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Byun DH, Chang RS, Park MB, Son HR, Kim CB. Prioritizing Community-Based Intervention Programs for Improving Treatment Compliance of Patients with Chronic Diseases: Applying an Analytic Hierarchy Process. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020455. [PMID: 33430108 PMCID: PMC7827405 DOI: 10.3390/ijerph18020455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/26/2020] [Accepted: 01/04/2021] [Indexed: 12/22/2022]
Abstract
The purpose of this study was to apply multicriteria decision making and an analytic hierarchy process (AHP) model for assessing sustainable management of hypertension and diabetes. Perception of two alternative health care priorities was also investigated. One priority was improving treatment compliance of patients with hypertension and diabetes. The other priority was strengthening the healthcare system for continuous care. Our study design to evaluate community-based intervention programs for hypertension and diabetes was developed using brainstorming, Delphi techniques, and content analysis along with literature review. We finally proposed a hierarchical structure of the AHP model with 50 third sub-criteria in six levels. By surveying this AHP questionnaire to a total of 185 community health practitioners in Korea, we found that improving treatment compliance of patients with chronic diseases should be relatively more important than strengthening the healthcare system. Further research is needed to expand survey subjects to primary care physicians and even policymakers of central government for the appropriate application of this AHP model.
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Affiliation(s)
- Do Hwa Byun
- Korean Association for AIDS Prevention, Gangwon Branch, Chuncheon 24405, Korea;
| | - Rho Soon Chang
- Department of Public Administration, Kangwon National University, Chuncheon 24341, Korea;
| | - Myung-Bae Park
- Department of Gerontology Health and Welfare, Pai Chai University, Daejeon 35345, Korea;
| | - Hyo-Rim Son
- Hongcheon County Hypertension and Diabetes Registration and Education Center, Hongcheon 25135, Korea;
| | - Chun-Bae Kim
- Hongcheon County Hypertension and Diabetes Registration and Education Center, Hongcheon 25135, Korea;
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
- Correspondence: ; Tel.: +82-(0)33-741-0344; Fax: +82-(0)33-747-0409
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Correia JC, Lachat S, Lagger G, Chappuis F, Golay A, Beran D. Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries:a scoping review. BMC Public Health 2019; 19:1542. [PMID: 31752801 PMCID: PMC6873661 DOI: 10.1186/s12889-019-7842-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/24/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs. METHODS Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results. RESULTS 198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%). CONCLUSION Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.
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Affiliation(s)
- Jorge César Correia
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Sarah Lachat
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Grégoire Lagger
- Division of Therapeutic Patient Education for Chronic Diseases. Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Alain Golay
- Division of Therapeutic Patient Education for Chronic Diseases. Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
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Sun X, Meng H, Ye Z, Conner KO, Duan Z, Liu D. Factors associated with the choice of primary care facilities for initial treatment among rural and urban residents in Southwestern China. PLoS One 2019; 14:e0211984. [PMID: 30730967 PMCID: PMC6366770 DOI: 10.1371/journal.pone.0211984] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/23/2019] [Indexed: 01/04/2023] Open
Abstract
Objective To explore influential factors contributing to the choice of primary care facilities (PCFs) for the initial treatment among rural and urban residents in Southwestern China. Methods A face-to-face survey was conducted on a multistage stratified random sample of 456 rural and 459 urban residents in Sichuan Province from January to August in 2014. A structured questionnaire was used to collect data on residents’ characteristics, provider of initial treatment and principal reason for the choice. Multivariate logistic regression was performed to identify factors associated with choosing PCFs for the initial treatment. Results The result showed that 65.4% of the rural residents and 50.5% of the urban residents chose PCFs as their initial contact for medical care. Among both rural and urban residents, the principal reason for choosing medical institutions for the initial treatment was convenience (42.3% versus 40.5%, respectively), followed by high quality of medical care (26.5% versus 29.4%, respectively). Compared to rural residents, urban residents were more likely to value trust in doctors and high quality of medical care but were less likely to value the insurance designation status of the facilities. Logistic regression analysis showed that both rural and urban residents were less likely to choose PCFs for the initial treatment if they lived more than 15 minutes (by walk) from the nearest facilities (rural: OR = 0.15, 95%CI = 0.09–0.26; urban: OR = 0.19, 95%CI = 0.10–0.36), had fair (rural: OR = 0.49, 95%CI = 0.26–0.92; urban: OR = 0.31, 95%CI = 0.15–0.64) or poor (rural: OR = 0.14, 95%CI = 0.07–0.30; urban: OR = 0.22, 95%CI = 0.11–0.44) self-reported health status. Among rural residents, attending college or higher education (OR = 0.21, 95%CI = 0.08–0.59), being retired (OR = 0.90, 95%CI = 0.44–1.84) and earning a per capita annual income of household of 10,000–29,999 (OR = 0.24, 95%CI = 0.11–0.52) and 30,000–49,999 (OR = 0.26, 95%CI = 0.07–0.92) were associated with lower rates of seeking care at PCFs. Conclusion Efforts should be made to improve the accessibility of PCFs and to upgrade the services capability of PCFs both in rural and urban areas in China. At the same time, resources should be prioritized to residents with poorer self-reported health status, and rural residents who retire or have better education and higher income levels should be taken into account.
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Affiliation(s)
- Xiaxia Sun
- Department of Health and Social Behavior, School of Public Health, Sichuan University, Chengdu, China
| | - Hongdao Meng
- School of Aging Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, United States of America
| | - Zhiqiu Ye
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Kyaien O. Conner
- Department of Mental Health Law & Policy, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, United States of America
| | - Zhanqi Duan
- Health and Family Planning Information Centre of Sichuan Province, Chengdu, China
| | - Danping Liu
- Department of Health and Social Behavior, School of Public Health, Sichuan University, Chengdu, China
- * E-mail:
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Zou G, Wei X. A qualitative study of two management models of community health centres in two Chinese megacities. Glob Public Health 2017; 13:1612-1624. [PMID: 29182049 DOI: 10.1080/17441692.2017.1407812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Two common public models of community health centres (CHCs) exist in China, i.e. the 'government-owned and government-managed' CHCs (G-CHCs) and the 'government-owned and hospital-managed' CHCs (H-CHCs). Shanghai and Shenzhen are two Chinese megacities that lead the primary care development on the G-CHC and H-CHC models, respectively. Using a qualitative case study design, this study compares the management of the G-CHC model in Shanghai and H-CHC model in Shenzhen, through perspectives of a range of health providers. In each city, we randomly selected four CHCs and in total conducted 31 interviews with officers from the municipal health authorities, directors, GPs, nurses and public health doctors of the CHCs. When comparing with the H-CHC model in Shenzhen, the G-CHC model in Shanghai, a model with more simplified but accountable structure tended to present better management conditions, in terms of financial transparency, recruitment autonomy, community health workforce development (CHC staffing and family medicine training), funding and priority for public health. However, regardless of the models, staff retention remained a challenge. While our study tends to suggest that the G-CHC model in Shanghai presents better management conditions, future study can test whether and to what extent the model itself can lead to such differences.
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Affiliation(s)
- Guanyang Zou
- a 21st Century Silk Road Research Institute , Jinan University , Guangzhou , People's Republic of China
| | - Xiaolin Wei
- b Division of Clinical Public Health & Institute of Health Policy, Management and Evaluation , Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada
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Liu D, Meng H, Dobbs D, Conner KO, Hyer K, Li N, Ren X, Gao B. Cross-sectional study of factors associated with community health centre use in a recently urbanised community in Chengdu, China. BMJ Open 2017; 7:e014510. [PMID: 28600364 PMCID: PMC5541612 DOI: 10.1136/bmjopen-2016-014510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Public investment in community health centres (CHCs) has been increasing as a response to rapid urbanisation in China. The objectives of this study were: (1) to examine factors associated with CHC use among residents from a recently urbanised community in western China and (2) to describe satisfaction with CHC among users. DESIGN Cross-sectional design. SETTING A community recently converted to urban status with a newly constructed CHC in Southwest China. PARTICIPANTS A random sample of 2259 adults in the Hezuo community in Chengdu, China, completed the survey in 2013. OUTCOME MEASURES Trained staff interviewed study participants in their homes using structured questionnaires. The survey included questions regarding sociodemographics, health status, access to and usage of healthcare, health behaviours and CHC use. The Andersen's behavioural model of health service use was used to guide multivariable logistic regression modelling in identifying predisposing, enabling and need factors associated with the likelihood of using CHC. Descriptive statistics were used to describe residents' satisfaction with the CHC. RESULTS A total of 71.8% of the respondents reported using the CHC during the past year. Factors influencing adults' CHC use included: gender, marital status, education level and knowledge of one's blood pressure (predisposing factors); annual household per capita income and walking time to the CHC (enabling factors) and self-rated health as well as physical activities (need factors). CHC users reported modest satisfaction across various aspects of the CHC. CONCLUSIONS Neighbourhood CHC in urban areas provides important services to these residents living in a recently urbanised community. All three categories of factors in the Andersen model help explain the likelihood of CHC use. There is much room for improvement in CHC to enhance customer satisfaction. Future research is needed to improve access to CHCs and promote their use in urbanised populations with low to modest education.
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Affiliation(s)
- Danping Liu
- Department of Health and Social Behavior, School of Public Health, Sichuan University, Chengdu, China
| | - Hongdao Meng
- School of Aging Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Debra Dobbs
- School of Aging Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Kyaien O Conner
- Department of Mental Health Law & Policy, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Kathryn Hyer
- School of Aging Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Ningxiu Li
- Department of Health and Social Behavior, School of Public Health, Sichuan University, Chengdu, China
| | - Xiaohui Ren
- Department of Health and Social Behavior, School of Public Health, Sichuan University, Chengdu, China
| | - Bo Gao
- Department of Health and Social Behavior, School of Public Health, Sichuan University, Chengdu, China
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Schmidt K, Aumann I, Hollander I, Damm K, von der Schulenburg JMG. Applying the Analytic Hierarchy Process in healthcare research: A systematic literature review and evaluation of reporting. BMC Med Inform Decis Mak 2015; 15:112. [PMID: 26703458 PMCID: PMC4690361 DOI: 10.1186/s12911-015-0234-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 12/15/2015] [Indexed: 01/12/2023] Open
Abstract
Background The Analytic Hierarchy Process (AHP), developed by Saaty in the late 1970s, is one of the methods for multi-criteria decision making. The AHP disaggregates a complex decision problem into different hierarchical levels. The weight for each criterion and alternative are judged in pairwise comparisons and priorities are calculated by the Eigenvector method. The slowly increasing application of the AHP was the motivation for this study to explore the current state of its methodology in the healthcare context. Methods A systematic literature review was conducted by searching the Pubmed and Web of Science databases for articles with the following keywords in their titles or abstracts: “Analytic Hierarchy Process,” “Analytical Hierarchy Process,” “multi-criteria decision analysis,” “multiple criteria decision,” “stated preference,” and “pairwise comparison.” In addition, we developed reporting criteria to indicate whether the authors reported important aspects and evaluated the resulting studies’ reporting. Results The systematic review resulted in 121 articles. The number of studies applying AHP has increased since 2005. Most studies were from Asia (almost 30 %), followed by the US (25.6 %). On average, the studies used 19.64 criteria throughout their hierarchical levels. Furthermore, we restricted a detailed analysis to those articles published within the last 5 years (n = 69). The mean of participants in these studies were 109, whereas we identified major differences in how the surveys were conducted. The evaluation of reporting showed that the mean of reported elements was about 6.75 out of 10. Thus, 12 out of 69 studies reported less than half of the criteria. Conclusion The AHP has been applied inconsistently in healthcare research. A minority of studies described all the relevant aspects. Thus, the statements in this review may be biased, as they are restricted to the information available in the papers. Hence, further research is required to discover who should be interviewed and how, how inconsistent answers should be dealt with, and how the outcome and stability of the results should be presented. In addition, we need new insights to determine which target group can best handle the challenges of the AHP.
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Affiliation(s)
- Katharina Schmidt
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hanover, Otto-Brenner-Str. 1, 30159, Hannover, Germany.
| | - Ines Aumann
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hanover, Otto-Brenner-Str. 1, 30159, Hannover, Germany.
| | - Ines Hollander
- Institute for Risk and Insurance, Leibniz University of Hanover, Otto-Brenner-Str. 1, 30159, Hannover, Germany.
| | - Kathrin Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University of Hanover, Otto-Brenner-Str. 1, 30159, Hannover, Germany.
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Zhang P, Zhao L, Liang J, Qiao Y, He Q, Zhang L, Wang F, Liang Y. Societal determination of usefulness and utilization wishes of community health services: a population-based survey in Wuhan city, China. Health Policy Plan 2014; 30:1243-50. [PMID: 25492032 PMCID: PMC4625757 DOI: 10.1093/heapol/czu128] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 12/02/2022] Open
Abstract
Background As a developing country with the world’s largest population in a state of economic transition, reforms to China’s health system, including community health services (CHS), are very complex and difficult. The aim of this study is to provide evidence and policy recommendations for the sustainable development of CHS for China, which could also be applicable to other developing countries. Methods A cross-sectional survey was conducted door-to-door and face-to-face in Wuhan city, central China with a sample of 1134 individuals aged 15 and older. The independent variables were duration of residence, previous treatment experience, familiarity with health staff, self-reported family economic status and health insurance. The dependent variables were views on the usefulness of CHS and willingness to use them. Sociodemographic variables and health status were used as control variables. Multiple logistic regression analysis was used to analyse the influence of the independent variables on the dependent variables. Findings This study shows that 26.10% of participants reported that the CHSs are not useful and 37.74% reported they did not want to use their CHS. The results found ‘familiarity with health staff’ and ‘previous experience of using services’ had a negative influence on their views on usefulness of and willingness to use CHS. Conclusion The aim of CHS to see ‘minor illnesses treated in the community and serious illness treated in hospital’ is not being fully realized. The key to increasing the use of CHS may be to enhance the quality of services and health staff. A policy pathway of targeting older residents and those with higher education levels as the priority population, and using these groups to encourage the rest of the community to seek minor services at CHS, may be an effective and sustainable development mechanism.
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Affiliation(s)
- Peipei Zhang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Lianyi Zhao
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jing Liang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yan Qiao
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Quanyan He
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Liuyi Zhang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Fang Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yuan Liang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Mühlbacher AC, Kaczynski A. Der Analytic Hierarchy Process (AHP): Eine Methode zur Entscheidungsunterstützung im Gesundheitswesen. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s40275-014-0011-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Community health nursing in China: status, challenges, and development strategies. Nurs Outlook 2012; 60:221-7. [PMID: 22512991 DOI: 10.1016/j.outlook.2012.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 02/06/2012] [Accepted: 03/10/2012] [Indexed: 02/05/2023]
Abstract
The article describes the origins and current state of development of community health nursing (CHN) in China, as well as several factors that have shaped its development. CHN began in China in 1997, and the quantity of services has increased greatly in recent years. However, most community nurses report that they merely duplicate the jobs of hospital nurses. Thus, CHN has not developed to its full potential, and the main causes can be attributed to inadequate management and a lack of personnel, funding, and public confidence. Although the Chinese government has implemented several policies to promote its development, Chinese CHN is still in its infancy and many difficulties must be overcome before it can meet the demands of social development.
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Mackie P, Sim F. Growth at any cost? Public Health 2010; 124:183-4. [DOI: 10.1016/j.puhe.2010.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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