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Healthcare, Volume 2, Issue 4 (December 2014) – 7 articles , Pages 417-526

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703 KiB  
Article
A Modern Approach to Disinfection, as Old as the Evolution of Vertebrates
by Franco Migliarina and Sergio Ferro
Healthcare 2014, 2(4), 516-526; https://doi.org/10.3390/healthcare2040516 - 19 Dec 2014
Cited by 9 | Viewed by 5704
Abstract
The immune system of vertebrates “naturally” produces hypochlorous acid (HOCl) to fight against bacteria and pathogens. A patented electrochemical technology mirrors the above defense system, allowing the synthesis of HOCl solutions through the electrolysis of water enriched in salts, at the level of [...] Read more.
The immune system of vertebrates “naturally” produces hypochlorous acid (HOCl) to fight against bacteria and pathogens. A patented electrochemical technology mirrors the above defense system, allowing the synthesis of HOCl solutions through the electrolysis of water enriched in salts, at the level of a few grams per liter. The system allows for the careful control of the pH of produced solutions, with consequent optimization of their activity. Once the HOCl is introduced into the water system; it is able to remove the biofilm from pipe network; significantly decreasing the level of Legionella colonization; within 8–10 weeks from the beginning of the disinfection approach. The technology has been applied in a variety of healthcare facilities, both in Italy and in neighboring European countries. In the present paper, two successful case studies are briefly presented: Data were obtained from experiences in two different healthcare facilities, one in Italy and the other in Germany. Destruction of biofilm was indirectly testified by an increase of total organic carbon content of water; as a consequence, and because of the dosing of the disinfecting agent, some μg/L of total halomethanes were also formed. However, both compositional features were only observed during the initial stages of the disinfection treatment. Full article
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451 KiB  
Article
A Prospective Cluster-Randomized Trial of Telehealth Coaching to Promote Bone Health and Nutrition in Deployed Soldiers
by Mary S. McCarthy
Healthcare 2014, 2(4), 505-515; https://doi.org/10.3390/healthcare2040505 - 18 Dec 2014
Cited by 3 | Viewed by 5069
Abstract
Findings from previous studies suggest that inadequate consumption of calcium and vitamin D and a decrease in exercise while deployed can be detrimental to bone health. This study enrolled 234 soldiers randomized to receive one-time nutrition and exercise education pre-deployment (n = 149), [...] Read more.
Findings from previous studies suggest that inadequate consumption of calcium and vitamin D and a decrease in exercise while deployed can be detrimental to bone health. This study enrolled 234 soldiers randomized to receive one-time nutrition and exercise education pre-deployment (n = 149), or telehealth coaching (n = 85), throughout the deployment cycle. Results suggest that online educational efforts may enhance sports activity, bone turnover, and vitamin D status. Improving vitamin D status and remaining active while deployed appears to sustain healthy bone density in young soldiers. Early and aggressive educational outreach to young adults may prevent chronic musculoskeletal conditions and disabling osteoporosis later in life. Full article
(This article belongs to the Special Issue The Close Relationship: Health and Nutrition)
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Article
Managing Everyday Life: A Qualitative Study of Patients’ Experiences of a Web-Based Ulcer Record for Home-Based Treatment
by Marianne V. Trondsen
Healthcare 2014, 2(4), 492-504; https://doi.org/10.3390/healthcare2040492 - 15 Dec 2014
Cited by 5 | Viewed by 5736
Abstract
Chronic skin ulcers are a significant challenge for patients and health service resources, and ulcer treatment often requires the competence of a specialist. Although e-health interventions are increasingly valued for ulcer care by giving access to specialists at a distance, there is limited [...] Read more.
Chronic skin ulcers are a significant challenge for patients and health service resources, and ulcer treatment often requires the competence of a specialist. Although e-health interventions are increasingly valued for ulcer care by giving access to specialists at a distance, there is limited research on patients’ use of e-health services for home-based ulcer treatment. This article reports an exploratory qualitative study of the first Norwegian web-based counselling service for home-based ulcer treatment, established in 2011 by the University Hospital of North Norway (UNN). Community nurses, general practitioners (GPs) and patients are offered access to a web-based record system to optimize ulcer care. The web-based ulcer record enables the exchange and storage of digital photos and clinical information, by the use of which, an ulcer team at UNN, consisting of specialized nurses and dermatologists, is accessible within 24 h. This article explores patients’ experiences of using the web-based record for their home-based ulcer treatment without assistance from community nurses. Semi-structured interviews were conducted with a total of four patients who had used the record. The main outcomes identified were: autonomy and flexibility; safety and trust; involvement and control; and motivation and hope. These aspects improved the patients’ everyday life during long-term ulcer care and can be understood as stimulating patient empowerment. Full article
(This article belongs to the Special Issue Wound Care)
580 KiB  
Review
Prevention of Diabetes after Gestational Diabetes: Better Translation of Nutrition and Lifestyle Messages Needed
by Sharleen L. O'Reilly
Healthcare 2014, 2(4), 468-491; https://doi.org/10.3390/healthcare2040468 - 21 Nov 2014
Cited by 18 | Viewed by 11540
Abstract
Type 2 Diabetes Mellitus (T2DM) and Gestational Diabetes (GDM) are important and escalating problems worldwide. GDM increases the risk of complications in pregnancy and birth, as well as a 1 in 2 chance of developing T2DM later in life. The burden of GDM [...] Read more.
Type 2 Diabetes Mellitus (T2DM) and Gestational Diabetes (GDM) are important and escalating problems worldwide. GDM increases the risk of complications in pregnancy and birth, as well as a 1 in 2 chance of developing T2DM later in life. The burden of GDM extends to offspring, who have an increased risk of obesity and diabetes—further perpetuating the cycle of diabetes within families. Clinical trial evidence demonstrates T2DM incidence reduced by up to 50% for women with GDM with nutrition and physical activity changes and the economic modeling suggests cost effectiveness. The key diet-related changes to reduce T2DM risk are reviewed, in addition to breastfeeding. The difficulties associated with the delivery of dietary and lifestyle behaviour change to women after GDM are discussed and focus on: complex healthcare system interactions needed for care delivery; women finding postpartum self-care challenging; and low levels of awareness being present across the board. In addition, studies currently underway to improve care provision in this important area will be examined. Full article
(This article belongs to the Special Issue The Close Relationship: Health and Nutrition)
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Review
Electrical Stimulation and Cutaneous Wound Healing: A Review of Clinical Evidence
by Sara Ud-Din and Ardeshir Bayat
Healthcare 2014, 2(4), 445-467; https://doi.org/10.3390/healthcare2040445 - 27 Oct 2014
Cited by 79 | Viewed by 25673
Abstract
Electrical stimulation (ES) has been shown to have beneficial effects in wound healing. It is important to assess the effects of ES on cutaneous wound healing in order to ensure optimization for clinical practice. Several different applications as well as modalities of ES [...] Read more.
Electrical stimulation (ES) has been shown to have beneficial effects in wound healing. It is important to assess the effects of ES on cutaneous wound healing in order to ensure optimization for clinical practice. Several different applications as well as modalities of ES have been described, including direct current (DC), alternating current (AC), high-voltage pulsed current (HVPC), low-intensity direct current (LIDC) and electrobiofeedback ES. However, no one method has been advocated as the most optimal for the treatment of cutaneous wound healing. Therefore, this review aims to examine the level of evidence (LOE) for the application of different types of ES to enhance cutaneous wound healing in the skin. An extensive search was conducted to identify relevant clinical studies utilising ES for cutaneous wound healing since 1980 using PubMed, Medline and EMBASE. A total of 48 studies were evaluated and assigned LOE. All types of ES demonstrated positive effects on cutaneous wound healing in the majority of studies. However, the reported studies demonstrate contrasting differences in the parameters and types of ES application, leading to an inability to generate sufficient evidence to support any one standard therapeutic approach. Despite variations in the type of current, duration, and dosing of ES, the majority of studies showed a significant improvement in wound area reduction or accelerated wound healing compared to the standard of care or sham therapy as well as improved local perfusion. The limited number of LOE-1 trials for investigating the effects of ES in wound healing make critical evaluation and assessment somewhat difficult. Further, better-designed clinical trials are needed to improve our understanding of the optimal dosing, timing and type of ES to be used. Full article
(This article belongs to the Special Issue Wound Care)
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639 KiB  
Review
The Relationship between Folic Acid and Risk of Autism Spectrum Disorders
by Yasmin Neggers
Healthcare 2014, 2(4), 429-444; https://doi.org/10.3390/healthcare2040429 - 23 Oct 2014
Cited by 7 | Viewed by 10710
Abstract
There is considerable scientific evidence that many aspects of diet influence the occurrence of human disease. Many factors such as genetic, psychological, environmental and behavioral characteristics influence development of human disease, and there is a close relationship between nutrition and disease. Though typical [...] Read more.
There is considerable scientific evidence that many aspects of diet influence the occurrence of human disease. Many factors such as genetic, psychological, environmental and behavioral characteristics influence development of human disease, and there is a close relationship between nutrition and disease. Though typical Western diets are not overtly deficient in essential nutrients, nutriture of a few micro nutrients such as folic acid has been reported to be sub-optimal, particularly in women of childbearing age. The role of folic acid in the prevention of macrocytic anemia and neural tube defects is well established. However, the relationship between folic acid and risk of autism is still evolving. Furthermore, environmental as well as nutritional factors such as folic acid are now well acknowledged as interacting with the individual genetic background in development of several diseases. In this article, recent research regarding the relationship between folic acid and risk of autism is evaluated. Full article
(This article belongs to the Special Issue The Close Relationship: Health and Nutrition)
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Article
Negative Pressure Wound Therapy on Surgical Site Infections in Women Undergoing Elective Caesarean Sections: A Pilot RCT
by Wendy Chaboyer, Vinah Anderson, Joan Webster, Anne Sneddon, Lukman Thalib and Brigid M. Gillespie
Healthcare 2014, 2(4), 417-428; https://doi.org/10.3390/healthcare2040417 - 30 Sep 2014
Cited by 41 | Viewed by 11165
Abstract
Obese women undergoing caesarean section (CS) are at increased risk of surgical site infection (SSI). Negative Pressure Wound Therapy (NPWT) is growing in use as a prophylactic approach to prevent wound complications such as SSI, yet there is little evidence of its benefits. [...] Read more.
Obese women undergoing caesarean section (CS) are at increased risk of surgical site infection (SSI). Negative Pressure Wound Therapy (NPWT) is growing in use as a prophylactic approach to prevent wound complications such as SSI, yet there is little evidence of its benefits. This pilot randomized controlled trial (RCT) assessed the effect of NPWT on SSI and other wound complications in obese women undergoing elective caesarean sections (CS) and also the feasibility of conducting a definitive trial. Ninety-two obese women undergoing elective CS were randomized in theatre via a central web based system using a parallel 1:1 process to two groups i.e., 46 women received the intervention (NPWT PICO™ dressing) and 46 women received standard care (Comfeel Plus® dressing). All women received the intended dressing following wound closure. The relative risk of SSI in the intervention group was 0.81 (95% CI 0.38–1.68); for the number of complications excluding SSI it was 0.98 (95% CI 0.34–2.79). A sample size of 784 (392 per group) would be required to find a statistically significant difference in SSI between the two groups with 90% power. These results demonstrate that a larger definitive trial is feasible and that careful planning and site selection is critical to the success of the overall study. Full article
(This article belongs to the Special Issue Wound Care)
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