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Healthcare, Volume 4, Issue 4 (December 2016)

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Research

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Open AccessArticle Effectiveness of a Lifestyle Intervention in Patients with Type 2 Diabetes: The Physical Activity and Nutrition for Diabetes in Alberta (PANDA) Trial
Healthcare 2016, 4(4), 73; doi:10.3390/healthcare4040073
Received: 16 August 2016 / Revised: 16 September 2016 / Accepted: 21 September 2016 / Published: 27 September 2016
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Abstract
Type 2 diabetes (T2D) patients often find integrating a new dietary pattern into their lifestyle challenging; therefore, the PANDA (Physical Activity and Nutrition for Diabetes in Alberta) menu plan intervention was developed to help people incorporate the Canadian Diabetes Association (CDA) nutrition therapy
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Type 2 diabetes (T2D) patients often find integrating a new dietary pattern into their lifestyle challenging; therefore, the PANDA (Physical Activity and Nutrition for Diabetes in Alberta) menu plan intervention was developed to help people incorporate the Canadian Diabetes Association (CDA) nutrition therapy guidelines into their daily lives. The menu plan focused on recipes and foods that were accessible, available and acceptable to Albertans. The objective was to evaluate the effectiveness of the intervention on blood glucose control and dietary adherence and quality among patients with T2D. Participants with T2D (n = 73) enrolled in a single-arm incorporating interactive education based on a four-week menu plan that incorporated the recommendations of the CDA nutrition therapy guidelines. Post-intervention follow-up was conducted at three and six months. After three months, there were beneficial changes in A1c (−0.7%), body mass index (BMI, −0.6 kg/m2), diastolic blood pressure (−4 mmHg), total cholesterol (−63 mg/dL), HDL- (+28 mg/dL) and LDL-cholesterol (−89 mg/dL), Healthy Eating Index (+2.1 score) and perceived dietary adherence (+8.5 score) (all p < 0.05). The significant improvements in A1c, BMI and lipids were maintained at six months. The PANDA menu plan intervention was effective in improving glycemic control and diet quality. The results suggest that a dietary intervention incorporating interactive education sessions focused on menu planning with familiar, accessible foods may be effective for diabetes management. Full article
(This article belongs to the Special Issue Diet Quality)
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Open AccessArticle The Role of Family in a Dietary Risk Reduction Intervention for Cardiovascular Disease
Healthcare 2016, 4(4), 74; doi:10.3390/healthcare4040074
Received: 25 July 2016 / Revised: 13 September 2016 / Accepted: 22 September 2016 / Published: 30 September 2016
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Abstract
Diet is an essential strategy for the prevention of primary and secondary cardiovascular disease (CVD) events. The objectives were to examine: how families at increased risk of CVD perceived personal risk, their motivations to make dietary changes, their understanding of diet, and the
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Diet is an essential strategy for the prevention of primary and secondary cardiovascular disease (CVD) events. The objectives were to examine: how families at increased risk of CVD perceived personal risk, their motivations to make dietary changes, their understanding of diet, and the influence of other family members. Individuals (>18 years) who completed an Australian family-based CVD risk reduction program were invited to a semi-structured telephone interview. Responses were recorded, transcribed verbatim and analysed using a systematic deductive approach with coding derived from key concepts developed as part of the interview structure. Seventeen participants from eight families were interviewed (aged 18–70 years, 47% male, five with CVD diagnosis). Key themes indicated both intrinsic and extrinsic motivations to improve heart health, variations in risk perception, recognition of the role diet plays in heart health, and the extent of family influences on eating patterns. Discrepancies between perceived and actual CVD risk perception impacted on perceived “need” to modify current dietary patterns towards heart health recommendations. Therefore, strategies not reliant on risk perception are needed to engage those with low risk perception. This could involve identifying and accessing the family “ringleader” to influence involvement and capitalising on personal accountability to other family members. Full article
(This article belongs to the Special Issue Nutrition and Cardiovascular Disease)
Open AccessArticle Effectiveness of a Brief Dietetic Intervention for Hyperlipidaemic Adults Using Individually-Tailored Dietary Feedback
Healthcare 2016, 4(4), 75; doi:10.3390/healthcare4040075
Received: 26 July 2016 / Revised: 28 September 2016 / Accepted: 3 October 2016 / Published: 11 October 2016
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Abstract
Dietary modifications can improve serum lipids and reduce cardiovascular disease (CVD) risk. However, attendance at multiple dietary consultations can be a barrier to achieving behaviour change. This study investigated the effectiveness of a brief dietetic intervention on CVD risk factors in hyperlipidaemic adults.
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Dietary modifications can improve serum lipids and reduce cardiovascular disease (CVD) risk. However, attendance at multiple dietary consultations can be a barrier to achieving behaviour change. This study investigated the effectiveness of a brief dietetic intervention on CVD risk factors in hyperlipidaemic adults. Adults with total cholesterol ≥ 5.0 mmol/L or low density lipoprotein (LDL) cholesterol ≥ 4.0 mmol/L and not currently taking lipid-lowering medication were eligible for a minimum 6-week dietary intervention. Dietary intake data and blood lipids were acquired prior to a single counselling session with an Accredited Practising Dietitian (APD). The intervention used targeted feedback with purpose-developed education materials to supplement advice. CVD risk factors and dietary intakes were used to assess pre-post intervention change using linear mixed model regression analyses. Thirty-nine participants (59.3 ± 11.1 years, n = 28 female) were analysed. Mean ± SD follow-up from baseline time was 9.5 ± 2.5 weeks. Significant (p < 0.05) reductions in total cholesterol (−0.51 mmol/L), total:HDL (high density lipoprotein) ratio (−0.27 mmol/L), triglycerides (−0.38 mmol/L), total energy (−870 kJ/day), energy from nutrient-poor foods (−1006 kJ/day) and sodium (−325 mg/day), and improved dietary fat quality (−5.1% of energy/day saturated, +5.0% of energy/day polyunsaturated) and body mass index (−0.4 kg/m2) were achieved. A brief intervention by an APD incorporating targeted, personalised dietary feedback and education in a single counselling session can improve lipid profiles in adults with hyperlipidaemia. Full article
(This article belongs to the Special Issue Nutrition and Cardiovascular Disease)
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Open AccessArticle Association between Vitamin D Status and Coronary Heart Disease among Adults in Saudi Arabia: A Case-Control Study
Healthcare 2016, 4(4), 77; doi:10.3390/healthcare4040077
Received: 19 July 2016 / Revised: 27 September 2016 / Accepted: 11 October 2016 / Published: 17 October 2016
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Abstract
Recent evidence has pointed out an association between vitamin D deficiency and coronary heart disease (CHD). Due to the growing epidemic of CHD and vitamin D deficiency in Saudi Arabia, exploring the role of vitamin D in the prevention of CHD is crucial.
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Recent evidence has pointed out an association between vitamin D deficiency and coronary heart disease (CHD). Due to the growing epidemic of CHD and vitamin D deficiency in Saudi Arabia, exploring the role of vitamin D in the prevention of CHD is crucial. The aim of this study was to examine the association between vitamin D status and CHD in Saudi Arabian adults. This case-control study included 130 CHD cases and 195 age-sex matched controls. Study subjects were recruited from three hospitals in the western region of Saudi Arabia. Study participants were interviewed face-to-face to collect data on their socio-demographic characteristics and family history of CHD. Fasting blood samples were collected, and serum levels of vitamin D, glucose, and total cholesterol were measured. Body weight, height, and blood pressure measurements were also recorded. Severe vitamin D deficiency (25(OH)D < 10 ng/mL) was much more prevalent in CHD cases than in controls (46% and 3%, respectively). The results of multivariate logistic regression showed that vitamin D deficiency (25(OH)D < 20 ng/mL) was associated with CHD, with an odds ratio of 6.5 (95% CI: 2.7–15, p < 0.001). The current study revealed that vitamin D deficiency is independently associated with CHD, suggesting an important predictor of CHD among Saudi adults. Full article
(This article belongs to the Special Issue Nutrition and Cardiovascular Disease)
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Open AccessArticle Quality Nutrition Care: Measuring Hospital Staff’s Knowledge, Attitudes, and Practices
Healthcare 2016, 4(4), 79; doi:10.3390/healthcare4040079
Received: 25 July 2016 / Revised: 29 September 2016 / Accepted: 10 October 2016 / Published: 20 October 2016
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Abstract
Understanding the knowledge, attitudes, and practices (KAP) of hospital staff is needed to improve care activities that support the detection/prevention/treatment of malnutrition, yet quality measures are lacking. The purpose was to develop (study 1) and assess the administration and discriminative potential (study 2)
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Understanding the knowledge, attitudes, and practices (KAP) of hospital staff is needed to improve care activities that support the detection/prevention/treatment of malnutrition, yet quality measures are lacking. The purpose was to develop (study 1) and assess the administration and discriminative potential (study 2) of using such a KAP measure in acute care. In study 1, a 27-question KAP questionnaire was developed, face validated (n = 5), and tested for reliability (n = 35). Kappa and Intraclass Correlation (ICC) were determined. In study 2, the questionnaire was sent to staff at five diverse hospitals (n = 189). Administration challenges were noted and analyses completed to determine differences across sites, professions, and years of practice. Study 1 results demonstrate that the knowledge/attitude (KA) and the practice (P) subscales are reliable (KA: ICC = 0.69 95% CI 0.45–0.84, F = 5.54, p < 0.0001; P: ICC = 0.84 95% CI 0.68−0.92, F = 11.12, p < 0.0001). Completion rate of individual questions in study 2 was high and suggestions to improve administration were identified. The KAP mean score was 93.6/128 (range 51–124) with higher scores indicating more knowledge, better attitudes and positive practices. Profession and years of practice were associated with KAP scores. The KAP questionnaire is a valid and reliable measure that can be used in needs assessments to inform improvements to nutrition care in hospital. Full article
Open AccessArticle Complementary and Alternative Medicine Use and Latina Breast Cancer Survivors’ Symptoms and Functioning
Healthcare 2016, 4(4), 80; doi:10.3390/healthcare4040080
Received: 9 July 2016 / Revised: 15 October 2016 / Accepted: 21 October 2016 / Published: 31 October 2016
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Abstract
Complementary and alternative medicine (CAM) is used widely in cancer populations, particularly among women, and has shown promise for addressing symptom and functioning outcomes. Few studies to date have evaluated CAM use and associations over time with symptoms and function among Latina breast
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Complementary and alternative medicine (CAM) is used widely in cancer populations, particularly among women, and has shown promise for addressing symptom and functioning outcomes. Few studies to date have evaluated CAM use and associations over time with symptoms and function among Latina breast cancer survivors. We administered a baseline (N = 136) and follow-up (n = 58) telephone survey in Spanish or English assessing Latina breast cancer survivor demographics, physical function, anxiety, depression, fatigue, satisfaction with social roles, and both CAM activities and devotional and spiritual practices. About one-third of our sample (35% baseline; 36% follow-up) reported using CAM (yoga, meditation, massage, or herbal/dietary supplements). We assessed devotional and spiritual practices separately from CAM (church attendance, prayer, religious groups, and reading devotional and religious texts); the majority of Latina survivors reported devotional and spiritual practices (80% baseline; 81% follow-up). At baseline, CAM demonstrated a positive association with better physical functioning and lower depression. In contrast, CAM use at the time of follow-up appeared to be related to lower levels of satisfaction with social roles and physical function. In longitudinal analyses, devotional and spiritual practices at baseline significantly predicted lower anxiety, depression, and fatigue at follow-up. Findings suggest CAM plays a complex and not always linear role in symptoms and function outcomes for Latina breast cancer survivors. These findings contribute to the literature on longitudinal CAM use and associations with symptom and functioning outcomes among Latina breast cancer survivors. Full article
(This article belongs to the Special Issue Holistic Needs of Those Living with and beyond Breast Cancer)
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Open AccessArticle Mental Health in Cypriot Citizens of the Rural Health Centre Kofinou
Healthcare 2016, 4(4), 81; doi:10.3390/healthcare4040081
Received: 7 August 2016 / Revised: 14 October 2016 / Accepted: 27 October 2016 / Published: 1 November 2016
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Abstract
Objective: The main purpose of this study was to investigate the mental health of Cypriot citizens living in the current difficult period of economic recession. The specific objective was to investigate the different factors (gender, age, socio-economic factors, etc.) that may affect
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Objective: The main purpose of this study was to investigate the mental health of Cypriot citizens living in the current difficult period of economic recession. The specific objective was to investigate the different factors (gender, age, socio-economic factors, etc.) that may affect the levels of emotional distress, anxiety, and depression in patients attending the Rural Health Centre of Kofinou. Materials and Methods: The sample consisted of a total of 300 Cypriots who visited Kofinou Health Centre in the period between July and September 2015. For the middle-aged citizens, the Greek version of the Hospital Anxiety Depression Scale (HADS) was applied to 150 persons [1], while for the visiting senior citizens (aged over 65 years), the Greek version of the Geriatric Depression Scale (GDS) was used [2]. Results: HADS: A total of 150 people of average age 47 ± 11.5 years (min 23–max 64) participated in the study. Fifty-six percent were women. Seventy-seven percent stated they had a reduction in income (mean reduction 35% ± 25%) and 46.7% suffered from chronic disease. The 36.6% and 28.7% of the visitors showed moderate or severe forms of anxiety and depression, accordingly. Higher emotional distress is associated with lower educational level (b = −2.63, p < 0.001), lower income (b = −1.07, p = 0.017), and the presence of a chronic disease (b = 5.45, p < 0.001). The same factors are significantly associated with higher anxiety (Education: b = −1.20, p = 0.003; Income: b = −0.64, p = 0.01; Chronic disease: b = 2.82, p = 0.001). Additionally, a reduction in income (>35%) is associated with increased depression (p = 0.028). GDS: 150 patients out of which 77 were women (51.3%). The average age of participants was 72 ± 5.5 years. Ninety-three (62%) participants declared a reduction in income due to the financial crisis (mean reduction 20% ± 8%), while 139 (92.7%) stated that they had chronic disease. Fifty-three participants (35.3%) thought they had symptoms of depression after the economic crisis. The women showed higher level of geriatric depression symptoms than men (b = −1.96, p = 0.005), while age is associated with higher levels of GDS (b = 0.16, p = 0.006). Conclusions: The study shows that stress levels, depression, and emotional distress are increased in specific population groups. The main variables associated with the mental health of the participants are the presence of a chronic disease, income, and level of education. Full article
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Open AccessArticle Self-Reported Ache, Pain, or Numbness in Feet and Use of Computers amongst Working-Age Finns
Healthcare 2016, 4(4), 82; doi:10.3390/healthcare4040082
Received: 12 June 2016 / Revised: 26 October 2016 / Accepted: 26 October 2016 / Published: 7 November 2016
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Abstract
The use of the computers and other technical devices has increased. The aim of our work was to study the possible relation between self-reported foot symptoms and use of computers and cell phones using a questionnaire. The study was carried out as a
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The use of the computers and other technical devices has increased. The aim of our work was to study the possible relation between self-reported foot symptoms and use of computers and cell phones using a questionnaire. The study was carried out as a cross-sectional study by posting a questionnaire to 15,000 working-age Finns. A total of 6121 responded, and 7.1% of respondents reported that they very often experienced pain, numbness, and aches in the feet. They also often experienced other symptoms: 52.3% had symptoms in the neck, 53.5% in had problems in the hip and lower back, and 14.6% often had sleeping disorders/disturbances. Only 11.2% of the respondents thought that their symptoms were connected to the use of desktop computers. We found that persons with symptoms in the feet quite often, or more often, had additional physical and mental symptoms. In future studies, it is important to take into account that the persons with symptoms in the feet may very often have other symptoms, and the use of computers can influence these symptoms. Full article
(This article belongs to the Special Issue Occupational Health Issues in the New Millennium)
Open AccessArticle Weight Management Advice for Clients with Overweight or Obesity: Allied Health Professional Survey
Healthcare 2016, 4(4), 85; doi:10.3390/healthcare4040085
Received: 6 October 2016 / Revised: 7 November 2016 / Accepted: 10 November 2016 / Published: 14 November 2016
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Abstract
The prevalence of obesity is increasing. The potential for allied health professionals to intervene through the provision of lifestyle advice is unknown. This study aimed to determine the knowledge, attitudes and practices of health professionals in the provision of dietary and physical activity
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The prevalence of obesity is increasing. The potential for allied health professionals to intervene through the provision of lifestyle advice is unknown. This study aimed to determine the knowledge, attitudes and practices of health professionals in the provision of dietary and physical activity advice for clients with overweight or obesity. Dietitians, exercise physiologists, nurses, occupational therapists, physiotherapists and psychologists (n = 296) working in New South Wales were surveyed using paper-based and online methods. The majority of health professionals (71%) believed that providing weight management advice was within their scope of practice; 81% provided physical activity advice but only 57% provided dietary advice. Other than dietitians, few had received training in client weight management during their professional qualification (14%) or continuing education (16%). Providing dietary advice was associated with: believing it was within their scope of practice (OR 3.9, 95% CI 1.9–7.9, p < 0.01), training during their entry-level qualification (OR 7.2, 3.2–16.4, p < 0.01) and having departmental guidelines (OR 4.7, 2.1–10.9, p < 0.01). Most health professionals are willing to provide lifestyle advice to clients with overweight or obesity but few have received required training. Developing guidelines and training for in client weight management may potentially impact on rising obesity levels. Full article
Open AccessArticle Construct Validity of the Late-Life Function and Disability Instrument in African American Breast Cancer Survivors
Healthcare 2016, 4(4), 87; doi:10.3390/healthcare4040087
Received: 3 August 2016 / Revised: 10 November 2016 / Accepted: 14 November 2016 / Published: 16 November 2016
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Abstract
Limited data exist on the validity of the Late-Life Function and Disability (LLFD) instrument in cancer survivors. We examined the construct validity of the abbreviated LLFD instrument in a sample of African-American breast cancer survivors. African American breast cancer survivors (n =
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Limited data exist on the validity of the Late-Life Function and Disability (LLFD) instrument in cancer survivors. We examined the construct validity of the abbreviated LLFD instrument in a sample of African-American breast cancer survivors. African American breast cancer survivors (n = 181) aged 50 years and older completed the abbreviated LLFD instrument and questions about sociodemographic and lifestyle characteristics. Confirmatory factor analysis (CFA), Cronbach alphas, and structural models were used to evaluate the construct validity of these measures. Minor modifications were made to the three-factor functional component portion of the inventory to improve model fit. Cronbach alpha’s (range 0.85–0.92) and inter-factor correlations (r = 0.3–0.5, all p < 0.05) were appropriate. The two-factor disability component fit the data and Cronbach alpha’s (0.91 and 0.98) were appropriate with a high inter-factor correlation (r = 0.95, p < 0.01). The average variance extracted (range = 0.55–0.93) and composite reliabilities (range = 0.86–0.98) were in acceptable ranges. Floor effects ranged from 7% for advanced lower function to 74% for personal role disability. Education and number of comorbidities were correlated significantly with functional outcomes. The abbreviated LLFD instrument had adequate construct validity in this sample of African American breast cancer survivors. Further studies are needed that examine the stability of the instrument over time. Full article
(This article belongs to the Special Issue Holistic Needs of Those Living with and beyond Breast Cancer)
Open AccessArticle A Holistic Model of Care to Support Those Living with and beyond Cancer
Healthcare 2016, 4(4), 88; doi:10.3390/healthcare4040088
Received: 21 July 2016 / Revised: 14 October 2016 / Accepted: 11 November 2016 / Published: 18 November 2016
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Abstract
Background: Globally, the burden of cancer continues to increase and it is well-documented that while not a homogeneous population, cancer patients and cancer survivors face many physical, psychological, social, spiritual, and financial issues. Cancer care is shifting from a disease-focused to a patient-centered
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Background: Globally, the burden of cancer continues to increase and it is well-documented that while not a homogeneous population, cancer patients and cancer survivors face many physical, psychological, social, spiritual, and financial issues. Cancer care is shifting from a disease-focused to a patient-centered approach resulting in an increased need to address these concerns. Methods: Utilizing a quality improvement approach, this paper describes an integrated cancer care model at Bloomhill Cancer Center (BCC) in Queensland, Australia that demonstrates the ability to meet the holistic needs of patients living with and beyond cancer and to identify opportunities for better practice and service provision. Results: Survey results indicate that 67% and 77% of respondents were very satisfied and 27% and 17% were satisfied with their first contact and very satisfied with their first meeting with a nurse at BCC. Clients also reported being very satisfied (46%) or satisfied (30%) with the emotional support they received at BCC and over 90% were very satisfied or satisfied with the touch therapies that the received. Conclusion: Due to the early success of the interventions provided by BCC, the model potentially offers other states and countries a framework for supportive cancer care provision for people living with and beyond cancer. Full article
(This article belongs to the Special Issue Holistic Needs of Those Living with and beyond Breast Cancer)
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Open AccessArticle Emotional Labour and Wellbeing: What Protects Nurses?
Healthcare 2016, 4(4), 89; doi:10.3390/healthcare4040089
Received: 29 July 2016 / Revised: 22 November 2016 / Accepted: 25 November 2016 / Published: 30 November 2016
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Abstract
Although compassionate care has wide-ranging benefits for patients, it can be emotionally demanding for healthcare staff. This may be a particular problem for those with little experience in a caring role. This study utilises the job demands-resources model to examine links between “emotional
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Although compassionate care has wide-ranging benefits for patients, it can be emotionally demanding for healthcare staff. This may be a particular problem for those with little experience in a caring role. This study utilises the job demands-resources model to examine links between “emotional labour” and emotional exhaustion in student nurses. In line with the triple-match principle—whereby interactive effects are more likely when job demands, resources, and outcomes are within the same qualitative domain—the protective role of emotional support and emotion-focused coping (i.e., emotional venting) in the relationship between emotional labour and exhaustion is also explored. An online questionnaire was completed by 351 student nurses with experience working in healthcare settings. A strong positive relationship was found between emotional labour and emotional exhaustion, and some support was found for the moderating effects of emotional support and emotion-focused coping. Ways to help student and qualified nurses develop the emotional resilience required to protect their wellbeing, while providing high-quality compassionate care to patients are considered. Full article
(This article belongs to the Special Issue Occupational Health Issues in the New Millennium)
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Open AccessArticle From Consultation to Application: Practical Solutions for Improving Maternal and Neonatal Outcomes for Adolescent Aboriginal Mothers at a Local Level
Healthcare 2016, 4(4), 90; doi:10.3390/healthcare4040090
Received: 31 August 2016 / Revised: 16 November 2016 / Accepted: 30 November 2016 / Published: 6 December 2016
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Abstract
Adolescent pregnancy has been typically linked to a range of adverse outcomes for mother and child. In Australia, Aboriginal and Torres Strait Islander women have a higher proportion of adolescent births compared with other adolescent Australian women, and are at greater risk of
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Adolescent pregnancy has been typically linked to a range of adverse outcomes for mother and child. In Australia, Aboriginal and Torres Strait Islander women have a higher proportion of adolescent births compared with other adolescent Australian women, and are at greater risk of poorer psychosocial and clinical outcomes if they are not well supported during pregnancy and beyond. Drawing on existing literature and consultations with young Aboriginal women and health professionals supporting pregnant Aboriginal women in Western Australia, this paper discusses the importance of creating models of antenatal care using a “social determinants of health” framework. Destigmatizing young parenthood and providing continuity of caregiver in culturally safe services, with culturally competent health professionals provides a means to encourage engagement with the health system and improve health outcomes for young mothers and their babies. Full article
(This article belongs to the Special Issue Clinical Trials in Antenatal and Intrapartum Care)
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Open AccessArticle The BASE-Program—A Multidimensional Approach for Health Promotion in Companies
Healthcare 2016, 4(4), 91; doi:10.3390/healthcare4040091
Received: 13 September 2016 / Revised: 16 November 2016 / Accepted: 5 December 2016 / Published: 8 December 2016
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Abstract
Multidimensional assessments for conducting interventions are needed to achieve positive health effects within companies. BASE is an acronym, consisting of B = “Bedarfsbestimmung” (requirements); A = “Arbeitsplatzorganisation” (organisation of work); S = “Schulung des belastungsverträglichen Alltagshandelns” (coaching preventive behaviour at work); E =
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Multidimensional assessments for conducting interventions are needed to achieve positive health effects within companies. BASE is an acronym, consisting of B = “Bedarfsbestimmung” (requirements); A = “Arbeitsplatzorganisation” (organisation of work); S = “Schulung des belastungsverträglichen Alltagshandelns” (coaching preventive behaviour at work); E = “Eigenverantwortung und Selbstwirksamkeit” (self-responsibility and self-efficacy). It is a prevention program designed to avoid and reduce work-related musculoskeletal diseases. It was developed to support prevention strategies within companies. It comprises aspects of health protection, ergonomics, exercise and self-efficacy. A comprehensive assessment will identify strain e.g., musculoskeletal discomforts due to body positions or psychological stress. Moreover, the general health status, preferences and barriers for participating in health promotion programs are evaluated. This analysis leads to practical and goal-oriented recommendations and interventions which suit the needs of companies and employees. These are executed onsite in real workplace situations and involve the introduction of first-hand experience in behavioural change. Therefore, this practical approach enhances the employees’ acceptance and self-efficacy for health promotion. This can result in long-term health promoting behaviour. This article presents the outcome and sustainability effects of BASE in three different application fields (logistic, industrial and office workers). Full article
(This article belongs to the Special Issue Occupational Health Issues in the New Millennium)
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Open AccessArticle Sharing the Load: Amish Healthcare Financing
Healthcare 2016, 4(4), 92; doi:10.3390/healthcare4040092
Received: 29 September 2016 / Revised: 3 December 2016 / Accepted: 8 December 2016 / Published: 14 December 2016
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Abstract
When settling healthcare bills, the Old Order Amish of Lancaster County, Pennsylvania rely on an ethos of mutual aid, independent of the government. Consonant with this philosophy, many Amish do not participate in or receive benefits from Social Security or Medicare. They are
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When settling healthcare bills, the Old Order Amish of Lancaster County, Pennsylvania rely on an ethos of mutual aid, independent of the government. Consonant with this philosophy, many Amish do not participate in or receive benefits from Social Security or Medicare. They are also exempted from the Affordable Care Act of 2010. This study expands the limited documentation of Amish Hospital Aid, an Amish health insurance program that covers major medical costs. Interview data from 11 Amish adults in Lancaster County depict how this aid program supplements traditional congregational alms coverage of medical expenses. The interview data delineate the structure of the program, its operation, and how it encourages cost containment and community interdependence. The manner in which the Amish collaborate to pay for medical expenses provides a thought-provoking paradigm for managing health care costs. Full article
Open AccessArticle Impact of Time-Varying Treatment Exposures on the Risk of Venous Thromboembolism in Multiple Myeloma
Healthcare 2016, 4(4), 93; doi:10.3390/healthcare4040093
Received: 12 October 2016 / Revised: 9 December 2016 / Accepted: 14 December 2016 / Published: 20 December 2016
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Abstract
Multiple myeloma (MM) has one of the highest risks of venous thromboembolism (VTE) of all cancers due to pathologic changes and treatment-related exposures. This study assessed the one-year incidence of VTE in newly diagnosed MM and to determine the baseline and time-varying treatment-related
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Multiple myeloma (MM) has one of the highest risks of venous thromboembolism (VTE) of all cancers due to pathologic changes and treatment-related exposures. This study assessed the one-year incidence of VTE in newly diagnosed MM and to determine the baseline and time-varying treatment-related factors associated with VTE risk in a U.S.-based cohort. MM patients were identified and age, gender, and baseline comorbidities were determined. Treatment-related exposures included thalidomide derivatives (IMIDs), proteasome inhibitors, cytotoxic chemotherapy, steroids, erythropoietin-stimulating agents (ESAs), stem cell transplants (SCT), hospitalizations, infection, and central venous catheters (CVC). Multiple statistical models were used including a baseline competing risks model, a time-varying exposure Cox proportional hazard (CPH) model, and a case-time-control analysis. The overall incidence of VTE was 107.2 per 1000 person-years with one-half of the VTEs occurring in the first 90 days. The baseline model showed that increasing age, heart failure, and hypertension were associated with one-year incidence of VTE. MM-specific IMID treatment had lower than expected associations with VTE based on prior literature. Instead, exposure to ESAs, SCT, CVC, and infection had higher associations. Based on these results, VTE risk in MM may be less straightforward than considering only chemotherapy exposures, and other treatment-related exposures should be considered to determine patient risk. Full article
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Open AccessArticle Newborn Care in the Home and Health Facility: Formative Findings for Intervention Research in Cambodia
Healthcare 2016, 4(4), 94; doi:10.3390/healthcare4040094
Received: 28 September 2016 / Revised: 13 December 2016 / Accepted: 14 December 2016 / Published: 21 December 2016
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Abstract
Global coverage and scale up of interventions to reduce newborn mortality remains low, though progress has been achieved in improving newborn survival in many low-income settings. An important factor in the success of newborn health interventions, and moving to scale, is appropriate design
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Global coverage and scale up of interventions to reduce newborn mortality remains low, though progress has been achieved in improving newborn survival in many low-income settings. An important factor in the success of newborn health interventions, and moving to scale, is appropriate design of community-based programs and strategies for local implementation. We report the results of formative research undertaken to inform the design of a newborn health intervention in Cambodia. Information was gathered on newborn care practices over a period of three months using multiple qualitative methods of data collection in the primary health facility and home setting. Analysis of the data indicated important gaps, both at home and facility level, between recommended newborn care practices and those typical in the study area. The results of this formative research have informed strategies for behavior change and improving referral of sick infants in the subsequent implementation study. Collection and dissemination of data on newborn care practices from settings such as these can contribute to efforts to advance survival, growth and development of newborns for intervention research, and for future newborn health programming. Full article
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Review

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Open AccessReview Symptom Management in Patients with Stage 5 CKD Opting for Conservative Management
Healthcare 2016, 4(4), 72; doi:10.3390/healthcare4040072
Received: 30 October 2015 / Revised: 13 September 2016 / Accepted: 15 September 2016 / Published: 22 September 2016
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Abstract
Chronic kidney disease (CKD) stages 3–5 now affects 8.5% of adults in the United Kingdom; with 4% of patients expected to reach stage 5 CKD. Increasing numbers of older patients are contributing to the growth of demand of kidney services. With the exception
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Chronic kidney disease (CKD) stages 3–5 now affects 8.5% of adults in the United Kingdom; with 4% of patients expected to reach stage 5 CKD. Increasing numbers of older patients are contributing to the growth of demand of kidney services. With the exception of transplantation, dialysis has been the main form of renal replacement therapy (RRT) for advanced CKD. This elderly population is usually too frail and has many other co-existing medical complaints or co morbidities to undergo transplantation. Dialysis is an invasive treatment, and some frail elderly patients can experience many dialysis related symptoms. An alternative option for these patients is to choose conservative management (CM) of their stage 5 CKD. These patients often have complex supportive and palliative care needs. The frequency, severity and distress caused by symptoms related to stage 5 CKD are often under recognized and under treated. There is a need for early identification and management of symptoms as they present in patients with stage 5 CKD being managed conservatively. Symptom assessment should be focused on anticipating, identifying and alleviating any symptoms. This needs to be incorporated into the regular practice of those managing CM patients. Full article
(This article belongs to the Special Issue Supportive and Palliative Care in Renal Disease)
Open AccessReview The Implications of the Developmental Origins of Health and Disease on Public Health Policy and Health Promotion in South Africa
Healthcare 2016, 4(4), 83; doi:10.3390/healthcare4040083
Received: 14 June 2016 / Revised: 18 August 2016 / Accepted: 3 November 2016 / Published: 9 November 2016
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Abstract
The developmental origins of health and disease (DOHaD) hypothesis states that environmental influences in utero and in early life can determine health and disease in later life through the programming of genes and/or altered gene expression. The DOHaD is likely to have had
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The developmental origins of health and disease (DOHaD) hypothesis states that environmental influences in utero and in early life can determine health and disease in later life through the programming of genes and/or altered gene expression. The DOHaD is likely to have had an effect in South Africa during the fifty years of apartheid; and during the twenty years since the dawn of democracy in 1994. This has profound implications for public health and health promotion policies in South Africa, a country experiencing increased prevalence of noncommunicable diseases (NCDs) and risk factors and behaviours for NCDs due to rapid social and economic transition, and because of the DOHaD. Public health policy and health promotion interventions, such as those introduced by the South African Government over the past 20 years, were designed to improve the health of pregnant women (and their unborn children). They could in addition, through the DOHaD mechanism, reduce NCDs and their risk factors in their offspring in later life. The quality of public health data over the past 40 years in South Africa precludes the possibility of proving the DOHaD hypothesis in that context. Nevertheless, public health and health promotion policies need to be strengthened, if South Africa and other low and middle income countries (LMICs) are to avoid the very high prevalence of NCDs seen in Europe and North America in the 50 years following the Second World War, as a result of socio economic transition and the DOHaD. Full article
Open AccessReview Using Technology, Bioinformatics and Health Informatics Approaches to Improve Learning Experiences in Optometry Education, Research and Practice
Healthcare 2016, 4(4), 86; doi:10.3390/healthcare4040086
Received: 30 July 2016 / Revised: 7 November 2016 / Accepted: 10 November 2016 / Published: 15 November 2016
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Abstract
Rapid advances in ocular diagnostic approaches and emerging links of pathological changes in the eye with systemic disorders have widened the scope of optometry as the front line of eye health care. Expanding professional requirements stipulate that optometry students get a meticulous training
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Rapid advances in ocular diagnostic approaches and emerging links of pathological changes in the eye with systemic disorders have widened the scope of optometry as the front line of eye health care. Expanding professional requirements stipulate that optometry students get a meticulous training in relevant information and communication technologies (ICT) and various bioinformatics and health informatics software to meet current and future challenges. Greater incorporation of ICT approaches in optometry education can facilitate increased student engagement in shared learning experiences and improve collaborative learning. This, in turn, will enable students to participate in and prepare for the complex real-world situations. A judicious use of ICTs by teachers in learning endeavors can help students develop innovative patterns of thinking to be a successful optometry professional. ICT-facilitated learning enables students and professionals to carry out their own research and take initiatives and thus shifts the equilibrium towards self-education. It is important that optometry and allied vision science schools adapt to the changing professional requirements with pedagogical evolution and react appropriately to provide the best educational experience for the students and teachers. This review aims to highlight the scope of ICT applications in optometry education and professional development drawing from similar experiences in other disciplines. Further, while enhanced use of ICT in optometry has the potential to create opportunities for transformative learning experiences, many schools use it merely to reinforce conventional teaching practices. Tremendous developments in ICT should allow educators to consider using ICT tools to enhance communication as well as providing a novel, richer, and more meaningful medium for the comprehensive knowledge construction in optometry and allied health disciplines. Full article

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Jump to: Research, Review

Open AccessErratum Erratum: Gibson, A.A.; et al. Comparison of Very Low Energy Diet Products Available in Australia and How to Tailor Them to Optimise Protein Content for Younger and Older Adult Men and Women Healthcare 2016, 4, 71
Healthcare 2016, 4(4), 76; doi:10.3390/healthcare4040076
Received: 12 October 2016 / Accepted: 12 October 2016 / Published: 12 October 2016
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Abstract
Please note that in the published paper [1], on page 5, three sentences in the second paragraph are wrongly placed in the third paragraph.[...] Full article
Open AccessDiscussion The Interacting Axes of Environmental, Health, and Social Justice Cumulative Impacts: A Case Study of the Blueberry River First Nations
Healthcare 2016, 4(4), 78; doi:10.3390/healthcare4040078
Received: 26 July 2016 / Revised: 16 September 2016 / Accepted: 27 September 2016 / Published: 18 October 2016
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Abstract
We consider the case of intensive resource extractive projects in the Blueberry River First Nations in Northern British Columbia, Canada, as a case study. Drawing on the parallels between concepts of cumulative environmental and cumulative health impacts, we highlight three axes along which
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We consider the case of intensive resource extractive projects in the Blueberry River First Nations in Northern British Columbia, Canada, as a case study. Drawing on the parallels between concepts of cumulative environmental and cumulative health impacts, we highlight three axes along which to gauge the effects of intensive extraction projects. These are environmental, health, and social justice axes. Using an intersectional analysis highlights the way in which using individual indicators to measure impact, rather than considering cumulative effects, hides the full extent by which the affected First Nations communities are impacted by intensive extraction projects. We use the case study to contemplate several mechanisms at the intersection of these axes whereby the negative effects of each not only add but also amplify through their interactions. For example, direct impact along the environmental axis indirectly amplifies other health and social justice impacts separately from the direct impacts on those axes. We conclude there is significant work still to be done to use cumulative indicators to study the impacts of extractive industry projects—like liquefied natural gas—on peoples, environments, and health. Full article
(This article belongs to the Special Issue Ethics, Health, and Natural Resources)
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Open AccessCommentary Promoting Healthy Growth or Feeding Obesity? The Need for Evidence-Based Oversight of Infant Nutritional Supplement Claims
Healthcare 2016, 4(4), 84; doi:10.3390/healthcare4040084
Received: 29 August 2016 / Revised: 10 October 2016 / Accepted: 27 October 2016 / Published: 12 November 2016
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Abstract
The Developmental Origins of Health and Disease (DOHaD) model recognizes growth in infancy and childhood as a fundamental determinant of lifespan health. Evidence of long-term health risks among small neonates who subsequently grow rapidly poses a challenge for interventions aiming to support healthy
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The Developmental Origins of Health and Disease (DOHaD) model recognizes growth in infancy and childhood as a fundamental determinant of lifespan health. Evidence of long-term health risks among small neonates who subsequently grow rapidly poses a challenge for interventions aiming to support healthy growth, not merely drive weight gain. Defining healthy growth beyond “getting bigger” is essential as infant and young child feeding industries expand. Liquid-based nutritional supplements, originally formulated for undernourished children, are increasingly marketed for and consumed by children generally. Clarifying the nature of the evidentiary base on which structure/function claims promoting “healthy growth” are constructed is important to curb invalid generalizations. Evidence points to changing social beliefs and cultural practices surrounding supplementary feeding, raising specific concerns about the long-term health consequences of an associated altered feeding culture, including reduced dietary variety and weight gain. Reassessing the evidence for and relevance of dietary supplements’ “promoting healthy growth” claims for otherwise healthy children is both needed in a time of global obesity and an opportunity to refine intervention approaches among small children for whom rapid subsequent growth in early life augments risk for chronic disease. Scientific and health care partnerships are needed to consider current governmental oversight shortfalls in protecting vulnerable populations from overconsumption. This is important because we may be doing more harm than good. Full article

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