Healthcare

15 pages, 439 KiB

Open AccessArticle

Readiness for Heart Failure Self-Care: Commitment and Capacity

by Stephanie L. Turrise, Carolyn Kleman, Caroline Jenkins, Nia D. Lewis, Heidi Winslow, Bridgette Williams, Kori E. Meyer, Sonya SooHoo and Barbara Lutz

Healthcare 2025, 13(14), 1725; https://doi.org/10.3390/healthcare13141725 (registering DOI) - 17 Jul 2025

Abstract

Background: The number of people with heart failure (HF) is rapidly increasing globally. Self-care plays a key role in improving HF outcomes. The readiness to engage in heart failure self-care (HFSC) behaviors encompasses a commitment to change and the capacity to make [...] Read more.

Background: The number of people with heart failure (HF) is rapidly increasing globally. Self-care plays a key role in improving HF outcomes. The readiness to engage in heart failure self-care (HFSC) behaviors encompasses a commitment to change and the capacity to make the change. Commitment is a personal investment and value toward enacting self-care and health-related behaviors. Capacity includes an individual’s skills, knowledge, beliefs, previous experience, and resources. Aim: The aim of this study was to describe patient-identified commitment and capacity factors influencing their readiness to carry out HFSC behaviors. Methods: A qualitative study using thematic analysis was conducted using data from 21 interviews to develop readiness for HFSC themes. Results: The commitment themes identified were cultural values and beliefs, social roles, will to live, attitude, self-efficacy, HF perceptions, and general emotional state. Capacity themes included HF literacy, functional capacity, environmental resources, comorbidities, time, cognitive functioning, and social support. Conclusions: Novel themes related to an individual’s commitment to HF self-care activities included their will to live and social roles, while time emerged as a consideration in the capacity to engage in self-care. To optimize HF outcomes, people with HF must be ready to engage in HFSC. Evaluating an individual’s readiness for HFSC can focus healthcare team efforts on targeting specific self-care activities that require intervention. Enhancing readiness by intervening with specific commitment and capacity factors is a step toward optimizing HFSC and improving patient outcomes. Full article

(This article belongs to the Special Issue Screening, Prevention and Response Strategies for Chronic Cardiopulmonary and Metabolic Diseases)

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14 pages, 905 KiB

Open AccessArticle

Burnout Syndrome Among Spanish Professionals Dedicated to Implant Dentistry: An Observational Study

by Ángel-Orión Salgado-Peralvo, Andrea Uribarri, Eugenio Velasco-Ortega, José López-López, Álvaro Jiménez-Guerra, Loreto Monsalve-Guil, Jesús Moreno-Muñoz, José-Luis Rondón-Romero, Iván Ortiz-García and Enrique Núñez-Márquez

Healthcare 2025, 13(14), 1724; https://doi.org/10.3390/healthcare13141724 (registering DOI) - 17 Jul 2025

Abstract

Background: Burnout syndrome (BS) is an occupational condition resulting from chronic stress, characterized by three dimensions, emotional exhaustion (EE), depersonalization (DE), and diminished personal accomplishment (PA), particularly prevalent in caregiving professions such as healthcare. The aim of this study is to analyse [...] Read more.

Background: Burnout syndrome (BS) is an occupational condition resulting from chronic stress, characterized by three dimensions, emotional exhaustion (EE), depersonalization (DE), and diminished personal accomplishment (PA), particularly prevalent in caregiving professions such as healthcare. The aim of this study is to analyse the prevalence of BS among Spanish dental implantology specialists, along with the impact of demographic, educational, and professional aspects. Methods: This is a cross-sectional observational study based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines and was open to respondents from May to December 2024. An electronic survey based on the Maslach Burnout Inventory—Human Services Survey (MBI–HSS) was sent to members of the Spanish Society of Implants. The data were analysed using descriptive analysis. Results: A total of 305 participants (20.9%) (31.5% females and 68.5% males) completed the questionnaire. The prevalence of BS was 4.3%; however, 61.0% of the dentists showed signs of suffering from the syndrome. The mean values of EE were “average” (20.3 ± 13.8) and of DE and EE “low” (5.1 ± 5.9, and 32.5 ± 14.5, respectively). The factors significantly associated with suffering from BS were being female and having more than 20 years of experience in dental implant treatments. Conclusions: It is advisable to conduct instructive and awareness-raising initiatives among dental professionals to promote an awareness of their mental health, ultimately aiming at preserving their physical and emotional well-being while delivering optimal care to their patients. Full article

(This article belongs to the Special Issue Occupational Stress and Burnout in Healthcare Workers)

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17 pages, 469 KiB

Open AccessArticle

Assessment of Food Safety and Practices in Nutrition Services: Case Study of Al-Ahsa Hospitals

by Randah Miqbil Alqurashi and Arwa Ibrahim Al-Humud

Healthcare 2025, 13(14), 1723; https://doi.org/10.3390/healthcare13141723 (registering DOI) - 17 Jul 2025

Abstract

Background/Objectives: This study assessed Knowledge and Practices related to Food Safety (KPFS) among nutrition services employees in hospitals across the Al-Ahsa Governorate, Kingdom of Saudi Arabia. The objective was to evaluate the staff’s understanding of key food safety principles, including foodborne illness prevention, [...] Read more.

Background/Objectives: This study assessed Knowledge and Practices related to Food Safety (KPFS) among nutrition services employees in hospitals across the Al-Ahsa Governorate, Kingdom of Saudi Arabia. The objective was to evaluate the staff’s understanding of key food safety principles, including foodborne illness prevention, food handling, personal hygiene, and food storage and preparation practices. Methods: A descriptive survey method was used, and data were collected using an electronic questionnaire, which was either self-administered by the participants or completed with the assistance of the researcher in cases involving employees who did not speak Arabic or English. This study included 302 staff members involved in the preparation, service, and supervision of food provided to hospital patients. Results: The results indicated a high level of knowledge among nutrition services employees regarding food safety principles, critical temperature control, cross-contamination prevention, and proper hygiene practices. The employees also demonstrated a strong commitment to personal hygiene behaviors, such as handwashing, wearing appropriate clothing, and avoiding unsafe practices. Additionally, a high degree of knowledge and understanding was found regarding food storage procedures and contamination prevention. The study also highlighted a very high level of awareness concerning the cleaning and sterilization of equipment, tools, and food storage surfaces, as well as maintaining a clean and healthy environment. These findings emphasize the importance of continuous training in enhancing food safety knowledge among nutrition services employees. Conclusions: It is recommended that all employees, regardless of education level, experience, or role, participate regularly in food safety training programs to sustain and improve food safety practices within hospital environments. Full article

(This article belongs to the Section Nutrition and Public Health)

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16 pages, 856 KiB

Open AccessSystematic Review

Assessing Grief in Cancer Care: A Systematic Review of Observational Studies Using Psychometric Instruments

by Rebecca Mattson, Margaret Henderson and Savitri Singh Carlson

Healthcare 2025, 13(14), 1722; https://doi.org/10.3390/healthcare13141722 (registering DOI) - 17 Jul 2025

Abstract

Background/Objectives: Grief in cancer patients represents a multidimensional psychological response encompassing anticipatory, existential, and identity-related distress. While the recent literature has examined grief in caregivers, family members, and even healthcare professionals, the psychological grief experienced by patients themselves following a cancer diagnosis [...] Read more.

Background/Objectives: Grief in cancer patients represents a multidimensional psychological response encompassing anticipatory, existential, and identity-related distress. While the recent literature has examined grief in caregivers, family members, and even healthcare professionals, the psychological grief experienced by patients themselves following a cancer diagnosis remains comparatively understudied and insufficiently characterized in empirical research. This systematic review aims to evaluate observational studies that used validated psychometric instruments to measure grief in adult cancer patients and to synthesize findings on the significance of grief in this population. Methods: Following PRISMA 2020 guidelines, a systematic search of PubMed, CINAHL, and PsycINFO was conducted to identify observational studies that employed validated tools to assess grief among adult cancer patients. The inclusion criteria required the use of psychometrically validated grief instruments and the collection of quantitative data. Fifteen studies met eligibility criteria and were included in the final analysis. Results: Grief symptoms were consistently present at moderate to high levels across diverse cancer types, care settings, and geographic regions. Preparatory Grief in Advanced Cancer (PGAC) scores often exceeded thresholds associated with clinical concern, with correlations observed between grief and psychological variables such as anxiety (r = 0.63), depression (r = 0.637), hopelessness (r = 0.63), and dignity (r = 0.654). Demographic factors (e.g., younger age, female gender) and illness perceptions (e.g., identity centrality, stigma) further intensified grief. Grief was a predominant psychological concern even when general distress measures failed to capture its presence. Conclusions: Future research is essential to identify an effective public health strategy for addressing grief through structured screening conducted in primary care and outpatient medical settings, coupled with accessible referral pathways to community-based support groups and coordinated follow-up services to facilitate grief management. Full article

(This article belongs to the Special Issue Mental Health and Nursing Care of Individuals with Cancer and Their Families—2nd Edition)

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14 pages, 466 KiB

Open AccessArticle

Step by Step: Investigating Children’s Physical Activity and Enjoyment in Outdoor Walking with Their Parents

by Patrick M. Filanowski, Jeremy A. Steeves and Emily Slade

Healthcare 2025, 13(14), 1721; https://doi.org/10.3390/healthcare13141721 (registering DOI) - 17 Jul 2025

Abstract

Background/Objectives: Although public health organizations encourage family walking, no studies have examined children’s physical activity and enjoyment during outdoor parent–child walks. This study addresses those gaps by examining children’s moderate-to-vigorous physical activity (MVPA) and enjoyment during outdoor walks with their parents, along [...] Read more.

Background/Objectives: Although public health organizations encourage family walking, no studies have examined children’s physical activity and enjoyment during outdoor parent–child walks. This study addresses those gaps by examining children’s moderate-to-vigorous physical activity (MVPA) and enjoyment during outdoor walks with their parents, along with parental barriers and their relationship with parent’s self-efficacy and co-activity minutes. Methods: Fifty parent–child dyads (children aged 6–12 years) completed 10 min, self-paced outdoor walks while wearing waist-worn ActiGraph monitors. Parents reported perceived barriers to walking outdoors with their child and self-efficacy for supporting their child’s daily physical activity. Results: Children reported high enjoyment (mean = 5.1 on a six-point scale) and attained high physical activity intensity (71.3% of time in MVPA, 22.0% in vigorous activity, mean step count = 1200). Parents reported an average of 2.6 barriers (SD = 1.0) to walking outdoors with their child, with poor weather (70%) and lack of time (70%) reported most frequently. Each additional barrier was associated with a 1.3-point reduction in parents’ self-efficacy (p = 0.007). Two barriers (‘diverse interests between parent and child’ and ‘other parent-suggested barriers’) were significantly associated with fewer co-activity minutes per week (p < 0.001). Conclusions: Our study highlights the benefits of parent–child outdoor walking for promoting MVPA and enjoyment in children. Because perceived barriers may lower parents’ self-efficacy in supporting their child’s physical activity, addressing these barriers may be essential for the success of family-based interventions that encourage walking together outdoors. Full article

(This article belongs to the Special Issue Interventions for Preventing Obesity in Children and Adolescents)

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12 pages, 2176 KiB

Open AccessArticle

Technical Skill Acquisition in Pediatric Minimally Invasive Surgery: Evaluation of a 3D-Printed Simulator for Thoracoscopic Esophageal Atresia Repair

by Sara Maria Cravano, Annalisa Di Carmine, Chiara De Maio, Marco Di Mitri, Cristian Bisanti, Edoardo Collautti, Michele Libri, Simone D’Antonio, Tommaso Gargano, Enrico Ciardini and Mario Lima

Healthcare 2025, 13(14), 1720; https://doi.org/10.3390/healthcare13141720 (registering DOI) - 17 Jul 2025

Abstract

Background: Minimally invasive surgery (MIS) is increasingly adopted in pediatric surgical practice, yet it demands specific technical skills that require structured training. Simulation-based education offers a safe and effective environment for skill acquisition, especially in complex procedures such as thoracoscopic repair of esophageal [...] Read more.

Background: Minimally invasive surgery (MIS) is increasingly adopted in pediatric surgical practice, yet it demands specific technical skills that require structured training. Simulation-based education offers a safe and effective environment for skill acquisition, especially in complex procedures such as thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA-TEF). Objective: This study aimed to evaluate the effectiveness of a 3D-printed simulator for training pediatric surgeons in thoracoscopic EA-TEF repair, assessing improvements in operative time and technical performance. Methods: A high-fidelity, 3D-printed simulator replicating neonatal thoracic anatomy was developed. Six pediatric surgeons at different training levels performed eight simulation sessions, including fistula ligation and esophageal anastomosis. Operative time and technical skill were assessed using the Stanford Microsurgery and Resident Training (SMaRT) Scale. Results: All participants showed significant improvements. The average operative time decreased from 115.6 ± 3.51 to 90 ± 6.55 min for junior trainees and from 100.5 ± 3.55 to 77.5 ± 4.94 min for senior trainees. The mean SMaRT score increased from 23.8 ± 3.18 to 38.3 ± 3.93. These results demonstrate a clear learning curve and enhanced technical performance after repeated sessions. Conclusions: Such 3D-printed simulation models represent an effective tool for pediatric MIS training. Even within a short time frame, repeated practice significantly improves surgical proficiency, supporting their integration into pediatric surgical curricula as an ethical, safe, and efficient educational strategy. Full article

(This article belongs to the Special Issue Contemporary Surgical Trends and Management)

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13 pages, 783 KiB

Open AccessArticle

The Immediate Hypoalgesic Effects of Mobilization and Manipulation in Patients with Non-Specific Chronic Low Back Pain: A Cross-Over Randomized Controlled Trial

by Thomas Sampsonis, Stefanos Karanasios and George Gioftsos

Healthcare 2025, 13(14), 1719; https://doi.org/10.3390/healthcare13141719 (registering DOI) - 17 Jul 2025

Abstract

Background/Objectives: Manual therapy techniques, including mobilization and manipulation, are commonly used for chronic low back pain (CLBP), with clinical guidelines recommending their use. This study aimed to compare the immediate hypoalgesic effects of mobilization and manipulation in patients with non-specific CLBP, evaluating their [...] Read more.

Background/Objectives: Manual therapy techniques, including mobilization and manipulation, are commonly used for chronic low back pain (CLBP), with clinical guidelines recommending their use. This study aimed to compare the immediate hypoalgesic effects of mobilization and manipulation in patients with non-specific CLBP, evaluating their impact on pain sensitivity and range of motion. Methods: A cross-over randomized controlled trial was conducted with 27 participants with non-specific CLBP. Participants received either mobilization or manipulation on two different intervention days. Outcome measures included pressure pain thresholds (PPTs) assessed with a digital algometer, pain intensity using a numeric rating scale, and lumbar range of motion (ROM) measured with a digital inclinometer. Results: The results indicated no statistically significant differences between mobilization and manipulation for any outcome measures (all p > 0.05). However, significant within-intervention improvements were observed, including pain reduction, increased PPTs, and enhanced ROM of the lower back. Conclusions: Our findings suggest that both mobilization and manipulation provide similar immediate benefits for patients with CLBP. The choice between these techniques should be based on therapists’ clinical reasoning and individualized risk stratification, considering the potential benefits and risks of each approach for a specific patient. Full article

(This article belongs to the Special Issue Pain Management in Healthcare Practice)

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18 pages, 308 KiB

Open AccessReview

Non-Pharmacological Interventions to Prevent Oropharyngeal Candidiasis in Patients Using Inhaled Corticosteroids: A Narrative Review

by Leonardo Arzayus-Patiño and Vicente Benavides-Córdoba

Healthcare 2025, 13(14), 1718; https://doi.org/10.3390/healthcare13141718 (registering DOI) - 17 Jul 2025

Abstract

Inhaled corticosteroids (ICSs) are widely used to manage chronic respiratory conditions such as asthma, chronic obstructive pulmonary disease (COPD), and human immunodeficiency virus (HIV). However, prolonged use of ICS is associated with the development of oropharyngeal candidiasis, a fungal infection primarily caused by [...] Read more.

Inhaled corticosteroids (ICSs) are widely used to manage chronic respiratory conditions such as asthma, chronic obstructive pulmonary disease (COPD), and human immunodeficiency virus (HIV). However, prolonged use of ICS is associated with the development of oropharyngeal candidiasis, a fungal infection primarily caused by Candida albicans, due to local immunosuppression in the oral cavity. The incidence of oropharyngeal candidiasis varies depending on geographic region, patient age, and comorbidities, with immunocompromised individuals, those with diabetes, and the elderly being particularly vulnerable. Key risk factors include high ICS doses, poor oral hygiene, and improper use of inhalers. Prevention is the cornerstone of managing oropharyngeal candidiasis associated with the chronic use of inhaled corticosteroids. Patient education on proper inhaler technique and oral hygiene is essential to reduce the risk of fungal overgrowth in the oral cavity. Additional preventive strategies include the use of spacers, mouth rinsing after inhalation, and proper denture care. In cases where these measures fail to prevent the infection, prompt detection and early intervention are crucial to prevent progression or recurrence. This narrative review aims to analyze the most effective prophylactic measures to prevent oropharyngeal candidiasis associated with the chronic use of inhaled corticosteroids, emphasizing patient education, oral hygiene, and proper use of inhalation devices. Full article

(This article belongs to the Section Preventive Medicine)

15 pages, 845 KiB

Open AccessArticle

Three Decades of Trends in Risk Factors Attributed to Disease Burden in Saudi Arabia: Findings from the Global Burden of Disease Study 2021

by Amal Zaidan

Healthcare 2025, 13(14), 1717; https://doi.org/10.3390/healthcare13141717 (registering DOI) - 17 Jul 2025

Abstract

Objective: This study aimed to explore the burden attributable to different groups of risk factors (environmental/occupational, behavioral, and metabolic) in Saudi Arabia that were stratified by gender and year and measured by summary exposure values (SEVs) and disability-adjusted life years (DALYs) per 100,000. [...] Read more.

Objective: This study aimed to explore the burden attributable to different groups of risk factors (environmental/occupational, behavioral, and metabolic) in Saudi Arabia that were stratified by gender and year and measured by summary exposure values (SEVs) and disability-adjusted life years (DALYs) per 100,000. Design: This study was structured as a systematic analysis. Methods: Using the GBD 2021 data, we extracted information on different risk factors attributed to the disease burden in Saudi Arabia to quantify the differences in exposure value (SEV) and disability-adjusted life year (DALY) rates (per 100,000) between females and males across different years. Results: Over the years, sustained progress in reducing the number of DALYs attributable to specific environmental and occupational risks has been observed, as well as a slight decrease in some behavioral risks. The highest disease burden was attributed to metabolic and behavioral risk factors, with body mass index being the leading risk factor for both genders. Between 1990 and 2021, the age-standardized DALY rate in those with high body mass indices increased by 168.4% and reached 3436.23 (95% UI 1878.7–5031.5) in males and increased by 125.2% to reach 2952.6 (95% UI 1456.9–4.407) in females. The age-standardized SEVs were the highest in females with a high body mass index, reaching an SEV of 57.98 (95% UI: 64.1–49.2), and in males, an SEV of 50.75 (95% UI: 57.1–42.3) was achieved. Regarding their attributable deaths in 2021, metabolic risk factors were identified as the primary contributors to NCD mortality in 2021. Conclusions: These results reveal persistent health disparities between males and females, underscoring the urgent need for gender-specific research, policies, and interventions. Strategies aimed at promoting health and reducing disease burden should acknowledge the unique health challenges encountered by males and females. Full article

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15 pages, 1599 KiB

Open AccessArticle

From Aid to Impact: The Cost-Effectiveness of Global Health Aid in Sub-Saharan Africa and the Evolving Role of Microinsurance

by Symeon Sidiropoulos, Alkinoos Emmanouil-Kalos, Michail Chouzouris, Panos Xenos and Athanassios Vozikis

Healthcare 2025, 13(14), 1716; https://doi.org/10.3390/healthcare13141716 - 16 Jul 2025

Abstract

Background: Development Assistance for Health (DAH) plays a vital role in health financing across Sub-Saharan Africa, particularly in tackling communicable diseases such as HIV/AIDS, malaria, and tuberculosis. Despite its importance, the efficiency and equity of DAH allocation remain contested. Objectives: The study [...] Read more.

Background: Development Assistance for Health (DAH) plays a vital role in health financing across Sub-Saharan Africa, particularly in tackling communicable diseases such as HIV/AIDS, malaria, and tuberculosis. Despite its importance, the efficiency and equity of DAH allocation remain contested. Objectives: The study aims to evaluate the cost-effectiveness of DAH in Sub-Saharan Africa from 1995 to 2018, as well as to explore differences in efficiency across diseases and country contexts. Methods: Data were drawn from the Institute for Health Metrics and Evaluation and applied Generalized Cost-Effectiveness Analysis in conjunction with the Gross Domestic Product-based thresholds. Averted Disability-Adjusted Life Years were analyzed across countries and diseases, and countries were categorized by the Human Development Index (HDI) level to assess differential DAH performance. Results: DAH cost-effectiveness showed similar patterns across HDI groups, with roughly equal proportions of cost-effective and dominated outcomes in both low- and middle-HDI countries. Thirteen countries were identified as very cost-effective, nine as cost-effective, and two as non-cost-effective. Twenty-one countries were dominated, reflecting persistent inefficiencies in aid impact that transcends the various levels of development. Conclusions: Tailoring DAH allocation to specific disease burdens and development levels enhances its impact. The study underscores the need for targeted investment and a strategic shift toward integrated health system strengthening. Additionally, microinsurance is highlighted as a key mechanism for improving healthcare access and financial protection in low-income settings. Full article

(This article belongs to the Section Health Policy)

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31 pages, 1012 KiB

Open AccessReview

The Relationship Between Self-Efficacy and Job Satisfaction: A Meta-Analysis from the Perspective of Teacher Mental Health

by Yu Xiao and Li Zheng

Healthcare 2025, 13(14), 1715; https://doi.org/10.3390/healthcare13141715 - 16 Jul 2025

Abstract

Teacher mental health is a growing concern in educational and public health systems worldwide. This meta-analysis systematically examines the relationship between teacher self-efficacy—a core construct in social cognitive theory—and job satisfaction, both considered crucial indicators of occupational well-being. A total of 39 studies [...] Read more.

Teacher mental health is a growing concern in educational and public health systems worldwide. This meta-analysis systematically examines the relationship between teacher self-efficacy—a core construct in social cognitive theory—and job satisfaction, both considered crucial indicators of occupational well-being. A total of 39 studies involving teachers across 18 countries were analyzed, yielding a significant positive correlation between self-efficacy and job satisfaction (r = 0.41, p < 0.001), with notable heterogeneity (I² = 97%). Subgroup analyses revealed that the relationship was significantly stronger among teachers in high school and post-secondary contexts, and in studies conducted in Southern Hemisphere countries, highlighting the role of contextual and systemic moderators such as educational level and geographic inequality. The findings underscore the need for school- and policy-level interventions that bolster teachers’ self-efficacy through professional development, emotional support, and improved working conditions. Such interventions are essential not only for enhancing job satisfaction and reducing attrition but also for promoting the psychological resilience and well-being of the global teaching workforce. The study provides evidence-based insights into education and health policymakers aiming to support teacher retention and mental health through scalable, targeted initiatives. Full article

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19 pages, 949 KiB

Open AccessReview

Assessment of Patients’ Quality of Care in Healthcare Systems: A Comprehensive Narrative Literature Review

by Yisel Mi Guzmán-Leguel and Simón Quetzalcoatl Rodríguez-Lara

Healthcare 2025, 13(14), 1714; https://doi.org/10.3390/healthcare13141714 - 16 Jul 2025

Abstract

Introduction: Assessing the quality of patient care within healthcare systems remains a multifaceted challenge due to varying definitions of “quality” and the complexity of care delivery structures worldwide. Patient-centeredness, institutional responsiveness, and contextual adaptability are increasingly recognized as core pillars in quality assessment. [...] Read more.

Introduction: Assessing the quality of patient care within healthcare systems remains a multifaceted challenge due to varying definitions of “quality” and the complexity of care delivery structures worldwide. Patient-centeredness, institutional responsiveness, and contextual adaptability are increasingly recognized as core pillars in quality assessment. Objective: This narrative literature review aims to explore conceptual models and practical frameworks for evaluating healthcare quality, emphasizing tools that integrate technical, functional, and emotional dimensions and proposing a comprehensive model adaptable to diverse health system contexts. Methodology: A systematic literature search was conducted in the PubMed, Scopus, and Cochrane Library databases, covering the years 2000 to 2024. Studies were selected based on relevance to quality assessment models, patient satisfaction, accreditation, and strategic improvement methodologies. The review followed a thematic synthesis approach, integrating structural, process-based, and outcome-driven perspectives. Results: Core frameworks such as Donabedian’s model and balancing measures were reviewed alongside evaluation tools like the Dutch Consumer Quality Index, SERVQUAL, and Importance–Performance Analysis (IPA). These models revealed significant gaps between patient expectations and actual service delivery, especially in functional and emotional quality dimensions. This review also identified limitations related to contextual generalizability and bias. A novel integrative model is proposed, emphasizing the dynamic interaction between institutional structure, clinical processes, and patient experience. Conclusions: High-quality healthcare demands a multidimensional approach. Integrating conceptual frameworks with context-sensitive strategies enables healthcare systems to align technical performance with patient-centered outcomes. The proposed model offers a foundation for future empirical validation, particularly in resource-limited or hybrid settings. Full article

(This article belongs to the Special Issue Innovation in Hospital Management: Strategies and Efforts for Patient and Healthcare Workers Safety and Prevention of Claims: 2nd Edition)

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16 pages, 625 KiB

Open AccessArticle

Social Support’s Dual Mechanisms in the Loneliness–Frailty Link Among Older Adults with Diabetes in Beijing: A Cross-Sectional Study of Mediation and Moderation

by Huan-Jing Cai, Hai-Lun Liang, Jia-Li Zhu, Lei-Yu Shi, Jing Li and Yi-Jia Lin

Healthcare 2025, 13(14), 1713; https://doi.org/10.3390/healthcare13141713 (registering DOI) - 16 Jul 2025

Abstract

Background: The mechanisms linking loneliness to frailty in older adults with diabetes remain unclear. Guided by the Loneliness–Health Outcomes Model, this study is the first to simultaneously validate the dual mechanisms (mediation and moderation) of social support in the loneliness–frailty relationship among older [...] Read more.

Background: The mechanisms linking loneliness to frailty in older adults with diabetes remain unclear. Guided by the Loneliness–Health Outcomes Model, this study is the first to simultaneously validate the dual mechanisms (mediation and moderation) of social support in the loneliness–frailty relationship among older Chinese adults with diabetes. Methods: A cross-sectional study enrolled 442 community-dwelling adults aged ≥60 years with type 2 diabetes in Beijing. Standardized scales assessed loneliness (UCLA Loneliness Scale), frailty (Tilburg Frailty Indicator), and social support (SSRS). Analyses included Pearson’s correlations, hierarchical regression, and PROCESS macro to evaluate mediating/moderating effects, after adjusting for demographics and comorbidities. Results: The frailty prevalence was 55.2%. Loneliness was positively correlated with frailty (r = 0.327, p < 0.01), while social support showed inverse associations with both loneliness (r = −0.496) and frailty (r = −0.315) (p < 0.01). Social support partially mediated loneliness’s effect on frailty (indirect effect: 30.86%; 95% CI: 0.028–0.087) and moderated this relationship (interaction β = −0.003, p = 0.011). High-risk clusters (e.g., aged ≥80 years, widowed, and isolated individuals) exhibited combined “high loneliness–low support–high frailty” profiles. Conclusions: Social support reduces the frailty risk through dual mechanisms. These findings advocate for tiered clinical interventions: (1) targeted home-visit systems and resource allocation for high-risk subgroups (e.g., solo-living elders aged ≥80 years); and (2) the integration of social support screening into routine diabetes care to identify individuals below the protective threshold (SSRS < 45.47). These findings advance psychosocially informed strategies for diabetes management in aging populations. Full article

(This article belongs to the Special Issue Chronic Diseases: Integrating Innovation, Equity and Care Continuity)

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6 pages, 941 KiB

Open AccessCase Report

Bertolotti Syndrome: Surgical Treatment in a Middle-Aged Triathlete—A Case Report

by Julia Mahler and Alex Alfieri

Healthcare 2025, 13(14), 1712; https://doi.org/10.3390/healthcare13141712 (registering DOI) - 16 Jul 2025

Abstract

Background: Bertolotti syndrome describes a painful lumbosacral transitional vertebra (LSTV) with a pseudoarticulation between an enlarged lateral process of the caudal lumbar vertebra (L5) and ilium or sacrum. It often presents with chronic lower back pain with or without radiculopathy. The current literature [...] Read more.

Background: Bertolotti syndrome describes a painful lumbosacral transitional vertebra (LSTV) with a pseudoarticulation between an enlarged lateral process of the caudal lumbar vertebra (L5) and ilium or sacrum. It often presents with chronic lower back pain with or without radiculopathy. The current literature emphasizes Bertolotti as a differential diagnosis in young adults. However, it is presumably underdiagnosed in middle-aged and older patients. Treatment ranges from conservative treatment with physiotherapy, infiltration, and radiofrequency ablation to surgical interventions. Case Description: In this case illustration, we present the diagnostic and therapeutic challenges in a 48-year-old female triathlete with persistent left gluteal pain caused by Bertolotti syndrome. When conservative treatment with physiotherapy, infiltrations, thermocoagulation, and radiofrequency ablation of the pseudoarticulation failed, microsurgical reduction of the hypertrophic transverse process was performed. This minimally invasive intervention achieved satisfactory pain relief of at least 70% one year after surgery, allowing the patient to resume her athletic activities. Conclusions: Bertolotti syndrome should be considered a potential differential diagnosis in patients of all ages. Since many patients endure years of misdiagnosis, adequate treatment is crucial upon diagnosis. If conservative measures fail, surgical treatment such as “processectomy” or spinal fusion should be evaluated. This case follows the CARE reporting guidelines. Full article

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25 pages, 731 KiB

Open AccessArticle

Community Stakeholders’ Perspectives on Recruiting Young Adolescents (Age 10–14) in Sexual Health Research

by Sadandaula Rose Muheriwa Matemba, Sarah Abboud, Rohan D. Jeremiah, Natasha Crooks, Danielle C. Alcena-Stiner, Lucia Yvone Collen, Chifundo Colleta Zimba, Christina Castellano, Alicia L. Evans, Dina Johnson, Tremain Harris and Natalie Marie LeBlanc

Healthcare 2025, 13(14), 1711; https://doi.org/10.3390/healthcare13141711 - 16 Jul 2025

Abstract

Background/Objectives: Sexual health research involving young adolescents remains scarce despite rising rates of early sexual debut, pregnancies, and sexually transmitted infections (STIs) in this population. We explored community stakeholders’ perspectives on engaging young adolescents in sexual health research in Western New York [...] Read more.

Background/Objectives: Sexual health research involving young adolescents remains scarce despite rising rates of early sexual debut, pregnancies, and sexually transmitted infections (STIs) in this population. We explored community stakeholders’ perspectives on engaging young adolescents in sexual health research in Western New York to inform strategies for engaging young adolescents in sexual health research. Methods: This qualitative descriptive study was conducted from April 2022 to June 2023. Seventeen community stakeholders, including health education teachers, youth counselors, and adolescent health providers, participated in semi-structured in-depth interviews. Data were analyzed using conventional content analysis, managed by MAXQDA 2020. The rigor and trustworthiness of the data were ensured through triangulation with observations, peer debriefing, team analysis, and respondent validation. Results: Participants were predominantly female (94.1%), 52.9% Black/African American, 41.2% White, and 5.9% Caucasian–Indian American, and aged 23–59 years. Four themes emerged: perspectives on conducting sexual health research with young adolescents, recruitment strategies, sexual health questions appropriate for young adolescents, and building readiness for participation in sexual health research. Participants reported the need for sexual health research with young adolescents and recommended building a trusting relationship and involving schools, parents, and trusted community organizations in the research process. Suggested research questions included those related to awareness of sex, STIs, available resources, experiences with sexual education, and desired support. The findings also revealed the need to initiate sexual health conversations early when children start asking questions, as a foundation for meaningful participation in sexual health research. Conclusions: The findings suggest that sexual health research with young adolescents is feasible and necessary, with implications for the design of developmentally appropriate sexual health research and interventions grounded in trust and community collaboration. Future research should explore the perspectives of caregivers and young adolescents to inform studies and programs that are attuned to young adolescents’ developmental needs. Full article

(This article belongs to the Special Issue Advancing Health Education: Integrating Education, Evaluation and Intervention for Population Well-Being in Healthcare and Sexuality)

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15 pages, 240 KiB

Open AccessArticle

Exploring Pediatric Perspectives on Crohn’s Disease: A Qualitative Study of Knowledge, Lived Experience, and Self-Management

by Sara Azevedo, Luís Rodrigues and Ana Isabel Lopes

Healthcare 2025, 13(14), 1710; https://doi.org/10.3390/healthcare13141710 - 16 Jul 2025

Abstract

Background: Pediatric Crohn’s Disease (CD) affects more than physical health, influencing emotional well-being, social integration, and developmental milestones, with an impact on disease management. This study aimed to explore adolescents’ lived experiences with CD and identify factors influencing their motivation for self-management. Methods: [...] Read more.

Background: Pediatric Crohn’s Disease (CD) affects more than physical health, influencing emotional well-being, social integration, and developmental milestones, with an impact on disease management. This study aimed to explore adolescents’ lived experiences with CD and identify factors influencing their motivation for self-management. Methods: A descriptive, cross-sectional qualitative study was conducted using a semi-structured, self-administered online questionnaire. Participants (n = 10) were adolescents with CD who had been diagnosed for over three years and were recruited from a tertiary pediatric gastroenterology center. Data included demographics, clinical characteristics, IMPACT-III (HRQOL), and PROMIS short forms. Open-ended responses underwent thematic analysis using the framework developed by Braun and Clarke. Results: Participants (80% female, median age 16.2 years, median disease duration 4.6 years) were all in clinical remission (median PCDAI = 2) and with good quality of life (median IMPACT-III = 80.7). Six themes emerged: (1) disease knowledge, (2) emotional responses, (3) coping and adaptation, (4) social support, (5) daily life and school impact, and (6) transition to adult care. Most participants demonstrated strong disease literacy and reported effective coping strategies. Emotional responses to diagnosis ranged from relief (60%) to distress (40%); relapses commonly triggered anxiety and fear. Therapeutic changes and disease monitoring were perceived as beneficial (100%) but with concern. Diagnostic procedures were viewed as burdensome by 70% of respondents. School performance and extracurricular participation were negatively affected in 40% during flares. Concerns regarding the future were reported by 40% of participants, with 30% believing that CD might limit life aspirations. While 60% managed their disease independently, 30% relied on parental support. All acknowledged the need for transition to adult care, though readiness varied. Conclusions: This study illustrates the overall impact of disease on pediatric CD patients. It reports significant emotional challenges and difficulties, as well as an impact on daily life, despite good disease knowledge. The findings underscore the importance of psychosocial well-being, ongoing mental health assessment, non-invasive monitoring, and holistic care, emphasizing the patient perspective, in managing pediatric CD. Full article

(This article belongs to the Special Issue Patient Safety and Quality Improvement Across the Nursing Practice Continuum)

18 pages, 556 KiB

Open AccessArticle

Clinical Outcomes in Patients with Schizophrenia Treated with Long-Acting Injectable vs. Oral Antipsychotics: A Naturalistic Study

by Francesca Bardi, Lorenzo Moccia, Georgios D. Kotzalidis, Gianluca Boggio, Andrea Brugnami, Greta Sfratta, Delfina Janiri, Gabriele Sani and Alessio Simonetti

Healthcare 2025, 13(14), 1709; https://doi.org/10.3390/healthcare13141709 - 16 Jul 2025

Abstract

Background/Objectives: Long-acting injectable antipsychotics (LAIs) represent a significant advancement in the treatment of schizophrenia (SCZ), particularly for improving adherence and long-term outcomes. This study aimed to assess the clinical outcomes of patients receiving atypical LAIs compared to those on various oral antipsychotics [...] Read more.

Background/Objectives: Long-acting injectable antipsychotics (LAIs) represent a significant advancement in the treatment of schizophrenia (SCZ), particularly for improving adherence and long-term outcomes. This study aimed to assess the clinical outcomes of patients receiving atypical LAIs compared to those on various oral antipsychotics over a one-year follow-up in a naturalistic setting. Methods: Sixty patients with SCZ were subdivided in two groups, those receiving LAIs (n = 25) and those receiving oral antipsychotics (n = 35). The groups were comparable for age, gender, educational attainment, employment status, marital status, smoking habits, and baseline SCZ severity, with no differences in baseline chlorpromazine equivalent dosages. Results: Over the follow-up period, patients in the LAI group discontinued treatment less frequently (χ² = 4.72, p = 0.030), showed fewer suicide attempts (χ² = 5.63, p = 0.018), fewer hospitalizations (χ² = 4.95, p = 0.026), and fewer relapses (χ² = 6.61, p = 0.010). Significant differences also emerged on the Drug Attitude Inventory (DAI-10) scores (F = 8.76, p = 0.005) and Body Mass Index (BMI) values (F = 8.32, p = 0.007), with the LAI group showing more favorable outcomes. Conclusions: LAIs, compared to oral antipsychotics, may promote treatment adherence, as shown by decreased hospitalization; furthermore, their use is related with better outcomes, like fewer relapses and less suicide attempts in individuals with SCZ in real-world settings. Full article

(This article belongs to the Special Issue Biological and Clinical Aspects of the Treatment of Schizophrenia and Related Disorders: Second Edition)

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18 pages, 2318 KiB

Open AccessSystematic Review

Dropout Rate of Participants with Cancer in Randomized Clinical Trials That Use Virtual Reality to Manage Pain—A Systematic Review with Meta-Analysis and Meta-Regression

by Cristina García-Muñoz, María-Dolores Cortés-Vega and Patricia Martínez-Miranda

Healthcare 2025, 13(14), 1708; https://doi.org/10.3390/healthcare13141708 - 16 Jul 2025

Abstract

Background/Objectives: Virtual reality has emerged as a promising intervention for pain management in individuals with cancer. Although its clinical effects have been explored, little is known about participant adherence and dropout behavior. This systematic review and meta-analysis aimed to estimate the pooled [...] Read more.

Background/Objectives: Virtual reality has emerged as a promising intervention for pain management in individuals with cancer. Although its clinical effects have been explored, little is known about participant adherence and dropout behavior. This systematic review and meta-analysis aimed to estimate the pooled dropout rate in randomized controlled trials using virtual reality to treat cancer pain; assess whether dropout differs between groups; and explore potential predictors of attrition. Methods: We conducted a systematic search of PubMed, Web of Science, Scopus, and CINAHL up to April 2025. Eligible studies were randomized trials involving cancer patients or survivors that compared VR interventions for pain management with any non-VR control. Proportion meta-analyses and odds ratio meta-analyses were performed. Heterogeneity was assessed using the I² statistic, and meta-regression was conducted to explore potential predictors of dropout. The JBI appraisal tool was used to assess the methodological quality and GRADE system to determine the certainty of evidence. Results: Six randomized controlled trials were included (n = 569). The pooled dropout rate was 16% (95% CI: 8.2–28.7%). Dropout was slightly lower in VR groups (12.7%) than in controls (21.4%), but the difference was not statistically significant (OR = 0.94; 95% CI: 0.51–1.72; I² = 9%; GRADE: very low). No significant predictors of dropout were identified. Conclusions: VR interventions appear to have acceptable retention rates in oncology settings. The pooled dropout estimate may serve as a reference for sample size calculations. Future trials should improve reporting practices and investigate how VR modality and patient characteristics influence adherence. Full article

(This article belongs to the Special Issue Innovative Approaches to Chronic Disease Patient Care)

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16 pages, 1441 KiB

Open AccessArticle

Adherence Barriers, Patient Satisfaction, and Depression in Albanian Ambulatory Patients

by Sonila Qirko, Vasilika Prifti, Emirjona Kicaj, Rudina Cercizaj and Liliana Rogozea

Healthcare 2025, 13(14), 1707; https://doi.org/10.3390/healthcare13141707 - 15 Jul 2025

Abstract

Background: Medication adherence is essential for managing chronic conditions, while non-adherence remains a widespread issue, leading to poorer health outcomes and higher healthcare costs. This study aimed to identify key adherence barriers, explore their relationship with patient satisfaction, and assess their impact on [...] Read more.

Background: Medication adherence is essential for managing chronic conditions, while non-adherence remains a widespread issue, leading to poorer health outcomes and higher healthcare costs. This study aimed to identify key adherence barriers, explore their relationship with patient satisfaction, and assess their impact on overall well-being among ambulatory patients in Albania. Methods: A cross-sectional study was conducted in three public urban health centers in Vlora, Albania, between November 2024 and January 2025. A total of 80 ambulatory patients were recruited using convenience sampling. Data were collected through face-to-face interviews using validated questionnaires, including the Adherence Barriers Questionnaire (ABQ), the Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), and the Patient Health Questionnaire (PHQ-9) for depression screening. Results: The study included 80 ambulatory patients (mean age 66.7 years; 48.7% female), predominantly diagnosed with diabetes (42.5%) and rheumatic diseases (36.3%). All participants reported at least one adherence barrier, with 92.5% experiencing multiple barriers. The most common were financial burden (91.3%) and fear of side effects (77.5%). A significant positive correlation was found between adherence barriers and depression severity (ρ = 0.518, p < 0.0001), while patient satisfaction did not significantly influence adherence barriers (ρ = −0.217, p = 0.053) or depression severity (ρ = −0.004, p = 0.969). Multiple regression analysis showed that higher depression severity (p = 0.0049) was significantly associated with greater adherence barriers, while postgraduate education was associated with fewer barriers (p = 0.0175). Conclusions: Financial burden, fear of side effects, and psychological distress are key barriers to adherence among Albanian ambulatory patients. Although there are limitations inherent to the cross-sectional design and modest sample size, our findings highlight the potential benefit of routine mental health screening, targeted financial support, and improved patient education on medication management within primary care. These insights may help inform future research and interventions aimed at enhancing adherence and overall well-being. Patient satisfaction did not significantly impact adherence or depression. Targeted interventions focusing on financial support, mental health care, and patient education are needed to improve adherence and patient well-being. These findings underscore the need for integrated mental health and adherence support strategies within routine primary care services. Full article

(This article belongs to the Special Issue Medication Therapy Management in Healthcare)

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