Healthcare, Volume 9, Issue 8 (August 2021) – 170 articles

Preschool wheezing and related hospitalization rates are increasing. Prenatal tobacco smoke exposure (PTSE) increases the risk of wheezing, yet >20% of French women smoke during pregnancy. In this observational retrospective monocentric study, we assessed the link between PTSE and hospital admissions. We included infants <2 years of age admitted for acute wheezing. A phone interview with mothers was completed by electronic records. The primary endpoint was the ratio of cumulative duration of the hospitalization stays (days)/age (months). 129 children were included (36.4% exposed to PTSE vs. 63.6% unexposed). There was a significant difference in the duration of hospitalization/age: 0.9 days/month (exposed) vs. 0.58 days/month (unexposed) (p = 0.008). Smoking one cigarette/day during pregnancy was associated with an increase in hospitalization duration of 0.055 days/month (r = 0.238, p = 0.006). In the multi-variable analysis, this positive association persisted (β = 0.04, p = 0.04; standardized β = 0.27, p = 0.03). There was a trend towards a dose-effect relationship between PTSE and other important parameters associated with hospital admissions. We have demonstrated a dose-effect relationship, without a threshold effect, between PTSE and duration of hospitalization for wheezing in non-premature infants during the first 2 years of life. Prevention campaigns for future mothers should be enforced. Full article

Warranties for healthcare can be greatly beneficial for cost reductions and improvements in patient satisfaction. Under healthcare warranties, healthcare providers receive a lump sum payment for the entire care episode, which covers a bundle of healthcare services, including treatment decisions during initial hospitalization and subsequent readmissions, as well as disease-monitoring plans composed of periodic follow-ups. Higher treatment intensities and more radical monitoring strategies result in higher medical costs, but high treatment intensities reduce the baseline readmission rates. This study intends to provide a systematic optimization framework for healthcare warranty policies. In this paper, the proposed model allows healthcare providers to determine the optimal combination of treatment decisions and disease-monitoring policies to minimize the total expected healthcare warranty cost over the prespecified period. Given the nature of the disease progression, we introduced a delay time model to simulate the progression of chronic diseases. Based on this, we formulated an accumulated age model to measure the effect of follow-up on the patient’s readmission risk. By means of the proposed model, the optimal treatment intensity and the monitoring policy can be derived. A case study of pediatric type 1 diabetes mellitus is presented to illustrate the applicability of the proposed model. The findings could form the basis of developing effective healthcare warranty policies for patients with chronic diseases. Full article

Background: Living with kidney failure and undergoing hospital haemodialysis (HD) is associated with a high prevalence of mental health problems and poor quality of life. However, the COVID-19 pandemic has brought additional challenges for this patient population. Objectives: To understand the impact on mental health and well-being during the COVID-19 pandemic in people receiving HD. Methods: An online survey using a cross-sectional study design. Two validated assessment tools (General Health Questionnaire-12 (GHQ-12); Personal Wellbeing Index (PWI)), binary, Likert and free-text qualitative questions were included. Individuals with kidney failure receiving HD, over 18 years of age, were recruited online between July and August 2020. Results: Forty-four participants were recruited. Approximately, 54% of respondents were tested for COVID-19; however, no positive results were reported by patients or associated family members. Scores of GHQ-12 and PWI were compared with those from previous studies. Mental health distress was higher in prevalence (68.2%) and severity (M = 18.3) in this study when compared to that of the general population in Northern Ireland during COVID-19 (April 2020). In addition, well-being (M = 37.16, SD = 18.19) was poorer when compared to that of a pre-COVID-19 dialysis patient population. Conclusion: During the current pandemic, individuals receiving hospital HD have heightened mental health distress, and their well-being is impacted negatively. This study reinforces the need to provide appropriate psychosocial care as well as supportive interventions for mental distress to patients with kidney failure during and after the COVID-19 pandemic. Full article

The COVID-19 pandemic represented a very difficult physical and psychological challenge for the general population and even more for healthcare workers (HCWs). The main aim of the present study is to test whether there were significant differences between frontline and non-frontline Italian HCWs concerning (a) personality traits, intolerance of uncertainty, coping strategies and perceived stress, and (b) the models of their associations. A total of 682 Italian HCWs completed a self-report questionnaire: 280 employed in COVID-19 wards and 402 in other wards. The analysis of variance omnibus test revealed significant differences between the two groups only for perceived stress, which was higher among the frontline. The multi-group path analysis revealed significant differences in the structure of the associations between the two groups of HCWs, specifically concerning the relations between: personality traits and intolerance of uncertainty; intolerance of uncertainty and coping strategies. Regarding the relation between coping strategies and stress no difference was identified between the two groups. In both of them, emotionally focused coping was negatively related with perceived stress, whereas dysfunctional coping was positively related with stress. These results could be useful in planning actions aiming to reduce stress and improve the effectiveness of HCWs’ interventions. Training programs aimed to provide HCWs with a skillset to tackle uncertain and stressful circumstances could represent an appropriate support to develop a preventive approach during outbreaks. Full article

One of the major problems in cardiology practice is poor adherence to antihypertensive medication. This study aimed to evaluate medication adherence; we also aim to investigate the predictors of intentional and unintentional non-adherence. We issued a survey containing questions about patient demographics, blood pressure control, pharmaceutical care, and adherence level to medication. Retrospective analysis of the prescription database of the National Health Service of the Republic of Latvia was performed. The prevalence of non-adherence was 45.9%. The lowest adherence rate (38.2%) was found among patients taking medication for 2–4.9 years. Even though 84.7% of respondents had a blood pressure monitor at home, only 25.3% of them reported measuring blood pressure regularly. There were differences between the groups of adherent patients in terms of the patients’ net income (p = 0.004), medication co-payments (p = 0.007), and whether the pharmacist offered to reduce the costs of drug therapy (p = 0.002). Roughly half of the prescriptions (50.4%) containing perindopril were purchased by patients from pharmacies. The medication adherence level and blood pressure control at home were assessed as low. Intentionally non-adherent respondents discontinued their medication because of fear of getting used to medicines. The pharmacists’ behaviour in terms of offering to reduce the costs of medications used was influenced by socio-economic factors. Full article

Objective: Acquiring online health-related information has become increasingly widespread. In this study, we aimed to evaluate the quality of the most-viewed YouTube videos on dysphagia regarding exercises and compensated maneuvers. Method: We searched for the keywords “dysphagia exercise”, “dysphagia rehabilitation”, “dysphagia maneuver”, “dysphagia therapy”, and “dysphagia compensation” on YouTube on 5 February 2021. The educational quality of videos on YouTube was investigated based on the Global Quality Scale (GQS) and categorized into three groups: high-, intermediate-, and low-quality. The modified DISCERN tool was used to evaluate the reliability of the YouTube videos. Video parameters were compared between the groups according to the quality of the videos. Results: Of the 51 videos evaluated, according to the GQS, 54.9% (n = 28) were of high-quality, 35.3% (n = 18) were of intermediate-quality, and 9.8% (n = 5) were of low-quality, respectively. When the video parameters were compared among the groups, there were no significant differences in the number of views, likes, dislikes, or comments per day (p > 0.05). However, there was a significant difference in the DISCERN scores between the groups (p < 0.001). Conclusion: YouTube can be deemed as a predominant source for high-quality videos on dysphagia exercise and compensated maneuvers. However, YouTube should be accepted as a mixed pool, with high-, intermediate-, and low-quality videos. Therefore, healthcare professionals, such as physicians and therapists, should verify the suitability and quality of the video, and suggest it to the patient, to ensure that the patient obtains the appropriate information. Full article

Background: Ultrasound-guided regional anesthesia has gained popularity over the last decade. This study aimed to assess whether YouTube videos sufficiently serve as an adjunctive tool for learning how to perform an ultrasound-guided brachial plexus block (BPB). Methods: All YouTube videos were classified, based on their sources, as either academic, manufacturer, educational, or individual videos. The metrics, accuracy, utility, reliability (using the Journal of American Medical Association Score benchmark criteria (JAMAS)), and educational quality (using the Global Quality Score (GQS) and Brachial Plexus Block Specific Quality Score (BSQS)) were validated. Results: Here, 175 videos were included. Academic (1.19 ± 0.62, mean ± standard deviation), manufacturer (1.17 ± 0.71), and educational videos (1.15 ± 0.76) had better JAMAS accuracy and reliability than individual videos (0.26 ± 0.67) (p < 0.001). Manufacturer (11.22 ± 1.63) and educational videos (10.33 ± 3.34) had a higher BSQS than individual videos (7.32 ± 4.20) (p < 0.001). All sources weakly addressed the equipment preparation and post-procedure questions after BSQS analysis. Conclusions: The reliability and quality of ultrasound-guided BPB videos differ depending on their source. As YouTube is a useful educational platform for learners and teachers, global societies of regional anesthesiologists should set a standard for videos. Full article

(1) Background: The Covid-19 pandemic has put our healthcare systems to the test, exposing their vulnerability and demanding a high degree of commitment and dedication from healthcare teams to confront and contain the disease. In this sense, nursing professionals have played a prominent role in the treatment of complex cases that have required hospitalisation and have manifested pre-existing health complications or mortality. This unprecedented situation made it difficult to regulate the emotional impact and manage grief, often turning it into a traumatic grief whose psychological and emotional manifestations are increasingly evident but very little researched in the current context. (2) Purpose: Validation of the definition, defining characteristics and related factors for the proposal of the nursing diagnosis of professional traumatic grief. (3) Method: Based on Fehring’s content validation model, the label name, defining characteristics and other related factors were agreed upon by Spanish experts. (4) Results: The content validity index was 0.9068. A total of 21 defining characteristics were validated by the experts, as all of them scored above 0.6. With respect to the related factors of the proposed 10, all were validated. (5) Conclusion: The present study supports the proposal to develop a nursing diagnosis for professional traumatic grief. The use of standardised language is only the first step in establishing professional traumatic grief as a diagnostic category. Full article

Negative-pressurized isolation rooms have been approved effectively and applied widely for infectious patients. However, the outbreak of COVID-19 has led to a huge demand for negative-pressurized isolation rooms. It is critical and essential to ensure infection control performance through best practice of ventilation systems and optimum airflow distribution within isolation rooms. This study investigates a retrofitting project of an isolation room to accommodate COVID-19 patients. The field measurement has been conducted to ensure the compliance with the design specification from the CDC of Taiwan. The pressure differentials between negative-pressurized isolation rooms and corridor areas should be at least 8 Pa, while the air change rate per hour (ACH) should be 8–12 times. Computational fluid dynamics (CFD) is applied to evaluate the ventilation performance and contamination control. Different layout arrangements of exhaust air have been proposed to enhance the ventilation performance for infection control. A simple projected air-jet curtain has been proposed in the simulation model to enhance extra protection of medical staff. The resulting ventilation control revealed that the contamination control can be improved through the minor adjustment of exhaust air arrangement and the application of an air-jet curtain. Full article

The aim of this study is to investigate the emotional responses of nursing students to the COVID-19 pandemic and the characteristics of these responses using the Q-methodology. The focus of the Q-methodology is to discover research participants’ subjective viewpoints. In May 2021, 50 Korean nursing students from first year to fourth year were selected to participate in the study, and data were collected by asking them to classify 37 selected Q-statements in a normal distribution on a 9-point scale. In the final analysis, a P-sample of 38 nursing students was used. The emotional responses of the Korean nursing students were categorized into four types: self-protection (Type 1), pessimism about the current situation (Type 2), realistic optimism (Type 3), and developmental-seeking (Type 4). The four factors accounted for 39% of the total variance. The individual explanatory powers of the four factors were 8%, 12%, 13%, and 6%, respectively. Thus, the study explored the subjectivity of emotional responses of Korean nursing students to the pandemic. The study recommends considering the results for intervention programs that are designed to prepare nursing students for future health crises and pandemics. Full article

This study aimed to compare rates of participation in physical activity according to the type of disability, sex, point of disability diagnosis (congenital vs. acquired), and ability to walk independently. The study involved individuals who were registered as disabled based on the 2020 Sports Survey for the Disabled project of the Korea Ministry of Health and Welfare. Participants (mean age: 49.94 ± 12.35 years) included those with physical disabilities (n = 889), visual impairments (n = 523), hearing/speech impairments (n = 412), intellectual disabilities (n = 561), and disabilities associated with brain lesions (n = 364). Rates of severe (100%) and congenital disability (65.95%) were highest in the intellectual disability group. Acquired disability was most frequent in the physical disability group (94.71%). The highest frequency of independent walking ability was observed in the hearing/speech impairment group (99.27%). The rate of participation in physical activity was significantly higher in the acquired (odds ratio [OR] = 1.46, 95% confidence interval [CI] = 1.12–1.87, p = 0.005) and independent walking (OR = 1.43, 95% CI = 1.11–1.84, p = 0.005) hearing/speech impairment groups than in the corresponding physical disability groups after adjusting for age, sex, and severity. Our findings highlight the need to promote physical activity for people with physical and intellectual disabilities based on the factors examined in this study. Full article

Background: The purpose of this study was to investigate the factors related to patient’s participation in leisure activity in breast cancer patients with axillary lymph node dissection at 3 months after surgery. Methods: In total, 160 women who were employed before their surgery were evaluated. Age, body mass index (BMI), employment, level of lymph node dissection, marital status, children, coresident household members, preoperative chemotherapy, postoperative chemotherapy, postoperative hormonal therapy, postoperative radiotherapy, shoulder range of motion test, upper limb function, quality of life, and patient’s participation in leisure activity were evaluated. Results: Patients who undertook leisure activities constituted the leisure activity group, and patients who did not constituted the non-leisure activity group. Global health status, emotional function, social function, and dyspnea were significantly different between the leisure activity group and the non-leisure activity group at 3 months after surgery (p < 0.05). Regarding factors that affected participation in leisure activities, logistic regression analysis showed that only participation in leisure activities before surgery was significantly associated with participation in leisure activities at 3 months after surgery (p < 0.05). Conclusion: Patients who did not participate in leisure activities prior to surgery were unlikely to participate 3 months after surgery and thus require intervention to encourage their involvement. Full article

Avoidance of medication errors is imperative for the safe use of medications, and community pharmacists are uniquely placed to identify and resolve the errors that may arise due to poorly handwritten prescriptions. Purpose: To explore the opinion and attitudes of community pharmacists towards poor prescription writing and their suggestions to overcome this concern. Methods: A cross-sectional, self-administered survey was conducted among the community pharmacists in the Jazan region, Saudi Arabia. Descriptive analysis and chi-square test were used at 5% p-value (p > 0.05) as the significance level. Results: The response rate for the survey was 78.66%, and 140 community pharmacists agreed to participate. Among the study subjects, the majority (73.57%) had a bachelor’s degree. Nearly three-fourths (3/4) of the pharmacists (72.29%) chose to send the patient back to the prescriber when they found difficulty in interpreting the information from an illegible prescription. As many as 80.71% of the pharmacists believed that poorly handwritten prescriptions were the cause of actual errors when dispensing medications. The most commonly encountered problem due to poorly handwritten prescriptions was the commercial name of medicine, which was reported by around two-thirds (67.86%) of the pharmacists. The use of e-prescription was suggested by 72.86% of the pharmacists as a probable solution to encounter this problem. Conclusion: Our findings highlight the belief and attitudes of community pharmacists in the region and their opinions to solve this impending problem of poor prescription writing. Continuous professional development courses can be adopted to tackle the problem. Additionally, health authorities can work on incorporating and facilitating the use of e-prescription in the community sector, which can be a boon to physicians, pharmacists, and patients. Proper and extensive training is however needed before the implementation of e-prescribing. Full article

Low-cost, portable, and easy-to-use Kinect-based systems achieved great popularity in out-of-the-lab motion analysis. The placement of a Kinect sensor significantly influences the accuracy in measuring kinematic parameters for dynamics tasks. We conducted an experiment to investigate the impact of sensor placement on the accuracy of upper limb kinematics during a typical upper limb functional task, the drinking task. Using a 3D motion capture system as the golden standard, we tested twenty-one Kinect positions with three different distances and seven orientations. Upper limb joint angles, including shoulder flexion/extension, shoulder adduction/abduction, shoulder internal/external rotation, and elbow flexion/extension angles, are calculated via our developed Kinect kinematic model and the UWA kinematic model for both the Kinect-based system and the 3D motion capture system. We extracted the angles at the point of the target achieved (PTA). The mean-absolute-error (MEA) with the standard represents the Kinect-based system’s performance. We conducted a two-way repeated measure ANOVA to explore the impacts of distance and orientation on the MEAs for all upper limb angles. There is a significant main effect for orientation. The main effects for distance and the interaction effects do not reach statistical significance. The post hoc test using LSD test for orientation shows that the effect of orientation is joint-dependent and plane-dependent. For a complex task (e.g., drinking), which involves body occlusions, placing a Kinect sensor right in front of a subject is not a good choice. We suggest that place a Kinect sensor at the contralateral side of a subject with the orientation around ${30}^{\circ }$ to ${45}^{\circ }$ for upper limb functional tasks. For all kinds of dynamic tasks, we put forward the following recommendations for the placement of a Kinect sensor. First, set an optimal sensor position for capture, making sure that all investigated joints are visible during the whole task. Second, sensor placement should avoid body occlusion at the maximum extension. Third, if an optimal location cannot be achieved in an out-of-the-lab environment, researchers could put the Kinect sensor at an optimal orientation by trading off the factor of distance. Last, for those need to assess functions of both limbs, the users can relocate the sensor and re-evaluate the functions of the other side once they finish evaluating functions of one side of a subject. Full article

Combined training (CT) may combine strength and endurance training within a given time period, but it can also encompass additional protocols consisting of velocity, balance, or mobility as part of the same intervention. These combined approaches have become more common in soccer. This systematic review was conducted to (1) characterize the training protocols used in CT studies in soccer, (2) summarize the main physiological and physical effects of CT on soccer players, and (3) provide future directions for research. Methods: A systematic review of Cochrane Library, PubMed, Scopus, SPORTDiscus, and Web of Science databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PICOS were defined as follows: P (soccer players of any age or sex); I (CT combining strength and endurance or sprinting or balance or mobility training); C (the control group (whenever applicable), with or without comparative interventions in addition to usual soccer training); O (acute and/or chronic responses: biochemical, physiological and physical); S (must have at least two groups, either randomized or non-randomized). The database search initially identified 79 titles. From those, eight articles were deemed eligible for the systematic review. Three studies analyzed acute responses to concurrent training, while the remaining five analyzed adaptations to CT. In those tested for acute responses, physiological (hormonal) and physical (strength and power external load, internal load) parameters were observed. Adaptations were mainly focused on physical parameters (strength and power, sprints, jumps, repeated sprint ability, aerobic, change-of-direction), with relatively little focus on physiological parameters (muscle architecture). Short-term responses to CT can affect hormonal responses of testosterone after resistance training with internal and external load. In turn, these responses’ effects on strength and power have produced mixed results, as have adaptations. Specifically, strength and hypertrophy are affected to a lesser extent than speed/power movements. Nevertheless, it is preferable to perform CT before endurance exercises since it is a limiting factor for interference. Volume, intensity, rest between sessions, and athletes’ fitness levels and nutrition dictate the degree of interference. Full article

The optimal type of exercise that simultaneously decreases body weight and preserves bone health in people with obesity is unknown. This parallel randomized trial aimed to compare the effect of endurance and endurance-strength training on bone mineral density (BMD) and content (BMC) in abdominally obese postmenopausal women. A total of 101 women were recruited and randomly assigned to endurance or endurance-strength training groups. Participants trained for 60 min per day, three times per week for 12 weeks. The endurance exercises were performed at an intensity of 50–75% of the maximum heart rate, whereas the strength exercises were at 50–60% of the one-repetition maximum. Pre- and post-intervention BMD and BMC of the total body, lumbar spine, and femoral neck and physical capacity were measured. There were no differences among the densitometric parameters in the endurance group, but a significant increase in whole-body BMD in the endurance-strength group was found. Moreover, there was a significant difference between the groups in the changes in the lumbar spine BMC. Furthermore, both training programs significantly improved physical capacity with no differences between groups. Endurance training was more effective in maintaining BMC at the lumbar spine. However, both groups did not differ in effect on BMD. Further studies with a long-term follow-up should be considered to confirm these findings. The study was registered with the German Clinical Trials Register within the number DRKS00019832, and the date of registration was 26 February 2020 (retrospective registration). Full article

With the rapid progress in mobile healthcare and Internet medicine, the impact of telehealth and telemedicine on the satisfaction of patients and their willingness to travel has become a focus of the academic research community. This study analyses the differences between telehealth and telemedicine and their role in medical tourism. We examine how the information quality and communication quality of telehealth and telemedicine influence patient satisfaction, and their effects on patients’ willingness to undertake medical travel and on their medical travel behaviours. We conducted an empirical study on the use of telehealth and telemedicine and on medical travel behaviour in Azerbaijan using a survey for data collection. A total of 500 results were collected and analysed using SmartPLS 3.0. Results show that (1) the communication quality and information quality of telehealth and telemedicine and their effects on satisfaction have significantly positive influences on willingness to undertake medical travel; (2) the psychological expectations of value and cost (perceived value and perceived cost) have a positive influence on medical travel; and (3) willingness to participate in medical travel positively influences medical travel behaviour. Moreover, results of this study have implications for research on, and the practice of, using telehealth and telemedicine as they relate to medical tourism. This research may help improve knowledge about telehealth and telemedicine and understand the differences between them in detail. This empirical research model may also be useful for researchers from other countries who wish to measure medical travel behaviour. Full article

Lithuania is the leader in pharmacovigilance among the three Baltic countries. However, comparisons with other European countries are difficult because the reported number of adverse drug reactions (ADRs) in Lithuania is too low to rely on in terms of the annual use of medicines by the population over the year. The aim of this study was to explore challenges related to the understanding and practices of general practitioners and community pharmacists in reporting ADRs in Lithuania. The qualitative study approach of face-to-face interviews was used. All interviews were recorded, transcribed verbatim, and thematically analyzed. Twelve interviews with general practitioners and community pharmacists were conducted from March 2020 through December 2020. All participants had a basic knowledge of pharmacovigilance, but only four participants reported ADRs to the interviewer. Six main barriers regarding ADR reporting were identified, and appropriate interventions were suggested. The importance of collaboration between physicians and pharmacists was highlighted, and the need for guidelines supporting collaboration was expressed. Medications are becoming more complex, and comprehensive medication management is key for the optimization of patient outcomes. Our results reveal the need to improve and innovate the current pharmacovigilance system at all levels, starting from education for pharmacy and healthcare students and continuing through the development of ADR procedures. Full article

Gastric cancer is one of the most prevalent cancers globally, with high mortality, particularly in East Asia. Certain ranitidine products contain potentially carcinogenic N-nitrosodimethylamine. We investigated the potential association between gastric cancer risk and ranitidine intake using a nationwide cohort, extracted from the Korean National Health Insurance Service. In this longitudinal study, we employed a 1:1 propensity score matching according to sociodemographic factors. A total of 40,887 subjects were enrolled, of which 906 developed gastric cancer during the follow-up period. We investigated gastric cancer events during the follow-up period using the survival analysis, log-rank test, and Cox proportional hazards regression models to estimate incidence, survival rate, and hazard ratio. The incidence of gastric cancer was 67,422; 67,470; and 67,444 person-years in the control, other histamine-2 blockers, and ranitidine groups, respectively. Because the adjusted hazard ratio of gastric cancer was 0.98 and 1.01 in the other histamine-2 blockers and ranitidine groups, respectively, we could not calculate the likelihood of gastric cancer development in the ranitidine group. Ranitidine intake did not significantly increase the incidence of gastric cancer. Therefore, the relative risk of gastric cancer may be low in patients taking ranitidine products in South Korea. Full article

Background: Periodontitis has been associated to systemic diseases and this association could be due to an increase in circulating inflammatory and oxidative stress biomarkers in the periodontal disease. This study aimed to evaluate the relationship between inflammatory and pro-oxidant markers according to different stages of periodontitis. Methods: This cross-sectional study included 70 subjects who were divided into three groups according to periodontitis stage: stage II (n = 22), stage III (n = 30), and stage IV (n = 18). We evaluated periodontal parameters and levels of high-sensitivity C-reactive protein (hsCRP), fibrinogen, and malondialdehyde (MDA) in serum, and 8-hydroxy-2′-deoxyguanosine (8-OHdG) in urine. Results: Serum hsCRP and fibrinogen levels were associated with periodontitis severity, which were higher in stage IV than in stages III and II of periodontitis (p = 0.003 and p = 0.025, respectively). We observed a slight yet insignificant increase in MDA levels related to periodontitis severity. Probing depth and clinical attachment loss were associated with serum fibrinogen and hsCRP levels. However, there were no significant associations between periodontal variables and MDA and 8-OHdG levels. Conclusion: Our data support an association between periodontitis and systemic inflammation, which increases with periodontal disease severity. This indicates the importance of the early diagnosis and treatment of periodontal disease to avoid the development or worsening of systemic inflammatory diseases. Full article

Teaching hospitals have a unique mission to not only deliver graduate medical education but to also provide both inpatient and ambulatory care and to conduct clinical medical research; therefore, they are under constant financial pressure, and it is important to explore what types of external environmental components affect their financial performance. This study examined if there is an association between the short-term and long-term financial performance of major teaching hospitals in the United States and the external environmental dimensions, as measured by the Resource Dependence Theory. Data for 226 major teaching hospitals spanning 46 states were analyzed. The dependent variable for short-term financial performance was days cash on hand, and dependent variable for long-term financial performance was return on assets, both an average of most recently available 4-year data (2014–2017). Utilizing linear regression model, results showed significance between outpatient revenue and days cash on hand as well as significant relationship between population of the metropolitan statistical area, unemployment rate of the metropolitan statistical area, and teaching hospital’s return on assets. Additionally, system membership, type of ownership/control, and teaching intensity also showed significant association with return on assets. By comprehensively examining all major teaching hospitals in the U.S. and analyzing the association between their short-term and long-term financial performance and external environmental dimensions, based upon Resource Dependence Theory, we found that by offering diverse outpatient services and novel delivery options, administrators of teaching hospitals may be able to increase organizational liquidity. Full article

The World Health Organization reported that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is caused by respiratory droplets and aerosols from the oral cavity of infected patients. The angiotensin-converting enzyme 2 (ACE2) is considered the host functional protein for SARS-CoV-2 infection. In this article, we first revealed that the positive proportion of ACE2 expression in gingival cells collected from the gingival sulcus was increased to the same level as the tongue. Our data demonstrate that cells in the gingival sulcus may be a new entry point for the SARS-CoV-2 virus via a high expression of ACE2. In addition, we first evaluated the expression of ACE2 in various sites of the oral cavity with noninvasive, convenient liquid-based cytology. The liquid-based cytology evaluation of oral tissue may provide a novel preventive medical avenue against COVID-19. Full article

This article shows our work for developing an elder care platform for social interaction and physical and cognitive stimulation using the Pepper robot and Android OS as clients, based on the knowledge acquired on our long-term social robotics research experience. The first results of the user’s acceptance of the solution are presented in this article. The platform is able to provide different services to the user, such as information, news, games, exercises or music. The games, which have a bi-modal way of interacting (speech and a touch screen interface), have been designed for cognitive stimulation based on the items of the mini-mental state examination. The results of the user’s performance are stored in a cloud database and can be reviewed by therapists through a web interface that also allows them to establish customized therapy plans for each user. The platform has been tested and validated, first using adult people and then deployed to an elder care facility where the robot has been interacting with users for a long period of time. The results and feedback received have shown that the robot can help to keep the users physically and mentally active as well as establish an emotional link between the user and the robot. Full article

Hypertension is usually accompanied by the impairment of organs and arteries, and seriously threatens human health. Aerobic exercise can effectively prevent and treat hypertension. However, the mechanism of exercise therapy in hypertension is still unclear. In this study, we explored how aerobic exercise effectively reversed the impairment of the heart, kidney, and arteries caused by hypertension through a pathomorphological perspective. Spontaneously hypertensive rats were subjected to fifteen weeks of 45 min and 90 min swimming training without weight, and we then tested the effect of exercise on the morphology and structure of the heart, kidney, iliac artery, and branch of the mesenteric artery. We found that the myocardial fibers became thinner, the cross-sectional area of myocardial cells decreased, and cardiomyocyte edema disappeared after 45 min of aerobic exercise. Additionally, the pathological microstructure of glomeruli and renal tubules were improved. At the same time, aerobic exercise could also reverse the morphology and structure of arteries and mesenteric artery branches in spontaneously hypertensive rats. Full article

Bright light therapy (BLT) has demonstrated positive short- and long-term effects in people with cognitive impairment or dementia; however, the immediate impact of BLT sessions has been scarcely investigated. In this study, we aimed to explore the immediate effects of BLT on behavior, mood, and physiological parameters (oxygen saturation/heart rate) in a sample of institutionalized older adults with moderate to very severe dementia, with a median age of 85.0 (interquartile range, IQR, 82.0–90.0), being higher in men (87.0 years, IQR 80.0–94.0) than in women (84.5 years, IQR 82.0–89.5). The BLT protocol consisted of 30-min morning sessions of 10,000 lux, Monday through Friday, for 4 weeks. The physiological parameters were recorded immediately before and after each session by pulse oximetry. Mood and behavior were assessed before, after, and during the sessions using the Interact scale. Post-session Interact scores showed a significant decrease in the items Tearful/sad and Talked spontaneously, and a significant increase in the items Enjoying self, active or alert, and Relaxed, content or sleeping appropriately. Interact scores during the sessions reflected a significant decrease in the speech-related items. Both physiological parameters changed positively from before to after sessions. Our results suggest that BLT provides immediate positive effects on mood, stimulation level, and physiological parameters, as well as a trend toward decreased speech. More robust research is needed to further explore the immediate impact of BLT. This study is registered with Clinicaltrials.gov (NCT04949984). Full article

Combined effects of metabolic abnormalities, including metabolic syndrome and obesity, should be identified to screen postmenopausal women at risk of developing cardiovascular diseases. The purpose of this study was to identify the combined effects of metabolic abnormalities and obesity on cardiovascular diseases among postmenopausal Korean women (aged 40–83 years). Data of 5959 postmenopausal women from the Korean National Health and Nutrition Examination Survey (2015–2018) were secondarily analyzed. Using complex simple analysis procedures, logistic regression analysis was performed to identify the combined effect of metabolic abnormalities and obesity on cardiovascular diseases among postmenopausal Korean women. In combination, metabolic syndrome (more than three metabolic abnormalities) and obesity (overweight [≥23 kg/m² and <25 kg/m² in body mass index] and obese [>25 kg/m² in body mass index]) increased the likelihood of developing cardiovascular diseases but combining more than one metabolic abnormality and obesity did not. Combining metabolic syndrome and non-obesity (underweight and normal weight) increased the likelihood of the prevalence of cardiovascular diseases but combining more than one metabolic abnormality and non-obesity did not. Increased cardiovascular diseases in postmenopausal women may be more commonly associated with metabolic syndrome having multiple metabolic abnormalities, but not obesity. Thus, instead of simple weight control, early management of metabolic syndrome is recommended to prevent cardiovascular disease among postmenopausal Korean women. Full article

Background: We aimed to determine a cut-off value for physical activity (PA), measured using an accelerometer, between patients with knee osteoarthritis (OA) who decided to undergo total knee arthroplasty (TKA) and those who continued conservative treatment. Methods: Forty-two participants were assigned to either a TKA group or a non-TKA group (21 per group). They were instructed to wear an accelerometer throughout the day. Average daily steps (steps/day), average daily time of light PA (LPA) (min/day), and average daily time of moderate-to-vigorous PA (MVPA) (min/day) were measured for seven days. Variables between the two groups were compared using univariate analyses, and then a stepwise logistic regression was conducted to determine which variables best correlated with undergoing TKA. The PA cut-offs were analysed using the receiver operating characteristic curve. Results: Pain severity (p = 0.002), KL grade (p = 0.001), and MVPA (p = 0.012) differed significantly between the groups. The most useful cut-off value was 5.84 (min/day) for MVPA (AUC = 0.773), although only pain severity and KL grade were found to be significant contributors to undergoing TKA. Conclusions: Our results revealed there was a significant decrease in PA levels (MVPA cut-off, 5–6 min/day) in the TKA group compared with the non-TKA group. Full article

Chimeric antigen receptor and T-cell receptor (CAR-T/TCR-T) cellular immunotherapies have shown remarkable success in the treatment of some refractory B-cell malignancies, with potential to provide durable clinical response for other types of cancer. In this paper, we look at all available FDA CAR-T/TCR-T clinical trials for the treatment of cancer, and analyze them with respect to different disease tissues, targeted antigens, products, and originator locations. We found that 627 of 1007 registered are currently active and of those 273 (44%) originated in China and 280 (45%) in the US. Our analysis suggests that the rapid increase in the number of clinical trials is driven by the development of different CAR-T products that use a similar therapeutic approach. We coin the term bioparallels to describe such products. Our results suggest that one feature of the CAR-T/TCR-T industry may be a robust response to success and failure of competitor products. Full article

Despite campaigns to increase public awareness of stroke symptoms by advocating FAST (Face-Arms-Speech-Time), some stroke patients still show delays in the recognition of and response to stroke symptoms and miss the golden first 4.5 h to receive rt-PA (recombinant tissue plasminogen activator) treatment. The aim of this study was to explore how acute ischemic stroke patients with prehospital delay seek help and undergo the decision process before arriving at the hospital. A qualitative approach using a grounded theory was applied. There were 24 ischemic stroke patients recruited by purposive sampling. Our main findings were: “Hesitating and puzzling” was the core category to describe and guide the process of acute ischemic stroke patients with prehospital delay. During the process, “Awareness the sudden change of physical sensation and/or function” was the antecedent category. In the prehospital delay experience, the following five interaction categories were identified: (1) “Self-judgment and interpretation according to previous experience,” (2) “Puzzling and doubting—it may only be a minor problem,” (3) “Self-treatment or seeking medical attention nearby,” (4) “Unexpected symptoms getting worse” needing immediate advanced medical help and (5) “Rushing to ER with different transportation—self-alerting that serious disease is coming.” Eventually, the patients “Regret to delay seeking treatment and become a disable person.” The process of prehospital delay provides some hidden cues for patients to increase their knowledge about strokes. The study emphasizes the importance of educating community residents about identifying stroke symptoms, breaking the myth of folk therapy, and seeking medical attention immediately. These results will assist healthcare providers by offering references for designing patient-centric educational strategies for preventing stroke prehospital delay to improve the quality of stroke medical care. Full article

Partnerships are an important mechanism to tackle complex problems that extend beyond traditional organizational divides. Partnerships are widely endorsed, but there is a need to strengthen the evidence base relating to claims of their effectiveness. This article presents findings from a mixed methods study conducted with the aim of understanding partnership processes and how various partnership factors contribute to partnership effectiveness. The study involved five multi-stakeholder partnerships in Canada and Australia working towards improving accessibility to primary health care for vulnerable populations. Qualitative data were collected through the observation of 14 partnership meetings and individual semi-structured interviews (n = 16) and informed the adaptation of an existing Partnership Self-Assessment Tool. The instrument was administered to five partnerships (n = 54). The results highlight partnership complexity and the dynamic and contingent nature of partnership processes. Synergistic action among multiple stakeholders was achieved through enabling processes at the interpersonal, operational and system levels. Synergy was associated with partnership leadership, administration and management, decision-making, the ability of partnerships to optimize the involvement of partners and the sufficiency of non-financial resources. The Partnership Synergy framework was useful in assessing the intermediate outcomes of ongoing partnerships when it was too early to assess the achievement of long-term intended outcomes. Full article