Healthcare

1 pages, 132 KB

Open AccessCorrection

Correction: Quansah et al. The Beneficial Effects of Lactobacillus Strains on Gut Microbiome in Alzheimer’s Disease: A Systematic Review. Healthcare 2025, 13, 74

by Michael Quansah, Monique Antoinette David, Ralph Martins, Emad El-Omar, Silvana Mirella Aliberti, Mario Capunzo, Slade O. Jensen and Mourad Tayebi

Healthcare 2026, 14(8), 974; https://doi.org/10.3390/healthcare14080974 (registering DOI) - 8 Apr 2026

Abstract

In the original publication [...] Full article

13 pages, 388 KB

Open AccessArticle

Translation and Validation of a Youth Self-Rated Insomnia Scale (YSIS) for Peruvian Adolescents

by Jessica J. Lucchini-Paredes, Alcides Flores-Paredes, Josue Pilco-Pezo, Gutember Peralta-Eugenio, Liset Z. Sairitupa-Sanchez, Sandra B. Morales-García, Oriana Rivera-Lozada, Patricia Soto-Casquero and Wilter C. Morales-García

Healthcare 2026, 14(8), 973; https://doi.org/10.3390/healthcare14080973 - 8 Apr 2026

Abstract

Background: Adolescent insomnia is a public health concern associated with affective disturbances, poor academic performance, and cardiometabolic risk. In Peru, nighttime screen use, psychosocial stressors, and social inequalities intensify its impact; however, brief, validated screening instruments remain limited. Objective: To translate, [...] Read more.

Background: Adolescent insomnia is a public health concern associated with affective disturbances, poor academic performance, and cardiometabolic risk. In Peru, nighttime screen use, psychosocial stressors, and social inequalities intensify its impact; however, brief, validated screening instruments remain limited. Objective: To translate, culturally adapt, and evaluate the psychometric properties of the Youth Self-rated Insomnia Scale (YSIS) in Peruvian adolescents, examining its internal structure, reliability, and invariance across sex. Methods: An instrumental study was conducted with 300 students aged 13 to 17 years (M = 15.02; SD = 1.07). Descriptive statistics were calculated, and confirmatory factor analysis (CFA) was performed using a robust estimator. Reliability was assessed through Cronbach’s alpha (α), McDonald’s omega (ω), and average variance extracted (AVE). Factorial invariance by sex was examined at the configural, metric, scalar, and strict levels. Results: The unidimensional model demonstrated adequate fit (χ² = 44.55, df = 18, p < 0.001; CFI = 0.97; TLI = 0.95; RMSEA = 0.07; SRMR = 0.04), with factor loadings ranging from 0.47 to 0.76, high internal consistency (α = 0.86; ω = 0.81), and AVE = 0.51. Although the two-factor model showed acceptable global fit indices, it revealed insufficient AVE in one factor (AVE = 0.40) and a high inter-factor correlation (r = 0.93), suggesting a lack of discriminant validity. Factorial invariance across sex was supported at all evaluated levels. Conclusions: The Spanish version of the YSIS demonstrates a unidimensional structure, adequate internal consistency, and factorial invariance across sex, supporting its use as a brief screening tool in clinical and school settings, as well as in epidemiological studies among Peruvian and Latin American adolescents. Full article

12 pages, 570 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

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 - 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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)

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