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Pinto-Bustamante BJ, Gómez-Córdoba AI, Gómez-Rivadeneira A, Montaño CAC, Vargas VAR, Romero HA, Pascual MGM, Cervera JIM. Access to assisted human reproduction techniques in Colombia: Disparity between the recognition of reproductive rights and their effective implementation. Int J Health Plann Manage 2024; 39:9-21. [PMID: 37740542 DOI: 10.1002/hpm.3707] [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: 03/28/2023] [Accepted: 09/01/2023] [Indexed: 09/24/2023] Open
Abstract
Public funding of assisted reproduction technologies (ARTs) is a controversial issue. Some health systems have proposed public funding of ARTs. In recent years, there has been evidence of a change in the line of jurisprudence and legislation in Colombia about this topic. This article analyzes the tension between the recognition of individual sexual and reproductive rights and the common good, in terms of the sustainability of the health system and the reasonable use of limited resources to meet the health needs of the population. This article concludes that, despite regulatory progress, there has been a lack of corresponding progress in their effective implementation and the recognition of reproductive rights.
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Affiliation(s)
| | | | | | | | | | - Helena Arango Romero
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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Yun I, Cha W, Nam CM, Nam JY, Park EC. The impact of assisted reproductive technology treatment coverage on marriage, pregnancy, and childbirth in women of childbearing age: an interrupted time-series analysis. BMC Public Health 2023; 23:1379. [PMID: 37464391 DOI: 10.1186/s12889-023-16286-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Korea is encountering major challenges related to its declining birth rate and aging population. Various policies have been introduced to prevent further population decrease and boost the birth rate, but their effectiveness has not been verified. Therefore, this study examined the effects of assisted reproductive technology (ART) insurance coverage on marriage, pregnancy, and childbirth in women of childbearing age. METHODS All information on marriage, pregnancy, childbirth of women of childbearing age was obtained from Statistics Korea and Korean National Health Insurance Service database. During a total follow-up period of 54 months (July 2015 to December 2019), an average of 12,524,214 women of childbearing age per month, and 29,701 live births per month were included in the analysis. An interrupted time series with segmented regression was performed to analyze the time trend and changes in outcomes. RESULTS The implementation of ART coverage policies had no significant impact on marriage or pregnancy rates. However, it did affect multiple pregnancy and multiple birth rates, which increased by 1.0% (Exp(β3) = 1.010, P-value = 0.0001) and 1.4% (Exp(β3) = 1.014, P-value = < 0.0001), respectively, compared to the pre-intervention period. Although the effect of covering ART treatment on total birth rates were not confirmed, a slightly slower decline was observed after the intervention (Exp(β1) = 0.993, P-value = < 0.0001, Exp(β1 + β3) = 0.996 P-value = 0.012). CONCLUSION This study identified the effects of ART health insurance coverage policy on the rates of multiple pregnancies and births. After the policy implementation, the downward trend in the total birth rate reduced slightly. Our findings suggest that interventions to support infertile couples should be expanded to solve the problem of low fertility rates. To address the intricate problems related to low birth rates, the Korean government introduced a policy that provides financial support and health insurance coverage for assisted reproductive technology (ART) treatment for infertile couples. As a result of evaluating the effectiveness of the ART coverage policy, it led to higher rates of pregnancies and births. In addition, although the total birth rate has been continuously decreasing over time, the decline may have been slowed down slightly by this policy.
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Affiliation(s)
- Il Yun
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Wontae Cha
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- CHA Hollywood Presbyterian Medical Center, Los Angeles, CA, United States of America
| | - Chung-Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, Republic of Korea
| | - Jin Young Nam
- Department of Healthcare Management, Eulji University, Sanseongdae-ro 553, Sujeong-gu, Seongnam, Gyeonggi-do, Republic of Korea.
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
- Department of Preventive Medicine, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, Republic of Korea.
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Ni Y, Tong C, Xu L, Qian W, Huang L, Zhang A, Fang Q. Prevalence and associated factors of medication adherence among infertile women undergoing frozen-thawed embryo transfer cycle: A cross-sectional study. Front Pharmacol 2023; 14:1148867. [PMID: 37007001 PMCID: PMC10064053 DOI: 10.3389/fphar.2023.1148867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/09/2023] [Indexed: 03/19/2023] Open
Abstract
Objective: This study aimed to explore the prevalence and associated factors of medication adherence among infertile women undergoing frozen-thawed embryo transfer (FET) cycle.Methods: A cross-sectional study was conducted with 556 infertile women undergoing FET cycle in total. The Self-efficacy for Appropriate Medication Use Scale (SEAMS), Herth Hope Index (HHI) scale, and Social Support Rating Scale (SSRS) were used to evaluate the patients. Data were described by univariate and multivariate analyses. Logistic regression method was performed to analyse the factors potentially associated with medication adherence.Results: The average score of Self-efficacy for Appropriate Medication Use Scale (SEAMS) was 30.38 ± 6.65, and 65.3% of participants showed non-adherence. Multiple regression analysis indicated that first-time FET cycle, treatment stage, methods of daily medication, social support and hope level were the main associated factors of the medication adherence among infertile women undergoing FET cycle (p < 0.001).Conclusion: This study revealed the medication adherence is at medium level among infertile women undergoing FET cycle, especially in patients with repeated FET cycles. The study also suggested that improving the hope level and social support of infertile women undergoing FET cycle may increase medication adherence.
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Affiliation(s)
- Ying Ni
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenye Tong
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianying Xu
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Qian
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Limin Huang
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aijun Zhang
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Qiong Fang, ; Aijun Zhang,
| | - Qiong Fang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Qiong Fang, ; Aijun Zhang,
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Kiyak S, Kocoglu-Tanyer D. Effectiveness of progressive muscle relaxation and laughter therapy on mental health and treatment outcomes in women undergoing in vitro fertilization: A randomized controlled trial. Res Nurs Health 2021; 44:945-956. [PMID: 34605040 DOI: 10.1002/nur.22187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/18/2021] [Accepted: 09/23/2021] [Indexed: 11/05/2022]
Abstract
A majority of infertile women experience emotional problems, such as anxiety and depression. Nurses need nonpharmacological methods rather than drugs to address women's emotional distress during the in vitro fertilization (IVF) process. The purpose of this study was to examine the effect of progressive muscle relaxation exercises and laughter therapy on the mental health and treatment outcomes of women receiving IVF treatment. This parallel-group, randomized controlled trial was conducted in a private IVF center. Participants were randomly assigned to the intervention group (IG; n = 71) and control group (CG; n = 70). The IG received progressive muscle relaxation and laughter therapy for 40 min in each session for 3-4 sessions, whereas the CG received routine care. Data were obtained from the patient information form, State-Trait Anxiety Inventory, Beck Depression Inventory, and medical records. The questionnaire was completed at recruitment (T1) and oocyte pick-up day (T2). In the evaluation performed on the day of the oocyte pick-up, depression and trait anxiety scores of the IG were found to be lower than those in the CG, and the effect size was small. Group × time interaction was significant for depression (large effect size) and trait anxiety (small effect size). The estradiol levels, the number of oocytes, transfer status, and pregnancy rates (according to a blood test) were similar between groups. Women receiving IVF treatment who received progressive muscle relaxation and laughter therapy demonstrated psychological changes; however, the treatment did not affect medical outcomes.
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Affiliation(s)
- Sibel Kiyak
- Department of Obstetrics and Gynecology Nursing, Seydişehir Kamil Akkanat Faculty of Health Sciences, Necmettin Erbakan University, Seydişehir, Konya, Turkey
| | - Deniz Kocoglu-Tanyer
- Department of Public Health Nursing, Faculty of Nursing, Selcuk University, Konya, Turkey
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Harel N, Bentwich ME. What can European Principlism Teach about Public Funding of IVF? The Israeli Case. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:441-454. [PMID: 33948866 DOI: 10.1007/s11673-021-10104-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
Fertility treatments, which are part of "assisted reproductive technologies" (ART), mainly undertaken through in vitro fertilization (IVF), offer the opportunity to infertile couples to conceive. IVF treatments are undertaken in Israel in significantly higher numbers than in the rest of the world. As such, Israel provides an important case-in-point for examining the validity of the actual claims used to justify the more generous public funding of IVF treatments at the policy level. In this article, we utilize an analytical philosophy approach to conduct this examination. First, we highlight two fundamental concepts that were used at the Israeli public policy level in order to justify the generous public funding of IVF treatments. These concepts are "emotional vulnerability" and the "worthlessness of the childless," where the latter emphasizes the infinite value of children. Then, by applying the perspective of the European model of Bioethical Principlism, and focusing the attention to these two concepts we show that these justifications are invalid. Specifically, it is suggested that these concepts are on the one hand both relying on and expressing the principles of vulnerability, dignity, and integrity; yet on the other hand, these concepts are also undermining the very principles of bioethics they are supposed to express and rely on. Based on this suggested criticism, we offer two "take home" messages informed by our analysis of the Israeli case, but reaching beyond it.
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Affiliation(s)
- Noa Harel
- Department of Obstetrics and Gynecology, Affiliated to the Azrieli Faculty of Medicine, Bar-Ilan University Baruch Padeh Medical Center, MPO Lower Galilee 15208, Poriya, Israel
| | - Miriam Ethel Bentwich
- Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, P.O. Box 1589, Safed, Israel.
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Raymer J, Guan Q, Norman RJ, Ledger W, Chambers GM. Projecting future utilization of medically assisted fertility treatments. Population Studies 2019; 74:23-38. [DOI: 10.1080/00324728.2019.1676461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Clinical guidelines summarise available evidence on medical treatment, and provide recommendations about the most effective and cost-effective options for patients with a given condition. However, sometimes patients do not desire the best available treatment. Should doctors in a publicly-funded healthcare system ever provide sub-optimal medical treatment? On one view, it would be wrong to do so, since this would violate the ethical principle of beneficence, and predictably lead to harm for patients. It would also, potentially, be a misuse of finite health resources. In this paper, we argue in favour of permitting sub-optimal choices on the basis of value pluralism, uncertainty, patient autonomy and responsibility. There are diverse views about how to evaluate treatment options, and patients' right to self-determination and taking responsibility for their own lives should be respected. We introduce the concept of cost-equivalence (CE), as a way of defining the boundaries of permissible pluralism in publicly-funded healthcare systems. As well as providing the most effective, available treatment for a given condition, publicly-funded healthcare systems should provide reasonable suboptimal medical treatments that are equivalent in cost to (or cheaper than) the optimal treatment. We identify four forms of cost-equivalence, and assess the implications of CE for decision-making. We evaluate and reject counterarguments to CE. Finally, we assess the relevance of CE for other treatment decisions including requests for potentially superior treatment.
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Affiliation(s)
- Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford, OX1 1PT, UK.
- John Radcliffe Hospital, Oxford, UK.
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford, OX1 1PT, UK
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DEFINING ELIGIBILITY CRITERIA FOR FUNDING POLICIES AROUND IN VITRO FERTILIZATION. Int J Technol Assess Health Care 2015; 31:426-33. [DOI: 10.1017/s0266462315000628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives: This review aims to assess the state of the science around the potential impact of certain patient characteristics on the safety and effectiveness of in vitro fertilization (IVF).Methods: Following Cochrane Collaboration guidelines and the PRISMA statement, a comprehensive systematic review of reviews and recent primary studies examining the impact of paternal age and maternal age, smoking, and body mass index (BMI) on the safety and effectiveness of IVF was performed. Papers, published between January 2007 and June 2014, were independently reviewed and critically appraised by two researchers using published quality assessment tools for reviews and primary studies. Due to heterogeneity across papers (different study designs and patient selection criteria), a qualitative analysis of extracted information was performed.Results: Seventeen papers (ten systematic reviews and seven primary studies) were included. They comprised evidence from retrospective observational studies in which maternal age, BMI, and smoking status were explored as part of secondary analyses of larger studies. The majority of papers found that the likelihood of achieving a pregnancy was lower among women who were >40 years, had a BMI ≥ 25 and smoked. Advanced maternal age and BMI were also associated with higher rates of preterm birth and low birth weight.Conclusions: Based on available evidence, it may be appropriate to consider “maternal age” and “morbid obesity” in public funding policies that aim to maximize the effectiveness of IVF. However, given inconsistencies in the effect of smoking across different pregnancy-related outcomes, support for incorporating it into funding conditions appears weak.
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Vaidya A, Stafinski T, Nardelli A, Motan T, Menon D. Assisted Reproductive Technologies in Alberta: An Economic Analysis to Inform Policy Decision-Making. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:1122-30. [PMID: 26637087 DOI: 10.1016/s1701-2163(16)30080-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Regulation and public funding of assisted reproductive technologies (ARTs) vary across the Canadian provinces. In Alberta, neither of these exists. We conducted this study to evaluate the cost effectiveness and budget impact of providing ARTs in Alberta under three different policy scenarios (a "restrictive" policy, a policy based on Quebec's model, and a "permissive" policy) in comparison with the status quo. METHODS To predict the cost effectiveness and budget impact of three policy options for publicly funded ARTs in Alberta, we developed an economic model by combining a state transition Markov model and a decision tree. The primary outcome was cost per healthy singleton. Probabilistic and one-way sensitivity analyses were conducted. RESULTS The restrictive policy was the most cost effective option for two subgroups of age (< 35 years and 35 to 39 years), while the Quebec policy option was most cost-effective for the ≥ 40 years subgroup. Budget impact analysis extending up to the age of 18 years for the children in the model showed the cost savings of $8.33 million for the restrictive policy for the < 35 years subgroup. For the ≥ 40 years subgroup, the Quebec policy option resulted in total cost savings of $3.75 million. Sensitivity analyses showed that the model results were robust. CONCLUSION This economic modelling study shows that publicly funded and scientifically regulated ARTs could provide treatment access and save health care expenditures for the province.
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Affiliation(s)
- Anil Vaidya
- Health Technology and Policy Unit, School of Public Health, University of Alberta, Edmonton AB
| | - Tania Stafinski
- Health Technology and Policy Unit, School of Public Health, University of Alberta, Edmonton AB
| | - Alexa Nardelli
- Health Technology and Policy Unit, School of Public Health, University of Alberta, Edmonton AB
| | - Tarek Motan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Alberta, Edmonton AB
| | - Devidas Menon
- Health Technology and Policy Unit, School of Public Health, University of Alberta, Edmonton AB
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Hann SK, Kang HS. Infertile Women's Perception on the National Support Program for Infertile Couples. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2015; 21:171-183. [PMID: 37684822 DOI: 10.4069/kjwhn.2015.21.3.171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/15/2015] [Accepted: 07/22/2015] [Indexed: 09/10/2023] Open
Abstract
PURPOSE The purpose of this study was to explore the perception of infertile women on the use of the national support program that provides medical expense aid to infertile couples. METHODS Thirty Korean infertile women participated in five focus groups. Data were collected from January to August 2014. After obtaining permission from the participants, each session of the focus group was audio-taped and transcribed. The responses were analyzed using qualitative content analysis. RESULTS The main themes identified from the sessions with the participants were "feeling thankful for the reliable support program," "feeling happy or unhappy," "enduring inconveniences," and "hoping for a more comprehensive support service." Although most of the participants perceived the benefits of the national support service positively, they stated that the service was not comprehensive because it did not cover all the medical expenses for tests and other medical treatments. CONCLUSION The benefits given to infertile couples by the program should be increased by covering all the medical expenses, expanding its criteria to include more eligible candidates, and by including special leave benefits for working women. Furthermore, it is essential to take measures for infertility prevention at the individual and national policy levels.
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Affiliation(s)
- Soo Kyoung Hann
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Hee Sun Kang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
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Nardelli AA, Stafinski T, Motan T, Klein K, Menon D. Assisted reproductive technologies (ARTs): evaluation of evidence to support public policy development. Reprod Health 2014; 11:76. [PMID: 25376649 PMCID: PMC4233043 DOI: 10.1186/1742-4755-11-76] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 10/25/2014] [Indexed: 11/30/2022] Open
Abstract
Over the years, IVF/ICSI protocols have continued to evolve with efforts to improve outcomes. As a result, treatment success may be related to certain procedural factors, including number of embryos transferred and stage at which they are transferred. This review aims to assess the safety and effectiveness of IVF/ICSI in comparison to spontaneous conception and less invasive ARTs and the impact of procedure-related factors on the outcomes of IVF/ICSI in order to support the development of local clinical and policy guidance. Following Cochrane Collaboration guidelines and the PRISMA statement, a comprehensive systematic review of literature examining the impact of procedural characteristics on the safety or effectiveness of IVF/ICSI from 2007 to date was performed. 33 systematic reviews and 3 primary studies evaluating the impact of procedural differences, IVF/ICSI in comparison to less invasive ARTs, and ARTs in comparison to spontaneous conception were found. IVF was shown to offer significant benefits over no treatment and IUI in achieving pregnancy and live birth among couples with endometriosis or unexplained infertility. Frozen and blastocyst-stage embryo transfers were as effective as fresh and cleavage-stage embryo transfers, respectively. In comparison to single embryo transfer, double embryo transfer significantly increased pregnancy, live birth and multiple pregnancy/birth rates. IVF/ICSI was associated with more complications during pregnancy and delivery, and in infants compared to naturally conceived pregnancies, particularly when multiple embryo transfer was used. Frozen embryo transfer had fewer adverse events during pregnancy and delivery than fresh embryo transfer, and was at least as safe in terms of infant outcomes. The potential complications of IVF/ICSI may be minimized through procedural choices, but such choices often impact effectiveness. Thus, in developing clinical and policy guidance around IVF/ICSI, the risk-benefit trade-offs patients and providers are willing to accept must be carefully considered.
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Affiliation(s)
- Alexa A Nardelli
- Health Technology and Policy Unit, School of Public Health, Department of Public Health Sciences, University of Alberta, Room 3021 Research Transition Facility, 8308 114 Street, Edmonton, Alberta T6G 2 V2, Canada.
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