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Birlie T, Biresaw B, Yadeta E, Getachew T, Debella A, Eyeberu A. Knee Pain After Retrograde Intramedullary Nailing with Surgical Implant Generation Network of Femur Shaft Fractures at Public Hospitals in Bahir Dar City, Ethiopia: Analysis of 6-Months Follow-Up Results. Orthop Res Rev 2023; 15:59-68. [PMID: 37077943 PMCID: PMC10106822 DOI: 10.2147/orr.s406176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/06/2023] [Indexed: 04/21/2023] Open
Abstract
Background The incidence of femur fractures in young and elderly people has increased, particularly in countries with limited resources like Ethiopia. Intra-medullary nailing (IM) has been an effective and cost-effective method of treating long bone shaft fractures, but it can lead to complications such as knee pain. Purpose This study aimed to evaluate knee pain and its associated factors following retrograde intramedullary nailing for femur fractures. Patients and Methods The study followed 110 patients diagnosed with femur fractures and treated with retrograde SIGN Standard Nail or Fin Nail from January 2020 to December 2022 at two hospitals in Ethiopia. The patients were followed up for at least 6 months, and data were collected from medical charts, patient interviews, and phone calls to patients who did not attend the follow-up appointment. Binary logistic regression analysis was used to identify factors associated with knee pain. Results The study showed that 40 patients reported knee pain at 6-months follow-up, making a prevalence of 36.4%. Factors significantly associated with knee pain were a time of injury to nailing (AOR=4.23, 95% CI: 1.28-13.92), use of a screw to the medial cortex (AOR=9.30, 95% CI: 2.90-12.74), and fracture site (AOR= 2.67, 95% CI: 14.01-7.03). Specifically, the longer the time from injury to nailing, the higher the risk of knee pain. The use of a longer screw to the medial cortex and a fracture site were also positively associated with knee pain. Conclusion This study concludes that although retrograde intramedullary nail fixation is an effective method for femur fractures, it often results in knee pain. Approximately 4 of 10 patients suffered from knee pain in this study. Avoiding delayed surgical management and minimizing the use of prominent metalwork may reduce knee pain.
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Affiliation(s)
- Tsegalem Birlie
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biniam Biresaw
- School of Medicine, College of Health and Medical Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Elias Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Correspondence: Elias Yadeta, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box: 138, Dire Dawa, Ethiopia, Tel +251924899107, Email
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Malhotra SK, White H, Dela Cruz NAO, Saran A, Eyers J, John D, Beveridge E, Blöndal N. Studies of the effectiveness of transport sector interventions in low- and middle-income countries: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1203. [PMID: 36951810 PMCID: PMC8724647 DOI: 10.1002/cl2.1203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND There are great disparities in the quantity and quality of infrastructure. European countries such as Denmark, Germany, Switzerland, and the UK have close to 200 km of road per 100 km2, and the Netherlands over 300 km per 100 km2. By contrast, Kenya and Indonesia have <30, Laos and Morocco <20, Tanzania and Bolivia <10, and Mauritania only 1 km per 100 km2. As these figures show, there is a significant backlog of transport infrastructure investment in both rural and urban areas, especially in sub-Saharan Africa. This situation is often exacerbated by weak governance and an inadequate regulatory framework with poor enforcement which lead to high costs and defective construction.The wellbeing of many poor people is constrained by lack of transport, which is called "transport poverty". Lucas et al. suggest that up to 90% of the world's population are transport poor when defined as meeting at least one of the following criteria: (1) lack of available suitable transport, (2) lack of transport to necessary destinations, (3) cost of necessary transport puts household below the income poverty line, (4) excessive travel time, or (5) unsafe or unhealthy travel conditions. OBJECTIVES The aim of this evidence and gap map (EGM) is to identify, map, and describe existing evidence from studies reporting the quantitative effects of transport sector interventions related to all means of transport (roads, rail, trams and monorail, ports, shipping, and inland waterways, and air transport). METHODS The intervention framework of this EGM reframes Berg et al's three categories (infrastructure, prices, and regulations) broadly as infrastructure, incentives, and institutions as subcategories for each intervention category which are each mode of transport (road, rail trams and monorail, ports, shipping, and inlands waterways, and air transport). This EGM identifies the area where intervention studies have been conducted as well as the current gaps in the evidence base.This EGM includes ongoing and completed impact evaluations and systematic reviews (SRs) of the effectiveness of transport sector interventions. This is a map of effectiveness studies (impact evaluations). The impact evaluations include experimental designs, nonexperimental designs, and regression designs. We have not included the before versus after studies and qualitative studies in this map. The search strategies included both academic and grey literature search on organisational websites, bibliographic searches and hand search of journals.An EGM is a table or matrix which provides a visual presentation of the evidence in a particular sector or a subsector. The map is presented as a matrix in which rows are intervention categories (e.g., roads) and subcategories (e.g., infrastructure) and the column outcome domains (e.g., environment) and subcategories as (e.g., air quality). Each cell contains studies of the corresponding intervention for the relevant outcome, with links to the available studies. Included studies were coded according to the intervention and outcomes assessed and additional filters as region, population, and study design. Critical appraisal of included SR was done using A Measurement Tool to Assess Systematic Reviews (AMSTAR -2) rating scale. SELECTION CRITERIA The search included both academic and grey literature available online. We included impact evaluations and SRs that assessed the effectiveness of transport sector interventions in low- and middle-income countries. RESULTS This EGM on the transport sector includes 466 studies from low- and middle-income countries, of which 34 are SRs and 432 impact evaluations. There are many studies of the effects of roads intervention in all three subcategories-infrastructure, incentives, and institutions, with the most studies in the infrastructure subcategories. There are no or fewer studies on the interventions category ports, shipping, and waterways and for civil aviation (Air Transport).In the outcomes, the evidence is most concentrated on transport infrastructure, services, and use, with the greatest concentration of evidence on transport time and cost (193 studies) and transport modality (160 studies). There is also a concentration of evidence on economic development and health and education outcomes. There are 139 studies on economic development, 90 studies on household income and poverty, and 101 studies on health outcomes.The major gaps in evidence are from all sectors except roads in the intervention. And there is a lack of evidence on outcome categories such as cultural heritage and cultural diversity and very little evidence on displacement (three studies), noise pollution (four studies), and transport equity (2). There is a moderate amount of evidence on infrastructure quantity (32 studies), location, land use and prices (49 studies), market access (29 studies), access to education facilities (23 studies), air quality (50 studies), and cost analysis including ex post CBA (21 studies).The evidence is mostly from East Asia and the Pacific Region (223 studies (40%), then the evidence is from the sub-Saharan Africa (108 studies), South Asia (96 studies), Latin America & Caribbean (79 studies). The least evidence is from Middle East & North Africa (30 studies) and Europe & Central Asia (20 studies). The most used study design is other regression design in all regions, with largest number from East Asia and Pacific (274). There is total 33 completed SRs identified and one ongoing, around 85% of the SR are rated low confidence, and 12% rated as medium confidence. Only one review was rated as high confidence. This EGM contains the available evidence in English. CONCLUSION This map shows the available evidence and gaps on the effectiveness of transport sector intervention in low- and middle-income countries. The evidence is highly concentrated on the outcome of transport infrastructure (especially roads), service, and use (351 studies). It is also concentrated in a specific region-East Asia and Pacific (223 studies)-and more urban populations (261 studies). Sectors with great development potential, such as waterways, are under-examined reflecting also under-investment.The available evidence can guide the policymakers, and government-related to transport sector intervention and its effects on many outcomes across sectors. There is a need to conduct experimental studies and quality SRs in this area. Environment, gender equity, culture, and education in low- and middle-income countries are under-researched areas in the transport sector.
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An SJ, Purcell LN, Mulima G, Charles AG. Characteristics and outcomes following motorized and non-motorized vehicular trauma in a resource-limited setting. Injury 2021; 52:2645-2650. [PMID: 33879340 PMCID: PMC8429052 DOI: 10.1016/j.injury.2021.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Despite the ubiquity of motorized vehicular transport, non-motorized transportation continues to be common in sub-Saharan Africa. METHODS We performed a retrospective analysis of trauma patients presenting to Kamuzu Central Hospital in Malawi from February 2008 to May 2018. Demographic and clinical variables including injury characteristics and outcomes were collected. We performed bivariate and multivariate logistic regression to determine predictors of mortality following non-motorized vehicular trauma. RESULTS This study included 36,412 patients involved in vehicular road injuries. Patients in the non-motorized group had a preponderance of men (84% versus 73%, p<0.01). The proportion of patients with Glasgow Coma Scale > 8 was slightly higher in the non-motorized group (99% versus 98%, p<0.01), though injury severity did not differ significantly between the two groups. A higher proportion in the motorized group had the most severe injury of contusions and abrasions (56% versus 50%, p<0.01). In contrast, the non-motorized group had a higher proportion of orthopedic injuries (24% versus 16%, p<0.01). The crude mortality rate was 4.51% and 2.15% in the motorized and non-motorized groups, respectively. After controlling for demographic factors and injury severity, the incidence rate ratio of mortality did not differ significantly between motorized and non-motorized trauma groups (IRR 0.91, p=0.35). CONCLUSIONS Non-motorized vehicular trauma remains a significant proportion of morbidity and mortality resulting from road traffic injuries. The injury severity and incidence rate ratio of mortality did not differ between motorized and non-motorized trauma groups. Health care providers should not underestimate the severity of injuries from non-motorized trauma.
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Affiliation(s)
- Selena J. An
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laura N. Purcell
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Anthony G. Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
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El-Gabri D, Barcenas LK, Meier B, Mvungi M, Haglund M, Gerardo CJ, Vissoci JRN, Staton CA. Injury patients' perceptions of drink-driving: A qualitative assessment of drink-driving behavior in Moshi, Tanzania. PLoS One 2020; 15:e0230662. [PMID: 32369492 PMCID: PMC7199952 DOI: 10.1371/journal.pone.0230662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 03/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Globally, about 2.3 billion people are current alcohol drinkers, and 283 million have an alcohol use disorder. Alcohol use while driving is a major contributor to road traffic injuries (RTI). We need to understand the culture and perception of drink-driving in this setting to understand why people continue to drink drive and allow policymakers to develop more effective ways to address drink-driving behavior. This study aims to qualitatively determine what injury patients, their families, and community advisory board members in Tanzania believe about drink-driving to help inform policies to address this problem. METHODS The semi-structured focus group was designed based on the grounded theory and assessed using thematic analysis. Focus groups participants were a convenience sample of injury patients, their families, and community advisory board (CAB) members. Analysis was iterative throughout the study. All transcripts were coded using a thematic narrative approach. Representative quotes for each theme were then selected based on comparative analysis of coding with input from research team members. RESULTS A total of ten focus groups were conducted (4 patient, 4 family, and 2 CAB) with a total of 104 participants (37 females and 67 males). The normalization of drinking among drivers has allowed this behavior to become ingrained in the culture. Participants expressed notions that passengers are responsible for their own safety, rather than drivers being responsible for their passengers. Most participants believe it is a citizen's duty to inform the police of suspected drink-driving, however there were differing opinions about how effective informed police officers can be in practice. Focus group discussions between all three population types highlighted major themes of 'drinking is ingrained in boda boda driver culture', 'individuals have a personal responsibility to address drink-driving', and a 'police enforcement on drink-driving is necessary'. CONCLUSIONS Normalization of drink-driving in commercial driver culture creates a dangerous environment for passengers which can be mitigated by education and health promotion. As most passengers already take personal responsibility for their own road traffic safety, they may be likely to make use of safe ride options, if available. While legislation is in place against drink-driving, police officers need to be empowered with appropriate training and funding to enforce them.
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Affiliation(s)
- Deena El-Gabri
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Loren K. Barcenas
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Brian Meier
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Mark Mvungi
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Michael Haglund
- Division of Neurosurgery and Neurology, Department of Neurosurgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Charles J. Gerardo
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Joao Ricardo N. Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
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Teixeira JRB, Mussi FC, Mota TN, Lua I, Macedo TTS, Souza ARD, de Araújo TM. Psychosocial risk factors at work associated with the level of physical activity among motorcycle taxi drivers. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2019; 75:307-316. [PMID: 31526117 DOI: 10.1080/19338244.2019.1666790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective: To analyze the association of psychosocial risk factors at work, sociodemographic, and occupational characteristics with the level of physical activity among motorcycle taxi drivers.Methods: Cross-sectional study with 750 male motorcycle taxi drivers from the municipality of Jequié, Bahia, Brazil. A form containing sociodemographic and occupational characteristics was utilized. The psychosocial risk factors at work were evaluated by the Job Content Questionnaire and the level of physical activity by the International Physical Activity Questionnaire. The adjusted associations were analyzed by means of the Poisson regression with robust variance. Results: the prevalence of an insufficiently active level of physical activity was of 59.6%. The crude prevalence ratios (PR) showed an association between physical inactivity in motorcycle taxi drivers and high strain job (PR: 1.31), with 5 or more years of experience (PR: 1.67), in night shifts (PR: 1.36) and 40 or more years old (PR: 1.77). In the multivariate model, adjusted by income, work in high strain is kept associated to a situation of being insufficiently active (PR: 1.13), duration of employment of five or more years raised by 51.0% the frequency of insufficiently active physical activity (PR: 1.51) and the work in predominantly nocturnal shifts increased it by 26.0% (PR: 1.26). It is made evident that age was an effect modifier (p < 0.001) and its interaction was evaluated by including the corresponding product term (job Demand-Control model), which shows that the association between highly straining work and being insufficiently active was observed only among the youngest (21-39 years old) (PR: 1,21).Conclusions: the age and exposure to unfavorable working conditions, like long duration of employment, night work and work under high psychological demand and low control, have an influence on the insufficient physical activity among motorcycle taxi drivers.
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Affiliation(s)
- Jules Ramon Brito Teixeira
- Epidemiology Center (NEPI), Post-Graduate Program in Collective Health, Department of Health, State University of Feira de Santana, Feira de Santana, Bahia, Brazil
| | - Fernanda Carneiro Mussi
- Interdisciplinary Group on Cardiovascular Health (Gisc), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Tilson Nunes Mota
- Study Group for Child and Adolescent Health (CRESCER), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Iracema Lua
- Epidemiology Center (NEPI), Post-Graduate Program in Collective Health, Department of Health, State University of Feira de Santana, Feira de Santana, Bahia, Brazil
| | - Tássia Teles Santana Macedo
- Interdisciplinary Group on Cardiovascular Health (Gisc), Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Tânia Maria de Araújo
- Epidemiology Center (NEPI), Post-Graduate Program in Collective Health, Department of Health, State University of Feira de Santana, Feira de Santana, Bahia, Brazil
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Scofield RM, Scofield S, Briggs E. Conspicuity Equipment and Its Contribution to the Welfare of Horse and Rider Combinations Using the Road System in the United Kingdom. J Equine Vet Sci 2019; 82:102770. [PMID: 31732115 DOI: 10.1016/j.jevs.2019.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
Limited research exists regarding proximity of vehicles to "vulnerable road users" and effects of "conspicuity equipment". Previous studies stated over 60% of horse/rider combinations experience near-miss traffic collisions in any one year, whereas use of fluorescent/reflective (FR) equipment did not decrease occurrences. Similarly, research into vehicle proximity to bicycles reported no significance in cyclists wearing FR. This study undertook a similar field experiment using a horse/rider combination wearing different conspicuity equipment to test proximity distance. Two horses with similar height, age, base coat color, and temperament were ridden using four conspicuity measures 60 times each (n = 240) along a straight 0.8 km lane. Measures were chosen by random crossover with two selected for each separate trip. These were an FR "tabard", a novel black/white pattern (BW), flashing lights on a helmet (L), and control of mid-blue (C). A novel proximity meter was used on the saddle pommel and distance/approach either front or rear were logged into a voice recorder. Analysis reported a significant difference between all measures and proximities observed (P = .000). Mann-Whitney tests concluded significant differences in proximity in C versus L and BW (P = .000; P = .000), respectively. FR versus C showed no significant difference in proximity (P = .005). L versus BW reported no significant difference in proximity (W = 3640.0, P = .958). Results may suggest wearing conspicuity equipment of L or BW outperforms both C and FR. Further study is recommended to test these findings, and it is pertinent to still consider suggesting the use of FR equipment due to previous positive findings with other road users.
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Affiliation(s)
- Rose M Scofield
- Health and Life Sciences, Oxford Brookes University, Gypsy Lane, Oxford, UK.
| | | | - Emma Briggs
- Health and Life Sciences, Oxford Brookes University, Gypsy Lane, Oxford, UK
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Ndagire M, Kiwanuka S, Paichadze N, Kobusingye O. Road safety compliance among motorcyclists in Kawempe Division, Kampala, Uganda: a cross-sectional study. Int J Inj Contr Saf Promot 2019; 26:315-321. [PMID: 31185794 DOI: 10.1080/17457300.2019.1607395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Motorcyclists are vulnerable road users in Uganda and 21.7% (3912/18,016) experienced crashes in 2012. This study determined the prevalence of and factors associated with compliance to selected road safety measures (helmet use, retro-reflective jackets use, riding permit and carrying one passenger) among commercial motorcyclists in Kawempe, from April to June 2014 using interviewer administered questionnaires. Total compliance was 0.9% and 24.4% to at least 3/4 measures. Compliance by measure was; 7.6% retroreflective jackets, 28.8% riding permits, 69.4% helmet use and 86.1% carrying one passenger. The associated factors were; knowing that (training before one starts to ride prevents crashes, Adjusted-odds-ratio (AOR) = 2.38 (1.36-4.19), maintaining the motorcycle in good condition prevents crashes, AOR = 0.34 (0.15-0.77) and padding reduces impact of road traffic injury, AOR = 0.37 (0.15-0.89)). Prevalence to compliance is very low. Road safety messages should highlight the importance of all road safety measures to improve compliance.
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Affiliation(s)
- Margaret Ndagire
- a Makerere University School of Public Health , Kampala , Uganda
| | - Suzanne Kiwanuka
- a Makerere University School of Public Health , Kampala , Uganda
| | - Nino Paichadze
- b Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Olive Kobusingye
- a Makerere University School of Public Health , Kampala , Uganda
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Bonnet E, Lechat L, Ridde V. What interventions are required to reduce road traffic injuries in Africa? A scoping review of the literature. PLoS One 2018; 13:e0208195. [PMID: 30500856 PMCID: PMC6267971 DOI: 10.1371/journal.pone.0208195] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/13/2018] [Indexed: 11/30/2022] Open
Abstract
Road traffic accidents are the major cause of mortality among people aged 15–29 years in Africa. World Health Organisation (WHO) and the World Bank launched a Decade of Action for Road Safety in 2011 with the goal of halving the number of injuries and deaths on the roads. No progress has been reported in Low and Middle Income Countries (LMICs) and the number of deaths remains very high. To reach the target set, there is a need for interventions in several areas. This scoping review proposes to produce a synthesis by identifying the kinds of interventions and outcomes which have been carried out on the African continent. Using the scoping studies method, 23 articles were selected and analysed. The study shows that interventions were developed in four fields: road safety policy, health education, safety equipment and data collection. It shows also that there were records of interventions in only twelve countries, mostly in Eastern and Southern Africa. The main conclusion of this study reveals both a lack of road safety interventions and shortcomings in the assessment of those performed and selected for our study.
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Affiliation(s)
- Emmanuel Bonnet
- Institut de Recherche pour le Développement, UMI Résiliences, Bondy, France
- * E-mail:
| | | | - Valéry Ridde
- Institut de Recherche pour le Développement, UMR CEPED, Université Paris Descartes, Paris, France
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Nguyen T, Vissoci JRN, Joelson T, Pesambili M, Haglund M, Gerardo CJ, Mvungi M, Staton CA. Injury prevalence and safety habits of boda boda drivers in Moshi, Tanzania: A mixed methods study. PLoS One 2018; 13:e0207570. [PMID: 30481196 PMCID: PMC6258469 DOI: 10.1371/journal.pone.0207570] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/02/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Traffic crashes are a major cause of global morbidity and mortality disproportionately affecting low- and middle-income countries (LMICs). Motorcycle taxi (boda boda) drivers are particularly vulnerable because they are exposed to traffic risks with limited safety equipment. This study aims to characterize injury prevalence and safety habits among boda boda drivers, as well as ways to improve road traffic safety in LMICs. METHODS A cross-sectional mixed methods study was conducted with 300 boda boda drivers between 24 March and 3 April 2014 in urban Moshi, Tanzania. A convenience sample of participants was drawn from 25 of 58 registered boda boda stands and 2 of 31 unregistered stands. Data were analyzed using R, and content thematic analysis was performed and agreed upon by three investigators. Logistic regression models were used to evaluate the association between boda boda characteristics and injury risk. RESULTS In total, 300 drivers participated, of whom 148 (49.3%) had experienced a crash during their lifetime, and 114 (77.0%) sustained at least one injury. Only 27 of those injured (23.4%) were hospitalized. Of all participants, 220 (73.3%) reported consistent helmet usage, despite 285 participants (95.0%) agreeing that helmet usage reduces injury severity. From the 280 helmets observed, 231 (82.5%) were either damaged or fit improperly. Having a cracked helmet was associated with higher risk of being involved in a traffic crash. Owning a helmet with a proper fit was associated with reduced risk for a traffic crash (OR = 0.06) and road traffic injuries (OR = 0.07). A thematic analysis of boda boda drivers' suggestions to increase road safety identified four intervention areas: 1) roadway infrastructure and traffic regulation, 2) road user attitudes and safe driving behaviors, 3) education and training, and 4) law enforcement. CONCLUSION Our study demonstrates boda boda drivers' safety behaviors and identifies four intervention areas that can be leveraged to increase overall road traffic safety. Unfortunately, while boda boda drivers are aware of ways to improve safety, adherence to safety habits remains low. Successful multi-sectoral interventions are needed to improve road safety for boda boda drivers in Tanzania.
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Affiliation(s)
- TuanDat Nguyen
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Duke University, Durham, North Carolina, United States of America
| | | | | | - Michael Haglund
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Duke University, Durham, North Carolina, United States of America
| | - Charles J. Gerardo
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Mark Mvungi
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Duke University, Durham, North Carolina, United States of America
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Meng F, Xu P, Wong SC, Huang H, Li YC. Occupant-level injury severity analyses for taxis in Hong Kong: A Bayesian space-time logistic model. ACCIDENT; ANALYSIS AND PREVENTION 2017; 108:297-307. [PMID: 28938225 DOI: 10.1016/j.aap.2017.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 02/01/2017] [Accepted: 08/07/2017] [Indexed: 06/07/2023]
Abstract
This study aimed to identify the factors affecting the crash-related severity level of injuries in taxis and quantify the associations between these factors and taxi occupant injury severity. Casualties resulting from taxi crashes from 2004 to 2013 in Hong Kong were divided into four categories: taxi drivers, taxi passengers, private car drivers and private car passengers. To avoid any biased interpretation caused by unobserved spatial and temporal effects, a Bayesian hierarchical logistic modeling approach with conditional autoregressive priors was applied, and four different model forms were tested. For taxi drivers and passengers, the model with space-time interaction was proven to most properly address the unobserved heterogeneity effects. The results indicated that time of week, number of vehicles involved, weather, point of impact and driver age were closely associated with taxi drivers' injury severity level in a crash. For taxi passengers' injury severity an additional factor, taxi service area, was influential. To investigate the differences between taxis and other traffic, similar models were established for private car drivers and passengers. The results revealed that although location in the network and driver gender significantly influenced private car drivers' injury severity, they did not influence taxi drivers' injury severity. Compared with taxi passengers, the injury severity of private car passengers was more sensitive to average speed and whether seat belts were worn. Older drivers, urban taxis and fatigued driving were identified as factors that increased taxi occupant injury severity in Hong Kong.
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Affiliation(s)
- Fanyu Meng
- Department of Civil Engineering, The University of Hong Kong, Hong Kong, China.
| | - Pengpeng Xu
- Department of Civil Engineering, The University of Hong Kong, Hong Kong, China.
| | - S C Wong
- Department of Civil Engineering, The University of Hong Kong, Hong Kong, China.
| | - Helai Huang
- School of Traffic and Transportation Engineering, Central South University, Changsha, China.
| | - Y C Li
- Department of Civil Engineering, The University of Hong Kong, Hong Kong, China.
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11
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Reardon JM, Andrade L, Hertz J, Kiwango G, Teu A, Pesambili M, El-Gabri D, Hocker M, Mvungi M, Vissoci JRN, Staton CA. The epidemiology and hotspots of road traffic injuries in Moshi, Tanzania: An observational study. Injury 2017; 48:1363-1370. [PMID: 28529012 PMCID: PMC5545685 DOI: 10.1016/j.injury.2017.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/02/2017] [Indexed: 02/02/2023]
Abstract
Road traffic injuries (RTIs) continue to increase with the proliferation of motor vehicles, especially in low-income countries where safe road infrastructure is lacking. Knowing where and why RTIs occur would allow for increased safety and prevention planning. In this study, police records of 300 motor vehicle collisions which occurred between February 2013 and January 2014 in Moshi, Tanzania were reviewed. Analysis of variables including victim age, gender, type of collision, conditions, and use of safety equipment were analyzed. Geographic information system (GIS) analysis was performed to identify areas with the most collisions. Most injuries occurred at four intersections on two main corridor. Car crashes represented 48% of reports while motorcycle collisions were 35% of reports. Victims were predominantly male. The majority (64%) of RTI victims in cars used seatbelts while only 43% of motorcyclists wore helmets; none of those who used the helmet or seatbelt suffered a grievous injury. These data demonstrate that RTIs in Moshi occur in predictable high traffic locations. RTIs injure victims of all backgrounds and safety equipment is not universally utilized. More investment is needed in improved data collection methods, and a greater emphasis on intersection safety is needed to reduce these preventable injuries.
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Affiliation(s)
- Joseph M Reardon
- Division of Emergency Medicine, Departmento of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Luciano Andrade
- Department of Medicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Julian Hertz
- Division of Emergency Medicine, Departmento of Surgery, Duke University Medical Center, Durham, NC, United States
| | | | - Anneth Teu
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Deena El-Gabri
- Division of Global Neurosurgery and Neuroscience, Department of Neurosurgery, Duke Univertsity School of Medicine, Durham, NC, United States
| | - Michael Hocker
- Division of Emergency Medicine, Departmento of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Mark Mvungi
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - João Ricardo N Vissoci
- Division of Emergency Medicine, Departmento of Surgery, Duke University Medical Center, Durham, NC, United States; Division of Global Neurosurgery and Neuroscience, Department of Neurosurgery, Duke Univertsity School of Medicine, Durham, NC, United States; Duke Global Health Institute, Duke University, Durham, NC, United States.
| | - Catherine A Staton
- Division of Emergency Medicine, Departmento of Surgery, Duke University Medical Center, Durham, NC, United States; Division of Global Neurosurgery and Neuroscience, Department of Neurosurgery, Duke Univertsity School of Medicine, Durham, NC, United States; Duke Global Health Institute, Duke University, Durham, NC, United States
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12
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Banstola A, Mytton J. Cost-effectiveness of interventions to prevent road traffic injuries in low- and middle-income countries: A literature review. TRAFFIC INJURY PREVENTION 2017; 18:357-362. [PMID: 27575954 DOI: 10.1080/15389588.2016.1212165] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/07/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The objective of this study was to identify, critically appraise, summarize, and synthesize evidence from cost-effectiveness analyses (CEAs) of interventions aimed at preventing road traffic injuries (RTIs) in low- and middle-income countries (LMICs) by age group and road users targeted. METHODS A search strategy was applied to 12 electronic databases for studies published between May 2002 and August 2015 that met prespecified inclusion criteria. Additional studies were identified by contacting authors and searching bibliographies. Included studies were critically appraised against published criteria and a narrative synthesis was conducted including a use of the strength of evidence criteria. RESULTS Five studies were included in the final review that reported 9 interventions. Only 2 out of 9 interventions (drink-drive legislation with enforcement via breath testing campaign and combined interventions for reducing RTIs) showed moderate evidence of being cost-effective, whereas the evidence of cost-effectiveness of other interventions was weak. Only 2 interventions (bicycle and motorcycle helmet use legislation and enforcement) were explicitly targeted to children, young people and vulnerable road users such as pedestrians and cyclists. The cost-effectiveness of interventions to prevent RTIs in LMICs ranged from US$4.14 per disability-adjusted life years (DALYs) averted for building speed bumps at the most dangerous junctions that caused 10% of junction deaths in the area studied to US$3,403 per DALYs averted for legislation and enforcement of helmet use by motorcyclists in the World Health Organization (WHO) sub-Saharan Africa region. CONCLUSIONS Evidence of cost-effectiveness of interventions to prevent RTIs in LMICs is limited, particularly for children, young people, and vulnerable road users. Evaluation of the effectiveness and cost-effectiveness of a larger number of possible road safety interventions in a variety of LMIC settings is warranted to generate the evidence base for effective traffic injury prevention programs.
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Affiliation(s)
- Amrit Banstola
- a Faculty of Health and Applied Sciences , The University of the West of England , Bristol , UK
- b Department of Research and Training , Public Health Perspective Nepal , Pokhara , Nepal
| | - Julie Mytton
- a Faculty of Health and Applied Sciences , The University of the West of England , Bristol , UK
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13
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Ndounga Diakou LA, Ntoumi F, Ravaud P, Boutron I. Published randomized trials performed in Sub-Saharan Africa focus on high-burden diseases but are frequently funded and led by high-income countries. J Clin Epidemiol 2017; 82:29-36.e6. [DOI: 10.1016/j.jclinepi.2016.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 10/10/2016] [Accepted: 10/26/2016] [Indexed: 01/05/2023]
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14
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Clelland SJ, Chauhan P, Mandari FN. The epidemiology and management of tibia and fibula fractures at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. Pan Afr Med J 2016; 25:51. [PMID: 28250875 PMCID: PMC5321146 DOI: 10.11604/pamj.2016.25.51.10612] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 09/26/2016] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Tibia/fibula fractures are one of the commonest admissions to the orthopaedic department at a resource-limited Northern Tanzanian hospital. These fractures are associated with poor prognosis and pose a huge socioeconomic burden on developing countries. However, to date there is a paucity of epidemiological data on lower-limb fractures in Tanzania. METHODS A retrospective review of admissions to the orthopaedic department at Kilimanjaro Christian Medical Centre (KCMC) was completed between February 2015 and 2016. Inpatient record books were used to source epidemiological data which was subsequently analysed. RESULTS 199 of the 1016 patients admitted sustained tibia/fibula fractures. 78% (n=156) of admissions were male and the most frequently affected age group was 21-30 years. Motor traffic accidents (MTAs) were the most common cause and accounted for 78% of fractures, with nearly half of these involving motorbikes (42%). Falls were identified as the second most common cause (13%). It was determined that 72% (n=143) of fractures were open, 19% (n=38) were comminuted and the most common site of injury was the distal-third of tibia/fibula. The most frequently recorded treatments were surgical toilet/debridement (66% of patients) and the application of a backslab (34% of patients). CONCLUSION Males in the 21-30 age group, who were involved in MTAs, were most commonly affected by tibia/fibula fractures. Given that MTA incidence is increasing in Tanzania, there is a growing public health concern that this will be reflected by a step-increase in the number of people who sustain lower-limb fractures.
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Affiliation(s)
- Samuel John Clelland
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Priyesh Chauhan
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
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15
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Staton C, Vissoci J, Gong E, Toomey N, Wafula R, Abdelgadir J, Zhou Y, Liu C, Pei F, Zick B, Ratliff CD, Rotich C, Jadue N, de Andrade L, von Isenburg M, Hocker M. Road Traffic Injury Prevention Initiatives: A Systematic Review and Metasummary of Effectiveness in Low and Middle Income Countries. PLoS One 2016; 11:e0144971. [PMID: 26735918 PMCID: PMC4703343 DOI: 10.1371/journal.pone.0144971] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/25/2015] [Indexed: 11/19/2022] Open
Abstract
Background Road traffic injuries (RTIs) are a growing but neglected global health crisis, requiring effective prevention to promote sustainable safety. Low- and middle-income countries (LMICs) share a disproportionately high burden with 90% of the world’s road traffic deaths, and where RTIs are escalating due to rapid urbanization and motorization. Although several studies have assessed the effectiveness of a specific intervention, no systematic reviews have been conducted summarizing the effectiveness of RTI prevention initiatives specifically performed in LMIC settings; this study will help fill this gap. Methods In accordance with PRISMA guidelines we searched the electronic databases MEDLINE, EMBASE, Scopus, Web of Science, TRID, Lilacs, Scielo and Global Health. Articles were eligible if they considered RTI prevention in LMICs by evaluating a prevention-related intervention with outcome measures of crash, RTI, or death. In addition, a reference and citation analysis was conducted as well as a data quality assessment. A qualitative metasummary approach was used for data analysis and effect sizes were calculated to quantify the magnitude of emerging themes. Results Of the 8560 articles from the literature search, 18 articles from 11 LMICs fit the eligibility and inclusion criteria. Of these studies, four were from Sub-Saharan Africa, ten from Latin America and the Caribbean, one from the Middle East, and three from Asia. Half of the studies focused specifically on legislation, while the others focused on speed control measures, educational interventions, enforcement, road improvement, community programs, or a multifaceted intervention. Conclusion Legislation was the most common intervention evaluated with the best outcomes when combined with strong enforcement initiatives or as part of a multifaceted approach. Because speed control is crucial to crash and injury prevention, road improvement interventions in LMIC settings should carefully consider how the impact of improvements will affect speed and traffic flow. Further road traffic injury prevention interventions should be performed in LMICs with patient-centered outcomes in order to guide injury prevention in these complex settings.
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Affiliation(s)
- Catherine Staton
- Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Joao Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Enying Gong
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Nicole Toomey
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Rebeccah Wafula
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Jihad Abdelgadir
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Yi Zhou
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Chen Liu
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Fengdi Pei
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Brittany Zick
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Camille D. Ratliff
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Claire Rotich
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Nicole Jadue
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Luciano de Andrade
- Department of Nursing, State University of the West of Parana, Foz do Iguaçu, Parana, Brazil
| | - Megan von Isenburg
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Michael Hocker
- Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
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16
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Staton CA, Msilanga D, Kiwango G, Vissoci JR, de Andrade L, Lester R, Hocker M, Gerardo CJ, Mvungi M. A prospective registry evaluating the epidemiology and clinical care of traumatic brain injury patients presenting to a regional referral hospital in Moshi, Tanzania: challenges and the way forward. Int J Inj Contr Saf Promot 2015; 24:69-77. [DOI: 10.1080/17457300.2015.1061562] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Catherine A. Staton
- Duke Division of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | | | | | | | - Rebecca Lester
- London School of Tropical Medicine and Hygiene, London, United Kingdom
| | - Michael Hocker
- Duke Division of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Charles J Gerardo
- Duke Division of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Mark Mvungi
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
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17
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Safe definitive orthopaedic surgery (SDS): repeated assessment for tapered application of Early Definitive Care and Damage Control?: an inclusive view of recent advances in polytrauma management. Injury 2015; 46:1-3. [PMID: 25540874 DOI: 10.1016/j.injury.2014.12.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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