Healthcare

19 pages, 2671 KB

Open AccessArticle

Development and Performance of an Artificial Intelligence-Based Deep Learning Model Designed for Evaluating Dental Ergonomics

by Sanjeev B. Khanagar, Aram Alshehri, Farraj Albalawi, Sara Kalagi, Maryam A. Alghilan, Mohammed Awawdeh and Kiran Iyer

Healthcare 2025, 13(18), 2277; https://doi.org/10.3390/healthcare13182277 - 11 Sep 2025

Abstract

Background/Objectives: Dental professionals engage in a variety of dental procedures within a confined workspace that is often challenging to access and navigate. This environment frequently results in static, asymmetrical, and inappropriate postures, which can lead to muscular imbalances and cause pain or [...] Read more.

Background/Objectives: Dental professionals engage in a variety of dental procedures within a confined workspace that is often challenging to access and navigate. This environment frequently results in static, asymmetrical, and inappropriate postures, which can lead to muscular imbalances and cause pain or damage to the musculoskeletal system. Such issues can adversely affect the dental workforce, resulting in increased absenteeism, reduced productivity, disability, and premature retirement from the profession. Therefore, the objective of this study was to develop and evaluate the performance of an Artificial Intelligence (AI)-based deep learning model designed to assess dental ergonomics. Methods: An AI-based Dental Ergonomic Posture Assessment Model [SBK-DentErgo] was developed through the strategic integration of YOLOv11 and MediaPipe. Model training and validation were conducted using 500 photographs of dental professionals performing procedures on patients, captured from both frontal and sagittal planes. In the initial phase of the study, two calibrated evaluators assessed 50 photographs, demonstrating excellent agreement. In the subsequent phase, five dental specialists, along with the AI model, evaluated the same set of photographs, and the results were recorded. Results: AI-based model demonstrated excellent agreement with that of calibrated evaluators (Kappa = 0.922, p = 0.000). The reliability of AI-based scores was also consistent (ICC = 1.000, p = 0.000). Human evaluation of ergonomic posture exhibited very low sensitivity (20.5%) compared to AI, which showed very high sensitivity (97%). The specificity of human evaluation was also extremely low (9.1%) in contrast to AI (85.7%). The AI model (AUC = 0.917, 95% CI 0.762–1.000) could serve as the ‘gold standard’ in evaluating dental operator ergonomics. Conclusions: This AI model demonstrated exceptional performance in evaluating the working postures of dental professionals, surpassing experienced specialists in both sensitivity and specificity. The model provides real-time feedback, enabling dentists to conduct self-assessments and correct their posture immediately, thereby preventing postural issues. Full article

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18 pages, 1130 KB

Open AccessStudy Protocol

Origins and Previous Experiences from a Gender Perspective on the Perception of Pain in Nursing Students: Study Protocol

by Juan Manuel Pérez-Pozuelo, Almudena Crespo-Cañizares, Sonsoles Hernández-Iglesias, Nuria García-Magro, Ángel López-González, Victoria Lopezosa-Villajos, Miriam Hermida-Mota and Sagrario Gómez-Cantarino

Healthcare 2025, 13(18), 2276; https://doi.org/10.3390/healthcare13182276 - 11 Sep 2025

Abstract

Background: The International Association for the Study of Pain (IASP) conceptualizes pain as a subjective experience, influenced by biopsychosocial factors, strongly related to the person’s environment and previous experience. It is necessary to understand painful experiences from birth and their influence on the [...] Read more.

Background: The International Association for the Study of Pain (IASP) conceptualizes pain as a subjective experience, influenced by biopsychosocial factors, strongly related to the person’s environment and previous experience. It is necessary to understand painful experiences from birth and their influence on the self-perception of pain later in life. In addition, training competent health professionals to identify and treat pain becomes a priority. The main objective of the protocol is to describe the situations that influence pain perception. These influences are conceived from birth to adulthood, taking into account the gender perspective. Methods: This is a two-year exploratory mixed-methods educational intervention design, incorporating cross-sectional assessments at baseline. The research will be carried out in the academic community, including nursing students from two universities. The following will be carried out: (1) practical seminars (groups of 20–25) to increase future healthcare professionals’ awareness of pain-inducing procedures and critical thinking; (2) a peer-mentoring session, led by senior students, addressing pain research, its clinical impact, and strategies for improved pain management through theoretical and practical components; (3) supervised sessions, where students will learn and perform vital sign measurements (HR, SpO₂), algometry, and the Cold Pressor Test (CPT) to assess pain perception, threshold, and tolerance, practicing in pairs; (4) a gender-specific questionnaire to evaluate students’ perceptions of pain, fostering reflection on gender differences in pain experiences. Discussion: The aim is to enhance knowledge about pain in future health professionals to increase their skills in the approach to pain. Conclusions: This study aims to promote formal academic contact between higher education students, promoting comprehensive care in the management of pain at different stages of life. Full article

(This article belongs to the Section Pain Management)

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4 pages, 212 KB

Open AccessEditorial

Healthcare Reloaded: Announcing the New Aims and Scope of Healthcare

by Lorraine S. Evangelista

Healthcare 2025, 13(18), 2274; https://doi.org/10.3390/healthcare13182274 - 11 Sep 2025

Abstract

Healthcare (ISSN 2227-9032) [...] Full article

16 pages, 1851 KB

Open AccessArticle

Effectiveness of the Research Practice Ability Enhancement Program on Evidence-Based Practice Competencies in Clinical Nurses: A Non-Randomized Controlled Trial

by Sun-Ae Kim and Hye-Won Jeong

Healthcare 2025, 13(18), 2273; https://doi.org/10.3390/healthcare13182273 - 11 Sep 2025

Abstract

Background/Objectives: Evidence-based practice (EBP) remains limited among clinical nurses worldwide, with Korean healthcare settings facing challenges. This study examined the effectiveness of the research practice ability enhancement program (RPAEP) in strengthening evidence-based practice (EBP) competencies among clinical nurses who had completed master’s coursework [...] Read more.

Background/Objectives: Evidence-based practice (EBP) remains limited among clinical nurses worldwide, with Korean healthcare settings facing challenges. This study examined the effectiveness of the research practice ability enhancement program (RPAEP) in strengthening evidence-based practice (EBP) competencies among clinical nurses who had completed master’s coursework without a thesis. Methods: A non-randomized controlled trial was conducted at a tertiary hospital in Korea (June–December 2022). Thirty participants were assigned by convenience sampling to intervention (n = 15) or control (n = 15) groups. The intervention comprised 12 biweekly sessions. The primary outcome was research practice ability (RPA); the secondary outcomes were EBP beliefs (EBPBs), EBP Attitudes (EBPAs), and Nursing Professional Values (NPVs). Analyses employed Wilcoxon signed-rank and Mann–Whitney U tests. The qualitative evaluation used thematic analysis of focus group interviews (FGIs) (n = 12). Results: All participants completed the study. The intervention group showed significant improvements in RPA (within-group: Z = −1.96, p = 0.050, ES = 0.82; between-group: t = −2.39, p = 0.016, ES = 1.02) and EBPBs (t = −3.30, p = 0.005, ES = 0.87). NPVs showed significant between-group differences (t = 2.38, p = 0.024, ES = 0.87), while EBPAs remained unchanged. The FGIs revealed three major themes related to participation in the research practice ability enhancement program: “barriers to research practice,” “guidance for research practice,” and “enhancing research practice ability.” Conclusions: The RPAEP enhanced nurses’ EBP competencies despite the non-randomized design. However, single-site implementation and convenience sampling limit generalizability. Sustained EBP integration requires addressing individual and organizational barriers through comprehensive education with institutional commitment. Full article

(This article belongs to the Special Issue From Evidence-Based Practice to Knowledge Translation in Nursing Care)

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11 pages, 481 KB

Open AccessArticle

Comparing Insomnia and Perceived Stress in Online vs. Frontal Learning: Psychometric Evaluation in a Health Sciences Cohort

by Johanna Andrea Márton, Flóra Busa, Nóra Rozmann, Attila András Pandur, Melinda Petőné Csima and David Sipos

Healthcare 2025, 13(18), 2272; https://doi.org/10.3390/healthcare13182272 - 11 Sep 2025

Abstract

Background/Objectives: University students in health sciences are particularly vulnerable to poor sleep quality and elevated stress due to academic and clinical demands. This follow-up study aimed to compare sleep quality and perceived stress levels among health science students during online and frontal [...] Read more.

Background/Objectives: University students in health sciences are particularly vulnerable to poor sleep quality and elevated stress due to academic and clinical demands. This follow-up study aimed to compare sleep quality and perceived stress levels among health science students during online and frontal (in-person) education periods and to examine the influence of behavioral and demographic factors. Methods: A prospective, follow-up design was applied involving students from the University of Pécs, Faculty of Health Sciences, across nursing, radiography, laboratory analytics, paramedicine, and physiotherapy programs. Data were collected via anonymous online questionnaires during two intervals: February–March 2023 (online education) and April–May 2023 (frontal education). The Athens Insomnia Scale (AIS) and Perceived Stress Scale (PSS-10) were used to assess sleep quality and stress, respectively. Internal consistency was evaluated using Cronbach’s alpha (AIS: α = 0.81–0.84; PSS: α = 0.87–0.90). Data were analyzed using descriptive statistics and paired sampled t-tests (p < 0.05). Results: AIS scores were significantly higher during online learning compared to in-person (5.47 ± 2.67 vs. 4.25 ± 2.48; p = 0.001), indicating poorer sleep quality. In contrast, PSS scores were higher during the frontal period (29.48 ± 8.67 vs. 24.31 ± 7.15; p < 0.05). Increased screen time, irregular routines, and lack of physical activity were associated with poorer outcomes. Conclusions: Online education may compromise sleep quality, while in-person learning appears to increase perceived stress. These findings highlight the need for targeted health promotion strategies adapted to different educational modalities. Full article

(This article belongs to the Special Issue Caring for the Mental Health of Higher Education Students: Coping Strategies and Well-Being Support)

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15 pages, 232 KB

Open AccessArticle

Relationship Between Oral Function and Social Participation Among Community-Dwelling Older Adults: An Observational Cross-Sectional Study

by Mayu Takeda, Yuhei Matsuda, Takafumi Abe, Kazumichi Tominaga, Hisaaki Saito, Jun Shimizu, Norikuni Maeda, Ryouji Matsuura, Yukio Inoue, Yuichi Ando, Shozo Yano, Minoru Isomura and Takahiro Kanno

Healthcare 2025, 13(18), 2271; https://doi.org/10.3390/healthcare13182271 - 11 Sep 2025

Abstract

Background and Objectives: Pre-frailty is characterized by a lack of social interaction, mental instability, and decreased interest in health behaviors and oral health. Thus, this study aimed to explore the relationship between oral function and social participation among community-dwelling older adults. Methods [...] Read more.

Background and Objectives: Pre-frailty is characterized by a lack of social interaction, mental instability, and decreased interest in health behaviors and oral health. Thus, this study aimed to explore the relationship between oral function and social participation among community-dwelling older adults. Methods: The study participants were community-dwelling older adults who underwent dental and oral health examinations and health checkups conducted by the Shimane Extended Union of the Medical Care System for Latter-Stage Elderly People between April 2020 and March 2022. General background data, oral health status, and social participation data were collected. Logistic regression analysis was performed as the primary analysis, with social participation as the objective variable. Results: The participants included 4196 cases, excluding 513 cases with missing data. Logistic regression analysis of the presence of going out at least once a week demonstrated significant correlations in age, lower leg circumference, masticatory function, and oral hygiene status (p < 0.05). Significant correlations were found in sex, lower leg circumference, masticatory function, swallowing function, and oral hygiene status for regular meetings with family or friends (p < 0.05). Conclusions: There may be an association between social participation and a decline in oral function and hygiene status among community-dwelling older adults. Full article

10 pages, 420 KB

Open AccessSystematic Review

Understanding the Variability of Associations Between Higher Ultra-Processed Food Consumption and Self-Reported Depression Severity: A Systematic Review of Epidemiological Studies

by Ume Odum and Mark Schure

Healthcare 2025, 13(18), 2270; https://doi.org/10.3390/healthcare13182270 - 11 Sep 2025

Abstract

Background/Objectives: Coinciding with an increasing trend of ultra-processed food (UPF) consumption, nations are experiencing a surge of diet-related chronic diseases such as diabetes and other metabolic conditions. While many studies have found positive associations of UPF consumption with physical health outcomes, few [...] Read more.

Background/Objectives: Coinciding with an increasing trend of ultra-processed food (UPF) consumption, nations are experiencing a surge of diet-related chronic diseases such as diabetes and other metabolic conditions. While many studies have found positive associations of UPF consumption with physical health outcomes, few studies have examined the effects of UPF consumption on mental health conditions. Therefore, the purpose of this systematic review is to understand the variability of associations between higher UPF consumption and depression severity across research studies with adult populations. Methods: Using PsychINFO, CINAHL Ultimate and Web of Science databases, we conducted a systematic review of recent observational studies examining the association of UPF consumption with self-reported depression in adult populations. To assess the quality of each study, Strengthening the Reporting of Observational Studies in Epidemiology—Modified (STROBE-M) checklist was used to assess risk of bias in each of the included studies. Results: Of the 530 records retrieved, 13 studies with a total of 264,519 participants met all eligibility criteria and were included in this review. All 13 studies reported a positive association between higher UPF consumption and depression severity, ranging from 1.15–2.04 (Hazard, Odds, and Relative Risk ratios). Some of the studies likely experienced selection bias due to loss of participants to follow-up. Conclusions: In adult populations, observational studies indicated a low to moderately increased risk of self-reported depression among those with diets that include higher amounts of ultra-processed foods. Full article

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27 pages, 1845 KB

Open AccessReview

Technological Evolution and Research Trends of Intelligent Question-Answering Systems in Healthcare

by Bingyin Lei and Panpan Yin

Healthcare 2025, 13(18), 2269; https://doi.org/10.3390/healthcare13182269 - 11 Sep 2025

Abstract

Background/Objective: This study investigates the implementation and evolution of intelligent medical question-answering (QA) systems in healthcare to enhance service efficiency and quality. Methods: Through an integrated literature review and bibliometric analysis using CiteSpace 6.3.R1(64-bit) Basic software, we systematically evaluated core concepts, frameworks, and [...] Read more.

Background/Objective: This study investigates the implementation and evolution of intelligent medical question-answering (QA) systems in healthcare to enhance service efficiency and quality. Methods: Through an integrated literature review and bibliometric analysis using CiteSpace 6.3.R1(64-bit) Basic software, we systematically evaluated core concepts, frameworks, and applications within medical QA systems, analyzing literature from 2018 to 2025 to identify research trends. Results: Significant applications were revealed across clinical decision support, medical knowledge retrieval, traditional Chinese medicine (TCM) formulation development, medical imaging report analysis, medical record quality control, mental health monitoring, and emotion recognition, demonstrating optimized resource allocation and service efficiency. Persistent challenges include system accuracy limitations, multimodal interaction capabilities, user trust barriers, and privacy protection concerns. Conclusion: Future research should prioritize multimodal diagnostic imaging, TCM-specific AI agents, and virtual-reality-assisted surgical exploration. Contributions: This work consolidates current achievements while establishing theoretical–practical foundations for innovation and large-scale implementation, advancing intelligent healthcare transformation. Full article

(This article belongs to the Topic eHealth and mHealth: Challenges and Prospects, 2nd Edition)

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17 pages, 1237 KB

Open AccessArticle

Effects of a Complex Care Model for Patients with Multimorbidity in Lithuania: Results from an Implementation Study

by Olga Vasiliauskienė, Dovydas Vasiliauskas, Aušrinė Kontrimienė, Brandon N. Jaafar, Leonas Valius, Lina Jaruševičienė and Ida Liseckienė

Healthcare 2025, 13(18), 2268; https://doi.org/10.3390/healthcare13182268 - 11 Sep 2025

Abstract

Background/Objectives: Multimorbidity is an increasing challenge in primary care, particularly in aging populations. The aim of the study was to evaluate the effects of a multidisciplinary, patient-centered complex care TELELISPA model on quality of life, mental health, and treatment burden among patients [...] Read more.

Background/Objectives: Multimorbidity is an increasing challenge in primary care, particularly in aging populations. The aim of the study was to evaluate the effects of a multidisciplinary, patient-centered complex care TELELISPA model on quality of life, mental health, and treatment burden among patients with multimorbidity in Lithuanian primary care settings. Methods: The study was conducted at seven primary healthcare centers in Lithuania and included all TELELISPA project participants who had at least two chronic health conditions including hypertension. Study participants were randomly assigned to intervention (n = 389) and control groups (n = 400): the intervention group received a coordinated, multidisciplinary care intervention for 15 months, whereas the control group received usual care. In the beginning and the end of the study, participants completed different quality of life, treatment burden and psychological health measures. Results: At the 15-month follow-up, the intervention group reported significantly better psychological health scores across different questionnaires—GAD-7 (p = 0.002), PHQ-9 (p < 0.001), EQ-5D-5L anxiety/depression score (p = 0.044), SF-36 emotional well-being score (p = 0.006). The intervention group also had significantly higher overall EQ-5D-5L quality of life scores (p = 0.02), and a better EQ-5D-5L mobility score (p = 0.036). Intervention group patients reported a reduced treatment burden in monitoring health conditions (p = 0.002), obtaining information about their conditions (p = 0.022), and accessing healthcare during the evenings and the weekends (p = 0.003). The interventions were better received by patients who were younger than 65 years of age, while mixed effects were observed between the groups with different numbers of chronic conditions, with or without polypharmacy, and different durations of education. Conclusions: The implementation of a multidisciplinary, team-based complex care model corresponded with improved psychological well-being, enhanced quality of life, and a partially alleviated treatment burden in patients with multimorbidity. The findings of the study support the wider adoption of integrated care models in aging populations and highlight the need for future studies assessing long-term outcomes and cost-effectiveness. Full article

(This article belongs to the Special Issue Aging Population and Healthcare Utilization)

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15 pages, 244 KB

Open AccessArticle

Barriers to Anti-Hypertensive Medication Adherence Among Patients in Private Healthcare in Edenvale, South Africa

by Bernard Hope Taderera

Healthcare 2025, 13(18), 2267; https://doi.org/10.3390/healthcare13182267 - 10 Sep 2025

Abstract

Background: Hypertension is a major global public health problem whose prevalence is increasing across the world. In consideration of this, there is insufficient understanding of the barriers that hinder the taking of anti-hypertensive medication among patients. In this regard, the aim of this [...] Read more.

Background: Hypertension is a major global public health problem whose prevalence is increasing across the world. In consideration of this, there is insufficient understanding of the barriers that hinder the taking of anti-hypertensive medication among patients. In this regard, the aim of this study was to analyze the possible barriers undermining adherence to anti-hypertensive medication among patients in private healthcare in Edenvale, South Africa. Methodology: This study used an exploratory cross-sectional research design within which quantitative data were collected through an online survey on a sample of randomly selected hypertensive patients attending private healthcare facilities in Edenvale. Participation in this study was voluntary, and informed consent was sought from each participant. Anonymity was assured during data collection through the de-identification of respondents and any data about them. The collected data were subjected to descriptive statistical analysis. Results: One hundred and twenty-two patients participated in this study. From this, 34.4% of participants revealed that lack of awareness was a barrier to a very small extent. Forgetfulness was a possible barrier to adherence to a large extent amongst 16.4% of participants, and 26.2% of the respondents had, to a large extent, doubts about their hypertension diagnosis. However, 42.6% revealed that side effects and difficulty taking medication whilst away from home (47.5%) were a barrier to a small extent. The fear of side effects (19.7%), interference of alcohol or drug use (29.5%) were challenges to a moderate extent. Conclusions: The findings of this study support that hypertensive patients in private healthcare encounter financial constraints, occasionally forget to take their medication, doubt their hypertension diagnosis, and lack awareness about the benefits of taking anti-hypertensive medication. This may be compounded by patients finding the anti-hypertensive medication regimen too complicated, feeling overburdened by having to take too many pills every day, the complexity of the medication regimens, perceived incorrect diagnosis, and lack of social support from family and friends. Understanding the extent of the barriers encountered by patients in taking anti-hypertension medication may help address adherence challenges, which may help improve health outcomes and lessen the burden on health systems in pursuing Sustainable Development Goal 3 and universal health coverage. Full article

(This article belongs to the Section Medication Management)

39 pages, 9593 KB

Open AccessArticle

An Integrated AI Framework for Occupational Health: Predicting Burnout, Long COVID, and Extended Sick Leave in Healthcare Workers

by Maria Valentina Popa, Călin Gheorghe Buzea, Irina Luciana Gurzu, Camer Salim, Bogdan Gurzu, Dragoș Ioan Rusu, Lăcrămioara Ochiuz and Letiția Doina Duceac

Healthcare 2025, 13(18), 2266; https://doi.org/10.3390/healthcare13182266 - 10 Sep 2025

Abstract

Background: Healthcare workers face multiple, interlinked occupational health risks—burnout, post-COVID-19 sequelae (Long COVID), and extended medical leave. These outcomes often share predictors, contribute to each other, and, together, impact workforce capacity. Yet, existing tools typically address them in isolation. Objective: The objective of [...] Read more.

Background: Healthcare workers face multiple, interlinked occupational health risks—burnout, post-COVID-19 sequelae (Long COVID), and extended medical leave. These outcomes often share predictors, contribute to each other, and, together, impact workforce capacity. Yet, existing tools typically address them in isolation. Objective: The objective of this study to develop and deploy an integrated, explainable artificial intelligence (AI) framework that predicts these three outcomes using the same structured occupational health dataset, enabling unified workforce risk monitoring. Methods: We analyzed data from 1244 Romanian healthcare professionals with 14 demographic, occupational, lifestyle, and comorbidity features. For each outcome, we trained a separate predictive model within a common framework: (1) a lightweight transformer neural network with hyperparameter optimization, (2) a transformer with multi-head attention, and (3) a stacked ensemble combining transformer, XGBoost, and logistic regression. The data were SMOTE-balanced and evaluated on held-out test sets using Accuracy, ROC-AUC, and F1-score, with 10,000-iteration bootstrap testing for statistical significance. Results: The stacked ensemble achieved the highest performance: ROC AUC = 0.70 (burnout), 0.93 (Long COVID), and 0.93 (extended leave). The F1 scores were >0.89 for Long COVID and extended leave, whereas the performance gains for burnout were comparatively modest, reflecting the multidimensional and heterogeneous nature of burnout as a binary construct. The gains over logistic regression were statistically significant (p < 0.0001 for Long COVID and extended leave; p = 0.0355 for burnout). The SHAP analysis identified overlapping top predictors—tenure, age, job role, cancer history, pulmonary disease, and obesity—supporting the value of a unified framework. Conclusions: We trained separate models for each occupational health risk but deployed them in a single, real-time web application. This integrated approach improves efficiency, enables multi-outcome workforce surveillance, and supports proactive interventions in healthcare settings. Full article

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19 pages, 1294 KB

Open AccessArticle

The Psychological Impact of Dealing with Death and the Risk of Dying Among Nurses Working in ICU and NICU: Specificities in Mediating and Moderating Variables

by Federica Vallone, Carmine Vincenzo Lambiase and Maria Clelia Zurlo

Healthcare 2025, 13(18), 2265; https://doi.org/10.3390/healthcare13182265 - 10 Sep 2025

Abstract

Background/Objectives. This study applied the Demands-Resources-and-Individual-Effects(DRIVE)-Nurses-Model to explore and compare the experiences of nurses working in Intensive Care Units (ICUs) and in Neonatal Intensive Care Units (NICUs), by investigating the effects of the interplay (main/mediating/moderating effects) of perceived stress related to dealing [...] Read more.

Background/Objectives. This study applied the Demands-Resources-and-Individual-Effects(DRIVE)-Nurses-Model to explore and compare the experiences of nurses working in Intensive Care Units (ICUs) and in Neonatal Intensive Care Units (NICUs), by investigating the effects of the interplay (main/mediating/moderating effects) of perceived stress related to dealing with death/critically ill patients (Death-and-Dying-Stressor)—which unavoidably features in the daily life of nurses working in ICU/NICU—with further potential Stressors in Nursing (Conflicts-with-Physicians, Peers, Supervisors, Patients/their families, Uncertainty-Concerning-Treatment, Inadequate-Emotional-Preparation, Discrimination, Workload), Work-Resources (Job-Control, Social-Support, Rewards), and Coping-Strategies (Problem-focused, Seek-Advice, Self-Blame, Wishful Thinking, Escape/Avoidance) on nurses’ psychological health conditions according to the working unit (ICU/NICU). Methods. Overall, 62 critical care nurses (ICU = 35; NICU = 27) completed self-report questionnaires. Main/mediating/moderating effects were tested by using Correlational-Analyses and Hayes-PROCESS-tool by working unit. Results. Nurses working in NICU reported higher Psychological Disease than nurses working in ICU. The detrimental psychological impact of Death-and-Dying-Stressor was mediated by Conflicts-with-Supervisors-Stressor among ICU nurses and by Uncertainty-Concerning-Treatment and Conflicts-with-Physicians stressors among NICU nurses. The recourse to Self-Blame and Escape/Avoidance coping strategies exacerbated the psychological risk among ICU nurses, while perceived Work-Resources (Job-Control/Social-Support) played a protective moderating role among NICU nurses. Conclusions. The application of the DRIVE-Nurses-Model to deepen the experience of nurses working in ICU/NICU could advance the understanding of the mechanisms underlying the relationship between Death-and-Dying-Stressor and nurses’ psychological health, suggesting tailored risk profiles and accounting for key protective factors, to provide nurses with the necessary resources for adjusting to their challenging and emotionally demanding work-related duties and experiences. Full article

(This article belongs to the Special Issue Mental Health of Healthcare Professionals)

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11 pages, 397 KB

Open AccessArticle

Clinical Characteristics and Mortality in Community-Acquired Sepsis and Septic Shock Patients in the Intensive Care Unit Setting in Latvia: An Observational Study

by Laura Puceta, Anna Zilde, Girts Freijs, Peteris Oss and Uga Dumpis

Healthcare 2025, 13(18), 2264; https://doi.org/10.3390/healthcare13182264 - 10 Sep 2025

Abstract

Background: Sepsis and septic shock are medical emergencies with increasing incidence and high intrahospital mortality rates, as they are common causes of admission to the intensive care units (ICU). Early recognition and adequate treatment are important in reducing mortality. Limited data are available [...] Read more.

Background: Sepsis and septic shock are medical emergencies with increasing incidence and high intrahospital mortality rates, as they are common causes of admission to the intensive care units (ICU). Early recognition and adequate treatment are important in reducing mortality. Limited data are available on characteristics and outcomes of community-acquired sepsis and septic shock in Latvia. Methods: In this single-center cohort study, we explore clinical characteristics and outcomes of 86 community-acquired sepsis and septic shock cases admitted to the ICU of a clinical university hospital between 2014 and 2018. Results: The ICU and intrahospital mortality rates were 45% and 58%, respectively. Respiratory tract infections, particularly pneumonia and abdominal and skin/soft tissue infections, were the most common sites of origin. Overall, 95% of patients initially received appropriate antibiotic treatment. However, the median time to antibiotics was 225 min (IQR 118–407 min), and only 10% received antimicrobial treatment within 1 h. Conclusions: The number of patients enrolled indicates that sepsis cases are underreported on a national level. The results also demonstrate high mortality rates among ICU patients with community-acquired sepsis and septic shock, compared to other reports. The analysis indicates that early recognition of sepsis signs and organ failure is crucial for improvements in treatment outcomes. Full article

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11 pages, 212 KB

Open AccessArticle

Attitudes of Jordanians Toward Therapeutic Abortion—A Qualitative Study

by Roqia S. Maabreh, Hekmat Y. Al-Akash, Mohammad N. Al-Shloul and Naser A. Alsharairi

Healthcare 2025, 13(18), 2263; https://doi.org/10.3390/healthcare13182263 - 10 Sep 2025

Abstract

Background: Therapeutic abortion is a controversial topic since people throughout the world have different views on it. Methods: In this qualitative study, 12 adults (ages 19–36 years) from Irbid, in the Northern region of Jordan, were selected from a variety of [...] Read more.

Background: Therapeutic abortion is a controversial topic since people throughout the world have different views on it. Methods: In this qualitative study, 12 adults (ages 19–36 years) from Irbid, in the Northern region of Jordan, were selected from a variety of public locations (markets, mosques) in April and May 2025 to participate in semi-structured interviews with the goal of exploring attitudes toward therapeutic abortion. The interviews, which lasted an average of 30 min, focused on two primary topics: attitudes about therapeutic abortion and determining who has the authority to make abortion decisions. An audio recorder was used to capture the responses, which were then preserved in their original, unaltered state. Following verbatim transcription, the responses were subjected to thematic analysis in order to determine the main themes. The original code was made manually. Results: Three themes were identified under the first topic: “unconditional rejection”, “conditional acceptance”, and “empathetic and woman-centered attitudes”. Medical and religious experts’ decision-making arose by the theme of “abortion decision” that emerged in relation to the second topic. Conclusions: Jordanians have conflicting views on therapeutic abortion and are adamantly opposed to making their own decisions on the matter. Full article

(This article belongs to the Special Issue Interdisciplinary Perspectives in Maternal Health: Integrating Theoretical Frameworks and Practical Applications)

38 pages, 840 KB

Open AccessReview

Gestational Diabetes Mellitus: Efficacy of Non-Pharmacological Interventions for Management and Prevention

by Naika Dubois and Isabelle Giroux

Healthcare 2025, 13(18), 2261; https://doi.org/10.3390/healthcare13182261 - 10 Sep 2025

Abstract

Background: Gestational diabetes mellitus (GDM) is a type of diabetes diagnosed during pregnancy and its prevalence is on the rise around the world. GDM increases the risk of serious adverse health outcomes for the mother and child. Multiple types of non-pharmacological interventions [...] Read more.

Background: Gestational diabetes mellitus (GDM) is a type of diabetes diagnosed during pregnancy and its prevalence is on the rise around the world. GDM increases the risk of serious adverse health outcomes for the mother and child. Multiple types of non-pharmacological interventions have been developed for the management and prevention of GDM; however, there is a lack of clarity regarding their effectiveness. Objective: To summarize the evidence on the efficacy of non-pharmacological interventions in the management and prevention of GDM. Methods: For this integrative review, a comprehensive literature search was conducted in the databases MEDLINE, CINAHL, Embase, Scopus, and Web of Science. The methodology followed the integrative approach outlined by Whittemore and Knafl’s, and study quality was evaluated using the Mixed Methods Assessment Tool. Results: A total of 44 relevant studies were included. Key themes identified for GDM management were (1) nutrition therapy and physical activity, (2) social and psychological support, (3) digital tools, and (4) barriers and facilitators. For GDM prevention, themes were categorized into individual-level approaches, (5) lifestyle and supplements, and population-level approaches: (6) environmental factors, and (7) health in all policies. Conclusions: The growing prevalence of GDM is a major public health concern that requires the implementation of effective multi-level evidence-based strategies. Environmental, socioeconomic, and racial determinants of health have substantial impacts on GDM, highlighting the need to address the root causes of the illness. Further research is needed to support effective preventive and management measures beyond standard pharmacological treatment, so that evidence-based solutions can be applied to enhance and safeguard the health of current and future generations. Full article

(This article belongs to the Special Issue The Role of Diet and Nutrition in Chronic Disease Prevention and Management)

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19 pages, 889 KB

Open AccessArticle

Stakeholders’ Roles and Views in the Provision of Sexually Transmitted Infection Services Among Key and Priority Populations in Limpopo Province, South Africa

by Mohlago Ablonia Seloka, Edith Phalane and Refilwe Nancy Phaswana-Mafuya

Healthcare 2025, 13(18), 2262; https://doi.org/10.3390/healthcare13182262 - 9 Sep 2025

Abstract

Background: There is a dearth of evidence on the roles and views of stakeholders regarding the sexually transmitted infections (STIs) service provision among key and priority populations (KPPs) within primary healthcare (PHC) settings. Aim: This study assessed the roles and views of [...] Read more.

Background: There is a dearth of evidence on the roles and views of stakeholders regarding the sexually transmitted infections (STIs) service provision among key and priority populations (KPPs) within primary healthcare (PHC) settings. Aim: This study assessed the roles and views of stakeholders regarding the STI services scope, content, accessibility, quality, affordability, and availability, as well as associated gaps and successes among KPP within PHC facilities in the Capricorn District of Limpopo Province in South Africa. Methods: An exploratory research design was used. In-depth face-to-face interviews with 18 STI stakeholders were conducted. The STI stakeholders were purposively selected from five PHC facilities. An inductive analytical approach was employed to develop themes and sub-themes. Tesch’s step analysis informed the development of the thematic analysis process. Results: The presence of peer counsellors, home-based caregivers, and the operation of STI services day and night in two selected facilities enhanced access and availability of STI services. Consistent in-service training for service providers was implemented to improve service quality and maintain professional competency. Barriers that prevented adequate STI service provision in this study included staff shortages, inadequate filing systems, lack of advanced-diagnostic equipment, and patients’ noncompliance with treatment regimens. The successes of the STI service provision were effective STI treatment and services integration within the facilities. Conclusions: The findings of this study have unveiled several methods to increase access and availability to STI services among KPPs in the selected PHC facilities. We recommend gathering responses and experiences from STI service users regarding the current STI service provision to foster innovative and targeted approaches within PHC facilities in Limpopo Province. Full article

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22 pages, 817 KB

Open AccessArticle

The Relationship Between Psychophysiological and Psychological Parameters of Job Stress and Working Capacity of Loggers During the Fly-In Period

by Yana Korneeva and Natalia Simonova

Healthcare 2025, 13(18), 2260; https://doi.org/10.3390/healthcare13182260 - 9 Sep 2025

Abstract

Background: Scientific research on fly-in/fly-out (FIFO) workers has identified a gap in understanding the dynamics of job stress parameters among forest workers throughout the shift cycle. Methods: This study investigated the relationship between psychological and psychophysiological parameters of job stress and [...] Read more.

Background: Scientific research on fly-in/fly-out (FIFO) workers has identified a gap in understanding the dynamics of job stress parameters among forest workers throughout the shift cycle. Methods: This study investigated the relationship between psychological and psychophysiological parameters of job stress and work capacity among loggers. The research was conducted during two simultaneous scientific expeditions in July 2024, involving 47 loggers from two teams with differing socio-psychological characteristics. Data were collected daily (morning and evening) using a battery of psychophysiological and psychological tests. Teams’ socio-psychological characteristics were assessed five times during the 15-day fly-in period. Results: The adaptation (beginning) and fatigue (end) phases of the shift were significantly more stressful than the middle period. During these critical phases, assessments of functional state showed greater consistency but were less favorable. Key findings indicate a psychological mobilization effect at the period’s start, where high subjective comfort coexisted with physiological strain. By the end, functional capabilities were maintained despite high fatigue. Furthermore, loggers in teams with a positive socio-psychological climate exhibited a more favorable functional state throughout the shift. Conclusions: The study’s novelty lies in its comprehensive mapping of the dynamic interplay between job stress and work capacity across the FIFO cycle, using both instrumental and questionnaire-based methods. The results underscore the critical influence of the team’s socio-psychological climate on worker well-being and highlight specific high-stress phases that warrant targeted interventions. Full article

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11 pages, 248 KB

Open AccessArticle

Real-World Safety Concerns of Tirzepatide: A Retrospective Analysis of FAERS Data (2022–2025)

by Hadi A. Almansour, Hilal A. Thaibah, Moaddey Alfarhan, Saeed A. Al-Qahtani, Amani A. Khardali and Thamir M. Alshammari

Healthcare 2025, 13(18), 2259; https://doi.org/10.3390/healthcare13182259 - 9 Sep 2025

Abstract

Background: Tirzepatide (Mounjaro or Zepbound), a dual GLP-1/GIP receptor agonist, is approved for type 2 diabetes and weight management. Despite its efficacy, real-world safety data remain limited. This study analyzed post-marketing adverse events (AEs) associated with tirzepatide using the FDA Adverse Event [...] Read more.

Background: Tirzepatide (Mounjaro or Zepbound), a dual GLP-1/GIP receptor agonist, is approved for type 2 diabetes and weight management. Despite its efficacy, real-world safety data remain limited. This study analyzed post-marketing adverse events (AEs) associated with tirzepatide using the FDA Adverse Event Reporting System (FAERS) to identify emerging safety concerns. Methods: FAERS reports from 2022 to Q1 2025 were analyzed. Disproportionality analyses (proportional reporting ratio [PRR], reporting odds ratio [ROR], empirical Bayes geometric mean [EBGM], and information component [IC]) were performed to detect safety signals. Reports were stratified by year, demographics, and AE type, focusing on cases in which tirzepatide was the primary suspect. Results: Among 65,974 reports, the majority originated from the U.S. (96%), with middle-aged females (40–59 years; 67%) most frequently affected. Incorrect dose administration was the top AE, increasing 8-fold from 1248 (2022) to 9800 (2024), with strong risk signals (ROR 22.15, 95% CI (20.75–23.65), and ROR 23.43, 95% CI (22.82–24.05), respectively, and PRR 16.80, 95% CI (15.74–17.93), and PRR 17.62, 95% CI (17.16–18.09), respectively). Other common AEs included injection-site reactions (e.g., pain [5273 cases in 2024]), gastrointestinal issues (nausea [3602 in 2024]), and off-label use. Class-related AEs (e.g., decreased appetite and blood glucose fluctuations) were also reported. Conclusions: Tirzepatide is associated with significant dosing errors, injection-site reactions, and gastrointestinal AEs in real-world use. The rising trend in reports underscores the need for enhanced provider and patient education, clearer dosing guidelines, and proactive monitoring. Further research is warranted to explore causative factors and optimize risk mitigation strategies. Full article

(This article belongs to the Special Issue Technological Advances, Precision Medicine and Regulatory Improvements in Drug Safety and Pharmacy Support)

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16 pages, 1000 KB

Open AccessArticle

Access to Orphan Medicinal Products in Bulgaria: An Analysis of the Positive Drug List and Individual Access Schemes

by Rumen Stefanov, Ralitsa Raycheva, Kostadin Kostadinov, Georgi Stefanov, Iva Zdravkova-Aneva, Elizabet Dzhambazova and Georgi Iskrov

Healthcare 2025, 13(18), 2258; https://doi.org/10.3390/healthcare13182258 - 9 Sep 2025

Abstract

Background/Objectives: Orphan medicinal products offer essential treatments for rare diseases, but patient access varies across European Union countries despite a common regulatory framework. In Bulgaria, access is primarily through inclusion in the positive drug list following health technology assessment or via individual [...] Read more.

Background/Objectives: Orphan medicinal products offer essential treatments for rare diseases, but patient access varies across European Union countries despite a common regulatory framework. In Bulgaria, access is primarily through inclusion in the positive drug list following health technology assessment or via individual access schemes under Ordinance No. 2/2019, which allows for ad hoc reimbursement. This study evaluates the timeliness and extent of Bulgarian patient access to orphan-designated drugs authorized by the European Medicines Agency. Methods: We analyzed European Medicines Agency-authorized orphan drugs between July 2006 and September 2023 using data from the European Medicines Agency, Bulgarian health technology assessment bodies, positive drug list records, and individual access scheme reports. Medians, interquartile ranges, stratified analyses, and permutation/bootstrapping methods were applied. Results: Of the 142 European Medicines Agency-approved orphan drugs, only 41 (28.9%) were included in the Bulgarian positive drug list. The median time to positive drug list inclusion was 828 days, with pre-health technology assessment delays (median 570 days) as the main bottleneck. Health technology assessment evaluations had a median duration of 204 days. Cancer and accelerated-assessment drugs reached health technology assessment faster, while conditional approvals faced longer delays. Twenty-four drugs were accessed through individual schemes; twenty remained outside the positive drug list. Overall, 43.0% of orphan drugs reached Bulgarian patients via either mechanism. Conclusions: Access to orphan drugs in Bulgaria is limited and delayed, mainly due to pre-health technology assessment lags. In light of the forthcoming European Union health technology assessment regulation, Bulgaria must ensure that national processes are capable of rapidly translating centralized assessments into meaningful patient access. Full article

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15 pages, 893 KB

Open AccessArticle

Preparedness for Disaster Response: An Assessment of Northeast Romanian Emergency Healthcare Workers

by Alexandra Haută, Radu-Alexandru Iacobescu, Paul Lucian Nedelea, Mihaela Corlade-Andrei, Tudor Ovidiu Popa and Carmen Diana Cimpoeșu

Healthcare 2025, 13(18), 2257; https://doi.org/10.3390/healthcare13182257 - 9 Sep 2025

Abstract

Background: Disasters, although predictable, often occur unexpectedly, and efforts must be directed towards reducing their impact. Emergency healthcare workers, key players in disaster response, should maintain a high level of preparedness to act in catastrophic situations. Data on knowledge, attitude, and disaster preparedness [...] Read more.

Background: Disasters, although predictable, often occur unexpectedly, and efforts must be directed towards reducing their impact. Emergency healthcare workers, key players in disaster response, should maintain a high level of preparedness to act in catastrophic situations. Data on knowledge, attitude, and disaster preparedness among emergency healthcare workers is scarce, particularly for developed countries in Europe. This study aimed to measure the perceived preparedness of various health practitioners in emergency care in Iași county (Romania) and identify factors that influence it. Materials and methods: A self-assessment web-based questionnaire was developed to measure knowledge (K), attitude (A), and preparedness (P). Nonparametric tests compared measurements between demographic groups. Spearman correlation, linear univariate, and multivariate regression models were used to test the effect of perceived knowledge, attitude, and other work-related factors (such as experience, training, and leadership) on disaster preparedness. Results: 211 valid entries were recorded (114 female and 97 male), of which 33.6% were doctors, 25.1% were nurses, and 23.7% were paramedics. There were differences in exposure to training across health professions for disasters and trauma management (p = 0.03 and p = 0.009). The sample’s overall scores for the three primary domains assessed were moderate. Univariate analyses identified a significant effect of knowledge and attitude on preparedness (B = 0.9, 95% CI: 0.79–1.01, p < 0.001, and B = 0.81, 95% CI: 0.66–0.97, p < 0.001, respectively), which was maintained in multivariate regression. Workplace factors (disaster plans and institutional collaboration), along with experience in disaster management and emergency care, were determinants of preparedness, while the effect of training was insignificant. Conclusions: Most healthcare workers displayed moderate preparedness for disasters, while exposure to training and practice was found to be inadequate. Focus should be placed on identifying barriers and enhancing training delivery, strengthening institutional involvement in staff preparedness, and improving inter-professional collaborations. Adequate training methods must be developed and validated in further studies. Full article

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11 pages, 778 KB

Open AccessArticle

Etiologies and Trends in Extremity Amputations: A Ten-Year Single-Center Experience

by Abdulrahman Alaseem, Mishari Alanezi, Mohammed N. Alhuqbani, Zyad A. Aldosari, Faisal Alkhunein, Khalid Alyahya, Khalid Alanezi, Mohammad N. Aljarba, Musaad Alhamzah, Ibrahim Alshaygy and Waleed Albishi

Healthcare 2025, 13(18), 2256; https://doi.org/10.3390/healthcare13182256 - 9 Sep 2025

Abstract

Background: Limb amputation is a life-altering event with substantial physical, psychological, and social consequences. Despite advances in healthcare, amputation remains a major global health concern, particularly in regions with high burdens of diabetes and vascular disease. This study aims to analyze demographic [...] Read more.

Background: Limb amputation is a life-altering event with substantial physical, psychological, and social consequences. Despite advances in healthcare, amputation remains a major global health concern, particularly in regions with high burdens of diabetes and vascular disease. This study aims to analyze demographic characteristics, etiologies, and trends in amputations over a ten-year period at a tertiary-care center. Methods: We retrospectively reviewed medical records of patients who underwent amputation at our tertiary-care hospital. Collected variables included patients’ demographics, etiology, level of amputation, type of admission, and surgical specialty involved. Descriptive statistics were used to summarize the data. Associations between categorical variables were analyzed using chi-square tests, with post hoc pairwise comparisons adjusted using the Bonferroni method where applicable. Continuous variables were compared using the Mann–Whitney U test. A p-value of <0.05 was considered statistically significant. All analyses were conducted using IBM SPSS version 26.0. Results: A total of 647 patients underwent amputation, with a mean age of 56 years and a male predominance (65%). Diabetic complications were the leading cause (67.7%), followed by trauma (11.7%) and vascular diseases (11.6%). Lower limb amputations were more prevalent, with toe amputations being the most frequent (39%). Emergency procedures accounted for 72% of cases, and vascular surgery was the most involved specialty, followed by orthopedic surgery. Conclusions: Our study highlights a substantial burden of amputations, predominantly involving the lower limb, as well as a significant association with diabetic complications. These findings emphasize the urgent need for integrated diabetic care, early interventions, and public health strategies to reduce the burden of amputations in Saudi Arabia. Full article

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9 pages, 342 KB

Open AccessArticle

Impact of Physician Practice Racial Composition on Patient Demographics

by Gnankang Sarah Napoé, Hyagriv N. Simhan and Lara S. Lemon

Healthcare 2025, 13(18), 2255; https://doi.org/10.3390/healthcare13182255 - 9 Sep 2025

Abstract

Background: Designing practices to better serve Black patients is necessary to decrease health disparities in America. Objective: To understand the impact of physician practice racial composition on patient demographics in a gynecology practice in the United States. We hypothesized that there will be [...] Read more.

Background: Designing practices to better serve Black patients is necessary to decrease health disparities in America. Objective: To understand the impact of physician practice racial composition on patient demographics in a gynecology practice in the United States. We hypothesized that there will be an increased proportion of Black patients seen by all physicians within a practice by adding Black physicians to that practice. Design: This is a retrospective study comparing patient demographics of three subspecialty gynecology practices: Practice A, with two Black physicians added to the staff during the study period, and Practice B and C, without any Black physicians. Methods: We compared patient demographics by practice over time, including race (Black and White), insurance status (public vs private), and area deprivation index (ADI) as a proxy for socioeconomic status. Results: During the study period, there was a statistically significant increase in Black patients in practice A (slope = 0.0029; p < 0.001), while the proportion trend of Black patients decreased or remained flat in Practice B (slope = −0.0020; p = 0.027) and C (slope = −0.0010; p = 0.23), respectively. While Black physicians saw more Black patients than nonBlack physicians in Practice A, the proportion of Black patients seen by nonBlack physicians, though modest, steadily increased during the study period. Practice A saw patients with higher ADI and more patients with public insurance. Black physicians in practice A saw more publicly insured patients than nonBlack physicians. There was no difference in patients’ ADI whether they were seen by Black or nonBlack physicians in Practice A. Conclusions: The addition of Black physicians to a practice is associated with increasing the proportion of Black patients seen by both Black and nonBlack physicians in that practice. Full article

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12 pages, 606 KB

Open AccessArticle

Chat GPT Performance in Multi-Disciplinary Boards—Should AI Be a Member of Cancer Boards?

by Ibrahim Dogan, Mehmet Kadir Bartin, Ezgi Sonmez, Erdogan Seyran, Halil Alper Bozkurt, Mehmet Yuksek, Ezgi Dicle Serbes, Gunel Zalova and Sebahattin Celik

Healthcare 2025, 13(18), 2254; https://doi.org/10.3390/healthcare13182254 - 9 Sep 2025

Abstract

Background: Multidisciplinary Tumor Councils (MDTs) are vital platforms that provide tailored treatment plans for cancer patients by combining expertise from various medical disciplines. Recently, Artificial Intelligence (AI) tools have been investigated as decision-support systems within these councils. Methods: In this prospective study, the [...] Read more.

Background: Multidisciplinary Tumor Councils (MDTs) are vital platforms that provide tailored treatment plans for cancer patients by combining expertise from various medical disciplines. Recently, Artificial Intelligence (AI) tools have been investigated as decision-support systems within these councils. Methods: In this prospective study, the compatibility of AI (ChatGPT-4.0) with MDT decisions was evaluated in 100 cancer patients presented to the tumor council between November 2024 and January 2025. AI-generated treatment recommendations based on anonymized, detailed clinical summaries were compared with real-time MDT decisions. Cohen’s Kappa and Spearman correlation tests were used for statistical analysis. Results: Neoadjuvant treatment (45%) and surgery (36%) were the most frequent MDT decisions. AI recommended surgery (39%) and neoadjuvant treatment (37%) most frequently. A high concordance rate of 76.4% was observed between AI and MDT decisions (κ = 0.764 [95% CI; 0.658–0.870] p < 0.001, ρ = 0.810 [95% CI; 0.729–0.868], p < 0.001). Most inconsistencies arose in cases requiring individualized decisions, indicating AI’s current limitations in incorporating contextual clinical judgment. Conclusion: AI demonstrates substantial agreement with MDT decisions, particularly in cases adhering to standardized oncological guidelines. However, for AI integration into clinical workflows, it must evolve to interpret real-time patient data and function transparently within ethical and legal frameworks. Full article

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

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Healthcare, Volume 13, Issue 18 (September-2 2025) – 23 articles

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