Healthcare

19 pages, 1375 KiB

Open AccessArticle

Evaluation of Machine Learning and Traditional Statistical Models to Assess the Value of Stroke Genetic Liability for Prediction of Risk of Stroke Within the UK Biobank

by Gideon MacCarthy and Raha Pazoki

Healthcare 2025, 13(9), 1003; https://doi.org/10.3390/healthcare13091003 (registering DOI) - 26 Apr 2025

Abstract

Background and Objective: Stroke is one of the leading causes of mortality and long-term disability in adults over 18 years of age globally, and its increasing incidence has become a global public health concern. Accurate stroke prediction is highly valuable for early intervention [...] Read more.

Background and Objective: Stroke is one of the leading causes of mortality and long-term disability in adults over 18 years of age globally, and its increasing incidence has become a global public health concern. Accurate stroke prediction is highly valuable for early intervention and treatment. There is a scarcity of studies evaluating the prediction value of genetic liability in the prediction of the risk of stroke. Materials and Methods: Our study involved 243,339 participants of European ancestry from the UK Biobank. We created stroke genetic liability using data from MEGASTROKE genome-wide association studies (GWASs). In our study, we built four predictive models with and without stroke genetic liability in the training set, namely a Cox proportional hazard (Coxph) model, gradient boosting model (GBM), decision tree (DT), and random forest (RF), to estimate time-to-event risk for stroke. We then assessed their performances in the testing set. Results: Each unit (standard deviation) increase in genetic liability increases the risk of incident stroke by 7% (HR = 1.07, 95% CI = 1.02, 1.12, p-value = 0.0030). The risk of stroke was greater in the higher genetic liability group, demonstrated by a 14% increased risk (HR = 1.14, 95% CI = 1.02, 1.27, p-value = 0.02) compared with the low genetic liability group. The Coxph model including genetic liability was the best-performing model for stroke prediction achieving an AUC of 69.54 (95% CI = 67.40, 71.68), NRI of 0.202 (95% CI = 0.12, 0.28; p-value = 0.000) and IDI of 1.0 × 10⁻⁴ (95% CI = 0.000, 3.0 × 10⁻⁴; p-value = 0.13) compared with the Cox model without genetic liability. Conclusions: Incorporating genetic liability in prediction models slightly improved prediction models of stroke beyond conventional risk factors. Full article

(This article belongs to the Special Issue Advances in Prediction, Prevention and Precision Medicine for Myocardial Infarction and Stroke)

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13 pages, 213 KiB

Open AccessArticle

Assessment of Quality of Life and Difficulties in Recording Data from Health-Related Quality of Life Questionnaires in Patients with Cancer Undergoing Immunotherapy Treatment

by Laura Bibiano Guillén, Cristina Recio Carrasco, José Miguel Cárdenas Rebollo, Dihan van Niekerk, Jesús Rodríguez Pascual, María Carmen Rubio-Rodríguez and Miguel A. Reina

Healthcare 2025, 13(9), 1002; https://doi.org/10.3390/healthcare13091002 (registering DOI) - 26 Apr 2025

Abstract

Background: Prospective studies evaluating the challenges of systematically assessing health-related quality of life in patients with cancer outside clinical trials are lacking. This study aimed to evaluate the quality of life of patients with cancer treated with immunotherapy such as checkpoint inhibitors and [...] Read more.

Background: Prospective studies evaluating the challenges of systematically assessing health-related quality of life in patients with cancer outside clinical trials are lacking. This study aimed to evaluate the quality of life of patients with cancer treated with immunotherapy such as checkpoint inhibitors and to determine the difficulties and limitations in achieving data collection from health-related quality of life questionnaires. Methods: We carried out a prospective observational study over 15 months in 30 patients with solid tumors undergoing checkpoint inhibitor therapy in an outpatient setting. We assessed health-related quality of life using the European Organization for Research and Treatment of Cancer QLQ-C30 quality of life questionnaire at treatment initiation, three months, and six months. We analyzed compliance rates, reported difficulties, and treatment-related toxicities. Results: Of the 30 patients, 26 completed the health-related quality of life standardized questionnaire at one month (86.6%), 24 at three months (80%), and 18 at six months (56.6%). Patients receiving checkpoint inhibitor monotherapy showed an improvement in global health status scores from 60 at baseline to 65 at three months and 70.8 at six months. These findings suggest that checkpoint inhibitor therapy delays symptom onset and positively impacts quality of life. Fatigue was the most frequently reported adverse effect, followed by pain, dyspnea, and gastrointestinal symptoms. Conclusions: Checkpoint inhibitor treatments may delay the onset of cancer-related symptoms, positively influencing patient-reported health-related quality of life (HRQoL) outcomes. However, this study highlights significant methodological challenges in collecting standardized HRQoL questionnaire data outside of clinical trials, including declining patient compliance over time. These findings underscore the need for adapted HRQoL assessment strategies tailored to the unique treatment trajectories of immunotherapy patients. Full article

18 pages, 780 KiB

Open AccessArticle

Hindering and Facilitating Factors While Implementing the Family and Community Nursing Model in Italy: Findings from a Qualitative Study

by Majda Clodig, Gaia Magro, Paola De Lucia, Marisa Prezza, Gaia Dussi, Sara Dentice, Chiara Moreal, Stefania Chiappinotto and Alvisa Palese

Healthcare 2025, 13(9), 1001; https://doi.org/10.3390/healthcare13091001 (registering DOI) - 26 Apr 2025

Abstract

Background/Objectives: Several Italian regions have started to introduce the Family and Community Nurse model. The aim of this study was to describe the facilitating and hindering factors that have influenced the implementation of the model by analyzing regional policies from the perspective of [...] Read more.

Background/Objectives: Several Italian regions have started to introduce the Family and Community Nurse model. The aim of this study was to describe the facilitating and hindering factors that have influenced the implementation of the model by analyzing regional policies from the perspective of nurses appointed as Family and Community Nurses. Methods: A qualitative study from 2023 to 2024 following the Standards for Reporting Qualitative Research. Nurses attending a training course were eligible (N = 68) and multi-method data collection was used. Mandatory written project works were requested at the end of the course, and interviews conducted after six months with 14 purposively selected nurses were used. The data were subjected to content analysis. The factors identified were categorized by level (nurse, microsystem, mesosystem, exosystem, and macrosystem) and by the domains of the Consolidated Framework for Implementation Research. Results: A total of 23 facilitating factors and 20 hindering factors were identified across all levels and four domains of the Consolidated Framework for Implementation Research. Implementation required nurses to shift from a task-oriented to a user-oriented approach to care that emphasizes accountability and citizen needs. Facilitating factors were the availability of advanced competencies, digital skills, familiarity with communities, and effective teamwork supported by leaders. Challenges arose from fragmented systems and unmet community expectations. Strengthening cross-sector collaboration, fostering trust, and engaging third sector resources were critical factors hindering holistic, patient-centred care. Conclusions: The Family and Community Nurses model promotes integrated, patient-centred care through proactive approaches that require advanced competence and interprofessional collaboration. Training, leadership support, and the removal of systemic barriers are critical. Future research should focus on integrating the identified factors into strategies to optimize the implementation of the Family and Community Nurses model. Full article

(This article belongs to the Special Issue The Specialist Nurse in European Healthcare towards 2030)

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22 pages, 2738 KiB

Open AccessArticle

Effects of Psychosocial and Ergonomic Risk Perceptions in the Hospital Environment on Employee Health, Job Performance, and Absenteeism

by Kadriye Sönmez, Salim Yilmaz and Derya Karabay

Healthcare 2025, 13(9), 1000; https://doi.org/10.3390/healthcare13091000 (registering DOI) - 26 Apr 2025

Abstract

Background: This study examined the effects of psychosocial and ergonomic risk perceptions in the hospital environment on employee health, job performance, and absenteeism. In fast-paced hospital settings, the cumulative physical and psychological demands of patient care, exacerbated by poor ergonomic conditions, can jeopardize [...] Read more.

Background: This study examined the effects of psychosocial and ergonomic risk perceptions in the hospital environment on employee health, job performance, and absenteeism. In fast-paced hospital settings, the cumulative physical and psychological demands of patient care, exacerbated by poor ergonomic conditions, can jeopardize employee well-being and compromise service quality. Methods: A cross-sectional study was conducted among healthcare professionals in Istanbul using a multimethod approach with a quantitative emphasis. To analyze the interrelationships among these variables while controlling for demographic factors, including age and sex, structural equation modeling was employed. Results: The findings indicated that both psychological safety and favorable ergonomic conditions significantly enhanced job satisfaction, which in turn positively influenced mental health and overall job performance. Moreover, better physical health was associated with reduced absenteeism, further contributing to improved job performance. These results highlight the significance of developing supportive and ergonomically sound work environments for enhancing employee well-being, reducing absenteeism, and optimizing performance in hospital settings. Conclusions: This study offers valuable insights for hospital administrators and policymakers seeking to implement effective interventions that address psychosocial and ergonomic challenges, thereby ensuring higher quality healthcare services. Full article

(This article belongs to the Special Issue Job Satisfaction and Mental Health of Workers: Second Edition)

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17 pages, 220 KiB

Open AccessArticle

Oral Care Experiences of Children with Down Syndrome: Caregiver and Dentist Perspectives

by Marinthea Richter, Elizabeth Isralowitz, José C. Polido, Sharon A. Cermak and Leah I. Stein Duker

Healthcare 2025, 13(9), 999; https://doi.org/10.3390/healthcare13090999 (registering DOI) - 26 Apr 2025

Abstract

Background/Objectives: Children with Down syndrome (DS) have distinct oral care needs and challenges, yet research on their care experiences, exploring caregiver and provider perspectives, is limited. Therefore, this study aimed to describe the barriers and facilitators to oral care for children with [...] Read more.

Background/Objectives: Children with Down syndrome (DS) have distinct oral care needs and challenges, yet research on their care experiences, exploring caregiver and provider perspectives, is limited. Therefore, this study aimed to describe the barriers and facilitators to oral care for children with DS, as reported by caregivers and dental professionals. Methods: In this qualitative inquiry, semi-structured questions were used to elicit narratives describing oral care experiences from one caregiver focus group (n = 5), individual caregiver interviews (n = 9), and individual dentist interviews (n = 8). The transcripts were coded and thematically analyzed. Results: Three themes emerged in both groups. The first theme, Access, described the challenges in locating a dentist willing and knowledgeable about how to treat children with DS, and the variability in experiences between different contexts (i.e., community-based vs. specialty clinics). The second theme, Pre-visit Preparation, noted the potential impact of dental trauma on dental visits and recommended the use of preparation strategies, such as desensitization appointments, strategic scheduling, and visual or verbal scripts or social stories, to introduce dental encounters. The final theme, Dental Encounters, dealt with the importance of communication and interpersonal connection, as well as concerns about and support for active/passive immobilization techniques and pharmacological intervention. Sensory strategies for auditory, tactile, and vestibular input were discussed, in addition to distraction techniques, the timing and pacing of dental encounters, and parental presence/absence. Conclusions: Tailoring dental care around the unique sensory and behavioral needs of children with DS and building effective partnerships between children, parents, and dentists were emphasized for optimizing the dental care experiences of children with DS. Full article

(This article belongs to the Special Issue Oral Health Care and Services for Patients)

19 pages, 11459 KiB

Open AccessCase Report

Complex Management of Bilateral Congenital Hydronephrosis in a Pediatric Patient: A Multidisciplinary Approach

by Nadica Motofelea, Ionela Florica Tamasan, Sonia Aniela Tanasescu, Teodora Hoinoiu, Jabri Tabrizi Madalina Ioana, Gheorghe Nicusor Pop and Alexandru Catalin Motofelea

Healthcare 2025, 13(9), 998; https://doi.org/10.3390/healthcare13090998 - 25 Apr 2025

Abstract

Congenital anomalies of the kidney and urinary tract (CAKUT) are common developmental malformations and a leading cause of pediatric renal dysfunction. Severe hydronephrosis, especially when accompanied by ureteral duplication, ureterocele, or neurogenic bladder, poses significant diagnostic and therapeutic challenges. This case report presents [...] Read more.

Congenital anomalies of the kidney and urinary tract (CAKUT) are common developmental malformations and a leading cause of pediatric renal dysfunction. Severe hydronephrosis, especially when accompanied by ureteral duplication, ureterocele, or neurogenic bladder, poses significant diagnostic and therapeutic challenges. This case report presents a 7-year-old male with prenatally diagnosed bilateral grade IV/V hydronephrosis (according to the radiology hydronephrosis grading system), complicated by the right pyeloureteral duplication, the left ureterocele, and the neurogenic bladder. The patient’s clinical course was marked by recurrent urinary tract infections (UTIs), progressive renal dysfunction, and multiple surgical interventions. Initial decompression via bilateral ureterostomy and stenting led to significant improvements in renal function. However, the patient experienced recurrent febrile UTIs caused by multidrug-resistant pathogens, necessitating repeated hospitalizations and intravenous antibiotic therapy. Serial imaging studies documented persistent hydronephrosis, a neurogenic bladder, and vesicoureteral reflux. Subsequent surgical interventions included bilateral ureteral reimplantation, excision of the left ureterocele, and removal of a fibroepithelial polyp from the bladder wall. Despite these interventions, residual left hydronephrosis and right kidney hypoplasia persisted, underscoring the need for long-term surveillance. This case highlights the diagnostic and therapeutic challenges of managing CAKUT and emphasizes the importance of a multidisciplinary approach integrating imaging, functional assessment, and surgical planning. Early diagnosis and timely intervention can stabilize renal function, but ongoing monitoring and individualized treatment remain crucial for optimizing long-term outcomes in children with complex CAKUT. Full article

(This article belongs to the Special Issue Innovative Approaches in Pediatric Urinary Care)

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16 pages, 594 KiB

Open AccessArticle

A Psychometric Evaluation of the Hypoglycemia Problem-Solving Scale (HPSS) in Turkish Older Adults with Diabetes

by Merve Dervişoğlu, Dilek Büyükkaya Besen, Merve Günbaş, Mehtap Ertaş and Barış Emekdaş

Healthcare 2025, 13(9), 997; https://doi.org/10.3390/healthcare13090997 - 25 Apr 2025

Abstract

Introduction: Hypoglycemia is a significant complication in diabetes management and presents an even greater risk for older adults. These individuals are particularly vulnerable to hypoglycemic episodes, which can result in serious health consequences. The Hypoglycemia Problem-Solving Scale (HPSS) evaluates problem-solving skills related to [...] Read more.

Introduction: Hypoglycemia is a significant complication in diabetes management and presents an even greater risk for older adults. These individuals are particularly vulnerable to hypoglycemic episodes, which can result in serious health consequences. The Hypoglycemia Problem-Solving Scale (HPSS) evaluates problem-solving skills related to hypoglycemia; however, it has not yet been validated in Türkiye. This study aimed to evaluate the validity and reliability of the Turkish adaptation of the HPSS. Materials and Methods: A descriptive, methodological, and cross-sectional study was conducted with 623 older adults (aged 65 and above) diagnosed with Type 2 diabetes and with a history of hypoglycemic episodes. The HPSS was adapted into Turkish, and its psychometric properties were assessed through content validity, Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and reliability analyses. Results: The mean age of participants was 72 ± 5.5 years. Expert agreement on the items was high (Kendall’s W = 0.83, p < 0.05), and all items had a Content Validity Ratio (CVR) above 0.56. The overall Content Validity Index (CVI) was 0.97. Exploratory Factor Analysis (EFA) revealed seven factors explaining 74.22% of the total variance. The Kaiser–Meyer–Olkin (KMO) value was 0.85, and Bartlett’s test of sphericity was significant (χ² = 7590.85, p < 0.001). Confirmatory Factor Analysis (CFA) demonstrated acceptable model fit (CFI = 0.952; χ²/df = 2.536). The scale demonstrated high internal consistency (Cronbach’s alpha = 0.88) and excellent test–retest reliability (r = 0.99, p < 0.001). Discussion/Conclusions: The Turkish version of the Hypoglycemia Problem-Solving Scale is a valid and reliable instrument for evaluating problem-solving skills related to hypoglycemia in older adults with diabetes. It can be effectively utilized in clinical practice to support better hypoglycemia management and improve overall diabetes care. Full article

19 pages, 417 KiB

Open AccessArticle

Determinants of Community Mental Health Service Utilization Among Psychiatric Outpatients at a Tertiary Medical Institution: Applying Andersen’s Behavioral Model

by Min Hee Jung and Sung Hee Shin

Healthcare 2025, 13(9), 996; https://doi.org/10.3390/healthcare13090996 - 25 Apr 2025

Abstract

Objectives: This study examined factors influencing community mental health service utilization and identified strategies to improve accessibility for psychiatric outpatients receiving care at the Department of Psychiatry. Methods: This cross-sectional descriptive survey utilized a structured questionnaire to collect data from 136 patients receiving [...] Read more.

Objectives: This study examined factors influencing community mental health service utilization and identified strategies to improve accessibility for psychiatric outpatients receiving care at the Department of Psychiatry. Methods: This cross-sectional descriptive survey utilized a structured questionnaire to collect data from 136 patients receiving outpatient psychiatric care at a tertiary medical institution in Seoul, Korea. Logistic regression analysis was performed using SPSS version 26.0 for Windows. Results: Logistic regression analysis identified significant factors influencing the utilization of community mental health services: being a man (OR = 3.33), duration of illness (OR = 2.31), recognition of service institutions (OR = 39.09), internalized stigma (OR = 4.90), and stress (OR = 3.14). Conclusions: To encourage the utilization of community mental health services by patients with mental illness, psychiatric nurses should increase the level of understanding and information about community-based mental health support. Additionally, details on community mental health services should be provided from the earliest stages of illness in a variety of gender-specific ways during discharge education, and patients with high levels of internalized stigma and stress should be encouraged to have an insight of their illness and to take an active role in their recovery. Full article

18 pages, 584 KiB

Open AccessArticle

Factors Associated with Postsurgical Pain and Swelling Following Endodontic Microsurgery: The Role of Radiographic Characteristics

by Abdulwahed Alghamdi, Dana Mominkhan, Reem Sabano, Noha F. Alqadi, Mey Al-Habib, Sarah Bukhari, Mohammed Howait and Loai Alsofi

Healthcare 2025, 13(9), 995; https://doi.org/10.3390/healthcare13090995 - 25 Apr 2025

Abstract

Objectives: Endodontic microsurgery has become an integral part of daily endodontic practice. However, research on the correlation between the lesion characteristics observed via cone beam computed tomography (CBCT) and pain and swelling after endodontic microsurgery (EMS) is still lacking in the literature. The [...] Read more.

Objectives: Endodontic microsurgery has become an integral part of daily endodontic practice. However, research on the correlation between the lesion characteristics observed via cone beam computed tomography (CBCT) and pain and swelling after endodontic microsurgery (EMS) is still lacking in the literature. The present study aims to examine the relationship between the radiographic characteristics of preoperative periapical lesions obtained from CBCT images and post-surgical symptoms such as pain and swelling. Materials and Methods: A total of 61 patients undergoing EMS utilizing modern techniques were asked to report their level of pain and swelling at 8, 24, 48, and 72 h after EMS using VAS. Independent variables such as age, gender, tooth location, CBCT periapical index, endodontic diagnosis, cortical bone perforation by the lesion, duration of the EMS, preoperative analgesic consumption, antibiotic prescription, and pre-/postoperative mouthwash were analyzed using the Fisher Exact test. Multivariate regression analysis was also conducted to determine the independent significant factors associated with pain and swelling. A p-value of ≤0.05 was considered statistically significant. Results: The maximum pain score was recorded at 8 h (4.26 ± 3.13), while peak swelling was measured after 24 h (6.46 ± 2.87). The risk of swelling was more likely to decrease by 75.7% for patients with a CBCT index score of >3 than those with a CBCT index score of ≤3 (AOR = 0.243; CI = 0.071–0.831; p = 0.024). The effects of all other factors on pain, including cortical bone perforation by the lesion (p = 0.290), swelling (p = 0.071), postoperative mouthwash use (p = 0.062), and swelling (p = 0.934), did not reach statistical significance. Conclusions: Patients with periapical lesions larger than 4 mm will likely experience less swelling after EMS, while pain is not affected by lesion size, cortical bone perforation, or mouthwash use. Clinical Relevance: This study identified a new predictor of swelling after EMS based on the size of the periapical lesion. These results will improve the management of post-surgical sequelae after EMS and support shared decision making. Full article

19 pages, 809 KiB

Open AccessReview

Strategies for Pain Management in Hepatocellular Carcinoma Patients Undergoing Transarterial Chemoembolisation: A Scoping Review of Current Evidence

by Wei-Zheng Zhang, Kok-Yong Chin, Roshaya Zakaria and Nor Haty Hassan

Healthcare 2025, 13(9), 994; https://doi.org/10.3390/healthcare13090994 - 25 Apr 2025

Abstract

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, with transarterial chemoembolisation (TACE) being a primary treatment for intermediate-stage disease. However, post-procedural pain remains a significant challenge due to inconsistent management practices and a lack of standardised protocols. This scoping review [...] Read more.

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, with transarterial chemoembolisation (TACE) being a primary treatment for intermediate-stage disease. However, post-procedural pain remains a significant challenge due to inconsistent management practices and a lack of standardised protocols. This scoping review synthesises current evidence on pain management strategies in HCC patients undergoing TACE, evaluates their effectiveness, identifies practice gaps, and proposes optimisation strategies. Methods: A comprehensive database search according to the methodological approach given by Arksey and O’Malley with the aid of the PRISMA-ScR guidelines across Cochrane Library, Web of Science, CINAHL, PubMed, and Scopus was performed. The terms associated with pain, TACE, and liver cancer were included in the search strategy. Two independent researchers systematically screened study titles, abstracts, and full texts and extracted key study characteristics and approaches to pain management. Results: Of 1515 identified studies, 29 met the inclusion criteria. Most (72.7%) focused on pharmacological interventions, with dexamethasone and lidocaine being the most frequently investigated agents. Non-pharmacological approaches, including psychological interventions, physical therapies, music therapy, health education, and comprehensive nursing, were also reported. Pain was primarily assessed using the visual analogue scale (VAS) and numeric rating scale (NRS). Conclusions: Pharmacological interventions, particularly dexamethasone and lidocaine, remain the cornerstone of pain management in TACE, yet consensus on their optimal use is lacking. Non-pharmacological strategies provide complementary benefits. standardised, evidence-based pain management protocols integrating both approaches are needed. Future large-scale, multicentre trials are essential to establish the most effective strategies for optimising patient outcomes. Full article

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14 pages, 262 KiB

Open AccessProtocol

Longitudinal Analysis of Intrinsic Capacity and Other Risk Factors in Aging: FREVO Study Protocol

by Rodrigo Cappato de Araújo, Letícia Bojikian Calixtre, Wildja de Lima Gomes, Juliana Daniele de Araújo Silva, Diógenes Candido Mendes Maranhão, Fernando Damasceno de Albuquerque Angelo, Gabriel Lucas Leite da Silva Santos, Késia Moreira Sampaio Amaral, Ruth Lahis da Silva Gonçalves, Julia Gomes de Alencar, Michele L. Callisaya, Francis Trombini-Souza and Ana Carolina Rodarti Pitangui

Healthcare 2025, 13(9), 993; https://doi.org/10.3390/healthcare13090993 - 25 Apr 2025

Abstract

Background/Objectives: Population aging presents important global and socio-economic challenges, especially in developing countries such as Brazil, where aging is projected to accelerate in the next years. This manuscript presents the protocol of the FREVO (risk factors in aging) study, a six-year longitudinal study [...] Read more.

Background/Objectives: Population aging presents important global and socio-economic challenges, especially in developing countries such as Brazil, where aging is projected to accelerate in the next years. This manuscript presents the protocol of the FREVO (risk factors in aging) study, a six-year longitudinal study that aims to assess intrinsic capacity and its interaction with other risk factors. Moreover, this study aims to evaluate the combination of these factors and their correlation with major adverse health outcomes among community-dwelling older adults in Petrolina, Brazil. Methods: This six-year prospective cohort study will recruit 496 participants aged 60 or older. Annual in-person assessments using validated tools will measure intrinsic capacity, personal information, lifestyle, and chronic conditions. Negative outcomes (falls, hospitalizations, dementia, and death) will be recorded biannually by phone. Statistical analyses will employ latent profile analysis to identify risk phenotypes and Cox regression models for time-to-event analyses. Results: This study will attempt to identify phenotypes and modifiable risk factors by using the WHO’s intrinsic capacity framework in a low-resource Brazilian context for the assessment and promotion of healthy aging. Conclusions: Our findings will address important gaps that can contribute to a localized understanding of aging, aligning global frameworks with regional realities to promote independence, functionality, and quality of life for older adults. Full article

18 pages, 665 KiB

Open AccessReview

Differential Effects of Decisional and Emotional Forgiveness on Psychological, Spiritual, Social, Volitional, and Physical Well-Being: A Scoping Review

by Richard G. Cowden, Everett L. Worthington, Jr., Caleb A. Chung and Zhuo Job Chen

Healthcare 2025, 13(9), 992; https://doi.org/10.3390/healthcare13090992 - 25 Apr 2025

Abstract

Within a stress-and-coping theory of forgiveness, two dimensions of forgiveness have been hypothesized—decisional forgiveness (DF) and emotional forgiveness (EF). Each is theorized to have different impacts on different dimensions of well-being—psychological, spiritual (or religious), social, volitional, and physical. A scoping review was performed [...] Read more.

Within a stress-and-coping theory of forgiveness, two dimensions of forgiveness have been hypothesized—decisional forgiveness (DF) and emotional forgiveness (EF). Each is theorized to have different impacts on different dimensions of well-being—psychological, spiritual (or religious), social, volitional, and physical. A scoping review was performed to explore the associations of each dimension of forgiveness with each dimension of well-being. A total of k = 30 articles met the criteria for inclusion, and estimates of the association between DF and/or EF with one or more indicators of well-being were extracted. Both dimensions of forgiveness were positively linked to all dimensions of well-being, except that there were too few studies on physical well-being (e.g., self-rated physical health) to analyze. DF was generally more strongly related to indicators of spiritual well-being (e.g., faith maturity), psychological well-being (e.g., happiness), and volitional well-being (e.g., conciliatory behavior) than EF, whereas the inverse was observed for social well-being (e.g., marital satisfaction). However, because most studies were cross-sectional, firm conclusions about the associations of both DF and EF with well-being were limited by a paucity of robust studies. Suggestions to guide future research are provided, including the need for more rigorous longitudinal research and better evidence-based theorizing. Full article

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15 pages, 276 KiB

Open AccessArticle

A Delphi Survey on the Validity and Feasibility of a Healthcare-Associated Infection Surveillance System for Traditional Korean Medicine Hospitals in South Korea

by Sun Young Jeong, Ji Hye Park, Sung Eun Lee, Somi Shin and Kwan-Il Kim

Healthcare 2025, 13(9), 991; https://doi.org/10.3390/healthcare13090991 - 25 Apr 2025

Abstract

Background: Current research on healthcare-associated infection (HAI) surveillance in traditional Korean medicine (TKM) institutions is limited. Methods: We utilized the Delphi method to evaluate the validity and feasibility of implementing an HAI surveillance system in TKM hospitals. This involved conducting a systematic literature [...] Read more.

Background: Current research on healthcare-associated infection (HAI) surveillance in traditional Korean medicine (TKM) institutions is limited. Methods: We utilized the Delphi method to evaluate the validity and feasibility of implementing an HAI surveillance system in TKM hospitals. This involved conducting a systematic literature review and focus group interviews with three infection control experts and five TKM doctors experienced in infection control within TKM hospitals. Based on these findings, we developed a Delphi questionnaire. The survey included a total of fifteen participants: ten TKM doctors and TKM-related policy researchers with infection control expertise, two infection control nurses, and three infectious disease doctors. Results: The survey results indicated strong consensus on the necessity of introducing an HAI surveillance system tailored to TKM hospitals, as well as their integration into the Korean National Healthcare-associated Infections Surveillance (KONIS) system. Since infectious diseases do not differentiate between acute care hospitals and TKM hospitals, it is reasonable for TKM hospitals to participate in infection surveillance systems. However, the feasibility of implementing HAI surveillance in TKM hospitals remains low due to a lack of awareness regarding infection surveillance, insufficient surveillance personnel, inadequate diagnostic and surveillance infrastructure, and limited policy support for infection control. Therefore, this study proposes a phased approach in which hand hygiene surveillance and safe injection practice monitoring, which received relatively higher consensus on feasibility, should be prioritized to establish the necessary surveillance infrastructure. Subsequently, a stepwise implementation of HAI surveillance can be introduced. Conclusions: Although TKM hospitals generally have a lower risk of HAIs compared to acute care facilities, they lack robust infection control systems and support. To address this gap, TKM hospitals should join the KONIS system. Appointing and training dedicated infection control personnel will enable their participation and enhance overall infection management. Full article

13 pages, 252 KiB

Open AccessArticle

Assessing Medical Students’ Perceptions of AI-Integrated Telemedicine: A Cross-Sectional Study in Romania

by Florina Onetiu, Melania Lavinia Bratu, Roxana Folescu, Felix Bratosin and Tiberiu Bratu

Healthcare 2025, 13(9), 990; https://doi.org/10.3390/healthcare13090990 - 24 Apr 2025

Abstract

Background and Objectives: The rapid advancement of Artificial Intelligence (AI) has driven the expansion of telemedicine solutions worldwide, enabling remote diagnosis, patient monitoring, and treatment support. This study aimed to explore medical students’ perceptions of AI in telemedicine, focusing on how these future [...] Read more.

Background and Objectives: The rapid advancement of Artificial Intelligence (AI) has driven the expansion of telemedicine solutions worldwide, enabling remote diagnosis, patient monitoring, and treatment support. This study aimed to explore medical students’ perceptions of AI in telemedicine, focusing on how these future physicians view AI’s potential, benefits, and challenges. Methods: A cross-sectional survey was conducted among 161 Romanian medical students spanning Years 1 through 6. Participants completed a 15-item questionnaire covering demographic factors, prior exposure to AI, attitudes toward telemedicine, perceived benefits, and concerns related to ethical and data privacy issues. A questionnaire on digital health acceptance was conceived and integrated into the survey instrument. Results: Out of 161 respondents, 70 (43.5%) reported prior telemedicine use, and 66 (41.0%) indicated high familiarity (Likert scores ≥ 4) with AI-based tools. Fifth- and sixth-year students showed significantly greater acceptance of AI-driven telemedicine compared to first- and second-year students (p = 0.014). A moderate positive correlation (r = 0.44, p < 0.001) emerged between AI familiarity and telemedicine confidence, while higher data privacy concerns negatively affected acceptance (β = −0.20, p = 0.038). Gender differences were noted but did not reach consistent statistical significance in multivariate models. Conclusions: Overall, Romanian medical students view AI-enhanced telemedicine favorably, particularly those in advanced academic years. Familiarity with AI technologies is a key driver of acceptance, though privacy and ethical considerations remain barriers. These findings underline the need for targeted curricular interventions to bolster AI literacy and address concerns regarding data security and clinical responsibility. By proactively integrating AI-related competencies, medical faculties can better prepare students for a healthcare landscape increasingly shaped by telemedicine. Full article

14 pages, 245 KiB

Open AccessArticle

Vestibular Well-Being Benefits of a Single Session of Functional Neurology Intervention on Saccadic Stimuli Dysfunction

by Guillermo Escribano-Colmena, Jorge Rey-Mota, Sara Hadid-Santiago, Álvaro Ramos-Garrido, José Francisco Tornero-Aguilera and Vicente Javier Clemente-Suárez

Healthcare 2025, 13(9), 989; https://doi.org/10.3390/healthcare13090989 - 24 Apr 2025

Abstract

Background/Objectives: This study aimed to analyze the psychophysiological effects of functional neurology intervention on dysfunction in vestibular saccadic stimuli, focusing on its impact on muscle performance, psychophysiological arousal, and pain perception. Methods: Seventy-five healthy volunteer participants were randomly divided into two groups: an [...] Read more.

Background/Objectives: This study aimed to analyze the psychophysiological effects of functional neurology intervention on dysfunction in vestibular saccadic stimuli, focusing on its impact on muscle performance, psychophysiological arousal, and pain perception. Methods: Seventy-five healthy volunteer participants were randomly divided into two groups: an experimental group that received functional neurology treatment and a control group that did not. Both groups underwent the same evaluations at four distinct time points. Key measurements included pressure pain threshold (PPT), hand strength, critical flicker fusion threshold (CFFT), blood oxygen saturation, heart rate, and the number of saccadic stimuli tolerated until dysfunction in an indicator muscle (anterior deltoid). The functional neurology intervention involved proprioceptive reflexes, trigger point desensitization, and systemic approaches to rectify neuromuscular dysfunctions. Results: The results showed that the functional neurology intervention significantly increased the number of saccadic stimuli tolerated, from 3.6 ± 3.3 to 26.1 ± 8.7, indicating an improvement in neuromuscular endurance. Additionally, PPT readings exhibited an upward trend from baseline to post-intervention, with the final reading averaging at 10.2 ± 5.3 kgf, and hand strength measurements showed a modest but significant increase post-intervention. Notably, CFFT and blood oxygen saturation levels remained relatively stable, suggesting that the intervention’s primary impact was on neuromuscular performance and pain perception rather than on cognitive arousal or systemic oxygenation. Heart rate data indicated a decrease post-intervention, implying potential improvements in autonomic nervous system function. In contrast, the control group did not present significant changes in any of the psychophysiological parameters evaluated. These findings underscore the potential of targeted functional neurology treatments to enhance physical performance and provide valuable therapeutic benefits for neuromuscular and cognitive dysfunctions. Conclusions: Functional neurology interventions can effectively improve muscle endurance, pain management, and overall neuromuscular health, highlighting its relevance as a therapeutic modality in sports performance optimization and rehabilitation contexts. Full article

(This article belongs to the Topic Exploring the Interplay of Psychology and Work-Related Health and Well-Being)

14 pages, 235 KiB

Open AccessArticle

Factors Affecting the Direct and Indirect Performance of Infection Control for Centrally Inserted Central Catheters Among ICU Nurses

by Yoonjeong Park and Seunghye Choi

Healthcare 2025, 13(9), 988; https://doi.org/10.3390/healthcare13090988 - 24 Apr 2025

Abstract

Background/Objectives: This descriptive study investigated the influence of intensive care unit (ICU) nurses’ knowledge and perception of the importance of patient safety management, nursing professionalism, and infection control organizational culture on the direct and indirect performance of centrally inserted central catheter (CICC) infection [...] Read more.

Background/Objectives: This descriptive study investigated the influence of intensive care unit (ICU) nurses’ knowledge and perception of the importance of patient safety management, nursing professionalism, and infection control organizational culture on the direct and indirect performance of centrally inserted central catheter (CICC) infection control. Direct performance encompasses immediate infection control interventions administered to patients, whereas indirect performance constitutes physician communication and documentation protocols. Methods: A structured questionnaire was used to survey 176 ICU nurses from a tertiary hospital in Korea. Results: There were no significant differences in CICC infection control performance according to participants’ general characteristics. The direct performance of CICC infection control showed a significant positive correlation with clinical experience (p = 0.006), ICU work experience (p = 0.020), the perception of the importance of patient safety management (p < 0.001), nursing professionalism (p < 0.001), and infection control organizational culture (p < 0.001). The indirect performance of CICC infection control did not show any significant correlation with participants’ general characteristics; however, it showed significant positive correlations with the perception of the importance of patient safety management (p < 0.001), nursing professionalism (p < 0.001), and infection control organizational culture (p < 0.001). The factors affecting the direct performance of CICC infection control were the perception of the importance of patient safety management and infection control organizational culture. The perception of the importance of patient safety management affected the indirect performance of CICC infection control. Conclusions: To enhance overall infection control performance among ICU nurses, it is crucial to raise the perception of the importance of patient safety management and implement systematic strategies targeting both the direct and indirect performance of CICC infection control. Healthcare institutions should establish more detailed guidelines distinguishing between direct and indirect performance of CICC infection control and continuously educate ICU nurses on the importance of compliance with both aspects. Full article

20 pages, 1762 KiB

Open AccessArticle

The Correlation Between Emotionality Changes and Alcohol Consumption in Young Persons: A Pilot Study

by Simona Dana Mitincu-Caramfil, Lavinia-Alexandra Moroianu, Andrei Vlad Bradeanu, Oana-Maria Isailă, Cecilia Curis and Eduard Drima

Healthcare 2025, 13(9), 987; https://doi.org/10.3390/healthcare13090987 - 24 Apr 2025

Abstract

Background/Objectives: Alcohol consumption in young persons is a growing phenomenon, with significant implications for physical and mental health. This behavior exposes adolescents and young adults to multiple risks, such as affecting cognitive functions, the development of emotional disorders, and social integration difficulties. The [...] Read more.

Background/Objectives: Alcohol consumption in young persons is a growing phenomenon, with significant implications for physical and mental health. This behavior exposes adolescents and young adults to multiple risks, such as affecting cognitive functions, the development of emotional disorders, and social integration difficulties. The present study sets out to investigate the way alcohol consumption influences emotionality in young people, focusing on the emotional changes (anxiety and irritability), cognitive changes (attention deficit and memory disorder), and behavioral changes (impulsivity and aggressiveness). Methods: The methodology involved collecting quantitative data from a sample of young people who consume and do not consume alcohol, using standardized questionnaires and advanced statistical software (processed in MATLAB version 9.11_R2021b). We analyzed variables such as consumption frequency and intensity, affective scores, and demographic factors to highlight the correlations between consumption level and the intensity of affective modifications. Results: The results revealed a significant association between alcohol consumption and the rise in anxiety and depression symptoms or a tendency toward impulsive behaviors. Additionally, we observed that psychosocial factors, including group pressure, family climate, and stressful contexts, can exacerbate emotional vulnerability. Conclusions: This study suggests the need for early psychological interventions and prevention programs to approach emotional and cognitive dimensions and the social influences associated with consumption. Implementing support and counseling strategies, as well as education and awareness campaigns, can contribute to reducing risky behavior and promoting young people’s harmonious development. Full article

(This article belongs to the Special Issue The Impact and Relationship of Lifestyle Behaviors and Mental Health)

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16 pages, 793 KiB

Open AccessArticle

Counseling and Prescription of Physical Exercise in Medical Consultations in Portugal: The Clinician’s Perspective

by Rita Quintas Oliveira, Edite Teixeira-Lemos, Jorge Oliveira, Joana Morais, Diogo Miguel, Luís Pedro Lemos and João Páscoa Pinheiro

Healthcare 2025, 13(9), 986; https://doi.org/10.3390/healthcare13090986 - 24 Apr 2025

Abstract

Background/Objectives: Physical exercise (PE) is essential in promoting health and quality of life and protecting against chronic diseases. Health professionals are identified as key figures in promoting and prescribing PE, yet various factors may impact this during consultations. This study aims to [...] Read more.

Background/Objectives: Physical exercise (PE) is essential in promoting health and quality of life and protecting against chronic diseases. Health professionals are identified as key figures in promoting and prescribing PE, yet various factors may impact this during consultations. This study aims to assess Portuguese specialist physicians’ understanding of the importance of PE prescriptions. It will also investigate the approaches they utilize in promoting and prescribing PE, their knowledge of incorporating this practice into their consultations, and the major facilitators or barriers to prescription. Methods: A cross-sectional observational study was conducted using a validated questionnaire distributed via email by the Centre Regional Section of the Portuguese Medical Association to physicians. The data were analyzed using descriptive and inferential statistics. Results: In total, 414 responses were collected, with participants representing different medical specialties. The participants were primarily women (62.8%) with a mean age of 49.9 ± 14.9 years. While 85.5% of physicians promoted and prescribed PE, recognizing its cardiovascular and metabolic health benefits, only 24.0% received specific training, and 73.7% were unaware of relevant guidelines. Older male physicians (over 60 years old) expressed more confidence in PE prescriptions, while younger ones were more familiar with electronic prescribing tools. Identified barriers included patient compliance (42.3%), a lack of accessible PE resources (18.4%), and limited consultation time (17.4%). Most physicians (64.4%) relied on oral counseling for prescriptions. Conclusions: Most Portuguese specialist doctors recognize the benefits of PE prescriptions. However, barriers like inadequate training and patient compliance hinder PE implementation. Enhanced training and resources are vital for effectively integrating PE into clinical practice. Full article

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21 pages, 3234 KiB

Open AccessArticle

Pre- Trained Language Models for Mental Health: An Empirical Study on Arabic Q&A Classification

by Hassan Alhuzali and Ashwag Alasmari

Healthcare 2025, 13(9), 985; https://doi.org/10.3390/healthcare13090985 - 24 Apr 2025

Abstract

Background: Pre-Trained Language Models hold significant promise for revolutionizing mental health care by delivering accessible and culturally sensitive resources. Despite this potential, their efficacy in mental health applications, particularly in the Arabic language, remains largely unexplored. To the best of our knowledge, comprehensive [...] Read more.

Background: Pre-Trained Language Models hold significant promise for revolutionizing mental health care by delivering accessible and culturally sensitive resources. Despite this potential, their efficacy in mental health applications, particularly in the Arabic language, remains largely unexplored. To the best of our knowledge, comprehensive studies specifically evaluating the performance of PLMs on diverse Arabic mental health tasks are still scarce. This study aims to bridge this gap by evaluating the performance of pre-trained language models in classifying questions and answers within the mental health care domain. Methods: We used the MentalQA dataset, which comprises Arabic Questions and Answers interactions related to mental health. Our experiments involved four distinct learning strategies: traditional feature extraction, using PLMs as feature extractors, fine-tuning PLMs, and employing prompt-based techniques with models, such as GPT-3.5 and GPT-4 in zero-shot and few-shot learning scenarios. Arabic-specific PLMs, including AraBERT, CAMelBERT, and MARBERT, were evaluated. Results: Traditional feature-extraction methods paired with Support Vector Machines (SVM) showed competitive performance, but PLMs outperformed them due to their superior ability to capture semantic nuances. In particular, MARBERT achieved the highest performance, with Jaccard scores of 0.80 for the question classification and 0.86 for the answer classification. Further analysis revealed that fine-tuning PLMs enhances their performance, and the size of the training dataset plays a critical role in model effectiveness. Prompt-based techniques, particularly few-shot learning with GPT-3.5, demonstrated significant improvements, increasing the accuracy of question classification by 12% and the accuracy of answer classification by 45%. Conclusions: The study demonstrates the potential of PLMs and prompt-based approaches to provide mental health support to Arabic-speaking populations, providing valuable tools for individuals seeking assistance in this field. This research advances the understanding of PLMs in mental health care and emphasizes their potential to improve accessibility and effectiveness in Arabic-speaking contexts. Full article

(This article belongs to the Section Health Informatics and Big Data)

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