Healthcare

14 pages, 262 KiB

Open AccessProtocol

Longitudinal Analysis of Intrinsic Capacity and Other Risk Factors in Aging: FREVO Study Protocol

by Rodrigo Cappato de Araújo, Letícia Bojikian Calixtre, Wildja de Lima Gomes, Juliana Daniele de Araújo Silva, Diógenes Candido Mendes Maranhão, Fernando Damasceno de Albuquerque Angelo, Gabriel Lucas Leite da Silva Santos, Késia Moreira Sampaio Amaral, Ruth Lahis da Silva Gonçalves, Julia Gomes de Alencar, Michele L. Callisaya, Francis Trombini-Souza and Ana Carolina Rodarti Pitangui

Healthcare 2025, 13(9), 993; https://doi.org/10.3390/healthcare13090993 (registering DOI) - 25 Apr 2025

Abstract

Background/Objectives: Population aging presents important global and socio-economic challenges, especially in developing countries such as Brazil, where aging is projected to accelerate in the next years. This manuscript presents the protocol of the FREVO (risk factors in aging) study, a six-year longitudinal study [...] Read more.

Background/Objectives: Population aging presents important global and socio-economic challenges, especially in developing countries such as Brazil, where aging is projected to accelerate in the next years. This manuscript presents the protocol of the FREVO (risk factors in aging) study, a six-year longitudinal study that aims to assess intrinsic capacity and its interaction with other risk factors. Moreover, this study aims to evaluate the combination of these factors and their correlation with major adverse health outcomes among community-dwelling older adults in Petrolina, Brazil. Methods: This six-year prospective cohort study will recruit 496 participants aged 60 or older. Annual in-person assessments using validated tools will measure intrinsic capacity, personal information, lifestyle, and chronic conditions. Negative outcomes (falls, hospitalizations, dementia, and death) will be recorded biannually by phone. Statistical analyses will employ latent profile analysis to identify risk phenotypes and Cox regression models for time-to-event analyses. Results: This study will attempt to identify phenotypes and modifiable risk factors by using the WHO’s intrinsic capacity framework in a low-resource Brazilian context for the assessment and promotion of healthy aging. Conclusions: Our findings will address important gaps that can contribute to a localized understanding of aging, aligning global frameworks with regional realities to promote independence, functionality, and quality of life for older adults. Full article

18 pages, 665 KiB

Open AccessReview

Differential Effects of Decisional and Emotional Forgiveness on Psychological, Spiritual, Social, Volitional, and Physical Well-Being: A Scoping Review

by Richard G. Cowden, Everett L. Worthington, Jr., Caleb A. Chung and Zhuo Job Chen

Healthcare 2025, 13(9), 992; https://doi.org/10.3390/healthcare13090992 (registering DOI) - 25 Apr 2025

Abstract

Within a stress-and-coping theory of forgiveness, two dimensions of forgiveness have been hypothesized—decisional forgiveness (DF) and emotional forgiveness (EF). Each is theorized to have different impacts on different dimensions of well-being—psychological, spiritual (or religious), social, volitional, and physical. A scoping review was performed [...] Read more.

Within a stress-and-coping theory of forgiveness, two dimensions of forgiveness have been hypothesized—decisional forgiveness (DF) and emotional forgiveness (EF). Each is theorized to have different impacts on different dimensions of well-being—psychological, spiritual (or religious), social, volitional, and physical. A scoping review was performed to explore the associations of each dimension of forgiveness with each dimension of well-being. A total of k = 30 articles met the criteria for inclusion, and estimates of the association between DF and/or EF with one or more indicators of well-being were extracted. Both dimensions of forgiveness were positively linked to all dimensions of well-being, except that there were too few studies on physical well-being (e.g., self-rated physical health) to analyze. DF was generally more strongly related to indicators of spiritual well-being (e.g., faith maturity), psychological well-being (e.g., happiness), and volitional well-being (e.g., conciliatory behavior) than EF, whereas the inverse was observed for social well-being (e.g., marital satisfaction). However, because most studies were cross-sectional, firm conclusions about the associations of both DF and EF with well-being were limited by a paucity of robust studies. Suggestions to guide future research are provided, including the need for more rigorous longitudinal research and better evidence-based theorizing. Full article

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15 pages, 276 KiB

Open AccessArticle

A Delphi Survey on the Validity and Feasibility of a Healthcare-Associated Infection Surveillance System for Traditional Korean Medicine Hospitals in South Korea

by Sun Young Jeong, Ji Hye Park, Sung Eun Lee, Somi Shin and Kwan-Il Kim

Healthcare 2025, 13(9), 991; https://doi.org/10.3390/healthcare13090991 (registering DOI) - 25 Apr 2025

Abstract

Background: Current research on healthcare-associated infection (HAI) surveillance in traditional Korean medicine (TKM) institutions is limited. Methods: We utilized the Delphi method to evaluate the validity and feasibility of implementing an HAI surveillance system in TKM hospitals. This involved conducting a systematic literature [...] Read more.

Background: Current research on healthcare-associated infection (HAI) surveillance in traditional Korean medicine (TKM) institutions is limited. Methods: We utilized the Delphi method to evaluate the validity and feasibility of implementing an HAI surveillance system in TKM hospitals. This involved conducting a systematic literature review and focus group interviews with three infection control experts and five TKM doctors experienced in infection control within TKM hospitals. Based on these findings, we developed a Delphi questionnaire. The survey included a total of fifteen participants: ten TKM doctors and TKM-related policy researchers with infection control expertise, two infection control nurses, and three infectious disease doctors. Results: The survey results indicated strong consensus on the necessity of introducing an HAI surveillance system tailored to TKM hospitals, as well as their integration into the Korean National Healthcare-associated Infections Surveillance (KONIS) system. Since infectious diseases do not differentiate between acute care hospitals and TKM hospitals, it is reasonable for TKM hospitals to participate in infection surveillance systems. However, the feasibility of implementing HAI surveillance in TKM hospitals remains low due to a lack of awareness regarding infection surveillance, insufficient surveillance personnel, inadequate diagnostic and surveillance infrastructure, and limited policy support for infection control. Therefore, this study proposes a phased approach in which hand hygiene surveillance and safe injection practice monitoring, which received relatively higher consensus on feasibility, should be prioritized to establish the necessary surveillance infrastructure. Subsequently, a stepwise implementation of HAI surveillance can be introduced. Conclusions: Although TKM hospitals generally have a lower risk of HAIs compared to acute care facilities, they lack robust infection control systems and support. To address this gap, TKM hospitals should join the KONIS system. Appointing and training dedicated infection control personnel will enable their participation and enhance overall infection management. Full article

13 pages, 252 KiB

Open AccessArticle

Assessing Medical Students’ Perceptions of AI-Integrated Telemedicine: A Cross-Sectional Study in Romania

by Florina Onetiu, Melania Lavinia Bratu, Roxana Folescu, Felix Bratosin and Tiberiu Bratu

Healthcare 2025, 13(9), 990; https://doi.org/10.3390/healthcare13090990 - 24 Apr 2025

Abstract

Background and Objectives: The rapid advancement of Artificial Intelligence (AI) has driven the expansion of telemedicine solutions worldwide, enabling remote diagnosis, patient monitoring, and treatment support. This study aimed to explore medical students’ perceptions of AI in telemedicine, focusing on how these future [...] Read more.

Background and Objectives: The rapid advancement of Artificial Intelligence (AI) has driven the expansion of telemedicine solutions worldwide, enabling remote diagnosis, patient monitoring, and treatment support. This study aimed to explore medical students’ perceptions of AI in telemedicine, focusing on how these future physicians view AI’s potential, benefits, and challenges. Methods: A cross-sectional survey was conducted among 161 Romanian medical students spanning Years 1 through 6. Participants completed a 15-item questionnaire covering demographic factors, prior exposure to AI, attitudes toward telemedicine, perceived benefits, and concerns related to ethical and data privacy issues. A questionnaire on digital health acceptance was conceived and integrated into the survey instrument. Results: Out of 161 respondents, 70 (43.5%) reported prior telemedicine use, and 66 (41.0%) indicated high familiarity (Likert scores ≥ 4) with AI-based tools. Fifth- and sixth-year students showed significantly greater acceptance of AI-driven telemedicine compared to first- and second-year students (p = 0.014). A moderate positive correlation (r = 0.44, p < 0.001) emerged between AI familiarity and telemedicine confidence, while higher data privacy concerns negatively affected acceptance (β = −0.20, p = 0.038). Gender differences were noted but did not reach consistent statistical significance in multivariate models. Conclusions: Overall, Romanian medical students view AI-enhanced telemedicine favorably, particularly those in advanced academic years. Familiarity with AI technologies is a key driver of acceptance, though privacy and ethical considerations remain barriers. These findings underline the need for targeted curricular interventions to bolster AI literacy and address concerns regarding data security and clinical responsibility. By proactively integrating AI-related competencies, medical faculties can better prepare students for a healthcare landscape increasingly shaped by telemedicine. Full article

14 pages, 245 KiB

Open AccessArticle

Vestibular Well-Being Benefits of a Single Session of Functional Neurology Intervention on Saccadic Stimuli Dysfunction

by Guillermo Escribano-Colmena, Jorge Rey-Mota, Sara Hadid-Santiago, Álvaro Ramos-Garrido, José Francisco Tornero-Aguilera and Vicente Javier Clemente-Suárez

Healthcare 2025, 13(9), 989; https://doi.org/10.3390/healthcare13090989 - 24 Apr 2025

Abstract

Background/Objectives: This study aimed to analyze the psychophysiological effects of functional neurology intervention on dysfunction in vestibular saccadic stimuli, focusing on its impact on muscle performance, psychophysiological arousal, and pain perception. Methods: Seventy-five healthy volunteer participants were randomly divided into two groups: an [...] Read more.

Background/Objectives: This study aimed to analyze the psychophysiological effects of functional neurology intervention on dysfunction in vestibular saccadic stimuli, focusing on its impact on muscle performance, psychophysiological arousal, and pain perception. Methods: Seventy-five healthy volunteer participants were randomly divided into two groups: an experimental group that received functional neurology treatment and a control group that did not. Both groups underwent the same evaluations at four distinct time points. Key measurements included pressure pain threshold (PPT), hand strength, critical flicker fusion threshold (CFFT), blood oxygen saturation, heart rate, and the number of saccadic stimuli tolerated until dysfunction in an indicator muscle (anterior deltoid). The functional neurology intervention involved proprioceptive reflexes, trigger point desensitization, and systemic approaches to rectify neuromuscular dysfunctions. Results: The results showed that the functional neurology intervention significantly increased the number of saccadic stimuli tolerated, from 3.6 ± 3.3 to 26.1 ± 8.7, indicating an improvement in neuromuscular endurance. Additionally, PPT readings exhibited an upward trend from baseline to post-intervention, with the final reading averaging at 10.2 ± 5.3 kgf, and hand strength measurements showed a modest but significant increase post-intervention. Notably, CFFT and blood oxygen saturation levels remained relatively stable, suggesting that the intervention’s primary impact was on neuromuscular performance and pain perception rather than on cognitive arousal or systemic oxygenation. Heart rate data indicated a decrease post-intervention, implying potential improvements in autonomic nervous system function. In contrast, the control group did not present significant changes in any of the psychophysiological parameters evaluated. These findings underscore the potential of targeted functional neurology treatments to enhance physical performance and provide valuable therapeutic benefits for neuromuscular and cognitive dysfunctions. Conclusions: Functional neurology interventions can effectively improve muscle endurance, pain management, and overall neuromuscular health, highlighting its relevance as a therapeutic modality in sports performance optimization and rehabilitation contexts. Full article

(This article belongs to the Topic Exploring the Interplay of Psychology and Work-Related Health and Well-Being)

14 pages, 235 KiB

Open AccessArticle

Factors Affecting the Direct and Indirect Performance of Infection Control for Centrally Inserted Central Catheters Among ICU Nurses

by Yoonjeong Park and Seunghye Choi

Healthcare 2025, 13(9), 988; https://doi.org/10.3390/healthcare13090988 - 24 Apr 2025

Abstract

Background/Objectives: This descriptive study investigated the influence of intensive care unit (ICU) nurses’ knowledge and perception of the importance of patient safety management, nursing professionalism, and infection control organizational culture on the direct and indirect performance of centrally inserted central catheter (CICC) infection [...] Read more.

Background/Objectives: This descriptive study investigated the influence of intensive care unit (ICU) nurses’ knowledge and perception of the importance of patient safety management, nursing professionalism, and infection control organizational culture on the direct and indirect performance of centrally inserted central catheter (CICC) infection control. Direct performance encompasses immediate infection control interventions administered to patients, whereas indirect performance constitutes physician communication and documentation protocols. Methods: A structured questionnaire was used to survey 176 ICU nurses from a tertiary hospital in Korea. Results: There were no significant differences in CICC infection control performance according to participants’ general characteristics. The direct performance of CICC infection control showed a significant positive correlation with clinical experience (p = 0.006), ICU work experience (p = 0.020), the perception of the importance of patient safety management (p < 0.001), nursing professionalism (p < 0.001), and infection control organizational culture (p < 0.001). The indirect performance of CICC infection control did not show any significant correlation with participants’ general characteristics; however, it showed significant positive correlations with the perception of the importance of patient safety management (p < 0.001), nursing professionalism (p < 0.001), and infection control organizational culture (p < 0.001). The factors affecting the direct performance of CICC infection control were the perception of the importance of patient safety management and infection control organizational culture. The perception of the importance of patient safety management affected the indirect performance of CICC infection control. Conclusions: To enhance overall infection control performance among ICU nurses, it is crucial to raise the perception of the importance of patient safety management and implement systematic strategies targeting both the direct and indirect performance of CICC infection control. Healthcare institutions should establish more detailed guidelines distinguishing between direct and indirect performance of CICC infection control and continuously educate ICU nurses on the importance of compliance with both aspects. Full article

20 pages, 432 KiB

Open AccessArticle

The Correlation Between Emotionality Changes and Alcohol Consumption in Young Persons: A Pilot Study

by Simona Dana Mitincu-Caramfil, Lavinia-Alexandra Moroianu, Andrei Vlad Bradeanu, Oana-Maria Isailă, Cecilia Curis and Eduard Drima

Healthcare 2025, 13(9), 987; https://doi.org/10.3390/healthcare13090987 - 24 Apr 2025

Abstract

Background/Objectives: Alcohol consumption in young persons is a growing phenomenon, with significant implications for physical and mental health. This behavior exposes adolescents and young adults to multiple risks, such as affecting cognitive functions, the development of emotional disorders, and social integration difficulties. The [...] Read more.

Background/Objectives: Alcohol consumption in young persons is a growing phenomenon, with significant implications for physical and mental health. This behavior exposes adolescents and young adults to multiple risks, such as affecting cognitive functions, the development of emotional disorders, and social integration difficulties. The present study sets out to investigate the way alcohol consumption influences emotionality in young people, focusing on the emotional changes (anxiety and irritability), cognitive changes (attention deficit and memory disorder), and behavioral changes (impulsivity and aggressiveness). Methods: The methodology involved collecting quantitative data from a sample of young people who consume and do not consume alcohol, using standardized questionnaires and advanced statistical software (processed in MATLAB version 9.11_R2021b). We analyzed variables such as consumption frequency and intensity, affective scores, and demographic factors to highlight the correlations between consumption level and the intensity of affective modifications. Results: The results revealed a significant association between alcohol consumption and the rise in anxiety and depression symptoms or a tendency toward impulsive behaviors. Additionally, we observed that psychosocial factors, including group pressure, family climate, and stressful contexts, can exacerbate emotional vulnerability. Conclusions: This study suggests the need for early psychological interventions and prevention programs to approach emotional and cognitive dimensions and the social influences associated with consumption. Implementing support and counseling strategies, as well as education and awareness campaigns, can contribute to reducing risky behavior and promoting young people’s harmonious development. Full article

(This article belongs to the Special Issue The Impact and Relationship of Lifestyle Behaviors and Mental Health)

16 pages, 454 KiB

Open AccessArticle

Counseling and Prescription of Physical Exercise in Medical Consultations in Portugal: The Clinician’s Perspective

by Rita Quintas Oliveira, Edite Teixeira-Lemos, Jorge Oliveira, Joana Morais, Diogo Miguel, Luís Pedro Lemos and João Páscoa Pinheiro

Healthcare 2025, 13(9), 986; https://doi.org/10.3390/healthcare13090986 - 24 Apr 2025

Abstract

Background/Objectives: Physical exercise (PE) is essential in promoting health and quality of life and protecting against chronic diseases. Health professionals are identified as key figures in promoting and prescribing PE, yet various factors may impact this during consultations. This study aims to [...] Read more.

Background/Objectives: Physical exercise (PE) is essential in promoting health and quality of life and protecting against chronic diseases. Health professionals are identified as key figures in promoting and prescribing PE, yet various factors may impact this during consultations. This study aims to assess Portuguese specialist physicians’ understanding of the importance of PE prescriptions. It will also investigate the approaches they utilize in promoting and prescribing PE, their knowledge of incorporating this practice into their consultations, and the major facilitators or barriers to prescription. Methods: A cross-sectional observational study was conducted using a validated questionnaire distributed via email by the Centre Regional Section of the Portuguese Medical Association to physicians. The data were analyzed using descriptive and inferential statistics. Results: In total, 414 responses were collected, with participants representing different medical specialties. The participants were primarily women (62.8%) with a mean age of 49.9 ± 14.9 years. While 85.5% of physicians promoted and prescribed PE, recognizing its cardiovascular and metabolic health benefits, only 24.0% received specific training, and 73.7% were unaware of relevant guidelines. Older male physicians (over 60 years old) expressed more confidence in PE prescriptions, while younger ones were more familiar with electronic prescribing tools. Identified barriers included patient compliance (42.3%), a lack of accessible PE resources (18.4%), and limited consultation time (17.4%). Most physicians (64.4%) relied on oral counseling for prescriptions. Conclusions: Most Portuguese specialist doctors recognize the benefits of PE prescriptions. However, barriers like inadequate training and patient compliance hinder PE implementation. Enhanced training and resources are vital for effectively integrating PE into clinical practice. Full article

21 pages, 3234 KiB

Open AccessArticle

Pre- Trained Language Models for Mental Health: An Empirical Study on Arabic Q&A Classification

by Hassan Alhuzali and Ashwag Alasmari

Healthcare 2025, 13(9), 985; https://doi.org/10.3390/healthcare13090985 - 24 Apr 2025

Abstract

Background: Pre-Trained Language Models hold significant promise for revolutionizing mental health care by delivering accessible and culturally sensitive resources. Despite this potential, their efficacy in mental health applications, particularly in the Arabic language, remains largely unexplored. To the best of our knowledge, comprehensive [...] Read more.

Background: Pre-Trained Language Models hold significant promise for revolutionizing mental health care by delivering accessible and culturally sensitive resources. Despite this potential, their efficacy in mental health applications, particularly in the Arabic language, remains largely unexplored. To the best of our knowledge, comprehensive studies specifically evaluating the performance of PLMs on diverse Arabic mental health tasks are still scarce. This study aims to bridge this gap by evaluating the performance of pre-trained language models in classifying questions and answers within the mental health care domain. Methods: We used the MentalQA dataset, which comprises Arabic Questions and Answers interactions related to mental health. Our experiments involved four distinct learning strategies: traditional feature extraction, using PLMs as feature extractors, fine-tuning PLMs, and employing prompt-based techniques with models, such as GPT-3.5 and GPT-4 in zero-shot and few-shot learning scenarios. Arabic-specific PLMs, including AraBERT, CAMelBERT, and MARBERT, were evaluated. Results: Traditional feature-extraction methods paired with Support Vector Machines (SVM) showed competitive performance, but PLMs outperformed them due to their superior ability to capture semantic nuances. In particular, MARBERT achieved the highest performance, with Jaccard scores of 0.80 for the question classification and 0.86 for the answer classification. Further analysis revealed that fine-tuning PLMs enhances their performance, and the size of the training dataset plays a critical role in model effectiveness. Prompt-based techniques, particularly few-shot learning with GPT-3.5, demonstrated significant improvements, increasing the accuracy of question classification by 12% and the accuracy of answer classification by 45%. Conclusions: The study demonstrates the potential of PLMs and prompt-based approaches to provide mental health support to Arabic-speaking populations, providing valuable tools for individuals seeking assistance in this field. This research advances the understanding of PLMs in mental health care and emphasizes their potential to improve accessibility and effectiveness in Arabic-speaking contexts. Full article

(This article belongs to the Section Health Informatics and Big Data)

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16 pages, 1225 KiB

Open AccessArticle

Association Between Self-Perceived Oral Health, Stress, and Oral Symptoms in South Korean University Students: A Cross-Sectional Study

by Jinhyoung Jeong, Wooyoung Jeong and Yuyeon Jung

Healthcare 2025, 13(9), 984; https://doi.org/10.3390/healthcare13090984 - 24 Apr 2025

Abstract

Background/Objectives: Self-perceived oral health is influenced by clinical and subjective oral factors, socioeconomic status, stress, and oral health behaviors. However, few studies have examined its association with dry mouth, salivary viscosity, and lifestyle factors. This study investigated the impact of self-perceived oral health [...] Read more.

Background/Objectives: Self-perceived oral health is influenced by clinical and subjective oral factors, socioeconomic status, stress, and oral health behaviors. However, few studies have examined its association with dry mouth, salivary viscosity, and lifestyle factors. This study investigated the impact of self-perceived oral health and stress levels on subjective oral symptoms and lifestyle factors. Methods: A total of 644 university students participated. Self-perceived oral health was subjectively evaluated using a single item, and stress levels were measured using the Korean version of the Perceived Stress Scale-10 (PSS-10), which has been validated for reliability and validity. Chi-square tests identified differences in self-perceived oral health and stress levels based on subjective oral symptoms and lifestyle factors. Logistic regression assessed the effects of tooth brushing frequency, periodontal disease diagnosis, dry mouth, and gingival bleeding on self-perceived oral health. Results: Subjective oral symptoms significantly associated with self-perceived oral health included gingival bleeding, dry mouth, and salivary viscosity; lifestyle factors included tooth brushing frequency and beverage consumption. Frequent tooth brushing increased the likelihood of perceiving oral health as good (OR = 1.363, p = 0.030), while dry mouth (OR = 0.576, p = 0.001) and gingival bleeding (OR = 0.597, p = 0.003) reduced it. Conclusions: This study’s results showed that gingival tooth brushing frequency and subjective oral symptoms significantly impacted self-perceived oral health. Therefore, effective educational programs should be implemented to promote self-perceived oral health awareness and oral health maintenance. Full article

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28 pages, 1393 KiB

Open AccessSystematic Review

Topical Dinoprostone vs. Foley’s Catheter: A Systematic Review and Meta-Analysis of Cervical Ripening Approaches

by Amal Yaseen Zaman, Howaida Amin Hassan, Nageshwar Venkatesh Reddy, Farzana Begum, Samar Ahmed Mahmoud, Hayat Alghamdi, Naglaa Kamel AbdAllah Hussein, Mariam Yousif Elhussain, Soad Mohamed Alnassry, Magda Mubarak Merghani, Manal Elzein Musa, Hanan Mohammed Mohammed and Hammad Ali Fadlalmola

Healthcare 2025, 13(9), 983; https://doi.org/10.3390/healthcare13090983 - 24 Apr 2025

Abstract

Background and aim: Labor induction is increasing in obstetric practice. In women with an unfavorable cervix, cervical ripening is required for successful induction. We conducted this review to compare the effectiveness and tolerance of two interventions used for cervical ripening, topical prostaglandin [...] Read more.

Background and aim: Labor induction is increasing in obstetric practice. In women with an unfavorable cervix, cervical ripening is required for successful induction. We conducted this review to compare the effectiveness and tolerance of two interventions used for cervical ripening, topical prostaglandin E2 (dinoprostone) and transcervical Foley’s catheter. Methods: We systematically searched four biomedical databases on 15 November 2024, for relevant studies. The studies’ eligibility was determined after screening their titles, abstracts, and full texts. We extracted relevant data from the studies included. RevMan software V5.4 was used to conduct the random-effect meta-analysis. Misoprostol was excluded from this review due to variability in dosing protocols and inconsistent reporting across studies. A review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number: CRD420251026183. Results: This review included 41 studies that in total enrolled 12,877 women (6722 for Foley’s catheter and 6155 for dinoprostone). The efficacy of the two interventions was comparable as evidenced by the similarity in the induction to delivery time, Bishop score change, the rate of vaginal delivery within 24 h, and the risk of induction failure. Foley’s catheter was linked with lower risks of caesarian delivery (RR = 0.84, p = 0.006), uterine hyperstimulation (RR = 0.39, p < 0.001), postpartum hemorrhage (RR = 0.76, p = 0.03), and a 1-min Apgar score < 7 (RR = 0.75, p = 0.02). However, it was associated with an extra need for oxytocin augmentation (RR = 1.18, p < 0.001). The risks of instrumental delivery, intrapartum pyrexia, postpartum infection, meconium passage, umbilical cord arterial pH < 7.1, a 5-min Apgar score < 7, and neonatal intensive care requirement were comparable for the two interventions. Conclusions: In comparison with dinoprostone, Foley’s catheter is equally effective and well tolerated. We recommend Foley’s catheter use for women with a previous caesarian delivery and in low-resource settings. Full article

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18 pages, 1859 KiB

Open AccessArticle

Extended Analysis of the Hospitalization Cost and Economic Burden of COVID-19 in Romania

by Alíz Bradács, László Lorenzovici, László-István Bába, Zoltán Kaló, Szabolcs Farkas-Ráduly, Andreea Mihaela Precup, Klementina Somodi, Maria Gheorghe, Alexandru Calcan, Gyöngyi Tar, Ovidiu Adam, Violeta Tincuta Briciu, Simin Aysel Florescu, Edith Simona Ianoși, Ovidiu Gârbovan, Dimitrie Cristian Siriopol and Zoltán Vokó

Healthcare 2025, 13(9), 982; https://doi.org/10.3390/healthcare13090982 - 24 Apr 2025

Abstract

Background/Objectives: COVID-19 has impacted Romania’s healthcare, economy, society, and public health. This study aims to evaluate the financial impact of the COVID-19 pandemic in Romania by analyzing both hospital costs and key elements of economic costs. The assessment was conducted from the perspective [...] Read more.

Background/Objectives: COVID-19 has impacted Romania’s healthcare, economy, society, and public health. This study aims to evaluate the financial impact of the COVID-19 pandemic in Romania by analyzing both hospital costs and key elements of economic costs. The assessment was conducted from the perspective of the national payer. Hospital costs were analyzed covering two distinct timeframes: Q4 2020–Q3 2021 and Q1 2022–Q4 2022. The estimation of economic costs covered Q4 2020–Q3 2021. Methods: Hospital care costs were estimated using financial data from eight hospitals. The costs were extrapolated to inpatient data from 60 public hospitals for each of the two study periods. The disease burden was determined based on official data, including the number of confirmed cases, hospital bed occupancy, reported fatalities, and various cost components from an economic perspective. Results: The findings indicate that the average hospital cost per patient episode was EUR 2267 (95% CI: 2137–2396) during the first period and EUR 2003 (95% CI: 1799–2207) in the second. The total national hospitalization expenses amounted to EUR 1.35 billion and EUR 730 million, respectively. When accounting for productivity losses and testing costs, the overall expenditure reached EUR 5.39 billion for Q4 2020–Q3 2021. Conclusions: In conclusion, the total economic burden of the COVID-19 pandemic in Romania by the end of 2021 was estimated at EUR 5.39 billion, encompassing hospitalization, isolation, premature deaths, quarantine, testing, and parental allowances. Despite the emergence of costlier treatment options, overall treatment costs declined, possibly due to increased vaccination rates. The study highlights the significant financial strain on the healthcare system and underscores the importance of evidence-based resource allocation to better manage future public health crises. Full article

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15 pages, 585 KiB

Open AccessSystematic Review

Identification of Barriers That Can Influence Older Adults in Community Pharmacies: A Systematic Review

by Rita Pedro, Ramona Mateos-Campos and Agostinho Cruz

Healthcare 2025, 13(9), 981; https://doi.org/10.3390/healthcare13090981 - 24 Apr 2025

Abstract

Objectives: This systematic review examines the barriers that may influence the proper care and counseling for people who are 65 years or older, in community pharmacies. Also, we attempt to identify potential strategies to mitigate these barriers. The research question addressed is [...] Read more.

Objectives: This systematic review examines the barriers that may influence the proper care and counseling for people who are 65 years or older, in community pharmacies. Also, we attempt to identify potential strategies to mitigate these barriers. The research question addressed is “What kind of barriers influence older people in community pharmacies?”. Methods: Five electronic databases were used: Medline from Pubmed, Core collection of Web of Science, Science direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL) through EBSCO and RCAAP (Repositório Científico de Acesso Aberto de Portugal). This systematic review followed the PRISMA guidelines. The protocol was prospectively published in PROSPERO (International Prospective Register of Systematic Review) having the following identification number: ID CRD42024516422. The original articles about individuals over 65 years of age and about barriers to counseling in community pharmacies were included. The Critical Appraisal tool made by Joanna Briggs Institute was chosen. Results: From a total of 919 articles identified, 9 were included in this systematic review. The identified barriers were categorized into four typologies: centered on the pharmacy profession, centered on older adults, centered on the pharmacy layout and infrastructure, and centered on society. Other than this, some facilitators were identified during the research and were also categorized into the same four typologies. Conclusions: The classification of the identified barriers and facilitators has significant importance as it provides essential insights for responsible bodies of community pharmacies. Comprehending these barriers and facilitators is crucial to transforming community pharmacies into a more accessible and supportive environment for older patients. Full article

(This article belongs to the Special Issue Healthy Ageing and Lifestyle Medicine: Current Knowledge and Future Direction)

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18 pages, 287 KiB

Open AccessArticle

Unhealthy Dietary Habits and Sedentary Behaviours Among Adolescents and Young Adults in Rome (Italy) Participating in the ALIMA Study: Growing Risks for Health

by Federica Intorre, Maria Stella Foddai and Eugenia Venneria

Healthcare 2025, 13(9), 980; https://doi.org/10.3390/healthcare13090980 - 23 Apr 2025

Abstract

Background/Objectives: This paper aims to assess the unhealthy dietary habits and sedentary behaviours among adolescents and young adults simultaneously. Methods: The sample consists of 682 participants aged 10–24 years old (58.9% males and 68.2% aged 15–19 years old), recruited for the [...] Read more.

Background/Objectives: This paper aims to assess the unhealthy dietary habits and sedentary behaviours among adolescents and young adults simultaneously. Methods: The sample consists of 682 participants aged 10–24 years old (58.9% males and 68.2% aged 15–19 years old), recruited for the ALIMA (ALImentazione Multiculturale negli Adolescenti) study in both secondary schools and youth aggregation centres, located in Rome. The study utilizes structured questionnaires to gather data on anthropometric measurements, eating habits, alcohol consumption, physical activity, and sedentary behaviours. Data are analyzed by using the Pearson chi-squared test. Results: Excessive screen time (>3 h/day) and inadequate dietary habits (insufficient consumption of fruit, vegetables, and legumes, skipping breakfast, and a high consumption of sugar-sweetened beverages and alcohol) are observed in the total sample, but mainly in older adolescents aged 15–19 years old. The adherence to the MD, measured via the KIDMED index, is significantly different among the three age groups (p = 0.001); 47.8% of the sample has a medium adherence, while among those with a low adherence, the highest percentage is represented by older adolescents (39.8%); those with foreign-born parents have healthier diets, whereas lower parental education correlates with unhealthy behaviours. Conclusions: These results highlight the need for targeted interventions tailored to adolescents and young adults to encourage healthier lifestyle choices. Full article

(This article belongs to the Special Issue Nutritional Status: How Diet Impacts Your Physical Health and Well-Being?)

29 pages, 2697 KiB

Open AccessArticle

Assessing the Need and Demand for a Community Emergency Paramedic Strategy in the Ambulance Rescue System of Hamburg, Germany

by Marion Sabine Rauner, Benjamin Swyter and Stefan Velev

Healthcare 2025, 13(9), 979; https://doi.org/10.3390/healthcare13090979 - 23 Apr 2025

Abstract

Background: Demand for Hamburg’s ambulance rescue system (ARS) in Germany, which is managed by the fire service, increased by more than 10% between 2019 and 2021. This increase was mainly driven by a more than 20% increase in non-critical ambulance rescues, while critical [...] Read more.

Background: Demand for Hamburg’s ambulance rescue system (ARS) in Germany, which is managed by the fire service, increased by more than 10% between 2019 and 2021. This increase was mainly driven by a more than 20% increase in non-critical ambulance rescues, while critical rescues decreased over the same period. Factors contributing to this trend include demographic changes, longer waiting times in primary care and declining quality in out-of-hospital care. To address this issue, the introduction of community emergency paramedics (CEPs)—who provide treatment and advice to patients at home before ambulance services are called—has been proposed as a potential solution to alleviate pressure on the ARS. Methods: In this study, 17 ARS stations in Hamburg, categorized into three operational areas (East, South, West), were analyzed using comprehensive statistical methods such as hypothesis testing, correlation analysis, regression modeling and clustering. Data from 2019 and 2021 were examined to assess the feasibility of integrating CEPs into the existing system. Results: Key findings identified specific stations with high potential for CEP support and optimal mission times (based on time of day, day of week and calendar week) to improve operational efficiency. The impact of regulatory measures introduced during the COVID-19 pandemic was also evident in the 2021 data. Conclusions: Finally, four policy scenarios—taking into account different synergy effects among the 17 stations—are presented, providing projections of the managerial and economic benefits for Hamburg policymakers. These policy implications aim to support the development of a robust CEP strategy to improve the overall efficiency and sustainability of the ARS. Full article

(This article belongs to the Special Issue Evaluation and Potential of Effective Decision-Making in Healthcare)

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23 pages, 307 KiB

Open AccessArticle

Informal Palliative Care at Home: A Focus Group Study Among Professionals Working in Palliative Care in Portugal

by Vanessa Marrazes, Laura Gonçalves, Ana Querido and Carlos Laranjeira

Healthcare 2025, 13(9), 978; https://doi.org/10.3390/healthcare13090978 - 23 Apr 2025

Abstract

Background/Objectives: Informal caregivers (ICs) are the backbone of home-based palliative care (PC) because they play a vital role in offering more seamless and timely support, preventing suffering and fostering comfort and dignity. Specialized home-based PC teams must recognize ICs’ unmet needs in fulfilling [...] Read more.

Background/Objectives: Informal caregivers (ICs) are the backbone of home-based palliative care (PC) because they play a vital role in offering more seamless and timely support, preventing suffering and fostering comfort and dignity. Specialized home-based PC teams must recognize ICs’ unmet needs in fulfilling daily responsibilities and enhance their preparedness for caring. In this vein, this study aimed to carry out the following: (a) explore how PC professionals perceive the preparedness of ICs to provide PC at home and (b) determine what barriers and enablers they consider essential for the delivery of high-quality PC at home. Methods: Using purposeful sampling, thirty-four professionals from four disciplines who worked in specialized PC teams were recruited for a descriptive qualitative research study. Four focus group discussions were conducted from September 2024 to January 2025. This was followed by a thematic analysis according to Braun and Clarke’s framework. The findings are reported following the COREQ checklist. Results: Most of the participants were female nurses (n = 22) with a mean age of 41.8 ± 8.62 years. Three overarching themes were identified: (1) IC needs and motivations for providing care; (2) perceived barriers to good-quality palliative home care; and (3) perceived enablers of good-quality palliative home care. The IC’s preparedness depends on personal characteristics, health status, the scope of tasks, and the ramifications stemming from the complexity of the illness trajectory. Conclusions: Professionals deemed it essential for PC staff to be experienced, accessible, person-centered, and proactive. Furthermore, effective communication and a well-defined network for requesting certain community resources or services were deemed crucial for delivering high-quality PC at home. Full article

(This article belongs to the Special Issue Primary and Community Care: Opportunities and Challenges)

11 pages, 434 KiB

Open AccessArticle

Sleep Deprivation Increases Mortality Risk Among Older Adults with Epilepsy

by Srikanta Banerjee, Jagdish Khubchandani and Stanley Nkemjika

Healthcare 2025, 13(9), 977; https://doi.org/10.3390/healthcare13090977 - 23 Apr 2025

Abstract

Introduction: Among U.S. adults, over 3 million report a history of epilepsy, accounting for nearly 1.2% of the population. Sleep deprivation is a well-known risk factor for increased likelihood, intensity, and length of seizures. However, the long-term impact of sleep deprivation on people [...] Read more.

Introduction: Among U.S. adults, over 3 million report a history of epilepsy, accounting for nearly 1.2% of the population. Sleep deprivation is a well-known risk factor for increased likelihood, intensity, and length of seizures. However, the long-term impact of sleep deprivation on people with epilepsy is not well explored. The purpose of this study was to assess mortality risk among individuals with epilepsy based on sleep duration. Methods: Data from the 2008–2018 National Health Interview Survey (NHIS) were linked with mortality data from the National Death Index (NDI) for US adults aged 65 years and older. Survival curves showed the combined effect of sleep deprivation and epilepsy, using the Kaplan–Meier product-limit method to estimate the percent survival of the subject at each point in time. Results: For all-cause mortality, the unadjusted hazard ratio (HR) for sleep deprivation to no sleep deprivation among people with epilepsy (PWE) was HR = 1.92. The adjusted HR was elevated, HR = 1.94, among individuals who had epilepsy and sleep deprivation but close to 1.0 among individuals who had a history of sleep deprivation without epilepsy after adjusting for demographic and health variables. Conclusions: From a nationally representative sample, this first-of-its-kind study in the U.S. found that sleep deprivation and epilepsy combined have worse outcomes than sleep deprivation alone. Clinicians should screen and manage sleep disorders to improve their long-term prognosis of people with epilepsy. Full article

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15 pages, 481 KiB

Open AccessSystematic Review

Uterotonic Drugs in Prevention and Management in Postpartum Haemorrhage in Prehospital Deliveries—A Systematic Review

by Hanna Wiciak, Mateusz Strózik and Jacek Smereka

Healthcare 2025, 13(9), 976; https://doi.org/10.3390/healthcare13090976 - 23 Apr 2025

Abstract

Background: Obstetric haemorrhage, particularly postpartum haemorrhage (PPH), remains a significant global health challenge and a leading cause of maternal mortality. Despite advancements in understanding and preventing PPH, haemorrhage remains a leading cause of maternal mortality worldwide. The aim of this study was to [...] Read more.

Background: Obstetric haemorrhage, particularly postpartum haemorrhage (PPH), remains a significant global health challenge and a leading cause of maternal mortality. Despite advancements in understanding and preventing PPH, haemorrhage remains a leading cause of maternal mortality worldwide. The aim of this study was to review the current literature on the use of uterotonic drugs, particularly oxytocin, in reducing perinatal mortality during prehospital deliveries. Methods: In December 2024, a comprehensive search was conducted across PubMed, Web of Science, Embase, and Scopus, yielding 108 records, of which four studies met the inclusion criteria. Results: The limited evidence underscores the need for targeted research and adherence to international obstetric guidelines to improve PPH management and maternal outcomes. In some countries, the only uterotonic drug available in all EMS teams is oxytocin; in others, there is none. Emergency Medical Services (EMS) play a critical role in providing lifesaving interventions during obstetric emergencies, often serving as the first and sometimes only point of medical contact for women experiencing complications during childbirth. Conclusion: There is a lack of high-quality clinical studies evaluating the effectiveness of uterotonic agents in EMS operations and their role in treating postpartum haemorrhage in prehospital settings. Addressing this gap requires targeted research to generate robust evidence and inform the development of standardized protocols. Such efforts could enhance the timely management of PPH, ultimately reducing maternal mortality and improving outcomes in resource-limited and prehospital environments. By bridging the evidence gap, EMS systems worldwide can be better equipped to handle obstetric emergencies effectively. Full article

(This article belongs to the Special Issue A Needle in a Haystack: Looking for Gaps in Treatment and Education in Emergency Medicine)

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14 pages, 719 KiB

Open AccessArticle

Surgery on the Road to the Land of Promise–Ιmpact of the Refugee Crisis on the Greek Healthcare System: Results from a Surgical Department of a Tertiary Hospital

by Christos Damaskos, Nikolaos Garmpis, Dimitrios Lamprinos, Gregory Kouraklis, Dionysios Prevezanos, Anna Garmpi, Miltiadis-Panagiotis Papandroudis, Iason Psilopatis, Dimitrios Papoutsas, Georgios Marinos, Stavros Kourlakis and Eleni I. Effraimidou

Healthcare 2025, 13(9), 975; https://doi.org/10.3390/healthcare13090975 - 23 Apr 2025

Abstract

Background/Objectives: The surge in migration from the Middle East and North Africa due to conflicts has significantly impacted healthcare systems, particularly in Greece. This study investigates how the sharp increase in refugees and migrants after July 2015 has strained the surgical departments of [...] Read more.

Background/Objectives: The surge in migration from the Middle East and North Africa due to conflicts has significantly impacted healthcare systems, particularly in Greece. This study investigates how the sharp increase in refugees and migrants after July 2015 has strained the surgical departments of the Greek National Health System (NHS). Methods: A retrospective analysis was conducted on 229 patients treated at the emergency department of a public hospital in Athens, Greece. Data were compared between two periods: January 2012–July 2015 (pre-July 2015) and July 2015–December 2018 (post-July 2015), with July 2015 chosen as the cutoff due to a significant influx of immigrants during that time. Results: Patients’ demographic details, diagnoses, and surgical interventions were analyzed. Results indicated a significant rise in surgical cases, with 72.5% of patients requiring procedures, notably for appendicitis (23.6%), cholecystitis (10.9%), lower extremity thrombophlebitis (9.6%), perianal abscess (8.3%), and inguinal hernia (5.7%). Post-July 2015, there was a notable increase in perianal abscess (12.2%), inguinal hernia (8.4%), and cholelithiasis (6.1%). However, the average hospital stay of 3.9 days remained unchanged. Conclusions: The findings reveal the profound economic and operational pressures on the NHS during the refugee crisis, highlighting the urgent need for resource optimization and policy reforms. Future studies should address long-term healthcare impacts to support more sustainable healthcare models amidst ongoing and future migration challenges. Full article

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16 pages, 343 KiB

Open AccessArticle

Impact on Health, Resources, and Satisfaction: A Qualitative Study of Primary Health Care Case-Management Nurses

by María José Molina-Gil, María Dolores Guerra-Martín and Rocío De Diego-Cordero

Healthcare 2025, 13(9), 974; https://doi.org/10.3390/healthcare13090974 - 23 Apr 2025

Abstract

The aging population and the increasing prevalence of chronic diseases necessitate new healthcare models. Case-Management Nurses (CMNs) emerge as a promising alternative to enhance patient care. Objective: To explore CMNs’ perceptions of the impact on health, resources, and professional satisfaction. Methods: A qualitative [...] Read more.

The aging population and the increasing prevalence of chronic diseases necessitate new healthcare models. Case-Management Nurses (CMNs) emerge as a promising alternative to enhance patient care. Objective: To explore CMNs’ perceptions of the impact on health, resources, and professional satisfaction. Methods: A qualitative study using semi-structured interviews was conducted with CMNs from a southern Spanish province. This study adheres to the Standards for Reporting Qualitative Research (SRQR). The population consisted of 61 CMNs. Three analytical categories of a theoretical or deductive nature were identified, directly related to this study’s objective. This study was approved by the Andalusian Biomedical Research Ethics Committee (Code: 1139-N-22) and conducted in accordance with the Declaration of Helsinki. Data analysis was performed using ATLAS.ti. Results: The sample was comprised of 31 CMNs (24 women). The mean age was 56.3 years. A total of 12 CMNs had more than 20 years of experience. Interviews were conducted between October and November 2022. Within each category, different emerging subcategories were identified: 1. Impact on health: Patients and caregivers. 2. Impact on resources: Computer tools, effectiveness/efficiency of the CMNs, and material resources. 3. Impact on professional satisfaction: Positive professional satisfaction and negative professional satisfaction. Conclusions: The findings suggest that the practice of CMNs in primary care improves the health and quality of life of patients and their caregivers while reducing healthcare resource utilization. CMNs reported high levels of job satisfaction. These findings support the implementation of this care model to optimize the management of chronic patients in home and residential care settings. However, larger-scale quantitative studies are needed to confirm these results and explore their generalizability. Full article

(This article belongs to the Special Issue Innovative Approaches to Chronic Disease Patient Care)

12 pages, 564 KiB

Open AccessArticle

Developing a Q Set Using the Modified Delphi Technique to Investigate ICU Nurses’ Perspectives on Working with Non-ICU Nurses

by Dalia Sunari and Adel Bashatah

Healthcare 2025, 13(9), 973; https://doi.org/10.3390/healthcare13090973 - 23 Apr 2025

Abstract

Background/Objectives: ICU nurses manage complex clinical situations of critically ill patients, including rapid patient deterioration and multiple invasive lines. The complexity intensifies in catastrophes when non-ICU nurses are trained on short notice and deployed to support ICU nurses. This article details the [...] Read more.

Background/Objectives: ICU nurses manage complex clinical situations of critically ill patients, including rapid patient deterioration and multiple invasive lines. The complexity intensifies in catastrophes when non-ICU nurses are trained on short notice and deployed to support ICU nurses. This article details the rigorous development of the Q set, which is essential for ensuring methodological robustness and validity in a Q methodology study exploring ICU nurses’ perspectives on working with non-ICU nurses. Methods: A modified Delphi approach was adopted for the expert consensus on the selection of statements, which ensured an unbiased Q sample construction. The methodology involved (1) concourse generation based on the literature review and semi-structured interviews of ICU nurses and (2) Q sample refinement via expert consensus. Results: The process extracted 152 statements in two Delphi rounds with ICU experts (head nurses, bedside nurses, and nursing faculty). The first round finalized 13 and excluded 8 statements. The second round further added 27 and excluded 5 statements. Thus, the final Q sample comprised 40 statements, which were reviewed by a Q methodology expert. Conclusions: The study improved the rigor, precision, and transparency of Q sample construction in ICU nursing research. The incorporation of the expert consensus minimized the bias to accurately examine ICU nurses’ perspectives. The results offer valuable insights into non-ICU nurses’ integration in critical care settings to guide staffing policies, training, and inter-professional collaborations. Full article

(This article belongs to the Section Nursing)

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17 pages, 3873 KiB

Open AccessArticle

Prediction of Post-Bath Body Temperature Using Fuzzy Inference Systems with Hydrotherapy Data

by Feng Han, Minghui Tang, Ziheng Zhang, Kenji Hirata, Yoji Okugawa, Yunosuke Matsuda, Jun Nakaya, Katsuhiko Ogasawara and Kohsuke Kudo

Healthcare 2025, 13(9), 972; https://doi.org/10.3390/healthcare13090972 - 23 Apr 2025

Abstract

Background/Objectives: Widely known for its therapeutic benefits, hydrotherapy utilizes water’s physical properties, such as temperature, hydrostatic pressure, and viscosity, to influence physiological responses. Among these, body temperature modulation plays a crucial role in enhancing circulatory function, muscle relaxation, and metabolic processes. While hydrotherapy [...] Read more.

Background/Objectives: Widely known for its therapeutic benefits, hydrotherapy utilizes water’s physical properties, such as temperature, hydrostatic pressure, and viscosity, to influence physiological responses. Among these, body temperature modulation plays a crucial role in enhancing circulatory function, muscle relaxation, and metabolic processes. While hydrotherapy can improve systemic health, particularly cardiac function, improper temperature control poses risks, especially for vulnerable populations such as the elderly or individuals with thermoregulatory impairments. Therefore, accurately predicting post-bath body temperature is essential for ensuring safety and optimizing therapeutic outcomes. Methods: This study explored the use of fuzzy inference systems to predict post-bath body temperature, leveraging an adaptive neuro-fuzzy inference system, evolutionary fuzzy inference system (EVOFIS), and enhanced Takagi-Sugeno fuzzy system. These models were compared with random forest and support vector machine models using hydrotherapy-related data. Results: The results show that EVOFIS outperformed other models, particularly in predicting deep body temperature, which is clinically significant as it is closely linked to core physiological regulation. Conclusions: The ability to accurately forecast deep-temperature dynamics enables proactive management of hyperthermia risk, supporting safer hydrotherapy practices for at-risk groups. These findings highlight the potential of FIS-based models for non-invasive temperature prediction, contributing to enhanced safety and personalization in hydrotherapy applications. Full article

(This article belongs to the Special Issue The Role of AI in Predictive and Prescriptive Healthcare)

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19 pages, 1092 KiB

Open AccessArticle

Shigella flexneri Outbreak at a Rehabilitation Center: First Report from Saudi Arabia

by Khalifa Binkhamis, Sarah Alangari, Fatema Juma, Sahar Althawadi, Ahmed A. Al-Qahtani, Marie Fe F. Bohol, Fatimah S. Alshahrani and Fawzia Alotaibi

Healthcare 2025, 13(9), 971; https://doi.org/10.3390/healthcare13090971 - 23 Apr 2025

Abstract

Background: Shigella flexneri is a major cause of shigellosis in developing regions and is known to cause outbreaks in institutional settings. Transmission occurs via the fecal–oral route. It invades intestinal epithelial cells, causing diarrhea, systemic symptoms, and complications such as hemolytic uremic syndrome. [...] Read more.

Background: Shigella flexneri is a major cause of shigellosis in developing regions and is known to cause outbreaks in institutional settings. Transmission occurs via the fecal–oral route. It invades intestinal epithelial cells, causing diarrhea, systemic symptoms, and complications such as hemolytic uremic syndrome. This study aimed to characterize the clinical presentation, administered treatment, infection outcomes, and infection control measures during a local S. flexneri outbreak at a rehabilitation center. Methods: This case series at King Saud University Medical City (Oct–Dec 2024) investigated S. flexneri infections from a rehabilitation center. Stool and blood samples were cultured and analyzed using microbiological methods. Molecular studies were used to verify the genetic linkage between the isolates and to study their virulence genes. Results: Four cases of S. flexneri were included, involving patients with various comorbidities, residing in a rehabilitation center, and presenting with symptoms like fever and diarrhea. Laboratory investigations revealed leukocytosis, electrolyte imbalances, and elevated inflammatory markers. Imaging studies showed findings consistent with colitis in two cases. Patients were managed with IV fluids and targeted antibiotics, leading to symptom resolution. Molecular studies confirmed the genetic relatedness between the S. flexneri isolates, with virulence genes indicating cellular invasion and inflammation as primary drivers of disease severity. Outbreak management comprised contact isolation, environmental disinfection, and education. Conclusions: S. flexneri outbreaks in long-term care facilities pose challenges among bedbound patients. Diapers may facilitate transmission, and infections may cause severe complications. Robust infection control, identifying outbreak sources, and strengthening prevention strategies are essential to protect vulnerable populations. Full article

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12 pages, 4816 KiB

Open AccessCase Report

Complete Hydatiform Mole with a Coexisting Living Fetus: A Case Report

by Irene Piccolotti, Silvia Zago, Maria Paola Bonasoni, Beatrice Rosignoli, Annachiara Boschi, Francesca Lostritto, Francesco Catania and Tiziana Arcangeli

Healthcare 2025, 13(9), 970; https://doi.org/10.3390/healthcare13090970 - 23 Apr 2025

Abstract

Background: Gestational trophoblastic diseases comprise the hydatiform moles (HMs), complete or partial, an abnormal development of trophoblastic tissue. HMs derive from a gametogenesis error during conception leading to an anomalous chromosomal asset. In the complete hydatiform mole (CHM), when one or two spermatozoa [...] Read more.

Background: Gestational trophoblastic diseases comprise the hydatiform moles (HMs), complete or partial, an abnormal development of trophoblastic tissue. HMs derive from a gametogenesis error during conception leading to an anomalous chromosomal asset. In the complete hydatiform mole (CHM), when one or two spermatozoa enter an empty oocyte, the karyotype, paternally derived, is diploid 46,XX or 46,XY. CHM is characterized by massive hydropic degeneration of the villi, with no fetal structures, easily detected by ultrasound (US) in early gestation, confirmed by elevated maternal beta-hCG levels. CHM with coexistent fetus (CHMCF) is an exceptional event with a high risk of malignant progression, and severe complications such as massive vaginal bleeding, preeclampsia, and fetal death. Methods/Results: We present a case of CHMCF in a 29-year-old woman, which resulted in a liveborn and healthy baby at 38 weeks of gestation. The patient was prenatally carefully monitored with biweekly US and periodic beta-hCG levels. Post-partum follow-up consisted of transvaginal US and beta-hCG levels at 1, 3, and 6 months. After 1 year post-delivery, both the mother and the newborn were healthy. Conclusions: CHMCF management can be challenging as shared guidelines are currently lacking and the case described may be helpful in adding more data. Full article

(This article belongs to the Section Perinatal and Neonatal Medicine)

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16 pages, 2313 KiB

Open AccessArticle

Identification of a Risk-Prediction Model for Hypertension Patients Concomitant with Nonalcoholic Fatty Liver Disease

by Xiaoyou Mai, Mingli Li, Xihui Jin, Shengzhu Huang, Mingjie Xu, Boteng Yan, Yushuang Wei, Xinyang Long, Yongxian Wu and Zengnan Mo

Healthcare 2025, 13(9), 969; https://doi.org/10.3390/healthcare13090969 - 23 Apr 2025

Abstract

Objective: Our study aims to develop a personalized nomogram model for predicting the risk of nonalcoholic fatty liver disease (NAFLD) in hypertension (HTN) patients and further validate its effectiveness. Methods: A total of 1250 hypertensive (HTN) patients from Guangxi, China, were divided into [...] Read more.

Objective: Our study aims to develop a personalized nomogram model for predicting the risk of nonalcoholic fatty liver disease (NAFLD) in hypertension (HTN) patients and further validate its effectiveness. Methods: A total of 1250 hypertensive (HTN) patients from Guangxi, China, were divided into a training group (875 patients, 70%) and a validation set (375 patients, 30%). LASSO regression, in combination with univariate and multivariate logistic regression analyses, was used to identify predictive factors associated with nonalcoholic fatty liver disease (NAFLD) in HTN patients within the training set. Subsequently, the performance of an NAFLD nomogram prediction model was evaluated in the separate validation group, including assessments of differentiation ability, calibration performance, and clinical applicability. This was carried out using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results: The risk-prediction model for the HTN patients concomitant with NAFLD included oral antidiabetic drugs (OADs) (OR = 2.553, 95% CI: 1.368–4.763), antihypertensives (AHs) (OR = 7.303, 95% CI: 4.168–12.794), body mass index (BMI) (OR = 1.145, 95% CI: 1.084–1.209), BUN (OR = 0.924, 95% CI: 0.860–0.992), triglycerides (TGs) (OR = 1.474, 95% CI: 1.201–1.809), aspartate aminotransferase (AST) (OR = 1.061, 95% CI: 1.018–1.105), and AST/ALT ratio (AAR) (OR = 0.249, 95% CI: 0.121–0.514) as significant predictors. The AUC of the NAFLD risk-prediction model in the training set and the validation set were 0.816 (95% CI: 0.785–0.847) and 0.794 (95% CI: 0.746–0.842), respectively. The Hosmer–Lemeshow test showed that the model has a good goodness-of-fit (p-values were 0.612 and 0.221). DCA suggested the net benefit of using a nomogram to predict the risk of HTN patients concomitant with NAFLD is higher. These results suggested that the model showed moderate predictive ability and good calibration. Conclusions: BMI, OADs, AHs, TGs, AST, and AAR were independent influencing factors of HTN combined with NAFLD, and the risk prediction model constructed based on this could help to identify the high-risk group of HTN combined with NAFLD at an early stage and guide the development of interventions. Larger cohorts with multiethnic populations are essential to verify our findings. Full article

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11 pages, 197 KiB

Open AccessArticle

The Knowledge and Awareness of Parents Regarding Pediatric Obstructive Sleep Apnea in the Central Region of Saudi Arabia

by Khalid M. Alkhalifah, Farah Saleh Allabun, Abdulrahman Ahmed Alsughayyir, Waleed Obaid Alharbi, Sarah Abdulaziz Almagushi, Meshal S. Alwabel and Waleed Alhazmi

Healthcare 2025, 13(9), 968; https://doi.org/10.3390/healthcare13090968 - 23 Apr 2025

Abstract

Background/Objectives: Pediatric obstructive sleep apnea (POSA) is a long-term sleep disorder characterized by repeated interruptions in breathing during sleep among children. These interruptions result from blockages in the upper airways, causing decreased oxygen intake and disturbed sleep. Assessing parents’ awareness level and [...] Read more.

Background/Objectives: Pediatric obstructive sleep apnea (POSA) is a long-term sleep disorder characterized by repeated interruptions in breathing during sleep among children. These interruptions result from blockages in the upper airways, causing decreased oxygen intake and disturbed sleep. Assessing parents’ awareness level and the factors affecting their knowledge is vital for enhancing early diagnosis and management of POSA. Methods: This was a cross-sectional study that utilized data from a sample of 838 parents in the Central Region of the Kingdom of Saudi Arabia. The participants completed self-administered online surveys, which ensured anonymity. Results: Only 320 (38.2%) of the parents demonstrated good knowledge about POSA, while the majority, 518 (61.8%), had poor knowledge. Nearly a third, 261 (31.2%), of the parents indicated that their primary sources of information on POSA were the internet and social media platforms. The prevalence of OSA among children was quite significant, with nearly a quarter, 236 (28.2%), of parents having a child affected by the condition. Commonly recognized symptoms included snoring, reported by 425 (50.7%), and mouth breathing, reported by 156 (18.6%). Frequently cited risk factors included obesity, mentioned by 373 (44.5%), and enlarged tonsils, mentioned by 175 (20.9%). A statistically significant association was found between age, gender, marital status, education level, specialization/work, source of knowledge about POSA, knowing someone with OSA, and having a child with OSA and the level of knowledge about POSA (p < 0.05). The study identified several significant factors predicting poor parental awareness of pediatric obstructive sleep apnea (POSA) including gender [AOR = 1.65; 95% CI = 1.220–2.223; p = 0.001], source of knowledge about pediatric obstructive sleep apnea [AOR = 1.35; 95% CI = 1.167–1.572; p < 0.001], and knowing someone with OSA [AOR = 1.92; 95% CI = 1.301–2.832; p = 0.001]. Conclusions: The study revealed that parents in the Central Region had limited knowledge about POSA. There were notable gaps in recognizing and understanding the symptoms of POSA and its impact on children’s mental health and academic performance. This underscores the importance of introducing targeted educational programs and initiatives for both parents and healthcare providers to enhance children’s mental health and overall well-being. Full article

(This article belongs to the Section Preventive Medicine)

16 pages, 310 KiB

Open AccessArticle

Trends in Homelessness and Social Sustainability: Veterans vs. Non-Veterans in the US

by Ângela Leite and Catarina Vieira da Silva

Healthcare 2025, 13(9), 967; https://doi.org/10.3390/healthcare13090967 - 22 Apr 2025

Abstract

Introduction: Social sustainability is deeply connected to the well-being of marginalized groups, and it is important to highlight how mental health impacts the social inclusion of homeless individuals, particularly veterans. Homelessness is a growing global issue, disproportionately affecting U.S. veterans, with mental [...] Read more.

Introduction: Social sustainability is deeply connected to the well-being of marginalized groups, and it is important to highlight how mental health impacts the social inclusion of homeless individuals, particularly veterans. Homelessness is a growing global issue, disproportionately affecting U.S. veterans, with mental health challenges playing a significant role in its onset and perpetuation. Purpose: This study aims to compare the sociodemographic and clinical characteristics of homeless veterans and non-veterans in the U.S. Method: Using public data (N = 6295), this quantitative study applies descriptive and inferential statistical analyses. Results: Homeless veterans are more likely than non-veterans to be older, male, and identify as Caucasian or African American. They are more frequently high school graduates or have higher education, and report being divorced, widowed, married, or in varied employment statuses (full-time, part-time, or unemployed). Veterans exhibit higher rates of severe mental illnesses, schizophrenia, trauma- and stressor-related disorders, ADHD, bipolar disorder, personality disorders, depression, anxiety, and substance or alcohol use disorders. However, they are less likely than non-veterans to report substance-induced disorders, intoxication, dependence, or abuse involving cocaine, cannabis, opioids, and other substances. Conclusions: Psychosocial interventions for homeless veterans should prioritize mental health-related concerns, whereas efforts for homeless non-veterans should focus on addressing substance use. Future research should develop tailored interventions, explore the sociodemographic factors influencing homelessness, and investigate the interplay between trauma, mental health, and substance use. Addressing these issues can contribute to a more resilient, inclusive, and sustainable society by providing long-term support and integration opportunities for those most affected. The novelty of this study lies in distinguishing between mental health issues prevalent in veterans and substance use disorders more common in non-veterans, offering insights for tailored interventions. It also connects these findings to social sustainability, suggesting that addressing these issues can promote a more inclusive and resilient society. Full article

(This article belongs to the Special Issue Healthcare Innovations in Global Mental Health and Addiction Treatment)

17 pages, 443 KiB

Open AccessArticle

Understanding Disclosure Decisions and Communication About HPV-Related Cancer: A Qualitative Exploration of Stigma and Social Support

by Seiichi Villalona, Julian Sanchez, Preeyapat Mangkalard and Alicia L. Best

Healthcare 2025, 13(9), 966; https://doi.org/10.3390/healthcare13090966 - 22 Apr 2025

Abstract

Background/Objectives: This study aimed to explore the barriers and facilitators influencing initial self-disclosure among individuals diagnosed with human papillomavirus (HPV)-related cancers, as well as examine the post-disclosure experiences of affected individuals. Emphasis was placed on understanding the roles of perceived and internalized [...] Read more.

Background/Objectives: This study aimed to explore the barriers and facilitators influencing initial self-disclosure among individuals diagnosed with human papillomavirus (HPV)-related cancers, as well as examine the post-disclosure experiences of affected individuals. Emphasis was placed on understanding the roles of perceived and internalized stigma in these interpersonal communication encounters. Methods: Semi-structured interviews were conducted with 27 participants diagnosed with an HPV-related cancer. MAXQDA was used for qualitative analysis with themes grounded in Attribution Theory and the Disclosure Model. Results: Barriers to disclosure identified among participants included privacy concerns, hesitancy to burden others, and discomfort discussing the anatomic location of their cancer. In contrast, seeking support, instances of misunderstanding HPV’s relation to cancer, and the proactive detailing of their diagnosis to avoid judgment emerged as facilitators of disclosure. While many recounted positive post-disclosure experiences, some participants expressed feelings of guilt and internalized stigma, suggesting a deeper emotional struggle in communicating about their diagnosis to others in their social support networks. Nuances in the internalized stigma were observed in specific subgroups among this patient population, such as those who identify as a sexual/gender minority. Conclusions: This study underscores the multifaceted challenges experienced among individuals diagnosed with HPV-related cancers when disclosing their diagnoses and seeking social support. This study highlights the imperative role of identifying psychosocial distress in the post-diagnosis period among individuals with HPV-related cancer. Future research should explore ways to enhance social support for this patient population by improving healthcare providers’ screening measures and providing integrated support services earlier to better address their psychosocial needs. Full article

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12 pages, 618 KiB

Open AccessArticle

Integrating Case Management in Cystic Fibrosis Units: A Key to Enhancing Patient-Centered Care

by Alessandra Russo Krauss, Andrea Lastrucci, Valentina Petrini, Nicola Gualtieri, Renzo Ricci, Matteo Tomaiuolo, Daniele Giansanti, Alessandro Bartoloni and Silvia Bresci

Healthcare 2025, 13(9), 965; https://doi.org/10.3390/healthcare13090965 - 22 Apr 2025

Abstract

Introduction: Cystic fibrosis (CF) is a chronic genetic disease affecting the respiratory and digestive systems. Multidisciplinary care is vital for managing CF’s complex complications. This study investigates the potential role of a Case Manager (CM) in improving care coordination and patient outcomes [...] Read more.

Introduction: Cystic fibrosis (CF) is a chronic genetic disease affecting the respiratory and digestive systems. Multidisciplinary care is vital for managing CF’s complex complications. This study investigates the potential role of a Case Manager (CM) in improving care coordination and patient outcomes at the CF Unit of Careggi University Hospital. Methods: A survey among 34 CF Unit healthcare professionals assessed the perceptions of integrating a CM. The survey included demographic questions and 12 Likert scale items on the CM’s role in care continuity, team collaboration, and treatment adherence. Responses were collected anonymously and analyzed using descriptive statistics. Results: The response rate was 100%, with strong support for the CM role, averaging 4.5/5 across Likert scales. Respondents highlighted the CM’s value in coordinating care, managing time-sensitive tasks, and improving communication with external care providers. Telemedicine was positively rated, particularly for reducing hospital visits and supporting the remote monitoring of CF patients treated. Discussion: Findings indicate that integrating a CM could enhance multidisciplinary CF care by improving communication and treatment adherence. Challenges, including team readiness and training, were noted. Future studies will focus on patient satisfaction and clinical outcomes following the integration of CM, with special attention to the role of telemedicine in CF care. Full article

(This article belongs to the Special Issue Moving Forward: Implementing Patient-Centered Care in Hospitals)

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Open AccessArticle

Mediation of Ethnic Disparity in the 5-Year Mortality of Cervical Cancer Patients in the US, 2001–2019

by Shi-Hao Zhou, Yong-Qiao He, Hua Diao, Da-Wei Yang, Tong-Min Wang, Ying Liao, Wei-Hua Jia and Wen-Qiong Xue

Healthcare 2025, 13(9), 964; https://doi.org/10.3390/healthcare13090964 - 22 Apr 2025

Abstract

Objectives: This study aims to investigate the potential mediators for ethnic disparity in cervical cancer 5-year mortality and identify potential patients affected by ethnic disparities. Methods: The cohort study analyzed 56,374 cervical cancer patients from the Surveillance, Epidemiology, and End Results (SEER) 17 [...] Read more.

Objectives: This study aims to investigate the potential mediators for ethnic disparity in cervical cancer 5-year mortality and identify potential patients affected by ethnic disparities. Methods: The cohort study analyzed 56,374 cervical cancer patients from the Surveillance, Epidemiology, and End Results (SEER) 17 database (2000–2019). The primary and secondary outcome were the 5-year mortality of cervical cancer patients for all causes and cervical cancer-specific death, respectively. Cox and competing risks models were applied to identifying prognostic factors for 5-year cervical cancer all-cause mortality and specific death, respectively. Potential mediators for ethnic disparity were analyzed using multiple mediation analyses. Results: NHB patients had a 49% higher risk of 5-year mortality than NHW patients, while Hispanic and API patients showed a 19% and 12% decreased risk, respectively. Mediation analyses revealed that clinical stage and surgery predominately contributed to NHW-NHB prognosis disparities, with an indirect effect proportion of 29.6% and 26.7% for all-cause mortality and 34.2% and 26.7% for disease-specific death, respectively. No significant mediation effect was observed for other ethnic disparities. Compared to NHW patients, the inferior prognosis of NHB patients was observed mainly for localized and regional cancer, receiving hysterectomy, and, especially, adenocarcinomas. Conversely, the superior prognosis of Hispanic and API patients was observed in the no surgery subgroup and mainly for squamous cell carcinomas. Conclusions: Delayed diagnosis and a lack of surgery are key contributors to the prognosis discrepancy between NHB and NHW patients. More attention should be paid to NHB patients with cervical adenocarcinoma to narrow the disparity. Full article

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Healthcare, Volume 13, Issue 9 (May-1 2025) – 35 articles

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