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HEALTH AND SAFETY (544 journals)                  1 2 3 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access  
A Life in the Day     Hybrid Journal   (Followers: 12)
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Scientiarum. Health Sciences     Open Access   (Followers: 1)
Adultspan Journal     Hybrid Journal   (Followers: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10)
Advances in Public Health     Open Access   (Followers: 23)
African Health Sciences     Open Access   (Followers: 2)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 6)
African Journal of Health Professions Education     Open Access   (Followers: 6)
Afrimedic Journal     Open Access   (Followers: 2)
Ageing & Society     Hybrid Journal   (Followers: 38)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 4)
AJOB Primary Research     Partially Free   (Followers: 3)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Health Economics     Full-text available via subscription   (Followers: 13)
American Journal of Health Education     Hybrid Journal   (Followers: 30)
American Journal of Health Promotion     Hybrid Journal   (Followers: 26)
American Journal of Health Sciences     Open Access   (Followers: 7)
American Journal of Health Studies     Full-text available via subscription   (Followers: 11)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 27)
American Journal of Public Health     Full-text available via subscription   (Followers: 207)
American Journal of Public Health Research     Open Access   (Followers: 27)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 4)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4)
Annals of Health Law     Open Access   (Followers: 3)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 12)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences : Interface And Interaction     Open Access   (Followers: 3)
Archive of Community Health     Open Access  
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Arquivos de Ciências da Saúde     Open Access  
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 9)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 3)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 8)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 3)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 3)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 7)
Behavioral Healthcare     Full-text available via subscription   (Followers: 6)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 8)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 6)
BMC Pregnancy and Childbirth     Open Access   (Followers: 21)
BMJ Simulation & Technology Enhanced Learning     Full-text available via subscription   (Followers: 10)
Brazilian Journal of Medicine and Human Health     Open Access  
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 16)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Cambridge Quarterly of Healthcare Ethics     Hybrid Journal   (Followers: 11)
Canadian Family Physician     Partially Free   (Followers: 11)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 9)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 2)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 19)
Case Reports in Women's Health     Open Access   (Followers: 3)
Case Studies in Fire Safety     Open Access   (Followers: 15)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
CES Medicina     Open Access  
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 10)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access  
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia e Innovación en Salud     Open Access  
Ciencia y Cuidado     Open Access   (Followers: 1)
Ciencia, Tecnología y Salud     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 2)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 3)
Conflict and Health     Open Access   (Followers: 7)
Contraception and Reproductive Medicine     Open Access  
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 4)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access   (Followers: 3)
Disaster Medicine and Public Health Preparedness     Hybrid Journal   (Followers: 11)
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Full-text available via subscription  
Duazary     Open Access   (Followers: 1)
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 17)
East African Journal of Public Health     Full-text available via subscription   (Followers: 3)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 19)
EcoHealth     Hybrid Journal   (Followers: 4)
Education for Health     Open Access   (Followers: 6)
electronic Journal of Health Informatics     Open Access   (Followers: 6)
ElectronicHealthcare     Full-text available via subscription   (Followers: 3)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 4)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access   (Followers: 2)
Environmental Sciences Europe     Open Access   (Followers: 1)
Epidemics     Open Access   (Followers: 4)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 5)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 18)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 4)
Ethiopian Journal of Health Development     Open Access   (Followers: 8)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 7)
Ethnicity & Health     Hybrid Journal   (Followers: 13)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 2)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 10)
Evidence-based Medicine & Public Health     Open Access   (Followers: 6)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Expressa Extensão     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 8)
Family & Community Health     Partially Free   (Followers: 12)
Family Medicine and Community Health     Open Access   (Followers: 6)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 2)
Food and Public Health     Open Access   (Followers: 12)
Food Quality and Safety     Open Access  
Frontiers in Public Health     Open Access   (Followers: 6)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 9)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 6)
Global Health Promotion     Hybrid Journal   (Followers: 15)
Global Journal of Health Science     Open Access   (Followers: 10)
Global Journal of Public Health     Open Access   (Followers: 13)
Global Medical & Health Communication     Open Access   (Followers: 2)
Global Mental Health     Open Access   (Followers: 6)
Global Security : Health, Science and Policy     Open Access   (Followers: 1)
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 3)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 15)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 7)
Health and Human Rights     Free   (Followers: 9)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 7)
Health and Social Work     Hybrid Journal   (Followers: 55)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 3)
Health Care Analysis     Hybrid Journal   (Followers: 15)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 17)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Notions     Open Access  
Health Policy     Hybrid Journal   (Followers: 42)
Health Policy and Technology     Hybrid Journal   (Followers: 4)
Health Professional Student Journal     Open Access   (Followers: 2)
Health Promotion International     Hybrid Journal   (Followers: 21)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 8)
Health Promotion Practice     Hybrid Journal   (Followers: 16)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 50)
Health Psychology Research     Open Access   (Followers: 19)
Health Psychology Review     Hybrid Journal   (Followers: 40)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 13)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Science Reports     Open Access  
Health Sciences and Disease     Open Access   (Followers: 2)
Health Services Insights     Open Access   (Followers: 1)
Health Systems     Hybrid Journal   (Followers: 4)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 12)
Health, Risk & Society     Hybrid Journal   (Followers: 12)
Healthcare     Open Access   (Followers: 3)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
Healthcare Technology Letters     Open Access  
HERD : Health Environments Research & Design Journal     Full-text available via subscription  
Highland Medical Research Journal     Full-text available via subscription  
Hispanic Health Care International     Full-text available via subscription  
HIV & AIDS Review     Full-text available via subscription   (Followers: 12)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 6)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 4)
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 3)
IMTU Medical Journal     Full-text available via subscription  
Indian Journal of Health Sciences     Open Access   (Followers: 3)
Indonesian Journal for Health Sciences     Open Access   (Followers: 1)
Indonesian Journal of Public Health     Open Access  
Inmanencia. Revista del Hospital Interzonal General de Agudos (HIGA) Eva Perón     Open Access  
Innovative Journal of Medical and Health Sciences     Open Access  
Institute for Security Studies Papers     Full-text available via subscription   (Followers: 2)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 5)
International Journal for Equity in Health     Open Access   (Followers: 6)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 34)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 2)
International Journal of Behavioural and Healthcare Research     Hybrid Journal   (Followers: 8)
International Journal of Circumpolar Health     Open Access   (Followers: 1)
International Journal of Community Medicine and Public Health     Open Access   (Followers: 5)
International Journal of E-Health and Medical Communications     Full-text available via subscription   (Followers: 2)
International Journal of Environmental Research and Public Health     Open Access   (Followers: 19)

        1 2 3 | Last

Journal Cover Healthcare
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  This is an Open Access Journal Open Access journal
   ISSN (Online) 2227-9032
   Published by MDPI Homepage  [198 journals]
  • Healthcare, Vol. 6, Pages 2: The Benefits of Higher Income in Protecting
           against Chronic Medical Conditions Are Smaller for African Americans than

    • Authors: Shervin Assari
      First page: 2
      Abstract: Background: Blacks’ diminished return is defined as smaller protective effects of socioeconomic status (SES) on health of African Americans compared to Whites. Aim: Using a nationally representative sample, the current study aimed to examine if the protective effect of income on chronic medical conditions (CMC) differs for African Americans compared to Whites. Methods: With a cross-sectional design, the National Survey of American Life (NSAL), 2003, included 3570 non-Hispanic African Americans and 891 non-Hispanic Whites. The dependent variable was CMC, treated as a continuous measure. The independent variable was income. Race was the focal moderator. Age, education, and marital status were covariates. Linear regressions were used to test if the protective effect of income against CMC varies by race. Results: High income was associated with a lower number of CMC in the pooled sample. We found a significant interaction between race and income, suggesting that income has a smaller protective effect against CMC for African Americans than it does for Whites. Conclusion: Blacks’ diminished return also holds for the effects of income on CMC. Blacks’ diminished return is a contributing mechanism to the racial disparities in health in the United States that is often overlooked. More research is needed on the role of diminished health return of SES resources among other minority groups.
      Citation: Healthcare
      PubDate: 2018-01-09
      DOI: 10.3390/healthcare6010002
      Issue No: Vol. 6, No. 1 (2018)
  • Healthcare, Vol. 6, Pages 1: Measuring Outcomes of Psychological
           Well-Being within Paediatric Health Settings

    • Authors: Halina Flannery, Sarah Glew, Aylana Brewster, Deborah Christie
      First page: 1
      Abstract: There are many widely used, validated patient reported outcome measures for physical and mental health. However, capturing outcomes from young people living with chronic health conditions presents a challenge, needing to take the complex interplay of physical and mental health into consideration. The authors found that regularly used outcome measures for child and adolescent emotional well-being in paediatric settings largely fall into two groups: paediatric quality of life and child and adolescent mental health measures. The applicability and potential for use of these measures within this context is discussed. Whilst offering some utility, neither approach leaves sufficient space for young people’s individual experiences of illness and treatment. The scope of using alternative qualitative approaches that capture the rich stories and experiences of young people living with chronic illnesses is considered.
      Citation: Healthcare
      PubDate: 2017-12-29
      DOI: 10.3390/healthcare6010001
      Issue No: Vol. 6, No. 1 (2017)
  • Healthcare, Vol. 5, Pages 60: Associations between Dietary Intake and
           Academic Achievement in College Students: A Systematic Review

    • Authors: Tracy Burrows, Megan Whatnall, Amanda Patterson, Melinda Hutchesson
      First page: 60
      Abstract: The impact of diet on academic achievement is a growing area of research. The aim of this systematic review was to evaluate the current evidence examining dietary intake and academic achievement in college/university students. Eight electronic databases were searched for studies published in English to January 2016. To be included, studies must have been conducted in higher education (i.e., college, university) students, reported measures of dietary intake and academic achievement, and reported the association between these. Data were extracted using a standardised tool, and studies were assessed for methodological quality. Seven studies were included, with four rated as positive quality, and the remaining three rated as neutral. Most studies were cross-sectional (n = 4), and conducted in America (n = 5). The most common dietary outcomes were fruit and vegetable (n = 3), and breakfast consumption (n = 3). Standardised grade point average (GPA) was the most common measure of academic achievement (n = 4). Five studies reported small to moderate significant positive associations between diet and academic achievement, including for breakfast, regular meal consumption, and meeting national recommendations for fruit intake. This review examines the current evidence regarding diet and academic achievement in college/university students. The results demonstrate that few studies exist in this population group. Future studies should consider the use of validated dietary assessment methods, comprehensive measures of overall diet, and use standardised assessment and reporting of academic outcomes.
      Citation: Healthcare
      PubDate: 2017-09-25
      DOI: 10.3390/healthcare5040060
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 61: Satisfaction with Daily Occupations for
           Elderly People (SDO-E)—Adaptation and Psychometric Testing

    • Authors: Jenny Hultqvist, Birgitta Wästberg, Mona Eklund
      First page: 61
      Abstract: Satisfaction with everyday occupations has been shown to be important for health and well-being in various populations. Research into satisfaction with everyday occupations among elderly persons is, however, lacking. The aim was to investigate the psychometric properties of an adapted test version of the Satisfaction with Daily Occupations instrument (SDO) for elderly people, called SDO-E. Five hospital-based occupational therapists working with elderly people evaluated the content validity and usability of the SDO-E. The elderly participants consisted of 50 people from outside of the health services and 42 inpatients at an internal medicine clinic. They completed the SDO-E and rated their perceived health, activity level, and general satisfaction with daily occupations. The SDO-E showed fair content validity and utility, acceptable internal consistency, good preliminary construct validity and relevant known-groups validity. The SDO-E thus appears to be a useful screening tool for assessing activity level and satisfaction with daily occupations among elderly people, and a complement to other self-report instruments concerning factors connected with health and well-being. Future research should further explore the content validity of the SDO-E, particularly the views of the elderly themselves, and investigate the SDO-E in terms of sensitivity to change.
      Citation: Healthcare
      PubDate: 2017-09-25
      DOI: 10.3390/healthcare5040061
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 62: Adolescent Neurological Development and
           Implications for Health and Well-Being

    • Authors: Angela Griffin
      First page: 62
      Abstract: Adolescence is evolution’s solution to bringing the capacity of our large, complex brains to fruition. It is a critical period for brain development and the experiences of each adolescent during this time helps to shape their adult brain. Brain developments lead to both the hormonal changes and the emotional, cognitive, and behavioral characteristics of the teenage years. They drive a growth towards independence via more complex reasoning skills, increased importance of social affiliations outside the family, and an urge to experiment and explore boundaries. In the context of still incomplete inhibitory systems, a heightened sensitivity to rewards, including the need for social acceptance, can mean risk-taking or impulsive behaviour in some. The continued plasticity of the brain can also mean a creativity and openness to novel solutions. These normative steps of adolescence are especially relevant to young people with chronic health conditions. An understanding of brain development at this time can help us appreciate the perspective and priorities of adolescents with health conditions. It can also guide us towards better ways of collaborating with them.
      Citation: Healthcare
      PubDate: 2017-09-29
      DOI: 10.3390/healthcare5040062
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 63: Economic Activity and Health Conditions in
           Adults Aged 65 Years and Older: Findings of the Korean National
           Longitudinal Study on Aging

    • Authors: Chae-Bong Kim, Seok-Jun Yoon, Jesuk Ko
      First page: 63
      Abstract: The population is aging because lifespans have continued to increase due to developments in modern medical science. The economic activity and health of the elderly are very important factors with reference to the problems of the aged. This cross-sectional study examined the association between the economic activity and health of the elderly. Subjects included 4226 elderly aged over 65 years among the adults who participated in the Fifth Korean National Longitudinal Study on Aging (KLoSA). Basic analysis, cross-analysis, binary logistic regression analysis, and multiple regression analysis were performed to fulfill each research purpose. Male subjects were influenced more by the factors that affect the subjective health of the elderly than females were. Further, subjective health influenced economic activity more than socio-demographic characteristics and health behavior did. Specifically, among the male subjects, the health condition of salaried, self-employed, and unpaid family workers was better as compared to recipients of national health insurance and private health insurance, and unemployed subjects. Preparing for a super-aged society is a worldwide issue. The elderly represent a social participation class that should not be neglected. Therefore, it is necessary to support health promotion policies and increase institutional improvement by reflecting the level of economic activity of the elderly.
      Citation: Healthcare
      PubDate: 2017-09-26
      DOI: 10.3390/healthcare5040063
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 64: Effects of Prenatal Tobacco and Wood-Fuel
           Smoke Exposure on Birth Weight in Sri Lanka

    • Authors: Malshani Pathirathna, Hansani Abeywickrama, Kayoko Sekijima, Mieko Sadakata, Naoshi Fujiwara, Yoshiyuki Muramatsu, Kuruppu Wimalasiri, Upali Jayawardene, Darshana de Silva, Chandraratne Dematawewa
      First page: 64
      Abstract: Low birth weight is a key public health problem in many developing countries, including Sri Lanka. Indoor air pollution from tobacco smoke and kitchen-fuel smoke are among the major contributors to low birth weight, factors of which there are little awareness of in Sri Lanka. We evaluated the effect of passive smoking and kitchen-fuel smoke exposure on birth weight. Seventy-six pregnant women were included in the study. Data were collected by questionnaire, and exposure assessment was conducted using a breath carbon monoxide monitor. Women exposed to second-hand tobacco smoke daily had a significantly lower mean gestational age at delivery (mean ± standard error [SE]: 38.0 ± 0.5 weeks) than women who were exposed to second-hand tobacco smoke only once a week (mean ± SE: 39.3 ± 0.3 weeks) (p < 0.05). Women who were exposed to tobacco smoke every day delivered neonates with significantly lower mean birth weight (mean ± SE: 2703 ± 135 g) than women who were only exposed once a week (mean ± SE: 3125 ± 147 g) (p < 0.05). A one-minute increase in cooking time in a kitchen without a chimney increased women’s expired air carbon monoxide concentration by 0.038 ppm (p = 0.006). Long-term exposure to wood-fuel smoke in a kitchen without a chimney can increase the risk of inhaling high concentrations of carbon monoxide.
      Citation: Healthcare
      PubDate: 2017-09-26
      DOI: 10.3390/healthcare5040064
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 65: The Effect of Personal Characteristics,
           Perceived Threat, Efficacy and Breast Cancer Anxiety on Breast Cancer
           Screening Activation

    • Authors: Patrick De Pelsmacker, Martine Lewi, Veroline Cauberghe
      First page: 65
      Abstract: In order to activate women to participate in breast cancer screening programs, a good understanding is needed of the personal characteristics that influence how women can be activated to search for more information, consult friends and doctors, and participate in breast cancer screening programs. In the current study, we investigate the effect of six personal characteristics that have in previous research been identified as important triggers of health behavior on breast cancer screening activation: Health awareness, Need for Cognition, Affect Intensity, Breast cancer knowledge, Topic involvement, and the Perceived breast cancer risk. We test the effect of these factors on four activation variables: intention of future information seeking, forwarding the message to a friend, talking to a doctor, and actual breast cancer screening attendance. Additionally, we try to unravel the process by means of which the antecedents (the six personal characteristics) lead to activation. To that end, we test the mediating role of perceived breast cancer threat, perceived efficacy of screening, and the evoked breast cancer anxiety as mediators in this process. The data were collected by means of a cross-sectional survey in a sample of 700 Flemish (Belgium) women who were invited to the free-of-charge breast cancer population screening. Screening attendance of this sample was provided by the government agency in charge of the organisation of the screening. Health awareness, affects intensity, topic involvement, and perceived risk have the strongest influence on activation. Breast cancer anxiety and perceived breast cancer threat have a substantial mediation effect on these effects. Efficacy perceptions are less important in the activation process. Increased health awareness and a higher level of perceived risk lead to less participation in the free of charge population based breast screening program. Implications for theory and practice are offered. The limitation of the study is that only a standard invitation message was used. In future research, other types of awareness and activation messages should be tested. Additionally, the analysis could be refined by investigating the potentially different activation process in different subgroups of women.
      Citation: Healthcare
      PubDate: 2017-09-27
      DOI: 10.3390/healthcare5040065
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 66: Falls and Fear of Falling among Persons Who
           Receive Housing Adaptations—Results from a Quasi-Experimental Study in

    • Authors: Gunilla Carlsson, Maria Nilsson, Lisa Ekstam, Carlos Chiatti, Agneta Malmgren Fänge
      First page: 66
      Abstract: While health might deteriorate through the ageing and disablement process, the impacts of disability can be reduced by adapting the environment. This study aimed to investigate the effects of applying a standardized research-based strategy to housing adaptation as compared to ordinary practice with respect to falls and fear of falling. Another aim was to investigate the overall effects of housing adaptations on fall-related outcomes over time. In total, 196 clients were included at baseline, with follow-up at 3 and 6 months after the housing adaptation was implemented. The only significant difference between the two approaches was identified with respect to fear of falling at 3 months after the housing adaptation, but not after 6 months. The number of clients reporting actual falls increased over time in both sites, whereas the number of reported near-falls decreased most in the intervention site, but without significant differences. Thus, the patterns of differences between the sites are inconsistent, as are the patterns of change in fall-related outcomes. An overall conclusion is that if the goal is to improve fall-related outcomes, housing adaptation should be complemented with other interventions preventing falls and explicitly address the clients’ activity limitations. In addition, longer follow-up times are necessary.
      Citation: Healthcare
      PubDate: 2017-09-29
      DOI: 10.3390/healthcare5040066
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 67: Impact of Pre-Pregnancy Weight and
           Gestational Weight Gain on Birth Outcomes by Nativity in the United
           States: A Systematic Review

    • Authors: Karen Tabb, Tumani Malinga, Maria Pineros-Leano, Flavia Andrade
      First page: 67
      Abstract: Background: Disparities in birth outcomes remain a problem in the United States. This study examined whether pre-pregnancy weight and gestational weight gain moderate the association between nativity and birth outcomes in the United States. Methods: We conducted a systematic review using Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. We searched PubMED, CINAHL, PsychInfo, and Cochrane Database of Systematic Reviews for relevant articles published before May 27, 2016. Results: Four articles met the eligibility criteria by adjusting for pre-pregnancy or gestational weight gain when examining birth outcomes by nativity. Results: Results from these studies show statistically significant differences in the risk of delivering low birth weight babies between foreign-born and U.S.-born women. These differences remained after adjusting for pre-pregnancy weight or gestational weight gain. However, results stratified by nativity still vary significantly by race/ethnicity. Conclusion: Few investigations include pre-pregnancy weight and gestational weight gain when examining differences in birth outcomes by nativity. Additional studies are needed to examine possible effect modification of these weight variables on the association between nativity and birth outcomes.
      Citation: Healthcare
      PubDate: 2017-09-29
      DOI: 10.3390/healthcare5040067
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 68: Three Types of Intimate Relationships among
           Individuals with Chronic Pain and a History of Trauma Exposure

    • Authors: Carissa van den Berk-Clark, Terri Weaver, F. Schneider
      First page: 68
      Abstract: Individuals with chronic pain often have psychiatric disorders, such as depression and posttraumatic stress disorder (PTSD), which can affect their intimate relationship satisfaction and stability. Little is known about the nature of support stemming from chronic pain patients’ intimate relationships, and therefore, this study sought to: (1) use cluster modeling to construct specific intimate relationship groups based on types of support patients receive, and (2) determine if there is a relationship between support type and PTSD, chronic pain, anxiety, and depression. Ward’s method of cluster analysis in Stata was used to create groups based on the level of informational, affirmation, confident, emotional, and fun support received from chronic pain patients’ most intimate relationship. Three types of support were identified: high (type 1, n = 17), high emotional/low instrumental (type 2, n = 9), and unstable (type 3, n = 15). Types 1 and 3 included more family members (Type 1: 100%, Type 2: 93%), than type 2 (77%). Type 2 patients experienced more trauma (Mean = 9.4 ± 1.7 vs. 7.5 ± 0.88 for types 1 and 3) and were significantly more likely to have PTSD (X2 = 7.91, p < 0.05. Patients with low familial support may also benefit from PTSD screening and referral but further study is needed.
      Citation: Healthcare
      PubDate: 2017-09-29
      DOI: 10.3390/healthcare5040068
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 69: What Else' The Basics and Beyond for
           Effective Consultations with Youth with Special Healthcare Needs

    • Authors: April S. Elliott, Monique C. Jericho
      First page: 69
      Abstract: Youth with special healthcare needs (YSHCN) require medical support for disease management and equally require that providers be responsive to their ever-changing and sometimes unique psychosocial and developmental needs. This paper reviews the fundamentals of adolescent consultation reminding the reader that YSHCN are, after all, still youth with the same basic needs as their healthy peers. Beyond the basics, consultations with this population are characterized by complexities which are best managed by providers who can nimbly adjust their clinical stance. In non-urgent clinical scenarios, clinicians can adopt a coaching stance which we introduce and expand upon in this paper. Characterized by the five elements of non-judgment, curiosity, empathy, openness, and flexibility, the coaching stance can be adopted without specific training. We demonstrate its application using TGROW (Topic, Goal, Reality, Options and Wrap Up), a coaching framework that holds promise for use in clinical settings. Consultants may consider incorporating the coaching stance and TGROW into their practice repertoire, as both may be particularly helpful when consulting with adolescents with chronic illness.
      Citation: Healthcare
      PubDate: 2017-10-01
      DOI: 10.3390/healthcare5040069
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 70: Social Determinants and Poor Diet Quality of
           Energy-Dense Diets of Australian Young Adults

    • Authors: Amanda Grech, Anna Rangan, Margaret Allman-Farinelli
      First page: 70
      Abstract: This research aimed to determine the diet quality and socio-demographic determinants by level of energy-density of diets of Australian young adults. Secondary analysis of the Australian National Nutrition and Physical Activity Survey-2011/2012 for adults aged 18–34 years (n = 2397) was conducted. Diet was assessed by 24-h recalls. Dietary energy-density was calculated as dietary energy/grams of food (kJ/g) and the Healthy-Eating-Index-for-Australians (HEIFA-2013) was used to assess diet quality (highest score = 100). Dietary energy-density was examined with respect to diet quality and sociodemographic determinants including gender, highest tertiary-education attainment, country-of-birth, age, income, and socio-economic-index-for-area (SEIFA). Higher dietary energy-density was associated with lower diet quality scores (β = −3.71, t (2394) = −29.29, p < 0.0001) and included fewer fruits and vegetables, and more discretionary foods. The mean dietary energy-density was 7.7 kJ/g and 7.2 kJ/g for men and women, respectively. Subpopulations most at risk of consuming high energy-dense diets included those with lower education, Australian and English-speaking countries of birth, and men with low income and women from areas of lower socio-economic status. Young adults reporting low energy-dense diets had higher quality diets. Intensive efforts are needed to reduce the high energy-density of young adults’ diets, and should ensure they include populations of lower socio-economic status.
      Citation: Healthcare
      PubDate: 2017-10-01
      DOI: 10.3390/healthcare5040070
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 71: Near Retirement Age (≥55 Years)
           Self-Reported Physical Symptoms and Use of Computers/Mobile Phones at Work
           and at Leisure

    • Authors: Leena Korpinen, Rauno Pääkkönen, Fabriziomaria Gobba
      First page: 71
      Abstract: The aim of this research is to study the symptoms and use of computers/mobile phones of individuals nearing retirement age (≥55 years). A questionnaire was sent to 15,000 Finns (aged 18–65). People who were ≥55 years of age were compared to the rest of the population. Six thousand one hundred and twenty-one persons responded to the questionnaire; 1226 of them were ≥55 years of age. Twenty-four percent of the ≥55-year-old respondents used desktop computers daily for leisure; 47.8% of them frequently experienced symptoms in the neck, and 38.5% in the shoulders. Workers aged ≥55 years had many more physical symptoms than younger people, except with respect to symptoms of the neck. Female daily occupational users of desktop computers had more physical symptoms in the neck. It is essential to take into account that, for people aged ≥55 years, the use of technology can be a sign of wellness. However, physical symptoms in the neck can be associated with the use of computers.
      Citation: Healthcare
      PubDate: 2017-10-08
      DOI: 10.3390/healthcare5040071
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 72: Reference Intervals for Non-Fasting CVD
           Lipids and Inflammation Markers in Pregnant Indigenous Australian Women

    • Authors: Tracy Schumacher, Christopher Oldmeadow, Don Clausen, Loretta Weatherall, Lyniece Keogh, Kirsty Pringle, Kym Rae
      First page: 72
      Abstract: Indigenous Australians experience high rates of cardiovascular disease (CVD). The origins of CVD may commence during pregnancy, yet few serum reference values for CVD biomarkers exist specific to the pregnancy period. The Gomeroi gaaynggal research project is a program that undertakes research and provides some health services to pregnant Indigenous women. Three hundred and ninety-nine non-fasting samples provided by the study participants (206 pregnancies and 175 women) have been used to construct reference intervals for CVD biomarkers during this critical time. A pragmatic design was used, in that women were not excluded for the presence of chronic or acute health states. Percentile bands for non-linear relationships were constructed according to the methods of Wright and Royston (2008), using the xriml package in StataIC 13.1. Serum cholesterol, triglycerides, cystatin-C and alkaline phosphatase increased as gestational age progressed, with little change seen in high-sensitivity C-Reactive Protein and γ glutamyl transferase. Values provided in the reference intervals are consistent with findings from other research projects. These reference intervals will form a basis with which future CVD biomarkers for pregnant Indigenous Australian women can be compared.
      Citation: Healthcare
      PubDate: 2017-10-14
      DOI: 10.3390/healthcare5040072
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 73: Importance of Leadership Style towards
           Quality of Care Measures in Healthcare Settings: A Systematic Review

    • Authors: Danae Sfantou, Aggelos Laliotis, Athina Patelarou, Dimitra Sifaki- Pistolla, Michail Matalliotakis, Evridiki Patelarou
      First page: 73
      Abstract: Effective leadership of healthcare professionals is critical for strengthening quality and integration of care. This study aimed to assess whether there exist an association between different leadership styles and healthcare quality measures. The search was performed in the Medline (National Library of Medicine, PubMed interface) and EMBASE databases for the time period 2004–2015. The research question that guided this review was posed as: “Is there any relationship between leadership style in healthcare settings and quality of care'” Eighteen articles were found relevant to our research question. Leadership styles were found to be strongly correlated with quality care and associated measures. Leadership was considered a core element for a well-coordinated and integrated provision of care, both from the patients and healthcare professionals.
      Citation: Healthcare
      PubDate: 2017-10-14
      DOI: 10.3390/healthcare5040073
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 74: Biopsychosocial Measures Related to Chronic
           Low Back Pain Postural Control in Older Adults

    • Authors: Ryan Hulla, Robert Gatchel, Angela Liegey-Dougall
      First page: 74
      Abstract: This study examined the biopsychosocial measures related to postural control in the growing population of older adults (i.e., 60 years and older). The sample of the study consisted of 129 older adults (M = 74.45, SD = 6.95), with 34 males and 95 females; 36 were classified with chronic low-back pain (CLBP), and 93 without chronic low-back pain (NCLBP). Physical and psychosocial constructs were analyzed as predictors for postural control measures. Additionally, gender and classification of low-back pain were examined as moderators for all physical and psychosocial measures. Results demonstrated that physical and psychosocial measures were able to significantly predict composite, visual, and vestibular balance measures, but not somatosensory or preference balance measures. The chair-stand test, modified sit-and-reach test, sleep disturbance, and balance efficacy were all identified as individually significant predictors. Gender and CLBP did not moderate the utility of any predictor variables. Results of the current study re-confirm the importance of utilizing the biopsychosocial approach for future research examining postural control in older adults.
      Citation: Healthcare
      PubDate: 2017-10-14
      DOI: 10.3390/healthcare5040074
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 75: Variability in Strength, Pain, and
           Disability Changes in Response to an Isolated Lumbar Extension Resistance
           Training Intervention in Participants with Chronic Low Back Pain

    • Authors: James Steele, James Fisher, Stewart Bruce-Low, Dave Smith, Neil Osborne, Dave Newell
      First page: 75
      Abstract: Strengthening the lumbar extensor musculature is a common recommendation for chronic low back pain (CLBP). Although reported as effective, variability in response in CLBP populations is not well investigated. This study investigated variability in responsiveness to isolated lumbar extension (ILEX) resistance training in CLBP participants by retrospective analysis of three previous randomized controlled trials. Data from 77 participants were available for the intervention arms (males = 43, females = 34) 37 participants data (males = 20, females = 17) from the control arms. Intervention participants had all undergone 12 weeks of ILEX resistance training and changes in ILEX strength, pain (visual analogue scale; VAS), and disability (Oswestry disability index; ODI) measured. True inter-individual (i.e., between participants) variability in response was examined through calculation of difference in the standard deviation of change scores for both control and intervention arms. Intervention participants were classified into responder status using k-means cluster analysis for ILEX strength changes and using minimal clinically important change cut-offs for VAS and ODI. Change in average ILEX strength ranged 7.6 Nm (1.9%) to 192.1 Nm (335.7%). Change in peak ILEX strength ranged −12.2 Nm (−17.5%) to 276.6 Nm (169.6%). Participants were classified for strength changes as low (n = 31), medium (n = 36), and high responders (n = 10). Change in VAS ranged 12.0 mm to −84.0 mm. Participants were classified for VAS changes as negative (n = 3), non-responders (n = 34), responders (n = 15), and high responders (n = 19). Change in ODI ranged 18 pts to −45 pts. Participants were classified for ODI changes as negative (n = 2), non-responders (n = 21), responders (n = 29), and high responders (n = 25). Considerable variation exists in response to ILEX resistance training in CLBP. Clinicians should be aware of this and future work should identify factors prognostic of successful outcomes.
      Citation: Healthcare
      PubDate: 2017-10-16
      DOI: 10.3390/healthcare5040075
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 76: Exploring Knowledge and Attitudes about
           Vitamin D among Adults in Saudi Arabia: A Qualitative Study

    • Authors: Najlaa Aljefree, Patricia Lee, Faruk Ahmed
      First page: 76
      Abstract: : Vitamin D deficiency is widespread in Saudi Arabia. The aim of this study was to explore participants’ knowledge about vitamin D and attitudes toward sun exposure. The study also aimed to explore the social and cultural factors that might potentially contribute to vitamin D deficiency in Saudi Arabia. Face-to-face interviews were carried out in the cities of Jeddah and Makkah between May and October 2015. The interview questions were semi-structured, and the data was analyzed using thematic analysis. Study participants showed a reasonable level of knowledge in different areas about vitamin D, including the effect of vitamin D deficiency on bone health and exposure to sunlight as the main source of vitamin D. Participants were also knowledgeable about vitamin D supplements as another source of this vitamin. Nevertheless, there was a shortage of knowledge in relation to dietary sources of vitamin D. In respect to attitudes toward sun exposure, some participants had positive attitudes toward sunlight and were willing to expose themselves to sunlight, but it was restricted to the early morning or late afternoon to avoid the heat. These participants who liked exposure to sunlight were largely exposing only their faces and hands to sunlight. Other participants had negative attitudes toward sun exposure and were avoiding sunlight. Moreover, the study participants identified several barriers to sun exposure, including hot climate, living in high-rise buildings, limited public areas allowing outdoor activities, lifestyle issues such as physical inactivity, and some religious concerns such as wearing the hijab. The study results also demonstrate that females were more enthusiastic about taking actions to improve their vitamin D status in comparison with males. Recommendations for health education interventions that increase awareness about vitamin D sources, especially food sources, are made. Also, educational interventions should focus on increasing awareness about the sufficient time of the day and duration for sun exposure to improve vitamin D status and the importance of the intake of vitamin D supplements as an affordable source to improve vitamin D status. Increasing males’ awareness of the benefits of vitamin D is important to encourage them to adopt behaviors to improve vitamin D.
      Citation: Healthcare
      PubDate: 2017-10-16
      DOI: 10.3390/healthcare5040076
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 77: Helping Health Services to Meet the Needs of
           Young People with Chronic Conditions: Towards a Developmental Model for

    • Authors: Albert Farre, Janet McDonagh
      First page: 77
      Abstract: The transition to adult healthcare has been the subject of increased research and policy attention over many years. However, unmet needs of adolescent and young adults (AYAs) and their families continue to be documented, and universal implementation has yet to be realised. Therefore, it is pertinent to re-examine health transition in light of the principles of adolescent medicine from which it emerged, and consider this particular life transition in terms of a developmental milestone rather than a negotiation of structural boundaries between child and adult services. Health transitions are an integral part of AYA development and as such, occur alongside, and in connection with, a range of other important transitions that affect many other areas of life. In this paper, we discuss the interrelated nature of health transitions and AYA development; outline the underpinnings of a developmentally appropriate approach to transitional care; and consider the outcome measurement of such care based on existing evidence. A developmental approach has the potential to refocus transition on the fundamental principles of adolescent medicine, enabling health transition to be integrated along with other life transitions into routine AYA developmental assessments rather than being limited to the geographies of different healthcare settings and a potential health crisis.
      Citation: Healthcare
      PubDate: 2017-10-19
      DOI: 10.3390/healthcare5040077
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 78: Perceptions of Risk Stratification Workflows
           in Primary Care

    • Authors: Rachel Ross, Bhavaya Sachdeva, Jesse Wagner, Katrina Ramsey, David Dorr
      First page: 78
      Abstract: Risk stratification (RS) in primary care is frequently used by policy-makers, payers, and health systems; the process requires risk assessment for adverse health outcomes across a population to assign patients into risk tiers and allow care management (CM) resources to be targeted effectively. Our objective was to understand the approach to and perception of RS in primary care practices. An online survey was developed, tested, and administered to 148 representatives of 37 primary care practices engaged in RS varying in size, location and ownership. The survey assessed practices’ approach to, perception of, and confidence in RS, and its effect on subsequent CM activities. We examined psychometric properties of the survey to determine validity and conducted chi-square analyses to determine the association between practice characteristics and confidence and agreement with risk scores. The survey yielded a 68% response rate (100 respondents). Overall, participants felt moderately confident in their risk scores (range 41–53.8%), and moderately to highly confident in their subsequent CM workflows (range 46–68%). Respondents from small and independent practices were more likely to have higher confidence and agreement with their RS approaches and scores (p < 0.01). Confidence levels were highest, however, when practices incorporated human review into their RS processes (p < 0.05). This trend was not affected by respondents’ professional roles. Additional work from a broad mixed-methods effort will add to our understanding of RS implementation processes and outcomes.
      Citation: Healthcare
      PubDate: 2017-10-21
      DOI: 10.3390/healthcare5040078
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 79: Is Obesity More Than a Double Burden among
           People with Mobility Disability' The Effect of Obesity on HRQoL and
           Participation in Society

    • Authors: Marianne Holmgren, Jeroen de Munter, Finn Rasmussen, Magnus Sandberg, Gerd Ahlström
      First page: 79
      Abstract: Obesity is more common in individuals with mobility disability than in those without this condition. Individuals with mobility disability also have lower health-related quality of life (HRQoL) and are limited in their participation in society. Therefore, this study aimed to investigate the body mass index (BMI) status and the association of overweight or obesity on HRQoL and participation in society among those with mobility disability in comparison to those without mobility disability. This cross-sectional study was based on a health survey conducted in Sweden in 2012 (n = 18,322; age, 18–64 years). Logistic regression with and without interaction analysis was applied. Effect modification by overweight status was significant for, moderate pain. For obesity, effect modification was seen for low general health, pain (moderate and severe), and not participating in work. BMI was higher among those with mobility disability, but no associations between overweight or obesity and HRQoL or participation in society were observed for those with mobility disability. Overweight and obesity did not add an additional burden to mobility disability, probably because mobility disability is associated with low HRQoL and low participation in society. Despite these results, population obesity prevention strategies are still needed.
      Citation: Healthcare
      PubDate: 2017-10-24
      DOI: 10.3390/healthcare5040079
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 80: Strengthening the Referral System through
           Social Capital: A Qualitative Inquiry in Ghana

    • Authors: Padmore Adusei Amoah, David R. Phillips
      First page: 80
      Abstract: The referral system in health care has been noted as very influential in determining which services are accessed and when. Nonetheless, existing studies have relied on specific measurable factors relating to health personnel, transportation and communication infrastructure, and finance to explain the challenges facing the referral policy in developing countries. While this is understandable, the role of social capital remains mostly uncharted even though it is implicit in the well-known lay referral system. Using various facets of the social capital concept, this paper empirically examines how the resources embedded in both structural and cognitive aspects of social relationships influence knowledge of, and adherence to, referral policy. This study is based on semi-structured in-depth interviews conducted with 79 adults in the Ashanti Region of Ghana in 2015. Of the 79 participants, 28 lived in urban areas and 51 in rural localities. Eight health personnel and eight community leaders also contributed to the study. Additionally, six focus group discussions were held. The findings indicated that both cognitive and structural forms of social capital considerably underpinned the ability and willingness of people to adhere to the referral process. Moreover, the role of social capital was double-barrelled. It contributed in a significant way to encouraging or dissuading potential patients from rightly embracing the policy. In addition, precepts of social capital reinforced both positive and adverse effects of the other determinants of the policy such as finance and transportation. However, the magnitude of such impact was linked to how ‘resourceful’ and ‘trustworthy’ one’s available social acquaintances were. The paper suggests that a cautious engagement with social capital will make it a potentially powerful tool for understanding the gaps in and improving the effectiveness of referral policy.
      Citation: Healthcare
      PubDate: 2017-10-25
      DOI: 10.3390/healthcare5040080
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 81: Senescent Nephropathy: The New Renal

    • Authors: Florencia Aiello, Eliana Dueñas, Carlos Musso
      First page: 81
      Abstract: Chronic kidney disease (CKD) is a condition characterized by progressive and irreversible deterioration of renal function due to the reduction of nephron mass for a period of at least three months. The prevalence of CKD is roughly 10% in the general population but increases with age, affecting more than one-third of people older than 65. Frailty is a condition usually found in elderly people, characterized by weakness, motility, and balance issues, with a declined ability to resist stressors leading to increased risks of adverse health outcomes including falls, fracture, hospitalization, institutionalization, disability, dependence, dementia, poor quality of life, and death. There is interdependence between CKD and normal ageing whereby CKD makes ageing more accelerated and pronounced (senescence), whereas senescence accelerates chronic nephropathy’s progression. Frailty status catalyzes this spiral, with renal and systemic consequences, phenomenon which can be named senescent nephropathy. In conclusion, senescent nephropathy is a new renal syndrome that should be taken into account, and we must try to handle its appearance and progression not only by applying nephron prevention measurements but also by diagnosis and treating frailty in the CKD population.
      Citation: Healthcare
      PubDate: 2017-10-28
      DOI: 10.3390/healthcare5040081
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 82: Updates on the Management of Non-Melanoma
           Skin Cancer (NMSC)

    • Authors: Artur Fahradyan, Anna Howell, Erik Wolfswinkel, Michaela Tsuha, Parthiv Sheth, Alex Wong
      First page: 82
      Abstract: Non-melanoma skin cancers (NMSCs) are the most common malignancy worldwide, of which 99% are basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) of skin. NMSCs are generally considered a curable diseases, yet they currently pose an increasing global healthcare problem due to rising incidence. This has led to a shift in emphasis on prevention of NMSCs with development of various skin cancer prevention programs worldwide. This article aims to summarize the most recent changes and advances made in NMSC management with a focus on prevention, screening, diagnosis, and staging.
      Citation: Healthcare
      PubDate: 2017-11-01
      DOI: 10.3390/healthcare5040082
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 83: Socioeconomic Status and Glycemic Control in
           Type 2 Diabetes; Race by Gender Differences

    • Authors: Shervin Assari, Maryam Moghani Lankarani, John Piette, James Aikens
      First page: 83
      Abstract: Background: This study aimed to investigate differences in the association between socioeconomic status (SES) and glycemic control in type 2 diabetes mellitus (DM) across race by gender groups. Methods: Using a convenient sampling strategy, participants were 112 patients with type 2 DM who were prescribed insulin (ns = 38 Black women, 34 Black men, 14 White women, and 26 White men, respectively). Linear regression was used to test the associations between sociodemographic variables (race, gender, SES, governmental insurance) and Hemoglobin A1c (HbA1c) in the pooled sample and within subgroups defined by race and gender. Results: In the pooled sample, neither SES nor governmental insurance were associated with HbA1c. However, the race by gender interaction approached statistical significance (B = 0.34, 95% CI = −0.24–3.00, p =0.094), suggesting higher HbA1c in Black women, compared to other race by gender groups. In stratified models, SES (B = −0.33, 95% CI = −0.10–0.00, p = 0.050), and governmental insurance (B = 0.35, 95% CI = 0.05–2.42, p = 0.042) were associated with HbA1c for Black men, but not for any of the other race by gender subgroups. Conclusion: Socioeconomic factors may relate to health outcomes differently across race by gender subgroups. In particular, SES may be uniquely important for glycemic control of Black men. Due to lack of generalizability of the findings, additional research is needed.
      Citation: Healthcare
      PubDate: 2017-11-01
      DOI: 10.3390/healthcare5040083
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 84: The Role of Medication in Supporting
           Emotional Wellbeing in Young People with Long-Term Needs

    • Authors: Nicola Gray, Damian Wood
      First page: 84
      Abstract: Young people frequently use and access prescribed medications for a range of health problems. Medications aimed at treating both common health problems and long-term physical and mental health needs in adolescence can have a significant effect on a young person’s emotional well-being. We use a series of case studies to illustrate the challenges for healthcare professionals supporting young people with medication use. The studies illustrate the efficacy and limitations of medication on improving emotional well-being by alleviating illness and distress, and how this efficacy must be balanced against both the adverse effects and the burden of treatment. There are specific challenges for medication management during adolescence including issues of adherence/concordance, facilitating autonomy and participation in decision making, and promoting independence.
      Citation: Healthcare
      PubDate: 2017-11-03
      DOI: 10.3390/healthcare5040084
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 85: Prescribing Physical Activity for the
           Prevention and Treatment of Osteoporosis in Older Adults

    • Authors: Lachlan McMillan, Ayse Zengin, Peter Ebeling, David Scott
      First page: 85
      Abstract: Osteoporosis is an age-related disease, characterised by low bone mineral density (BMD) and compromised bone geometry and microarchitecture, leading to reduced bone strength. Physical activity (PA) has potential as a therapy for osteoporosis, yet different modalities of PA have varying influences on bone health. This review explores current evidence for the benefits of PA, and targeted exercise regimes for the prevention and treatment of osteoporosis in older adults. In particular, the outcomes of interventions involving resistance training, low- and high-impact weight bearing activities, and whole-body vibration therapy are discussed. Finally, we present recommendations for future research that may maximise the potential of exercise in primary and secondary prevention of osteoporosis in the ageing population.
      Citation: Healthcare
      PubDate: 2017-11-06
      DOI: 10.3390/healthcare5040085
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 86: Multimodal Counseling Interventions: Effect
           on Human Papilloma Virus Vaccination Acceptance

    • Authors: Oroma Nwanodi, Helen Salisbury, Curtis Bay
      First page: 86
      Abstract: Human papilloma virus (HPV) vaccine was developed to reduce HPV-attributable cancers, external genital warts (EGW), and recurrent respiratory papillomatosis. Adolescent HPV vaccination series completion rates are less than 40% in the United States of America, but up to 80% in Australia and the United Kingdom. Population-based herd immunity requires 80% or greater vaccination series completion rates. Pro-vaccination counseling facilitates increased vaccination rates. Multimodal counseling interventions may increase HPV vaccination series non-completers’ HPV-attributable disease knowledge and HPV-attributable disease prophylaxis (vaccination) acceptance over a brief 14-sentence counseling intervention. An online, 4-group, randomized controlled trial, with 260 or more participants per group, found that parents were more likely to accept HPV vaccination offers for their children than were childless young adults for themselves (68.2% and 52.9%). A combined audiovisual and patient health education handout (PHEH) intervention raised knowledge of HPV vaccination purpose, p = 0.02, and HPV vaccination acceptance for seven items, p < 0.001 to p = 0.023. The audiovisual intervention increased HPV vaccination acceptance for five items, p < 0.001 to p = 0.006. That HPV causes EGW, and that HPV vaccination prevents HPV-attributable diseases were better conveyed by the combined audiovisual and PHEH than the control 14-sentence counseling intervention alone.
      Citation: Healthcare
      PubDate: 2017-11-06
      DOI: 10.3390/healthcare5040086
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 87: “To Work Just Like Anyone Else”—A
           Narrative from a Man Aging with Spinal Cord Injury

    • Authors: Ulrica Lundström, Margareta Lilja, Gunilla Isaksson
      First page: 87
      Abstract: People aging with spinal cord injury (SCI) develop medical problems commonly associated with the aging process at a younger age than the general population. However, research about how the life story changes and how meaning will be experienced in occupations is lacking. The aim was to describe and offer an explanation of how a man experienced meaning in everyday occupations while aging with an SCI. Four narrative interviews were performed over a four-year period, with a man in his fifties, who lived with SCI for 39 years. The narrative analysis generated an overall plot, named “To Work Just Like Anyone Else,” and gives a picture of his experiences, thoughts, and reflections about meaning in occupations, from when he became injured to the present, and in relation to his future. His life story is characterized by secondary health complications, and his experiences of negotiating with the aging body and making choices to continue working. Further, how occupational risk factors, e.g., imbalance, alienation, and deprivation, occur as a result of lack of rehabilitation and support from social systems is addressed. Future research should explore how rehabilitation and social systems can support people aging with SCI to experience meaning in everyday occupations and to have balance in everyday life.
      Citation: Healthcare
      PubDate: 2017-11-09
      DOI: 10.3390/healthcare5040087
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 88: The New Old (and Old New) Medical Model:
           Four Decades Navigating the Biomedical and Psychosocial Understandings of
           Health and Illness

    • Authors: Albert Farre, Tim Rapley
      First page: 88
      Abstract: The importance of how disease and illness are conceptualised lies in the fact that such definition is paramount to understand the boundaries and scope of responsibility associated with medical work. In this paper, we aim to provide an overview of the interplay of these understandings in shaping the nature of medical work, philosophically, and in practice. We first discuss the emergence of the biopsychosocial model as an attempt to both challenge and broaden the traditional biomedical model. Then, we outline the main criticisms associated with the biopsychosocial model and note a range of contributions addressing the shortcomings of the model as initially formulated. Despite recurrent criticisms and uneven uptake, the biopsychosocial model has gone on to influence core aspects of medical practice, education, and research across many areas of medicine. One of these areas is adolescent medicine, which provides a particularly good exemplar to examine the contemporary challenges associated with the practical application of the biopsychosocial model. We conclude that a more optimal use of existing bodies of evidence, bringing together evidence-based methodological advances of the biopsychosocial model and existing evidence on the psychosocial needs associated with specific conditions/populations, can help to bridge the gap between philosophy and practice.
      Citation: Healthcare
      PubDate: 2017-11-18
      DOI: 10.3390/healthcare5040088
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 89: The Geography of the Alzheimer’s Disease
           Mortality in Spain: Should We Focus on Industrial Pollutants

    • Authors: Èrica Martínez-Solanas, Montse Vergara-Duarte, Miquel Ortega Cerdà, Juan Martín-Sánchez, Maria Buxó, Eduard Rodríguez-Farré, Joan Benach, Glòria Pérez
      First page: 89
      Abstract: Alzheimer’s disease (AD) has a high worldwide prevalence but little is known about its aetiology and risk factors. Recent research suggests environmental factors might increase AD risk. We aim to describe the association between AD mortality and the presence of highly polluting industry in small areas in Spain between 1999 and 2010. We calculated AD age-adjusted Standardized Mortality Ratio (SMR), stratified by sex, grouped by industrial pollution density, compared for each small area of Spain. In the small areas with the highest mortality, the SMR among women was at least 25% greater than the national average (18% in men). The distribution of AD mortality was generally similar to that of high industrial pollution (higher mortality in the north, the Mediterranean coast and in some southern areas). The risk of AD mortality among women was 140% higher (123% among men) in areas with the highest industrial density in comparison to areas without polluting industries. This study has identified a geographical pattern of small areas with higher AD mortality risk and an ecological positive association with the density of highly polluting industry. Further research is needed on the potential impact of this type of industry pollution on AD aetiology and mortality.
      Citation: Healthcare
      PubDate: 2017-11-25
      DOI: 10.3390/healthcare5040089
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 90: Home Hemodialysis (HHD) Treatment as an
           Effective yet Underutilized Treatment Modality in the United States

    • Authors: Jihane Hajj, Krzysztof Laudanski
      First page: 90
      Abstract: End-stage renal disease (ESRD) is a major health burden and its incidence has been increasing yearly reaching 120,000 cases in 2014. Home hemodialysis (HHD) is a treatment modality option that has been shown to contribute to numerous clinical benefits but is largely underutilized due to many contributing factors. The purpose of this review paper is to analyze the advantages and disadvantages of HHD and the reasons for its low utilization with a special focus on its socioeconomic impact as compared to facility hemodialysis. Key factors contributing to HHD underutilization are related to the reimbursement system of the facility and nephrologists as well as the underutilization of the pre-dialysis educational benefit. Based on this comprehensive review of the literature, we propose several suggestions which may contribute to the expansion of HHD treatment modality.
      Citation: Healthcare
      PubDate: 2017-11-28
      DOI: 10.3390/healthcare5040090
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 91: Cross-National Differences in Psychosocial
           Factors of Perinatal Depression: A Systematic Review of India and Japan

    • Authors: Mizuki Takegata, Yukiko Ohashi, Anisha Lazarus, Toshinori Kitamura
      First page: 91
      Abstract: Perinatal depression is prevalent worldwide. However, there are few available studies that discuss the different cultural factors affecting perinatal depression within Asian countries. This study aims to compare the literature regarding related factors relating to perinatal depression in India and Japan, and to synthesize the evidence common to both countries in addition to the country-specific evidence. We conducted a systematic review using several databases (CINAHL, MEDLINE, Pubmed, Ovid, SCOPUS, IndMED, and ICHUSI). Keywords were “antenatal depression” or “postpartum depression”, and “India” or “Japan”. Both Japanese and English language papers were reviewed. The identified evidence was compared between the two countries, as well as with non-Asian countries based on previous reports. In total, 15 articles on India and 35 on Japan were reviewed. Although several factors were shared between the two countries as well as with other non-Asian countries (vulnerable personality, being abused, age, marital conflict, and lower socio-demographic status), some differing factors were identified between India and Japan and non-Asian countries; India: poor socioeconomic status, living only with the husband, pregnancy not welcomed by the husband, a female baby, and poor relationship with in-laws; Japan: infertility treatment, conflict with work–life balance, poor relationships with biological mother or in-laws, and concerns about social relations with the other mother’s friends. To conclude, involving the family and community may be important for implementing both global standardized and culture-specific interventions. In India, treatment involving the in-laws may be effective because large family structure is a significant predictor of perinatal depression. In Japan, a family/community approach involving not only the mother’s family of origin but also the working environment is essential.
      Citation: Healthcare
      PubDate: 2017-12-04
      DOI: 10.3390/healthcare5040091
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 92: The Impact of Hemodialysis on
           Spatio-Temporal Characteristics of Gait and Role of Exercise: A Systematic

    • Authors: Anuradha Sawant, Tom Overend
      First page: 92
      Abstract: Background: People with end-stage kidney disease (ESKD) on hemodialysis (HD) commonly have functional impairments. The purpose of this systematic review was to evaluate the effect of HD on spatio-temporal characteristics of gait, and effect of exercise on these parameters. Methods: Electronic databases were searched to identify relevant citations. Extracted data was computed using a random effects model for means (Hedges’ and 95% confidence interval (CI). Results: 27 studies met inclusion criteria. Mean values: gait speed (GS)—1.0 m/s (CI: 0.9–1.1 m/s; 16 studies), fast walking speed (FWS)—1.5 m/s (CI: 1.3–1.6 m/s; 7 studies), timed get-up & go test (TUG) —6.8 s (CI: 6.1–7.5 s; 2 studies), walk tests (WT) 193.0 s (CI: 116.0–270.0; 5 studies), 6 min-walk-test (6MWT)—386.6 m (CI: 243.2–530.0 m; 11 studies). 4 studies compared participants on HD with normal controls and 10 studies evaluated the effect of nutrition/exercise. Conclusions: Compared to age-matched populations, people with ESKD/HD had significantly slower GS and reduced walk distances; with intervention, the change in the distance walked was significant. Further research is required to evaluate the effect of HD on gait parameters, and the type of exercise/nutrition that will lead to meaningful changes.
      Citation: Healthcare
      PubDate: 2017-12-05
      DOI: 10.3390/healthcare5040092
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 93: Connecting the Mind–Body Split:
           Understanding the Relationship between Symptoms and Emotional Well-Being
           in Chronic Pain and Functional Gastrointestinal Disorders

    • Authors: Line Caes, Alex Orchard, Deborah Christie
      First page: 93
      Abstract: Paediatric chronic conditions, e.g., chronic pain and functional gastrointestinal disorders, are commonly diagnosed, with fatigue, pain and abdominal discomfort the most frequently reported symptoms across conditions. Regardless of whether symptoms are connected to an underlying medical diagnosis or not, they are often associated with an increased experience of psychological distress by both the ill child and their parents. While pain and embarrassing symptoms can induce increased distress, evidence is also accumulating in support of a reciprocal relationship between pain and distress. This reciprocal relationship is nicely illustrated in the fear avoidance model of pain, which has recently been found to be applicable to childhood pain experiences. The purpose of this article is to illustrate how mind (i.e., emotions) and body (i.e., physical symptoms) interact using chronic pain and gastrointestinal disorders as key examples. Despite the evidence for the connection between mind and body, the mind–body split is still a dominant position for families and health care systems, as evidenced by the artificial split between physical and mental health care. In a mission to overcome this gap, this article will conclude by providing tools on how the highlighted evidence can help to close this gap between mind and body.
      Citation: Healthcare
      PubDate: 2017-12-05
      DOI: 10.3390/healthcare5040093
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 94: Measuring Activity Performance of Older
           Adults Using the activPAL: A Rapid Review

    • Authors: Charice Chan, Susan Slaughter, C. Jones, Carla Ickert, Adrian Wagg
      First page: 94
      Abstract: Current measures of physical activity and sedentary behaviors such as questionnaires and functional assessments are insufficient to provide comprehensive data on older adults. In response, the use of activity monitors has increased. The purpose of this review was to summarize and assess the quality of observational literature on activity measuring of older adults using the activPAL activity monitor. Seventeen databases and a bibliography, compiled by the activPAL creators, were searched. Articles were included if they were in English, were peer-reviewed, included people 65 years or older, measured activity using the activPAL and reported at least one of the following outcomes: step count, hours upright, hours sitting/lying, hours stepping, or hours standing. The search revealed 404 titles; after exclusions 24 were included in the final review. Of these studies, one examined older adults from residential aged care, six from hospital in-patient clinics, nine from outpatient clinics and eight examined community-dwellers. Mean age ranged from 66.0 to 84.2 years. Not all studies reported similar outcome variables, preventing data pooling. The review found a lack of high quality articles. There may be limitations to using the activPAL among older adults but further research is required to examine its use in this population.
      Citation: Healthcare
      PubDate: 2017-12-13
      DOI: 10.3390/healthcare5040094
      Issue No: Vol. 5, No. 4 (2017)
  • Healthcare, Vol. 5, Pages 30: Progestin Intrauterine Devices and
           Metformin: Endometrial Hyperplasia and Early Stage Endometrial Cancer
           Medical Management

    • Authors: Oroma Nwanodi
      First page: 30
      Abstract: Globally, endometrial cancer is the sixth leading cause of female cancer-related deaths. Non-atypical endometrial hyperplasia (EH), has a lifetime progression rate to endometrial cancer ranging from less than 5%, if simple without atypia, to 40%, if complex with atypia. Site specific, long-acting intrauterine devices (IUDs) provide fertility sparing, progestin-based EH medical management. It is unclear which IUD is most beneficial, or if progesterone sensitizing metformin offers improved outcomes. For resolution, PubMed searches for “Mirena” or “Metformin,” “treatment,” “endometrial hyperplasia,” or “stage 1 endometrial cancer,” were performed, yielding 33 articles. Of these, 19 articles were included. The 60 mg high-dose frameless IUD/20 mcg levonorgestrel has achieved sustained regression of Grade 3 endometrial intraepithelial neoplasia for 14 years. Case series on early stage endometrial cancer (EC) treatment with IUDs have 75% or greater regression rates. For simple through complex EH with atypia, the 52 mg-IUD/10–20 mcg-LNG-14t has achieved 100% complete regression in 6-months. Clearly, IUDs have an outcome advantage over oral progestins. However, studies on metformin for EH, and of progestins or metformin for early stage EC management are underpowered, with inadequate dose ranges to achieve significant differences in, or optimal outcomes for, the treatment modalities. Therefore, outcomes from the feMMe trial for the 52 mg-IUD/10–20 mcg-LNG-14t and metformin will fill a gap in the literature.
      Citation: Healthcare
      PubDate: 2017-07-08
      DOI: 10.3390/healthcare5030030
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 31: End Stage Renal Disease—A Nephrologist’s
           Perspective of Two Different Circumstances as Typified by Kidney
           Transplantation Experience in a Nigerian Hospital Versus a Large US
           Medical School

    • Authors: Macaulay Onuigbo
      First page: 31
      Abstract: Renal transplantation is the sine qua non consummate form of renal replacement therapy (RRT) for end stage renal disease (ESRD). Despite the increasing ESRD burden worldwide, developing countries continue to experience a gross lack of RRT options for its teeming citizens with ESRD. This report is a demonstration of a nephrologist’s experience and dilemma trying to make sense of the yawning disparity between RRT options, especially renal transplantation, as it applies to the citizens of the USA versus the citizens of Nigeria. The limited three-year experience of renal transplantation at Garki Hospital, located in Abuja, the capital of Nigeria, which is one of the very few centers carrying out renal transplantation in Nigeria, was starkly contrasted with this author’s first-hand experience at the University of Maryland Medical School, in Baltimore, Maryland, USA, as a Nephrology Fellow between 2000 and 2002. The potential role of public-private partnership (PPP) ventures in developing countries is considered as a way to help bridge this gap.
      Citation: Healthcare
      PubDate: 2017-07-11
      DOI: 10.3390/healthcare5030031
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 32: Integrating Mental and Physical Health Care
           for Low-Income Americans: Assessing a Federal Program’s Initial Impact
           on Access and Cost

    • Authors: Evan Goldstein
      First page: 32
      Abstract: Individuals with mental health disorders often die decades earlier than the average person, and low-income individuals disproportionately experience limited access to necessary services. In 2014, the U.S. Health Resources & Services Administration (HRSA) leveraged Affordable Care Act funds to address these challenges through behavioral health integration. The objective of this study is to assess the US$55 million program’s first-year impact on access and cost. This analysis uses multivariable difference-in-difference regression models to estimate changes in outcomes between the original 219 Federally Qualified Health Center (FQHC) Behavioral Health Integration grantees and two comparison groups. The primary outcome variables are annual depression screening rate, percentage of mental health and substance use patients served, and per capita cost. The results change when comparing the Behavioral Health Integration (BHI) grantees to a propensity score-matched comparison group versus comparing the grantees to the full population of health centers. After one year of implementation, the grant program appeared ineffective as measured by this study’s outcomes, though costs did not significantly rise because of the program. This study has limitations that must be discussed, including non-randomized study design, FQHC data measurement, and BHI program design consequences. Time will tell if FQHC-based behavioral–physical health care integration will improve access among low-income, medically-underserved populations.
      Citation: Healthcare
      PubDate: 2017-07-12
      DOI: 10.3390/healthcare5030032
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 33: Lateral Violence in Nursing Survey:
           Instrument Development and Validation

    • Authors: Lynne Nemeth, Karen Stanley, Mary Martin, Martina Mueller, Diana Layne, Kenneth Wallston
      First page: 33
      Abstract: An examination of the psychometric properties of the Lateral Violence in Nursing Survey (LVNS), an instrument previously developed to measure the perceived incidence and severity of lateral violence (LV) in the nursing workplace, was carried out. Conceptual clustering and principal components analysis were used with survey responses from 663 registered nurses and ancillary nursing staff in a southeastern tertiary care medical center. Where appropriate, Cronbach’s alpha (α) evaluated internal consistency. The prevalence/severity of lateral violence items constitute two distinct subscales (LV by self and others) with Cronbach’s alpha of 0.74 and 0.86, respectively. The items asking about potential causes of LV are unidimensional and internally consistent (alpha = 0.77) but there is no conceptually coherent theme underlying the various causes. Respondents rating a potential LV cause as “major” scored higher on both prevalence/severity subscales than those rating it a “minor” cause or not a cause. Subsets of items on the LVNS are internally reliable, supporting construct validity. Revisions of the original LVNS instrument will improve its use in future work.
      Citation: Healthcare
      PubDate: 2017-07-19
      DOI: 10.3390/healthcare5030033
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 34: Pediatric Respiratory Support Technology and
           Practices: A Global Survey

    • Authors: Amélie O. von Saint André-von Arnim, Shelina M. Jamal, Grace C. John-Stewart, Ndidiamaka L. Musa, Joan Roberts, Larissa I. Stanberry, Christopher R. A. Howard
      First page: 34
      Abstract: Objective: This global survey aimed to assess the current respiratory support capabilities for children with hypoxemia and respiratory failure in different economic settings. Methods: An online, anonymous survey of medical providers with experience in managing pediatric acute respiratory illness was distributed electronically to members of the World Federation of Pediatric Intensive and Critical Care Society, and other critical care websites for 3 months. Results: The survey was completed by 295 participants from 64 countries, including 28 High-Income (HIC) and 36 Low- and Middle-Income Countries (LMIC). Most respondents (≥84%) worked in urban tertiary care centers. For managing acute respiratory failure, endotracheal intubation with mechanical ventilation was the most commonly reported form of respiratory support (≥94% in LMIC and HIC). Continuous Positive Airway Pressure (CPAP) was the most commonly reported form of non-invasive positive pressure support (≥86% in LMIC and HIC). Bubble-CPAP was used by 36% HIC and 39% LMIC participants. ECMO for acute respiratory failure was reported by 45% of HIC participants, compared to 34% of LMIC. Oxygen, air, gas humidifiers, breathing circuits, patient interfaces, and oxygen saturation monitoring appear widely available. Reported ICU patient to health care provider ratios were higher in LMIC compared to HIC. The frequency of respiratory assessments was hourly in HIC, compared to every 2–4 h in LMIC. Conclusions: This survey indicates many apparent similarities in the presence of respiratory support systems in urban care centers globally, but system quality, quantity, and functionality were not established by this survey. LMIC ICUs appear to have higher patient to medical staff ratios, with decreased patient monitoring frequencies, suggesting patient safety should be a focus during the introduction of new respiratory support devices and practices.
      Citation: Healthcare
      PubDate: 2017-07-21
      DOI: 10.3390/healthcare5030034
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 35: Student Perceptions and Acceptance of Mobile
           Technology in an Undergraduate Nursing Program

    • Authors: Tracy P. George, Claire DeCristofaro, Pamela F. Murphy, Archie Sims
      First page: 35
      Abstract: Mobile technology allows healthcare students to access current evidence-based resources. The purpose of this study was to evaluate the student experience of implementing point-of-care (POC) smartphone applications in a first-semester undergraduate nursing program. Teaching methods included using case studies in the laboratory to familiarize students with the apps. At community screening sites, evidence-based guidelines were referenced when students discussed screening results with patients. Surveys were administered prior to implementing this innovation and after the students utilized the apps in direct patient interactions. Survey results were analyzed to evaluate student perceptions and acceptance of mobile technology. Students felt that healthcare smartphone apps were a helpful and convenient way to obtain evidence-based clinical information pertinent to direct care settings. Over 90% of students planned to continue using healthcare smartphone apps. In conclusion, healthcare smartphone apps are a way for students to become comfortable accessing evidence-based clinical resources. It is important to encourage students to use these resources early in the curriculum. Community screenings are an independent health promotion activity which assists in the attainment of health equity and fosters nursing leadership.
      Citation: Healthcare
      PubDate: 2017-07-21
      DOI: 10.3390/healthcare5030035
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 36: Through the Patients’ Eyes: The Experience
           of End-Stage Renal Disease Patients Concerning the Provided Nursing Care

    • Authors: Areti Stavropoulou, Maria G. Grammatikopoulou, Michail Rovithis, Konstantina Kyriakidi, Andriani Pylarinou, Anastasia G. Markaki
      First page: 36
      Abstract: Chronic kidney disease is a condition that affects both the physical and mental abilities of patients. Nursing care is of pivotal importance, in particular when end-stage renal disease (ESRD) patients are concerned, since the quality of the provided care may severely influence the patient’s quality of life. This is why it is important to explore patient experiences concerning the rendered care. However, limited up-to-date studies have addressed this issue. The aim of the present study was to stress the experiences of ESRD patients concerning the provided nursing care in the hemodialysis unit at the University Hospital in Heraklion, Crete. A qualitative methodological approach was used, based on the principles of phenomenological epistemology. Semi-structured interviews were conducted, and open-ended questions were applied to record how patients experienced the rendered care during dialysis. The recorded data were analyzed via qualitative content analysis, which revealed three main themes: ‘Physical Care’, ‘Psychological Support’ and ‘Education’. Patients’ views were conceptualized into sub-themes within each main theme. The interviews revealed the varied and distinct views of ESRD patients, indicating that the rendered care should be individualized.
      Citation: Healthcare
      PubDate: 2017-07-21
      DOI: 10.3390/healthcare5030036
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 37: Healtheatre: Drama and Medicine in Concert

    • Authors: Ian Walsh, Paul Murphy
      First page: 37
      Abstract: Introduction: Clinical practice includes expressing empathy and understanding key features of humanity, such as mortality and illness. The Stanislavski “System” of actor training negotiates a journey from the unconscious via feeling, will and intellect to a proposed supertask. This study explored these areas during collaborative learning amongst undergraduate medical and drama students. Materials and Methods: Each of two interactive sessions involved teams of final year medical students rotating through challenging simulated clinical scenarios, enacted by undergraduate drama students, deploying key techniques from the Stanslavski system of actor training. Team assessment of performance was via a ratified global scoring system and dynamic debriefing techniques. Results: Medical students reported an enhanced immersive experience within simulated clinical scenarios. Drama students reported increased challenge and immersion within their roles. Medical faculty and standardised patients reported positive utility and value for the approach. Clinical team assessment scores increased by 47% (p < 0.05) with this intervention. Discussion: Qualitative and quantitative data demonstrated the merit and utility of such interdisciplinary learning. All students and faculty appreciated the value of the activity and described enhanced learning. Collaborative dynamic debriefing allowed for a continuation of the immersive experience and allowed for an exploration of arenas such as empathy. Conclusions: The deployment of drama students trained in the Stanislavski system significantly enriched medical and drama student experience and performance. Team assessment scores further demonstrated the effectiveness of this approach. Feedback from students, faculty and standardised patients was uniformly positive. The approach facilitated exploration of empathy.
      Citation: Healthcare
      PubDate: 2017-07-28
      DOI: 10.3390/healthcare5030037
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 38: Challenges in Expanding Access to Dialysis

    • Authors: Harriet Etheredge, June Fabian
      First page: 38
      Abstract: South Africa is a country with two distinct health sectors, which are both characterised by inequalities. Within this context, patients with end stage renal disease face unique and sometimes impenetrable barriers to accessing dialysis. There are a number of reasons for this situation. These include: the South African government’s endorsement of discordant, unequal policies, which disadvantage the most vulnerable; a lack of robust national guidelines; and divisive rationing practices, which are ad hoc and place the burden of responsibility for rationing dialysis on the clinician. In this paper, we trace the socio-economic mechanisms of how we have come to be in this situation, and overlay this with a detailed examination of South African legislation. Finally, we make comprehensive practical recommendations for rectifying the situation, which include engagement with key stakeholders, public–private partnerships, and more equitable funding mechanisms.
      Citation: Healthcare
      PubDate: 2017-07-31
      DOI: 10.3390/healthcare5030038
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 39: A Population-Based, Cross-Sectional Study
           Examining Health Services Deficits of US Veterans Using 2014 Behavioral
           Risk Factor Surveillance System Data: Is Rural Residency an Independent
           Risk Factor after Controlling for Multiple Covariates'

    • Authors: Catherine St. Hill, Michael Swanoski, Martin Lipsky, May Lutfiyya
      First page: 39
      Abstract: Introduction: In 2014, it was reported that there was a backlog of an estimated 1.2 million claims nationwide at the United States Veterans Administration (VA). This ecological occurrence opened up a space for asking and answering some important questions about health service deficits (HSD) of US veterans, which is the focus of the research reported on in this paper. The purpose of this study was to ascertain if rural veterans were more likely to experience HSDs than urban military veterans after controlling for a number of covariates. Methods: Bivariate and multivariate data analysis strategies were used to examine 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey data. HSD was the dependent variable. Results: Two multivariate models were tested. The first logistic regression analysis yielded that rural veterans had higher odds of having at least one HSD. The second yielded that rural US veterans in 2014 who had higher odds of having at least one HSD were: 18–64 years of age, unemployed seeking employment, living in households with annual incomes lower than $75,000, without a university degree, not part of a married or unmarried couple, a current smoker, and/or a binge drinker within the last 30 days. Conclusions: The study described here fills identified epidemiological gaps in our knowledge regarding rural US military veterans and HSDs. The findings are not only interesting but important, and should be used to inform interventions to reduce HSDs for rural veterans.
      Citation: Healthcare
      PubDate: 2017-07-31
      DOI: 10.3390/healthcare5030039
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 40: Chronic Respiratory Disorders and Their
           Treatment among Older People with Intellectual Disability and/or Autism
           Spectrum Disorder in Comparison with the General Population

    • Authors: Anna Axmon, Peter Höglund, Gerd Ahlström
      First page: 40
      Abstract: Respiratory disorders are common among people with intellectual disabilities (ID). However, few studies have investigated these disorders among older people with ID. We identified 7936 people, aged 55+ years, with ID and a reference cohort from the general population. Data on diagnoses of chronic respiratory disorders, with a focus on asthma and chronic obstructive pulmonary disease (COPD), were collected, as was information on health care visits due to such disorders. We also added data on the prescription of drugs for obstructive airway diseases. Whereas the risk of having at least one diagnosis of asthma during the study period was similar in the two cohorts, people with ID were less likely than the general population to have been diagnosed with COPD. The same was found for health care visits due to asthma and COPD, respectively. The patterns of drug prescription were similar among people with ID and the general population, with the exception of adrenergics for systemic use, which were more commonly prescribed to people with ID. Thus, older people with ID do not seem to have an increased risk of asthma or COPD. Moreover, the indications are that when diagnosed with any of these disorders, they receive treatment adapted to their particular needs.
      Citation: Healthcare
      PubDate: 2017-08-01
      DOI: 10.3390/healthcare5030040
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 41: Using Jazz as a Metaphor to Teach
           Improvisational Communication Skills

    • Authors: Paul Haidet, Jodi Jarecke, Chengwu Yang, Cayla Teal, Richard Street, Heather Stuckey
      First page: 41
      Abstract: Metaphor helps humans understand complex concepts by “mapping” them onto accessible concepts. The purpose of this study was to investigate the effects of using jazz as a metaphor to teach senior medical students improvisational communication skills, and to understand student learning experiences. The authors designed a month-long course that used jazz to teach improvisational communication. A sample of fourth-year medical students (N = 30) completed the course between 2011 and 2014. Evaluation consisted of quantitative and qualitative data collected pre- and post-course, with comparison to a concurrent control group on some measures. Measures included: (a) Student self-reports of knowledge and ability performing communicative tasks; (b) blinded standardized patient assessment of students’ adaptability and quality of listening; and (c) qualitative course evaluation data and open-ended interviews with course students. Compared to control students, course students demonstrated statistically significant and educationally meaningful gains in adaptability and listening behaviors. Students’ course experiences suggested that the jazz components led to high engagement and creativity, and provided a model to guide application of improvisational concepts to their own communication behaviors. Metaphor proved to be a powerful tool in this study, partly through enabling increased reflection and decreased resistance to behaviors that, on the surface, tended to run counter to generally accepted norms. The use of jazz as a metaphor to teach improvisational communication warrants further refinement and investigation.
      Citation: Healthcare
      PubDate: 2017-08-04
      DOI: 10.3390/healthcare5030041
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 42: Ability to Work among Patients with ESKD:
           Relevance of Quality Care Metrics

    • Authors: Nancy Kutner, Rebecca Zhang
      First page: 42
      Abstract: Enabling patient ability to work was a key rationale for enacting the United States (US) Medicare program that provides financial entitlement to renal replacement therapy for persons with end-stage kidney disease (ESKD). However, fewer than half of working-age individuals in the US report the ability to work after starting maintenance hemodialysis (HD). Quality improvement is a well-established objective in oversight of the dialysis program, but a more patient-centered quality assessment approach is increasingly advocated. The ESKD Quality Incentive Program (QIP) initiated in 2012 emphasizes clinical performance indicators, but a newly-added measure requires the monitoring of patient depression—an issue that is important for work ability and employment. We investigated depression scores and four dialysis-specific QIP measures in relation to work ability reported by a multi-clinic cohort of 528 working-age maintenance HD patients. The prevalence of elevated depression scores was substantially higher among patients who said they were not able to work, while only one of the four dialysis-specific clinical measures differed for patients able/not able to work. Ability to work may be among patients’ top priorities. As the parameters of quality assessment continue to evolve, increased attention to patient priorities might facilitate work ability and employment outcomes.
      Citation: Healthcare
      PubDate: 2017-08-07
      DOI: 10.3390/healthcare5030042
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 43: Psychotherapy Training on Psychological
           Mindedness in a Japanese Nurse Population: Effects and Personality

    • Authors: Tomomi Saito, Satoru Takeda, Yukiko Yamagishi, Reiko Kubo, Toshinori Kitamura
      First page: 43
      Abstract: Aims and objective: The aim of this study was to determine whether the training would influence the psychological mindedness of nurses and midwives. In addition, we explored the relationship of the change of psychological mindedness before and after the training and the correlation with their personality traits. Background: It is important for perinatal health professionals such as nurses and midwives to acquire intervention skills such as psychotherapy and counselling techniques. We think that one of the essential requisites is psychological mindedness. Method: A total of 45 perinatal health professionals who participated in the postpartum depression prevention programme were distributed a set of questionnaires including the Psychological Mindedness Scale (PMS) and Temperament and Character Inventory (TCI) at the beginning and end of the training. Results: The PMS scores increased significantly after the training. A structured equation modelling suggested that PMS and self-directedness predicted each other whereas PMS predicted low harm avoidance. Conclusion: These findings indicate that the psychological mindedness of nurses and midwives could be advanced by a course of training and that this could be supported by high self-directedness. The harm avoidance trait may be reduced by increased psychological mindedness. Relevance to clinical practice: Nurses and nursing students are apt to psychological skill training in the advancement of psychological mindedness.
      Citation: Healthcare
      PubDate: 2017-08-08
      DOI: 10.3390/healthcare5030043
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 44: Interventions to Support Integrated
           Psychological Care and Holistic Health Outcomes in Paediatrics

    • Authors: Roz Shafran, Sophie Bennett, Mhairi McKenzie Smith
      First page: 44
      Abstract: There are strong calls from many national and international bodies for there to be a ‘holistic’ and integrated approach to the understanding and management of psychological and physical health needs. Such holistic approaches are characterized by the treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease. Holistic approaches can impact on mental and physical health and are cost-effective. Several psychological interventions have demonstrated efficacy in improving holistic health outcomes, for example Cognitive Behaviour Therapy, Behavioural Therapies and Problem Solving Therapies. They have shown to impact upon a wide range of outcomes, including psychological distress, pain, physical health, medication adherence, and family outcomes. There is increasing recognition that the holistic goals of the child and family should be prioritised, and that interventions and outcomes should reflect these goals. A focus on holistic goals in therapy can be achieved through a combination of personalised goal-based outcomes in addition to symptom-based measures.
      Citation: Healthcare
      PubDate: 2017-08-16
      DOI: 10.3390/healthcare5030044
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 45: Healthy Ageing in People with Intellectual
           Disabilities from Managers’ Perspective: A Qualitative Study

    • Authors: Maria Johansson, Petra Björne, Ingrid Runesson, Gerd Ahlström
      First page: 45
      Abstract: An increasing number of people with intellectual disability (ID) are reaching older ages today although they experience more health problems than the older population without ID. Leaders in intellectual disability services can greatly influence the conditions for a healthy ageing, and the aim of the present study was to explore healthy ageing in this group from the perspective of the leaders. Interviews with 20 leaders were subjected to qualitative content analysis. The findings gave rise to the overall theme ageing in dependence, which emerged from the following six categories: Supporting self-determination; Inaccessible activities after retirement; Signs of decline; Increased and specific needs for support and care; A non-question of gender; Aspects concerning the end of life and death. A prerequisite for healthy ageing in the case of people with ID is, according to the leaders, that they can live the life according to their preferences and make independent choices whilst at the same time receiving adequate support. With the shrinking of their social network after retirement, they become increasingly dependent on staff and leaders in the group home, who need to know what healthy ageing implies.
      Citation: Healthcare
      PubDate: 2017-08-18
      DOI: 10.3390/healthcare5030045
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 46: Nature Versus Nurture: Does Proteostasis
           Imbalance Underlie the Genetic, Environmental, and Age-Related Risk
           Factors for Alzheimer’s Disease'

    • Authors: Elise Kikis
      First page: 46
      Abstract: Aging is a risk factor for a number of “age-related diseases”, including Alzheimer’s disease (AD). AD affects more than a third of all people over the age of 85, and is the leading cause of dementia worldwide. Symptoms include forgetfulness, memory loss, and cognitive decline, ultimately resulting in the need for full-time care. While there is no cure for AD, pharmacological approaches to alleviate symptoms and target underlying causes of the disease have been developed, albeit with limited success. This review presents the age-related, genetic, and environmental risk factors for AD and proposes a hypothesis for the mechanistic link between genetics and the environment. In short, much is known about the genetics of early-onset familial AD (EO-FAD) and the central role played by the Aβ peptide and protein misfolding, but late-onset AD (LOAD) is not thought to have direct genetic causes. Nonetheless, genetic risk factors such as isoforms of the protein ApoE have been identified. Additional findings suggest that air pollution caused by the combustion of fossil fuels may be an important environmental risk factor for AD. A hypothesis suggesting that poor air quality might act by disrupting protein folding homeostasis (proteostasis) is presented.
      Citation: Healthcare
      PubDate: 2017-08-22
      DOI: 10.3390/healthcare5030046
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 47: Content Analysis of Student Essays after
           Attending a Problem-Based Learning Course: Facilitating the Development of
           Critical Thinking and Communication Skills in Japanese Nursing Students

    • Authors: Tomoya Itatani, Kyoko Nagata, Kiyoko Yanagihara, Noriko Tabuchi
      First page: 47
      Abstract: The importance of active learning has continued to increase in Japan. The authors conducted classes for first-year students who entered the nursing program using the problem-based learning method which is a kind of active learning. Students discussed social topics in classes. The purposes of this study were to analyze the post-class essay, describe logical and critical thinking after attended a Problem-Based Learning (PBL) course. The authors used Mayring’s methodology for qualitative content analysis and text mining. In the description about the skills required to resolve social issues, seven categories were extracted: (recognition of diverse social issues), (attitudes about resolving social issues), (discerning the root cause), (multi-lateral information processing skills), (making a path to resolve issues), (processivity in dealing with issues), and (reflecting). In the description about communication, five categories were extracted: (simple statement), (robust theories), (respecting the opponent), (communication skills), and (attractive presentations). As the result of text mining, the words extracted more than 100 times included “issue,” “society,” “resolve,” “myself,” “ability,” “opinion,” and “information.” Education using PBL could be an effective means of improving skills that students described, and communication in general. Some students felt difficulty of communication resulting from characteristics of Japanese.
      Citation: Healthcare
      PubDate: 2017-08-22
      DOI: 10.3390/healthcare5030047
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 48: The Collaborative Payer Provider Model
           Enhances Primary Care, Producing Triple Aim Plus One Outcomes: A Cohort

    • Authors: Thomas Doerr, Lisa Olsen, Deborah Zimmerman
      First page: 48
      Abstract: Rising health care costs are threatening the fiscal solvency of patients, employers, payers, and governments. The Collaborative Payer Provider Model (CPPM) addresses this challenge by reinventing the role of the payer into a full-service collaborative ally of the physician. From 2010 through 2014, a Medicare Advantage plan prospectively deployed the CPPM, averaging 30,561 members with costs that were 73.6% of fee-for-service (FFS) Medicare (p < 0.001). The health plan was not part of an integrated delivery system. After allocating $80 per member per month (PMPM) for primary care costs, the health plan had medical cost ratios averaging 75.1% before surplus distribution. Member benefits were the best in the market. The health plan was rated 4.5 Stars by the Centers for Medicare and Medicaid Services for years 1–4, and 5 Stars in study year 5 for quality, patient experience, access to care, and care process metrics. Primary care and specialist satisfaction were significantly better than national benchmarks. Savings resulted from shifts in spending from inpatient to outpatient settings, and from specialists to primary care physicians when appropriate. The CPPM is a scalable model that enables a win-win-win system for patients, providers, and payers.
      Citation: Healthcare
      PubDate: 2017-08-27
      DOI: 10.3390/healthcare5030048
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 49: Breakfast Cereal Consumption and Obesity
           Risk amongst the Mid-Age Cohort of the Australian Longitudinal Study on
           Women’s Health

    • Authors: Angelica Quatela, Robin Callister, Amanda Patterson, Mark McEvoy, Lesley MacDonald-Wicks
      First page: 49
      Abstract: Obesity affects 27.5% of Australian women. Breakfast cereal consumption has been proposed to be protective against obesity. This study investigated the association of breakfast cereal consumption with the risk of developing obesity (Body Mass Index (BMI) ≥ 30 kg/m2) over 12 years among mid-age participants in the Australian Longitudinal Study on Women’s Health (ALSWH). Dietary data were obtained at S3 and obesity incidence at S4–S7. Women were excluded if: dietary data were incomplete, energy intake was <4500 or >20,000 kJ/day, or they reported being overweight or obese at S3. Logistic regressions with discrete time survival analysis investigated the association between breakfast cereal intake and incident obesity and were adjusted for: area of residency, income, smoking, physical activity, hypertension, dietary intakes and a discrete measure of time. There were 308 incident cases of obesity. Any breakfast cereal intake was not associated with incident obesity (Odds Ratio (OR): 0.92; p = 0.68). Oat-based cereal (OR: 0.71; p = 0.01), muesli (OR: 0.57; p = 0.00) and All-Bran (OR: 0.62; p = 0.01) intakes were associated with a significant reduction in obesity risk. Among this cohort, muesli on its own, or as part of oat-based cereals, and All-Bran, were associated with a reduction in obesity. This effect may be due to particular characteristics of these cereal eaters, but the relationship warrants further investigation.
      Citation: Healthcare
      PubDate: 2017-08-30
      DOI: 10.3390/healthcare5030049
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 50: Nurse Perceptions of Artists as
           Collaborators in Interprofessional Care Teams

    • Authors: Jill Sonke, Virginia Pesata, Jenny Lee, John Graham-Pole
      First page: 50
      Abstract: Increased attention is being given to interprofessional collaboration in healthcare, which has been shown to improve patient satisfaction, patient safety, healthcare processes, and health outcomes. As the arts and artists are being more widely incorporated into healthcare settings throughout the world, professional artists are contributing to interprofessional care teams. A secondary directed content analysis of interviews with 31 nurses on a medical-surgical care unit investigated the roles and impacts of professional artists on the interprofessional care team. The investigation utilized established domains of interprofessional care, including values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork, and created the domain of quality of care. Findings suggest that artists are valued by nurses as members of the interprofessional care team, that they enhance the provision of patient-centered care, and that they improve quality of care by providing holistic dimensions of caring, including cognitive and social engagement, and meaningful interaction. The presence of artists on interprofessional teams provides a cost-effective and welcome resource for clinical staff and builds a culture in which creativity and interdisciplinary collaboration are more highly valued and activated.
      Citation: Healthcare
      PubDate: 2017-08-30
      DOI: 10.3390/healthcare5030050
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 51: Telemonitoring via Self-Report and Video
           Review in Community Palliative Care: A Case Report

    • Authors: Deidre Morgan, Kate Swetenham, Timothy To, David Currow, Jennifer Tieman
      First page: 51
      Abstract: Continuous monitoring and management of a person’s symptoms and performance status are critical for the delivery of effective palliative care. This monitoring occurs routinely in inpatient settings; however, such close evaluation in the community has remained elusive. Patient self-reporting using telehealth offers opportunities to identify symptom escalation and functional decline in real time, and facilitate timely proactive management. We report the case of a 57­year-old man with advanced non-small cell lung cancer who participated in a telehealth trial run by a community palliative care service. This gentleman was able to complete self-reporting of function and symptoms via iPad although at times he was reticent to do so. Self-reporting was perceived as a means to communicate his clinical needs without being a bother to the community palliative care team. He also participated in a videoconference with clinical staff from the community palliative care service and his General Practitioner. Videoconferencing with the nurse and GP was highly valued as an effective way to communicate and also because it eliminated the need for travel. This case report provides important information about the feasibility and acceptability of palliative care telehealth as a way to better manage clinical care in a community setting.
      Citation: Healthcare
      PubDate: 2017-08-31
      DOI: 10.3390/healthcare5030051
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 52: The Impact of Hemodialysis Frequency and
           Duration on Blood Pressure Management and Quality of Life in End-Stage
           Renal Disease Patients

    • Authors: Mohammad Shafiee, Pouyan Chamanian, Pouyan Shaker, Yasmin Shahideh, Behrooz Broumand
      First page: 52
      Abstract: Cardiovascular complications are the most prominent causes of morbidity and mortality among chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients undergoing standard hemodialysis (HD) therapy. Cardiovascular disease risk is increased significantly through persistent hypertension and blood pressure (BP) fluctuation, which are the most common complications of CKD. It was hypothesized that an extended approach with lengthier and more frequent dialysis sessions, referred to in this paper as “extended hemodialysis” (EHD), can potentially lower and stabilize blood pressure, and consequently reduce the rate of morbidity and mortality. A greater reduction of volume (salt and water) with higher frequency can improve patient quality of life (QOL). Eleven papers, including clinical trials and systematic reviews were chosen and analyzed. The extracted data was used to evaluate the change in blood pressure levels between standard HD and EHD. Overall, the studies showed that EHD resulted in improved blood pressure management; therefore, we concluded that there will be a decrease in cardiovascular disease risk, stroke, and morbidity and mortality rate. There will be also an improvement in patient QOL due to beneficial effects of the EHD.
      Citation: Healthcare
      PubDate: 2017-09-02
      DOI: 10.3390/healthcare5030052
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 53: Paint it Black: Using Change-Point Analysis
           to Investigate Increasing Vulnerability to Depression towards the End of
           Vincent van Gogh’s Life

    • Authors: Arnold van Emmerik, Ellen Hamaker
      First page: 53
      Abstract: This study investigated whether Vincent van Gogh became increasingly self-focused—and thus vulnerable to depression—towards the end of his life, through a quantitative analysis of his written pronoun use over time. A change-point analysis was conducted on the time series formed by the pronoun use in Van Gogh’s letters. We used time as a predictor to see whether there was evidence for increased self-focus towards the end of Van Gogh’s life, and we compared this to the pattern in the letters written before his move to Arles. Specifically, we examined Van Gogh’s use of first person singular pronouns (FPSP) and first person plural pronouns (FPPP) in the 415 letters he wrote while working as an artist before his move to Arles, and in the next 248 letters he wrote after his move to Arles until his death in Auvers-sur-Oise. During the latter period, Van Gogh’s use of FPSP showed an annual increase of 0.68% (SE = 0.15, p < 0.001) and his use of FPPP showed an annual decrease of 0.23% (SE = 0.04, p < 0.001), indicating increasing self-focus and vulnerability to depression. This trend differed from Van Gogh’s pronoun use in the former period (which showed no significant trend in FPSP, and an annual increase of FPPP of 0.03%, SE = 0.02, p = 0.04). This study suggests that Van Gogh’s death was preceded by a gradually increasing self-focus and vulnerability to depression. It also illustrates how existing methods (i.e., quantitative linguistic analysis and change-point analysis) can be combined to study specific research questions in innovative ways.
      Citation: Healthcare
      PubDate: 2017-09-04
      DOI: 10.3390/healthcare5030053
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 54: Decrease in Healthcare Utilization and Costs
           for Opioid Users Following Residential Integrated Treatment for
           Co-Occurring Disorders

    • Authors: Siobhan Morse, Brian Bride
      First page: 54
      Abstract: Background: Opioid use results in higher healthcare utilization and costs, particularly among those with co-occurring mental health disorders. Presumably, effective treatment would result in a reduction in healthcare utilization and costs. To date, research has not examined this question. As such, the purpose of this study was to estimate and compare pre- and post-treatment healthcare utilization and costs for individuals receiving residential integrated treatment for co-occurring mental health and opioid use disorders. Methods: A single-group, repeated measures design was used to examine changes in pre- and post-treatment healthcare utilization and costs among a sample of individuals with co-occurring mental health and opioid use disorders who received residential, integrated treatment. Results: Significant reductions in emergency rooms visits, inpatient admissions, and resulting costs were observed in the six months following treatment. Conclusions: Residential, integrated treatment of co-occurring mental health and opioid use disorders can significantly decrease both utilization and cost of healthcare among opioid users with co-occurring mental health disorders.
      Citation: Healthcare
      PubDate: 2017-09-07
      DOI: 10.3390/healthcare5030054
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 55: Attitudes towards Human Papilloma Virus
           Vaccination in the Latin American Andean Region

    • Authors: Oroma Nwanodi
      First page: 55
      Abstract: This commentary explores the distribution of human papilloma virus (HPV) and HPV-related diseases, and factors affecting attitudes towards HPV, HPV-related diseases, and HPV vaccination in the Latin American Andean region. Lack of knowledge of HPV, known negative attitudes or incorrect assumptions about HPV, HPV-related diseases, and HPV vaccination provide a basis upon which to develop targeted HPV awareness and preventive health media campaigns. For maximal effect, media campaigns should use the internet, radio, and television to address health care providers, parents, and students. Additional programming can be developed for clinics to use in-house with their clients. Ministries of Education, Finance, and Health all have roles to play to increase national HPV, HPV-related diseases, and HPV vaccination awareness.
      Citation: Healthcare
      PubDate: 2017-09-08
      DOI: 10.3390/healthcare5030055
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 56: Reducing the Shared Burden of Chronic
           Conditions among Persons Aging with Disability and Older Adults in the
           United States through Bridging Aging and Disability

    • Authors: Margaret Campbell, Michelle Putnam
      First page: 56
      Abstract: Persons aging with long-term disabilities such as spinal cord injury or multiple sclerosis and older adults share similar chronic conditions in mid and later life in the United States. The rising general interest and more prevalent federal requirements for use of evidence-based practices (EBP) in health promotion and chronic condition interventions highlight the gap between demand and the availability of EBPs for persons aging with disability in particular. Addressing this gap will require focused efforts that will benefit substantially by bridging the fields of aging and disability/rehabilitation to develop new EBPs, translate existing EBPs across populations, and borrow best practices across fields where there are few current EBPs. Understanding distinctions between disability-related secondary conditions and age-related chronic conditions is a first step in identifying shared conditions that are important to address for both mid-life and older adults with disabilities. This review articulates these distinctions, describes shared conditions, and discusses the current lack of EBPs for both populations. It also provides recommendations for bridging activities in the United States by researchers, professionals, and consumer advocates. We argue that these can more efficiently move research and practice than if activities were undertaken separately in each field (aging and disability/rehabilitation).
      Citation: Healthcare
      PubDate: 2017-09-12
      DOI: 10.3390/healthcare5030056
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 57: Performable Case Studies in Ethics Education

    • Authors: Richard Robeson, Nancy M. P. King
      First page: 57
      Abstract: Bioethics education often includes the study of short stories, novels, plays, and films, because such materials present case examples that can highlight relevant issues and questions especially vividly for a wide range of students. In addition, creative writing is widely used in the education of health professional students and in continuing education settings for health professionals. There are very few academic or professional disciplines that do not use case studies, but the case study in dialogic form has not been standard practice for thousands of years. Dramatic arts casuistry—the creation and performance of short case studies designed specifically to raise bioethics issues for discussion—represents an application of literature and the medical humanities that is both unique and uniquely valuable. This essay describes the development and history of a course that has been successfully taught to medical students and graduate bioethics students, in which the class researches, writes, and performs a case study designed to elicit reflection and discussion about a topic and set of bioethics issues of current interest to both academic and general audiences. The model is also suited to the presentation and discussion of existing case studies, both live and via on-demand audio.
      Citation: Healthcare
      PubDate: 2017-09-12
      DOI: 10.3390/healthcare5030057
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 58: Force and Presence in the World of Medicine

    • Authors: Alan Bleakley
      First page: 58
      Abstract: Medicine can not only be read with a poetic imagination, but also configured as a poetic practice, moving beyond the instrumental. The poet Wallace Stevens made a distinction between ‘Force’ and ‘Presence’—the former can be read as combative, the latter as pacific. Modern medicine has been shaped historically by the combative metaphor of a ‘war against disease’, turning medicine into a quasi-militaristic culture fond of hierarchy. This is supplemented by the metaphor of the ‘body as machine’, reducing the complex and unpredictable body to a linear, if complicated, apparatus. The two metaphors align medicine with the modern industrial–military complex that is masculine, heroic, and controlling in character. In an era in which medicine is feminising and expected to be patient-centred, collaborative (inter-professional) and transparent to the public as a democratic gesture, the industrial–military metaphor complex should no longer be shaping medicine—yet its influence is still keenly felt, especially in surgery. This continuing dominance of Force over Presence matters because it is a style running counter to the collaborative, team-based medicine needed for high levels of patient safety. Medicine will authentically democratise only as new, pacific shaping metaphors emerge: those of ‘Presence’, such as ‘hospitality’. Hospitals can once again become places of hospitality.
      Citation: Healthcare
      PubDate: 2017-09-13
      DOI: 10.3390/healthcare5030058
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 59: “Found Performance”: Towards a Musical
           Methodology for Exploring the Aesthetics of Care

    • Authors: Stuart Wood
      First page: 59
      Abstract: Concepts of performance in fine art reflect key processes in music therapy. Music therapy enables practitioners to reframe patients as performers, producing new meanings around the clinical knowledge attached to medical histories and constructs. In this paper, music therapy practices are considered in the wider context of art history, with reference to allied theories from social research. Tracing a century in art that has revised the performativity of found objects (starting with Duchamp’s “Fountain”), and of found sound (crystallised by Cage’s 4′ 33) this paper proposes that music therapy might be a pioneer methodology of “found performance”. Examples from music therapy and contemporary socially engaged art practices are brought as potential links between artistic methodologies and medical humanities research, with specific reference to notions of Aesthetics of Care.
      Citation: Healthcare
      PubDate: 2017-09-18
      DOI: 10.3390/healthcare5030059
      Issue No: Vol. 5, No. 3 (2017)
  • Healthcare, Vol. 5, Pages 18: Disability and Psychiatric Symptoms in Men
           Referred for Treatment with Work-Related Problems to Primary Mental Health

    • Authors: S. Bailey, Christopher Mushquash, John Haggarty
      First page: 18
      Abstract: The relationship between male sex and employment as barriers to accessing mental health care is unclear. The aim of this research was to examine (1) whether the clinical features of men referred to a shared mental health care (SMHC) service through primary care differed when symptoms were affecting them in the work domain; and (2) empirically re-evaluate the effectiveness of a SMHC model for work-related disability using a pre-post chart review of N = 3960 referrals to SMHC. ANOVA and logistic regression were performed to examine symptoms (Patient Health Questionnaire, PHQ) and disability (World Health Organization Disability Assessment Schedule, WHODAS 2) at entry and discharge. Men were RR (relative risk) = 1.8 (95% C.I.: 1.60–2.05) times more likely to be referred to SMHC with work problems than women. Having greater disability and more severe somatic symptoms increased the likelihood of a work-related referral. There were no significant differences after treatment. Problems in the work domain may play an important role in men’s treatment seeking and clinicians’ recognition of a mental health care need. This study is relevant because men are underrepresented in mental health (MH) treatment and primary care is the main gateway to accessing MH care. Asking men about functioning in the work domain may increase access to helpful psychiatric services.
      PubDate: 2017-03-24
      DOI: 10.3390/healthcare5020018
      Issue No: Vol. 5, No. 2 (2017)
  • Healthcare, Vol. 5, Pages 19: Healthcare Engagement as a Potential Source
           of Psychological Distress among People without Religious Beliefs: A
           Systematic Review

    • Authors: Samuel Weber, James Lomax, Kenneth Pargament
      First page: 19
      Abstract: Research into religion and mental health is increasing, but nonbelievers in terms of religion are often overlooked. Research has shown that nonbelievers experience various forms of psychological distress and that the negative perception of nonbelievers by others is a potential source of distress. This review builds on that research by identifying another potential source of psychological distress for nonbelievers: engagement with the healthcare system. Poor understanding of nonbelievers by healthcare professionals may lead to impaired communication in the healthcare setting, resulting in distress. Attempts by nonbelievers to avoid distress may result in different patterns of healthcare utilization. Awareness of these concerns may help healthcare providers to minimize distress among their nonbelieving patients.
      PubDate: 2017-04-05
      DOI: 10.3390/healthcare5020019
      Issue No: Vol. 5, No. 2 (2017)
  • Healthcare, Vol. 5, Pages 20: Hand Motion Detection in fNIRS Neuroimaging

    • Authors: Mohammadreza Abtahi, Amir Amiri, Dennis Byrd, Kunal Mankodiya
      First page: 20
      Abstract: As the number of people diagnosed with movement disorders is increasing, it becomes vital to design techniques that allow the better understanding of human brain in naturalistic settings. There are many brain imaging methods such as fMRI, SPECT, and MEG that provide the functional information of the brain. However, these techniques have some limitations including immobility, cost, and motion artifacts. One of the most emerging portable brain scanners available today is functional near-infrared spectroscopy (fNIRS). In this study, we have conducted fNIRS neuroimaging of seven healthy subjects while they were performing wrist tasks such as flipping their hand with the periods of rest (no movement). Different models of support vector machine is applied to these fNIRS neuroimaging data and the results show that we could classify the action and rest periods with the accuracy of over 80% for the fNIRS data of individual participants. Our results are promising and suggest that the presented classification method for fNIRS could further be applied to real-time applications such as brain computer interfacing (BCI), and into the future steps of this research to record brain activity from fNIRS and EEG, and fuse them with the body motion sensors to correlate the activities.
      PubDate: 2017-04-15
      DOI: 10.3390/healthcare5020020
      Issue No: Vol. 5, No. 2 (2017)
  • Healthcare, Vol. 5, Pages 21: Irritable Bowel Syndrome: Clinical
           Manifestations, Dietary Influences, and Management

    • Authors: Ronald Ikechi, Bradford Fischer, Joshua DeSipio, Sangita Phadtare
      First page: 21
      Abstract: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is characterized by symptoms of chronic abdominal pain and altered bowel habits in the absence of an overtly identifiable cause. It is the most commonly diagnosed functional gastrointestinal disorder, accounting for about one third of gastroenterology visits. It generally presents as a complex of symptoms, including psychological dysfunction. Hypersensitivity to certain foods, especially foods that contain high amounts of fructose, plays a role in the pathophysiology of IBS. Elevated consumption of high-fructose corn syrup (HFCS) has been discussed in this aspect. The treatment options for IBS are challenging and varied. In addition to dietary restrictions for HFCS-induced IBS, such as low-FODMAP (Fermentable Oligosaccharides, Disaccharide, Monosaccharides, and Polyols) diets, existing drug therapies are administered based on the predominant symptoms and IBS-subtype. Patients with IBS are likely to suffer from issues, such as anxiety, depression, and post-traumatic-stress disorder. Biopsychosocial factors particularly socioeconomic status, sex, and race should, thus, be considered for diagnostic evaluation of patients with IBS.
      PubDate: 2017-04-26
      DOI: 10.3390/healthcare5020021
      Issue No: Vol. 5, No. 2 (2017)
  • Healthcare, Vol. 5, Pages 22: Reliability and Validity of the Medical
           Outcomes Study Short Form-12 Version 2 (SF-12v2) in Adults with Non-Cancer

    • Authors: Corey Hayes, Naleen Bhandari, Niranjan Kathe, Nalin Payakachat
      First page: 22
      Abstract: Limited evidence exists on how non-cancer pain (NCP) affects an individual’s health-related quality of life (HRQoL). This study aimed to validate the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2), a generic measure of HRQoL, in a NCP cohort using the Medical Expenditure Panel Survey Longitudinal Files. The SF Mental Component Summary (MCS12) and SF Physical Component Summary (PCS12) were tested for reliability (internal consistency and test-retest reliability) and validity (construct: convergent and discriminant; criterion: concurrent and predictive). A total of 15,716 patients with NCP were included in the final analysis. The MCS12 and PCS12 demonstrated high internal consistency (Cronbach’s alpha and Mosier’s alpha > 0.8), and moderate and high test-retest reliability, respectively (MCS12 intraclass correlation coefficient (ICC): 0.64; PCS12 ICC: 0.73). Both scales were significantly associated with a number of chronic conditions (p < 0.05). The PCS12 was strongly correlated with perceived health (r = 0.52) but weakly correlated with perceived mental health (r = 0.25). The MCS12 was moderately correlated with perceived mental health (r = 0.42) and perceived health (r = 0.33). Increasing PCS12 and MCS12 scores were significantly associated with lower odds of reporting future physical and cognitive limitations (PCS12: OR = 0.90 95%CI: 0.89–0.90, MCS12: OR = 0.94 95%CI: 0.93–0.94). In summary, the SF-12v2 is a reliable and valid measure of HRQoL for patients with NCP.
      PubDate: 2017-04-26
      DOI: 10.3390/healthcare5020022
      Issue No: Vol. 5, No. 2 (2017)
  • Healthcare, Vol. 5, Pages 23: Acceptance and Commitment Therapy for
           Inpatients with Psychosis (the REACH Study): Protocol for Treatment
           Development and Pilot Testing

    • Authors: Brandon Gaudiano, Carter Davis, Gary Epstein-Lubow, Jennifer Johnson, Kim Mueser, Ivan Miller
      First page: 23
      Abstract: Patients with schizophrenia-spectrum disorders frequently require treatment at inpatient hospitals during periods of acute illness for crisis management and stabilization. Acceptance and Commitment Therapy (ACT), a “third wave” cognitive-behavioral intervention that employs innovative mindfulness-based strategies, has shown initial efficacy in randomized controlled trials for improving acute and post-discharge outcomes in patients with psychosis when studied in acute-care psychiatric hospitals in the U.S. However, the intervention has not been widely adopted in its current form because of its use of an individual-only format and delivery by doctoral-level research therapists with extensive prior experience using ACT. The aim of the Researching the Effectiveness of Acceptance-based Coping during Hospitalization (REACH) Study is to adapt a promising acute-care psychosocial treatment for inpatients with psychosis, and to pilot test its effectiveness in a routine inpatient setting. More specifically, we describe our plans to: (a) further develop and refine the treatment and training protocols, (b) conduct an open trial and make further modifications based on the experience gained, and (c) conduct a pilot randomized controlled trial in preparation for a future fully-powered clinical trial testing the effectiveness of ACT.
      PubDate: 2017-05-05
      DOI: 10.3390/healthcare5020023
      Issue No: Vol. 5, No. 2 (2017)
  • Healthcare, Vol. 5, Pages 24: Microbiota and Particulate Matter Assessment
           in Portuguese Optical Shops Providing Contact Lens Services

    • Authors: Carla Viegas, Tiago Faria, Cátia Pacífico, Mateus Dos Santos, Ana Monteiro, Carla Lança, Elisabete Carolino, Susana Viegas, Sandra Cabo Verde
      First page: 24
      Abstract: The aim of this work was to assess the microbiota (fungi and bacteria) and particulate matter in optical shops, contributing to a specific protocol to ensure a proper assessment. Air samples were collected through an impaction method. Surface and equipment swab samples were also collected side-by-side. Measurements of particulate matter were performed using portable direct-reading equipment. A walkthrough survey and checklist was also applied in each shop. Regarding air sampling, eight of the 13 shops analysed were above the legal requirement and 10 from the 26 surfaces samples were overloaded. In three out of the 13 shops fungal contamination in the analysed equipment was not detected. The bacteria air load was above the threshold in one of the 13 analysed shops. However, bacterial counts were detected in all sampled equipment. Fungi and bacteria air load suggested to be influencing all of the other surface and equipment samples. These results reinforce the need to improve air quality, not only to comply with the legal requirements, but also to ensure proper hygienic conditions. Public health intervention is needed to assure the quality and safety of the rooms and equipment in optical shops that perform health interventions in patients.
      PubDate: 2017-05-15
      DOI: 10.3390/healthcare5020024
      Issue No: Vol. 5, No. 2 (2017)
  • Healthcare, Vol. 5, Pages 25: Linoleic Acid: A Nutritional Quandary

    • Authors: Ronald J. Jandacek
      First page: 25
      Abstract: Over the course of the twentieth century, there was a 20-fold increase in consumption of vegetable oils resulting both from their increased availability and from recommendations to consume these oils as an aid to lower blood cholesterol levels. This dietary change markedly increased the consumption of linoleic acid to current levels of approximately 6% of total dietary energy. While considerable research has focused on the effects of dietary linoleic acid on cardiovascular health, questions about optimum dietary levels remain. For example, meta-analyses disagree about the role of dietary linoleic acid in atherosclerosis, and recent publications indicate that linoleic acid’s reduction of blood cholesterol levels does not predict its effect on the development of atherosclerosis. Further, there are also detrimental effects of elevated dietary linoleic acid on human health related to its role in inflammation and its activity as a promoter of cancer in animals. Current data do not allow determination of the level of dietary linoleic acid needed for optimum health. Studies of the effects of a wide range of linoleic acid consumption may help determine dietary recommendations that are optimal for human health.
      PubDate: 2017-05-20
      DOI: 10.3390/healthcare5020025
      Issue No: Vol. 5, No. 2 (2017)
  • Healthcare, Vol. 5, Pages 26: Breast Cancer: Exploring the Facts and
           Holistic Needs during and beyond Treatment

    • Authors: Zhi Ng, Mei Ong, Tamilarasi Jegadeesan, Shuo Deng, Celestial Yap
      First page: 26
      Abstract: Breast cancer patients face challenges throughout the journey of diagnosis, treatment, post-treatment, and recovery. The breast cancer patient is exposed to a multidisciplinary team including doctors, nurses, therapists, counselors, and psychologists. While the team assembled together aims to address multiple facets in breast cancer care, the sub-specialized nature of individual professional practices may constrain the overview of patients’ holistic needs and a comprehensive approach to cancer management. This paper aims to provide an overview of the holistic needs of breast cancer patients at each stage of their cancer journey, addressing their complex physical, psychological, and social needs. As every patient is different, cancer care has to be tailored to each patient based on a holistic needs assessment. This paper also explores how support can be provided from the perspectives of the healthcare providers, family members and caretakers. Examples of general practices at healthcare institutions worldwide as well as supportive care provided by support groups are discussed. The needs of breast cancer patients extend beyond the resolution of cancer as a disease, and the restoration of health as far as possible is a critical component of healing. Understanding the complex issues involved in the journey of breast cancer will aid healthcare providers to be better equipped to sensitively address their concerns and focus on healing the patient holistically. Methodology: This paper provides a literature review of validated practices in different countries and elaborates on the holistic needs of patients at various stages of recovery. This review is based on more than a decade of publications sourced from multiple resources including PubMed journal articles; books and official websites of breast cancer organizations.
      PubDate: 2017-05-24
      DOI: 10.3390/healthcare5020026
      Issue No: Vol. 5, No. 2 (2017)
  • Healthcare, Vol. 5, Pages 27: The Role of Affect and Cognition in
           Processing Messages about Early Diagnosis for Alzheimer’s Disease by
           Older People

    • Authors: Patrick De Pelsmacker, Martine Lewi, Veroline Cauberghe
      First page: 27
      Abstract: Through early diagnosis of symptoms, the Alzheimer’s disease process can be decelerated. The main concern is to encourage the population at risk to take responsible actions at the earliest stage of the onset of the disease. Persuasive communication is essential to achieve this. In an experimental study, the evaluation of awareness messages for early diagnosis containing weak and strong arguments and negative and positive images was performed on a sample of older Belgians. The mediating role of affective responses and message thoughts was explored. Strong arguments led to a more positive evaluation of the message than weak arguments directly and indirectly via the positive effect they had on message affect and thoughts, which, in turn, positively affected message evaluation. A negative message image led to a more positive message evaluation than a positive one. This effect was not mediated by either message affect or message thoughts.
      PubDate: 2017-06-12
      DOI: 10.3390/healthcare5020027
      Issue No: Vol. 5, No. 2 (2017)
  • Healthcare, Vol. 5, Pages 28: Population Characteristics in a Tertiary
           Pain Service Cohort Experiencing Chronic Non-Cancer Pain: Weight Status,
           Comorbidities, and Patient Goals

    • Authors: Katherine Brain, Tracy Burrows, Megan Rollo, Chris Hayes, Fiona Hodson, Clare Collins
      First page: 28
      Abstract: We describe the characteristics of patients attending an Australian tertiary multidisciplinary pain service and identify areas for nutrition interventions. This cross-sectional study targets patients experiencing chronic pain who attended the service between June–December 2014. Self-reported data was captured from: (1) an Electronic Persistent Pain Outcomes Collaboration (ePPOC) referral questionnaire, incorporating demographics, pain status, and mental health; (2) a Pain Assessment and Recovery Plan (PARP), which documents patients’ perceived problems associated with pain and personal treatment goals. The ePPOC referral questionnaire was completed by 166 patients and the PARP by 153. The mean (SD) patient age was 53 ± 13 years, with almost 60% experiencing pain for >5 years. Forty-five percent of patients were classified as obese (BMI ≥ 30 kg/m2, mean (SD) BMI was 31 ± 7 kg/m2), with a mean waist circumference of 104 ± 19.4 cm (SD). The most frequent patient nominated treatment goals related to physical activity (39%), followed by nutritional goals (23%). Traditionally, pain management programs have included physical, psychosocial, and medical, but not nutritional, interventions. By contrast, patients identified and reported important nutrition-related treatment goals. There is a need to test nutrition treatment pathways, including an evaluation of dietary intake and nutrition support. This will help to optimize dietary behaviors and establish nutrition as an important component of multidisciplinary chronic pain management.
      PubDate: 2017-06-14
      DOI: 10.3390/healthcare5020028
      Issue No: Vol. 5, No. 2 (2017)
  • Healthcare, Vol. 5, Pages 29: Saturated Fatty Acids and Cardiovascular
           Disease: Replacements for Saturated Fat to Reduce Cardiovascular Risk

    • Authors: Michelle Briggs, Kristina Petersen, Penny Kris-Etherton
      First page: 29
      Abstract: Dietary recommendations to decrease the risk of cardiovascular disease (CVD) have focused on reducing intake of saturated fatty acids (SFA) for more than 50 years. While the 2015–2020 Dietary Guidelines for Americans advise substituting both monounsaturated and polyunsaturated fatty acids for SFA, evidence supports other nutrient substitutions that will also reduce CVD risk. For example, replacing SFA with whole grains, but not refined carbohydrates, reduces CVD risk. Replacing SFA with protein, especially plant protein, may also reduce CVD risk. While dairy fat (milk, cheese) is associated with a slightly lower CVD risk compared to meat, dairy fat results in a significantly greater CVD risk relative to unsaturated fatty acids. As research continues, we will refine our understanding of dietary patterns associated with lower CVD risk.
      PubDate: 2017-06-21
      DOI: 10.3390/healthcare5020029
      Issue No: Vol. 5, No. 2 (2017)
  • Healthcare, Vol. 5, Pages 2: Impact of Menthol Smoking on Nicotine
           Dependence for Diverse Racial/Ethnic Groups of Daily Smokers

    • Authors: Julia Soulakova, Ryan Danczak
      First page: 2
      Abstract: Introduction: The aims of this study were to evaluate whether menthol smoking and race/ethnicity are associated with nicotine dependence in daily smokers. Methods: The study used two subsamples of U.S. daily smokers who responded to the 2010–2011 Tobacco Use Supplement to the Current Population Survey. The larger subsample consisted of 18,849 non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic (HISP) smokers. The smaller subsample consisted of 1112 non-Hispanic American Indian/Alaska Native (AIAN), non-Hispanic Asian (ASIAN), non-Hispanic Hawaiian/Pacific Islander (HPI), and non-Hispanic Multiracial (MULT) smokers. Results: For larger (smaller) groups the rates were 45% (33%) for heavy smoking (16+ cig/day), 59% (51%) for smoking within 30 min of awakening (Sw30), and 14% (14%) for night-smoking. Overall, the highest prevalence of menthol smoking corresponded to NHB and HPI (≥65%), followed by MULT and HISP (31%–37%), and then by AIAN, NHW, and ASIAN (22%–27%) smokers. For larger racial/ethnic groups, menthol smoking was negatively associated with heavy smoking, not associated with Sw30, and positively associated with night-smoking. For smaller groups, menthol smoking was not associated with any measure, but the rates of heavy smoking, Sw30, and night-smoking varied across the groups. Conclusions: The diverse associations between menthol smoking and nicotine dependence maybe due to distinction among the nicotine dependence measures, i.e., individually, each measure assesses a specific smoking behavior. Menthol smoking may be associated with promoting smoking behaviors.
      PubDate: 2017-01-11
      DOI: 10.3390/healthcare5010002
      Issue No: Vol. 5, No. 1 (2017)
  • Healthcare, Vol. 5, Pages 3: Acknowledgement to Reviewers of Healthcare in

    • Authors: Healthcare Editorial Office
      First page: 3
      Abstract: n/a
      PubDate: 2017-01-10
      DOI: 10.3390/healthcare5010003
      Issue No: Vol. 5, No. 1 (2017)
  • Healthcare, Vol. 5, Pages 4: Brazilian Specialists’ Perspectives on the
           Patient Referral Process

    • Authors: Carmen Juliani, Maura MacPhee, Wilza Spiri
      First page: 4
      Abstract: Since 1988, healthcare has been considered a citizen’s right in Brazil. The Sistema Único de Saúde (SUS), has undergone development and expansion to ensure universal health coverage for the Brazilian public, the world’s fifth largest population. The coordination of effective communications between primary care physicians, specialists and patients is a significant challenge, particularly the referral process. Our study objective was to understand the facilitators and barriers associated with referral process communications between primary care physicians and regional university hospital specialists in the State of Sao Paulo. This paper reports specialists’ perspectives of the referral process. This was a phenomenological study that employed a qualitative research method with three components (description, reduction and comprehension). We conducted focus groups with 54 hospital residents from different specialties (surgery, medicine, obstetrics/gynecology, pediatrics) from July to October 2014. The main results showed lack of an adequate referral-return referral process resulting in treatment delays and inappropriate use of emergency services. Communications were impeded by lack of integrated, computerized booking and standardized referral-return referral processes; underlying lack of trust in primary care physicians; and patients’ inappropriate use of healthcare services. Although computerized systems will facilitate communications between primary and specialty care, other strategies are needed to promote collaboration between services, and ensure appropriate utilization of them.
      PubDate: 2017-01-29
      DOI: 10.3390/healthcare5010004
      Issue No: Vol. 5, No. 1 (2017)
  • Healthcare, Vol. 5, Pages 5: The Role of Lipid Biomarkers in Major

    • Authors: Amy Parekh, Demelza Smeeth, Yasmin Milner, Sandrine Thure
      First page: 5
      Abstract: In the UK, the lifetime-documented prevalence of major depressive disorder (MDD) is currently 10%. Despite its increasing prevalence and devastating impact on quality of life, the pathophysiological mechanisms underpinning MDD remain to be fully elucidated. Current theories of neurobiological components remain incomplete and protein-centric, rendering pharmacological treatment options suboptimal. In this review, we highlight the pivotal role of lipids in intra- and inter-neuronal functioning, emphasising the potential use of lipids as biomarkers for MDD. The latter has significant implications for improving our understanding of MDD at the cellular and circuit level. There is particular focus on cholesterol (high and low density lipoprotein), omega-3, and omega-6 polyunsaturated fatty acids due to established evidence in the literature of a link between atherosclerotic disease and major depression. We argue that there is significant potential scope for the use of such peripheral biomarkers in the diagnosis, stratification and treatment of MDD.
      PubDate: 2017-02-03
      DOI: 10.3390/healthcare5010005
      Issue No: Vol. 5, No. 1 (2017)
  • Healthcare, Vol. 5, Pages 6: Reducing Low Birth Weight among African
           Americans in the Midwest: A Look at How Faith-Based Organizations Are
           Poised to Inform and Influence Health Communication on the Developmental
           Origins of Health and Disease (DOHaD)

    • Authors: Crystal Lumpkins, Jarron Saint Onge
      First page: 6
      Abstract: Low birth weight (LBW) rates remain the highest among African Americans despite public health efforts to address these disparities; with some of the highest racial disparities in the Midwest (Kansas). The Developmental Origins of Health and Disease (DOHaD) perspective offers an explanation for how LBW contributes to racial health disparities among African Americans and informs a community directed health communication framework for creating sustainable programs to address these disparities. Trusted community organizations such as faith-based organizations are well situated to explain health communication gaps that may occur over the life course. These entities are underutilized in core health promotion programming targeting underserved populations and can prove essential for addressing developmental origins of LBW among African Americans. Extrapolating from focus group data collected from African American church populations as part of a social marketing health promotion project on cancer prevention, we theoretically consider how a similar communication framework and approach may apply to address LBW disparities. Stratified focus groups (n = 9) were used to discover emergent themes about disease prevention, and subsequently applied to explore how faith-based organizations (FBOs) inform strategic health care (media) advocacy and health promotion that potentially apply to address LBW among African Americans. We argue that FBOs are poised to meet health promotion and health communication needs among African American women who face social barriers in health.
      PubDate: 2017-02-04
      DOI: 10.3390/healthcare5010006
      Issue No: Vol. 5, No. 1 (2017)
  • Healthcare, Vol. 5, Pages 7: Socio-Demographic Determinants of Diet
           Quality in Australian Adults Using the Validated Healthy Eating Index for
           Australian Adults (HEIFA-2013)

    • Authors: Amanda Grech, Zhixian Sui, Hong Siu, Miaobing Zheng, Margaret Allman-Farinelli, Anna Rangan
      First page: 7
      Abstract: Diet quality indices have been shown to predict cardiovascular disease, cancer, Type 2 Diabetes, obesity and all-cause mortality. This study aimed to determine the socio-demographics of Australian adults with poor diet quality. Diet quality was assessed for participants of the 2011–2012 National Nutrition and Physical Activity Survey aged 18 years or above (n = 9435), with the validated 11-component Healthy Eating Index for Australians (HEIFA-2013), based on the 2013 Australian Dietary Guidelines. Differences in scores by demographics (ANOVA) and regression models for associations between the HEIFA-2013 score and demographic characteristics were conducted. The mean (SD) HEIFA-2013 score was 45.5 (14.7) out of 100 due to poor intakes of vegetables, fruit, grains, dairy and fat and high intakes of added sugar, sodium and discretionary foods. Lower mean HEIFA-2013 scores (SD) were found for males 43.3 (14.7), young-adults 41.6 (14.2) obese 44.1 (14.3), smokers 40.0 (14.2), low socio-economic status 43.7 (14.9) and Australian country-of-birth 44.2 (14.6) (p < 0.05). The overall diet quality of the Australian population is poor and targeted interventions for young-adults, males, obese and those with lower socio-economic status are recommended.
      PubDate: 2017-02-04
      DOI: 10.3390/healthcare5010007
      Issue No: Vol. 5, No. 1 (2017)
  • Healthcare, Vol. 5, Pages 8: Preventive Healthcare: A Neural Network
           Analysis of Behavioral Habits and Chronic Diseases

    • Authors: Viju Raghupathi, Wullianallur Raghupathi
      First page: 8
      Abstract: The research aims to explore the association between behavioral habits and chronic diseases, and to identify a portfolio of risk factors for preventive healthcare. The data is taken from the Behavioral Risk Factor Surveillance System (BRFSS) database of the Centers for Disease Control and Prevention, for the year 2012. Using SPSS Modeler, we deploy neural networks to identify strong positive and negative associations between certain chronic diseases and behavioral habits. The data for 475,687 records from BRFS database included behavioral habit variables of consumption of soda and fruits/vegetables, alcohol, smoking, weekly working hours, and exercise; chronic disease variables of heart attack, stroke, asthma, and diabetes; and demographic variables of marital status, income, and age. Our findings indicate that with chronic conditions, behavioral habits of physical activity and fruit and vegetable consumption are negatively associated; soda, alcohol, and smoking are positively associated; and income and age are positively associated. We contribute to individual and national preventive healthcare by offering a portfolio of significant behavioral risk factors that enable individuals to make lifestyle changes and governments to frame campaigns and policies countering chronic conditions and promoting public health.
      PubDate: 2017-02-06
      DOI: 10.3390/healthcare5010008
      Issue No: Vol. 5, No. 1 (2017)
  • Healthcare, Vol. 5, Pages 9: UK Dietary Policy for the Prevention of
           Cardiovascular Disease

    • Authors: Louis Levy, Alison Tedstone
      First page: 9
      Abstract: Nutrition advice is devolved within each of the four UK countries, but share a common evidence base provided through the Scientific Advisory Committee on Nutrition (SACN). Current UK dietary recommendations to prevent cardiovascular disease (CVD) is based upon recommendations from SACN and its predecessor committee. Dietary advice in the UK has recently been revised in relation to intakes of free sugar and fibre. This paper highlights current UK recommendations for the prevention of CVD, in particular related to energy intake, saturated fat, free sugars, salt, fruit, vegetables, oily fish and fibre. It describes how this advice is promulgated including the refresh of the Eatwell Guide and wider action that will impact on CVD.
      PubDate: 2017-02-20
      DOI: 10.3390/healthcare5010009
      Issue No: Vol. 5, No. 1 (2017)
  • Healthcare, Vol. 5, Pages 10: Conceptual Foundations of Systems Biology
           Explaining Complex Cardiac Diseases

    • Authors: George Louridas, Katerina Lourida
      First page: 10
      Abstract: Systems biology is an important concept that connects molecular biology and genomics with computing science, mathematics and engineering. An endeavor is made in this paper to associate basic conceptual ideas of systems biology with clinical medicine. Complex cardiac diseases are clinical phenotypes generated by integration of genetic, molecular and environmental factors. Basic concepts of systems biology like network construction, modular thinking, biological constraints (downward biological direction) and emergence (upward biological direction) could be applied to clinical medicine. Especially, in the field of cardiology, these concepts can be used to explain complex clinical cardiac phenotypes like chronic heart failure and coronary artery disease. Cardiac diseases are biological complex entities which like other biological phenomena can be explained by a systems biology approach. The above powerful biological tools of systems biology can explain robustness growth and stability during disease process from modulation to phenotype. The purpose of the present review paper is to implement systems biology strategy and incorporate some conceptual issues raised by this approach into the clinical field of complex cardiac diseases. Cardiac disease process and progression can be addressed by the holistic realistic approach of systems biology in order to define in better terms earlier diagnosis and more effective therapy.
      PubDate: 2017-02-21
      DOI: 10.3390/healthcare5010010
      Issue No: Vol. 5, No. 1 (2017)
  • Healthcare, Vol. 5, Pages 11: WearSense: Detecting Autism Stereotypic
           Behaviors through Smartwatches

    • Authors: Amir Amiri, Nicholas Peltier, Cody Goldberg, Yan Sun, Anoo Nathan, Shivayogi Hiremath, Kunal Mankodiya
      First page: 11
      Abstract: Autism is a complex developmental disorder that affects approximately 1 in 68 children (according to the recent survey conducted by the Centers for Disease Control and Prevention—CDC) in the U.S., and has become the fastest growing category of special education. Each student with autism comes with her or his own unique needs and an array of behaviors and habits that can be severe and which interfere with everyday tasks. Autism is associated with intellectual disability, impairments in social skills, and physical health issues such as sleep and abdominal disturbances. We have designed an Internet-of-Things (IoT) framework named WearSense that leverages the sensing capabilities of modern smartwatches to detect stereotypic behaviors in children with autism. In this work, we present a study that used the inbuilt accelerometer of a smartwatch to detect three behaviors, including hand flapping, painting, and sibbing that are commonly observed in children with autism. In this feasibility study, we recruited 14 subjects to record the accelerometer data from the smartwatch worn on the wrist. The processing part extracts 34 different features in each dimension of the three-axis accelerometer, resulting in 102 features. Using and comparing various classification techniques revealed that an ensemble of 40 decision trees has the best accuracy of around 94.6%. This accuracy shows the quality of the data collected from the smartwatch and feature extraction methods used in this study. The recognition of these behaviors by using a smartwatch would be helpful in monitoring individuals with autistic behaviors, since the smartwatch can send the data to the cloud for comprehensive analysis and also to help parents, caregivers, and clinicians make informed decisions.
      PubDate: 2017-02-28
      DOI: 10.3390/healthcare5010011
      Issue No: Vol. 5, No. 1 (2017)
  • Healthcare, Vol. 5, Pages 12: Minerals and Trace Elements Intakes and Food
           Consumption Patterns of Young Children Living in Rural Areas of Tibet
           Autonomous Region, P.R. China: A Cross-Sectional Survey

    • Authors: Michael Dermience, Françoise Mathieu, Xiao Li, Stefanie Vandevijvere, William Claus, Viviane De Maertelaer, Ghislaine Dufourny, Li Bin, Dechen Yangzom, Georges Lognay
      First page: 12
      Abstract: Background and objectives: Several studies revealed clinical signs of stunting and rickets among rural populations of Tibet Autonomous Region (T.A.R.), and especially amid children. Further, these populations are affected by a bone disease named Kashin-Beck disease (KBD). However, little is known about the dietary status of this population. This survey aimed to assess the usual intakes of young Tibetan children living in rural areas around Lhasa for energy, water, and ten minerals and trace elements (Na, K, Ca, P, Mg, Fe, Zn, Cu, Mn, and Se) involved in bone metabolism. Design: A cross-sectional survey was designed. Totally, 250 pre-school children aged 3–5 years living in rural areas were enrolled. The 24-h food recall method was used to collect the intakes for two days, during two different seasons (September 2012 and April 2013). Because Tibetan foods are mainly derived from local agriculture and artisanal production, a combination of food composition tables was compiled, including specific and local food composition data. Results: The Chinese dietary recommended intakes are not met for most of the elements investigated. Intake of sodium is much too high, while usual intakes are too low for K, Ca, Zn, Cu, and Se. Bioavailability of Ca, Fe, and Zn may be of concern due to the high phytic acid content in the diet. Conclusion: These nutrient imbalances may impact growth and bone metabolism of young Tibetan children. The advantages of the implementation of food diversification programs are discussed as well as the relevance of supplements distribution.
      PubDate: 2017-03-01
      DOI: 10.3390/healthcare5010012
      Issue No: Vol. 5, No. 1 (2017)
  • Healthcare, Vol. 5, Pages 13: Knowledge, Attitude and Behaviours towards
           Recommended Vaccinations among Healthcare Workers

    • Authors: Giuseppe La Torre, Stefania Scalingi, Veronica Garruto, Marco Siclari, Massimiliano Chiarini, Alice Mannocci
      First page: 13
      Abstract: Healthcare workers (HCWs) are an important group of professionals exposed to biological risk during their work activities. So, the aim of this study is to perform a survey on the knowledge, attitude and behaviour of Italian HCWs towards the vaccinations recommended by the Ministry of Health. A cross-sectional study was carried out during the period September 2014–August 2015 in the Lazio region. The study was conducted by recruiting HCWs and biomedical students. The sample was comprised of 571 responders, of whom 12.4% were physicians, 18.9% were nurses, 34.3% were other HCW, and 34.3% were biomedical students (medical and nurses students). Hepatitis B virus (HBV) is perceived as a risk for personal health by 457 (80%) participants; TB is also worrying (434; 76%). Moreover, HBV (70.9%) and tuberculosis (TB) (79.2%) are perceived as a risk for health, while influenza is not considered so by most participants (46.2%). There is an underestimation of the role of influenza, perceived as a risk for 137 respondents (24%). The vaccination rate among these HCWs is highest for Hepatitis B virus (HBV) (82%), and lowest for influenza (28.5%) and varicella (40.3%). The vast majority of responders are in favour of HBV (77.8%) and TB (64.8%) vaccines. For other vaccinations there is less interest (between 33% and 40% for measles, mumps, rubella, pertussis and influenza). This study shows that knowledge of recommended occupational vaccinations is insufficient in HCWs, with few exceptions represented by HBV and TB. There is a need for novel approaches in this field, with the aim of enhancing vaccine coverage among HCW.
      PubDate: 2017-03-07
      DOI: 10.3390/healthcare5010013
      Issue No: Vol. 5, No. 1 (2017)
  • Healthcare, Vol. 5, Pages 14: Developmental Origins of Health and Disease:
           A Lifecourse Approach to the Prevention of Non-Communicable Diseases

    • Authors: Janis Baird, Chandni Jacob, Mary Barker, Caroline Fall, Mark Hanson, Nicholas Harvey, Hazel Inskip, Kalyanaraman Kumaran, Cyrus Cooper
      First page: 14
      Abstract: Non-communicable diseases (NCDs), such as cardiovascular disease and osteoporosis, affect individuals in all countries worldwide. Given the very high worldwide prevalence of NCDs across a range of human pathology, it is clear that traditional approaches targeting those at most risk in older adulthood will not efficiently ameliorate this growing burden. It will thus be essential to robustly identify determinants of NCDs across the entire lifecourse and, subsequently, appropriate interventions at every stage to reduce an individual’s risk of developing these conditions. A lifecourse approach has the potential to prevent NCDs, from before conception through fetal life, infancy, childhood, adolescence, adulthood and into older age. In this paper, we describe the origins of the lifecourse concept, the importance of early life influences, for example during pregnancy, examine potential underlying mechanisms in both cell biology and behavior change, and finally describe current efforts to develop interventions that take a lifecourse approach to NCD prevention. Two principal approaches to improving women’s nutritional status are outlined: nutritional supplementation and behavior change.
      PubDate: 2017-03-08
      DOI: 10.3390/healthcare5010014
      Issue No: Vol. 5, No. 1 (2017)
  • Healthcare, Vol. 5, Pages 15: Supplementation with Phycocyanobilin,
           Citrulline, Taurine, and Supranutritional Doses of Folic Acid and
           Biotin—Potential for Preventing or Slowing the Progression of Diabetic

    • Authors: Mark McCarty
      First page: 15
      Abstract: Oxidative stress, the resulting uncoupling of endothelial nitric oxide synthase (eNOS), and loss of nitric oxide (NO) bioactivity, are key mediators of the vascular and microvascular complications of diabetes. Much of this oxidative stress arises from up-regulated nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity. Phycocyanobilin (PhyCB), the light-harvesting chromophore in edible cyanobacteria such as spirulina, is a biliverdin derivative that shares the ability of free bilirubin to inhibit certain isoforms of NADPH oxidase. Epidemiological studies reveal that diabetics with relatively elevated serum bilirubin are less likely to develop coronary disease or microvascular complications; this may reflect the ability of bilirubin to ward off these complications via inhibition of NADPH oxidase. Oral PhyCB may likewise have potential in this regard, and has been shown to protect diabetic mice from glomerulosclerosis. With respect to oxidant-mediated uncoupling of eNOS, high-dose folate can help to reverse this by modulating the oxidation status of the eNOS cofactor tetrahydrobiopterin (BH4). Oxidation of BH4 yields dihydrobiopterin (BH2), which competes with BH4 for binding to eNOS and promotes its uncoupling. The reduced intracellular metabolites of folate have versatile oxidant-scavenging activity that can prevent oxidation of BH4; concurrently, these metabolites promote induction of dihydrofolate reductase, which functions to reconvert BH2 to BH4, and hence alleviate the uncoupling of eNOS. The arginine metabolite asymmetric dimethylarginine (ADMA), typically elevated in diabetics, also uncouples eNOS by competitively inhibiting binding of arginine to eNOS; this effect is exacerbated by the increased expression of arginase that accompanies diabetes. These effects can be countered via supplementation with citrulline, which efficiently enhances tissue levels of arginine. With respect to the loss of NO bioactivity that contributes to diabetic complications, high dose biotin has the potential to “pinch hit” for diminished NO by direct activation of soluble guanylate cyclase (sGC). High-dose biotin also may aid glycemic control via modulatory effects on enzyme induction in hepatocytes and pancreatic beta cells. Taurine, which suppresses diabetic complications in rodents, has the potential to reverse the inactivating impact of oxidative stress on sGC by boosting synthesis of hydrogen sulfide. Hence, it is proposed that concurrent administration of PhyCB, citrulline, taurine, and supranutritional doses of folate and biotin may have considerable potential for prevention and control of diabetic complications. Such a regimen could also be complemented with antioxidants such as lipoic acid, N-acetylcysteine, and melatonin—that boost cellular expression of antioxidant enzymes and glutathione—as well as astaxanthin, zinc, and glycine. The development of appropriate functional foods might make it feasible for patients to use complex nutraceutical regimens of the sort suggested here.
      PubDate: 2017-03-14
      DOI: 10.3390/healthcare5010015
      Issue No: Vol. 5, No. 1 (2017)
  • Healthcare, Vol. 5, Pages 16: Mobile Phonocardiogram Diagnosis in Newborns
           Using Support Vector Machine

    • Authors: Amir Amiri, Mohammadreza Abtahi, Nick Constant, Kunal Mankodiya
      First page: 16
      Abstract: Phonocardiogram (PCG) monitoring on newborns is one of the most important and challenging tasks in the heart assessment in the early ages of life. In this paper, we present a novel approach for cardiac monitoring applied in PCG data. This basic system coupled with denoising, segmentation, cardiac cycle selection and classification of heart sound can be used widely for a large number of the data. This paper describes the problems and additional advantages of the PCG method including the possibility of recording heart sound at home, removing unwanted noises and data reduction on a mobile device, and an intelligent system to diagnose heart diseases on the cloud server. A wide range of physiological features from various analysis domains, including modeling, time/frequency domain analysis, an algorithm, etc., is proposed in order to extract features which will be considered as inputs for the classifier. In order to record the PCG data set from multiple subjects over one year, an electronic stethoscope was used for collecting data that was connected to a mobile device. In this study, we used different types of classifiers in order to distinguish between healthy and pathological heart sounds, and a comparison on the performances revealed that support vector machine (SVM) provides 92.2% accuracy and AUC = 0.98 in a time of 1.14 seconds for training, on a dataset of 116 samples.
      PubDate: 2017-03-18
      DOI: 10.3390/healthcare5010016
      Issue No: Vol. 5, No. 1 (2017)
  • Healthcare, Vol. 5, Pages 17: Translating Developmental Origins: Improving
           the Health of Women and Their Children Using a Sustainable Approach to
           Behaviour Change

    • Authors: Mary Barker, Janis Baird, Tannaze Tinati, Christina Vogel, Sofia Strömmer, Taylor Rose, Rufia Begum, Megan Jarman, Jenny Davies, Sue Thompson, Liz Taylor, Hazel Inskip, Cyrus Cooper, Don Nutbeam, Wendy Lawrence
      First page: 17
      Abstract: Theories of the developmental origins of health and disease imply that optimising the growth and development of babies is an essential route to improving the health of populations. A key factor in the growth of babies is the nutritional status of their mothers. Since women from more disadvantaged backgrounds have poorer quality diets and the worst pregnancy outcomes, they need to be a particular focus. The behavioural sciences have made a substantial contribution to the development of interventions to support dietary changes in disadvantaged women. Translation of such interventions into routine practice is an ideal that is rarely achieved, however. This paper illustrates how re-orientating health and social care services towards an empowerment approach to behaviour change might underpin a new developmental focus to improving long-term health, using learning from a community-based intervention to improve the diets and lifestyles of disadvantaged women. The Southampton Initiative for Health aimed to improve the diets and lifestyles of women of child-bearing age through training health and social care practitioners in skills to support behaviour change. Analysis illustrates the necessary steps in mounting such an intervention: building trust; matching agendas and changing culture. The Southampton Initiative for Health demonstrates that developing sustainable; workable interventions and effective community partnerships; requires commitment beginning long before intervention delivery but is key to the translation of developmental origins research into improvements in human health.
      PubDate: 2017-03-20
      DOI: 10.3390/healthcare5010017
      Issue No: Vol. 5, No. 1 (2017)
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