Healthcare

13 pages, 432 KiB

Open AccessArticle

Treatment of Adolescent Idiopathic Scoliosis with the Conservative Schroth Method: A Randomized Controlled Trial

by Vanja Dimitrijević, Bojan Rašković, Miroslav P. Popović, Dejan Viduka, Siniša Nikolić, Nikola Jevtić, Samra Pjanić and Borislav Obradović

Healthcare 2025, 13(6), 688; https://doi.org/10.3390/healthcare13060688 - 20 Mar 2025

Viewed by 550

Abstract

Objective: The objective of this study was to determine the effectiveness of the conservative Schroth method in patients with adolescent idiopathic scoliosis. Methods: A total of 34 respondents, 24 male and 10 female, aged between 11 and 16 years, participated in the research. [...] Read more.

Objective: The objective of this study was to determine the effectiveness of the conservative Schroth method in patients with adolescent idiopathic scoliosis. Methods: A total of 34 respondents, 24 male and 10 female, aged between 11 and 16 years, participated in the research. The study was a single-blind randomized trial, in which subjects were divided into control and experimental groups by stratified randomization according to the stratum of the Cobb angle. The control group performed the Schroth method at home without the supervision of Schroth therapists, while the experimental group performed the Schroth method under the supervision of Schroth therapists three times a week for 90 min over eight weeks. Initial and final outcome measurements were performed: Cobb angle, angle of trunk rotation, vital capacity, forced vital capacity, forced expiratory volume in the first second, the percentage of forced expiratory volume in the first second in forced vital capacity, and chest expansion. Results: There was a statistically significant improvement in all measured outcomes in the experimental group, while no statistically significant changes were recorded in the control group. The Cobb angle decreased by 2.12°, while ATR decreased by 2.88°; VC increased by 0.15 L, FVC by 0.13 L, FEV1 by 0.1 L, and CE increased by 0.78 cm. Conclusions: The application of an eight-week therapy program using Schroth method by subjects with adolescent idiopathic scoliosis had statistically significant changes in all measured outcomes in the group that was supervised by Schroth’s therapists, while there was no statistically significant improvement in the group that applied therapy at home without supervision. Full article

(This article belongs to the Section School Health)

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17 pages, 888 KiB

Open AccessArticle

Exploring the Association Between Physical Activity, Regulatory Emotional Self-Efficacy, Perceived Self-Burden, and Social Isolation Among Older Adults in China

by Shicheng Yang, Huimin Peng, Longjun Jing, Huilin Wang and Shuyin Chen

Healthcare 2025, 13(6), 687; https://doi.org/10.3390/healthcare13060687 - 20 Mar 2025

Viewed by 203

Abstract

Background: As people age, their physical functions decline, and changes in social roles and life experiences put older adults at a higher risk of social isolation. Methods: In this study, we employed both snowball and purposive sampling techniques to collect valid [...] Read more.

Background: As people age, their physical functions decline, and changes in social roles and life experiences put older adults at a higher risk of social isolation. Methods: In this study, we employed both snowball and purposive sampling techniques to collect valid data from 237 seniors aged 60 to 75 residing in Hunan Province. Using structural equation modeling (SEM) with the partial least squares (PLS) method, we examined the relationship between physical activity and social isolation among this elderly population. Result: Findings from this study indicate a positive association between physical activity and regulatory emotional self-efficacy, while revealing a negative association with the perception of being a burden to others. Moreover, a higher regulatory emotional self-efficacy is linked to reduced social isolation, whereas an increased sense of self-perceived burden is associated with greater social isolation. This study also uncovers that the link between physical activity and reduced social isolation is influenced by both regulatory emotional self-efficacy and the perception of self-burden. Conclusion: It is imperative for a collaborative effort involving government entities, societal groups, family units, and individuals to meticulously address and cater to the diverse requirements of senior citizens. Full article

(This article belongs to the Special Issue Association Between Health Literacy and Physical Activity Among Older People)

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20 pages, 1263 KiB

Open AccessArticle

Intended and Unintended Impacts of ‘4+7’ Volume-Based Drug Procurement on the Use of Drugs in China: A Natural Experimental Study

by Dantong Zhao and Zhongliang Zhou

Healthcare 2025, 13(6), 686; https://doi.org/10.3390/healthcare13060686 - 20 Mar 2025

Viewed by 254

Abstract

Background: Volume-based drug procurement is regarded as a pharmaceutical cost-containment measure in healthcare provision globally. The Centralized Volume-Based Drug Procurement (CVBDP) launched in March 2019 in China, also known as the ‘4+7’ policy. 11 cities, including Xi’an city in Shaanxi Province, were set [...] Read more.

Background: Volume-based drug procurement is regarded as a pharmaceutical cost-containment measure in healthcare provision globally. The Centralized Volume-Based Drug Procurement (CVBDP) launched in March 2019 in China, also known as the ‘4+7’ policy. 11 cities, including Xi’an city in Shaanxi Province, were set up as pilots. This study aims to examine the intended and unintended impacts of the ‘4+7’ policy on the use of original and generic drugs in city-level and county-level hospitals in Shaanxi, China. Methods: The data used in this study came from the Shaanxi Drug and Apparatus Centralized Procurement Platform (SDACPP). In total, 111,999 drug procurement order records of 118 policy-related drugs (including 25 ‘4+7’ policy-list drugs and 93 alternative drugs by generic name) from April 2017 to November 2019 were included in analyses. Policy-list drugs were divided into bid-winning and non-winning drug products. The volume and the expenditure of the drugs served as the outcome variables, measured by Defined Daily Doses (DDDs) and Chinese yuan (CNY), respectively. A difference-in-differences (DID) approach was used to estimate the policy’s net effect. Results: After the ‘4+7’ policy, the volume of bid-winning, policy-list, and policy-related drugs increased. An unexpected increase in volume was observed among alternative drugs, especially original drugs in city-level hospitals. The expenditure of policy-list and non-winning drugs declined, whereas that of alternative drugs unanticipatedly increased. Changes in volume and expenditure were both greater in generic drugs and in city-level hospitals, compared to their original and county-level hospital counterparts. Conclusions: Our findings highlight the positive effects of the ‘4+7’ policy on generic drug substitution and pharmaceutical expenditure containment, which are greater in city-level hospitals. The unanticipatedly incremental volume of original drugs in city-level hospitals suggests the potential risk of the poor quality of bid-winning drugs, lower compliance with bid-winning drugs among patients, or physicians’ profit-seeking behaviors in urban areas. More regulations and supervisions for the prescription and financial incentives of physicians are needed to address these concerns. Full article

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13 pages, 1730 KiB

Open AccessArticle

Self-Study-Based Informed Decision-Making Tool for Empowerment of Treatment Adherence Among Chronic Heart Failure Patients—A Pilot Study

by Lea Iten, Kevin Selby, Celine Glauser, Sara Schukraft and Roger Hullin

Healthcare 2025, 13(6), 685; https://doi.org/10.3390/healthcare13060685 - 20 Mar 2025

Viewed by 205

Abstract

Background: Adherence to drug prescriptions is often suboptimal among heart failure (HF) patients. Informed decision-making may improve patients’ adherence to HF drug prescriptions. Aims of the study: We aimed to test whether a self-study-based informed decision-making tool could improve adherence to drug prescriptions [...] Read more.

Background: Adherence to drug prescriptions is often suboptimal among heart failure (HF) patients. Informed decision-making may improve patients’ adherence to HF drug prescriptions. Aims of the study: We aimed to test whether a self-study-based informed decision-making tool could improve adherence to drug prescriptions among ambulatory HF patients. Methods: A tool and a statement-based questionnaire were developed to evaluate drug adherence willingness based on COMPAR-EU recommendations. The test group (n = 40) was exposed to the tool + questionnaire; controls (n = 40) answered the questionnaire only. Agreement with statements of the questionnaire was graded on a scale of 0 to 4 points, reflecting no to full agreement. Results: The median age of controls was younger (56 vs. 61 years; p = 0.04); test and control group patients did not differ across other parameters (always p > 0.05). Patients in both groups agreed that “HF is a life-long disease” (3.5 vs. 4; p = 0.19) and that “only life-long drug treatment provides benefit” (4 vs. 4; p = 0.22). More test group patients confirmed improved comprehension of HF disease (3 vs. 2; p = 0.03) and greater acceptance that “achievement of benefit asks for a combination of HF drugs” (4 vs. 3; p = 0.009) and “daily intake” (4 vs. 3; p = 0.004). In test group patients, questions remained, resulting in less agreement that “all aspects of my heart disease” are understood (1 vs. 3; p < 0.001). Willingness to adhere to HF-drug treatment was not different between the groups (3 vs. 3.5; p = 0.28). Conclusions: The self-study-based informed decision-making tool improved the comprehension of HF and the need for HF treatment, but did not improve willingness to adhere since questions remained unanswered. Full article

(This article belongs to the Special Issue Medication Therapy Management in Healthcare)

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11 pages, 201 KiB

Open AccessArticle

by Łukasz Dudziński, Łukasz Czyżewski and Janusz Wyzgał

Healthcare 2025, 13(6), 684; https://doi.org/10.3390/healthcare13060684 - 20 Mar 2025

Viewed by 284

Abstract

Aim: The aim of this study was to analyze service-related musculoskeletal injuries of professional firefighters in 2021–2023. Material and methods: Analysis was completed on the basis of annual reports on the injury status of the State Fire Service (SFS) obtained from the Office [...] Read more.

Aim: The aim of this study was to analyze service-related musculoskeletal injuries of professional firefighters in 2021–2023. Material and methods: Analysis was completed on the basis of annual reports on the injury status of the State Fire Service (SFS) obtained from the Office of Occupational Safety and Health (OOSH) at General Headquarters. The report databases were searched using keywords typical of bone injuries and including anatomical names: “sprain”, “fracture”, “dislocation”, “bone injury”, “bone”, “joint”, “spine”, “skull and “musculoskeletal injury”. Results: Events matching the analysis target of N = 1944 (2021—n = 707; 2022—n = 589; 2023—n = 648) accounted for 49.4% from all accidents in the State Fire Service in Poland in the analyzed period. A significant increase in the analyzed period 2021–2023 was observed in events where the cause of injury was sports activities (45% vs. 49% vs. 63%, p < 0.001). A significant decrease was observed in events where the cause of injury was interventions (26% vs. 27% vs. 17%, p < 0.001), technical and maintenance (TM) work (8% vs. 6% vs. 5%, p = 0.008) and category “other” (15% vs. 14% vs. 11%, p = 0.034). Statistically significant differences were found between cause and the type of injury (p = 0.002), season (p < 0.001) and the location of injury (p < 0.001). Conclusions: A large number of musculoskeletal injuries are associated with sports activities, which is inherent in the risks of the activities. The lower extremities are most affected by injuries during sports activities The spring period dominates in the season category, which may be related to the difficulty of the terrain and return to increased sports activity after the winter period. Full article

(This article belongs to the Section Health Policy)

11 pages, 230 KiB

Open AccessArticle

Unequal Burdens: Gendered and Socioeconomic Dimensions of Occupational Health Among Hong Kong’s Informal Waste Pickers

by Siu-Ming Chan, Yuen-Ki Tang, Heng Xu, Jasmine Zhang, Kim Kwok, Wai-Yiu Tam and Wing-Him Tang

Healthcare 2025, 13(6), 683; https://doi.org/10.3390/healthcare13060683 - 20 Mar 2025

Viewed by 270

Abstract

Background: This study explores the multifaceted inequalities faced by informal waste pickers in Hong Kong, focusing on the impacts of gender and socioeconomic status in shaping their working environment, income, and psychological health. Recognizing that social stratification encompasses a series of structural [...] Read more.

Background: This study explores the multifaceted inequalities faced by informal waste pickers in Hong Kong, focusing on the impacts of gender and socioeconomic status in shaping their working environment, income, and psychological health. Recognizing that social stratification encompasses a series of structural factors, i.e., gender, race, and socioeconomic status, we aim to fill the gap in existing literature regarding the precarious employment of this population. Methods: Utilizing a comprehensive, territory-wide survey, we analyzed the experiences of male and female waste pickers across different socioeconomic backgrounds. Differences between genders for continuous variables were assessed using the independent samples t-test. Differences across categories defined by gender and socioeconomic status were analyzed using one-way ANOVA, followed by post hoc comparisons with the least significant difference (LSD) method. Results: Our findings indicate that both gender and socioeconomic status significantly influence working environment, occupational income, and psychological health outcomes. Specifically, female waste pickers from lower socioeconomic backgrounds face more adverse working environments, lower income levels, and heightened psychological health risks compared to their higher-status counterparts. Conclusions: These results underscore the urgent need for targeted outreach and tailored healthcare services for vulnerable female waste pickers, as well as social support systems that empower them to negotiate with intermediaries and recycling shop owners. By recognizing their essential role in Hong Kong’s urban recycling ecosystem, this study advocates for policies that address these disparities and promote psychological health and social well-being among this marginalized group. Full article

(This article belongs to the Special Issue Psychological Health and Social Wellbeing Among Older Adults)

18 pages, 3961 KiB

Open AccessStudy Protocol

Timely and Personalized Interventions and Vigilant Care in Neurodegenerative Conditions: The FIT4TeleNEURO Pragmatic Trial

by Francesca Baglio, Federica Rossetto, Elisa Gervasoni, Ilaria Carpinella, Giulia Smecca, Irene Aprile, Roberto De Icco, Stefania De Trane, Chiara Pavese, Christian Lunetta, Cira Fundarò, Laura Marcuccio, Giovanna Zamboni, Franco Molteni, Cristina Messa and FIT4TeleNEURO Working Group

Healthcare 2025, 13(6), 682; https://doi.org/10.3390/healthcare13060682 - 20 Mar 2025

Viewed by 305

Abstract

Parkinson’s disease (PD) and multiple sclerosis (MS) are two chronic neurological diseases (CNDs) that have a high demand for early and continuous rehabilitation. However, accessing professional care remains a challenge, making it a key priority to identify sustainable solutions for ensuring early rehabilitation [...] Read more.

Parkinson’s disease (PD) and multiple sclerosis (MS) are two chronic neurological diseases (CNDs) that have a high demand for early and continuous rehabilitation. However, accessing professional care remains a challenge, making it a key priority to identify sustainable solutions for ensuring early rehabilitation availability. Objective: The FIT4TeleNEURO pragmatic trial proposes to investigate, in real-life care settings, the superiority in terms of the effectiveness of early rehabilitation intervention with harmonized, mix-model telerehabilitation (TR) protocols (TR single approach, task-oriented—TRsA; TR combined approach, task-oriented and impairment-oriented—TRcA) compared to conventional management (control treatment, CeT) in people with PD and MS. Design, and Methods: This multicenter, randomized, three-treatment arm pragmatic trial will involve 300 patients with CNDs (PD, N = 150; MS, N = 150). Each participant will be randomized (1:1:1) to the experimental groups (20 sessions of TRsA or TRcA according to a mix-model—3 asynchronous + 1 synchronous session/week) or the control group (20 sessions of CeT). Primary and secondary outcome measures will be obtained at the baseline (T0), post-intervention (T1, 5 weeks after baseline), and follow-up (T2, 3 months after the end of the treatment). A multidimensional evaluation (cognitive, motor, and quality of life domains) will be conducted at each time point of assessment (T0; T1; T2). The primary outcome measures will be the assessment of change (T0 vs. T1 vs. T2) in static and dynamic balance, measured using the Mini-Balance Evaluation Systems Test. Usability and acceptability assessment will be also investigated. Expected Results: Implementing TR protocols will enable a more targeted and efficient response to the growing demand for rehabilitation in the early stages of CNDs. Both the TRsA and TRcA approaches are expected to be more effective than CeT, with the combined approach likely providing greater benefits in secondary outcome measures. Finally, the acceptability of the asynchronous modality could open the door to scalable solutions, such as digital therapeutics. Full article

(This article belongs to the Special Issue Assistive Technologies, Robotics, and Automated Machines in the Health Domain: Second Edition)

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10 pages, 581 KiB

Open AccessArticle

Health Inequity in the Distribution of Diseases Among Adults in the City of Pécs, Hungary, 2024

by Addisu Alemayehu Gube, Szimonetta Lohner and Jozsef Vitrai

Healthcare 2025, 13(6), 681; https://doi.org/10.3390/healthcare13060681 - 20 Mar 2025

Viewed by 275

Abstract

Background: Health inequalities between citizens of different European countries and between socially advantaged and disadvantaged groups are seen as challenges to the EU’s commitment to solidarity, social and economic cohesion, human rights, and equality of opportunity. This study aimed to assess inequity in [...] Read more.

Background: Health inequalities between citizens of different European countries and between socially advantaged and disadvantaged groups are seen as challenges to the EU’s commitment to solidarity, social and economic cohesion, human rights, and equality of opportunity. This study aimed to assess inequity in the distribution of specific communicable and non-communicable diseases among the adult population of Pécs City, Hungary. Methods: This is an ecological study combined with health inequity analysis. The study population comprised adult patients living in the city of Pécs who were treated for circulatory, neoplasm, or respiratory diseases in 2019. Hospitalization and local socioeconomic data by zip codes were obtained from the National Health Insurance Fund of Hungary and the Hungarian Central Statistical Office. Diseases were classified according to the International Classification of Diseases, 10th revision (ICD-10). The differences and ratios of the proportions of treated diseases were calculated, along with the concentration index (C). Zip codes were ranked into categories 1 to 5 based on socio-demographic variables: education, employment status, and apartment ownership. A p-value of less than 0.05 was used as the cut-off point for statistical significance. IBM SPSS version 25 and STATA version 14.0 software were used for data analysis. Results: All 36 zip codes in the city of Pécs were included in this study. Analysis based on employment status showed a higher prevalence of neoplasms in areas with higher unemployment (C = −0.0528; 95% CI = −0.0975, −0.0080). In terms of apartment ownership, neoplasms (C = −0.0742; 95% CI = −0.1102, −0.0382) and circulatory diseases (C = −0.0280; 95% CI = −0.0520, −0.0039) were more prevalent in zip codes with fewer apartment owners. Conclusions: This study identified significant inequity in the distribution of neoplasms and circulatory diseases among the adult population of Pécs, especially in areas where the low socioeconomic segment of the population lives. Efforts should be made to establish tailored interventions such as targeted healthcare funding and employment programs for the unemployed and National Housing Trust Fund for those who do not own houses through multisectoral collaboration among healthcare providers, employers, governors, and policymakers. Full article

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17 pages, 1090 KiB

Open AccessArticle

The Influence of Recreational Hiking on the Prevalence of Cardiovascular and Psychiatric Diseases Among Population of Republic of Serbia

by Milos Gostimirovic, Jovana Rajkovic, Ana Bukarica and Ljiljana Gojkovic-Bukarica

Healthcare 2025, 13(6), 680; https://doi.org/10.3390/healthcare13060680 - 20 Mar 2025

Viewed by 455

Abstract

Background: Hiking is a physical activity recommended for people of all ages. In an era of increased incidence of cardiovascular and psychiatric diseases, directing individuals to hiking can be very important from both public health and socioeconomic perspectives. Since the health status of [...] Read more.

Background: Hiking is a physical activity recommended for people of all ages. In an era of increased incidence of cardiovascular and psychiatric diseases, directing individuals to hiking can be very important from both public health and socioeconomic perspectives. Since the health status of recreational hikers and the general population in the Republic of Serbia has not been compared yet, our objectives are to compare the health-related characteristics of those two groups, including the prevalence of comorbidities, pharmacotherapy, and drug consumption. Methods: A descriptive epidemiological study was conducted. Research questions were asked via two specially prepared questionnaires distributed through the Google Forms platform. The means of the two groups were tested by a two-sample Student t-test for independent variables. Results: The sample consisted of 259 hikers and 292 people from the general population. A total of 199 hikers (76.8%) and 218 people from the general population group (74.7%) were declared as healthy. The statistically significant differences between the groups included age, sex, education level, and body mass index. In both groups, the majority of those with pre-existing medical conditions had at least one cardiovascular disease (23.5% of the hikers and 19.5% of the individuals in the general group). Pre-existing psychiatric diseases were noted in 6% of the hikers and in 12% of those in the general group. The average durations of the disease in the hiker and general population were 11.9 and 8.4 years, respectively (p < 0.05), whereas, there were no differences in drug consumption. Conclusions: This pilot study represents the comparison of the cardiovascular and mental health among hikers and the general population in the Republic of Serbia. Although psychiatric diseases were clearly less prevalent among hikers, the prevalence and burden of cardiovascular diseases must be interpreted with caution, due to big age difference between the respondents from both groups. However, our future studies will employ objective measurements and clinical parameters rather than self-reported surveys, so that the health benefits of hiking appear more clearly. Full article

(This article belongs to the Special Issue The Impact of Exercise on the Mental Health and Quality of Life of People—the Second Edition)

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19 pages, 253 KiB

Open AccessArticle

Exploring the Impact of Workplace Violence in Urban Emergency Departments: A Qualitative Study

by Brendan Lyver, Brendan Singh, Nathan Balzer, Manu Agnihotri, Jennifer Hulme, Kathryn Chan, Rickinder Sethi, Charlene Reynolds, Jennifer Haines, Robert Whiteside, Marc Toppings and Christian Schulz-Quach

Healthcare 2025, 13(6), 679; https://doi.org/10.3390/healthcare13060679 - 20 Mar 2025

Viewed by 361

Abstract

Background: Workplace violence (WPV) in healthcare, particularly in emergency departments (EDs), is a growing and complex issue that significantly impacts healthcare providers (HCPs). Following the COVID-19 pandemic, the rates of WPV have increased globally, contributing to increased burnout, reduced morale, and heightened challenges [...] Read more.

Background: Workplace violence (WPV) in healthcare, particularly in emergency departments (EDs), is a growing and complex issue that significantly impacts healthcare providers (HCPs). Following the COVID-19 pandemic, the rates of WPV have increased globally, contributing to increased burnout, reduced morale, and heightened challenges in staff retention within EDs. Objective: This study aimed to explore HCPs’ perspectives on WPV in EDs. The insights gathered were intended to inform targeted interventions in a quality improvement initiative focused on addressing WPV in our healthcare institutions. Methods: A qualitative study involving semi-structured interviews was conducted with 52 HCPs across two urban EDs at a multi-site academic health center. Participants from various roles and shifts shared experiences related to safety, leadership, training, and security. Interviews were recorded, transcribed, anonymized, and thematically analyzed to identify key themes surrounding WPV in EDs. Results: The thematic analysis identified four main themes, including (1) Violence is Part of the Job, (2) Leadership Dynamics regarding WPV, (3) Disconnect Among ED Staff During WPV Response, and (4) Enhancing Systems and Culture for Effective WPV Management. These themes provide a comprehensive view of HCPs’ experiences and offer actionable recommendations for healthcare organizations seeking to address WPV. Conclusions: The study provides valuable qualitative insights into WPV in EDs, emphasizing the importance of addressing cultural, structural, and procedural gaps. These findings can guide the development of more supportive and effective strategies to create a safer environment for ED staff. Further rounds of interviews are planned post-intervention to assess changes in HCPs’ perceptions and experiences. Full article

(This article belongs to the Special Issue Patient Safety, Environment, and Mental Health)

9 pages, 468 KiB

Open AccessArticle

The Association Between Poor Sleep Quality and Lipid Levels Among Dyslipidemia Patients in Thailand: A Prospective Cross-Sectional Study

by Jakkrit Pintacom, Suphawita Pliannuom, Nida Buawangpong, Chaisiri Angkurawaranon and Kanokporn Pinyopornpanish

Healthcare 2025, 13(6), 678; https://doi.org/10.3390/healthcare13060678 - 20 Mar 2025

Viewed by 293

Abstract

Background: Dyslipidemia increases cardiometabolic risk, but the impact of sleep quality on lipid levels remains uncertain. This study aims to assess the prevalence of poor sleep quality in patients with dyslipidemia and its association with lipid levels. Methods: A cross-sectional and prospective study [...] Read more.

Background: Dyslipidemia increases cardiometabolic risk, but the impact of sleep quality on lipid levels remains uncertain. This study aims to assess the prevalence of poor sleep quality in patients with dyslipidemia and its association with lipid levels. Methods: A cross-sectional and prospective study was conducted among patients aged 20 years and older who were diagnosed with dyslipidemia at the Family Medicine Outpatient Clinic in Thailand from July to December 2023. Data were collected through interviews and a review of electronic health records. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Blood levels of triglycerides, HDL-C, and LDL-C were measured. The association between sleep quality and lipid levels was analyzed using multivariable regression, adjusting for age, sex, body mass index, diabetes mellitus, hypertension, alcohol use, exercise, statins, fibrates, and ezetimibe. Results: Of the 257 participants, 183 (71.21%) were female, with a mean age of 69.31 ± 7.48 years. Overall, 86 participants (33.64%) reported poor sleep quality. A higher sum score of PSQI was significantly associated with elevated triglyceride levels (adjusted mean difference [AMD] 2.59, 95% CI 0.07–5.11, p = 0.044), particularly in the sleep latency domain (AMD 8.58, 95% CI 0.00–17.16, p = 0.050). Additionally, higher scores in the subjective sleep quality domain were significantly associated with increased LDL-C levels (AMD 8.08, 95% CI 1.70–14.60, p = 0.013). Conclusions: This study highlights a significant association between poor sleep quality and elevated triglyceride and LDL-C levels. These findings underscore the importance of integrated healthcare strategies that address both sleep quality and lipid management to mitigate cardiovascular risks. Full article

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28 pages, 5950 KiB

Open AccessSystematic Review

Efficacy and Safety of the Combination of Diclofenac and Thiocolchicoside in the Treatment of Low Back Pain and Other Conditions: Systematic Review of the Literature

by Ioannis Oikonomou and Karolina Akinosoglou

Healthcare 2025, 13(6), 677; https://doi.org/10.3390/healthcare13060677 - 20 Mar 2025

Viewed by 574

Abstract

Background/Objectives: Low back pain (LBP) is a leading cause of disability worldwide. Diclofenac, a non-steroidal anti-inflammatory drug (NSAID), and thiocolchicoside, a muscle relaxant, are commonly combined to target inflammation and muscle spasm. However, the efficacy and safety of their combination remain under [...] Read more.

Background/Objectives: Low back pain (LBP) is a leading cause of disability worldwide. Diclofenac, a non-steroidal anti-inflammatory drug (NSAID), and thiocolchicoside, a muscle relaxant, are commonly combined to target inflammation and muscle spasm. However, the efficacy and safety of their combination remain under discussion. This systematic review evaluates the efficacy and safety of diclofenac-thiocolchicoside therapy for LBP and other musculoskeletal conditions. Methods: A systematic review was conducted following PRISMA guidelines. Eligible studies included randomized controlled trials (RCTs) and observational studies comparing diclofenac-thiocolchicoside combination with placebo, monotherapy, or alternative treatments. A search was performed in PubMed, Scopus, and relevant websites, identifying articles published up to 30 September 2024. Studies from trial registries were excluded. Risk of bias was assessed using Revised Cochrane Risk of Bias for randomized trials (RoB 2) for RCTs and the Newcastle-Ottawa Scale (NOS) for observational studies. Evidence certainty was evaluated with the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Results were visualized using Robvis, tables, and graphs. Results: Of 393 identified records, 9 studies (1097 patients) met the inclusion criteria. Seven RCTs reported significant pain reduction and functional improvement with combination therapy compared to placebo or active controls. However, study heterogeneity, dosage variations, and risk of bias limited comparability. Adverse events (AEs) included gastrointestinal (GI) discomfort and drowsiness, though no severe complications were consistently reported. Conclusions: Despite methodological limitations, the diclofenac-thiocolchicoside combination demonstrates promising efficacy for acute LBP and musculoskeletal pain management. However, there is no clear evidence of its clinical superiority over other available treatments, due to study heterogeneity and potential biases. Rigorous, standardized research with larger sample sizes and consistent methodologies is essential to definitively establish the efficacy and safety of diclofenac-thiocolchicoside, providing clearer guidance for clinical decision-making. Full article

(This article belongs to the Special Issue Pain Management in Healthcare Practice)

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18 pages, 975 KiB

Open AccessArticle

The Relationship Between Depressive Symptoms and Self-Neglect in Chinese Older Adults Living Alone: A Latent Profile Analysis

by Yali Hu, Miaomiao Wu, Yan Zhang and Lunfang Xie

Healthcare 2025, 13(6), 676; https://doi.org/10.3390/healthcare13060676 - 20 Mar 2025

Viewed by 304

Abstract

Objectives: To clarify the latent profile of depressive symptoms in Chinese older adults living alone and to explore the relationship between this profile and self-neglect. Methods: Data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) were utilized to conduct a [...] Read more.

Objectives: To clarify the latent profile of depressive symptoms in Chinese older adults living alone and to explore the relationship between this profile and self-neglect. Methods: Data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) were utilized to conduct a latent profile analysis for the identification of depressive symptoms. Logistic regression was employed to analyze the related factors. Generalized linear modeling was used to assess the impact of different profiles of depressive symptoms on self-neglect. Results: A total of 1822 older adults living alone, with a mean age of (83.60 ± 9.15) years, were included in the study. Three categories of depression were identified: the C1 mild depression–sleep disturbance group (29.36%), the C2 moderate depression–forcefulness group (55.22%), and the C3 major depression–loneliness loss group (15.42%). Logistic regression analysis indicated that gender, place of residence, annual household income, educational level, reason for living alone, self-rated health status, cognitive function, and emotional support were significant influencing factors (p < 0.05). The risk of experiencing higher levels of self-neglect in the C2 was 1.264 times greater than in the C1. Furthermore, the risk of higher levels of self-neglect in the C3 was 2.040 times greater than in the C1. Conclusions: Heterogeneity in depressive symptoms is evident among Chinese older adults living alone, with variations in self-neglect across different potential categories of these individuals. The focus should be on older adults in the C2 and C3 profiles. This study proposes targeted intervention strategies from family, community, and policy development perspectives to help improve self-neglect in older adults. Full article

(This article belongs to the Topic Healthy, Safe and Active Aging, 2nd Edition)

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11 pages, 856 KiB

Open AccessArticle

Risk Factors for Poor Sleep Quality and Subjective Cognitive Decline in Older Adults Living in the United States During the COVID-19 Pandemic

by Celina Pluim McDowell, Jairo E. Martinez, Averi Giudicessi, Diana Munera, Clara Vila-Castelar, Edmarie Guzmán-Vélez, Liliana Ramirez-Gomez, Jeanne F. Duffy, Alice Cronin-Golomb and Yakeel T. Quiroz

Healthcare 2025, 13(6), 675; https://doi.org/10.3390/healthcare13060675 - 20 Mar 2025

Viewed by 258

Abstract

Background/Objectives: Poor sleep quality, depression, and anxiety are associated with subjective cognitive decline (SCD) and greater risk for developing cognitive impairment and Alzheimer’s disease. The COVID-19 pandemic negatively impacted sleep habits and psychological well-being in many individuals, yet their relationship to SCD in [...] Read more.

Background/Objectives: Poor sleep quality, depression, and anxiety are associated with subjective cognitive decline (SCD) and greater risk for developing cognitive impairment and Alzheimer’s disease. The COVID-19 pandemic negatively impacted sleep habits and psychological well-being in many individuals, yet their relationship to SCD in this context remains understudied. We examined sociodemographic characteristics, depression, anxiety, and sleep changes during the pandemic (i.e., increased problems/poorer quality) and SCD in older individuals living in the US. Methods: In total, 288 older adults (M_age = 67.4 [7.4]) completed an online survey including a sociodemographic questionnaire, the Center for Epidemiologic Studies Depression Scale (Revised) (CES-D-10; depression), General Anxiety Disorder-7 (GAD-7; anxiety), the Everyday Cognition scale (ECog; SCD), and a question about increased sleep problems/worsened sleep quality during the pandemic. Hierarchical and logistic regression analyses were used to assess relations among sociodemographic factors, depression, anxiety, changes in sleep quality, and SCD. Results: Self-reported pandemic-related impairments in sleep were associated with greater SCD (β = 0.16, p = 0.01). Depression (β = 0.46, p < 0.001) and anxiety (β = 0.29, p < 0.001) were also associated with greater SCD. Depression (OR = 1.17, p < 0.001) and anxiety (OR = 1.15, p = 0.017) predicted reported poorer sleep during the pandemic. Conclusions: Depression, anxiety, and poorer sleep quality during the COVID-19 pandemic were associated with greater SCD concerns. Greater depression and anxiety were also associated with the reported sleep problems/worsened sleep quality. Prevention and management of anxiety and depressive symptoms may help maintain sleep quality and reduce risk of cognitive decline. Full article

(This article belongs to the Special Issue Human Health Before, During, and After COVID-19)

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13 pages, 446 KiB

Open AccessArticle

Effects of Daily Lifestyle Habits on Non-Neurogenic Orthostatic Hypotension in Older Adults in South Korea: A Cross-Sectional Study

by Nahyun Kim and Hye-Kyung Oh

Healthcare 2025, 13(6), 674; https://doi.org/10.3390/healthcare13060674 - 19 Mar 2025

Viewed by 237

Abstract

Background: Orthostatic hypotension (OH) is a chronic, debilitating condition common in older adults. This study examined the effects of daily lifestyle habits on non-neurogenic OH in older adults in South Korea. We further compared the effects of daily lifestyle habits on OH to [...] Read more.

Background: Orthostatic hypotension (OH) is a chronic, debilitating condition common in older adults. This study examined the effects of daily lifestyle habits on non-neurogenic OH in older adults in South Korea. We further compared the effects of daily lifestyle habits on OH to those of the autonomic nervous system (ANS) function. Methods: In a cross-sectional study, 217 community-dwelling older adults aged ≥65 years were recruited using the convenience sampling method. Data were collected using two questionnaires to assess OH and daily lifestyle habits: OH was measured by Orthostatic Grading Scale (OGS) and lifestyle habits included nutrition, sleep, physical activity, and psychological status (stress and depression levels). Plasma catecholamines (epinephrine and norepinephrine) were measured to indicate the ANS function. The data were analyzed using t-tests, Pearson’s correlation coefficients, and multiple linear regression analysis. Results: Significant factors related to OGA score included nutritional status (B = −0.20, p ≤ 0.040), poorer sleep quality (B = 0.15, p = 0.005), physical activity (B = −0.01, p = 0.032), stress (B = 0.04, p = 0.001), and depression (B = 0.23, p = 0.001). These together explained 40.5% of the variance in OH. However, no significant association was found between catecholamines and OGS score. Conclusions: These results suggest that lifestyle habits are important factors, while ANS function may be less associated with non-neurogenic OH. Thus, preventive and non-pharmacological interventions for decreasing OH symptoms should focus on maintaining healthy lifestyle habits in older adults. Full article

(This article belongs to the Section Nursing)

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28 pages, 1645 KiB

Open AccessSystematic Review

Nurses’ Attitudes and Perceptions Towards Heart Failure Palliative Care: A Mixed Method Systematic Review

by Dalia Caleffi, Sara Alberti, Sergio Rovesti, Maria Chiara Bassi, Hajer Hassen, Ilaria Saguatti, Domenico Cannizzaro and Paola Ferri

Healthcare 2025, 13(6), 673; https://doi.org/10.3390/healthcare13060673 - 19 Mar 2025

Viewed by 351

Abstract

Background/Objectives: Heart failure assistance is strictly correlated with the concept of palliative care. Supportive treatment should be part of the heart failure patient pathway from the beginning. Palliative care with interprofessional effective collaboration could be an important resource used to reduce heart failure [...] Read more.

Background/Objectives: Heart failure assistance is strictly correlated with the concept of palliative care. Supportive treatment should be part of the heart failure patient pathway from the beginning. Palliative care with interprofessional effective collaboration could be an important resource used to reduce heart failure distressing symptoms and improve quality of life. Nurses, as professionals with a holistic vision of care, play a crucial role in palliative care introduction and implementation. The aim was to explore nurses’ attitudes and perceptions of heart failure palliative care, updating and adding knowledge to the current evidence. Methods: A systematic mixed-method review following the Joanna Briggs Institute methodology was undertaken. The screening of articles, data extraction and quality appraisal were performed by more than one author. The search was undertaken in May 2024 and applied to PubMed, Cinahl, Embase, Web of science, PsycInfo, Cochrane library and Scopus. A convergent integrated approach allowed us to combine qualitative and quantitative data. The analysis and synthesis of results was guided by the Theoretical Domain Framework. Results: Of the 1048 records identified, 26 met the inclusion criteria. Twelve framework domains were completed with data extracted. A flow chart was elaborated to offer an overview of the main concepts included. Conclusions: Numerous behaviors and elements influenced heart failure palliative care implementations. Analysis has shown that each analyzed element was strictly correlated one with another. When implementation was possible, outcome improvement sustained palliative care benefits with the direct involvement of nurses as educators and coordinators. Full article

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13 pages, 392 KiB

Open AccessArticle

The Positive Cycle of Breastfeeding—Mental Health Outcomes of Breastfeeding Mothers Following Birth Trauma

by Abigail Wheeler, Fay Sweeting, Andrew Mayers, Amy Brown and Shanti Farrington

Healthcare 2025, 13(6), 672; https://doi.org/10.3390/healthcare13060672 - 19 Mar 2025

Viewed by 1887

Abstract

Background/Objectives: It is established that both birth and infant feeding experiences can impact maternal mental health, but little is known about how the two might interact. Potentially, a positive breastfeeding experience might help to mitigate feelings associated with birth trauma, but conversely, a [...] Read more.

Background/Objectives: It is established that both birth and infant feeding experiences can impact maternal mental health, but little is known about how the two might interact. Potentially, a positive breastfeeding experience might help to mitigate feelings associated with birth trauma, but conversely, a difficult feeding experience might further compound birth trauma. The aim of this study was therefore to explore how mothers’ experiences of breastfeeding following birth trauma might impact their mental health. Methods: To explore this, mothers were invited to complete an online survey about their experiences of birth and breastfeeding and how they felt these affected their wellbeing. There were 501 responses, with 159 (32%) describing their birth experience as traumatic and therefore included in this analysis. A thematic analysis approach was used to explore themes around breastfeeding experiences and the impact on wellbeing. Results: Mothers who described positive breastfeeding experiences felt that breastfeeding helped them to bond with their baby post birth trauma and that this protected their mental health. Conversely, mothers who had a difficult experience described how pain, exhaustion, and low milk supply further negatively impacted their wellbeing. Conclusions: The findings show the importance of enhanced support for breastfeeding mothers who have experienced birth trauma, as feeding experiences can potentially help heal or compound challenging memories, thoughts, and emotions around birth. Full article

(This article belongs to the Section Women's Health Care)

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14 pages, 286 KiB

Open AccessPerspective

Professional Role Transition in Nursing: Leveraging Transition Theory to Mitigate the Current Human Resource Crises

by Stella Akomeng Aryeequaye, Kathryn Corneau and Judy E. Duchscher

Healthcare 2025, 13(6), 671; https://doi.org/10.3390/healthcare13060671 - 19 Mar 2025

Viewed by 574

Abstract

New graduate nurse (NGN) turnover is emerging as one of the foremost issues in healthcare systems, primarily due to the implications for patient care and the need to secure the human resource future of the nursing profession. The initial months of transitioning into [...] Read more.

New graduate nurse (NGN) turnover is emerging as one of the foremost issues in healthcare systems, primarily due to the implications for patient care and the need to secure the human resource future of the nursing profession. The initial months of transitioning into the professional role are crucial for cultivating and developing clinical practice patterns, professional values and a connection to the profession. However, the initial transition period for new nurses is associated with numerous challenges that can interrupt a healthy introduction into practice, justifying the critical prioritization of these issues. In light of these challenges to NGN entry to practice, this paper aims to conceptualize the contemporary professional role transition experiences of new graduate nurses and highlight the potential leverage that transition theories offer in managing this experience. Eleven transition theories relevant to this discourse were identified to enhance the understanding and comprehension of the new graduate nurses to inform future initiatives, directives, interventions and policies. Full article

(This article belongs to the Section Nursing)

10 pages, 209 KiB

Open AccessArticle

A Greek Nationwide Survey About Sources of Information on Seasonal Influenza and COVID-19 Vaccination Used by Healthcare Facility Staff During the Pandemic

by Ioanna Avakian, Katerina Dadouli, Stamatia Kokkali, Konstantinos Fotiadis, Christos Hadjichristodoulou and Varvara Α. Mouchtouri

Healthcare 2025, 13(6), 670; https://doi.org/10.3390/healthcare13060670 - 19 Mar 2025

Viewed by 265

Abstract

Background: Workers in healthcare facilities can encourage and serve as role models for the general population regarding vaccination. The information source preferences of employees in healthcare facilities can play an important role in their decisions to receive COVID-19 and seasonal influenza vaccinations [...] Read more.

Background: Workers in healthcare facilities can encourage and serve as role models for the general population regarding vaccination. The information source preferences of employees in healthcare facilities can play an important role in their decisions to receive COVID-19 and seasonal influenza vaccinations (SIVs). A study of specific channels of information and their impact on vaccine acceptance could provide valuable insights. Methods: A cross-sectional questionnaire-based survey was conducted during the first semester of 2021 among 2592 staff members in healthcare facilities (primary, secondary and tertiary). Results: Higher odds of seasonal influenza vaccination (SIV) acceptance were found among staff who were informed by the National Public Health Organization (NPHO) (adjusted Odds Ratio (aOR): 1.47, 95% confidence intervals (CI): 1.13–1.90), the Hellenic Ministry of Health (HMH) (aOR: 1.50, 95% CI: 1.16–1.94) and the Healthcare Facilities Infection Control Committees (ICC) (aOR: 1.35, 95% CI: 1.06–1.73). Professionals who were more willing to accept a COVID-19 vaccine were more likely to obtain information from television (aOR: 1.43, 95% CI: 1.08–1.92), the ICC (aOR: 1.36, 95% CI: 1.03–1.81), the NPHO (aOR: 1.71, 95% CI: 1.28–2.28) and the HMH (aOR: 1.68, 95% CI: 1.26–2.26). Social media presented no statistically significant association with either COVID-19 vaccine acceptance or SIV. Conclusions: Workers in healthcare facilities who received information from highly credible organizations were more likely to accept vaccines. Television was effective in disseminating COVID-19 vaccine campaigns. Full article

(This article belongs to the Special Issue Expanding Competency of Primary Health Care: Emotional and Bio-Social Meanings for General Practice Consultation)

14 pages, 216 KiB

Open AccessArticle

Healthcare Professionals’ Perceptions of Pre-, Peri-, and Postoperative Virtual Reality Immersion in Elderly Patients

by Kristian Hermander, Pether Jildenstål, Sofia Erestam, Peter Dahm, Sophie Lindgren, Joakim Strömberg and Carina Sjöberg

Healthcare 2025, 13(6), 669; https://doi.org/10.3390/healthcare13060669 - 19 Mar 2025

Viewed by 332

Abstract

Background/Objectives: There is a lack of research examining healthcare professionals’ perspectives regarding the potential of non-pharmacological solutions such as immersive virtual reality (VR). The aim of this study was to investigate opportunities and challenges related to the application of immersive virtual reality (VR) [...] Read more.

Background/Objectives: There is a lack of research examining healthcare professionals’ perspectives regarding the potential of non-pharmacological solutions such as immersive virtual reality (VR). The aim of this study was to investigate opportunities and challenges related to the application of immersive virtual reality (VR) technology in patients aged 65 and older undergoing surgery with regional anesthesia and sedation. Method: A qualitative, multicenter study was conducted in the spring of 2024, involving semi-structured interviews with 17 healthcare professionals. Result: A qualitative content analysis of the interviews identified the main theme “Healthcare professionals’ openness to opportunities for this technology for elderly patients”, with the subthemes and themes “elderly patients”, which included the participants’ attitudes towards elderly patients; “virtual reality”, which concerned opportunities, barriers, and risks; and “sustainable healthcare”, which comprised the participants’ thoughts about its impact on sustainable development. Conclusions: The participants suggested potential areas of use for VR during the perioperative period but also identified limitations and risks. They suggested VR was likely to have a positive impact on sustainable healthcare, as well as economic advantages. For its successful implementation, the equipment must be safe. There also needs to be a clear division of responsibilities for it to be functional and suitable for its users. Strategies such as nudging can be used to facilitate its implementation. Full article

14 pages, 410 KiB

Open AccessSystematic Review

Exploring Influential Factors Shaping Nursing as a Profession and Science in Healthcare System—A Systematic Literature Review

by Vlora Ejupi, Allison Squires and Brigita Skela-Savič

Healthcare 2025, 13(6), 668; https://doi.org/10.3390/healthcare13060668 - 19 Mar 2025

Viewed by 1276

Abstract

Introduction: Nursing faces numerous challenges amidst broader socio-political transitions in many countries. Despite efforts to establish formal nursing education and legislative frameworks, the profession’s status remains relatively low within some healthcare systems. This study aims to examine the factors influencing nursing professionalism [...] Read more.

Introduction: Nursing faces numerous challenges amidst broader socio-political transitions in many countries. Despite efforts to establish formal nursing education and legislative frameworks, the profession’s status remains relatively low within some healthcare systems. This study aims to examine the factors influencing nursing professionalism and provide insights into strategies for its enhancement. Aim: The study seeks to summarize the existing literature on nursing professionalism, assess methodological quality, and derive recommendations for future research. Through a systematic review, the study explores various factors shaping nursing professionalism, including communication skills, resilience, education, and cultural perceptions. Methods: A systematic search was conducted across multiple electronic databases from 2014 to 2024 to identify relevant studies on nursing professionalism. The search strategy encompassed elements of professionalism, nursing, and exclusion criteria. Selected studies underwent methodological quality assessment using the Critical Appraisal Skills Programme Qualitative Checklist. Results: The review identified 421 records, yielding 72 eligible studies after screening and eliminating duplicates. Fourteen studies met the inclusion criteria, revealing a complex framework of factors influencing nursing professionalism. The key determinants include communication skills, resilience, education, and cultural perceptions. Studies emphasized the importance of effective communication, resilience in crisis management, quality education, and understanding psychological and cultural influences on professionalism. Conclusions: Nursing professionalism is influenced by multifaceted factors, including communication skills, resilience, education, and cultural perceptions. Recognizing these factors is vital for promoting high-quality nursing practice and ensuring patient safety. Addressing these elements can inform targeted interventions to enhance nursing professionalism and support nurses in delivering optimal healthcare. This study underscores the importance of investing in nursing education, fostering resilience, and considering cultural nuances to cultivate a culture of excellence and professionalism within healthcare systems. Full article

(This article belongs to the Special Issue Nursing Competencies: New Advances in Nursing Care)

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13 pages, 501 KiB

Open AccessArticle

Comparative Analyses Between Vulnerability Biomarkers of Aging and Health Biomarkers in Middle-Aged and Older Female Adults

by Klara Karin Brigitte Knoblauch, Luana Froes Losnack, Gustavo Castillo Zacarias, Gabriel Gasparini Satyro, Rodrigo Villar and Anderson Saranz Zago

Healthcare 2025, 13(6), 667; https://doi.org/10.3390/healthcare13060667 - 18 Mar 2025

Viewed by 365

Abstract

Biological aging is normally associated with greater physiological changes which predispose individuals to adverse outcomes. In this way, the evaluation of vulnerability biomarkers and their relationships with other health biomarkers could contribute to the promotion of interventions and the improvement of older adults’ [...] Read more.

Biological aging is normally associated with greater physiological changes which predispose individuals to adverse outcomes. In this way, the evaluation of vulnerability biomarkers and their relationships with other health biomarkers could contribute to the promotion of interventions and the improvement of older adults’ quality of life. Thereby, this study aimed to compare vulnerability biomarkers (Growth Differentiation Factor 15 (GDF-15), General Functional Fitness Index (GFFI), and frailty phenotype) and their influence on health markers (blood biochemistry, body composition, and hemodynamic variables) in middle-aged and older female adults. Methods: A cross-sectional observational study was conducted with community-dwelling females aged 54–84 with at least 6 months of experience with physical training. The participants were categorized based on functional fitness, frailty phenotype, and GDF-15 quartiles. The General Functional Fitness Index (GFFI) was assessed using the AAHPERD test battery, while frailty phenotype was determined using Fried’s criteria. GDF-15 levels were measured through ELISA. Results: A higher training status (TS) showed better functional fitness and favorable biochemical profiles, including lower total cholesterol (p = 0.006, η²p = 0.253), LDL cholesterol (p = 0.001, η²p = 0.346), triglycerides (p = 0.048, η²p = 0.195), and systolic blood pressure (p = 0.001, η²p = 0.333). Individuals classified as robust (non-frail) had better physical performance and lower total cholesterol (p = 0.002, η²p = 0.306) and LDL cholesterol (p = 0.014, η²p = 0.216) compared to those classified as frail and pre-frail. The GDF-15 quartile did not present differences in health markers between groups. Conclusions: These findings suggest that GFFI may be considered a health biomarker for middle-aged and female older adults while highlighting the need for further research on the role of biomarkers of vulnerability and healthy aging. Full article

(This article belongs to the Special Issue Chronic Disease Management for Older Adults)

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14 pages, 470 KiB

Open AccessReview

End of Life in Italy: Ethical and Legal Perspectives

by Rosagemma Ciliberti, Linda Alfano, Chiara Robba and Nicolò Antonino Patroniti

Healthcare 2025, 13(6), 666; https://doi.org/10.3390/healthcare13060666 - 18 Mar 2025

Viewed by 318

Abstract

The regulation of end-of-life decisions has been the subject of intense debate for years, marked by the challenge of reconciling two fundamental ethical principles: preservation of life and individual self-determination. From a legal perspective, numerous court rulings have outlined an evolving framework, highlighting [...] Read more.

The regulation of end-of-life decisions has been the subject of intense debate for years, marked by the challenge of reconciling two fundamental ethical principles: preservation of life and individual self-determination. From a legal perspective, numerous court rulings have outlined an evolving framework, highlighting the difficulty of establishing a regulatory approach that balances constitutional rights with ethical values. This study examines key Italian judicial decisions, with a particular focus on recent Constitutional Court rulings regarding end-of-life issues, and discusses the underlying ethical and humanistic perspectives. We aim to explore the key ethical and legal issues arising in the context of end-of-life regulation. Judicial developments demonstrate an increasing recognition of individual self-determination in accessing assisted suicide despite persisting ongoing ambiguities and regulatory gaps. The end-of-life debate underscores the urgency of moving beyond abstract and schematic approaches, favoring a perspective that integrates multidisciplinary expertise and human sensitivity. Ensuring effective access to palliative care and comprehensive social and healthcare systems is essential to alleviate suffering and provide genuine alternatives to assisted suicide. Full article

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20 pages, 2014 KiB

Open AccessArticle

Barriers to the Utilization of mHealth Applications in Saudi Arabia: Insights from Patients with Chronic Diseases

by Haitham Alzghaibi

Healthcare 2025, 13(6), 665; https://doi.org/10.3390/healthcare13060665 - 18 Mar 2025

Cited by 1 | Viewed by 393

Abstract

Background: Mobile health (mHealth) applications play a crucial role in enhancing healthcare accessibility, patient engagement, and chronic disease management. However, technical, usability, accessibility, and privacy-related barriers continue to hinder their widespread adoption. The Sehaty app, a government-managed mHealth platform in Saudi Arabia, is [...] Read more.

Background: Mobile health (mHealth) applications play a crucial role in enhancing healthcare accessibility, patient engagement, and chronic disease management. However, technical, usability, accessibility, and privacy-related barriers continue to hinder their widespread adoption. The Sehaty app, a government-managed mHealth platform in Saudi Arabia, is widely used for scheduling medical appointments, accessing health records, and communicating with healthcare providers. Understanding the challenges associated with its utilization is essential for optimizing its functionality and improving user experience. Aim: This study aims to identify and evaluate the key barriers affecting the adoption and usability of the Sehaty mHealth application among patients with chronic conditions in Saudi Arabia. Specifically, it examines challenges related to technical performance, usability, accessibility, privacy, and security and their impact on user satisfaction and engagement. Methods: A cross-sectional study was conducted using a structured questionnaire distributed to 344 participants selected through purposive sampling to ensure the inclusion of active Sehaty users with chronic conditions. The questionnaire assessed 10 primary usability barriers, including technical issues, navigation difficulties, privacy concerns, and accessibility limitations. Descriptive statistics and correlation analyses were performed to evaluate the prevalence and interrelationships of these barriers. Results: The findings indicate that technical barriers, including frequent application crashes, slow responsiveness, and system instability, significantly hinder user satisfaction. Usability challenges, such as difficulties in navigation and task completion, further impede engagement. Moreover, privacy and security concerns emerged as significant deterrents, with users expressing apprehensions about data safety and transparency. Accessibility barriers, particularly for older adults and individuals with disabilities, were associated with insufficient support and training, making the app less user-friendly for these populations. The study highlights the interconnected nature of usability challenges, suggesting that improvements in technical stability and interface design could lead to enhanced user confidence, engagement, and overall satisfaction. Conclusions: Addressing these barriers requires targeted technical enhancements, user-centered design improvements, and strengthened data security measures to promote trust and engagement. Additionally, implementing comprehensive user support systems and accessibility features is essential to ensuring equitable access to mHealth services. While the study’s generalizability is limited by its focus on a single government-managed platform, its findings offer valuable insights applicable to broader mHealth initiatives. Future research should incorporate longitudinal studies to assess the long-term impact of usability improvements on mHealth adoption and healthcare outcomes. Full article

(This article belongs to the Special Issue Healthcare Goes Digital: Mobile Health and Electronic Health Technology in the 21st Century)

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13 pages, 1055 KiB

Open AccessArticle

Understanding Cancer Screening Behavior in South Korea: A Biopsychosocial Approach to Regional Differences

by Yoon-Hee Cho and Joohyun Lee

Healthcare 2025, 13(6), 664; https://doi.org/10.3390/healthcare13060664 - 18 Mar 2025

Viewed by 311

Abstract

Background/Objectives: This study aimed to examine regional cancer screening participation rates among South Korean adults aged 40 and over and to identify biological, psychological, and sociocultural factors associated with cancer screening behavior using the biopsychosocial model. Methods: This research was a secondary analysis [...] Read more.

Background/Objectives: This study aimed to examine regional cancer screening participation rates among South Korean adults aged 40 and over and to identify biological, psychological, and sociocultural factors associated with cancer screening behavior using the biopsychosocial model. Methods: This research was a secondary analysis study. Data were obtained from the 2023 Korean Community Health Survey, focusing on adults residing in cities that exhibited the highest and lowest rates of cancer screening. Differences in cancer screening rates by city were visualized using a location-based open service platform. Variables were categorized into biological, psychological, and sociocultural factors, and logistic regression analysis was conducted to ascertain the factors associated with screening participation. Results: The cancer screening rate for adults aged 40 or older in 17 metropolitan cities in Korea ranged from 64.9% to 76.0%, and the national average was 70.9%. In the city with the highest screening rate, participation was positively associated with oral health, physical activity, breakfast-eating habits, and past smoking. In the city with the lowest screening rate, higher screening participation correlated with family cohabitation and satisfaction with the social environment. Conclusions: Our results suggest that cancer screening participation rates vary across regions and that the factors associated with cancer screening participation differ between regions with the highest and lowest participation rates. These results provide evidence for targeted interventions that take into account regional factors to improve cancer screening rates in South Korea. Full article

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13 pages, 1383 KiB

Open AccessArticle

Effect of a Supervised Aerobic Exercise Training Program and Ginkgo Biloba Extract on Metabolic Parameters and Functional Capacity in HIV-Infected Subjects

by Raúl Soria-Rodríguez, Javier Méndez-Magaña, Nathaly Torres-Castillo, Erika Martínez-López, Edtna Jauregui-Ulloa, Juan López-Taylor, Cesar O. de Loera-Rodríguez, Ramón Sigala-Arellano and Fernando Amador-Lara

Healthcare 2025, 13(6), 663; https://doi.org/10.3390/healthcare13060663 - 18 Mar 2025

Viewed by 812

Abstract

Background: A remarkable increase in metabolic comorbidities occur in people living with HIV infection (PLWH). Supervised physical activity provides significant health benefits. Ginkgo biloba (GKB) extract has been reported to have a wide range of metabolic advantages. This study aimed to examine [...] Read more.

Background: A remarkable increase in metabolic comorbidities occur in people living with HIV infection (PLWH). Supervised physical activity provides significant health benefits. Ginkgo biloba (GKB) extract has been reported to have a wide range of metabolic advantages. This study aimed to examine the effects of an exercise training (ET) program and a GKB extract on PLWH. Methods: This was a randomized placebo-controlled double-blind study. Twenty-eight PLWH were assigned to receive a placebo (n = 10), GKB extract (n = 10), or statins (n = 8). All patients underwent a supervised ET program 3–5 times per week. Anthropometric measurements, functional capacities, and metabolic parameters were assessed in all participants at baseline and after 12 weeks of follow-up. Results: After the 12-week intervention, body fat decreased significantly by 2–3% in all groups relative to their baseline values (p < 0.05). Total cholesterol and LDL-c were significantly decreased in the ET + statin group (p = 0.04, and p = 0.007, respectively) compared to baseline values, while HbA1c and the HOMA-IR index were significantly decreased in the ET + GKB group (p = 0.03 and p = 0.02, respectively) compared to baseline values, and a significant increase in CD4+ T cell mean was observed in the ET + placebo group (p = 0.005) compared to baseline values. A significant increase in cardiorespiratory capacity (VO_2max) from their baseline values was observed in all groups (p < 0.001) after 12 weeks of intervention from their baseline values. Conclusions: Body fat and cardiorespiratory fitness significantly improved after a 12-week supervised ET program. GKB extract significantly decreased insulin resistance. Full article

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14 pages, 2215 KiB

Open AccessArticle

Learning Objectives Matrix in DIM.RUHR: A Didactic Concept for the Interprofessional Teaching of Data Literacy in Outpatient Health Care

by Vivian Lüdorf, Anne Mainz, Sven Meister, Jan P. Ehlers and Julia Nitsche

Healthcare 2025, 13(6), 662; https://doi.org/10.3390/healthcare13060662 - 18 Mar 2025

Viewed by 249

Abstract

(1) Background: Each year, significant volumes of healthcare data are generated through both research and care. Since fundamental digital processes cannot function effectively without essential data competencies, the challenge lies in enhancing the quality of data management by establishing data literacy among [...] Read more.

(1) Background: Each year, significant volumes of healthcare data are generated through both research and care. Since fundamental digital processes cannot function effectively without essential data competencies, the challenge lies in enhancing the quality of data management by establishing data literacy among professionals in outpatient healthcare and research. (2) Methods: Within the DIM.RUHR project (Data Competence Center for Interprofessional Use of Health Data in the Ruhr Metropolis), a didactic concept for interprofessional data literacy education is developed, structured as a learning objectives matrix. Initially conceived through a literature review, this concept has been continually developed through collaboration with interprofessional project partners. The study was conducted between February 2023 and June 2024. (3) Results: The foundational structure and content of the didactic concept are based on various scientific studies related to general data literacy and the outcomes of an interactive workshop with project partners. Eight distinct subject areas have been developed to encompass the data literacy required in healthcare professions: (1) Fundamentals and general concepts, (2) ethical, legal, and social considerations, (3) establishing a data culture, (4) acquiring data, (5) managing data, (6) analyzing data, (7) interpreting data, and (8) deriving actions. Within these, learners’ data literacy is assessed across the four competency areas: basic, intermediate, advanced, and highly specialized. (4) Conclusions: The learning objectives matrix is anticipated to serve as a solid foundation for the development of teaching and learning modules aimed at enhancing data literacy across healthcare professions, enabling them to effectively manage data processes while addressing the challenges associated with digital transformation. Full article

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10 pages, 533 KiB

Open AccessArticle

The Impact of ISO Certification Procedures on Patient Safety Culture in Public Hospital Departments

by Georgia Kyriakeli, Anastasia Georgiadou, Maria Lithoxopoulou, Zoi Tsimtsiou and Vasilios Kotsis

Healthcare 2025, 13(6), 661; https://doi.org/10.3390/healthcare13060661 - 18 Mar 2025

Viewed by 304

Abstract

Background: ISO certification is widely implemented as a quality assurance tool in healthcare services; however, its impact on patient safety culture (PSC) in public hospitals remains insufficiently explored. Aim: This study aims to assess the effect of ISO certification procedures on different dimensions [...] Read more.

Background: ISO certification is widely implemented as a quality assurance tool in healthcare services; however, its impact on patient safety culture (PSC) in public hospitals remains insufficiently explored. Aim: This study aims to assess the effect of ISO certification procedures on different dimensions of PSC in public hospital departments by comparing ISO-certified and non-certified departments across two phases (Phase A: pre-certification; Phase B: 18 months post-certification). Methods: A two-phase cross-sectional study was conducted in a tertiary public hospital in Greece. Healthcare professionals from both ISO-certified and non-certified departments participated. The Hospital Survey on Patient Safety Culture (HSOPSC v1.0) was administered at two time points (Phase A: baseline, pre-certification; Phase B: 18 months post-certification). A repeated measures analysis was performed to assess the changes over time and differences between the two groups. Results: The findings suggest that ISO certification has a mixed impact on the PSC dimensions. A significant improvement was observed in “Supervisor’s/Manager’s Expectations and Actions Promoting Safety” (p = 0.012), while “Teamwork Within Units” (p = 0.026) and “Handoffs and Transitions” (p = 0.037) showed statistically significant changes. These results indicate that certification may enhance structured managerial oversight and interdepartmental collaboration, but at the same time, may negatively impact the teamwork within hospital units. However, no statistically significant changes were observed in “Overall Perception of Safety” (p = 0.135) and “Non-Punitive Response to Error” (p = 0.101), suggesting that while there was a trend towards a stricter safety evaluation, this was not statistically confirmed. Additionally, the staffing perceptions remained unchanged (p = 0.745). Conclusions: ISO certification appears to reinforce managerial safety expectations and interdepartmental teamwork, yet does not significantly improve the overall perceptions of patient safety or non-punitive error responses. The results indicate the need for targeted interventions to ensure that certification processes do not increase administrative burdens or negatively impact staff perceptions. Future research should explore whether these effects persist over time and how hospitals can optimize certification processes to strengthen PSC without unintended consequences. Full article

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13 pages, 479 KiB

Open AccessArticle

A Scale for Assessing Pain in Older Adults: The Influence on Activities of Daily Living

by Zuleyma González Miguel, María de Lourdes García Hernández, Yolanda Hernández Ortega, María Alberta García Jiménez, María de Lourdes Rico González, Patricia Cruz Bello, María Gicela Pérez Hernández, Nicolas Santiago-González, Marisol Ignacio Albino and Erika López Martiñón

Healthcare 2025, 13(6), 660; https://doi.org/10.3390/healthcare13060660 - 17 Mar 2025

Viewed by 331

Abstract

Physical functional impairment generates pain, fear and anguish, impacting the activities of daily living (ADLs) of older adults (OAs); The background was to design an instrument that can measure pain in OA living with pain. Methods: mixed analytical and cross-sectional study in two [...] Read more.

Physical functional impairment generates pain, fear and anguish, impacting the activities of daily living (ADLs) of older adults (OAs); The background was to design an instrument that can measure pain in OA living with pain. Methods: mixed analytical and cross-sectional study in two non-probabilistic samples: 15 experts in the care of OAs and 185 OAs from day homes in three municipalities of the State of Mexico. The instruments used included an integrated scale of 30 items, elaborated with the Delphi technique over three rounds, and the Scale for Measuring Pain in Older Adults (SMPOA), with 30 items divided into four factors. An analysis was conducted using content validity ratios and the Lawshe´s method adapted by Tristán for qualitative studies, with a minimum of 0.87 and a maximum of 1.0. An exploratory factor analysis (EFA) was conducted to structure the underlying factors into a data matrix, addressing the relationships between a set of variables, and a confirmatory factor analysis (CFA) was conducted to validate the scale using the main axis method and rotation via Quartimax with Kaiser normalisation. Results: proposal of a scale to measure pain in MA (EMEDAM). Conclusion: the adapted scale assesses sensory and affective intensity and the influence on the ADLs and can be used in OAs living with acute or chronic pain. Full article

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Open AccessArticle

Adolescents’ Well-Being and Democratic Parenting: Does Environmental Sensitivity Matter?

by Nicolò Maria Iannello, Nicla Cucinella, Alida Lo Coco, Sonia Ingoglia, Costanza Baviera, Cristiano Inguglia, Francesca Lionetti, Michael Pluess and Maria Grazia Lo Cricchio

Healthcare 2025, 13(6), 659; https://doi.org/10.3390/healthcare13060659 - 17 Mar 2025

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Abstract

Background/Objectives: This study examines the relations between democratic parenting and adolescents’ subjective well-being, focusing on the potential moderating role of youth environmental sensitivity. Three environmental sensitivity models (diathesis–stress, vantage sensitivity, differential susceptibility) were tested to unveil the heterogeneity of the effects of democratic [...] Read more.

Background/Objectives: This study examines the relations between democratic parenting and adolescents’ subjective well-being, focusing on the potential moderating role of youth environmental sensitivity. Three environmental sensitivity models (diathesis–stress, vantage sensitivity, differential susceptibility) were tested to unveil the heterogeneity of the effects of democratic parenting on adolescents’ subjective well-being according to the type of environmental influences (positive, negative, both positive and negative) youths are more susceptible to. Methods: A sample of 321 Italian adolescents (75% females; M_age = 16.83, SD = 1.35) completed online self-report measures assessing perceptions of democratic parenting, environmental sensitivity, and various dimensions of subjective well-being (positivity, vitality, anxiety, and general health). Results: Three path analysis models were run to evaluate the associations between democratic parenting, environmental sensitivity, and youths’ well-being. The results showed that democratic parenting was positively related to adolescents’ positivity, vitality, and general health and negatively to anxiety. Adolescents with higher environmental sensitivity reported reduced subjective well-being. A moderating effect of environmental sensitivity was detected such that highly sensitive adolescents had lower general health when democratic parenting was low. Conclusions: These findings support a diathesis–stress model, suggesting that environmental sensitivity might be a vulnerability factor in less supportive environments. Full article

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Healthcare, Volume 13, Issue 6 (March-2 2025) – 110 articles

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