Healthcare

12 pages, 646 KB

Open AccessArticle

Effect of a Guide-Suture-Assisted Modified Fascial Closure Technique on Postoperative Pain and Early Mobilization After Cesarean Section: A Mixed-Methods Study

by Fatma Kılıç Hamzaoğlu, Betül Dik, Emine Türen Demir and Hasan Energin

Healthcare 2026, 14(7), 972; https://doi.org/10.3390/healthcare14070972 - 7 Apr 2026

Abstract

Background/Objections: One of the most common surgical procedures performed internationally is the cesarean section. It is known to be associated with intense postoperative pain and a slow recovery process. Focusing on surgical techniques, especially the type of fascial closure, is an area that [...] Read more.

Background/Objections: One of the most common surgical procedures performed internationally is the cesarean section. It is known to be associated with intense postoperative pain and a slow recovery process. Focusing on surgical techniques, especially the type of fascial closure, is an area that has received very little attention when it comes to postoperative pain and rapid recovery. Using a mixed-methods approach, the primary objective of this study was to assess the impact of guide-suture-assisted modified fascial closure on postoperative pain and early mobilization after cesarean sections. Methods: Women undergoing elective cesarean sections with Pfannenstiel’s incision were the study participants of this prospective, single-center, randomized mixed-methods study. Participants were enrolled in the study and randomized to either classical continuous fascial closure or guide-suture-assisted modified fascial closure, which was carried out in a 1:1 ratio. Quantitative data assessed postoperative pain through the Visual Analog Scale (VAS), a Numeric Rating Scale (NRS), and the Short-Form McGill Pain Questionnaire (SF-MPQ), and functional recovery was assessed through walking distances at postoperative 6, 12, 24, and 48 h. Qualitative data were collected via semi-structured interviews and analyzed through conventional content analysis to understand the patients’ perceptions of pain and recovery experiences. Results: The first 24 h postoperative period pain levels were significantly lower for the modified fascial closure group versus the classical closure group (p < 0.05). Moreover, the modified closure group had a significantly better functional recovery, evidenced by walking greater distances at 12, 24, and 48 h postoperative. Qualitative results indicated improved comfort and stronger early mobilization confidence, in addition to less movement apprehension, consistent with the above results, among those with the modified technique. Conclusions: The modified fascial closure technique with guide suture was linked to less pain in the early postoperative period and better functional recovery after cesarean section. This technique is a good candidate for addition to standard obstetric procedures since it is cost effective, easily added, and surgical practice will improve comfort for mothers and assist with early mobilization. Full article

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19 pages, 1077 KB

Open AccessArticle

Usability of a Patch-Type Ultrasound System for Non-Invasive Hemodynamic Monitoring: A Simulation Study in Anesthesiologists

by Soyeon Noh, Hyungmin Kim, Hyeonkyeong Choi and Wonseuk Jang

Healthcare 2026, 14(7), 971; https://doi.org/10.3390/healthcare14070971 - 7 Apr 2026

Abstract

Background/Objectives: Non-invasive hemodynamic monitoring technologies are being developed to support clinical decisions while reducing risks from invasive procedures. Usability evaluation is essential to assess safety and effectiveness before commercial release. This study examined the usability of a novel patch-type ultrasound-based system (CW10) [...] Read more.

Background/Objectives: Non-invasive hemodynamic monitoring technologies are being developed to support clinical decisions while reducing risks from invasive procedures. Usability evaluation is essential to assess safety and effectiveness before commercial release. This study examined the usability of a novel patch-type ultrasound-based system (CW10) designed for continuous monitoring in perioperative settings. Methods: A summative evaluation was conducted following IEC 62366-1 with 15 anesthesiologists. Potential hazards were identified via the FDA MAUDE database (Code: DQK) to inform test scenarios. Participants were stratified by clinical experience (1–<5, 5–<10, and ≥10 years) to observe potential variations in operation. In a simulated operating room, users performed 9 clinical scenarios (49 tasks). Metrics included task success rates, subjective satisfaction (5-point Likert scale), and the System Usability Scale (SUS). Results: The overall task success rate was 98.2%. No statistically significant differences were observed across groups in performance, subjective ratings, or SUS scores (p > 0.05). The mean SUS score was 78.5, corresponding to a “Good” usability level. While some use errors occurred in tasks like probe orientation, root cause analysis suggested these were likely due to negative transfer from prior device experience rather than interface complexity. Conclusions: The results suggest the system demonstrates acceptable usability and consistent operation across experience levels. Integrated automated features and the patch design may contribute to reducing inter-user variability for continuous monitoring. This study provides usability evidence that may inform the development of similar non-invasive technologies. Full article

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

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31 pages, 1166 KB

Open AccessArticle

Survival in Men Treated for Lung Cancer: A Single-Center Retrospective Cohort Study in Poland

by Magdalena Królikowska-Jerużalska, Magdalena Kurkiewicz, Aleksandra Moździerz, Anna Rzepecka-Stojko and Jerzy Stojko

Healthcare 2026, 14(7), 970; https://doi.org/10.3390/healthcare14070970 (registering DOI) - 7 Apr 2026

Abstract

Introduction: Lung cancer remains the leading cause of cancer-related mortality among men in Poland. Prognosis is generally poor, largely due to late diagnosis at advanced stages and the aggressive biological nature of the disease. Aim: This study aimed to evaluate the effectiveness of [...] Read more.

Introduction: Lung cancer remains the leading cause of cancer-related mortality among men in Poland. Prognosis is generally poor, largely due to late diagnosis at advanced stages and the aggressive biological nature of the disease. Aim: This study aimed to evaluate the effectiveness of various treatment modalities and determine their impact on overall survival in male patients diagnosed with small-cell (SCLC) and non-small-cell lung cancer (NSCLC). Methods: This retrospective cohort study analyzed 1431 men (mean age: 61.5 years) treated at the Katowice Oncology Center in Poland between 2002 and 2012. Overall survival was assessed using the Kaplan–Meier method and multivariable Cox proportional hazards regression. Evaluated prognostic factors included clinical stage, surgical intervention (partial or total lung resection), first-line treatment regimen, and the number of treatment cycles. Results: Survival probabilities declined progressively with advancing clinical stage for both SCLC and NSCLC. Patients who underwent surgical resection demonstrated significantly longer survival compared to non-surgically treated patients (p < 0.001). Furthermore, combined radiochemotherapy yielded superior therapeutic outcomes compared to chemotherapy alone. In the non-surgical NSCLC cohort, first-line treatment with platinum derivatives combined with gemcitabine resulted in the highest 1-year survival rate compared to other pharmacological schemes. Discussion: The high mortality observed within the first 12 months post diagnosis reflects the late-stage presentation common during the study period. The findings align with established oncological principles, confirming that surgical resection and multimodal therapies offer the greatest survival advantages for eligible patients. Conclusions: Survival rates for both SCLC and NSCLC are overwhelmingly dictated by early diagnosis and the feasibility of surgical resection. Improving long-term outcomes depends heavily on implementing effective lung cancer screening programs to detect the disease at operable stages and utilizing optimized combined treatment protocols. Full article

(This article belongs to the Special Issue Transforming Healthcare: Innovation, Economics, and Clinical Applications)

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10 pages, 1683 KB

Open AccessCase Report

A Novel Homozygous Truncating CD8A Variant (p.Arg107Ter) in a Patient with Recurrent Sinopulmonary Infections: A Case Report and Literature Review

by Ali A. Asseri, Ebtesam Elgezawy, Sarah Ibrahim Summan, Abdullah A. Alamoudi and Ashwag Asiri

Healthcare 2026, 14(7), 969; https://doi.org/10.3390/healthcare14070969 - 7 Apr 2026

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Abstract

Background: CD8A-related CD8α deficiency (Immunodeficiency 116) is a rare autosomal recessive primary immunodeficiency disease characterized by absent CD8⁺ T cells and variable sinopulmonary disease. Case Presentation: A seven-year-old boy from a consanguineous family was referred for chronic wet cough [...] Read more.

Background: CD8A-related CD8α deficiency (Immunodeficiency 116) is a rare autosomal recessive primary immunodeficiency disease characterized by absent CD8⁺ T cells and variable sinopulmonary disease. Case Presentation: A seven-year-old boy from a consanguineous family was referred for chronic wet cough and “uncontrolled asthma” despite being prescribed high-dose inhaled corticosteroids and montelukast. He was hospitalized seven times over a two-year period for presumed asthma exacerbations complicated by pneumonia. An examination revealed bilateral crackles without wheezing. Throat culture tested positive for Haemophilus influenzae. CT imaging showed signs of chronic rhinosinusitis (maxillary mucosal thickening) and chronic airway disease with bronchiectatic changes. The patient’s immunoglobulin levels were within normal ranges for his age group. Flow cytometry revealed profound CD8⁺ T-cell lymphopenia (CD8⁺ 0.21%; 11 cells/µL; near-absent after excluding dual-positive cells) with expansion of CD3⁺CD4⁻CD8⁻ T cells (29.5%). CD8A gene sequencing identified a novel homozygous nonsense variant NM_001768.7:c.319C>T (p.Arg107Ter; GRCh38: chr2:86790412G>A), consistent with loss of CD8α and secondary loss of CD8β surface expression. A literature review identified three previously reported symptomatic patients (and two asymptomatic sisters in the first family), all with recurrent respiratory infections and variable structural lung disease. Conclusions: This case highlights CD8A deficiency as a rare mimic of pediatric asthma and expands the genotype spectrum with a truncating CD8A variant. Early lymphocyte immunophenotyping in children with recurrent sinopulmonary infections may prevent delayed diagnosis and progressive airway damage. Full article

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18 pages, 1050 KB

Open AccessArticle

Real-Time Integration of an AI-Based ECG Interpretation System in the Emergency Department: A Pragmatic Alternating-Day Study of Diagnostic Performance and Clinical Process Metrics

by Min Seok Choi, Su Il Kim, Yun Deok Jang, Seong Ju Kim, In Hye Kang and Woong Bin Jeong

Healthcare 2026, 14(7), 968; https://doi.org/10.3390/healthcare14070968 - 7 Apr 2026

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Abstract

Background/Objectives: Rapid and accurate electrocardiogram (ECG) interpretation is essential for timely recognition of ST-elevation myocardial infarction (STEMI) and initiation of reperfusion therapy in the emergency department (ED). We evaluated the diagnostic performance of a real-time artificial intelligence (AI) ECG interpretation system and its [...] Read more.

Background/Objectives: Rapid and accurate electrocardiogram (ECG) interpretation is essential for timely recognition of ST-elevation myocardial infarction (STEMI) and initiation of reperfusion therapy in the emergency department (ED). We evaluated the diagnostic performance of a real-time artificial intelligence (AI) ECG interpretation system and its pragmatic impact when integrated into routine ED workflows. Methods: This prospective, single-center pragmatic observational study was conducted in a regional emergency medical center ED in Busan, Republic of Korea (1 January–31 December 2024). Consecutive adults (≥18 years) undergoing 12-lead ECG for cardiovascular-related symptoms were enrolled (N = 1524). A predefined alternating-day protocol allocated visits to physician-only interpretation days (physician-days, N = 763) or AI output disclosure days (AI-days, N = 761). Diagnostic performance for STEMI was assessed using paired ECG-level comparisons between physician-alone interpretation and AI output against a blinded expert-panel reference standard; clinical impact outcomes included reperfusion-related time metrics, hospital length of stay (LOS), and in-hospital mortality. Results: Against the expert reference standard, AI showed higher STEMI sensitivity than physician-alone interpretation (96.7% vs. 68.3%; McNemar p = 0.027), while specificity was lower (75.9% vs. 84.5%; p = 0.018). In pragmatic day-level comparisons, door-to-balloon time was shorter on AI-days (40.0 ± 19.81 vs. 47.34 ± 21.90 min; p = 0.001), and time to PCI was significantly reduced among patients with atypical presentations (42.3 ± 18.21 vs. 57.1 ± 20.11 min; p = 0.013). Among admitted patients, hospital LOS was shorter on AI-days (13 ± 9.21 vs. 17 ± 10.31 days; p = 0.010), whereas in-hospital mortality did not differ significantly between groups (17.0% vs. 16.77%; p = 0.191). Conclusions: Real-time AI-ECG integration in the ED was associated with improved STEMI detection sensitivity and shorter reperfusion-related time metrics, particularly in atypical presentations, and with reduced hospital LOS among admitted patients. Short-term mortality was comparable between groups. Further multicenter studies are warranted to confirm generalizability and to balance benefits against potential false-positive-related operational impacts. Full article

(This article belongs to the Special Issue AI-Driven Healthcare: Transforming Patient Care and Outcomes)

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14 pages, 283 KB

Open AccessArticle

Perceptions of the Body in Cerebral Palsy: Voices of Family Caregivers

by Mariana Cristina Palermo Ferreira, Érica Cesário Defilipo, Lélia Cápua Nunes and Pedro Henrique Berbert de Carvalho

Healthcare 2026, 14(7), 967; https://doi.org/10.3390/healthcare14070967 - 7 Apr 2026

Viewed by 55

Abstract

Background/Objectives: Cerebral palsy (CP) is the most prevalent physical disability in the pediatric population, resulting in functional limitations and restrictions in participation, with higher prevalence rates in low- and middle-income countries. Caregivers of children and adolescents with CP face both physical and [...] Read more.

Background/Objectives: Cerebral palsy (CP) is the most prevalent physical disability in the pediatric population, resulting in functional limitations and restrictions in participation, with higher prevalence rates in low- and middle-income countries. Caregivers of children and adolescents with CP face both physical and emotional challenges, and their perceptions of the body may act as contextual and cultural indicators shaping children’s participation, care practices, and well-being within the family environment. This study aimed to understand the perceptions, values, and cultural beliefs of family caregivers about the bodies of children and adolescents with CP. Methods: A qualitative study was conducted using six focus groups with 22 mothers and grandmothers of children and adolescents with CP. Participants were recruited from rehabilitation services. Discussions were audio-recorded, transcribed verbatim, and analyzed using content analysis. The analytical process involved systematic coding, categorization, and thematic interpretation to identify recurring meanings and patterns across narratives. Results: Three thematic categories emerged: (1) perceptions of the body within social interactions; (2) viewing the body as capable of performing activities independently when stimulated/taught; and (3) viewing the body as dependent, requiring constant supervision and support. Conclusions: The findings highlight the need to expand family caregivers’ knowledge about CP to promote children’s participation and mitigate beliefs related to limitations, dependence, fragility, and vulnerability. Full article

15 pages, 1898 KB

Open AccessArticle

Sex Differences in Overall Survival Among Patients with Non-Small-Cell Lung Cancer Across Clinical Stages: A Population-Based SEER Study

by Yuan Li, Takayuki Noma, Long Liang and Wenhao Weng

Healthcare 2026, 14(7), 966; https://doi.org/10.3390/healthcare14070966 - 7 Apr 2026

Viewed by 70

Abstract

Background/Objective: Sex-based disparities in cancer outcomes have gained increasing attention in women’s health research. We examined the relationship between sex and overall survival (OS) among patients with non-small-cell lung cancer (NSCLC), with particular emphasis on the survival advantage observed in women across different [...] Read more.

Background/Objective: Sex-based disparities in cancer outcomes have gained increasing attention in women’s health research. We examined the relationship between sex and overall survival (OS) among patients with non-small-cell lung cancer (NSCLC), with particular emphasis on the survival advantage observed in women across different clinical stages and treatment settings. Sex-related differences in cancer outcomes have become an important focus in oncology and women’s health research. This study aimed to investigate the association between sex and overall survival (OS) in patients with non-small-cell lung cancer (NSCLC), with particular attention to the observed survival advantage in women across clinical stages and treatment contexts. Methods: A total of 129,864 patients diagnosed with NSCLC were identified, including 78,460 men and 51,404 women. Demographic characteristics, socioeconomic status, tumor features, treatment modalities, and survival outcomes were compared between sexes. Kaplan–Meier survival analyses and stage-stratified Cox proportional hazards models were used to evaluate overall survival differences between female and male patients. Results: Women demonstrated significantly superior OS compared with men across all stages of NSCLC (all p < 0.001). This survival advantage persisted regardless of receipt of chemotherapy. Among patients receiving chemotherapy, survival improvements were observed in both sexes; however, women consistently exhibited longer median OS at each stage. From stage IB to IV, median OS in women was 52.0, 30.0, 13.0, and 5.0 months, respectively, compared with 33.0, 23.0, 11.0, and 4.0 months in men. Notably, the magnitude of sex-related survival differences was more pronounced in earlier stages (IB/II) than in advanced stages (III/IV), suggesting potential biological or treatment response differences favoring women. Age-stratified analyses further demonstrated that women older than 45 years experienced a consistent survival advantage across all stages. Multivariable Cox regression confirmed that female sex was independently associated with reduced mortality risk at every stage (HRs ranging from 0.766 to 0.857; all p < 0.001). Conclusions: Women with NSCLC exhibit a significant and independent survival advantage over men across clinical stages, regardless of chemotherapy status, particularly among patients older than 45 years. These findings highlight the importance of considering sex in prognostic assessment and support further investigation into factors contributing to survival differences in NSCLC. Full article

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18 pages, 288 KB

Open AccessArticle

Medication Experience and Associated Factors in Older Adults with Multiple Chronic Conditions in Rural Henan Province, China: A Single-Center Cross-Sectional Study

by Xiaofan Wang, Linlin Su, Xiao Yang, Ruofan Qiao, Jixuan Zheng, Chunhui Zhang, Xian Zhang, Lixia Qu and Beilei Lin

Healthcare 2026, 14(7), 965; https://doi.org/10.3390/healthcare14070965 - 7 Apr 2026

Viewed by 153

Abstract

Objectives: We aimed to investigate the medication experience of older adults with multiple chronic conditions in rural areas and to analyze its associated factors, so as to provide evidence for developing targeted medication management interventions. Design: This was a single-center cross-sectional study. Methods: [...] Read more.

Objectives: We aimed to investigate the medication experience of older adults with multiple chronic conditions in rural areas and to analyze its associated factors, so as to provide evidence for developing targeted medication management interventions. Design: This was a single-center cross-sectional study. Methods: From June to July 2025, a convenience sample of 539 older adults with multiple chronic conditions was recruited from a county hospital in Henan Province, China. The survey utilized a general information questionnaire, the Chinese version of the Medication Experience Scale, the Safe Medication Knowledge Scale, the Perceived Social Support Scale, the Chinese version of the Chronic Disease Self-Efficacy Scale, and the Chinese version of the Medication Errors Scale. Results: The medication experience score among rural older adults with multiple chronic conditions was (117.14 ± 17.19). Multivariate hierarchical regression analysis revealed that age, marriage status, source of income, medical insurance schemes, duration of medication use, safe medication knowledge, perceived social support, self-efficacy for chronic disease management, and medication errors were significant factors associated with medication experience (all p < 0.05). Conclusions: The medication experience among older adults with multiple chronic conditions in our study sample was at a moderate level. Age, marriage status, source of income, medical insurance schemes, duration of medication use, safe medication knowledge, perceived social support, self-efficacy for chronic disease management, and medication errors were associated factors of medication experience for older adults with multiple chronic conditions. Countermeasures should be implemented to improve medication experience in this population. Full article

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

30 pages, 1979 KB

Open AccessArticle

Design Consistency and Aesthetic Experience in Digital Health Communication: A Mixed-Method Study of Lifestyle Medicine Product Ecosystems

by Yuexing Wang and Xin Ma

Healthcare 2026, 14(7), 964; https://doi.org/10.3390/healthcare14070964 - 7 Apr 2026

Viewed by 183

Abstract

Background/Objectives: Digital health ecosystems increasingly integrate content, behavioral interventions, and commercial offerings across multiple platforms. While design consistency is established as critical for trust in commercial contexts, its associations with health behavior change and objective health outcomes remain underexplored. This study examined how [...] Read more.

Background/Objectives: Digital health ecosystems increasingly integrate content, behavioral interventions, and commercial offerings across multiple platforms. While design consistency is established as critical for trust in commercial contexts, its associations with health behavior change and objective health outcomes remain underexplored. This study examined how cross-platform design consistency and aesthetic experience are associated with behavioral adoption through psychological pathways and investigated relationships between design-driven adoption and objective health outcomes. Methods: A convergent mixed-method design comprised five integrated studies: systematic content analysis of short-form videos (N = 200), expert evaluation and user testing (N = 33), a cross-sectional survey (N = 186), semi-structured interviews (N = 15), and a 3-month longitudinal health outcome analysis (N = 143). Structural equation modeling tested pathways from design features through psychological mediators and COM-B components (capability, opportunity, motivation) to behavioral adoption and health outcomes. Results: Design consistency was significantly associated with trust (β = 0.52), perceived value (β = 0.68), and reduced perceived risk (β = −0.41; all p < 0.001). Aesthetic experience predicted emotional resonance (β = 0.71, p < 0.001) and moderated design–trust associations. COM-B components mediated 75% of the intention-to-adoption pathway (total indirect effect = 0.51, p < 0.001). High-adoption users showed clinically meaningful improvements in weight (−2.8 kg, d = 0.89), HbA1c (−0.7%, d = 0.65), fasting glucose (−0.9 mmol/L, d = 0.72), and LDL-C (−0.4 mmol/L, d = 0.51) over three months. Conclusions: Within a single, influencer-centered Chinese digital health ecosystem, design consistency and aesthetic experience were significantly associated with trust, psychological readiness, and behavioral adoption. These findings are observational; randomized controlled trials and multi-site replication are required to establish causal mechanisms and assess generalizability. Full article

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25 pages, 671 KB

Open AccessArticle

Cytotoxic Drug Handling Practices Among Pharmacy Technicians in Portugal: The Dig Deeper Study

by Ana Reis, Vítor Silva, João José Joaquim, Cristiano Matos, Carolina Valeiro, Cristiana Freitas, Olívia R. Pereira, Ramona Mateos-Campos and Fernando Moreira

Healthcare 2026, 14(7), 963; https://doi.org/10.3390/healthcare14070963 - 6 Apr 2026

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Abstract

Background: Occupational exposure to cytotoxic drugs remains a major concern for pharmacy personnel, due to their well-established, carcinogenic, mutagenic and organ-specific effects. Despite the existence of robust international guidelines, evidence suggests substantial variability in compliance, training quality and operational conditions across healthcare [...] Read more.

Background: Occupational exposure to cytotoxic drugs remains a major concern for pharmacy personnel, due to their well-established, carcinogenic, mutagenic and organ-specific effects. Despite the existence of robust international guidelines, evidence suggests substantial variability in compliance, training quality and operational conditions across healthcare settings. Objective: This study aimed to characterise current handling practices, assess working conditions, training, safety procedures, exposure patterns, and perceived risk factors among pharmacy technicians involved in the preparation of cytotoxic drugs in Portugal. Methods: A cross-sectional descriptive study was conducted using a structured questionnaire grounded in international standards (ISOPP, NIOSH, ASHP, USP <800>). The instrument was developed through literature review, expert panel validation (n = 42), and pre-testing. Data were collected electronically between April and May 2025 from pharmacy technicians actively handling cytotoxic drugs in Portugal. Results: A total of 124 valid responses were analysed. Most participants were female (78%) and under 50 years, with nearly one-third having less than one year of experience. Prolonged daily exposure (31.5% participants worked ≥ 5 h/day) extended uninterrupted handling periods (28.2% worked > 120 min), and high preparation workloads were common. While adherence to core protective measures—such as reinforced gowns, double gloves, and Class II B2 biological safety cabinets—was high, important gaps were identified, including incomplete use of closed system transfer devices, inconsistent respiratory and foot protection, limited automation, and insufficient environmental monitoring. Structured competency assessment, periodic training, and formal documentation were frequently absent. Institutional policies on reproductive risk showed strong protection for women but less clarity for male workers. Conclusions: Cytotoxic drug handling practices in Portugal demonstrate satisfactory adherence to fundamental protective measures but reveal significant structural and organisational gaps related to workload management, environmental monitoring, and continuous training. The absence of unified national guidance contributes to variability across institutions. These findings highlight the need for greater standardisation of occupational safety practices. Full article

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12 pages, 874 KB

Open AccessArticle

Synovial Fluid Characteristics and Pain Recovery Trajectory Following Rehabilitation in Patients with Meniscal Tears: A Retrospective Cohort Study

by Murat Baloğlu

Healthcare 2026, 14(7), 962; https://doi.org/10.3390/healthcare14070962 - 6 Apr 2026

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Abstract

Background: Meniscal tears are a common cause of knee pain and functional limitation, yet determinants of pain recovery following rehabilitation remain incompletely understood. Structural imaging findings often show limited correlation with clinical symptoms. This study aimed to evaluate longitudinal pain trajectories after rehabilitation [...] Read more.

Background: Meniscal tears are a common cause of knee pain and functional limitation, yet determinants of pain recovery following rehabilitation remain incompletely understood. Structural imaging findings often show limited correlation with clinical symptoms. This study aimed to evaluate longitudinal pain trajectories after rehabilitation in patients with meniscal tears and to investigate whether synovial fluid characteristics and structural joint degeneration are associated with pain improvement. Methods: This retrospective cohort study included 59 patients with meniscal tears who underwent structured rehabilitation. Structural degeneration was assessed using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Synovial fluid cytology evaluated neutrophil predominance (PNL) and erythrocyte positivity. Pain intensity was measured using the Visual Analog Scale (VAS) at 3 months, 6 months, and 1 year. Longitudinal changes were analyzed using the Friedman test, and predictors of pain improvement (ΔVAS from 3 months to 1 year) were evaluated using multivariable linear regression. Results: VAS scores decreased significantly over time (p < 0.001), indicating sustained pain reduction during follow-up. In the multivariable regression model (F(4, 54) = 2.80, p = 0.035), 17% of the variance in pain improvement was explained (R² = 0.17). Synovial erythrocyte positivity was modestly associated with greater longitudinal pain reduction (β = 0.75, 95% CI 0.15–1.36, p = 0.016). Age was also a significant predictor (β = 0.025, p = 0.043), whereas WORMS score and PNL positivity were not significantly associated with pain improvement. Conclusions: Pain recovery following rehabilitation in patients with meniscal tears appears to be influenced more by intra-articular biological characteristics than by structural imaging severity alone. Synovial erythrocyte positivity may indicate a potentially reversible inflammatory phenotype associated with higher early pain but greater subsequent improvement. These findings support a multidimensional model of knee pain and suggest that synovial characteristics may help improve clinical risk stratification during rehabilitation planning. Full article

(This article belongs to the Special Issue Physical Activity and Chronic Pain Management)

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16 pages, 517 KB

Open AccessArticle

Physician-Level Determinants of Cervical Cancer Screening Practices: A Socio-Ecological Model-Based Study from Adjara, Georgia

by Koba Kamashidze, Tina Beruchashvili, Tamar Peshkova, Irina Nakashidze, Liana Jashi and Sarfraz Ahmad

Healthcare 2026, 14(7), 961; https://doi.org/10.3390/healthcare14070961 - 6 Apr 2026

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Abstract

Background/Objectives: Cervical cancer is widely recognized as a preventable disease; however, participation in screening programs remains insufficient in many transitional health systems. In the Georgia, organized screening services are available, yet utilisation remains low, indicating barriers to screening extend beyond access alone. This [...] Read more.

Background/Objectives: Cervical cancer is widely recognized as a preventable disease; however, participation in screening programs remains insufficient in many transitional health systems. In the Georgia, organized screening services are available, yet utilisation remains low, indicating barriers to screening extend beyond access alone. This study, therefore, examined physician-level factors influencing the promotion of cervical cancer screening in the Adjara region of Georgia, with focus on routine clinical practice and organizational conditions. Methods: A cross-sectional survey was carried out among physicians providing outpatient and preventive services in six municipalities of the Adjara region. The analysis was guided by a socio-ecological framework and examined individual, inter-personal, and organizational factors in relation to physicians’ recent cervical cancer screening recommendation practices. Multivariable logistic and ordinal regression analyses were used to identify factors associated with screening promotion. Results: Despite a generally high level of support for cervical cancer screening among physicians, regular screening recommendations were not consistently reported. Limited consultation time, uncertainty regarding screening-related harms, and rural practice settings were independently associated with a lower probability of having recently recommended screening. In contrast, favourable attitudes toward screening on their own were not sufficient to translate into routine preventive practice. Conclusions: These findings indicate that gaps between physician attitudes and screening promotion are largely driven by structural and organizational factors rather than a lack of professional support. Efforts to reduce workflow constraints, improve clarity around screening guidance, and integrate preventive counselling into routine clinical practice may be essential for improving screening uptake in similar healthcare system contexts. Full article

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10 pages, 1910 KB

Open AccessArticle

Mental Fatigue in High School Students Through Spanish Physical Education Teachers’ Perceptions of Causes, Consequences, and Reduction Strategies: A Survey Study

by Francisco Javier Roldán-Ramos, Juan de Dios Benítez-Sillero, Ana Rodríguez-Cano and Javier Raya-González

Healthcare 2026, 14(7), 960; https://doi.org/10.3390/healthcare14070960 - 6 Apr 2026

Viewed by 143

Abstract

Background/Objectives: Mental fatigue in adolescents is a growing concern in educational contexts, positioning physical education (PE) teachers as key agents in designing effective mitigation strategies. This study examined the perceptions of Spanish high school PE teachers regarding the causes, consequences, and potential [...] Read more.

Background/Objectives: Mental fatigue in adolescents is a growing concern in educational contexts, positioning physical education (PE) teachers as key agents in designing effective mitigation strategies. This study examined the perceptions of Spanish high school PE teachers regarding the causes, consequences, and potential countermeasures for students’ mental fatigue. Methods: A total of 116 in-service teachers (81 males and 35 females; mean teaching experience 7.8 ± 5.3 years) from 12 autonomous communities throughout Spain completed a comprehensive 34-item electronic questionnaire. The instrument assessed the perceived existence, etiology, and outcomes of mental fatigue through multiple-choice, dichotomous (yes/no), and five-point Likert scale questions, with particular attention given to the role of physical activity (PA) in symptom alleviation. A quantitative frequency analysis was conducted to examine the data. Results: The main findings reveal a strong consensus among the teachers (77.6% to 87.9%) on the prevalence of mental fatigue, with its primary causes attributed to academic pressure and sedentarism. The consequences were identified as increased irritability and reduced cognitive performance. The teachers overwhelmingly endorsed moderate intensity PA as the most effective countermeasure. However, a significant gap was identified between this theoretical awareness and the systematic implementation of targeted strategies within schools. Conclusions: These results underscore the critical need for professional development programs and structural support to translate teacher knowledge into practical intervention, suggesting important directions for future research. Full article

(This article belongs to the Special Issue The Role of Physical Exercises in Students’ Health)

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13 pages, 1598 KB

Open AccessArticle

Low Back Pain and Disabilities Among Postpartum Women: Prevalence, Severity and Associated Factors

by Samiah Alqabbani, Maha F. Algabbani, Abeer A. Alazmi, Samiha M. I. Abdelkader, Mai Aldera, Lolwah AlRashed AlHumaid, Rehab F. M. Gwada, Munera M. Almurdi, Wafa Alahmari, Afrah Almuwais, Madawi Alotaibi, Jawahr Alagil and Afaf A. M. Shaheen

Healthcare 2026, 14(7), 959; https://doi.org/10.3390/healthcare14070959 - 6 Apr 2026

Viewed by 165

Abstract

Background: Low back pain is a common musculoskeletal complaint among postpartum women due to physical changes that occur during pregnancy and delivery, which can lead to different disability levels. Therefore, the aim of this study was to evaluate the disability levels and [...] Read more.

Background: Low back pain is a common musculoskeletal complaint among postpartum women due to physical changes that occur during pregnancy and delivery, which can lead to different disability levels. Therefore, the aim of this study was to evaluate the disability levels and associated factors of postpartum women within the first year after childbirth. Methods: A descriptive cross-sectional study design was used to gather data from post-partum women between 6 weeks and 12 months after childbirth using an online self-administered questionnaire. This questionnaire included demographic variables, the Nordic Musculoskeletal Symptoms Questionnaire, the Pain Intensity Numeric Rating Scale, and a back disability questionnaire. Results: Among 400 postpartum mothers, 71% reported low back pain, with 51.1% experiencing mild disability. Logistic regression showed significant predictors of disability, including cesarean delivery (6.49 times higher likelihood), having 4–5 children (1.98 times), and more than six children (3.45 times). Breastfeeding increased disability risk (2.44 times), while mixed feeding reduced it (0.52 times). The model explained 49.8% of disability variance (p < 0.001). Conclusions: Disability is a common problem among postpartum women, highlighting the importance of healthcare providers addressing these challenges. Full article

(This article belongs to the Section Women’s and Children’s Health)

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19 pages, 283 KB

Open AccessArticle

Depression, Anxiety and Stress Among Students at the University of Pristina-Kosovska Mitrovica, Kosovo and Metohija, Serbia

by Danijela Ilic, Jovana Milosevic, Jovana Todorovic, Zorica Terzic-Supic, Ilija Dragojevic, Mirjana Stojanovic-Tasic, Emilija Novakovic, Tijana Spasojevic, Svetozar Memarovic, Milivoje Galjak, Kristina Rakic, Mirijana Virijevic, Kristina Stevanovic, Jelena Stefanovic, Biljana Trajkovic, Andrija Milovic and Momcilo Mirkovic

Healthcare 2026, 14(7), 958; https://doi.org/10.3390/healthcare14070958 - 6 Apr 2026

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Abstract

Introduction: The aim of this study was to examine the prevalence of scores indicating depression, anxiety and stress (<95th percentile of the score on each of the domains) among students at the University of Pristina-Kosovska Mitrovica and social and lifestyle characteristics associated with [...] Read more.

Introduction: The aim of this study was to examine the prevalence of scores indicating depression, anxiety and stress (<95th percentile of the score on each of the domains) among students at the University of Pristina-Kosovska Mitrovica and social and lifestyle characteristics associated with scores indicative of depression, anxiety and stress in this population studying in a post-conflict area. Methods: The cross-sectional study applying the non-probabilistic convenience sampling that included a total of 656 students of nine faculties who were present in the classes during the day of this study at the University of Pristina-Kosovska Mitrovica was conducted during the 2024/2025 school year. Results: A total of 9.3% had a score on the DASS-D scale, indicating severe or extremely severe depression, 19.6% had a score indicating severe or extremely severe anxiety, and 13.9% had a score indicative of severe or extremely severe stress. Our study showed the association of scores indicating depression with living in rural areas, average self-rated health, use of anti-anxiety medications, and mobile phone addiction. Our study showed the association of scores indicating anxiety and average self-rated health, use of anti-anxiety medications, score on social support scale, and score on state impulsivity scale. Our study showed the association of scores indicating stress with female sex, age in years, poor self-rated financial status, average self-rated health, use of anti-anxiety medications, and score on the state impulsivity scale. Conclusions: This study has shown a significant burden of psychological distress among students at the University of Pristina-Kosovska Mitrovica. Full article

17 pages, 673 KB

Open AccessArticle

Quality of Drug Allergy Documentation in a Resource-Limited Paper-Based Hospital in Pakistan: Audit of Concordance and Completeness

by Akef Obeidat, Athar Ud Din, Muhammad Amir Khan, Amara Asad Khan, Eshal Atif, Muhammad Atif Mazhar, Muhammad Zain Khan and Sadia Qazi

Healthcare 2026, 14(7), 957; https://doi.org/10.3390/healthcare14070957 - 6 Apr 2026

Viewed by 221

Abstract

Background/Objectives: Accurate drug allergy documentation is essential for patient safety; however, documentation quality remains poor worldwide. In resource-limited settings that rely on paper records, allergy information may become fragmented across multiple forms, and evidence on concordance between paper-based documentation systems is limited. This [...] Read more.

Background/Objectives: Accurate drug allergy documentation is essential for patient safety; however, documentation quality remains poor worldwide. In resource-limited settings that rely on paper records, allergy information may become fragmented across multiple forms, and evidence on concordance between paper-based documentation systems is limited. This audit assessed concordance between clinical notes and drug Kardex records, and completeness of drug allergy documentation entries, in a manual hospital system. Methods: This retrospective clinical audit, reported in accordance with SQUIRE 2.0 guidelines, examined 88 randomly selected patient records from 525 consecutive admissions to a general medicine ward in Pakistan during June–July 2024, retrospectively reviewed in August 2024. The audit assessed allergy status documentation in clinical notes and the drug Kardex, evaluated completeness against five internationally recommended elements (drug name, reaction description, severity, date, and treatment), and measured inter-system concordance using McNemar’s test and Cohen’s kappa. Results: Drug allergy status was documented in 25.0% of clinical notes (95% CI: 16.5–35.4%) versus 94.3% of drug Kardex records (95% CI: 87.2–98.1%), representing a 69.3 percentage-point gap (McNemar χ² = 59.06, p < 0.001). Inter-system agreement was poor (κ = 0.0079; 95% CI: −0.046 to 0.062), with an overall concordance of 28.4%. Discordant pairs showed that undocumented allergy status was far more likely in clinical notes than in the drug Kardex (OR = 62.00). Kardex-only documentation occurred in 62 of 88 patients (70.5%). Among nine patients with documented allergy history in at least one source, none met the five-element completeness standards (0%; 95% CI: 0.0–33.6%). Recorded entries were generic statements such as “drug allergy” or “allergic to antibiotics” without clinically actionable details. Conclusions: Drug allergy documentation showed two major quality failures: poor concordance between parallel paper records and lack of actionable detail in recorded entries. The two systems functioned independently rather than as complementary safety checks, with allergy information often present in the drug Kardex but absent from clinical notes. This Kardex-only failure mode may be a practical target for quality improvement through structured five-element templates, prompts for clinicians to review the drug Kardex, and interdisciplinary allergy-reconciliation workflows. These strategies require prospective evaluation in this setting. Full article

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

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13 pages, 236 KB

Open AccessArticle

Housing Affordability as a Social Determinant of Mental Health: Longitudinal Evidence from China

by Yi Chen, Chunqi Wu and Jianping Ye

Healthcare 2026, 14(7), 956; https://doi.org/10.3390/healthcare14070956 - 6 Apr 2026

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Abstract

Background: Housing affordability is one of the most pressing social and political challenges in urban China, yet empirical evidence on its impact on residents’ mental health remains limited. Methods: Guided by the Social Determinants of Health (SDOH) framework, this study examines [...] Read more.

Background: Housing affordability is one of the most pressing social and political challenges in urban China, yet empirical evidence on its impact on residents’ mental health remains limited. Methods: Guided by the Social Determinants of Health (SDOH) framework, this study examines its relationship with mental health using nationally representative longitudinal data from the China Family Panel Studies (CFPS) across the 2016, 2018, and 2020 waves. We employ two-way fixed effects models and further incorporate an instrumental variable strategy to address potential endogeneity. Results: There is a significant association between housing affordability and mental health; greater affordability is associated with a lower likelihood of experiencing depressive symptoms. Heterogeneity analyses further reveal that these benefits vary by housing asset status and educational attainment. Conclusions: From an SDOH perspective, this study provides empirical evidence on how housing affordability contributes to mental health inequities in the Chinese context. Housing affordability should be recognized as a public health concern requiring coordinated policy responses. Targeted interventions are necessary to protect vulnerable populations that are most exposed to affordability shocks. Full article

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

16 pages, 349 KB

Open AccessArticle

Physical Activity and Mental Well-Being Among University Students: The Role of Beliefs in the Mental Health Benefits of Physical Activity

by Dragan Glavaš, Marija Šakić Velić and Patrik Grubor

Healthcare 2026, 14(7), 955; https://doi.org/10.3390/healthcare14070955 - 6 Apr 2026

Viewed by 204

Abstract

Background/Objectives: In an effort to clarify the mechanisms underlying the relationship between physical activity (PA) and mental well-being, emerging evidence points to a potentially important role of beliefs about PA’s impact on mental health. Nevertheless, research in this area remains scarce. This cross-sectional [...] Read more.

Background/Objectives: In an effort to clarify the mechanisms underlying the relationship between physical activity (PA) and mental well-being, emerging evidence points to a potentially important role of beliefs about PA’s impact on mental health. Nevertheless, research in this area remains scarce. This cross-sectional study examined whether belief in the mental health benefits of PA mediates the relationship between PA level and mental well-being among university students. Methods: A total of 339 university students, aged 18–28, completed the Godin–Shephard Leisure-Time Physical Activity Questionnaire, the Warwick–Edinburgh Mental Wellbeing Scale, and a newly developed Belief in the Mental Health Benefits of Physical Activity Scale. Results: Structural equation modelling indicated a non-significant direct effect of PA level on mental well-being. However, a significant indirect effect was observed, with higher PA level being associated with stronger belief in the mental health benefits of one’s own PA, which in turn was related to better mental well-being. Conclusions: The findings suggest that PA level is indirectly associated with mental well-being through belief in the mental health benefits of PA among university students. These findings highlight the potential importance of PA-related beliefs in mental health promotion and point to indirect psychological pathways that may link PA and mental well-being, warranting further longitudinal examination. Full article

(This article belongs to the Special Issue Exercise Science and Health Promotion)

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36 pages, 2940 KB

Open AccessReview

Sustainable Management of Medical Waste in Surgical Units: Operational Challenges and Policy Perspectives

by Ilie Cirstea, Ada Radu, Andrei-Flavius Radu, Delia Mirela Tit, Gabriela S. Bungau, Daniela Gitea and Bogdan Uivaraseanu

Healthcare 2026, 14(7), 954; https://doi.org/10.3390/healthcare14070954 - 5 Apr 2026

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Abstract

Surgical wards constitute a significant contributor to global medical waste (MW), accounting for over one-third of total healthcare sector trash. Medical interventions produce hazardous, infectious, and potentially toxic byproducts, making effective MW management crucial, especially where current mechanisms are insufficient. Substantial disparities persist [...] Read more.

Surgical wards constitute a significant contributor to global medical waste (MW), accounting for over one-third of total healthcare sector trash. Medical interventions produce hazardous, infectious, and potentially toxic byproducts, making effective MW management crucial, especially where current mechanisms are insufficient. Substantial disparities persist between high-income and low- and middle-income countries regarding MW infrastructure, enforcement, and adoption of safe, sustainable treatment technologies. Proper segregation, recycling, treatment, and disposal are key to protecting public health, environmental integrity, and promoting healthcare sustainability. Waste treatment technologies divide into thermal and physico-chemical processes, requiring thorough evaluation of advantages, disadvantages, and suitability for each waste type. This narrative review updates MW knowledge by synthesizing data from scientific literature, institutional documents, and regulatory sources. Key quantitative data indicate operating rooms generate up to 30% of total hospital waste, with recyclable materials representing over 40% of that volume. Improper segregation rates remain high, and incineration remains dominant despite sustainability concerns. The Romanian case study highlights progressive EU alignment, enforcing standardized MW classification, color-coded segregation, and specialized disposal protocols in surgical wards. Despite legal compliance, Romania is advancing incrementally, with systematic audits, digital tracking, and national outcome-based evaluations yet to be fully established. The Plastic Surgery Unit at Oradea County Emergency Clinical Hospital demonstrates good protocol adherence; however, strengthening data feedback mechanisms would enhance hospital-wide performance optimization and strategic waste reduction. Training and monitoring represent important areas for continued development. Coordinated professional engagement, modernized infrastructure, and enforceable audits are identified as critical priorities for improving MW handling in surgical environments. Future research should emphasize management innovation, evidence-based policy formulation, and a systematic strategy to achieve sustainable MW. Full article

(This article belongs to the Section Healthcare and Sustainability)

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8 pages, 1375 KB

Open AccessArticle

Effectiveness of Dynamic Brace in Posterior Tibial Translation in Acute PCL Lesion: A Pilot, Single Center Exploratory Study

by Giorgio Zappalà, Michelangelo Delmedico, Davide Ciclamini, Nicholas Trapella, Carlo Pasquali, Camilla Crespi and Mario Ronga

Healthcare 2026, 14(7), 953; https://doi.org/10.3390/healthcare14070953 - 5 Apr 2026

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Abstract

Background: Acute posterior cruciate ligament (PCL) injuries are uncommon and often challenging to treat. While conservative treatment is frequently proposed in the acute phase, conventional rigid bracing may lead to complications such as joint stiffness and quadriceps atrophy. Dynamic braces applying posterior [...] Read more.

Background: Acute posterior cruciate ligament (PCL) injuries are uncommon and often challenging to treat. While conservative treatment is frequently proposed in the acute phase, conventional rigid bracing may lead to complications such as joint stiffness and quadriceps atrophy. Dynamic braces applying posterior to anterior force during flexion have been proposed as a more functional alternative. Purpose: To evaluate the biomechanical efficacy of a dynamic PCL brace in reducing posterior tibial translation during the acute post-traumatic phase using standardized stress radiographs. Methods: The study was conducted on 11 patients with acute PCL injuries (four isolated, seven multiligamentous) treated within 15 days from trauma. Posterior tibial translation was measured with X-rays at 90° of flexion under four conditions: static (resting), stress (150 N), brace unloaded, and brace loaded (50 N posterior force). Three blinded orthopedic surgeons performed all measurements independently. Results: The dynamic brace significantly reduced posterior tibial translation across all conditions. Translation under stress was reduced from a mean of 7.1 mm to 2.68 mm with the loaded brace (p < 0.001). Conclusions: The study demonstrates that dynamic bracing provides effective biomechanical control of posterior tibial translation in the acute PCL injury. These findings support the potential role of dynamic bracing in conservative treatment protocols. Full article

(This article belongs to the Special Issue Sports Trauma: From Prevention to Surgery and Return to Sport)

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10 pages, 398 KB

Open AccessArticle

Educating for Equity: Preparing Student Midwives for Antenatal Care of Vulnerable Pregnant Women—A Pilot Study

by Janice Hill, Tina Werringloer, Ulrike Keim, Maria Meisl and Claudia F. Plappert

Healthcare 2026, 14(7), 952; https://doi.org/10.3390/healthcare14070952 - 5 Apr 2026

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Abstract

Background: Maternity care for vulnerable pregnant women presents a particular challenge within midwifery practice. In Germany, maternity services lack standardized frameworks to adequately address the specific needs of individuals who have experienced, among other factors, sexualized violence, poverty, female genital mutilation/cutting (FGM/C), or [...] Read more.

Background: Maternity care for vulnerable pregnant women presents a particular challenge within midwifery practice. In Germany, maternity services lack standardized frameworks to adequately address the specific needs of individuals who have experienced, among other factors, sexualized violence, poverty, female genital mutilation/cutting (FGM/C), or discrimination. Limited access to healthcare among these populations contributes to increased maternal and neonatal morbidity and mortality. Emerging evidence indicates that comprehensive medical and psychosocial support provided by midwives can substantially improve obstetric outcomes for marginalized pregnant women. Methods: An elective course, Antenatal Care for Vulnerable Women, was offered in the sixth semester of the Bachelor’s program in Midwifery Science at the University of Tübingen in 2025. The course provided insights into the psychosocial challenges faced by vulnerable pregnant women and prepared students for these specific aspects of midwifery practice. The curriculum incorporated foundational lectures and innovative teaching formats aimed at cultivating constructivist approaches to problem-solving. All sixth-semester midwifery students were asked to assess their knowledge and skills across five vulnerability categories: asylum-seeking, FGM/C, intimate partner violence, trauma, and racism. A pilot pre–posttest analysis using a 6-point Likert scale (1 = very good, 6 = poor) was conducted as hypothesis-generating and curriculum-guiding. The pretest included 38 respondents. The posttest included 11 respondents who attended the course. Results: Students who attended the course demonstrated observable gains in knowledge and skills across all categories, with the greatest improvements in asylum-seeking, median of 5 (IQR 4–5) vs. 2 (2–3); FGM/C, 5 (4–5) vs. 2 (2–3); and racism, 5 (3–5) vs. 2 (2–3). Conclusions: Innovative teaching methods may contribute to preparing midwifery students for targeted care of vulnerable pregnant women. Findings from the pre- and posttests provide preliminary insight into the potential value of experiential learning and may inform the further development of practice-oriented teaching methods. Full article

(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)

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11 pages, 337 KB

Open AccessArticle

Injury Characteristics and Associated Factors in Federated Artistic Skaters: A Cross-Sectional Survey

by Nerea Blanco-Martínez, Daniel González-Devesa, Isabel Domingo Díaz-Malaguilla and Carlos Ayán-Pérez

Healthcare 2026, 14(7), 951; https://doi.org/10.3390/healthcare14070951 - 5 Apr 2026

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Abstract

Background: Artistic skating involves high mechanical demands (e.g., jumps and spins) that may increase injury frequency, yet discipline-specific evidence remains limited. Objective: The aim of this study is to describe injury characteristics in federated artistic skaters and to explore factors associated with [...] Read more.

Background: Artistic skating involves high mechanical demands (e.g., jumps and spins) that may increase injury frequency, yet discipline-specific evidence remains limited. Objective: The aim of this study is to describe injury characteristics in federated artistic skaters and to explore factors associated with injury frequency. Methods: A descriptive cross-sectional study was conducted using an online survey distributed to federated clubs. Eligible participants practiced show and/or free skating, were federated athletes, and had competed at least once in an official competition. Results: Fifty artistic skaters participated (90% women; age 18.37 ± 3.58 years), recruited from 13 clubs; 28% competed in show, 30% in free, and 42% in both disciplines. All participants reported at least one injury; 58% occurred on the right side, and injuries most frequently affected the lower limb. The most commonly reported injury types were muscle injuries (26%), sprains (20%), tendon injuries (18%), and single-bone fractures (12%). Jumping was the most frequent action at the time of injury (40%), followed by spins (20%). Injuries most often occurred on parquet (42%) and polished concrete (38%), and 54% of athletes required physiotherapy. Time-loss was ≤7 days in 44% of cases, while 28% reported >28 days. A significant association was found between time since first menstruation and having sustained >1 injury (p = 0.034). No significant differences were observed in other demographic variables, training/competition characteristics, or preventive practices between groups (p > 0.05). Conclusions: Injuries in federated Spanish artistic skaters were predominantly lower-limb and commonly occurred during jumping, frequently requiring physiotherapy and, in a substantial proportion, leading to prolonged time-loss. Injury frequency was associated with time since first menstruation, while training load indicators and preventive practices did not differ between skaters with one versus multiple injuries. Full article

(This article belongs to the Special Issue Injury Prevention and Health Promotion in Sports and Physical Activity)

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16 pages, 1783 KB

Open AccessArticle

Workplace and Healthcare Stigma in Hereditary Angioedema: Links to Anxiety and Functional Impairment

by Kutay Kirdok, Cenan Hepdurgun, Meryem Irem Toksoy Senturk, Atakan Citak, Sebnem Pirildar and Emine Nihal Mete Gokmen

Healthcare 2026, 14(7), 950; https://doi.org/10.3390/healthcare14070950 - 4 Apr 2026

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Abstract

Background/Objectives: Stigmatization is an under-recognized burden in hereditary angioedema (HAE) that may exacerbate psychosocial distress and functional impairment. Although links to adverse outcomes exist, the domain-specific pathways remain insufficiently characterized. This study investigated the impact of stigma types (workplace, healthcare, social) on [...] Read more.

Background/Objectives: Stigmatization is an under-recognized burden in hereditary angioedema (HAE) that may exacerbate psychosocial distress and functional impairment. Although links to adverse outcomes exist, the domain-specific pathways remain insufficiently characterized. This study investigated the impact of stigma types (workplace, healthcare, social) on anxiety, quality of life, and functional impairment, specifically testing the mediating role of disease-specific quality of life. Methods: This single-center, cross-sectional study included 60 adults with confirmed HAE. Participants completed the Chronic Illness Anticipated Stigma Scale (CIASS), Hospital Anxiety and Depression Scale (HADS), Angioedema Quality of Life Questionnaire (AE-QoL), and Work Productivity and Activity Impairment Questionnaire (WPAI). Hierarchical regression and mediation analyses were used to assess relationships between stigma domains, psychosocial outcomes, and activity impairment. Results: Female patients reported significantly higher anxiety (d = 0.85) and poorer quality of life (d = 0.77) compared to males. In hierarchical regression models, workplace stigma was a significant predictor of activity impairment (p = 0.002). Mediation analysis suggested an indirect association between workplace stigma and activity impairment through disease-specific quality of life (Indirect effect = 1.22; 95% CI: 0.29–3.01). Conclusions: Anticipated stigma in HAE appears to follow domain-specific patterns, with workplace stigma showing the strongest association with functional impairment and poorer disease-specific quality of life. Female gender emerged as an independent correlate of anxiety. These findings underscore the need for HAE management strategies that integrate psychosocial evaluation alongside biomedical control. Full article

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23 pages, 3318 KB

Open AccessArticle

Effectiveness Assessment of a Multi-Functional Neonatal Incubator in the NICU

by Hyeonkyeong Choi and Wonseuk Jang

Healthcare 2026, 14(7), 949; https://doi.org/10.3390/healthcare14070949 - 4 Apr 2026

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Abstract

Background/Objectives: Preterm and critically ill neonates in neonatal intensive care units (NICUs) require multiple medical devices, including incubators, radiant warmers, phototherapy systems, and patient monitors. The coexistence of standalone devices without interoperability increases cognitive and operational burdens for healthcare providers and leads [...] Read more.

Background/Objectives: Preterm and critically ill neonates in neonatal intensive care units (NICUs) require multiple medical devices, including incubators, radiant warmers, phototherapy systems, and patient monitors. The coexistence of standalone devices without interoperability increases cognitive and operational burdens for healthcare providers and leads to spatial inefficiency. This study aimed to develop and evaluate a multi-functional neonatal incubator integrating these core functions into a single platform, using user-centered design (UCD) and usability engineering principles. Methods: By synthesizing and analyzing international standards (ISO 13485, IEC 62366-1, IEC 62366-2, and ISO 9241-210), a four-phase design process was established. Following the development of the monitoring system, the design was iteratively refined and validated through repeated formative usability evaluations. A summative usability evaluation was then conducted with 20 NICU clinicians in a simulated NICU environment, using 13 scenarios comprising 39 tasks. Outcome measures included task success rate, the After-Scenario Questionnaire (ASQ), the NASA Task Load Index (NASA-TLX), and the System Usability Scale (SUS). Results: The overall task success rate was 95.64%. When analyzed by function, success rates were 94.63% for incubator-related tasks, 98.33% for patient monitoring, 96.67% for radiant warmer tasks, and 98.33% for phototherapy tasks. The mean SUS score was 78.63, exceeding the benchmark score of 68 that indicates good usability. In addition, no statistically significant differences were observed in workload (NASA-TLX) or usability (SUS) scores according to clinical role or length of clinical experience. Conclusions: The multi-functional neonatal incubator developed in this study demonstrated high usability despite the integration of multiple medical device functions. The findings suggest that this integrated system has the potential to enhance clinical workflow efficiency, optimize spatial utilization, and improve patient safety in NICU settings. Full article

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17 pages, 1273 KB

Open AccessArticle

Depressive and Anxiety Symptoms Predict Health-Related Quality of Life More than Cognitive Impairment After Minor Stroke or Transient Ischemic Attack: A Hierarchical Regression Analysis

by María Rocío Córdova-Infantes and José María Ramírez-Moreno

Healthcare 2026, 14(7), 948; https://doi.org/10.3390/healthcare14070948 - 4 Apr 2026

Viewed by 278

Abstract

Background: Transient ischemic attack (TIA) and minor stroke often result in excellent functional recovery but are frequently followed by substantial psychological morbidity. It remains unclear whether mood disturbances or cognitive impairment are the primary contributors to reduced health-related quality of life (HRQoL) in [...] Read more.

Background: Transient ischemic attack (TIA) and minor stroke often result in excellent functional recovery but are frequently followed by substantial psychological morbidity. It remains unclear whether mood disturbances or cognitive impairment are the primary contributors to reduced health-related quality of life (HRQoL) in this population. Methods: We conducted a prospective observational case–control study including 90 patients with acute TIA or minor stroke confirmed by diffusion-weighted imaging and 92 age-matched healthy controls. At 90 days, participants completed the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Montreal Cognitive Assessment, and the EQ-5D-5L. Hierarchical multiple regression using standardized z-scores identified independent predictors of HRQoL. Bias-corrected bootstrapped mediation analyses (5000 iterations) assessed whether cognitive impairment mediated the relationship between mood symptoms and HRQoL. Results: Compared with controls, patients exhibited markedly higher rates of depressive symptoms (82.2% vs. 18.5%), anxiety symptoms (81.1% vs. 21.7%), and cognitive impairment (66.7% vs. 13.0%) (all p < 0.001). Psychopathological variables explained an additional 36.6% of HRQoL variance, whereas cognitive and neuroimaging variables contributed only 1.7% (ΔR² = 0.017; p = 0.523). In the fully adjusted regression model, HAM-A showed the numerically largest standardized coefficient (β = −0.055; p = 0.064), representing a trend toward significance, while HDRS-17 did not individually reach statistical significance (β = −0.043; p = 0.147); cognitive impairment had negligible independent effects (β = −0.001; p = 0.947). Both mood variables collectively accounted for the substantial majority of explained HRQoL variance, far exceeding the contribution of cognitive and neuroimaging predictors. Mediation analyses revealed no significant indirect effects, indicating that mood and cognitive complications are statistically consistent with a model in which mood and cognitive symptoms exert independent effects on HRQoL; temporal ordering cannot be established from these cross-sectional measures. Conclusions: Following TIA or minor stroke, depressive and anxiety symptoms are highly prevalent, persist despite good neurological recovery, and exert a disproportionately negative impact on HRQoL. Anxiety appears particularly influential in determining patient-reported outcomes. The statistical consistency of the mediation models with parallel rather than sequential mood–cognition pathways suggests that these represent independent neurobiological sequelae requiring separate clinical attention, underscoring the need for routine and concurrent assessment of both mood and cognitive function after TIA and minor stroke. Full article

(This article belongs to the Special Issue Focus on Quality of Neurology and Stroke Care for Patients)

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13 pages, 219 KB

Open AccessArticle

Preoperative Hypoalbuminemia Predicts Infection, Fracture, and Repeat Revision After Revision Total Hip Arthroplasty; Prealbumin Stratification Does Not Refine Risk: A Retrospective Database Analysis

by Nicholas Reid Kiritsis, Alisa Diane Geier, Konstantinos Oikonomou, Jackson P. Midtlien, Isabel R. Shaffrey, John Shepherd Shields, Maxwell Kenneth Langfitt and Molly Amanda Hartzler

Healthcare 2026, 14(7), 947; https://doi.org/10.3390/healthcare14070947 - 4 Apr 2026

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Abstract

Background/Objectives: Hypoalbuminemia is a marker of poor nutritional status and has been associated with increased postoperative complications following total joint arthroplasty. However, its long-term implications in the revision total hip arthroplasty (THA) population are poorly characterized, and the utility of prealbumin to further [...] Read more.

Background/Objectives: Hypoalbuminemia is a marker of poor nutritional status and has been associated with increased postoperative complications following total joint arthroplasty. However, its long-term implications in the revision total hip arthroplasty (THA) population are poorly characterized, and the utility of prealbumin to further risk-stratify these patients remains unclear. We aimed to study the association between preoperative hypoalbuminemia and complications after rTHA. Methods: We identified patients who underwent rTHA with preoperative albumin levels obtained within one month of surgery. Patients were divided into hypoalbuminemia (<3.5 g/dL) and normal albumin (3.5–6.0 g/dL) cohorts. A second analysis was conducted stratifying hypoalbuminemia patients by prealbumin level (<16 mg/dL vs. ≥16 mg/dL), measured within two weeks of surgery. Each cohort was 1:1 propensity score matched with a 1:1 nearest-neighbor greedy matching approach with a 0.10 standard deviation (SD) caliper, following a logistic regression to calculate patient propensity scores. Outcomes were compared at 90-day, 2-year, and 5-year intervals. Results: The matched cohorts included 4137 patients in both the hypoalbuminemia and normal-albumin groups. Hypoalbuminemia was significantly associated with increased short-term rates of any adverse event (38.9% vs. 22.5%; OR 2.195), wound dehiscence (5.4% vs. 3.1%; OR 1.808), surgical site infection (10.7% vs. 5.0%; OR: 2.271), and periprosthetic fracture (13.9% vs. 10.2%; OR: 1.414). Repeat revision THA was significantly more common within 90 days (6.6% vs. 4.5%; OR: 1.490). Periprosthetic fracture and prosthetic loosening were also more common within 2 years and 5 years (q = 0.001). There were no differences in repeat rTHA within 2 years and 5 years. Among hypoalbuminemic patients with prealbumin data, stratification by prealbumin level did not demonstrate any statistically significant differences in 90-day, 2-year, and 5-year complications. Conclusions: Hypoalbuminemia is a strong indicator of increased complication risk after rTHA, with increased risk for complications lasting to at least 5 years postoperatively. However, prealbumin stratification among hypoalbuminemic patients did not differentiate complication risk. These findings support preoperative albumin as a practical biomarker for risk stratification in rTHA patients. Full article

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

22 pages, 2141 KB

Open AccessArticle

Association Between Rurality and Mortality: Observational Study of Spanish and United States Prehospital Emergency Care Cohorts

by Álvaro Astasio-Picado, José Luis Martín-Conty, Begoña Polonio-López, Cristina Rivera-Picón, Juan J. Bernal-Jiménez, Paula Álvarez Buitrago, Jorge García-Criado, María Cubillo-Jiménez, Juan F. Delgado Benito, Francisco Martín-Rodríguez and Ancor Sanz-García

Healthcare 2026, 14(7), 946; https://doi.org/10.3390/healthcare14070946 - 4 Apr 2026

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Abstract

Background/Objectives: Differences between rural and urban settings, as well as between emergency medical service (EMS) systems, may influence short-term mortality among patients attended in the prehospital setting. The aim of this study was to determine the associations of rurality and the US and [...] Read more.

Background/Objectives: Differences between rural and urban settings, as well as between emergency medical service (EMS) systems, may influence short-term mortality among patients attended in the prehospital setting. The aim of this study was to determine the associations of rurality and the US and Spanish EMS health systems with patient mortality. Methods: This was a multicenter, EMS-based, observational study involving a prospective dataset, the Salud de Castilla y Leon dataset (SACYL) from Spain, and a retrospective dataset, the National Emergency Medical Services Information System (NEMSIS) from the US. All consecutive EMS activations of adult patients (≥18 years) requiring high-priority transport to emergency departments were included in the analysis. The collected variables included demographic characteristics, EMS transport characteristics, case characteristics, and rural or urban origin. The primary outcome was 2-day, short-term mortality. Results: A total of 54,981 EMS activations were considered from both datasets. The mortality rate was 8.47% for rural areas and 11.8% for urban areas (p < 0.001). Multivariable analyses showed that mortality patterns differed according to geographic setting and EMS system. Male sex and the use of advanced life support were associated with higher odds of mortality in several models, while prehospital time intervals and call characteristics showed context- and system-dependent associations, including protective effects in specific subgroups. Conclusions: Short-term mortality differed between rural and urban settings, with heterogeneous patterns across EMS systems. These findings highlight the importance of considering both geographic context and system-level organizational characteristics when evaluating prehospital care and mortality outcomes. Full article

(This article belongs to the Special Issue Integrating Artificial Intelligence and Contextual Factors in Emergency Care)

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23 pages, 845 KB

Open AccessArticle

Determinants of the Public’s Behavioral Intention to Adopt AI-Assisted Lung Cancer Screening: An Extended UTAUT Model Integrating Trust and Risk

by Langwei Yan, Xue Bai, Xiurong Lin, Jingfu Lai, Shuhan Sun, Hengwei Chen, Ruqing Liu and Ruwei Hu

Healthcare 2026, 14(7), 945; https://doi.org/10.3390/healthcare14070945 - 3 Apr 2026

Viewed by 263

Abstract

Background: The integration of artificial intelligence (AI) into lung cancer screening offers significant potential; however, public adoption of AI-assisted lung cancer screening remains inconsistent and poorly understood. A robust understanding of the psychological and social determinants underlying adoption is critical to inform evidence-based [...] Read more.

Background: The integration of artificial intelligence (AI) into lung cancer screening offers significant potential; however, public adoption of AI-assisted lung cancer screening remains inconsistent and poorly understood. A robust understanding of the psychological and social determinants underlying adoption is critical to inform evidence-based implementation strategies. Objective: This study aims to identify the key factors that influence the public’s Behavioral Intention (BI) to adopt AI-assisted lung cancer screening. We built on the Unified Theory of Acceptance and Use of Technology (UTAUT) and integrated Doctor–Patient Trust and Perceived Risk into the framework to examine the associations between these medically specific factors, together with traditional adoption variables, and the public’s BI. Methods: A cross-sectional survey was conducted among 971 residents in China from September to November 2025. Based on the extended UTAUT, a measurement instrument was developed and refined through expert consultations and pilot testing. Exploratory factor analysis (EFA) was performed to validate the questionnaire’s construct validity. Hypothesis testing was then carried out via Partial Least Squares Structural Equation Modeling (PLS-SEM) to evaluate the measurement model and examine the structural relationships among latent constructs. Results: EFA results indicated a seven-factor structure (KMO = 0.897, p < 0.001). The structural model accounted for 35.0% of the variance in BI. Social Influence (β = 0.292, p < 0.001), Facilitating Conditions (β = 0.156, p < 0.001), Performance Expectancy (β = 0.101, p = 0.004), Doctor–Patient Trust (β = 0.107, p = 0.002) were positively associated with BI, while Perceived Risk (β = −0.106, p < 0.001) showed a negative association. Furthermore, Doctor–Patient Trust was significantly and negatively associated with Perceived Risk (β = −0.168, p < 0.001), suggesting a potential mediating pathway from trust to intention (Indirect Effect = 0.018, p = 0.003). Conclusions: Adoption of AI-assisted lung cancer screening appears to be associated not only with perceived utility but also with trust in medical professionals and Perceived Risk. These findings suggest the importance of integrating technological innovation with strategic public education and tailored communication strategies to foster its adoption. Public health interventions should leverage physician endorsements and promote AI awareness to support informed, trust-based engagement with AI technologies. Full article

(This article belongs to the Section Artificial Intelligence in Healthcare)

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13 pages, 427 KB

Open AccessArticle

The Roles and Activities of Medical Simulation Technicians in Poland: A Preliminary Exploratory Study

by Jakub Zalewski, Mateusz Ptak, Dawid Obłój, Joanna Grzesik Gąsior and Katarzyna Zalewska

Healthcare 2026, 14(7), 944; https://doi.org/10.3390/healthcare14070944 - 3 Apr 2026

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Abstract

Introduction: The role of medical simulation technicians varies across countries and institutions. Technicians ensure simulators function according to the designed training scenarios and manage their physiological responses, such as breathing and circulation. They are responsible for ongoing maintenance, repairs, and software installation [...] Read more.

Introduction: The role of medical simulation technicians varies across countries and institutions. Technicians ensure simulators function according to the designed training scenarios and manage their physiological responses, such as breathing and circulation. They are responsible for ongoing maintenance, repairs, and software installation or updates. Additionally, they manage audio–video systems, including recording simulation sessions, organizing live broadcasts, and preparing materials for post-training review and analysis. These responsibilities suggest that technicians contribute to the technical and organizational foundations of simulation-based education. Methods: This exploratory study used a predominantly quantitative survey design with an additional qualitative component. An open-ended question allowed respondents to freely express their opinions and reflections regarding the professional responsibilities of medical simulation technicians. This mixed-methods approach enabled both statistical analysis and deeper insight into the technicians’ perspectives. Results: Thirty-five simulation technicians participated in the study. Most respondents were men (71.43%), while women accounted for 28.57%. Respondents reported performing a broad range of technical, organizational, and selected educational support tasks. Conclusions: This exploratory study suggests that medical simulation technicians in Poland perform a broad range of technical, organizational, and selected educational support tasks. The findings also indicate local variability in role configuration and unclear boundaries between technical and educational responsibilities. Given the limited sample size and purposive recruitment strategy, the results should be interpreted cautiously. Full article

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26 pages, 1892 KB

Open AccessReview

Artificial Intelligence–Driven Tools in Mental Health Service Delivery: A Scoping Review

by Yeshin Woo and Kibum Jung

Healthcare 2026, 14(7), 943; https://doi.org/10.3390/healthcare14070943 - 3 Apr 2026

Viewed by 259

Abstract

Background: Artificial intelligence (AI) holds transformative potential for mental health services. However, existing reviews have predominantly focused on algorithmic accuracy, with limited attention to how these technologies are implemented and integrated into real-world service delivery. This scoping review addresses this gap by [...] Read more.

Background: Artificial intelligence (AI) holds transformative potential for mental health services. However, existing reviews have predominantly focused on algorithmic accuracy, with limited attention to how these technologies are implemented and integrated into real-world service delivery. This scoping review addresses this gap by examining the contexts in which AI technologies—including large language models (LLMs) and machine learning—are implemented, as well as the factors influencing their sustainable adoption within real-world mental health service systems. Methods: Following the established methodological framework, a systematic search (2015–2026) was conducted in PubMed and Scopus. Two independent reviewers screened an initial pool of 829 records using Zotero and Rayyan to minimize selection bias. Following title, abstract, and full-text screening based on predefined eligibility criteria, 26 studies focusing on real-world AI applications (e.g., clinical settings, community services, and case management) were included in the final synthesis. Results: The findings indicate a rapid acceleration in research, with 50% of included studies (n = 13) published since 2024. AI-driven decision support systems were the most prevalent (50%, n = 13), followed by predictive machine learning models (27%) and generative AI applications (15%). Most tools were designed for clinician use (77%) and implemented in hospital-based settings (46%). Although 46% of studies reported real-world implementation, more than half remained at the pilot stage. Notably, research emphasis has shifted from technical efficacy toward feasibility, and implementation contexts (n = 17). Conclusion: AI in mental health is transitioning from laboratory validation to real-world integration. However, the current landscape remains heavily centered on clinician workflows and screening functions, with limited expansion into community-based recovery and long-term prevention. To move beyond the pilot stage, future initiatives should prioritize seamless workflow integration and the application of structured ethical and implementation frameworks that support clinician–patient relationships. This review provides an evidentiary basis for advancing sustainable, AI-enhanced mental health service delivery. Full article

(This article belongs to the Special Issue Artificial Intelligence in Health Services Research and Organizations)

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