Special Issue "A Focus on Healthcare from the Perspective of Gender, Culture, Management, and the Economy"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: 31 October 2021.

Special Issue Editors

Prof. Dr. José Siles Gonzalez
E-Mail Website
Chief Guest Editor
Department of Nursing, Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain
Interests: nursing history; anthropology of care; nursing based on narrative; health, context, and culture; dialectical structural model of care; anthropology of education
Prof. Dr. Paulo Joaquim Pina Queirós
E-Mail Website
Assistant Guest Editor
Escola Superior de Enfermagem de Coimbra, 3046-851 Coimbra, Portugal
Interests: nursing history; theory; method of care; epistemology
Prof. Dr. Carmen Solano Ruiz
E-Mail Website
Assistant Guest Editor
Department of Nursing, Faculty of Health Sciences University of Alicante, 03690 Alicante, Spain
Interests: clinical anthropology; anthropology of care; gender and health; intercultural care; anthropology of education
Prof. Dr. Benito Yañez-Araque
E-Mail Website
Assistant Guest Editor
Department of Physical Activity and Sports Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain
Interests: healthcare and hospital management; occupational risks prevention; corporate social responsibility; quality management; marketing; strategy; corporate governance; business intelligence; innovation; human resources; sports management

Special Issue Information

Dear Colleagues,

The literature has highlighted the organization and provision of health-oriented care in societies over time, along with the implications for gender equality. In turn, care throughout history (both paid and unpaid) has been fundamental to both human wellbeing and economic and social development. In other words, what is of particular interest to the care economy is the relationship between the way societies have organized their members’ healthcare and the management of the functioning of the health economic system. Therefore, gender and culture are foundations of individual and social identity, which condition the various forms of interaction in the care administration relationship between the professional and the patient/family. In recent years, emphasis has been placed on the study of the so-called care economy from the perspective of gender, culture, and healthcare management.

The objective that we propose in this Special Edition is to bring together the latest research framed in the culture of care, its evolution in societies, care economics, and care management, highlighting the gender perspective. Likewise, we propose to do this through the adoption of transdisciplinary approaches that prioritize in these studies relational analysis in the context of health scenarios, ideologies, and people.

Therefore, studies are justified in relation to health and illness, the culture of care, and the profile (sex/gender) of the care provider. This Special Issue seeks studies with different quantitative and qualitative methodologies, as well as studies of mixed methods. Reviews following quality criteria will also be considered. We particularly welcome research projects that adopt a multisectoral and transdisciplinary approach.

Prof. Dr. José Siles Gonzalez
Prof. Dr. Carmen Solano Ruiz
Prof. Dr. Paulo Joaquim Pina Queirós
Prof. Dr. Benito Yañez-Araque
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • gender and health
  • intercultural care
  • health economics
  • health education
  • hospital management
  • health promotion
  • healthcare
  • clinical anthropology
  • anthropology of education

Published Papers (20 papers)

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Research

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Communication
Peripherally Inserted Central Catheter Placement in a Cardiology Ward: A Focus Group Study of Nurses’ Perspectives
Int. J. Environ. Res. Public Health 2021, 18(14), 7618; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18147618 - 17 Jul 2021
Viewed by 353
Abstract
Intravenous therapy administration through peripheral venous catheters is one of the most common nursing procedures performed in clinical contexts. However, peripherally inserted central catheters (PICC) remain insufficiently used by nurses and can be considered a potential alternative for patients who need aggressive intravenous [...] Read more.
Intravenous therapy administration through peripheral venous catheters is one of the most common nursing procedures performed in clinical contexts. However, peripherally inserted central catheters (PICC) remain insufficiently used by nurses and can be considered a potential alternative for patients who need aggressive intravenous therapy and/or therapy for extended periods. The purpose of this study was to understand nurses’ perspectives about PICC implementation in their clinical practice. As part of an action-research project, three focus groups were developed in June 2019 with nineteen nurses of a cardiology ward from a Portuguese tertiary hospital. From the content analysis, two main categories emerged: ‘nursing practices’ and ‘patients’. Nurses considered PICC beneficial for their clinical practice because it facilitates maintenance care and catheter replacement rates. Moreover, nurses suggested that, since there is a need for specific skills, the constitution of vascular access teams, as recommended by international guidelines, could be an advantage. Regarding patient benefits, nurses highlighted a decrease in the number of venipunctures and also of patient discomfort, which was associated with the number of peripheral venous catheters. Infection prevention was also indicated. As an emerging medical device used among clinicians, peripherally inserted central catheters seem to be essential to clinical practice. Full article
Article
Examining the Determinants of Healthcare Workers’ Performance: A Configurational Analysis during COVID-19 Times
Int. J. Environ. Res. Public Health 2021, 18(11), 5671; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18115671 - 25 May 2021
Viewed by 746
Abstract
The evaluation of the work performance of health professionals has focused the interest of scientific research in recent decades as a basis for improving the quality of health services. The global COVID-19 pandemic has pushed countries’ health systems to the limit and had [...] Read more.
The evaluation of the work performance of health professionals has focused the interest of scientific research in recent decades as a basis for improving the quality of health services. The global COVID-19 pandemic has pushed countries’ health systems to the limit and had previously unknown consequences on the job performance of health professionals. In this context, what are the determinants of performance? There are numerous studies that link job performance with other variables that directly affect it, such as leadership, job satisfaction, organizational commitment, and work environment. However, there are no studies that jointly relate all these variables, and even less in the field of health. The main objective of this work is to analyse how these variables are configured together to generate a good level of performance of health professionals during the times of COVID-19. To do this, a fuzzy set qualitative comparative analysis (fsQCA) is carried out, an appropriate method that will allow finding the joint causal effects of key variables in human resources to ensure a good level of job performance in health organizations. The study reveals that leadership and commitment are the two key drivers of performance. The data confirm that the “recipe” to achieve a good level of performance consists of the combination of leadership, commitment, and a good work environment. Additionally, in the case of less satisfied workers, linking leadership and commitment is a sufficient condition. Full article
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Article
Occupational Health and Safety, Organisational Commitment, and Turnover Intention in the Spanish IT Consultancy Sector
Int. J. Environ. Res. Public Health 2021, 18(11), 5658; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18115658 - 25 May 2021
Viewed by 883
Abstract
Background: The purpose of this study is to analyse the impact that occupational health and safety policies have on employees’ work and organisational commitment and, in turn, on their intention to leave the company. Methods: For this study, we designed a questionnaire with [...] Read more.
Background: The purpose of this study is to analyse the impact that occupational health and safety policies have on employees’ work and organisational commitment and, in turn, on their intention to leave the company. Methods: For this study, we designed a questionnaire with a five-level Likert scale and distributed it among professionals from different companies in the IT consultancy sector in Spain. The data collected from 458 completed questionnaires were analysed using the partial least squares structural equation modelling (PLS-SEM) technique using the SmartPLS software. Results: From the analysis of the data, it was concluded that there is indeed a positive relationship between occupational health and safety policies and employees’ work and organisational commitment, as well as a negative relationship between these policies and the intention to leave the company. Similarly, there is a negative relationship between employees’ work and organisational commitment and their turnover intention. Conclusions: Although, due to the activity of professionals in the sector, occupational health and safety has not been an area of priority, it was concluded from this study that an improvement in these areas would have a beneficial effect on the commitment of workers to the company, thus helping to reduce the high levels of turnover in the sector. Future lines of research, as well as their practical application and the limitations of the study, are indicated at the end of the paper. Full article
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Article
The Impact of Internalized Stigma on LGBT Parenting and the Importance of Health Care Structures: A Qualitative Study
Int. J. Environ. Res. Public Health 2021, 18(10), 5373; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105373 - 18 May 2021
Viewed by 536
Abstract
Research on LGBTIQ+ families has focused on the effects of being in a diverse family on the development of children. We seek to show the experience of parenthood from the perspective of LGBTIQ+ people, considering its particularities and the role that health care [...] Read more.
Research on LGBTIQ+ families has focused on the effects of being in a diverse family on the development of children. We seek to show the experience of parenthood from the perspective of LGBTIQ+ people, considering its particularities and the role that health care services play as a potential support network. We used the biographical method through open-ended interviews, participants were LGBT people, and key informants from Chile, Colombia, and Mexico were selected based on a sociostructural sampling. We found that internalized stigma impacts LGBTIQ+ parenting in five ways: the impossibility of thinking of oneself as a parent, fear of violating children’s rights, fear of passing on the stigma, fear of introducing their LGBTIQ+ partner, and the greater discrimination that trans and intersex people suffer. We identified gaps in health care perceptions: the need to guarantee universal access to health care, the need to include a gender perspective and inclusive treatment by health personnel, mental health programs with a community approach, access to assisted fertilization programs, and the generation of collaborative alliances between health services, civil society organizations, and the LGBTIQ+ community. We conclude that the health system is a crucial space from which to enable guarantees for the exercise of rights and overcome internalized stigma. Full article
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Article
Health Investment Management and Healthcare Quality in the Public System: A Gender Perspective
Int. J. Environ. Res. Public Health 2021, 18(5), 2304; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052304 - 26 Feb 2021
Cited by 1 | Viewed by 878
Abstract
The aim of this empirical research was to provide useful information for health system managers on the costs and investments involved in improving the quality of the National Health Service (NHS) based on patient assessments and from a gender perspective, i.e., without assuming [...] Read more.
The aim of this empirical research was to provide useful information for health system managers on the costs and investments involved in improving the quality of the National Health Service (NHS) based on patient assessments and from a gender perspective, i.e., without assuming that the perceived experience is identical for men and women. A cross-sectional study of 31 variables was applied using partial least squares structural equation modeling (PLS-SEM) as a research tool. The data were obtained from the Spanish Ministry of Health, Consumption, and Social Welfare for the entire Spanish territory between 2005 and 2018. The influence of expenditure, resource allocation, and mortality was hypothesized with regard to patient satisfaction according to disconfirmation theory. Patient satisfaction reflects clinical effectiveness, and therefore is a measure of health system quality. The results show that women are more sensitive to public investment in health than men, i.e., an increase in the level of spending and resources increases satisfaction more in women. In both sexes, the level of expenditure has a direct influence on patient satisfaction, and therefore on the quality of the healthcare system. It is important to increase spending on primary care, especially on specialized medical care and diagnostic equipment. However, reducing the use of drugs in favor of alternative treatments or therapies is considered to be positive. Likewise, spending has an impact on available resources, and these, in turn, have a positive influence on the level of use and a negative impact on mortality. Resources, especially healthcare staff, nuclear magnetic resonance equipment, and the number of posts in day hospitals, increase patients’ positive perception of the NHS. Full article
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Communication
Work Methods for Nursing Care Delivery
Int. J. Environ. Res. Public Health 2021, 18(4), 2088; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18042088 - 21 Feb 2021
Viewed by 921
Abstract
This article analyzes the work methods based on care design, identification of needs, care organization, planning, delivery, evaluation, continuity, safety, and complexity of care, and discharge preparation. It describes the diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation that [...] Read more.
This article analyzes the work methods based on care design, identification of needs, care organization, planning, delivery, evaluation, continuity, safety, and complexity of care, and discharge preparation. It describes the diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation that contribute to adopting a given work conception and/or method for nursing care delivery. Later, the concepts underlying the several methods—management theories and theoretical nursing concepts—are presented, with reference to relevant authors. The process of analysis and selection of the method is explained, highlighting the importance of diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation. The importance of various elements is highlighted, such as structural aspects, nature of care, target population, resources, and philosophy of the institution, which may condition the adoption of a method. The importance of care conceptualization is also underlined. The work methods are presented with a description of the key characteristics, advantages, and disadvantages of the task-oriented method (functional nursing) and patient-centered methods: individual, team nursing, and primary nursing. A critical and comparative analysis of the methods is then performed, alluding to the combination of person-centered methods. Full article
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Article
The Quality of Carer–Patient Relationship Scale: Adaptation and Validation into Portuguese
Int. J. Environ. Res. Public Health 2021, 18(3), 1264; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18031264 - 31 Jan 2021
Viewed by 803
Abstract
Background: This study aimed to translate and adapt the Quality of the Carer–Patient Relationship (QCPR) scale into Portuguese and analyse both its psychometric properties and correlation with sociodemographic and clinical variables. Methods: Phase (1) Translate and culturally adapt the scale. Phase (2) Assess [...] Read more.
Background: This study aimed to translate and adapt the Quality of the Carer–Patient Relationship (QCPR) scale into Portuguese and analyse both its psychometric properties and correlation with sociodemographic and clinical variables. Methods: Phase (1) Translate and culturally adapt the scale. Phase (2) Assess the scale’s confirmatory factorial analysis, internal consistency, construct validity, and correlations. Results: The experts classified the overall quality of the translation as adequate. A total of 53 dyads (cared-for person and carer) were assessed. In both versions, measures of central tendency and symmetry were also adequate, and the two factors under investigation had appropriate reliability, although in the conflict/critical factor, this was more fragile. Cronbach’s alpha values were 0.89 for the cared-for person version and 0.91 for the carer version. Conclusions: The QCPR scale showed satisfactory to good values of reliability. The assessment is essential to guarantee structured interventions by health professionals, since the quality of the dyads’ relationship seems to influence both older adults’ quality of life and carers’ health status. This study is a significant contribution to the introduction of the QCPR scale in the Portuguese clinical and scientific culture but also an opportunity to increase its use internationally. Full article
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Article
Men’s Positive and Negative Experiences Following Acute Myocardial Infarction
Int. J. Environ. Res. Public Health 2021, 18(3), 1053; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18031053 - 25 Jan 2021
Viewed by 814
Abstract
(1) Objective: To describe men’s experiences as acute myocardial infarction sufferers from a social phenomenological perspective, a year after the event (2) Methods: The phenomenological interview was used to capture the participants’ discourse. The data were analyzed according to the theoretical methodological approach [...] Read more.
(1) Objective: To describe men’s experiences as acute myocardial infarction sufferers from a social phenomenological perspective, a year after the event (2) Methods: The phenomenological interview was used to capture the participants’ discourse. The data were analyzed according to the theoretical methodological approach of social phenomenology. (3) Results: The discourse analysis of the content produced the following categories, set out according reasons “why”: personal biography, knowledge set, warning signs prior to the illness, experience at the intensive care unit, and rehabilitation process; and reasons “for”: expectations as regards the illness, health professionals, and future social life and work prospects. (4) Conclusions: Participants had not established a healthy condition one year after myocardial infarction, perceiving a very thin line between life and death. Personal biography influences the coping of the disease. They feel like the illness helped them to create new meanings and value of life. They envisage a future full of great restrictions and uncertainty. The results of this study have underlined the need to involve care at all stages of the illness: the physical and emotional dependence upon admittance at the intensive care unit, the need to be cured, the constant demand for information about the illness, the difficulties encountered upon returning home, uncertainty about the future, etc. All these moments indicate that proper nursing care adapted to the specific needs of each individual and their family members must be provided in order to help them to overcome all the stages involved in this process. It is necessary to individualize care because the sense of reality is common and universal, but the ways of expressing are subjective, and it depended on the totality of experiences accumulated throughout life. Full article
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Article
Adaptations to Swimming Training in Athletes with Down’s Syndrome
Int. J. Environ. Res. Public Health 2020, 17(24), 9175; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249175 - 08 Dec 2020
Viewed by 808
Abstract
Swimming training programs may help to limit declines in cardiovascular conditioning, muscle strength, mobility and social functioning in individuals with Down’s Syndrome (DS): (1) Background: This study aims to analyze the effects of a periodized swimming training program on swimming speed, lower body [...] Read more.
Swimming training programs may help to limit declines in cardiovascular conditioning, muscle strength, mobility and social functioning in individuals with Down’s Syndrome (DS): (1) Background: This study aims to analyze the effects of a periodized swimming training program on swimming speed, lower body force and power and body composition in a group of swimmers with DS; (2) Methods: Nine swimmers with DS (2 men and 7 women; aged 21–30 years-old) completed an 18-week periodized swimming program. The swimmers were assessed, pre and post-training, for 25 m, 50 m and 100 m freestyle swim performance, countermovement jump performance and body composition; (3) Results: Significant and large improvements in 25 m (mean −6.39%, p < 0.05, d = 1.51), 50 m (mean −4.95%, p < 0.01, d = 2.08) and 100 m (mean −3.08%, p < 0.05, d = 1.44) freestyle performance were observed following training, with no significant changes in body composition or consistent changes in jump performance (although a large mean 14.6% decrease in relative peak force, p < 0.05, d = 1.23) (4) Conclusions: A periodized 18-week training intervention may improve swimming performance in a small group of trained swimmers with DS, with less clear changes in jump performance or body composition. This program provides a training profile for coaches working with swimmers with DS and a platform for further research into the benefits of swimming training with this under-represented population. Full article
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Article
Nursing Students’ Relational Skills with Elders Improve through Humanitude Care Methodology
Int. J. Environ. Res. Public Health 2020, 17(22), 8588; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17228588 - 19 Nov 2020
Cited by 2 | Viewed by 824
Abstract
Nursing students have difficulties interacting with cognitively impaired elders. This study aimed to identify students’ difficulties in interacting with elders, the causes of the difficulties in interacting with elders, the strategies used to reduce these difficulties, and the importance attributed to the Structured [...] Read more.
Nursing students have difficulties interacting with cognitively impaired elders. This study aimed to identify students’ difficulties in interacting with elders, the causes of the difficulties in interacting with elders, the strategies used to reduce these difficulties, and the importance attributed to the Structured Sequence of Humanitude Care Procedures (SSHCP). It also aimed to assess the contribution of the Humanitude Care Methodology (HCM) to the development of interaction skills in nursing students. An exploratory descriptive study with a quasi-experimental design was conducted with a sample of 64 nursing students during their hospital clinical training. A control group (usual training) and an experimental group (HCM training) were used. Data were collected through a questionnaire applied at baseline and follow-up. Content analysis, chi-square tests, and Student’s t-tests were performed. The main difficulty identified was caring for agitated and confused elders. Difficulties were associated with a lack of theoretical–practical teaching, the clinical training context, lack of experience, and personality traits. HCM impacted positively on the development of students’ interaction skills. This study shows that HCM is an innovative methodology in nursing education that will allow for moving from an instrumental and technicist education into a more humanized training capable of transforming care. Full article
Article
Usability Assessment of an Innovative Device in Infusion Therapy: A Mix-Method Approach Study
Int. J. Environ. Res. Public Health 2020, 17(22), 8335; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17228335 - 11 Nov 2020
Viewed by 601
Abstract
Background: Flushing a venous access device is an important procedure to maintain their patency and prevent malfunctioning and complications. An innovative double-chamber syringe was developed, allowing for the assessment of catheter patency, drug delivery and final flush. This study aims to assess [...] Read more.
Background: Flushing a venous access device is an important procedure to maintain their patency and prevent malfunctioning and complications. An innovative double-chamber syringe was developed, allowing for the assessment of catheter patency, drug delivery and final flush. This study aims to assess the usability of this new device, considering three development stages (concept, semi-functional prototype, functional prototype). Methods: An iterative methodology based on a mix-method design (qualitative and quantitative) enabled the assessment of the devices’ usability by their primary end-users. A usability questionnaire was developed and applied, along with focus groups and individual interviews to nurses. Results: The usability questionnaire integrated 42 items focused on four dimensions (usefulness; ease of use; ease of learning; satisfaction and intention to use). The initial psychometric findings indicate a good internal consistency and the conceptual relevance of the items. The scores seem to be sensitive to the usability evaluation of the medical devices in different stages of product development (with lower values on functional prototype evaluation), and related to nurses’ perceptions about functional and ergonomic characteristics. Conclusions: Quantitative and qualitative data provided a comprehensive overview of the double-chamber syringes’ usability from the nurses’ point of view, informing us of features that must be addressed. Full article
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Article
Facilitating Factors of Professional Health Practice Regarding Female Genital Mutilation: A Qualitative Study
Int. J. Environ. Res. Public Health 2020, 17(21), 8244; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17218244 - 08 Nov 2020
Viewed by 788
Abstract
Introduction: According to figures released by UNICEF (United Nations Children’s Fund), more than 200 million girls and women have suffered female genital mutilation (FGM) in 30 African and Middle East countries. An increasing number of African women who come from ethnic groups where [...] Read more.
Introduction: According to figures released by UNICEF (United Nations Children’s Fund), more than 200 million girls and women have suffered female genital mutilation (FGM) in 30 African and Middle East countries. An increasing number of African women who come from ethnic groups where FGM is practised are arriving in Western countries. Healthcare professionals play a fundamental role in its prevention. Goals: To learn about the factors that healthcare professionals consider as facilitators for prevention and action when faced with female genital mutilation. Methods: A cross-sectional descriptive study developed on the basis of the qualitative methodological perspective, where 43 healthcare professionals participated. A series of analysis dimensions were established, based on which, the interview and discussion group scripts were designed. Results: Addressing FGM requires a series of structural adaptations of the healthcare system that facilitate the recording and monitoring of cases, both for treatment and for prevention. In addition, it is necessary to establish coordination between the healthcare, social services and education sectors. Conclusions: The existence of a protocol of action and training in its use is one of the key tools to take into account. Full article
Article
How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China
Int. J. Environ. Res. Public Health 2020, 17(21), 8040; https://doi.org/10.3390/ijerph17218040 - 31 Oct 2020
Cited by 2 | Viewed by 646
Abstract
How one can reshape the current healthcare sector into a tiered healthcare system with clarified division of functions between primary care facilities and hospitals, and improve the utilization of primary care, is a worldwide problem, especially for the low and middle-income countries (LMICs). [...] Read more.
How one can reshape the current healthcare sector into a tiered healthcare system with clarified division of functions between primary care facilities and hospitals, and improve the utilization of primary care, is a worldwide problem, especially for the low and middle-income countries (LMICs). This paper aimed to evaluate the impact of the Beijing Reform on healthcare-seeking behavior and tried to explain the mechanism of the change of patient flow. In this before and after study, we evaluated the changes of outpatient visits and inpatient visits among different levels of health facilities. Using the monitored and statistical data of 373 healthcare institutions 1-year before and 1-year after the Beijing Reform, interrupted time series analysis was applied to evaluate the impact of the reform on healthcare-seeking behavior. Semi-structured interviews were used to further explore the mechanisms of the changes. One year after the reform, the flow of outpatients changed from tertiary hospitals to community health centers with an 11.90% decrease of outpatients in tertiary hospitals compared to a 15.01% increase in primary healthcare facilities. The number of ambulatory care visits in primary healthcare (PHC) showed a significant upward trend (P < 0.10), and the reform had a significant impact on the average number of ambulatory care visits per institution in Beijing’s tertiary hospitals (p < 0.10). We concluded that the Beijing Reform has attracted a substantial number of ambulatory care visits from hospitals to primary healthcare facilities in the short-term. Comprehensive reform policies were necessary to align incentives among relative stakeholders, which was a critical lesson for other provinces in China and other LMICs. Full article
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Article
Translation and Validation of the Modified A-DIVA Scale to European Portuguese: Difficult Intravenous Access Scale for Adult Patients
Int. J. Environ. Res. Public Health 2020, 17(20), 7552; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17207552 - 17 Oct 2020
Cited by 2 | Viewed by 854
Abstract
(1) Background: In Portugal, no accurate and reliable predictive instruments are known that could assist healthcare professionals in recognizing patients with difficult venous access. Thus, this study aimed to translate and validate the Modified A-DIVA scale to European Portuguese. (2) Methods: A methodological [...] Read more.
(1) Background: In Portugal, no accurate and reliable predictive instruments are known that could assist healthcare professionals in recognizing patients with difficult venous access. Thus, this study aimed to translate and validate the Modified A-DIVA scale to European Portuguese. (2) Methods: A methodological and cross-sectional study was conducted in two phases: translation of the Modified A-DIVA scale to European Portuguese following six stages proposed by Beaton and collaborators, and assessment of its psychometric properties in a non-probability sample of 100 patients who required peripheral intravenous catheterization in a Portuguese hospital. (3) Results: The European version of the Modified A-DIVA scale (A-DM scale) showed excellent inter-rater accordance scores, k = 0.593 (95% CI, 0.847 to 0.970), p < 0.0005. The A-DM scale’s criterion and construct validity was assessed through predictive, convergent, and correlational analysis with variables identified in the literature as associated with difficult peripheral intravenous access, with moderate to large magnitudes and statistical significance. (4) Conclusions: The A-DM scale is a reliable and valid instrument that can support healthcare professionals and researchers in the early identification of patients at risk of difficult peripheral intravenous access. Future validation studies are needed to test the A-DM scale’s applicability across clinical settings and in different patient cohorts. Full article
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Article
The Knowledge, Attitude, Practices, and Satisfaction of Non-Invasive Prenatal Testing among Chinese Pregnant Women under Different Payment Schemes: A Comparative Study
Int. J. Environ. Res. Public Health 2020, 17(19), 7187; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17197187 - 30 Sep 2020
Cited by 1 | Viewed by 750
Abstract
Non-invasive prenatal testing (NIPT) for aneuploidy screening has been widely applied across China, and costs can affect Chinese pregnant women’s choices. This study aims to assess the knowledge, attitude, practices (KAP) and satisfaction regarding NIPT among pregnant women in China, and to further [...] Read more.
Non-invasive prenatal testing (NIPT) for aneuploidy screening has been widely applied across China, and costs can affect Chinese pregnant women’s choices. This study aims to assess the knowledge, attitude, practices (KAP) and satisfaction regarding NIPT among pregnant women in China, and to further explore the relationship between payment schemes and women’s acceptability of and satisfaction with NIPT. A questionnaire survey was performed in Shenzhen and Zhengzhou, China, which separately applied “insurance coverage” and “out-of-pocket” payment scheme for NIPT. The major differences between the two cities were compared using chi-square test, Wilcoxon rank sum test, and propensity score matched analysis. Logistic regression models were applied to explore predictors for women’s acceptability and satisfaction. Compared with Zhengzhou participants, a higher proportion of Shenzhen women had heard of NIPT (87.30% vs. 64.03%), were willing to receive NIPT (91.80% vs. 80.43%) and had taken NIPT (83.12% vs. 54.54%), while their satisfaction level was lower. Having NIPT-related knowledge was associated with higher acceptability, and receiving genetic counseling helped to improve satisfaction. Besides, women with higher annual household incomes were more likely to take and be satisfied with NIPT. In conclusion, more attention should be paid to health education, subsidies for NIPT, and genetic counseling. Full article

Review

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Review
A Meta-Analysis of the Efficacy of Hyaluronic Acid Eye Drops for the Treatment of Dry Eye Syndrome
Int. J. Environ. Res. Public Health 2021, 18(5), 2383; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052383 - 01 Mar 2021
Cited by 1 | Viewed by 899
Abstract
Hyaluronic acid (HA) is commonly used for treating dry eye syndrome (DES). This meta-analysis was performed to compare the efficacies of HA- and non-HA-based eye drops, including saline and conventional artificial tears (ATs), for the treatment of dry eye disease. Eight databases (PubMed, [...] Read more.
Hyaluronic acid (HA) is commonly used for treating dry eye syndrome (DES). This meta-analysis was performed to compare the efficacies of HA- and non-HA-based eye drops, including saline and conventional artificial tears (ATs), for the treatment of dry eye disease. Eight databases (PubMed, EMBASE, Cochrane Central Register of Controlled Trials, DBpia, KoreaMed, KMBASE, RISS, KISS) were searched for studies comparing the efficacies of HA- and non-HA-based ATs in patients with DES published up to September 2020. Two independent reviewers assessed the quality and extracted the relevant data. The mean differences of Schirmer’s (SH) test scores, tear breakup times (TBUT), corneal fluorescein staining scores (Oxford scale, 0–4), and ocular surface disease indexes were calculated. The standard mean difference and 95% confidence interval were calculated using a random effect model. Nineteen studies, including 2078 cases, were included. HA eye drops significantly improved tear production compared with non-HA-based eye drops (standard mean difference (SMD) 0.18; 95% confidence interval (CI) 0.03, 0.33). In a subgroup analysis, the SH test scores and TBUT values after using HA significantly increased compared to those measured after using saline (SMD 0.27; 95% CI 0.05, 0.49 and SMD 0.28; 95% CI 0.03, 0.52, respectively). Based on these results, HA eye drops may be superior to non-HA eye drops including normal saline and ATs. Further research is needed to assess the efficacies stratified by age, treatment duration, the severity of dry eye, and optimal dosages. Full article
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Review
Woman, Mother, Wet Nurse: Engine of Child Health Promotion in the Spanish Monarchy (1850–1910)
Int. J. Environ. Res. Public Health 2020, 17(23), 9005; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17239005 - 03 Dec 2020
Viewed by 670
Abstract
In Spain, the wet nurse increased the survival of children through care and breastfeeding of other women’s children. They had a great development together with the Spanish monarchy between 1850 and 1910. The aim is to identify the role of wet nurses in [...] Read more.
In Spain, the wet nurse increased the survival of children through care and breastfeeding of other women’s children. They had a great development together with the Spanish monarchy between 1850 and 1910. The aim is to identify the role of wet nurses in the Spanish monarchy and the survival of the royal infants (s. XIX–XX). A scoping review is presented to study documents about the wet nurse in the Spanish monarchy. Applying the dialectical structural model of care (DSMC). Recognizing five thematic blocks that shape the historical-cultural model. Books, decrees and databases were analyzed: Scopus, Scielo, Dialnet, Cuiden, Medline/Pubmed, CINAHL, Science Direct and Google Scholar, from January to July 2020. The selection process was rigorous because it was difficult to choose. They had to overcome medical and moral exams. The selected rural northern wet nurses emigrated to Madrid. The contract was regulated by laws and paid. Wet nurses were hired by the monarchy due to health problems of the biological mother and a need for greater offspring. The wet nurse wore a typical costume, a symbol of wealth. The northern wet nurses hired by the monarchists have been the engine that has promoted the health of infants through the breastfeeding process. Full article
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Review
Developing a Family-Centered Care Model in the Neonatal Intensive Care Unit (NICU): A New Vision to Manage Healthcare
Int. J. Environ. Res. Public Health 2020, 17(19), 7197; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17197197 - 01 Oct 2020
Cited by 2 | Viewed by 1343
Abstract
Family-centered care (FCC) currently takes a greater role in health care, due to the increasing empowerment parents experience. Within neonatal intensive care units (NICUs), family participation has an impact on the humanized care of the preterm newborn (PN). This integrative review conducted according [...] Read more.
Family-centered care (FCC) currently takes a greater role in health care, due to the increasing empowerment parents experience. Within neonatal intensive care units (NICUs), family participation has an impact on the humanized care of the preterm newborn (PN). This integrative review conducted according to Whittemore and Knafl investigated current knowledge of the FCC model and its application in PN care in specific units. The data were collected from PubMed, Cochrane, CINHAL, Scopus, and Google Scholar. A total of 45 articles were used, of which 13 were selected which met inclusion criteria. Their methodological quality was evaluated using the mixed method appraisal tool (MMAT), and after they were analyzed and grouped into four thematic blocks: (1) parental participation; (2) health parental training; (3) benefits of family empowerment; and (4) humanized care. The results revealed that FCCs promote the integration of health equipment and family. In addition, parents become the primary caregivers. The benefits of the family–PN binomial enable an earlier hospital discharge. Humanized care involves an ethical approach, improving health care. Changes are still needed by health managers to adapt health services to the needs of the family and PNs. Full article
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Other

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Study Protocol
Study Protocol for Two-Steps Parallel Randomized Controlled Trial: Pre-Clinical Usability Tests for a New Double-Chamber Syringe
Int. J. Environ. Res. Public Health 2020, 17(22), 8376; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17228376 - 12 Nov 2020
Viewed by 547
Abstract
A new double-chamber syringe (DUO Syringe) was developed for intravenous drug administration and catheter flushing. This study presents a protocol for pre-clinical usability tests to validate the golden prototype of this new device, performed in a high-fidelity simulation lab by nurses. A two-steps [...] Read more.
A new double-chamber syringe (DUO Syringe) was developed for intravenous drug administration and catheter flushing. This study presents a protocol for pre-clinical usability tests to validate the golden prototype of this new device, performed in a high-fidelity simulation lab by nurses. A two-steps parallel randomized controlled trial with two arms was designed (with standard syringes currently used in clinical practice and with the DUO Syringe). After randomization, eligible and consented participants will be requested to perform, individually, intravenous drug administration and flushing, following the arm that has been allocated. The procedure will be video-recorded for posterior analyses. After the completion of the tasks, nurses will be asked to answer a demographic survey, as well as an interview about their qualitative assessment of the device. A final focus group with all participants will also be conducted. Primary outcomes will concern the DUO Syringe’s effectiveness, efficiency, and safety, while secondary outcomes will focus on nurses’ satisfaction and intention of use. The pre-clinical protocol was defined according to the legal requirements and ISO norms and was reviewed and approved by the Ethics Committee of the Health Sciences Research Unit: Nursing of the Nursing School of Coimbra. Full article
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Brief Report
Brief Report on Double-Chamber Syringes Patents and Implications for Infusion Therapy Safety and Efficiency
Int. J. Environ. Res. Public Health 2020, 17(21), 8209; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17218209 - 06 Nov 2020
Cited by 2 | Viewed by 670
Abstract
This review aimed to map the existing patents of double-chamber syringes that can be used for intravenous drug administration and catheter flush. A search was conducted in the Google patents database for records published prior to 28 October 2020, using several search terms [...] Read more.
This review aimed to map the existing patents of double-chamber syringes that can be used for intravenous drug administration and catheter flush. A search was conducted in the Google patents database for records published prior to 28 October 2020, using several search terms related to double-chamber syringes (DCS). Study eligibility and data extraction were performed by two independent reviewers. Of the initial 26,110 patents found, 24 were included in this review. The 24 DCS that were found display two or more independent chambers that allow for the administration of multiple solutions. While some of the DCS have designated one of the chambers as the flushing chamber, most patents only allow for the sequential use of the flushing chamber after intravenous drug administration. Most DCS were developed for drug reconstitution, usually with a freeze-dried drug in one chamber. Some patents were designed for safety purposes, with a parallel post-injection safety sheath chamber for enclosing a sharpened needle tip. None of the DCS found allow for a pre- and post-intravenous drug administration flush. Given the current standards of care in infusion therapy, future devices must allow for the sequential use of the flushing chamber to promote a pre-administration patency assessment and a post-administration device flush. Full article
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