Healthcare

18 pages, 297 KiB

Open AccessEditor’s ChoiceArticle

E-Learning as a Factor Optimizing the Amount of Work Time Devoted to Preparing an Exam for Medical Program Students during the COVID-19 Epidemic Situation

by Magdalena Roszak, Bartosz Sawik, Jacek Stańdo and Ewa Baum

Healthcare 2021, 9(9), 1147; https://doi.org/10.3390/healthcare9091147 - 2 Sep 2021

Cited by 14 | Viewed by 20295

Abstract

The COVID-19 pandemic had a huge impact on the learning and teaching processes, particularly in healthcare education and training, because of the principal position of the cutting-edge student–patient interaction. Replacing the traditional form of organization and implementation of knowledge evaluation with its web-based [...] Read more.

The COVID-19 pandemic had a huge impact on the learning and teaching processes, particularly in healthcare education and training, because of the principal position of the cutting-edge student–patient interaction. Replacing the traditional form of organization and implementation of knowledge evaluation with its web-based equivalent on an e-learning platform optimizes the whole didactic process not only for the unit carrying it out but, above all, for students. This research is focused on the effectiveness of the application of e-learning for computer-based knowledge evaluation and optimizing exam administration for students of medical sciences. The proposed approach is considered in two categories: from the perspective of the providers of the evaluation process, that is, the teaching unit; and the recipients of the evaluation process, that is, the students. Full article

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

20 pages, 2357 KiB

Open AccessEditor’s ChoiceReview

A Review of Monitoring Methods for Cerebral Blood Oxygen Saturation

by Wentao Zhong, Zhong Ji and Changlong Sun

Healthcare 2021, 9(9), 1104; https://doi.org/10.3390/healthcare9091104 - 26 Aug 2021

Cited by 32 | Viewed by 12324

Abstract

In recent years, cerebral blood oxygen saturation has become a key indicator during the perioperative period. Cerebral blood oxygen saturation monitoring is conducive to the early diagnosis and treatment of cerebral ischemia and hypoxia. The present study discusses the three most extensively used [...] Read more.

In recent years, cerebral blood oxygen saturation has become a key indicator during the perioperative period. Cerebral blood oxygen saturation monitoring is conducive to the early diagnosis and treatment of cerebral ischemia and hypoxia. The present study discusses the three most extensively used clinical methods for cerebral blood oxygen saturation monitoring from different aspects: working principles, relevant parameters, current situations of research, commonly used equipment, and relative advantages of different methods. Furthermore, through comprehensive comparisons of the methods, we find that near-infrared spectroscopy (NIRS) technology has significant potentials and broad applications prospects in terms of cerebral oxygen saturation monitoring. Despite the current NIRS technology, the only bedside non-invasive cerebral oxygen saturation monitoring technology, still has many defects, it is more in line with the future development trend in the field of medical and health, and will become the main method gradually. Full article

(This article belongs to the Section Critical Care)

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11 pages, 751 KiB

Open AccessFeature PaperEditor’s ChoiceArticle

Lipid-Free Parenteral Nutrition Is Associated with an Increased Risk of Hepatic Dysfunction in Surgical Critically Ill Patients: A Retrospective Observational Study

by Shih-Chi Wu, Te-An Chen, I-Ju Tsai, Yu-Chun Wang, Han-Tsung Cheng, Chia-Wei Tzeng, Chia-Hao Hsu and Chih-Hsin Muo

Healthcare 2021, 9(9), 1096; https://doi.org/10.3390/healthcare9091096 - 25 Aug 2021

Cited by 6 | Viewed by 2738

Abstract

To evaluate the effects of lipid-free parenteral nutrition (PN) and various intravenous fat emulsions (IVFEs) on hepatic function in surgical critically ill trauma/acute care surgery patients. We retrospectively reviewed trauma/acute care surgery patients without admission hepatic disorder that received PN. The PN groups [...] Read more.

To evaluate the effects of lipid-free parenteral nutrition (PN) and various intravenous fat emulsions (IVFEs) on hepatic function in surgical critically ill trauma/acute care surgery patients. We retrospectively reviewed trauma/acute care surgery patients without admission hepatic disorder that received PN. The PN groups include lipid-free, soybean oil/medium-chain triglyceride, olive oil-based, and fish-oil contained PN. We excluded patients with (1) age <18 years, (2) without surgery, (3) preexisting liver injury/diseases, (4) hyperbilirubinemia at admission, (5) received more than one type of PN, and (6) repeated ICU episodes in the same hospitalization. Hepatic dysfunction was considered as serum total–bilirubin >6.0 mg/dL. The demographics, severity score, comorbidities, blood stream infection, and mortality were collected for analyses. The major outcome is hepatic function. We also performed analyses stratified by separated lipid doses (g/kg/day). A total of 249 patients were enrolled. There were no demographic differences among groups. The lipid-free PN group had a higher incidence of hepatic dysfunction and mortality. Compared to the lipid-free group, the other three IVFEs had significantly lower risks of hepatic dysfunction, while the olive oil-based group had a significantly lower risk of 30 and 90-day mortality. After being stratified by separating lipid doses, the soybean oils showed a decreasing trend of hepatic dysfunction and mortality with increased dosage. Fish oil >0.05 g/kg/day was associated with lower hepatic dysfunction incidences. Our findings suggest that, when compared to IVFEs, surgical critically ill patients with trauma/acute care surgery that received lipid-free PN are associated with an increased risk of hepatic dysfunction. In addition, the olive oil-based group had a significantly lower risk of mortality, while fish oil >0.05 g/kg/day was associated with lower incidences of hepatic dysfunction; however, further studies are warranted. Full article

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12 pages, 451 KiB

Open AccessEditor’s ChoiceArticle

The First 1000 Days: Impact of Prenatal Tobacco Smoke Exposure on Hospitalization Due to Preschool Wheezing

by Cyrielle Collet, Michael Fayon, Florence Francis, François Galode, Stephanie Bui and Stephane Debelleix

Healthcare 2021, 9(8), 1089; https://doi.org/10.3390/healthcare9081089 - 23 Aug 2021

Cited by 6 | Viewed by 2415

Abstract

Preschool wheezing and related hospitalization rates are increasing. Prenatal tobacco smoke exposure (PTSE) increases the risk of wheezing, yet >20% of French women smoke during pregnancy. In this observational retrospective monocentric study, we assessed the link between PTSE and hospital admissions. We included [...] Read more.

Preschool wheezing and related hospitalization rates are increasing. Prenatal tobacco smoke exposure (PTSE) increases the risk of wheezing, yet >20% of French women smoke during pregnancy. In this observational retrospective monocentric study, we assessed the link between PTSE and hospital admissions. We included infants <2 years of age admitted for acute wheezing. A phone interview with mothers was completed by electronic records. The primary endpoint was the ratio of cumulative duration of the hospitalization stays (days)/age (months). 129 children were included (36.4% exposed to PTSE vs. 63.6% unexposed). There was a significant difference in the duration of hospitalization/age: 0.9 days/month (exposed) vs. 0.58 days/month (unexposed) (p = 0.008). Smoking one cigarette/day during pregnancy was associated with an increase in hospitalization duration of 0.055 days/month (r = 0.238, p = 0.006). In the multi-variable analysis, this positive association persisted (β = 0.04, p = 0.04; standardized β = 0.27, p = 0.03). There was a trend towards a dose-effect relationship between PTSE and other important parameters associated with hospital admissions. We have demonstrated a dose-effect relationship, without a threshold effect, between PTSE and duration of hospitalization for wheezing in non-premature infants during the first 2 years of life. Prevention campaigns for future mothers should be enforced. Full article

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

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3 pages, 170 KiB

Open AccessEditor’s ChoiceCommentary

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: When Suffering Is Multiplied

by Anthony L. Komaroff

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

Cited by 11 | Viewed by 25147

Abstract

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

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

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

19 pages, 1515 KiB

Open AccessEditor’s ChoiceReview

Application of Smartphone Technologies in Disease Monitoring: A Systematic Review

by Jeban Chandir Moses, Sasan Adibi, Sheikh Mohammed Shariful Islam, Nilmini Wickramasinghe and Lemai Nguyen

Healthcare 2021, 9(7), 889; https://doi.org/10.3390/healthcare9070889 - 14 Jul 2021

Cited by 56 | Viewed by 11246

Abstract

Technologies play an essential role in monitoring, managing, and self-management of chronic diseases. Since chronic patients rely on life-long healthcare systems and the current COVID-19 pandemic has placed limits on hospital care, there is a need to explore disease monitoring and management technologies [...] Read more.

Technologies play an essential role in monitoring, managing, and self-management of chronic diseases. Since chronic patients rely on life-long healthcare systems and the current COVID-19 pandemic has placed limits on hospital care, there is a need to explore disease monitoring and management technologies and examine their acceptance by chronic patients. We systematically examined the use of smartphone applications (apps) in chronic disease monitoring and management in databases, namely, Medline, Web of Science, Embase, and Proquest, published from 2010 to 2020. Results showed that app-based weight management programs had a significant effect on healthy eating and physical activity (p = 0.002), eating behaviours (p < 0.001) and dietary intake pattern (p < 0.001), decreased mean body weight (p = 0.008), mean Body Mass Index (BMI) (p = 0.002) and mean waist circumference (p < 0.001). App intervention assisted in decreasing the stress levels (paired t-test = 3.18; p < 0.05). Among cancer patients, we observed a high acceptance of technology (76%) and a moderately positive correlation between non-invasive electronic monitoring data and questionnaire (r = 0.6, p < 0.0001). We found a significant relationship between app use and standard clinical evaluation and high acceptance of the use of apps to monitor the disease. Our findings provide insights into critical issues, including technology acceptance along with regulatory guidelines to be considered when designing, developing, and deploying smartphone solutions targeted for chronic patients. Full article

(This article belongs to the Special Issue Emerging Technologies in Health Informatics and Management)

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17 pages, 3255 KiB

Open AccessFeature PaperEditor’s ChoiceArticle

Mechanism Influencing Older People’s Willingness to Use Intelligent Aged-Care Products

by Biao Wang, Rui Zhang and Ying Wang

Healthcare 2021, 9(7), 864; https://doi.org/10.3390/healthcare9070864 - 8 Jul 2021

Cited by 5 | Viewed by 2855

Abstract

Background: With the continuous integration of information technology in the aged-care industry, intelligent aged-care products have gradually appeared, positively promoting the development of the industry. To support the use of these products and to help older people to improve their own health literacy, [...] Read more.

Background: With the continuous integration of information technology in the aged-care industry, intelligent aged-care products have gradually appeared, positively promoting the development of the industry. To support the use of these products and to help older people to improve their own health literacy, we built a theoretical model of the mechanism influencing older people’s willingness to use intelligent aged-care products. Methods: A total of 241 valid questionnaires were collected through surveys in aged-care institutions in Anhui Province, China, for empirical analysis. Results: Older people’s perception of quality can significantly affect their emotional attachment and willingness to use these products. Emotional attachment has a significant positive impact on the willingness to use. Self-perceived ageing can also significantly affect the emotional attachment and willingness of older people to use these products. Conclusion: Through empirical analysis, the comprehensive mechanism influencing older people on the willingness to use intelligent aged-care products is clarified, which can help older people to better deal with the problems caused by ageing and help aged-care institutions better relieve the pressure on nursing staff. Full article

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15 pages, 1921 KiB

Open AccessEditor’s ChoiceArticle

Six-Month Outcomes in COVID-19 ICU Patients and Their Family Members: A Prospective Cohort Study

by Nadine van Veenendaal, Ingeborg C. van der Meulen, Marisa Onrust, Wolter Paans, Willem Dieperink and Peter H. J. van der Voort

Healthcare 2021, 9(7), 865; https://doi.org/10.3390/healthcare9070865 - 8 Jul 2021

Cited by 49 | Viewed by 6286

Abstract

Background: The COVID-19 pandemic has resulted in a major influx of intensive care unit (ICU) admissions. Currently, there is limited knowledge on the long-term outcomes of COVID-19 ICU-survivors and the impact on family members. This study aimed to gain an insight into the [...] Read more.

Background: The COVID-19 pandemic has resulted in a major influx of intensive care unit (ICU) admissions. Currently, there is limited knowledge on the long-term outcomes of COVID-19 ICU-survivors and the impact on family members. This study aimed to gain an insight into the long-term physical, social and psychological functioning of COVID-19 ICU-survivors and their family members at three- and six-months following ICU discharge. Methods: A single-center, prospective cohort study was conducted among COVID-19 ICU-survivors and their family members. Participants received questionnaires at three and six months after ICU discharge. Physical functioning was evaluated using the MOS Short-Form General Health Survey, Clinical Frailty Scale and spirometry tests. Social functioning was determined using the McMaster Family Assessment Device and return to work. Psychological functioning was assessed using the Hospital Anxiety and Depression Scale. Results: Sixty COVID-19 ICU-survivors and 78 family members participated in this study. Physical functioning was impaired in ICU-survivors as reflected by a score of 33.3 (IQR 16.7–66.7) and 50 (IQR 16.7–83.3) out of 100 at 3- and 6-month follow-ups, respectively. Ninety percent of ICU-survivors reported persistent symptoms after 6 months. Social functioning was impaired since 90% of COVID-19 ICU-survivors had not reached their pre-ICU work level 6 months after ICU-discharge. Psychological functioning was unaffected in COVID-19 ICU-survivors. Family members experienced worse work status in 35% and 34% of cases, including a decrease in work rate among 18.3% and 7.4% of cases at 3- and 6-months post ICU-discharge, respectively. Psychologically, 63% of family members reported ongoing impaired well-being due to the COVID-19-related mandatory physical distance from their relatives. Conclusion: COVID-19 ICU-survivors suffer from a prolonged disease burden, which is prominent in physical and social functioning, work status and persisting symptoms among 90% of patients. Family members reported a reduction in return to work and impaired well-being. Further research is needed to extend the follow-up period and study the effects of standardized rehabilitation in COVID-19 patients and their family members. Full article

(This article belongs to the Section Critical Care)

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10 pages, 1115 KiB

Open AccessEditor’s ChoiceArticle

Quality of Life, Depression, and Anxiety in Survivors of Critical Illness from a Greek ICU. A Prospective Observational Study

by Charikleia S. Vrettou, Vassiliki Mantziou, Ioannis Ilias, Alice G. Vassiliou, Stylianos E. Orfanos, Anastasia Kotanidou and Ioanna Dimopoulou

Healthcare 2021, 9(7), 849; https://doi.org/10.3390/healthcare9070849 - 5 Jul 2021

Cited by 6 | Viewed by 2926

Abstract

The physical and psychological consequences of critical illness may affect intensive care unit survivors for up to five years, and hence, health-related quality of life has emerged as an important measure of outcome in this population. We aimed at investigating the quality of [...] Read more.

The physical and psychological consequences of critical illness may affect intensive care unit survivors for up to five years, and hence, health-related quality of life has emerged as an important measure of outcome in this population. We aimed at investigating the quality of life, the presence of anxiety and depression symptoms, and the correlations of clinical and psychological parameters with the quality of life scores in survivors of critical illness one year after discharge from intensive care. Widely used scales that have been validated for the Greek population were used. One thousand two hundred and seventy (1270) patients were assessed for eligibility. Inclusion criteria were age between 18 and 68 years and the presence of critical illness requiring endotracheal intubation and mechanical ventilation for more than three days. One hundred and four (104) patients were included in the final analysis; forty-nine age and sex-matched healthy volunteers were included for comparison. One year following intensive care unit discharge, survivors of critical illness had impaired quality of life scores, as measured with the WHOQOL-Bref, compared to healthy subjects (p < 0.001 for the physical and psychological domains, and p = 0.006 for the domain of social relationships). In addition, we found that quality of life scores were significantly lower in patients with comorbidities (p < 0.01), and correlated with the duration of ICU stay (r = −0.19, p = 0.04) and with the presence of symptoms suggestive of depression (r = −0.66, p < 0.0001) and post-traumatic stress disorder (r = −0.61, p < 0.0001). Approximately one-third of our patients scored high in the CES-D scale for depression, while the majority of them scored high in the STAI scale for anxiety symptoms. Full article

(This article belongs to the Section Critical Care)

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8 pages, 701 KiB

Open AccessEditor’s ChoiceArticle

Post-Operative All-Cause Mortality in Elderly Patients Undergoing Abdominal Emergency Surgery: Role of Charlson Comorbidity Index

by Fabio Fabbian, Alfredo De Giorgi, Silvia Ferro, Domenico Lacavalla, Dario Andreotti, Simona Ascanelli, Stefano Volpato and Savino Occhionorelli

Healthcare 2021, 9(7), 805; https://doi.org/10.3390/healthcare9070805 - 26 Jun 2021

Cited by 10 | Viewed by 3048

Abstract

(1) Background: The Charlson comorbidity index (CCI) score has been shown to predict 10-year all-cause mortality, but its validity is a matter of debate in surgical patients. We wanted to evaluate CCI on predicting all-cause mortality in elderly patients undergoing emergency abdominal surgery [...] Read more.

(1) Background: The Charlson comorbidity index (CCI) score has been shown to predict 10-year all-cause mortality, but its validity is a matter of debate in surgical patients. We wanted to evaluate CCI on predicting all-cause mortality in elderly patients undergoing emergency abdominal surgery (EAS); (2) Methods: This retrospective single center study included all patients aged 65 years or older consecutively admitted from January 2017 to December 2019, who underwent EAS and were discharged alive. CCI was calculated by using of the International Classification of Diseases, 9th Revision, Clinical Modification codes. Our outcome was all-cause death recorded during the 20.8 ± 8.8 month follow-up; (3) Results: We evaluated 197 patients aged 78.4 ± 7.2 years of whom 47 (23.8%) died. Mortality was higher in patients who underwent open abdominal surgery than in those treated with laparoscopic procedure (74% vs. 26%, p < 0.001), and in those who needed colon, small bowel, and gastric surgery. Mean CCI was 4.98 ± 2.2, and in subjects with CCI ≥ 4 survival was lower. Cox regression analysis showed that CCI (HR 1.132, 95% CI 1.009–1.270, p = 0.035), and open surgery (HR 10.298, 95%CI 1.409–75.285, p = 0.022) were associated with all-cause death independently from age and sex; (4) Conclusions: Calculation of CCI, could help surgeons in the preoperative stratification of risk of death after discharge in subjects aged ≥65 years who need EAS. CCI ≥ 4, increases the risk of all-causes mortality independently from age. Full article

(This article belongs to the Section Chronic Care)

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15 pages, 20697 KiB

Open AccessFeature PaperEditor’s ChoiceArticle

Development and Preliminary Validation of LoAD Calc, a Mobile App for Calculating the Maximum Safe Single Dose of Local Anesthetics

by Mélanie Suppan, Tal Sarah Beckmann, Cenan Gercekci, Thérèse Sigrist, Georges Louis Savoldelli, Roxane Fournier and Caroline Flora Samer

Healthcare 2021, 9(7), 799; https://doi.org/10.3390/healthcare9070799 - 25 Jun 2021

Cited by 5 | Viewed by 2827

Abstract

Local anesthetics systemic toxicity can lead to life-threatening situations. Correct calculation of the maximum safe dose is therefore paramount in preventing such complications. Different solutions have already emerged to support anesthesiologists but are seldom used in clinical practice as they require either access [...] Read more.

Local anesthetics systemic toxicity can lead to life-threatening situations. Correct calculation of the maximum safe dose is therefore paramount in preventing such complications. Different solutions have already emerged to support anesthesiologists but are seldom used in clinical practice as they require either access to a computer or specific documents to be at hand. A mobile app could provide an easy and practical solution; however, the few apps already created for this purpose often lack key elements, allowing invalid data to be entered and suggesting doses that might exceed the maximum safe dose. We describe the development of LoAD Calc, a mobile health (mHealth) app developed using a modified version of the Information Systems Research framework, which adds design thinking modes to the original framework. The app was enhanced through multiple iterations and developed with the aid of contextual observations and interviews, brainswarming sessions, prototyping, and continuous feedback. The design process led to the creation of two prototypes which underwent thorough testing by a sample of eight anesthesiologists. The final version of the app, LoAD Calc, was deployed on Apple and Android mobile test platforms and tested again by the same sample until deemed fit for release. Full article

(This article belongs to the Section Healthcare Quality and Patient Safety)

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15 pages, 602 KiB

Open AccessEditor’s ChoiceArticle

Attitudes of Nursing Students towards Vaccination and Other Preventive Measures for Limitation of COVID-19 Pandemic: Cross-Sectional Study in Three European Countries

by Nevenka Kregar Velikonja, Beata Dobrowolska, Sanja Stanisavljević, Karmen Erjavec, Vislava Globevnik Velikonja and Ivan Verdenik

Healthcare 2021, 9(7), 781; https://doi.org/10.3390/healthcare9070781 - 22 Jun 2021

Cited by 31 | Viewed by 6474

Abstract

Several preventive measures have been applied to limit the COVID-19 pandemic, including successful the development and introduction of vaccines. The aim of this study was to investigate adherence to preventive measures and vaccination intentions among nursing students in three European countries and the [...] Read more.

Several preventive measures have been applied to limit the COVID-19 pandemic, including successful the development and introduction of vaccines. The aim of this study was to investigate adherence to preventive measures and vaccination intentions among nursing students in three European countries and the factors associated with vaccination intention and advising vaccination. A cross-sectional study using convenience/snow-ball sampling strategy was performed in Slovenia, Poland, and Serbia between 12 February and 5 March 2021. Data from 872 eligible respondents were analyzed (mean age 23.5 ± 6.5 years, 89% female). Higher adherence to preventive behavior was declared by those working in healthcare (p < 0.001), engaged in COVID-19 departments (p < 0.001), had not had the disease yet (p < 0.001), and had children (p = 0.01). Those groups also expressed higher vaccination intention and advised vaccination to others. Higher vaccination intention and advising vaccination were mostly associated with belief in benefits of vaccine, trust in institutions, perceived effectiveness of vaccine, influence of social environment, protection of patients and perceived health care professionals’ duty. Fear of side effects and general refusal of vaccines are the main reasons for vaccination hesitancy. The results of the study indicate how higher education institutions can support the development of appropriate professional attitudes and behaviors among nursing students. Full article

(This article belongs to the Special Issue Nursing Education and Health Promotion)

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16 pages, 538 KiB

Open AccessFeature PaperEditor’s ChoiceArticle

A Content Analysis of Video Advertisements for Dietary Supplements in Japan

by Reina Iye, Tsuyoshi Okuhara, Hiroko Okada, Rie Yokota and Takahiro Kiuchi

Healthcare 2021, 9(6), 742; https://doi.org/10.3390/healthcare9060742 - 17 Jun 2021

Cited by 6 | Viewed by 4163

Abstract

Dietary supplements are widely advertised and the market is expanding worldwide. Research suggests that dietary supplement advertising may lead consumers to make inappropriate health-related decisions, to express behaviors such as overdosing, and to neglect healthy lifestyle behaviors. We conducted a content analysis of [...] Read more.

Dietary supplements are widely advertised and the market is expanding worldwide. Research suggests that dietary supplement advertising may lead consumers to make inappropriate health-related decisions, to express behaviors such as overdosing, and to neglect healthy lifestyle behaviors. We conducted a content analysis of video advertisements for dietary supplements and described the content of advertisements with high numbers and frequent views. We analyzed 82 video advertisements on YouTube that promoted fat-reduction effects. We extracted 22 themes and classified them into 10 categories. The categories with the highest numbers of advertisements were “Exemption” (i.e., consuming the product frees the audience from refraining from binge eating) (20 ads, 24.4%) and “Health Concerns” (i.e., the product intake solves the health concerns of the audience) (19 ads, 23.2%). These advertisements may stimulate negative audience attitudes toward appropriate health behaviors. The category with the most frequent views was “Lifestyle” (i.e., adding product intake to a healthy lifestyle) (3,035,298 views). “Lifestyle” advertisements portray physical activity in a positive light and may promote appropriate health behaviors in the audience. We discuss the possible effects of the advertisements on audiences and consider issues for future research and practice. Full article

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13 pages, 284 KiB

Open AccessEditor’s ChoiceArticle

Adolescents, Ambivalent Sexism and Social Networks, a Conditioning Factor in the Healthcare of Women

by Jose Luis Gil Bermejo, Cinta Martos Sánchez, Octavio Vázquez Aguado and E. Begoña García-Navarro

Healthcare 2021, 9(6), 721; https://doi.org/10.3390/healthcare9060721 - 12 Jun 2021

Cited by 11 | Viewed by 4850

Abstract

Even though gender equality being present in the social and political sphere, we still encounter aspects that are characteristic of sexism. Such aspects impact upon gender inequality and different types of violence towards women. The present article aims to examine the behaviour of [...] Read more.

Even though gender equality being present in the social and political sphere, we still encounter aspects that are characteristic of sexism. Such aspects impact upon gender inequality and different types of violence towards women. The present article aims to examine the behaviour of adolescents from Huelva with regards to ambivalent sexism towards women on social networks and their influence on health. Furthermore, we seek to uncover adolescent’s perceptions with regards to gender differences in the use of social networks, the relationship between sexism and women’s emotional well-being was observed. The study sample was formed by young people aged between 14 and 16 years who were residing in rural and urban zones in the south of Spain. A mixed methods approach was taken. At a quantitative level, a sample of 400 young people was recruited. These were administered a questionnaire about sexism which was composed of two scales and has been validated at a national and international level. At a qualitative level, the study counted on 33 young people who participated in in-depth discussions via interviews and discussion groups. The results showed that sexism emerges in adolescence in the analysed sample from the south of Spain. This favoured a digital gender gap and was reinforced through social networks such as Instagram and Snapchat. Rising awareness and a critical view of the aforementioned sexism was shown on the behalf of females, particularly those from urban backgrounds. Full article

(This article belongs to the Special Issue Cybersecurity and the Digital Health: An Investigation on the State of the Art and the Position of the Actors)

14 pages, 276 KiB

Open AccessEditor’s ChoiceReview

Protective Measures against COVID-19: Dental Practice and Infection Control

by Sri Nitya Reddy Induri, Yunah Caroline Chun, Joonmo Christopher Chun, Kenneth E. Fleisher, Robert S. Glickman, Fangxi Xu, Efthimia Ioannidou, Xin Li and Deepak Saxena

Healthcare 2021, 9(6), 679; https://doi.org/10.3390/healthcare9060679 - 4 Jun 2021

Cited by 16 | Viewed by 6000

Abstract

The onset of the Coronavirus 2019 (COVID-19) pandemic has challenged the worldwide healthcare sector, including dentistry. The highly infectious nature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and risk of transmission through aerosol generating procedures has profoundly impacted the delivery of [...] Read more.

The onset of the Coronavirus 2019 (COVID-19) pandemic has challenged the worldwide healthcare sector, including dentistry. The highly infectious nature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and risk of transmission through aerosol generating procedures has profoundly impacted the delivery of dental care services globally. As dental practices with renewed infection control strategies and preventive measures are re-opening in the “new normal” period, it is the responsibility of healthcare professionals to constantly analyze new data and limit the spread of COVID-19 in dental care settings. In the light of new variants of SARS-CoV-2 rapidly emerging in different geographic locations, there is an urgent need to comply more than ever with the rigorous public health measures to mitigate COVID-19 transmission. The aim of this article is to provide dental clinicians with essential information regarding the spread of SARS-CoV-2 virus and protective measures against COVID-19 transmission in dental facilities. We complied and provided guidance and standard protocols recommended by credible national and international organizations. This review will serve as an aid to navigating through this unprecedented time with ease. Here we reviewed the available literature recommended for the best current practices that must be taken for a dental office to function safely and successfully. Full article

(This article belongs to the Collection Healthcare in Dentistry)

15 pages, 687 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Challenges and Opportunities of Targeted Behavioral Interventions for Groups at Risk for Developing Rheumatoid Arthritis

by Alessandra Zaccardelli and Jeffrey A. Sparks

Healthcare 2021, 9(6), 641; https://doi.org/10.3390/healthcare9060641 - 28 May 2021

Cited by 4 | Viewed by 4221

Abstract

Background: Rheumatoid arthritis (RA) is a serious autoimmune disease which causes painful, swollen joints and can impact quality of life and increase morbidity and mortality. There are several preclinical stages of RA that correspond to at-risk groups that include: genetic risk, risk [...] Read more.

Background: Rheumatoid arthritis (RA) is a serious autoimmune disease which causes painful, swollen joints and can impact quality of life and increase morbidity and mortality. There are several preclinical stages of RA that correspond to at-risk groups that include: genetic risk, risk from behaviors, elevation of RA-related autoantibodies, and early clinical disease manifestations such as undifferentiated arthritis. Early interventions are crucial to slowing progression to and potentially preventing RA onset. Modification of behaviors among at-risk individuals may decrease RA risk. There are several challenges and opportunities in implementing preventative behavioral interventions, which may vary within different at-risk groups. Methods: We performed a narrative review of the literature, including meta-analyses focused on RA risk-related behaviors as well as publications investigating the potential efficacy of behavioral modifications on RA risk. Results: There are multiple behavioral risk factors associated with RA, including smoking, obesity, low physical activity, low quality diet, and poor dental hygiene, which may contribute to progression to clinical RA. Meta-analyses have been performed for smoking, excess body weight, and physical activity. Likelihood of adopting behavioral modifications may increase as RA risk increases. Conclusions: Clinicians may be able to tailor preventative approaches to various RA at-risk groups to help reduce RA risk, but further research is needed. A better understanding of the relationship of behaviors with RA risk and optimized approaches to implementing behavioral changes may allow for clinicians to tailor their preventative approaches for at-risk individuals. Full article

(This article belongs to the Special Issue Rheumatoid Arthritis Prevention and Control)

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29 pages, 727 KiB

Open AccessEditor’s ChoiceReview

Identifying and Managing Suicidality in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

by Lily Chu, Meghan Elliott, Eleanor Stein and Leonard A. Jason

Healthcare 2021, 9(6), 629; https://doi.org/10.3390/healthcare9060629 - 25 May 2021

Cited by 11 | Viewed by 15216

Abstract

Adult patients affected by myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are at an increased risk of death by suicide. Based on the scientific literature and our clinical/research experiences, we identify risk and protective factors and provide a guide to assessing and managing suicidality in [...] Read more.

Adult patients affected by myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are at an increased risk of death by suicide. Based on the scientific literature and our clinical/research experiences, we identify risk and protective factors and provide a guide to assessing and managing suicidality in an outpatient medical setting. A clinical case is used to illustrate how information from this article can be applied. Characteristics of ME/CFS that make addressing suicidality challenging include absence of any disease-modifying treatments, severe functional limitations, and symptoms which limit therapies. Decades-long misattribution of ME/CFS to physical deconditioning or psychiatric disorders have resulted in undereducated healthcare professionals, public stigma, and unsupportive social interactions. Consequently, some patients may be reluctant to engage with mental health care. Outpatient medical professionals play a vital role in mitigating these effects. By combining evidence-based interventions aimed at all suicidal patients with those adapted to individual patients’ circumstances, suffering and suicidality can be alleviated in ME/CFS. Increased access to newer virtual or asynchronous modalities of psychiatric/psychological care, especially for severely ill patients, may be a silver lining of the COVID-19 pandemic. Full article

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

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10 pages, 203 KiB

Open AccessEditor’s ChoiceArticle

Effect of e-Health Literacy on COVID-19 Infection-Preventive Behaviors of Undergraduate Students Majoring in Healthcare

by Kyung Jin Hong, Noo Lee Park, Soo Yeon Heo, Seo Hyun Jung, Ye Been Lee and Ji Hoon Hwang

Healthcare 2021, 9(5), 573; https://doi.org/10.3390/healthcare9050573 - 12 May 2021

Cited by 34 | Viewed by 4357

Abstract

This study examined and verified the level of e-health literacy (e-HL) and infection preventive behaviors related to COVID-19 among undergraduate students majoring in healthcare. An online survey was conducted with 274 university students majoring in nursing, clinical pathology, and occupational therapy in South [...] Read more.

This study examined and verified the level of e-health literacy (e-HL) and infection preventive behaviors related to COVID-19 among undergraduate students majoring in healthcare. An online survey was conducted with 274 university students majoring in nursing, clinical pathology, and occupational therapy in South Korea. The e-HL consisted of functional, communicational, and critical literacy, and preventive behaviors were based on the Prevention Guideline on Droplet Infection. The mean score for e-HL was 3.62, with nursing students obtaining the highest scores. The overall e-HL score and the scores on its three sub-dimensions were related to infection-preventive behaviors. Moreover, e-HL affected infection-preventive behaviors (p < 0.001). Findings from this study highlight the necessity of education for improving the e-HL of undergraduate students majoring in healthcare to strengthen infection-preventive behaviors and protect patients from infectious diseases. Full article

(This article belongs to the Special Issue Telehealth: How Technology Is Evolving Healthcare Training and Patient Education)

12 pages, 638 KiB

Open AccessEditor’s ChoiceSystematic Review

Systematic Review of Sleep Characteristics in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

by Rebekah Maksoud, Natalie Eaton-Fitch, Michael Matula, Hélène Cabanas, Donald Staines and Sonya Marshall-Gradisnik

Healthcare 2021, 9(5), 568; https://doi.org/10.3390/healthcare9050568 - 11 May 2021

Cited by 7 | Viewed by 7916

Abstract

(1) Background—Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a multifaceted illness characterized by profound and persistent fatigue unrelieved by rest along with a range of other debilitating symptoms. Experiences of unrefreshing and disturbed sleep are frequently described by ME/CFS patients. This is the first [...] Read more.

(1) Background—Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a multifaceted illness characterized by profound and persistent fatigue unrelieved by rest along with a range of other debilitating symptoms. Experiences of unrefreshing and disturbed sleep are frequently described by ME/CFS patients. This is the first systematic review assessing sleep characteristics in ME/CFS. The aim of this review is to determine whether there are clinical characteristics of sleep in ME/CFS patients compared to healthy controls using objective measures such as polysomnography and multiple sleep latency testing. (2) Methods—the following databases—Pubmed, Embase, Medline (EBSCO host) and Web of Science, were systematically searched for journal articles published between January 1994 to 19 February 2021. Articles that referred to polysomnography or multiple sleep latency testing and ME/CFS patients were selected, and further refined through use of specific inclusion and exclusion criteria. Quality and bias were measured using the Joanna Briggs Institute checklist. (3) Results—twenty observational studies were included in this review. The studies investigated objective measures of sleep quality in ME/CFS. Subjective measures including perceived sleep quality and other quality of life factors were also described. (4) Conclusions—Many of the parameters measured including slow- wave sleep, apnea- hypopnea index, spectral activity and multiple sleep latency testing were inconsistent across the studies. The available research on sleep quality in ME/CFS was also limited by recruitment decisions, confounding factors, small sample sizes and non-replicated findings. Future well-designed studies are required to understand sleep quality in ME/CFS patients. Full article

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

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27 pages, 374 KiB

Open AccessEditor’s ChoiceReview

Elements of Suffering in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: The Experience of Loss, Grief, Stigma, and Trauma in the Severely and Very Severely Affected

by Patricia A. Fennell, Nancy Dorr and Shane S. George

Healthcare 2021, 9(5), 553; https://doi.org/10.3390/healthcare9050553 - 9 May 2021

Cited by 22 | Viewed by 17290

Abstract

People who are severely and very severely affected by Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) experience profound suffering. This suffering comes from the myriad of losses these patients experience, the grief that comes from these losses, the ongoing stigma that is often experienced as [...] Read more.

People who are severely and very severely affected by Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) experience profound suffering. This suffering comes from the myriad of losses these patients experience, the grief that comes from these losses, the ongoing stigma that is often experienced as a person with a poorly understood, controversial chronic illness, and the trauma that can result from how other people and the health care community respond to this illness. This review article examines the suffering of patients with ME/CFS through the lens of the Fennell Four-Phase Model of chronic illness. Using a systems approach, this phase framework illustrates the effects of suffering on the patient and can be utilized to help the clinician, patient, family, and caregivers understand and respond to the patient’s experiences. We highlight the constructs of severity, uncertainty, ambiguity, and chronicity and their role in the suffering endured by patients with ME/CFS. A composite case example is used to illustrate the lives of severely and very severely affected patients. Recommendations for health care providers treating patients with ME/CFS are given and underscore the importance of providers understanding the intense suffering that the severely and very severely affected patients experience. Full article

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

12 pages, 692 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Intermittent Energy Restriction, Weight Loss and Cardiometabolic Risk: A Critical Appraisal of Evidence in Humans

by Alexia L. Katsarou, Nicholas L. Katsilambros and Chrysi C. Koliaki

Healthcare 2021, 9(5), 495; https://doi.org/10.3390/healthcare9050495 - 22 Apr 2021

Cited by 8 | Viewed by 5840

Abstract

Dietary patterns with intermittent energy restriction (IER) have been proposed as an attractive alternative to continuous energy restriction (CER) for the management of obesity and its associated comorbidities. The most widely studied regimens of IER comprise energy restriction on two days per week [...] Read more.

Dietary patterns with intermittent energy restriction (IER) have been proposed as an attractive alternative to continuous energy restriction (CER) for the management of obesity and its associated comorbidities. The most widely studied regimens of IER comprise energy restriction on two days per week (5:2), alternate-day energy restriction by 60–70% (ADF), and timely restriction of energy intake during a specific time window within the day (TRF; time-restricted feeding). Although there is some evidence to suggest that IER can exert beneficial effects on human cardiometabolic health, yet is apparently not superior compared to CER, there are still some critical issues/questions that warrant further investigation: (i) high-quality robust scientific evidence regarding the long-term effects of IER (safety, efficacy, compliance) is limited since the vast majority of intervention studies had a duration of less than 6 months; (ii) whether the positive effects of IER are independent of or actually mediated by weight loss remains elusive; (iii) it remains unknown whether IER protocols are a safe recommendation for the general population; (iv) data concerning the impact of IER on ectopic fat stores, fat-free mass, insulin resistance and metabolic flexibility are inconclusive; (v) the cost-effectiveness of IER dietary regimens has not been adequately addressed; (vi) direct head-to-head studies comparing different IER patterns with variable macronutrient composition in terms of safety and efficacy are scarce; and (vii) evidence is limited with regard to the efficacy of IER in specific populations, including males, the elderly and patients with morbid obesity and diabetes mellitus. Until more solid evidence is available, individualization and critical perspective are definitely warranted to determine which patients might benefit the most from an IER intervention, depending on their personality traits and most importantly comorbid health conditions. Full article

(This article belongs to the Special Issue Obesity—a Hot Topic in Modern Medicine—a Multidisciplinary Challenge)

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12 pages, 279 KiB

Open AccessEditor’s ChoiceArticle

Empathy and Coping in Allied Health Sciences: Gender Patterns

by Artemisa R. Dores, Helena Martins, Ana C. Reis and Irene P. Carvalho

Healthcare 2021, 9(5), 497; https://doi.org/10.3390/healthcare9050497 - 22 Apr 2021

Cited by 11 | Viewed by 3530

Abstract

This study aimed to examine the patterns of associations between empathy and coping among undergraduate men and women studying at Allied Health Sciences. This cross-sectional study is part of a larger longitudinal study conducted in an Allied Health Sciences School. Participants were 183 [...] Read more.

This study aimed to examine the patterns of associations between empathy and coping among undergraduate men and women studying at Allied Health Sciences. This cross-sectional study is part of a larger longitudinal study conducted in an Allied Health Sciences School. Participants were 183 undergraduate students from 12 training programs (e.g., Physiotherapy, Occupational Therapy, Speech Therapy). Their mean age was 20.79 years (SD = 2.64), and they were in their first, third, and fourth years of school. The instruments were the Brief-COPE and the Interpersonal Reactivity Index (IRI). Empathy correlated with coping strategies in both genders, though showing different patterns of association. First, distinct coping strategies were associated with the same empathy dimension (perspective taking) among women (positive reframing and self-blame) and among men (active coping). Second, the same three coping strategies appeared in both genders (seeking emotional or instrumental support and resorting to religion) but associated with different empathy dimensions (cognitive empathy among women and mostly emotional empathy among men). Third, among women (but not among men), two coping strategies (positive reframing and behavioral disengagement) were each simultaneously correlated with cognitive and emotional empathy in opposite directions. Fourth, emotional empathy correlated, only among women, with several coping strategies considered to be maladaptive (behavioral disengagement, denial and substance use). Among men, only one significant coping strategy was considered to be maladaptive (behavioral disengagement) and it was negatively correlated with cognitive empathy (perspective taking). Unlike in women, relationships between the empathic dimension of fantasy and coping strategies were non-significant among men. These distinct patterns of associations emerged despite significant differences in empathy by gender (fantasy, personal distress and empathic concern) and in coping strategies (instrumental support, emotional support, religion and venting). These results support the idea that the display of empathy might be associated with gender differences in the underlying empathy dimensions and in the coping strategies used to deal with stress in the undergraduate programs of Allied Health Sciences. Full article

(This article belongs to the Special Issue New Advancements in the Science of Emotional Health among Vulnerable Youth)

6 pages, 231 KiB

Open AccessEditor’s ChoiceArticle

Hospitalization for Short-Term Diabetes-Related Complications: Focus on Patients Aged over 85 Years

by Giuseppe Di Martino, Pamela Di Giovanni, Fabrizio Cedrone, Francesca Meo, Piera Scampoli, Ferdinando Romano and Tommaso Staniscia

Healthcare 2021, 9(4), 460; https://doi.org/10.3390/healthcare9040460 - 14 Apr 2021

Cited by 8 | Viewed by 2730

Abstract

(1) Background: The prevalence of diabetes in elderly people is frequently high. When occurring in the elderly, diabetes is often accompanied by complications and comorbidities, at least one in 60% and four or more in 40% of older people with diabetes. As [...] Read more.

(1) Background: The prevalence of diabetes in elderly people is frequently high. When occurring in the elderly, diabetes is often accompanied by complications and comorbidities, at least one in 60% and four or more in 40% of older people with diabetes. As far as short-term complications among the elderly are concerned, hypoglycemia and hyperglycemic crises prove to be frequent. The aim of this study was to investigate the difference in hospitalization for short-term diabetes complications in patients below and over 85 years of age. (2) Methods: Data were collected from hospital discharge records (HDRs) of all hospital admissions that occurred in Abruzzo Region, Italy, from 2006 to 2015. Only diabetic patients aged over 65 years were included. Outcomes included were diabetic ketoacidosis, hyperosmolar coma, hypoglycemic shock, iatrogenic hypoglycemic coma, and other diabetic comas. (3) Results: During the study period, 144,376 admissions were collected, 116,305 (80.56%) of which referred to patients below 85 years. Those aged over 85 years were significantly associated to all short-term diabetes-related complications with the exception of ketoacidosis. (4) Conclusions: In older diabetic patients, the avoidance of short-term diabetes complications are a greater concern than in younger patients. Diabetes management among very elderly patients should be tailored accordingly to patient characteristics. Full article

(This article belongs to the Special Issue Diabetes and Comorbidities)

11 pages, 255 KiB

Open AccessFeature PaperEditor’s ChoiceArticle

Relationship between Oral Health Status and Bone Mineral Density in Community-Dwelling Elderly Individuals: A Cross-Sectional Study

by Mayu Takeda, Yuhei Matsuda, Kumi Ikebuchi, Miwako Takeda, Takafumi Abe, Kazumichi Tominaga, Minoru Isomura, Toru Nabika and Takahiro Kanno

Healthcare 2021, 9(4), 432; https://doi.org/10.3390/healthcare9040432 - 7 Apr 2021

Cited by 4 | Viewed by 2508

Abstract

The relationship between oral health status and bone mineral density has been poorly elucidated. We conducted a cross-sectional study to examine the relationship between oral health status and bone mineral density with data from healthy community-dwelling elderly individuals in Ohnan-cho, Shimane Japan who [...] Read more.

The relationship between oral health status and bone mineral density has been poorly elucidated. We conducted a cross-sectional study to examine the relationship between oral health status and bone mineral density with data from healthy community-dwelling elderly individuals in Ohnan-cho, Shimane Japan who were recruited in 2019 for the Shimane Center for Community-Based Health Research and Education (CoHRE) study. The study included 702 participants (306 men and 396 women). The median age, bone mineral density, and number of remaining teeth were 69.0 years, 86.2%, and 26.0, respectively. The two groups (Low teeth group and High teeth group) showed significant differences in age, hemoglobin A1c (HbA1c) level, and masticatory function in men (p < 0.05). In women, age, number of untreated teeth, and masticatory function were significantly different (p < 0.05). The odds ratio of propensity score analysis for the association between the number of remaining teeth and bone mineral density was 27.7 (95% confidence interval: 1.86–414.9, p < 0.05). The number of remaining teeth could be associated with bone mineral density in the healthy elderly women, and no significant association was observed in men. Number of remaining teeth and bone mineral density may be interrelated, and oral care by dentists/dental hygienists may play an important role in maintaining bone mineral density in elderly women. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Health Care)

9 pages, 243 KiB

Open AccessEditor’s ChoiceArticle

Mozambican Adolescents and Youths during the COVID-19 Pandemic: Knowledge and Awareness Gaps in the Provinces of Sofala and Tete

by Claudia Marotta, Ussene Nacareia, Alba Sardon Estevez, Francesca Tognon, Giselle Daiana Genna, Giovanna De Meneghi, Edoardo Occa, Lucy Ramirez, Marzia Lazzari, Francesco Di Gennaro and Giovanni Putoto

Healthcare 2021, 9(3), 321; https://doi.org/10.3390/healthcare9030321 - 13 Mar 2021

Cited by 11 | Viewed by 3040

Abstract

(1) Background: Mozambique has an average population age of 17 years and adolescents and youths have a pivotal role in SARS-CoV-2 pandemic control. (2) Methods: We conducted a cross-sectional study in order to assess the awareness and information needs with regard to COVID-19 [...] Read more.

(1) Background: Mozambique has an average population age of 17 years and adolescents and youths have a pivotal role in SARS-CoV-2 pandemic control. (2) Methods: We conducted a cross-sectional study in order to assess the awareness and information needs with regard to COVID-19 among a sample of adolescents and youths from two different Mozambican provinces. (3) Results: Only 25% of adolescents and youths had a high level of awareness and only 543/2170 participants reported a high level of knowledge regarding COVID-19. In our multivariate model, significant predictors of reporting a high level of knowledge about COVID-19 include female sex (O.R. = 1.47; 95% confidence interval (CI) 1.23–2.89), having a house without a thatched roof (O.R. = 1.85; 95% CI 1.02–2.95) and HIV-positive status (O.R. = 1.56; 95% CI 1.36–2.87). (4) Conclusions: Our study highlights an important and relevant knowledge gap in adolescents and youths with respect to the COVID-19 pandemic. Involving young people and adolescents in the fight against SARS-CoV-2 is an essential strategy, especially in countries where the national average age is young, such as Mozambique, and where this epidemic can aggravate an already fragile health system. Full article

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

9 pages, 239 KiB

Open AccessFeature PaperEditor’s ChoiceArticle

Investigation of Factors Affecting Early Quality of Life of Patients after Breast Cancer Surgery

by Yoshiteru Akezaki, Eiji Nakata, Masato Kikuuchi, Ritsuko Tominaga, Hideaki Kurokawa, Masaki Okamoto, Makiko Hamada, Kenjiro Aogi, Shozo Ohsumi and Shinsuke Sugihara

Healthcare 2021, 9(2), 213; https://doi.org/10.3390/healthcare9020213 - 16 Feb 2021

Cited by 11 | Viewed by 3135

Abstract

Objective: The purpose of this study was to investigate factors related to early quality of life (QOL) three months after surgery in breast cancer patients with axillary lymph node dissection. Methods: The subjects of this study were 195 consecutive patients who underwent axillary [...] Read more.

Objective: The purpose of this study was to investigate factors related to early quality of life (QOL) three months after surgery in breast cancer patients with axillary lymph node dissection. Methods: The subjects of this study were 195 consecutive patients who underwent axillary lymph node dissection for breast cancer. Age, body mass index, level of lymph node dissection, marriage, children, co-resident household members, neoadjuvant chemotherapy, postoperative chemotherapy, postoperative hormonal therapy, postoperative radiotherapy, upper limb function (disabilities of the arm, shoulder, and hand (DASH)), and QOL (European Organization for the Treatment and Research of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)) were evaluated. For each item of the EORTC QLQ-C30, compared with preoperative status and three months after surgery, those who improved or remained unchanged in the three months after surgery were classified as the maintenance and improved groups, and those with worsening status were classified as the worsened group. Results: Age, level of lymph node dissection, DASH, neoadjuvant chemotherapy, postoperative chemotherapy, and postoperative radiotherapy were significantly associated with QOL (p < 0.05). Conclusions: The early QOL of postoperative patients with breast cancer is affected by multiple factors, such as upper limb function and postoperative chemotherapy, and thus comprehensive intervention is required. Full article

11 pages, 1780 KiB

Open AccessEditor’s ChoiceArticle

A Cross-Sectional Study Examining Differences in Indication for Cesarean Delivery by Race/Ethnicity

by Rebecca Delafield, Jennifer Elia, Ann Chang, Bliss Kaneshiro, Tetine Sentell and Catherine M. Pirkle

Healthcare 2021, 9(2), 159; https://doi.org/10.3390/healthcare9020159 - 3 Feb 2021

Cited by 7 | Viewed by 2976

Abstract

(1) Background: There are persistent racial/ethnic disparities in cesarean delivery in the United States (U.S.), yet the causes remain unknown. One factor could be provider bias. We examined medical indications for cesarean delivery that involve a greater degree of physician discretion (more subjective) [...] Read more.

(1) Background: There are persistent racial/ethnic disparities in cesarean delivery in the United States (U.S.), yet the causes remain unknown. One factor could be provider bias. We examined medical indications for cesarean delivery that involve a greater degree of physician discretion (more subjective) versus medical indications that involve less physician discretion (more objective) to better understand factors contributing to the higher rate among Micronesian, one of the most recent migrant groups in the state, compared to White women in Hawai‘i. (2) Methods: A retrospective chart review was conducted to collect data on 620 cesarean deliveries (N = 296 White and N = 324 Micronesian) at the state’s largest maternity hospital. Multivariate regression models were used to examine associations between maternal and obstetric characteristics and (1) subjective indication defined as non-reassuring fetal heart tracing (NRFHT) and arrest of labor disorders, and (2) objective indication defined as all other indications (e.g., malpresentation). (3) Results: We found that Micronesian women had significantly higher odds of cesarean delivery due to a subjective indication compared to White women (aOR: 4.17; CI: 2.52-6.88; P < 0.001; N = 619) after adjusting for multiple covariates. (4) Conclusion: These findings suggest unmeasured factors, possibly provider bias, may influence cesarean delivery recommendations for Micronesian women in Hawai‘i. Full article

(This article belongs to the Section Perinatal and Neonatal Medicine)

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11 pages, 243 KiB

Open AccessEditor’s ChoiceArticle

Homebound versus Bedridden Status among Those with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

by Karl Conroy, Shaun Bhatia, Mohammed Islam and Leonard A. Jason

Healthcare 2021, 9(2), 106; https://doi.org/10.3390/healthcare9020106 - 20 Jan 2021

Cited by 14 | Viewed by 6792

Abstract

Persons living with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) vary widely in terms of the severity of their illness. It is estimated that of those living with ME/CFS in the United States, about 385,000 are homebound. There is a need to know more about [...] Read more.

Persons living with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) vary widely in terms of the severity of their illness. It is estimated that of those living with ME/CFS in the United States, about 385,000 are homebound. There is a need to know more about different degrees of being homebound within this severely affected group. The current study examined an international sample of 2138 study participants with ME/CFS, of whom 549 were severely affected (operationalized as ‘Homebound’). A subsample of 89 very severely affected participants (operationalized as ‘Homebound-bedridden’) was also examined. The findings showed a significant association between severely and very severely affected participants within the post-exertional malaise (PEM) symptom domain. The implications of these findings are discussed. Full article

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

16 pages, 1132 KiB

Open AccessEditor’s ChoiceArticle

Cognitive Differences and Influencing Factors of Chinese People’s Old-Age Care Responsibility against the Ageing Background

by Yan Wang, Ruilian Zhang and Shengping Peng

Healthcare 2021, 9(1), 72; https://doi.org/10.3390/healthcare9010072 - 14 Jan 2021

Cited by 10 | Viewed by 3036

Abstract

With the rapid increase in the ageing population (60+) in China since 1999, the problem of supporting the aged is facing increasingly severe challenges. Based on the 2072 valid samples from the Chinese General Social Survey (CGSS) of 2017, a non-sequential multinomial logistic [...] Read more.

With the rapid increase in the ageing population (60+) in China since 1999, the problem of supporting the aged is facing increasingly severe challenges. Based on the 2072 valid samples from the Chinese General Social Survey (CGSS) of 2017, a non-sequential multinomial logistic regression model was established to analyse the changing trends and micro-influencing factors of Chinese people’s cognition of old-age care responsibility (COACR). The result shows that offspring responsibility still is a common COACR, but this concept has been gradually weakened and been replaced by the responsibility of the government and the aged. Individual characteristics and relationships with relatives in the models all significantly affect people’s COACR. It is obviously unrealistic for China to completely rely on government and society to provide for the aged. The traditional ethical role of inter-generational responsibility in providing for the aged should be brought into play. Reshaping the inter-generational responsibility ethics of old-age care requires the joint efforts of government, society, families, individuals and other responsible subjects to construct a diversified old-age care service system. Full article

(This article belongs to the Section Community Care)

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