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Healthcare, Volume 7, Issue 4 (December 2019)

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Open AccessArticle
Study on the Recognition of Exercise Intensity and Fatigue on Runners Based on Subjective and Objective Information
Healthcare 2019, 7(4), 150; https://doi.org/10.3390/healthcare7040150 (registering DOI) - 20 Nov 2019
Abstract
A running exhaustion experiment was used to explore the correlations between the time-frequency domain indexes extracted from the surface electromyography (EMG) signals of targeted muscles, heart rate and exercise intensity, and subjective fatigue. The study made further inquiry into the feasibility of reflecting [...] Read more.
A running exhaustion experiment was used to explore the correlations between the time-frequency domain indexes extracted from the surface electromyography (EMG) signals of targeted muscles, heart rate and exercise intensity, and subjective fatigue. The study made further inquiry into the feasibility of reflecting and evaluating the exercise intensity and fatigue effectively during running using physiological indexes,thus providing individualized guidance for running fitness. Twelve healthy men participated in a running exhaustion experiment with an incremental and constant load. The percentage of heart rate reserve (%HRR), mean power frequency (MPF) and root mean square (RMS) from surface EMG (sEMG) signals of the rectus femoris (RF), biceps femoris (BF), tibialis anterior muscle (TA), and the lateral head of gastrocnemius (GAL) were obtained in real-time. The data were processed and analyzed with the rating of perceived exertion (RPE) scale. The experimental results show that the MPF on all the muscles increased with time, but there was no significant correlation between MPF and RPE in both experiments. Additionally, there was no significant correlation between RMS and RPE of GAL and BF, but there was a negative correlation between RMS and RPE of RF. The correlation coefficient was lower in the constant load mode, with the value of only −0.301. The correlation between RMS and RPE of TA was opposite in both experiments. There was a significant linear correlation between %HRR and exercise intensity (r = 0.943). In the experiment, %HRR was significantly correlated with subjective exercise fatigue (r = 0.954). Based on the above results,the MPF and RMS indicators on the four targeted muscles could not conclusively identify fatigue of lower extremities during running. The %HRR could be used to identify exercise intensity and human fatigue during running and could be used as an indicator of recognizing fatigue and exercise intensity in runners. Full article
Open AccessArticle
Nutritional Knowledge and Self-Reported Nutritional Practice against Malnutrition among Physicians in Jeddah, Saudi Arabia
Healthcare 2019, 7(4), 149; https://doi.org/10.3390/healthcare7040149 (registering DOI) - 19 Nov 2019
Abstract
The new era of healthcare emphasizes the integration of nutritional care into healthcare management to improve patient outcomes. Previous studies indicated that nutritional knowledge among physicians is insufficient. Thus far, only a limited number of studies have assessed nutritional knowledge among Saudi physicians, [...] Read more.
The new era of healthcare emphasizes the integration of nutritional care into healthcare management to improve patient outcomes. Previous studies indicated that nutritional knowledge among physicians is insufficient. Thus far, only a limited number of studies have assessed nutritional knowledge among Saudi physicians, without providing data regarding their views toward practice against malnutrition. Therefore, the aim of the present cross-sectional study was to address this knowledge gap among Saudi physicians in the hospitals of Jeddah, Saudi Arabia. A total of 117 physicians were recruited using a questionnaire to collect physician characteristics, nutritional knowledge, and knowledge and practice related to malnutrition. The mean nutritional knowledge scores were low (50%; SD: 24%). Saudi physicians scored high in questions related to the medical field; however, their knowledge related to nutrition topics was poor. The majority of Saudi physicians agreed that the nutritional management of malnourished patients was difficult at screening (79%), assessment (78%), and treatment (78%) stages. The self-assessed knowledge and interest of physicians toward malnutrition was modest, and they found the malnutrition management to be only moderately relevant to their work. Nutritional knowledge and practice against malnutrition among Saudi physicians is insufficient. Saudi physicians require proper education and training in nutrition. Full article
Open AccessArticle
Influence of Cardiorespiratory Clinical Placements on the Specialty Interest of Physiotherapy Students
Healthcare 2019, 7(4), 148; https://doi.org/10.3390/healthcare7040148 - 17 Nov 2019
Abstract
Clinical placements are an important part of health students’ training. Whilst much value is placed on the clinical environment as a place to learn, there is a paucity of direct evidence about its effectiveness. The aim of this study was to compare the [...] Read more.
Clinical placements are an important part of health students’ training. Whilst much value is placed on the clinical environment as a place to learn, there is a paucity of direct evidence about its effectiveness. The aim of this study was to compare the competence, importance, and interest in cardiorespiratory physiotherapy of students before and after one month of clinical practice. A pre- and post-placement questionnaire about students’ interest in different physiotherapy subspecialties was used. The students with a cardiorespiratory clinical placement showed a significant change in their perception about the importance of the cardiorespiratory specialty (0.348 ± 1.01; p < 0.001), while no significant change was observed in the students without cardiorespiratory placement (−0.014 ± 0.825; p = 0.883). The presence or absence of clinical placements seems to have a definitive impact on students’ choice of a specialty. This implies the need for developing a set of clinical placements in all the subareas of physiotherapy in order to give undergraduate students the opportunity to make a better decision. Full article
Open AccessArticle
Robot Helps When Robot Fits: Examining the Role of Baby Robots in Fertility Promotion
Healthcare 2019, 7(4), 147; https://doi.org/10.3390/healthcare7040147 - 15 Nov 2019
Abstract
Considering China is facing a precipitous decline in its population, there is an emerging trend of developing baby robots to encourage people’s willingness to become “parents”. Based on the decomposed theory of planned behavior and the theory of uncanny valley, this study empirically [...] Read more.
Considering China is facing a precipitous decline in its population, there is an emerging trend of developing baby robots to encourage people’s willingness to become “parents”. Based on the decomposed theory of planned behavior and the theory of uncanny valley, this study empirically investigated whether a baby robot could perform as a prominent antecedent of fertility intention in China, and how this relates to its visual appearance. Consistent with prior research, the current study used a between-subjects design to show (1) a baby robot could significantly improve people’s fertility attitude through temporal visual stimulation; (2) fertility attitude, subjective norms from peers, and perceived behavioral control of finance could significantly contribute to fertility intention. Theoretical contributions and implications are discussed in this study. Full article
(This article belongs to the Special Issue Mobile Health Care with Smart Technology Applications)
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Open AccessArticle
AR-Therapist: Design and Simulation of an AR-Game Environment as a CBT for Patients with ADHD
Healthcare 2019, 7(4), 146; https://doi.org/10.3390/healthcare7040146 - 15 Nov 2019
Abstract
Attention Deficit Hyperactivity Disorder is one of the most common neurodevelopmental disorders in which patients have difficulties related to inattention, hyperactivity, and impulsivity. Those patients are in need of a psychological therapy use Cognitive Behavioral Therapy (CBT) to enhance the way they think [...] Read more.
Attention Deficit Hyperactivity Disorder is one of the most common neurodevelopmental disorders in which patients have difficulties related to inattention, hyperactivity, and impulsivity. Those patients are in need of a psychological therapy use Cognitive Behavioral Therapy (CBT) to enhance the way they think and behave. This type of therapy is mostly common in treating patients with anxiety and depression but also is useful in treating autism, obsessive compulsive disorder and post-traumatic stress disorder. A major limitation of traditional CBT is that therapists may face difficulty in optimizing patients’ neuropsychological stimulus following a specified treatment plan. Other limitations include availability, accessibility and level-of-experience of the therapists. Hence, this paper aims to design and simulate a generic cognitive model that can be used as an appropriate alternative treatment to traditional CBT, we term as “AR-Therapist.” This model takes advantage of the current developments of augmented reality to engage patients in both real and virtual game-based environments. Full article
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Open AccessArticle
Clinical Determinants Affecting Indications for Surgery and Chemotherapy in Recurrent Ovarian Granulosa Cell Tumor
Healthcare 2019, 7(4), 145; https://doi.org/10.3390/healthcare7040145 - 14 Nov 2019
Abstract
Background: Because reports on the management of recurrent granulosa cell tumor have been sparse, a consensus as to which patients should undergo surgical resection and which patients should be considered for chemotherapy has not been established. Methods: A total of 21 tumor recurrences [...] Read more.
Background: Because reports on the management of recurrent granulosa cell tumor have been sparse, a consensus as to which patients should undergo surgical resection and which patients should be considered for chemotherapy has not been established. Methods: A total of 21 tumor recurrences in eight patients with granulosa cell tumor were reviewed. Results: Surgery was performed as the main treatment for 13 recurrences, while chemotherapy was chosen as the main treatment for eight recurrences. Complete tumor resection could be accomplished in 13 of 16 surgeries (81.3%), which include all the ten recurrences without involvement of liver or diaphragm and without ascites. The number of recurrent masses was significantly higher in the early recurrence group (progression free survival < 2 years) than in the late recurrence (progression free survival > 2 years). All cases with a solitary recurrent tumor at an extra-peritoneal site presented a significantly longer progression free survival. Conclusions: For patients with recurrent granulosa cell tumor, surgery may provide the best disease control. In cases with complete resection, the number of recurrent masses was the predictive factor for the next recurrence, and adjuvant chemotherapy might be considered in such cases. Full article
(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)
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Open AccessArticle
Impact of Media Reports and Environmental Pollution on Health and Health Expenditure Efficiency
Healthcare 2019, 7(4), 144; https://doi.org/10.3390/healthcare7040144 - 13 Nov 2019
Abstract
Over the past few decades, China’s rapid economic, energy, and industrial developments have caused serious environmental damage. However, as there are large resource, energy use, economic, and environmental damage differences across Chinese regions, the Chinese government is seeking to reduce city pollution across [...] Read more.
Over the past few decades, China’s rapid economic, energy, and industrial developments have caused serious environmental damage. However, as there are large resource, energy use, economic, and environmental damage differences across Chinese regions, the Chinese government is seeking to reduce city pollution across the country. Most previous analyses have only looked at these issues on a single level; for example, the impact of environmental pollution on health, or energy and environmental efficiency analyses, but there have been few studies that have conducted overall analyses. Further, many of the methods that have been used in previous research have employed one-stage radial or non-radial analyses without considering regional differences. Therefore, this paper developed a meta undesirable two-stage EBM DEA model to analyze the energy, environment, health, and media communication efficiencies in 31 Chinese cities, from which it was found that the productivity efficiency in most cities was better than the health treatment efficiencies, the GDP and fixed asset efficiency improvements were small, the air quality index (AQI) and CO2 efficiencies varied widely between the cities, media report and governance inputs were generally inefficient, the birth rate efficiencies were better than the respiratory disease efficiencies, and the technical gap was best in Guangzhou, Shanghai, and Lhasa. Also, it found that high-income cities have a higher technology gap than upper middle–income cities, and media reports efficiency have a high correlation with respiratory diseases and CO2. Full article
Open AccessProtocol
Randomized Single-Case Experimental Designs in Healthcare Research: What, Why, and How?
Healthcare 2019, 7(4), 143; https://doi.org/10.3390/healthcare7040143 - 13 Nov 2019
Abstract
Health problems are often idiosyncratic in nature and therefore require individualized diagnosis and treatment. In this paper, we show how single-case experimental designs (SCEDs) can meet the requirement to find and evaluate individually tailored treatments. We give a basic introduction to the methodology [...] Read more.
Health problems are often idiosyncratic in nature and therefore require individualized diagnosis and treatment. In this paper, we show how single-case experimental designs (SCEDs) can meet the requirement to find and evaluate individually tailored treatments. We give a basic introduction to the methodology of SCEDs and provide an overview of the available design options. For each design, we show how an element of randomization can be incorporated to increase the internal and statistical conclusion validity and how the obtained data can be analyzed using visual tools, effect size measures, and randomization inference. We illustrate each design and data analysis technique using applied data sets from the healthcare literature. Full article
(This article belongs to the Special Issue N-of-1 Trials in Healthcare)
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Open AccessArticle
Establishing and Sustaining a Culture of Evidence-Based Practice: An Evaluation of Barriers and Facilitators to Implementing the Best Practice Spotlight Organization Program in the Australian Healthcare Context
Healthcare 2019, 7(4), 142; https://doi.org/10.3390/healthcare7040142 - 12 Nov 2019
Abstract
Background: Nurses and midwives are central to the implementation and delivery of quality care through evidence-based practice (EBP). However, implementation of EBP in nursing and midwifery is under-researched with few examples of systematic and sustained change. The Registered Nurses Association of Ontario’s Best-Practice [...] Read more.
Background: Nurses and midwives are central to the implementation and delivery of quality care through evidence-based practice (EBP). However, implementation of EBP in nursing and midwifery is under-researched with few examples of systematic and sustained change. The Registered Nurses Association of Ontario’s Best-Practice Spotlight Organization (BPSO) Program was adopted in South Australia as a framework to systematically implement EBP in two diverse and complex healthcare settings. Methods: The study was a post-implementation, mixed-method evaluation conducted at two healthcare settings in Adelaide, South Australia utilizing qualitative and quantitative data. Proctor’s implementation evaluation framework guided the evaluation design. Information sources included; interviews, focus groups, questionnaires, and document review. Results: Clinical and executive staff (n = 109 participants) from a broad range of stakeholder groups participated in the interviews, focus groups, and returned questionnaires. A number of facilitators directly affecting program implementation were identified; these pertained to embedding continuity into the program’s implementation and delivery, a robust governance structure, and executive sponsorship. Barriers to implementation were also identified. These barriers pertained to organizational or workforce challenges; staff turnover and movement (e.g., secondment), insufficient staff to allow people to attend training, and a lack of organizational commitment to the program, especially at an executive level. As a result of successful implementation, it was observed that over three years, the BPSO program positively influenced the uptake and implementation of EBP by clinicians and the organizations into which they were introduced. Conclusions: The BPSO model can be translocated to new healthcare systems and has the potential to act as a mechanism for establishing and sustaining EBP change. This study was the first to apply an implementation evaluation framework to the BPSO program, which allowed for structured analysis of facilitating or impeding factors that affected implementation success. The findings have important implications for other health systems looking to translocate the same or similar EBP programs, as well as contributing to the growing body of implementation evaluation literature. Full article
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Open AccessReview
Oral Appliances in Obstructive Sleep Apnea
Healthcare 2019, 7(4), 141; https://doi.org/10.3390/healthcare7040141 - 08 Nov 2019
Abstract
Oral appliance therapy is increasingly prescribed as a non-invasive treatment option for patients diagnosed with obstructive sleep apnea. The custom-made titratable mandibular advancement devices (MAD) are the recommended type of oral appliances. Mandibular advancement devices are efficacious in reducing the severity of obstructive [...] Read more.
Oral appliance therapy is increasingly prescribed as a non-invasive treatment option for patients diagnosed with obstructive sleep apnea. The custom-made titratable mandibular advancement devices (MAD) are the recommended type of oral appliances. Mandibular advancement devices are efficacious in reducing the severity of obstructive sleep apnea, however, only to a lesser extent than standard therapy using continuous positive airway pressure (CPAP). Although oral appliance therapy is known to reduce the severity of obstructive sleep apnea in most of the patients, one out of three patients still show negligible improvement under MAD therapy. Therefore, the selection of the appropriate candidates for this therapy is imperative and several upfront prediction tools are described. Overall, the health outcome of mandibular advancement device therapy is similar to that of CPAP, probably due to the inferior compliance of CPAP compared to MAD therapy, resulting in similar clinical effectiveness. Full article
(This article belongs to the Special Issue Management of Obstructive Sleep Apnoea)
Open AccessArticle
Parental Influence in Forming Preschool Children’s Eating Behaviors—A Cross-Sectional Survey in Chongqing, China
Healthcare 2019, 7(4), 140; https://doi.org/10.3390/healthcare7040140 - 07 Nov 2019
Abstract
Children’s eating habits are closely related to their health problems and the outlook for children’s nutritional statuses appears poor. A cross-sectional survey was conducted among parents of preschool children from December 2018 to January 2019. Sixteen representative kindergartens in 6 districts of Chongqing, [...] Read more.
Children’s eating habits are closely related to their health problems and the outlook for children’s nutritional statuses appears poor. A cross-sectional survey was conducted among parents of preschool children from December 2018 to January 2019. Sixteen representative kindergartens in 6 districts of Chongqing, China, were included in the study. We took 2200 samples and collected information by questionnaire and after screening, 1781 questionnaires were valid and finally included in the data analysis (n = 1781). Ordinal logistic regression analysis found that age, fathers’ education level, forced diet and perception of children’s body shape were factors associated with children’s eating behaviors (ordered logistic regression/three-level eating behavior; odds ratios p < 0.05). 80.24% of preschool children may have unhealthy eating behavior in this survey and 80.35% of parents had forced their children to eat. Eating behaviors of preschool children in Chongqing are closely related to family factors. This study provides important insight for parents and health care workers in China to improve preschool-aged children’s nutritional behaviors. Intervention programs should focus on parents with low income, low education levels, coercive dietary behaviors and deviated body shape perceptions to reduce children’s eating behavioral problems. Full article
Open AccessArticle
On the Suitability and Potential of Nursing Care Discussion Forums as a Health Promotion Measure for Long-Distance Caregiving Relatives: Evidence from Upper Austria
Healthcare 2019, 7(4), 139; https://doi.org/10.3390/healthcare7040139 - 07 Nov 2019
Abstract
Background: The number of persons who have to overcome extensive geographical distances for caring for their older parent(s), hereinafter referred to as long-distance caregiving relatives (LDCs), is rising. However, in the non-English-speaking Global North, little is known about the LDCs’ health literacy [...] Read more.
Background: The number of persons who have to overcome extensive geographical distances for caring for their older parent(s), hereinafter referred to as long-distance caregiving relatives (LDCs), is rising. However, in the non-English-speaking Global North, little is known about the LDCs’ health literacy and the design of tailor-made health promotion measures for this target-group. Using the example of nursing care discussion forums (NCDF), this paper reflects the requirements and (future) potential of professionally-lead support groups for LDCs on the case-study example of Upper Austria. Methods: In order to approach this unexplored topic considering spatial-related aspects, a qualitative-explorative study design was chosen, focusing on the providers’ perspective. A written survey among all NCDF-group leaders was carried out. Results: LDCs do not make use of NCDFs at present. It is considered that this is above all for time constraints, lack of information and location-based problems of fit. This applies for urban as well as rural contexts. Conclusions: LDCs need more attention in public health. Suitable NCDFs have to be located in the LCDs’ residential municipalities and have to fulfill different requirements from those of local caregiving relatives, particularly with regard to purpose and scope. Full article
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Open AccessArticle
Dynamic Linkages among Economic Development, Energy Consumption, Environment and Health Sustainable in EU and Non-EU Countries
Healthcare 2019, 7(4), 138; https://doi.org/10.3390/healthcare7040138 - 06 Nov 2019
Abstract
There is a close and important relationship between environmental pollution and public health, and environmental pollution has an important impact on the public health. This study employed the two-stage meta-frontier dynamic network data envelopment analysis (TMDN-DEA) model to explore the environment pollution effects [...] Read more.
There is a close and important relationship between environmental pollution and public health, and environmental pollution has an important impact on the public health. This study employed the two-stage meta-frontier dynamic network data envelopment analysis (TMDN-DEA) model to explore the environment pollution effects from energy consumption on the mortality of children and adult, tuberculosis rate, survival rate and health expenditure efficiencies in 28 EU countries and 53 non-EU countries from 2010 to 2014. We calculated the overall efficiency scores and the technology gap ratios of each EU and non-EU countries and the efficiencies of input and output variables in the production and health stage. The average overall efficiencies each year in EU countries are higher than in the non-EU countries. But EU countries have higher energy efficiency than non-EU countries, and non-EU countries have higher health efficiency than EU countries. The health expenditure efficiencies in the EU countries are obviously lower than those in non-EU countries. The renewable energy efficiencies are obviously higher than the non-renewable energy efficiencies; PM2.5 efficiencies are obviously higher than the CO2 efficiencies and the children’s mortality rate efficiencies are higher than the adult’s mortality rate efficiencies for EU countries and non-EU countries. The government management in the EU and non-EU countries should be strengthened to reduce the air pollutant and carbon dioxide emissions and raise energy transformation to the clean energy in renewable energy and improve health efficiencies in medical and health care field. Full article
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Open AccessArticle
Comparison of Aggregated N-of-1 Trials with Parallel and Crossover Randomized Controlled Trials Using Simulation Studies
Healthcare 2019, 7(4), 137; https://doi.org/10.3390/healthcare7040137 - 06 Nov 2019
Abstract
Background: N-of-1 trials offer an innovative approach to delivering personalized clinical care together with population-level research. While increasingly used, these methods have raised some statistical concerns in the healthcare community. Methods: We discuss concerns of selection bias, carryover effects from treatment, and trial [...] Read more.
Background: N-of-1 trials offer an innovative approach to delivering personalized clinical care together with population-level research. While increasingly used, these methods have raised some statistical concerns in the healthcare community. Methods: We discuss concerns of selection bias, carryover effects from treatment, and trial data analysis conceptually, then rigorously evaluate concerns of effect sizes, power, and sample size through simulation study. Four variance structures for patient heterogeneity and model error are considered in a series of 5000 simulated trials with three cycles, which compare N-of-1 trials to parallel randomized controlled trials (RCTs) and crossover trials. Results: N-of-1 trials outperformed both traditional parallel RCTs and crossover designs when trial designs were simulated in terms of power and required sample size to obtain a given power. N-of-1 designs resulted in a higher type-I error probability than parallel RCT and cross over designs when moderate-to-strong carryover or washout effects were not considered or in the presence of modeled selection bias. However, N-of-1 designs allowed better estimation of patient-level random effects. These results reinforce the need to account for these factors when planning N-of-1 trials. Conclusion: N-of-1 trial designs offer a rigorous method for advancing personalized medicine and healthcare with the potential to minimize costs and resources. Interventions can be tested with adequate power with far fewer patients than traditional RCT and crossover designs. Operating characteristics compare favorably to both traditional RCT and crossover designs. Full article
(This article belongs to the Special Issue N-of-1 Trials in Healthcare)
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Open AccessProtocol
N-of-1 Trials as a Decision Support Tool in Clinical Practice: A Protocol for a Systematic Literature Review and Narrative Synthesis
Healthcare 2019, 7(4), 136; https://doi.org/10.3390/healthcare7040136 - 06 Nov 2019
Abstract
The n-of-1 trial can utilized in clinical practice as a decision support tool, which may improve patient outcomes by providing both the patient and the clinician with objective evidence to inform personalized treatment decisions. As its use broadens, it will be important to [...] Read more.
The n-of-1 trial can utilized in clinical practice as a decision support tool, which may improve patient outcomes by providing both the patient and the clinician with objective evidence to inform personalized treatment decisions. As its use broadens, it will be important to study whether the added time and effort of an n-of-1 trial results in measurable improvements in important patient outcomes compared to usual clinical practice. Parallel-group randomized clinical trials testing the n-of-1 approach versus usual care have been undertaken in a number of medical settings. A systematic review will be performed according to PRISMA guidelines, using MEDLINE, Embase, Cochrane, CINAHL, PsycINFO, Scopus, and Web of Science to search for randomized clinical trials in humans, without date or language restriction. Reports from the gray literature and ongoing studies in trial registries will be included. Articles will be screened by two independent reviewers with a third reviewer consulted to adjudicate disagreement. The quality of included studies will be assessed using the Cochrane Collaboration’s tool for assessing risk of bias. A narrative synthesis will explore the differing methodological approaches of the included studies. The protocol will be registered in the PROSPERO registry, and the results of the review will be published in a peer-reviewed journal. To our knowledge, this systematic review will be the first to comprehensively assess the existing research on randomized trials testing the n-of-1 trial approach in clinical practice. Full article
(This article belongs to the Special Issue N-of-1 Trials in Healthcare)
Open AccessArticle
Education and Protein Supplementation Improve Nutritional Biomarkers among Hypoalbuminemic Peritoneal Dialysis Patients: A Quasi-Experimental Design
Healthcare 2019, 7(4), 135; https://doi.org/10.3390/healthcare7040135 - 05 Nov 2019
Abstract
Protein-energy wasting is prevalent in peritoneal dialysis patients, which causes a heavy burden for individuals and healthcare systems. We aimed to investigate the effect of nutritional education, and/or protein supplementation on nutritional biomarkers in hypoalbuminemic peritoneal dialysis patients. A quasi-experimental study was conducted [...] Read more.
Protein-energy wasting is prevalent in peritoneal dialysis patients, which causes a heavy burden for individuals and healthcare systems. We aimed to investigate the effect of nutritional education, and/or protein supplementation on nutritional biomarkers in hypoalbuminemic peritoneal dialysis patients. A quasi-experimental study was conducted in two dialysis centers at Taipei Tzu Chi Hospital and Shin Kong Wu Ho-Su Memorial Hospital. Patients were allocated in three groups including control (n = 12), milk protein (n = 21) and soy protein (n = 20). All patients received dietary guidelines from dietitians and completed 3-day dietary records during monthly visits for consecutive three months. Nutrients were analyzed using Nutritionist Professional software. Blood urea nitrogen (BUN), creatinine, albumin, total protein, hemoglobin, serum calcium, phosphorus, sodium, and potassium were assessed monthly. Total cholesterol and triglycerides were measured every three months. After three-month intervention, protein intake (percent of total calories), and serum albumin were significantly increased in three groups. Protein, phosphorus intake, and BUN were increased in two intervention groups. Total serum protein increased in control and milk protein groups, and creatinine increased the control group. Serum phosphorus was not significantly changed. Nutritional education alone, or combined with protein supplementation, significantly improve protein intake, and nutritional status by increasing serum albumin, but not serum phosphorus in hypoalbuminemic peritoneal dialysis patients. Full article
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Open AccessDiscussion
Personalised Medicine Using N-of-1 Trials: Overcoming Barriers to Delivery
Healthcare 2019, 7(4), 134; https://doi.org/10.3390/healthcare7040134 - 05 Nov 2019
Abstract
In this paper we discuss the value of N-of-1 trials in personalising health care. We describe the challenges faced in implementing N-of-1 trials in the United Kingdom’s National Health Service and suggest how making greater use of these personalised trials might be facilitated. [...] Read more.
In this paper we discuss the value of N-of-1 trials in personalising health care. We describe the challenges faced in implementing N-of-1 trials in the United Kingdom’s National Health Service and suggest how making greater use of these personalised trials might be facilitated. Full article
(This article belongs to the Special Issue N-of-1 Trials in Healthcare)
Open AccessArticle
What Drives Patients Affected by Depression to Share in Online Depression Communities? A Social Capital Perspective
Healthcare 2019, 7(4), 133; https://doi.org/10.3390/healthcare7040133 - 04 Nov 2019
Abstract
Online depression communities give people additional opportunities to share their experiences and exchange social support to care for themselves in fighting against depression. We aimed to explore what drives patients to share in online depression communities. We used three dimensions of social capital [...] Read more.
Online depression communities give people additional opportunities to share their experiences and exchange social support to care for themselves in fighting against depression. We aimed to explore what drives patients to share in online depression communities. We used three dimensions of social capital (structural, relational, and cognitive) to explain their sharing behaviors. We further proposed that five factors (social interaction ties, a sense of shared identity, trust, expertise, and a sense of shared values) will have significant, positive effects on sharing behaviors and that there are differences among patients who have spent different lengths of time participating in online depression communities. We then chose a popular online depression community in China as our data source and obtained a dataset consisting of 31,440 posts from 197 members. Then, we employed panel data regression analyses to test all six hypotheses. The results revealed that all five factors had significant, positive effects (p < 0.01) on patients’ sharing behaviors, and the effects were significantly different across groups. Our empirical results help designers and managers of online depression communities take specific measures to facilitate community members’ access to social capital resources. Meanwhile, our results have implications for existing health management and e-health literature. Full article
(This article belongs to the Section Health Informatics and Big Data)
Open AccessArticle
Measuring Transformational Leadership in Establishing Nursing Care Excellence
Healthcare 2019, 7(4), 132; https://doi.org/10.3390/healthcare7040132 - 04 Nov 2019
Abstract
Transformational leadership (TL) is known to be essential to achieving Magnet® recognition, an internationally prestigious status for nursing care excellence. Since its inception in the 1980s, empirical studies have identified benefits of implementing the Magnet® Model involving improved patient care and [...] Read more.
Transformational leadership (TL) is known to be essential to achieving Magnet® recognition, an internationally prestigious status for nursing care excellence. Since its inception in the 1980s, empirical studies have identified benefits of implementing the Magnet® Model involving improved patient care and nursing workforce outcomes. However, little is known about the leadership styles of nurse managers (NMs) working in a regional Australian context, which may hinder achieving Magnet® status. To close the knowledge gap, a self-administered survey was conducted to measure leadership styles of NMs at a large health organization comprising hospitals with a wide range of service profiles in regional Australia using a validated tool—the Multifactor Leadership Questionnaire (MLQ-6S). One-way of variance (ANOVA) was used to identify statistical significance between respondents’ demographic characteristics (e.g., age, education, gender) and their MLQ-6S scores. Respondents (n = 78) reported their leadership styles as more transformational, compared to transactional or passive/avoidant leadership styles. The findings indicated that NMs’ higher education (p = 0.02) and older age (p = 0.03) were associated with TL styles, whereas passive/avoidant leadership was generally reported by female (p = 0.04) and younger (p = 0.06) respondents. This study has identified differences in reported leadership styles among NMs, providing a unique organizational insight into developing strategies to improve NMs’ TL, which could help to facilitate the implementation of the Magnet® framework. Healthcare organizations in similar settings could benefit from replicating this study to identify a dominant leadership style and customize strategies to improve TL. Full article
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Open AccessArticle
Heterogeneous Impacts of Basic Social Health Insurance on Medical Expenditure: Evidence from China’s New Cooperative Medical Scheme
Healthcare 2019, 7(4), 131; https://doi.org/10.3390/healthcare7040131 - 03 Nov 2019
Abstract
This paper examines the effects of China’s New Cooperative Medical Scheme (NCMS) on medical expenditure. Utilizing the quasi-random rollout of the NCMS for a difference-in-difference analysis, we find that the NCMS increased medical expenditure by 12.3%. Most significantly, the good-health group witnessed a [...] Read more.
This paper examines the effects of China’s New Cooperative Medical Scheme (NCMS) on medical expenditure. Utilizing the quasi-random rollout of the NCMS for a difference-in-difference analysis, we find that the NCMS increased medical expenditure by 12.3%. Most significantly, the good-health group witnessed a 22.1% rise in medical expenditure, and the high-income group saw a rise of 20.6%. The effects, however, were not significant among the poor-health or low-income groups. The findings are suggestive of the need for more help for the very poor and less healthy. Full article
Open AccessEditorial
Creating Age-Friendly Communities: Housing and Technology
Healthcare 2019, 7(4), 130; https://doi.org/10.3390/healthcare7040130 - 03 Nov 2019
Abstract
Taking an international perspective of healthy ageing, people are living longer and are generally in better health than previous generations [...] Full article
(This article belongs to the Special Issue Creating Age-friendly Communities: Housing and Technology)
Open AccessArticle
Evaluating the Comparative Effectiveness of Two Diets in Pediatric Inflammatory Bowel Disease: A Study Protocol for a Series of N-of-1 Trials
Healthcare 2019, 7(4), 129; https://doi.org/10.3390/healthcare7040129 - 01 Nov 2019
Abstract
Inflammatory bowel disease (IBD) affects 3 million children and adults in the US. Treatment involves medications with considerable risk profiles. Dietary modification, such as the specific carbohydrate diet (SCD), may be helpful in treating IBD, but there is insufficient evidence of its effectiveness. [...] Read more.
Inflammatory bowel disease (IBD) affects 3 million children and adults in the US. Treatment involves medications with considerable risk profiles. Dietary modification, such as the specific carbohydrate diet (SCD), may be helpful in treating IBD, but there is insufficient evidence of its effectiveness. N-of-1 trials are ideal for addressing this important research question. The Personalized Research on Diet in Ulcerative Colitis and Crohn’s Disease (PRODUCE) study employs a series of 50 individual N-of-1 trials that compare the SCD to a modified SCD. Treatment periods are assigned in blocks of two, with each patient completing two balanced treatment blocks. Patients are randomized to start with the SCD or modified SCD and alternate between conditions for four eight-week periods. A mobile app guides collecting and viewing data, transitioning diets, and reviewing personal results. Primary outcomes include patient reported outcomes (PROs) of stool frequency, stool consistency, pain interference, and gastrointestinal (GI) symptom severity. We examine changes in inflammation via fecal calprotectin. Participants will receive a personalized answer regarding comparative effectiveness between the SCD and a less restrictive diet option (modified SCD), as well as compared to their baseline diet. We will aggregate the results of completed N-of-1 trials across patients to estimate population level comparative effectiveness of these treatments and the effectiveness of each diet. Full article
(This article belongs to the Special Issue N-of-1 Trials in Healthcare)
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Open AccessArticle
Effect of Decontamination Treatments on Micro-Shear Bond Strength between Blood–Saliva-Contaminated Post-Etched Dentin Substrate and Composite Resin
Healthcare 2019, 7(4), 128; https://doi.org/10.3390/healthcare7040128 - 01 Nov 2019
Abstract
Blood–saliva contamination negatively affects the bonding potential of adhesive agents. The study aimed to assess the effect of various cleaning protocols on micro-shear bond strength (μSBS) between blood–saliva-contaminated post-etched dentin and composite resin in total-etch and self-etch adhesives. The cleaning methods tested were [...] Read more.
Blood–saliva contamination negatively affects the bonding potential of adhesive agents. The study aimed to assess the effect of various cleaning protocols on micro-shear bond strength (μSBS) between blood–saliva-contaminated post-etched dentin and composite resin in total-etch and self-etch adhesives. The cleaning methods tested were water rinsing, 37.5% phosphoric acid (H3PO4) re-etching, 6% sodium hypochlorite (NaoCl), 2% chlorhexidine gluconate (CXG), isopropyl alcohol (IPA), and pumice. Nono-hybrid composite cylinders with a 3-mm diameter and 2-mm height were directly cured over the dentin substrate, stored for 24 h, and subjected to 12,000 thermocycles. The shear force was exerted with a 200-μm knife-edged chisel-shaped head from a universal testing machine. The type of failure was assessed with stereomicroscope magnified images. The obtained data were evaluated by Kruskal–Wallis and Mann–Whitney U post-hoc tests. Water-rinsed contaminated dentin surfaces showed substantially reduced μSBS in the total etch from 25.93 to 20.29 Mpa and the corresponding values for the one-step self-etch adhesive were 10.10 to 8.8. Re-etching with 37.5% H3Po4 resulted in a recovery of bonding potential in both total-etch (24.58 Mpa) and self-etch adhesive (9.23 Mpa). Alternately, NaoCl and pumice cleaning showed promising results for the total-etch (23.51 Mpa) and self-etch (7.79 Mpa). Full article
(This article belongs to the Section Healthcare Quality and Patient Safety)
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Open AccessArticle
Measuring and Assessing Healthcare Organisational Culture in the England’s National Health Service: A Snapshot of Current Tools and Tool Use
Healthcare 2019, 7(4), 127; https://doi.org/10.3390/healthcare7040127 - 01 Nov 2019
Abstract
Healthcare Organisational Culture (OC) is a major contributing factor in serious failings in healthcare delivery. Despite an increased awareness of the impact that OC is having on patient care, there is no universally accepted way to measure culture in practice. This study was [...] Read more.
Healthcare Organisational Culture (OC) is a major contributing factor in serious failings in healthcare delivery. Despite an increased awareness of the impact that OC is having on patient care, there is no universally accepted way to measure culture in practice. This study was undertaken to provide a snapshot as to how the English National Health Service (NHS) is currently measuring culture. Although the study is based in England, the findings have potential to influence the measurement of healthcare OC internationally. An online survey was sent to 234 NHS hospital trusts, with a response rate of 35%. Respondents who completed the online survey, on behalf of their representative organisations, were senior clinical governance leaders. The findings demonstrate that the majority of organisations, that responded, were actively measuring culture. Significantly, a wide variety of tools were in use, with variable levels of satisfaction and success. The majority of tools had a focus on patient safety, not on understanding the determining factors which impact upon healthcare OC. This paper reports the tools currently used by the respondents. It highlights that there are deficits in these tools that need to be addressed, so that organisations can interpret their own culture in a standardised, evidence-based way. Full article
Open AccessArticle
Using Citizen Science to Explore Neighbourhood Influences on Ageing Well: Pilot Project
Healthcare 2019, 7(4), 126; https://doi.org/10.3390/healthcare7040126 - 01 Nov 2019
Cited by 1
Abstract
Outdoor and indoor environments impact older people’s mobility, independence, quality of life, and ability to “age in place”. Considerable evidence suggests that not only the amount, but also the quality, of public green spaces in the living environment is important. The quality of [...] Read more.
Outdoor and indoor environments impact older people’s mobility, independence, quality of life, and ability to “age in place”. Considerable evidence suggests that not only the amount, but also the quality, of public green spaces in the living environment is important. The quality of public green spaces is mostly measured through expert assessments by planners, designers and developers. A disadvantage of this expert-determined approach is that it often does not consider the appraisals or perceptions of residents. Daily experience, often over long periods of time, means older residents have acquired insider knowledge of their neighbourhood, and thus, may be more qualified to assess these spaces, including measuring what makes a valued or quality public green space. The aim of this Australian pilot study on public green spaces for ageing well was to test an innovative citizen science approach to data collection using smart phones. “Senior” citizen scientists trialed the smart phone audit tool over a three-month period, recording and auditing public green spaces in their neighbourhoods. Data collected included geocoded location data, photographs, and qualitative comments along with survey data. While citizen science research is already well established in the natural sciences, it remains underutilised in the social sciences. This paper focuses on the use of citizen science with older participants highlighting the potential for this methodology in the fields of environmental gerontology, urban planning and landscape architecture. Full article
(This article belongs to the Special Issue Creating Age-friendly Communities: Housing and Technology)
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Open AccessCommentary
Help-Seeking Experiences of Hepatitis B Patients in Transnational Medical Care: The Solution to Health Inequality Is Social Mobility
Healthcare 2019, 7(4), 125; https://doi.org/10.3390/healthcare7040125 - 31 Oct 2019
Abstract
This paper tracked hepatitis B patients from Medan, Indonesia to Penang, Malaysia under transnational medical care and has an understanding of their medical history and socioeconomic status. The condition of these patients improved as a result of good compliance with medical treatment, including [...] Read more.
This paper tracked hepatitis B patients from Medan, Indonesia to Penang, Malaysia under transnational medical care and has an understanding of their medical history and socioeconomic status. The condition of these patients improved as a result of good compliance with medical treatment, including lifestyle adjustment and regular medication. Under the influence of the marketization of healthcare, transnational medical patients in the social structure, based on their economic ability and socioeconomic status, may be expected to experience health inequalities. People with unhealthy medical distribution and weak socioeconomic status are easily prone to diseases due to environmental and social conditions; it is easier for such patients to delay or give up their medical treatment. After continuous tracking and increasing patient exposure to medical knowledge and self-care management opportunities, increasing awareness, screening, care, and treatment, the transmission of hepatitis B can be reduced to enable them to gain upward mobility by their capacities and thus improve their health. Social mobility is deemed the main approach to reduce social inequality. There have been limited medical clinical observations and tracking confirming this theory. This paper, which uses medical observation, confirmed that social mobility is considered as the principal key to reducing inequalities in health. Full article
Open AccessArticle
A New Methodology for Use by a Single Caregiver to Bathe Bedridden Elderly Persons Using Advanced Mechatronic Systems
Healthcare 2019, 7(4), 124; https://doi.org/10.3390/healthcare7040124 - 28 Oct 2019
Abstract
In the framework of this paper, we aimed to propose a methodology for giving baths to elderly, bedridden persons, when this task is performed by a single caregiver. Usually, two caregivers are required for nursing a bedridden patient, especially when certain important tasks [...] Read more.
In the framework of this paper, we aimed to propose a methodology for giving baths to elderly, bedridden persons, when this task is performed by a single caregiver. Usually, two caregivers are required for nursing a bedridden patient, especially when certain important tasks are needed (e.g., bathing the patient), but this is not always possible. The entire study considers the primary user’s perspective—the caregiver—who is responsible for a wide range of tasks; thus, suffering physical and psychological exhaustion over time. A physical prototype has been developed for allowing caregivers to perform tests in a life-like environment, by means of the device and the methodology. This technology, therefore, will represent an important contribution to the quality of life of caregivers. Considering an increase in the share of the elderly population and the related problems that arise in daily care, this project intends to be beneficial contemporarily. The presented methodology has been successfully tested and validated. Full article
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Open AccessArticle
Cancer Survival Data Representation for Improved Parametric and Dynamic Lifetime Analysis
Healthcare 2019, 7(4), 123; https://doi.org/10.3390/healthcare7040123 - 28 Oct 2019
Abstract
Survival functions are often characterized by a median survival time or a 5-year survival. Whether or not such representation is sufficient depends on tumour development. Different tumour stages have different mean survival times after therapy. The validity of an exponential decay and the [...] Read more.
Survival functions are often characterized by a median survival time or a 5-year survival. Whether or not such representation is sufficient depends on tumour development. Different tumour stages have different mean survival times after therapy. The validity of an exponential decay and the origins of deviations are substantiated. The paper shows, that representation of survival data as logarithmic functions visualizes differences better, which allows for differentiating short- and long-term dynamic lifetime. It is more instructive to represent the changing lifetime expectancy for an individual who has survived a certain time, which can be significantly different from the initial expectation just after treatment. Survival data from 15 publications on cancer are compared and re-analysed based on the well-established: (i) exponential decay (ii) piecewise constant hazard (iii) Weibull model and our proposed parametric survival models, (iv) the two-τ and (v) the sliding-τ model. The new models describe either accelerated aging or filtering out of defects with numerical parameters with a physical meaning and add information to the usually provided log-rank P-value or median survival. The statistical inhomogeneity in a group by mixing up different tumour stages, metastases and treatments is the main origin for deviations from the exponential decay. Full article
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Open AccessReview
Healthcare Received in the Last Months of Life in Portugal: A Systematic Review
Healthcare 2019, 7(4), 122; https://doi.org/10.3390/healthcare7040122 - 24 Oct 2019
Abstract
Background: While evidence demonstrates that end-of-life care practices vary across countries, there is still a lack of evidence regarding the healthcare that is received by adult individuals in the last months of life in Portugal. Methods: This is a systematic review [...] Read more.
Background: While evidence demonstrates that end-of-life care practices vary across countries, there is still a lack of evidence regarding the healthcare that is received by adult individuals in the last months of life in Portugal. Methods: This is a systematic review that aims to examine the evidence published until 2019 regarding the healthcare received by adult individuals in the last months of life in Portugal. Results: Nine studies were included in this review. All of these were quantitative and retrospective studies, used patient records as the source of information, and were conducted in hospital settings. The time frame analysis before death ranged from 48 h to 3 months. The majority of the studies focused on the physical aspects of care, such as physical needs assessment and symptom management, prescribed medication, and invasive interventions. No evidence was found regarding spiritual, psychological, social or cultural needs. Conclusion: Although using patient records as a source of information may introduce a bias, this study indicates that there is a greater emphasis on the physical aspects of care and less on the psychological, spiritual or social aspects of care received by adult individuals in their last months of life in Portugal. Full article
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Open AccessArticle
Line Immunoblot Assay for Tick-Borne Relapsing Fever and Findings in Patient Sera from Australia, Ukraine and the USA
Healthcare 2019, 7(4), 121; https://doi.org/10.3390/healthcare7040121 - 21 Oct 2019
Viewed by 90
Abstract
Tick-borne relapsing fever (TBRF) is caused by spirochete bacteria of the genus Borrelia termed relapsing fever Borreliae (RFB). TBRF shares symptoms with Lyme disease (LD) caused by related Lyme disease Borreliae (LDB). TBRF and LD are transmitted by ticks and occur in overlapping [...] Read more.
Tick-borne relapsing fever (TBRF) is caused by spirochete bacteria of the genus Borrelia termed relapsing fever Borreliae (RFB). TBRF shares symptoms with Lyme disease (LD) caused by related Lyme disease Borreliae (LDB). TBRF and LD are transmitted by ticks and occur in overlapping localities worldwide. Serological detection of antibodies used for laboratory confirmation of LD is not established for TBRF. A line immunoblot assay using recombinant proteins from different RFB species, termed TBRF IB, was developed and its diagnostic utility investigated. The TBRF IBs were able to differentiate between antibodies to RFB and LDB and had estimated sensitivity, specificity, and positive and negative predictive values of 70.5%, 99.5%, 97.3%, and 93.4%, respectively, based on results with reference sera from patients known to be positive and negative for TBRF. The use of TBRF IBs and analogous immunoblots for LD to test sera of patients from Australia, Ukraine, and the USA with LD symptoms revealed infection with TBRF alone, LD alone, and both TBRF and LD. Diagnosis by clinical criteria alone can, therefore, underestimate the incidence of TBRF. TBRF IBs will be useful for laboratory confirmation of TBRF and understanding its epidemiology worldwide. Full article
(This article belongs to the Special Issue Lyme Disease and Related Tickborne Infections)
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