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Healthcare, Volume 9, Issue 11 (November 2021) – 206 articles

Cover Story (view full-size image): End-stage kidney disease has a negative impact on patients’ quality of life. People who receive a kidney transplant experience an improvement in many areas of their daily life. Sexuality is a general component of health, which can be affected by end-stage kidney disease and kidney transplant. The aim of this study was to explore and understand the experiences and perspectives of kidney transplant recipients regarding their sexuality. Healthcare professionals rarely discuss sexuality concerns with kidney transplant recipients. However, participants reported that healthcare professionals should receive additional sexual training in order to properly discuss sexuality concerns with patients. Sexuality is an important issue for kidney transplants recipients, and it is essential to include it in their care plan. View this paper
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Article
Social Support, Self-Care Behaviour and Self-Efficacy in Patients with Type 2 Diabetes during the COVID-19 Pandemic: A Cross-Sectional Study
Healthcare 2021, 9(11), 1607; https://doi.org/10.3390/healthcare9111607 - 22 Nov 2021
Cited by 1 | Viewed by 957
Abstract
Diabetes mellitus is a major public health issue that considerably impacts mortality, morbidity, and healthcare costs worldwide. The COVID-19 pandemic has created havoc in diabetes management, too, like other spectrums of life. A descriptive, cross-sectional study was adopted to determine the effect of [...] Read more.
Diabetes mellitus is a major public health issue that considerably impacts mortality, morbidity, and healthcare costs worldwide. The COVID-19 pandemic has created havoc in diabetes management, too, like other spectrums of life. A descriptive, cross-sectional study was adopted to determine the effect of Social Support, Self-Care Behaviour and Self-Efficacy in Type 2 Diabetes Mellitus (T2D) during this COVID-19 pandemic. Two hundred T2D patients who satisfied the inclusion criteria were chosen using a convenient sampling procedure. The tool consists of four sections, including socio-demographic characteristics, Multidimensional Scale of Perceived Social Support (MSPSS), revised Summary of Diabetes Self-Care Activities (SDSCA) Scale and modified Diabetes Management Self-Efficacy Scale (DMS). Descriptive and inferential statistics were used to analyze the obtained data. The mean and SD of diabetic management self-efficacy is 5.74 (1.95) and 4.37 (1.4), respectively, for patients with HbA1c < 6.5% and HbA1c ≥ 6.5%. The self-care activities of the patients who had good glycemic control were 4.31 (2.06) compared to 3.50 (1.73) who did not. The social support received by the patients was 6.13 (2.13) vs. 5.31 (1.67) among patients with glycemic control vs. no control. The results show that social support (p = 0.04), self-efficacy (p =0.01) and self-care activities (p = 0.001) were significantly related to the level of glycemic control of the T2D patients. A significant relationship was also identified between gender (p = 0.036), age (p = 0.001) and education status (p = 0.000) with HbA1c control of the participants. This study demonstrates a significant relationship between social support, self-care behaviours, self-efficacy and glycemic management in T2D patients. During this COVID-19 pandemic, interventions to enhance the self-care activities like exercise and social support to boost their self-efficacy; for better diabetes management, reducing diabetes complications or prolonging their onset are the need of the hour. Full article
(This article belongs to the Special Issue Diabetes and Comorbidities)
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Article
The Effect of a Mindfulness-Based Education Program on Brain Waves and the Autonomic Nervous System in University Students
Healthcare 2021, 9(11), 1606; https://doi.org/10.3390/healthcare9111606 - 22 Nov 2021
Cited by 1 | Viewed by 901
Abstract
Background: Mindfulness, defined as the awareness emerging from purposefully paying attention to the present moment, has been shown to be effective in reducing stress and, thus, promoting psychological well-being. This study investigated the effects of a mindfulness-based education program on mindfulness, brain waves, [...] Read more.
Background: Mindfulness, defined as the awareness emerging from purposefully paying attention to the present moment, has been shown to be effective in reducing stress and, thus, promoting psychological well-being. This study investigated the effects of a mindfulness-based education program on mindfulness, brain waves, and the autonomic nervous system (ANS) in university students in Korea. Methods: This study is a quantitative and experimental research with a single-group pre-post design. Six sessions of mindfulness-based intervention were applied. In total, 42 students completed a mindfulness questionnaire before and after the intervention, and 28 among them completed pre-intervention and post-intervention measures of brain waves and ANS. Results: The level of mindfulness increased in the participants after intervention. Regarding brain waves, the alpha and theta waves increased, but the beta waves decreased. There was no significant difference in the ANS, presenting no change in heart rate variability. Conclusions: We identified the positive effects of the mindfulness-based education program for university students. The findings indicate that this program may help students not only relax, but also generate a mindfulness state in stressful situations, potentially leading to a successful university life. This study can be used as a basis for quality improvement and sustainability of mindfulness-based education programs for university students. Full article
(This article belongs to the Collection Mindfulness in Healthcare)
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Article
Perceived Usefulness of Telerehabilitation of Musculoskeletal Disorders: A Belgium–France Pilot Study during Second Wave of COVID-19 Pandemic
Healthcare 2021, 9(11), 1605; https://doi.org/10.3390/healthcare9111605 - 22 Nov 2021
Cited by 1 | Viewed by 1053
Abstract
Background: COVID-19 has affected the practice of physiotherapy, and telerehabilitation (TR) may be seen as an alternative model of care if it is accepted by patients and physiotherapists. This study investigates the perceived usefulness of TR and the intention to use it among [...] Read more.
Background: COVID-19 has affected the practice of physiotherapy, and telerehabilitation (TR) may be seen as an alternative model of care if it is accepted by patients and physiotherapists. This study investigates the perceived usefulness of TR and the intention to use it among physiotherapists and patients from Belgium and France concerned with musculoskeletal disorders (MSDs) during the pandemic period. Methods: An online questionnaire based on the technology-acceptance model was designed. Sociodemographic data were collected and Likert scales were proposed to assess perceived ease-of-use, perceived usefulness and intention to use TR. Data were collected between 17 January and 17 March 2021; 68 patients and 107 physiotherapists answered. Results: In total, 88% of patients and 76% physiotherapists had not used TR at the time they answered. Only 12% of patients and 1% of physiotherapists are willing to use TR, and 50% of physiotherapists think they will never use TR compared to 25% of patients. A total of 98% of participants agreed that they had a good mastery of the technological tools requested. Conclusions: Physiotherapists are more reluctant to use TR than patients, regardless of convincing EBM results. This is related to their own representation of proper MSD management, which must include the use of hands-on techniques. Full article
(This article belongs to the Special Issue Assessment and Treatment for Healthcare of the Musculoskeletal System)
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Review
Halotherapy—An Ancient Natural Ally in the Management of Asthma: A Comprehensive Review
Healthcare 2021, 9(11), 1604; https://doi.org/10.3390/healthcare9111604 - 22 Nov 2021
Cited by 1 | Viewed by 942
Abstract
The increasing production of modern medication emerges as a new source of environmental pollution. The scientific community is interested in developing alternative, ecological therapies in asthma. Halotherapy proved its benefits in asthma diagnosis, treatment, and prevention and may represent a reliable therapeutic addition [...] Read more.
The increasing production of modern medication emerges as a new source of environmental pollution. The scientific community is interested in developing alternative, ecological therapies in asthma. Halotherapy proved its benefits in asthma diagnosis, treatment, and prevention and may represent a reliable therapeutic addition to the allopathic treatment, due to its ecological and environment-friendly nature, in order to prevent or prolong the time to exacerbations in patients with asthma. We aimed to review up-to-date research regarding halotherapy benefits in asthma comprehensively. We searched the electronic databases of PubMed, MEDLINE, EMBASE for studies that evaluated the exposure of asthmatic patients to halotherapy. Eighteen original articles on asthma were included. Five studies in adults and five in children assessed the performance of hypertonic saline bronchial challenges to diagnose asthma or vocal cord dysfunction in asthmatic patients. Three papers evaluated the beneficial effects of halotherapy on mucociliary clearance in asthmatic adults. The therapeutic effect of halotherapy on acute or chronic asthma was appraised in three studies in adults and one in children. The preventive role was documented in one paper reporting the ability of halotherapy to hinder nocturnal asthma exacerbations. All studies seem to sustain the overall positive effects of halotherapy as adjuvant therapy on asthma patients with no reported adverse events. Halotherapy is a crucial natural ally in asthma, but further evidence-based studies on larger populations are needed. Full article
Review
Phacoemulsification: Proposals for Improvement in Its Application
Healthcare 2021, 9(11), 1603; https://doi.org/10.3390/healthcare9111603 - 22 Nov 2021
Viewed by 681
Abstract
A cataract is defined as opacity of the crystalline lens. It is currently one of the most prevalent ocular pathologies and is generally associated with aging. The most common treatment for cataracts is surgery. Cataract surgery is a quick and painless process, is [...] Read more.
A cataract is defined as opacity of the crystalline lens. It is currently one of the most prevalent ocular pathologies and is generally associated with aging. The most common treatment for cataracts is surgery. Cataract surgery is a quick and painless process, is very effective, and has few risks. The operation consists of removing the opacified lens and replacing it with an intraocular lens. The most common intraocular lens removal procedure that is currently used is phacoemulsification. The energy applied in this process is generated by ultrasonic waves, which are mechanical waves with a frequency higher than 20 kHz. A great deal of research on the different ways to perform the stages of this surgical procedure and the analysis of the possible side effects of the operation has been published, but there is little information on the technical characteristics, the intensities applied, and the use of ultrasound-emitting (U/S) equipment for cataract removal. More studies on the method and depth of absorption of ultrasonic waves in our visual system when performing the phacoemulsification procedure are needed. It would be advisable for health authorities and medical professionals to develop guidelines for the handling and use of ultrasonic wave-emitting equipment, such as those that exist for ultrasound and physiotherapy. This could help us to reduce undesirable effects after the operation. Full article
(This article belongs to the Special Issue Preventative Medicine)
Review
Effects of Prehabilitation on Functional Capacity in Aged Patients Undergoing Cardiothoracic Surgeries: A Systematic Review
Healthcare 2021, 9(11), 1602; https://doi.org/10.3390/healthcare9111602 - 22 Nov 2021
Cited by 3 | Viewed by 847
Abstract
Background: an increasing number of advanced age patients are considered for cardiothoracic surgeries. Prehabilitation optimizes the patients’ functional capacity and physiological reserve. However, the effectiveness of prehabilitation on physical functioning and postoperative recovery in the scope of cardiothoracic surgery is still uncertain. Objective: [...] Read more.
Background: an increasing number of advanced age patients are considered for cardiothoracic surgeries. Prehabilitation optimizes the patients’ functional capacity and physiological reserve. However, the effectiveness of prehabilitation on physical functioning and postoperative recovery in the scope of cardiothoracic surgery is still uncertain. Objective: to assess the effectiveness of prehabilitation on pre- and/or postoperative functional capacity and physiological reserve in aged patients that are considered for cardiothoracic surgeries. Methods: this systematic review was registered in PROSPERO (CRD42021247117). The searches were conducted in PubMed, Web of Science, Scopus, and Cochrane CENTRAL until 18 April 2021. Randomized clinical trials that compared different prehabilitation strategies with usual care on the pre- and-postoperative results in aged patients undergoing cardiothoracic surgeries were included. Methodological quality was assessed by means of the Jadad scale, and the effectiveness of the interventions according to the Consensus on Therapeutic Exercise Training. Results: nine studies with 876 participants aged from 64 to 71.5 years old were included. Risk of bias was moderate due to the absence of double-blinding. The content of the interventions (multimodal prehabilitation n = 3; based on physical exercises n = 6) and the result measures presented wide variation, which hindered comparison across the studies. In general, the trials with better therapeutic quality (n = 6) reported more significant improvements in physical functioning, cardiorespiratory capacity, and in the postoperative results in the participants under-going prehabilitation. Conclusions: prehabilitation seems to improve functional capacity and postoperative recovery in aged patients undergoing cardiothoracic surgeries. However, due to the significant heterogeneity and questionable quality of the trials, both the effectiveness of prehabilitation and the optimum content are still to be determined. Full article
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Article
Analysis of the Effect of Wearing Extensible and Non-Extensible Lumbar Belts on Biomechanical Factors of the Sit-to-Stand Movement and Pain-Related Psychological Factors Affecting Office Workers with Low Back Pain
Healthcare 2021, 9(11), 1601; https://doi.org/10.3390/healthcare9111601 - 22 Nov 2021
Viewed by 781
Abstract
This study aimed to investigate the effects of wearing extensible and non-extensible lumbar belt (LB) on biomechanical factors of the sit-to-stand (STD) movement and pain-related psychological factors affecting office workers with low back pain. Among 30 office workers, 15 with low back pain [...] Read more.
This study aimed to investigate the effects of wearing extensible and non-extensible lumbar belt (LB) on biomechanical factors of the sit-to-stand (STD) movement and pain-related psychological factors affecting office workers with low back pain. Among 30 office workers, 15 with low back pain (LBP) were assigned to the experimental group and 15 healthy adults were assigned to the control group. The participants performed STD movement in random order of three different conditions: without LB (Condition 1), with extensible LB (Condition 2), and with non-extensible LB (Condition 3). Biomechanical variables of STD movement in each condition were measured using a three-dimensional motion analysis system and force plate. Pain-related psychological factors were measured only in the experimental group. Among the biomechanical factors of STD movement, an interaction effect was found in the maximum anterior pelvic tilt angle and total-phase range of motion of the trunk (p < 0.05). Pain intensity, pain-related anxiety, and pain catastrophizing were decreased in the conditions with lumbar belts (Conditions 2 and 3) compared to the condition without LB (Condition 1) (p < 0.05). Extensible and non-extensible lumbar belts engender biomechanically beneficial effects during STD movement in both office workers with LBP and healthy office workers. Further, pain intensity, pain-related anxiety, and pain catastrophizing were decreased in office workers with LBP. Therefore, both types of extensible lumbar belts may be helpful in the daily life of patients with LBP and office workers. Full article
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Article
Assessing Knowledge and Attitude of Healthcare Professionals on Biosimilars: A National Survey for Pharmacists and Physicians in Taiwan
Healthcare 2021, 9(11), 1600; https://doi.org/10.3390/healthcare9111600 - 21 Nov 2021
Cited by 2 | Viewed by 608
Abstract
Despite the first approval of biosimilars’ in 2010, biosimilar products usage has remained low in Taiwan. This cross-sectional survey study assessed healthcare professionals’ (HCPs)—hospital pharmacists, oncologists, and rheumatologists—knowledge, and attitudes toward biosimilars. More precisely, their knowledge and attitude towards biosimilars’ current usage and [...] Read more.
Despite the first approval of biosimilars’ in 2010, biosimilar products usage has remained low in Taiwan. This cross-sectional survey study assessed healthcare professionals’ (HCPs)—hospital pharmacists, oncologists, and rheumatologists—knowledge, and attitudes toward biosimilars. More precisely, their knowledge and attitude towards biosimilars’ current usage and regulations in Taiwan were analyzed. The mean ± standard deviation knowledge score was 2.56 ± 0.86 out of 4 (n = 395), and a difference in knowledge score was determined according to the hospital types (p = 0.004). Rheumatologists possessed significantly higher confidence in their knowledge of biosimilars than other HCPs (p = 0.001). Pharmacists showed the highest acceptance—and rheumatologists the least—for switching patients from reference drugs to biosimilars (p = 0.02). Hospital type was associated with the respondent’s confidence in their knowledge (p = 0.04) and the preference for distinguishable naming of biosimilars (p = 0.007). Their knowledge scores were associated with their confidence in the efficacy and safety of biosimilars (p = 0.02). The study found that the current level of biosimilar knowledge of HCPs in Taiwan is low. The higher the knowledge score, the greater the confidence in biosimilars and the familiarity with relevant regulations. Full article
(This article belongs to the Section Health Policy)
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Article
Associations of Sleep Quality, Anxiety, and Depression with Cognitive and Executive Functions among Community-Dwelling Women Aged ≥ 65 Years: A Cross-Sectional Study
Healthcare 2021, 9(11), 1599; https://doi.org/10.3390/healthcare9111599 - 21 Nov 2021
Viewed by 757
Abstract
(1) Background: The objective of this study was to evaluate the associations of sleep quality, anxiety, and depression with cognitive performance, executive functions, and verbal fluency among women aged ≥ 65 years; (2) Methods: A cross-sectional study was conducted on 241 women (72.52 [...] Read more.
(1) Background: The objective of this study was to evaluate the associations of sleep quality, anxiety, and depression with cognitive performance, executive functions, and verbal fluency among women aged ≥ 65 years; (2) Methods: A cross-sectional study was conducted on 241 women (72.52 ± 3.93 years). Cognitive performance (Mini-Mental State Examination) and impairment (Montreal Cognitive Assessment), verbal fluency (Isaacs test) and executive function (Trail Making Test), Sleep quality (Pittsburgh Sleep quality Index) and anxiety and depression (Hospital Anxiety and Depression Scale) were determined; (3) Results: The linear regression analysis indicated that anxiety, depression and age, were related to lower Mini-Mental State Examination score (adjusted R2 = 0.306), and age, anxiety and daytime dysfunction were linked to reduced Montreal Cognitive Assessment score (adjusted R2 = 0.248). Age and daytime dysfunction were associated with worse verbal fluency (adjusted R2 = 0.094). Finally, sleep latency, sleep disturbances, the Pittsburgh Sleep quality Index total score were associated with longer times in TMT-A (adjusted R2 = 0.758) and TMT-B (adjusted R2 = 0.508); (4) Conclusions: Sleep quality was associated with cognitive performance, verbal fluency and executive functions. Besides, both anxiety and depression were related with cognitive performance, while only anxiety was linked to executive functions. As for confounders, age was associated with cognitive performance and verbal fluency. Full article
(This article belongs to the Special Issue Mental and Behavioral Healthcare)
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Case Report
An Elderly COVID-19 Patient with Community-Acquired Legionella and Mycoplasma Coinfections: A Rare Case Report
Healthcare 2021, 9(11), 1598; https://doi.org/10.3390/healthcare9111598 - 21 Nov 2021
Cited by 2 | Viewed by 646
Abstract
The combination of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection and other respiratory pathogens is a real challenge for health care systems in terms of diagnosis, treatment, and management. Most of the reported bacterial coinfections among SARS-CoV-2 patients are hospital-acquired infections that [...] Read more.
The combination of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection and other respiratory pathogens is a real challenge for health care systems in terms of diagnosis, treatment, and management. Most of the reported bacterial coinfections among SARS-CoV-2 patients are hospital-acquired infections that occurred after several days of hospitalization. Little is known about the incidence of community-acquired atypical bacterial coinfections with SARS-CoV-2. In this work, we report on a rare case of an elderly SARS-CoV-2 patient with underdiagnosed bacterial coinfections who received care in the medical ward for 23 days then was discharged home. Retrospective serological investigation revealed positivity for Legionella pneumophila and Mycoplasma pneumoniae, indicating double community-acquired atypical bacterial coinfections that were in agreement with clinical manifestations that patients showed at his admission to the hospital. Screening for possible community-acquired respiratory co-pathogens among elderly SARS-CoV-2 patients is critical for effective treatment and management. Full article
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Article
Media, Trust in Government, and Risk Perception of COVID-19 in the Early Stage of Epidemic: An Analysis Based on Moderating Effect
by
Healthcare 2021, 9(11), 1597; https://doi.org/10.3390/healthcare9111597 - 20 Nov 2021
Cited by 5 | Viewed by 947
Abstract
Previous research has revealed that environmental, social, and cultural factors affect people’s risk perception of COVID-19, especially the influence of media and trust, while the dynamics of how they affect it is still not clear. Through the analysis of online survey data, this [...] Read more.
Previous research has revealed that environmental, social, and cultural factors affect people’s risk perception of COVID-19, especially the influence of media and trust, while the dynamics of how they affect it is still not clear. Through the analysis of online survey data, this article shows that there are two opposed paths of action. Trust in the government will enhance people’s confidence in controlling COVID-19. It then moderates and decreases the effects of people’s level and frequency of concernon the risk perception (both cognition and worries) of COVID-19, on the contrary, obtaining information from unofficial channels also moderates and increases the effects of the people’s level and frequency of concern on the second dimension (worries) of risk perception of COVID-19 rather than the first dimension (cognition). These conclusions have important policy implications for the control of the COVID-19 epidemic all over the world. Full article
(This article belongs to the Section Coronaviruses (CoV) and COVID-19 Pandemic)
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Article
Towards the Development of a Substance Abuse Index (SEI) through Informatics
Healthcare 2021, 9(11), 1596; https://doi.org/10.3390/healthcare9111596 - 20 Nov 2021
Cited by 1 | Viewed by 667
Abstract
Substance abuse or drug dependence is a prevalent phenomenon, and is on the rise in United States. Important contributing factors for the prevalence are the addictive nature of certain medicinal/prescriptive drugs, individual dispositions (biological, physiological, and psychological), and other external influences (e.g., pharmaceutical [...] Read more.
Substance abuse or drug dependence is a prevalent phenomenon, and is on the rise in United States. Important contributing factors for the prevalence are the addictive nature of certain medicinal/prescriptive drugs, individual dispositions (biological, physiological, and psychological), and other external influences (e.g., pharmaceutical advertising campaigns). However, currently there is no comprehensive computational or machine learning framework that allows systematic studies of substance abuse and its factors with majority of the works using subjective surveys questionnaires and focusing on classification techniques. Lacking standardized methods and/or measures to prescribe medication and to study substance abuse makes it difficult to advance through collective research efforts. Thus, in this paper, we propose to test the feasibility of developing a, objective substance effect index, SEI, that can measure the tendency of an individual towards substance abuse. To that end, we combine the benefits of Electronics Medical Records (EMR) with machine learning technology by defining SEI as a function of EMR data and using logistics regression to obtain a closed form expression for SEI. We conduct various evaluations to validate the proposed model, and the results show that further work towards the development of SEI will not only provide researchers with standard computational measure for substance abuse, but may also allow them to study certain attribute interactions to gain further insights into substance abuse tendencies. Full article
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Article
Factors Related to Locomotive Syndrome in School-Aged Children in Okazaki: A Cross-Sectional Study
Healthcare 2021, 9(11), 1595; https://doi.org/10.3390/healthcare9111595 - 20 Nov 2021
Cited by 1 | Viewed by 600
Abstract
The relationship of locomotive syndrome with other physical characteristics and lifestyle habits in children has not been fully elucidated. The aim of this study was to assess the prevalence of children’s locomotive syndrome, and to determine its relationship with the above-mentioned factors. This [...] Read more.
The relationship of locomotive syndrome with other physical characteristics and lifestyle habits in children has not been fully elucidated. The aim of this study was to assess the prevalence of children’s locomotive syndrome, and to determine its relationship with the above-mentioned factors. This was a cross-sectional study of 285 elementary school children who volunteered to participate in a medical checkup for physical function. Data was collected via medical examination, clinical measurements, and questionnaires. A multivariable logistic regression model was used to determine the relationship (odds ratios; ORs) of participants’ characteristics, physical functions, and other outcomes determined by questionnaire on locomotive syndrome. The following factors were related to locomotive syndrome: older age (OR = 1.421, 95% confidence interval [CI] [1.039, 1.945]), male sex (OR = 4.011, 95% CI [2.189, 7.347]), and more time spent watching television per day (OR = 1.281, 95% CI [1.001, 1.640]). These results may assist in the encouragement of children to perform appropriate physical activities and avoid unhealthy lifestyle habits, reducing the occurrence of locomotive syndrome. Full article
(This article belongs to the Special Issue Comprehensive Clinical Physiotherapy and Rehabilitation: Version II)
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Review
Abortion in Countries with Restrictive Abortion Laws—Possible Directions and Solutions from the Perspective of Poland
Healthcare 2021, 9(11), 1594; https://doi.org/10.3390/healthcare9111594 - 20 Nov 2021
Cited by 3 | Viewed by 1546
Abstract
The tendency towards the radicalization of abortion law is observed in numerous countries, including Poland. The aim of the present paper was to determine the main factors influencing the number of abortions performed worldwide and to indicate the main directions which should be [...] Read more.
The tendency towards the radicalization of abortion law is observed in numerous countries, including Poland. The aim of the present paper was to determine the main factors influencing the number of abortions performed worldwide and to indicate the main directions which should be followed to improve the patients’ well-being. The authors conducted their search in the PubMed of the National Library of Medicine and Google Scholar. Databases were extensively searched for all original and review articles/book chapters in English until June 2021. The main problems associated with the contemporary policy of birth regulation include no possibility of undergoing a termination because of the conscience clause invoked by the medical personnel, restrictive abortion law and lack of sexual education. Minimal changes that should be considered are: improved sex education and the availability of contraception, free access to abortion-inducing drugs with adequate information provided by qualified medical personnel in countries with a conscience clause invoked by the personnel, and the development of an international network which would facilitate undergoing a pregnancy termination abroad to provide women with access to legal abortion assisted by professional medical personnel. Full article
Article
Content Analysis of the Free COVID-19 Telephone Consultations Available during the First Wave of the Pandemic in Japan
Healthcare 2021, 9(11), 1593; https://doi.org/10.3390/healthcare9111593 - 20 Nov 2021
Viewed by 573
Abstract
This cross-sectional study aimed to (1) describe the unclassified contents of telephone consultation services provided by a public health center during the first wave of COVID-19 in Japan and (2) examine whether the contents required assistance from public health nurses (PHNs). We analyzed [...] Read more.
This cross-sectional study aimed to (1) describe the unclassified contents of telephone consultation services provided by a public health center during the first wave of COVID-19 in Japan and (2) examine whether the contents required assistance from public health nurses (PHNs). We analyzed a total of 207 calls in which the purpose of the call was unclassified into pre-set categories. PHNs transcribed the exact text of the consultation conversations recorded from 25 March to 20 April 2020 in City A. Approximately half of the calls were from residents. Seven categories were extracted through a qualitative content analysis. The most common topic was infection control measures, where the presence of COVID-19 infection was assumed (n = 62); the second most common was extreme anxiety and fear of infection (n = 50). Questions about the COVID-19 response system (n = 30), discrimination and misunderstandings about COVID-19 (n = 24), and response measures for COVID-19 outbreaks within organizations (n = 18) were also included. The unclassified consultations included various topics, several of which required the expertise of a PHN. Each local government should consider sharing and task-shifting telephone consultation services among PHNs and other staff to reduce their burden and allow them to concentrate on conducting infection control more effectively. Full article
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Article
Nanostring-Based Identification of the Gene Expression Profile in Trigger Finger Samples
Healthcare 2021, 9(11), 1592; https://doi.org/10.3390/healthcare9111592 - 20 Nov 2021
Viewed by 747
Abstract
Trigger finger is a common yet vastly understudied fibroproliferative hand pathology, severely affecting patients’ quality of life. Consistent trauma due to inadequate positioning within the afflicted finger’s tendon/pulley system leads to cellular dysregulation and eventual fibrosis. While the genetic characteristics of the fibrotic [...] Read more.
Trigger finger is a common yet vastly understudied fibroproliferative hand pathology, severely affecting patients’ quality of life. Consistent trauma due to inadequate positioning within the afflicted finger’s tendon/pulley system leads to cellular dysregulation and eventual fibrosis. While the genetic characteristics of the fibrotic tissue in the trigger finger have been studied, the pathways that govern the initiation and propagation of fibrosis are still unknown. The complete gene expression profile of the trigger finger has never been explored. Our study has used the Nanostring nCounter gene expression assay to investigate the molecular signaling involved in trigger finger pathogenesis. We collected samples from patients undergoing trigger finger (n = 4) release surgery and compared the gene expression to carpal tunnel tissue (n = 4). Nanostring nCounter analysis identified 165 genes that were differentially regulated; 145 of these genes were upregulated, whereas 20 genes were downregulated. We found that several collagen genes were significantly upregulated, and a regulatory matrix metalloproteinase (MMP), MMP-3, was downregulated. Bioinformatic analysis revealed that several known signaling pathways were dysregulated, such as the TGF-β1 and Wnt signaling pathways. We also found several novel signaling pathways (e.g., PI3K, MAPK, JAK-STAT, and Notch) differentially regulated in trigger finger. The outcome of our study helps in understanding the molecular signaling pathway involved in the pathogenesis of the trigger finger. Full article
(This article belongs to the Special Issue Musculoskeletal Pain Care and Management in Rare Diseases)
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Article
Agreement between 3D Motion Analysis and Tele-Assessment Using a Video Conferencing Application for Telerehabilitation
Healthcare 2021, 9(11), 1591; https://doi.org/10.3390/healthcare9111591 - 20 Nov 2021
Viewed by 673
Abstract
The global pandemic of the coronavirus disease 2019 (COVID-19) has highlighted the need for remote healthcare services. This study aimed to evaluate the concurrent validity and reliability of tele-assessment using 3D motion analysis and video conferencing applications. The subjects of this study were [...] Read more.
The global pandemic of the coronavirus disease 2019 (COVID-19) has highlighted the need for remote healthcare services. This study aimed to evaluate the concurrent validity and reliability of tele-assessment using 3D motion analysis and video conferencing applications. The subjects of this study were 14 Pilates instructors and 14 healthy adults, who repeated five exercises of “side spine stretch”, “bridge”, “toe taps”, “quadruped leg raise”, and “cat and cow” five times each. We performed 3D kinematic analysis with 16 infrared cameras while the subject performed each exercise, and the image captured by one webcam was transmitted to the evaluators through a video conferencing application, and eight raters evaluated the mobility, stability, and symmetry of the movement. The result was then compared with the gold standard 3D motion analysis to evaluate the teleassessment system. The concurrent validity of the data obtained using both methods was analyzed. In addition, the inter-rater reliability of the data from the eight raters was evaluated. As a result, mobility showed excellent (ICC > 0.75, ICCs: intraclass correlation coefficients) or good agreement (ICC = 0.6–0.74) with 3D motion analysis and tele-assessment in all motions. The analysis of stability showed high agreement in general, but it was not significant in “cat and cow.” Symmetry showed moderate agreement only in “bridge” and “toe taps”, showing low agreement compared to other components. In addition, the inter-rater reliability of the tele-assessment showed good agreement (ICC = 0.744). Although there were few components with weaker agreements, the results of this study confirmed that it is a valid and reliable method of tele-assessment using video conferencing applications and showed feasibility as an alternative to the existing face-to-face examination. Full article
(This article belongs to the Section TeleHealth and Digital Healthcare)
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Article
Assessment of Recidivism Risk in Sex Offenders: A Pilot Study in Central Italy
Healthcare 2021, 9(11), 1590; https://doi.org/10.3390/healthcare9111590 - 20 Nov 2021
Viewed by 573
Abstract
Knowing the risk factors of recidivism in sex offenders is important in order to prepare effective preventative interventions and treatment in custody. In this regard, the following paper shows the results of a pilot study carried out in the prisons of central Italy [...] Read more.
Knowing the risk factors of recidivism in sex offenders is important in order to prepare effective preventative interventions and treatment in custody. In this regard, the following paper shows the results of a pilot study carried out in the prisons of central Italy in which 44 sex offenders participated. These participants were given the following tests: Historical Clinical Risk Management-20-version 3 (HCR20v3), Psychopathy Checklist-Revised (PCL-R) and Personal Inventory Dimensional (PID-5). The results show a high positivity in the factors of the sub-scales H (historical factors) and C (clinical factors) of HCR20v3; the average total score of the PCR-L is 16.47, with five subjects who are in the “high psychopathy” range (X ≥ 30); with regard to PID-5, the most positive domain is negative affectivity (56.10%). Full article
(This article belongs to the Special Issue Health in Prison)
Article
Integrating the Public Health Services Model into Age-Friendly Pharmacies: A Case Study on the Pharmacies in Taiwan
Healthcare 2021, 9(11), 1589; https://doi.org/10.3390/healthcare9111589 - 19 Nov 2021
Viewed by 660
Abstract
Taiwan is expected to become a superaged society by 2026. Community pharmacies have recently joined Taiwan’s primary care system; they have great potential to provide professional healthcare services. This study examined whether the services provided by community pharmacists enhance medication adherence, enable the [...] Read more.
Taiwan is expected to become a superaged society by 2026. Community pharmacies have recently joined Taiwan’s primary care system; they have great potential to provide professional healthcare services. This study examined whether the services provided by community pharmacists enhance medication adherence, enable the identification and solution of drug therapy problems, and are accepted by community residents. The Department of Public Health, Taoyuan City, collaborated with the Taoyuan Pharmacist Association over 11 months in 2018 in enabling pharmacists to dispense prescriptions and provide medication adherence consultations, cognitive services, and home and institutional medical care services. This study designed four satisfaction questionnaires to assess the feasibility and performance of these services. Regarding the services related to medication knowledge and adherence, 92.10% of the patients reported overall satisfaction, and all understanding and ability scores were improved in more than 95% of patients. The number of patients highly cooperative regarding their medication had risen from 14 to 234 after the intervention, and the number with low medication adherence had dropped from 533 to 33. More than 90% of respondents indicated that the institutional medical care services had significantly improved their medication knowledge and behaviors. The feasibility of the incorporation of integrated the public health services model into age-friendly pharmacies was confirmed by this study. Full article
(This article belongs to the Collection Healthcare Strategy and Community Care)
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Article
Relationships among the Internal Health Locus of Control, Mental Health Problems, and Subjective Well-Being of Adults in South Korea
Healthcare 2021, 9(11), 1588; https://doi.org/10.3390/healthcare9111588 - 19 Nov 2021
Cited by 2 | Viewed by 959
Abstract
The purpose of this study was to confirm the relationship between internal health locus of control, mental health problems, and subjective well-being in adults during the prolonged COVID-19 pandemic. In particular, the mediating effect of mental health problems on the relationship between internal [...] Read more.
The purpose of this study was to confirm the relationship between internal health locus of control, mental health problems, and subjective well-being in adults during the prolonged COVID-19 pandemic. In particular, the mediating effect of mental health problems on the relationship between internal health locus of control and subjective well-being was examined. A cross-sectional descriptive design was conducted via online survey. The participants were 600 adults over 20 years of age living in South Korea. The collected data were analyzed using hierarchical regression analysis and SPSS Process Macro (Model 4). As a result of the study, the internal health locus of control had a significant negative effect on mental health problems. In addition, in the process of the internal health locus of control affecting subjective well-being, the mediating effect of mental health problems was significantly shown. In the period of an infectious disease pandemic such as COVID-19, it is necessary to establish a strong internal health locus of control of individuals and to promote monitoring and treatment introduction for those with a low internal health locus of control. In addition, it was discussed that controlling mental health problems can improve subjective well-being, which is life satisfaction and happiness. Full article
(This article belongs to the Special Issue Mental Health in Times of Pandemic: Protective and Risk Factors)
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Article
Development and Psychometric Testing of the Mental Health Scale for Childrearing Fathers
Healthcare 2021, 9(11), 1587; https://doi.org/10.3390/healthcare9111587 - 19 Nov 2021
Viewed by 522
Abstract
The mental health of fathers influences the development of children and the functioning of families significantly. However, there is no useful scale for the mental health screening of childrearing fathers. This study developed a Mental Health Scale for Childrearing Fathers (MSCF) and determined [...] Read more.
The mental health of fathers influences the development of children and the functioning of families significantly. However, there is no useful scale for the mental health screening of childrearing fathers. This study developed a Mental Health Scale for Childrearing Fathers (MSCF) and determined its reliability and validity. Childrearing fathers are working fathers who co-parent with their spouses. This survey was conducted in two stages: a pilot study and a main survey. Data were obtained from 98 fathers raising preschoolers in the pilot study and 306 fathers in the main survey. The collected data were used to confirm the construct validity, criterion-related validity, convergent validity, and internal consistency reliability. The final MSCF consisted of 25 items comprising four factors: peaceful familial connection, healthy mind and body, satisfying paternal alliances, and leading a meaningful life as a parent. The internal consistency reliability estimated using Cronbach’s alpha coefficient for the total scale was 0.918. The validity of the MSCF was logically secured using a confirmatory factor analysis. The MSCF can be an effective tool for mental health screening among fathers in relation to the burden of childrearing during regular infant health checks. Full article
(This article belongs to the Section Nursing)
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Article
Analysis of Factors Affecting Post-Stroke Fatigue: An Observational, Cross-Sectional, Retrospective Chart Review Study
Healthcare 2021, 9(11), 1586; https://doi.org/10.3390/healthcare9111586 - 19 Nov 2021
Cited by 1 | Viewed by 777
Abstract
Post-stroke fatigue (PSF) is one of the most common emotional and mood disorders in stroke survivors. Several studies have suggested associations between PSF and various factors. However, they describe conflicting results. Therefore, this study aimed to evaluate the factors affecting PSF. We retrospectively [...] Read more.
Post-stroke fatigue (PSF) is one of the most common emotional and mood disorders in stroke survivors. Several studies have suggested associations between PSF and various factors. However, they describe conflicting results. Therefore, this study aimed to evaluate the factors affecting PSF. We retrospectively reviewed the medical records of 178 hospitalized stroke patients. The collected data were compared between the PSF and control groups. To evaluate the association between factors and PSF, regression analysis was conducted. A total of 96 patients (53.9%) were assigned to the PSF group, and 82 patients were assigned to the control group. Age, neurological deficits, cognitive dysfunction, degree of depression, hs-CRP, and ESR differed significantly between the two groups. For both types of stroke, multiple linear regression analyses showed that degree of depression and degree of inflammation were significantly associated with PSF. Through subgroup analysis, multiple linear regression analyses showed that the degree of depression in ischemic and hemorrhagic stroke and the platelet-to-lymphocyte ratio in hemorrhagic stroke had a significant association with PSF. In conclusion, post-stroke depression and degree of inflammation could be clinically significant predictors of PSF in all types of stroke patients. However, larger, prospective studies are required to obtain more concrete results. Full article
(This article belongs to the Section Nursing)
Article
“Together We Stand”: A Pilot Study Exploring the Feasibility, Acceptability, and Preliminary Effects of a Family-Based Psychoeducational Intervention for Patients on Hemodialysis and Their Family Caregivers
Healthcare 2021, 9(11), 1585; https://doi.org/10.3390/healthcare9111585 - 19 Nov 2021
Viewed by 871
Abstract
This pilot study aimed to assess the feasibility, acceptability, and preliminary effects of a family-based psychoeducational intervention for patients undergoing hemodialysis (HD) and their family members. This was a single-group (six dyads), six-week, pre–post pilot study, delivered in a multifamily group format. Feasibility [...] Read more.
This pilot study aimed to assess the feasibility, acceptability, and preliminary effects of a family-based psychoeducational intervention for patients undergoing hemodialysis (HD) and their family members. This was a single-group (six dyads), six-week, pre–post pilot study, delivered in a multifamily group format. Feasibility was based on screening, eligibility, content, retention, completion, and intervention adherence rates. Acceptability was assessed at post-intervention through a focus group interview. Self-reported anxiety and depression and patients’ inter-dialytic weight gain (IDWG) were also measured. The screening (93.5%), retention (85.7%), and completion (100%) rates were satisfactory, whereas eligibility (22.8%), consent (18.4%), and intervention adherence (range: 16.7–50%) rates were the most critical. Findings showed that participants appreciated the intervention and perceived several educational and emotional benefits. The results from the Wilcoxon Signed-Rank Test showed that a significant decrease in anxiety symptoms (p = 0.025, r = 0.646) was found, which was followed by medium to large within-group effect sizes for changes in depression symptoms (p = 0.261, r = 0.325) and patients’ IDWG (p = 0.248, r = 0.472), respectively. Overall, the results indicated that this family-based psychoeducational intervention is likely to be feasible, acceptable, and effective for patients undergoing HD and their family caregivers; nonetheless, further considerations are needed on how to make the intervention more practical and easily implemented in routine dialysis care before proceeding to large-scale trials. Full article
(This article belongs to the Special Issue Healthcare and Rehabilitation of Older Adults)
Article
Assessing the Impact of Unfolding Case Study Scenarios during High-Fidelity Pediatric Simulation among Undergraduate Nursing Students
Healthcare 2021, 9(11), 1584; https://doi.org/10.3390/healthcare9111584 - 19 Nov 2021
Cited by 2 | Viewed by 791
Abstract
Simulation helps to prepare prelicensure nursing students for practice by providing opportunities to perform clinical skills and make decisions in a safe environment. The integration of nursing knowledge, skills, and decision-making abilities during simulated unfolding case-study scenarios may enhance student self-confidence and foster [...] Read more.
Simulation helps to prepare prelicensure nursing students for practice by providing opportunities to perform clinical skills and make decisions in a safe environment. The integration of nursing knowledge, skills, and decision-making abilities during simulated unfolding case-study scenarios may enhance student self-confidence and foster clinical judgement skills. The purpose of this study was to assess the impact of simulation using unfolding case-study scenarios on undergraduate nursing students’ self-confidence in pediatric nursing knowledge, skills, and clinical judgment/decision-making abilities. This mixed methods study included a pre- and post-survey design to evaluate undergraduate nursing students’ confidence in pediatric nursing knowledge, skills, and decision-making abilities after participation in both an instructor-led (guided) and a student-led (decision-making) simulation involving unfolding case-study scenarios. Friedman’s ANOVA analyses revealed that all 16-items demonstrated statistically significant differences between the three measured responses (pre-simulation and both post-simulation surveys). Post-hoc Wilcoxon signed-rank tests revealed statistically significant differences in student ratings pre-simulation and post-instructor-led (guided) experience for all 16-scored items. The qualitative themes identified were perception of experience, pediatric nursing care, assimilation of knowledge, and critical thinking. Unfolding case-study simulation experiences positively impact the learning, self-confidence, and clinical judgement of undergraduate nursing students. Full article
(This article belongs to the Special Issue Nursing, Child and Pediatric Health)
Article
An Observational Study to Evaluate the Association between Intestinal Permeability, Leaky Gut Related Markers, and Metabolic Health in Healthy Adults
Healthcare 2021, 9(11), 1583; https://doi.org/10.3390/healthcare9111583 - 19 Nov 2021
Cited by 2 | Viewed by 785
Abstract
We explored whether metabolic health is linked to intestinal permeability, using a multi-sugar (MS) permeability test, and whether intestinal permeability is correlated with the leaky gut-related markers (LGM) zonulin, LBP, and sCD14. Metabolically healthy (n = 15) and unhealthy subjects (n [...] Read more.
We explored whether metabolic health is linked to intestinal permeability, using a multi-sugar (MS) permeability test, and whether intestinal permeability is correlated with the leaky gut-related markers (LGM) zonulin, LBP, and sCD14. Metabolically healthy (n = 15) and unhealthy subjects (n = 15) were recruited based on waist circumference, fasting glucose, and high-density lipoprotein cholesterol levels. Participants underwent an MS permeability test that assessed site-specific permeabilities of the gastroduodenum and small and large intestines. The test was performed with/without an acetylsalicylic acid challenge to measure and correlate the gut permeability, LGM, and metabolic health. At baseline, metabolic health showed no correlation with gut permeability. Significant correlations were found between the metabolic health parameters and LGM. In the acetylsalicylic acid challenged MS permeability test, low-density lipoprotein cholesterol was correlated with the sucralose/erythritol ratio, reflecting the whole intestinal permeability. Correlations between most metabolic health parameters and LGM during the acetylsalicylic acid challenge were less pronounced than at baseline. In both MS permeability tests, no significant correlations were found between LGM (plasma and serum) and gut permeability. Thus, correlations between LGM and metabolic health might not be linked with paracellular gut permeability. Transcellular translocation and/or lipoprotein-related transportation is a more likely mechanism underlying the association between LGM and metabolic health. Full article
(This article belongs to the Section Nutrition and Public Health)
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Article
Differences in Perceived Occupational Stress by Demographic Characteristics, of European Emergency Medical Services Personnel during the COVID-19 Virus Pandemic—An International Study
Healthcare 2021, 9(11), 1582; https://doi.org/10.3390/healthcare9111582 - 19 Nov 2021
Viewed by 1192
Abstract
Objectives: The outbreak of the COVID-19 pandemic has brought commercial, social, and economic consequences in every country that has experienced substantial SARS-CoV-2 infection rates. The complete change in the environment that took place due to the outbreak of the pandemic can lead to [...] Read more.
Objectives: The outbreak of the COVID-19 pandemic has brought commercial, social, and economic consequences in every country that has experienced substantial SARS-CoV-2 infection rates. The complete change in the environment that took place due to the outbreak of the pandemic can lead to stressful situations, especially among healthcare personnel. Material and methods: The research were conducted during the COVID-19 pandemic between the 27 March 2020 and the 20 April 2020. The research included 1984 employees of emergency medical systems in seven European countries. An internet-based questionnaire format was adopted for the study (ΩMc-Donald > 0.7). Results: The highest level of stress was experienced by personnel in the United Kingdom M = 4.03, and the lowest by Norwegian employees M = 2.89. High levels of stress were also experienced by nurses from Spain and Poland. Women actively working in the healthcare system during the pandemic experienced higher stress levels than men. Conclusions: Women working in European emergency medical systems are more vulnerable to work-related stress, while carrying out emergency medical procedures during the pandemic. Differences in the level of stress experienced while carrying out duties in pre-hospital conditions were only found among Spanish emergency medical system personnel. Full article
(This article belongs to the Topic Burden of COVID-19 in Different Countries)
Erratum
Erratum: Barsasella et al. Sleep Quality among Breast and Prostate Cancer Patients: A Comparison between Subjective and Objective Measurements. Healthcare 2021, 9, 785
Healthcare 2021, 9(11), 1581; https://doi.org/10.3390/healthcare9111581 - 19 Nov 2021
Viewed by 460
Abstract
The authors wish to make the following erratum to this paper [...] Full article
(This article belongs to the Special Issue Sleep Disorders Effect on Human Health)
Article
Perception of Medical Professionalism among Medical Residents in Spain
Healthcare 2021, 9(11), 1580; https://doi.org/10.3390/healthcare9111580 - 18 Nov 2021
Cited by 2 | Viewed by 660
Abstract
Background: Medical professionalism, defined as commitment to the primacy of patient welfare, is the basis for doctor–patient–society relationships, but previous research with medical students has shown that professionalism and social commitment to medicine may be waning. To determine if this trend also appears [...] Read more.
Background: Medical professionalism, defined as commitment to the primacy of patient welfare, is the basis for doctor–patient–society relationships, but previous research with medical students has shown that professionalism and social commitment to medicine may be waning. To determine if this trend also appears in recently qualified practicing doctors, we surveyed 90 newly graduated doctors currently working as medical residents in two university hospitals in Murcia, Spain. A previously validated questionnaire that studies the perception of six categories (responsibility, altruism, service, excellence, honesty and integrity, and respect) defining medical professionalism was used. Results: A good perception of professionalism was found among medical residents, with more than 70% positive responses in all these six categories. There is an increasing trend in the number of negative responses as the residency goes on. Altruism was the category with the greatest percentage of negative answers (22.3%) and Respect was the category with the lowest percentage (12.9%). Conclusions: The results show a good professionalism perception in medical residents, but also a slight decline in positive answers that began during medical school. A significant trend was found when including both students and residents. Although there were some differences between students and residents, these were not statistically significant. Educational interventions are needed both at the level of medical school and postgraduate medical residency. Full article
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Article
Deep Learning Approaches to Automated Video Classification of Upper Limb Tension Test
Healthcare 2021, 9(11), 1579; https://doi.org/10.3390/healthcare9111579 - 18 Nov 2021
Cited by 2 | Viewed by 701
Abstract
The purpose of this study was to classify ULTT videos through transfer learning with pre-trained deep learning models and compare the performance of the models. We conducted transfer learning by combining a pre-trained convolution neural network (CNN) model into a Python-produced deep learning [...] Read more.
The purpose of this study was to classify ULTT videos through transfer learning with pre-trained deep learning models and compare the performance of the models. We conducted transfer learning by combining a pre-trained convolution neural network (CNN) model into a Python-produced deep learning process. Videos were processed on YouTube and 103,116 frames converted from video clips were analyzed. In the modeling implementation, the process of importing the required modules, performing the necessary data preprocessing for training, defining the model, compiling, model creation, and model fit were applied in sequence. Comparative models were Xception, InceptionV3, DenseNet201, NASNetMobile, DenseNet121, VGG16, VGG19, and ResNet101, and fine tuning was performed. They were trained in a high-performance computing environment, and validation and loss were measured as comparative indicators of performance. Relatively low validation loss and high validation accuracy were obtained from Xception, InceptionV3, and DenseNet201 models, which is evaluated as an excellent model compared with other models. On the other hand, from VGG16, VGG19, and ResNet101, relatively high validation loss and low validation accuracy were obtained compared with other models. There was a narrow range of difference between the validation accuracy and the validation loss of the Xception, InceptionV3, and DensNet201 models. This study suggests that training applied with transfer learning can classify ULTT videos, and that there is a difference in performance between models. Full article
(This article belongs to the Topic Artificial Intelligence in Healthcare)
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Article
Effect of Practice Environment on Nurse Reported Quality and Patient Safety: The Mediation Role of Person-Centeredness
Healthcare 2021, 9(11), 1578; https://doi.org/10.3390/healthcare9111578 - 18 Nov 2021
Cited by 10 | Viewed by 895
Abstract
This study aims to explore the potential mediation role of person-centeredness between the effects of the work environment and nurse reported quality and patient safety. A quantitative cross-sectional survey collected data from 1055 nurses, working in medical and surgical units, in twelve Malaysian [...] Read more.
This study aims to explore the potential mediation role of person-centeredness between the effects of the work environment and nurse reported quality and patient safety. A quantitative cross-sectional survey collected data from 1055 nurses, working in medical and surgical units, in twelve Malaysian private hospitals. The data collection used structured questionnaires. The Hayes macro explored the mediation effect of person-centeredness between the associations of work environment dimensions and care outcomes, controlling nurses’ demographics and practice characteristics. A total of 652 nurses responded completely to the survey (61.8% response rate). About 47.7% of nurses worked 7-h shifts, and 37.0% were assigned more than 15 patients. Higher workload was associated with unfavorable outcomes. Nurses working in 12-h shifts reported a lower work environment rating (3.46 ± 0.41, p < 0.01) and person-centered care (3.55 ± 0.35, p < 0.01). Nurses assigned to more than 15 patients were less likely to report a favorable practice environment (3.53 ± 0.41, p < 0.05), perceived lower person-centered care (3.61 ± 0.36, p < 0.01), and rated lower patient safety (3.54 ± 0.62, p < 0.05). Person-centeredness mediates the effect of nurse work environment dimensions on quality and patient safety. Medical and surgical nurses, working in a healthy environment, had a high level of person-centeredness, which, in turn, positively affected the reported outcomes. The function of person-centeredness was to complement the effects of the nurse work environment on care outcomes. Improving the nurse work environment (task-oriented) with a high level of person-centeredness (patient-oriented) was a mechanism through which future initiatives could improve nursing care and prevent patient harm. Full article
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