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Healthcare, Volume 11, Issue 24 (December-2 2023) – 96 articles

Cover Story (view full-size image): We analyzed adherence to an intervention to quit maladaptive behaviors (quitting tobacco and cannabis use) and increase healthy behaviors (physical activity) using the cell phone app: App-terapia Prescinde. We analyzed adherence in terms of persistence rate and frequency of use of the app. Our results are very useful as they allow us to understand the usage patterns of cell phone interventions over time. In particular, they provide detailed information on the socio-demographic variables and their relationship with the use of the therapy app Prescinde. Our findings allow us to conceptualize the extent to which cell phone interventions produce behavioral changes aimed at quitting addictive behaviors. This challenge can help to design specific interventions that are low cost and sustainable for the healthcare system. View this paper
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15 pages, 800 KiB  
Review
Health Service Impacts and Risk Factors for Severe Trauma in Mountain Biking: A Narrative Review
Healthcare 2023, 11(24), 3196; https://doi.org/10.3390/healthcare11243196 - 18 Dec 2023
Viewed by 627
Abstract
Mountain biking is growing in participation but carries risk for severe injury and burden on health systems. Little is known about the impact of these injuries on emergency medical services, definitive healthcare, and factors contributing to accidents. This review aimed to determine the [...] Read more.
Mountain biking is growing in participation but carries risk for severe injury and burden on health systems. Little is known about the impact of these injuries on emergency medical services, definitive healthcare, and factors contributing to accidents. This review aimed to determine the health service impacts of severe mountain bike trauma and risk factors, with a view to understanding critical gaps and needs. A systematic online search was conducted using the databases PubMed and MEDLINE complete and grey literature relating to mountain bike injury since the databases’ inception to July 2023. The results show that although mountain biking has relatively high injury rates that are increasing, the impacts on health services were rarely documented, with some evidence indicating that even small increases in injuries from race events can overwhelm local health services. Severe injuries were more common in downhill disciplines. However, the definitions of what constitutes severe injury were variable. Severe injuries were more common in downhill disciplines, influenced by the rider skill level, demographics, participation in competitive events, trail design, environmental factors, and healthcare availability. Further research in these areas is needed, along with the more consistent reporting of injury severity. Full article
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21 pages, 1828 KiB  
Article
Is a Maximal Strength-Training Program Effective on Physical Fitness, Injury Incidence, and Injury Burden in Semi-Professional Soccer Players? A Randomized Controlled Trial
Healthcare 2023, 11(24), 3195; https://doi.org/10.3390/healthcare11243195 - 18 Dec 2023
Viewed by 692
Abstract
The aims of the study were to analyze the effects of a 12-week maximal strength- training program on injury incidence, injury burden, and physical fitness in semi-professional soccer players and to compare the perceived exertion load and well-being state between injured and non-injured [...] Read more.
The aims of the study were to analyze the effects of a 12-week maximal strength- training program on injury incidence, injury burden, and physical fitness in semi-professional soccer players and to compare the perceived exertion load and well-being state between injured and non-injured soccer players. Twenty semi-professional male soccer players participated in this study. Participants were randomly allocated to an experimental group (EG, n = 10 players), who performed a maximal strength-training program, or to a control group (CG, n = 10 players), who only performed their regular soccer training. Physical fitness was measured at baseline and after the training program. In addition, the injury incidence, burden, training/match load, and the state of well-being of the players were recorded. The EG showed significant improvements in vertical jumps, change in direction ability, linear sprints, repeated sprint ability, isometric strength (p < 0.003; effect size = 1.78–11.86), and quadriceps–hamstring imbalance in both legs (p < 0.001; effect size = 2.37–3.71) in comparison to the CG. In addition, the EG players showed a significantly (p < 0.05) lower injury burden (p < 0.001, relative risk = 5.05, 95% confidence interval = 3.27–7.79). This study demonstrated the beneficial effects of a 12-week maximal strength-training program on physical fitness attributes and injury burden in semi-professional soccer players. Full article
(This article belongs to the Special Issue Supporting Athlete Development: The Role of Supporting Structures)
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14 pages, 358 KiB  
Article
Internet Addiction, Sleep Habits and Family Communication: The Perspectives of a Sample of Adolescents
Healthcare 2023, 11(24), 3194; https://doi.org/10.3390/healthcare11243194 - 18 Dec 2023
Viewed by 813
Abstract
Background: With the increase in communication technologies, the internet has become an indispensable tool in the life of the individual. Several studies report on the advantages of this resource; however, there is still a group of individuals who use the internet excessively. The [...] Read more.
Background: With the increase in communication technologies, the internet has become an indispensable tool in the life of the individual. Several studies report on the advantages of this resource; however, there is still a group of individuals who use the internet excessively. The aim of this study was to explore the relationships between internet addiction, daytime sleepiness, and family communication in adolescents. Methods: A total of 340 adolescents aged between 12 and 17 years participated in this study. All completed the sociodemographic questionnaire, the internet addiction test, the pediatric daytime sleepiness scale, and the family communication scale. Results: The results indicate that 64.1% of the adolescents had mild to moderate addiction to the internet. The main results suggest that internet addiction in adolescents is negatively associated with family communication and positively associated with excessive daytime sleepiness. It was also observed that gender had a significant effect on daytime sleepiness, with female participants having more excessive daytime sleepiness. Regarding age, the results indicate higher values of internet addiction among younger adolescents. Conclusions: In view of the above, it is considered important to develop preventive actions with a view to healthy family communication, with the adoption of sleep hygiene habits and the promotion of healthy use of the internet. Full article
12 pages, 263 KiB  
Article
Telehealth Utilization and Good Care among Informal Caregivers: Health Information National Trends Survey, 2022
Healthcare 2023, 11(24), 3193; https://doi.org/10.3390/healthcare11243193 - 18 Dec 2023
Viewed by 650
Abstract
Background: The COVID-19 pandemic accelerated the adoption of telehealth services. Informal caregivers provide vital support to family and friends. Studying telehealth among informal caregivers is crucial to understanding how technology can support and enhance their caregiving responsibilities, potentially enhancing telehealth services for them [...] Read more.
Background: The COVID-19 pandemic accelerated the adoption of telehealth services. Informal caregivers provide vital support to family and friends. Studying telehealth among informal caregivers is crucial to understanding how technology can support and enhance their caregiving responsibilities, potentially enhancing telehealth services for them as well as their patients. The present study aims to nationally investigate telehealth utilization and quality among informal caregivers. Methods: This cross-sectional investigation employed the 2022 Health Information National Trends Survey (HINTS) dataset. Informal caregivers, telehealth variables (utilization, good care, technical problems, convenience, and concerns about infection exposure), and sociodemographic factors (age, gender, race/ethnicity, income, education, health insurance, and census regions) were identified based on questions in the survey. Weighted multivariable logistic regression models were employed to calculate odds ratios (ORs), 95% confidence intervals (CIs), and p-values. Results: Significant disparities in telehealth utilization were detected among informal caregivers (N = 831), when telehealth users were compared to non-users. Those aged 50–64 (OR = 0.36, 95% CI = 0.20–0.65) and 65+ (OR = 0.40, 95% CI = 0.21–0.74) had significantly lower odds of using telehealth than those aged 35–49. Men had significantly lower odds of telehealth utilization (OR = 0.47, 95% CI = 0.25–0.87). Black caregivers compared to Whites had significantly lower odds (OR = 0.49, 95% CI = 0.24–0.99), while health insurance increased odds (OR = 5.31, 95% CI = 1.67–16.86) of telehealth utilization. Informal caregivers who used telehealth were more likely to be perceived as good telehealth caregivers if they had no telehealth technical issues compared to caregivers who had (OR = 4.61, CI = 1.61–13.16; p-value = 0.0051) and if they were from the South compared to the West (OR = 2.95, CI = 1.18–7.37, p-value = 0.0213). Conclusions: For the first time, to the best of our knowledge, we have nationally investigated telehealth utilization and quality among informal caregivers. Disparities in telehealth utilization among informal caregivers are evident, with age, gender, race, and health insurance being significant determinants. Telehealth quality is significantly influenced by technical problems and census regions, emphasizing the importance of addressing these aspects in telehealth service development for informal caregivers. Full article
21 pages, 3513 KiB  
Systematic Review
Instruments of Child-to-Parent Violence: Systematic Review and Meta-Analysis
Healthcare 2023, 11(24), 3192; https://doi.org/10.3390/healthcare11243192 - 18 Dec 2023
Viewed by 808
Abstract
This systematic review and reliability generalization meta-analysis synthesized psychometric literature on instrumentation assessing child-to-parent violence published through September 2023 across four databases. In the screening, we identified studies reporting Cronbach’s alpha internal consistency estimates for the child-to-parent violence scales. The eligible reliability coefficients [...] Read more.
This systematic review and reliability generalization meta-analysis synthesized psychometric literature on instrumentation assessing child-to-parent violence published through September 2023 across four databases. In the screening, we identified studies reporting Cronbach’s alpha internal consistency estimates for the child-to-parent violence scales. The eligible reliability coefficients ranged from 0.610 to 0.930, mostly exceeding the minimum threshold of 0.700. Random-effects models calculated pooled Cronbach’s alphas separately for global, father-specific, and mother-specific subscales. The results demonstrated cumulative values of 0.83 (global: standard error = 0.0129), 0.800 (fathers: standard error = 0.0203), and 0.81 (mothers: standard error = 0.0179), denoting largely adequate reliability. However, significant between-study heterogeneity was observed. While the mean alpha levels seem acceptable for most tools, substantial variability coupled with the possibility of some studies violating reliability assumptions indicates that a conservative interpretation is warranted. Ongoing scale refinement and additional psychometric evaluations will strengthen the rigor methodology in this developing research domain. However, these results should be interpreted with caution, as there is a high level of heterogeneity, and it is possible that some studies have not verified the assumptions underlying Cronbach’s alpha. Full article
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10 pages, 794 KiB  
Article
Pain Prevalence and Satisfaction with Pain Management in Inpatients: A Cross-Sectional Study
Healthcare 2023, 11(24), 3191; https://doi.org/10.3390/healthcare11243191 - 18 Dec 2023
Viewed by 647
Abstract
Background: Pain in hospitalized adults is underestimated and undervalued. The aim of this study was to evaluate pain prevalence and satisfaction with the hospital’s pain management among patients attending a tertiary university hospital. Predictor factors of pain were also studied. Methods: A prospective, [...] Read more.
Background: Pain in hospitalized adults is underestimated and undervalued. The aim of this study was to evaluate pain prevalence and satisfaction with the hospital’s pain management among patients attending a tertiary university hospital. Predictor factors of pain were also studied. Methods: A prospective, cross-sectional study was carried out through a structured questionnaire given on one day to all hospitalized patients in a university hospital. Clinical data, such as personal history and analgesic treatment, were collected from medical records. Other variables related to pain (including intensity rated by the visual analogue scale as well as location and patient satisfaction measured by the numerical rating scale) were also obtained. Results: Of the 274 surveyed patients, pain prevalence was 52.9%, with an average intensity of 5.3 ± 2.8 according to VAS. The overall satisfaction was 87.2%, and 72.6% had already been prescribed at least one analgesic. Patients receiving analgesics showed higher pain intensity (VAS 3.6 ± 3.4) than those without treatment (VAS 1.1 ± 2.1) (p < 0.001). However, patients with treatment showed more satisfaction (NRS 7.8 ± 2 vs. 5.3 ± 1.4, p < 0.001). Conclusions: The prevalence of pain in hospitalized patients was high, despite the fact that patient satisfaction was also very high. Full article
(This article belongs to the Special Issue Pain Management Practice and Research)
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15 pages, 1314 KiB  
Article
Resident Impact of the Single Site Order Restricting Staff Mobility across Long-Term Care Homes in British Columbia, Canada
Healthcare 2023, 11(24), 3190; https://doi.org/10.3390/healthcare11243190 - 17 Dec 2023
Viewed by 637
Abstract
The Single Site Order (SSO)—a policy restricting staff from working at multiple long-term care (LTC) homes—was mandated by the Public Health Agency of Canada to control the spread of COVID-19 in LTC homes, where nearly 70% of COVID-19-related deaths in Canada occurred. This [...] Read more.
The Single Site Order (SSO)—a policy restricting staff from working at multiple long-term care (LTC) homes—was mandated by the Public Health Agency of Canada to control the spread of COVID-19 in LTC homes, where nearly 70% of COVID-19-related deaths in Canada occurred. This mixed methods study assesses the impact of the SSO on LTC residents in British Columbia. Interviews were conducted (residents (n = 6), family members (n = 9), staff (n = 18), and leadership (n = 10) from long-term care homes (n = 4)) and analyzed using thematic analysis. Administrative data were collected between April 2019 and March 2020 and between April 2020 and March 2021 and analyzed using descriptive statistics and data visualization. Qualitative and quantitative data were triangulated and demonstrated that staffing challenges became worse during the implementation of the SSO, resulting in the mental and physical health deterioration of LTC residents. Qualitative data demonstrated decreased time for personalized and proactive care, increased communication challenges, and increased loneliness and isolation. Quantitative data showed a decline in activities of daily living, increased antipsychotic medication use, pressure ulcers, behavioural symptoms, and an increase in falls. Addressing staff workload and staffing shortages during SSO-related policy implementation is essential to avoid resident health deterioration. Full article
(This article belongs to the Special Issue Healthcare Policy, Inequity, and Systems Research)
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16 pages, 1461 KiB  
Review
Effectiveness of the Combined Use of a Brain–Machine Interface System and Virtual Reality as a Therapeutic Approach in Patients with Spinal Cord Injury: A Systematic Review
Healthcare 2023, 11(24), 3189; https://doi.org/10.3390/healthcare11243189 - 17 Dec 2023
Viewed by 814
Abstract
Spinal cord injury has a major impact on both the individual and society. This damage can cause permanent loss of sensorimotor functions, leading to structural and functional changes in somatotopic regions of the spinal cord. The combined use of a brain–machine interface and [...] Read more.
Spinal cord injury has a major impact on both the individual and society. This damage can cause permanent loss of sensorimotor functions, leading to structural and functional changes in somatotopic regions of the spinal cord. The combined use of a brain–machine interface and virtual reality offers a therapeutic alternative to be considered in the treatment of this pathology. This systematic review aimed to evaluate the effectiveness of the combined use of virtual reality and the brain–machine interface in the treatment of spinal cord injuries. A search was performed in PubMed, Web of Science, PEDro, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and Medline, including articles published from the beginning of each database until January 2023. Articles were selected based on strict inclusion and exclusion criteria. The Cochrane Collaboration’s tool was used to assess the risk of bias and the PEDro scale and SCIRE systems were used to evaluate the methodological quality of the studies. Eleven articles were selected from a total of eighty-two. Statistically significant changes were found in the upper limb, involving improvements in shoulder and upper arm mobility, and weaker muscles were strengthened. In conclusion, most of the articles analyzed used the electroencephalogram as a measurement instrument for the assessment of various parameters, and most studies have shown improvements. Nonetheless, further research is needed with a larger sample size and long-term follow-up to establish conclusive results regarding the effect size of these interventions. Full article
(This article belongs to the Special Issue Virtual Reality and Robotics Interventions for Neurological Diseases)
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14 pages, 2133 KiB  
Study Protocol
Frailty Prevention Care Management Program (FPCMP) on Frailty and Health Function in Community-Dwelling Older Adults: A Quasi-Experimental Trial Protocol
Healthcare 2023, 11(24), 3188; https://doi.org/10.3390/healthcare11243188 - 17 Dec 2023
Viewed by 631
Abstract
Background: Frailty often results from deteriorating muscle strength and decreased physical function in older adults. Frailty includes not only physical components, but also psychological and social aspects. Previous research has shown that exercise programs, especially resistance exercises combined with nutritional care, can reduce [...] Read more.
Background: Frailty often results from deteriorating muscle strength and decreased physical function in older adults. Frailty includes not only physical components, but also psychological and social aspects. Previous research has shown that exercise programs, especially resistance exercises combined with nutritional care, can reduce frailty. Objectives: This study aimed to develop a Frailty Prevention Care Management Program that prevents frailty and improves physical activity and nutrition compared to usual care for community-dwelling older adults. Methods: A quasi-experimental and single-blinded trial with a non-equivalent control group using a before-after design will be performed involving Frailty Prevention Care Management Program interventions, taking place both at the communities. Participants will be divided into two different intervention groups and two control groups. All groups will be assessed three times: at baseline, immediately after the intervention, and 3 months post intervention. A total of 72 community-dwelling older adults are recruited. This intervention includes an exercise program (design TRX program) and nutritional education. The control group will not receive any specific exercise training. The primary outcome shall comprise the effect of the Frailty Prevention Care Management Program on frailty using the Taiwanese version of the Tilburg frailty indicator. Secondary outcomes include the effect of physical activity using the Senior Fitness Test and nutrition measures using the Mini Nutritional Assessment-Short Form. A generalized estimating equation is constructed to analyze the effects of the intervention. Conclusions: This trial will provide vital information to guide interventions to improve outcomes (frailty, physical activity, and nutrition) and inform the integration of nutrition and TRX exercises in community-dwelling older adults. Full article
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10 pages, 1026 KiB  
Perspective
Challenges of Teleneurology in the Care of Complex Neurodegenerative Disorders: The Case of Parkinson’s Disease with Possible Solutions
Healthcare 2023, 11(24), 3187; https://doi.org/10.3390/healthcare11243187 - 17 Dec 2023
Viewed by 640
Abstract
Teleneurology is a specialist field within the realm of telemedicine, which is dedicated to delivering neurological care and consultations through virtual encounters. Teleneurology has been successfully used in acute care (e.g., stroke) and outpatient evaluation for chronic neurological conditions such as epilepsy and [...] Read more.
Teleneurology is a specialist field within the realm of telemedicine, which is dedicated to delivering neurological care and consultations through virtual encounters. Teleneurology has been successfully used in acute care (e.g., stroke) and outpatient evaluation for chronic neurological conditions such as epilepsy and headaches. However, for some neurologic entities like Parkinson’s disease, in which an in-depth physical examination by palpating muscles and performing neurologic maneuvers is the mainstay of monitoring the effects of medication, the yield and feasibility of a virtual encounter are low. Therefore, in this prospective review, we discuss two promising teleneurology approaches and propose adjustments to enhance the value of virtual encounters by improving the validity of neurological examination: ‘hybrid teleneurology’, which involves revising the workflow of virtual encounters; and ‘artificial intelligence (AI)-assisted teleneurology’, namely the use of biosensors and wearables and data processing using AI. Full article
(This article belongs to the Section TeleHealth and Digital Healthcare)
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8 pages, 1105 KiB  
Communication
Can Gastric Juice Analysis with EndoFaster® Reduce the Environmental Impact of Upper Endoscopy?
Healthcare 2023, 11(24), 3186; https://doi.org/10.3390/healthcare11243186 - 17 Dec 2023
Viewed by 692
Abstract
Gastrointestinal (GI) endoscopy services are in third place as major contributors to CO2 emissions among healthcare facilities, especially due to their massive waste production. One of the measures suggested to reduce this environmental impact is a reduction in histological examinations performed on [...] Read more.
Gastrointestinal (GI) endoscopy services are in third place as major contributors to CO2 emissions among healthcare facilities, especially due to their massive waste production. One of the measures suggested to reduce this environmental impact is a reduction in histological examinations performed on biopsy specimens taken during endoscopy. A reliable candidate to reduce the rate of biopsies and, consequently, the impact of CO2 emissions could be EndoFaster®, an innovative medical device that allows one to suspect or rule out both H. pylori infection and precancerous lesions on the gastric mucosa by analyzing a small amount of gastric juice aspirated during endoscopy in real time. In the present study, we investigated the ability of EndoFaster® to reduce the environmental impact of upper endoscopy, comparing the CO2 production of standard biopsy sampling as suggested in guidelines and biopsies guided by real-time EndoFaster® results during endoscopy. By estimating an overall 90% rate of biopsies according to standard guidelines and a reduction of 50% of gastric biopsies based on EndoFaster® results, we calculated a 44% overall reduction in CO2 emissions, demonstrating that by using this tool, it is possible to distinctly reduce the contribution of upper endoscopy to global warming. Full article
(This article belongs to the Section Environmental Factors and Global Health)
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31 pages, 1101 KiB  
Article
A Federated Learning Approach to Breast Cancer Prediction in a Collaborative Learning Framework
Healthcare 2023, 11(24), 3185; https://doi.org/10.3390/healthcare11243185 - 17 Dec 2023
Viewed by 694
Abstract
Breast cancer continues to pose a substantial worldwide public health concern, necessitating the use of sophisticated diagnostic methods to enable timely identification and management. The present research utilizes an iterative methodology for collaborative learning, using Deep Neural Networks (DNN) to construct a breast [...] Read more.
Breast cancer continues to pose a substantial worldwide public health concern, necessitating the use of sophisticated diagnostic methods to enable timely identification and management. The present research utilizes an iterative methodology for collaborative learning, using Deep Neural Networks (DNN) to construct a breast cancer detection model with a high level of accuracy. By leveraging Federated Learning (FL), this collaborative framework effectively utilizes the combined knowledge and data assets of several healthcare organizations while ensuring the protection of patient privacy and data security. The model described in this study showcases significant progress in the field of breast cancer diagnoses, with a maximum accuracy rate of 97.54%, precision of 96.5%, and recall of 98.0%, by using an optimum feature selection technique. Data augmentation approaches play a crucial role in decreasing loss and improving model performance. Significantly, the F1-Score, a comprehensive metric for evaluating performance, turns out to be 97%. This study signifies a notable advancement in the field of breast cancer screening, fostering hope for improved patient outcomes via increased accuracy and reliability. This study highlights the potential impact of collaborative learning, namely, in the field of FL, in transforming breast cancer detection. The incorporation of privacy considerations and the use of diverse data sources contribute to the advancement of early detection and the treatment of breast cancer, hence yielding significant benefits for patients on a global scale. Full article
(This article belongs to the Special Issue Prevention, Diagnosis, and Treatment of Breast Cancer)
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15 pages, 302 KiB  
Article
The Role of Resilience in the Relationship between Sociodemographic, Clinical Characteristics, and Social Support among Breast Cancer Patients in Serbia
Healthcare 2023, 11(24), 3184; https://doi.org/10.3390/healthcare11243184 - 16 Dec 2023
Viewed by 642
Abstract
Background. The management of breast cancer treatments within the limitations of family, social, and professional life is emotionally burdening and negatively affects physical, psychological, and social well-being, reducing the overall quality of life of patients and their families. Methods: This cross-sectional descriptive–analytical study [...] Read more.
Background. The management of breast cancer treatments within the limitations of family, social, and professional life is emotionally burdening and negatively affects physical, psychological, and social well-being, reducing the overall quality of life of patients and their families. Methods: This cross-sectional descriptive–analytical study was conducted from March to August 2023 at the “Dr. Radivoj Simonović” General Hospital in Sombor. A total of 236 breast cancer patients participated in this study. The research was conducted using the following instruments: a questionnaire on sociodemographic and clinical characteristics of patients, the Berlin Social-Support Scales—for assessing social support—and the Connor–Davidson Resilience Scale—for assessing resilience. This study aimed to determine the predictors and levels of social support and resilience of breast cancer patients. We also wanted to examine whether resilience is a mediator between patients’ sociodemographic and clinical characteristics and levels of social support. Results: The total average value of social support was 3.51 ± 0.63, while on the resilience scale, the respondents achieved a total average score of 52.2 ± 9.63. Perceived and actually received social support of breast cancer patients were positively correlated with resilience [p < 0.01], while no statistically significant correlations were found for the need for support and satisfaction. The sets of predictors can significantly predict their effects on all types of perceived social support (emotional social support: 9%; perceived instrumental social support: 9%) and all types of received social support (actually received emotional social support: 8%; actually received instrumental social support: 7%; actually received informational social support: 8%). There is a potential mediating role of resilience in relation to sociodemographic factors, clinical characteristics, and the need for support. Conclusion: This study confirms that a strong connection exists between social support and resilience. However, the analysis did not confirm the mediating role of resilience between the sociodemographic and clinical characteristics on the one hand and social support on the other. Full article
(This article belongs to the Special Issue Nursing Care for Cancer Patients)
15 pages, 265 KiB  
Article
Prevalence of Varicose Veins and Its Risk Factors among Nurses Working at King Khalid University Hospital Riyadh, Saudi Arabia: A Cross-Sectional Study
Healthcare 2023, 11(24), 3183; https://doi.org/10.3390/healthcare11243183 - 16 Dec 2023
Viewed by 995
Abstract
This quantitative observational cross-sectional study assessed the prevalence and level of risk scores for varicose veins among nurses, and the association between varicose veins and sociodemographic, occupational, and lifestyle risk factors. Using simple random sampling, from August–December 2022, 250 nurses from different departments [...] Read more.
This quantitative observational cross-sectional study assessed the prevalence and level of risk scores for varicose veins among nurses, and the association between varicose veins and sociodemographic, occupational, and lifestyle risk factors. Using simple random sampling, from August–December 2022, 250 nurses from different departments at King Khalid University Hospital completed a validated self-administered questionnaire and underwent an observational physical examination. Most nurses (191) had low-risk scores for varicose veins, 46 nurses had moderate-risk scores, and 13 nurses had high-risk scores. From the outpatient clinics, 61.5% of nurses had significant high-risk scores for varicose veins. Those with a statistically significant association had a family history of varicose veins (p < 0.001) and other chronic medical conditions (p = 0.04). Physical activity, especially race-walking/running (p = 0.006), showed a statistically significant association with the varicose veins score. The years as a staff nurse were statistically significant among the occupational risk factors (p = 0.003). The adjusted multivariable regression model showed three significant predictors: a positive family history, running/walking, and total years as a staff nurse (p < 0.001, p = 0.02, and p < 0.001, respectively). Nurses working at outpatient clinics, positive family history, years as a staff nurse, and other chronic conditions are risk factors for varicose veins, while race-walking/running is a protective factor. Full article
23 pages, 1127 KiB  
Article
Cigarette Smoking, Risky Alcohol Consumption, and Marijuana Smoking among University Students in Germany: Identification of Potential Sociodemographic and Study-Related Risk Groups and Predictors of Consumption
Healthcare 2023, 11(24), 3182; https://doi.org/10.3390/healthcare11243182 - 16 Dec 2023
Viewed by 661
Abstract
(1) Background: Cigarette smoking, risky alcohol consumption, and marijuana smoking are the most common behaviors related to legal and illicit drug use worldwide, including among university students. To plan effective evidence-based programs to prevent the risky consumption of these substances among university students, [...] Read more.
(1) Background: Cigarette smoking, risky alcohol consumption, and marijuana smoking are the most common behaviors related to legal and illicit drug use worldwide, including among university students. To plan effective evidence-based programs to prevent the risky consumption of these substances among university students, the present study aimed to identify potential sociodemographic and study-related risk groups and predictors of consumption. (2) Methods: A cross-sectional online health survey with approximately 270 health-related items was conducted among students at the University of Mainz, Germany. Cigarette smoking, risky alcohol consumption (AUDIT-C score: female ≥ 4, male ≥ 5), and marijuana smoking were chosen as dependent variables. Of the 270 health-related items, 56 were chosen as independent variables and collated into five groups (sociodemographic, psychological, study-related psychosocial, general psychosocial and health behavior). The prevalence of cigarette smoking, risky alcohol consumption, and marijuana smoking was assessed using established and validated instruments. Pearson’s chi-square test was used to analyze the differences in prevalence between the sociodemographic and study-related groups, and binary logistic regression was used for analyses with stepwise inclusion of the five variable groups. (3) Results: Of the 3991 university students who entered the analyses, 14.9% reported smoking cigarettes, 38.6% reported risky alcohol consumption, and 10.9% reported smoking marijuana. The prevalence of these differed between genders, fields of study, and aspired degree level, among other factors. Binary logistic regression analyses revealed nine significant predictors (p ≤ 0.05) of cigarette smoking (Nagelkerke R2 = 0.314), 18 significant predictors of risky alcohol consumption (Nagelkerke R2 = 0.270), and 16 significant predictors of marijuana smoking (Nagelkerke R2 = 0.239). (4) Conclusions: This study showed cigarette smoking, risky alcohol consumption, and marijuana smoking among university students in Germany to be associated with multiple factors, especially health behaviors. Furthermore, each of the substances was highly associated with each of the two other substances we examined. Other variable groups, such as psychological or psychosocial variables, seemed to play a rather minor role. Therefore, our recommendation for future prevention programs is that substance use among university students should be addressed as a whole, not just in terms of specific substances. Full article
(This article belongs to the Special Issue Substance Use Disorders: A Global Public Health Issue)
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16 pages, 1283 KiB  
Article
Subjective Well-Being in Cancer Patients: The Roles of Social Support, Purpose in Life, Resilience, and Informativeness
Healthcare 2023, 11(24), 3181; https://doi.org/10.3390/healthcare11243181 - 16 Dec 2023
Viewed by 612
Abstract
The aim of this research was to determine the relationship between subjective well-being (life satisfaction, positive and negative experiences, and prosperity) and various psychosocial factors (social support received from family members and partners, purpose in life, resilience and information) in cancer patients and [...] Read more.
The aim of this research was to determine the relationship between subjective well-being (life satisfaction, positive and negative experiences, and prosperity) and various psychosocial factors (social support received from family members and partners, purpose in life, resilience and information) in cancer patients and to examine the possibility of predicting components of subjective well-being based on these mentioned factors in cancer patients. A total of 338 adult cancer patients from Croatia participated in the study (41.1% male and 58.9% female). To measure the constructs, the Diener Subjective Well-Being Scale, the Social Support Scale at work and in the family, the Purpose in Life Scale, the Short Resilience Scale, and the EORTC-QLQ information questionnaire were used. Results showed a high level of life satisfaction and prosperity, as well as more frequent positive compared to negative experiences. A medium to high level of social support received from family members and from the partner was determined. High levels of purpose in life and medium levels of resilience and information were found. A high correlation was found among the components of the construct of subjective well-being, and a low to medium correlation among the predictors. Positive associations were found between the criteria of life satisfaction and prosperity with psychosocial factors. Negative associations were established between the positive/negative experience variables and the factors. Furthermore, the purpose in life was determined as an important predictor of all three components of subjective well-being, social support (both sources) as important for predicting life satisfaction, resilience for experiencing positive and negative experiences, and social family support for predicting the prosperity of cancer patients. Full article
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10 pages, 247 KiB  
Article
Quality of Reporting Randomized Controlled Trials Published in Three of the Most Citable Periodontal Journals from 2018 to 2022
Healthcare 2023, 11(24), 3180; https://doi.org/10.3390/healthcare11243180 - 16 Dec 2023
Cited by 1 | Viewed by 488
Abstract
This study aimed to evaluate the reporting quality of randomized clinical trials (RCTs) in periodontology. Three leading periodontology journals, the Journal of Periodontology (JOP), the Journal of Clinical Periodontology (JOCP), and the Journal of Periodontal Research (JOPR), were selected for this investigation. The [...] Read more.
This study aimed to evaluate the reporting quality of randomized clinical trials (RCTs) in periodontology. Three leading periodontology journals, the Journal of Periodontology (JOP), the Journal of Clinical Periodontology (JOCP), and the Journal of Periodontal Research (JOPR), were selected for this investigation. The RCTs were identified by manually searching for human trial articles published in these three journals. Two authors independently conducted the literature search, and a pre-piloted extraction sheet was used to screen the potential RCTs. The CONSORT checklist guidelines were employed to calculate the score value. Intra-examiner reliability was assessed by scoring a random sample of 10% of the papers in a second round conducted by the first examiner three months after the initial data collection. A search of abstracts published over a five-year period yielded 176 articles that reported RCTs, accounting for 11.7% of all articles published in the three journals. The highest number of RCTs was published in 2020, and more than half of the included RCTs (51%) originated from Europe. Many of the analyzed RCTs inadequately reported almost half of the items on the CONSORT checklist. Furthermore, univariate analysis revealed significant associations between certain factors and the overall CONSORT score, such as publication in JOP (p = 0.048), publication year of 2019 (p = 0.041) and 2021 (p = 0.042), first author from North America (p = 0.016), and RCTs with more than six authors (p = 0.042). Clinical trial research in periodontics has made significant progress in the past five years. However, there is room for improvement in adhering to the CONSORT guidelines. Full article
(This article belongs to the Special Issue Oral Healthcare: Diagnosis, Prevention and Treatment)
21 pages, 1723 KiB  
Article
A Panel-Agnostic Strategy ‘HiPPo’ Improves Diagnostic Efficiency in the UK Genomic Medicine Service
Healthcare 2023, 11(24), 3179; https://doi.org/10.3390/healthcare11243179 - 15 Dec 2023
Viewed by 662
Abstract
Genome sequencing is available as a clinical test in the UK through the Genomic Medicine Service (GMS). The GMS analytical strategy predominantly filters genome data on preselected gene panels. Whilst this reduces variants requiring assessment by reporting laboratories, pathogenic variants outside applied panels [...] Read more.
Genome sequencing is available as a clinical test in the UK through the Genomic Medicine Service (GMS). The GMS analytical strategy predominantly filters genome data on preselected gene panels. Whilst this reduces variants requiring assessment by reporting laboratories, pathogenic variants outside applied panels may be missed, and variants in genes without established disease–gene relationships are largely ignored. This study compares the analysis of a research exome to a GMS clinical genome for the same patients. For the research exome, we applied a panel-agnostic approach filtering for variants with High Pathogenic Potential (HiPPo) using ClinVar, allele frequency, and in silico prediction tools. We then restricted HiPPo variants to Gene Curation Coalition (GenCC) disease genes. These results were compared with the GMS genome panel-based approach. Twenty-four participants from eight families underwent parallel research exome and GMS genome sequencing. Exome HiPPo analysis identified a similar number of variants as the GMS panel-based approach. GMS genome analysis returned two pathogenic variants and one de novo variant. Exome HiPPo analysis returned the same variants plus an additional pathogenic variant and three further de novo variants in novel genes, where case series are underway. When HiPPo was restricted to GenCC disease genes, statistically fewer variants required assessment to identify more pathogenic variants than reported by the GMS, giving a diagnostic rate per variant assessed of 20% for HiPPo versus 3% for the GMS. With UK plans to sequence 5 million genomes, strategies are needed to optimise genome analysis beyond gene panels whilst minimising the burden of variants requiring clinical assessment. Full article
(This article belongs to the Section Health Informatics and Big Data)
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15 pages, 937 KiB  
Review
Clinical Applications of Virtual Reality in Musculoskeletal Rehabilitation: A Scoping Review
Healthcare 2023, 11(24), 3178; https://doi.org/10.3390/healthcare11243178 - 15 Dec 2023
Viewed by 946
Abstract
(1) Background: VR is based on a virtual world that creates sounds effects and videos that replace the real environment. Arising literature shows VR efficacy in the field of neurological rehabilitation (NR) and that its use is also taking a place in musculoskeletal [...] Read more.
(1) Background: VR is based on a virtual world that creates sounds effects and videos that replace the real environment. Arising literature shows VR efficacy in the field of neurological rehabilitation (NR) and that its use is also taking a place in musculoskeletal rehabilitation (MSR), as a treatment of various disorders that cause disability and chronic pain. (2) Aim: We discuss the role of VR in MSR, presenting its use and development on acute and chronic musculoskeletal disorders, based on the most recent literature. (3) Design and Methods: Literature searches were conducted in the databases Pubmed and Medline up to 30 September 2023. The PRISMA-Scr Checklist was followed. (4) Results: A total of 51 records were included. The analysed studies were conducted within a variety of populations, musculoskeletal disorders, settings, and VR technologies. Only a few studies could statistically affirm the efficacy of VR in MSR, as mentioned for the rehabilitation of the upper limb. Nevertheless, the observed trend is an improvement of the global perceived effect compared to traditional rehabilitation. (5) Conclusion: VR allows for the personalisation of treatment with an adaptable treatment platform, which may improve the participation of the patient and increase acceptability and adherence to long-term rehabilitation programs. We provide recommendations and suggestions for future research and use of VR in musculoskeletal rehabilitation. Full article
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12 pages, 602 KiB  
Article
Empowering Healthcare through Precision Medicine: Unveiling the Nexus of Social Factors and Trust
Healthcare 2023, 11(24), 3177; https://doi.org/10.3390/healthcare11243177 - 15 Dec 2023
Viewed by 746
Abstract
This study investigated the impact of social factors on the acceptance of precision medicine (PM) using a quantitative survey grounded in the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. The findings revealed that social influence has a significantly positive effect [...] Read more.
This study investigated the impact of social factors on the acceptance of precision medicine (PM) using a quantitative survey grounded in the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. The findings revealed that social influence has a significantly positive effect on PM acceptance, while the influence of social media is found to be insignificant. Performance expectancy emerged as the most influential factor, demonstrating a significant relationship with PM acceptance. Trust plays a crucial moderating role, mitigating the impact of social factors on PM acceptance. While exploring the mediating effects of trust, we identified a significant mediation effect for social influence and performance expectancy on PM acceptance. However, the mediation effect of social media influence is insignificant. These findings highlight the importance of trust in shaping decisions regarding PM acceptance. These findings have significant implications for healthcare practitioners and policymakers aiming to promote the adoption of precision medicine in clinical practice. Full article
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16 pages, 955 KiB  
Review
Problematic Gaming during COVID-19 Pandemic: A Systematic Review, Meta-Analysis, and Meta-Regression
Healthcare 2023, 11(24), 3176; https://doi.org/10.3390/healthcare11243176 - 15 Dec 2023
Viewed by 675
Abstract
The COVID-19 pandemic led to government measures enforcing isolation in order to mitigate the spread of the virus. Consequently, online activities, including gaming, increased during this challenging period. Thus, it was possible that problematic gaming (PG) patterns also increased. In this systematic review [...] Read more.
The COVID-19 pandemic led to government measures enforcing isolation in order to mitigate the spread of the virus. Consequently, online activities, including gaming, increased during this challenging period. Thus, it was possible that problematic gaming (PG) patterns also increased. In this systematic review and meta-analysis, we estimated the prevalence of PG during the COVID-19 pandemic and examined differences among subpopulations. The evaluation of 38 studies revealed that the overall prevalence of PG during the COVID-19 pandemic was 3.6%. Furthermore, higher PG scores were found in undergraduate and gamer subpopulations, as well as in studies using the Gaming Addiction Scale. Finally, meta-regression analyses suggest that stricter government measures, as identified by the Government Stringency Index, may have contributed to a lower prevalence of PG behaviors. A potential explanation of this finding is that containment measures had a protective function with respect to emotional distress, and thus towards PG; alternatively, it could be that current measures for PG become less precise if an individual’s functioning is already impaired due to other reasons, such as COVID-19 restrictions. Further theoretical, methodological, and practical implications of the findings are discussed. Full article
(This article belongs to the Section Coronaviruses (CoV) and COVID-19 Pandemic)
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8 pages, 579 KiB  
Article
Effects of Hippotherapy on Health-Related Quality of Life in Caregivers of Children with Cerebral Palsy: A Pilot Quasi-Experimental Study in Japan
Healthcare 2023, 11(24), 3175; https://doi.org/10.3390/healthcare11243175 - 15 Dec 2023
Viewed by 653
Abstract
Background: Despite accumulating data regarding the beneficial effects of hippotherapy on gait and balance skills in children with cerebral palsy (CP), its effects on caregivers’ quality of life (QOL) are limited, presumably due to a lack of reliable and valid measurement tools. This [...] Read more.
Background: Despite accumulating data regarding the beneficial effects of hippotherapy on gait and balance skills in children with cerebral palsy (CP), its effects on caregivers’ quality of life (QOL) are limited, presumably due to a lack of reliable and valid measurement tools. This study aims to evaluate the impact of hippotherapy on the health-related QOL of primary caregivers using the Japanese version of the Cerebral Palsy Quality of Life for Children (CP QOL) questionnaire. Methods: A quasi-experimental design embedded within our existing cohort was utilized. A total of 29 children with CP (range 4–12 years) and their caregivers participated in either a weekly hippotherapy or recreation (usual care) program for 1 year. In addition to gait-related measurements (Gross Motor Function Measure [GMFM]-E) of children, CP QOL-evidenced determinants of the caregivers’ health-related QOL and well-being were compared before and after the intervention. Results: In addition to improvements in children’s GMFM-E scores, hippotherapy improved CP QOL domains related to participation and physical health, children’s emotional well-being, and parents’ overall health (p < 0.05). Linear regression analysis showed a positive relationship between the children’s GMFM-E scores and their caregivers’ health domains in participants who received hippotherapy (r2 = 0.404; p = 0.011). Conclusions: Hippotherapy has a beneficial effect on the physical and mental well-being and satisfaction of Japanese parents caring for children with CP. Full article
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14 pages, 1919 KiB  
Review
What If the Clinical and Older Adults’ Perspectives about Frailty Converge? A Call for a Mixed Conceptual Model of Frailty: A Traditional Literature Review
Healthcare 2023, 11(24), 3174; https://doi.org/10.3390/healthcare11243174 - 15 Dec 2023
Viewed by 701
Abstract
Existing frailty models have enhanced research and practice; however, none of the models accounts for the perspective of older adults upon defining and operationalizing frailty. We aim to propose a mixed conceptual model that builds on the integral model while accounting for older [...] Read more.
Existing frailty models have enhanced research and practice; however, none of the models accounts for the perspective of older adults upon defining and operationalizing frailty. We aim to propose a mixed conceptual model that builds on the integral model while accounting for older adults’ perceptions and lived experiences of frailty. We conducted a traditional literature review to address frailty attributes, risk factors, consequences, perceptions, and lived experiences of older adults with frailty. Frailty attributes are vulnerability/susceptibility, aging, dynamic, complex, physical, psychological, and social. Frailty perceptions and lived experience themes/subthemes are refusing frailty labeling, being labeled “by others” as compared to “self-labeling”, from the perception of being frail towards acting as being frail, positive self-image, skepticism about frailty screening, communicating the term “frail”, and negative and positive impacts and experiences of frailty. Frailty risk factors are classified into socio-demographic, biological, physical, psychological/cognitive, behavioral, and situational/environmental factors. The consequences of frailty affect the individual, the caregiver/family, the healthcare sector, and society. The mixed conceptual model of frailty consists of interacting risk factors, interacting attributes surrounded by the older adult’s perception and lived experience, and interacting consequences at multiple levels. The mixed conceptual model provides a lens to qualify frailty in addition to quantifying it. Full article
(This article belongs to the Special Issue Frailty in Community-Dwelling Older People: Second Edition)
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22 pages, 2234 KiB  
Article
Predicting Nurse Turnover for Highly Imbalanced Data Using the Synthetic Minority Over-Sampling Technique and Machine Learning Algorithms
Healthcare 2023, 11(24), 3173; https://doi.org/10.3390/healthcare11243173 - 15 Dec 2023
Viewed by 640
Abstract
Predicting nurse turnover is a growing challenge within the healthcare sector, profoundly impacting healthcare quality and the nursing profession. This study employs the Synthetic Minority Over-sampling Technique (SMOTE) to address class imbalance issues in the 2018 National Sample Survey of Registered Nurses dataset [...] Read more.
Predicting nurse turnover is a growing challenge within the healthcare sector, profoundly impacting healthcare quality and the nursing profession. This study employs the Synthetic Minority Over-sampling Technique (SMOTE) to address class imbalance issues in the 2018 National Sample Survey of Registered Nurses dataset and predict nurse turnover using machine learning algorithms. Four machine learning algorithms, namely logistic regression, random forests, decision tree, and extreme gradient boosting, were applied to the SMOTE-enhanced dataset. The data were split into 80% training and 20% validation sets. Eighteen carefully selected variables from the database served as predictive features, and the machine learning model identified age, working hours, electric health record/electronic medical record, individual income, and job type as important features concerning nurse turnover. The study includes a performance comparison based on accuracy, precision, recall (sensitivity), F1-score, and AUC. In summary, the results demonstrate that SMOTE-enhanced random forests exhibit the most robust predictive power in the classical approach (with all 18 predictive variables) and an optimized approach (utilizing eight key predictive variables). Extreme gradient boosting, decision tree, and logistic regression follow in performance. Notably, age emerges as the most influential factor in nurse turnover, with working hours, electric health record/electronic medical record usability, individual income, and region also playing significant roles. This research offers valuable insights for healthcare researchers and stakeholders, aiding in selecting suitable machine learning algorithms for nurse turnover prediction. Full article
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18 pages, 361 KiB  
Article
Dating Violence and Mental Health in Emerging Adulthood
Healthcare 2023, 11(24), 3172; https://doi.org/10.3390/healthcare11243172 - 15 Dec 2023
Viewed by 616
Abstract
Dating violence constitutes a serious social and health problem. This study aims to increase knowledge on dating violence in emerging adulthood by analysing the relevance of gender and of having or not having a current partner in the victimization and perpetration of such [...] Read more.
Dating violence constitutes a serious social and health problem. This study aims to increase knowledge on dating violence in emerging adulthood by analysing the relevance of gender and of having or not having a current partner in the victimization and perpetration of such violence. It also analyses the association between dating violence and mental health, as well as the relevance of traditional gender role attitudes and the internalization of feminine/expressive and masculine/instrumental traits in the victimization and perpetration of such types of violence. The participants were 930 Spanish emerging adults who were assessed by six self-report questionnaires and scales. Men reported more psychological and physical violence victimization and physical violence perpetration than women, and women and men without a current partner reported more psychological and sexual violence than women and men with a current partner. Dating violence victimization was associated with more mental symptomatology, less life satisfaction, and lower self-esteem in men with a current partner and in women without a current partner. The main predictor of dating violence victimization was dating violence perpetration, and the main predictor of dating violence perpetration was victimization by such violence. More traditional gender role attitudes also predicted greater victimization and perpetration of dating violence, except among women without a current partner. Full article
9 pages, 625 KiB  
Article
The Impact of Neighborhood Deprivation on the Survival Rates of Patients with Cancer in Korea
Healthcare 2023, 11(24), 3171; https://doi.org/10.3390/healthcare11243171 - 15 Dec 2023
Viewed by 666
Abstract
The objective of this study is to investigate the correlation between the neighborhood deprivation index and survival rates of cancer patients in Korea. In this study, 5-year age-standardized survival rates of patients with cancer were determined using the National Cancer Cohort from 2014 [...] Read more.
The objective of this study is to investigate the correlation between the neighborhood deprivation index and survival rates of cancer patients in Korea. In this study, 5-year age-standardized survival rates of patients with cancer were determined using the National Cancer Cohort from 2014 to 2018 in Korea. The primary cancer sites were the stomach, colorectum, liver, lung, breast, cervix, prostate, and thyroid. Disparities were measured, and their impact on the overall survival rates was assessed using the Korean version of the Neighborhood Deprivation Index. Pearson’s correlation coefficient was calculated to determine the strength of the correlation. The study cohort comprised 726,665 patients with cancer, of whom 50.7% were male. The predominant primary cancer sites were the stomach (n = 138,462), colorectum (n = 125,156), and thyroid gland (n = 120,886). Urban residents showed better survival outcomes than those situated in rural areas. The most deprived quartile had the lowest survival rate, while the least deprived quartile had the highest (p < 0.001). Most cancer types revealed significant correlations between neighborhood deprivation and 5-year age-standardized overall survival, with lung cancer showing the most substantial negative correlation (r = −0.510), followed by prostate cancer (r = −0.438). However, thyroid cancer showed only a marginal correlation (p = 0.069). The results of this study suggested that neighborhood deprivation is closely linked to disparities in overall survival across various types of cancer. A substantial negative correlation between the neighborhood deprivation index and all-cause mortality for lung and prostate cancer, as compared to breast and cervical cancers covered by the National Cancer Screening Program, may reinforce the need to address healthcare access and improve the early detection of cancer in socioeconomically deprived neighborhoods. Full article
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16 pages, 776 KiB  
Systematic Review
Experience in Accessing Healthcare in Ethnic Minority Patients with Chronic Respiratory Diseases: A Qualitative Meta-Synthesis
Healthcare 2023, 11(24), 3170; https://doi.org/10.3390/healthcare11243170 - 15 Dec 2023
Viewed by 720
Abstract
Background: Access to healthcare is part of every individual’s human rights; however, many studies have illustrated that ethnic minority patients seem to be confronted with barriers when using healthcare services. Understanding how healthcare utilities are accessed from the perspective of patients and why [...] Read more.
Background: Access to healthcare is part of every individual’s human rights; however, many studies have illustrated that ethnic minority patients seem to be confronted with barriers when using healthcare services. Understanding how healthcare utilities are accessed from the perspective of patients and why healthcare disparities occur with patients from a minority background has the potential to improve health equality and care quality. This qualitative systematic review aims to gain insights into the experiences of people with chronic respiratory diseases (CRDs) from a minority background and explore factors contributing to their experiences in accessing healthcare to inform related health policy makers and healthcare providers. Methods: This systematic review complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, where the Joanna Briggs Institute meta-aggregative instrument facilitated the qualitative synthesis. The study protocol was registered with PROSPERO (CRD42022346055). PubMed, Scopus, Web of Science, and CINAHL were the databases explored. Results: From the papers selected, 47 findings were derived from 10 included studies, and four synthesised findings were generated: (1) the relationship between patients and healthcare professionals affects the usage of healthcare services; (2) patients’ perceptions and cultural beliefs affect their compliance with disease management; (3) personal behaviours affect the usage of healthcare services; and (4) health resource inequalities have an impact on accessing healthcare services. Conclusions: This systematic review demonstrates that ethnic minorities with CRDs face inequalities when engaging in healthcare. The relationship between patients and clinicians impacting the use of healthcare is the most pivotal discovery, where not speaking the same language and being of a different race alongside the accompanying criticism and faith in facilities are key contributors to this effect. In addition, the thinking patterns of these marginalised groups may reflect their cultural upbringing and diminish their engagement with therapies. This paper has uncovered ways to attenuate inequalities amongst ethnic minorities in engaging with healthcare providers and provides insight into building effective equity-promoting interventions in healthcare systems. To overcome these disparities, coaching doctors to communicate better with minority cohorts could help such patients to be more comfortable in connecting with medical facilities. Full article
(This article belongs to the Section Healthcare Quality and Patient Safety)
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15 pages, 279 KiB  
Article
Community Health Nursing Education in Austria—The Need for Competences in Planning, Management and Collaboration: A Problem-Centered Qualitative Study
Healthcare 2023, 11(24), 3169; https://doi.org/10.3390/healthcare11243169 - 14 Dec 2023
Viewed by 666
Abstract
(1) Background: The Austrian health care system is extremely fragmented. Primary care is mainly provided by self-employed GPs. Other health professionals are rarely integrated into primary care. But, according to the political plans of the Austrian government, a system of community nurses and [...] Read more.
(1) Background: The Austrian health care system is extremely fragmented. Primary care is mainly provided by self-employed GPs. Other health professionals are rarely integrated into primary care. But, according to the political plans of the Austrian government, a system of community nurses and community health nurses should be implemented and several pilot projects have already been started. (2) Objective: The present study explores the skills and competences needed in the planning, management and collaboration for the change in the system and gives recommendations for community health nurse education in Austria. (3) Methodology: Fifteen qualitative, problem-centered interviews were conducted with experts in the field of community health nursing and analyzed using qualitative content analysis. (4) Results: The skills and competences often and widely mentioned are interprofessional collaboration, cooperation with other actors, systems thinking, project and change management, and basic management skills, including strategic planning, communication, accounting and finance. Areas such as health planning and lobbying are also highlighted. The main competences are broken down into subcompetences, making it possible to create a detailed competence grid. Competences in planning, management and collaboration are particularly important in the initial stages of the first implementation of a community health nursing system. (5) Conclusions: Skills and competences in these areas occupy a central position. A multilayered breakdown of these competences is required in order to create a targeted requirements profile. Due to the small-scale fragmentation of the Austrian health care system, collaboration and coordination are more difficult and costly, but all the more important. The aforementioned skills and competences represent an essential expansion of nursing education in Austria. Full article
(This article belongs to the Special Issue Health Professional Education and Primary Health Care)
15 pages, 1829 KiB  
Article
Evidence for a Negative Loss Spiral between Co-Worker Social Support and Burnout: Can Psychosocial Safety Climate Break the Cycle?
Healthcare 2023, 11(24), 3168; https://doi.org/10.3390/healthcare11243168 - 14 Dec 2023
Viewed by 694
Abstract
Previous research suggests that co-worker social support predicts burnout, but this relationship may be far more complex, with the potential for a reciprocal cycle of loss. Leading research on loss spirals has explicitly called for more research on interindividual factors such as social [...] Read more.
Previous research suggests that co-worker social support predicts burnout, but this relationship may be far more complex, with the potential for a reciprocal cycle of loss. Leading research on loss spirals has explicitly called for more research on interindividual factors such as social support and, by extension, how interventions that operate on these interpersonal resources could play a role in primary and secondary prevention (i.e., intervening in cycles of loss). In this study, we explore the reciprocal relationship between burnout and co-worker social support, with psychosocial safety climate (PSC) as an upstream predictor and moderator of this relationship. Using hierarchical linear modelling (N = 380 frontline healthcare workers, nested within N = 63 teams) on longitudinal data, we found a reciprocal relationship between burnout and co-worker support, which was both triggered and moderated by PSC. These findings provide initial evidence for a social support–burnout loss spiral, wherein individuals with poor co-worker support are more likely to become burnt-out, and in this depleted state they are subsequently less likely to reach out for those social supports when available, which would, in turn, lead to further burnout. This social support–burnout loss spiral is exacerbated when working in a low-PSC context, as the environment does not send positive safety signals about resource scarcity and replenishment. Therefore, PSC may be a potential target for intervention both in primary prevention (i.e., stopping the loss spiral in the first instance) and in secondary intervention, as high PSC signals to workers already in the burnout–support loss cycle when it is safe to reinvest resources or engage in recovery behavior. Full article
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16 pages, 334 KiB  
Article
Boss, Can’t You Hear Me? The Impact Mechanism of Supervisor Phone Snubbing (Phubbing) on Employee Psychological Withdrawal Behavior
Healthcare 2023, 11(24), 3167; https://doi.org/10.3390/healthcare11243167 - 14 Dec 2023
Viewed by 550
Abstract
With the excessive smartphone use in the workplace, supervisor phubbing has drawn broad concerns in managerial and academic fields. Though the neglect is unintentional, this behavior can generate counterproductive working behaviors. The basic assumptions of this study are that supervisor phubbing can impact [...] Read more.
With the excessive smartphone use in the workplace, supervisor phubbing has drawn broad concerns in managerial and academic fields. Though the neglect is unintentional, this behavior can generate counterproductive working behaviors. The basic assumptions of this study are that supervisor phubbing can impact employee psychological withdrawal behavior directly and indirectly via work alienation. To provide empirical evidence for the assumptions, the two-wave online survey of 302 Chinese employees without any supervisory functions was conducted on the Questionnaire Star platform. Based on the stressor-emotion model, work alienation is proved to be the psychological path in the positive relationship between supervisor phubbing and employee psychological withdrawal behavior. Different from the current studies exploring the impact mechanism of phubbing behavior on psychological withdrawal behavior between parents and children, couples, or friends, we put this mechanism into the workplace and focus on subordinate–superior relationships. In addition, the positive indirect effects are enhanced when employees have higher interpersonal sensitivity. In practice, these findings suggest that organizations should normalize the smart devices use in the workplace, and supervisors should balance their working roles with other roles. In addition, organizations should strengthen training on adjusting to negative emotions and interpersonal sensitivity control at work. Although two rounds of the time-lagged data were collected in a one-month interval, the limitations of cross-section data still exist, so the conclusions cannot establish causality. Hence, future research may conduct experimental or longitudinal research designs to make the conclusion more rigorous. Full article
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