Journal Description
Healthcare
Healthcare
is an international, scientific, peer-reviewed, open access journal on health care systems, industry, technology, policy, and regulation, and is published semimonthly online by MDPI. The European Medical Association (EMA), Ocular Wellness & Nutrition Society (OWNS) and Italian Society of Nephrology Nurses (SIAN) are affiliated with Healthcare and their members receive discounts on the article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE and SSCI (Web of Science), PubMed, PMC, and other databases.
- Journal Rank: JCR - Q2 (Health Policy and Services) / CiteScore - Q1 (Leadership and Management)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 22.4 days after submission; acceptance to publication is undertaken in 2.9 days (median values for papers published in this journal in the second half of 2025).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
- Companion journals for Healthcare include: Trauma Care and European Burn Journal.
- Journal Cluster of Healthcare Sciences and Services: Geriatrics, Journal of Ageing and Longevity, Healthcare, Hospitals, Hygiene, International Journal of Environmental Research and Public Health and Nursing Reports.
Impact Factor:
2.7 (2024);
5-Year Impact Factor:
2.8 (2024)
Latest Articles
Knowledge, Attitudes and Perceived Preparedness Regarding Cardiopulmonary Resuscitation and Automated External Defibrillator Use Among Health-Related University Students: A Cross-Sectional Study
Healthcare 2026, 14(6), 730; https://doi.org/10.3390/healthcare14060730 (registering DOI) - 12 Mar 2026
Abstract
Background: Early cardiopulmonary resuscitation (CPR) and timely use of automated external defibrillators (AEDs) are critical determinants of survival following out-of-hospital cardiac arrest (OHCA). University students enrolled in healthcare degree programs represent a strategic target population for the dissemination of basic life support and
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Background: Early cardiopulmonary resuscitation (CPR) and timely use of automated external defibrillators (AEDs) are critical determinants of survival following out-of-hospital cardiac arrest (OHCA). University students enrolled in healthcare degree programs represent a strategic target population for the dissemination of basic life support and defibrillation (BLS-D) skills. However, evidence on their level of knowledge, attitudes, and perceived preparedness remains limited in Southern Italy. Methods: A cross-sectional observational study was conducted between mid-December 2025 and 15 January 2026 among undergraduate healthcare students at the Magna Graecia University of Catanzaro (Italy). Data were collected using a structured, self-administered questionnaire assessing socio-demographic characteristics, CPR/AED knowledge, attitudes, and perceived confidence. Composite knowledge scores were calculated and categorized as poor, sufficient, good, or excellent. Statistical analyses included chi-square tests, Cramér’s V, and Spearman’s rank correlation. Results: A total of 604 students were included (mean age 24.4 ± 6.7 years; 69.9% female), of whom 46.4% reported prior BLS-D training. Knowledge levels were heterogeneous: myocardial infarction was widely recognized as a cause of cardiac arrest (81.1%), whereas recognition of non-shockable rhythms, including asystole and pulseless electrical activity, remained low (<25%). Procedural knowledge, particularly regarding the chain of survival and chest compression rate, improved with academic year and prior BLS-D training. Conversely, ventilation skills and correct AED pad placement were consistently inadequate. Attitudes toward CPR were largely positive; however, perceived confidence in performing resuscitation was moderate to low, especially in complex scenarios. More than 80% of students expressed strong interest in further training and supported mandatory BLS-D education. Conclusions: Healthcare students demonstrated favorable attitudes toward CPR but insufficient and uneven knowledge, particularly in rhythm recognition, ventilation, and AED use. Academic progression and structured BLS-D training were associated with improved competencies, although critical gaps persisted. Integrating mandatory, hands-on BLS-D training with regular refresher sessions into healthcare curricula should enhance preparedness and potentially reduce OHCA-related mortality, especially in high-risk regions such as Calabria.
Full article
(This article belongs to the Special Issue Challenges and Innovations in Nursing Management Within Modern Healthcare Systems)
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Open AccessArticle
Nurses’ Knowledge and Attitudes Toward Pain Management at a Tertiary Hospital in Saudi Arabia: Impact of an Evidence-Based Instructional Program
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Mahmoud Abdel Hameed Shahin, Fatmah Alamoudi, Magda Yousif Ramadan, Adil Abdalla, Sarah Fahad Al Ojaimi, Nada Saleh Al Saadi, Anfal Shaheen Aleid and Hanan Alfahd
Healthcare 2026, 14(6), 729; https://doi.org/10.3390/healthcare14060729 - 12 Mar 2026
Abstract
Background/Objectives: Pain is highly prevalent among hospitalized patients, and suboptimal pain assessment and management remain common in clinical practice. Nurses are central to timely pain recognition and intervention, yet knowledge and attitudinal gaps can hinder evidence-based pain care. Therefore, this study aimed to
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Background/Objectives: Pain is highly prevalent among hospitalized patients, and suboptimal pain assessment and management remain common in clinical practice. Nurses are central to timely pain recognition and intervention, yet knowledge and attitudinal gaps can hinder evidence-based pain care. Therefore, this study aimed to evaluate the impact of an evidence-based instructional program on nurses’ knowledge and attitudes toward pain management at a tertiary hospital in Saudi Arabia. Methods: A one-group pretest–posttest quasi-experimental study was conducted at King Fahad Military Medical Complex, Dhahran, Saudi Arabia (January–July 2025). Registered nurses providing direct patient care (N = 226) completed a researcher-developed questionnaire assessing pain management knowledge (30 items) and attitudes (10 items, 5-point Likert scale) immediately before and one week after a structured three-hour evidence-based educational program. Data were analyzed using descriptive statistics, paired-sample t-tests, and Pearson correlation coefficients (SPSS v30), with p < 0.05 considered statistically significant. Results: Baseline findings indicated moderate knowledge (mean of total scores = 15.54 ± 4.32) and generally positive attitudes toward pain management (mean = 3.83 ± 0.60). Knowledge scores increased significantly after the intervention to become moderate to high (pretest: 15.54 ± 4.32 vs. posttest: 18.65 ± 3.83; p < 0.001). Attitude scores also improved significantly following the program (p < 0.001). Knowledge and attitudes showed a significant positive correlation both preintervention (r = 0.241, p < 0.001) and postintervention (r = 0.435, p < 0.001). Conclusions: A brief evidence-based educational program yielded measurable improvements in nurses’ pain management knowledge and attitudes. Integrating structured pain education into continuing professional development may strengthen patient-centered pain care and support more consistent evidence-based practice in tertiary settings.
Full article
(This article belongs to the Special Issue Pain Management in Healthcare Practice: 2nd Edition)
Open AccessArticle
Effects of Sleep Duration on Electroencephalographic and Autonomic Nervous System Responses to High-Intensity Exercise
by
Jae-Hyun Jung, Wi-Young So and Jae-Myun Ko
Healthcare 2026, 14(6), 728; https://doi.org/10.3390/healthcare14060728 - 12 Mar 2026
Abstract
Objective: This study examined whether changes in electroencephalography (EEG)-derived indices, photoplethysmography (PPG)-derived autonomic nervous system indices, heart rate, and rating of perceived exertion (RPE) post-high-intensity exercise differ depending on sleep duration. Methods: Forty physically healthy female university students in their twenties
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Objective: This study examined whether changes in electroencephalography (EEG)-derived indices, photoplethysmography (PPG)-derived autonomic nervous system indices, heart rate, and rating of perceived exertion (RPE) post-high-intensity exercise differ depending on sleep duration. Methods: Forty physically healthy female university students in their twenties were randomly assigned to the sleep restriction (SR) or normal sleep (NS) group. EEG-derived indices—the theta-to-beta ratio (TBR) and spectral edge frequency at 90% (SEF-90)—and PPG-derived autonomic nervous system indices (HRV index, sympathetic activity, and parasympathetic activity) were measured for one minute at rest before exercise and for one minute immediately after exercise. Heart rate was assessed at rest, immediately after exercise, and at 5, 10, and 15 min post-exercise. The group × time interaction effects were assessed using two-way mixed-design analysis of variance, followed by post hoc analyses. Results: TBR increased significantly post-exercise in the SR group (p = 0.002) with no significant change in the NS group. SEF-90 decreased significantly in the SR group (p < 0.001) with no significant change in the NS group. The HRV index decreased significantly in the SR group (p = 0.004) with no significant change in the NS group. Sympathetic activity increased and parasympathetic activity decreased significantly in the SR group (both p < 0.001). Heart rate was significantly higher in the SR group at rest (p < 0.001), immediately after exercise (p = 0.020), and 5 min post-exercise (p = 0.009). RPE was significantly higher in the SR group (p = 0.003). Conclusions: In healthy young adult women, the central and autonomic nervous systems respond differently to high-intensity exercise depending on sleep duration.
Full article
(This article belongs to the Special Issue Innovative Exercise-Based Approaches for Chronic Condition Management)
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Open AccessArticle
Exploring the Expression and Perceived Relational Correlates of Perfectionism in Higher Education: A Multicenter Study
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Anna Marchetti, Anna De Benedictis, Elena Sandri, Valentina Micheluzzi, Michela Piredda and Maria Grazia De Marinis
Healthcare 2026, 14(6), 727; https://doi.org/10.3390/healthcare14060727 - 12 Mar 2026
Abstract
Background: Perfectionism is a multidimensional disposition marked by exceptionally high standards and self-worth contingent on flawless performance. In university settings, academic demands may amplify perfectionistic pressure, with maladaptive outcomes most consistently linked to socially prescribed expectations and self-critical failure processing. This study profiled
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Background: Perfectionism is a multidimensional disposition marked by exceptionally high standards and self-worth contingent on flawless performance. In university settings, academic demands may amplify perfectionistic pressure, with maladaptive outcomes most consistently linked to socially prescribed expectations and self-critical failure processing. This study profiled perfectionism dimensions in Italian university students and examined their associations with perceived relational and self-related correlates (Roots). Methods: A multicenter cross-sectional study was conducted with Italian university students. Participants completed two validated tools: the 14-item Multidimensional Perfectionism Scale—Revised (MPS-R) and the 16-item Roots questionnaire. Descriptive statistics, Spearman correlations, and non-parametric group comparisons were performed. Results: Self-oriented perfectionism was the most prominent dimension, while socially prescribed perfectionism (SPP) was comparatively lower but showed the clearest links with vulnerability-related correlates. Lower perceived parental and interpersonal trust was associated with stronger failure-based self-appraisals and perceived excessive demands from others. Higher SPP was observed among women and younger students and in more evaluative study contexts. Conclusions: Perfectionism in this sample was predominantly self-directed, yet risk-relevant profiles were characterized by SPP and self-critical failure processing in conjunction with lower perceived trust/acceptance. These findings support screening approaches that move beyond global scores and inform prevention strategies targeting fear of mistakes, contingent self-worth, and perceived evaluative pressure to promote student well-being. Longitudinal and intervention studies are needed to test temporal pathways and scalable, targeted prevention strategies.
Full article
(This article belongs to the Special Issue Promoting Mental Health in School and Community Settings)
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Open AccessArticle
Breastfeeding and Early Childhood Dental Caries: Evidence from Birth Cohort Studies in Australia and Brazil
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Helena Silveira Schuch, Marcos Britto Correa, Jane A. Scott, Iná S. Santos, Andréa Dâmaso Bertoldi, Flavio Fernando Demarco and Diep Hong Ha
Healthcare 2026, 14(6), 726; https://doi.org/10.3390/healthcare14060726 - 12 Mar 2026
Abstract
While breastfeeding is strongly recommended for infant health, uncertainty remains regarding its independent association with early childhood caries after accounting for sugar exposure. Objective: This study aimed to evaluate the controlled direct effect of breastfeeding on dental caries. Methods: Data were drawn from
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While breastfeeding is strongly recommended for infant health, uncertainty remains regarding its independent association with early childhood caries after accounting for sugar exposure. Objective: This study aimed to evaluate the controlled direct effect of breastfeeding on dental caries. Methods: Data were drawn from two population-based birth cohort studies: the 2015 Pelotas Birth Cohort Study (Brazil) and the SMILE Study (Australia). The exposure was any breastfeeding at 3, 6, and 12 months, with sugar consumption at 12 and 24 months as the mediator. The outcome was dental caries at ages 4/5, assessed as early childhood caries (ECC), severe ECC, any disease experience, or any decayed teeth. Marginal Structural Models with inverse probability of treatment weight were used to estimate the controlled direct effect of breastfeeding on dental caries, accounting for sociodemographic confounders and sugar consumption. Results: A total of 751 Australian and 3545 Brazilian children were included in at least one sub-analysis. Findings indicate a contextual difference: in Australia, breastfeeding had no effect on dental caries after considering sugar consumption as mediator, whereas in Brazil, children not breastfed had a lower risk of dental caries. For instance, adjusted Brazilian estimates showed a reduced relative risk ranging from 0.63 (95% CI 0.55; 0.72) for ECC to 0.43 (95% CI 0.34; 0.55) for severe ECC. Conclusions: The association between breastfeeding and dental caries appears to vary across socio-environmental contexts. In settings with high caries burden, prolonged breastfeeding may increase caries risk independently of sugar consumption; however, breastfeeding remains strongly recommended given its substantial overall health benefits. These findings highlight the importance of integrating early oral health guidance such as oral health education into breastfeeding support programs.
Full article
(This article belongs to the Special Issue From Early Childhood to Older Age: Inequality in Dental Caries Burden)
Open AccessReview
Biopsychosocial and Cultural Determinants of Functioning and Healthcare Outcomes in Chronic Non-Cancer Pain: An Integrative Review
by
Rocío Cáceres-Matos, Miguel Garrido-Bueno, Juan Manuel Fernández-Sarmiento, Ana María Porcel-Gálvez and Manuel Pabón-Carrasco
Healthcare 2026, 14(6), 725; https://doi.org/10.3390/healthcare14060725 - 12 Mar 2026
Abstract
Background: Chronic non-cancer pain (CNCP) is an increasing global health concern and a multidimensional condition shaped by biological, psychological, social, and cultural factors, with impacts on functioning, quality of life, and healthcare. However, evidence remains fragmented, limiting integrated understanding and care. Objective: This
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Background: Chronic non-cancer pain (CNCP) is an increasing global health concern and a multidimensional condition shaped by biological, psychological, social, and cultural factors, with impacts on functioning, quality of life, and healthcare. However, evidence remains fragmented, limiting integrated understanding and care. Objective: This study aimed to synthesize and critically analyze existing evidence on the biological, psychological, social, and cultural dimensions characterizing individuals with CNCP, and their impact on functionality, quality of life, and healthcare. Methodology: An integrative review was conducted following the Whittemore and Knafl framework. Searches were performed in Medline, Cumulative Index of Nursing and Allied Literature Complete (CINAHL), PsycINFO, Scopus, Web of Science, and grey literature in English and Spanish, without time restrictions. Studies were screened using predefined eligibility criteria and appraised with Joanna Briggs Institute tools. Data were systematically extracted and synthesized using thematic analysis to identify key attributes of people living with CNCP. Quantitative findings were summarized descriptively and mapped to thematic domains, while qualitative data were analyzed interpretively. Both evidence streams were integrated through convergent thematic synthesis. Results: Forty-four studies were included, predominantly cross-sectional and observational. Five themes emerged: biological aspects; functioning and quality of life; psychological and mental factors; social support and peer relationships; and social and gender determinants. CNCP was consistently associated with multimorbidity, sleep disturbance, psychological distress, and maladaptive coping, contributing to reduced functional capacity, greater disability, poorer quality of life, and increased healthcare utilization. Socioeconomic disadvantages and environmental constraints were linked to higher pain burden, whereas resilience and social support emerged as protective factors mitigating functional and psychosocial impact. Conclusions: Evidence largely concentrates on biomedical, functional, and psychological dimensions, whereas social determinants and healthcare quality remain comparatively underexplored. Broadening these perspectives is essential to inform public health strategies and support multidisciplinary, equitable care for individuals living with CNCP.
Full article
(This article belongs to the Special Issue Innovative Approaches to Chronic Disease Patient Care)
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Open AccessSystematic Review
Does Character Strength Have an Influence on Children’s Susceptibility to Technological Addiction? A Systematic Review
by
Ana Jimenez-Perianes, Carlos Monfort-Vinuesa, Elena Saiz-Clar, Maria P. Egea-Romero, Cristina Rebate, Monica Rodriguez-Cañas, Caroline Villarroel and Esther Rincon
Healthcare 2026, 14(6), 724; https://doi.org/10.3390/healthcare14060724 - 12 Mar 2026
Abstract
Background: The misuse of technology and the consequences of addiction are topics that are increasingly addressed by researchers. Specifically, more attention is being paid to strategies aimed at preventing such addiction in minors. In all likelihood, this is the first systematic review
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Background: The misuse of technology and the consequences of addiction are topics that are increasingly addressed by researchers. Specifically, more attention is being paid to strategies aimed at preventing such addiction in minors. In all likelihood, this is the first systematic review to focus on the role of moral values in preventing minors from developing digital addictions. The aim of the study is to review the scientific research on the issue in order to answer the following questions: (1) Is character strength (or related variables) linked to an increased probability that minors will develop a technology addiction? (2) What types of character strengths protect minors from these problems? (3) What kinds of training programmes have been provided to instil these values in both minors and parents? Methods: The authors systematically examined the peer-reviewed literature from the Web of Science Core Collection (WOS), Medline, and Scopus while adhering to the PRISMA statement. Only articles published until 26 April 2025, and which were written in the English language, were reviewed. The search was conducted with no year restrictions. Results: A total of 609 studies were obtained, of which 9 were finally selected. The results provide a complete overview of the presence of moral values as a protective factor against digital addiction. Conclusions: Several challenges remain with regard to enhancing the knowledge of moral values, as well as their importance as an instrument available to minors for their safe interaction with technology.
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(This article belongs to the Special Issue Applications of Digital Technology in Comprehensive Healthcare)
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Open AccessArticle
Green Hospital Awareness: Evidence from Healthcare Technician Students
by
Ayşegül Doğan Kaya and Arzum Çelik Bekleviç
Healthcare 2026, 14(6), 723; https://doi.org/10.3390/healthcare14060723 - 12 Mar 2026
Abstract
Background/Objectives: Climate change and environmental degradation pose increasing public health threats, while healthcare systems significantly contribute through high energy use, water consumption, and waste generation. In hospital settings, healthcare technicians play a critical role, as their routine practices directly influence environmental sustainability.
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Background/Objectives: Climate change and environmental degradation pose increasing public health threats, while healthcare systems significantly contribute through high energy use, water consumption, and waste generation. In hospital settings, healthcare technicians play a critical role, as their routine practices directly influence environmental sustainability. Despite this central role, healthcare technicians remain an under-recognized group in sustainability research and health policy. Green hospital practices therefore constitute a key public health strategy, requiring strategic management attention to this operational workforce. This study aimed to assess green hospital awareness among healthcare technician students in Türkiye and to examine associated sociodemographic factors from a public health perspective. Methods: This descriptive cross-sectional study included 313 students enrolled in health services vocational programs who were receiving hospital-based practical training. Data were collected using a personal information form and the validated Green Hospital Awareness Scale. Descriptive statistics, independent t-tests, one-way ANOVA, and Spearman correlation analyses were conducted using SPSS version 26.0, with statistical significance set at p < 0.05. Results: Although most participants reported no prior knowledge of the green hospital concept, overall awareness levels were moderate to high. The highest mean scores were observed in indoor environmental quality and materials–resources subdimensions, whereas water efficiency scores were the lowest. Female students demonstrated significantly higher total awareness and materials–resources scores (p < 0.05). No significant differences were observed by age or academic department. Conclusions: Healthcare technician students exhibit measurable green hospital awareness; however, important gaps remain in resource- and infrastructure-related sustainability domains. Strengthening educational and policy initiatives targeting this often-overlooked yet operationally essential workforce may improve environmentally responsible practices, enhance resource efficiency, and support sustainable healthcare systems and population health.
Full article
(This article belongs to the Section Healthcare and Sustainability)
Open AccessArticle
Age–Comorbidity Interactions and Clinical Outcomes in Septic Shock: An Emergency Department-Based Multicenter Cohort Study
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Seung Jin Maeng, Jong Eun Park, Gun Tak Lee, Sung Yeon Hwang, Minha Kim, Sejin Heo, Tae Ho Lim, Sung Phil Chung, Sung-Hyuk Choi and Tae Gun Shin
Healthcare 2026, 14(6), 722; https://doi.org/10.3390/healthcare14060722 - 12 Mar 2026
Abstract
Background: Sepsis remains a leading cause of mortality worldwide. This study evaluated the independent and combined effects of age and chronic comorbidities on clinical outcomes in patients with septic shock. Methods: We conducted a multicenter retrospective observational study to evaluate the
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Background: Sepsis remains a leading cause of mortality worldwide. This study evaluated the independent and combined effects of age and chronic comorbidities on clinical outcomes in patients with septic shock. Methods: We conducted a multicenter retrospective observational study to evaluate the factors associated with 28-day mortality in the Korean Shock Society registry between 2015 and 2023. Adults with suspected infection and refractory hypotension or hypoperfusion within 6 h of emergency department (ED) arrival were included. Patients were grouped by age (<50, 50–74, and ≥75 years) and comorbidity status. Comorbidities encompass major chronic conditions including hypertension, diabetes mellitus, malignancy, history of organ transplant, dementia, nursing home residence, chronic disease of cardiac, lung, liver, and kidney. The primary outcome was 28-day mortality. Multivariable logistic regression analysis was used. Results: Among 8787 patients (median age 70.2 years), the 28-day mortality rate was 22.9% (n = 2018). Elderly patients with comorbidities had the highest mortality (27.5%). Additionally, patients aged over 50 with at least one comorbidity accounted for 18% of the total cohort (n = 1605) but accounted for nearly 80% of all 28-day deaths. Although younger patients without comorbidities represented a small subgroup, their mortality was not negligible (7.3%) and was substantially higher with comorbidities (22.2%). Compared with patients <50 years, adjusted odds ratios (aORs) of 28-day mortality were 1.81 (95% CI, 1.08–3.03) for 50–74 years and 3.21 (95% CI, 1.92–5.37) for ≥75. The presence of any comorbidities was independently associated with higher odds of 28-day mortality compared with no comorbidity (aOR 2.67; 95% CI, 1.57–4.54). A significant interaction between age and comorbidity status (p for interaction = 0.008) suggested that the age-related gradient in mortality differed depending on comorbidity burden. Conclusions: Age and comorbidities were both significantly associated with septic shock mortality, and their significant interaction demonstrates effect modification, indicating that the prognostic impact of comorbidities differs by age group and that age-related mortality gradients are influenced by comorbidity burden.
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(This article belongs to the Section Clinical Care)
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Open AccessArticle
Comparison of Frailty and Autonomy Levels in Older Adults According to Place of Residence
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Andrea Machado, Pedro Forte and Filipe Rodrigues
Healthcare 2026, 14(6), 721; https://doi.org/10.3390/healthcare14060721 - 12 Mar 2026
Abstract
Background/Objectives: The present study aimed to compare levels of frailty and functional independence in older adults according to their place of residence and to analyze the associations between age, frailty, and autonomy, considering sex. Methods: A cross-sectional analytical study was conducted
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Background/Objectives: The present study aimed to compare levels of frailty and functional independence in older adults according to their place of residence and to analyze the associations between age, frailty, and autonomy, considering sex. Methods: A cross-sectional analytical study was conducted with a sample of 77 older adults (80.16 ± 8.68 years), divided into community-dwelling (n = 38) and institutionalized (n = 39) participants. Data collection included sociodemographic characterization and the assessment of frailty and autonomy. Results: Older adults in the community showed significantly higher levels of autonomy (94.21 ± 10.81) compared to those who were institutionalized (75.53 ± 23.21; p < 0.001). No significant differences were found in frailty levels between the groups (p = 0.674). Correlation analysis revealed a strong negative association between frailty and autonomy, which was more pronounced in institutionalized older adults (r = −0.64) and in males (r = −0.72). Age was only correlated with the loss of autonomy in men (r = −0.43). Conclusions: Place of residence is a critical determinant of functional autonomy but not of perceived frailty. The results highlight a health-survival paradox, where men exhibit a more abrupt functional decline associated with frailty. The implementation of gerontomotricity programs in residential care facilities is suggested to mitigate learned dependency.
Full article
(This article belongs to the Special Issue Aging and Older Adults’ Healthcare)
Open AccessArticle
Scaling up an Evidence-Based Exercise Intervention for Wide-Scale Implementation: A Conceptual Roadmap Using the PRACTIS Framework
by
Louise Declerck, Trinh L. T. Huynh and Robert W. Motl
Healthcare 2026, 14(6), 720; https://doi.org/10.3390/healthcare14060720 - 11 Mar 2026
Abstract
Background: Exercise is safe and beneficial for managing symptoms, preventing progression, and enhancing the physical and mental well-being of people with multiple sclerosis (MS). Such evidence has supported prescriptive guidelines delivered alongside behavioral interventions to promote and sustain exercise behavior. Evidence-based exercise training
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Background: Exercise is safe and beneficial for managing symptoms, preventing progression, and enhancing the physical and mental well-being of people with multiple sclerosis (MS). Such evidence has supported prescriptive guidelines delivered alongside behavioral interventions to promote and sustain exercise behavior. Evidence-based exercise training interventions now exist for people with MS, such as Project GEMS, a home-based program grounded in MS-specific exercise training guidelines and supported by principles of behavior change based on social–cognitive theory. The field is now ready for the process of translating evidence-based programs from research settings into clinical or community contexts for greater reach and accessibility, but dissemination and implementation remain significant challenges. Objectives: The current paper presents a conceptual roadmap for implementing a validated home-based exercise training intervention for people with MS, originally tested in controlled research environments, within the broader community context. This is guided by the PRACTIS framework for scaling up physical activity/exercise interventions. Roadmap: Our paper presents a conceptual example along with details regarding strategic adaptations for tailoring the remote GEMS program for a diverse and wide MS population, integrating input from community stakeholders and ensuring long-term sustainability through collaborative researcher–stakeholder partnerships. Such an initiative may bridge the gap between research and practice in the domains of exercise training and behavioral interventions for people with MS and further serve as a scalable model for promoting exercise behavior in other neurological conditions by expanding accessibility for effective digital resources. Conclusion: The design of the exercise intervention discussed in this paper offers one example and conceptual pathway for expanding access for evidence-based exercise programs at the wider level.
Full article
(This article belongs to the Special Issue Enhancing Physical and Mental Well-Being in People with Disabilities)
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Open AccessSystematic Review
Emotion Regulation and Eating Disorders in Sports: A Systematic Review
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Silvia P. Espinoza-Barrón, Abril Cantú-Berrueto, María Á. Castejón and Rosendo Berengüí
Healthcare 2026, 14(6), 719; https://doi.org/10.3390/healthcare14060719 - 11 Mar 2026
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Background: Emotion regulation refers to the processes through which individuals influence their emotional experiences, including how emotions are generated, experienced, and expressed. Difficulties in emotion regulation have been identified as a relevant factor in the development and maintenance of Eating Disorders (EDs). In
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Background: Emotion regulation refers to the processes through which individuals influence their emotional experiences, including how emotions are generated, experienced, and expressed. Difficulties in emotion regulation have been identified as a relevant factor in the development and maintenance of Eating Disorders (EDs). In the sports context, high physical and performance demands may intensify emotional challenges, potentially increasing vulnerability to eating disorder symptomatology among athletes. Objectives: This systematic review aimed to examine the relationship between emotion regulation and EDs in athletic populations, with a particular focus on emotion regulation strategies and related emotional processes. Methods: The PICO model was used, and PRISMA guidelines were followed. The Redalyc, Dialnet, SpringerLink, and PubMed databases were searched from inception to April 2025, with an update in November 2025. After the selection process, nine studies involving athletes from different disciplines and competitive levels were included. Methodological quality and risk of bias were assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. Results: The findings indicate that adaptive emotion regulation strategies, such as Cognitive Reappraisal and emotional identification, are associated with lower levels of eating disorder symptomatology, body dissatisfaction, and greater resilience to sport-related pressures. In contrast, dysfunctional strategies, including expressive suppression, emotional unawareness, and difficulties in emotion management, were consistently associated with restrictive eating behaviors, bulimic symptomatology, excessive weight control, and increased ED risk. Additional emotional factors, including anxiety, perfectionism, low self-esteem, and body image dissatisfaction, were also related to higher vulnerability to EDs, particularly in sports with high aesthetic or weight-related demands. Conclusions: Emotional regulation is closely associated with ED risk in athletes. Adaptive emotion regulation strategies may serve as protective factors, whereas dysfunctional strategies are associated with increased risk.
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Open AccessArticle
Effectiveness of a Telemedicine Exercise Program to Improve Lung Function in Young Adults After COVID-19: A Pilot Study
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Eyckle C. H. Wong, Raymond W. M. Lo, Rachel L. C. Kwan, Natalie N. M. Chan, Sara W. Y. Lam, Ruby Y. K. Ng, Suyi K. C. Wong and Grace P. Y. Szeto
Healthcare 2026, 14(6), 718; https://doi.org/10.3390/healthcare14060718 - 11 Mar 2026
Abstract
Background: COVID-19 can have adverse effects on individuals’ lung functions for up to 6 months or more after the episode. As a result, people may be reluctant to exercise, and this can have further adverse effects on their lung capacity and fitness.
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Background: COVID-19 can have adverse effects on individuals’ lung functions for up to 6 months or more after the episode. As a result, people may be reluctant to exercise, and this can have further adverse effects on their lung capacity and fitness. This study aimed to examine the effectiveness of a telemedicine program designed to increase the exercise participation of young adults after COVID-19 and evaluate the changes in lung function after exercise training. Methods: The quasi-experimental pre–post study recruited sixty university students who had suffered from COVID-19 within the past 12 months. Four pulmonary outcomes were compared: forced expiratory volume in one second (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR), and the ratio of FEV1 to FVC. The telemedicine exercise (TE) group (n = 36) received an intervention to carry out regular stepping exercise (up to 10,000 steps) via online video instruction and frequent WhatsApp reminder messages. The control group (n = 24) only received an initial WhatsApp message to carry out regular stepping exercise, with no further follow-up. Results: The FVC, FEV1, and FEV1/FVC ratio revealed significant overall improvement both within groups and between groups (p < 0.001), with moderate effect sizes. PEFR showed a significant improvement within groups (p = 0.007) but not between groups (p = 0.533). The TE group recorded a significant increase in daily step count (from 7165 to 9733, p < 0.001) after 4 weeks of training. The control group showed a significant reduction in step count (from 6975 to 6442, p = 0.049). Conclusions: The results confirmed the beneficial effects of the telemedicine exercise program in contributing to increased exercise participation and improved lung functions.
Full article
(This article belongs to the Special Issue Innovations in Primary and Community Care for Rehabilitation)
Open AccessReview
A Meta-Synthesis on Clients’ Experience with Telerehabilitation
by
Yughdtheswari Muniandy, Karmegam Karuppiah, Muhammad Hibatullah Romli, Rajkumar Krishnan Vasanthi, Nina Fatma Ali, Thenmoly Subramaniam, Jayesh Chandran, Haidzir Manaf and Hernan Cortez Labao
Healthcare 2026, 14(6), 717; https://doi.org/10.3390/healthcare14060717 - 11 Mar 2026
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Background: Telerehabilitation (TR) enables equitable access to therapeutic care over a distance; however, there is still a level of uncertainty about its efficiency in comparison with the traditional methods. Perception of patients has been inconclusive with aspects of technology use, quality care provision,
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Background: Telerehabilitation (TR) enables equitable access to therapeutic care over a distance; however, there is still a level of uncertainty about its efficiency in comparison with the traditional methods. Perception of patients has been inconclusive with aspects of technology use, quality care provision, and the satisfaction of patients with TR services being raised as issues to be investigated further. A systematic synthesis of patient experience is needed to establish TR’s general implications on health and well-being. Hence, the aim of this study is to review perceptions and experiences of clients on telerehabilitation. Methods: A systematic review of qualitative studies was conducted using eight electronic databases from inception to February 2026. Data were synthesized and the Critical Appraisal Skills Programme (CASP) tool was employed to assess quality of included studies. Results: The search strategy identified a total of 1667 articles and after removing duplicates and excluding articles based on title and abstract, and full text screening, 26 studies were included. Four major themes were developed: enhanced accessibility and reduced burden, perceived efficiency and continuity of care, therapeutic relationship and social presence, and digital and contextual challenges. Conclusions: Telerehabilitation reshapes rehabilitation delivery rather than merely adding technology. Its effectiveness depends on alignment among patient capability, clinical needs, and organizational support. When supported by adequate infrastructure and relational adaptation, it can enhance access and continuity and contribute to inclusive health delivery. However, if digital and contextual barriers remain unaddressed, telerehabilitation may inadvertently reinforce existing inequities.
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Open AccessArticle
“Therapy Beyond the Screen”: A Qualitative Exploration of Tele-Therapy Experiences Among Clinical Psychologists and Speech and Language Therapists
by
İbrahim Can Yaşa, Pınar Akgün, Sakine Deniz Yılmaz, Muhsin Dölek, Seda Eyilikeder Tekin and Ayşe Serra Kaya
Healthcare 2026, 14(6), 716; https://doi.org/10.3390/healthcare14060716 - 11 Mar 2026
Abstract
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Background/Objectives: With the diversification of technological tools, the prevalence of online therapy has increased among both clients and practitioners. Clinical psychologists and specialist speech and language therapists are two professional groups that frequently use online therapy. Understanding their experiences is important for evaluating
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Background/Objectives: With the diversification of technological tools, the prevalence of online therapy has increased among both clients and practitioners. Clinical psychologists and specialist speech and language therapists are two professional groups that frequently use online therapy. Understanding their experiences is important for evaluating the effectiveness of this service model and informing its further development. The aim of this study was to examine and compare the online therapy experiences of these two professional groups. Methods: This qualitative study included 10 practitioners (five clinical psychologists and five specialist speech and language therapists) who were actively delivering online sessions in Türkiye. Participants were recruited using convenience sampling. Data were collected through semi structured, open-ended interviews conducted online and were analyzed using thematic analysis. Results: A total of 8 themes emerged regarding practitioners’ experiences with online therapy, including the therapeutic relationship, techniques and materials used, advantages and disadvantages, coping strategies, professional reflections, required improvements, ethical issues, and recommendations. Similarities and differences were identified between the two professional groups across these themes. Conclusions: Participants considered online therapy to be an effective and feasible option, particularly due to increased accessibility, time savings, and the ability to deliver services independent of location. Challenges encountered during online therapy were described as areas requiring improvement rather than factors undermining effectiveness. Overall, the findings suggest that online therapy may become a more widespread intervention modality as technological infrastructure improves and practitioners gain greater experience with online delivery.
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Open AccessArticle
“BEmotions” Intervention: A Pilot Study on Promoting Emotional Competence Among Emergency Department Nurses
by
Vera Frazão, João Gomes, Filipe Batista and Tânia Morgado
Healthcare 2026, 14(6), 715; https://doi.org/10.3390/healthcare14060715 - 11 Mar 2026
Abstract
(1) Background: Working in emergency departments (EDs) affects healthcare professionals’ mental health and impacts their ability to provide safe, high-quality care. Emotional competence (EC) is recognized as a protective factor in occupational settings. The “BEmotions” intervention aimed to promote nurses’ EC and
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(1) Background: Working in emergency departments (EDs) affects healthcare professionals’ mental health and impacts their ability to provide safe, high-quality care. Emotional competence (EC) is recognized as a protective factor in occupational settings. The “BEmotions” intervention aimed to promote nurses’ EC and satisfaction with their work group in an ED in Portugal. (2) Methods: A quasi-experimental pilot study using a single-group pretest–posttest design was conducted. The BEmotions intervention was based on Veiga Branco’s construct of EC, which includes five dimensions: self-awareness, emotion management, self-motivation, empathy, and emotional regulation in groups. It consisted of five weekly sessions, each lasting 90 min. The instruments used were: (a) A self-developed sociodemographic questionnaire; (b) EVCE-r33—Veiga’s Reduced EC Scale; and (c) the Work Group Satisfaction Scale (ESAG). (3) Results: The study sample comprised 10 nurses, of whom 80% were female, with a mean age of 45.3 years (SD = 7.07). This pilot study suggests positive results regarding overall EC (p < 0.05; d = 0.81) and Job Satisfaction (JS) (p < 0.01; d = 1.22) among emergency department nurses. (4) Conclusions: the ‘BEmotions’ intervention suggests promising preliminary directions for replication in other contexts and for promoting mental health in the workplace; however, its methodological limitations highlight the need for further research.
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(This article belongs to the Special Issue Patient Safety, Environment, and Mental Health)
Open AccessArticle
Symptom Severity, Body Image Dissatisfaction, and Movement Behaviors in Irritable Bowel Syndrome: Analysis of Quality of Life Determinants
by
María Ángeles López-González, Eduardo José Fernández-Ozcorta, Félix Arbinaga, Manuel J. Arrayás-Grajera and Inmaculada Tornero-Quiñones
Healthcare 2026, 14(6), 714; https://doi.org/10.3390/healthcare14060714 - 11 Mar 2026
Abstract
Background: Irritable Bowel Syndrome (IBS) exerts a profound burden on Health-Related Quality of Life (HRQoL) and psychosocial well-being. While lifestyle changes are recommended, the dose–response relationship between physical activity (PA) intensities, symptom severity, and body image remains unclear. This study analyzed the interrelationships
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Background: Irritable Bowel Syndrome (IBS) exerts a profound burden on Health-Related Quality of Life (HRQoL) and psychosocial well-being. While lifestyle changes are recommended, the dose–response relationship between physical activity (PA) intensities, symptom severity, and body image remains unclear. This study analyzed the interrelationships between PA intensities, symptom severity, body image satisfaction, and HRQoL in IBS patients. Methods: A cross-sectional study was conducted with 40 adult patients (60% female; 32.53 ± 12.54 years) diagnosed via Rome III/IV criteria. Validated instruments were used to assess PA (IPAQ-SF), sedentary behavior (SBQ), HRQoL (IBS-QoL), symptom severity (IBS-SSS), and body image (BIS). Data were analyzed using Quantile Regression, Robust Linear Regression, and Causal Mediation Analysis. Results: Participants reported moderate symptom severity (210.1 ± 79.2) and high sedentary time (511.1 ± 265.0 min/day). Quantile Regression showed no statistically significant associations between PA intensities and clinical severity (all p ≥ 0.289). PA did not moderate the negative relationship between pain and HRQoL (p = 0.738). However, symptom severity was a significant predictor of body dissatisfaction (β = 0.36, p < 0.001). A sexual dimorphism was observed, as women exhibited higher baseline dissatisfaction and greater sensitivity to symptom worsening than men (β = −0.50, p = 0.004). Conclusions: Symptom severity is strongly associated with body dissatisfaction in IBS, particularly among women, independent of nutritional status. While PA did not directly mitigate symptoms in this cohort, the significant relationship with body image underscores the need for clinical interventions to integrate psychosocial support to address perceptual vulnerability.
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(This article belongs to the Special Issue The Role of Physical Activity and Sports in Enhancing Psychological Well-Being and Quality of Life)
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Open AccessArticle
Impact of Medicaid Enrollment Timing on Tumor Stage at Diagnosis and Survival in Breast, Colorectal, and Lung Cancer
by
Gabriel A. Benavidez, Stella Self, Anthony J. Alberg, Janice Probst and Jan M. Eberth
Healthcare 2026, 14(6), 713; https://doi.org/10.3390/healthcare14060713 - 11 Mar 2026
Abstract
Background: Medicaid-insured patients experience higher rates of late-stage cancer diagnosis and worse survival than non-Medicaid patients. The impact of Medicaid enrollment timing on cancer outcomes is less clear. This study examines the association between Medicaid enrollment and timing with tumor stage and cancer-specific
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Background: Medicaid-insured patients experience higher rates of late-stage cancer diagnosis and worse survival than non-Medicaid patients. The impact of Medicaid enrollment timing on cancer outcomes is less clear. This study examines the association between Medicaid enrollment and timing with tumor stage and cancer-specific survival for breast, colorectal, and lung cancers. Methods: We analyzed SEER-Medicaid linked data for 276,755 breast, 104,784 colorectal, and 101,058 lung cancer patients < 65 years of age. Patients were categorized as non-Medicaid enrollees, pre-diagnosis enrollees (≥12 months before), or post-diagnosis enrollees (≤12 months after). Multivariable logistic regression estimated odds ratios of late-stage diagnosis, and cause-specific Cox proportional hazards models were used to assess cancer-specific survival, adjusting for demographic and socioeconomic factors. Results: Compared to non-Medicaid enrollees, post-diagnosis enrollees had the highest odds of late-stage diagnosis (breast cancer: OR: 3.41; colorectal cancer: OR: 3.78; lung cancer: OR: 1.87). Pre-diagnosis enrollees also had increased odds, but the association was weaker than post-diagnosis enrollees. Cancer-specific mortality was higher for both pre- and post-diagnosis enrollees compared to non-Medicaid enrollees for each cancer examined across tumor stage at diagnosis. Among Medicaid enrollees, those enrolled post-diagnosis had higher cancer-specific mortality than those enrolled pre-diagnosis for localized-stage colorectal (HR: 1.82) and lung cancer (HR: 1.30). In contrast, those enrolled post-diagnosis had lower mortality than those enrolled pre diagnosis for distant-stage breast cancer (HR: 0.91). Conclusions: Compared with cancer patients not insured by Medicaid, post-diagnosis Medicaid enrollment was associated with a greater likelihood of late-stage cancer and worse cancer-specific survival across each cancer type examined. Future research is warranted to examine the role of Medicaid enrollment timing in cancer care to better understand its impact on cancer outcomes.
Full article
(This article belongs to the Section Public Health and Preventive Medicine)
Open AccessArticle
Caring in Context: Development of a Family-Centred and Cross-Sectoral Framework to Support Young Carers
by
Marianne Frech, Martin Nagl-Cupal, Steffen Kaiser and Anna-Maria Spittel
Healthcare 2026, 14(6), 712; https://doi.org/10.3390/healthcare14060712 - 11 Mar 2026
Abstract
Background/Objectives: Children and adolescents who care for family members with illness, disability, or mental health conditions face challenges across educational, health, and psychosocial domains. Although research and practice have developed conceptual models and assessment tools to better understand and address young carers’ situations,
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Background/Objectives: Children and adolescents who care for family members with illness, disability, or mental health conditions face challenges across educational, health, and psychosocial domains. Although research and practice have developed conceptual models and assessment tools to better understand and address young carers’ situations, a persistent gap remains between their needs and available support, reflecting structural fragmentation across health, education, and social care systems. To address this gap, this article presents the development of a family-centred framework spanning these sectors. Methods: The framework was developed through an iterative, empirically grounded process based on two studies within a larger research project on young carers in Switzerland. Key themes, structural challenges, and support-related factors were identified by systematically synthesising the findings of the two studies and integrated into an overarching framework linking young carers’ family contexts with cross-sectoral service structures. Results: The Caring in Context Framework synthesises empirical findings into a coherent framework for understanding and addressing young carers’ situations. By systematically extending the whole family approach to include a cross-sectoral dimension, it bridges relational family dynamics and structural service contexts. Sustainable support is conceptualised as dependent on the structural visibility and institutional recognition of young carers across all system levels, positioning identification and recognition as prerequisites for coordinated responses in research, policy, and practice. Conclusion: The framework advances conceptual clarity by integrating family-centred and cross-sectoral perspectives. Rather than creating new services, it emphasises adapting and coordinating existing structures while ensuring systematic recognition of young carers to support coherent, sustainable, and inclusive strategies.
Full article
(This article belongs to the Special Issue Young Carers: Prevention, Intervention, Services and Outcomes—What Works?)
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Open AccessSystematic Review
Efficacy and Safety of Oral Herbal Medicine Combined with Diosmectite for Pediatric Rotavirus Gastroenteritis: A Systematic Review and Meta-Analysis
by
Jung-Hyun Cho, Eun-Jin Kim, Hyun-Kyung Sung and Sang-Yeon Min
Healthcare 2026, 14(6), 711; https://doi.org/10.3390/healthcare14060711 - 11 Mar 2026
Abstract
Background/Objectives: Rotavirus is a leading cause of severe acute gastroenteritis in children and is commonly associated with prolonged diarrhea and dehydration. Herbal medicine (HM) is frequently used in combination with diosmectite in clinical practice, but the effectiveness of this combined approach has
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Background/Objectives: Rotavirus is a leading cause of severe acute gastroenteritis in children and is commonly associated with prolonged diarrhea and dehydration. Herbal medicine (HM) is frequently used in combination with diosmectite in clinical practice, but the effectiveness of this combined approach has not been systematically evaluated. This study aimed to assess the efficacy and safety of HM combined with diosmectite in pediatric rotavirus gastroenteritis. Methods: We searched 12 databases from inception to 10 December 2025. Randomized controlled trials comparing HM plus diosmectite with diosmectite alone in children with rotavirus gastroenteritis were included. Study selection, data extraction, and risk-of-bias assessment were independently performed by two researchers. Meta-analyses were conducted using RevMan 5.4, and the certainty of evidence was evaluated with GRADEpro. Results: A total of 26 RCTs involving 2876 children were included. Compared with diosmectite alone, HM combined with diosmectite significantly reduced the duration of diarrhea (SMD −1.31; 95% CI −1.63 to −0.99), improved the total effective rate (RR 1.25; 95% CI 1.19 to 1.31), decreased the incidence of adverse events (RR 0.24; 95% CI 0.06 to 0.92), and a shorter length of hospital stay (MD −1.53; 95% CI −1.73 to −1.33). The certainty of evidence ranged from moderate to very low. Conclusions: HM combined with diosmectite may offer a potential adjunctive therapy for pediatric rotavirus gastroenteritis. However, more robust and high-quality evidence is required to further substantiate its efficacy and safety.
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(This article belongs to the Section Women’s and Children’s Health)
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