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Healthcare, Volume 6, Issue 1 (March 2018)

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Cover Story (view full-size image) Weight retention following childbirth is common and has implications for a woman’s life-long weight [...] Read more.
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Editorial

Jump to: Research, Review

Open AccessEditorial Acknowledgement to Reviewers of Healthcare in 2017
Healthcare 2018, 6(1), 4; doi:10.3390/healthcare6010004
Received: 10 January 2018 / Revised: 10 January 2018 / Accepted: 10 January 2018 / Published: 10 January 2018
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Abstract
Peer review is an essential part in the publication process, ensuring that Healthcare maintains high quality standards for its published papers.[...] Full article

Research

Jump to: Editorial, Review

Open AccessArticle The Benefits of Higher Income in Protecting against Chronic Medical Conditions Are Smaller for African Americans than Whites
Healthcare 2018, 6(1), 2; doi:10.3390/healthcare6010002
Received: 15 November 2017 / Revised: 28 December 2017 / Accepted: 2 January 2018 / Published: 9 January 2018
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Abstract
Background: Blacks’ diminished return is defined as smaller protective effects of socioeconomic status (SES) on health of African Americans compared to Whites. Aim: Using a nationally representative sample, the current study aimed to examine if the protective effect of income on chronic medical
[...] Read more.
Background: Blacks’ diminished return is defined as smaller protective effects of socioeconomic status (SES) on health of African Americans compared to Whites. Aim: Using a nationally representative sample, the current study aimed to examine if the protective effect of income on chronic medical conditions (CMC) differs for African Americans compared to Whites. Methods: With a cross-sectional design, the National Survey of American Life (NSAL), 2003, included 3570 non-Hispanic African Americans and 891 non-Hispanic Whites. The dependent variable was CMC, treated as a continuous measure. The independent variable was income. Race was the focal moderator. Age, education, and marital status were covariates. Linear regressions were used to test if the protective effect of income against CMC varies by race. Results: High income was associated with a lower number of CMC in the pooled sample. We found a significant interaction between race and income, suggesting that income has a smaller protective effect against CMC for African Americans than it does for Whites. Conclusion: Blacks’ diminished return also holds for the effects of income on CMC. Blacks’ diminished return is a contributing mechanism to the racial disparities in health in the United States that is often overlooked. More research is needed on the role of diminished health return of SES resources among other minority groups. Full article
Open AccessArticle Evaluating the Impact of a Clinician Improvement Program for Treating Patients with Intellectual and Developmental Disabilities: The Challenging Case of Mississippi
Healthcare 2018, 6(1), 3; doi:10.3390/healthcare6010003
Received: 11 November 2017 / Revised: 14 December 2017 / Accepted: 6 January 2018 / Published: 10 January 2018
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Abstract
In recent years, people with intellectual and developmental disabilities (IDD) have moved from institutionalized settings to local community residences. While deinstitutionalization has yielded quality of life improvements for people with IDD, this transition presents significant health-related challenges. Community clinicians have typically not been
[...] Read more.
In recent years, people with intellectual and developmental disabilities (IDD) have moved from institutionalized settings to local community residences. While deinstitutionalization has yielded quality of life improvements for people with IDD, this transition presents significant health-related challenges. Community clinicians have typically not been trained to provide sound medical care to people with IDD, a subpopulation that exhibits unique medical needs and significant health disparities. This study reports the results of a comprehensive evaluation of an IDD-focused clinician improvement program implemented throughout Mississippi. DETECT (Developmental Evaluation, Training and Consultative Team) was formed to equip Mississippi’s physicians and nurses to offer competent medical care to people with IDD living in community residences. Given the state’s pronounced health disparities and its clinician shortage, Mississippi offers a stringent test of program effectiveness. Results of objective survey indicators and subjective rating barometers administered before and after clinician educational seminars reveal robust statistically significant differences in clinician knowledge and self-assessed competence related to treating people with IDD. These results withstand controls for various confounding factors. Positive post-only results were also evident in a related program designed specifically for medical students. The study concludes by specifying a number of implications, including potential avenues for the wider dissemination of this program and promising directions for future research. Full article
Open AccessArticle Poor People Are Hospitalized Three Times More for Mental Health Services than the Non-Poor in Central Valley California
Healthcare 2018, 6(1), 5; doi:10.3390/healthcare6010005
Received: 3 December 2017 / Revised: 9 January 2018 / Accepted: 10 January 2018 / Published: 12 January 2018
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Abstract
Introduction: Providing health insurance to the poor has become a standard policy response to health disparities between the poor and the non-poor. It is often assumed that if the poor people are given health insurance, they will use preventative care, which will prevent
[...] Read more.
Introduction: Providing health insurance to the poor has become a standard policy response to health disparities between the poor and the non-poor. It is often assumed that if the poor people are given health insurance, they will use preventative care, which will prevent more expensive emergency visits and inpatient hospitalization, and in turn, it will save healthcare cost in the long run. This paper presents the findings from our study in California about what happens to the poor when they are given health insurance. The purpose of the study was to understand how the healthcare system in California treats the poor patients differently than the non-poor. Method: Using multivariate logistic regressions, this study analyzed a large patient discharge data (PDD) from the California Office of Statewide Planning and Development (OSHPD) for eight counties in the Central Valley California (N = 423,640). First, utilizing International Classification of Diseases (ICD 10) as diagnostic criteria, mental-health vs. non-mental health hospitalization rates were estimated. Second, health insurance status was used as a proxy measure of poverty of the patients. Using chi-Square, the probability of hospitalization for mental health services was estimated based on their insurance types. Finally, using step-wise logistic regression, the odds of mental health hospitalization was estimated conditional on individual characteristics, health insurance types, and geographic characteristics. Findings: When the poor people were given health insurance, they were three times more likely to be hospitalized for mental health services than the non-poor. The more than three-fold variation in mental health hospitalization was not driven by demographic or geographic characteristics. The findings are new and have important implications for the healthcare policies for the poor. Further studies are needed to understand the extent to which the disproportionately high rate of mental health hospitalizations of the poor are driven by the provider-induced needs. Full article
Open AccessArticle Age and Gender Differences in Psychological Distress among African Americans and Whites: Findings from the 2016 National Health Interview Survey
Healthcare 2018, 6(1), 6; doi:10.3390/healthcare6010006
Received: 1 December 2017 / Revised: 10 January 2018 / Accepted: 11 January 2018 / Published: 17 January 2018
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Abstract
Previous studies report a race and mental health paradox: Whites score higher on measures of major depression compared to African Americans, but the opposite is true for psychological distress (i.e., African Americans score higher on distress measures compared to Whites). Independently, race, age,
[...] Read more.
Previous studies report a race and mental health paradox: Whites score higher on measures of major depression compared to African Americans, but the opposite is true for psychological distress (i.e., African Americans score higher on distress measures compared to Whites). Independently, race, age, and gender outcomes for psychological distress are well documented in the literature. However, there is relatively little research on how psychological distress interferes with the lives of African Americans and Whites at the intersection of their various race, age, and gender identities. This study uses data from the 2016 National Health Interview Survey to examine age and gender differences in psychological distress and how much psychological distress interferes with the lives of African Americans and Whites. Our study findings are contrary to the paradox such that young White women (M = 3.36, SD = 1.14) and middle-aged White men (M = 2.55, SD = 3.97) experienced higher psychological distress than all other race, age, and gender groups. Psychological distress interference was relatively high among the high distress groups, except for older African American men (M = 1.73, SD = 1.05) and young African American women (M = 1.93, SD = 0.95). Implications for studies that consider cultural experiences of psychological distress, and how it impacts different demographic groups are discussed. Full article
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Open AccessArticle How Neighborhood Effects Vary: Childbearing and Fathering among Latino and African American Adolescents
Healthcare 2018, 6(1), 7; doi:10.3390/healthcare6010007
Received: 20 November 2017 / Revised: 29 December 2017 / Accepted: 10 January 2018 / Published: 18 January 2018
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Abstract
This study examines what neighborhood conditions experienced at age 15 and after are associated with teen childbearing and fathering among Latino and African American youth and whether these neighborhood effects vary by gender and/or ethnicity. Administrative and survey data from a natural experiment
[...] Read more.
This study examines what neighborhood conditions experienced at age 15 and after are associated with teen childbearing and fathering among Latino and African American youth and whether these neighborhood effects vary by gender and/or ethnicity. Administrative and survey data from a natural experiment are used for a sample of 517 Latino and African American youth whose families were quasi-randomly assigned to public housing operated by the Denver (CO) Housing Authority (DHA). Characteristics of the neighborhood initially assigned by DHA to wait list applicants are utilized as identifying instruments for the neighborhood contexts experienced during adolescence. Cox Proportional Hazards (PH) models reveal that neighborhoods having higher percentages of foreign-born residents but lower levels of social capital robustly predict reduced odds of teen parenting though the magnitude of these effects was contingent on gender and ethnicity. Specifically, the presence of foreign-born neighbors on the risk of teen parenting produced a stronger dampening effect for African American youth when compared to Latino youth. Additionally, the effects of social capital on teen parenting were stronger for males than females. Full article
Open AccessArticle Postpartum Women’s Perspectives of Engaging with a Dietitian and Exercise Physiologist via Video Consultations for Weight Management: A Qualitative Evaluation
Healthcare 2018, 6(1), 8; doi:10.3390/healthcare6010008
Received: 27 November 2017 / Revised: 15 January 2018 / Accepted: 17 January 2018 / Published: 19 January 2018
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Abstract
Optimising weight status after childbirth is important. Video consultations are an unexplored opportunity to deliver real-time support to postpartum women to improve lifestyle behaviours. This study aims to provide insight into postpartum women’s perspectives of engaging with a dietitian and exercise physiologist through
[...] Read more.
Optimising weight status after childbirth is important. Video consultations are an unexplored opportunity to deliver real-time support to postpartum women to improve lifestyle behaviours. This study aims to provide insight into postpartum women’s perspectives of engaging with a dietitian and exercise physiologist through video consultations for tailored nutrition and exercise care. A qualitative study using individual telephone interviews (13–36 min) was undertaken. 21 women (body mass index (BMI): 28.1 ± 3.8 kg/m2; age: 32.3 ± 3.0 years; parity: 1.6 ± 0.9 children) who had completed the 8 week “Video-coaching to assist lifestyle (VITAL) change for mums” intervention participation included up to five video consultations with a dietitian and exercise physiologist. The interviews were audiorecorded and transcribed. Thematic data analysis was conducted by an independent researcher using NVIVO11. Themes relating to the video consultation experience included feeling that they did not differ from other consultations, they were convenient, and the length of time and flexible options were appropriate; however there was a desire for increased contact frequency. The dietitian and exercise physiologist were perceived to increase the participants’ knowledge and confidence to improve health behaviours. The approach to setting realistic and tailored goals was well received. Tailored advice from a dietitian and exercise physiologist received via video consultations is acceptable for postpartum women and offers a viable alternative to in-person care. Full article
(This article belongs to the Special Issue Burden of Obesity on Health, Wellbeing and Healthcare)
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Open AccessArticle Nutrition Care after Discharge from Hospital: An Exploratory Analysis from the More-2-Eat Study
Healthcare 2018, 6(1), 9; doi:10.3390/healthcare6010009
Received: 12 December 2017 / Revised: 8 January 2018 / Accepted: 17 January 2018 / Published: 20 January 2018
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Abstract
Many patients leave hospital in poor nutritional states, yet little is known about the post-discharge nutrition care in which patients are engaged. This study describes the nutrition-care activities 30-days post-discharge reported by patients and what covariates are associated with these activities. Quasi-randomly selected
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Many patients leave hospital in poor nutritional states, yet little is known about the post-discharge nutrition care in which patients are engaged. This study describes the nutrition-care activities 30-days post-discharge reported by patients and what covariates are associated with these activities. Quasi-randomly selected patients recruited from 5 medical units across Canada (n = 513) consented to 30-days post-discharge data collection with 48.5% (n = 249) completing the telephone interview. Use of nutrition care post-discharge was reported and bivariate analysis completed with relevant covariates for the two most frequently reported activities, following recommendations post-discharge or use of oral nutritional supplements (ONS). A total of 42% (n = 110) received nutrition recommendations at hospital discharge, with 65% (n = 71/110) of these participants following those recommendations; 26.5% (n = 66) were taking ONS after hospitalization. Participants who followed recommendations were more likely to report following a special diet (p = 0.002), different from before their hospitalization (p = 0.008), compared to those who received recommendations, but reported not following them. Patients taking ONS were more likely to be at nutrition risk (p < 0.0001), malnourished (p = 0.0006), taking ONS in hospital (p = 0.01), had a lower HGS (p = 0.0013; males only), and less likely to believe they were eating enough to meet their body’s needs (p = 0.005). This analysis provides new insights on nutrition-care post-discharge. Full article
Open AccessArticle Professional Well-Being of Practicing Physicians: The Roles of Autonomy, Competence, and Relatedness
Healthcare 2018, 6(1), 12; doi:10.3390/healthcare6010012
Received: 16 January 2018 / Revised: 27 January 2018 / Accepted: 30 January 2018 / Published: 2 February 2018
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Abstract
This study investigated the roles of basic psychological needs—autonomy, competence, and relatedness—in physicians’ professional well-being, specifically satisfaction with professional life, work-related engagement, and exhaustion. Using an online survey, quantitative data were collected from 57 practicing physicians. Overall, 65% of the participants were female;
[...] Read more.
This study investigated the roles of basic psychological needs—autonomy, competence, and relatedness—in physicians’ professional well-being, specifically satisfaction with professional life, work-related engagement, and exhaustion. Using an online survey, quantitative data were collected from 57 practicing physicians. Overall, 65% of the participants were female; 49% were family medicine (FM) physicians, with the rest of the participants practicing in various non-FM specialties (e.g., internal medicine, pediatrics, surgery); and 47% were in the early-career stage (≤10 years in practice). Multivariate regression analyses indicated that of the three psychological needs, the need for relatedness had the largest unique contributions to physicians’ satisfaction with professional life, work-related engagement, and exhaustion, respectively. The unique contributions of the needs for autonomy and competence were relatively small. These findings extend basic psychological needs theory to the work domain of practicing physicians in an attempt to examine underpinnings of physicians’ professional well-being, a critical component of quality patient care. Full article
(This article belongs to the Special Issue Humanities and Healthcare)
Open AccessArticle Moderating Effect of Residential History on the Effects of a Fatherhood Program on Parenting Skills Satisfaction among Nonresident African American Fathers
Healthcare 2018, 6(1), 13; doi:10.3390/healthcare6010013
Received: 12 December 2017 / Revised: 25 January 2018 / Accepted: 1 February 2018 / Published: 9 February 2018
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Abstract
Nonresident African American (AA) fathers sometimes face challenges to achieving satisfaction with their parenting skills, which may inhibit their motivations for parenting. Studies have found that residential history of fathers is associated with parental involvement; however, current fatherhood programs rarely consider the influence
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Nonresident African American (AA) fathers sometimes face challenges to achieving satisfaction with their parenting skills, which may inhibit their motivations for parenting. Studies have found that residential history of fathers is associated with parental involvement; however, current fatherhood programs rarely consider the influence of different residential history on fathering. In the current study, we examined whether nonresident AA fathers’ residential history with their sons moderated their parenting skills satisfaction after participating in the Fathers and Sons Program. Our results indicated that after controlling for fathers’ pretest parenting skills satisfaction, age, education, marital status, employment, and ever lived with their son’s mother; there was a moderating effect of residential history on the intervention’s effects on posttest parenting skills satisfaction. The regression analyses showed that fathers in the intervention group who had lived with their son increased their parenting skills satisfaction more at posttest compared with fathers who had never lived with their sons. However, fathers in the comparison group who had lived with their sons had lower posttest parenting skills satisfaction. Future fatherhood programs for nonresident AA fathers should develop more nuanced group-specific interventions that consider residential history as a critical factor to enhance their parenting skills satisfaction as a strategy for improving father involvement. Full article
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Open AccessArticle A Quick Surgical Treatment of Conjunctivochalasis Using Radiofrequencies
Healthcare 2018, 6(1), 14; doi:10.3390/healthcare6010014
Received: 3 January 2018 / Revised: 8 February 2018 / Accepted: 11 February 2018 / Published: 12 February 2018
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Abstract
The purpose of our study is to present a quick surgical procedure for the treatment of Conjunctivochalasis (CCH) and to evaluate its effectiveness. Thirty consecutive patients, in whom CCH was diagnosed on clinical examination, were investigated for the presence of symptoms of dry
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The purpose of our study is to present a quick surgical procedure for the treatment of Conjunctivochalasis (CCH) and to evaluate its effectiveness. Thirty consecutive patients, in whom CCH was diagnosed on clinical examination, were investigated for the presence of symptoms of dry eye. The 60 eyes were evaluated according to their symptomatology and the 40 symptomatic eyes were grouped in two stages using the LIPCOF (stage 1, one small fold; stage 2, more than two folds but not higher than the tear meniscus) classification and included in the study. After a subconjunctival injection of lidocaine 20 mg/mL, a medium frequency alternating current (RF) was used, adjusted in low power. With a wide tip, redundant conjunctiva was ablated leaving space between the ablations. Postoperative treatment included eye oint.gentamicin 0.3% with dexamethasone 0.03% three times a day for 5 days. At postoperative day 10, conjunctival edema had subsided and conjunctival epithelium was intact after fluorescein staining. Symptoms had improved in all patients. During follow-up, no complication was detected. Mild conjunctival hyperemia was present in all cases but resolved with standard postoperative medications. To conclude, CCh treatment with RF appears to be a safe, quick, and effective surgical technique. Operation time is less than 10 min and can be performed in an outpatient clinic. Full article
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Open AccessArticle A Randomized Controlled Trial to Investigate the Effectiveness of the Prevention of Aspiration Pneumonia Using Recommendations for Swallowing Care Guided by Ultrasound Examination
Healthcare 2018, 6(1), 15; doi:10.3390/healthcare6010015
Received: 25 December 2017 / Revised: 29 January 2018 / Accepted: 8 February 2018 / Published: 12 February 2018
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Abstract
Prevention for aspiration pneumonia requires assessment of aspiration and adequate swallowing care. This randomized controlled trial aimed to investigate the effectiveness of ultrasound examination and recommendations for swallowing care for the reduction of aspiration and pharyngeal post-swallow residue as compared with standard swallowing
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Prevention for aspiration pneumonia requires assessment of aspiration and adequate swallowing care. This randomized controlled trial aimed to investigate the effectiveness of ultrasound examination and recommendations for swallowing care for the reduction of aspiration and pharyngeal post-swallow residue as compared with standard swallowing care. Twenty-three participants were randomized to the intervention group and 23 to the control group. The intervention consisted of four ultrasound examinations during mealtimes and recommendations for swallowing care every 2 weeks during an 8 week period. No recommendations concerning swallowing care based on ultrasound examinations were provided to the control group. The frequency of aspiration or residue was defined as x/y × 100% when aspiration or residue were detected x times from y times concerning the total ultrasound measurements. The proportion of the residents with reduced frequency of aspiration which was detected by ultrasonography at eight weeks were 4.3% in the intervention group and 0% in the control group. The median reduction in the frequency of aspiration and residue in the intervention group was 31%, and that in the control group was 11%. In conclusion, swallowing care guided by frequent ultrasound examinations during mealtimes had a trend of reducing the frequency of aspiration and residue during an 8-week period in individuals relative to standard swallowing care alone. Full article
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Open AccessArticle The Financial Implications of a Well-Hidden and Ignored Chronic Lyme Disease Pandemic
Healthcare 2018, 6(1), 16; doi:10.3390/healthcare6010016
Received: 11 September 2017 / Revised: 11 December 2017 / Accepted: 22 December 2017 / Published: 13 February 2018
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Abstract
1 million people are predicted to get infected with Lyme disease in the USA in 2018. Given the same incidence rate of Lyme disease in Europe as in the USA, then 2.4 million people will get infected with Lyme disease in Europe in
[...] Read more.
1 million people are predicted to get infected with Lyme disease in the USA in 2018. Given the same incidence rate of Lyme disease in Europe as in the USA, then 2.4 million people will get infected with Lyme disease in Europe in 2018. In the USA by 2050, 55.7 million people (12% of the population) will have been infected with Lyme disease. In Europe by 2050, 134.9 million people (17% of the population) will have been infected with Lyme disease. Most of these infections will, unfortunately, become chronic. The estimated treatment cost for acute and chronic Lyme disease for 2018 for the USA is somewhere between 4.8 billion USD and 9.6 billion USD and for Europe somewhere between 10.1 billion EUR and 20.1 billion EUR. If governments do not finance IV treatment with antibiotics for chronic Lyme disease, then the estimated government cost for chronic Lyme disease for 2018 for the USA is 10.1 billion USD and in Europe 20.1 billion EUR. If governments in the USA and Europe want to minimize future costs and maximize future revenues, then they should pay for IV antibiotic treatment up to a year even if the estimated cure rate is as low as 25%. The cost for governments of having chronic Lyme patients sick in perpetuity is very large. Full article
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Open AccessArticle Examining Differential Resilience Mechanisms by Comparing ‘Tipping Points’ of the Effects of Neighborhood Conditions on Anxiety by Race/Ethnicity
Healthcare 2018, 6(1), 18; doi:10.3390/healthcare6010018
Received: 28 December 2017 / Revised: 14 February 2018 / Accepted: 16 February 2018 / Published: 20 February 2018
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Abstract
Exposure to adverse environmental and social conditions affects physical and mental health through complex mechanisms. Different racial/ethnic (R/E) groups may be more or less vulnerable to the same conditions, and the resilience mechanisms that can protect them likely operate differently in each population.
[...] Read more.
Exposure to adverse environmental and social conditions affects physical and mental health through complex mechanisms. Different racial/ethnic (R/E) groups may be more or less vulnerable to the same conditions, and the resilience mechanisms that can protect them likely operate differently in each population. We investigate how adverse neighborhood conditions (neighborhood disorder, NDis) differentially impact mental health (anxiety, Anx) in a sample of white and Black (African American) young women from Southeast Texas, USA. We illustrate a simple yet underutilized segmented regression model where linearity is relaxed to allow for a shift in the strength of the effect with the levels of the predictor. We compare how these effects change within R/E groups with the level of the predictor, but also how the “tipping points,” where the effects change in strength, may differ by R/E. We find with classic linear regression that neighborhood disorder adversely affects Black women’s anxiety, while in white women the effect seems negligible. Segmented regressions show that the Ndis → Anx effects in both groups of women appear to shift at similar levels, about one-fifth of a standard deviation below the mean of NDis, but the effect for Black women appears to start out as negative, then shifts in sign, i.e., to increase anxiety, while for white women, the opposite pattern emerges. Our findings can aid in devising better strategies for reducing health disparities that take into account different coping or resilience mechanisms operating differentially at distinct levels of adversity. We recommend that researchers investigate when adversity becomes exceedingly harmful and whether this happens differentially in distinct populations, so that intervention policies can be planned to reverse conditions that are more amenable to change, in effect pushing back the overall social risk factors below such tipping points. Full article
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Open AccessArticle Health Care Utilisation by Bullying Victims: A Cross-Sectional Study of A 9-Year-Old Cohort in Ireland
Healthcare 2018, 6(1), 19; doi:10.3390/healthcare6010019
Received: 23 January 2018 / Revised: 13 February 2018 / Accepted: 17 February 2018 / Published: 25 February 2018
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Abstract
Children frequently refrain from disclosing being bullied. Early identification of bullying by healthcare professionals in children may prevent adverse health consequences. The aim of our study was to determine whether Health Care Utilisation (HCU) is higher in 9-year-olds who report being bullied and
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Children frequently refrain from disclosing being bullied. Early identification of bullying by healthcare professionals in children may prevent adverse health consequences. The aim of our study was to determine whether Health Care Utilisation (HCU) is higher in 9-year-olds who report being bullied and factors influencing type of HCU. The study consists of cross-sectional surveys of Child Cohort of Irish National Longitudinal Study of Children (Wave 1), 8,568 9-year-olds, and their carers. Being bullied was assessed by a self-reported questionnaire completed by children at home. HCU outcomes consisted of the following: visits to GP, Mental Health Practitioner (MHP), Emergency Department (ED), and nights in hospital by parent interview. Bivariate logistic regression and gender-stratified Poisson models were used to determine association. Victimisation by bullying independently increased visits to GP (OR 1.13, 95% confidence interval (CI): 1.03 to 1.25; p = 0.02), MHP (OR 1.31, 95% CI: 1.05 to 1.63; p = 0.02), though not ED visits (OR 0.99, 95% CI: 0.87 to 1.13; p = 0.8) or nights in hospital (OR 1.07 95% CI: 0.97 to 1.18; p = 0.2), adjusting for underlying chronic condition(s) and socio-demographic confounders. Victimised girls made higher GP visits (RR 1.14, 95% CI: 1.06 to 1.23; p < 0.001) and spent more nights in hospital (RR 1.10, 95% CI: 1.04 to 1.15; p < 0.001). Victimised boys were more likely to contact MHPs (RR 1.21, 95% CI: 1.02 to 1.44; p = 0.03). 9-year-old bullied subjects were more likely to utilise primary care services than non-bullied 9-year-olds. Different HCU patterns were observed according to gender and gender differences in the presentation of victimisation. Our findings may lead to the development of clinical practice guidelines for early detection and appropriate management of bullied children. Full article
(This article belongs to the Special Issue Feature Papers in Healthcare in 2018)
Open AccessArticle Ethnic and Gender Differences in Family Social Support among Black Adolescents
Healthcare 2018, 6(1), 20; doi:10.3390/healthcare6010020
Received: 28 January 2018 / Revised: 24 February 2018 / Accepted: 28 February 2018 / Published: 2 March 2018
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Abstract
This study examines black adolescents’ reports of the most helpful types of social support that they receive from and provide to family members, and whether family support exchanges vary by ethnicity (African American vs. Black Caribbean) and gender. Data for this study are
[...] Read more.
This study examines black adolescents’ reports of the most helpful types of social support that they receive from and provide to family members, and whether family support exchanges vary by ethnicity (African American vs. Black Caribbean) and gender. Data for this study are from the National Survey of American Life Adolescent Supplement (NSAL-A), a national, probability sample of African American and Black Caribbean youth (ages 13–17). Overall, youth reported financial support, followed by emotional assistance and practical support as the most helpful types of support that they received. Practical and emotional assistance characterized the most commonly reported types of support that they provided to family members. Black Caribbean adolescents were more likely than African American adolescents to report financial and practical assistance as the most helpful types of support that they received from family members; no ethnic differences were observed in the provision of support to relatives. There were no significant gender differences in the receipt of support, but adolescent girls reported greater involvement in providing emotional support and caregiving than adolescent boys. The results of this paper reveal that African American and Black Caribbean adolescents are involved in a complex pattern of reciprocal support exchanges with their extended family members. Study findings also reinforce the importance of research focused on racial/ethnic and gender differences in family support exchanges in order to develop a more nuanced understanding of family support behaviors within these groups. Full article
Open AccessArticle Digital Analysis of Sit-to-Stand in Masters Athletes, Healthy Old People, and Young Adults Using a Depth Sensor
Healthcare 2018, 6(1), 21; doi:10.3390/healthcare6010021
Received: 8 January 2018 / Revised: 12 February 2018 / Accepted: 28 February 2018 / Published: 2 March 2018
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Abstract
The aim of this study was to compare the performance between young adults (n = 15), healthy old people (n = 10), and masters athletes (n = 15) using a depth sensor and automated digital assessment framework. Participants were asked
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The aim of this study was to compare the performance between young adults (n = 15), healthy old people (n = 10), and masters athletes (n = 15) using a depth sensor and automated digital assessment framework. Participants were asked to complete a clinically validated assessment of the sit-to-stand technique (five repetitions), which was recorded using a depth sensor. A feature encoding and evaluation framework to assess balance, core, and limb performance using time- and speed-related measurements was applied to markerless motion capture data. The associations between the measurements and participant groups were examined and used to evaluate the assessment framework suitability. The proposed framework could identify phases of sit-to-stand, stability, transition style, and performance between participant groups with a high degree of accuracy. In summary, we found that a depth sensor coupled with the proposed framework could identify performance subtleties between groups. Full article
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Open AccessArticle Citizen Science and Community Engagement in Tick Surveillance—A Canadian Case Study
Healthcare 2018, 6(1), 22; doi:10.3390/healthcare6010022
Received: 14 January 2018 / Revised: 22 February 2018 / Accepted: 27 February 2018 / Published: 2 March 2018
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Abstract
Lyme disease is the most common tick-borne disease in North America and Europe, and on-going surveillance is required to monitor the spread of the tick vectors as their populations expand under the influence of climate change. Active surveillance involves teams of researchers collecting
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Lyme disease is the most common tick-borne disease in North America and Europe, and on-going surveillance is required to monitor the spread of the tick vectors as their populations expand under the influence of climate change. Active surveillance involves teams of researchers collecting ticks from field locations with the potential to be sites of establishing tick populations. This process is labor- and time-intensive, limiting the number of sites monitored and the frequency of monitoring. Citizen science initiatives are ideally suited to address this logistical problem and generate high-density and complex data from sites of community importance. In 2014, the same region was monitored by academic researchers, public health workers, and citizen scientists, allowing a comparison of the strengths and weaknesses of each type of surveillance effort. Four community members persisted with tick collections over several years, collectively recovering several hundred ticks. Although deviations from standard surveillance protocols and the choice of tick surveillance sites makes the incorporation of community-generated data into conventional surveillance analyses more complex, this citizen science data remains useful in providing high-density longitudinal tick surveillance of a small area in which detailed ecological observations can be made. Most importantly, partnership between community members and researchers has proven a powerful tool in educating communities about of the risk of tick-vectored diseases and in encouraging tick bite prevention. Full article
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Open AccessArticle Long-Term Melatonin Therapy for Adolescents and Young Adults with Chronic Sleep Onset Insomnia and Late Melatonin Onset: Evaluation of Sleep Quality, Chronotype, and Lifestyle Factors Compared to Age-Related Randomly Selected Population Cohorts
Healthcare 2018, 6(1), 23; doi:10.3390/healthcare6010023
Received: 8 February 2018 / Revised: 23 February 2018 / Accepted: 27 February 2018 / Published: 2 March 2018
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Abstract
The extent of continuance of melatonin therapy initiated in pre-pubertal children with chronic sleep onset insomnia (CSOI) was investigated in young adult life. Sleep timing, sleep quality, adverse events, reasons for cessation of therapy, and patient characteristics with regard to therapy regimen, chronotype
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The extent of continuance of melatonin therapy initiated in pre-pubertal children with chronic sleep onset insomnia (CSOI) was investigated in young adult life. Sleep timing, sleep quality, adverse events, reasons for cessation of therapy, and patient characteristics with regard to therapy regimen, chronotype and lifestyle factors possibly influencing sleeping behavior were assessed. With an online survey using questionnaires (Pittsburgh Sleep Quality Index, Insomnia Severity Index, Morningness-Eveningness Questionnaire, and Munich Chronotype Questionnaire), outcomes were measured and compared with age-related controls. These controls were extracted from published epidemiological research programs applying the same questionnaires. At the moment of the survey, melatonin was still continued by 27.3% of the patients, with a mean treatment duration of 10.8 years. The overall average treatment duration was 7.1 years. Sleep quality of both discontinued and persistent melatonin users did not deviate from controls. Sleep timing and chronotype scores indicated evening type preference in all responders. Adverse events were scarce but the perceived timing of pubertal development suggested a tendency towards delayed puberty in former and current users of melatonin. This study may underestimate the number of children that are able to stop using melatonin due to the response rate (47.8%) and appeal for continuing users. Sleep timing parameters were based on self-reported estimates. Control populations were predominantly students and were of varying nationalities. The statistical power of this study is low due to the limited sample size. Melatonin therapy sustained for 7.1 years does not result in substantial deviations of sleep quality as compared to controls and appears to be safe. The evening type preference suggests a causal relation with CSOI. This study shows that ten years after initiation of treatment with melatonin for CSOI, approximately 75% of the patients will have normal sleep quality without medication. Full article
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Open AccessArticle Correlates of Objective Social Isolation from Family and Friends among Older Adults
Healthcare 2018, 6(1), 24; doi:10.3390/healthcare6010024
Received: 20 November 2017 / Revised: 28 February 2018 / Accepted: 1 March 2018 / Published: 3 March 2018
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Abstract
This study examined the correlates of objective social isolation from extended family members and friends among older adults. The analysis is based on the older adult sub-sample of the National Survey of American Life (n = 1321). Multinomial logistic regression analyses examined
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This study examined the correlates of objective social isolation from extended family members and friends among older adults. The analysis is based on the older adult sub-sample of the National Survey of American Life (n = 1321). Multinomial logistic regression analyses examined race/ethnicity, demographics, functional health and family and friend network factors as correlates of objective isolation from family and friends. Only 4.47% of respondents were objectively isolated from both their extended family and friends, 10.82% were isolated from their friends, and 7.43% were isolated from their family members. Men were more likely to be objectively isolated from both family and friends and older adults who live with others were significantly more likely to be objectively isolated from their friends. When controlling for subjective social isolation, the two measures of functional health were significantly associated with objective social isolation. In particular, higher levels of self-care impairment decreased the risk of being objectively isolated from friends only, whereas higher mobility impairment was associated with an increased likelihood of being objectively isolated from friends only. Subjective evaluations of social isolation from family and friends were consistently associated with being objectively isolated from family and friends. There were no significant differences between African-Americans, Black Caribbeans and non-Hispanic Whites in objective isolation. These and other findings are discussed in detail. Full article
Open AccessArticle A 40-Day Journey to Better Health: Utilizing the DanielFast to Improve Health Outcomes in Urban Church-Based Settings
Healthcare 2018, 6(1), 25; doi:10.3390/healthcare6010025
Received: 31 January 2018 / Revised: 27 February 2018 / Accepted: 1 March 2018 / Published: 5 March 2018
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Abstract
Background: As the costs associated with obesity increase, it is vital to evaluate the effectiveness of chronic disease prevention among underserved groups, particularly in urban settings. This research study evaluated Philadelphia area Keystone First members and church participants enrolled in a group health
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Background: As the costs associated with obesity increase, it is vital to evaluate the effectiveness of chronic disease prevention among underserved groups, particularly in urban settings. This research study evaluated Philadelphia area Keystone First members and church participants enrolled in a group health education program to determine the impact of the Daniel Fast on physical health and the adoption of healthy behaviors. Methods: Participants attended six-weekly health education sessions in two participating churches, and were provided with a digital healthy eating platform. Results: There was a statistically significant decrease from baseline to post assessment for weight, waist circumference and cholesterol. Participants reported a significant improvement in their overall well-being, social and physical functioning, vitality and mental health. Conclusion: Results of this study demonstrate that dietary recommendations and comprehensive group health education delivered in churches and reinforced on a digital platform can improve physical health, knowledge and psychosocial outcomes. Full article
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Open AccessArticle The Patient Experience: Informing Practice through Identification of Meaningful Communication from the Patient’s Perspective
Healthcare 2018, 6(1), 26; doi:10.3390/healthcare6010026
Received: 2 March 2018 / Revised: 8 March 2018 / Accepted: 11 March 2018 / Published: 20 March 2018
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Abstract
(1) Background: There is limited empirical knowledge concerning aspects of healthcare that contribute to a good patient experience from the patient’s perspective and how patient feedback informs service development. (2) Aim: To examine the issues that influence the effectiveness of communication on patient
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(1) Background: There is limited empirical knowledge concerning aspects of healthcare that contribute to a good patient experience from the patient’s perspective and how patient feedback informs service development. (2) Aim: To examine the issues that influence the effectiveness of communication on patient satisfaction, experience and engagement, in an acute National Health Service (NHS) setting, through identification of the patient’s requirements and expectations. (3) Method: Data was gathered from a large teaching hospital using a Friends and Family Test (FFT) and a communication specific survey. Both surveys captured patient narrative to identify predominant influences to explain the quantitative responses. (4) Results: The key priorities for patients are involvement in their care and receiving the right amount of information to support this. However, the delivery of compassionate care was identified as having the most influence on the likelihood of patients to recommend an acute NHS Trust. (5) Conclusion: The findings support a broader understanding of the constituents of an all-encompassing patient experience from the patient’s perspective. (6) Implications: healthcare organizations need to focus their resources on how to improve patient/provider communication to support patients to be true partners in their care. Full article
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Open AccessArticle Rescuing Suboptimal Patient-Reported Outcome Instrument Data in Clinical Trials: A New Strategy
Healthcare 2018, 6(1), 27; doi:10.3390/healthcare6010027
Received: 12 December 2017 / Revised: 28 February 2018 / Accepted: 8 March 2018 / Published: 20 March 2018
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Abstract
Background: Psychometric instruments such as the Repeated Battery for the Assessment of Neuropsychological Status (RBANS) are commonly used under conditions for which they were not developed or validated. They may then generate troublesome data that could conceal potential findings. Methods: Based
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Background: Psychometric instruments such as the Repeated Battery for the Assessment of Neuropsychological Status (RBANS) are commonly used under conditions for which they were not developed or validated. They may then generate troublesome data that could conceal potential findings. Methods: Based on a previously published refinement of the RBANS, we reanalyzed the data on 303 patients from two National Institutes of Health (NIH) trails in Parkinson’s disease and contrasted the results using the original versus refined scores. Results: Findings from the original RBANS scores were inconsistent; however, use of the refined scores produced potential findings that were in agreement with independent reports. Conclusion: This study demonstrates that, for negative trials using instrument scores as primary outcomes, it is possible to rescue potential findings. The key to this new strategy is to validate and refine the instrument for the specific disease and conditions under study and then to reanalyze the data. This study offers a demonstration of this new strategy for general approaches. Full article
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Review

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Open AccessReview Measuring Outcomes of Psychological Well-Being within Paediatric Health Settings
Healthcare 2018, 6(1), 1; doi:10.3390/healthcare6010001
Received: 2 November 2017 / Revised: 21 December 2017 / Accepted: 22 December 2017 / Published: 29 December 2017
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Abstract
There are many widely used, validated patient reported outcome measures for physical and mental health. However, capturing outcomes from young people living with chronic health conditions presents a challenge, needing to take the complex interplay of physical and mental health into consideration. The
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There are many widely used, validated patient reported outcome measures for physical and mental health. However, capturing outcomes from young people living with chronic health conditions presents a challenge, needing to take the complex interplay of physical and mental health into consideration. The authors found that regularly used outcome measures for child and adolescent emotional well-being in paediatric settings largely fall into two groups: paediatric quality of life and child and adolescent mental health measures. The applicability and potential for use of these measures within this context is discussed. Whilst offering some utility, neither approach leaves sufficient space for young people’s individual experiences of illness and treatment. The scope of using alternative qualitative approaches that capture the rich stories and experiences of young people living with chronic illnesses is considered. Full article
Open AccessReview A Novel Approach to Transforming Smoking Cessation Practice for Pregnant Aboriginal Women and Girls Living in the Pilbara
Healthcare 2018, 6(1), 10; doi:10.3390/healthcare6010010
Received: 23 October 2017 / Revised: 8 December 2017 / Accepted: 29 December 2017 / Published: 23 January 2018
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Abstract
Tobacco smoking during pregnancy contributes to a range of adverse perinatal outcomes; but is a potentially modifiable behavior. In Australia Aboriginal and Torres Strait Islander women face a range of barriers that hinder; rather than support smoking cessation. Few smoking cessation programs consider
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Tobacco smoking during pregnancy contributes to a range of adverse perinatal outcomes; but is a potentially modifiable behavior. In Australia Aboriginal and Torres Strait Islander women face a range of barriers that hinder; rather than support smoking cessation. Few smoking cessation programs consider the broader social determinants of women’s lives; the gendered nature of these or the complexities which impinge on behavior change in the presence of social and economic disadvantage and substantial individual and intergenerational trauma. Drawing on the salient gender and trauma-informed literature this paper describes the rationale underpinning formative research which will inform the design of a localized, culturally meaningful smoking cessation program for Aboriginal women living in the Hedland and Western Desert communities of the remote Pilbara region of Western Australia. We contend that a women-centered, trauma-informed approach to smoking cessation has much to offer those seeking to address this critical public health issue Full article
Open AccessReview Managing Early Childhood Caries for Young Children in China
Healthcare 2018, 6(1), 11; doi:10.3390/healthcare6010011
Received: 22 November 2017 / Revised: 25 January 2018 / Accepted: 26 January 2018 / Published: 30 January 2018
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Abstract
The latest national survey found that 70% of 5-year-old children in China had dental caries. The prevalence of early childhood caries (ECC) may not only be attributed to poor oral hygiene and unhealthy diet, but also to limited access to and availability of
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The latest national survey found that 70% of 5-year-old children in China had dental caries. The prevalence of early childhood caries (ECC) may not only be attributed to poor oral hygiene and unhealthy diet, but also to limited access to and availability of dental care. The prevailing preventive measures adopted by industrialised countries for ECC management are neither practical nor affordable in China. Hence, an alternative approach to ECC management is necessary. Atraumatic restorative treatment (ART) has been advocated because the simple and short operative time renders ART affordable. However, the success rate of ART in restoring anterior primary teeth is unfavourable. Although there is no water fluoridation in China, topical fluorides may be used to manage ECC. Tooth brushing with fluoride toothpaste is effective for caries control, but not all toothpastes in China are fluoridated. Professionally applied fluorides such as sodium fluoride varnish can be a cost-effective treatment for managing the high prevalence of ECC in China. Silver diamine fluoride (SDF) at 38% is suggested to be effective in arresting ECC in China. It can be a simple, non-invasive and low-cost treatment. However, it stains caries black. Children and their parents must be well informed before SDF treatment. Full article
Open AccessReview Ageing with HIV
Healthcare 2018, 6(1), 17; doi:10.3390/healthcare6010017
Received: 17 October 2017 / Revised: 29 January 2018 / Accepted: 7 February 2018 / Published: 14 February 2018
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Abstract
The population of people living with HIV (PLWH) is growing older with an estimated 4 million over the age of 50 years, a figure which has doubled since the introduction of effective antiretroviral therapy (ART) and which is increasing globally. Despite effective ART,
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The population of people living with HIV (PLWH) is growing older with an estimated 4 million over the age of 50 years, a figure which has doubled since the introduction of effective antiretroviral therapy (ART) and which is increasing globally. Despite effective ART, PLWH still experience excess morbidity and mortality compared to the general population with increased prevalence of age-related, non-AIDS illnesses (NAI) such as cardiovascular disease, malignancies, cognitive impairment and reduced bone mineral density, which impact disability and everyday functioning. This review will discuss the challenges presented by comorbidities in ageing PLWH and discuss the aetiology and management of age-related illnesses in this vulnerable population. Full article
(This article belongs to the Special Issue Ageing with Chronic Disease and Disability)
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