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Zapata LB, Kortsmit K, Curtis KM, Romero L, Hurst S, Lathrop E, Acosta Perez E, Sánchez Cesáreo M, Whiteman MK. Continuation of Reversible Contraception Following Enrollment in the Zika Contraception Access Network (Z-CAN) in Puerto Rico, 2016-2020. Stud Fam Plann 2024; 55:105-125. [PMID: 38659169 PMCID: PMC11299421 DOI: 10.1111/sifp.12262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
The Zika Contraception Access Network (Z-CAN) provided access to high-quality client-centered contraceptive services across Puerto Rico during the 2016-2017 Zika virus outbreak. We sent online surveys during May 2017-August 2020 to a subset of Z-CAN patients at 6, 24, and 36 months after program enrollment (response rates: 55-60 percent). We described contraceptive method continuation, method satisfaction, and method switching, and we identified characteristics associated with discontinuation using multivariable logistic regression. Across all contraceptive methods, continuation was 82.5 percent, 64.2 percent, and 49.9 percent at 6, 24, and 36 months, respectively. Among continuing users, method satisfaction was approximately ≥90 percent. Characteristics associated with decreased likelihood of discontinuation included: using an intrauterine device or implant compared with a nonlong-acting reversible contraceptive method (shot, pills, ring, patch, or condoms alone); wanting to prevent pregnancy at follow-up; and receiving as their baseline method the same method primarily used before Z-CAN. Other associated characteristics included: receiving the method they were most interested in postcounseling (6 and 24 months) and being very satisfied with Z-CAN services at the initial visit (6 months). Among those wanting to prevent pregnancy at follow-up, about half reported switching to another method. Ongoing access to contraceptive services is essential for promoting reproductive autonomy, including supporting patients with continued use, method switching, or discontinuation.
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Grants
- CC999999 Intramural CDC HHS
- The CDC Foundation secured large-scale donations, offers of contraceptive products, support tools, and services from Bayer, Allergan, Medicines360, Americares and Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Mylan, the Pfizer Foundation, Teva Pharmaceuticals, Church & Dwight Co., Inc., RB, Power to Decide (formerly The National Campaign to Prevent Teen and Unplanned Pregnancy), Upstream USA, and Market Vision, Culture Inspired Marketing.
- Funding for the Z-CAN program via the CDC Foundation was made possible by the Bill & Melinda Gates Foundation, Bloomberg Philanthropies, the William and Flora Hewlett Foundation, the Pfizer Foundation, and the American College of Obstetricians and Gynecologists.
- This data collection was funded by the Centers for Disease Control and Prevention (CDC).
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Affiliation(s)
- Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Katherine Kortsmit
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Kathryn M Curtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Stacey Hurst
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
| | - Eva Lathrop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA 30303, USA
| | - Edna Acosta Perez
- Graduate School of Public Health, Medical Science Campus, University of Puerto Rico, PO Box 365067 San Juan, Puerto Rico 00936-5067, USA
| | - Marizaida Sánchez Cesáreo
- Graduate School of Public Health, Medical Science Campus, University of Puerto Rico, PO Box 365067 San Juan, Puerto Rico 00936-5067, USA
| | - Maura K Whiteman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
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Romero L, Acosta-Pérez E, Bednar H, Hurst S, Zapata LB, Torres SV, Powell R, Lathrop E. Perceptions of the Zika Virus, Contraceptive Access, and Motivation to Participate in the Zika Contraception Access Network Program: Qualitative Analysis of Focusgroup Discussions with Puerto Rican Women. PUERTO RICO HEALTH SCIENCES JOURNAL 2024; 43:46-53. [PMID: 38512761 PMCID: PMC11002974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVE During the 2016-2017 Zika virus outbreak in Puerto Rico, the Zika Contraception Access Network (Z-CAN) provided client-centered contraceptive counseling and access to the full range of reversible contraceptive methods at no cost to prevent unintended pregnancies and thereby to reduce Zika-related birth outcomes. METHODS To understand how Puerto Rican women's perceptions of the Zika virus affected contraceptive decisions and assess how they heard about the Z-CAN program and what influenced their participation, or lack thereof, 24 focus-group discussions were conducted among women of reproductive age who did and did not participate in Z-CAN. RESULTS Women who participated in the discussions often had heard about Z-CAN from their physician or friends; non-participants had heard about Z-CAN from Facebook or friends. Women expressed satisfaction on finding a Z-CAN clinic and valued the same-day provision of contraceptives. When a preferred contraceptive method or a first appointment was not readily available, women reconsidered accessing the program. Women's perceptions and trust of reproductive healthcare providers, their engagement in social networks, and their ability to choose a contraceptive method that best meets their needs can influence participation in contraception-access programs. CONCLUSION Focus groups can be used to understand women's knowledge of the Zika virus, barriers and facilitators to contraception access, and motivations for participation in the Z-CAN program.
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Affiliation(s)
- Lisa Romero
- Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333
| | - Edna Acosta-Pérez
- Third Mission Institute, Albizu University and Medical Sciences Campus, University of Puerto Rico, PO Box 10663, San Juan, PR 00922
| | - Hailey Bednar
- Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333
| | - Stacey Hurst
- Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333
| | - Lauren B. Zapata
- Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333
| | - Samaris Vega Torres
- Third Mission Institute, Albizu University and Medical Sciences Campus, University of Puerto Rico, PO Box 10663, San Juan, PR 00922
| | - Rachel Powell
- National Foundation for the Centers for Disease Control and Prevention, 600 Peachtree St. NE, #1000, Atlanta, GA 30308
| | - Eva Lathrop
- Emory University School of Medicine, Department of Gynecology and Obstetrics, 69 Jesse Hill Jr. Dr., Atlanta, GA 30303
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Burkel VK, Newton SM, Acosta J, Valencia D, Benavides M, Tong VT, Daza M, Sancken C, Gonzalez M, Polen K, Rodriguez H, Borbón M, Rao CY, Gilboa SM, Honein MA, Ospina ML, Johnson CY. Zika virus knowledge, attitudes and prevention behaviors among pregnant women in the ZEN cohort study, Colombia, 2017-2018. Trans R Soc Trop Med Hyg 2023; 117:496-504. [PMID: 36864562 PMCID: PMC10910550 DOI: 10.1093/trstmh/trad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/20/2023] [Accepted: 02/07/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Zika virus (ZIKV) infection during pregnancy can cause severe birth defects in the fetus and is associated with neurodevelopmental abnormalities in childhood. Our objective was to describe ZIKV knowledge and attitudes among pregnant women in Colombia while ZIKV was circulating and whether they predicted the adoption of behaviors to prevent ZIKV mosquito-borne and sexual transmission. METHODS We used self-reported data from Zika en Embarazadas y Niños (ZEN), a cohort study of women in early pregnancy across three regions of Colombia during 2017-2018. We used Poisson regression to estimate associations between knowledge, attitudes and previous experience with mosquito-borne infection and preventative behaviors. RESULTS Among 1519 women, knowledge of mosquito-borne transmission was high (1480; 97.8%) and 1275 (85.5%) participants were worried about ZIKV infection during pregnancy. The most common preventive behavior was wearing long pants (1355; 89.4%). Regular mosquito repellent use was uncommon (257; 17.0%). While ZIKV knowledge and attitudes were not associated with the adoption of ZIKV prevention behaviors, previous mosquito-borne infection was associated with increased condom use (prevalence ratio 1.4, 95% CI 1.1 to 1.7). CONCLUSIONS Participants were well informed about ZIKV transmission and its health consequences. However, whether this knowledge resulted in behavior change is less certain.
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Affiliation(s)
- Veronica K. Burkel
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
- Eagle Global Services, LLC, Atlanta, GA 30341, USA
| | - Suzanne M. Newton
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | | | - Diana Valencia
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | | | - Van T. Tong
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | | | - Christina Sancken
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | | | - Kara Polen
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | | | | | - Carol Y. Rao
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Suzanne M. Gilboa
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Margaret A. Honein
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | | | - Candice Y. Johnson
- U. S. Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
- Department of Family Medicine and Community Health, Duke University, Durham, NC 27705, USA
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Chang KT, Snead MC, Serrano Rodriguez RA, Bish C, Shapiro-Mendoza CK, Ellington SR. Condom use among women of reproductive age (18-49 years) in Puerto Rico during the 2016 Zika virus outbreak: secondary analysis of data from a cross-sectional, population-based, cell-phone survey. BMJ Open 2022; 12:e065592. [PMID: 35835533 PMCID: PMC9289039 DOI: 10.1136/bmjopen-2022-065592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Zika virus (ZIKV) can be sexually transmitted, and ZIKV infection during pregnancy can cause birth defects. Contraception is a medical countermeasure to reduce unintended pregnancy and ZIKV-associated birth defects. We estimated the prevalence of condom use and associated factors among women at risk for unintended pregnancy in Puerto Rico during the 2016 ZIKV outbreak. DESIGN Secondary analysis of a cross-sectional, population-based, cell-phone survey. SETTING AND PARTICIPANTS Women, 18-49 years, living in Puerto Rico during July-November 2016. We limited our analytical sample (n=1840) to women at risk for unintended pregnancy, defined as those who were sexually active with a man in the last 3 months and did not report menopause, hysterectomy, current pregnancy or desiring pregnancy. OUTCOME MEASURES We estimated the weighted prevalence of any condom use among women at risk for unintended pregnancy. We calculated crude and adjusted prevalence ratios (aPRs) to examine the association between condom use and ZIKV-related factors, stratified by use of more effective versus less effective or no contraception. RESULTS Overall, 32.7% (95% CI: 30.2% to 35.1%) of women reported any condom use in the last 3 months. Among women using more effective contraception, condom use was higher for women who received ZIKV counselling (aPR: 1.61, 95% CI: 1.15 to 2.25) and those worried about having a child with a ZIKV-associated birth defect (aPR: 1.47, 95% CI: 1.03 to 2.10). Among women using less effective or no contraception, condom use was associated with being worried (aPR: 1.20, 95% CI: 1.01 to 1.43) compared with those not worried about ZIKV infection or with a previous known infection. CONCLUSIONS During the 2016 ZIKV outbreak, one in three women at risk for unintended pregnancy reported any condom use. Counselling to promote consistent and correct condom use may address concerns regarding ZIKV among women of reproductive age, which may differ by use of effective contraception.
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Affiliation(s)
- Karen T Chang
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Margaret Christine Snead
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Connie Bish
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carrie K Shapiro-Mendoza
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sascha R Ellington
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Li R, Ellington SR, Galang RR, Grosse SD, Mendoza Z, Hurst S, Vale Y, Lathrop E, Romero L. Economic evaluation of Zika Contraception Access Network in Puerto Rico during the 2016-17 Zika virus outbreak. Contraception 2021; 107:68-73. [PMID: 34748752 DOI: 10.1016/j.contraception.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 10/04/2021] [Accepted: 10/23/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE During the 2016-2017 Zika virus (ZIKV) outbreak, the prevention of unintended pregnancies was identified as a primary strategy to prevent birth defects. This study estimated the cost-effectiveness of the Zika Contraception Access Network (Z-CAN), an emergency response intervention that provided women in Puerto Rico with access to the full range of reversible contraception at no cost and compared results with a pre-implementation hypothetical cost-effectiveness analysis (CEA). STUDY DESIGN We evaluated costs and outcomes of Z-CAN from a health sector perspective compared to no intervention using a decision tree model. Number of people served, contraception methods mix, and costs under Z-CAN were from actual program data and other input parameters were from the literature. Health outcome measures included the number of Zika-associated microcephaly (ZAM) cases and unintended pregnancies. The economic benefits of the Z-CAN intervention were ZIKV-associated direct costs avoided, including lifetime medical and supportive costs associated with ZAM cases, costs of monitoring ZIKV-exposed pregnancies and infants born from Zika-virus infected mothers, and the costs of unintended pregnancies prevented during the outbreak as a result of increased contraception use through the Z-CAN intervention. RESULTS The Z-CAN intervention cost a total of $26.1 million, including costs for the full range of reversible contraceptive methods, contraception related services, and programmatic activities. The program is estimated to have prevented 85% of cases of estimated ZAM cases and unintended pregnancies in the absence of Z-CAN. The intervention cost was projected to have been more than offset by $79.9 million in ZIKV-associated costs avoided, 96% of which were lifetime ZAM-associated costs, as well as $137.0 million from avoided unintended pregnancies, with total net savings in one year of $216.9 million. The results were consistent with the previous CEA study. CONCLUSION Z-CAN was likely cost-saving in the context of a public health emergency response setting.
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Affiliation(s)
- Rui Li
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Sascha R Ellington
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Romeo R Galang
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Zipatly Mendoza
- National Foundation for the Centers for Disease Control and Prevention, 600 Peachtree Street NE, Suite 1000, Atlanta, GA, 30308
| | - Stacey Hurst
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yari Vale
- University of Puerto Rico, Department of Gynecology and Obstetrics
| | - Eva Lathrop
- Department of Obstetrics and Gynecology, Emory University School of Medicine, Atlanta, GA
| | - Lisa Romero
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
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Ellington SR, Simeone RM, Serrano-Rodriguez RA, Bertolli J, Swartzendruber A, Goldberg HI, Mercado AS, Jamieson DJ, Honein MA, Cordero JF, Shapiro-Mendoza CK. Zika Prevention Behaviors Among Women of Reproductive Age in Puerto Rico, 2016. Am J Prev Med 2021; 61:e149-e155. [PMID: 33952412 PMCID: PMC9843536 DOI: 10.1016/j.amepre.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Zika virus is primarily transmitted through mosquito bites. Because Zika virus infection during pregnancy can cause serious birth defects, reproductive-aged women need protection from Zika virus infection. This report describes Zika virus prevention behaviors among women aged 18-49 years and assesses whether pregnancy status and healthcare provider counseling increases Zika virus prevention behaviors. METHODS A population-based cell phone survey of women aged 18-49 years living in Puerto Rico was conducted in July-November 2016. Data were analyzed in 2018-2019. Prevalence estimates and 95% CIs were calculated for Zika virus prevention behaviors. Adjusted prevalence ratios were estimated to examine the association of pregnancy status with healthcare provider counseling on Zika virus prevention behaviors, controlling for age, education, and health insurance status. RESULTS Most women reported using screens on open doors/windows (87.7%) and eliminating standing water in/around their homes (92.3%). Other Zika virus prevention behaviors were less common (<33%). In adjusted analysis, pregnant women were more likely than women not at risk for unintended pregnancy to report using mosquito repellent every/most days (adjusted prevalence ratio=1.44, 95% CI=1.13, 1.85). Healthcare provider counseling was associated with receiving professional spraying/larvicide treatment (adjusted prevalence ratio=1.42, 95% CI=1.17, 1.74), sleeping under a bed net (adjusted prevalence ratio=2.37, 95% CI=1.33, 4.24), using mosquito repellent (adjusted prevalence ratio=1.57, 95% CI=1.40, 1.77), and wearing long sleeves/pants (adjusted prevalence ratio=1.32, 95% CI=1.12, 1.55). CONCLUSIONS Receipt of healthcare provider counseling was more consistently associated with Zika virus prevention behaviors than pregnancy status. Healthcare provider counseling is an important strategy for increasing the uptake of Zika virus prevention behaviors among women aged 18-49 years.
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Affiliation(s)
- Sascha R Ellington
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology & Biostatistics, College of Public Health, University of Georgia, Athens, Georgia.
| | - Regina M Simeone
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jeanne Bertolli
- Division of Human Development and Disability, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea Swartzendruber
- Department of Epidemiology & Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
| | - Howard I Goldberg
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Margaret A Honein
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - José F Cordero
- Department of Epidemiology & Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
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Freed B, Hillman S, Shantikumar S, Bick D, Dale J, Gauly J. The impact of disasters on contraception in OECD member countries: a scoping review. EUR J CONTRACEP REPR 2021; 26:429-438. [PMID: 34126834 DOI: 10.1080/13625187.2021.1934440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Review evidence is lacking about how contraception is affected by severe social disruption, such as that caused by the COVID-19 pandemic. The purpose of this scoping review was to explore the impact of natural and man-made disasters on contraception in OECD member countries. METHODS Manual searches and systematic searches in six electronic databases were conducted with no language restrictions. All articles were screened by at least two researchers. The data were analysed thematically. RESULTS 108 articles were included. Most focussed on the Zika virus outbreak (n = 50) and the COVID-19 pandemic (n = 28). Four key themes were identified: importance of contraception during disasters, impact of disasters on contraceptive behaviour, barriers to contraception during disasters and ways of improving use of contraception during disasters. Despite efforts to increase access to contraception including by transforming ways of delivery, barriers to use meant that unmet need persisted. CONCLUSIONS To prevent adverse health outcomes and reduce health costs as a result of failure to have access to contraception during disasters, there is a need to intensify efforts to remove barriers to use. This should include increasing access and information on methods of contraception and their side effects (e.g., menstrual suppression) and making contraception freely available.
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Affiliation(s)
- Benjamin Freed
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Sarah Hillman
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Debra Bick
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Julia Gauly
- Warwick Medical School, University of Warwick, Coventry, UK
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