Healthcare最新文献

{"title":"Comorbidities and Pregnancy-Related Risk Factors in Patients with Severe Maternal Morbidity: Application of a Validated Obstetrical Comorbidity Scoring System to a Surveillance-Identified Population.","authors":"Carrie Wolfson, Jessica Tsipe Angelson, Alexandra D Forrest, Erin D Michos, Saifuddin Ahmed, Abimbola Aina-Mumuney, Andreea A Creanga","doi":"10.3390/healthcare13182351","DOIUrl":"10.3390/healthcare13182351","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Patient characteristics-especially comorbidities-influence the risk of severe maternal morbidity (SMM). Recent efforts have sought to derive an obstetric comorbidity score to be used for case-mix adjustment. We assess the use of a validated obstetric comorbidity index among patients with SMM and identify additional conditions that could be included in the index. <b>Methods</b>: We applied a validated obstetrical comorbidity scoring system to patients identified through Maryland's SMM Surveillance and Review program, using chi-square analyses to compare prevalence of comorbidities by primary causes of SMM. We compared mean and median comorbidity score by hospital level of care and adverse outcomes (length of stay, volume of blood product transfusion, intensive care unit (ICU) admission, transfer to a higher level of care, and neonatal intensive care unit (NICU) admission). Through the review of case data, we identified additional risk factors for SMM. Using tetrachoric correlation, we examined the degree of correlation between comorbidities from the validated index and the additional risk factors in our sample. <b>Results</b>: A total of 978 SMM events were identified and reviewed between 2020 and 2024. Mean comorbidity score was highest among patients with SMM from hypertensive disorders of pregnancy, and prevalence of index comorbidities varied by primary cause of SMM. Patients that delivered at level IV hospitals had the highest mean comorbidity scores. Scores were also higher with a length of stay ≥4 days, larger volumes of blood product transfusion, and patients whose newborns were admitted to the NICU. We identified 13 additional risk factors for consideration in future indices, finding minimal correlation between the 27 indicators in the validated index and the additional 13. <b>Conclusions</b>: Accurately identifying patient risk for SMM has important applications in both clinical settings and population-level perinatal health research.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174810","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":"Implementing a Mixed Health Service Model as an Informed Modality to Enhance Prevention and Promote Workplace Health in the Greek Regional Public Sector: A Pilot Study in Crete.","authors":"Nikos Frantzeskakis, Maria Tziraki, Marios Spanakis, Spyridoula D Katsarou, Nikolaos Papadopoulos, Manolis Linardakis, Charikleia Vova-Chatzi, Apostolos Kamekis, George Pitsoulis, Antonios Papadakis, Emmanouil K Symvoulakis","doi":"10.3390/healthcare13182337","DOIUrl":"10.3390/healthcare13182337","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Preventive care in Greece remains underdeveloped, especially in workplace settings. To address this, a mixed service model was piloted to integrate preventive and occupational health for public sector employees in Region of Crete. <b>Methods</b>: Between January and July 2025, 180 employees enrolled for a 30 min consultation including medical history review, lifestyle assessment, and evaluation of vaccination and screening status according to age, risk factors, and national guidelines. Standardized tools (PSS-14, PHQ-9) assessed perceived stress and mental well-being. Participants rated satisfaction and perceived care quality on a 10-point Likert scale. <b>Results</b>: Of 180 enrolled, 154 completed the evaluation. The majority of participants were female (68.8%), with a mean age of 54 years, and 42.9% held a higher education degree. Common lifestyle characteristics included current smoking (24.7%), regular alcohol consumption (9.8%), and insufficient sleep (mean 6.5 h/night). Overweight (40.3%) and obesity (29.2%) were prevalent. Chronic conditions were reported in 87.0% of participants, with dyslipidemia (54.5%), allergies (35.8%), and hypertension (26.9%) being the most frequent. Criteria for metabolic syndrome were found in 33.1% of participants with a higher prevalence in men (50.0% vs. 25.0%; <i>p</i> = 0.029). Mental health assessments revealed moderate stress levels (mean PSS-14: 23.7) and mostly minimal depressive symptoms (mean PHQ-9: 4.3). Preventive screening was variable, with higher adherence for mammography (79.2%) and lower for colonoscopy (40.2%). Service satisfaction was high, with significant increases in perceived usefulness (8.96 to 9.80, <i>p</i> < 0.001) and satisfaction (9.08 to 9.87, <i>p</i> < 0.001) after the intervention. <b>Conclusions</b>: This pilot revealed critical gaps in vaccination, cardiometabolic risk, and stress management among public employees. It was also shown that integrated workplace-based health models are both feasible and acceptable. These models can effectively deliver preventive actions on a scale and represent a promising strategy for strengthening occupational health in employed adult population.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174847","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":"Quantification of Thoracic Volume and Spinal Length of Pediatric Scoliosis Patients on Chest MRI Using a 3D U-Net Segmentation.","authors":"Romy E Buijs, Dingina M Cornelissen, Dimo Devetzis, Peter P G Lafranca, Daniel Le, Jiaxin Zhang, Mitko Veta, Koen L Vincken, Tom P C Schlösser","doi":"10.3390/healthcare13182327","DOIUrl":"10.3390/healthcare13182327","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Adolescent idiopathic scoliosis (AIS) can lead to significant chest deformations. The quantification of chest deformity and spinal length could provide additional insights for monitoring during follow-up and treatment. This study proposes a 3D U-Net convolutional neural network (CNN) for automatic thoracic and spinal segmentations of chest MRI scans. <b>Methods:</b> In this proof-of-concept study, axial chest MRI scans from 19 girls aged 8-10 years at risk for AIS development and 19 asymptomatic young adults were acquired (n = 38). The thoracic volume and spine were manually segmented as the ground truth (GT). A 3D U-Net CNN was trained on 31 MRI scans. The seven remaining MRI scans were used for validation, reported by the Dice similarity coefficient (DSC), the Hausdorff distance (HD), precision, and recall. From these segmentations, the thoracic volume and 3D spinal length were calculated. <b>Results:</b> Automatic chest segmentation was possible for all chest MRIs. For the chest volume segmentations, the average DSC was 0.91, HD was 51.89, precision was 0.90, and recall 0.99. For the spinal segmentation, the average DSC was 0.85, HD was 25.98, precision was 0.74, and recall 0.99. Chest volumes and 3D spinal lengths differed by on average 11% and 12% between automatic and GT, respectively. Qualitative analysis showed agreement between the automatic and manual segmentations in most cases. <b>Conclusions:</b> The proposed 3D U-Net CNN shows a high accuracy and good predictions in terms of HD, DSC, precision, and recall. This suggested 3D U-Net CNN could potentially be used to monitor the progression of chest deformation in scoliosis patients in a radiation-free manner. Improvement can be made by training the 3D U-net with more data and improving the GT data.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174868","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":"Psychosocial Correlates of Fatigue in Young Adults with Multiple Sclerosis: Exploring the Roles of Resilience, Mindfulness, and Illness Perception.","authors":"Silvia Poli, Valeria Donisi, Roshan das Nair, Maria Angela Mazzi, Alberto Gajofatto, Michela Rimondini","doi":"10.3390/healthcare13182335","DOIUrl":"10.3390/healthcare13182335","url":null,"abstract":"<p><p><b>Background and Objectives</b>: Fatigue, despite being one of the most common and disabling symptoms in multiple sclerosis (MS), is far from being fully understood. The aim of the present study was to explore the association between fatigue and resilience, illness perception, and mindfulness traits, accounting for the impact of anxiety and depression in young adults with MS (YawMS). <b>Methods</b>: For this cross-sectional exploratory analysis, the following inclusion criteria applied: age 18-45 years, MS diagnosis, Expanded Disability Status Scale <3.5. Fifty-one YAwMS (mean age: 33.5 ± 6.7 years; 76% women, 24% men; 96% relapsing-remitting MS) completed validated questionnaires. Student's t-tests and Spearman correlations, with partial correlations controlling for anxiety and depression, were performed. Finally, a preliminary multivariate model (seemingly unrelated regression) was applied. <b>Results</b>: Despite low disability levels, 69% experienced moderate to severe fatigue (average fatigue score 61.9 ± 17.9). Higher total fatigue was associated with negative illness perception, particularly regarding identity and consequences (<i>p</i> = 0.66 and <i>p</i> = 0.67, respectively), and lower levels of non-judgment and non-reactivity (<i>p</i> = -0.48 and <i>p</i> = -0.54, respectively), and these relationships persisted after controlling for anxiety and depression. Although resilience was negatively correlated with fatigue, its impact was not maintained. <b>Conclusions</b>: Our findings emphasize the relevance of fatigue in YawMS with low disability levels. Cognitive and emotional processing might be associated with fatigue, beyond and beside disease severity itself.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174804","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":"Intraoperative Surgeon-Performed Ultrasound in Complex Partial Nephrectomy: Insights from Challenging Renal Tumors.","authors":"Stelian Ianiotescu, Constantin Gingu, Nicoleta Sanda, Alexandru Iordache, Alexandru Dick, Ioanel Sinescu","doi":"10.3390/healthcare13182325","DOIUrl":"10.3390/healthcare13182325","url":null,"abstract":"<p><p><b>Introduction:</b> Intraoperative ultrasound (IOUS) is increasingly utilized in nephron-sparing surgery for its ability to provide real-time, high-resolution imaging that enhances tumor localization and resection accuracy. Its role becomes particularly important in anatomically complex cases such as endophytic, multifocal, or recurrent renal tumors, as well as in patients with a solitary kidney. <b>Methods:</b> We conducted a retrospective analysis of 152 patients who underwent partial nephrectomy for localized renal tumors between January 2019 and December 2024. Patients were divided into two groups: Group A (n = 24) included patients with a solitary surgical kidney or tumor recurrence; Group B (n = 128) included patients with a contralateral functional kidney. IOUS was used in 31 cases (20%). Demographic, perioperative, and oncological outcomes were compared, with specific attention to the use and impact of IOUS. <b>Results:</b> IOUS was significantly more common in Group A (75%) than in Group B (10%) (<i>p</i> < 0.001), reflecting its preferential use in higher-complexity surgeries. The rate of positive surgical margins was low overall, with no significant difference between the IOUS and non-IOUS groups (3.2% vs. 1.7%; <i>p</i> = 0.54). IOUS was more frequently employed in cases involving medium/high RENAL nephrometry scores and multifocal tumors, contributing to improved intraoperative tumor delineation without increasing complication rates. <b>Conclusions:</b> IOUS enhances surgical precision and supports oncologic safety in both robotic and open partial nephrectomies, particularly in complex scenarios. Its use should be encouraged as a standard adjunct in conservative renal surgery, especially in patients with a solitary kidney, recurrent disease, or multifocal tumors.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174494","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":"Stakeholder Roles and Views in the Implementation of the Differentiated HIV Treatment Service Delivery Model Among Female Sex Workers in Gauteng Province, South Africa.","authors":"Lifutso Motsieloa, Edith Phalane, Refilwe N Phaswana-Mafuya","doi":"10.3390/healthcare13182329","DOIUrl":"10.3390/healthcare13182329","url":null,"abstract":"<p><p><b>Background:</b> Key populations (KPs), particularly female sex workers (FSWs), continue to face significant barriers in accessing HIV-related healthcare services in South Africa. Structural challenges have historically hindered equitable HIV treatment access, worsened by the COVID-19 pandemic. Overburdened clinics, staff shortages, and travel constraints disrupted HIV services and ART adherence. In response, the Differentiated Service Delivery (DSD) model was rapidly scaled up to decentralise care and improve treatment continuity. <b>Objective</b>: To solicit the views of stakeholders regarding their interests, roles and experiences in the implementation of the HIV treatment DSD model among FSWs in South Africa, as well as associated successes and barriers thereof. <b>Methods</b>: We purposively selected and interviewed eight stakeholders, comprising government officials, implementers and sex workers' advocacy organizations. Thematic analysis was used to explore the perceived impact of DSD models and associated successes and barriers in the current service delivery landscape. <b>Results</b>: The study found that decentralization of DSD models improved access to services for FSWs. However, the criminalization of sex work perpetuates fear and marginalization, while stigma and discrimination within healthcare settings remain significant deterrents to HIV treatment uptake. High mobility among FSWs also disrupts continuity of care, contributing to treatment interruptions and lack of data on loss to follow-up. Participants highlighted the need for legal reform, increased healthcare provider sensitization, and the integration of mental health and psychosocial support in HIV services. Peer-led interventions and digital health innovations, such as biometric systems and electronic medical records, emerged as promising strategies for enhancing patient tracking and retention. Nonetheless, the sustainability of DSD models is threatened by an overreliance on external donor funding and insufficient government ownership. <b>Conclusions</b>: To achieve equitable healthcare access and improved HIV outcomes for KPs, especially FSWs, a multi-pronged, rights-based approach is essential. This must include community engagement, structural and legal reforms, integrated support services, and sustainable financing mechanisms to ensure the long-term impact and scalability of DSD models.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174552","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 Impact of Toxic Leadership on Nurse Retention: A Scoping Review.","authors":"Eleni Tsapnidou, Maria Moudatsou, George Katharakis, Sofia Koukouli, Michael Rovithis, Martha Kelesi, Areti Stavropoulou","doi":"10.3390/healthcare13182341","DOIUrl":"10.3390/healthcare13182341","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Toxic leadership has arisen as a matter of serious concern within the nursing profession, with growing evidence linking it to diminished job satisfaction, ineffective conflict management, and weakened organizational commitment. These effects not only compromise nurse retention but also threaten the quality of patient care and overall healthcare outcomes. This scoping review aimed to examine the impact of toxic nursing leadership on staff retention by synthesizing evidence from existing literature and a broad range of published studies. <b>Methods</b>: A comprehensive literature search was conducted across multiple databases, including PubMed/MEDLINE, Scopus, CINAHL and Science Direct databases yielding 1356 articles. Of these, 18 met the predefined inclusion criteria. The scoping review followed the six-stage methodological framework proposed by Arksey and O'Malley. Thematic analysis identified two core categories: (a) key dimensions shaping perceptions of toxic leadership and (b) the impact of toxic leadership on nursing staff retention. <b>Results</b>: The findings reveal that toxic leadership contributes to organizational silence, emotional exhaustion, diminished psychological safety, and low professional commitment. Such behaviors not only jeopardize nurse engagement and productivity but also negatively affect patient safety and care quality. In contrast, leadership styles such as transformational and transactional leadership are associated with higher job satisfaction, reduced burnout, and improved retention outcomes. <b>Conclusions</b>: This review underscores the need for healthcare organizations to identify and address toxic leadership behaviors promptly. By promoting supportive and ethical leadership styles, institutions can foster a healthier workplace, improve nurse retention, and ultimately enhance the quality of care. The study offers practical implications for healthcare administrators, emphasizing leadership development.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174802","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":"Conservative and Pharmacological Strategies for Preventing Osteoporotic Stress Fractures in Older Recreational Competitors.","authors":"Lana Ružić, Marija Rakovac, Ines Bilić-Ćurčić, Domagoj Jakovac, Maja Cigrovski Berković","doi":"10.3390/healthcare13182328","DOIUrl":"10.3390/healthcare13182328","url":null,"abstract":"<p><p>Exercise and bone health are crucial for overall cardiovascular and metabolic well-being. However, certain types of activities can increase the risk of osteoporotic fractures. Preventing injuries while remaining active can be challenging, particularly for older competitive recreational athletes whose training volumes can be comparable to those of professional athletes. While high levels of physical activity in older adults typically lead to thicker cortical bone and improved physical fitness, age-related bone loss, hormonal changes, nutrition, and a history of fractures can significantly raise the risk of osteoporosis. This narrative review provides a descriptive summary of the current understanding of the paradox between exercise and bone fragility, particularly in recreational athletes. Many older athletes may be unaware of their declining bone mineral density, believing that their activity levels are sufficient. Ironically, high-impact activities like running and jumping, which are generally recommended for the prevention of osteoporosis, can also increase the risk of stress fractures. Early detection of osteoporosis is crucial, and this can be achieved through DEXA scans and regular bone density tests, allowing for timely intervention before fractures occur. Alongside medications, strength training, as well as balance and stability exercises, can be very beneficial. It is also important to maintain healthy lifestyle choices, ensure adequate energy levels, and consume sufficient amounts of calcium and vitamin D. Furthermore, monitoring training volume and allowing for proper recovery can help reduce the risk of osteoporotic stress fractures in athletes.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174805","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":"Patterns of Prescription Switching in a Uniform-Pricing System for Multi-Source Drugs: A Retrospective Population-Based Cohort Study.","authors":"Dong Han Kim, Song Hee Hong","doi":"10.3390/healthcare13182339","DOIUrl":"10.3390/healthcare13182339","url":null,"abstract":"<p><p><b>Background:</b> Generic drugs account for approximately 40% of the Korean prescription drug market, despite limited generic substitution at the point of dispensing. This suggests that switching between originator and generic drugs often occurs at the point of prescription. Physicians, in fact, have opposed pharmacy-level substitution due to concerns about the clinical equivalence of generics, despite the regulatory confirmation of their bioequivalence. Importantly, multi-source prescription switching (MSPS) may reflect discretionary prescribing behavior, underscoring the need for targeted benefit policies to enhance substitutability and promote effective competition among multi-source drugs. This study aimed to quantify the extent of physician-initiated MSPS among adults with hypertension or diabetes and to identify factors associated with these switching behaviors. <b>Methods:</b> We conducted a retrospective cohort study using Korean National Health Insurance claims data. The studied cohort consisted of patients newly initiated, between January and June 2014, on a pharmaceutically equivalent and bioequivalent antihypertensive or antidiabetic drug. Patients were followed for up to 24 months to identify MSPS episodes occurring during drug therapy courses, which were defined as 12 ± 3 consecutive visits resulting in prescriptions for pharmaceutically equivalent, bioequivalent multi-source drugs. An MSPS episode was defined as a change in product code-uniquely identifying a multi-source drug-within the same pharmaceutically equivalent drug code between any two consecutive prescriptions within the course. We estimated the mean MSPS rate and assessed variation by patient characteristics, drug types, physician practices, and geographic regions. <b>Results:</b> Among 1,325,334 identified drug therapy courses, 17.06% involved at least one MSPS. Switching rates varied substantially (coefficient of variation = 227%) by physician practice setting (e.g., public health center branches: 26%; tertiary hospitals: 15%) and by drug market size (e.g., glimepiride: 29%; cilnidipine: 1%). In contrast, patient age and gender were not associated with switching behavior. <b>Conclusions:</b> In Korea, physicians frequently switch prescriptions between originator and generic drugs, even as generic substitution at the pharmacy level remains uncommon. The substantial variation in MSPS across provider settings and drug markets-but not by patient characteristics-underscores the need for targeted pharmacy benefit policies to promote effective substitutability and competition among multi-source drugs.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174867","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":"A Mediation Analysis of Trauma Symptoms on the Well-Being in Caregivers of Children with Medical Complexity.","authors":"Courtney M Holmes, Kanako Iwanaga, Tiffany Kimbrough, Simran Singh, Marcia A Winter, Ayomide Popoola, Genevive Heymann, Makayla Burton, Heather A Jones","doi":"10.3390/healthcare13182332","DOIUrl":"10.3390/healthcare13182332","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Parent caregivers of children with medical complexity experience high levels of chronic stress and trauma symptoms. Despite ongoing and continuous involvement with the healthcare system, parents often do not seek support for their own mental health concerns. Parent mental wellness is a critical component of reducing family distress. This study aimed to explore how various factors such as resilience, coping, and support impacted well-being and trauma symptom severity. <b>Methods</b>: Parents/caregivers from a complex care clinic in a mid-Atlantic children's hospital were recruited for this study. A total of 125 participants completed the study which included a battery of measures focused on trauma symptoms, well-being, coping, and resilience. <b>Results</b>: PTSD symptom severity was significantly negatively related to resilience and subjective well-being. Significant mediators included informational support, indicating that collaboration between healthcare providers and caregivers/parents is critical. <b>Conclusions</b>: This study highlights potential target intervention areas to promote well-being and reduce trauma symptom severity, such as resiliency promotion and enhancement and increasing informational support provided by healthcare professionals.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174743","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}