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Kamyab A, Gholami T, Behdad K, Jeihooni AK. An application of a series of theory-based educational intervention based on the health belief model on skin cancer prevention behaviors in female high school students. Heliyon 2023; 9:e17209. [PMID: 37441393 PMCID: PMC10333432 DOI: 10.1016/j.heliyon.2023.e17209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 05/29/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Abstract
Background Cancer is a leading cause of death globally and the second cause of death in developed countries. Having a rising incidence, skin cancer is the most prevalent cancer in Iran. Long-term UV radiations, particularly during childhood and adolescence, is a major cause of skin cancers. The Theory of Planned Behavior as the most precise indicator of behavior, contains motivational factors affecting behavior. This theory has been successful in predicting factors related to chronic diseases, especially cancer. As this model was successful in assessing sun-protective behaviors in previous studies, this study was designed to figure out how a theory-based educational intervention can affect the skin cancer prevention practices of Iranian female high school students. Methods This experimental investigation was carried out 2019-2020 using multistage cluster sampling method on 400 female high school students in Fasa, Fars, Iran. A questionnaire consisting of demographic data and a questionnaire including the components of the Theory of Planned Behavior was used to assess skin cancer preventative behaviors of both the trial and control groups of the study. An educational program based on the Theory of Planned Behavior was held for the experimental group for eight weeks regarding skin cancer preventive behaviors. The two groups completed questionnaires three months following the intervention for a second time. Results The study's findings revealed that prior to the intervention, there was no considerable distinction between the two study groups with regard to knowledge, attitude, subjective norms, perceived behavioral control, behavioral intentions, and skin cancer prevention behaviors; yet, three months later, the experimental group demonstrated increases in each of the mentioned variables with a significant difference. In contrast, the control group showed no discernible difference. Conclusions The findings of this investigation highlighted the success of the Theory of Planned Behavior for designing educational interventions aimed at encouraging skin cancer prevention in a population of female high school students.
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Affiliation(s)
| | - Tahereh Gholami
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa, Iran
| | - Kasra Behdad
- Department of Dermatology, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Ali Khani Jeihooni
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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ÇELİK BA, KOÇ V. Skin Cancer-Related Health Behavior Interventions in the Context of the Health Belief Model. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1112210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The incidence of skin cancer is increasing around the world every year. Although there are many reasons for the occurrence of skin cancer, UV radiation caused by sunlight is seen as the most important factor. Therefore, reducing exposure to UV radiation should be a top priority for skin cancer prevention. In addition, different demographic features also affect the amount of UV exposure. These include age, gender and professional groups. On the other hand, people can be exposed to UV radiation voluntarily. Sunbathing or using tanning devices can be shown as examples for this. For these reasons, interventions to reduce exposure to UV radiation should focus on demographic features and the desire to tan. At the same time, it is emphasized in the literature that theory-based and systematic interventions are more effective than others. In this context, we think that the Health Belief Model, which is an effective psychosocial model for health behaviors, will be useful in developing sun protection behaviors. In this review, interventions based on the Health Belief Model in the context of tanning behavior, age, gender, and outdoor activities for the prevention of skin cancer and the improvement of sun protection behaviors have been discussed.
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Eshtiaghi P, Khosravi-Hafshejani T, Sara G, Lui H, Kalia S. Assessment of sun-safety education behavior via spectrophotometric evaluation: A preliminary study. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2022; 38:451-458. [PMID: 34967974 DOI: 10.1111/phpp.12768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/12/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Biases inherent in self-assessment of sun exposure and sun-safe behavior may lead to inaccurate conclusions about the effectiveness of sun-safety educational programs. OBJECTIVES We aimed to compare self-reports to objective measures of sun exposure, when examining the effectiveness of passive versus active educational interventions. METHODS From May to June 2018, 73 participants recruited at a dermatology clinic were sequentially assigned to receive sun-safety education through one of 3 modes: interactive online module, video, or no education. A baseline Sun Exposure and Behavior Inventory (SEBI) questionnaire was administered, and spectrophotometric measurements of sun-exposed and sun-protected areas were taken and reported in the CIE L*a*b* color space. Participants were followed 4-8 and 16 weeks after the initial visit where the SEBI was re-administered, and serial measurements of skin color were taken. The change in SEBI scores and L*a*b values, as calculated by the individual typology angle (ITA°), was analyzed. RESULTS There was a significant increase in skin darkening in all the groups at 4-8 and 16 weeks follow-up. There was no statistically significant difference between the groups in the magnitude of color change. However, subjectively at 4-8 weeks post-intervention, participants in the interactive module and video groups had significantly improved self-reported SEBI scores compared to control (p < .05, Kruskal-Wallis). By 16 weeks, only the interactive module group showed significant improvement in SEBI scores compared to control (p < .05, ANOVA). CONCLUSION In determining the effectiveness of sun-safety programs, spectrophotometric evaluation of sun-induced skin pigmentation can allow for a more complete evaluation of self-reported sun exposure and sun-protective behavior.
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Affiliation(s)
- Panteha Eshtiaghi
- Department of Dermatology and Skin Science, University of British Columbia, Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Touraj Khosravi-Hafshejani
- Department of Dermatology and Skin Science, University of British Columbia, Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Gulaab Sara
- Department of Dermatology and Skin Science, University of British Columbia, Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Harvey Lui
- Department of Dermatology and Skin Science, University of British Columbia, Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Departments of Cancer Control Research Program and/or Integrative Oncology-Imaging Unit, British Columbia Cancer Agency, Vancouver, Canada
| | - Sunil Kalia
- Department of Dermatology and Skin Science, University of British Columbia, Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Departments of Cancer Control Research Program and/or Integrative Oncology-Imaging Unit, British Columbia Cancer Agency, Vancouver, Canada
- BC Children's Hospital Research Institute, Vancouver, Canada
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Niu Z, Bhurosy T, Heckman CJ. Digital interventions for promoting sun protection and skin self-examination behaviors: A systematic review. Prev Med Rep 2022; 26:101709. [PMID: 35529530 PMCID: PMC9073560 DOI: 10.1016/j.pmedr.2022.101709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/05/2022] [Accepted: 01/22/2022] [Indexed: 01/22/2023] Open
Abstract
A considerable number of digital interventions for skin cancer prevention have been evaluated. Most skin cancer digital interventions focus on sun protection-related outcomes. Most interventions use web-based digital technology (websites, webpages, mobile apps) rather than videos, emails or text messages alone as the delivery platform. Multi-component digital interventions are effective in promoting sun protection and skin self-examination. Almost all studies found digital interventions to be equally or more effective compared to non-digital interventions.
The skin cancer incidence rate has been rising, and digital health interventions can promote skin cancer prevention and detection behaviors. A systematic review was conducted to investigate the outcomes of digital interventions that promote sun protection and skin self-examination (SSE). This review examined studies that utilized randomized controlled designs or quasi-experiments, included outcomes related to sun safety or SSE, employed at least one digital platform, and were published in English from January 2000 to October 2020. A total of 62 studies were included in the review. Digital modalities included web-based (e.g., websites) alone (n = 29), mobile-based (e.g., mobile apps) alone (n = 12), game-based (n = 1), emails or text messages alone (n = 8), videos alone (n = 6), social media (n = 3), both text messages and mobile apps (n = 2), or both text messages and video (n = 1). Most studies (n = 44) only evaluated sun protection-related outcomes, seven studies assessed SSE outcomes only, nine studies examined both, and two assessed other related outcomes. Digital interventions are effective compared to non-intervention control conditions in promoting sun safety or SSE. Almost all studies found digital interventions to be equally or more effective compared to non-digital interventions. This review suggests that although the digital interventions varied, they showed promising effects on improving sun protection or SSE outcomes. Future research should include more sophisticated phase-based and rigorous longitudinal research designs, additional investigation of social media and other newer technologies, as well as more detailed reporting of methods and results.
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Affiliation(s)
- Zhaomeng Niu
- Section of Behavioral Sciences, Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, United States
- Corresponding author.
| | - Trishnee Bhurosy
- Department of Population Health, Hofstra University, Hempstead, NY, United States
| | - Carolyn J. Heckman
- Section of Behavioral Sciences, Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, United States
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Trenerry C, Fletcher C, Wilson C, Gunn K. "She'll Be Right, Mate": A Mixed Methods Analysis of Skin Cancer Prevention Practices among Australian Farmers-An At-Risk Group. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052940. [PMID: 35270633 PMCID: PMC8910209 DOI: 10.3390/ijerph19052940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 11/23/2022]
Abstract
This study examined Australian farmers’ engagement with skin cancer prevention behaviours and explored what made it hard for them to be ‘SunSmart’ (barriers), and what could be done to make prevention easier (facilitators). In total, 498 farmers (83.1% male, 22–89 years, 50.8% grain, sheep, or cattle farmers) participated. The least frequently performed SunSmart behaviours (reported as never practiced during summer) were using SPF 30+ sunscreen (16.6%), wearing protective sunglasses (10.5%), and wearing protective clothing (8.6%). Greater engagement (i.e., higher scores on scale from Never to Always) with SunSmart behaviours was explained by gender (female), educational attainment (trade or technical college certificate vs. high school), personal skin cancer history, and skin sun sensitivity. Barriers reported by farmers related to personal preferences (e.g., short-sleeved rather than long-sleeved clothing), comfort, and perceived impracticality of sun protection. Farmers’ solutions included making protective clothing and sunscreen more appropriate for farm work (e.g., by making clothing more breathable). A personal health scare was the most reported motivation for skin cancer prevention. Findings highlight the need for increased access to sun-protective clothing and sunscreen that is suitable for wearing when working on farms, complemented by culturally appropriate health education messaging, to encourage more farmers to perform SunSmart behaviours.
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Affiliation(s)
- Camilla Trenerry
- School of Psychology, The University of Adelaide, Adelaide, SA 5000, Australia;
- Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Adelaide, SA 5000, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
| | - Chloe Fletcher
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia;
| | - Carlene Wilson
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
- Olivia Newton John Cancer Wellness Research Centre, Austin Health, Heidelberg, VIC 3084, Australia
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3083, Australia
| | - Kate Gunn
- Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Adelaide, SA 5000, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia;
- Correspondence:
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Thoonen K, van Osch L, Crutzen R, de Vries H, Schneider F. Identification of Relevant Sociocognitive Determinants Explaining Multiple Parental Sun Protection Behaviors. HEALTH EDUCATION & BEHAVIOR 2021; 49:392-404. [PMID: 34053307 PMCID: PMC9150145 DOI: 10.1177/10901981211010434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Adequate sun safety during childhood is crucial for decreasing skin cancer risk in later life. Although parents are an essential target group in applying sun protection measures for their children, insight into the determinants associated with their sun protection behaviors is limited. Aims This study aims to identify the most relevant determinants in predicting multiple parental sun protection intentions and behaviors in different sun exposure situations. Method A longitudinal survey study with two measurements was conducted among Dutch parents (N = 670) of children (4–12 years old). Twenty-seven sociocognitive determinants were examined in terms of relevance regarding four parental sun protection behaviors in different sun exposure situations. The Confidence Interval-Based Estimation of Relevance approach was used to visualize room for improvement (sample means) on all determinants and their association strengths (correlations) with sun protection intentions and behaviors. Results Behavior-specific rather than generic determinants were most relevant in explaining all sun protection behaviors. Of these determinants, attitude, self-efficacy and action planning, and especially parental feelings of difficulty in performing sun protection behaviors, were most relevant. Altogether, the explained variance of all sociocognitive determinants was highest for shade-seeking behavior (R2 = .41 and .43) and lowest for supportive behavior (R2 = .19 and .29) in both planned and incidental sun exposure situations, respectively. Discussion This study provides detailed insight into relevant sociocognitive determinants of parental sun protection behaviors in various sun exposure situations and directions for composing parental skin cancer prevention interventions. Conclusions Future composition of sun safety interventions should emphasize on enhancing parental feelings of self-efficacy, especially for shade-seeking and clothing behaviors.
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Affiliation(s)
- Karlijn Thoonen
- Maastricht University, Maastricht, the Netherlands
- Karlijn Thoonen, Department of Health Promotion, School CAPHRI, Maastricht University, P. Debyeplein 1, Maastricht, 6229 HA, the Netherlands.
| | | | - Rik Crutzen
- Maastricht University, Maastricht, the Netherlands
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Tong E, Phan K, Smith SD. A cross-sectional study of sun-related behaviours in the internet era. J DERMATOL TREAT 2020; 33:314-323. [DOI: 10.1080/09546634.2020.1751039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Elissa Tong
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Australia
- Northern Clinical School, University of Sydney, St Leonards, Australia
| | - Kevin Phan
- Department of Dermatology, Liverpool Hospital, Liverpool, Australia
| | - Saxon D. Smith
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Australia
- Northern Clinical School, University of Sydney, St Leonards, Australia
- The Dermatology and Skin Cancer Centre, Gosford, Australia
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Sinclair PM, Day J, Levett-Jones T, Kable A. Barriers and facilitators to opportunistic chronic kidney disease screening by general practice nurses. Nephrology (Carlton) 2018; 22:776-782. [PMID: 27436704 DOI: 10.1111/nep.12856] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 11/30/2022]
Abstract
AIM Opportunistic screening in general practice (GP) is a cost-effective and viable approach to the early identification of chronic kidney disease (CKD). This study sought to identify the barriers and facilitators to CKD screening practices of GP nurses working in a regional area of New South Wales, Australia. METHODS An eight-item elicitation questionnaire informed by the Theory of Planned Behaviour was administered to a convenience sample of 26 GP nurses. RESULTS Participants identified that the advantages of CKD screening were its early detection and treatment, the reduction of disease burden, and the opportunity to increase awareness and provide disease prevention education. These positive attitudinal beliefs were offset by negative beliefs about the impost of opportunistic screening on nursing time, particularly when there were other competing clinical priorities. Participants reported that practice doctors were wary of the financial costs associated with additional non-claimable services and believed that unfunded services, regardless of patient benefit, were difficult to justify in a private business environment. Screening was enabled in GP settings with existing screening protocols or initiatives, and when patients presented with known risk factors. Barriers to screening were more frequently described and illustrated a strong focus on financial aspects of GP. Without reimbursement through the Medicare Benefits Scheme, screening was not considered an economical use of nursing time. Other competing and billable clinical services took precedence. CONCLUSION The findings of this study can be used to inform the development and evaluation of interventions that target opportunistic CKD screening in the GP setting.
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Affiliation(s)
- Peter M Sinclair
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jenny Day
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Tracy Levett-Jones
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Ashley Kable
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
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Bruce AF, Theeke L, Mallow J. A state of the science on influential factors related to sun protective behaviors to prevent skin cancer in adults. Int J Nurs Sci 2017; 4:225-235. [PMID: 31406745 PMCID: PMC6626215 DOI: 10.1016/j.ijnss.2017.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/03/2017] [Accepted: 05/31/2017] [Indexed: 11/17/2022] Open
Abstract
Skin cancer rates have risen over the past decades, making it imperative that adults understand the need for protection from sun exposure. Though some risk factors have been identified as predictive for skin cancers, there is a lack of synthesized information about factors that influence adults in their decisions to engage in sun protective behaviors. The purpose of this paper is to present the current state of the science on influential factors for sun protective behaviors in the general adult population. A rigorous literature search inclusive of a generally White, Caucasian, and non-Hispanic adult population was performed, and screening yielded 18 quantitative studies for inclusion in this review. Findings indicate that modifiable and non-modifiable factors are interdependent and play a role in sun protective behaviors. This study resulted in a proposed conceptual model for affecting behavioral change in sun protection including the following factors: personal characteristics, cognitive factors, family dynamics, and social/peer group influences. These factors are introduced to propose tailored nursing interventions that would change current sun protective behavior practice. Key implications for nursing research and practice focus on feasibility of annual skin cancer screening facilitated by advanced practice nurses, incorporating the identified influential factors to reduce skin cancer risk and unnecessary sun exposure.
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Affiliation(s)
- Amy F. Bruce
- West Virginia University Institute of Technology, Department of Nursing, Montgomery, WV, USA
- Corresponding author. WVU Tech Department of Nursing, 2404 Orndorff hall, Montgomery, WV, USA.
| | - Laurie Theeke
- West Virginia University School of Nursing, Department of Adult Health, Morgantown, WV, USA
| | - Jennifer Mallow
- West Virginia University School of Nursing, Department of Adult Health, Morgantown, WV, USA
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Starfelt Sutton LC, White KM. Predicting sun-protective intentions and behaviours using the theory of planned behaviour: a systematic review and meta-analysis. Psychol Health 2016; 31:1272-92. [DOI: 10.1080/08870446.2016.1204449] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bérubé M, Albert M, Chauny JM, Contandriopoulos D, DuSablon A, Lacroix S, Gagné A, Laflamme É, Boutin N, Delisle S, Pauzé AM, MacThiong JM. Development of theory-based knowledge translation interventions to facilitate the implementation of evidence-based guidelines on the early management of adults with traumatic spinal cord injury. J Eval Clin Pract 2015; 21:1157-68. [PMID: 25832735 DOI: 10.1111/jep.12342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2015] [Indexed: 12/12/2022]
Abstract
RATIONALE Optimal, early management following a spinal cord injury (SCI) can limit individuals' disabilities and costs related to their care. Several knowledge syntheses were recently published to guide health care professionals with regard to early interventions in SCI patients. However, no knowledge translation (KT) intervention, selected according to a behaviour change theory, has been proposed to facilitate the use of SCI guidelines in an acute care setting. OBJECTIVES To develop theory-informed KT interventions to promote the application of evidence-based recommendations on the acute care management of SCI patients. METHODS The first four phases of the knowledge-to-action model were used to establish the study design. Knowledge selection was based on the Grading of Recommendations Assessment, Development and Evaluation system. Knowledge adaptation to the local context was sourced from the ADAPTE process. The theoretical domains framework oriented the selection and development of the interventions based on an assessment of barriers and enablers to knowledge application. RESULTS Twenty-nine recommendations were chosen and operationalized in measurable clinical indicators. Barriers related to knowledge, skills, perceived capacities, beliefs about consequences, social influences, and the environmental context and resources theoretical domains were identified. The mapping of behaviour change techniques associated with those barriers led to the development of an online educational curriculum, interdisciplinary clinical pathways as well as policies and procedures. CONCLUSIONS This research project allowed us developing KT interventions according to a thorough behavioural change methodology. Exposure to the generated interventions will support health care professionals in providing the best care to SCI patients.
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Affiliation(s)
- Mélanie Bérubé
- Orthopaedics and Trauma, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,McGill University, Montreal, Quebec, Canada
| | - Martin Albert
- Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Marc Chauny
- Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Montreal, Quebec, Canada
| | | | - Anne DuSablon
- Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Sébastien Lacroix
- Université de Montréal, Montreal, Quebec, Canada.,Hôtel Dieu de St-Jérôme, Montreal, Quebec, Canada
| | - Annick Gagné
- Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Élise Laflamme
- Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Nathalie Boutin
- Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | | | | | - Jean-Marc MacThiong
- Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Montreal, Quebec, Canada
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