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Healthcare, Volume 9, Issue 10 (October 2021) – 159 articles

Cover Story (view full-size image): Serious pathologies of the neck can potentially result in cranial nerve palsy. Cranial nerve examination (CNE) may potentially impact appropriate clinical reasoning and the screening process for referral. Physiotherapists’ knowledge about CNE seems sparse, and its use is still unknown. Our online cross-sectional survey showed that a substantial proportion of Italian physiotherapists are not schooled in the fundamentals of CNE. Given the number of physiotherapists who work in first contact roles, this is a professional concern. Improvement of the physiotherapy core curriculum concerning screening for referral competencies and cranial nerve examination is important. To guide physiotherapists in their daily practice, we created an infographic for public use. View this paper
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Review
The Utilization and Benefits of Telehealth Services by Health Care Professionals Managing Breast Cancer Patients during the COVID-19 Pandemic
Healthcare 2021, 9(10), 1401; https://doi.org/10.3390/healthcare9101401 - 19 Oct 2021
Cited by 12
Abstract
Telehealth is the delivery of many health care services and technologies to individuals at different geographical areas and is categorized as asynchronously or synchronously. The coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions in health care delivery to breast cancer (BCa) patients [...] Read more.
Telehealth is the delivery of many health care services and technologies to individuals at different geographical areas and is categorized as asynchronously or synchronously. The coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions in health care delivery to breast cancer (BCa) patients and there is increasing demand for telehealth services. Globally, telehealth has become an essential means of communication between patient and health care provider. The application of telehealth to the treatment of BCa patients is evolving and increasingly research has demonstrated its feasibility and effectiveness in improving clinical, psychological and social outcomes. Two areas of telehealth that have significantly grown in the past decade and particularly since the beginning of the COVID-19 pandemic are telerehabilitation and teleoncology. These two technological systems provide opportunities at every stage of the cancer care continuum for BCa patients. We conducted a literature review that examined the use of telehealth services via its various modes of delivery among BCa patients particularly in areas of screening, diagnosis, treatment modalities, as well as satisfaction among patients and health care professionals. The advantages of telehealth models of service and delivery challenges to patients in remote areas are discussed. Full article
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Article
Prevalence of Colorectal Polyps Based on Cardiorespiratory Fitness, Muscle Strength, Health Behavior, and Abdominal Obesity in Asymptomatic Elderly
Healthcare 2021, 9(10), 1400; https://doi.org/10.3390/healthcare9101400 - 19 Oct 2021
Cited by 1
Abstract
Colorectal polyps are precursor lesions of colorectal cancer and are known to be associated with obesity, low physical activity, and unhealthy behavior. This cross-sectional study analyzed the prevalence of colorectal polyps based on cardiorespiratory fitness (CRF), muscle strength, and health behavior in older [...] Read more.
Colorectal polyps are precursor lesions of colorectal cancer and are known to be associated with obesity, low physical activity, and unhealthy behavior. This cross-sectional study analyzed the prevalence of colorectal polyps based on cardiorespiratory fitness (CRF), muscle strength, and health behavior in older adults. Participants were asymptomatic and included 1024 men and 472 women aged 65–80 years who visited the health care center. Colonoscopy was performed under conscious sedation, and cardiorespiratory fitness was measured as the maximum oxygen uptake using gas analysis. Muscle strength was determined using isokinetic equipment, and physical activity, alcohol consumption, and smoking status were investigated using questionnaires. Waist circumference was measured at the thickest part of the middle of the abdomen. Logistic regression analysis was used to calculate the prevalence of colorectal polyps using odds ratios (ORs) based on the variables. The incidence of colorectal polyps was 65.2% in men and 48.5% in women. The ORs of colorectal polyps for obesity were 1.151 (95% confidence interval [CI], 1.010–2.291) and 1.178 (95% CI, 1.015–2.612) in men and women, respectively. The OR for colorectal polyps in male current smokers was 1.884. The ORs for low CRF were 1.985 and 1.841 in men and women, respectively, compared with high CRF. The prevalence of polyps increased with low muscle strength (men’s OR 1.343 women’s OR 1.440) and physical activity in both men (OR 1.693) and women (OR 1.861). In conclusion, lower CRF and muscle strength were associated with an increased prevalence of colorectal polyps in men and women. In both sexes, high waist circumference and low physical activity increased the prevalence of colorectal polyps. Full article
(This article belongs to the Special Issue Promotion of Health and Exercise)
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Article
Borderline Personality Symptoms: What Not to Be Overlooked When Approaching Suicidal Ideation among University Students
Healthcare 2021, 9(10), 1399; https://doi.org/10.3390/healthcare9101399 - 19 Oct 2021
Cited by 4
Abstract
Suicidal ideation is a serious condition antecedent to suicidal attempts and is highly related not only to depression but also other psychosocial factors. This study aimed to examine the predictive effects of these potential factors for suicidal ideation among young adult university students. [...] Read more.
Suicidal ideation is a serious condition antecedent to suicidal attempts and is highly related not only to depression but also other psychosocial factors. This study aimed to examine the predictive effects of these potential factors for suicidal ideation among young adult university students. A cross-sectional survey was conducted on a sample of university students in Thailand. An online questionnaire employed the perceived stress scale-10 (PSS-10), the patient health questionnaire-8 (PHQ-8), the multidimensional scale of perceived social support (MSPSS), and a screening instrument for borderline personality disorder. An ordinal regression analysis was applied to determine the predictive effects of the independent variables. Of 336 students, the mean age was 20.26 ± 1.3 years, 80.4% of whom were female; 14.3% had suicidal ideation. The significant predictors of suicidal thoughts were perceived stress (AOR 1.11, 95% CI 1.01 to 1.22); depressive symptoms (AOR 1.16, 95% CI 1.05 to 1.22); borderline personality symptoms (AOR 1.19, 95% CI 1.01 to 1.40); and perceived social support (AOR 0.97, 95% CI 0.94 to 1.00). Not only did depressive symptoms contribute to suicidal ideation but they also constituted important variables. Therefore, they should be included in intervention plans to prevent suicidality among university students. Full article
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Article
Self-Reported Prevalence of HIV Infection, Sexually Transmitted Infections and Risky Sexual Behavior among Mental Health Care Users Accessing Healthcare Services in Tshwane District, South Africa
Healthcare 2021, 9(10), 1398; https://doi.org/10.3390/healthcare9101398 - 19 Oct 2021
Abstract
The rate of HIV and sexually transmitted infections among mental patients is higher than that of the general population worldwide. Many risky sexual behaviors are associated with mental illness. However, mental health care users (MHCUs) are not specifically targeted for HIV preventative care, [...] Read more.
The rate of HIV and sexually transmitted infections among mental patients is higher than that of the general population worldwide. Many risky sexual behaviors are associated with mental illness. However, mental health care users (MHCUs) are not specifically targeted for HIV preventative care, and routine HIV testing is not done among this population. Limited studies have investigated self-reported HIV and STI prevalence and associated risky sexual behavior in persons with mental illnesses accessing health care services in South Africa in particular. This study set out to determine both the Sexually Transmitted Infections (STI) and human immunodeficiency virus (HIV) self-reported prevalence and sexual practices of MHCUs. A descriptive cross-sectional survey using purposive sampling was used to select 107 MHCUs across five clinics within Gauteng Province of South Africa who were above the age of 18, had a mental illness, and were currently stable and receiving chronic medication. Descriptive statistics were performed using Stata IC version 16. The chi square test was used to indicate statistical significance (p < 0.05) of differences in frequency distributions. More males (52.5%) than females were currently in a sexual relationship (50.0%), having multiple sexual partners (n = 4.13%), and having alcohol-driven sex (n = 4.19%). The majority of MHCUs (n = 82.77%) had an STI in the past six months, and a quarter (n = 21.25%) were HIV-positive with over two-thirds of MHCU (n = 69.70%) perceiving themselves not at risk for HIV. MHCUs engaged in risky behaviors had a low perception of the risks of contracting HIV. Bivariate analysis of gender by sexual behavior revealed that female MHCUs are more at risk of being forced to have sex compared to males (p = 0.006). Integrated interventions should be put in place to ensure that MHCUs’ sexual and reproductive health are not left behind and issues such as sexual education, safe sex, and sexually transmitted infections should form part of the care of MHCUs. Full article
Systematic Review
Isolated Resistance Training Programs to Improve Peripheral Muscle Function in Outpatients with Chronic Obstructive Pulmonary Diseases: A Systematic Review
Healthcare 2021, 9(10), 1397; https://doi.org/10.3390/healthcare9101397 - 19 Oct 2021
Cited by 2
Abstract
This systematic review aims to establish which isolated resistance training (RT) programs have been used in outpatients with chronic obstructive pulmonary disease (COPD) and their impact on all aspects of peripheral skeletal muscle function. Electronic databases were systematically searched up to June 2021. [...] Read more.
This systematic review aims to establish which isolated resistance training (RT) programs have been used in outpatients with chronic obstructive pulmonary disease (COPD) and their impact on all aspects of peripheral skeletal muscle function. Electronic databases were systematically searched up to June 2021. The eligibility criteria were: (1) randomized controlled trials investigating the effects of supervised and isolated RT programs in outpatients with COPD and (2) RT programs lasting 8–12 weeks, (3) including at least one outcome measure related to trainable muscle characteristics. Initially, 6576 studies were identified, whereas 15 trials met the inclusion criteria. All the included trials reported that isolated RT improved both upper and lower limbs’ maximal strength. Muscle endurance and power also increased after RT but received less attention in the analysis. Furthermore, few studies assessed the effect of RT on muscle mass and cross-sectional area, reporting only limited improvement. Isolated RT programs carried out 2–3 days a week for 8–12 weeks improved skeletal muscle function in individuals with COPD. The RT program should be specifically focused to the trainable muscle characteristic to be improved. For this reason, we further encourage the introduction of a detailed assessment of muscle function and structure during the pulmonary rehabilitation practice. Full article
(This article belongs to the Special Issue Physiotherapy and Cardiothoracic Care in Acute and Chronic Care)
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Case Report
Major Hepatectomy En Bloc with Cava Vein Resection for Locally Invasive Caudate Lobe Hepatocarcinoma
Healthcare 2021, 9(10), 1396; https://doi.org/10.3390/healthcare9101396 - 19 Oct 2021
Abstract
Background/Aim: Locally advanced liver tumours with vascular invasion have been considered for a long period of time as unresectable lesions, so the patient was further deferred to oncology services for palliation. However, improvement of the surgical techniques and the results reported so far [...] Read more.
Background/Aim: Locally advanced liver tumours with vascular invasion have been considered for a long period of time as unresectable lesions, so the patient was further deferred to oncology services for palliation. However, improvement of the surgical techniques and the results reported so far came to demonstrate that extended hepatic and vascular resections might be safely performed in such cases and might significantly improve the long-term outcomes. Materials and Methods: A 61-year-old patient was diagnosed with a caudate lobe tumour invading the inferior cava vein and the right hepatic pedicle. Results: The patient was successfully submitted to surgery, and an extended right hepatectomy en bloc with cava vein resection was performed; the continuity of the cava vein was re-established by the placement of a synthetic graft. The postoperative outcome was uneventful. Conclusions: Although initially considered as a formal contraindication for resection, vascular invasion of the greater vessels should not preclude surgery if complete resection is achievable. Full article
(This article belongs to the Special Issue Recent Advances in Haemostasis and Thrombosis Research in Cancer)
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Article
Clinical Outcomes of Genotype-Matched Therapy for Recurrent Gynecological Cancers: A Single Institutional Experience
Healthcare 2021, 9(10), 1395; https://doi.org/10.3390/healthcare9101395 - 19 Oct 2021
Abstract
Recent advances in next-generation sequencing and genome medicine have contributed to treatment decisions in patients with cancer. Most advanced gynecological cancers develop resistance to chemotherapy and have a poor prognosis. Therefore, we conducted genomic tests in gynecological tumors to examine the efficacy and [...] Read more.
Recent advances in next-generation sequencing and genome medicine have contributed to treatment decisions in patients with cancer. Most advanced gynecological cancers develop resistance to chemotherapy and have a poor prognosis. Therefore, we conducted genomic tests in gynecological tumors to examine the efficacy and clinical feasibility of genotype-matched therapy. Target sequencing was performed in 20 cases of gynecological cancers (cervical cancer, 6; endometrial cancer, 6; and ovarian cancer, 6). Both actionable and druggable genes were identified in 95% (19/20) of the cases. Among them, seven patients (35%) received genotype-matched therapy, which was effective in three patients. Of the three patients, one patient with a PTEN mutation received everolimus, another patient with a TSC2 mutation received everolimus and letrozole, and the patient with a BRIP1 mutation received olaparib. Subsequently, disease control in these three patients lasted for more than half a year. However, all patients relapsed between 9 and 13 months after the initiation of genotype-matched therapy. In this study, the response rate of genotype-matched therapy was 43% (3/7), which may have contributed to improved prognoses. Therefore, genotype-matched therapies may help patients with refractory gynecological cancers achieve better outcomes. Full article
(This article belongs to the Special Issue Cancer in Human Health and Healthcare)
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Article
Effects of Shoe Midsole Hardness on Lower Extremity Biomechanics during Jump Rope in Healthy Males
Healthcare 2021, 9(10), 1394; https://doi.org/10.3390/healthcare9101394 - 18 Oct 2021
Cited by 4
Abstract
This study investigated differences in lower extremity muscle activations and vertical stiffness during a 2.2 Hz jump rope exercise with different midsole hardnesses (45, 50, 55, and 60 Shores C). Twelve healthy male participants wore customized shoes with different hardness midsoles and performed [...] Read more.
This study investigated differences in lower extremity muscle activations and vertical stiffness during a 2.2 Hz jump rope exercise with different midsole hardnesses (45, 50, 55, and 60 Shores C). Twelve healthy male participants wore customized shoes with different hardness midsoles and performed jump rope exercises in a random order. A nine-camera motion analysis system (150 Hz), a force platform (1500 Hz), and a wireless electromyography (EMG) system (Noraxon, 1500 Hz) were used to measure the biomechanical parameters during the jump rope exercise. The biceps femoris %MVC of barefoot participants was significantly greater than that of those wearing the 45 Shores C (p = 0.048) and 55 Shores C (p = 0.009) midsole 100 ms before landing. The vastus medialis %MVC of barefoot participants was significantly greater than that of those wearing the 55 C midsole (p = 0.005). Nonsignificant differences in vertical stiffness were found between midsole hardnesses and barefoot. Lower extremity muscle activation differed between conditions. The results of this study indicate that for repetitive activities that entail multiple impacts, sports shoes with a low midsole hardness (e.g., 50 Shores C or 45 Shores C) may be appropriate. It is important to provide customers with information regarding midsole hardness in shoe product labeling so that they properly consider the function of the shoes. Full article
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Article
A Fusion-Based Machine Learning Approach for the Prediction of the Onset of Diabetes
Healthcare 2021, 9(10), 1393; https://doi.org/10.3390/healthcare9101393 - 18 Oct 2021
Cited by 44
Abstract
A growing portfolio of research has been reported on the use of machine learning-based architectures and models in the domain of healthcare. The development of data-driven applications and services for the diagnosis and classification of key illness conditions is challenging owing to issues [...] Read more.
A growing portfolio of research has been reported on the use of machine learning-based architectures and models in the domain of healthcare. The development of data-driven applications and services for the diagnosis and classification of key illness conditions is challenging owing to issues of low volume, low-quality contextual data for the training, and validation of algorithms, which, in turn, compromises the accuracy of the resultant models. Here, a fusion machine learning approach is presented reporting an improvement in the accuracy of the identification of diabetes and the prediction of the onset of critical events for patients with diabetes (PwD). Globally, the cost of treating diabetes, a prevalent chronic illness condition characterized by high levels of sugar in the bloodstream over long periods, is placing severe demands on health providers and the proposed solution has the potential to support an increase in the rates of survival of PwD through informing on the optimum treatment on an individual patient basis. At the core of the proposed architecture is a fusion of machine learning classifiers (Support Vector Machine and Artificial Neural Network). Results indicate a classification accuracy of 94.67%, exceeding the performance of reported machine learning models for diabetes by ~1.8% over the best reported to date. Full article
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Article
The Experiences of a Complex Arts-Based Intervention for Patients with End-Stage Kidney Disease Whilst Receiving Haemodialysis: A Qualitative Process Evaluation
Healthcare 2021, 9(10), 1392; https://doi.org/10.3390/healthcare9101392 - 18 Oct 2021
Cited by 3
Abstract
The global prevalence and burden of end-stage kidney disease (ESKD) is increasing, partially as a result of an aging population. Patients with ESKD who receive haemodialysis experience a difficult, protracted treatment regimen that can negatively impact mental health and wellbeing. One way of [...] Read more.
The global prevalence and burden of end-stage kidney disease (ESKD) is increasing, partially as a result of an aging population. Patients with ESKD who receive haemodialysis experience a difficult, protracted treatment regimen that can negatively impact mental health and wellbeing. One way of addressing this issue could be through the provision of arts-based interventions during haemodialysis treatment. A process evaluation was conducted as part of a larger feasibility study, to explore experiences and acceptability of an intra-dialytic (during haemodialysis) arts-based intervention. Thirteen patients and nine healthcare professionals were interviewed. The interviews were transcribed verbatim and thematically analysed. Three themes related to the experience of art on dialysis included: the perception of art participation, as patients described initial anxiety around participating in art, which reduced after they experienced the intervention; the benefits of art participation on both patients and healthcare professionals; the benefits including improved self-esteem, motivation, increased social interaction and an overall improved haemodialysis experience; and the acceptability of the arts-based intervention, as the intervention was highly acceptable, even when delivered by a facilitator who was not a professional artist. This study highlights that arts-based interventions could be used to improve the mental health and wellbeing of patients with ESKD receiving haemodialysis. Full article
Article
Psychometric Properties of the Health Literacy Scale Used in the Taiwan Longitudinal Study on Middle-Aged and Older People
Healthcare 2021, 9(10), 1391; https://doi.org/10.3390/healthcare9101391 - 18 Oct 2021
Cited by 3
Abstract
Health literacy, an important factor in public and personal health, is regarded as the core of patient-centered care. Older people with high health literacy are more likely to maintain a healthier lifestyle, with good control and management of chronic diseases, than those lacking [...] Read more.
Health literacy, an important factor in public and personal health, is regarded as the core of patient-centered care. Older people with high health literacy are more likely to maintain a healthier lifestyle, with good control and management of chronic diseases, than those lacking or with poor health literacy. Purpose: The present study investigated the validity and reliability of the Taiwan Longitudinal Study on Aging (TLSA) Health Literacy Scale. We also evaluated the health literacy of middle-aged and older Taiwanese adults, and its probable association with health outcomes and life satisfaction. Method: We analyzed the internal consistency reliability of the nine items of the 2015 TLSA Health Literacy Scale, and their relationship with the demographic variables. Brody Instrumental Activities of Daily Living (IADL) and the Life Satisfaction Index were used for criterion validity. Moreover, exploratory factor analysis was used to examine the construct validity and to test the known-group validity. Results: The TLSA health literacy scale has good internal consistency reliability. Criterion-related validity was supported by the fact that the health literacy score was significantly correlated with the IADL and Life Satisfaction Index. Factor analysis indicated a three-factor structure. Known-group validity was supported by the results, showing that middle-aged and older people with good self-reported health status had better health literacy. Conclusions: The TLSA health literacy scale is a reliable and valid instrument for measuring health literacy in middle-aged and older people. Full article
(This article belongs to the Special Issue Promotion of Health and Exercise)
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Article
Development and Effect of Virtual Reality Practice Program for Improving Practical Competency of Caregivers Specializing in Dementia
Healthcare 2021, 9(10), 1390; https://doi.org/10.3390/healthcare9101390 - 18 Oct 2021
Cited by 2
Abstract
The number of dementia patients in Korea is increasing with the increase in the elderly population. Accordingly, the importance of the role of the caregivers, who are the main care worker other than the family, is increasing. Therefore, in this study, a virtual [...] Read more.
The number of dementia patients in Korea is increasing with the increase in the elderly population. Accordingly, the importance of the role of the caregivers, who are the main care worker other than the family, is increasing. Therefore, in this study, a virtual reality practice program was developed to enhance the practical competency of caregivers who take care of dementia patients, and the effects were analyzed. The caregiver said that among the mental behaviors of dementia patients, aggression and delusion were the most difficult. Based on this information, a practice program was developed by realizing a case of a male dementia patient who expressed refusal to bathing help as an aggressive behavior due to delusion in virtual reality, and the effect of the virtual reality practice program was analyzed for five caregivers. As a result, ‘interest in new teaching methods’, ‘improving concentration of practical education based on real cases’, and ‘increasing confidence in caring for dementia patients’ were found. As this study is a pilot test, it is necessary to repeat the study with more subjects in the future, and to develop virtual reality implementation cases for various mental and behavioral symptoms. Full article
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Article
Spatial Patterns and Multilevel Analysis of Factors Associated with Antenatal Care Visits in Nigeria: Insight from the 2018 Nigeria Demographic Health Survey
Healthcare 2021, 9(10), 1389; https://doi.org/10.3390/healthcare9101389 - 18 Oct 2021
Cited by 2
Abstract
Despite global progress towards antenatal care (ANC) uptake, ANC utilization in a number of countries in sub-Saharan Africa, such as Nigeria, is low. Although several studies have identified the determinants and factors associated with ANC services utilization in Nigeria, there is a gap [...] Read more.
Despite global progress towards antenatal care (ANC) uptake, ANC utilization in a number of countries in sub-Saharan Africa, such as Nigeria, is low. Although several studies have identified the determinants and factors associated with ANC services utilization in Nigeria, there is a gap in knowledge about the spatial patterns in ANC use. Therefore, this study aims to map the spatial distribution and factors associated with ANC visits in Nigeria. A cross-sectional dataset was obtained from the 2018 Nigeria Demographic and Health Survey. A total of 20,003 women aged 15–49 were considered in this study. Both spatial and multilevel analyses were carried out. The results were presented in spatial maps and adjusted odds ratios (aOR) at a 95% confidence interval (CI). Hot spot areas (high proportion of an incomplete ANC visit) were located in Sokoto, Kebbi, Zamfara, Katsina, Kano, Jigawa, Bauchi, Niger, Borno, Gombe, and Bayelsa. Regional disparities in incomplete ANC visits were found in this study. Maternal age, maternal education, partner’s level of education, working status, ethnicity, parity, religion, exposure to media, place of residence, wealth index, region, and community literacy level were factors associated with incomplete ANC. There is a need to consider these factors in the design and strengthening of existing interventions (e.g., mini-clinics) aimed at increasing ANC visits to help attain maternal health-related Sustainable Development Goals by 2030. The regional disparities in incomplete ANC visits also need to be considered by encouraging pregnant women in hotspot areas to attend ANC visits. Full article
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Article
The Quality of the Supervisor–Nurse Relationship and Its Influence on Nurses’ Job Satisfaction
Healthcare 2021, 9(10), 1388; https://doi.org/10.3390/healthcare9101388 - 17 Oct 2021
Cited by 2
Abstract
Background: Leader–Member Exchange theory provides strategic information about how to improve the leader’s role and nurses’ satisfaction on healthcare organizations. Objectives: The main objective of this research was to study the quality of the supervisor–nurse relationship in relation to the nurses’ job satisfaction. [...] Read more.
Background: Leader–Member Exchange theory provides strategic information about how to improve the leader’s role and nurses’ satisfaction on healthcare organizations. Objectives: The main objective of this research was to study the quality of the supervisor–nurse relationship in relation to the nurses’ job satisfaction. This research also analyses how the relationship between Leader–Member exchanges and nurse job satisfaction could be moderated by other variables, such as nurse psychological empowerment, nurse-perceived organizational support and Leader–Leader Exchange. Methods: The sample comprises of 2541 registered nurses who work in public hospitals in the Autonomous Region of Aragon (Spain). Regression analyses were conducted. Results: The statistically significant results demonstrate the influence that the supervisor’s leadership exerts on the job satisfaction of the nurse. Conclusions: The moderating variables (Empowerment, Perceived Organizational Support and Leader–Leader relationship) play an important role explaining the job satisfaction of the nurse. Deepening in these relationships could help us implement precise strategies to improve the nurse organizational commitment and the quality of health care performance. Full article
(This article belongs to the Section Nursing)
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Article
Current Novel Caries Diagnostic Technologies: Restorative Dentists’ Attitude and Use Preferences
Healthcare 2021, 9(10), 1387; https://doi.org/10.3390/healthcare9101387 - 17 Oct 2021
Cited by 1
Abstract
Early detection of caries lesions is key to a successful restorative dental treatment plan. The aim of this study was to investigate the preferences and attitude of graduate restorative dentistry residents (RDRs) regarding novel caries diagnostic technologies (NCDT) and to provide a brief [...] Read more.
Early detection of caries lesions is key to a successful restorative dental treatment plan. The aim of this study was to investigate the preferences and attitude of graduate restorative dentistry residents (RDRs) regarding novel caries diagnostic technologies (NCDT) and to provide a brief overview of available technologies for both specialized and general dental practice. This cross-sectional study used an online questionnaire (17 questions) concerning RDRs’ attitude, preferences, and insights regarding five available NCDTs. It was distributed among twenty RDRs at a local government dental school following a review session about NCDTs. Collected responses were analyzed statistically using one-way analysis of variance (ANOVA), chi-squared with Bonferroni correction, and Kruskal-Wallis tests at a 0.05 significance level. Sixty-five percent of RDRs reported an interest in NCDTs as a discussion topic and almost half of them were positive towards their use, however, sixty percent of respondents were hesitant to diagnose caries solely using NCDTs. Fiber-optic-transillumination (FOTI) systems were ranked the best overall and with regard to all the investigated criteria (p < 0.05). Chosen reasons for FOTI included price followed by ease of use. In general, high price rated as the most perceived reason for not choosing a given NCDT followed by low practical applicability. Meanwhile, ease of use followed by relevant application ranked as the main reported reasons to choose an NCDTs. Full article
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Article
Trends and Factors Associated with Oral Contraceptive Use among Korean Women
Healthcare 2021, 9(10), 1386; https://doi.org/10.3390/healthcare9101386 - 16 Oct 2021
Abstract
Although oral contraceptives (OC) are widely used, few national-level epidemiologic studies have evaluated the prevalence of OC use and factors related to their use in Korea. We performed a population-based cross-sectional study on OC use by premenopausal women aged 20–59 years residing in [...] Read more.
Although oral contraceptives (OC) are widely used, few national-level epidemiologic studies have evaluated the prevalence of OC use and factors related to their use in Korea. We performed a population-based cross-sectional study on OC use by premenopausal women aged 20–59 years residing in Korea. We used secondary data from the 2010–2019 National Health and Nutrition Examination Survey to examine trends in the annual prevalence of OC use between 2010 and 2019, and factors influencing OC use. Based on data from 14,386 premenopausal women, the average annual prevalence of OC use was 8.2–10.7% between 2010 and 2014; it increased to 12.6–14.4% during 2015–2019. The prevalence of OC use was significantly higher in women with higher (≥5) than lower gravidity (<5). In addition, among sociodemographic factors, education level, household income, cigarette smoking, and alcohol drinking were significantly associated with OC use in Korean women. As OC use is affected by sociodemographic factors, a contraceptive plan that considers sociodemographic factors is needed to establish an effective family planning policy. Full article
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Article
The Effect of Using Participatory Working Time Scheduling Software on Employee Well-Being and Workability: A Cohort Study Analysed as a Pseudo-Experiment
Healthcare 2021, 9(10), 1385; https://doi.org/10.3390/healthcare9101385 - 16 Oct 2021
Cited by 4
Abstract
Shift workers are at increased risk of health problems. Effective preventive measures are needed to reduce the unfavourable effects of shift work. In this study we explored whether use of digital participatory working time scheduling software improves employee well-being and perceived workability by [...] Read more.
Shift workers are at increased risk of health problems. Effective preventive measures are needed to reduce the unfavourable effects of shift work. In this study we explored whether use of digital participatory working time scheduling software improves employee well-being and perceived workability by analysing an observational cohort study as a pseudo-experiment. Participants of the Finnish Public Sector cohort study with payroll records available between 2015 and 2019 were included (N = 2427). After estimating the propensity score of using the participatory working time scheduling software on the baseline characteristics using multilevel mixed-effects logistic regression and assigning inverse probability of treatment weights for each participant, we used generalised linear model to estimate the effect of using the participatory working time scheduling software on employees’ control over scheduling of shifts, perceived workability, self-rated health, work-life conflict, psychological distress and short sleep (≤6 h). During a 2-year follow-up, using the participatory working time scheduling software reduced the risk of employees’ low control over scheduling of shifts (risk ratio [RR] 0.34; 95% CI 0.25–0.46), short sleep (RR 0.70; 95% CI 0.52–0.95) and poor workability (RR 0.74; 95% CI 0.55–0.99). The use of the software was not associated with changes in psychological distress, self-rated health and work-life conflict. In this observational study, we analysed as a pseudo-experiment, the use of participatory working time scheduling software was associated with increased employees’ perceived control over scheduling of shifts and improved sleep and self-rated workability. Full article
(This article belongs to the Section Nursing)
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Article
Perception and Awareness about Developmental Dysplasia of the Hip in Children among Pregnant Ladies in the Aseer Region, Southwestern Saudi Arabia
Healthcare 2021, 9(10), 1384; https://doi.org/10.3390/healthcare9101384 - 16 Oct 2021
Cited by 2
Abstract
Background: Developmental dysplasia of the hip (DDH) is classified as a group of malformations, varying from abnormal acetabulum (dysplasia) and mild subluxation of the femoral head to fixed displacement (congenital dislocation). This study aimed to assess the knowledge level and its determinants regarding [...] Read more.
Background: Developmental dysplasia of the hip (DDH) is classified as a group of malformations, varying from abnormal acetabulum (dysplasia) and mild subluxation of the femoral head to fixed displacement (congenital dislocation). This study aimed to assess the knowledge level and its determinants regarding DDH in children among pregnant females in the Aseer region of southwestern Saudi Arabia. Methods: A descriptive cross-sectional study was conducted targeting all pregnant females in the Aseer region between 1 February 2021 and 1 May 2021. A pre-structured online questionnaire was constructed by the researchers to obtain the participating females’ bio-demographic data (including age, education status, and obstetric history) and awareness regarding DDH. The last section asked for their source of information regarding DDH. Results: A total of 253 pregnant females (aged between 18 and 45 years; mean age = 30.5 ± 10.2 years) fulfilling the inclusion criteria completed the study questionnaire. About 5% of the females reported having a child with DDH, and 166 (65.6%) pregnant females knew about DDH. Additionally, 110 (43.5%) females reported that they know about how DDH is treated, and 99 (39.1%) knew about DDH complications. The most commonly reported source of information was relatives and friends (44.3%), followed by social media (11.9%) and study and work (7.1%). Conclusions: Pregnant females in the Aseer region have poor knowledge and awareness about DDH and its causes, treatment modalities, and complications. Higher knowledge was associated with either high parity or having a child with DDH. Full article
(This article belongs to the Special Issue Maternal Nutrition on Neonatal Health)
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Article
The Prevalence and Determinant of PTSD Symptoms among Home-Quarantined Chinese University Students during the COVID-19 Pandemic
Healthcare 2021, 9(10), 1383; https://doi.org/10.3390/healthcare9101383 - 16 Oct 2021
Cited by 5
Abstract
Background: When COVID-19 emerged in China in late 2019, most Chinese university students were home-quarantined to prevent the spread of the virus, considering the great impact of the lockdown on young people habits and their psychological well-being. This study explored the prevalence of [...] Read more.
Background: When COVID-19 emerged in China in late 2019, most Chinese university students were home-quarantined to prevent the spread of the virus, considering the great impact of the lockdown on young people habits and their psychological well-being. This study explored the prevalence of post-traumatic stress disorder (PTSD) and its associated factors among Chinese university students who are isolated at home during the COVID-19 pandemic. Method: 4520 participants from five universities in China were surveyed by online questionnaire and the PTSD Checklist—Civilian Version (PCL-C) was adopted as a screening instrument. Results: Exposure to virus was significantly related to PTSD outcomes. The most important predictors for PTSD outcomes were parents’ relationship and the way parents educated, and university-provided psychological counseling was a protective factor against developing PTSD. Conclusions: The COVID-19 pandemic had adverse psychological consequences on Chinese university students who were isolated at home due to the relatively high prevalence rate of PTSD which was reported. Adverse parental relationships and the extreme way parents educate their children could be the major risk factors for PTSD outcomes. Psychological interventions need to be made available to home-quarantined university students, and those in the worst-hit and exposed areas to virus should be given priority focus. Full article
(This article belongs to the Topic Burden of COVID-19 in Different Countries)
Article
Risk Factors and Outcomes of Heart Failure Following First-Episode of Acute Myocardial Infarction—A Case Series Study of 161,384 Cases
Healthcare 2021, 9(10), 1382; https://doi.org/10.3390/healthcare9101382 - 16 Oct 2021
Cited by 1
Abstract
Background: Heart failure (HF) is one of the important complications of acute myocardial infarction (AMI), but the epidemiology, associated risks and outcomes have not been well investigated in the era of broad use of fluoroscopy-guided angiographic intervention. Methods: We analysed 161,384 subjects who [...] Read more.
Background: Heart failure (HF) is one of the important complications of acute myocardial infarction (AMI), but the epidemiology, associated risks and outcomes have not been well investigated in the era of broad use of fluoroscopy-guided angiographic intervention. Methods: We analysed 161,384 subjects who had experienced the first episode of AMI during 1 January 2000 and 31 December 2012 using the Taiwan National Health Insurance Research Database. Results: During the index AMI hospitalization, 23.6% of cases developed HF. Female, ≥65 years-old, non-ST-segment elevation type of MI, diabetes mellitus (DM), peripheral vascular occlusion disease (PAOD), chronic obstructive pulmonary disease (COPD), atrial fibrillation, and ventricular tachycardia/fibrillation (VT/VF) were associated with higher risks of developing HF. HF cases had inferior survival outcomes compared to non-HF cases in both the short and long term. Among those HF patients, ≥65 years, DM, PAOD, and VT/VF were associated with worse outcomes. On the contrary, coronary reperfusion intervention and treat-to-target pharmacologic treatment were associated with favourable survival outcomes. Conclusions: HF remains common in the modern age and poses negative impacts in survival of AMI patients. It highlights that prudent prevention and early treatment of HF during AMI hospitalization is an important medical issue. Full article
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Review
User Perception of Automated Dose Dispensed Medicine in Home Care: A Scoping Review
Healthcare 2021, 9(10), 1381; https://doi.org/10.3390/healthcare9101381 - 15 Oct 2021
Abstract
(1) Background: Automated dose dispensing (ADD) systems are today used around the world. The ADD robots are placed in patients’ homes to increase medication safety as well as medication adherence; however, little is known about how ADD robots affect the patient’s day-to-day lives, [...] Read more.
(1) Background: Automated dose dispensing (ADD) systems are today used around the world. The ADD robots are placed in patients’ homes to increase medication safety as well as medication adherence; however, little is known about how ADD robots affect the patient’s day-to-day lives, receiving the daily doses of medicine from a machine rather than from a human healthcare professional. The aim of this study is to review the available literature on users’ perceptions of having an ADD robot and collect evidence on how they perceive having less human contact after implementing this technology in their homes. (2) Methods: References were searched for in Embase and PubMed. Literature investigating ADD robots in primary healthcare was included in this study and literature in a hospital setting was excluded. After screening processes, eleven publications were included in this review. (3) Results: The literature reported high medication adherence when using ADD robots and general satisfaction in terms of user experiences with the acceptability and functionality of ADD. (4) Conclusion: The review is the first focusing on user experience and perceptions regarding ADD robots. General satisfaction was shown towards ADD robots as an intervention, but the review indicates that research is missing on healthcare professionals and patient perceptions on how ADD affects their routines, both in relation to work and daily life. Full article
(This article belongs to the Special Issue Management and Automation of Health Organizations)
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Article
The Regionalization Process for Universal Health Coverage in Brazil (2008–2015)
Healthcare 2021, 9(10), 1380; https://doi.org/10.3390/healthcare9101380 - 15 Oct 2021
Abstract
The objective of this article is to analyze the development of the public and private offer for the universalization of health services, specifically, for the progression of the public network. The time period examined is from 2008 to 2015, when there was considerable [...] Read more.
The objective of this article is to analyze the development of the public and private offer for the universalization of health services, specifically, for the progression of the public network. The time period examined is from 2008 to 2015, when there was considerable economic growth and expansion of private health insurance and an unprecedented historical period with economic growth and reduction of social inequality. Across 5570 municipalities, the multivariate analysis model was used to estimate the level of concentration and the imbalance (heterogeneity) of installed health capacity of the network of health care services. Public spending on investment and human resources showed positive variation in all regions and in almost all population strata. The offer by the Unified Health System (public) of primary health care increased by 8000 new establishments in all regions, especially in previously uncovered cities and cities that had shortages of public health services. Public universalization almost reached its maximum, with about 70% of municipalities. The only setback was the significant reduction of 50% in the number of private establishments in primary health care services. The data suggest a positive movement toward the universalization of health services in Brazil, with the concentration of high-complexity care and the heterogeneity of the installed capacity being points for improvement. Full article
(This article belongs to the Special Issue Inequalities in Environmental Exposure and in Health Care)
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Article
The Provision and Utilization of Traditional Korean Medicine in South Korea: Implications on Integration of Traditional Medicine in a Developed Country
Healthcare 2021, 9(10), 1379; https://doi.org/10.3390/healthcare9101379 - 15 Oct 2021
Cited by 6
Abstract
Traditional Korean medicine (TKM) is formally integrated into the Korean national health system and monitored through the systematic and computerized system, which could grasp the whole medical services utilization in Korea. This study analyzed TKM resources as input and utilization as output using [...] Read more.
Traditional Korean medicine (TKM) is formally integrated into the Korean national health system and monitored through the systematic and computerized system, which could grasp the whole medical services utilization in Korea. This study analyzed TKM resources as input and utilization as output using data from 2008–2017 and compared them to Conventional Medicine (CM). As a result, 25.4% of Koreans utilized TKM yearly, and the proportion of TKM medical expenditure (ME) to total ME in national health insurance was around 4% between 2008 to 2017. The proportion of ME has been stagnating or decreasing over the past ten years. Primary users are the elderly, women, and patients with musculoskeletal diseases. The Korean Ministry of health and welfare has also developed and operated programs that have taken advantage of the strengths of TKM. This study analyzes the current status of TKM in Korea comparing with that of CM. It also explores how and why the patterns of TKM and CM are different. Although the study focuses on input and output indicators, it also highlights the challenge of evaluating whether these lead to outcomes. Lastly, it seeks to inform relevant authorities of the importance of monitoring roles and evidence-informed policymaking. Full article
(This article belongs to the Section Health Policy)
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Article
Effects of Somatic, Depression Symptoms, and Sedentary Time on Sleep Quality in Middle-Aged Women with Risk Factors for Cardiovascular Disease
Healthcare 2021, 9(10), 1378; https://doi.org/10.3390/healthcare9101378 - 15 Oct 2021
Abstract
Cardiovascular disease (CVD) is the second leading cause of death among Korean women, and its incidence is dramatically elevated in middle-aged women. This study aimed to identify the predictors of sleep quality, a CVD risk factor, in middle-aged women with CVD risk factors [...] Read more.
Cardiovascular disease (CVD) is the second leading cause of death among Korean women, and its incidence is dramatically elevated in middle-aged women. This study aimed to identify the predictors of sleep quality, a CVD risk factor, in middle-aged women with CVD risk factors to provide foundational data for developing intervention strategies for the prevention of CVD. The subjects, 203 middle-aged women (40–65 years old) with one or more CVD risk factors were selected through convenience sampling and included in this descriptive correlational study. The effects of somatic symptoms, depression symptoms, and sedentary time on sleep quality were examined. CVD-related characteristics were analyzed using descriptive statistics, whereas the mean values of the independent variables were analyzed using t-tests and analysis of variance. Predictors of sleep quality were analyzed using multiple regression analysis. The results showed that sleep quality increased with decreasing somatic symptoms (β = −0.36, p < 0.001), depression symptom score (β = −0.17, p = 0.023), and daily sedentary time (β = −0.13, p = 0.041), and the regression model was significant (F = 19.80, p < 0.001). Somatic symptoms are the most potent predictors of sleep quality in middle-aged women. Thus, intervention strategies that improve somatic symptoms are crucial for the enhancement of sleep quality, which deteriorates with advancing age. Full article
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Article
Association of Moral Distress with Anxiety, Depression, and an Intention to Leave among Nurses Working in Intensive Care Units during the COVID-19 Pandemic
Healthcare 2021, 9(10), 1377; https://doi.org/10.3390/healthcare9101377 - 15 Oct 2021
Cited by 7
Abstract
Background: Wide geographical variations in depression and anxiety rates related to the ethical climate have been reported during the COVID-19 pandemic in intensive care units (ICUs). The objective was to investigate whether moral distress is associated and has predictive values for depression, anxiety, [...] Read more.
Background: Wide geographical variations in depression and anxiety rates related to the ethical climate have been reported during the COVID-19 pandemic in intensive care units (ICUs). The objective was to investigate whether moral distress is associated and has predictive values for depression, anxiety, and intention to resign. Methods: 79 consenting ICU nurses completed MMD-HP and PHQ-4 scales in this cross-sectional study between October 2020–February 2021, after ethical approval. The association between MMD-HP and PHQ-4, and the predictive value of MMD-HP for anxiety, depression, and an intention to leave were analyzed (linear regression and receiver operating characteristics curve analysis). Results: From MMD-HP items, system related factors had highest scores (Kruskal–Wallis test, p < 0.0001). MMD-HP and PHQ-4 were weakly correlated (r = 0.41 [0.21–0.58]). MMD-HP and its system-related factors discriminate between nurses with and without depression or anxiety, while system-related factors differentiate those intending to resign (p < 0.05). The MMD-HP score had 50 [37.54–62.46] sensitivity with 80.95 [60–92.33] specificity to predict the intention to leave, and 76.12 [64.67–84.73] sensitivity with 58.33 [31.95–80.67] specificity to detect anxiety or depression symptoms. Conclusions: During the COVID-19 pandemic, system-associated factors seem to be the most important root factors inducing moral distress. Moral distress is associated with negative psychological outcomes. Full article
(This article belongs to the Section Coronaviruses (CoV) and COVID-19 Pandemic)
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Review
Safety Assessment of Endocrine Disruption by Menopausal Health Functional Ingredients
Healthcare 2021, 9(10), 1376; https://doi.org/10.3390/healthcare9101376 - 15 Oct 2021
Cited by 1
Abstract
During menopause, women experience various symptoms including hot flashes, mood changes, insomnia, and sweating. Hormone replacement therapy (HRT) has been used as the main treatment for menopausal symptoms; however, other options are required for women with medical contraindications or without preference for HRT. [...] Read more.
During menopause, women experience various symptoms including hot flashes, mood changes, insomnia, and sweating. Hormone replacement therapy (HRT) has been used as the main treatment for menopausal symptoms; however, other options are required for women with medical contraindications or without preference for HRT. Functional health foods are easily available options for relieving menopausal symptoms. There are growing concerns regarding menopausal functional health foods because the majority of them include phytoestrogens which have the effect of endocrine disruption. Phytoestrogens may cause not only hormonal imbalance or disruption of the normal biological function of the organ systems, but also uterine cancer or breast cancer if absorbed and accumulated in the body for a long period of time, depending on the estrogen receptor binding capacity. Therefore, we aimed to determine the effects and safety of menopausal functional health ingredients and medicines on the human body as endocrine disruptors under review in the literature and the OECD guidelines. Full article
(This article belongs to the Special Issue Diagnosis and Treatment for Women's Health)
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Article
Pain in Hemodialysis Patients: Prevalence, Intensity, Location, and Functional Interference in Daily Activities
Healthcare 2021, 9(10), 1375; https://doi.org/10.3390/healthcare9101375 - 14 Oct 2021
Cited by 1
Abstract
Although pain is a frequent complaint of patients with chronic kidney disease who undergo hemodialysis, few studies have assessed the functional interference of pain in activities of daily living (ADLs). Hence, the aim of this study was to evaluate the prevalence, location, intensity, [...] Read more.
Although pain is a frequent complaint of patients with chronic kidney disease who undergo hemodialysis, few studies have assessed the functional interference of pain in activities of daily living (ADLs). Hence, the aim of this study was to evaluate the prevalence, location, intensity, and functional interference of pain in ADLs of chronic kidney disease patients undergoing hemodialysis and to estimate the association of specific pain sites with severe functional interference by pain in ADLs. This cross-sectional study included patients with chronic kidney disease undergoing hemodialysis. The prevalence, intensity, and functional interference of pain in ADLs were assessed using the brief pain inventory. Poisson regression was used to calculate the prevalence ratio. A total of 65 patients participated in the study. The overall prevalence of pain was 89.23%; the prevalence of headache was 18.46% and that of pain in the trunk was 55.38%, upper limbs was 35.38%, and lower limbs was 60.00%. The prevalence of moderate and severe pain at the time of hemodialysis was 13.85% and 21.54%, respectively. A high prevalence of severe functional interference of pain in general activity (61.54%), mobility (56.92%), and disposition (55.38%) was observed. Pain is a frequent complaint in patients undergoing hemodialysis, mainly musculoskeletal and intradialytic, and it interferes with ADLs and incapacitates the patient. Pain was highly prevalent in the upper and lower limbs and the trunk. Furthermore, a higher prevalence of severe pain at the time of hemodialysis and functional interference of pain, mainly in general activity, mobility, and disposition, were observed. Full article
(This article belongs to the Section Critical Care)
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Article
Private Healthcare Expenditure in China: A Regional Comparative Analysis
Healthcare 2021, 9(10), 1374; https://doi.org/10.3390/healthcare9101374 - 14 Oct 2021
Cited by 1
Abstract
Private (out-of-pocket) healthcare expenditure (PHCE) is a complex phenomenon that is shaped by many different factors. In this paper, we analyzed the influencing factors of PHCE in China, with a specific focus on regional differences. We found that old-age dependency ratio, income, and [...] Read more.
Private (out-of-pocket) healthcare expenditure (PHCE) is a complex phenomenon that is shaped by many different factors. In this paper, we analyzed the influencing factors of PHCE in China, with a specific focus on regional differences. We found that old-age dependency ratio, income, and education have significant impacts on PHCE in all regions, whereas public HCE, number of beds in medical institutions, and economic development levels have significant impacts only in some regions. The results indicate that the government should pay attention to regional inequality and implement targeted adjustments for improving the health service system. In particular, we recommend: (1) monitoring regional inequality in PHCE and other healthcare issues to unmask geographical differences in healthcare interventions; (2) adopting regional-specific policy measures—the government should divert some resources from eastern to western and central regions to increasing the support for public health undertakings and improve the quality of the local health services while providing matching medical resources by targeting the needs of the residents; (3) paying more attention to the healthcare demand of the elderly population; and (4) improving the education level of residents to improve public health and avoid high PHCE. Full article
(This article belongs to the Collection Health Economics & Finance and Global Public Health)
Article
Examination of Electrolyte Replacements in the ICU Utilizing MIMIC-III Dataset Demonstrates Redundant Replacement Patterns
Healthcare 2021, 9(10), 1373; https://doi.org/10.3390/healthcare9101373 - 14 Oct 2021
Abstract
Electrolyte repletion in the ICU is one of the most ubiquitous tasks in critical care, involving significant resources while having an unclear risk/benefit ratio. Prior data indicate most replacements are administered while electrolytes are within or above reference ranges with little effect on [...] Read more.
Electrolyte repletion in the ICU is one of the most ubiquitous tasks in critical care, involving significant resources while having an unclear risk/benefit ratio. Prior data indicate most replacements are administered while electrolytes are within or above reference ranges with little effect on serum post-replacement levels and potential harm. ICU electrolyte replacement patterns were analyzed using the MIMIC-III database to determine the threshold governing replacement decisions and their efficiency. The data of serum values for potassium, magnesium, and phosphate before and after repletion events were evaluated. Thresholds for when repletion was administered and temporal patterns in the repletion behaviors of ICU healthcare providers were identified. Most electrolyte replacements happened when levels were below or within reference ranges. Of the lab orders placed, a minuscule number of them were followed by repletion. Electrolyte repletion resulted in negligible (phosphate), small (potassium), and modest (magnesium) post-replacement changes in electrolyte serum levels. The repletion pattern followed hospital routine work and was anchored around shift changes. A subset of providers conducting over-repletion in the absence of clinical indication was also identified. This pattern of behavior found in this study supports previous studies and may allude to a universal pattern of over-repletion in the ICU setting. Full article
(This article belongs to the Special Issue Anesthesiology and Critical Care)
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Article
Immediate Effects of Sforzesco® Bracing on Respiratory Function in Adolescents with Idiopathic Scoliosis
Healthcare 2021, 9(10), 1372; https://doi.org/10.3390/healthcare9101372 - 14 Oct 2021
Cited by 8
Abstract
The thoraco-lumbar bracing is an effective management of adolescent idiopathic scoliosis (AIS). Studies have shown that brace wearing reduces lung volume. Whether or not the Sforzesco brace, frequently used in Italy, affects lung volume has not been investigated. We studied the immediate effect [...] Read more.
The thoraco-lumbar bracing is an effective management of adolescent idiopathic scoliosis (AIS). Studies have shown that brace wearing reduces lung volume. Whether or not the Sforzesco brace, frequently used in Italy, affects lung volume has not been investigated. We studied the immediate effect of Sforzesco bracing on lung volumes in 11 AIS patients (10 F, 1 M; aged 13.6 ± 1.6 yrs) mean Cobb angle 26 ± 4.49 degrees. Lung function variables and the perceived respiratory effort were recorded twice, before and 5 min after bracing. The one-way analysis of variance repeated measures, and multiple comparison tests, showed that means of unbraced variables were not significantly different from the corresponding means of predicted values, whereas means under brace were significantly lower (p < 0.05) compared to both predicted and baseline values of respiratory variables. In addition, a significant correlation (p < 0.0001) was found between unbraced and braced values, and linear regression equations were calculated. A significant but clinically unimportant increase in perceived effort was observed under the brace. In conclusion, data indicate that lung function is not impaired in moderate AIS and that wearing the Sforzesco brace causes an immediate, predictable reduction of lung volumes. Data also suggest that the respiratory discomfort during brace wearing could not be due to respiratory function defects. Full article
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