Healthcare

25 pages, 824 KiB

Open AccessStudy Protocol

Effects of a Multidimensional Exercise and Mindfulness Approach Targeting Physical, Psychological, and Functional Outcomes: Protocol for the BACKFIT Randomized Controlled Trial with an Active Control Group

by Belén Donoso, Gavriella Tsiarleston, Yolanda Castellote-Caballero, Alba Villegas-Fuentes, Yolanda María Gil-Gutiérrez, José Enrique Fernández-Álvarez, Santiago Montes, Manuel Delgado-Fernández, Antonio Manuel Mesa-Ruíz, Pablo Molina-García, Rocío Pozuelo-Calvo, Miguel David Membrilla-Mesa and Víctor Segura-Jiménez

Healthcare 2025, 13(16), 2065; https://doi.org/10.3390/healthcare13162065 - 20 Aug 2025

Abstract

Introduction: Chronic primary low back pain (CPLBP) is a prevalent condition in primary care and a leading cause of disability and absenteeism worldwide. Multidimensional approaches may be necessary to achieve physical and mental health benefits in individuals with CPLBP. Objective: The BACKFIT [...] Read more.

Introduction: Chronic primary low back pain (CPLBP) is a prevalent condition in primary care and a leading cause of disability and absenteeism worldwide. Multidimensional approaches may be necessary to achieve physical and mental health benefits in individuals with CPLBP. Objective: The BACKFIT randomized controlled trial aims to evaluate the effectiveness of a multidimensional intervention—combining supervised exercise and mindfulness—on pain, physical fitness, mental health, and functional outcomes in individuals with CPLBP. Hypothesis: Both the supervised exercise program focused on motor control and trunk muscle strength (IG1) and the multidimensional intervention combining supervised exercise with mindfulness training (IG2) are expected to produce significant health improvements in individuals with CPLBP. It is further hypothesized that IG2 will yield greater improvements compared to IG1, both immediately post-intervention and at the two-month follow-up. Design. Randomized controlled trial. Setting: Virgen de las Nieves University Hospital, Granada (Spain). Participants: 105 individuals. Inclusion criteria: Previously diagnosed with CPLBP, aged ≥18 and ≤65 years, able to read and understand the informed consent, and able to walk, move, and communicate without external assistance. Exclusion criteria: serious lumbar structural disorders, acute or terminal illness, physical injury, mental illness, and medical prescriptions that prevent participation in the study. Intervention: Individuals will be randomly assigned to a supervised physical exercise group (2 days per week, 45 min per session), a multidimensional intervention group (same as supervised physical exercise group, and mindfulness 1 day per week, 2.5 h per session) or an active control group (usual care, 2 days per week, 45 min per session). The intervention will last 8 weeks. Main Outcome Measures: Primary outcome: pain threshold, perceived acute pain, and disability due to pain. Secondary measures: body composition, muscular fitness, gait parameters, device-measured physical activity and sedentary behavior, self-reported sedentary behavior, quality of life, pain catastrophizing, mental health, sleep duration and quality, and central sensitization. The groups will undergo pre-intervention, post-intervention, and a 2-month follow-up after a detraining period. Statistical Analysis: Both per-protocol and intention-to-treat approaches (≥70% attendance) will be used. Program effects will be assessed via one-way ANCOVA for between-group changes in primary and secondary outcomes. Conclusions: Given the complex nature of CPLBP, multidimensional approaches are recommended. If effective, this intervention may provide low-cost alternatives for health professionals. Full article

14 pages, 259 KiB

Open AccessArticle

Resilience Protects Nurses from Workplace Gaslighting and Quiet Quitting, and Improves Their Work Engagement: A Cross-Sectional Study in Greece

by Ioannis Moisoglou, Aglaia Katsiroumpa, Olympia Konstantakopoulou, Ioanna V. Papathanasiou, Ioanna Prasini, Maria Rekleiti and Petros Galanis

Healthcare 2025, 13(16), 2064; https://doi.org/10.3390/healthcare13162064 - 20 Aug 2025

Abstract

Background: Although gaslighting is an alarming issue, the literature on predictors of this phenomenon is scarce. Objective: To examine the association between resilience and gaslighting in the workplace, quiet quitting, and work engagement among nurses. Methods: We conducted a cross-sectional study in Greece [...] Read more.

Background: Although gaslighting is an alarming issue, the literature on predictors of this phenomenon is scarce. Objective: To examine the association between resilience and gaslighting in the workplace, quiet quitting, and work engagement among nurses. Methods: We conducted a cross-sectional study in Greece during December 2024. We used the Brief Resilience Scale (BRS) to measure levels of resilience in our sample. Moreover, we used the Gaslighting at Work Scale (GWS), the Quiet Quitting Scale, and the Utrecht Work Engagement Scale-3 to measure workplace gaslighting, quiet quitting, and work engagement, respectively. Results: The study population included 462 nurses with a mean age of 36.80 years. We found that resilience protected nurses from workplace gaslighting. After adjusting gender, age, educational level, and work experience, a negative association was found between resilience and GWS score (p < 0.001), loss of self-trust (p < 0.001), and abuse of power (p < 0.001). Moreover, our multivariable analysis identified a negative association between resilience and Quiet Quitting Scale score (p < 0.001), detachment (p < 0.001), lack of initiative (p < 0.001), and lack of motivation (p < 0.001). Additionally, we identified a positive relationship between resilience and work engagement (p < 0.001). Conclusions: Our findings suggested the protective role of resilience against gaslighting in the workplace and quiet quitting in nurses. Moreover, we found that resilience improved nurses’ work engagement. However, the cross-sectional nature of this study cannot imply causality between the study variables, and, thus, further studies are required to clarify the association between resilience, workplace gaslighting, quiet quitting, and work engagement. Full article

(This article belongs to the Special Issue Well-Being of Healthcare Professionals: New Insights After COVID-19)

20 pages, 3523 KiB

Open AccessArticle

Telerehabilitation After Surgery in Adolescent Idiopathic Scoliosis: A Randomized Controlled Trial

by İrem Çetinkaya, Tuğba Kuru Çolak, Mehmet Fatih Korkmaz and Mehmet Aydoğan

Healthcare 2025, 13(16), 2063; https://doi.org/10.3390/healthcare13162063 - 20 Aug 2025

Abstract

Background: Structured postoperative rehabilitation is not routinely provided for individuals with adolescent idiopathic scoliosis (AIS) after surgery, with physiotherapy typically limited to the immediate inpatient period. Telerehabilitation offers an accessible and supervised option to address persistent functional limitations, pain, and quality-of-life concerns [...] Read more.

Background: Structured postoperative rehabilitation is not routinely provided for individuals with adolescent idiopathic scoliosis (AIS) after surgery, with physiotherapy typically limited to the immediate inpatient period. Telerehabilitation offers an accessible and supervised option to address persistent functional limitations, pain, and quality-of-life concerns in this population. Objectives: This study aimed to evaluate the effects of a synchronous telerehabilitation program—designed to support post-surgical recovery in individuals with adolescent idiopathic scoliosis (AIS)—on trunk muscle endurance, trunk flexibility, functional capacity, pain severity, perception of appearance, and quality of life. Methods: Thirty-two individuals with AIS, who had undergone surgery 6 months to 2 years prior, were randomly assigned to either an intervention group or a control group. The intervention group participated in a supervised telerehabilitation program twice weekly for eight weeks, while the control group received no exercise intervention. All outcome measures were assessed before and after the intervention. Results: The telerehabilitation group demonstrated significant improvements across all outcome measures compared with the control group (p < 0.05). Post-intervention, the telerehabilitation group had superior trunk muscle endurance, flexibility, and quality-of-life scores, as well as reduced pain intensity (p < 0.05). However, no significant differences were observed between the groups in functional capacity or perception of appearance (p > 0.05). Conclusions: A supervised telerehabilitation program initiated six months after surgery can effectively improve trunk muscle endurance, flexibility, pain intensity, and quality of life in individuals with AIS. These findings emphasize the value of structured post-surgical rehabilitation and raise awareness of the potential benefits of remotely delivered exercise programs in this population. Full article

(This article belongs to the Special Issue Scoliosis Deformity—Etiological Aspects, Management and Rehabilitation)

► Show Figures

Figure 1

10 pages, 374 KiB

Open AccessArticle

Do Primary Care Providers’ Medicaid Panels Represent the Communities They Serve?

by Anushree Vichare, Qian (Eric) Luo and Mandar Bodas

Healthcare 2025, 13(16), 2062; https://doi.org/10.3390/healthcare13162062 - 20 Aug 2025

Abstract

Disparities in primary care access among Medicaid enrollees may be driven by differences in provider acceptance of Medicaid, yet the extent to which primary care provider (PCP) panels reflect the racial and ethnic diversity of local Medicaid populations is unknown. Objectives: To [...] Read more.

Disparities in primary care access among Medicaid enrollees may be driven by differences in provider acceptance of Medicaid, yet the extent to which primary care provider (PCP) panels reflect the racial and ethnic diversity of local Medicaid populations is unknown. Objectives: To quantify the alignment between the racial/ethnic composition of PCP Medicaid panels and the underlying Medicaid population in their service areas. Methods: We conducted a cross-sectional analysis of 2019 Transformed Medicaid Statistical Information System Analytic Files from 44 states focusing on non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic enrollees. We calculated a panel representation ratio (PRR) for each PCP (physicians, nurse practitioners, and physician associates) as the proportion of a racial/ethnic group in their panel divided by that group’s proportion in the county Medicaid population. PRRs > 1 indicate overrepresentation; PRRs < 1, underrepresentation. Analyses were stratified by provider specialty, rurality, and Health Professional Shortage Area (HPSA) status. Results: The study sample included 372,320 PCPs from the following professions: nurse practitioners (NPs) and physician associates (PAs), along with physicians from the following specialties: family physicians (FPs), internal medicine physicians (IM), obstetrician gynecologists (ObGyn), and pediatricians (Peds). In the full sample, PRR was 1.28 for NHW enrollees, but less than one for NHB (0.98) and Hispanic (0.82) enrollees. Across provider specialties and professions, NHW enrollees were overrepresented in both rural and urban areas. In rural areas, NHB enrollees were overrepresented, but Hispanic enrollees remained underrepresented regardless of Health Professional Shortage Area (HPSA) status. In urban areas, both NHB and Hispanic enrollees were underrepresented in provider panels. Conclusions: Medicaid PCP panels do not reflect the racial/ethnic diversity of local Medicaid populations, particularly for NHB and Hispanic enrollees in urban settings. Efforts to improve equitable access to primary care must address these disparities in provider panel composition. Full article

(This article belongs to the Section Health Policy)

► Show Figures

Figure 1

12 pages, 657 KiB

Open AccessArticle

Sexual Dysfunction in Breast Cancer Survivors: The Role of Clinical, Hormonal, and Psychosocial Factors

by Pınar Karaçin and İrem Küçükşahin

Healthcare 2025, 13(16), 2061; https://doi.org/10.3390/healthcare13162061 - 20 Aug 2025

Abstract

Background and Objectives: This study aims to investigate female sexual dysfunction (FSD) and the clinical, pathological, and social factors affecting it in women diagnosed with non-metastatic breast cancer. Materials and Methods: The study included patients over the age of 18 who were followed [...] Read more.

Background and Objectives: This study aims to investigate female sexual dysfunction (FSD) and the clinical, pathological, and social factors affecting it in women diagnosed with non-metastatic breast cancer. Materials and Methods: The study included patients over the age of 18 who were followed up between January 2020 and December 2024, diagnosed with breast cancer at least 12 months previously, and treated. The Female Sexual Function Index (FSFI) and its six subheadings (desire, arousal, lubrication, orgasm, satisfaction, and pain) were used to assess sexual dysfunction, and the Hospital Anxiety and Depression Scale (HADs) was used to assess depression. Results: FSD was identified in 86.6% of the 217 patients (mean FSFI score: 20.38). Among women undergoing breast cancer treatment, being over 45 years of age (p = 0.003) and the use of luteinizing hormone-releasing hormone (LHRH) agonists (p < 0.001) were significantly associated with reduced sexual desire. Conversely, premenopausal status (p = 0.012) was associated with increased sexual satisfaction. Independent risk factors for FSD included age, menopausal status, use of LHRH agonists, income level, and axillary dissection. Furthermore, depression was found to have a significant negative impact on sexual desire, lubrication, and orgasm. Conclusions: This study demonstrates that sexual dysfunction is common among women undergoing treatment for breast cancer and is influenced by numerous clinical and social factors. These findings highlight the need for strategic interventions to reduce the adverse effects of treatment processes on the sexual health of women with breast cancer. Full article

► Show Figures

Figure 1

11 pages, 212 KiB

Open AccessArticle

Impact of Volume Control Biosensors on Blood Pressure During Haemodialysis: A Quasi-Experimental Study

by Veronica Gimeno-Hernan, Carla Perez-Ingidua, Ana Belen Rivas-Paterna, Natividad Codesal-Sanabria, Guillermo Perez-Duque, Ana Ascaso-del-Rio and Ismael Ortuño-Soriano

Healthcare 2025, 13(16), 2060; https://doi.org/10.3390/healthcare13162060 - 20 Aug 2025

Abstract

Background: Intradialytic hypotension is a common complication in haemodialysis, affecting up to 30% of sessions. It results from an imbalance between ultrafiltration and compensatory mechanisms, such as vascular tone and plasma refilling. Volume-controlled biosensors allow for the continuous monitoring of the haemoconcentration, enabling [...] Read more.

Background: Intradialytic hypotension is a common complication in haemodialysis, affecting up to 30% of sessions. It results from an imbalance between ultrafiltration and compensatory mechanisms, such as vascular tone and plasma refilling. Volume-controlled biosensors allow for the continuous monitoring of the haemoconcentration, enabling early detection and prevention of hypotension. Methods: A quasi-experimental study was conducted to assess the effectiveness of biosensors in reducing hypotensive episodes. Two biosensors were compared: the Blood Volume Monitor and the Haemomaster system. Data were collected over two four-month periods: before and after biosensor implementation. Nursing staff received specific training, and a protocol for consistent data collection was established. Informed consent was obtained from all eligible participants. The incidence of intradialytic hypotension was compared between sessions with and without biosensor use. Additionally, outcomes were analysed according to biosensor type. Results: A total of 2262 dialysis sessions from 22 patients were analysed. The cohort was 54.5% male, with a mean age of 60 years (SE = 21); 27.3% had diabetes and 81.8% had hypertension. Post-dilution haemodiafiltration was performed in 62.8% of sessions. Intradialysis hypotension occurred in 11.2% of sessions using biosensors compared to 14.0% without (p = 0.021). No significant difference was found between biosensor types (10.8% vs. 11.8%; p = 0.531), although device 1 reached a significantly lower critical blood volume (mean: 10 litres; SE = 4 vs. 16 litres; SE = 5; p = 0.000). Conclusions: Biosensor use was associated with fewer hypotensive episodes and greater haemodynamic stability. These findings support their integration into routine dialysis practice to improve treatment, safety, and individualised care. Full article

(This article belongs to the Special Issue Bridging the Gap in Nephrology Nursing: Addressing the Growing Burden of Chronic Kidney Disease)

11 pages, 711 KiB

Open AccessArticle

Therapeutic Plasma Exchange in Acute Liver Failure: A Real-World Study in Mexico

by Jose Carlos Gasca-Aldama, Jesús Enrique Castrejón-Sánchez, Mario A. Carrasco Flores, Enzo Vásquez-Jiménez, Paulina Carpinteyro-Espin, Juanita Pérez-Escobar, Karlos Dhamian Gutierrez-Toledo, Pablo E. Galindo, Marcos Vidals-Sanchez and Paula Costa-Urrutia

Healthcare 2025, 13(16), 2059; https://doi.org/10.3390/healthcare13162059 - 20 Aug 2025

Abstract

Background/Objectives: Acute liver failure (ALF) is a life-threatening condition with high mortality in nontransplant candidates. Therapeutic plasma exchange (TPE) has emerged as a promising intervention for removing inflammatory mediators and toxic metabolites. In Latin America, data on the efficacy of TPE in [...] Read more.

Background/Objectives: Acute liver failure (ALF) is a life-threatening condition with high mortality in nontransplant candidates. Therapeutic plasma exchange (TPE) has emerged as a promising intervention for removing inflammatory mediators and toxic metabolites. In Latin America, data on the efficacy of TPE in ALF patients are limited. This real-world study aimed to compare 30-day survival outcomes between patients receiving standard medical treatment (SMT) and those receiving SMT plus TPE. Methods: We analyzed 25 ALF patients admitted to the tertiary intensive care unit (ICU) of Hospital Juárez of Mexico City, Mexico, from 2018 to 2024. Patients received either standard medical treatment (SMT group, n = 12) or SMT with TPE (TPE group, n = 13), including high-volume TPE (n = 8) and standard-volume TPE (n = 5). Survival analysis was performed via Kaplan–Meier estimates, and binomial regression analysis was run to estimate the mortality probability stratified by the hepatic encephalopathy grade. Results: At 30 days, survival was significantly greater in the TPE group (92%) than in the SMT group (50%) (p = 0.02). The greatest survival benefit was observed in patients with Grade 4 encephalopathy. The ICU stay was longer in the TPE group, reflecting the complexity of ALF management. Conclusions: TPE significantly improves 30-day survival in ALF patients compared with SMT alone, supporting its role as an adjunct therapy. Further studies are needed to refine patient selection and optimize treatment protocols. Full article

(This article belongs to the Section Critical Care)

► Show Figures

Figure 1

13 pages, 238 KiB

Open AccessArticle

A Comparative Study of Selected Hospital-Based Health Professionals’ Perceptions of a Learning Organisation in Five South African Districts

by Nombulelo Chitha, Ruth Tshabalala, Onke Mnyaka, Mirabel Nanjoh, Ntiyiso Khosa, Thokoe Makola and Kedibone Maake

Healthcare 2025, 13(16), 2058; https://doi.org/10.3390/healthcare13162058 - 20 Aug 2025

Abstract

Background/Objectives: The concept of learning organisations, which rely on research-based evidence and emphasise employees’ continuous learning and professional development, is essential for effectively managing change and enhancing the quality of services. To better understand the effects of implementing learning organisation principles in [...] Read more.

Background/Objectives: The concept of learning organisations, which rely on research-based evidence and emphasise employees’ continuous learning and professional development, is essential for effectively managing change and enhancing the quality of services. To better understand the effects of implementing learning organisation principles in hospital settings, this study aimed to compare the perceptions of selected health professionals regarding learning organisations across five sub-districts in South Africa’s Eastern Cape province. Methods: This study employed a quantitative, cross-sectional survey design to collect data from selected health professionals in 9 hospitals in Eastern Cape province. Results: Overall, the study showed wide variations in how different healthcare professionals perceived the commitment and communication of department leaders regarding the importance of learning. Key findings showed that 90.9% of dentists agreed that department leaders communicate the importance of learning. In comparison, 68.8% of allied health professionals and 56.5% of pharmacists agreed that department leaders communicated the importance of learning; 21.7% of pharmacists and 25% of allied health professionals disagreed. Conclusions: The study has highlighted significant disparities in the perceptions of selected hospital-based health professionals toward introducing a learning organisation in healthcare facilities. This divergence points to the need for tailored approaches in communicating and implementing LO strategies within hospital settings to ensure that all health professionals are equally engaged and that the benefits of continuous learning are fully realised across disciplines. Full article

18 pages, 767 KiB

Open AccessArticle

Investigating Nutrition and Supportive Care Needs in Esophageal and Gastric Cancer Survivors: A Cross-Sectional Survey

by Fatemeh Sadeghi, Juliette Hussey and Suzanne L. Doyle

Healthcare 2025, 13(16), 2057; https://doi.org/10.3390/healthcare13162057 - 20 Aug 2025

Abstract

Background/Objectives: Advances in cancer diagnosis and treatment improved survivorship rates, but survivors’ long-term quality of life remains a critical concern. Survivors of esophageal and gastric cancer often undergo extensive curative surgery, which can have lasting impacts on nutritional status. This study aimed [...] Read more.

Background/Objectives: Advances in cancer diagnosis and treatment improved survivorship rates, but survivors’ long-term quality of life remains a critical concern. Survivors of esophageal and gastric cancer often undergo extensive curative surgery, which can have lasting impacts on nutritional status. This study aimed to assess the nutritional status, dietary challenges, and supportive care needs of this population of cancer survivors. Methods: In this cross-sectional study, adults diagnosed with esophageal or gastric cancer were invited to complete an anonymous survey to assess their nutritional status, quality of life, and psychological well-being. Results: A total of 114 responses were analyzed. Although over 70% of participants were more than two years post-diagnosis, more than 30% remained at risk of malnutrition. Additionally, over 36% reported ongoing dietary complications such as swallowing difficulties, dumping syndrome, diarrhea, and reflux. Impaired quality of life was observed in 31.7% of respondents, defined as having a global health status score below 66.1 on the EORTC QLQ-C30. Psychological distress was also evident, with over 25% screening positive for anxiety or borderline anxiety, and more than 22% for depression or borderline depression. Conclusions: Malnutrition, gastrointestinal symptoms, impaired quality of life, and psychological distress remain prevalent among esophageal and gastric cancer survivors many years after diagnosis. These findings underscore the need for ongoing monitoring and the provision of targeted supportive care to improve long-term survivorship outcomes. Full article

(This article belongs to the Special Issue Updates on Oncology Rehabilitation)

► Show Figures

Figure 1

17 pages, 2559 KiB

Open AccessSystematic Review

Optical Coherence Tomography Angiography (OCTA) Characteristics of Acute Retinal Arterial Occlusion: A Systematic Review

by Saud Aljohani

Healthcare 2025, 13(16), 2056; https://doi.org/10.3390/healthcare13162056 - 20 Aug 2025

Abstract

Purpose: To systematically review the evidence regarding the characteristics of Optical Coherence Tomography Angiography (OCTA) in acute retinal arterial occlusion (RAO), with a particular focus on vascular alterations across the superficial and deep capillary plexuses, choroid, and peripapillary regions. Methods: A comprehensive [...] Read more.

Purpose: To systematically review the evidence regarding the characteristics of Optical Coherence Tomography Angiography (OCTA) in acute retinal arterial occlusion (RAO), with a particular focus on vascular alterations across the superficial and deep capillary plexuses, choroid, and peripapillary regions. Methods: A comprehensive literature search was performed across PubMed, Web of Science, Scopus, EMBASE, Google Scholar, and the Cochrane Database up to April 2025. The search terms included “Optical coherence tomography angiography,” “OCTA,” “Retinal arterial occlusion,” “Central retinal artery occlusion,” and “Branch retinal artery occlusion.” Studies were included if they evaluated the role of OCTA in diagnosing or assessing acute RAO. Case reports, conference abstracts, and non-English articles were excluded. Two reviewers independently conducted the study selection and data extraction. The methodological quality of the included studies was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Results: The initial search yielded 457 articles, from which 10 studies were ultimately included in the final analysis after a rigorous screening process excluding duplicates, non-English publications, and ineligible articles based on title, abstract, or full-text review. The included studies consistently demonstrated that OCTA is a valuable, noninvasive modality for evaluating microvascular changes in RAO. Key OCTA findings in acute RAO include significant perfusion deficits and reduced vessel density in both the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Several studies noted more pronounced involvement of the SCP compared to the DCP. OCTA parameters, such as vessel density in the macular region, have been found to correlate with visual acuity, suggesting a prognostic value. While findings regarding the foveal avascular zone (FAZ) were mixed, the peripapillary area frequently showed reduced vessel density. Conclusion: Acute RAO is an ocular emergency that causes microvascular ischemic changes detectable by OCTA. This review establishes OCTA as a significant noninvasive tool for diagnosing, monitoring, and prognosticating RAO. It effectively visualizes perfusion deficits that correlate with clinical outcomes. However, limitations such as susceptibility to motion artifacts, segmentation errors, and the lack of standardized normative data must be considered. Future standardization of OCTA protocols and analysis is essential to enhance its clinical application in managing RAO. Full article

► Show Figures

Figure 1

14 pages, 662 KiB

Open AccessArticle

Influence of Teaching Efficacy and Competence on Life Satisfaction in Pre-Service Physical Education Teachers: Is There a Gender Difference?

by Ginés David López-García, María Carrasco-Poyatos, Rut López-Osca and Antonio Granero-Gallegos

Healthcare 2025, 13(16), 2055; https://doi.org/10.3390/healthcare13162055 - 20 Aug 2025

Abstract

Purpose: Grounded in Social Cognitive Theory and Self-Determination Theory, this study analyzed gender differences in the relationships between teachers’ sense of efficacy, basic psychological need satisfaction and frustration (competence), and life satisfaction among Physical Education (PE) pre-service teachers. Method: A sample [...] Read more.

Purpose: Grounded in Social Cognitive Theory and Self-Determination Theory, this study analyzed gender differences in the relationships between teachers’ sense of efficacy, basic psychological need satisfaction and frustration (competence), and life satisfaction among Physical Education (PE) pre-service teachers. Method: A sample of 368 PE pre-service teachers (Mage = 23.41 ± 2.37; 48.1% women) participated. A multi-group structural equation modeling approach was used. Results: Male participants reported significantly higher levels of competence satisfaction compared to their female counterparts. Teaching efficacy positively predicted life satisfaction, both directly and indirectly via competence satisfaction. Notably, the indirect effects were stronger among women, while direct effects were observed only in the female group. Conclusions: The findings emphasize the key role of competence satisfaction in explaining how teaching efficacy influences life satisfaction in pre-service teachers. Gender differences suggest that while both men and women benefit from feeling competent, the pathways differ, highlighting the importance of gender sensitive strategies in teacher education programs. Full article

(This article belongs to the Special Issue Bridging Neuroscience and Cognitive Psychology: Implications for Mental Health and Well-Being)

► Show Figures

Figure 1

12 pages, 230 KiB

Open AccessArticle

Empathy in Future Nurses: Insights for Healthcare Management from a Greek Student Sample

by Kejsi Ramollari and Nikolaos Kontodimopoulos

Healthcare 2025, 13(16), 2054; https://doi.org/10.3390/healthcare13162054 - 20 Aug 2025

Abstract

Background/Objectives: Empathy is a core competency in nursing, contributing to patient care quality and professional resilience. This study investigated empathy levels among Greek undergraduate nursing students at the University of Peloponnese and examined the personal and educational factors that contribute to empathic development. [...] Read more.

Background/Objectives: Empathy is a core competency in nursing, contributing to patient care quality and professional resilience. This study investigated empathy levels among Greek undergraduate nursing students at the University of Peloponnese and examined the personal and educational factors that contribute to empathic development. Methods: A cross-sectional survey was conducted with 144 students from all academic years using the Jefferson Scale of Physician Empathy—Health Professions (JSPE-HP) and the SF-12 Health Survey. Data were analyzed using ANOVA and stepwise multiple linear regression. Results: Mean empathy scores were relatively high (M = 110.31, SD = 10.52). Empathy increased significantly with academic progression (p < 0.001), and higher scores were associated with parental status (p = 0.030) and better mental health (p = 0.044). Conversely, students with a chronically ill close contact reported lower empathy (p = 0.018). Regression analysis identified having children and exposure to chronic illness as significant predictors. Conclusions: Educational progression, life experience, and well-being are key contributors to empathy development. These insights support strategies to enhance empathy through curriculum design, student support, and wellness programs. Integrating empathy training into management policy can foster professional growth, reduce burnout, and improve patient care and workforce sustainability. Full article

14 pages, 604 KiB

Open AccessPerspective

International Partnerships in AI-Driven Healthcare: Opportunities and Challenges for Advancing the UN Sustainable Development Goals—A Perspective

by Tao Yun and Le Zhang

Healthcare 2025, 13(16), 2053; https://doi.org/10.3390/healthcare13162053 - 20 Aug 2025

Abstract

Artificial Intelligence (AI) is reshaping global healthcare systems by offering innovative solutions to improve diagnostic accuracy, optimize treatment planning, and enhance public health management. This article provides a structured perspective on the role of international partnerships in accelerating the adoption of AI-driven healthcare, [...] Read more.

Artificial Intelligence (AI) is reshaping global healthcare systems by offering innovative solutions to improve diagnostic accuracy, optimize treatment planning, and enhance public health management. This article provides a structured perspective on the role of international partnerships in accelerating the adoption of AI-driven healthcare, with a focus on advancing the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being). Drawing on representative global initiatives, the paper explores best practices in technology transfer, ethical data sharing, and capacity building—key enablers for inclusive and equitable AI healthcare adoption. It further analyzes common challenges such as digital infrastructure gaps, regulatory fragmentation, and global inequities in data and talent. Through a synthesis of recent collaborations and policy frameworks, this article offers actionable insights for fostering global alliances that bridge innovation with healthcare accessibility. Full article

(This article belongs to the Special Issue UN Sustainable Development Goals (SDGs) Beyond 2030 Agenda: The Role of International Partnerships and Alliances Towards Equitable Access to Care)

► Show Figures

Figure 1

16 pages, 438 KiB

Open AccessArticle

Psychometric Evaluation of the Validity and Reliability of the Italian Version of the London Measure of Unplanned Pregnancy Amongst Postnatal Women

by Martina Smorti, Paul Christiansen, Geraldine Barrett, Jennifer A. Hall, Chiara Ionio, Giulia Ciuffo, Marta Landoni, Anna Maria Della Vedova, Elana Payne, Mia Richell, Semra Worrall, Giulia Mauri, Victoria Fallon, Alessandra Bramante and Sergio A. Silverio

Healthcare 2025, 13(16), 2052; https://doi.org/10.3390/healthcare13162052 - 20 Aug 2025

Abstract

Background: Unplanned pregnancy is a public health issue and understanding women’s decision making aids practitioners in assessing fertility trends, contraception use, and family planning counselling. In Italy, Catholicism reinforces ‘natural reproduction’ and ‘traditional’ contraception, making it an ‘Imperfect Contraceptive Society.’ A valid [...] Read more.

Background: Unplanned pregnancy is a public health issue and understanding women’s decision making aids practitioners in assessing fertility trends, contraception use, and family planning counselling. In Italy, Catholicism reinforces ‘natural reproduction’ and ‘traditional’ contraception, making it an ‘Imperfect Contraceptive Society.’ A valid and reliable measure of pregnancy intentionality is increasingly important, and the London Measure of Unplanned Pregnancy (LMUP) has proved effective. Objectives and Methods: This study comprised four stages: (1) English–Italian translation and back-translation to create the Italian version [LMUP-IT]; (2) online data collection from postnatal women; (3) evaluation of its psychometric properties (targeting, reliability, construct validity via CFA and measurement invariance with a UK sample, ‘known groups’ hypothesis testing); and (4) exploratory analysis of its associations with perinatal mental health. The sample comprised 450 postnatal women (M_age = 33.6 ± 4.5). Results: The LMUP-IT was shown to be reliable (ωT = 0.81, α = 0.76), with acceptable targeting. Measurement invariance testing confirmed consistency with the UK sample in factor structure, loadings, intercepts, and errors. LMUP-IT scores significantly correlated with well-known indicators of perinatal mental health. Conclusions: Overall, the LMUP-IT is a reliable measure of pregnancy intention in Italian for postpartum women. Understanding pregnancy intention will help healthcare professionals tailor interventions to better support women’s mental health during the transition to motherhood. Full article

► Show Figures

Figure 1

23 pages, 1743 KiB

Open AccessArticle

Trends in Pediatric Malpractice Claims at a Tertiary Children’s Hospital

by Beatrice Defraia, Simone Faccioli, Emanuele Gori, Barbara Gualco, Rossella Grifoni, Massimo Pacitti, Fortuna Pierro, Ilaria Lombardi, Vilma Pinchi and Martina Focardi

Healthcare 2025, 13(16), 2051; https://doi.org/10.3390/healthcare13162051 - 19 Aug 2025

Abstract

Background: Examining medico-legal cases within hospitals aids in identifying care-related problems, facilitating necessary corrections and emphasizing successful preventive measures. The case of Meyer Children’s Hospital is particularly noteworthy as it offers insights into the evolution of litigation in regard to a tertiary [...] Read more.

Background: Examining medico-legal cases within hospitals aids in identifying care-related problems, facilitating necessary corrections and emphasizing successful preventive measures. The case of Meyer Children’s Hospital is particularly noteworthy as it offers insights into the evolution of litigation in regard to a tertiary pediatric hospital. Methods: The study sample comprised 158 malpractice claims received by Meyer Children’s Hospital from 1 January 2010 to 31 December 2023, which were managed by the Claims Management Committee (CMC) responsible for civil liability within the hospital. In this observational retrospective study, the following variables were analyzed: (1) The characteristics of the patients (age–sex) and the manner in which they interacted with the hospital, ultimately resulting in the compensation claim (method of access, area of specialty, outcomes based on the International Classification of Patient Safety (ICPS)). (2) Medico-legal factors: the details of the compensation claim, the significant issues noted in various cases, and the findings of the medico-legal inquiry conducted by the CMC. In cases of ADR (Alternative Dispute Resolution), we evaluated the nature of the procedure, the results, and the amount of compensation awarded. Results: We conducted a descriptive statistical analysis to delineate the trend of claims and identify specific deficiencies within structures or departments over time. Invasive procedures and surgical operations were identified as the leading causes of accidents, resulting in heightened mortality rates and serious injuries. The most common errors observed were diagnostic and therapeutic. Conclusions: The data that emerged highlighted a low rate of claims (11.28/year) and a low claim/service ratio (0.0002%), suggesting a high level of safety of patient care at the hospital. The acceptance rate (32%), the percentage of rejected cases (48/158~30% of total, or 48/99~49% of resolved claims), the average compensation (EUR 68,312), and the percentage of cases (92%) with judicial opinions consistent with those of the CMC indicate a tendency to pursue exploratory compensation requests and the effectiveness of CMC’s activity. Meanwhile, the predominant error types (surgical and diagnostic) are in accordance with national and international data. Finally, the scarcity of disputes concerning informed consent reflects the impressive effectiveness of the communication strategies utilized by the pediatricians at this center. Full article

(This article belongs to the Topic Health Services Optimization, Improvement, and Management: Worldwide Experiences)

► Show Figures

Figure 1

19 pages, 2498 KiB

Open AccessArticle

Evaluation of Motor Control Through Functional Movement Patterns of the Lumbar Spine Among Elite Special Forces Operators: A Pilot Study

by Rita Hansdorfer Korzon, Jolanta Szamotulska, Piotr Wąż, Maciej Śliwiński, Jakub Ławnicki and Rafał Studnicki

Healthcare 2025, 13(16), 2050; https://doi.org/10.3390/healthcare13162050 - 19 Aug 2025

Abstract

Background: A comprehensive physical therapy process includes prevention against musculoskeletal overload syndromes. Monitoring the occurrence of motor control disorders is one of the tools for preventing overload syndromes of the musculoskeletal system and consequent injuries. Assessing motor control and preventive actions can [...] Read more.

Background: A comprehensive physical therapy process includes prevention against musculoskeletal overload syndromes. Monitoring the occurrence of motor control disorders is one of the tools for preventing overload syndromes of the musculoskeletal system and consequent injuries. Assessing motor control and preventive actions can contribute to minimizing the risk of a soldier being removed from duty, reducing the likelihood of injury and thus preventing job loss. The aim of the study was to evaluate directional control of the lumbar spine using the dissociation tests included in the Kinetic Control physiotherapy method. This physiotherapeutic method is used to identify and assess the occurrence and therapy of motor control disorders, including uncontrolled movement in the locomotor system. Methods: Twenty-three soldiers (40.26 ± 4.5 age) from special units of the Polish Armed Forces were qualified for a one-time assessment. The research methods included the evaluation of motor control using dissociation tests based on the physiological method of kinetic control. The control of the lumbar spine in the directions of flexion, extension, and rotation during hip joint movements was evaluated. Uncontrolled movement was understood as the inability to maintain a stationary lumbar spine in a neutral position during specific directions of hip joint movement included in the tests. Results: The survey showed that the area of pain reported by the operators was the lumbar spine in the last three months. 69.57% of the respondents indicated that this area was the site of their complaints. The results of the motor examination showed statistically significant test results (p-value < 0.0001) indicating the presence of motor control disorders in the form of uncontrolled movement of the lumbar spine in control tests for flexion, rotation, and extension. Conclusions: The main results of the present study showed the appearance of interference with the functional movement patterns of the lumbar spine in a group of special unit operators. Impaired control of movement was observed in the direction of flexion, rotation, and lumbar extension, which may be potentially associated with the generation of lumbar spine pain syndromes. Full article

(This article belongs to the Special Issue Advances in Manual Therapy: Diagnostics, Prevention and Treatment)

► Show Figures

Figure 1

15 pages, 259 KiB

Open AccessArticle

Mind–Body Practices for Mental Health in Higher Education: Breathing, Grounding, and Consistency Are Essential for Stress and Anxiety Management

by Kristian Park Frausing, Manja Harsted Flammild and Jesper Dahlgaard

Healthcare 2025, 13(16), 2049; https://doi.org/10.3390/healthcare13162049 - 19 Aug 2025

Abstract

Background and objectives: Mental health issues such as anxiety and stress are prevalent in educational settings, highlighting the need for individualized, scalable interventions. Mind–body approaches are promising for distress management, and this study explored which body-based strategies students found effective. Methods: [...] Read more.

Background and objectives: Mental health issues such as anxiety and stress are prevalent in educational settings, highlighting the need for individualized, scalable interventions. Mind–body approaches are promising for distress management, and this study explored which body-based strategies students found effective. Methods: A cross-sectional study assessed mental health and the use of body-based coping strategies among 152 primarily female students, age 21–52, in the Educational Program for Psychomotor Therapy, a group familiar with such strategies. An electronic survey assessed well-being (WHO-5), stress (PSS-10), anxiety (HADS-A), and use of 13 mind–body practices (e.g., breathing, grounding, muscle relaxation). Participants were grouped by mental health risk and a logistic regression explored associations with coping strategy use. Results: High-frequency use of more body-based strategies predicted lower odds of being in the high-risk group (p = 0.039), while sporadic use of more strategies predicted high mental health risk (p = 0.022). Breathing and grounding were the most frequently used and helpful practices, with minimal barriers. High-risk students cited capability concerns and time as barriers, while all participants mentioned forgetting to use the practices. Conclusions: High-risk students use a broader range of practices sporadically, whereas low-risk students adopt selected strategies more consistently. Proper integration of practices through education and training may be crucial for enhancing their efficacy. Full article

(This article belongs to the Special Issue Caring for the Mental Health of Higher Education Students: Coping Strategies and Well-Being Support)

► Show Figures

Figure 1

21 pages, 563 KiB

Open AccessReview

Addressing Patient–Provider Communication Gaps in Vanishing Twin Syndrome: Implications for Patient Care and Clinical Guidelines

by Nichole M. Cubbage, Samantha L. P. Schilit, Allison Groff, Stephanie Ernst and Marc A. Nascarella

Healthcare 2025, 13(16), 2048; https://doi.org/10.3390/healthcare13162048 - 19 Aug 2025

Abstract

Background: Vanishing twin syndrome (VTS) represents a complex and under-recognized phenomenon in multifetal pregnancies, associated with both clinical uncertainty and significant psychosocial impact. Despite its frequency, gaps remain in diagnostic clarity, international guidelines, and communication strategies with patients and families. Materials and [...] Read more.

Background: Vanishing twin syndrome (VTS) represents a complex and under-recognized phenomenon in multifetal pregnancies, associated with both clinical uncertainty and significant psychosocial impact. Despite its frequency, gaps remain in diagnostic clarity, international guidelines, and communication strategies with patients and families. Materials and Methods: This hybrid review integrates narrative and systematic elements to assess the diagnostic, clinical, and psychosocial gaps in VTS. A systematic literature search was conducted across Medline/PubMed, CINAHL, PsycINFO, EBM Reviews, and Scopus using terms such as “vanishing twin syndrome,” “patient-provider communicat*,” and “bereave* care.” Sources included systematic reviews, randomized controlled trials, cohort studies, and qualitative studies. Exclusion criteria were outdated publications (>10 years old). Results: Evidence revealed multiple domains of concern. Clinical risks and diagnostics remain poorly defined, with inconsistent recognition of maternal and neonatal complications. Psychosocial impacts were prominent, encompassing grief, identity disruption, and unmet support needs. Patient–provider communication was frequently inadequate, with insufficient training and lack of standardized language. International guidelines varied widely in scope, with only a few of them providing clear recommendations for bereavement care in multifetal loss contexts. Discussion: Emerging discourse highlights the limitations of the traditional fission model and alternative conceptual frameworks, such as Herranz’s model, for understanding VTS. These theoretical differences underscore the need for precise terminology and consistent diagnostic practices. Clinical implications extend to prenatal screening, obstetric management, and the integration of psychosocial support. Patient-centered communication and structured support initiatives (e.g., the Butterfly Project) demonstrate the potential to bridge communication gaps and improve care experiences. Conclusions: VTS requires recognition as both a medical and psychosocial condition. Improved clinical definitions, harmonized international guidelines, and emphasis on empathetic communication are essential to address the current gaps. Integrating these elements into practice may enhance patient outcomes and provide families with validation and support following multifetal loss. Full article

► Show Figures

Figure 1

18 pages, 1323 KiB

Open AccessArticle

When Age Matters: How Regulatory Emotional Self-Efficacy in Managing Negative Emotions Can Mitigate the Effects of Emotional Inertia for Younger Workers

by Simone Tavolucci, Lorenzo Filosa, Valentina Sommovigo, Valentina Rosa, Fabio Alivernini, Roberto Baiocco, Anna Borghi, Andrea Chirico, Chiara Fini, Tommaso Palombi, Jessica Pistella, Fabio Lucidi and Guido Alessandri

Healthcare 2025, 13(16), 2047; https://doi.org/10.3390/healthcare13162047 - 19 Aug 2025

Abstract

Background/Objectives: Negative emotional inertia describes the extent to which a prior emotional state can predict the subsequent one, and it is considered a significant indicator of psychological maladjustment that has several negative consequences in the workplace. The current study tested a theoretical [...] Read more.

Background/Objectives: Negative emotional inertia describes the extent to which a prior emotional state can predict the subsequent one, and it is considered a significant indicator of psychological maladjustment that has several negative consequences in the workplace. The current study tested a theoretical model in which the inertia of negative emotions is moderated by regulatory emotional self-efficacy beliefs (RESE) in managing negative affects across workers of different ages. Specifically, we hypothesized that RESE moderates the relation between negative emotions at consecutive time points, reducing their persistence, and that age would influence this relation, with older workers relying less on this resource than younger ones. Methods: Participants were 221 workers (57.8% females) exposed to social work stressors who reported their affectivity every evening for 31 consecutive days. We analyzed the data using dynamic structural equation models (DSEM), which enable examining within-person time series trends while estimating individual differences therein. Results/Conclusions: In line with our predictions, results suggest that emotional self-efficacy is a key personal resource that might be able to buffer individuals from emotional stasis, a resource primarily useful for younger workers who rely less on actual emotional regulation expertise than older adults. Full article

(This article belongs to the Special Issue The Role of Psychological, Environmental, and Social Factors in the Promotion of Older Adults’ Health and Well-Being)

► Show Figures

Figure 1

Journal Description

Healthcare

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Topical Collections

Further Information

Guidelines

MDPI Initiatives

Follow MDPI