Healthcare最新文献

{"title":"AI-Augmented Digital Diagnostics in Minimally Invasive Dentistry: A Case Report on Clinically Occult Approximal Caries.","authors":"Michal Augustín, Tomáš Siebert","doi":"10.3390/healthcare14193282","DOIUrl":"10.3390/healthcare14193282","url":null,"abstract":"<p><strong>Background: </strong>Approximal dental caries pose a persistent diagnostic challenge, as early lesions frequently remain clinically occult beneath intact enamel surfaces during routine visual-tactile inspection. This case report describes the clinical utility, limitations, and decision-making discrepancies within a multimodal digital diagnostic workflow combining intraoral radiography, near-infrared light transillumination (NILT), and deep-learning artificial intelligence (AI) radiographic analysis.</p><p><strong>Case presentation: </strong>A 19-year-old female patient presented with provoked cold and sweet sensitivity localized to the upper left quadrant. Clinical inspection revealed visually intact accessible enamel surfaces (ICDAS 0 on tooth 25. To resolve the discrepancy between subjective symptoms and inconclusive initial visual findings, periapical radiography and NILT were performed. After the clinician-led treatment plan had been established, the radiograph was additionally processed using ClinicalAID as a parallel research analysis. Diagnostic Assessment and Management: Periapical radiography and NILT revealed approximal demineralization on teeth 24, 25, and 26. After the clinician-led treatment plan had been established, the radiograph was additionally processed with ClinicalAID as a parallel research analysis, yielding model confidence scores of 100%, 99%, and 98% for teeth 24, 25, and 26, respectively. Pre-operative therapeutic stratification remained entirely clinician-led: teeth 24 and 25 were selected for operative intervention based on provoked symptomatology and radiographic appearance of dentinal involvement, whereas tooth 26 was managed non-operatively with topical fluoridation and scheduled monitoring. Operative clinical reference assessment confirmed demineralization extending into the middle third of the dentin on tooth 25.</p><p><strong>Conclusions: </strong>High AI caries-detection confidence scores do not differentiate between lesion depth, cavitation status, or the necessity of operative intervention, as evidenced by divergent clinical pathways despite near-identical AI output scores on teeth 25 and 26. Deep-learning algorithms must function strictly as adjunctive decision-support tools within a human-in-the-loop framework (Intelligence Augmentation), with treatment planning governed by clinical symptoms, caries risk, and conventional diagnostic synthesis.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192881","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":"Self-Reported Prebiotics and Probiotics Recognition and Recommendation Practices Among Dentists in Sibiu County, Romania: A Cross-Sectional Questionnaire Survey.","authors":"Tiberiu H Ionaș, Mona Ionaș, Radu Chicea, Albertina Stănilă, Gabriela Boța","doi":"10.3390/healthcare14193274","DOIUrl":"10.3390/healthcare14193274","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Probiotics and prebiotics are being investigated as adjuncts for the management of oral dysbiosis, but little is known about how dentists understand and recommend them. We describe self-reported recognition of oral microbiome concepts, identification of the definitions of prebiotics and probiotics, and recommendation practices among dentists in Sibiu County, Romania. <b>Methods</b>: A cross-sectional online questionnaire survey (comprising eight closed items; delivered using Google Forms) was distributed through the county professional association WhatsApp messaging channel and to personal contacts between 20 February 2026 and 9 March 2026. Of a target of 630 dentists, 107 completed the questionnaire (response rate: 17.0%), forming a voluntary local sample. Three pre-specified hypotheses (definition accuracy × recommendation; general recommendation × adjunct recommended during antibiotic therapy; and years of experience × definition accuracy and recommendation) were tested with exact tests, odds ratios (ORs), and 95% confidence intervals (CIs) with Holm adjustment; other item associations were exploratory and adjusted within families. <b>Results</b>: A microbial role was recognized for periodontal disease by 98.1% of respondents, for dental caries by 92.5%, for focal infection by 73.8%, and for bone infection of dental origin by 64.5%. Diet, antibiotics, oral hygiene, and smoking were recognized as microbial influencing factors by 78-84%, probiotics by 58.9%, and prebiotics by 52.3%. Definitions of the adjuncts were correctly identified by 83.2% (prebiotics) and 80.4% (probiotics). Prebiotics were recommended by 50.5% and probiotics by 86.0% of respondents. Correct definitions were not associated with recommendation (prebiotics: OR 1.76, 95% CI 0.62-4.95; probiotics: OR 1.60, 95% CI 0.46-5.65). During antibiotic therapy, dentists who recommended prebiotics were more likely to select a prebiotic-probiotic combination than those who did not (57.4% versus 3.8%; exact <i>p</i> < 0.001). No outcome differed by years of experience. <b>Conclusions</b>: In this self-selected sample, biotics were recognized as microbiome-influencing factors less often than classical factors, and knowing the definitions was not associated with recommending the products. The reasons behind recommendation habits were not measured and require dedicated study.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193003","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":"Classifying Unsafe Health and Care Behaviors in the Context of Just Culture: A Comparative Video-Based Vignette Study.","authors":"Susana Lorenzo, Eva Gil-Hernández, Irene Carrillo, Cristina Navarro, Pedro Lozano Gago, Marta Macías Maroto, Elvira Eva Moreno Campoy, Paloma Trillo López, Elena Corpas Nogales, Ángel Cobos-Vargas, Mª Del Carmen Jiménez Estrada, Pastora Pérez-Pérez, María Teresa Gea-Velázquez de Castro, Mercedes Arencibia-Jiménez, Alberto Asencio, Juan Molina Ribera, Jesús María Aranaz-Andres, Diego San Jose-Saras, José J Mira","doi":"10.3390/healthcare14193275","DOIUrl":"10.3390/healthcare14193275","url":null,"abstract":"<p><p><b>Background</b>: Just Culture requires organizations to distinguish human mistakes from unsafe behavior while maintaining transparency, accountability and trust. However, little is known about how different stakeholders interpret these boundaries in realistic healthcare situations. This study aimed to explore how unsafe healthcare behaviors are classified by professionals and community and public-opinion stakeholders within the framework of Just Culture. <b>Methods</b>: This structured judgment study used standardized video vignettes across primary care, hospital, and nursing home settings. A purposive and convenience sample of 449 healthcare professionals, managers, and community/public representatives classified behaviors as honest error, at-risk behavior, or reckless behavior and provided written justifications. Concordance with a prespecified study-defined reference classification was examined using mixed-effects logistic regression. <b>Results</b>: Across 2976 classification opportunities, 2610 were analyzable within the three predefined categories. At-risk behavior was most frequent (40.5%), followed by honest error (33.5%) and reckless behavior (25.9%). Exact concordance with the prespecified reference classification was 48.4% and was highest for reckless behavior (67.4%). Participants' justifications for their classification choices centered on intention, contextual pressure, foreseeability, omitted safety barriers, professional duty, and relational expectations. <b>Conclusions</b>: Participants generally distinguished human fallibility from the omission of available safeguards, but many behaviors were located in an intermediate zone of at-risk conduct rather than clear error or recklessness. The observed variability in interpreting error, risk, and responsibility, particularly around at-risk behavior, may be relevant to the implementation of Just Culture.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193004","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":"Lower Urinary Tract Symptoms and Female Sexual Function During Pregnancy: A Correlational and Comparative Analysis.","authors":"Ahmet Şanlı, Nuran Nur Aypar Akbağ, Yasemin Şanlı","doi":"10.3390/healthcare14193267","DOIUrl":"10.3390/healthcare14193267","url":null,"abstract":"<p><p><b>Aim:</b> This study aimed to examine the relationship between lower urinary tract symptoms and sexual function among pregnant women and to evaluate variations in these outcomes according to demographic, obstetric, and sexual characteristics. <b>Methods:</b> This descriptive, cross-sectional, and correlational study was conducted with 278 pregnant women. Data were collected through face-to-face interviews between June and July 2026. The data collection instruments included the Descriptive Information Form, the Bristol Female Lower Urinary Tract Symptoms Questionnaire (BFLUTS), and the Female Sexual Function Index (FSFI). <b>Results:</b> The mean age of the pregnant women was 28.88 ± 4.13 years. The mean total FSFI score was 19.06 ± 5.72, with 95.7% of participants scoring below the conventional cutoff of 26.55. Women scoring below the conventional FSFI cutoff had significantly higher BFLUTS filling and urinary incontinence scores. In the adjusted regression model, greater urinary filling symptom severity (B = -0.346, SE = 0.162, β = -0.145, t = -2.129, <i>p</i> = 0.034) and a history of curettage (B = 2.436, SE = 1.088, β = 0.160, t = 2.238, <i>p</i> = 0.026) were associated with lower total FSFI scores. Obstetric characteristics, self-reported sexual knowledge, and sexual practices were also associated with variations in specific urinary symptom and sexual function domains. <b>Conclusions:</b> Urinary filling symptoms and obstetric history were associated with sexual function during pregnancy, even after adjustment for other characteristics. These findings support the consideration of urinary symptoms and sexual health in comprehensive antenatal assessment and highlight the potential value of individualized counseling.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193020","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":"Pre-Analytical Errors Before, During, and After the COVID-19 Pandemic: A Multi-Year Retrospective Observational Study.","authors":"Betül Özbek Kurtul, Bağnu Dündar, Fatma Bozkurt, Sevgi Koçyiğit Sevinç, Çiğdem Aktaş, Asiye Gök Yurttaş","doi":"10.3390/healthcare14193286","DOIUrl":"10.3390/healthcare14193286","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The pre-analytical phase is the stage at which laboratory errors most frequently occur and is therefore of critical importance for patient safety. During the COVID-19 pandemic, the marked increase in workload, organizational restructuring, staff and resource redeployment, changes in patient volume and clinical workflows, and disease-related pathophysiological alterations affecting specimen characteristics created unprecedented conditions that could influence laboratory quality indicators. This study aimed to characterize changes in specimen rejection rates across the pre-pandemic, pandemic, and normalization periods between 2018 and 2023, and to determine whether pandemic-related disruptions in health care delivery were associated with differences in the number, rate, and distribution of specimen rejections according to clinical unit, rejection reason, and time interval, with emphasis on the magnitude of these differences rather than statistical significance alone. The study also sought to generate evidence that could inform the development of preventive systems and strengthen laboratory preparedness for future large-scale disruptions to health care services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This retrospective observational study used routinely collected, aggregated laboratory information system (LIS) data from the Central Laboratory of Istanbul Atlas University Hospital for 1 January 2018 through 31 December 2023. The LIS extract was restricted to eligible specimen types, including spot and 24 h urine, serum, and whole-blood or plasma specimens collected in EDTA-, citrate-, or heparin-containing tubes; all other specimen types were excluded. Specimen rejection rates were evaluated by study period, clinical unit, time interval, and rejection reason. For cross-period comparisons, the total number of specimens within each respective study period was used as the denominator for calculating rejection rates, whereas for rejection-reason-specific analyses, the number of specimen types relevant to each rejection category was used as the denominator. Negative-binomial regression with denominator-based offsets estimated adjusted rejection-rate ratios (RRs) with 95% confidence intervals (CIs), with Bonferroni adjustment for selected pairwise comparisons. No missing or unclassifiable values were identified; no imputation was required. Reporting follows STROBE and the RECORD extension for studies using routinely collected health data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The overall rejection rate increased progressively from 0.23% in the pre-pandemic period to 0.49% during the pandemic and 0.65% in the normalization period, and monthly observed rates supported this progressive increase. In adjusted terms, the rejection rate was 2.20-fold higher during the pandemic than in the pre-pandemic period (95% CI: 1.96-2.46) and increased a further 1.42-fold in the normalization period compared with the pandemic period (95% CI: ","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193089","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":"Intra- and Inter-Operator Reliability of Internal Jugular Vein Ultrasound Image Acquisition by Ultrasound-Naive Nurses.","authors":"Yukie Tamura, Kazumi Ishii, Miharu Matsumoto, Hiromitsu Kobayashi","doi":"10.3390/healthcare14193272","DOIUrl":"10.3390/healthcare14193272","url":null,"abstract":"<p><p><b>Background:</b> Venous congestion assessment is essential in heart failure management. Inferior vena cava (IVC) ultrasonography has been widely used to determine fluid status but may not always provide satisfactory images. Hence, internal jugular vein (IJV) ultrasonography has been proposed as an alternative; however, the reliability of IJV ultrasound image acquisition by nurses without previous clinical ultrasound experience remains unclear. This study evaluated the intra- and inter-operator reliability of IJV ultrasound image acquisition by nurses without previous clinical ultrasound experience. <b>Methods:</b> Two nurses without prior clinical ultrasound experience acquired right IJV ultrasound images after preparatory training. Short-axis cine loops were obtained during quiet breathing and the Valsalva maneuver in healthy adults. A single investigator measured the major and minor diameters from selected still frames. Intra- and inter-operator reliability were then assessed using intraclass correlation coefficients (ICCs), after which agreement was evaluated by Bland-Altman analysis. <b>Results:</b> Both nurses successfully acquired IJV images suitable for subsequent quantitative analysis from all participants. Intra-operator reliability ranged from good to excellent, with ICC (1, 1) values of 0.765-0.967. Meanwhile, inter-operator reliability ranged from moderate to excellent, with ICC (2, 1) values of 0.629-0.916. Bland-Altman analysis revealed fixed bias in three parameters but no proportional bias. Absolute bias was <1 mm for all measurements. <b>Conclusions:</b> Following preparatory training, nurses without prior clinical ultrasound experience were able to acquire IJV ultrasound images with moderate-to-excellent inter-operator and good-to-excellent intra-operator relative reliability.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192420","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":"Locked in, Left Behind: Clinical, Psychosocial, and Ethical Dimensions of Prison Health-A Narrative Review.","authors":"Adelina Ioana Coman, Marius Florentin Popa, Sorin Deacu, Lavinia Simona Neculai-Candea, Miruna Gherase-Cristian, Carmen Corina Radu","doi":"10.3390/healthcare14193262","DOIUrl":"10.3390/healthcare14193262","url":null,"abstract":"<p><p>The global prison population has expanded over recent decades, straining correctional systems and positioning detention facilities as critical, yet frequently overlooked, sites of health inequity. With an estimated 11.5 million people currently incarcerated worldwide, prisons have become pivotal settings for examining the convergence of clinical vulnerability, psychosocial adversity, and human rights concerns. The aim of this narrative review was to examine how clinical, psychosocial, and bioethical factors interact to shape the health of incarcerated populations and to address four questions: (i) what is the burden and distribution of disease in correctional settings; (ii) which psychosocial consequences of confinement are most consistently reported and through which mechanisms; (iii) what bioethical tensions arise in the delivery of prison healthcare; and (iv) how do these patterns manifest across global, European, and Romanian contexts? We conducted an integrative narrative review reported against the SANRA criteria, searching PubMed, ScienceDirect and Scopus databases, alongside institutional sources from the World Health Organization, the United Nations Office on Drugs and Crime, the Council of Europe, and national correctional authorities, and synthesizing the evidence thematically across the three domains. The evidence indicates that incarcerated populations experience increased rates of infectious disease, chronic illness, mental disorders, and substance use disorders, combined with overcrowding, resource-limited healthcare systems, and restricted access to preventive care. Psychosocial stressors are consistently associated with elevated risk of anxiety, depression, self-harm, and suicide. Ethical tensions persist between institutional security requirements and the obligation to protect the autonomy, dignity, and right to healthcare of people deprived of liberty, equivalent to that available in the community. The contribution of this review is to integrate three literatures that are usually examined separately, the epidemiological, the psychosocial, and the bioethical, into a single conceptual framework spanning three nested levels of analysis and to apply that framework to a Central and Eastern European system that is under-represented in the prison health literature. Because the majority of incarcerated individuals eventually return to their communities, improving prison health is not solely a correctional priority but a public health and social justice imperative; the policy implications set out here follow from the broader literature synthesized in this review rather than from outcomes demonstrated by the review itself.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193075","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":"Spiritual Well-Being, Treatment Adherence, and Self-Management in Hemodialysis Care: A Cross-Sectional Study.","authors":"Handan Özdemir, Sıddıka Ersoy","doi":"10.3390/healthcare14193266","DOIUrl":"10.3390/healthcare14193266","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Hemodialysis requires sustained patient participation in demanding treatment and self-management routines. Spiritual well-being may be a patient-centered psychosocial resource relevant to adherence and self-management, but its independent associations with these patient-reported outcomes remain uncertain. This study examined the associations of spiritual well-being with treatment adherence and self-management among adults undergoing hemodialysis. <b>Methods:</b> This single-center cross-sectional study included 72 adults receiving maintenance hemodialysis at a public hospital in Türkiye between March and May 2025. Spiritual well-being, treatment adherence, and self-management were assessed using the Spiritual Well-Being Scale, End-Stage Renal Disease Adherence Questionnaire, and Chronic Disease Self-Management Scale, respectively. Pearson correlations and two multivariable linear regression models with HC3 robust standard errors were used. Models were adjusted for age, sex, dialysis duration, and number of comorbidities. Rank-based, influence-restricted, and nonlinear sensitivity analyses were performed. <b>Results:</b> Spiritual well-being was positively correlated with treatment adherence (r = 0.822, <i>p</i> < 0.001) and self-management (r = 0.891, <i>p</i> < 0.001). In adjusted linear models, higher spiritual well-being was associated with greater treatment adherence (B = 4.338, 95% CI 3.550-5.126; <i>p</i> < 0.001; adjusted R² = 0.655) and better self-management (B = 0.494, 95% CI 0.418-0.569; <i>p</i> < 0.001; adjusted R² = 0.787). Sensitivity analyses confirmed the direction and statistical significance of both associations, while nonlinear models suggested attenuation at higher spiritual well-being scores. <b>Conclusions:</b> Spiritual well-being was associated with two patient-reported outcomes relevant to long-term hemodialysis care after adjustment for the measured demographic and clinical covariates. Person-centered nephrology assessment may consider spiritual well-being alongside health literacy, psychological distress, social support, and practical treatment barriers. Longitudinal multicenter studies should determine the temporal direction and clinical implications of these relationships.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193156","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":"Self-Perceived Knowledge and Self-Reported Clinical Use of Minimally Invasive Endodontics Among General Dentists and Endodontists in Türkiye: A Cross-Sectional Survey.","authors":"Selin Bıçaklıoğlu, Melis Oya Ateş","doi":"10.3390/healthcare14193279","DOIUrl":"10.3390/healthcare14193279","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Minimally invasive endodontics (MIE) has gained increasing attention as an approach focused on preserving dental tissues while achieving the objectives of endodontic treatment. This study compared self-perceived knowledge, perceived adequacy of education, self-reported clinical use and practices, implementation difficulties, and barriers to routine use of MIE approaches among general dentists and endodontists in Türkiye. <b>Methods</b>: This online cross-sectional survey used non-probability voluntary sampling and included 300 participants (150 general dentists and 150 endodontists). Group comparisons used Pearson's chi-square test, Yates-corrected Pearson's chi-square test, or Fisher's exact test as appropriate. For multiple-response items, option-specific comparisons were adjusted using the Benjamini-Hochberg false discovery rate (FDR) procedure. Associated factors were evaluated using binary logistic regression, with professional group, professional experience, institutional setting, and weekly number of root canal treatments included simultaneously in multivariable models. <b>Results</b>: Endodontists reported higher self-perceived knowledge of MIE and more frequent self-reported use of MIE approaches than general dentists (both <i>p</i> < 0.001). In multivariable models, endodontist status was associated with higher odds of reported use of vital pulp therapies (odds ratio (OR) = 5.626) and minimally invasive root canal preparation (OR = 2.238), whereas the association with minimally invasive access cavity use was not statistically significant (OR = 1.668; <i>p</i> = 0.200). General dentist status was associated with higher odds of reporting difficulties during vital pulp therapies (OR = 10.420) and minimally invasive root canal preparation (OR = 2.379), whereas no significant association was detected for minimally invasive access cavity difficulties. The use of magnification systems and specialized endodontic burs for access cavity preparation or refinement was reported more frequently among endodontists. Reduced loss of tooth structure was the most frequently selected reason for using MIE, while inadequate training or lack of knowledge was the most frequently reported barrier to routine implementation. <b>Conclusions</b>: Among the participating dentists, endodontists reported higher self-perceived MIE knowledge and more frequent self-reported clinical use than general dentists. Professional and practice-related characteristics were associated with several MIE-related outcomes. Greater emphasis on practical, case-based training may support the appropriate implementation of MIE; however, the findings should be interpreted in light of the cross-sectional, self-reported design.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192819","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":"Equity Meets Primary-Care-Sensitive Performance: A Longitudinal Benchmark of Cost-Related Unmet Care and Avoidable Hospitalization in Europe.","authors":"Fatih Özcan, Tuna Can Güleç, Merve Vatansever Balcan, Elif Sıdal Gültekin, Sena Sönmez","doi":"10.3390/healthcare14193294","DOIUrl":"10.3390/healthcare14193294","url":null,"abstract":"<p><strong>Background/objectives: </strong>This study compares European health systems by considering the cost-related unmet-care inequality between income groups and primary-care-sensitive avoidable hospitalizations.</p><p><strong>Methods: </strong>This was a longitudinal comparative benchmarking study. The main sample consists of 275 country-year observations from 20 European countries with at least ten years of data during 2009-2023. The first dimension is measured by the absolute difference between the lowest and highest income quintiles in the prevalence of unmet medical examination or treatment because it was too expensive. The second dimension uses age- and sex-standardized avoidable hospitalization rates for asthma, chronic obstructive pulmonary disease, congestive heart failure, and diabetes. The 20-country core sample was defined before within-year rank normalization. The indicators were converted into rank scores on a scale of 0-1 within each annual comparison set, with equal weighting for both dimensions. Temporal uncertainty in country rankings was examined using a three-year synchronized moving-block bootstrap with 10,000 iterations.</p><p><strong>Results: </strong>In the main comparison, the Netherlands, Slovenia, Spain, Sweden, and Finland ranked in the top five. The Netherlands and Slovenia remained in the top five in all valid bootstrap replications; the corresponding probabilities were 99.90% for Spain, 90.67% for Sweden, and 95.66% for Finland. Top-five membership nevertheless changed under some alternative weighting, disease-omission, scaling, and balanced-period specifications. In the spending-adjusted assessment, each country was compared based on a nonlinear spending-performance relationship established from other countries, without including its own observations in the estimation equation; Slovenia, the Netherlands, and Spain took the top three positions.</p><p><strong>Conclusions: </strong>The findings should be interpreted not as a definitive country ranking, but as a relative assessment of health systems that highlights the differences between health inequality, primary care-sensitive outcomes, and resource intensity.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192989","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}