Healthcare

21 pages, 10785 KiB

Open AccessEditor’s ChoiceArticle

Clinical and Biological Adaptations in Obese Older Adults Following 12-Weeks of High-Intensity Interval Training or Moderate-Intensity Continuous Training

by Layale Youssef, Jordan Granet, Vincent Marcangeli, Maude Dulac, Guy Hajj-Boutros, Olivier Reynaud, Fanny Buckinx, Pierrette Gaudreau, José A. Morais, Pascale Mauriège, Gilles Gouspillou, Philippe Noirez and Mylène Aubertin-Leheudre

Healthcare 2022, 10(7), 1346; https://doi.org/10.3390/healthcare10071346 - 20 Jul 2022

Cited by 16 | Viewed by 5113

Abstract

Sarcopenia and obesity are considered a double health burden. Therefore, the implementation of effective strategies is needed to improve the quality of life of older obese individuals. The aim of this study was to compare the impact of high-intensity interval training (HIIT) and [...] Read more.

Sarcopenia and obesity are considered a double health burden. Therefore, the implementation of effective strategies is needed to improve the quality of life of older obese individuals. The aim of this study was to compare the impact of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on functional capacities, muscle function, body composition and blood biomarkers in obese older adults. Adipose tissue gene expression and markers of muscle mitochondrial content and quality control involved in exercise adaptations were also investigated. Sixty-eight participants performed either HIIT (n = 34) on an elliptical trainer or MICT (n = 34) on a treadmill, three times per week for 12 weeks. HIIT produced significantly higher benefits on some physical parameters (six-minute walking test (HIIT: +12.4% vs. MICT: +5.2%); step test (HIIT: +17.02% vs. MICT: +5.9%); ten-repetition chair test (HIIT: −17.04% vs. MICT: −4.7%)). Although both HIIT and MICT led to an improvement in lower limb power (HIIT: +25.2% vs. MICT: +20.4%), only MICT led to higher improvement in lower limb muscle strength (HIIT: +4.3% vs. MICT: +23.2%). HIIT was more beneficial for increasing total lean body mass (HIIT: +1.58% vs. MICT: −0.81%), while MICT was more effective for decreasing relative gynoid fat mass (HIIT: −1.09% vs. MICT: −4.20%). Regarding adipose tissue gene expression, a significant change was observed for cell death-inducing DFFA (DNA fragmentation factor-alpha)-like effector A (CIDEA) in the HIIT group (A.U; HIIT at T0: 32.10 ± 39.37 vs. HIIT at T12: 48.2 ± 59.2). Mitochondrial transcription factor A (TFAM) content, a marker of mitochondrial biogenesis, increased significantly following HIIT (+36.2%) and MICT (+57.2%). A significant increase was observed in the HIIT group for Translocase of Outer Membrane 20 (TOM20; +54.1%; marker of mitochondrial content), Mitofusin-2 (MFN2; +71.6%; marker of mitochondrial fusion) and Parkin RBR E3 Ubiquitin Protein Ligase (PARKIN; +42.3%; marker of mitophagy). Overall, our results indicate that even though MICT (walking on treadmill) and HIIT (on an elliptical) are effective intervention strategies in obese older adults, HIIT appears to have slightly more beneficial effects. More specifically, HIIT led to higher improvements than MICT on functional capacities, lean mass and skeletal muscle markers of mitochondrial content, fusion, and mitophagy. Thus, MICT but also HIIT (time-efficient training) could be recommended as exercise modalities for obese older adults to maintain or improve mobility, health and quality of life. Full article

(This article belongs to the Special Issue Strategies to Manage Obesity in Older Adults)

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9 pages, 1591 KiB

Open AccessEditor’s ChoiceReview

Adverse Childhood Events, Post-Traumatic Stress Disorder, Infectious Encephalopathies and Immune-Mediated Disease

by Robert C. Bransfield

Healthcare 2022, 10(6), 1127; https://doi.org/10.3390/healthcare10061127 - 17 Jun 2022

Cited by 2 | Viewed by 7359

Abstract

Adverse Childhood Events (ACE), Post-Traumatic Stress Disorder (PTSD), and infectious encephalopathies are associated with immune-mediated diseases. Data supporting this are reviewed, and an integrated hypothesis is provided. All three can be associated with intrusive symptoms and temporal lobe pathology. ACE and PTSD are [...] Read more.

Adverse Childhood Events (ACE), Post-Traumatic Stress Disorder (PTSD), and infectious encephalopathies are associated with immune-mediated diseases. Data supporting this are reviewed, and an integrated hypothesis is provided. All three can be associated with intrusive symptoms and temporal lobe pathology. ACE and PTSD are accompanied by an impaired mental capacity to differentiate external danger vs. safety. Infectious encephalopathies are accompanied by a failure of adaptive immunity and an impaired immune capacity to differentiate internal danger vs. safety. All three conditions are associated with impairments to differentiate danger vs. safety and adapt effectively. There are reciprocal interactions between ACE, PTSD, and infectious encephalopathies with accompanying persistent immune activation. This is associated with immune dysregulation, chronic hyperarousal, activation of the stress response, and impairments of the fear recognition and response neural circuits, hypothalamic–pituitary–adrenal axis, amygdala, and hippocampus. The pathophysiological processes can result in a broad spectrum of chronic neuropsychiatric and somatic symptoms and diseases. Understanding the psychodynamic, neurological, neuroimmune, inflammatory and autoimmune components of this interactive process expands the effective treatment opportunities. Full article

(This article belongs to the Collection Why Some Patients Never Fully Recover: Post Active Phase of Infection Syndromes (PAPIS))

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Graphical abstract

14 pages, 561 KiB

Open AccessEditor’s ChoiceReview

Virtual Reality in the Rehabilitation of Patients with Injuries and Diseases of Upper Extremities

by Pinar Tokgöz, Susanne Stampa, Dirk Wähnert, Thomas Vordemvenne and Christoph Dockweiler

Healthcare 2022, 10(6), 1124; https://doi.org/10.3390/healthcare10061124 - 16 Jun 2022

Cited by 29 | Viewed by 5114

Abstract

Upper-extremity injuries and diseases rarely have life-threatening consequences, but failure to manage them properly can result in severe dysfunction. This article presents the current state of using virtual reality to support the rehabilitation process of patients with injuries and diseases of the upper [...] Read more.

Upper-extremity injuries and diseases rarely have life-threatening consequences, but failure to manage them properly can result in severe dysfunction. This article presents the current state of using virtual reality to support the rehabilitation process of patients with injuries and diseases of the upper extremities and points out their effects on upper-extremity functions. A scoping review was conducted to provide a comprehensive overview of the field of virtual reality for upper-extremity rehabilitation. PubMed, Web of Science, and the Cochrane Library were searched by two independent researchers between April and May 2021 to identify relevant publications and were examined according to inclusion and exclusion criteria. As a result of the literature review, 11 studies of various target groups were identified. Virtual-reality technologies were categorized into multisensory high-end systems and game-based systems. With respect to functional recovery, technologies based on virtual reality were not inferior to traditional rehabilitation. In addition, the users were highly motivated and satisfied. The results emphasize the need for stronger evidence-based virtual-reality technologies for rehabilitation of injuries and diseases of upper extremities. Full article

(This article belongs to the Special Issue Assistive Technologies, Robotics, and Automated Machines in the Health Domain)

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10 pages, 1287 KiB

Open AccessEditor’s ChoiceArticle

Polycystic Ovary Syndrome (PCOS) and Non-Suicidal Self-Injury (NSSI): A Community-Based Study

by Sophie Williams, Dean Fido and David Sheffield

Healthcare 2022, 10(6), 1118; https://doi.org/10.3390/healthcare10061118 - 15 Jun 2022

Cited by 9 | Viewed by 3895

Abstract

Polycystic Ovary Syndrome (PCOS) is an endocrine condition that has been associated with atypical emotional regulation strategy use as well as elevated levels of depression, anxiety, self-harm and suicidal ideation. Despite the existence of clinical screening guidance for this population, there is still [...] Read more.

Polycystic Ovary Syndrome (PCOS) is an endocrine condition that has been associated with atypical emotional regulation strategy use as well as elevated levels of depression, anxiety, self-harm and suicidal ideation. Despite the existence of clinical screening guidance for this population, there is still little to no understanding of how non-suicidal self-injury and suicidal ideation and intention manifest in women with PCOS and how this might differ from women without PCOS. Within this cross-sectional investigation, women with and without a diagnosis of PCOS (n = 418) completed validated metrics of emotion dysregulation, rumination and non-suicidal self-injury (NSSI), as well as self-reported indices of previous suicidal ideation and future suicidal intention. Group comparisons indicated that women with, relative to those without, PCOS reported significantly greater metrics across all variables. Moreover, serial mediation analyses were conducted to test the ideation-to-action framework of suicide in women with PCOS, with the positive relationship between a PCOS diagnosis and future suicidal intention being explained through the indirect pathway of increased emotion dysregulation, recent suicidal ideation and NSSI. Our findings call to action the need for international screening for suicide intention and self-harm in women with PCOS. Full article

(This article belongs to the Special Issue Diagnosis, Prevention, Treatment and Medical Care for Gynecologic and Perinatal Diseases)

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17 pages, 306 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Medicaid Expansions: Probing Medicaid’s Filling of the Cancer Genetic Testing and Screening Space

by Stephen M. Modell, Lisa Schlager, Caitlin G. Allen and Gail Marcus

Healthcare 2022, 10(6), 1066; https://doi.org/10.3390/healthcare10061066 - 8 Jun 2022

Cited by 4 | Viewed by 2750

Abstract

Cancer is the third largest source of spending for Medicaid in the United States. A working group of the American Public Health Association Genomics Forum Policy Committee reviewed 133/149 pieces of literature addressing the impact of Medicaid expansion on cancer screening and genetic [...] Read more.

Cancer is the third largest source of spending for Medicaid in the United States. A working group of the American Public Health Association Genomics Forum Policy Committee reviewed 133/149 pieces of literature addressing the impact of Medicaid expansion on cancer screening and genetic testing in underserved groups and the general population. Breast and colorectal cancer screening rates improved during very early Medicaid expansion but displayed mixed improvement thereafter. Breast cancer screening rates have remained steady for Latina Medicaid enrollees; colorectal cancer screening rates have improved for African Americans. Urban areas have benefited more than rural. State programs increasingly cover BRCA1/2 and Lynch syndrome genetic testing, though testing remains underutilized in racial and ethnic groups. While increased federal matching could incentivize more states to engage in Medicaid expansion, steps need to be taken to ensure that they have an adequate distribution of resources to increase screening and testing utilization. Full article

(This article belongs to the Special Issue Medicaid and Public Health)

10 pages, 252 KiB

Open AccessEditor’s ChoiceArticle

Telemedicine Patient Satisfaction Dimensions Moderated by Patient Demographics

by Andrew N. Mason, Matt Brown and Kevin Mason

Healthcare 2022, 10(6), 1029; https://doi.org/10.3390/healthcare10061029 - 1 Jun 2022

Cited by 17 | Viewed by 4172

Abstract

Background: A multi-dimensional telemedicine patient satisfaction measure is utilized to provide managerial insights into where service improvements are needed and factors that impact patient service perceptions. This research explores the influence of patient demographics on telemedicine satisfaction. Four dimensions of telemedicine patient satisfaction [...] Read more.

Background: A multi-dimensional telemedicine patient satisfaction measure is utilized to provide managerial insights into where service improvements are needed and factors that impact patient service perceptions. This research explores the influence of patient demographics on telemedicine satisfaction. Four dimensions of telemedicine patient satisfaction (health benefits, patient-centered care, monetary costs, and non-monetary costs) were compared across patient gender, income, and education levels. Methods: A survey of 440 US telemedicine patients on patient satisfaction was measured with Likert scale items to create a multi-dimensional construct using the SERVQUAL model. MANOVA, ANOVA, and linear contrasts were used to examine the impact of patient demographics on telemedicine satisfaction dimensions. Results: The findings revealed that patient demographic characteristics moderated various dimensions of their telemedicine experience satisfaction. Satisfaction with telemedicine health benefits was moderated by patient gender and income levels. Patient-centered care was moderated by patient gender, income, and education levels. Satisfaction with the monetary cost of telemedicine was associated with patient gender and education level. Patient education level influenced their satisfaction with telemedicine non-monetary costs. Discussion: Notable trends include generally higher patient satisfaction for women and those with lower education levels. Patient income showed mixed trends regarding the four dimensions of patient satisfaction. Improvements in patient health literacy along with customized services may improve telemedicine patient care satisfaction and health outcomes. Conclusions: Measuring telemedicine patient satisfaction with a multi-dimensional assessment tool provides insights into how patient demographics influence perceptions of services received. The findings highlighted perceptions of telemedicine patient satisfaction dimensions that differed across patient demographics and provided insights into their overall impact on telemedicine patient satisfaction. Full article

(This article belongs to the Section TeleHealth and Digital Healthcare)

10 pages, 278 KiB

Open AccessEditor’s ChoiceArticle

Does the Quality of Postpartum Hemorrhage Local Protocols Improve the Identification and Management of Blood Loss after Vaginal Deliveries? A Multicenter Cohort Study

by Françoise Vendittelli, Chloé Barasinski, Olivier Rivière, Caroline Da Costa Correia, Catherine Crenn-Hébert, Michel Dreyfus, Anne Legrand and Laurent Gerbaud

Healthcare 2022, 10(6), 992; https://doi.org/10.3390/healthcare10060992 - 27 May 2022

Cited by 5 | Viewed by 2876

Abstract

Substandard care, which can result from a delayed recognition of the severity of blood loss, can increase maternal morbidity. Our objectives were to assess the incidence of postpartum hemorrhage (PPH) and of second-line procedures in maternity units according to the quality of their [...] Read more.

Substandard care, which can result from a delayed recognition of the severity of blood loss, can increase maternal morbidity. Our objectives were to assess the incidence of postpartum hemorrhage (PPH) and of second-line procedures in maternity units according to the quality of their PPH protocol. We used a mixed design, a prospective cohort (3442 women with PPH after vaginal delivery; February–July 2011), and an audit of the written protocols (177 French maternity units; September 2010–June 2011). A quality score was calculated for the protocol of each unit. Maternity units were classified into three categories according to this score: category 1 (total score: 0–8), category 2 (9–12.5), and category 3 (>12.5). The PPH incidence (>500 mL) was 3.2%, 3.3% and 4.6% among maternity units in categories 1, 2 and 3, respectively (p < 0.0001). The incidence of severe maternal morbidity (surgery and/or artery embolization and/or blood transfusion) was higher among maternity units in category 1 (54.8%; 95% CI: 51.9, 57.7) than in either category 2 (50.1%; 95% CI: 47.8, 52.5) or 3 (38.0%; 95% CI: 33.8, 42.4]) (p < 0.0001). The risks of severe maternal morbidity were lower for category 3 than category 1 and 2 (respectively, adjusted RR 0.68, 95% CI 0.60–0.86 and 0.77, 95% CI 0.68–0.87). Finally, maternity units with higher scores identified PPH better and used fewer curative second-line procedures. Full article

(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)

19 pages, 1310 KiB

Open AccessEditor’s ChoiceArticle

Last Aid Training Online: Participants’ and Facilitators’ Perceptions from a Mixed-Methods Study in Rural Scotland

by Leah Macaden, Kirsten Broadfoot, Clare Carolan, Kevin Muirhead, Siobhan Neylon and Jeremy Keen

Healthcare 2022, 10(5), 918; https://doi.org/10.3390/healthcare10050918 - 16 May 2022

Cited by 6 | Viewed by 3982

Abstract

(1) Background: Palliative and end-of-life care services are increasingly gaining centre stage in health and social care contexts in the UK and globally. Death and dying need are relational processes. Building personal and community capacity along with resilience is vital to support families [...] Read more.

(1) Background: Palliative and end-of-life care services are increasingly gaining centre stage in health and social care contexts in the UK and globally. Death and dying need are relational processes. Building personal and community capacity along with resilience is vital to support families and communities to normalise death and dying. Last Aid Training (LAT) is one such innovative educational initiative which teaches the general public about the fundamentals of palliative care and promotes public discussion about death and dying. The Highland Hospice [HH] in Scotland has pioneered delivery of LAT in face-to-face settings since March 2019 and online since March 2020 to accommodate pandemic restrictions. (2) Methods: This study used a mixed-methods approach, combining an online survey with LAT participants followed by individual semi-structured qualitative interviews with both LAT participants and facilitators. The primary aim of this study was to investigate the impacts of LAT for participants at the individual, family, and community levels, as well as explore participant and facilitator experiences and perspectives of LAT in an online environment. (3) Results: Overall, this evaluation demonstrates that provision of foundational death literacy education in social contexts enhances the personal knowledge, skills, and confidence of individual community members and supports the notion that this personal growth could lead to strengthened community action. (4) Conclusions: Findings from this study concluded that there is potential to include LAT as the foundational core training to promote death literacy in communities with further exploration to integrate/align LAT with other national/global end-of-life care frameworks. Full article

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

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14 pages, 535 KiB

Open AccessEditor’s ChoiceSystematic Review

Prevalence of Frailty among Community-Dwelling Older Adults in Asian Countries: A Systematic Review and Meta-Analysis

by Thi-Lien To, Thanh-Nhan Doan, Wen-Chao Ho and Wen-Chun Liao

Healthcare 2022, 10(5), 895; https://doi.org/10.3390/healthcare10050895 - 12 May 2022

Cited by 49 | Viewed by 5089

Abstract

This study aimed to synthesize frailty prevalence among community-dwelling older adults in Asia and identify factors influencing prevalence estimates. Five electronic databases were searched by 29 April 2022, including representative samples of community-dwelling adults who were aged 60 years and older and lived [...] Read more.

This study aimed to synthesize frailty prevalence among community-dwelling older adults in Asia and identify factors influencing prevalence estimates. Five electronic databases were searched by 29 April 2022, including representative samples of community-dwelling adults who were aged 60 years and older and lived in Asia. Cross-sectional or national longitudinal population-based cohort studies completed with validated instruments were selected. Twenty-one studies with 52,283 participants were included. The pooled prevalence rate of frailty was 20.5% (95% CI = 15.5% to 26.0%). The estimated frailty prevalence was 14.6% (95% CI = 10.9% to 18.8%) while assessed by the Fried frailty phenotype, 28.0% (95% CI = 21.3% to 35.3%) by the Cumulative Frailty Index, 36.4% (95% CI = 33.6% to 39.3%) by the Study of Osteoporotic Fractures (SOF) index, and 46.3% (95% CI = 40.1% to 52.4%) by the Clinical Frailty Scale (p < 0.01). Subgroup analysis in studies using the Fried’s phenotype tool found that frailty prevalence was increased with older age (p = 0.01) and was higher in those who were single (21.5%) than in married participants (9.0%) (p = 0.02). The study results supported a better understanding of frailty prevalence in different geographical distributions and provide references for health policy decision-making regarding preventing frailty progression in older adults. Full article

(This article belongs to the Special Issue Frailty in Community-Dwelling Older People)

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21 pages, 1135 KiB

Open AccessEditor’s ChoiceArticle

A Cluster Analysis of the Acceptance of a Contact Tracing App—The Identification of Profiles for the Italian Immuni Contact Tracing App

by Marcello Sarini, Rossana Actis Grosso, Maria Elena Magrin, Silvia Mari, Nadia Olivero, Giulia Paganin and Silvia Simbula

Healthcare 2022, 10(5), 888; https://doi.org/10.3390/healthcare10050888 - 11 May 2022

Cited by 4 | Viewed by 4364

Abstract

Digital contact tracing apps have been introduced by governments as a strategy to limit the spread of the COVID-19 pandemic. Digital contact tracking is an alternative to traditional contact tracing performed by human tracers who have to reconstruct each contact an infected person [...] Read more.

Digital contact tracing apps have been introduced by governments as a strategy to limit the spread of the COVID-19 pandemic. Digital contact tracking is an alternative to traditional contact tracing performed by human tracers who have to reconstruct each contact an infected person had in the recent past by means of interviews. The Italian government proposed the Immuni digital contact tracking app as a solution. Immuni uses Bluetooth technology to anonymously register all close contacts a person had: if she tests positive for COVID-19 then all registered contacts are notified. The main aim of the paper is to propose a cluster analysis of some factors concerning the possible acceptance of the Immuni app to build behaviour profiles that explain and predict the possible behaviours of the respondents. The factors considered referred to three different pillars: the technological pillar, investigated by considering factors from the technology acceptance models family; the health pillar, where variables of the health belief model were used; and the sociopolitical pillar, where some values of the respondents were considered as possible barriers to or facilitators of the acceptance of this technology. As a result of the cluster analysis, three behavioural profiles were built: the ProApp profile, the Hesitant profile, and the AntiApp profile. The first is the profile grouping the respondents who intend to use the contact tracing app; the second is more about people who are favourable of the use of the app, but some issues such as privacy reduce the strength of their intention; the last profile is about people who are less favourable to use the app. We are confident that the behaviour profiles found would be useful to build more tailored communication campaigns to help promote the use of the app by managing factors that could either be facilitators or barriers. Full article

(This article belongs to the Special Issue Digital Technology to Control the COVID-19 Epidemic Infection: Issues, Successes and Failures)

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29 pages, 694 KiB

Open AccessEditor’s ChoiceReview

Wishes and Needs of Nursing Home Residents: A Scoping Review

by Roxana Schweighart, Julie Lorraine O’Sullivan, Malte Klemmt, Andrea Teti and Silke Neuderth

Healthcare 2022, 10(5), 854; https://doi.org/10.3390/healthcare10050854 - 6 May 2022

Cited by 26 | Viewed by 5671

Abstract

Falling birth rates and rising life expectancy are leading to global aging. The proportional increase in older people can be observed in almost all countries and regions worldwide. As a result, more people spend their later years in nursing homes. In homes where [...] Read more.

Falling birth rates and rising life expectancy are leading to global aging. The proportional increase in older people can be observed in almost all countries and regions worldwide. As a result, more people spend their later years in nursing homes. In homes where person-centered care is implemented, residents report greater satisfaction and quality of life. This approach is based on the wishes and needs of the residents. Therefore, the purpose of this scoping review is to explore the wishes and needs of nursing home residents. A scoping review of the literature was conducted in which 12 databases were systematically searched for relevant articles according to PRISMA-ScR guidelines. Both quantitative and qualitative study designs were considered. A total of 51 articles met the inclusion criteria. Included articles were subjected to thematic analysis and synthesis to categorize findings into themes. The analysis identified 12 themes to which the wishes and needs were assigned: (1) Activities, leisure, and daily routine; (2) Autonomy, independence, choice, and control; (3) Death, dying, and end-of-life; (4) Economics; (5) Environment, structural conditions, meals, and food; (6) Health condition; (7) Medication, care, treatment, and hygiene; (8) Peer relationship, company, and social contact; (9) Privacy; (10) Psychological and emotional aspects, security, and safety; (11) Religion, spirituality; and (12) Sexuality. Nursing home residents are not a homogeneous group. Accordingly, a wide range of needs and wishes are reported in the literature, assigned to various topics. This underscores the need for tailored and person-centered approaches to ensure long-term well-being and quality of life in the nursing home care setting. Full article

(This article belongs to the Special Issue Long-Term Care for Older Adults)

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25 pages, 1523 KiB

Open AccessEditor’s ChoiceArticle

A Two-Stage De-Identification Process for Privacy-Preserving Medical Image Analysis

by Arsalan Shahid, Mehran H. Bazargani, Paul Banahan, Brian Mac Namee, Tahar Kechadi, Ceara Treacy, Gilbert Regan and Peter MacMahon

Healthcare 2022, 10(5), 755; https://doi.org/10.3390/healthcare10050755 - 19 Apr 2022

Cited by 9 | Viewed by 6043

Abstract

Identification and re-identification are two major security and privacy threats to medical imaging data. De-identification in DICOM medical data is essential to preserve the privacy of patients’ Personally Identifiable Information (PII) and requires a systematic approach. However, there is a lack of sufficient [...] Read more.

Identification and re-identification are two major security and privacy threats to medical imaging data. De-identification in DICOM medical data is essential to preserve the privacy of patients’ Personally Identifiable Information (PII) and requires a systematic approach. However, there is a lack of sufficient detail regarding the de-identification process of DICOM attributes, for example, what needs to be considered before removing a DICOM attribute. In this paper, we first highlight and review the key challenges in the medical image data de-identification process. In this paper, we develop a two-stage de-identification process for CT scan images available in DICOM file format. In the first stage of the de-identification process, the patient’s PII—including name, date of birth, etc., are removed at the hospital facility using the export process available in their Picture Archiving and Communication System (PACS). The second stage employs the proposed DICOM de-identification tool for an exhaustive attribute-level investigation to further de-identify and ensure that all PII has been removed. Finally, we provide a roadmap for future considerations to build a semi-automated or automated tool for the DICOM datasets de-identification. Full article

(This article belongs to the Section Health Informatics and Big Data)

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23 pages, 8131 KiB

Open AccessEditor’s ChoiceReview

Impacts on Context Aware Systems in Evidence-Based Health Informatics: A Review

by Stella C. Christopoulou

Healthcare 2022, 10(4), 685; https://doi.org/10.3390/healthcare10040685 - 5 Apr 2022

Cited by 5 | Viewed by 3501

Abstract

Background: The application of Context Aware Computing (CAC) can be an effective, useful, feasible, and acceptable way to advance medical research and provide health services. Methods: This review was conducted in accordance with the principles of the development of a mixed [...] Read more.

Background: The application of Context Aware Computing (CAC) can be an effective, useful, feasible, and acceptable way to advance medical research and provide health services. Methods: This review was conducted in accordance with the principles of the development of a mixed methods review and existing knowledge in the field via the Synthesis Framework for the Assessment of Health Information Technology to evaluate CAC implemented by Evidence-Based Health Informatics (EBHI). A systematic search of the literature was performed during 18 November 2021–22 January 2022 in Cochrane Library, IEEE Xplore, PUBMED, Scopus and in the clinical registry platform Clinicaltrials.gov. The author included the articles in the review if they were implemented by EBHI and concerned with CAC technologies. Results: 29 articles met the inclusion criteria and refer to 26 trials published between 2011 and 2022. The author noticed improvements in healthcare provision using EBHI in the findings of CAC application. She also confirmed that CAC systems are a valuable and reliable method in health care provision. Conclusions: The use of CAC systems in healthcare is a promising new area of research and development. The author presented that the evaluation of CAC systems in EBHI presents positive effects on the state of health and the management of long-term diseases. These implications are presented in this article in a detailed, clear, and reliable manner. Full article

(This article belongs to the Section TeleHealth and Digital Healthcare)

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9 pages, 668 KiB

Open AccessEditor’s ChoiceArticle

Can Lung Ultrasound Be the Ideal Monitoring Tool to Predict the Clinical Outcome of Mechanically Ventilated COVID-19 Patients? An Observational Study

by Luigi Vetrugno, Francesco Meroi, Daniele Orso, Natascia D’Andrea, Matteo Marin, Gianmaria Cammarota, Lisa Mattuzzi, Silvia Delrio, Davide Furlan, Jonathan Foschiani, Francesca Valent and Tiziana Bove

Healthcare 2022, 10(3), 568; https://doi.org/10.3390/healthcare10030568 - 18 Mar 2022

Cited by 13 | Viewed by 2369

Abstract

Background: During the COVID-19 pandemic, lung ultrasound (LUS) has been widely used since it can be performed at the patient’s bedside, does not produce ionizing radiation, and is sufficiently accurate. The LUS score allows for quantifying lung involvement; however, its clinical prognostic role [...] Read more.

Background: During the COVID-19 pandemic, lung ultrasound (LUS) has been widely used since it can be performed at the patient’s bedside, does not produce ionizing radiation, and is sufficiently accurate. The LUS score allows for quantifying lung involvement; however, its clinical prognostic role is still controversial. Methods: A retrospective observational study on 103 COVID-19 patients with respiratory failure that were assessed with an LUS score at intensive care unit (ICU) admission and discharge in a tertiary university COVID-19 referral center. Results: The deceased patients had a higher LUS score at admission than the survivors (25.7 vs. 23.5; p-value = 0.02; cut-off value of 25; Odds Ratio (OR) 1.1; Interquartile Range (IQR) 1.0−1.2). The predictive regression model shows that the value of LUSt0 (OR 1.1; IQR 1.0–1.3), age (OR 1.1; IQR 1.0−1.2), sex (OR 0.7; IQR 0.2−3.6), and days in spontaneous breathing (OR 0.2; IQR 0.1–0.5) predict the risk of death for COVID-19 patients (Area under the Curve (AUC) 0.92). Furthermore, the surviving patients showed a significantly lower difference between LUS scores at admission and discharge (mean difference of 1.75, p-value = 0.03). Conclusion: Upon entry into the ICU, the LUS score may play a prognostic role in COVID-19 patients with ARDS. Furthermore, employing the LUS score as a monitoring tool allows for evaluating the patients with a higher probability of survival. Full article

(This article belongs to the Special Issue Pulmonary and Critical Care Medicine)

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9 pages, 450 KiB

Open AccessEditor’s ChoiceReview

Current Practice of High Flow through Nasal Cannula in Exacerbated COPD Patients

by Andrea Bruni, Eugenio Garofalo, Daniela Procopio, Silvia Corrado, Antonio Caroleo, Eugenio Biamonte, Corrado Pelaia and Federico Longhini

Healthcare 2022, 10(3), 536; https://doi.org/10.3390/healthcare10030536 - 15 Mar 2022

Cited by 5 | Viewed by 6199

Abstract

Acute Exacerbation of Chronic Obstructive Pulmonary Disease is a form of severe Acute Respiratory Failure (ARF) requiring Conventional Oxygen Therapy (COT) in the case of absence of acidosis or the application of Non-Invasive Ventilation (NIV) in case of respiratory acidosis. In the last [...] Read more.

Acute Exacerbation of Chronic Obstructive Pulmonary Disease is a form of severe Acute Respiratory Failure (ARF) requiring Conventional Oxygen Therapy (COT) in the case of absence of acidosis or the application of Non-Invasive Ventilation (NIV) in case of respiratory acidosis. In the last decade, High Flow through Nasal Cannula (HFNC) has been increasingly used, mainly in patients with hypoxemic ARF. However, some studies were also published in AECOPD patients, and some evidence emerged. In this review, after describing the mechanism underlying potential clinical benefits, we analyzed the possible clinical application of HFNC to AECOPD patients. In the case of respiratory acidosis, the gold-standard treatment remains NIV, supported by strong evidence in favor. However, HFNC may be considered as an alternative to NIV if the latter fails for intolerance. HFNC should also be considered and preferred to COT at NIV breaks and weaning. Finally, HFNC should also be preferred to COT as first-line oxygen treatment in AECOPD patients without respiratory acidosis. Full article

(This article belongs to the Special Issue Pulmonary and Critical Care Medicine)

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9 pages, 470 KiB

Open AccessEditor’s ChoiceReview

Patient Active Approaches in Osteopathic Practice: A Scoping Review

by Christian Lunghi, Francesca Baroni, Andrea Amodio, Giacomo Consorti, Marco Tramontano and Torsten Liem

Healthcare 2022, 10(3), 524; https://doi.org/10.3390/healthcare10030524 - 14 Mar 2022

Cited by 14 | Viewed by 7814

Abstract

Background: In the field of manual therapies there is a growing interest in moving from passive hands-on approaches to patient active approaches. In the osteopathic field there are both active and passive methods described as integrated in the process of care. However, this [...] Read more.

Background: In the field of manual therapies there is a growing interest in moving from passive hands-on approaches to patient active approaches. In the osteopathic field there are both active and passive methods described as integrated in the process of care. However, this prospective linkage has not been formally explored and is not well shared in the community of practice. The present review aims to appraise the relevant literature on the functioning and principles of Patient active osteopathic approaches (PAOAs) and explore a prospective model for selecting the different types of PAOA, highlighting their integration into patient management strategies. Methods: A scoping review was conducted to analyze the relevant literature on the functioning and the different principles of PAOA and to obtain a comprehensive perspective on the phenomenon. Results: The eligible articles provide insights into the mechanisms of functioning and principles of application of active approaches to be integrated with hands-on approaches. These results provide new insights into the relevance of PAOA to clinical practice. Conclusions: The proposal, emerging from the review, may promote discussions in the community of practice and provide a road map for research towards achieving an evidence-based structure for PAOA. Full article

(This article belongs to the Collection Osteopathic and Manual Therapy Healthcare Reconceptualization: Health Needs and New Evidence)

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14 pages, 4412 KiB

Open AccessEditor’s ChoiceArticle

A Web-Based Application to Monitor and Inform about the COVID-19 Outbreak in Italy: The {COVID-19ita} Initiative

by Corrado Lanera, Danila Azzolina, Francesco Pirotti, Ilaria Prosepe, Giulia Lorenzoni, Paola Berchialla and Dario Gregori

Healthcare 2022, 10(3), 473; https://doi.org/10.3390/healthcare10030473 - 3 Mar 2022

Cited by 5 | Viewed by 3012

Abstract

The pandemic outbreak of COVID-19 has posed several questions about public health emergency risk communication. Due to the effort required for the population to adopt appropriate behaviors in response to the emergency, it is essential to inform the public of the epidemic situation [...] Read more.

The pandemic outbreak of COVID-19 has posed several questions about public health emergency risk communication. Due to the effort required for the population to adopt appropriate behaviors in response to the emergency, it is essential to inform the public of the epidemic situation with transparent data sources. The COVID-19ita project aimed to develop a public open-source tool to provide timely, updated information on the pandemic’s evolution in Italy. It is a web-based application, the front end for the eponymously named R package freely available on GitHub, deployed both in English and Italian. The web application pulls the data from the official repository of the Italian COVID-19 outbreak at the national, regional, and provincial levels. The app allows the user to select information to visualize data in an interactive environment and compare epidemic situations over time and across different Italian regions. At the same time, it provides insights about the outbreak that are explained and commented upon to yield reasoned, focused, timely, and updated information about the outbreak evolution. Full article

(This article belongs to the Special Issue Digital Technology to Control the COVID-19 Epidemic Infection: Issues, Successes and Failures)

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12 pages, 708 KiB

Open AccessEditor’s ChoiceArticle

Self-Service System for the Family Members of ICU Patients: A Pilot Study

by I-Chiu Chang, Ying-Hui Hou, Li-Jung Lu and Yu-Chen Tung

Healthcare 2022, 10(3), 467; https://doi.org/10.3390/healthcare10030467 - 2 Mar 2022

Cited by 3 | Viewed by 2756

Abstract

Family members of intensive care unit patients are often experience high anxiety and require more information about the patients. However, most Taiwanese healthcare institutions currently face manpower shortages due to the COVID-19 pandemic. Therefore, the task of providing additional services to meet family [...] Read more.

Family members of intensive care unit patients are often experience high anxiety and require more information about the patients. However, most Taiwanese healthcare institutions currently face manpower shortages due to the COVID-19 pandemic. Therefore, the task of providing additional services to meet family members’ needs and relieve their stress was deferred by some healthcare institutions. The self-service system, known to be effective and efficient in other industries, was recommended for use in the healthcare industry. This study aims to explore an intensive care unit self-service system (ICU-SSS) designed for the family members of ICU patients. This study investigates the feasibility of the system by following a mixed method approach, including qualitative interviews and a quantitative survey. Firstly, interviews with five family members and five ICU staff members of a case hospital were conducted to identify the need to develop an ICU-SSS for the family member. Secondly, a survey was completed by 30 family members to evaluate the system. The interview results reveal nine categories of family members’ needs and the survey results show that the ICU family members assigned acceptable scores to all the ICU-SSS functions, except the importance of “Logistical information”. Based on these findings, the scientific and practical implications are discussed. Full article

(This article belongs to the Section TeleHealth and Digital Healthcare)

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11 pages, 778 KiB

Open AccessEditor’s ChoiceArticle

Establishing a New ECMO Referral Center Using an ICU-Based Approach: A Feasibility and Safety Study

by Ryszard Gawda, Maciej Piwoda, Maciej Marszalski, Katarzyna Lyp, Jolanta Piwoda, Magdalena Maj, Maciej Gawor, Maciej Molsa, Marek Pietka and Tomasz Czarnik

Healthcare 2022, 10(3), 414; https://doi.org/10.3390/healthcare10030414 - 22 Feb 2022

Cited by 3 | Viewed by 3306

Abstract

Background: A high-volume center with a multidisciplinary team is regarded as the optimal place for providing extracorporeal membrane oxygenation (ECMO). We hypothesize that an ECMO center can also be successfully created and subsequently developed entirely by intensivists in a mid-size mixed intensive care [...] Read more.

Background: A high-volume center with a multidisciplinary team is regarded as the optimal place for providing extracorporeal membrane oxygenation (ECMO). We hypothesize that an ECMO center can also be successfully created and subsequently developed entirely by intensivists in a mid-size mixed intensive care unit (ICU). Methods: A model was created for setting up a new ECMO referral center within the structure of an existing mixed ICU in a tertiary hospital. A retrospective analysis was carried out of the first 33 patients treated in the initial period of the center’s activity, from mid 2018 to the end of 2020. Results: An ECMO center was established and developed entirely based on the resources of an existing mixed ICU. Thirty-three patients were treated. They had an overall survival rate at 90 days of 60.6%. In veno-venous (VV) mode ECMO duration, ICU length of stay, and SOFA score were significantly higher than in veno-arterial mode. No significant differences in clinical characteristics were observed between survivors and non-survivors on VV-ECMO. Conclusions: A regional ECMO center can be set up as an integral part of a mixed ICU in a tertiary hospital. Extracorporeal therapy, such as continuous renal replacement therapy and mechanical ventilation can be managed entirely by intensivists. Further studies are needed to show that the ICU-based approach to setting up a new ECMO center is no less effective than the multidisciplinary approach. Full article

(This article belongs to the Special Issue Pulmonary and Critical Care Medicine)

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8 pages, 364 KiB

Open AccessEditor’s ChoiceArticle

Can Social Media Profiles Be a Reliable Source of Information on Nutrition and Dietetics?

by Paweł Kabata, Dorota Winniczuk-Kabata, Piotr Maciej Kabata, Janusz Jaśkiewicz and Karol Połom

Healthcare 2022, 10(2), 397; https://doi.org/10.3390/healthcare10020397 - 20 Feb 2022

Cited by 16 | Viewed by 6341

Abstract

Background: Social media are growing worldwide platforms for unlimited exchange of various content. Owing to their accessibility and short form, they can be utilized as usable, wide-range communication and information tools for companies, scientific communities, patient advocacy organizations, and special interest groups. This [...] Read more.

Background: Social media are growing worldwide platforms for unlimited exchange of various content. Owing to their accessibility and short form, they can be utilized as usable, wide-range communication and information tools for companies, scientific communities, patient advocacy organizations, and special interest groups. This study aimed to investigate whether Instagram^® profiles can be reliable sources of information and knowledge about nutrition and dietetics. Materials and Methods: Random identification of nutrition-related posts was performed using a built-in website search engine. Posts were searched by five popular hashtags: #nutrition, #nutritionist, #instadiet, #diet, and #dietitian, 250 newest posts of each. Advertisement posts were discarded. Each eligible post was then categorized (dietetics, fitness, motivation, other) and assessed with regard to the quality of nutrition information provided (five levels from none to good quality), popularity (number of followers, likes, and comments), and engagement measures (like, comment, and engagement ratio). Results: A total of 1189 posts were reviewed. The overall quality of the content regarding nutritional knowledge was extremely low (93.9% of all posts), also when divided into categories. Among all posts, 63.8% were categorized as “nutrition and dietetics”, while “fitness”, “motivation”, and “other” categories comprised 8.2%, 4.8%, and 23.2% of the posts, respectively. Posts recognized as dietetics were the most liked (mean n = 116 likes per post) and of the highest quality. However, those motivational raised the greatest degree of engagement (32.7%). Posts with cooking recipes were the most commented. Conclusions: Random post search cannot provide viewers with valuable nutrition information. A dedicated search for high-quality professional profiles is preferred to obtain quality information. Full article

(This article belongs to the Special Issue The Role of Social Media in Innovative Digital Health)

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16 pages, 1351 KiB

Open AccessEditor’s ChoiceArticle

A Preliminary Italian Cross-Sectional Study on the Level of Digital Psychiatry Training, Knowledge, Beliefs and Experiences among Medical Students, Psychiatry Trainees and Professionals

by Laura Orsolini, Silvia Bellagamba, Virginia Marchetti, Giulia Menculini, Silvia Tempia Valenta, Virginio Salvi and Umberto Volpe

Healthcare 2022, 10(2), 390; https://doi.org/10.3390/healthcare10020390 - 18 Feb 2022

Cited by 9 | Viewed by 2550

Abstract

The COVID-19 pandemic led to the implementation of digital psychiatry (DP), resulting in the need for a new skilled healthcare workforce. The purpose of this study was to investigate the level of training, knowledge, beliefs, and experiences of young mental health professionals and [...] Read more.

The COVID-19 pandemic led to the implementation of digital psychiatry (DP), resulting in the need for a new skilled healthcare workforce. The purpose of this study was to investigate the level of training, knowledge, beliefs, and experiences of young mental health professionals and medical students in DP. An ad hoc cross-sectional survey was administered and descriptive analyses, Student’s t and ANOVA tests were conducted, together with an exploratory factor analysis, bivariate correlations and linear regression. Most of the sample (N = 239) declared that DP was never discussed within their academic training (89.1%), mainly revealing an overall lack of knowledge on the issue. Nevertheless, subjects mostly declared that DP represents a valuable therapeutic tool in mental health (80%) and that their training should include this topic (54.4%). Moreover, most subjects declared that digital interventions are less effective than face-to-face ones (73.2%), despite the emerging evidence that being trained in DP is significantly associated with the belief that digital and in-person interventions are comparable in their effectiveness (p ≤ 0.05). Strong positive correlations were found between the knowledge score (KS) and perceived significance index (PSI) (r = 0.148, p < 0.001), and KS and Digital Psychiatry Opinion (DPO) index (r = 0.193, p < 0.001). PSI scores statistically significantly predicted KS total scores (F(1, 237) = 5.283, R² = 0.022, p = 0.022). KS scores statistically significantly predicted DPO total scores (F(1, 237) = 9.136, R² = 0.037, p = 0.003). During the current pandemic, DP represented an ideal response to the forced physical distancing by ensuring the advantage of greater access to care. However, this kind of intervention is still uncommon, and mental health professionals still prove to be skeptical. The lack of formal training on DP during the academic years could be a limiting factor. Full article

(This article belongs to the Collection E-learning and Digital Training in Healthcare Education: Current Trends and New Challenges)

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19 pages, 8856 KiB

Open AccessEditor’s ChoiceArticle

Regression Analysis for COVID-19 Infections and Deaths Based on Food Access and Health Issues

by Abrar Almalki, Balakrishna Gokaraju, Yaa Acquaah and Anish Turlapaty

Healthcare 2022, 10(2), 324; https://doi.org/10.3390/healthcare10020324 - 8 Feb 2022

Cited by 11 | Viewed by 17002

Abstract

COVID-19, or SARS-CoV-2, is considered as one of the greatest pandemics in our modern time. It affected people’s health, education, employment, the economy, tourism, and transportation systems. It will take a long time to recover from these effects and return people’s lives back [...] Read more.

COVID-19, or SARS-CoV-2, is considered as one of the greatest pandemics in our modern time. It affected people’s health, education, employment, the economy, tourism, and transportation systems. It will take a long time to recover from these effects and return people’s lives back to normal. The main objective of this study is to investigate the various factors in health and food access, and their spatial correlation and statistical association with COVID-19 spread. The minor aim is to explore regression models on examining COVID-19 spread with these variables. To address these objectives, we are studying the interrelation of various socio-economic factors that would help all humans to better prepare for the next pandemic. One of these critical factors is food access and food distribution as it could be high-risk population density places that are spreading the virus infections. More variables, such as income and people density, would influence the pandemic spread. In this study, we produced the spatial extent of COVID-19 cases with food outlets by using the spatial analysis method of geographic information systems. The methodology consisted of clustering techniques and overlaying the spatial extent mapping of the clusters of food outlets and the infected cases. Post-mapping, we analyzed these clusters’ proximity for any spatial variability, correlations between them, and their causal relationships. The quantitative analyses of the health issues and food access areas against COVID-19 infections and deaths were performed using machine learning regression techniques to understand the multi-variate factors. The results indicate a correlation between the dependent variables and independent variables with a Pearson correlation R²-score = 0.44% for COVID-19 cases and R² = 60% for COVID-19 deaths. The regression model with an R²-score of 0.60 would be useful to show the goodness of fit for COVID-19 deaths and the health issues and food access factors. Full article

(This article belongs to the Special Issue Socio-Economic Burden of Disease: The COVID-19 Case)

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6 pages, 220 KiB

Open AccessEditor’s ChoiceOpinion

Environment, Environmental Crimes, Environmental Forensic Medicine, Environmental Risk Management and Environmental Criminology

by Michelangelo Bruno Casali, Guido Vittorio Travaini, Carlotta Virginia Di Francesco and Umberto Rosario Genovese

Healthcare 2022, 10(2), 263; https://doi.org/10.3390/healthcare10020263 - 29 Jan 2022

Cited by 4 | Viewed by 3683

Abstract

Forensic medicine has always held the human environment, either seen as a source for pathological agents or the background of judicial events, in great consideration. The concept of the environment has evolved through time, expanding itself to include all the physical and virtual [...] Read more.

Forensic medicine has always held the human environment, either seen as a source for pathological agents or the background of judicial events, in great consideration. The concept of the environment has evolved through time, expanding itself to include all the physical and virtual sub-spaces in which we exist. We can nowadays talk of technoenvironmental reality; virtual spaces exploded because of the COVID-19 pandemic making us come to terms with the fact that those are the places where we work, where we socialize and, even, where we meet our doctors and can be cured. Artificial Intelligence (AI) has contributed to shaping new virtual realities that have got their own rules yet to be discovered, carved and respected. We already fight a daily battle to save our natural environment: along with the danger of green crimes, comes the need for environmental justice and environmental forensic medicine that will probably develop a forensic branch and an experimental branch, to implement our technical culture leading to definition of the real dimension of the risk itself to improve the role of legal medicine in the Environmental Risk Management. While green criminology addresses widespread green crimes, a virtual environment criminology will also develop, maybe with a contribution of AI in the justice field. For a sustainable life, the environmental revolution must rapidly take place, and there is the need for a new justice, a new forensic medicine and a new criminology too. Full article

(This article belongs to the Special Issue New Trends in Forensic and Legal Medicine)

13 pages, 1126 KiB

Open AccessEditor’s ChoiceArticle

Identifying Cardiovascular Risk Profiles Clusters among Mediterranean Adolescents across Seven Countries

by Riki Tesler, Sharon Barak, Orna Reges, Concepción Moreno-Maldonado, Rotem Maor, Tânia Gaspar, Oya Ercan, Yael Sela, Gizell Green, Avi Zigdon, Adilson Marques, Kwok Ng and Yossi Harel-Fisch

Healthcare 2022, 10(2), 268; https://doi.org/10.3390/healthcare10020268 - 29 Jan 2022

Cited by 6 | Viewed by 3969

Abstract

Cardiovascular diseases (CVDs) are the number one cause of death globally and are partially due to the inability to control modifiable lifestyle risk factors. The aim of this study was to analyze the profiles of adolescents from seven Mediterranean countries (Greece, Israel, Italy, [...] Read more.

Cardiovascular diseases (CVDs) are the number one cause of death globally and are partially due to the inability to control modifiable lifestyle risk factors. The aim of this study was to analyze the profiles of adolescents from seven Mediterranean countries (Greece, Israel, Italy, Macedonia, Malta, Portugal, Spain) according to their modifiable lifestyle risk factors for CVD (overweight/obesity, physical activity, smoking, alcohol consumption). The sample consisted of 26,110 adolescents (52.3% girls) aged 11, 13, and 15 years who participated in the Health Behavior in School-aged Children (HBSC) survey in 2018 across the seven countries. Sociodemographic characteristics (sex, age, country of residence, socioeconomic status) and CVD modifiable lifestyle risk factors (overweight/obesity, physical activity, smoking, alcohol consumption) were recorded. A two-step cluster analysis, one-way analysis of variance, and chi-square test were performed. Four different cluster groups were identified: two low-risk groups (64.46%), with risk among those with low physical activity levels; moderate-risk group (14.83%), with two risk factors (unhealthy weight and low physical activity level); and a high-risk group (20.7%), which presented risk in all modifiable lifestyle risk factors. Older adolescents reported a higher likelihood of being in the high-risk group. Given that the adolescence period constitutes an important time for interventions aimed at CVD prevention, identifying profiles of moderate- and high-risk adolescents is crucial. Full article

(This article belongs to the Special Issue Child and Adolescent Health: Challenges and Perspectives)

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31 pages, 2882 KiB

Open AccessEditor’s ChoiceReview

Current and Future Applications of Artificial Intelligence in Coronary Artery Disease

by Nitesh Gautam, Prachi Saluja, Abdallah Malkawi, Mark G. Rabbat, Mouaz H. Al-Mallah, Gianluca Pontone, Yiye Zhang, Benjamin C. Lee and Subhi J. Al’Aref

Healthcare 2022, 10(2), 232; https://doi.org/10.3390/healthcare10020232 - 26 Jan 2022

Cited by 27 | Viewed by 9281

Abstract

Cardiovascular diseases (CVDs) carry significant morbidity and mortality and are associated with substantial economic burden on healthcare systems around the world. Coronary artery disease, as one disease entity under the CVDs umbrella, had a prevalence of 7.2% among adults in the United States [...] Read more.

Cardiovascular diseases (CVDs) carry significant morbidity and mortality and are associated with substantial economic burden on healthcare systems around the world. Coronary artery disease, as one disease entity under the CVDs umbrella, had a prevalence of 7.2% among adults in the United States and incurred a financial burden of 360 billion US dollars in the years 2016–2017. The introduction of artificial intelligence (AI) and machine learning over the last two decades has unlocked new dimensions in the field of cardiovascular medicine. From automatic interpretations of heart rhythm disorders via smartwatches, to assisting in complex decision-making, AI has quickly expanded its realms in medicine and has demonstrated itself as a promising tool in helping clinicians guide treatment decisions. Understanding complex genetic interactions and developing clinical risk prediction models, advanced cardiac imaging, and improving mortality outcomes are just a few areas where AI has been applied in the domain of coronary artery disease. Through this review, we sought to summarize the advances in AI relating to coronary artery disease, current limitations, and future perspectives. 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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10 pages, 850 KiB

Open AccessEditor’s ChoiceArticle

Timing to Intubation COVID-19 Patients: Can We Put It Off until Tomorrow?

by Júlio César Garcia de Alencar, Juliana Martes Sternlicht, Alicia Dudy Muller Veiga, Julio Flávio Meirelles Marchini, Juliana Carvalho Ferreira, Carlos Roberto Ribeiro de Carvalho, Izabel Marcilio, Katia Regina da Silva, Vilson Cobello Junior, Marcelo Consorti Felix, Luz Marina Gomez Gomez, Heraldo Possolo de Souza, Denis Deratani Mauá, Emergency USP COVID Group and HCFMUSP COVID-19 Study Group

Healthcare 2022, 10(2), 206; https://doi.org/10.3390/healthcare10020206 - 21 Jan 2022

Cited by 2 | Viewed by 3797

Abstract

Background: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the association between intubation day and [...] Read more.

Background: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the association between intubation day and mortality in COVID-19 patients. Methods: We performed a unicentric retrospective cohort study considering all COVID-19 patients consecutively admitted between March 2020 and August 2020 requiring invasive mechanical ventilation. The primary outcome was all-cause mortality within 28 days after intubation, and a Cox model was used to evaluate the effect of time from onset of symptoms to intubation in mortality. Results: A total of 592 (20%) patients of 3020 admitted with COVID-19 were intubated during study period, and 310 patients who were intubated deceased 28 days after intubation. Each additional day between the onset of symptoms and intubation was significantly associated with higher in-hospital death (adjusted hazard ratio, 1.018; 95% CI, 1.005–1.03). Conclusion: Among patients infected with SARS-CoV-2 who were intubated and mechanically ventilated, delaying intubation in the course of symptoms may be associated with higher mortality. Trial registration: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068). Full article

(This article belongs to the Special Issue Pulmonary and Critical Care Medicine)

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10 pages, 957 KiB

Open AccessEditor’s ChoiceConcept Paper

Implementation of Compassionate Communities: The Taipei Experience

by Chia-Jen Liu, Sheng-Jean Huang and Samuel Shih-Chih Wang

Healthcare 2022, 10(1), 177; https://doi.org/10.3390/healthcare10010177 - 17 Jan 2022

Cited by 9 | Viewed by 4535

Abstract

A worldwide movement to empower communities to support their members to care for each other at the end of life (EoL) has emerged since Kellehear published the Compassionate City Charter. This current report discusses the implementation experiences and preliminary outcomes of Compassionate Communities [...] Read more.

A worldwide movement to empower communities to support their members to care for each other at the end of life (EoL) has emerged since Kellehear published the Compassionate City Charter. This current report discusses the implementation experiences and preliminary outcomes of Compassionate Communities (CC) in Taipei City. Using the guidance of the Charter and international experiences, we have developed and multiplied a culturally sensitive, sustainable, and holistic CC program that composes municipal hospital, social, and other services, partnering with community leaders, non-governmental organizations, university students, and volunteers. Innovative campaigns, such as workshops, conferences, and the Life Issue Café, have been delivered to facilitate engagement, public education, and leadership with reverence to folk beliefs and the use of existing social networks. We have identified a model with strong collaborative leadership, high participation rates, and ongoing commitment. The gaps between asking/accepting and providing help were bridged when social connectedness was strengthened. We also integrated home-based medical care, home-based palliative care, and advance care planning to help the vulnerable who live alone, with poor status, or with limited resource access, and continue to support the community throughout the COVID-19 pandemic. Full article

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

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33 pages, 13277 KiB

Open AccessEditor’s ChoiceArticle

Artificial Intelligence Analysis of Gene Expression Predicted the Overall Survival of Mantle Cell Lymphoma and a Large Pan-Cancer Series

by Joaquim Carreras, Naoya Nakamura and Rifat Hamoudi

Healthcare 2022, 10(1), 155; https://doi.org/10.3390/healthcare10010155 - 14 Jan 2022

Cited by 28 | Viewed by 5822

Abstract

Mantle cell lymphoma (MCL) is a subtype of mature B-cell non-Hodgkin lymphoma characterized by a poor prognosis. First, we analyzed a series of 123 cases (GSE93291). An algorithm using multilayer perceptron artificial neural network, radial basis function, gene set enrichment analysis (GSEA), and [...] Read more.

Mantle cell lymphoma (MCL) is a subtype of mature B-cell non-Hodgkin lymphoma characterized by a poor prognosis. First, we analyzed a series of 123 cases (GSE93291). An algorithm using multilayer perceptron artificial neural network, radial basis function, gene set enrichment analysis (GSEA), and conventional statistics, correlated 20,862 genes with 28 MCL prognostic genes for dimensionality reduction, to predict the patients’ overall survival and highlight new markers. As a result, 58 genes predicted survival with high accuracy (area under the curve = 0.9). Further reduction identified 10 genes: KIF18A, YBX3, PEMT, GCNA, and POGLUT3 that associated with a poor survival; and SELENOP, AMOTL2, IGFBP7, KCTD12, and ADGRG2 with a favorable survival. Correlation with the proliferation index (Ki67) was also made. Interestingly, these genes, which were related to cell cycle, apoptosis, and metabolism, also predicted the survival of diffuse large B-cell lymphoma (GSE10846, n = 414), and a pan-cancer series of The Cancer Genome Atlas (TCGA, n = 7289), which included the most relevant cancers (lung, breast, colorectal, prostate, stomach, liver, etcetera). Secondly, survival was predicted using 10 oncology panels (transcriptome, cancer progression and pathways, metabolic pathways, immuno-oncology, and host response), and TYMS was highlighted. Finally, using machine learning, C5 tree and Bayesian network had the highest accuracy for prediction and correlation with the LLMPP MCL35 proliferation assay and RGS1 was made. In conclusion, artificial intelligence analysis predicted the overall survival of MCL with high accuracy, and highlighted genes that predicted the survival of a large pan-cancer series. 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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16 pages, 2407 KiB

Open AccessEditor’s ChoiceReview

Effectiveness of Physiotherapy in Patients with Ankylosing Spondylitis: A Systematic Review and Meta-Analysis

by Luca Pontone Gravaldi, Francesca Bonetti, Simona Lezzerini and Fernando De Maio

Healthcare 2022, 10(1), 132; https://doi.org/10.3390/healthcare10010132 - 10 Jan 2022

Cited by 21 | Viewed by 13097

Abstract

This study aimed to evaluate the safety and effectiveness of non-pharmacological interventions supervised by a physiotherapist in patients with Ankylosing Spondylitis, PROSPERO Protocol number CRD42020209453. Five databases (PubMed, PEDro, Scopus, Web of Science Core, and EMBASE) and reference lists with relevant articles were [...] Read more.

This study aimed to evaluate the safety and effectiveness of non-pharmacological interventions supervised by a physiotherapist in patients with Ankylosing Spondylitis, PROSPERO Protocol number CRD42020209453. Five databases (PubMed, PEDro, Scopus, Web of Science Core, and EMBASE) and reference lists with relevant articles were searched. Randomised controlled trials (RCTs) on the effectiveness of non-pharmacological interventions supervised by a physiotherapist were compared with usual care or home-based exercise programmes. Two investigators independently screened eligible studies. A total of 12 RCTs satisfied eligible criteria. The risk of bias ranged between medium and high. The meta-analysis results indicated that between supervised physiotherapy and usual care, the former was significantly associated with improvement in disease activity (standardised mean difference = −0.37, 95% CI, −0.64; −0.11; p < 0.001, I² = 71.25%, n = 629), and functional capacity (standardised mean difference = −0.36, 95% CI, −0.61; −0.12, p < 0.05; n = 629). No statistically significant differences emerged when interventions were compared with home-based exercise programmes. Supervised physiotherapy is more effective than usual care in improving disease activity, functional capacity, and pain in patients with ankylosing spondylitis. No significant improvements emerged when supervised physiotherapy and home-based exercise programmes were compared. Further investigation and RCTs with larger samples are needed. Full article

(This article belongs to the Special Issue Neurorehabilitation Outcome Measures and Innovative Approaches in Physiotherapy)

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11 pages, 837 KiB

Open AccessEditor’s ChoiceArticle

Preventable Adverse Events in Obstetrics—Systemic Assessment of Their Incidence and Linked Risk Factors

by Beate Hüner, Christina Derksen, Martina Schmiedhofer, Sonia Lippke, Wolfgang Janni and Christoph Scholz

Healthcare 2022, 10(1), 97; https://doi.org/10.3390/healthcare10010097 - 4 Jan 2022

Cited by 8 | Viewed by 4355

Abstract

(1) Background: Adverse events (AEs) are an inherent part of all medical care. Obstetrics is special: it is characterized by a very high expectation regarding safety and has rare cases of harm, but extremely high individual consequences of harm. However, there is no [...] Read more.

(1) Background: Adverse events (AEs) are an inherent part of all medical care. Obstetrics is special: it is characterized by a very high expectation regarding safety and has rare cases of harm, but extremely high individual consequences of harm. However, there is no standardized identification, documentation, or uniform terminology for the preventability of AEs in obstetrics. In this study, therefore, an obstetrics-specific matrix on the preventable factors of AEs is established based on existing literature to enable standardized reactive risk management in obstetrics. (2) Methods: AEs in obstetrics from one hospital from the year 2018 were retrospectively evaluated according to a criteria matrix regarding preventability. Risk factors for preventable AEs (pAEs) were identified. (3) Results: Out of 2865 births, adverse events were identified in 659 cases (23%). After detailed case analysis, 88 cases (13%) showed at least 1 pAE. A total of 19 risk factors could be identified in 6 categories of pAEs. (4) Conclusion: Preventable categories of error could be identified. Relevant obstetric risk factors related to the error categories were identified and categorized. If these can be modified in the future with targeted measures of proactive risk management, pAEs in obstetrics could also be reduced. Full article

(This article belongs to the Special Issue Pregnancy and Perinatal Health)

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14 pages, 1150 KiB

Open AccessEditor’s ChoiceArticle

Role-Play versus Standardised Patient Simulation for Teaching Interprofessional Communication in Care of the Elderly for Nursing Students

by Alda Elena Cortés-Rodríguez, Pablo Roman, María Mar López-Rodríguez, Isabel María Fernández-Medina, Cayetano Fernández-Sola and José Manuel Hernández-Padilla

Healthcare 2022, 10(1), 46; https://doi.org/10.3390/healthcare10010046 - 27 Dec 2021

Cited by 20 | Viewed by 6462

Abstract

This study aims to describe and compare the effects of standardised patient simulation and role-play in the acquisition and retention of interprofessional communication in elderly care competence amongst nursing students. In this controlled clustered randomised trial, 121 nursing students attended a workshop on [...] Read more.

This study aims to describe and compare the effects of standardised patient simulation and role-play in the acquisition and retention of interprofessional communication in elderly care competence amongst nursing students. In this controlled clustered randomised trial, 121 nursing students attended a workshop on interprofessional communication in elderly care using role-play or standardised patient simulation. The study was conducted between September 2017 and February 2018. Participants’ knowledge, self-efficacy and communication skills were assessed using a simulated scenario at pre-test, post-test and 6-week follow-up points. Between-subject and within-subject differences were measured using counts and proportions of participants who achieved competence. Regardless of the strategy applied, a significant improvement in knowledge, skills, self-efficacy and overall interprofessional communication competence was found between pre-test and post-test. Moreover, there were significant differences between pre-test and follow-up for all the studied variables, but no differences were found between post-test and follow-up. Lastly, when comparing the success rates of both strategies, no significant differences were observed (p > 0.05). In conclusion, standardised patient simulation and role-play have been shown to promote an improvement on knowledge, self-efficacy and interprofessional communication skills in nursing students, although it is not possible to state which strategy is the most adequate for teaching this competency. Full article

(This article belongs to the Collection Aging and Chronic Disease: Experiences, Holisitic Care and Quality of Life)

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9 pages, 587 KiB

Open AccessEditor’s ChoiceArticle

Improving Humanization Skills through Simulation-Based Computers Using Simulated Nursing Video Consultations

by Diana Jiménez-Rodríguez, Mercedes Pérez-Heredia, María del Mar Molero Jurado, María del Carmen Pérez-Fuentes and Oscar Arrogante

Healthcare 2022, 10(1), 37; https://doi.org/10.3390/healthcare10010037 - 26 Dec 2021

Cited by 12 | Viewed by 4137

Abstract

During the COVID-19 confinement, we converted our clinical simulation sessions into simulated video consultations. This study aims to evaluate the effects of virtual simulation-based training on developing and cultivating humanization competencies in undergraduate nursing students. A quasi-experimental study was conducted with 60 undergraduate [...] Read more.

During the COVID-19 confinement, we converted our clinical simulation sessions into simulated video consultations. This study aims to evaluate the effects of virtual simulation-based training on developing and cultivating humanization competencies in undergraduate nursing students. A quasi-experimental study was conducted with 60 undergraduate nursing students. A validated questionnaire was used to evaluate the acquisition of humanization competencies (self-efficacy, sociability, affection, emotional understanding, and optimism). The development of humanization competencies in this group composed of undergraduate nursing students was evaluated using virtual simulation-based training, comparing the levels obtained in these competencies at baseline (pre-test) and after the virtual simulation experience (post-test). After the virtual simulation sessions, students improved their levels in humanization total score and the emotional understanding and self-efficacy competencies, obtaining large effects sizes in all of them (rB = 0.508, rB = 0.713, and rB = 0.505 respectively). This virtual simulation modality enables training in the humanization of care with the collaboration of standardized patients in the form of simulated nursing video consultations and the performance of high-fidelity simulation sessions that comply with the requirements of best practices. Therefore, this methodology could be considered as another choice for virtual simulation. Additionally, this virtual modality could be a way to humanize virtual simulation. Full article

(This article belongs to the Collection E-learning and Digital Training in Healthcare Education: Current Trends and New Challenges)

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13 pages, 1556 KiB

Open AccessEditor’s ChoiceReview

International Overview of Somatic Dysfunction Assessment and Treatment in Osteopathic Research: A Scoping Review

by Marco Tramontano, Federica Tamburella, Fulvio Dal Farra, Andrea Bergna, Christian Lunghi, Mattia Innocenti, Fabio Cavera, Federica Savini, Vincenzo Manzo and Giandomenico D’Alessandro

Healthcare 2022, 10(1), 28; https://doi.org/10.3390/healthcare10010028 - 24 Dec 2021

Cited by 31 | Viewed by 9795

Abstract

Background: Osteopathic manipulative treatment (OMT) is a patient-centred, whole-body intervention aimed at enhance the person’s self-regulation. OMT interventions are focused on somatic dysfunctions (SD) that can be defined as an altered regulative function associated with inflammatory signs palpable in the body framework in [...] Read more.

Background: Osteopathic manipulative treatment (OMT) is a patient-centred, whole-body intervention aimed at enhance the person’s self-regulation. OMT interventions are focused on somatic dysfunctions (SD) that can be defined as an altered regulative function associated with inflammatory signs palpable in the body framework in different body regions. The conceptual model that sustains SD, as well as its usefulness for the osteopathic profession, is still being discussed by the osteopathic community. Understanding the role and the application of SD is the aim of this scoping review. Methods: A literature search was carried out through the main biomedical databases: Pubmed (Medline), Cochrane, Central (Cochrane), Embase, PEDro and Scopus. Grey literature was considered via Google Scholar and the Osteopathic Research Web. The review was prepared by referring to the “Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews” (PRISMA-ScR). Results: A total of 37,279 records were identified through database searching and other sources. After the duplicates were removed, 27,023 titles and abstracts were screened. A total of 1495 full-text articles were assessed for eligibility. The qualitative synthesis included 280 studies. Conclusions: Treating SD is an important part of osteopathic practice that varies from country to country. SD should be considered as a clinical value that assists in the clinical assessment and guides the decision-making process of osteopathic practitioners. Further studies should be designed to better understand why and how to choose the different assessment and intervention modalities to approach SD and to evaluate new osteopathic models. Full article

(This article belongs to the Special Issue Neurorehabilitation Outcome Measures and Innovative Approaches in Physiotherapy)

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35 pages, 827 KiB

Open AccessEditor’s ChoiceReview

SHIP-MR and Radiology: 12 Years of Whole-Body Magnetic Resonance Imaging in a Single Center

by Norbert Hosten, Robin Bülow, Henry Völzke, Martin Domin, Carsten Oliver Schmidt, Alexander Teumer, Till Ittermann, Matthias Nauck, Stephan Felix, Marcus Dörr, Marcello Ricardo Paulista Markus, Uwe Völker, Amro Daboul, Christian Schwahn, Birte Holtfreter, Torsten Mundt, Karl-Friedrich Krey, Stefan Kindler, Maria Mksoud, Stefanie Samietz, Reiner Biffar, Wolfgang Hoffmann, Thomas Kocher, Jean-Francois Chenot, Andreas Stahl, Frank Tost, Nele Friedrich, Stephanie Zylla, Anke Hannemann, Martin Lotze, Jens-Peter Kühn, Katrin Hegenscheid, Christian Rosenberg, Georgi Wassilew, Stefan Frenzel, Katharina Wittfeld, Hans J. Grabe and Marie-Luise Kromrey Show full author list Hide full author list

Healthcare 2022, 10(1), 33; https://doi.org/10.3390/healthcare10010033 - 24 Dec 2021

Cited by 12 | Viewed by 5129

Abstract

The Study of Health in Pomerania (SHIP), a population-based study from a rural state in northeastern Germany with a relatively poor life expectancy, supplemented its comprehensive examination program in 2008 with whole-body MR imaging at 1.5 T (SHIP-MR). We reviewed more than 100 [...] Read more.

The Study of Health in Pomerania (SHIP), a population-based study from a rural state in northeastern Germany with a relatively poor life expectancy, supplemented its comprehensive examination program in 2008 with whole-body MR imaging at 1.5 T (SHIP-MR). We reviewed more than 100 publications that used the SHIP-MR data and analyzed which sequences already produced fruitful scientific outputs and which manuscripts have been referenced frequently. Upon reviewing the publications about imaging sequences, those that used T1-weighted structured imaging of the brain and a gradient-echo sequence for R2* mapping obtained the highest scientific output; regarding specific body parts examined, most scientific publications focused on MR sequences involving the brain and the (upper) abdomen. We conclude that population-based MR imaging in cohort studies should define more precise goals when allocating imaging time. In addition, quality control measures might include recording the number and impact of published work, preferably on a bi-annual basis and starting 2 years after initiation of the study. Structured teaching courses may enhance the desired output in areas that appear underrepresented. Full article

(This article belongs to the Collection Radiology-Driven Projects: Science, Networks, and Healthcare)

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8 pages, 807 KiB

Open AccessEditor’s ChoiceArticle

The Caregiver Support Ratio in Europe: Estimating the Future of Potentially (Un)Available Caregivers

by Oscar Ribeiro, Lia Araújo, Daniela Figueiredo, Constança Paúl and Laetitia Teixeira

Healthcare 2022, 10(1), 11; https://doi.org/10.3390/healthcare10010011 - 22 Dec 2021

Cited by 27 | Viewed by 4835

Abstract

The caregiver support ratio (CSR) is defined as the number of potential caregivers aged 45–64 years, the most common caregiving age range, for each person aged 80+, the subgroup of older adults most at risk of needing long-term services and support. This study [...] Read more.

The caregiver support ratio (CSR) is defined as the number of potential caregivers aged 45–64 years, the most common caregiving age range, for each person aged 80+, the subgroup of older adults most at risk of needing long-term services and support. This study uses data from the CENSUS HUB database and from the UN database to calculate the current (last year available: 2011) and projected (2020, 2030, 2040 and 2050) CSR for a group of European countries. Mediterranean countries, France, Belgium, and Sweden presented the lowest CSR (5:1) in 2011. The countries with the highest CSR were Slovakia (9:1) and Ireland, Poland, Cyprus, and Malta (8:1). The estimated CSR is expected to progressively decline from 6:1 (2011) to 2:1 (2050) for all countries. Although differences in the CSR exist between countries, the number of people aged 45–64 who are available to care for each person aged 80+ will decrease uniformly in the coming decades. Cross-national challenges for gerontological social policies and healthcare provision are expected due to the increasing demand for long-term care among the oldest population. Full article

(This article belongs to the Special Issue Healthcare and Rehabilitation of Older Adults)

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11 pages, 1816 KiB

Open AccessEditor’s ChoiceArticle

Efficacy of Early and Enhanced Respiratory Physiotherapy and Mobilization after On-Pump Cardiac Surgery: A Prospective Randomized Controlled Trial

by Georgios Afxonidis, Dimitrios V. Moysidis, Andreas S. Papazoglou, Christos Tsagkaris, Anna Loudovikou, Georgios Tagarakis, Georgios T. Karapanagiotidis, Ioannis A. Alexiou, Christophoros Foroulis and Kyriakos Anastasiadis

Healthcare 2021, 9(12), 1735; https://doi.org/10.3390/healthcare9121735 - 15 Dec 2021

Cited by 13 | Viewed by 6788

Abstract

Background: This randomized controlled trial aimed to investigate the influence of physical activity and respiratory physiotherapy on zero postoperative day on clinical, hemodynamic and respiratory parameters of patients undergoing cardiac surgeries under extracorporeal circulation. Methods: 78 patients undergoing coronary artery bypass graft (CABG) [...] Read more.

Background: This randomized controlled trial aimed to investigate the influence of physical activity and respiratory physiotherapy on zero postoperative day on clinical, hemodynamic and respiratory parameters of patients undergoing cardiac surgeries under extracorporeal circulation. Methods: 78 patients undergoing coronary artery bypass graft (CABG) or/and valvular heart disease surgeries were randomly assigned into an early and enhanced physiotherapy care group (EEPC group; n = 39) and a conventional physiotherapy care group (CPC group; n = 39). Treatment protocol for the EEPC group included ≤3 Mets of physical activity and respiratory physiotherapy on zero post-operative day and an extra physiotherapy session during the first three post-operative days, whereas the CPC group was treated with usual physiotherapy care after the first post-operative day. The length of hospital and intensive care unit (ICU) stay were set as the primary study outcomes, while pre- and post-intervention measurements were also performed to assess the oxymetric and hemodynamic influence of early mobilization and physiotherapy. Results: Participants’ mean age was 51.9 ± 13.8 years. Of them 48 (61.5%) underwent CABG. Baseline and peri-procedural characteristics did not differ between the two groups. The total duration of hospital and ICU stay were significantly higher in the CPC group compared to the EEPC group (8.1 ± 0.4 days versus 8.9 ± 0.6 days and 25.4 ± 3 h versus 23.2 ± 0.6 h, p < 0.001, respectively). Statistically significant differences in pre-intervention oxygen saturation, and post-intervention PO2 and lactate levels were also observed between the two groups (p = 0.022, 0.027 and 0.001, respectively). Conclusion: In on-pump cardiac surgery, early and enhanced post-procedural physical activity (≤3 METS) can prevent a prolonged ICU stay and decrease the duration of hospitalization while ameliorating post-operative hemodynamic and oxymetric parameters. Full article

(This article belongs to the Special Issue Physiotherapy and Cardiothoracic Care in Acute and Chronic Care)

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12 pages, 281 KiB

Open AccessEditor’s ChoiceArticle

Levels of Moral Distress among Health Care Professionals Working in Hospital and Community Settings: A Cross Sectional Study

by Noemi Giannetta, Rebecca Sergi, Giulia Villa, Federico Pennestrì, Roberta Sala, Roberto Mordacci and Duilio Fiorenzo Manara

Healthcare 2021, 9(12), 1673; https://doi.org/10.3390/healthcare9121673 - 3 Dec 2021

Cited by 22 | Viewed by 3444

Abstract

Moral distress is a concern for all healthcare professionals working in all care settings. Based on our knowledge, no studies explore the differences in levels of moral distress in hospital and community settings. This study aims to examine the level of moral distress [...] Read more.

Moral distress is a concern for all healthcare professionals working in all care settings. Based on our knowledge, no studies explore the differences in levels of moral distress in hospital and community settings. This study aims to examine the level of moral distress among healthcare professional working in community or hospital settings and compare it by demographic and workplace characteristics. This is a cross-sectional study. All the professionals working in the hospitals or community settings involved received personal e-mail invitations to participate in the study. The Moral Distress Thermometer was used to measure moral distress among healthcare professionals. Before data collection, ethical approval was obtained from each setting where the participants were enrolled. The sample of this study is made up of 397 healthcare professionals: 53.65% of the sample works in hospital setting while 46.35% of the sample works in community setting. Moral distress was present in all professional groups. Findings have shown that nurses experienced level of moral distress higher than other healthcare professionals (mean: 4.91). There was a significant differences between moral distress among different professional categories (H(6) = 14.407; p < 0.05). The ETA Coefficient test showed significant variation between healthcare professionals working in community and in hospital settings. Specifically, healthcare professionals who work in hospital experienced a higher level of moral distress than those who work in community settings (means 4.92 vs. means 3.80). The results of this study confirm that it is imperative to develop educational programs to reduce moral distress even in those settings where the level perceived is low, in order to mitigate the moral residue and the crescendo effect. Full article

(This article belongs to the Collection Healthcare Strategy and Community Care)

33 pages, 3277 KiB

Open AccessEditor’s ChoiceReview

Buccal Bone Thickness in Anterior and Posterior Teeth—A Systematic Review

by Diana Heimes, Eik Schiegnitz, Robert Kuchen, Peer W. Kämmerer and Bilal Al-Nawas

Healthcare 2021, 9(12), 1663; https://doi.org/10.3390/healthcare9121663 - 30 Nov 2021

Cited by 18 | Viewed by 8467

Abstract

(1) Background: Immediate dental implant placement has been a subject of great interest over the last decade. Here, information regarding the anatomy and bone thickness of the jaw prior to dental implant placement is crucial to increase the surgery’s success and the patient’s [...] Read more.

(1) Background: Immediate dental implant placement has been a subject of great interest over the last decade. Here, information regarding the anatomy and bone thickness of the jaw prior to dental implant placement is crucial to increase the surgery’s success and the patient’s safety. The clinical premises for this approach have been controversially discussed. One of those heavily discussed premises is a buccal bone thickness of at least 1 mm thickness. This meta-analysis aims to systematically review buccal bone thickness (BBT) in healthy patients. Thus, the feasibility of immediate dental implant placement in daily practice can be assessed. (2) Methods: A search in the electronic databases was performed to identify articles reporting on BBT that was measured by computed tomography in adults. (3) Results: We were able to find 45 studies, including 4324 patients with 25,452 analyzed teeth. The analysis showed a BBT at the alveolar crest of 0.76 ± 0.49 mm in the maxillary frontal and of 1.42 ± 0.74 mm in the maxillary posterior region. In the mandible, the average measured values were similar to those in the maxilla (front: 0.95 ± 0.58 mm; posterior: 1.20 ± 0.96 mm). In the maxillary frontal region 74.4% and in the mandibular frontal region 61.2% of the crestal buccal bones showed widths <1 mm. (4) Conclusions: In more than 60% of the cases, the BBT at the alveolar crest is <1 mm in maxillary and mandibular frontal regions. This anatomic data supports careful pre-surgical assessment, planning of a buccal graft, and critical selection of indication for immediate implant placement, especially in the maxillary and mandibular frontal and premolar region. Full article

(This article belongs to the Collection Dentistry, Oral Health and Maxillofacial Surgery)

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10 pages, 1542 KiB

Open AccessEditor’s ChoiceArticle

Cognitive Aid for Anesthetic Preparation in An Emergency Situation: A Simulation-Based Study

by Emmanuel Rineau, Anna Collard, Lorine Jean, Sarah Guérin, Louise Maunoury, Ludovic Martin, Sigismond Lasocki and Maxime Léger

Healthcare 2021, 9(12), 1646; https://doi.org/10.3390/healthcare9121646 - 27 Nov 2021

Cited by 2 | Viewed by 5960

Abstract

When anesthesia checklists and preparations are performed urgently, omissions may occur and be deleterious to the patient. The aim of this study was to evaluate in simulation the interest of a cognitive aid to effectively prepare an anesthetic room for an emergency. In [...] Read more.

When anesthesia checklists and preparations are performed urgently, omissions may occur and be deleterious to the patient. The aim of this study was to evaluate in simulation the interest of a cognitive aid to effectively prepare an anesthetic room for an emergency. In a prospective single-center simulation-based study, 32 anesthesia residents had to prepare an anesthetic room in an emergency scenario, without cognitive aid in the first phase. Three months later (phase 2), they were randomly assigned to receive a cognitive aid (aid group) or no additional aid (control) and were involved in the same scenario. The primary outcome was the validation rate of each essential item in the first 5 min in phase 2. Eight items were significantly more frequently completed in the first 5 min in the aid group in phase 2 (vs. phase 1), compared with two only in the control group. However, there were no significant differences in the overall number of completed items between the two groups, as both groups completed significantly more items in phase 2, either in the first 5 min (19 (14–23) vs. 13 (9–15) in phase 1 for all residents, p < 0.001) or without time limit. Preparation times were reduced in phase 2 in both groups. In conclusion, the use of a cognitive aid allowed anesthesia residents to complete some safety items of a simulated urgent anesthesia preparation more frequently. In addition, despite daily clinical experience, a single simulation session improved anesthesia preparation and reduced the preparation time with or without cognitive aid. Full article

(This article belongs to the Special Issue Anesthesiology and Critical Care)

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8 pages, 369 KiB

Open AccessEditor’s ChoiceArticle

Relationships between Gait Regularity and Cognitive Function, including Cognitive Domains and Mild Cognitive Impairment, in Community-Dwelling Older People

by Takasuke Miyazaki, Ryoji Kiyama, Yuki Nakai, Masayuki Kawada, Yasufumi Takeshita, Sota Araki and Hyuma Makizako

Healthcare 2021, 9(11), 1571; https://doi.org/10.3390/healthcare9111571 - 18 Nov 2021

Cited by 11 | Viewed by 2751

Abstract

The aim of this cross-sectional study was to examine the correlations between gait regularity, cognitive functions including cognitive domains, and the mild cognitive impairment (MCI) in community-dwelling older people. This study included 463 older adults (63.4% women, mean age: 74.1), and their step [...] Read more.

The aim of this cross-sectional study was to examine the correlations between gait regularity, cognitive functions including cognitive domains, and the mild cognitive impairment (MCI) in community-dwelling older people. This study included 463 older adults (63.4% women, mean age: 74.1), and their step and stride regularity along the three-axis components was estimated from trunk acceleration, which was measured by inertial measurement units during a comfortable gait. Four aspects of cognitive function were assessed using a tablet computer: attention, executive function, processing speed, and memory, and participants were classified into those with or without MCI. The vertical component of stride and step regularity was associated with attention and executive function (r = −0.176–−0.109, p ≤ 0.019), and processing speed (r = 0.152, p < 0.001), after it was adjusted for age and gait speed. The low vertical component of step regularity was related to the MCI after it was adjusted for covariates (OR 0.019; p = 0.016). The results revealed that cognitive function could affect gait regularity, and the vertical component of gait regularity, as measured by a wearable sensor, could play an important role in investigating cognitive decline in older people. Full article

(This article belongs to the Special Issue Healthcare and Rehabilitation of Older Adults)

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10 pages, 907 KiB

Open AccessEditor’s ChoiceArticle

Are We Overdoing It? Changes in Diagnostic Imaging Workload during the Years 2010–2020 including the Impact of the SARS-CoV-2 Pandemic

by Mateusz Winder, Aleksander Jerzy Owczarek, Jerzy Chudek, Joanna Pilch-Kowalczyk and Jan Baron

Healthcare 2021, 9(11), 1557; https://doi.org/10.3390/healthcare9111557 - 16 Nov 2021

Cited by 50 | Viewed by 4981

Abstract

Since the 1990s, there has been a significant increase in the number of imaging examinations as well as a related increase in the healthcare expenditure and the exposure of the population to X-rays. This study aimed to analyze the workload trends in radiology [...] Read more.

Since the 1990s, there has been a significant increase in the number of imaging examinations as well as a related increase in the healthcare expenditure and the exposure of the population to X-rays. This study aimed to analyze the workload trends in radiology during the last decade, including the impact of COVID-19 in a single university hospital in Poland and to identify possible solutions to the challenges that radiology could face in the future. We compared the annual amount of computed tomography (CT), radiography (X-ray), and ultrasound (US) examinations performed between the years 2010 and 2020 and analyzed the changes in the number of practicing radiologists in Poland. The mean number of patients treated in our hospital was 60,727 per year. During the last decade, the number of CT and US examinations nearly doubled (from 87.4 to 155.7 and from 52.1 to 86.5 per 1000 patients in 2010 and 2020 respectively), while X-ray examinations decreased from 115.1 to 96.9 per 1000 patients. The SARS-CoV-2 pandemic did not change the workload trends as more chest examinations were performed. AI, which contributed to the COVID-19 diagnosis, could aid radiologists in the future with the growing workload by increasing the efficiency of radiology departments as well as by potentially minimizing the related costs. Full article

(This article belongs to the Collection Radiology-Driven Projects: Science, Networks, and Healthcare)

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10 pages, 525 KiB

Open AccessEditor’s ChoiceArticle

Stress Levels and Mental Well-Being among Slovak Students during e-Learning in the COVID-19 Pandemic

by Anna Rutkowska, David Liska, Błażej Cieślik, Adam Wrzeciono, Jaroslav Broďáni, Miroslava Barcalová, Daniel Gurín and Sebastian Rutkowski

Healthcare 2021, 9(10), 1356; https://doi.org/10.3390/healthcare9101356 - 12 Oct 2021

Cited by 31 | Viewed by 5083

Abstract

The SARS-CoV-2 virus pandemic has forced far-reaching changes in higher education. Isolation from peers and distance learning have significantly limited interpersonal contacts, which might have affected the mental well-being of students. Therefore, the aim of the study was to investigate the prevalence of [...] Read more.

The SARS-CoV-2 virus pandemic has forced far-reaching changes in higher education. Isolation from peers and distance learning have significantly limited interpersonal contacts, which might have affected the mental well-being of students. Therefore, the aim of the study was to investigate the prevalence of depressive symptoms and the level of perceived stress during e-learning among Slovak students and to identify the variables that have the most significant impact on mental health among students. The study included 3051 participants, 1773 women (58%) and 1278 (42%) with a mean age of 22.37 years. The Perceived Stress Scale (PSS-10) and Beck Depression Inventory (BDI-II) were used to measure the severity of stress and depression level. In addition, an author’s survey was used assessing the areas of social life, education skills, economic field, nutrition habits, and drugs. Almost all study participants were characterized by increased stress level and 47% of them were depressed. Moreover, isolation affected women more, especially in terms of social life and economics. It seems necessary to implement appropriate support programs for students, which could have the potential to improve their psychological condition. Full article

(This article belongs to the Special Issue Mental Health in Times of Pandemic: Protective and Risk Factors)

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17 pages, 1698 KiB

Open AccessEditor’s ChoiceReview

The First Thousand Days: Kidney Health and Beyond

by Chien-Ning Hsu and You-Lin Tain

Healthcare 2021, 9(10), 1332; https://doi.org/10.3390/healthcare9101332 - 6 Oct 2021

Cited by 17 | Viewed by 7793

Abstract

The global burden of chronic kidney disease (CKD) is rising. A superior strategy to advance global kidney health is required to prevent and treat CKD early. Kidney development can be impacted during the first 1000 days of life by numerous factors, including malnutrition, [...] Read more.

The global burden of chronic kidney disease (CKD) is rising. A superior strategy to advance global kidney health is required to prevent and treat CKD early. Kidney development can be impacted during the first 1000 days of life by numerous factors, including malnutrition, maternal illness, exposure to chemicals, substance abuse, medication use, infection, and exogenous stress. In the current review, we summarize environmental risk factors reported thus far in clinical and experimental studies relating to the programming of kidney disease, and systematize the knowledge on common mechanisms underlying renal programming. The aim of this review is to discuss the primary and secondary prevention actions for enhancing kidney health from pregnancy to age 2. The final task is to address the potential interventions to target renal programming through updating animal studies. Together, we can enhance the future of global kidney health in the first 1000 days of life. Full article

(This article belongs to the Special Issue The First 1000 Days of Infant)

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10 pages, 483 KiB

Open AccessEditor’s ChoiceArticle

Association between Cerebral Infarction Risk and Medication Adherence in Atrial Fibrillation Patients Taking Direct Oral Anticoagulants

by Yuuki Akagi, Akiko Iketaki, Reiko Nakamura, Shigeo Yamamura, Minori Endo, Keisuke Morikawa, Shun Oikawa, Takahiro Ohta, Shimpei Tatsumi, Takafumi Suzuki, Atsuhiro Mizushima, Keiichi Koido and Tatsuya Takahashi

Healthcare 2021, 9(10), 1313; https://doi.org/10.3390/healthcare9101313 - 1 Oct 2021

Cited by 9 | Viewed by 2671

Abstract

Direct oral anticoagulants (DOACs) are available for nonvalvular atrial fibrillation patients. The advantage of DOACs is that regular anticoagulation monitoring is not required. However, adherence to the recommended regimen is essential. We investigated the association between medication adherence and the risk of cerebral [...] Read more.

Direct oral anticoagulants (DOACs) are available for nonvalvular atrial fibrillation patients. The advantage of DOACs is that regular anticoagulation monitoring is not required. However, adherence to the recommended regimen is essential. We investigated the association between medication adherence and the risk of cerebral infarction in patients taking DOACs. Patients admitted to any of the participating hospitals for cerebral infarction from September 2018 to February 2020 and prescribed DOACs before admission were defined as the case group, and patients hospitalized for diseases other than cerebral infarction, except for bleeding disorders, and prescribed DOACs before admission were defined as the control group. A nested case–control study was adapted, and 58 and 232 patients were included in the case and control groups, respectively. Medication adherence was assessed by the pharmacists through standardized interviewing. The adjusted odds ratio for the risk of cerebral infarction for low-adherence patients (<80% adherence rate) against good-adherence patients (100% adherence rate) was 9.69 (95% confidence interval, 3.86–24.3; p < 0.001). The patients’ age and other background characteristics were not found to be risk factors for cerebral infarction. In conclusion, low adherence is a risk factor for cerebral infarction in patients taking DOACs. Pharmacists should focus on maintaining ≥80% adherence to DOAC therapy to prevent cerebral infarction. Full article

(This article belongs to the Section Medication Management)

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15 pages, 520 KiB

Open AccessEditor’s ChoiceArticle

Self-Efficacy, Social Activity, and Spirituality in the Care of Elderly Patients with Polypharmacy in Germany—A Multicentric Cross-Sectional Study within the HoPES3 Trial

by Noemi Sturm, Regina Stolz, Friederike Schalhorn, Jan Valentini, Johannes Krisam, Eckhard Frick, Ruth Mächler, Joachim Szecsenyi and Cornelia Straßner

Healthcare 2021, 9(10), 1312; https://doi.org/10.3390/healthcare9101312 - 1 Oct 2021

Cited by 9 | Viewed by 4725

Abstract

About one third of Europe’s elderly population takes ≥5 drugs. Polypharmacy increases their risk of adverse drug reactions. To ensure drug safety, innovative approaches are needed. The aim of this cross-sectional study was to explore the relationship between psychosocial factors and medication-related beliefs [...] Read more.

About one third of Europe’s elderly population takes ≥5 drugs. Polypharmacy increases their risk of adverse drug reactions. To ensure drug safety, innovative approaches are needed. The aim of this cross-sectional study was to explore the relationship between psychosocial factors and medication-related beliefs and behaviors. Medication lists of 297 patients were recorded according to the ATC classification. Correlations between the dependent variables, Medication Adherence (MARS) and Beliefs about Medicines (BMQ), and independent variables, General Self-Efficacy (GSE), self-efficacy for managing chronic diseases (SES6G), spiritual needs (SpNQ), patient activity (PAM), loneliness (DJG), and social networks (LSNS), were measured. Patients with higher self-efficacy (OR: 1.113; 95% CI [1.056–1.174]; p < 0.001) or self-confidence in managing their chronic condition (OR: 1.188; 95% CI [1.048–1.346]; p < 0.007) also showed higher adherence. Lonely patients (OR: 0.420; 95% CI [0.267–0.660]; p < 0.001) and those with a need for inner peace (OR: 0.613; 95% CI [0.444–0.846], p = 0.003) were more likely nonadherent. Stronger positive beliefs about medications’ usefulness weakly correlated with higher scores on the SES6G (ρ = 0.178, p = 0.003) and GSES scale (ρ = 0.121, p = 0.042), patient activity (ρ = 0.155, p = 0.010) and functioning social networks scale (ρ = 0.159, p = 0.008). A weak positive correlation was found between loneliness and the belief that drugs were harmful (ρ = 0.194, p = 0.001). Furthermore, interesting correlations were detected regarding the number of medications and overuse beliefs. Psychosocial factors, such as self-efficacy, loneliness, and spiritual needs and medication-related beliefs and behaviors seem to interrelate. Addressing these factors may improve medication management and drug safety. Full article

(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)

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14 pages, 499 KiB

Open AccessEditor’s ChoiceArticle

Moral Distress in Community and Hospital Settings for the Care of Elderly People. A Grounded Theory Qualitative Study

by Giulia Villa, Federico Pennestrì, Debora Rosa, Noemi Giannetta, Roberta Sala, Roberto Mordacci and Duilio Fiorenzo Manara

Healthcare 2021, 9(10), 1307; https://doi.org/10.3390/healthcare9101307 - 30 Sep 2021

Cited by 21 | Viewed by 4116

Abstract

Background: Moral distress has frequently been investigated in single healthcare settings and concerning a single type of professional. This study aimed to describe the experience of moral distress in all the types of professionals providing daily care to elderly patients and residents. Methods: [...] Read more.

Background: Moral distress has frequently been investigated in single healthcare settings and concerning a single type of professional. This study aimed to describe the experience of moral distress in all the types of professionals providing daily care to elderly patients and residents. Methods: The Grounded Theory approach, developed by Corbin and Strauss, was used. This study included participants from hospital and nursing homes of northern Italy. Purposive and theoretical sampling was used. Between December 2020 and April 2021, semi-structured interviews were conducted. Results: Thirteen participants were included in the study. Four categories were derived from the data: talking and listening, care provider wellbeing, decision making, protective factors, and potential solutions. The core category identified was “sharing daily”. Interviewees confirm how hard it may be to communicate to the elderly, but at the same time, how adequate communication with the leader is a protective factor of moral distress. They also confirm how communication is key to managing or downsizing misunderstandings at all levels. Findings highlight the scarcity of operators as a fundamental trigger of moral distress. Conclusions: Many determinants of this phenomenon lie behind the direct control of professionals, but education can help them learn how to prevent, manage, or downsize the consequences. Full article

(This article belongs to the Section Nursing)

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19 pages, 1999 KiB

Open AccessEditor’s ChoiceArticle

A Comprehensive Examination of Severely Ill ME/CFS Patients

by Chia-Jung Chang, Li-Yuan Hung, Andreas M. Kogelnik, David Kaufman, Raeka S. Aiyar, Angela M. Chu, Julie Wilhelmy, Peng Li, Linda Tannenbaum, Wenzhong Xiao and Ronald W. Davis

Healthcare 2021, 9(10), 1290; https://doi.org/10.3390/healthcare9101290 - 29 Sep 2021

Cited by 22 | Viewed by 21170

Abstract

One in four myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients are estimated to be severely affected by the disease, and these house-bound or bedbound patients are currently understudied. Here, we report a comprehensive examination of the symptoms and clinical laboratory tests of a cohort [...] Read more.

One in four myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients are estimated to be severely affected by the disease, and these house-bound or bedbound patients are currently understudied. Here, we report a comprehensive examination of the symptoms and clinical laboratory tests of a cohort of severely ill patients and healthy controls. The greatly reduced quality of life of the patients was negatively correlated with clinical depression. The most troublesome symptoms included fatigue (85%), pain (65%), cognitive impairment (50%), orthostatic intolerance (45%), sleep disturbance (35%), post-exertional malaise (30%), and neurosensory disturbance (30%). Sleep profiles and cognitive tests revealed distinctive impairments. Lower morning cortisol level and alterations in its diurnal rhythm were observed in the patients, and antibody and antigen measurements showed no evidence for acute infections by common viral or bacterial pathogens. These results highlight the urgent need of developing molecular diagnostic tests for ME/CFS. In addition, there was a striking similarity in symptoms between long COVID and ME/CFS, suggesting that studies on the mechanism and treatment of ME/CFS may help prevent and treat long COVID and vice versa. Full article

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

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25 pages, 2736 KiB

Open AccessEditor’s ChoiceReview

Systematic Review of RCTs Assessing the Effectiveness of mHealth Interventions to Improve Statin Medication Adherence: Using the Behaviour-Change Technique Taxonomy to Identify the Techniques That Improve Adherence

by Zoe Bond, Tanya Scanlon and Gaby Judah

Healthcare 2021, 9(10), 1282; https://doi.org/10.3390/healthcare9101282 - 28 Sep 2021

Cited by 19 | Viewed by 4305

Abstract

Statin non-adherence is a common problem in the management of cardiovascular disease (CVD), increasing patient morbidity and mortality. Mobile health (mHealth) interventions may be a scalable way to improve medication adherence. The objectives of this review were to assess the literature testing mHealth [...] Read more.

Statin non-adherence is a common problem in the management of cardiovascular disease (CVD), increasing patient morbidity and mortality. Mobile health (mHealth) interventions may be a scalable way to improve medication adherence. The objectives of this review were to assess the literature testing mHealth interventions for statin adherence and to identify the Behaviour-Change Techniques (BCTs) employed by effective and ineffective interventions. A systematic search was conducted of randomised controlled trials (RCTs) measuring the effectiveness of mHealth interventions to improve statin adherence against standard of care in those who had been prescribed statins for the primary or secondary prevention of CVD, published in English (1 January 2000–17 July 2020). For included studies, relevant data were extracted, the BCTs used in the trial arms were coded, and a quality assessment made using the Risk of Bias 2 (RoB2) questionnaire. The search identified 17 relevant studies. Twelve studies demonstrated a significant improvement in adherence in the mHealth intervention trial arm, and five reported no impact on adherence. Automated phone messages were the mHealth delivery method most frequently used in effective interventions. Studies including more BCTs were more effective. The BCTs most frequently associated with effective interventions were “Goal setting (behaviour)”, “Instruction on how to perform a behaviour”, and “Credible source”. Other effective techniques were “Information about health consequences”, “Feedback on behaviour”, and “Social support (unspecified)”. This review found moderate, positive evidence of the effect of mHealth interventions on statin adherence. There are four primary recommendations for practitioners using mHealth interventions to improve statin adherence: use multifaceted interventions using multiple BCTs, consider automated messages as a digital delivery method from a credible source, provide instructions on taking statins, and set adherence goals with patients. Further research should assess the optimal frequency of intervention delivery and investigate the generalisability of these interventions across settings and demographics. Full article

(This article belongs to the Special Issue Medication Adherence and Beliefs About Medication)

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13 pages, 295 KiB

Open AccessEditor’s ChoiceArticle

Association of Adherence to a Mediterranean Diet with Excess Body Mass, Muscle Strength and Physical Performance in Overweight or Obese Adults with or without Type 2 Diabetes: Two Cross-Sectional Studies

by Amy Buchanan and Anthony Villani

Healthcare 2021, 9(10), 1255; https://doi.org/10.3390/healthcare9101255 - 24 Sep 2021

Cited by 18 | Viewed by 3700

Abstract

Overweight and obesity in older adults is associated with disability and is exacerbated by the presence of type 2 diabetes (T2DM). There is emerging evidence that adherence to a Mediterranean diet (MedDiet) reduces adiposity and attenuates physical disability. These cross-sectional studies explored the [...] Read more.

Overweight and obesity in older adults is associated with disability and is exacerbated by the presence of type 2 diabetes (T2DM). There is emerging evidence that adherence to a Mediterranean diet (MedDiet) reduces adiposity and attenuates physical disability. These cross-sectional studies explored the associations of adherence to a MedDiet with body mass index (BMI), adiposity, muscle strength, and physical performance in older adults without diabetes and in middle-aged or older adults with T2DM. MedDiet adherence was assessed using the Mediterranean Diet Adherence Screener. Fat mass and percent body fat were assessed by dual energy X-ray absorptiometry. Muscle strength was assessed using hand-grip strength, while physical performance was assessed using the Short Physical Performance Battery and gait speed. A total of n = 87 participants with T2DM (T2DM sample: 71.2 ± 8.2 years, BMI: 29.5 ± 5.9) and n = 65 participants without diabetes (non-T2DM sample: 68.7 ± 5.6 years, BMI: 33.7 ± 4.9) were included in these analyses. In the T2DM sample, when controlled for age, gender, and appendicular lean mass index, adherence to a MedDiet was inversely associated with BMI, fat mass, and percent body fat. However, this was no longer maintained in the fully adjusted models. Although, adherence to a MedDiet was positively associated with gait speed (β = 0.155; p = 0.050) independent of all covariates used. Adherence to a MedDiet may be a suitable dietary strategy for preserving lower body physical function in middle-aged and older adults with T2DM. However, these findings should be further investigated using well-designed randomised controlled trials and prospective cohort studies with a wider range of adherence scores to investigate temporal associations. Full article

(This article belongs to the Special Issue Strategies to Manage Obesity in Older Adults)

11 pages, 1143 KiB

Open AccessEditor’s ChoiceArticle

SARS-CoV-2 in Pediatric Inpatient Care: Management, Clinical Presentation and Utilization of Healthcare Capacity

by Christine Busch, Maximilian Blickle, Beatrix Schmidt, Laura Katharina Sievers and Constanze Pfitzer

Healthcare 2021, 9(9), 1190; https://doi.org/10.3390/healthcare9091190 - 9 Sep 2021

Cited by 1 | Viewed by 2211

Abstract

This study scrutinizes management and clinical presentation of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) in pediatric inpatient care and evaluates the utilization of pediatric healthcare capacity during the pandemic. Within this retrospective cohort study, we systematically reviewed data of all 16,785 [...] Read more.

This study scrutinizes management and clinical presentation of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) in pediatric inpatient care and evaluates the utilization of pediatric healthcare capacity during the pandemic. Within this retrospective cohort study, we systematically reviewed data of all 16,785 pediatric patients (<18 years admitted to our clinical center between January 2018 and June 2021). Data on SARS-CoV-2 test numbers, hospital admissions and clinical characteristics of infected patients were collected. Since January 2020, a total of 2513 SARS-CoV-2 tests were performed. In total, 36 patients had a positive test result. In total, 25 out of 36 SARS-CoV-2 positive children showed at least mild clinical symptoms while 11 were asymptomatic. Most common clinical symptoms were fever (60%), cough (60%) and rhinitis (20%). In parallel with the rising slope of SARS-CoV-2 in spring and fall 2020, we observed a slight decrease in the number of patients admitted to the pediatric department while the median duration of hospital treatment and intensive care occupancy remained unchanged. This study underlines that SARS-CoV-2 infected children most frequently exhibit an asymptomatic or mild clinical course. Noteworthy, the number of hospital admissions went down during the pandemic. The health and economic consequences need to be discussed within health care society and politics. Full article

(This article belongs to the Special Issue Current Health Challenges for Child and Adolescent)

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