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Healthcare, Volume 9, Issue 2 (February 2021) – 137 articles

Cover Story (view full-size image): Mechanobiology shows how endogenous and exogenous mechanical stimuli can induce cellular biochemical and epigenetic modifications. Mechanical stress can influence the flux of calcium ion (Ca2+) and mitochondrial behavior—that is, biogenesis, mitophagy, fusion, fission and energy production. These processes are paramount for sport performance, which, in fact, alter mitochondria. Since manual therapies have been shown to affect cell behavior, it is conceivable that they could also affect mitochondrial metabolism by inducing mechanical forces that are transmitted to mitochondria through the extracellular matrix and the cytoskeleton. Therefore, the present narrative review aims to highlight the effects that manual therapies could have on mitochondria, as these effects could improve athletic performance management, and to suggest possible directions for future laboratory and clinical [...] Read more.
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Open AccessArticle
Relationship between Active Aging and Quality of Life in Middle-Aged and Older Koreans: Analysis of the 2013–2018 KNHANES
Healthcare 2021, 9(2), 240; https://doi.org/10.3390/healthcare9020240 (registering DOI) - 23 Feb 2021
Viewed by 208
Abstract
With the increase in the aging population worldwide, social interest in having a vibrant and valuable old age has been increasing with changes in the perspectives on old age. This study aimed to determine the relationship between active aging and health-related quality of [...] Read more.
With the increase in the aging population worldwide, social interest in having a vibrant and valuable old age has been increasing with changes in the perspectives on old age. This study aimed to determine the relationship between active aging and health-related quality of life (HRQOL) in middle-aged and older Korean using national data. The subjects were 14,117 adults aged ≥55 years. HRQOL was evaluated using the EuroQol–5 Dimension (EQ-5D) questionnaire, and active aging was defined based on the health factors, participation factors, and security factors. The average EQ-5D score was 91.04 ± 0.143. Hierarchical multiple regression analysis sequentially inputting the health, participation, and security factors showed that health factors had the strongest influence on HRQOL (F = 216.656, p < 0.001). In the final model, which included all variables, activity limit (B = −10.477, p < 0.001) and subjective health status (B = −7.282, p < 0.001) were closely related to the HRQOL. In addition, economic activity, income level, home ownership, private health insurance, and unmet healthcare needs were associated with HRQOL. The R2 of the model was 38.2%. To improve the HRQOL of middle-aged and older people, it is necessary to consider active aging factors. Furthermore, follow-up studies using various indicators reflecting active aging should be conducted. Full article
(This article belongs to the collection Health Care and Services for Elderly Population)
Open AccessArticle
The Most Widely Disseminated COVID-19-Related Scientific Publications in Online Media: A Bibliometric Analysis of the Top 100 Articles with the Highest Altmetric Attention Scores
Healthcare 2021, 9(2), 239; https://doi.org/10.3390/healthcare9020239 (registering DOI) - 23 Feb 2021
Viewed by 154
Abstract
The novel coronavirus disease 2019 (COVID-19) is a global pandemic. This study’s aim was to identify and characterize the top 100 COVID-19-related scientific publications, which had received the highest Altmetric Attention Scores (AASs). Hence, we searched Altmetric Explorer using search terms such as [...] Read more.
The novel coronavirus disease 2019 (COVID-19) is a global pandemic. This study’s aim was to identify and characterize the top 100 COVID-19-related scientific publications, which had received the highest Altmetric Attention Scores (AASs). Hence, we searched Altmetric Explorer using search terms such as “COVID” or “COVID-19” or “Coronavirus” or “SARS-CoV-2” or “nCoV” and then selected the top 100 articles with the highest AASs. For each article identified, we extracted the following information: the overall AAS, publishing journal, journal impact factor (IF), date of publication, language, country of origin, document type, main topic, and accessibility. The top 100 articles most frequently were published in journals with high (>10.0) IF (n = 67), were published between March and July 2020 (n = 67), were written in English (n = 100), originated in the United States (n = 45), were original articles (n = 59), dealt with treatment and clinical manifestations (n = 33), and had open access (n = 98). Our study provides important information pertaining to the dissemination of scientific knowledge about COVID-19 in online media. Full article
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Open AccessStudy Protocol
Development of a Logic Model for a Programme to Reduce the Magnetic Resonance Imaging Rate for Non-Specific Lower Back Pain in a Tertiary Care Centre
Healthcare 2021, 9(2), 238; https://doi.org/10.3390/healthcare9020238 (registering DOI) - 23 Feb 2021
Viewed by 293
Abstract
Tertiary care centres continue to experience over-utilisation of diagnostic imaging services for lower back pain cases that may not be required. Moreover, these services may require additional time and consequently delay access to services that offer conservative management, i.e., physiotherapy, and hence, increase [...] Read more.
Tertiary care centres continue to experience over-utilisation of diagnostic imaging services for lower back pain cases that may not be required. Moreover, these services may require additional time and consequently delay access to services that offer conservative management, i.e., physiotherapy, and hence, increase the direct and indirect costs with no added quality of care. A logic model was developed based on qualitative and quantitative studies that explains the plan and process evaluation strategies to reduce imaging for lower back pain in tertiary hospitals. Logic models are useful tools for defining programme components. The delivery of the components is ensured by well-defined process evaluations that identify any needed modifications. The proposed logic model provides a road map for spine clinics in tertiary care hospitals to decrease the number of patient referrals for magnetic resonance imaging and waiting times for consultations and services and promote early access to physiotherapy services. Full article
(This article belongs to the Section Health Policy)
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Open AccessArticle
Age Estimation Using the Cameriere Methods of Open Apices: A Meta-Analysis
Healthcare 2021, 9(2), 237; https://doi.org/10.3390/healthcare9020237 - 23 Feb 2021
Viewed by 109
Abstract
Purpose: To evaluate the actual variability of the mean difference between chronological and dental age using the Cameriere method of open apices and to test its accuracy in variable age groups. Method: We selected studies that contained data about the mean, standard deviation, [...] Read more.
Purpose: To evaluate the actual variability of the mean difference between chronological and dental age using the Cameriere method of open apices and to test its accuracy in variable age groups. Method: We selected studies that contained data about the mean, standard deviation, and number of cases for chronological age, dental age and gender. We used a random-effects model. Statistical significance was estimated, at a p < 0.05, using prediction intervals. For the analysis of publication bias we used the funnel plot and Egger’s regression test for plot asymmetry. I2 was used to test the presence of heterogeneity between studies. The Z test was used to test for statistical differences between subgroups, with p < 0.05 being considered statistically significant. We also used 95% for confidence intervals and prediction intervals. Results: In boys, the average difference between chronological and dental age was 0.44 (0.26–0.63) years, while in girls the average difference between chronological and dental age was 0.34 (0.19–0.49) years. In the 6–7 years age group and in the 14–15 years age group, there was a statistically significant difference between dental and chronological age. Our study shows that the Cameriere method is useful for estimating the chronological age, with errors of less than one year. Conclusions: The Cameriere method of evaluating dental age using open apices is sufficiently accurate for forensic practice, at least in the 7–14 age-interval. Full article
(This article belongs to the Special Issue New Trends in Forensic and Legal Medicine)
Open AccessArticle
Prolonged Running Using Bionic Footwear Influences Lower Limb Biomechanics
Healthcare 2021, 9(2), 236; https://doi.org/10.3390/healthcare9020236 - 23 Feb 2021
Viewed by 130
Abstract
The running biomechanics of unstable shoes have been well investigated, however, little is known about how traditional neutral shoes in combination with unstable design elements and scientifically (bionic) designed shoes influence prolonged running biomechanics. The purpose of this study was to investigate biomechanical [...] Read more.
The running biomechanics of unstable shoes have been well investigated, however, little is known about how traditional neutral shoes in combination with unstable design elements and scientifically (bionic) designed shoes influence prolonged running biomechanics. The purpose of this study was to investigate biomechanical changes for a typical 5 km run and how footwear technology may affect outcomes. Sixteen healthy male recreational heel strike runners participated in this study, and completed two prolonged running sessions (neutral shoe session and bionic shoe session), with 7 to 10 days interval between sessions. A two-way repeated-measures analysis of variance (ANOVA, shoe × time) was conducted to determine any differences in joint biomechanics. Main effects for shoe type were observed at the ankle, knee and hip joints during the stance phase. In particular, decreased range of motion (ROM) was observed using the bionic shoes for all three joints, and the joint moments also had significant changes except for the frontal plane of the hip. Main effects for time were also observed at the ankle, knee and hip joints. The ROM of the sagittal plane in the knee and hip decreased post-5 km running. The reduction of ankle dorsiflexion, hip flexion, hip adduction and hip internal rotation angles were observed post-5 km running, as well as the increase of ankle eversion and external rotation, knee adduction and internal rotation angles. The kinetics also exhibited significant differences between pre-5 km running and post-5 km running. The interaction effects only existed in the ROM of the hip sagittal plane, hip adduction angle and hip internal rotation angle. The results suggested that bionic shoes could be beneficial for strengthening muscle control, enhancing postural stability and proprioceptive ability. Footwear personalization could be a solution that benefits runners, reduces injury risk and improves running performance. Full article
(This article belongs to the Special Issue Comprehensive Clinical Physiotherapy and Rehabilitation)
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Open AccessCommentary
Perspectives of Registered Dietitian Nutritionists on Adoption of Telehealth for Nutrition Care during the COVID-19 Pandemic
Healthcare 2021, 9(2), 235; https://doi.org/10.3390/healthcare9020235 - 23 Feb 2021
Viewed by 124
Abstract
Widespread transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in a global coronavirus disease 2019 (COVID-19) pandemic that is straining medical resources worldwide. In the United States (US), hospitals and clinics are challenged to accommodate surging patient populations [...] Read more.
Widespread transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in a global coronavirus disease 2019 (COVID-19) pandemic that is straining medical resources worldwide. In the United States (US), hospitals and clinics are challenged to accommodate surging patient populations and care needs while preventing further infection spread. Under such conditions, meeting with patients via telehealth technology is a practical way to help maintain meaningful contact while mitigating SARS-CoV-2 transmission. The application of telehealth to nutrition care can, in turn, contribute to better outcomes and lower burdens on healthcare resources. To identify trends in telehealth nutrition care before and during the pandemic, we emailed a 20-question, qualitative structured survey to approximately 200 registered dietitian nutritionists (RDNs) from hospitals and clinics that have participated in the Malnutrition Quality Improvement Initiative (MQii). RDN respondents reported increased use of telehealth-based care for nutritionally at-risk patients during the pandemic. They suggested that use of such telehealth nutrition programs supported positive patient outcomes, and some of their sites planned to continue the telehealth-based nutrition visits in post-pandemic care. Nutrition care by telehealth technology has the potential to improve care provided by practicing RDNs, such as by reducing no-show rates and increasing retention as well as improving health outcomes for patients. Therefore, we call on healthcare professionals and legislative leaders to implement policy and funding changes that will support improved access to nutrition care via telehealth. Full article
Open AccessArticle
A Multi-Country Analysis of Prevalence of Anxiety-Induced Sleep Disturbance and Its Associated Factors among In-School Adolescents in Sub-Saharan Africa Using the Global School-Based Health Survey
Healthcare 2021, 9(2), 234; https://doi.org/10.3390/healthcare9020234 - 22 Feb 2021
Viewed by 198
Abstract
(1) Background: Among the health problems affecting adolescents, anxiety disorders are considered among the health-compromising or debilitating outcomes that affect adolescents’ mental health. We examined the prevalence and factors associated with anxiety-induced sleep disturbance among in-school adolescents in sub-Saharan Africa (SSA). (2) Methods: [...] Read more.
(1) Background: Among the health problems affecting adolescents, anxiety disorders are considered among the health-compromising or debilitating outcomes that affect adolescents’ mental health. We examined the prevalence and factors associated with anxiety-induced sleep disturbance among in-school adolescents in sub-Saharan Africa (SSA). (2) Methods: This study involved a cross-sectional analysis of data from the Global School-Based Health Survey (GSHS). We analyzed data on 25,454 in-school adolescents from eleven (11) countries in SSA with a dataset between 2010 and 2017. Two multivariable logistic regression models were built to determine the strength of the association between anxiety-induced sleep disturbance and the explanatory variables. The results of the regression analyses were presented using adjusted odds ratios (aOR) and their respective 95% confidence intervals (CIs). Statistical significance was set at p-value < 0.05. (3) Results: The overall prevalence of anxiety-induced sleep disturbance among in-school adolescents in SSA was 12.2%. The prevalence ranged from 5.1% in Tanzania to 20.5% in Benin. The odds of anxiety-induced sleep disturbance was higher among adolescents aged 15 and above [aOR = 1.26, 95% CI = 1.15, 1.39] compared to those aged 14 or younger. Additionally, the odds of anxiety-induced sleep disturbance was higher among adolescents who were bullied [aOR = 1.54, 95% CI = 1.42, 1.67], those that felt lonely [aOR = 3.85, 95% CI = 3.52, 4.22], those who had suicidal ideations [aOR = 1.70, 95% CI = 1.52, 1.90], those who had suicidal plan [aOR = 1.26, 95% CI = 1.13, 1.41], those who have had suicidal attempt [aOR = 1.21, 95% CI = 1.08, 1.35], those who used marijuana [aOR = 1.27, 95% CI = 1.06, 1.52], and those who were truant at school [aOR = 1.33, 95% CI = 1.22, 1.46]. However, male adolescents had lower odds of anxiety-induced sleep disturbance [aOR = 0.88, 95% CI = 0.81, 0.95], compared to their female counterparts. (4) Conclusions: We found a relatively high prevalence of anxiety-induced sleep disturbance among in-school adolescents in SSA. Higher age, being female, being bullied, loneliness, having suicidal ideations/plan/attempt, use of marijuana and truancy were risk factors for anxiety-induced sleep disturbance. The findings, therefore, highlight the urgency for policies (e.g., early school-based screening) and interventions (e.g., Rational Emotive Behavioral Education (REBE), Social Emotional Learning (SEL) that target in-school adolescents within the most at-risk populations of anxiety-induced sleep disturbance in SSA. Full article
(This article belongs to the Section School Health)
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Open AccessReview
Feminist Political Economy of Health: Current Perspectives and Future Directions
Healthcare 2021, 9(2), 233; https://doi.org/10.3390/healthcare9020233 - 22 Feb 2021
Viewed by 267
Abstract
Feminist political economy of health is a term that has emerged as a result of research that has combined and connected a feminist political economy lens with a focus on health disparities of women. This paper provides an overview of the literature from [...] Read more.
Feminist political economy of health is a term that has emerged as a result of research that has combined and connected a feminist political economy lens with a focus on health disparities of women. This paper provides an overview of the literature from the work of feminist medical sociologists and feminist health scholars that have shaped the concept of feminist political economy of health. The analysis indicates that while women have experienced health inequities inside the healthcare system, there are also significant health disparities that are experienced outside the healthcare system due to women’s social, economic, political, and cultural conditions. Given that there are dual crises with respect to the COVID-19 pandemic as well as social movements pushing for change, further work that uses intersectional approaches is advocated. Full article
(This article belongs to the Section Health Policy)
Open AccessArticle
Written Informed Consent—Translating into Plain Language. A Pilot Study
Healthcare 2021, 9(2), 232; https://doi.org/10.3390/healthcare9020232 - 20 Feb 2021
Viewed by 149
Abstract
Background: Informed consent is important in clinical practice, as a person’s written consent is required prior to many medical interventions. Many informed consent forms fail to communicate simply and clearly. The aim of our study was to create an easy-to-understand form. Methods: Our [...] Read more.
Background: Informed consent is important in clinical practice, as a person’s written consent is required prior to many medical interventions. Many informed consent forms fail to communicate simply and clearly. The aim of our study was to create an easy-to-understand form. Methods: Our assessment of a Polish-language plastic surgery informed consent form used the Polish-language comprehension analysis program (jasnopis.pl, SWPS University) to assess the readability of texts written for people of various education levels; and this enabled us to modify the form by shortening sentences and simplifying words. The form was re-assessed with the same software and subsequently given to 160 adult volunteers to assess the revised form’s degree of difficulty or readability. Results: The first software analysis found the language was suitable for people with a university degree or higher education, and after revision and re-assessment became suitable for persons with 4–6 years of primary school education and above. Most study participants also assessed the form as completely comprehensible. Conclusions: There are significant benefits possible for patients and practitioners by improving the comprehensibility of written informed consent forms. Full article
(This article belongs to the Section Healthcare Quality and Patient Safety)
Open AccessReview
Echocardiographic Screening of Anomalous Origin of Coronary in Athletes with a Focus on High Take-Off
Healthcare 2021, 9(2), 231; https://doi.org/10.3390/healthcare9020231 (registering DOI) - 20 Feb 2021
Viewed by 141
Abstract
Anomalous aortic origin of coronary arteries (AAOCA) represents a rare congenital heart disease. However, this disease is the second most common cause of sudden cardiac death in apparently healthy athletes. The aim of this systematic review is to analyze the feasibility and the [...] Read more.
Anomalous aortic origin of coronary arteries (AAOCA) represents a rare congenital heart disease. However, this disease is the second most common cause of sudden cardiac death in apparently healthy athletes. The aim of this systematic review is to analyze the feasibility and the detection rate of AAOCA by echocardiography in children and adults. A literature search was performed within the National Library of Medicine using the following keywords: coronary artery origin anomalies and echocardiography; then, the search was redefined by adding the keywords: athletes, children, and high take-off. Nine echocardiographic studies investigating AAOCA and a total of 33,592 children and adults (age range: 12–49 years) were included in this review. Of these, 6599 were athletes (12–49 years). All studies demonstrated a high feasibility and accuracy of echocardiography for the evaluation of coronary arteries origin as well as their proximal tracts. However, some limitations exist: the incidence of AAOCA varied from 0.09% to 0.39% (up to 0.76%) and was lower than described in computed tomography series (0.3–1.8%). Furthermore, echocardiographic views for the evaluation of AAOCA and the definition of “minor” defects (e.g., high take-off coronary arteries) have not been standardized. An echocardiographic protocol to diagnose the high take-off of coronary arteries is proposed in this article. In conclusion, the screening of AAOCA by echocardiography is feasible and accurate when appropriate examinations are performed; however, specific acoustic windows and definitions of defects other than AAOCA need to be standardized to improve sensitivity and specificity. Full article
(This article belongs to the Section Community Care)
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Open AccessArticle
The Pandemic within a Pandemic: Testing a Sequential Mediation Model to Better Understand Racial/Ethnic Disparities in COVID-19 Preventive Behavior
Healthcare 2021, 9(2), 230; https://doi.org/10.3390/healthcare9020230 (registering DOI) - 20 Feb 2021
Viewed by 156
Abstract
Recent Centers for Disease Control and Prevention (CDC) data reveal that COVID-19 hospitalization and mortality rates are higher for certain racial/ethnic groups. Labeled as the “pandemic within a pandemic”, African Americans and Hispanics are bearing more of the brunt of the disease compared [...] Read more.
Recent Centers for Disease Control and Prevention (CDC) data reveal that COVID-19 hospitalization and mortality rates are higher for certain racial/ethnic groups. Labeled as the “pandemic within a pandemic”, African Americans and Hispanics are bearing more of the brunt of the disease compared to Caucasians. Testing a new sequential mediation model on a sample of 483 US African American, Caucasian, and Hispanic adults, the present study investigates the role of fear of COVID-19, information receptivity, perceived knowledge, and self-efficacy to explain disparities in preventive behaviors. Study contributions include the specification of a new predictive model that improves upon the long-used Health Belief Model (HBM). The Sequential Mediation Model appears to have greater explanatory capacity than the HBM. Study results also provide important insights into racial/ethnic differences in health-seeking behavior related to the coronavirus. Findings show that African Americans reported higher levels of preventive behaviors and self-efficacy than Caucasians. It is possible that SES, rather than race per se, is more important in explaining differences in COVID-19 preventive behaviors. Certain “cues to action” (precipitating factors) also help explain this somewhat surprising result. Additionally, significant differences were found across the three racial/ethnic groups for all the new model’s variables except perceived knowledge. The new model was supported across all three racial/ethnic groups with notable differences across each group. Given the severity of implications surrounding the COVID-19 pandemic (physical, mental, and economic), it is critical that an improved understanding of what drives individual health-seeking behavior be achieved. Study limitations and future research suggestions are discussed. Full article
(This article belongs to the Special Issue Health Disparities and Stigma in the Era of COVID-19)
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Open AccessArticle
Quality of Information for Skin Cancer Prevention: A Quantitative Evaluation of Internet Offerings
Healthcare 2021, 9(2), 229; https://doi.org/10.3390/healthcare9020229 - 19 Feb 2021
Viewed by 208
Abstract
(1) Background: Different sources of information are used by the population regarding skin cancer prevention. The pertinent quality of information that can be retrieved via an internet search engine needs assessment; (2) Methods: Four topical searches in common language were entered into Google™. [...] Read more.
(1) Background: Different sources of information are used by the population regarding skin cancer prevention. The pertinent quality of information that can be retrieved via an internet search engine needs assessment; (2) Methods: Four topical searches in common language were entered into Google™. The first 200 “hits” were stored for further use. Eligible websites were evaluated using content-based criteria based on the current German medical guideline “Skin cancer prevention” and employing generic (DISCERN, HONcode) quality criteria. (3) Results: Overlap between the four search results was between 0 and 7 of 200. The completeness of relevant content was scored with a median of 10 points (first quartile (Q1):6; Q3:14) and thus, it was much lower than the theoretical maximum of 43 points. Global quality, with a maximum of 10 points, was 3 in median (Q1:2; Q3:4). Quality and completeness, respectively, were somewhat higher in the higher ranks of search results. The generic quality was moderate. (4) Conclusions: A direct comparison with other sources of information (print, audio-visual, presentation, or personal counselling) is not possible, but important deficits concerning the quality and scope of relevant information on the internet are demonstrated. Full article
(This article belongs to the Section Health Assessments)
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Open AccessArticle
Association between Leisure Screen Time and Junk Food Intake in a Nationwide Representative Sample of Spanish Children (1–14 Years): A Cross-Sectional Study
Healthcare 2021, 9(2), 228; https://doi.org/10.3390/healthcare9020228 - 18 Feb 2021
Viewed by 323
Abstract
Evidence on the association between new patterns of leisure screen time and junk food consumption in Spanish children at the national level is scarce. The aim of this study is to assess the relation between daily leisure screen time and the frequency of [...] Read more.
Evidence on the association between new patterns of leisure screen time and junk food consumption in Spanish children at the national level is scarce. The aim of this study is to assess the relation between daily leisure screen time and the frequency of sweet, soft drink, fast food, and snack intake in a representative sample of Spanish children and adolescents aged from 1 to 14 years. We conducted a cross-sectional study using a representative sample of the Spanish population under 15 years recruited for the 2017 Spanish National Health Survey (n = 5480). We dichotomized sweet, soft drink, fast food, and snack intake (high/low) and categorized daily leisure screen time (0–59, 60–119, 120–179, and ≥180 min). We calculated crude prevalence ratios and adjusted prevalence ratios, and their 95% confidence intervals (95% CI), of high frequency of sweet, soft drink, fast food, and snack intake. Children spending at least one hour of daily leisure screen time had higher prevalence of high frequency of sweet and snack intake than children being exposed less than one hour. For soft drinks and fast food, prevalence of high frequency intake was significantly higher from two and three hours of exposure, respectively. Longer periods of screen exposure in Spanish children during their leisure time may be associated with poorer dietary behaviors. The negative effects of excessive screen time in pediatrics population should be further studied. Full article
(This article belongs to the Special Issue Current Health Challenges for Child and Adolescent)
Open AccessArticle
ECG Enhancement and R-Peak Detection Based on Window Variability
Healthcare 2021, 9(2), 227; https://doi.org/10.3390/healthcare9020227 - 18 Feb 2021
Viewed by 176
Abstract
In ECG applications, the correct recognition of R-peaks is extremely important for detecting abnormalities, such as arrhythmia and ventricular hypertrophy. In this work, a novel ECG enhancement and R-peak detection method based on window variability is presented, and abbreviated as SQRS. Firstly, the [...] Read more.
In ECG applications, the correct recognition of R-peaks is extremely important for detecting abnormalities, such as arrhythmia and ventricular hypertrophy. In this work, a novel ECG enhancement and R-peak detection method based on window variability is presented, and abbreviated as SQRS. Firstly, the ECG signal corrupted by various high or low-frequency noises is denoised by moving-average filtering. Secondly, the window variance transform technique is used to enhance the QRS complex and suppress the other components in the ECG, such as P/T waves and noise. Finally, the signal, converted by window variance transform, is applied to generate the R-peaks candidates, and the decision rules, including amplitude and kurtosis adaptive thresholds, are applied to determine the R-peaks. A special squared window variance transform (SWVT) is proposed to measure the signal variability in a certain time window, and this technique reduces false detection rate caused by the various types of interference presented in ECG signals. For the MIT-BIH arrhythmia database, the sensitivity of R-peak detection can reach 99.6% using the proposed method. Full article
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Open AccessArticle
Impact of Sensitization of Family Caregivers upon Treatment Compliance among Geriatric Patients Suffering from Elder Abuse and Neglect
Healthcare 2021, 9(2), 226; https://doi.org/10.3390/healthcare9020226 - 18 Feb 2021
Viewed by 202
Abstract
Geriatric patients in various outpatient department (OPDs) have been found to agonize from elder abuse and neglect (EAN). Such suffering imposes depressive states within individuals, which in turn affects treatment compliance. The objective of this study was to evaluate the impact of sensitization [...] Read more.
Geriatric patients in various outpatient department (OPDs) have been found to agonize from elder abuse and neglect (EAN). Such suffering imposes depressive states within individuals, which in turn affects treatment compliance. The objective of this study was to evaluate the impact of sensitization (psychotherapeutic) of family caregivers (FCGs) upon two denture treatment parameters (maintenance and treatment satisfaction) among EAN patients and compare the differences in outcome with non-abused patients. A survey of completely edentulous subjects (n = 860, aged 41–80 years) provided a sampling frame of 332 EAN patients from which 150 patients (including FCGs) fulfilling the study criteria were distributed (simple random, convenient) into two groups (Group A—control, Group B—test). FCG sensitization for subjects in Group B was performed by a clinical psychologist in 2–4 short (30 min) sessions. Demographic characteristics (frequency) were measured using a self-reported questionnaire, denture maintenance was measured using a denture hygiene index (scores), and treatment satisfaction was analyzed on a 10-point visual analog scale. Relevant data were calculated for means and absolute/relative frequencies. Any difference between two groups was estimated using an unpaired t-test while the level of relationship was determined by Karl Pearson’s test at a p-value of < 0.05. The results showed highest frequency (38.6%) for neglect, with elder neglect (EN) being most common (38.14% alone and 14% in combination). EN was found more if the FCG was a son (52%), in the age group (21–30 years), and with low education and low income (75%). Patients whose FCGs were counselled (Group B) demonstrated low denture plaque scores (mean = 1.38 ± 0.618), while demonstrating comparatively higher scores in six different parameters of treatment satisfaction. Differences between the two groups for both parameters were also found to be statistically significant. Psychotherapeutic counselling in the form of FCG sensitization brings better results of denture maintenance and treatment satisfaction. Full article
(This article belongs to the Section Healthcare Quality and Patient Safety)
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Open AccessArticle
Engaging Mothers on the Growth of School-Age Children in a Rural South African Health and Demographic Site: A Qualitative Insight
Healthcare 2021, 9(2), 225; https://doi.org/10.3390/healthcare9020225 - 18 Feb 2021
Viewed by 256
Abstract
A qualitative study was conducted to explore mothers’ insights on the growth of school-age children in a rural Health and Demographic site of Limpopo Province, in South Africa. The participants were selected using purposive sampling. Data were collected from seven focus group discussions, [...] Read more.
A qualitative study was conducted to explore mothers’ insights on the growth of school-age children in a rural Health and Demographic site of Limpopo Province, in South Africa. The participants were selected using purposive sampling. Data were collected from seven focus group discussions, which were audio-taped and transcribed verbatim. NVivo10 was used to analyse interview transcripts, following qualitative thematic analysis. Fifty-four mothers aged between 27 and 52 years were interviewed. Unfavourable sociodemographic status with poor living conditions of mothers were observed, particularly in terms of unemployment, minimal tertiary education, and rural locality. The perceptions of mothers on child growth linked growth of their children to various factors such as poverty and socioeconomic status, genetic/family heredity, and household environment. Mothers further related child growth to purchasing power and decisions regarding types of food, food unavailability, affordability issues, feeding beliefs and practices; and child food preferences, school feeding schemes, and maternal and societal cultural beliefs and practices. Despite their concerns, mothers perceived that their children were growing well, but differently. It is worth noting that the views of mothers on child growth were up to their aptitude level and might have been restricted due to their level of education and rural locality. Hence, there is a need for novel information, education, and communication strategies to effectively reach mothers, especially in rural areas, regarding the importance of identifying children with growth failure and its prevention. Mothers should be able to identify when a child is affected by growth failure and to seek healthcare, in order to prevent children from progressing to severe forms. This study informs on the timing of nutritional interventions for children and context-specific health promotion and health education programs to improve the knowledge of mothers on child growth. Full article
Open AccessArticle
Comparison of Physical, Occupational, and Sociocognitive Characteristics of Corporate and Private Taxi Drivers in Korea
Healthcare 2021, 9(2), 224; https://doi.org/10.3390/healthcare9020224 - 17 Feb 2021
Viewed by 206
Abstract
Taxis are a form of public transport which is very closely related to the safety of the public. Although private and corporate taxis have quite different characteristics, there have only been a few studies comparing the characteristics of corporate and private taxis. Moreover, [...] Read more.
Taxis are a form of public transport which is very closely related to the safety of the public. Although private and corporate taxis have quite different characteristics, there have only been a few studies comparing the characteristics of corporate and private taxis. Moreover, among various characteristics, research was conducted mainly focusing on occupational characteristics. This study was undertaken to compare various physical, occupational, and sociocognitive characteristics of corporate and private taxi drivers. A descriptive cross-sectional study was conducted from 22 August to 11 September 2018. The subjects of this study were 960 corporate and private taxi drivers over 30 years old in Seoul to compare the means and association between private and corporate taxi drivers’ characteristics. In terms of the physical characteristics, corporate taxi drivers’ general physical health status was worse. In terms of the occupational characteristics, corporate taxi drivers had a high working intensity, and the incidence rate of traffic accidents and near misses was also high. This comparison of the characteristics of corporate and private taxis is expected to serve as evidence for developing tailored policies and programs to improve the health of corporate and private taxi drivers. Full article
Open AccessArticle
The Uncertainty of COVID-19 Inducing Social Fear and Pressure on the Continuity of Rural, Community-Based Medical Education: A Thematic Analysis
Healthcare 2021, 9(2), 223; https://doi.org/10.3390/healthcare9020223 - 17 Feb 2021
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Abstract
Rural community-based medical education (CBME) enriches undergraduate and postgraduate students’ learning but has been impacted by the coronavirus disease 2019 (COVID-19) pandemic. We identified the challenges faced by stakeholders as well as the relevant solutions to provide recommendations for sustainable CBME in community [...] Read more.
Rural community-based medical education (CBME) enriches undergraduate and postgraduate students’ learning but has been impacted by the coronavirus disease 2019 (COVID-19) pandemic. We identified the challenges faced by stakeholders as well as the relevant solutions to provide recommendations for sustainable CBME in community hospitals during the COVID-19 pandemic. A total of 31 pages of field and reflection notes were collated through direct observation and used for analysis. Five physicians, eight nurses, one clerk, fourteen medical trainees, and three rural citizens were interviewed between 1 April and 30 September 2020. The interviews were recorded and their contents were transcribed verbatim and analyzed using thematic analysis. Three themes emerged: uncertainty surrounding COVID-19, an overwhelming sense of social fear and pressure within and outside communities, and motivation and determination to continue providing CBME. Rural CBME was impacted by not only the fear of infection but also social fear and pressure within and outside communities. Constant assessment of the risks associated with the pandemic and the implications for CMBE is essential to ensure the sustainability of CBME in rural settings, not only for medical educators and students but also stakeholders who administrate rural CBME. Full article
(This article belongs to the Section Community Care)
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Open AccessArticle
Assessing the Psychological Impact of COVID-19 among College Students: An Evidence of 15 Countries
Healthcare 2021, 9(2), 222; https://doi.org/10.3390/healthcare9020222 - 17 Feb 2021
Viewed by 264
Abstract
Mental health issues among college students is a leading public health concern, which seems to have been exacerbating during the COVID-19 pandemic. While previous estimates related to psychological burden among college students are available, quantitative synthesis of available data still needs to be [...] Read more.
Mental health issues among college students is a leading public health concern, which seems to have been exacerbating during the COVID-19 pandemic. While previous estimates related to psychological burden among college students are available, quantitative synthesis of available data still needs to be performed. Therefore, this meta-analysis endeavors to present collective evidence discussing the psychological impact of COVID-19 among college students. Bibliographical library databases, including Embase, Medline, CINAHL, Scopus, and PsycINFO, were systematically searched for relevant studies. Titles, abstracts, and full articles were screened, and two reviewers extracted data. Heterogeneity was assessed by I2 statistic. The random-effects model was utilized to obtain the pooled estimates of psychological indicators among college students. Location, gender, level of severity, and quality scores were used as moderator variables for subgroup analyses. Funnel plot and Egger linear regression test was used to assess publication bias. Twenty-seven studies constituting 90,879 college students met the inclusion criteria. The results indicated 39.4% anxiety (95% CI: 28.6, 51.3; I2 = 99.8%; p-value < 0.0001) and 31.2% depression (95% CI: 19.7, 45.6; I2= 99.8%, p < 0.0001) among college students. The pooled prevalence of stress (26.0%), post-traumatic stress disorder (29.8%), and impaired sleep quality (50.5%) were also reported. College students bear a disproportionate burden of mental health problems worldwide, with females having higher anxiety and depression levels than males. This study‘’s findings underscore the need to develop appropriate public health interventions to address college students’ emotional and psychosocial needs. The policies should be reflective of demographic and socioeconomic differentials. Full article
(This article belongs to the Special Issue COVID-19: Impact on Public Health and Healthcare)
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Open AccessArticle
Factors Associated with an Unhealthy Lifestyle among Adults in Riyadh City, Saudi Arabia
Healthcare 2021, 9(2), 221; https://doi.org/10.3390/healthcare9020221 - 17 Feb 2021
Viewed by 228
Abstract
Background: Unhealthy lifestyles are a global concern. This study measured the prevalence and factors associated with an unhealthy lifestyle in Riyadh city, Saudi Arabia. Methods: An interview-based, cross-sectional study was conducted with 968 males and 2029 females, aged 30–75 years, covering 18 primary [...] Read more.
Background: Unhealthy lifestyles are a global concern. This study measured the prevalence and factors associated with an unhealthy lifestyle in Riyadh city, Saudi Arabia. Methods: An interview-based, cross-sectional study was conducted with 968 males and 2029 females, aged 30–75 years, covering 18 primary health care centers in Riyadh. Multivariate logistic regression analyses were conducted to identify the significant determinants associated with an unhealthy lifestyle. Results: Overall, men were 1.49 (1.28, 1.74) times at higher risk of an unhealthy lifestyle compared to women. Men reporting unhealthy lifestyle were 2.1 (1.3, 3.4) and 1.5 (1.0, 2.6) times more likely than men with healthy lifestyle to cite not enjoying physical activity, lack of social support, and not having enough information about a healthy diet [1.5 (1.0, 2.0)], whereas those ≥ 45 years age group were 30 times less likely to report unhealthy lifestyle [0.7 (0.5, 0.9)]. In contrast, in women aged ≥ 45 years [1.3 (1.1, 1.7)], lack of motivation [1.3 (1.1, 1.7)], feeling conscious while exercising [2.0 (1.4, 2.9)], not enjoying healthy food [1.6 (1.3, 2.1)], and no family support to prepare healthy food [1.4 (1.1, 1.8)] were significantly associated with an unhealthy lifestyle. Conclusions: In a Saudi sample, younger men and older women are at higher risk of an unhealthy lifestyle. In addition to self-motivation, combined strategies to promote physical activity and healthy eating are required to improve lifestyle. Full article
(This article belongs to the Section Environmental Factors and Global Health)
Open AccessArticle
Nationwide Lockdown, Population Density, and Financial Distress Brings Inadequacy to Manage COVID-19: Leading the Services Sector into the Trajectory of Global Depression
Healthcare 2021, 9(2), 220; https://doi.org/10.3390/healthcare9020220 - 17 Feb 2021
Viewed by 199
Abstract
The service industry provides distributive services, producer services, personal services, and social services. These services largely breakdowns due to restrictions on border movements, confined travel and transportation services, a decline in international tourists’ visitation, nationwide lockdowns, and maintaining social distancing in the population. [...] Read more.
The service industry provides distributive services, producer services, personal services, and social services. These services largely breakdowns due to restrictions on border movements, confined travel and transportation services, a decline in international tourists’ visitation, nationwide lockdowns, and maintaining social distancing in the population. Although these measures are highly needed to contain coronavirus, it decreases economic and financial activities in a country, which requires smart solutions to globally subsidize the services sector. The study used different COVID-19 measures, and its resulting impact on the services industry by using world aggregated data from 1975 through 2020. The study benefited from the Keynesian theory of aggregate demand that remains provided a solution to minimize economic shocks through stringent or liberalizing economic policies. The COVID-19 pandemic is more severe than the financial shocks of 2018 that affected almost all sectors of the globalized world, particularly the services sector, which has been severally affected by COVID-19; it is a high time to revisit economic policies to control pandemic recession. The study used quantiles regression and innovation accounting matrix to obtain ex-ante and ex-post analysis. The quantile regression estimates show that causes of death by communicable diseases, including COVID-19, mainly decline the share of services value added to the global GDP at different quantiles distribution. In contrast, word-of-mouth helps to prevent it from the transmission channel of coronavirus plague through information sharing among the general masses. The control of food prices and managing physical distancing reduces suspected coronavirus cases; however, it negatively affects the services sector’s value share. The smart lockdown and sound economic activities do not decrease coronavirus cases, while they support increasing the percentage of the services sector to the global GDP. The innovation accounting matrix suggested that smart lockdown, managing physical distancing, effective price control, and sound financial activities will help to reduce coronavirus cases that will further translate into increased services value-added for the next ten years. The social distancing will exert a more considerable variance error shock to the services industry, which indicates the viability of these measures to contained novel coronavirus over a time horizon. The study used the number of proxies to the COVID-19 measures on the service sector that can be continued with real-time variables to obtain more inferences. Full article
(This article belongs to the Special Issue Socio-Economic Burden of Disease: The COVID-19 Case)
Open AccessArticle
Self-Reported Assessment of Empathy and Its Variations in a Sample of Greek Social Workers
Healthcare 2021, 9(2), 219; https://doi.org/10.3390/healthcare9020219 - 17 Feb 2021
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Abstract
The aim of the study was twofold: (a) to examine the way in which professional social workers perceive and apply in their practice the concept of empathy; (b) to explore sociodemographic factors, education/special training and work characteristics associated with their empathic skills. This [...] Read more.
The aim of the study was twofold: (a) to examine the way in which professional social workers perceive and apply in their practice the concept of empathy; (b) to explore sociodemographic factors, education/special training and work characteristics associated with their empathic skills. This is a cross-sectional study with a purposive sample of 203 Greek social workers. For the assessment of empathy, the Empathy Scale for Social Workers (ESSW) was used. The sample consisted mainly of female social workers with a mean age of 43.8 years. More than 70% of them were practicing the profession for more than 10 years. Nearly one-third participated in psychotherapy courses, and only half of them have been certified. On average, they reported high levels of empathy. Initial univariate analyses showed that empathy scores were significantly higher for older social workers, married, the more experienced, those who referred to working experience with disabled people or people having problems with substance use and the professionals who had obtained a certification in psychotherapy. ‘Having a middle work experience of 10–19 years’ was a significant correlate in all scales and related negatively to empathy indicating a burnout effect. The implications for social work education and future training are discussed. Full article
(This article belongs to the Special Issue Burnout, Perceived Efficacy, Compassion Fatigue and Job Satisfaction)
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Open AccessArticle
Impact of Economic Accessibility on Realized Utilization of Home-Based Healthcare Services for the Older Adults in China
Healthcare 2021, 9(2), 218; https://doi.org/10.3390/healthcare9020218 - 17 Feb 2021
Viewed by 286
Abstract
Home-based healthcare service has gradually become the most important model to cope with aging in China. However, the contradiction between oversupply and insufficient demand of healthcare services is becoming increasingly serious. How to effectively improve the realized utilization of healthcare resources has become [...] Read more.
Home-based healthcare service has gradually become the most important model to cope with aging in China. However, the contradiction between oversupply and insufficient demand of healthcare services is becoming increasingly serious. How to effectively improve the realized utilization of healthcare resources has become a key issue in the development of healthcare services. Based on the social background of “getting old before getting rich”, this article explores the relationship between economic accessibility and realized utilization, and finds that the impact of economic accessibility on realized utilization is inverted U-shaped, not a linear positive effect. In addition, considering the moderating role of family support, it is found that family support can strengthen the inverted U-shaped effect of economic accessibility on realized utilization. Therefore, exerting the role of family and improving economic accessibility can effectively solve the dilemma of low utilization of healthcare services. Full article
(This article belongs to the collection Health Care and Services for Elderly Population)
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Open AccessCase Report
Malignant Post-Transplant Lymphoproliferative Disorder of Nasopharynx in Myelodysplastic Disorder
Healthcare 2021, 9(2), 217; https://doi.org/10.3390/healthcare9020217 - 17 Feb 2021
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Abstract
(1) Background: Post-transplant lymphoproliferative disorder (PTLD) is a hematological disease and occurs because of immunosuppression after organ transplantation. Only a few studies have reported PTLD in the nasopharynx. In most cases, PTLD developed after solid organ transplantation, and cases of PTLD after bone [...] Read more.
(1) Background: Post-transplant lymphoproliferative disorder (PTLD) is a hematological disease and occurs because of immunosuppression after organ transplantation. Only a few studies have reported PTLD in the nasopharynx. In most cases, PTLD developed after solid organ transplantation, and cases of PTLD after bone marrow transplantation, are uncommon. (2) Case presentation: We report the case of a 40-year-old woman with myelodysplastic disorder who underwent hematopoietic stem cell transplantation (HSCT). After 3 months, she developed low-grade fever, progressive nasal obstruction, and bloody rhinorrhea. Endoscopy revealed a mass completely occupying the nasopharynx. A polymorphic PTLD was diagnosed on the basis of histopathological examination results. Reduction in immunosuppression and low-dose radiotherapy were prescribed for treatment. After a 3-year follow-up, no recurrence of PTLD or myelodysplastic disorder was detected. (3) Conclusions: While nasopharyngeal PTLD is rare, a routine examination of the nasopharynx should be considered in the post-transplant follow-up of patients for early detection and treatment of PTLD. Full article
(This article belongs to the Special Issue Oral and Maxillofacial Health Care)
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Open AccessArticle
The Influence of Maturity Status on Resting Energy Expenditure, Body Composition and Blood Pressure in Physically Active Children
Healthcare 2021, 9(2), 216; https://doi.org/10.3390/healthcare9020216 - 16 Feb 2021
Viewed by 233
Abstract
Peak height velocity (PHV) is the period where the maximum rate of growth occurs. The moment the sports player reaches PHV can be estimated by monitoring the growth of body structures. The aim of this study was to assess changes in resting energy [...] Read more.
Peak height velocity (PHV) is the period where the maximum rate of growth occurs. The moment the sports player reaches PHV can be estimated by monitoring the growth of body structures. The aim of this study was to assess changes in resting energy expenditure (REE), body composition and blood pressure in young, male soccer players between the pre-PHV, circa-PHV and post-PHV periods. This transverse study was conducted among 184 children aged 9 to 17 and included measurements of the resting energy expenditure (REE) using indirect calorimetry, body composition (bioimpedance) and blood pressure (sphygmomanometer). In addition, births in each quartile were analyzed. Children in the pre-PHV group had significantly lower REE values compared to the other two groups (p < 0.0001). The differences in the value of the REE between the children in the circum and post groups were not statistically significant. Additionally, the fat-free mass was significantly lower in the pre-PHV period compared to the other two periods (p < 0.0001), and the same relationship concerned the z-score body mass index (BMI) and systolic blood pressure. Early-born players were overrepresented (p < 0.05). Full article
(This article belongs to the Section Nutrition and Public Health)
Open AccessCase Report
Three Cases of Severe ME/CFS in Adults
Healthcare 2021, 9(2), 215; https://doi.org/10.3390/healthcare9020215 - 16 Feb 2021
Viewed by 925
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, only partially understood multi-system disease whose onset and severity vary widely. Symptoms include overwhelming fatigue, post-exertional malaise, sleep disruptions, gastrointestinal issues, headaches, orthostatic intolerance, cognitive impairment, etc. ME/CFS is a physiological disease with an onset [...] Read more.
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, only partially understood multi-system disease whose onset and severity vary widely. Symptoms include overwhelming fatigue, post-exertional malaise, sleep disruptions, gastrointestinal issues, headaches, orthostatic intolerance, cognitive impairment, etc. ME/CFS is a physiological disease with an onset often triggered by a viral or bacterial infection, and sometimes by toxins. Some patients have a mild case and are able to function nearly on a par with healthy individuals, while others are moderately ill and still others are severely, or even, very severely ill. The cohort of moderately to very severely ill is often housebound or bedbound, has lost employment or career, and has engaged in a long, and often futile, search for treatment and relief. Here, we present three case studies, one each of a moderately ill, a severely ill, and a very severely ill person, to demonstrate the complexity of the disease, the suffering of these patients, and what health care providers can do to help. Full article
(This article belongs to the Special Issue ME/CFS – the Severely and Very Severely Affected)
Open AccessArticle
Biomechanical Analysis of Serious Neck Injuries Resulting from Judo
Healthcare 2021, 9(2), 214; https://doi.org/10.3390/healthcare9020214 - 16 Feb 2021
Viewed by 215
Abstract
To establish a basis for initial diagnosis and for proposing preventive measures for the serious neck injuries occasionally experienced by judo practitioners, the biomechanical mechanisms of these injuries were analyzed. Two male judo experts repeatedly threw an anthropomorphic test device (POLAR dummy) using [...] Read more.
To establish a basis for initial diagnosis and for proposing preventive measures for the serious neck injuries occasionally experienced by judo practitioners, the biomechanical mechanisms of these injuries were analyzed. Two male judo experts repeatedly threw an anthropomorphic test device (POLAR dummy) using three throwing techniques (Seoi-nage, Osoto-gari, and Ouchi-gari). The dummy’s kinematic data were captured using a high-speed digital camera, and the load and moment of the neck were measured with load cells. The neck injury criterion (Nij) and beam criterion were also calculated. In Seoi-nage, the anterior and parietal regions of the dummy’s head contacted the tatami (judo mat). Subsequently, most of the body weight was applied, with the neck experiencing the highest compression. However, in Osoto-gari and Ouchi-gari, the occipital region of the dummy’s head contacted the tatami. Significantly higher values of both Nij (median 0.68) and beam criterion (median 0.90) corresponding to a 34.7% to 37.1% risk of neck injury with an abbreviated injury scale score ≥2 were shown in Seoi-nage than in either Ouchi-gari or Osoto-gari. In judo, when thrown by the Seoi-nage technique, serious neck injuries can occur as a result of neck compression that occurs when the head contacts the ground. Full article
(This article belongs to the Special Issue Physical Rehabilitation & Prevention in Sports Injuries)
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Open AccessFeature PaperArticle
Investigation of Factors Affecting Early Quality of Life of Patients after Breast Cancer Surgery
Healthcare 2021, 9(2), 213; https://doi.org/10.3390/healthcare9020213 - 16 Feb 2021
Viewed by 182
Abstract
Objective: The purpose of this study was to investigate factors related to early quality of life (QOL) three months after surgery in breast cancer patients with axillary lymph node dissection. Methods: The subjects of this study were 195 consecutive patients who underwent axillary [...] Read more.
Objective: The purpose of this study was to investigate factors related to early quality of life (QOL) three months after surgery in breast cancer patients with axillary lymph node dissection. Methods: The subjects of this study were 195 consecutive patients who underwent axillary lymph node dissection for breast cancer. Age, body mass index, level of lymph node dissection, marriage, children, co-resident household members, neoadjuvant chemotherapy, postoperative chemotherapy, postoperative hormonal therapy, postoperative radiotherapy, upper limb function (disabilities of the arm, shoulder, and hand (DASH)), and QOL (European Organization for the Treatment and Research of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)) were evaluated. For each item of the EORTC QLQ-C30, compared with preoperative status and three months after surgery, those who improved or remained unchanged in the three months after surgery were classified as the maintenance and improved groups, and those with worsening status were classified as the worsened group. Results: Age, level of lymph node dissection, DASH, neoadjuvant chemotherapy, postoperative chemotherapy, and postoperative radiotherapy were significantly associated with QOL (p < 0.05). Conclusions: The early QOL of postoperative patients with breast cancer is affected by multiple factors, such as upper limb function and postoperative chemotherapy, and thus comprehensive intervention is required. Full article
Open AccessArticle
Chronotropic Incompetence Limits Aerobic Exercise Capacity in Patients Taking Beta-Blockers: Real-Life Observation of Consecutive Patients
Healthcare 2021, 9(2), 212; https://doi.org/10.3390/healthcare9020212 - 16 Feb 2021
Viewed by 240
Abstract
Background: Chronotropic incompetence in patients taking beta-blockers is associated with poor prognosis; however, its impact on exercise capacity (EC) remains unclear. Methods: We analyzed data from consecutive patients taking beta-blockers referred for cardiopulmonary exercise testing to assess EC. Chronotropic incompetence was defined as [...] Read more.
Background: Chronotropic incompetence in patients taking beta-blockers is associated with poor prognosis; however, its impact on exercise capacity (EC) remains unclear. Methods: We analyzed data from consecutive patients taking beta-blockers referred for cardiopulmonary exercise testing to assess EC. Chronotropic incompetence was defined as chronotropic index (CI) ≤ 62%. Results: Among 140 patients all taking beta-blockers (age 61 ± 9.7 years; 73% males), 64% with heart failure, chronotropic incompetence was present in 80.7%. EC assessed as peak oxygen uptake was lower in the group with chronotropic incompetence, 18.3 ± 5.7 vs. 24.0 ± 5.3 mL/kg/min, p < 0.001. EC correlated positively with CI (β = 0.14, p < 0.001) and male gender (β = 5.12, p < 0.001), and negatively with age (β = −0.17, p < 0.001) and presence of heart failure (β = −3.35, p < 0.001). Beta-blocker dose was not associated with EC. Partial correlation attributable to CI accounted for more than one-third of the variance in EC explained by the model (adjusted R2 = 59.8%). Conclusions: In patients taking beta-blockers, presence of chronotropic incompetence was associated with lower EC, regardless of the beta-blocker dose. CI accounted for more than one-third of EC variance explained by our model. Full article
(This article belongs to the Section Health Assessments)
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Open AccessArticle
Cost-Effectiveness Analysis of Type 2 Diabetes Mellitus (T2DM) Treatment in Patients with Complications of Kidney and Peripheral Vascular Diseases in Indonesia
Healthcare 2021, 9(2), 211; https://doi.org/10.3390/healthcare9020211 (registering DOI) - 16 Feb 2021
Viewed by 173
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic disease with high-cost treatment. This study aimed to analyze the cost-effectiveness of T2DM treatment in hospitalized patients with complications of kidney and peripheral vascular disease (PVD) in Indonesia by focusing on patients of Health Social [...] Read more.
Type 2 diabetes mellitus (T2DM) is a chronic disease with high-cost treatment. This study aimed to analyze the cost-effectiveness of T2DM treatment in hospitalized patients with complications of kidney and peripheral vascular disease (PVD) in Indonesia by focusing on patients of Health Social Security Agency (BPJS Kesehatan). An observational study was applied by collecting data retrospectively from patients’ medical record at the biggest public hospital in West Java Province, Indonesia. Two perspectives of payer and healthcare provider were applied to estimate the treatment cost. We considered following inclusion criteria: (i) Hospitalized T2DM patients without complication, with complications of kidney and PVD during 2014–2017; (ii) member of BPJS Kesehatan; (iii) >18 years old patients; and (iv) patients with complete medical record data. The results showed that the majority patients were female (56.72%), 45–64 years old (69.40%), and had a length of stay at 4–10 days (54.48%). The greatest contributions in the total treatment cost were found to be hospital room, medical services and medicines for the treatment of T2DM without complications, with complications of kidney and PVD, respectively. From the perspective of payer, the incremental cost-effectiveness ratios (ICERs) of T2DM treatment with complications of kidney and PVD would be IDR 215,723 and IDR 234,591 per 1 mg/dL blood glucose reduction, respectively. From the perspective of healthcare provider, the ICERs of T2DM treatment with complications of kidney and PVD would be IDR 166,289 and IDR 681,853 per 1 mg/dL blood glucose reduction in both perspectives (1 US$ = IDR 13,451). In a comparison with T2DM without complication, reducing 1 mg/dL blood glucose in T2DM treatment with complication of PVD would require higher cost than in T2DM treatment with complication of kidney from both perspectives. Full article
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