- New
- Research Article
- 10.3390/healthcare14040479
- Feb 13, 2026
- Healthcare
- Chrysovalantis Karagkounis + 3 more
Background/Objectives: Palliative care (PC) has traditionally focused on patients with cancer and their families. However, individuals living with advanced non-malignant chronic diseases and their caregivers face comparable challenges that significantly affect their quality of life. This study aimed to explore the PC needs of patients with advanced non-malignant chronic conditions through the lived experiences of both patients and their informal caregivers. Methods: Semi-structured interviews were conducted with eight patients and nine caregivers recruited via the Municipality of Katerini “Help at Home” program (Jan–Mar 2025). Interviews were audio-recorded, transcribed verbatim (in Greek), and analyzed inductively using reflexive thematic analysis. Ethical approval was obtained from the International Hellenic University (Ref. No. 18/22.12.2022), and official consent was gained from the Municipality of Katerini (Approval Ref. No. 7803-/30/01/2025). Results: Five themes emerged: (1) basic daily care and physical support; (2) psychosomatic and emotional impact; (3) social withdrawal and role change; (4) support systems and coping resources; and (5) experience with the healthcare system and organized care. Participants highlighted urgent needs for home-based physiotherapy/nursing, caregiver respite, and psychological support. Coping and resilience-related resources—expressed through family support, familiarity of the home environment, and spirituality—were described as essential mechanisms that helped dyads sustain home care and shaped how needs were experienced across multiple domains, particularly amid service gaps. Conclusions: These findings document complex, interlinked needs among patients with advanced non-malignant chronic conditions and their caregivers and support the development of community-based, integrated PC services. Larger, multicenter studies and the development/validation of a needs-assessment tool are recommended.
- New
- Research Article
- 10.3390/healthcare14040472
- Feb 13, 2026
- Healthcare
- Jie Huang + 3 more
Background: Spousal caregivers and adult-child caregivers are the main sources of informal care of patients with dementia. They are primarily responsible for providing daily assistance, emotional support, and long-term care within the family. Methods: A cross-sectional survey was conducted in June 2024 in Nanjing, Jiangsu Province, China. A total of 410 family caregivers (154 spousal and 256 adult-child caregivers) participated. Perceived family cohesion was measured using the Family Adaptability Cohesion Scale, Second Edition, Chinese version (FACES II-CV). Caregiver-related characteristics included the following: caregivers’ self-reported physical health, social support, self-efficacy, and the number of family members assisting in caregiving. Results: (1) adult-child caregivers reported significantly higher perceived family cohesion than spousal caregivers (p < 0.001); (2) regression analyses revealed that caregiver role and caregiver-related characteristics were positively associated with perceived family cohesion (all p < 0.05); and (3) mediation analyses revealed that caregiver-related characteristics mediate the relationship between caregiver role and perceived family cohesion, with mediating effects of 0.109, 0.293, 0.087 and 0.174, respectively. Conclusions: Given that caregiver-related characteristics act as mediators of family cohesion, interventions should focus on strengthening caregivers’ physical health, social support, self-efficacy, and family involvement in caregiving to equalize the perception of family cohesion between spousal caregivers and adult-child caregivers.
- New
- Research Article
- 10.3390/healthcare14040477
- Feb 13, 2026
- Healthcare
- Ilona Tamutienė + 4 more
Introduction: A woman’s health and her child’s development are greatly affected by the responsiveness and support of the health system throughout the postpartum period. While various scholars have analysed the qualities of continuity of care and their effects during that phase, this article aims to reveal women’s experiences of postpartum care by analysing the impact of continuity of care through home visiting (HVCoC) versus standard care. Methods: Semi-structured interviews have been conducted in a qualitative study with 19 mothers of children under 1 year of age, who meet at least one criterion, such as living in poverty, being under 18 while giving birth, lacking permanent housing, residing in crisis centres due to domestic violence, or giving birth for the first time. All participants of the study have received either standard care or continuity of care through home visiting within the HVCoC model project. Results: The study has shown that women’s postpartum care experiences depend on the service delivery model. The standard care model, compared with the HVCoC model, has led to negative experiences for women across three dimensions: Relational, informational, and management continuity of care. Conclusions: While existing research has concluded that adequate postpartum support is related to the continuity of care model, this study’s findings reveal how different care organisation models affect the value women receive from their healthcare. Decision makers should develop postnatal care services that ensure continuity of care throughout pregnancy and the postpartum period by providing access to the same healthcare specialist for ongoing care.
- New
- Research Article
- 10.3390/healthcare14040482
- Feb 13, 2026
- Healthcare
- Seoyoon Heo + 2 more
Background: Physical inactivity remains a major public health challenge, particularly for underserved populations lacking exercise facility access. AI-powered smartphone applications with real-time human pose estimation offer scalable solutions, but they lack rigorous clinical validation. Objective: This study validates the clinical efficacy of a 16-week on-device AI-driven resistance training program using MediaPipe pose estimation technology in young adults with limited facility access. Primary outcomes included muscular strength (1RM squat), body composition, functional movement (FMS), and cardiorespiratory fitness (VO2max). Methods: A single-group pre–post study enrolled 216 participants (mean age 23.77 ± 4.02 years; 69.2% male), with 146 (67.6%) completing the protocol. Participants performed three 30 min weekly sessions of seven compound exercises delivered via a smartphone app providing real-time pose analysis (97.2% key point accuracy, 28.6 ms inference), multimodal feedback, and personalized progression using self-selected equipment. Results: Significant improvements across all domains: muscular strength (+4.39 kg 1RM squat, p < 0.001, d = 1.148), body fat (−2.92%, p < 0.001, d = −1.373), skeletal muscle mass (+2.19 kg, p < 0.001, d = 1.433), FMS (+0.29 points, p = 0.001, d = 0.285), and VO2max (+1.82 mL/kg/min, p < 0.001, d = 0.917). Pose classification accuracy reached 95.8% vs. physiotherapist assessment (ICC = 0.94). Conclusions: This study provides the first clinical evidence that on-device AI pose estimation enables facility-independent resistance training with outcomes comparable to traditional programs. Unlike cloud-based systems, our lightweight model (28.6 ms inference) supports real-time mobile deployment, advancing accessible precision exercise medicine. Limitations include a single-arm design and gender imbalance, warranting future RCTs with diverse cohorts.
- New
- Research Article
- 10.3390/healthcare14040478
- Feb 13, 2026
- Healthcare
- Vojko Vučković + 2 more
Background/Objectives: Understanding the determinants of physical activity (PA) and health outcomes requires integrating environmental and motivational perspectives. Grounded in Self-Determination Theory (SDT), this study tested a sequential model in which perceived sport infrastructure service quality enhances exercise motivation, which subsequently increases PA and leads to better self-rated health (SRT). Methods: A total of 546 recreational adult exercisers completed validated questionnaires assessing sport infrastructure service quality (SQAS), exercise motivation (MPAM-R), PA (IPAQ), and self-rated health. Structural equation modelling (SEM) was used to examine the hypothesised relationships among variables. Results: The proposed sequential model was supported. Perceived service quality positively predicted exercise motivation (β = 0.255, p < 0.001), motivation significantly predicted PA (β = 0.266, p < 0.001), and PA was positively associated with self-rated health (β = 0.115, p < 0.005). Model fit indices indicated a good and acceptable fit to the data (CFI = 0.947, TLI = 0.935, NFI = 0.914, GFI = 0.931, RMSEA = 0.072, SRMR = 0.067, χ2/df = 3.85). Conclusions: The findings underscore the importance of high-quality exercise infrastructure as a key environmental factor that supports motivational engagement and promotes healthier behaviour patterns. Interventions aimed at increasing PA and improving perceived health should address both environmental quality and motivational processes.
- New
- Research Article
- 10.3390/healthcare14040474
- Feb 13, 2026
- Healthcare
- Shadha Nasser Bahutair + 8 more
Background: Poor sleep quality is common among university students and may contribute to adverse reproductive health outcomes, including dysmenorrhea. However, limited evidence exists on whether chronic sleep disturbance independently predicts dysmenorrhea severity or menstrual-related functional impairment after accounting for key confounders. Objectives: We aimed to determine the prevalence of poor sleep quality among female university students and to examine its association with (1) severe dysmenorrhea and (2) menstrual-related functional impairment. Methods: A cross-sectional study was conducted among female undergraduate students at Ras Al Khaimah Medical and Health Sciences University (United Arab Emirates). Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), and perceived stress was assessed using the Perceived Stress Scale (PSS-10). Dysmenorrhea severity was assessed using a 0–10 visual analog scale; functional impairment was defined as moderate/severe disruption in ≥1 life domain. Multivariable logistic regression models estimated adjusted odds ratios (aORs) for the association between sleep quality and menstrual outcomes after controlling for age, BMI, socioeconomic status, and stress. A component-level analysis examined independent effects of PSQI dimensions. Results: Of the 254 participants, 68.9% reported poor sleep quality and 48.8% reported severe dysmenorrhea. In adjusted models, moderate sleep problems (aOR = 2.00, 95% CI: 1.09–3.67, p = 0.024) and severe sleep problems (aOR = 3.63, 95% CI: 1.45–9.06, p = 0.006) were significantly associated with severe dysmenorrhea. Severe dysmenorrhea strongly predicted menstrual-related functional impairment (aOR = 4.81, 95% CI: 2.63–8.77, p < 0.001). Poor sleep quality remained independently associated with functional impairment (aOR = 1.96, 95% CI: 1.05–3.65, p = 0.035). In component analysis, sleep disturbance (PSQI Component 5) was the only independent predictor of severe dysmenorrhea (aOR = 2.11, 95% CI: 1.31–3.41, p = 0.002). Conclusions: Poor sleep quality, particularly sleep disturbance, is associated with increased odds of severe dysmenorrhea and menstrual-related functional impairment in female university students. Sleep fragmentation may represent a key mechanistic and modifiable contributor to menstrual pain severity. Integrating sleep assessment into dysmenorrhea management and evaluating sleep-focused interventions in longitudinal and interventional studies are warranted.
- New
- Research Article
- 10.3390/healthcare14040480
- Feb 13, 2026
- Healthcare
- Keun-Young Kim + 6 more
Background/Objectives: In March 2024, a resident doctor’s strike in South Korea created staffing gaps in teaching-hospital emergency departments. The purpose of this study was to evaluate pre- and post-strike changes in job stress, self-efficacy, job satisfaction, and job performance confidence among paramedics who work in hospitals and to compare patterns of change by career stage. Methods: Paramedics who work in hospitals designated as regional and local emergency medical centers completed a structured 41-item questionnaire across four domains on a 5-point Likert scale. Retrospective pre- and post-strike ratings were analyzed using paired t-tests. Subgroup analyses compared senior (≥5 years) and junior (1–2 years) paramedics. Results: Job stress increased after the strike, including additional task instruction (2.8 ± 0.9 to 3.6 ± 1.0), insufficient rest (3.1 ± 0.7 to 3.9 ± 0.9), and multitasking burden (3.3 ± 0.8 to 4.1 ± 0.9). Self-efficacy declined modestly (confronting difficult tasks: 3.9 ± 0.9 to 3.6 ± 0.9). Job satisfaction decreased (reward after work: 3.9 ± 0.7 to 3.5 ± 0.9), while turnover intention increased (2.7 ± 1.0 to 3.9 ± 0.9). Performance confidence showed minimal change (competence: 4.4 ± 0.6 to 4.3 ± 0.8). Subgroup findings were similar in seniors and juniors, with stress increasing and self-efficacy decreasing overall. Conclusions: Resident workforce shortages increased job stress among paramedics working in teaching-hospital emergency departments and heightened negative perceptions of their work. To prepare for similar workforce crises in the future, it is necessary to revise and realign the legal scope of practice to reflect paramedics’ roles and responsibilities in real-world settings while simultaneously establishing the policy and institutional infrastructure needed to support these changes.
- New
- Research Article
- 10.3390/healthcare14040481
- Feb 13, 2026
- Healthcare
- Emanuele Maria Merlo + 7 more
The doctor–patient relationship is a central factor in healthcare delivery. Artificial Intelligence (AI) represents an emerging technological frontier whose implications remain to be fully clarified. Evidence-based studies provide reliable analyses of effects and offer a deeper understanding of both limits and benefits. This narrative review aimed to explore the role of AI in modern clinical practice, with particular reference to its effects on the doctor–patient relationship. Scopus and Web of Science databases were searched between 1 and 10 December 2025 to identify suitable studies. Inclusion criteria comprised English-language articles published in the last 10 years, with a direct focus on the doctor–patient relationship and exclusively employing empirical research designs. A total of 21 studies published between 2021 and 2025 were identified as eligible. The most common AI applications were conceptual systems discussed at a perceptual level (thirteen studies), followed by simulated AI decision-making scenarios (two studies). Implemented AI applications were less frequent and mainly included AI-based clinical decision support systems, administrative and documentation-focused tools, and a small number of conversational or relational AI applications (six studies in total). These studies focused on patients, healthcare professionals, and medical students preparing for future clinical roles. Results highlighted generally positive patient attitudes toward AI, often mediated by educational level, technological familiarity, and risk awareness. Among healthcare professionals, positive attitudes also emerged, although concerns regarding epistemic and professional values were noted. Greater involvement of clinicians in its development was consistently recommended. Findings from academic samples aligned with those of patients and clinicians, showing that integrating AI with traditional clinical practices was consistently preferred. Empathy, compassion, effective communication, accuracy, ethics, and trust were highlighted as fundamental values essential for mitigating risks. These elements are fundamental to the effective implementation of technologies aimed at improving clinical practice, while an integrative perspective is needed to safeguard the doctor–patient relationship. Overall, the use of AI in medical practice emerged as promising. Further studies should strengthen the empirical basis of the field to support an evidence-based approach to AI integration in healthcare.
- New
- Research Article
- 10.3390/healthcare14040473
- Feb 13, 2026
- Healthcare
- Dailet Fredes-Collarte + 5 more
Background/Objectives: The aviation sector is characterized by high-density flight operations and chronic stressors that compromise worker health. This study focuses on burnout syndrome as a multidimensional phenomenon resulting from the interaction between high emotional demands and personal resources. The primary objective was to analyze the relationship between job satisfaction and health problems among cabin crew members, testing a structural model where burnout—specifically its dimensions of enthusiasm toward the job, psychological strain, indolence, and guilt—acts as a mediating factor. Methods: A quantitative, cross-sectional design was implemented with a sample of 732 cabin crew members from an international airline. Participants completed the Spanish Burnout Inventory (SBI) and the UNIPSICO subscales for job satisfaction and psychosomatic problems. Data was processed using Structural Equation Modeling (SEM) to evaluate the hypothesized interdependent relationships and global model fit. Results: The structural model demonstrated an acceptable fit (CFI = 0.890; RMSEA = 0.056), confirming that job satisfaction is positively related to enthusiasm toward the job and inversely associated with psychological strain. All burnout dimensions were significantly linked to health outcomes; notably, guilt was identified as a critical mediator between indolence and psychosomatic problems. Conclusions: The findings underscore burnout as an insidiously progressive process that mediates the deterioration of cabin crew health. The study highlights guilt as a determining factor in the syndrome’s severity. Consequently, preventive organizational strategies must move beyond general fatigue management to include emotional labor training and early diagnosis of psychosocial risks to preserve operational safety and crew well-being.
- New
- Research Article
- 10.3390/healthcare14040468
- Feb 12, 2026
- Healthcare
- Shu-Ling Huang + 4 more
Background/Objectives: White-collar workers experience a unique dual burden of high psychological demands and prolonged static loading, creating a need to understand how physical resilience may mitigate these stressors. This study investigated the moderating role of specific muscle fitness components in the associations between work stress, burnout, and well-being among white-collar workers. To address the gap in task-specific physical resilience, we employed a cross-sectional design involving 321 full-time employees. Methods: Work stress (job control and demands), burnout, and well-being were assessed via structured questionnaires, while grip strength, abdominal endurance, and back muscle endurance were objectively measured. Results: Results indicated that the muscle fitness components were not directly associated with either burnout or well-being. However, the moderation model for burnout was significant (F = 15.837, p < 0.001; adjusted R2 = 0.278), where back muscle endurance significantly moderated the association between psychological job demands and burnout (β = −0.121, p < 0.05), whereas no such moderating effect was observed for well-being. In contrast, no such moderating effect was observed for well-being, nor did grip strength or abdominal endurance exhibit significant buffering effects on either psychological outcome. Conclusions: These findings demonstrate the relevance of task-specific physical resources in sedentary environments, specifically that back endurance functions as a buffer against burnout but may be insufficient to directly enhance overall well-being. The results suggest that while integrating task-specific physical assessments is vital for burnout prevention, psychosocial organizational support remains essential for fostering comprehensive well-being.