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Volume 10
Issue 3
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Healthcare, Volume 10, Issue 3 (March 2022) – 183 articles

Cover Story (view full-size image): Despite the guidelines available, a large percentage of cancer patients continue to suffer from ineffectively treated pain. This survey aims to assess the strengths and weaknesses of cancer pain management in Italy. Only 22% of physicians are exclusively pain therapists; 75% are specialists in anesthesiology, intensive care, and pain medicine. Most pain centers are hospital or university facilities. The strengths are careful opioid prescriptions, the use of strategies for the treatment of neuropathic pain, patient/healthcare provider partnerships, and breakthrough cancer pain management. Weaknesses to be addressed include poor adherence to guidelines, inadequate attention toward the patient’s quality of life, insufficient use of minimally invasive techniques, lack of teamwork approaches, inappropriate timing of pain specialist engagement, and poor telemedicine use. View this paper.
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17 pages, 1870 KiB  
Review
A Comparison between Conventional and Extracorporeal Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis
by Reem Alfalasi, Jessica Downing, Stephanie Cardona, Bobbi-Jo Lowie, Matthew Fairchild, Caleb Chan, Elizabeth Powell, Ali Pourmand, Alison Grazioli and Quincy K. Tran
Healthcare 2022, 10(3), 591; https://doi.org/10.3390/healthcare10030591 - 21 Mar 2022
Cited by 14 | Viewed by 4036
Abstract
There is limited evidence comparing the use of extracorporeal cardiopulmonary resuscitation (ECPR) to CPR in the management of refractory out-of-hospital cardiac arrest (OHCA). We conducted a systematic review and meta-analysis to compare survival and neurologic outcomes associated with ECPR versus CPR in the [...] Read more.
There is limited evidence comparing the use of extracorporeal cardiopulmonary resuscitation (ECPR) to CPR in the management of refractory out-of-hospital cardiac arrest (OHCA). We conducted a systematic review and meta-analysis to compare survival and neurologic outcomes associated with ECPR versus CPR in the management of OHCA. We searched PubMed, EMBASE, and Scopus to identify observational studies and randomized controlled trials comparing ECPR and CPR. We used the Newcastle–Ottawa Scale and Cochrane’s risk-of-bias tool to assess studies’ quality. We used random-effects models to compare outcomes between the pooled populations and moderator analysis to identify sources of heterogeneity and perform subgroup analysis. We identified 2088 articles and included 13, with 18,620 patients with OHCA. A total of 16,701 received CPR and 1919 received ECPR. Compared with CPR, ECPR was associated with higher odds of achieving favorable neurologic outcomes at 3 (OR 5, 95% CI 1.90–13.1, p < 0.01) and 6 months (OR 4.44, 95% CI 2.3–8.5, p < 0.01). We did not find a significant survival benefit or impact on neurologic outcomes at hospital discharge or 1 month following arrest. ECPR is a promising but resource-intensive intervention with the potential to improve long-term outcomes among patients with OHCA. Full article
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<p>Flow diagram for study selection. Abbreviations: cCPR, conventional cardiopulmonary resuscitation; ECPR, extracorporeal cardiopulmonary resuscitation; IHCA, in-hospital cardiac arrest. Adapted from the PRISMA 2020 statement [<a href="#B10-healthcare-10-00591" class="html-bibr">10</a>].</p> Full article ">Figure 2
<p>Association of ECPR and conventional CPR with any favorable outcome, defined as survival to hospital discharge or favorable neurologic function at hospital discharge or 30 or more days after cardiac arrest, among patients with OHCA. Abbreviations: CPR, cardiopulmonary resuscitation; ECPR, extracorporeal pulmonary resuscitation; OHCA, out-of-hospital cardiac arrest.</p> Full article ">Figure 3
<p>Association of ECPR and conventional CPR with survival to hospital discharge among patients with OHCA.</p> Full article ">Figure 4
<p>Association of ECPR and conventional CPR with survival with a favorable neurologic outcome among patients with OHCA. Favorable neurologic outcome is defined as Cerebral Performance Category 1 or 2. (<b>a</b>) Odds ratio of favorable neurological outcome at hospital discharge; (<b>b</b>) Odds ratio of favorable neurological outcome at one month after arrest; (<b>c</b>) Odds ratio of favorable neurological outcome at three months after arrest; (<b>d</b>) Odds ratio of favorable neurological outcome at six months after arrest.</p> Full article ">
24 pages, 4688 KiB  
Article
Characterizing the Dynamic Evolution of Interagency Collaborative Decision-Making Networks in Response to COVID-19 in China: A Policy Document Analysis
by Quan Cheng, Shulin Zheng, Zheng Xiong and Minwang Lin
Healthcare 2022, 10(3), 590; https://doi.org/10.3390/healthcare10030590 - 21 Mar 2022
Cited by 7 | Viewed by 2836
Abstract
Collaborative decision-making across multiple government agencies is considered a critical and effective strategy to combat public health crisis; however, we know little about how the collaborative decision-making works and evolves during periods of crisis. To fill this lacuna, this study uncovers the structure [...] Read more.
Collaborative decision-making across multiple government agencies is considered a critical and effective strategy to combat public health crisis; however, we know little about how the collaborative decision-making works and evolves during periods of crisis. To fill this lacuna, this study uncovers the structure and evolving dynamics of the network by employing a policy document analysis. Based on the policy documents, jointly issued by the agencies of Chinese central government in four phases regarding COVID-19 control, we first constructed a co-occurrence matrix of policy-issuing agencies to outline the network structure, then drew a breadth–depth matrix to identify the role evolution of agencies, and lastly built a two-mode network consisting of policy topics and agencies to determine the evolution mechanisms of policy attentions for each agency. It was found that the network structure of interagency collaboration involves three forms: discrete structure in the early phase, subgroup structure in the middle phase, and connected structure in the latter phase. Agencies embedded in the network can be categorized into three types: leading agencies, key agencies, and auxiliary agencies, with their constituent members changed as the pandemic risks are gradually becoming under control. Furthermore, each type has its own primary policy attentions, but shares some common foci in all four phases and shifts attention in the emergency management process. This study contributes to shedding light on the formation of and variations in collaborative networks in health emergencies and provides policy implications for other countries that have struggled against COVID-19. Full article
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<p>Research methods design.</p> Full article ">Figure 2
<p>Collaborative decision-making networks in each phase. (<b>a</b>) T1 (20 January 2020–20 February 2020); (<b>b</b>) T2 (21 February 2020–17 March 2020); (<b>c</b>) T3 (18 March 2020–28 April 2020); (<b>d</b>) T4 (29 April 2020–7 August 2020).</p> Full article ">Figure 3
<p>Two-dimensional “breadth–depth” matrix.</p> Full article ">Figure 3 Cont.
<p>Two-dimensional “breadth–depth” matrix.</p> Full article ">Figure 4
<p>“Agency–topic” relationship network in the first phase.</p> Full article ">Figure 5
<p>“Agency–topic” relationship network in the second phase.</p> Full article ">Figure 6
<p>“Agency–topic” relationship network in the third phase.</p> Full article ">Figure 7
<p>Agency–topic relationship network in the fourth phase.</p> Full article ">Figure 8
<p>“Agency–topic” relationship evolution Sankey diagram.</p> Full article ">
16 pages, 1287 KiB  
Article
The Impact of Public, Private, and Out-of-Pocket Health Expenditures on Under-Five Mortality in Malaysia
by Renuka Devi Logarajan, Norashidah Mohamed Nor, Abdalla Sirag, Rusmawati Said and Saifuzzaman Ibrahim
Healthcare 2022, 10(3), 589; https://doi.org/10.3390/healthcare10030589 - 21 Mar 2022
Cited by 6 | Viewed by 4569
Abstract
Health financing in Malaysia is intensely subsidised by public funding and is increasingly sourced by household out-of-pocket financing, yet the under-five mortality rate has been gradually increasing in the last decade. In this context, this study aims to investigate the relationship between public, [...] Read more.
Health financing in Malaysia is intensely subsidised by public funding and is increasingly sourced by household out-of-pocket financing, yet the under-five mortality rate has been gradually increasing in the last decade. In this context, this study aims to investigate the relationship between public, private, and out-of-pocket health expenditures and the under-five mortality rate in Malaysia using the autoregressive distributed lag (ARDL) estimation technique, whereby critical test values are recalculated using the response surface method for a time-series data of 22 years. The findings reveal that out-of-pocket health expenditure deteriorates the under-five mortality rate in Malaysia, while public and private health expenditures are statistically insignificant. Therefore, an effective health financing safety net may be an option to ensure an imperative child health outcome. Full article
(This article belongs to the Collection Health Economics & Finance and Global Public Health)
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<p>Global health expenditure in 2018. Source: Report on Global Spending on Health 2020: Weathering the Storm (WHO, 2020) and Malaysia National Health Accounts: Health Expenditure Report 1997–2018 (Ministry of Health, 2020).</p> Full article ">Figure 2
<p>Health expenditure in Malaysia, from 1997 to 2018. Source: Malaysia National Health Accounts, Health Expenditure Report 1997–2018 (Ministry of Health, 2020).</p> Full article ">Figure 3
<p>Under-five mortality rate from 1990 to 2018. Source: Department of Statistics Malaysia and United Nations Inter-Agency Group for Child Mortality Estimation 2018.</p> Full article ">Figure 4
<p>Cumulative sum (CUSUM) and CUSUM square test for stability.</p> Full article ">
13 pages, 879 KiB  
Article
Evaluation of Sleep Disturbances in Patients with Nocturnal Epileptic Seizures in a Romanian Cross-Sectional Study
by Réka Szabó, Florica Voiță-Mekereș, Cristina Tudoran, Ahmed Abu-Awwad, Mariana Tudoran, Petru Mihancea and Codrin Dan Nicolae Ilea
Healthcare 2022, 10(3), 588; https://doi.org/10.3390/healthcare10030588 - 21 Mar 2022
Cited by 3 | Viewed by 2227
Abstract
(1) Background: Based on the premise that epilepsy is frequently associated with hypnopathies, in this study we aim to analyze the prevalence of sleep disturbances among patients with epilepsy, with exclusively or predominantly nocturnal seizures, in relation to demographic factors as well as [...] Read more.
(1) Background: Based on the premise that epilepsy is frequently associated with hypnopathies, in this study we aim to analyze the prevalence of sleep disturbances among patients with epilepsy, with exclusively or predominantly nocturnal seizures, in relation to demographic factors as well as clinical and electroencephalography (EEG) aspects. (2) Methods: 69 patients with nocturnal epilepsy were included in our study. Sleep disturbances were measured with the Pittsburgh Sleep Quality Index (PSQI) questionnaire, followed by a long-term video-EEG monitoring during sleep. We analyzed the PSQI results in relation to patients’ gender and age and determined the correlations between the PSQI scores and the modifications on video-EEG recordings, in comparison to a control group of 25 patients with epilepsy but without nocturnal seizures. (3) Results: We found a statistically significant difference between the PSQI of patients with nocturnal seizures compared to those without nocturnal epileptic manifestations. In the experimental group, the mean PSQI score was 7.36 ± 3.91 versus 5.04 ± 2.56 in controls. In women, the average PSQI score was 8.26, whilst in men it only reached 6.41, highlighting a statistically significant difference between genders (p ˂ 0.01). By examining the relationships between the PSQI scores and certain sleep-related factors, evidenced on the nocturnal video-EEG, we found a statistically significant difference between PSQI values of patients who reached the N2 stage, and those who reached the N3 stage of nonrapid eye movement (NREM) sleep, highlighting that those with a more superficial nocturnal sleep also had higher PSQI scores. There were no statistically significant differences regarding the PSQI scores between patients with or without interictal epileptiform discharges, and also in the few patients with nocturnal seizures where we captured ictal activity. (4) Conclusions: we evidenced in this study a poor quality of sleep in patients with nocturnal epilepsy, mostly in women, independent of age. We observed that sleep disturbances were due to superficial and fragmented sleep with frequent microarousals, not necessarily caused by the electrical epileptiform activity. Full article
(This article belongs to the Special Issue Sleep Disorders: Chronic Medical Burden)
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<p>PSQI score distribution according to the deepest sleep stage reached. PSQI score distribution depending on sleep fragmentation by microarousals; comparison between the experimental group versus the control group.</p> Full article ">Figure 2
<p>Correlation between PSQI score in relation to patients’ age in the experimental group versus control group; Spearman’s correlation.</p> Full article ">
14 pages, 1372 KiB  
Article
Design and Definition of a New Decision Support System Aimed to the Hierarchization of Patients Candidate to Be Admitted to Intensive Care Units
by Manuel Casal-Guisande, Alberto Comesaña-Campos, Jorge Cerqueiro-Pequeño and José-Benito Bouza-Rodríguez
Healthcare 2022, 10(3), 587; https://doi.org/10.3390/healthcare10030587 - 21 Mar 2022
Cited by 4 | Viewed by 2339
Abstract
The triage processes prior to the assignation of healthcare resources in hospitals are some of the decision-making processes that more severely affect patients. This effect gets even worse in health emergency situations and intensive care units (ICUs). Aiming to facilitate the decision-making process, [...] Read more.
The triage processes prior to the assignation of healthcare resources in hospitals are some of the decision-making processes that more severely affect patients. This effect gets even worse in health emergency situations and intensive care units (ICUs). Aiming to facilitate the decision-making process, in this work the use of vague fuzzy numbers is proposed, aiming to define a multi-attribute patient hierarchization method to be used in emergency situations at hospital ICUs. The incorporation of fuzzy models allows for modelling the vagueness and uncertainty associated with decision criteria evaluation, with which more efficient support is provided to the decision-making process. After defining the methodology, the effectiveness of this new system for patient hierarchization is shown in a case study. As a consequence of that, it is proved that the integration of decision-support systems into healthcare environments results to be efficient and productive, suggesting that if a part of the decision process is supported by these systems, then the errors associated with wrong interpretations and/or diagnoses might be reduced. Full article
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<p>Flow diagram for the decision support system. This diagram shows the different flows of information across the system stages presented in <a href="#healthcare-10-00587-t005" class="html-table">Table 5</a>. Label 1 is related with the preliminary assessments, label 2 with the weightings calculation block, label 3 with the patients’ status assessment, label 4 with the hierarchy calculation block, and finally, label 5 is related with decision-making.</p> Full article ">Figure 2
<p>‘Definition of the type of problem’ screen with data already loaded.</p> Full article ">Figure 3
<p>Hierarchy calculation module.</p> Full article ">
17 pages, 63162 KiB  
Systematic Review
The Dose-Response Efficacy of Physical Training on Frailty Status and Physical Performance in Community-Dwelling Elderly: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
by Pei-Shan Li, Chia-Jung Hsieh, Eva Berthy Tallutondok and Hsuan-Ju Peng
Healthcare 2022, 10(3), 586; https://doi.org/10.3390/healthcare10030586 - 21 Mar 2022
Cited by 7 | Viewed by 3263
Abstract
Purpose: This systematic review and meta-analysis was conducted to explore the effect of physical training on frailty status and physical performance in the community dwelling elderly. Methods: We set keywords and used the Boolean operator to search the CEPS, CINAHL, Cochrane Library, PubMed, [...] Read more.
Purpose: This systematic review and meta-analysis was conducted to explore the effect of physical training on frailty status and physical performance in the community dwelling elderly. Methods: We set keywords and used the Boolean operator to search the CEPS, CINAHL, Cochrane Library, PubMed, MEDLINE, and EMBASE databases from inception to 10 August 2021. The search was limited to randomized controlled trials (RCTs) conducted within a five-year period. The Cochrane Collaboration bias assessment tool was used to assess article quality, and RevMan 5.4.1. software (Cochrane Training site based in London, UK) was used to conduct the meta-analysis. Results: Physical training was found to improve frailty status, physical performance, lower limb strength and balance. The best dose-response for physical training was 60 min per time, 2–3 times per week, for 3 months. Conclusion: Designing an appropriate physical training program can decrease the frailty score and increase physical performance in frail elderly in the community. Full article
(This article belongs to the Topic Applied System on Biomedical Engineering, Healthcare and Sustainability)
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<p>RISMA flow diagram.</p> Full article ">Figure 2
<p>Risk of bias summary of all included studies.</p> Full article ">Figure 3
<p>Forest plot of effects on frailty and subgroup analysis for dose-response. The size of the green square represents the weight of the study in the meta-analysis. The rhombus represents the combined OR. OR = odds ratio.</p> Full article ">Figure 4
<p>Forest plot of effects on SBBP and subgroup analysis for dose-response. The size of the green square represents the weight of the study in the meta-analysis. The rhombus represents the combined OR. OR = odds ratio.</p> Full article ">Figure 5
<p>Forest plot of effects on upper limb strength and subgroup analysis for dose-response. The size of the green square represents the weight of the study in the meta-analysis. The rhombus represents the combined OR. OR = odds ratio.</p> Full article ">Figure 6
<p>Forest plot of effects on lower-limb strength and subgroup analysis for dose-response. The size of the green square represents the weight of the study in the meta-analysis. The rhombus represents the combined OR. OR = odds ratio.</p> Full article ">Figure 7
<p>Forest plot of effects on balance and subgroup analysis for dose-response. The size of the green square represents the weight of the study in the meta-analysis. The rhombus represents the combined OR. OR = odds ratio.</p> Full article ">Figure 8
<p>Forest plot of effects on mobility and subgroup analysis for dose-response. The size of the green square represents the weight of the study in the meta-analysis. The rhombus represents the combined OR. OR = odds ratio.</p> Full article ">
17 pages, 2548 KiB  
Article
Examining Psychosocial Factors and Community Mitigation Practices to Limit the Spread of COVID-19: Evidence from Nigeria
by Ekundayo Shittu, Funmilayo Adewumi, Nkemdilim Ene, Somto Chloe Keluo-Udeke and Chizoba Wonodi
Healthcare 2022, 10(3), 585; https://doi.org/10.3390/healthcare10030585 - 21 Mar 2022
Cited by 4 | Viewed by 2746
Abstract
We examine the psychosocial factors influencing community adoption of non-pharmaceutical interventions (NPI) to limit the spread of COVID-19. Using data from 990 respondents in communities across Nigeria, we examine the correlation of health behaviors and socioeconomic indicators. We conduct logistic regression to estimate [...] Read more.
We examine the psychosocial factors influencing community adoption of non-pharmaceutical interventions (NPI) to limit the spread of COVID-19. Using data from 990 respondents in communities across Nigeria, we examine the correlation of health behaviors and socioeconomic indicators. We conduct logistic regression to estimate the relationship between mask wearing as a health-seeking NPI with demographic and socioeconomic variables. We estimate separate models in the sensitivity robustness checks with other NPIs and control for differences across sex, age, education, number in household, and the presence of a student in the respondent’s household. A crucial finding is that health-seeking NPI behaviors are statistically significantly affected in different ways by the menu of socioeconomic indicators. The control for age, sex, education, and household size indicates that there is intersectionality of how these factors influence specific mitigation practices. We find that women are more likely to engage in mask wearing, hand washing, and use of hand sanitizers and tissues than men, and the provision of palliatives and access to family supplies significantly enhances community mitigation. Palliatives and access to family supplies enhance most health-seeking behaviors. The implication for pandemic mitigation policy is that minimizing incidence rates requires having responsive initiatives such as information updates on pandemic progression. Full article
(This article belongs to the Topic Burden of COVID-19 in Different Countries)
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<p>Theoretical framework: The COVID-19 prevention NPIs.</p> Full article ">Figure 2
<p>Map of Nigeria showing the states where the communities covered are located.</p> Full article ">Figure 3
<p>Some of the prompts in the data collection survey.</p> Full article ">Figure 4
<p>Safe practices in Nigeria from a World Bank study [<a href="#B24-healthcare-10-00585" class="html-bibr">24</a>].</p> Full article ">Figure 5
<p>Age distribution of the respondents.</p> Full article ">Figure 6
<p>Education distribution of the respondents.</p> Full article ">Figure 7
<p>Distribution of the protective behaviors of the respondents.</p> Full article ">Figure 8
<p>Palliatives distribution of the respondents.</p> Full article ">Figure 9
<p>Distribution of access to health facility by the respondents.</p> Full article ">Figure 10
<p>The interaction of respondent age and awareness of household diabetic under mask wearing.</p> Full article ">Figure 11
<p>The interaction of age and diabetics in household under social distancing.</p> Full article ">
10 pages, 270 KiB  
Article
Mental Health Shame, Caregiver Identity, and Self-Compassion in UK Education Students
by Yasuhiro Kotera, Freya Tsuda-McCaie, Ann-Marie Edwards, Divya Bhandari, Dan Williams and Siobhan Neary
Healthcare 2022, 10(3), 584; https://doi.org/10.3390/healthcare10030584 - 21 Mar 2022
Cited by 7 | Viewed by 4030
Abstract
Although students in education have high rates of mental health problems, many of them do not ask for help, which can exacerbate their symptoms. One reason for their low help-seeking is shame associated with mental health problems. As education students aspire to provide [...] Read more.
Although students in education have high rates of mental health problems, many of them do not ask for help, which can exacerbate their symptoms. One reason for their low help-seeking is shame associated with mental health problems. As education students aspire to provide care for children, they may feel ashamed to care for themselves, as the role identity theory suggests. Self-compassion is reported to reduce shame and mental health problems. This study explored the relationships between mental health problems, mental health shame, self-compassion, and caregiver identity among UK education students. One hundred and nine postgraduate students completed four self-report scales regarding those constructs. Correlation and regression analyses were performed. Mental health problems were positively associated with shame and identity, and negatively associated with self-compassion. Self-compassion was the only significant predictor of mental health problems. Findings will help educators and education students to develop effective approaches for their mental health problems. Full article
(This article belongs to the Special Issue Mental Health Matters: From Cross-Cultural Perspectives)
9 pages, 229 KiB  
Article
The Effect of an Optimized Diet as an Adjunct to Non-Surgical Periodontal Therapy in Subjects with Periodontitis: A Prospective Study
by Paolo De Angelis, Giulio Gasparini, Paolo Francesco Manicone, Pier Carmine Passarelli, Domenico Azzolino, Edoardo Rella, Giuseppe De Rosa, Piero Papi, Giorgio Pompa, Silvio De Angelis, Roberta Grassi and Antonio D’Addona
Healthcare 2022, 10(3), 583; https://doi.org/10.3390/healthcare10030583 - 21 Mar 2022
Cited by 8 | Viewed by 2553
Abstract
Diet and nutrition are generally categorized as modifiable lifestyle risk factors for the development of periodontal disease because diet may influence a person’s inflammatory status. This study aimed to evaluate the efficacy of the application of a diet plan focused on reducing inflammation [...] Read more.
Diet and nutrition are generally categorized as modifiable lifestyle risk factors for the development of periodontal disease because diet may influence a person’s inflammatory status. This study aimed to evaluate the efficacy of the application of a diet plan focused on reducing inflammation and oxidative stress in treating periodontitis. Subjects suffering from periodontitis were divided into two groups. Both groups underwent non-surgical periodontal therapy, and in the optimized diet (OD) group, this treatment was associated with a diet plan. The sample consisted of 60 subjects; 32 (53%) were treated in the non-optimized diet group (ND group) and 28 (47%) in the OD group. In both groups, the periodontal treatment significantly improved the recorded periodontal outcomes between T0 and T1 (FMPS, FMBS, CAL, PPD). Inter-group differences were not statistically significant (p < 0.05). The linear regression models showed that the optimized diet was associated with a higher reduction in PPD and FMBS after the treatment, while patients who had higher LDL levels (over 100 mg/mL) had a less favorable improvement of PPD. The application of an improved diet plan can increase the reduction in PPD and FMBS after non-surgical periodontal therapy when compared with periodontal treatment alone. Full article
(This article belongs to the Special Issue Preventive Oral Health Strategies and Oral Health Status)
15 pages, 286 KiB  
Article
Physicians’ Compliance with COVID-19 Regulations: The Role of Emotions and Trust
by Shosh Shahrabani, Shiran Bord, Hanna Admi and Michael Halberthal
Healthcare 2022, 10(3), 582; https://doi.org/10.3390/healthcare10030582 - 20 Mar 2022
Cited by 14 | Viewed by 2885
Abstract
(1) Background: Medical teams are at the forefront of the COVID-19 pandemic. Decision making among medical staff is important for promoting and maintaining the health of patients and staff. This study examines factors associated with physicians’ decision making and preventive behavior during the [...] Read more.
(1) Background: Medical teams are at the forefront of the COVID-19 pandemic. Decision making among medical staff is important for promoting and maintaining the health of patients and staff. This study examines factors associated with physicians’ decision making and preventive behavior during the COVID-19 pandemic in Israel. (2) Methods: An online survey was conducted among 187 Israeli physicians in April and May 2020 during the COVID-19 pandemic. The questionnaire included the levels of physicians’ perceived threat and perceived risk during the epidemic, trust in the health system, emotions, and the degree of compliance with hygiene rules and mandated behaviors. (3) Results: Most physicians reported complying with the rules of hygiene at work (73%) and full compliance with Ministry of Health guidelines (61%). The findings show that higher levels of trust, positive emotions, and threat and risk perceptions were associated with a higher degree of compliance with Ministry of Health guidelines and more careful decision making among physicians. (4) Conclusions: Levels of trust in the health system and positive emotions among healthcare staff during the pandemic are related to careful adherence to guidelines. Taking steps to maintain physical and mental health among healthcare staff is important for their functioning and for maintaining public health. Full article
(This article belongs to the Section Preventive Medicine)
10 pages, 244 KiB  
Article
Grounding the Body Improves Sleep Quality in Patients with Mild Alzheimer’s Disease: A Pilot Study
by Chien-Hung Lin, Shih-Ting Tseng, Yao-Chung Chuang, Chun-En Kuo and Nai-Ching Chen
Healthcare 2022, 10(3), 581; https://doi.org/10.3390/healthcare10030581 - 20 Mar 2022
Cited by 6 | Viewed by 11473 | Correction
Abstract
Background: Grounding refers to having direct contact with the Earth, such as by walking barefoot or lying on the ground. Research has found that grounding can improve inflammation, free radical damage, blood pressure, sleep quality, pain, stress, mood, and wound healing. However, there [...] Read more.
Background: Grounding refers to having direct contact with the Earth, such as by walking barefoot or lying on the ground. Research has found that grounding can improve inflammation, free radical damage, blood pressure, sleep quality, pain, stress, mood, and wound healing. However, there has been no research on the effect of utilizing grounding for patients with Alzheimer’s disease (AD). Thus, in this study, we investigated the effectiveness of grounding as a non-pharmacological therapy for treating sleep disturbances, anxiety, and depression in patients with mild AD. Methods: Patients with mild AD were enrolled in the study. The electrochemical analyzer CHI 1205b was employed to check the electrochemical signals at acupoints KI1 and GV16. We used the Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II (BDI-II) to evaluate sleep quality, anxiety, and depression, respectively, at weeks 0 and 12. Results: This 12-week placebo-controlled study enrolled 22 patients, but only 15 patients completed the 12-week intervention and survey. Grounding significantly improved PSQI scores compared to the sham-grounding group (mean ± SD: 0.3 ± 0.7 vs. 3.0 ± 1.9, p = 0.006). The scores on the BAI and BDI-II did not change significantly after grounding in comparison to the sham-grounding group. Conclusions: Grounding can improve sleep quality, but it does not significantly improve anxiety and depression among patients with mild AD. Full article
17 pages, 8567 KiB  
Article
A Novel Hybrid Machine Learning Based System to Classify Shoulder Implant Manufacturers
by Esra Sivari, Mehmet Serdar Güzel, Erkan Bostanci and Alok Mishra
Healthcare 2022, 10(3), 580; https://doi.org/10.3390/healthcare10030580 - 20 Mar 2022
Cited by 17 | Viewed by 3186
Abstract
It is necessary to know the manufacturer and model of a previously implanted shoulder prosthesis before performing Total Shoulder Arthroplasty operations, which may need to be performed repeatedly in accordance with the need for repair or replacement. In cases where the patient’s previous [...] Read more.
It is necessary to know the manufacturer and model of a previously implanted shoulder prosthesis before performing Total Shoulder Arthroplasty operations, which may need to be performed repeatedly in accordance with the need for repair or replacement. In cases where the patient’s previous records cannot be found, where the records are not clear, or the surgery was conducted abroad, the specialist should identify the implant manufacturer and model during preoperative X-ray controls. In this study, an auxiliary expert system is proposed for classifying manufacturers of shoulder implants on the basis of X-ray images that is automated, objective, and based on hybrid machine learning models. In the proposed system, ten different hybrid models consisting of a combination of deep learning and machine learning algorithms were created and statistically tested. According to the experimental results, an accuracy of 95.07% was achieved using the DenseNet201 + Logistic Regression model, one of the proposed hybrid machine learning models (p < 0.05). The proposed hybrid machine learning algorithms achieve the goal of low cost and high performance compared to other studies in the literature. The results lead the authors to believe that the proposed system could be used in hospitals as an automatic and objective system for assisting orthopedists in the rapid and effective determination of shoulder implant types before performing revision surgery. Full article
(This article belongs to the Special Issue Artificial Intelligence Applications in Medicine)
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<p>Samples from the dataset.</p> Full article ">Figure 2
<p>Overview of the proposed method.</p> Full article ">Figure 3
<p>Learning curves of machine learning classifiers.</p> Full article ">Figure 4
<p>The learning curve of the DenseNet201 network.</p> Full article ">Figure 5
<p>Confusion matrix.</p> Full article ">Figure 6
<p>Confusion matrices of hybrid machine learning algorithms.</p> Full article ">
9 pages, 1483 KiB  
Article
Assessing Physical Therapy Knowledge amongst the New Graduates in Saudi Arabia: Competency Examination across the Nation
by Fahad Alanazi and Muhammad Alrwaily
Healthcare 2022, 10(3), 579; https://doi.org/10.3390/healthcare10030579 - 20 Mar 2022
Cited by 2 | Viewed by 2340 | Correction
Abstract
Given the increasing demand for more trained physical therapists in providing care to patients in Saudi Arabia, it has become vital to adequately assess individual physical therapy graduate academic learning and performance. Therefore, the present study aimed at evaluating the knowledge and skills [...] Read more.
Given the increasing demand for more trained physical therapists in providing care to patients in Saudi Arabia, it has become vital to adequately assess individual physical therapy graduate academic learning and performance. Therefore, the present study aimed at evaluating the knowledge and skills of Saudi PT graduates. A competency examination adapted from a practice test that is commercially available and simulates the National Physical Therapy Examination (NPTE) was conducted. Out of 398 Saudi physical therapists that were approached with the examination link, 149 PT graduates consented to the study. Seventy questions were randomly selected by two individuals familiar with the content of PT programs in the United States and Saudi Arabia. The content outline of the selected questions followed the NPTE recommendations for body systems and non-systems. Each question was multiple choice with four answers. The examination was distributed electronically. Each participant was given 90 min to complete the examination. The passing score was set at 55%. Out of 149, only 6six (4.02%) participants passed the examination with an average passing score of 67% (range: 56–96%). In the primary domains of body systems, the score was highest in the endocrine domain (55.1%), followed by the integumentary (42.18%) and the neurology (40.9%) domains. In the non-system, participants had the highest score in the professionalism domain (89.8%). The highest mean knowledge score was obtained in the field of assessment (38.57%). PT graduates from Saudi Arabia performed poorly in the examination, demonstrating weak domain knowledge and skills. Full article
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<p>Mean knowledge score of participants in different domains of the body system.</p> Full article ">Figure 2
<p>Mean knowledge score of participants in different non-system domains.</p> Full article ">Figure 3
<p>Mean knowledge score of participants in different categories.</p> Full article ">Figure 4
<p>Mean scores of participants from different universities in Saudi Arabia.</p> Full article ">
10 pages, 375 KiB  
Article
Clinical Validation of Cardiac Arrest Hospital Prognosis (CAHP) Score and MIRACLE2 Score to Predict Neurologic Outcomes after Out-of-Hospital Cardiac Arrest
by Jun-Zuo Wu, Wei-Che Chiu, Wei-Ting Wu, I-Min Chiu, Kuo-Chen Huang, Chih-Wei Hung and Fu-Jen Cheng
Healthcare 2022, 10(3), 578; https://doi.org/10.3390/healthcare10030578 - 20 Mar 2022
Cited by 3 | Viewed by 2756
Abstract
Background. Out-of-hospital cardiac arrest (OHCA) remains a challenge for emergency physicians, given the poor prognosis. In 2020, MIRACLE2, a new and easier to apply score, was established to predict the neurological outcome of OHCA. Objective. The aim of this study is to compare [...] Read more.
Background. Out-of-hospital cardiac arrest (OHCA) remains a challenge for emergency physicians, given the poor prognosis. In 2020, MIRACLE2, a new and easier to apply score, was established to predict the neurological outcome of OHCA. Objective. The aim of this study is to compare the discrimination of MIRACLE2 score with cardiac arrest hospital prognosis (CAHP) score for OHCA neurologic outcomes. Methods. This retrospective cohort study was conducted between January 2015 and December 2019. Adult patients (>17 years) with cardiac arrest who were brought to the hospital by an emergency medical service crew were included. Deaths due to trauma, burn, drowning, resuscitation not initiated due to pre-ordered “do not resuscitate” orders, and patients who did not achieve return of spontaneous circulation were excluded. Receiver operating characteristic curve analysis with Youden Index was performed to calculate optimal cut-off values for both scores. Results. Overall, 200 adult OHCA cases were analyzed. The threshold of the MIRACLE2 score for favorable neurologic outcomes was 5.5, with an area under the curve (AUC) value of 0.70 (0.61–0.80, p < 0.001); the threshold of the CAHP score was 223.4, with an AUC of 0.77 (0.68–0.86, p < 0.001). On setting the MIRACLE2 score cut-off value, we documented 64.7% sensitivity (95% confidence interval [CI], 56.9–71.9%), 66.7.0% specificity (95% CI, 48.2–82.0%), 90.8% positive predictive value (PPV; 95% CI, 85.6–94.2%), and 27.2% negative predictive value (NPV; 95% CI, 21.4–33.9%). On establishing a CAHP cut-off value, we observed 68.2% sensitivity (95% CI, 60.2–75.5%), 80.6% specificity (95% CI, 62.5–92.6%), 94.6% PPV (95% CI, 88.6%–98.0%), and 33.8% NPV (95% CI, 23.2–45.7%) for unfavorable neurologic outcomes. Conclusions. The CAHP score demonstrated better discrimination than the MIRACLE2 score, affording superior sensitivity, specificity, PPV, and NPV; however, the CAHP score remains relatively difficult to apply. Further studies are warranted to establish scores with better discrimination and ease of application. Full article
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<p>Flowchart of patients selection.</p> Full article ">
10 pages, 1731 KiB  
Article
Clinical Prediction Scoring Scheme for 24 h Mortality in Major Traumatic Adult Patients
by Waratsuda Samuthtai, Jayanton Patumanond, Pawitrabhorn Samutrtai, Thammanard Charernboon, Kijja Jearwattanakanok and Jiraporn Khorana
Healthcare 2022, 10(3), 577; https://doi.org/10.3390/healthcare10030577 - 20 Mar 2022
Cited by 5 | Viewed by 2445
Abstract
A death rate of approximately 32.7 in 100,000 traffic injury victims was reported in Thailand. The prediction of early death would identify and enable prioritization of the most severe patients for resuscitation and consequently reduce the number of deaths. This study aimed to [...] Read more.
A death rate of approximately 32.7 in 100,000 traffic injury victims was reported in Thailand. The prediction of early death would identify and enable prioritization of the most severe patients for resuscitation and consequently reduce the number of deaths. This study aimed to develop a clinical prediction scoring system for 24 h mortality in adult major trauma patients. Retrospective-prognostic clinical prediction was applied in the case of 3173 adult trauma patients who were classified into three groups: death within 8 h, death between 8 and 24 h, and alive at 24 h. The predictors were obtained by univariable and multivariable logistic regression, and the coefficient of parameters was converted to predict early death. The numbers of patients who died within 8 h and between 8 and 24 h were 46 (1.5%) and 123 (3.8%), respectively. The predictors included systolic blood pressure <90 mmHg, heart rate ≥120 bpm, Glasgow coma scale ≤8, traffic injury, and assault injury. The scores of 4 indicated a mortality rate of 12% with a high specificity of 0.89. The suggested TERMINAL-24 scoring system can be used for the prediction of early death in the Emergency Department. However, its discrimination ability and precision should be validated before practical use. Full article
(This article belongs to the Section Healthcare Quality and Patient Safety)
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<p>Flow diagram to show the development of TERMINAL-24 score.</p> Full article ">Figure 2
<p>The distribution of TERMINAL-24 score by criterion-classified severity level; stacked bar charts with 0–100% bar for median/IQR (at 25%, 50%, and 75%); for each outcome group; the number in the bar chart represents the number of patients.</p> Full article ">Figure 3
<p>The discrimination of the probability of death based on TERMINAL-24 score. The dotted line represents the probability of overall death in 24 h, the dashed line represents the probability of death between 8 and 24 h, and the solid line represents the probability of death in under 8 h.</p> Full article ">Figure 4
<p>The area under ROC curve of TERMINAL-24 score in (<b>A</b>) death within 8 h and (<b>B</b>) death within 24 h.</p> Full article ">Figure 5
<p>Risk curve of TERMINAL-24 score in (<b>A</b>) the death within 8 h group and (<b>B</b>) the death within 24 h group. The lines represent the predicted risks using TERMINAL-24 score. The circles represent the observed risks, and the size of circles represents the sample size.</p> Full article ">
11 pages, 720 KiB  
Article
Characteristics of SARS-CoV-2 Seropositivity among Emergency Department Healthcare Workers at a Tertiary Care Center in Baltimore
by Anna Russell, Edbert B. Hsu, Katherine Z. J. Fenstermacher, Erin P. Ricketts, Gabriella Dashler, Allison Chen, Kathryn Shaw-Saliba, Patrizio P. Caturegli, Andrew Pekosz and Richard E. Rothman
Healthcare 2022, 10(3), 576; https://doi.org/10.3390/healthcare10030576 - 20 Mar 2022
Cited by 1 | Viewed by 2095
Abstract
Early in the COVID-19 pandemic (March–July 2020 in Baltimore), emergency department (ED) healthcare workers (HCWs) were considered to be at greater risk of contracting SARS-CoV-2. Limited data existed, however, on the prevalence of SARS-CoV-2 infection and its impact in this workforce population. We [...] Read more.
Early in the COVID-19 pandemic (March–July 2020 in Baltimore), emergency department (ED) healthcare workers (HCWs) were considered to be at greater risk of contracting SARS-CoV-2. Limited data existed, however, on the prevalence of SARS-CoV-2 infection and its impact in this workforce population. We enrolled 191 ED HCWs from a tertiary academic center, administered baseline and weekly surveys, and tested them twice (July and December 2020) for serum antibodies against SARS-CoV-2 spike protein. Approximately 6% (11 of 191, 5.8%) of ED HCWs had spike antibodies in July, a prevalence that doubled by December (21 of 174, 12.1%). A positive PCR test was self-reported by 15 of 21 (71%) seropositive and 6 of 153 (4%) seronegative HCWs (p < 0.001). Of the total 27 HCWs who had antibodies and/or were PCR positive, none required hospitalization, 18 (67%) had a self-perceived COVID-19 illness, and 12 of the 18 reported symptoms. The median number of missed workdays was 8.5 (ranging from 2 to 21). While most seropositive ED HCWs who reported symptoms took work absences, none required hospitalization, indicating that COVID-19’s impact on staffing prior to vaccination was not as great as feared. Full article
(This article belongs to the Section Coronaviruses (CoV) and COVID-19 Pandemic)
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<p>Seropositivity and PCR Positivity.</p> Full article ">Figure 2
<p>Seropositivity and PCR Positivity Concordance.</p> Full article ">
11 pages, 293 KiB  
Article
Effectiveness of Custom Foot Insoles to Decrease Plantar Pressure: A Cross-over Randomized Trial Study
by Israel Casado-Hernández, Ricardo Becerro-de-Bengoa-Vallejo, Marta Elena Losa-Iglesias, Julia Cosín-Matamoros, César Calvo-Lobo, David Rodríguez-Sanz, Daniel López-López and Eva María Martínez-Jiménez
Healthcare 2022, 10(3), 575; https://doi.org/10.3390/healthcare10030575 - 20 Mar 2022
Cited by 3 | Viewed by 2282
Abstract
Background: Harderness insoles decrease plantar pressure and reduce the foot injury incidence in sport. The purpose of our study was to analyze the plantar pressure variation in moto riders after riding in a real speed circuit with a custom foot 520 Shore [...] Read more.
Background: Harderness insoles decrease plantar pressure and reduce the foot injury incidence in sport. The purpose of our study was to analyze the plantar pressure variation in moto riders after riding in a real speed circuit with a custom foot 520 Shore EVA insole. Methods: A crossover randomized trial study was performed (consent no. #050520165316). Riders were assessed by an expert motorsport senior podiatry. The participants’ mean age was 35 ± 3.29. Participants completed a 20 min training riding with their own motorcycle in a real speed circuit. Plantar pressures were registered with a baropodometric platform evaluating an Ethyl Vinyl Acetate custom foot insole (CFI) manufactured with 3 mm thickness and 52° Shore A hardness. The Plantar pressures were registered before riding, after riding without EVA insole, and after riding with EVA insole. Results: Total Plantar pressures in right and left foot, and total surface area decrease after riding with EVA insoles. Conclusion: The use of an EVA insole with 520 shore A hardness riding on a motorcycle in speed circuit decreased the total plantar pressures and surface areas values. Full article
9 pages, 1003 KiB  
Article
Automatic Recognition of Ragged Red Fibers in Muscle Biopsy from Patients with Mitochondrial Disorders
by Jacopo Baldacci, Marco Calderisi, Chiara Fiorillo, Filippo Maria Santorelli and Anna Rubegni
Healthcare 2022, 10(3), 574; https://doi.org/10.3390/healthcare10030574 - 19 Mar 2022
Cited by 2 | Viewed by 2966
Abstract
Mitochondrial dysfunction is considered to be a major cause of primary mitochondrial myopathy in children and adults, as reduced mitochondrial respiration and morphological changes such as ragged red fibers (RRFs) are observed in muscle biopsies. However, it is also possible to hypothesize the [...] Read more.
Mitochondrial dysfunction is considered to be a major cause of primary mitochondrial myopathy in children and adults, as reduced mitochondrial respiration and morphological changes such as ragged red fibers (RRFs) are observed in muscle biopsies. However, it is also possible to hypothesize the role of mitochondrial dysfunction in aging muscle or in secondary mitochondrial dysfunctions. The recognition of true histological patterns of mitochondrial myopathy can avoid unnecessary genetic investigations. The aim of our study was to develop and validate machine-learning methods for RRF detection in light microscopy images of skeletal muscle tissue. We used image sets of 489 color images captured from representative areas of Gomori’s trichrome-stained tissue retrieved from light microscopy images at a 20× magnification. We compared the performance of random forest, gradient boosting machine, and support vector machine classifiers. Our results suggested that the advent of scanning technologies, combined with the development of machine-learning models for image classification, make neuromuscular disorders’ automated diagnostic systems a concrete possibility. Full article
(This article belongs to the Topic Artificial Intelligence in Healthcare)
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<p>Left panel: ragged red fiber (RRF), hallmark of mitochondrial disorders, in Gomori’s trichrome stain (magnification: 20×; image acquired from the muscle of patient 8). Right panel: it shows the method used to create the dataset for our analysis: each acquired image was subdivided in 165 sub-images (15 × 11). All the sub-images that contain a portion of an RRF were added to the dataset and labeled as “ragged” (R label in the figure, written in white). After that, we arbitrarily collected a similar number of sub-images that do not contain RRFs, labeling them as “not ragged” (NR label, written in orange) and some “waste” sub-images (W label, written in red). The rest of the sub-images were discarded to avoid the unbalancing of the dataset.</p> Full article ">Figure 2
<p>Receiver-operating characteristic (ROC) curve calculated on the test set for each model: (<b>a</b>) waste-tissue classification results; (<b>b</b>) ragged–not ragged classification results.</p> Full article ">
8 pages, 837 KiB  
Case Report
VLCKD in Combination with Physical Exercise Preserves Skeletal Muscle Mass in Sarcopenic Obesity after Severe COVID-19 Disease: A Case Report
by Elisabetta Camajani, Alessandra Feraco, Sabrina Basciani, Lucio Gnessi, Luigi Barrea, Andrea Armani and Massimiliano Caprio
Healthcare 2022, 10(3), 573; https://doi.org/10.3390/healthcare10030573 - 19 Mar 2022
Cited by 8 | Viewed by 3750
Abstract
The prevalence of sarcopenic obesity is increasing worldwide, with a strong impact on public health and the national health care system. Sarcopenic obesity consists of fat depot expansion and associated systemic low-grade inflammation, exacerbating the decline in skeletal muscle mass and strength. Dietary [...] Read more.
The prevalence of sarcopenic obesity is increasing worldwide, with a strong impact on public health and the national health care system. Sarcopenic obesity consists of fat depot expansion and associated systemic low-grade inflammation, exacerbating the decline in skeletal muscle mass and strength. Dietary approach and physical exercise represent essential tools for reducing body weight and preserving muscle mass and function in subjects with sarcopenic obesity. This case report describes the effects of a dietary intervention, based on a Very-Low-Calorie Ketogenic Diet (VLCKD) combined with physical exercise, on body composition, cardiometabolic risk factors, and muscle strength in a woman with sarcopenic obesity, two weeks after hospitalization for bilateral interstitial pneumonia due to COVID-19. To our knowledge, this is the first case report to describe the efficacy of a combined approach intervention including VLCKD along with physical exercise, in reducing fat mass, improving metabolic profile, and preserving skeletal muscle performance in a patient with obesity, soon after severe COVID-19 disease. Full article
(This article belongs to the Special Issue Promotion of Health and Exercise)
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<p>Body composition analysis was performed using BIA at the beginning (T0) and at the end (T6) of VLCKD+IT.</p> Full article ">Figure 2
<p>Physical performance measured by the handgrip strength test and chair stand test at the beginning (T0) and at the end (T6) of VLCKD+IT.</p> Full article ">
12 pages, 292 KiB  
Case Report
Effect of Online Home-Based Training on Functional Capacity and Strength in Two CKD Patients: A Case Study
by Giulia Marrone, Elisa Grazioli, Eliana Tranchita, Attilio Parisi, Claudia Cerulli, Arianna Murri, Carlo Minganti, Manuela Di Lauro, Nicolò Piacentini, Leonarda Galiuto, Nicola Di Daniele and Annalisa Noce
Healthcare 2022, 10(3), 572; https://doi.org/10.3390/healthcare10030572 - 18 Mar 2022
Cited by 1 | Viewed by 2790
Abstract
Chronic kidney disease (CKD) is a clinical condition characterized by the loss of kidney function over time, as well as several complications affecting gastrointestinal, cardiovascular, and musculoskeletal systems. Physical exercise seems to induce positive adaptations in CKD patients, without side effects. Usually, these [...] Read more.
Chronic kidney disease (CKD) is a clinical condition characterized by the loss of kidney function over time, as well as several complications affecting gastrointestinal, cardiovascular, and musculoskeletal systems. Physical exercise seems to induce positive adaptations in CKD patients, without side effects. Usually, these patients show a reduced physical activity and physical performance. The aim of this case-report was to evaluate the effects of an online training protocol on functional capacity and on muscle mass, in CKD stage III patients. Methods: Two CKD (stage III according to KDIGO guidelines) participants (1 female, Patient A; 1 male, Patient B) were enrolled and they performed an online tailored-supervised combined training lasting 12 weeks, including multi-joint strength exercises using TheraBand and an aerobic session at 65–70% of the patients’ heart rate reserve. Results: Both patients showed an improving trend on functional capacity (6 min walking test: Patient A = +3%; Patient B = +5.3%) and on strength of the upper arms (handgrip strength test-right: Patient A = +13.4%; Patient B = +19.1%; handgrip strength test-left: Patient A = +42.8%; Patient B= +12.9%), as well as a reduction in inflammation and oxidative stress biomarkers. The protocol was feasible, and no side effects were evidenced. These case studies suggest that the online combined training can produce beneficial effects in CKD patients under conservative therapy, by reducing the CKD-related complications and improving the adherence to exercise of this population of patients, overcoming logistic barriers such as transportation, availability of facilities, and working and personal-life schedule. Full article
(This article belongs to the Topic Applied System on Biomedical Engineering, Healthcare and Sustainability)
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12 pages, 1146 KiB  
Article
Factors Associated with Vaginal/Cesarean Birth Attitudes among Medical Students
by Anna Michalik, Agnieszka Czerwińska-Osipiak, Anna Szablewska, Michalina Pracowity and Jolanta Olszewska
Healthcare 2022, 10(3), 571; https://doi.org/10.3390/healthcare10030571 - 18 Mar 2022
Cited by 1 | Viewed by 1737
Abstract
Background: Polish perinatal care is facing a high, ever-increasing cesarean section (CS) rate that is currently at 43%. Crucially, reports have revealed that the attitudes, experiences, and skills of clinicians directly contribute to this elevated CS rate. Methods: This cross-sectional study, which included [...] Read more.
Background: Polish perinatal care is facing a high, ever-increasing cesarean section (CS) rate that is currently at 43%. Crucially, reports have revealed that the attitudes, experiences, and skills of clinicians directly contribute to this elevated CS rate. Methods: This cross-sectional study, which included 748 Polish medical students, aimed to identify medical students’ attitudes regarding birth methods. A descriptive questionnaire was distributed via the academic email addresses of surveyed medical students. Group comparisons were performed using Welch’s t-test for continuous data or a Chi-squared test for categorical data. We also used the Mann–Whitney U test and Kruskal–Wallis H test. Results: Midwifery students (96.2%) were the most unified group of students, with most agreeing that VB (vaginal birth) presents a safer option for women at low risk for VB-related complications vs. cesarean section. Of Medical Faculty students, 68% believed that fewer complications typically occur during vaginal birth than during CS. Students in their final vs. initial years of study furthermore considered VB more beneficial for women than CS. Conclusions: An important factor identified at the individual clinician level is the presence of leadership and executive support. For medical students, we can interpret this as support from their trainers and supervisors. Full article
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<p>Students’ answers to the question: “Do you think that VB is safer than C-section?” Organized according to field of study.</p> Full article ">Figure 2
<p>Changes in students’ opinions about VB and CS over years of study.</p> Full article ">
10 pages, 12337 KiB  
Article
Effect of Pelvic Floor Muscle Training Using Pressure Biofeedback on Pelvic Floor Muscle Contraction and Trunk Muscle Activity in Sitting in Healthy Women
by Min-Joo Ko, Min-Suk Koo, Eun-Joo Jung, Won-Jeong Jeong and Jae-Seop Oh
Healthcare 2022, 10(3), 570; https://doi.org/10.3390/healthcare10030570 - 18 Mar 2022
Cited by 3 | Viewed by 3210
Abstract
Pelvic floor muscle training (PFMT) has been recommended as the first choice as one of the effective methods for preventing and improving urinary incontinence (UI). We aimed to determine whether pressure biofeedback unit training (PBUT) improves short term and retention performance of pelvic [...] Read more.
Pelvic floor muscle training (PFMT) has been recommended as the first choice as one of the effective methods for preventing and improving urinary incontinence (UI). We aimed to determine whether pressure biofeedback unit training (PBUT) improves short term and retention performance of pelvic floor muscle contraction. The muscle activities of the external oblique (EO), transversus/internal oblique (TrA/IO), multifidus (MF) and the bladder base displacement were measured in the verbal feedback group (n = 10) and PBU group (n = 10) three times (baseline, post-training, and at the 1-week follow-up). Surface electromyographic activity was recorded from the EO, TrA/IO, and MF muscles. The bladder base displacement was measured using ultrasound. The results were analyzed using two way mixed ANOVA. The bladder base displacement may have elevated more in the PBU group than in the verbal feedback group due to decreased TrA/IO activity. These findings indicate that PBUT is a better method than verbal feedback training. Full article
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<p>Performing pelvic floor muscle contraction with different feedback methods. (<b>A</b>) Pressure biofeedback. (<b>B</b>) Verbal feedback.</p> Full article ">Figure 2
<p>Ultrasound probe and electromyographic (EMG) electrode displacement.</p> Full article ">
15 pages, 8095 KiB  
Article
Support and Empowerment for Older Adult Spousal Caregiving of People with Mild and Moderate Dementia: A Participatory Action Research
by Chia-Jung Hsieh, Pei-Fang Yin, Chi-Yi Chiu, Yu-Ping Hsiao and Yu-Ling Hsiao
Healthcare 2022, 10(3), 569; https://doi.org/10.3390/healthcare10030569 - 18 Mar 2022
Cited by 5 | Viewed by 2882
Abstract
Background: Little attention has been given to the older adult caregivers of spouses with mild and moderate dementia in the caring dynamics process. The aim of this action research was to develop a program for providing support and empowerment to older adult caregivers [...] Read more.
Background: Little attention has been given to the older adult caregivers of spouses with mild and moderate dementia in the caring dynamics process. The aim of this action research was to develop a program for providing support and empowerment to older adult caregivers of spouses with mild and moderate dementia in the community. Methods: The researchers acted as facilitators, with a view to empowering participants. We recruited participants from a day-care center and two community service stations. Data were collected with semi-structured, in-depth interviews with 19 dementia care dyads and from the notes, reflections, and feedback of collaborative researchers. Relevant themes for content analysis were extracted. Results: Three action cycles were completed over 18 months. The results revealed goals of three cycles: to connect the home situation and effective dialogue as a bridge to the researcher, to confirm the daily needs or expectations of the caregiver and the patient, and to enhance the interactions and quality of life of family members with resources and network. This process was cyclical and repetitive, and it also generated partnerships that built relationships among the interdisciplinary team, families, and researchers. At the same time, team workers formed a cooperative and coordinated family service mechanism to reflect the professional values and practice capabilities. Conclusions: The intervention program was based on the promotion of factors for the caregiver, linking to environmental protective factors, and the stabilization of mental and neurological symptoms of dementia patients, thereby enhancing the response capabilities of home caregivers while meeting the patient’s care needs in life. It is a tool that can effectively be used for support and empowerment in this population. Full article
(This article belongs to the Special Issue Long-Term Care for Older Adults)
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<p>The planning process and goals of action research.</p> Full article ">Figure 2
<p>The action of home care empowerment program.</p> Full article ">
9 pages, 668 KiB  
Article
Can Lung Ultrasound Be the Ideal Monitoring Tool to Predict the Clinical Outcome of Mechanically Ventilated COVID-19 Patients? An Observational Study
by Luigi Vetrugno, Francesco Meroi, Daniele Orso, Natascia D’Andrea, Matteo Marin, Gianmaria Cammarota, Lisa Mattuzzi, Silvia Delrio, Davide Furlan, Jonathan Foschiani, Francesca Valent and Tiziana Bove
Healthcare 2022, 10(3), 568; https://doi.org/10.3390/healthcare10030568 - 18 Mar 2022
Cited by 13 | Viewed by 2133
Abstract
Background: During the COVID-19 pandemic, lung ultrasound (LUS) has been widely used since it can be performed at the patient’s bedside, does not produce ionizing radiation, and is sufficiently accurate. The LUS score allows for quantifying lung involvement; however, its clinical prognostic role [...] Read more.
Background: During the COVID-19 pandemic, lung ultrasound (LUS) has been widely used since it can be performed at the patient’s bedside, does not produce ionizing radiation, and is sufficiently accurate. The LUS score allows for quantifying lung involvement; however, its clinical prognostic role is still controversial. Methods: A retrospective observational study on 103 COVID-19 patients with respiratory failure that were assessed with an LUS score at intensive care unit (ICU) admission and discharge in a tertiary university COVID-19 referral center. Results: The deceased patients had a higher LUS score at admission than the survivors (25.7 vs. 23.5; p-value = 0.02; cut-off value of 25; Odds Ratio (OR) 1.1; Interquartile Range (IQR) 1.0−1.2). The predictive regression model shows that the value of LUSt0 (OR 1.1; IQR 1.0–1.3), age (OR 1.1; IQR 1.0−1.2), sex (OR 0.7; IQR 0.2−3.6), and days in spontaneous breathing (OR 0.2; IQR 0.1–0.5) predict the risk of death for COVID-19 patients (Area under the Curve (AUC) 0.92). Furthermore, the surviving patients showed a significantly lower difference between LUS scores at admission and discharge (mean difference of 1.75, p-value = 0.03). Conclusion: Upon entry into the ICU, the LUS score may play a prognostic role in COVID-19 patients with ARDS. Furthermore, employing the LUS score as a monitoring tool allows for evaluating the patients with a higher probability of survival. Full article
(This article belongs to the Special Issue Pulmonary and Critical Care Medicine)
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<p>Flowchart of the enrollment process. Surviving patients show an additional 4 classes based on the extent of ΔLUS score magnitude. ΔLUS = delta lung ultrasound.</p> Full article ">Figure 2
<p>Comparison between LUS score distributions of surviving and deceased patients (23.5 vs. 25.7; * <span class="html-italic">p</span> = 0.02). LUS = lung ultrasound.</p> Full article ">Figure 3
<p>ROC Curve for the predictive regression model. The most predictive variables are LUSt0 (OR 1.1; IQR 1.0−1.3), age (OR 1.1; IQR 1.0−1.2), sex (OR 0.7; IQR 0.2−3.6), and days in spontaneous breath (OR 0.2; IQR 0.1−0.5) predict the risk of death for COVID-19 patients. AUC = Area Under the Curve.</p> Full article ">Figure 4
<p>Comparison between LUS score at admission and discharge of surviving patients. The difference is statistically significant (mean difference of 1.75, * <span class="html-italic">p</span>-value = 0.03). LUS = lung ultrasound.</p> Full article ">
12 pages, 869 KiB  
Brief Report
Effects of Animal-Assisted Therapy (AAT) in Alzheimer’s Disease: A Case Study
by Armando Gregorini, Angela Di Canio, Emanuele Palmucci, Marco Tomasetti, Marco B. L. Rocchi and Mariastella Colomba
Healthcare 2022, 10(3), 567; https://doi.org/10.3390/healthcare10030567 - 18 Mar 2022
Cited by 1 | Viewed by 4102
Abstract
Alzheimer’s disease (AD) is a neurodegenerative disorder, characterized by cortical dementia and irreversibly progressive developments leading to a vegetative state and, finally, to death. Although many aspects of its etiology, diagnosis and treatment still remain obscure and the current approach to the disease [...] Read more.
Alzheimer’s disease (AD) is a neurodegenerative disorder, characterized by cortical dementia and irreversibly progressive developments leading to a vegetative state and, finally, to death. Although many aspects of its etiology, diagnosis and treatment still remain obscure and the current approach to the disease mostly suffers from limited and low-efficiency therapeutic means, nevertheless, recent interventions have aimed at improving patients’ quality of life through nonpharmacological approaches, including animal-assisted therapy (AAT), arousing growing interest. In order to assess the physiological and neuropsychological effects of AAT on AD, 24 residents of a rest house in northern Italy were enrolled. The intervention consisted of one 45-minute AAT session per week over ten weeks. Twelve residents (six AD and six non-AD) received AAT and twelve (six AD and six non-AD) were controls. In order to evaluate the physiological and clinical effect of AAT on AD residents, three cardiac parameters, including the systolic and diastolic blood pressure and heart rate, were measured. Moreover, the neurocognitive and depressive states were assessed by the Mini Mental State Examination and the Geriatric Depression Scale, respectively. Analyses were performed by a four-way ANOVA model (including two ways for repeated measures) considering each main effect and interaction possible in the design. Our findings, despite the small sample size, suggest that AAT has a positive significant effect on physiological parameters and neurocognitive impairment, while no effect was observed on the depression level. Full article
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<p>Kinetic of cardiac parameters. Systolic blood pressure (<b>A</b>), diastolic blood pressure (<b>B</b>) and heart rate (<b>C</b>) were monitored once a week, before (pre) and after (post) each session over 10 weeks. X axis: labels (1–10) correspond to sessions, pre and post are indicated as “.1” and “.2”, respectively.</p> Full article ">Figure 2
<p>Evaluation of neurocognitive and depressive state performed by the Mini Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS), respectively. MMSE (<b>A</b>) and GDS (<b>B</b>) scores were assessed before the beginning of session one (T1), after the end of session 5 (T5) and after the end of session 10 (T10).</p> Full article ">
10 pages, 278 KiB  
Review
Ketamine in Acute Brain Injury: Current Opinion Following Cerebral Circulation and Electrical Activity
by Christian Zanza, Fabio Piccolella, Fabrizio Racca, Tatsiana Romenskaya, Yaroslava Longhitano, Francesco Franceschi, Gabriele Savioli, Giuseppe Bertozzi, Stefania De Simone, Luigi Cipolloni and Raffaele La Russa
Healthcare 2022, 10(3), 566; https://doi.org/10.3390/healthcare10030566 - 17 Mar 2022
Cited by 14 | Viewed by 5836
Abstract
The use of ketamine in patients with TBI has often been argued due to its possible deleterious effects on cerebral circulation and perfusion. Early studies suggested that ketamine could increase intracranial pressure, decreasing cerebral perfusion pressure and thereby reducing oxygen supply to the [...] Read more.
The use of ketamine in patients with TBI has often been argued due to its possible deleterious effects on cerebral circulation and perfusion. Early studies suggested that ketamine could increase intracranial pressure, decreasing cerebral perfusion pressure and thereby reducing oxygen supply to the damaged cerebral cortex. Some recent studies have refuted these conclusions relating to the role of ketamine, especially in patients with TBI, showing that ketamine should be the first-choice drug in this type of patient at induction. Our narrative review collects evidence on ketamine’s use in patients with TBI. Databases were examined for studies in which ketamine had been used in acute traumatic brain injury (TBI). The outcomes considered in this narrative review were: mortality of patients with TBI; impact on intracranial pressure and cerebral perfusion pressure; blood pressure and heart rate values; depolarization rate; and preserved neurological functions. 11 recent studies passed inclusion and exclusion criteria and were included in this review. Despite all the benefits reported in the literature, the use of ketamine in patients with brain injury still appears to be limited. A slight increase in intracranial pressure was found in only two studies, while two smaller studies showed a reduction in intracranial pressure after ketamine administration. There was no evidence of harm from the ketamine’s use in patients with TBI. Full article
(This article belongs to the Section Forensic Medicine)
7 pages, 211 KiB  
Article
Self-Efficacy of Saudi Patients with Autoimmune Diseases in Managing Hydroxychloroquine-Induced Ocular Complications: A Cross-Sectional Survey
by Amal Aldarwesh, Ali Almustanyir, Duja Alhayan, Mazoon Alharthi and Mohammed Alblowi
Healthcare 2022, 10(3), 565; https://doi.org/10.3390/healthcare10030565 - 17 Mar 2022
Cited by 3 | Viewed by 2289
Abstract
Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are common autoimmune diseases (AD) that affect joints and have multi-organ involvement that results in disability, morbidity, and increased mortality. Both conditions are known to cause a wide range of ocular manifestations. Antimalarial drugs, mainly [...] Read more.
Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are common autoimmune diseases (AD) that affect joints and have multi-organ involvement that results in disability, morbidity, and increased mortality. Both conditions are known to cause a wide range of ocular manifestations. Antimalarial drugs, mainly hydroxychloroquine (HCQ), are among the treatment options for AD that is uniquely characterized by retinopathy as a main side effect. This study examines self-efficacy levels in autoimmune disease patients who were or are currently treated with HCQ and related factors such as patient education, communication with the physician, self-education, and ability to cope with the disease. Full article
15 pages, 49363 KiB  
Article
3D Low-Cost Equipment for Automated Peritoneal Dialysis Therapy
by Samuel Rivero-Urzua, Juan Carlos Paredes-Rojas, Sergio Rodrigo Méndez-García, Fernando Eli Ortiz-Hernández, Armando Oropeza-Osornio and Christopher René Torres-SanMiguel
Healthcare 2022, 10(3), 564; https://doi.org/10.3390/healthcare10030564 - 17 Mar 2022
Cited by 5 | Viewed by 3902
Abstract
A breakthrough in peritoneal dialysis (PD) therapy occurred in 1977 with the development of continuous ambulatory peritoneal dialysis (CAPD). Its simplicity, low cost, and ease with which CAPD could be performed on patients at home contributed to the popularity of this procedure. However, [...] Read more.
A breakthrough in peritoneal dialysis (PD) therapy occurred in 1977 with the development of continuous ambulatory peritoneal dialysis (CAPD). Its simplicity, low cost, and ease with which CAPD could be performed on patients at home contributed to the popularity of this procedure. However, there is a need for continuous improvement in building optimal systems for incident chronic kidney disease (CKD) patients. This research showed the design and construction of a simplified prototype of low-cost automated peritoneal dialysis (APD) equipment that meets international standards to automatically regulate infusion and fluid drainage in and out of a patient with low margins of error. Experimental tests allowed the adjustment of the RPM values concerning the flow rate provided. In addition, thanks to the pressure sensor, it was possible to observe a fluctuation ranging from 9 to 13 kPa, which is within the permissible average specified in the catalogs of medical instruments and equipment. Furthermore, a turbidity sensor was added to decrease the possibility of presenting peritonitis. The results showed absolute values of flow, angular velocity, and pressure that it could deliver for use in APD therapies. Finally, the construction of the APD equipment is presented generally, showing the electronic and mechanical components that constitute it. Full article
(This article belongs to the Special Issue Prevention and Management of Kidney Injury)
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<p>Stages of the machine.</p> Full article ">Figure 2
<p>Machine assembly cabinet.</p> Full article ">Figure 3
<p>Heating base with extension.</p> Full article ">Figure 4
<p>Peristaltic pumps parallel arrangement.</p> Full article ">Figure 5
<p>Peristaltic pump structure: (1) Lower casing, (2) Clamping, (3) Back casing, (4) Hose holder housing, (5) Hinge axis, (6) Safety bolt axis, (7) Safety bolt, (8) Socket head screw M4 × 12, (9) Socket head screw M4 × 16, (10) Nut M4, (11) Union stem, (12) Adjusting bearing, (13) Rollers.</p> Full article ">Figure 6
<p>The electronic system of the APD machine: (1) LN298 motor controller, (2) thermostat controller, (3) Arduino board.</p> Full article ">Figure 7
<p>Electronic diagram of the testbed.</p> Full article ">Figure 8
<p>Algorithms’ flowchart: (<b>a</b>) electronic diagram in testbed; (<b>b</b>) flow diagram in therapy.</p> Full article ">Figure 9
<p>APD prototype.</p> Full article ">Figure 10
<p>APD machine with turbidity measure section.</p> Full article ">Figure 11
<p>Flow/velocity graph.</p> Full article ">Figure 12
<p>Pressure/velocity graph.</p> Full article ">Figure 13
<p>Average flow graph.</p> Full article ">Figure 14
<p>As explained in the last steps, the process menu shows the menu that the machine has while practicing the therapy.</p> Full article ">Figure 15
<p>Turbidity measure section: (<b>a</b>) experimental sensor assembled, (<b>b</b>) display menu.</p> Full article ">
13 pages, 625 KiB  
Article
Validation of the Portuguese Version of the Fertility Adjustment Scale
by Joana Romeiro, Paulo Nogueira and Sílvia Caldeira
Healthcare 2022, 10(3), 563; https://doi.org/10.3390/healthcare10030563 - 17 Mar 2022
Viewed by 1912
Abstract
There is an urgent need to provide healthcare professionals and midwives with validated tools as to improve fertility adjustment and promote well-being of couples with infertility. The purpose of this study was to test validity of the Fertility Adjustment Scale among people undergoing [...] Read more.
There is an urgent need to provide healthcare professionals and midwives with validated tools as to improve fertility adjustment and promote well-being of couples with infertility. The purpose of this study was to test validity of the Fertility Adjustment Scale among people undergoing assisted reproductive techniques. A cross-sectional and methodological study was conducted, and a total of 104 Portuguese adults undergoing fertility treatment were recruited through fertility-related websites. The Fertility Adjustment Scale was administered along with the Spiritual Well-Being Questionnaire and the Resilience Scale for adults as a measure of concurrent validity. Scores revealed the sample’s lack of adjustment to fertility. A significant correlation with measures of resilience provided evidence of convergent validity. There was a significant association of fertility adjustment with time of consultation and the cause of infertility. A Fertility Adjustment Scale with six items is a reliable tool that offers early recognition of patients’ difficulties in adaptation to fertility problems during assisted reproductive techniques, which could be beneficial in not only an early recognition of healthcare intervention but of a more individualized approach to such patients. Full article
(This article belongs to the Special Issue Nursing, Child and Pediatric Health)
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<p>Scree plot representing the eigenvalues (10-item Fertility Adjustment Scale).</p> Full article ">Figure 2
<p>Scree plot representing the eigenvalues (6-item FAS).</p> Full article ">
19 pages, 1091 KiB  
Article
A Content Analysis of Osteopaths’ Attitudes for a More Inclusive Clinical Practice towards Transgender People
by Irene Baldin, Jorge E. Esteves, Marco Tramontano, Mia Macdonald, Francesca Baroni and Christian Lunghi
Healthcare 2022, 10(3), 562; https://doi.org/10.3390/healthcare10030562 - 17 Mar 2022
Cited by 2 | Viewed by 4491
Abstract
Objectives. The aim of this qualitative study was to explore the attitudes, beliefs, and preferences of Italian osteopaths regarding the management of transgender patients through a content analysis of emergent data from semi-structured interviews. Methods. This study was a content analysis based on [...] Read more.
Objectives. The aim of this qualitative study was to explore the attitudes, beliefs, and preferences of Italian osteopaths regarding the management of transgender patients through a content analysis of emergent data from semi-structured interviews. Methods. This study was a content analysis based on the Standards for Reporting Qualitative Research guidelines. Purposive sampling of 10 Italian osteopaths was applied. Data were collected through semi-structured interviews, from March to April 2021, and subsequently transcribed verbatim with the content analysis carried out as an iterative process. Results. One participant was excluded during the first interview due to them being unsuitable for this study. Data saturation was reached after two interviews with the remaining nine participants. Data analysis revealed four main themes: microaggressions, acceptance and non-judgement, person-centered treatment, and education implementation. Conclusions. This study presents cisgender Italian osteopaths’ attitudes in the care of transgender people, revealing the desire to embrace and apply osteopathic tenets regardless of the patient’s gender identity. Full article
(This article belongs to the Collection Osteopathic and Manual Therapy Healthcare Reconceptualization: Health Needs and New Evidence)
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Graphical abstract

Graphical abstract
Full article ">Figure 1
<p>Study design and methods.</p> Full article ">Figure 2
<p>Osteopaths’ attitudes toward transgender patients: a thematic map.</p> Full article ">
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