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Kovalak EE, Özyürek EŞ, Karabay Akgül Ö, Karacan T. Hormonal changes in consecutive clomiphene citrate stimulation cycles and their effect on pregnancy rates. Turk J Obstet Gynecol 2022; 19:221-228. [PMID: 36149263 PMCID: PMC9511931 DOI: 10.4274/tjod.galenos.2022.40607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To determine the relationship between the cumulative effect of sequential clomiphene citrate (CC) treatments in unexplained infertile women with intercycle and intracycle serum hormone changes. Materials and Methods: Patients who received CC 50 mg in the first cycle (group I, n=34) as ovulation induction and those who received CC 50 mg in the second consecutive cycle (group II, n=18) were compared. Basal (cycle days 2-5) and trigger day (the day that recombinant human chorionic gonadotropin is given) levels of gonadotropin and steroid hormones were measured. Results: The 17OHP increase on trigger day was found to be statistically significantly higher in group II compared to the basal day (p=0.083). The testosterone (T) response on the trigger day of the patients in group II was found to be statistically significantly higher than that in group I (p=0.023). The number of selected follicles was negatively correlated with a follicle-stimulating hormone decrease and positively correlated with an estradiol increase. Endometrial thickness was positively correlated with a luteinizing hormone increase, and cycle cancelation was positively correlated with decreased estradiol. Conclusion: Based on this study, it was concluded that the reason for the increased efficiency rate in successive cycles of CC may be the cumulative increase in T and 17OHP levels. However, this result was found not to affect the clinical pregnancy rate.
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Lakhno I. The Insight into Obstetric Care near the Front Line in Kharkiv. Acta Med Litu 2022; 29:236-244. [PMID: 37733431 PMCID: PMC9799006 DOI: 10.15388/amed.2022.29.2.10] [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: 07/15/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives The invasion of Russian troops into independent Ukraine has changed the humanitarian situation in the Kharkiv region. The paper is focused on the peculiarities and issues of the management of labor and delivery near the front line. Materials and methods Totally 2030 patients were enrolled in the study. 1410 women who delivered in the second half of 2021 were enrolled in Group I. 620 women who delivered in the first half of 2022 were observed in Group II. Some patients from Group II were used for the investigation of the comparative situation during first months of 2022. 85 women who delivered in January were included in Subgroup IIA. 94 women who have completed their pregnancies and delivered in February were observed in Subgroup IIB. 67 case histories of deliveries which occurred during March were united in Subgroup IIC. Results The level of anemia, uterine contractile activity in labor abnormalities, and episiotomies were surprisingly lower during wartime in March. The obtained results showed an almost similar level of obstetric complications, maternal comorbidities, and interventions during labor and delivery in all groups. The stressed environment was a possible reason for the elevation of cardiovascular disease and endocrine disorders. Conclusion The study did not reveal any significant changes in the structure of maternal pathologies and obstetric complications during the first months of wartime near the front line. But later the levels of cardiovascular disease and endocrine disorders were found to be elevated.
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Affiliation(s)
- Igor Lakhno
- Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
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García-Tizón Larroca S, Amor Valera F, Ayuso Herrera E, Cueto Hernandez I, Cuñarro Lopez Y, De Leon-Luis J. Human Development Index of the maternal country of origin and its relationship with maternal near miss: A systematic review of the literature. BMC Pregnancy Childbirth 2020; 20:224. [PMID: 32299375 PMCID: PMC7164222 DOI: 10.1186/s12884-020-02901-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 03/27/2020] [Indexed: 01/09/2023] Open
Abstract
Background The reduction in maternal mortality worldwide has increased the interest in studying more frequent severe events such as maternal near miss. The Human Development Index is a sociodemographic country-specific variable that includes key human development indicators such as living a long and healthy life, acquiring knowledge, and enjoying a decent standard of living, allowing differentiation between countries. In a globalised environment, it is necessary to study whether the Human Development Index of each patient's country of origin can be associated with the maternal near-miss rate and thus classify the risk of maternal morbidity and mortality. Methods A systematic review of the literature published between 2008 and 2019 was conducted, including all articles that reported data about maternal near miss in their sample of pregnant women, in addition to describing the study countries of their sample population. The Human Development Index of the study country, the maternal near-miss rate, the maternal mortality rate, and other maternal-perinatal variables related to morbidity and mortality were used. Results After the systematic review, eighty two articles from over thirty countries were included, for a total of 3,699,697 live births, 37,191 near miss cases, and 4029 mortality cases. A statistically significant (p <0.05) inversely proportional relationship was observed between the Human Development Index of the study country and the maternal near-miss and mortality rates. The most common cause of maternal near miss was haemorrhage, with an overall rate of 38.5%, followed by hypertensive disorders of pregnancy (34.2%), sepsis (7.5%), and other undefined causes (20.9%). Conclusions The Human Development Index of the maternal country of origin is a sociodemographic variable allowing differentiation and classification of the risk of maternal mortality and near miss in pregnant women. The most common cause of maternal near miss published in the literature was haemorrhage. Trial registration PROSPERO ID: CRD 42019133464
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Affiliation(s)
- Santiago García-Tizón Larroca
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain.
| | - Francisco Amor Valera
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Esther Ayuso Herrera
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Ignacio Cueto Hernandez
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Yolanda Cuñarro Lopez
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Juan De Leon-Luis
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain.,Department of Public and Maternal-Infant Health, Complutense University, Madrid, Spain
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Adanikin AI, Umeora O, Nzeribe E, Agbata AT, Ezeama C, Ezugwu FO, Ugwu GO, Ikechebelu JI, Oladapo OT. Maternal near-miss and death associated with abortive pregnancy outcome: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey. BJOG 2019; 126 Suppl 3:33-40. [PMID: 31050874 DOI: 10.1111/1471-0528.15699] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the prevalence of life-threatening complications related to pregnancies with abortive outcome and the associated health service events and performance in Nigerian public tertiary hospitals. DESIGN Secondary analysis of a nationwide cross-sectional study. SETTING Forty-two tertiary hospitals. POPULATION Women admitted for pregnancy-related complications. METHODS All cases of severe maternal outcomes (SMO: maternal near-miss or death) due to abortive pregnancy complications (defined as spontaneous or induced abortion, and ectopic pregnancy) were prospectively identified over 1 year using uniform identification criteria. MAIN OUTCOME MEASURES Prevalence of SMO, mortality index (% maternal death/SMO), case fatality rate, time until death after admission, and health service performance. RESULTS Of 5779 women admitted with abortive pregnancy complications, 444 (7.9%) experienced an SMO: 366 maternal near-misses and 78 maternal deaths. Intra-hospital maternal mortality ratio from complicated abortive pregnancy outcome was 85/100 000 live births. Case fatality rate was worst for abortion-related infections (19.1%). A quarter of maternal deaths occurred on the same day of admission; however, the peak time of occurrence of death was 3-7 days of admission. Women experiencing cardiovascular, renal or coagulation organ dysfunction were less likely to survive. Higher level of maternal education and closer residence to a health facility improved chance of maternal survival. CONCLUSIONS Abortive outcome remains a major contributor to SMO in Nigeria. Although early hospital presentation by women is critical to surviving abortive pregnancy complications, improved, appropriate, and timely management is essential to enhance maternal survival. TWEETABLE ABSTRACT 78 maternal deaths and 366 near-misses occurred from abortions and ectopic pregnancies in 42 Nigerian referral hospitals in 1 year.
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Affiliation(s)
- A I Adanikin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ouj Umeora
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria
| | - E Nzeribe
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Owerri, Nigeria
| | - A T Agbata
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria
| | - C Ezeama
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - F O Ezugwu
- Department of Obstetrics and Gynaecology, Enugu State University Teaching Hospital, Enugu, Nigeria
| | - G O Ugwu
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku Ozalla, Nigeria
| | - J I Ikechebelu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - O T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Mortensen B, Lieng M, Diep LM, Lukasse M, Atieh K, Fosse E. Improving Maternal and Neonatal Health by a Midwife-led Continuity Model of Care - An Observational Study in One Governmental Hospital in Palestine. EClinicalMedicine 2019; 10:84-91. [PMID: 31193799 PMCID: PMC6543174 DOI: 10.1016/j.eclinm.2019.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND From 2013 a midwife-led continuity model of care was implemented in the Nablus region in occupied Palestine, involving a governmental hospital and ten rural villages. This study analysed the relation between the midwife-led model and maternal and neonatal health outcomes. METHOD A register-based, retrospective cohort design was used, involving 2201 singleton births between January 2016 and June 2017 at Nablus governmental hospital. Data from rural women, with singleton pregnancies and mixed risk status, who either lived in villages that offered the midwife-led continuity model and had registered at the governmental clinic, or who lived in villages without the midwife-led model and received regular care, were compared. Primary outcome was unplanned caesarean section. Secondary outcomes were other modes of birth, postpartum anaemia, preterm birth, birth weight, and admission to neonatal intensive care unit. FINDINGS Statistically significant less women receiving the midwife-led model had unplanned caesarean sections, 12·8% vs 15·9%, adjusted risk ratio (aRR) 0·80 (95% CI 0·64-0·99) and postpartum anaemia,19·8% vs 28·6%, aRR 0·72 (0·60-0·85). There was also a statistically significant lower rate of preterm births within the exposed group, 13·1% vs 16·8, aRR 0·79 (0·63-0·98), admission to neonatal intensive care unit, 7·0% vs 9·9%, aRR 0·71 (0·52-0·98) and newborn with birth weight 1500 g and less, 0·1% vs 1·1%, aRR 0·13 (0·02-0·97). INTERPRETATION Receiving the midwife-led continuity model of care in Palestine was associated with several improved maternal and neonatal health outcomes. The findings support further implementation of the model. Implementation research, including randomised studies, would be useful to further investigate the effect and feasibility of the model in a low resource setting. FUNDING This study was partly funded by the Research Council of Norway through the Global Health and Vaccination Program (GLOBVAC), project number 243706. The implementation received public funding through Norwegian Aid Committee (NORWAC).
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Affiliation(s)
- Berit Mortensen
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, The Intervention Centre, Sognsvannsveien 20, 0372 Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Corresponding author at: Oslo University Hospital, Rikshospitalet, The Intervention Centre, Sognsvannsveien 20, 0372 Oslo, Norway.
| | - Marit Lieng
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Lien My Diep
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Mirjam Lukasse
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Faculty of Health and Social Sciences, University of Southeast Norway, Oslo, Norway
| | - Kefaya Atieh
- Palestinian Ministry of Health, Nablus, Palestine
| | - Erik Fosse
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, The Intervention Centre, Sognsvannsveien 20, 0372 Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Mortensen B, Lukasse M, Diep LM, Lieng M, Abu-Awad A, Suleiman M, Fosse E. Can a midwife-led continuity model improve maternal services in a low-resource setting? A non-randomised cluster intervention study in Palestine. BMJ Open 2018; 8:e019568. [PMID: 29567846 PMCID: PMC5875636 DOI: 10.1136/bmjopen-2017-019568] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To improve maternal health services in rural areas, the Palestinian Ministry of Health launched a midwife-led continuity model in the West Bank in 2013. Midwives were deployed weekly from governmental hospitals to provide antenatal and postnatal care in rural clinics. We studied the intervention's impact on use and quality indicators of maternal services after 2 years' experience. DESIGN A non-randomised intervention design was chosen. The study was based on registry data only available at cluster level, 2 years before (2011and2012) and 2 years after (2014and2015) the intervention. SETTING All 53 primary healthcare clinics in Nablus and Jericho regions were stratified for inclusion. PRIMARY AND SECONDARY OUTCOMES Primary outcome was number of antenatal visits. Important secondary outcomes were number of referrals to specialist care and number of postnatal home visits. Differences in changes within the two groups before and after the intervention were compared by using mixed effect models. RESULTS 14 intervention clinics and 25 control clinics were included. Number of antenatal visits increased by 1.16 per woman in the intervention clinics, while declined by 0.39 in the control clinics, giving a statistically significant difference in change of 1.55 visits (95% CI 0.90 to 2.21). A statistically significant difference in number of referrals was observed between the groups, giving a ratio of rate ratios of 3.65 (2.78-4.78) as number of referrals increased by a rate ratio of 3.87 in the intervention group, while in the control the rate ratio was only 1.06.Home visits increased substantially in the intervention group but decreased in the control group, giving a ratio of RR 97.65 (45.20 - 210.96) CONCLUSION: The Palestinian midwife-led continuity model improved use and some quality indicators of maternal services. More research should be done to investigate if the model influenced individual health outcomes and satisfaction with care. TRIAL REGISTRATION NUMBER NCT03145571; Results.
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Affiliation(s)
- Berit Mortensen
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mirjam Lukasse
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Faculty of Health and Social Sciences, University College of Southeast Norway, Oslo, Norway
| | - Lien My Diep
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Marit Lieng
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Amal Abu-Awad
- Department of Education in Health, Palestinian Ministry of Health, Nablus, Palestine
| | - Munjid Suleiman
- Department of Statistics, Palestinian Ministry of Education and Higher Education, Ramallah, Palestine
| | - Erik Fosse
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Shahawy S, Diamond MB. Perspectives on induced abortion among Palestinian women: religion, culture and access in the occupied Palestinian territories. CULTURE, HEALTH & SEXUALITY 2018; 20:289-305. [PMID: 28720025 DOI: 10.1080/13691058.2017.1344301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Induced abortion is an important public health issue in the occupied Palestinian territories (OPT), where it is illegal in most cases. This study was designed to elicit the views of Palestinian women on induced abortion given the unique religious, ethical and social challenges in the OPT. Sixty Palestinian women were interviewed on their perceptions of the religious implications, social consequences and accessibility of induced abortions in the OPT at Al-Makassed Islamic Charitable Hospital in East Jerusalem. Themes arising from the interviews included: the centrality of religion in affecting women's choices and views on abortion; the importance of community norms in regulating perspectives on elective abortion; and the impact of the unique medico-legal situation of the OPT on access to abortion under occupation. Limitations to safe abortion access included: legal restrictions; significant social consequences from the discovery of an abortion by one's community or family; and different levels of access to abortion depending on whether a woman lived in East Jerusalem, the West Bank, or Gaza. This knowledge should be incorporated to work towards a legal and medical framework in Palestine that would allow for safe abortions for women in need.
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Affiliation(s)
| | - Megan B Diamond
- b T.H. Chan School of Public Health , Harvard University , Boston , MA , USA
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Hassan S, Vikanes A, Laine K, Zimmo K, Zimmo M, Bjertness E, Fosse E. Building a research registry for studying birth complications and outcomes in six Palestinian governmental hospitals. BMC Pregnancy Childbirth 2017; 17:112. [PMID: 28399841 PMCID: PMC5387267 DOI: 10.1186/s12884-017-1296-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 03/28/2017] [Indexed: 12/16/2022] Open
Abstract
Background Electronic-health (e-health) provides opportunities for quality improvement of healthcare, but implementation in low and middle income countries is still limited. Our aim was to describe the implementation of a registration (case record form; CRF) for obstetric interventions and childbirth events using e-health in a prospective birth cohort study in Palestine. We also report the completeness and the reliability of the data. Methods Data on maternal and fetal health was collected prospectively for all women admitted to give birth during the period from 1st March 2015 to 31st December 2015 in three governmental hospitals in Gaza and three in the West Bank. Essential indicators were noted in a case registration form (CRF) and subsequently entered into the District Health Information Software 2 (DHIS 2) system. Completeness of registered cases was checked against the monthly hospital birth registries. Reliability (correct information) of DHIS2 registration and entry were checked for 22 selected variables, collected during the first 10 months. In the West Bank, a comparison between our data registration and entry and data obtained from the Ministry of Health patient electronic records was conducted in the three hospitals. Results According to the hospital birth registries, a total of 34,482 births occurred in the six hospitals during the study period. Data on the mothers and children registered on CRF was almost complete in two hospitals (100% and 99.9%); in the other hospitals the completeness ranged from 72.1% to 98.7%. Eighty birth events were audited for 22 variables in the three hospitals in the West Bank. Out of 1760 registrations in each hospital, the rates of correct data registration ranged from 81% to 93.2% and data entry ranged from 84.5% to 93.1%. Conclusions The registered and entered data on birth events in six hospitals was almost complete in five out of six hospitals. The collected data is considered reliable for research purposes. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1296-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sahar Hassan
- Faculty of Nursing, Pharmacy and Health Professions and Institute of Community and Public Health, Birzeit University, Ramallah, State of Palestine.
| | - Ase Vikanes
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Katariina Laine
- Department of Obstetrics, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Khaled Zimmo
- The Intervention Centre, Oslo University Hospital, Oslo, Norway.,Department of Obstetrics and Gynecology, Al Aqsa Hospital, Gaza, State of Palestine
| | - Mohammad Zimmo
- The Intervention Centre, Oslo University Hospital, Oslo, Norway.,Department of Obstetrics and Gynecology, Shifa Hospitals, Gaza, State of Palestine
| | - Espen Bjertness
- Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Erik Fosse
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
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