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Healthcare, Volume 9, Issue 3 (March 2021) – 124 articles

Cover Story (view full-size image): We can certainly place among the most marvelous and shocking technological developments of recent years those of collaborative robotics and, among them, those related to social robotics. The social robot represents an important technological issue to deeply explore both from a technological and clinical point of view. Research and assessment of the impact of technology in this area is very active and focused on (a) research in biomechatronics, neuroscience, and artificial intelligence; (b) bioethics; and (c) economics and politics. In light of this, the goal of the study was to produce a deep analysis, useful in the field of research, without neglecting other aspects. In particular, we highlighted a map point and a conceptual contextualization of these technologies, starting from the roots, and investigated which direction these devices are taking and what we can expect in the future. View this paper.
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Article
Dentists’ Working Conditions during the First COVID-19 Pandemic Lockdown: An Online Survey
Healthcare 2021, 9(3), 364; https://doi.org/10.3390/healthcare9030364 - 23 Mar 2021
Cited by 4 | Viewed by 830
Abstract
The aim of this study was to investigate the operating conditions of dentists in Central Europe during the first coronavirus disease 2019 (COVID-19) lockdown. A survey including 24 questions was emailed to dentists in Austria, Germany, Switzerland and South Tyrol (Italy). Questions regarding [...] Read more.
The aim of this study was to investigate the operating conditions of dentists in Central Europe during the first coronavirus disease 2019 (COVID-19) lockdown. A survey including 24 questions was emailed to dentists in Austria, Germany, Switzerland and South Tyrol (Italy). Questions regarding dentists’ field of work, working hours, treatments performed, personal protective equipment and protocols, and economic consequences were asked. 1731 participants were included. 30.4% of participants worked mainly in Austria, 60.8% in Germany, 6% in Switzerland and 2.1% in South Tyrol. A country-specific analysis for the situation of South Tyrol was not possible due to the low participation; 53.7% of German, 45.5% of Austrian, and 11.7% of Swiss respondents reduced their working hours; 42.8% of Austrian, 41.5% of Swiss, and 17.3% of German participants closed their offices temporarily; 52.2% of respondents provided emergency service including pain management, restorations/temporaries, and denture repairs. A lack of access to FFP2/FFP3 (filtering facepiece) respirators was indicated by 59.4% Austrian, 38.0% German, and 11.7% Swiss dentists (p < 0.001). FFP2/FFP3 respirators were, when available, most frequently used in Austria (86.9%), followed by Switzerland (61.2%) and Germany (56.7%) (p < 0.001). Financial consequences could not be conclusively quantified by 58.6% of the participants. Most respondents in all partaking countries made use of governmental support. A lack of blueprints/guidelines resulted in heterogeneous working conditions. In consideration of a potentially high risk of infection in the dental setting, non-emergency dental treatments were largely suspended in all participating countries. Full article
(This article belongs to the Collection Healthcare in Dentistry)
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Article
Diagnostic Delay in Patients with Primary Sjögren’s Syndrome: A Population-Based Cohort Study in Taiwan
Healthcare 2021, 9(3), 363; https://doi.org/10.3390/healthcare9030363 - 23 Mar 2021
Cited by 1 | Viewed by 572
Abstract
The diagnosis of primary Sjögren’s syndrome (pSS) can be challenging because the cardinal sicca syndromes may be subjective and subclinical. Diagnostic delay is common among patients with pSS. The aim of this study was to assess the time of lag between the onset [...] Read more.
The diagnosis of primary Sjögren’s syndrome (pSS) can be challenging because the cardinal sicca syndromes may be subjective and subclinical. Diagnostic delay is common among patients with pSS. The aim of this study was to assess the time of lag between the onset of sicca symptoms and a subsequent diagnosis of pSS. We used population-based data from Taiwan’s National Health Insurance (NHI) claims directory spanning up to 6 years between 2006 and 2011. All NHI-covered patients receiving a first-time approved catastrophic illness certificate (CIC) for pSS in 2011 were included; their sicca symptoms and utilization of medical resources were then traced retrospectively over five years to 2006. The time of lag was identified by observing the onset of sicca symptoms, a diagnosis of Sjögren’s syndrome, and the related claim for CIC. A total of 1970 pSS patients were included in this study. The median time of lag between the onset of sicca symptoms and pSS diagnosis was 115 weeks (interquartile range [IQR] 27–205), and between pSS diagnosis and approval of CIC, was 6 (IQR 2–37) weeks. During the time of lag between sicca symptoms, diagnosis, and approval of a CIC for pSS, the median numbers of outpatient visits were 3 (IQR 1–8) and 3 (IQR 2–7), respectively. These numbers were higher in female and elderly groups. Patients experience a significant diagnostic delay of pSS and in the initiation of regular follow-up care. Targeted guardian programs or public health interventions are required to inform symptom interpretation and reduce delays. Full article
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Article
Shedding Light on the Direct and Indirect Impact of the COVID-19 Pandemic on the Lebanese Radiographers or Radiologic Technologists: A Crisis within Crises
Healthcare 2021, 9(3), 362; https://doi.org/10.3390/healthcare9030362 - 23 Mar 2021
Cited by 2 | Viewed by 1066
Abstract
With the novel coronavirus disease 2019 (COVID-19) pandemic, the need for radiologic procedures is increasing for the effective diagnosis and follow-up of pulmonary diseases. There is an immense load on the radiographers’ shoulders to cope with all the challenges associated with the pandemic. [...] Read more.
With the novel coronavirus disease 2019 (COVID-19) pandemic, the need for radiologic procedures is increasing for the effective diagnosis and follow-up of pulmonary diseases. There is an immense load on the radiographers’ shoulders to cope with all the challenges associated with the pandemic. However, amidst this crisis, Lebanese radiographers are also suffering from a socioeconomic crisis and record hyperinflation that have posed additional challenges. A cross-sectional study was conducted among registered Lebanese radiographers to assess the general, workplace conditions, health and safety, mental/psychologic, financial, and skill/knowledge development impacts. Despite applying an adapted safety protocol, institutions are neither providing free RT-PCR testing to their staff nor showing adequate support for infected staff members, thus causing distress about contracting the virus from the workplace. Aggravated by the deteriorating economic situation that affected the radiographers financially, they additionally suffer from severe occupational physical and mental burnout. Regardless of that, they used their free time during the lockdown for skill/knowledge development and have performed many recreational activities. This cross-sectional study highlighted the different ways the pandemic has impacted the radiographers: physically, psychologically, and financially. It aimed to shed light on what these frontline heroes are passing through in the midst of all these unprecedented crises. Full article
(This article belongs to the Special Issue Socio-Economic Burden of Disease: The COVID-19 Case)
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Article
Relationship between Sleep Duration Trajectories and Self-Rated Depressive Symptoms in South Koreans with Physical Disabilities
Healthcare 2021, 9(3), 361; https://doi.org/10.3390/healthcare9030361 - 23 Mar 2021
Viewed by 535
Abstract
Physically disabled persons can have sleep problems, which affects their mental health more than those in non-disabled people. However, there are few studies on the relationship between sleep duration and mental health targeting physically disabled people in South Korea, and existing studies on [...] Read more.
Physically disabled persons can have sleep problems, which affects their mental health more than those in non-disabled people. However, there are few studies on the relationship between sleep duration and mental health targeting physically disabled people in South Korea, and existing studies on the disabled have mostly used data collected from convenience rather than nationally representative samples, limiting the generalization of the results. This study used data from the second wave of the Panel Survey of Employment for the Disabled (PSED, 2016–2018, 1st–3rd year). Participants included 1851 physically disabled individuals. The Chi-square test and generalized estimating equation (GEE) were used and the Akaike information criterion (AIC) value and the AIC log Bayes factor approximation were used to select sleep trajectories. This is the first study to elucidate multiple sleep trajectories in physically disabled people in Korea, and the relationship between sleep duration trajectories and self-rated depressive symptoms. People with physical disabilities who sleep more than 9 h have the highest risk of depression and need more intensive management as a priority intervention. Full article
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Article
Blood Pressure Awareness and Knowledge of Cardio-Cerebrovascular Diseases in South Korean Women with Hypertension
Healthcare 2021, 9(3), 360; https://doi.org/10.3390/healthcare9030360 - 23 Mar 2021
Viewed by 582
Abstract
(1) Background: It is essential to increase the awareness of cardiovascular diseases’ symptoms and reduce treatment delays among women with hypertension (HTN). This study aimed to assess the knowledge of cardio-cerebrovascular diseases’ warning signs (KCVDs), according to awareness of their blood pressure levels [...] Read more.
(1) Background: It is essential to increase the awareness of cardiovascular diseases’ symptoms and reduce treatment delays among women with hypertension (HTN). This study aimed to assess the knowledge of cardio-cerebrovascular diseases’ warning signs (KCVDs), according to awareness of their blood pressure levels (AoBP), and identify the factors associated with KCVDs and AoBP in women with HTN. (2) Methods: This study used the data from the Korea Community Health Survey of 2018. A total of 29,832 women with HTN were included in the final analysis. Data on sociodemographic characteristics, KCVDs, and AoBP were identified. A negative binomial regression was used to identify factors associated with KCVDs. (3) Results: Of the participants, 42.9% were not aware of their blood pressure level, and 9.1% did not have any knowledge of KCVD symptoms. Factors associated with KCVDs were AoBP (odds ratio (OR) = 1.121, p < 0.001), middle age (OR = 1.012, p = 0.008), employment (OR = 1.034, p < 0.017), and being married and living with a spouse (OR = 1.068, p < 0.001). Lower levels of education (OR = 0.931, p < 0.001) and regular walking (OR = 0.964, p = 0.015) were also associated with KCVDs. Health-related quality of life (HRQoL) and subjective health status were associated with increased AoBP. (4) Conclusions: AoBP was positively associated with KCVDs. It is necessary to include AoBP in public campaigns and regular policy support to improve KCVDs. In addition, findings in this study can serve as basic data for developing socio-cultural interventions, aimed at mitigating cardio-cerebrovascular diseases, by improving levels of KCVDs. Full article
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Article
Promoting Emotional and Social Well-Being and a Sense of Belonging in Adolescents through Participation in Volunteering
Healthcare 2021, 9(3), 359; https://doi.org/10.3390/healthcare9030359 - 22 Mar 2021
Cited by 1 | Viewed by 810
Abstract
The aim of this study was to analyze the differences within education-related degrees with respect to participation in volunteering. Volunteering motivation promotes and encourages emotional and social well-being and a sense of belonging in university students. This study was based on a total [...] Read more.
The aim of this study was to analyze the differences within education-related degrees with respect to participation in volunteering. Volunteering motivation promotes and encourages emotional and social well-being and a sense of belonging in university students. This study was based on a total sample of 985 students undertaking Degrees in Early Childhood Education, Primary Education, and Social Education who attended higher education institutions in Northern Africa (Spain) and Eastern Spain. Once the quality parameters of the instrument were determined, the reliability was confirmed, and data collection was initiated. In order to analyze the results, a multilevel study (ANOVA) was conducted by interacting the variables for degrees with three levels (PE = Primary Education; EC = Early Childhood Education; SE = Social Education) and the variable “volunteering is my motivation to feel better”, with five levels (strongly disagree, disagree, unsure, agree, and strongly agree). From the data obtained, it was concluded that there were significant differences between the different degree paths, the assessment covering sociodemographic variables and areas of interest showing that volunteering benefits university students both socially and in their decision-making processes. Full article
Article
Effects of School-Based Exercise Program on Obesity and Physical Fitness of Urban Youth: A Quasi-Experiment
Healthcare 2021, 9(3), 358; https://doi.org/10.3390/healthcare9030358 - 22 Mar 2021
Cited by 1 | Viewed by 829
Abstract
(1) Purpose: The purpose of this study was to evaluate if an after-school intervention program could prevent obesity and promote the physical fitness of urban sedentary school children. (2) Methods: A 16-week after-school physical fitness program was provided to 36 middle school students [...] Read more.
(1) Purpose: The purpose of this study was to evaluate if an after-school intervention program could prevent obesity and promote the physical fitness of urban sedentary school children. (2) Methods: A 16-week after-school physical fitness program was provided to 36 middle school students (7th, 8th, and 9th graders) recruited from a middle school for three days a week. They were high-risk youth showing poor health status (level 4 or 5) in the regular physical fitness evaluation conducted. Their body mass index (BMI), cardiovascular endurance, muscular strength and endurance, quickness, and flexibility were evaluated. (3) Results: A paired sample t-test was used (α = 0.05). There were statistical differences ((x ± s), p < 0.05) between the pre-Progressive Aerobic Cardiovascular Endurance Run (PACER) (13.36 ± 4.98 (# of laps)) and post-PACER (18.64 ± 6.31 (# of laps)) (p < 0.001), between the pre-sit-up (18.06 ± 7.22 (# of sit-ups)) and post-sit-up (24.89 ± 7.52 (# of sit-ups)) (p < 0.001), and between the pre-Trunk Flexion (2.64 ± 3.49 ((cm))) and post-Trunk Flexion (5.97 ± 2.78 ((cm)) (p < 0.001). There was no statistical difference between the pre-50m-Run (10.74 ± 1.30 ((sec))) and post-50m-Run results (10.69 ± 1.25 (sec)) (p = 0.063) or between the pre-BMI (24.84 ± 3.97 (kg/m2)) and post-BMI (24.76 ± 3.61 (kg/m2)) (p = 0.458). Overall, the physical fitness measures improved, whereas BMI did not change after 16 weeks. (4) Conclusion: Sixteen weeks of the school-based Health-related Physical Fitness (HrPF) program can be effective in improving overall physical fitness levels of adolescents, although additional treatments would be required to change BMI, which showed no improvement in the present study. It is concluded that in order for adolescents to maintain and promote physical fitness and health, participation in a school-based HrPF program is recommended for at least 30 min a day, three days a week. In addition, schools should provide high-risk youth with easy access to physical activities that are similar to the objectives of the physical education curriculum. In order to promote the health of school-age children, each school should establish and operate school-based systematic intervention programs. Full article
(This article belongs to the Special Issue Current Health Challenges for Child and Adolescent)
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Systematic Review
Influencing Factors of Acceptance and Use Behavior of Mobile Health Application Users: Systematic Review
Healthcare 2021, 9(3), 357; https://doi.org/10.3390/healthcare9030357 - 22 Mar 2021
Cited by 1 | Viewed by 845
Abstract
Purpose/Significance: Mobile health applications provide a convenient way for users to obtain health information and services. Studying the factors that influence users’ acceptance and use of mobile health applications (apps or Apps) will help to improve users’ actual usage behavior. Method/Process: Based on [...] Read more.
Purpose/Significance: Mobile health applications provide a convenient way for users to obtain health information and services. Studying the factors that influence users’ acceptance and use of mobile health applications (apps or Apps) will help to improve users’ actual usage behavior. Method/Process: Based on the literature review method and using the Web of Science core database as the data source, this paper summarizes the relevant research results regarding the influencing factors of the acceptance and use behavior of mobile health application users and makes a systematic review of the influencing factors from the perspectives of the individual, society, and application (app or App) design. Result/Conclusion: In terms of the individual dimension, the users’ behavior is influenced by demographic characteristics and motivations. Social attributes, source credibility, and legal issues all affect user behavior in the social dimension. In the application design dimension, functionality, perceived ease of use and usefulness, security, and cost are the main factors. At the end of the paper, suggestions are given to improve the users’ acceptability of mobile health applications and improve their use behavior. Full article
(This article belongs to the Special Issue Use of Innovative Technologies in Health Behavior Research)
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Article
The Top 100 Most Cited Articles Published in Dentistry: 2020 Update
Healthcare 2021, 9(3), 356; https://doi.org/10.3390/healthcare9030356 - 21 Mar 2021
Cited by 1 | Viewed by 1056
Abstract
This bibliometric review is aimed to analyze the top 100 most-cited publications in dentistry and to compare its outcomes. A literature search was performed using Elsevier’s Scopus, without any restriction of language, publication year, or study design. Of 336,381 articles, the top 100 [...] Read more.
This bibliometric review is aimed to analyze the top 100 most-cited publications in dentistry and to compare its outcomes. A literature search was performed using Elsevier’s Scopus, without any restriction of language, publication year, or study design. Of 336,381 articles, the top 100 were included based on their citation count, which ranged from 638 to 4728 citations (Feijoo et al., 326 to 2050). The most productive decade was the 2000s, with 40 articles on the list (Feijoo et al., 1980s: 26). Marx RE (7%) was the major contributor in this study (Feijoo et al., Socransky SS: 9%), and almost half (48%) of articles were from the USA. Of the top 100 articles, 26% focused on periodontology (Feijoo et al., periodontology: 43%), while 17% of the total were published in the Journal of Dental Research (Feijoo et al., Journal of Clinical Periodontology: 20%). Most of the publications were narrative reviews/expert opinion (36%), (Feijoo et al., case series: 22%), and were within the evidence level V (64%) (Feijoo et al., 54%). The citation count that a paper secures is not necessarily a reflection of research’s quality, however, the current analysis provides the latest citation trends in dentistry. Full article
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Article
High-Fidelity Virtual Objective Structured Clinical Examinations with Standardized Patients in Nursing Students: An Innovative Proposal during the COVID-19 Pandemic
Healthcare 2021, 9(3), 355; https://doi.org/10.3390/healthcare9030355 - 20 Mar 2021
Viewed by 1187
Abstract
In response to the cancellation of in-person objective structured clinical examinations (OSCEs) prompted by confinement due to the COVID-19 pandemic, we designed a solution to adapt our traditional OSCEs to this new reality in nursing education. We implemented an innovative teaching proposal based [...] Read more.
In response to the cancellation of in-person objective structured clinical examinations (OSCEs) prompted by confinement due to the COVID-19 pandemic, we designed a solution to adapt our traditional OSCEs to this new reality in nursing education. We implemented an innovative teaching proposal based on high-fidelity virtual OSCEs with standardized patients. The purposes of our study were to describe this innovative teaching proposal and compare nursing competence acquisition in final year nursing students through virtual and in-person OSCE modalities. The study included 234 undergraduate students: 123 students were assessed through high-fidelity virtual OSCEs during May 2020, whereas 111 students were assessed through in-person OSCEs during May 2019. The structure of OSCEs, including its stations, clinical simulated scenarios, and checklists, was the same in both OSCE modalities. The effect size of the differences among the competence categories of checklists, including their total scores, was small. Regarding our virtual OSCEs was similarly successful to in-person OSCEs, this online format was found to be useful, feasible, and cost-saving when in-person OSCE was not possible. Therefore, high-fidelity virtual OSCEs with standardized patients could be considered as another choice of OSCE not only in the current COVID-19 pandemic but could also be extended to normal situations, even post-pandemic. Full article
(This article belongs to the Collection Clinical Simulation in Health Sciences)
Study Protocol
Effect on Chest Compression Fraction of Continuous Manual Compressions with Asynchronous Ventilations Using an i-gel® versus 30:2 Approach during Simulated Out-of-Hospital Cardiac Arrest: Protocol for a Manikin Multicenter Randomized Controlled Trial
Healthcare 2021, 9(3), 354; https://doi.org/10.3390/healthcare9030354 - 20 Mar 2021
Cited by 1 | Viewed by 1253
Abstract
The optimal airway management strategy during cardiopulmonary resuscitation is uncertain. In the case of out-of-hospital cardiac arrest, a high chest compression fraction is paramount to obtain the return of spontaneous circulation and improve survival and neurological outcomes. To improve this fraction, providing continuous [...] Read more.
The optimal airway management strategy during cardiopulmonary resuscitation is uncertain. In the case of out-of-hospital cardiac arrest, a high chest compression fraction is paramount to obtain the return of spontaneous circulation and improve survival and neurological outcomes. To improve this fraction, providing continuous chest compressions should be more effective than using the conventional 30:2 ratio. Airway management should, however, be adapted, since face-mask ventilation can hardly be carried out while continuous compressions are administered. The early insertion of a supraglottic device could therefore improve the chest compression fraction by allowing ventilation while maintaining compressions. This is a protocol for a multicenter, parallel, randomized simulation study. Depending on randomization, each team made up of paramedics and emergency medical technicians will manage the 10-min scenario according either to the standard approach (30 compressions with two face-mask ventilations) or to the experimental approach (continuous manual compressions with early insertion of an i-gel® supraglottic device to deliver asynchronous ventilations). The primary outcome will be the chest compression fraction during the first two minutes of cardiopulmonary resuscitation. Secondary outcomes will be chest compression fraction (per cycle and overall), compressions and ventilations quality, time to first shock and to first ventilation, user satisfaction, and providers’ self-assessed cognitive load. Full article
(This article belongs to the Special Issue Urgent and Acute Prehospital Care)
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Article
Dynamics of Public Spending on Health and Socio-Economic Development in the European Union: An Analysis from the Perspective of the Sustainable Development Goals
Healthcare 2021, 9(3), 353; https://doi.org/10.3390/healthcare9030353 - 20 Mar 2021
Viewed by 657
Abstract
In recent years, healthcare has become a fundamental pillar of the level of well-being of any society. With the aim of improving the lives of countries and societies, in 2015 the United Nations (UN) approved the 2030 Agenda for Sustainable Development. Among the [...] Read more.
In recent years, healthcare has become a fundamental pillar of the level of well-being of any society. With the aim of improving the lives of countries and societies, in 2015 the United Nations (UN) approved the 2030 Agenda for Sustainable Development. Among the Sustainable Development Goals (SDGs) set out in the Agenda are health and well-being (O3) and the reduction of inequalities (O10). The general objective of this paper is to analyse the impact that the level of socioeconomic development, as well as the evolution of inequalities, have had on public spending on health in European Union countries. The research methodology is based on the application of a regression model and statistical techniques such as sigma convergence, beta convergence and the Gini index. We can see that the levels of public spending on health per capita, the level of socio-economic development and the degree of inequality are closely related in these countries. For this reason, we suggest maintaining sustainable economic growth to reduce the economic disparities between EU countries, and also the current differences in public spending on health per capita. Full article
(This article belongs to the Special Issue Health Economics & Finance and Global Public Health)
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Article
ATP Bioluminescence for Assessing the Efficacy of the Manual Cleaning Procedure during the Reprocessing of Reusable Surgical Instruments
Healthcare 2021, 9(3), 352; https://doi.org/10.3390/healthcare9030352 - 19 Mar 2021
Cited by 2 | Viewed by 703
Abstract
Achieving sterilization by adopting proper practices is essential to ensure that surgical instruments do not transmit microorganisms to patients. As the effectiveness of sterilization mandates effective cleaning, it is necessary to verify the success of cleaning procedures. In this study, we used the [...] Read more.
Achieving sterilization by adopting proper practices is essential to ensure that surgical instruments do not transmit microorganisms to patients. As the effectiveness of sterilization mandates effective cleaning, it is necessary to verify the success of cleaning procedures. In this study, we used the adenosine triphosphate (ATP) bioluminescence method for assessing the efficacy of the manual cleaning procedure during the reprocessing of reusable surgical instruments. The ATP bioluminescence assay was performed on 140 surgical instruments of 12 different types, both before being cleaned (baseline) and after each of the cleaning procedures (i.e., decontamination, manual washing, drying, and visual inspection). For each instrument, two swabs were used as follows: one to sample the entire surface (test point 1) and the other to sample the most difficult part of the surface to clean (test point 2). Overall, for each type of instrument, there was a decrease in contamination ranging from 99.6 to >99.9% (log reduction from 2.40 to 3.76). Thus, in order to standardize the assessment of cleanliness, it may be useful to introduce the bioluminescence method into the daily routine or, at least, at regular time intervals as a complementary check combined with visual inspection. This would allow real-time verification of the achievement of an adequate level of cleanliness. Full article
(This article belongs to the Section Perioperative Care)
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Article
Vaccine Enthusiasm and Hesitancy in Cancer Patients and the Impact of a Webinar
Healthcare 2021, 9(3), 351; https://doi.org/10.3390/healthcare9030351 - 19 Mar 2021
Cited by 16 | Viewed by 1888
Abstract
(1) Background: Vaccine hesitancy and rejection are major threats to controlling coronavirus disease 2019 (COVID-19). There is a paucity of information about the attitudes of cancer patients towards vaccinations and the role of clinical oncologists in influencing vaccination acceptance. (2) Methods: Cancer patients [...] Read more.
(1) Background: Vaccine hesitancy and rejection are major threats to controlling coronavirus disease 2019 (COVID-19). There is a paucity of information about the attitudes of cancer patients towards vaccinations and the role of clinical oncologists in influencing vaccination acceptance. (2) Methods: Cancer patients and caregivers were invited to participate in a webinar and two surveys (pre- and post-webinar) assessing intention and thought processes associated with receiving COVID-19 vaccines. (3) Results: Two hundred and sixty-four participants participated in the webinar and registered to take at least one survey. Participants reported receiving most of their COVID-19 vaccine information from their doctor, clinic, or hospital. Before the webinar, 71% of participants reported the intention to receive a COVID-19 vaccine, 24% were unsure, and 5% had no intention of receiving a vaccine. The strongest predictors of vaccine enthusiasm were (a) planning to encourage the vaccination of family, friends, co-workers, and community, and (b) physician recommendation. The chief reason for vaccine hesitancy was a fear of side effects. After the webinar, 82.5% reported the intention to receive a vaccine, 15.4% were still unsure, and 2% stated that they had no intention of receiving a vaccine. The webinar shifted the attitude towards vaccine enthusiasm, despite an already vaccine-enthusiastic population. Communicating about vaccines using positive framing is associated with greater vaccine enthusiasm. (4) Conclusions: Patient education programs co-hosted by multiple stakeholders and delivered by oncologists can increase cancer patient enthusiasm for COVID-19 vaccination. Full article
(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)
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Article
Senior Managers’ Experience with Health, Happiness, and Motivation in Hospitals and the Perceived Impact on Health Systems: The Case of Meru County, Kenya
Healthcare 2021, 9(3), 350; https://doi.org/10.3390/healthcare9030350 - 18 Mar 2021
Cited by 1 | Viewed by 587
Abstract
Hospitals play a significant role in health systems. Studies among the health workforce have revealed their experiences with mental health challenges. In comparison, there is limited literature on their positive mental health. The purpose of this study was to explore senior managers’ experiences [...] Read more.
Hospitals play a significant role in health systems. Studies among the health workforce have revealed their experiences with mental health challenges. In comparison, there is limited literature on their positive mental health. The purpose of this study was to explore senior managers’ experiences with health status, happiness, and motivation in hospitals and the perceived impact on the health system in Kenya. This qualitative study applied a phenomenological research design. Senior managers within the hospital management teams were selected using purposive sampling. Semi-structured interviews were carried out among senior managers across eleven hospitals in Meru County, Kenya. Among the eleven participants 63.6% were female and 36.4%, were male and the mean age was 44.5 years. The audio-taped data were transcribed and analyzed using Colaizzi’s phenomenological approach. The five themes revealed were: (1) Happiness in the health system; (2) Health status in the health system; (3) Motivation in the health system; (4) Challenges in the health system; (5) Possible solutions to the challenges in the health system. This study revealed the positive and negative impact of the three domains, challenges, and solutions, from the senior managers’ perspective. Healthy, happy, and motivated senior managers and healthcare workers are more responsive and perform better. Policy interventions and programs promoting happiness, health status, and motivation are necessary for strengthening the health workforce and health system. Full article
(This article belongs to the Special Issue Psycho-Social Factors of Workplace Health and Safety)
Article
Inequality in Health: The Correlation between Poverty and Injury—A Comprehensive Analysis Based on Income Level in Taiwan: A Cross-Sectional Study
Healthcare 2021, 9(3), 349; https://doi.org/10.3390/healthcare9030349 - 18 Mar 2021
Viewed by 671
Abstract
Is income still an obstacle that influences health in Taiwan, the National Health Insurance system was instituted in 1995? After collecting injured inpatient data from the health insurance information of nearly the whole population, we categorized the cases as either low-income or nonlow-income [...] Read more.
Is income still an obstacle that influences health in Taiwan, the National Health Insurance system was instituted in 1995? After collecting injured inpatient data from the health insurance information of nearly the whole population, we categorized the cases as either low-income or nonlow-income and tried to determine the correlation between poverty and injury. Chi-square tests, Fisher’s exact tests, an independent-samples t-test, and percentages were used to identify differences in demographics, causes for hospitalization, and other hospital care variables. Between 1998 and 2015, there were 74,337 inpatients with low-income injuries, which represented 1.6% of all inpatients with injury events. The hospitalization mortality rate for the low-income group was 1.9 times higher than that of the nonlow-income group. Furthermore, the average length of hospital stay (9.9 days), average medical expenses (1681 USD), and mortality rate (3.6%) values for the low-income inpatients were higher than those of the nonlow-income group (7.6 days, 1573 USD, and 2.1%, respectively). Among the injury causes, the percentages of “fall,” “suicide,” and “homicide” incidences were higher for the low-income group than for the nonlow-income group. These findings support our hypothesis that there is a correlation between poverty and injury level, which results in health inequality. Achieving healthcare equality may require collaboration between the government and private and nonprofit organizations to increase the awareness of this phenomenon. Full article
(This article belongs to the Special Issue Inequalities in Environmental Exposure and in Health Care)
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Article
Effects of Tooth Brushing Training, Based on Augmented Reality Using a Smart Toothbrush, on Oral Hygiene Care among People with Intellectual Disability in Korea
Healthcare 2021, 9(3), 348; https://doi.org/10.3390/healthcare9030348 - 18 Mar 2021
Viewed by 836
Abstract
(1) Purpose: In modern society, augmented reality (AR)-based training using a smart device has emerged as a means of resolving problems with training. Thus, this feasibility study aimed to identify the effects of tooth-brushing training, based on AR using a smart toothbrush, on [...] Read more.
(1) Purpose: In modern society, augmented reality (AR)-based training using a smart device has emerged as a means of resolving problems with training. Thus, this feasibility study aimed to identify the effects of tooth-brushing training, based on AR using a smart toothbrush, on oral hygiene care among people with an intellectual disability in Korea. (2) Methods: Thirty people with an intellectual disability, residing in a residential care facility, were selected. Tooth-brushing training based on AR, using a smart toothbrush, was applied in the experimental group (n = 15), and training using visual material was applied in the control group (n = 15). As an assessment of oral hygiene care, the changes in tooth-brushing performance and oral hygiene were measured. (3) Results: There were significant differences in all results after training between the two groups. (4) Conclusions: Tooth-brushing training based on AR using a smart toothbrush is more effective than training using visual material on oral hygiene care among the subjects of this feasibility study. Thus, training based on AR using a smart toothbrush could be applied to people with intellectual disabilities residing in residential care facilities as an individual tool for tooth-brushing training. Full article
(This article belongs to the Special Issue Smart Home Care)
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Article
Experiences of Pathology Course among Hospital Management Graduates
Healthcare 2021, 9(3), 347; https://doi.org/10.3390/healthcare9030347 - 18 Mar 2021
Viewed by 522
Abstract
The purpose of this study was to explore hospital management graduates’ experience in pathology courses. Data were gathered through four focus group interviews by 16 hospital management graduates who attended pathology courses. Data were collected from June to August, 2020. Conventional content analysis [...] Read more.
The purpose of this study was to explore hospital management graduates’ experience in pathology courses. Data were gathered through four focus group interviews by 16 hospital management graduates who attended pathology courses. Data were collected from June to August, 2020. Conventional content analysis was used for data analysis. Six categories were extracted that described hospital management graduates’ experience in pathology courses, as follows: “Suggestions for the curriculum,” “Students’ preference for pathology professor,” “Demands for various teaching methods,” “Broad and difficult class content,” “Recognition of pathology courses during college years,” and “The importance of studying the pathology course realized after graduation.” The findings suggest that it is important to identify hospital management graduates’ perspectives to improve pathology curriculum in the educational process. Additionally, it is necessary to continuously connect educational and practical environments for the effective management of pathology courses. Full article
Article
Communication Skills and Transformational Leadership Style of First-Line Nurse Managers in Relation to Job Satisfaction of Nurses and Moderators of This Relationship
Healthcare 2021, 9(3), 346; https://doi.org/10.3390/healthcare9030346 - 18 Mar 2021
Cited by 2 | Viewed by 1815
Abstract
The job satisfaction of nurses is reflected in almost all organizational outputs of medical facilities. First-line nurse managers (FLNMs), who are directly related to subordinate nurses, have a great influence on this satisfaction. The aim of our paper is to examine the connection [...] Read more.
The job satisfaction of nurses is reflected in almost all organizational outputs of medical facilities. First-line nurse managers (FLNMs), who are directly related to subordinate nurses, have a great influence on this satisfaction. The aim of our paper is to examine the connection between communication skills and the transformation style of FLNMs management with the job satisfaction of nurses and to verify the influence of three moderators on the strength of this relationship. The chosen moderators—the practice of managing FLNMs, the degree of control (span of control) and psychosocial work—follow from theoretical studies. The moderating effect of the variable management practice is also significant from the point of view of Slovak legislation. The sample consisted of 132 FLNMs from five university hospitals in Slovakia. Data collection took place in the form of a questionnaire. All data were processed using the SPSS 24 software package. A series of regression analyzes were used to identify the proposed hypotheses. ANOVA analysis was used to analyze multiple dependencies. We worked at a 5% level of significance. The findings point to the strong direct effects of communication skills and the transformational leadership style of FLNMs on nurses’ job satisfaction. Moderation effects are mild, but significant in the case of management and span of control practices. The lower values of both variables reinforce the positive relationships among the two predictors and the job satisfaction of nurses. The third moderator, psychosocial work factors, also have a significant moderating effect, which is negative, and the higher value of this moderator mitigates both positive direct effects. Full article
(This article belongs to the Special Issue Burnout, Perceived Efficacy, Compassion Fatigue and Job Satisfaction)
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Systematic Review
Effects of the Small-Sided Soccer Games on Blood Pressure in Untrained Hypertensive Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Healthcare 2021, 9(3), 345; https://doi.org/10.3390/healthcare9030345 - 18 Mar 2021
Viewed by 681
Abstract
This systematic review with meta-analysis was conducted to assess the effects of small-sided games (SSGs)-based programs on the systolic and diastolic blood pressure of untrained hypertensive adults. The data sources utilized were Web of Science, Scopus, SPORTDiscus, and PubMed. The eligibility criteria were: [...] Read more.
This systematic review with meta-analysis was conducted to assess the effects of small-sided games (SSGs)-based programs on the systolic and diastolic blood pressure of untrained hypertensive adults. The data sources utilized were Web of Science, Scopus, SPORTDiscus, and PubMed. The eligibility criteria were: (i) randomized controlled trials including a control group and an intervention group exclusively using soccer SSGs; (ii) intervention and control groups including an untrained hypertensive adult population; (iii) articles written in English; and (iv) only full-text and original articles. The database search initially identified 241 titles. From those, five articles were eligible for the systematic review and meta-analysis. The included randomized controlled studies involved five individual experimental groups and 88 participants, and 68 participants in the five control groups. The results showed a large and beneficial effect of SSG on systolic (ES = 1.69; 95% CI = 0.71 to 2.66; p = 0.001; I2 = 85.2%; Egger’s test p = 0.101) and diastolic blood pressure (ES = 2.25; 95% CI = 1.44 to 3.06; p < 0.001; I2 = 74.8%; Egger’s test p = 0.118) when compared to the control groups. The findings of the current systematic review and meta-analysis revealed consistent beneficial effects of recreational soccer SSGs on untrained men and women from the hypertensive population, although high levels of heterogeneity. Full article
(This article belongs to the Special Issue Sport and Exercise Medicine)
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Article
Development and Validation of a Social Media Questionnaire for Nursing Training: A Pilot Study
Healthcare 2021, 9(3), 344; https://doi.org/10.3390/healthcare9030344 - 18 Mar 2021
Viewed by 980
Abstract
Background: Social media platforms are integrated into the lives of students. Their use in education has been studied, but this research is scarce in nursing. The objective of this study was to develop and validate the questionnaire “Use and views of the social [...] Read more.
Background: Social media platforms are integrated into the lives of students. Their use in education has been studied, but this research is scarce in nursing. The objective of this study was to develop and validate the questionnaire “Use and views of the social media for nursing education” through a pilot study, to describe the use and attitudes of nursing students to social media. Methods: Cross-sectional design to validate the modified scale “Students’ Use and Views of the Social Media questionnaire.” The sample consisted of 107 undergraduate nursing students. Results: The factor analysis extracted three main components to explain social media use for nursing education, with component 1 being the “Need to use media in my professional training,” component 2—“To deepen my professional knowledge” and component 3 “Contrast information.” High reliability was demonstrated with Chronbach’s alpha value (0.84). Conclusion: The final tool was proven to have high validity and reliability values, so it is positioned as a viable tool to explore this reality. Students use social media for education in a high proportion and have positive attitudes regarding their education inclusion. Full article
Article
Remote Monitoring of Critically-Ill Post-Surgical Patients: Lessons from a Biosensor Implementation Trial
Healthcare 2021, 9(3), 343; https://doi.org/10.3390/healthcare9030343 - 18 Mar 2021
Cited by 2 | Viewed by 711
Abstract
Biosensors represent one of the numerous promising technologies envisioned to extend healthcare delivery. In perioperative care, the healthcare delivery system can use biosensors to remotely supervise patients who would otherwise be admitted to a hospital. This novel technology has gained a foothold in [...] Read more.
Biosensors represent one of the numerous promising technologies envisioned to extend healthcare delivery. In perioperative care, the healthcare delivery system can use biosensors to remotely supervise patients who would otherwise be admitted to a hospital. This novel technology has gained a foothold in healthcare with significant acceleration due to the COVID-19 pandemic. However, few studies have attempted to narrate, or systematically analyze, the process of their implementation. We performed an observational study of biosensor implementation. The data accuracy provided by the commercially available biosensors was compared to those offered by standard clinical monitoring on patients admitted to the intensive care unit/perioperative unit. Surveys were also conducted to examine the acceptance of technology by patients and medical staff. We demonstrated a significant difference in vital signs between sensors and standard monitoring which was very dependent on the measured variables. Sensors seemed to integrate into the workflow relatively quickly, with almost no reported problems. The acceptance of the biosensors was high by patients and slightly less by nurses directly involved in the patients’ care. The staff forecast a broad implementation of biosensors in approximately three to five years, yet are eager to learn more about them. Reliability considerations proved particularly troublesome in our implementation trial. Careful evaluation of sensor readiness is most likely necessary prior to system-wide implementation by each hospital to assess for data accuracy and acceptance by the staff. Full article
(This article belongs to the Special Issue Perioperative Care)
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Article
Self-Rated Health and Subjective Economic Status in Life Satisfaction among Older Chinese Immigrants: A Cross-Sectional Study
Healthcare 2021, 9(3), 342; https://doi.org/10.3390/healthcare9030342 - 17 Mar 2021
Viewed by 444
Abstract
This study examines the influence of self-rated health and subjective economic status on the life satisfaction of older Chinese immigrants in the United States. Data were obtained from a cross-sectional survey of 205 older Chinese immigrants aged 66 to 90 years living in [...] Read more.
This study examines the influence of self-rated health and subjective economic status on the life satisfaction of older Chinese immigrants in the United States. Data were obtained from a cross-sectional survey of 205 older Chinese immigrants aged 66 to 90 years living in Los Angeles and Honolulu. Ordinary Least Squares (OLS) regression analysis was employed to explore the independent effects of self-rated health and subjective economic status. The results demonstrated that self-rated health and subjective economic status were positively associated with life satisfaction. This cross-sectional study provides empirical evidence that self-rated health and subjective economic status are directly associated with subjective life satisfaction among older Chinese immigrants. Full article
Case Report
Sudden Death from Primary Cerebral Melanoma: Clinical Signs and Pathological Observations
Healthcare 2021, 9(3), 341; https://doi.org/10.3390/healthcare9030341 - 17 Mar 2021
Cited by 2 | Viewed by 572
Abstract
Primary cerebral tumors rarely provoke sudden death. The incidence is often underestimated with reported frequencies in the range of 0.02 to 2.1% in medicolegal autopsy series. Furthermore, primary cerebral melanoma is an uncommon neoplasm. It represents approximately 1% of all melanoma cases and [...] Read more.
Primary cerebral tumors rarely provoke sudden death. The incidence is often underestimated with reported frequencies in the range of 0.02 to 2.1% in medicolegal autopsy series. Furthermore, primary cerebral melanoma is an uncommon neoplasm. It represents approximately 1% of all melanoma cases and 0.07% of all brain tumors. This neoplasm is very aggressive, and its annual incidence is about 1 in 10 million people. In the present study, a 20-year-old male was admitted to hospital with vomiting, headache, paresthesia and aggressive behavior. A computed tomography (CT) scan of the head was performed showing a hyperdense nodule in the right parietal lobe with inflammation of the Silvian fissure. A complete autopsy was performed 48 h after death. A blackish material was displayed on the skull base, and posterior fossa. Microscopic examination diagnosed primary brain melanoma. A systematic review of the literature was also performed where no previous analogous cases were found. The forensic pathologist rarely encounters primary cerebral melanoma, and for these reasons, it seemed appropriate to describe this case as presenting aspecific clinical symptoms and leading to sudden unexpected death. Histopathological observations are reported and discussed to explain this surprising sudden death caused by a primary cerebral melanoma. Full article
(This article belongs to the Special Issue Forensic Science and Legal Medicine: A Multidisciplinary Puzzle!)
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Article
The Effect of a Points System on Incentivizing Academic Behaviors of Attending Ophthalmologists
Healthcare 2021, 9(3), 340; https://doi.org/10.3390/healthcare9030340 - 17 Mar 2021
Viewed by 399
Abstract
(1) Background: Little is known regarding the best ways to promote academic throughput within the ranks of attending ophthalmology physicians. The purpose of this project is to evaluate the effect of a monetized points system on incentivizing research output and other academic activity [...] Read more.
(1) Background: Little is known regarding the best ways to promote academic throughput within the ranks of attending ophthalmology physicians. The purpose of this project is to evaluate the effect of a monetized points system on incentivizing research output and other academic activity in academic ophthalmology attendings. (2) Methods: This is a retrospective study of 15 academic ophthalmology attendings at a single academic teaching hospital from 1 July 2015 to 30 June 2020. A points system was implemented in the 2017 academic year (1 July 2016–30 June 2017), in which ophthalmology attendings accrued points for eight categories of academic achievement. We compared the overall number of publications, number of first/senior author publications, and corresponding impact factors of journals via the PubMed database in the two years of data before and after the points system was implemented. We analyzed points awarded for eight categories of academic achievement in the first, second, and third year of the program. (3) Results: There was no significant change in research productivity for attending ophthalmologists after institution of the points system. From 2017 to 2019, Mann–Whitney analysis revealed a significant increase in points awarded for mentorship per physician (p = 0.013). (4) Conclusions: Our data suggest that within the framework of the points system, attendings—rather than prioritizing publications—gravitated towards mentorship activities to accrue points. Full article
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Review
A Realist Review of Violence Prevention Education in Healthcare
Healthcare 2021, 9(3), 339; https://doi.org/10.3390/healthcare9030339 - 17 Mar 2021
Viewed by 1206
Abstract
Violence from patients and visitors towards healthcare workers is an international concern affecting the safety and health of workers, quality of care, and healthcare system sustainability. Although the predominant intervention has been violence prevention (VP) education for healthcare workers, evaluating its effectiveness is [...] Read more.
Violence from patients and visitors towards healthcare workers is an international concern affecting the safety and health of workers, quality of care, and healthcare system sustainability. Although the predominant intervention has been violence prevention (VP) education for healthcare workers, evaluating its effectiveness is challenging due to underreporting of violence and the inherent complexity of both violence and the health care environment. This review utilized a theory-driven, realist approach to synthesize and analyze a wide range of academic and grey literature to identify explanations of how and why VP education makes a difference in preventing violence and associated physical and psychological injury to workers. The review confirmed the importance of positioning VP education as part of a VP strategy, and consideration of the contexts that influence successful application of VP knowledge and skills. Synthesis and analysis of patterns of evidence across 64 documents resulted in 11 realist explanations of VP education effectiveness. Examples include education specific to clinical settings, unit-level modeling and mentoring support, and support of peers and supervisors during violent incidents. This review informs practical program and policy decisions to enhance VP education effectiveness in healthcare settings. Full article
(This article belongs to the Special Issue Violence Prevention and Management in the Healthcare Sector)
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Article
Incidence and Death Rates from COVID-19 Are Not Always Coupled: An Analysis of Temporal Data on Local, Federal, and National Levels
Healthcare 2021, 9(3), 338; https://doi.org/10.3390/healthcare9030338 - 17 Mar 2021
Cited by 2 | Viewed by 601
Abstract
SARS-CoV-2 has caused a deadly pandemic worldwide, placing a burden on local health care systems and economies. Infection rates with SARS-CoV-2 and the related mortality of COVID-19 are not equal among countries or even neighboring regions. Based on data from official German health [...] Read more.
SARS-CoV-2 has caused a deadly pandemic worldwide, placing a burden on local health care systems and economies. Infection rates with SARS-CoV-2 and the related mortality of COVID-19 are not equal among countries or even neighboring regions. Based on data from official German health authorities since the beginning of the pandemic, we developed a case-fatality prediction model that correctly predicts COVID-19-related death rates based on local geographical developments of infection rates in Germany, Bavaria, and a local community district city within Upper Bavaria. Our data point towards the proposal that local individual infection thresholds, when reached, could lead to increasing mortality. Restrictive measures to minimize the spread of the virus could be applied locally based on the risk of reaching the individual threshold. Being able to predict the necessity for increasing hospitalization of COVID-19 patients could help local health care authorities to prepare for increasing patient numbers. Full article
(This article belongs to the Section Coronaviruses (CoV) and COVID-19 Pandemic)
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Article
Oral Health Impact Profile in Orthodontic Patients with Ectopic Canine: A Prospective Clinical Intervention of Four Treatment Modalities
Healthcare 2021, 9(3), 337; https://doi.org/10.3390/healthcare9030337 - 16 Mar 2021
Viewed by 451
Abstract
This study evaluated the oral health-related quality of life (OHRQoL) in Saudi subjects with ectopic canine, severe crowding, and class I normal occlusion. Moreover, we assessed the differences among orthodontic treatment modalities (OTM) in the ectopic canine group. Study design: Retrospective and prospective [...] Read more.
This study evaluated the oral health-related quality of life (OHRQoL) in Saudi subjects with ectopic canine, severe crowding, and class I normal occlusion. Moreover, we assessed the differences among orthodontic treatment modalities (OTM) in the ectopic canine group. Study design: Retrospective and prospective evaluation. A total of 96 subjects were assessed for OHRQoL using the Oral Health Impact Profile, English version (OHIP-16). Initial comparison of the baseline data of ectopic canine subjects was made with severe crowding (>8 mm) and class I normal occlusion with the matched number and age of the subjects in later groups. Moreover, a comparison of OHIP-16 scores among four OTM in the ectopic canine group, baseline, 1 day, and 28 days after treatment were performed. OHIP-16 scores of ectopic canine, severe crowding, and class I normal occlusion group were 33.06, 33.09, and 26.43, respectively. Subjects with ectopic canine and severe crowding reported a significantly greater negative impact in terms of embarrassment, avoiding smiling, and lack of self-confidence. OHRQoL had no significant changes among the four OTM groups (p > 0.05). Untreated malocclusion had a significant negative impact on OHRQoL. The negative impact was seen in several domains 1 day after treatment, and gradual improvement was noted 28 days after treatment. Full article
(This article belongs to the Collection Healthcare in Dentistry)
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Article
The Perimenopausal Fatigue Self-Management Scale Is Suitable for Evaluating Perimenopausal Taiwanese Women’s Vulnerability to Fatigue Syndrome
Healthcare 2021, 9(3), 336; https://doi.org/10.3390/healthcare9030336 - 16 Mar 2021
Cited by 1 | Viewed by 591
Abstract
The purpose of this study was to test the feasibility of utilizing the established perimenopausal fatigue self-management scale (P-MFSMS) to evaluate perimenopausal Taiwanese women’s vulnerability to fatigue syndrome. A cross-sectional study design was adopted to survey 220 perimenopausal Taiwanese women with a mean [...] Read more.
The purpose of this study was to test the feasibility of utilizing the established perimenopausal fatigue self-management scale (P-MFSMS) to evaluate perimenopausal Taiwanese women’s vulnerability to fatigue syndrome. A cross-sectional study design was adopted to survey 220 perimenopausal Taiwanese women with a mean age of 51.8 ± 4.64 years and a mean body mass index of 23.07 ± 3.04 kg/m2, 75.9% of whom were married, 52.3% had a college education or above, 80.4% had salaries, 81.3% had small families, and 96.4% were not using hormone therapy. The P-MFSMS consists of 25 questions based on six categories: (1) strive to maintain work energy and efficiency; (2) seek self-help from medical resources (doctor shopping); (3) strive to maintain the normal operation of the family (seeking help and support from family or significant other); (4) make time for activities or exercise in busy life; (5) slow down or adjust lifestyle; (6) frustration. For all of these six categories, the minimum loading of each question on the factor was calculated to be over 0.50, with a Cronbach’s α of 0.78 and a corrected total-item correlation of >0.50. The goodness of fit of the model was determined to be acceptable, with a chi-square/df value of <3.0 (χ2 = 503.45 and df = 260), a root mean square error of approximation (RMSEA) value of 0.065 (<0.08), as well as a Kaiser–Meyer–Olkin (KMO) value of 0.892. The Tucker–Lewis index (TLI = 0.91), Comparative Fit index (CFI = 0.92), and Incremental Fit index (IFI = 0.92) were all >0.90. There was no statistically significant difference in the difficulty between perimenopausal and postmenopausal women utilizing differential item function (DIF) analysis. Taken together, the 25-question P-MFSMS may be a potentially valid and reliable instrument for suitably evaluating perimenopausal Taiwanese women’s vulnerability to fatigue syndrome. Future studies will be conducted to test the effectiveness of the P-MFSMS for evaluating perimenopausal Taiwanese women’s vulnerability to fatigue syndrome in clinical practice. Full article
(This article belongs to the Section Women Health)
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Article
Predictive Factors for Severe Maternal Morbidity in Brazil: A Case-Control Study
Healthcare 2021, 9(3), 335; https://doi.org/10.3390/healthcare9030335 - 16 Mar 2021
Viewed by 651
Abstract
The maternal mortality or "maternal near miss" ratio in Brazil reflects the socioeconomic indicators as well as the healthcare quality in some areas of this country, pointing out fragile points in the health services. The aim of this study was to estimate the [...] Read more.
The maternal mortality or "maternal near miss" ratio in Brazil reflects the socioeconomic indicators as well as the healthcare quality in some areas of this country, pointing out fragile points in the health services. The aim of this study was to estimate the association of diverse variables related to pregnancy and the occurrence of Near Miss in a population of women who were cared in public maternity wards in Brazil. A case-control study was performed. The association between variables and outcomes was verified through a chi-square test. A multiple analysis was carried out, producing odds ratio (OR) estimates with values of p≤0.25 in the univariate model. The results point to the following risk factors for Severe Maternal Morbidity: non-white (<0.001, OR 2.973), family income of up to two minimum wage salaries (<0.001; OR 2.159), not having a partner (<0.001, OR 2.694), obesity (<0.001, OR 20.852), not having received pre-natal care (<0.001, OR 2.843), going to less than six prenatal appointments (<0.001, OR 3.498), undergoing an inter-hospital transfer (<0.001, OR 24.655), and the absence of labor during admission (<0.001, OR 25.205). Although the results vary, the incidence of women with potential life-threatening complications is high in Brazil, which reinforces the need to universalize more complex interventions as well as coverage of primary care. The presence of precarious socio-economic indicators and unqualified obstetric care were risk factors for Severe Maternal Morbidity. Full article
(This article belongs to the Section Perinatal and Neonatal Medicine)
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