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

A topical collection in International Journal of Environmental Research and Public Health (ISSN 1660-4601). This collection belongs to the section "Health Care Sciences".

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Editors

Prof. Dr. José Siles Gonzalez

E-Mail Website
Collection 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. Carmen Solano Ruiz

E-Mail Website
Collection 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. Paulo Joaquim Pina Queirós

E-Mail Website
Collection Editor
Escola Superior de Enfermagem de Coimbra, 3046-851 Coimbra, Portugal
Interests: nursing history; theory; method of care; epistemology
Dr. Benito Yañez-Araque

E-Mail Website
Collection 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 Issues, Collections and Topics in MDPI journals

Topical Collection 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
Collection Editors

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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 monthly journal published by MDPI.

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Keywords

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

Published Papers (28 papers)

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2023

Jump to: 2022, 2021, 2020

36 pages, 2974 KiB  
Article
Female Leadership during COVID-19: The Effectiveness of Diverse Approaches towards Mitigation Management during a Pandemic
by Esra Ozdenerol, Rebecca Michelle Bingham-Byrne and Jacob Seboly
Int. J. Environ. Res. Public Health 2023, 20(21), 7023; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20217023 - 06 Nov 2023
Viewed by 2185
Abstract
This paper tackles the question of how female leaders at national levels of government managed COVID-19 response and recovery from the first COVID-19 case in their respective countries through to 30 September 2021. The aim of this study was to determine which COVID-19 [...] Read more.
This paper tackles the question of how female leaders at national levels of government managed COVID-19 response and recovery from the first COVID-19 case in their respective countries through to 30 September 2021. The aim of this study was to determine which COVID-19 mitigations were effective in lowering the viral reproduction rate and number of new cases (per million) in each of the fourteen female presidents’ countries—Bangladesh, Barbados, Belgium, Bolivia, Denmark, Estonia, Finland, Germany, Iceland, Lithuania, New Zealand, Norway, Serbia, and Taiwan. We first compared these countries by finding a mean case rate (29,420 per million), mean death rate (294 per million), and mean excess mortality rate (+1640 per million). We then analyzed the following mitigation measures per country: school closing, workplace closing, canceling public events, restrictions on gatherings, closing public transport, stay-at-home requirements, restrictions on internal movement, international travel controls, income support, debt/contract relief, fiscal measures, international support, public information campaigns, testing policy, contact tracing, emergency investment in healthcare, investment in vaccines, facial coverings, vaccination policy, and protection of the elderly. We utilized the random forest approach to examine the predictive significance of these variables, providing more interpretability. Subsequently, we then applied the Wilcoxon rank-sum statistical test to see the differences with and without mitigation in effect for the variables that were found to be significant by the random forest model. We observed that different mitigation strategies varied in their effectiveness. Notably, restrictions on internal movement and the closure of public transportation proved to be highly effective in reducing the spread of COVID-19. Embracing qualities such as community-based, empathetic, and personable leadership can foster greater trust among citizens, ensuring continued adherence to governmental policies like mask mandates and stay-at-home orders, ultimately enhancing long-term crisis management. Full article
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12 pages, 357 KiB  
Article
Changes in Cardiorespiratory Fitness and Probability of Developing Abdominal Obesity at One and Two Years
by Ricardo Ortega, Gonzalo Grandes, María Teresa Agulló-Ortuño and Sagrario Gómez-Cantarino
Int. J. Environ. Res. Public Health 2023, 20(6), 4754; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20064754 - 08 Mar 2023
Viewed by 1050
Abstract
Low cardiorespiratory fitness (CRF) is associated with an increased risk of developing abdominal obesity (AO), but it is not known if and/or how changes in CRF affect AO. We examined the relationship between changes in CRF and the risk of developing AO. This [...] Read more.
Low cardiorespiratory fitness (CRF) is associated with an increased risk of developing abdominal obesity (AO), but it is not known if and/or how changes in CRF affect AO. We examined the relationship between changes in CRF and the risk of developing AO. This is a retrospective observational study of a cohort of 1883 sedentary patients, who had participated in a clinical trial of physical activity promotion carried out in Spain (2003–2007). These data were not used in the clinical trial. At baseline, they were free of cardiovascular disease, hypertension, diabetes, dyslipidemia, and/or AO; with an indirect VO2max measurement; 19–80 years old; and 62% were women. All the measures were repeated at 6, 12, and 24 months. The exposure factor was the change in CRF at 6 or 12 months, categorized in these groups: unfit-unfit, unfit-fit, fit-unfit, and fit-fit. We considered fit and unfit participants as those with VO2max values in the high tertile, and in the moderate or low tertiles, respectively. The main outcome measure was the risk of developing AO at one and two years, as defined by waist circumference >102 (men) and >88 (women) cm. At two years, 10.5% of the participants had developed AO: 13.5% in the unfit-unfit group of change at 6 months; 10.3% in the unfit-fit group (adjusted odds ratio (AOR) 0.86; 95% confidence interval (CI) 0.49–1.52); 2.6% in the fit-unfit group (AOR 0.13; 95%CI 0.03–0.61); and 6.0% in the fit-fit group (AOR 0.47; 95%CI 0.26–0.84). Those who stayed fit at 6 months decreased the probability of developing abdominal obesity at two years. Full article
11 pages, 695 KiB  
Article
Does Healthcare Provider Counseling for Weight Management Behaviors among Hispanic Adults Who Are Overweight/Obese Vary by Acculturation Level?
by Mary L. Greaney, Furong Xu, Christie L. Ward-Ritacco, Steven A. Cohen, Kerri A. Ellis and Deborah Riebe
Int. J. Environ. Res. Public Health 2023, 20(4), 2778; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20042778 - 04 Feb 2023
Viewed by 1077
Abstract
This cross-sectional study explored differences in the receipt of health care provider (HCP) counseling to control/lose weight and adopt weight-related lifestyle behavior changes among Hispanic respondents according to acculturation level. Differences in reported action regarding HCP counseling were also examined. Data from four [...] Read more.
This cross-sectional study explored differences in the receipt of health care provider (HCP) counseling to control/lose weight and adopt weight-related lifestyle behavior changes among Hispanic respondents according to acculturation level. Differences in reported action regarding HCP counseling were also examined. Data from four National Health and Nutrition Examination Survey (NHANES) cycles (2011–2018) were analyzed, with the analytic sample limited to Hispanic respondents who were overweight/obese. Respondents’ acculturation levels were derived from their reported country of origin and the primary language spoken at home. Respondents who reported speaking only Spanish or more Spanish than English at home were classified as primarily speaking Spanish at home. In contrast, those who reported speaking Spanish and English equally, more English than Spanish, or only English were categorized as primarily speaking English at home. Weighted multivariate logistic regression models were utilized to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to determine if differences in acculturation levels existed regarding the likelihood of receiving HCP counseling to (1) control/lose weight, (2) increase exercise/PA, and (3) reduce fat/calorie intake. Similar analyses examined differences in reported action regarding HCP counseling according to acculturation level. The analysis found no significant differences in receiving HCP counseling according to acculturation level. However, non-US-born respondents who primarily spoke Spanish at home were less likely than US-born respondents to report acting to control/lose weight (p = 0.009) or increase exercise/PA (p = 0.048), but were more likely to report having taken action to reduce fat/calorie intake (p = 0.016). This study revealed differences between acting on recommendations of health care professionals according to acculturation level, indicating a need for interventions tailored to acculturation levels. Full article
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2022

Jump to: 2023, 2021, 2020

11 pages, 354 KiB  
Article
Adaptation and Validation of the Sexuality Attitudes and Beliefs Scale for the Italian Context
by Cinzia Gradellini, Shaniko Kaleci, Margarida Sim-Sim, Hélia Dias, Daniela Mecugni, Vicki Aaberg and Sagrario Gómez-Cantarino
Int. J. Environ. Res. Public Health 2022, 19(21), 14162; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192114162 - 29 Oct 2022
Cited by 2 | Viewed by 1623
Abstract
Background: Nurses dealing with a patient’s sexuality must start from an awareness of their own experience, specific attitudes, and possible limits. What emerges from the literature is a conservative tendency in nurses, which underlines the difficulty in this awareness, but even a difficulty [...] Read more.
Background: Nurses dealing with a patient’s sexuality must start from an awareness of their own experience, specific attitudes, and possible limits. What emerges from the literature is a conservative tendency in nurses, which underlines the difficulty in this awareness, but even a difficulty in improving the necessary knowledge/skills. It is, therefore, essential to create tools that can raise awareness of these limits. Objective: the present study aims to explore the psychometric properties of the Attitudes and Beliefs about Sexuality Scale, adapted and validated for the Italian context. Method: This is an instrumental, cross-sectional piece of research, whose SABS validation process applies the steps of Beaton and Valmi. The convenience sample collected data from 223 participants in the first approach. This was followed by a retest involving 44 students randomly selected from those who responded in the first phase. Ethical principles were respected. Results: The SABS questionnaire demonstrated good test-retest reliability, good internal consistency, and adequate construct validity. Conclusions: The Italian version of the SABS is valid and reliable for use with nursing students. This is the fourth language in which the SABS is available for research. Full article
19 pages, 979 KiB  
Review
Current Social Perception of and Value Attached to Nursing Professionals’ Competences: An Integrative Review
by Margarita Rodríguez-Pérez, Francisco Mena-Navarro, Abraham Domínguez-Pichardo and Cristina Teresa-Morales
Int. J. Environ. Res. Public Health 2022, 19(3), 1817; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031817 - 05 Feb 2022
Cited by 13 | Viewed by 6616
Abstract
In order to develop nurses’ identities properly, they need to publicise their professional competences and make society aware of them. For that, this study was conducted to describe the competences that society currently attributes to nursing professionals and how nursing is valued in [...] Read more.
In order to develop nurses’ identities properly, they need to publicise their professional competences and make society aware of them. For that, this study was conducted to describe the competences that society currently attributes to nursing professionals and how nursing is valued in society. This review was based on the conceptual framework by Whittemore and Knafl. The literature search was conducted using PubMed, WOS, and CINAHL databases, and the search strategy was based on a combination of natural language and standardised keywords, with limits and criteria for inclusion, exclusion, and quality. The results of the studies were classified and coded in accordance with the competence groups of the professional profile described in the Tuning Educational Structures in Europe programme. Fourteen studies were selected. The most commonly reported competence groups were as follows: nursing practice and clinical decision making; and communication and interpersonal competences. Nursing is perceived as a healthcare profession dedicated to caring for individuals. Its other areas of competence and its capacity for leadership are not well known. In order to develop a professional identity, it is essential to raise awareness of the competences that make up this professional profile. Full article
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13 pages, 321 KiB  
Article
Extended Prescribing Roles for Pharmacists in Poland—A Survey Study
by Jagoda Miszewska, Natalia Wrzosek and Agnieszka Zimmermann
Int. J. Environ. Res. Public Health 2022, 19(3), 1648; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031648 - 31 Jan 2022
Cited by 3 | Viewed by 2732
Abstract
Background: In recent years, a systematic increase in the role and powers of pharmacists has been observed. The COVID-19 pandemic has shown that this is a professional group that is extremely necessary for the smooth functioning of the health care system. One of [...] Read more.
Background: In recent years, a systematic increase in the role and powers of pharmacists has been observed. The COVID-19 pandemic has shown that this is a professional group that is extremely necessary for the smooth functioning of the health care system. One of the important powers of pharmacists is the possibility of issuing prescriptions for both patients in the pharmacy and for themselves and their family members. Polish pharmacists obtained extended entitlements in this field in March 2020. Due to the extension of pharmacists’ prescribing rights in Poland, it was decided in this study to determine the current practice of pharmaceutical prescribing, and pharmacists’ views on their new duties. Methods: The study used the method of a questionnaire, which was distributed to all pharmacists actively working in Poland. During the study, 309 completed questionnaires were obtained that gathered information about prescriptions written by pharmacists, as well as their opinions related to this entitlement. The results of the survey were analyzed using descriptive statistics. Results: Out of all authorized pharmacists, 75.62% use the new, extended authorization to issue pharmaceutical prescriptions. About half of them believe their prescriptions should be refundable. Only 11.52% of respondents do not use the entitlement to issue prescriptions for themselves or their family members. In addition, it was noticed that those who write such prescriptions most often use the fully paid version. Conclusions: Polish pharmacists use the new entitlements willingly but carefully. The legal provisions governing electronic prescription should be clearer. In addition, the idea of continued prescription should be developed as this is the most common reason that pharmacists issue prescriptions. Full article
15 pages, 1553 KiB  
Article
The Impact of Absorptive Capacity on Innovation: The Mediating Role of Organizational Learning
by Rafael Sancho-Zamora, Felipe Hernández-Perlines, Isidro Peña-García and Santiago Gutiérrez-Broncano
Int. J. Environ. Res. Public Health 2022, 19(2), 842; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19020842 - 12 Jan 2022
Cited by 27 | Viewed by 5814
Abstract
Although the relevant literature has already demonstrated the impact that absorptive capacity has on companies’ innovation capacity, we have found few studies that analyze the role of learning capability in this relationship. The main objective of this study was to examine the role [...] Read more.
Although the relevant literature has already demonstrated the impact that absorptive capacity has on companies’ innovation capacity, we have found few studies that analyze the role of learning capability in this relationship. The main objective of this study was to examine the role of organizational learning in this relationship. For this purpose, a quantitative research approach was used. A total of 306 valid questionnaires were obtained from small and medium-sized Spanish companies in different sectors. The collected data were analyzed using the multivariate Partial Least Square (PLS) quantitative structural equation technique. According to the result, absorption capacity turns into innovation mainly when learning capacity is involved in this process. This study provides empirical evidence of this relationship and fills this gap. It can also help organizations understand and clarify what would be the most appropriate way in to manage knowledge to improve their innovation levels. Full article
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2021

Jump to: 2023, 2022, 2020

17 pages, 1028 KiB  
Article
Determinants of Consumers’ Trust in Biotech Brands and Purchase Intentions towards the Cord Blood Products
by Shih-Wei Chen, Ku-Yuan Lee and Chi-Ming Hsieh
Int. J. Environ. Res. Public Health 2021, 18(21), 11574; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182111574 - 04 Nov 2021
Viewed by 1947
Abstract
The development of the biotech industry is in full swing, and consumers have begun to value biotech brands. Since biotech products often focus on the future or special benefits, consumers inevitably bear certain risks when purchasing biotech products, and their trust in the [...] Read more.
The development of the biotech industry is in full swing, and consumers have begun to value biotech brands. Since biotech products often focus on the future or special benefits, consumers inevitably bear certain risks when purchasing biotech products, and their trust in the biotech brand will have an important impact on their purchase intention. Previous studies have lacked a targeted understanding of consumer trust in biotech brands and a discussion of cultural viewpoints. This study introduced the concept of personal connections in Chinese relationalism and trust strategies in Chinese society to address this gap. In-depth interviews and focus group discussions were conducted in collaboration with Company X, a listed Taiwanese cord blood company, to extract the key factors influencing consumer trust and purchase intention of biotech brands. After constructing the structure model, the study was validated using a structural equation model through investigation and survey. The findings indicated that consumer trust in biotech brands was constructed by a combination of kinship trust transfer and emergent trust transfer within the consumer relationship network, as well as institutional trust and professional trust outside the relationship network and that a significant positive correlation existed between consumer trust in biotech brands and purchase intention. The acquaintances within the consumer relationship network include not only relatives and friends but also health care workers and netizens that consumers come into contact with. In addition, kinship trust transfer and emergent trust transfer within the consumer relationship network have a greater impact on trust in biotech brands than the institutional trust and professional trust outside the relationship network. The findings of this study deepen the understanding of consumer trust in biotech brands across cultures, and suggest that future marketing communication should be expanded to include key players within the consumer relationship network. Full article
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8 pages, 333 KiB  
Communication
Peripherally Inserted Central Catheter Placement in a Cardiology Ward: A Focus Group Study of Nurses’ Perspectives
by Anabela Salgueiro-Oliveira, Rafael A. Bernardes, David Adriano, Beatriz Serambeque, Paulo Santos-Costa, Liliana B. Sousa, Fernando Gama, Rita Barroca, Luciene M. Braga, João Graveto and Pedro Parreira
Int. J. Environ. Res. Public Health 2021, 18(14), 7618; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18147618 - 17 Jul 2021
Cited by 1 | Viewed by 2579
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
15 pages, 661 KiB  
Article
Examining the Determinants of Healthcare Workers’ Performance: A Configurational Analysis during COVID-19 Times
by Benito Yáñez-Araque, Sagrario Gómez-Cantarino, Santiago Gutiérrez-Broncano and Víctor-Raúl López-Ruiz
Int. J. Environ. Res. Public Health 2021, 18(11), 5671; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18115671 - 25 May 2021
Cited by 18 | Viewed by 4511
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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13 pages, 611 KiB  
Article
Occupational Health and Safety, Organisational Commitment, and Turnover Intention in the Spanish IT Consultancy Sector
by Julio Suárez-Albanchez, Juan Jose Blazquez-Resino, Santiago Gutierrez-Broncano and Pedro Jimenez-Estevez
Int. J. Environ. Res. Public Health 2021, 18(11), 5658; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18115658 - 25 May 2021
Cited by 17 | Viewed by 5340
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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15 pages, 1671 KiB  
Article
The Impact of Internalized Stigma on LGBT Parenting and the Importance of Health Care Structures: A Qualitative Study
by Carolina Alday-Mondaca and Siu Lay-Lisboa
Int. J. Environ. Res. Public Health 2021, 18(10), 5373; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105373 - 18 May 2021
Cited by 8 | Viewed by 5220
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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14 pages, 2094 KiB  
Review
A Meta-Analysis of the Efficacy of Hyaluronic Acid Eye Drops for the Treatment of Dry Eye Syndrome
by Yun-Jung Yang, Won-Young Lee, Young-jin Kim and Yeon-pyo Hong
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 40 | Viewed by 6986
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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24 pages, 1146 KiB  
Article
Health Investment Management and Healthcare Quality in the Public System: A Gender Perspective
by María del Carmen Valls Martínez, Alicia Ramírez-Orellana and Mayra Soledad Grasso
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 8 | Viewed by 2933
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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17 pages, 1780 KiB  
Communication
Work Methods for Nursing Care Delivery
by Pedro Parreira, Paulo Santos-Costa, Manoel Neri, António Marques, Paulo Queirós and Anabela Salgueiro-Oliveira
Int. J. Environ. Res. Public Health 2021, 18(4), 2088; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18042088 - 21 Feb 2021
Cited by 22 | Viewed by 12944
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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13 pages, 1186 KiB  
Article
The Quality of Carer–Patient Relationship Scale: Adaptation and Validation into Portuguese
by Rosa Silva, Elzbieta Bobrowicz-Campos, Paulo Santos-Costa, Isabel Gil, Hugo Neves and João Apóstolo
Int. J. Environ. Res. Public Health 2021, 18(3), 1264; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18031264 - 31 Jan 2021
Cited by 1 | Viewed by 2905
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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10 pages, 617 KiB  
Article
Men’s Positive and Negative Experiences Following Acute Myocardial Infarction
by MCarmen Solano-Ruiz, Genival Fernandes de Freitas, M. Idoia Ugarte-Gurrutxaga, Sagrario Gómez-Cantarino and José Siles-González
Int. J. Environ. Res. Public Health 2021, 18(3), 1053; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18031053 - 25 Jan 2021
Cited by 4 | Viewed by 2967
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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2020

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10 pages, 660 KiB  
Article
Adaptations to Swimming Training in Athletes with Down’s Syndrome
by José María González-Ravé, Anthony P. Turner and Shaun M. Phillips
Int. J. Environ. Res. Public Health 2020, 17(24), 9175; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249175 - 08 Dec 2020
Cited by 3 | Viewed by 3259
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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19 pages, 877 KiB  
Review
Woman, Mother, Wet Nurse: Engine of Child Health Promotion in the Spanish Monarchy (1850–1910)
by José Siles-González, Laura Romera-Álvarez, Mercedes Dios-Aguado, Mª. Idioia Ugarte-Gurrutxaga and Sagrario Gómez-Cantarino
Int. J. Environ. Res. Public Health 2020, 17(23), 9005; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17239005 - 03 Dec 2020
Cited by 5 | Viewed by 2727
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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16 pages, 366 KiB  
Article
Nursing Students’ Relational Skills with Elders Improve through Humanitude Care Methodology
by Rosa Cândida Carvalho Pereira Melo, Paulo Joaquim Pina Queirós, Luiza Hiromi Tanaka, Liliana Vanessa Lúcio Henriques and Hugo Leiria Neves
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 5 | Viewed by 2743
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
11 pages, 961 KiB  
Study Protocol
Study Protocol for Two-Steps Parallel Randomized Controlled Trial: Pre-Clinical Usability Tests for a New Double-Chamber Syringe
by Pedro Parreira, Liliana B. Sousa, Inês A. Marques, Paulo Santos-Costa, Sara Cortez, Filipa Carneiro, Arménio Cruz and Anabela Salgueiro-Oliveira
Int. J. Environ. Res. Public Health 2020, 17(22), 8376; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17228376 - 12 Nov 2020
Cited by 1 | Viewed by 2292
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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13 pages, 687 KiB  
Article
Usability Assessment of an Innovative Device in Infusion Therapy: A Mix-Method Approach Study
by Pedro Parreira, Liliana B. Sousa, Inês A. Marques, Paulo Santos-Costa, Sara Cortez, Filipa Carneiro, Arménio Cruz and Anabela Salgueiro-Oliveira
Int. J. Environ. Res. Public Health 2020, 17(22), 8335; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17228335 - 11 Nov 2020
Cited by 12 | Viewed by 3036
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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14 pages, 337 KiB  
Article
Facilitating Factors of Professional Health Practice Regarding Female Genital Mutilation: A Qualitative Study
by M Idoia Ugarte-Gurrutxaga, Brígida Molina-Gallego, Laura Mordillo-Mateos, Sagrario Gómez-Cantarino, M. Carmen Solano-Ruiz and Gonzalo Melgar de Corral
Int. J. Environ. Res. Public Health 2020, 17(21), 8244; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17218244 - 08 Nov 2020
Cited by 8 | Viewed by 2481
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
8 pages, 667 KiB  
Brief Report
Brief Report on Double-Chamber Syringes Patents and Implications for Infusion Therapy Safety and Efficiency
by Liliana B. Sousa, Paulo Santos-Costa, Inês A. Marques, Arménio Cruz, Anabela Salgueiro-Oliveira and Pedro Parreira
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 5 | Viewed by 2132
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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14 pages, 2352 KiB  
Article
How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China
by Shuduo Zhou, Jin Xu, Xiaochen Ma, Beibei Yuan, Xiaoyun Liu, Hai Fang and Qingyue Meng
Int. J. Environ. Res. Public Health 2020, 17(21), 8040; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17218040 - 31 Oct 2020
Cited by 6 | Viewed by 2310
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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11 pages, 725 KiB  
Article
Translation and Validation of the Modified A-DIVA Scale to European Portuguese: Difficult Intravenous Access Scale for Adult Patients
by Paulo Santos-Costa, Liliana B. Sousa, Fredericus H.J. van Loon, Anabela Salgueiro-Oliveira, Pedro Parreira, Margarida Vieira and João Graveto
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 12 | Viewed by 3231
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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22 pages, 804 KiB  
Review
Developing a Family-Centered Care Model in the Neonatal Intensive Care Unit (NICU): A New Vision to Manage Healthcare
by Sagrario Gómez-Cantarino, Inmaculada García-Valdivieso, Eva Moncunill-Martínez, Benito Yáñez-Araque and M. Idoia Ugarte Gurrutxaga
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 31 | Viewed by 9303
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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13 pages, 336 KiB  
Article
The Knowledge, Attitude, Practices, and Satisfaction of Non-Invasive Prenatal Testing among Chinese Pregnant Women under Different Payment Schemes: A Comparative Study
by Wenjun Zhu, XiaoXiao Ling, Wenru Shang and Jiayan Huang
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 7 | Viewed by 2262
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
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