Healthcare最新文献

Background/Objectives: The COVID-19 pandemic has significantly altered healthcare systems worldwide, highlighting healthcare expenditure's critical role in fostering population resilience and wellness. This extraordinary situation has brought to light the delicate balance that governments must maintain between the need to protect public health and budgetary restraints. The relationship between healthcare expenditure and outcomes, such as healthy life years, health expectancy, and standardized death rate, has become a central point in understanding the dynamics of healthcare systems and their capacity to adapt to emerging challenges. Methods: Using extensive datasets and predictive approaches such as artificial neural networks, exponential smoothing models, and ARIMA techniques, this study explores these connections in the context of the European Union. Results: The study better explains how healthcare financing schemes influence important health outcomes by examining past trends and forecasting future developments. The results show that household healthcare expenditures correlate negatively with standardized death rates and substantially benefit healthy life years and health expectancy. These findings underline the significance of household contributions in influencing health outcomes across various healthcare systems. Long-term and strategic investments in health services are essential, as the pandemic has demonstrated the proactive capacity of well-designed healthcare systems to reduce risks and enhance overall resilience. The results suggest that focused investments can raise life expectancy and lower death rates, supporting the development of robust, adaptable healthcare systems in the post-pandemic era. Conclusions: The main contribution of this research is demonstrating the significant role of healthcare expenditure, particularly household contributions, in improving key health outcomes and fostering healthcare system resilience in the EU context.

Introduction: The relationships between calcium, bone mineral density, and hip fracture have been studied for a long time, but there are still different opinions on the matter. The aim of this study was to decipher the relationship between these factors from National Health and Nutrition Examination Survey (NHANES) data. Methods: After we performed data cleaning for the obtained NHANES data, we used multiple imputation to obtain the complete data and conducted an analysis for different variables. First, by using multivariate linear regression models, we confirmed the association between calcium and bone mineral density, and then we confirmed the association between bone mineral density and hip fracture by using multivariate logistic regression models. A mediation analysis of these variables was performed. Results: The analysis in this study included data on 18,003 participants from the NHANES, and we were able to find a strong association between calcium and bone mineral density (p < 0.001). The association between bone mineral density and hip fracture was also significant (p < 0.001). One augmented gram of daily calcium intake was associated with a 0.04 unit increase in BMD level, and a one unit increase in BMD level could downgrade the occurrence of hip fracture for 5.4 times. The mediation analysis showed that the femur BMD level and total BMD level have a mediating relationship with hip fracture, and no clear relationship among calcium, BMD, and hip fracture could be established. Conclusions: Although it is difficult to draw strict conclusions from the mediation analysis in this study, we can observe a clear association between calcium and BMD as well as an association between BMD and hip fracture.

Background: Complications due to frailty and injury after falls are a significant problem for people living in residential aged care. This can lead to a range of negative outcomes including poor physical, social, and psychological well-being. The Australian Royal Commission into Aged Care Quality and Safety highlighted many aspects of care in residential aged care homes requiring improvement, leading to specific recommendations aimed at improving the outcomes in this area. This contributed to four recommendations calling for increased allied health interventions to meet the unmet needs in residential aged care. This intervention aims to implement and evaluate evidence-based allied health interventions for people living in residential aged care specifically relating to frailty, preventing falls, and maintaining engagement in everyday activities.

Method: This is a pragmatic, non-randomised, pre-post design study where six groups of up to 10 residents of an aged care home will start the intervention at staggered times. The EAHOP intervention is an integrated application of a suite of allied health services (occupational therapy, physiotherapy, dietetics, speech pathology, pharmacy, and optometry), with general practitioner involvement, using allied health assistants in an integrated transdisciplinary model of care. The baseline period is 6 weeks, and intervention is a maximum of 36 weeks with follow-up at 12 and 24 weeks. Primary outcomes measure changes in falls, frailty, and quality of life. A qualitative program evaluation will be completed as well as an economic analysis.

Conclusion: The results of the study will provide information about the clinical, implementation, and effectiveness outcomes of this integrated, transdisciplinary allied health service model for people living in residential aged care. The results will be used to develop evidence-informed guidelines for residential aged care providers on the delivery of allied health services.

Background/objectives: Rural populations in the US bear a disproportionate burden of cancer mortality, which may be partly due to their elevated tobacco use and the limited receipt of tobacco use interventions in rural healthcare settings. Here, we examine providers' use of the 5As (Ask, Advise, Assess, Assist, and Arrange), a brief tobacco cessation intervention, with their patients to assess intervention gaps.

Methods: Provider practices in substance use treatment centers (SUTCs) and medical healthcare centers (MHCs), each serving rural and/or medically underserved areas (MUAs) of Texas, were compared. In total, 347 providers from 10 SUTCs (n = 174) and 9 MHCs (n = 173) responded to an anonymized survey about their cigarette and non-cigarette screening and intervention delivery, along with their perceived importance and workforce's preparedness to help patients stop using tobacco. Linear mixed and generalized linear mixed models were used to assess differences between practices at SUTCs and MHCs.

Results: More MHC than SUTC providers reported that cigarette and non-cigarette tobacco use cessation intervention were (respectively) important parts of their job (p = 0.0009; p = 0.0023) and that their workforce was prepared to help their patients quit tobacco (p = 0.0275), although less than half of all respondents endorsed preparedness. Relative to those at SUTCs, MHC providers reported higher rates of asking (SUTCs = 59.57% and MHCs = 77.21%; p = 0.0182) and advising (SUTCs = 45.34% and MHCs = 72.35%; p = 0.0017) their patients to quit cigarette smoking and advising them to quit non-cigarette tobacco products (SUTCs = 43.94% and MHCs = 71.76%; p = 0.0016).

Conclusions: Overall, providers in both settings may benefit from greater preparation to deliver tobacco cessation care; needs were more prevalent within SUTCs than MHCs. Our findings can inform strategic planning to improve centers' capacity to comprehensively address their patients' tobacco use in rural/MUAs of Texas, US.

Background/objectives: Attitudes towards COVID-19 vaccination vary globally, influenced by political and cultural factors. This research aimed to assess the views of people without a healthcare qualification in Europe on COVID-19 vaccination safety, effectiveness, and necessity as well as how well informed they felt. The secondary outcomes focused on how respondents' views were affected by demographic and context factors and included a comparison by country of the level of feeling well informed. Methods: A mixed-method cross-sectional online survey in eight European countries, using convenience sampling. Results: A total of 1008 adults completed the survey, 60% of whom were female. While only 44.1% considered the vaccines safe, 43.5% effective, and 44.9% necessary, 80.0% had been vaccinated. Four in ten adults strongly agreed that they were well informed, while over a quarter did not answer the question. Younger respondents, well-informed individuals, and German respondents were more inclined to perceive COVID-19 vaccination as both effective and necessary. Conclusions: Motivations for vaccination included perceived health and social benefits, while concerns included a preference for "natural immunity", the rapid development of the vaccine, and potential unknown long-term effects. A correlation existed between respondents feeling well informed about the different COVID-19 vaccines in their country and the likelihood of having been vaccinated.

Background: Advanced haemodynamic monitoring has been recommended for use in high-risk surgeries and high-risk patients undergoing surgery. This study aims to assess the current practices of haemodynamic monitoring in high-risk surgical patients among Malaysian anaesthesiologists.

Methodology: This is a cross-sectional survey among Malaysian anaesthesiologists, following approval from the institution's Medical Research Ethics Committee and the National Medical Research Register. The survey utilised a questionnaire developed by Cannesson et al. to gather demographic data, practice information, and haemodynamic monitoring practices. Statistical analysis was performed using SPSS, and results were presented as the mean, median, or frequency as appropriate.

Results: A total of 366 participants responded to the questionnaire, and 2 dropped out due to an incomplete form. This study found differences in the frequency of haemodynamic optimisation and monitoring techniques used in different healthcare settings. Written protocols or statements concerning haemodynamic management in high-risk surgical cases were only available to 15.7% of participants in the institution. The overall utilisation rate of cardiac output monitoring was found to be 31.1%, with a significant majority of the usage observed in university hospitals (p < 0.001). Central venous pressure was more commonly used in university hospitals and private hospitals compared to public hospitals (p < 0.001). The usage of advanced parameters such as stroke volume variation, cardiac index, and systemic vascular resistance was significantly higher in university hospitals, with a p value < 0.001. Transthoracic echocardiography was the most common tool used for high-risk surgical patients. The primary reasons for participants not utilising cardiac output monitoring include the lack of availability of such monitoring in their respective settings, which constitutes 66.9% of the respondents. The overwhelming majority of participants, namely 98%, expressed the belief that there is room for improvement in their present haemodynamic care.

Conclusions: This study offers significant insights into the prevailing haemodynamic monitoring practices employed by Malaysian anaesthesiologists in the context of high-risk surgical patients. The findings have the potential to contribute to future educational initiatives and establish practice standards for haemodynamic monitoring in high-risk surgical procedures.

Background/objectives: Previous studies on aquatic exercises have primarily focused on either physical fitness or psychological outcomes. This study examines the effects of a structured 10-week aqua fitness program on physical fitness and psychosocial outcomes in healthy adult women. Additionally, a 4-week training cessation period was incorporated to assess the sustainability of any observed physical fitness benefits. Methods: A total of 32 female participants (mean age 51.28 ± 9.12 years) with prior aqua aerobics experience engaged in supervised aqua fitness sessions, conducted three times per week (~55 min/session) at moderate intensity (RPE = 12, on a 6-20 scale). The physical fitness outcomes assessed included dominant hand grip strength, lower limb muscle endurance, dynamic balance, mobility, and upper and lower limb flexibility. The psychosocial outcomes included subjective well-being and social inclusion. Results: The results demonstrate significant improvements in dynamic balance (ES = 0.85) and lower limb flexibility (ES = 0.73 and 0.65 for the two limbs, respectively), with smaller yet notable gains observed in other physical fitness outcomes (ES = from 0.20 to 0.48). On the contrary, only a marginal improvement was detected in a single domain of subjective well-being (environmental domain, ES = 0.35) and no changes were observed across the seven domains of social inclusion. Importantly, all physical fitness gains were maintained during the 4-week training cessation period, with lower limb flexibility showing additional improvements. Conclusions: These findings underscore the effectiveness of supervised aqua fitness programs in enhancing physical fitness in middle-aged women, while their impact on psychosocial outcomes appears limited in this population.

Background/Objectives: Considering the unique body image challenges faced by young women with breast cancer, this study aims to deepen our understanding of how coping strategies and perceived social support contribute to fostering positive body image in this population. This is an important issue as body image is capable of influencing women's self-esteem and psychological adaptation to breast cancer. Methods: A sample of 157 young women with breast cancer (M age = 41.43; SD = 6.05; Min 26 years, Max 50 years), 43% of whom had undergone breast reconstruction, completed an online survey. The survey included measures of coping strategies, positive body image, and perceived social support. Results: No significant differences in coping strategies, perceived social support, or positive body image were observed based on reconstruction status. Moderation analyses revealed that both avoidant and problem-focused coping were significantly associated with positive body image at moderate and high levels of perceived social support, but not at low levels of perceived social support. Perceived social support moderated the relationship between coping strategies and positive body image in women with breast cancer. Conclusions: These findings highlight the importance of social support in enhancing the effectiveness of both avoidant and problem-focused coping strategies in promoting positive body image. Future interventions should prioritize strengthening social support networks to optimize psychological outcomes in this population.

Introduction: Women experience more social barriers, gender stereotypes, biases, and discrimination than men, which can increase their vulnerability to mental health problems. Therefore, it is essential to adopt a gender perspective in research on nursing students, examining the impact of these factors on their well-being and psychological resources like resilience. This study aims to analyze the relationship between gender roles in resilience and positive or negative affect among female nursing students. Methods: A cross-sectional study was conducted with first- and fourth-year female nursing students at a public university in Madrid, Spain. Sociodemographic variables, positive and negative affect (PANAS scale), resilience (CD-RISC scale), and gender roles (BRSI inventory) were analyzed. ANOVA, correlation analysis, and linear regression models were used to study the relationships between variables. Results: The study included 338 students with a mean age of 21.43 years, of which 80.2% had a high level of resilience, with a positive affect score of 31.96 (SD: 7.34) and a negative affect score of 22.99 (SD: 7.35). Overall, 48.5% had undifferentiated roles, 23.7% feminine roles, 14.2% androgynous roles, and 13.6% masculine roles. Female students with masculine and androgynous roles showed higher resilience levels (93.48% and 97.92%) compared to those with feminine and undifferentiated roles (81.25% and 70.73%) (p < 0.001). Female students with androgynous and masculine roles showed higher positive affect levels compared to those with feminine and undifferentiated roles (p < 0.001), with no differences in negative affect. These results were observed in both first- and fourth-year students. A high correlation was found between masculine roles and positive affect and resilience in both first- and fourth-year students. Conclusions: Gender roles influence positive affect and resilience in females. Among female nursing students, androgynous and masculine roles are associated with higher levels of resilience and positive affect compared to feminine and undifferentiated roles. Differences in psychological well-being may be related to socially constructed gender roles rather than biological sex, with masculine roles enhancing resilience and feminine roles correlating with greater vulnerability.

Background: Falls among older adults are a pervasive and significant concern worldwide. A practice guideline has been developed to address the prevention of falls and their resulting consequences in hospital and long-term care settings.

Aim: The study aimed to assess the fall down rate and preventive tools among older adult patients in nursing homes.

Methods: A cross-sectional study was conducted on randomly selected older adult patients by using a questionnaire with the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool in nursing homes at the Ministry of Human Resource and Social Development.

Results: Among 323 older adult patients, most of them (73.1%) were male, 23.8% were from Makkah, and the age ranged from 60 to 90 years and older. Results showed that 64.8% had a psychiatric disorder, 41.8% had hypertension, 38.4% had diabetes, 38.1% had movement disorders, 11.3% had heart diseases, and 1.5% had no chronic conditions. The mean STEADI tool score was 3.5 out of 12, and of the 323 older adult patients, 51.7% had a low risk to fall and 48.3% had a high risk to fall. Of the 13 interventions used to prevent falls, the most used intervention was rehabilitative physical therapy, followed by providing patient facilities and muscle strengthening exercises.

Conclusions: The level of falls was markedly low, and a significant correlation was observed between the risk of falling and the participants' region of residence.