Healthcare

2024

Jump to: 2023, 2022, 2021

15 pages, 997 KiB

Open AccessArticle

The Interrelationship of Benefit Finding, Demoralization, and Stigma among Patients with Parkinson’s Disease and Their Caregivers

by Pei-Chien Chou, Yu Lee, Yung-Yee Chang, Chi-Fa Hung, Ying-Fa Chen, Tsu-Kung Lin, Fu-Yuan Shih, Wu-Fu Chen, Pao-Yen Lin, Mian-Yoon Chong and Liang-Jen Wang

Healthcare 2024, 12(9), 878; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare12090878 - 23 Apr 2024

Viewed by 495

Abstract

Parkinson’s disease (PD) is a debilitating neurodegenerative disease with a relentlessly progressive course of illness. This study aimed to assess the dyadic dynamics of benefit finding (BF), demoralization, and stigma on the depression severity of PD patients and their caregivers. This study used [...] Read more.

Parkinson’s disease (PD) is a debilitating neurodegenerative disease with a relentlessly progressive course of illness. This study aimed to assess the dyadic dynamics of benefit finding (BF), demoralization, and stigma on the depression severity of PD patients and their caregivers. This study used a cross-sectional design with purposive sampling. In total, 120 PD patients and 120 caregivers were recruited from the neurological ward or neurological outpatient clinic of a medical center in Taiwan from October 2021 to September 2022. PD patients and their caregivers were enrolled and assessed using the Mini International Neuropsychiatric Interview, the Benefit Finding scale, Demoralization Scale, Stigma Subscale of the Explanatory Model Interview Catalogue, and Taiwanese Depression Questionnaire. Among the 120 patients and 120 caregivers that successfully completed the study, 41.7% (N = 50) and 60% (N = 72) were female, respectively. The most common psychiatric diagnoses of both the PD patients (17.5%) and their caregivers (13.3%) were depressive disorders. Using structural equation modeling, we found that the stigma, BF, and demoralization of PD patients might contribute to their depression severity. Demoralization and stigma of PD patients’ caregivers might also contribute to the depression severity of PD patients. Caregivers’ BF and demoralization were significantly linked with their depression severity. PD patients’ BF degree and their caregivers’ BF degree had significant interactive effects. Both patients’ and their caregivers’ stigma levels had significant interactive effects. Clinicians should be aware of and manage these contributing factors between PD patients and their caregivers in order to prevent them from exacerbating each other’s depression. Full article

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13 pages, 692 KiB

Open AccessArticle

Prevalence and Risk Factors for Renal Insufficiency among Adults Living with HIV in Tanzania: Results from a Cross-Sectional Study in 2020–2021

by Theresia A. Ottaru, Gideon P. Kwesigabo, Zeeshan Butt, Matthew Caputo, Pilly Chillo, Hellen Siril, Lisa R. Hirschhorn and Claudia Hawkins

Healthcare 2024, 12(6), 657; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare12060657 - 14 Mar 2024

Viewed by 657

Abstract

With improved survival, adults living with HIV (ALHIV) are increasingly likely to experience age-related and HIV-related comorbidities, including renal insufficiency. Other risk factors for renal insufficiency (high blood pressure (BP), obesity, diabetes, and dyslipidemia) are also growing more common among ALHIV. To determine [...] Read more.

With improved survival, adults living with HIV (ALHIV) are increasingly likely to experience age-related and HIV-related comorbidities, including renal insufficiency. Other risk factors for renal insufficiency (high blood pressure (BP), obesity, diabetes, and dyslipidemia) are also growing more common among ALHIV. To determine the prevalence of renal insufficiency (defined as an eGFR < 60 mL/min/1.73 m²) and factors associated with reduced eGFR, we conducted a cross-sectional study at six HIV clinics in Dar-es-Salaam, Tanzania. We applied multivariable (MV) ordinal logistic regression models to identify factors associated with reduced eGFR and examined the interaction of age with BP levels. Among the 450 ALHIV on ART analyzed [26% males; median age 43 (IQR: 18–72) years; 89% on tenofovir-containing ART; 88% HIV viral load ≤50 copies/mL], 34 (7.5%) had renal insufficiency. Prevalence was higher among males (12%) vs. females (6%), p = 0.03; ALHIV ≥50 (21%) vs. <50 years (2.5%), p < 0.001; those with high [≥130/80 mmHg (15%)] vs. normal [<120/80 mmHg (4%)] BP, p < 0.01 and those with dyslipidemia (10%) vs. those without (4.5%), p < 0.03. After adjusting for covariates, age (in years) was the only covariate with a statistically significant association with reduced eGFR (OR = 1.09 (1.07–1.12), p < 0.001). No significant interaction between age and BP was found. Interventions to increase routine screening for renal insufficiency, especially among older ALHIV, and improve BP control are critical to reducing kidney disease-related morbidity and mortality. Full article

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15 pages, 654 KiB

Open AccessReview

Living with Multimorbidity through Time: A Meta-Synthesis of Qualitative Longitudinal Evidence

by Cheng Cheng and Martin Christensen

Healthcare 2024, 12(4), 446; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare12040446 - 09 Feb 2024

Viewed by 775

Abstract

The growing prevalence of multimorbidity places a strain on primary healthcare globally. The current study’s aim was to identify, appraise, and synthesize published qualitative longitudinal research on individuals’ experiences concerning living with multimorbidity through time. The authors searched two electronic databases, MEDLINE and [...] Read more.

The growing prevalence of multimorbidity places a strain on primary healthcare globally. The current study’s aim was to identify, appraise, and synthesize published qualitative longitudinal research on individuals’ experiences concerning living with multimorbidity through time. The authors searched two electronic databases, MEDLINE and CINAHL, and performed an additional literature search in Google Scholar. A thematic synthesis approach was used to analyze the qualitative data across the studies. A total of 10 reports that met the inclusion and exclusion criteria were included in the synthesis. Five descriptive themes emerged from the analysis of the living experiences of individuals with multimorbidity: (1) perceiving multimorbidity, (2) managing chronic conditions, (3) emotional struggles in everyday life with multimorbidity, (4) interactions with the healthcare system and healthcare professionals, and (5) family support. This meta-synthesis provides insights into the diverse perceptions of multimorbidity and how individuals cope with their chronic conditions in their daily lives. The findings highlight the importance of establishing effective patient-centered care that acknowledges and supports the multifaceted needs of this population. It is also recommended to involve a psychological component in the care of individuals with multimorbidity, as part of a collaborative and interprofessional approach. Full article

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2023

Jump to: 2024, 2022, 2021

14 pages, 1461 KiB

Open AccessArticle

Association of Self-Reported Sleep Characteristics and Hip Fracture: Observational and Mendelian Randomization Studies

by Yan-Fei Wang, Yu-Feng Luo, Asmi Mhalgi, Wen-Yan Ren and Long-Fei Wu

Healthcare 2023, 11(7), 926; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare11070926 - 23 Mar 2023

Viewed by 1681

Abstract

Previous observational studies on the relationship between sleep characteristics and fracture have yielded contradictory results. The goal of this study was to replicate the findings in a large longitudinal cohort and then conduct a Mendelian randomization (MR) analysis to infer the causality between [...] Read more.

Previous observational studies on the relationship between sleep characteristics and fracture have yielded contradictory results. The goal of this study was to replicate the findings in a large longitudinal cohort and then conduct a Mendelian randomization (MR) analysis to infer the causality between sleep behaviors and fracture risk. Based on data from the China Health and Retirement Longitudinal Study (CHARLS) including 17,708 participants, we found that individuals with short sleep duration (<5 h) (OR [odds ratio] = 1.62, 95% CI: 1.07–2.44) or restless sleep (OR = 1.55, 95% CI: 1.10–2.19) have a higher risk of hip fracture. A U-shaped relationship between nighttime sleep duration and hip fracture risk (p-nonlinear = 0.01) was observed using restricted cubic spline regression analysis. Through joint effect analysis, we found that participants with short sleep duration (<5 h) combined with midday napping could significantly decrease hip fracture incidence. We further inferred the causal relationship between self-reported sleep behaviors and hip fracture using the MR approach. Among four sleep phenotypic parameters (sleep duration, daytime napping, chronotype, and insomnia), we found a modest causal relationship between sleep duration and fracture (OR = 0.69, 95% CI: 0.48 to 0.99, p = 0.04). However, no causal relationship was observed for other sleep traits. In conclusion, our findings suggest that short sleep duration has a potential detrimental effect on hip fracture. Improving sleep patterns is of significance for developing hip fracture preventive strategies in the middle-aged and the elderly populations. Full article

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10 pages, 745 KiB

Open AccessArticle

Factors Influencing the Use of Walking Aids by Frail Elderly People in Senior Day Care Centers

by Yuya Sakano, Shin Murata, Akio Goda and Hideki Nakano

Healthcare 2023, 11(6), 858; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare11060858 - 14 Mar 2023

Viewed by 1734

Abstract

Background: Senior day care centers in Japan are the most commonly used insurance service for frail elderly people, and it is important to examine the factors that influence the use of walking aids at these centers. We aimed to investigate the factors affecting [...] Read more.

Background: Senior day care centers in Japan are the most commonly used insurance service for frail elderly people, and it is important to examine the factors that influence the use of walking aids at these centers. We aimed to investigate the factors affecting the use of walking aids by frail elderly patients in senior daycare centers. Methods: A total of 131 frail elderly people (mean age 82.7 ± 6.4 years) formed our study population. They were divided into two groups: solo walking (n = 87) and walking aid (n = 44). Individuals with cognitive decline were excluded. All participants were assessed using Functional Independence Measure Motor (FIM-M) sub-scores. Grip strength, knee extension strength, the 10 s Chair Stand test for Frail elderly (Frail CS-10), Single Leg Standing (SLS), and Timed Up and Go (TUG) tests were measured and compared between the two groups. Results: The walking aid group scored significantly lower than the solo walking group for five items: FIM-M, knee extension muscle strength, Frail CS-10, SLS, and TUG (p < 0.05). Logistic regression analysis revealed that knee extension muscle strength was the only factor that affected the use or disuse of walking aids (p < 0.05). The cut-off value of the knee extensor muscle strength-to-weight ratio for walking alone was 28.5%. Conclusions: Knee extensor muscle strength was the most important factor in determining the use of a walking aid. Full article

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9 pages, 277 KiB

Open AccessArticle

Determination of Foetal Scalp Blood Sampling pH as an Indicator of Loss of Foetal Well-Being in Women Undergoing Caesarean Section

by Raquel Alarcón-Rodríguez, María Paz Martín-Álvarez, Jessica García-González, Mar Requena-Mullor, Mª Carmen Rodríguez-García, Ruirui Zheng and Raúl Romero-del Rey

Healthcare 2023, 11(5), 725; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare11050725 - 02 Mar 2023

Viewed by 1479

Abstract

Asphyxia during birth is one of the three leading causes of neonatal morbidity and mortality among newborns carried to term. The objective of this study was to evaluate the measurement of the foetal scalp blood pH as a measure of foetal status, evaluating: [...] Read more.

Asphyxia during birth is one of the three leading causes of neonatal morbidity and mortality among newborns carried to term. The objective of this study was to evaluate the measurement of the foetal scalp blood pH as a measure of foetal status, evaluating: cord gases, meconium-stained fluid, APGAR score or the need for neonatal resuscitation in pregnant women undergoing caesarean sections. A cross-sectional study was carried out over a period of 5 years (2017–2021) at the Hospital de Poniente (southern Spain). A total of 127 pregnant women participated from whom a foetal scalp blood pH sample was taken and used to indicate the need for an urgent caesarean section. The results showed a correlation between the pH of the scalp blood and the pH of the umbilical cord artery, umbilical cord vein (Rho of Spearman arterial pH: 0.64, p < 0.001; Rho of Spearman venous pH: 0.58, p < 0.001) and the APGAR test one minute after delivery (Spearman’s Rho coefficient of 0.33, p < 0.01). These results suggest that the foetal scalp pH should not be considered a foolproof method to indicate an urgent caesarean section. Foetal scalp pH sampling can be used as a complementary test, in conjunction with cardiotocography, to indicate whether an emergency caesarean section is necessary due to loss of foetal well-being. Full article

2022

Jump to: 2024, 2023, 2021

11 pages, 294 KiB

Open AccessArticle

The Impact of COVID-19 on the Monitoring of Pregnancy and Delivery of Pregnant Women in the Dominican Republic

by Mar Requena-Mullor, Jessica García-González, Ruqiong Wei, Raúl Romero-del Rey and Raquel Alarcón-Rodríguez

Healthcare 2022, 10(11), 2266; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10112266 - 11 Nov 2022

Cited by 7 | Viewed by 1574

Abstract

Pregnancy monitoring is vital to guaranteeing that both the foetus and the mother are in optimal health conditions. WHO protocols recommend at least eight medical examinations during the pregnancy period. While the cancellation or reduction of appointments during pregnancy due to the pandemic [...] Read more.

Pregnancy monitoring is vital to guaranteeing that both the foetus and the mother are in optimal health conditions. WHO protocols recommend at least eight medical examinations during the pregnancy period. While the cancellation or reduction of appointments during pregnancy due to the pandemic may help reduce the risk of infection, it could also negatively influence perinatal outcomes and the birthing process. The aim of this research was to analyse the differences in perinatal outcomes and birth characteristics in two groups of pregnant women: women who gave birth before and during the pandemic, and whether these differences are due to changes in pregnancy monitoring because of the COVID-19 situation. A retrospective study was carried out from July 2018 to December 2021, at the Santo Domingo Hospital (Dominican Republic). A total of 1109 primiparous pregnant women were recruited for this study during the birthing process and perinatal visits. The results describe how women who gave birth before the pandemic had greater control and monitoring of their pregnancy, more doctor visits (p = 0.001), fewer caesarean sections (p = 0.006), and more skin-to-skin contact after birth (p = 0.02). During the COVID-19 pandemic, pregnant women’s attendance at routine pregnancy monitoring, both doctor visits and ultrasound scans, has decreased, leading to an increase in the number of caesarean and instrumental deliveries. At the perinatal level, processes such as skin-to-skin contact after birth between mother and newborn or the introduction of early breastfeeding in the delivery room have also been reduced. Full article

9 pages, 700 KiB

Open AccessArticle

Gait Characteristics of Dynapenia, Sarcopenia, and Presarcopenia in Community-Dwelling Japanese Older Women: A Cross-Sectional Study

by Kohei Mori, Shin Murata, Akio Goda, Yuki Kikuchi, Kayoko Shiraiwa, Jun Horie and Hideki Nakano

Healthcare 2022, 10(10), 1905; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10101905 - 28 Sep 2022

Cited by 6 | Viewed by 1938

Abstract

Age-related decline in skeletal muscle mass and function are risk factors for reduced walking ability. This study aimed to understand the characteristic gait parameters of presarcopenia (low muscle mass only), dynapenia (low muscle function only), and sarcopenia (low muscle mass and function), which [...] Read more.

Age-related decline in skeletal muscle mass and function are risk factors for reduced walking ability. This study aimed to understand the characteristic gait parameters of presarcopenia (low muscle mass only), dynapenia (low muscle function only), and sarcopenia (low muscle mass and function), which have differing skeletal muscle characteristics. Skeletal muscle mass, grip strength, and gait parameters (walking speed, cadence, step length, step width, gait angle, foot angle, stance time, swing time, and double stance time) were evaluated in 307 older Japanese women. Low muscle function was determined by grip strength and normal walking speed. Participants were assessed and divided into the normal (60.9%, n = 187), presarcopenia (25.7%, n = 79), dynapenia (5.2%, n = 16), and sarcopenia (8.1%, n = 25) groups. When compared to the normal group, the sarcopenia group had significantly slower walking speed and shorter step length (p < 0.05); the dynapenia group had significantly slower walking speed, smaller cadence, shorter step length, wider step width, and longer stance time (p < 0.05); and the presarcopenia group showed no differences. Skeletal muscle function may therefore be more strongly related to reduced walking function in older adults than body composition factors. The decrease in walking function was most pronounced in older women with dynapenia. Full article

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10 pages, 265 KiB

Open AccessArticle

A Cross-Sectional Assessment of Complementary and Alternative Medicine (CAM) Use among Patients with Chronic Diseases (CDs) in Qassim, Saudi Arabia

by Maryam Farooqui, Hanan Alreshidi, Jana Alkheraiji, Suhaj Abdulsalim, Mohammed Salem Alshammari, Lamyaa Kassem, Samah Hussein and Wan Ismahanisa Ismail

Healthcare 2022, 10(9), 1728; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10091728 - 08 Sep 2022

Cited by 7 | Viewed by 1966

Abstract

This study aims to investigate CAM use among CD patients from Qassim, Saudi Arabia and to compare CAM practice with different demographic and disease characteristics of the participants. A cross-sectional study was conducted among CD patients. During the three-months of data collection period, [...] Read more.

This study aims to investigate CAM use among CD patients from Qassim, Saudi Arabia and to compare CAM practice with different demographic and disease characteristics of the participants. A cross-sectional study was conducted among CD patients. During the three-months of data collection period, a total of 377 patients were approached and 208 patients participated in the study, giving a response rate of 55.17%. A p value of <0.05 was considered as significant. Among the study population, 94 (45.2%) patients were CAM users. Diabetes mellitus patients were the majority (48 (51.06%)) followed by hypertensive patients (34 (36.17%)). Spiritual therapies were the most common CAM followed by herbal products. Among CAM users, 41 (19.7%) patients reported disclosing CAM use to their health care providers. Among all the sociodemographic variables, gender (p = 0.029), marital status (p = 0.034) and education level (p = 0.047) were significantly associated with CAM use. In conclusion, the use of CAM among CD patients was relatively high in Qassim. Patients reported using CAM without disclosing to their health care providers which is a major health risk. It is critical to counsel CD patients regarding rational and informed CAM use in order to prevent harmful and unwanted effects. Full article

10 pages, 892 KiB

Open AccessArticle

Effects of Extensor Digitorum Longus and Tibialis Anterior Taping on Balance and Gait Performance in Patients Post Stroke

by Kyun-Hee Cho and Shin-Jun Park

Healthcare 2022, 10(9), 1692; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10091692 - 05 Sep 2022

Cited by 2 | Viewed by 6762

Abstract

The purpose of this study was to investigate the effects of extensor digitorum longus taping (EDLT) and tibialis anterior taping (TAT) on balance and gait performance in patients post-stroke. The study included 40 stroke patients randomly assigned to two intervention groups: the EDLT [...] Read more.

The purpose of this study was to investigate the effects of extensor digitorum longus taping (EDLT) and tibialis anterior taping (TAT) on balance and gait performance in patients post-stroke. The study included 40 stroke patients randomly assigned to two intervention groups: the EDLT group and the TAT group. Therapeutic taping was applied to the extensor digitorum in the EDLT group and applied to the tibialis anterior in the TAT group. Balance variables were measured using BioRescue equipment, and gait variables were measured using G-walk equipment. Balance and gait variables were significantly increased in both the EDLT and TAT groups after the intervention, but there were no significant differences between the two groups. Therefore, we concluded that eversion (EDLT) or inversion (TAT) through taping did not affect the outcome. Only dorsiflexion affects gait speed increase post-stroke. As a result of this study, extensor digitorum longus taping and tibialis anterior taping were taping methods with no difference in the improvement of balance ability and gait performance. Full article

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9 pages, 251 KiB

Open AccessArticle

Care Dependency of Hospitalized Stroke Patients Based on Family Caregivers’ and Nurses’ Assessments: A Comparative Study

by Nursiswati Nursiswati, Ruud J. G. Halfens and Christa Lohrmann

Healthcare 2022, 10(6), 1007; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10061007 - 30 May 2022

Cited by 2 | Viewed by 1881

Abstract

Stroke impacts care dependency, and thus the patient needs home care after suffering a stroke. This study was carried out to investigate similarities and differences between the assessments made by family caregivers and nurses regarding the care dependency level of stroke patients in [...] Read more.

Stroke impacts care dependency, and thus the patient needs home care after suffering a stroke. This study was carried out to investigate similarities and differences between the assessments made by family caregivers and nurses regarding the care dependency level of stroke patients in Indonesian hospitals. This study was a comparative study of the care dependency of stroke patients. Data were collected on the stroke wards on the day of admission using the Care Dependency Scale (CDS). The sample consisted of 118 family caregivers and 21 nurses. The Wilcoxon signed-rank test was performed to determine the mean differences between the paired data collected by family caregivers and nurses. The results of this study show that significant differences exist between the family caregivers’ and nurses’ assessments regarding the care dependency levels of stroke patients. Nurses assigned higher scores to all CDS items than family caregivers did. Significant differences between the family caregivers’ and nurses’ assessments were observed on numerous items of the Care Dependency Scale. This study contributes to efforts to raise awareness of potential differences in perceived care dependency levels of stroke patients. The findings can help nurses plan the patient’s discharge together with family caregivers. Full article

8 pages, 932 KiB

Open AccessArticle

Appropriate Needle Length Determined by Ultrasonic Echography for Intramuscular Injection in Japanese Elderly over 50 Years

by Tetsuo Nakayama, Hisakuni Sekino, Hirokazu Aihara and Minoru Kino

Healthcare 2022, 10(5), 800; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10050800 - 25 Apr 2022

Cited by 1 | Viewed by 1783

Abstract

Adjuvanted vaccines are administered through intramuscular injection. To perform appropriate injection using an appropriate needle in different age groups or different daily living activities, we investigated the depth from the skin surface to muscle fascia and bone in the deltoid muscle area in [...] Read more.

Adjuvanted vaccines are administered through intramuscular injection. To perform appropriate injection using an appropriate needle in different age groups or different daily living activities, we investigated the depth from the skin surface to muscle fascia and bone in the deltoid muscle area in 156 elderly aged ≥ 50 years by ultrasonic echography. Subjects consisted of 50 healthy elderly aged 50–64 years, 50 subjects aged 65–74 years, and 56 subjects aged ≥ 75 years (20 outpatients, 18 who needed nursing care, and 18 bedridden in a nursing home). The mean depth ± 1.0 SD from the skin surface to muscle fascia was 7.52 ± 2.13 mm for subjects aged ≥ 75 years, being shorter than 9.16 ± 3.02 mm in those aged 50–64years (p < 0.01). The depth from the skin surface to bone was 22.54 ± 3.85 mm for subjects aged ≥ 75 years and 25.41 ± 4.24 mm for those aged 65–74 years, significantly shorter than those aged 50–64 years (p < 0.01), depending on the reduced muscle volume. The subcutaneous volume length was greater in females (8.29 ± 2.63 mm) than in males (5.62 ± 2.80 mm) aged 50–64 years (p < 0.01). A similar result was obtained in those aged 65–74 years, but there was no difference in the muscle volume length. Our study found that a five-eighths of an inch (16 mm) needle was an appropriate length for average-sized elderly aged ≥ 50 years, but it should be longer for those with large body sizes. Full article

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10 pages, 464 KiB

Open AccessArticle

Effects of Changes in Multiple Chronic Conditions on Medical Costs among Older Adults in South Korea

by Soojin Park and Jin Young Nam

Healthcare 2022, 10(4), 742; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10040742 - 15 Apr 2022

Cited by 2 | Viewed by 1722

Abstract

This study aims to analyze the relationship between cognitive function and out-of-pocket cost of the state change of multiple chronic conditions in individuals aged 60 or older. Data from the 2014 to 2018 Korean Longitudinal Study of Aging were used for 2202 older [...] Read more.

This study aims to analyze the relationship between cognitive function and out-of-pocket cost of the state change of multiple chronic conditions in individuals aged 60 or older. Data from the 2014 to 2018 Korean Longitudinal Study of Aging were used for 2202 older adults who were cognitively “normal” at the start of the survey. Four status change groups were established (“Good → Good,” “Good → Bad,” “Bad → Good,” and “Bad → Bad”) according to the change in the number of chronic diseases. Generalized estimating equation modeling analyzed the association between these changes and out-of-pocket medical cost. Out-of-pocket cost was significantly higher among older adults with multiple chronic conditions (p < 0.0001). Total out-of-pocket medical cost and out-of-pocket cost for outpatient care and prescription drugs were significantly higher for Bad→ Bad or Good → Bad changes. Older adults with cognitive decline had significantly higher total out-of-pocket medical cost and out-of-pocket cost for prescription drugs. This study demonstrates the need to improve the multiple chronic conditions management construction model to enhance the health of older adults in Korea and secure national health care finances long-term. It provides a foundation for related medical and medical expenses-related systems. Full article

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9 pages, 2371 KiB

Open AccessArticle

Two-Month Individually Supervised Exercise Therapy Improves Walking Speed, Step Length, and Temporal Gait Symmetry in Chronic Stroke Patients: A before–after Trial

by Kiyoshi Yoshioka, Tatsunori Watanabe, Norikazu Maruyama, Mizuki Yoshioka, Keita Iino, Kimikazu Honda and Koshiro Hayashida

Healthcare 2022, 10(3), 527; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10030527 - 14 Mar 2022

Cited by 2 | Viewed by 2234

Abstract

Gait asymmetry is common after stroke and is a major risk factor for falls. In particular, temporal gait asymmetry often remains in the chronic stage of stroke. However, health insurance does not cover rehabilitation for patients with chronic stroke in many countries. Accordingly, [...] Read more.

Gait asymmetry is common after stroke and is a major risk factor for falls. In particular, temporal gait asymmetry often remains in the chronic stage of stroke. However, health insurance does not cover rehabilitation for patients with chronic stroke in many countries. Accordingly, it is undetermined whether individually supervised exercise therapy has beneficial effects on chronic hemiparetic gait. Patients with stroke (n = 25) more than 6 months after onset performed 70 min of individually supervised exercise twice weekly for 2 months in 16 sessions with qualified personnel. The intervention significantly reduced the pre-swing phase on the paretic side (mean = 91.8%, 95%CI, 84.8–98.8). In addition, there was a significant improvement in pre-swing phase symmetry in those with great asymmetry prior to the intervention (p = 0.022). Step length significantly increased after the intervention on both sides (non-paretic, p = 0.029; paretic, p = 0.0055). Walking time at both comfortable and maximum speeds was significantly shortened (comfortable, p = 0.0041; maximum, p < 0.0001). Our findings suggest that there remains scope to improve gait ability with individually supervised exercise therapy in patients with chronic stroke, whose functional recovery is often considered unlikely. This type of intervention may be a simple and effective option to improve gait parameters, including temporal asymmetry, even in patients with chronic stroke. Full article

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11 pages, 594 KiB

Open AccessArticle

New-Onset Atrial Fibrillation Is a Risk Factor of Ischemic Stroke in Chronic Obstructive Pulmonary Disease

by Chi-Chun Liu, Yu-Hsuan Chen, Yin-Han Chang, Wu-Chien Chien, Hui-Chen Lin, Chun-Gu Cheng and Chun-An Cheng

Healthcare 2022, 10(2), 381; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10020381 - 17 Feb 2022

Cited by 3 | Viewed by 1889

Abstract

Chronic obstructive pulmonary disease (COPD) induces atrial fibrillation (AF) and stroke, and COPD with AF increased ischemic stroke (IS) in a cross-sectional study. Therefore, healthcare providers must be concerned and well-informed about this particular situation. For this study, inpatient data were obtained from [...] Read more.

Chronic obstructive pulmonary disease (COPD) induces atrial fibrillation (AF) and stroke, and COPD with AF increased ischemic stroke (IS) in a cross-sectional study. Therefore, healthcare providers must be concerned and well-informed about this particular situation. For this study, inpatient data were obtained from the Taiwan National Health Insurance Database in 2010. We identified patients who were hospitalized with COPD (International Classification of Disease, Ninth Revision, Clinical Modification [ICD-9-CM] is 491, 492, and 496). Patients who experienced AF (ICD-9-CM to 427.3) during the same admission or after COPD hospitalization were discharged and defined as new-onset AF. The outcome was IS (ICD-9-CM as 433–437). The factors related to IS after COPD were used for multivariate logistic regression. There were 4177/62,163 (6.72%) patients with incident IS. The risk of IS after COPD hospitalization was shown to have an adjusted odds ratio of 1.749 (95% CI: 1.584–1.93, p < 0.001) for patients with new-onset AF. Other factors included advanced age, atherosclerosis factors, comorbidity severity, sepsis and lower-level hospital admission. In conclusion, COPD patients suffering from new-onset AF had an increased incidence of IS in the population observation study. New-onset AF was an omit risk factor for IS in COPD in the Chinese population. Full article

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6 pages, 6217 KiB

Open AccessArticle

Home Respiratory Care: Design of a Prototype for Continuous Measurement at the Nasal Septum

by Roshini Narayanan, Evan Bender, Raphael Chernoff, Luis Mendoza, Samuel Bernstein, Emma Turner, Stephen Mathai and Constanza Miranda

Healthcare 2022, 10(2), 318; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10020318 - 08 Feb 2022

Viewed by 1977

Abstract

Chronic respiratory diseases have been on the rise, especially due to COVID-19, extreme air pollution, and other external circumstances. Millions of people around the world suffer from progressive lung diseases and require supplemental oxygen therapy to maintain blood oxygen (SpO2) levels above 90% [...] Read more.

Chronic respiratory diseases have been on the rise, especially due to COVID-19, extreme air pollution, and other external circumstances. Millions of people around the world suffer from progressive lung diseases and require supplemental oxygen therapy to maintain blood oxygen (SpO2) levels above 90% to prevent hypoxic episodes that can lead to further organ damage. Today, these chronic episodes are more prevalent in aging populations suffering from Chronic Obstructive Pulmonary Disorder (COPD). Existing SpO2 measurement equipment, designed to assist with treating COPD at home, are suboptimal as they cannot measure SpO2 levels continuously, meaning supplemental oxygen devices are unable to adjust oxygen flow rates to the patient’s needs. These discrepancies can result in hypoxic episodes of blood oxygen levels below 90%. Following this need, our team demonstrates preliminary results of the novel placement of a SpO2 sensor in the nasal septum to allow for comfortable and sustained SpO2 measurement. This will improve the experience of home-respiratory care with continuously obtained data from a novel location. Full article

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16 pages, 1815 KiB

Open AccessArticle

Emotional Intelligence as a Predictor of Prosocial Behaviors in Spanish and Colombian Older Adults Based on Path Models

by Manuel Martí-Vilar, Carlos Andrés Trejos-Gil and Juan Diego Betancur-Arias

Healthcare 2022, 10(2), 284; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10020284 - 01 Feb 2022

Cited by 5 | Viewed by 2533

Abstract

Emotional intelligence (EI), empathy, and prosocial behavior (PB) are widely studied in the early stages of life, up to adolescence. However, there have been few studies in older adults. Using a multivariate methodology, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were [...] Read more.

Emotional intelligence (EI), empathy, and prosocial behavior (PB) are widely studied in the early stages of life, up to adolescence. However, there have been few studies in older adults. Using a multivariate methodology, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were applied with structural equation models (SEM) in 271 older adults in Colombia, along with a Spanish sample made up of 139 adults over 60 years of age, for a total sample of 411 older adults. The results confirmed that EI, as measured with the WLEIS, scale is the best predictor of PB, with excellent adjustment criteria (GFI = 0.99; CFI = 0.98; RMSEA = 0.064; PCLOSE = 0.28; SRMR = 0.023; AIC = 57.30). It is concluded that the path model yielded a reliable predictive explanation of PB, including EI as a key variable that explains prosocial tendencies. Full article

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14 pages, 5390 KiB

Open AccessArticle

Baseline Quality of Life of Physical Function Is Highly Relevant for Overall Survival in Advanced Rectal Cancer

by Tim Fitz, Christopher Sörgel, Sandra Rutzner, Markus Hecht, Rainer Fietkau and Luitpold V. Distel

Healthcare 2022, 10(1), 141; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10010141 - 12 Jan 2022

Cited by 2 | Viewed by 1476

Abstract

In advanced rectal cancer, neoadjuvant radiochemotherapy and total mesorectal excision lead to long overall survival. The quality of life (QOL) of the patients is clearly related to the prognosis. Our question was whether the prognosis can be represented with only one question or [...] Read more.

In advanced rectal cancer, neoadjuvant radiochemotherapy and total mesorectal excision lead to long overall survival. The quality of life (QOL) of the patients is clearly related to the prognosis. Our question was whether the prognosis can be represented with only one question or one score from the QOL questionnaires. 360 consecutively recruited patients diagnosed with advanced rectal cancer were questioned during radiochemotherapy and a follow-up of 8 years. The questionnaires QLQ-C30 and QLQ-CR38 were used; 10 functional and 17 symptom scores were calculated. The functional score “physical function” and the symptom scores “fatigue”, “nausea and vomiting”, “pain” and “appetite loss” were highly prognostic (p < 0.001) for overall survival. “Physical function” was highly prognostic at all time points up to 1 year after starting therapy (p ≤ 0.001). The baseline “physical function” score divided the cohort into a favorable group with an 8-year overall survival rate of 70.4% versus an unfavorable group with 47.5%. In the multivariable analysis, baseline “physical function”, age and distant metastases were independent predictors of overall survival. The score “physical function” is a powerful unrelated risk factor for overall survival in patients with rectal cancer. Future analyses should study whether increased “physical function” after diagnosis could improve survival. Full article

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10 pages, 1180 KiB

Open AccessReview

Prevalence of Frailty in the Middle East: Systematic Review and Meta-Analysis

by Bader A. Alqahtani, Mohammed M. Alshehri, Ragab K. Elnaggar, Saad M. Alsaad, Ahmed A. Alsayer, Noura Almadani, Ahmed Alhowimel, Mohammed Alqahtani and Aqeel M. Alenazi

Healthcare 2022, 10(1), 108; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10010108 - 06 Jan 2022

Cited by 7 | Viewed by 2407

Abstract

(1) We aimed to systematically search available data on the prevalence of frailty among community-dwelling elders in Middle Eastern countries. The results from available studies are cumulated to provide comprehensive evidence for the prevalence of frailty. (2) Methods: A meta-analysis was done. A [...] Read more.

(1) We aimed to systematically search available data on the prevalence of frailty among community-dwelling elders in Middle Eastern countries. The results from available studies are cumulated to provide comprehensive evidence for the prevalence of frailty. (2) Methods: A meta-analysis was done. A literature search was carried out using PRISMA guidelines in PubMed, Web of Science, and SCOPUS websites for studies up to 2020. Inclusion criteria entailed all primary studies conducted in Middle Eastern countries on frailty in community-dwelling older adults aged 60 years and older. (3) Results: A total of 10 studies were selected for this study. Random-effects meta-analysis of nine studies indicated there was a pooled prevalence rate of 0.3924 with a standard error of 0.037. This pooled prevalence point estimate of 0.3924 was statistically significant (p < 0.001). The Egger’s regression test and the trim-fill method for detecting publication bias did not detect any evidence of publication bias in the sample of included studies. The Egger’s regression test was not statistically significant. The trim-fill method indicated zero studies were missing on either side; (4) Conclusions: The study’s findings indicate that the prevalence of frailty is higher in Middle Eastern nations. Despite indications that many of these nations’ populations are rapidly ageing, we presently lack information on the incidence of frailty in these populations; this information is essential to health, policymakers, and social care planning. Full article

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2021

Jump to: 2024, 2023, 2022

10 pages, 370 KiB

Open AccessArticle

Developing Domains and Items about Self-Management among Elderly People with Chronic Disease

by Gain Shin and Hae Yean Park

Healthcare 2022, 10(1), 54; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10010054 - 29 Dec 2021

Cited by 2 | Viewed by 1675

Abstract

Lifestyle is considered as a key factor that affects one’s health and quality of life, and it has become the focus of increasing research interest worldwide. Objectives: We aimed to determine the areas of self-management necessary as part of occupational therapy for elderly [...] Read more.

Lifestyle is considered as a key factor that affects one’s health and quality of life, and it has become the focus of increasing research interest worldwide. Objectives: We aimed to determine the areas of self-management necessary as part of occupational therapy for elderly people suffering from chronic diseases living in local communities, as well as elements to be included in each area. Method: Delphi survey methodology was utilized. Participants answered three surveys, and we derived the mean, standard deviation, and content validity ratios for each domain and item. Results: We derived 13 domains and 68 items about self-management, derived the fit and importance of 1 domain and 23 items, and finally derived 12 domains and 54 items. Conclusion: The program developed using this research can become a systematic and evidence-based intervention and provide an opportunity for self-management to the target population. Full article

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14 pages, 1150 KiB

Open AccessEditor’s ChoiceArticle

Role-Play versus Standardised Patient Simulation for Teaching Interprofessional Communication in Care of the Elderly for Nursing Students

by Alda Elena Cortés-Rodríguez, Pablo Roman, María Mar López-Rodríguez, Isabel María Fernández-Medina, Cayetano Fernández-Sola and José Manuel Hernández-Padilla

Healthcare 2022, 10(1), 46; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10010046 - 27 Dec 2021

Cited by 11 | Viewed by 4696

Abstract

This study aims to describe and compare the effects of standardised patient simulation and role-play in the acquisition and retention of interprofessional communication in elderly care competence amongst nursing students. In this controlled clustered randomised trial, 121 nursing students attended a workshop on [...] Read more.

This study aims to describe and compare the effects of standardised patient simulation and role-play in the acquisition and retention of interprofessional communication in elderly care competence amongst nursing students. In this controlled clustered randomised trial, 121 nursing students attended a workshop on interprofessional communication in elderly care using role-play or standardised patient simulation. The study was conducted between September 2017 and February 2018. Participants’ knowledge, self-efficacy and communication skills were assessed using a simulated scenario at pre-test, post-test and 6-week follow-up points. Between-subject and within-subject differences were measured using counts and proportions of participants who achieved competence. Regardless of the strategy applied, a significant improvement in knowledge, skills, self-efficacy and overall interprofessional communication competence was found between pre-test and post-test. Moreover, there were significant differences between pre-test and follow-up for all the studied variables, but no differences were found between post-test and follow-up. Lastly, when comparing the success rates of both strategies, no significant differences were observed (p > 0.05). In conclusion, standardised patient simulation and role-play have been shown to promote an improvement on knowledge, self-efficacy and interprofessional communication skills in nursing students, although it is not possible to state which strategy is the most adequate for teaching this competency. Full article

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11 pages, 262 KiB

Open AccessArticle

The Experiences of Home Care Nurses in Regard to the Care of Vulnerable Populations: A Qualitative Study

by Isabel María Fernández-Medina, María Dolores Ruíz-Fernández, Felisa Gálvez-Ramírez, Evangelina Martínez-Mengíbar, Manuel Eduardo Ruíz-García, María del Mar Jiménez-Lasserrotte, Ángela María Ortega-Galán and José Manuel Hernández-Padilla

Healthcare 2022, 10(1), 21; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare10010021 - 23 Dec 2021

Cited by 4 | Viewed by 3064

Abstract

Home care nurses have become the main references in home care for vulnerable patients. In patients’ homes they offer comprehensive and continuous care to both the vulnerable population and their families. The aim of this qualitative study was to explore experiences and perspectives [...] Read more.

Home care nurses have become the main references in home care for vulnerable patients. In patients’ homes they offer comprehensive and continuous care to both the vulnerable population and their families. The aim of this qualitative study was to explore experiences and perspectives of home care nurses regarding the care of vulnerable patients in Spain. We conducted in-depth semi-structured interviews with 15 home care nurses working with a vulnerable population. From a data analysis, two themes and four subthemes emerged: (1) “barriers to providing home care to vulnerable populations”, with the following subthemes: “the particularities of the patient and their home caregivers” and “perceived barriers for the involvement of home care nurses in the care”; and (2) “the emotional cost of home care” with the subthemes “home care is draining for caregivers” and “the impact of home care on the home care nurses”. These findings show us that nurses face a number of difficulties in home care for vulnerable patients. The training of nurses in certain competencies and skills by the social health services would enhance the quality of care offered to these patients. Full article

15 pages, 301 KiB

Open AccessArticle

Experience of Primary Care Nurses of Sexuality Care for Persons with Disabilities: A Qualitative Study

by Karim El-Marbouhe-El-Faqyr, María del Mar Jiménez-Lasserrotte, Isabel María Fernández-Medina, Cayetano Fernández-Sola, José Manuel Hernández-Padilla and Laura Helena Antequera-Raynal

Healthcare 2021, 9(12), 1711; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9121711 - 09 Dec 2021

Viewed by 2211

Abstract

(1) Background: Disability is a dynamic interaction between a person’s health conditions and personal and environmental factors. Disability is an evolving concept, which can be improved by intervening in the barriers that prevent disabled people from functioning in their daily life and enjoying [...] Read more.

(1) Background: Disability is a dynamic interaction between a person’s health conditions and personal and environmental factors. Disability is an evolving concept, which can be improved by intervening in the barriers that prevent disabled people from functioning in their daily life and enjoying a satisfactory sexual life. Sexuality is an important dimension of life that affects people’s well-being. The aim was to describe and understand the experiences of primary care nurses regarding care for the sexuality of persons with disabilities. (2) Methods: A descriptive qualitative study was designed. Twenty-one in-depth interviews were conducted with nurses. A thematic analysis was used to analyse the data. (3) Results: three main themes emerged: (1) Initial assessment of the patient: competencies for a nurse-patient therapeutic relationship; (2) A comprehensive approach to nursing care for persons with disabilities: the importance of sexuality; and (3) Sex counselling in nursing consultations. (4) Conclusions: Nurses have the skills to develop a good therapeutic relationship with patients. Planning of nursing interventions is required in order to promote individual coping, emotional support, and sex education. Sex counselling is essential to promote autonomy, with the figure of the sex therapist emerging for this purpose. Full article

16 pages, 633 KiB

Open AccessArticle

Resilience as a Mediator of the Association between Spirituality and Self-Management among Older People with Chronic Obstructive Pulmonary Disease

by Zhongyi Chen, Yuyu Jiang, Mengjie Chen, Nuerdawulieti Baiyila and Jiang Nan

Healthcare 2021, 9(12), 1631; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9121631 - 25 Nov 2021

Cited by 9 | Viewed by 2607

Abstract

This study examined the mediating effect of resilience in the relationship between spirituality and self-management among older people with chronic obstructive pulmonary disease (COPD). The participants were 151 older people with COPD in four general hospitals in Jiangsu Province, China. Data were collected [...] Read more.

This study examined the mediating effect of resilience in the relationship between spirituality and self-management among older people with chronic obstructive pulmonary disease (COPD). The participants were 151 older people with COPD in four general hospitals in Jiangsu Province, China. Data were collected from September 2020 to May 2021 using a questionnaire developed by the investigator, the Function Assessment of Chronic Illness Therapy-Spiritual Scale (FACIT-SP-12), 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and COPD Self-Management Scale (CSMS). One-way ANOVA and t-test were used to compare the level of self-management in patients with different sociodemographic and clinical characteristics. Partial correlation analysis was used to explore the correlation between spirituality, resilience, and self-management. Hierarchical multiple regression analyses were performed to examine the contribution of spirituality and resilience to the prediction of self-management. A bootstrapping test was implemented using the SPSS PROCESS macro to test the statistical significance of the mediating effect. There was a pairwise positive correlation between spirituality, resilience, and self-management. Resilience mediated the relationship between spirituality and self-management. These findings suggested that resilience interventions could be incorporated into future COPD self-management interventions to better improve self-management and health outcomes. Moreover, resilience should be an important component of healthy aging initiatives. Full article

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11 pages, 685 KiB

Open AccessReview

Effects of Prehabilitation on Functional Capacity in Aged Patients Undergoing Cardiothoracic Surgeries: A Systematic Review

by Damián Fernández-Costa, Juan Gómez-Salgado, Andrés Castillejo del Río, Álvaro Borrallo-Riego and María Dolores Guerra-Martín

Healthcare 2021, 9(11), 1602; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9111602 - 22 Nov 2021

Cited by 12 | Viewed by 2385

Abstract

Background: an increasing number of advanced age patients are considered for cardiothoracic surgeries. Prehabilitation optimizes the patients’ functional capacity and physiological reserve. However, the effectiveness of prehabilitation on physical functioning and postoperative recovery in the scope of cardiothoracic surgery is still uncertain. Objective: [...] Read more.

Background: an increasing number of advanced age patients are considered for cardiothoracic surgeries. Prehabilitation optimizes the patients’ functional capacity and physiological reserve. However, the effectiveness of prehabilitation on physical functioning and postoperative recovery in the scope of cardiothoracic surgery is still uncertain. Objective: to assess the effectiveness of prehabilitation on pre- and/or postoperative functional capacity and physiological reserve in aged patients that are considered for cardiothoracic surgeries. Methods: this systematic review was registered in PROSPERO (CRD42021247117). The searches were conducted in PubMed, Web of Science, Scopus, and Cochrane CENTRAL until 18 April 2021. Randomized clinical trials that compared different prehabilitation strategies with usual care on the pre- and-postoperative results in aged patients undergoing cardiothoracic surgeries were included. Methodological quality was assessed by means of the Jadad scale, and the effectiveness of the interventions according to the Consensus on Therapeutic Exercise Training. Results: nine studies with 876 participants aged from 64 to 71.5 years old were included. Risk of bias was moderate due to the absence of double-blinding. The content of the interventions (multimodal prehabilitation n = 3; based on physical exercises n = 6) and the result measures presented wide variation, which hindered comparison across the studies. In general, the trials with better therapeutic quality (n = 6) reported more significant improvements in physical functioning, cardiorespiratory capacity, and in the postoperative results in the participants under-going prehabilitation. Conclusions: prehabilitation seems to improve functional capacity and postoperative recovery in aged patients undergoing cardiothoracic surgeries. However, due to the significant heterogeneity and questionable quality of the trials, both the effectiveness of prehabilitation and the optimum content are still to be determined. Full article

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16 pages, 290 KiB

Open AccessArticle

The Portuguese Model of Home Respiratory Care: Healthcare Professionals’ Perspective

by Cátia Caneiras, Cristina Jácome, Daniela Oliveira, Emília Moreira, Cláudia Camila Dias, Liliane Mendonça, Sagrario Mayoralas-Alises, João Almeida Fonseca, Salvador Diaz-Lobato, Joan Escarrabill and João Carlos Winck

Healthcare 2021, 9(11), 1523; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9111523 - 09 Nov 2021

Viewed by 1667

Abstract

Patients’ and carers’ views regarding the Portuguese model of home respiratory care were recently described, yet the complementary perspective of healthcare professionals (HCPs) is still to be investigated. Thus, this study explored HCPs experience in the management of patients needing home respiratory therapies [...] Read more.

Patients’ and carers’ views regarding the Portuguese model of home respiratory care were recently described, yet the complementary perspective of healthcare professionals (HCPs) is still to be investigated. Thus, this study explored HCPs experience in the management of patients needing home respiratory therapies (HRT), and their perspective about the Portuguese model. A phenomenological descriptive study, using focus groups, was carried out with 28 HCPs (median 42 y, 68% female) with distinct backgrounds (57% pulmonologists, 29% clinical physiologists, 7% physiotherapists, 7% nurses). Three focus groups were conducted in three regions of Portugal. Thematic analysis was performed by two independent researchers. HCPs have in general a positive view about the organization of the Portuguese model of home respiratory care, which was revealed in four major topics: Prescription (number of references, n = 171), Implementation and maintenance (n = 162), Carer involvement (n = 65) and Quality of healthcare (n = 247). Improvements needed were related to patients’ late referral, HRT prescription (usability of the medical electronic prescription system and renewals burden), patients’ education, access to hospital care team, lack of multidisciplinary work and articulation between hospital, primary and home care teams. This study describes the perspective of HCPs about the Portuguese model of home respiratory care and identifies specific points where improvements and reflections are needed. This knowledge may be useful to decision makers improve the current healthcare model. Full article

12 pages, 286 KiB

Open AccessArticle

Sexuality in Kidney Transplant Recipients: A Qualitative Study

by Ximena Abarca-Durán, Isabel María Fernández-Medina, María del Mar Jiménez-Lasserrotte, Iria Dobarrio-Sanz, Ana Lucía Martínez-Abarca and Cayetano Fernández-Sola

Healthcare 2021, 9(11), 1432; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9111432 - 24 Oct 2021

Cited by 1 | Viewed by 2658

Abstract

End-stage kidney disease has a negative impact on patients’ quality of life. People who receive a kidney transplant experience an improvement in many areas of their daily life. Sexuality is a general component of health, which can be affected by end-stage kidney disease [...] Read more.

End-stage kidney disease has a negative impact on patients’ quality of life. People who receive a kidney transplant experience an improvement in many areas of their daily life. Sexuality is a general component of health, which can be affected by end-stage kidney disease and kidney transplant. The aim of this study was to explore and understand the experiences and perspectives of kidney transplant recipients regarding their sexuality. A qualitative study based on Gadamer’s hermeneutic philosophy was carried out. Two focus groups and nine interviews were conducted with 18 kidney transplant recipients. Data were audio-recorded, transcribed, and analyzed with the help of qualitative analysis software. Two main themes emerged from the data: (1) “The impact of a kidney transplant on sexuality”, with the subthemes “sexuality is relegated to the background”, “physical decline acts as a sexual inhibitor”, and “changes in sexual activity following a kidney transplant”; (2) “Sexual education in kidney transplant recipients” with the subthemes “sexuality: a hidden concern amongst kidney transplant recipients” and “talking about sexuality with healthcare professionals”. Sexuality is a frequent concern among kidney transplant recipients. The physiological and emotional changes experienced after kidney transplant exert a great influence on their sexuality. Healthcare professionals rarely discuss sexuality concerns with kidney transplant recipients. Professional sexual education and assistance are necessary to improve sexual health satisfaction of kidney transplant recipients. Full article

12 pages, 3654 KiB

Open AccessArticle

Cost and Effectiveness of Long-Term Care Following Integrated Discharge Planning: A Prospective Cohort Study

by Yu-Chun Wang, Wen-Ying Lee, Ming-Yueh Chou, Chih-Kuang Liang, Hsueh-Fen Chen, Shu-Chuan Jennifer Yeh, Chih-Liang Yaung, Kang-Ting Tsai, Joh-Jong Huang, Chi Wang, Yu-Te Lin, Shi-Jer Lou and Hon-Yi Shi

Healthcare 2021, 9(11), 1413; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9111413 - 21 Oct 2021

Cited by 3 | Viewed by 2156

Abstract

Little is known about the effects of seamless hospital discharge planning on long-term care (LTC) costs and effectiveness. This study evaluates the cost and effectiveness of the recently implemented policy from hospital to LTC between patients discharged under seamless transition and standard transition. [...] Read more.

Little is known about the effects of seamless hospital discharge planning on long-term care (LTC) costs and effectiveness. This study evaluates the cost and effectiveness of the recently implemented policy from hospital to LTC between patients discharged under seamless transition and standard transition. A total of 49 elderly patients in the standard transition cohort and 119 in the seamless transition cohort were recruited from November 2016 to February 2018. Data collected from medical records included the Multimorbidity Frailty Index, Activities of Daily Living Scale, and Malnutrition Universal Screening Tool during hospitalization. Multiple linear regression and Cox regression models were used to explore risk factors for medical resource utilization and medical outcomes. After adjustment for effective predictors, the seamless cohort had lower direct medical costs, a shorter length of stay, a higher survival rate, and a lower unplanned readmission rate compared to the standard cohort. However, only mean total direct medical costs during hospitalization and 6 months after discharge were significantly (p < 0.001) lower in the seamless cohort (USD 6192) compared to the standard cohort (USD 8361). Additionally, the annual per-patient economic burden in the seamless cohort approximated USD 2.9–3.3 billion. Analysis of the economic burden of disability in the elderly population in Taiwan indicates that seamless transition planning can save approximately USD 3 billion in annual healthcare costs. Implementing this policy would achieve continuous improvement in LTC quality and reduce the financial burden of healthcare on the Taiwanese government. Full article

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6 pages, 1404 KiB

Open AccessCase Report

Unilateral Cauda Equina Syndrome Due to Cancer Metastasis Diagnosed with Electromyography: A Case Report

by Chan-Hee Park, Eunhee Park and Tae-Du Jung

Healthcare 2021, 9(10), 1370; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9101370 - 14 Oct 2021

Viewed by 3996

Abstract

Background: Typical cauda equina syndrome (CES) presents as low back pain, bilateral leg pain with motor and sensory deficits, genitourinary dysfunction, saddle anesthesia and fecal incontinence. In addition, it is a neurosurgical emergency, which is essential to diagnose as soon as possible, [...] Read more.

Background: Typical cauda equina syndrome (CES) presents as low back pain, bilateral leg pain with motor and sensory deficits, genitourinary dysfunction, saddle anesthesia and fecal incontinence. In addition, it is a neurosurgical emergency, which is essential to diagnose as soon as possible, and needs prompt intervention. However, unilateral CES is rare. Here, we report a unique case of a patient who had unilateral symptoms of CES due to cancer metastasis and was diagnosed through electromyography. Methods: A 71-year-old man with diffuse large B cell lymphoma (DLBCL) suffered from severe pain, motor weakness in the right lower limb and urinary incontinence, and hemi-saddle anesthesia. It was easy to be confused with lumbar radiculopathy due to the unilateral symptoms. Lumbar spine magnetic resonance imaging (MRI) showed suspected multifocal bone metastasis in the TL spine, including T11-L5, the bilateral sacrum and iliac bones, and suspected epidural metastasis at L4/5, L5/S1 and the sacrum. PET CT conducted after the third R-CHOP showed residual hypermetabolic lesions in L5, the sacrum, and the right presacral area. Results: Nerve conduction studies (NCS) revealed peripheral neuropathy in both hands and feet. Electromyography (EMG) presented abnormal results indicating development of muscle membrane instability following neural injury, not only on the right symptomatic side, but also on the other side which was considered intact. Overall, he was diagnosed with cauda equina syndrome caused by DLBCL metastasis, and referred to neurosurgical department. Conclusions: Early diagnosis of unilateral CES may go unnoticed due to its unilateral symptoms. Failure to perform the intervention at the proper time can impede recovery and leave permanent complications. Therefore, physicians need to know not only the typical CES, but also the clinical features of atypical CES when encountering a patient, and further evaluation such as electrodiagnostic study or lumbar spine MRI have to be considered. Full article

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11 pages, 970 KiB

Open AccessArticle

Psychometric Properties of the Taiwanese Version of the Tilburg Frailty Indicator for Community-Dwelling Older Adults

by Chia-Hui Lin, Chieh-Yu Liu and Jiin-Ru Rong

Healthcare 2021, 9(9), 1193; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9091193 - 10 Sep 2021

Cited by 8 | Viewed by 1944

Abstract

Screening the frailty level of older adults is essential to avoid morbidity, prevent falls and disability, and maintain quality of life. The Tilburg Frailty Indicator (TFI) is a self-report instrument developed to assess frailty for community-dwelling older adults. The aim of this study [...] Read more.

Screening the frailty level of older adults is essential to avoid morbidity, prevent falls and disability, and maintain quality of life. The Tilburg Frailty Indicator (TFI) is a self-report instrument developed to assess frailty for community-dwelling older adults. The aim of this study was to explore the psychometric properties of the Taiwanese version of TFI (TFI-T). The sample consisted of 210 elderly participants living in the community. The scale was implemented to conduct a confirmatory factor analysis (CFA) test for validity. The models were evaluated through sensitivity, specificity, area under the curve, and receiving operating characteristic (ROC) curve. CFA was performed to evaluate construct validity, and the TFI-T has a goodness of fit with the three-factor structure of the TFI. Totally, the 15 items of TFI-T have acceptable internal consistency (Cronbach’s alpha = 0.78), and test–retest reliability (r = 0.88, p < 0.001). The criterion-related validity was examined, the TFI-T correlation with the Kihon Checklist (KCL) score (r = 0.74; p < 0.001). The cutoff of 5.5 based on the Youden index was considered optimal. The area under the ROC curve analysis indicated that the TFI-T has good accuracy in frailty screening. The TFI-T exhibits good reliability and validity and can be used as a sensitive and accurate instrument, which is highly applicable to screen frailty in Taiwan among older adults. Full article

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10 pages, 1782 KiB

Open AccessArticle

Correlation between Psoas Muscle Index and Degeneration of Spinal Back Muscle in Patients with Back Pain

by Donggyu Lee and Minsoo Kang

Healthcare 2021, 9(9), 1189; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9091189 - 09 Sep 2021

Cited by 8 | Viewed by 2965

Abstract

Sarcopenia is characterized by a decline in systemic muscle mass and physical performance. Disc degeneration also causes back muscle atrophy. Therefore, we aimed to evaluate the influence of systemic muscle mass decline on back muscle atrophy and fatty infiltration compared to disc degeneration. [...] Read more.

Sarcopenia is characterized by a decline in systemic muscle mass and physical performance. Disc degeneration also causes back muscle atrophy. Therefore, we aimed to evaluate the influence of systemic muscle mass decline on back muscle atrophy and fatty infiltration compared to disc degeneration. We included 127 patients (65.54 ± 14.93 years) with back pain who underwent lumbar spine magnetic resonance imaging (MRI). Axial T2-weighted MRI data of the L4–5 and L5-S1 levels were used to measure the cross-sectional area (CSA) of the psoas and spinal muscles. The psoas index (cm²/m²) was used as a surrogate for systemic muscle mass. The Pfirrmann grading system was used to evaluate intervertebral disc degeneration. The functional area of the back muscles was calculated by subtracting the fat infiltration area from the CSA; the functional CSA ratio was calculated by dividing the functional CSA by the CSA. Image-processing software (ImageJ; National Institutes of Health, Bethesda, MD, USA) was used for analysis. Psoas index and aging significantly affected CSA and the ratio of functional CSA of the back muscles and multifidi. Disc degeneration did not significantly affect the back muscles beyond aging in patients with back pain. Males showed substantially higher CSA of the back muscles and multifidi than females; however, sex did not affect the functional CSA ratio of these muscles. Systemic muscle mass decline showed a more powerful influence on back muscle atrophy and fatty infiltration than disc degeneration. Therefore, proper evaluation of sarcopenia is needed for patients with chronic back pain and back muscle degeneration. Full article

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10 pages, 549 KiB

Open AccessArticle

The Socio-Demographic Characteristics Associated with Non-Communicable Diseases among the Adult Population of Dubai: Results from Dubai Household Survey 2019

by Wafa K. Alnakhi, Heba Mamdouh, Hamid Y. Hussain, Gamal M. Ibrahim, Amar Sabri Ahmad, Raghib Ali and Abdishakur Abdulle

Healthcare 2021, 9(9), 1139; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9091139 - 31 Aug 2021

Cited by 5 | Viewed by 5235

Abstract

Background: Non-communicable diseases (NCDs) are the leading causes of death worldwide. In the UAE, NCDs account for nearly 77% of all deaths. There is limited empirical research on this topic in the UAE. We aimed to examine the association of non-communicable diseases and [...] Read more.

Background: Non-communicable diseases (NCDs) are the leading causes of death worldwide. In the UAE, NCDs account for nearly 77% of all deaths. There is limited empirical research on this topic in the UAE. We aimed to examine the association of non-communicable diseases and the sociodemographic characteristics among the adult population of Dubai. Methods: The study used secondary data from the Dubai Household Health Survey (DHHS), 2019. DHHS is a cross-sectional complex design, stratified by geographic area, and uses multistage probability sampling. In this survey, 2247 families were interviewed and only adults aged 18+ were included for the analysis. The quasi-binomial distribution was used to identify the socio-demographic characteristics association with NCDs. Results: The prevalence of NCDs among the adult population of Dubai was 15.01%. Individuals aged 60+, local Arabs (Emirati), divorced and widowed individuals, and individuals who were not currently working reported NCDs more than the other groups. In the regression analysis, the association with NCDs were reported among elderly people, males, unmarried individuals, older individuals who are unmarried, and Emiratis. Conclusion: The study identified several socio-demographic characteristics associated with reporting NCDs. This is one of the few studies related to NCDs in Dubai. Allocating appropriate resources to the population groups identified is crucial to reduce the incidence of NCDs in the Emirate. Full article

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14 pages, 1649 KiB

Open AccessArticle

The Impacts of Regional Regulatory Policies on the Prevention and Control of Chronic Diseases in China: A Mediation Analysis

by Huihui Huangfu, Qinwen Yu, Peiwu Shi, Qunhong Shen, Zhaoyang Zhang, Zheng Chen, Chuan Pu, Lingzhong Xu, Zhi Hu, Anning Ma, Zhaohui Gong, Tianqiang Xu, Panshi Wang, Hua Wang, Chao Hao, Qingyu Zhou, Li Li, Chengyue Li and Mo Hao

Healthcare 2021, 9(8), 1058; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9081058 - 18 Aug 2021

Cited by 1 | Viewed by 1813

Abstract

Regional regulatory policies (RPs) are a major factor in the prevention and control of chronic diseases (PCCDs) through the implementation of various measures. This study aimed to explore the impacts of RPs on PCCDs, with a focus on the mediating roles of community [...] Read more.

Regional regulatory policies (RPs) are a major factor in the prevention and control of chronic diseases (PCCDs) through the implementation of various measures. This study aimed to explore the impacts of RPs on PCCDs, with a focus on the mediating roles of community service. The soundness of the regulatory mechanism (SORM) was used to measure the soundness of RPs based on 1095 policy documents (updated as of 2015). Coverage provided by community service institutions (CSIs) and community health centres (CHCs) was used to represent community service coverage derived from the China Statistical Yearbook (2015), while the number of chronic diseases (NCDs) was used to measure the effects of PCCDs based on data taken from the 2015 China Health and Retirement Longitudinal Study survey. To assess the relationship between SORM, NCDs and community service, a negative binomial regression model and mediation analysis with bootstrapping were conducted. Results revealed that there was a negative correlation between SORM and NCDs. CSIs had a major effect on the relationship between RPs and PCCDs, while CHCs had a partial mediating effect. RPs can effectively prevent and control chronic diseases. Increased effort should also be aimed at strengthening the roles of CSIs and CHCs. Full article

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13 pages, 515 KiB

Open AccessArticle

Evaluation of and Intervention for Sarcopenia in Hepatology Departments: A Survey of Nurses in Japan

by Kazuki Ohashi, Madoka Ito, Megumi Kawakubo and Ikue Sato

Healthcare 2021, 9(8), 1021; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9081021 - 09 Aug 2021

Cited by 2 | Viewed by 1882

Abstract

Sarcopenia is associated with poor prognosis and decreased quality of life in patients with chronic liver disease (CLD). The present study aimed to clarify the dissemination of interventions such as evaluations, prevention efforts, and treatments for sarcopenia among patients in hepatology outpatient departments [...] Read more.

Sarcopenia is associated with poor prognosis and decreased quality of life in patients with chronic liver disease (CLD). The present study aimed to clarify the dissemination of interventions such as evaluations, prevention efforts, and treatments for sarcopenia among patients in hepatology outpatient departments and wards in Japan, as well as examine the factors related to such dissemination. A cross-sectional study was performed involving nurses from hospitals accredited by the Japan Society of Hepatology. Participants completed a questionnaire regarding evaluations and interventions for sarcopenia in their department. Nurses from 72 outpatient departments and 162 wards provided responses to the questionnaire. Overall, 37.9% of outpatient departments and 37.6% of wards performed evaluations or interventions for sarcopenia. Outpatient departments and wards that evaluated sarcopenia or intervened held more workshops or training regarding sarcopenia than departments and wards that did not (outpatient departments: 52.0% vs. 12.2%, wards: 32.1% vs. 12.9%). Holding workshops or training regarding sarcopenia (outpatient departments; OR = 7.51, 95% confidence interval (CI): 2.12–26.6, wards; OR = 2.61, 95% CI: 1.11–6.15) was significantly associated with dissemination practices. These findings suggest that expanding knowledge of sarcopenia and developing practical skills among general nurses may aid in preventing sarcopenia among patients with CLD. Full article

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22 pages, 2463 KiB

Open AccessArticle

Inequalities in Health Care Experience of Patients with Chronic Conditions: Results from a Population-Based Study

by Roberto Nuño-Solínis, Maider Urtaran-Laresgoiti, Esther Lázaro, Sara Ponce, Juan F. Orueta and María Errea Rodríguez

Healthcare 2021, 9(8), 1005; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9081005 - 05 Aug 2021

Cited by 1 | Viewed by 2007

Abstract

Patients’ experience is an acknowledged key factor for the improvement of healthcare delivery quality. This study aims to explore the differences in healthcare experience among patients with chronic conditions according to individual sociodemographic and health-related variables. A population-based and cross-sectional study was conducted. [...] Read more.

Patients’ experience is an acknowledged key factor for the improvement of healthcare delivery quality. This study aims to explore the differences in healthcare experience among patients with chronic conditions according to individual sociodemographic and health-related variables. A population-based and cross-sectional study was conducted. The sample consisted of 3981 respondents of the Basque Health Survey (out of 8036 total respondents to the individual questionnaire), living in the Basque Country, aged 15 or older, self-reporting at least one chronic condition. Patient experience was assessed with the Instrument for Evaluation of the Experience of Chronic Patients questionnaire, which encompasses three major factors: interactions between patients and professionals oriented to improve outcomes (productive interactions); new ways of patient interaction with the health care system (the new relational model); and the ability of individuals to manage their care and improve their wellbeing based on professional-mediated interventions (self-management). We conducted descriptive and regression analyses. We estimated linear regression models with robust variances that allow testing for differences in experience according to sociodemographic characteristics, the number of comorbidities and the condition (for all chronic or for chronic patients’ subgroups). Although no unique inequality patterns by these characteristics can be inferred, females reported worse global results than males and older age was related to poorer experience with the new relational model in health care. Individuals with lower education levels tend to report lower experiences. There is not a clear pattern observed for the type of occupation. Multimorbidity and several specific chronic conditions were associated (positive or negatively) with patients’ experience. Health care experience was better in patients with greater quality of life. Understanding the relations among the patients’ experience and their sociodemographic and health-related characteristics is an essential issue for health care systems to improve quality of assistance. Full article

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15 pages, 282 KiB

Open AccessArticle

Continuity of Care and Self-Management among Patients with Stroke: A Cross-Sectional Study

by Nai-Yu Kuo, Yu-Huei Lin and Hsiao-Mei Chen

Healthcare 2021, 9(8), 989; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9080989 - 04 Aug 2021

Cited by 3 | Viewed by 2274

Abstract

(1) Background: Stroke is an important topic in the healthcare industry. The objective of the present study was to investigate patients’ sociodemographic characteristics, health status, continuity of care, self-management, and other predictors that affect their self-management. (2) Methods: This cross-sectional correlational study was [...] Read more.

(1) Background: Stroke is an important topic in the healthcare industry. The objective of the present study was to investigate patients’ sociodemographic characteristics, health status, continuity of care, self-management, and other predictors that affect their self-management. (2) Methods: This cross-sectional correlational study was carried out from March to September 2020, and included a total of 150 patients aged 20 and above who were diagnosed within the past 6 months. The research participants were selected from the Division of Neurology, Department of Internal Medicine/Department of Surgery, at a medical center in Central Taiwan. (3) Results: The mean self-management score of patients with stroke was 110.50 points (30–150 points). As shown in the stepwise regression analysis, the overall regression model explained approximately 44.5% of the variance in self-management. Educational level (10.8%), frequency of exercise per week (2.1%), time that patients were affected by stroke (2.4%), and continuity of care (29.2%) were the main predictors affecting the self-management of stroke patients. (4) Conclusions: To improve stroke patients’ self-management, medical teams should provide appropriate continuity of care to those with lower educational levels, those without exercise habits, and those who experienced a stroke within the past six months. Full article

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