Healthcare

30 pages, 347 KiB

Open AccessArticle

by Nadine Schunter, Mahtab Bahramsoltani, Luise Böhler and Heide Glaesmer

Healthcare 2025, 13(8), 938; https://doi.org/10.3390/healthcare13080938 (registering DOI) - 19 Apr 2025

Background/Objectives: Compared to the general population in Germany, higher risks for depression, suicidal ideation and suicide risk have been reported for German veterinary students. This study assessed various demographic and study-related risk factors for depression, suicidal ideation and suicide risk for the [...] Read more.

Background/Objectives: Compared to the general population in Germany, higher risks for depression, suicidal ideation and suicide risk have been reported for German veterinary students. This study assessed various demographic and study-related risk factors for depression, suicidal ideation and suicide risk for the first time. Methods: An online survey was conducted among German veterinary students to determine demographic and study-related characteristics, study conditions, depression, suicidal ideation, suicide risk, Effort–Reward Imbalance (ERI student version) and motivation and achievement goals (Achievement Goal Inventory) during studies. Data of 913 German veterinary students (90.7% female) aged 18 to 46 years (mean age 23.6 years) were analyzed (response rate 14.3%). Hierarchical logistic regression analyses were conducted, with depression, suicidal ideation and suicide risk as dependent variables and demographic as well as study-related factors as independent variables. Results: With the factors used, the variance explanation was highest for depression, followed by suicidal ideation and suicide risk. Low reward and high overcommitment were found to be the most important predictors for depression, suicidal ideation and suicide risk. Significant associations with depression, suicidal ideation and suicide risk were also revealed for time of study choice, general university entrance qualification grade, learning in a learning group, perceived peer competition and performance expectation from lecturers, as well as transparency of study requirements and transparency of examination requirements. Conclusions: The results of this study provide indications for the development of suitable prevention and intervention measures at veterinary medical schools to strengthen the mental health of veterinary students in Germany. Full article

(This article belongs to the Special Issue Health and Well-Being in Veterinary Medicine)

14 pages, 229 KiB

Open AccessArticle

Validation and Cultural Adaptation of the Serbian Version of the Cleveland Clinic Colorectal Cancer Quality of Life Questionnaire: A Comprehensive Psychometric Evaluation

by Vladimir Nikolic, Ljiljana Markovic-Denic, Lidija Masic, Aleksandar Sekulic, Stefan Kmezic, Djordje Knezevic, Aleksandar Radovanovic, Djordje Nektarijevic and Andrija Antic

Healthcare 2025, 13(8), 937; https://doi.org/10.3390/healthcare13080937 (registering DOI) - 18 Apr 2025

Abstract

Backround/Objectives: Colorectal cancer presents a significant quality of life (QoL) challenge as a result of both the disease and its treatments. This study aimed to validate and culturally adapt the Cleveland Clinic Colorectal Cancer Quality of Life Questionnaire (CCF-CaQL) for Serbian-speaking colorectal cancer [...] Read more.

Backround/Objectives: Colorectal cancer presents a significant quality of life (QoL) challenge as a result of both the disease and its treatments. This study aimed to validate and culturally adapt the Cleveland Clinic Colorectal Cancer Quality of Life Questionnaire (CCF-CaQL) for Serbian-speaking colorectal cancer patients. Methods: The CCF-CaQL offers a detailed assessment of the physical, emotional, social, and functional impacts of the disease. This study, conducted at the University Clinical Center of Serbia, involved 150 colorectal cancer patients undergoing treatment. The translation and adaptation process followed the EORTC Quality of Life Group’s guidelines, ensuring cultural relevance and comprehensibility. Statistical analyses, including Cronbach’s alpha for internal consistency and Pearson’s correlation for concurrent validity, reliability, and known-groups validity, were performed using SPSS and R software. Results: The Serbian version of the CCF-CaQL maintains strong psychometric properties with high internal consistency (Cronbach’s alpha = 0.85) and significant correlations with the FACT-C questionnaire, confirming its validity. Known-groups validity showed distinct variations in QoL scores based on tumor location, stoma presence, and neoadjuvant therapy status, highlighting its sensitivity to different clinical conditions. Conclusions: The CCF-CaQL questionnaire has been skillfully translated, culturally adapted, and carefully validated through psychometric evaluations for Serbian patients diagnosed with colorectal cancer. Full article

18 pages, 5347 KiB

Open AccessArticle

An Image Analysis for the Development of a Skin Change-Based AI Screening Model as an Alternative to the Bite Pressure Test

by Yoshihiro Takeda, Kanetaka Yamaguchi, Naoto Takahashi, Yasuhiro Nakanishi and Morio Ochi

Healthcare 2025, 13(8), 936; https://doi.org/10.3390/healthcare13080936 (registering DOI) - 18 Apr 2025

Abstract

Background/Objectives: Oral function assessments in hospitals and nursing facilities are mainly performed by nurses and caregivers but are sometimes not properly assessed. As a result, elderly people are not provided with meals appropriate for their masticatory function, increasing the risk of aspiration and [...] Read more.

Background/Objectives: Oral function assessments in hospitals and nursing facilities are mainly performed by nurses and caregivers but are sometimes not properly assessed. As a result, elderly people are not provided with meals appropriate for their masticatory function, increasing the risk of aspiration and other complications. In the present study, we aimed to examine image analysis conditions in order to create an AI model that can easily and objectively screen masticatory function based on occlusal pressure. Methods: Sampling was conducted at the Hokkaido University of Health Sciences (Hokkaido, Japan) and the university’s affiliated dental clinic in Hokkaido. Results: We collected 241 waveform images of changes in skin shape during chewing over a 20 s test period from 110 participants. Our study used two approaches for image analysis: convolutional neural networks (CNNs) and transfer learning. In the transfer learning analysis, MobileNetV2 and Xception achieved the highest classification accuracy (validation accuracy: 0.673). Conclusions: Therefore, it was determined that analyses of waveform images of changes in skin shape may contribute to the development of a skin change-based screening model as an alternative to the bite pressure test. Full article

(This article belongs to the Special Issue Novel Therapeutic and Diagnostic Strategies for Oral Diseases)

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21 pages, 641 KiB

Open AccessSystematic Review

Mathematical Contact Tracing Models for the COVID-19 Pandemic: A Systematic Review of the Literature

by Honoria Ocagli, Gloria Brigiari, Erica Marcolin, Michele Mongillo, Michele Tonon, Filippo Da Re, Davide Gentili, Federica Michieletto, Francesca Russo and Dario Gregori

Healthcare 2025, 13(8), 935; https://doi.org/10.3390/healthcare13080935 - 18 Apr 2025

Abstract

Background: Contact tracing (CT) is a primary means of controlling infectious diseases, such as coronavirus disease 2019 (COVID-19), especially in the early months of the pandemic. Objectives: This work is a systematic review of mathematical models used during the COVID-19 pandemic that [...] Read more.

Background: Contact tracing (CT) is a primary means of controlling infectious diseases, such as coronavirus disease 2019 (COVID-19), especially in the early months of the pandemic. Objectives: This work is a systematic review of mathematical models used during the COVID-19 pandemic that explicitly parameterise CT as a potential mitigator of the effects of the pandemic. Methods: This review is registered in PROSPERO. A comprehensive literature search was conducted using the PubMed, EMBASE, Cochrane Library, CINAHL, and Scopus databases. Two reviewers independently selected the title/abstract, full text, data extraction, and risk of bias. Disagreements were resolved through discussion. The characteristics of the studies and mathematical models were collected from each study. Results: A total of 53 articles out of 2101 were included. The modelling of the COVID-19 pandemic was the main objective of 23 studies, while the remaining articles evaluated the forecast transmission of COVID-19. Most studies used compartmental models to simulate COVID-19 transmission (26, 49.1%), while others used agent-based (16, 34%), branching processes (5, 9.4%), or other mathematical models (6). Most studies applying compartmental models consider CT in a separate compartment. Quarantine and basic reproduction numbers were also considered in the models. The quality assessment scores ranged from 13 to 26 of 28. Conclusions: Despite the significant heterogeneity in the models and the assumptions on the relevant model parameters, this systematic review provides a comprehensive overview of the models proposed to evaluate the COVID-19 pandemic, including non-pharmaceutical public health interventions such as CT. Prospero Registration: CRD42022359060. Full article

(This article belongs to the Section Coronaviruses (CoV) and COVID-19 Pandemic)

16 pages, 1580 KiB

Open AccessArticle

Disconnecting from Difficult Emotions in Times of Crisis: The Role of Self-Compassion and Experiential Avoidance in the Link Between Perceived COVID-19 Threat and Adjustment Disorder Severity

by Paweł Holas, Aleksandra Juszczyk, Jan Wardęszkiewicz, Joseph Ciarrochi and Steven C. Hayes

Healthcare 2025, 13(8), 934; https://doi.org/10.3390/healthcare13080934 - 18 Apr 2025

Abstract

Objectives: The COVID-19 pandemic has significantly impacted mental health worldwide. This study investigated the relationship between perceived COVID-19 threat and adjustment disorder (AjD) severity, examining self-compassion (SC) and experiential avoidance (EA) as potential moderators. Additionally, cluster analysis—a statistical method for grouping individuals based [...] Read more.

Objectives: The COVID-19 pandemic has significantly impacted mental health worldwide. This study investigated the relationship between perceived COVID-19 threat and adjustment disorder (AjD) severity, examining self-compassion (SC) and experiential avoidance (EA) as potential moderators. Additionally, cluster analysis—a statistical method for grouping individuals based on similar psychological characteristics—was employed to identify distinct profiles of SC and EA and their associations with AjD, depression, and anxiety symptoms. Methods: A sample of 308 participants meeting AjD criteria completed measures assessing AjD severity (ADNM-20), depression (PHQ-9), anxiety (GAD-7), SC, EA, and perceived threat of COVID-19. Moderation analyses were performed using the PROCESS macro. Cluster analysis identified profiles based on SC and EA scores, with clusters compared on AjD, PHQ, and GAD symptom severity. Results: SC and EA moderated the relationship between perceived COVID-19 threat and AjD severity. Interestingly, individuals with high EA and low SC exhibited no significant association between perceived threat and AjD symptoms. Cluster analysis revealed four distinct profiles: (1) high SC and low EA, (2) average SC and EA, (3) low SC and low EA, and (4) low SC and high EA. Participants in the high SC/low EA cluster reported significantly lower levels of AjD, depression, and anxiety symptoms compared to those in the low SC/high EA cluster, who exhibited the highest symptom severity across all measures. Conclusions: Our findings suggest that individuals who relied on experiential avoidance and lacked self-compassion experienced less emotional distress related to pandemic-related worries, potentially shielding themselves from acute AjD symptoms. However, this strategy was associated with greater emotional distress, as those with high AE and SC exhibited more symptoms of AjD, depression, and anxiety. In contrast, individuals with low AE and high SC demonstrated significantly better psychological well-being. Full article

(This article belongs to the Special Issue Psychological Diagnosis and Treatment of People with Mental Disorders)

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11 pages, 189 KiB

Open AccessArticle

Confidence, Barriers, and Role Identity of General Practice Independent Pharmacist Prescribers in Northern Ireland

by Lyndsey Alexander, Kingston Rajiah, Aaron Courtenay, Nermeen Ali and Ahmed Abuelhana

Healthcare 2025, 13(8), 933; https://doi.org/10.3390/healthcare13080933 - 18 Apr 2025

Abstract

Background: The role of General Practice Independent Pharmacist Prescribers (GPIPPs) has expanded significantly in primary care, with increasing responsibilities in medicines optimisation and chronic disease management. However, gaps remain in understanding their confidence in clinical decision-making, the barriers they face, and their professional [...] Read more.

Background: The role of General Practice Independent Pharmacist Prescribers (GPIPPs) has expanded significantly in primary care, with increasing responsibilities in medicines optimisation and chronic disease management. However, gaps remain in understanding their confidence in clinical decision-making, the barriers they face, and their professional identity within multidisciplinary teams. This study aimed to explore GPIPPs’ confidence, identify barriers to their prescribing autonomy, and assess the clarity of their role and their support within primary care settings in Northern Ireland. Methods: A cross-sectional study design was employed, combining quantitative and qualitative approaches. Data were collected via a Jisc online questionnaire distributed to GPIPPs working in general practices across Northern Ireland. The questionnaire assessed their demographic information, confidence in clinical decision-making, barriers to prescribing, and professional identity. Qualitative data from open-ended responses were analysed using thematic analysis. Results: Quantitative findings indicated that most GPIPPs viewed clinical decision-making as integral to their role, yet only a few felt adequately prepared by their independent prescribing courses. Qualitative analysis revealed themes such indemnity concerns, insufficient training, role ambiguity, and variability in GP support. Conclusions: The study highlights that while GPIPPs are confident in their prescribing roles, significant barriers such as indemnity concerns, training gaps, and role ambiguity hinder their full potential. Policy-level changes, including clearer indemnity policies, enhanced training programs, and standardised mentorship, are essential to optimise GPIPPs’ integration and effectiveness in primary care. Addressing these challenges will ensure that GPIPPs can fully contribute to patient care as autonomous prescribers. Full article

14 pages, 232 KiB

Open AccessReview

Novel and Emerging Treatments for Agitation in Schizophrenia and Bipolar Disorder

by Sydney A. Mashaw, Ahmed I. Anwar, Judy N. Vu, Austin S. Thomassen, Maya L. Beesley, Sahar Shekoohi and Alan D. Kaye

Healthcare 2025, 13(8), 932; https://doi.org/10.3390/healthcare13080932 - 18 Apr 2025

Abstract

Background: Agitation is a frequent and challenging symptom in schizophrenia and bipolar disorder, characterized by heightened motor activity, emotional distress, and potential aggression. This symptom is most observed during acute episodes, representing a significant burden on patients, caregivers, and healthcare systems. Agitation is [...] Read more.

Background: Agitation is a frequent and challenging symptom in schizophrenia and bipolar disorder, characterized by heightened motor activity, emotional distress, and potential aggression. This symptom is most observed during acute episodes, representing a significant burden on patients, caregivers, and healthcare systems. Agitation is a leading cause of emergency department visits and psychiatric hospitalizations, necessitating prompt and effective interventions to ensure safety and mitigate its far-reaching impact. Traditional treatments, including high-potency antipsychotics and benzodiazepines, remain first-line options but are associated with significant drawbacks such as sedation, extrapyramidal symptoms, tolerance, and limited applicability in certain patient populations, especially those with respiratory or cardiac depression and the elderly. Non-pharmacologic strategies like de-escalation techniques and environmental modifications are invaluable but may be impractical in acute care settings, as speed and efficiency are critical in emergent settings. These limitations, including the onset of extrapyramidal symptoms with high-dose antipsychotics and the development of tolerance with benzodiazepines, highlight gaps in care, including the need for faster-acting, safer, and more patient-friendly alternatives that reduce reliance on physical restraints and invasive interventions. Methods: This review explores the evolution of treatments for agitation, focusing on alternative and innovative approaches. To highlight these treatments, an extensive review of the literature was conducted utilizing PubMed, Google Scholar, Embase.com, and other search engines. Results: Key developments include sublingual dexmedetomidine, recently FDA-approved, which offers sedation without respiratory depression and a non-invasive administration route. Similarly, subcutaneous olanzapine provides a more convenient alternative to intramuscular injections, reducing injection-related complications. Other emerging treatments such as gabapentin, pregabalin, and ketamine show promise in addressing agitation in specific contexts, including comorbid conditions and treatment-resistant cases. A comparative analysis of these therapies highlights their mechanisms of action, clinical evidence, and practical challenges. Conclusions: Future directions emphasize intranasal delivery systems, novel pharmacologic agents, and potential roles for cannabinoids in managing agitation. These innovations aim to balance rapid symptom control with improved patient safety and experience. The set back with these emerging techniques is a lack of standardized dosing and protocols. They also face ethical concerns, including the chance of misuse or abuse, as well as regulatory barriers, as they lack FDA approval and their legality changes between states. This review underscores the clinical, practical, and ethical considerations in advancing care for agitated patients, paving the way for more effective and compassionate management strategies in psychiatric settings. Full article

9 pages, 890 KiB

Open AccessArticle

Efficacy of Chemotherapy in Pain Control of Patients with Cancer at the Early Phase of Their Disease

by Ștefan Spînu, Daniel Sur, Veronica Creciun, Daniela Moșoiu and Daniel Ciurescu

Healthcare 2025, 13(8), 931; https://doi.org/10.3390/healthcare13080931 - 18 Apr 2025

Abstract

Scope: The rationale of the present study is to measure the impact of chemotherapy on the pain caused by the disease. Materials and Methods: The present study was based on the completion of two standardized questionnaires for the assessment of physical symptoms (Brief [...] Read more.

Scope: The rationale of the present study is to measure the impact of chemotherapy on the pain caused by the disease. Materials and Methods: The present study was based on the completion of two standardized questionnaires for the assessment of physical symptoms (Brief Pain Inventory—BPI—and the revised Edmonton Symptom Assessment System—ESASr) in three different moments. The research was conducted at the Oncology Institute “Prof. Dr. Ion Chiricuță” Cluj-Napoca between 2022 and 2023. Results: 24 patients were included in the study, and they received different cytostatic treatment regimens, adapted to the underlying pathology. We analyzed the distribution of all symptoms from the ESASr and the total score. In terms of the general situation, if we exclude pain, there is never a difference between Time 2 and 3. Furthermore, in all cases where there is a statistically significant effect, there is a difference between Time 1 and 3. We also analyzed the distribution of activities with which pain interacts in BPI. Regarding the general situation, three patterns of influence of pain on the examined parameters are found: for general activity, mood, ability to work, and sleep, there are significant differences between moments 1 and 2 and 1 and 3, without significant differences between moments 2 and 3. The second pattern identified refers to the lack of effect of pain on the ability to walk and on the relationship with other people. The peculiarity is represented by the influence on the enjoyment of life that was significantly improved only from Time 1 to 3. Conclusions: The present study demonstrated a considerable effect of cytostatic treatment on the management of cancer-related pain, as shown across different evaluations. Full article

(This article belongs to the Special Issue Management and Nursing Strategy for Patients with Pain)

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18 pages, 244 KiB

Open AccessArticle

From Insight into Action: Understanding How Employer Perspectives Shape Endometriosis-Inclusive Workplace Policies

by Danielle Howe, Michelle O’Shea, Sarah Duffy and Mike Armour

Healthcare 2025, 13(8), 930; https://doi.org/10.3390/healthcare13080930 - 18 Apr 2025

Abstract

Background: Endometriosis costs Australia $9.7 billion AUD annually, with absenteeism and lost productivity mostly contributing to this cost burden. Previous research has shown how the absence of workplace support(s) for endometriosis symptom management can exacerbate negative effects. Despite this knowledge, the role [...] Read more.

Background: Endometriosis costs Australia $9.7 billion AUD annually, with absenteeism and lost productivity mostly contributing to this cost burden. Previous research has shown how the absence of workplace support(s) for endometriosis symptom management can exacerbate negative effects. Despite this knowledge, the role of employers and workplace policies in supporting employees with endometriosis remains unexamined. Background/Objectives: As part of the Endo@Work project (co-designed endometriosis workplace guidelines), this study examines the perceptions and experiences of managers, HR, and senior leaders to understand how the Endo@Work guidelines can be successfully implemented. Methods: Seven focus groups with 24 Australian employers were undertaken. Using reflexive thematic analysis, data were interpreted through a post-structural feminist lens with focus group discussions revealing how employers recognise the importance of workplace guidance/policies. Results/Conclusions: Problematically, existing policies and practices were often tokenistic and inconsistently implemented. This study identifies how leadership buy-in, flexible work arrangements, and the thoughtful integration of workplace education initiatives contribute to supporting employees managing endometriosis symptoms at work. This study’s findings emphasise how consistent policy enactment alongside ongoing education/training foster inclusive workplaces and gender equity outcomes. Full article

(This article belongs to the Special Issue Occupational Health and Workers’ Well-Being: From Research to Practice)

16 pages, 1261 KiB

Open AccessArticle

Lokomat vs. Conventional Therapy—Impact on Gait Symmetry in Hemiparetic Patients: Preliminary Clinical Study

by Marina Potašová, Peter Mačej, Eva Moraučíková, Patrícia Shtin Baňárová and Peter Kutiš

Healthcare 2025, 13(8), 929; https://doi.org/10.3390/healthcare13080929 - 18 Apr 2025

Abstract

Background/Objectives: One of the primary goals of neurorehabilitation after stroke is gait reeducation, as it provides the patient with greater autonomy and enhances their safety in daily activities. A preliminary clinical study was undertaken to determine whether robotic gait reeducation using the [...] Read more.

Background/Objectives: One of the primary goals of neurorehabilitation after stroke is gait reeducation, as it provides the patient with greater autonomy and enhances their safety in daily activities. A preliminary clinical study was undertaken to determine whether robotic gait reeducation using the Lokomat device is more effective than conventional therapy in achieving gait symmetry. Methods: The research group consisted of 107 patients, with an average age of 63.54 years, all in the subacute stage of hemiparesis. These patients underwent 4 weeks of neurorehabilitation and were assigned into experimental and control groups. The patients in the experimental group underwent neurorehabilitation (20 sessions) and twice-weekly walking on the Lokomat device (10 sessions). The control group received equivalent neurorehabilitation and conventional gait reeducation. We monitored the return of ideal limb loading (to a 50:50 ratio) and the restoration of the step length on the paretic limb to a physiological length (73 cm), as well as the subsequent restoration of gait symmetry. The measurements were performed using the HP Cosmos Zebris Treadmill FDM-T device. The Wilcoxon Signed Rank test was conducted within each group to analyze the effectiveness of gait reeducation before and after therapy. To compare the results between the two groups, the Mann–Whitney test (α = 0.05) was employed. Results: There was no significant difference between the robotic and conventional therapy groups (p = 0.432 (>0.05)). A significant change occurred only in the control group in the 50:50 limb loading parameter (p = 0.042). There were no significant changes in the other parameters. Conclusions: Under the conditions of our study, robot-guided gait reeducation did not appear to be more effective than conventional therapy. The monthly duration of gait reeducation is insufficient to achieve a symmetrical gait in patients with spastic hemiparesis. Full article

(This article belongs to the Special Issue Physical Therapy and Rehabilitation of Neurological Disorders)

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15 pages, 653 KiB

Open AccessArticle

Utilizing Balance Assessment Tools by Physical Therapists for Patients with Balance Disorders

by Abdulaziz A. Albalwi, Ahmad A. Alharbi, Hamad S. Al Amer, Samia A. Alamrani, Hani F. Albalawi, Maryam K. Alatawi, Wahaj A. Albalawi, Basmah A. Albalawi, Amani M. Qari, Waad A. Alatawi and Jamsheed Javid

Healthcare 2025, 13(8), 928; https://doi.org/10.3390/healthcare13080928 - 17 Apr 2025

Abstract

Background/Objectives: Physical therapists’ use of various balance assessment tools is essential for accurately identifying deficits and guiding rehabilitation plans. This study aimed to investigate clinical balance assessment practices in Saudi Arabia, examine physical therapists’ preferences for different balance assessment tools, and analyze how [...] Read more.

Background/Objectives: Physical therapists’ use of various balance assessment tools is essential for accurately identifying deficits and guiding rehabilitation plans. This study aimed to investigate clinical balance assessment practices in Saudi Arabia, examine physical therapists’ preferences for different balance assessment tools, and analyze how participant characteristics—such as age, experience, and practice setting—affect these preferences. Methods: A descriptive cross-sectional study was conducted between April and July 2024 in Saudi Arabia. A total of 194 physical therapists (62.9% male; 45.9% with 1–5 years of experience) who actively manage individuals with balance disorders were recruited using a convenience sampling technique. Data were collected through a self-structured questionnaire. Participants reported their use of balance assessment tools on a six-point Likert scale, incorporating both numeric and descriptive anchors. Results: The Single-Leg Stance was the most regularly used tool (54.6%), followed by the Berg Balance Scale and Functional Gait Assessment (FGA) (both 43.8%). Conversely, tools such as the Performance-Oriented Mobility Assessment (68.1%), Mini Balance Evaluation System (65.4%), and Fall Efficacy Scale International (56.2%) were the most underutilized. Significant associations were observed between tool preferences and participant characteristics, including area of practice, academic qualification, experience level, and work environment (p < 0.05). However, several validated assessment tools remain underutilized, highlighting gaps in awareness and training. Conclusions: The findings of this study highlight the need for greater standardization in balance assessment practices. Improving training programs, establishing clear clinical guidelines, and standardizing assessment protocols across healthcare settings can help make balance evaluations more consistent and effective. Full article

(This article belongs to the Section Healthcare Quality and Patient Safety)

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17 pages, 1667 KiB

Open AccessArticle

The Perspective on Secondary Research Practices: A Cross-Sectional Analysis

by Piotr Ratajczak, Katarzyna Oziewicz, Isolde Sommer, Dorota Kopciuch, Anna Paczkowska, Tomasz Zaprutko and Krzysztof Kus

Healthcare 2025, 13(8), 927; https://doi.org/10.3390/healthcare13080927 - 17 Apr 2025

Abstract

Background: The surge in scientific publications during the COVID-19 pandemic has heightened the need for reliable secondary studies such as Systematic Reviews, synthesising evidence to guide clinical and public health decisions. This study aimed to analyse the current practices, preferences, and challenges faced [...] Read more.

Background: The surge in scientific publications during the COVID-19 pandemic has heightened the need for reliable secondary studies such as Systematic Reviews, synthesising evidence to guide clinical and public health decisions. This study aimed to analyse the current practices, preferences, and challenges faced by researchers conducting secondary studies and assess the impact of the COVID-19 pandemic on these practices. Methods: An online survey was conducted among researchers actively involved in secondary research. Email addresses were collected from PubMed for publications related to COVID-19 secondary studies between 2020 and 2022. The survey comprised 24 questions, including single- and multiple-choice formats, covering general information, Systematic Review processes, and changes during the pandemic. Statistical analysis, including Pearson’s Chi² test, was performed on key responses to identify significant correlations. Results: This study highlights that only 26.9% of respondents use keyword-generation tools. However, those using PubMed were more likely to utilise MeSH (p = 0.01486, df = 1, Chi² = 5.932568). Systematic Review software adoption was prevalent, particularly for Rapid Reviews, with Covidence being commonly used (p = 0.00843, df = 1, Chi² = 6.938953), especially during the screening stage (p = 0.02400, df = 1, Chi² = 5.094851). Despite this, many researchers still reported that they did not use any software. A total of 94.9% of respondents reported adherence to PRISMA guidelines, and protocol registration was strongly associated with following these guidelines (p = 0.00320, df = 2, Chi² = 11.48858). Researchers using Embase were significantly more likely to incorporate RCTs (p = 0.00360, df = 1, Chi² = 8.476092), while Cochrane reviewers showed a lower reliance on non-randomised trials (p = 0.02601, df = 1, Chi² = 4.955580). During the COVID-19 pandemic, 64.3% of respondents observed a significant increase in secondary studies. Conclusions: This study highlights key trends in secondary research, emphasising adherence to established guidelines and the growing reliance on software tools. However, gaps remain in protocol registration and keyword generation practices. Addressing these gaps through targeted training may improve the quality of future secondary studies, particularly during global health crises. Full article

(This article belongs to the Special Issue Cost, Economics and Databases of Pharmaceutical Drugs in Public Health: Second Edition)

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9 pages, 515 KiB

Open AccessArticle

The Effect of SARS-CoV-2 Vaccination on HIV Viral Load in Patients Under Bictegravir/Tenofovir Alafenamide/Emtricitabine Therapy: A Retrospective Observational Study

by Giuseppe Pipitone, Giacomo Ciusa, Stefano Agrenzano, Francesco Di Lorenzo, Caterina Sagnelli, Antonio Cascio, Chiara Iaria and TheBICivico StudyGroup

Healthcare 2025, 13(8), 926; https://doi.org/10.3390/healthcare13080926 - 17 Apr 2025

Abstract

Background: The aim of our study is to evaluate the impact of SARS-CoV-2 vaccination on HIV viremia in patients treated under bictegravir-based therapy. Methods: We conducted a retrospective observational study in a tertiary hospital, analyzing data from 152 patients treated with BIC/TAF/FTC between [...] Read more.

Background: The aim of our study is to evaluate the impact of SARS-CoV-2 vaccination on HIV viremia in patients treated under bictegravir-based therapy. Methods: We conducted a retrospective observational study in a tertiary hospital, analyzing data from 152 patients treated with BIC/TAF/FTC between 2020 and 2022. Patients were divided into two groups: “vaccinated” (110/152) and “unvaccinated” (42/152) against SARS-CoV-2. The outcomes considered were the presence of “blips” (detectable viremia ≥ 20 copies/mL), “rebound” (viremia ≥ 50 copies/mL), and virological failures. Results: A lower incidence of blips in the “vaccinated” group compared to the “unvaccinated” group (9.1% vs. 28.6%, p = 0.002), and a reduced risk of blips in the vaccinated group (OR 3.8, 95% CI 1.4–9.8) were noticed. The rebound rate was lower in the vaccinated group compared to non-vaccinated, with a statistically significant difference (respectively, 2.7% vs. 11.9%, p = 0.037). Conclusions: our data suggest that SARS-CoV-2 vaccination may stimulate an immune response that enhances CD4+ and CD8+ cell function, contributing to a reduction in the number of blips and maintaining good viro-immunological control in patients with HIV, supporting the importance of vaccination in this population. Full article

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15 pages, 907 KiB

Open AccessArticle

Cardiometabolic Disease Risk Factors and Lifestyle Behaviors Among Adolescents: A Latent Class Analysis

by Fernanda Rocha de Faria, Valter Paulo Neves Miranda, Cheryl Howe, Jeffer Eidi Sasaki, Alessandra Amato, Giuseppe Musumeci and Paulo Roberto dos Santos Amorim

Healthcare 2025, 13(8), 925; https://doi.org/10.3390/healthcare13080925 (registering DOI) - 17 Apr 2025

Abstract

Background/Objectives: Cardiometabolic disease (CD) risk factors refer to the conditions that increase the likelihood of developing several health complications. The purpose of this study was to identify latent classes of CD risk factors among Brazilian adolescents and their association with sociodemographic and [...] Read more.

Background/Objectives: Cardiometabolic disease (CD) risk factors refer to the conditions that increase the likelihood of developing several health complications. The purpose of this study was to identify latent classes of CD risk factors among Brazilian adolescents and their association with sociodemographic and lifestyle behaviors. Methods: This was a cross-sectional study involving 349 adolescents aged 15 to 19 years old. A latent class analysis (LCA) was performed based on body mass index, body fat percentage, waist circumference, waist-to-height ratio, and blood pressure. Demographic characteristics and lifestyle variables related to screen time (ST), moderate-to-vigorous physical activity (MVPA), sedentary behavior (SB), and sleep duration were assessed through questionnaires. Results: Three CD risk factor classes were identified as follows: “Low Risk” (Class 1 = 79.5% of the sample), “Moderate Risk” (Class 2 = 8.6%), and “High Risk” (Class 3 = 11.9%). Sex and high ST (defined as >4 h/day) were associated with a greater likelihood of belonging to the higher CD risk classes. Adolescents with high ST presented a 4.39 (CI 95% 1.64–11.07) times greater chance of belonging to the “High Risk” instead of the “Low Risk” class. Adolescents with longer MVPA time had a higher probability of belonging to the “Low CD Risk” class. Conclusions: Female adolescents with less MVPA, more ST, and higher SB had a higher probability of being classified as “Higher CD Risk”. Efficient strategies to increase MVPA and reduce ST may contribute to the reduction in body fat accumulation and BP, which are the manifest variables in the proposed model. Full article

(This article belongs to the Special Issue Promoting Children’s Health Through Movement Behavior)

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19 pages, 3386 KiB

Open AccessArticle

Facility Management Costs for Hospital Infrastructures: Insights from the Italian Healthcare System

by Michele Dolcini, Sofia Borghi, Marco Rossitti, Andrea Brambilla, Silvia Mangili, Francesca Torrieri and Stefano Capolongo

Healthcare 2025, 13(8), 924; https://doi.org/10.3390/healthcare13080924 - 17 Apr 2025

Abstract

Background: Hospital infrastructures account for a significant portion of healthcare expenditures, yet the factors driving facility management costs (FMCs) remain underexplored, particularly in the Italian context. This study aims to analyze FMCs in hospitals, focusing on utility and maintenance expenses, while providing [...] Read more.

Background: Hospital infrastructures account for a significant portion of healthcare expenditures, yet the factors driving facility management costs (FMCs) remain underexplored, particularly in the Italian context. This study aims to analyze FMCs in hospitals, focusing on utility and maintenance expenses, while providing benchmarking values to support decision making. Methods: This study employed a mixed-methods approach, integrating a literature review, financial data analysis, and a case study of 27 hospital facilities in Lombardy. Data on utility and maintenance costs were collected from financial statements and supplemented with targeted questionnaires to enhance precision. Descriptive statistics and parametric cost indicators (e.g., EUR/sqm, EUR/bed) were analyzed to identify trends and disparities. Results: FMC increased by an average of 32.90% between 2019 and 2022, with utility expenses constituting 77.45% of total costs and maintenance accounting for 22.45%. Utility costs rose significantly (37.34%), driven by energy and cleaning services, while maintenance costs grew more moderately (18.66%). Cost variability was evident across hospital typologies, with Basic Healthcare Centers averaging 122.86 EUR/sqm compared to 232.66 EUR/sqm for Level II Emergency Hospitals. Conclusions: This study highlights significant variability in FMCs across Italian hospitals and underscores the need for benchmarking to optimize resource allocation. Future research should expand the dataset, incorporating extraordinary maintenance costs, and examine management models to enhance cost efficiency. These findings provide actionable insights for policymakers and healthcare administrators to improve hospital infrastructure sustainability and efficiency. Full article

(This article belongs to the Special Issue Efficiency, Innovation, and Sustainability in Healthcare Systems)

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23 pages, 314 KiB

Open AccessReview

New Therapeutic Challenges in Pediatric Gastroenterology: A Narrative Review

by Valeria Dipasquale and Claudio Romano

Healthcare 2025, 13(8), 923; https://doi.org/10.3390/healthcare13080923 - 17 Apr 2025

Abstract

Pediatric gastroenterology is entering a pivotal phase marked by significant challenges and emerging opportunities in treating conditions like celiac disease (CeD), eosinophilic esophagitis (EoE), inflammatory bowel disease (IBD), and autoimmune hepatitis (AIH) pose significant clinical hurdles, but new therapeutic avenues are emerging. Advances [...] Read more.

Pediatric gastroenterology is entering a pivotal phase marked by significant challenges and emerging opportunities in treating conditions like celiac disease (CeD), eosinophilic esophagitis (EoE), inflammatory bowel disease (IBD), and autoimmune hepatitis (AIH) pose significant clinical hurdles, but new therapeutic avenues are emerging. Advances in precision medicine, particularly proteomics, are reshaping care by tailoring treatments to individual patient characteristics. For CeD, therapies like gluten-degrading enzymes (latiglutenase, Kuma030) and zonulin inhibitors (larazotide acetate) show promise, though clinical outcomes are inconsistent. Immunotherapy and microbiota modulation, including probiotics and fecal microbiota transplantation (FMT), are also under exploration, with potential benefits in symptom management. Transglutaminase 2 inhibitors like ZED-1227 could help prevent gluten-induced damage. Monoclonal antibodies targeting immune pathways, such as AMG 714 and larazotide acetate, require further validation in pediatric populations. In EoE, biologics like dupilumab, cendakimab, dectrekumab (IL-13 inhibitors), and mepolizumab, reslizumab, and benralizumab (IL-5/IL-5R inhibitors) show varying efficacy, while thymic stromal lymphopoietin (TSLP) inhibitors like tezepelumab are also being investigated. These therapies require more pediatric-specific research to optimize their use. For IBD, biologics like vedolizumab, ustekinumab, and risankizumab, as well as small molecules like tofacitinib, etrasimod, and upadacitinib, are emerging treatments. New medications for individuals with refractory or steroid-dependent AIH have been explored. Personalized therapy, integrating precision medicine, therapeutic drug monitoring, and lifestyle changes, is increasingly guiding pediatric IBD management. This narrative review explores recent breakthroughs in treating CeD, EoE, IBD, and AIH, with a focus on pediatric studies when available, and discusses the growing role of proteomics in advancing personalized gastroenterological care. Full article

12 pages, 493 KiB

Open AccessArticle

Muscle Activation Differences Between CKCUEST and Modified CKCUEST: A Pilot Study

by Samuel Eloy Gutiérrez-Torre, Miguel Ángel Lozano-Melero, Maria Gómez-Jiménez and Daniel Manoso-Hernando

Healthcare 2025, 13(8), 922; https://doi.org/10.3390/healthcare13080922 - 17 Apr 2025

Abstract

Background/Objectives: The validity of shoulder orthopaedic tests to establish a diagnosis has recently been challenged. For this reason, functional tests, such as the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), have started to be used in clinical settings. The aim of this [...] Read more.

Background/Objectives: The validity of shoulder orthopaedic tests to establish a diagnosis has recently been challenged. For this reason, functional tests, such as the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), have started to be used in clinical settings. The aim of this study is to compare the electromyography (EMG) activity during the CKCUEST and the modified CKCUEST in a healthy adult population. Methods: Ten male (age: 26.6 ± 4.8) and ten female participants (age: 24.2 ± 6.0) were recruited from a university setting. The Edinburgh Handedness Inventory, the International Physical Activity Questionnaire and the percentage of activation of the maximum voluntary contraction of the infraspinatus, anterior deltoid and upper trapezius, of both upper limbs, throughout the CKCUEST and modified CKCUEST were analysed. Results: The percentage of activation of the infraspinatus (p < 0.01), anterior deltoid (p < 0.01) and upper trapezius (p < 0.01) in both sides was significantly higher in the CKCUEST compared to the modified CKCUEST. No differences were observed between laterality and the activation percentage of the infraspinatus (p > 0.05), anterior deltoid (p > 0.05) and upper trapezius (p > 0.05) in both sides during the CKCUEST. Conclusions: The results of this research showed a higher percentage of EMG activation during the CKCUEST compared to the modified CKCUEST in all the muscular structures analysed, regardless of the participants’ hemibody. Full article

(This article belongs to the Special Issue Physical Therapy and Rehabilitation in Sports)

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19 pages, 559 KiB

Open AccessArticle

Association Between Alcohol Consumption, Other Healthy Habits and Sociodemographic Variables and the Values of Different Insulin Resistance Risk Scales in 139,634 Spanish Workers

by Joan Obrador de Hevia, Ángel Arturo López-González, José Ignacio Ramírez-Manent, Hernán Paublini, Pedro Juan Tárraga López, Cristina Martorell Sánchez and Pere Riutord-Sbert

Healthcare 2025, 13(8), 921; https://doi.org/10.3390/healthcare13080921 - 17 Apr 2025

Abstract

Background: Alcohol consumption is a major public health concern, influencing metabolic health and insulin resistance (IR). While moderate alcohol intake has been associated with potential metabolic benefits, excessive consumption is linked to IR and related disorders. This study examines the association between [...] Read more.

Background: Alcohol consumption is a major public health concern, influencing metabolic health and insulin resistance (IR). While moderate alcohol intake has been associated with potential metabolic benefits, excessive consumption is linked to IR and related disorders. This study examines the association between sociodemographic variables, health habits, and IR risk using validated metabolic indices. Methods: A dual-phase study was conducted, including a cross-sectional analysis of 139,634 Spanish workers and a retrospective longitudinal follow-up of 40,431 participants (2009–2019). Data on sociodemographic factors (age, sex and socioeconomic status) and health habits (smoking, alcohol consumption, diet and physical activity) were collected through standardized occupational health assessments. IR risk was assessed using the Triglyceride-Glucose Index (TyG), Metabolic Score for Insulin Resistance (METS-IR), and Single-Point Insulin Sensitivity Estimator (SPISE-IR). Binary logistic regression was used for statistical analysis. Results: Age, male sex, lower socioeconomic status, smoking, alcohol consumption, physical inactivity and low adherence to the Mediterranean diet were significantly associated with higher IR risk across all indices (p < 0.001). Alcohol consumption exhibited a dose-dependent relationship with IR, with excessive intake significantly increasing the risk of IR. Longitudinal data revealed a worsening IR profile over time, particularly among older, low-income and physically inactive individuals. Conclusions: Sociodemographic factors and lifestyle habits strongly influence IR. Preventive strategies focused on reducing alcohol consumption, smoking cessation and promoting physical activity and dietary improvements are essential to mitigate the risk of IR, especially in vulnerable populations. Further longitudinal studies are needed to establish causal relationships and refine intervention strategies. Full article

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14 pages, 4751 KiB

Open AccessArticle

Electromyographic Analysis of Thigh Muscle Activity in Arthritic Knees During Sit-to-Stand and Stand-to-Sit Movements: Effects of Seat Height and Foot Position

by Hamad S. Al Amer, Mohamed A. Sabbahi, Hesham N. Alrowayeh, William J. Bryan and Sharon L. Olson

Healthcare 2025, 13(8), 920; https://doi.org/10.3390/healthcare13080920 - 17 Apr 2025

Abstract

Background: Knee osteoarthritis (OA) impairs functional mobility, including sit-to-stand and stand-to-sit movements. Thigh muscles stabilize the knee during these transitions, and variations in seat height and foot positioning may affect muscle activation. Assessing thigh muscle activity during these tasks may provide strategies [...] Read more.

Background: Knee osteoarthritis (OA) impairs functional mobility, including sit-to-stand and stand-to-sit movements. Thigh muscles stabilize the knee during these transitions, and variations in seat height and foot positioning may affect muscle activation. Assessing thigh muscle activity during these tasks may provide strategies to enhance function and guide targeted rehabilitation for individuals with knee OA. Objective: The aim of this study was to examine the EMG activity of the vastus medialis oblique (VMO), rectus femoris (RF), and biceps femoris (BF) muscles of arthritic knees during sit-to-stand and stand-to-sit movements when using varying seat heights and feet positions. Methods: The EMG activity was recorded from the three thigh muscles in the arthritic side during sit-to-stand and stand-to-sit movements under six different seating conditions from eight patients (three females; mean age: 64.6 ± 11.0 years). A three-way ANOVA was used to examine the effects of seat height, foot positioning, and movement type on muscle activation. Results: The results demonstrated significant interactions between muscle activation, movement type, and seating conditions (p = 0.022). The EMG activity of VMO and RF increased significantly during sit-to-stand movements from lower seat heights compared to knee-height seats (p < 0.05). RF activation was also significantly elevated during stand-to-sit transitions at low seat heights (p = 0.023). Additionally, sit-to-stand transitions with symmetrical foot placement elicited significantly greater VMO activation compared to BF activation (p < 0.05). While BF activation remained relatively low across most conditions, it was highest when the arthritic knee was positioned behind the sound foot during both movements. Conclusions: Seat height and foot positioning significantly impact thigh muscle activation in individuals with knee OA during sit-to-stand and stand-to-sit transitions. Lower seat heights require greater VMO and RF activation, indicating increased mechanical demands. Additionally, placing the arthritic knee behind the sound foot enhances BF activation, suggesting a potential strategy for targeted hamstring engagement. These findings provide directions for quadriceps and hamstring strengthening, alongside strategic seating adjustments to optimize functional mobility and reduce joint stress in individuals with knee OA. Full article

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