Healthcare

27 pages, 994 KB

Open AccessSystematic Review

Analysis of the Multifactorial Risks of Postpartum Urinary Incontinence: A Systematic Review

by Nikoleta Tsinisizeli, Anastasia Bothou, Kleanthi Gourounti, Anna Deltsidou, Aikaterini Lykeridou and Giannoula Kyrkou

Healthcare 2026, 14(3), 418; https://doi.org/10.3390/healthcare14030418 - 6 Feb 2026

Viewed by 725

Abstract

Introduction: Urinary incontinence (UI) is one of the most common pelvic floor disorders after childbirth and depends on hormonal changes, anatomical damage that occurs after childbirth, muscle and connective tissue weakness, fascia and nerves. UI is distinguished into three subtypes, including stress [...] Read more.

Introduction: Urinary incontinence (UI) is one of the most common pelvic floor disorders after childbirth and depends on hormonal changes, anatomical damage that occurs after childbirth, muscle and connective tissue weakness, fascia and nerves. UI is distinguished into three subtypes, including stress urinary incontinence (SUI), urgent urinary incontinence (UUI) and mixed urinary incontinence (MUI). Aim: The purpose of this review is to collect and summarize the results of studies related to the risk factors of urinary incontinence, to disseminate this information to scientists so that this major issue can be prevented, identified and managed. Methodology: This review followed the methodology of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PECO eligibility criteria were used. We included studies published up to 2025 and not before 2019. The review was limited to studies published within the last six years in order to reflect contemporary diagnostic criteria, assessment tools and current postpartum care practices related to urinary incontinence. We searched PubMed, Google Scholar and Scopus for studies concerning the relationship between risk factors and postpartum UI. Results: A total of 1321 citations were identified. Following our exclusion criteria, 36 papers were selected to identify the risk factors for UI. All the research focused on the associated factors of any type of urinary incontinence. Vaginal and instrumental delivery, obesity, maternal age and the neonate’s birth weight were the main risk factors. The multiparity and incontinence symptoms before and during pregnancy were also strong risk factors. Heterogeneity across studies in assessment tools, in outcome measures and timing of postpartum assessment are some of the limitations of the study. Restriction to English-language publications and the absence of protocol registration were some of the additional limitations of the study. Conclusions: This problem affects the inclusion of women in society, the family, limits social activities and even their ability to work. Detection of the type of urinary incontinence by healthcare professionals, lifestyle modifications, monitoring women’s body weight and encouraging them to follow a program of pelvic floor muscle exercises should be a priority for professionals. The strategy of developing prognostic models in the coming years will be the only way to ensure the early identification and follow-up of women at high risk for urinary disorders. Full article

(This article belongs to the Special Issue Contemporary Perspectives in Women's and Maternal Health: Systems, Prevention, Nutrition and Midwifery-Led Innovation)

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17 pages, 446 KB

Open AccessReview

Nurses’ Experience in Providing End-of-Life Care in Intensive Care Unit: A Scoping Review

by Y. Dodi Setyawan, Indah Ayu Susanti, Cecep Eli Kosasih and Hartiah Haroen

Healthcare 2026, 14(3), 417; https://doi.org/10.3390/healthcare14030417 - 6 Feb 2026

Viewed by 894

Abstract

Background: Most ICU patients are in the terminal phase and require complex palliative care support and End-of-Life Care (EoLC). Nurses play a central role in symptom management, emotional support, and shared decision-making. However, evidence on nurses’ experiences in providing EoLC remains fragmented and [...] Read more.

Background: Most ICU patients are in the terminal phase and require complex palliative care support and End-of-Life Care (EoLC). Nurses play a central role in symptom management, emotional support, and shared decision-making. However, evidence on nurses’ experiences in providing EoLC remains fragmented and lacks a comprehensive synthesis. Objective: This review aimed to identify, map, and synthesize global evidence on ICU nurses’ experiences in delivering EoLC, including challenges, coping strategies, and implications for critical care nursing practice. Methods: A scoping review was conducted following Arksey and O’Malley’s framework and PRISMA-ScR guidelines. Systematic searches were performed in the PubMed, Scopus, and EBSCOhost databases for studies published between 2015 and 2025. Thematic analysis was applied to the qualitative studies to identify patterns and key issues. Results: Twelve qualitative studies conducted in diverse countries met the inclusion criteria. Five major themes emerged: (1) emotional and moral challenges; (2) cultural and spiritual influences; (3) communication and interprofessional collaboration; (4) professional development and organizational support; and (5) resource constraints. These findings indicate that ICU nurses’ experiences with EoLC are multidimensional and shaped by the cultural context and institutional policies. Conclusions: ICU nurses’ experiences with EoLC reflect complex ethical, emotional, and organizational dimensions. Improving care quality requires structured training, organizational support, and culturally sensitive policies to strengthen critical care nursing practice. Full article

(This article belongs to the Special Issue Holistic Assessment in Palliative Care)

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25 pages, 524 KB

Open AccessArticle

Where Is the Client in Client-Centered Care? Centering the Experiences of Integrated Care Among Black Women in Public Health Settings

by Annalise J. Tolley, Victoria C. Scott, Jennifer Langhinrichsen-Rohling, Alicia A. Dahl, Ebony Rao and Jae Hoon Lim

Healthcare 2026, 14(3), 416; https://doi.org/10.3390/healthcare14030416 - 6 Feb 2026

Viewed by 465

Abstract

Background/Objectives: Integrated behavioral healthcare (IC) in public health settings may be optimal for advancing mental health equity among low-income and economically marginalized (LIEM) Black women. This study explores the provision of mental health services in public health clinics and assesses client experiences [...] Read more.

Background/Objectives: Integrated behavioral healthcare (IC) in public health settings may be optimal for advancing mental health equity among low-income and economically marginalized (LIEM) Black women. This study explores the provision of mental health services in public health clinics and assesses client experiences and recommendations for healthcare system improvement. Methods: Black women receiving mental health services in public health clinics completed surveys (n = 81) and in-depth interviews (n = 8, follow-up: n = 7). Analysis included descriptive statistics, interpretive phenomenological analysis, and member checking (n = 4). Results: Survey respondents reported high perceptions of providers’ cultural responsiveness (M = 13.35/14) and high satisfaction with IC services (M = 4.48/5.0). However, qualitative interviews revealed that these scores may be relative to low baseline expectations for care. Across interviewees, personalized care emerged as critical for high-quality IC service delivery, and pregnant interviewees reflected on the importance of IC during pregnancy, which can compound prior mental health concerns. Notably, positive IC reflections waned over time, and 75% of interviewees “fell through the cracks” between receiving referral for and accessing community resources, resulting in persistent unmet mental health needs. This experience, paired with a lack of systemic follow-up from the public health department, was perceived as a form of institutional betrayal. Conclusions: While IC in public health settings holds promise for health equity, results underscore the need for person-centered care that prioritizes authentic screening, warm handoffs, and closed-loop referrals—particularly for LIEM Black women, who frequently have prior experiences with fragmented healthcare systems. To ensure IC meets client needs without causing unintentional harm, healthcare systems should co-design solutions with clients. Full article

(This article belongs to the Special Issue Health Equity and People-Centered Systems: Meeting Needs and Creating Opportunities for Diverse Communities)

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11 pages, 1863 KB

Open AccessArticle

Inequity in Schoolchildren’s Access to Oral Health Services in Romania: Implications for Public Oral Health Policies

by Anca-Cristina Perpelea, Ruxandra Sfeatcu, Silviu-Mirel Pițuru and Florentina Ligia Furtunescu

Healthcare 2026, 14(3), 415; https://doi.org/10.3390/healthcare14030415 - 6 Feb 2026

Viewed by 435

Abstract

Background/Objectives: In Romania, the oral health status of schoolchildren is insufficiently documented at the national level. This is due to the lack of systematic oral health reporting and fragmented access to dental care services. Methods: In this context, the main factors [...] Read more.

Background/Objectives: In Romania, the oral health status of schoolchildren is insufficiently documented at the national level. This is due to the lack of systematic oral health reporting and fragmented access to dental care services. Methods: In this context, the main factors influencing schoolchildren’s access to dental services were identified through a triangulation approach that integrated documentary research, routine data on health service coverage, and oral health indicators collected through a survey conducted on 3843 schoolchildren. Results: The results highlight a multitude of interdependent factors that shape children’s access to dental care, namely policy-level constraints, dental workforce distribution and individual-level determinants—and provide insight into how public health policies can be adapted to more effectively meet the needs of this group. Conclusions: Despite legislative provisions on children’s oral health care in Romania, territorial disparities persist, and the use of preventive services remains low. These findings underscore the need for national- and county-level public health policies to improve access, promote preventive dental check-ups, strengthen health literacy, and develop targeted programs specifically dedicated to school-age children. Full article

(This article belongs to the Section Public Health and Preventive Medicine)

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12 pages, 512 KB

Open AccessArticle

Compensation Stability and Workforce Retention During COVID-19: A Paired Comparative Study of Home Care Nurses

by Naudrey Parker-Jenkins and John Kwame Duah

Healthcare 2026, 14(3), 414; https://doi.org/10.3390/healthcare14030414 - 6 Feb 2026

Viewed by 369

Abstract

Background/Objectives: Home care nurses play a vital role in maintaining continuity of care for vulnerable populations. However, the COVID-19 pandemic exposed long-standing vulnerabilities in the workforce within home and community-based services. While compensation is often emphasized as a primary driver of workforce retention, [...] Read more.

Background/Objectives: Home care nurses play a vital role in maintaining continuity of care for vulnerable populations. However, the COVID-19 pandemic exposed long-standing vulnerabilities in the workforce within home and community-based services. While compensation is often emphasized as a primary driver of workforce retention, less is known about how compensation satisfaction and retention intentions changed over time during a public health emergency. Methods: This study employed a cross-sectional survey with retrospective paired comparisons among home care nurses at five home care agencies in Maryland. To assess temporal changes, respondents retrospectively evaluated compensation satisfaction, job satisfaction, and retention intentions before and during the COVID-19 pandemic. Paired samples t-tests were used to examine within-respondent differences across time periods. Herzberg’s Motivator-Hygiene Theory guided the interpretation of these changes in extrinsic and intrinsic workplace factors. Results: Compensation satisfaction did not differ significantly between the pre-pandemic and pandemic periods. In contrast, selected retention-related perceptions, particularly financial stability and feeling well paid, changed significantly and were associated with organizational and preparedness-related factors such as leadership, communication, and professional growth opportunities. Several intrinsic job satisfaction dimensions improved during the pandemic, while resource-related challenges remained. Conclusions: The findings suggest that compensation stability functioned as a hygiene factor that was insufficient to secure workforce retention during the COVID-19 pandemic. Retention intentions were shaped by the interaction of financial security and organizational preparedness. Workforce policies to strengthen home care systems should combine compensation strategies with leadership development, professional growth opportunities, and emergency preparedness planning to build resilience during future crises. Full article

(This article belongs to the Section Healthcare Organizations, Systems, and Providers)

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20 pages, 947 KB

Open AccessSystematic Review

A Systematic Review of Multimodal Frameworks for Assessing Health Vulnerability in Academicians Across Ergonomic, Lifestyle, and Dietary Domains

by Pooja Oza, Shraddha Phansalkar, Aayush Shrivastava, Abhishek Sharma, Jun-Jiat Tiang and Wei Hong Lim

Healthcare 2026, 14(3), 413; https://doi.org/10.3390/healthcare14030413 - 6 Feb 2026

Viewed by 659

Abstract

Background: Lifestyle challenges such as prolonged sitting, irregular dietary habits, high stress levels, and lack of physical activity have become increasingly common among working professionals. All these factors contribute to the risk of chronic diseases such as diabetes, heart disease, obesity, and high [...] Read more.

Background: Lifestyle challenges such as prolonged sitting, irregular dietary habits, high stress levels, and lack of physical activity have become increasingly common among working professionals. All these factors contribute to the risk of chronic diseases such as diabetes, heart disease, obesity, and high blood pressure, which in turn result in reduced work performance and quality of life and may further affect health services access through increase healthcare needs. The teaching environment, like many other work environments, is mentally, emotionally, and practically demanding, and it puts extra pressure on those who work in it. Academicians, who devote themselves to guiding young minds, often make unhealthy daily choices and face significant work-related stress, which can lead to serious long-term health problems. This review highlights that health and well-being are shaped not by a single factor such as diet, work patterns, or habits, but by their combined effect. Methods: A study of around 113 studies has highlighted that academicians usually feel drained and physically exhausted. Result: The factors like prolonged fasts, insufficient water intake, long-standing hours, long and continuous talking, and extended periods in the sitting position have added to their stress levels at the workplace. The most critical finding is that these factors do not affect in isolation but impact as a combined interaction. These issues influence each other, thus increasing the vulnerability to lifestyle disorders. Conclusions: This critical problem can be addressed with a Multimodal Assessment Framework that integrates teachers’ data on dietary habits, workplace ergonomics, sleep quality, and levels of physical activity. The presented work also proposes a statistical technique with an Artificial Intelligence (AI) model, and generates Vulnerability Quotient (VQ) that show lifestyle disease-related exposure of the teachers, which may be further used to provide remedial interventions. These insights can further guide institutions and policymakers to design healthier, supportive, and sustainable teaching environments. Full article

(This article belongs to the Special Issue Occupational Health and Workers’ Well-Being: From Research to Practice)

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15 pages, 950 KB

Open AccessArticle

Usability and Feasibility of a School-Based Digital Framework for Bullying Prevention

by Christopher Murray, Claudia G. Vincent, Dorothy L. Espelage, Luis Anunciacao, Hill Walker, Rita Svanks, Alberto Valido and Brion Marquez

Healthcare 2026, 14(3), 412; https://doi.org/10.3390/healthcare14030412 - 6 Feb 2026

Viewed by 550

Abstract

Bullying and school violence contribute directly to mental health difficulties among youth in the United States. Background/Objectives: This study describes the development and initial evaluation of a technology-enabled, multi-component school safety framework designed to support bullying prevention in middle and high schools. [...] Read more.

Bullying and school violence contribute directly to mental health difficulties among youth in the United States. Background/Objectives: This study describes the development and initial evaluation of a technology-enabled, multi-component school safety framework designed to support bullying prevention in middle and high schools. Methods: Students (n = 46), school personnel (n = 79), and parents/caregivers (n = 28) participated in three waves of usability and feasibility testing focused on a mobile application (Speak Out with Advocatr), companion classroom instructional materials, and guidelines for a school-wide safety campaign. Quantitative data were summarized using descriptive statistics and benchmark comparisons, and group differences across respondent roles were examined using analysis of variance with post hoc pairwise tests. Given small and unequal sample sizes, bootstrap resampling with 1000 resamples was used to obtain robust estimates of group means and confidence intervals. Qualitative responses were analyzed using content analysis. Results: Across waves, mean ratings generally met or exceeded predefined usability benchmarks, indicating favorable perceptions of the system. Findings indicated strong student acceptance and engagement with the framework. Adult participants expressed particular interest in restorative approaches to addressing student conflict, as well as concerns about preventing the recurrence of bullying behaviors. Conclusions: Findings provide initial support for the usability and feasibility of a multi-component, technology-enabled approach to school-based bullying prevention. Results also highlight the value of role-specific feedback for refining integrated mental health and safety interventions within school settings. Full article

(This article belongs to the Special Issue The Relationship of Social Media and Cyberbullying with Mental Health)

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13 pages, 3666 KB

Open AccessArticle

Strain Analysis from Transverse CMR Cine Imaging in Congenital Heart Disease: Feasibility, Reproducibility, and Comparison to Global Longitudinal Strain

by Victoria Zieschang, Peter Kramer, Collin Götze, Sebastian Kelle, Regina Stegherr, Alireza Khasheei, Felix Berger, Johannes Nordmeyer, Titus Kühne, Sarah Nordmeyer and Marie Schafstedde

Healthcare 2026, 14(3), 411; https://doi.org/10.3390/healthcare14030411 - 6 Feb 2026

Viewed by 430

Abstract

Background: Global longitudinal strain (GLS), derived from long-axis cine images (LAX), is a sensitive marker for myocardial dysfunction and a strong predictor for clinical events and future ventricular deterioration. In patients with complex congenital heart disease (CHD) transverse-oriented cine imaging is part [...] Read more.

Background: Global longitudinal strain (GLS), derived from long-axis cine images (LAX), is a sensitive marker for myocardial dysfunction and a strong predictor for clinical events and future ventricular deterioration. In patients with complex congenital heart disease (CHD) transverse-oriented cine imaging is part of the standard cardiac magnetic resonance (CMR) protocol. We aimed to study the feasibility and reproducibility of strain measurements derived from transverse-oriented cine images (Transverse Strain (TrS)) and compare them with standard GLS. Methods: We retrospectively analyzed CMR cine images from 40 patients (n = 20 Fontan, n = 20 Tetralogy of Fallot (ToF)) and 10 healthy controls. Strain analysis was performed in every subject using both the conventional GLS and the TrS approach. Results: TrS showed high intra- and interobserver reproducibility in patients with CHD (intraclass correlation coefficient (ICC) > 0.75, p < 0.05). Intermethod agreement between TrS and GLS was strong in Fontan patients and in the right ventricle (RV) of ToF patients (ICC > 0.75) but showed a positive bias for TrS in the left ventricle (LV) of ToF patients (mean difference = 5.03) and in both ventricles of healthy controls (mean difference LV = 5.36, RV = 4.01). Conclusions: TrS is feasible and reproducible and may offer a new methodological approach for strain assessment, especially in CHD patients with univentricular physiology and ToF patients. Further studies are needed to validate this new approach and perform correlations to clinical outcomes. Full article

(This article belongs to the Special Issue Advances in Cardiac Imaging: Innovations, AI Integration, and Clinical Applications)

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20 pages, 378 KB

Open AccessArticle

Adolescents’ Responses to High-Intensity Versus Standard Physical Education on Body Fat, Blood Pressure, and VO₂max: A Secondary Analysis Using TE-Based Responder Classification

by Jarosław Domaradzki, Eugenia Murawska-Ciałowicz, Katarzyna Kochan-Jacheć, Paweł Szkudlarek, Dawid Koźlenia and Marek Popowczak

Healthcare 2026, 14(3), 410; https://doi.org/10.3390/healthcare14030410 - 5 Feb 2026

Viewed by 512

Abstract

Background/Objectives: A persistent challenge in adolescent health promotion is insufficient exercise intensity during physical education (PE) lessons, limiting their potential to reduce cardiometabolic risk. National curricula further restrict teacher flexibility in implementing effective preventive strategies. Brief, high-intensity exercise protocols may provide a [...] Read more.

Background/Objectives: A persistent challenge in adolescent health promotion is insufficient exercise intensity during physical education (PE) lessons, limiting their potential to reduce cardiometabolic risk. National curricula further restrict teacher flexibility in implementing effective preventive strategies. Brief, high-intensity exercise protocols may provide a scalable solution within school systems. Although their general effectiveness is established, less is known about the variability of individual health responses, particularly across multiple outcomes and in relation to sex and intervention type. This study aimed to (1) assess the prevalence of responders (Rs) and non-responders (NRs) by sex and intervention type, (2) examine sex-by-intervention interactions, and (3) evaluate the likelihood of combined positive health responses across body fat percentage (BFP), systolic and diastolic blood pressure (SBP and DBP), and cardiorespiratory fitness (maximal oxygen consumption [VO₂max]). Methods: A total of 145 adolescents (aged 16 years; 48% males) from experimental school-based PE programs were analyzed. Two intervention modalities were implemented: high-intensity interval training (HIIT) and high-intensity plyometric training (HIPT). Rs were identified using typical error (TE) methodology. Statistical analyses included chi-squared tests (χ²), log-linear modeling, and odds ratios (ORs). Results: Chi-squared analyses indicated sex-by-intervention associations in the distribution of responder classifications for body fat percentage (BFP), systolic blood pressure (SBP), diastolic blood pressure (DBP), and VO₂max (χ² range = 8.26–10.10, p < 0.01). A simple association between intervention type and DBP was also observed (χ² = 6.49, p = 0.011). However, logistic regression analyses yielded odds ratios with wide 95% confidence intervals crossing the null value for all outcomes, indicating limited precision and the absence of statistically robust interaction effects. Multinomial logistic regression examining combined responses (two or three concurrent improvements) revealed no statistically significant main or interaction effects (all p > 0.05). Conclusions: Brief high-intensity exercise protocols delivered within school-based physical education were associated with favorable changes in adiposity, blood pressure, and cardiorespiratory fitness in a substantial proportion of adolescents. However, sex- and intervention-specific differences in responder classification were not statistically significant and should be interpreted as exploratory. Further adequately powered studies are required to determine whether individual characteristics meaningfully moderate responsiveness to specific high-intensity exercise modalities. Full article

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12 pages, 940 KB

Open AccessArticle

How Risky Is Mixed Martial Arts? Injury Rates and Patterns in Competitive Versus Recreational Athletes

by Lukas Groessing, Vasco Starke, Armin Runer, Friedemann Schneider, Markus Merkl, Wolfgang Zemann and Michael Schwaiger

Healthcare 2026, 14(3), 409; https://doi.org/10.3390/healthcare14030409 - 5 Feb 2026

Viewed by 675

Abstract

Background/Objectives: Mixed martial arts (MMA) is a popular full-contact combat sport. The aim of this study was to determine injury mechanisms, rates, severity, patterns, circumstances, and the resulting economic healthcare consequences by conducting a detailed survey of competitive and recreational athletes. Methods [...] Read more.

Background/Objectives: Mixed martial arts (MMA) is a popular full-contact combat sport. The aim of this study was to determine injury mechanisms, rates, severity, patterns, circumstances, and the resulting economic healthcare consequences by conducting a detailed survey of competitive and recreational athletes. Methods: In 2023, MMA athletes were retrospectively questioned regarding their injuries in the last 24 months and the resulting healthcare impact (medical attention, hospitalization, incapacity to work). An injury was defined as any physical complaint resulting from MMA exposure. The severity of the injury was categorized according to the resulting restriction of sport participation (i.e., ‘severe’: more than four weeks of restriction). Results: A total of 112 participants (93% male; 41% non-competitive and 59% competitive) were included. All in all, 93,857 h of MMA activities were performed, and 127 injuries were recorded, resulting in an overall injury rate of 1.4 injuries per 1000 h of exposure. Non-competitive athletes reported significantly fewer total injuries in the past 24 months (95% CI 0.87–2.04; p = 0.003) and had significantly fewer severe or even critical injuries compared to competitive athletes (OR 0.55; 95% CI 0.21–1.43; p = 0.042). Head- and neck lesions (20%) were the most common injuries. The most common types of injury were joint sprains (21%) and ligament strains (17%). The healthcare burden of these sports-related injuries was minimal: By median, injuries led to zero days of hospitalization and incapacity to work, with no statistically significant differences between recreational and competitive athletes. Conclusions: Competitive athletes suffer more severe injuries compared to recreational athletes. Overall, injuries in MMA are rare, and the economic impact and burden on the healthcare system are negligible compared to other sport disciplines. Full article

(This article belongs to the Special Issue Healthcare Advances in Trauma and Orthopaedic Surgery)

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15 pages, 551 KB

Open AccessArticle

A Moderated Mediation Analysis of Timely EMS Activation and Bystander CPR in the Association Between Regional Deprivation and Outcomes Following Out-of-Hospital Cardiac Arrest

by So Yeon Kong and Seungmin Jeong

Healthcare 2026, 14(3), 408; https://doi.org/10.3390/healthcare14030408 - 5 Feb 2026

Viewed by 399

Abstract

Background/Objectives: Out-of-hospital cardiac arrest (OHCA) outcomes remain poor and vary widely across communities with socioeconomic deprivation. This study examines whether delays in emergency medical services (EMS) activation, the earliest link in the Chain of Survival, mediate the association between regional deprivation and [...] Read more.

Background/Objectives: Out-of-hospital cardiac arrest (OHCA) outcomes remain poor and vary widely across communities with socioeconomic deprivation. This study examines whether delays in emergency medical services (EMS) activation, the earliest link in the Chain of Survival, mediate the association between regional deprivation and OHCA outcomes, and whether this effect is modified by bystander cardiopulmonary resuscitation (CPR) status. Methods: We analyzed adult patients (aged 18–80 years) with witnessed, EMS-treated OHCA of presumed cardiac etiology from the Korean nationwide OHCA registry (2015–2022). Regional deprivation was defined by the Regional Deprivation Index and dichotomized into deprived (top 20%) vs. non-deprived areas. Timely EMS activation, defined as collapse to EMS activation, was measured as an awareness time interval (ATI) < 5 min. Outcomes were good neurological recovery (CPC 1–2) and survival to discharge. Causal mediation analysis within the counterfactual framework quantified the proportion of the association mediated by timely EMS activation, with stratification by bystander CPR status. Results: Among 43,032 patients, 6.1% resided in deprived areas. Deprived areas had lower bystander CPR (22.6% vs. 36.3%) and timely EMS activation (67.8% vs. 75.6%) (p < 0.05 for all). Regional deprivation was associated with poorer outcomes (good neurological prognosis: aOR 0.46, 95% CI 0.39–0.55; survival: aOR 0.65, 95% CI 0.57–0.73). Mediation analysis showed that ATI < 5 min accounted for 3.7% of the total deprivation effect on good neurological outcome and 7.9% on survival, with stronger mediation among patients receiving bystander CPR (7.9% and 14.7%, respectively). Conclusions: Regional deprivation is significantly associated with poorer OHCA outcomes, partly mediated by delays in EMS activation, particularly among patients who received bystander CPR. Interventions to enhance early recognition, rapid EMS activation, and bystander CPR in deprived communities are critical to improving survival equity after OHCA. Full article

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14 pages, 826 KB

Open AccessArticle

Well-Being and Sexual Diversity in Higher Education: The Role of Mental Health, Optimism, Academic Performance, and Motivation in Portuguese Students

by José Alberto Ribeiro-Gonçalves, Diana Fernandes, Ester Câmara and Margarida Pocinho

Healthcare 2026, 14(3), 407; https://doi.org/10.3390/healthcare14030407 - 5 Feb 2026

Viewed by 367

Abstract

Introduction. Entering higher education represents a significant and challenging stage, marked by substantial changes that impact students’ well-being, mental health, and academic performance. These challenges can be particularly intensified for lesbian, gay, or bisexual (LGB) students, who are frequently subject to minority stress. [...] Read more.

Introduction. Entering higher education represents a significant and challenging stage, marked by substantial changes that impact students’ well-being, mental health, and academic performance. These challenges can be particularly intensified for lesbian, gay, or bisexual (LGB) students, who are frequently subject to minority stress. In this context, few studies have focused on aspects associated with the well-being of these students. This study aimed to assess well-being, mental health, optimism, motivation, and academic performance according to students’ sexual orientation, as well as the main predictors of well-being in both groups. Method. The sample comprised 285 higher education Portuguese students, of whom 129 were heterosexual and 156 were LGB, aged between 18 and 69 years. Results. The results revealed that the LGB students showed significantly lower levels of optimism, but higher levels of academic performance and mental health, compared to heterosexual students. Among LGB students, optimism stood out as one of the main predictors of well-being, while mental health stood out among heterosexual students. Conclusions. The results highlight the need for more inclusive university environments and psychological interventions focused on promoting optimism to reduce the impact of minority stress and promote the well-being and academic retention of LGB students. More studies are needed that consider the diverse sexual orientations of university students. Full article

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

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26 pages, 1468 KB

Open AccessViewpoint

The Anabranch Framework for the Ruralization of Health Professional Education

by Debra Jones, Annemarie Hennessy, Mariah Goldsworthy, Xiang-Yu Hou, Sandra Thompson, Hannah Dean, Kazuma Honda, Danielle Minnis, Charlene Noye, Tracy Robinson, Wendy Gleeson, Reakeeta Smallwood, Aliza Lord, Brendan McCormack and Danielle White

Healthcare 2026, 14(3), 406; https://doi.org/10.3390/healthcare14030406 - 5 Feb 2026

Viewed by 601

Abstract

Background/Objective: The quality of care afforded to rural, remote, and First Nations Peoples is dependent on access to a health workforce with the capacity to contextualize healthcare and practice to the needs and expectations of these populations. In Australia, the lack of representation [...] Read more.

Background/Objective: The quality of care afforded to rural, remote, and First Nations Peoples is dependent on access to a health workforce with the capacity to contextualize healthcare and practice to the needs and expectations of these populations. In Australia, the lack of representation of rural health in undergraduate and post graduate health professional education undermines this preparedness and consideration of rural practice uptake and longevity, compounding the inequities confronted by 7 million Australians residing in these locations. Urgent educational reforms are required to address this omission, the deficit discourses used to characterize rural healthcare, and the persistent health workforce shortages experienced. This paper presents the Anabranch Framework for the Ruralization of Health Professional Education, a high-level strategy to transform rural healthcare provision, professional practice, and health workforce outcomes. Methods: The framework was developed through an iterative process involving a series of systematic steps. The process included the following: individual and group critical dialogues with internal academic educators, external health service leaders, metropolitan academic allies, and leaders of other rural health academic departments; an internal review of empirical studies of relevance to the ruralization of health professional education and practice; the visualization of a place-based framework; the academic conceptualization of the framework; and further critical dialogues to test the framework’s face validity. Results: The Anabranch Framework comprises four inter-related rural domains: theories, pedagogies, practices, and connectivity; four constructs: knowledge acquisition and generation, immersion in rural curriculum, knowledge translation and sharing, and relational practice; and two structural elements: spiraled and scaffolded curriculum and duration and the quality of rural placement and practice. Conclusions: The Anabranch Framework is a high-level strategy to ruralize health professional worldviews, advance rural person-centered practice, enable a deeper understanding of rural places and the development of an equity-orientated, sustainable and rural-literate health workforce. Full article

(This article belongs to the Topic Bridging Socio-Economic Inequalities in Health: Addressing Access Gaps in Low-Income and Vulnerable Populations)

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21 pages, 1480 KB

Open AccessArticle

Early Detection of Chronic Kidney Disease in Men Using Lifestyle and Demographic Indicators: A Machine Learning Approach for Primary Healthcare Settings

by Mc Neil Valencia, Jun Kim, Zeeshan Abbas and Seung Won Lee

Healthcare 2026, 14(3), 405; https://doi.org/10.3390/healthcare14030405 - 5 Feb 2026

Viewed by 955

Abstract

Background/Objective: Chronic kidney disease (CKD) is a major global health concern associated with significant morbidity, mortality, and healthcare burden. This study aimed to develop an explainable machine learning framework that integrates lifestyle, sociodemographic, and biochemical factors for early CKD risk prediction among middle-aged [...] Read more.

Background/Objective: Chronic kidney disease (CKD) is a major global health concern associated with significant morbidity, mortality, and healthcare burden. This study aimed to develop an explainable machine learning framework that integrates lifestyle, sociodemographic, and biochemical factors for early CKD risk prediction among middle-aged men using public health survey data. Methods: Data from 968 male participants were preprocessed by removing missing values, deriving eGFR and ACR, and labeling CKD status. Five machine learning algorithms, (i.e., Random Forest, AdaBoost, Naïve Bayes, SVM, and XGBoost) were trained and evaluated using accuracy, precision, recall, and F1-score. Model interpretability was assessed using SHAP, LIME, Boruta, and Pearson’s correlation analyses. Results: AdaBoost yielded the best performance (accuracy = 0.7258, F1 = 0.6457, recall = 0.6923), with robust generalization confirmed by the precision–recall curve (AP = 0.715). SHAP and LIME revealed that serum creatinine, blood urea nitrogen, urinary creatinine, and age were major predictors, whereas lifestyle and metabolic indicators such as BMI, sodium and sugar intake, and sleep duration emerged as secondary factors for CKD. Conclusions: This study demonstrates the effectiveness of an explainable machine learning model that integrates lifestyle, sociodemographic and biochemical data for early CKD prediction among middle-aged men. The AdaBoost-based framework shows strong potential for implementation as a clinical decision-support tool within EHR systems and may contribute to personalized and preventive interventions. It emphasizes the growing importance of modifiable behaviors in kidney disease development and supports future work involving multiple cohorts and temporal model expansion to improve risk stratification for individuals at risk of kidney disease. Full article

(This article belongs to the Special Issue Digital Health and AI for Chronic Disease Control and Management)

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18 pages, 966 KB

Open AccessArticle

Love, Compassion, and Personality as Predictors of Burnout in Nurses: A Path Analysis Study

by Agapi L. Batiridou, Elena Dragioti, Zoe Konstanti, Stefanos Mantzoukas and Mary Gouva

Healthcare 2026, 14(3), 404; https://doi.org/10.3390/healthcare14030404 - 5 Feb 2026

Viewed by 1073

Abstract

Background/Objectives: This study examined how personality traits, compassion, and love are associated with the three dimensions of burnout among nurses, while accounting for demographic factors such as gender, age, and work shift. Methods: A total of 403 nurses participated in this [...] Read more.

Background/Objectives: This study examined how personality traits, compassion, and love are associated with the three dimensions of burnout among nurses, while accounting for demographic factors such as gender, age, and work shift. Methods: A total of 403 nurses participated in this cross-sectional study and completed validated self-report measures of personality, compassionate love, and burnout, as well as an in-house, exploratory Love Instrument. Path analysis was used to examine patterns of direct and indirect associations among the study variables while controlling demographic covariates. Results: Men reported higher psychoticism and depersonalization, whereas women scored higher in compassion. Neuroticism was associated with greater emotional exhaustion and depersonalization and with lower personal accomplishment. Compassion showed indirect association patterns linking extraversion and the Lie scale with personal accomplishment and linking psychoticism with depersonalization. Extraversion was positively associated with accomplishment both directly and indirectly, while psychoticism was associated with higher depersonalization. Love-related variables showed mixed findings. Specifically, love experience was not associated with burnout, whereas love intensity was positively associated with both depersonalization and accomplishment. Older nurses reported more exhaustion but also greater accomplishment; male gender and rotating shifts were associated with higher depersonalization and exhaustion. Conclusions: The findings support neuroticism as a key dispositional vulnerability correlated with burnout and suggest that compassion and extraversion are linked to more favorable burnout-related profiles, particularly higher accomplishment and lower depersonalization. Love-related emotion intensity showed small, mixed associations and should be interpreted cautiously given the exploratory measurement approach. These results highlight the emotional complexity of nursing and may inform future research and workplace initiatives aimed at supporting occupational well-being. Full article

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

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17 pages, 552 KB

Open AccessArticle

Gestational Weight Gain Counseling Insights from Healthcare Providers and Saudi Women: Riyadh Mother and Baby Follow-Up Study (RAHMA Explore)

by Amel Fayed, Samia Esmaeil, Alya Khalid AlZabin, Wijdan Awad Almutiri, Ebtesam Hoshan Almajed and Hayfaa Wahabi

Healthcare 2026, 14(3), 403; https://doi.org/10.3390/healthcare14030403 - 5 Feb 2026

Viewed by 400

Abstract

Background: Monitoring and managing gestational weight gain (GWG) during antenatal care (ANC) is linked to better maternal and neonatal outcomes. The Institute of Medicine (IOM) guidelines are based on pre-pregnancy BMI and reduce obstetric risks. Pregnant women’s views and healthcare providers’ (HCPs) [...] Read more.

Background: Monitoring and managing gestational weight gain (GWG) during antenatal care (ANC) is linked to better maternal and neonatal outcomes. The Institute of Medicine (IOM) guidelines are based on pre-pregnancy BMI and reduce obstetric risks. Pregnant women’s views and healthcare providers’ (HCPs) practices are key to effective GWG counseling. This study aims to: (1) investigate the proportion of women who received GWG advice per IOM guidelines, and (2) explore HCP practices and views on GWG counseling. Methods: This is a cross-sectional study of Saudi pregnant women who delivered within one year of the study and HCPs who provided ANC. Women provided data on demographics, pre-pregnancy BMI, recall of GWG advice, and their target GWG. HCPs rated their knowledge and counseling practices. Results: Of 1151 women, 48.8% were pre-pregnancy overweight or obese, 47.6% were normal weight, and 3.6% were underweight. Most women (74.5%) received no GWG advice, and only 8.8% followed IOM guidelines. Women with obesity and overweight were more likely to receive correct advice (15.5% and 11.5%), compared to 5.3% of normal-weight and 2.4% underweight women. Overweight and obese women were more likely to define the correct GWG (AOR = 2.84 and 5.85). Receiving proper advice greatly increased the likelihood of proper GWG definition (AOR = 7.13). Among 28 HCPs, 53.6% reported that women rarely ask about the GWG target. Nearly 93% of them weigh women at each visit, but only 21.4% set personalized GWG targets. Most HCPs (82.2%) viewed discussing GWG as a high priority, and 70% felt confident providing guidance on GWG, diet, and exercise. Conclusions: Many women receive no GWG guidance, and most advice does not align with IOM guidelines. Enhancing Saudi women’s knowledge regarding GWG targets through health education, in conjunction with ongoing medical education for healthcare professionals concerning guidelines for GWG, represents modifiable factors and a critical opportunity to foster healthier pregnancy outcomes. Full article

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14 pages, 273 KB

Open AccessArticle

Implementing a Group Psychoeducational Program for Emotional Well-Being in Primary Care Teams: A Qualitative Study in Catalonia

by Enric Aragonès, Sara Rodoreda, Meritxell Guitart, Eva Garcia, Anna Berenguera, Francisco Martín-Luján, Concepció Rambla, Guillem Aragonès, Antoni Calvo, Ariadna Mas, Dolors Rodríguez and Josep Basora

Healthcare 2026, 14(3), 402; https://doi.org/10.3390/healthcare14030402 - 5 Feb 2026

Viewed by 575

Abstract

Background/Objectives: Healthcare workers have faced increasing emotional strain driven by organizational constraints, rising workload, and accumulated post-pandemic pressure. To support emotional well-being in primary care professionals, the Catalan Health Institute implemented a large-scale psychoeducational group program in its primary care centers. This [...] Read more.

Background/Objectives: Healthcare workers have faced increasing emotional strain driven by organizational constraints, rising workload, and accumulated post-pandemic pressure. To support emotional well-being in primary care professionals, the Catalan Health Institute implemented a large-scale psychoeducational group program in its primary care centers. This study explored its feasibility, acceptability, and the factors shaping real-world implementation from the perspectives of participating professionals and community psychologists who taught it. Methods: A qualitative study was conducted involving five online focus groups held with community psychologists (two groups) and primary care professionals who participated in the program (three groups), selected through purposive sampling. Additional qualitative material was obtained from implementation-related field notes. Session transcripts were analyzed using inductive thematic analysis. The study is registered at ClinicalTrials.gov (NCT05720429). Results: Participants described a context of sustained emotional strain that increased motivation to engage with the program. The sessions were perceived as a valuable protected space for emotional expression, interpersonal connection, and learning self-care strategies. Community psychologists were regarded as key facilitators due to their embedded role and contextual knowledge. However, inconsistent managerial engagement, lack of protected time, competing workloads, and inadequate physical spaces were barriers to successful implementation. Participants proposed strengthening institutional support and offering follow-up sessions to consolidate benefits. Conclusions: The program was positively valued and was perceived to provide individual and team-level benefits. Its sustainability requires stronger organizational commitment and integration into routine practice. Findings underscore the need to complement individual-focused interventions with systemic actions addressing workload, staffing, and organizational culture. Full article

(This article belongs to the Special Issue Depression, Anxiety and Emotional Problems Among Healthcare Workers)

21 pages, 1087 KB

Open AccessArticle

The Last Aid Course Professional as a Low-Threshold Opportunity for Professionals from Health and Social Care to Talk About Dying, Death and Grief and to Learn the Foundations of Palliative Care—A Mixed-Methods Study

by Georg Bollig, Boris Knopf, Dirk Aumann, Marina Schmidt and Raymond Voltz

Healthcare 2026, 14(3), 401; https://doi.org/10.3390/healthcare14030401 - 5 Feb 2026

Viewed by 417

Abstract

Background: Last Aid Courses (LACs) for the public aim to enhance the public discussion about dying, death and grief and to increase the awareness for palliative care throughout the whole society. Based on the wishes and needs of professionals from health and social [...] Read more.

Background: Last Aid Courses (LACs) for the public aim to enhance the public discussion about dying, death and grief and to increase the awareness for palliative care throughout the whole society. Based on the wishes and needs of professionals from health and social care and results from previous studies on LACs, a longer Last Aid Course Professional (LACP) was developed. The aim of the present study was to evaluate the experiences and views of course participants and instructors on the Last Aid Course Professional (LACP) with ten teaching hours including the foundations of palliative care based on the storyline method. Methods: A mixed-methods approach was used including qualitative and quantitative data from a questionnaire for LACP participants and focus group interviews of LACP instructors. Results: A total of 394 of the 422 participants participated in the study by returning a questionnaire (response rate 93%). The age ranged from 21 to 81 years (median 45 years). In addition, 14 instructors participated in two focus group interviews. The results from the questionnaires showed that 84% of all participants assess the course as useful for all professionals working in health and social care. The qualitative data show that the LACP was well accepted by different organizations and participants from different professions. The participants welcome the opportunity for interprofessional exchange and the possibility for a change in perspective, as well as getting insight from different perspectives, reflecting on ethical challenges, and working on different options for action in palliative care. Lack of staff was the main barrier for participation in the LACP. Conclusions: The LACP is very well accepted by the participants and is a good option for palliative care education for professionals from health and social care. Full article

(This article belongs to the Special Issue New Perspectives in Palliative Care: Opportunities and Challenges)

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16 pages, 2277 KB

Open AccessArticle

Delayed Postural Responses to Fear of Falling During Gait Initiation in Low Vision: Insights from Virtual-Reality-Based Fear Simulation

by Mansoo Ko, Praveena K. Gupta, Gregory Brusola, Metha R. Chea, Pranati Ahuja, Tony Chao and Rodney L. Welsh

Healthcare 2026, 14(3), 400; https://doi.org/10.3390/healthcare14030400 - 5 Feb 2026

Viewed by 482

Abstract

Purpose: This study aimed to quantify the severity of fear of falling (FOF) in people with low vision (LV) compared with age–gender-matched healthy individuals during gait initiation (GI). Methods: A total of 14 adults with LV and 14 age–gender-matched healthy adults were recruited [...] Read more.

Purpose: This study aimed to quantify the severity of fear of falling (FOF) in people with low vision (LV) compared with age–gender-matched healthy individuals during gait initiation (GI). Methods: A total of 14 adults with LV and 14 age–gender-matched healthy adults were recruited from local communities. The Falls Efficacy Scale International was used to evaluate FOF. We compared temporal events between healthy and LV groups. For the healthy group, GI under normal vision was further compared to conditions using a low-vision sight simulator (SS) and an immersive virtual reality (VR) environment designed to simulate a fear-evoking experience. Independent t-test and one-way repeated measure ANOVA were conducted for statistical analysis (p < 0.05). Results: People with LV showed a significantly greater FOF than healthy individuals (p < 0.05). During GI, participants with LV exhibited significantly prolonged anticipatory postural adjustment (APA) durations compared to healthy normal and SS conditions (p < 0.05). While VR-evoked fear in healthy participants primarily prolonged the push-off (PO) phase, the delay in the LV group was characterized by a significantly extended initial anticipation (AP) phase. Notably, the APA duration in the LV group showed no significant difference compared to the healthy VR condition, indicating that the inherent fear in LV produces postural delays as severe as those induced by extreme VR-evoked fear of heights (p > 0.05). Conclusions: This study demonstrates that individuals with LV adopt a chronically conservative motor program during the transition from standing to walking. These postural hesitations are statistically comparable to those observed under fear-evoking, VR-induced environments. These findings suggest that LV is associated with a distinct biomechanical strategy that prioritizes static stability over dynamic movement. Accordingly, multidisciplinary rehabilitation approaches that emphasize sensory reweighting, including vestibular training, alongside interventions targeting FOF, may be essential for mitigating altered postural control and reducing fall risk in the LV population. Full article

(This article belongs to the Special Issue Fall Prevention and Geriatric Nursing)

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18 pages, 513 KB

Open AccessArticle

Analyzing Smart Healthcare Adoption in Remote-Island Primary Care Clinics: A Hybrid MDM-AHP Study from Kinmen Island

by Tsu-Ming Yeh, Hsiao-Yuan Lu and Yi-Hsuan Huang

Healthcare 2026, 14(3), 399; https://doi.org/10.3390/healthcare14030399 - 5 Feb 2026

Viewed by 286

Abstract

Background: Smart healthcare is increasingly promoted to strengthen primary care services; however, adoption challenges are amplified on remote islands due to geographic isolation and resource constraints. Objectives: This study aimed to identify and prioritize key success factors (KSFs) for smart healthcare [...] Read more.

Background: Smart healthcare is increasingly promoted to strengthen primary care services; however, adoption challenges are amplified on remote islands due to geographic isolation and resource constraints. Objectives: This study aimed to identify and prioritize key success factors (KSFs) for smart healthcare adoption in remote-island primary care clinics and to examine whether priorities differ across physician subgroups. Methods: A hybrid framework combining the Modified Delphi Method (MDM) and the Analytic Hierarchy Process (AHP) was applied. MDM (two rounds) refined a literature-based indicator pool to five dimensions and 20 criteria. AHP pairwise comparisons were collected from 21 physicians in Kinmen to derive weights and rankings. Results: System Quality (0.308) was the most critical dimension, followed by Organization (0.221), System Functionality (0.212), Environment (0.165), and Resource Investment (0.094). At the criterion level, Competitive Advantage and Security and Privacy were the two highest-ranked factors, followed by Accuracy and Data Integrity. Subgroup profiles varied across medical specialties and age groups. Conclusions: For remote-island primary care, adoption strategies should prioritize system quality and information assurance, while implementation support and resource considerations should be tailored to specialty- and cohort-specific needs. Full article

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11 pages, 236 KB

Open AccessFeature PaperArticle

Psychological Distress and Quality of Life in a Community-Based Sample of Adults with Atopic Dermatitis: A Cross-Sectional Exploratory Study

by Florence Mei Fung Wong, Pui Ka Fung, Hoi Yan Mak and Richard Yi Tsun Kao

Healthcare 2026, 14(3), 398; https://doi.org/10.3390/healthcare14030398 - 5 Feb 2026

Viewed by 464

Abstract

Background/Objectives: Atopic dermatitis (AD) is a chronic inflammatory skin condition associated with psychological distress and reduced quality of life (QoL). The complex interrelationships among anxiety, depression, and multidimensional QoL in adults with AD remain insufficiently understood. This study aimed to examine these [...] Read more.

Background/Objectives: Atopic dermatitis (AD) is a chronic inflammatory skin condition associated with psychological distress and reduced quality of life (QoL). The complex interrelationships among anxiety, depression, and multidimensional QoL in adults with AD remain insufficiently understood. This study aimed to examine these relationships and key factors linking psychological distress and QoL in this population. Methods: In this cross-sectional study, 47 adult participants with AD completed the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization Quality of Life (WHOQOL-BREF). Bivariate and multivariate analyses were used to identify associations and correlates among anxiety, depression, and QoL domains. Results: Participants demonstrated elevated anxiety (mean score: 7.91 ± 3.27) and depression (mean score: 6.28 ± 3.62) scores, with moderate-to-poor QoL reported across all domains. Both anxiety and depression were significantly negatively correlated with all QoL dimensions (p < 0.05). Higher depression and self-reported stress were independently associated with poorer self-perceived QoL (p < 0.001). Self-reported inadequate sleep was associated with lower environmental QoL (p = 0.006), while more self-reported frequent AD flares correlated with reduced psychological QoL (p = 0.007). Conclusions: This study highlights the substantial psychological burden and impaired QoL experienced by adults with AD. Self-reported stress and inadequate sleep were commonly cited as modifiable factors associated with poorer outcomes, alongside elevated depression scores. An integrated care approach addressing both physical and psychological factors is recommended to improve overall outcomes in this population. Future research should prioritize longitudinal designs and AD-specific assessments to further elucidate causal pathways and inform targeted interventions. Full article

(This article belongs to the Special Issue Community Healthcare in the New Era)

16 pages, 407 KB

Open AccessArticle

Patients’ Perspective of Medication Safety in Hungary: A Netnography-Based Mixed-Method Content Analysis

by Barbara Báldy and Judit Lám

Healthcare 2026, 14(3), 397; https://doi.org/10.3390/healthcare14030397 - 4 Feb 2026

Viewed by 481

Abstract

Background/Objectives: Medication-related safety incidents rank among the most prevalent patient safety concerns globally. In addition to healthcare professionals, patients also play a vital role in ensuring safe medication practices. To effectively engage them, it is essential to gain a deeper understanding of [...] Read more.

Background/Objectives: Medication-related safety incidents rank among the most prevalent patient safety concerns globally. In addition to healthcare professionals, patients also play a vital role in ensuring safe medication practices. To effectively engage them, it is essential to gain a deeper understanding of their knowledge and perspectives. Methods: We conducted a netnography-based mixed-method content analysis study within the Hungarian online environment to identify key patient concerns. A total of 5174 relevant comments and discussions were analyzed (from 14 August 2020 to 14 August 2023), utilizing a medication safety framework based on Glies et al. The analysis was confined to publicly accessible online content related to oral medications and did not include demographic information about commenters. Results: The framework was applicable, though its representation was uneven. Patients predominantly focused on issues related to Access to services and Communication. Online discussions were primarily dominated by patients, with contributions from relatives and healthcare professionals being comparatively limited. The majority of concerns pertained to prescription medications, particularly in the fields of gynecology, internal medicine, and gastroenterology. ATC codes G and A were most frequently referenced, corresponding to the healthcare domains discussed. Conclusions: Initiatives aimed at enhancing medication safety should prioritize improving access and communication. Patients must be empowered as active agents in safety efforts; they can aid in preventing errors, reporting incidents, and offering feedback. Their engagement supports organizational learning and promotes safer healthcare delivery. Full article

(This article belongs to the Section Healthcare Quality, Patient Safety, and Self-care Management)

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18 pages, 450 KB

Open AccessArticle

Sport Participation and Happiness Among Veteran Footballers: The Mediating Role of Social Capital

by Eda Adatepe, Murat Kul, Ali Özkan, Fatih Kırkbir, Ümit Öz, Yılmaz Ünlü, Cansu Seleciler and Emre Boz

Healthcare 2026, 14(3), 396; https://doi.org/10.3390/healthcare14030396 - 4 Feb 2026

Viewed by 309

Abstract

Aim: As the global population is aging rapidly, promoting physical activity in later life is increasingly seen as a good strategy to enhance and sustain the social and psychological well-being of older adults from a positive aging perspective. This study explored how social [...] Read more.

Aim: As the global population is aging rapidly, promoting physical activity in later life is increasingly seen as a good strategy to enhance and sustain the social and psychological well-being of older adults from a positive aging perspective. This study explored how social capital influences the relationship between playing football and happiness in veteran footballers. Specifically, it aimed to understand if social capital acts as a mediator between these two factors. Materials and Methods: This cross-sectional study was performed on a convenience sample of 423 veteran footballers aged from 38 to 59 years who completed a survey at 35th Sakarya Veterans Football Tournament in Sakarya in north-west Turkey. Football participation was assessed using the Serious Leisure Inventory. Social capital was assessed in both cognitive and structural aspects. A single-item scale assessed general happiness. Data were analyzed with Pearson correlation coefficients and were calculated using SPSS (version 24) to assess the direction and strength of the links between the investigated variables. Path coefficients were calculated through regression analyses. For testing mediation effects, the study utilized Hayes’ bootstrapping method, executed with the Version 4.2 Beta of the PROCESS macro. Results: According to the research findings, the direct effect of football participation on happiness was determined to be 0.43 (p < 0.01). While community involvement played a significant mediating role with a coefficient of 0.11 (95% CI [0.05, 0.15]), the social trust and neighborhood dimensions of social capital did not yield statistically significant effects. Collectively, the model explains 24% of the variance in happiness (R² = 0.24), with a total effect of football participation calculated at 0.57 (p = 0.000). Conclusions: it is believed that social environments that include participation in sport can contribute to successful and comfortable aging by greatly enhancing the overall well-being and happiness of older athletes/adults. Full article

(This article belongs to the Section Mental Health and Psychosocial Well-being)

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17 pages, 424 KB

Open AccessArticle

The VALUE Study: Exploring the Value of a Clinical Ethics Consultation Service at the “A. Gemelli” Hospital

by Salvatore Simone Masilla, Barbara Corsano, Simona Giardina, Costanza Raimondi, Pietro Refolo, Dario Sacchini, Clara Todini and Antonio G. Spagnolo

Healthcare 2026, 14(3), 395; https://doi.org/10.3390/healthcare14030395 - 4 Feb 2026

Viewed by 533

Abstract

Background: Clinical Ethics Consultation (CEC) helps healthcare professionals, patients, and families address ethically complex situations in clinical practice. Since 2016, requests for CEC at the Fondazione Policlinico Universitario “A. Gemelli” IRCCS (FPG) have been entered into the hospital IT system like other consulting [...] Read more.

Background: Clinical Ethics Consultation (CEC) helps healthcare professionals, patients, and families address ethically complex situations in clinical practice. Since 2016, requests for CEC at the Fondazione Policlinico Universitario “A. Gemelli” IRCCS (FPG) have been entered into the hospital IT system like other consulting services. This has increased both the number of requests and the need to monitor and evaluate the service. Aims: This qualitative study investigates how the CEC service at FPG is perceived in terms of its value, role, and impact, and further aims to identify appropriate strategies for evaluating the service. Methods: Semi-structured interviews were conducted with 28 healthcare professionals who had used or taken part in the service within the previous two years. Data were examined using reflective thematic analysis, leading to the development of codes and themes. Results: Five main themes emerged: (1) Role and identity of the clinical ethics consultant the, (2) Benefits of CEC for clinical practice, (3) How to evaluate the CEC Service, (4) HCPs’ Evaluation, and (5) CEC Service Improvement Strategies. Participants saw the consultant as an “active third party” who combines ethical, clinical, and communication skills to mediate conflicts, support teamwork, and guide shared care planning. The service was viewed as strengthening patient-centered care by improving communication with patients and families, clarifying treatment proportionality, and reducing clinicians’ decisional isolation. Interviewees emphasized the need for structured evaluation tools that include both quantitative indicators and qualitative feedback. Satisfaction with the service was consistently high, with recommendations to expand consultant availability, improve timeliness, and enhance training. Conclusions: CEC appears to serve as a clinical, relational, and training resource that fosters ethically grounded, collaborative, and person-centered care. Full article

(This article belongs to the Special Issue ETHICA—ETHICs in Action: Values, Dilemmas, and Decision-Making in Contemporary Healthcare)

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12 pages, 525 KB

Open AccessArticle

Combined Conventional Blood Biomarkers as Discriminators of Excessive Alcohol Consumption in Men: A Large-Scale Cross-Sectional Study

by Ichiro Wakabayashi

Healthcare 2026, 14(3), 394; https://doi.org/10.3390/healthcare14030394 - 4 Feb 2026

Viewed by 451

Abstract

Background/Objectives: Blood biomarkers for estimating alcohol consumption are useful for preventing alcohol-related harms. Although there are conventional blood biomarkers of heavy alcohol drinkers, it remains to be clarified whether their combination is useful for estimation of excessive alcohol consumption from the viewpoint [...] Read more.

Background/Objectives: Blood biomarkers for estimating alcohol consumption are useful for preventing alcohol-related harms. Although there are conventional blood biomarkers of heavy alcohol drinkers, it remains to be clarified whether their combination is useful for estimation of excessive alcohol consumption from the viewpoint of preventing hypertension. Methods: Participants included 8172 men aged from 31 to 70 years who had undergone health checkups. Overall, participants were classified into three groups of nondrinkers, occasional drinkers, and regular drinkers by frequency; regular drinkers were further classified into four groups of light (<22 g/day), moderate (≥22 and <44 g/day), heavy (≥44 and <66 g/day), and very heavy drinkers (≥66 g/day) according to the amount of average daily alcohol consumption. The relationships of blood biomarkers (mean corpuscular volume [MCV], gamma glutamyl transferase [GGT], and HDL cholesterol [HDL-C]) and their products with alcohol consumption were investigated by using correlation analysis and receiver-operating characteristics (ROC) analysis. Results: Seven variables of blood biomarkers and their products were significantly correlated with frequency and amount of alcohol consumption, and the degrees of the correlations were stronger in the following order: HDL-C alone < product of MCV and HDL-C < MCV alone < GGT alone < product of MCV and GGT < product of GGT and HDL-C < product of MCV, HDL-C and GGT. In the ROC analysis, the area under the ROC curve for the relationship between the product of MCV, HDL-C, and GGT (named the alcohol consumption index [ACI]) and excessive alcohol intake (22 g/day or more) was 0.819 (95% confidence interval: 0.809–0.830), and the cutoff of this index was 194,863 with a sensitivity and specificity of 0.745 and 0.751, respectively. The positive predictive value was 69.2%. Conclusions: Among the three conventional blood biomarkers and their combinations, ACI demonstrated the strongest associations with alcohol consumption and excessive alcohol intake in men. Although the combined biomarkers are unlikely to be useful as a diagnostic tool, there is a possibility of future application by integrating ACI with recent biomarkers including carbohydrate-deficient transferrin for estimation of alcohol consumption. Full article

(This article belongs to the Section Public Health and Preventive Medicine)

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28 pages, 1715 KB

Open AccessArticle

The Significance of Hypophosphatemia in Deciding on an Optimal Clinical Choice of Parenteral Iron Therapy in Patients with Chronic Inflammatory Bowel Disease in Slovenia: An Umbrella Review and Economic Evaluation

by Rok Hren, Tamás Dóczi, Erika Országh and Tomaž Kocjan

Healthcare 2026, 14(3), 393; https://doi.org/10.3390/healthcare14030393 - 4 Feb 2026

Cited by 1 | Viewed by 555

Abstract

Background/Objectives: Iron-deficiency anemia (IDA) is a common extraintestinal complication of inflammatory bowel disease (IBD). Among high-dose intravenous (IV) iron options, ferric carboxymaltose (FCM) carries a higher risk of treatment-emergent hypophosphatemia than ferric derisomaltose (FDI), with potential clinical consequences. Slovenia’s healthcare setting, characterized [...] Read more.

Background/Objectives: Iron-deficiency anemia (IDA) is a common extraintestinal complication of inflammatory bowel disease (IBD). Among high-dose intravenous (IV) iron options, ferric carboxymaltose (FCM) carries a higher risk of treatment-emergent hypophosphatemia than ferric derisomaltose (FDI), with potential clinical consequences. Slovenia’s healthcare setting, characterized by very low IV iron infusion tariffs and recent pricing in which FCM is substantially less expensive than FDI, warrants a setting-specific cost effectiveness evaluation. Methods: We integrated two methodological components: (i) a payer-perspective cost-effectiveness analysis using a patient-level microsimulation model with (ii) an umbrella review of systematic reviews and a targeted search of expert consensus statements on IV-iron-associated hypophosphatemia. Results: In the base case, FDI required fewer infusions than FCM (11.1 vs. 14.2 over 10 years) but generated only €95 in IV iron administration savings due to low tariffs, while drug procurement was €1166 higher with FDI than FCM. When incorporating the clinical impact of hypophosphatemia, incremental quality-adjusted life years (QALYs) were 0.136, yielding an incremental cost-effectiveness ratio (ICER) of €6590/QALY. The umbrella review consistently showed higher hypophosphatemia incidence with FCM (up to 92%) compared with other IV iron formulations (<10%), with recent recommendations emphasizing phosphate monitoring and risk mitigation through alternative formulations. Conclusions: Despite Slovenia’s low IV iron infusion tariffs and lower FCM price, FDI remained cost-effective in this model, largely due to its more favorable hypophosphatemia profile within the model. These findings suggest that hypophosphatemia risk should be considered when selecting IV iron therapy in routine IBD care. Full article

(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)

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25 pages, 767 KB

Open AccessFeature PaperArticle

Post-COVID-19 Muscle Weakness and Recovery Patterns After Mild-to-Moderate Infection: A Retrospective Analysis of a Structured Rehabilitation Program Using the MRC Scale

by Ovidiu Cristian Chiriac, Daniela Miricescu, Raluca Mititelu, Silviu Marcel Stanciu, Corina Sporea, Ana Raluca Mitrea, Dragos Constantin Lunca, Sarah Adriana Nica, Cristian Constantin Popa and Ileana Adela Vacaroiu

Healthcare 2026, 14(3), 392; https://doi.org/10.3390/healthcare14030392 - 4 Feb 2026

Viewed by 646

Abstract

Background/Objectives: Post-COVID-19 muscle weakness is common even after mild or moderate infection, driven by systemic inflammation, prolonged inactivity, and reduced functional reserve. This study aimed to describe changes in global muscle strength assessed using the Medical Research Council (MRC) scale in adults [...] Read more.

Background/Objectives: Post-COVID-19 muscle weakness is common even after mild or moderate infection, driven by systemic inflammation, prolonged inactivity, and reduced functional reserve. This study aimed to describe changes in global muscle strength assessed using the Medical Research Council (MRC) scale in adults recovering from mild or moderate COVID-19 who participated in a structured two-week rehabilitation program, and to compare these changes with those observed under standard medical follow-up. Methods: This retrospective study included 193 adults recovering from mild or moderate COVID-19: 160 who completed a structured inpatient rehabilitation program (study group) and 33 who received no supervised rehabilitation (control group). Muscle strength was assessed using the MRC scale at baseline and at follow-up. Non-parametric analyses (Wilcoxon signed-rank test, Mann–Whitney U test, and Spearman correlation) were used to evaluate within-group changes, between-group differences, and associations with age and sex. Results: Both groups showed significant within-group improvements in muscle strength. In the study group, median MRC scores increased from 50 (IQR 40–56) to 52 (IQR 50–56), with a mean ΔMRC of 2.76 ± 8.72 (p < 0.001). In the control group, MRC scores rose from 50 (40–56) to 52 (43–56), corresponding to a mean ΔMRC of 1.00 ± 2.09 (p = 0.005). The between-group comparison of ΔMRC did not reach statistical significance overall; however, age-stratified analyses indicated greater muscle strength gains in the rehabilitation group among participants aged ≥60 years. Conclusions: Short-term improvements in global muscle strength were observed both after structured rehabilitation and under standard medical follow-up, indicating a substantial contribution of natural recovery. Although participants in the rehabilitation group showed numerically larger gains—most notably in the ≥60-year subgroup—between-group differences in ΔMRC were not statistically significant. Overall, these findings support the feasibility and potential functional value of early, individualized rehabilitation while underscoring the need for adequately powered prospective studies to clarify its incremental benefit beyond spontaneous recovery. Full article

(This article belongs to the Special Issue Physical and Rehabilitation Medicine—2nd Edition)

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15 pages, 406 KB

Open AccessArticle

Staff Wellbeing and Engagement: A Strategic Priority at a Hospital in Singapore

by Dorcas Yuen Mei Won, Jolene Wei Ling Ooi, Zhen Wei Lew, Sandra En Ting Tan and Soon Noi Goh

Healthcare 2026, 14(3), 391; https://doi.org/10.3390/healthcare14030391 - 4 Feb 2026

Viewed by 623

Abstract

Background: In today’s dynamic healthcare environment, Changi General Hospital (CGH) has positioned staff wellbeing and engagement as fundamental priorities that underpin workforce sustainability and quality care delivery. Recognizing that allied health professionals (AHPs) face unique emotional demands and potential empathy fatigue, the CGH [...] Read more.

Background: In today’s dynamic healthcare environment, Changi General Hospital (CGH) has positioned staff wellbeing and engagement as fundamental priorities that underpin workforce sustainability and quality care delivery. Recognizing that allied health professionals (AHPs) face unique emotional demands and potential empathy fatigue, the CGH Allied Health Division (AHD) uses three strategic pillars: individual empowerment, leaders as key stewards and institutional support systems to address staff wellbeing and engagement. This paper will evaluate the outcomes of implementing the programs and identifying the barriers and enablers to achieving staff wellbeing and engagement. Methods: It adopts a mixed-methods approach using both quantitative survey data and qualitative feedback. Results: A total of 314 AHPs participated with a mean employment duration of 8.89 years. While 95% agreed that their work was meaningful and 76.8% reported happiness at work, 40.8% did not experience being recognized by the organization and approximately 30% did not find higher management responsive to their needs or transparent in their communication. Qualitative analysis revealed concerns about psychological safety of sharing one’s opinions and concerns, and a desire for better renumeration and career progression. Conclusions: AHPs reported happiness and meaningfulness in their clinical work. However, issues with organizational recognition, higher management responsiveness and transparency, as well as psychological safety were elicited. Working towards addressing fostering psychological safety and enhancing recognition and communication with management are important in order to develop and sustain a thriving healthcare workforce capable of high-quality patient care. Overall, the findings reinforced AHD direction of putting employee wellbeing and engagement as a strategic priority. Full article

(This article belongs to the Special Issue Depression, Anxiety and Emotional Problems Among Healthcare Workers)

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8 pages, 223 KB

Open AccessArticle

Baseline Sleep Literacy, Habits, and Perceptions Among Primary School Children: Foundations for a MAIEC-Guided Community Intervention in Sleep and Mental Health

by Pedro Melo, Joana Bastos, Paula Moreira, Carlos Pinto, Vanessa Monteiro, Jóni Madureira, Bárbara Ferreira, Filipe Rodrigues-Pires, Teresa Martins and Ana Paula Cantante

Healthcare 2026, 14(3), 390; https://doi.org/10.3390/healthcare14030390 - 3 Feb 2026

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Abstract

Sleep plays a fundamental role in children’s cognitive, emotional, and behavioral development, and inadequate sleep hygiene is increasingly recognized as a modifiable risk factor for mental-health vulnerability. Background/Objectives: This article presents the child level baseline component of a broader quasi experimental study grounded [...] Read more.

Sleep plays a fundamental role in children’s cognitive, emotional, and behavioral development, and inadequate sleep hygiene is increasingly recognized as a modifiable risk factor for mental-health vulnerability. Background/Objectives: This article presents the child level baseline component of a broader quasi experimental study grounded in the Community Assessment, Intervention and Empowerment Model (MAIEC). The aim was to characterize Sleep Habits, sleep-hygiene knowledge, and sleep-related perceptions among third-grade children from two primary-school communities in northern Portugal, prior to the implementation of a MAIEC-based community intervention. Methods: Regarding the reporting, only the baseline child level assessment of the study presented in the manuscript, a structured questionnaire, integrating the Portuguese version of the Children’s Sleep Habits Questionnaire (CSHQ PT) and questions about Sleep Habits and sleep-hygiene literacy were administered to 40 children. Three composite indices were computed: Sleep Literacy (SLI), Sleep Habits (SHI), and Sleep Symptoms and Perceptions (SSPI). Results: Baseline results revealed heterogeneous Sleep Habits and variable sleep-hygiene knowledge. Children in the experimental community demonstrated higher scores across all indices, with the difference in Sleep Habits (SHI) approaching statistical significance (p = 0.052) and moderate effect sizes observed overall. No sex-based differences were found. Conclusions: These findings identify modifiable behavioral and knowledge-related sleep determinants linked to emotional regulation and mental-health risk. This article reports baseline child-level data from a broader MAIEC-guided study, with the quasi-experimental intervention currently underway and community empowerment already assessed. Future work will present the evaluation of community processes. Overall, these baseline results provide a structured diagnostic foundation for a MAIEC-based community intervention aimed at promoting healthy sleep and strengthening mental-health resilience in primary-school settings. Full article

(This article belongs to the Special Issue Research and Survey on the Mental Health of Children and Adolescents: Second Edition)

24 pages, 1924 KB

Open AccessArticle

An Autophotographic–Phenomenological Investigation of British Transmen’s Psychological Well-Being

by Harry Cosford and Iain Richard Williamson

Healthcare 2026, 14(3), 389; https://doi.org/10.3390/healthcare14030389 - 3 Feb 2026

Viewed by 511

Abstract

Background/Objectives: British trans and gender-expansive individuals face stigma and consistently experience lengthy waits for gender-enhancing interventions. Researchers are using a range of qualitative methodologies to give this marginalised community a voice. In this study the focus is on the lived experiences of [...] Read more.

Background/Objectives: British trans and gender-expansive individuals face stigma and consistently experience lengthy waits for gender-enhancing interventions. Researchers are using a range of qualitative methodologies to give this marginalised community a voice. In this study the focus is on the lived experiences of British transgender men seeking medical intervention around their gender identity. The aim was to explore how psychological well-being for this group of transmen was both threatened and supported. Methods: Online semi-structured interviews using auto-photography were conducted with eleven transmen aged between 18 and 68 years. Both verbal and visual data were analysed together using interpretive phenomenological analysis. Analysis: Three themes focus on challenges and supportive strategies utilised by participants both before their decision to transition and after. All participants expressed significant mental health difficulties before commencing their transition, typically originating from childhood and continuing until they gained access to gender-affirming medical care. Their transition journeys damaged their well-being through resistance and rejection from families and communities, and difficulties navigating healthcare systems. A series of resources which significantly enhanced well-being were also reported. Unconditional acceptance and belonging found within and beyond the trans community, connecting with nature and ultimately progressing with gender-affirming healthcare were key elements in protecting and promoting well-being. Conclusions: The toll on the well-being of trans and other gender-expansive individuals is considerable and recent changes in UK law have exacerbated the hostile environment faced by TGE individuals. Community-based allyship and access to affirmative professional psychological support at all stages is vital. Full article

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

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Healthcare, Volume 14, Issue 3 (February-1 2026) – 134 articles

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