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Healthcare, Volume 13, Issue 19 (October-1 2025) – 163 articles

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11 pages, 237 KB  
Article
Moral Distress in Ethical Dilemmas: A Comparative Study of Medical Students and Physicians
by George-Dumitru Constantin, Bogdan Hoinoiu, Ioana Veja, Crisanta-Alina Mazilescu, Teodora Hoinoiu, Ruxandra Elena Luca, Ioana Roxana Munteanu and Roxana Oancea
Healthcare 2025, 13(19), 2547; https://doi.org/10.3390/healthcare13192547 - 9 Oct 2025
Viewed by 214
Abstract
Background: Ethical dilemmas and the moral distress they generate are central challenges in healthcare practice and professional identity formation. While moral reasoning has been widely studied, comparative evidence on how medical students and practicing physicians approach ethical dilemmas remains scarce in Eastern [...] Read more.
Background: Ethical dilemmas and the moral distress they generate are central challenges in healthcare practice and professional identity formation. While moral reasoning has been widely studied, comparative evidence on how medical students and practicing physicians approach ethical dilemmas remains scarce in Eastern Europe. Methods: A total of 244 participants (51 senior medical students and 193 physicians) completed an adapted version of the Defining Issues Test, version 2 (DIT-2). Three classical dilemmas were assessed: end-of-life decision-making, access to life-saving medication, and the reintegration of a fugitive. Responses were analyzed through descriptive statistics and chi-square tests to identify differences in decision choices and underlying reasoning. Results: Physicians consistently endorsed conventional, law-based reasoning, emphasizing legality and professional codes, while medical students demonstrated greater variability, indecision, and openness to compassion-driven justifications. In the “Jan and the Drug” and “Fugitive” dilemmas, significant between-group differences highlighted tensions between legality, empathy, and justice (p < 0.01). These differences in reasoning indicate differing vulnerabilities to moral distress, especially when legal and compassionate perspectives conflict. Conclusions: The findings reveal distinct patterns of moral reasoning that reflect different levels of vulnerability to moral distress in healthcare contexts. Integrating structured ethics training and reflective dialogue into both undergraduate and continuing medical education could mitigate moral distress by fostering a balance between justice, compassion, and professional responsibility. Full article
(This article belongs to the Special Issue Ethical Dilemmas and Moral Distress in Healthcare)
12 pages, 246 KB  
Article
Applying the WHO ICF Framework to Fetal Alcohol Spectrum Disorder (FASD): A Forensic and Clinical Perspective on Disability Assessment and Patient Support
by Davide Ferorelli, Francesco Calò, Gianmarco Sirago, Dania Comparcini, Filippo Gibelli, Francesco Sessa, Marco Carotenuto, Biagio Solarino and Monica Salerno
Healthcare 2025, 13(19), 2546; https://doi.org/10.3390/healthcare13192546 - 9 Oct 2025
Viewed by 251
Abstract
Background/Objectives: This article aims to investigate the multifaceted effects of alcohol on neurophysiopathological development from gestational stages through adult life and the consequent dynamic-relational challenges in individuals with Fetal Alcohol Spectrum Disorder (FASD). FASD, resulting from prenatal alcohol exposure (PAE), is characterized [...] Read more.
Background/Objectives: This article aims to investigate the multifaceted effects of alcohol on neurophysiopathological development from gestational stages through adult life and the consequent dynamic-relational challenges in individuals with Fetal Alcohol Spectrum Disorder (FASD). FASD, resulting from prenatal alcohol exposure (PAE), is characterized by a range of neurological, cognitive, behavioral, and sometimes physical impairments. This article explores how alcohol and its toxic metabolites cross the placenta, inducing direct cellular toxicity and epigenetic alterations that disrupt critical neurodevelopmental processes such as neurogenesis and brain circuit formation. Clinically, individuals with FASD exhibit diverse deficits in executive functioning, learning, memory, social skills, and sensory-motor abilities, leading to significant lifelong disabilities. A central focus is the application of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) criteria to comprehensively frame these disabilities. The ICF’s biopsychosocial model allows for a multidimensional assessment of impairments in body functions and structures, limitations in activities, and restrictions in participation, while also considering the crucial role of environmental factors. Methods: PubMed and Semantic Scholar databases were searched for relevant papers published in English. Results: This article highlights the utility of the ICF in creating individualized functioning profiles to guide interventions and support services, addressing the limitations of traditional assessment methods. Conclusions: While the ICF framework offers a robust approach for understanding and managing FASD, further research is essential to develop and validate FASD-specific ICF-based assessment tools to enhance support and social participation for affected individuals. Full article
14 pages, 419 KB  
Article
Effects of a Standing Program for Ambulatory Children with Myelomeningocele: A Single-Subject Design
by Marianne Hanover, Elizabeth M. Ardolino and Megan B. Flores
Healthcare 2025, 13(19), 2545; https://doi.org/10.3390/healthcare13192545 - 9 Oct 2025
Viewed by 243
Abstract
Background/Objectives: Children with myelomeningocele (MMC) often experience lower extremity muscular contractures, which can impact their functional mobility. While standing programs have demonstrated benefits for children with other neuromuscular conditions, there is limited evidence on their use in ambulatory children with MMC who have [...] Read more.
Background/Objectives: Children with myelomeningocele (MMC) often experience lower extremity muscular contractures, which can impact their functional mobility. While standing programs have demonstrated benefits for children with other neuromuscular conditions, there is limited evidence on their use in ambulatory children with MMC who have joint deformities. This single-subject design study examined the impact of a home-based standing program on two ambulatory children with MMC, focusing on lower extremity muscle flexibility, functional movement quality, gait velocity, and participation in daily activities. Methods: Two children participated in a multi-phase single-subject (ABABA) withdrawal design beginning with the baseline phase and then alternating between the intervention and withdrawal phases. The intervention consisted of 60-minute standing sessions, five days a week, using a sit-to-stand stander (STSS) with support and supervision from a physical therapist (PT) and the parent. Primary outcomes included goniometric passive range of motion (PROM) and 10-Meter Walk Test (10 MWT). Secondary outcomes included the Pediatric Neuromuscular Recovery Scale (Peds NRS) and the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT). Results: Improvements in hip and knee muscle flexibility were observed during the intervention phases, with some loss during the withdrawal phase. Functional movement quality improved in both children. Gait velocity and participation in daily activity scores remained stable during intervention phases. Parental feedback reflected increased independence and high engagement with the home program. One child discontinued due to a heel injury, highlighting the need for individualized support. Conclusions: Personalized standing programs may improve muscle flexibility and functional movement quality in ambulatory children with MMC. Further research is warranted to determine the optimal dosing regimen, ensure safety, and assess long-term functional outcomes. Full article
(This article belongs to the Section Chronic Care)
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18 pages, 454 KB  
Article
Associations Between Sedentary Behaviors and Sedentary Patterns with Metabolic Syndrome in Children and Adolescents: The UP&DOWN Longitudinal Study
by Alejandro Sánchez-Delgado, Alejandro Perez-Bey, Julio Conde-Caveda, Rocío Izquierdo-Gómez, Sonia Gómez-Martínez, Oscar L. Veiga, Ascensión Marcos and José Castro-Piñero
Healthcare 2025, 13(19), 2544; https://doi.org/10.3390/healthcare13192544 - 9 Oct 2025
Viewed by 287
Abstract
Background/Objectives: The longitudinal associations between different modalities of sedentary behaviors (SBs) and sedentary patterns (SPs) with metabolic syndrome (MetS) in children and adolescents are unclear. We aimed to analyze the cross-sectional and longitudinal (2-year follow-up) association between SB and SP with the MetS [...] Read more.
Background/Objectives: The longitudinal associations between different modalities of sedentary behaviors (SBs) and sedentary patterns (SPs) with metabolic syndrome (MetS) in children and adolescents are unclear. We aimed to analyze the cross-sectional and longitudinal (2-year follow-up) association between SB and SP with the MetS score in Spanish children and adolescents. Methods: 76 children (34 females) and 186 adolescents (94 females) were included for SB analyses, and 175 children (82 females) and 188 adolescents (95 females) for SP. Children and adolescents were aged 6–11.9 years and 12–17.9 years, respectively. SB were assessed by a self-reported questionnaire and SP were determined by accelerometry. The MetS score was computed from the waist circumference, systolic blood pressure, triglycerides, high-density lipoprotein cholesterol, and glucose levels. Different linear regression models were implemented to examine cross-sectional, longitudinal, and change associations of SB and SP with MetS. Results: Total daily SB, educative daily SB, and mean SB were longitudinal and inversely associated with MetS (β = −0.001, all p < 0.05) in male adolescents, while other daily SB was longitudinal and inversely associated with MetS (β = −0.002, all p < 0.05) in female adolescents. Changes in screen and other daily SB were directly associated with MetS in female adolescents (β = 0.001 to 0.002, all p < 0.05). In contrast, changes in educative daily SB were inversely associated with MetS in female adolescents (β = −0.001, all p < 0.05). Conclusions: Few associations between SB modalities and the MetS score were found, mainly in adolescents and often in unexpected directions. In male adolescents, total and educative daily SB were negatively associated with MetS. In female adolescents, other daily SB and changes in educative daily SB showed negative associations, while changes in screen-based and other daily SB were positively associated with MetS. No associations were found between SP and MetS. Given the low evidence available to date, more longitudinal studies analyzing SB and SP simultaneously are needed to reach solid conclusions. Full article
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13 pages, 857 KB  
Article
Patterns of Psychiatric Comorbidity Among Drug Users: A Prospective Observational Study in a Romanian Psychiatric Hospital
by Andreea Atena Zaha, Antonia Lucia Comșa, Dana Carmen Zaha and Cosmin Mihai Vesa
Healthcare 2025, 13(19), 2543; https://doi.org/10.3390/healthcare13192543 - 9 Oct 2025
Viewed by 244
Abstract
Background: A large number of substance use disorders are increasingly associated with complex clinical presentations and unknown mental and medical risks, presenting a growing challenge for mental health worldwide. Research exploring the interplay between substance use and psychiatric disorders remains limited in Eastern [...] Read more.
Background: A large number of substance use disorders are increasingly associated with complex clinical presentations and unknown mental and medical risks, presenting a growing challenge for mental health worldwide. Research exploring the interplay between substance use and psychiatric disorders remains limited in Eastern Europe. Objectives: We investigated the demographic and clinical features of 203 patients admitted to a major Romanian psychiatric hospital, aiming to clarify the patterns of dual diagnosis and symptomatology within this vulnerable population. Results: Cannabis, novel psychoactive substances and unknown substances were the most commonly used drugs. Psychiatric comorbidity was rather the rule than the exception within our group. Cluster analysis revealed three distinct symptom profiles: manic/psychotic, negative affective and disorganized. While individual drug type did not independently predict symptom severity or readmission risk, a significant interaction effect between drug use and psychiatric comorbidity influenced symptom cluster membership. Conclusions: These findings highlight the complexity and heterogeneity of dual diagnoses and underline the importance of an integrated, multidisciplinary approach in addiction medicine. Full article
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10 pages, 342 KB  
Article
A VR-Based Trauma Nursing Education Program for Clinical Nurses: Integrating Jeffries’ Model and the 5E Learning Cycle
by Heeyeon Kim, Gyuli Baek and Eunju Lee
Healthcare 2025, 13(19), 2542; https://doi.org/10.3390/healthcare13192542 - 9 Oct 2025
Viewed by 388
Abstract
Background/Objectives: Nurses’ professional competencies are critical in trauma patient care, and educational programs that strengthen these competencies contribute to improved patient safety and higher-quality care. This study aimed to develop and evaluate the effectiveness of a virtual reality (VR)-based trauma nursing education program [...] Read more.
Background/Objectives: Nurses’ professional competencies are critical in trauma patient care, and educational programs that strengthen these competencies contribute to improved patient safety and higher-quality care. This study aimed to develop and evaluate the effectiveness of a virtual reality (VR)-based trauma nursing education program by applying Jeffries’ simulation model and the 5E Learning Cycle. Methods: A quasi-experimental, non-equivalent control group pretest–post-test design was employed. Participants were 34 nurses with more than one year of clinical experience, recruited from three university hospitals in Daegu, Korea, each with over 800 beds. Participants were allocated to either the experimental group (n = 17) or the control group (n = 17). The experimental group received the VR-based program, while the control group received standard training. Effectiveness was assessed using validated questionnaires measuring trauma-related knowledge, confidence in trauma care, and emergency nursing competency. Data were analyzed with repeated-measures ANOVA. Results: The experimental group demonstrated significant improvements in trauma-related knowledge and confidence in trauma care compared with the control group. Emergency nursing competency also increased significantly in both groups over time, but the degree of improvement did not differ between groups. Conclusions: The VR-based trauma nursing education program, designed using Jeffries’ simulation model and the 5E Learning Cycle, enhanced trauma-related knowledge and confidence among clinical nurses. Although no between-group difference was found for emergency nursing competency, the findings provide foundational evidence supporting the use of VR-based interventions to advance emergency and critical care nursing education. Full article
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11 pages, 216 KB  
Article
Emotional Health: Improving Emotional Intelligence Through Physical Education
by Karen Troncoso-Ulloa, Izaskun Luis-de-Cos, Saioa Urrutia-Gutierrez, Gurutze Luis-de-Cos and Silvia Arribas-Galarraga
Healthcare 2025, 13(19), 2540; https://doi.org/10.3390/healthcare13192540 - 9 Oct 2025
Viewed by 348
Abstract
Background/Objectives: Difficulties in emotional regulation are recognized as a risk factor for a variety of emotion-based psychopathologies, including anxiety and depression. In this context, movement and physical activity have been identified as a key element in preventing these health issues, particularly during [...] Read more.
Background/Objectives: Difficulties in emotional regulation are recognized as a risk factor for a variety of emotion-based psychopathologies, including anxiety and depression. In this context, movement and physical activity have been identified as a key element in preventing these health issues, particularly during the initial teacher training. This study aimed to analyze the impact of an emotional health physical education program on the Emotional Intelligence of university students studying physical education in Chile. Methods: A quasi-experimental design with experimental and control groups and repeated measures (pre test-post test) was employed. A total of 214 male and female students from two Chilean universities participated and completed the Spanish version of the Trait Meta-Mood Scale (TMMS-24). Results: Results confirmed the program’s effectiveness in fostering Emotional Intelligence, revealing statistically significant improvements (p < 0.05) in the dimensions of emotional attention and clarity. Conclusions: These findings suggest that emotional physical education programs can be effective in promoting emotional skills essential for the learning and mental well-being of university students who will later become primary and secondary school teachers. Full article
22 pages, 3295 KB  
Brief Report
The Greek Versions of the HLS19 Health Literacy Instruments (HLS19-NAV-GR, HLS19-COM-GR, and HLS19-VAC-GR): Translation, Cultural Adaptation, and Descriptive Pilot Evaluation
by Angeliki Flokou, Panagiotis Theodorou, Dimitris A. Niakas and Petros Kostagiolas
Healthcare 2025, 13(19), 2541; https://doi.org/10.3390/healthcare13192541 - 8 Oct 2025
Viewed by 282
Abstract
Background: Health literacy (HL) is a key determinant of health outcomes and equity. The European Health Literacy Survey 2019 (HLS19) introduced three domain-specific instruments—HLS19-NAV, HLS19-COM-P-Q11, and HLS19-VAC. We present the translation, cultural adaptation, field [...] Read more.
Background: Health literacy (HL) is a key determinant of health outcomes and equity. The European Health Literacy Survey 2019 (HLS19) introduced three domain-specific instruments—HLS19-NAV, HLS19-COM-P-Q11, and HLS19-VAC. We present the translation, cultural adaptation, field testing, and descriptive pilot evaluation of their Greek versions (HLS19-NAV-GR, HLS19-COM-GR, HLS19-VAC-GR). Methods: Dual forward/back-translation and expert review (11 health professionals/academics) produced the final versions. A purposive, quota-guided field test (N = 71) approximated population distributions by sex, age, education, and geographical region. Test–retest stability (n = 16; ~12 days) was summarized primarily with intraclass correlation ICC (2,1), with Pearson/Spearman correlations reported secondarily. Internal consistency was assessed using ordinal alpha computed from polychoric (polytomous) and tetrachoric (dichotomous) correlations. We report item- and scale-level descriptive statistics for both the original polytomous (four-category, 1–4) responses and a dichotomous difficulty–ease scheme (1–2 vs. 3–4). Given the non-probability sampling in this pilot, the results are descriptive, not statistically representative. Results: Instruments were well accepted, requiring only minor revisions. Scales demonstrated high short-term stability and good internal consistency; inter-scale correlations were moderate, interpreted as associations among related but distinct constructs. Item distributions skewed toward Easy/Very Easy; several HLS19-VAC-GR items showed a clear ceiling, suggesting the need to consider harder items or a larger item pool in future validation. By scale, scores followed the descending order NAV, COM, and VAC. Distributions and ranking patterns broadly mirrored population-level findings from other countries. Conclusions: The adapted HLS19-NAV/COM/VAC-GR instruments are linguistically and culturally appropriate and prepared for large-scale validation, while items NAV9, COM4, and the VAC ceiling are flagged for further assessment. Full article
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14 pages, 1917 KB  
Article
Health Information Seeking and Behavior in the Korean Population During the COVID-19 Pandemic
by Hanna Choi, Meiling Jin and Byungsun Park
Healthcare 2025, 13(19), 2539; https://doi.org/10.3390/healthcare13192539 - 8 Oct 2025
Viewed by 311
Abstract
Background: Online health information seeking emerged as a critical form of public health behavior during the COVID-19 pandemic, generating substantial research interest. However, empirical studies examining health information-seeking patterns among Korean populations and their behavioral outcomes during the pandemic remain limited. Grounded in [...] Read more.
Background: Online health information seeking emerged as a critical form of public health behavior during the COVID-19 pandemic, generating substantial research interest. However, empirical studies examining health information-seeking patterns among Korean populations and their behavioral outcomes during the pandemic remain limited. Grounded in the information–motivation–behavior skills model, this study investigates online health information-seeking behaviors, including information sources, search terms, and engagement patterns, while also exploring their association with actual health behaviors during the COVID-19 pandemic. Methods: A structured survey was developed based on 1014 adults aged 19 years or older using the 2021 Korean version of the Health Information National Trends Survey (K-HINTS) to obtain nationally representative data. We adopted a structural equation model and analyzed the data using SPSS 25.0 and the WordArt site. Results: Of the respondents, 74.2% sought health information online, with vaccine details being the most widely searched topic. Mobile phones were the most commonly used devices (75.8%), and 98% searched for health information online via mobile devices at least once a week. Information (β = 0.230, p < 0.001), motivation (β = 0.117, p < 0.01), and behavior skills (β = 0.117, p < 0.01) positively influenced consumers’ behavioral changes regarding health. Behavioral skills also mediated the influences that information seeking and motivation had on behavioral changes. Conclusions: This study examines four aspects of online health information seeking through nationally representative COVID-19 data in South Korea. Exploring the relationship between information-seeking and actual health behaviors provides crucial insights for predicting post-pandemic consumer behavior and developing effective public health communication strategies for future crises. Full article
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13 pages, 797 KB  
Article
An Exploratory Analysis of Public Perspectives and Attitudes Towards Radiation in Saudi Arabia
by Hanan M. Alzahrani, Fahad Alzahrani, Hala Aljohani, Shouq Albalawi, Shatha Aljurbua, Maisa Elzaki, Walaa Alsharif, Bashair Alhummiany, Awadia Gareeballah, Eman Abdurhman Altay, Tasneem S. A. Elmahdi, Amirah Alsaedi, Manal J. Abdallah, Lamia Ghazi Jamjoom and Bander S. Almutairi
Healthcare 2025, 13(19), 2538; https://doi.org/10.3390/healthcare13192538 - 8 Oct 2025
Viewed by 264
Abstract
Aim: Radiation exposure is a growing public health concern; however, public understanding of its sources, risks, and protective measures remains limited. This study examined familiarity, misconceptions, and attitudes towards both ionising and nonionising radiation among residents of Saudi Arabia, an area that has [...] Read more.
Aim: Radiation exposure is a growing public health concern; however, public understanding of its sources, risks, and protective measures remains limited. This study examined familiarity, misconceptions, and attitudes towards both ionising and nonionising radiation among residents of Saudi Arabia, an area that has received limited attention in the literature. Methods: A cross-sectional survey was conducted among 888 Saudi residents aged 18 years and above by using a validated online questionnaire. The instrument comprised demographic items, 13 statements assessing radiation familiarity (including knowledge of sources and safety), and 21 items assessing attitudes (including safety practices and willingness to receive further education), all rated on a five-point Likert scale. Descriptive statistics and nonparametric inferential analyses were performed using SPSS v27. Results: Participants had a moderate mean familiarity score (3.34 ± 1.16), whereas attitude scores were high (3.56 ± 1.14). Demographic variables, including age, sex, region, and previous training, significantly affected familiarity and attitudes. A medical background and previous radiation education were associated with a higher familiarity level. Nonetheless, most participants expressed a strong interest in acquiring additional knowledge. Conclusion: Moderate familiarity with radiation and strong attitudes towards protection among the Saudi public highlight opportunities to strengthen practical safety knowledge. These findings indicate the need for targeted, accessible educational initiatives, particularly through digital platforms, to enhance radiation literacy and support the objectives of Saudi Vision 2030. Full article
(This article belongs to the Section Healthcare Organizations, Systems, and Providers)
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10 pages, 414 KB  
Article
Variation in Quality of Women’s Health Topic Information from Systematic Internet Searches
by Bianca Kyrie Wanamaker, Ashley N. Tomlinson, Alivia R. Abernathy, Vanessa Cordova, Anika D. Baloun and Benjamin D. Duval
Healthcare 2025, 13(19), 2537; https://doi.org/10.3390/healthcare13192537 - 8 Oct 2025
Viewed by 685
Abstract
Background/Objectives: The internet has unquestionably altered how people acquire health information. Instead of consulting with a medical professional, billions of pages of information can be accessed by anyone with a smartphone. Women’s health issues have been historically and culturally taboo in many [...] Read more.
Background/Objectives: The internet has unquestionably altered how people acquire health information. Instead of consulting with a medical professional, billions of pages of information can be accessed by anyone with a smartphone. Women’s health issues have been historically and culturally taboo in many cultures globally; therefore, internet searches may be particularly useful when researching these topics. Methods: As an exercise in scientific information evaluation, we chose 12 non-cancer topics specific to women’s health and developed a scoring metric based on quantifiable webpage attributes to answer: What topics generate the highest and lowest scores? Does the quality of information (mean score) vary across topics? Does the variation (score deviation) differ among topics? Data were collected following systematic searches after filtering with advanced features of Google and analyzed in a Bayesian framework. Results: The mean score per topic was significantly correlated with the number of sources cited within an article. There were significant differences in the quality scores across topics; “pregnancy” and “sleep” scored the highest and had more sources cited per page than all other topics. The greatest variation in scores were for “cortisol” and “weight”. Conclusions: A purposeful, systematic internet search of 12 critical women’s health topics suggests that scrutiny is necessary when this information is obtained by a typical internet user. Future work should include review by medical professionals based on their interaction with patients who self-report what they know or think about a condition they present and respect, while educating, patients’ own internet searching. Full article
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14 pages, 643 KB  
Article
Development and Validation of the Knowledge of Human Papillomavirus Scale in Japan
by Ayano Tokuda, Atsuko Shiota, Pasang Wangmo and Kimiko Kawata
Healthcare 2025, 13(19), 2536; https://doi.org/10.3390/healthcare13192536 - 8 Oct 2025
Viewed by 407
Abstract
Background/Objectives: In Japan, the human papillomavirus (HPV) vaccine introduction process is unique, and no HPV knowledge scale with established reliability and validity currently exists. This study aimed to develop a new HPV knowledge scale and evaluate its reliability and validity for practical [...] Read more.
Background/Objectives: In Japan, the human papillomavirus (HPV) vaccine introduction process is unique, and no HPV knowledge scale with established reliability and validity currently exists. This study aimed to develop a new HPV knowledge scale and evaluate its reliability and validity for practical use. Methods: With permission from the original authors of the HPV Knowledge Scale (Jo Waller et al.), we created a Japanese version incorporating the original two subscales and adding new items. The translation process involved multiple researchers, back-translation by a professional agency, and expert review to ensure linguistic and contextual accuracy. The study was approved by the Clinical Research Ethics Review Board of the researchers’ affiliated universities and conducted between April and August 2024. Results: Reliability and validity were assessed using data from 793 parents of junior high school students, including both boys and girls. Confirmatory factor analysis showed a good model fit (Goodness-of-Fit Index [GFI] = 0.934, Adjusted GFI [AGFI] = 0.907, Comparative Fit Index [CFI] = 0.928, Root Mean Square Error of Approximation [RMSEA] = 0.063). Cronbach’s alpha ranged from 0.688 to 0.845 and item-total correlations ranged from 0.393 to 0.584. Test–retest reliability, assessed with Spearman’s rank correlation, was r = 0.791 (p < 0.001). The final scale, named the Japan HPV Knowledge Scale (J-HPV-KS), includes 17 items across five factors. Conclusions: The J-HPV-KS covers HPV-related diseases, transmission routes, natural history, and vaccines. It demonstrated sufficient reliability and validity for use in Japan and is a useful tool for assessing HPV-related knowledge among Japanese parents and guardians. Full article
(This article belongs to the Special Issue HPV Vaccine and Cervical Cancer Prevention)
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16 pages, 1929 KB  
Review
Analyzing Global Research Trends on Medical Resident Burnout and Physical Activity: A Bibliometric Analysis (2005–2025)
by Hamdi Henchiri, Amr Chaabeni, Ismail Dergaa, Halil İbrahim Ceylan, Valentina Stefanica, Wissem Dhahbi, Chayma Harrathi, Safa Abidi, Abdullah H. Allihebi, Anis Jellad and Fairouz Azaiez
Healthcare 2025, 13(19), 2535; https://doi.org/10.3390/healthcare13192535 - 7 Oct 2025
Viewed by 467
Abstract
Background: Medical resident burnout is a critical threat to healthcare workforce sustainability, with physical activity (PA) posited as a protective factor. This bibliometric analysis maps the global research landscape on this topic from 2005 to 2025. Methods: Systematic search of the [...] Read more.
Background: Medical resident burnout is a critical threat to healthcare workforce sustainability, with physical activity (PA) posited as a protective factor. This bibliometric analysis maps the global research landscape on this topic from 2005 to 2025. Methods: Systematic search of the Web of Science Core Collection identified 110 relevant English-language articles. Performance analysis and scientific mapping were conducted using R and VOSviewer. Results: The field saw an annual growth rate of 3.35%, with a peak of 16 publications in 2019. The United States was the dominant contributor, accounting for 68% of the total output. Analysis identified several major thematic areas, including stress and behavioral factors, occupational mental health, and institutional support mechanisms. The findings reveal a rapidly growing but geographically concentrated body of research, underscoring a significant gap in globally representative evidence. Conclusions: This analysis provides a foundational map for future research, underscoring the need for institutional wellness programs incorporating PA, international collaborative studies, and policy-level interventions. We conclude that integrating physical activity is not a luxury but a critical strategy for healthcare system sustainability. Full article
(This article belongs to the Section Healthcare Organizations, Systems, and Providers)
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16 pages, 1153 KB  
Article
Health-Related Quality of Life Among High-Risk Pregnant Women Hospitalized in a Maternal-Fetal Intensive Care Unit: A Structural Equation Modeling Analysis
by Hyuna Seol, Jina Oh and Mihae Im
Healthcare 2025, 13(19), 2534; https://doi.org/10.3390/healthcare13192534 - 7 Oct 2025
Viewed by 305
Abstract
Objectives: The aim of this study was to establish a structural model that could explain and predict factors influencing health-related quality of life (HRQoL) in high-risk pregnant women. Methods: This study adopted a structural equation model based on the HRQoL model. [...] Read more.
Objectives: The aim of this study was to establish a structural model that could explain and predict factors influencing health-related quality of life (HRQoL) in high-risk pregnant women. Methods: This study adopted a structural equation model based on the HRQoL model. Data were collected from 200 high-risk pregnant women hospitalized in a maternal-fetal intensive care unit. Structured questionnaires measured antenatal depression, marital intimacy, fetal attachment, self-care behavior, perceived health status, and HRQoL. All data were collected simultaneously during a single point in participants’ hospitalization. Results: Among the factors, antenatal depression showed the greatest influence on HRQoL (β = −0.27, p < 0.001), followed by marital intimacy (β = 0.26, p < 0.001), fetal attachment (β = 0.25, p < 0.001), perceived health status (β = 0.14, p = 0.005), and self-care behavior (β = 0.12, p = 0.037), with an explanatory power of 73.4%. Conclusions: To improve the HRQoL of high-risk pregnant women, psychological nursing intervention strategies are needed to reduce antenatal depression. It is necessary to provide education that encourages self-care behavior. Furthermore, the findings indicate that strategic nursing interventions are necessary to enhance marital intimacy, fetal attachment, and perceived health status. As a theoretical basis, this study will contribute to the preparation of basic data that will improve the HRQoL of pregnant women at high risk. Full article
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16 pages, 625 KB  
Article
Traveling Towards Timeliness: The Association Between Travel Time and Wait Time for Rheumatoid Arthritis Care
by Xiaoxiao Liu, Alka B. Patel, Judy E. Seidel, Dianne P. Mosher, John Hagens and Deborah A. Marshall
Healthcare 2025, 13(19), 2533; https://doi.org/10.3390/healthcare13192533 - 7 Oct 2025
Viewed by 282
Abstract
Objectives: The aim was to measure wait times for rheumatologist consultation and disease-modifying antirheumatic drug (DMARD) treatment and examine their association with travel time to primary care practitioners (PCP) and rheumatologists within a centralized intake system, respectively. Methods: Within a centralized [...] Read more.
Objectives: The aim was to measure wait times for rheumatologist consultation and disease-modifying antirheumatic drug (DMARD) treatment and examine their association with travel time to primary care practitioners (PCP) and rheumatologists within a centralized intake system, respectively. Methods: Within a centralized intake system serving 4.2 million people, we measured wait time for rheumatologist consultations and DMARD treatment for an RA incidence cohort between 1 April 2015 and 31 March 2020. Wait times were reported as the median with the interquartile range (IQR). Using multivariate logistics regression models, we examined the impact of travel times to primary/rheumatology care on wait times for rheumatologist consultation (28-day benchmark) and DMARD treatment (14-day benchmark). Travel times were defined according to quantiles and pre-defined categories. Results: The median wait time was 47 days (IQR: 18–114) for rheumatologist consultations (36% meeting the benchmark) and 35 days (IQR: 1–132) for DMARD treatment (43% meeting the benchmark). Patients living >120 min away had lower odds of meeting the 28-day consultation benchmark compared with those within 30 min (OR 0.64; 95% CI: 0.42–0.97). Compared with patients driving ≤30 min, lower odds of meeting the 14-day benchmark for DMARD treatment were observed for those driving over 60 min to PCPs (OR 0.62; 95% CI: 0.39–0.99) and patients driving 30–60 min to rheumatologists (OR 0.68; 95% CI: 0.55–0.85). Conclusion: RA management was suboptimal due to low rates of meeting RA consultation and treatment benchmarks, which was significantly associated with long travel times to both primary and RA care within a centralized triage system. This highlights the need for complementary strategies (e.g., tele-rheumatology, travel support, or alternate care providers) to ensure timely RA care in rural and remote communities. Full article
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12 pages, 3466 KB  
Article
Comparative Analysis of Traumatic Cardiac Arrest: Role of Early Intervention and Care Pathway
by Sung Woo Jang, Jae Sik Chung and Pil Young Jung
Healthcare 2025, 13(19), 2532; https://doi.org/10.3390/healthcare13192532 - 7 Oct 2025
Viewed by 200
Abstract
(1) Background: This study aimed to assess the characteristics and factors influencing 72 h survival after traumatic cardiac arrest (TCA), comparing out-of-hospital TCA (oTCA) with in-hospital TCA (iTCA). (2) Methods: This is a retrospective review of 286 patients with TCA admitted to the [...] Read more.
(1) Background: This study aimed to assess the characteristics and factors influencing 72 h survival after traumatic cardiac arrest (TCA), comparing out-of-hospital TCA (oTCA) with in-hospital TCA (iTCA). (2) Methods: This is a retrospective review of 286 patients with TCA admitted to the regional trauma center (RTC) in Gangwon Province, Korea, between 2013 and 2019. (3) Results: Transfer from another hospital (hazard ratio [HR] 0.86 [0.76–0.97]) and longer duration between accident and cardiopulmonary resuscitation (CPR) (HR 0.95 [0.90–0.99]) were associated with lower 72 h mortality. Transfer showed a significant association with lower 72 h mortality in all patients and in the high-injury-severity-score (ISS) group, but not in the low-ISS group. Subgroup analysis indicated that patients transferred from another hospital had significantly lower HR than directly admitted patients to the RTC for oTCA occurrence (HR 0.36 [0.23–0.57]), total CPR duration > 30 min (HR 0.34 [0.23–0.52]), and accident-to-CPR duration < 30 min (HR 0.25 [0.11–0.55]). Additionally, shorter distances from the accident site to the first hospital were associated with lower relative HRs. (4) Conclusions: Considering the extremely poor outcomes of TCA, basic resuscitation and evaluation at nearby medical institutions rather than immediate transfer to specialized trauma centers, particularly when TCA occurs or is anticipated, are important. Early damage-control resuscitation at a nearby hospital can impact on improving the survival rate of patients with TCA. Full article
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11 pages, 934 KB  
Article
The Hidden Risks of Hip Replacement: Unveiling Mortality and Costs in 1.6 Million Patients
by Yaron Berkovich, Binyamin Finkel, Assil Mahamid, Hadar Gan-Or, Loai Ahmad Takrori, Yaniv Yonai and David Maman
Healthcare 2025, 13(19), 2531; https://doi.org/10.3390/healthcare13192531 - 7 Oct 2025
Viewed by 322
Abstract
Methods: Using the most recent pre-COVID National Inpatient Sample (2016–2019), we evaluated inpatient mortality and economic impact after elective primary total hip arthroplasty (THA) across 327,123 cases (1,635,615 weighted discharges).Results: Overall inpatient mortality was 0.04%, but was higher in patients ≥ 80 years [...] Read more.
Methods: Using the most recent pre-COVID National Inpatient Sample (2016–2019), we evaluated inpatient mortality and economic impact after elective primary total hip arthroplasty (THA) across 327,123 cases (1,635,615 weighted discharges).Results: Overall inpatient mortality was 0.04%, but was higher in patients ≥ 80 years (0.15%), with weekend admissions (0.10%), and with surgical delay ≥ 1 day (0.17%). Comorbidities with the greatest mortality association included congestive heart failure and chronic kidney disease (both with markedly elevated odds), and acute in-hospital complications (e.g., pulmonary embolism) carried substantial risk. Complications also increased resource use; for example, heart failure, pulmonary edema, and acute coronary artery disease were each associated with significantly higher costs and prolonged length of stay. Conclusion: These findings provide a contemporary, pre-pandemic national baseline that quantifies high-risk subgroups and the economic footprint of adverse events, supporting targeted perioperative strategies and hospital planning for elective THA. Full article
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19 pages, 836 KB  
Article
Activity Intensity and All-Cause Mortality Following Fall Injury Among Older Adults: Results from a 12-Year National Survey
by Oluwaseun Adeyemi, Tracy Chippendale, Olugbenga Ogedegbe, Dowin Boatright and Joshua Chodosh
Healthcare 2025, 13(19), 2530; https://doi.org/10.3390/healthcare13192530 - 7 Oct 2025
Viewed by 443
Abstract
Background: Fall injury is a sentinel event for mortality among older adults, and activity intensity may play a role in mitigating this outcome. This study assessed the relationship between activity intensity and all-cause mortality following fall injury among community-dwelling U.S. older adults. Methods: [...] Read more.
Background: Fall injury is a sentinel event for mortality among older adults, and activity intensity may play a role in mitigating this outcome. This study assessed the relationship between activity intensity and all-cause mortality following fall injury among community-dwelling U.S. older adults. Methods: For this retrospective cohort study, we pooled 12 years of data from the National Health Interview Survey and identified older adults (aged 65 years and older) who sustained fall injuries (N = 2454). The outcome variable was time to death following a fall injury. We defined activity intensity as a binary variable, none-to-low and normal-to-high, using the American Heart Association’s weekly 500 Metabolic Equivalent of Task (MET) as a cutoff. We controlled for sociodemographic, healthcare access, and health characteristics; performed survey-weighted Cox proportional hazard regression analysis; and reported the adjusted mortality risks (plus 95% confidence interval (CI)). Results: The survey comprised 2454 older adults with fall injuries, representing 863,845 US older adults. The population was predominantly female (68%), non-Hispanic White (85%), and divorced/separated (54%). During the follow-up period, 45% of the study population died. Approximately 81% of the study population had low activity levels. However, between 2006 and 2017, the proportion of the study population with low physical activity decreased from 90% to 67%. After adjusting for sociodemographic, healthcare access, and health characteristics, none-to-low activity intensity was associated with 50% increased mortality risk (aHR: 1.50; 95% CI: 1.20–1.87). Conclusions: Promoting higher physical activity levels may significantly reduce the all-cause mortality risk following fall injury among older adults. Full article
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10 pages, 224 KB  
Brief Report
Hypothyroidism and Mandibular Cortical Alterations Evaluated on Panoramic Radiography: A Cross-Sectional Study in Women
by Vicente Vera-Rodríguez, María Pedrera-Canal, Olga Leal-Hernández, Juan Fabregat-Fernández, María Luz Canal-Macías, Fidel López-Espuela, Francisco M. García-Blazquez, Jose M. Moran and Raúl Roncero-Martín
Healthcare 2025, 13(19), 2529; https://doi.org/10.3390/healthcare13192529 - 7 Oct 2025
Viewed by 222
Abstract
Background/Objectives: Thyroid hormone deficiency may impair bone metabolism, but its mandibular impact remains uncertain. We aimed to compare the prevalence of altered Mandibular Cortical Index (MCI; C2–C3) and Panoramic Mandibular Index (PMI) on digital panoramic radiographs in adult women with primary hypothyroidism versus [...] Read more.
Background/Objectives: Thyroid hormone deficiency may impair bone metabolism, but its mandibular impact remains uncertain. We aimed to compare the prevalence of altered Mandibular Cortical Index (MCI; C2–C3) and Panoramic Mandibular Index (PMI) on digital panoramic radiographs in adult women with primary hypothyroidism versus euthyroid controls, considering age and key clinical covariates. To our knowledge, this is the first study out of Spain addressing this question. Methods: This is a cross-sectional study (September 2021–June 2024) of 179 white women recruited at a university clinic. Cases were on L-thyroxine for ≥6 months, with TSH > 4.5 mIU/L and normal FT4; controls were euthyroid and untreated. Demographics, reproductive history, and BMI were recorded. Panoramic radiographs (Ratograph EVO 3D; 72 kV, 6 mA, 14.4 s) were analysed; MCI was graded (Klemetti C1–C3) distal to the mental foramen; PMI and mandibular cortical width (MCW) were measured bilaterally. Results: Women with hypothyroidism showed higher BMI and a greater number of years since menopause; age was slightly higher, but the difference was not significant. MCI distribution did not differ between groups (C3 and C2–C3, both p > 0.45). PMI (left/right) was similar (p = 0.253/0.160). Left MCW was higher in hypothyroidism in a crude analysis (4.86 ± 0.98 vs. 4.46 ± 0.94 mm; p = 0.039), but lost significance after age adjustment (adjusted p = 0.191); right MCW showed no differences. Total tooth loss tended to be higher (p = 0.055) without conclusive evidence. Conclusions: In this cohort, primary hypothyroidism was not associated with a differential mandibular cortical pattern by MCI or PMI; the crude MCW difference was explained by age. These Spain-based data refine heterogeneous prior findings and indicate that, in women treated for hypothyroidism, mandibular cortical metrics largely resemble those of their euthyroid peers. Longitudinal and multicentre studies are warranted to clarify trajectories and enhance generalisability. Full article
13 pages, 509 KB  
Article
Caught in the Web—Emotional Regulation Difficulties and Internet Addiction Among Romanian Medical and Technical University Students: A Pilot Cross-Sectional Study
by Simona Magdalena Hainagiu and Simona Nicoleta Neagu
Healthcare 2025, 13(19), 2528; https://doi.org/10.3390/healthcare13192528 - 6 Oct 2025
Viewed by 408
Abstract
Background and Objectives: Young people of all ages are now prematurely overexposed to a tech-addicted life, with negative psychological, physiological, sociological, and educational effects. Ease of access to and normalization of exposure to technology are indicated as the main causes of internet addiction [...] Read more.
Background and Objectives: Young people of all ages are now prematurely overexposed to a tech-addicted life, with negative psychological, physiological, sociological, and educational effects. Ease of access to and normalization of exposure to technology are indicated as the main causes of internet addiction and a mental health concern, especially in Romania, a country with widespread and easy access to the internet. Methods: This exploratory cross-sectional study with 132 participants investigated the relationship between emotional regulation difficulties (ERDs) and the risk of internet addiction (IA) among medical and technical students—two educational cultures defined by intense educational and emotional stress—with the aim of identifying specific patterns of variability. Standardized self-report data were collected, and specific descriptive and correlational statistical methods were used. Results: Key findings suggest similar moderate difficulty in emotional regulation for each student sample and normal-to-mild internet use for technical and medical students. A moderately strong Pearson correlation was observed between internet addiction and emotional regulation difficulties across the entire group of students (r = 0.54, p < 0.001). However, higher levels of emotional dysregulation and internet addiction risk were evident for the medical students. Conclusions: These results suggest that IA is closely linked to ERD rather than to the exposure to technology itself, as we presumed in the case of technical students. Moreover, medical students have a greater need for institutional support measures than their technical peers to cope with a highly challenging educational environment that exceeds individual levels of effective self-regulation. Full article
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21 pages, 444 KB  
Article
Therapeutic Goals of One-on-One Viniyoga: A Qualitative Study of Practitioner Perspectives and Case Applications
by Jennifer Vasquez, Michele Quintin Quill and Chase Bossart
Healthcare 2025, 13(19), 2527; https://doi.org/10.3390/healthcare13192527 - 6 Oct 2025
Viewed by 198
Abstract
Background/Objectives: Viniyoga is a person-centered approach to yoga that emphasizes individualized adaptation of breath, movement, and meditative practices to support health and well-being. This qualitative study investigates the therapeutic goals of one-to-one Viniyoga from the perspective of experienced therapists. Methods: Fourteen certified Viniyoga [...] Read more.
Background/Objectives: Viniyoga is a person-centered approach to yoga that emphasizes individualized adaptation of breath, movement, and meditative practices to support health and well-being. This qualitative study investigates the therapeutic goals of one-to-one Viniyoga from the perspective of experienced therapists. Methods: Fourteen certified Viniyoga practitioners participated in in-depth interviews, which were analyzed using Interpretative Phenomenological Analysis (IPA). This study details how Viniyoga therapists define therapeutic Viniyoga. Results: The findings identify three core therapeutic goals that guide Viniyoga therapy: restoring balance, cultivating self-regulation, and guiding transformation. Two case studies are presented to illustrate the application of these goals in clinical contexts. Conclusions: Qualitative information provided by the interviewed Viniyoga therapists supports the positive role of individualized Viniyoga therapy in contributing to sustainable healing and supporting clients’ return to balance, self-regulation, and personal transformation. The Viniyoga therapeutic model is applicable across diverse populations and in a variety of integrative and complementary healthcare settings. Full article
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15 pages, 519 KB  
Article
Therapeutic Exercises During Hospitalization in Oncohematological Patients: A Randomized Clinical Trial
by Bruna Cunha de Souza, Cintia Freire Carniel, Juliana Zangirolami-Raimundo and Rodrigo Daminello Raimundo
Healthcare 2025, 13(19), 2526; https://doi.org/10.3390/healthcare13192526 - 6 Oct 2025
Viewed by 352
Abstract
Background/Objectives: Therapeutic exercises during hospitalization may provide important benefits for onco-hematological patients. However, the most effective protocols and outcomes for evaluation remain unclear. The objective of this study was to evaluate the effects of a structured exercise program during hospitalization. Methods: We conducted [...] Read more.
Background/Objectives: Therapeutic exercises during hospitalization may provide important benefits for onco-hematological patients. However, the most effective protocols and outcomes for evaluation remain unclear. The objective of this study was to evaluate the effects of a structured exercise program during hospitalization. Methods: We conducted a randomized clinical trial with hospitalized onco-hematological patients. The control group performed conventional exercises, while the intervention group received a combined program of aerobic and resistance training. Outcomes included functional capacity, muscle strength, quality of life, and fatigue, assessed at admission and discharge. The sample size was calculated for a moderate effect size (Cohen’s d = 0.50; α = 0.05; power = 80%), yielding a target of 35 participants per group. Data were analyzed using repeated measures analysis of variance, followed by Bonferroni post hoc tests. The significance level was set at 5%. Results: The intervention group showed significant improvements in dyspnea (p = 0.017) and pain (p = 0.024) compared with the control group. In addition, reductions in insomnia (p = 0.021) and improvements in emotional functioning (p = 0.024) were observed. No significant between-group differences were found for fatigue, muscle strength, or functional capacity. Conclusions: A short-term program of aerobic and resistance exercises was safe and improved pain and dyspnea in hospitalized onco-hematological patients, with additional favorable effects on insomnia and emotional function. However, no significant effects were detected in fatigue, muscle strength, or functional capacity, likely due to the short hospitalization period and limited number of sessions. Future studies should consider longer interventions and post-discharge follow-up to clarify the sustainability of these benefits. Full article
(This article belongs to the Special Issue Association Between Physical Activity and Chronic Condition)
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12 pages, 226 KB  
Article
Perceptions of Spectacle Use Among Undergraduate Students in Oman: Visual Symptoms, Convenience, and Disadvantages
by Janitha Plackal Ayyappan, Hilal Alrahbi, Gopi Vankudre, Zoelfigar Mohamed, Virgina Varghese and Sabitha Sadandan
Healthcare 2025, 13(19), 2525; https://doi.org/10.3390/healthcare13192525 - 6 Oct 2025
Viewed by 258
Abstract
Background: Globally, uncorrected refractive errors are recognized as the primary cause of visual impairment and blindness. According to a report by the World Health Organization (WHO), providing spectacle lenses at an affordable cost remains a significant challenge, particularly for underprivileged populations in developing [...] Read more.
Background: Globally, uncorrected refractive errors are recognized as the primary cause of visual impairment and blindness. According to a report by the World Health Organization (WHO), providing spectacle lenses at an affordable cost remains a significant challenge, particularly for underprivileged populations in developing countries. This challenge contributes to the low compliance with spectacle wear worldwide. However, the benefits of wearing spectacles are influenced by the perceptions of the population regarding spectacle use. Methods: A quantitative, cross-sectional survey-based study was conducted at a superior educative center in Oman, the University of Buraimi. Participants were recruited from the four major colleges, namely, the College of Health Sciences (COHS), College of Business (COB), College of Engineering (COE), and College of Law (COL), and the Center for Foundation Studies (CFS). This study was conducted over the period from 18 December 2022 to 18 December 2023. Essential data were collected using an electronic questionnaire facilitated by the Google platform. The initial section of the questionnaire outlines this study’s objectives and its benefits to the community. The digital survey comprises three sections: the first section addresses the sociodemographic profile of the participants; the second section explores perceptions related to spectacles; and the third section examines visual symptoms associated with spectacle wear. In this study, a pre-tested survey was administered following consultation with a panel of three subject matter experts who reviewed the clarity and content validity of the test items. Data analyses were performed using descriptive statistics, and linear regression was applied to assess the effect of socioeconomic profile on perceptions of spectacles. Additionally, data entry, processing, and analysis were conducted using SPSS 25 software. The overall mean score for spectacle-related visual symptoms was 2.51 ± 0.75, indicating a moderate level of symptom occurrence. Results: A total of 415 participants (N = 415) were included in this study, comprising 133 males (32.0%) and 282 females (68.0%). The most prominent symptoms related to spectacle perception were “light sensitivity” and “eye pain”, with mean values of 3.03 ± 1.30 and 3.04 ± 1.25, respectively. Additionally, 249 participants (60%) reported moderate concern regarding spectacle-related visual symptoms. Among female participants, 118 (41.8%) exhibited little concern about visual symptoms associated with spectacle wear, whereas this was observed in 25.6% of male participants. Descriptive statistics indicated the mean perceived spectacle-related disadvantages score measured on a scale of 0 to 4 was 2.88 ± 1.16 (57.69% ± 23.15% in percentages), reflecting a moderate perception of such disadvantages. The linear regression model demonstrated statistical significance, as indicated by the likelihood ratio chi-square = 199.194 (df = 15, p < 0.001). The most significant predictor was study major (χ2 = 72.922, p < 0.001). Conclusions: The present study indicates that undergraduate students generally exhibit a low perception of the disadvantages associated with wearing spectacles. Randomized sampling should be preferred in future studies to the convenience sampling technique. The most frequently reported visual symptoms include “light sensitivity and eye pain” among spectacle wearers. Therefore, it is imperative to implement health education programs and foundational studies across colleges to address these issues among undergraduate university students. Full article
(This article belongs to the Special Issue Advances in Primary Health Care and Community Health)
13 pages, 264 KB  
Article
Prevalence and Predictors of Musculoskeletal Pain Among Pregnant Women: A Cross-Sectional Study
by Jalal Uddin, Shahida Sultana Shumi and Jason D. Flatt
Healthcare 2025, 13(19), 2524; https://doi.org/10.3390/healthcare13192524 - 5 Oct 2025
Viewed by 480
Abstract
Background: Musculoskeletal (MSK) pain is a frequent but under-addressed concern during pregnancy. In Bangladesh, challenges such as limited antenatal care (ANC) access and heavy maternal workloads make this issue particularly urgent for maternal health. This study aimed to determine the prevalence and [...] Read more.
Background: Musculoskeletal (MSK) pain is a frequent but under-addressed concern during pregnancy. In Bangladesh, challenges such as limited antenatal care (ANC) access and heavy maternal workloads make this issue particularly urgent for maternal health. This study aimed to determine the prevalence and predictors of MSK pain among pregnant women attending government ANC clinics in Bangladesh. Methods: A facility-based cross-sectional study was conducted among 300 pregnant women recruited from two government hospitals in Dhaka Division. Data were collected using structured interviewer-administered questionnaires covering patient characteristics, pain-related characteristics, and pregnancy-related characteristics. Pain was measured using the Numeric Pain Rating Scale (NPRS; mild <4, moderate 4–7, severe >7), and body mass index (BMI) was calculated based on self-reported height and weight. Descriptive statistics, chi-square tests, and multivariable logistic regression were employed to identify factors independently associated with MSK pain. Results: Overall, 67% of women reported MSK pain, most frequently in the lower back and lower abdomen. Women in later trimesters had about twice the odds of experiencing pain, while those with obesity had nearly six times higher odds compared to women with normal body mass index (BMI). Conclusions: MSK pain is common among pregnant women in Bangladesh and shows associations with later gestational stages and obesity. These findings suggest that integrating routine screening and non-pharmacological management into ANC may help support maternal health and reduce preventable complications in resource-limited settings. Full article
16 pages, 2104 KB  
Review
Enteroenteric Fistula Following Multiple Magnet Ingestion in an Adult: Case Report, Literature Review and Management Algorithm
by Laurențiu Augustus Barbu, Liliana Cercelaru, Ionică-Daniel Vîlcea, Valeriu Șurlin, Stelian-Stefaniță Mogoantă, Tiberiu Stefăniță Țenea Cojan, Nicolae-Dragoș Mărgăritescu, Ana-Maria Țenea Cojan, Valentina Căluianu, Mihai Popescu, Gabriel Florin Răzvan Mogoș and Liviu Vasile
Healthcare 2025, 13(19), 2523; https://doi.org/10.3390/healthcare13192523 - 5 Oct 2025
Viewed by 310
Abstract
Background: Multiple high-powered magnet ingestion is a surgical emergency due to inter-loop attraction leading to ischemia, necrosis, perforation, and fistula formation. While well documented in children, adult cases—particularly those complicated by entero-enteric fistula—remain rare, and management is largely extrapolated from pediatric guidelines. Objective: [...] Read more.
Background: Multiple high-powered magnet ingestion is a surgical emergency due to inter-loop attraction leading to ischemia, necrosis, perforation, and fistula formation. While well documented in children, adult cases—particularly those complicated by entero-enteric fistula—remain rare, and management is largely extrapolated from pediatric guidelines. Objective: To present a rare case of adult entero-enteric fistula following multiple neodymium magnet ingestion, we review the literature and propose an adapted management algorithm for adults. Methods: A narrative PubMed review was performed to identify pediatric and adult cases of magnet ingestion complicated by gastrointestinal fistula. Search terms included magnet ingestion, entero-enteric fistula, neodymium, and adult. Reported case characteristics, diagnostic modalities, treatments, and outcomes were analyzed. Results: A 38-year-old male with schizophrenia presented with small bowel obstruction five days after ingesting multiple magnets. Abdominal radiography revealed clustered radiopaque bodies in the distal ileum. Emergency laparotomy identified an entero-enteric fistula caused by pressure necrosis from inter-loop magnetic attraction. Segmental enterectomy with side-to-side anastomosis was performed, with uneventful recovery. The literature review identified only a few adult cases, which showed similar pathophysiology but frequent diagnostic delays and higher complication rates compared with pediatric cases. Conclusions: This case adds to the scarce adult literature on magnet-induced entero-enteric fistula and supports the adaptation of pediatric-based protocols for adults, with attention paid to psychiatric comorbidity and delayed presentation. Early imaging, timely intervention, and multidisciplinary care are essential to prevent severe gastrointestinal injury. Full article
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34 pages, 1125 KB  
Systematic Review
A Systematic Review of Government-Led Free Caesarean Section Policies in Low- and Middle-Income Countries from 2009 to 2025
by Victor Abiola Adepoju, Abdulrakib Abdulrahim and Qorinah Estiningtyas Sakilah Adnani
Healthcare 2025, 13(19), 2522; https://doi.org/10.3390/healthcare13192522 - 4 Oct 2025
Viewed by 286
Abstract
Background: Caesarean section (CS) is a critical intervention, yet stark inequities in access persist across low- and middle-income countries (LMICs). Over the last decade, governments have introduced policies to eliminate or subsidize user fees; however, the collective impact of these initiatives on [...] Read more.
Background: Caesarean section (CS) is a critical intervention, yet stark inequities in access persist across low- and middle-income countries (LMICs). Over the last decade, governments have introduced policies to eliminate or subsidize user fees; however, the collective impact of these initiatives on utilization, equity, and financial protection has not been fully synthesized. Methods: We conducted a systematic review in line with PRISMA 2020 guidelines. Searches were conducted in PubMed, Dimensions, Google Scholar, Scopus, Web of Science, and government portals for studies published between 1 January 2009 and 30 May 2025. Eligible studies evaluated government-initiated financing reforms, including full user-fee exemptions, partial subsidies, vouchers, insurance schemes, and provider-payment restructuring. Two reviewers independently applied the PICOS criteria, extracted data using a 15-item template, and assessed the study quality. Given heterogeneity, results were synthesized narratively. Results: Thirty-seven studies from 28 LMICs were included. Most (70%) evaluated fee exemptions. Mixed-methods and cross-sectional designs predominated, while only six studies employed interrupted time series designs. Twenty-two evaluations (59%) reported increased CS uptake, ranging from a 1.4-fold rise in Senegal to a threefold increase in Kano State, Nigeria. Similar surges were also observed in non-African contexts such as Iran and Georgia, where reforms included incentives for vaginal delivery or punitive tariffs to curb overuse. Fourteen of 26 fee-exemption studies documented pro-rich or pro-urban drift, while catastrophic expenditure persisted for 12–43% of households, despite the implementation of “free” policies. Median out-of-pocket costs ranged from USD 14 in Burkina Faso to nearly USD 300 in Dakar’s slums. Only one study linked reforms to a reduction in neonatal mortality (a 30% decrease in Mali/Benin), while none demonstrated an impact on maternal mortality. Qualitative evidence highlighted hidden costs, delayed reimbursements, and weak accountability. At the same time, China and Bangladesh demonstrated how demographic reforms or voucher schemes could inadvertently lead to CS overuse or expose gaps in service readiness. Conclusions: Government-led financing reforms consistently increased CS volumes but fell short of ensuring equity, financial protection, or sustained quality. Effective initiatives combined fee removal with investments in surgical capacity, timely reimbursement, and transparent accountability. Future CS policies must integrate real-time monitoring of equity and quality and adopt robust quasi-experimental designs to enable mid-course correction. Full article
(This article belongs to the Special Issue Policy Interventions to Promote Health and Prevent Disease)
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12 pages, 694 KB  
Article
Polysomnographic Evidence of Enhanced Sleep Quality with Adaptive Thermal Regulation
by Jeong-Whun Kim, Sungjin Heo, Dongheon Lee, Joonki Hong, Donghyuk Yang and Sungeun Moon
Healthcare 2025, 13(19), 2521; https://doi.org/10.3390/healthcare13192521 - 4 Oct 2025
Viewed by 540
Abstract
Background/Objective: Sleep is a vital determinant of human health, where both its quantity and quality directly impact physical and mental well-being. Thermoregulation plays a pivotal role in sleep quality, as the body’s ability to regulate temperature varies across different sleep stages. This study [...] Read more.
Background/Objective: Sleep is a vital determinant of human health, where both its quantity and quality directly impact physical and mental well-being. Thermoregulation plays a pivotal role in sleep quality, as the body’s ability to regulate temperature varies across different sleep stages. This study examines the effects of a novel real-time temperature adjustment (RTA) mattress, which dynamically modulates temperature to align with sleep stage transitions, compared to constant temperature control (CTC). Through polysomnographic (PSG) assessments, this study evaluates how adaptive thermal regulation influences sleep architecture, aiming to identify its potential for optimizing restorative sleep. Methods: A prospective longitudinal cohort study involving 25 participants (13 males and 12 females; mean age: 39.7 years) evaluated sleep quality across three conditions: natural sleep (Control), CTC (33 °C constant mattress temperature), and RTA (temperature dynamically adjusted: 30 °C during REM sleep; 33 °C during non-REM sleep). Each participant completed three polysomnography (PSG) sessions. Sleep metrics, including total sleep time (TST), sleep efficiency, wake after sleep onset (WASO), and sleep stage percentages, were assessed. Repeated-measures ANOVA and post hoc analyses were performed. Results: RTA significantly improved sleep quality metrics compared to Control and CTC. TST increased from 356.2 min (Control) to 383.2 min (RTA, p = 0.030), with sleep efficiency rising from 82.8% to 87.3% (p = 0.030). WASO decreased from 58.2 min (Control) and 64.6 min (CTC) to 49.0 min (RTA, p = 0.067). REM latency was notably reduced under RTA (110.4 min) compared to Control (141.8 min, p = 0.002). The REM sleep percentage increased under RTA (20.8%, p = 0.006), with significant subgroup-specific enhancements in males (p = 0.010). Females showed significant increases in deep sleep percentage under RTA (12.3%, p = 0.011). Conclusions: Adaptive thermal regulation enhances sleep quality by aligning mattress temperature with physiological needs during different sleep stages. These findings highlight the potential of RTA as a non-invasive intervention to optimize restorative sleep and promote overall well-being. Further research could explore long-term health benefits and broader applications. Full article
(This article belongs to the Section Clinical Care)
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13 pages, 737 KB  
Article
Impact of the COVID-19 Pandemic on Hemato-Oncology Services: A Retrospective Dual-Center Cohort Study in Kazakhstan
by Maral Yerdenova, Aigulsum Izekenova, Akbope Myrkassymova, Gaukhar Mergenova, Mohammed Merzah, Balday Issenova, Maksat Mamyrkul, Aliya Atabayeva, Vytenis Kalibatas, Dejan Nikolic and Yineng Chen
Healthcare 2025, 13(19), 2520; https://doi.org/10.3390/healthcare13192520 - 4 Oct 2025
Viewed by 1035
Abstract
Background: Numerous healthcare services have been affected by the COVID-19 pandemic worldwide. Specialized healthcare services were postponed or canceled, potentially compromising regular services for hemato-oncology patients. The current study aimed to analyze the impact of the COVID-19 pandemic on access to hemato-oncology services [...] Read more.
Background: Numerous healthcare services have been affected by the COVID-19 pandemic worldwide. Specialized healthcare services were postponed or canceled, potentially compromising regular services for hemato-oncology patients. The current study aimed to analyze the impact of the COVID-19 pandemic on access to hemato-oncology services in Almaty, the largest city in Kazakhstan. Methods: We retrospectively analyzed the socio-demographic characteristics of patients admitted to two large tertiary centers rendering hemato-oncology services, the City Clinical Hospital 7 (H7) and the Kazakh Institute of Oncology and Radiology (KazIOR). All data were retrieved for the period spanning from 1 March 2019 to 28 February 2022. The retrieved variables included age, gender, type of residence, hospitalization rate, treatment outcomes (discharged/deceased), bed days, diagnoses according to International Classification of Diseases (ICD-10) (acute leukemia and hematopoietic depression, lymphoproliferative diseases, and myeloproliferative diseases), and referral sources (ambulance, another hospital, consultative and diagnostic assistance, primary healthcare, self-referral, and referrals from hematologists’ offices). Results: In the 2019–2022 period, 6763 hemato-oncology hospitalizations were registered: 3583 in H7 and 3180 in KazIOR. The mean age at hospitalization was 55.04 (SD = 16.07) for females and 51.2 (SD = 16.7) for males. The proportion of hospitalized urban and rural patients differed significantly: 6191 (92%) and 571 (8,4%), respectively (χ2 = 13.8, p = 0.001). In the 2020–2021 period, fewer patients were discharged (n = 2047) compared to 2019–2020 (n = 2387) and 2021–2022 (n = 2081) (χ2 = 20.09, p = 0.003). However, the proportion of deaths in the 2020–2021 period (3.5%) was higher than in the 2019–2020 (3.2%) and 2021–2022 periods (2.6%) (χ2 = 20.09, p = 0.003). A total of 403 (19%) hospital admissions were carried out by ambulance (emergency cases) in the 2020–2021 period, 368 (14.8%) in 2019–2020, and 394 (18.3%) in 2021–2022 (χ2 = 2231, p < 0.001). The number of patients transferred from other hospitals to H7 and KazIOR increased by 12.4% in the 2020–2021 period. Conclusions: Our findings indicate a negative impact of the COVID-19 pandemic on access to hemato-oncology services, leading to increased mortality. Further studies are warranted to explore factors underlying the trends in hospitalizations and mortality of hemato-oncology patients during healthcare crises. Full article
(This article belongs to the Collection COVID-19: Impact on Public Health and Healthcare)
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13 pages, 346 KB  
Article
Post-Traumatic Stress, Workplace Violence, Resilience, and Burnout: A Path Analysis Among Korean Paramedics
by Jieun Sung and Nayoon Lee
Healthcare 2025, 13(19), 2519; https://doi.org/10.3390/healthcare13192519 - 4 Oct 2025
Viewed by 370
Abstract
Background/Objectives: Paramedics frequently encounter potentially traumatic events and workplace violence, increasing their risk of burnout. Resilience may attenuate these effects. We examined the pathways through which post-traumatic stress (PTS) and workplace violence influence burnout and clarified the role of resilience among Korean [...] Read more.
Background/Objectives: Paramedics frequently encounter potentially traumatic events and workplace violence, increasing their risk of burnout. Resilience may attenuate these effects. We examined the pathways through which post-traumatic stress (PTS) and workplace violence influence burnout and clarified the role of resilience among Korean paramedics. Methods: We studied duty-related trauma and violence experienced by 208 Busan Fire Department paramedics using standardized measures of PTS, workplace violence, resilience, and burnout. Using structural equation modeling, we tested the direct and indirect effects; covariates included sex, nursing license, and intention to stay. Results: PTS was most strongly associated with burnout, whereas workplace violence was indirectly associated with burnout through PTS. Resilience reduced PTS, yielding an indirect protective effect on burnout; however, it had no direct effect on burnout. Holding a nursing license and lack of intention to stay were significantly associated with burnout, and female sex and lack of intention to stay were indirectly associated with burnout via PTS. Conclusions: Burnout is primarily driven by PTS, and workplace violence amplifies PTS and indirectly exacerbates burnout. Strengthening violence prevention/response systems, early PTS screening/treatment, and resilience-building programs is warranted, with targeted support for vulnerable subgroups. Full article
(This article belongs to the Topic New Research in Work-Related Diseases, Safety and Health)
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19 pages, 366 KB  
Article
A Quasi-Experimental Hip-Hop-Based Program to Improve Motor Competence and Physical Activity in Preschoolers in Portugal: The “Grow+” Program
by Cristiana Mercê, Sofia Bernardino, Neuza Saramago, Marco Branco and David Catela
Healthcare 2025, 13(19), 2518; https://doi.org/10.3390/healthcare13192518 - 4 Oct 2025
Viewed by 800
Abstract
Background/Objectives: Dance, particularly hip-hop, offers a dynamic means of fostering physical activity (PA) and encouraging movement in health-related initiatives among children and youth in educational environments. Hip-hop offers benefits across motor, physical, social, and mental domains. Given the importance of PA in [...] Read more.
Background/Objectives: Dance, particularly hip-hop, offers a dynamic means of fostering physical activity (PA) and encouraging movement in health-related initiatives among children and youth in educational environments. Hip-hop offers benefits across motor, physical, social, and mental domains. Given the importance of PA in early development, and the preschool period as a sensitive phase for acquiring motor skills, this study aimed to examine the effects of the “Grow+” hip-hop program on motor competence (MC), perceived motor coordination (PMCoor), and PA levels in preschoolers. Methods: A quasi-experimental within-subjects design was used, including 37 children aged 3 to 4 (M = 4.29 ± 0.58). The intervention included two 4-week hip-hop periods, separated by a 4-week break. Four assessments were conducted using the MCA battery (MC), PA’s pictorial scales, and questionnaires completed by caregivers and educators (PMCoor). Data were analyzed using repeated measures ANOVA and Spearman correlations. Results: MC and PA levels showed a nonsignificant but positive trend across the study. Significant improvements in MC were observed during intervention periods, while no significant changes occurred during the break. Educators’ perceptions of PMCoor remained unchanged, despite improvements in MC. Conclusions: The findings suggest that the “Grow+” hip-hop program contributed meaningfully to improvements in MC and PA levels among children in early childhood. These findings accentuate the potential efficacy of structured rhythmic movement interventions in promoting motor development throughout early childhood, thereby supporting their integration into early childhood education curricula. Full article
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