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Healthcare, Volume 12, Issue 10 (May-2 2024) – 99 articles

Cover Story (view full-size image): Cystic fibrosis (CF), a chronic disease requiring lifelong multidisciplinary care, often poses challenges in treatment adherence in children and adolescents. Telerehabilitation is increasingly recognized as a resource that can positively impact disease outcomes. Given the limited research in this area, this scoping review aims to identify technology-mediated rehabilitation interventions for children and adolescents with CF. Employing the Joanna Briggs Institute guidelines, five studies, encompassing interventions such as physical exercise programs, therapeutic regimen management, and symptom control and utilizing internet platforms, video games, and telephones, underwent a narrative analysis. It was concluded that supervised telerehabilitation with telemonitoring emerged as a feasible and safe approach. View this paper
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19 pages, 2276 KiB  
Systematic Review
Inequalities in Out-of-Pocket Health Expenditure Measured Using Financing Incidence Analysis (FIA): A Systematic Review
by Askhat Shaltynov, Ulzhan Jamedinova, Yulia Semenova, Madina Abenova and Ayan Myssayev
Healthcare 2024, 12(10), 1051; https://doi.org/10.3390/healthcare12101051 - 20 May 2024
Viewed by 557
Abstract
Government efforts and reforms in health financing systems in various countries are aimed at achieving universal health coverage. Household spending on healthcare plays a very important role in achieving this goal. The aim of this systematic review was to assess out-of-pocket health expenditure [...] Read more.
Government efforts and reforms in health financing systems in various countries are aimed at achieving universal health coverage. Household spending on healthcare plays a very important role in achieving this goal. The aim of this systematic review was to assess out-of-pocket health expenditure inequalities measured by the FIA across different territories, in the context of achieving UHC by 2030. A comprehensive systematic search was conducted in the PubMed, Scopus, and Web of Science databases to identify original quantitative and mixed-method studies published in the English language between 2016 and 2022. A total of 336 articles were initially identified, and after the screening process, 15 articles were included in the systematic review, following the removal of duplicates and articles not meeting the inclusion criteria. Despite the overall regressivity, insurance systems have generally improved population coverage and reduced inequality in out-of-pocket health expenditures among the employed population, but regional studies highlight the importance of examining the situation at a micro level. The results of the study provide further evidence supporting the notion that healthcare financing systems relying less on public funding and direct tax financing and more on private payments are associated with a higher prevalence of catastrophic health expenditures and demonstrate a more regressive pattern in terms of healthcare financing, highlighting the need for policy interventions to address these inequities. Governments face significant challenges in achieving universal health coverage due to inequalities experienced by financially vulnerable populations, including high out-of-pocket payments for pharmaceutical goods, informal charges, and regional disparities in healthcare financing administration. Full article
(This article belongs to the Special Issue Healthcare Policy, Inequity, and Systems Research)
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14 pages, 280 KiB  
Article
From Crisis to Opportunity: A Qualitative Study on Rehabilitation Therapists’ Experiences and Post-Pandemic Perspectives
by Marianne Saragosa, Farwa Goraya, Frances Serrano, Behdin Nowrouzi-Kia, Sara Guilcher, Yasmin Abdul Aziz and Basem Gohar
Healthcare 2024, 12(10), 1050; https://doi.org/10.3390/healthcare12101050 - 20 May 2024
Viewed by 567
Abstract
Rehabilitation therapists (RTs) have developed substantial mental health problems since the pandemic. Our study aimed to understand the experience of COVID-19 on occupational therapists and physiotherapists practicing in Canada, how the pandemic may have affected care delivery, and to identify new learnings articulated [...] Read more.
Rehabilitation therapists (RTs) have developed substantial mental health problems since the pandemic. Our study aimed to understand the experience of COVID-19 on occupational therapists and physiotherapists practicing in Canada, how the pandemic may have affected care delivery, and to identify new learnings articulated by RTs. A qualitative descriptive study design guided data collection through one-on-one interviews, dyadic interviews, and focus groups. We recruited active RTs across Canada, advertising on professional practice networks and social media platforms and using snowball sampling. Forty-nine RTs representing seven Canadian provinces participated. The four overarching themes developed using thematic analysis were (1) navigating uncertainty along with ever-changing practices, policies, and attitudes, (2) morphing roles within a constrained system, (3) witnessing patients suffering and experiencing moral distress, and (4) recognizing the personal toll of the pandemic on self and others, as well as lessons learned. Our study demonstrated that many RTs suffered moral distress, poor mental health, and some from challenging financial situations, especially those in the private sector. They also expressed a resilient attitude in response to these stressors. Implications in the future include identifying promising communication strategies that could act as protective factors, addressing workforce constraints and diminishing resources through innovative models of care. Full article
(This article belongs to the Special Issue The Impact of COVID-19 on Mental Health across Diverse Populations)
13 pages, 257 KiB  
Article
Comparison of Financial Hardship and Healthcare Utilizations Associated with Cancer in the United States Medicare Programs during the COVID-19 Pandemic
by Jiamin Hu, Mishal Khan, Xiaobei Chen, Lee Revere and Young-Rock Hong
Healthcare 2024, 12(10), 1049; https://doi.org/10.3390/healthcare12101049 - 20 May 2024
Viewed by 518
Abstract
Background: In the United States, Medicare beneficiaries diagnosed with cancer often face significant financial challenges due to the expensive nature of cancer treatments and increased cost-sharing responsibilities. However, there is limited knowledge regarding the financial hardships and healthcare utilizations faced by those enrolled [...] Read more.
Background: In the United States, Medicare beneficiaries diagnosed with cancer often face significant financial challenges due to the expensive nature of cancer treatments and increased cost-sharing responsibilities. However, there is limited knowledge regarding the financial hardships and healthcare utilizations faced by those enrolled in Medicare Advantage (MA) compared to those in traditional fee-for-service Medicare (TM) during the COVID-19 pandemic. Our study aims to investigate the subjective financial hardships experienced by individuals enrolled in TM and MA and to determine whether these two Medicare programs exhibit differences in healthcare utilization during the pandemic. Methods: We utilized data from the 2020–2022 National Health Interview Survey (NHIS), focusing on nationally representative samples of cancer survivors aged 65 or older. Financial hardship was categorized into three distinct groups: material (e.g., problems with medical bills), psychological (e.g., worry about paying), and behavioral (e.g., delayed care due to cost). Healthcare utilization included wellness visits (preventive care), emergency care services, hospitalizations, and telehealth. We used survey design-adjusted analysis to compare the study outcomes between MA and TM. Results: Among a weighted sample of 4.4 million Medicare beneficiaries with cancer (mean age: 74.9), 76% were enrolled in MA plans. Cancer survivors with a college degree (59.3% vs. 49.8%) and high family income (38.2% vs. 31.1%) were more likely to enroll in MA plans. There were no significant differences in any material, psychological, or behavioral financial hardship domains between beneficiaries with MA and TM plans except forgone counseling due to cost. For healthcare utilization measures, cancer survivors in MA were more likely than those in TM to have flu vaccination (77.2% vs. 70.1%) and experience lower hospitalizations (16.0% vs. 20.0%). However, there were no differences in other health service utilizations between MA and TM. Conclusion: While no significant differences were observed in any materialized, psychological, or behavioral financial hardships, older cancer survivors enrolled in MA plans were more likely to receive vaccinations and lower hospitalization rates during COVID-19. Although other preventive or primary care visits (i.e., wellness visits) were higher, their difference did not reach statistical significance. As MA grows in popularity, it is essential to consistently monitor and evaluate the performance and outcomes of Medicare plans for cancer survivors as we navigate the post-pandemic landscape. Full article
(This article belongs to the Section Health Policy)
16 pages, 727 KiB  
Article
How Does Physical Exercise Improve the Subjective Well-Being of the Chinese Adult Population? A Moderated Mediation Model
by Zhan Liu, Yufeng Zhao, Tianning Zhang and Dianxi Wang
Healthcare 2024, 12(10), 1048; https://doi.org/10.3390/healthcare12101048 - 20 May 2024
Viewed by 490
Abstract
Based on the 2017 data from the China General Social Survey (CGSS), the conditional process analysis method was used to explore the relationship between physical exercise and subjective well-being, as well as the mediating effect of social capital and the moderating effect of [...] Read more.
Based on the 2017 data from the China General Social Survey (CGSS), the conditional process analysis method was used to explore the relationship between physical exercise and subjective well-being, as well as the mediating effect of social capital and the moderating effect of Internet use. This study found that the effect of physical exercise on subjective well-being includes both direct effects and indirect effects. Physical exercise directly and positively affects SWB and partially affects SWB through social networks as a mediating variable. Additionally, Internet use can moderate the direct effect of physical exercise on SWB and the mediating effect of social networks on the relationship between the two. As the frequency of Internet use increases, the link between physical exercise and social capital weakens, resulting in a decreased promotion effect on SWB. The results of this study further reveal the internal mechanism linking physical exercise and the improvement of SWB, which is of great significance for enhancing the accessibility of physical exercise facilities and promoting a healthy online lifestyle, ultimately leading to improved well-being among residents. Full article
(This article belongs to the Section TeleHealth and Digital Healthcare)
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13 pages, 973 KiB  
Article
Assessment of Paracetamol Usage Practices and Perceptions among Caregivers for Children Post-COVID-19 in Saudi Arabia: A Cross-Sectional Analysis
by Saad S. Alqahtani, David Banji and Otilia J. F. Banji
Healthcare 2024, 12(10), 1047; https://doi.org/10.3390/healthcare12101047 - 20 May 2024
Viewed by 506
Abstract
Caregivers often use paracetamol in the management of pediatric illnesses without a clear rationale. This study evaluated the perception and practices of caregivers regarding the use of paracetamol in children in Southwestern Saudi Arabia. This study involved a cross-sectional design involving 373 caregivers [...] Read more.
Caregivers often use paracetamol in the management of pediatric illnesses without a clear rationale. This study evaluated the perception and practices of caregivers regarding the use of paracetamol in children in Southwestern Saudi Arabia. This study involved a cross-sectional design involving 373 caregivers of children under twelve. The questionnaire elucidated the reasons, usage frequency, and safe usage practices. Data were analyzed using SPSS, applying Chi-square tests and logistic regression. Most caregivers were in the age range of 31–40 years, and with intermediate education. Paracetamol was mainly used for fever, generalized pain and, diarrhea, with fewer opting for other self-care measures. Caregivers with primary or less education were more likely to perceive paracetamol as safe (AOR = 2.98 (1.3–6.73), p = 0.009) and less inclined to check warning labels (AOR: 0.11 (0.05–0.25), p < 0.001) and expiry dates (AOR: 0.063 (0.027–0.14), p < 0.001). The caregiver’s education level significantly influenced the determination of treatment duration (χ2 = 21.58 (4), p < 0.001), dosage (χ2 = 30.70 (4), p < 0.001), and frequency of administration (χ2 = 17.77 (4), p = 0.001). In conclusion, inadequate health literacy can result in a lack of attention towards crucial safety information about pediatric paracetamol use. Hence, counselling initiatives should be undertaken to ensure the safe and effective use of paracetamol in children. Full article
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9 pages, 270 KiB  
Article
Dental Profile of Brazilian Patients with Rare Skeletal Genetic Disorders: Clinical Features and Associated Factors
by Ivanete Cláudia de Oliveira Vilar, Jennifer Reis-Oliveira, Gabriela Lopes Ângelo Dornas, Mauro Henrique Nogueira Guimarães de Abreu, Natália Cristina Ruy Carneiro and Ana Cristina Borges-Oliveira
Healthcare 2024, 12(10), 1046; https://doi.org/10.3390/healthcare12101046 - 19 May 2024
Viewed by 499
Abstract
The aim of this study is to compare the dental profiles of Brazilian patients with rare genetic skeletal disorders and normotypical patients. A cross-sectional study was carried out with 210 individuals aged between 2 and 54 years old [105 with rare diseases (Mucopolysaccharidosis/MPS [...] Read more.
The aim of this study is to compare the dental profiles of Brazilian patients with rare genetic skeletal disorders and normotypical patients. A cross-sectional study was carried out with 210 individuals aged between 2 and 54 years old [105 with rare diseases (Mucopolysaccharidosis/MPS n = 27 and Osteogenesis Imperfecta/OI n = 78) and 105 without rare diseases] and their parents/caregivers. The parents/caregivers answered a questionnaire about individual aspects of their child and the dental profile was identified from questions related to dental history and the presence/absence of dental problems. The patients’ oral cavity was also examined by three examiners for dental caries, malocclusion, gingivitis, and dental anomalies. The average age of individuals with a rare disease was 14.1 years (±12.2) and the median was 9.5 years. Participants who had already used the public health system (SUS) dental care services had a 2.24 times higher chance of belonging to the group with a rare disease (OR = 2.24; 95% CI: 1.07–4.89). Patients with rare diseases are 14.86 times more likely to have difficulty receiving dental treatment (OR = 14.86; 95% CI: 5.96–27.03) and 10.38 times more likely to have one or more dental problems (OR = 10.38; 95% CI: 1.95–35.17). Individuals with rare disorders have a greater history of difficulty in accessing dental treatment, using the SUS, and were diagnosed with more dental problems compared to normotypical individuals. Full article
(This article belongs to the Special Issue Contemporary Oral and Dental Health Care: Issues and Challenges)
23 pages, 783 KiB  
Article
Community-Based Health Education Led by Women’s Groups Significantly Improved Maternal Health Service Utilization in Southern Ethiopia: A Cluster Randomized Controlled Trial
by Amanuel Yoseph, Wondwosen Teklesilasie, Francisco Guillen-Grima and Ayalew Astatkie
Healthcare 2024, 12(10), 1045; https://doi.org/10.3390/healthcare12101045 - 18 May 2024
Viewed by 687
Abstract
Objective: This study aimed to evaluate the effect of health education intervention (HEI) on maternal health service utilization (MHSU) in southern Ethiopia. Methods: From 10 January to 1 August 2023, a community-based, two-arm, parallel-group cluster randomized controlled trial (cRCT) was conducted among pregnant [...] Read more.
Objective: This study aimed to evaluate the effect of health education intervention (HEI) on maternal health service utilization (MHSU) in southern Ethiopia. Methods: From 10 January to 1 August 2023, a community-based, two-arm, parallel-group cluster randomized controlled trial (cRCT) was conducted among pregnant mothers in the Northern Zone of Sidama National Regional State, Ethiopia. We utilized multilevel mixed-effects modified Poisson regression with robust variance to control for the effects of clustering and potential confounders. The level of significance was adjusted for multiple comparisons. Results: The overall utilization of at least one antenatal care (ANC) visit was 90.2% in the treatment group and 59.5% in the comparator group (χ2 = 89.22, p < 0.001). Health facility delivery (HFD) utilization was considerably different between the treatment group (74.3%) and the comparator group (50.8%) (χ2 = 70.50, p < 0.001). HEI significantly increased ANC utilization (adjusted risk ratio [ARR]: 1.32; 99% CI: 1.12–1.56) and HFD utilization (ARR: 1.24; 99% CI: 1.06–1.46). The utilization of at least one postnatal care (PNC) service was 65.4% in the treatment group and 52.1% in the comparator group (χ2 = 19.51, p = 0.01). However, after controlling for the effects of confounders and clustering, the impact of HEI on PNC utilization was insignificant between the two groups (ARR: 1.15; 99% CI: 0.89–1.48). Conclusion: A community-based HEI significantly increased ANC and HFD utilization but did not increase PNC utilization. Expanding the HEI with certain modifications will have a superior effect on improving MHSU. Trial registration number: NCT05865873. Full article
(This article belongs to the Special Issue Research into Women's Health and Care Disparities)
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15 pages, 453 KiB  
Article
Prisoners’ Perceptions and Satisfaction with Telepsychiatry Services in Greece and the Effects of Its Use on the Coercion of Mental Healthcare
by Evangelia Karachaliou, Phoebe Douzenis, Fotios Chatzinikolaou, Nikos Pantazis, Sophia Martinaki, Panagiota Bali, Konstantinos Tasios and Athanasios Douzenis
Healthcare 2024, 12(10), 1044; https://doi.org/10.3390/healthcare12101044 - 18 May 2024
Viewed by 476
Abstract
Background: Prisoners are often associated with mental health and substance use disorders. Coercive measures are widely used in prison settings. The objective of this study was to compare inmates’ perceptions and satisfaction with telepsychiatry versus face-to-face consultation and the effects of telepsychiatry on [...] Read more.
Background: Prisoners are often associated with mental health and substance use disorders. Coercive measures are widely used in prison settings. The objective of this study was to compare inmates’ perceptions and satisfaction with telepsychiatry versus face-to-face consultation and the effects of telepsychiatry on the use of coercive measures. The sample consisted of 100 male inmates from various backgrounds who had experienced both approaches of services (face to face and telepsychiatry). Method: The data were obtained through an interview where the individuals completed a Demographic Data Questionnaire, a Participant Satisfaction Questionnaire to assess satisfaction with face-to-face psychiatric services, and a Participant Satisfaction Questionnaire to assess their satisfaction with services offered via telepsychiatry. Additionally, calculations of time spent waiting for a face-to-face psychiatric evaluation and time spent in handcuffs and in confined spaces were made before and after the introduction of telepsychiatry. Results: Statistically significant improvements (all p-values < 0.001) were noted in waiting times, support for relapse prevention, follow up, quality of mental health care, quality of care in the management of psychiatric problems and related medication, behavior of psychiatrists, duration of the assessment, sense of comfort, and confidentiality. Telepsychiatry led to the elimination of time spent in handcuffs and in confined spaces (transport vehicles). Conclusion: According to the results of this study, telepsychiatry is an acceptable method of service delivery in correctional facilities and was associated with a reduction of coercive practices. Full article
(This article belongs to the Special Issue Moving Away from Coercion in Mental Health Care)
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11 pages, 421 KiB  
Article
Use of Different Iron Preparations for Prophylaxis and Effects on Iron Status in Infancy
by Merve Tosyalı, Yavuz Demirçelik, Özlem Bağ, Utku Karaarslan, Şule Gökçe and Feyza Koç
Healthcare 2024, 12(10), 1043; https://doi.org/10.3390/healthcare12101043 - 18 May 2024
Viewed by 572
Abstract
Aim: To evaluate using different iron preparations for iron deficiency and/or iron deficiency anemia prophylaxis in infants and their iron status. Methods: In this study, we retrospectively evaluated the electronic patient records of 651 healthy children aged 9 to 13 months who met [...] Read more.
Aim: To evaluate using different iron preparations for iron deficiency and/or iron deficiency anemia prophylaxis in infants and their iron status. Methods: In this study, we retrospectively evaluated the electronic patient records of 651 healthy children aged 9 to 13 months who met the inclusion criteria and who were followed up in pediatric follow-up outpatient clinics between January 2023 and June 2023. Results: A total of 651 children with a mean age of 11.2 ± 1.4 months, 54.7% of whom were boys, who met the inclusion criteria were included in the study; 56.5% of the children were using Fe + 3 salt and the others were using Fe + 2 salt, microencapsulated iron, or sucrosomial iron drops. After the fifth month of prophylaxis, when the effects of the iron preparations used on the mean laboratory values were evaluated, it was found that hemoglobin, serum iron, and ferritin levels were lower in sucrosomial iron and microencapsulated iron users compared to other preparations (p = 0.001). When statistically pairwise comparisons were made between the groups, hemoglobin and serum iron values were found to be lower in the group using sucrosomial iron compared to the groups using Fe + 2 and Fe + 3 salts (p < 0.0001). Hemoglobin and ferritin levels were higher in the group using Fe + 2 salt compared to both sucrosomial iron and microencapsulated iron groups (p < 0.0001). When the infants were evaluated according to iron status, it was found that 208 (31.9%) had iron deficiency. Iron deficiency was found to be less in infants of families who defined their economic status as rich and in infants who used iron regularly (p-values 0.044 and 0.001, respectively). Iron deficiency/iron deficiency anemia was observed at a higher rate in the group using sucrosomial iron and microencapsulated iron prophylaxis (p = 0.001). Conclusions: To prevent iron deficiency, it is very important to use appropriate iron preparations for prophylaxis and to feed foods with high iron content. Although we found that families were willing to use different iron preparations other than iron salts for their infants, the results presented herein indicate that the rate of iron deficiency was lower in patients using iron salts. However, randomized controlled studies are needed to determine whether these preparations are effective in iron prophylaxis in infants. Full article
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32 pages, 614 KiB  
Systematic Review
Factors Influencing Social Isolation among Cancer Patients: A Systematic Review
by Can Wang, Xiaoke Qiu, Xueli Yang, Jiayu Mao and Qiuping Li
Healthcare 2024, 12(10), 1042; https://doi.org/10.3390/healthcare12101042 - 17 May 2024
Viewed by 657
Abstract
(1) Background: Social isolation, which has numerous adverse effects on health status, is prevalent among cancer patients. This review proposes to identify the influencing factors of social isolation among cancer patients. (2) Methods: Articles published in English or Chinese from six electronic databases [...] Read more.
(1) Background: Social isolation, which has numerous adverse effects on health status, is prevalent among cancer patients. This review proposes to identify the influencing factors of social isolation among cancer patients. (2) Methods: Articles published in English or Chinese from six electronic databases before December 2023 were identified via a systematic search. A manual search was also performed. (3) Results: Twenty-eight studies were identified in this systematic review. The factors associated with social isolation can be summarized into the following categories: demographic characteristics, having cancer, health status, coping, social support and social interaction. Despite the heterogeneity, 20 factors were significantly associated with social isolation, including age, gender, comorbidity burden, education level, residence, medical insurance, occupation status, personality, race, smoking status, having children, not living alone, household income level, marital status, the role of primary caregiver, physical health status, mental health status, social health status, coping styles, and the level of social support and social interaction. (4) Conclusions: The systematic review showed that cancer patients’ social isolation was influenced by their demographic characteristics, cancer-related factors, physical condition, psychological status, social health status, coping styles, and level of social support and social interaction. In addition, future group intervention could be considered to improve social isolation. Full article
(This article belongs to the Section Nursing)
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13 pages, 223 KiB  
Article
A Cost–Consequence Analysis of Nutritional Interventions Used in Hospital Settings for Older Adults with or at Risk of Malnutrition
by Alvin Wong, Yingxiao Huang, Merrilyn D. Banks, P. Marcin Sowa and Judy D. Bauer
Healthcare 2024, 12(10), 1041; https://doi.org/10.3390/healthcare12101041 - 17 May 2024
Viewed by 581
Abstract
Background: Malnutrition is a significant and prevalent issue in hospital settings, associated with increased morbidity and mortality, longer hospital stays, higher readmission rates, and greater healthcare costs. Despite the potential impact of nutritional interventions on patient outcomes, there is a paucity of research [...] Read more.
Background: Malnutrition is a significant and prevalent issue in hospital settings, associated with increased morbidity and mortality, longer hospital stays, higher readmission rates, and greater healthcare costs. Despite the potential impact of nutritional interventions on patient outcomes, there is a paucity of research focusing on their economic evaluation in the hospital setting. This study aims to fill this gap by conducting a cost–consequence analysis (CCA) of nutritional interventions targeting malnutrition in the hospital setting. Methods: We performed a CCA using data from recent systematic reviews and meta-analyses, focusing on older adult patients with or at risk of malnutrition in the hospital setting. The analysis included outcomes such as 30-day, 6-month, and 12-month mortality; 30-day and 6-month readmissions; hospital complications; length of stay; and disability-adjusted life years (DALYs). Sensitivity analyses were conducted to evaluate the impact of varying success rates in treating malnutrition and the proportions of malnourished patients seen by dietitians in SingHealth institutions. Results: The CCA indicated that 28.15 DALYs were averted across three SingHealth institutions due to the successful treatment or prevention of malnutrition by dietitians from 1 April 2021 to 31 March 2022, for an estimated 45,000 patients. The sensitivity analyses showed that the total DALYs averted ranged from 21.98 (53% success rate) to 40.03 (100% of malnourished patients seen by dietitians). The cost of implementing a complex nutritional intervention was USD 218.72 (USD 104.59, USD 478.40) per patient during hospitalization, with additional costs of USD 814.27 (USD 397.69, USD 1212.74) when the intervention was extended for three months post-discharge and USD 638.77 (USD 602.05, USD 1185.90) for concurrent therapy or exercise interventions. Conclusion: Nutritional interventions targeting malnutrition in hospital settings can have significant clinical and economic benefits. The CCA provides valuable insights into the costs and outcomes associated with these interventions, helping healthcare providers and policymakers to make informed decisions on resource allocation and intervention prioritization. Full article
40 pages, 1694 KiB  
Review
Cultural Competence Interventions in European Healthcare: A Scoping Review
by Berta De-María, Gabriela Topa and M. Angeles López-González
Healthcare 2024, 12(10), 1040; https://doi.org/10.3390/healthcare12101040 - 17 May 2024
Viewed by 745
Abstract
Europe is undergoing rapid social change and is distinguished by its cultural superdiversity. Healthcare is facing an increasing need for professionals to adapt to this environment. Thus, the promotion of cultural competence in healthcare has become a priority. However, the training being developed [...] Read more.
Europe is undergoing rapid social change and is distinguished by its cultural superdiversity. Healthcare is facing an increasing need for professionals to adapt to this environment. Thus, the promotion of cultural competence in healthcare has become a priority. However, the training being developed and their suitability for the European context are not well known. The aim of this qualitative study has been to map the scientific literature in order to comprehend the current state of research on this topic. For this purpose, we conducted a systematic scoping review of the empirical publications focused on cultural competence interventions for healthcare professionals in European countries. The search was conducted in eight thematic (PsycINFO, MedLine, and PubPsych) and multidisciplinary databases (Academic Search Ultimate, E-Journals, Scopus, ProQuest, and Web of Science) to identify relevant publications up to 2023. Results were presented qualitatively. Out of the initial 6506 records screened, a total of 63 publications were included. Although the interventions were implemented in 23 different European countries, cultural competence interventions have not been widely adopted in Europe. Significant heterogeneity was observed in the conception and operacionalización of cultural competence models and in the implementation of the interventions. The interventions have mostly aimed at improving healthcare for minority population groups and have focused on the racial and ethnic dimensions of the individual. Future research is needed to contribute to the conceptual development of cultural competence to design programs tailored to European superdiversity. This scoping review has been registered in OSF and is available for consultation. Full article
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17 pages, 1103 KiB  
Article
Developing a Tool for Assessing the Process of Seeking Health Information: Online Think-Aloud Method
by Asim Alhejaili, Heather Wharrad and Richard Windle
Healthcare 2024, 12(10), 1039; https://doi.org/10.3390/healthcare12101039 - 17 May 2024
Viewed by 574
Abstract
Nursing students can access massive amounts of online health data to drive cutting-edge evidence-based practice in clinical placement, to bridge the theory–practice gap. This activity requires investigation to identify the strategies nursing students apply to evaluate online health information. Online Think-Aloud sessions enabled [...] Read more.
Nursing students can access massive amounts of online health data to drive cutting-edge evidence-based practice in clinical placement, to bridge the theory–practice gap. This activity requires investigation to identify the strategies nursing students apply to evaluate online health information. Online Think-Aloud sessions enabled 14 participants to express their cognitive processes in navigating various educational resources, including online journals and databases, and determining the reliability of sources, indicating their strategies for information-seeking, which helped to create this scoring system. Easy access and user convenience were clearly the instrumental factors in this behavior, which has troubling implications for the lack of use of higher-quality resources (e.g., from peer-reviewed academic journals). The identified challenges encountered during resource access included limited skills in the critical evaluation of information credibility and reliability, signaling a requirement for improved information literacy skills. Participants acknowledged the importance of evidence-based, high-quality information, but faced numerous barriers, such as restricted access to professional and specialty databases, and a lack of academic skills training. This paper develops and critiques a Performative Tool for assessing the process of seeking health information using an online Think-Aloud method, and explores factors and strategies contributing to evidence-based health information access and utilization in clinical practice, aiming to provide insight into individuals’ information-seeking behaviors in online health contexts. Full article
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13 pages, 6656 KiB  
Article
Effects of Manual Lymphatic Drainage with Mobilization and Myofascial Release on Muscle Activities during Dynamic Balance in Adults with Calf Muscle Shortening
by Se-Yeon Kim, Ki-Song Kim and Young-In Hwang
Healthcare 2024, 12(10), 1038; https://doi.org/10.3390/healthcare12101038 - 17 May 2024
Viewed by 761
Abstract
Mobilization with movement (MWM) and myofascial release (MFR) are treatment techniques that increase ankle dorsiflexion range of motion (DFROM). Manual lymphatic drainage (MLD) facilitates waste drainage and improves soft tissue tension in peripheral tissues. To date, no studies have investigated how the combination [...] Read more.
Mobilization with movement (MWM) and myofascial release (MFR) are treatment techniques that increase ankle dorsiflexion range of motion (DFROM). Manual lymphatic drainage (MLD) facilitates waste drainage and improves soft tissue tension in peripheral tissues. To date, no studies have investigated how the combination of MLD, MWM, and MFR influences the human body. The purpose of this study is to determine how the combination of MLD, MWM, and MFR affects DFROM and balance ability. We randomly assigned 16 individuals (26 feet) to one of three groups: MWM-MFR (MR), MWM-MLD (MD), or MWM-MFR-MLD (MRD) intervention. To confirm the intervention effect of each group, DFROM was assessed using a modified lunge test, and dynamic balance was measured using a modified star excursion balance test. In the results, differences were found between the MR and MRD groups in PL and mGCM activities in the 1 section (p = 0.008, p = 0.036) and between the MD and MRD groups in mGCM activity in the 4 and 5 sections (p = 0.049, p = 0.004). We suggest that the application of MRD is the most effective intervention for increasing muscle activation of the PL and mGCM during the modified star excursion balance test. Full article
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12 pages, 277 KiB  
Article
The Perceived Quality of Life of Older People in Spain Who Care for Grandchildren and Related Variables: A Mixed Methods Study
by Sofía García-Sanjuán, Ana Isabel Gutiérrez-García, María José Cabañero-Martínez, Juan Miguel Aguilar-Sánchez, María Carmen Rocamora-Rodríguez and Silvia Escribano
Healthcare 2024, 12(10), 1037; https://doi.org/10.3390/healthcare12101037 - 16 May 2024
Viewed by 500
Abstract
Grandparental care of grandchildren is a prevalent social phenomenon. This study explores the perceptions of health-related quality of life of grandparents caring for their grandchildren. A mixed methods design was developed. In the first phase, participants were interviewed using a baseline questionnaire. The [...] Read more.
Grandparental care of grandchildren is a prevalent social phenomenon. This study explores the perceptions of health-related quality of life of grandparents caring for their grandchildren. A mixed methods design was developed. In the first phase, participants were interviewed using a baseline questionnaire. The second phase consisted of focus groups with 19 of the 100 participants in the quantitative phase. The scores obtained from the quantitative analysis are in line with the qualitative data; they reflect that grandparent carers who are more involved in the care of their grandchildren have more symptoms of depression and stress and have poorer perceptions of physical health-related quality of life. What may at first appear to be a positive aspect, keeping grandparent carers active, can become negative when it comes to shared care and when the grandparents’ willingness to provide care is abused. Full article
(This article belongs to the Special Issue Aging and Quality of Life)
31 pages, 1517 KiB  
Systematic Review
Assessment of the Effects of Physiotherapy on Back Care and Prevention of Non-Specific Low Back Pain in Children and Adolescents: A Systematic Review and Meta-Analysis
by José Manuel García-Moreno, Inmaculada Calvo-Muñoz, Antonia Gómez-Conesa and José Antonio López-López
Healthcare 2024, 12(10), 1036; https://doi.org/10.3390/healthcare12101036 - 16 May 2024
Viewed by 755
Abstract
Non-specific low back pain (NSLBP) in children and adolescents has increased in recent years, and the evidence of the physiotherapy interventions in back care needs to be updated. Our main goal was to quantify the effects of preventive physiotherapy interventions on improving behavior [...] Read more.
Non-specific low back pain (NSLBP) in children and adolescents has increased in recent years, and the evidence of the physiotherapy interventions in back care needs to be updated. Our main goal was to quantify the effects of preventive physiotherapy interventions on improving behavior and knowledge related to back care and prevention of NSLBP in children and adolescents. Based on two previous meta-analyses, Cochrane Library, MEDLINE, PEDro, Web of Science, LILACS, IBECS, PsycINFO, and IME databases and several journals were searched. Two researchers independently extracted data and assessed the risk of bias in the studies using the RoB2 tool. Data were described according to PRISMA guidelines. A total of 24 studies (28 reports) were included. In the posttest, the behavior variable obtained an overall effect size of d+ = 1.48 (95%CI: 0.40 to 2.56), and the knowledge variable obtained an effect size of d+ = 1.41 (95%CI: 1.05 to 1.76). Physiotherapy has demonstrated beneficial impacts on behavior and knowledge concerning back care and to prevent NSLBP in children and adolescents. Interventions focusing on postural hygiene and exercise should be preferred, especially those that are shorter in number of weeks, more intense, and incorporate as many intervention hours as possible. Full article
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22 pages, 1404 KiB  
Systematic Review
The Effect of Different Electric Toothbrush Technologies on Interdental Plaque Removal: A Systematic Review with a Meta-Analysis
by Robert David Lewis, Shalini Kanagasingam, Neil Cook, Marta Krysmann, Kathryn Taylor and Flavio Pisani
Healthcare 2024, 12(10), 1035; https://doi.org/10.3390/healthcare12101035 - 16 May 2024
Viewed by 535
Abstract
The removal of dental plaque from the gingival margins of the teeth is essential to maintaining periodontal health. Whilst it has been established that electric toothbrushes demonstrate a greater ability to remove plaque, no systematic review has specifically investigated which technology is better [...] Read more.
The removal of dental plaque from the gingival margins of the teeth is essential to maintaining periodontal health. Whilst it has been established that electric toothbrushes demonstrate a greater ability to remove plaque, no systematic review has specifically investigated which technology is better for removing plaque from the interdental tooth surfaces, where plaque control may be more difficult. Three databases were searched until October 2023: MEDLINE and DOSSS via EBSCOhost and Embase. Data extraction was carried out on studies which met the inclusion criteria, and a risk of bias assessment was completed. The study findings were combined via a narrative synthesis and a meta-analysis where appropriate. A total of 77 studies were found, out of which 14 were selected and included in the analysis. The mean difference in interproximal plaque reduction, measured using the Rustogi Modified Naval Plaque Index (RMNPI) at 8 weeks, was 0.09 (p < 0.00001) in favor of the oscillating–rotating toothbrush. At 6 and 12 weeks, the mean difference in plaque reduction (RMNPI) was 0.05 (p = 0.0008) and 0.04 (p = 0.0001) in favor of the oscillating–rotating toothbrush, respectively. The studies show a tendency for oscillating–rotating toothbrushes to remove more interproximal plaque than oscillating toothbrushes, especially in a short time (8 weeks). Full article
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12 pages, 703 KiB  
Article
The Relationship and Effects of Self-Esteem and Body Shape on Eating Disorder Behavior: A Cross-Sectional Survey of Chinese University Students
by Zeng Gao, Jingyi Zhao, Sanying Peng and Han Yuan
Healthcare 2024, 12(10), 1034; https://doi.org/10.3390/healthcare12101034 - 16 May 2024
Viewed by 704
Abstract
Background: Eating disorders (EDs) have become a global public health concern among adolescents and young adults. However, Chinese university students exhibit a high prevalence of eating disorders. This study aims to investigate the effects of self-esteem (SE) and body shape (BS) on ED [...] Read more.
Background: Eating disorders (EDs) have become a global public health concern among adolescents and young adults. However, Chinese university students exhibit a high prevalence of eating disorders. This study aims to investigate the effects of self-esteem (SE) and body shape (BS) on ED behaviors among Chinese university students. Methods: Using random sampling, 946 Chinese university students (aged 18 to 24, M = 19.94, SD = 1.04) participated in a survey comprising the Sick, Control, One, Fat, and Food Questionnaire (SCOFF-Q), the Body Shape Questionnaire (BS-Q), and the Rosenberg Self-Esteem Scale (RS-S) to assess their eating disorder or non-eating disorder (NED) behavior. Results: There was a significant positive correlation between body shape and eating disorder behaviors (r = 0.19, p < 0.01), while there was a significant negative correlation between self-esteem and eating disorder behaviors (r = −0.14, p = 0.001 < 0.01). Gender was a moderating factor in the relationship between body shape and eating disorder behaviors (t = 3.14, p = 0.002 < 0.01), while parents’ marital status was a moderating factor in the relationship between self-esteem and eating disorder behavior (t = 2.72, p = 0.007 < 0.01). Body shape (z = 6.47, p = 0.001 < 0.01), self-esteem (z = −2.81, p = 0.005 < 0.05), and gender (z = 3.06, p = 0.002 < 0.01) significantly influenced eating disorder behavior among Chinese university students aged 18–24 years. Conclusions: There was a direct effect between body shape and self-esteem and eating disorder behaviors among Chinese university students aged 18–24 years. Alarmingly, female university students are becoming susceptible to external influences on self-esteem and body shape, leading to eating disorder behaviors at an increasingly younger age in China. Full article
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15 pages, 975 KiB  
Article
Online Video-Mediated Compassion Training Program for Mental Health and Well-Being of University Students
by Thupten Tendhar, Melissa Ann Marcotte, Paul Bueno de Mesquita and Manob Jyoti Saikia
Healthcare 2024, 12(10), 1033; https://doi.org/10.3390/healthcare12101033 - 16 May 2024
Viewed by 719
Abstract
College students experiencing psychological distress have significantly greater negative emotions than students who practice compassionate thinking. We have developed Eight Steps to Great Compassion (ESGC), an innovative brief and no-cost online video training program about how to increase compassion among busy and young [...] Read more.
College students experiencing psychological distress have significantly greater negative emotions than students who practice compassionate thinking. We have developed Eight Steps to Great Compassion (ESGC), an innovative brief and no-cost online video training program about how to increase compassion among busy and young adult university students. To examine the effectiveness and benefits of the ESGC, a single-group pre-test–post-test quantitative design with undergraduate university students (N = 92; Mage = 20.39) evaluated its effects. The results from the post-test showed that the ESGC had a significant positive impact on increased feelings of compassion towards oneself, compassion for others, and the sense of personal well-being from the pre-test. The analysis of the PERMA-Profiler subscales also reflected a statistically significant increase in overall well-being and health and a decrease in negative emotions and loneliness. From the Post-Survey Lesson Feedback, 88% of the participants reported significant positive changes in themselves and the way that they live due to the program. These findings appear to show important implications for improving healthy minds and reducing negative emotions among university students. Full article
(This article belongs to the Special Issue Psychological Well-Being for Adolescents and Youths)
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10 pages, 258 KiB  
Article
Assessment of Postpartum Stress Using the Maternal Postpartum Stress Scale (MPSS) in Spanish Women
by Sergio Martínez Vázquez, Adrián Ruíz Perete, Alejandro de la Torre-Luque, Sandra Nakić Radoš, Maja Brekalo, Carmen Amezcua-Prieto and Rafael A. Caparros-Gonzalez
Healthcare 2024, 12(10), 1032; https://doi.org/10.3390/healthcare12101032 - 16 May 2024
Viewed by 573
Abstract
Although scales that evaluate postpartum stress exist, they lack specificity in maternal postpartum stress. The MPSS was created because there was a need to assess maternal stress during the postpartum stage. The introduction of the MPSS has enriched the evaluation tools for postpartum [...] Read more.
Although scales that evaluate postpartum stress exist, they lack specificity in maternal postpartum stress. The MPSS was created because there was a need to assess maternal stress during the postpartum stage. The introduction of the MPSS has enriched the evaluation tools for postpartum stress and has helped understand maternal stress at various postpartum time points and identify women at high risk for postpartum stress during this period. The aim was to translate the MPSS into Spanish and study its psychometric properties. Postpartum women (N = 167) with a mean age of 34.26 (SD = 4.71) were involved in this study. In addition to the MPSS, a battery of instruments was administered: a demographic sheet, the Birth Satisfaction Scale-Revised (BSS-R) and the Edinburgh Postnatal Depression Scale (EPDS). The MPSS data were analyzed, checking item communality first. As a result, three items showed unsatisfactory communality values (h2 < 0.40). Confirmatory Factor Analysis was conducted, comparing factor models using the full pool of MPSS items or the version without items with unacceptable communality. As a result, the original three-factor structure was endorsed on the Spanish MPSS, with better fit indices when removing items with low communality (RMSEA = 0.067, CFI = 0.99, TLI = 0.99). The reliability of this version was satisfactory (ω = 0.93). Finally, group comparisons for some perinatal variables were performed, showing no significant differences between groups of interest (p = 0.05 and above). To conclude, the MPSS will contribute to the existing literature, having a wider capacity to assess perinatal mental health difficulties in Spanish-speaking populations. Full article
24 pages, 587 KiB  
Review
Assessing the Competence of Nursing Students in Clinical Practice: The Clinical Preceptors’ Perspective
by Watin Arif Alkhelaiwi, Marian Traynor, Katherine Rogers and Iseult Wilson
Healthcare 2024, 12(10), 1031; https://doi.org/10.3390/healthcare12101031 - 16 May 2024
Viewed by 853
Abstract
Nursing students’ integration of theoretical knowledge and practical abilities is facilitated by their practice of nursing skills in a clinical environment. A key role of preceptors is to assess the learning goals that nursing students must meet while participating in clinical practice. Consequently, [...] Read more.
Nursing students’ integration of theoretical knowledge and practical abilities is facilitated by their practice of nursing skills in a clinical environment. A key role of preceptors is to assess the learning goals that nursing students must meet while participating in clinical practice. Consequently, the purpose of this study was to explore the current evidence in relation to competency assessment and assessment approaches, and the willingness of preceptors for assessing nursing students’ competency in a clinical setting. The scoping review used the five-stage methodological framework that was developed by Arksey and O’Malley, as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Relevant studies were searched by applying a comprehensive literature search strategy up to April 2024 across the following databases: CINAHL, OVID MEDLINE, EMBASE, and PUBMED. A total of 11,297 studies published between 2000 and April 2024 were revealed, and 38 were eligible for inclusion, which the research team categorised into three main themes: definitions of competence, tools for assessing competence and preceptors’ and mentors’ viewpoints in relation to the assessment of nursing students’ competence. This review established that there are a multitude of quantitative instruments available to assess clinical competence; however, a lack of consistency among assessment instruments and approaches between countries and higher education institutions is prevalent. Existing research evidence suggests that the preceptors carried out the assessment process clinically and they found difficulties in documenting assessment. The assessing of nursing students’ competency and the complexity of assessment is a concern for educators and mentors worldwide. The main concern centers around issues such as the interpretation of competence and complex measurement tools. Full article
(This article belongs to the Collection Current Nursing Practice and Education)
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11 pages, 2392 KiB  
Article
Current Status and Barriers of Exercise in Individuals with Spinal Cord Injuries in Korea: A Survey
by Yuna Kim, Sung-Hwa Ko, Jung-Lim Lee and Sungchul Huh
Healthcare 2024, 12(10), 1030; https://doi.org/10.3390/healthcare12101030 - 16 May 2024
Viewed by 544
Abstract
This study investigated exercise participation, health status, and barriers to exercise in 109 individuals with spinal cord injury (SCI) using a self-report questionnaire. The responses of the exercise and non-exercise groups were statistically analyzed using t-tests or Fisher’s exact test. Significant differences were [...] Read more.
This study investigated exercise participation, health status, and barriers to exercise in 109 individuals with spinal cord injury (SCI) using a self-report questionnaire. The responses of the exercise and non-exercise groups were statistically analyzed using t-tests or Fisher’s exact test. Significant differences were observed in the cause of injury and the American Spinal Injury Association Impairment Scale between the groups. The non-exercise group had a higher incidence of traumatic and complete injuries. Demographic factors such as gender, age, income level, and marital status did not significantly influence exercise participation. The exercise group reported lower pain scores, less inconvenience from complications, and higher activity and participation scores. However, less than half of the individuals with SCI met the recommended exercise intensity, and community facility usage was low. Barriers to exercise participation included severe disabilities, lack of time, insufficient exercise information, and lack of facility accessibility. To enhance exercise among individuals with SCI, it is essential to develop and extend exercise programs tailored to individual physical factors and a comprehensive understanding of barriers. Prioritizing community-based data management, alongside developing social systems and health policies, is crucial to overcome barriers to exercise participation for individuals with SCI. Full article
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13 pages, 2514 KiB  
Article
Relationship between Spinal Range of Motion and Functional Tests in University Students: The Role of Demographic Factors
by Nela Tatiana Balint, Bogdan Alexandru Antohe, Huseyin Sahin Uysal, Alina Mihaela Cristuță and Marinela Rață
Healthcare 2024, 12(10), 1029; https://doi.org/10.3390/healthcare12101029 - 16 May 2024
Viewed by 569
Abstract
Spinal disorders are some of the most prevalent health concerns, especially among students. Based on student demographics, this cross-sectional study evaluated the correlation between functional tests (FTs) and spinal range of motion (ROM). This study included 206 students (age = 19.85 ± 1.80 [...] Read more.
Spinal disorders are some of the most prevalent health concerns, especially among students. Based on student demographics, this cross-sectional study evaluated the correlation between functional tests (FTs) and spinal range of motion (ROM). This study included 206 students (age = 19.85 ± 1.80 years) from the Vasile Alecsandri University of Bacău. Participants’ assessments were conducted using the following tests: (i) Ott, (ii) Schober, (iii) Stibor, (iv) finger-to-floor distance, (v) lateral flexion of the cervical and lumbar spine, and (vi) flexion of the cervical spine. Correlation analyses were evaluated using the Spearman correlation coefficient analysis. The results indicated a very strong relationship between lateral flexion of the lumbar spine on the left (LFLSL) and right (LFLSR) for all departments (r = 0.85 to 0.97, p < 0.05). There was a stronger relationship between FT results and spinal ROM for physical-education-department students compared to students from other departments (n = 17, r = −0.38 to 0.93, p < 0.05). There was no statistically significant correlation between FTs and spinal ROM based on age (p > 0.05). The study results provide evidence of the primary risk factors that predispose students to postural deviations. Practitioners and physiotherapists can utilize these values as a reference for potential therapeutic interventions. Full article
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18 pages, 3243 KiB  
Article
Prediction Model for Cognitive Impairment among Disabled Older Adults: A Development and Validation Study
by Xiangyu Cui, Xiaoyu Zheng and Yun Lu
Healthcare 2024, 12(10), 1028; https://doi.org/10.3390/healthcare12101028 - 15 May 2024
Viewed by 667
Abstract
Disabled older adults exhibited a higher risk for cognitive impairment. Early identification is crucial in alleviating the disease burden. This study aims to develop and validate a prediction model for identifying cognitive impairment among disabled older adults. A total of 2138, 501, and [...] Read more.
Disabled older adults exhibited a higher risk for cognitive impairment. Early identification is crucial in alleviating the disease burden. This study aims to develop and validate a prediction model for identifying cognitive impairment among disabled older adults. A total of 2138, 501, and 746 participants were included in the development set and two external validation sets. Logistic regression, support vector machine, random forest, and XGBoost were introduced to develop the prediction model. A nomogram was further established to demonstrate the prediction model directly and vividly. Logistic regression exhibited better predictive performance on the test set with an area under the curve of 0.875. It maintained a high level of precision (0.808), specification (0.788), sensitivity (0.770), and F1-score (0.788) compared with the machine learning models. We further simplified and established a nomogram based on the logistic regression, comprising five variables: age, daily living activities, instrumental activity of daily living, hearing impairment, and visual impairment. The areas under the curve of the nomogram were 0.871, 0.825, and 0.863 in the internal and two external validation sets, respectively. This nomogram effectively identifies the risk of cognitive impairment in disabled older adults. Full article
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14 pages, 633 KiB  
Protocol
Investigating the Implementation of Community-Based Stroke Telerehabilitation in England; A Realist Synthesis Study Protocol
by Niki Chouliara, Trudi Cameron, Scott Ballard-Ridley, Rebecca J. Fisher, Jade Kettlewell, Lisa Kidd, Leanna Luxton, Valerie Pomeroy, Rachel C. Stockley, Shirley Thomas and Adam L. Gordon
Healthcare 2024, 12(10), 1027; https://doi.org/10.3390/healthcare12101027 - 15 May 2024
Viewed by 790
Abstract
Telerehabilitation (TR) shows promise as a method of remote service delivery, yet there is little guidance to inform implementation in the context of the National Health Service (NHS) in England. This paper presents the protocol for a realist synthesis study aiming to investigate [...] Read more.
Telerehabilitation (TR) shows promise as a method of remote service delivery, yet there is little guidance to inform implementation in the context of the National Health Service (NHS) in England. This paper presents the protocol for a realist synthesis study aiming to investigate how TR can be implemented to support the provision of high-quality, equitable community-based stroke rehabilitation, and under what conditions. Using a realist approach, we will synthesise information from (1) an evidence review, (2) qualitative interviews with clinicians (n ≤ 30), and patient–family carer dyads (n ≤ 60) from three purposively selected community stroke rehabilitation services in England. Working groups including rehabilitation professionals, service-users and policy-makers will co-develop actionable recommendations. Insights from the review and the interviews will be synthesised to test and refine programme theories that explain how TR works and for whom in clinical practice, and draw key messages for service implementation. This protocol highlights the need to improve our understanding of TR implementation in the context of multidisciplinary, community-based stroke service provision. We suggest the use of a realist methodology and co-production to inform evidence-based recommendations that consider the needs and priorities of clinicians and people affected by stroke. Full article
(This article belongs to the Special Issue Advances in Telerehabilitation for Optimising Recovery)
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24 pages, 473 KiB  
Article
Holistic Sexual-Reproductive Healthcare Services and Needs for Queer Individuals: Healthcare Providers’ Perspectives
by Raikane James Seretlo, Hanlie Smuts and Mathildah Mpata Mokgatle
Healthcare 2024, 12(10), 1026; https://doi.org/10.3390/healthcare12101026 - 15 May 2024
Viewed by 671
Abstract
There are ongoing debates and controversies about whether genderqueer individuals have specific sexual-reproductive healthcare services and needs (SRHSNs). This study intended to identify and explore queer-specific SRHSNs among healthcare providers (HCPs) in Gauteng Province, South Africa. This was an exploratory sequential mixed-methods study, [...] Read more.
There are ongoing debates and controversies about whether genderqueer individuals have specific sexual-reproductive healthcare services and needs (SRHSNs). This study intended to identify and explore queer-specific SRHSNs among healthcare providers (HCPs) in Gauteng Province, South Africa. This was an exploratory sequential mixed-methods study, and this article focuses on the qualitative findings of that investigation. Thirty-three HCPs were purposively sampled, and semi-structured one-on-one interviews were used to collect data between September and November 2023. The data were analyzed using thematic content analysis (TCA). The results of this study revealed nine main themes: a crucial need for inclusive healthcare facilities; a need for psychological, counseling, and therapeutic support in sexual and reproductive healthcare; access to sexual-reproductive education and integrating support; suggested reproductive health services for queer sexual wellness; improved accessibility and particular queer reproductive healthcare; optimizing services related to human immunodeficiency virus (HIV), pre-exposure prophylaxis (PrEP) access, and sexually transmitted illness (STI) treatment; genderqueer persons’ parenthood aspirations and empowerment; the safe availability of intimacy tools; and navigation transitions. A holistic and inclusive healthcare approach that fits psychological support, comprehensive sexual-reproductive education, and specialized services to accommodate the unique needs of queer individuals should be implemented and made easily accessible. Full article
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22 pages, 5285 KiB  
Article
Explainable Artificial Intelligence in Quantifying Breast Cancer Factors: Saudi Arabia Context
by Turki Alelyani, Maha M. Alshammari, Afnan Almuhanna and Onur Asan
Healthcare 2024, 12(10), 1025; https://doi.org/10.3390/healthcare12101025 - 15 May 2024
Viewed by 738
Abstract
Breast cancer represents a significant health concern, particularly in Saudi Arabia, where it ranks as the most prevalent cancer type among women. This study focuses on leveraging eXplainable Artificial Intelligence (XAI) techniques to predict benign and malignant breast cancer cases using various clinical [...] Read more.
Breast cancer represents a significant health concern, particularly in Saudi Arabia, where it ranks as the most prevalent cancer type among women. This study focuses on leveraging eXplainable Artificial Intelligence (XAI) techniques to predict benign and malignant breast cancer cases using various clinical and pathological features specific to Saudi Arabian patients. Six distinct models were trained and evaluated based on common performance metrics such as accuracy, precision, recall, F1 score, and AUC-ROC score. To enhance interpretability, Local Interpretable Model-Agnostic Explanations (LIME) and SHapley Additive exPlanations (SHAP) were applied. The analysis identified the Random Forest model as the top performer, achieving an accuracy of 0.72, along with robust precision, recall, F1 score, and AUC-ROC score values. Conversely, the Support Vector Machine model exhibited the poorest performance metrics, indicating its limited predictive capability. Notably, the XAI approaches unveiled variations in the feature importance rankings across models, underscoring the need for further investigation. These findings offer valuable insights into breast cancer diagnosis and machine learning interpretation, aiding healthcare providers in understanding and potentially integrating such technologies into clinical practices. Full article
(This article belongs to the Section Artificial Intelligence in Medicine)
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15 pages, 824 KiB  
Article
Longitudinal Analysis and Latent Growth Modeling of the Modified Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR)
by Emilie N. Miley, Michael A. Pickering, Scott W. Cheatham, Lindsay W. Larkins, Adam C. Cady and Russell T. Baker
Healthcare 2024, 12(10), 1024; https://doi.org/10.3390/healthcare12101024 - 15 May 2024
Viewed by 579
Abstract
The Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) was developed as a short-form survey to measure progress after total hip arthroplasty (THA). However, the longitudinal validity of the scale structure pertaining to the modified five-item HOOS-JR has not been assessed. [...] Read more.
The Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) was developed as a short-form survey to measure progress after total hip arthroplasty (THA). However, the longitudinal validity of the scale structure pertaining to the modified five-item HOOS-JR has not been assessed. Therefore, the purpose of this study was to evaluate the structural validity, longitudinal invariance properties, and latent growth curve (LGC) modeling of the modified five-item HOOS-JR in a large multi-site sample of patients who underwent a THA. A longitudinal study was conducted using data from the Surgical Outcome System (SOS) database. Confirmatory factor analyses (CFAs) were conducted to assess the structural validity and longitudinal invariance across five time points. Additionally, LGC modeling was performed to assess the heterogeneity of the recovery patterns for different subgroups of patients. The resulting CFAs met most of the goodness-of-fit indices (CFI = 0.964–0.982; IFI = 0.965–0.986; SRMR = 0.021–0.035). Longitudinal analysis did not meet full invariance, exceeding the scalar invariance model (CFIDIFF = 0.012; χ2DIFF test = 702.67). Partial invariance requirements were met upon release of the intercept constraint associated with item five (CFIDIFF test = 0.010; χ2DIFF = 1073.83). The equal means model did not pass the recommended goodness-of-fit indices (CFIDIFF = 0.133; χ2DIFF = 3962.49). Scores significantly changed over time, with the highest scores identified preoperatively and the lowest scores identified at 2- and 3-years postoperatively. Upon conclusion, partial scalar invariance was identified within our model. We identified that patients self-report most improvements in their scores within 6 months postoperatively. Females reported more hip disability at preoperative time points and had faster improvement as measured by the scores of the modified five-item HOOS-JR. Full article
(This article belongs to the Special Issue Patient-Reported Measures)
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15 pages, 749 KiB  
Article
Physician Workforce in Lithuania: Changes during Thirty Years of Independence
by Linas Šablinskas and Mindaugas Stankūnas
Healthcare 2024, 12(10), 1023; https://doi.org/10.3390/healthcare12101023 - 15 May 2024
Viewed by 620
Abstract
Healthcare human resource planning is one of the biggest challenges facing the healthcare systems in many countries. Inadequate decisions in human resource planning can lead to an insufficient number of healthcare professionals then healthcare inequalities. One of the components of resource planning in [...] Read more.
Healthcare human resource planning is one of the biggest challenges facing the healthcare systems in many countries. Inadequate decisions in human resource planning can lead to an insufficient number of healthcare professionals then healthcare inequalities. One of the components of resource planning in the healthcare system is long-term data monitoring and the identification of potential trends. Since 1990, the number of physicians in Lithuania has decreased by 15.3% (−2266), but the decrease in the population has led to a 13.61% increase in the number of physicians per 10,000 inhabitants (5.32). During the analyzed period, the largest decrease in the number of physicians workforce by specialty was the number of medical physicians (−73.08%), epidemiology and hygiene (−69.30%), children’s diseases (−49.08%), the most increased number was of family/general practitioners (GPs), geneticists, physical medicine, and rehabilitation specialists. Since 1992, the number of visits to physicians in Lithuania, which has been decreasing for a long time, began increasing, and in 2022 (9.3 visits) it has almost reached the number of visits (9.5) per capita as in 1991. The aim of this research was to collect long-term data from various databases, summarize them, and identify possible trends and the reasons for data changes. The study analyzed data from the Lithuanian healthcare system from the Declaration of Independence of Lithuania to the last 30 years. The data includes or affects the indicators of the healthcare system, changes in population and doctors, the number of visits to doctors, the number of medical students and residents, and data determining inequalities in the healthcare system. Long-term data analysis is useful for developing a model of healthcare human resource planning and for planning healthcare resources. Full article
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12 pages, 319 KiB  
Article
Healthy Lifestyle Related to Executive Functions in Chilean University Students: A Pilot Study
by Felipe Caamaño-Navarrete, Carlos Arriagada-Hernández, Gerardo Fuentes-Vilugrón, Lorena Jara-Tomckowiack, Alvaro Levin-Catrilao, Pablo del Val Martín, Flavio Muñoz-Troncoso and Pedro Delgado-Floody
Healthcare 2024, 12(10), 1022; https://doi.org/10.3390/healthcare12101022 - 15 May 2024
Viewed by 711
Abstract
Background: A negative lifestyle is reported to be related to cognitive problems. However, there is little information about this in relation to university students. The objective of the present study was to investigate the association between executive functions (EFs) and lifestyle parameters (i.e., [...] Read more.
Background: A negative lifestyle is reported to be related to cognitive problems. However, there is little information about this in relation to university students. The objective of the present study was to investigate the association between executive functions (EFs) and lifestyle parameters (i.e., physical activity (PA), sleep duration, screen time (ST), and food habits) among Chilean university students. Methods: This cross-sectional study included a total of 150 university students (94 females and 56 males, aged 21.28 ± 3.15 and 22.18 ± 2.90 years, respectively). Cognitive outcomes were measured using the CogniFit assessment battery. Lifestyle was measured through validated questionnaires. Results: Across the total sample, attention exhibited a positive association with PA h/week (β: 24.34 95% CI: 12.46 to 36.22, p = 0.001). Additionally, coordination was positively associated with PA h/week (β: 15.06 95% CI: 0.62 to 29.50, p < 0.041). PA h/week was positively linked with reasoning (β: 20.34 95% CI: 4.52 to 36.17, p = 0.012) and perception (β: 13.81 95% CI: 4.14 to 23.49, p = 0.005). Moreover, PA h/week was significantly linked to memory (β: 23.01 95% CI: 7.62 to 38.40, p = 0.004). In terms of the EFs, PA h/week showed a positive association with cognitive flexibility (β: 45.60 95% CI: 23.22 to 67.69, p = 0.001). Conclusions: In conclusion, lifestyle (PA h/week) was positively associated with EFs. Therefore, an increase in PA levels among these students should be a target for community- and university-based interventions in order to promote cognitive development such as attention, coordination, reasoning, perception, memory, and cognitive flexibility. Full article
(This article belongs to the Special Issue Psychological Well-Being for Adolescents and Youths)
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