Healthcare

19 pages, 286 KB

Open AccessArticle

‘he’s not just a dog… he’s something bigger… my family.’ A Qualitative Study on Dog Ownership and Emotional Well-Being

by Eirini Stamataki and Panagiota Tragantzopoulou

Healthcare 2025, 13(21), 2666; https://doi.org/10.3390/healthcare13212666 (registering DOI) - 22 Oct 2025

Background/Objectives: Dogs are widely regarded as reliable sources of companionship and emotional support. In many instances, they are not merely considered pets, but valued as integral members of the family who significantly influence their caregivers’ emotional and psychological health. Within this framework, [...] Read more.

Background/Objectives: Dogs are widely regarded as reliable sources of companionship and emotional support. In many instances, they are not merely considered pets, but valued as integral members of the family who significantly influence their caregivers’ emotional and psychological health. Within this framework, this research examines how dog ownership through adoption may serve as both a protective and empowering factor against feelings of loneliness, while also fostering emotional resilience and a renewed sense of purpose in everyday life. Methods: Employing a qualitative research design, this study involved ten Greek participants, five women and five men, aged between 26 and 72, all of whom were the primary caregivers of their dogs. Data were collected through semi-structured interviews aimed at eliciting rich, in-depth personal narratives. Thematic analysis was used to identify recurring emotional patterns and explore the meanings embedded in participants’ accounts. Results: The findings revealed that the human–dog bond functions as a stable emotional anchor, promoting non-judgmental connection and emotional security. Participants reported experiencing greater emotional expression, enhanced social engagement, and improved psychological balance. Conclusions: Overall, the results demonstrate how dog ownership through adoption may act as a protective factor against loneliness while fostering resilience and emotional balance, pointing to the broader mental health benefits of nurturing human–animal bonds. Full article

20 pages, 944 KB

Open AccessSystematic Review

Digital Health Technologies in the Treatment of Chronic Pelvic Pain Syndromes: A Systematic Review of Randomized Clinical Trials

by Irene Torres-Sánchez, Olga Tejada-Vega, Guadalupe Rebollo-Segovia, Laura López-López and Esther Díaz-Mohedo

Healthcare 2025, 13(21), 2665; https://doi.org/10.3390/healthcare13212665 (registering DOI) - 22 Oct 2025

Abstract

Objective: To comprehensively examine the qualitative results of current studies reporting the efficacy of digital health (DH) technologies in the treatment of chronic pelvic pain syndromes (CPPS) and to describe the characteristics of these interventions. Materials and methods: In line with Preferred Reporting [...] Read more.

Objective: To comprehensively examine the qualitative results of current studies reporting the efficacy of digital health (DH) technologies in the treatment of chronic pelvic pain syndromes (CPPS) and to describe the characteristics of these interventions. Materials and methods: In line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, CINAHL, MEDLINE (via PubMed), Scopus and Web of Science databases were searched for trials published between database inception and July 2024. Randomized clinical trials using DH technologies for CPPS treatment were included. Methodological quality and risk of bias were appraised using the Downs and Black scale and the Cochrane Risk of Bias Assessment Tool. Results: Six articles were included. Four studies showed pain reduction in both groups between baseline and the end of the study, but this reduction was significant only in the experimental groups. One study showed an increase in pain intensity in all the groups, although it was smaller in the experimental groups. The last study found significant pain reduction in both groups, with no significant difference between them. Conclusions: DH technologies seem to offer some improvement in CPPS patients’ pain intensity. However, the studies showed high heterogeneity, which influences the consistency of the results. Full article

► Show Figures

Figure 1

9 pages, 753 KB

Open AccessArticle

Thoracic Motion Analysis Using a TrueDepth Camera in Patients with Relapsing Polychondritis: A Pilot Study

by Yoshihiro Nishi, Shohei Sato, Hiroshi Handa, Hiroki Nishine, Takemi Matsui and Masamichi Mineshita

Healthcare 2025, 13(21), 2664; https://doi.org/10.3390/healthcare13212664 (registering DOI) - 22 Oct 2025

Abstract

Background/Objectives: Relapsing polychondritis (RP) is a rare autoimmune disorder marked by recurrent inflammation of cartilaginous tissues, including the airways. Airway involvement, such as subglottic stenosis and airway malacia, significantly impacts prognosis. Although spirometry is the standard for evaluating respiratory function, it may [...] Read more.

Background/Objectives: Relapsing polychondritis (RP) is a rare autoimmune disorder marked by recurrent inflammation of cartilaginous tissues, including the airways. Airway involvement, such as subglottic stenosis and airway malacia, significantly impacts prognosis. Although spirometry is the standard for evaluating respiratory function, it may be unfeasible in patients with severe airway narrowing or tracheostomy. This study evaluated the potential of a smartphone-based application, DepthRecorder, which uses the iPhone’s TrueDepth camera to analyze thoracic motion in real time. Methods: Twelve patients with RP were enrolled. All underwent simultaneous respiratory assessment using spirometry and the DepthRecorder application. Thoracic motion data were corrected for height using previously validated regression formulas. Correlation between DepthRecorder and spirometry values was analyzed using Spearman’s rank correlation for forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), and the FEV₁/FVC ratio. Results: Mean age was 53.8 ± 13.3 years, with equal numbers of males and females. Before correction, DepthRecorder showed moderate correlations for FEV₁ (ρ = 0.48, p = 0.003) and FEV₁/FVC (%) (ρ = 0.57, p < 0.001). After correction, stronger correlations were observed for FVC (ρ = 0.76, p < 0.001), FEV₁ (ρ = 0.72, p < 0.001), and FEV₁/FVC (%) (ρ = 0.60, p < 0.001). Conclusions: The DepthRecorder application demonstrated strong correlations with spirometry following height-based correction. This method may offer a practical, non-invasive tool for respiratory assessment in RP patients who cannot undergo conventional lung function testing. Further studies are needed to validate these findings and establish clinical reference standards. Full article

16 pages, 715 KB

Open AccessArticle

Study on the Trend of Cervical Cancer Inpatient Costs and Its Influencing Factors in Economically Underdeveloped Areas of China, 2019–2023: An Analysis in Gansu Province

by Xi Chen, Yinan Yang, Yan Li, Jiaxian Zhou, Dan Wang, Yanxia Zhang, Jie Lu and Xiaobin Hu

Healthcare 2025, 13(21), 2663; https://doi.org/10.3390/healthcare13212663 (registering DOI) - 22 Oct 2025

Abstract

Background: Comprehensive data on the economic burden of cervical cancer treatment remain scarce in China’s less developed regions, necessitating this study on hospitalization costs and expenditure trends in these areas. Methods: Employing a multi-stage stratified cluster sampling approach, this study enrolled [...] Read more.

Background: Comprehensive data on the economic burden of cervical cancer treatment remain scarce in China’s less developed regions, necessitating this study on hospitalization costs and expenditure trends in these areas. Methods: Employing a multi-stage stratified cluster sampling approach, this study enrolled 10,070 cervical cancer inpatients from 72 healthcare facilities in Gansu Province. Clinical and expenditure data were extracted from hospital information systems. Rank sum tests and Spearman correlation analyses were performed for univariate assessment, while quantile regression and random forest models were applied to identify determinant factors. Results: From 2019 to 2023, the average hospitalization duration for cervical cancer patients in Gansu Province was 16.12 days, with an average hospitalization cost of USD 3862.08 (2023 constant prices, converted from CNY at 1:7.0467). During these five years, the average inpatient costs per hospitalization increased from USD 3473.45 to USD 4202.57, and the average daily hospitalization cost rose from USD 230.53 to USD 241.77. The average drug cost decreased from USD 769.06 to USD 640.16. The main factors influencing hospitalization costs included the length of hospital stay, whether cervical cancer surgery was performed, hospital type, hospital level, and the proportion of medications. Conclusions: Our findings indicate that cervical cancer is a considerable economic burden on both families and society. This highlights the need to control the length of hospital stay and optimize the allocation of medical resources, in addition to strengthening cervical cancer screening and HPV vaccination in underdeveloped areas, in order to enhance the efficiency of prevention and treatment and ensure medical equity. Full article

(This article belongs to the Section Women’s and Children’s Health)

► Show Figures

Figure 1

16 pages, 2028 KB

Open AccessArticle

Acceptability of Patient Portals and Phone Consultations in Hybrid Primary Care: A Slovenian Multi-Centre Pilot Study

by Matic Mihevc, Snežana Đurić and Marija Petek Šter

Healthcare 2025, 13(21), 2662; https://doi.org/10.3390/healthcare13212662 (registering DOI) - 22 Oct 2025

Abstract

Background/Objectives: With digital transformation, patient portals and phone consultations are increasingly integrated into hybrid primary care workflows that combine in-person and remote services. This study aimed to assess the acceptability of these tools among patients and identify factors associated with acceptability. Methods [...] Read more.

Background/Objectives: With digital transformation, patient portals and phone consultations are increasingly integrated into hybrid primary care workflows that combine in-person and remote services. This study aimed to assess the acceptability of these tools among patients and identify factors associated with acceptability. Methods: Between April and June 2025, a multicenter cross-sectional survey was conducted in four primary healthcare centers in Slovenia. The sample included 214 people who had used both patient portals and phone consultations within the previous 12 months. Data collected covered socio-demographic and clinical profile, digital communication skills, quality of life, and annual use of digital tools. Acceptability was assessed using the Theoretical Framework of Acceptability (TFA) tool. Univariate and multivariable linear regression analyses were performed to identify factors associated with acceptability. Results: Among the 214 participants (mean age 42.9 ± 14.1 years; 61.2% female), both patient portals and phone consultations were generally acceptable, with similar overall TFA scores (3.9/5). Patient portals were considered as significantly less time-consuming and better for communication, whereas phone consultations were preferred for accessibility and reliability. Multivariable analyses showed that higher digital communication skills and better quality of life predicted greater acceptability for both methods, whereas lower education level and more frequent use were associated with higher acceptability of phone consultations. Conclusions: Acceptability of patient portals and phone consultations varies by education, digital communication skills, and quality of life. This highlights the need for personalized hybrid care solutions. Healthcare providers should offer flexible digital options, invest in digital literacy programs, and develop interoperable eHealth infrastructure to enable safe and sustainable integration of advanced tools such as video consultations. Full article

► Show Figures

Figure 1

16 pages, 452 KB

Open AccessArticle

Real-World Evidence on the Use of Traditional Korean Medicine in Managing Intervertebral Disc Disease

by Boram Lee, Jun-Su Jang and Mi Hong Yim

Healthcare 2025, 13(21), 2661; https://doi.org/10.3390/healthcare13212661 (registering DOI) - 22 Oct 2025

Abstract

Background/Objectives: Korean medicine healthcare (KMHC), a form of traditional medicine including acupuncture and herbal medicine, is widely utilized by patients with intervertebral disc disease (IVDD). With the increasing use of real-world evidence (RWE) in the medical field, this study aims to derive RWE [...] Read more.

Background/Objectives: Korean medicine healthcare (KMHC), a form of traditional medicine including acupuncture and herbal medicine, is widely utilized by patients with intervertebral disc disease (IVDD). With the increasing use of real-world evidence (RWE) in the medical field, this study aims to derive RWE on KMHC utilization and its associated factors in patients with IVDD. Methods: Data from 495 individuals who received outpatient healthcare for IVDD regardless of the purpose such as treatment, examination, rehabilitation, monitoring, or prescription were analyzed using the 2022 Korea Health Panel Survey (KHPS). Multinomial logistic regression analyses were performed to identify factors associated with healthcare use for IVDD. Regression models were constructed by sequentially adding predisposing, enabling, and need factors following Andersen’s behavioral model. All statistical analyses accounted for the complex survey design of the KHPS using survey sampling weights. Results: Individuals aged 45–59 years were less likely to use both KMHC and conventional medicine healthcare (CMHC) for IVDD compared to those aged 19–44 years (adjusted odds ratio [95% confidence interval], 0.28 [0.09, 0.89]). People with disabilities showed lower utilization of both KMHC and CMHC for IVDD compared to those without disabilities (0.27 [0.09, 0.81]). Individuals who were employed (2.37 [1.06, 5.3]) or perceived their health status as fair (3.05 [1.17, 8]) or poor/very poor (6.13 [2.04, 18.45]) were more inclined to use both KMHC and CMHC for IVDD. Individuals who engaged in regular physical activities (2.65 [1.19, 5.9]) or had shoulder joint diseases (3.71 [1.22, 11.29]) or other spine-related diseases (2.63 [1.16, 5.96]) were more inclined to use KMHC-only for IVDD. Conclusions: This study identified significant demographic and health-related factors influencing KMHC utilization for IVDD. These findings emphasize the need for tailored healthcare policies regarding KMHC for IVDD for effective resource distribution. Full article

(This article belongs to the Special Issue Emerging Developments in Integrative and Complementary Medicine: Advancements in Research and Clinical Applications—Second Edition)

► Show Figures

Figure 1

14 pages, 933 KB

Open AccessSystematic Review

Adolescent Mental Health, Contraceptive Knowledge, and Teen Pregnancy Risk: A Systematic Review

by Denisa Hinoveanu, Ileana Enatescu, Catalin Dumitru, Patricia Octavia Mazilu, Daniel Popa, Cristina Anemari Popa, Mihail-Alexandru Badea, Felicia Marc and Adrian Gluhovschi

Healthcare 2025, 13(21), 2660; https://doi.org/10.3390/healthcare13212660 (registering DOI) - 22 Oct 2025

Abstract

Background: Adolescent depressive and anxiety symptoms may erode motivation and problem-solving needed for timely contraception, while online information quality is uneven. We synthesized evidence linking mental health, contraceptive knowledge/access, and teen pregnancy risk. Methods: Following PRISMA-2020, we searched PubMed, Embase, and [...] Read more.

Background: Adolescent depressive and anxiety symptoms may erode motivation and problem-solving needed for timely contraception, while online information quality is uneven. We synthesized evidence linking mental health, contraceptive knowledge/access, and teen pregnancy risk. Methods: Following PRISMA-2020, we searched PubMed, Embase, and Scopus to 7 July 2025 for primary studies including adolescents that measured validated mental health symptoms or psychiatric settings and reported contraceptive knowledge/access/behavior and/or teen pregnancy outcomes. Two reviewers screened/extracted data; risk of bias was appraised with the Newcastle–Ottawa Scale and ROBINS-I. Given heterogeneity, we conducted narrative synthesis. Results: Six U.S.-based studies met the criteria, spanning community colleges, a national cohort, school surveillance, psychiatric inpatient care, and pediatric emergency departments (samples: n = 143 to weighted N = 29,755). Depressive symptoms were associated with contraception access (adjusted odds ratio [aOR] 1.58, 95% CI 1.27–1.96) and anxiety/stress with similar risk (aOR 1.46, 1.17–1.82). A first depressive episode in the same year as sexual debut increased teenage pregnancy hazard (adjusted hazard ratio 2.70, 1.15–6.34). School surveillance showed mental health indicators correlated with contraception non-use at last sex (odds ratios 1.78–2.71). Among psychiatric inpatients, not knowing where to obtain contraception and access difficulties strongly predicted interest in information (aOR 2.96–3.33) and initiation (aOR 2.85–4.72). In a pediatric emergency department trial, same-day initiation occurred in 26.8% versus 3.1% under usual care. Conclusions: Evidence directly linking adolescent mental health symptoms to teen pregnancy is limited (one study), whereas multiple studies show associations with contraception knowledge/access and delayed or non-use, suggesting plausible indirect pathways to pregnancy risk. These findings support hypothesis-generating, integrated approaches and highlight the need for studies with teen pregnancy endpoints. Full article

► Show Figures

Figure 1

14 pages, 267 KB

Open AccessArticle

Effectiveness of Vaginal Pessary Use in Improving Quality of Life Among Women with Pelvic Organ Prolapse: A Prospective Study

by Ngoc Thi Tran, Thanh Quang Le, Hai Thanh Pham and Nam Hoang Tran

Healthcare 2025, 13(21), 2659; https://doi.org/10.3390/healthcare13212659 (registering DOI) - 22 Oct 2025

Abstract

Background: Pelvic organ prolapse (POP) significantly impairs women’s quality of life (QoL), particularly in resource-limited settings where surgical options may be restricted. Vaginal pessaries provide a conservative and cost-effective treatment, yet local evidence on their effectiveness in Vietnam remains scarce. Methods: In this [...] Read more.

Background: Pelvic organ prolapse (POP) significantly impairs women’s quality of life (QoL), particularly in resource-limited settings where surgical options may be restricted. Vaginal pessaries provide a conservative and cost-effective treatment, yet local evidence on their effectiveness in Vietnam remains scarce. Methods: In this six-month prospective study, 130 women with stage II–IV POP received vaginal pessaries. QoL was evaluated using validated PFDI-20 and PFIQ-7 questionnaires, and changes in symptoms, satisfaction, and adverse events were analyzed. Results: Most women presented with advanced POP (65.4% stage III, 19.2% stage IV). Ring pessaries were most frequently used (64.6%), followed by Gellhorn (23.9%) and Donut (11.5%). Successful fitting was achieved in 95.4% of participants, with six women discontinuing use due to expulsion or discomfort. QoL scores improved significantly after six months: mean PFDI-20 total decreased from 78.5 ± 51.4 to 42.2 ± 38.3 (p < 0.001), and PFIQ-7 total decreased from 62.6 ± 43.2 to 25.1 ± 22.9 (p < 0.001), with all subscales showing consistent improvement. Nearly all women (98.5%) reported symptomatic improvement, and 95.4% were satisfied with treatment. Correlation analyses showed no significant relationships between POP stage and obstetric factors (vaginal delivery, macrosomia, and episiotomy). In multivariate regression analysis including only age, BMI, and POP stage, none were significantly associated with QoL improvement. Conclusions: Vaginal pessary use was safe, highly effective, and well tolerated, leading to symptom and QoL improvements among Vietnamese women with advanced POP. These findings support pessary use as a first-line management option, especially for women who are elderly, have comorbidities, or lack access to surgery. Full article

(This article belongs to the Special Issue Pelvic Floor Health and Care)

5 pages, 150 KB

Open AccessEditorial

Data-Driven Insights in Healthcare

by Victor R. Prybutok and Gayle L. Prybutok

Healthcare 2025, 13(21), 2658; https://doi.org/10.3390/healthcare13212658 - 22 Oct 2025

Abstract

We are pleased to present this Special Issue, which is a curated collection of research that showcases the transformative power of data-driven approaches in healthcare [...] Full article

(This article belongs to the Special Issue Data Driven Insights in Healthcare)

14 pages, 358 KB

Open AccessArticle

Concerns, Beliefs and Attitudes of Pharmacists About Medical Cannabis Use in Poland

by Piotr Merks, Jameason Cameron, Justyna Kazmierczak, Artur Białkowski, Dariusz Świetlik, Mariola Borowska, Waldemar Wierzba, Urszula Bołkun-Skórnicka, Daniel Śliż, Eliza Blicharska, Jarosław Fedorowski, Regis Vaillancourt and Urszula Religioni

Healthcare 2025, 13(21), 2657; https://doi.org/10.3390/healthcare13212657 - 22 Oct 2025

Abstract

Introduction: The global use of medical cannabis is steadily increasing. In Poland, medical cannabis was legalised in 2017; however, its use remains limited and not widely integrated into clinical practice. This study aimed to explore the attitudes, concerns, and beliefs of pharmacists and [...] Read more.

Introduction: The global use of medical cannabis is steadily increasing. In Poland, medical cannabis was legalised in 2017; however, its use remains limited and not widely integrated into clinical practice. This study aimed to explore the attitudes, concerns, and beliefs of pharmacists and pharmacy students regarding the medical use of cannabis. Methods: A study was conducted in 2021 among 422 pharmacists and pharmacy students in Poland, primarily working in community pharmacies. Data were collected using a custom-designed questionnaire addressing beliefs, concerns, and professional experiences related to medical cannabis. Results: Nearly half of the respondents (48.9%) believe that cannabis should be used exclusively for medical purposes, while 47.6% support its use for both medical and recreational purposes following legalisation. A substantial majority (over 90%) consider cannabis effective for treating adults, with nearly 70% acknowledging its potential for treating children. Over 66% of respondents feel comfortable discussing medical cannabis with patients; however, fewer are confident in providing detailed advice about its use. The findings also highlight concerns about the long-term effects and potential legal implications of dispensing medical cannabis. Conclusions: Pharmacists and pharmacy students in Poland demonstrate openness to the medical use of cannabis and recognise its therapeutic potential. However, to enhance their ability to advise patients effectively, targeted educational initiatives are needed. These should focus on the clinical applications, safety, and long-term effects of cannabis, alongside strategies for addressing patient concerns and ensuring responsible usage. Full article

(This article belongs to the Special Issue Patient Experience and the Quality of Health Care)

► Show Figures

Figure 1

15 pages, 614 KB

Open AccessArticle

Telomere Length and COVID-19 Severity: A Comparative Cross-Sectional Study Across the Clinical Spectrum

by Flora Bacopoulou, Anastasios Tentolouris, Eleni Koniari, Dimitrios Kalogirou, Dimitrios Basoulis, Ioanna Eleftheriadou, Pinelopi Grigoropoulou, Vasiliki Efthymiou, Konstantina K. Georgoulia, Ioanna A. Anastasiou, Stavroula Papadodima, George Chrousos and Nikolaos Tentolouris

Healthcare 2025, 13(20), 2656; https://doi.org/10.3390/healthcare13202656 - 21 Oct 2025

Abstract

Background: Telomere attrition has been implicated in immune function and vulnerability to infectious diseases. However, the relation between telomere length and COVID-19 severity remains unclear. Methods: In this cross-sectional study, patients aged 30–75 years, with confirmed SARS-CoV-2 infection, as well as [...] Read more.

Background: Telomere attrition has been implicated in immune function and vulnerability to infectious diseases. However, the relation between telomere length and COVID-19 severity remains unclear. Methods: In this cross-sectional study, patients aged 30–75 years, with confirmed SARS-CoV-2 infection, as well as age- and BMI-matched controls without COVID-19, were recruited over a period of 1 year (2021–2022) from the outpatient clinics and wards of the General Hospitals “Laiko” and “Elpis” in Athens, Greece. Telomere length, expressed as a telomere to single-copy gene (T/S) ratio, was measured in all participants using a quantitative PCR-based method. Participants’ clinical, biochemical, demographic, and respiratory parameters were assessed in relation to their telomere length. Results: Study participants included a total of 139 individuals divided into three groups: controls (n = 34), patients with non-severe COVID-19 (n = 50), and patients with severe COVID-19 (n = 55). Patients with severe COVID-19 had significantly shorter telomeres when compared to both the non-severe COVID-19 group and controls (p < 0.001). Logistic regression analysis confirmed that telomere length was independently associated with disease severity (p < 0.001). Females demonstrated longer telomeres than males (p = 0.039), but no significant correlation was found between telomere length and age. When patients with non-severe and severe COVID-19 were analyzed together, no significant difference in telomere length was observed compared to controls (p = 0.727). Conclusions: Shortened telomeres may be linked to more severe forms of COVID-19, suggesting a potential role for telomere biology in disease progression. Results highlight the need for further research into telomere dynamics as a biomarker for disease susceptibility and outcome in viral infections. Full article

► Show Figures

Figure 1

19 pages, 959 KB

Open AccessArticle

Tracing How the Emergence of Chronic Pain Affects Military Identity: A Narrative Inquiry of Pain Trajectories Among Canadian Veterans

by Umair Majid, Tom Hoppe, Phoebe Priest, Leane Lacroix, Nicholas Held, David Pedlar and Kerry Kuluski

Healthcare 2025, 13(20), 2655; https://doi.org/10.3390/healthcare13202655 - 21 Oct 2025

Abstract

Background/Objectives: Military identity serves as a foundational lens through which service members navigate the events of everyday military and civilian life. However, the very process that cultivates a sense of unity and purpose can be a double-edged sword in civilian life. Although the [...] Read more.

Background/Objectives: Military identity serves as a foundational lens through which service members navigate the events of everyday military and civilian life. However, the very process that cultivates a sense of unity and purpose can be a double-edged sword in civilian life. Although the prevalence and transition needs are known, few studies have explored how chronic pain specifically disrupts military identity in depth. This qualitative study explores three distinct trajectories through which Veterans with chronic pain experience identity change. Methods: This study used narrative inquiry involving two sets of in-depth interviews with 20 Veterans. Reflexive thematic analysis was employed to describe and differentiate three distinct trajectories of chronic pain. Results: Veterans with chronic pain experience identity change through three overlapping pain trajectories: (1) traumatic injury -> immediate discharge; (2) misdiagnosed/non-traumatic injury -> delayed discharge; and (3) cumulative wear and tear -> gradual discharge. Regardless of trajectory, chronic pain consistently disrupted military identity and forced Veterans to confront tensions between institutional expectations of stoicism and combat readiness and the physical realities of chronic pain during military service. Those interviewed described experiencing fragmented institutional support, uneven access to care, and the systemic invalidation of pain that did not conform to military ideals. Conclusions: These findings underscore the need for Veteran-centred approaches, including responsive services, comprehensive pain science education throughout military careers, early detection of conditions that can lead to chronic pain, and flexible care pathways tailored to the nuances of each pain trajectory and grounded in military culture and lifestyle. Full article

(This article belongs to the Special Issue Health Equity and People-Centered Systems: Meeting Needs and Creating Opportunities for Diverse Communities)

► Show Figures

Figure 1

16 pages, 460 KB

Open AccessArticle

Factors Associated with Health Service Use for Self-Reported Balance Problems in Community-Dwelling Adults: A Secondary Analysis of Nationally Representative NHANES 2001–2004 Data

by Shweta Kapur, Kwame S. Sakyi, Joshua L. Haworth, Prateek Lohia and Daniel J. Goble

Healthcare 2025, 13(20), 2654; https://doi.org/10.3390/healthcare13202654 - 21 Oct 2025

Abstract

Background: Balance problems are one of the major risk factors for falls. Despite the availability of effective fall prevention interventions, falls and related injuries are rising. This study explored the factors associated with healthcare utilization for balance problems in community-dwelling adults in the [...] Read more.

Background: Balance problems are one of the major risk factors for falls. Despite the availability of effective fall prevention interventions, falls and related injuries are rising. This study explored the factors associated with healthcare utilization for balance problems in community-dwelling adults in the United States. Methods: Study involved secondary analysis of nationally representative National Health and Nutrition Examination Survey 2001–2004 data (latest data with variables of interest at the time of study). All adults (≥40 years) who reported balance problems in the past 12 months were included. Dependent variable was whether the individual ever saw a healthcare professional for balance problems. All analyses were adjusted for probability sampling weights. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were calculated using multivariable logistic regression. Results: Study included 1834 adults with self-reported balance problems (mean age 60.1 years (0.5 SE), 62.3% females). Of these, only 32.13% ever saw a healthcare professional for their balance problems. Having encounter(s) with a healthcare provider for any reason in the past year (AOR 2.45; 95% CI,1.19–5.06; p = 0.017), lack of health insurance (AOR 0.52; 95% CI,0.32–0.84; p = 0.009), falls in the past year (AOR, 1.29; 95% CI,1.03–1.61; p = 0.028) and age (AOR, 0.98; 95% CI,0.97–0.996; p = 0.011) had significant association with healthcare utilization for balance problems. The predicted probability of healthcare use for balance problems decreased from 0.39 for 40-year-olds to 0.26 for 80-year-olds. Conclusions: This study reports the association between factors such as age, health insurance, encounter with a healthcare provider, and falls in the past year with healthcare utilization for balance problems among community-dwelling adults with self-reported balance problems and identifies populations at increased risk of underutilization. Despite the use of older data, it provides useful information for guiding future research in this novel domain of healthcare research. Full article

► Show Figures

Figure 1

69 pages, 2280 KB

Open AccessSystematic Review

Neurodevelopmental Pathways from Maternal Obesity to Offspring Outcomes: An Umbrella Review of Cognitive and Behavioral Consequences Across Development

by Evgenia Gkintoni, Eleni Papachatzi, Erifili Efthymiadou, Emmanuella Magriplis and Apostolos Vantarakis

Healthcare 2025, 13(20), 2653; https://doi.org/10.3390/healthcare13202653 - 21 Oct 2025

Abstract

Background: Maternal obesity affects 20–25% of pregnancies globally and has been associated with adverse offspring neurodevelopmental outcomes. This umbrella review synthesized evidence on neurodevelopmental pathways linking maternal obesity to offspring cognitive, executive, and behavioral outcomes. Methods: Following PRISMA 2020 guidelines, we systematically searched [...] Read more.

Background: Maternal obesity affects 20–25% of pregnancies globally and has been associated with adverse offspring neurodevelopmental outcomes. This umbrella review synthesized evidence on neurodevelopmental pathways linking maternal obesity to offspring cognitive, executive, and behavioral outcomes. Methods: Following PRISMA 2020 guidelines, we systematically searched six databases (PubMed/MEDLINE, Scopus, Web of Science, PsycINFO, EMBASE, CINAHL) for studies published 2008–2024. We included original peer-reviewed studies examining maternal pre-pregnancy obesity (BMI ≥ 30 kg/m2) and offspring neurodevelopmental outcomes using prospective cohort, experimental, neuroimaging, or systematic review designs with validated assessments. Risk of bias was assessed using Newcastle–Ottawa Scale, Cochrane RoB 2.0, and SYRCLE guidelines. Results: Analysis of 78 studies encompassing 650,000+ mother–child pairs from 17 countries revealed significant associations. Study designs included prospective cohorts (59%), animal experiments (22%), systematic reviews/meta-analyses (13%), neuroimaging studies (4%), and randomized trials (3%). Maternal obesity (BMI ≥ 30 kg/m2) was associated with reduced cognitive abilities (IQ differences: −2.5 to −5.8 points), impaired executive function (OR 1.4–2.3), and increased ADHD symptoms (OR 1.4–2.8) and emotional dysregulation (OR 1.5–2.2). Dose–response relationships revealed threshold effects at BMI ≥ 30 kg/m2, accelerating at BMI ≥ 35 kg/m2. Four primary mechanistic pathways were identified: inflammatory, metabolic, epigenetic, and neurotransmitter alterations. Only 57.7% of studies used prospectively measured pre-pregnancy BMI. Conclusions: Observational and experimental evidence indicates maternal obesity represents a modifiable risk factor for offspring neurodevelopmental impairment. The primarily observational human evidence, supported by mechanistic animal studies, suggests multimodal interventions targeting identified pathways during critical windows (pre-conception through early postnatal period) warrant investigation. Full article

(This article belongs to the Special Issue Neurodiagnostics in Public Health: Cognitive Decline, Mental Health, and Emerging Technologies)

20 pages, 1041 KB

Open AccessArticle

Comparative Evaluation and Performance of Large Language Models in Clinical Infection Control Scenarios: A Benchmark Study

by Shuk-Ching Wong, Edwin Kwan-Yeung Chiu, Kelvin Hei-Yeung Chiu, Anthony Raymond Tam, Pui-Hing Chau, Ming-Hong Choi, Wing-Yan Ng, Monica Oi-Tung Kwok, Benny Yu Chau, Michael Yuey-Zhun Ng, Germaine Kit-Ming Lam, Peter Wai-Ching Wong, Tom Wai-Hin Chung, Siddharth Sridhar, Edmond Siu-Keung Ma, Kwok-Yung Yuen and Vincent Chi-Chung Cheng

Healthcare 2025, 13(20), 2652; https://doi.org/10.3390/healthcare13202652 - 21 Oct 2025

Abstract

Background: Infection prevention and control (IPC) in hospitals relies heavily on infection control nurses (ICNs) who manage complex consultations to prevent and control infections. This study evaluated large language models (LLMs) as artificial intelligence (AI) tools to support ICNs in IPC decision-making [...] Read more.

Background: Infection prevention and control (IPC) in hospitals relies heavily on infection control nurses (ICNs) who manage complex consultations to prevent and control infections. This study evaluated large language models (LLMs) as artificial intelligence (AI) tools to support ICNs in IPC decision-making processes. Our goal is to enhance the efficiency of IPC practices while maintaining the highest standards of safety and accuracy. Methods: A cross-sectional benchmarking study at Queen Mary Hospital, Hong Kong assessed three LLMs—GPT-4.1, DeepSeek V3, and Gemini 2.5 Pro Exp—using 30 clinical infection control scenarios. Each model generated clarifying questions to understand the scenarios before providing IPC recommendations through two prompting methods: an open-ended inquiry and a structured template. Sixteen experts, including senior and junior ICNs and physicians, rated these responses on coherence, conciseness, usefulness and relevance, evidence quality, and actionability (1–10 scale). Quantitative and qualitative analyses assessed AI performance, reliability, and clinical applicability. Results: GPT-4.1 and DeepSeek V3 scored significantly higher on the composite quality scale, with adjusted means (95% CI) of 36.77 (33.98–39.57) and 36.25 (33.45–39.04), respectively, compared with Gemini 2.5 Pro Exp at 33.19 (30.39–35.99) (p < 0.001). GPT-4.1 led in evidence quality, usefulness, and relevance. Gemini 2.5 Pro Exp failed to generate responses in 50% of scenarios under structured prompt conditions. Structured prompting yielded significant improvements, primarily by enhancing evidence quality (p < 0.001). Evaluator background influenced scoring, with doctors rating outputs higher than nurses (38.83 vs. 32.06, p < 0.001). However, a qualitative review revealed critical deficiencies across all models, for example, tuberculosis treatment solely based on a positive acid-fast bacilli (AFB) smear without considering nontuberculous mycobacteria in DeepSeek V3 and providing an impractical and noncommittal response regarding the de-escalation of precautions for Candida auris in Gemini 2.5 Pro Exp. These errors highlight potential safety risks and limited real-world applicability, despite generally positive scores. Conclusions: While GPT-4.1 and DeepSeek V3 deliver useful IPC advice, they are not yet reliable for autonomous use. Critical errors in clinical judgment and practical applicability highlight that LLMs cannot replace the expertise of ICNs. These technologies should serve as adjunct tools to support, rather than automate, clinical decision-making. Full article

(This article belongs to the Section Artificial Intelligence in Healthcare)

► Show Figures

Figure 1

16 pages, 869 KB

Open AccessArticle

Characteristics and Distribution of Radiologists in Saudi Arabia: A Cross-Sectional Study Based on National Data

by Jaber Hussain Alsalah

Healthcare 2025, 13(20), 2651; https://doi.org/10.3390/healthcare13202651 - 21 Oct 2025

Abstract

Background: In healthcare institutions, radiologists play an essential role in patients’ care, enabling them to begin treatment and start their recoveries. However, data on the characteristics and distribution of the radiology workforce in Saudi Arabia are limited. Therefore, this study aimed to conduct [...] Read more.

Background: In healthcare institutions, radiologists play an essential role in patients’ care, enabling them to begin treatment and start their recoveries. However, data on the characteristics and distribution of the radiology workforce in Saudi Arabia are limited. Therefore, this study aimed to conduct a comprehensive analysis of the radiology workforce in SA based on national data and identify key distributional and specialty trends relevant to workforce planning and radiology service delivery. Methods: The following data were obtained from the Saudi Commission for Health Specialties (SCFHS) Registry: total number of registered radiologists, age, subspecialty, professional classification, place of qualification, and geographical location. Descriptive statistics were used for data analysis. Additionally, the findings were compared with those of published international benchmarks. Results: There were 5150 radiologists registered with SCFHS in SA, which corresponded to 147 radiologists per 1,000,000 inhabitants. The mean age was 40.8 years (standard deviation [SD] 9.8), with 60% of them being aged 30–44 years. Most of the radiologists specialised in general diagnostic radiology (83.7%), with few of them specialising in interventional radiology (1.8%), paediatric radiology (1.1%), and breast imaging (0.9%). The workforce mainly comprised consultants (35.0%), followed by registrars (29.7%) and senior registrars (22.7%). Two-thirds (65.0%) of the radiologists had obtained their qualifications abroad. More than half of the radiologists resided in three provinces: Riyadh (29%), Mecca (23%), and the Eastern Region (15%), while several provinces had fewer than 2% of the available workforce. Conclusions: The radiology workforce in SA is relatively young and has a higher density than the average in the European Union. Further, most of the radiologists are professionally classified as consultants or registrars. However, there is a clear imbalance in their geographic distribution, which is consistent with the population sizes of the respective cities. Targeted training expansion and reduced reliance on foreign-trained professionals are warranted to meet future service demands in line with the Vision 2030 objectives. Full article

► Show Figures

Figure 1

13 pages, 230 KB

Open AccessArticle

Hostility in the ICU Waiting Room: Extrapunitive and Intropunitive Reactions Among Family Members

by Zoe Konstanti, Fotios Tatsis, Konstantinos Stamatis, Foteini Veroniki, Georgios Papathanakos, Vasilios Koulouras and Mary Gouva

Healthcare 2025, 13(20), 2650; https://doi.org/10.3390/healthcare13202650 - 21 Oct 2025

Abstract

Background/Objectives: Families of ICU patients endure intense psychological strain. While anxiety and depression are well documented, less attention has been given to hostility—expressed both outwardly as anger and inwardly as guilt or self-criticism. Hostility, however, often shapes the climate of the ICU waiting [...] Read more.

Background/Objectives: Families of ICU patients endure intense psychological strain. While anxiety and depression are well documented, less attention has been given to hostility—expressed both outwardly as anger and inwardly as guilt or self-criticism. Hostility, however, often shapes the climate of the ICU waiting room and the collaboration between families and staff. This study examined the levels and forms of hostility among ICU relatives, focusing on demographic predictors that may influence extrapunitive and intropunitive reactions. Methods: A cross-sectional study was conducted between June 2018 and December 2019 with 215 family members of ICU patients. Hostility was assessed using the Hostility and Direction of Hostility Questionnaire (HDHQ). Descriptive statistics, t-tests, ANOVAs, and multivariate regression analyses were performed to examine the effects of age, gender, and education on hostility subscales. Results: Male relatives exhibited higher acting-out hostility (M = 4.80, SD = 2.63) compared with female relatives (M = 4.12, SD = 2.21; t(216) = 1.96, p = 0.05, Cohen’s d = 0.28). Relatives with lower educational attainment showed significantly higher total hostility (β = −1.23, 95% CI [−1.78, −0.67], p < 0.001) and greater self-criticism (β = −0.44, 95% CI [−0.84, −0.03], p = 0.037). Younger age was associated with increased acting-out hostility (β = −0.029, 95% CI [−0.055, −0.002], p = 0.035). The regression models explained 12–26% of the variance across subscales (R² range = 0.12–0.26). These findings suggest two vulnerability trajectories: an externalized (extrapunitive) pattern in younger men and a broad internalized (intropunitive) pattern in relatives with lower education. Conclusions: Hostility in ICU families emerges in two distinct trajectories: externalized anger among young men and broad hostility in relatives with lower education. Recognizing these patterns is vital for preventing conflict, addressing hidden guilt and self-blame, and developing subgroup-sensitive interventions. The ICU waiting room is a space not only of fear and uncertainty but also of anger, guilt, and fragile attempts at psychological survival—dimensions that deserve systematic attention in both clinical practice and research. Full article

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

14 pages, 264 KB

Open AccessArticle

Impact of Chemotherapy on Motor–Cognitive Dual-Task Performance in Strength and Mobility Tests

by Almudena Martínez-Sánchez, Candela Guerrero-Torrico, Francisco Javier Dominguez-Muñoz, Narcis Gusi and Santos Villafaina

Healthcare 2025, 13(20), 2649; https://doi.org/10.3390/healthcare13202649 - 21 Oct 2025

Abstract

Background/Objectives: Chemotherapy often leads to persistent physical and cognitive impairments, and while the dual-task paradigm is a sensitive tool for detecting such deficits, its application to functional strength in oncology remains largely unexplored. Methods: This cross-sectional study, while not designed to [...] Read more.

Background/Objectives: Chemotherapy often leads to persistent physical and cognitive impairments, and while the dual-task paradigm is a sensitive tool for detecting such deficits, its application to functional strength in oncology remains largely unexplored. Methods: This cross-sectional study, while not designed to establish causality, included 44 participants including cancer patients (11 undergoing chemotherapy and 15 post-treatment survivors) and healthy controls. Functional fitness was assessed with the Senior Fitness Test battery under single- and dual-task conditions. The dual-task condition incorporated a cognitive subtraction task, and the dual-task cost was calculated. Group comparisons were analyzed using t-tests and ANOVA with effect sizes reported (p < 0.05). Results: Within-group comparisons showed that the cancer group exhibited reduced performance from the single- to the dual-task condition, with significant declines in strength and mobility (Chair Stand Test, p = 0.011; Timed Up and Go, p < 0.001). Greater dual-task costs were observed in the Arm Curl Test for cognitive (p = 0.005) and success (p = 0.004) outcomes. Conclusions: Dual-task testing revealed greater impairments in cancer patients and survivors, supporting the impact of chemotherapy-related cognitive impairment and highlighting the need for integrated motor–cognitive rehabilitation strategies. Further research is warranted in this field, employing larger sample sizes and stratified analyses by specific cancer types, and including a spectrum of complexity in the cognitive task to characterize the effects of cancer and its treatment on motor–cognitive integration. Full article

(This article belongs to the Special Issue Impact of Physical Activity on Chronic Diseases)

11 pages, 1576 KB

Open AccessArticle

Inter-Finger Variability of SpO₂ During Hypoxemia and Step Resaturation

by Simon Walzel, Veronika Rafl-Huttova, Martin Rozanek, Petr Kudrna, Marian Rybar and Jakub Rafl

Healthcare 2025, 13(20), 2648; https://doi.org/10.3390/healthcare13202648 - 21 Oct 2025

Abstract

Background: Pulse oximetry is a non-invasive method for continuous monitoring of peripheral blood oxygen saturation (SpO₂) to estimate arterial oxygen saturation. Previous studies suggested that SpO₂ measurements show variability depending on the particular finger that is used for measurement. To [...] Read more.

Background: Pulse oximetry is a non-invasive method for continuous monitoring of peripheral blood oxygen saturation (SpO₂) to estimate arterial oxygen saturation. Previous studies suggested that SpO₂ measurements show variability depending on the particular finger that is used for measurement. To date, no study has compared all fingers for SpO₂ under hypoxemia and during continuous simultaneous monitoring with randomization of finger sensor placement. Objectives: The aim of this study was to assess the inter-finger variability of SpO₂ values during sequential desaturation and step resaturation. Methods: Forty-three out of forty-five healthy participants (age 23.0 ± 1.8 years, BMI 24.0 ± 4.4 kg·m^–2) completed the experimental assessment with short-term induced hypoxemia by consecutive inhalation of three prepared gas mixtures with reduced oxygen concentrations (14%, 12%, and 10%). SpO₂ was measured continuously with the Masimo Radical-97 (Masimo Corp., Irvine, CA, USA) pulse oximeters. Results: The SpO₂ measured on the thumb was lower than all other fingers by 0.6% to 0.7% SpO₂, a systematic difference that is less than the clinically accepted accuracy of oximeters. No difference in SpO₂ dynamics was found between any of the fingers during step resaturation. Conclusions: A systematic difference in measured SpO₂ exists between the thumb and the other fingers during desaturation, which should be considered at least as well as the impact of the performance of a particular oximeter, sensor placement or anatomical variability. Full article

► Show Figures

Figure 1

Journal Description

Healthcare

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Topical Collections

Further Information

Guidelines

MDPI Initiatives

Follow MDPI