Open AccessArticle
How Neighborhood Effects Vary: Childbearing and Fathering among Latino and African American Adolescents
Healthcare 2018, 6(1), 7; doi:10.3390/healthcare6010007 (registering DOI) -
Abstract
This study examines what neighborhood conditions experienced at age 15 and after are associated with teen childbearing and fathering among Latino and African American youth and whether these neighborhood effects vary by gender and/or ethnicity. Administrative and survey data from a natural experiment
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This study examines what neighborhood conditions experienced at age 15 and after are associated with teen childbearing and fathering among Latino and African American youth and whether these neighborhood effects vary by gender and/or ethnicity. Administrative and survey data from a natural experiment are used for a sample of 517 Latino and African American youth whose families were quasi-randomly assigned to public housing operated by the Denver (CO) Housing Authority (DHA). Characteristics of the neighborhood initially assigned by DHA to wait list applicants are utilized as identifying instruments for the neighborhood contexts experienced during adolescence. Cox Proportional Hazards (PH) models reveal that neighborhoods having higher percentages of foreign-born residents but lower levels of social capital robustly predict reduced odds of teen parenting though the magnitude of these effects was contingent on gender and ethnicity. Specifically, the presence of foreign-born neighbors on the risk of teen parenting produced a stronger dampening effect for African American youth when compared to Latino youth. Additionally, the effects of social capital on teen parenting were stronger for males than females. Full article
Open AccessArticle
Age and Gender Differences in Psychological Distress among African Americans and Whites: Findings from the 2016 National Health Interview Survey
Healthcare 2018, 6(1), 6; doi:10.3390/healthcare6010006 -
Abstract
Previous studies report a race and mental health paradox: Whites score higher on measures of major depression compared to African Americans, but the opposite is true for psychological distress (i.e., African Americans score higher on distress measures compared to Whites). Independently, race, age,
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Previous studies report a race and mental health paradox: Whites score higher on measures of major depression compared to African Americans, but the opposite is true for psychological distress (i.e., African Americans score higher on distress measures compared to Whites). Independently, race, age, and gender outcomes for psychological distress are well documented in the literature. However, there is relatively little research on how psychological distress interferes with the lives of African Americans and Whites at the intersection of their various race, age, and gender identities. This study uses data from the 2016 National Health Interview Survey to examine age and gender differences in psychological distress and how much psychological distress interferes with the lives of African Americans and Whites. Our study findings are contrary to the paradox such that young White women (M = 3.36, SD = 1.14) and middle-aged White men (M = 2.55, SD = 3.97) experienced higher psychological distress than all other race, age, and gender groups. Psychological distress interference was relatively high among the high distress groups, except for older African American men (M = 1.73, SD = 1.05) and young African American women (M = 1.93, SD = 0.95). Implications for studies that consider cultural experiences of psychological distress, and how it impacts different demographic groups are discussed. Full article
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Open AccessArticle
Poor People Are Hospitalized Three Times More for Mental Health Services than the Non-Poor in Central Valley California
Healthcare 2018, 6(1), 5; doi:10.3390/healthcare6010005 -
Abstract
Introduction: Providing health insurance to the poor has become a standard policy response to health disparities between the poor and the non-poor. It is often assumed that if the poor people are given health insurance, they will use preventative care, which will prevent
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Introduction: Providing health insurance to the poor has become a standard policy response to health disparities between the poor and the non-poor. It is often assumed that if the poor people are given health insurance, they will use preventative care, which will prevent more expensive emergency visits and inpatient hospitalization, and in turn, it will save healthcare cost in the long run. This paper presents the findings from our study in California about what happens to the poor when they are given health insurance. The purpose of the study was to understand how the healthcare system in California treats the poor patients differently than the non-poor. Method: Using multivariate logistic regressions, this study analyzed a large patient discharge data (PDD) from the California Office of Statewide Planning and Development (OSHPD) for eight counties in the Central Valley California (N = 423,640). First, utilizing International Classification of Diseases (ICD 10) as diagnostic criteria, mental-health vs. non-mental health hospitalization rates were estimated. Second, health insurance status was used as a proxy measure of poverty of the patients. Using chi-Square, the probability of hospitalization for mental health services was estimated based on their insurance types. Finally, using step-wise logistic regression, the odds of mental health hospitalization was estimated conditional on individual characteristics, health insurance types, and geographic characteristics. Findings: When the poor people were given health insurance, they were three times more likely to be hospitalized for mental health services than the non-poor. The more than three-fold variation in mental health hospitalization was not driven by demographic or geographic characteristics. The findings are new and have important implications for the healthcare policies for the poor. Further studies are needed to understand the extent to which the disproportionately high rate of mental health hospitalizations of the poor are driven by the provider-induced needs. Full article
Open AccessEditorial
Acknowledgement to Reviewers of Healthcare in 2017
Healthcare 2018, 6(1), 4; doi:10.3390/healthcare6010004 -
Abstract
Peer review is an essential part in the publication process, ensuring that Healthcare maintains high quality standards for its published papers.[...] Full article
Open AccessArticle
Evaluating the Impact of a Clinician Improvement Program for Treating Patients with Intellectual and Developmental Disabilities: The Challenging Case of Mississippi
Healthcare 2018, 6(1), 3; doi:10.3390/healthcare6010003 -
Abstract
In recent years, people with intellectual and developmental disabilities (IDD) have moved from institutionalized settings to local community residences. While deinstitutionalization has yielded quality of life improvements for people with IDD, this transition presents significant health-related challenges. Community clinicians have typically not been
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In recent years, people with intellectual and developmental disabilities (IDD) have moved from institutionalized settings to local community residences. While deinstitutionalization has yielded quality of life improvements for people with IDD, this transition presents significant health-related challenges. Community clinicians have typically not been trained to provide sound medical care to people with IDD, a subpopulation that exhibits unique medical needs and significant health disparities. This study reports the results of a comprehensive evaluation of an IDD-focused clinician improvement program implemented throughout Mississippi. DETECT (Developmental Evaluation, Training and Consultative Team) was formed to equip Mississippi’s physicians and nurses to offer competent medical care to people with IDD living in community residences. Given the state’s pronounced health disparities and its clinician shortage, Mississippi offers a stringent test of program effectiveness. Results of objective survey indicators and subjective rating barometers administered before and after clinician educational seminars reveal robust statistically significant differences in clinician knowledge and self-assessed competence related to treating people with IDD. These results withstand controls for various confounding factors. Positive post-only results were also evident in a related program designed specifically for medical students. The study concludes by specifying a number of implications, including potential avenues for the wider dissemination of this program and promising directions for future research. Full article
Open AccessArticle
The Benefits of Higher Income in Protecting against Chronic Medical Conditions Are Smaller for African Americans than Whites
Healthcare 2018, 6(1), 2; doi:10.3390/healthcare6010002 -
Abstract
Background: Blacks’ diminished return is defined as smaller protective effects of socioeconomic status (SES) on health of African Americans compared to Whites. Aim: Using a nationally representative sample, the current study aimed to examine if the protective effect of income on chronic medical
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Background: Blacks’ diminished return is defined as smaller protective effects of socioeconomic status (SES) on health of African Americans compared to Whites. Aim: Using a nationally representative sample, the current study aimed to examine if the protective effect of income on chronic medical conditions (CMC) differs for African Americans compared to Whites. Methods: With a cross-sectional design, the National Survey of American Life (NSAL), 2003, included 3570 non-Hispanic African Americans and 891 non-Hispanic Whites. The dependent variable was CMC, treated as a continuous measure. The independent variable was income. Race was the focal moderator. Age, education, and marital status were covariates. Linear regressions were used to test if the protective effect of income against CMC varies by race. Results: High income was associated with a lower number of CMC in the pooled sample. We found a significant interaction between race and income, suggesting that income has a smaller protective effect against CMC for African Americans than it does for Whites. Conclusion: Blacks’ diminished return also holds for the effects of income on CMC. Blacks’ diminished return is a contributing mechanism to the racial disparities in health in the United States that is often overlooked. More research is needed on the role of diminished health return of SES resources among other minority groups. Full article
Open AccessReview
Measuring Outcomes of Psychological Well-Being within Paediatric Health Settings
Healthcare 2018, 6(1), 1; doi:10.3390/healthcare6010001 -
Abstract
There are many widely used, validated patient reported outcome measures for physical and mental health. However, capturing outcomes from young people living with chronic health conditions presents a challenge, needing to take the complex interplay of physical and mental health into consideration. The
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There are many widely used, validated patient reported outcome measures for physical and mental health. However, capturing outcomes from young people living with chronic health conditions presents a challenge, needing to take the complex interplay of physical and mental health into consideration. The authors found that regularly used outcome measures for child and adolescent emotional well-being in paediatric settings largely fall into two groups: paediatric quality of life and child and adolescent mental health measures. The applicability and potential for use of these measures within this context is discussed. Whilst offering some utility, neither approach leaves sufficient space for young people’s individual experiences of illness and treatment. The scope of using alternative qualitative approaches that capture the rich stories and experiences of young people living with chronic illnesses is considered. Full article
Open AccessReview
Measuring Activity Performance of Older Adults Using the activPAL: A Rapid Review
Healthcare 2017, 5(4), 94; doi:10.3390/healthcare5040094 -
Abstract
Current measures of physical activity and sedentary behaviors such as questionnaires and functional assessments are insufficient to provide comprehensive data on older adults. In response, the use of activity monitors has increased. The purpose of this review was to summarize and assess the
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Current measures of physical activity and sedentary behaviors such as questionnaires and functional assessments are insufficient to provide comprehensive data on older adults. In response, the use of activity monitors has increased. The purpose of this review was to summarize and assess the quality of observational literature on activity measuring of older adults using the activPAL activity monitor. Seventeen databases and a bibliography, compiled by the activPAL creators, were searched. Articles were included if they were in English, were peer-reviewed, included people 65 years or older, measured activity using the activPAL and reported at least one of the following outcomes: step count, hours upright, hours sitting/lying, hours stepping, or hours standing. The search revealed 404 titles; after exclusions 24 were included in the final review. Of these studies, one examined older adults from residential aged care, six from hospital in-patient clinics, nine from outpatient clinics and eight examined community-dwellers. Mean age ranged from 66.0 to 84.2 years. Not all studies reported similar outcome variables, preventing data pooling. The review found a lack of high quality articles. There may be limitations to using the activPAL among older adults but further research is required to examine its use in this population. Full article
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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 -
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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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 -
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
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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 -
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
Home Hemodialysis (HHD) Treatment as an Effective yet Underutilized Treatment Modality in the United States
Healthcare 2017, 5(4), 90; doi:10.3390/healthcare5040090 -
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
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 -
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
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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 -
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 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 -
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
Open AccessReview
Prescribing Physical Activity for the Prevention and Treatment of Osteoporosis in Older Adults
Healthcare 2017, 5(4), 85; doi:10.3390/healthcare5040085 -
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
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Open AccessArticle
Multimodal Counseling Interventions: Effect on Human Papilloma Virus Vaccination Acceptance
Healthcare 2017, 5(4), 86; doi:10.3390/healthcare5040086 -
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
The Role of Medication in Supporting Emotional Wellbeing in Young People with Long-Term Needs
Healthcare 2017, 5(4), 84; doi:10.3390/healthcare5040084 -
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
Socioeconomic Status and Glycemic Control in Type 2 Diabetes; Race by Gender Differences
Healthcare 2017, 5(4), 83; doi:10.3390/healthcare5040083 -
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 AccessReview
Updates on the Management of Non-Melanoma Skin Cancer (NMSC)
Healthcare 2017, 5(4), 82; doi:10.3390/healthcare5040082 -
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