Healthcare最新文献

{"title":"Design and Feasibility Assessment of a Compact Emergency Unit in Rural and Remote Areas: A Multicenter Analysis of KTAS-Based Triage Data.","authors":"Kyungman Cha, Youngjin Kim, Sohee Lee, Jaekwang Shin, Jee Yong Lim","doi":"10.3390/healthcare14081099","DOIUrl":"10.3390/healthcare14081099","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Emergency department (ED) overcrowding burdens rural and remote areas where geographic isolation limits timely care. The Compact Emergency Unit (CEU)-a 24 h facility with remote physician oversight-has been proposed but lacks an empirical foundation. We aimed to (1) quantify CEU-eligible (final KTAS 4-5) patients in a multicenter ED cohort; (2) compare their operational metrics with non-eligible patients; (3) characterize hourly demand for facility planning; and (4) develop machine-learning models for non-discharge prediction within this low-acuity stratum. <b>Methods:</b> Retrospective analysis of 12 months (January-December 2025) of NEDIS data from two Korean university-affiliated EDs. Effect sizes (Cliff's δ, Cramér's V) were reported alongside <i>p</i>-values. Three classifiers (logistic regression, random forest, and XGBoost) were developed with patient-level cross-validation, comparing a 16-feature baseline and a 22-feature set augmented with arrival vital signs. Calibration and decision curve analysis were performed. <b>Results:</b> Of 34,544 valid triage visits (27,743 unique patients), 9871 (28.6%) were CEU-eligible. They had shorter LOS (92 vs. 171 min; Cliff's δ = -0.51), 98.8% symptomatic home discharge, and a median of 0 specialty consultations. Nighttime visits comprised 43.7% of CEU-eligible encounters, peaking at 20:00 (1.76 visits/h/day). The non-discharge rate was 1.20% (118/9871). The vital-augmented random forest reached AUROC 0.794 (95% CI 0.758-0.829); XGBoost calibration was near-perfect (ECE 0.020). A combined ML-or-vital-sign screening rule raised non-discharge sensitivity to 94.1%. <b>Conclusions:</b> Approximately 29% of ED visits could be CEU-suitable. Single-modality machine learning is insufficient for safety-critical triage, but a layered ML-plus-vitals screening approach achieves operationally relevant sensitivity. Prospective implementation studies are required before clinical deployment.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 8","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13116313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric Validation of the Connor-Davidson Resilience Scale 10 in Peruvian Nurses and Its Association with Stress and Empathy.","authors":"Roberto Zegarra-Chapoñan, Jhon Alex Zeladita-Huaman, Rosa Castro-Murillo, Flor De Jeanette Blas Bergara, Eduardo Franco-Chalco, Nataly Julissa Membrillo-Pillpe, Henry Castillo-Parra, Gabriela Samillán-Yncio, Laryn Smith","doi":"10.3390/healthcare14081097","DOIUrl":"10.3390/healthcare14081097","url":null,"abstract":"<p><p><b>Background</b>: This study aims to psychometrically validate the abbreviated version of the Connor-Davidson Resilience Scale (CD-RISC-10) in Peruvian nurses, evaluating its convergent validity through its association with perceived stress and empathy. <b>Methods</b>: A cross-sectional psychometric study was conducted in 374 Peruvian nurses to evaluate the psychometric properties of CD-RISC-10 through confirmatory factor analysis (CFA). Furthermore, concurrent validity was assessed through correlational analysis using Spearman's rho coefficient to evaluate the relationships among resilience, perceived stress, and empathy. <b>Results</b>: The CFA supported the predominantly one-dimensional model showing an adequate fit when the residual covariance between Items 4 and 7 was specified after correlating the residuals of Items 4 and 7 (CFI = 0.978, TLI = 0.971, RMSEA = 0.080, and SRMR = 0.044). Ordinal Cronbach's alpha of 0.89 and McDonald's omega of 0.81 were obtained. Concurrent validity showed significant correlations with perceived stress (rho = -0.53, <i>p</i> < 0.001) and empathy (rho = 0.31, <i>p</i> < 0.001). <b>Conclusions</b>: The CD-RISC-10 has adequate psychometric properties in Peruvian nurses. Future studies are needed to evaluate its factorial invariance between clinical specialties and establish normative thresholds.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 8","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13115857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Mental Health Profiles of Healthcare Workers in Northern Saudi Arabia: A Cross-Sectional DASS-21 Study with Implications for Prevention and Interdisciplinary Care.","authors":"Ahmed M Alhuwaydi, Oqab Ahmed F Alsharari, Abdulelah Faisal A Alfandi, Ahmed Meshal H Alorayyidh, Abdulrahman Yousef A Alfayyadh, Ashokkumar Thirunavukkarasu, Aliyah Muteb Al-Ruwaili","doi":"10.3390/healthcare14081101","DOIUrl":"10.3390/healthcare14081101","url":null,"abstract":"<p><strong>Background and objectives: </strong>Mental health assessment of healthcare workers (HCWs) is essential to inform prevention-oriented policies and interdisciplinary support strategies to strengthen HCWs' mental health and optimize patient care. Therefore, the present study assessed mental health status and associated factors of HCWs using the DASS-21.</p><p><strong>Methods: </strong>Using a cross-sectional study design and the standardized DASS-21 questionnaire, we assessed the mental health status of HCWs of different categories from various healthcare settings of northern Saudi Arabia. A binomial logistic regression analysis was performed to examine the factors associated with each DASS-21 domain. Finally, Spearman's correlation test was done to find the correlation across the domains.</p><p><strong>Results: </strong>Of the 385 participants, some forms of depression, anxiety, and stress were found in 49.6%, 49.4%, and 39.0% of the participants, respectively. Extremely severe symptoms were observed in depression and anxiety (9.6% each), and the lowest were observed for stress (3.9%). Depression was significantly associated with female gender (<i>p</i> = 0.017) and being single (<i>p</i> = 0.043), while anxiety was associated with nurses (<i>p</i> = 0.002) and non-Saudi nationality (<i>p</i> = 0.037). Stress was higher among HCWs working in specialty hospitals (<i>p</i> = 0.045) and lower among those aged > 40 years (<i>p</i> = 0.003). Furthermore, a positive correlation was noted within each DASS-21 domain (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Given the high prevalence of mental health issues, the relevant authorities should consider implementing preventative measures, including regular screening, psychoeducation workshops, interdisciplinary care, and proper referral pathways for the HCWs who screen positive for any of the mental health domains.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 8","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13116207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological Characteristics and Mental Health Disparities Between War-Displaced Ukrainian and Host-Country People Living with HIV in Slovakia: A Cross-Sectional Study.","authors":"Kristína Doležalová, Ricardo Massmann, Ľubomír Soják, Lucia Kročková, Matej Bendžala, Eliška Marešová, Peter Mihalov, Soňa Kašická, Mária Borsányiová, Jakub Vallo, Peter Sabaka","doi":"10.3390/healthcare14081093","DOIUrl":"10.3390/healthcare14081093","url":null,"abstract":"<p><p><b>Background</b>: The full-scale Russian invasion of Ukraine in 2022 triggered the largest displacement crisis in Europe in recent decades. Displacement may affect both clinical outcomes and mental health among people living with HIV (PLHIV). Evidence comparing displaced PLHIV with host-country patients within the same healthcare system remains limited. This study aimed to compare epidemiological characteristics, clinical staging, and mental health outcomes between war-displaced Ukrainian PLHIV and Slovak PLHIV receiving care in the same clinical setting, with particular attention to sex-specific differences. <b>Methods</b>: This cross-sectional study included 137 PLHIV receiving care at the HIV/AIDS Centre, University Hospital Bratislava, Slovakia (69 from Ukraine and 68 from Slovakia). Anxiety and depressive symptoms were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales. Scores were categorized into three severity groups (0-4, 5-9, ≥10). <b>Results</b>: Age distribution was comparable between cohorts (<i>p</i> = 0.2438). Transmission patterns differed substantially: heterosexual transmission predominated among Ukrainian participants, whereas men who have sex with men (MSM) transmission predominated among Slovak men (<i>p</i> < 0.001). Ukrainian patients were more frequently classified in CDC stage C, while Slovak patients more often presented in stage A. The combined antiretroviral therapy coverage was 100% in both cohorts and viral suppression rates were high (HIV RNA < 200 copies/mL: 91.3% in Ukraine vs. 94.1% in Slovakia). Overall anxiety and depressive symptom severity did not differ significantly between cohorts (GAD-7 <i>p</i> = 0.4145; PHQ-9 <i>p</i> = 0.7661). However, within the Ukrainian cohort, women demonstrated higher depressive symptom severity compared with men (<i>p</i> = 0.0478). <b>Conclusions</b>: War-displaced Ukrainian PLHIV achieved comparable biomedical outcomes to host-country patients within a structured healthcare system. However, depressive vulnerability emerged at the intersection of gender and displacement. These findings highlight the importance of integrating gender-sensitive mental health screening and psychosocial support into routine HIV care for displaced populations.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 8","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13115772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Home Blood Pressure Monitoring for Patients with Hypertensive Disorders of Pregnancy: A Rapid Review.","authors":"Meighan Mary, Sarah Clifford, Andreea A Creanga","doi":"10.3390/healthcare14081102","DOIUrl":"10.3390/healthcare14081102","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Hypertensive disorders of pregnancy (HDPs) affect approximately one in seven hospital deliveries in the United States and increase the risk of pregnancy-associated mortality. Home blood pressure monitoring (HBPM) for patients with HDPs has emerged as a model of care poised to improve ascertainment of blood pressure and triage of care during pregnancy and postpartum periods. However, the strength of evidence supporting HBPM approaches has been variable. This rapid review aimed to understand how HBPM approaches for pregnant and postpartum populations with HDPs have been evaluated in order to strengthen future research. <b>Methods</b>: Search criteria included peer-reviewed literature in English and French published during 2018-2024 that assessed HBPM approaches for pregnant and postpartum populations in high-income countries. A total of 370 records were screened and reviewed to identify 52 eligible articles. Key study characteristics, methodologies, and outcome measures were extracted. Identified outcome measures were mapped by outcome type (implementation, health service, and client) to assess gaps in evaluation of HBPM approaches. <b>Results</b>: A range of study designs were employed to evaluate HBPM approaches: experimental (17%), observational (52%), qualitative (10%), mixed method (10%), and economic (11%) designs. Over a third employed a comparison group, most of which compared HBPM approaches to usual antepartum or postpartum care. Only 11 studies reported on impact outcomes (long-term blood pressure control, adverse maternal and perinatal outcomes). Significant gaps were identified among the implementation outcomes examined. While patient engagement measures were common, assessment of provider adherence and engagement was limited. Hospital admissions and emergency department visits were often employed as proxies to measure HBPM effectiveness, efficiency, and safety. However, no studies adequately reported effectiveness measures for remote patient triage. <b>Conclusions</b>: Our results call for improved HBPM metrics to ensure patients are receiving high-quality care responsive to their clinical condition. Future studies on HBPM approaches should prioritize more transparent reporting on health actor engagement. A composite measure including both patient and provider adherence to monitoring and triage processes will provide stronger evidence on the effectiveness of HBPM for pregnant and postpartum patients and share impactful learning for health systems interested in adopting HBPM approaches.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 8","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13115600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profiling Culturally Responsive Care: Intercultural Communication and Empathy in the Nursing Workforce.","authors":"Fatma Ayşin Kurak, Ersin Taşatan, Hayriye Deniz Şelimen","doi":"10.3390/healthcare14081095","DOIUrl":"10.3390/healthcare14081095","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Culturally responsive care requires both intercultural communication competence (ICC) and empathy; however, these constructs are often examined separately in nursing research. This study aimed to (i) describe nurses' ICC and empathy levels, (ii) test the association between ICC and empathy, and (iii) examine group differences by selected demographic and professional variables. <b>Methods:</b> A quantitative, cross-sectional correlational design was conducted with 300 nurses recruited from state and private hospitals. ICC was measured using the Arasaratnam Intercultural Communication Competence Scale (cognitive, affective, and total), and empathy was assessed using the 18-item Jefferson Scale of Empathy (compassionate care, perspective taking, standing in the patient's shoes, and total). Data were analyzed with descriptive statistics, Pearson correlations, independent-samples t-tests, and one-way ANOVAs with Scheffé post hoc tests (α = 0.05). <b>Results:</b> Both ICC and empathy were above the scale midpoint. Cognitive ICC (M = 4.71, SD = 1.42) exceeded affective ICC (M = 4.35, SD = 1.34), and total empathy was high (M = 4.50, SD = 0.90), with compassionate care as the highest subscale (M = 4.60, SD = 1.10). ICC total was moderately correlated with total empathy (r = 0.607, <i>p</i> < 0.05); affective ICC correlated with compassionate care (r = 0.455) and perspective taking (r = 0.493). Male nurses reported higher ICC than female nurses (<i>p</i> < 0.05), while empathy did not differ by gender. Younger nurses (20-29) scored higher in ICC and empathy than older groups, and nurses with ≥28 years of experience also showed elevated levels. Nurses who willingly chose nursing had higher ICC and empathy across dimensions (all <i>p</i> < 0.001). Hospital type showed minimal differences except for \"standing in the patient's shoes\" (private > state, <i>p</i> = 0.04). <b>Conclusions:</b> ICC and empathy were generally high and interrelated among nurses, with meaningful variation across workforce characteristics. Training should emphasize experiential and reflective approaches to strengthen affective ICC and perspective taking, while organizational strategies should foster intrinsic motivation and support professional development across career stages.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 8","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13116090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy of Local Versus Overseas Natural Environments in 360-Degree Virtual Reality Video for Improving Mental Wellness in Medical Students: A Retrospectively Registered Two-Arm Parallel Randomized Trial.","authors":"Muhammad Hizri Bin Hatta, Farah Deena Abdul Samad, Siew Koon Chong, Suriati Mohamed Saini","doi":"10.3390/healthcare14081087","DOIUrl":"10.3390/healthcare14081087","url":null,"abstract":"<p><p><b>Objective:</b> This study aimed to compare the efficacy of immersive 360-degree Virtual Reality (VR) videos depicting local (Malaysian) versus overseas (Western European) natural environments on the mental health of medical students. The primary outcome was overall mental well-being (WHO-5), and the co-secondary outcomes were changes in anxiety, stress, and depression symptoms (DASS-21). <b>Methods:</b> A two-arm parallel randomized trial was conducted with 84 fourth-year and fifth-year medical students. Participants were randomized into two groups (n = 42 each) using a custom, gender-balancing minimization algorithm: Group 1 viewed local environments, and Group 2 viewed overseas environments. Each participant underwent two 15-min VR sessions spaced two weeks apart. Outcomes were measured at baseline (T0), after the first intervention (T1), and at the primary time point after the second intervention (T2). Data were analyzed using a repeated-measures ANOVA with Greenhouse-Geisser and Bonferroni corrections. <b>Results:</b> The VR intervention demonstrated a statistically significant improvement in well-being (<i>p</i> < 0.001, ηp2 = 0.380) and a significant reduction in anxiety (<i>p</i> < 0.001, ηp2 = 0.255) and stress (<i>p</i> < 0.001, ηp2 = 0.311) across all participants over time. No significant change was observed in depression scores (<i>p</i> = 0.122, ηp2 = 0.028). Notably, there were no statistically significant differences between the local and overseas groups for well-being (<i>p</i> = 0.399, ηp2 = 0.011), anxiety (<i>p</i> = 0.593, ηp2 = 0.005), stress (<i>p</i> = 0.945, ηp2 < 0.001), or depression (<i>p</i> = 0.546, ηp2 = 0.006). <b>Conclusions:</b> A two-session immersive VR nature intervention is effective for improving well-being and reducing anxiety and stress in medical students. The geographical familiarity of the environment did not significantly impact therapeutic effectiveness, suggesting that the restorative effects of virtual nature may generalize across different environmental and cultural contexts. Trial Registration: NCT07447310; retrospectively registered on 25 February 2026.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 8","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13115815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147813877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disinformation, Psychosocial Vulnerability, and Media Trust in the Digital Era: Implications for Health Behaviour and Societal Resilience.","authors":"João Miguel Alves Ferreira, Vaitsa Giannouli, Sergii Tukaiev","doi":"10.3390/healthcare14081089","DOIUrl":"10.3390/healthcare14081089","url":null,"abstract":"<p><p>Disinformation, amplified by digital platforms and algorithmic distribution systems, represents a growing challenge for media trust, public health communication, and societal stability. This narrative literature review examines disinformation through an integrative psychosocial perspective, focusing on how patterns of exposure interact with individual vulnerability factors-including education, political beliefs, social identity, personality traits, and emotional responses to uncertainty-to influence the processing and acceptance of misleading information. The review synthesises interdisciplinary evidence on how algorithmic amplification and emotionally salient content increase susceptibility to disinformation and shape risk perception, health-related decision-making, and preventive behaviours. Findings indicate that repeated exposure to false or misleading information reinforces perceived credibility through familiarity effects, contributes to declining trust in institutional sources, and intensifies social and political polarisation. Disinformation is therefore conceptualised not only as an informational problem but also as a psychosocial process affecting emotional regulation, cognitive evaluation, and collective responses to crises, particularly in public health contexts. The analysis further highlights a recursive feedback loop in which reduced media trust increases vulnerability to subsequent disinformation, with broader implications for democratic participation and social cohesion. Mitigation strategies discussed include media literacy initiatives, critical thinking education, platform governance, regulatory approaches, and interventions targeting psychosocial drivers of susceptibility.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 8","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13116957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ICU Length of Stay Patterns and In-Hospital Mortality: Clinical Determinants in a Tertiary-Care Hospital.","authors":"Carmen Pantis, Mihaela Simona Popoviciu, Timea Claudia Ghitea, Alina Manuela Pop, Roxana Daniela Brata","doi":"10.3390/healthcare14081092","DOIUrl":"10.3390/healthcare14081092","url":null,"abstract":"<p><p><b>Background</b>: Length of stay (LOS) reflects healthcare utilization but may also capture patient clinical trajectories. We investigated the relationship between LOS categories, organ support requirements, and in-hospital mortality. <b>Methods</b>: This retrospective observational study included 1332 consecutive adult ICU patients in a tertiary-care center. ICU LOS patterns were categorized using median-based and predefined cutoffs. Multivariable logistic regression was used to identify independent predictors of in-hospital mortality. <b>Results</b>: Prolonged ICU LOS was associated with higher crude mortality (61.0% vs. 43.5%, <i>p</i> < 0.001). However, in LOS-adjusted models, mortality was independently associated with mechanical ventilation (aOR 29.89, 95% CI 17.92-49.86), inotropic support (aOR 4.94, 95% CI 3.50-6.97), hemodialysis (aOR 5.43, 95% CI 2.52-11.72), older age, and diabetes mellitus. Prolonged LOS was not independently associated with mortality (aOR 0.93, <i>p</i> = 0.630). <b>Conclusions</b>: LOS reflects underlying disease severity rather than acting as an independent driver of mortality. Integrating LOS pattern assessment with markers of organ dysfunction may improve risk stratification and resource planning in hospitalized populations.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 8","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13115808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Exercise in Myasthenia Gravis: A Systematic Review.","authors":"Claudia Vinciguerra, Ignazio Leale, Nicasio Rini, Fabio Tiziano Orlando, Liliana Bevilacqua, Paolo Barone, Filippo Brighina, Vincenzo Di Stefano, Giuseppe Battaglia","doi":"10.3390/healthcare14081100","DOIUrl":"10.3390/healthcare14081100","url":null,"abstract":"<p><p><b>Background:</b> Myasthenia gravis (MG) is a chronic autoimmune disorder characterized by fluctuating skeletal muscle weakness and fatigue, leading to reduced functional independence and impaired quality of life (QoL). Although exercise has historically been discouraged due to concerns about symptom exacerbation, emerging evidence suggest that structured exercise programs may be safe and beneficial in clinically stable patients. This systematic review critically evaluates current evidence on exercise and physical activity interventions in MG, focusing on effectiveness, safety, and impact on functional outcomes, fatigue, and QoL. <b>Materials and Methods:</b> A systematic review was conducted following PRISMA guidelines. Searches were performed in PubMed, Web of Science, Google Scholar, Scopus and ScienceDirect for studies published between 2015 and 2025. Keywords included MG, physical activity, aerobic training, resistance training, and respiratory muscle training. Methodological quality was assessed using the Downs and Black checklist. <b>Results:</b> Eight controlled studies met the inclusion criteria, encompassing aerobic, resistance, combined, and respiratory muscle training interventions. Sample sizes ranged from small pilot studies to moderate-size randomized controlled trials. Overall, exercise interventions were well tolerated, with no evidence of sustained symptoms exacerbation. Aerobic and combined programs consistently improved functional capacity, muscle strength, and activities of daily living. Respiratory muscle training demonstrated improvements in pulmonary function and inspiratory muscle strength, although findings were more heterogeneous. Study quality ranged from poor to excellent, with common limitations including small sample size, short follow-up duration, and heterogeneity in exercise programs. <b>Conclusions:</b> Current evidence supports the safety and potential efficacy of individualized, symptom-guided exercise interventions in clinically stable MG. Regular physical activity exercise may reduce secondary deconditioning, improve functional outcomes, and enhance QoL. However, larger, high-quality randomized controlled trials with standardized programs and longer follow-up periods are required to strengthen clinical recommendations and clarify long-term effects.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 8","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13115947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}