Healthcare

35 pages, 827 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 11 | Viewed by 3868

Abstract

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

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

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

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8 pages, 807 KiB

Open AccessEditor’s ChoiceArticle

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

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

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

Cited by 15 | Viewed by 3370

Abstract

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

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

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

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11 pages, 1816 KiB

Open AccessEditor’s ChoiceArticle

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

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

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

Cited by 7 | Viewed by 4667

Abstract

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

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

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

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12 pages, 281 KiB

Open AccessEditor’s ChoiceArticle

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

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

Healthcare 2021, 9(12), 1673; https://doi.org/10.3390/healthcare9121673 - 03 Dec 2021

Cited by 11 | Viewed by 2128

Abstract

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

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

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

33 pages, 3277 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 10 | Viewed by 5518

Abstract

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

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

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

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10 pages, 1542 KiB

Open AccessEditor’s ChoiceArticle

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

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

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

Cited by 1 | Viewed by 4497

Abstract

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

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

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

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8 pages, 369 KiB

Open AccessEditor’s ChoiceArticle

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

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

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

Cited by 8 | Viewed by 1892

Abstract

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

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

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

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10 pages, 907 KiB

Open AccessEditor’s ChoiceArticle

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

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

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

Cited by 32 | Viewed by 3045

Abstract

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

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

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

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10 pages, 525 KiB

Open AccessEditor’s ChoiceArticle

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

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

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

Cited by 27 | Viewed by 3829

Abstract

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

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

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

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17 pages, 1698 KiB

Open AccessEditor’s ChoiceReview

The First Thousand Days: Kidney Health and Beyond

by Chien-Ning Hsu and You-Lin Tain

Healthcare 2021, 9(10), 1332; https://doi.org/10.3390/healthcare9101332 - 06 Oct 2021

Cited by 9 | Viewed by 4951

Abstract

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

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

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

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10 pages, 483 KiB

Open AccessEditor’s ChoiceArticle

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

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

Healthcare 2021, 9(10), 1313; https://doi.org/10.3390/healthcare9101313 - 01 Oct 2021

Cited by 6 | Viewed by 1979

Abstract

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

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

(This article belongs to the Section Medication Management)

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15 pages, 520 KiB

Open AccessEditor’s ChoiceArticle

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

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

Healthcare 2021, 9(10), 1312; https://doi.org/10.3390/healthcare9101312 - 01 Oct 2021

Cited by 5 | Viewed by 3843

Abstract

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

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

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

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14 pages, 499 KiB

Open AccessEditor’s ChoiceArticle

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

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

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

Cited by 18 | Viewed by 2953

Abstract

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

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

(This article belongs to the Section Nursing)

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19 pages, 1999 KiB

Open AccessEditor’s ChoiceArticle

A Comprehensive Examination of Severely Ill ME/CFS Patients

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

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

Cited by 13 | Viewed by 18221

Abstract

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

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

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

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25 pages, 2736 KiB

Open AccessEditor’s ChoiceReview

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

by Zoe Bond, Tanya Scanlon and Gaby Judah

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

Cited by 15 | Viewed by 2939

Abstract

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

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

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

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13 pages, 295 KiB

Open AccessEditor’s ChoiceArticle

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

by Amy Buchanan and Anthony Villani

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

Cited by 13 | Viewed by 2518

Abstract

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

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

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

11 pages, 1143 KiB

Open AccessEditor’s ChoiceArticle

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

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

Healthcare 2021, 9(9), 1190; https://doi.org/10.3390/healthcare9091190 - 09 Sep 2021

Cited by 1 | Viewed by 1709

Abstract

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

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

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

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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 - 02 Sep 2021

Cited by 8 | Viewed by 18446

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 13 | Viewed by 8565

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 5 | Viewed by 1928

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 5 | Viewed by 1774

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 9 | Viewed by 23569

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 36 | Viewed by 7326

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 - 08 Jul 2021

Cited by 3 | Viewed by 2012

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 - 08 Jul 2021

Cited by 37 | Viewed by 5195

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 - 05 Jul 2021

Cited by 4 | Viewed by 2081

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 7 | Viewed by 2022

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 4 | Viewed by 1968

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 27 | Viewed by 5463

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 4 | Viewed by 2901

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 5 | Viewed by 3461

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 - 04 Jun 2021

Cited by 14 | Viewed by 4609

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 3 | Viewed by 3459

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 9 | Viewed by 12960

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 30 | Viewed by 3474

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 6 | Viewed by 6528

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 - 09 May 2021

Cited by 12 | Viewed by 14266

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 7 | Viewed by 4678

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 7 | Viewed by 2631

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 7 | Viewed by 2017

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 - 07 Apr 2021

Cited by 4 | Viewed by 1787

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 10 | Viewed by 2368

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 8 | Viewed by 2251

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 - 03 Feb 2021

Cited by 7 | Viewed by 2114

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 10 | Viewed by 5575

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 6 | Viewed by 2160

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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