Healthcare

17 pages, 2513 KB

Open AccessArticle

Modeling Multivariate Distributions of Lipid Panel Biomarkers for Reference Interval Estimation and Comorbidity Analysis

by Julian Velev, Luis Velázquez-Sosa, Jack Lebien, Heeralal Janwa and Abiel Roche-Lima

Healthcare 2025, 13(19), 2499; https://doi.org/10.3390/healthcare13192499 - 1 Oct 2025

Abstract

Background/Objectives: Laboratory tests are a cornerstone of modern medicine, and their interpretation depends on reference intervals (RIs) that define expected values in healthy populations. Standard RIs are obtained in cohort studies that are costly and time-consuming and typically do not account for [...] Read more.

Background/Objectives: Laboratory tests are a cornerstone of modern medicine, and their interpretation depends on reference intervals (RIs) that define expected values in healthy populations. Standard RIs are obtained in cohort studies that are costly and time-consuming and typically do not account for demographic factors such as age, sex, and ethnicity that strongly influence biomarker distributions. This study establishes a data-driven approach for deriving RIs directly from routinely collected laboratory results. Methods: Multidimensional joint distributions of lipid biomarkers were estimated from large-scale real-world laboratory data from the Puerto Rican population using a Gaussian Mixture Model (GMM). GMM and additional statistical analyses were used to enable separation of healthy and pathological subpopulations and exclude the influence of comorbidities all without the use of diagnostic codes. Selective mortality patterns were examined to explain counterintuitive age trends in lipid values while comorbidity implication networks were constructed to characterize interdependencies between conditions. Results: The approach yielded sex- and age-stratified RIs for lipid panel biomarkers estimated from the inferred distributions (total cholesterol, LDL, HDL, triglycerides). Apparent improvements in biomarker profiles after midlife were explained by selective survival. Comorbidities exerted pronounced effects on the 95% ranges, with their broader influence captured through network analysis. Beyond fixed limits, the method yields full distributions, allowing each individual result to be mapped to a percentile and interpreted as a continuous measure of risk. Conclusions: Population-specific and sex- and age-segmented RIs can be derived from real-world laboratory data without recruiting healthy cohorts. Incorporating selective mortality effects and comorbidity networks provides additional insight into population health dynamics. Full article

(This article belongs to the Special Issue Data Driven Insights in Healthcare)

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12 pages, 607 KB

Open AccessArticle

Impact of Perceived Stress, Locus of Control, and Self-Efficacy on Allergic Contact Dermatitis

by Francisco José Navarro-Triviño, Álvaro Prados-Carmona, Ricardo Ruiz-Villaverde and María Isabel Peralta-Ramírez

Healthcare 2025, 13(19), 2498; https://doi.org/10.3390/healthcare13192498 - 1 Oct 2025

Abstract

Background/Objectives: Allergic contact dermatitis (ACD) is a chronic inflammatory disease with a high prevalence, affecting various aspects of patients’ lives. Psychosocial factors may influence disease management and outcomes, including perceived stress, locus of control, and self-efficacy. This study examines the presence of [...] Read more.

Background/Objectives: Allergic contact dermatitis (ACD) is a chronic inflammatory disease with a high prevalence, affecting various aspects of patients’ lives. Psychosocial factors may influence disease management and outcomes, including perceived stress, locus of control, and self-efficacy. This study examines the presence of these factors in ACD and their association with disease severity and patient characteristics. Methods: A cross-sectional study included 225 adults with ACD and 225 healthy controls. Exclusion criteria were other skin diseases, psychiatric disorders, or intellectual disabilities. Sociodemographic and clinical variables, such as disease duration and severity, were recorded. Perceived stress, locus of control, and self-efficacy were assessed using validated questionnaires. Statistical analyses, including t-tests and multiple linear regression, were performed to explore group differences and predictors of clinical and psychosocial outcomes. Results: ACD patients exhibited higher perceived stress than controls (M = 39.36 vs. 24.74, p < 0.001), with stress levels correlating with disease severity (B = 0.062, 95% CI [0.050, 0.074], p < 0.001). Female sex (B = −5.896, p < 0.001) and lower education (B = −2.606, p = 0.035) predicted higher stress. Locus of control and self-efficacy showed statistically significant but modest differences between groups. Conclusions: Perceived stress was significantly associated with the severity of ACD, highlighting the necessity of incorporating psychological interventions into disease management. Programs focused on stress reduction and patient education should be integrated into clinical care to enhance outcomes. Longitudinal research is essential to establish causal relationships and evaluate the long-term benefits of tailored psychological support on disease progression and patient well-being. Full article

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18 pages, 3115 KB

Open AccessArticle

Conception of Comprehensive Training Program for Family Caregivers: Optimization of Telemedical Skills in Home Care

by Kevin-Justin Schwedler, Jan P. Ehlers, Thomas Ostermann and Gregor Hohenberg

Healthcare 2025, 13(19), 2497; https://doi.org/10.3390/healthcare13192497 - 1 Oct 2025

Abstract

Background/Objectives: In view of demographic change and the increase in chronic illnesses, home care poses a considerable challenge. Telemedical technologies offer considerable potential for improving the quality of care and relieving the burden on family caregivers. With this study, we aim to develop [...] Read more.

Background/Objectives: In view of demographic change and the increase in chronic illnesses, home care poses a considerable challenge. Telemedical technologies offer considerable potential for improving the quality of care and relieving the burden on family caregivers. With this study, we aim to develop appropriate training strategies for the use of telemedical applications in home care, focusing on the specific requirements of patients with dementia, heart failure, diabetes mellitus, chronic obstructive pulmonary disease, and stroke. Methods: A comprehensive survey was conducted among 31 family caregivers to record their experience with digital technologies and to analyze caregiver acceptance of these technologies and barriers to their use. The survey comprised 29 questions, including a mix of multiple-choice, Likert scale, and open-ended questions. The internal consistency of the questionnaire was high (Cronbach’s alpha = 0.8876). Results: The results show that although 32% of respondents already use digital technologies, there is a significant need for training and support. Key barriers identified include a lack of technical skills (cited by 45% of respondents), limited access to suitable devices (38%), and privacy concerns (35%). In addition, 90% of respondents expressed a willingness to participate in training programs. Conclusions: Based on the survey results, evidence-based recommendations are provided for the design of training programs tailored to the individual needs of family caregivers. Through a targeted combination of e-learning modules, webinars, and practical exercises, family caregivers can be empowered to take full advantage of telemedical technologies and thus significantly improve the quality of care at home. The results underscore the importance of overcoming technical barriers and providing comprehensive training to ensure the effective use of telemedicine in home care. Full article

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26 pages, 908 KB

Open AccessSystematic Review

Beetroot Supplementation as a Nutritional Strategy to Support Post-Exercise Autonomic Recovery in Postmenopausal Women: A Systematic Review and Meta-Analysis

by Rodrigo D. Raimundo, Lucas Fornari Laurindo, Fabiana V. M. Gimenez, Jonas Benjamim, Luana A. Gonzaga, Marianne P. C. R. Barbosa, Marina de Moraes Martins, Edson H. Ito, Alexandre L. Barroca, Giovanna de J. Brito, Derfel R. M. A. Folegatti, Andrey A. Porto, David M. Garner, Sandra Maria Barbalho and Vitor E. Valenti

Healthcare 2025, 13(19), 2496; https://doi.org/10.3390/healthcare13192496 - 1 Oct 2025

Abstract

Background/Objectives: Beetroot supplementation is a rich source of inorganic nitrate and has been proposed to enhance nitric oxide bioavailability and support cardiovascular recovery after exercise. This study aimed to evaluate the effects of beetroot supplementation on post-exercise cardiovascular and autonomic recovery in [...] Read more.

Background/Objectives: Beetroot supplementation is a rich source of inorganic nitrate and has been proposed to enhance nitric oxide bioavailability and support cardiovascular recovery after exercise. This study aimed to evaluate the effects of beetroot supplementation on post-exercise cardiovascular and autonomic recovery in postmenopausal women. Methods: A systematic review and meta-analysis were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Searches were performed in PubMed, Scopus, and Web of Science databases from inception to July 2025. Ten trials involving postmenopausal women were included. Outcomes assessed included cardiovascular measures (blood pressure and vascular function), autonomic parameters derived from heart rate variability (HRV)—specifically the root mean square of successive differences (RMSSD), the standard deviation of normal-to-normal intervals (SDNN), and high-frequency power (HF)—as well as physical performance (peak oxygen uptake [VO_2peak or VO_2max] and functional fitness tests). Four independent reviewers extracted data, assessed risk of bias, and evaluated the certainty of evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Results: Pooled analyses from two trials (n = 54) revealed a statistically significant improvement in RMSSD with beetroot supplementation (mean difference: 6.68 ms; 95% CI: 0.86 to 12.50; p = 0.02), suggesting enhanced parasympathetic reactivation after exercise. No significant effects were detected for HF (mean difference: 61.75 ms²; 95% CI: −70.92 to 194.43; p = 0.36) or SDNN (mean difference: 6.20 ms; 95% CI: −9.69 to 22.09; p = 0.44). Substantial to considerable heterogeneity was identified across outcomes (I² = 73–86%). Certainty of evidence was rated moderate for RMSSD, low for SDNN, and very low for HF. Conclusions: Beetroot supplementation may enhance post-exercise autonomic recovery in postmenopausal women, primarily through improvements in RMSSD. However, further trials with standardized protocols, larger samples, and longer intervention durations are required to clarify its impact on broader HRV domains, cardiovascular function, and clinical outcomes. Full article

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15 pages, 485 KB

Open AccessArticle

Uptake, Willingness, and Determinants of Herpes Zoster Vaccination in Adults with Chronic Diseases in Riyadh, Saudi Arabia

by Haytham I. Alsaif, Lara AlMuaawi, Shaikhah Alsenani, Nouf Aldalaqan, Yara Mulia, Farah Alqazlan, Sara Alsheikh, Muath Alsaidan, Norah A. Alshehri and Abdullah A. Alrasheed

Healthcare 2025, 13(19), 2495; https://doi.org/10.3390/healthcare13192495 - 1 Oct 2025

Abstract

Background/Objectives: Herpes zoster (HZ) poses a substantial risk to adults aged ≥50, particularly those with chronic disease, and may lead to postherpetic neuralgia. Following Saudi Arabia’s introduction of the recombinant zoster vaccine (RZV), we assessed the RZV’s uptake among adults ≥50 and [...] Read more.

Background/Objectives: Herpes zoster (HZ) poses a substantial risk to adults aged ≥50, particularly those with chronic disease, and may lead to postherpetic neuralgia. Following Saudi Arabia’s introduction of the recombinant zoster vaccine (RZV), we assessed the RZV’s uptake among adults ≥50 and their willingness to receive it and examined how knowledge and attitudes influenced these outcomes. Methods: In 2024, we conducted a cross-sectional, interview-based study in the outpatient clinics of a Riyadh tertiary hospital using a structured questionnaire adapted from the literature to assess knowledge, attitudes, and practices regarding HZ and RZV. Results: Among 333 participants, HZ vaccine uptake was low (12%). Among the unvaccinated, 45.7% (134/293) were willing to be vaccinated, and knowledge of HZ and RZV was low (mean: 3.84/14). Uptake was most strongly associated with physician recommendation (OR: 7.5; 95% CI: 2.79–20.11), followed by greater knowledge (OR: 1.42; 95% CI: 1.19–1.67). Willingness was best predicted by higher attitude scores (OR: 1.28; 95% CI: 1.12–1.48). The most reported barrier was low perceived risk (27%; n = 79). Conclusions: Uptake among adults aged ≥50 with chronic disease was low due to poor knowledge and low perceived risk, yet many were willing to be vaccinated. Enhancing physician–patient counseling and targeted campaigns addressing HZ risk and RZV misconceptions could increase uptake. Full article

(This article belongs to the Special Issue Prevention and Treatment: Focus More on People with Chronic Illness)

16 pages, 1057 KB

Open AccessArticle

Cost-Effectiveness Analysis of Pitavastatin in Dyslipidemia: Vietnam Case

by Nam Xuan Vo, Hanh Thi My Nguyen, Nhat Manh Phan, Huong Lai Pham, Tan Trong Bui and Tien Thuy Bui

Healthcare 2025, 13(19), 2494; https://doi.org/10.3390/healthcare13192494 - 1 Oct 2025

Abstract

Background/Objectives: Dyslipidemia is becoming a significant economic healthcare burden in low- to middle-income countries (LMICs) due to its role in heightening cardiovascular-related mortality. Statins are the first-line treatment for reducing LDL-C levels, thereby minimizing direct costs associated with cardiovascular disease management, with [...] Read more.

Background/Objectives: Dyslipidemia is becoming a significant economic healthcare burden in low- to middle-income countries (LMICs) due to its role in heightening cardiovascular-related mortality. Statins are the first-line treatment for reducing LDL-C levels, thereby minimizing direct costs associated with cardiovascular disease management, with pitavastatin being of the newest generation of statins. This research work conducted a cost-utility analysis of pitavastatin to determine the economic benefit in Vietnam. Methods: A decision tree model was developed to compare the rate of LDL-C controlled patients over a lifetime horizon among patients treated with pitavastatin, atorvastatin, and rosuvastatin. The primary outcome was the incremental cost-effectiveness ratio (ICER), measured from the healthcare system perspective. Effectiveness was evaluated in terms of quality-adjusted life years (QALYs), using an annual discount rate of 3%. A one-way sensitivity analysis was performed to identify the key input parameters that most influenced the ICER outcomes. Results: Pitavastatin was cost-effective compared to atorvastatin but was dominated by rosuvastatin. Although pitavastatin gained fewer QALYs than atorvastatin, the ICER was 195,403,312 VND/QALY, well below Vietnam’s 2024 willingness-to-pay. Drug cost had the most significant impact on ICERs. Conclusions: Pitavastatin represents an economical short-term alternative to atorvastatin, particularly in resource-constrained settings. Full article

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20 pages, 284 KB

Open AccessArticle

A Comparison of Chinese and Korean Older Adult Immigrants’ Transnational Healthcare Practices in Toronto, Canada: A Mixed-Methods Study

by Leah Czukar, Lu Wang, Sepali Guruge, Janet Lum and Meira Greenbaum

Healthcare 2025, 13(19), 2493; https://doi.org/10.3390/healthcare13192493 - 1 Oct 2025

Abstract

Background/Objectives: While immigrants represent 21% of Canada’s total population, they represent 30% of the country’s older population. Sociocultural and economic barriers to the Canadian healthcare system have been frequently reported among older adult immigrants. These barriers are intricately linked to a vastly understudied [...] Read more.

Background/Objectives: While immigrants represent 21% of Canada’s total population, they represent 30% of the country’s older population. Sociocultural and economic barriers to the Canadian healthcare system have been frequently reported among older adult immigrants. These barriers are intricately linked to a vastly understudied phenomenon-transnational health practices (THP), which may involve travelling to home countries for healthcare, accessing medicine and health-related information and resources linked to home countries. This study aimed to explore the relationships among local healthcare experiences in Canada, individual characteristics and use of THP among older adult immigrants. Methods: A mixed-methods approach was used combining statistical, spatial and qualitative methods to analyze group patterns of THP and its influencing factors. Primary data was collected through surveys and focus groups of older Mainland Chinese and older South Korean immigrants residing in Toronto. They are the two largest East Asian groups in Canada, with documented transnational ties with their home country. Results: The study found that THP were sought by both groups but were more prevalent among older Chinese immigrants. By integrating quantitative and qualitative analyses, the study revealed complex relationships between THP and barriers in local healthcare access relating to wait times, cost, language, availability, spatial accessibility and quality of care, for different types of care including primary, specialist, eye and dental care. Conclusions: The study generates new knowledge on THP in Canada and adds to the growing body of literature on transnational healthcare practices and behaviours among migrants across different countries and regions. It provides implications to inform health policy and deliver care for older adult immigrants as their populations continue to increase. Full article

(This article belongs to the Special Issue Healthcare for Migrants and Minorities)

11 pages, 660 KB

Open AccessArticle

Recovery Time of Electrical Sensory, Motor, and Pain Thresholds: A Pilot Study Towards Standardization of Quantitative Sensory Testing in Healthy Population

by Izarbe Ríos-Asín, Miguel Malo-Urriés, Jorge Pérez-Rey, Marta García-Díez, Lucía Burgos-Garlito and Elena Bueno-Gracia

Healthcare 2025, 13(19), 2492; https://doi.org/10.3390/healthcare13192492 - 1 Oct 2025

Abstract

Background/Objectives: Electrical threshold testing (ETT) offers a promising method for assessing somatosensory function. Despite its growing use, fundamental aspects such as the physiological recovery time required between repeated threshold measurements remain poorly understood. This gap is critical when evaluating sensory, motor, or pain [...] Read more.

Background/Objectives: Electrical threshold testing (ETT) offers a promising method for assessing somatosensory function. Despite its growing use, fundamental aspects such as the physiological recovery time required between repeated threshold measurements remain poorly understood. This gap is critical when evaluating sensory, motor, or pain thresholds (EST, EMT, EPT) in pre–post designs or rapid intra-session protocols. The aim is to investigate the short-term recovery dynamics of electrical thresholds following electrical threshold testing, and to determine the minimum interval required for values to return to a stable baseline. Methods: In this pilot, repeated-measures study, 10 healthy adults (20 upper limbs) underwent three progressive stimulation trials (sensory, motor, and pain). Electrical thresholds were assessed at fixed recovery intervals (0–120 s), with duplicate measurements at each time point. Stability was defined as the absence of significant differences between repeated measures. Results: EST stabilized rapidly after sensory or motor stimulation, showing no significant differences beyond 0 and 15 s, respectively. Within pain stimulation, EST recovered at 60 s. EMT showed immediate recovery with motor stimulation and required longer recovery with pain stimulation, with stabilization observed at 90 s. EPT exhibited the highest variability, with the smallest time-dependent differences observed immediately after the first assessment. Conclusion: Recovery time after electrical stimulation varies by threshold type and intensity of the stimuli. EST and EMT can be reliably reassessed immediately after sensory and motor stimulation, respectively. However, when stimulation reaches EPT level, EST requires 60 s to recover and EMT needs 90 s. EPT demonstrates higher variability, indicating the need for further investigation. These findings support the implementation of standardized recovery intervals in ETT and underscore the importance of interpreting EPT results with caution during rapid assessments. Full article

(This article belongs to the Special Issue New Approaches in Invasive and Non-Invasive Rehabilitation: From Basic Science to Clinical Intervention—Second Edition)

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13 pages, 284 KB

Open AccessArticle

Resilience as a Predictor of Indirect Trauma Among Korean Adolescents: A Cross-Sectional Correlational Study

by Suyon Baek

Healthcare 2025, 13(19), 2491; https://doi.org/10.3390/healthcare13192491 - 30 Sep 2025

Abstract

Background/Objectives: Adolescents aged 13–18 are exposed to traumatic content even without direct experience, owing to the increasing media coverage of disasters. Such indirect exposure can result in post-traumatic stress symptoms, including intrusion, avoidance, and hyperarousal, as well as associated emotions such as sadness, [...] Read more.

Background/Objectives: Adolescents aged 13–18 are exposed to traumatic content even without direct experience, owing to the increasing media coverage of disasters. Such indirect exposure can result in post-traumatic stress symptoms, including intrusion, avoidance, and hyperarousal, as well as associated emotions such as sadness, anger, and guilt. These effects may persist for months, reflecting the vulnerability of adolescents during cognitive and emotional development. This study examined resilience and social support as protective predictors against indirect trauma. Methods: A cross-sectional correlational design was employed, with middle- and high-school students aged 13–18 years in Seoul, South Korea, as participants. Indirect trauma, resilience, and perceived social support were assessed using validated self-report instruments. Correlation analyses were conducted, followed by stepwise regression. Owing to multicollinearity, resilience was retained as the sole predictor in the final model. Results: The average indirect trauma score was 1.20 out of 4, and 59.2% of participants exhibited partial or full post-traumatic stress disorder. The mean resilience and social support scores were 3.47 and 3.82 out of 5, respectively. Resilience was positively correlated with social support (r = 0.60, p = 0.001). The regression analysis indicated that resilience significantly predicted indirect trauma (β = 0.82, p < 0.001), accounting for 66.4% of the variance, whereas social support showed no direct effect. Conclusions: Resilience emerged as a key predictor of indirect trauma, underscoring its importance in mitigating distress. Although social support did not directly predict trauma, its positive correlation with resilience suggests potential indirect effects. These findings highlight the need to strengthen resilience and expand school-based counseling and support systems to help adolescents deal with indirect trauma. Full article

18 pages, 436 KB

Open AccessArticle

Evaluating the Perceptions, Expectations, and Concerns of Community Pharmacists in Germany Regarding Prescribing by Pharmacists

by Niklas Zimmermann, Jan Siefert, Trudi McIntosh and Ágnes Mészáros

Healthcare 2025, 13(19), 2490; https://doi.org/10.3390/healthcare13192490 - 30 Sep 2025

Abstract

Background: Expanding the role of healthcare professionals could improve patient care. Workforce shortages and financial challenges within the healthcare system have led to non-medical prescribing models, such as pharmacist prescribing in several countries. However, in Germany, the prescribing authority remains with medical [...] Read more.

Background: Expanding the role of healthcare professionals could improve patient care. Workforce shortages and financial challenges within the healthcare system have led to non-medical prescribing models, such as pharmacist prescribing in several countries. However, in Germany, the prescribing authority remains with medical professionals, leaving pharmacist prescribing unexplored. Objectives: The aim of this study was to assess community pharmacists’ perceptions of the concept of prescribing by pharmacists, to investigate general concerns, and to evaluate the overall readiness and willingness of community pharmacists to take on prescribing responsibilities. Methods: A cross-sectional anonymous online survey of community pharmacists was conducted between August and October 2023. The 22-item questionnaire included demographic characteristics, daily work routines, and statements regarding the concept of prescribing by pharmacists. The data were coded and analyzed using IBM SPSS Statistics version 28.0.1. Results: The key finding was that attitudes toward prescribing by pharmacists were generally very positive, regardless of the pharmacists’ age and the size of the city in which the pharmacy was located. This positive perception was reflected by 82.3% of the participants, indicating support for the concept of prescribing by pharmacists in Germany. Additionally, 81.8% expressed confidence in taking on a prescribing role after completing the necessary qualifications and training, which 85.9% of all participants considered a basic requirement. Conclusions: Most participants expressed strong support for prescribing by pharmacists and indicated openness to its implementation on a certain scale while addressing the importance of further and specialized training. Full article

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13 pages, 315 KB

Open AccessArticle

Trends in the Prevalence and Case Characteristics of Child Sexual Abuse in Mexico, 2018–2023

by Leonor Rivera-Rivera, Marina Séris-Martínez, Paola Adanari Ortega-Ceballos, Arturo Reding-Bernal, Claudia I. Astudillo-García, Lorena Elizabeth Castillo Castillo and Luz Myriam Reynales-Shigematsu

Healthcare 2025, 13(19), 2489; https://doi.org/10.3390/healthcare13192489 - 30 Sep 2025

Abstract

Background: Child sexual abuse (CSA) is a serious public health concern that violates the rights of children. In Mexico, little is known about the actual figures for this type of violence. Objective: This study aimed to determine trends in the prevalence [...] Read more.

Background: Child sexual abuse (CSA) is a serious public health concern that violates the rights of children. In Mexico, little is known about the actual figures for this type of violence. Objective: This study aimed to determine trends in the prevalence and case characteristics of CSA in a representative sample of children in Mexico. Materials and Methods: Data from the National Health and Nutrition Survey (ENSANUT) for 2018, 2020, 2021, 2022 and 2023 were used (n = 24,179). Proportions of CSA were estimated using the weighted mean of a binary variable, and the variance of the estimated proportion was calculated using the Taylor linearization method. Logistic regression models were estimated, and Adjusted Odds Ratios (AORs) with 95% Confidence Intervals (95% CIs) were obtained. Results: The prevalence of CSA ranged from 2.22% (2018) to 5.66% (2023). There was an increasing trend in CSA between 2018 and 2021, which was even more pronounced (154.95%) between 2018 and 2023 (p < 0.001). The main perpetrator in CSA cases was a family member (78.51%), and most victims did not report the abuse to the authorities. Girls were more likely to experience CSA (AOR = 2.83, 95% CI: 1.72–4.68), and as years passed (from 2018 to 2023), the likelihood of becoming a victim of CSA increased. Conclusions: CSA is a problem that has increased in recent years in Mexico. It is noteworthy that the main perpetrator is within the family, which may influence the lack of reporting of these cases. In view of this situation, it is necessary to implement strategies to prevent CSA in children, involving mothers, fathers, and caregivers. Full article

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17 pages, 5039 KB

Open AccessArticle

AI-Enhanced Lower Extremity X-Ray Segmentation: A Promising Tool for Sarcopenia Diagnosis

by Hyunwoo Park, Hyeonsu Kim and Junil Yoo

Healthcare 2025, 13(19), 2488; https://doi.org/10.3390/healthcare13192488 - 30 Sep 2025

Abstract

Background/Objectives: Sarcopenia, characterized by progressive loss of skeletal muscle mass and strength, significantly impacts physical function and quality of life in older adults. Traditional measurement methods like Dual-energy X-ray absorptiometry (DEXA) are often inaccessible in primary care. This study aimed to develop [...] Read more.

Background/Objectives: Sarcopenia, characterized by progressive loss of skeletal muscle mass and strength, significantly impacts physical function and quality of life in older adults. Traditional measurement methods like Dual-energy X-ray absorptiometry (DEXA) are often inaccessible in primary care. This study aimed to develop and validate an AI-driven auto-segmentation model for muscle mass assessment using long X-rays as a more accessible alternative to DEXA. Methods: This was a retrospective validation study using data from the Real Hip Cohort at Inha University Hospital in South Korea. 351 lower extremity X-ray images from 157 patients were collected and analyzed. AI-based semantic segmentation models, including U-Net, V-Net, and U-Net++, were trained and validated on this dataset to automatically segment muscle regions. Model performance was assessed using Intersection over Union (IoU) and Dice Similarity Coefficient (DC) metrics. The correlation between AI-derived muscle measurements and the DEXA-derived skeletal muscle index was evaluated using Pearson correlation analysis and Bland–Altman analysis. Results: The study analyzed data from 157 patients (mean age 77.1 years). The U-Net++ architecture achieved the best segmentation performance with an IoU of 0.93 and DC of 0.95. Pearson correlation demonstrated a moderate to strong positive correlation between the AI model’s muscle estimates and DEXA results (r = 0.72, *** p < 0.0001). Regression analysis showed a coefficient of 0.74, indicating good agreement with reference measurements. Conclusions: This study successfully developed and validated an AI-driven auto-segmentation model for estimating muscle mass from long X-rays. The model provides an accessible alternative to DEXA, with potential to improve sarcopenia diagnosis and management in community and primary care settings. Future work will refine the model and explore its application to additional muscle groups. Full article

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18 pages, 2244 KB

Open AccessArticle

Unveiling Social Media Content Related to ADHD Treatment: Machine Learning Study Using X’s Posts over 15 Years

by Alba Gómez-Prieto, Alejandra Mercado-Rodriguez, Juan Pablo Chart-Pascual, Cesar I. Fernandez-Lazaro, Francisco J. Lara-Abelenda, María Montero-Torres, Claudia Aymerich, Javier Quintero, Melchor Alvarez-Mon, Ana Gonzalez-Pinto, Cesar A. Soutullo and Miguel Angel Alvarez-Mon

Healthcare 2025, 13(19), 2487; https://doi.org/10.3390/healthcare13192487 - 30 Sep 2025

Abstract

Background: Public discourse on social media plays an increasingly influential role in shaping health-related perceptions and behaviours. Individuals share experiences, concerns, and opinions beyond clinical settings around different issues. X (formerly Twitter) provides a unique lens through which to examine how different treatments [...] Read more.

Background: Public discourse on social media plays an increasingly influential role in shaping health-related perceptions and behaviours. Individuals share experiences, concerns, and opinions beyond clinical settings around different issues. X (formerly Twitter) provides a unique lens through which to examine how different treatments are perceived, used, and debated across diverse communities over time. Objective: The study aims to (a) identify the types of ADHD medications mentioned in posts, depending on language and user type; (b) evaluate the popularity of content related to these medications, considering language and user type; (c) analyse temporal changes in the frequency of mentions between 2006 and 2022; and (d) examine the distribution of tweets across different content categories. By addressing these objectives, this study provides insights into public perceptions of ADHD medications, which may help healthcare professionals better understand online discussions and improve their communication with patients, facilitating more informed treatment decisions. Methods: An observational study was conducted analysing 254,952 tweets in Spanish and English about ADHD medications from January 2006 to December 2022. Content analysis combined inductive and deductive approaches to develop a categorisation codebook. BERTWEET and BETO models were used for machine learning classification of English and Spanish tweets, respectively. Descriptive statistical analysis was performed. Results: Overall, stimulant medications were posted more frequently and received higher engagement than non-stimulant medications. Methylphenidate, dextroamphetamine, and atomoxetine were the most commonly mentioned medications, especially by patients, who emerged as the most active users among the English tweets. Regarding medical content, tweets in English contained more than twice the number of mentions of inappropriate use compared to those in Spanish. There was a high content of online medication requests and offers in both languages. Conclusions: In this study, conducted on X, discussions on ADHD medications highlighted concerns about misuse, adherence, and trivialisation, with clear differences between English and Spanish tweets regarding focus and type of user participation. These findings suggest that monitoring social media can provide early signals about emerging trends, helping clinicians address misconceptions during consultations and informing public health strategies aimed at the safer and more responsible use of ADHD medications. Full article

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15 pages, 468 KB

Open AccessArticle

Targeted Physical Function Exercises for Frailty and Falls Management in Pre-Frail Community-Dwelling Older Adults: A Randomized Controlled Trial

by Ioannis Savvakis, Athina Patelarou, Enkeleint A. Mechili, Eirini Stratidaki, Evridiki Patelarou and Konstantinos Giakoumidakis

Healthcare 2025, 13(19), 2486; https://doi.org/10.3390/healthcare13192486 - 30 Sep 2025

Abstract

Background/Objectives: Exercise is essential for older adults to maintain or improve their physical condition. This study aimed to investigate whether improvements in physical performance, functional mobility, and balance through targeted physical function exercises could positively influence Concerns about Falling (CaF) and frailty in [...] Read more.

Background/Objectives: Exercise is essential for older adults to maintain or improve their physical condition. This study aimed to investigate whether improvements in physical performance, functional mobility, and balance through targeted physical function exercises could positively influence Concerns about Falling (CaF) and frailty in pre-frail community-dwelling older adults. Methods: We conducted an 18-month randomized controlled trial involving 112 pre-frail community-dwelling older adults aged 65 years or older. 55 individuals in the control group (CG) and 57 in the intervention group (IG) were assessed. The IG participated in a home-based physical function exercise program. Primary outcomes included Physical Performance (Short Physical Performance Battery, SPPB), Functional Mobility (Timed Up and Go, TUG), Balance (Berg Balance Scale, BBS), CaF (Falls Efficacy Scale–International, FES-I), and Frailty status (SHARE-FI). Assessments were conducted at baseline, 6, 12, and 18 months. Results: The IG showed significant improvements in BBS (p < 0.01, partial eta² 0.17), SPPB (p < 0.01, partial eta² 0.13), TUG (p < 0.01, partial eta² 0.14) and FES-I (p < 0.01, partial eta² 0.07) compared to the CG and their baseline after 6, 12 and 18 months of intervention. By 18 months, frailty status improved in the IG, with 12.3% classified as non-frail compared to 2.0% in the CG, while 14.5% of the CG transitioned to frailty versus none in the IG. Discussion: The intervention appears to support improvements in physical function and may contribute to reductions in CaF and beneficial changes in frailty status among pre-frail community-dwelling older adults. Full article

(This article belongs to the Special Issue Advances in Chronic Disease Management, Rehabilitation, and Health Outcomes)

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23 pages, 4225 KB

Open AccessArticle

Physical Therapists’ Use of Behavior Change Strategies to Promote Physical Activity for Individuals with Neurological Conditions

by Amber LaMarca, Gwendolyn Larsen, Kathleen D. Lyons and Julie Keysor

Healthcare 2025, 13(19), 2485; https://doi.org/10.3390/healthcare13192485 - 30 Sep 2025

Abstract

Background/Objectives: People living with neurological conditions are inactive despite widespread literature showing physical activity (PA) is beneficial for this population. To impact long term changes in PA behavior, physical therapists treating individuals with neurological conditions need to provide effective PA promotion in [...] Read more.

Background/Objectives: People living with neurological conditions are inactive despite widespread literature showing physical activity (PA) is beneficial for this population. To impact long term changes in PA behavior, physical therapists treating individuals with neurological conditions need to provide effective PA promotion in combination with behavior change techniques (BCTs). The purpose of this study is to (1) characterize the use of BCTs during neurorehabilitation, and (2) to gain an understanding of considerations related to PA promotion. Methods: Observations of outpatient physical therapy encounters with subsequent semi-structured interviews were conducted. Observations were transcribed with detailed field notes and analyzed with descriptive analysis and deductive coding. Interviews were analyzed with thematic analysis. Results: Observations indicated that PA promotion in neurorehabilitation practice emphasizes home exercise programs, with less focus on aerobic activity. The most common BCTs used were instruction on how to perform the behavior, behavioral practice and rehearsal, and social support. Primary themes that impacted physical therapist use of BCTS for PA promotion included knowledge, decision processes, perceived role, beliefs, environmental context, and social influences. Conclusions: PA promotion from physical therapists in neurorehabilitation is not targeting activity guidelines and there is uncertainty about using behavior change strategies and PA guidelines for PA promotion. Full article

(This article belongs to the Special Issue Adherence and Behavior Change in Health and Rehabilitation Interventions)

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11 pages, 2478 KB

Open AccessArticle

Comparative Evaluation of Ultrasound Measurement of the Plantar Fascia Between Expert and Novice Technicians

by Alba Larriba-Pérez, Mª Carmen Ledesma-Alcázar, María Teresa García-Martínez, Carmen García-Gomariz, José-María Blasco and Paula Cobos-Moreno

Healthcare 2025, 13(19), 2484; https://doi.org/10.3390/healthcare13192484 - 30 Sep 2025

Abstract

Background and Objectives: Plantar fasciitis is one of the most common foot pathologies, and its diagnosis and clinical follow-up increasingly rely on the use of ultrasound. The aim of this study is to compare the reliability of ultrasound measurements of plantar fascia [...] Read more.

Background and Objectives: Plantar fasciitis is one of the most common foot pathologies, and its diagnosis and clinical follow-up increasingly rely on the use of ultrasound. The aim of this study is to compare the reliability of ultrasound measurements of plantar fascia thickness between an expert technician, with more than 5 years of ultrasound experience, and a novice technician, with no prior ultrasound experience—both of whom are podiatrists. This allows us to assess whether operator experience significantly influences the results. Methods: An observational, descriptive, and cross-sectional study was designed with a sample of 60 healthy patients aged between 20 and 32 years. The thickness of the plantar fascia in both feet was measured using ultrasound. Each patient was evaluated by two observers (one expert and one novice) using a Vinno E35 ultrasound machine. Results: The results of the analysis indicated that there were no statistically significant differences in the measurements obtained either between the two technicians or between the left and right feet of the same individual, as the calculated p-value in both cases was greater than the conventional threshold of 0.05. This suggests that the measurements were consistent regardless of the operator or the side being evaluated. Nevertheless, when examining the differences in the time required to measure the plantar fascia between the two technicians, the situation was different. In this case, the data distribution did not meet the assumption of normality, as evidenced (p-value of less than 0.001). Furthermore, it was observed that the experienced technician not only completed the measurements in a shorter amount of time but also demonstrated less variability in those times, indicating a more efficient and standardized approach to the procedure. In contrast, the novice technician initially took longer and exhibited greater inconsistency; however, as the study progressed, a noticeable and progressive learning effect became apparent. Specifically, from approximately the midpoint of the study onward, the novice technician showed a significant improvement, achieving faster and more consistent measurement times compared to the earlier stages of the research. Conclusions: The study demonstrates that ultrasound measurements of the plantar fascia are consistent between technicians. However, the expert technician performs the measurements with greater speed and precision, and a learning effect is evident in the novice technician. Full article

(This article belongs to the Special Issue Research on Podiatric Medicine and Healthcare)

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19 pages, 556 KB

Open AccessArticle

From Uncertainty to Consent: Educational Intervention Effects on Knowledge and Willingness to Donate Organs After Death

by Aruzhan Asanova, Saule Shaisultanova, Dana Anafina, Gulnur Daniyarova, Vitaliy Sazonov, Aidos Bolatov, Aigerim Abdiorazova and Yuriy Pya

Healthcare 2025, 13(19), 2483; https://doi.org/10.3390/healthcare13192483 - 30 Sep 2025

Abstract

Background: The willingness to donate organs after death remains low in many populations, often due to informational and psychological barriers. This study assessed the impact of an educational lecture on knowledge and attitudes toward postmortem organ donation among university students in Kazakhstan. Methods: [...] Read more.

Background: The willingness to donate organs after death remains low in many populations, often due to informational and psychological barriers. This study assessed the impact of an educational lecture on knowledge and attitudes toward postmortem organ donation among university students in Kazakhstan. Methods: A total of 129 students completed a pre-lecture questionnaire on donation attitudes, knowledge, and barriers; 97 also completed the post-lecture assessment. Changes were analyzed using paired t-tests, repeated-measures ANOVA, and logistic regression. Participants were grouped by attitudinal changes to identify predictors of consent. Results: Knowledge about organ donation increased significantly after the lecture (p < 0.001), with larger gains among females and non-medical students. The number of participants who were willing to donate rose from 27 to 56 (p < 0.001). About 37% showed a positive shift, while 3% shifted toward refusal. In the initially ambivalent group (n = 49), female gender (AOR = 35.6), greater knowledge gain (AOR = 3.03), and lower perceived barriers (AOR = 0.05) predicted a change towards consent. Uncertainty about how to express consent was the only significantly differing barrier (p = 0.036). Conclusion: A brief educational lecture effectively increased knowledge and willingness to donate. Targeted information on procedural aspects may reduce indecision and promote informed donor registration. Full article

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18 pages, 692 KB

Open AccessArticle

Active Breaks in Primary and Secondary School Children and Adolescents: The Point of View of Teachers

by Michela Persiani, Andrea Ceciliani, Gabriele Russo, Laura Dallolio, Giulio Senesi, Laura Bragonzoni, Marco Montalti, Rossella Sacchetti and Alice Masini

Healthcare 2025, 13(19), 2482; https://doi.org/10.3390/healthcare13192482 - 29 Sep 2025

Abstract

Background/Objectives: Engaging in regular physical activity (PA) and reducing sedentary behaviors benefits youth health, especially for those with disabilities. However, two-thirds of European children remain insufficiently active. In schools, Active Breaks, brief 5–15 min PA sessions led by teachers during or between lessons, [...] Read more.

Background/Objectives: Engaging in regular physical activity (PA) and reducing sedentary behaviors benefits youth health, especially for those with disabilities. However, two-thirds of European children remain insufficiently active. In schools, Active Breaks, brief 5–15 min PA sessions led by teachers during or between lessons, offer a feasible strategy to increase movement. This study investigated teachers’ perceptions of ABs by comparing implementers and non-implementers, examining facilitators and barriers to implementation, and exploring their potential to support the inclusion of students with disabilities. Methods: An observational cross-sectional study was conducted among primary and secondary school teachers in the Emilia-Romagna region (Italy), all of whom had completed a 6 h training course on the implementation of ABs. Data were collected using an ad hoc questionnaire consisting of four sections: sociodemographic data, an adapted Attitudes Toward Physical Activity scale, ABs’ practicality/sustainability, and inclusiveness. Results: Overall, 65% of teachers reported implementing ABs, with higher adoption in primary (69.5%) than secondary schools (58.6%). Implementers reported more positive perceptions and attitudes across individual, classroom, and school-support domains (p < 0.05). In addition, primary teachers consistently scored higher than their secondary counterparts, particularly in terms of class characteristics and benefit perceptions (p < 0.001). Most teachers, especially in primary schools (84.2%), reported no difficulties, although one-third of secondary teachers reported challenges. Exploratory factor analysis on barrier items identified two dimensions (practical/logistical feasibility; institutional/procedural difficulties), but internal consistency was low. Teachers mainly reported using motor activities, with sessions lasting 5–10 min, typically scheduled mid-morning. Inclusion analysis revealed that 60% of teachers had students with disabilities in their classes. While most students participated without adjustments, 25% required occasional or consistent modifications. Conclusions: ABs are a practical and inclusive strategy to reduce SBs in schools. However, not all teachers are currently able to implement them, due to varying contextual constraints, levels of support, and perceived barriers. Primary school settings appear more conducive to their integration, whereas secondary schools may require more tailored support. Fostering teacher confidence, peer collaboration, and inclusive planning can enhance both the implementation and long-term sustainability of educational initiatives. Full article

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

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12 pages, 1787 KB

Open AccessArticle

Psychometric Evaluation of the Pittsburgh Sleep Quality Index in Korean Breast Cancer Survivors: A Confirmatory Factor Analysis

by Mi Sook Jung, Moonkyoung Park, Kyeongin Cha, Xirong Cui, Ah Rim Lee and Jeongeun Hwang

Healthcare 2025, 13(19), 2481; https://doi.org/10.3390/healthcare13192481 - 29 Sep 2025

Abstract

Background/Objectives: Poor sleep quality is a prevalent and burdensome concern among breast cancer survivors. However, its assessment relies heavily on the Pittsburgh Sleep Quality Index (PSQI), whose latent structure has shown inconsistent support across populations. This study aimed to examine the underlying [...] Read more.

Background/Objectives: Poor sleep quality is a prevalent and burdensome concern among breast cancer survivors. However, its assessment relies heavily on the Pittsburgh Sleep Quality Index (PSQI), whose latent structure has shown inconsistent support across populations. This study aimed to examine the underlying factor structure and reliability of the PSQI among Korean breast cancer survivors using confirmatory factor analysis. Methods: A cross-sectional survey was conducted with 386 non-metastatic breast cancer survivors recruited from a university cancer center in South Korea. Ten competing one-, two-, and three-factor models were identified in previous studies and tested using confirmatory factor analysis with maximum likelihood estimation. Model fit was assessed with χ²/df, Comparative Fit Index (CFI), Tucker–Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), and Standardized Root Mean Square Residual (SRMR), and model parsimony was compared using Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC). Results: The mean global PSQI score was 7.46 (SD = 3.95), and 72.8% of participants were classified as poor sleepers. Among the tested model, a three-factor solution provided the best fit (χ²/df = 0.795, CFI ≈ 1.000, TLI ≈ 1.000, RMSEA ≈ 0.000, SRMR = 0.017) and achieved the lowest AIC and BIC values. This finding indicates the most favorable balance between fit and parsimony. This three-factor model delineates three distinct but related domains: perceived sleep quality, sleep efficiency, and daily disturbances. The global PSQI demonstrates acceptable reliability. Conclusions: These findings support the three-factor structure of the PSQI as the most valid representation of sleep quality among Korean breast cancer survivors. These results underscore the importance of population-specific validation of sleep measures and confirm the clinical utility of this measure as a multidimensional tool for assessing sleep in survivorship care. Full article

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