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Healthcare, Volume 8, Issue 3 (September 2020) – 71 articles

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Open AccessCommentary
The Perioperative Surgical Home in Pediatrics: Improve Patient Outcomes, Decrease Cancellations, Improve HealthCare Spending and Allocation of Resources during the COVID-19 Pandemic
Healthcare 2020, 8(3), 258; https://doi.org/10.3390/healthcare8030258 (registering DOI) - 07 Aug 2020
Viewed by 141
Abstract
Cancellations or delays in surgical care for pediatric patients that present to the operating room create a great obstacle for both the physician and the patient. Perioperative outpatient management begins prior to the patient entering the hospital for the day of surgery, and [...] Read more.
Cancellations or delays in surgical care for pediatric patients that present to the operating room create a great obstacle for both the physician and the patient. Perioperative outpatient management begins prior to the patient entering the hospital for the day of surgery, and many organizations practice using the perioperative surgical home (PSH), incorporating enhanced recovery concepts. This paper describes changes in standard operating procedures caused by the COVID-19 pandemic, and proposes the expansion of PSH, as a means of improving perioperative quality of care in pediatric populations. Full article
(This article belongs to the Special Issue Perioperative Care)
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Open AccessArticle
GENE2D: A NoSQL Integrated Data Repository of Genetic Disorders Data
Healthcare 2020, 8(3), 257; https://doi.org/10.3390/healthcare8030257 (registering DOI) - 06 Aug 2020
Viewed by 143
Abstract
There are few sources from which to obtain clinical and genetic data for use in research in Saudi Arabia. Numerous obstacles led to the difficulty of integrating these data from silos and scattered sources to provide standardized access to large data sets for [...] Read more.
There are few sources from which to obtain clinical and genetic data for use in research in Saudi Arabia. Numerous obstacles led to the difficulty of integrating these data from silos and scattered sources to provide standardized access to large data sets for patients with common health conditions. To this end, we sought to contribute to this area and offer a practical and easy-to-implement solution. In this paper, we aim to design and implement a “not only SQL” (NoSQL) based integration framework to generate an Integrated Data Repository of Genetic Disorders Data (GENE2D) to integrate data from various genetic clinics and research centers in Saudi Arabia and provide an easy-to-use query interface for researchers to conduct their studies on large datasets. The major components involved in the GENE2D architecture consists of the data sources, the integrated data repository (IDR) as a central database, and the application interface. The IDR uses a NoSQL document store via MongoDB (an open source document-oriented database program) as a backend database. The application interface called Query Builder provides multiple services for data retrieval from the database using a custom query to answer simple or complex research questions. The GENE2D system demonstrates its potential to help grow and develop a national genetic disorders database in Saudi Arabia. Full article
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Open AccessArticle
The Effects of China’s Targeted Poverty Alleviation Policy on the Health and Health Equity of Rural Poor Residents: Evidence from Shaanxi Province
Healthcare 2020, 8(3), 256; https://doi.org/10.3390/healthcare8030256 - 06 Aug 2020
Viewed by 141
Abstract
Objective: China’s targeted poverty alleviation policy has a profound impact on the country’s rural economic and social development now. This study aimed to learn about the health status and health equity of rural poor residents under the implementation of the policy. It [...] Read more.
Objective: China’s targeted poverty alleviation policy has a profound impact on the country’s rural economic and social development now. This study aimed to learn about the health status and health equity of rural poor residents under the implementation of the policy. It further explores the factors affecting the health status and health equity of rural poor residents in order to contribute to the improvement of the policy. Methods: The data of 1233 rural poor residents were collected from a questionnaire survey from 12 prefecture-level cities and areas of Shaanxi province in 2017, and the self-reported health was used to reflect the health status. A concentration index was applied to measure the inequity of the health status of rural poor residents. The decomposition method was employed to explore the source of health inequity. Results: The results showed that 44.56% of rural poor residents in Shaanxi province had a poor or very poor health status, which was affected by their economic level, gender, age, degree of education, and marital status. Additionally, participation in agricultural industry development, relocation, health poverty alleviation, and basic living standards were significantly correlated with health status. The concentration index of the health status of rural poor residents was 0.0327. The primary contributors to the health inequity in different regions varied, but the economic level and the degree of education were the most significant factors, and the targeted poverty alleviation policy had a significant impact on health equity. Conclusions: The results indicated that the health status of rural poor residents in Shaanxi province was generally poor, there was a pro-rich inequity in the health status, and the degree of education and economic level were the primary factors affecting the health status and health equity. The targeted poverty alleviation policy greatly impacted the health status and health equity of rural poor residents, and the difference in health status would lead to the inequity of benefits of the targeted poverty alleviation policy. In the future, the policy should focus on ensuring the sustainable development ability of rural residents with poor health status. Full article
Open AccessArticle
Sarcopenic Obesity and Activities of Daily Living in Stroke Rehabilitation Patients: A Cross-Sectional Study
Healthcare 2020, 8(3), 255; https://doi.org/10.3390/healthcare8030255 (registering DOI) - 06 Aug 2020
Viewed by 281
Abstract
Reports investigating the relationship between sarcopenic obesity and activities of daily living in older patients with stroke were limited. This study aimed to examine the prevalence of sarcopenic obesity and its association with activities of daily living in older post-stroke patients in convalescent [...] Read more.
Reports investigating the relationship between sarcopenic obesity and activities of daily living in older patients with stroke were limited. This study aimed to examine the prevalence of sarcopenic obesity and its association with activities of daily living in older post-stroke patients in convalescent rehabilitation wards. This study was performed in older post-stroke patients admitted to convalescent rehabilitation wards between January 2017 and March 2019. Sarcopenia was diagnosed based on the skeletal muscle mass index and hand grip strength according to the criteria of the 2019 Asian Working Group for Sarcopenia. Obesity was diagnosed according to the body fat percentage; ≥27% in men, ≥38% in women. The primary outcome was the Functional Independence Measure (FIM) score upon admission, which was analyzed using multiple linear regression. In total, 376 participants (women 44%; mean age 77.5 years) were analyzed and classified as normal (22%), simple obesity (17%), sarcopenia without obesity (32%), and sarcopenic obesity (28%). The presence of sarcopenic obesity was independently associated with the FIM score (95% CI, −16.157 to −5.353), whereas simple obesity and sarcopenia without obesity were not. In conclusion, sarcopenic obesity was independently associated with lower activities of daily living capability in older patients with stroke. Full article
(This article belongs to the Special Issue Nutrition Disorders in Older Adults)
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Open AccessArticle
End-of-Life Care in Acute Hospitals: Practice Change Reported by Health Professionals Following Online Education
Healthcare 2020, 8(3), 254; https://doi.org/10.3390/healthcare8030254 - 06 Aug 2020
Viewed by 161
Abstract
Providing quality care for those dying in hospital is challenging for health professionals who receive little training in this. “End of Life Essentials” (EOLE) was developed to address gaps in health professionals’ knowledge, skills and confidence in end-of-life care via the provision of [...] Read more.
Providing quality care for those dying in hospital is challenging for health professionals who receive little training in this. “End of Life Essentials” (EOLE) was developed to address gaps in health professionals’ knowledge, skills and confidence in end-of-life care via the provision of online learning modules and practice resources. This study aimed to determine whether respondents could describe clinical practice change as a result of module completion. Deidentified data were collected between October and November 2018 from learners registered for the online learning modules. Both quantitative and qualitative data were extracted and analysed. The survey design and conduct were reviewed, and ethical approval was obtained. Although the response rate was very low, results from n = 122 learners show improvements in knowledge, skills, awareness and confidence as a result of the undertaking of the learning modules. Two thirds self-reported practice changes (71%, n = 59) following the education, with “communication” cited most commonly (n = 19). The findings suggest that the EOLE education modules can help to improve end-of-life care by increasing health professionals’ awareness of good practice as well as their knowledge, skills and confidence. Online learning has also been reinforced as an appropriate forum for end-of-life education. Following education, implementing what has been learned occurs more easily at a personal level rather than at a team and organisational level. Barriers to and enablers of clinical practice change in hospital are described, including the fact that the organisation may not be responsive to changes or have the relevant resources to support change. Full article
(This article belongs to the Special Issue Improving Management and Decision-Making Near End of Life)
Open AccessArticle
Low Disclosure Rates to Sexual Partners and Unsafe Sexual Practices of Youth Recently Diagnosed with HIV; Implications for HIV Prevention Interventions in South Africa
Healthcare 2020, 8(3), 253; https://doi.org/10.3390/healthcare8030253 - 03 Aug 2020
Viewed by 219
Abstract
The study investigated the motivation to disclose or the decision to withhold one’s HIV serostatus to one’s partners and assessed the implications of non-disclosure on young peoples’ sexual behaviour and access to treatment. This was a cross-sectional survey conducted with 253 youth aged [...] Read more.
The study investigated the motivation to disclose or the decision to withhold one’s HIV serostatus to one’s partners and assessed the implications of non-disclosure on young peoples’ sexual behaviour and access to treatment. This was a cross-sectional survey conducted with 253 youth aged 18–25 years receiving antiretroviral therapy in a health district in North West Province, South Africa. The majority were female (75%), the mean time since the HIV diagnosis was 22 months, 40% did not know their partner’s HIV status, 32% had more than two sexual partners, and 63% had not used a condom during the last sexual act. The prevalence of disclosure was 40%, 36% delayed disclosure for over a year, and most disclosed to protect the partner from HIV transmission, to receive support, and to be honest and truthful. The prevalence of non-disclosure was high, as 60% withheld disclosure due to fear of abandonment, stigma and discrimination, accusations of unfaithfulness, and partner violence. Over half (55%) had no intentions to disclose at all. The lower disclosure rates imply that HIV transmission continues to persist among sexual partners in these settings. The findings suggest that high levels of perceived stigma impact on disclosure and HIV treatment, which increases the risk of on-going HIV transmission among youth receiving long-term antiretroviral therapy (ART) in South Africa. Full article
(This article belongs to the Special Issue Family Medicine: Opportunities and Challenges for Primary Healthcare)
Open AccessProject Report
Expanding Pharmacotherapy Data Collection, Analysis, and Implementation in ERAS® Programs—The Methodology of an Exploratory Feasibility Study
Healthcare 2020, 8(3), 252; https://doi.org/10.3390/healthcare8030252 - 03 Aug 2020
Viewed by 211
Abstract
Surgical organizations dedicated to the improvement of patient outcomes have led to a worldwide paradigm shift in perioperative patient care. Since 2012, the Enhanced Recovery After Surgery (ERAS®) Society has published guidelines pertaining to perioperative care in numerous disciplines including elective [...] Read more.
Surgical organizations dedicated to the improvement of patient outcomes have led to a worldwide paradigm shift in perioperative patient care. Since 2012, the Enhanced Recovery After Surgery (ERAS®) Society has published guidelines pertaining to perioperative care in numerous disciplines including elective colorectal and gynecologic/oncology surgery patients. The ERAS® and ERAS-USA® Societies use standardized methodology for collecting and assessing various surgical parameters in real-time during the operative process. These multi-disciplinary groups have constructed a bundled framework of perioperative care that entails 22 specific components of clinical interventions, which are logged in a central database, allowing a system of audit and feedback. Of these 22 recommendations, nine of them specifically involve the use of medications or pharmacotherapy. This retrospective comparative pharmacotherapy project will address the potential need to (1) collect more specific pharmacotherapy data within the existing ERAS Interactive Audit System® (EIAS) program, (2) understand the relationship between medication regimen and patient outcomes, and (3) minimize variability in pharmacotherapy use in the elective colorectal and gynecologic/oncology surgical cohort. Primary outcomes measures include data related to surgical site infections, venous thromboembolism, and post-operative nausea and vomiting as well as patient satisfaction, the frequency and severity of post-operative complications, length of stay, and hospital re-admission at 7 and 30 days, respectively. The methodology of this collaborative research project is described. Full article
(This article belongs to the Special Issue Perioperative Care)
Open AccessCommentary
Health Promotion Programs to Reduce Noncommunicable Diseases: A Call for Action in Kuwait
Healthcare 2020, 8(3), 251; https://doi.org/10.3390/healthcare8030251 - 03 Aug 2020
Viewed by 264
Abstract
Most public health issues in Kuwait are related to unhealthy behaviours. Research shows that behaviours are the result not only exclusively of personal choices but also of myriads of other social and environmental factors. Kuwait is one of the leading countries in obesity [...] Read more.
Most public health issues in Kuwait are related to unhealthy behaviours. Research shows that behaviours are the result not only exclusively of personal choices but also of myriads of other social and environmental factors. Kuwait is one of the leading countries in obesity and tobacco use in the world. Cardiovascular diseases stemming from complications related to these and other risk factors are important health issues based on their morbidity and mortality implications. These risks are spread across society and affect the old as well as young boys. The serious gaps between Kuwait’s health-related needs and the existing policies to reduce public health risks in Kuwait create a significant obstacle to healthy behaviour change. Kuwait requires adequate laws, policies, regulations, activities, and programs to promote people’s health. The Socio-Ecological Model (SEM) has been used successfully in health promotion in various behavioural settings, including obesity, physical inactivity, and smoking. We propose the use of SEM as a planning framework in building sustainable health promotion programs in Kuwait while paying attention to other concepts such as systems thinking, authentic community participation, community capacity, policy development, public health infrastructure enhancement, health coaching, and equity. Full article
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Open AccessArticle
Physicians’ Perspectives on COVID-19: An International Survey
Healthcare 2020, 8(3), 250; https://doi.org/10.3390/healthcare8030250 - 02 Aug 2020
Viewed by 337
Abstract
Coronavirus disease 2019 (COVID-19) has put a tremendous pressure over health care systems worldwide. Physicians were faced to fight this novel, emerging disease, without evidence-based recommendations. Our aim was to investigate physicians’ point of view regarding the new coronavirus disease. We designed an [...] Read more.
Coronavirus disease 2019 (COVID-19) has put a tremendous pressure over health care systems worldwide. Physicians were faced to fight this novel, emerging disease, without evidence-based recommendations. Our aim was to investigate physicians’ point of view regarding the new coronavirus disease. We designed an on-line survey with 30 questions to assess physicians’ perception of personal impact as well as epidemiology, clinical features, management, and outcome in COVID-19. A total of 194 physicians from 43 countries, of which 42.3% were male, 45.4% had more than 5 years’ experience and 10.8% were heads of department/professors, filled-out the questionnaire. Although 47.4% of the physicians were currently treating patients, over 80% thought that they might get in contact with COVID-19 patients. A total of 36.6% physicians thought that they are not and 30.9% were not sure if they were being protected by the ongoing procedures. A total of 21.1% of the doctors felt that they are avoided by the persons with whom they usually interact in daily life and 24.7% were isolated from the household members they usually live with. A total of 72.7% of physicians considered that COVID-19-free patients are currently neglected. The results of the current survey raise awareness about the impact of COVID-19 on physicians’ practice. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
Open AccessArticle
Conceptualizing COVID-19 and Public Panic with the Moderating Role of Media Use and Uncertainty in China: An Empirical Framework
Healthcare 2020, 8(3), 249; https://doi.org/10.3390/healthcare8030249 - 02 Aug 2020
Viewed by 333
Abstract
Uncertainty puts people in a binary state of mind, where every piece of external information can positively or negatively affect their state of health. Given the uncertain situation created by the new coronavirus pandemic, this study claims to be the first empirical analysis [...] Read more.
Uncertainty puts people in a binary state of mind, where every piece of external information can positively or negatively affect their state of health. Given the uncertain situation created by the new coronavirus pandemic, this study claims to be the first empirical analysis of the real-time status of public panic in China. It frames peoples’ intrinsic and extrinsic stimuli, creating a psychosocial analysis of public panic. We conducted an online survey of WeChat and QQ users in February 2020 and collected 1613 samples through a QR code questionnaire. We used the ordinary least squares (OLS) regression equation model to conceptualize public panic pathways in different gender and age groups. This underlines the psychological origins of fear and anxiety and points out how the media uses socially constructed public panic. The results show that the outbreak of COVID-19 created uncertainty among the public, and the official media intensified it because of the late dissemination of news about the outbreak’s real-time status. Hence, unofficial media remained faster in news reporting, but the news reporting remained contradictory with official reports. This created doubts about the authenticity of the given information and caused public mental health abnormalities. The study provides a conceptual framework based on lessons learned from physiology, psychology, and social psychology and real-time public analysis to inform policymakers and public administrators about the contextual dynamics of public panic in China. It provides useful insights into the wise handling of this uncertain time and controlling the fatal conditions of public panic created by COVID-19. It has implications for other countries as well. Full article
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Open AccessArticle
Evaluation of Carer Strain and Carer Coping with Medications for People with Dementia after Discharge: Results from the SMS Dementia Study
Healthcare 2020, 8(3), 248; https://doi.org/10.3390/healthcare8030248 - 31 Jul 2020
Viewed by 224
Abstract
This study reports carer strain and coping with medications for people with dementia with an unplanned admission to hospital, and it evaluates the impact of a safe medication intervention on carer coping and carer strain. This was a quasi-experimental pre/post-controlled trial that included [...] Read more.
This study reports carer strain and coping with medications for people with dementia with an unplanned admission to hospital, and it evaluates the impact of a safe medication intervention on carer coping and carer strain. This was a quasi-experimental pre/post-controlled trial that included a survey of carers about managing medications for people with dementia after discharge. For 88 carers who completed surveys, 33% were concerned about managing medications, and 40% reported difficulties with medication management, including resistive behaviours by people with dementia. Dose administration aids were used by 72% of carers; however, only 15% reported receiving a recent home medicines review by a community pharmacist. High carer strain was reported by 74% of carers. Carer comments described many issues that contributed to high carer stress, as well as their engagement in vigilant activities to maintain medication safety. Strategies that can contribute to carers managing medications and reducing their strain include an increased use of dose administration aids, increased provision of home medicines reviews, and increased education of health professionals to provide adequate support and education about managing medications. Full article
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Open AccessArticle
Prediction of Type 2 Diabetes Risk and Its Effect Evaluation Based on the XGBoost Model
Healthcare 2020, 8(3), 247; https://doi.org/10.3390/healthcare8030247 - 31 Jul 2020
Viewed by 220
Abstract
In view of the harm of diabetes to the population, we have introduced an ensemble learning algorithm—EXtreme Gradient Boosting (XGBoost) to predict the risk of type 2 diabetes and compared it with Support Vector Machines (SVM), the Random Forest (RF) and K-Nearest Neighbor [...] Read more.
In view of the harm of diabetes to the population, we have introduced an ensemble learning algorithm—EXtreme Gradient Boosting (XGBoost) to predict the risk of type 2 diabetes and compared it with Support Vector Machines (SVM), the Random Forest (RF) and K-Nearest Neighbor (K-NN) algorithm in order to improve the prediction effect of existing models. The combination of convenient sampling and snowball sampling in Xicheng District, Beijing was used to conduct a questionnaire survey on the personal data, eating habits, exercise status and family medical history of 380 middle-aged and elderly people. Then, we trained the models and obtained the disease risk index for each sample with 10-fold cross-validation. Experiments were made to compare the commonly used machine learning algorithms mentioned above and we found that XGBoost had the best prediction effect, with an average accuracy of 0.8909 and the area under the receiver’s working characteristic curve (AUC) was 0.9182. Therefore, due to the superiority of its architecture, XGBoost has more outstanding prediction accuracy and generalization ability than existing algorithms in predicting the risk of type 2 diabetes, which is conducive to the intelligent prevention and control of diabetes in the future. Full article
(This article belongs to the Special Issue Statistical Process Monitoring in Healthcare)
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Open AccessArticle
A School Nurse Competency Framework for Continuing Education
Healthcare 2020, 8(3), 246; https://doi.org/10.3390/healthcare8030246 - 30 Jul 2020
Viewed by 231
Abstract
Background: This study develops a school nurse competency framework for continuing education based on focus group interviews and a literature review. Methods: This study uses a qualitative content analysis with 12 school nurses. Six school nurses verify the content validity for the competency [...] Read more.
Background: This study develops a school nurse competency framework for continuing education based on focus group interviews and a literature review. Methods: This study uses a qualitative content analysis with 12 school nurses. Six school nurses verify the content validity for the competency framework for continuing education using the content validity index. Results: School nurse competencies are defined as the knowledge, skills, and attitudes required of school nurses to provide safe school nursing. Six core competencies are identified. These include the ability to (1) provide patient-centered care; (2) communicate and collaborate with students, teaching staff, and community resources; (3) think critically for evidence-based practice; (4) implement school health services and programs; (5) integrate legal and ethical nursing practice, and (6) conduct health education. Conclusion: It is necessary to develop and implement continuing education programs for school nurses based on the training needs and competency indicators identified in this study. Full article
(This article belongs to the Section Nursing)
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Open AccessArticle
Resilience Design of Healthcare Resources Supply Network Based on Self-Organized Criticality
Healthcare 2020, 8(3), 245; https://doi.org/10.3390/healthcare8030245 - 30 Jul 2020
Viewed by 225
Abstract
The healthcare resources supply network design for resilience is an effective way to deal with uncertainty disruption. In this article we propose a model of supply network self-organization evolution, and establish self-organized criticality as a cause of cascade failure. Our main purpose is [...] Read more.
The healthcare resources supply network design for resilience is an effective way to deal with uncertainty disruption. In this article we propose a model of supply network self-organization evolution, and establish self-organized criticality as a cause of cascade failure. Our main purpose is to keep the system in a resilient range, i.e., critical state. A network structural design with smaller degree distribution exponent can achieve better absorptive capacity at macro level. An interactive rule design with extremal optimization has better adaptive capacity at micro level. Using macro statistic and indicator micro performance indicator, we demonstrate that our design can slow the development to a supercritical state and can improve the resilience of the supply network. Full article
(This article belongs to the Special Issue Healthcare Resource Management in Large-Scale Epidemics)
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Open AccessArticle
Effect of an Integrated Healthcare Program for Korean Rural Older Adults: A Quasi-Experimental Study
Healthcare 2020, 8(3), 244; https://doi.org/10.3390/healthcare8030244 - 30 Jul 2020
Viewed by 248
Abstract
Studies have been conducted on the development of healthcare programs for older adults in rural areas, not only in Asia but also in Europe and the United States. However, these reports have been limited by largely non-comprehensive results, lack of demand surveys, or [...] Read more.
Studies have been conducted on the development of healthcare programs for older adults in rural areas, not only in Asia but also in Europe and the United States. However, these reports have been limited by largely non-comprehensive results, lack of demand surveys, or programs with no systematic development. The purpose of this study was to develop an integrated healthcare program for rural older adults and investigate the effects of the program. A nonequivalent control group pretest–posttest design was used. Subjects were aged over 65 and lived in the rural community. The integrated healthcare program involved 12 three-hour sessions over 12 weeks. Compared with the control group, the experimental group demonstrated significant differences in both upper extremities strengths (t = 2.74, p = 0.008; t = 2.03, p = 0.047), static balance (z = −2.38, p = 0.017), dynamic balance (t = −4.82, p < 0.001), loneliness (t = −3.02, p = 0.003), and role self-efficacy (t = 2.39, p = 0.020), but no differences for ego integration (t = 1.51, p = 0.137). To improve physical, mental, and social health of the rural older adults, we developed an integrated healthcare program. The program improved physical functions, loneliness, and role self-efficiency of the rural older adults. Therefore, it is recommended that healthcare professionals actively apply this program in primary healthcare institutes and elsewhere. Full article
(This article belongs to the Special Issue Health Care and Services for Elderly Population)
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Open AccessArticle
Enhancing Privacy and Data Security across Healthcare Applications Using Blockchain and Distributed Ledger Concepts
Healthcare 2020, 8(3), 243; https://doi.org/10.3390/healthcare8030243 - 29 Jul 2020
Viewed by 259
Abstract
Nowadays, blockchain is developing as a secure and trustworthy platform for secure information sharing in areas of application like banking, supply chain management, food industry, energy, the Internet, and medical services. Besides, the blockchain can be described in a decentralized manner as an [...] Read more.
Nowadays, blockchain is developing as a secure and trustworthy platform for secure information sharing in areas of application like banking, supply chain management, food industry, energy, the Internet, and medical services. Besides, the blockchain can be described in a decentralized manner as an immutable ledger for recording data entries. Furthermore, this new technology has been developed to interrupt a variety of data-driven fields, including the health sector. However, blockchain refers to the distributed ledger technology, which constitutes an innovation in the information recording and sharing without a trusted third party. In this paper, blockchain and Distributed Ledger-based Improved Biomedical Security system (BDL-IBS) has been proposed to enhance the privacy and data security across healthcare applications. Further, our goal is to make it possible for patients to use the data to support their care and to provide strong consent systems for sharing data among different organizations and applications, since this includes managing and accessing a high amount of medical information, and this technology can maintain data to ensure reliability. Finally, results show that new blockchain-based digital platforms allow for fast, easy, and seamless interactions between data suppliers to enhance privacy and data security, including for patients themselves. Full article
(This article belongs to the Special Issue Cyber Security and Data Privacy for Healthcare Industry)
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Open AccessArticle
Factors Related to Diabetes Mellitus in the Middle-Aged and Over in Taiwan
Healthcare 2020, 8(3), 242; https://doi.org/10.3390/healthcare8030242 - 29 Jul 2020
Viewed by 220
Abstract
Study Objective: to investigate the factors related to diabetes mellitus in the middle-aged and over in Taiwan. Method: data from seven surveys (in 1989–2011) from the “Taiwan Longitudinal Study on Aging” (TLSA), among cohort B (above the age 60 in 1989), cohort [...] Read more.
Study Objective: to investigate the factors related to diabetes mellitus in the middle-aged and over in Taiwan. Method: data from seven surveys (in 1989–2011) from the “Taiwan Longitudinal Study on Aging” (TLSA), among cohort B (above the age 60 in 1989), cohort A (aged 50–66 in 1996), and cohort C (aged 50–66 in 2003), were analyzed by the interval-censored Cox model. Results: in the early aging stage (aged 60–64), diabetes mellitus prevalence among the same age appeared the lowest in cohort B, followed by cohort A; cohort C reveals the highest than the young generation. Moreover, suffering from hypertension and kidney diseases are closely related to diabetes mellitus, with the diabetes mellitus suffering hazard ratio of 2.53 (95%: 2.35, 2.73) and 1.26 (95%: 1.11, 1.44) times, respectively. For people with fair and poor self-rated health, the risk of suffering from diabetes mellitus is 1.16 (95%: 1.07, 1.27) and 1.50 (95%: 1.35, 1.67) times compared to people with good self-rated health, respectively. Conclusions: in this study, it is considered that an advanced interval censoring model analysis could more accurately grasp the characteristics of factors in people who are middle-aged and over suffering from diabetes mellitus in Taiwan. Full article
(This article belongs to the Section Chronic Care)
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Open AccessArticle
Developing and Evaluating A One-Stop Patient-Centered Interprofessional Collaboration Platform in Taiwan
Healthcare 2020, 8(3), 241; https://doi.org/10.3390/healthcare8030241 - 29 Jul 2020
Viewed by 237
Abstract
(1) Background: Effective healthcare collaboration not only improves the outcomes of patients, but also provides benefits to healthcare providers. A patient-centered communication platform, a so-called “one-stop platform”, is necessary to promote interprofessional collaboration (IPC) for optimal patient care. (2) Methods: Chi Mei Medical [...] Read more.
(1) Background: Effective healthcare collaboration not only improves the outcomes of patients, but also provides benefits to healthcare providers. A patient-centered communication platform, a so-called “one-stop platform”, is necessary to promote interprofessional collaboration (IPC) for optimal patient care. (2) Methods: Chi Mei Medical Center developed a patient-centered computerized platform to fulfill interprofessional collaboration needs. The platform features a spiral-shaped integrated care area and a communication area that allows the medical team to access patients’ information including the medical care they received within seven days, and veritably shows whether the team members have read communication messages. After pilot adoption, an online survey was conducted. (3) Results: A one-stop IPC platform was implemented and promoted for patient care. The online survey revealed that medical team members have high positive appraisal of the platform. It also pointed out that resistance to change among the medical team still has a significant impact on behavioral intention. (4) Conclusions: The interprofessional collaboration platform was recognized by the medical teams of Chi Mei Medical Center as an effective and convenient tool for assisting clinical decision making. However, actions to reduce user resistance to change and encourage collaboration among team members still need to be continued. Shared decision making within physicians and patients will be valuable to develop in the platform in the future. Full article
(This article belongs to the Special Issue Decision Modelling for Healthcare Evaluation)
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Open AccessReview
Satisfaction with Health Care Interventions among Community Dwelling People with Cognitive Disorders and Their Informal Caregivers—A Systematic Review
Healthcare 2020, 8(3), 240; https://doi.org/10.3390/healthcare8030240 - 29 Jul 2020
Viewed by 223
Abstract
Informal caregivers have a leading role when implementing health care services for people with cognitive disorders living at home. This study aims to examine the current evidence for interventions with dual satisfaction with health care services for people with cognitive disorders and their [...] Read more.
Informal caregivers have a leading role when implementing health care services for people with cognitive disorders living at home. This study aims to examine the current evidence for interventions with dual satisfaction with health care services for people with cognitive disorders and their caregivers. Original papers with quantitative and mixed method designs were extracted from two databases, covering years 2009–2018. Thirty-five original papers reported on satisfaction with health care services. The International Classification of Health Interventions (ICHI) was used to classify the interventions. Most interventions had a home-based approach (80%). Reduction in caregiver depression was the outcome measure with the highest level of satisfaction. Interventions to reduce depression or increase cognitive performance in persons with cognitive disorders gave the least satisfaction. Satisfaction of both caregivers and persons with cognitive disorders increased their use of services. In the ICHI, nearly 50% of the interventions were classified as activities and participation. A limited number of interventions have a positive effect on satisfaction of both the persons with cognitive disorders and the caregiver. It is important to focus on interventions that will benefit both simultaneously. More research is needed with a clear definition of satisfaction and the use of the ICHI guidelines. Full article
(This article belongs to the Special Issue Health Care and Services for Elderly Population)
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Open AccessReview
Play Therapy as an Intervention in Hospitalized Children: A Systematic Review
Healthcare 2020, 8(3), 239; https://doi.org/10.3390/healthcare8030239 - 29 Jul 2020
Viewed by 230
Abstract
Background: Hospitalization disrupts children’s lives and can produce feelings such as anxiety, fear, or pain. Playing is an important part of children’s lives. Thus, it is necessary to ensure holistic care during the process, including play therapy. The aim of this study was [...] Read more.
Background: Hospitalization disrupts children’s lives and can produce feelings such as anxiety, fear, or pain. Playing is an important part of children’s lives. Thus, it is necessary to ensure holistic care during the process, including play therapy. The aim of this study was to analyze the effect of therapeutic play in hospitalized children. Methods: A systematic review was performed. The search was conducted in CINAHL (Cumulative Index of Nursing and Allied Health Literature), CUIDEN, and PubMed (Medline). The search equation was “pediatric nurs* AND play therapy”. The search was performed in March 2020. Results: n = 14 studies were included in the review. The studies reveal that the application of therapeutic play in hospitalized children decreases postoperative pain, improves behavior and attitude, and reduces anxiety during the hospital stay. Conclusions: play therapy has a beneficial impact on the care of hospitalized children and should be implemented in pediatric units after assessing the resources and training needed for pediatric nurses. Full article
(This article belongs to the Section Nursing)
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Open AccessArticle
Using High-Fidelity Simulation to Introduce Communication Skills about End-of-Life to Novice Nursing Students
Healthcare 2020, 8(3), 238; https://doi.org/10.3390/healthcare8030238 - 29 Jul 2020
Viewed by 227
Abstract
Background: High-fidelity simulation is being considered as a suitable environment for imparting the skills needed to deal with end-of-life (EOL) situations. The objective was to evaluate an EOL simulation project that introduced communication skills to nursing students who had not yet begun [...] Read more.
Background: High-fidelity simulation is being considered as a suitable environment for imparting the skills needed to deal with end-of-life (EOL) situations. The objective was to evaluate an EOL simulation project that introduced communication skills to nursing students who had not yet begun their training in real healthcare environments. Methods: A sequential approach was used. The “questionnaire for the evaluation of the end-of-life project” was employed. Results: A total of 130 students participated. Increasing the time spent in high-fidelity simulation significantly favored the exploration of feelings and fears regarding EOL (t = −2.37, p = 0.019), encouraged dialogue (t = −2.23, p = 0.028) and increased the acquisition of communication skills (t = −2.32, p = 0.022). Conclusions: High-fidelity simulation promotes communication skills related to EOL in novice nursing students. Full article
(This article belongs to the Special Issue Clinical Simulation in Health Sciences)
Open AccessArticle
Effects of Mulligan Mobilization and Low-Level Laser Therapy on Physical Disability, Pain, and Range of Motion in Patients with Chronic Low Back Pain: A Pilot Randomized Controlled Trial
Healthcare 2020, 8(3), 237; https://doi.org/10.3390/healthcare8030237 - 29 Jul 2020
Viewed by 263
Abstract
This study aimed to determine the combined treatment effects of Mulligan sustained natural apophyseal glides (SNAGs) and low-level laser therapy (LLLT) on function, pain, and range of motion (ROM) in patients with chronic low back pain. A total of 49 adults participated in [...] Read more.
This study aimed to determine the combined treatment effects of Mulligan sustained natural apophyseal glides (SNAGs) and low-level laser therapy (LLLT) on function, pain, and range of motion (ROM) in patients with chronic low back pain. A total of 49 adults participated in this study and were randomly divided into three groups (SNAGs with LLLT group, SNAGs group, and control group). The participants in the SNAGs with LLLT group received SNAGs for 10 min, LLLT for 10 min, and electrotherapy for 10 min. The SNAGs group received SNAGs for 10 min and electrotherapy for 20 min. The control group received electrotherapy for 30 min. All participants received the assigned treatment for 30 min a day, 3 times a week, for 4 weeks. We used the visual analogue scale (VAS) to measure pain, the modified-modified Schober test (MMST) to measure ROM, and the Roland Morris disability questionnaire (RMDQ) to measure physical disability. Compared to the pre-intervention values, the VAS and MMST scores significantly increased after the intervention in the SNAGs with LLLT group (p = 0.000) and the SNAGs group (p = 0.000). The RMDQ score significantly improved in the SNAGs with LLLT (p = 0.000), SNAGs (p = 0.000) and control (p = 0.025) group after the intervention. The inter-group differences were greater for the SNAGs with LLLT and SNAGs groups than for the control group (p = 0.001), and the difference was greater for the SNAGs with LLLT than for the SNAGs (p = 0.001) with respect to the VAS, MMST, and RMDQ scores. These results indicate that significant improvement in pain, function, and ROM may be achieved by a combination of SNAGs and LLLT to treat chronic low back pain. Full article
(This article belongs to the Special Issue Chronic Pain Care and Management)
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Open AccessArticle
Tuberculosis Skin Test Screening in the National Tuberculosis Program of Trinidad and Tobago
Healthcare 2020, 8(3), 236; https://doi.org/10.3390/healthcare8030236 - 27 Jul 2020
Viewed by 289
Abstract
Globally, a quarter of the population is infected with tuberculosis (TB), caused by Mycobacterium tuberculosis. About 5–10% of latent TB infections (LTBI) progress to active disease during the lifetime. Prevention of TB and treating LTBI is a critical component of the World [...] Read more.
Globally, a quarter of the population is infected with tuberculosis (TB), caused by Mycobacterium tuberculosis. About 5–10% of latent TB infections (LTBI) progress to active disease during the lifetime. Prevention of TB and treating LTBI is a critical component of the World Health Organization’s (WHO) End TB Strategy. This study aims to examine the screening practices for prevention and treatment employed by the National Tuberculosis Program of Trinidad and Tobago in comparison to the WHO’s standard guidelines. A cross-sectional retrospective study was conducted from the TB registers (2018–2019) for persons aged 18 years and above with recorded tuberculin skin test reactions (TST). Bivariate comparisons for categorical variables were made using Chi-square or Fisher’s exact test. Binary logistic regression was used for exploring predictors of TST positivity with adjustment for demographic confounders in multivariable models. Of the total 1972 eligible entries studied, 384 (19.4%) individuals were tested positive with TST. TB contact screening (aOR 2.49; 95% CI 1.65, 3.75) and Bacillus Calmette–Guerin (BCG) vaccination status (aOR 1.66; 95% CI, 1.24 to 2.22) were associated with a positive TST reaction, whereas, preplacement screening failed to show such association when compared to those screened as suspect cases. The findings suggest that TB contact screening and positive BCG vaccination status are associated with TST positivity independent of age and gender. Full article
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Open AccessArticle
Mental Health Patients’ Expectations about the Non-Medical Care They Receive in Primary Care: A Cross-Sectional Descriptive Study
Healthcare 2020, 8(3), 235; https://doi.org/10.3390/healthcare8030235 - 27 Jul 2020
Viewed by 284
Abstract
A health system’s responsiveness is the result of patient expectations for the non-medical care they receive. The objective of this study was to assess mental patients’ responsiveness to the health system in primary care, as related to the domains of dignity, autonomy, confidentiality, [...] Read more.
A health system’s responsiveness is the result of patient expectations for the non-medical care they receive. The objective of this study was to assess mental patients’ responsiveness to the health system in primary care, as related to the domains of dignity, autonomy, confidentiality, and communication. Data were collected from 215 people over the age of 18 with mental disorders, using the Multi-Country Survey Study (MCSS) developed by the World Health Organization. Of them, 95% reported a good experience regarding the dignity, confidentiality, communication, and autonomy domains. Regarding responsiveness, patients valued the dignity domain as the most important one (25.1%). Among the patients who experienced poor confidentiality, five out of seven earned less than 900 euros per month (Χ2 = 10.8, p = 0.004). Among those who experienced good autonomy, 85 out of 156 belonged to the working social class (90.4%), and among those who valued it as poor (16.1%), the highest proportion was for middle class people (Χ2 = 13.1, p = 0.028). The two students and 87.5% of retirees experienced this dimension as good, and most patients who valued it as poor were unemployed (43.5%) (Χ2 = 13.0, p = 0.011). Patients with a household income higher than 900 euros more frequently valued responsiveness as good, regarding those domains related to communication, with OR = 3.84, 95% CI = 1.05–14.09, and confidentiality, with OR = 10.48, 95% CI = 1.94–56.59. To conclude, as regards responsiveness in primary care, the dignity domain always obtained the best scores by people with mental disorders. Low economic income is related to a poor assessment of confidentiality. Working class patients, students, and retirees value autonomy as good. Full article
(This article belongs to the Special Issue Care for People with Mental Illness in the Community)
Open AccessArticle
A Frequency Pattern Mining Model Based on Deep Neural Network for Real-Time Classification of Heart Conditions
Healthcare 2020, 8(3), 234; https://doi.org/10.3390/healthcare8030234 - 26 Jul 2020
Viewed by 490
Abstract
Recently, a massive amount of big data of bioinformation is collected by sensor-based IoT devices. The collected data are also classified into different types of health big data in various techniques. A personalized analysis technique is a basis for judging the risk factors [...] Read more.
Recently, a massive amount of big data of bioinformation is collected by sensor-based IoT devices. The collected data are also classified into different types of health big data in various techniques. A personalized analysis technique is a basis for judging the risk factors of personal cardiovascular disorders in real-time. The objective of this paper is to provide the model for the personalized heart condition classification in combination with the fast and effective preprocessing technique and deep neural network in order to process the real-time accumulated biosensor input data. The model can be useful to learn input data and develop an approximation function, and it can help users recognize risk situations. For the analysis of the pulse frequency, a fast Fourier transform is applied in preprocessing work. With the use of the frequency-by-frequency ratio data of the extracted power spectrum, data reduction is performed. To analyze the meanings of preprocessed data, a neural network algorithm is applied. In particular, a deep neural network is used to analyze and evaluate linear data. A deep neural network can make multiple layers and can establish an operation model of nodes with the use of gradient descent. The completed model was trained by classifying the ECG signals collected in advance into normal, control, and noise groups. Thereafter, the ECG signal input in real time through the trained deep neural network system was classified into normal, control, and noise. To evaluate the performance of the proposed model, this study utilized a ratio of data operation cost reduction and F-measure. As a result, with the use of fast Fourier transform and cumulative frequency percentage, the size of ECG reduced to 1:32. According to the analysis on the F-measure of the deep neural network, the model had 83.83% accuracy. Given the results, the modified deep neural network technique can reduce the size of big data in terms of computing work, and it is an effective system to reduce operation time. Full article
(This article belongs to the Special Issue Decision Modelling for Healthcare Evaluation)
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Open AccessArticle
Price-Cutting Trends in New Drugs after Listing in South Korea: The Effect of the Reimbursement Review Pathway on Price Reduction
Healthcare 2020, 8(3), 233; https://doi.org/10.3390/healthcare8030233 - 26 Jul 2020
Viewed by 365
Abstract
This study aims to analyze the trends of post-listing price changes for new drugs listed from 2007, when the health technology assessment (HTA) was introduced in South Korea, until 2017. We analyzed 135 products that have undergone price cuts. These products were analyzed [...] Read more.
This study aims to analyze the trends of post-listing price changes for new drugs listed from 2007, when the health technology assessment (HTA) was introduced in South Korea, until 2017. We analyzed 135 products that have undergone price cuts. These products were analyzed by their respective review pathways, namely, pharmaco-economic study (PE), weighted average price (WAP), and the without a cost-effectiveness (CE) pathway. Prices were discounted faster in PE than in WAP (p = 0.002 in a comparison between PE and WAP). In addition, the median discount rate of the first price cut was 5.0% (range: 0.1–20.0) for PE, 3.0% (range: <0.1–30.0) for WAP, and 5.0% (range: 0.6–10.9) without a CE pathway. The median cumulative discount rate of PE and WAP showed that the PE pathway products’ discount rates were higher: 10.4% for PE and 6.0% for WAP (p = 0.025 for comparison between PE and WAP). It is necessary to discuss the practical effects of the price-cutting system from a myriad of perspectives, including insurance finance, the value of new drugs, and the accessibility of new drugs to patients. Full article
(This article belongs to the Special Issue Essential Medicines Policies in the World)
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Open AccessArticle
Knowledge and Attitude of Dental Practitioners Related to Disinfection during the COVID-19 Pandemic
Healthcare 2020, 8(3), 232; https://doi.org/10.3390/healthcare8030232 - 25 Jul 2020
Viewed by 716
Abstract
The world is currently facing a pandemic crisis due to a novel coronavirus. For this purpose, acquiring updated knowledge regarding prevention and disinfection during the current pandemic is necessary for every dental practitioner. In our study, we aimed to evaluate globally the level [...] Read more.
The world is currently facing a pandemic crisis due to a novel coronavirus. For this purpose, acquiring updated knowledge regarding prevention and disinfection during the current pandemic is necessary for every dental practitioner. In our study, we aimed to evaluate globally the level of knowledge and the attitude of dental practitioners related to disinfection. A total of 385 participants out of 401 participants from 23 different countries across the world were included in the final analysis after the exclusion of incomplete responses. The majority of the dentists who responded were females (53.8%) and were practicing at private health institutes (36.4%). The mean knowledge score of the participants was estimated to be 4.19 ± 1.88 out of 12, reflecting insufficient knowledge, and the mean attitude score of the participants was estimated to be 12.24 ± 3.23 out of 15, which shows a positive attitude toward disinfection practices during coronavirus 2019 (COVID-19). Thus, the current study indicated a lack of knowledge in fundamental aspects of disinfection protocols with a significant and positive attitude from dental health professionals toward disinfection regarding the coronavirus 2019 (COVID-19) pandemic. Full article
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Open AccessArticle
Spatio-Temporal Comprehensive Measurements of Chinese Citizens’ Health Levels and Associated Influencing Factors
Healthcare 2020, 8(3), 231; https://doi.org/10.3390/healthcare8030231 - 25 Jul 2020
Viewed by 306
Abstract
Health is the basis of a good life and a guarantee of a high quality of life. Furthermore, it is a symbol of social development and progress. How to further improve the health levels of citizens and reduce regional differences in citizens’ health [...] Read more.
Health is the basis of a good life and a guarantee of a high quality of life. Furthermore, it is a symbol of social development and progress. How to further improve the health levels of citizens and reduce regional differences in citizens’ health status has become a research topic of great interest that is attracting attention globally. This study takes 31 provinces (municipalities and autonomous regions) of China as the research object. Through using GIS (Geographic Information System) technology, the entropy method, spatial autocorrelation, stepwise regression, and other quantitative analysis methods, measurement models and index systems are developed in order to perform an analysis of the spatio-temporal comprehensive measurements of Chinese citizens’ health levels. Furthermore, the associated influencing factors are analyzed. It has important theoretical and practical significance. The conclusions are as follows: (1) Between 2002 and 2018, the overall health levels of Chinese citizens have generally exhibited an upward trend. Moreover, for most provinces, the health levels of their citizens have improved dramatically, although some provinces, such as Tianjin and Henan, showed a fluctuating downward trend, suggesting that the health levels of citizens in these regions displayed a tendency to deteriorate. (2) The health levels of citizens from China’s various provinces showed clear spatial distribution characteristics of clustering, as well as an obvious spatial dependence and spatial heterogeneity. As time goes by, the degree of spatial clustering with regard to citizens’ health levels tends to weaken. The health levels of Chinese citizens have developed a certain temporal stability, the overall health status of Chinese citizens shows a spatial differentiation of a northeast–southwest distribution pattern. (3) The average years of education and urbanization rate have a significant positive effect on the improvement of citizens’ health levels. The increase of average years of education and urbanization rate can promote the per capita income, which certainly could help improve citizens’ health status. The Engel coefficient, urban–rural income ratio, and amount of wastewater discharge all pose a significant negative effect on the improvement of citizens’ health levels, these three factors have played important roles in hindering the improvements of citizen health. Full article
(This article belongs to the Section Health Assessments)
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Open AccessArticle
Can Simple Tests Prior to Endoscopy Predict the OLGA Stage of Gastritis?
Healthcare 2020, 8(3), 230; https://doi.org/10.3390/healthcare8030230 - 24 Jul 2020
Viewed by 301
Abstract
Gastritis is a progressive disease that evolves from a non-atrophic to atrophic state and progresses through intestinal metaplasia, with some cases leading eventually to gastric cancer. Since gastritis by definition is an inflammatory process of the mucosal lining of the stomach and is [...] Read more.
Gastritis is a progressive disease that evolves from a non-atrophic to atrophic state and progresses through intestinal metaplasia, with some cases leading eventually to gastric cancer. Since gastritis by definition is an inflammatory process of the mucosal lining of the stomach and is usually associated with pain, we aimed to identify any association between the severity of gastritis and pain and a simple inflammatory marker derived from a complete blood count (CBC). This was a prospective cross-sectional study which enrolled 155 consecutive adult patients who underwent an upper endoscopy. Prior to the endoscopy, all patients were given a questionnaire, numerical rating scale (NRS) and complete blood count evaluation. The biopsy was obtained from the gastric mucosa according to the modified Sydney classification and scored with the Operative Link for Gastritis Assessment (OLGA) scoring system. The results showed a significant correlation between NRS and intestinal metaplasia (p < 0.01); moreover, a correlation was also found between the NRS and OLGA stage (r = 0.469, p < 0.001). A nonlinear curve was constructed for OLGA stage estimation according to NRS scores (r2 was found to be 0.442, with p < 0.001). The results also showed a correlation between the neutrophil to the lymphocyte ratio (NLR) and OLGA stage (p < 0.01). No correlation was found between the other gastric parameters and NLR (p > 0.05). Helicobacter pylori positivity did not correlate with NRS and NLR. As a conclusion, pain measured by NRS and NLR, which are simply calculated from the CBC prior to endoscopy, may be used to predict OLGA stages and estimate the severity of gastritis in endoscopy patients. Full article
(This article belongs to the Section Perioperative Care)
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Open AccessArticle
Lessons from South Korea Regarding the Early Stage of the COVID-19 Outbreak
Healthcare 2020, 8(3), 229; https://doi.org/10.3390/healthcare8030229 - 24 Jul 2020
Viewed by 391
Abstract
South Korea has experienced difficulty in controlling the spread of the novel coronavirus disease (COVID-19) during the early stages of the outbreak. South Korea remains passionately determined to protect Koreans against COVID-19 and through trial and error hopes to improve the strategies used [...] Read more.
South Korea has experienced difficulty in controlling the spread of the novel coronavirus disease (COVID-19) during the early stages of the outbreak. South Korea remains passionately determined to protect Koreans against COVID-19 and through trial and error hopes to improve the strategies used to limit the outbreak. Here, we review how COVID-19 spread and what prevention strategies were implemented during the early stages of the outbreak in South Korea. We investigated online newspapers published in South Korea from 21 January 2020 to 20 March 2020, and reviewed academic medical articles related to COVID-19. Additionally, we acquired data on COVID-19 cases through the official website for COVID-19 in South Korea. To date, numerous measures have been applied by the government and the medical community during the early stages of the COVID-19 outbreak including the reporting of methods for diagnostic testing, patient classification, the introduction of drive-through screening centers, COVID-19 preventive measures, implementation of government policies for the shortage of face masks, and entry restrictions. Here, we present data from the early stages of the COVID-19 outbreak and measures to prevent its spread in South Korea. We believe that sharing the experience of South Korea during the COVID-19 outbreak can help other countries to implement strategies to prevent its rapid transmission. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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