Healthcare, Volume 14, Issue 6 (March-2 2026) – 125 articles

Digital stress, the psychological strain from constant connectivity, is a growing challenge, but the research field remains conceptually fragmented. This study aims to (1) map the evolution of digital stress research via bibliometric and scientometric analyses; (2) quantify measurement consistency through a meta-analysis of the Digital Stress Scale (DSS); and (3) synthesize thematic trends to clarify the construct’s boundaries. A multi-method review was conducted, integrating bibliometric analysis of 215 documents (Scopus/WoS), Google Ngram analysis, a random-effects meta-analysis of 10 DSS studies (n = 8572), and a thematic analysis of keyword co-occurrence. Bibliometrics and Ngram analysis show the field is maturing, with publications rising sharply post-2020, distinguishing it from ‘technostress.’ The construct evolved from biomedical/engineering uses to a psychosocial concept linked to ‘social media’ and ‘mental health.’ The meta-analysis found a moderate pooled mean stress level (2.45 on a 1–5 scale, 95% CI: 2.12–2.78), falling within the ‘average’ range of U.S. norms. High heterogeneity (I² = 99.7%) confirmed that cultural and contextual factors significantly moderate stress levels. Thematic analysis identified four key dimensions: conceptual ambiguity, contextual moderators, the digital transformation paradox, and digital well-being. Digital stress is a distinct, multidimensional construct encompassing social-evaluative pressures beyond original technostress models. This review consolidates its theoretical boundaries and confirms the DSS’s psychometric consistency, highlighting digital stress as a critical, context-dependent factor in human adaptation to technology. Full article

Objective: This exploratory study presents an international, multi-stakeholder snapshot of perceptions regarding real-world data and real-world evidence in health technology assessment. The aim is to identify perceived opportunities, barriers, and enabling conditions rather than to generate generalizable conclusions. Methods: A 21-item, expert-validated questionnaire was distributed via LimeSurvey to diverse health technology assessment stakeholders, including academia, industry, health technology assessment agencies, healthcare providers, policymakers, patients, and payers. The survey explored perceptions of value, methodological and regulatory challenges, and future outlooks for RWD/RWE use in HTA. Ethical approval was obtained by the University of West Attica Ethics Committee, and pilot testing was conducted prior to dissemination. Data were analyzed using descriptive statistics, consistent with the study’s exploratory intent and acknowledging that results are preliminary and not statistically generalizable. Results: Thirty-two completed responses demonstrated preliminary stakeholder support for integrating real-world data and real-world evidence into health technology assessment. Respondents represented academia, industry, HTA agencies, healthcare providers, policymakers, and patient/advocacy groups; however, no payer responses were obtained. Respondents emphasized the value of real-world data in complementing clinical trials by capturing real-world effectiveness, patient diversity, and long-term outcomes, especially in rare diseases and cancer. Key challenges included poor data quality, confounding biases, and regulatory barriers. Stakeholders highlighted the importance of standardization, transparency, and international collaboration. Opportunities included better decision-making, personalized healthcare, and improved post-market monitoring, with strong calls for robust infrastructure, clear methodologies, patient involvement, and supportive health policy frameworks. Conclusions: Real-world data and evidence enhance health technology assessment by supporting better decisions and personalized care. However, issues like data quality, methods, and trust must be addressed through standardization, strong infrastructure, and collaboration to ensure effective and impactful implementation in healthcare, while acknowledging these insights are based on a small exploratory sample. Full article

Background/Objectives: Oral diseases represent a major public health challenge in Africa, considering socioeconomic disparities and limited healthcare access. This systematic review aimed to comprehensively analyze the oral health status, conditions, and associated socioeconomic and cultural associated factors in North and West African regions. Methods: A systematic search was conducted in PubMed, Web of Science, and Scopus for cross-sectional studies. Using the CoCoPop framework, 19 studies were selected and evaluated for risk of bias using the JBI critical appraisal tool. Results: The findings reveal a substantial burden of untreated pathology, with localized caries prevalence reaching 74% in children. Periodontal health is consistently compromised in adults, characterized by high levels of calculus and gingival bleeding. Self-reported data highlight a symptom-driven culture, where lower-socioeconomic-status (SES) households rely on traditional remedies or emergency extractions due to economic and geographic barriers. Conclusions: Oral health in North and West Africa is characterized by profound inequalities. Current systems fail to reach vulnerable populations, emphasizing the urgent need for a structural shift toward integrated, equity-oriented primary care models that prioritize prevention over reactive, extraction-based treatments. Full article

Background: This study aims to systematically analyze the structural transition of AI in mental health, differentiating between passive tools and autonomous agents, and to propose a governance framework to facilitate responsible integration or mitigate integration risks. Methods: Employing a semi-systematic approach, we screened records from IEEE Xplore, PubMed, and ACM DL, ultimately analyzing 61 included studies. We track the transition from the first paradigm, AI-as-Tool (AI-T) to the second paradigm, AI-as-Agent (AI-A). Results: Early empirical evidence suggests that AI-A systems may assist in fostering preliminary working alliances and demonstrate potential for symptom reduction in controlled settings; however, their efficacy cannot currently be equated with, nor serve as a replacement for, standard low-intensity clinical care. Conclusions: To mitigate these risks, we propose the Tiered Human–AI Healing Ecosystem (THHE) for mental health. This framework utilizes dynamic autonomy modulation—automatically restricting AI agency based on real-time risk markers—to manage transitions between AI-led support and human-led care, promoting clinical safety. Full article

Background/Objectives: Cervical facet-mediated pain is a significant underlying factor of persistent neck pain (CNP). Pulsed radiofrequency (PRF) or conventional radiofrequency (CRF) has been introduced as a treatment alternative. However, comparative clinical data remain limited. Methods: This single-center retrospective cohort study analyzed patients with cervical facet-mediated pain who underwent PRF (n = 40) or CRF (n = 44) between January 2023 and December 2024. The success of the procedure was assessed using the Numeric Rating Scale (NRS) and the Neck Disability Index (NDI) before the procedures and at 1, 3, 6, and 12 months following the injections. Patients’ feedback was evaluated using the Global Perceived Effect (GPE) scale. Results: For both groups, a substantial decrease in the mean pain and disability severity was recorded between the initial measurement and the first, third, and sixth months of follow-up, but the outcomes were significant only in the CRF group at the 12th month. The groups did not show a substantial difference in terms of pain relief, disability improvement, medication use, or patient satisfaction at one and three months (p > 0.05), but at six and 12 months, patients treated with CRF showed significantly greater outcomes (p < 0.001). No notable difference in complication rates was found between the PRF (10%) and CRF (16%) groups (p = 0.53). Conclusions: Both pulsed and conventional radiofrequency ablation effectively reduced pain and improved function in the early-midterm follow-up. However, CRF provided more sustained relief and greater patient-reported success at 6 and 12 months, without an increase in complication rates, suggesting that CRF may offer a more durable long-term treatment option. Full article

Background/Objectives: In Japan, hospital births predominate, with home births comprising only 0.1% of deliveries. This study assessed how documented practices for planned home births attended by independent midwives align with national guidelines and WHO intrapartum care recommendations, and assess maternal and neonatal differences before and after the COVID-19 pandemic. Methods: Records of 430 low-risk pregnant women who received continuous care at a private midwifery home over 25 years were reviewed. After excluding 8 maternal and 22 neonatal transfers, 400 records were analyzed. Descriptive statistics were compared with WHO recommendations and between the pre-pandemic (1999–2019) and post-pandemic (2020–2024) periods. Results: All women experienced spontaneous singleton cephalic labors with intermittent fetal heart rate auscultation. The mean gestational age was 277.3 days and the median labor duration was 303.5 min. Labor onset was spontaneous in 83.5% of cases. Nearly half of the women had no perineal lacerations. Postpartum blood loss ≥500 mL occurred in 14.1% of cases. Family presence was nearly universal. Neonates had a mean birth weight of 3129.0 g and high Apgar scores. Skin-to-skin contact occurred in 52.9%; exclusive breastfeeding reached 93.8% at 1 month. Post-pandemic births showed higher maternal age and higher neonatal birth weight, although these differences should be interpreted cautiously due to the small post-pandemic sample. Conclusions: Independent midwives provided evidence-based, physiologically oriented care, partially aligning with selected WHO intrapartum recommendations during planned home births. Midwife-led home births may support positive childbirth experiences and favorable maternal/neonatal outcomes for low-risk women. Post-pandemic shifts underscore the need for continued monitoring and flexible, community-based perinatal support, while recognizing the limitations of retrospective, single-site data. Full article

Background/Objectives: This study aimed to determine the prevalence of self-reported prior diagnosis of mental health disorders and identify their sociodemographic, behavioral, and comorbidity-related determinants among primary healthcare attendees in Riyadh, Saudi Arabia. Methods: A cross-sectional survey was conducted among 14,239 Saudi residents visiting primary healthcare centers in Riyadh. Univariate analysis (p-value < 0.25) and multivariable logistic regression (p-value < 0.05) were employed to identify independent predictors of self-reported prior diagnosis of mental health disorders. Results: The prevalence of self-reported prior diagnosis of mental health disorders was 2.5% (95% CI: 2.24–2.76%). Multivariable analysis revealed several significant independent predictors. Individuals aged less than 50 years (AOR = 1.47, 95% CI: 1.19–1.83, p < 0.001) and females (AOR = 1.98, 95% CI: 1.56–2.50, p < 0.001) had significantly higher odds of reporting a prior diagnosis of a mental health disorder. The presence of health insurance was also found to be associated with increased odds (AOR = 1.85, 95% CI: 1.48–2.30, p < 0.001). Most importantly, smoking (AOR = 4.45, 95% CI: 3.22–6.15, p <0.001), hypertension (AOR = 2.32, 95% CI: 1.61–3.34, p <0.001), obesity (AOR = 9.40, 95% CI: 6.96–12.70, p <0.001), hypercholesterolemia (AOR = 2.84, 95% CI: 1.98–4.07, p < 0.001) and heart disease (AOR = 12.74, 95% CI: 9.25–17.56, p < 0.001) all were strong independent predictors of a prior diagnosis of a mental health disorder. Conclusions: The study identifies a measurable burden of self-reported prior mental health diagnoses among primary healthcare attendees in Riyadh, with higher odds observed among younger individuals, women, smokers, and those with chronic physical conditions. These findings highlight the importance of integrating mental health screening and management into primary healthcare services in Saudi Arabia. Full article

Background/Objective: Frailty is a major public health concern among older adults, particularly those living alone who may experience limited social support and increased nutritional vulnerability. With the rapid expansion of digital technologies, electronic device usage has become an important factor influencing daily life and health behaviors in older populations. This study aimed to examine the association between electronic device usage and frailty among older adults living alone and to investigate whether nutrition management mediates this relationship. Methods: This cross-sectional study conducted a secondary analysis using data from the 2023 Korean Elderly Survey. A total of 3423 adults aged ≥ 65 years who were living alone and completed the survey independently were included in the analysis. Descriptive statistics, independent t-tests, one-way analysis of variance, and Pearson correlation analyses were performed using SPSS version 26.0. Mediation analysis was conducted using Model 4 of the PROCESS macro (version 4.1) to examine the mediating role of nutrition management in the relationship between electronic device usage and frailty. Results: Electronic device usage was negatively associated with frailty and positively associated with nutrition management. Frailty was significantly higher among individuals with poorer nutrition management. Mediation analysis indicated that electronic device usage had both a direct effect on frailty and an indirect effect through nutrition management. Nutrition management partially mediated the relationship between electronic device usage and frailty, accounting for approximately 18% of the total effect. Conclusions: Electronic device usage was associated with lower levels of frailty among older adults living alone, and this relationship was partially mediated by nutrition management. These findings suggest that improving digital engagement may support better nutrition management and potentially contribute to frailty prevention among older adults living alone. Future longitudinal studies are needed to clarify the causal relationships among these variables. Full article

There is a high rate of morbidity and considerable functional dependence in older adults, requiring care from informal caregivers. Person-centered care is a personalized approach that meets the person’s needs, taking their context into account. Objectives: Our aim was to assess the available evidence on Person-Centered Health Intervention Programs (PCHCIPs) in a home setting among older adults with multimorbidity and their informal caregivers, namely regarding their main characteristics and respective health outcomes. Methods: A systematic literature review was conducted in accordance with the PRISMA guidelines. Bibliographic searches were performed in five databases (CINAHL, MEDLINE, MedicLatina, Scopus, and Psychology and Behavioral Sciences Collection) in November 2024, including studies published between January 2014 and November 2024. Inclusion criteria: Randomized Controlled Trials of person-centered health intervention programs delivered to older adults and their caregivers in home care settings, and scientific articles published betweeen 2014 and 2024. The review protocol was registered in PROSPERO (registration number: CRD42022303687. Results: Twelve articles were included (n = 12). The PCHCIPs provides psychoeducational training and empowerment with physical, psychological, and social interventions that result in health outcomes for the dependent older adults (decreased health-related events and increased social involvement), for the caregiver (improved QoL, reduced burden), and for both participants (increased life satisfaction and reduced costs in health). Conclusions: PCHCIPs covering different areas of intervention (physical, psychosocial and economic) demonstrate positive health outcomes for older adults and their caregivers. It is important to explore more programs that encompass both participants. Full article

Background/Objectives: The goal of the study was to identify the peculiarities of attention deficit hyperactivity disorder (ADHD) on the base of the behavioral characteristics and acoustic features of speech of children with ADHD and ADHD with comorbidity—ADHD and autism spectrum disorders (ASD) and ADHD and intellectual disabilities (ID)—within the framework of one test task. Behavioral characteristics were selected using DSM-V criteria; acoustic features of speech were considered by researchers as speech markers of ASD and ID detected for different languages. Methods: The study includes 92 children aged 5–13 years with ADHD, ADHD and ID, ADHD and ASD, and control groups of children diagnosed with ASD, ID and typically developing (TD) children. The children were tested using the test task “co-op play”. Video and audio recordings of children performing the test task were collected. We used a complex approach to study the peculiarities of children with ADHD through expert analysis of children’s behavior and play, acoustic spectrographic analysis of speech and questionnaires about early childhood development filled out by parents. Results: The characteristics of behavior, play, and acoustic features of speech of children with ADHD and ADHD and comorbidity were revealed. Children with ADHD had lower behavior scores in the play situation on the expert assessment than TD children, with the greatest differences for characteristics of play, “Playing for toy”, and of behavior “Displaced activity” and “Losing attention”. The speech of children with ADHD is characterized by low values of the third formant and the difference between the first two formants, compared to the corresponding speech features of children from other groups. The speech of children with ADHD+ASD is characterized by maximal pitch values (high voice), while that of children with ADHD+ID is characterized by low vowel articulation index values. Conclusions: Based on the analysis of behavior and speech of children with TD, ADHD, ADHD and comorbidity performing the “co-op play” test task, the set of characteristics specific to ADHD was identified. The obtained data expand our understanding of the specificity of children with ADHD and may contribute to the development of qualified support for families with children with ADHD. Full article

Background: As China enters the digital era and actively promotes an active aging strategy, smart wearable devices have become increasingly prevalent among older adults; however, their impact on health inequality remains unclear. This study investigates the association between smart wearable devices and health, as well as health inequality, among Chinese older adults, and further examines the mediating roles of joy of living and social participation. Methods: Data were derived from two waves (2018 and 2020) of the China Longitudinal Aging Social Survey (CLASS), with a final sample of 7098 adults aged 60 and above. A two-way fixed-effects model, propensity score matching–difference-in-differences (PSM-DID) approach, and mediation analysis were employed. Results: Smart wearable devices were significantly positively associated with both health and health inequality among older adults in China. Mediation analysis revealed that joy of living and social participation played an intermediary role. Conclusions: This study provides preliminary evidence that smart wearable devices are associated with health and health inequality among Chinese older adults. Policy efforts should focus on developing more user-friendly devices, promoting digital literacy among older adults, and supporting disadvantaged groups. Furthermore, the mediating effects suggest that fostering joy of living and encouraging active social participation may serve as effective pathways to improve health. Full article

Background/Objectives: Le Fort I osteotomy, a commonly performed maxillary surgical procedure, is known to influence nasal aesthetics and perceived breathing function due to its close anatomical relationship with the nasal structures. While objective nasal changes have been extensively documented, patient-reported perceptions of aesthetic appearance and breathing remain clinically important for evaluating surgical success. This study aimed to assess patient-reported perceptions of nasal aesthetic and functional outcomes following Le Fort I osteotomy using a postoperative survey-based approach. Materials and Methods: This study included 200 patients (mean age: 25 ± 4.19 years) who underwent Le Fort I osteotomy at the Department of Orthodontics, Ankara University. Patient perceptions of nasal aesthetics and breathing were evaluated using a structured Likert-scale questionnaire administered six months postoperatively. Perceived preoperative conditions and current postoperative perceptions were assessed within the same survey. Statistical analysis was performed using SPSS version 26, with the significance level set at p < 0.05. Results: The findings demonstrated a statistically significant improvement in patient-reported satisfaction with nasal appearance and perceived breathing comfort following surgery. A greater proportion of patients reported increased satisfaction with their nasal aesthetics, believed that others viewed their nasal appearance more positively, and experienced improved nasal breathing in the postoperative period. Conclusions: Le Fort I osteotomy was associated with positive patient-reported perceptions of both nasal aesthetics and breathing function. However, individual anatomical characteristics and patient expectations appear to influence the perceived outcomes. These findings underscore the value of incorporating patient-reported outcome measures into preoperative counseling and postoperative evaluation in orthognathic surgery. Full article

Background: Theoretical frameworks are essential for understanding and predicting medication adherence behaviours. The Theory of Planned Behaviour (TPB) posits that behavioural intentions, shaped by attitudes, subjective norms, and perceived behavioural control, are the proximal determinants of behaviour. This cross-sectional study examined associations between TPB constructs and antiplatelet medication adherence among Saudi patients following percutaneous coronary intervention (PCI). Methods: A cross-sectional survey was conducted among 236 Saudi adults post-PCI at two tertiary cardiac centres in Riyadh. TPB constructs (attitude, subjective norms, perceived behavioural control, intention) were assessed using a validated questionnaire. Adherence was measured via the Morisky Medication Adherence Scale-8 (MMAS-8). Hierarchical multiple regression examined associations between TPB constructs and adherence, controlling for demographic and clinical variables. Results: The results demonstrated significant associations with adherence. In the final regression model, intention (β = 0.273, p < 0.001), perceived behavioural control (β = 0.189, p = 0.007), and subjective norms (β = 0.142, p = 0.038) were significantly associated with adherence. Attitude was not significantly associated (β = 0.087, p = 0.194). The TPB constructs explained an additional 18.7% of variance in adherence beyond demographic and clinical factors. Conclusions: The TPB provides a useful framework for understanding antiplatelet adherence patterns in Saudi post-PCI patients. These findings suggest that interventions addressing behavioural intentions, perceived control over medication-taking, and normative influences from significant others may potentially enhance adherence outcomes. Theory-informed nurse-led interventions incorporating strategies such as implementation intentions and family involvement are recommended. Full article

Background: Medication use in paediatric populations is inherently complex and carries a heightened risk of prescribing errors, particularly within primary health-care settings. Despite this concern, evidence describing paediatric prescribing errors in Saudi Arabia remains scarce. Hence, the present study aimed to evaluate the prevalence and patterns of prescribing errors in paediatric primary care and to characterize the pharmacist-led interventions undertaken to resolve these errors. Methods: A prospective, mixed-methods cross-sectional study was conducted over three months at a primary health-care centre. Paediatric outpatient prescriptions were systematically reviewed during routine practice by trained clinical pharmacists. All suspected errors were independently validated and classified for severity by a multidisciplinary expert panel. Descriptive statistics were used to summarise prescribing errors, and associations with patient and prescription characteristics were assessed using chi-square tests. Qualitative data were analysed using a descriptive thematic approach to explore mechanisms of error identification and the nature of corrective pharmacist interventions. Results: A total of 545 paediatric outpatient prescriptions were reviewed, of which 142 prescriptions (26.1%) contained at least one prescribing error. Across these prescriptions, a total of 145 individual prescribing errors were identified. Dose-related errors were the most common (68.3%), followed by inaccuracies in dosing frequency (11.0%) and inappropriate drug selection (9.0%). The occurrence of prescribing errors was significantly associated with patient weight (p = 0.016), the number of medications per prescription (p < 0.001), and the recorded diagnosis (p = 0.018). The majority of errors were intercepted prior to medication dispensing (93.0%), and no cases of patient harm were identified. Qualitative analysis revealed that errors were predominantly detected through cross-checking with authoritative drug references, recalculation of weight-based doses, and application of clinical judgement, and were most often resolved through direct communication with the prescribing clinician. Conclusions: Prescribing errors occur frequently in paediatric outpatient settings; however, most are preventable with appropriate safeguards. Pharmacists play a critical role in identifying and resolving these errors before they result in patient harm. Enhancing paediatric prescribing support systems and strengthening interprofessional collaboration may further advance medication safety within primary health-care services. Full article

Background/Objectives: Virtual surgical planning (VSP) allows three-dimensional assessment of complex dentofacial deformities and has become integral to modern orthognathic surgery. However, evidence remains limited regarding how skeletal characteristics and malocclusion patterns translate into surgical movement selection. This study aimed to evaluate demographic features, skeletal malocclusion patterns, and clinical treatment strategies in patients undergoing VSP-guided orthognathic surgery. Methods: This retrospective study included 158 patients who underwent VSP-assisted orthognathic surgery between 2019 and 2025. Sagittal skeletal classification, vertical growth pattern, facial asymmetry, and maxillary crossbite were evaluated together with planned maxillary and mandibular movements. Surgical procedures were analyzed according to skeletal malocclusion classes (Class I, II, and III). Group comparisons were performed using chi-square and Kruskal–Wallis tests. Multivariable logistic regression analysis was conducted to assess factors associated with bimaxillary surgery (p < 0.05). Results: Skeletal Class I malocclusion was most prevalent (46.8%), followed by Class III (29.7%) and Class II (23.4%). Hyperdivergent growth patterns were predominantly observed in Class II patients, whereas normodivergent patterns were most common in Class III cases (p < 0.05). Mandibular advancement and setback generally followed expected class-based trends but were also observed across non-corresponding skeletal classes. Maxillary impaction and mandibular autorotation were frequently incorporated. Bimaxillary surgery was performed in 84.2% of cases. Logistic regression analysis showed no independent predictors of bimaxillary surgery (p > 0.05). Conclusions: VSP-assisted orthognathic surgery demonstrates that surgical planning cannot be reduced to sagittal skeletal classification alone. Treatment decisions are shaped by combined sagittal, vertical, transverse, and patient-specific factors, supporting a multidimensional and individualized planning approach. Full article

Background: Diabetes mellitus is a global health challenge, especially among homeless people. Early prediction of diabetes can reduce treatment costs and improve interventions. This study aimed to identify predictors of diabetes among homeless adults by utilizing artificial intelligence and providing recommendations for diabetes prevention. Methods: A case-control study of 150 homeless adults in Giza, Egypt (99 diabetes cases and 51 controls), analyzed 43 variables collected through interviews and physiological measures, with missing data imputed. Feature selection using recursive feature elimination and univariate and correlation analyses reduced the predictors to 13 variables. The class imbalance was addressed using synthetic minority over-sampling on the training set. Six models and a stacking ensemble with XGBoost as a meta-learner were evaluated using 5-fold cross-validation and performance metrics, including the accuracy, precision, recall, F1-score, and AUC-ROC. Results: The key predictors included BMI, systolic blood pressure, triceps skinfold thickness, waist circumference, lifestyle factors, comorbidities, diastolic blood pressure, age, medication adherence, educational level, marital status, duration of residence, and diabetes knowledge. Individual classifiers achieved a moderate performance (accuracy: 56.7–70.0%, F1-score: 0.686–0.781). The stacking ensemble substantially outperformed individual models, achieving a 95.45% accuracy, a 100% precision, a 93.75% recall, a 0.968 F1-score, and a 0.979 AUC-ROC on the test set. Conclusions: Machine learning models can reliably predict diabetes. The proposed hybrid stacking model outperformed conventional classifiers in terms of the prediction performance, highlighting the benefits of ensemble learning and sophisticated resampling strategies in dealing with imbalanced medical data. It is recommended that healthcare institutions integrate AI-powered diagnostic assistance technology into clinical processes to aid in the early detection and treatment of diabetes. Full article

Background/Objectives: The advent of the pandemic catalysed the global adoption of digital health services. In Spain, this transition has markedly influenced eHealth accessibility, particularly through mobile-based technologies. This study compares reported real-access experiences of users of digital health at two key moments—2018 (pre-pandemic) and 2025 (post-pandemic)—to identify how access determinants have evolved. Methods: The evolution of users who have accessed digital health resources and their characterization, including the specification of who uses websites and mobile applications, was analyzed using binary logistic regression models for each year. These models incorporated sociodemographic characteristics and patterns of device usage as predictors. Results: Access to digital health services increased significantly between 2018 and 2025. The proportion of the population using such services increased from 50.2% to 85.4%. The use of mobile applications grew from 24.4% to 80.2%. In 2018, access was linked to a wider range of factors, including age, education, municipality size, self-rated health, and computer or tablet use. In contrast, the 2025 model revealed a more concentrated set of determinants. Age emerged as the primary barrier, especially >65 years, reducing the likelihood of eHealth access. Meanwhile, frequent use of digital devices (e.g., computers, smartwatches) was positively correlated with accessing eHealth. Conclusions: The study reveals an increase in access to digital health services in Spain, accompanied by shifts in the factors influencing this access. Notwithstanding technological advances, the digital divide could persist as a major impediment to access for the groups mentioned earlier. This analysis suggests the need for targeted digital inclusion measures, especially as mobile platforms are becoming the main entry point to healthcare services. Full article

Background: Exacerbations of chronic obstructive pulmonary disease (COPD) are a leading cause of morbidity, mortality, and healthcare burden worldwide. Early detection and timely intervention remain important challenges in COPD management, given the unpredictable nature of acute deterioration and limitations of traditional spirometry-based risk assessment. Methods: This narrative review synthesizes artificial intelligence (AI)-driven approaches for predicting and detecting chronic obstructive pulmonary disease (COPD) exacerbations across electronic health records, wearable sensors, imaging, environmental data, and patient-reported outcomes, emphasizing novel discoveries and emerging relationships rather than predictive performance. Results: Three major discoveries have been made. First, measurable physiological and behavioral deterioration may precede symptom recognition by approximately 7–14 days, thereby establishing a potential intervention window for anticipatory care. Second, machine learning (ML) models integrating pollutant exposure, medication adherence, and clinical characteristics have identified phenotypes with differential environmental sensitivity, including unexpected exposure–adherence interactions. Third, deep neural network analysis of full spirometry curves has revealed structural phenotypes beyond traditional Forced Expiratory Volume (FEV₁)-based measures and novel imaging biomarkers. The predictive performance ranges from the Area Under the Curve (AUC) 0.72–0.95, with a pooled meta-analytic AUC of approximately 0.77. Conclusions: AI has uncovered hidden patterns in the progression of COPD, supporting a shift from reactive to anticipatory management. Translation to routine care requires prospective validation, improved interpretability, workflow integration, and generalizability and equity. Full article

Background/Objectives: Despite growing recognition of empathy as a cornerstone of high-quality care, its role within interprofessional collaboration remains underexplored. While the Interprofessional Education Collaborative explicitly references empathy only under the Values and Ethics domain, emerging evidence suggests its potential relevance across all four core competencies. This study aimed to explore the influence of empathy on each of the Interprofessional Education Collaborative core competencies and to highlight its role in the contemporary interprofessional healthcare environment. Methods: A narrative literature review was conducted to identify articles published in English between 2014 and 2025, through searches of PubMed and Scopus. The sub-competency statements of the Interprofessional Education Collaborative framework were used to guide keyword selection and map concepts that empathy may influence. Results: Seventy-two articles were included in this narrative review. According to the literature, evidence suggests that empathy may support humanitarian values and ethical decision making (Values and Ethics), but the mechanisms underlying this remain to be considered. Empathy has also been discussed in relation to therapeutic and team communication (Communication), as well as to processes such as conflict resolution, supportive leadership, team cohesion, and staff well-being (Teams and Teamwork). The evidence regarding the Roles and Responsibilities domain remains relatively limited, preventing definitive conclusions about the potential influence of empathy in this domain. A clear distinction emerges between clinical and interprofessional empathy, with evidence suggesting that both are essential for collaborative practice. Conclusions: Empathy appears to be linked with several domains of interprofessional collaboration and may represent an important relational component in collaborative healthcare practice. However, the influence of empathy may depend on structural and organizational conditions and may vary across different interprofessional healthcare contexts. These findings offer a conceptual bridge between empathy and interprofessional collaboration, providing actionable insights for educators, leaders, and policymakers involved in healthcare training. Full article

Background: Adverse newborn outcomes in patients with severe maternal morbidity (SMM) are understudied, and this study examines their association with insurance type (Medicaid vs. commercial) in patients who experienced SMM. The aim of this study is to examine disparities in preterm birth, low birthweight, and neonatal intensive care (NICU) admission among Medicaid vs. commercially insured patients with severe maternal morbidity in Maryland. Methods: This cross-sectional study analyzed data from 588 SMM patients enrolled in Maryland’s Severe Maternal Morbidity (SMM) Surveillance Program (August 2020–December 2023). We utilized unadjusted and multivariable logistic regression models to evaluate the relationship between primary insurance type and the outcomes of interest: preterm birth (<37 weeks), low birthweight (<2500 g), and neonatal intensive care unit (NICU) admissions. Results: Of 588 patients with SMM, 45.1% had Medicaid. These patients were younger, more often non-Hispanic Black or Hispanic, had higher parity and comorbidity scores, and initiated prenatal care later compared with commercially insured patients. Medicaid patients had 2.2 to 2.6 times higher odds of adverse newborn outcomes after adjusting for other socio-demographic and medical factors. Patients’ comorbidities significantly increased the odds of adverse newborn outcomes, as did all other primary SMM causes other than obstetric hemorrhage. Conclusions: Adverse newborn outcomes were more prevalent among Medicaid than commercially insured patients who experienced SMM. Differences in maternal health status and primary SMM cause partly explain the observed differences in newborn outcomes. Our findings emphasize the need for comprehensive prenatal care and improved healthcare access for women with high-risk pregnancies. Full article

Background: Essential tremor (ET) is a common movement disorder that predominantly affects older adults, with rising global prevalence due to population aging. Pharmacological treatments, including propranolol and primidone, are often limited by inadequate efficacy or poor tolerability, and surgical options carry inherent risks. Acupuncture has shown promise as an alternative or adjunctive therapy for ET, but evidence comparing the effectiveness of different acupuncture modalities remains limited. Objective: To systematically evaluate the comparative efficacy and safety of various acupuncture-related interventions for essential tremor (ET) through a network meta-analysis, and to provide evidence-based recommendations for clinical practice. Methods: We systematically searched eight electronic databases (PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, VIP, Wanfang, and CBM) from inception to 20 October 2025. Randomized controlled trials (RCTs) evaluating any form of acupuncture therapy for ET were included. Conventional pairwise meta-analysis and network meta-analysis were performed to compare the efficacy (response rate, Tremor Six Score) and safety (adverse events) of different interventions. Surface under the cumulative ranking curve (SUCRA) values were used to rank treatment modalities. Results: Twenty randomized controlled trials involving 1067 participants were included. Traditional meta-analysis indicated that acupuncture-related interventions significantly outperformed controls in improving response rate [RR 4.36, 95% CI (3.14, 6.03), p < 0.00001], reducing Tremor Six Score [MD −1.99, 95% CI (−2.25, −1.73), p < 0.00001], and lowering the incidence of adverse events [RR 0.13, 95% CI (0.07, 0.25), p < 0.00001]. Network meta-analysis based on SUCRA values revealed that: for symptom relief, scalp acupuncture (S) demonstrated the highest effectiveness (SUCRA = 81.5%); for reducing Tremor Six Score, manual acupuncture (A) showed the most significant effect (SUCRA = 76.6%); and for safety outcomes, Acupuncture + Scalp Acupuncture + Propranolol (A+S+P) achieved the highest SUCRA score (SUCRA = 73.1%). Conclusions: This network meta-analysis demonstrates that acupuncture-related interventions are effective and safe for treating essential tremor. However, caution is warranted in interpreting these findings due to methodological limitations in the included randomized controlled trials (small sample sizes, lack of blinding, inadequate allocation concealment), sparse data for some interventions, and the concentration of studies within China, which limits their generalizability. Despite these limitations, acupuncture offers a valuable non-pharmacological treatment option for patients with poor medication tolerance. Future large-scale, multicenter trials with rigorous designs are needed to validate these findings. Full article

Background/Objectives: Research examining the emotional and psychological challenges experienced by couples undergoing in vitro fertilisation (IVF) remains limited. Existing evidence suggests that women undergoing IVF often report elevated levels of depression, anxiety, and emotional distress, whereas men may experience feelings of anger, inadequacy, and self-doubt, especially following unsuccessful treatment cycles. Successful IVF outcomes are commonly associated with intense joy, relief, and fulfilment as couples realise their aspiration to become parents. In light of the limited qualitative research conducted in Greece to date, in the present study, we aimed to explore the lived experiences of couples undergoing IVF treatment, with particular attention to emotional, relational, and systemic dimensions. Methods: A qualitative research design was employed. Semi-structured, in-depth interviews were conducted with six heterosexual couples (aged 18–49 years) residing in Athens and Karditsa, Greece, all of whom had undergone IVF treatment. Interviews were audio-recorded, transcribed verbatim, and analysed using Interpretative Phenomenological Analysis. Results: Our analysis revealed five interrelated superordinate themes with associated subordinate themes: (1) making sense of infertility and IVF, (2) negotiating relationships under the strain of IVF, (3) IVF as an emotionally demanding journey, (4) navigating institutional and systemic barriers, and (5) projecting the future through IVF experience. Lived experiences of infertile couples undergoing IVF treatment highlighted a range of emotions, social pressure, and attitudes towards IVF and related policies. Conclusions: In Greece, where demographic decline has been widely discussed in policy debates, IVF has gained societal and policy attention. For many participants, IVF represented a hopeful pathway towards achieving parenthood despite the emotional and practical challenges involved. Full article

Background/Aim: This study aimed to describe experiences of ageism and to explore related perceptions among older adults registered at an Education Family Health Centre (EFHC) in Türkiye. Methods: This mixed-methods study was conducted with 83 older adults registered with the education family health center (EFHC). In the quantitative part of the study, surveys (the Sociodemographic data form and the Ageism Survey, which evaluates the negative aspects of ageism) were administered face-to-face. In the qualitative section, four semi-structured questions about ageism were asked by phone. A descriptive cross-sectional survey design was used in the quantitative component of the study, and thematic analysis in the qualitative part. Results: The mean age of the participants was 69.9 ± 4.8 years. According to Ageism Survey, 79.6% of participants gave a score higher than 0 and indicated that they had experienced age discrimination at least once. Eight participants completed the qualitative section, and three themes were identified: (1) Self-directed ageism, (2) Increasing health problems and social isolation with age, and (3) Ageism. Conclusions: In this EFHC-based sample, the majority of participants reported at least one experience of ageism. Social awareness about ageism needs to be increased. Educational interventions can be planned at the micro, meso, and macro levels to raise awareness and combat ageism. Family physicians who serve with a holistic approach can play a pivotal role in this regard. Full article

Background: The growing use of digital health technologies in diabetes care offers new opportunities for self-management and clinical monitoring. However, there remains significant variability in the extent to which individuals engage with these digital tools. Understanding the psychosocial and clinical factors associated with the use of digital health technologies is crucial for developing targeted implementation strategies. Objectives: The aim of this study was to assess the use of digital health technologies among adults with diabetes and to explore their relationship with psychosocial factors—especially technology acceptance and self-efficacy—as well as certain clinical characteristics, including diabetes-related stress, age, and disease duration. Methods: We conducted a cross-sectional study involving 304 adults with diabetes. Digital engagement was measured using the Digital Adherence and Use Questionnaire (DAUQ), a 7-item self-report instrument (Cronbach’s α = 0.89), from which a composite Digital Engagement Score was calculated (range 1–5) to indicate the level of technology-related self-management behaviors. Participants were descriptively categorized into low- and high-engagement groups. Engagement patterns were also analyzed by diabetes type to understand structural differences in technology exposure. Relationships between psychosocial variables and the outcome were examined using correlation analyses. Since engagement among participants with type 1 diabetes (T1D) showed limited variability, multivariable regression analyses were performed on participants with type 2 diabetes (T2D) using beta regression, with linear regression as a sensitivity analysis. An exploratory beta regression was also conducted for T1D. Results: Overall, 35.5% of participants were classified as having high digital engagement. High engagement was observed in more than 90% of participants with T1D, compared to 4.1% of those with T2D. Median engagement scores differed significantly between low- and high-engagement groups (median [Q1–Q3]: 1.71 [1.71–2.39] vs. 3.86 [3.86–4.43]). Highly engaged participants reported much higher levels of openness to technology (median [Q1–Q3]: 5.00 [1.00–5.00] vs. 1.00 [1.00–1.00], p < 0.001) and self-efficacy (median [Q1–Q3]: 3.00 [3.00–3.00] vs. 5.00 [5.00–5.00], p < 0.001). In T1D, multivariable beta regression analyses showed that age was independently associated with digital engagement, with each 10-year increase corresponding to a decrease in engagement (β = −0.147, 95% CI −0.219 to −0.075, p < 0.001). Diabetes duration and psychosocial variables were not independently associated with engagement in the multivariable model. In contrast, among participants with T2D, insulin treatment emerged as the strongest independent predictor of engagement (β = 0.996, 95% CI 0.859–1.134, p < 0.001), and diabetes-related stress emerged as an independent predictor of engagement (β = 0.069, 95% CI 0.006–0.132, p = 0.033). Technology acceptance was positively associated with engagement (β = 0.694, 95% CI 0.350–1.037, p < 0.001), whereas higher self-efficacy was independently associated with lower engagement intensity (β = −0.366, 95% CI −0.608 to −0.124, p = 0.003). Age and diabetes duration were not independently associated with engagement after adjustment. Conclusions: Digital engagement appears to function as a structurally embedded component of self-management in T1D, with limited variability and largely independent of psychosocial modulation. In T2D, engagement is predominantly driven by treatment characteristics (insulin treatment), psychosocial dynamics (stress, technology acceptance), with higher self-efficacy associated with reduced reliance on digital tools. These findings suggest distinct behavioral mechanisms underlying digital health utilization across diabetes types and support the need for tailored implementation strategies. Full article

Introduction: Lifestyle is characterized by identifiable behavioral patterns that can affect individuals’ health, and is considered one of the predominant factors for maintaining both quality of life and people’s health. This triad (lifestyle, quality of life and health) is closely associated with well-being. Objective: The aim of this study is to evaluate the relationship between lifestyles, well-being, and self-esteem in students who have completed secondary education and are in the process of transitioning to higher education. Methods: Data were collected using a questionnaire of sociodemographic (e.g., age, gender) and physical (e.g., BMI) variables, a Self-Esteem Scale, a Well-Being scale, and the FANTASTICO Lifestyle questionnaire. Statistical analysis was performed using canonical correlation analysis and a Structural Equation Model. Results: The sample consisted of 235 students, with a mean age of 18.4 years. Canonical correlation analysis revealed that lifestyle explains 58.5% of the variance in mental health. The first (most important) canonical function (r = 0.86; p < 0.001) highlighted that the domains of introspection, sleep/stress management, and family/social support are the primary predictors of higher levels of self-esteem and psychological well-being. Structural Equation Modeling confirmed that lifestyle positively predicts psychological well-being through both direct and indirect pathways (β = 0.172; 95.0% BC CI [0.095, 0.253]). Self-esteem emerged as a significant partial mediator in this relationship, suggesting that healthy lifestyle habits reinforce the perception of personal competence, which, in turn, enhances emotional adjustment. Together, these findings validate the dynamic triad between behavior, self-perception, and well-being during the transition to higher education. Conclusions: This study shows that the transition to higher education is a pivotal period where lifestyle patterns significantly shape students’ psychological adjustment. The findings confirm that a healthy lifestyle, specifically centered on stress management, sleep, and social support, serves as a robust predictor of both self-esteem and psychological well-being. By identifying self-esteem as a key partial mediator, the results suggest that healthy habits do more than just improve physical health. Full article

Background: Automated discharge instructions are increasingly used to support post-discharge communication, patient education, and nursing follow-up, yet the current state remains unidentified. This systematic review explores the types of automated discharge instructions used and their effectiveness in enhancing patient engagement and reducing readmission, emergency department visits and reoperation rates. Methods: A systematic search was conducted on 15 April 2025, using Embase, PubMed, Scopus, Web of Science, and CINAHL, following PRISMA guidelines. Inclusion criteria required peer-reviewed original research evaluating the utilization of automated patient discharge instructions following hospital admission or surgical stay. Exclusion criteria included correspondence, reviews, educational materials, not peer-reviewed, retracted reports, not retrievable, and no English translation. Risk of bias was assessed independently using NIH, JBI, ROB-2, and ROBINS-I tools. Two investigators independently conducted the screening, extraction, and synthesis of results using Endnote and Microsoft Excel. Results: Of the 1252 records identified, 13 studies were selected for analysis. There was a total of 34,386 patients across a diverse range of healthcare settings and clinical contexts. The average sample size per study was approximately 4912, with study samples ranging from 16 to 13,188 patients. The modalities of discharge instructions included automated phone calls (23.1%) and/or text messages (53.8%), as well as printed out auto-generated summaries (15.4%). Patient engagement was generally high, with automated phone calls showing the most consistent interaction, with completion rates ranging from 44% to 56%, often prompting clinical follow-up. SMS tools demonstrated strong scalability and response rates up to 87%. Two studies reported on hospital readmission outcomes and only a single study reported on emergency department revisit rates, while none assessed reoperation outcomes. Among those reporting readmission, automated phone calls and SMS were associated with lower or proxy-reduced readmission rates. Included studies had low to moderate levels of bias. Conclusions: While evidence on clinical outcomes such as readmissions, emergency department revisits, and reoperations remains limited and inconclusive, automated discharge tools—particularly phone calls and SMS—consistently demonstrated high patient engagement. Automated discharge tools show promise for supporting transitional care, discharge education, and post-discharge monitoring, highlighting the future role of automated tools in nursing workflows to support follow-up, escalation, and continuity of care. Full article

Background: Medical Assistance in Dying (MAiD) was first legalized in Canada in 2016, with legislation expanding from foreseeable to non-foreseeable natural deaths. A sole underlying medical condition of mental illness is expected to be added in 2027. Although legislation and reporting requirements are federally mandated, the implementation and delivery of MAiD are the responsibility of individual provinces and territories. Objectives: The aim of this study is to compare the organization, delivery, and oversight of MAiD programs across provinces and territories in consideration of access, equity, and safeguards. Methods: This study used a mixed methods approach to collect data. A comprehensive and systematic search for published peer reviewed literature on MAiD programs in Canada was conducted along with qualitative interviews with key informants using purposive and snowball sampling. A qualitative descriptive design was used for qualitative data, including content analysis. To facilitate a detailed comparative analysis of MAiD across jurisdictions, separate tables were created for each component or element, organizing the results of the literature review and qualitative analysis by jurisdiction. Patterns within these tables were identified through qualitative interpretation. The findings were then summarized in a narrative format. Results: A total of 113 interviews were conducted, representing all provinces and territories but Nunavut. Findings showed varied practices throughout the MAiD process between jurisdictions. Conclusions: The main findings of this study are that the organization of MAiD programs, oversight, reporting methods to Health Canada, intake, preliminary assessments, assessments, provision, and bereavement support vary. In addition, specific policies related to potentially vulnerable populations are lacking and jurisdictional practices also vary. Centralized, multidisciplinary MAiD programs with strong oversight mechanisms may strengthen issues related to access, equity, and safeguards. Full article

Background: Diabetic foot ulcers (DFUs) are considered a prevalent complication of diabetes mellitus, frequently accompanied with compromised peripheral circulation, slower healing, as well as high risk of infection in addition to risk of amputation. Additional treatments that enhance microvascular perfusion and lessen plantar pressure may accelerate the healing process. This study was carried out to examine the impact of pulsed electromagnetic field (EMF) therapy as well as customized silicone gel insoles in terms of peripheral circulation in addition to vascular indices in patients with DFUs. Methods: A randomized, controlled clinical trial, including sixty-six adults diagnosed with type II diabetes as well as plantar DFUs (Wagner grade I–II) were divided into three groups (n = 22 each): Group A was given low-frequency electromagnetic field therapy (15–50 Hz, 2–5 mT, 30 min, three times per week for 8 weeks), Group B was given a customized silicone gel insoles produced for ulcer offloading, and Group C (control) was given conventional physiotherapy along with wound care. Peripheral microcirculation as well as tissue perfusion were the primary outcomes, and they were measured using Laser Doppler Flowmetry (LDF), Photoplethysmography (PPG), in addition to the Toe–Brachial Index (TBI). The secondary outcome included the Ankle–Brachial Pressure Index (ABPI). A blinded assessor measured the outcomes at the beginning of the study, after the intervention (week 8), and again after the follow-up (week 16). Results: EMF therapy significantly improved LDF (baseline: 45.2 ± 6.5 PU; week 8: 62.5 ± 7.2 PU), PPG (0.42 ± 0.08 mV to 0.68 ± 0.10 mV), TBI (0.64 ± 0.07 to 0.82 ± 0.08), and ABPI (0.88 ± 0.06 to 0.97 ± 0.05) compared with insoles and controls (p < 0.001, partial η² 0.25–0.37). The insole group exhibited moderate enhancements, whereas the control group demonstrated minor changes. Between-group analyses showed substantial differences in favor of EMF therapy across all measured variables (F = 13.5–19.9, p < 0.001). Improvements continued at the 8-week follow-up. Conclusions: Patients with DFUs who receive EMF therapy experience a significant improvement in their peripheral microcirculation, tissue perfusion, as well as vascular indices. This is more effective than just mechanical offloading, and custom insoles offer extra benefits by redistributing pressure. Combining EMF therapy with regular DFU care may speed up healing and lower the risk of problems. Additional research should investigate the efficacy of combined EMF as well as off-loading interventions and their long-term outcomes. Full article

Background: Dentists constitute one of the most heavily burdened groups of healthcare professionals, experiencing high levels of musculoskeletal disorders, occupational stress, burnout, and diminished quality of life. Although extensive literature addresses these issues, no study has directly examined biological age or epigenetic markers of aging in this population. This narrative review, informed by systematic methodological principles, seeks to fill this gap by connecting established occupational stressors with contemporary concepts of biological aging and chronomedicine, ultimately proposing a preventive well-being framework specifically for dentists. Methods: A narrative review informed by systematic methodology was conducted following PRISMA 2020 guidelines. Searches in PubMed, Scopus, and the Cochrane Library (2015–2025) used combined keywords and MeSH terms related to lifestyle factors, occupational stress, musculoskeletal disorders, quality of life, and wellness among dentists. Of the 943 records identified, 15 met the inclusion criteria and were assessed for outcomes, methodological quality, and relevant risk factors. Results: The included studies consistently indicated a significant occupational burden, with musculoskeletal pain, emotional exhaustion, anxiety, and depersonalization as frequent findings. Quality of life was generally moderate to low, especially regarding mental health. Lifestyle patterns were characterized by inadequate sleep, limited physical activity, irregular eating habits, and insufficient recovery. These conditions-chronic stress, poor sleep, inactivity, and suboptimal nutrition-are recognized accelerators of biological aging, implying that the professional demands of dentistry may adversely influence the biological clock. Although none of the studies measured biological age directly, the collective evidence underscores the need for preventive strategies informed by chronomedicine. Conclusions: This review highlights a critical gap in the dental literature: the complete absence of biological-age assessment in a professional population exposed to multiple aging accelerators. Integrating occupational health data with modern concepts of biological aging and chronomedicine, the study proposes a targeted preventive framework to regulate biological rhythms, reduce cumulative biological deterioration, and improve the long-term quality of life and professional sustainability of dentists. Full article

Background/Objectives: Healthcare professionals operate in complex and demanding environments characterized by high workloads, emotional strain, and organizational pressures that can undermine well-being. According to Self-Determination Theory, the fulfillment of core psychological needs (autonomy, competence, and relatedness) leads to increased job satisfaction, a key indicator of occupational well-being. Additionally, leadership plays a central role in shaping needs-fulfilling environments. Drawing on Leader–Member Exchange Theory (LMX), which emphasizes that high-quality leader-follower relationships foster greater discretion, provide learning opportunities, and build constructive team interactions, this study aimed to examine whether supportive leadership is associated with job satisfaction through the mediation of autonomy, team task cohesion, and perceived training opportunities. Methods: Data were collected from a local health authority in Northern Italy through an anonymous online survey, completed by 697 healthcare professionals, including 546 non-medical healthcare staff (primarily nurses) and 151 physicians. Structural equation modeling with a robust maximum likelihood estimator was employed to test the mediation model, including professional role as a covariate. Results: Higher LMX was positively and directly associated with job satisfaction, through the partial mediation of autonomy, team cohesion, and training opportunities, all positively associated with satisfaction. Team task cohesion showed the strongest associations with both LMX and satisfaction. Physicians reported slightly higher levels of autonomy, training opportunities, and job satisfaction than non-medical professionals. Conclusions: The findings suggest that supportive leadership contributes to healthcare professionals’ job satisfaction both directly and indirectly by contributing to core needs fulfillment. Interventions that strengthen relational quality, promote team cohesion, and enhance professional development may help sustain well-being and adaptive functioning in high-demand healthcare environments. Full article