Healthcare

15 pages, 239 KiB

Open AccessArticle

Associations Between Domains and Patterns of Sedentary Behavior with Sleep Quality and Duration in Pregnant Women

by Nada Khojah, Bethany Barone Gibbs, Saja Abdullah Alghamdi, Alawyah Alsalman, Om Kalthom Sowadi, Hadeel Saad, Ghareeb Omar Alshuwaier and Abdullah Bandar Alansare

Healthcare 2025, 13(3), 348; https://doi.org/10.3390/healthcare13030348 - 6 Feb 2025

Viewed by 708

Abstract

Objectives: To assess the associations of sedentary behavior (SB) with sleep quality and duration in pregnant women by trimesters and to consider SB domains and patterns. Methods: This investigation included 935 participants (age = 30.0 ± 5.6 years; first trimester = 24.1%, second [...] Read more.

Objectives: To assess the associations of sedentary behavior (SB) with sleep quality and duration in pregnant women by trimesters and to consider SB domains and patterns. Methods: This investigation included 935 participants (age = 30.0 ± 5.6 years; first trimester = 24.1%, second trimester = 33.9%, third trimester = 42.0%). The total, domains (leisure, occupational, commuting), and patterns (weekdays, weekends) of SB, as well as sleep quality and duration, were self-reported. Adjusted logistic regression models examined the associations of different SBs with the risk of poor sleep quality, not adhering to sleep duration guidelines (7–9 h/day), or being a short- or long-sleeper. Results: The odds of poor sleep quality were significantly higher by 14.2% and 7.4% for each hour increase in total and leisure SB on weekends, respectively. The odds of not adhering to sleep duration guidelines were significantly higher by 5.5% and 11.4% for each hour increase in total and leisure SB during weekdays, respectively; paradoxically, the odds of not complying with the sleep duration guidelines were significantly lower, ranging between 6.6% and 34.4% for each hour increase in total, leisure, or commuting SB on weekends. Further, when analyzed separately, the likelihood of being a short- or long-sleeper was highly variable across SB domains, with associations being more apparent in the first and third trimesters. Conclusions: The relationship between SB and healthy sleep during pregnancy was complex. These variable findings underscore the importance of considering domains and patterns of SB beyond simple total durations in future research to inform interventions and guidelines to improve sleep health during pregnancy. Full article

(This article belongs to the Special Issue Healthy Lifestyle for Pregnant and Postpartum Women)

16 pages, 787 KiB

Open AccessArticle

A Cross-Sectional Survey on the Management of Medication Adherence Among Healthcare Professionals in Saudi Arabia

by Wael Y. Khawagi, Fahad H. Baali, Norah M. Alnefaie, Shatha A. Albishi, Alla H. Al-swat, Dinan A. Alshahrani, Ragad A. Alshemaimri and Abdullah A. Alshehri

Healthcare 2025, 13(3), 347; https://doi.org/10.3390/healthcare13030347 - 6 Feb 2025

Viewed by 1079

Abstract

Background/Objectives: Medication adherence is essential for effective healthcare, significantly influencing treatment success and overall health outcomes. However, there is limited understanding of how healthcare professionals in Saudi Arabia manage and support medication adherence. This study aims to examine physicians’ and pharmacists’ approaches to [...] Read more.

Background/Objectives: Medication adherence is essential for effective healthcare, significantly influencing treatment success and overall health outcomes. However, there is limited understanding of how healthcare professionals in Saudi Arabia manage and support medication adherence. This study aims to examine physicians’ and pharmacists’ approaches to managing medication adherence in Saudi Arabia by examining the methods used for adherence assessment, interventions to enhance adherence, and the challenges faced. Methods: A cross-sectional study was conducted over nine months using a self-administered online questionnaire. The study targeted physicians and pharmacists actively working in Saudi Arabia. The questionnaire was distributed through professional networks to ensure a broad and representative sample. Results: A total of 397 healthcare professionals met the inclusion criteria, comprising 81.1% pharmacists and 18.9% physicians. Direct patient inquiry was the most common assessment method, frequently or always used by 81.3% of physicians and 57.1% of pharmacists. Treatment response evaluation was similarly frequent (89.3% of physicians and 56.2% of pharmacists). Standardized tools, such as the Morisky Medication Adherence Scale, were underutilized (14.7%). Adherence-enhancing interventions focused on patient education, and their use was reported by 89.3% of physicians and 74.2% of pharmacists as frequent or always. Written information was more commonly used by pharmacists (65.8%) than physicians (45.3%). Barriers included excessive workloads and short consultation times (59.9%), absence of effective systems for tracking adherence (51.9%), lack of reliable tools for assessing adherence (48.9%), and insufficient training in behavioral interventions (48.1%). Conclusions: This study reveals significant differences in medication adherence management practices between physicians and pharmacists in Saudi Arabia, emphasizing their distinct roles. Key barriers, including excessive workload, limited consultation time, and inadequate tracking systems, hinder the adoption of evidence-based tools. Tailored interventions, enhanced interprofessional collaboration, and systemic support are essential to address these challenges and improve adherence management, ultimately enhancing patient outcomes. Full article

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14 pages, 903 KiB

Open AccessArticle

Coping and Positive Body Image in Young Women with Breast Cancer: The Buffering Role of Social Support

by Márcia Almeida, Maria Inês Griff and Tânia Brandão

Healthcare 2025, 13(3), 346; https://doi.org/10.3390/healthcare13030346 - 6 Feb 2025

Viewed by 720

Abstract

Background/Objectives: Considering the unique body image challenges faced by young women with breast cancer, this study aims to deepen our understanding of how coping strategies and perceived social support contribute to fostering positive body image in this population. This is an important [...] Read more.

Background/Objectives: Considering the unique body image challenges faced by young women with breast cancer, this study aims to deepen our understanding of how coping strategies and perceived social support contribute to fostering positive body image in this population. This is an important issue as body image is capable of influencing women’s self-esteem and psychological adaptation to breast cancer. Methods: A sample of 157 young women with breast cancer (M age = 41.43; SD = 6.05; Min 26 years, Max 50 years), 43% of whom had undergone breast reconstruction, completed an online survey. The survey included measures of coping strategies, positive body image, and perceived social support. Results: No significant differences in coping strategies, perceived social support, or positive body image were observed based on reconstruction status. Moderation analyses revealed that both avoidant and problem-focused coping were significantly associated with positive body image at moderate and high levels of perceived social support, but not at low levels of perceived social support. Perceived social support moderated the relationship between coping strategies and positive body image in women with breast cancer. Conclusions: These findings highlight the importance of social support in enhancing the effectiveness of both avoidant and problem-focused coping strategies in promoting positive body image. Future interventions should prioritize strengthening social support networks to optimize psychological outcomes in this population. Full article

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16 pages, 247 KiB

Open AccessArticle

Barriers to Providing Optimal Care in Idaho from the Perspective of Healthcare Providers: A Descriptive Analysis

by Alexis A. Ericsson, Allie D. McCurry, Lucas A. Tesnohlidek, B. Kelton Kearsley, Morgan L. Hansen-Oja, Gillian C. Glivar, Allie M. Ward, Kathryn J. Craig, Eva B. Chung, Skyler J. Smith, Tabarak O. Alomar, Luke A. La Mue, Karina S. Lopez, Jake R. Goodwin, Thinh T. Kieu, Audrey J. Dingel, Catherine M. Rockwell Hill, Madeline P. Casanova, Jonathan D. Moore, Ryan Wiet and Russell T. Baker Show full author list Hide full author list

Healthcare 2025, 13(3), 345; https://doi.org/10.3390/healthcare13030345 - 6 Feb 2025

Viewed by 1234

Abstract

Background/Objectives: Few studies have assessed barriers to providing care from the perspective of interprofessional healthcare providers. Despite Idaho’s predominantly rural geography, limited research exists assessing barriers to providing care within the state. This study sought to assess barriers to providing optimal healthcare [...] Read more.

Background/Objectives: Few studies have assessed barriers to providing care from the perspective of interprofessional healthcare providers. Despite Idaho’s predominantly rural geography, limited research exists assessing barriers to providing care within the state. This study sought to assess barriers to providing optimal healthcare using a sample of 400 healthcare providers at 22 clinic sites across the state. Methods: A barriers to providing optimal care 9-factor, 41-item survey was modified from an existing survey. Healthcare providers rated barrier items using an 11-point Likert scale. The survey was distributed to a convenience sample of healthcare providers in 22 different clinic sites in rural Idaho. Results: Four hundred interprofessional healthcare providers in Idaho across 13 professional disciplines completed surveys. Items in the Service Access (mean = 7.14), Patient Complexity (mean = 6.59), and Resource Limitations (mean = 6.18) factors were reported as the most commonly perceived barriers to providing optimal care. Conclusions: Few studies have assessed rural interprofessional providers’ perceived barriers to providing optimal, high-quality, care, specifically in the rural state of Idaho, where healthcare services are often not equitable compared to urban regions. The results suggest that commonly perceived barriers exist throughout the state, particularly Service Access, Patient Complexity, and Resource Limitations. Further research is needed to develop data-driven decisions to address these concerns. Full article

16 pages, 255 KiB

Open AccessArticle

How People in Eight European Countries Felt About the Safety, Effectiveness, and Necessity of COVID-19 Vaccination: A Cross-Sectional Survey

by Kristien Coteur, Marija Zafirovska, Aleksandar Zafirovski, Jelena Danilenko, Heidrun Lingner, Felix Bauch, Christine Brütting, Nicola Buono, Vanja Lazic, Liljana Ramasaco, Vija Silina, Lara-Marie Fuehner and Michael Harris

Healthcare 2025, 13(3), 344; https://doi.org/10.3390/healthcare13030344 - 6 Feb 2025

Viewed by 735

Abstract

Background/objectives: Attitudes towards COVID-19 vaccination vary globally, influenced by political and cultural factors. This research aimed to assess the views of people without a healthcare qualification in Europe on COVID-19 vaccination safety, effectiveness, and necessity as well as how well informed they felt. [...] Read more.

Background/objectives: Attitudes towards COVID-19 vaccination vary globally, influenced by political and cultural factors. This research aimed to assess the views of people without a healthcare qualification in Europe on COVID-19 vaccination safety, effectiveness, and necessity as well as how well informed they felt. The secondary outcomes focused on how respondents’ views were affected by demographic and context factors and included a comparison by country of the level of feeling well informed. Methods: A mixed-method cross-sectional online survey in eight European countries, using convenience sampling. Results: A total of 1008 adults completed the survey, 60% of whom were female. While only 44.1% considered the vaccines safe, 43.5% effective, and 44.9% necessary, 80.0% had been vaccinated. Four in ten adults strongly agreed that they were well informed, while over a quarter did not answer the question. Younger respondents, well-informed individuals, and German respondents were more inclined to perceive COVID-19 vaccination as both effective and necessary. Conclusions: Motivations for vaccination included perceived health and social benefits, while concerns included a preference for “natural immunity”, the rapid development of the vaccine, and potential unknown long-term effects. A correlation existed between respondents feeling well informed about the different COVID-19 vaccines in their country and the likelihood of having been vaccinated. Full article

(This article belongs to the Section Coronaviruses (CoV) and COVID-19 Pandemic)

16 pages, 1043 KiB

Open AccessArticle

Anxiety and Depression and Related Risk Factors in Italian Healthcare Providers Involved in Adverse Events

by Isolde Martina Busch, Maria Angela Mazzi, Fiammetta Cosci, Loretta Berti, Veronica Marinelli, Francesca Moretti, Olga Maggioni, Albert W. Wu and Michela Rimondini

Healthcare 2025, 13(3), 343; https://doi.org/10.3390/healthcare13030343 - 6 Feb 2025

Viewed by 625

Abstract

Background/Objectives: Despite the importance of the second victim phenomenon for healthcare systems, there is limited research on Italian healthcare providers. We assessed emotional distress in individuals impacted by an adverse event using the Withstand-PSY Questionnaire (WS-PSY-Q). Additionally, we aimed to identify potential risk [...] Read more.

Background/Objectives: Despite the importance of the second victim phenomenon for healthcare systems, there is limited research on Italian healthcare providers. We assessed emotional distress in individuals impacted by an adverse event using the Withstand-PSY Questionnaire (WS-PSY-Q). Additionally, we aimed to identify potential risk factors for anxiety and depression. Methods: A cross-sectional online survey of 284 participants. Measures included the WS-PSY-Q, Beck Depression Inventory-II (BDI-II), and State-Trait Anxiety Inventory (STAI-Y). Descriptive analyses and seemingly unrelated regression, jointly estimating anxiety and depression, were conducted using Stata (version 18). Results: Fifty-nine percent of the participants tested positive for anxiety (WS-PSY-Q anxiety subscale ≥ 16), thirty-seven percent for depression (WS-PSY-Q depression subscale ≥ 22), and thirty-five percent for both. In the final model, anxiety symptoms following the adverse event were associated with pre-event anxiety levels (p < 0.01), seeking psychological help (p < 0.05), self-perceived responsibility (p < 0.01), severity of the adverse event for the patient (p < 0.05), and punitive workplace climate (p < 0.05). Correlates of post-event depressive symptoms included pre-existing depression (p < 0.01), self-perceived responsibility (p < 0.01), severity of the impact of the adverse event (p < 0.01), punitive or neutral workplace climate (p < 0.05), and seeking psychological help (p < 0.01). Conclusions: This study adds to the growing understanding of the mental health difficulties that healthcare workers in Italy encounter after adverse events, addressing both individual and systemic risk factors. Proactive implementation of mental health measures for healthcare workers could foster their well-being after adverse events and promote a stronger, more just organizational culture. Full article

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10 pages, 814 KiB

Open AccessArticle

Risk and Preventive Measures Among Older Adults in Nursing Homes in Saudi Arabia: An Exploratory Study on Falls

by Hmoud M. Aljarbou, Alia M. Almoajel, Mohammed M. Althomali and Khaled M. Almutairi

Healthcare 2025, 13(3), 342; https://doi.org/10.3390/healthcare13030342 - 6 Feb 2025

Viewed by 724

Abstract

Background: Falls among older adults are a pervasive and significant concern worldwide. A practice guideline has been developed to address the prevention of falls and their resulting consequences in hospital and long-term care settings. Aim: The study aimed to assess the fall down [...] Read more.

Background: Falls among older adults are a pervasive and significant concern worldwide. A practice guideline has been developed to address the prevention of falls and their resulting consequences in hospital and long-term care settings. Aim: The study aimed to assess the fall down rate and preventive tools among older adult patients in nursing homes. Methods: A cross-sectional study was conducted on randomly selected older adult patients by using a questionnaire with the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool in nursing homes at the Ministry of Human Resource and Social Development. Results: Among 323 older adult patients, most of them (73.1%) were male, 23.8% were from Makkah, and the age ranged from 60 to 90 years and older. Results showed that 64.8% had a psychiatric disorder, 41.8% had hypertension, 38.4% had diabetes, 38.1% had movement disorders, 11.3% had heart diseases, and 1.5% had no chronic conditions. The mean STEADI tool score was 3.5 out of 12, and of the 323 older adult patients, 51.7% had a low risk to fall and 48.3% had a high risk to fall. Of the 13 interventions used to prevent falls, the most used intervention was rehabilitative physical therapy, followed by providing patient facilities and muscle strengthening exercises. Conclusions: The level of falls was markedly low, and a significant correlation was observed between the risk of falling and the participants’ region of residence. Full article

(This article belongs to the Collection Health Care and Services for Elderly Population)

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12 pages, 706 KiB

Open AccessProtocol

A Protocol for Enhancing Allied Health Care for Older People in Residential Care: The EAHOP Intervention

by Stephen Isbel, Nathan M. D’Cunha, Lara Wiseman, Paresh Dawda, Sam Kosari, Claire Pearce, Angela Fearon, Faran Sabeti, Jennifer Hewitt, Jane Kellett, Mark Naunton, Helen Southwood, Pip Logan, Ramanathan Subramanian, Neil H. Chadborn, Rachel Davey, Kasia Bail, John R. Goss, Ananthan Ambikairajah, Michelle Lincoln, Helen Holloway and Diane Gibson Show full author list Hide full author list

Healthcare 2025, 13(3), 341; https://doi.org/10.3390/healthcare13030341 - 6 Feb 2025

Viewed by 1259

Abstract

Background: Complications due to frailty and injury after falls are a significant problem for people living in residential aged care. This can lead to a range of negative outcomes including poor physical, social, and psychological well-being. The Australian Royal Commission into Aged Care [...] Read more.

Background: Complications due to frailty and injury after falls are a significant problem for people living in residential aged care. This can lead to a range of negative outcomes including poor physical, social, and psychological well-being. The Australian Royal Commission into Aged Care Quality and Safety highlighted many aspects of care in residential aged care homes requiring improvement, leading to specific recommendations aimed at improving the outcomes in this area. This contributed to four recommendations calling for increased allied health interventions to meet the unmet needs in residential aged care. This intervention aims to implement and evaluate evidence-based allied health interventions for people living in residential aged care specifically relating to frailty, preventing falls, and maintaining engagement in everyday activities. Method: This is a pragmatic, non-randomised, pre–post design study where six groups of up to 10 residents of an aged care home will start the intervention at staggered times. The EAHOP intervention is an integrated application of a suite of allied health services (occupational therapy, physiotherapy, dietetics, speech pathology, pharmacy, and optometry), with general practitioner involvement, using allied health assistants in an integrated transdisciplinary model of care. The baseline period is 6 weeks, and intervention is a maximum of 36 weeks with follow-up at 12 and 24 weeks. Primary outcomes measure changes in falls, frailty, and quality of life. A qualitative program evaluation will be completed as well as an economic analysis. Conclusion: The results of the study will provide information about the clinical, implementation, and effectiveness outcomes of this integrated, transdisciplinary allied health service model for people living in residential aged care. The results will be used to develop evidence-informed guidelines for residential aged care providers on the delivery of allied health services. Full article

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18 pages, 1257 KiB

Open AccessArticle

Severity Benchmarks for the Level of Personality Functioning Scale—Brief Form 2.0 (LPFS-BF 2.0) in Polish Adults

by Karolina Juras, Mateusz Mendrok, Janusz Pach and Marcin Moroń

Healthcare 2025, 13(3), 340; https://doi.org/10.3390/healthcare13030340 - 6 Feb 2025

Viewed by 896

Abstract

Background/Objectives: The Level of Personality Functioning Scale—Brief Form 2.0 (LPFS-BF 2.0) is a self-report screening measure of personality impairments according to the DSM-5 Alternative Model for Personality Disorders and the ICD-11 classification of personality disorders. Nevertheless, reliable cut-off scores that could help in [...] Read more.

Background/Objectives: The Level of Personality Functioning Scale—Brief Form 2.0 (LPFS-BF 2.0) is a self-report screening measure of personality impairments according to the DSM-5 Alternative Model for Personality Disorders and the ICD-11 classification of personality disorders. Nevertheless, reliable cut-off scores that could help in clinical decision making are still lacking for many populations. The aim of this study was to develop severity benchmarks of the LPFS-BF 2.0 for a Polish population based on the item response theory (IRT) approach. Methods: A sample of Polish adults (n = 530) took part in the study. The participants assessed their personality functioning and pathological personality traits and provided information about psychiatric diagnosis and psychotherapy seeking. The severity benchmarks were developed using IRT and validated using mean and frequency comparisons between groups of different personality impairments according to the developed cut-offs. Results: Confirmatory factor analysis (CFA) supported a unidimensional model of the LPFS-BF 2.0. The graded IRT model indicated satisfactory item functioning for all LPFS-BF 2.0 items. The normative observed score thresholds at different latent severity levels of personality impairments were developed, and significant overall differences were found between the LPFS-BF 2.0 norm-based severity benchmarks in pathological personality traits and psychotherapy seeking. Conclusions: The IRT-based cut-offs for the LPFS-BF 2.0 identified individuals high on pathological personality traits (particularly disinhibition) and were predictive of psychotherapy seeking. The developed severity benchmarks allow for the interpretation of LPFS-BF 2.0 scores, supporting clinical diagnosis and relevant decision making in the Polish population. Practical implications for healthcare practice and research are being discussed. Full article

(This article belongs to the Special Issue Psychological Diagnosis and Treatment of People with Mental Disorders)

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19 pages, 1350 KiB

Open AccessArticle

Current Practices of Haemodynamic Monitoring in High-Risk Surgical Patients: A Nationwide Survey Among Malaysian Anaesthesiologists

by Syarifah Noor Nazihah Sayed Masri, Iskandar Khalid, Weng Ken Chan, Azarinah Izaham, Qurratu Aini Musthafa, Mohd Fitry Zainal Abidin, Siti Nadzrah Yunus, Ina Ismiarti Shariffuddin, Afifah Samsudin, Mohd Zulfakar Mazlan and Maxime P. Cannesson

Healthcare 2025, 13(3), 339; https://doi.org/10.3390/healthcare13030339 - 6 Feb 2025

Viewed by 645

Abstract

Background: Advanced haemodynamic monitoring has been recommended for use in high-risk surgeries and high-risk patients undergoing surgery. This study aims to assess the current practices of haemodynamic monitoring in high-risk surgical patients among Malaysian anaesthesiologists. Methodology: This is a cross-sectional survey among Malaysian [...] Read more.

Background: Advanced haemodynamic monitoring has been recommended for use in high-risk surgeries and high-risk patients undergoing surgery. This study aims to assess the current practices of haemodynamic monitoring in high-risk surgical patients among Malaysian anaesthesiologists. Methodology: This is a cross-sectional survey among Malaysian anaesthesiologists, following approval from the institution’s Medical Research Ethics Committee and the National Medical Research Register. The survey utilised a questionnaire developed by Cannesson et al. to gather demographic data, practice information, and haemodynamic monitoring practices. Statistical analysis was performed using SPSS, and results were presented as the mean, median, or frequency as appropriate. Results: A total of 366 participants responded to the questionnaire, and 2 dropped out due to an incomplete form. This study found differences in the frequency of haemodynamic optimisation and monitoring techniques used in different healthcare settings. Written protocols or statements concerning haemodynamic management in high-risk surgical cases were only available to 15.7% of participants in the institution. The overall utilisation rate of cardiac output monitoring was found to be 31.1%, with a significant majority of the usage observed in university hospitals (p < 0.001). Central venous pressure was more commonly used in university hospitals and private hospitals compared to public hospitals (p < 0.001). The usage of advanced parameters such as stroke volume variation, cardiac index, and systemic vascular resistance was significantly higher in university hospitals, with a p value < 0.001. Transthoracic echocardiography was the most common tool used for high-risk surgical patients. The primary reasons for participants not utilising cardiac output monitoring include the lack of availability of such monitoring in their respective settings, which constitutes 66.9% of the respondents. The overwhelming majority of participants, namely 98%, expressed the belief that there is room for improvement in their present haemodynamic care. Conclusions: This study offers significant insights into the prevailing haemodynamic monitoring practices employed by Malaysian anaesthesiologists in the context of high-risk surgical patients. The findings have the potential to contribute to future educational initiatives and establish practice standards for haemodynamic monitoring in high-risk surgical procedures. Full article

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19 pages, 309 KiB

Open AccessArticle

Differences in Provider Beliefs and Delivery of the 5As for Cigarette and Non-Cigarette Tobacco Use Between Two Types of Healthcare Centers Serving Rural and/or Medically Underserved Areas of Texas, US

by Ammar D. Siddiqi, Brian J. Carter, Maggie Britton, Tzuan A. Chen, Isabel Martinez Leal, Asfand B. Moosa, Teresa Williams, Kathleen Casey, Hector Sanchez and Lorraine R. Reitzel

Healthcare 2025, 13(3), 338; https://doi.org/10.3390/healthcare13030338 - 6 Feb 2025

Viewed by 791

Abstract

Background/Objectives: Rural populations in the US bear a disproportionate burden of cancer mortality, which may be partly due to their elevated tobacco use and the limited receipt of tobacco use interventions in rural healthcare settings. Here, we examine providers’ use of the 5As [...] Read more.

Background/Objectives: Rural populations in the US bear a disproportionate burden of cancer mortality, which may be partly due to their elevated tobacco use and the limited receipt of tobacco use interventions in rural healthcare settings. Here, we examine providers’ use of the 5As (Ask, Advise, Assess, Assist, and Arrange), a brief tobacco cessation intervention, with their patients to assess intervention gaps. Methods: Provider practices in substance use treatment centers (SUTCs) and medical healthcare centers (MHCs), each serving rural and/or medically underserved areas (MUAs) of Texas, were compared. In total, 347 providers from 10 SUTCs (n = 174) and 9 MHCs (n = 173) responded to an anonymized survey about their cigarette and non-cigarette screening and intervention delivery, along with their perceived importance and workforce’s preparedness to help patients stop using tobacco. Linear mixed and generalized linear mixed models were used to assess differences between practices at SUTCs and MHCs. Results: More MHC than SUTC providers reported that cigarette and non-cigarette tobacco use cessation intervention were (respectively) important parts of their job (p = 0.0009; p = 0.0023) and that their workforce was prepared to help their patients quit tobacco (p = 0.0275), although less than half of all respondents endorsed preparedness. Relative to those at SUTCs, MHC providers reported higher rates of asking (SUTCs = 59.57% and MHCs = 77.21%; p = 0.0182) and advising (SUTCs = 45.34% and MHCs = 72.35%; p = 0.0017) their patients to quit cigarette smoking and advising them to quit non-cigarette tobacco products (SUTCs = 43.94% and MHCs = 71.76%; p = 0.0016). Conclusions: Overall, providers in both settings may benefit from greater preparation to deliver tobacco cessation care; needs were more prevalent within SUTCs than MHCs. Our findings can inform strategic planning to improve centers’ capacity to comprehensively address their patients’ tobacco use in rural/MUAs of Texas, US. Full article

(This article belongs to the Section Preventive Medicine)

16 pages, 4288 KiB

Open AccessArticle

A Decade of Change in Peritoneal Dialysis in Brazil: Challenges and Perspectives in the Public Health System

by José A. Moura-Neto, Luís Gustavo Modelli de Andrade, Ana Flávia Moura and Constança Margarida Sampaio Cruz

Healthcare 2025, 13(3), 337; https://doi.org/10.3390/healthcare13030337 - 6 Feb 2025

Viewed by 858

Abstract

Background/Objectives: The Brazilian Constitution defines health as a universal right and a State responsibility, with the Unified Public Health System (SUS) ensuring free access to comprehensive care, including renal replacement therapies (RRTs) such as dialysis and kidney transplantation. This study aimed to analyze [...] Read more.

Background/Objectives: The Brazilian Constitution defines health as a universal right and a State responsibility, with the Unified Public Health System (SUS) ensuring free access to comprehensive care, including renal replacement therapies (RRTs) such as dialysis and kidney transplantation. This study aimed to analyze trends in peritoneal dialysis (PD) usage within Brazil’s public health system over a 10-year period, focusing on geographic, demographic, and clinical changes. Methods: Using data from DATASUS and the Brazilian Society of Nephrology Dialysis Census, we analyzed PD usage and patient characteristics from 2014 to 2023. This methodology enabled an in-depth examination of shifts in RRT trends across regions and patient demographics. Results: PD usage declined from 6.5% in 2014 to 4.3% in 2023, with the steepest reductions observed in the North and Northeast regions. Usage increased in the Central-West region, while the Southeast and South experienced steady declines from 2016 to 2023. The proportion of centers offering PD decreased from 51.6% in 2014 to 37.9% in 2023. Over time, the average age of PD patients increased, as did the proportion of Brown/Black individuals receiving PD. Despite these shifts, patient serum levels of hemoglobin, parathyroid hormone, and phosphorus remained stable. Conclusions: This study highlights a relative decline in PD availability and use within Brazil’s public health system, with notable regional disparities. These findings underscore the urgent need for targeted policies to support PD infrastructure, funding, and training to ensure equitable access to RRT across the country. Full article

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15 pages, 833 KiB

Open AccessArticle

Influence of Gender Role on Resilience and Positive Affect in Female Nursing Students: A Cross-Sectional Study

by L. Iván Mayor-Silva, Guillermo Moreno, Alfonso Meneses-Monroy, Patricia Martín-Casas, Marta M. Hernández-Martín, Antonio G. Moreno-Pimentel and Leyre Rodríguez-Leal

Healthcare 2025, 13(3), 336; https://doi.org/10.3390/healthcare13030336 - 6 Feb 2025

Viewed by 1142

Abstract

Introduction: Women experience more social barriers, gender stereotypes, biases, and discrimination than men, which can increase their vulnerability to mental health problems. Therefore, it is essential to adopt a gender perspective in research on nursing students, examining the impact of these factors [...] Read more.

Introduction: Women experience more social barriers, gender stereotypes, biases, and discrimination than men, which can increase their vulnerability to mental health problems. Therefore, it is essential to adopt a gender perspective in research on nursing students, examining the impact of these factors on their well-being and psychological resources like resilience. This study aims to analyze the relationship between gender roles in resilience and positive or negative affect among female nursing students. Methods: A cross-sectional study was conducted with first- and fourth-year female nursing students at a public university in Madrid, Spain. Sociodemographic variables, positive and negative affect (PANAS scale), resilience (CD-RISC scale), and gender roles (BRSI inventory) were analyzed. ANOVA, correlation analysis, and linear regression models were used to study the relationships between variables. Results: The study included 338 students with a mean age of 21.43 years, of which 80.2% had a high level of resilience, with a positive affect score of 31.96 (SD: 7.34) and a negative affect score of 22.99 (SD: 7.35). Overall, 48.5% had undifferentiated roles, 23.7% feminine roles, 14.2% androgynous roles, and 13.6% masculine roles. Female students with masculine and androgynous roles showed higher resilience levels (93.48% and 97.92%) compared to those with feminine and undifferentiated roles (81.25% and 70.73%) (p < 0.001). Female students with androgynous and masculine roles showed higher positive affect levels compared to those with feminine and undifferentiated roles (p < 0.001), with no differences in negative affect. These results were observed in both first- and fourth-year students. A high correlation was found between masculine roles and positive affect and resilience in both first- and fourth-year students. Conclusions: Gender roles influence positive affect and resilience in females. Among female nursing students, androgynous and masculine roles are associated with higher levels of resilience and positive affect compared to feminine and undifferentiated roles. Differences in psychological well-being may be related to socially constructed gender roles rather than biological sex, with masculine roles enhancing resilience and feminine roles correlating with greater vulnerability. Full article

(This article belongs to the Special Issue Sexuality, Health, and Gender)

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18 pages, 243 KiB

Open AccessArticle

Examining Burnout Among Intern Physicians During the COVID-19 Pandemic: Insights and Solutions from Qualitative Research

by Vithawat Surawattanasakul, Wuttipat Kiratipaisarl, Vitchayut Phetsayanavin, Chantarateera Pholvivat, Natcha Auernaruemonsuk, Chanon Lamlert, Warisa Soonthornvinit, Lakkana Hengboriboon and Penprapa Siviroj

Healthcare 2025, 13(3), 335; https://doi.org/10.3390/healthcare13030335 - 6 Feb 2025

Viewed by 882

Abstract

Background/Objectives: The extensive exposure of physicians to the COVID-19 pandemic has contributed to occupational stress and burnout in their daily lives. This study aimed to explore the lived experiences of intern physicians who experienced burnout during the COVID-19 pandemic and to identify potential [...] Read more.

Background/Objectives: The extensive exposure of physicians to the COVID-19 pandemic has contributed to occupational stress and burnout in their daily lives. This study aimed to explore the lived experiences of intern physicians who experienced burnout during the COVID-19 pandemic and to identify potential solutions to enhance clinical practices in future pandemics. Methods: This study employed a qualitative, phenomenological study utilizing in-depth interviews. The participants were 19 first-year intern physicians from public hospitals in Thailand, selected through a purposeful sampling approach who had experienced burnout. Semi-structured interviews were conducted face-to-face and via online platforms. A thematic narrative analysis approach was used. Results: Phenomenological explorations included two parts: the first explored physicians’ workplace conditions while providing patient care, and the second focused on their proposed solutions for policy changes in clinical practices and hospital management. Four main themes in the first part were derived: (1) emotional suffering and burnout; (2) engaging with a high-intensity workplace; (3) hostile work environments; and (4) deterioration of relationships with staff and colleagues. The second part identified three main themes: (1) changes in policy of clinical practices; (2) effective hospital management; and (3) building interpersonal skills. Conclusions: The COVID-19 pandemic has exacerbated challenges faced by intern physicians, such as high-pressure working conditions, deteriorated relationships with colleagues, and ineffective management, all of which contribute to burnout. These challenges require targeted policy changes in clinical practices, effective hospital management, and building interpersonal skills. Recommendations include improved clinical practices, increased academic support, comprehensive orientation programs, effective communication, teamwork assistance, stress management, and transforming organizational culture to value physicians during internships. Full article

(This article belongs to the Special Issue Exploring the Burden on the Healthcare Service Sector Arising from Occupational Injury and Psychological Distress Caused by Poor Work Environments)

12 pages, 407 KiB

Open AccessArticle

Impact of a 10-Week Aqua Fitness Intervention on Physical Fitness and Psychosocial Measures in Inactive Healthy Adult Women

by Athanasios A. Dalamitros, Aristotelis Kouloglou, Giorgos Nasoufidis, Kleopatra Stogiannidou, Nur Eradli and Vasiliki Manou

Healthcare 2025, 13(3), 334; https://doi.org/10.3390/healthcare13030334 - 6 Feb 2025

Viewed by 694

Abstract

Background/objectives: Previous studies on aquatic exercises have primarily focused on either physical fitness or psychological outcomes. This study examines the effects of a structured 10-week aqua fitness program on physical fitness and psychosocial outcomes in healthy adult women. Additionally, a 4-week training [...] Read more.

Background/objectives: Previous studies on aquatic exercises have primarily focused on either physical fitness or psychological outcomes. This study examines the effects of a structured 10-week aqua fitness program on physical fitness and psychosocial outcomes in healthy adult women. Additionally, a 4-week training cessation period was incorporated to assess the sustainability of any observed physical fitness benefits. Methods: A total of 32 female participants (mean age 51.28 ± 9.12 years) with prior aqua aerobics experience engaged in supervised aqua fitness sessions, conducted three times per week (~55 min/session) at moderate intensity (RPE = 12, on a 6–20 scale). The physical fitness outcomes assessed included dominant hand grip strength, lower limb muscle endurance, dynamic balance, mobility, and upper and lower limb flexibility. The psychosocial outcomes included subjective well-being and social inclusion. Results: The results demonstrate significant improvements in dynamic balance (ES = 0.85) and lower limb flexibility (ES = 0.73 and 0.65 for the two limbs, respectively), with smaller yet notable gains observed in other physical fitness outcomes (ES = from 0.20 to 0.48). On the contrary, only a marginal improvement was detected in a single domain of subjective well-being (environmental domain, ES = 0.35) and no changes were observed across the seven domains of social inclusion. Importantly, all physical fitness gains were maintained during the 4-week training cessation period, with lower limb flexibility showing additional improvements. Conclusions: These findings underscore the effectiveness of supervised aqua fitness programs in enhancing physical fitness in middle-aged women, while their impact on psychosocial outcomes appears limited in this population. Full article

(This article belongs to the Special Issue Exercise Interventions and Testing for Effective Health Promotion)

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14 pages, 645 KiB

Open AccessArticle

Severity Matters: How COVID-19 Severity Impacts Long-Term Effects on Symptoms, Physical Activity and Functionality—An Observational Study

by Laura Pérez-Gisbert, Concepción Morales-García, José Antonio Sánchez-Martínez, María Victoria González-Gutiérrez, Marie Carmen Valenza and Irene Torres-Sánchez

Healthcare 2025, 13(3), 333; https://doi.org/10.3390/healthcare13030333 - 6 Feb 2025

Viewed by 689

Abstract

Background/Objectives: The existing literature has described the common symptoms and long-term effects of coronavirus disease (COVID-19). However, there is a lack of detailed information on how different degrees of disease severity affect survivors differently. This study aims to fill that gap by evaluating [...] Read more.

Background/Objectives: The existing literature has described the common symptoms and long-term effects of coronavirus disease (COVID-19). However, there is a lack of detailed information on how different degrees of disease severity affect survivors differently. This study aims to fill that gap by evaluating the symptoms, physical activity, and functionality of COVID-19 survivors across a spectrum of severity levels, comparing them with those of healthy individuals. Methods: An observational study was carried out following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria and checklist. Participants were divided into 5 groups based on COVID-19 severity according to the World Health Organization classification: healthy (COVID-19-negative), mild (symptomatic without pneumonia or dyspnoea), moderate (pneumonia and dyspnoea without hospitalisation), severe (severe pneumonia requiring hospitalisation), and critical (severe pneumonia with admission to the intensive care unit). Descriptive variables, symptoms (Fatigue Borg Scale, Fatigue Impact Scale, Fatigue Severity Scale, Dyspnoea Borg Scale, Visual Analogue Scale, Hospital Anxiety and Depression Scale, and European Quality of Life-5 Dimensions), physical activity (the International Physical Activity Questionnaire) and functionality (Patient-Specific Functional Scale, Short Physical Performance Battery, Arm Curl test, and 2 min step test) were measured. Results: A total of 304 participants were included: healthy (n = 42), mild (n = 143), moderate (n = 49), severe (n = 52), and critical (n = 18) COVID-19 patients. The impact of COVID-19 on surviving patients varies significantly with the severity of the disease. The results show that the hospitalisation time, age, and comorbidities of the patients are greater in those with a greater severity of the disease. Patients with more severe COVID-19 also experience greater frailty, dysphagia, fatigue, dyspnoea, and pain. Additionally, those with severe cases have poorer overall health, reduced physical activity, and diminished functionality. No evidence of post-COVID-19 anxiety or depression is found in the sample, even considering the timeframe between the negative test and the assessment. Conclusions: Patients with higher COVID-19 severity (severe or critical) experience more symptoms than those with lower COVID-19 severity (mild or moderate). Additionally, those with severe cases have poorer overall health, reduced physical activity and diminished functionality. Register: Clinicaltrials.gov: NCT05731817. Full article

(This article belongs to the Special Issue Innovations in Chronic Patient Management: Monitoring, Evaluation and Rehabilitation)

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11 pages, 215 KiB

Open AccessReview

Consciousness Research Through Pain

by Dong Ah Shin and Min Cheol Chang

Healthcare 2025, 13(3), 332; https://doi.org/10.3390/healthcare13030332 - 6 Feb 2025

Viewed by 983

Abstract

Background/Objectives: Consciousness is a complex and elusive phenomenon encompassing self-awareness, sensory perception, emotions, and cognition. Despite significant advances in neuroscience, understanding the neural mechanisms underlying consciousness remains challenging. Pain, as a subjective and multifaceted experience, offers a unique lens for exploring consciousness by [...] Read more.

Background/Objectives: Consciousness is a complex and elusive phenomenon encompassing self-awareness, sensory perception, emotions, and cognition. Despite significant advances in neuroscience, understanding the neural mechanisms underlying consciousness remains challenging. Pain, as a subjective and multifaceted experience, offers a unique lens for exploring consciousness by integrating sensory inputs with emotional and cognitive dimensions. This study examines the relationship between consciousness and pain, highlighting the potential of pain as a model for understanding the interplay between subjective experience and neural activity. Methods: Literature review. Results: Key theories of consciousness, such as the Global Workspace Theory and the Integrated Information Theory, provide diverse frameworks for interpreting the emergence of consciousness. Similarly, pain research emphasizes the role of subjective interpretation and emotional context in shaping sensory experiences, reflecting broader challenges in consciousness studies. The limitations of current methodologies, particularly the difficulty of objectively measuring subjective phenomena, like pain and consciousness, are also addressed. This highlights the importance of neural correlates, with a particular focus on brain regions, such as the anterior cingulate cortex and the insula, which bridge sensory and emotional experiences. By analyzing the shared attributes of pain and consciousness, this study underscores the potential for pain to serve as a measurable proxy in consciousness research. Conclusions: Ultimately, it contributes to unraveling the neural and philosophical underpinnings of consciousness, offering implications for mental health treatment and advancements in artificial intelligence. This study fills a critical gap by leveraging pain as a measurable and reproducible model for exploring the neural and subjective mechanisms of consciousness. By combining theoretical frameworks with empirical evidence, it offers novel insights into how consciousness emerges from neural processes. Full article

(This article belongs to the Special Issue Pain Management Practice and Research)

10 pages, 671 KiB

Open AccessArticle

Evaluation of ABL90 and ABL800 Radiometer Blood Gas Analyzers: Challenges and Applications in Point-of-Care Cancer Diagnostics in Saudi Arabia

by Abdulaziz Yahya Al-shahrani and Johra Khan

Healthcare 2025, 13(3), 331; https://doi.org/10.3390/healthcare13030331 - 6 Feb 2025

Viewed by 660

Abstract

Background: Point-of-care (POC) diagnostics is an innovative approach to healthcare analysis that brings the diagnostic process closer to the patient’s immediate care setting. This study was conducted to assess POC testing devices’ use in diagnosing cancer and detecting the main challenges facing laboratory [...] Read more.

Background: Point-of-care (POC) diagnostics is an innovative approach to healthcare analysis that brings the diagnostic process closer to the patient’s immediate care setting. This study was conducted to assess POC testing devices’ use in diagnosing cancer and detecting the main challenges facing laboratory specialists. Method: A cross-sectional study was conducted on conveniently selected laboratory specialists working in the Prince Mohammed bin Abdulaziz Hospital in Riyadh for six weeks. Result: A total of 187 study participants (51% males and 49% females) were enrolled. Around one-half of them (96, 51%) were less than 30 years old, and 85% had 1–5 years of experience, with 61% (124) having no previous cancer diagnosis devices training. Most of this study’s cohort was using ABL 90 Radio meter/blood gases (45, 24%), followed by ABL 800 Radio meter/blood gases (39, 20.9%), as the main cancer diagnostic devices. Several challenges were faced by this study’s participants during their work with cancer diagnosis devices. The participants shared that some time was needed to use most of the devices, and learning how to use them was a significantly steep learning curve (2.99 ± 0.07 of participants). Most participants (113, 60.4%) carried out all the control testing, and their results were compared completely (100%) with the central laboratory. They took special precautions to keep the instruments safe (162, 86.6%). Conclusion: The correlation between type of devices used and the challenges faced during the use of POCT cancer diagnosis devices showed that there is a significant correlation between all challenges facing the participants and the type of devices (p = 0.001), except for the need for time to use these devices (p = 0.53). There are many challenges facing workers who operate point-of-care cancer diagnosis devices to a high degree. Full article

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11 pages, 657 KiB

Open AccessArticle

Physician Assistant/Associate Urology Workforce: A National Analysis

by Roderick S. Hooker, Mirela Bruza-Augatis, Kasey Puckett, Andrzej Kozikowski and Todd J. Doran

Healthcare 2025, 13(3), 330; https://doi.org/10.3390/healthcare13030330 - 5 Feb 2025

Viewed by 943

Abstract

Introduction/Background: The urology workforce is shifting in terms of the number of physicians per capita, age, gender, and availability. To meet this growing need, physician assistants/associates (PAs) and nurse practitioners (NPs) are part of this workforce backfilling effort. However, limited studies have been [...] Read more.

Introduction/Background: The urology workforce is shifting in terms of the number of physicians per capita, age, gender, and availability. To meet this growing need, physician assistants/associates (PAs) and nurse practitioners (NPs) are part of this workforce backfilling effort. However, limited studies have been conducted on the demographic and employment attributes of PAs practicing in urology. Thus, using a national dataset, this study aims to compare the attributes of PAs in the urology workforce compared with PAs in all other surgical and medical disciplines. Methods: We analyzed the practice of PAs in urology using data from the 2022 National Commission on Certification of PAs (NCCPA). This study drew on responses from 117,748 board-certified PAs who reported their medical and surgical specialty. Our analysis involved descriptive and inferential statistics, comparing the demographic and practice attributes of PAs in urology (n = 1199) with PAs in all other medical disciplines (n = 116,549). Results: In 2022, 1199 (1.0%) PAs were reported to be clinically active in urology. Among PAs in urology, 68.1% self-identified as female, with a median age of 39 [IQR: 32–48]. Compared to PAs in other medical disciplines, PAs in urology resided in urban locations (94.5% vs. 92.5%, p = 0.002). They were also more likely to practice in office-based settings (53.6% vs. 37.0%), work over 40 h weekly (37.9% vs. 29.3%), and partake in telemedicine (52.0% vs. 40.1%; all p < 0.001). No statistical differences were found among PAs in urology versus PAs in all other medical fields related to job satisfaction (p = 0.763), symptoms of burnout (p = 0.124), and retirement plans in the next 5 years (p = 0.442). Conclusions: Given the predicted shortfalls of urologists and their changing demographic composition, this study has important implications for practice in the urology workforce. Our findings can inform workforce planning, recruitment strategies, and organizational policies to support the expansion of PAs in urology and help address shortages in this discipline. Full article

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20 pages, 1435 KiB

Open AccessCommunication

Empowering Health Professionals with Digital Skills to Improve Patient Care and Daily Workflows

by Joao C. Ferreira, Luis B. Elvas, Ricardo Correia and Miguel Mascarenhas

Healthcare 2025, 13(3), 329; https://doi.org/10.3390/healthcare13030329 - 5 Feb 2025

Viewed by 2102

Abstract

The increasing digitalisation of healthcare has created a pressing need for health professionals to develop robust digital skills. This paper explores the imperative of equipping health professionals with the necessary digital proficiency to enhance their daily workflows and improve patient care. The expanding [...] Read more.

The increasing digitalisation of healthcare has created a pressing need for health professionals to develop robust digital skills. This paper explores the imperative of equipping health professionals with the necessary digital proficiency to enhance their daily workflows and improve patient care. The expanding use of digital technologies, including electronic health records, telehealth, and artificial intelligence, has transformed the healthcare landscape. However, the adoption of these technologies has been hindered by barriers, such as a lack of interoperability and hesitancy among healthcare providers. To address these challenges, this paper argues that digital skill development must be a core component of healthcare education and professional training. Medical schools and healthcare organisations must prioritise the integration of digital health curricula and continuous learning opportunities to ensure that the next generation of healthcare providers is well-equipped to navigate the digital healthcare ecosystem. Additionally, this paper highlights the importance of fostering a culture of digital innovation and collaboration within healthcare settings. By empowering health professionals to actively participate in the development and testing of new digital health applications, the industry can unlock the full potential of digital technologies to enhance daily workflows and improve patient outcomes. Full article

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11 pages, 232 KiB

Open AccessArticle

Exploring the Relationship Between Clinical Supervision and Well-Being in the Otolaryngology Residency Board in Saudi Arabia

by Mohammad Ali Alessa, Sarah Ahmed Eltouny, Hashem O. Alsaab and Rabab Abdel Ra’oof Abed

Healthcare 2025, 13(3), 328; https://doi.org/10.3390/healthcare13030328 - 5 Feb 2025

Viewed by 630

Abstract

Background/ Objectives: Surgical residency is widely recognized as a highly stressful phase due to long working hours and the challenges of managing complex cases. Additionally, family responsibilities, such as being a spouse or parent, can have a positive or negative impact on residents’ [...] Read more.

Background/ Objectives: Surgical residency is widely recognized as a highly stressful phase due to long working hours and the challenges of managing complex cases. Additionally, family responsibilities, such as being a spouse or parent, can have a positive or negative impact on residents’ well-being. This study aimed to explore the relationship between clinical supervision and mental well-being among otolaryngology residents in Saudi Arabia, focusing on how supervision conditions influence well-being at different stages of training. Methods: This was an analytical cross-sectional correlational study conducted among Saudi otolaryngology head and neck surgery residents. An online survey was used to collect data from 64 residents, utilizing the Dutch Residents Educational Climate Test (D-RECT) to assess clinical supervision and the Warwick–Edinburgh Mental Well-being Scale (WEMWBS) to measure well-being. The data were analyzed to determine the association between supervision conditions and well-being across different residency levels. Results: The results showed that the majority of residents reported higher mean scores for items such as “I’ve been feeling useful” (3.53 ± 1.23), “I’ve been feeling interested in new things” (3.28 ± 1.13), and “I’ve been dealing with problems well” (3.27 ± 1.10). No statistically significant difference in overall WEMWBS scores was found between junior and senior residents. However, mental well-being was significantly associated with all four D-RECT domains (supervision, feedback, coaching assessment, and consultant attitude), with a positive correlation observed between clinical supervision and well-being. Conclusions: This study highlights the critical role of clinical supervision in supporting the mental well-being of otolaryngology residents. Enhanced supervision practices, particularly those emphasizing constructive feedback and supportive consultant attitudes, could mitigate burnout and improve resident outcomes. These findings underscore the need for targeted interventions in residency programs to promote well-being and optimize the learning environment. Full article

9 pages, 208 KiB

Open AccessArticle

Providers’ Practices and Associated Factors in Educating Pregnant Women on the Prevention of Maternal Anemia During Antenatal Care Visits in Ujiji Municipality, Kigoma Region, Tanzania

by Fredy Marwa, Eveline Konje, Theckla Tupa, Mlemile Gwimile and Namanya Basinda

Healthcare 2025, 13(3), 327; https://doi.org/10.3390/healthcare13030327 - 5 Feb 2025

Viewed by 650

Abstract

Background: Anemia in pregnancy is among the preventable severe public health problems, responsible for around 14.5% of maternal mortality in Tanzania. Antenatal visits are among the pillars that aid in reducing the burden of anemia in pregnancy. However, there are discrepancies in adherence [...] Read more.

Background: Anemia in pregnancy is among the preventable severe public health problems, responsible for around 14.5% of maternal mortality in Tanzania. Antenatal visits are among the pillars that aid in reducing the burden of anemia in pregnancy. However, there are discrepancies in adherence and performance across different domains of Antenatal care (ANC) by healthcare workers. Therefore, this study examined providers’ practices and associated factors in educating pregnant women on preventing maternal anemia during antenatal care visits in Kigoma and Ujiji Municipal Council in the Kigoma region. Methods: This was a cross-sectional design involving a total of 430 client exit interviews across 18 facilities. The association between the provision of maternal anemia education and other factors such as health facility level, age group, sex, economic activities, and ANC visitation was analyzed using multivariate logistic regression. p-values less than 0.05 were considered significant throughout the study. Results: The study revealed that most participants (70.4%) reported receiving anemia information during ANC visits. The most common topics were insecticide-treated nets (ITNs) (76%) and types of food to prevent anemia (74%), while 20.8% and 24.8% reported receiving information about worm infestation and deworming, respectively. Only 34.4% (95%CI: 26.5–43.3%) of pregnant women were informed of at least five topics. Conclusions: The study reveals limited education provision on anemia among pregnant women. There is a discrepancy in topic coverage among facilities and individuals. Full article

18 pages, 306 KiB

Open AccessArticle

Factors Associated with the Usage of Psychological Support Services for Employees in the Romanian Technology Industry

by Mihai Bran, Dragoş Ovidiu Alexandru, Rebeca Sara Chesini, Lavinia Corina Duică, Sanda Amelia Drăcea, Elena Daciana Pintilie and Mihail Cristian Pîrlog

Healthcare 2025, 13(3), 326; https://doi.org/10.3390/healthcare13030326 - 5 Feb 2025

Viewed by 663

Abstract

Background/Objectives: Mental health challenges significantly impact employee productivity, especially in high-stress industries like technology. This study aims to investigate the factors influencing the intention to use psychological support services among Romanian tech employees, focusing on barriers and motivators related to availability, accessibility, [...] Read more.

Background/Objectives: Mental health challenges significantly impact employee productivity, especially in high-stress industries like technology. This study aims to investigate the factors influencing the intention to use psychological support services among Romanian tech employees, focusing on barriers and motivators related to availability, accessibility, affordability, and acceptability. Methods: A cross-sectional survey was conducted among 372 Romanian tech employees using a structured online questionnaire. The survey assessed socio-demographic data, prior experience with mental health services, perceived distress levels, and barriers categorized into four dimensions. Data were analyzed using descriptive statistics and inferential analysis to identify key predictors of the intention to use these services. Results: Key factors influencing the use of psychological support services included prior experience with mental health services, the need to take time off work, and the absence of a companion. Barriers such as cost, transportation, awareness of services, and stigma were not significant. The regression model explained 8.4% of the variance in the likelihood of using these services, suggesting that additional factors may need further exploration. Conclusions: Addressing practical barriers, such as time constraints and the absence of support during access, is essential to improving accessibility of these services. Leveraging positive past experiences with mental health services can enhance engagement. These findings can guide the development of targeted interventions to promote the uptake of psychological support services in the tech sector, contributing to a healthier and more productive workforce. Full article

24 pages, 909 KiB

Open AccessReview

Integrated Care in Atrial Fibrillation: A Multidisciplinary Approach to Improve Clinical Outcomes and Quality of Life

by Ana Mónica Machado, Fernanda Leite and M. Graça Pereira

Healthcare 2025, 13(3), 325; https://doi.org/10.3390/healthcare13030325 - 5 Feb 2025

Viewed by 1128

Abstract

Background: Atrial fibrillation (AF) is the most common arrhythmia globally, associated with serious complications such as stroke and heart failure, as well as significant impacts on patients’ quality of life. Objectives: This theoretical article explores the role of integrated care in the [...] Read more.

Background: Atrial fibrillation (AF) is the most common arrhythmia globally, associated with serious complications such as stroke and heart failure, as well as significant impacts on patients’ quality of life. Objectives: This theoretical article explores the role of integrated care in the management of AF, highlighting the need for a multidisciplinary approach that goes beyond rhythm and heart rate control. Methods: Through a review of the literature, this article explores the prevalence of AF, the challenges of diagnosis, the socioeconomic and psychological impact, as well as the benefits of integrating medical, psychological, and social interventions, drawing on insights from studies about integrative care in AF. Results: The findings highlight the challenges of managing AF, including its high prevalence, complex diagnosis, and significant socioeconomic and psychological impacts on patients. Integrated care models, combining medical, psychological, and social interventions, improve treatment adherence, reduce complications like stroke and heart failure, and enhance patient quality of life. Conclusions: Integrated care models hold significant promise in improving outcomes in AF patients through structured, multidisciplinary approaches. Evidence supports reductions in cardiovascular events, hospitalizations, and mortality when adhering to clinical guidelines, emphasizing patient education, and implementing individualized care strategies. Despite challenges, like regional disparities and suboptimal implementation, the integration of multidisciplinary teams and emerging technologies offers a way to enhance care delivery and accessibility. Future efforts should focus on personalizing care, promoting professional collaboration, and taking advantage of technological advances to optimize AF management and promote sustainable health systems. Full article

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54 pages, 1125 KiB

Open AccessSystematic Review

Investigation into Application of AI and Telemedicine in Rural Communities: A Systematic Literature Review

by Kinalyne Perez, Daniela Wisniewski, Arzu Ari, Kim Lee, Cristian Lieneck and Zo Ramamonjiarivelo

Healthcare 2025, 13(3), 324; https://doi.org/10.3390/healthcare13030324 - 4 Feb 2025

Cited by 5 | Viewed by 3443

Abstract

Recent advances in artificial intelligence (AI) and telemedicine are transforming healthcare delivery, particularly in rural and underserved communities. Background/Objectives: The purpose of this systematic review is to explore the use of AI-driven diagnostic tools and telemedicine platforms to identify underlying themes (constructs) in [...] Read more.

Recent advances in artificial intelligence (AI) and telemedicine are transforming healthcare delivery, particularly in rural and underserved communities. Background/Objectives: The purpose of this systematic review is to explore the use of AI-driven diagnostic tools and telemedicine platforms to identify underlying themes (constructs) in the literature across multiple research studies. Method: The research team conducted an extensive review of studies and articles using multiple research databases that aimed to identify consistent themes and patterns across the literature. Results: Five underlying constructs were identified with regard to the utilization of AI and telemedicine on patient diagnosis in rural communities: (1) Challenges/benefits of AI and telemedicine in rural communities, (2) Integration of telemedicine and AI in diagnosis and patient monitoring, (3) Future considerations of AI and telemedicine in rural communities, (4) Application of AI for accurate and early diagnosis of diseases through various digital tools, and (5) Insights into the future directions and potential innovations in AI and telemedicine specifically geared towards enhancing healthcare delivery in rural communities. Conclusions: While AI technologies offer enhanced diagnostic capabilities by processing vast datasets of medical records, imaging, and patient histories, leading to earlier and more accurate diagnoses, telemedicine acts as a bridge between patients in remote areas and specialized healthcare providers, offering timely access to consultations, follow-up care, and chronic disease management. Therefore, the integration of AI with telemedicine allows for real-time decision support, improving clinical outcomes by providing data-driven insights during virtual consultations. However, challenges remain, including ensuring equitable access to these technologies, addressing digital literacy gaps, and managing the ethical implications of AI-driven decisions. Despite these hurdles, AI and telemedicine hold significant promise in reducing healthcare disparities and advancing the quality of care in rural settings, potentially leading to improved long-term health outcomes for underserved populations. Full article

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17 pages, 409 KiB

Open AccessArticle

Working Conditions and Well-Being of School Nurses in Spain: Impact on Job Satisfaction and Professional Quality of Life

by José Antonio Zafra-Agea, Estel·la Ramírez-Baraldes, Eduard Maldonado-Manzano, Núria Obradors-Rial, Antònia Puiggrós-Binefa and Ester Colillas-Malet

Healthcare 2025, 13(3), 323; https://doi.org/10.3390/healthcare13030323 - 4 Feb 2025

Viewed by 783

Abstract

Background: School nurses play a crucial role in promoting student health, addressing issues such as substance use, mental health, physical health, violence, and sexual health. However, their job satisfaction has been understudied, particularly in relation to the challenges they face. Objective: This study [...] Read more.

Background: School nurses play a crucial role in promoting student health, addressing issues such as substance use, mental health, physical health, violence, and sexual health. However, their job satisfaction has been understudied, particularly in relation to the challenges they face. Objective: This study evaluates the job satisfaction and professional quality of life among school nurses and nurses working in educational settings in Spain. Methods: A descriptive cross-sectional study was conducted (November 2023–February 2024) with 553 nurses from various regions of Spain, using the Font-Roja job satisfaction and CPV-35 professional quality of life questionnaires. Results: Our results showed significant differences in job satisfaction between nurses in healthcare and educational settings, influenced by factors such as workload and institutional support. Most participants (97.5% women, median age ~40 years) had less than 5 years of experience. The lack of a dedicated nurse in half of the schools highlights disparities in service provision. Discussion: This study emphasizes the need for supportive policies and work environments to improve the well-being and job satisfaction of nurses in school settings. Full article

(This article belongs to the Section School Health)

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11 pages, 1519 KiB

Open AccessArticle

Antidiabetic Medicines Utilisation During Pre-Pandemic, Pandemic and Post-Pandemic Period of COVID-19—Data for Bulgarian Population

by Zornitsa Mitkova, Desislava Stanimirova, Miglena Manova, Nikolay Gerasimov, Konstantin Mitov and Guenka Petrova

Healthcare 2025, 13(3), 322; https://doi.org/10.3390/healthcare13030322 - 4 Feb 2025

Viewed by 558

Abstract

Background: Type 2 diabetes is a chronic disease with high global prevalence and significant social and economic burden. The pandemic affected patients’ diagnostics and medicines dispensing. Diabetes was among the most-affected conditions during lockdown due to the limited resources and unaffordable medicines. The [...] Read more.

Background: Type 2 diabetes is a chronic disease with high global prevalence and significant social and economic burden. The pandemic affected patients’ diagnostics and medicines dispensing. Diabetes was among the most-affected conditions during lockdown due to the limited resources and unaffordable medicines. The impact of the pandemic on utilisation and cost has not been thoroughly studied, which inspired us to conduct the current study. Objectives: The study explored cost dynamics, changes in antidiabetic medicines utilisation, and public expenditure of pharmacotherapy in three periods: pre-pandemic (2018–2019), during the pandemic (2020–2021), and post-pandemic (2022–2023). Methods: It is a retrospective, observational, macroeconomic analysis. Reimbursed cost and utilisation were analysed as a crude sum and as indexes of the average value. Results: The result shows that five new INNs have been included in the Positive Medicines List (PML), two of these being fixed dose combinations (FDCs). During the pandemic, a slow tendency of increase of the crude sum of public expenditure was observed, followed by a sharp increase in the post-pandemic period. The public spending increased more than twice, and we found a 30,018,982 Euro growth. The highest public spending is found for dapagliflozine in post-pandemic vs. pandemic period (index = 1.67), as well as empagliflozin/metformin and dapagliflozine in pandemic vs. pre-pandemic period (index = 0.21). Total utilisation increases from 58.16 to 71.78 DDD/1000 inh/day during 2018–2023. The most significant rise of utilisation is found for canagliflozin (index = 0.68) pandemic vs. pre-pandemic and dapagliflozin (index = 3.66) post-pandemic vs. pandemic. Conclusions: Analysis of the antidiabetic medicines market reveals the rising of reimbursed cost and utilisation in pre-, post-, and during the pandemic. In conclusion, organisation of the supply and financing of antidiabetic medicines was not affected during the pandemic. Full article

(This article belongs to the Section Health Policy)

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17 pages, 271 KiB

Open AccessArticle

Policy Challenges in Ultra-Rare Cancers: Ethical, Social, and Legal Implications of Melanoma Prevention and Diagnosis in Children, Adolescents, and Young Adults

by Pietro Refolo, Costanza Raimondi, Livio Battaglia, Josep M. Borràs, Paula Closa, Alessandra Lo Scalzo, Marco Marchetti, Sonia Muñoz López, Joan Prades Perez, Laura Sampietro-Colom and Dario Sacchini

Healthcare 2025, 13(3), 321; https://doi.org/10.3390/healthcare13030321 - 4 Feb 2025

Cited by 1 | Viewed by 1045

Abstract

Background: The ultra-rare nature of melanoma in children, adolescents, and young adults poses significant challenges to the development and implementation of effective prevention and diagnostic strategies. This article delves into the ELSIs surrounding these strategies, placing particular emphasis on the transformative potential of [...] Read more.

Background: The ultra-rare nature of melanoma in children, adolescents, and young adults poses significant challenges to the development and implementation of effective prevention and diagnostic strategies. This article delves into the ELSIs surrounding these strategies, placing particular emphasis on the transformative potential of AI-driven tools and applications. Methods: Using an exploratory sequential mixed methods approach, this study integrated a PICO-guided literature review and qualitative insights from two focus groups. The review included 26 peer-reviewed articles published in English from January 2019 to January 2024, addressing ELSIs in melanoma, rare diseases, and AI in dermatology. Focus groups included a March 2024 session in Berlin with 15 stakeholders (patients, caregivers, advocates, healthcare professionals) and a November 2024 online session with 5 interdisciplinary experts. Results: Six key priorities for healthcare policies emerged: addressing cultural factors, such as the glorification of tanned skin; enhancing professional training for accurate diagnosis; balancing the risks of overdiagnosis and underdiagnosis; promoting patient autonomy through transparent communication; reducing inequalities to ensure equitable access to care; and making ethical and legal use of AI in healthcare. Conclusion: These priorities provide a comprehensive framework for advancing the prevention and diagnosis of melanoma in children, adolescents, and young adults, leveraging AI technologies while prioritizing equitable and patient-centered healthcare delivery. Full article

(This article belongs to the Special Issue Ethics of Well-Done Work and Proposals for a Better Healthcare System)

17 pages, 236 KiB

Open AccessArticle

Patterns and Mitigation Strategies for Rejected Claims Among Health Facilities Providing Services for the National Health Insurance Fund in Mwanza, Tanzania

by Ritha Fulla, Namanya Basinda, Theckla Tupa, Peter Chilipweli, Anthony Kapesa, Eveline T. Konje, Domenica Morona and Stephen E. Mshana

Healthcare 2025, 13(3), 320; https://doi.org/10.3390/healthcare13030320 - 4 Feb 2025

Viewed by 1106

Abstract

Background: Rejected medical claims pose a significant challenge for healthcare facilities accredited by Tanzania’s National Health Insurance Fund (NHIF). Despite the NHIF’s role in reducing out-of-pocket costs, claim rejections have been a persistent issue, largely due to documentation errors, coding mistakes, and [...] Read more.

Background: Rejected medical claims pose a significant challenge for healthcare facilities accredited by Tanzania’s National Health Insurance Fund (NHIF). Despite the NHIF’s role in reducing out-of-pocket costs, claim rejections have been a persistent issue, largely due to documentation errors, coding mistakes, and non-compliance with NHIF regulations. This study determined the patterns of rejected claims and the strategies employed by NHIF-accredited hospitals to mitigate these challenges. Methodology: This cross-sectional study was conducted between July and August 2024 and used quantitative and qualitative approaches. The study utilized secondary data (August 2023 to January 2024) on the rejected claims from 46 healthcare facilities (HFs) and key informant interviews from the respective selected facilities. Descriptive data analysis was carried out using STATA version 15 and qualitative data analysis was conducted using NViVo2 version 12 software. Results: A total of 46 public (27) and private (19) HFs were included in this study. The data revealed significant variation in the average number of items rejected per claim across HFs, ranging from 0.21 in a regional referral hospital to 1.21 in a zonal hospital. Non-adherence to standard treatment guidelines (STGs) was significantly more common (p < 0.001) in polyclinics, accounting for 17.2% of the items rejected, and with the lowest number (0.8%) seen in zonal hospitals. Overutilization (drugs and investigations) was commonly reported in all HFs, ranging from 12.5% in polyclinics to 31.8% in district hospitals (p < 0.001). Non-applicable consultation charges were only reported in one zonal hospital. To mitigate these rejections, HFs implemented strategies such as immediate error verification, regular communication with NHIF, staff training, technology use, and regular supervision by the internal audit units. Despite these efforts, challenges persisted, particularly those stemming from complex NHIF policies, which account for most rejections in zonal health facilities. Conclusions: There are significant variations in rejection patterns among HFs, with attendance date anomalies, non-adherence to STGs, NHIF pricing, and overutilization being the most common reasons across all HFs. Strategies to address rejections should be tailored to specific health facilities, coupled with electronic systems that will detect errors during patient management. Full article

15 pages, 1934 KiB

Open AccessArticle

The Dark Side of the Hospitality Industry: Workplace Bullying and Employee Well-Being with Feedback Avoidance as a Mediator and Psychological Safety as a Moderator

by Ibrahim A. Elshaer, Alaa M. S. Azazz, Mohammed E. A. Zain, Sameh Fayyad, Noha Ismaeil ElShaaer and Samy Wageh Mahmoud

Healthcare 2025, 13(3), 319; https://doi.org/10.3390/healthcare13030319 - 4 Feb 2025

Cited by 2 | Viewed by 924

Abstract

Objectives: The tourism and hospitality industry, well-known as a people-oriented industry, is not immune to the adverse outcomes of workplace bullying. This paper explores the darker side of the tourism and hospitality sector by investigating workplace bullying and its potential impact on shaping [...] Read more.

Objectives: The tourism and hospitality industry, well-known as a people-oriented industry, is not immune to the adverse outcomes of workplace bullying. This paper explores the darker side of the tourism and hospitality sector by investigating workplace bullying and its potential impact on shaping employee well-being. Specifically, the study explores how feedback avoidance can mediate the relationship between information flow and employee well-being and how psychological safety can moderate the relationship between information flow and employee well-being in bullying contexts. Methods: Using a quantitative-methods approach, the paper analyzed survey data from 341 employees at five-star hotels in Sharm El-Sheikh, Egypt, with structural equation modelling (PLS-SEM program). Results: The findings indicated that the spread of information about workplace bullying promotes the feelings of stress among employees which negatively affects their wellbeing in the workplace. Additionally, feedback avoidance as a mediator was found to foster the harmful impacts of bullying. Conversely, psychological safety as a moderator functioned as a protective element, mitigating the negative influence of workplace bullying on employees’ well-being. Conclusions: This paper enhanced our understanding of the dark side of the hospitality industry, specifically workplace bullying, by highlighting the key role of information dynamics about bullying in the workplace and the role of psychological safety in shaping overall employee well-being. Full article

(This article belongs to the Special Issue Employees’ Well-Being: Effective Measures to Cope with Job Stress and Workplace Bullying)

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Healthcare, Volume 13, Issue 3 (February-1 2025) – 144 articles

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