Next Issue
Volume 8, December
Previous Issue
Volume 8, June

Healthcare, Volume 8, Issue 3 (September 2020) – 167 articles

Cover Story (view full-size image): Sarcopenic obesity is strongly associated with decreased activities of daily living in community-dwelling older adults. We hypothesized that sarcopenic obesity also has a negative impact on activities of daily living in patients after stroke. A cross-sectional study was conducted to clarify the relationship between sarcopenic obesity, simple obesity and sarcopenia without obesity and activities of daily living capability in patients with stroke in convalescent rehabilitation wards. We found that approximately 30% of patients were classified to have sarcopenic obesity, and it was independently associated with lower ability to perform activities of daily living. Based on the findings, we ascertain that body composition of the patients after stroke should be assessed routinely as a part of daily rehabilitation assessment in rehabilitation settings. View this paper.
  • Issues are regarded as officially published after their release is announced to the table of contents alert mailing list.
  • You may sign up for e-mail alerts to receive table of contents of newly released issues.
  • PDF is the official format for papers published in both, html and pdf forms. To view the papers in pdf format, click on the "PDF Full-text" link, and use the free Adobe Readerexternal link to open them.
Order results
Result details
Select all
Export citation of selected articles as:
Article
Knowledge, Attitude and Implementation of Evidence-Based Practice among Physiotherapists Working in the Kingdom of Saudi Arabia: A Cross-Sectional Survey
Healthcare 2020, 8(3), 354; https://doi.org/10.3390/healthcare8030354 - 22 Sep 2020
Cited by 1 | Viewed by 943
Abstract
The current study aimed to investigate knowledge, attitudes, and implementation of evidence-based practice among physiotherapists working in Saudi Arabia. A sample of physiotherapists working in various outpatient settings in Saudi Arabia participated in this survey. Sixty-four therapists (30 females, 34 males) completed a [...] Read more.
The current study aimed to investigate knowledge, attitudes, and implementation of evidence-based practice among physiotherapists working in Saudi Arabia. A sample of physiotherapists working in various outpatient settings in Saudi Arabia participated in this survey. Sixty-four therapists (30 females, 34 males) completed a 28-item survey questionnaire. Approximately half of the participants indicated that evidence-based practice was useful and important for clinical practice. About 60% of the participants reported that they have adopted the evidence-based practice on a regular basis. Participants who had a membership in a physiotherapy organization and had advanced degrees showed more positive attitudes (t = −2.31, p = 0.02 and t = −2.15, p = 0.04, respectively) and greater levels of knowledge (t = −2.32, p = 0.02 and t = −3.86, p = 0.001, respectively) regarding evidence-based practice terminology. Furthermore, place of training (trained overseas) was associated with a positive attitude towards literature findings (t = 2.26, p = 0.03). The results of this study demonstrated that participants reported that evidence-based practice had not been extensively implemented, despite positive attitudes regarding its implementation among physiotherapists practicing in Saudi Arabia. Full article
(This article belongs to the Special Issue Comprehensive Clinical Physiotherapy and Rehabilitation)
Article
Web Search Trends of Implementing the Patient Autonomy Act in Taiwan
Healthcare 2020, 8(3), 353; https://doi.org/10.3390/healthcare8030353 - 21 Sep 2020
Viewed by 787
Abstract
Background: The Patient Autonomy Act was implemented in Taiwan on 6 January 2019. It is the first patient-oriented act in Taiwan, and also the first special act to completely protect patient autonomy in Asia. Our study aimed to investigate the web resources citizens [...] Read more.
Background: The Patient Autonomy Act was implemented in Taiwan on 6 January 2019. It is the first patient-oriented act in Taiwan, and also the first special act to completely protect patient autonomy in Asia. Our study aimed to investigate the web resources citizens were able to access on the eve of the implementation of the Patient Autonomy Act in Taiwan. Methods: Patient Autonomy Act-related web resources were searched for by entering 10 related terms individually into the Google search engine in January 2019 and again in April 2019. Search activity data were analyzed using Google Trends. Results: “Advance care planning” and “advance decision” were the most relevant keywords for finding information about the Patient Autonomy Act on the eve of the act’s implementation in Taiwan. The main online information sources were non-governmental websites including news sites and online magazines. The related search volume only increased on the eve of implementation. Conclusions: Even though the Patient Autonomy Act was first published three years before its implementation, the related search volume only increased on the eve of its implementation. Therefore, whether the three-year buffer between its publication and implementation was necessary requires further investigation. Full article
(This article belongs to the Section Health Policy)
Show Figures

Figure 1

Article
Risk Factors Associated with Recurrent Clostridioides difficile Infection
Healthcare 2020, 8(3), 352; https://doi.org/10.3390/healthcare8030352 - 21 Sep 2020
Cited by 2 | Viewed by 813
Abstract
Clostridioides difficile (CD) is responsible for nosocomial diarrhea syndrome with possible severe progression. Recurrence of the disease induces higher health system costs, as well as exposes patients to additional health risks. Patients with recurrence of this disease are difficult to identify, so the [...] Read more.
Clostridioides difficile (CD) is responsible for nosocomial diarrhea syndrome with possible severe progression. Recurrence of the disease induces higher health system costs, as well as exposes patients to additional health risks. Patients with recurrence of this disease are difficult to identify, so the purpose of this study is to quantify various demographic, clinical, and treatment factors that could prevent further progression to recurrence of the disease. In the period 2018–2019, about 195 patients were diagnosed with more than one episode of CDI in the three months following the first episode. The recurrence rate for CDI was 53.84% (60.95% for one episode and 39.05% for multiple episodes). Most commonly afflicted were 60–69-year-old patients, or those with higher Charlson Comorbidity Index (CCI). Multiple analyses associated cardiovascular (odds ratios (OR) = 3.02, 95% confidence intervals (CI) = 1.23–7.39, p = 0.015), digestive (OR = 3.58, 95% CI = 1.01–12.63, p = 0.047), dementia (OR = 3.26, 95% CI = 1.26–8.41, p = 0.014), immunosuppressive (OR = 3.88, 95% CI = 1.34–11.21, p = 0.012) comorbidities with recurrences. Risk factor identification in the first episode of CDI could lead to the implementation of treatment strategies to improve the patients’ quality of life affected by this disease. Full article
Show Figures

Graphical abstract

Article
Sleep Deprivation from the Perspective of a Patient Hospitalized in the Intensive Care Unit—Qualitative Study
Healthcare 2020, 8(3), 351; https://doi.org/10.3390/healthcare8030351 - 21 Sep 2020
Cited by 2 | Viewed by 927
Abstract
(1) Introduction: Sleep architecture of Intensive Care Unit (ICU) patients is altered, with over 60% of them reporting sleep disorders or even sleep deprivation during their stay. The aim of the study was to describe the experiences related to sleep and nighttime rest [...] Read more.
(1) Introduction: Sleep architecture of Intensive Care Unit (ICU) patients is altered, with over 60% of them reporting sleep disorders or even sleep deprivation during their stay. The aim of the study was to describe the experiences related to sleep and nighttime rest of patients hospitalized in the ICU. (2) Method: the study used a qualitative project based on phenomenology as a research method. A semi-structured interview was used as the method to achieve the goal. The patients’ answers were recorded and transcribed. The data were coded and cross-processed. (3) Results: twenty-three patients were surveyed, fifteen men and eight women. The average age was 49.7 years. The average time of hospitalization was 34.3 days. During the ICU stay, patients required mechanical ventilation through the tracheostomy tube. Five themes were identified from the interview as factors disturbing sleep: fear, noise, light, medical staff, and at home best. (4) Conclusions: chronic anxiety appears to contribute to sleep disturbances in the ICUs, psychological support, and individualized approach to the hospitalized patient seem necessary. By raising the awareness of the essence of sleep among medical staff, environmental factors can be reduced as disturbing sleep. Based on the participants’ comments, it is possible that repeated actions could also increase the patients’ sense of security. Full article
Show Figures

Figure 1

Article
What Happens at Work Comes Home
Healthcare 2020, 8(3), 350; https://doi.org/10.3390/healthcare8030350 - 21 Sep 2020
Viewed by 1208
Abstract
Emergency responders (police, fire, ambulance and defence force personnel) risk exposure to dangerous and traumatic events, and the possible subsequent development of post-traumatic stress disorder. Consequently, partners of these emergency responders risk developing secondary traumatic stress (STS) from vicarious exposure to the trauma [...] Read more.
Emergency responders (police, fire, ambulance and defence force personnel) risk exposure to dangerous and traumatic events, and the possible subsequent development of post-traumatic stress disorder. Consequently, partners of these emergency responders risk developing secondary traumatic stress (STS) from vicarious exposure to the trauma through communication and engagement with their responders. A mixed-methods study of the partners of emergency responders in New Zealand examined the extent of such partner-associated STS. This article focuses on two research questions: to what extent were risk factors for STS identified within that population, and what did the participants believe may help them to mitigate the impact of STS. An online anonymous survey was developed and eligible participants completed a 17-item STS scale, a social support measure, and answered several open-ended questions. Of the 646 participants, twenty percent appear to be experiencing intrusion, arousal, and avoidance symptoms related to the trauma experienced by their responder. Almost half stated they have little or no emotional/informational support related to their responder’s work. Thematic analysis of free-text responses identified the need for additional support and more direct communication/engagement from the organisations for partners to navigate their experiences of STS and the level of social support received and required. The authors conclude with recommendations to emergency responder organisations. Full article
(This article belongs to the Special Issue Burnout, Perceived Efficacy, Compassion Fatigue and Job Satisfaction)
Show Figures

Figure 1

Article
Testing the Strength of Hospital Accreditation as a Signal of the Quality of Care in Romania: Do Patients’ and Health Professionals’ Perceptions Align?
Healthcare 2020, 8(3), 349; https://doi.org/10.3390/healthcare8030349 - 19 Sep 2020
Cited by 2 | Viewed by 984
Abstract
Hospital accreditation, as a quality signal, is gaining its popularity among low- and middle-income countries, such as Romania, despite its costly nature. Nevertheless, its effectiveness as a quality signal in driving patients’ choice of hospital services remains unclear. In this study, we intend [...] Read more.
Hospital accreditation, as a quality signal, is gaining its popularity among low- and middle-income countries, such as Romania, despite its costly nature. Nevertheless, its effectiveness as a quality signal in driving patients’ choice of hospital services remains unclear. In this study, we intend to empirically explore the perceptions of both healthcare professionals and patients toward Romanian hospital accreditation and identify perception gaps between the two parties. Exploratory and confirmatory factor analyses were carried out to extract the latent constructs of health professionals’ perceived effects of hospital accreditation. The Wilcoxon rank-sum test and Kruskal–Wallis test were used to identify correlations between patients’ sociodemographic characteristics and their behavioral intentions when confronted with low-quality services. We found that health professionals believe that hospital accreditation plays a positive role in improving patient satisfaction, institutional reputation, and healthcare services quality. However, we found a lack of awareness of hospital accreditation status among patients, indicating the existence of the perception gap of the accreditation effectiveness as a market signal. Our results suggest that the effect of interpersonal trust in current service providers may distract patients from the accreditation status. Our study provides important practical implications for Romanian hospitals on enhancing the quality of accreditation signal and suggests practical interventions. Full article
Show Figures

Figure 1

Article
A Smart Architecture for Diabetic Patient Monitoring Using Machine Learning Algorithms
Healthcare 2020, 8(3), 348; https://doi.org/10.3390/healthcare8030348 - 19 Sep 2020
Cited by 3 | Viewed by 1120
Abstract
Continuous monitoring of diabetic patients improves their quality of life. The use of multiple technologies such as the Internet of Things (IoT), embedded systems, communication technologies, artificial intelligence, and smart devices can reduce the economic costs of the healthcare system. Different communication technologies [...] Read more.
Continuous monitoring of diabetic patients improves their quality of life. The use of multiple technologies such as the Internet of Things (IoT), embedded systems, communication technologies, artificial intelligence, and smart devices can reduce the economic costs of the healthcare system. Different communication technologies have made it possible to provide personalized and remote health services. In order to respond to the needs of future intelligent e-health applications, we are called to develop intelligent healthcare systems and expand the number of applications connected to the network. Therefore, the 5G network should support intelligent healthcare applications, to meet some important requirements such as high bandwidth and high energy efficiency. This article presents an intelligent architecture for monitoring diabetic patients by using machine learning algorithms. The architecture elements included smart devices, sensors, and smartphones to collect measurements from the body. The intelligent system collected the data received from the patient, and performed data classification using machine learning in order to make a diagnosis. The proposed prediction system was evaluated by several machine learning algorithms, and the simulation results demonstrated that the sequential minimal optimization (SMO) algorithm gives superior classification accuracy, sensitivity, and precision compared to other algorithms. Full article
Show Figures

Figure 1

Article
Subjective and Objective Mental and Physical Functions Affect Subjective Cognitive Decline in Community-Dwelling Elderly Japanese People
Healthcare 2020, 8(3), 347; https://doi.org/10.3390/healthcare8030347 - 18 Sep 2020
Cited by 1 | Viewed by 972
Abstract
Subjective cognitive decline (SCD) is complex and not well understood, especially among Japanese people. In the present study, we aimed to elucidate the relationships of subjective and objective mental and physical function with SCD among older community-dwelling Japanese adults. SCD was evaluated using [...] Read more.
Subjective cognitive decline (SCD) is complex and not well understood, especially among Japanese people. In the present study, we aimed to elucidate the relationships of subjective and objective mental and physical function with SCD among older community-dwelling Japanese adults. SCD was evaluated using the Kihon Checklist: Cognitive Function. Other parameters were evaluated using the Mini-Mental State Examination (MMSE) and the five-item version of the Geriatric Depression Scale (GDS-5), for an objective mental function other than SCD. A timed up-and-go test (TUG) and knee extension strength were used to test objective physical function, and the Mental Component Summary (MCS) and Physical Component Summary (PCS) in the Health-Related Quality of Life survey eight-item short form (SF-8) were used for subjective mental and physical functions. The results of the MMSE, GDS-5, TUG, knee extension strength, and MCS were significantly worse in the SCD group. In addition, logistic regression analysis showed that GDS-5 and MCS were associated with SCD onset. Depressive symptoms and decreased subjective mental function contribute to SCD among community-dwelling Japanese adults. These findings will be useful for planning dementia prevention and intervention programs for older Japanese adults. Full article
(This article belongs to the Collection Health Care and Services for Elderly Population)
Show Figures

Figure 1

Article
Sedentary Behavior in Older Patients before and after Total Hip Arthroplasty: A Prospective Cohort Study
Healthcare 2020, 8(3), 346; https://doi.org/10.3390/healthcare8030346 - 18 Sep 2020
Cited by 2 | Viewed by 718
Abstract
Objective: To compare the habitual sedentary behavior (SB) and physical activity (PA) of older hip osteoarthritis patients before and after elective arthroplasty. Methods: SB, PA and joint-specific disability of 16 patients (68.9 ± 6.8 years) were assessed by accelerometry and questionnaires before and [...] Read more.
Objective: To compare the habitual sedentary behavior (SB) and physical activity (PA) of older hip osteoarthritis patients before and after elective arthroplasty. Methods: SB, PA and joint-specific disability of 16 patients (68.9 ± 6.8 years) were assessed by accelerometry and questionnaires before and 9 months after arthroplasty. Results: All patients reported substantial postoperative improvements of their joint-related complaints (p ≤ 0.001). Accelerometry showed changes in neither daily SB (10–60 min sedentary bouts, p ≥ 0.569) nor in PA (steps, time in mild-to-vigorous activity and energy expenditure, p ≥ 0.255). Correlation analyses revealed that patients with severe preoperative disability showed a decrease in sedentary time, which was the opposite in patients with mild preoperative disability. Conclusion: SB and PA do not necessarily change after arthroplasty in older orthopedic patients. Even longer bouts of uninterrupted sitting, which are detrimental to health, do not decrease. Preoperative patient education is recommended to foster behavioral changes following elective arthroplasty. Full article
(This article belongs to the Section Health Assessments)
Show Figures

Figure 1

Article
An Economic Evaluation Framework for Government-Funded Home Adaptation Schemes: A Quantitative Approach
Healthcare 2020, 8(3), 345; https://doi.org/10.3390/healthcare8030345 - 18 Sep 2020
Viewed by 796
Abstract
The ability to live independently plays a crucial role in the mental and psychological wellbeing of the disabled. To achieve this goal, most governments spend a substantial budget on home adaptation projects. It has been observed that schemes with different target clients (residents [...] Read more.
The ability to live independently plays a crucial role in the mental and psychological wellbeing of the disabled. To achieve this goal, most governments spend a substantial budget on home adaptation projects. It has been observed that schemes with different target clients (residents versus landlords) are different in efficiency and effectiveness. To understand why and how these schemes differ in performance, this paper develops and applies a generic economic evaluation framework for government-funded home adaptation schemes. Based on the individual-level surveys collected in the United Kingdom, an empirical model was formulated to quantify the determinants for various performance indicators, including money costs, time costs and client satisfaction. Robust estimation procedures were applied to deal with the heteroscedasticity and outlier problems in the data. Results showed that a specialized independent living scheme dedicated to disability adaptations (e.g., the Physical Adaptations Grant, PAG) had higher efficiency and effectiveness than general-purpose schemes (e.g., the Disabled Facilities Grant, DFG), because the funds were provided to the landlords who had a stronger motivation to minimize the time cost in the short run and maximize the future rent potential in the long run. A “unified system” approach to adaptations should be a guiding principle for policy development, regardless of who actually delivers the service. Full article
(This article belongs to the Section Health Policy)
Show Figures

Figure 1

Article
Are Individuals Perceived as More Attractive within a Group? A Confirmative Study of Group Attractiveness Effect and the Cheerleader Effect in China
Healthcare 2020, 8(3), 344; https://doi.org/10.3390/healthcare8030344 - 17 Sep 2020
Cited by 2 | Viewed by 1199
Abstract
The stereotype “what is beautiful is good” suggests that having an attractive physical appearance is very important to people’s lives. Physical attractiveness, as an important personal trait, plays vital roles for shaping one’s first impression, and for influencing one’s subsequent evaluation and selection, [...] Read more.
The stereotype “what is beautiful is good” suggests that having an attractive physical appearance is very important to people’s lives. Physical attractiveness, as an important personal trait, plays vital roles for shaping one’s first impression, and for influencing one’s subsequent evaluation and selection, based on obvious visual features. However, the contextual difference of the physical attractiveness between a group and its group members has been given less attention. For this reason, Van Osch et al. proposed and tested that the perceived physical attractiveness of a group is greater than the average attractiveness of its members (GA-effect), while Walker and Vul found that an individual as a group member is perceived to be more attractive in group context than in isolation (cheerleader effect). Our present work seeks to replicate these two effects on a sample of 1005 Chinese participants to check whether such effects also exist in China, a collectivist culture. Participants were asked to rate the degree of attractiveness presented in each photo stimuli and in each rating condition, and the results show that: (a) the participants’ ratings of physical attractiveness of a group was significantly higher than the average attractiveness of its members (i.e., replicating the GA-effect); (b) the participants’ ratings of physical attractiveness of an individual was evaluated higher in a group than in isolation (i.e., replicating the cheerleader effect); and (c) the larger the group size, the larger the GA-effect. This validating study may aid in understanding human behavior, judgments, and perceptions according to the GA-effect and the cheerleader effect used in a different context in China. Full article
Show Figures

Figure 1

Article
Association of Low Bone Mass with Decreased Skeletal Muscle Mass: A Cross-Sectional Study of Community-Dwelling Older Women
Healthcare 2020, 8(3), 343; https://doi.org/10.3390/healthcare8030343 - 16 Sep 2020
Viewed by 905
Abstract
This study aimed to investigate the characteristics of skeletal muscle mass, muscle strength, and physical performance among community-dwelling older women. Data were collected from 306 older adults, and the data of 214 older women were included in the final analysis. Participants’ calcaneus bone [...] Read more.
This study aimed to investigate the characteristics of skeletal muscle mass, muscle strength, and physical performance among community-dwelling older women. Data were collected from 306 older adults, and the data of 214 older women were included in the final analysis. Participants’ calcaneus bone mass was measured using ultrasonography. Based on their T-scores, participants were divided into the following three groups: normal (T-score > −1), low (−2.5 < T-score ≤ −1), and very low (T-score ≤ −2.5) bone mass. Further, participants’ skeletal muscle mass, muscle strength (grip and knee extension strength), and physical performance [gait speed and timed up and go (TUG)] were measured. Arm skeletal muscle index (SMI, skeletal muscle mass/height2), leg SMI, and appendicular SMI in the very low bone mass group were low compared to those of the low bone mass group (p = 0.034, p = 0.011, and p = 0.009, respectively). Grip and knee extension strength, gait speed, and TUG were not significantly different between the groups. These findings suggest that older women with low bone density had decreased skeletal muscle mass. Therefore, maintaining or improving skeletal muscle mass may prevent low bone mass. Full article
(This article belongs to the Collection Health Care and Services for Elderly Population)
Show Figures

Figure 1

Article
Effect of Tai Chi Combined with Mental Imagery on Cutaneous Microcirculatory Function and Blood Pressure in a Diabetic and Elderly Population
Healthcare 2020, 8(3), 342; https://doi.org/10.3390/healthcare8030342 - 16 Sep 2020
Viewed by 870
Abstract
The purpose of this study was to investigate the effects of Tai Chi (TC) training combined with mental imagery (MI) on blood pressure and cutaneous microcirculatory function in individuals with diabetes and age-matched healthy subjects. All subjects participated in a one-hour Yang style [...] Read more.
The purpose of this study was to investigate the effects of Tai Chi (TC) training combined with mental imagery (MI) on blood pressure and cutaneous microcirculatory function in individuals with diabetes and age-matched healthy subjects. All subjects participated in a one-hour Yang style TC exercise with MI twice per week for 8 weeks. An activities-specific balance confidence (ABC) measurement, a single-leg stance (SLS), a functional reach test (FRT), systolic and diastolic blood pressure, and skin blood flow were assessed. All functional outcomes were significantly improved in both groups, and systolic and diastolic blood pressures were lower in both groups after the TC training (p < 0.05), but there was no significant group effect. Skin blood flow decreased in the age-matched elderly group when heat and occlusion were applied (p < 0.05), but no difference was found in the diabetes group. Combining TC with MI showed an improvement in functional outcomes and blood pressure but cutaneous microcirculatory function did not improve. Combining TC intervention with MI theory showed an improvement in functional outcomes and blood pressure, which showed cardiovascular benefits not only in diabetes but in age-matched healthy subjects. However, cutaneous microcirculatory function was increased only in age-matched healthy subjects. Full article
Show Figures

Figure 1

Article
Identifying Predictive Characteristics of Opioid Medication Use among a Nationally Representative Sample of United States Older Adults with Pain and Comorbid Hypertension or Hypercholesterolemia
Healthcare 2020, 8(3), 341; https://doi.org/10.3390/healthcare8030341 - 15 Sep 2020
Viewed by 753
Abstract
The prevalence of older adults with pain and comorbid cardiovascular conditions is increasing in the United States (U.S.). This retrospective, cross-sectional database study used 2017 Medical Expenditure Panel Survey data and hierarchical logistic regression models to identify predictive characteristics of opioid use among [...] Read more.
The prevalence of older adults with pain and comorbid cardiovascular conditions is increasing in the United States (U.S.). This retrospective, cross-sectional database study used 2017 Medical Expenditure Panel Survey data and hierarchical logistic regression models to identify predictive characteristics of opioid use among a nationally representative sample of older U.S. adults (aged ≥50 years) with pain in the past four weeks and comorbid hypertension (pain–hypertension group) or hypercholesterolemia (pain–hypercholesterolemia group). The pain–hypertension group included 2733 subjects (n = 803 opioid users) and the pain–hypercholesterolemia group included 2796 subjects (n = 795 opioid users). In both groups, predictors of opioid use included: White race versus others, Hispanic versus non-Hispanic ethnicity, 1 versus ≥5 chronic conditions, little/moderate versus quite a bit/extreme pain, good versus fair/poor perceived mental health, functional limitation versus no functional limitation, smoker versus non-smoker, and Northeast versus West census region. In addition, Midwest versus West census region was a predictor in the pain–hypertension group, and 4 versus ≥5 chronic conditions was a predictor in the pain–hypercholesterolemia group. In conclusion, several characteristics of older U.S. adults with pain and comorbid hypertension or hypercholesterolemia were predictive of opioid use. These characteristics could be addressed to optimize individuals’ pain management and help address the opioid overdose epidemic. Full article
(This article belongs to the Section Pain Management)
Show Figures

Figure 1

Perspective
Trauma-Informed Care in Primary Health Settings—Which Is Even More Needed in Times of COVID-19
Healthcare 2020, 8(3), 340; https://doi.org/10.3390/healthcare8030340 - 14 Sep 2020
Cited by 2 | Viewed by 1343
Abstract
Included in the general practitioner’s (GP) core competencies is the ability to adopt a person-centered approach, and the use of the biopsychosocial model in their clinical work. Traumatic events (TEs) are frequently experienced within the population and are known to dysregulate the stress [...] Read more.
Included in the general practitioner’s (GP) core competencies is the ability to adopt a person-centered approach, and the use of the biopsychosocial model in their clinical work. Traumatic events (TEs) are frequently experienced within the population and are known to dysregulate the stress response system and to be associated with psychiatric and physical disorders. GPs may feel reluctant to confront TEs for a variety of reasons, such as a lack of sufficient training in trauma-informed care or a fear of causing harm when discussing a patient’s more complicated issues, among others. This perspective paper aims to review the existing studies that support the practice of trauma-informed healthcare and to summarise best practices. Studies have shown that patients appreciate the questions that clinicians ask them about trauma-related issues and that they understand that this can be important for their healthcare. Furthermore, asking about trauma-related issues in a patient-centered and empathic way can result in better doctor–patient relationships, which improves the levels of satisfaction of both the patient and the doctor with the consultation, as well as improved health-related outcomes. As past traumatic experiences increase the risk of developing post-traumatic stress disorder on exposure to a new TE, the onset of the COVID-19 pandemic has led to trauma-informed care becoming even more important if the strategy is to continue to invest in preventive medicine. Full article
(This article belongs to the Section Coronaviruses (CoV) and COVID-19 Pandemic)
Article
Predictors of Death Rate during the COVID-19 Pandemic
Healthcare 2020, 8(3), 339; https://doi.org/10.3390/healthcare8030339 - 14 Sep 2020
Cited by 6 | Viewed by 3744
Abstract
Coronavirus (COVID-19) is a potentially fatal viral infection. This study investigates geography, demography, socioeconomics, health conditions, hospital characteristics, and politics as potential explanatory variables for death rates at the state and county levels. Data from the Centers for Disease Control and Prevention, the [...] Read more.
Coronavirus (COVID-19) is a potentially fatal viral infection. This study investigates geography, demography, socioeconomics, health conditions, hospital characteristics, and politics as potential explanatory variables for death rates at the state and county levels. Data from the Centers for Disease Control and Prevention, the Census Bureau, Centers for Medicare and Medicaid, Definitive Healthcare, and USAfacts.org were used to evaluate regression models. Yearly pneumonia and flu death rates (state level, 2014–2018) were evaluated as a function of the governors’ political party using a repeated measures analysis. At the state and county level, spatial regression models were evaluated. At the county level, we discovered a statistically significant model that included geography, population density, racial and ethnic status, three health status variables along with a political factor. A state level analysis identified health status, minority status, and the interaction between governors’ parties and health status as important variables. The political factor, however, did not appear in a subsequent analysis of 2014–2018 pneumonia and flu death rates. The pathogenesis of COVID-19 has a greater and disproportionate effect within racial and ethnic minority groups, and the political influence on the reporting of COVID-19 mortality was statistically relevant at the county level and as an interaction term only at the state level. Full article
(This article belongs to the Special Issue Health Disparities and Stigma in the Era of COVID-19)
Show Figures

Figure 1

Article
Mortality Rate and Predictors of Mortality in Hospitalized COVID-19 Patients with Diabetes
Healthcare 2020, 8(3), 338; https://doi.org/10.3390/healthcare8030338 - 13 Sep 2020
Cited by 8 | Viewed by 1835
Abstract
Studies have confirmed COVID-19 patients with diabetes are at higher risk of mortality than their non-diabetic counterparts. However, data-driven evidence of factors associated with increased mortality risk among hospitalized COVID-19 patients with diabetes is scarce in South Korea. This study was conducted to [...] Read more.
Studies have confirmed COVID-19 patients with diabetes are at higher risk of mortality than their non-diabetic counterparts. However, data-driven evidence of factors associated with increased mortality risk among hospitalized COVID-19 patients with diabetes is scarce in South Korea. This study was conducted to determine the mortality rate and identify risk factors of mortality among hospitalized COVID-19 patients with type 2 diabetes in Gyeongsangbuk-do province, South Korea. In this hospital-based, cross-sectional study, we enrolled a total of 324 patients with confirmed COVID-19, hospitalized at two of the tertiary level healthcare facilitates of Gyeongsangbuk-do, South Korea from 18 February to 30 June 2020. Demographic and clinical data and laboratory profiles were analyzed and multivariate logistic regression analysis was used to identify risk factors of mortality among diabetic patients with COVID-19. Of the 324 patients, 55 (16.97%) had diabetes mellitus. The mean age of all study subjects was 55 years, and the mean age of those with diabetes was greater than that of those without (69.8 years vs. 51.9 years). Remarkably, the mortality rate was much higher among those with diabetes (20.0% vs. 4.8%). Multivariate logistic regression analysis revealed that an older age (≥70 years) and a high serum lactate dehydrogenase (LDH) levels significantly predicted mortality among hospitalized COVID-19 patients with diabetes. Our study cautions more attention to be paid to patients with diabetes mellitus hospitalized for COVID-19, especially those aged ≥ 70 years and those with a high serum LDH level, to reduce the risk of mortality. Full article
(This article belongs to the Section Coronaviruses (CoV) and COVID-19 Pandemic)
Article
Association between Periodontal Disease and Levels of Triglyceride and Total Cholesterol among Korean Adults
Healthcare 2020, 8(3), 337; https://doi.org/10.3390/healthcare8030337 - 12 Sep 2020
Viewed by 794
Abstract
Although the correlation between periodontal condition and hyperlipidemia was shown by previous researches, it remains disputed. This study was based on data from the seventh Korea National Health and Nutrition Examination Survey 2016–2018. Data included 14,068 subjects’ demographic characteristics, total cholesterol levels, triglyceride [...] Read more.
Although the correlation between periodontal condition and hyperlipidemia was shown by previous researches, it remains disputed. This study was based on data from the seventh Korea National Health and Nutrition Examination Survey 2016–2018. Data included 14,068 subjects’ demographic characteristics, total cholesterol levels, triglyceride levels, and periodontal conditions. We analyzed the correlation between periodontal disease and blood lipid levels using complex-sample chi square tests and complex-sample logistic regression. The results of chi square tests showed a significant difference in demographic characteristics according to total cholesterol level and triglyceride level. The results of logistic regression, adjusted for the subjects’ demographic characteristics such as age, gender, house income, marital status, home ownership, number of persons living together, health insurance coverage, and economic activity, showed that prevalence of periodontal disease was 1.048-fold (confidence interval (CI) 0.827–1.133) higher in the high-total-cholesterol group and 1.499-fold (CI 1.576–1.983) higher in high-triglyceride group. We found that not high total cholesterol but high triglyceride level was connected with periodontal disease. Therefore, management of triglyceride level could be a possible precaution of periodontal disease. Full article
(This article belongs to the Special Issue Cohort Study of Oral Health)
Commentary
COVID-19 and Mental Well-Being: Guidance on the Application of Behavioral and Positive Well-Being Strategies
Healthcare 2020, 8(3), 336; https://doi.org/10.3390/healthcare8030336 - 12 Sep 2020
Cited by 11 | Viewed by 3710
Abstract
The raging COVID-19 pandemic has been a great source of anxiety, distress, and stress among the population. Along with mandates for social distancing and infection control measures, the growing importance of managing and cultivating good mental well-being practices cannot be disregarded. The purpose [...] Read more.
The raging COVID-19 pandemic has been a great source of anxiety, distress, and stress among the population. Along with mandates for social distancing and infection control measures, the growing importance of managing and cultivating good mental well-being practices cannot be disregarded. The purpose of this commentary is to outline and discuss some research-proven positive well-being and stress reduction strategies to instill healthy coping mechanisms among individuals and community members. The authors anticipate that usage of these strategies at the individual and the community level should greatly benefit the mental well-being not only in the current COVID-19 pandemic but also in any future epidemics at the national level. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
Article
Virtual Reality-Based Cognitive–Motor Rehabilitation in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Study on Motivation and Cognitive Function
Healthcare 2020, 8(3), 335; https://doi.org/10.3390/healthcare8030335 - 11 Sep 2020
Cited by 1 | Viewed by 1128
Abstract
The purpose of this study was to investigate the effects of virtual reality-based cognitive–motor rehabilitation (VRCMR) on the rehabilitation motivation and cognitive function in older adults. This study enrolled 40 older adults with mild cognitive impairment (MCI), living in the community. The subjects [...] Read more.
The purpose of this study was to investigate the effects of virtual reality-based cognitive–motor rehabilitation (VRCMR) on the rehabilitation motivation and cognitive function in older adults. This study enrolled 40 older adults with mild cognitive impairment (MCI), living in the community. The subjects were randomly assigned to a VRCMR group (n = 20) or a conventional cognitive rehabilitation (CCR) group (n = 20). The VRCMR group underwent VRCMR using MOTOcog, a computer recognition program, whereas the CCR group underwent conventional cognitive rehabilitation, which included puzzles, wood blocks, card play, stick construction activity, and maze activity. Both interventions were performed 30 min per day, 5 days/week, for 6 weeks. This study performed a cognitive assessment using the Montreal Cognitive Assessment (MoCA) scale, Trail Making Test A and B (TMT-A/B), and Digit Span Test forward and backward (DST-forward/backward). In addition, a 0-to-10 numeric rating self-report scale was used to assess interest and motivation during the rehabilitation training. After the intervention, the VRCMR group showed a significantly greater improvement in the MoCA (p = 0.045), TMT-A (p = 0.039), TMT-B (p = 0.040), and DST-forward (p = 0.011) scores compared to the CCR group, but not in the DST-backward score (p = 0.424). In addition, subjects in the experimental group had significantly higher interest (p = 0.03) and motivation (p = 0.03) than those in the control group. Cohen’s d effect size was 0.4, 0.3, 0.35, 0.4, and 0.5 for the MoCA, TMT-A, TMT-B, DST-forward, and DST-backward tests, respectively. This study demonstrates that VRCMR enhances motivation for rehabilitation and cognitive function in older adults with MCI better than CCR. Full article
(This article belongs to the Section Community Care)
Show Figures

Figure 1

Article
Underreporting of Obesity in Hospital Inpatients: A Comparison of Body Mass Index and Administrative Documentation in Australian Hospitals
Healthcare 2020, 8(3), 334; https://doi.org/10.3390/healthcare8030334 - 11 Sep 2020
Cited by 1 | Viewed by 1007
Abstract
Despite its high prevalence, there is no systematic approach to documenting and coding obesity in hospitals. This study aimed to determine the prevalence of obesity among inpatients, the proportion of obese patients recognised as obese by hospital administration, and the cost associated with [...] Read more.
Despite its high prevalence, there is no systematic approach to documenting and coding obesity in hospitals. This study aimed to determine the prevalence of obesity among inpatients, the proportion of obese patients recognised as obese by hospital administration, and the cost associated with their admission. A cross-sectional study was undertaken in three hospitals in Queensland, Australia. Inpatients present on three audit days were included in this study. Data collected were age, sex, height, and weight. Body mass index (BMI) was calculated in accordance with the World Health Organization’s definition. Administrative data were sourced from hospital records departments to determine the number of patients officially documented as obese. Total actual costing data were sourced from hospital finance departments. From a combined cohort of n = 1327 inpatients (57% male, mean (SD) age: 61 (19) years, BMI: 28 (9) kg/m2), the prevalence of obesity was 32% (n = 421). Only half of obese patients were recognised as obese by hospital administration. A large variation in the cost of admission across BMI categories prohibited any statistical determination of difference. Obesity is highly prevalent among hospital inpatients in Queensland, Australia. Current methods of identifying obesity for administrative/funding purposes are not accurate and would benefit from reforms to measure the true impact of healthcare costs from obesity. Full article
(This article belongs to the Special Issue Hospital Care and Outcomes for Obese Patients)
Show Figures

Figure 1

Protocol
Determinants of Dental Service Use Based on the Andersen Model: A Study Protocol for a Systematic Review
Healthcare 2020, 8(3), 333; https://doi.org/10.3390/healthcare8030333 - 10 Sep 2020
Cited by 2 | Viewed by 811
Abstract
Introduction: Drawing on the Andersen model, there is a large body of evidence examining the determinants of health care use, such as doctor visits or hospitalization. However, far less is known about the determinants of dental service use, explicitly using the Andersen model. [...] Read more.
Introduction: Drawing on the Andersen model, there is a large body of evidence examining the determinants of health care use, such as doctor visits or hospitalization. However, far less is known about the determinants of dental service use, explicitly using the Andersen model. Consequently, the aim of this systematic review is to summarize and critically analyze evidence from observational studies that examine the determinants of dental service use based on the Andersen model. Methods and analysis: The following electronic databases will be searched: PubMed, PsycInfo, and CINAHL. Our main inclusion criterion is: observational studies (cross-sectional and longitudinal) investigating the determinants of dental service use based on the Andersen model. Disease-specific samples will be excluded. Data extraction will concentrate on methods (such as measurement of dental service use), sample characteristics (such as age and gender) and key results. The study quality will be assessed using an appropriate tool. Three steps (selecting the studies, extracting the data and assessment of study conducted) will be performed by two reviewers. The findings will be displayed using figures, summary tables, narrative summaries and meta-analysis (if studies are deemed similar enough and of appropriate quality). Full article
Article
The Relationship between Workplace Violence and Innovative Work Behavior: The Mediating Roles of Employee Wellbeing
Healthcare 2020, 8(3), 332; https://doi.org/10.3390/healthcare8030332 - 10 Sep 2020
Cited by 4 | Viewed by 1616
Abstract
It has been contended that violence is prevalent in the workplace, and there has been increasing research interest into its potential effects. Human interactions at workplaces are apparent. However, the interactions among humans may have positive or negative dimensions. Usually, the positive or [...] Read more.
It has been contended that violence is prevalent in the workplace, and there has been increasing research interest into its potential effects. Human interactions at workplaces are apparent. However, the interactions among humans may have positive or negative dimensions. Usually, the positive or negative interactions between workers lead to different outcomes. Sometimes, they lead to a productive working environment; however, in some cases, they lead to toxicity among workers. In this study, we investigate the impact of workplace violence (WV) on innovative work behavior (IWB). Specifically, it examines the impact of the three dimensions of WV, namely, harassment, mobbing, and sabotage. Moreover, employees’ wellbeing mediates the relationship between WV (harassment, mobbing, and sabotage) and IWB. A questionnaire survey approach was used in this study. The target population were the workers of SMEs entrepreneurs located in Guangdong Province (China). The results confirm that, in the direct relationship, WV (harassment, mobbing, and sabotage) has a negative relationship with innovative IWB. Moreover, results also confirm that employee wellbeing is mediated between WV (harassment, mobbing, and sabotage) and IWB. Therefore, the empirical results of this paper identify that workplace violence reduces employees’ innovative work behavior by reducing their subjective and eudemonic wellbeing, which further broadens the perspective of IWB’s motivation analysis. Practical implications for small and medium enterprise organizations have also been discussed in this paper. Full article
Show Figures

Figure 1

Article
Exit Music: The Experience of Music Therapy within Medical Assistance in Dying
Healthcare 2020, 8(3), 331; https://doi.org/10.3390/healthcare8030331 - 10 Sep 2020
Viewed by 1145
Abstract
Since the 2015 Canadian legalization of medical assistance in dying (MAiD), many Canadian music therapists have become involved in the care of those requesting this procedure. This qualitative study, the first of its kind, examines the experience of music therapy within MAiD, exploring [...] Read more.
Since the 2015 Canadian legalization of medical assistance in dying (MAiD), many Canadian music therapists have become involved in the care of those requesting this procedure. This qualitative study, the first of its kind, examines the experience of music therapy within MAiD, exploring lived experience from three perspectives: the patient, their primary caregiver, and the music therapist/researcher. Overall thematic findings of a hermeneutic phenomenological analysis of ten MAiD cases demonstrate therapeutically beneficial outcomes in terms of quality of life, symptom management, and life review. Further research is merited to continue an exploration of the role of music therapy in the context of assisted dying. Full article
(This article belongs to the Special Issue The Expanding Scope of Music in Healthcare)
Article
United States County-level COVID-19 Death Rates and Case Fatality Rates Vary by Region and Urban Status
Healthcare 2020, 8(3), 330; https://doi.org/10.3390/healthcare8030330 - 09 Sep 2020
Cited by 3 | Viewed by 1163
Abstract
COVID-19 is a global pandemic with uncertain death rates. We examined county-level population morality rates (per 100,000) and case fatality rates by US region and rural-urban classification, while controlling for demographic, socioeconomic, and hospital variables. We found that population mortality rates and case [...] Read more.
COVID-19 is a global pandemic with uncertain death rates. We examined county-level population morality rates (per 100,000) and case fatality rates by US region and rural-urban classification, while controlling for demographic, socioeconomic, and hospital variables. We found that population mortality rates and case fatality rates were significantly different across region, rural-urban classification, and their interaction. All significant comparisons had p < 0.001. Northeast counties had the highest population mortality rates (27.4) but had similar case fatality rates (5.9%) compared to other regions except the Southeast, which had significantly lower rates (4.1%). Population mortality rates were highest in urban counties but conversely, case fatality rates were highest in rural counties. Death rates in the Northeast were driven by urban areas (e.g., small, East Coast states), while case fatality rates tended to be highest in the most rural counties for all regions, especially the Southwest. However, on further inspection, high case fatality rate percentages in the Southwest, as well as in overall US counties, were driven by a low case number. This makes it hard to distinguish genuinely higher mortality or an artifact of a small sample size. In summary, coronavirus deaths are not homogenous across the United States but instead vary by region and population and highlight the importance of fine-scale analysis. Full article
(This article belongs to the Section Coronaviruses (CoV) and COVID-19 Pandemic)
Show Figures

Figure 1

Review
Personality, Healthcare Use and Costs—A Systematic Review
Healthcare 2020, 8(3), 329; https://doi.org/10.3390/healthcare8030329 - 09 Sep 2020
Cited by 3 | Viewed by 1029
Abstract
Background: Thus far, there is a lack of a systematic review synthesizing empirical studies that analyze the link between personality factors and healthcare use (HCU) or costs. Consequently, the purpose of our systematic review is to give an overview of empirical findings from [...] Read more.
Background: Thus far, there is a lack of a systematic review synthesizing empirical studies that analyze the link between personality factors and healthcare use (HCU) or costs. Consequently, the purpose of our systematic review is to give an overview of empirical findings from observational studies examining the association between personality factors and HCU or costs. Methods: PubMed, PsycINFO, and NHS EED (NHS Economic Evaluation Database) were searched. Observational studies examining the association between personality factors and HCU costs by using validated tools were included. Two reviewers performed study selection and data extraction and evaluated the study quality. Findings were synthesized qualitatively. Results: In total, n = 15 studies (HCU, n = 14; cost studies, n = 1) were included in the final synthesis. A few studies point to an association between conscientiousness and HCU (with mixed evidence). Some more evidence was found for an association between higher agreeableness, higher extraversion, and higher openness to experience and increased HCU. The majority of studies analyzed found a link between higher neuroticism and increased HCU. Conclusion: Personality factors, and particularly neuroticism, are associated with HCU. This knowledge is important to manage healthcare use. However, future research based on longitudinal data and studies investigating the link between personality characteristics and costs are required. Full article
Show Figures

Figure 1

Case Report
Suspected Malignant Hyperthermia and the Application of a Multidisciplinary Response
Healthcare 2020, 8(3), 328; https://doi.org/10.3390/healthcare8030328 - 09 Sep 2020
Cited by 1 | Viewed by 1293
Abstract
Purpose: Malignant hyperthermia (MH) is a critical and potentially life-threatening emergency associated with inhaled anesthetic and depolarizing neuromuscular blocker administration. This is a single center’s response to MH. Summary: When signs of MH are observed, a page for “anesthesia STAT-MH crisis” is called, [...] Read more.
Purpose: Malignant hyperthermia (MH) is a critical and potentially life-threatening emergency associated with inhaled anesthetic and depolarizing neuromuscular blocker administration. This is a single center’s response to MH. Summary: When signs of MH are observed, a page for “anesthesia STAT-MH crisis” is called, triggering a multidisciplinary response, including the deployment of a Malignant Hyperthermia Cart. The MH cart and the delegation of duties allows nurses, physicians and pharmacists to quickly understand their role in the stabilization, transition and recovery of a suspected MH patient. Conclusion: This case highlights the importance of multi-disciplinary involvement in these rare, but potentially fatal, cases. Full article
(This article belongs to the Special Issue Perioperative Care)
Show Figures

Figure 1

Article
The Use of Therapeutic Music Training to Remediate Cognitive Impairment Following an Acquired Brain Injury: The Theoretical Basis and a Case Study
Healthcare 2020, 8(3), 327; https://doi.org/10.3390/healthcare8030327 - 08 Sep 2020
Viewed by 983
Abstract
Cognitive impairment is the most common sequelae following an acquired brain injury (ABI) and can have profound impact on the life and rehabilitation potential for the individual. The literature demonstrates that music training results in a musician’s increased cognitive control, attention, and executive [...] Read more.
Cognitive impairment is the most common sequelae following an acquired brain injury (ABI) and can have profound impact on the life and rehabilitation potential for the individual. The literature demonstrates that music training results in a musician’s increased cognitive control, attention, and executive functioning when compared to non-musicians. Therapeutic Music Training (TMT) is a music therapy model which uses the learning to play an instrument, specifically the piano, to engage and place demands on cognitive networks in order to remediate and improve these processes following an acquired brain injury. The underlying theory for the efficacy of TMT as a cognitive rehabilitation intervention is grounded in the literature of cognition, neuroplasticity, and of the increased attention and cognitive control of musicians. This single-subject case study is an investigation into the potential cognitive benefit of TMT and can be used to inform a future more rigorous study. The participant was an adult male diagnosed with cognitive impairment as a result of a severe brain injury following an automobile accident. Pre- and post-tests used standardized neuropsychological measures of attention: Trail Making A and B, Digit Symbol, and the Brown– Peterson Task. The treatment period was twelve months. The results of Trail Making Test reveal improved attention with a large decrease in test time on both Trail Making A (−26.88 s) and Trail Making B (−20.33 s) when compared to normative data on Trail Making A (−0.96 s) and Trail Making B (−3.86 s). Digit Symbol results did not reveal any gains and indicated a reduction (−2) in free recall of symbols. The results of the Brown–Peterson Task reveal improved attention with large increases in the correct number of responses in the 18-s delay (+6) and the 36-s delay (+7) when compared with normative data for the 18-s delay (+0.44) and the 36-s delay (−0.1). There is sparse literature regarding music based cognitive rehabilitation and a gap in the literature between experimental research and clinical work. The purpose of this paper is to present the theory for Therapeutic Music Training (TMT) and to provide a pilot case study investigating the potential efficacy of TMT to remediate cognitive impairment following an ABI. Full article
(This article belongs to the Special Issue The Expanding Scope of Music in Healthcare)
Article
Maximum and Minimum Phonatory Glottal Area before and after Treatment for Vocal Nodules
Healthcare 2020, 8(3), 326; https://doi.org/10.3390/healthcare8030326 - 07 Sep 2020
Viewed by 908
Abstract
Background: Vocal fold nodules (VFNs) are a challenge for otolaryngologists. Glottal area (GA) waveform analysis is an examination method used for assessing vocal fold vibration and function. However, GA in patients with VFNs has rarely been studied. This study investigated the maximum [...] Read more.
Background: Vocal fold nodules (VFNs) are a challenge for otolaryngologists. Glottal area (GA) waveform analysis is an examination method used for assessing vocal fold vibration and function. However, GA in patients with VFNs has rarely been studied. This study investigated the maximum and minimum GA in VFN patients using modern waveform analysis combining ImageJ software and videostroboscopy. Methods: This study enrolled 42 patients newly diagnosed with VFN, 15 of whom received voice therapy and 27 of whom underwent surgery. Acoustic parameters and maximum phonation time (MPT) were recorded, and patients completed the Chinese Voice Handicap Index-10 (VHI-C10) before and after treatment. After videostroboscopy examination, the maximum and minimum GAs were calculated using ImageJ software. The GAs of patients with VFNs before and after surgery or voice therapy were analyzed. Results: The MPTs of the patients before and after voice therapy or surgery did not change significantly. VHI-C10 scores decreased after voice therapy but the decrease was nonsignificant (14.0 ± 8.44 vs. 9.40 ± 10.24, p = 0.222); VHI-C10 scores were significantly decreased after surgery (22.53 ± 7.17 vs. 12.75 ± 9.84, p = 0.038). Voice therapy significantly increased the maximum GA (5.58 ± 2.41 vs. 8.65 ± 3.17, p = 0.012) and nonsignificantly decreased the minimum GA (0.60 ± 0.73 vs. 0.21 ± 0.46, p = 0.098). Surgery nonsignificantly increased the maximum GA (6.34 ± 3.82 vs. 8.73 ± 5.57, p = 0.118) and significantly decreased the minimum GA (0.30 ± 0.59 vs. 0.00 ± 0.00, p = 0.036). Conclusion: This study investigated the GA of patients with VFNs who received voice therapy or surgery. The findings indicated that voice therapy significantly increased maximum GA and surgery significantly decreased minimum GA. GA analysis could be applied to evaluate the efficacy of voice therapy, and it may help physicians to develop precise treatment for VFN patients (either by optimizing voice therapy or by performing surgery directly). Full article
(This article belongs to the Section Nursing)
Show Figures

Figure 1

Review
Autopsy Findings in Case of Fatal Scorpion Sting: A Systematic Review of the Literature
Healthcare 2020, 8(3), 325; https://doi.org/10.3390/healthcare8030325 - 06 Sep 2020
Cited by 1 | Viewed by 1279
Abstract
Scorpion sting is a public health issue in several countries, particularly in America, the Middle East, India and Africa. The estimated annual global incidence of scorpion envenomings is about 1.5 million, resulting in 2600 deaths. Scorpions are Arthropoda characterized by a tail ending [...] Read more.
Scorpion sting is a public health issue in several countries, particularly in America, the Middle East, India and Africa. The estimated annual global incidence of scorpion envenomings is about 1.5 million, resulting in 2600 deaths. Scorpions are Arthropoda characterized by a tail ending in a terminal bulbous (telson) containing paired venom glands and the stinger. There are 19 known families of scorpions and more than 2200 species, of which about 50 from the families of Buthidae, Hemiscorpiidae and Scorpionidae are harmful to humans. Scorpion venom is a complex structure composed of neurotoxic proteins, salts, acidic proteins and organic compounds, thereby having neurologic, cardiovascular, hematologic and renal side effects, in addition to local effects such as redness, pain, burning and swelling. When the sting is fatal, the mechanism of death is often related to cardiotoxicity with terminal pulmonary edema. However, the cholinergic excess or the neuromuscular excitation can provoke respiratory failure. Sometimes, death is due to an anaphylactic reaction to the envenoming. The purpose of this literature review is to evaluate the autopsy findings in scorpion sting-related deaths in order to better understand the pathophysiological mechanisms underlying them, thus helping pathologists in defining the correct diagnosis. Full article
(This article belongs to the Section Forensic Medicine)
Show Figures

Figure 1

Previous Issue
Next Issue
Back to TopTop