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Healthcare
Volume 11
Issue 13
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Healthcare, Volume 11, Issue 13 (July-1 2023) – 165 articles

Cover Story (view full-size image): The integration of Tele-Dermatology with mHealth has progressed rapidly during the COVID-19 pandemic. This integration, often also embedding AI, has facilitated the monitoring of dermatological issues and enabled remote specialist consultations, reducing the need for in-person visits. The opportunities are numerous and significant. They include enhancing service quality, streamlining healthcare processes, reducing costs, and delivering more accessible care. Looking ahead, future developments in this field anticipate further integration with AI and Augmented Reality, as well as the utilization of wearable sensors. However, this integration also gives rise to certain challenges and problems related to regulations, ethics, cybersecurity, data privacy, and device management. Scholars and policymakers must prioritize addressing these issues. View this paper
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14 pages, 499 KiB  
Article
The Prospective Effects of Coping Strategies on Mental Health and Resilience at Five Months after HSCT
by Maya Corman, Michael Dambrun, Marie-Thérèse Rubio, Aurélie Cabrespine, Isabelle Brindel, Jacques-Olivier Bay and Régis Peffault de La Tour
Healthcare 2023, 11(13), 1975; https://doi.org/10.3390/healthcare11131975 - 7 Jul 2023
Cited by 1 | Viewed by 1524
Abstract
Objectives: Hematopoietic stem cell transplantation (HSCT) is a stressful event that engenders psychological distress. This study examines the prospective effects of coping strategies during hospitalization on resilience and on various mental-health dimensions at five months after transplantation. Methods. One hundred and seventy patients [...] Read more.
Objectives: Hematopoietic stem cell transplantation (HSCT) is a stressful event that engenders psychological distress. This study examines the prospective effects of coping strategies during hospitalization on resilience and on various mental-health dimensions at five months after transplantation. Methods. One hundred and seventy patients (Mage = 52.24, SD = 13.25) completed a questionnaire assessing adjustment strategies during hospitalization, and 91 filled out a questionnaire five months after HSCT (Mage = 51.61, SD = 12.93). Results: Multiple regression analyses showed that a fighting spirit strategy positively predicted resilience (p < 0.05), whereas anxious preoccupations predicted anxiety (p < 0.05), poorer mental QoL (p < 0.01), and were associated with an increased risk of developing PTSD (OR = 3.27, p < 0.01; 95% CI: 1.36, 7.84) at five months after transplantation. Hopelessness, avoidance, and denial coping strategies were not predictive of any of the mental health outcomes. Finally, the number of transplantations was negatively related to a fighting spirit (p < 0.01) and positively related to hopelessness-helplessness (p < 0.001): Conclusions: These results highlight the importance of developing psychological interventions focused on coping to alleviate the negative psychological consequences of HSCT. Full article
(This article belongs to the Special Issue Mental Health Promotion and Illness Prevention in Vulnerable Populations)
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<p>Flow diagram of protocol.</p> Full article ">
10 pages, 972 KiB  
Article
Sedentary Behavior and Physical Activity of Community-Dwelling Korean Breast Cancer Survivors: A Nationwide Study
by Jung Soo Lee, Mina Park and Yeo Hyung Kim
Healthcare 2023, 11(13), 1974; https://doi.org/10.3390/healthcare11131974 - 7 Jul 2023
Cited by 3 | Viewed by 1506
Abstract
This study aimed to investigate the contemporary characteristics of sedentary behavior and physical activity levels in breast cancer survivors. The cross-sectional data of 10,073 community-dwelling Korean women aged ≥50 years in the Korea National Health and Nutrition Examination Survey were analyzed. The differences [...] Read more.
This study aimed to investigate the contemporary characteristics of sedentary behavior and physical activity levels in breast cancer survivors. The cross-sectional data of 10,073 community-dwelling Korean women aged ≥50 years in the Korea National Health and Nutrition Examination Survey were analyzed. The differences in sedentary behavior, walking activity, and moderate-to-vigorous physical activity (MVPA) levels between breast cancer survivors, other cancer survivors, and women with no history of cancer were compared by complex-sample general linear models. Breast cancer survivors spent significantly less mean time in sedentary behavior than other cancer survivors and women with no history of cancer; however, among them, 48.34% spent a long sedentary time of ≥420 min/day. Breast cancer survivors had a significantly higher level of walking activity and similar total MVPA levels compared to women with no history of cancer. When comparing domain-specific MVPA levels, breast cancer survivors showed significantly lower work-related MVPA levels than women with no history of cancer. In recent years, community-dwelling Korean breast cancer survivors were less sedentary, walked more, and had equivalent MVPA levels compared with women with no history of cancer. Considering the growing emphasis on healthy lifestyles, our results may reflect more contemporary behavior trends of breast cancer survivors. Full article
(This article belongs to the Special Issue Breast Cancer Prevention in Healthcare: A Comprehensive Overview)
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<p>Mean daily time of sedentary behavior in community-dwelling women aged 50 years or older by cancer status. Values are adjusted for age, body mass index, education, occupation, residence, alcohol consumption, hypertension, diabetes, hypercholesterolemia, anemia, cardiovascular disease, and depression.</p> Full article ">Figure 2
<p>Mean weekly METs of walking/MVPA in community-dwelling women aged 50 years or older by cancer status. Values are adjusted for age, body mass index, education, occupation, residence, alcohol consumption, hypertension, diabetes, hypercholesterolemia, anemia, cardiovascular disease, and depression. MVPA, moderate-to-vigorous physical activity; MET, metabolic equivalent of task.</p> Full article ">
17 pages, 297 KiB  
Article
A Prospective Cross-Sectional Study of Acute Coronary Syndrome Patients’ Quality of Life and Drug Prescription Patterns at Riyadh Region Hospitals, Saudi Arabia
by Mohamed F. Balaha, Ahmed A. Alamer, Ahmed M. Kabel, Saad A. Aldosari and Sarah Fatani
Healthcare 2023, 11(13), 1973; https://doi.org/10.3390/healthcare11131973 - 7 Jul 2023
Cited by 2 | Viewed by 1685
Abstract
Acute coronary syndrome (ACS) is a leading cause of cardiovascular-related morbidity and mortality worldwide. The present study investigated the health-related quality of life (HRQOL) and drug prescribing patterns in ACS patients at Riyadh hospitals in Saudi Arabia. This study was a 12-month prospective [...] Read more.
Acute coronary syndrome (ACS) is a leading cause of cardiovascular-related morbidity and mortality worldwide. The present study investigated the health-related quality of life (HRQOL) and drug prescribing patterns in ACS patients at Riyadh hospitals in Saudi Arabia. This study was a 12-month prospective cross-sectional study that included 356 patients with ACS. The current study showed that younger male (67.42%) and urban (75.84%) patients suffered more from ACS. Moreover, most patients with NSTEMI (51.69%) experienced Grade 1 dyspnea (33.43%) and NYHA Stage 2 (29.80%); however, STEMI patients were at greater mortality risk. The HRQOL questionnaire showed that ACS patients were significantly impaired in all QOL domains (emotional [23.0%, p = 0.001], physical [24.4%, p = 0.003], and social [27.2%, p = 0.002]). Furthermore, the most commonly prescribed medications were statins (93%), antiplatelets (84%), anticoagulants (79%), coronary vasodilators (65%), and beta-blockers (63%). Additionally, 64% of patients received PCIs or CABGs, with the majority of cases receiving PCIs (49%), whereas 9% received dual anticoagulant therapy. Thus, there is an urgent need to educate healthcare teams about the relevance of QOL in ACS control and prevention and the new ACS management recommendations. ACS is also growing among younger people, requiring greater attention and prevention. Full article
26 pages, 6999 KiB  
Article
Tripartite Evolutionary Game and Simulation Analysis of Healthcare Fraud Supervision under the Government Reward and Punishment Mechanism
by Change Zhu, Lulin Zhou, Xinjie Zhang and Christine A. Walsh
Healthcare 2023, 11(13), 1972; https://doi.org/10.3390/healthcare11131972 - 7 Jul 2023
Cited by 2 | Viewed by 1110
Abstract
This study aims to provide useful insights for the Chinese government in dealing with healthcare fraud by creating an evolutionary game model that involves hospitals, third-party entities, and the government based on the government reward and punishment mechanism. This paper analyzes the evolutionary [...] Read more.
This study aims to provide useful insights for the Chinese government in dealing with healthcare fraud by creating an evolutionary game model that involves hospitals, third-party entities, and the government based on the government reward and punishment mechanism. This paper analyzes the evolutionary stability of each participant’s strategy choice, discusses the influence of each element on the tripartite strategy choice, and further analyzes the stability of the equilibrium point in the tripartite game system. The results show that (1) the government increasing fines on hospitals is conducive to compliant hospital operations, and the incentive mechanism has little effect on such operations; (2) the lack of an incentive mechanism for third parties results in false investigations by third parties; and (3) rewards from higher levels of government promote strict supervision by local governments, but that the high cost of supervision and rewards for hospitals inhibits the probability of strict supervision. Finally, Matlab 2020a is used for simulation analysis to provide a reference for the government to improve the supervision of healthcare fraud. Full article
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<p>The relationship of game players.</p> Full article ">Figure 2
<p>Replicated dynamic phase diagram of the hospital.</p> Full article ">Figure 3
<p>Replicated dynamic phase diagram of the third party.</p> Full article ">Figure 4
<p>Replicated dynamic phase diagram of the local government.</p> Full article ">Figure 5
<p>Evolutionary process of the behavior of the hospital, the third party, and the local government under scenario 1: (<b>a</b>) the hospital, (<b>b</b>) the third party, and (<b>c</b>) the local government.</p> Full article ">Figure 6
<p>The effects of <math display="inline"><semantics><mrow><msub><mi>C</mi><mrow><mi>h</mi><mn>1</mn></mrow></msub><mo>−</mo><msub><mi>C</mi><mrow><mi>h</mi><mn>2</mn></mrow></msub></mrow></semantics></math> on evolutionary process of the behavior of hospital, the third party, and local government under scenario 1: (<b>a</b>) the hospital, (<b>b</b>) the third party, and (<b>c</b>) the local government.</p> Full article ">Figure 7
<p>The effects of <math display="inline"><semantics><mrow><msub><mi>I</mi><mrow><mi>h</mi><mn>2</mn></mrow></msub><mo>−</mo><msub><mi>I</mi><mrow><mi>h</mi><mn>1</mn></mrow></msub></mrow></semantics></math> on evolutionary process of the behavior of hospital, the third party, and local government under scenario 1: (<b>a</b>) the hospital, (<b>b</b>) the third party, and (<b>c</b>) the local government.</p> Full article ">Figure 8
<p>The effects of <math display="inline"><semantics><mrow><msub><mi>C</mi><mi>g</mi></msub></mrow></semantics></math> on evolutionary process of the behavior of hospital, the third party, and the local government under scenario 1: (<b>a</b>) the hospital, (<b>b</b>) the third party, and (<b>c</b>) the local government.</p> Full article ">Figure 9
<p>Evolutionary process of the behavior of hospital, the third party, and the local government under scenario 2: (<b>a</b>) the hospital, (<b>b</b>) the third party, and (<b>c</b>) the local government.</p> Full article ">Figure 10
<p>The effects of <math display="inline"><semantics><mrow><msub><mi>C</mi><mi>g</mi></msub></mrow></semantics></math> on evolutionary process of the behavior of hospital, the third party, and the local government under scenario 2: (<b>a</b>) the hospital, (<b>b</b>) the third party, and (<b>c</b>) the local government.</p> Full article ">Figure 11
<p>The effects of <math display="inline"><semantics><mrow><msub><mi>A</mi><mi>g</mi></msub></mrow></semantics></math> on evolutionary process of the behavior of hospital, the third party, and local government under scenario 2: (<b>a</b>) the hospital, (<b>b</b>) the third party, and (<b>c</b>) the local government.</p> Full article ">Figure 12
<p>The effects of <math display="inline"><semantics><mrow><msub><mi>P</mi><mi>g</mi></msub></mrow></semantics></math> on evolutionary process of the behavior of hospital, the third party, and the local government under scenario 2: (<b>a</b>) the hospital, (<b>b</b>) the third party, and (<b>c</b>) the local government.</p> Full article ">Figure 13
<p>Evolutionary process of the behavior of hospital, the third party, and the local government under scenario 3: (<b>a</b>) the hospital, (<b>b</b>) the third party, and (<b>c</b>) the local government.</p> Full article ">Figure 14
<p>The effects of <math display="inline"><semantics><mrow><msub><mi>P</mi><mi>h</mi></msub></mrow></semantics></math> on evolutionary process of the behavior of hospital, the third party, and local government under scenario 3: (<b>a</b>) the hospital, (<b>b</b>) the third party, and (<b>c</b>) the local government.</p> Full article ">Figure 15
<p>The effects of <math display="inline"><semantics><mrow><msub><mi>A</mi><mi>h</mi></msub></mrow></semantics></math> on evolutionary process of the behavior of hospital, the third party, and local government under scenario 3: (<b>a</b>) the hospital, (<b>b</b>) the third party, and (<b>c</b>) the local government.</p> Full article ">
12 pages, 466 KiB  
Article
Measuring Knowledge of Healthcare Providers on Pediatric Palliative Care with an Online Questionnaire Based on the National Core Curriculum in Italy
by Elisa Zanello, Roberta Vecchi, Giulia Zamagni, Maria Celeste Biagi, Irene Bruno, Elisa Cragnolin, Elisabetta Danielli, Silvia Paoletti, Marco Rabusin, Luca Ronfani and Emanuelle Pessa Valente
Healthcare 2023, 11(13), 1971; https://doi.org/10.3390/healthcare11131971 - 7 Jul 2023
Viewed by 1364
Abstract
There is a lack of highly reliable tools evaluating healthcare professionals’ competences on Pediatric Palliative Care (PPC) and Pain Therapy (PT). The aim of this study is to document the development of an online questionnaire to assess Perceived, Wished and Actual Knowledge of [...] Read more.
There is a lack of highly reliable tools evaluating healthcare professionals’ competences on Pediatric Palliative Care (PPC) and Pain Therapy (PT). The aim of this study is to document the development of an online questionnaire to assess Perceived, Wished and Actual Knowledge of healthcare workers on PPC/PT. The tool was built on the basis of the Italian Society for Palliative Care PPC Core Curriculum (CC) for physicians, nurses and psychologists. Face validity, internal consistency and the underlying structure were evaluated after a field testing in a referral hospital, Friuli-Venezia Giulia, Italy. One hundred five respondents completed the questionnaire. High internal consistency for both scales of Perceived and Wished Knowledge was found (α = 0.95 and α = 0.94, respectively). Psychologists reported higher levels of self-Perceived skills on the psychosocial needs of the child and family at the end of life (p = 0.006), mourning (p = 0.003) and ethics and deontology in PT/PC (p = 0.049). Moreover, when Actual Knowledge was tested, they also provided the highest number of correct answers (p = 0.022). No differences were found by profession for Wished Knowledge. The questionnaire showed promising psychometric properties. Our findings suggest the need of continuous training in this field and identify contents to be addressed in future training programs. Full article
(This article belongs to the Special Issue Quality and Patient Safety in Palliative Care)
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<p>Flow diagram showing the steps of the questionnaire development process. The underline emphasizes the involvement of experts in the item selection process.</p> Full article ">
17 pages, 2603 KiB  
Review
Effectiveness of Digital Physiotherapy Practice Compared to Usual Care in Long COVID Patients: A Systematic Review
by María-José Estebanez-Pérez, Rocío Martín-Valero, Maria Jesus Vinolo-Gil and José-Manuel Pastora-Bernal
Healthcare 2023, 11(13), 1970; https://doi.org/10.3390/healthcare11131970 - 7 Jul 2023
Cited by 2 | Viewed by 1715
Abstract
Long COVID syndrome has been recognized as a public health problem. Digital physiotherapy practice is an alternative that can better meet the needs of patients. The aim of this review was to synthesize the evidence of digital physiotherapy practice in Long COVID patients. [...] Read more.
Long COVID syndrome has been recognized as a public health problem. Digital physiotherapy practice is an alternative that can better meet the needs of patients. The aim of this review was to synthesize the evidence of digital physiotherapy practice in Long COVID patients. A systematic review was carried out until December 2022. The review was complemented by an assessment of the risk of bias and methodological quality. A narrative synthesis of results was conducted, including subgroup analyses by intervention and clinical outcomes. Six articles, including 540 participants, were selected. Five articles were considered of high enough methodological quality. Parallel-group, single-blind, randomized controlled trials were the most commonly used research design. Tele-supervised home-based exercise training was the most commonly used intervention. Great heterogeneity in clinical outcomes and measurement tools was found. A subgroup analysis showed that digital physiotherapy is effective in improving clinical outcomes. Significant differences in favor of digital interventions over usual care were reported. Nevertheless, discrepancies regarding effectiveness were found. Improvements in clinical outcomes with digital physiotherapy were found to be at least non-inferior to usual care. This review provides new evidence that digital physiotherapy practice is an appropriate intervention for Long COVID patients, despite the inherent limitations of the review. Registration: CRD42022379004. Full article
(This article belongs to the Topic The Use of New Technologies for Health and Clinical Practice)
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<p>PRISMA Flowchart.</p> Full article ">Figure 2
<p>Risk of bias summary [<a href="#B37-healthcare-11-01970" class="html-bibr">37</a>,<a href="#B38-healthcare-11-01970" class="html-bibr">38</a>,<a href="#B39-healthcare-11-01970" class="html-bibr">39</a>,<a href="#B40-healthcare-11-01970" class="html-bibr">40</a>,<a href="#B41-healthcare-11-01970" class="html-bibr">41</a>,<a href="#B42-healthcare-11-01970" class="html-bibr">42</a>].</p> Full article ">Figure 3
<p>Risk of bias graph.</p> Full article ">Figure A1
<p>Prisma Checklist.</p> Full article ">
11 pages, 228 KiB  
Article
Relationship Building between International Healthcare Volunteers and Local Healthcare Providers in Ethiopia: Real-Life Experiences in Low-Income Country
by Jiwon Kang and Purum Kang
Healthcare 2023, 11(13), 1969; https://doi.org/10.3390/healthcare11131969 - 7 Jul 2023
Viewed by 1025
Abstract
Background: The number of international healthcare volunteers in low-income countries that need trained human resources has been increasing. However, migrating to a foreign country requires adapting to its environment and culture. The purpose of this study was to explore the international healthcare volunteers’ [...] Read more.
Background: The number of international healthcare volunteers in low-income countries that need trained human resources has been increasing. However, migrating to a foreign country requires adapting to its environment and culture. The purpose of this study was to explore the international healthcare volunteers’ experiences in Ethiopia in building relationships with local healthcare providers. Methods: Six participants were enrolled in the study, and data were collected through individual in-depth interviews conducted between September and October 2018. The collected data were analyzed using Colaizzi’s phenomenological method. Results: Ten subthemes emerged from five themes: “facing new situations”, “accepting myself as an outsider in Ethiopia”, “impact on the wall of prejudice”, “adapting to a new culture”, and “positive outlook”. Conclusions: This study shows that international healthcare volunteers in Ethiopia experienced challenges in building relationships with local healthcare providers due to linguistic and cultural gaps. Nevertheless, they strived to accept the culture and play their part as helpers in providing healthcare services. Full article
47 pages, 17581 KiB  
Article
Impact of a Digital Tool on Pharmacy Students’ Ability to Perform Medication Reviews: A Randomized Controlled Trial
by Armin Dabidian, Emina Obarcanin, Bushra Ali Sherazi, Sabina Schlottau, Holger Schwender and Stephanie Laeer
Healthcare 2023, 11(13), 1968; https://doi.org/10.3390/healthcare11131968 - 7 Jul 2023
Cited by 4 | Viewed by 1642
Abstract
Digital Medication Review Tools (DMRTs) are increasingly important in pharmacy practice. To ensure that young pharmacists are sufficiently competent to perform medication reviews after graduation, the introduction of DMRTs teaching in academic education is necessary. The aim of our study was to demonstrate [...] Read more.
Digital Medication Review Tools (DMRTs) are increasingly important in pharmacy practice. To ensure that young pharmacists are sufficiently competent to perform medication reviews after graduation, the introduction of DMRTs teaching in academic education is necessary. The aim of our study was to demonstrate the effect of DMRTs use on pharmacy students’ performance when conducting a medication review (MR) in a randomized controlled pre-post design. Forty-one pharmacy students were asked to complete a MR within 60 min, followed by a 10-min consultation with (intervention group) and without a DMRT (control group). The MR performance was subdivided into four categories: communication skills, subjective and objective patient data, assessment, and plan. Performance was assessed using objective structured clinical examinations (OSCEs) and analytical checklists. With the use of DMRTs, the overall performance was improved by 17.0% compared to the control group (p < 0.01). Improvement through DMRTs was seen in the subcategories “Assessment” and “Plan”. Furthermore, pharmacy students liked using DMRTs and felt more confident overall. Our study results demonstrate that DMRTs improve the performance of MRs, hence DMRTs should become an integral part of pharmacy curriculum. Consequently, digitally enabled pharmacists using DMRTs will be better prepared for their professional careers in pharmacy practice. Full article
(This article belongs to the Special Issue Healthcare in Digital Environments: An Interdisciplinary Perspective)
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<p>Study procedure and time-schedule. OSCE = objective structured clinical examination.</p> Full article ">Figure 2
<p>Overall performance in the first and second OSCE measured by an analytic checklist. Horizontal line = median; (*) = outlier.</p> Full article ">Figure 3
<p>Performance development for the control and the intervention groups between the first and the second OSCE. Performance development was generated by subtracting participants’ performance on the second OSCE with their performance on the first OSCE. Horizontal line = median.</p> Full article ">Figure 4
<p>Performance of the first and second OSCE in the subcategory “Assessment”. Horizontal line = median; (*) = outlier.</p> Full article ">Figure 5
<p>Performance of the first and second OSCE in the subcategory “Plan”. Horizontal line = median; (*) = outlier.</p> Full article ">Figure 6
<p>Display of the results of the questionnaire in a forest plot. The box represents the arithmetic mean. The horizontal lines to the left and right of the box indicate the 95% confidence interval. Consensus on a statement is reached when the confidence interval does not intersect the vertical line on 3 of the X-axis of the forest plot. While consensus was reached on all statements for the intervention group, no consensus was reached on statements 2, 3, 5, and 6 for the control group.</p> Full article ">Figure A1
<p>Subjective and objective patient data—Patient 1 in the first OSCE.</p> Full article ">Figure A2
<p>Medication schedule—Patient 1 in the first OSCE.</p> Full article ">Figure A3
<p>Subjective and objective patient data—Patient 2 in the first OSCE.</p> Full article ">Figure A4
<p>Medication schedule—Patient 2 in the first OSCE.</p> Full article ">Figure A5
<p>Subjective and objective patient data—Patient 3 in the first OSCE.</p> Full article ">Figure A6
<p>Medication schedule—Patient 3 in the first OSCE.</p> Full article ">Figure A7
<p>Subjective and objective patient data—Patient 4 in the first OSCE.</p> Full article ">Figure A8
<p>Medication schedule—Patient 4 in the first OSCE.</p> Full article ">Figure A9
<p>Subjective and objective patient data—Patient 5 in the second OSCE.</p> Full article ">Figure A10
<p>Medication schedule—Patient 5 in the second OSCE.</p> Full article ">Figure A11
<p>Subjective and objective patient data—Patient 6 in the second OSCE.</p> Full article ">Figure A12
<p>Medication schedule—Patient 6 in the second OSCE.</p> Full article ">Figure A13
<p>Subjective and objective patient data—Patient 7 in the second OSCE.</p> Full article ">Figure A14
<p>Medication schedule—Patient 7 in the second OSCE.</p> Full article ">Figure A15
<p>Subjective and objective patient data—Patient 8 in the second OSCE.</p> Full article ">Figure A16
<p>Medication schedule—Patient 8 in the second OSCE.</p> Full article ">Figure A17
<p>Corresponding OSCE checklist for Patient 1 in the first OSCE.</p> Full article ">Figure A17 Cont.
<p>Corresponding OSCE checklist for Patient 1 in the first OSCE.</p> Full article ">Figure A18
<p>Corresponding OSCE checklist for Patient 2 in the first OSCE.</p> Full article ">Figure A18 Cont.
<p>Corresponding OSCE checklist for Patient 2 in the first OSCE.</p> Full article ">Figure A19
<p>Corresponding OSCE checklist for Patient 3 in the first OSCE.</p> Full article ">Figure A19 Cont.
<p>Corresponding OSCE checklist for Patient 3 in the first OSCE.</p> Full article ">Figure A20
<p>Corresponding OSCE checklist for Patient 4 in the first OSCE.</p> Full article ">Figure A20 Cont.
<p>Corresponding OSCE checklist for Patient 4 in the first OSCE.</p> Full article ">Figure A21
<p>Corresponding OSCE checklist for Patient 5 in the second OSCE.</p> Full article ">Figure A21 Cont.
<p>Corresponding OSCE checklist for Patient 5 in the second OSCE.</p> Full article ">Figure A22
<p>Corresponding OSCE checklist for Patient 6 in the second OSCE.</p> Full article ">Figure A22 Cont.
<p>Corresponding OSCE checklist for Patient 6 in the second OSCE.</p> Full article ">Figure A23
<p>Corresponding OSCE checklist for Patient 7 in the second OSCE.</p> Full article ">Figure A23 Cont.
<p>Corresponding OSCE checklist for Patient 7 in the second OSCE.</p> Full article ">Figure A24
<p>Corresponding OSCE checklist for Patient 8 in the second OSCE.</p> Full article ">Figure A24 Cont.
<p>Corresponding OSCE checklist for Patient 8 in the second OSCE.</p> Full article ">
14 pages, 585 KiB  
Article
The Role of Medication Beliefs in COVID-19 Vaccine and Booster Uptake in Healthcare Workers: An Exploratory Study
by Carys Dale, Catherine Heidi Seage, Rhiannon Phillips and Delyth James
Healthcare 2023, 11(13), 1967; https://doi.org/10.3390/healthcare11131967 - 7 Jul 2023
Viewed by 1428
Abstract
Illness and medication beliefs have shown to predict COVID-19 vaccination behaviour in the general population, but this relationship has yet to be demonstrated in healthcare staff. This research aimed to explore the potential explanatory value of illness and medication beliefs on the COVID-19 [...] Read more.
Illness and medication beliefs have shown to predict COVID-19 vaccination behaviour in the general population, but this relationship has yet to be demonstrated in healthcare staff. This research aimed to explore the potential explanatory value of illness and medication beliefs on the COVID-19 vaccination uptake of a sample of patient-facing healthcare workers (HCWs). A web-based questionnaire—measuring beliefs about vaccinations (the BMQ), perceptions of COVID-19 (the BIPQ), vaccine hesitancy, and vaccine uptake—was targeted to HCWs via social media platforms between May–July 2022. Open text responses allowed participants to provide explanations for any delay in vaccine uptake. A total of 91 participants completed the questionnaire. Most respondents (77.1%, n = 64) had received three doses of the COVID-19 vaccination, and vaccination uptake (number of doses received) was predicted by Vaccine Concerns, Vaccine Hesitancy, and their Necessity–Concerns Differential score. Vaccine Hesitancy was predicted by Necessity, Concerns, and Overuse scores, as well as Necessity–Concerns Differential scores. Delay in Vaccine Uptake could only be predicted for Dose 3 (Booster). Qualitative data revealed that hesitant respondents were “unable to take time off work” for vaccination and that some had concerns over vaccine safety. In conclusion, illness and medication beliefs have potential value in predicting vaccine hesitancy and uptake in healthcare workers. Interventions to improve vaccination uptake in this population should address concerns about vaccine safety and releasing staff for vaccination booster appointments should be prioritised. Future research should further investigate the relationship between illness and medication beliefs and COVID-19 vaccine uptake in a larger sample of healthcare workers. Full article
(This article belongs to the Section Coronaviruses (CoV) and COVID-19 Pandemic)
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<p>Number of participants reporting having received each dose of the COVID-19 Vaccination (<span class="html-italic">n</span> = 82).</p> Full article ">
12 pages, 640 KiB  
Article
The Senior Companion Program Plus: An Innovative Training Approach for Alzheimer’s Disease and Related Dementia
by Noelle L. Fields, Ling Xu, Ishan C. Williams, Joseph E. Gaugler, Daisha J. Cipher, Jessica Cassidy and Gretchen Feinhals
Healthcare 2023, 11(13), 1966; https://doi.org/10.3390/healthcare11131966 - 7 Jul 2023
Viewed by 1298
Abstract
African Americans adults are disproportionately affected by Alzheimer’s disease and related dementias (ADRD) and are underrepresented in research about ADRD. Reducing gaps in the knowledge about ADRD in the African American community is important for addressing dementia care disparities. The existing psychoeducation interventions [...] Read more.
African Americans adults are disproportionately affected by Alzheimer’s disease and related dementias (ADRD) and are underrepresented in research about ADRD. Reducing gaps in the knowledge about ADRD in the African American community is important for addressing dementia care disparities. The existing psychoeducation interventions are often limited by cost and scalability; for these reasons, lay provider (i.e., volunteer) interventions are of increasing interest in ADRD research. The purpose of this study was to evaluate a training of African American Senior Companion (SC) volunteers (n = 11) with dementia-specific knowledge (i.e., Senior Companion Program/SCP Plus), as part of a culturally informed, in-home, psychoeducational intervention for African American ADRD family caregivers. Learning outcomes were measured pre- and post-training, using the Knowledge of Alzheimer’s Disease/dementia scale (KAD), the Sense of Competence Questionnaire, and the Preparedness for Caregiving Scale. The results showed significant improvements in knowledge of Alzheimer’s disease/dementia, one competence item, “It is clear to me how much care my care recipient needs”, and preparedness for caregiving. Overall, the study findings suggest the SCP Plus is a promising, culturally relevant, and potentially scalable lay provider training for ADRD with potential benefits that augment the existing Senior Companion Program. Full article
(This article belongs to the Section Community Care)
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<p>Principles of the Senior Companion Program Training (adapted from [<a href="#B35-healthcare-11-01966" class="html-bibr">35</a>]). SC = Senior Companions; ADRD = Alzheimer’s diseases and related dementia; and SCP = Senior Companion Programs.</p> Full article ">
10 pages, 852 KiB  
Article
Social Support and Commitment to Life and Living: Bidirectional Associations in Late Life over Time
by Sara Carmel, Norm O’Rourke, Hava Tovel, Victoria H. Raveis, Naama Antler and Ella Cohn-Schwartz
Healthcare 2023, 11(13), 1965; https://doi.org/10.3390/healthcare11131965 - 7 Jul 2023
Viewed by 982
Abstract
Objectives: This study aims to enhance the understanding of longitudinal associations between two important facets of well-being in late life: social support and commitment to life and living (CTL). Methods: Structured home interviews were conducted with 824 Israelis ≥75 years of age, with [...] Read more.
Objectives: This study aims to enhance the understanding of longitudinal associations between two important facets of well-being in late life: social support and commitment to life and living (CTL). Methods: Structured home interviews were conducted with 824 Israelis ≥75 years of age, with three annual data collection timepoints. We hypothesized and tested a cross-lagged, longitudinal structural equation model (SEM) in which CTL and social support were assumed to predict each other over time, covarying for previously reported CTL and social support. Results: Social support has a positive, contemporaneous effect, predicting commitment to living at T1 and T3, while CTL predicts social support the following year (i.e., T1–T2 & T2–T3). Satisfaction with relationships significantly contributes to measurement of both latent constructs at each point of data collection. Discussion: Commitment to life and living and social support are intertwined phenomena. Whereas social support has a concomitant effect on CTL, the effect of CTL on social support emerges over time. This suggests that greater social support fosters greater CTL, leading older adults to nurture social networks and relationships; the effect of which is greater social support in the future. The implications of these results warrant further research over longer periods and across cultures. Full article
(This article belongs to the Section Health Assessments)
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<p>Social Support and Commitment to Life and Living over 2 years, Israelis ≥75 Years of Age.</p> Full article ">
33 pages, 905 KiB  
Article
Experience with the Implementation of Continuous Medical Education among Mother-and-Child Healthcare Providers in Ukraine: A Case Study Based on Two International Collaboration Initiatives
by Tetiana Chernysh, Lucas Opitz, Nataliia Riabtseva, Martin Raab and Milena Pavlova
Healthcare 2023, 11(13), 1964; https://doi.org/10.3390/healthcare11131964 - 7 Jul 2023
Cited by 3 | Viewed by 1502
Abstract
Background: Healthcare labor market shortages due to migration, inadequate investments, and lack of continuous training are essential concerns in the Eastern European region. This article aims to describe and reflect on the experience with the implementation of continuous medical education among mother-and-child healthcare [...] Read more.
Background: Healthcare labor market shortages due to migration, inadequate investments, and lack of continuous training are essential concerns in the Eastern European region. This article aims to describe and reflect on the experience with the implementation of continuous medical education among mother-and-child healthcare providers in Ukraine, including achievements, challenges, and barriers. We analyze this case based on two international collaboration initiatives: the Swiss–Ukrainian program in mother-and-child health that ran from 2000 to 2015, supplemented by the recent Ukrainian–Swiss project “Medical education development” in 2018–2023. Methods: We use a case study approach as the methodology for our study. We collected data from documents (project reports reviews) and in-depth interviews with stakeholders. We apply the method of directed qualitative content analysis. Results: As a result of the Swiss–Ukrainian collaborations, the knowledge and awareness of medical personnel were greatly improved. Modern clinical concepts not well understood at the outset became commonplace and were incorporated into clinical activities. Nevertheless, obstacles to the implementation and rapid uptake of changes were found in the lack of knowledge of the English language among medical doctors, the fear of changes, and the lack of openness and readiness for novel evidence-based clinical practices. However, primary healthcare practitioners in this new project seem to be more inclined to change. Conclusions: A modernized continuous medical education which is based on the values of openness, respect, dialogue, and professionalism can be implemented with the input of an international assistance program despite the resistance of the system towards change. Full article
(This article belongs to the Special Issue Advances and Challenges in the Labour Markets for Healthcare Professionals)
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<p>Geographical coverage of the Swiss–Ukrainian collaboration.</p> Full article ">
11 pages, 1670 KiB  
Article
Long-Term Impacts of COVID-19 Pneumonia on Quality of Life: A Single Institutional Pilot Study
by Athavudh Deesomchok, Chalerm Liwsrisakun, Warawut Chaiwong, Chaicharn Pothirat, Pilaiporn Duangjit, Chaiwat Bumroongkit, Theerakorn Theerakittikul, Atikun Limsukon, Pattraporn Tajarernmuang, Konlawij Trongtrakul and Nutchanok Niyatiwatchanchai
Healthcare 2023, 11(13), 1963; https://doi.org/10.3390/healthcare11131963 - 7 Jul 2023
Cited by 1 | Viewed by 1121
Abstract
Many studies have demonstrated poor quality of life (QoL) at 3, 6, 12, and 24 months after coronavirus disease 2019 (COVID-19). However, these studies were limited due to cross-sectional design, a longer gap between visits, and lack of controls for comparison. Therefore, the [...] Read more.
Many studies have demonstrated poor quality of life (QoL) at 3, 6, 12, and 24 months after coronavirus disease 2019 (COVID-19). However, these studies were limited due to cross-sectional design, a longer gap between visits, and lack of controls for comparison. Therefore, the aim of our prospective study was to assess the impact of COVID-19 pneumonia on QoL in both physical and mental health. A prospective study was conducted on adult patients with COVID-19 pneumonia. We used the 36-Item Short Form Health Survey (SF-36) and Euro Quality of Life-5 Dimensions-5 Levels (EQ-5D-5L), EQ visual analogue scale (EQ-VAS), and Hospital Anxiety and Depression Scale to collect data at months, 1, 3, 6, 9, and 12. Thirty-eight patients with COVID-19 pneumonia and twenty-five healthy subjects were completely followed up on all visits. All domains of SF-36, except bodily pain and EQ-5D-5L of the patients, were lower than controls. There was an improvement of EQ-VAS and SF-36 including physical functioning, social functioning, and role limitation (physical problems) domains throughout study period in the COVID-19 pneumonia group. Adult patients who recovered from COVID-19 pneumonia had lower QoL which improved over the one-year follow-up period. Full article
(This article belongs to the Collection COVID-19: Impact on Public Health and Healthcare)
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<p>The long-term impact of post-COVID-19 pneumonia on symptoms. Abbreviation: COVID-19, coronavirus disease 2019.</p> Full article ">Figure 2
<p>The Long-Term Impact of Post-COVID-19 Pneumonia on Symptoms of Cough (<b>A</b>) and Fatigue (<b>B</b>). Abbreviation: COVID-19, coronavirus disease 2019.</p> Full article ">Figure 3
<p>Health-Related Quality of Life Measured by SF-36 during follow-up period in post-COVID-19 pneumonia patients compared to healthy controls. Physical functioning (<b>A</b>), social functioning (<b>B</b>), role limitations physical problems (<b>C</b>), role limitations emotional problems (<b>D</b>), bodily pain (<b>E</b>), general health perceptions (<b>F</b>), mental health (<b>G</b>), and vitality (<b>H</b>). Note: Data are presented as mean ± SEM; * <span class="html-italic">p</span> Value &lt; 0.05 compared to healthy controls; <sup>#</sup> <span class="html-italic">p</span> Value &lt; 0.05 compared to month 1 visit. Abbreviations: COVID-19, coronavirus disease 2019; SF-36, 36-item Short-Form Health Survey.</p> Full article ">Figure 3 Cont.
<p>Health-Related Quality of Life Measured by SF-36 during follow-up period in post-COVID-19 pneumonia patients compared to healthy controls. Physical functioning (<b>A</b>), social functioning (<b>B</b>), role limitations physical problems (<b>C</b>), role limitations emotional problems (<b>D</b>), bodily pain (<b>E</b>), general health perceptions (<b>F</b>), mental health (<b>G</b>), and vitality (<b>H</b>). Note: Data are presented as mean ± SEM; * <span class="html-italic">p</span> Value &lt; 0.05 compared to healthy controls; <sup>#</sup> <span class="html-italic">p</span> Value &lt; 0.05 compared to month 1 visit. Abbreviations: COVID-19, coronavirus disease 2019; SF-36, 36-item Short-Form Health Survey.</p> Full article ">Figure 4
<p>Hospital Anxiety and Depression Scale Measured by HADS Questionnaire in post-COVID-19 pneumonia patients compared to healthy controls. Anxiety (<b>A</b>) and Depression (<b>B</b>). Abbreviation: HADS, the Hospital and Anxiety and Depression Scale questionnaire; COVID-19, coronavirus disease 2019.</p> Full article ">
15 pages, 265 KiB  
Article
Patient Safety Subcultures among Nursing Home Staff in Italy: A Cross-Sectional Study
by Ilaria Tocco Tussardi, Lucia Cazzoletti, Maria Elisabetta Zanolin, Annarita Comini, Donatella Visentin, Emanuele Torri, Stefano Tardivo and Francesca Moretti
Healthcare 2023, 11(13), 1962; https://doi.org/10.3390/healthcare11131962 - 7 Jul 2023
Cited by 2 | Viewed by 1112
Abstract
Nursing home (NH) residents are vulnerable subjects and highly susceptible to adverse events. Knowledge of patient safety culture (PSC) is essential for an organization to ensure patient safety. However, research on PSC in NHs, and its variability among staff, is still scarce. This [...] Read more.
Nursing home (NH) residents are vulnerable subjects and highly susceptible to adverse events. Knowledge of patient safety culture (PSC) is essential for an organization to ensure patient safety. However, research on PSC in NHs, and its variability among staff, is still scarce. This study aimed to explore whether and how PSC differed among NH staff (Managers, Nurses, Direct Care Staff, Support Staff, Administrative Staff and Other Providers) in the Autonomous Province of Trento, Italy. This study employed a cross-sectional design and collected data from 1145 NH providers using the Nursing Home Survey on Patient Safety Culture (NHSPSC). Data were analyzed using linear mixed models, with each of the 12 NHSPSC domains as a response variable. The majority of the respondents (61.6%) were Direct Care Staff members. ‘Feedback and Communication about Incidents’ and ‘Overall Perceptions of Resident Safety’ were the domains with the highest proportions of positive answers (PPAs). For most staff categories, ‘Staffing’ was the domain with the lowest PPA. Support Staff showed significantly lower scores in the majority of domains (8/12). Shorter job tenure, fewer weekly working hours, working mostly during the day and working in highly specialized areas were associated with higher scores in several domains. Interventions to improve PSC must consider the differences between professional groups. Further research is needed to explore the relationship between job-related features and perceptions of patient safety among NH workers. Full article
(This article belongs to the Special Issue Nursing Care for Older Health)
13 pages, 268 KiB  
Article
Nurses’ Silence: Understanding the Impacts of Second Victim Phenomenon among Israeli Nurses
by Rinat Cohen, Yael Sela, Inbal Halevi Hochwald and Rachel Nissanholz-Gannot
Healthcare 2023, 11(13), 1961; https://doi.org/10.3390/healthcare11131961 - 7 Jul 2023
Cited by 2 | Viewed by 1707
Abstract
Introduction: The ‘second victim’ phenomenon, (SVP) refers to a health professional who was involved in an adverse event (AE) and continues to suffer from the event to the detriment of personal and professional functioning. The second victims’ natural history of recovery model predicts [...] Read more.
Introduction: The ‘second victim’ phenomenon, (SVP) refers to a health professional who was involved in an adverse event (AE) and continues to suffer from the event to the detriment of personal and professional functioning. The second victims’ natural history of recovery model predicts stages of the phenomenon from AE occurrence until the ‘moving on’ stage and serves as a suitable structure for many organizational support programs worldwide. Purpose: Using the second victims’ natural history of recovery model to examine the impact of the SVP on Israeli nurses, with a specific focus on the organizational support they felt they required compared with the support they felt that they had received from their organizations. Methods: Fifteen in-depth interviews were conducted, using a semi-structured questionnaire, among nurses who had experienced the SVP. The interviews were recorded subject to the interviewees’ consent, transcribed, and analyzed using thematic content analysis. Findings: Throughout all six stages of recovery, all interviewees reported physical and emotional manifestations following exposure to an AE, regardless of the type of event or severity. They also reported difficulty in emotion regulation, as well as damage to functioning and overall quality of life. Most of the nurse interviewees reported a need to share the events with someone, but, despite this desire to receive appropriate support, almost none of them proactively requested help from a professional source, nor did their organizational management initiate proactive support. This lack of referral for further assistance is possibly explained through limited awareness of the SVP as a valid response to an AE, a perceived lack of legitimacy to receive organizational support, and personal barriers that accompany the phenomenon. Conclusions: Appropriate organizational support, offered proximal to an AE as well as over time, is essential for the nurse, the patient, and the organization. Personal barriers, together with limited awareness, may challenge the identification and provision of appropriate assistance. Hence, it is important to address the phenomenon as part of the general organizational policy to improve the quality of care and patient safety. Full article
(This article belongs to the Topic Employee Quality of Life, Well-Being and Wellness: A Pathway to Organizational Performance, Efficiency, and Sustainability)
15 pages, 279 KiB  
Article
Nurse–Patient Communication and Relationship When Wearing Personal Protective Equipment: Nurses’ Experience in a COVID-19 Ward
by Raffaella Gualandi, Dhurata Ivziku, Rosario Caruso, Chiara Di Giacinto, Marzia Lommi, Daniela Tartaglini and Anna De Benedictis
Healthcare 2023, 11(13), 1960; https://doi.org/10.3390/healthcare11131960 - 7 Jul 2023
Cited by 1 | Viewed by 3162
Abstract
Little is known about which communication strategies nurses carried out and whether the nurse–patient relationship has been altered due to the mandated use of personal protective equipment during the COVID-19 pandemic. This study describes how nurse–patient communication and relationships took place from the [...] Read more.
Little is known about which communication strategies nurses carried out and whether the nurse–patient relationship has been altered due to the mandated use of personal protective equipment during the COVID-19 pandemic. This study describes how nurse–patient communication and relationships took place from the point of view of nurses engaged in caring for patients with COVID-19. A qualitative descriptive study design following COREQ guidelines was conducted. Semi-structured telephone interviews with nurses working in the COVID ward of an Italian university hospital were performed between September 2020 and June 2021. Ten nurses were recruited using convenience sampling. One overarching theme, three main themes, and nine sub-themes were identified. The overarching theme ‘The in-out relationship: ‘in here and out there’ and ‘inside me and out of me’ included the main themes ‘A closed system different from normal’, ‘Uncovering meaningful human gestures’, and ‘A deep experience to live’’. The relational nature of nursing—where ‘me and you’ and the context are the main elements—leads nurses to find new ways of interacting and communicating with patients, even in a new situation that has never been experienced. Enhancing human gestures, thinking about new contexts of care, and educating new generations to maintain human-to-human interaction, regardless of the context of care, are the directives to be explored for creating the future of nursing care. Full article
(This article belongs to the Special Issue Best Practice: Proposals for Preparing Pandemics Governance)
15 pages, 319 KiB  
Article
Indicators Related to Marital Dissatisfaction
by Claudia Sánchez and Cecilia Mota
Healthcare 2023, 11(13), 1959; https://doi.org/10.3390/healthcare11131959 - 7 Jul 2023
Viewed by 1465
Abstract
This is a study on indicators related to marital dissatisfaction. The research was conducted by the psychology department of a reproductive health institution in Mexico City. The objective was to know the relation between marital satisfaction/dissatisfaction and gender roles, self-esteem, the types of [...] Read more.
This is a study on indicators related to marital dissatisfaction. The research was conducted by the psychology department of a reproductive health institution in Mexico City. The objective was to know the relation between marital satisfaction/dissatisfaction and gender roles, self-esteem, the types of coping strategies and the types of violence perceived from the partner. It was a nonexperimental, retrospective, cross-sectional study of two samples—one of women and one of men—classified by marital satisfaction or dissatisfaction. The nonprobability quota sampling included 208 participants: 104 women and 104 men. Comparisons, correlations and a discriminant analysis were made to identify the most significant variables. Women with marital dissatisfaction perceived blackmail, psychological violence and humiliation/devaluation from their partner; they preferably adopt a submissive gender role and use escape/avoidance as a coping strategy, and so do the men with marital dissatisfaction, who also perceived blackmail, control and psychological violence from their partner; they have low self-esteem, and they preferably adopt a submissive gender role. Isolating factors will allow for more specificity in terms of psychological care at health institutions as well as avoiding gender biases and preventing an increase of violence in couples. Full article
(This article belongs to the Special Issue Intimate Partner Violence: Risk and Vulnerability Factors, Health Promotion and Prevention in Educational and Healthcare Contexts)
12 pages, 655 KiB  
Review
Recent Evidence on Polycyclic Aromatic Hydrocarbon Exposure
by Xiaohan Zhao, Jiuhe Gao, Lingzi Zhai, Xi Yu and Ying Xiao
Healthcare 2023, 11(13), 1958; https://doi.org/10.3390/healthcare11131958 - 7 Jul 2023
Cited by 10 | Viewed by 2419
Abstract
This review provides a comprehensive conclusion of the relationship between the intake of various polycyclic aromatic hydrocarbons (PAHs) and different dietary patterns, pointing to the accompanying potential health risks. To achieve this, existing pertinent research was collected and analyzed. The collation revealed that [...] Read more.
This review provides a comprehensive conclusion of the relationship between the intake of various polycyclic aromatic hydrocarbons (PAHs) and different dietary patterns, pointing to the accompanying potential health risks. To achieve this, existing pertinent research was collected and analyzed. The collation revealed that the concentration of PAHs in food and their dietary patterns were diverse in different regions. Specifically, the concentration of PAHs in food was found to be related to the level of pollution in the area, including soil, air, and water pollution, which is then accumulated through the food chain into food that can be ingested directly by the human body, resulting in malformations in offspring, increased risk of cancer, and gene mutation. Guidebooks and dietary surveys were consulted to uncover disparities in dietary patterns, which indicated regional variations in taste preferences, traditional foods, and eating habits. Different regions are spatially categorized in this assessment by cities, countries, and continents. Notably, smoking and grilling are two of the food processing methods most likely to produce high levels of PAHs. To prevent excessive intake of PAHs from food items and attain a higher quality of life, more health education is urgently needed to promote healthy eating patterns. Full article
(This article belongs to the Special Issue The Role of Dietary Patterns and Health Consciousness in Healthcare)
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<p>PAHs exposure from different dietary patterns.</p> Full article ">
13 pages, 646 KiB  
Article
Psychometric Properties of the Italian Version of the Leader Member Exchange Scale (LMX-7): A Validation Study
by Marzia Lommi, Ippolito Notarnicola, Rosario Caruso, Laura Iacorossi, Francesca Gambalunga, Laura Sabatino, Roberto Latina, Teresa Rea, Assunta Guillari, Maddalena De Maria, Rocco Mazzotta, Gennaro Rocco, Alessandro Stievano, Raffaella Gualandi, Daniela Tartaglini and Dhurata Ivziku
Healthcare 2023, 11(13), 1957; https://doi.org/10.3390/healthcare11131957 - 6 Jul 2023
Cited by 3 | Viewed by 2164
Abstract
For decades, scholars have studied leader–member exchange (LMX) relationships to understand and explain the effects of leadership on follower attitudes and performance outcomes within work settings. One available instrument to measure these aspects is the LMX-7 scale. This measurement has been widely used [...] Read more.
For decades, scholars have studied leader–member exchange (LMX) relationships to understand and explain the effects of leadership on follower attitudes and performance outcomes within work settings. One available instrument to measure these aspects is the LMX-7 scale. This measurement has been widely used in empirical studies, but its psychometric properties have been poorly explored. The aim of this study was to test the psychometric characteristics (content, structural and construct validity, and reliability) of the Italian version of the LMX-7 scale and to support its cultural adaptation. We used a cross-sectional multi-center design. The forward–backward translation process was used to develop the Italian version of the scale. The scale was administered through an online survey to 837 nurses and nurse managers working in different settings. The factorial structure was tested using both exploratory and confirmatory factor analyses (EFA and CFA), and reliability was evaluated using Cronbach’s alpha. For the construct validity, we used hypothesis testing and differentiation by known groups. The Italian version of the LMX-7 scale presented one dimension. All the psychometric tests performed confirmed its validity and suggested its usefulness for future research. Full article
(This article belongs to the Section Nursing)
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<p>Model of the CFA performed on the LMX-7 scale.</p> Full article ">
11 pages, 1723 KiB  
Article
Botulinum Toxin for Drooling in Adults with Diseases of the Central Nervous System: A Meta-Analysis
by Chih-Rung Chen, Yu-Chi Su, Hui-Chuan Chen and Yu-Ching Lin
Healthcare 2023, 11(13), 1956; https://doi.org/10.3390/healthcare11131956 - 6 Jul 2023
Viewed by 1726
Abstract
(1) Background: The purpose of this study was to determine whether the drooling of adult patients with diverse central nervous system diseases can be treated with botulinum toxin type A. (2) Methods: The Cochrane Library, MEDLINE, and Embase were all searched for studies [...] Read more.
(1) Background: The purpose of this study was to determine whether the drooling of adult patients with diverse central nervous system diseases can be treated with botulinum toxin type A. (2) Methods: The Cochrane Library, MEDLINE, and Embase were all searched for studies that fit the inclusion criteria. The patients in the studies had to be adults (>18 years old), and the studies had to be randomized placebo-controlled trials, controlled trials, or prospective studies. Each study had to have enough quantifiable data available for meta-analysis. The primary outcome measure was the Drooling Severity and Frequency Scale (DSFS). (3) Results: The meta-analysis comprised three studies. A statistically significant difference in DSFS score between the treatment and control groups was observed in the meta-analysis, with an overall standardized mean difference of −0.9377 (95% CI, −1.2919 to −0.5836; p < 0.0001). A total of seven studies were ineligible for inclusion in the meta-analysis and were only assessed as qualitative data. All qualitative studies showed a significant reduction in DSFS score a few weeks or months after the injection of botulinum toxin. (4) Conclusions: Botulinum toxin type A is safe and effective as a treatment for drooling in adult patients with central nervous system diseases. Full article
(This article belongs to the Special Issue Drug Regulation, Drug Safety and Promoting Pharmacy Support for Patients)
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<p>Flow diagram showing the number of studies selected for this study.</p> Full article ">Figure 2
<p>(<b>a</b>) Forest plot of the four randomized, placebo-controlled trials included for this meta-analysis [<a href="#B15-healthcare-11-01956" class="html-bibr">15</a>,<a href="#B16-healthcare-11-01956" class="html-bibr">16</a>,<a href="#B17-healthcare-11-01956" class="html-bibr">17</a>]. The random effects model is used. Each treatment group with its respective dosage is studied separately. The time points of each study are combined as a mean and are not interpreted as independent groups. A statistically significant improvement in DSFS score was observed, with an overall standardized difference in means of −0.938 (95% CI, −1.292 to −0.584; <span class="html-italic">p</span> &lt; 0.0001). (<b>b</b>) Heterogeneity is assessed with the <span class="html-italic">I</span><sup>2</sup> statistic (0%). Moderate or high heterogeneity in this meta-analysis is unlikely. The forest plot and the effect size and measure are created and calculated using Comprehensive Meta-Analysis software.</p> Full article ">Figure 3
<p>Risk of bias graph and summary [<a href="#B15-healthcare-11-01956" class="html-bibr">15</a>,<a href="#B16-healthcare-11-01956" class="html-bibr">16</a>,<a href="#B17-healthcare-11-01956" class="html-bibr">17</a>].</p> Full article ">
14 pages, 287 KiB  
Article
Access to Healthcare and Health Literacy in Croatia: Empirical Investigation
by Ana Bobinac
Healthcare 2023, 11(13), 1955; https://doi.org/10.3390/healthcare11131955 - 6 Jul 2023
Cited by 3 | Viewed by 1549
Abstract
Health literacy is related to different health-related outcomes. However, the nature of the relationship between health literacy and health outcomes is not well understood. One pathway may lead from health literacy to health outcomes by means of access to healthcare. The goal of [...] Read more.
Health literacy is related to different health-related outcomes. However, the nature of the relationship between health literacy and health outcomes is not well understood. One pathway may lead from health literacy to health outcomes by means of access to healthcare. The goal of the current study is to explore the association between health literacy and the particular measure of access to healthcare—unmet medical need—for the first time in Croatia and, to the best of our knowledge, for the first time in the EU context. We use data obtained from face-to-face interviews in a large nationally representative sample of the Croatian population (n = 1000) to estimate the level of health literacy and self-reported access to care and investigate the association between health literacy and self-perceived barriers to access. Our study showed that limited and problematic health literacy is prevalent and associated with higher rates of unmet medical need. Unmet need is largely caused by long waiting lists. It is therefore essential to design health services fitting the needs of those who have limited and/or problematic health literacy as well as enhance health education with the potential of improving the access to care and health outcomes as well as design policies that reduce waiting times. Full article
9 pages, 587 KiB  
Article
The Crisis in the Nursing Labour Market: Canadian Policy Perspectives
by Andrea Baumann and Mary Crea-Arsenio
Healthcare 2023, 11(13), 1954; https://doi.org/10.3390/healthcare11131954 - 6 Jul 2023
Cited by 14 | Viewed by 7890
Abstract
The labour market for care professionals has experienced significant changes, resulting in critical shortages globally. Nurses represent the largest share of health workers worldwide; nonetheless, an estimated 13 million more nurses will be needed over the next 10 years. Prior to the pandemic, [...] Read more.
The labour market for care professionals has experienced significant changes, resulting in critical shortages globally. Nurses represent the largest share of health workers worldwide; nonetheless, an estimated 13 million more nurses will be needed over the next 10 years. Prior to the pandemic, the domestic supply of nurses in Canada had not kept pace with the ever-increasing demand for services. Pre-pandemic age- and needs-based forecasting models have estimated shortages in an excess of 100,000 nurses nationwide by 2030. While COVID-19 has accelerated the demand for and complexity of service requirements, it has also resulted in losses of healthcare professionals due to an increased sick leave, unprecedented burnout and retirements. This paper examines key factors that have contributed to nursing supply issues in Canada over time and provides examples of policy responses to the present shortage facing the healthcare system. To provide adequate care, the nursing workforce must be stabilized and—more importantly—recognized as critical to the health of the population. Full article
(This article belongs to the Special Issue Advances and Challenges in the Labour Markets for Healthcare Professionals)
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<p>Age distribution of employed nurses in Ontario, 2014 and 2021. Source: College of Nurses of Ontario (2022). Registration statistics report [<a href="#B18-healthcare-11-01954" class="html-bibr">18</a>].</p> Full article ">Figure 2
<p>Work status of new nurses in Ontario, 2015–2022. Source: College of Nurses of Ontario (2022). Registration statistics report [<a href="#B18-healthcare-11-01954" class="html-bibr">18</a>].</p> Full article ">
10 pages, 658 KiB  
Article
Mediating Effect of Humanism on the Relationship between Task Performance Competence and Holistic Nursing Competence for Clinical Nurses
by Junghee Yu, Taehui Kim and Hyesun Kim
Healthcare 2023, 11(13), 1953; https://doi.org/10.3390/healthcare11131953 - 6 Jul 2023
Cited by 1 | Viewed by 1443
Abstract
This is a cross-sectional descriptive study that investigates the mediating effect of humanism on the relationship between task performance and holistic nursing competence among clinical nurses. The participants were nurses with more than one year of work experience in general hospitals in South [...] Read more.
This is a cross-sectional descriptive study that investigates the mediating effect of humanism on the relationship between task performance and holistic nursing competence among clinical nurses. The participants were nurses with more than one year of work experience in general hospitals in South Korea, recruited using convenience sampling. A total of 227 data samples were collected. A self-reported questionnaire including the task performance competence scale, holistic nursing competence scale, and humanism scale was used for the survey. Data were analyzed using the t-test, analysis of variance, Pearson’s correlation coefficients, and hierarchical multiple regression after checking for normal distribution. The results showed that task performance competence, holistic nursing competence, and humanism differed according to characteristics such as gender, age, educational level, marital status, position, length of career, and job and salary satisfaction. Task performance competence was positively correlated with holistic nursing competence and humanism. A positive correlation was also observed between holistic nursing competence and humanism. A partial mediating effect of humanism in the relationship between task performance competence and holistic nursing competence was confirmed. Thus, to increase nurses’ holistic nursing competence, it is necessary to improve task performance competence and formulate a continuous and repetitive education program that includes humanism. Full article
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<p>Mediating effect of humanism on the relationship between task performance and holistic nursing competence.</p> Full article ">
2 pages, 178 KiB  
Editorial
A Retrospect of the Special Issue “Second Edition of Innovative Solutions for Oral Healthcare”
by Saturnino Marco Lupi
Healthcare 2023, 11(13), 1952; https://doi.org/10.3390/healthcare11131952 - 6 Jul 2023
Viewed by 728
Abstract
Medicine and oral health are constantly progressing through a series of small advancements that, together, lead to significant discoveries and breakthroughs [...] Full article
(This article belongs to the Special Issue Second Edition of Innovative Solutions for Oral Healthcare)
10 pages, 702 KiB  
Article
Reliability and Validity Analysis of the Korean Version of the Affinity for Technology Interaction Scale
by Taehui Kim, Seyeon Park and Miri Jeong
Healthcare 2023, 11(13), 1951; https://doi.org/10.3390/healthcare11131951 - 6 Jul 2023
Viewed by 1145
Abstract
This study aimed to translate the affinity for technology interaction (ATI) scale into Korean and examine its validity and reliability to measure nurses’ interactions and affinity with digital healthcare. Data from 154 nurses employed by general hospitals were analyzed. This developmental and psychometrical [...] Read more.
This study aimed to translate the affinity for technology interaction (ATI) scale into Korean and examine its validity and reliability to measure nurses’ interactions and affinity with digital healthcare. Data from 154 nurses employed by general hospitals were analyzed. This developmental and psychometrical evaluation of the ATI scale included a translation, a pilot test, and psychometric properties. Concurrent validity, content validity, construct validity, and reliability testing were completed. The corrected item–total correlation was below the standard of 0.3, and the content validity index was >0.8. The Kaiser–Meyer–Olkin and Bartlett sphericity test values were 0.81 and Χ2 = 496.25 (p < 0.001), respectively. The exploratory factor analysis (EFA) result was extracted as two factors, with an overall variance of 60.52%. The correlation between the ATI scale and the Quality Improvement Information System acceptance tool was examined to confirm concurrent validity and showed a significant correlation. Cronbach’s α was 0.75, indicating adequate reliability. ATI’s internal, construct, and concurrent validity demonstrated its suitability as a tool. Therefore, assessing nurses’ information and communication technology proficiency and developing strategies for boosting it would be possible. Full article
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<p>Scree plot.</p> Full article ">
14 pages, 1014 KiB  
Article
KIT 1 (Keep in Touch) Project—Televisits for Cancer Patients during Italian Lockdown for COVID-19 Pandemic: The Real-World Experience of Establishing a Telemedicine System
by Calogero Casà, Barbara Corvari, Francesco Cellini, Patrizia Cornacchione, Andrea D’Aviero, Sara Reina, Silvia Di Franco, Alessandra Salvati, Giuseppe Ferdinando Colloca, Alfredo Cesario, Stefano Patarnello, Mario Balducci, Alessio Giuseppe Morganti, Vincenzo Valentini, Maria Antonietta Gambacorta and Luca Tagliaferri
Healthcare 2023, 11(13), 1950; https://doi.org/10.3390/healthcare11131950 - 6 Jul 2023
Cited by 2 | Viewed by 1846
Abstract
To evaluate the adoption of an integrated eHealth platform for televisit/monitoring/consultation during the COVID-19 pandemic. Methods: During the lockdown imposed by the Italian government during the COVID19 pandemic spread, a dedicated multi-professional working group was set up in the Radiation Oncology Department with [...] Read more.
To evaluate the adoption of an integrated eHealth platform for televisit/monitoring/consultation during the COVID-19 pandemic. Methods: During the lockdown imposed by the Italian government during the COVID19 pandemic spread, a dedicated multi-professional working group was set up in the Radiation Oncology Department with the primary aim of reducing patients’ exposure to COVID-19 by adopting de-centralized/remote consultation methodologies. Each patient’s clinical history was screened before the visit to assess if a traditional clinical visit would be recommended or if a remote evaluation was to be preferred. Real world data (RWD) in the form of patient-reported outcomes (PROMs) and patient reported experiences (PREMs) were collected from patients who underwent televisit/teleconsultation through the eHealth platform. Results: During the lockdown period (from 8 March to 4 May 2020) a total of 1956 visits were managed. A total of 983 (50.26%) of these visits were performed via email (to apply for and to upload of documents) and phone call management; 31 visits (1.58%) were performed using the eHealth system. Substantially, all patients found the eHealth platform useful and user-friendly, consistently indicating that this type of service would also be useful after the pandemic. Conclusions: The rapid implementation of an eHealth system was feasible and well-accepted by the patients during the pandemic. However, we believe that further evidence is to be generated to further support large-scale adoption. Full article
(This article belongs to the Special Issue Primary Healthcare Services and Innovative Models during COVID-19)
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<p>Number of televisits during Italian lockdown period.</p> Full article ">Figure 2
<p>Flow diagram of visits scheduled during the Italian lockdown period (from 8 March to 4 May 2020).</p> Full article ">Figure 3
<p>Patient-reported outcomes measures (PROMs).</p> Full article ">
9 pages, 782 KiB  
Article
COVID-19 Social Restrictions’ Impact on the Health-Related Physical Fitness of the Police Cadets
by Eduarda Sousa-Sá, Sara Pereira, Pedro B. Júdice, Luís Monteiro and Luís Miguel Massuça
Healthcare 2023, 11(13), 1949; https://doi.org/10.3390/healthcare11131949 - 5 Jul 2023
Viewed by 1180
Abstract
We aim to examine the changes in health-related physical fitness components, before and after COVID-19 social restrictions, in Police Academy cadets by age, sex, and physical activity (PA) level. A longitudinal analysis of 156 cadets (29.5% women) aged 25.4 ± 5.3 years old [...] Read more.
We aim to examine the changes in health-related physical fitness components, before and after COVID-19 social restrictions, in Police Academy cadets by age, sex, and physical activity (PA) level. A longitudinal analysis of 156 cadets (29.5% women) aged 25.4 ± 5.3 years old was conducted. All variables were collected before and after the lockdown period (13 weeks). PA levels were assessed with a self-reported questionnaire. Health-related physical fitness components were assessed based on the standardized protocols of morphological evaluation, speed, agility, strength, flexibility, and aerobic capacity tests. Despite the high correlations between pre- and post-pandemic social restrictions, we found significantly higher values for anthropometric indicators and lower physical fitness levels in post-pandemic restrictions, except for lower-body strength. When stratifying the sample by sex, age, and PA categories, the results indicate that the COVID-19 lockdown tends to differently impact anthropometric indicators and the physical fitness of the cadets, according to their sex, age, and PA categories. Our findings show that our sample reduces several health-related physical fitness components due to the social lockdown, with emphasis on cardiorespiratory fitness in men and upper-limb strength in women, highlighting the need to create effective strategies to keep police officers active during situations of less physical work. Full article
(This article belongs to the Special Issue Effects of Prescribed Exercise and Physical Activity Interventions on Health Indices and Disease Improvement)
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<p>Graphical representation of the anthropometric indicators and physical fitness levels of pre- and post-pandemic restrictions by sex (all variables were standardized (<span class="html-italic">z</span>-scores)).</p> Full article ">Figure 2
<p>Graphical representation of the anthropometric indicators and physical fitness levels during pre- and post-pandemic restrictions by age (all variables were standardized (<span class="html-italic">z</span>-scores)).</p> Full article ">
17 pages, 656 KiB  
Article
How Much Is an Abortion Worth? Was a Human “Not Formed”? An Italian Proposal
by Maricla Marrone, Benedetta Pia De Luca, Fortunato Pititto, Ignazio Grattagliano, Nicola Laforgia, Antonella Vimercati and Alessandro Dell’Erba
Healthcare 2023, 11(13), 1948; https://doi.org/10.3390/healthcare11131948 - 5 Jul 2023
Viewed by 1137
Abstract
Introduction: “Human capital” is defined as an integration of innate skills and knowledge acquired by investing in the formation of an individual; it is a real “capital” that pays off in the long term. In the Italian legal system, a human being is [...] Read more.
Introduction: “Human capital” is defined as an integration of innate skills and knowledge acquired by investing in the formation of an individual; it is a real “capital” that pays off in the long term. In the Italian legal system, a human being is recognised as a “person” from the moment of birth. This determines the acquisition of the personal rights of an individual. Necessarily, therefore, by law, a fetus does not own such rights; nevertheless, it has an innate “potential” to acquire such rights after birth. Objective: In Italian jurisprudence, in general, the damage from a loss of a parental relationship is justified by the condition of existential emptiness caused in the family by the loss of a child. Compensation for this damage in the event of abortion due to third-party responsibility presents a non-uniform recognition in the judgements of the Italian courts, but in any case, it is almost always recognised with limitations since the emotional relationship with the lost individual is defined only in terms of “potential”. Consequently, in this matter, at least two questions can be raised: (i) Is the economic estimate of abortion based on objective and standardised criteria, or is it heavily influenced by subjective evaluation? (ii) Is it possible to find standard criteria that may act as guidelines to quantify the loss of that human capital “in progress”? Methodology: The authors try to answer these questions by analysing the different approaches to this issue adopted at an international level. Conclusions: In conclusion, the authors propose homogeneous criteria to quantify the damage caused by abortion. Full article
(This article belongs to the Special Issue Forensic and Legal Medicine in the Third Millennium)
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<p>Risk of miscarriage according to maternal age. The bars for each point reflect the 95% confidence intervals (table extracted from Magnus et al. [<a href="#B20-healthcare-11-01948" class="html-bibr">20</a>]).</p> Full article ">
14 pages, 654 KiB  
Article
Effectiveness of a Therapeutic Educational Oral Health Program for Persons with Schizophrenia: A Cluster Randomized Controlled Trial and Qualitative Approach
by Frederic Denis, Corinne Rat, Lucie Cros, Valerie Bertaud, Wissam El-Hage, Lysiane Jonval and Agnès Soudry-Faure
Healthcare 2023, 11(13), 1947; https://doi.org/10.3390/healthcare11131947 - 5 Jul 2023
Cited by 1 | Viewed by 1339
Abstract
Background: The oral health of people with schizophrenia (PWS) is very poor, suggesting a need for oral health promotion programmes with a high level of evidence. The aim of the EBENE study (Clinicaltrials.gov: NCT02512367) was to develop and evaluate the effectiveness of a [...] Read more.
Background: The oral health of people with schizophrenia (PWS) is very poor, suggesting a need for oral health promotion programmes with a high level of evidence. The aim of the EBENE study (Clinicaltrials.gov: NCT02512367) was to develop and evaluate the effectiveness of a multidisciplinary therapeutic educational programme in oral health (TEPOH) for PWS. Methods: A multicentre cluster randomised controlled trial, with outpatient psychiatry centres as the unit of randomisation, was designed to compare the effectiveness of TEPOH (intervention group) versus standard care (control group). The trial was conducted in 26 outpatient psychiatry centres in France (14 in the intervention group, 12 in the control group). Eligible patients with a diagnosis of schizophrenia were enroled between 2016 and 2020 and followed for 6 months. The TEPOH group received a multicomponent intervention (comprising an introductory session, three educational sessions, and a debriefing session). The primary endpoint was the evaluation of periodontal disease as a community periodontal index (CPI) score ≥ 3 at Month 6. The trial was completed using a qualitative approach based on semi-structured interviews with caregivers conducted between July 2018 and December 2019. The trial was stopped early due to difficulties in recruiting patients. Results: Overall, 81 patients (of 250 planned) were included, and 54 patients completed the trial: 40 in the TEPOH group and 14 in the control group. At baseline, the percentage of CPI ≥ 3 was 42.5% in the TEPOH group and 9.1% in the control group. At Month 6, the percentage of CPI ≥ 3 was 20% in the TEPOH group and 14.3% in the control group. The qualitative evaluation underlined that the professionals emphasised the “seriousness” and “assiduity” of the patients’ participation in this programme and that the TEPOH reinforced carers’ investment in oral hygiene. It also highlighted structural factors (lack of resources for professionals, lack of teeth in PWS, COVID-19 pandemic) that may have exacerbated the difficulties with enrolment and follow-up. Conclusions: The effectiveness of this TEPOH, developed for PWS as part of the EBENE study, has not been demonstrated. Certain aspects of the programme’s content and implementation need to be reconsidered. In particular, an adapted subjective measurement scale should be developed. Full article
(This article belongs to the Collection Healthcare in Dentistry)
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<p>Flow chart of randomised population.</p> Full article ">
20 pages, 2072 KiB  
Review
Antimicrobial Resistance: A Growing Serious Threat for Global Public Health
by Md. Abdus Salam, Md. Yusuf Al-Amin, Moushumi Tabassoom Salam, Jogendra Singh Pawar, Naseem Akhter, Ali A. Rabaan and Mohammed A. A. Alqumber
Healthcare 2023, 11(13), 1946; https://doi.org/10.3390/healthcare11131946 - 5 Jul 2023
Cited by 307 | Viewed by 37740
Abstract
Antibiotics are among the most important discoveries of the 20th century, having saved millions of lives from infectious diseases. Microbes have developed acquired antimicrobial resistance (AMR) to many drugs due to high selection pressure from increasing use and misuse of antibiotics over the [...] Read more.
Antibiotics are among the most important discoveries of the 20th century, having saved millions of lives from infectious diseases. Microbes have developed acquired antimicrobial resistance (AMR) to many drugs due to high selection pressure from increasing use and misuse of antibiotics over the years. The transmission and acquisition of AMR occur primarily via a human–human interface both within and outside of healthcare facilities. A huge number of interdependent factors related to healthcare and agriculture govern the development of AMR through various drug-resistance mechanisms. The emergence and spread of AMR from the unrestricted use of antimicrobials in livestock feed has been a major contributing factor. The prevalence of antimicrobial-resistant bacteria has attained an incongruous level worldwide and threatens global public health as a silent pandemic, necessitating urgent intervention. Therapeutic options of infections caused by antimicrobial-resistant bacteria are limited, resulting in significant morbidity and mortality with high financial impact. The paucity in discovery and supply of new novel antimicrobials to treat life-threatening infections by resistant pathogens stands in sharp contrast to demand. Immediate interventions to contain AMR include surveillance and monitoring, minimizing over-the-counter antibiotics and antibiotics in food animals, access to quality and affordable medicines, vaccines and diagnostics, and enforcement of legislation. An orchestrated collaborative action within and between multiple national and international organizations is required urgently, otherwise, a postantibiotic era can be a more real possibility than an apocalyptic fantasy for the 21st century. This narrative review highlights on this basis, mechanisms and factors in microbial resistance, and key strategies to combat antimicrobial resistance. Full article
(This article belongs to the Section Healthcare Quality and Patient Safety)
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<p>Timeline of discovery of major antibiotics and antibiotic resistance.</p> Full article ">Figure 2
<p>Antibiotic targets and mechanisms of drug resistance (created with BioRender.com (accessed on 12 November 2022)).</p> Full article ">Figure 3
<p>Major interventions to combat AMR.</p> Full article ">
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