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Healthcare, Volume 9, Issue 10 (October 2021) – 144 articles

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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 (registering DOI) - 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 (registering DOI) - 16 Oct 2021
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 (registering DOI) - 16 Oct 2021
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 (registering DOI) - 16 Oct 2021
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 (registering DOI) - 16 Oct 2021
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 (registering DOI) - 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 (registering DOI) - 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 (registering DOI) - 15 Oct 2021
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)
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 (registering DOI) - 15 Oct 2021
Viewed by 22
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 (registering DOI) - 15 Oct 2021
Viewed by 124
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 (registering DOI) - 15 Oct 2021
Viewed by 165
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 (registering DOI) - 14 Oct 2021
Viewed by 138
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
Viewed by 110
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 Special Issue 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
Viewed by 183
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
Viewed by 166
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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Communication
Microbiome Forensic Biobanking: A Step toward Microbial Profiling for Forensic Human Identification
Healthcare 2021, 9(10), 1371; https://doi.org/10.3390/healthcare9101371 - 14 Oct 2021
Viewed by 170
Abstract
In recent years many studies have highlighted the great potential of microbial analysis in human identification for forensic purposes, with important differences in microbial community composition and function across different people and locations, showing a certain degree of uncertainty. Therefore, further studies are [...] Read more.
In recent years many studies have highlighted the great potential of microbial analysis in human identification for forensic purposes, with important differences in microbial community composition and function across different people and locations, showing a certain degree of uncertainty. Therefore, further studies are necessary to enable forensic scientists to evaluate the risk of microbial transfer and recovery from various items and to further critically evaluate the suitability of current human DNA recovery protocols for human microbial profiling for identification purposes. While the establishment and development of microbiome research biobanks for clinical applications is already very structured, the development of studies on the applicability of microbiome biobanks for forensic purposes is still in its infancy. The creation of large population microbiome biobanks, specifically dedicated to forensic human identification, could be worthwhile. This could also be useful to increase the practical applications of forensic microbiology for identification purposes, given that this type of evidence is currently absent from most real casework investigations and judicial proceedings in courts. Full article
(This article belongs to the Special Issue Forensic Science and Legal Medicine: A Multidisciplinary Puzzle!)
Case Report
Unilateral Cauda Equina Syndrome Due to Cancer Metastasis Diagnosed with Electromyography: A Case Report
Healthcare 2021, 9(10), 1370; https://doi.org/10.3390/healthcare9101370 - 14 Oct 2021
Viewed by 187
Abstract
Background: Typical cauda equina syndrome (CES) presents as low back pain, bilateral leg pain with motor and sensory deficits, genitourinary dysfunction, saddle anesthesia and fecal incontinence. In addition, it is a neurosurgical emergency, which is essential to diagnose as soon as possible, [...] Read more.
Background: Typical cauda equina syndrome (CES) presents as low back pain, bilateral leg pain with motor and sensory deficits, genitourinary dysfunction, saddle anesthesia and fecal incontinence. In addition, it is a neurosurgical emergency, which is essential to diagnose as soon as possible, and needs prompt intervention. However, unilateral CES is rare. Here, we report a unique case of a patient who had unilateral symptoms of CES due to cancer metastasis and was diagnosed through electromyography. Methods: A 71-year-old man with diffuse large B cell lymphoma (DLBCL) suffered from severe pain, motor weakness in the right lower limb and urinary incontinence, and hemi-saddle anesthesia. It was easy to be confused with lumbar radiculopathy due to the unilateral symptoms. Lumbar spine magnetic resonance imaging (MRI) showed suspected multifocal bone metastasis in the TL spine, including T11-L5, the bilateral sacrum and iliac bones, and suspected epidural metastasis at L4/5, L5/S1 and the sacrum. PET CT conducted after the third R-CHOP showed residual hypermetabolic lesions in L5, the sacrum, and the right presacral area. Results: Nerve conduction studies (NCS) revealed peripheral neuropathy in both hands and feet. Electromyography (EMG) presented abnormal results indicating development of muscle membrane instability following neural injury, not only on the right symptomatic side, but also on the other side which was considered intact. Overall, he was diagnosed with cauda equina syndrome caused by DLBCL metastasis, and referred to neurosurgical department. Conclusions: Early diagnosis of unilateral CES may go unnoticed due to its unilateral symptoms. Failure to perform the intervention at the proper time can impede recovery and leave permanent complications. Therefore, physicians need to know not only the typical CES, but also the clinical features of atypical CES when encountering a patient, and further evaluation such as electrodiagnostic study or lumbar spine MRI have to be considered. Full article
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Article
Patient Satisfaction and Hospital Quality of Care Evaluation in Malaysia Using SERVQUAL and Facebook
Healthcare 2021, 9(10), 1369; https://doi.org/10.3390/healthcare9101369 - 14 Oct 2021
Viewed by 138
Abstract
Social media sites, dubbed patient online reviews (POR), have been proposed as new methods for assessing patient satisfaction and monitoring quality of care. However, the unstructured nature of POR data derived from social media creates a number of challenges. The objectives of this [...] Read more.
Social media sites, dubbed patient online reviews (POR), have been proposed as new methods for assessing patient satisfaction and monitoring quality of care. However, the unstructured nature of POR data derived from social media creates a number of challenges. The objectives of this research were to identify service quality (SERVQUAL) dimensions automatically from hospital Facebook reviews using a machine learning classifier, and to examine their associations with patient dissatisfaction. From January 2017 to December 2019, empirical research was conducted in which POR were gathered from the official Facebook page of Malaysian public hospitals. To find SERVQUAL dimensions in POR, a machine learning topic classification utilising supervised learning was developed, and this study’s objective was established using logistic regression analysis. It was discovered that 73.5% of patients were satisfied with the public hospital service, whereas 26.5% were dissatisfied. SERVQUAL dimensions identified were 13.2% reviews of tangible, 68.9% of reliability, 6.8% of responsiveness, 19.5% of assurance, and 64.3% of empathy. After controlling for hospital variables, all SERVQUAL dimensions except tangible and assurance were shown to be significantly related with patient dissatisfaction (reliability, p < 0.001; responsiveness, p = 0.016; and empathy, p < 0.001). Rural hospitals had a higher probability of patient dissatisfaction (p < 0.001). Therefore, POR, assisted by machine learning technologies, provided a pragmatic and feasible way for capturing patient perceptions of care quality and supplementing conventional patient satisfaction surveys. The findings offer critical information that will assist healthcare authorities in capitalising on POR by monitoring and evaluating the quality of services in real time. Full article
Review
A Reporting Quality Assessment of Systematic Reviews and Meta-Analyses in Sports Physical Therapy: A Review of Reviews
Healthcare 2021, 9(10), 1368; https://doi.org/10.3390/healthcare9101368 - 14 Oct 2021
Viewed by 164
Abstract
This review of reviews aimed to evaluate the reporting quality of published systematic reviews and meta-analyses in the field of sports physical therapy using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This review of reviews included a literature search; [...] Read more.
This review of reviews aimed to evaluate the reporting quality of published systematic reviews and meta-analyses in the field of sports physical therapy using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This review of reviews included a literature search; in total, 2047 studies published between January 2015 and December 2020 in the top three journals related to sports physical therapy were screened. Among the 125 identified articles, 47 studies on sports physical therapy were included in the analysis (2 systematic reviews and 45 meta-analyses). There were several problems areas, including a lack of reporting for key components of the structured summary (10/47, 21.3%), protocol and registration (18/47, 38.3%), risk of bias in individual studies (28/47, 59.6%), risk of bias across studies (24/47, 51.1%), effect size and variance calculations (5/47, 10.6%), additional analyses (25/47, 53.2%), and funding (10/47, 21.3%). The quality of the reporting of systematic reviews and meta-analyses of studies on sports physical therapy was low to moderate. For better evidence-based practice in sports physical therapy, both authors and readers should examine assumptions in more detail, and report valid and adequate results. The PRISMA guideline should be used more extensively to improve reporting practices in sports physical therapy. Full article
(This article belongs to the Special Issue Sport and Exercise Medicine)
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Article
Stress and Burnout Related to Electronic Health Record Use among Healthcare Providers during the COVID-19 Pandemic in Saudi Arabia: A Preliminary National Randomized Survey
Healthcare 2021, 9(10), 1367; https://doi.org/10.3390/healthcare9101367 - 14 Oct 2021
Viewed by 154
Abstract
Healthcare providers’ burnout may potentially have a negative impact on patient care. The use of the electronic health record (EHR) increases the burden for healthcare providers (HCPs), particularly during the coronavirus disease-2019 (COVID-19) pandemic. This study assessed the stress and burnout related to [...] Read more.
Healthcare providers’ burnout may potentially have a negative impact on patient care. The use of the electronic health record (EHR) increases the burden for healthcare providers (HCPs), particularly during the coronavirus disease-2019 (COVID-19) pandemic. This study assessed the stress and burnout related to the use of EHRs and health information technology (HIT) tools among HCPs during COVID-19 in Saudi Arabia. We used a self-developed survey tool. It consisted of five sections; demographics and professional data, experience using EHR, effects of EHR use, use of EHR and technology tools during COVID-19, and health and wellbeing. The survey link was emailed to a random sample of HCPs registered with a national scientific regulatory body. Univariate, bivariate, and multivariate analyses were performed to measure the association between burnout and study variables. A total of 182 participants completed the survey. 50.5% of participants reported a presence of HIT-related stress, and 40.1% reported a presence of burnout. The variables independently associated with burnout were providing tertiary level of care, working with COVID-19 suspected cases, dissatisfaction with EHRs, and agreement with the statement that using EHRs added frustration to the workday. Further research that explores possible solutions is warranted to minimize burnout among HCPs, especially during infectious outbreaks. Full article
(This article belongs to the Special Issue Mental and Behavioral Healthcare)
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Article
Factors Associated with Hepatitis C Antibody Positivity in Korean Adults: A Cross-Sectional Study Based on 2013–2018 Korea National Health and Nutrition Examination Survey
Healthcare 2021, 9(10), 1366; https://doi.org/10.3390/healthcare9101366 (registering DOI) - 14 Oct 2021
Viewed by 178
Abstract
This study aimed to provide basic data on the prevention of hepatitis C infection by identifying factors related to it based on the data from the National Health and Nutrition Examination Survey (KNHANES). The sixth (2013–2015) and seventh (2016–2018) Korean National Health and [...] Read more.
This study aimed to provide basic data on the prevention of hepatitis C infection by identifying factors related to it based on the data from the National Health and Nutrition Examination Survey (KNHANES). The sixth (2013–2015) and seventh (2016–2018) Korean National Health and Nutrition Examination Surveys conducted by the Korean Disease Control and Prevention Agency were analyzed. This is a population-based, nationally representative, multistage, cross-sectional survey of noninstitutionalized persons in Korea. Multivariate regression analysis was used to assess the significance of the variables. A total of 32,942 persons aged >20 years were selected for this study. Among them, 282 tested positive for hepatitis C antibodies, while 32,660 tested negative. Of the 282 persons who tested positive, 48.6% were men and 51.4% were women. The factors associated with hepatitis C infection were age, education level, self-rated health status, and liver cirrhosis. Therefore, there is a need to educate people and implement preventive programs based on age and education levels to reduce the incidence of hepatitis C infections. In addition, it is necessary to include hepatitis C screening as part of the National Health Examination to diagnose hepatitis C infections. Full article
Article
A Knowledge, Attitude, and Practice Survey on Medication Safety in Korean Older Adults: An Analysis of an Ageing Society
Healthcare 2021, 9(10), 1365; https://doi.org/10.3390/healthcare9101365 - 14 Oct 2021
Viewed by 121
Abstract
Background: Older adults have certain limitations in acquiring and understanding information regarding medication safety. This study surveyed their medication habits and analysed the importance of relevant education to improve knowledge, attitudes, and practice (KAP). Methods: Our survey included adults aged 65 years or [...] Read more.
Background: Older adults have certain limitations in acquiring and understanding information regarding medication safety. This study surveyed their medication habits and analysed the importance of relevant education to improve knowledge, attitudes, and practice (KAP). Methods: Our survey included adults aged 65 years or older. We developed a questionnaire on medication safety based on the KAP model. To identify the interrelationships among KAP, we calculated the correlation coefficients using Pearson’s correlation analysis. A t-test was performed to verify the differences in KAP associated with the respondents’ medication safety education experience. Results: We found that 79.4% of respondents self-administered their medications. Of the respondents, 28.2% had received medication safety education. Overall, the respondents had typical levels of knowledge, attitude responses, and behavioural practices associated with medication safety. The results showed significant differences between knowledge and practice; those who were educated on medication safety performed higher levels of safe practice than those who were not (p < 0.05). Conclusion: The KAP survey confirmed that knowledge about the safe use of medication positively affected older adults’ attitudes and practices. To improve their medication usage habits, older adults should receive well-organised medication safety education. Full article
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Article
Impact of Nursing Professionalism on Perception of Patient Privacy Protection in Nursing Students: Mediating Effect of Nursing Informatics Competency
Healthcare 2021, 9(10), 1364; https://doi.org/10.3390/healthcare9101364 - 14 Oct 2021
Viewed by 218
Abstract
In recent times, as the healthcare system becomes more informational, the importance of patient privacy protection increases, making it necessary to identify factors that affect the perception of patient privacy protection. This study aimed to evaluate the relationship between nursing professionalism and the [...] Read more.
In recent times, as the healthcare system becomes more informational, the importance of patient privacy protection increases, making it necessary to identify factors that affect the perception of patient privacy protection. This study aimed to evaluate the relationship between nursing professionalism and the perception of patient privacy protection and the mediating role of nursing informatics competency. The study recruited 242 nursing students who had experienced dealing with patient information during clinical practice. The mediating model using the Hayes’ PROCESS macro (Model 4) was employed to test the study hypothesis. Nursing professionalism was found to be positively and significantly associated with the perception of patient privacy protection (β = 0.09, p = 0.021) with the mediation of nursing informatics (β = 0.18, p < 0.001). Our findings showed that nursing professionalism and nursing informatics competency determined the perception of patient privacy protection. The mediating role of nursing informatics competency implies that curricula designed to enhance nursing informatics competency of nursing students may increase their perception of patient privacy protection. Full article
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Article
Use of Soft Cervical Collar among Whiplash Patients in Two Italian Emergency Departments Is Associated with Persistence of Symptoms: A Propensity Score Matching Analysis
Healthcare 2021, 9(10), 1363; https://doi.org/10.3390/healthcare9101363 - 14 Oct 2021
Viewed by 223
Abstract
Purpose: Although the use of soft cervical collars in the emergency department (ED), for whiplash-associated disorders (WAD), is controversial, it is still widely adopted. The purpose of our study was to investigate the impact of the early use of soft cervical collars on [...] Read more.
Purpose: Although the use of soft cervical collars in the emergency department (ED), for whiplash-associated disorders (WAD), is controversial, it is still widely adopted. The purpose of our study was to investigate the impact of the early use of soft cervical collars on the return to the ED, within three months of a road traffic collision. Methods: We conducted a retrospective observational study on WAD patients from two EDs in Verona (Italy). Patients in the earlier acute phase of WAD (within 48 h from the trauma) were included; those with serious conditions (WAD IV) were excluded. As an end point, we considered patients who returned to the ED complaining of WAD symptoms within three months as positive outcome for WAD persistence. Results: 2162 patients were included; of those, 85.4% (n = 1847/2162) received a soft cervical collar prescription. Further, 8.4% (n = 156/1847) of those with a soft cervical collar prescription, and 2.5% (n = 8/315) of those without a soft cervical collar (p < 0.001) returned to the ED within three months. The use of the soft cervical collar was an independent risk factor for ED return within three months, with an OR, adjusted for possible clinical confounders, equal to 3.418 (95% CI 1.653–7.069; p < 0.001). After the propensity score matching, 25.5% of the patients (n = 25/98) using the soft cervical collar returned to the ED at three months, compared to the 6.1% (n = 6/98) that did not adopt the soft cervical collar. The use of a soft cervical collar was associated with ED return with an OR = 4.314 (95% CI 2.066–11.668; p = 0.001). Conclusions: Our study shows that the positioning of the soft collar in a cohort of patients with acute WAD, following a rear-end car collision, is an independent potential risk factor to the return to the ED. Clinically, the use of the collar is a non-recommended practice and seems to be related to an increased risk of delayed recovery. There is a need to inform healthcare providers involved in the ED of the aim to limit the use of the soft cervical collar. A closer collaboration between clinicians (e.g., physicians, physical therapists, nurses) is suggested in the ED. Future primary studies should determine differences between having used or not having used the collar, and compare early physical therapy in the ED compared with the utilization of the collar. Full article
(This article belongs to the Special Issue Traffic Injuries and Prevention)
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Article
The COVID-19 Run on Medical Resources in Wuhan China: Causes, Consequences and Lessons
Healthcare 2021, 9(10), 1362; https://doi.org/10.3390/healthcare9101362 - 13 Oct 2021
Viewed by 145
Abstract
The COVID-19 run on medical resources crashed Wuhan’s medical care system, a medical disaster duplicated in many countries facing the COVID-19 pandemic. In a novel approach to understanding the run on Wuhan’s medical resources, we draw from bank run theory to analyze the [...] Read more.
The COVID-19 run on medical resources crashed Wuhan’s medical care system, a medical disaster duplicated in many countries facing the COVID-19 pandemic. In a novel approach to understanding the run on Wuhan’s medical resources, we draw from bank run theory to analyze the causes and consequences of the COVID-19 run on Wuhan’s medical resources and recommend policy changes and government actions to attenuate runs on medical resources in the future. Like bank runs, the cause of the COVID-19 medical resource run was rooted in China’s local medical resource context and a sudden realignment of expectations, reflecting shortages and misallocations of hospital resources (inadequate liquidity and portfolio composition); high level hospitals siphoning-off patients from lower level health providers (bank moral hazard and adverse selection problem); patients selecting high-level hospitals over lower-level health care (depositor moral hazard problem); inadequate government oversight and uncontrolled risky hospital behavior (inadequate bank regulatory control); biased medical insurance schemes (inadequate depositor insurance); and failure to provide medical resource reserves (failure as lender of last resort). From Wuhan’s COVID-19 run on medical resources, we recommend that control and reform by government enlarge medical resource supply, improve the capacity of primary medical care, ensure timely virus information, formulate principles for the allocation of medical resources that suit a country’s national conditions, optimize the medical insurance schemes and public health fund allocations and enhance the emergency support of medical resources. Full article
(This article belongs to the Topic Burden of COVID-19 in Different Countries)
Article
Access to Healthcare for Minors: An Ethical Analysis of Judgments of the European Court of Human Rights
Healthcare 2021, 9(10), 1361; https://doi.org/10.3390/healthcare9101361 - 13 Oct 2021
Viewed by 148
Abstract
The right to non-discriminatory access to healthcare is anchored in the European Convention on Human Rights and other international treaties or guidelines. Since its ratification, the European Convention on Human Rights was made binding in all Member States of the Council of Europe [...] Read more.
The right to non-discriminatory access to healthcare is anchored in the European Convention on Human Rights and other international treaties or guidelines. Since its ratification, the European Convention on Human Rights was made binding in all Member States of the Council of Europe and is interpreted by the European Court of Human Rights (ECtHR). Despite its legal recognition, discrimination in healthcare provision has repeatedly been an issue of medicoethical and political consideration. In this context, minors are particularly in danger of being deprived of this fundamental right. The aim of this study is to analyze the current state of the ECtHR jurisdiction on challenges in accessing healthcare for minor patients. We conducted a systematic search of judgments by the ECtHR using the keywords “healthcare” and “child”. We performed descriptive statistics and qualitative thematic analysis. Our search resulted in n = 66 judgments, which were all screened. Access to healthcare for minors played a role in n = 21 judgments, which involved applications against n = 13 countries. We formed five, partially overlapping categories, which represent recurring themes regarding the research topic. These themes are governance failure (n = 11), the status of refugee, asylum seeker or migrant (n = 5), parental home (n = 5), maternity and birth (n = 4) and others (n = 2). The normative framework of the ECtHR’s jurisprudence illustrates intersections between social, legal and medicoethical aspects of minors’ discrimination in the healthcare system. It emphasizes the particular vulnerability of children, who require exceptional protection. Inadequate access to healthcare manifests itself in specific situations, such as in the context of migration or staying in public institutions. Healthcare professionals need to be sensitized for such discrimination mechanisms, as they are often at the forefront of encountering structural discrimination in the healthcare system. Full article
(This article belongs to the Special Issue Access and Healthcare for Disadvantaged Populations)
Article
Methoxyflurane in Non-Life-Threatening Traumatic Pain—A Retrospective Observational Study
Healthcare 2021, 9(10), 1360; https://doi.org/10.3390/healthcare9101360 - 13 Oct 2021
Viewed by 126
Abstract
Pain management is a key issue in prehospital trauma. In Switzerland, paramedics have a large panel of analgesic options. Methoxyflurane was recently introduced into Switzerland, and the goal of this study was to describe both the effect of this medication and the satisfaction [...] Read more.
Pain management is a key issue in prehospital trauma. In Switzerland, paramedics have a large panel of analgesic options. Methoxyflurane was recently introduced into Switzerland, and the goal of this study was to describe both the effect of this medication and the satisfaction of its use. This was a retrospective cohort study, performed in one emergency ambulance service. It included adult patients with traumatic pain and a self-assessment of 3 or more on the visual analogue scale or verbal numerical rating scale. The primary outcome was the reduction in pain between the start of the care and the arrival at the hospital. Secondary outcomes included successful analgesia and staff satisfaction. From December 2018 to 4 June to October 2020, 263 patients were included in the study. Most patients had a low prehospital severity score. The median pain at arrival on site was 8 and the overall decrease in pain observed was 4.2 (95% CI 3.9–4.5). Regarding secondary outcomes, almost 60% had a successful analgesia, and over 70% of paramedics felt satisfied. This study shows a reduction in pain, following methoxyflurane, similar to outcomes in other countries, as well as the attainment of a satisfactory level of pain reduction, according to paramedics, with the advantage of including patients in their own care. Full article
(This article belongs to the Special Issue Urgent and Acute Prehospital Care)
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Article
A Qualitative Content Analysis of Cardiovascular Diseases Related Health Information Targeted at the Hui Minority on Chinese WeChat Official Accounts
Healthcare 2021, 9(10), 1359; https://doi.org/10.3390/healthcare9101359 - 13 Oct 2021
Viewed by 191
Abstract
In this study, we focus on the information available in WeChat official accounts about cardiovascular diseases (CVDs), which are a leading cause of death in China. We are particularly interested in information targeting the Chinese Hui minority people, who have a high prevalence [...] Read more.
In this study, we focus on the information available in WeChat official accounts about cardiovascular diseases (CVDs), which are a leading cause of death in China. We are particularly interested in information targeting the Chinese Hui minority people, who have a high prevalence of cardiovascular risk factors (CVRFs). Our exploratory research therefore investigates whether and how the articles on WeChat official accounts are targeted at the Hui people. We used a qualitative approach to analyze 108 articles. Two related themes emerged: descriptions of how to live a healthy life; and explanations of CVDs and CVRFs. Traditional Chinese medicine likewise surfaced from the analysis as a specific and unique theme in the Chinese social and cultural context. Despite the high prevalence of CVRFs among the Hui, none of the articles included information tailored to them. Full article
(This article belongs to the Special Issue Social Media and Public Health)
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Article
Effect of Incorporating Short-Foot Exercises in the Balance Rehabilitation of Flat Foot: A Randomized Controlled Trial
Healthcare 2021, 9(10), 1358; https://doi.org/10.3390/healthcare9101358 - 13 Oct 2021
Viewed by 199
Abstract
Effective balance rehabilitation is essential to address flat foot (pes planus) which is closely associated with reduced postural stability. Although sensorimotor training (SMT) and short-foot exercise (SFE) have been effective for improving postural stability, the combined effects of SMT with SFE have not [...] Read more.
Effective balance rehabilitation is essential to address flat foot (pes planus) which is closely associated with reduced postural stability. Although sensorimotor training (SMT) and short-foot exercise (SFE) have been effective for improving postural stability, the combined effects of SMT with SFE have not been evaluated in previous studies. The aim of this study was to compare the lone versus combined effects of SMT with SFE on postural stability among participants with flat foot. This was a single-blinded, randomized controlled trial. A total of 32 flat-footed participants were included in the study (14 males and 18 females) and assigned to the SMT combined with SFE group and SMT alone group. All participants underwent 18 sessions of the SMT program three times a week for six weeks. Static balance, dynamic balance, and the Hmax/Mmax ratio were compared before and after the interventions. Static and dynamic balance significantly increased in the SMT combined with SFE group compared with the SMT alone group. However, the Hmax/Mmax ratio was not significantly different between the two groups. Therefore, this study confirms that the combination of SMT and SFE is superior to SMT alone to improve postural balance control in flat-footed patients in clinical settings. Full article
(This article belongs to the Special Issue Sport and Exercise Medicine)
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Article
Portuguese Medical Students’ Interest for Science and Research Declines after Freshman Year
Healthcare 2021, 9(10), 1357; https://doi.org/10.3390/healthcare9101357 (registering DOI) - 12 Oct 2021
Viewed by 185
Abstract
The integration of scientific research into medical curricula remains insufficient despite its advantages for medical students’ professional development and the advancement of medicine. This study aimed to evaluate the impact of first-year medical course attendance on medical students’ attitudes and perceptions towards scientific [...] Read more.
The integration of scientific research into medical curricula remains insufficient despite its advantages for medical students’ professional development and the advancement of medicine. This study aimed to evaluate the impact of first-year medical course attendance on medical students’ attitudes and perceptions towards scientific research and clinical practice, while also assessing the contribution of sociodemographic and academic factors. Two hundred and thirteen medical students self-administrated a questionnaire at the beginning and at the end of the first school year. Their responses were compared and two regression models were calculated to assess factors influencing students’ attitudes and perceptions. After freshman year, students displayed significantly lower positive attitudes towards science and research. Their motivation to perform research and to integrate it into the curriculum also decreased, while the importance attributed to research skills for clinical practice increased. Motivation to perform research and negative attitudes were positively and negatively associated with grade point average (GPA), respectively. Female students and those who attended public secondary schools attributed greater importance to communication skills. This study reinforces the need to early develop research skills and positive attitudes in medical students, motivating them to become physician-scientists. Additional follow-up studies may offer further contributions to the integration of research into medical curricula. Full article
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