Open AccessReview
A Systematic Review on Healthcare Analytics: Application and Theoretical Perspective of Data Mining
Healthcare 2018, 6(2), 54; https://doi.org/10.3390/healthcare6020054 (registering DOI) -
Abstract
The growing healthcare industry is generating a large volume of useful data on patient demographics, treatment plans, payment, and insurance coverage—attracting the attention of clinicians and scientists alike. In recent years, a number of peer-reviewed articles have addressed different dimensions of data mining
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The growing healthcare industry is generating a large volume of useful data on patient demographics, treatment plans, payment, and insurance coverage—attracting the attention of clinicians and scientists alike. In recent years, a number of peer-reviewed articles have addressed different dimensions of data mining application in healthcare. However, the lack of a comprehensive and systematic narrative motivated us to construct a literature review on this topic. In this paper, we present a review of the literature on healthcare analytics using data mining and big data. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a database search between 2005 and 2016. Critical elements of the selected studies—healthcare sub-areas, data mining techniques, types of analytics, data, and data sources—were extracted to provide a systematic view of development in this field and possible future directions. We found that the existing literature mostly examines analytics in clinical and administrative decision-making. Use of human-generated data is predominant considering the wide adoption of Electronic Medical Record in clinical care. However, analytics based on website and social media data has been increasing in recent years. Lack of prescriptive analytics in practice and integration of domain expert knowledge in the decision-making process emphasizes the necessity of future research. Full article
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Open AccessArticle
Chronicity and Mental Health Service Utilization for Anxiety, Mood, and Substance Use Disorders among Black Men in the United States; Ethnicity and Nativity Differences
Healthcare 2018, 6(2), 53; https://doi.org/10.3390/healthcare6020053 (registering DOI) -
Abstract
This study investigated ethnic and nativity differences in the chronicity and treatment of psychiatric disorders of African American and Caribbean Black men in the U.S. Data were analyzed from the National Survey of American Life, a population-based study which included 1859 self-identified Black
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This study investigated ethnic and nativity differences in the chronicity and treatment of psychiatric disorders of African American and Caribbean Black men in the U.S. Data were analyzed from the National Survey of American Life, a population-based study which included 1859 self-identified Black men (1222 African American, 176 Caribbean Black men born within the U.S., and 461 Caribbean Black men born outside the U.S.). Lifetime and twelve-month prevalence of DSM-IV mood, anxiety, and substance use disorders (including Bipolar I and Dysthmia), disorder chronicity, and rate of mental health services use among those meeting criteria for a lifetime psychiatric disorder were examined. Logistic regression models were employed to determine ethnic differences in chronicity, and treatment utilization for disorders. While rates of DSM-IV disorders were generally low in this community sample of Black men, their disorders were chronic and remained untreated. Caribbean Black men born in the U.S. had higher prevalence of Post-Traumatic Stress Disorder, Major Depressive Disorder, and Alcohol Abuse Disorder compared with African American men. Foreign born Caribbean Black men experienced greater chronicity in Social Phobia and Generalized Anxiety Disorder compared to other Black Men. Utilization of mental health service was low for all groups of Black Men, but lowest for the foreign born Caribbean Black men. Results underscore the large unmet needs of both African American and Caribbean Black men in the United States. Results also highlight the role of ethnicity and nativity in mental disorder chronicity and mental health service utilization patterns of Black men. Full article
Open AccessArticle
A Comparative Study of Oral Health Status between International and Japanese University Student Patients in Japan
Healthcare 2018, 6(2), 52; https://doi.org/10.3390/healthcare6020052 -
Abstract
Background: The number of international students enrolled in universities in Japan is increasing. To provide better oral care services for international students, we have to understand their oral environment and dental health behaviors. However, few studies have investigated the oral health status of
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Background: The number of international students enrolled in universities in Japan is increasing. To provide better oral care services for international students, we have to understand their oral environment and dental health behaviors. However, few studies have investigated the oral health status of international university students. The object of the present study was to clarify the current oral status of international university students. Methods: The subjects were students who visited the dental department at the University of Tokyo’s Health Services Center between April 2012 and March 2013. Our medical records were reviewed with regard to the following items: attributes (nationality, gender, and age); chief complaint (reason for visit); history of dental treatment; mean number of decayed (D), missing (M) or filled (F) teeth as a single (DMFT) index; degree of calculus deposition; gingival condition; and oral hygiene status. Results: The records of 554 university students (138 international and 416 non-international students) were analyzed; 88.4% of the 138 international students were from Asian countries (n = 122), of which 47.1% were from China and 10.9% from Korea, followed by North America (5.8%), Europe (4.3%), and Africa (1.5%). Although no significant differences were found regarding the history of dental treatment between international and non-international students (49.3% and 48.8%, respectively), international students had a significantly higher dental caries morbidity rate (60.1%) than non-international students (49.0%). The international students showed a significantly higher DMFT value compared with the non-international students: 5.0 and 4.0 per individual, respectively. Severe calculus deposition was observed in international students compared with non-international students (51.9% and 31.7%, respectively). Conclusions: The international university students had poorer oral health status than the non-international students, even though the result might include many uncertainties and possible biases. Full article
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Open AccessArticle
Health Disparities Score Composite of Youth and Parent Dyads from an Obesity Prevention Intervention: iCook 4-H
Healthcare 2018, 6(2), 51; https://doi.org/10.3390/healthcare6020051 -
Abstract
iCook 4-H is a lifestyle intervention to improve diet, physical activity and mealtime behavior. Control and treatment dyads (adult primary meal preparer and a 9–10-year-old youth) completed surveys at baseline and 4, 12, and 24 months. A Health Disparity (HD) score composite was
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iCook 4-H is a lifestyle intervention to improve diet, physical activity and mealtime behavior. Control and treatment dyads (adult primary meal preparer and a 9–10-year-old youth) completed surveys at baseline and 4, 12, and 24 months. A Health Disparity (HD) score composite was developed utilizing a series of 12 questions (maximum score = 12 with a higher score indicating a more severe health disparity). Questions came from the USDA short form U.S. Household Food Security Survey (5), participation in food assistance programs (1), food behavior (2), level of adult education completed (1), marital status (1), and race (1 adult and 1 child). There were 228 dyads (control n = 77; treatment n = 151) enrolled in the iCook 4-H study. Baseline HD scores were 3.00 ± 2.56 among control dyads and 2.97 ± 2.91 among treatment dyads, p = 0.6632. There was a significant decline in the HD score of the treatment group from baseline to 12 months (p = 0.0047) and baseline to 24 months (p = 0.0354). A treatment by 12-month time interaction was found (baseline mean 2.97 ± 2.91 vs. 12-month mean 1.78 ± 2.31; p = 0.0406). This study shows that behavioral change interventions for youth and adults can help improve factors that impact health equity; although, further research is needed to validate this HD score as a measure of health disparities across time. Full article
Open AccessArticle
Under the Same Sky: Connecting Students and Cultures through Circumpolar Nursing Education
Healthcare 2018, 6(2), 50; https://doi.org/10.3390/healthcare6020050 -
Abstract
The recruitment and retention of health professionals in rural, remote, and northern regions is an ongoing challenge. The Northern Nursing Education Network brought together nursing students working in rural and remote regions of the circumpolar north in Innovative Learning Institute on Circumpolar Health
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The recruitment and retention of health professionals in rural, remote, and northern regions is an ongoing challenge. The Northern Nursing Education Network brought together nursing students working in rural and remote regions of the circumpolar north in Innovative Learning Institute on Circumpolar Health (ILICH) events to create opportunities for shared learning and expose both students and faculty to local and traditional knowledge that informs health behaviors specific to regions with Indigenous populations. Using participant experience data extracted from program discussions, evaluations, and reflective notes conducted after ILICH events held in 2015–2017, this paper explores how these two-week institutes can contribute to knowledge that is locally relevant yet transferable to rural areas across the circumpolar north. The findings clustered around experiences related to (1) Language as a barrier and an enabler; (2) shared values and traditions across borders; (3) differences and similarities in nursing practice; (4) new perspectives in nursing; and (5) building sustainable partnerships. Students learned more about their own culture as well as others by exploring the importance of language, cultures, and health inequity on different continents. Shared values and traditional knowledge impacted student perspectives of social determinants of health that are highly relevant for nurses working in the circumpolar north. Full article
Open AccessArticle
Human Babesiosis Caused by Babesia duncani Has Widespread Distribution across Canada
Healthcare 2018, 6(2), 49; https://doi.org/10.3390/healthcare6020049 -
Abstract
Human babesiosis caused by Babesia duncani is an emerging infectious disease in Canada. This malaria-like illness is brought about by a protozoan parasite infecting red blood cells. Currently, controversy surrounds which tick species are vectors of B. duncani. Since the availability of a
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Human babesiosis caused by Babesia duncani is an emerging infectious disease in Canada. This malaria-like illness is brought about by a protozoan parasite infecting red blood cells. Currently, controversy surrounds which tick species are vectors of B. duncani. Since the availability of a serological or molecular test in Canada for B. duncani has been limited, we conducted a seven-year surveillance study (2011–2017) to ascertain the occurrence and geographic distribution of B. duncani infection country-wide. Surveillance case data for human B. duncani infections were collected by contacting physicians and naturopathic physicians in the United States and Canada who specialize in tick-borne diseases. During the seven-year period, 1119 cases were identified. The presence of B. duncani infections was widespread across Canada, with the highest occurrence in the Pacific coast region. Patients with human babesiosis may be asymptomatic, but as this parasitemia progresses, symptoms range from mild to fatal. Donors of blood, plasma, living tissues, and organs may unknowingly be infected with this piroplasm and are contributing to the spread of this zoonosis. Our data show that greater awareness of human babesiosis is needed in Canada, and the imminent threat to the security of the Canadian blood supply warrants further investigation. Based on our epidemiological findings, human babesiosis should be a nationally notifiable disease in Canada. Whenever a patient has a tick bite, health practitioners must watch for B. duncani infections, and include human babesiosis in their differential diagnosis. Full article
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Open AccessArticle
Transitioning from Acute to Chronic Pain: An Examination of Different Trajectories of Low-Back Pain
Healthcare 2018, 6(2), 48; https://doi.org/10.3390/healthcare6020048 -
Abstract
Traditionally, there has been a widely accepted notion that the transition from acute to chronic pain follows a linear trajectory, where an injury leads to acute episodes, subacute stages, and progresses to a chronic pain condition. However, it appears that pain progression is
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Traditionally, there has been a widely accepted notion that the transition from acute to chronic pain follows a linear trajectory, where an injury leads to acute episodes, subacute stages, and progresses to a chronic pain condition. However, it appears that pain progression is much more complicated and individualized than this original unsupported assumption. It is now becoming apparent that, while this linear progression may occur, it is not the only path that pain, specifically low-back pain, follows. It is clear there is a definite need to evaluate how low-back pain trajectories are classified and, subsequently, how we can more effectively intervene during these progression stages. In order to better understand and manage pain conditions, we must examine the different pain trajectories, and develop a standard by which to use these classifications, so that clinicians can better identify and predict patient-needs and customize treatments for maximum efficacy. The present article examines the most recent trajectory research, and highlights the importance of developing a broader model for patient evaluation. Full article
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Open AccessArticle
Modeling the Population Health Impact of Introducing a Modified Risk Tobacco Product into the U.S. Market
Healthcare 2018, 6(2), 47; https://doi.org/10.3390/healthcare6020047 -
Abstract
Philip Morris International (PMI) has developed the Population Health Impact Model (PHIM) to quantify, in the absence of epidemiological data, the effects of marketing a candidate modified risk tobacco product (cMRTP) on the public health of a whole population. Various simulations were performed
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Philip Morris International (PMI) has developed the Population Health Impact Model (PHIM) to quantify, in the absence of epidemiological data, the effects of marketing a candidate modified risk tobacco product (cMRTP) on the public health of a whole population. Various simulations were performed to understand the harm reduction impact on the U.S. population over a 20-year period under various scenarios. The overall reduction in smoking attributable deaths (SAD) over the 20-year period was estimated as 934,947 if smoking completely went away and between 516,944 and 780,433 if cMRTP use completely replaces smoking. The reduction in SADs was estimated as 172,458 for the World Health Organization (WHO) 2025 Target and between 70,274 and 90,155 for the gradual cMRTP uptake. Combining the scenarios (WHO 2025 Target and cMRTP uptake), the reductions were between 256,453 and 268,796, depending on the cMRTP relative exposure. These results show how a cMRTP can reduce overall population harm additionally to existing tobacco control efforts. Full article
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Open AccessArticle
Striking a Balance: A Qualitative Study of Next of Kin Participation in the Care of Older Persons in Nursing Homes in Sweden
Healthcare 2018, 6(2), 46; https://doi.org/10.3390/healthcare6020046 -
Abstract
Most of the care in nursing homes is palliative in nature, as it is the oldest and the frailest people who live in nursing homes. The aim of this study was to explore next of kin’s experiences of participating in the care of
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Most of the care in nursing homes is palliative in nature, as it is the oldest and the frailest people who live in nursing homes. The aim of this study was to explore next of kin’s experiences of participating in the care of older persons at nursing homes. A qualitative design was used, based on semi-structured interviews with 40 next of kin, and analyzed using qualitative content analysis. An overarching theme emerged, a balancing act consisting of three categories: (1) visiting the nursing home; (2) building and maintaining relationships; and (3) gathering and conveying information. The next of kin have to balance their own responsibility for the older person’s wellbeing by taking part in their care and their need to leave the responsibility to the staff due to critical health conditions. The next of kin wanted to participate in care meetings and conversations, not only in practical issues. The findings indicate the need to improve the next of kin’s participation in the care as an equal partner. Increased knowledge about palliative care and decision-making of limiting life-prolonging treatment may lead to a higher quality of care. Full article
Open AccessReview
Oral Health Care in Hong Kong
Healthcare 2018, 6(2), 45; https://doi.org/10.3390/healthcare6020045 -
Abstract
Hong Kong, as a special administrative region of the People’s Republic of China, is a metropolitan city in Asia with a population of approximately 7.4 million. This paper reflects the oral health care situation in Hong Kong. Water fluoridation was introduced in 1961
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Hong Kong, as a special administrative region of the People’s Republic of China, is a metropolitan city in Asia with a population of approximately 7.4 million. This paper reflects the oral health care situation in Hong Kong. Water fluoridation was introduced in 1961 as the primary strategy for the prevention of dental caries. The fluoride level is currently 0.5 parts per million. Dental care is mainly provided by private dentists. The government’s dentists primarily serve civil servants and their dependents, with limited emergency dental service for pain relief offered to the general public. Nevertheless, the government runs the school dental care service, which provides dental treatments to primary school children through dental therapists. They also set up an oral health education unit to promote oral health in the community. Hong Kong had 2280 registered dentists in 2017, and the dentist-to-population ratio was about 1:3200. The Faculty of Dentistry at the University of Hong Kong is the only institution to provide basic and advanced dentistry training programs in Hong Kong. Dental hygienists, dental surgery assistants, dental therapists, and dental technicians receive training as paradental staff through the university or the government. Full article
Open AccessArticle
The Association between Quality Improvement Initiatives in Dementia Care and Supportive Psychosocial Work Environments in Nursing Homes
Healthcare 2018, 6(2), 44; https://doi.org/10.3390/healthcare6020044 -
Abstract
Background: Quality improvement initiatives can help nursing homes strengthen psychosocial work environments. The aim of the present study was to examine the association between supportive psychosocial work environment, and professional and organizational characteristics regarding quality improvement initiatives in dementia care. Methods:
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Background: Quality improvement initiatives can help nursing homes strengthen psychosocial work environments. The aim of the present study was to examine the association between supportive psychosocial work environment, and professional and organizational characteristics regarding quality improvement initiatives in dementia care. Methods: A paper questionnaire survey was administered to a convenience sample of 365 professional caregivers in 12 special nursing homes in Japan. Psychosocial work environment was assessed using the Social Capital and Ethical Climate at the Workplace Scale to calculate a score of social capital in the workplace, ethical leadership, and exclusive workplace climate. Variables for quality improvement initiatives included type of home (unit-type or traditional), presence of additional benefit for dementia care, and professionalism in dementia care among caregivers evaluated using the Japanese version of the Sense of Competence in Dementia Care Staff Scale. Results: Elevated professionalism and unit-type home were significantly associated with high social capital, strong ethical leadership, and low exclusive workplace climate. The presence of dementia care benefit was not associated with any subscale of psychosocial work environment. Conclusions: Quality improvement initiatives to foster supportive psychosocial work environment should enhance professionalism in dementia care with unit-based team building of professional caregivers in special nursing homes. Full article
Open AccessReview
The Role of Adult Day Services in Supporting the Occupational Participation of People with Dementia and Their Carers: An Integrative Review
Healthcare 2018, 6(2), 43; https://doi.org/10.3390/healthcare6020043 -
Abstract
The increasing numbers of people with dementia places considerable stress on health and aged care services and has resulted in the development of community adult day services. Aim: The aim of this integrative review is to determine the extent to which these
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The increasing numbers of people with dementia places considerable stress on health and aged care services and has resulted in the development of community adult day services. Aim: The aim of this integrative review is to determine the extent to which these services support the occupational participation of people with dementia, and how they impact their primary carers. Method: The mixed-methods appraisal tool (MMAT) was used to identify relevant studies in the period 2011–2016. Results: Nine databases were searched and yielded 16 articles with a variety of research designs for inclusion in the review. Conclusions: Findings indicate that adult day services use a range of approaches to support attendees and their carers. In spite of these efforts, there appears to be a lack of interest in utilizing these services while a person is in the early stages of dementia. This suggests that policies in aged care, such as aging-in-place, need to consider the pressure and stress they exert on carer’s quality of life. Another consideration is to better promote the benefits of participating in adult day services in the early stages of dementia for both the attendees and their carers, thereby delaying the tendency towards early institutionalization. Full article
Open AccessArticle
The Delivery of Health Promotion and Environmental Health Services; Public Health or Primary Care Settings?
Healthcare 2018, 6(2), 42; https://doi.org/10.3390/healthcare6020042 -
Abstract
The WHO Regional Office for Europe developed a set of public health functions resulting in the ten Essential Public Health Operations (EPHO). Public health or primary care settings seem to be favorable to embrace all actions included into EPHOs. The presented paper aims
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The WHO Regional Office for Europe developed a set of public health functions resulting in the ten Essential Public Health Operations (EPHO). Public health or primary care settings seem to be favorable to embrace all actions included into EPHOs. The presented paper aims to guide readers on how to assign individual health promotion and environmental health services to public health or primary care settings. Survey tools were developed based on EPHO 2, 3 and 4; there were six key informant surveys out of 18 contacted completed via e-mails by informants working in Denmark on health promotion and five face-to-face interviews were conducted in Australia (Melbourne and Victoria state) with experts from environmental health, public health and a physician. Based on interviews, we developed a set of indicators to support the assignment process. Population or individual focus, a system approach or one-to-one approach, dealing with hazards or dealing with effects, being proactive or reactive were identified as main element of the decision tool. Assignment of public health services to one of two settings proved to be possible in some cases, whereas in many there is no clear distinction between the two settings. National context might be the one which guides delivery of public health services. Full article
Open AccessArticle
Assessing the Effectiveness of the Aging Mastery Program
Healthcare 2018, 6(2), 41; https://doi.org/10.3390/healthcare6020041 -
Abstract
Background: Successful aging is best determined by active management and self-determination of one’s aging roadmap. Some individuals are ready to respond to these challenges, others may benefit from assistance that might be offered through an evidence-based intervention. The Aging Mastery Program®
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Background: Successful aging is best determined by active management and self-determination of one’s aging roadmap. Some individuals are ready to respond to these challenges, others may benefit from assistance that might be offered through an evidence-based intervention. The Aging Mastery Program® (AMP) has been developed to meet these needs. Method: In a cross over design the intervention was tested in ten senior centers and aging network agencies looking at impacts upon general health and quality of life, patient activation, physical activity and advanced care planning. Results: There was a statistically significant (tested at a 0.05 level) level of improvement found in physical activity and advanced care planning. Conclusion: Findings support the program’s effectiveness and its value as an evidence-based intervention for older adult programming. Full article
Open AccessCommentary
Skin Protective Nutraceuticals: The Current Evidence in Brief
Healthcare 2018, 6(2), 40; https://doi.org/10.3390/healthcare6020040 -
Abstract
Nutraceuticals are important for healthy skin maintenance. Probiotics, phenolics, and vitamins are just a few of the nutraceuticals meant to potentially prevent and assist medical management of dermatologic conditions. Among these, probiotics, vitamin E, and green tea catechins may offer the broadest array
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Nutraceuticals are important for healthy skin maintenance. Probiotics, phenolics, and vitamins are just a few of the nutraceuticals meant to potentially prevent and assist medical management of dermatologic conditions. Among these, probiotics, vitamin E, and green tea catechins may offer the broadest array of skin protective mechanisms with probiotics having the greatest clinical range. Probiotics’ amelioration of atopic dermatitis and opportunistic infections of skin burns has been targeted in recent research efforts. This includes the improvement of Scoring Atopic Dermatitis index scores, p = 0.02, with intact Lactobacillus rhamnosus Goldin and Gorbach (LGG) in comparison to heat inactivated LGG or placebo. Lactobacillus reuteri used prior to or concurrently with Staphylococcus aureus infection can increase epidermal keratinocyte survival, p < 0.01. Phenolics may not have been extensively studied for atopic dermatitis or skin burns. However, phenolics do have a role in photoprotection. The phenolic rutin increases ultraviolet B radiation filter reactive oxygen species scavenging at 75%, p < 0.002, and peak wavelength absorption, p < 0.001. While oral and topical probiotics have untapped potential for atopic dermatitis amelioration and skin infection prevention, phenolics will be increasingly used for photoprotection. With optimized bioavailability, dosage, and formulation, nutraceuticals will become crucial for healthy skin maintenance. Full article
Open AccessArticle
A Targeted and Tailored eHealth Weight Loss Program for Young Women: The Be Positive Be Healthe Randomized Controlled Trial
Healthcare 2018, 6(2), 39; https://doi.org/10.3390/healthcare6020039 -
Abstract
Young women are gaining weight rapidly. Evidence for effective weight loss interventions targeting young women is lacking. This randomized controlled trial assessed the efficacy and acceptability of a six-month targeted and tailored eHealth weight loss program for young women (Be Positive Be Health
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Young women are gaining weight rapidly. Evidence for effective weight loss interventions targeting young women is lacking. This randomized controlled trial assessed the efficacy and acceptability of a six-month targeted and tailored eHealth weight loss program for young women (Be Positive Be Healthe (BPBH)). Women aged 18–35 years were randomized to BPBH (n = 29) or control (n = 28). BPBH supported participants to modify diet and physical activity behaviours using evidenced-based strategies (e.g., self-monitoring) tailored for young women and delivered using e-health (website, social media, smartphone application, email, text messages). The primary outcome was a change in weight (kg) at six months. Acceptability was assessed via a process evaluation survey and usage of intervention components. No significant between-group differences were observed for weight, with significant mean differences favouring the intervention group observed for body fat (kg) (−3.10 (−5.69, 0.52), p = 0.019) and intakes of alcohol (g) (−0.69 (−1.33, 0.04), p = 0.037), vegetables (% energy/day) (4.71 (−2.20, 7.22), p < 0.001) and energy-dense, nutrient-poor foods (% energy/day) (−9.23 (−16.94, 1.52), p = 0.018). Retention, intervention usage and satisfaction were moderate. BPBH facilitated positive improvements in body fat and dietary intake, but not weight. Intervention acceptability findings support the use of some intervention components (e.g., Facebook, Smartphone app) with young women. Full article
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Open AccessFeature PaperArticle
Ethnic Variations in Psychosocial and Health Correlates of Eating Disorders
Healthcare 2018, 6(2), 38; https://doi.org/10.3390/healthcare6020038 -
Abstract
The aim of this study is to explore ethnic variations in psychosocial and health correlates of eating disorders in the United States, Specifically, we compared associations between gender, socioeconomic status (SES), body mass index (BMI), physical and mental self-rated health (SRH), and major
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The aim of this study is to explore ethnic variations in psychosocial and health correlates of eating disorders in the United States, Specifically, we compared associations between gender, socioeconomic status (SES), body mass index (BMI), physical and mental self-rated health (SRH), and major depressive disorder (MDD) with eating disorders (EDs) across 10 different ethnic groups in the United States. Data was obtained from the Collaborative Psychiatric Epidemiology Surveys (CPES), a national household probability sample collected in 2001–2003. Data for this study included a sample of 17,729 individuals with the following ethnic profile: 520 Vietnamese, 508 Filipino, 600 Chinese, 656 Other Asian, 577 Cuban, 495 Puerto Rican, 1442 Mexican, 1106 Other Hispanic, 4746 African American, and 7587 Non-Latino Whites. Gender, SES (education and income), BMI, SRH, MDD, and presence of EDs were measured across different ethnic groups. Logistic regression analysis was conducted for each ethnic group with lifetime EDs as the main outcome. Ethnic group varied in psychosocial and health correlates of EDs. In most ethnic groups, gender and SES were not associated with EDs. In almost all ethnic groups, EDs were associated with MDD and BMI. EDs were found to be associated with SRH in half of the ethnic groups studied. The associations between gender, SES, BMI, SRH, MDD, and EDs vary across different ethnic groups. These differences must be considered in further studies and in clinical practice in order to improve our approach towards diagnosis and treatment of EDs. Full article
Open AccessFeature PaperArticle
High Income Protects Whites but Not African Americans against Risk of Depression
Healthcare 2018, 6(2), 37; https://doi.org/10.3390/healthcare6020037 -
Abstract
Background: Built on the Blacks’ diminished return theory, defined as smaller effects of socioeconomic status (SES) on a wide range of health outcomes for African Americans compared to Whites, the current study compared African Americans and Whites for the association between household income
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Background: Built on the Blacks’ diminished return theory, defined as smaller effects of socioeconomic status (SES) on a wide range of health outcomes for African Americans compared to Whites, the current study compared African Americans and Whites for the association between household income and risk of lifetime, 12-month, and 30-day major depressive disorder (MDD). Methods: For the current cross-sectional study, we used data from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001–2003. With a nationally representative sampling, CPES included 4746 non-Hispanic African Americans and 7587 non-Hispanic Whites. The dependent variables were lifetime, 12-month, and 30-day MDD, measured using Composite International Diagnostic Interview (CIDI). The independent variable was household income. Age, gender, education, chronic medical conditions, and obesity were covariates. Race was the focal moderator. Logistic regression models were used to test the protective effects of household income against MDD in the overall sample and also by race. Results: In the overall sample, household income was inversely associated with the risk of 12-month and 30-day MDD. We found a significant interaction between race and household income on 12-month and 30-day MDD, suggesting a smaller protective effect of household income against MDD for African Americans compared to Whites. Conclusion: In line with the Blacks’ diminished return theory, household income better protects Whites than African Americans against MDD. The contribution of diminished return of SES as an underlying mechanism behind racial disparities in health in the United States is often overlooked. Additional research is needed on why and how SES resources generate smaller health gain among minority groups. Full article
Open AccessFeature PaperArticle
Depressive Symptoms Increase the Risk of Mortality for White but Not Black Older Adults
Healthcare 2018, 6(2), 36; https://doi.org/10.3390/healthcare6020036 -
Abstract
Introduction. Long-term studies have shown that depressive symptoms predict the risk of mortality. However, it is unknown if this effect is present in shorter time intervals. In addition, recent research suggests that the salience of the negative affect on the risk of mortality
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Introduction. Long-term studies have shown that depressive symptoms predict the risk of mortality. However, it is unknown if this effect is present in shorter time intervals. In addition, recent research suggests that the salience of the negative affect on the risk of mortality is not similar across racial groups. The current study uses data from a national study of Black and White older adults to examine racial differences in the effect of baseline depressive symptoms on mortality risk over three years in the United States. Methods. This study used a longitudinal prospective design and followed 1493 older adults who were either White (n = 759) or Black (n = 734) for three years from 2001 to 2004. Depressive symptoms measured at baseline was the independent variable. Demographic factors, socio-economic characteristics (education, income, marital status), health behaviors (smoking and drinking), and health (self-rated health) measured at baseline in 2001 were covariates. The dependent variable was all-cause mortality between 2001 and 2004. Race was the moderator. Logistic regressions were used for data analysis. Results. In the pooled sample, high depressive symptoms at baseline were not associated with the three-year risk of mortality. In the pooled sample, we found a significant interaction between race and depressive symptoms on mortality, suggesting a stronger effect for Whites in comparison to Blacks. In race stratified models, depressive symptoms at baseline were predictive of mortality risk for Whites, but not Blacks. Conclusions. In the United States, Black-White differences exist in the effects of depressive symptoms on mortality risk in older adults. White older adults may be more vulnerable to the effects of depressive symptoms on mortality risk. Full article
Open AccessConcept Paper
A Rationale for Music Training to Enhance Executive Functions in Parkinson’s Disease: An Overview of the Problem
Healthcare 2018, 6(2), 35; https://doi.org/10.3390/healthcare6020035 -
Abstract
Music listening interventions such as Rhythmic Auditory Stimulation can improve mobility, balance, and gait in Parkinson’s Disease (PD). Yet, the impact of music training on executive functions is not yet known. Deficits in executive functions (e.g., attention, processing speed) in patients with PD
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Music listening interventions such as Rhythmic Auditory Stimulation can improve mobility, balance, and gait in Parkinson’s Disease (PD). Yet, the impact of music training on executive functions is not yet known. Deficits in executive functions (e.g., attention, processing speed) in patients with PD result in gait interference, deficits in emotional processing, loss of functional capacity (e.g., intellectual activity, social participation), and reduced quality of life. The model of temporal prediction and timing suggests two networks collectively contribute to movement generation and execution: the basal ganglia-thalamocortical network (BGTC) and the cerebellar-thalamocortical network (CTC). Due to decreases in dopamine responsible for the disruption of the BGTC network in adults with PD, it is hypothesized that rhythmic auditory cues assist patients through recruiting an alternate network, the CTC, which extends to the supplementary motor areas (SMA) and the frontal cortices. In piano training, fine motor finger movements activate the cerebellum and SMA, thereby exercising the CTC network. We hypothesize that exercising the CTC network through music training will contribute to enhanced executive functions. Previous research suggested that music training enhances cognitive performance (i.e., working memory and processing speed) in healthy adults and adults with cognitive impairments. This review and rationale provides support for the use of music training to enhance cognitive outcomes in patients with Parkinson’s Disease (PD). Full article