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Pommier T, Duloquin G, Pinguet V, Comby PO, Guenancia C, Béjot Y. Atrial fibrillation and preexisting cognitive impairment in ischemic stroke patients: Dijon Stroke Registry. Arch Gerontol Geriatr 2024; 123:105446. [PMID: 38640772 DOI: 10.1016/j.archger.2024.105446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/22/2024] [Accepted: 04/13/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Atrial Fibrillation (AF) is a common cause of ischemic stroke (IS), and is associated with cognitive impairment in the general population. We aimed to compare the prevalence of preexisting cognitive impairment between IS patients with and without AF, and to assess whether prior brain damage could contribute to the observed differences. METHODS Patients with acute IS were prospectively identified from the population-based Dijon Stroke Registry, France. Patients who had a CT-scan as brain imaging modality were included in this analysis to assess the presence of preexisting leukoaraiosis, old vascular brain lesions, and cerebral atrophy. Characteristics of patients including prior-to-stroke cognitive status (normal cognition, mild cognitive impairment (MCI), or dementia) were compared between those with and without AF. RESULTS Among 916 IS patients, 288 (31.4 %) had AF, of whom 88 had newly diagnosed AF. AF patients had more frequent prior MCI (17.8 % versus 10.2 %) or dementia (22.4 % versus 13.1 %) (p = 0.001), vascular risk factors, and preexisting brain damage. In unadjusted model, preexisting cognitive impairment was associated with AF (OR=2.24; 95 % CI: 1.49-3.37, p < 0.001 for MCI; OR=2.20; 95 % CI: 1.52-3.18, p < 0.001 for dementia). After adjustment for clinical and imaging variables, preexisting mild cognitive impairment (OR=1.87; 95 % CI: 1.06-3.32, p = 0.032) and dementia (OR=1.98; 95 % CI: 1.15-3.40, p = 0.013) were independently associated with AF. CONCLUSION AF is a common condition in IS patients and is associated with preexisting cognitive impairment. Brain lesions visible on imaging did not seem to fully account for this association that may involve other mechanisms yet to be elucidated.
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Affiliation(s)
- Thibaut Pommier
- Dijon Stroke Registry, Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2), University of Burgundy, EA7460, France; Department of Cardiology, University Hospital of Dijon, France
| | - Gauthier Duloquin
- Dijon Stroke Registry, Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2), University of Burgundy, EA7460, France; Department of Neurology, University Hospital of Dijon, 14 rue Paul Gaffarel, BP 77908, Dijon cedex 21079, France
| | - Valentin Pinguet
- Dijon Stroke Registry, Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2), University of Burgundy, EA7460, France; Department of Neuroimaging, University Hospital of Dijon, France
| | - Pierre-Olivier Comby
- Dijon Stroke Registry, Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2), University of Burgundy, EA7460, France; Department of Neuroimaging, University Hospital of Dijon, France
| | - Charles Guenancia
- Dijon Stroke Registry, Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2), University of Burgundy, EA7460, France; Department of Cardiology, University Hospital of Dijon, France
| | - Yannick Béjot
- Dijon Stroke Registry, Pathophysiology and Epidemiology of Cardio-cerebrovascular disease (PEC2), University of Burgundy, EA7460, France; Department of Neurology, University Hospital of Dijon, 14 rue Paul Gaffarel, BP 77908, Dijon cedex 21079, France.
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Pellón-Elexpuru I, Van Dijk R, Van der Valk I, Martínez-Pampliega A, Molleda A, Cormenzana S. Divorce and physical health: A three-level meta-analysis. Soc Sci Med 2024; 352:117005. [PMID: 38824838 DOI: 10.1016/j.socscimed.2024.117005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 06/04/2024]
Abstract
Divorce is often considered a major and stressful life transition. Given that divorcees are overrepresented in primary care and there is a association between individuals' physical health and psychological adjustment, potential post-divorce health problems are of concern. Yet, empirical evidence is lacking on the magnitude of the overall physical health risk after divorce, on possible differences across specific pathologies, and on factors that may increase or reduce this risk. The current meta-analysis addresses these issues. We identified 94 studies including u = 248 relevant effect sizes, based on N = 1,384,507 participants. Generally, compared to married individuals, divorcees showed significantly worse self-reported health (OR = 1.20, [1.08-1.33]), experienced more physical symptoms (OR = 1.34, [1.17-1.53]), and had a higher risk for diabetes (OR = 1.18 [1.05-1.33]), joint pathologies (OR = 1.24, [1.14-1.34]), cardiovascular (OR = 1.24, [1.09-1.41]) and cerebrovascular conditions (OR = 1.31, [1.14-1.51]), and sexually transmitted diseases (OR = 2.48, [1.32-4.64]). However, they had no increased risk of hypertension, hypercholesterolemia, cancer and cancer development, disabilities or limitations, or cognitive pathologies. Nor did divorcees significantly differ from married individuals when aggregating all pathologies to measure overall physical health problems (OR = 1.14, [0.85 to 1.54]). Yet, moderation analyses revealed that being female, unemployed, childless, or having a lower education constitutes a higher risk for overall physical health problems after divorce. The same applied to having a heavy alcohol consumption, lack of exercise, and being overweight. Our meta-analysis shows that divorcees are at heightened risk of certain pathologies, with sexually transmitted diseases as a particular post-divorce hazard. These findings call for more awareness among counsellors and physicians on divorcees' health conditions and the characteristics that make divorcees even more vulnerable to health problems.
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Affiliation(s)
| | - Rianne Van Dijk
- Youth&Family Department, Utrecht University, Utrecht, the Netherlands
| | - Inge Van der Valk
- Youth&Family Department, Utrecht University, Utrecht, the Netherlands
| | | | - Asier Molleda
- Deusto FamilyPsych, Deusto University, Bilbao, Spain
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Michael YL, Senerat AM, Buxbaum C, Ezeanyagu U, Hughes TM, Hayden KM, Langmuir J, Besser LM, Sánchez B, Hirsch JA. Systematic Review of Longitudinal Evidence and Methodologies for Research on Neighborhood Characteristics and Brain Health. Public Health Rev 2024; 45:1606677. [PMID: 38596450 PMCID: PMC11002187 DOI: 10.3389/phrs.2024.1606677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/20/2024] [Indexed: 04/11/2024] Open
Abstract
Objective: Synthesize longitudinal research evaluating neighborhood environments and cognition to identify methodological approaches, findings, and gaps. Methods: Included studies evaluated associations between neighborhood and cognition longitudinally among adults >45 years (or mean age of 65 years) living in developed nations. We extracted data on sample characteristics, exposures, outcomes, methods, overall findings, and assessment of disparities. Results: Forty studies met our inclusion criteria. Most (65%) measured exposure only once and a majority focused on green space and/or blue space (water), neighborhood socioeconomic status, and recreation/physical activity facilities. Similarly, over half studied incident impairment, cognitive function or decline (70%), with one examining MRI (2.5%) or Alzheimer's disease (7.5%). While most studies used repeated measures analysis to evaluate changes in the brain health outcome (51%), many studies did not account for any type of correlation within neighborhoods (35%). Less than half evaluated effect modification by race/ethnicity, socioeconomic status, and/or sex/gender. Evidence was mixed and dependent on exposure or outcome assessed. Conclusion: Although longitudinal research evaluating neighborhood and cognitive decline has expanded, gaps remain in types of exposures, outcomes, analytic approaches, and sample diversity.
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Affiliation(s)
- Yvonne L. Michael
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Araliya M. Senerat
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Channa Buxbaum
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Ugonwa Ezeanyagu
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Timothy M. Hughes
- Department of Internal Medicine, Medical Center Boulevard, Winston-Salem, NC, United States
| | - Kathleen M. Hayden
- Department of Social Sciences and Health Policy, Bowman Gray Center for Medical Education, Winston-Salem, NC, United States
| | - Julia Langmuir
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Lilah M. Besser
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Brisa Sánchez
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Jana A. Hirsch
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
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Wändell PE, Ljunggren G, Wahlström L, Carlsson AC. Psychiatric diseases and dementia and their association with open-angle glaucoma in the total population of Stockholm. Ann Med 2022; 54:3349-3356. [PMID: 36411732 PMCID: PMC9704081 DOI: 10.1080/07853890.2022.2148735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Association between some somatic diseases and primary open-angle glaucoma (POAG) are well-known. We aimed to study psychiatric diseases and dementia and their association with POAG in the total population of Region Stockholm. METHODS All living individuals above 18 years of age who resided in Stockholm County, Sweden, on 1 January 2017 (N = 1,703,675) were included. Data were obtained from administrative regional data. We identified individuals with specified psychiatric disorders in the years 2010-2019, and further identified those with an incident diagnosis of POAG during 2012-2018. Analyses were performed by age-group and sex. We calculated odds ratios (ORs) with 95% confidence intervals (95% CI), adjusted for age and neighborhood socio-economic status for individuals with POAG, and used individuals without POAG as referents. RESULTS A total of 16,299 cases of POAG were identified, of whom 9204 were women and 7095 men. Adjusted OR (95% CI) for the risk of POAG was 0.653 (0.610-0.698) for women and 0.714 (0.656-0.778) for men with dementia, respectively. The OR for POAG was 0.478 (0.355-0.643) for women with psychosis, and 1.164 (1.105-1.227) for women with depression. A high neighbourhood socio-economic status was associated with a higher risk of POAG. Other associations were non-significant. CONCLUSION The prevalence of newly diagnosed POAG was decreased in men and women with dementia, and in women with psychosis, which could be an underestimation, owing to lack of investigation, which warrants attention. The risk of POAG was increased in women with depression, which could be secondary to the glaucoma diagnosis.KEY MESSAGESThe prevalence of newly diagnosed glaucoma was decreased in men and women with dementia, and in women with psychosis. A lower prevalence of newly diagnosed glaucoma may be due to an underestimation, owing to a lack of investigation.The risk of glaucoma was increased in women with depression, which could be secondary to the glaucoma diagnosis.
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Affiliation(s)
- Per E Wändell
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden
| | - Gunnar Ljunggren
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden.,Academic Primary Health Care Centre, Region Stockholm Region, Stockholm, Sweden
| | - Lars Wahlström
- Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Axel Carl Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden.,Academic Primary Health Care Centre, Region Stockholm Region, Stockholm, Sweden
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Wu-Chung EL, Leal SL, Denny BT, Cheng SL, Fagundes CP. Spousal caregiving, widowhood, and cognition: A systematic review and a biopsychosocial framework for understanding the relationship between interpersonal losses and dementia risk in older adulthood. Neurosci Biobehav Rev 2022; 134:104487. [PMID: 34971701 PMCID: PMC8925984 DOI: 10.1016/j.neubiorev.2021.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 01/18/2023]
Abstract
Accumulating research suggests that stressful life events, especially those that threaten close intimate bonds, are associated with an increased risk of dementia. Grieving the loss of a spouse, whether in the form of caregiving or after the death, ranks among 'life's most significant stressors', evoking intense psychological and physiological distress. Despite numerous studies reporting elevated dementia risk or poorer cognition among spousal caregivers and widow(er)s compared to controls, no review has summarized findings across cognitive outcomes (i.e., dementia incidence, cognitive impairment rates, cognitive performance) or proposed a theoretical model for understanding the links between partner loss and abnormal cognitive decline. The current systematic review summarizes findings across 64 empirical studies. Overall, both cross-sectional and longitudinal studies revealed an adverse association between partner loss and cognitive outcomes. In turn, we propose a biopsychosocial model of cognitive decline that explains how caregiving and bereavement may position some to develop cognitive impairment or Alzheimer's disease and related dementias. More longitudinal studies that focus on the biopsychosocial context of caregivers and widow(er)s are needed.
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Affiliation(s)
| | | | - Bryan T. Denny
- Department of Psychological Sciences, Rice University, Houston, TX
| | | | - Christopher P. Fagundes
- Department of Psychological Sciences, Rice University, Houston, TX,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX,Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX
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Holm E, Jacobsen KK, Lony TB, Lembeck M, Pedersen H, Andersson C, Johannsen P, Jørgensen TSH, Torp‐Pedersen C. Frequency of missed or delayed diagnosis in dementia is associated with neighborhood socioeconomic status. ALZHEIMER'S & DEMENTIA: TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2022; 8:e12271. [PMID: 35356741 PMCID: PMC8943602 DOI: 10.1002/trc2.12271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 11/12/2022]
Abstract
Introduction Underdetection of dementia in areas with low socioeconomic status (SES) may interfere with findings concerning associations between SES and dementia. Methods Using administrative registers we assessed the associations between age‐ and sex‐adjusted dementia incidence and neighborhood socioeconomic status (nSES) in 94 Danish municipalities. Wealth was divided into income quartiles and other nSES variables were dichotomized into high versus low according to the median. Results High population density (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.18–1.24), higher proportion of inhabitants in higher income quartiles (P for trend < .0001), and high educational level (OR 1.19, 95% CI 1.15–1.22) were associated with higher incidence of dementia. High proportion of residents above 65 years was associated with lower age‐adjusted dementia incidence (OR 0.86, 95% CI 0.84–0.89). Discussion Low nSES municipalities have a lower age‐adjusted incidence of dementia diagnosis. These findings corroborate prior concerns that a large number of dementia diagnoses may be missed in municipalities characterized by low SES.
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Affiliation(s)
- Ellen Holm
- Department of Internal Medicine University Hospital Zealand Køge Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Katja Kemp Jacobsen
- Department of Technology Faculty of Health and Technology University College Copenhagen Copenhagen Denmark
| | - Thea Bang Lony
- Geriatric Section Department of Internal Medicine Nykøbing Falster Hospital Nykøbing Falster Denmark
| | - Maurice Lembeck
- Geriatric Section Department of Internal Medicine Nykøbing Falster Hospital Nykøbing Falster Denmark
| | - Hanne Pedersen
- Geriatric Section Department of Internal Medicine in Glostrup Amager Hvidovre Hospital Glostrup Denmark
| | - Charlotte Andersson
- Department of Medicine Section of Cardiovascular Medicine Boston University Medical Center Boston Massachusetts USA
| | - Peter Johannsen
- International Medical Vice President, Medical & Science Clinical Drug Development Novo Nordisk Copenhagen Denmark
| | | | - Christian Torp‐Pedersen
- Department of Cardiology and Clinical Research Nordsjaellands Hospital Hillerød Denmark
- Department of Public Health University of Copenhagen Copenhagen Denmark
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Clinical Utility of the Pathogenesis-Related Proteins in Alzheimer's Disease. Int J Mol Sci 2020; 21:ijms21228661. [PMID: 33212853 PMCID: PMC7698353 DOI: 10.3390/ijms21228661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/05/2020] [Accepted: 11/13/2020] [Indexed: 12/16/2022] Open
Abstract
Research on the Aβ cascade and alternations of biomarkers in neuro-inflammation, synaptic dysfunction, and neuronal injury followed by Aβ have progressed. But the question is how to use the biomarkers. Here, we examine the evidence and pathogenic implications of protein interactions and the time order of alternation. After the deposition of Aβ, the change of tau, neurofilament light chain (NFL), and neurogranin (Ng) is the main alternation and connection to others. Neuro-inflammation, synaptic dysfunction, and neuronal injury function is exhibited prior to the structural and metabolic changes in the brain following Aβ deposition. The time order of such biomarkers compared to the tau protein is not clear. Despite the close relationship between biomarkers and plaque Aβ deposition, several factors favor one or the other. There is an interaction between some proteins that can predict the brain amyloid burden. The Aβ cascade hypothesis could be the pathway, but not all subjects suffer from Alzheimer's disease (AD) within a long follow-up, even with very elevated Aβ. The interaction of biomarkers and the time order of change require further research to identify the right subjects and right molecular target for precision medicine therapies.
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Wändell P, Fredrikson S, Carlsson AC, Li X, Sundquist J, Sundquist K. Multiple sclerosis among first- and second-generation immigrant groups in Sweden. Acta Neurol Scand 2020; 142:339-349. [PMID: 32648932 DOI: 10.1111/ane.13314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 06/08/2020] [Accepted: 07/03/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Risk of multiple sclerosis (MS) is low among first-generation immigrants in Sweden. We aimed to study incident MS in first- and second-generation immigrant groups. MATERIALS & METHODS We included adults aged 18 years and older in Sweden in first-generation (n = 6 042 891) and second-generation (n = 4 860 469) sub-studies. MS was defined via two diagnoses in the Swedish National Patient Register. MS risk was estimated by Cox regression, with hazard ratios (HRs) and 95% confidence intervals (CI), in different immigrant groups, using Swedish-born as referents in first-generation sub-study, and individuals with Swedish-born parents in the second-generation. Full models were adjusted for age, geographic residence in Sweden, educational level, marital status, neighborhood socioeconomic status, and co-morbidity. RESULTS MS was diagnosed among 10 746 individuals in the first-generation sub-study, (men 3055 and women 7691), and 11 737 in the second-generation sub-study (men 3549 and women 8188) in the period 1998-2015. The annual incidence rate was higher in Swedish-born compared to foreign-born, 11.5 vs 6.3 per 100 000 person-years (age-standardized to the European standard population). Fully adjusted HRs were lower in first-generation immigrant men (HR 0.72, 0.64-0.82) and women (HR 0.67, 0.62-0.73), and in second-generation immigrant men (HR 0.88, 0.79-0.97) and women (HR 0.79; 0.73-0.84). Among first-generation immigrants, lower HRs were found in most groups. SIGNIFICANCE The MS risk was lower in first- and second-generation immigrants compared to Swedish-born or individuals with Swedish-born parents.
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Affiliation(s)
- Per Wändell
- Division of Family Medicine and Primary Care Department of Neurobiology, Care Sciences and Society Karolinska Institutet Huddinge Sweden
| | - Sten Fredrikson
- Department of Clinical Neuroscience Division of Neurology Karolinska Institutet Huddinge Stockholm Sweden
| | - Axel C. Carlsson
- Division of Family Medicine and Primary Care Department of Neurobiology, Care Sciences and Society Karolinska Institutet Huddinge Sweden
- Academic Primary Health Care Centre Stockholm Region Stockholm Sweden
| | - Xinjun Li
- Center for Primary Health Care Research Lund University Malmö Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research Lund University Malmö Sweden
- Department of Family Medicine and Community Health Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai New York NY USA
- Department of Functional Pathology Center for Community‐based Healthcare Research and Education (CoHRE) School of Medicine Shimane University Matsue Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research Lund University Malmö Sweden
- Department of Family Medicine and Community Health Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai New York NY USA
- Department of Functional Pathology Center for Community‐based Healthcare Research and Education (CoHRE) School of Medicine Shimane University Matsue Japan
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