes-related self-care management. Full article

(This article belongs to the Section Chronic Care)

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22 pages, 327 KB

Open AccessReview

Fluoride in Dental Caries Prevention and Treatment: Mechanisms, Clinical Evidence, and Public Health Perspectives

by Chin-Hsuan Yeh, Yung-Li Wang, Thi Thuy Tien Vo, Yi-Ching Lee and I-Ta Lee

Healthcare 2025, 13(17), 2246; https://doi.org/10.3390/healthcare13172246 - 8 Sep 2025

Viewed by 301

Abstract

Background: Dental caries remains one of the most prevalent chronic diseases worldwide. Fluoride has long been recognized as a cornerstone of caries prevention through enamel remineralization, inhibition of demineralization, and antibacterial activity. However, controversies persist regarding systemic exposure, potential health risks, and ethical [...] Read more.

Background: Dental caries remains one of the most prevalent chronic diseases worldwide. Fluoride has long been recognized as a cornerstone of caries prevention through enamel remineralization, inhibition of demineralization, and antibacterial activity. However, controversies persist regarding systemic exposure, potential health risks, and ethical debates over community water fluoridation. Previous reviews often focused on isolated interventions, whereas a critical synthesis of mechanisms, clinical efficacy, safety, and public health perspectives is still lacking. Methods: This narrative review synthesized peer-reviewed publications from 2000 to 2025 retrieved from PubMed, Scopus, Web of Science, and leading dental journals. Emphasis was placed on randomized controlled trials, systematic reviews, meta-analyses, and major policy documents. Evidence was thematically appraised across mechanisms of action, clinical applications, comparative efficacy, safety, and sociocultural considerations. Results: Fluoride consistently shows preventive and therapeutic benefits across multiple delivery forms, including toothpaste, varnishes, mouthrinses, supplements, and silver diamine fluoride, with particular advantages for high-risk groups such as children, orthodontic patients, and older adults. Nonetheless, study heterogeneity, variations in protocols, and concerns regarding fluorosis and possible neurodevelopmental effects highlight persistent uncertainties. Comparative analyses reveal trade-offs between efficacy and acceptance, for example, the high caries-arrest rate of silver diamine fluoride compared with its esthetic drawback. Emerging alternatives such as nano-hydroxyapatite, fluoride-containing bioactive glass, and probiotic-based approaches are promising but currently supported by limited clinical data. Conclusions: Fluoride remains central to caries prevention, yet its optimal use requires balancing benefits against risks, addressing cultural and socioeconomic barriers, and tailoring strategies to individual and community contexts. This narrative synthesis underscores the need for well-designed multicenter randomized controlled trials, longitudinal studies to refine safe exposure thresholds, evaluations of novel biomaterials and delivery systems, and the incorporation of patient-reported outcomes to guide future evidence-based policies and clinical practices. Full article

(This article belongs to the Special Issue Oral Healthcare: Diagnosis, Prevention and Treatment—2nd Edition)

8 pages, 196 KB

Open AccessCase Report

A Novel Presentation of Euglycemic Diabetic Ketoacidosis Associated with SGLT2 Inhibitor and Weekly GLP-1 Agonist: Case Report

by Young Sang Lyu

Healthcare 2025, 13(17), 2245; https://doi.org/10.3390/healthcare13172245 - 8 Sep 2025

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Abstract

Background: Sodium–glucose cotransporter-2 (SGLT2) inhibitors are widely used to manage type 2 diabetes mellitus (T2DM) because of their glucose-lowering and cardioprotective effects. However, euglycemic diabetic ketoacidosis (euDKA) is an uncommon but serious adverse event. EuDKA is characterized by metabolic acidosis and ketosis with [...] Read more.

Background: Sodium–glucose cotransporter-2 (SGLT2) inhibitors are widely used to manage type 2 diabetes mellitus (T2DM) because of their glucose-lowering and cardioprotective effects. However, euglycemic diabetic ketoacidosis (euDKA) is an uncommon but serious adverse event. EuDKA is characterized by metabolic acidosis and ketosis with only mild-to-moderate hyperglycemia, making diagnosis challenging. The risk of this interaction may be increased with the concurrent use of glucagon-like peptide-1 receptor agonists (GLP-1RAs), particularly during periods of reduced caloric intake or the presence of gastrointestinal symptoms. Case: A 38-year-old woman with newly diagnosed T2DM presented with five days of fatigue, poor oral intake, nausea, and vomiting. She had recently initiated semaglutide (GLP-1RA) for weight loss and practiced prolonged intermittent fasting. One week prior, she had started metformin and enavogliflozin, a selective SGLT2 inhibitor. Laboratory results showed a glucose level of 137 mg/dL, urine ketones (+++), lactate level of 4.87 mg/dL, HbA1c of 9.3%, C-peptide of 0.88 ng/mL, and high anion gap metabolic acidosis. She was diagnosed with euDKA and treated with IV fluids, insulin infusion, dextrose, and potassium supplementation. Her symptoms resolved, and she was discharged in a stable condition. Conclusion: This case highlights the importance of recognizing euDKA in patients using SGLT2 inhibitors and GLP-1RAs, particularly those with fasting or gastrointestinal symptoms. Clinicians should suspect euDKA even without significant hyperglycemia to enable prompt diagnosis and management, thereby preventing complications. Full article

13 pages, 324 KB

Open AccessReview

Acute and Chronic Immunological Responses to Different Exercise Modalities: A Narrative Review

by Ebru Sever, Sıla Yılmaz and Mitat Koz

Healthcare 2025, 13(17), 2244; https://doi.org/10.3390/healthcare13172244 - 8 Sep 2025

Viewed by 263

Abstract

The relationship between exercise and immune function has been widely studied, yet findings remain inconsistent regarding how different exercise modalities and intensities influence acute and chronic immunological responses. Previous reviews have often focused on single exercise types or limited outcomes, leaving a gap [...] Read more.

The relationship between exercise and immune function has been widely studied, yet findings remain inconsistent regarding how different exercise modalities and intensities influence acute and chronic immunological responses. Previous reviews have often focused on single exercise types or limited outcomes, leaving a gap for an integrated synthesis. This narrative review aims to address this gap by summarizing and comparing immunological effects across aerobic exercise, resistance training, high-intensity interval training (HIIT), blood flow restriction (BFR), isometric exercise, mind–body interventions, and hypoxic training. A structured narrative approach was adopted. Literature published between January 2000 and December 2024 was searched in PubMed, Scopus, and Web of Science. Experimental and observational studies on humans and animal models were included, with study selection and data extraction performed by two reviewers. Findings were synthesized thematically by exercise modality to capture both acute and chronic immune responses. Twenty-four eligible studies were identified. Aerobic and mind–body exercises consistently demonstrated anti-inflammatory and immunoprotective effects, including increased IL-10 production, improved T cell profiles, and reduced inflammatory markers. Isometric training showed favorable modulation of cytokines and T cell balance, while resistance training evidence was limited but suggested cortisol-lowering benefits. HIIT, BFR, and hypoxic exercise produced mixed results, often combining transient pro-inflammatory responses with immunological benefits. Acute and chronic immunological responses to exercise are highly modality- and intensity-dependent. Aerobic and mind–body interventions provide the most consistent benefits, whereas HIIT, BFR, and hypoxic training show variable effects. Further high-quality trials are needed to clarify mechanisms and guide exercise-based immune recommendations. Full article

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9 pages, 380 KB

Open AccessArticle

The Economic Impact of Premarital Screening (PMS) of Sickle Cell Anemia on the Saudi Health System: A Cost Analysis Study

by Amal F. Alotaibi, Rami A. Almalki, Mona Y. Alsheikh, Ghufran O. Omran, Hana A. Althobaiti and Wejdan S. AlQurashi

Healthcare 2025, 13(17), 2243; https://doi.org/10.3390/healthcare13172243 - 8 Sep 2025

Viewed by 323

Abstract

Background: In Saudi Arabia, the government has implemented compulsory premarital screening and consultations for high-risk and positive sickle cell results (traits = AS gene and disease = SS gene). However, despite these measures being in place since 2004, there are still cases of [...] Read more.

Background: In Saudi Arabia, the government has implemented compulsory premarital screening and consultations for high-risk and positive sickle cell results (traits = AS gene and disease = SS gene). However, despite these measures being in place since 2004, there are still cases of children being born with sickle cell disease. This study aims to evaluate the costs associated with the government’s mandatory premarital screening for sickle cell anemia, compare these expenses with those incurred due to high-risk marriages and analyze the government’s healthcare spending on sickle cell anemia management. Method: A decision tree model was conceptualized for the purpose of this study to identify the possible paths from the premarital screening (PMS) procedure. A total of 300,000 cases were processed through this decision tree model. Results: The annual management costs for children with the probability of having sickle cell disease are estimated to be USD 10,746,450 in the screening arm and USD 40,488,000 in the no-screening arm. These costs vary depending on the genetic combination of the parents. For individuals with the SS/SS gene combination, the estimated cost is USD 8,137,800 per year. When parents have the SS/AS gene combination, the estimated cost is USD 2,071,950 annually. For those with the sickle cell trait combination (AS/AS), the cost is estimated to be USD 536,700 per year. A direct comparison shows a modeled PMS incremental cost is estimated at USD 29,741,550, which is approximately a 73% reduction in healthcare costs. Conclusions: The premarital screening for sickle cell disease is not only cost-saving but also shows the potential for significantly reducing healthcare spending related to sickle cell disease in the future. Full article

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12 pages, 212 KB

Open AccessArticle

Factors Influencing Depression Among Female Professional Caregivers as per Employment Type (Full-Time vs. Part-Time)

by Ji-Hyun Moon and Hye-Sun Jung

Healthcare 2025, 13(17), 2242; https://doi.org/10.3390/healthcare13172242 - 8 Sep 2025

Viewed by 249

Abstract

Background/Objectives: South Korea is rapidly transitioning into a super-aged society, increasing the importance of care services to ensure the health and quality of life of older adults. Although the number of professional caregivers has steadily grown, these workers face a high risk of [...] Read more.

Background/Objectives: South Korea is rapidly transitioning into a super-aged society, increasing the importance of care services to ensure the health and quality of life of older adults. Although the number of professional caregivers has steadily grown, these workers face a high risk of depression due to the emotional labor inherent to their roles. This study aimed to analyze factors influencing depression among female professional caregivers by employment type (full-time and part-time) and to explore policy and practical intervention strategies to promote their mental health. Methods: Using data from the Korea Occupational Safety and Health Agency, we selected 223 professional caregivers with at least 1 year of work experience. After excluding insincere responses and male participants, 217 participants were included in the final analysis: 121 full-time and 96 part-time professional caregivers. Results: We found that full-time workers experienced higher levels of depression when they lacked access to health and safety education and could not use paid leave. Part-time workers experienced high levels of depression when engaging in physical activity <3 days per week and when exposed to violence. Conclusions: Based on these findings, the study recommends regular and systematic health and safety education, the establishment of substitute worker support to facilitate paid leave use, promotion of physical activity through education and community programs, regular violence prevention education, and comprehensive support systems for victims. This study is significant in empirically identifying depression risk factors by employment type among female professional caregivers. Future research should include male professional caregivers and employ more advanced measurement tools and longitudinal designs. Full article

17 pages, 607 KB

Open AccessSystematic Review

The Effectiveness of Using Autologous Fat in Temporomandibular Joint Ankylosis Treatment with Interposition Arthroplasty Method: A Systematic Literature Review

by Gerda Kilinskaite, Nida Kilinskaite and Marijus Leketas

Healthcare 2025, 13(17), 2241; https://doi.org/10.3390/healthcare13172241 - 8 Sep 2025

Viewed by 252

Abstract

Relevance of the problem and aim of the work: Ankylosis of the temporomandibular joint (TMJ) affects physical, psychological, and social well-being and quality of life. One of the most frequently used surgical interventions for the treatment of temporomandibular joint ankylosis is interpositional [...] Read more.

Relevance of the problem and aim of the work: Ankylosis of the temporomandibular joint (TMJ) affects physical, psychological, and social well-being and quality of life. One of the most frequently used surgical interventions for the treatment of temporomandibular joint ankylosis is interpositional arthroplasty, particularly in cases where joint preservation is feasible, with different autologous fats: dermis fat, buccal fat pad, and full thickness skin-subcutaneous fat. The aim of the work was to evaluate the efficiency of using different autologous fats in temporomandibular joint ankylosis treatment with interposition arthroplasty method. Materials and Methods: This systematic literature review was conducted according to PRISMA guidelines and registered in the PROSPERO database (CRD420251038325). A comprehensive search was performed in PubMed, the Cochrane Library, and ScienceDirect databases using combinations of keywords: (temporomandibular joint disorders OR temporomandibular joint) AND (adipose tissue or autologous) AND (ankylosis OR arthroplasty). Inclusion criteria were clinical studies conducted on human subjects, written in English, that evaluated the use of autologous fat in interpositional arthroplasty for TMJ ankylosis. The main outcome measures included postoperative maximum mouth opening (MMO), pain intensity, and relative fat volume contraction. Risk of bias was assessed using the Cochrane RoB 2 tool for randomized controlled trials and the Newcastle–Ottawa Scale for cohort studies. Most included studies were of moderate to high quality. Results: A total of 20 publications were selected, including a total of 369 patients. In a qualitative analysis, the best results for maximal opening of mouth (MOM) at 3, 6, 12, and more than 12 months were obtained with dermal fat. After 3 months, the MOM was 40.0 ± 2.7 mm, after 6 months—40.80 ± 4.26 mm, after 12 months—41.9 ± 4.0 mm, after more than 12 months—43.5 mm. The lowest pain intensity was observed using dermal fat taken from the iliac crest region. The rate of volumetric fat shrinkage was greater using buccal fat pad than dermis fat. Conclusions: The most commonly used types of autologous fat in interposition arthroplasty in ankylosis are the following: dermal fat from the abdominal region (iliac crest, subumbilical area, groin), buccal fat pad and full-thickness subcutaneous fat. The best results after the surgical treatment of TMJ ankylosis with interposition arthroplasty are obtained using dermis fat. Full article

(This article belongs to the Special Issue Novel Therapeutic and Diagnostic Strategies for Oral Diseases)

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13 pages, 513 KB

Open AccessArticle

Clinical and Sleep Characteristics and the Effect of CPAP Treatment on Obese Patients with Obstructive Sleep Apnea and Asthma—A Retrospective Study

by Konstantina Chadia, Kostas Archontogeorgis, Fotios Drakopanagiotakis, Konstantinos Bonelis, Stavros Anevlavis and Paschalis Steiropoulos

Healthcare 2025, 13(17), 2240; https://doi.org/10.3390/healthcare13172240 - 8 Sep 2025

Viewed by 328

Abstract

Introduction: Patients with obstructive sleep apnea (OSA) and asthma share common symptoms and risk factors. Aim: The aim of this study is to evaluate the clinical characteristics of patients with OSA and asthma and assess the impact of CPAP treatment on asthma control [...] Read more.

Introduction: Patients with obstructive sleep apnea (OSA) and asthma share common symptoms and risk factors. Aim: The aim of this study is to evaluate the clinical characteristics of patients with OSA and asthma and assess the impact of CPAP treatment on asthma control and exacerbations. Methods: Consecutive patients diagnosed with concomitant OSA and asthma were enrolled in the study. Data on patients’ characteristics, respiratory function during wakefulness, and polysomnography were recorded. Additionally, asthma control and exacerbation history were assessed the year before and after initiation of CPAP therapy. Results: The cohort included 102 patients (53 men and 49 women; mean age 56.5 ± 12.8 years). The severity of OSA was classified as severe in 49%, moderate in 27.5%, and mild in 23.5% of patients. The most common comorbidities were arterial hypertension (66.7%) and dyslipidemia (52%). Before CPAP initiation, most patients (55.9%) had moderate asthma control (ACT score 17.4 ± 0.9). Following CPAP treatment, the ACT score was improved (p < 0.001) and asthma exacerbations were significantly reduced (p = 0.002). Moreover, the Asthma Control Test (ACT) score was negatively correlated with BMI (r = −0.209, p = 0.035), AHI (r = −0.426, p < 0.001), oxygen desaturation index (r = −0.466, p < 0.001), and percentage of sleep time with oxygen saturation <90% (T < 90%) (r = −0.228, p = 0.021). Also, patients who experienced exacerbations (44/102) had higher AHI (p = 0.022) and more severe nocturnal hypoxia (T < 90%, p = 0.016). Conclusions: Asthma control is associated with OSA severity and BMI, while CPAP therapy seems to improve asthma control and reduces exacerbations in patients with concomitant OSA and asthma. Full article

(This article belongs to the Special Issue Sleep Disorders Management in Primary Care—Second Edition)

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16 pages, 3662 KB

Open AccessArticle

Self-Assessed Quality of Life Is Differently Impacted Depending on Diagnostic Grouping in Otorhinolaryngology: An Observational Study

by Dragica Severinac, Ines Begović, Emili Dragaš, Goran Geber, Davor Vagić and Andro Košec

Healthcare 2025, 13(17), 2239; https://doi.org/10.3390/healthcare13172239 - 8 Sep 2025

Viewed by 228

Abstract

Background and Objectives: Quality of life is significantly impacted by patients’ diagnosis perceptions, and self-assessment of quality of life is increasingly used in medicine. With this study, we aim to provide an overview of the differences in self-assessed quality of life among [...] Read more.

Background and Objectives: Quality of life is significantly impacted by patients’ diagnosis perceptions, and self-assessment of quality of life is increasingly used in medicine. With this study, we aim to provide an overview of the differences in self-assessed quality of life among patients in different diagnostic categories in otorhinolaryngology, focusing on physical health, physical pain, and social and emotional well-being. We hypothesize that these differences are substantial and can further improve patient care. Methods: The research was carried out from 1 May to 30 June 2024 with 127 otorhinolaryngology patients scheduled for a follow-up appointment at an otorhinolaryngology clinic. The 36-Item Short Form Health Survey, adequately completed by 114 patients, was used to determine the differences in self-reported quality of life between patients with different otorhinolaryngological diagnoses, classified by the International Classification of Diseases. Results: The results showed significant differences in the self-assessed quality of life for patients with different otorhinolaryngology diagnoses. Patients with oncological diagnoses had lower scores for emotional (p ≤ 0.001) and social functioning (p ≤ 0.038) compared with patients with other diagnoses but scored similarly to patients with chronic inflammation of the nose and patients with impaired communication due to ear or voice diseases. Conclusions: Self-assessment of quality of life is significantly different across diagnostic categories in otorhinolaryngology. These findings underscore the necessity of tailoring healthcare communication strategies to the specific needs of individual patients, addressing not only their physical but also emotional well-being. Full article

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11 pages, 1556 KB

Open AccessArticle

A Comparison Between Physical Methods Based on Mechanical Action and Pharmacotherapy in the Treatment of Discogenic Low Back Pain

by Julia Pingot, Michał Słupiński, Adam Lipski and Marta Woldańska-Okońska

Healthcare 2025, 13(17), 2238; https://doi.org/10.3390/healthcare13172238 - 8 Sep 2025

Viewed by 247

Abstract

Background/Objectives: Back pain affects a large number of people and, therefore, represents a significant financial burden for the state. In most cases, it can be treated conservatively. The aim of this study is to evaluate and compare the effects of multiple impulse [...] Read more.

Background/Objectives: Back pain affects a large number of people and, therefore, represents a significant financial burden for the state. In most cases, it can be treated conservatively. The aim of this study is to evaluate and compare the effects of multiple impulse therapy (MIT), the McKenzie method, axial traction using the Saunders lumbar lift, and NSAID pharmacotherapy in patients with discogenic low back pain (DLBP). Methods: All patients completed a subjective evaluation of pain, both before and immediately after treatment, providing values on the Laitinen and VAS scales. The Schober test was performed in all groups. Pain and mobility were also assessed 30 days after the completion of treatment. Results: In all groups of patients, a significant improvement was obtained both at the end of treatment and 30 days after the applied therapies. On the Laitinen scale, the best results were obtained with McKenzie therapy and were similar with Saunders traction. On the VAS scale, the best results were observed in the group of patients treated with multiple impulse therapy and according to the Schober test. Conclusions: Multiple impulse therapy functions as a valuable modality for pain control for treating patients with discogenic low back pain compared to McKenzie MDT and Saunders traction. MIT is well-tolerated by patients, completely safe, and non-invasive. Physiokinetic methods such as Saunders’ traction, McKenzie, and MIT showed greater analgesic efficacy when compared to drug treatment in patients with discogenic low back pain. Full article

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14 pages, 972 KB

Open AccessArticle

Determinants of Family Empowerment and Complementary Feeding Quality: Evidence from a Transcultural Care Framework

by Bayu Prabowo, Ratna Wardani, Agusta Dian and Suwarto Suwarto

Healthcare 2025, 13(17), 2237; https://doi.org/10.3390/healthcare13172237 - 8 Sep 2025

Viewed by 381

Abstract

Background: Stunting remains a major public health issue globally and in Indonesia, often linked to inadequate complementary feeding, cultural practices, and limited family empowerment. Objective: This study aimed to develop and evaluate a family empowerment model based on transcultural care theory to improve [...] Read more.

Background: Stunting remains a major public health issue globally and in Indonesia, often linked to inadequate complementary feeding, cultural practices, and limited family empowerment. Objective: This study aimed to develop and evaluate a family empowerment model based on transcultural care theory to improve quality and prevent stunting among children aged 6–24 months. Methods: A cross-sectional explanatory survey was conducted among 324 mother–child pairs from 11 primary healthcare centers in Kediri, East Java. Data were collected using a validated questionnaire covering demographic, educational, technological, economic, and cultural factors, as well as family empowerment and quality. Structural Equation Modeling with Partial Least Squares (SEM-PLS) was applied for hypothesis testing and model development. Results: The model showed moderate explanatory power (R² = 0.223 for family empowerment; R² = 0.115 for complementary feeding quality). Demographic, educational, technological, economic, and cultural factors significantly influenced family empowerment (p < 0.05), which in turn had a strong positive effect on quality (β = 0.340, p < 0.001). Family empowerment mediated the relationship between these factors and quality. Key contributors included knowledge, technology access, income level, and cultural practices. Conclusions: The proposed transcultural care-based family empowerment model effectively improves quality. Strengthening health education, supporting community health volunteers, and integrating culturally sensitive practices, such as encouraging paternal involvement and shared meals, should be prioritized in stunting prevention programs. The model may be adapted for use in similar community settings to enhance program effectiveness. Full article

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13 pages, 728 KB

Open AccessArticle

Comparison of Two Low-Dose Regimens of Intravenous Fentanyl for Pain Relief During Labor: A Double-Blind Randomized Controlled Trial

by Veeraphol Srinil, Panjai Inphum and Sukanya Srinil

Healthcare 2025, 13(17), 2236; https://doi.org/10.3390/healthcare13172236 - 7 Sep 2025

Viewed by 822

Abstract

Background: Concerns exist regarding the lowest effective dose of opioids in opioid-naïve pregnancies. This study aimed to compare the effectiveness of 25 µg vs. 50 µg fentanyl in relieving labor pain. Methods: In total, 122 term-singleton pregnant females, who planned vaginal delivery, were [...] Read more.

Background: Concerns exist regarding the lowest effective dose of opioids in opioid-naïve pregnancies. This study aimed to compare the effectiveness of 25 µg vs. 50 µg fentanyl in relieving labor pain. Methods: In total, 122 term-singleton pregnant females, who planned vaginal delivery, were randomized to receive 25 µg or 50 µg intravenous fentanyl, followed by hourly doses—as needed—for labor pain relief. The primary outcome was the comparison of pain score reduction 30 min after treatment between these regimens. Secondary outcomes included maternal and neonatal safety, total fentanyl dose administered, maternal satisfaction with the fentanyl dosing regimen, and breastfeeding, which were analyzed using appropriate statistical tests. Results: Within-group analysis revealed significant pain score reduction 30 min after fentanyl injection: −1.57 (95% confidence interval, CI −2.1 to −1.1, p < 0.001) and −1.69 (95% CI −2.2 to −1.2, p < 0.001) for 25 µg and 50 µg fentanyl groups, respectively. No significant differences in the pain reduction were observed in between-group comparisons (0.3, 95% CI −0.6 to 1.2, p > 0.999), including secondary maternal and neonatal outcomes. Total fentanyl dose was significantly lower in the 25 µg group compared with the 50 µg group (32.8 ± 13.3 vs. 60.2 ± 22.1, p < 0.001). Conclusions: A 25 µg intravenous fentanyl dose can reduce VAS score, used for evaluating labor pain 30 min after treatment, and is comparable to a 50 µg intravenous fentanyl dose. Given the efficacy of the reduced dosage of fentanyl, this study suggests using 25 µg intravenous fentanyl as an alternative initial dosing for labor pain relief. Full article

(This article belongs to the Section Pain Management)

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14 pages, 624 KB

Open AccessArticle

Socio-Demographic Factors Linked to Psychological Well-Being in Dementia Caregivers

by Liviu Florian Tatomirescu, Cristiana Susana Glavce, Gabriel Ioan Prada, Adriana Borosanu and Suzana Turcu

Healthcare 2025, 13(17), 2235; https://doi.org/10.3390/healthcare13172235 - 7 Sep 2025

Viewed by 315

Abstract

Background: Caregivers of individuals with cognitive impairment face heightened emotional and psychological burdens, yet the interaction between caregiver well-being, patient characteristics, and socio-demographic factors still requires investigation. This study aimed to examine the psychological well-being of family caregivers in an urban Romanian context, [...] Read more.

Background: Caregivers of individuals with cognitive impairment face heightened emotional and psychological burdens, yet the interaction between caregiver well-being, patient characteristics, and socio-demographic factors still requires investigation. This study aimed to examine the psychological well-being of family caregivers in an urban Romanian context, focusing on the role of depressive and anxiety symptoms, education, and care-recipient cognition function. Methods: A cross-sectional study was conducted among family caregivers recruited from a neurology-psychiatry service in Bucharest. Caregivers completed Ryff’s Psychological Well-Being Scales, the Patient Health Questionnaire-9 (PHQ-9), and the COVI Scale. Cognitive status of care recipients was obtained from medical records (Mini-Mental State Examination, MMSE). Descriptive statistics, correlation analyses, and separate linear regression models were performed for each well-being dimension. Results: Caregivers reported moderate to high well-being scores, with Environmental Mastery highest (M = 38.01, SD = 8.70) and Purpose in Life lowest (M = 33.14, SD = 6.72). Depression scores averaged 18.49 (SD = 6.55), indicating moderate depressive symptoms, and anxiety scores averaged 12.14 (SD = 2.23), consistent with severe anxiety. Cognitive impairment in care recipients was marked (MMSE M = 11.47, SD = 6.99). Bivariate analyses showed that lower MMSE scores were associated with higher caregiver anxiety (ρ = −0.287, p = 0.014). Regression models (R² = 0.08–0.25) indicated that higher education was positively associated with autonomy, personal growth, positive relations, and environmental mastery, whereas older age and female gender were linked to lower well-being in several domains. Depressive symptoms were unexpectedly associated with higher autonomy and self-acceptance. Conclusions: Caregiver psychological well-being was modestly associated with depressive symptoms, education, gender, and age, while care-recipient cognitive status showed only weak links to anxiety. Education emerged as a consistent protective factor, whereas female gender and older age were associated with lower well-being. Although the Bonferroni correction eliminated significance in separate models, a complementary multivariate multiple regression confirmed global effects of education, caregiver gender, and depression across well-being domains. These findings emphasize the need for systematic psychological support for caregivers and call for larger, longitudinal studies to clarify causal mechanisms and additional protective factors. Full article

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18 pages, 641 KB

Open AccessReview

A Scoping Review of the Use and Determinants of Social Media Among College Students

by Anam Fatima, Md. Sohail Akhter, Amar Kanekar, Sharmistha Roy, Rupam Mitra, Blessing Imade and Manoj Sharma

Healthcare 2025, 13(17), 2234; https://doi.org/10.3390/healthcare13172234 - 6 Sep 2025

Viewed by 737

Abstract

Background/Objectives: Use of social media among college students is ubiquitous. Excessive use of social media has been linked to distractions, reduced academic focus, and poor mental health outcomes such as anxiety and depression. The determinants of social media use among college students [...] Read more.

Background/Objectives: Use of social media among college students is ubiquitous. Excessive use of social media has been linked to distractions, reduced academic focus, and poor mental health outcomes such as anxiety and depression. The determinants of social media use among college students are not well understood. Hence, the purpose of this study was to conduct a scoping review on the behavioral, demographic, and psychosocial determinants, explore theoretical frameworks, and suggest evidence-based recommendations. Methods: This scoping review was conducted between January 2024 and May 2025 following PRISMA-ScR guidelines, using MEDLINE (PubMed), CINAHL, and ERIC databases. Peer-reviewed studies were included if they focused on college students (ages 18–30), investigated determinants of social media use, and met predefined inclusion criteria. Results: A total of 22 studies met the inclusion criteria. Studies were conducted in Bangladesh, Canada, China, Egypt, India, Nigeria, Pakistan, Saudi Arabia, Turkey, and the United States, and the majority used cross-sectional designs (n = 20). A consistent finding across the reviewed studies was the strong association between social media overuse and symptoms of depression, anxiety, stress, and emotional dysregulation. Very few theoretical frameworks for understanding the determinants of social media were used. According to the reviewed studies, factors such as fear of missing out, sleep quality, and prolonged social media use consistently emerged as significant predictors of adverse mental health outcomes (p < 0.05). Conclusions: In this study, problematic social media use (PSMU) was linked to increased mental health issues, suggesting that students frequently engage in social comparison and experience feelings of missing out (FoMO), which exacerbate emotional distress. There is a need for integrated approaches in addressing PSMU within educational environments, particularly in fostering healthier digital habits among students. There is a need to conduct more concerted research using longitudinal designs and contemporary theoretical frameworks in this area. Full article

(This article belongs to the Special Issue The Influence of Social Media on Health Behavior)

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11 pages, 307 KB

Open AccessArticle

Family Health History Completeness in Prenatal Genetic Counseling: An Exploratory Study at a Single University Hospital

by Tomoharu Tokutomi, Akiko Yoshida and Kunihiko Miura

Healthcare 2025, 13(17), 2233; https://doi.org/10.3390/healthcare13172233 - 6 Sep 2025

Viewed by 253

Abstract

Background: Family health history (FHH) is essential for genomic medicine and risk assessment, but its completeness in Japanese prenatal settings is poorly understood. Prior studies show that details such as cause of death (COD) and age at onset are often missing. To address [...] Read more.

Background: Family health history (FHH) is essential for genomic medicine and risk assessment, but its completeness in Japanese prenatal settings is poorly understood. Prior studies show that details such as cause of death (COD) and age at onset are often missing. To address this gap, we conducted a pilot observational exploratory study evaluating FHH completeness in a Japanese prenatal genetic counseling setting. Methods: We analyzed data from 24 participants (12 couples) who underwent prenatal genetic counseling at a university hospital, most of whom were of advanced maternal age and had undergone non-invasive prenatal testing (NIPT). FHH was collected using a structured form at the first visit and revised at the second visit. Completeness was assessed for four items: medical history, age at death, COD, and age at disease onset. Associations with participant characteristics were also explored. Results: Disease history was most complete, while COD and age at onset were frequently missing. Age at death was more complete than COD, indicating that information on deceased relatives or timelines was harder to obtain. Participants with personal or family medical conditions tended to provide more complete FHH. The structured form and opportunity for revision likely enhanced completeness. Conclusions: This pilot study shows that COD and age at onset are the least complete components of FHH in Japanese prenatal counseling. The small sample size and single-hospital setting limit the generalizability of the findings, but they suggest that structured prompts and preparation before visits may improve FHH completeness and enhance risk assessment in clinical practice. Full article

(This article belongs to the Section Family Medicine)

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15 pages, 281 KB

Open AccessArticle

The Role of Physical Activity in Moderating Psychopathological Symptoms and Quality of Life Among Adult Cancer Survivors: A Cross-Sectional Study

by Andreia Pereira Tavares, Paula Saraiva Carvalho and Ana Torres

Healthcare 2025, 13(17), 2232; https://doi.org/10.3390/healthcare13172232 - 6 Sep 2025

Viewed by 320

Abstract

Background/Objectives: Several studies indicate that physical activity is both safe and beneficial for most cancer survivors—before, during and after treatment. These benefits include improved mental health and a subsequent positive impact on quality of life. This study aimed to (1) assess the [...] Read more.

Background/Objectives: Several studies indicate that physical activity is both safe and beneficial for most cancer survivors—before, during and after treatment. These benefits include improved mental health and a subsequent positive impact on quality of life. This study aimed to (1) assess the mental health of cancer survivors in terms of depression and anxiety, (2) analyze levels of physical activity within the sample, and (3) explore the relationship between psychopathological symptoms, physical activity, and perceived quality of life. Methods: This is a cross-sectional study of 55 cancer survivors, with a mean age of 62.27 ± 11.91, living in inland of Portugal and not undergoing palliative care. Data were collected using a sociodemographic, clinical and physical activity questionnaire, the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder scale (GAD-7), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30), and the Godin Leisure-Time Exercise Questionnaire (GLTEQ). Data was analyzed using descriptive statistics, Cronbach’s coefficient to assess the internal consistency, Spearman’s correlation, and multiple linear regression. Results: The results revealed significant associations between physical activity, psychopathological symptomatology, and quality of life. Specifically, the interaction between depression and physical activity had a negative impact on quality of life (B = −0.181; 95% CI −0.291 to −0.070; p = 0.002), whereas the interaction between anxiety and physical activity showed a positive effect (B = 0.165; 95% CI 0.037 to 0.293; p = 0.013). Conclusions: Physical activity enhances the quality of life of cancer survivors and moderates the negative impact of psychopathological symptoms. This highlights the importance of promoting healthy lifestyles and empowering healthcare professionals to recommend supervised physical activity as part of integrated and personalized care. Further studies should explore the relationship between other psychopathological symptoms, such as somatization, and physical activity in relation to quality of life. Full article

(This article belongs to the Special Issue Quality of Life and Health Promotion in Chronic Illness or Critical Medical Conditions: Implications for Integrated Health Care Delivery)

16 pages, 280 KB

Open AccessArticle

Pharmacists’ Knowledge, Attitudes, and Practices Toward CGRP Inhibitors in Migraine Management: A Cross-Sectional Study

by Anwar Seraj Alfahmi, Lana Abdullah Alqarni, Lura Abdulrahman Alkhatabi and Fahad S. Alshehri

Healthcare 2025, 13(17), 2231; https://doi.org/10.3390/healthcare13172231 - 6 Sep 2025

Viewed by 460

Abstract

Background: Calcitonin gene-related peptide (CGRP) inhibitors represent a novel class of medications for the prevention and treatment of migraines. Given their expanding role in migraine management, pharmacists are increasingly expected to be knowledgeable about their use. However, limited data exist regarding pharmacists’ awareness [...] Read more.

Background: Calcitonin gene-related peptide (CGRP) inhibitors represent a novel class of medications for the prevention and treatment of migraines. Given their expanding role in migraine management, pharmacists are increasingly expected to be knowledgeable about their use. However, limited data exist regarding pharmacists’ awareness and engagement with CGRP inhibitors in Saudi Arabia. Objective: To assess the knowledge, attitudes, and practices (KAP) of pharmacists in Saudi Arabia toward CGRP inhibitors for migraine management and identify areas for improvement. Methods: A cross-sectional survey was conducted from October 2024 to January 2025 among licensed pharmacists in Saudi Arabia using an online questionnaire distributed via social media platforms, pharmacy networks, and in-person outreach. The survey consisted of 26 questions across four sections: demographics, knowledge, attitudes, and practices. Descriptive statistics and regression analyses were performed to evaluate the data using SPSS version 29. Results: A total of 419 pharmacists participated (response rate: 98.8%). Most practiced in community pharmacies (90.5%) and the Western region (48.2%). Overall, pharmacists demonstrated moderate knowledge (54.7%), attitudes (55.6%), and practices (49.9%) toward CGRP inhibitors in migraine management. While 54.7% were familiar with CGRP inhibitors, only 37.2% were aware of relevant clinical guidelines, and 32.5% recognized adverse effects such as hypertension. Regarding attitudes, 32.2% believed CGRP inhibitors were superior to conventional therapies, but over 50% expressed neutral views across key items. Practice patterns revealed limited engagement, with more than half reporting neutral responses toward patient education, interdisciplinary collaboration, and safety monitoring. Conclusions: The study highlights moderate awareness but suboptimal application of CGRP inhibitor knowledge among pharmacists. Notable gaps exist in guideline familiarity, patient education, and interdisciplinary collaboration. Targeted training and inclusion of CGRP inhibitors in pharmacy curricula and continuing education programs are warranted to support effective migraine management. Full article

(This article belongs to the Topic Optimization of Drug Utilization and Medication Adherence)

30 pages, 2065 KB

Open AccessReview

Embodied Mindfulness Through Movement: A Scoping Review of Dance-Based Interventions for Mental Well-Being in Recreational Populations

by Aglaia Zafeiroudi, Ioannis Tsartsapakis, Ioannis Trigonis, Olga Kouli, Dimitrios Goulimaris and Charilaos Kouthouris

Healthcare 2025, 13(17), 2230; https://doi.org/10.3390/healthcare13172230 - 5 Sep 2025

Viewed by 309

Abstract

Background/Objectives: Mindfulness has expanded from seated meditation to include embodied practices emphasizing somatic awareness and emotional regulation. Dance offers a creative, accessible pathway to mindfulness, especially in non-clinical settings where movement-based approaches may better support self-regulation, interoception, and well-being. This scoping review investigated [...] Read more.

Background/Objectives: Mindfulness has expanded from seated meditation to include embodied practices emphasizing somatic awareness and emotional regulation. Dance offers a creative, accessible pathway to mindfulness, especially in non-clinical settings where movement-based approaches may better support self-regulation, interoception, and well-being. This scoping review investigated empirical studies on dance-based mindfulness interventions targeting non-clinical, amateur and recreational populations. Methods: Six databases (PubMed, PsycINFO, Scopus, ERIC, Web of Science, and Google Scholar) were searched for peer-reviewed studies published between 2010 and 2025. Eligible studies combined dance with mindfulness and somatic movement practices and were conducted with non-professional participants of all ages in non-clinical settings. Study selection, data extraction, and appraisal followed PRISMA-ScR guidelines. Results: Ten empirical studies met the inclusion criteria, spanning diverse populations from primary school children to older adults. Interventions included Dance/Movement Therapy, ballet with yoga, Sufi-inspired group dance, and school- or community-based mindful movement programs. Reported outcomes included improvements in body awareness, emotional regulation, stress reduction, self-compassion, social connection, and overall well-being. A thematic synthesis identified five domains: (1) psychological and emotional outcomes, (2) embodiment and self-compassion, (3) relational and social benefits, (4) feasibility and acceptability, and (5) sustained and preventive effects. Conclusions: Dance-based mindfulness interventions in recreational contexts show promising psychosomatic and emotional benefits. Although the current empirical base is limited and methodologically diverse, this scoping review provides a necessary foundation for understanding this emerging field. There remains a strong need for interventions that are theoretically grounded, culturally sensitive, and pedagogically integrated, particularly within classroom-based dance educational contexts. Full article

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19 pages, 386 KB

Open AccessReview

Associations Between Common Hip and Knee Osteoarthritis Treatments and All-Cause Mortality

by John W. Orchard, L. Edward Tutt, Anna Hines and Jessica J. Orchard

Healthcare 2025, 13(17), 2229; https://doi.org/10.3390/healthcare13172229 - 5 Sep 2025

Viewed by 425

Abstract

Background: Osteoarthritis has a large and growing burden in an ageing population. Controversy exists in current management, particularly regarding opioid use due to increasing negative effects. Clinicians need guidance on the individual mortality associations for common osteoarthritis treatments when compared to a control. [...] Read more.

Background: Osteoarthritis has a large and growing burden in an ageing population. Controversy exists in current management, particularly regarding opioid use due to increasing negative effects. Clinicians need guidance on the individual mortality associations for common osteoarthritis treatments when compared to a control. Aims: The aim is to undertake a structured narrative literature review comparing mortality associations for common osteoarthritis management options. Methods: A search strategy (Web of Science 23 September 2024) was performed to identify observational studies which reported all-cause mortality in a treatment group compared to a control. The control group could be either the general population or those with osteoarthritis who were treated with the following: NSAIDs (non-steroidal anti-inflammatory drugs), opioids, paracetamol, GLP-1 RAs (Glucagon-like peptide-1 receptor agonists), hip or knee arthroplasty, or exercise. Articles were screened by two authors, and each included article was assessed for adequate quality using the strengthening the reporting of observational studies in epidemiology (STROBE) framework. Results: Of 2362 studies retrieved, 39 cohort studies met the inclusion requirements. Exercise, compared to no or lower levels of exercise, had ten studies reporting substantially reduced all-cause mortality. GLP-1 RA agonists had two related studies showing all-cause mortality reduction up to 5 years. Mortality following joint arthroplasty followed a multi-phasic response. There was a short-term post-surgical increase in mortality. However, from 90 days post-surgery to 8–11 years, there were significant reductions in mortality. After 9–12 years post arthroplasty, mortality increased and became significantly higher. Opioids were associated with an increase in mortality in 6 out of 7 studies. Inconsistent trends were found for NSAIDs and paracetamol. Conclusions: Exercise and GLP-1 RA prescription are associated with reduced all-cause mortality. Arthroplasty was found to have survival benefit until 9–11 years post-operatively, whereafter mortality then increased. Opioids were found to consistently increase mortality when used for non-cancer pain at all time points. The other common osteoarthritis treatments assessed were not consistently associated with changes in mortality. Full article

(This article belongs to the Section Healthcare Quality, Patient Safety, and Self-care Management)

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16 pages, 918 KB

Open AccessArticle

Efficacy and Safety of Manual Therapy in Haemophilic Ankle Arthropathy: A Randomised Crossover Clinical Trial

by Carlos Truque-Díaz, Raúl Pérez-Llanes, Javier Meroño-Gallut, Rubén Cuesta-Barriuso and Elena Donoso-Úbeda

Healthcare 2025, 13(17), 2228; https://doi.org/10.3390/healthcare13172228 - 5 Sep 2025

Viewed by 357

Abstract

Background: Recurrent haemarthrosis leads to progressive and degenerative joint damage in patients with haemophilia from an early age. Haemophilic arthropathy is characterised by chronic pain, restricted range of motion, proprioceptive deficits, and structural alterations. The aim of this study was to evaluate the [...] Read more.

Background: Recurrent haemarthrosis leads to progressive and degenerative joint damage in patients with haemophilia from an early age. Haemophilic arthropathy is characterised by chronic pain, restricted range of motion, proprioceptive deficits, and structural alterations. The aim of this study was to evaluate the effectiveness of a manual therapy protocol in patients with haemophilic ankle arthropathy. Methods: A randomised, crossover, double-blind clinical trial was conducted. Thirteen patients with haemophilia were allocated to two sequences: A–B (intervention phase followed by placebo control) and B–A (placebo control followed by intervention). The intervention comprised joint mobilisation techniques, high-velocity low-amplitude manipulations, and myofascial release. In the placebo control condition, a simulated protocol was applied, consisting of intermittent contact and light pressure. Both conditions involved three physiotherapy sessions, delivered once weekly over three consecutive weeks. Outcome measures included functional capacity (2-Minute Walk Test), pain intensity (visual analogue scale), range of motion (goniometer), pressure pain threshold (algometer), joint status (Haemophilia Joint Health Score), kinesiophobia (Tampa Scale of Kinesiophobia), and postural stability (pressure platform). Following a four-week washout period, participants crossed over to the alternate condition. Results: No participants experienced ankle haemarthrosis or other adverse events during the intervention, confirming the safety of the protocol. Significant time*sequence interactions (p < 0.05) with high post hoc power (≥0.80) were observed for functional capacity, range of motion, and joint status. A significant sequence effect was also found for most clinical outcomes, with no evidence of a carry-over effect. Conclusions: This manual therapy protocol might be safe for patients with haemophilia. The physiotherapy intervention demonstrated improvements in functionality, range of motion, and joint status in individuals with haemophilic ankle arthropathy. Full article

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18 pages, 267 KB

Open AccessArticle

‘Making the System Work’: A Multi-Site Qualitative Study of Dietitians’ Use of iEMR to Support Nutrition Care Transitions for Older Adults with Malnutrition

by Kristin Gomes, Shelley Roberts, Ben Desbrow and Jack Bell

Healthcare 2025, 13(17), 2227; https://doi.org/10.3390/healthcare13172227 - 5 Sep 2025

Viewed by 378

Abstract

Background: Older adults with malnutrition (≥65 years) require coordinated nutrition care during hospital-to-home transitions. A key purpose of integrated electronic medical record (iEMR) systems is to support clinicians in ensuring continuity of care across settings, yet little is known about their use in [...] Read more.

Background: Older adults with malnutrition (≥65 years) require coordinated nutrition care during hospital-to-home transitions. A key purpose of integrated electronic medical record (iEMR) systems is to support clinicians in ensuring continuity of care across settings, yet little is known about their use in nutrition care discharge practices. This study explored how clinical dietitians use the iEMR to support nutrition care discharge practices for older adults with malnutrition and identified opportunities for optimisation to enhance care continuity. Methods: Semi-structured interviews were conducted with 16 clinical dietitians (11 frontline clinicians, 5 senior leaders) from 10 public hospitals across Queensland, Australia. Analysis combined deductive coding using the Consolidated Framework for Implementation Research 2.0 with inductive thematic analysis to identify system-level, organisational and behavioural influences on iEMR use and optimisation opportunities. Results: Four themes and ten subthemes were identified. System fragmentation, policy constraints and documentation burden limited dietitians’ ability to coordinate discharge care. Workarounds were common and reflected both practical adaptation and conditional trust in iEMR. Discharge practices were also shaped by local culture, professional norms and variable expectations for iEMR use. Despite these constraints, participants expressed aspirations for an optimised iEMR with embedded referral tools, real-time alerts and analytics to support improved service delivery. Conclusions: This study identified key factors influencing iEMR use by clinical dietitians to support nutrition care transitions for older adults with malnutrition. While current systems present significant challenges, optimising iEMR alongside organisational and policy enablers holds potential to strengthen nutrition care discharge practices and care continuity. Full article

(This article belongs to the Special Issue Nutrition in Patient Care)

16 pages, 635 KB

Open AccessArticle

The Impact of Nutritional Knowledge of Mothers on Their Children’s Nutritional Knowledge and Weight Status

by Mai Adil Ghabashi, Abrar M. Babateen, Alyaa M. Zagzoog and Abeer M. Aljaadi

Healthcare 2025, 13(17), 2226; https://doi.org/10.3390/healthcare13172226 - 5 Sep 2025

Viewed by 429

Abstract

Objectives: This cross-sectional study assessed the nutritional knowledge of Saudi mothers and their children. Then, it examined the association between the nutritional knowledge of mothers and the nutritional knowledge and weight status of their schoolchildren in Makkah City, Saudi Arabia. Methods: The mothers’ [...] Read more.

Objectives: This cross-sectional study assessed the nutritional knowledge of Saudi mothers and their children. Then, it examined the association between the nutritional knowledge of mothers and the nutritional knowledge and weight status of their schoolchildren in Makkah City, Saudi Arabia. Methods: The mothers’ nutritional knowledge was assessed using the validated Arabic version of the General Nutrition Knowledge Questionnaire (GNKQ). The children’s nutritional knowledge was assessed through an interviewer-administered questionnaire, and their weight status was determined based on their Body Mass Index (BMI) Z-score, which was calculated according to their anthropometric measurements. Results: One hundred children and sixty mothers were included in this study. Only 6.67% of the mothers had a high level of nutrition knowledge. A total of 54% of their children had low nutritional knowledge scores, and approximately 27% was classified as having excess weight. More than 40% of the children reported consuming fruits and vegetables 4–5 times/week, whereas 50% of the children consumed fast foods 1–3 times/week. Multiple linear regression analyses showed that higher nutritional knowledge scores among the children were significantly associated with higher mothers’ knowledge scores [(0.06 (95%CI: 0.0.03, 0.0.08)] and older age among these children [0.61 (95%CI: 0.44, 0.77)], as the older children had higher knowledge scores. The children’s nutritional knowledge, however, was not associated with the child’s sex, mothers’ age, or mothers’ education. The maternal knowledge scores were not associated with the child’s weight status. Conclusions: Given that the nutrition knowledge scores of Saudi mothers are significantly associated with those of their children, but not with their weight status, it can be concluded that nutrition knowledge alone may not be sufficient to address the overweight and obesity epidemic in Saudi Arabia. However, it remains a crucial component of multifaceted interventions that also enhance physical activity and promote behavior change to improve health outcomes and weight status in the Saudi population. Full article

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

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16 pages, 2020 KB

Open AccessArticle

Obesity and Occupational Disparities in Urban China: Evidence from a Large-Scale Cross-Sectional Study

by Guoxi Zhang, Huyang Zhang, Gordon G. Liu and Leiyu Shi

Healthcare 2025, 13(17), 2225; https://doi.org/10.3390/healthcare13172225 - 5 Sep 2025

Viewed by 393

Abstract

Background/Objectives: Obesity has become a global public health crisis, with China now ranking among the countries with the highest number of obese adults. Urban China faces a growing burden of obesity, but little is known about how obesity prevalence differs by occupation. [...] Read more.

Background/Objectives: Obesity has become a global public health crisis, with China now ranking among the countries with the highest number of obese adults. Urban China faces a growing burden of obesity, but little is known about how obesity prevalence differs by occupation. This study aimed to assess the prevalence of overweight and obesity in 2022 among urban adults in northern and southern China, and to examine disparities across occupational groups. Methods: This study utilized cross-sectional data from 2022 health examinations to calculate the prevalence of overweight and obesity in different occupations in cities of southern and northern China. A logistic regression model was applied to analyze association between occupational categories and obesity, controlling for confounding factors like age, gender and region. Results: A total of 1,427,978 participants in 2022 were included. The aggregate prevalence of overweight and obesity was 30.78% and 7.90%, respectively. After being adjusted by logistic regression, the study showed that the highest adjusted odds ratio of overweight was observed in the Real Estate Industry sector with AOR 1.17 (1.15, 1.19), while the lowest odds ratio occurred in the Mining Industry sector, which was 0.90 (0.80, 1.01). The highest adjusted odds ratio of the prevalence of obesity was associated with the Production and Supply of Electricity, Heat, Gas, and Water sector (AOR: 1.92 (1.78, 2.07)), whereas the lowest odds ratio was observed in the Scientific Research and Technical Services sector. After categorizing occupations into four broad groups, the Blue-Collar group had the highest adjusted odds ratio of the prevalence of overweight (AOR: 1.07 (1.06, 1.08)), whereas the Sales/Office group exhibited the highest odds ratio of the prevalence of obesity (AOR: 1.37 (1.35, 1.39)). Conclusions: The prevalence of overweight and obesity differed substantially across occupational groups especially for obesity. More detailed and occupation-specific BMI management policies should be released to reduce obesity-related health inequalities in urban China. Full article

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Open AccessArticle

Feasibility and Preliminary Efficacy of a Telerehabilitation Intervention for Diastasis Recti Abdominis—A Pilot Study

by Anastasia Skoura, Maria Antoniou, Nikolaos Thanatsis, Dimitra Tania Papanikolaou, George Tsirogiannis, Elena Drakonaki and Evdokia Billis

Healthcare 2025, 13(17), 2224; https://doi.org/10.3390/healthcare13172224 - 5 Sep 2025

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Abstract

Background: Diastasis recti abdominis (DRA) is a common postpartum condition typically managed with rehabilitation exercises. Given its high prevalence and postpartum barriers in attending in-person sessions, telerehabilitation may offer a feasible alternative. This small pilot study evaluates the preliminary effectiveness and user [...] Read more.

Background: Diastasis recti abdominis (DRA) is a common postpartum condition typically managed with rehabilitation exercises. Given its high prevalence and postpartum barriers in attending in-person sessions, telerehabilitation may offer a feasible alternative. This small pilot study evaluates the preliminary effectiveness and user satisfaction of a 12-week telerehabilitation exercise program for women with postpartum DRA. Methods: Parous women with DRA participated in a 12-week trunk stabilization program, including synchronous and asynchronous sessions, from April 2024 to May 2025. The primary outcome was satisfaction (Telehealth Usability Questionnaire—TUQ_Greek and two additional custom-made questions). Secondary outcomes included inter-recti distance (IRD), trunk muscle endurance tests, body image (BISS_Greek), and adherence to exercise. Results: Thirteen participants aged 37.54 ± 5.49 completed the pilot intervention. Satisfaction was high (TUQ_Greek = 6.28 ± 0.60), with 84.62% (11/13 subjects) rating telerehabilitation as very satisfactory. Statistically significant reductions in IRD were observed at 2 cm (large effect, d = 1.00; 95% CI [0.12 to 0.47]) and 5 cm (large effect, d = 0.81; 95% CI [0.08 to 0.58]) above the umbilicus (p < 0.05). Post-intervention, most trunk muscle endurance tests improved significantly (p < 0.05) at 4 and 12 weeks (large effect, η² = 0.44 to–0.56). Body image (BISS_Greek) also improved post-intervention (p < 0.05, medium to large effect, d = −0.73; 95% CI [(–1.75 to –0.16]). Mean adherence reached 71.37%. Conclusions: This small pilot supports the feasibility and acceptability of a telerehabilitation program as well as its effectiveness in improving key clinical outcomes. However, since this was a small pilot, generalizability might be limited by the small sample size and should be confirmed in larger studies. Full article

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Healthcare, Volume 13, Issue 17 (September-1 2025) – 174 articles

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