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Volatility, Uncertainty, Complexity, and Ambiguity (VUCA) in Healthcare
Impact of Workplace Bullying on Quiet Quitting in Nurses: The Mediating Effect of Coping Strategies

Journal Description

Healthcare

Healthcare is an international, scientific, peer-reviewed, open access journal on health care systems, industry, technology, policy, and regulation, and is published semimonthly online by MDPI. Ocular Wellness & Nutrition Society (OWNS) is affiliated with Healthcare and its members receive discounts on article processing charges.

Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
High Visibility: indexed within Scopus, SCIE and SSCI (Web of Science), PubMed, PMC, and other databases.
Journal Rank: JCR - Q2 (Health Care Sciences and Services) / CiteScore - Q2 (Leadership and Management)
Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 20.5 days after submission; acceptance to publication is undertaken in 2.7 days (median values for papers published in this journal in the first half of 2024).
Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
Companion journals for Healthcare include: Trauma Care and European Burn Journal.

Impact Factor: 2.4 (2023); 5-Year Impact Factor: 2.5 (2023)

Imprint Information Journal Flyer Open Access ISSN: 2227-9032

Latest Articles

15 pages, 1727 KiB

Open AccessArticle

Comparison of Self-Care Practices and BMI between Celiac and Non-Celiac Adolescent Populations

by Montserrat Monserrat-Hernández, Juan Carlos Checa-Olmos, Ángeles Arjona Garrido and Rafael Galera-Martínez

Healthcare 2024, 12(17), 1796; https://doi.org/10.3390/healthcare12171796 (registering DOI) - 8 Sep 2024

Celiac disease (CD) is a chronic gastrointestinal disorder that is most frequently found in Western countries, and the only treatment available today is a lifelong gluten-free diet (GFD). The main aim of the present study is to compare the self-care practices and body [...] Read more.

Celiac disease (CD) is a chronic gastrointestinal disorder that is most frequently found in Western countries, and the only treatment available today is a lifelong gluten-free diet (GFD). The main aim of the present study is to compare the self-care practices and body mass index (BMI) of adolescents with CD and without CD in different dimensions (physical, psychological, social, and management). The non-probabilistic sample included 236 participants (118 with CD) aged between 12 and 16 years old, who were part of the project “Role of the family in the perception of youth self-care”. The data were obtained through the self-administration of the Practice and Management of Youth Self-care questionnaire, while the celiac population also completed the Adherence to a Gluten-Free Diet (GFD) questionnaire. The celiac population analyzed showed significant correlations between the Physical Practices and Management with adherence to a GFD, and between a GFD and Psychological Practices. Differences were observed between the celiac and the non-celiac populations in the dimensions of Physical Practices, Social Practices, and Management. With respect to BMI, age and CD showed a significant influence of a GFD on BMI (p < 0.001). In conclusion, the application of multi-dimensional questionnaires and their relationship with the adherence to a GFD provide valuable information to propose interventions directed to this population. Full article

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14 pages, 950 KiB

Open AccessArticle

Integrated Psycho-Socio-Educational Programmes for Women Victims of Gender-Based Violence

by María Cristina Lopes-Dos-Santos and Sagrario Anaut-Bravo

Healthcare 2024, 12(17), 1795; https://doi.org/10.3390/healthcare12171795 (registering DOI) - 8 Sep 2024

Although women victims of gender-based violence suffer health and self-care issues, there is still a lack of coordinated integrated support programmes aimed at mitigating the socio-health impact of gender-based violence on women that are suitably adapted to new social contexts. Given the importance [...] Read more.

Although women victims of gender-based violence suffer health and self-care issues, there is still a lack of coordinated integrated support programmes aimed at mitigating the socio-health impact of gender-based violence on women that are suitably adapted to new social contexts. Given the importance of analysing the effectiveness of integrated psycho-socio-educational interventions and self-care programmes, this study reviews the interventions and programmes implemented in Spain, focusing specifically on their implementation and impact in the autonomous region of Navarra. The data reviewed were extracted from official publications and websites pertaining to the 17 Spanish autonomous regions and the corresponding Spanish government ministries. Additionally, 18 reports on psycho-socio-educational interventions (n = 63) for the whole of Spain centring on integrated support for self-care were analysed. In the case of the autonomous region of Navarra, four psycho-socio-educational intervention programmes (n = 4) involving self-care were analysed. The analysis found that there are a number of diverse integrated psycho-socio-educational programmes focusing on self-care that provide support and interventions. The results indicate that the women who benefit from the services, especially those relating to self-care (self-esteem, healthcare, personal image, and health), report improvements in their general wellbeing. Full article

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15 pages, 380 KiB

Open AccessArticle

Perceived Pressures and Mental Health of Breastfeeding Mothers: A Qualitative Descriptive Study

by Abigail Wheeler, Shanti Farrington, Fay Sweeting, Amy Brown and Andrew Mayers

Healthcare 2024, 12(17), 1794; https://doi.org/10.3390/healthcare12171794 (registering DOI) - 8 Sep 2024

When a mother is supported to breastfeed, the benefits for her mental health are significant. However, if pressured or unsupported, the opposite is true. This research examines mothers’ breastfeeding experiences, exploring how perceived pressure can impact perinatal mental health. A sample of 501 [...] Read more.

When a mother is supported to breastfeed, the benefits for her mental health are significant. However, if pressured or unsupported, the opposite is true. This research examines mothers’ breastfeeding experiences, exploring how perceived pressure can impact perinatal mental health. A sample of 501 respondents to a research questionnaire was explored using Reflexive Thematic Analysis. Three main themes identified were perceived pressure to breastfeed, perceived pressure not to breastfeed and mental health impact. The main findings were that mothers received conflicting advice from healthcare professionals, and pressures to feed in a certain way came from their support networks, as well as from their internal beliefs. Perceived pressures negatively impacted maternal mental health, while positive breastfeeding experiences benefitted mental health outcomes. Full article

(This article belongs to the Special Issue Perinatal Mental Health Care)

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10 pages, 487 KiB

Open AccessArticle

Long-Term Bone Density Changes and Fracture Risk in Myasthenia Gravis: Implications for FRAX^® Tool Application

by Shingo Konno, Takafumi Uchi, Hideo Kihara and Hideki Sugimoto

Healthcare 2024, 12(17), 1793; https://doi.org/10.3390/healthcare12171793 (registering DOI) - 8 Sep 2024

Myasthenia gravis (MG) patients often require long-term glucocorticoid therapy, which may affect bone health. This study aimed to assess long-term changes in bone mineral density (BMD), evaluate osteoporotic fracture incidence, and examine the relationship between MG-specific factors and bone health outcomes over a [...] Read more.

Myasthenia gravis (MG) patients often require long-term glucocorticoid therapy, which may affect bone health. This study aimed to assess long-term changes in bone mineral density (BMD), evaluate osteoporotic fracture incidence, and examine the relationship between MG-specific factors and bone health outcomes over a 10-year period. This single-center, prospective cohort study included 28 MG patients. BMD, T-scores, Z-scores, and bone turnover markers were measured at baseline. FRAX^® scores were calculated and adjusted for glucocorticoid dose. Fracture occurrence was monitored for over 10 years. Five (17.9%) patients experienced major osteoporotic fractures during follow-up. The fracture group had significantly lower baseline BMD and T-scores than the no-fracture group. Baseline FRAX^® scores for major osteoporotic fracture risk were significantly higher in the fracture group (median 19.0% vs. 5.7%, p = 0.001). The fracture group progressed from osteopenia at baseline to osteoporosis by the end of this study. This study highlights the importance of early and regular bone health assessments in MG patients, particularly those receiving long-term glucocorticoid therapy. The FRAX^® tool may be valuable for fracture risk stratification in this population. These findings can inform clinical practice and improve long-term management strategies for MG patients who are at risk of osteoporotic fractures. Full article

(This article belongs to the Section Chronic Care)

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11 pages, 437 KiB

Open AccessArticle

Parent–Child Mismatch in Educational Expectations and Depressive Symptoms among Chinese Adolescents

by Yueyun Zhang and Meng Jiang

Healthcare 2024, 12(17), 1792; https://doi.org/10.3390/healthcare12171792 (registering DOI) - 7 Sep 2024

Background: The roles of both parents’ and children’s educational expectations in shaping adolescent depressive symptoms have increasingly been discussed, yet in a separate manner. To date, few studies have associated parent–child mismatch in educational expectations with depressive symptoms, and less is known about [...] Read more.

Background: The roles of both parents’ and children’s educational expectations in shaping adolescent depressive symptoms have increasingly been discussed, yet in a separate manner. To date, few studies have associated parent–child mismatch in educational expectations with depressive symptoms, and less is known about the variation in the association across gender (male vs. female), educational level (primary vs. secondary), and region status (urban vs. rural) in the Chinese educational setting. Methods: Respondents were from a nationally representative sample of adolescent students in China (sample size: 1844; age range: 10–15 years). Parent–child mismatch in educational expectations included three categories: (1) “match”, (2) “mismatch—parent higher”, and (3) “mismatch—parent lower”. Regression analysis with inverse propensity-score weighting was employed to estimate the effect of parent–child mismatch as to educational expectations on depressive symptoms, and stratified analysis was used to examine the variation of the effect by gender, educational level, and region. Results: Compared with the “match” group, the “mismatch—parent higher” group had significantly higher levels of depressive symptoms. Furthermore, the pattern remained consistent between boys and girls, but differed significantly by adolescents’ educational level and region status. Specifically, the pattern was more pronounced in the primary school and urban subsamples. Conclusions: Findings in this study indicated that educators and policymakers can develop tailored strategies to alleviate depressive symptoms among the “mismatch—parent higher” group, and especially for those children from primary schools and urban areas. Full article

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12 pages, 812 KiB

Open AccessArticle

Physical Exercise Prevents the Cognitive Decline among Older Adults in Romania

by Andrei Ciobica, Romeo Dobrin, Alin Iordache, Ioannis Mavroudis, Cezar Honceriu, Antoneta Dacia Petroaie, Veronica Bild, Alexandru Vasincu, Răzvan-Nicolae Rusu, Alin Ciobica and Walther Bild

Healthcare 2024, 12(17), 1791; https://doi.org/10.3390/healthcare12171791 (registering DOI) - 7 Sep 2024

Cognitive decline is one of the most important challenges related to the aging process, due to its important impact on individuals. Several studies have reported that physical exercise with a specific intensity and frequency is beneficial for maintaining cognitive health in the ageing [...] Read more.

Cognitive decline is one of the most important challenges related to the aging process, due to its important impact on individuals. Several studies have reported that physical exercise with a specific intensity and frequency is beneficial for maintaining cognitive health in the ageing population. The present study investigated the impact of general physical exercise on cognitive health in the older population in Romania. The study involved 60 individuals (60% male, 40% female), with a mean age of 60.78 years (SD = 2.97). The Health Interview Survey and The Minnesota Heart Survey assessed exercise frequency and intensity, while the Montreal Cognitive Assessment (MoCA) determined mild cognitive impairment (MCI) levels. The results of the statistical analysis showed that high-intensity physical exercise at a frequency of three to four times a week at the age of 40–50 years is recommended in order to significantly reduce cognitive decline. In addition, for the age of 60 years old, the results established that engaging in physical activities of a moderate intensity with a frequency of 2–3 times per month is sufficient to maintain healthy cognition. The findings suggest that exercise can serve as a behavioral intervention to mitigate cognitive dysfunction and complement past research on its cognitive health advantages. Full article

(This article belongs to the Special Issue Physical Activity, Nutrition, and Mental Health Symptoms and Disorders)

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17 pages, 13169 KiB

Open AccessArticle

Information Support or Emotional Support? Social Support in Online Health Information Seeking among Chinese Older Adults

by Xiaowen Zhu and Chang Li

Healthcare 2024, 12(17), 1790; https://doi.org/10.3390/healthcare12171790 (registering DOI) - 7 Sep 2024

Online Health Information Seeking (OHIS) serves as an alternative form of social capital that can help older adults alleviate offline medical-related stress. This study collected and analyzed user interaction data from Patient-to-Doctor and Patient-to-Peer platforms and compared the roles of social support between [...] Read more.

Online Health Information Seeking (OHIS) serves as an alternative form of social capital that can help older adults alleviate offline medical-related stress. This study collected and analyzed user interaction data from Patient-to-Doctor and Patient-to-Peer platforms and compared the roles of social support between them. Significant differences were identified in the dimensions of social support (information, emotional, and companion) on the Patient-to-Peer platforms compared with Patient-to-Doctor platforms (p < 0.05). The overall and core–core network density values for social support on Patient-to-Peer platforms were higher than those on Patient-to-Doctor platforms. Patient-to-Doctor interactions focused on information support, displaying a more centralized and efficient network with structural holes pertaining to treatment effects. By contrast, Patient-to-Peer interactions provided more emotional support, with a dispersed and redundant network containing structural holes related to individual information. Companion support was found to be weaker on both platforms. Additionally, digital literacy, surrogate seeking, and altruistic information significantly explained the variances between the two platforms (p < 0.01), with surrogate seeking playing a crucial role. These findings enhance our understanding of OHIS disparities among older adults and their surrogates, offering valuable insights for developing effective support systems and regulatory frameworks for health information platforms. Full article

(This article belongs to the Special Issue Research on Health-Related Quality of Life and Well-Being among Older People)

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20 pages, 2600 KiB

Open AccessArticle

Psychometric Analysis of the Hip Disability and Osteoarthritis Outcome Score (HOOS)

by Emilie N. Miley, Madeline P. Casanova, Michael A. Pickering, Scott W. Cheatham, Lindsay W. Larkins, Adam C. Cady and Russell T. Baker

Healthcare 2024, 12(17), 1789; https://doi.org/10.3390/healthcare12171789 (registering DOI) - 7 Sep 2024

Hip Disability and Osteoarthritis Outcome Survey (HOOS) was developed as a region- and disease-specific outcome to assess hip disability. Despite the use of the HOOS in clinical practice and research, psychometric analyses of the scale in a large dataset of patients have not [...] Read more.

Hip Disability and Osteoarthritis Outcome Survey (HOOS) was developed as a region- and disease-specific outcome to assess hip disability. Despite the use of the HOOS in clinical practice and research, psychometric analyses of the scale in a large dataset of patients have not been performed. As such, the purposes of this study were to assess the structural validity of the HOOS in patients who underwent a total hip arthroplasty. Data were obtained from the Surgical Outcome System (SOS) global registry. Confirmatory factor analysis (CFA) was conducted to assess the scale structure of the 40-item HOOS and exploratory factor analysis (EFA) was conducted to identify a parsimonious scale structure. The parsimonious model identified was subjected to multi-group and longitudinal invariance testing and LGC modeling. The original five-factor, 40-item HOOS did not meet recommended model fit indices values (CFI = 0.822, TLI = 0.809, IFI = 0.822, RMSEA = 0.085). Alternate model generation identified an alternative model (i.e., HOOS-9). Sound model fit was identified for the HOOS-9 (CFI = 0.974, TLI = 0.961, RMSEA = 0.046). Invariance testing criteria were also met between groups (i.e., age and sex) and across time. Lastly, a nonlinear growth trajectory was identified in responses pertaining to hip disability. The original scale structure of the 40-item HOOS was not supported. The HOOS-9 met contemporary model fit recommendations, along with multi-group and longitudinal invariance testing. Our findings support the preliminary use of the HOOS-9 to assess hip function and disability in research and clinical practice. Full article

(This article belongs to the Special Issue Current Topics in Rehabilitation for Musculoskeletal Injury)

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19 pages, 760 KiB

Open AccessSystematic Review

The State-of-the-Art of Mycobacterium chimaera Infections and the Causal Link with Health Settings: A Systematic Review

by Vittorio Bolcato, Matteo Bassetti, Giuseppe Basile, Luca Bianco Prevot, Giuseppe Speziale, Elena Tremoli, Francesco Maffessanti and Livio Pietro Tronconi

Healthcare 2024, 12(17), 1788; https://doi.org/10.3390/healthcare12171788 - 6 Sep 2024

(1) Background. A definition of healthcare-associated infections is essential also for the attribution of the restorative burden to healthcare facilities in case of harm and for clinical risk management strategies. Regarding M. chimaera infections, there remains several issues on the ecosystem and pathogenesis. [...] Read more.

(1) Background. A definition of healthcare-associated infections is essential also for the attribution of the restorative burden to healthcare facilities in case of harm and for clinical risk management strategies. Regarding M. chimaera infections, there remains several issues on the ecosystem and pathogenesis. We aim to review the scientific evidence on M. chimaera beyond cardiac surgery, and thus discuss its relationship with healthcare facilities. (2) Methods. A systematic review was conducted on PubMed and Web of Science on 7 May 2024 according to PRISMA 2020 guidelines for reporting systematic reviews, including databases searches with the keyword “Mycobacterium chimaera”. Article screening was conducted by tree authors independently. The criterion for inclusion was cases that were not, or were improperly, consistent with the in-situ deposition of aerosolised M. chimaera. (3) Results. The search yielded 290 eligible articles. After screening, 34 articles (377 patients) were included. In five articles, patients had undergone cardiac surgery and showed musculoskeletal involvement or disseminated infection without cardiac manifestations. In 11 articles, respiratory specimen reanalyses showed M. chimaera. Moreover, 10 articles reported lung involvement, 1 reported meninges involvement, 1 reported skin involvement, 1 reported kidney involvement after transplantation, 1 reported tendon involvement, and 1 reported the involvement of a central venous catheter; 3 articles reported disseminated cases with one concomitant spinal osteomyelitis. (4) Conclusions. The scarce data on environmental prevalence, the recent studies on M. chimaera ecology, and the medicalised sample selection bias, as well as the infrequent use of robust ascertainment of sub-species, need to be weighed up. The in-house aerosolization, inhalation, and haematogenous spread deserve experimental study, as M. chimaera cardiac localisation could depend to transient bacteraemia. Each case deserves specific ascertainment before tracing back to the facility, even if M. chimaera represents a core area for healthcare facilities within a framework of infection prevention and control policies. Full article

(This article belongs to the Special Issue Innovation in Hospital Management: Strategies and Efforts for Patient and Healthcare Workers Safety and Prevention of Claims: 2nd Edition)

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21 pages, 574 KiB

Open AccessArticle

Italian Version of the Hospital Aggressive Behaviour Scale-Users: Initial Psychometric Evaluation among Hospital Healthcare Professionals

by Elena Cavallari, Ilaria Setti, Matteo Curcuruto, Cristina Gremita and Valentina Sommovigo

Healthcare 2024, 12(17), 1787; https://doi.org/10.3390/healthcare12171787 - 6 Sep 2024

Background: Healthcare professionals frequently encounter various forms of aggression, ranging from verbal abuse to physical assaults, which can compromise both their occupational well-being and patient-care quality. Despite its prevalence and serious consequences, workplace aggression is often underreported due to a lack of standardized [...] Read more.

Background: Healthcare professionals frequently encounter various forms of aggression, ranging from verbal abuse to physical assaults, which can compromise both their occupational well-being and patient-care quality. Despite its prevalence and serious consequences, workplace aggression is often underreported due to a lack of standardized assessment tools. This study aims to develop a valid Italian version of the Hospital Aggressive Behaviour Scale-Users. Methods: The scale’s structure was evaluated using exploratory (EFA) and confirmatory (CFA) factor analyses on two samples of healthcare professionals during and after the pandemic. Reliability, measurement invariance, and nomological validity were examined. Results: EFA revealed a two-factor structure comprising eight items (χ² = 59.651, df = 13, p = 0.00; CFI = 0.98; TLI = 0.95; RMSEA = 0.07; SRMR = 0.02), distinguishing non-physical and physical aggression, and meeting all recommended criteria. CFA confirmed this structure, demonstrating good reliability and outperforming alternative models. The same factor structure was confirmed in standard (χ² = 35.01, df = 19, p = 0.00; CFI = 0.99; TLI = 0.99; RMSEA = 0.03; SRMR = 0.02) and emergency (χ² = 30.65, df = 19, p = 0.04; CFI = 0.98; TLI = 0.97; RMSEA = 0.06; SRMR = 0.04) contexts. Full residual invariance was found across job tenure groups. Aggression was positively associated with emotional exhaustion, psychological distance, psychosomatic symptoms, post-traumatic stress symptoms, and turnover intentions while negatively related to job satisfaction. Nurses and healthcare assistants reported higher levels of aggression than doctors. Conclusions: This study provides a reliable, context-specific instrument for documenting and analysing outsider aggression. The insights can inform targeted interventions, contributing to a healthier hospital environment. Full article

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18 pages, 311 KiB

Open AccessReview

Gerontology and Geriatrics in Undergraduate Nursing Education in Portugal and Spain: An Integrative and Comparative Curriculum Review

by Sara Brás Alves, Carlos Pires Magalhães, Adília Fernandes, Mª José Fermoso Palmero and Helder Fernandes

Healthcare 2024, 12(17), 1786; https://doi.org/10.3390/healthcare12171786 - 6 Sep 2024

Nurses play a critical role in caring for elderly patients; however, the emphasis on aging care in undergraduate programs may be insufficient. The present study aims at identifying the relevance given to theoretical and/or practical gerontological and geriatric contents in undergraduate study plans [...] Read more.

Nurses play a critical role in caring for elderly patients; however, the emphasis on aging care in undergraduate programs may be insufficient. The present study aims at identifying the relevance given to theoretical and/or practical gerontological and geriatric contents in undergraduate study plans in Portugal and Spain. Presenting a two-part investigation, an integrative review approach examines nursing education on a global scale and a comparative analysis, using Bereday’s comparative method, to assess the nursing curricula between Portugal and Spain. The search found 117 documents, with 16 being included. Studies covered diverse educational practices in geriatric and gerontological nursing, emphasizing curriculum development, faculty expertise, practical training, attitudes towards elderly care, and future directions. The comparative analysis of nursing curricula revealed that Portugal places a priority on building foundational theoretical knowledge in the first year and then gradually integrating practical training. In contrast, Spain emphasizes an extensive and integrated approach with a strong focus on practical skills and comprehensive assessments. Our research emphasizes the need to incorporate aging-focused education into nursing curricula and update the curriculum, providing hands-on training with early exposure to these environments. Additionally, simulation classes can enhance critical thinking by allowing students to experience aging effects firsthand. Full article

10 pages, 228 KiB

Open AccessArticle

How Were European GPs/FPs Involved in the COVID-19 Vaccination Campaign? A European Questionnaire Study about the Experiences of the Vaccinations in 2021

by Imre Rurik and Péter Torzsa

Healthcare 2024, 12(17), 1785; https://doi.org/10.3390/healthcare12171785 - 6 Sep 2024

Background: The SARS-CoV-2 pandemic has become the greatest public health challenge worldwide. Soon after the appearance of the virus in 2019, intensive efforts to develop vaccines were initiated, and by late 2020, delivery of vaccines for the targeted population as a campaign had [...] Read more.

Background: The SARS-CoV-2 pandemic has become the greatest public health challenge worldwide. Soon after the appearance of the virus in 2019, intensive efforts to develop vaccines were initiated, and by late 2020, delivery of vaccines for the targeted population as a campaign had started. Aim: Collect information from European Union countries regarding how and to what extent were family physicians (FPs)/general practitioners (GPs) involved in the vaccination campaigns in 2021 and how these were organized at the national level. Method: A short questionnaire was distributed through the secretariats of WONCA (World Organization of Family Doctors) Europe and the European Forum for Primary Care (EFPC). Results: In most of the countries, participation of FPs/GPs was compulsory. The vaccination was usually centrally organized by governmental authorities. In the beginning, registration (web-based) of patients was required, mainly at the national level. By the middle of 2021, vaccination on a walk-in basis became available in almost every country for the first immunization as well as for the booster injections. The remunerations of GPs/FPs differed; in some countries, no extra payments were offered. The Pfizer vaccine was used in all countries, while in nine countries, non-European Medicines Agency (EMA)-approved vaccines were also given in primary care settings and at vaccination centers. In some countries, professional homepages helped the GPs. The involvement of primary health care (PHC) providers did not correlate to the vaccination coverage of the entire population of the respective countries. It was the highest in the more developed countries with higher living standards, where participation of GPs was voluntary and appropriate financial incentives were offered to them. Conclusions: The vaccination campaign was a professional and logistic challenge and an excellent performance of PCH providers. Experiences gained could be used in the future to manage similar pandemic challenges. Full article

(This article belongs to the Special Issue Human Health before, during, and after COVID-19)

11 pages, 485 KiB

Open AccessArticle

Analysis of Indirect Costs of Absence Associated with Mental Disorders on the Basis of Social Security Data (2012–2023)

by Paweł Juraszek, Karolina Sobczyk, Karolina Krupa-Kotara and Mateusz Grajek

Healthcare 2024, 12(17), 1784; https://doi.org/10.3390/healthcare12171784 - 6 Sep 2024

Background: Mental and behavioral disorders significantly impair psychophysical functioning, leading to challenges in daily activities. The increasing recognition of the importance of mental health in global development goals has resulted in its inclusion in the United Nations’ Sustainable Development Goals. The burden of [...] Read more.

Background: Mental and behavioral disorders significantly impair psychophysical functioning, leading to challenges in daily activities. The increasing recognition of the importance of mental health in global development goals has resulted in its inclusion in the United Nations’ Sustainable Development Goals. The burden of mental disorders has grown worldwide due to demographic changes, with substantial economic and social impacts. Objective: This study aimed to examine the indirect costs of mental disorders in Poland by analyzing the expenditures by the Social Insurance Institution (ZUS) on work incapacity benefits and disability pensions from 2012 to 2023. The goal was to identify trends, dependencies, and the economic impact of policy changes. Material and Methods: Data were collected from ZUS reports on annual expenditures for work incapacity benefits and disability pensions. Advanced statistical methods, including linear regression and Pearson correlation, were employed to analyze trends and relationships. Student’s t-tests assessed the statistical significance of the observed trends. Results: The expenditures on benefits for work incapacity due to mental disorders increased significantly over the past decade, particularly from 2020 to 2023, partly due to the COVID-19 pandemic. Short-term absenteeism due to mental disorders accounted for 10.5% of the total sick leave days. A strong positive correlation was found between years and benefit expenditures. Conversely, the disability pension expenditures exhibited a downward trend, potentially reflecting improvements in public health or policy changes. Conclusions: The significant increase in expenditures on benefits related to mental disorders may reflect greater awareness, improved diagnostics, and the impact of the COVID-19 pandemic. In contrast, the decline in disability pension expenditures could suggest improved mental health or effective policy measures. However, it is important to emphasize that the presented data are not the only factor influencing this situation. Multiple variables, including societal, economic, and healthcare system changes, contribute to these trends. Therefore, further research is necessary to fully understand the underlying causes and to guide effective policy development. Regular monitoring and continued investment in mental health are essential to managing indirect costs such as absenteeism and presenteeism efficiently. Full article

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12 pages, 2631 KiB

Open AccessArticle

Do Audible Sounds during a Lumbar Spine Thrust Manipulation Have an Impact on Brainwave Activity?

by Rob Sillevis, Tiffanny de Zayas, Anne Weller Hansen and Halle Krisinski

Healthcare 2024, 12(17), 1783; https://doi.org/10.3390/healthcare12171783 - 6 Sep 2024

Background: To manage pain and stiffness of the lumbar spine, thrust manipulation is commonly used. High-velocity, small-amplitude thrust manipulation often elicits audible sounds. What causes this audible sound remains unclear, and its clinical significance has not been shown. This study aimed to identify [...] Read more.

Background: To manage pain and stiffness of the lumbar spine, thrust manipulation is commonly used. High-velocity, small-amplitude thrust manipulation often elicits audible sounds. What causes this audible sound remains unclear, and its clinical significance has not been shown. This study aimed to identify how audible sound affects brainwave activity following a side-lying right rotatory thrust manipulation in a group of healthy individuals. Methods: This was a quasi-experimental repeated measures study design in which 44 subjects completed the study protocol. A portable Bluetooth EEG device was used to capture brainwave activity. The environment was controlled during testing to minimize any factors influencing the acquisition of real-time EEG data. After a short accommodation period, initial brainwaves were measured. Following this, each subject underwent a lumbar 4–5 side-lying right rotatory thrust manipulation, immediately followed by a second brainwave measurement. A third measurement took place one minute later, followed by a fourth one at the three-minute mark. Results: 21 subjects did not experience audible sounds, while 23 subjects experienced audible sounds. Both groups had significant changes measured by the 14 electrodes (p < 0.05). The audible group had more significant changes, which lasted only two minutes. Conclusion: The lack of brainwave response differences between the audible and non-audible groups implies no direct, measurable placebo or beneficial effect from the audible sound. This study could not identify a benefit from the audible sound during an HVLA manipulation of the subjects. Full article

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12 pages, 2232 KiB

Open AccessArticle

Achieving Robust Medical Coding in DRGs Systems: Innovative Actions Adopted in Greece

by Charalampos Platis, Leonidas Papaioannou, Panagiota Sideri, Pantelis Messaropoulos, Konstantinos Chalkias and Nikolaos Kontodimopoulos

Healthcare 2024, 12(17), 1782; https://doi.org/10.3390/healthcare12171782 - 6 Sep 2024

The purpose of this study is to evaluate and illustrate the effectiveness of a specialized digital platform developed to improve the accuracy of medical coding during the full implementation of Greece’s new DRG system, and to highlight innovative actions for achieving and/or improving [...] Read more.

The purpose of this study is to evaluate and illustrate the effectiveness of a specialized digital platform developed to improve the accuracy of medical coding during the full implementation of Greece’s new DRG system, and to highlight innovative actions for achieving and/or improving accurate medical coding. Already grouped DRG cases recorded in the first DRG implementation year in the region of Crete were examined. A sample of 133,922 cases was analyzed and audited, through a process consisting of three stages: (i) digitalization, (ii) auditor training, and (iii) control and consultation. The results indicated that a significant proportion of DRG coding, with a length of stay exceeding one day, was reclassified into different DRG categories. This reclassification was primarily due to coding errors—such as the omission of secondary diagnoses, exclusion of necessary medical procedures, and the use of less specific codes—rather than mistakes in selecting the principal diagnosis. The study underscores the importance of medical coding control and consulting services. It demonstrates that targeted actions in these areas can significantly enhance the implementation of the DRG coding system. Accurate medical coding is crucial for transparent allocation of resources within hospitals, ensuring that hospital services and reimbursements are appropriately managed and allocated based on the true complexity and needs of patient cases. Full article

(This article belongs to the Special Issue Efficiency, Innovation, and Sustainability in Healthcare Systems)

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10 pages, 1600 KiB

Open AccessArticle

Online Patient Education in Obstructive Sleep Apnea: ChatGPT versus Google Search

by Serena Incerti Parenti, Maria Lavinia Bartolucci, Elena Biondi, Alessandro Maglioni, Giulia Corazza, Antonio Gracco and Giulio Alessandri-Bonetti

Healthcare 2024, 12(17), 1781; https://doi.org/10.3390/healthcare12171781 - 5 Sep 2024

The widespread implementation of artificial intelligence technologies provides an appealing alternative to traditional search engines for online patient healthcare education. This study assessed ChatGPT-3.5’s capabilities as a source of obstructive sleep apnea (OSA) information, using Google Search as a comparison. Ten frequently searched [...] Read more.

The widespread implementation of artificial intelligence technologies provides an appealing alternative to traditional search engines for online patient healthcare education. This study assessed ChatGPT-3.5’s capabilities as a source of obstructive sleep apnea (OSA) information, using Google Search as a comparison. Ten frequently searched questions related to OSA were entered into Google Search and ChatGPT-3.5. The responses were assessed by two independent researchers using the Global Quality Score (GQS), Patient Education Materials Assessment Tool (PEMAT), DISCERN instrument, CLEAR tool, and readability scores (Flesch Reading Ease and Flesch–Kincaid Grade Level). ChatGPT-3.5 significantly outperformed Google Search in terms of GQS (5.00 vs. 2.50, p < 0.0001), DISCERN reliability (35.00 vs. 29.50, p = 0.001), and quality (11.50 vs. 7.00, p = 0.02). The CLEAR tool scores indicated that ChatGPT-3.5 provided excellent content (25.00 vs. 15.50, p < 0.001). PEMAT scores showed higher understandability (60–91% vs. 44–80%) and actionability for ChatGPT-3.5 (0–40% vs. 0%). Readability analysis revealed that Google Search responses were easier to read (FRE: 56.05 vs. 22.00; FKGL: 9.00 vs. 14.00, p < 0.0001). ChatGPT-3.5 delivers higher quality and more comprehensive OSA information compared to Google Search, although its responses are less readable. This suggests that while ChatGPT-3.5 can be a valuable tool for patient education, efforts to improve readability are necessary to ensure accessibility and utility for all patients. Healthcare providers should be aware of the strengths and weaknesses of various healthcare information resources and emphasize the importance of critically evaluating online health information, advising patients on its reliability and relevance. Full article

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19 pages, 10239 KiB

Open AccessSystematic Review

Acupuncture and Acupoints for Managing Pediatric Cerebral Palsy: A Meta-Analysis of Randomized Controlled Trials

by Ya-Yun Cheng, Ying-Yu Huang, Tsung-Hsien Yang, Yi-Jung Chang, Ren-Huei Fu and Hsing-Yu Chen

Healthcare 2024, 12(17), 1780; https://doi.org/10.3390/healthcare12171780 - 5 Sep 2024

Background: Acupuncture is frequently used to manage pediatric cerebral palsy (CP), yet updated evidence is needed to guide future research and clinical practice. Methods: Seven databases were searched from 1994 to 26 June 2023. Randomized controlled trials (RCTs) involving body, scalp, or ear [...] Read more.

Background: Acupuncture is frequently used to manage pediatric cerebral palsy (CP), yet updated evidence is needed to guide future research and clinical practice. Methods: Seven databases were searched from 1994 to 26 June 2023. Randomized controlled trials (RCTs) involving body, scalp, or ear acupuncture for managing CP, excluding acupoint injection, catgut embedding, electro-acupuncture, or laser acupuncture, were included. Results: Twenty RCTs with 1797 participants were analyzed. Acupuncture groups had better improvements in gross motor function measure (GMFM) scores by 5% (mean difference: 5.93, 95% CI: 3.67–8.19, p < 0.001, I² = 57%); a 16% higher probability to yield prominent improvement in effectiveness rate (ER) (risk ratio: 1.16, 95% CI: 1.08–1.25, p < 0.001, I² = 0%); and better outcomes in the Modified Ashworth Scale (MAS) (standardized mean difference [SMD]: 0.3, 95%, CI: 0.11–0.49, p < 0.001, I² = 0%), the Berg Balance Scale (BBS) (SMD: 2.48; 95% CI: 2.00–2.97, p < 0.001, I² = 72%) and ADL (SMD: 1.66; 95% CI: 1.23–2.08, p < 0.001, I² = 91%). Studies with eight core acupoints identified from all ninety-five acupoints had better ER. Conclusions: Acupuncture, especially using core acupoints, may be effective for managing symptoms in children with CP. Full article

(This article belongs to the Special Issue Emerging Developments in Integrative and Complementary Medicine: Advancements in Research and Clinical Applications)

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13 pages, 584 KiB

Open AccessArticle

The Mediating Effects of Symptom Experiences on the Relationship between Body Image and Quality of Life among Hemodialysis Patients in a Single Center

by Yaki Yang

Healthcare 2024, 12(17), 1779; https://doi.org/10.3390/healthcare12171779 - 5 Sep 2024

This study aimed to confirm the mediating effects of symptom experiences on the relationship between the body image and quality of life of hemodialysis patients. Data were collected from 153 patients who were diagnosed with ESRD at a tertiary general hospital and receiving [...] Read more.

This study aimed to confirm the mediating effects of symptom experiences on the relationship between the body image and quality of life of hemodialysis patients. Data were collected from 153 patients who were diagnosed with ESRD at a tertiary general hospital and receiving regular hemodialysis in Korea. The data were collected between 20 July and 11 August 2023. The following statistical analyses were conducted: t-test, ANOVA, Scheffé test, Pearson’s correlation coefficient analysis, and Hayes’ Process Macro Model 4 (to test the mediating effect). The factors influencing quality of life were body image (β = 0.46, p < 0.001), monthly family income (over KRW 3 million) (β = 0.22, p = 0.002), and symptom experiences (β = −0.20, p = 0.001). The mediation analysis indicated that the symptom experiences mediated the relationship between body image and quality of life. Based on the results, education, counseling, and symptom management programs that can improve body image and reduce symptom experience should be developed, and customized programs that reflect the characteristics of a target population, such as economic level, should be developed and provided. Full article

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9 pages, 683 KiB

Open AccessArticle

Effects of Using a Special Weighted Vest on Muscle Activity around the Scapula during Knee Push-Up Plus in Healthy Subjects

by Lin Liu, Ying Liu, Young-sam Yuk and Hyoung-won Lim

Healthcare 2024, 12(17), 1778; https://doi.org/10.3390/healthcare12171778 - 5 Sep 2024

Muscle imbalances in the upper body can lead to ineffective movement patterns and potential injury. The purpose of this study was to investigate the muscle activity, impact, and muscle activation ratio of the serratus anterior (SA), upper trapezius (UT), lower trapezius (LT), and [...] Read more.

Muscle imbalances in the upper body can lead to ineffective movement patterns and potential injury. The purpose of this study was to investigate the muscle activity, impact, and muscle activation ratio of the serratus anterior (SA), upper trapezius (UT), lower trapezius (LT), and pectoralis major (PM) during the knee push-up plus (KPUP) exercise under various loads. Method: Electromyography assessed scapular muscle activity in 32 healthy adults (15 males, 17 females) during three KPUP variations. Results: PM and UT showed no significant activity differences across loads, whereas SA and LT did. SA activity was significantly higher in the weighted KPUP (WKPUP) 3 kg than that in KPUP and WKPUP 1 kg. LT activity was also significantly higher in WKPUP 3 kg compared to KPUP and WKPUP 1 kg, with KPUP showing higher activity than WKPUP 1 kg. PM/SA ratios remained consistent across loads, while UT/LT ratios varied significantly, being notably lower at 3 kg compared to 0 kg and 1 kg. Similarly, UT/SA ratios differed significantly among loads, being notably lower at 3 kg and 1 kg compared to 0 kg. Conclusion: WKPUP with 3 kg demonstrated significantly higher SA and LT activity compared to KPUP and WKPUP 1 kg. The lowest UT/LT ratio was observed during the WKPUP 3 kg, suggesting its effectiveness for optimizing muscle activation balance during KPUP exercises. These findings may inform the development of exercise protocols aimed at improving scapular stabilization. Full article

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12 pages, 210 KiB

Open AccessArticle

Evaluation of Soldiers’ Knowledge and Sense of Threats Regarding Exposure to Biological Risk Factors at the Place of Service

by Magdalena Zawadzka, Aleksandra Lis, Justyna Marszałkowska-Jakubik and Paweł Szymański

Healthcare 2024, 12(17), 1777; https://doi.org/10.3390/healthcare12171777 - 5 Sep 2024

Exposure to harmful biological agents and the level of knowledge about specific risk factors are extremely important topics, especially among military personnel. This study evaluates the knowledge and perceptions of soldiers regarding exposure to biological risk factors during their service. This research was [...] Read more.

Exposure to harmful biological agents and the level of knowledge about specific risk factors are extremely important topics, especially among military personnel. This study evaluates the knowledge and perceptions of soldiers regarding exposure to biological risk factors during their service. This research was conducted using an online survey distributed through the WBBS research panel, in which 1331 soldiers from various demographic groups and ranks participated. The survey assessed awareness of biological threats, the level of knowledge about preventive measures, and the perceived adequacy of occupational health and safety training. The findings reveal that over 80% of respondents possess some level of knowledge about the types of biological agents they may encounter, yet significant gaps remain, particularly in training related to region-specific infectious diseases, with more than 75% of participants having not received such training. Additionally, approximately 5% of respondents reported high exposure, and around 4% reported very high exposure to harmful biological agents, highlighting the need for enhanced educational programs and preventive measures in military contexts. The study underscores the importance of continuous education and training to mitigate risks associated with biological hazards in military environments. Full article

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