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Healthcare, Volume 5, Issue 4 (December 2017)

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Cover Story The impact of diet on academic achievement is a growing area of research, and while reviews in [...] Read more.
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Open AccessArticle Satisfaction with Daily Occupations for Elderly People (SDO-E)—Adaptation and Psychometric Testing
Healthcare 2017, 5(4), 61; doi:10.3390/healthcare5040061
Received: 25 August 2017 / Revised: 12 September 2017 / Accepted: 22 September 2017 / Published: 25 September 2017
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Abstract
Satisfaction with everyday occupations has been shown to be important for health and well-being in various populations. Research into satisfaction with everyday occupations among elderly persons is, however, lacking. The aim was to investigate the psychometric properties of an adapted test version of
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Satisfaction with everyday occupations has been shown to be important for health and well-being in various populations. Research into satisfaction with everyday occupations among elderly persons is, however, lacking. The aim was to investigate the psychometric properties of an adapted test version of the Satisfaction with Daily Occupations instrument (SDO) for elderly people, called SDO-E. Five hospital-based occupational therapists working with elderly people evaluated the content validity and usability of the SDO-E. The elderly participants consisted of 50 people from outside of the health services and 42 inpatients at an internal medicine clinic. They completed the SDO-E and rated their perceived health, activity level, and general satisfaction with daily occupations. The SDO-E showed fair content validity and utility, acceptable internal consistency, good preliminary construct validity and relevant known-groups validity. The SDO-E thus appears to be a useful screening tool for assessing activity level and satisfaction with daily occupations among elderly people, and a complement to other self-report instruments concerning factors connected with health and well-being. Future research should further explore the content validity of the SDO-E, particularly the views of the elderly themselves, and investigate the SDO-E in terms of sensitivity to change. Full article
(This article belongs to the Special Issue Ageing with Chronic Disease and Disability)
Open AccessArticle Economic Activity and Health Conditions in Adults Aged 65 Years and Older: Findings of the Korean National Longitudinal Study on Aging
Healthcare 2017, 5(4), 63; doi:10.3390/healthcare5040063
Received: 11 August 2017 / Revised: 14 September 2017 / Accepted: 22 September 2017 / Published: 26 September 2017
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Abstract
The population is aging because lifespans have continued to increase due to developments in modern medical science. The economic activity and health of the elderly are very important factors with reference to the problems of the aged. This cross-sectional study examined the association
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The population is aging because lifespans have continued to increase due to developments in modern medical science. The economic activity and health of the elderly are very important factors with reference to the problems of the aged. This cross-sectional study examined the association between the economic activity and health of the elderly. Subjects included 4226 elderly aged over 65 years among the adults who participated in the Fifth Korean National Longitudinal Study on Aging (KLoSA). Basic analysis, cross-analysis, binary logistic regression analysis, and multiple regression analysis were performed to fulfill each research purpose. Male subjects were influenced more by the factors that affect the subjective health of the elderly than females were. Further, subjective health influenced economic activity more than socio-demographic characteristics and health behavior did. Specifically, among the male subjects, the health condition of salaried, self-employed, and unpaid family workers was better as compared to recipients of national health insurance and private health insurance, and unemployed subjects. Preparing for a super-aged society is a worldwide issue. The elderly represent a social participation class that should not be neglected. Therefore, it is necessary to support health promotion policies and increase institutional improvement by reflecting the level of economic activity of the elderly. Full article
Open AccessCommunication Effects of Prenatal Tobacco and Wood-Fuel Smoke Exposure on Birth Weight in Sri Lanka
Healthcare 2017, 5(4), 64; doi:10.3390/healthcare5040064
Received: 9 August 2017 / Revised: 17 September 2017 / Accepted: 23 September 2017 / Published: 26 September 2017
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Abstract
Low birth weight is a key public health problem in many developing countries, including Sri Lanka. Indoor air pollution from tobacco smoke and kitchen-fuel smoke are among the major contributors to low birth weight, factors of which there are little awareness of in
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Low birth weight is a key public health problem in many developing countries, including Sri Lanka. Indoor air pollution from tobacco smoke and kitchen-fuel smoke are among the major contributors to low birth weight, factors of which there are little awareness of in Sri Lanka. We evaluated the effect of passive smoking and kitchen-fuel smoke exposure on birth weight. Seventy-six pregnant women were included in the study. Data were collected by questionnaire, and exposure assessment was conducted using a breath carbon monoxide monitor. Women exposed to second-hand tobacco smoke daily had a significantly lower mean gestational age at delivery (mean ± standard error [SE]: 38.0 ± 0.5 weeks) than women who were exposed to second-hand tobacco smoke only once a week (mean ± SE: 39.3 ± 0.3 weeks) (p < 0.05). Women who were exposed to tobacco smoke every day delivered neonates with significantly lower mean birth weight (mean ± SE: 2703 ± 135 g) than women who were only exposed once a week (mean ± SE: 3125 ± 147 g) (p < 0.05). A one-minute increase in cooking time in a kitchen without a chimney increased women’s expired air carbon monoxide concentration by 0.038 ppm (p = 0.006). Long-term exposure to wood-fuel smoke in a kitchen without a chimney can increase the risk of inhaling high concentrations of carbon monoxide. Full article
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Open AccessArticle The Effect of Personal Characteristics, Perceived Threat, Efficacy and Breast Cancer Anxiety on Breast Cancer Screening Activation
Healthcare 2017, 5(4), 65; doi:10.3390/healthcare5040065
Received: 2 August 2017 / Revised: 23 September 2017 / Accepted: 23 September 2017 / Published: 27 September 2017
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Abstract
In order to activate women to participate in breast cancer screening programs, a good understanding is needed of the personal characteristics that influence how women can be activated to search for more information, consult friends and doctors, and participate in breast cancer screening
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In order to activate women to participate in breast cancer screening programs, a good understanding is needed of the personal characteristics that influence how women can be activated to search for more information, consult friends and doctors, and participate in breast cancer screening programs. In the current study, we investigate the effect of six personal characteristics that have in previous research been identified as important triggers of health behavior on breast cancer screening activation: Health awareness, Need for Cognition, Affect Intensity, Breast cancer knowledge, Topic involvement, and the Perceived breast cancer risk. We test the effect of these factors on four activation variables: intention of future information seeking, forwarding the message to a friend, talking to a doctor, and actual breast cancer screening attendance. Additionally, we try to unravel the process by means of which the antecedents (the six personal characteristics) lead to activation. To that end, we test the mediating role of perceived breast cancer threat, perceived efficacy of screening, and the evoked breast cancer anxiety as mediators in this process. The data were collected by means of a cross-sectional survey in a sample of 700 Flemish (Belgium) women who were invited to the free-of-charge breast cancer population screening. Screening attendance of this sample was provided by the government agency in charge of the organisation of the screening. Health awareness, affects intensity, topic involvement, and perceived risk have the strongest influence on activation. Breast cancer anxiety and perceived breast cancer threat have a substantial mediation effect on these effects. Efficacy perceptions are less important in the activation process. Increased health awareness and a higher level of perceived risk lead to less participation in the free of charge population based breast screening program. Implications for theory and practice are offered. The limitation of the study is that only a standard invitation message was used. In future research, other types of awareness and activation messages should be tested. Additionally, the analysis could be refined by investigating the potentially different activation process in different subgroups of women. Full article
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Open AccessArticle Falls and Fear of Falling among Persons Who Receive Housing Adaptations—Results from a Quasi-Experimental Study in Sweden
Healthcare 2017, 5(4), 66; doi:10.3390/healthcare5040066
Received: 30 August 2017 / Revised: 15 September 2017 / Accepted: 22 September 2017 / Published: 29 September 2017
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Abstract
While health might deteriorate through the ageing and disablement process, the impacts of disability can be reduced by adapting the environment. This study aimed to investigate the effects of applying a standardized research-based strategy to housing adaptation as compared to ordinary practice with
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While health might deteriorate through the ageing and disablement process, the impacts of disability can be reduced by adapting the environment. This study aimed to investigate the effects of applying a standardized research-based strategy to housing adaptation as compared to ordinary practice with respect to falls and fear of falling. Another aim was to investigate the overall effects of housing adaptations on fall-related outcomes over time. In total, 196 clients were included at baseline, with follow-up at 3 and 6 months after the housing adaptation was implemented. The only significant difference between the two approaches was identified with respect to fear of falling at 3 months after the housing adaptation, but not after 6 months. The number of clients reporting actual falls increased over time in both sites, whereas the number of reported near-falls decreased most in the intervention site, but without significant differences. Thus, the patterns of differences between the sites are inconsistent, as are the patterns of change in fall-related outcomes. An overall conclusion is that if the goal is to improve fall-related outcomes, housing adaptation should be complemented with other interventions preventing falls and explicitly address the clients’ activity limitations. In addition, longer follow-up times are necessary. Full article
(This article belongs to the Special Issue Ageing with Chronic Disease and Disability)
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Open AccessArticle Three Types of Intimate Relationships among Individuals with Chronic Pain and a History of Trauma Exposure
Healthcare 2017, 5(4), 68; doi:10.3390/healthcare5040068
Received: 15 August 2017 / Revised: 6 September 2017 / Accepted: 22 September 2017 / Published: 29 September 2017
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Abstract
Individuals with chronic pain often have psychiatric disorders, such as depression and posttraumatic stress disorder (PTSD), which can affect their intimate relationship satisfaction and stability. Little is known about the nature of support stemming from chronic pain patients’ intimate relationships, and therefore, this
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Individuals with chronic pain often have psychiatric disorders, such as depression and posttraumatic stress disorder (PTSD), which can affect their intimate relationship satisfaction and stability. Little is known about the nature of support stemming from chronic pain patients’ intimate relationships, and therefore, this study sought to: (1) use cluster modeling to construct specific intimate relationship groups based on types of support patients receive, and (2) determine if there is a relationship between support type and PTSD, chronic pain, anxiety, and depression. Ward’s method of cluster analysis in Stata was used to create groups based on the level of informational, affirmation, confident, emotional, and fun support received from chronic pain patients’ most intimate relationship. Three types of support were identified: high (type 1, n = 17), high emotional/low instrumental (type 2, n = 9), and unstable (type 3, n = 15). Types 1 and 3 included more family members (Type 1: 100%, Type 2: 93%), than type 2 (77%). Type 2 patients experienced more trauma (Mean = 9.4 ± 1.7 vs. 7.5 ± 0.88 for types 1 and 3) and were significantly more likely to have PTSD (X2 = 7.91, p < 0.05. Patients with low familial support may also benefit from PTSD screening and referral but further study is needed. Full article
Open AccessArticle Social Determinants and Poor Diet Quality of Energy-Dense Diets of Australian Young Adults
Healthcare 2017, 5(4), 70; doi:10.3390/healthcare5040070
Received: 31 August 2017 / Revised: 26 September 2017 / Accepted: 27 September 2017 / Published: 1 October 2017
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Abstract
This research aimed to determine the diet quality and socio-demographic determinants by level of energy-density of diets of Australian young adults. Secondary analysis of the Australian National Nutrition and Physical Activity Survey-2011/2012 for adults aged 18–34 years (n = 2397) was conducted.
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This research aimed to determine the diet quality and socio-demographic determinants by level of energy-density of diets of Australian young adults. Secondary analysis of the Australian National Nutrition and Physical Activity Survey-2011/2012 for adults aged 18–34 years (n = 2397) was conducted. Diet was assessed by 24-h recalls. Dietary energy-density was calculated as dietary energy/grams of food (kJ/g) and the Healthy-Eating-Index-for-Australians (HEIFA-2013) was used to assess diet quality (highest score = 100). Dietary energy-density was examined with respect to diet quality and sociodemographic determinants including gender, highest tertiary-education attainment, country-of-birth, age, income, and socio-economic-index-for-area (SEIFA). Higher dietary energy-density was associated with lower diet quality scores (β = −3.71, t (2394) = −29.29, p < 0.0001) and included fewer fruits and vegetables, and more discretionary foods. The mean dietary energy-density was 7.7 kJ/g and 7.2 kJ/g for men and women, respectively. Subpopulations most at risk of consuming high energy-dense diets included those with lower education, Australian and English-speaking countries of birth, and men with low income and women from areas of lower socio-economic status. Young adults reporting low energy-dense diets had higher quality diets. Intensive efforts are needed to reduce the high energy-density of young adults’ diets, and should ensure they include populations of lower socio-economic status. Full article
(This article belongs to the Special Issue Population Health Management)
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Open AccessArticle Near Retirement Age (≥55 Years) Self-Reported Physical Symptoms and Use of Computers/Mobile Phones at Work and at Leisure
Healthcare 2017, 5(4), 71; doi:10.3390/healthcare5040071
Received: 25 July 2017 / Revised: 16 September 2017 / Accepted: 27 September 2017 / Published: 8 October 2017
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Abstract
The aim of this research is to study the symptoms and use of computers/mobile phones of individuals nearing retirement age (≥55 years). A questionnaire was sent to 15,000 Finns (aged 18–65). People who were ≥55 years of age were compared to the rest
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The aim of this research is to study the symptoms and use of computers/mobile phones of individuals nearing retirement age (≥55 years). A questionnaire was sent to 15,000 Finns (aged 18–65). People who were ≥55 years of age were compared to the rest of the population. Six thousand one hundred and twenty-one persons responded to the questionnaire; 1226 of them were ≥55 years of age. Twenty-four percent of the ≥55-year-old respondents used desktop computers daily for leisure; 47.8% of them frequently experienced symptoms in the neck, and 38.5% in the shoulders. Workers aged ≥55 years had many more physical symptoms than younger people, except with respect to symptoms of the neck. Female daily occupational users of desktop computers had more physical symptoms in the neck. It is essential to take into account that, for people aged ≥55 years, the use of technology can be a sign of wellness. However, physical symptoms in the neck can be associated with the use of computers. Full article
Open AccessArticle Reference Intervals for Non-Fasting CVD Lipids and Inflammation Markers in Pregnant Indigenous Australian Women
Healthcare 2017, 5(4), 72; doi:10.3390/healthcare5040072
Received: 4 September 2017 / Revised: 6 October 2017 / Accepted: 8 October 2017 / Published: 14 October 2017
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Abstract
Indigenous Australians experience high rates of cardiovascular disease (CVD). The origins of CVD may commence during pregnancy, yet few serum reference values for CVD biomarkers exist specific to the pregnancy period. The Gomeroi gaaynggal research project is a program that undertakes research and
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Indigenous Australians experience high rates of cardiovascular disease (CVD). The origins of CVD may commence during pregnancy, yet few serum reference values for CVD biomarkers exist specific to the pregnancy period. The Gomeroi gaaynggal research project is a program that undertakes research and provides some health services to pregnant Indigenous women. Three hundred and ninety-nine non-fasting samples provided by the study participants (206 pregnancies and 175 women) have been used to construct reference intervals for CVD biomarkers during this critical time. A pragmatic design was used, in that women were not excluded for the presence of chronic or acute health states. Percentile bands for non-linear relationships were constructed according to the methods of Wright and Royston (2008), using the xriml package in StataIC 13.1. Serum cholesterol, triglycerides, cystatin-C and alkaline phosphatase increased as gestational age progressed, with little change seen in high-sensitivity C-Reactive Protein and γ glutamyl transferase. Values provided in the reference intervals are consistent with findings from other research projects. These reference intervals will form a basis with which future CVD biomarkers for pregnant Indigenous Australian women can be compared. Full article
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Open AccessArticle Biopsychosocial Measures Related to Chronic Low Back Pain Postural Control in Older Adults
Healthcare 2017, 5(4), 74; doi:10.3390/healthcare5040074
Received: 1 September 2017 / Revised: 27 September 2017 / Accepted: 9 October 2017 / Published: 14 October 2017
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Abstract
This study examined the biopsychosocial measures related to postural control in the growing population of older adults (i.e., 60 years and older). The sample of the study consisted of 129 older adults (M = 74.45, SD = 6.95), with 34 males and 95
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This study examined the biopsychosocial measures related to postural control in the growing population of older adults (i.e., 60 years and older). The sample of the study consisted of 129 older adults (M = 74.45, SD = 6.95), with 34 males and 95 females; 36 were classified with chronic low-back pain (CLBP), and 93 without chronic low-back pain (NCLBP). Physical and psychosocial constructs were analyzed as predictors for postural control measures. Additionally, gender and classification of low-back pain were examined as moderators for all physical and psychosocial measures. Results demonstrated that physical and psychosocial measures were able to significantly predict composite, visual, and vestibular balance measures, but not somatosensory or preference balance measures. The chair-stand test, modified sit-and-reach test, sleep disturbance, and balance efficacy were all identified as individually significant predictors. Gender and CLBP did not moderate the utility of any predictor variables. Results of the current study re-confirm the importance of utilizing the biopsychosocial approach for future research examining postural control in older adults. Full article
Open AccessArticle Variability in Strength, Pain, and Disability Changes in Response to an Isolated Lumbar Extension Resistance Training Intervention in Participants with Chronic Low Back Pain
Healthcare 2017, 5(4), 75; doi:10.3390/healthcare5040075
Received: 3 August 2017 / Revised: 4 September 2017 / Accepted: 26 September 2017 / Published: 16 October 2017
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Abstract
Strengthening the lumbar extensor musculature is a common recommendation for chronic low back pain (CLBP). Although reported as effective, variability in response in CLBP populations is not well investigated. This study investigated variability in responsiveness to isolated lumbar extension (ILEX) resistance training in
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Strengthening the lumbar extensor musculature is a common recommendation for chronic low back pain (CLBP). Although reported as effective, variability in response in CLBP populations is not well investigated. This study investigated variability in responsiveness to isolated lumbar extension (ILEX) resistance training in CLBP participants by retrospective analysis of three previous randomized controlled trials. Data from 77 participants were available for the intervention arms (males = 43, females = 34) 37 participants data (males = 20, females = 17) from the control arms. Intervention participants had all undergone 12 weeks of ILEX resistance training and changes in ILEX strength, pain (visual analogue scale; VAS), and disability (Oswestry disability index; ODI) measured. True inter-individual (i.e., between participants) variability in response was examined through calculation of difference in the standard deviation of change scores for both control and intervention arms. Intervention participants were classified into responder status using k-means cluster analysis for ILEX strength changes and using minimal clinically important change cut-offs for VAS and ODI. Change in average ILEX strength ranged 7.6 Nm (1.9%) to 192.1 Nm (335.7%). Change in peak ILEX strength ranged −12.2 Nm (−17.5%) to 276.6 Nm (169.6%). Participants were classified for strength changes as low (n = 31), medium (n = 36), and high responders (n = 10). Change in VAS ranged 12.0 mm to −84.0 mm. Participants were classified for VAS changes as negative (n = 3), non-responders (n = 34), responders (n = 15), and high responders (n = 19). Change in ODI ranged 18 pts to −45 pts. Participants were classified for ODI changes as negative (n = 2), non-responders (n = 21), responders (n = 29), and high responders (n = 25). Considerable variation exists in response to ILEX resistance training in CLBP. Clinicians should be aware of this and future work should identify factors prognostic of successful outcomes. Full article
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Open AccessArticle Exploring Knowledge and Attitudes about Vitamin D among Adults in Saudi Arabia: A Qualitative Study
Healthcare 2017, 5(4), 76; doi:10.3390/healthcare5040076
Received: 3 August 2017 / Revised: 12 October 2017 / Accepted: 13 October 2017 / Published: 16 October 2017
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Abstract
Abstract: Vitamin D deficiency is widespread in Saudi Arabia. The aim of this study was to explore participants’ knowledge about vitamin D and attitudes toward sun exposure. The study also aimed to explore the social and cultural factors that might potentially contribute
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Abstract: Vitamin D deficiency is widespread in Saudi Arabia. The aim of this study was to explore participants’ knowledge about vitamin D and attitudes toward sun exposure. The study also aimed to explore the social and cultural factors that might potentially contribute to vitamin D deficiency in Saudi Arabia. Face-to-face interviews were carried out in the cities of Jeddah and Makkah between May and October 2015. The interview questions were semi-structured, and the data was analyzed using thematic analysis. Study participants showed a reasonable level of knowledge in different areas about vitamin D, including the effect of vitamin D deficiency on bone health and exposure to sunlight as the main source of vitamin D. Participants were also knowledgeable about vitamin D supplements as another source of this vitamin. Nevertheless, there was a shortage of knowledge in relation to dietary sources of vitamin D. In respect to attitudes toward sun exposure, some participants had positive attitudes toward sunlight and were willing to expose themselves to sunlight, but it was restricted to the early morning or late afternoon to avoid the heat. These participants who liked exposure to sunlight were largely exposing only their faces and hands to sunlight. Other participants had negative attitudes toward sun exposure and were avoiding sunlight. Moreover, the study participants identified several barriers to sun exposure, including hot climate, living in high-rise buildings, limited public areas allowing outdoor activities, lifestyle issues such as physical inactivity, and some religious concerns such as wearing the hijab. The study results also demonstrate that females were more enthusiastic about taking actions to improve their vitamin D status in comparison with males. Recommendations for health education interventions that increase awareness about vitamin D sources, especially food sources, are made. Also, educational interventions should focus on increasing awareness about the sufficient time of the day and duration for sun exposure to improve vitamin D status and the importance of the intake of vitamin D supplements as an affordable source to improve vitamin D status. Increasing males’ awareness of the benefits of vitamin D is important to encourage them to adopt behaviors to improve vitamin D. Full article
Open AccessArticle Perceptions of Risk Stratification Workflows in Primary Care
Healthcare 2017, 5(4), 78; doi:10.3390/healthcare5040078
Received: 6 September 2017 / Revised: 17 October 2017 / Accepted: 18 October 2017 / Published: 21 October 2017
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Abstract
Risk stratification (RS) in primary care is frequently used by policy-makers, payers, and health systems; the process requires risk assessment for adverse health outcomes across a population to assign patients into risk tiers and allow care management (CM) resources to be targeted effectively.
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Risk stratification (RS) in primary care is frequently used by policy-makers, payers, and health systems; the process requires risk assessment for adverse health outcomes across a population to assign patients into risk tiers and allow care management (CM) resources to be targeted effectively. Our objective was to understand the approach to and perception of RS in primary care practices. An online survey was developed, tested, and administered to 148 representatives of 37 primary care practices engaged in RS varying in size, location and ownership. The survey assessed practices’ approach to, perception of, and confidence in RS, and its effect on subsequent CM activities. We examined psychometric properties of the survey to determine validity and conducted chi-square analyses to determine the association between practice characteristics and confidence and agreement with risk scores. The survey yielded a 68% response rate (100 respondents). Overall, participants felt moderately confident in their risk scores (range 41–53.8%), and moderately to highly confident in their subsequent CM workflows (range 46–68%). Respondents from small and independent practices were more likely to have higher confidence and agreement with their RS approaches and scores (p < 0.01). Confidence levels were highest, however, when practices incorporated human review into their RS processes (p < 0.05). This trend was not affected by respondents’ professional roles. Additional work from a broad mixed-methods effort will add to our understanding of RS implementation processes and outcomes. Full article
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Open AccessArticle Is Obesity More Than a Double Burden among People with Mobility Disability? The Effect of Obesity on HRQoL and Participation in Society
Healthcare 2017, 5(4), 79; doi:10.3390/healthcare5040079
Received: 25 September 2017 / Revised: 16 October 2017 / Accepted: 19 October 2017 / Published: 24 October 2017
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Abstract
Obesity is more common in individuals with mobility disability than in those without this condition. Individuals with mobility disability also have lower health-related quality of life (HRQoL) and are limited in their participation in society. Therefore, this study aimed to investigate the body
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Obesity is more common in individuals with mobility disability than in those without this condition. Individuals with mobility disability also have lower health-related quality of life (HRQoL) and are limited in their participation in society. Therefore, this study aimed to investigate the body mass index (BMI) status and the association of overweight or obesity on HRQoL and participation in society among those with mobility disability in comparison to those without mobility disability. This cross-sectional study was based on a health survey conducted in Sweden in 2012 (n = 18,322; age, 18–64 years). Logistic regression with and without interaction analysis was applied. Effect modification by overweight status was significant for, moderate pain. For obesity, effect modification was seen for low general health, pain (moderate and severe), and not participating in work. BMI was higher among those with mobility disability, but no associations between overweight or obesity and HRQoL or participation in society were observed for those with mobility disability. Overweight and obesity did not add an additional burden to mobility disability, probably because mobility disability is associated with low HRQoL and low participation in society. Despite these results, population obesity prevention strategies are still needed. Full article
(This article belongs to the Special Issue Burden of Obesity on Health, Wellbeing and Healthcare)
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Open AccessArticle Strengthening the Referral System through Social Capital: A Qualitative Inquiry in Ghana
Healthcare 2017, 5(4), 80; doi:10.3390/healthcare5040080
Received: 12 June 2017 / Revised: 25 September 2017 / Accepted: 26 September 2017 / Published: 25 October 2017
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Abstract
The referral system in health care has been noted as very influential in determining which services are accessed and when. Nonetheless, existing studies have relied on specific measurable factors relating to health personnel, transportation and communication infrastructure, and finance to explain the challenges
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The referral system in health care has been noted as very influential in determining which services are accessed and when. Nonetheless, existing studies have relied on specific measurable factors relating to health personnel, transportation and communication infrastructure, and finance to explain the challenges facing the referral policy in developing countries. While this is understandable, the role of social capital remains mostly uncharted even though it is implicit in the well-known lay referral system. Using various facets of the social capital concept, this paper empirically examines how the resources embedded in both structural and cognitive aspects of social relationships influence knowledge of, and adherence to, referral policy. This study is based on semi-structured in-depth interviews conducted with 79 adults in the Ashanti Region of Ghana in 2015. Of the 79 participants, 28 lived in urban areas and 51 in rural localities. Eight health personnel and eight community leaders also contributed to the study. Additionally, six focus group discussions were held. The findings indicated that both cognitive and structural forms of social capital considerably underpinned the ability and willingness of people to adhere to the referral process. Moreover, the role of social capital was double-barrelled. It contributed in a significant way to encouraging or dissuading potential patients from rightly embracing the policy. In addition, precepts of social capital reinforced both positive and adverse effects of the other determinants of the policy such as finance and transportation. However, the magnitude of such impact was linked to how ‘resourceful’ and ‘trustworthy’ one’s available social acquaintances were. The paper suggests that a cautious engagement with social capital will make it a potentially powerful tool for understanding the gaps in and improving the effectiveness of referral policy. Full article
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Open AccessArticle Socioeconomic Status and Glycemic Control in Type 2 Diabetes; Race by Gender Differences
Healthcare 2017, 5(4), 83; doi:10.3390/healthcare5040083
Received: 11 August 2017 / Revised: 4 October 2017 / Accepted: 6 October 2017 / Published: 1 November 2017
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Abstract
Background: This study aimed to investigate differences in the association between socioeconomic status (SES) and glycemic control in type 2 diabetes mellitus (DM) across race by gender groups. Methods: Using a convenient sampling strategy, participants were 112 patients with type 2
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Background: This study aimed to investigate differences in the association between socioeconomic status (SES) and glycemic control in type 2 diabetes mellitus (DM) across race by gender groups. Methods: Using a convenient sampling strategy, participants were 112 patients with type 2 DM who were prescribed insulin (ns = 38 Black women, 34 Black men, 14 White women, and 26 White men, respectively). Linear regression was used to test the associations between sociodemographic variables (race, gender, SES, governmental insurance) and Hemoglobin A1c (HbA1c) in the pooled sample and within subgroups defined by race and gender. Results: In the pooled sample, neither SES nor governmental insurance were associated with HbA1c. However, the race by gender interaction approached statistical significance (B = 0.34, 95% CI = −0.24–3.00, p =0.094), suggesting higher HbA1c in Black women, compared to other race by gender groups. In stratified models, SES (B = −0.33, 95% CI = −0.10–0.00, p = 0.050), and governmental insurance (B = 0.35, 95% CI = 0.05–2.42, p = 0.042) were associated with HbA1c for Black men, but not for any of the other race by gender subgroups. Conclusion: Socioeconomic factors may relate to health outcomes differently across race by gender subgroups. In particular, SES may be uniquely important for glycemic control of Black men. Due to lack of generalizability of the findings, additional research is needed. Full article
Open AccessArticle The Role of Medication in Supporting Emotional Wellbeing in Young People with Long-Term Needs
Healthcare 2017, 5(4), 84; doi:10.3390/healthcare5040084
Received: 12 July 2017 / Revised: 20 October 2017 / Accepted: 29 October 2017 / Published: 3 November 2017
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Abstract
Young people frequently use and access prescribed medications for a range of health problems. Medications aimed at treating both common health problems and long-term physical and mental health needs in adolescence can have a significant effect on a young person’s emotional well-being. We
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Young people frequently use and access prescribed medications for a range of health problems. Medications aimed at treating both common health problems and long-term physical and mental health needs in adolescence can have a significant effect on a young person’s emotional well-being. We use a series of case studies to illustrate the challenges for healthcare professionals supporting young people with medication use. The studies illustrate the efficacy and limitations of medication on improving emotional well-being by alleviating illness and distress, and how this efficacy must be balanced against both the adverse effects and the burden of treatment. There are specific challenges for medication management during adolescence including issues of adherence/concordance, facilitating autonomy and participation in decision making, and promoting independence. Full article
Open AccessArticle Multimodal Counseling Interventions: Effect on Human Papilloma Virus Vaccination Acceptance
Healthcare 2017, 5(4), 86; doi:10.3390/healthcare5040086
Received: 10 October 2017 / Revised: 27 October 2017 / Accepted: 29 October 2017 / Published: 6 November 2017
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Abstract
Human papilloma virus (HPV) vaccine was developed to reduce HPV-attributable cancers, external genital warts (EGW), and recurrent respiratory papillomatosis. Adolescent HPV vaccination series completion rates are less than 40% in the United States of America, but up to 80% in Australia and the
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Human papilloma virus (HPV) vaccine was developed to reduce HPV-attributable cancers, external genital warts (EGW), and recurrent respiratory papillomatosis. Adolescent HPV vaccination series completion rates are less than 40% in the United States of America, but up to 80% in Australia and the United Kingdom. Population-based herd immunity requires 80% or greater vaccination series completion rates. Pro-vaccination counseling facilitates increased vaccination rates. Multimodal counseling interventions may increase HPV vaccination series non-completers’ HPV-attributable disease knowledge and HPV-attributable disease prophylaxis (vaccination) acceptance over a brief 14-sentence counseling intervention. An online, 4-group, randomized controlled trial, with 260 or more participants per group, found that parents were more likely to accept HPV vaccination offers for their children than were childless young adults for themselves (68.2% and 52.9%). A combined audiovisual and patient health education handout (PHEH) intervention raised knowledge of HPV vaccination purpose, p = 0.02, and HPV vaccination acceptance for seven items, p < 0.001 to p = 0.023. The audiovisual intervention increased HPV vaccination acceptance for five items, p < 0.001 to p = 0.006. That HPV causes EGW, and that HPV vaccination prevents HPV-attributable diseases were better conveyed by the combined audiovisual and PHEH than the control 14-sentence counseling intervention alone. Full article
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Open AccessArticle “To Work Just Like Anyone Else”—A Narrative from a Man Aging with Spinal Cord Injury
Healthcare 2017, 5(4), 87; doi:10.3390/healthcare5040087
Received: 16 October 2017 / Revised: 3 November 2017 / Accepted: 7 November 2017 / Published: 9 November 2017
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Abstract
People aging with spinal cord injury (SCI) develop medical problems commonly associated with the aging process at a younger age than the general population. However, research about how the life story changes and how meaning will be experienced in occupations is lacking. The
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People aging with spinal cord injury (SCI) develop medical problems commonly associated with the aging process at a younger age than the general population. However, research about how the life story changes and how meaning will be experienced in occupations is lacking. The aim was to describe and offer an explanation of how a man experienced meaning in everyday occupations while aging with an SCI. Four narrative interviews were performed over a four-year period, with a man in his fifties, who lived with SCI for 39 years. The narrative analysis generated an overall plot, named “To Work Just Like Anyone Else,” and gives a picture of his experiences, thoughts, and reflections about meaning in occupations, from when he became injured to the present, and in relation to his future. His life story is characterized by secondary health complications, and his experiences of negotiating with the aging body and making choices to continue working. Further, how occupational risk factors, e.g., imbalance, alienation, and deprivation, occur as a result of lack of rehabilitation and support from social systems is addressed. Future research should explore how rehabilitation and social systems can support people aging with SCI to experience meaning in everyday occupations and to have balance in everyday life. Full article
(This article belongs to the Special Issue Ageing with Chronic Disease and Disability)
Open AccessCommunication The Geography of the Alzheimer’s Disease Mortality in Spain: Should We Focus on Industrial Pollutants Prevention?
Healthcare 2017, 5(4), 89; doi:10.3390/healthcare5040089
Received: 31 October 2017 / Revised: 21 November 2017 / Accepted: 22 November 2017 / Published: 25 November 2017
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Abstract
Alzheimer’s disease (AD) has a high worldwide prevalence but little is known about its aetiology and risk factors. Recent research suggests environmental factors might increase AD risk. We aim to describe the association between AD mortality and the presence of highly polluting industry
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Alzheimer’s disease (AD) has a high worldwide prevalence but little is known about its aetiology and risk factors. Recent research suggests environmental factors might increase AD risk. We aim to describe the association between AD mortality and the presence of highly polluting industry in small areas in Spain between 1999 and 2010. We calculated AD age-adjusted Standardized Mortality Ratio (SMR), stratified by sex, grouped by industrial pollution density, compared for each small area of Spain. In the small areas with the highest mortality, the SMR among women was at least 25% greater than the national average (18% in men). The distribution of AD mortality was generally similar to that of high industrial pollution (higher mortality in the north, the Mediterranean coast and in some southern areas). The risk of AD mortality among women was 140% higher (123% among men) in areas with the highest industrial density in comparison to areas without polluting industries. This study has identified a geographical pattern of small areas with higher AD mortality risk and an ecological positive association with the density of highly polluting industry. Further research is needed on the potential impact of this type of industry pollution on AD aetiology and mortality. Full article
(This article belongs to the Special Issue Population Health Management)
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Review

Jump to: Research, Other

Open AccessReview Associations between Dietary Intake and Academic Achievement in College Students: A Systematic Review
Healthcare 2017, 5(4), 60; doi:10.3390/healthcare5040060
Received: 23 August 2017 / Revised: 14 September 2017 / Accepted: 22 September 2017 / Published: 25 September 2017
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Abstract
The impact of diet on academic achievement is a growing area of research. The aim of this systematic review was to evaluate the current evidence examining dietary intake and academic achievement in college/university students. Eight electronic databases were searched for studies published in
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The impact of diet on academic achievement is a growing area of research. The aim of this systematic review was to evaluate the current evidence examining dietary intake and academic achievement in college/university students. Eight electronic databases were searched for studies published in English to January 2016. To be included, studies must have been conducted in higher education (i.e., college, university) students, reported measures of dietary intake and academic achievement, and reported the association between these. Data were extracted using a standardised tool, and studies were assessed for methodological quality. Seven studies were included, with four rated as positive quality, and the remaining three rated as neutral. Most studies were cross-sectional (n = 4), and conducted in America (n = 5). The most common dietary outcomes were fruit and vegetable (n = 3), and breakfast consumption (n = 3). Standardised grade point average (GPA) was the most common measure of academic achievement (n = 4). Five studies reported small to moderate significant positive associations between diet and academic achievement, including for breakfast, regular meal consumption, and meeting national recommendations for fruit intake. This review examines the current evidence regarding diet and academic achievement in college/university students. The results demonstrate that few studies exist in this population group. Future studies should consider the use of validated dietary assessment methods, comprehensive measures of overall diet, and use standardised assessment and reporting of academic outcomes. Full article
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Open AccessReview Adolescent Neurological Development and Implications for Health and Well-Being
Healthcare 2017, 5(4), 62; doi:10.3390/healthcare5040062
Received: 25 July 2017 / Revised: 8 September 2017 / Accepted: 8 September 2017 / Published: 29 September 2017
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Abstract
Adolescence is evolution’s solution to bringing the capacity of our large, complex brains to fruition. It is a critical period for brain development and the experiences of each adolescent during this time helps to shape their adult brain. Brain developments lead to both
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Adolescence is evolution’s solution to bringing the capacity of our large, complex brains to fruition. It is a critical period for brain development and the experiences of each adolescent during this time helps to shape their adult brain. Brain developments lead to both the hormonal changes and the emotional, cognitive, and behavioral characteristics of the teenage years. They drive a growth towards independence via more complex reasoning skills, increased importance of social affiliations outside the family, and an urge to experiment and explore boundaries. In the context of still incomplete inhibitory systems, a heightened sensitivity to rewards, including the need for social acceptance, can mean risk-taking or impulsive behaviour in some. The continued plasticity of the brain can also mean a creativity and openness to novel solutions. These normative steps of adolescence are especially relevant to young people with chronic health conditions. An understanding of brain development at this time can help us appreciate the perspective and priorities of adolescents with health conditions. It can also guide us towards better ways of collaborating with them. Full article
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Open AccessReview Importance of Leadership Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review
Healthcare 2017, 5(4), 73; doi:10.3390/healthcare5040073
Received: 1 August 2017 / Revised: 15 September 2017 / Accepted: 25 September 2017 / Published: 14 October 2017
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Abstract
Effective leadership of healthcare professionals is critical for strengthening quality and integration of care. This study aimed to assess whether there exist an association between different leadership styles and healthcare quality measures. The search was performed in the Medline (National Library of Medicine,
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Effective leadership of healthcare professionals is critical for strengthening quality and integration of care. This study aimed to assess whether there exist an association between different leadership styles and healthcare quality measures. The search was performed in the Medline (National Library of Medicine, PubMed interface) and EMBASE databases for the time period 2004–2015. The research question that guided this review was posed as: “Is there any relationship between leadership style in healthcare settings and quality of care?” Eighteen articles were found relevant to our research question. Leadership styles were found to be strongly correlated with quality care and associated measures. Leadership was considered a core element for a well-coordinated and integrated provision of care, both from the patients and healthcare professionals. Full article
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Open AccessReview Helping Health Services to Meet the Needs of Young People with Chronic Conditions: Towards a Developmental Model for Transition
Healthcare 2017, 5(4), 77; doi:10.3390/healthcare5040077
Received: 31 July 2017 / Revised: 12 October 2017 / Accepted: 14 October 2017 / Published: 19 October 2017
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Abstract
The transition to adult healthcare has been the subject of increased research and policy attention over many years. However, unmet needs of adolescent and young adults (AYAs) and their families continue to be documented, and universal implementation has yet to be realised. Therefore,
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The transition to adult healthcare has been the subject of increased research and policy attention over many years. However, unmet needs of adolescent and young adults (AYAs) and their families continue to be documented, and universal implementation has yet to be realised. Therefore, it is pertinent to re-examine health transition in light of the principles of adolescent medicine from which it emerged, and consider this particular life transition in terms of a developmental milestone rather than a negotiation of structural boundaries between child and adult services. Health transitions are an integral part of AYA development and as such, occur alongside, and in connection with, a range of other important transitions that affect many other areas of life. In this paper, we discuss the interrelated nature of health transitions and AYA development; outline the underpinnings of a developmentally appropriate approach to transitional care; and consider the outcome measurement of such care based on existing evidence. A developmental approach has the potential to refocus transition on the fundamental principles of adolescent medicine, enabling health transition to be integrated along with other life transitions into routine AYA developmental assessments rather than being limited to the geographies of different healthcare settings and a potential health crisis. Full article
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Open AccessReview Senescent Nephropathy: The New Renal Syndrome
Healthcare 2017, 5(4), 81; doi:10.3390/healthcare5040081
Received: 30 August 2017 / Revised: 25 September 2017 / Accepted: 24 October 2017 / Published: 28 October 2017
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Abstract
Chronic kidney disease (CKD) is a condition characterized by progressive and irreversible deterioration of renal function due to the reduction of nephron mass for a period of at least three months. The prevalence of CKD is roughly 10% in the general population but
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Chronic kidney disease (CKD) is a condition characterized by progressive and irreversible deterioration of renal function due to the reduction of nephron mass for a period of at least three months. The prevalence of CKD is roughly 10% in the general population but increases with age, affecting more than one-third of people older than 65. Frailty is a condition usually found in elderly people, characterized by weakness, motility, and balance issues, with a declined ability to resist stressors leading to increased risks of adverse health outcomes including falls, fracture, hospitalization, institutionalization, disability, dependence, dementia, poor quality of life, and death. There is interdependence between CKD and normal ageing whereby CKD makes ageing more accelerated and pronounced (senescence), whereas senescence accelerates chronic nephropathy’s progression. Frailty status catalyzes this spiral, with renal and systemic consequences, phenomenon which can be named senescent nephropathy. In conclusion, senescent nephropathy is a new renal syndrome that should be taken into account, and we must try to handle its appearance and progression not only by applying nephron prevention measurements but also by diagnosis and treating frailty in the CKD population. Full article
(This article belongs to the Special Issue The Socio-Economic Impact of End Stage Kidney Disease)
Open AccessReview Updates on the Management of Non-Melanoma Skin Cancer (NMSC)
Healthcare 2017, 5(4), 82; doi:10.3390/healthcare5040082
Received: 8 September 2017 / Revised: 20 October 2017 / Accepted: 24 October 2017 / Published: 1 November 2017
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Abstract
Non-melanoma skin cancers (NMSCs) are the most common malignancy worldwide, of which 99% are basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) of skin. NMSCs are generally considered a curable diseases, yet they currently pose an increasing global healthcare problem due to
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Non-melanoma skin cancers (NMSCs) are the most common malignancy worldwide, of which 99% are basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) of skin. NMSCs are generally considered a curable diseases, yet they currently pose an increasing global healthcare problem due to rising incidence. This has led to a shift in emphasis on prevention of NMSCs with development of various skin cancer prevention programs worldwide. This article aims to summarize the most recent changes and advances made in NMSC management with a focus on prevention, screening, diagnosis, and staging. Full article
Open AccessReview Prescribing Physical Activity for the Prevention and Treatment of Osteoporosis in Older Adults
Healthcare 2017, 5(4), 85; doi:10.3390/healthcare5040085
Received: 22 September 2017 / Revised: 11 October 2017 / Accepted: 31 October 2017 / Published: 6 November 2017
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Abstract
Osteoporosis is an age-related disease, characterised by low bone mineral density (BMD) and compromised bone geometry and microarchitecture, leading to reduced bone strength. Physical activity (PA) has potential as a therapy for osteoporosis, yet different modalities of PA have varying influences on bone
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Osteoporosis is an age-related disease, characterised by low bone mineral density (BMD) and compromised bone geometry and microarchitecture, leading to reduced bone strength. Physical activity (PA) has potential as a therapy for osteoporosis, yet different modalities of PA have varying influences on bone health. This review explores current evidence for the benefits of PA, and targeted exercise regimes for the prevention and treatment of osteoporosis in older adults. In particular, the outcomes of interventions involving resistance training, low- and high-impact weight bearing activities, and whole-body vibration therapy are discussed. Finally, we present recommendations for future research that may maximise the potential of exercise in primary and secondary prevention of osteoporosis in the ageing population. Full article
(This article belongs to the Special Issue Ageing with Chronic Disease and Disability)
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Open AccessReview The New Old (and Old New) Medical Model: Four Decades Navigating the Biomedical and Psychosocial Understandings of Health and Illness
Healthcare 2017, 5(4), 88; doi:10.3390/healthcare5040088
Received: 31 July 2017 / Revised: 10 November 2017 / Accepted: 14 November 2017 / Published: 18 November 2017
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Abstract
The importance of how disease and illness are conceptualised lies in the fact that such definition is paramount to understand the boundaries and scope of responsibility associated with medical work. In this paper, we aim to provide an overview of the interplay of
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The importance of how disease and illness are conceptualised lies in the fact that such definition is paramount to understand the boundaries and scope of responsibility associated with medical work. In this paper, we aim to provide an overview of the interplay of these understandings in shaping the nature of medical work, philosophically, and in practice. We first discuss the emergence of the biopsychosocial model as an attempt to both challenge and broaden the traditional biomedical model. Then, we outline the main criticisms associated with the biopsychosocial model and note a range of contributions addressing the shortcomings of the model as initially formulated. Despite recurrent criticisms and uneven uptake, the biopsychosocial model has gone on to influence core aspects of medical practice, education, and research across many areas of medicine. One of these areas is adolescent medicine, which provides a particularly good exemplar to examine the contemporary challenges associated with the practical application of the biopsychosocial model. We conclude that a more optimal use of existing bodies of evidence, bringing together evidence-based methodological advances of the biopsychosocial model and existing evidence on the psychosocial needs associated with specific conditions/populations, can help to bridge the gap between philosophy and practice. Full article
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Open AccessReview Home Hemodialysis (HHD) Treatment as an Effective yet Underutilized Treatment Modality in the United States
Healthcare 2017, 5(4), 90; doi:10.3390/healthcare5040090
Received: 13 October 2017 / Revised: 9 November 2017 / Accepted: 17 November 2017 / Published: 28 November 2017
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Abstract
End-stage renal disease (ESRD) is a major health burden and its incidence has been increasing yearly reaching 120,000 cases in 2014. Home hemodialysis (HHD) is a treatment modality option that has been shown to contribute to numerous clinical benefits but is largely underutilized
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End-stage renal disease (ESRD) is a major health burden and its incidence has been increasing yearly reaching 120,000 cases in 2014. Home hemodialysis (HHD) is a treatment modality option that has been shown to contribute to numerous clinical benefits but is largely underutilized due to many contributing factors. The purpose of this review paper is to analyze the advantages and disadvantages of HHD and the reasons for its low utilization with a special focus on its socioeconomic impact as compared to facility hemodialysis. Key factors contributing to HHD underutilization are related to the reimbursement system of the facility and nephrologists as well as the underutilization of the pre-dialysis educational benefit. Based on this comprehensive review of the literature, we propose several suggestions which may contribute to the expansion of HHD treatment modality. Full article
(This article belongs to the Special Issue The Socio-Economic Impact of End Stage Kidney Disease)
Open AccessReview Cross-National Differences in Psychosocial Factors of Perinatal Depression: A Systematic Review of India and Japan
Healthcare 2017, 5(4), 91; doi:10.3390/healthcare5040091
Received: 17 October 2017 / Revised: 30 November 2017 / Accepted: 30 November 2017 / Published: 4 December 2017
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Abstract
Perinatal depression is prevalent worldwide. However, there are few available studies that discuss the different cultural factors affecting perinatal depression within Asian countries. This study aims to compare the literature regarding related factors relating to perinatal depression in India and Japan, and to
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Perinatal depression is prevalent worldwide. However, there are few available studies that discuss the different cultural factors affecting perinatal depression within Asian countries. This study aims to compare the literature regarding related factors relating to perinatal depression in India and Japan, and to synthesize the evidence common to both countries in addition to the country-specific evidence. We conducted a systematic review using several databases (CINAHL, MEDLINE, Pubmed, Ovid, SCOPUS, IndMED, and ICHUSI). Keywords were “antenatal depression” or “postpartum depression”, and “India” or “Japan”. Both Japanese and English language papers were reviewed. The identified evidence was compared between the two countries, as well as with non-Asian countries based on previous reports. In total, 15 articles on India and 35 on Japan were reviewed. Although several factors were shared between the two countries as well as with other non-Asian countries (vulnerable personality, being abused, age, marital conflict, and lower socio-demographic status), some differing factors were identified between India and Japan and non-Asian countries; India: poor socioeconomic status, living only with the husband, pregnancy not welcomed by the husband, a female baby, and poor relationship with in-laws; Japan: infertility treatment, conflict with work–life balance, poor relationships with biological mother or in-laws, and concerns about social relations with the other mother’s friends. To conclude, involving the family and community may be important for implementing both global standardized and culture-specific interventions. In India, treatment involving the in-laws may be effective because large family structure is a significant predictor of perinatal depression. In Japan, a family/community approach involving not only the mother’s family of origin but also the working environment is essential. Full article
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Open AccessReview The Impact of Hemodialysis on Spatio-Temporal Characteristics of Gait and Role of Exercise: A Systematic Review
Healthcare 2017, 5(4), 92; doi:10.3390/healthcare5040092
Received: 13 November 2017 / Revised: 28 November 2017 / Accepted: 30 November 2017 / Published: 5 December 2017
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Abstract
Background: People with end-stage kidney disease (ESKD) on hemodialysis (HD) commonly have functional impairments. The purpose of this systematic review was to evaluate the effect of HD on spatio-temporal characteristics of gait, and effect of exercise on these parameters. Methods: Electronic databases were
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Background: People with end-stage kidney disease (ESKD) on hemodialysis (HD) commonly have functional impairments. The purpose of this systematic review was to evaluate the effect of HD on spatio-temporal characteristics of gait, and effect of exercise on these parameters. Methods: Electronic databases were searched to identify relevant citations. Extracted data was computed using a random effects model for means (Hedges’ and 95% confidence interval (CI). Results: 27 studies met inclusion criteria. Mean values: gait speed (GS)—1.0 m/s (CI: 0.9–1.1 m/s; 16 studies), fast walking speed (FWS)—1.5 m/s (CI: 1.3–1.6 m/s; 7 studies), timed get-up & go test (TUG) —6.8 s (CI: 6.1–7.5 s; 2 studies), walk tests (WT) 193.0 s (CI: 116.0–270.0; 5 studies), 6 min-walk-test (6MWT)—386.6 m (CI: 243.2–530.0 m; 11 studies). 4 studies compared participants on HD with normal controls and 10 studies evaluated the effect of nutrition/exercise. Conclusions: Compared to age-matched populations, people with ESKD/HD had significantly slower GS and reduced walk distances; with intervention, the change in the distance walked was significant. Further research is required to evaluate the effect of HD on gait parameters, and the type of exercise/nutrition that will lead to meaningful changes. Full article
(This article belongs to the Special Issue The Socio-Economic Impact of End Stage Kidney Disease)
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Open AccessFeature PaperReview Connecting the Mind–Body Split: Understanding the Relationship between Symptoms and Emotional Well-Being in Chronic Pain and Functional Gastrointestinal Disorders
Healthcare 2017, 5(4), 93; doi:10.3390/healthcare5040093
Received: 4 October 2017 / Revised: 28 November 2017 / Accepted: 30 November 2017 / Published: 5 December 2017
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Abstract
Paediatric chronic conditions, e.g., chronic pain and functional gastrointestinal disorders, are commonly diagnosed, with fatigue, pain and abdominal discomfort the most frequently reported symptoms across conditions. Regardless of whether symptoms are connected to an underlying medical diagnosis or not, they are often associated
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Paediatric chronic conditions, e.g., chronic pain and functional gastrointestinal disorders, are commonly diagnosed, with fatigue, pain and abdominal discomfort the most frequently reported symptoms across conditions. Regardless of whether symptoms are connected to an underlying medical diagnosis or not, they are often associated with an increased experience of psychological distress by both the ill child and their parents. While pain and embarrassing symptoms can induce increased distress, evidence is also accumulating in support of a reciprocal relationship between pain and distress. This reciprocal relationship is nicely illustrated in the fear avoidance model of pain, which has recently been found to be applicable to childhood pain experiences. The purpose of this article is to illustrate how mind (i.e., emotions) and body (i.e., physical symptoms) interact using chronic pain and gastrointestinal disorders as key examples. Despite the evidence for the connection between mind and body, the mind–body split is still a dominant position for families and health care systems, as evidenced by the artificial split between physical and mental health care. In a mission to overcome this gap, this article will conclude by providing tools on how the highlighted evidence can help to close this gap between mind and body. Full article
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Other

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Open AccessBrief Report Impact of Pre-Pregnancy Weight and Gestational Weight Gain on Birth Outcomes by Nativity in the United States: A Systematic Review
Healthcare 2017, 5(4), 67; doi:10.3390/healthcare5040067
Received: 11 August 2017 / Revised: 22 September 2017 / Accepted: 25 September 2017 / Published: 29 September 2017
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Abstract
Background: Disparities in birth outcomes remain a problem in the United States. This study examined whether pre-pregnancy weight and gestational weight gain moderate the association between nativity and birth outcomes in the United States. Methods: We conducted a systematic review using
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Background: Disparities in birth outcomes remain a problem in the United States. This study examined whether pre-pregnancy weight and gestational weight gain moderate the association between nativity and birth outcomes in the United States. Methods: We conducted a systematic review using Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. We searched PubMED, CINAHL, PsychInfo, and Cochrane Database of Systematic Reviews for relevant articles published before May 27, 2016. Results: Four articles met the eligibility criteria by adjusting for pre-pregnancy or gestational weight gain when examining birth outcomes by nativity. Results: Results from these studies show statistically significant differences in the risk of delivering low birth weight babies between foreign-born and U.S.-born women. These differences remained after adjusting for pre-pregnancy weight or gestational weight gain. However, results stratified by nativity still vary significantly by race/ethnicity. Conclusion: Few investigations include pre-pregnancy weight and gestational weight gain when examining differences in birth outcomes by nativity. Additional studies are needed to examine possible effect modification of these weight variables on the association between nativity and birth outcomes. Full article
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Open AccessViewpoint What Else? The Basics and Beyond for Effective Consultations with Youth with Special Healthcare Needs
Healthcare 2017, 5(4), 69; doi:10.3390/healthcare5040069
Received: 11 July 2017 / Revised: 25 September 2017 / Accepted: 25 September 2017 / Published: 1 October 2017
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Abstract
Youth with special healthcare needs (YSHCN) require medical support for disease management and equally require that providers be responsive to their ever-changing and sometimes unique psychosocial and developmental needs. This paper reviews the fundamentals of adolescent consultation reminding the reader that YSHCN are,
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Youth with special healthcare needs (YSHCN) require medical support for disease management and equally require that providers be responsive to their ever-changing and sometimes unique psychosocial and developmental needs. This paper reviews the fundamentals of adolescent consultation reminding the reader that YSHCN are, after all, still youth with the same basic needs as their healthy peers. Beyond the basics, consultations with this population are characterized by complexities which are best managed by providers who can nimbly adjust their clinical stance. In non-urgent clinical scenarios, clinicians can adopt a coaching stance which we introduce and expand upon in this paper. Characterized by the five elements of non-judgment, curiosity, empathy, openness, and flexibility, the coaching stance can be adopted without specific training. We demonstrate its application using TGROW (Topic, Goal, Reality, Options and Wrap Up), a coaching framework that holds promise for use in clinical settings. Consultants may consider incorporating the coaching stance and TGROW into their practice repertoire, as both may be particularly helpful when consulting with adolescents with chronic illness. Full article
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