Healthcare最新文献

{"title":"Burnout and Perceived Stress Among Female Health Sciences Faculty Members at a University in Riyadh, Saudi Arabia: A Cross-Sectional Study.","authors":"Zeinab A Abusabeib","doi":"10.3390/healthcare14193339","DOIUrl":"10.3390/healthcare14193339","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Burnout and perceived stress are important concerns among health sciences faculty, whose roles often overlap across teaching, research, administrative, and clinical responsibilities. This study assessed burnout dimensions and perceived stress among female health sciences faculty at a single university in Riyadh, Saudi Arabia. <b>Methods:</b> This cross-sectional study included 228 female faculty members from five health sciences colleges, yielding a 64.4% response rate. Burnout was assessed using the Maslach Burnout Inventory-Educators Survey (MBI-ES), and perceived stress using the 10-item Perceived Stress Scale (PSS-10). Bivariate analyses incorporated effect sizes and false discovery rate adjustment for multiple comparisons. Multivariable linear regression models examined associations of demographic and professional characteristics with continuous emotional exhaustion and perceived stress scores. <b>Results:</b> For descriptive categorization, 34.2% of participants had high emotional exhaustion, 21.1% high depersonalization, 30.3% low personal accomplishment, and 15.2% high perceived stress. Perceived stress correlated most strongly with emotional exhaustion (r = 0.54, <i>p</i> < 0.001). In adjusted analyses, increasing age was associated with lower emotional exhaustion (B = -0.27, <i>p</i> < 0.001) and perceived stress (B = -0.16, <i>p</i> < 0.001), whereas working >50 h/week was associated with higher emotional exhaustion (B = 6.81, <i>p</i> < 0.001) and perceived stress (B = 3.13, <i>p</i> = 0.005). Overall adjusted college effects were not statistically significant. <b>Conclusion:</b> Longer working hours and younger age were associated with poorer faculty well-being, although the models explained modest proportions of outcome variance. These findings support institutional assessment of workload patterns and faculty well-being while underscoring the need for longitudinal research evaluating organizational demands, resources, and targeted interventions.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192902","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 Assessment of Structural Validity and Internal Consistency of the Polish Health Literacy Questionnaire (HLQ) in Primary Care Settings.","authors":"Agnieszka Lipiak, Barbara Gawłowska, Marlena Szewczyczak, Monika Karasiewicz, Rafał Staszewski, Richard Osborne, Melanie Hawkins, Ewelina Chawłowska","doi":"10.3390/healthcare14193320","DOIUrl":"10.3390/healthcare14193320","url":null,"abstract":"<p><strong>Background/objectives: </strong>Health literacy extends beyond individual competencies and encompasses how people engage with health systems. The Health Literacy Questionnaire (HLQ) is a widely used multidimensional instrument designed to assess different health literacy aspects across nine distinct domains. This study aimed to examine structural validity and internal consistency of the Polish version of the HLQ among primary care service users.</p><p><strong>Methods: </strong>The HLQ was used in a cross-sectional survey among 360 adults (mean age 51.76 years, SD 17.48) attending four primary care clinics in Poland. The assessment included confirmatory factor analysis (CFA) and internal consistency tests.</p><p><strong>Results: </strong>A nine-factor CFA model was applied to the HLQ items, without allowing cross-loadings or correlated residuals. The fit indices confirmed good model fit: χ²_WLSMV (df = 866) = 1175.63, <i>p</i> < 0.001; CFI = 0.98; TLI = 0.98; RMSEA = 0.038; and SRMR = 0.056. The factor loadings ranged from 0.55 to 0.94, indicating acceptable item-factor relationships across all domains. Internal consistency was satisfactory across all nine domains, with composite reliability ranging from 0.76 to 0.87 and Cronbach's alpha from 0.78 to 0.88.</p><p><strong>Conclusions: </strong>The findings provide preliminary evidence supporting structural validity and internal consistency of the Polish HLQ in this sample of primary care service users and suggest the potential value of the instrument for multi-dimensional assessment of health literacy in similar Polish primary care populations. Future studies should evaluate additional measurement properties of the tool, as well as the performance of the instrument in nationally representative samples and across diverse clinical settings.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193128","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":"Nonuse and Nonpurchase of Assistive Devices After Stroke: An Exploratory Interview Study of Retrospective Device Histories Among Community-Dwelling Adults.","authors":"EunRae Ro, Kwang-Ok An, Sung-Yong Lee, Dong-A Kim, Seon-Deok Eun","doi":"10.3390/healthcare14193327","DOIUrl":"10.3390/healthcare14193327","url":null,"abstract":"<p><strong>Background/objectives: </strong>Because function typically improves after stroke, the devices people need, and for how long, may change along the recovery trajectory. This exploratory study examined retrospective accounts of assistive device use, discontinuation, replacement, and nonpurchase across two post-onset stages, hospitalization and home and community reintegration.</p><p><strong>Methods: </strong>Ten community-dwelling adults with chronic stroke (mean disability duration 13.9 years) were interviewed twice at home, with caregivers contributing where present, and reconstructed their device histories from recall; the resulting accounts are treated as joint participant-caregiver reports. Instruments followed the Human-Activity-Assistive Technology (HAAT) model; field notes and completed device checklists were analyzed by inductive qualitative content analysis, and facilitators and barriers were classified with the World Health Organization people-centered assistive technology (5P) framework. Aggregate figures for the stroke subsample of the 2020 National Survey on Persons with Disabilities (<i>n</i> = 662) are reported as national context rather than as independent confirmation.</p><p><strong>Results: </strong>Participants reported having used a mean of 11.2 device types, yet named only 1.3 devices that were needed but not purchased. Discontinuation was concentrated among devices used during inpatient rehabilitation: standing frames (9/9), walkers (5/5), and manual wheelchairs (8/10) had been set aside. Functional improvement was the only reason recorded for walkers, but for standing frames and manual wheelchairs it was recorded alongside cost, bulk, replacement, and, in one case, continuing unmet need, so its independent contribution could not be established. A second cluster reflected the poor fit of body-worn devices to a changing hemiplegic limb (ankle-foot orthoses, 4/6). The nonpurchase barrier reported most often was inability to find a suitable product on the market.</p><p><strong>Conclusions: </strong>These retrospective accounts from ten participants cannot support policy conclusions. They generate hypotheses, requiring prospective testing, about whether ownership-based funding with fixed durability periods fits stage-limited need and whether rental provision, prescription-based provision for orthoses, and targeted product development would fit it better.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193152","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":"Respect for Patients' Rights in Hospital Practice: Associations with Physicians' Legal Knowledge, Defensive Medicine, and Patient-Centered Care.","authors":"Alina Doina Tănase, Sorin Dan Chiriac, Ștefania Dinu, Adriana Pădure, Codruța-Eliza Ille, Bogdan Hoinoiu, Cristina Ioana Talpoș Niculescu","doi":"10.3390/healthcare14193332","DOIUrl":"10.3390/healthcare14193332","url":null,"abstract":"<p><p><i>Background/Objectives:</i> This study examined associations of physicians' legal knowledge, defensive medicine, and patient-centered orientation with self-reported respect for patients' rights. <i>Methods:</i> A single-center cross-sectional study (February-June 2026) included 96 physicians. The primary outcome was the Patients' Rights Respect Score (PRRS, 0-100). The confirmatory analysis compared PRRS between legal-knowledge groups (adequate ≥70/100). Multivariable regression was secondary; mediation and prediction were exploratory. <i>Results:</i> Adequate legal knowledge (34/96, 35.4%) was associated with higher PRRS (76.8 ± 7.1 vs. 71.0 ± 8.4; difference 5.8, 95% CI 2.6-9.0, <i>p</i> < 0.001, d = 0.73) and lower Defensive Medicine Scale scores (44.5 ± 6.8 vs. 48.5 ± 9.3, <i>p</i> = 0.016). Patient-Practitioner Orientation Scale scores were independently associated with PRRS (B = 6.64 per point, <i>p</i> < 0.001; model R² = 0.513); the adjusted legal-knowledge coefficient was not statistically significant (B = 1.09 per 10 points, <i>p</i> = 0.094). In exploratory parallel mediation models, 41.8% of the knowledge-PRRS association was statistically accounted for by indirect associations, mainly through patient-centered orientation; concurrent measurement precludes causal ordering. An exploratory model for PRRS < 70 had an optimism-corrected AUC of 0.789 (internal validation only). <i>Conclusions:</i> Legal knowledge was associated with greater self-reported respect in unadjusted comparisons. Indirect associations were hypothesis-generating, and predictive performance does not establish clinical utility. Confirmation requires multicenter, longitudinal studies with objective measures of practice.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192395","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":"Perceptions, Expectations, and Acceptability of Digital Physical Activity Programs Among Adults with Chronic Diseases in Saudi Arabia: A Qualitative Descriptive Study.","authors":"Jamal M Alzahrani, Abdulaziz M Alodhailah, Nada Alattar, Nasser Aldosari, Rayhanah R Almutairi, Asrar S Almutairi, Hend N Almutairi, Rahmah I Albahrani, Mohammed Almutairi","doi":"10.3390/healthcare14193334","DOIUrl":"10.3390/healthcare14193334","url":null,"abstract":"<p><strong>Background/objectives: </strong>Digital programs may extend physical activity support beyond clinic visits, but qualitative evidence on how adults with chronic diseases in Saudi Arabia perceive them is limited. This study explored perceptions, expectations, and acceptability among such adults who had continued using the physical activity function of Sehhaty, the Ministry of Health's national health application, which served as the reference point.</p><p><strong>Methods: </strong>A COREQ-reported qualitative descriptive study was conducted in chronic disease units at three tertiary centres in Riyadh between December 2025 and February 2026. Semi-structured interviews were held with a purposive sample of 14 adults (38-72 years; 8 women, 6 men) with type 2 diabetes mellitus, hypertension, cardiovascular disease, or combinations, all of whom had used the program independently for 4-16 weeks. Recruitment and analysis proceeded iteratively across two stages (18 approached). Data were analysed using reflexive thematic analysis.</p><p><strong>Results: </strong>Four themes were developed: reframed expectations of what a technology-based presence could offer; a gap between perceived usefulness and everyday usability; the dual motivational and discouraging potential of numerical feedback; and the expectation that programs fit Islamic practice, family involvement, and climate constraints.</p><p><strong>Conclusions: </strong>For these participants, acceptability depended on ease of use, natural Arabic wording, reminders and suggestions that fit prayer times, family routines, and summer heat, and feedback that recognised health circumstances. Because all participants were sustained users, the findings do not estimate acceptability in the wider population.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193046","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":"Development and Psychometric Validation of the Mistreatment Questionnaire for Medical Trainees (MQMT) in Mexican Medical Students, Interns, and Residents.","authors":"Ramsés Barrera-Águila, Luis Eduardo Del Moral-Trinidad, Blanca Estela Ríos-González, Daniela De-Loza-Cázares, Perla Jazmín Figueroa-Martínez, Ingrid Patricia Dávalos-Rodríguez, Aniel Jessica Leticia Brambila-Tapia","doi":"10.3390/healthcare14193333","DOIUrl":"10.3390/healthcare14193333","url":null,"abstract":"<p><p><b>Introduction:</b> Mistreatment in medical training is a highly prevalent phenomenon that occurs in different types and forms. However, despite its high frequency, no measurement instrument has been validated that represents these different types of mistreatment in its factorial structure. Therefore, the objective of this study was to design the Mistreatment Questionnaire for Medical Trainees (MQMT) and to obtain initial evidence of its validity and reliability. <b>Methods:</b> Medical trainees at different stages (non-clinical and clinical undergraduate medical students, interns, and residents) were invited to participate through social media and personal invitation. The electronic survey included a 28-item pool adapted from previous mistreatment questionnaires, together with measures of anxiety (GAD-7), depression (PHQ-9), and perceived stress (PSS-10). The sample was randomly split into exploratory and confirmatory subsamples. <b>Results:</b> A total of 555 medical trainees were included (64% women; mean age, 23.7 years). Exploratory factor analysis (EFA; n = 280) suggested four factors, one of which combined physical mistreatment and discrimination items. A 16-item, five-factor model (academic mistreatment, psychological mistreatment, physical mistreatment, discrimination, and sexual harassment) was specified on empirical and theoretical grounds and compared with competing models in an independent subsample (n = 275), using weighted least squares with mean- and variance-adjusted test statistics (WLSMV) on polychoric correlations as the primary estimator and robust maximum likelihood (MLR) as a sensitivity analysis. The five-factor model showed good fit (CFI = 0.984, TLI = 0.980, RMSEA = 0.066, SRMR = 0.049); the MLR solution was consistent and favored the same model. Standardized loadings ranged from 0.814 to 0.980, and subscale reliability was satisfactory in the confirmatory subsample (α = 0.866-0.943; ω = 0.868-0.943). Academic mistreatment was the most frequently reported dimension, followed by psychological mistreatment. MQMT scores showed small-to-moderate positive correlations with symptoms of anxiety, depression, and stress, with stronger associations for academic and psychological mistreatment. <b>Conclusions:</b> The MQMT is a brief 16-item, five-dimensional instrument with initial evidence of validity and reliability in Mexican medical trainees. Subscale scores are the primary scores of the instrument, and the empirical distinction between discrimination with physical mistreatment and sexual harassment is not yet firmly established. Replication in other populations is needed.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192927","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":"Benchmarking Generative AI Chatbots in Preventive Medicine: A Comparative Analysis of Accuracy, Completeness, and Inter-Rater Reliability.","authors":"Nojoud Zoraib Alshahrani, Abdullah Alsabaani, Ali Hassan Almaqsudi, Ali Alshahrani, Naif Moshabub Mosfer Alqahtani, Mazen Abdullah N Alshahrani","doi":"10.3390/healthcare14193330","DOIUrl":"10.3390/healthcare14193330","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Artificial intelligence (AI) chatbots are increasingly used for healthcare information retrieval, education, and clinical support; however, concerns remain regarding the accuracy and completeness of AI-generated information in preventive medicine, where evidence-based recommendations, epidemiological interpretation, risk assessment, and public health guidance require reliable responses. Comparative evidence across multiple preventive medicine domains remains limited, particularly using standardized expert-validated reference answers. This study aimed to evaluate and compare the accuracy and completeness of responses generated by five AI chatbots across major preventive medicine domains. <b>Methods:</b> A comparative cross-sectional benchmarking study evaluated ChatGPT, DeepSeek, Perplexity AI, Claude AI, and Gemini Advanced using 15 expert-validated questions covering General Preventive Medicine, Clinical Preventive Medicine, Epidemiology and Biostatistics, Occupational Medicine, and Social and Behavioral Science. Responses were independently evaluated by two investigators using predefined accuracy and completeness scoring frameworks. Between-model comparisons were conducted using mixed-effects models accounting for clustering by question, and inter-rater reliability was assessed using agreement statistics. <b>Results:</b> Claude AI achieved the highest overall accuracy (5.67 ± 0.41) and completeness (2.87 ± 0.35), followed by ChatGPT (accuracy, 5.47 ± 0.66; completeness, 2.67 ± 0.49), whereas Gemini Advanced demonstrated the lowest overall performance. Epidemiology and Biostatistics showed the highest pooled completeness score (2.60; 95% CI: 2.32-2.88). Mixed-effects analysis accounting for clustering by question demonstrated a significant overall difference in accuracy among chatbot models (<i>p</i> < 0.001), while inter-rater agreement was high, supporting the consistency of the scoring procedure. <b>Conclusions:</b> Substantial variability in accuracy and completeness was observed among the evaluated AI chatbots, with Claude AI and ChatGPT demonstrating comparatively stronger performance within this specific question set. Given the limited number of unique questions and the continuously evolving nature of AI models, these findings should be considered exploratory and should not be generalized as definitive evidence of model superiority or clinical utility. Larger studies using more diverse question sets and standardized evaluation frameworks are required to confirm these findings.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192889","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":"Physiological Versus Directed Pushing During the Second Stage of Labor: A Non-Randomized Quasi-Experimental Study of Maternal Recovery and Clinical Outcomes.","authors":"Alya Mansour Alshamrani, Nouran Essam Katooa, Safaa Gaber Aly Salem, Enas Mohamed Lotfy, Hanan Elsayed Mohamed Elsayed, Ahmed Azzam, Hala Ahmed Thabet","doi":"10.3390/healthcare14193319","DOIUrl":"10.3390/healthcare14193319","url":null,"abstract":"<p><p><b>Background:</b> Pushing technique may influence maternal effort, labor progression, and birth outcomes, yet evidence comparing physiological and directed pushing remains inconsistent, particularly for early maternal recovery. This study compared the two approaches in relation to postpartum fatigue and perceived energy, second-stage duration, and selected maternal and neonatal outcomes. <b>Methods:</b> This non-randomized quasi-experimental comparative study included 120 women assigned during two sequential labor-unit implementation periods to physiological pushing (<i>n</i> = 60) or directed pushing (<i>n</i> = 60). No individual random allocation sequence was used. The physiological-pushing intervention was provider-guided open-glottis, short-duration pushing with urge-led initiation, whereas directed pushing used coached closed-glottis Valsalva efforts. The primary outcome was fatigue at 24 h postpartum. Covariate-adjusted regression was used for 24 h fatigue and perceived energy, mixed-effects models for repeated scores, proportional-odds regression for categorized second-stage duration, and exact methods for binary outcomes. Propensity-score overlap weighting evaluated the robustness of the primary result. <b>Results:</b> At 24 h postpartum, no between-group difference in fatigue was detected after adjustment for baseline fatigue, age, body mass index, education, gravidity, gestational age, first-stage duration, and oxytocin use (physiological-minus-directed difference, 0.20 points; 95% CI, -2.05 to 2.45; <i>p</i> = 0.860). Adjusted perceived energy was also similar (difference, -0.79 points; 95% CI, -2.18 to 0.59; <i>p</i> = 0.260). Across both groups, fatigue decreased and perceived energy increased over time (both time effects <i>p</i> < 0.001), with no group × time interaction. The overlap-weighted analysis supported the primary finding (difference, 0.25 points; 95% CI, -1.79 to 2.29; <i>p</i> = 0.809). Physiological pushing was associated with lower odds of occupying a longer second-stage-duration category in the adjusted proportional-odds model (adjusted OR, 0.20; 95% CI, 0.09 to 0.45; <i>p</i> < 0.001; Holm-adjusted <i>p</i> = 0.0007). None of the six binary maternal or neonatal outcomes differed after Holm correction. <b>Conclusions:</b> Compared with directed pushing, physiological pushing was not associated with lower fatigue or higher perceived energy at 24 h postpartum. Directed pushing likewise showed no consistent advantage over physiological pushing across the evaluated maternal and neonatal outcomes. The observed association between physiological pushing and lower odds of a longer second-stage duration represents an exploratory secondary finding and should be interpreted cautiously in view of the non-randomized design and the possibility of residual confounding.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193144","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":"Area-Level Correlates of Inpatient Care Self-Sufficiency in Subnational Health Planning Areas: A Disease-Stratified Ecological Study from Aichi Prefecture, Japan.","authors":"Wataru Sonta, Kikue Sato","doi":"10.3390/healthcare14193322","DOIUrl":"10.3390/healthcare14193322","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Japan organizes inpatient care through secondary medical areas (SMAs), but evidence linking area-level care self-sufficiency with population need, healthcare supply, and socioeconomic context is limited. We quantified disease-stratified self-sufficiency across Aichi Prefecture and examined its ecological correlates. <b>Methods:</b> This cross-sectional ecological study analyzed fiscal-year 2024 Diagnosis Procedure Combination discharges from 203 of 276 acute-care hospitals across 11 SMAs. The dataset comprised 396 cells (11 SMAs × 18 Major Diagnostic Categories × surgical/non-surgical strata) linked to census, healthcare-resource, household, and pooled 2020-2024 standardized mortality ratio (SMR) data. Pre-specified single-predictor regressions at the SMA level (<i>n</i> = 11) were supplemented by spatial and cluster-robust sensitivity analyses. Self-sufficiency represented observed resident-to-provider flows within the participating hospital network. <b>Results:</b> Mean self-sufficiency ranged from 34.0% to 88.3% across SMAs (intra-class correlation, 0.54) and was 8.5 percentage points lower for surgical cells (95% CI, 5.9-11.1). Greater shares of residents aged ≥75 years (β = -12.80; 95% CI, -22.84 to -2.75) and households containing an elderly member (β = -13.53; 95% CI, -23.02 to -4.05) were the strongest negative correlates. Supply-density estimates were consistently positive; in the cell-level sensitivity model, physician, general-bed, and psychiatric-bed densities were associated with above-median self-sufficiency (ORs, 2.51-3.16). Exploratory analyses suggested differing patterns across acute and chronic conditions. <b>Conclusions:</b> Self-sufficiency varied substantially across planning areas and was associated with demographic, household, supply, and mortality characteristics. These findings support disease-specific evaluation of regional concentration versus local completion but do not establish causal or individual-level relationships. Multi-prefecture studies with individual-level case-mix adjustment are needed before resource-allocation applications.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192944","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":"Privacy Concerns and Configurational Patterns of Health Information Sharing Intention Among Patients with Chronic Diseases in Online Health Communities: An SEM and fsQCA Analysis.","authors":"Zongliang Wen, Xinting Qi, Yiheng Qin, Xin Ouyang, Yan Zhu","doi":"10.3390/healthcare14193337","DOIUrl":"10.3390/healthcare14193337","url":null,"abstract":"<p><strong>Background/objectives: </strong>Privacy concerns are negatively associated with health information sharing intention, but their role within combinations of facilitating conditions remains unclear. This study examined variable-level associations and configurational patterns among patients with chronic diseases.</p><p><strong>Methods: </strong>This single-center, cross-sectional study used a convenience sample of 428 patients who had used online health communities. The outcome was self-reported sharing intention rather than observed disclosure. Covariance-based structural equation modeling (SEM) assessed adjusted associations, and fuzzy-set qualitative comparative analysis (fsQCA) identified configurations sufficient for high or low intention under the selected calibration and thresholds.</p><p><strong>Results: </strong>The six-construct model was selected after data-dependent modification of an eight-construct candidate model and should therefore be interpreted as exploratory. Attitude toward sharing (β = 0.204), social rewards (β = 0.220), past positive experience (β = 0.220), and trust (β = 0.228) were positively associated with sharing intention (all <i>p</i> < 0.001), whereas privacy concerns were negatively associated with sharing intention (β = -0.119, <i>p</i> = 0.002). No single condition met the necessity threshold. The baseline fsQCA identified five high-intention and two low-intention configurations, although some expressions changed in sensitivity analyses. Low privacy concerns appeared in four high-intention configurations. In the remaining minimized expression, privacy concerns were not retained, so their level was unrestricted. The empirical truth table showed that high privacy concerns and high intention coexisted in some cases, but this does not establish a positive or compensatory contribution of privacy concerns.</p><p><strong>Conclusions: </strong>In this convenience sample, privacy concerns showed an overall negative association with self-reported sharing intention, while their role in minimized configurations varied with the analytical specification. The findings require independent, multicenter validation and do not establish intervention or platform-design effects.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193239","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}