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Healthcare, Volume 8, Issue 2 (June 2020) – 119 articles

Cover Story (view full-size image): Given the burgeoning aging population, current medical staff and healthcare providers are increasingly burdened by caring for age-related Alzheimer’s disease (AD) and Alzheimer’s-disease-related dementia (ADRD) patients. As a result, we can expect to see a large increase in the field of medical robotics, especially in the form of socially assistive robots (SARs) for senior patients and healthcare providers. In fact, SARs may fulfill AD and ADRD patients’ and their caregivers’ unmet medical needs. Thus, we have proposed a design outline for such a SAR, based on a review of the current literature. We believe the next generation of SARs will enhance health and wellbeing, reduce illness and disability, and improve quality of life for AD and ADRD patients and their caregivers. View this paper.
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Open AccessArticle
Assessing the Implementation of a Behavior Change Intervention: Process Evaluation of a Stepped-Wedge Cluster Randomized Controlled Trial for Newborn Health
Healthcare 2020, 8(2), 187; https://doi.org/10.3390/healthcare8020187 - 26 Jun 2020
Viewed by 967
Abstract
Maternal and under five-year-old mortality rates have reduced in the last two decades globally due to concerted effort, yet newborn deaths remain unacceptably prevalent. Behavior change is an important component of interventions to address newborn health problems in low-income countries. In Cambodia, maternal [...] Read more.
Maternal and under five-year-old mortality rates have reduced in the last two decades globally due to concerted effort, yet newborn deaths remain unacceptably prevalent. Behavior change is an important component of interventions to address newborn health problems in low-income countries. In Cambodia, maternal and newborn mortality has markedly decreased, and continued improvements will allow the country to achieve further reduction in newborn morbidity. The results of an implementation study of the Newborn Care and Infection Control Initiative using process evaluation are presented to provide insight into the trial implementation and context of the program that may have contributed to intervention results. The study utilized a mixed method process to explore the context, mechanisms, and implementation of intervention components: training of village health support group volunteers to provide home visits, training of midwives on infection prevention and control around the perinatal period, counseling on newborn care, and provision of training materials for counseling and intervention. Implementation was evaluated through quantitative and qualitative data collection including surveys, observation, semi-structured interviews, focus groups, and visual media. Descriptive statistics summarized the quantitative data and thematic analysis was used to explore the qualitative data. The evaluation identified several factors that might have influenced the outcomes of the trial: continuity of health center staff communication, timing and ability to complete home visits, and training quality. Additional support for parents in the perinatal period, preferably provided at the community level, will contribute to further improvement in health outcomes for newborns in this area. Researchers in this context should consider mechanisms to improve the coordination of health facility staff counseling while providing support and resources to ensure home visits to families with newborns are made on time. Attention to staffing, training, and quality of newborn health interventions is critical in planning for the scaling-up of newborn health programming. Full article
(This article belongs to the Section Environmental Factors and Global Health)
Open AccessArticle
Interactive Impact of Sleep Duration and Sleep Quality on the Risk of Developing Metabolic Syndrome in Korean Adults
Healthcare 2020, 8(2), 186; https://doi.org/10.3390/healthcare8020186 - 25 Jun 2020
Viewed by 961
Abstract
Sleep quality is important for the normal functioning of hormonal and metabolic processes in the body; however, few studies have considered the effects of both sleep duration and sleep quality on predicting metabolic syndrome risk. We examined the interactive impact of sleep duration [...] Read more.
Sleep quality is important for the normal functioning of hormonal and metabolic processes in the body; however, few studies have considered the effects of both sleep duration and sleep quality on predicting metabolic syndrome risk. We examined the interactive impact of sleep duration and sleep quality on the risk of developing metabolic syndrome using logistic regression analysis with a threshold based on hours of sleep. Data were collected from 411 adults in South Korea and, according to the estimated threshold of 6 h of sleep (95% Confidence Interval, CI = 5–7 h), participants were classified as short (<6 h) or adequate-long (≥6 h) sleepers. The two groups differed significantly on various health measures. While short sleepers were more likely than adequate-long sleepers to experience adverse health conditions, which increased their risk of developing metabolic syndrome, they were not influenced by sleep quality. For adequate-long sleepers, however, a decrease in sleep quality was associated with an increased risk of developing metabolic syndrome (odds ratio = 1.24, 95% CI = 1.07–1.43). Our results suggest that both sleep duration and sleep quality are crucial determinants of the development of metabolic syndrome and that it is important to maintain at least 6 h of sleep. Full article
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Open AccessArticle
Consistency of Medical Data Using Intelligent Neuron Faster R-CNN Algorithm for Smart Health Care Application
Healthcare 2020, 8(2), 185; https://doi.org/10.3390/healthcare8020185 - 25 Jun 2020
Cited by 1 | Viewed by 1157
Abstract
The purpose of this study is to increase interest in health as human life is extended in modern society. Hence, many people in hospitals produce much medical data (EMR, PACS, OCS, EHR, MRI, X-ray) after treatment. Medical data are stored as structured and [...] Read more.
The purpose of this study is to increase interest in health as human life is extended in modern society. Hence, many people in hospitals produce much medical data (EMR, PACS, OCS, EHR, MRI, X-ray) after treatment. Medical data are stored as structured and unstructured data. However, many medical data are causing errors, omissions and mistakes in the process of reading. This behavior is very important in dealing with human life and sometimes leads to medical accidents due to physician errors. Therefore, this research is conducted through the CNN intelligent agent cloud architecture to verify errors in reading existing medical image data. To reduce the error rule when reading medical image data, a faster R-CNN intelligent agent cloud architecture is proposed. It shows the result of increasing errors of existing error reading by more than 1.4 times (140%). In particular, it is an algorithm that analyses data stored by actual existing medical data through Conv feature map using deep ConvNet and ROI Projection. The data were verified using about 120,000 databases. It uses data to examine human lungs. In addition, the experimental environment established an environment that can handle GPU’s high performance and NVIDIA SLI multi-OS and multiple Quadro GPUs were used. In this experiment, the verification data composition was verified and randomly extracted from about 120,000 medical records and the similarity compared to the original data were measured by comparing about 40% of the extracted images. Finally, we want to reduce and verify the error rate of medical data reading. Full article
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Open AccessArticle
Cultural Adaptation and Validation of the Korean Version of the iMTA Productivity Cost Questionnaire
Healthcare 2020, 8(2), 184; https://doi.org/10.3390/healthcare8020184 - 24 Jun 2020
Cited by 1 | Viewed by 926
Abstract
This study develops the Korean version of the Institute for Medical Technology Assessment Productivity Cost Questionnaire (iPCQ) through translation/cultural adaptation and evaluation of psychometric properties. We included 110 outpatients visiting a gynecology clinic. We conducted the translation and cross-cultural adaptation of the iPCQ, [...] Read more.
This study develops the Korean version of the Institute for Medical Technology Assessment Productivity Cost Questionnaire (iPCQ) through translation/cultural adaptation and evaluation of psychometric properties. We included 110 outpatients visiting a gynecology clinic. We conducted the translation and cross-cultural adaptation of the iPCQ, including forward and back-translation, pilot test with cognitive debriefing, and finalization. We analyzed the feasibility (using average time of filling in the iPCQ and the proportion of missing values), test–retest reliability (using the intra-class correlation coefficient [ICC]), and validity (concurrent validity with the Work Productivity and Activity Impairment [WPAI] and construct validity with the 36-Item Short Form Survey [SF-36], using Spearman’s ρ). The Korean version of iPCQ showed appropriate feasibility (average filling in time was 5.0 min without missing values), and had excellent values in the domains of absenteeism, presenteeism, and unpaid work for test–retest reliability (ICC: 0.92–0.99). For concurrent validity, the Korean version of iPCQ showed moderate–high correlation for absenteeism and presenteeism with the WPAI. All domains of productivity losses measured by the Korean version of iPCQ showed negative correlation with the quality of life estimated by the SF-36. Through this study, we developed a Korean instrument that can measure and value health-related productivity losses including unpaid work as well as absenteeism and presenteeism. Full article
(This article belongs to the Section Health Assessments)
Open AccessReview
Monitoring Response to Home Parenteral Nutrition in Adult Cancer Patients
Healthcare 2020, 8(2), 183; https://doi.org/10.3390/healthcare8020183 - 23 Jun 2020
Cited by 2 | Viewed by 1070
Abstract
Current guidelines recommend home parenteral nutrition (HPN) for cancer patients with chronic deficiencies of dietary intake or absorption when enteral nutrition is not adequate or feasible in suitable patients. HPN has been shown to slow down progressive weight loss and improve nutritional status, [...] Read more.
Current guidelines recommend home parenteral nutrition (HPN) for cancer patients with chronic deficiencies of dietary intake or absorption when enteral nutrition is not adequate or feasible in suitable patients. HPN has been shown to slow down progressive weight loss and improve nutritional status, but limited information is available on the monitoring practice of cancer patients on HPN. Clinical management of these patients based only on nutritional status is incomplete. Moreover, some commonly used clinical parameters to monitor patients (weight loss, body weight, body mass index, and oral food intake) do not accurately reflect patient’s body composition, while bioelectrical impedance analysis (BIA) is a validated tool to properly assess nutritional status on a regular basis. Therefore, patient’s monitoring should rely on other affordable indicators such as Karnofsky Performance Status (KPS) and modified Glasgow Prognostic Score (mGPS) to also assess patient’s functional status and prognosis. Finally, catheter-related complications and quality of life represent crucial issues to be monitored over time. The purpose of this narrative review is to describe the role and relevance of monitoring cancer patients on HPN, regardless of whether they are receiving anticancer treatments. These practical tips may be clinically useful to better guide healthcare providers in the nutritional care of these patients. Full article
(This article belongs to the Special Issue Artificial Nutrition in Cancer Patients)
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Open AccessArticle
LTOT Patients’ Experience of a Portable Oxygen Unit and Health-Related Quality of Life—A Cross-Sectional Study
Healthcare 2020, 8(2), 182; https://doi.org/10.3390/healthcare8020182 - 23 Jun 2020
Viewed by 918
Abstract
Background: The purpose of the present study was to elucidate the experiences of long-term oxygen therapy (LTOT) patients with a portable oxygen unit and to describe the patients’ self-assessed health-related quality of life (HRQoL). Methods: The study employed a prospective cross-sectional design. Data [...] Read more.
Background: The purpose of the present study was to elucidate the experiences of long-term oxygen therapy (LTOT) patients with a portable oxygen unit and to describe the patients’ self-assessed health-related quality of life (HRQoL). Methods: The study employed a prospective cross-sectional design. Data collection entailed two questionnaires, namely the MedTech20 (patients’ experience of the medical device in four areas) and EQ-5D (HRQoL). The informants consisted of patients (n = 148) treated with such a medical device and that were registered in Skåne University Hospital’s database, Medusa. Results: In the domain Sense of security the informant felt the equipment reliable and safe to use and expressed a sense of control for the user. Regarding Social participation, the responses did not indicate the device to facilitate leisure activities, movement outside the homes, traveling or everyday tasks to a larger extent. The respondents did express a reduced sense of compromised integrity, with a minor effect on Intimacy. With regards to Convenience, the responses indicated the product to provide Adaptability to personal needs. Overall, a strongly affected HRQoL (Your current health condition, EQ-VAS Md = 50 (IQR 36–70)) with strong correlation with EQ-5D was seen. Conclusions: Informants experienced the portable oxygen unit as reliable and safe to use while giving a sense of control over the disease itself. A minor impact on social participation was reported, except for a reduced sense of compromised integrity. The patients also reported a strongly reduced HRQoL. Full article
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Open AccessArticle
Multiple Ensemble Neural Network Models with Fuzzy Response Aggregation for Predicting COVID-19 Time Series: The Case of Mexico
Healthcare 2020, 8(2), 181; https://doi.org/10.3390/healthcare8020181 - 19 Jun 2020
Cited by 13 | Viewed by 2550
Abstract
In this paper, a multiple ensemble neural network model with fuzzy response aggregation for the COVID-19 time series is presented. Ensemble neural networks are composed of a set of modules, which are used to produce several predictions under different conditions. The modules are [...] Read more.
In this paper, a multiple ensemble neural network model with fuzzy response aggregation for the COVID-19 time series is presented. Ensemble neural networks are composed of a set of modules, which are used to produce several predictions under different conditions. The modules are simple neural networks. Fuzzy logic is then used to aggregate the responses of several predictor modules, in this way, improving the final prediction by combining the outputs of the modules in an intelligent way. Fuzzy logic handles the uncertainty in the process of making a final decision about the prediction. The complete model was tested for the case of predicting the COVID-19 time series in Mexico, at the level of the states and the whole country. The simulation results of the multiple ensemble neural network models with fuzzy response integration show very good predicted values in the validation data set. In fact, the prediction errors of the multiple ensemble neural networks are significantly lower than using traditional monolithic neural networks, in this way showing the advantages of the proposed approach. Full article
(This article belongs to the Special Issue Feature Papers in Artificial Intelligence in Medicine)
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Open AccessArticle
Novel Insight into How Nurses Working at PH Specialist Clinics in Sweden Perceive Their Work
Healthcare 2020, 8(2), 180; https://doi.org/10.3390/healthcare8020180 - 19 Jun 2020
Viewed by 874
Abstract
Outpatient pulmonary hypertension (PH) specialist centers have an important role in the optimal management of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). The aim of the present study was to gain an understanding of the work facing nurses at the [...] Read more.
Outpatient pulmonary hypertension (PH) specialist centers have an important role in the optimal management of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). The aim of the present study was to gain an understanding of the work facing nurses at the outpatient PH specialist centers in Sweden. All nurses (n = 14) working at the outpatient PH specialist centers in Sweden were included. Qualitative content analysis was employed to analyze the interviews, wherein an overarching theme emerged: “Build and maintain a relationship with the patient”. Three categories described the nurses’ experiences: “Ambiguous satisfaction regarding information and communication”, “Acting as a coordinator” and “Professional and personal development”. To provide good patient care, the nurses described the key components as the ability to give information on all aspects of the disease and their availability by phone for patients, their relatives, and other healthcare resources. This requires evidence-based, specialist knowledge about the disease, its care, and treatments as well as experience. In conclusion, working as a nurse at the outpatient PH specialist centers highlight the advantages, expectations, and difficulties in working with patients with a rare and life-threatening illness. The overall knowledge and skills were high, but the nurses expressed a need for in-depth and continued training. Full article
(This article belongs to the Section Nursing)
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Open AccessArticle
Design of an Interactive Nostalgic Amusement Device with User-Friendly Tangible Interfaces for Improving the Health of Older Adults
Healthcare 2020, 8(2), 179; https://doi.org/10.3390/healthcare8020179 - 19 Jun 2020
Viewed by 995
Abstract
To help older adults achieve active aging, an interactive device with tangible interfaces is proposed, which combines human–machine interaction techniques and older adults’ life experiences to provide three functions: nostalgia, leisure, and entertainment. Firstly, by a review of related theories and studies, principles [...] Read more.
To help older adults achieve active aging, an interactive device with tangible interfaces is proposed, which combines human–machine interaction techniques and older adults’ life experiences to provide three functions: nostalgia, leisure, and entertainment. Firstly, by a review of related theories and studies, principles for designing a desirable interactive device were established. Accordingly, a prototype device with an interactive game was constructed, which was then tested in a field experiment and improved according to the users’ opinions collected by interviews. Subsequently, in a second experiment the users’ and some experts’ feedback about the system’s usability and user interaction satisfaction was collected and analyzed, and found to be reliable and valid for further evaluations of the effectiveness of the proposed system, resulting in the following findings about the older adults who have played the game: the participants become more willing to use technological devices; involving them in the game creates positive aging effects; participants become more receptive to technology products; the participating older adults’ cognitive abilities are trained and their body exercises increased, creating sensory stimulation and health promotion effects; and considering users with cognitive impairments who have stress and difficulty operating the device, the system needs to be improved in the future. Full article
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Open AccessArticle
A Study of Care Workers’ Wages and Relevant Factors in South Korea
Healthcare 2020, 8(2), 178; https://doi.org/10.3390/healthcare8020178 - 19 Jun 2020
Cited by 1 | Viewed by 1038
Abstract
The purpose of this study is to analyze the wages of South Korea’s care workers as reported by the Korean national health insurance services database. We also try to identify the factors determining the wages of these 1,221,085 care workers. According to the [...] Read more.
The purpose of this study is to analyze the wages of South Korea’s care workers as reported by the Korean national health insurance services database. We also try to identify the factors determining the wages of these 1,221,085 care workers. According to the results of the analysis, first, the wage level of care workers is fundamentally low compared to other jobs; second, the labor conditions of home care facilities (compared to those in residential care facilities) are poor, because these depend on wages, which in turn depend on the external environment, such as care institutes’ management; and third, it was verified that the locations of care institutes affect the wages of care workers. As the South Korean population continues to age, the supply of high-quality care workers has important clinical implications for improving the quality of care received by the elderly. Throughout this study, it is argued that the establishment of a social service corporation has become desirable in terms of strengthening public care institutes in Korea. Full article
(This article belongs to the Section Nursing)
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Open AccessArticle
Locomotive Syndrome is a Risk Factor for the Dropout of Continuous Positive Airway Pressure Treatment in Patients with Obstructive Sleep Apnea Syndrome
Healthcare 2020, 8(2), 177; https://doi.org/10.3390/healthcare8020177 - 19 Jun 2020
Viewed by 993
Abstract
Objective: The purpose of this study was to investigate the risk factors linked to patient dropout from continuous positive airway pressure (CPAP) therapy for the treatment of obstructive sleep apnea syndrome (OSAS). Methods: This study included 1191 patients with OSAS at baseline assessment, [...] Read more.
Objective: The purpose of this study was to investigate the risk factors linked to patient dropout from continuous positive airway pressure (CPAP) therapy for the treatment of obstructive sleep apnea syndrome (OSAS). Methods: This study included 1191 patients with OSAS at baseline assessment, who were followed for 3 years. We evaluated clinical parameters, indicators related to OSAS treatment, exercise habits and the presence of locomotive syndrome (LS). LS was evaluated by a ‘loco-check’, as established by the Japanese Orthopedic Association. The OSAS patients were categorized at baseline as belonging to an ‘LS group’ or a ‘non-LS group’, and clinical parameters were compared. Results: Eighty-six patients (7.2%) dropped out of CPAP therapy during the 3 year follow-up period. The dropout rate of the LS group was significantly higher than that of the non-LS group. Using a Cox-proportional hazard model, the LS, old age and poor compliance were determined to be significant risk factors for dropping out of CPAP therapy. The hazard ratios (95% CI) of LS, elderly people and poor CPAP compliance were 2.11 (1.31–3.48), 1.80 (1.11–2.94) and 1.61 (1.04–2.47), respectively. Conclusion: LS may be the critical risk factor for dropping out of CPAP therapy among patients with OSAS. Full article
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Open AccessArticle
The COVID-19 Pandemic and the Pathology of the Economic and Political Architecture in Cameroon
Healthcare 2020, 8(2), 176; https://doi.org/10.3390/healthcare8020176 - 17 Jun 2020
Cited by 2 | Viewed by 1940
Abstract
This article examines the factors restricting an effective response to the COVID-19 pandemic in Cameroon. It argues that structural adjustment policies in the 1980s and 1990s as well as corruption and limited investment in recent times have severely weakened the country’s health system. [...] Read more.
This article examines the factors restricting an effective response to the COVID-19 pandemic in Cameroon. It argues that structural adjustment policies in the 1980s and 1990s as well as corruption and limited investment in recent times have severely weakened the country’s health system. This article also emphasises the interconnection between poverty, slums, and COVID-19. This interconnection brings to the fore inequality in Cameroon. Arguably, this inequality could facilitate the spread of COVID-19 in the country. This article draws attention to the political forces shaping the response to the pandemic and contends that in some regions in the country, the lack of an effective response to the pandemic may not necessarily be due to a lack of resources. In so doing, it critiques the COVID-19 orthodoxy that focuses exclusively on the pathology of the disease and advocates “technical” solutions to the pandemic, while ignoring the political and socio-economic forces that shape the fight against the pandemic. At times, medical supplies and other forms of assistance may be available, but structural violence impairs access to these resources. Politics must be brought into the COVID-19 discourse, as it shapes the response to the pandemic. Full article
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Open AccessArticle
Long-Term Socioeconomic Impact of Informal Care Provided to Patients with Pacemakers: Remote vs. Conventional Monitoring
Healthcare 2020, 8(2), 175; https://doi.org/10.3390/healthcare8020175 - 16 Jun 2020
Viewed by 929
Abstract
The impact of informal care immediately after pacemaker (PM) implantation has been well established; however, not much is known about its long-term effects. The present study compared personal characteristics, associated problems, workloads, time, and costs related to informal care provided to patients with [...] Read more.
The impact of informal care immediately after pacemaker (PM) implantation has been well established; however, not much is known about its long-term effects. The present study compared personal characteristics, associated problems, workloads, time, and costs related to informal care provided to patients with PM under remote monitoring (RM) vs. conventional monitoring (CM) in the hospital, five years after implantation. The PONIENTE study was a controlled, non-randomized or masked clinical trial conducted with information obtained from the perspective of informal caregivers. Data were collected at 12 and 60 months after PM implantation. The patients in the study were assigned to two different groups: remote monitoring (RM) and conventional monitoring (CM). The “Disability, personal autonomy, and dependency situations survey” (EDAD) was administered to collect information on sociodemographic characteristics, time, care difficulties, health status, professional aspects, and impact on economic, family, or leisure aspects of the main caregivers providing care to patients with pacemakers. After five years, 55 patients completed the study (RM = 21; CM = 34). The average age was 63.14 years (SD = 14.90), 96% of them were women, and the most predominant marital status was married (72%). Informal caregivers lived in the homes of the patients in 70% of cases, and 88% indicated that they had to provide care six to seven days a week. The average cost per patient during the monitoring period studied was 13.17% lower in the RM group than in the CM group, and these differences were not statistically significant (p = 0.35). This study found similar results in the two groups under study with respect to sociodemographic characteristics, workload, time, and problems associated with health, leisure and family members. The costs associated with care were higher in the CM group; however, these differences were not statistically significant. Full article
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Open AccessArticle
The Effect of Loving-Kindness Meditation on Flight Attendants’ Spirituality, Mindfulness and Subjective Well-Being
Healthcare 2020, 8(2), 174; https://doi.org/10.3390/healthcare8020174 - 16 Jun 2020
Cited by 3 | Viewed by 1302
Abstract
Background: This study investigated: (1) the effects of the loving-kindness meditation (LKM) on mindfulness, subjective well-being (SWB), and spirituality and (2) the relationships between mindfulness, spirituality, and SWB. Methods: 98 flight attendants from Xiamen Airlines in China were recruited and randomly [...] Read more.
Background: This study investigated: (1) the effects of the loving-kindness meditation (LKM) on mindfulness, subjective well-being (SWB), and spirituality and (2) the relationships between mindfulness, spirituality, and SWB. Methods: 98 flight attendants from Xiamen Airlines in China were recruited and randomly assigned to the LKM training group (n = 49) or the waiting control group (n = 49). The LKM training group underwent an 8-week LKM training intervention, and the control group did not undergo intervention. The three main variables (SWB, mindfulness, and spirituality) were measured both before (pre-test) and after (post-test) the LKM training intervention. Results: In the experimental group, SWB and spirituality increased significantly. In the control group, no significant differences were observed for the three variables between the pre-test and post-test. Conclusions: Our results indicated that LKM may help to improve SWB and spirituality. However, the mechanisms which underlie the effects of the LKM on mindfulness, spirituality, SWB, and other psychological constructs require further elucidation. Full article
(This article belongs to the Special Issue Mindfulness in Healthcare)
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Open AccessArticle
Assessing Community Empowerment for an Innovative Epidemiologic Approach
Healthcare 2020, 8(2), 173; https://doi.org/10.3390/healthcare8020173 - 15 Jun 2020
Cited by 1 | Viewed by 1334
Abstract
Community empowerment can be a process, but also the result of nursing care. To analyze it as a result there is an instrument that allows to quantify its level in nine domains. According to Melo (2020), health centers can be considered communities, becoming [...] Read more.
Community empowerment can be a process, but also the result of nursing care. To analyze it as a result there is an instrument that allows to quantify its level in nine domains. According to Melo (2020), health centers can be considered communities, becoming the potential target of community and public health nurses care, especially in the public health unit. One of the main functions of a public health unit is the epidemiological surveillance of the population’s health state. However, traditional epidemiological surveillance is focused on diseases and Melo (2020) proposes a new approach for epidemiology focused on people in what concerns nursing diagnosis. The aim of this research is to identify the level of empowerment of four Portuguese primary healthcare structures, named as ACeS, so as to improve the epidemiological surveillance of nursing diagnoses. As methodology, we developed four focus group with all nursing leaders from all primary care units of the four ACeS, using the Portuguese version of the empowerment assessment rating scale. The results present the level of community empowerment of each ACeS according to the nine domains of the scale. The needs of intervention to improve the ACeS empowerment were also identified in order to develop the epidemiological surveillance of nursing diagnoses. Full article
(This article belongs to the Section Nursing)
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Open AccessConcept Paper
Nursing Genetic Research: New Insights Linking Breast Cancer Genetics and Bone Density
Healthcare 2020, 8(2), 172; https://doi.org/10.3390/healthcare8020172 - 15 Jun 2020
Viewed by 1067
Abstract
Nursing research is expected to provide options for the primary prevention of disease and health promotion, regardless of pathology or disease. Nurses have the skills to develop and lead research that addresses the relationship between genetic factors and health. Increasing genetic knowledge and [...] Read more.
Nursing research is expected to provide options for the primary prevention of disease and health promotion, regardless of pathology or disease. Nurses have the skills to develop and lead research that addresses the relationship between genetic factors and health. Increasing genetic knowledge and research capacity through interdisciplinary cooperation as well as the development of research resources, will accelerate the rate at which nurses contribute to the knowledge about genetics and health. There are currently different fields in which knowledge can be expanded by research developed from the nursing field. Here, we present an emerging field of research in which it is hypothesized that genetics may affect bone metabolism. Better insight of genetic factors that are contributing to metabolic bone diseases would allow for focused nursing care and preventive interventions. Full article
(This article belongs to the Section Nursing)
Open AccessArticle
Breast Cancer Screening Behaviors in Women Aged 40 Years and Over in a Semi-Urban Region in Turkey: Relationships with Health Beliefs
Healthcare 2020, 8(2), 171; https://doi.org/10.3390/healthcare8020171 - 13 Jun 2020
Cited by 1 | Viewed by 1078
Abstract
In this study, we aimed to determine the breast cancer screening behavior of women and to investigate the relationship between health beliefs and screening behaviors. The study was cross-sectional. It was conducted between April 2017 and June 2017 with 416 women aged ≥40. [...] Read more.
In this study, we aimed to determine the breast cancer screening behavior of women and to investigate the relationship between health beliefs and screening behaviors. The study was cross-sectional. It was conducted between April 2017 and June 2017 with 416 women aged ≥40. The Sociodemographic Information Form and the Champion’s Health Belief Model Scale were used to collect data. In the statistical analysis, the number, percentage, mean, standard deviation, Pearson chi-square test, and multivariate binary logistic regression analysis were used. The rates for participating women performing breast self-examination, having clinical breast examination, and undergoing mammography were 11.8%, 8.9%, and 11.3%, respectively. Perceived susceptibility, seriousness, self-efficacy, benefits, health motivation, and perceived barriers were found to have strong associations with screening behaviors (p < 0.05). In this study, we found that few women performed breast self-examination, had clinical breast examination and mammography. In the present study, women perceived barriers related to both performing breast self-examination and undergoing mammography. Full article
(This article belongs to the Section Women Health)
Open AccessArticle
Methodology Proposal for the Management of Nursing Competencies towards a Strategic Training. A Theoretical Analysis
Healthcare 2020, 8(2), 170; https://doi.org/10.3390/healthcare8020170 - 13 Jun 2020
Viewed by 1167
Abstract
Professional and academic legislation relating to nursing skills reflects conceptual and professional developments. In this sense, conceptual and methodological analyses are required to describe the concept of nursing competencies, the individual or group self-perception of competencies, to identify training needs, and to specify [...] Read more.
Professional and academic legislation relating to nursing skills reflects conceptual and professional developments. In this sense, conceptual and methodological analyses are required to describe the concept of nursing competencies, the individual or group self-perception of competencies, to identify training needs, and to specify the nursing professional profile within the health organization. A sequential mixed methodology was proposed combining qualitative and quantitative approaches. The qualitative methodology involves the Focus Group and the Delphi technique. The quantitative methodology involves surveying and analyzing self-perception (descriptive and analytical in relation to personal and professional variables and levels of excellence). The methodology was piloted among primary care nurses. Competencies were analyzed and distributed across the training program. The combination of qualitative and quantitative methods showed that obtaining a deep insight into the nurses’ competencies would be a good process. This proposal is applicable as an approach to global nursing competencies or to a particular specialty. Full article
(This article belongs to the Section Nursing)
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Open AccessArticle
Cerebral Blood Flow Is Reduced in Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients During Mild Orthostatic Stress Testing: An Exploratory Study at 20 Degrees of Head-Up Tilt Testing
Healthcare 2020, 8(2), 169; https://doi.org/10.3390/healthcare8020169 - 13 Jun 2020
Cited by 3 | Viewed by 4085
Abstract
Introduction: In a study of 429 adults with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), we demonstrated that 86% had symptoms of orthostatic intolerance in daily life. Using extracranial Doppler measurements of the internal carotid and vertebral arteries during a 30-min head-up tilt to 70 [...] Read more.
Introduction: In a study of 429 adults with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), we demonstrated that 86% had symptoms of orthostatic intolerance in daily life. Using extracranial Doppler measurements of the internal carotid and vertebral arteries during a 30-min head-up tilt to 70 degrees, 90% had an abnormal reduction in cerebral blood flow (CBF). A standard head-up tilt test of this duration might not be tolerated by the most severely affected bed-ridden ME/CFS patients. This study examined whether a shorter 15-min test at a lower 20 degree tilt angle would be sufficient to provoke reductions in cerebral blood flow in severe ME/CFS patients. Methods and results: Nineteen severe ME/CFS patients with orthostatic intolerance complaints in daily life were studied: 18 females. The mean (SD) age was 35(14) years, body surface area (BSA) was 1.8(0.2) m2 and BMI was 24.0(5.4) kg/m2. The median disease duration was 14 (IQR 5–18) years. Heart rate increased, and stroke volume index and end-tidal CO2 decreased significantly during the test (p ranging from <0.001 to <0.0001). The cardiac index decreased by 26(7)%: p < 0.0001. CBF decreased from 617(72) to 452(63) mL/min, a 27(5)% decline. All 19 severely affected ME/CFS patients met the criteria for an abnormal CBF reduction. Conclusions: Using a less demanding 20 degree tilt test for 15 min in severe ME/CFS patients resulted in a mean CBF decline of 27%. This is comparable to the mean 26% decline previously noted in less severely affected patients studied during a 30-min 70 degree head-up tilt. These observations have implications for the evaluation and treatment of severely affected individuals with ME/CFS. Full article
(This article belongs to the Special Issue ME/CFS – the Severely and Very Severely Affected)
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Open AccessEditorial
Examining Social Determinants of Health, Stigma, and COVID-19 Disparities
Healthcare 2020, 8(2), 168; https://doi.org/10.3390/healthcare8020168 - 12 Jun 2020
Cited by 24 | Viewed by 4662
Abstract
There is growing attention to disparities in the incidence, prevalence, and mortality associated with COVID-19 (Coronavirus disease 2019) in racial/ethnic communities. The conditions leading to these disparities may be a function of social determinants of health and stigma linked to the disease. It [...] Read more.
There is growing attention to disparities in the incidence, prevalence, and mortality associated with COVID-19 (Coronavirus disease 2019) in racial/ethnic communities. The conditions leading to these disparities may be a function of social determinants of health and stigma linked to the disease. It is important to examine how these factors may be implicated in COVID-19 onset, treatment, and outcomes. A brief overview of these issues allows for a cursory examination of the role of social determinants of health and stigma in COVID-19. Consideration is given to how understanding COVID-19 in the context of social determinants and stigma may be included in interventions to mitigate its transmission within vulnerable populations. Full article
(This article belongs to the Special Issue Health Disparities and Stigma in the Era of COVID-19)
Open AccessArticle
Nursing Care Ethical Implications Regarding Chronic Patients at Hospital Discharge
Healthcare 2020, 8(2), 167; https://doi.org/10.3390/healthcare8020167 - 11 Jun 2020
Viewed by 994
Abstract
Mortality rates among pluripathological patients are significantly higher in the hospital setting, with advanced age and dependence on certain vital functions the main clinical aspects. Other features involved in the care, such as the loss of autonomy and social problems, have important ethical [...] Read more.
Mortality rates among pluripathological patients are significantly higher in the hospital setting, with advanced age and dependence on certain vital functions the main clinical aspects. Other features involved in the care, such as the loss of autonomy and social problems, have important ethical implications. The aim of this article is to analyze the health problems and the functional and social situation of chronic patients after hospital admission in order to determine their care needs and the ethical implications these might have. For this, a cross-sectional descriptive study is being carried out with a sample of 111 chronic pluripathological patients admitted to the internal medicine service and discharged later. Overall, 96.6% of the patients in the sample were dependent, 91.7% had social problems or were at social risk and 36.9% had cognitive impairment. Among dependent patients, 59.4% had social problems (p = 0.029), 19.2% lived alone (p = 0.13), and in 73.3% of cases the housing was inadequate (p = 0.47). Among those with cognitive impairment, 79.5% of patients had social problems (p = 0.001), and 10.3% lived alone (p = 0.038). The results of the study confirm the presence of dependence and social problems at hospital discharge in a high proportion of chronic patients. Planning their care can lead to ethical conflicts related to the use of information technologies, which are destined to promote the patients’ autonomy, and to the social problems associated with the illness. Full article
(This article belongs to the Section Nursing)
Open AccessArticle
Relationship between Muscle Cross-Sectional Area by MRI and Muscle Thickness by Ultrasonography of the Triceps Surae in the Sitting Position
Healthcare 2020, 8(2), 166; https://doi.org/10.3390/healthcare8020166 - 10 Jun 2020
Cited by 1 | Viewed by 958
Abstract
The purpose of this study was to determine the differences in the muscle cross-sectional area (MCSA) of the triceps surae in the supine and sitting positions using magnetic resonance imaging (MRI), and the relationship between the MCSA of the triceps surae in the [...] Read more.
The purpose of this study was to determine the differences in the muscle cross-sectional area (MCSA) of the triceps surae in the supine and sitting positions using magnetic resonance imaging (MRI), and the relationship between the MCSA of the triceps surae in the sitting position and muscle thickness (MT), assessed using MRI and ultrasonography, respectively. This study included 16 healthy young male participants. The measurement positions were 90° flexion of the knee joint and neutral position of the ankle joint in the sitting or supine positions. Using an open-configuration MRI system with a vertical gap and ultrasonography, we measured the MCSA and MT of the soleus muscle and the medial and lateral heads of the gastrocnemius muscle at three selected locations in the ventral part of the muscle. As a result, the 50% portion of the soleus muscle and the 25% and 50% portions of the gastrocnemius medial and lateral heads were higher in the sitting position than in the supine position. Furthermore, only 50% of the gastrocnemius medial head showed a correlation between the MCSA and MT. When using the MT of the triceps surae as an indicator of muscle volume in the sitting position, the muscle site should be considered. Full article
(This article belongs to the Section Health Assessments)
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Open AccessArticle
Telehealth Use among Community Health Centers and Cardio-Metabolic Health Outcomes
Healthcare 2020, 8(2), 165; https://doi.org/10.3390/healthcare8020165 - 10 Jun 2020
Viewed by 1402
Abstract
Public health interventions to manage the cardio-metabolic syndrome (CMS) have had modest success, necessitating the expansion of telehealth services to where people live. This effort analyzes the association between telehealth provision and the management of CMS-related quality measures (hypertension, diabetes, weight assessment and [...] Read more.
Public health interventions to manage the cardio-metabolic syndrome (CMS) have had modest success, necessitating the expansion of telehealth services to where people live. This effort analyzes the association between telehealth provision and the management of CMS-related quality measures (hypertension, diabetes, weight assessment and related counseling, lipid therapy for coronary artery disease, and antiplatelet therapy for ischemic vascular disease) using the Uniform Data System administrative database during the period 2016–2018. A total of 523, 600, and 586 community health centers (CHCs) were documented using telehealth, out of the 1367, 1373, and 1362 total CHCs, in the respective three years. Our primary analysis showed that there was no association between telehealth use and the outcomes. A difference in difference approach that compared the CHCs which transitioned from not using it to using it with those that did not use telehealth in two consecutive years also produced null results. However, among rural areas, the odds of better managing the outcomes were greater for certain outcomes. Our study provides limited support that the adoption of telehealth is potentially beneficial in improving certain outcomes in the CHCs setting that are based in rural areas. More specificity in data regarding the nature of telehealth implementation in the CHC setting could bring clarity in these associations. Full article
(This article belongs to the Special Issue Mobile Health Care with Smart Technology Applications)
Open AccessReview
Determinants of Motivation among Healthcare Workers in the East African Community between 2009–2019: A Systematic Review
Healthcare 2020, 8(2), 164; https://doi.org/10.3390/healthcare8020164 - 10 Jun 2020
Cited by 6 | Viewed by 1406
Abstract
Healthcare workers are an essential element in the functionality of the health system. However, the health workforce impact on health systems tends to be overlooked. Countries within the Sub-Saharan region such as the six in the East African Community (EAC) have weak and [...] Read more.
Healthcare workers are an essential element in the functionality of the health system. However, the health workforce impact on health systems tends to be overlooked. Countries within the Sub-Saharan region such as the six in the East African Community (EAC) have weak and sub-optimally functioning health systems. As countries globally aim to attain Universal Health Coverage and the Sustainable Development Goal 3, it is crucial that the significant role of the health workforce in this achievement is recognized. In this systematic review, we aimed to synthesise the determinants of motivation as reported by healthcare workers in the EAC between 2009 and 2019. A systematic search was performed using four databases, namely Cochrane library, EBSCOhost, ProQuest and PubMed. The eligible articles were selected and reviewed based on the authors’ selection criteria. A total of 30 studies were eligible for review. All six countries that are part of the EAC were represented in this systematic review. Determinants as reported by healthcare workers in six countries were synthesised. Individual-level-, organizational/structural- and societal-level determinants were reported, thus revealing the roles of the healthcare worker, health facilities and the government in terms of health systems and the community or society at large in promoting healthcare workers’ motivation. Monetary and non-monetary determinants of healthcare workers’ motivation reported are crucial for informing healthcare worker motivation policy and health workforce strengthening in East Africa. Full article
(This article belongs to the Section Health Policy)
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Open AccessArticle
Objective Work-Related Factors, Job Satisfaction and Depression: An Empirical Study among Internal Migrants in China
Healthcare 2020, 8(2), 163; https://doi.org/10.3390/healthcare8020163 - 09 Jun 2020
Viewed by 1184
Abstract
This study examines the associations between objective work-related factors, job satisfaction and depression among migrants in China. Data from a representative sample of Chinese migrants named Management and Services of Migrants Study (MSMS) were used after excluding 1068 self-employed participants. We employed multivariate [...] Read more.
This study examines the associations between objective work-related factors, job satisfaction and depression among migrants in China. Data from a representative sample of Chinese migrants named Management and Services of Migrants Study (MSMS) were used after excluding 1068 self-employed participants. We employed multivariate linear regression analysis. Depression was measured by the Centre for Epidemiologic Study Depression (C-ESD) scale. Objective work-related factors included firm size, job classification, mode of employment, working hours per week, union membership and working overtime compulsorily. Measurement of job satisfaction was derived from the Job Descriptive Index. We found that migrants in the sales/services sector and the clerical/technical/managerial sector had more depressive symptoms compared with those in the manufacturing/transportation sector. Working more than 55 h per week was associated with more depressive symptoms. Working overtime compulsorily and joining a labour union were all associated with more depressive symptoms. In addition, job satisfaction was negatively associated with depressive symptoms. The research findings on the relationship between work-related factors and depressive symptoms may serve as a guide for vocational rehabilitation counselling programs and for further research on depression in workplaces. Full article
(This article belongs to the Special Issue Burnout, Perceived Efficacy, Compassion Fatigue and Job Satisfaction)
Open AccessArticle
Immediate Effect of Balance Taping Using Kinesiology Tape on Dynamic and Static Balance after Ankle Muscle Fatigue
Healthcare 2020, 8(2), 162; https://doi.org/10.3390/healthcare8020162 - 09 Jun 2020
Cited by 4 | Viewed by 1293
Abstract
The objective of this study was to investigate whether ankle balance taping (ABT) applied after muscle fatigue-inducing exercise can cause immediate improvements in dynamic and static balance. A total of 31 adults (16 males and 15 females) met the inclusion criteria. The experiment [...] Read more.
The objective of this study was to investigate whether ankle balance taping (ABT) applied after muscle fatigue-inducing exercise can cause immediate improvements in dynamic and static balance. A total of 31 adults (16 males and 15 females) met the inclusion criteria. The experiment was designed using a single-blinded, randomized controlled trial. Changes in static and dynamic balance were measured before and after inducing muscle fatigue in the ankles and after ABT or ankle placebo taping (APT). After ankle muscle fatigue-inducing exercise, both the ABT and APT groups showed significant increases in surface area ellipses in the static state with eyes open (p < 0.05), and significant increases in surface area ellipses in the static and dynamic states with eyes closed (both p < 0.05). After taping of the fatigued ankle, surface area ellipses decreased significantly when eyes were open and closed in the static and dynamic states, but only in the ABT group (p < 0.05). Static balance was significantly different between groups (eyes open, 36.2 ± 86; eyes closed, 22.9 ± 46.7). Dynamic balance was significantly different between groups (eyes open, 68.6 ± 152.1; eyes closed, 235.8 ± 317.6). ABT may help prevent ankle injuries in individuals who experience muscle fatigue around the ankles after sports and daily activities. Full article
(This article belongs to the Special Issue Physical Rehabilitation & Prevention in Sports Injuries)
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Open AccessCommunication
Detection of Methicillin Susceptible and Resistant Staphylococcus aureus Nasal Carriage and Its Antibiotic Sensitivity among Basic and Clinical Years Medical Students
Healthcare 2020, 8(2), 161; https://doi.org/10.3390/healthcare8020161 - 06 Jun 2020
Cited by 1 | Viewed by 988
Abstract
Background: Healthcare workers (HCWs) and medical students can be asymptomatic carriers in transmitting methicillin resistant and susceptible Staphylococcus aureus (MRSA and MSSA). Studying epidemiological and antibiotic susceptibility data is necessary to limit the spread of infections, help with treatment and understand the transmission [...] Read more.
Background: Healthcare workers (HCWs) and medical students can be asymptomatic carriers in transmitting methicillin resistant and susceptible Staphylococcus aureus (MRSA and MSSA). Studying epidemiological and antibiotic susceptibility data is necessary to limit the spread of infections, help with treatment and understand the transmission dynamics of MSSA and MRSA. Our study assessed the rate of MSSA and MRSA nasal carriage and its antibiogram among medical students in basic and clinical years at the University of Jordan. Methods: A total of 210 nasal swabs were randomly collected from participants. MSSA and MRSA were identified by culture, biochemical and other phenotypical analysis methods. Antibiotic susceptibility was determined by the disc diffusion method. Results: The nasal carriage of MSSA was 6.6% and 11.4% and that of MRSA was 1.9% and 2.8% among basic and clinical years, respectively. There was no significant difference for the nasal carriage of MSSA and MRSA among basic and clinical year students (p value ≥ 0.05). MSSA resistance ranged between 25% and 33% for trimethoprim-sulfamethoxazole, tetracycline and ciprofloxacin. For MRSA, the highest resistance was to trimethoprim-sulfamethoxazole and tetracycline (67% to 100%), followed by gentamicin and ciprofloxacin (33% to 67%), in all participants in the study. Conclusion: The difference in the carriage rates of MSSA and MRSA among basic and clinical students was statistically insignificant. The continuous awareness and implementation of infection control procedures and guided patient contact are recommended. The results might also suggest that healthcare workers could be victims in the cycle of MRSA nasal carriage, a theory that needs further study. Full article
(This article belongs to the Section Health Assessments)
Open AccessArticle
Modeling Public Opinion Reversal Process with the Considerations of External Intervention Information and Individual Internal Characteristics
Healthcare 2020, 8(2), 160; https://doi.org/10.3390/healthcare8020160 - 05 Jun 2020
Cited by 21 | Viewed by 1989
Abstract
With the rapid development of “we media” technology, external information about the same sudden hot social event is often involved repetitiously, leading to frequent public opinion reversal. However, the phenomenon of public opinion reversal process usually has a long-lasting duration and spreads wide, [...] Read more.
With the rapid development of “we media” technology, external information about the same sudden hot social event is often involved repetitiously, leading to frequent public opinion reversal. However, the phenomenon of public opinion reversal process usually has a long-lasting duration and spreads wide, making the event itself attract the widespread attention of ordinary people. Focusing on the public opinion reversal process of sudden social hot topic (a popular and widely discussed issue), this paper firstly identifies the internal and external factors that affect the reversal, namely individual internal characteristics and external intervention information. Secondly, information intensity and the amount of information perceived by individuals are introduced to describe the impact of external intervention information on the public opinion reversal. Thirdly, the parameters of individual attention and conservation are used to describe the process of individual’s selection of external information, so as to reveal the influence of the internal characteristics on public opinion reversal, and then build a public opinion reversal model. Fourthly, the effects of information intensity and individual attention, as well as individual conservation on the process of public opinion reversal are analyzed by simulation experiment. Simulation results show that: (1) the intensity of external intervention information affects the direction and degree of public opinion reversal; (2) when individual conservation is strong or individual attention is weak, even if external intervention information is strong, there will still be no obvious reversal of public opinion. Subsequently, the rationality and effectiveness of the proposed model are verified by a real case. Finally, some recommendations and policy implications are also given. Full article
(This article belongs to the Section TeleHealth and Digital Healthcare)
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Open AccessArticle
Rural Community Perceptions and Interests in Pharmacogenomics
Healthcare 2020, 8(2), 159; https://doi.org/10.3390/healthcare8020159 - 05 Jun 2020
Cited by 1 | Viewed by 976
Abstract
Pharmacogenomics testing is a rapidly expanding field with increasing importance to individualized patient care. However, it remains unclear whether the general public in rural areas would be willing to engage in this service. The objective of this survey was to determine rural community-dwelling [...] Read more.
Pharmacogenomics testing is a rapidly expanding field with increasing importance to individualized patient care. However, it remains unclear whether the general public in rural areas would be willing to engage in this service. The objective of this survey was to determine rural community-dwelling members’ perceptions of pharmacogenomics. A questionnaire was developed consisting of five Likert-style questions on knowledge and perceptions of pharmacogenomics, a single multiple-choice question on cost of testing, and a free-response question. Two cohorts received the same questionnaire: attendees at a university-sponsored health fair and patients presenting to two independent community pharmacies in southeastern Idaho. While both showed positive reception to the implementation and value of pharmacogenomics, those at the health fair were more in favor of pharmacogenomics, suggesting a need for greater outreach and education to the general public. The findings suggest that interest of rural community-dwelling individuals may be amenable to the expansion of pharmacogenomics testing. Full article
(This article belongs to the Section Community Care)
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Open AccessArticle
Quality of Life in Older Adults with Benign Prostatic Hyperplasia
Healthcare 2020, 8(2), 158; https://doi.org/10.3390/healthcare8020158 - 04 Jun 2020
Cited by 1 | Viewed by 1183
Abstract
The purpose of this study is to identify factors that affect health-related quality of life (HRQOL) of older patients with Benign Prostatic Hyperplasia (BPH) and suggest ways to improve the same. Through this, we will improve the self-management practice of patients and promote [...] Read more.
The purpose of this study is to identify factors that affect health-related quality of life (HRQOL) of older patients with Benign Prostatic Hyperplasia (BPH) and suggest ways to improve the same. Through this, we will improve the self-management practice of patients and promote the treatment of BPH in older patients. The 2015 Korea Health Panel Survey data were used in this study. A total of 422 BPH patients aged 65 or older were included. Logistic regression analysis was conducted to identify factors affecting the HRQOL of older patients with BPH. General characteristics of factors affecting older patients with BPH included income level and type of insurance. In addition, among medical-related characteristics and health behavior factors, subjective health status, unmet medical care needs, moderate physical activity, sitting time, and drinking influenced the HRQOL. Therefore, in order to improve the HRQOL of adult patients with BPH, it is necessary to improve medical accessibility by strengthening primary care. In addition, it is necessary to increase the amount of activity in daily life through healthcare medical devices. Full article
(This article belongs to the Collection Health Care and Services for Elderly Population)
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