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  Subjects -> HEALTH AND SAFETY (Total: 1424 journals)
    - CIVIL DEFENSE (23 journals)
    - DRUG ABUSE AND ALCOHOLISM (87 journals)
    - HEALTH AND SAFETY (626 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (387 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (107 journals)
    - PHYSICAL FITNESS AND HYGIENE (112 journals)
    - WOMEN'S HEALTH (82 journals)

HEALTH AND SAFETY (626 journals)                  1 2 3 4 | 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: 24)
African Health Sciences     Open Access   (Followers: 3)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 7)
African Journal of Health Professions Education     Open Access   (Followers: 6)
Afrimedic Journal     Open Access   (Followers: 2)
Ageing & Society     Hybrid Journal   (Followers: 43)
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: 15)
American Journal of Health Education     Hybrid Journal   (Followers: 32)
American Journal of Health Promotion     Hybrid Journal   (Followers: 30)
American Journal of Health Sciences     Open Access   (Followers: 8)
American Journal of Health Studies     Full-text available via subscription   (Followers: 12)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 28)
American Journal of Public Health     Full-text available via subscription   (Followers: 241)
American Journal of Public Health Research     Open Access   (Followers: 28)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 5)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5)
Annales des Sciences de la Santé     Open Access  
Annals of Global Health     Open Access   (Followers: 10)
Annals of Health Law     Open Access   (Followers: 3)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 13)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences: Interface And Interaction     Open Access   (Followers: 3)
Apuntes Universitarios     Open Access   (Followers: 1)
Archive of Community Health     Open Access   (Followers: 1)
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: 10)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 4)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 9)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 4)
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: 7)
Autism & Developmental Language Impairments     Open Access   (Followers: 9)
Behavioral Healthcare     Full-text available via subscription   (Followers: 7)
Bijzijn     Hybrid Journal   (Followers: 1)
Bijzijn XL     Hybrid Journal  
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 8)
Birat Journal of Health Sciences     Open Access  
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 7)
BMC Pregnancy and Childbirth     Open Access   (Followers: 22)
BMJ Simulation & Technology Enhanced Learning     Hybrid Journal   (Followers: 10)
Boletin Médico de Postgrado     Open Access  
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: 18)
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: 13)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 11)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 2)
Canadian Journal of Public Health     Hybrid Journal   (Followers: 22)
Cannabis and Cannabinoid Research     Hybrid Journal   (Followers: 1)
Carta Comunitaria     Open Access  
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   (Followers: 2)
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 y Salud Virtual     Open Access  
Ciencia, Tecnología y Salud     Open Access   (Followers: 2)
Clinical and Experimental Health Sciences     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 2)
Clocks & Sleep     Open Access   (Followers: 1)
CME     Hybrid Journal   (Followers: 2)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 3)
Conflict and Health     Open Access   (Followers: 7)
Contraception and Reproductive Medicine     Open Access   (Followers: 1)
Cuadernos de la Escuela de Salud Pública     Open Access  
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 9)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access   (Followers: 4)
Disaster Medicine and Public Health Preparedness     Hybrid Journal   (Followers: 13)
Diversity of Research in Health Journal     Open Access  
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Open Access   (Followers: 1)
Duazary     Open Access   (Followers: 1)
Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi / Journal of Duzce University Health Sciences Institute     Open Access  
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 21)
East African Journal of Public Health     Full-text available via subscription   (Followers: 4)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 22)
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: 5)
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: 3)
Environmental Sciences Europe     Open Access   (Followers: 1)
Epidemics     Open Access   (Followers: 5)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 5)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 19)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 6)
Ethiopian Journal of Health Development     Open Access   (Followers: 7)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 8)
Ethnicity & Health     Hybrid Journal   (Followers: 13)
Eurasian Journal of Health Technology Assessment     Open Access  
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 3)
European Medical, Health and Pharmaceutical Journal     Open Access   (Followers: 1)
Evaluation & the Health Professions     Hybrid Journal   (Followers: 10)
Evidence-based Medicine & Public Health     Open Access   (Followers: 8)
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: 9)
Family & Community Health     Hybrid Journal   (Followers: 13)
Family Medicine and Community Health     Open Access   (Followers: 9)
Family Relations     Partially Free   (Followers: 13)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 2)
Finnish Journal of eHealth and eWelfare : Finjehew     Open Access  
Food and Public Health     Open Access   (Followers: 16)
Food Quality and Safety     Open Access   (Followers: 1)
Frontiers in Public Health     Open Access   (Followers: 7)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access   (Followers: 1)
Gazi Sağlık Bilimleri Dergisi     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 9)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Challenges     Open Access  
Global Health : Science and Practice     Open Access   (Followers: 7)
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: 8)
Global Reproductive Health     Open Access  
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  
Hastane Öncesi Dergisi     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: 10)
Health and Human Rights     Free   (Followers: 10)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 9)
Health and Social Work     Hybrid Journal   (Followers: 57)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 3)
Health Care Analysis     Hybrid Journal   (Followers: 15)
Health Equity     Open Access  
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 23)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Notions     Open Access  
Health Policy     Hybrid Journal   (Followers: 43)
Health Policy and Technology     Hybrid Journal   (Followers: 4)
Health Professional Student Journal     Open Access   (Followers: 4)
Health Promotion International     Hybrid Journal   (Followers: 22)
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: 53)
Health Psychology Bulletin     Open Access   (Followers: 1)
Health Psychology Research     Open Access   (Followers: 20)
Health Psychology Review     Hybrid Journal   (Followers: 42)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 14)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Science Reports     Open Access  
Health Sciences and Disease     Open Access   (Followers: 2)
Health Security     Hybrid Journal  
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: 14)
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  
Healthy Aging Research     Open Access  
HERD : Health Environments Research & Design Journal     Full-text available via subscription  
Highland Medical Research Journal     Full-text available via subscription  

        1 2 3 4 | Last

Similar Journals
Journal Cover
Healthcare
Number of Followers: 3  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2227-9032
Published by MDPI Homepage  [215 journals]
  • Healthcare, Vol. 6, Pages 70: Strategies to Engage Adolescents in Digital
           Health Interventions for Obesity Prevention and Management

    • Authors: Stephanie R. Partridge, Julie Redfern
      First page: 70
      Abstract: Obesity is one of the greatest health challenges facing today’s adolescents. Dietary interventions are the foundation of obesity prevention and management. As adolescents are digital frontrunners and early adopters of technology, digital health interventions appear the most practical modality for dietary behavior change interventions. Despite the rapid growth in digital health interventions, effective engagement with adolescents remains a pertinent issue. Key strategies for effective engagement include co-designing interventions with adolescents, personalization of interventions, and just-in-time adaptation using data from wearable devices. The aim of this paper is to appraise these strategies, which may be used to improve effective engagement and thereby improve the dietary behaviors of adolescents now and in the future.
      Citation: Healthcare
      PubDate: 2018-06-21
      DOI: 10.3390/healthcare6030070
      Issue No: Vol. 6, No. 3 (2018)
       
  • Healthcare, Vol. 6, Pages 71: Improving Cardiovascular Disease Knowledge
           among Rural Participants: The Results of a Cluster Randomized Trial

    • Authors: Laurie S. Abbott, Elizabeth H. Slate
      First page: 71
      Abstract: Cardiovascular disease (CVD) is a major cause of death and disability, especially among people living in the rural, southern United States. Rural African Americans are often diagnosed with CVD earlier in life, and they bear a disproportionate burden of CVD risk factors, morbidity, and mortality. Health equity among historically underserved, rural populations can potentially be attained through culturally relevant interventions that teach people skills to stay well and avoid CVD-related risk and diagnoses. The purpose of this secondary analysis was to determine the effect of an evidence-based intervention on cardiovascular health knowledge and the stages of change toward the action and maintenance phases. The pre-test-post-test data were obtained during a cluster randomized trial involving twelve rural churches that were randomized to intervention (n = 6) and control (n = 6) groups. Participants (n = 115) in the intervention group received a cardiovascular health intervention, and those (n = 114) in the control group could receive the intervention following the study’s completion. The data were analyzed using a linear mixed model to compare group differences from pre-test to post-test. The cardiovascular health promotion intervention significantly improved cardiovascular health knowledge and was associated with advancements in the stages of change toward the action and maintenance phases.
      Citation: Healthcare
      PubDate: 2018-06-25
      DOI: 10.3390/healthcare6030071
      Issue No: Vol. 6, No. 3 (2018)
       
  • Healthcare, Vol. 6, Pages 72: Effect of Skeletal Muscle and Fat Mass on
           Muscle Strength in the Elderly

    • Authors: Koji Nonaka, Shin Murata, Kayoko Shiraiwa, Teppei Abiko, Hideki Nakano, Hiroaki Iwase, Koichi Naito, Jun Horie
      First page: 72
      Abstract: It is important for elderly people to maintain or improve muscle strength and for clinicians to know the factors that affect muscle strength. Therefore, the purpose of this study was to compare the effects of fat mass (FM) and skeletal muscle mass (SMM) on muscle strength. The participants included 192 community-dwelling elderly women. The SMM and FM, grip strength, and knee extension strength were measured. Data were evaluated using stepwise multiple linear regression analysis, which was performed with grip or knee extension strength as a dependent variable and the SMM and FM of the upper and lower limbs as the independent variables. The SMM and FM of the upper limbs were associated with grip strength, whereas the SMM but not the FM of the lower limbs was associated with knee extension strength. These findings suggest that there may be thresholds for the SMM/FM ratio to affect muscle strength.
      Citation: Healthcare
      PubDate: 2018-06-26
      DOI: 10.3390/healthcare6030072
      Issue No: Vol. 6, No. 3 (2018)
       
  • Healthcare, Vol. 6, Pages 73: Defining the Optimal Dietary Approach for
           Safe, Effective and Sustainable Weight Loss in Overweight and Obese Adults
           

    • Authors: Chrysi Koliaki, Theodoros Spinos, Μarianna Spinou, Μaria-Eugenia Brinia, Dimitra Mitsopoulou, Nicholas Katsilambros
      First page: 73
      Abstract: Various dietary approaches with different caloric content and macronutrient composition have been recommended to treat obesity in adults. Although their safety and efficacy profile has been assessed in numerous randomized clinical trials, reviews and meta-analyses, the characteristics of the optimal dietary weight loss strategy remain controversial. This mini-review will provide general principles and practical recommendations for the dietary management of obesity and will further explore the components of the optimal dietary intervention. To this end, various dietary plans are critically discussed, including low-fat diets, low-carbohydrate diets, high-protein diets, very low-calorie diets with meal replacements, Mediterranean diet, and diets with intermittent energy restriction. As a general principle, the optimal diet to treat obesity should be safe, efficacious, healthy and nutritionally adequate, culturally acceptable and economically affordable, and should ensure long-term compliance and maintenance of weight loss. Setting realistic goals for weight loss and pursuing a balanced dietary plan tailored to individual needs, preferences, and medical conditions, are the key principles to facilitate weight loss in obese patients and most importantly reduce their overall cardiometabolic risk and other obesity-related comorbidities.
      Citation: Healthcare
      PubDate: 2018-06-28
      DOI: 10.3390/healthcare6030073
      Issue No: Vol. 6, No. 3 (2018)
       
  • Healthcare, Vol. 6, Pages 74: Functionality in Middle-Aged and Older
           Overweight and Obese Individuals with Knee Osteoarthritis

    • Authors: Neda S. Akhavan, Lauren Ormsbee, Sarah A. Johnson, Kelli S. George, Elizabeth M. Foley, Marcus L. Elam, Zahra Ezzat-Zadeh, Lynn B. Panton, Bahram H. Arjmandi
      First page: 74
      Abstract: Patients with knee osteoarthritis (OA) suffer from immobility and pain. The objective of this cross-sectional study was to investigate the relationship between pain and functionality in middle-aged and older overweight and obese individuals with mild-to-moderate knee OA. Overall pattern, physical activity, and total energy expenditure (TEE) were assessed in 83 participants. The Western Ontario McMaster Universities Arthritis Index (WOMAC) was used to assess lower extremity pain and function. The six-minute walk test (6-MWT) and range of motion (ROM) were also assessed. Results indicated that age was inversely associated with body mass index (BMI) (r = 0.349) and total WOMAC scores (r = 0.247). BMI was positively associated with TEE (r = 0.430) and WOMAC scores (r = 0.268), while ROM was positively associated with the 6-MWT (r = 0.561) and negatively associated with WOMAC (r = 0.338) and pain scores (r = 0.222). Furthermore, women had significantly greater WOMAC scores (p = 0.046) than men. Older participants (≥65 years old) had significantly lower BMI (p = 0.002), and distance traveled during the 6-MWT (p = 0.013). Our findings indicate that older individuals in this population with knee OA had lower BMI, greater ROM, and less pain and stiffness and walked slower than middle-aged individuals. Women reported greater pain, stiffness, and reduced functionality, indicating that the manifestation of OA may vary due to gender.
      Citation: Healthcare
      PubDate: 2018-07-04
      DOI: 10.3390/healthcare6030074
      Issue No: Vol. 6, No. 3 (2018)
       
  • Healthcare, Vol. 6, Pages 75: Lost in Translation: Transforming Behaviour
           Change Techniques into Engaging Digital Content and Design for the StopApp
           

    • Authors: Emily Anne Fulton, Kayleigh L. Kwah, Sue Wild, Katherine E. Brown
      First page: 75
      Abstract: Frameworks to support the application of behaviour change theory to the choice of behaviour change techniques (BCTs) in designing digital behaviour change interventions (DBCIs) are becoming well established, and have been employed by the authors in the development of StopApp. However, guidance on the next stage—effective operationalisation (translation) of these BCTs to a digital context, including the precise delivery and design of “behavioural intervention technology” (BIT) elements, is still in its infancy. This is despite growing recognition of the need to optimise engagement and usability, alongside a theoretical basis, for intervention effectiveness. The aim of this study was to explore methods to translate BCTs into digital content in an accurate and systematic manner. We describe the process of using co-creation (user-led) rather than expert-driven methods in the development of user-facing features and design in StopApp, including the iterative “bottom-up” and “top-down processes” necessary for accurate BCT translation. We found a small disparity between the intended and actual BCT content, reflecting the difficulties of translating BCTs into digital intervention content and the need for better guidance and methodical approaches to enhance this under-researched process. The involvement of our Patient and Public Involvement (PPI) group throughout these processes is described.
      Citation: Healthcare
      PubDate: 2018-07-06
      DOI: 10.3390/healthcare6030075
      Issue No: Vol. 6, No. 3 (2018)
       
  • Healthcare, Vol. 6, Pages 76: Recruitment Strategies for a Randomised
           Controlled Trial Comparing Fast Versus Slow Weight Loss in Postmenopausal
           Women with Obesity—The TEMPO Diet Trial

    • Authors: Michelle S. H. Hsu, Claudia Harper, Alice A. Gibson, Arianne N. Sweeting, John McBride, Tania P. Markovic, Ian D. Caterson, Nuala M. Byrne, Amanda Sainsbury, Radhika V. Seimon
      First page: 76
      Abstract: Current research around effective recruitment strategies for clinical trials of dietary obesity treatments have largely focused on younger adults, and thus may not be applicable to older populations. The TEMPO Diet Trial (Type of Energy Manipulation for Promoting optimal metabolic health and body composition in Obesity) is a randomised controlled trial comparing the long-term effects of fast versus slow weight loss on body composition and cardio-metabolic health in postmenopausal women with obesity. This paper addresses the recruitment strategies used to enrol participants into this trial and evaluates their relative effectiveness. 101 post-menopausal women aged 45–65 years, with a body mass index of 30–40 kg/m2 were recruited and randomised to either fast or slow weight loss. Multiple strategies were used to recruit participants. The total time cost (labour) and monetary cost per randomised participant from each recruitment strategy was estimated, with lower values indicating greater cost-effectiveness and higher values indicating poorer cost-effectiveness. The most cost-effective recruitment strategy was word of mouth, followed (at equal second place) by free publicity on TV and radio, and printed advertorials, albeit these avenues only yielded 26/101 participants. Intermediate cost-effective recruitment strategies were flyer distribution at community events, hospitals and a local tertiary education campus, internet-based strategies, and clinical trial databases and intranets, which recruited a further 40/101 participants. The least cost-effective recruitment strategy was flyer distribution to local health service centres and residential mailboxes, and referrals from healthcare professionals were not effective. Recruiting for clinical trials involving postmenopausal women could benefit from a combination of recruitment strategies, with an emphasis on word of mouth and free publicity via radio, TV, and print media, as well as strategic placement of flyers, supplemented with internet-based strategies, databases and intranets if a greater yield of participants is needed.
      Citation: Healthcare
      PubDate: 2018-07-06
      DOI: 10.3390/healthcare6030076
      Issue No: Vol. 6, No. 3 (2018)
       
  • Healthcare, Vol. 6, Pages 77: Oral Health in Pregnant Chinese Women in
           Singapore: A Call to Go beyond the Traditional Clinical Care

    • Authors: Preethi Balan, Hong-Gu He, Fengchunzhi Cao, Mun Loke Wong, Yap Seng Chong, Violeta Lopez, Shu E. Soh, Chaminda Jayampath Seneviratne
      First page: 77
      Abstract: Objective: To examine the correlations among oral health knowledge, attitude, practices and oral disease among pregnant Chinese women in Singapore. Methods: A descriptive correlational study was conducted in pregnant Chinese women in Singapore. A questionnaire was used to collect data of oral health knowledge, attitude and practices. Plaque index scores were used to assess the oral health of subjects. Results: A total of 82 pregnant women participated in the study, out of whom 38% showed adequate oral health knowledge, nearly half of them achieved adequate and oral health attitude and practice scores while 34% had good Plaque index scores. The lower income group had higher experience of self-reported dental problems during pregnancy than those in the higher income group (p = 0.03). There were significant positive correlations between scores of oral health practice, attitude and oral health knowledge levels. The plaque index scores negatively correlated with the oral health practice scores (p = 0.02). Conclusions: Our findings provided evidence that oral health knowledge, attitude and practices among Chinese pregnant women were not optimal which implies the importance of promoting their oral health during pregnancy through the improvement of knowledge and attitudes. This would facilitate formulation and implementation of appropriate oral health promotion policies.
      Citation: Healthcare
      PubDate: 2018-07-09
      DOI: 10.3390/healthcare6030077
      Issue No: Vol. 6, No. 3 (2018)
       
  • Healthcare, Vol. 6, Pages 78: Developing a Case-Based Blended Learning
           Ecosystem to Optimize Precision Medicine: Reducing Overdiagnosis and
           Overtreatment

    • Authors: Vivek Podder, Binod Dhakal, Gousia Ummae Salma Shaik, Kaushik Sundar, Madhava Sai Sivapuram, Vijay Kumar Chattu, Rakesh Biswas
      First page: 78
      Abstract: Introduction: Precision medicine aims to focus on meeting patient requirements accurately, optimizing patient outcomes, and reducing under-/overdiagnosis and therapy. We aim to offer a fresh perspective on accuracy driven “age-old precision medicine” and illustrate how newer case-based blended learning ecosystems (CBBLE) can strengthen the bridge between age-old precision approaches with modern technology and omics-driven approaches. Methodology: We present a series of cases and examine the role of precision medicine within a “case-based blended learning ecosystem” (CBBLE) as a practicable tool to reduce overdiagnosis and overtreatment. We illustrated the workflow of our CBBLE through case-based narratives from global students of CBBLE in high and low resource settings as is reflected in global health. Results: Four micro-narratives based on collective past experiences were generated to explain concepts of age-old patient-centered scientific accuracy and precision and four macro-narratives were collected from individual learners in our CBBLE. Insights gathered from a critical appraisal and thematic analysis of the narratives were discussed. Discussion and conclusion: Case-based narratives from the individual learners in our CBBLE amply illustrate their journeys beginning with “age-old precision thinking” in low-resource settings and progressing to “omics-driven” high-resource precision medicine setups to demonstrate how the approaches, used judiciously, might reduce the current pandemic of over-/underdiagnosis and over-/undertreatment.
      Citation: Healthcare
      PubDate: 2018-07-10
      DOI: 10.3390/healthcare6030078
      Issue No: Vol. 6, No. 3 (2018)
       
  • Healthcare, Vol. 6, Pages 79: The Oral Healthcare System in Japan

    • Authors: Takashi Zaitsu, Tomoya Saito, Yoko Kawaguchi
      First page: 79
      Abstract: This paper describes the present Japanese oral healthcare system and outlines the future challenges and perspectives for Japan. Japan has developed a system for providing high-quality and appropriate health care efficiently through a universal health insurance system which has been in operation since 1961. This health insurance covers most restorative, prosthetic and oral surgery treatment. Therefore, all people can receive dental treatment at a relatively low cost, with the same fees applying throughout the nation. In Japan, public oral health services are provided by the local governments according to the life stage of their populations. These services are mainly conducted by private dental practitioners under contracts with local governments. National oral health data shows that the oral health of the Japanese population has improved over the last several decades. Future challenges and perspectives for Japanese dentistry include: tackling the regional differences in oral health, decreasing the cost of health expenditure, establishment of sustainable emergency oral healthcare services in times of disaster, and the development a new tele-dental system for remote areas without access to dental professionals.
      Citation: Healthcare
      PubDate: 2018-07-10
      DOI: 10.3390/healthcare6030079
      Issue No: Vol. 6, No. 3 (2018)
       
  • Healthcare, Vol. 6, Pages 28: The Healthfulness of Entrées and
           Students’ Purchases in a University Campus Dining Environment

    • Authors: Krista Leischner, Lacey McCormack, Brian Britt, Greg Heiberger, Kendra Kattelmann
      First page: 28
      Abstract: The purpose of this study is to determine the availability of “more healthful” (MH) versus “less healthful” (LH) entrée items in the campus dining and if students’ purchases are reflective of what is offered. This is an observational study in which purchases of the available entrée items in the campus dining at South Dakota State University in one academic year were collected and categorized as either MH or LH according to the American Heart Association guidelines. Chi-square tests were used to determine the differences between the proportion of purchased MH and LH versus those available. Odds ratio estimates with 95% confidence limits were used to determine the associations between the demographics and MH and LH purchases. Of the total entrée items available, 15.0% were MH and 85.0% were LH. In the fall, 8.0% of purchases were MH and 92.0% purchases were LH as compared to 8.9% MH and 91.1% LH in the spring. Whites were less likely than non-whites to purchase a MH entrée. Females were two times more likely to choose MH entrées than males. The campus dining offerings and students’ purchases of entrees were primarily LH. Work with campus dining providers to create profitable, yet healthful, dining entrees is needed to improve the healthfulness of offerings.
      Citation: Healthcare
      PubDate: 2018-03-22
      DOI: 10.3390/healthcare6020028
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 29: Racial, Ethnic, and Nativity Differences in
           Mental Health Visits to Primary Care and Specialty Mental Health
           

    • Authors: Audrey Jones, Susan Cochran, Arleen Leibowitz, Kenneth Wells, Gerald Kominski, Vickie Mays
      First page: 29
      Abstract: Background. Black and Latino minorities have traditionally had poorer access to primary care than non-Latino Whites, but these patterns could change with the Affordable Care Act (ACA). To guide post-ACA efforts to address mental health service disparities, we used a nationally representative sample to characterize baseline race-, ethnicity-, and nativity-associated differences in mental health services in the context of primary care. Methods. Data were obtained from the Medical Expenditures Panel Survey (MEPS), a two-year panel study of healthcare use, satisfaction with care, and costs of services in the United States (US). We pooled data from six waves (14–19) of participants with serious psychological distress to examine racial, ethnic, and nativity disparities in medical and mental health visits to primary care (PC) and specialty mental health (SMH) providers around the time of ACA reforms, 2010–2015. Results. Of the 2747 respondents with serious psychological distress, 1316 were non-Latino White, 632 non-Latino Black, 532 identified as Latino with Mexican, Central American, or South American (MCS) origins, and 267 as Latino with Caribbean island origins; 525 were foreign/island born. All racial/ethnic groups were less likely than non-Latino Whites to have any PC visit. Of those who used PC, non-Latino Blacks were less likely than Whites to have a PC mental health visit, while foreign born MCS Latinos were less likely to visit an SMH provider. Conditional on any mental health visit, Latinos from the Caribbean were more likely than non-Latino Whites to visit SMH providers versus PC providers only, while non-Latino Blacks and US born MCS Latinos received fewer PC mental health visits than non-Latino Whites. Conclusion. Racial-, ethnic-, and nativity-associated disparities persist in PC provided mental health services.
      Citation: Healthcare
      PubDate: 2018-03-22
      DOI: 10.3390/healthcare6020029
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 30: Importance of Patient–Provider
           Communication to Adherence in Adolescents with Type 1 Diabetes

    • Authors: Niral Patel, Karishma Datye, Sarah Jaser
      First page: 30
      Abstract: Effective communication between pediatric diabetes patients and their providers has the potential to enhance patient satisfaction and health outcomes, as well as improve diabetes-related self-management. In this review, we highlight the importance of communication between patients and providers, focusing on the effect of communication on adherence in the high-risk population of adolescents with type 1 diabetes. We synthesize the literature describing patient–provider communication in pediatric populations and provide implications for practice that focus on the most relevant, modifiable factors for improving self-management in adolescents with type 1 diabetes.
      Citation: Healthcare
      PubDate: 2018-03-28
      DOI: 10.3390/healthcare6020030
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 31: Home Hospitalization for Acute Decompensated
           Heart Failure: Opportunities and Strategies for Improved Health Outcomes

    • Authors: Konstantinos Voudris, Marc Silver
      First page: 31
      Abstract: Importance: Heart failure (HF) is the leading cause of hospitalization among patients over the age of 65 in the United States and developed countries, posing a significant economic burden to the health care systems. More than half of the patients with HF will be readmitted to the hospital within 6 months from discharge, leading not only to increased health care related expenses but also functional decline, iatrogenic injuries and in-hospital infections. With the increasing prevalence of HF, there is a substantial need for innovative delivery care models that can provide hospital level of care at a patient’s home. Observations: Home hospitalization was originally used to safely manage chronically ill patients with general medical (stroke, chronic obstructive pulmonary disease, deep vein thrombosis, community acquired pneumonia) and surgical conditions and was associated with improved patient satisfaction and improvement in activity of daily living status. This had no clear effect on readmission or cost. When hospital at home care model was applied to HF patients it demonstrated increased time to readmission, reduced index costs and improved health related quality of life, with no significant differences in adverse events. Eligible patients should be selected based on multiple factors taking into consideration applicable limitations and comorbidities. Conclusions and Relevance: Providing in-hospital level care to the patient’s house presents a reliable alternative, yielding multiple benefits both for the patient, as well as the health care system. Formulating a well-defined model is necessary before wide implementation.
      Citation: Healthcare
      PubDate: 2018-03-28
      DOI: 10.3390/healthcare6020031
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 32: Associations between Parents’ Health
           Literacy and Sleeping Hours in Children: A Cross-Sectional Study

    • Authors: Hiroto Ogi, Daisuke Nakamura, Masato Ogawa, Teruhiko Nakamura, Kazuhiro Izawa
      First page: 32
      Abstract: Background: Sleep in preschool children is an important factor for their health and active lives. The lack of adequate sleep in preschool children is a serious public problem in Japan. The relationship between health literacy (HL) and health status is well recognized. The purpose of this study was to investigate the association between the sleep duration of preschool children and the HL of their parents. Methods: In the present study, participants were preschool children (3–6 years) and their parents. We assessed the HL of the parents with the 14-item Health Literacy Scale (HLS-14) questionnaire. Sleep duration of the children was reported by their parents. We divided parents into two groups according to HLS-14 score and analyzed children’s sleeping time separately. Results: Data from 279 parents and their children were ultimately analyzed. The high HL group comprised 210 families (75.3%) and the low HL group comprised 69 families (24.7%). Average children’s sleep duration was significantly longer in the high HL group (9.5 ± 0.9 h) than in the low HL group (9.1 ± 1.1 h) (p = 0.013). A positive correlation was found in the low HL group between parents’ HL and their children’s sleeping times (p < 0.01, r = 0.32) but the difference was not significant in the high HL group (p = 0.98, r = −0.0009). Conclusion: The HL of parents appears to affect their children’s sleep duration, suggesting that parental HL may be an appropriate target for interventions aiming to lengthen children’s sleeping time.
      Citation: Healthcare
      PubDate: 2018-04-02
      DOI: 10.3390/healthcare6020032
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 33: Persistent Borrelia Infection in Patients
           with Ongoing Symptoms of Lyme Disease

    • Authors: Marianne Middelveen, Eva Sapi, Jennie Burke, Katherine Filush, Agustin Franco, Melissa Fesler, Raphael Stricker
      First page: 33
      Abstract: Introduction: Lyme disease is a tickborne illness that generates controversy among medical providers and researchers. One of the key topics of debate is the existence of persistent infection with the Lyme spirochete, Borrelia burgdorferi, in patients who have been treated with recommended doses of antibiotics yet remain symptomatic. Persistent spirochetal infection despite antibiotic therapy has recently been demonstrated in non-human primates. We present evidence of persistent Borrelia infection despite antibiotic therapy in patients with ongoing Lyme disease symptoms. Methods: In this pilot study, culture of body fluids and tissues was performed in a randomly selected group of 12 patients with persistent Lyme disease symptoms who had been treated or who were being treated with antibiotics. Cultures were also performed on a group of ten control subjects without Lyme disease. The cultures were subjected to corroborative microscopic, histopathological and molecular testing for Borrelia organisms in four independent laboratories in a blinded manner. Results: Motile spirochetes identified histopathologically as Borrelia were detected in culture specimens, and these spirochetes were genetically identified as Borrelia burgdorferi by three distinct polymerase chain reaction (PCR)-based approaches. Spirochetes identified as Borrelia burgdorferi were cultured from the blood of seven subjects, from the genital secretions of ten subjects, and from a skin lesion of one subject. Cultures from control subjects without Lyme disease were negative for Borrelia using these methods. Conclusions: Using multiple corroborative detection methods, we showed that patients with persistent Lyme disease symptoms may have ongoing spirochetal infection despite antibiotic treatment, similar to findings in non-human primates. The optimal treatment for persistent Borrelia infection remains to be determined.
      Citation: Healthcare
      PubDate: 2018-04-14
      DOI: 10.3390/healthcare6020033
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 34: Physical Activity on Prescription with
           Counsellor Support: A 4-Year Registry-Based Study in Routine Health Care
           in Sweden

    • Authors: Pia Andersen, Sara Holmberg, Lena Lendahls, Per Nilsen, Margareta Kristenson
      First page: 34
      Abstract: Background: Public health gains from physical activity on prescription (PAP) depend on uptake in routine care. We performed an evaluation of the implementation, in a Swedish county council, of counsellors who give personalized support to PAP recipients aimed at facilitating PAP delivery. The aim was to compare characteristics between PAP recipients and the health care population as well as between PAP recipients who used and did not use counsellor support. We also investigated professional belonging and health care setting of health care professionals who prescribed PAP. Methods: All patients’ ≥18 years who received PAP during 2009–2012 in primary and secondary care in the County Council of Kronoberg were included (n = 4879). Data were retrieved from electronic medical records. Main outcome measures were patient and professional characteristics. Results: A third of the PAP recipients had diseases in ≥5 diagnostic groups and more than half had ≥11 office visits the year before receiving PAP. Counsellor support was used by one-third and PAP recipients who used counsellor support had more multiple diagnoses and office visits compared with non-users. Physicians issued 44% of prescriptions and primary care was the predominant setting. The amount of PAP did not change over time, but the proportion of physicians’ prescriptions decreased while the proportion of nurses’ prescriptions increased. Conclusions: PAP recipients had high morbidity and were frequent health care attenders, indicating that PAP was predominantly used for secondary or tertiary prevention. PAP rates did not increase as intended after the implementation of counsellor support.
      Citation: Healthcare
      PubDate: 2018-04-16
      DOI: 10.3390/healthcare6020034
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 35: A Rationale for Music Training to Enhance
           Executive Functions in Parkinson’s Disease: An Overview of the Problem

    • Authors: Teresa Lesiuk, Jennifer A. Bugos, Brea Murakami
      First page: 35
      Abstract: Music listening interventions such as Rhythmic Auditory Stimulation can improve mobility, balance, and gait in Parkinson’s Disease (PD). Yet, the impact of music training on executive functions is not yet known. Deficits in executive functions (e.g., attention, processing speed) in patients with PD result in gait interference, deficits in emotional processing, loss of functional capacity (e.g., intellectual activity, social participation), and reduced quality of life. The model of temporal prediction and timing suggests two networks collectively contribute to movement generation and execution: the basal ganglia-thalamocortical network (BGTC) and the cerebellar-thalamocortical network (CTC). Due to decreases in dopamine responsible for the disruption of the BGTC network in adults with PD, it is hypothesized that rhythmic auditory cues assist patients through recruiting an alternate network, the CTC, which extends to the supplementary motor areas (SMA) and the frontal cortices. In piano training, fine motor finger movements activate the cerebellum and SMA, thereby exercising the CTC network. We hypothesize that exercising the CTC network through music training will contribute to enhanced executive functions. Previous research suggested that music training enhances cognitive performance (i.e., working memory and processing speed) in healthy adults and adults with cognitive impairments. This review and rationale provides support for the use of music training to enhance cognitive outcomes in patients with Parkinson’s Disease (PD).
      Citation: Healthcare
      PubDate: 2018-04-22
      DOI: 10.3390/healthcare6020035
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 36: Depressive Symptoms Increase the Risk of
           Mortality for White but Not Black Older Adults

    • Authors: Shervin Assari
      First page: 36
      Abstract: Introduction. Long-term studies have shown that depressive symptoms predict the risk of mortality. However, it is unknown if this effect is present in shorter time intervals. In addition, recent research suggests that the salience of the negative affect on the risk of mortality is not similar across racial groups. The current study uses data from a national study of Black and White older adults to examine racial differences in the effect of baseline depressive symptoms on mortality risk over three years in the United States. Methods. This study used a longitudinal prospective design and followed 1493 older adults who were either White (n = 759) or Black (n = 734) for three years from 2001 to 2004. Depressive symptoms measured at baseline was the independent variable. Demographic factors, socio-economic characteristics (education, income, marital status), health behaviors (smoking and drinking), and health (self-rated health) measured at baseline in 2001 were covariates. The dependent variable was all-cause mortality between 2001 and 2004. Race was the moderator. Logistic regressions were used for data analysis. Results. In the pooled sample, high depressive symptoms at baseline were not associated with the three-year risk of mortality. In the pooled sample, we found a significant interaction between race and depressive symptoms on mortality, suggesting a stronger effect for Whites in comparison to Blacks. In race stratified models, depressive symptoms at baseline were predictive of mortality risk for Whites, but not Blacks. Conclusions. In the United States, Black-White differences exist in the effects of depressive symptoms on mortality risk in older adults. White older adults may be more vulnerable to the effects of depressive symptoms on mortality risk.
      Citation: Healthcare
      PubDate: 2018-04-23
      DOI: 10.3390/healthcare6020036
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 37: High Income Protects Whites but Not African
           Americans against Risk of Depression

    • Authors: Shervin Assari
      First page: 37
      Abstract: Background: Built on the Blacks’ diminished return theory, defined as smaller effects of socioeconomic status (SES) on a wide range of health outcomes for African Americans compared to Whites, the current study compared African Americans and Whites for the association between household income and risk of lifetime, 12-month, and 30-day major depressive disorder (MDD). Methods: For the current cross-sectional study, we used data from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001–2003. With a nationally representative sampling, CPES included 4746 non-Hispanic African Americans and 7587 non-Hispanic Whites. The dependent variables were lifetime, 12-month, and 30-day MDD, measured using Composite International Diagnostic Interview (CIDI). The independent variable was household income. Age, gender, education, chronic medical conditions, and obesity were covariates. Race was the focal moderator. Logistic regression models were used to test the protective effects of household income against MDD in the overall sample and also by race. Results: In the overall sample, household income was inversely associated with the risk of 12-month and 30-day MDD. We found a significant interaction between race and household income on 12-month and 30-day MDD, suggesting a smaller protective effect of household income against MDD for African Americans compared to Whites. Conclusion: In line with the Blacks’ diminished return theory, household income better protects Whites than African Americans against MDD. The contribution of diminished return of SES as an underlying mechanism behind racial disparities in health in the United States is often overlooked. Additional research is needed on why and how SES resources generate smaller health gain among minority groups.
      Citation: Healthcare
      PubDate: 2018-04-23
      DOI: 10.3390/healthcare6020037
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 38: Ethnic Variations in Psychosocial and Health
           Correlates of Eating Disorders

    • Authors: Shervin Assari, Mariana R. DeFreitas
      First page: 38
      Abstract: The aim of this study is to explore ethnic variations in psychosocial and health correlates of eating disorders in the United States, Specifically, we compared associations between gender, socioeconomic status (SES), body mass index (BMI), physical and mental self-rated health (SRH), and major depressive disorder (MDD) with eating disorders (EDs) across 10 different ethnic groups in the United States. Data was obtained from the Collaborative Psychiatric Epidemiology Surveys (CPES), a national household probability sample collected in 2001–2003. Data for this study included a sample of 17,729 individuals with the following ethnic profile: 520 Vietnamese, 508 Filipino, 600 Chinese, 656 Other Asian, 577 Cuban, 495 Puerto Rican, 1442 Mexican, 1106 Other Hispanic, 4746 African American, and 7587 Non-Latino Whites. Gender, SES (education and income), BMI, SRH, MDD, and presence of EDs were measured across different ethnic groups. Logistic regression analysis was conducted for each ethnic group with lifetime EDs as the main outcome. Ethnic group varied in psychosocial and health correlates of EDs. In most ethnic groups, gender and SES were not associated with EDs. In almost all ethnic groups, EDs were associated with MDD and BMI. EDs were found to be associated with SRH in half of the ethnic groups studied. The associations between gender, SES, BMI, SRH, MDD, and EDs vary across different ethnic groups. These differences must be considered in further studies and in clinical practice in order to improve our approach towards diagnosis and treatment of EDs.
      Citation: Healthcare
      PubDate: 2018-04-25
      DOI: 10.3390/healthcare6020038
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 39: A Targeted and Tailored eHealth Weight Loss
           Program for Young Women: The Be Positive Be Healthe Randomized Controlled
           Trial

    • Authors: Melinda J. Hutchesson, Robin Callister, Philip J. Morgan, Ilung Pranata, Erin D. Clarke, Geoff Skinner, Lee M. Ashton, Megan C. Whatnall, Mark Jones, Christopher Oldmeadow, Clare E. Collins
      First page: 39
      Abstract: Young women are gaining weight rapidly. Evidence for effective weight loss interventions targeting young women is lacking. This randomized controlled trial assessed the efficacy and acceptability of a six-month targeted and tailored eHealth weight loss program for young women (Be Positive Be Healthe (BPBH)). Women aged 18–35 years were randomized to BPBH (n = 29) or control (n = 28). BPBH supported participants to modify diet and physical activity behaviours using evidenced-based strategies (e.g., self-monitoring) tailored for young women and delivered using e-health (website, social media, smartphone application, email, text messages). The primary outcome was a change in weight (kg) at six months. Acceptability was assessed via a process evaluation survey and usage of intervention components. No significant between-group differences were observed for weight, with significant mean differences favouring the intervention group observed for body fat (kg) (−3.10 (−5.69, 0.52), p = 0.019) and intakes of alcohol (g) (−0.69 (−1.33, 0.04), p = 0.037), vegetables (% energy/day) (4.71 (−2.20, 7.22), p < 0.001) and energy-dense, nutrient-poor foods (% energy/day) (−9.23 (−16.94, 1.52), p = 0.018). Retention, intervention usage and satisfaction were moderate. BPBH facilitated positive improvements in body fat and dietary intake, but not weight. Intervention acceptability findings support the use of some intervention components (e.g., Facebook, Smartphone app) with young women.
      Citation: Healthcare
      PubDate: 2018-05-02
      DOI: 10.3390/healthcare6020039
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 40: Skin Protective Nutraceuticals: The Current
           Evidence in Brief

    • Authors: Oroma Nwanodi
      First page: 40
      Abstract: Nutraceuticals are important for healthy skin maintenance. Probiotics, phenolics, and vitamins are just a few of the nutraceuticals meant to potentially prevent and assist medical management of dermatologic conditions. Among these, probiotics, vitamin E, and green tea catechins may offer the broadest array of skin protective mechanisms with probiotics having the greatest clinical range. Probiotics’ amelioration of atopic dermatitis and opportunistic infections of skin burns has been targeted in recent research efforts. This includes the improvement of Scoring Atopic Dermatitis index scores, p = 0.02, with intact Lactobacillus rhamnosus Goldin and Gorbach (LGG) in comparison to heat inactivated LGG or placebo. Lactobacillus reuteri used prior to or concurrently with Staphylococcus aureus infection can increase epidermal keratinocyte survival, p < 0.01. Phenolics may not have been extensively studied for atopic dermatitis or skin burns. However, phenolics do have a role in photoprotection. The phenolic rutin increases ultraviolet B radiation filter reactive oxygen species scavenging at 75%, p < 0.002, and peak wavelength absorption, p < 0.001. While oral and topical probiotics have untapped potential for atopic dermatitis amelioration and skin infection prevention, phenolics will be increasingly used for photoprotection. With optimized bioavailability, dosage, and formulation, nutraceuticals will become crucial for healthy skin maintenance.
      Citation: Healthcare
      PubDate: 2018-05-04
      DOI: 10.3390/healthcare6020040
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 41: Assessing the Effectiveness of the Aging
           Mastery Program

    • Authors: Lisa Ferretti, Philip McCallion, Emily McDonald, Hayoung Kye, Angelica P. Herrera-Venson, James Firman
      First page: 41
      Abstract: Background: Successful aging is best determined by active management and self-determination of one’s aging roadmap. Some individuals are ready to respond to these challenges, others may benefit from assistance that might be offered through an evidence-based intervention. The Aging Mastery Program® (AMP) has been developed to meet these needs. Method: In a cross over design the intervention was tested in ten senior centers and aging network agencies looking at impacts upon general health and quality of life, patient activation, physical activity and advanced care planning. Results: There was a statistically significant (tested at a 0.05 level) level of improvement found in physical activity and advanced care planning. Conclusion: Findings support the program’s effectiveness and its value as an evidence-based intervention for older adult programming.
      Citation: Healthcare
      PubDate: 2018-05-07
      DOI: 10.3390/healthcare6020041
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 42: The Delivery of Health Promotion and
           Environmental Health Services; Public Health or Primary Care Settings'
           

    • Authors: Lene Bjørn Jensen, Irena Lukic, Gabriel Gulis
      First page: 42
      Abstract: The WHO Regional Office for Europe developed a set of public health functions resulting in the ten Essential Public Health Operations (EPHO). Public health or primary care settings seem to be favorable to embrace all actions included into EPHOs. The presented paper aims to guide readers on how to assign individual health promotion and environmental health services to public health or primary care settings. Survey tools were developed based on EPHO 2, 3 and 4; there were six key informant surveys out of 18 contacted completed via e-mails by informants working in Denmark on health promotion and five face-to-face interviews were conducted in Australia (Melbourne and Victoria state) with experts from environmental health, public health and a physician. Based on interviews, we developed a set of indicators to support the assignment process. Population or individual focus, a system approach or one-to-one approach, dealing with hazards or dealing with effects, being proactive or reactive were identified as main element of the decision tool. Assignment of public health services to one of two settings proved to be possible in some cases, whereas in many there is no clear distinction between the two settings. National context might be the one which guides delivery of public health services.
      Citation: Healthcare
      PubDate: 2018-05-07
      DOI: 10.3390/healthcare6020042
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 43: The Role of Adult Day Services in Supporting
           the Occupational Participation of People with Dementia and Their Carers:
           An Integrative Review

    • Authors: Janice Du Preez, Jeannine Millsteed, Ruth Marquis, Janet Richmond
      First page: 43
      Abstract: The increasing numbers of people with dementia places considerable stress on health and aged care services and has resulted in the development of community adult day services. Aim: The aim of this integrative review is to determine the extent to which these services support the occupational participation of people with dementia, and how they impact their primary carers. Method: The mixed-methods appraisal tool (MMAT) was used to identify relevant studies in the period 2011–2016. Results: Nine databases were searched and yielded 16 articles with a variety of research designs for inclusion in the review. Conclusions: Findings indicate that adult day services use a range of approaches to support attendees and their carers. In spite of these efforts, there appears to be a lack of interest in utilizing these services while a person is in the early stages of dementia. This suggests that policies in aged care, such as aging-in-place, need to consider the pressure and stress they exert on carer’s quality of life. Another consideration is to better promote the benefits of participating in adult day services in the early stages of dementia for both the attendees and their carers, thereby delaying the tendency towards early institutionalization.
      Citation: Healthcare
      PubDate: 2018-05-08
      DOI: 10.3390/healthcare6020043
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 44: The Association between Quality Improvement
           Initiatives in Dementia Care and Supportive Psychosocial Work Environments
           in Nursing Homes

    • Authors: Miharu Nakanishi, Maki Tei-Tominaga
      First page: 44
      Abstract: Background: Quality improvement initiatives can help nursing homes strengthen psychosocial work environments. The aim of the present study was to examine the association between supportive psychosocial work environment, and professional and organizational characteristics regarding quality improvement initiatives in dementia care. Methods: A paper questionnaire survey was administered to a convenience sample of 365 professional caregivers in 12 special nursing homes in Japan. Psychosocial work environment was assessed using the Social Capital and Ethical Climate at the Workplace Scale to calculate a score of social capital in the workplace, ethical leadership, and exclusive workplace climate. Variables for quality improvement initiatives included type of home (unit-type or traditional), presence of additional benefit for dementia care, and professionalism in dementia care among caregivers evaluated using the Japanese version of the Sense of Competence in Dementia Care Staff Scale. Results: Elevated professionalism and unit-type home were significantly associated with high social capital, strong ethical leadership, and low exclusive workplace climate. The presence of dementia care benefit was not associated with any subscale of psychosocial work environment. Conclusions: Quality improvement initiatives to foster supportive psychosocial work environment should enhance professionalism in dementia care with unit-based team building of professional caregivers in special nursing homes.
      Citation: Healthcare
      PubDate: 2018-05-08
      DOI: 10.3390/healthcare6020044
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 45: Oral Health Care in Hong Kong

    • Authors: Sherry Shiqian Gao, Kitty Jieyi Chen, Duangporn Duangthip, Edward Chin Man Lo, Chun Hung Chu
      First page: 45
      Abstract: Hong Kong, as a special administrative region of the People’s Republic of China, is a metropolitan city in Asia with a population of approximately 7.4 million. This paper reflects the oral health care situation in Hong Kong. Water fluoridation was introduced in 1961 as the primary strategy for the prevention of dental caries. The fluoride level is currently 0.5 parts per million. Dental care is mainly provided by private dentists. The government’s dentists primarily serve civil servants and their dependents, with limited emergency dental service for pain relief offered to the general public. Nevertheless, the government runs the school dental care service, which provides dental treatments to primary school children through dental therapists. They also set up an oral health education unit to promote oral health in the community. Hong Kong had 2280 registered dentists in 2017, and the dentist-to-population ratio was about 1:3200. The Faculty of Dentistry at the University of Hong Kong is the only institution to provide basic and advanced dentistry training programs in Hong Kong. Dental hygienists, dental surgery assistants, dental therapists, and dental technicians receive training as paradental staff through the university or the government.
      Citation: Healthcare
      PubDate: 2018-05-11
      DOI: 10.3390/healthcare6020045
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 46: Striking a Balance: A Qualitative Study of
           Next of Kin Participation in the Care of Older Persons in Nursing Homes in
           Sweden

    • Authors: Birgitta Wallerstedt, Lina Behm, Åsa Alftberg, Anna Sandgren, Eva Benzein, Per Nilsen, Gerd Ahlström
      First page: 46
      Abstract: Most of the care in nursing homes is palliative in nature, as it is the oldest and the frailest people who live in nursing homes. The aim of this study was to explore next of kin’s experiences of participating in the care of older persons at nursing homes. A qualitative design was used, based on semi-structured interviews with 40 next of kin, and analyzed using qualitative content analysis. An overarching theme emerged, a balancing act consisting of three categories: (1) visiting the nursing home; (2) building and maintaining relationships; and (3) gathering and conveying information. The next of kin have to balance their own responsibility for the older person’s wellbeing by taking part in their care and their need to leave the responsibility to the staff due to critical health conditions. The next of kin wanted to participate in care meetings and conversations, not only in practical issues. The findings indicate the need to improve the next of kin’s participation in the care as an equal partner. Increased knowledge about palliative care and decision-making of limiting life-prolonging treatment may lead to a higher quality of care.
      Citation: Healthcare
      PubDate: 2018-05-11
      DOI: 10.3390/healthcare6020046
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 47: Modeling the Population Health Impact of
           Introducing a Modified Risk Tobacco Product into the U.S. Market

    • Authors: Smilja Djurdjevic, Peter N. Lee, Rolf Weitkunat, Zheng Sponsiello-Wang, Frank Lüdicke, Gizelle Baker
      First page: 47
      Abstract: Philip Morris International (PMI) has developed the Population Health Impact Model (PHIM) to quantify, in the absence of epidemiological data, the effects of marketing a candidate modified risk tobacco product (cMRTP) on the public health of a whole population. Various simulations were performed to understand the harm reduction impact on the U.S. population over a 20-year period under various scenarios. The overall reduction in smoking attributable deaths (SAD) over the 20-year period was estimated as 934,947 if smoking completely went away and between 516,944 and 780,433 if cMRTP use completely replaces smoking. The reduction in SADs was estimated as 172,458 for the World Health Organization (WHO) 2025 Target and between 70,274 and 90,155 for the gradual cMRTP uptake. Combining the scenarios (WHO 2025 Target and cMRTP uptake), the reductions were between 256,453 and 268,796, depending on the cMRTP relative exposure. These results show how a cMRTP can reduce overall population harm additionally to existing tobacco control efforts.
      Citation: Healthcare
      PubDate: 2018-05-16
      DOI: 10.3390/healthcare6020047
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 48: Transitioning from Acute to Chronic Pain: An
           Examination of Different Trajectories of Low-Back Pain

    • Authors: Robert J. Gatchel, Kelley Bevers, John C. Licciardone, Jianzhong Su, Ying Du, Marco Brotto
      First page: 48
      Abstract: Traditionally, there has been a widely accepted notion that the transition from acute to chronic pain follows a linear trajectory, where an injury leads to acute episodes, subacute stages, and progresses to a chronic pain condition. However, it appears that pain progression is much more complicated and individualized than this original unsupported assumption. It is now becoming apparent that, while this linear progression may occur, it is not the only path that pain, specifically low-back pain, follows. It is clear there is a definite need to evaluate how low-back pain trajectories are classified and, subsequently, how we can more effectively intervene during these progression stages. In order to better understand and manage pain conditions, we must examine the different pain trajectories, and develop a standard by which to use these classifications, so that clinicians can better identify and predict patient-needs and customize treatments for maximum efficacy. The present article examines the most recent trajectory research, and highlights the importance of developing a broader model for patient evaluation.
      Citation: Healthcare
      PubDate: 2018-05-17
      DOI: 10.3390/healthcare6020048
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 49: Human Babesiosis Caused by Babesia duncani
           Has Widespread Distribution across Canada

    • Authors: John D. Scott, Catherine M. Scott
      First page: 49
      Abstract: Human babesiosis caused by Babesia duncani is an emerging infectious disease in Canada. This malaria-like illness is brought about by a protozoan parasite infecting red blood cells. Currently, controversy surrounds which tick species are vectors of B. duncani. Since the availability of a serological or molecular test in Canada for B. duncani has been limited, we conducted a seven-year surveillance study (2011–2017) to ascertain the occurrence and geographic distribution of B. duncani infection country-wide. Surveillance case data for human B. duncani infections were collected by contacting physicians and naturopathic physicians in the United States and Canada who specialize in tick-borne diseases. During the seven-year period, 1119 cases were identified. The presence of B. duncani infections was widespread across Canada, with the highest occurrence in the Pacific coast region. Patients with human babesiosis may be asymptomatic, but as this parasitemia progresses, symptoms range from mild to fatal. Donors of blood, plasma, living tissues, and organs may unknowingly be infected with this piroplasm and are contributing to the spread of this zoonosis. Our data show that greater awareness of human babesiosis is needed in Canada, and the imminent threat to the security of the Canadian blood supply warrants further investigation. Based on our epidemiological findings, human babesiosis should be a nationally notifiable disease in Canada. Whenever a patient has a tick bite, health practitioners must watch for B. duncani infections, and include human babesiosis in their differential diagnosis.
      Citation: Healthcare
      PubDate: 2018-05-17
      DOI: 10.3390/healthcare6020049
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 50: Under the Same Sky: Connecting Students and
           Cultures through Circumpolar Nursing Education

    • Authors: Bente Norbye, Lorna Butler, Heather Exner-Pirot
      First page: 50
      Abstract: The recruitment and retention of health professionals in rural, remote, and northern regions is an ongoing challenge. The Northern Nursing Education Network brought together nursing students working in rural and remote regions of the circumpolar north in Innovative Learning Institute on Circumpolar Health (ILICH) events to create opportunities for shared learning and expose both students and faculty to local and traditional knowledge that informs health behaviors specific to regions with Indigenous populations. Using participant experience data extracted from program discussions, evaluations, and reflective notes conducted after ILICH events held in 2015–2017, this paper explores how these two-week institutes can contribute to knowledge that is locally relevant yet transferable to rural areas across the circumpolar north. The findings clustered around experiences related to (1) Language as a barrier and an enabler; (2) shared values and traditions across borders; (3) differences and similarities in nursing practice; (4) new perspectives in nursing; and (5) building sustainable partnerships. Students learned more about their own culture as well as others by exploring the importance of language, cultures, and health inequity on different continents. Shared values and traditional knowledge impacted student perspectives of social determinants of health that are highly relevant for nurses working in the circumpolar north.
      Citation: Healthcare
      PubDate: 2018-05-21
      DOI: 10.3390/healthcare6020050
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 51: Health Disparities Score Composite of Youth
           and Parent Dyads from an Obesity Prevention Intervention: iCook 4-H

    • Authors: Melissa D. Olfert, Makenzie L. Barr, Rebecca L. Hagedorn, Lisa Franzen-Castle, Sarah E. Colby, Kendra K. Kattelmann, Adrienne A. White
      First page: 51
      Abstract: iCook 4-H is a lifestyle intervention to improve diet, physical activity and mealtime behavior. Control and treatment dyads (adult primary meal preparer and a 9–10-year-old youth) completed surveys at baseline and 4, 12, and 24 months. A Health Disparity (HD) score composite was developed utilizing a series of 12 questions (maximum score = 12 with a higher score indicating a more severe health disparity). Questions came from the USDA short form U.S. Household Food Security Survey (5), participation in food assistance programs (1), food behavior (2), level of adult education completed (1), marital status (1), and race (1 adult and 1 child). There were 228 dyads (control n = 77; treatment n = 151) enrolled in the iCook 4-H study. Baseline HD scores were 3.00 ± 2.56 among control dyads and 2.97 ± 2.91 among treatment dyads, p = 0.6632. There was a significant decline in the HD score of the treatment group from baseline to 12 months (p = 0.0047) and baseline to 24 months (p = 0.0354). A treatment by 12-month time interaction was found (baseline mean 2.97 ± 2.91 vs. 12-month mean 1.78 ± 2.31; p = 0.0406). This study shows that behavioral change interventions for youth and adults can help improve factors that impact health equity; although, further research is needed to validate this HD score as a measure of health disparities across time.
      Citation: Healthcare
      PubDate: 2018-05-22
      DOI: 10.3390/healthcare6020051
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 52: A Comparative Study of Oral Health Status
           between International and Japanese University Student Patients in Japan

    • Authors: Ai Ohsato, Masanobu Abe, Kazumi Ohkubo, Hidemi Yoshimasu, Liang Zong, Kazuto Hoshi, Tsuyoshi Takato, Shintaro Yanagimoto, Kazuhiko Yamamoto
      First page: 52
      Abstract: Background: The number of international students enrolled in universities in Japan is increasing. To provide better oral care services for international students, we have to understand their oral environment and dental health behaviors. However, few studies have investigated the oral health status of international university students. The object of the present study was to clarify the current oral status of international university students. Methods: The subjects were students who visited the dental department at the University of Tokyo’s Health Services Center between April 2012 and March 2013. Our medical records were reviewed with regard to the following items: attributes (nationality, gender, and age); chief complaint (reason for visit); history of dental treatment; mean number of decayed (D), missing (M) or filled (F) teeth as a single (DMFT) index; degree of calculus deposition; gingival condition; and oral hygiene status. Results: The records of 554 university students (138 international and 416 non-international students) were analyzed; 88.4% of the 138 international students were from Asian countries (n = 122), of which 47.1% were from China and 10.9% from Korea, followed by North America (5.8%), Europe (4.3%), and Africa (1.5%). Although no significant differences were found regarding the history of dental treatment between international and non-international students (49.3% and 48.8%, respectively), international students had a significantly higher dental caries morbidity rate (60.1%) than non-international students (49.0%). The international students showed a significantly higher DMFT value compared with the non-international students: 5.0 and 4.0 per individual, respectively. Severe calculus deposition was observed in international students compared with non-international students (51.9% and 31.7%, respectively). Conclusions: The international university students had poorer oral health status than the non-international students, even though the result might include many uncertainties and possible biases.
      Citation: Healthcare
      PubDate: 2018-05-22
      DOI: 10.3390/healthcare6020052
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 53: Chronicity and Mental Health Service
           Utilization for Anxiety, Mood, and Substance Use Disorders among Black Men
           in the United States; Ethnicity and Nativity Differences

    • Authors: Vickie M. Mays, Audrey L. Jones, Susan D. Cochran, Robert Joseph Taylor, Jane Rafferty, James S. Jackson
      First page: 53
      Abstract: This study investigated ethnic and nativity differences in the chronicity and treatment of psychiatric disorders of African American and Caribbean Black men in the U.S. Data were analyzed from the National Survey of American Life, a population-based study which included 1859 self-identified Black men (1222 African American, 176 Caribbean Black men born within the U.S., and 461 Caribbean Black men born outside the U.S.). Lifetime and twelve-month prevalence of DSM-IV mood, anxiety, and substance use disorders (including Bipolar I and Dysthmia), disorder chronicity, and rate of mental health services use among those meeting criteria for a lifetime psychiatric disorder were examined. Logistic regression models were employed to determine ethnic differences in chronicity, and treatment utilization for disorders. While rates of DSM-IV disorders were generally low in this community sample of Black men, their disorders were chronic and remained untreated. Caribbean Black men born in the U.S. had higher prevalence of Post-Traumatic Stress Disorder, Major Depressive Disorder, and Alcohol Abuse Disorder compared with African American men. Foreign born Caribbean Black men experienced greater chronicity in Social Phobia and Generalized Anxiety Disorder compared to other Black Men. Utilization of mental health service was low for all groups of Black Men, but lowest for the foreign born Caribbean Black men. Results underscore the large unmet needs of both African American and Caribbean Black men in the United States. Results also highlight the role of ethnicity and nativity in mental disorder chronicity and mental health service utilization patterns of Black men.
      Citation: Healthcare
      PubDate: 2018-05-23
      DOI: 10.3390/healthcare6020053
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 54: A Systematic Review on Healthcare Analytics:
           Application and Theoretical Perspective of Data Mining

    • Authors: Md Saiful Islam, Md Mahmudul Hasan, Xiaoyi Wang, Hayley D. Germack, Md Noor-E-Alam
      First page: 54
      Abstract: The growing healthcare industry is generating a large volume of useful data on patient demographics, treatment plans, payment, and insurance coverage—attracting the attention of clinicians and scientists alike. In recent years, a number of peer-reviewed articles have addressed different dimensions of data mining application in healthcare. However, the lack of a comprehensive and systematic narrative motivated us to construct a literature review on this topic. In this paper, we present a review of the literature on healthcare analytics using data mining and big data. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a database search between 2005 and 2016. Critical elements of the selected studies—healthcare sub-areas, data mining techniques, types of analytics, data, and data sources—were extracted to provide a systematic view of development in this field and possible future directions. We found that the existing literature mostly examines analytics in clinical and administrative decision-making. Use of human-generated data is predominant considering the wide adoption of Electronic Medical Record in clinical care. However, analytics based on website and social media data has been increasing in recent years. Lack of prescriptive analytics in practice and integration of domain expert knowledge in the decision-making process emphasizes the necessity of future research.
      Citation: Healthcare
      PubDate: 2018-05-23
      DOI: 10.3390/healthcare6020054
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 55: Fecal Distribution Changes Using Colorectal
           Ultrasonography in Older People with Physical and Cognitive Impairment
           Living in Long-Term Care Facilities: A Longitudinal Observational Study

    • Authors: Shiho Tanaka, Koichi Yabunaka, Masaru Matsumoto, Nao Tamai, Hiroshi Noguchi, Mikako Yoshida, Gojiro Nakagami, Junko Sugama, Hiromi Sanada
      First page: 55
      Abstract: Nurses encounter difficulties evaluating constipation in elderly people with physical and cognitive impairment. Transabdominal ultrasonography (US) has been used to evaluate fecal impaction or fecal quality. However, it is unclear whether colorectal US can evaluate constipation symptoms in older people. Using colorectal US, we continuously observed the elderly and clarified the relationship between patterns of fecal distribution changes and constipation symptoms in older people with physical and cognitive impairment at long-term care facilities. This study included patients aged ≥65 years with oral intake. US was performed once a day until the next defecation, and fecal hardness was assessed. US images were extracted and categorized. Then, patterns of fecal distribution changes in the colorectum were classified. Multiple logistic regression analysis was performed to examine related factors associated with a constipation pattern. Among 101 patients, US images of 95 patients were analyzed. In 74.4% of the patients, US showed continuation of reflection with acoustic shadow in the rectum, which was significantly associated with defecation on the bed. Of the patients with a continuous crescent-shaped reflection pattern (R3), 92.9% had hard stool. R3 was found to be significantly associated with a Mini-Mental State Examination score of ≤10. In most of the patients, US detected a continuation of reflection with acoustic shadow in rectal patterns, indicating fecal retention in the rectum. Point-of-care US can be used by nurses to visualize rectal fecal retention as constipation patterns in the older people with physical and cognitive impairment at long-term care facilities.
      Citation: Healthcare
      PubDate: 2018-05-25
      DOI: 10.3390/healthcare6020055
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 56: Chief Nursing Officers’ Views on Meeting
           

    • Authors: Charlene Ingwell-Spolan
      First page: 56
      Abstract: Chief Nursing Officers (CNOs) have a demanding, complex role that commands accountability in leading the nursing profession and achieving quality patient outcomes. The purpose of this study was to understand the CNO’s view of meeting the needs of the Registered Nurse (RN) at point of care and how this could affect quality patient outcomes. In two qualitative studies twenty-five CNOs were individually interviewed in eight states including: Florida, Tennessee, Kentucky, Maine, New Hampshire, Vermont, Massachusetts, and New Jersey. The majority of these CNOs interviewed believed they were doing the best for their nurses and their healthcare facility. After analyzing their responses, it was apparent that some CNOs actually encouraged peer pressure among nurses to achieve compliance and felt patient acuity is being addressed adequately, since most patients were discharged within three to four days and those that were more critical were admitted to the critical care units. The average length of stay, which is the number of paid days a patient remained in the hospital, was an important metric. A large amount of nurses felt they were unable to deliver the care needed for their patients due to patient load, lack of collaboration among the health care team, higher patient acuity and absence of decision-making and autonomy. Many of the CNOs trusted that patient care outcomes, meaning relatively short hospital stays, demonstrated that the nursing practice was successful; rather than first having the nurse being set up for success to provide the best care possible to their patients.
      Citation: Healthcare
      PubDate: 2018-05-31
      DOI: 10.3390/healthcare6020056
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 57: From Inpatient to Ambulatory Care: The
           Introduction of a Rapid Access Transient Ischaemic Attack Service

    • Authors: Mohana Maddula, Laura Adams, Jonathan Donnelly
      First page: 57
      Abstract: Background: Transient Ischaemic Attacks (TIA) should be treated as a medical emergency. While high-risk TIAs have higher stroke risks than low-risk patients, there is an inherent limitation to this risk stratification, as some low-risk patients may have undiagnosed high-risk conditions. Inequity of care for TIA patients was observed, such that high-risk patients received urgent assessment through acute admission, while low-risk patients faced long waits for clinical consultation. A redesign of the TIA service was planned to offer timely assessment for all patients and avoid acute admission for high-risk patients. Methods: Service reconfiguration was undertaken to set up a daily weekday rapid access TIA clinic where patients would be assessed, investigated, and treated. Results: A re-audit of clinic performance showed a significant increase in the number of patients seen in the ages of 18 to 52. The median time from referral to clinical consultation improved from 10 days to 1. There were similar significant improvements seen in median time to brain imaging (from 10.5 days to 1), and carotid ultrasound (from 10 days to all scans being performed on the same day). Conclusions: The redesigned service achieved the objective of offering urgent assessment and investigations for all TIA patients, including low-risk patients, while avoiding the acute admission for high-risk patients. We share our experience of establishing a successful rapid access ambulatory service without any additional resources.
      Citation: Healthcare
      PubDate: 2018-06-01
      DOI: 10.3390/healthcare6020057
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 58: Exploring Demographics and Health as
           Predictors of Risk-Taking in UK Help-Seeking Veterans

    • Authors: Rachel Ashwick, Shabeer Syed, Dominic Murphy
      First page: 58
      Abstract: Risk-taking amongst veterans has severe consequences, yet few studies have examined factors that may predict risk-taking in help-seeking veteran populations. This paper presents a cross-sectional study involving a random sample of 667 UK help-seeking veterans, investigating the role of demographics, mental health and physical health presentations on the propensity for risk-taking. Out of 403 (73.4%) veterans, 350 (86.8%) reported risk-taking in the past month. We found that younger age, being in a relationship, probable PTSD, common mental health difficulties and traumatic brain injury were significantly associated with risk-taking. Additionally, a direct association was found between increased risk-taking and PTSD symptom clusters, including higher hyperarousal, elevated negative alterations in mood and cognition. Our findings provide initial evidence for demographic and mental health presentations as predictors of risk-taking in help-seeking veterans. Further research and longitudinal studies are needed to facilitate valid risk assessments, and early intervention for veteran services.
      Citation: Healthcare
      PubDate: 2018-06-05
      DOI: 10.3390/healthcare6020058
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 59: Psychometric Evaluation of the Team Member
           Perspectives of Person-Centered Care (TM-PCC) Survey for Long-Term Care
           Homes

    • Authors: Veronique M. Boscart, Meaghan Davey, Jenny Ploeg, George Heckman, Sherry Dupuis, Linda Sheiban, Jessica Luh Kim, Paul Brown, Souraya Sidani
      First page: 59
      Abstract: Person-centered care (PCC) is fundamental for providing high-quality care in long-term care homes. This study aimed to evaluate the psychometric properties of an 11-item Team Member Perspectives of Person-Centered Care (TM-PCC) survey, adapted from White and colleagues (2008). In a cross-sectional study, 461 staff from four long-term care homes in Ontario, Canada, completed the TM-PCC. Construct validity and internal consistency of the TM-PCC were examined with a principal component analysis and Cronbach’s alpha coefficient. Findings revealed a three-component structure with factor 1, Supporting Social Relationships; factor 2, Familiarity with Residents’ Preferences; and factor 3, Meaningful Resident–Staff Relationships. The TM-PCC, as compared to the original survey, presented with less components (i.e., did not address Resident Autonomy, Personhood, Comfort, Work with Residents, Personal Environment, and Management Structure), yet included one new component (Meaningful Resident–Staff Relationships). The TM-PCC has a similar internal consistency (Cronbach’s alpha coefficient 0.82 vs. White et al. 0.74–0.91). The TM-PCC can be used to assess PCC from the staff’s perspective in long-term care homes.
      Citation: Healthcare
      PubDate: 2018-06-06
      DOI: 10.3390/healthcare6020059
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 60: Impact of Standardized Prenatal Clinical
           Training for Traditional Birth Attendants in Rural Guatemala

    • Authors: Sasha Hernandez, Jessica Oliveira, Leah Jones, Juan Chumil, Taraneh Shirazian
      First page: 60
      Abstract: In low-and-middle-income countries (LMICs), traditional birth attendant (TBA) training programs are increasing, yet reports are limited on how those programs affect the prenatal clinical abilities of trained TBAs. This study aims to assess the impact of clinical training on TBAs before and after a maternal health-training program. A prospective observational study was conducted in rural Guatemala from March to December 2017. Thirteen participants conducted 116 prenatal home visits. Data acquisition occurred before any prenatal clinical training had occurred, at the completion of the 14-week training program, and at six months post program completion. The paired t-test and McNemar’s test was used and statistical analyses were performed with R Version 3.3.1. There was a statistically significant improvement in prenatal clinical skills before and after the completion of the training program. The mean percentage of prenatal skills done correctly before any training occurred was 25.8%, 62.3% at the completion of the training program (p-value = 0.0001), and 71.0% after six months of continued training (p-value = 0.034). This study highlights the feasibility of prenatal skill improvement through a standardized and continuous clinical training program for TBAs. The improvement of TBA prenatal clinical skills could benefit indigenous women in rural Guatemala and other LMICs.
      Citation: Healthcare
      PubDate: 2018-06-09
      DOI: 10.3390/healthcare6020060
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 61: Use of Real Patients and
           Patient-Simulation-Based Methodologies for Teaching Gastroenterology to
           Pre-Clinical Medical Students

    • Authors: Joshua DeSipio, John Gaughan, Susan Perlis, Sangita Phadtare
      First page: 61
      Abstract: In recent years, there has been an increasing focus on the need to integrate formal knowledge with clinical experience in the pre-clinical years since the initial years of medical education play an important role in shaping the attitudes of medical students towards medicine and support the development of clinical reasoning. In this study, we describe approaches that involve real patients and patient-simulation-based methodologies to teach gastroenterology to second year medical students. Our goals were to (i) demonstrate bio-psychosocial aspects of clinical practice, (ii) demonstrate commonality of gastrointestinal ailments, and (iii) help understand complex gastroenterology concepts. We used two main approaches including brief, pre-prepared questions and answers discussing with the patients in various sessions throughout the course and a two-hour session that included patient participation, patient simulation modalities with high fidelity mannequins, a lightening round of interactive cases, and a Patient Oriented Problem Solving (POPS) session. The approaches improved the effectiveness of the delivery of the content-heavy, fast-paced GI course and provided opportunities for the students to think about gastroenterology from both basic and clinical points of view. The approaches involved peer teaching, which supports knowledge acquisition and comprehension. Very positive feedback and overall engagement of students suggested that these approaches were well-received.
      Citation: Healthcare
      PubDate: 2018-06-12
      DOI: 10.3390/healthcare6020061
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 62: Poverty Status and Childhood Asthma in White
           and Black Families: National Survey of Children’s Health

    • Authors: Shervin Assari, Maryam Moghani Lankarani
      First page: 62
      Abstract: Background: Living above the poverty line reduces the risk of physical illnesses, including childhood asthma (CA). Minorities’ Diminished Return theory, however, suggests that the protective effects of socioeconomic status (SES) on health are weaker for racial minorities than White families. It is unknown whether the association between SES and CA differs for White and Black families. Aims: Using a national sample, the current study compared Black and White families for the association between living above the poverty line and CA. Methods: Data came from the National Survey of Children’s Health (NSCH), 2003–2004, a national telephone survey. A total of 86,537 Black or White families with children (17 years old or younger) were included in the study. This sample was composed of 76,403 White (88.29%) and 10,134 Black (11.71%) families. Family SES (living above the poverty line) was the independent variable. The outcome was CA, reported by the parent. Age, gender, and childhood obesity were the covariates. Race was conceptualized as the moderator. A number of multivariable logistic regressions were used in the pooled sample and specific to each race for data analysis. Results: In the pooled sample, living above the poverty line was associated with lower odds of CA. An interaction was found between race and living above the poverty line on odds of CA, indicating a smaller association for Black compared to White families. Although race-stratified logistic regressions showed negative associations between living above the poverty line and CA in both White and Black families, the magnitude of this negative association was larger for White than Black families. Conclusions: The health gain from living above the poverty line may be smaller for Black than White families. Due to the existing Minorities’ Diminished Return, policies that merely reduce the racial gap in SES may not be sufficient in eliminating racial health disparities in the United States. Public policies must go beyond reducing poverty to address structural and environmental risk factors that disproportionately impact Blacks’ health. Policies should help Black families gain health as they gain upward social mobility. As they are more likely to face societal and structural barriers, multi-level interventions are needed for the health promotion of Blacks.
      Citation: Healthcare
      PubDate: 2018-06-12
      DOI: 10.3390/healthcare6020062
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 63: Conversations about Death and Dying with
           Older People: An Ethnographic Study in Nursing Homes

    • Authors: Åsa Alftberg, Gerd Ahlström, Per Nilsen, Lina Behm, Anna Sandgren, Eva Benzein, Birgitta Wallerstedt, Birgit H. Rasmussen
      First page: 63
      Abstract: Nursing homes are often places where older persons “come to die.” Despite this, death and dying are seldom articulated or talked about. The aim of this study was to explore assistant nurses’ experiences of conversations about death and dying with nursing home residents. This study is part of an implementation project through a knowledge-based educational intervention based on palliative care principles. An ethnographic study design was applied in seven nursing homes, where eight assistant nurses were interviewed and followed in their daily assignments through participant observations. The assistant nurses stated that they had the knowledge and tools to conduct such conversations, even though they lacked the time and felt that emotional strain could be a hinder for conversations about death and dying. The assistant nurses used the strategies of distracting, comforting, and disregarding either when they perceived that residents’ reflections on death and dying were part of their illness and disease or when there was a lack of alignment between the residents’ contemplations and the concept of dying well. They indicated that ambivalence and ambiguity toward conversations about death and dying should be taken into consideration in future implementations of knowledge-based palliative care that take place in nursing homes after this project is finalized.
      Citation: Healthcare
      PubDate: 2018-06-14
      DOI: 10.3390/healthcare6020063
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 64: “That Guy, Is He Really Sick at
           All'” An Analysis of How Veterans with PTSD Experience Nature-Based
           Therapy

    • Authors: Dorthe Varning Poulsen, Ulrika K. Stigsdotter, Annette Sofie Davidsen
      First page: 64
      Abstract: Serving in the military leads to mental diseases, such as post-traumatic stress disorder (PTSD), for a percentage of soldiers globally. The number of veterans with PTSD is increasing and, although medication and psychological treatments are offered, treatment results could be improved. Historically, different forms of nature-based therapy have been used for this target group. However, in spite of anecdotally good results, studies measuring the effect of this form of therapy are still lacking. The aim of this study is to explore how veterans with PTSD manage their everyday lives during and after a ten-week nature-based intervention in a therapy garden. Methods: Eight veterans participated in qualitative interviews, which were conducted during a one-year period and were analyzed using interpretative phenomenological analysis (IPA). Results: Five themes emerged from the IPA analysis: Bodily symptoms; relationships; building new identities; the future; and lessons learned. All the participating veterans gained a greater insight into and mastering of their condition, achieved better control of their lives, and developed tools to handle life situations more appropriately and to build a new identity. This improved their ability to participate in social activities and employment. Conclusion: The results should be considered in the future treatment of veterans with PTSD.
      Citation: Healthcare
      PubDate: 2018-06-14
      DOI: 10.3390/healthcare6020064
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 65: Impact of Nurse Practitioner Practice
           Regulations on Rural Population Health Outcomes

    • Authors: Judith Ortiz, Richard Hofler, Angeline Bushy, Yi-ling Lin, Ahmad Khanijahani, Andrea Bitney
      First page: 65
      Abstract: Background: For decades, U.S. rural areas have experienced shortages of primary care providers. Nurse practitioners (NPs) are helping to reduce that shortage. However, NP scope of practice regulations vary from state-to-state ranging from autonomous practice to direct physician oversight. The purpose of this study was to determine if clinical outcomes of older rural adult patients vary by the level of practice autonomy that states grant to NPs. Methods: This cross-sectional study analyzed data from a sample of Rural Health Clinics (RHCs) (n = 503) located in eight Southeastern states. Independent t-tests were performed for each of five variables to compare patient outcomes of the experimental RHCs (those in “reduced practice” states) to those of the control RHCs (in “restricted practice” states). Results: After matching, no statistically significant difference was found in patient outcomes for RHCs in reduced practice states compared to those in restricted practice states. Yet, expanded scope of practice may improve provider supply, healthcare access and utilization, and quality of care (Martsolf et al., 2016). Conclusions: Although this study found no significant relationship between Advanced Registered Nurse Practitioner (ARNP) scope of practice and select patient outcome variables, there are strong indications that the quality of patient outcomes is not reduced when the scope of practice is expanded.
      Citation: Healthcare
      PubDate: 2018-06-15
      DOI: 10.3390/healthcare6020065
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 66: A Health System’s Journey toward Better
           Population Health through Empanelment and Panel Management

    • Authors: Peter McGough, Vandna Chaudhari, Suzanne El-Attar, Pamela Yung
      First page: 66
      Abstract: The USA is steadily moving towards a health system that emphasizes ‘wellness’ over ‘sickness’ care. An effective wellness program utilizes a ‘population health’ approach that ensures that all patients who seek care from a health system receive the services recommended by evidence and best practice. This means attending not just to patients who are seen for care, but also to patients who have not yet been seen. A key strategy for population health is empanelment and panel management for patients in primary care. This article relates the experience of UW (University of Washington) Medicine in implementing such a program.
      Citation: Healthcare
      PubDate: 2018-06-15
      DOI: 10.3390/healthcare6020066
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 67: Pain and Pain Medication among Older People
           with Intellectual Disabilities in Comparison with the General Population

    • Authors: Anna Axmon, Gerd Ahlström, Hans Westergren
      First page: 67
      Abstract: Little is known about pain and pain treatment among people with intellectual disabilities (IDs). We aimed to describe pain and pain medications among older people with ID compared to the general population. Data on diagnoses and prescriptions were collected from national registers for the period between 2006 and 2012 for 7936 people with an ID and a referent cohort from the general population. IDs were associated with a decreased risk of being diagnosed with headaches, musculoskeletal pain, and pain related to the circulatory and respiratory systems, but they were associated with increased risk of being diagnosed with pain related to the urinary system. Among men, IDs were associated with an increased risk of being diagnosed with visceral pain. People with IDs were more likely to be prescribed paracetamol and fentanyl regardless of the type of pain but were less likely to be prescribed COX(1+2) and COX2 inhibitors and weak opioids. Healthcare staff and caregivers must be made aware of signs of pain among people with IDs who may not be able to communicate it themselves. Further research is needed to investigate whether people with IDs are prescribed paracetamol rather than other pain drugs due to physicians trying to avoid polypharmacy or if there are other reasons not to prescribe a greater range of pain treatments.
      Citation: Healthcare
      PubDate: 2018-06-15
      DOI: 10.3390/healthcare6020067
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 68: Thoracic Outlet Syndrome: Biomechanical and
           Exercise Considerations

    • Authors: Nicholas A. Levine, Brandon R. Rigby
      First page: 68
      Abstract: Thoracic outlet syndrome (TOS) describes a group of disorders that are due to a dynamic compression of blood vessels or nerves, between the clavicle and first rib or cervical vertebral nerve roots. Individuals with TOS typically experience upper limb pain, numbness, tingling, or weakness that is exacerbated by shoulder or neck movement. The causes of TOS vary, and can include abrupt movements, hypertrophy of the neck musculature, and anatomical variations in which the brachial plexus roots pass through this musculature, edema, pregnancy, repeated overhead motions, the blockage of an artery or vein, or abnormal posture. To understand the complexity of this condition, an analysis of shoulder anatomy and mechanics are needed to help describe limitations and the subsequent pathophysiology of TOS. Several treatment options are available, including surgery, medications, and exercise. A comprehensive study of shoulder anatomy and biomechanics, and knowledge of the benefits of exercise, may help clinicians and healthcare practitioners determine the most appropriate treatment plan for an individual with TOS.
      Citation: Healthcare
      PubDate: 2018-06-19
      DOI: 10.3390/healthcare6020068
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 69: A Community Study of Borrelia burgdorferi
           Antibodies among Individuals with Prior Lyme Disease in Endemic Areas

    • Authors: Barbara Strobino, Katja Steinhagen, Wolfgang Meyer, Thomas Scheper, Sandra Saschenbrecker, Wolfgang Schlumberger, Winfried Stöcker, Andrea Gaito, Brian A. Fallon
      First page: 69
      Abstract: The objective was to examine the prevalence of Borrelia antibodies among symptomatic individuals with recent and past Lyme disease in endemic communities using standard assays and novel assays employing next-generation antigenic substrates. Single- and two-tiered algorithms included different anti-Borrelia ELISAs and immunoblots. Antibody prevalence was examined in sera from 32 individuals with recent erythema migrans (EM), 335 individuals with persistent symptoms following treatment for Lyme disease (PTLS), and 41 community controls without a history of Lyme disease. Among convalescent EM cases, sensitivity was highest using the C6 ELISA (93.8%) compared to other single assays; specificity was 92.7% for the C6 ELISA vs. 85.4–97.6% for other assays. The two-tiered ELISA-EUROLINE IgG immunoblot combinations enhanced case detection substantially compared to the respective ELISA-IgG Western blot combinations (75.0% vs. 34.4%) despite similar specificity (95.1% vs. 97.6%, respectively). For PTLS cohorts, two-tier ELISA-IgG-blot positivity ranged from 10.1% to 47.4%, depending upon assay combination, time from initial infection, and clinical history. For controls, the two-tier positivity rate was 0–14.6% across assays. A two-tier algorithm of two-ELISA assays yielded a high positivity rate of 87.5% among convalescent EM cases with specificity of 92.7%. For convalescent EM, combinations of the C6 ELISA with a second-tier ELISA or line blot may provide useful alternatives to WB-based testing algorithms.
      Citation: Healthcare
      PubDate: 2018-06-19
      DOI: 10.3390/healthcare6020069
      Issue No: Vol. 6, No. 2 (2018)
       
  • Healthcare, Vol. 6, Pages 2: The Benefits of Higher Income in Protecting
           against Chronic Medical Conditions Are Smaller for African Americans than
           Whites

    • 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 3: Evaluating the Impact of a Clinician
           Improvement Program for Treating Patients with Intellectual and
           Developmental Disabilities: The Challenging Case of Mississippi

    • Authors: John Bartkowski, Janelle Kohler, Craig Escude, Xiaohe Xu, Stephen Bartkowski
      First page: 3
      Abstract: In recent years, people with intellectual and developmental disabilities (IDD) have moved from institutionalized settings to local community residences. While deinstitutionalization has yielded quality of life improvements for people with IDD, this transition presents significant health-related challenges. Community clinicians have typically not been trained to provide sound medical care to people with IDD, a subpopulation that exhibits unique medical needs and significant health disparities. This study reports the results of a comprehensive evaluation of an IDD-focused clinician improvement program implemented throughout Mississippi. DETECT (Developmental Evaluation, Training and Consultative Team) was formed to equip Mississippi’s physicians and nurses to offer competent medical care to people with IDD living in community residences. Given the state’s pronounced health disparities and its clinician shortage, Mississippi offers a stringent test of program effectiveness. Results of objective survey indicators and subjective rating barometers administered before and after clinician educational seminars reveal robust statistically significant differences in clinician knowledge and self-assessed competence related to treating people with IDD. These results withstand controls for various confounding factors. Positive post-only results were also evident in a related program designed specifically for medical students. The study concludes by specifying a number of implications, including potential avenues for the wider dissemination of this program and promising directions for future research.
      Citation: Healthcare
      PubDate: 2018-01-10
      DOI: 10.3390/healthcare6010003
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 4: Acknowledgement to Reviewers of Healthcare in
           2017

    • Authors: Healthcare Editorial Office
      First page: 4
      Abstract: Peer review is an essential part in the publication process, ensuring that Healthcare maintains high quality standards for its published papers.[...]
      Citation: Healthcare
      PubDate: 2018-01-10
      DOI: 10.3390/healthcare6010004
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 5: Poor People Are Hospitalized Three Times More
           

    • Authors: Gyanesh Lama, Emanuel Alcala, John Capitman
      First page: 5
      Abstract: Introduction: Providing health insurance to the poor has become a standard policy response to health disparities between the poor and the non-poor. It is often assumed that if the poor people are given health insurance, they will use preventative care, which will prevent more expensive emergency visits and inpatient hospitalization, and in turn, it will save healthcare cost in the long run. This paper presents the findings from our study in California about what happens to the poor when they are given health insurance. The purpose of the study was to understand how the healthcare system in California treats the poor patients differently than the non-poor. Method: Using multivariate logistic regressions, this study analyzed a large patient discharge data (PDD) from the California Office of Statewide Planning and Development (OSHPD) for eight counties in the Central Valley California (N = 423,640). First, utilizing International Classification of Diseases (ICD 10) as diagnostic criteria, mental-health vs. non-mental health hospitalization rates were estimated. Second, health insurance status was used as a proxy measure of poverty of the patients. Using chi-Square, the probability of hospitalization for mental health services was estimated based on their insurance types. Finally, using step-wise logistic regression, the odds of mental health hospitalization was estimated conditional on individual characteristics, health insurance types, and geographic characteristics. Findings: When the poor people were given health insurance, they were three times more likely to be hospitalized for mental health services than the non-poor. The more than three-fold variation in mental health hospitalization was not driven by demographic or geographic characteristics. The findings are new and have important implications for the healthcare policies for the poor. Further studies are needed to understand the extent to which the disproportionately high rate of mental health hospitalizations of the poor are driven by the provider-induced needs.
      Citation: Healthcare
      PubDate: 2018-01-12
      DOI: 10.3390/healthcare6010005
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 6: Age and Gender Differences in Psychological
           Distress among African Americans and Whites: Findings from the 2016
           National Health Interview Survey

    • Authors: Daphne Watkins, Natasha Johnson
      First page: 6
      Abstract: Previous studies report a race and mental health paradox: Whites score higher on measures of major depression compared to African Americans, but the opposite is true for psychological distress (i.e., African Americans score higher on distress measures compared to Whites). Independently, race, age, and gender outcomes for psychological distress are well documented in the literature. However, there is relatively little research on how psychological distress interferes with the lives of African Americans and Whites at the intersection of their various race, age, and gender identities. This study uses data from the 2016 National Health Interview Survey to examine age and gender differences in psychological distress and how much psychological distress interferes with the lives of African Americans and Whites. Our study findings are contrary to the paradox such that young White women (M = 3.36, SD = 1.14) and middle-aged White men (M = 2.55, SD = 3.97) experienced higher psychological distress than all other race, age, and gender groups. Psychological distress interference was relatively high among the high distress groups, except for older African American men (M = 1.73, SD = 1.05) and young African American women (M = 1.93, SD = 0.95). Implications for studies that consider cultural experiences of psychological distress, and how it impacts different demographic groups are discussed.
      Citation: Healthcare
      PubDate: 2018-01-17
      DOI: 10.3390/healthcare6010006
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 7: How Neighborhood Effects Vary: Childbearing
           and Fathering among Latino and African American Adolescents

    • Authors: Jessica Lucero, Anna Santiago, George Galster
      First page: 7
      Abstract: This study examines what neighborhood conditions experienced at age 15 and after are associated with teen childbearing and fathering among Latino and African American youth and whether these neighborhood effects vary by gender and/or ethnicity. Administrative and survey data from a natural experiment are used for a sample of 517 Latino and African American youth whose families were quasi-randomly assigned to public housing operated by the Denver (CO) Housing Authority (DHA). Characteristics of the neighborhood initially assigned by DHA to wait list applicants are utilized as identifying instruments for the neighborhood contexts experienced during adolescence. Cox Proportional Hazards (PH) models reveal that neighborhoods having higher percentages of foreign-born residents but lower levels of social capital robustly predict reduced odds of teen parenting though the magnitude of these effects was contingent on gender and ethnicity. Specifically, the presence of foreign-born neighbors on the risk of teen parenting produced a stronger dampening effect for African American youth when compared to Latino youth. Additionally, the effects of social capital on teen parenting were stronger for males than females.
      Citation: Healthcare
      PubDate: 2018-01-18
      DOI: 10.3390/healthcare6010007
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 8: Postpartum Women’s Perspectives of Engaging
           with a Dietitian and Exercise Physiologist via Video Consultations for
           Weight Management: A Qualitative Evaluation

    • Authors: Lisa Vincze, Megan Rollo, Melinda Hutchesson, Robin Callister, Debbe Thompson, Clare Collins
      First page: 8
      Abstract: Optimising weight status after childbirth is important. Video consultations are an unexplored opportunity to deliver real-time support to postpartum women to improve lifestyle behaviours. This study aims to provide insight into postpartum women’s perspectives of engaging with a dietitian and exercise physiologist through video consultations for tailored nutrition and exercise care. A qualitative study using individual telephone interviews (13–36 min) was undertaken. 21 women (body mass index (BMI): 28.1 ± 3.8 kg/m2; age: 32.3 ± 3.0 years; parity: 1.6 ± 0.9 children) who had completed the 8 week “Video-coaching to assist lifestyle (VITAL) change for mums” intervention participation included up to five video consultations with a dietitian and exercise physiologist. The interviews were audiorecorded and transcribed. Thematic data analysis was conducted by an independent researcher using NVIVO11. Themes relating to the video consultation experience included feeling that they did not differ from other consultations, they were convenient, and the length of time and flexible options were appropriate; however there was a desire for increased contact frequency. The dietitian and exercise physiologist were perceived to increase the participants’ knowledge and confidence to improve health behaviours. The approach to setting realistic and tailored goals was well received. Tailored advice from a dietitian and exercise physiologist received via video consultations is acceptable for postpartum women and offers a viable alternative to in-person care.
      Citation: Healthcare
      PubDate: 2018-01-19
      DOI: 10.3390/healthcare6010008
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 9: Nutrition Care after Discharge from Hospital:
           An Exploratory Analysis from the More-2-Eat Study

    • Authors: Celia Laur, Lori Curtis, Joel Dubin, Tara McNicholl, Renata Valaitis, Pauline Douglas, Jack Bell, Paule Bernier, Heather Keller
      First page: 9
      Abstract: Many patients leave hospital in poor nutritional states, yet little is known about the post-discharge nutrition care in which patients are engaged. This study describes the nutrition-care activities 30-days post-discharge reported by patients and what covariates are associated with these activities. Quasi-randomly selected patients recruited from 5 medical units across Canada (n = 513) consented to 30-days post-discharge data collection with 48.5% (n = 249) completing the telephone interview. Use of nutrition care post-discharge was reported and bivariate analysis completed with relevant covariates for the two most frequently reported activities, following recommendations post-discharge or use of oral nutritional supplements (ONS). A total of 42% (n = 110) received nutrition recommendations at hospital discharge, with 65% (n = 71/110) of these participants following those recommendations; 26.5% (n = 66) were taking ONS after hospitalization. Participants who followed recommendations were more likely to report following a special diet (p = 0.002), different from before their hospitalization (p = 0.008), compared to those who received recommendations, but reported not following them. Patients taking ONS were more likely to be at nutrition risk (p < 0.0001), malnourished (p = 0.0006), taking ONS in hospital (p = 0.01), had a lower HGS (p = 0.0013; males only), and less likely to believe they were eating enough to meet their body’s needs (p = 0.005). This analysis provides new insights on nutrition-care post-discharge.
      Citation: Healthcare
      PubDate: 2018-01-20
      DOI: 10.3390/healthcare6010009
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 10: A Novel Approach to Transforming Smoking
           Cessation Practice for Pregnant Aboriginal Women and Girls Living in the
           Pilbara

    • Authors: Paula Wyndow, Roz Walker, Tracy Reibel
      First page: 10
      Abstract: Tobacco smoking during pregnancy contributes to a range of adverse perinatal outcomes; but is a potentially modifiable behavior. In Australia Aboriginal and Torres Strait Islander women face a range of barriers that hinder; rather than support smoking cessation. Few smoking cessation programs consider the broader social determinants of women’s lives; the gendered nature of these or the complexities which impinge on behavior change in the presence of social and economic disadvantage and substantial individual and intergenerational trauma. Drawing on the salient gender and trauma-informed literature this paper describes the rationale underpinning formative research which will inform the design of a localized, culturally meaningful smoking cessation program for Aboriginal women living in the Hedland and Western Desert communities of the remote Pilbara region of Western Australia. We contend that a women-centered, trauma-informed approach to smoking cessation has much to offer those seeking to address this critical public health issue
      Citation: Healthcare
      PubDate: 2018-01-23
      DOI: 10.3390/healthcare6010010
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 11: Managing Early Childhood Caries for Young
           Children in China

    • Authors: Kitty Chen, Sherry Gao, Duangporn Duangthip, Edward Lo, Chun Chu
      First page: 11
      Abstract: The latest national survey found that 70% of 5-year-old children in China had dental caries. The prevalence of early childhood caries (ECC) may not only be attributed to poor oral hygiene and unhealthy diet, but also to limited access to and availability of dental care. The prevailing preventive measures adopted by industrialised countries for ECC management are neither practical nor affordable in China. Hence, an alternative approach to ECC management is necessary. Atraumatic restorative treatment (ART) has been advocated because the simple and short operative time renders ART affordable. However, the success rate of ART in restoring anterior primary teeth is unfavourable. Although there is no water fluoridation in China, topical fluorides may be used to manage ECC. Tooth brushing with fluoride toothpaste is effective for caries control, but not all toothpastes in China are fluoridated. Professionally applied fluorides such as sodium fluoride varnish can be a cost-effective treatment for managing the high prevalence of ECC in China. Silver diamine fluoride (SDF) at 38% is suggested to be effective in arresting ECC in China. It can be a simple, non-invasive and low-cost treatment. However, it stains caries black. Children and their parents must be well informed before SDF treatment.
      Citation: Healthcare
      PubDate: 2018-01-30
      DOI: 10.3390/healthcare6010011
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 12: Professional Well-Being of Practicing
           Physicians: The Roles of Autonomy, Competence, and Relatedness

    • Authors: Oksana Babenko
      First page: 12
      Abstract: This study investigated the roles of basic psychological needs—autonomy, competence, and relatedness—in physicians’ professional well-being, specifically satisfaction with professional life, work-related engagement, and exhaustion. Using an online survey, quantitative data were collected from 57 practicing physicians. Overall, 65% of the participants were female; 49% were family medicine (FM) physicians, with the rest of the participants practicing in various non-FM specialties (e.g., internal medicine, pediatrics, surgery); and 47% were in the early-career stage (≤10 years in practice). Multivariate regression analyses indicated that of the three psychological needs, the need for relatedness had the largest unique contributions to physicians’ satisfaction with professional life, work-related engagement, and exhaustion, respectively. The unique contributions of the needs for autonomy and competence were relatively small. These findings extend basic psychological needs theory to the work domain of practicing physicians in an attempt to examine underpinnings of physicians’ professional well-being, a critical component of quality patient care.
      Citation: Healthcare
      PubDate: 2018-02-02
      DOI: 10.3390/healthcare6010012
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 13: Moderating Effect of Residential History on
           the Effects of a Fatherhood Program on Parenting Skills Satisfaction among
           Nonresident African American Fathers

    • Authors: Yiqing Qian, E. De Loney, Cleopatra Caldwell
      First page: 13
      Abstract: Nonresident African American (AA) fathers sometimes face challenges to achieving satisfaction with their parenting skills, which may inhibit their motivations for parenting. Studies have found that residential history of fathers is associated with parental involvement; however, current fatherhood programs rarely consider the influence of different residential history on fathering. In the current study, we examined whether nonresident AA fathers’ residential history with their sons moderated their parenting skills satisfaction after participating in the Fathers and Sons Program. Our results indicated that after controlling for fathers’ pretest parenting skills satisfaction, age, education, marital status, employment, and ever lived with their son’s mother; there was a moderating effect of residential history on the intervention’s effects on posttest parenting skills satisfaction. The regression analyses showed that fathers in the intervention group who had lived with their son increased their parenting skills satisfaction more at posttest compared with fathers who had never lived with their sons. However, fathers in the comparison group who had lived with their sons had lower posttest parenting skills satisfaction. Future fatherhood programs for nonresident AA fathers should develop more nuanced group-specific interventions that consider residential history as a critical factor to enhance their parenting skills satisfaction as a strategy for improving father involvement.
      Citation: Healthcare
      PubDate: 2018-02-09
      DOI: 10.3390/healthcare6010013
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 14: A Quick Surgical Treatment of
           Conjunctivochalasis Using Radiofrequencies

    • Authors: Alexandra Trivli, Georgios Dalianis, Chryssa Terzidou
      First page: 14
      Abstract: The purpose of our study is to present a quick surgical procedure for the treatment of Conjunctivochalasis (CCH) and to evaluate its effectiveness. Thirty consecutive patients, in whom CCH was diagnosed on clinical examination, were investigated for the presence of symptoms of dry eye. The 60 eyes were evaluated according to their symptomatology and the 40 symptomatic eyes were grouped in two stages using the LIPCOF (stage 1, one small fold; stage 2, more than two folds but not higher than the tear meniscus) classification and included in the study. After a subconjunctival injection of lidocaine 20 mg/mL, a medium frequency alternating current (RF) was used, adjusted in low power. With a wide tip, redundant conjunctiva was ablated leaving space between the ablations. Postoperative treatment included eye oint.gentamicin 0.3% with dexamethasone 0.03% three times a day for 5 days. At postoperative day 10, conjunctival edema had subsided and conjunctival epithelium was intact after fluorescein staining. Symptoms had improved in all patients. During follow-up, no complication was detected. Mild conjunctival hyperemia was present in all cases but resolved with standard postoperative medications. To conclude, CCh treatment with RF appears to be a safe, quick, and effective surgical technique. Operation time is less than 10 min and can be performed in an outpatient clinic.
      Citation: Healthcare
      PubDate: 2018-02-12
      DOI: 10.3390/healthcare6010014
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 15: A Randomized Controlled Trial to Investigate
           the Effectiveness of the Prevention of Aspiration Pneumonia Using
           Recommendations for Swallowing Care Guided by Ultrasound Examination

    • Authors: Yuka Miura, Gojiro Nakagami, Koichi Yabunaka, Haruka Tohara, Hiroshi Noguchi, Taketoshi Mori, Hiromi Sanada
      First page: 15
      Abstract: Prevention for aspiration pneumonia requires assessment of aspiration and adequate swallowing care. This randomized controlled trial aimed to investigate the effectiveness of ultrasound examination and recommendations for swallowing care for the reduction of aspiration and pharyngeal post-swallow residue as compared with standard swallowing care. Twenty-three participants were randomized to the intervention group and 23 to the control group. The intervention consisted of four ultrasound examinations during mealtimes and recommendations for swallowing care every 2 weeks during an 8 week period. No recommendations concerning swallowing care based on ultrasound examinations were provided to the control group. The frequency of aspiration or residue was defined as x/y × 100% when aspiration or residue were detected x times from y times concerning the total ultrasound measurements. The proportion of the residents with reduced frequency of aspiration which was detected by ultrasonography at eight weeks were 4.3% in the intervention group and 0% in the control group. The median reduction in the frequency of aspiration and residue in the intervention group was 31%, and that in the control group was 11%. In conclusion, swallowing care guided by frequent ultrasound examinations during mealtimes had a trend of reducing the frequency of aspiration and residue during an 8-week period in individuals relative to standard swallowing care alone.
      Citation: Healthcare
      PubDate: 2018-02-12
      DOI: 10.3390/healthcare6010015
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 16: The Financial Implications of a Well-Hidden
           and Ignored Chronic Lyme Disease Pandemic

    • Authors: Marcus Davidsson
      First page: 16
      Abstract: 1 million people are predicted to get infected with Lyme disease in the USA in 2018. Given the same incidence rate of Lyme disease in Europe as in the USA, then 2.4 million people will get infected with Lyme disease in Europe in 2018. In the USA by 2050, 55.7 million people (12% of the population) will have been infected with Lyme disease. In Europe by 2050, 134.9 million people (17% of the population) will have been infected with Lyme disease. Most of these infections will, unfortunately, become chronic. The estimated treatment cost for acute and chronic Lyme disease for 2018 for the USA is somewhere between 4.8 billion USD and 9.6 billion USD and for Europe somewhere between 10.1 billion EUR and 20.1 billion EUR. If governments do not finance IV treatment with antibiotics for chronic Lyme disease, then the estimated government cost for chronic Lyme disease for 2018 for the USA is 10.1 billion USD and in Europe 20.1 billion EUR. If governments in the USA and Europe want to minimize future costs and maximize future revenues, then they should pay for IV antibiotic treatment up to a year even if the estimated cure rate is as low as 25%. The cost for governments of having chronic Lyme patients sick in perpetuity is very large.
      Citation: Healthcare
      PubDate: 2018-02-13
      DOI: 10.3390/healthcare6010016
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 17: Ageing with HIV

    • Authors: Padraig McGettrick, Elena Alvarez Barco, Patrick W. G. Mallon
      First page: 17
      Abstract: The population of people living with HIV (PLWH) is growing older with an estimated 4 million over the age of 50 years, a figure which has doubled since the introduction of effective antiretroviral therapy (ART) and which is increasing globally. Despite effective ART, PLWH still experience excess morbidity and mortality compared to the general population with increased prevalence of age-related, non-AIDS illnesses (NAI) such as cardiovascular disease, malignancies, cognitive impairment and reduced bone mineral density, which impact disability and everyday functioning. This review will discuss the challenges presented by comorbidities in ageing PLWH and discuss the aetiology and management of age-related illnesses in this vulnerable population.
      Citation: Healthcare
      PubDate: 2018-02-14
      DOI: 10.3390/healthcare6010017
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 18: Examining Differential Resilience Mechanisms
           by Comparing ‘Tipping Points’ of the Effects of Neighborhood
           Conditions on Anxiety by Race/Ethnicity

    • Authors: Emil Nicolae Coman, Helen Zhao Wu
      First page: 18
      Abstract: Exposure to adverse environmental and social conditions affects physical and mental health through complex mechanisms. Different racial/ethnic (R/E) groups may be more or less vulnerable to the same conditions, and the resilience mechanisms that can protect them likely operate differently in each population. We investigate how adverse neighborhood conditions (neighborhood disorder, NDis) differentially impact mental health (anxiety, Anx) in a sample of white and Black (African American) young women from Southeast Texas, USA. We illustrate a simple yet underutilized segmented regression model where linearity is relaxed to allow for a shift in the strength of the effect with the levels of the predictor. We compare how these effects change within R/E groups with the level of the predictor, but also how the “tipping points,” where the effects change in strength, may differ by R/E. We find with classic linear regression that neighborhood disorder adversely affects Black women’s anxiety, while in white women the effect seems negligible. Segmented regressions show that the Ndis → Anx effects in both groups of women appear to shift at similar levels, about one-fifth of a standard deviation below the mean of NDis, but the effect for Black women appears to start out as negative, then shifts in sign, i.e., to increase anxiety, while for white women, the opposite pattern emerges. Our findings can aid in devising better strategies for reducing health disparities that take into account different coping or resilience mechanisms operating differentially at distinct levels of adversity. We recommend that researchers investigate when adversity becomes exceedingly harmful and whether this happens differentially in distinct populations, so that intervention policies can be planned to reverse conditions that are more amenable to change, in effect pushing back the overall social risk factors below such tipping points.
      Citation: Healthcare
      PubDate: 2018-02-20
      DOI: 10.3390/healthcare6010018
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 19: Health Care Utilisation by Bullying Victims:
           A Cross-Sectional Study of A 9-Year-Old Cohort in Ireland

    • Authors: Catherine Hayes, Dervla Kelly, Cristina Taut, Elizabeth Nixon, Lina Zgaga, James Williams, Thomas O’Dowd, Udo Reulbach
      First page: 19
      Abstract: Children frequently refrain from disclosing being bullied. Early identification of bullying by healthcare professionals in children may prevent adverse health consequences. The aim of our study was to determine whether Health Care Utilisation (HCU) is higher in 9-year-olds who report being bullied and factors influencing type of HCU. The study consists of cross-sectional surveys of Child Cohort of Irish National Longitudinal Study of Children (Wave 1), 8,568 9-year-olds, and their carers. Being bullied was assessed by a self-reported questionnaire completed by children at home. HCU outcomes consisted of the following: visits to GP, Mental Health Practitioner (MHP), Emergency Department (ED), and nights in hospital by parent interview. Bivariate logistic regression and gender-stratified Poisson models were used to determine association. Victimisation by bullying independently increased visits to GP (OR 1.13, 95% confidence interval (CI): 1.03 to 1.25; p = 0.02), MHP (OR 1.31, 95% CI: 1.05 to 1.63; p = 0.02), though not ED visits (OR 0.99, 95% CI: 0.87 to 1.13; p = 0.8) or nights in hospital (OR 1.07 95% CI: 0.97 to 1.18; p = 0.2), adjusting for underlying chronic condition(s) and socio-demographic confounders. Victimised girls made higher GP visits (RR 1.14, 95% CI: 1.06 to 1.23; p < 0.001) and spent more nights in hospital (RR 1.10, 95% CI: 1.04 to 1.15; p < 0.001). Victimised boys were more likely to contact MHPs (RR 1.21, 95% CI: 1.02 to 1.44; p = 0.03). 9-year-old bullied subjects were more likely to utilise primary care services than non-bullied 9-year-olds. Different HCU patterns were observed according to gender and gender differences in the presentation of victimisation. Our findings may lead to the development of clinical practice guidelines for early detection and appropriate management of bullied children.
      Citation: Healthcare
      PubDate: 2018-02-25
      DOI: 10.3390/healthcare6010019
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 20: Ethnic and Gender Differences in Family
           Social Support among Black Adolescents

    • Authors: Christina Cross, Robert Taylor, Linda Chatters
      First page: 20
      Abstract: This study examines black adolescents’ reports of the most helpful types of social support that they receive from and provide to family members, and whether family support exchanges vary by ethnicity (African American vs. Black Caribbean) and gender. Data for this study are from the National Survey of American Life Adolescent Supplement (NSAL-A), a national, probability sample of African American and Black Caribbean youth (ages 13–17). Overall, youth reported financial support, followed by emotional assistance and practical support as the most helpful types of support that they received. Practical and emotional assistance characterized the most commonly reported types of support that they provided to family members. Black Caribbean adolescents were more likely than African American adolescents to report financial and practical assistance as the most helpful types of support that they received from family members; no ethnic differences were observed in the provision of support to relatives. There were no significant gender differences in the receipt of support, but adolescent girls reported greater involvement in providing emotional support and caregiving than adolescent boys. The results of this paper reveal that African American and Black Caribbean adolescents are involved in a complex pattern of reciprocal support exchanges with their extended family members. Study findings also reinforce the importance of research focused on racial/ethnic and gender differences in family support exchanges in order to develop a more nuanced understanding of family support behaviors within these groups.
      Citation: Healthcare
      PubDate: 2018-03-02
      DOI: 10.3390/healthcare6010020
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 21: Digital Analysis of Sit-to-Stand in Masters
           Athletes, Healthy Old People, and Young Adults Using a Depth Sensor

    • Authors: Daniel Leightley, Moi Yap
      First page: 21
      Abstract: The aim of this study was to compare the performance between young adults (n = 15), healthy old people (n = 10), and masters athletes (n = 15) using a depth sensor and automated digital assessment framework. Participants were asked to complete a clinically validated assessment of the sit-to-stand technique (five repetitions), which was recorded using a depth sensor. A feature encoding and evaluation framework to assess balance, core, and limb performance using time- and speed-related measurements was applied to markerless motion capture data. The associations between the measurements and participant groups were examined and used to evaluate the assessment framework suitability. The proposed framework could identify phases of sit-to-stand, stability, transition style, and performance between participant groups with a high degree of accuracy. In summary, we found that a depth sensor coupled with the proposed framework could identify performance subtleties between groups.
      Citation: Healthcare
      PubDate: 2018-03-02
      DOI: 10.3390/healthcare6010021
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 22: Citizen Science and Community Engagement in
           Tick Surveillance—A Canadian Case Study

    • Authors: Julie Lewis, Corinne Boudreau, James Patterson, Jonathan Bradet-Legris, Vett Lloyd
      First page: 22
      Abstract: Lyme disease is the most common tick-borne disease in North America and Europe, and on-going surveillance is required to monitor the spread of the tick vectors as their populations expand under the influence of climate change. Active surveillance involves teams of researchers collecting ticks from field locations with the potential to be sites of establishing tick populations. This process is labor- and time-intensive, limiting the number of sites monitored and the frequency of monitoring. Citizen science initiatives are ideally suited to address this logistical problem and generate high-density and complex data from sites of community importance. In 2014, the same region was monitored by academic researchers, public health workers, and citizen scientists, allowing a comparison of the strengths and weaknesses of each type of surveillance effort. Four community members persisted with tick collections over several years, collectively recovering several hundred ticks. Although deviations from standard surveillance protocols and the choice of tick surveillance sites makes the incorporation of community-generated data into conventional surveillance analyses more complex, this citizen science data remains useful in providing high-density longitudinal tick surveillance of a small area in which detailed ecological observations can be made. Most importantly, partnership between community members and researchers has proven a powerful tool in educating communities about of the risk of tick-vectored diseases and in encouraging tick bite prevention.
      Citation: Healthcare
      PubDate: 2018-03-02
      DOI: 10.3390/healthcare6010022
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 23: Long-Term Melatonin Therapy for Adolescents
           and Young Adults with Chronic Sleep Onset Insomnia and Late Melatonin
           Onset: Evaluation of Sleep Quality, Chronotype, and Lifestyle Factors
           Compared to Age-Related Randomly Selected Population Cohorts

    • Authors: Tom Zwart, Marcel Smits, Toine Egberts, Carin Rademaker, Ingeborg van Geijlswijk
      First page: 23
      Abstract: The extent of continuance of melatonin therapy initiated in pre-pubertal children with chronic sleep onset insomnia (CSOI) was investigated in young adult life. Sleep timing, sleep quality, adverse events, reasons for cessation of therapy, and patient characteristics with regard to therapy regimen, chronotype and lifestyle factors possibly influencing sleeping behavior were assessed. With an online survey using questionnaires (Pittsburgh Sleep Quality Index, Insomnia Severity Index, Morningness-Eveningness Questionnaire, and Munich Chronotype Questionnaire), outcomes were measured and compared with age-related controls. These controls were extracted from published epidemiological research programs applying the same questionnaires. At the moment of the survey, melatonin was still continued by 27.3% of the patients, with a mean treatment duration of 10.8 years. The overall average treatment duration was 7.1 years. Sleep quality of both discontinued and persistent melatonin users did not deviate from controls. Sleep timing and chronotype scores indicated evening type preference in all responders. Adverse events were scarce but the perceived timing of pubertal development suggested a tendency towards delayed puberty in former and current users of melatonin. This study may underestimate the number of children that are able to stop using melatonin due to the response rate (47.8%) and appeal for continuing users. Sleep timing parameters were based on self-reported estimates. Control populations were predominantly students and were of varying nationalities. The statistical power of this study is low due to the limited sample size. Melatonin therapy sustained for 7.1 years does not result in substantial deviations of sleep quality as compared to controls and appears to be safe. The evening type preference suggests a causal relation with CSOI. This study shows that ten years after initiation of treatment with melatonin for CSOI, approximately 75% of the patients will have normal sleep quality without medication.
      Citation: Healthcare
      PubDate: 2018-03-02
      DOI: 10.3390/healthcare6010023
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 24: Correlates of Objective Social Isolation
           from Family and Friends among Older Adults

    • Authors: Linda Chatters, Harry Taylor, Emily Nicklett, Robert Taylor
      First page: 24
      Abstract: This study examined the correlates of objective social isolation from extended family members and friends among older adults. The analysis is based on the older adult sub-sample of the National Survey of American Life (n = 1321). Multinomial logistic regression analyses examined race/ethnicity, demographics, functional health and family and friend network factors as correlates of objective isolation from family and friends. Only 4.47% of respondents were objectively isolated from both their extended family and friends, 10.82% were isolated from their friends, and 7.43% were isolated from their family members. Men were more likely to be objectively isolated from both family and friends and older adults who live with others were significantly more likely to be objectively isolated from their friends. When controlling for subjective social isolation, the two measures of functional health were significantly associated with objective social isolation. In particular, higher levels of self-care impairment decreased the risk of being objectively isolated from friends only, whereas higher mobility impairment was associated with an increased likelihood of being objectively isolated from friends only. Subjective evaluations of social isolation from family and friends were consistently associated with being objectively isolated from family and friends. There were no significant differences between African-Americans, Black Caribbeans and non-Hispanic Whites in objective isolation. These and other findings are discussed in detail.
      Citation: Healthcare
      PubDate: 2018-03-03
      DOI: 10.3390/healthcare6010024
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 25: A 40-Day Journey to Better Health: Utilizing
           the DanielFast to Improve Health Outcomes in Urban Church-Based Settings

    • Authors: Nicole Vaughn, Darryl Brown, Beatriz Reyes, Crystal Wyatt, Kimberly Arnold, Elizabeth Dalianis, Paula Kalksma, Caryn Roth, Jason Langheier, Maria Pajil-Battle, Meg Grant
      First page: 25
      Abstract: Background: As the costs associated with obesity increase, it is vital to evaluate the effectiveness of chronic disease prevention among underserved groups, particularly in urban settings. This research study evaluated Philadelphia area Keystone First members and church participants enrolled in a group health education program to determine the impact of the Daniel Fast on physical health and the adoption of healthy behaviors. Methods: Participants attended six-weekly health education sessions in two participating churches, and were provided with a digital healthy eating platform. Results: There was a statistically significant decrease from baseline to post assessment for weight, waist circumference and cholesterol. Participants reported a significant improvement in their overall well-being, social and physical functioning, vitality and mental health. Conclusion: Results of this study demonstrate that dietary recommendations and comprehensive group health education delivered in churches and reinforced on a digital platform can improve physical health, knowledge and psychosocial outcomes.
      Citation: Healthcare
      PubDate: 2018-03-05
      DOI: 10.3390/healthcare6010025
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 26: The Patient Experience: Informing Practice
           through Identification of Meaningful Communication from the Patient’s
           Perspective

    • Authors: Angela Grocott, Wilfred McSherry
      First page: 26
      Abstract: (1) Background: There is limited empirical knowledge concerning aspects of healthcare that contribute to a good patient experience from the patient’s perspective and how patient feedback informs service development. (2) Aim: To examine the issues that influence the effectiveness of communication on patient satisfaction, experience and engagement, in an acute National Health Service (NHS) setting, through identification of the patient’s requirements and expectations. (3) Method: Data was gathered from a large teaching hospital using a Friends and Family Test (FFT) and a communication specific survey. Both surveys captured patient narrative to identify predominant influences to explain the quantitative responses. (4) Results: The key priorities for patients are involvement in their care and receiving the right amount of information to support this. However, the delivery of compassionate care was identified as having the most influence on the likelihood of patients to recommend an acute NHS Trust. (5) Conclusion: The findings support a broader understanding of the constituents of an all-encompassing patient experience from the patient’s perspective. (6) Implications: healthcare organizations need to focus their resources on how to improve patient/provider communication to support patients to be true partners in their care.
      Citation: Healthcare
      PubDate: 2018-03-20
      DOI: 10.3390/healthcare6010026
      Issue No: Vol. 6, No. 1 (2018)
       
  • Healthcare, Vol. 6, Pages 27: Rescuing Suboptimal Patient-Reported Outcome
           Instrument Data in Clinical Trials: A New Strategy

    • Authors: Chengwu Yang, Kent Vrana
      First page: 27
      Abstract: Background: Psychometric instruments such as the Repeated Battery for the Assessment of Neuropsychological Status (RBANS) are commonly used under conditions for which they were not developed or validated. They may then generate troublesome data that could conceal potential findings. Methods: Based on a previously published refinement of the RBANS, we reanalyzed the data on 303 patients from two National Institutes of Health (NIH) trails in Parkinson’s disease and contrasted the results using the original versus refined scores. Results: Findings from the original RBANS scores were inconsistent; however, use of the refined scores produced potential findings that were in agreement with independent reports. Conclusion: This study demonstrates that, for negative trials using instrument scores as primary outcomes, it is possible to rescue potential findings. The key to this new strategy is to validate and refine the instrument for the specific disease and conditions under study and then to reanalyze the data. This study offers a demonstration of this new strategy for general approaches.
      Citation: Healthcare
      PubDate: 2018-03-20
      DOI: 10.3390/healthcare6010027
      Issue No: Vol. 6, No. 1 (2018)
       
 
 
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