Healthcare

18 pages, 822 KiB

Open AccessSystematic Review

Virtual Care Perceptions and Experiences of Older Adults During COVID-19 in Canada: A Systematic Review

by Donna Gao, Angela Xu and Lixia Yang

Healthcare 2025, 13(15), 1937; https://doi.org/10.3390/healthcare13151937 (registering DOI) - 7 Aug 2025

Background/Objectives: Older adults (65+) are the fastest growing age group in Canada, comprising 18.8% of the country’s population. During the COVID-19 pandemic, use of virtual care, including telehealth and tele-medicine, increased dramatically among older adults in Canada who often face higher health [...] Read more.

Background/Objectives: Older adults (65+) are the fastest growing age group in Canada, comprising 18.8% of the country’s population. During the COVID-19 pandemic, use of virtual care, including telehealth and tele-medicine, increased dramatically among older adults in Canada who often face higher health risks, mobility limitations, and many barriers to accessing healthcare. Despite the rapid expansion in virtual care, no systematic review has focused specifically on virtual care among older adults in Canada. This review aims to explore the factors influencing virtual care adoption and the experiences of older Canadians during the pandemic through a systematic review. Methods: Conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, the review involved a comprehensive search of PubMed, Scopus, ESCBOHost, and Web of Science on 2 May 2025, yielding 281 unique citations. After screening and applying eligibility criteria, 15 studies employing quantitative, qualitative, or mixed-methods designs, with sample sizes ranging from 15 to 2,282,798, were included and appraised using the Mixed Methods Appraisal Tool (MMAT). Results: The review identified three domains of factors and the ways in which each factor shapes older adults’ virtual care experiences: (1) personal factors influencing virtual care use and demand (e.g., age, education, language, income, immigration status, community sizes), (2) resource factors impacting virtual care adoption (e.g., technology access, support), and (3) varying virtual care experiences among older adults (e.g., in assessment and communication efficacy, privacy, care quality, convenience, safety, and costs). Conclusions: This review highlights the complexities of virtual care engagement among older adults and underscores the need for inclusive, tailored strategies to improve the accessibility and effectiveness of virtual care delivery in both pandemic and post-pandemic contexts. Full article

(This article belongs to the Special Issue Aging and Older Adults’ Healthcare)

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17 pages, 682 KiB

Open AccessArticle

“What You Leave…Will Leave You”: A Qualitative Study of Perceptions of Midwifery’s Intangible Heritage and Professional Identity Among Midwives and Student Midwives in Cyprus

by Maria Panagiotou, Eleni Hadjigeorgiou, Stavros Vryonides, Maria Karanikola, Anastasios Merkouris and Nicos Middleton

Healthcare 2025, 13(15), 1936; https://doi.org/10.3390/healthcare13151936 - 7 Aug 2025

Abstract

Background: Midwifery’s Intangible Heritage was officially recognized by the United Nations Educational, Scientific and Cultural Organization on 6 December 2023, highlighting that elements of midwifery knowledge and practice, shaped over generations, constitute cultural heritage worth safeguarding. While previous studies have investigated midwives’ perceptions [...] Read more.

Background: Midwifery’s Intangible Heritage was officially recognized by the United Nations Educational, Scientific and Cultural Organization on 6 December 2023, highlighting that elements of midwifery knowledge and practice, shaped over generations, constitute cultural heritage worth safeguarding. While previous studies have investigated midwives’ perceptions of professional identity, none have done so within the explicit framework of MIH. Objective: this study explored how midwives and student midwives in Cyprus perceive the intangible heritage of their profession and how it relates to their shared professional identity. Methods: A qualitative descriptive study was conducted between April and July 2023. Three focus groups were held, involving 22 participants: 15 registered midwives and 7 student midwives. A semi-structured interview guide consisting of 10 questions was used, developed by the lead author (M.P.) based on the literature and improvisation and finalized with the research team (E.H., S.V., N.M.) after expert input. Thematic analysis was performed inductively to identify recurrent themes. Results: Four major themes emerged: (1) key elements of Midwifery’s Intangible Heritage and their transmission across generations; (2) a sense of shared professional identity; (3) perceived threats to the midwifery profession; and (4) midwives’ expectations for the future of the profession. Conclusions: The findings reflect the historical background of midwifery in Cyprus and its contrast with contemporary practice, particularly within the context of the overmedicalization of birth and societal perceptions of midwifery in the socio-cultural setting. Safeguarding Midwifery’s Intangible Heritage requires both empowering women to seek midwifery-led care and enabling midwives to practice autonomously within their full professional scope. In addition, policymakers and educational bodies must support the preservation of midwives’ core skills through targeted educational curricula, structured mentorship, and continuous professional development. Full article

(This article belongs to the Section Women's Health Care)

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10 pages, 214 KiB

Open AccessArticle

Pacifier Usage Among Saudi Children: A Cross-Sectional Study in Jeddah, Saudi Arabia

by Sara M. Bagher, Logain Alattas, Haneen Bakhaidar, Najat M. Farsi, Shahad N. Abudawood and Heba Jafar Sabbagh

Healthcare 2025, 13(15), 1935; https://doi.org/10.3390/healthcare13151935 - 7 Aug 2025

Abstract

Background/Objectives: Pacifier use in infants has both beneficial and harmful implications, and dipping pacifiers in sweeteners is used by some parents to soothe infants. This study aimed to assess pacifier usage among mothers in Jeddah, Saudi Arabia, and to examine its association with [...] Read more.

Background/Objectives: Pacifier use in infants has both beneficial and harmful implications, and dipping pacifiers in sweeteners is used by some parents to soothe infants. This study aimed to assess pacifier usage among mothers in Jeddah, Saudi Arabia, and to examine its association with child demographics, maternal socioeconomic status (SES), and maternal knowledge of the risks associated with dipping pacifiers in sweeteners. Methods: A cross-sectional study was conducted among mothers of healthy children aged 2 to 4 years during community-awareness events in Jeddah. Participants completed a validated Arabic questionnaire covering pacifier use patterns, feeding practices, SES background, and knowledge regarding the adverse effects of pacifier sweetening. Results: A total of 1438 mothers participated. The mean age of children was 34.3 ± 10.7 months, with 441 children (30.7%) reported as pacifier users. Among them, 202 (45.8%) used pacifiers both during the day and at night. Most children (35.6%) discontinued use between 4 and 6 months of age. Only 6.1% of mothers reported adding sweeteners to pacifiers. Pacifier usage was significantly higher among first-born children (37.6%, p < 0.001), those who received both bottle- and breastfeeding (65.5%, p < 0.001), and children enrolled in nursery (62.1%, p = 0.007). Most mothers (75.6%) were aware of the link between sweetened pacifiers and dental caries, and 69.4% of those who had this knowledge avoided giving their child a pacifier (p = 0.077). Conclusions: Birth order, feeding practices, and nursery attendance are key predictors of pacifier use. Enhancing parental awareness and education may support early interventions to promote healthier oral and feeding habits in young children. Full article

(This article belongs to the Special Issue Oral Medicine in Focus: Improving Diagnosis and Treatment Through Continued Education)

14 pages, 702 KiB

Open AccessArticle

Patient Safety Culture of Hospitals in Southern Laos: A Cross-Sectional Study Using the Hospital Survey on Patient Safety Culture

by Miho Sodeno, Moe Moe Thandar, Somchanh Thounsavath, Olaphim Phouthavong, Masahiko Hachiya and Yasunori Ichimura

Healthcare 2025, 13(15), 1934; https://doi.org/10.3390/healthcare13151934 - 7 Aug 2025

Abstract

Background: Patient safety culture is critical for enhancing the quality and safety of healthcare. Studies in low- and middle-income countries have reported challenges in developing patient safety culture, especially in implementing nonpunitive responses to errors and event reporting. However, evidence from Laos remains [...] Read more.

Background: Patient safety culture is critical for enhancing the quality and safety of healthcare. Studies in low- and middle-income countries have reported challenges in developing patient safety culture, especially in implementing nonpunitive responses to errors and event reporting. However, evidence from Laos remains limited. Objectives: This study aimed to assess patient safety culture in hospitals in southern Laos, using a validated survey tool to identify strengths and areas of improvement. Methods: A cross-sectional study using purposive sampling was conducted in four provincial and twenty-three district hospitals in southern Laos. Healthcare workers on patient safety committees responded to the Hospital Survey on Patient Safety Culture. The positive response rate was analyzed. Bivariate tests (chi-square/Fisher’s exact) were applied to compare positive response rates between hospital types and professions. Results: A total of 253 valid responses (75.5%) were analyzed. “Organizational Learning–Continuous Improvement” scored over 75% in both provincial and district hospitals. In contrast, “Nonpunitive Response to Error” and “Frequency of Events Reported” were scored <20% on average. Provincial hospitals scored significantly higher than district hospitals in supervisory support and handoffs. Conclusions: This study illustrated strengths in organizational learning while identifying nonpunitive responses and event reporting as critical areas of improvement for hospitals in Laos. To improve patient safety, hospitals in Laos must promote a culture in which errors can be reported without fear of blame. Strengthening leadership support and reporting systems is essential. These findings can inform strategies to enhance patient safety in other low-resource healthcare settings. Full article

(This article belongs to the Special Issue Advancing Healthcare Delivery and Patient Quality of Care Through Healthcare Professionals’ Development)

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21 pages, 452 KiB

Open AccessSystematic Review

Mental Health Issues in Undercover Police Officers: A Systematic Literature Search from a Psychiatric Perspective

by Giulia Moretti, Lucrezia Cavagnis, Emma Flutti, Serena Silvestri and Guido Vittorio Travaini

Healthcare 2025, 13(15), 1933; https://doi.org/10.3390/healthcare13151933 - 7 Aug 2025

Abstract

Background: Undercover police work is a psychologically high-risk profession that exposes officers to chronic stress, identity conflicts, and moral dilemmas. The aim of the present review is to evaluate the psychological consequences associated with undercover police work, focusing on specific psychopathological risk factors. [...] Read more.

Background: Undercover police work is a psychologically high-risk profession that exposes officers to chronic stress, identity conflicts, and moral dilemmas. The aim of the present review is to evaluate the psychological consequences associated with undercover police work, focusing on specific psychopathological risk factors. Methods: A systematic search was conducted in PubMed, PsycINFO, Web of Science, and Scopus databases. Studies were conducted in the United States, the United Kingdom, New Zealand, and Canada. The present systematic review analyzed data from 380 current undercover operatives, 372 former UCOs, 578 officers without undercover experience, and 60 pre-operational agents. Results: From an initial pool of 365 records, 10 studies were identified, of which 6 met the inclusion criteria. The most frequently reported psychological risk factors included anxiety, hypervigilance, identity issues, dissociative symptoms, and substance misuse. These were assessed using validated self-report instruments (e.g., SCL-90), structured interviews, and clinical evaluations. Long-term consequences were more prominent post-deployment, particularly among former UCOs. Conclusions: Undercover work is associated with an elevated risk of mental health problems, especially after the end of operations. Future research should focus on standardizing assessment tools and identifying protective factors. The findings support the development of targeted interventions such as pre-deployment psychological screening, ongoing monitoring, and structured reintegration programs to safeguard UCOs’ well-being. Full article

(This article belongs to the Section Health Assessments)

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12 pages, 224 KiB

Open AccessReview

Italian Guidelines for Cardiological Evaluation in Competitive Football Players: A Detailed Review of COCIS Protocols

by Umile Giuseppe Longo, Georg Ahlbaumer, Roberto Vannicelli, Emanuele Gregorace, Davide Ortolina, Guido Nicodemi, Daniele Altieri, Arianna Carnevale, Silvia Carucci, Alessandra Colella, Francesco Scalfaro and Erika Lemme

Healthcare 2025, 13(15), 1932; https://doi.org/10.3390/healthcare13151932 - 7 Aug 2025

Abstract

Background: Medical clearance for competitive sports is vital to safeguarding athletes’ health, particularly in high-intensity disciplines like football. In Italy, fitness assessments follow stringent protocols set by the Commissione di Vigilanza per il controllo dell’Idoneità Sportiva (COCIS), with a strong focus on cardiovascular [...] Read more.

Background: Medical clearance for competitive sports is vital to safeguarding athletes’ health, particularly in high-intensity disciplines like football. In Italy, fitness assessments follow stringent protocols set by the Commissione di Vigilanza per il controllo dell’Idoneità Sportiva (COCIS), with a strong focus on cardiovascular screening. The primary goal is to prevent sudden cardiac death (SCD), a rare but catastrophic event in athletes. Methods: This paper provides an in-depth narrative review of the 2023 COCIS guidelines, examining the cardiological screening process, required diagnostic tests, management of identified cardiovascular conditions, and the protocols’ role in reducing SCD risk. Results: Comparisons with international standards underscore the effectiveness of the Italian approach. Conclusions: The COCIS 2023 guidelines provide clear, evidence-based protocols for cardiovascular risk assessment, significantly enhancing athlete safety and reducing the incidence of SCD in high-intensity sports. Full article

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

16 pages, 229 KiB

Open AccessArticle

The Multi-Level Influencing Factors of Internet Use Among the Elderly Population and Its Association with Mental Health Promotion: Empirical Research Based on Mixed Cross-Sectional Data

by Yifan Yang and Xinying He

Healthcare 2025, 13(15), 1931; https://doi.org/10.3390/healthcare13151931 - 7 Aug 2025

Abstract

Background: China is confronted with the dual challenges of deeply interwoven population aging and the digitalization process. The digital integration and mental health issues of the elderly group are becoming increasingly prominent. Objectives: The present study aimed to analyze the pathways [...] Read more.

Background: China is confronted with the dual challenges of deeply interwoven population aging and the digitalization process. The digital integration and mental health issues of the elderly group are becoming increasingly prominent. Objectives: The present study aimed to analyze the pathways through which individual, family, and social factors influence Internet use in the elderly through a multi-level analysis framework, to examine the association between Internet use and mental health with a view to providing empirical evidence for digital technology-based mental health intervention programs for the elderly, and to promote the scientific practice of the goal of healthy aging. Methods: Based on the data of the 2021 China General Social Survey (CGSS) and provincial Internet development indicators, a mixed cross-sectional dataset was constructed. Logistic hierarchical regression and OLS regression methods were adopted to systematically investigate the multi-level factors associated with Internet use among the elderly group and its association with mental health. Results: The results indicate that individual resources (younger age, higher education level, and good health status) and family technical support (family members’ Internet access) are strongly associated with Internet usage among the elderly, while regional Internet penetration rate appears to operate indirectly through micro-mechanisms. Analysis of the association with mental health showed that Internet use was related to a lower score of depressive tendency (p < 0.05), and this association remained robust after controlling for variables at the individual, family, and social levels. Conclusions: The research results provide empirical evidence for the health promotion policies for the elderly, advocating the construction of a collaborative intervention framework of “individual ability improvement–intergenerational family support–social adaptation for the elderly” to bridge the digital divide and promote the digital integration of the elderly population in China. Full article

18 pages, 531 KiB

Open AccessArticle

Exploring Empowerment in Group Antenatal Care: Insights from an Insider and Outsider Perspective

by Florence Talrich, Astrid Van Damme, Marlies Rijnders, Hilde Bastiaens and Katrien Beeckman

Healthcare 2025, 13(15), 1930; https://doi.org/10.3390/healthcare13151930 - 7 Aug 2025

Abstract

Background: Empowerment during pregnancy is linked to improved maternal and infant health outcomes and greater maternal well-being. Group Antenatal Care (GANC), a participant-centered model of care, promotes empowerment, active engagement, and the deconstruction of hierarchy between participants and care providers. It combines health [...] Read more.

Background: Empowerment during pregnancy is linked to improved maternal and infant health outcomes and greater maternal well-being. Group Antenatal Care (GANC), a participant-centered model of care, promotes empowerment, active engagement, and the deconstruction of hierarchy between participants and care providers. It combines health assessment, interactive learning, and community building. While empowerment is a core concept of GANC, the ways it manifests and the elements that facilitate it remain unclear. Method: We conducted a generic qualitative study across four organizations in Brussels, using multiple data collection methods. This included interviews with 13 participants and 21 observations of GANC sessions, combining both the insider and outsider perspective. An adapted version of the Pregnancy-Related Empowerment Scale (PRES) guided the interviews guide and thematic analysis. Results: We identified seven themes that capture how empowerment occurs in GANC: peer connectedness, provider connectedness, skillful decision-making, responsibility, sense of control, taking action, and gaining voice. Several aspects of GANC contribute to empowerment, particularly the role of facilitators. Conclusions: This study highlights how GANC enhances empowerment during pregnancy through interpersonal, internal, and external processes. Important components within GANC that support this process include the group-based format and the interactive nature of the discussions. The presence of skillful GANC facilitators is an essential prerequisite. In a diverse and often vulnerable context like Brussels, strengthening empowerment through GANC presents challenges but is especially crucial. Full article

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

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17 pages, 1954 KiB

Open AccessArticle

Personalizing Patient Education for Pancreatic Cancer Patients Receiving Multidisciplinary Care with Integration of Novel Digital Tools

by Nicole Nardella, Matt Adams, Adrianna Oraiqat, Brian D. Gonzalez, Corinne Thomas, Sarah Goodchild, Sonia Adamson, Maria Sandoval, Jessica Frakes, Russell F. Palm, Carrie Stricker, Joe Herman, Pamela Hodul, Sarah Krüg and Sarah Hoffe

Healthcare 2025, 13(15), 1929; https://doi.org/10.3390/healthcare13151929 - 7 Aug 2025

Abstract

Background/Objectives: Pancreatic cancer (PC) is a diagnosis with a poor prognosis which can be associated with significant distress and may hinder a patient’s ability to understand treatment details. Educating patients based on their learning preferences (LPs) and emotions may allow for personalized, enhanced [...] Read more.

Background/Objectives: Pancreatic cancer (PC) is a diagnosis with a poor prognosis which can be associated with significant distress and may hinder a patient’s ability to understand treatment details. Educating patients based on their learning preferences (LPs) and emotions may allow for personalized, enhanced care. Methods: This prospective project enrolled patients with non-metastatic PC. Phase 1 utilized the Learning Preference Barometer (LPB) and Emotional Journey Barometer (EJB), which are digital instruments co-designed by CANCER101 (C101) and the Health Collaboratory, to assess patient LPs and emotional states. Phase 2 provided information prescriptions aligned with LPs through C101’s Prescription to Learn^® (P2L) platform. Collected data included demographics, treatment, LPs (auditory, kinesthetic, linguistic, visual), patient engagement with P2L, and patient emotional states with qualitative verbal validation. Descriptive variables were used to report outcomes. Results: Primary LPs in the 47 participating patients were as follows: linguistic 45%, visual 34%, auditory 11%, and kinesthetic 9%, with secondary preferences in the majority (53%). Those patients (66%) who accessed P2L had linguistic and visual preferences; the majority accessed 1- 2 resources out of the 25 provided. Resources accessed aligned to 88% of patient LPs. The majority of patients (60%) initiated treatment prior to initial EJB, and 40% were treatment naive. Common baseline emotions were optimistic (47% vs. 36%, respectively), satisfied (11% vs. 25%), acceptance (11% vs. 11%), and overwhelmed (5% vs. 11%). Conclusions: Assessing LPs and emotional state allows for personalized patient education and clinical encounters for PC patients. Future work includes examining the effects of personalized approaches on patient satisfaction, decision-making, health outcomes, and the overall patient–clinician relationship. Full article

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17 pages, 560 KiB

Open AccessArticle

Quality of Life and Executive Function Deficits in Inflammatory Arthritis: A Comparative Study of Rheumatoid and Psoriatic Arthritis

by Cigdem Cekmece, Begum Capa Tayyare, Duygu Karadag, Selime Ilgin Sade, Ayse Cefle and Nigar Dursun

Healthcare 2025, 13(15), 1928; https://doi.org/10.3390/healthcare13151928 - 7 Aug 2025

Abstract

Background/Objective: Executive functions (EFs) are essential in the daily management of arthritis, as they influence treatment adherence, decision-making, and the ability to cope with disease-related challenges. The objective of this study was to compare EFs alongside functional status and quality of life in [...] Read more.

Background/Objective: Executive functions (EFs) are essential in the daily management of arthritis, as they influence treatment adherence, decision-making, and the ability to cope with disease-related challenges. The objective of this study was to compare EFs alongside functional status and quality of life in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) and examine their associations with disease activity and clinical variables. Methods: In this cross-sectional study, 140 patients (70 RA, 70 PsA) were assessed using the Stroop-TBAG, Wisconsin Card Sorting Test (WCST), and Adult Executive Functioning Inventory (ADEXI). Functional status and quality of life were measured with the Health Assessment Questionnaire (HAQ) and WHOQOL-BREF, respectively. Correlations with disease activity (DAS28-CRP), age, and disease duration were examined. Results: RA patients had significantly higher disease activity and longer disease duration. They showed poorer performance on the Stroop Test (color–word time: 61.6 ± 14.8 vs. 52.4 ± 10.9 s, p < 0.001; errors: 3.2 ± 2.1 vs. 2.1 ± 1.5, p = 0.001), more WCST perseverative errors (p = 0.002), and higher ADEXI inhibition scores (13.9 ± 2.5 vs. 12.9 ± 3.0, p = 0.013). DAS28-CRP was correlated with EF impairments, disability, and poorer quality of life in RA (p < 0.05). In PsA, EFs remained relatively stable, although higher disease activity was associated with worse HAQ scores (p = 0.001). Treatment type was not linked to EF, but patients on combination therapy reported lower physical (p = 0.009) and psychological (p = 0.014) quality of life, along with higher HAQ scores (p = 0.016). Conclusions: This study revealed that patients with RA exhibit more pronounced executive dysfunction, along with lower ADL skills and quality of life compared to those with PsA. These findings highlight the need for multidimensional assessment strategies in inflammatory arthritis, especially in RA, where cognitive and functional outcomes are closely tied to clinical burden. Full article

(This article belongs to the Special Issue Relationship Between Musculoskeletal Problems and Quality of Life)

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10 pages, 216 KiB

Open AccessArticle

Prevalence, Causes, and Risk Factors of Visual Impairment: Evidence from Duhknah, a Rural Community in Saudi Arabia

by Sulaiman Aldakhil

Healthcare 2025, 13(15), 1927; https://doi.org/10.3390/healthcare13151927 - 7 Aug 2025

Abstract

Background: Visual impairment (VI) continues to be a significant global public health concern, especially in underserved rural communities. Objectives: This study aims to assess the prevalence of VI and refractive errors, as well as to identify the causes and risk factors associated [...] Read more.

Background: Visual impairment (VI) continues to be a significant global public health concern, especially in underserved rural communities. Objectives: This study aims to assess the prevalence of VI and refractive errors, as well as to identify the causes and risk factors associated with VI in Duhknah, a rural area in Qassim Province, Saudi Arabia. Methods: This cross-sectional study, conducted in May 2024, included 929 participants aged 6–90 years from Duhknah, a rural area in Qassim Province, Saudi Arabia. Refractive errors (REs) were measured using a non-cycloplegic autorefractometer. Anterior and posterior eye examinations were performed using slit lamp biomicroscopy, direct ophthalmoscopy, and 90 D fundus biomicroscopy. VI was classified based on the International Classification of Diseases 11th revision (ICD-11), 2018. Results: The findings revealed that 671 (72.2%) participants had never undergone an eye examination. The overall prevalence of presenting VI was 370 (39.8%), comprising 21.6% with mild VI, 11.0% moderate, 4.1% severe, and 3.1% classified as blind. The prevalence of hyperopia, myopia, and astigmatism was 20.6%, 36.9%, and 13.2%, respectively. Uncorrected REs were the most common cause of VI (81.4%), followed by amblyopia (13.5%) and cataracts (3.2%). Regression analysis showed that women had 1.58 times higher odds of VI (p = 0.001). Participants with eye examinations for one year or more had 3.64 times higher odds (p < 0.001). Additionally, the risk of VI was significantly lower among older participants (ages 18–90) compared to younger ones (ages 6–17), (p < 0.001). Conclusions: This study found most participants had never had an eye exam, and VI was highly prevalent in the rural community. These findings underscore the need to strengthen primary eye care in rural Saudi Arabia. Regular vision screening, particularly for children, and better access to refractive services could significantly reduce VI and support the goals of Saudi Vision 2030. Full article

21 pages, 864 KiB

Open AccessReview

Health Education in Mass Gatherings: A Scoping Review to Guide Public Health Preparedness and Practice

by Rania Zaini, Altaf A. Abdulkhaliq, Saleh A. K. Saleh, Heba M. Adly, Salwa Abdulmajeed Aldahlawi, Laila A. Alharbi, Hani M. Almoallim, Nahla H. Hariri, Ismail Ahmad Alghamdi, Majed Sameer Obaid, Amar Mohammad A. Alkhotani, Aous Sami Hayat Alhazmi, Anas A. Khan, Fahad A. Alamri and Mohammed A. Garout

Healthcare 2025, 13(15), 1926; https://doi.org/10.3390/healthcare13151926 - 7 Aug 2025

Abstract

Objectives: In view of a lack of evidence on the subject, we aimed to perform a scoping review to understand the impact of health education among people attending mass gatherings. Methods: We followed the Preferred Reporting Items for Systematic Reviews and [...] Read more.

Objectives: In view of a lack of evidence on the subject, we aimed to perform a scoping review to understand the impact of health education among people attending mass gatherings. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Guidelines. PubMed, EMBASE, Scopus, and Cochrane Library were searched from inception to March 2025 to identify eligible studies. Observational and interventional studies that reported the impact of health education on any health-related outcome among those attending a mass gathering were considered. A narrative synthesis of review results was performed to gather evidence. Recommendations were framed in the context of this evidence. Results: Of the 1731 records, only 17 studies met the inclusion criteria. These included cross-sectional (n = 10), pre-post design (n = 3), quasi-experimental (n = 2), randomized controlled trial (n = 1), and ethnographic (n = 1) studies. These studies involved participants attending hajj, umrah, and basketball events. The current evidence on health education in mass gatherings is highly varied in its objectives, intervention strategy, educational plan, mode of delivery, design, and reported outcomes. Most studies agreed that health education should be initiated by the country of origin and continued throughout the event. It is recommended that this education should be tailored to patient needs based on age, medical condition, and other personal factors, and given in the local language for better acceptability. Such sources can be provided in various forms, either online or offline, as per the participant’s convenience. Conclusions: The current evidence on the effectiveness of health education during mass gatherings, particularly in pilgrimage settings, is varied and inconsistent. Participant-tailored health education should be provided, preferably in the local language, through convenient formats. Full article

(This article belongs to the Special Issue Health Education and Prevention: New Healthcare Perspectives for Emerging Challenges)

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11 pages, 571 KiB

Open AccessArticle

Effects of a Positive Psychology Intervention on Mental Health and Well-Being Among Mothers in Riyadh, Saudi Arabia

by Munira Abdullah AlHugail and Deemah Ateeq AlAteeq

Healthcare 2025, 13(15), 1925; https://doi.org/10.3390/healthcare13151925 - 6 Aug 2025

Abstract

Background: Concerns over women’s mental health have intensified globally, especially among mothers managing dual careers and family responsibilities. Positive Psychology Interventions (PPIs), such as gratitude journaling and well-being workshops, have demonstrated promise in enhancing mental health; however, their applicability in Arab contexts remains [...] Read more.

Background: Concerns over women’s mental health have intensified globally, especially among mothers managing dual careers and family responsibilities. Positive Psychology Interventions (PPIs), such as gratitude journaling and well-being workshops, have demonstrated promise in enhancing mental health; however, their applicability in Arab contexts remains underexplored. This study aims to investigate the effectiveness of PPIs on mothers’ well-being, gratitude, depression, anxiety, and stress in Saudi Arabia. Methods: This quasi-experimental, one-group pretest–posttest study assessed the effects of a four-week PPI on 37 Saudi working mothers (aged 21–50 years) employed at a private school in Riyadh. The intervention included guided gratitude journaling thrice weekly and two workshops on positive psychology and gratitude. Pre- and post-intervention assessments used validated Arabic versions of the Depression Anxiety Stress Scale (DASS-21), WHO-5 Well-being Index, and Gratitude Questionnaire (GQ-6). Results: Significant improvements were found post-intervention: depression, anxiety, and stress scores decreased (p < 0.001), while well-being and gratitude increased (p = 0.001). However, participants with lower household income (<50,000 SAR) showed less improvement, indicating a potential moderating effect of socioeconomic status. Conclusions: The intervention demonstrated promising short-term improvements in mental health and well-being among Saudi mothers. The findings underscore the importance of culturally appropriate PPIs and highlight the need for further research using controlled, long-term designs. Limitations include the small, non-random sample, absence of a control group, and restriction to a single geographic region. Full article

(This article belongs to the Topic Global Mental Health Trends)

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16 pages, 752 KiB

Open AccessSystematic Review

Balancing Accuracy, Safety, and Cost in Mediastinal Diagnostics: A Systematic Review of EBUS and Mediastinoscopy in NSCLC

by Serban Radu Matache, Ana Adelina Afetelor, Ancuta Mihaela Voinea, George Codrut Cosoveanu, Silviu-Mihail Dumitru, Mihai Alexe, Mihnea Orghidan, Alina Maria Smaranda, Vlad Cristian Dobrea, Alexandru Șerbănoiu, Beatrice Mahler and Cornel Florentin Savu

Healthcare 2025, 13(15), 1924; https://doi.org/10.3390/healthcare13151924 - 6 Aug 2025

Abstract

Background: Mediastinal staging plays a critical role in guiding treatment decisions for non-small cell lung cancer (NSCLC). While mediastinoscopy has been the gold standard for assessing mediastinal lymph node involvement, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a minimally invasive alternative [...] Read more.

Background: Mediastinal staging plays a critical role in guiding treatment decisions for non-small cell lung cancer (NSCLC). While mediastinoscopy has been the gold standard for assessing mediastinal lymph node involvement, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a minimally invasive alternative with comparable diagnostic accuracy. This systematic review evaluates the diagnostic performance, safety, cost-effectiveness, and feasibility of EBUS-TBNA versus mediastinoscopy for mediastinal staging. Methods: A systematic literature review was conducted in accordance with PRISMA guidelines, including searches in Medline, Scopus, EMBASE, and Cochrane databases for studies published from 2010 onwards. A total of 1542 studies were identified, and after removing duplicates and applying eligibility criteria, 100 studies were included for detailed analysis. The extracted data focused on sensitivity, specificity, complications, economic impact, and patient outcomes. Results: EBUS-TBNA demonstrated high sensitivity (85–94%) and specificity (~100%), making it an effective first-line modality for NSCLC staging. Mediastinoscopy remained highly specific (~100%) but exhibited slightly lower sensitivity (86–90%). EBUS-TBNA had a lower complication rate (~2%) and was more cost-effective, while mediastinoscopy provided larger biopsy samples, essential for molecular and histological analyses. The need for general anaesthesia, longer hospital stays, and increased procedural costs make mediastinoscopy less favourable as an initial approach. Combining both techniques in select cases enhanced overall staging accuracy, reducing false negatives and improving diagnostic confidence. Conclusions: EBUS-TBNA has become the preferred first-line mediastinal staging method due to its minimally invasive approach, high diagnostic accuracy, and lower cost. However, mediastinoscopy remains crucial in cases requiring posterior mediastinal node assessment or larger tissue samples. The integration of both techniques in a stepwise diagnostic strategy offers the highest accuracy while minimizing risks and costs. Given the lower hospitalization rates and economic benefits associated with EBUS-TBNA, its widespread adoption may contribute to more efficient resource utilization in healthcare systems. Full article

(This article belongs to the Special Issue Correlations Between Diagnostic Imaging and Morphology in Personalized Medicine)

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19 pages, 253 KiB

Open AccessArticle

The Application of Artificial Intelligence in Acute Prescribing in Homeopathy: A Comparative Retrospective Study

by Rachael Doherty, Parker Pracjek, Christine D. Luketic, Denise Straiges and Alastair C. Gray

Healthcare 2025, 13(15), 1923; https://doi.org/10.3390/healthcare13151923 - 6 Aug 2025

Abstract

Background/Objective: The use of artificial intelligence to assist in medical applications is an emerging area of investigation and discussion. The researchers studied whether there was a difference between homeopathy guidance provided by artificial intelligence (AI) (automated) and live professional practitioners (live) for acute [...] Read more.

Background/Objective: The use of artificial intelligence to assist in medical applications is an emerging area of investigation and discussion. The researchers studied whether there was a difference between homeopathy guidance provided by artificial intelligence (AI) (automated) and live professional practitioners (live) for acute illnesses. Additionally, the study explored the practical challenges associated with validating AI tools used for homeopathy and sought to generate insights on the potential value and limitations of these tools in the management of acute health complaints. Method: Randomly selected cases at a homeopathy teaching clinic (n = 100) were entered into a commercially available homeopathic remedy finder to investigate the consistency between automated and live recommendations. Client symptoms, medical disclaimers, remedies, and posology were compared. The findings of this study show that the purpose-built homeopathic remedy finder is not a one-to-one replacement for a live practitioner. Result: In the 100 cases compared, the automated online remedy finder provided between 1 and 20 prioritized remedy recommendations for each complaint, leaving the user to make the final remedy decision based on how well their characteristic symptoms were covered by each potential remedy. The live practitioner-recommended remedy was included somewhere among the auto-mated results in 59% of the cases, appeared in the top three results in 37% of the cases, and was a top remedy match in 17% of the cases. There was no guidance for managing remedy responses found in live clinical settings. Conclusion: This study also highlights the challenge and importance of validating AI remedy recommendations against real cases. The automated remedy finder used covered 74 acute complaints. The live cases from the teaching clinic included 22 of the 74 complaints. Full article

(This article belongs to the Special Issue The Role of AI in Predictive and Prescriptive Healthcare)

21 pages, 1343 KiB

Open AccessArticle

Effectiveness of Psychoeducation via Telenursing on Reducing Caregiver Burden Among Caregivers for Patients with Schizophrenia in Saudi Arabia: A Quasi-Experimental Study

by Loujain Sharif, Manal Sadan Al-Zahrani, Fatimah Raji Alanzi, Alaa Mahsoon, Khalid Sharif, Sultan Ahmed Al-Qubali, Rebecca J. Wright and Ayman Mohamed El-Ashry

Healthcare 2025, 13(15), 1922; https://doi.org/10.3390/healthcare13151922 - 6 Aug 2025

Abstract

Background/Objectives: Family caregivers of individuals with schizophrenia often face considerable psychological and physical strain due to the complexity of caregiving. Although psychoeducation has demonstrated benefits in alleviating this burden, its provision via telenursing remains underexplored in Saudi Arabia. This study evaluated the [...] Read more.

Background/Objectives: Family caregivers of individuals with schizophrenia often face considerable psychological and physical strain due to the complexity of caregiving. Although psychoeducation has demonstrated benefits in alleviating this burden, its provision via telenursing remains underexplored in Saudi Arabia. This study evaluated the effect of a psychoeducational program delivered via telenursing on reducing caregiver burden. Methods: A quasi-experimental design was used with 60 caregivers from a tertiary mental health hospital in northern Saudi Arabia, who were divided equally into intervention and control groups. The intervention group participated in a structured four-week psychoeducational program via Zoom, while the control group received routine care. Caregiver burden was assessed using the Family Burden Interview Schedule (FBIS), a validated tool designed to measure the objective and subjective burden experienced by family members caring for individuals with mental illness. The FBIS was administered before and three months after the intervention. The statistical analysis included independent and paired t-tests and ANOVA. Results: The pre-intervention scores showed no significant differences, confirming baseline equivalence. The post-intervention scores showed a significant reduction in burden among the intervention group (p < 0.001), while no meaningful change occurred in the control group. Additionally, a lower burden was associated with higher education, sufficient income (i.e., the caregiver’s perception of being able to meet essential household expenses without financial strain), strong family support, and absence of caregiver illness. Conclusions: These findings suggest that psychoeducation through telenursing is an effective strategy for reducing caregiver burden and improving support accessibility, particularly for those in remote areas. Full article

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14 pages, 1437 KiB

Open AccessArticle

Age-Stratified Classification of Common Middle Ear Pathologies Using Pressure-Less Acoustic Immittance (PLAI™) and Machine Learning

by Aleksandar Miladinović, Francesco Bassi, Miloš Ajčević and Agostino Accardo

Healthcare 2025, 13(15), 1921; https://doi.org/10.3390/healthcare13151921 - 6 Aug 2025

Abstract

Background/Objective: This study explores a novel approach for diagnosing common middle ear pathologies using Pressure-Less Acoustic Immittance (PLAI™), a non-invasive alternative to conventional tympanometry. Methods: A total of 516 ear measurements were collected and stratified into three age groups: 0–3, 3–12, and 12+ [...] Read more.

Background/Objective: This study explores a novel approach for diagnosing common middle ear pathologies using Pressure-Less Acoustic Immittance (PLAI™), a non-invasive alternative to conventional tympanometry. Methods: A total of 516 ear measurements were collected and stratified into three age groups: 0–3, 3–12, and 12+ years, reflecting key developmental stages. PLAI™-derived acoustic parameters, including resonant frequency, peak admittance, canal volume, and resonance peak frequency boundaries, were analyzed using Random Forest classifiers, with SMOTE addressing class imbalance and SHAP values assessing feature importance. Results: Age-specific models demonstrated superior diagnostic accuracy compared to non-stratified approaches, with macro F1-scores of 0.79, 0.84, and 0.78, respectively. Resonant frequency, ear canal volume, and peak admittance consistently emerged as the most informative features. Notably, age-based stratification significantly reduced false negative rates for conditions such as Otitis Media with Effusion and tympanic membrane retractions, enhancing clinical reliability. These results underscore the relevance of age-aware modeling in pediatric audiology and validate PLAI™ as a promising tool for early, pressure-free middle ear diagnostics. Conclusions: While further validation on larger, balanced cohorts is recommended, this study supports the integration of machine learning and acoustic immittance into more accurate, developmentally informed screening frameworks. Full article

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19 pages, 298 KiB

Open AccessReview

Speaking the Self: How Native-Language Psychotherapy Enables Change in Refugees: A Person-Centered Perspective

by Viktoriya Zipper-Weber

Healthcare 2025, 13(15), 1920; https://doi.org/10.3390/healthcare13151920 - 6 Aug 2025

Abstract

Background: Since the outbreak of war in Ukraine, countless forcibly displaced individuals facing not only material loss, but also deep psychological distress, have sought refuge across Europe. For those traumatized by war, the absence of a shared language in therapy can hinder healing [...] Read more.

Background: Since the outbreak of war in Ukraine, countless forcibly displaced individuals facing not only material loss, but also deep psychological distress, have sought refuge across Europe. For those traumatized by war, the absence of a shared language in therapy can hinder healing and exacerbate suffering. While cultural diversity in psychotherapy has gained recognition, the role of native-language communication—especially from a person-centered perspective—remains underexplored. Methods: This narrative review with a thematic analysis examines whether and how psychotherapy in the mother tongue facilitates access to therapy and enhances therapeutic efficacy. Four inter-related clusters emerged: (1) the psychosocial context of trauma and displacement; (2) language as a structural gatekeeper to care (RQ1); (3) native-language therapy as a mechanism of change (RQ2); (4) potential risks such as over-identification or therapeutic mismatch (RQ2). Results: The findings suggest that native-language therapy can support the symbolic integration of trauma and foster the core conditions for healing. The implications for multilingual therapy formats, training in interpreter-mediated settings, and future research designs—including longitudinal, transnational studies—are discussed. Conclusions: In light of the current crises, language is not just a tool for access to therapy, but a pathway to psychological healing. Full article

(This article belongs to the Special Issue Healthcare for Immigrants and Refugees)

16 pages, 1290 KiB

Open AccessArticle

Passion, Motivation, and Subjective Well-Being in Sport for People with Disabilities

by Luís Cid, Anabela Vitorino, Teresa Bento, Diogo Teixeira, Pedro Duarte-Mendes and Nuno Couto

Healthcare 2025, 13(15), 1919; https://doi.org/10.3390/healthcare13151919 - 6 Aug 2025

Abstract

Objective: Considering the absence of research testing the entire sequence of passion, behavioral regulation, and subjective well-being (SWB), this study aimed to analyze the hypothetical causal relationships between the variables of a model that integrates the Dualistic Passion Model (DMP) and Self-Determination Theory [...] Read more.

Objective: Considering the absence of research testing the entire sequence of passion, behavioral regulation, and subjective well-being (SWB), this study aimed to analyze the hypothetical causal relationships between the variables of a model that integrates the Dualistic Passion Model (DMP) and Self-Determination Theory (SDT) in order to understand the impact of harmonious passion (HP) and obsessive passion (OP) and the regulation of motivation on the SWB of elite athletes with disability. Method: This study includes 143 elite athletes from national adapted sports (36 female; 107 male) aged between 15 and 59 (M = 29.21; SD = 10.45). Weekly training sessions ranged from 1 to 12 (M = 4.52; SD = 2.71), and the years of competitive practice ranged from 1 to 28 (M = 5.55; SD = 6.98). Data were collected using valid and reliable questionnaires for the study population and analyzed using structural equation analysis. The following results were identified: a positive and a significant effect between OP and self-determination motivation (SDM); a positive but not a significant effect between OP and non-self-determination motivation (NSDM); a significant effect between SDM and SWL and SDM and positive affect (PA); and, finally, a positive but non-significant effect between SDM and negative affect (NA). In contrast, there is a positive and significant effect between HP and SDM; a negative and significant effect between HP and NSDM; a positive but non-significant effect between NSDM and SWL; a negative and significant effect between NSDM and PA; and, finally, a positive and significant effect between NSDM and NA. Conclusions: The perception of passion regarding sport can be a positive predictor of SDM, which, in turn, can influence levels of SWB, both from a cognitive point of view (SWL) and from an emotional point of view (PA). This reinforces the positive effect of the self-determination behavior in adapted sport on SWB and its contribution to health and quality of life in people with disabilities. Full article

(This article belongs to the Special Issue Physical Activity, Exercise, and Sport in People with Disabilities: Strategies for Health Promotion)

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