Healthcare

3 pages, 170 KiB

Open AccessEditor’s ChoiceCommentary

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: When Suffering Is Multiplied

by Anthony L. Komaroff

Healthcare 2021, 9(7), 919; https://doi.org/10.3390/healthcare9070919 - 20 Jul 2021

Cited by 10 | Viewed by 24155

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an illness defined predominantly by symptoms. Routine laboratory test results often are normal, raising the question of whether there are any underlying objective abnormalities. In the past 20 years, however, new research technologies have uncovered a series [...] Read more.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an illness defined predominantly by symptoms. Routine laboratory test results often are normal, raising the question of whether there are any underlying objective abnormalities. In the past 20 years, however, new research technologies have uncovered a series of biological abnormalities in people with ME/CFS. Unfortunately, many physicians remain unaware of this, and some tell patients that “there is nothing wrong” with them. This skepticism delegitimizes, and thereby multiplies, the patients’ suffering. Full article

(This article belongs to the Special Issue ME/CFS – the Severely and Very Severely Affected)

13 pages, 2437 KiB

Open AccessArticle

Can Residential Greenspace Exposure Improve Pain Experience? A Comparison between Physical Visit and Image Viewing

by Hansen Li, Xing Zhang, Shilin Bi, Yang Cao and Guodong Zhang

Healthcare 2021, 9(7), 918; https://doi.org/10.3390/healthcare9070918 - 20 Jul 2021

Cited by 8 | Viewed by 3197

Abstract

Reducing the burden of pain via greenspace exposure is a rising research topic. However, insufficient evidence has been found in relation to the environmental effect itself. Residential greenspace, as a convenient but limited natural environment for urban dwellers, has benefits and services yet [...] Read more.

Reducing the burden of pain via greenspace exposure is a rising research topic. However, insufficient evidence has been found in relation to the environmental effect itself. Residential greenspace, as a convenient but limited natural environment for urban dwellers, has benefits and services yet to be discovered. Therefore, the current study recruited 24 young adults to evaluate the effects of physical visit to, or image viewing of, residential greenspace on pain perception and related psychophysiological outcomes, via simulated pain. Pain threshold and tolerance were recorded via the level of pain stimuli, and pain intensity was evaluated using the Visual Analog Scale (VAS). The state scale of the State–Trait Anxiety Inventory (STAI-S) and two adjective pairs were employed to measure the state anxiety and subjective stress, respectively. Meanwhile, heart rate (HR), heart rate variability (HRV), and blood pressure (BP) were measured to investigate physiological responses. Besides, Scenic Beauty Estimation (SBE) was also employed to assess participants’ preference regarding the experimental environments. The results revealed that visiting the greenspace significantly increased the pain threshold and tolerance, while no significant effect was observed for image viewing. On the other hand, no significant difference was observed in pain-related psychophysiological indices between the experimental settings, but significantly negative associations were found between the scores of SBE and subjective stress and state anxiety. In conclusion, the current study brings experimental evidence of improving pain experience via residential greenspace exposure, while the related psychophysiological benefits require further investigation. Full article

(This article belongs to the Special Issue Outdoor and Nature Therapy)

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13 pages, 485 KiB

Open AccessArticle

Polish Adaptation of the Pregnancy-Related Anxiety Questionnaire—Revised 2 for All Pregnant Women

by Anna Michalik, Lucyna Wójcicka, Agata Zdun-Ryżewska, Agnieszka Czerwińska-Osipiak, Michał Krzemiński, Jolanta Olszewska, Dagmara Klasa-Mazurkiewicz and Anja C. Huizink

Healthcare 2021, 9(7), 917; https://doi.org/10.3390/healthcare9070917 - 20 Jul 2021

Cited by 5 | Viewed by 2886

Abstract

Pregnancy-related anxiety (PrA) is a specific type of anxiety characteristic of the perinatal period. PrA can affect pregnancy and birth. However, no validated tool exists to measure PrA in Polish obstetric practice. The aim of this study was to translate the Pregnancy-Related Anxiety [...] Read more.

Pregnancy-related anxiety (PrA) is a specific type of anxiety characteristic of the perinatal period. PrA can affect pregnancy and birth. However, no validated tool exists to measure PrA in Polish obstetric practice. The aim of this study was to translate the Pregnancy-Related Anxiety Questionnaire—Revised 2 (PRAQ-R2) into Polish and to evaluate its reliability and factorial and construct validity. This study was conducted in Poland as an online questionnaire in April 2020 and included 175 healthy women. To validate the PRAQ-R2, we used standardized tools for the measurement of general anxiety: the modified Visual Analog Scale (VAS), the Ten-Item Personality Inventory (TIPI), and the Hospital Anxiety and Depression Scale (HADS). Scale reliability was assessed using Cronbach’s alpha. Concurrent validity was evaluated by calculating Spearman’s rho correlation coefficients. Statistical analyses were performed using R ver. 4.0.2. Values for comparative fit index >0.90, Tucker–Lewis index >0.90, and root mean square error of approximation <0.08 indicated acceptable model fit, confirming the reliability of the three-factor structure of the translation. The subscales and total scores had good consistency (α > 0.7), and convergent validity was demonstrated. The PRAQ-R2 as translated into Polish represents the first validated tool in Poland to measure PrA for all pregnant women. Full article

(This article belongs to the Collection Stress Management for Health)

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8 pages, 262 KiB

Open AccessBrief Report

Differences in Dietary Habits, Physical Exercise, and Quality of Life between Patients with Obesity and Overweight

by Carmen Herrera-Espiñeira, Ana María de Pascual y Medina, Manuel López-Morales, Paloma Díaz Jiménez, Antonia Rodríguez Ruiz and Manuela Expósito-Ruiz

Healthcare 2021, 9(7), 916; https://doi.org/10.3390/healthcare9070916 - 20 Jul 2021

Cited by 6 | Viewed by 2809

Abstract

Background: Overweight and obesity differ in their repercussions on the health and health-related quality of life (HRQoL) of patients. The objective of this study was to compare physical activity levels and dietary habits before admission and HRQoL at discharge between patients with obesity [...] Read more.

Background: Overweight and obesity differ in their repercussions on the health and health-related quality of life (HRQoL) of patients. The objective of this study was to compare physical activity levels and dietary habits before admission and HRQoL at discharge between patients with obesity and overweight. Methods: A cross-sectional study was undertaken among participants in a clinical trial on education for healthy eating and physical activity, enrolling non-diabetic patients admitted to Internal Medicine Departments. These were classified by body mass index (BMI) as having overweight (25–29.9 Kg/m²) or obesity (≥30 kg/m²). Data were gathered on sociodemographic characteristics, clinical variables (medication for anxiety/depression, Charlson Comorbidity Index, length of hospital stay), physical exercise and diet (International Physical Activity and Pardo Questionnaires), and HRQoL (EQ-5D-5L). The study included 98 patients with overweight (58.2% males) and 177 with obesity (52% males). Results: In comparison to patients with obesity, those with overweight obtained better results for regular physical exercise (p = 0.007), healthy diet (p = 0.004), and “emotional eating” (p = 0.017). No between-group difference was found in HqoL scores. Conclusion: Patients with overweight and obesity differ in healthy dietary and physical exercise behaviors. Greater efforts are warranted to prevent an increase in the BMI of patients, paying special attention to their state of mind. Full article

(This article belongs to the Section Nutrition and Public Health)

19 pages, 529 KiB

Open AccessReview

A Survey on Recent Advances in Machine Learning Based Sleep Apnea Detection Systems

by Anita Ramachandran and Anupama Karuppiah

Healthcare 2021, 9(7), 914; https://doi.org/10.3390/healthcare9070914 - 20 Jul 2021

Cited by 47 | Viewed by 6436

Abstract

Sleep apnea is a sleep disorder that affects a large population. This disorder can cause or augment the exposure to cardiovascular dysfunction, stroke, diabetes, and poor productivity. The polysomnography (PSG) test, which is the gold standard for sleep apnea detection, is expensive, inconvenient, [...] Read more.

Sleep apnea is a sleep disorder that affects a large population. This disorder can cause or augment the exposure to cardiovascular dysfunction, stroke, diabetes, and poor productivity. The polysomnography (PSG) test, which is the gold standard for sleep apnea detection, is expensive, inconvenient, and unavailable to the population at large. This calls for more friendly and accessible solutions for diagnosing sleep apnea. In this paper, we examine how sleep apnea is detected clinically, and how a combination of advances in embedded systems and machine learning can help make its diagnosis easier, more affordable, and accessible. We present the relevance of machine learning in sleep apnea detection, and a study of the recent advances in the aforementioned area. The review covers research based on machine learning, deep learning, and sensor fusion, and focuses on the following facets of sleep apnea detection: (i) type of sensors used for data collection, (ii) feature engineering approaches applied on the data (iii) classifiers used for sleep apnea detection/classification. We also analyze the challenges in the design of sleep apnea detection systems, based on the literature survey. Full article

(This article belongs to the Special Issue Artificial Intelligence (AI) and Machine Learning (ML) in Human Health and Healthcare)

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14 pages, 735 KiB

Open AccessReview

Role of Laboratory Medicine in SARS-CoV-2 Diagnostics. Lessons Learned from a Pandemic

by Irena Duś-Ilnicka, Aleksander Szymczak, Małgorzata Małodobra-Mazur and Miron Tokarski

Healthcare 2021, 9(7), 915; https://doi.org/10.3390/healthcare9070915 - 19 Jul 2021

Cited by 6 | Viewed by 3276

Abstract

Since the 2019 novel coronavirus outbreak began in Wuhan, China, diagnostic methods in the field of molecular biology have been developing faster than ever under the vigilant eye of world’s research community. Unfortunately, the medical community was not prepared for testing such large [...] Read more.

Since the 2019 novel coronavirus outbreak began in Wuhan, China, diagnostic methods in the field of molecular biology have been developing faster than ever under the vigilant eye of world’s research community. Unfortunately, the medical community was not prepared for testing such large volumes or ranges of biological materials, whether blood samples for antibody immunological testing, or salivary/swab samples for real-time PCR. For this reason, many medical diagnostic laboratories have made the switch to working in the field of molecular biology, and research undertaken to speed up the flow of samples through laboratory. The aim of this narrative review is to evaluate the current literature on laboratory techniques for the diagnosis of SARS-CoV-2 infection available on pubmed.gov, Google Scholar, and according to the writers’ knowledge and experience of the laboratory medicine. It assesses the available information in the field of molecular biology by comparing real-time PCR, LAMP technique, RNA sequencing, and immunological diagnostics, and examines the newest techniques along with their limitations for use in SARS-CoV-2 diagnostics. Full article

(This article belongs to the Special Issue COVID-19 Pandemic: Challenges Facing the Health System)

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9 pages, 418 KiB

Open AccessFeature PaperArticle

Knowledge, Perception, and Performance of Hand Hygiene and Their Correlation among Nursing Students in Republic of Korea

by Hyang Soon Oh

Healthcare 2021, 9(7), 913; https://doi.org/10.3390/healthcare9070913 - 19 Jul 2021

Cited by 4 | Viewed by 2966

Abstract

Recently, various outbreaks of newly emerging or reemerging diseases are expected more frequently and regularly. The importance of hand hygiene (HH) competency of nursing students (NS) is further required as a crucial learning objective of nursing education in universities. Purpose: This study aimed [...] Read more.

Recently, various outbreaks of newly emerging or reemerging diseases are expected more frequently and regularly. The importance of hand hygiene (HH) competency of nursing students (NS) is further required as a crucial learning objective of nursing education in universities. Purpose: This study aimed to investigate knowledge, perception, and performance of HH among NS and analyze their correlation. Methods: A cross-sectional questionnaire (modified from a World Health Organization questionnaire) was conducted from 23 November to 22 December 2019; 233 responses were used for the final analysis. Results: The average scores (mean ± standard deviation (range)) for knowledge, perception, and performance of HH were 17.82 ± 2.15 (0–25), 77.24 ± 10.78 (15–96), and 67.42 ± 23.10 (0–100), respectively. No significant variables were discovered to the knowledge of HH. Grade, university-affiliated hospitals, and the most recent healthcare institute of clinical practice nursing course significantly affected perceptions of HH (p < 0.039, p = 044, p < 0.001). Knowledge of HH was positively correlated with performance of HH (p = 0.002). The perception and the performance of HH of NS were positively correlated with HH performance of healthcare workers (HCWs); p < 0.001, p = 0.002. Conclusion: HH education for NS is crucial for improving the performance and the knowledge of HH. Good HH performance of healthcare workers (HCWs) can contribute to increased perception and performance of HH among NS. The cooperation of nursing education in a university and clinical practice with competent HCWs in healthcare institutions may create an effective education program for good HH performance of NS, who will be nurses during unpredictable pandemics. Full article

(This article belongs to the Special Issue Innovations in Ecological Public Health and Health Education)

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11 pages, 1453 KiB

Open AccessArticle

The Effect of Post-Graduate Year Training on the Self-Efficacy and Emotional Traits of Physicians Facing the COVID-19 Pandemic

by Chih-Hung Chen, Ya-Hui Cheng, Yuan-Chi Shen, Chia-Te Kung, Peng-Chen Chien and Ching-Hua Hsieh

Healthcare 2021, 9(7), 912; https://doi.org/10.3390/healthcare9070912 - 19 Jul 2021

Viewed by 2639

Abstract

Background: Taiwan implemented the post-graduate year (PGY) training to reform the medical education system to provide holistic medical care after severe acute respiratory syndrome in 2003. In late 2019, COVID-19 quickly spread across the globe and became a pandemic crisis. This study aimed [...] Read more.

Background: Taiwan implemented the post-graduate year (PGY) training to reform the medical education system to provide holistic medical care after severe acute respiratory syndrome in 2003. In late 2019, COVID-19 quickly spread across the globe and became a pandemic crisis. This study aimed to investigate whether the establishment of the PGY training had positive effects on the self-efficacy and emotional traits of medical workers. Methods: One hundred and ten physicians, including PGY, residents, and visiting staff, were investigated using the General Self-Efficacy Scale (GSES) and Emotional Trait and State Scale (ETSS), and their feedback and suggestions were collected. An exploratory factor analysis was done to reduce the factor dimensions using the varimax rotation method, which was reduced to four factors: “the ability to cope with ease”, “proactive ability”, “negative emotion”, and “positive emotion”. A comparison with and without PGY training when facing the COVID-19 pandemic was conducted. Results: Those who had received PGY training (n = 77) were younger, had a lower grade of seniority, and had less practical experience than those who had not received PGY (n = 33). Those who had received PGY training had significantly higher scores for the factors “ability to cope with ease”, “proactive ability”, and “positive emotion” than those who had not received PGY training. Conclusion: The study revealed that PGY training may have had positive effects on the personal self-efficacy and emotional traits of physicians coping with the COVID-19 pandemic. Full article

(This article belongs to the Collection COVID-19: Impact on Public Health and Healthcare)

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14 pages, 3870 KiB

Open AccessCommunication

Modeling and Predicting the Cell Migration Properties from Scratch Wound Healing Assay on Cisplatin-Resistant Ovarian Cancer Cell Lines Using Artificial Neural Network

by Entaz Bahar and Hyonok Yoon

Healthcare 2021, 9(7), 911; https://doi.org/10.3390/healthcare9070911 - 19 Jul 2021

Cited by 17 | Viewed by 6324

Abstract

The study of artificial neural networks (ANN) has undergone a tremendous revolution in recent years, boosted by deep learning tools. The presence of a greater number of learning tools and their applications, in particular, favors this revolution. However, there is a significant need [...] Read more.

The study of artificial neural networks (ANN) has undergone a tremendous revolution in recent years, boosted by deep learning tools. The presence of a greater number of learning tools and their applications, in particular, favors this revolution. However, there is a significant need to deal with the issue of implementing a systematic method during the development phase of the ANN to increase its performance. A multilayer feedforward neural network (FNN) was proposed in this paper to predict the cell migration assay on cisplatin-sensitive and cisplatin-resistant (CisR) ovarian cancer (OC) cell lines via scratch wound healing assay. An FNN training algorithm model was generated using the MATLAB fitting function in a MATLAB script to accomplish this task. The input parameters were types of cell lines, times, and wound area, and outputs were relative wound area, percentage of wound closure, and wound healing speed. In addition, we tested and compared the initial accuracy of various supervised learning classifier and support vector regression (SVR) algorithms. The proposed ANN model achieved good agreement with the experimental data and minimized error between the estimated and experimental values. The conclusions drawn demonstrate that the developed ANN model is a useful, accurate, fast, and inexpensive method to predict cancerous cell migration characteristics evaluated via scratch wound healing assay. Full article

(This article belongs to the Special Issue Artificial Intelligence Developments for Medical Diagnosis and Monitoring)

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15 pages, 731 KiB

Open AccessArticle

A Short Mindfulness Retreat for Students to Reduce Stress and Promote Self-Compassion: Pilot Randomised Controlled Trial Exploring Both an Indoor and a Natural Outdoor Retreat Setting

by Dorthe Djernis, Mia S. O’Toole, Lone O. Fjorback, Helle Svenningsen, Mimi Y. Mehlsen, Ulrika K. Stigsdotter and Jesper Dahlgaard

Healthcare 2021, 9(7), 910; https://doi.org/10.3390/healthcare9070910 - 18 Jul 2021

Cited by 10 | Viewed by 4878

Abstract

Here, we developed and examined a new way of disseminating mindfulness in nature to people without meditation experience, based on the finding that mindfulness conducted in natural settings may have added benefits. We evaluated a 5-day residential programme aiming to reduce stress and [...] Read more.

Here, we developed and examined a new way of disseminating mindfulness in nature to people without meditation experience, based on the finding that mindfulness conducted in natural settings may have added benefits. We evaluated a 5-day residential programme aiming to reduce stress and improve mental health outcomes. We compared an indoor and an outdoor version of the programme to a control group in a pilot randomised controlled trial (RCT). Sixty Danish university students experiencing moderate to high levels of stress were randomised into a residential mindfulness programme indoors (n = 20), in nature (n = 22), or a control group (n = 18). Participants completed the Perceived Stress Scale and the Self-Compassion Scale (primary outcomes) along with additional secondary outcome measures at the start and end of the program and 3 months after. Stress was decreased with small to medium effect sizes post-intervention, although not statistically significant. Self-compassion increased post-intervention, but effect sizes were small and not significant. At follow-up, changes in stress were not significant, however self-compassion increased for both interventions with medium-sized effects. For the intervention groups, medium- to large-sized positive effects on trait mindfulness after a behavioural task were found post-intervention, and small- to medium-sized effects in self-reported mindfulness were seen at follow-up. Connectedness to Nature was the only outcome measure with an incremental effect in nature, exceeding the control with a medium-sized effect at follow-up. All participants in the nature arm completed the intervention, and so did 97% of the participants in all three arms. Overall, the results encourage the conduct of a larger-scale RCT, but only after adjusting some elements of the programme to better fit and take advantage of the potential benefits of the natural environment. Full article

(This article belongs to the Special Issue Outdoor and Nature Therapy)

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10 pages, 814 KiB

Open AccessArticle

Influences of Lavender Essential Oil Inhalation on Stress Responses during Short-Duration Sleep Cycles: A Pilot Study

by Wakako Yogi, Mana Tsukada, Yosuke Sato, Takuji Izuno, Tatsuki Inoue, Yoshiki Tsunokawa, Takayuki Okumo, Tadashi Hisamitsu and Masataka Sunagawa

Healthcare 2021, 9(7), 909; https://doi.org/10.3390/healthcare9070909 - 18 Jul 2021

Cited by 6 | Viewed by 6900

Abstract

Lavender essential oil (LEO) was reported to improve sleep quality. We investigated the influence of aromatherapy by testing the effects of LEO on stress responses during a short-duration sleep in a single-blind, randomized, crossover trial. The subjects were twelve healthy adults who were [...] Read more.

Lavender essential oil (LEO) was reported to improve sleep quality. We investigated the influence of aromatherapy by testing the effects of LEO on stress responses during a short-duration sleep in a single-blind, randomized, crossover trial. The subjects were twelve healthy adults who were nonsmokers without any known disease and who were not prescribed medications, and nine of these completed the study. After the subjects had fallen asleep, they were sprayed with LEO using an aroma diffuser. Before and after 90 min of sleep, α-amylase, chromogranin A (CgA), and cortisol levels in saliva were measured as objective stress indicators, and the Japanese version of the UWIST Mood Adjective Checklist was used as a subjective indicator. A comparison of changes before and after sleep, with and without LEO, revealed that the cortisol level did not significantly change; however, α-amylase (p < 0.05) and CgA (p < 0.01) levels significantly decreased after LEO inhalation. A mood test indicated no change in mood before and after sleep, with or without LEO. Since α-amylase and CgA reflect the sympathetic nervous system response, these results indicate that LEO aromatherapy during a short-duration sleep cycle suppresses the stress response, especially that of the sympathetic nervous system. Full article

(This article belongs to the Collection Integrative, Complementary and Alternative Medicine (CAM) in Healthcare)

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11 pages, 243 KiB

Open AccessArticle

The Impact of China’s Zero Markup Drug Policy on Hospitalization Expenses for Inpatients in Tertiary Public Hospitals: Evidence Based on Quantile Difference-in-Difference Models

by Ziling Ni, Jie Jia, Lu Cui, Siyu Zhou and Xiaohe Wang

Healthcare 2021, 9(7), 908; https://doi.org/10.3390/healthcare9070908 - 18 Jul 2021

Cited by 9 | Viewed by 2585

Abstract

Objectives: The aim of this study was to determine the impact of the Zero Markup drug (ZMD) policy on hospitalization expenses for inpatients in tertiary Chinese hospitals. Methods: Using the administrative data from hospital electronic health records (EHRs) between 2015 and 2017, we [...] Read more.

Objectives: The aim of this study was to determine the impact of the Zero Markup drug (ZMD) policy on hospitalization expenses for inpatients in tertiary Chinese hospitals. Methods: Using the administrative data from hospital electronic health records (EHRs) between 2015 and 2017, we implemented the quantile difference-in-differences (QDID) estimators to evaluate the impact of the ZMD policy on hospitalization expenses while controlling for patient-level and hospital-level characteristics. Results: According to the QDID models, the introduction of ZMD policy significantly induced lower drug costs for all inpatients especially at the 50th (-USD 507.84 (SE = USD 90.91), 75th (-USD 844.77 (SE = USD 149.70), and 90th (-USD 1400.00 (SE = USD 209.97)) percentiles of the overall distributions. However, the total hospitalization, diagnostic, treatment, material and services expenses for inpatients were significantly higher for the treated group than the control group. This tendency was more pronounced for inpatients in tertiary hospitals with lower expenses (in the 10th, 25th and 50th percentiles). Conclusion: The implementation of ZMD policy alone may not be enough to change the medical service providers’ profit-driven behavior. The targeted supervision of hospital costs by the Chinese health administration department should be strengthened to avoid unreasonable hospital charges. Full article

(This article belongs to the Special Issue Health Care Management and Cost Estimation)

10 pages, 554 KiB

Open AccessArticle

The Economic Burden Associated with the Management of Different Stages of Breast Cancer: A Retrospective Cost of Illness Analysis in Saudi Arabia

by Ahmed Alghamdi, Bander Balkhi, Shahad Alqahtani and Hamoud Almotairi

Healthcare 2021, 9(7), 907; https://doi.org/10.3390/healthcare9070907 - 18 Jul 2021

Cited by 16 | Viewed by 5458

Abstract

Globally, breast cancer management is associated with a heavy economic burden, but its impact in Saudi Arabia has not been fully quantified. The aim of this study was to estimate the economic burden of breast cancer management at various disease stages, in Saudi [...] Read more.

Globally, breast cancer management is associated with a heavy economic burden, but its impact in Saudi Arabia has not been fully quantified. The aim of this study was to estimate the economic burden of breast cancer management at various disease stages, in Saudi Arabia, from a payer perspective. We conducted a retrospective, multicenter cost of illness study in two governmental healthcare centers from January to December 2018, using the data of 300 patients at different breast cancer stages. A micro-costing, bottom-up method was used, and descriptive and inferential statistics were analyzed. The total estimated cost for treating breast cancer during the study period was $13.345 million USD, with the average cost per patient ranging from $14,249 USD in stage I to $81,489 USD in stage IV (p < 0.001). Medication cost was the main driver of total healthcare spending, followed by hospitalization and diagnostic tests. The cost of targeted therapy drugs represented 67% of the total medication costs, mostly driven by trastuzumab-based regimens. The economic burden of breast cancer management in Saudi Arabia is substantial and increases significantly with disease advancement. Early detection screening programs, evaluating the value of highly expensive interventions, and considering biosimilars, may contribute toward cost savings. Full article

(This article belongs to the Collection Health Economics & Finance and Global Public Health)

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10 pages, 673 KiB

Open AccessFeature PaperArticle

Lessons Learned from Introducing Last Aid Courses at a University Hospital in Germany

by Evelyn Mueller, Georg Bollig, Gerhild Becker and Christopher Boehlke

Healthcare 2021, 9(7), 906; https://doi.org/10.3390/healthcare9070906 - 16 Jul 2021

Cited by 3 | Viewed by 2139

Abstract

In recent years, so called “Last Aid courses”, concerning end-of-life care for people dying, have successfully been established in community settings in several European countries, Australia, and South-America. To date, they have not been evaluated in hospital settings, where educational needs (concerning care [...] Read more.

In recent years, so called “Last Aid courses”, concerning end-of-life care for people dying, have successfully been established in community settings in several European countries, Australia, and South-America. To date, they have not been evaluated in hospital settings, where educational needs (concerning care of the dying) are especially high, and may differ from the general population. To evaluate if Last Aid courses are feasible in hospital settings, and if informational needs of hospital staff are met by the curriculum, we introduced Last Aid courses at a university hospital. Five courses were offered; participants of courses 1 and 2 completed surveys with open-ended questions; the answers were used to develop the evaluation questionnaire employed in courses 3–5. In these three courses, 55 of the 56 participants completed an evaluation survey to explore their learning goals and obtain feedback. Courses were fully booked; participants were heterogeneous with regard to their professional background. The most prevalent learning goals were “preparation for emotional aspects in care of dying” (65.5% ratings “very important”), “preparation for medical/care aspects in care of dying” (60.0%), and “knowledge of supportive services and facilities” (54.5%). Overall, the evaluation showed that Last Aid courses were more suitable to educate non-medical hospital staff about care of the dying. Medical staff, in contrast to non-medical staff, more often requested courses with an extended curriculum in order to meet their learning goals. Last Aid courses were well accepted and helped to reduce information deficits on care of the dying in a heterogeneous population of hospital staff. Full article

(This article belongs to the Special Issue Public Health Palliative Care and Public Palliative Care Education)

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14 pages, 697 KiB

Open AccessArticle

Implementation of the Multidisciplinary Guideline on Chronic Pain in Vulnerable Nursing Home Residents to Improve Recognition and Treatment: A Qualitative Process Evaluation

by Lizanne E. van den Akker, Margot W. M. de Waal, Paul J. E. M. Geels, Else Poot and Wilco P. Achterberg

Healthcare 2021, 9(7), 905; https://doi.org/10.3390/healthcare9070905 - 16 Jul 2021

Cited by 4 | Viewed by 2944

Abstract

The recognition and treatment of pain in nursing home residents presents challenges best addressed by a multidisciplinary approach. This approach is also recommended in the applicable Dutch guideline; however, translating guidelines into practical strategies is often difficult in nursing homes. Nevertheless, a better [...] Read more.

The recognition and treatment of pain in nursing home residents presents challenges best addressed by a multidisciplinary approach. This approach is also recommended in the applicable Dutch guideline; however, translating guidelines into practical strategies is often difficult in nursing homes. Nevertheless, a better understanding of guideline implementation is key to improving the quality of care. Here we describe and qualitatively evaluate the implementation process of the multidisciplinary guideline ‘Recognition and treatment of chronic pain in vulnerable elderly’ in a Dutch nursing home. The researchers used interviews and document analyses to study the nursing home’s implementation of the guideline. The project team of the nursing home first filled out an implementation matrix to formulate goals based on preferred knowledge, attitudes, and behaviors for the defined target groups. Together with experts and organizations, pharmacotherapy audit meetings were organized, an expert pain team was appointed, a policy document and policy flowchart were prepared, and ‘anchor personnel’ were assigned to disseminate knowledge amongst professionals. Implementation was partially successful and resulted in a functioning pain team, a pain policy, the selection of preferred measurement instruments, and pain becoming a fixed topic during multidisciplinary meetings. Nevertheless, relatively few professionals were aware of the implementation process. Full article

(This article belongs to the Special Issue Problems for Managing Chronic Pain)

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12 pages, 395 KiB

Open AccessArticle

An Incentive-Based Framework for Analyzing the Alignment of Institutional Interventions in the Public Primary Healthcare Sector: The Portuguese Case

by Miguel Alves Pereira, Rui Cunha Marques and Diogo Cunha Ferreira

Healthcare 2021, 9(7), 904; https://doi.org/10.3390/healthcare9070904 - 16 Jul 2021

Cited by 13 | Viewed by 2509

Abstract

Over the years, the Portuguese National Health Service has undergone several reforms to face the challenges posed by internal and external factors on the access to and quality of its health services. One of its most recent reforms addressed the primary healthcare sector, [...] Read more.

Over the years, the Portuguese National Health Service has undergone several reforms to face the challenges posed by internal and external factors on the access to and quality of its health services. One of its most recent reforms addressed the primary healthcare sector, where understanding the incentives behind the actors of the inherent institutional interventions and how they are aligned with the governing health policies is paramount for reformative success. With the purpose of acknowledging the alignment of the primary healthcare sector’s institutional interventions from an incentive-based perspective, we propose a framework resting on a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis, which was built in cooperation with a panel of decision-making actors from the Portuguese Ministry of Health. In the end, we derive possible policy implications and strategies. This holistic approach highlighted the positive impact of the primary healthcare reform in the upgrade of physical resources and human capital but stressed the geosocial asymmetries and the lack of intra- and inter-sectorial coordination. The proposed framework serves also as a guideline for future primary healthcare reforms, both national- and internationally. Full article

(This article belongs to the Section Health Policy)

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11 pages, 255 KiB

Open AccessFeature PaperArticle

Cross-National Study of Worrying, Loneliness, and Mental Health during the COVID-19 Pandemic: A Comparison between Individuals with and without Infection in the Family

by Tore Bonsaksen, Janni Leung, Mariyana Schoultz, Hilde Thygesen, Daicia Price, Mary Ruffolo and Amy Østertun Geirdal

Healthcare 2021, 9(7), 903; https://doi.org/10.3390/healthcare9070903 - 16 Jul 2021

Cited by 13 | Viewed by 3617

Abstract

Objective: The objective of this study was to examine differences in worry, loneliness, and mental health between those individuals infected by COVID-19 or having someone their family infected, and the rest of the population. Methods: A cross-sectional online survey was conducted in Norway, [...] Read more.

Objective: The objective of this study was to examine differences in worry, loneliness, and mental health between those individuals infected by COVID-19 or having someone their family infected, and the rest of the population. Methods: A cross-sectional online survey was conducted in Norway, UK, USA, and Australia during April/May 2020. Participants (n = 3810) were recruited via social media postings by the researchers and the involved universities. Differences between those with and without infection in the family were investigated with chi-square tests and independent t-tests. Multiple regression analyses were used to assess associations between sociodemographic variables and psychological outcomes (worry, loneliness, and mental health) in both groups. Results: Compared to their counterparts, participants with infection in the family reported higher levels of worries about themselves (p < 0.05) and their family members (p < 0.001) and had poorer mental health (p < 0.05). However, the effect sizes related to the differences were small. The largest effect (d = 0.24) concerned worries about their immediate family. Poorer psychological outcomes were observed in those who were younger, female, unemployed, living alone and had lower levels of education, yet with small effect sizes. Conclusions: In view of the small differences between those with and without infection, we generally conclude that the mental health effects of the COVID-19 situation are not limited to those who have been infected or have had an infection within the family but extend to the wider population. Full article

(This article belongs to the Section Coronaviruses (CoV) and COVID-19 Pandemic)

9 pages, 846 KiB

Open AccessArticle

Tumor Characteristic Variations between Symptomatic and Asymptomatic Endometrial Cancer

by Petra Vinklerová, Markéta Bednaříková, Luboš Minář, Michal Felsinger, Jitka Hausnerová, Petra Ovesná and Vít Weinberger

Healthcare 2021, 9(7), 902; https://doi.org/10.3390/healthcare9070902 - 16 Jul 2021

Cited by 1 | Viewed by 2586

Abstract

Endometrial cancer is the most common gynecologic malignancy in Europe and usually diagnosed in its initial stage owing to early symptoms of abnormal bleeding. There is no population screening for this disease, although it can sometimes be accidentally diagnosed in asymptomatic patients. Our [...] Read more.

Endometrial cancer is the most common gynecologic malignancy in Europe and usually diagnosed in its initial stage owing to early symptoms of abnormal bleeding. There is no population screening for this disease, although it can sometimes be accidentally diagnosed in asymptomatic patients. Our study aims to determine differences in clinical and tumor characteristics between an asymptomatic and symptomatic group of patients. This unicentric prospective observational study took place in University Hospital Brno between January 2016 and December 2019. A total of 264 patients met inclusion criteria (26% asymptomatic, 74% with reported symptoms). We did not find a statistically significant difference in clinical characteristics (menopausal status, parity, age, BMI, and serum level of CA 125) between groups. According to ultrasound examination, bleeding tumors were larger (19.5 vs. 12.7 mm, p ≤ 0.001). Definitive histology results indicated more frequent lymphovascular space invasion (p < 0.001), along with deep myometrial (p = 0.001) and cervical (p = 0.002) invasion. There was no difference in advanced stages of the tumor. We did not substantiate statistically significant difference in immunohistochemical profile (estrogen and progesterone receptors, L1 cell adhesion molecule, tumor protein p53), which is relevant for tumor recurrence risk and survival capacity. Our conclusions affirmed that bleeding occurs more often among patients with local tumor invasion into the myometrium and cervical stroma. Final International Federation of Gynecology and Obstetrics (FIGO) stage, histology, and immunohistochemical characteristics do not significantly affect symptom appearance. Full article

(This article belongs to the Special Issue Diagnosis and Treatment for Women's Health)

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10 pages, 623 KiB

Open AccessArticle

Tropical Australian Health-Data Linkage Shows Excess Mortality Following Severe Infectious Disease Is Present in the Short-Term and Long-Term after Hospital Discharge

by Oyelola A. Adegboye, Emma S. McBryde and Damon P. Eisen

Healthcare 2021, 9(7), 901; https://doi.org/10.3390/healthcare9070901 - 15 Jul 2021

Cited by 1 | Viewed by 2099

Abstract

Background: In this study, we aimed to assess the risk factors associated with mortality due to an infectious disease over the short-, medium-, and long-term based on a data-linkage study for patients discharged from an infectious disease unit in North Queensland, Australia, between [...] Read more.

Background: In this study, we aimed to assess the risk factors associated with mortality due to an infectious disease over the short-, medium-, and long-term based on a data-linkage study for patients discharged from an infectious disease unit in North Queensland, Australia, between 2006 and 2011. Methods: Age-sex standardised mortality rates (SMR) for different subgroups were estimated, and the Kaplan-Meier method was used to estimate and compare the survival experience among different groups. Results: Overall, the mortality rate in the hospital cohort was higher than expected in comparison with the Queensland population (SMR: 15.3, 95%CI: 14.9–15.6). The long-term mortality risks were significantly higher for severe infectious diseases than non-infectious diseases for male sex, Indigenous, residential aged care and elderly individuals. Conclusion: In general, male sex, Indigenous status, age and comorbidity were associated with an increased hazard for all-cause deaths. Full article

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10 pages, 1551 KiB

Open AccessArticle

Mechanical Changes of the Lumbar Intervertebral Space and Lordotic Angle Caused by Posterior-to-Anterior Traction Using a Spinal Thermal Massage Device in Healthy People

by Yong-Soon Yoon, Jong-Hoo Lee, Mihyun Lee, Ka-Eun Kim, Hong-Young Jang, Kyu-Jae Lee, Johny Bajgai, Cheol-Su Kim and Il-Young Cho

Healthcare 2021, 9(7), 900; https://doi.org/10.3390/healthcare9070900 - 15 Jul 2021

Cited by 5 | Viewed by 4477

Abstract

Background: The axial (horizontal) traction approach has been traditionally used for treatment of low back pain-related spinal disorders such as nuclear protrusion, primary posterolateral root pain, and lower thoracic disc herniation; however, it is known to have some technical limitations due to reductions [...] Read more.

Background: The axial (horizontal) traction approach has been traditionally used for treatment of low back pain-related spinal disorders such as nuclear protrusion, primary posterolateral root pain, and lower thoracic disc herniation; however, it is known to have some technical limitations due to reductions of the spinal curve. Lumbar lordosis plays a pivotal function in maintaining sagittal balance. Recently, vertical traction and combination traction have been attracting attention due to improving therapeutic outcomes, although evidence of their clinical application is rare; therefore, this study was conducted to investigate the mechanical changes of lumbar intervertebral space, lordotic angle, and the central spinal canal area through vertical traction treatment using a spinal massage device in healthy participants. Methods: In total, 10 healthy subjects with no musculoskeletal disorders and no physical activity restrictions participated. The participants lay on the experimental device (CGM MB-1901) in supine extended posture and vertical traction force was applied in a posterior-to-anterior direction on the L3–4 and L4–5 lumbar sections at level 1 (baseline) and level 9 (traction mode). Magnetic resonance (MR) images were recorded directly under traction mode using the MRI scanner. The height values of the intervertebral space (anterior, center, and posterior parts) and lordosis angle of the L3–4 and L4–5 sections were measured using Image J software and the central spinal canal area (L4–5) was observed through superimposition method using the MR images. All measurement and image analyses were conducted by 2 experienced radiologists under a single-blinded method. Results: The average height values of the intervertebral space under traction mode were significantly increased in both L3–4 and L4–5 sections compared to baseline, particularly in the anterior and central parts but not in the posterior part. Cobb’s angle also showed significant increases in both L3–4 and L4–5 sections compared to baseline (p < 0.001). The central spinal canal area showed a slightly expanded feature in traction mode. Conclusions: In this pilot experiment, posterior-to-anterior vertical traction on L3–4 and L4–5 sections using a spinal massage device caused positive and significant changes based on increases of the intervertebral space height, lumbar lordosis angle, and central spinal canal area compared to the baseline condition. Our results are expected to be useful as underlying data for the clinical application of vertical traction. Full article

(This article belongs to the Special Issue Vertebral Related Diseases in Healthcare: The Role of Pain Management and Rehabilitation)

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12 pages, 484 KiB

Open AccessArticle

Prediction of Cardiovascular Risk Using Nonalcoholic Fatty Liver Disease Scoring Systems

by Ye-Na Kweon, Hae-Jin Ko, A-Sol Kim, Hye-In Choi, Ji-Eun Song, Ji-Yeon Park, Sung-Min Kim, Hee-Eun Hong and Kyung-Jin Min

Healthcare 2021, 9(7), 899; https://doi.org/10.3390/healthcare9070899 - 15 Jul 2021

Cited by 7 | Viewed by 2309

Abstract

This study aimed to determine whether nonalcoholic fatty liver disease (NAFLD) is an independent risk factor for CVD and to identify the most useful NAFLD diagnostic tool for predicting CVD. Data from a total of 23,376 Korean adults without established CVD were analyzed. [...] Read more.

This study aimed to determine whether nonalcoholic fatty liver disease (NAFLD) is an independent risk factor for CVD and to identify the most useful NAFLD diagnostic tool for predicting CVD. Data from a total of 23,376 Korean adults without established CVD were analyzed. Cardiovascular risk was calculated using the Framingham Risk Score (FRS) 2008. The presence of NAFLD was defined as moderate-to-severe fatty liver disease diagnosed by ultrasonography. Scores for fatty liver were calculated using four NAFLD scoring systems (Fatty Liver Index, FLI; Hepatic Steatosis Index, HSI; Simple NAFLD Score, SNS; Comprehensive NAFLD Score, CNS), and were compared and analyzed according to cardiovascular risk group. Using the FRS, 67.4% of participants were considered to be at low risk of CVD, 21.5% at intermediate risk, and 11.1% at high risk. As the risk of CVD increased, both the prevalence of NAFLD and the score from each NAFLD scoring system increased significantly (p < 0.001). In the unadjusted analysis, the CNS had the strongest association with high CVD risk; in the adjusted analysis, the FLI score was most strongly associated with high CVD risk. Fatty liver is an important independent risk factor for CVD. Therefore, the available NAFLD scoring systems could be utilized to predict CVD. Full article

(This article belongs to the Special Issue Family Medicine: Opportunities and Challenges for Primary Healthcare)

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19 pages, 1774 KiB

Open AccessFeature PaperArticle

Understanding the Evolution of Government Attention in Response to COVID-19 in China: A Topic Modeling Approach

by Quan Cheng, Jianhua Kang and Minwang Lin

Healthcare 2021, 9(7), 898; https://doi.org/10.3390/healthcare9070898 - 15 Jul 2021

Cited by 14 | Viewed by 3509

Abstract

The effective control over the outbreak of COVID-19 in China showcases a prompt government response, in which, however, the allocation of attention, as an essential parameter, remains obscure. This study is designed to clarify the evolution of the Chinese government’s attention in tackling [...] Read more.

The effective control over the outbreak of COVID-19 in China showcases a prompt government response, in which, however, the allocation of attention, as an essential parameter, remains obscure. This study is designed to clarify the evolution of the Chinese government’s attention in tackling the pandemic. To this end, 674 policy documents issued by the State Council of China are collected to establish a text corpus, which is then used to extract policy topics by applying the latent dirichlet allocation (LDA) model, a topic modelling approach. It is found that the response policies take different tracks in a four-stage controlling process, and five policy topics are identified as major government attention areas in all stages. Moreover, a topic evolution path is highlighted to show internal relationships between different policy topics. These findings shed light on the Chinese government’s dynamic response to the pandemic and indicate the strength of applying adaptive governance strategies in coping with public health emergencies. Full article

(This article belongs to the Collection Health Economics & Finance and Global Public Health)

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10 pages, 868 KiB

Open AccessArticle

A Greek Validation Study of the Multiple Sclerosis Work Difficulties Questionnaire-23

by Christos Bakirtzis, Artemios Artemiadis, Elli Nteli, Marina Kleopatra Boziki, Maria-Valeria Karakasi, Cynthia Honan, Lambros Messinis, Grigorios Nasios, Efthimios Dardiotis and Nikolaos Grigoriadis

Healthcare 2021, 9(7), 897; https://doi.org/10.3390/healthcare9070897 - 15 Jul 2021

Cited by 3 | Viewed by 2757

Abstract

The Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23) is a self-report instrument developed to assess barriers faced by People with Multiple Sclerosis (PwMS) in the workplace. The aim of this study was to explore the psychometric properties of the Greek version of the MSWDQ-23. [...] Read more.

The Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23) is a self-report instrument developed to assess barriers faced by People with Multiple Sclerosis (PwMS) in the workplace. The aim of this study was to explore the psychometric properties of the Greek version of the MSWDQ-23. The study sample consisted of 196 PwMS, all currently working in part- or full-time jobs. Participants underwent clinical examination and cognitive screening with the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and completed self-report measures of fatigue, psychological functioning, and quality of life, along with the MSWDQ-23 questionnaire. Confirmatory Factor Analysis (CFA) was performed, and goodness-of-fit measures were used to evaluate construct validity. Convergent validity was checked by correlating MSWDQ-23 scores with study measures. Cronbach’s alpha value was produced to assess internal consistency. CFA yielded a model with a fair fit confirming the three-factor structure of the instrument. Higher work difficulties were associated with higher Expanded Disability Status Scale (EDSS) scores, poorer cognitive function, more fatigue, stress, anxiety, and depression, and poorer health status, supporting the convergent validity of MSWDQ-23. Internal consistency (Cronbach’s alpha = 0.94) and test–retest reliability (ICC = 0.996, 95%, CI = 0.990–0.998) were excellent. The Greek MSWDQ-23 can be considered a valid patient-reported outcome measure and can be used in interventions aiming to improve the vocational status of PwMS. Full article

(This article belongs to the Special Issue Neurorehabilitation: Looking Back and Moving Forward)

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14 pages, 268 KiB

Open AccessArticle

Comparison of Stigmatization of Suicidal People by Medical Professionals with Stigmatization by the General Population

by Jill Julia Eilers, Erich Kasten and Thomas Schnell

Healthcare 2021, 9(7), 896; https://doi.org/10.3390/healthcare9070896 - 15 Jul 2021

Cited by 3 | Viewed by 2024

Abstract

Stigmatization of suicide (SOS) affects help-seeking for suicidality and impedes successful treatment. This study aimed to identify different types of stigmatization and understand the causes and glorification of suicide by comparing three groups; within each of the following groups, the impact of age [...] Read more.

Stigmatization of suicide (SOS) affects help-seeking for suicidality and impedes successful treatment. This study aimed to identify different types of stigmatization and understand the causes and glorification of suicide by comparing three groups; within each of the following groups, the impact of age and gender was explored: (1) practicing medical professional in direct contact with suicidality (psychotherapists, psychiatrists, related medical professions (nurses, etc.)), (2) future medical professionals still in training, (3) and the general population with no professional contact with suicidality. German adults completed an online survey with a total of 742 participants. A MANCOVA was calculated with age and gender being controlled as covariates, due to different distribution. Practicing professionals showed significantly higher levels of SOS than the other groups, while the future professionals showed no differences in SOS from the general population. The understanding of suicide causes was similar across all groups. Men showed higher levels of SOS than women, while women scored higher at understanding of causes and glorification of suicide. Within the individual groups, female professionals in the age group “36–65 years” stigmatized suicide most, while showing the least glorification. The results suggest that tendencies towards SOS are promoted by practical experience with suicidality. Therefore, special training is recommended to reduce SOS. Full article

(This article belongs to the Special Issue Patient Safety, Human Factors, and Simulation and Their Impact upon the Delivery and Quality of Healthcare)

14 pages, 685 KiB

Open AccessArticle

Clinical Factors Associated with COVID-19 Severity in Mexican Patients: Cross-Sectional Analysis from a Multicentric Hospital Study

by Joel Monárrez-Espino, Carolina Ivette Zubía-Nevárez, Lorena Reyes-Silva, Juan Pablo Castillo-Palencia, Julio Enrique Castañeda-Delgado, Ana Sofía Herrera van-Oostdam and Yamilé López-Hernández

Healthcare 2021, 9(7), 895; https://doi.org/10.3390/healthcare9070895 - 15 Jul 2021

Cited by 4 | Viewed by 2233

Abstract

(1) Background: Latin America has been harshly hit by SARS-CoV-2, but reporting from this region is still incomplete. This study aimed at identifying and comparing clinical characteristics of patients with COVID-19 at different stages of disease severity. (2) Methods: Cross-sectional multicentric study. Individuals [...] Read more.

(1) Background: Latin America has been harshly hit by SARS-CoV-2, but reporting from this region is still incomplete. This study aimed at identifying and comparing clinical characteristics of patients with COVID-19 at different stages of disease severity. (2) Methods: Cross-sectional multicentric study. Individuals with nasopharyngeal PCR were categorized into four groups: (1) negative, (2) positive, not hospitalized, (3) positive, hospitalized with/without supplementary oxygen, and (4) positive, intubated. Clinical and laboratory data were compared, using group 1 as the reference. Multivariate multinomial logistic regression was used to compare adjusted odds ratios. (3) Results: Nine variables remained in the model, explaining 76% of the variability. Men had increased odds, from 1.90 (95%CI 0.87–4.15) in the comparison of 2 vs. 1, to 3.66 (1.12–11.9) in 4 vs. 1. Diabetes and obesity were strong predictors. For diabetes, the odds for groups 2, 3, and 4 were 1.56 (0.29–8.16), 12.8 (2.50–65.8), and 16.1 (2.87–90.2); for obesity, these were 0.79 (0.31–2.05), 3.38 (1.04–10.9), and 4.10 (1.16–14.4), respectively. Fever, myalgia/arthralgia, cough, dyspnea, and neutrophilia were associated with the more severe COVID-19 group. Anosmia/dysgeusia were more likely to occur in group 2 (25.5; 2.51–259). (4) Conclusion: The results point to relevant differences in clinical and laboratory features of COVID-19 by level of severity that can be used in medical practice. Full article

(This article belongs to the Special Issue Novel Coronavirus (SARS-CoV-2) Outbreak: Epidemiology, Research and Implications for Public Health)

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13 pages, 1044 KiB

Open AccessArticle

Impacts of Human Robot Proxemics on Human Concentration-Training Games with Humanoid Robots

by Li Liu, Yangguang Liu and Xiao-Zhi Gao

Healthcare 2021, 9(7), 894; https://doi.org/10.3390/healthcare9070894 - 15 Jul 2021

Cited by 3 | Viewed by 2552

Abstract

The use of humanoid robots within a therapeutic role, that is, helping individuals with social disorders, is an emerging field, but it remains unexplored in terms of concentration training. To seamlessly integrate humanoid robots into concentration games, an investigation into the impacts of [...] Read more.

The use of humanoid robots within a therapeutic role, that is, helping individuals with social disorders, is an emerging field, but it remains unexplored in terms of concentration training. To seamlessly integrate humanoid robots into concentration games, an investigation into the impacts of human robot interactive proxemics on concentration-training games is particularly important. In the case of an epidemic diffusion especially—for example, during the COVID-19 pandemic—HRI games may help in the therapeutic phase, significantly reducing the risk of contagion. In this paper, concentration games were designed by action imitation involving 120 participants to verify the hypothesis. Action-imitation accuracy, the assessment of emotional expression, and a questionnaire were compared with analysis of variance (ANOVA). Experimental results showed that a 2 m distance and left-front orientation for a human and a robot are optimal for human robot interactive concentration training. In addition, females worked better than males did in HRI imitation games. This work supports some valuable suggestions for the development of HRI concentration-training technology, involving the designs of friendlier and more useful robots, and HRI game scenarios. Full article

(This article belongs to the Special Issue Rehabilitation and Robotics: Are They Working Well Together?)

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10 pages, 462 KiB

Open AccessArticle

COVID-19 Lockdown Effect on Not Institutionalized Patients with Dementia and Caregivers

by Rita Moretti, Paola Caruso, Mauro Giuffré and Claudio Tiribelli

Healthcare 2021, 9(7), 893; https://doi.org/10.3390/healthcare9070893 - 15 Jul 2021

Cited by 12 | Viewed by 2828

Abstract

SARS-COV-2 is a severe medical condition. Old patients are very vulnerable, but they have been studied only as institutionalized patients. During the lock-down, little attention is dedicated to old, demented patients who lived at home. This study wants to examine their behavioral reactions [...] Read more.

SARS-COV-2 is a severe medical condition. Old patients are very vulnerable, but they have been studied only as institutionalized patients. During the lock-down, little attention is dedicated to old, demented patients who lived at home. This study wants to examine their behavioral reactions by video-phone follow-up. We conducted a longitudinal study in subcortical vascular dementia (sVAD) patients. We enrolled 221 sVAD, not institutionalized patients. We divided sVAD patients into low-medium grade sVAD (A) and severe sVAD (B), based on neuroimaging severity degree and executive alterations. At baseline, at the end of lock-down, and two months later, global behavioral symptoms were recorded for each patient. We found significantly higher scores of general behavioral deterioration, anxiety, delusions, hallucinations and apathy after controlling for sVAD severity. The direct consequence was a drastic increment of psychotropic drugs prescribed and employed during the lock-down. Moreover, caregivers’ stress has been evaluated, together with their anxiety and depression levels. During the lock-down, their scores increased and reflected a severe worsening of their behavior. Our data demonstrate that social isolation induces a severe perception of loneliness and abandonment; these fears can exacerbate behavior disturbances in old-aged frail persons. Thus, these can be considered as indirect victims of SARS-COV-2. Full article

(This article belongs to the Special Issue Mental Health and Coping During COVID-19)

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11 pages, 603 KiB

Open AccessArticle

Spinal Orthoses Prescription for Vertebral Fragility Fractures by Italian Physical and Rehabilitation Medicine Physicians: The SPIN-VER Survey

by Alessandro de Sire, Antonio Ammendolia, Alessandra Gimigliano, Roberto Tiberi, Carlo Cisari and Marco Invernizzi

Healthcare 2021, 9(7), 892; https://doi.org/10.3390/healthcare9070892 - 15 Jul 2021

Cited by 10 | Viewed by 2407

Abstract

Vertebral fragility fractures (VFFs) are the most common type of osteoporotic fractures, related to pain and disability. In this scenario, physical and rehabilitative medicine (PRM) physicians prescribe a patient-tailored rehabilitation plan, including spinal orthoses. However, there is a high heterogeneity in the clinical [...] Read more.

Vertebral fragility fractures (VFFs) are the most common type of osteoporotic fractures, related to pain and disability. In this scenario, physical and rehabilitative medicine (PRM) physicians prescribe a patient-tailored rehabilitation plan, including spinal orthoses. However, there is a high heterogeneity in the clinical indications of spinal orthoses. Thus, the aim of this survey was to investigate common clinical practice in terms of the prescription of spinal orthoses. This nationwide cross-sectional survey recruited Italian PRM physicians commonly involved in the management of patients with VFFs. One hundred twenty-six PRM physicians completed the survey. The results showed that most PRM physicians prescribe spinal orthoses in outpatients suffering from VFFs (n = 106; 83.9%). The most prescribed spinal orthosis for acute VFF patients was the three-point rigid orthosis (n = 64; 50.8%), followed by the semirigid thoraco-lumbar orthosis (n: 20; 15.9%). However, most PRM physicians prescribed dynamic orthoses in outpatients with chronic VFFs (n = 66; 52.4%). Albeit that a correct management of VFFs is mandatory to improve pain and reduce disability, our findings highlighted uncertainty in the type of spinal orthosis prescription in both the acute and chronic VFF phase. Therefore, high-quality research trials are warranted to provide clear recommendations for the correct clinical management of VFF. Full article

(This article belongs to the Special Issue Vertebral Related Diseases in Healthcare: The Role of Pain Management and Rehabilitation)

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16 pages, 708 KiB

Open AccessArticle

Clusters of Physical Frailty and Cognitive Impairment and Their Associated Comorbidities in Older Primary Care Patients

by Sanja Bekić, František Babič, Viera Pavlišková, Ján Paralič, Thomas Wittlinger and Ljiljana Trtica Majnarić

Healthcare 2021, 9(7), 891; https://doi.org/10.3390/healthcare9070891 - 15 Jul 2021

Cited by 10 | Viewed by 2829

Abstract

(1) Objectives: We aimed to identify clusters of physical frailty and cognitive impairment in a population of older primary care patients and correlate these clusters with their associated comorbidities. (2) Methods: We used a latent class analysis (LCA) as the clustering technique to [...] Read more.

(1) Objectives: We aimed to identify clusters of physical frailty and cognitive impairment in a population of older primary care patients and correlate these clusters with their associated comorbidities. (2) Methods: We used a latent class analysis (LCA) as the clustering technique to separate different stages of mild cognitive impairment (MCI) and physical frailty into clusters; the differences were assessed by using a multinomial logistic regression model. (3) Results: Four clusters (latent classes) were identified: (1) highly functional (the mean and SD of the “frailty” test 0.58 ± 0.72 and the Mini-Mental State Examination (MMSE) test 27.42 ± 1.5), (2) cognitive impairment (0.97 ± 0.78 and 21.94 ± 1.95), (3) cognitive frailty (3.48 ± 1.12 and 19.14 ± 2.30), and (4) physical frailty (3.61 ± 0.77 and 24.89 ± 1.81). (4) Discussion: The comorbidity patterns distinguishing the clusters depend on the degree of development of cardiometabolic disorders in combination with advancing age. The physical frailty phenotype is likely to exist separately from the cognitive frailty phenotype and includes common musculoskeletal diseases. Full article

(This article belongs to the Special Issue Artificial Intelligence (AI) and Machine Learning (ML) in Human Health and Healthcare)

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19 pages, 614 KiB

Open AccessArticle

Assessing the Impact of a Global Health Fellowship on Pharmacists’ Leadership Skills and Consideration of Benefits to the National Health Service (NHS) in the United Kingdom

by Claire Brandish, Frances Garraghan, Bee Yean Ng, Kate Russell-Hobbs, Omotayo Olaoye and Diane Ashiru-Oredope

Healthcare 2021, 9(7), 890; https://doi.org/10.3390/healthcare9070890 - 15 Jul 2021

Cited by 8 | Viewed by 5178

Abstract

Antimicrobial resistance (AMR) poses a global, public health concern that affects humans, animals and the environment. The UK Fleming Fund’s Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) scheme aimed to support antimicrobial stewardship initiatives to tackle AMR through a health partnership model that utilises [...] Read more.

Antimicrobial resistance (AMR) poses a global, public health concern that affects humans, animals and the environment. The UK Fleming Fund’s Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) scheme aimed to support antimicrobial stewardship initiatives to tackle AMR through a health partnership model that utilises volunteers. There is evidence to indicate that NHS staff participating in international health projects develop leadership skills. Running in parallel with the CwPAMS scheme was the first Chief Pharmaceutical Officer’s Global Health (CPhOGH) Fellowship for pharmacists in the UK. In this manuscript, we evaluate the impact, if any, of participation in the CwPAMS scheme and the CPhOGH Fellowship, particularly in relation to leadership skills, and consider if there are demonstrable benefits for the NHS. The 16 CPhOGH Fellows were invited to complete anonymised baseline and post-Fellowship self-assessment. This considered the impact of the Fellowship on personal, professional and leadership development. Senior colleagues were invited to provide insights into how the Fellows had performed over the course of the Fellowship. All Fellows responded to both the pre- and post-Fellowship questionnaires with a return of 100% (16/16) response rate. There was a significant improvement in Fellows’ perception of their confidence, teaching abilities, understanding of behaviour change, management and communication skills. However, there was no change in the Fellows’ attitude to work. Feedback was received from 26 senior colleagues for 14 of the CPhOGH Fellows. Overall, senior colleagues considered CPhOGH Fellows to progress from proficient/established competencies to strong/excellent when using the national pharmacy Peer Assessment Tool and NHS Healthcare Leadership Model. The majority (88%) of senior colleagues would recommend the Fellowship to other pharmacists. The analysis of the data provided suggests that this CPhOGH Fellowship led to the upskilling of more confident, motivated pharmacist leaders with a passion for global health. This supports the NHS’s long-term plan “to strengthen and support good compassionate and diverse leadership at all levels”. Constructive feedback was received for improvements to the Fellowship. Job satisfaction and motivation improved, with seven CPhOGH Fellows reporting a change in job role and five receiving a promotion. Full article

(This article belongs to the Special Issue Pharmacy Practice and Administration)

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