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Dawit AM. Lower limb salvage in necrotizing burn wound infection: The role of fibular ostectomy and local flaps in a resource-limited setting - A case report and literature review. Int J Surg Case Rep 2024; 122:110054. [PMID: 39032353 PMCID: PMC11325075 DOI: 10.1016/j.ijscr.2024.110054] [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: 05/17/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION Necrotizing burn wound infections following burn injuries are rare. Literature on these cases is also scarce. These infections are life- and limb- threatening unless properly managed. They also pose significant reconstructive challenge, especially in settings lacking microvascular capability. This report describes a limb preservation strategy for limb-threatening necrotizing infection of the leg that complicated a burn injury. Innovative approach was used, utilizing proximal fibular ostectomy, bipedicled local advancement flap and split thickness skin graft. CASE PRESENTATION A 26-year-old female patient presented to our burn unit after sustaining a contact burn injury from a burning charcoal to her right lateral leg within three days. On the second day of admission, the patient developed significant changes in the appearance of the wound, leading to the diagnosis of necrotizing myofacitis. Emergent debridements were done with the aim of preserving the limb. Subsequent successful, albeit sub-optimal, reconstruction was also achieved despite the lack of microvascular surgical capability in the burn unit. DISCUSSION This case report and literature review describes a rare limb-threatening necrotizing burn wound infection. The significant reconstructive challenge posed by the defect was addressed using a simple but rarely described reconstructive technique. The importance of limb preservation in LMIC is also emphasized. CONCLUSION The goal of preserving a limb can be met by using a simple reconstructive technique, despite the lack of microvascular capabilities.
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Affiliation(s)
- Anteneh Meaza Dawit
- Addis Ababa University, Department of Plastic & Reconstructive surgery, Resident physician, Ethiopia.
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Castro-Franco AD, Siqueiros-Hernández M, García-Angel V, Mendoza-Muñoz I, Vargas-Osuna LE, Magaña-Almaguer HD. A Review of Natural Fiber-Reinforced Composites for Lower-Limb Prosthetic Designs. Polymers (Basel) 2024; 16:1293. [PMID: 38732761 PMCID: PMC11085599 DOI: 10.3390/polym16091293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
This paper presents a comprehensive review of natural fiber-reinforced composites (NFRCs) for lower-limb prosthetic designs. It covers the characteristics, types, and properties of natural fiber-reinforced composites as well as their advantages and drawbacks in prosthetic designs. This review also discusses successful prosthetic designs that incorporate NFRCs and the factors that make them effective. Additionally, this study explores the use of computational biomechanical models to evaluate the effectiveness of prosthetic devices and the key factors that are considered. Overall, this document provides a valuable resource for anyone interested in using NFRCs for lower-limb prosthetic designs.
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Affiliation(s)
- Angel D. Castro-Franco
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali 21280, Baja California, Mexico; (A.D.C.-F.); (V.G.-A.); (I.M.-M.); (L.E.V.-O.)
| | - Miriam Siqueiros-Hernández
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali 21280, Baja California, Mexico; (A.D.C.-F.); (V.G.-A.); (I.M.-M.); (L.E.V.-O.)
| | - Virginia García-Angel
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali 21280, Baja California, Mexico; (A.D.C.-F.); (V.G.-A.); (I.M.-M.); (L.E.V.-O.)
| | - Ismael Mendoza-Muñoz
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali 21280, Baja California, Mexico; (A.D.C.-F.); (V.G.-A.); (I.M.-M.); (L.E.V.-O.)
| | - Lidia E. Vargas-Osuna
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali 21280, Baja California, Mexico; (A.D.C.-F.); (V.G.-A.); (I.M.-M.); (L.E.V.-O.)
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Ahkami B, Ahmed K, Thesleff A, Hargrove L, Ortiz-Catalan M. Electromyography-Based Control of Lower Limb Prostheses: A Systematic Review. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2023; 5:547-562. [PMID: 37655190 PMCID: PMC10470657 DOI: 10.1109/tmrb.2023.3282325] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Most amputations occur in lower limbs and despite improvements in prosthetic technology, no commercially available prosthetic leg uses electromyography (EMG) information as an input for control. Efforts to integrate EMG signals as part of the control strategy have increased in the last decade. In this systematic review, we summarize the research in the field of lower limb prosthetic control using EMG. Four different online databases were searched until June 2022: Web of Science, Scopus, PubMed, and Science Direct. We included articles that reported systems for controlling a prosthetic leg (with an ankle and/or knee actuator) by decoding gait intent using EMG signals alone or in combination with other sensors. A total of 1,331 papers were initially assessed and 121 were finally included in this systematic review. The literature showed that despite the burgeoning interest in research, controlling a leg prosthesis using EMG signals remains challenging. Specifically, regarding EMG signal quality and stability, electrode placement, prosthetic hardware, and control algorithms, all of which need to be more robust for everyday use. In the studies that were investigated, large variations were found between the control methodologies, type of research participant, recording protocols, assessments, and prosthetic hardware.
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Affiliation(s)
- Bahareh Ahkami
- Center for Bionics and Pain Research, 43130 Mölndal, Sweden, and also with the Department of Electrical Engineering, Chalmers University of Technology, 41296 Gothenburg, Sweden
| | - Kirstin Ahmed
- Center for Bionics and Pain Research, 43130 Mölndal, Sweden, and also with the Department of Electrical Engineering, Chalmers University of Technology, 41296 Gothenburg, Sweden
| | - Alexander Thesleff
- Center for Bionics and Pain Research, 43130 Mölndal, Sweden, also with the Department of Electrical Engineering, Chalmers University of Technology, 41296 Gothenburg, Sweden, and also with Integrum AB, 43153 Molndal, Sweden
| | - Levi Hargrove
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL 60611 USA, and also with the Regenstein Foundation Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL 60611 USA
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, 43130 Mölndal, Sweden, also with the Department of Electrical Engineering, Chalmers University of Technology, 41296 Gothenburg, Sweden, also with the Operational Area 3, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden, and also with Bionics Institute, Melbourne, VIC 3002, Australia
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Urva M, Donnelley CA, Challa ST, Haonga BT, Morshed S, Shearer DW, Razani N. Transfemoral amputation and prosthesis provision in Tanzania: Patient and provider perspectives. Afr J Disabil 2023; 12:1084. [PMID: 36876024 PMCID: PMC9982473 DOI: 10.4102/ajod.v12i0.1084] [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: 05/27/2022] [Accepted: 10/10/2022] [Indexed: 02/15/2023] Open
Abstract
Background The burden of disability because of traumatic limb amputation, particularly transfemoral amputation (TFA) is disproportionately carried by low- and middle-income countries. The need for improved access to prosthesis services in these settings is well-documented, but perspectives on the burden imposed by TFA and the challenges associated with subsequent prosthesis provision vary among patients, caregivers and healthcare providers. Objectives To examine the burden of TFA and barriers to prosthesis provision as perceived by patient, caregiver and healthcare professional, at a single tertiary referral hospital in Tanzania. Method Data were collected from five patients with TFA and four caregivers recruited via convenience sampling, in addition to 11 purposively sampled healthcare providers. All participants participated in in-depth interviews regarding their perceptions of amputation, prostheses and underlying barriers to improving care for persons with TFA in Tanzania. A coding schema and thematic framework were established from interviews using inductive thematic analysis. Results All participants noted financial and psychosocial burdens of amputation, and perceived prostheses as an opportunity for return to normality and independence. Patients worried about prosthesis longevity. Healthcare providers noted significant obstacles to prosthesis provision, including infrastructural and environmental barriers, limited access to prosthetic services, mismatched patient expectations and inadequate coordination of care. Conclusion This qualitative analysis identifies factors influencing prosthesis-related care for patients with TFA in Tanzania which are lacking in the literature. Persons with TFA and their caregivers experience numerous hardships exacerbated by limited financial, social and institutional support. Contribution This qualitative analysis informs future directions for research into improving prosthesis-related care for patients with TFA in Tanzania.
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Affiliation(s)
- Mayur Urva
- Department of Orthopedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, United States
| | - Claire A Donnelley
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, United States
| | - Sravya T Challa
- Department of Orthopaedic Surgery, Harvard University, Boston, United States
| | - Billy T Haonga
- Department of Orthopaedic Surgery, Muhimbili Orthopaedic Institute, Dar es Salaam, United Republic of Tanzania
| | - Saam Morshed
- Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, United States
| | - David W Shearer
- Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, United States
| | - Nooshin Razani
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States
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Barth CA, Wladis A, Blake C, Bhandarkar P, Aebischer Perone S, O'Sullivan C. Retrospective observational study of characteristics of persons with amputations accessing International Committee of the Red Cross (ICRC) rehabilitation centres in five conflict and postconflict countries. BMJ Open 2021; 11:e049533. [PMID: 34853101 PMCID: PMC8638157 DOI: 10.1136/bmjopen-2021-049533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 11/05/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Limb amputation incidence is particularly high in fragile contexts due to conflict, accidents and poorly managed diabetes. The study aim was to analyse (1) demographic and amputation characteristics of persons with any type of acquired amputation (PwA) and (2) time between amputation and first access to rehabilitation in five conflict and postconflict countries. DESIGN A retrospective, observational study analysing differences in demographic and clinical factors and time to access rehabilitation between users with traumatic and non-traumatic amputations. SETTING Five countries with the highest numbers of PwA in the global International Committee of the Red Cross database (Afghanistan, Cambodia, Iraq, Myanmar, Sudan). Cleaned and merged data from 2009 to 2018 were aggregated by sex; age at amputation and registration; cause, combination and anatomical level of amputation(s); living environment. PARTICIPANTS All PwA newly attending rehabilitation. RESULTS Data for 28 446 individuals were included (4329 (15.2%) female). Most were traumatic amputations (73.4%, 208 90); of these, 48.6% (138 01) were conflict related. Average age at traumatic amputation for men and women was 26.9 and 24.1 years, respectively; for non-traumatic amputation it was 49.1 years and 45.9 years, respectively. Sex differences in age were statistically significant for traumatic and non-traumatic causes (p<0.001, p=0.003). Delay between amputation and rehabilitation was on average 8.2 years for those with traumatic amputation, significantly higher than an average 3 years for those with non-traumatic amputation (p<0.001). CONCLUSIONS Young age for traumatic and non-traumatic amputations indicates the devastating impact of war and fragile health systems on a society. Long delays between amputation and rehabilitation reveal the mismatch of needs and resources. For rehabilitation service providers in fragile settings, it is an enormous task to manage the diversity of PwA of various causes, age, sex and additional conditions. Improved collaboration between primary healthcare, surgical and rehabilitation services, a prioritisation of rehabilitation and increased resource provision are recommended to ensure adequate access to comprehensive rehabilitation care for PwA.
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Affiliation(s)
- Cornelia Anne Barth
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Cochrane Switzerland, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Andreas Wladis
- Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Prashant Bhandarkar
- BARC Hospital, WHO collaborating centre for research in surgical needs in LMICs, Mumbai, India
- School of Health Systems Studies, Tata Institute of Social Sciences, Deonar, India
| | - Sigirya Aebischer Perone
- Health Unit, International Committee of the Red Cross, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Cliona O'Sullivan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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von Kaeppler EP, Hetherington A, Donnelley CA, Ali SH, Shirley C, Challa ST, Lutyens E, Haonga BT, Morshed S, Andrysek J, Shearer DW. Impact of prostheses on quality of life and functional status of transfemoral amputees in Tanzania. Afr J Disabil 2021; 10:839. [PMID: 34692432 PMCID: PMC8517763 DOI: 10.4102/ajod.v10i0.839] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background The rise of diabetes and traumatic injury has increased limb loss-related morbidity in low- and middle-income countries (LMICs). Despite this, the majority of amputees in LMICs have no access to prosthetic devices, and the magnitude of prosthesis impact on quality of life (QOL ) and function has not been quantified. Objectives Quantify the impact of prostheses on QOL and function in Tanzanian transfemoral amputees. Method A prospective cohort study was conducted. Transfemoral amputees at Muhimbili Orthopaedic Institute were assessed twice before and three times after prosthetic fitting using EuroQol-5D-3L (EQ-5D-3L), Prosthetic Limb Users Survey of Mobility (PLUS-M), 2-minute walk test (2MWT) and Physiologic Cost Index (PCI). Data were analysed for change over time. Subgroup analysis was performed for amputation aetiology (vascular or non-vascular) and prosthesis use. Results Amongst 30 patients, EQ-5D, PLUS-M and 2MWT improved after prosthesis provision (p < 0.001). EuroQol-5D increased from 0.48 to 0.85 at 1 year (p < 0.001). EuroQol-5D and 2MWT were higher in non-vascular subgroup (p < 0.030). At 1-year, 84% of non-vascular and 44% of vascular subgroups reported using their prosthesis (p = 0.068). Conclusion Prosthesis provision to transfemoral amputees in an LMIC improved QOL and function. This benefit was greater for non-vascular amputation aetiologies. Quality of life and function returned to pre-prosthesis levels with discontinued use of prosthesis.
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Affiliation(s)
- Ericka P von Kaeppler
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Alexander Hetherington
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Claire A Donnelley
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Syed H Ali
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Corin Shirley
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Sravya T Challa
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | | | - Billy T Haonga
- Department of Orthopaedic Surgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Saam Morshed
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Jan Andrysek
- LegWorks, Inc., Buffalo, United States of America.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - David W Shearer
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
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McDonald CL, Westcott-McCoy S, Weaver MR, Haagsma J, Kartin D. Global prevalence of traumatic non-fatal limb amputation. Prosthet Orthot Int 2021; 45:105-114. [PMID: 33274665 DOI: 10.1177/0309364620972258] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/12/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Reliable information on both global need for prosthetic services and the current prosthetist workforce is limited. Global burden of disease estimates can provide valuable insight into amputation prevalence due to traumatic causes and global prosthetists needed to treat traumatic amputations. OBJECTIVES This study was conducted to quantify and interpret patterns in global distribution and prevalence of traumatic limb amputation by cause, region, and age within the context of prosthetic rehabilitation, prosthetist need, and prosthetist education. STUDY DESIGN A secondary database descriptive study. METHODS Amputation prevalence and prevalence rate per 100,000 due to trauma were estimated using the 2017 global burden of disease results. Global burden of disease estimation utilizes a Bayesian metaregression and best available data to estimate the prevalence of diseases and injuries, such as amputation. RESULTS In 2017, 57.7 million people were living with limb amputation due to traumatic causes worldwide. Leading traumatic causes of limb amputation were falls (36.2%), road injuries (15.7%), other transportation injuries (11.2%), and mechanical forces (10.4%). The highest number of prevalent traumatic amputations was in East Asia and South Asia followed by Western Europe, North Africa, and the Middle East, high-income North America and Eastern Europe. Based on these prevalence estimates, approximately 75,850 prosthetists are needed globally to treat people with traumatic amputations. CONCLUSION Amputation prevalence estimates and patterns can inform prosthetic service provision, education and planning.
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Affiliation(s)
- Cody L McDonald
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Sarah Westcott-McCoy
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Marcia R Weaver
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Juanita Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Deborah Kartin
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Magnusson L, Ghosh R, Jensen KR, Göbel K, Wågberg J, Wallén S, Svensson A, Stavenheim R, Ahlström G. Quality of life of prosthetic and orthotic users in South India: a cross-sectional study. Health Qual Life Outcomes 2019; 17:50. [PMID: 30894184 PMCID: PMC6425682 DOI: 10.1186/s12955-019-1116-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to compare QOL among people in India using lower-limb prostheses or orthoses with people without disability. A further aim was to compare subgroups and investigate whether QOL was associated with physical disability, gender, income, living area, and education. METHODS A cross-sectional questionnaire study in which the World Health Organization Quality of Life-Bref was used to collect self-reported data. A total of 277 participants from India were included, 155 with disability and 122 without. Group comparisons were conducted using the Mann-Whitney U and the Kruskal-Wallis tests and associations were explored using regression analyses of the four QOL domains: physical health, psychological, social relationships, and environment. RESULTS Participants with physical disability scored significantly lower than did participants without disability in three of the four QOL domains, i.e., physical health, (Median 14.29 vs 16.29; p < .001) psychological, (Median 14.67 vs. 15.33; p = .017) and environment (Median13.00 vs 14.00; p = .006). For people with disability those with no or irregular income and those not attending school having the lowest QOL scores in all four domains. Education was associated with all four QOL domains and income was associated with psychological and environment. Living in urban slums was associated with a higher risk of lower QOL in three QOL domains, i.e., physical health, psychology, and environment. CONCLUSIONS Despite rehabilitation services, people with physical disability experienced lower QOL in terms of the physical health, psychological, and environmental domains than did people without disability. Community-based rehabilitation programmes for prosthetic and orthotic users need to increase and improve their rehabilitation services to increase income and improve access to education. Priority could be given to those who have no or irregular income, live in urban slums, and have not attended school to further improve their QOL.
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Affiliation(s)
- Lina Magnusson
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00 Lund, Sweden
| | - Ritu Ghosh
- Mobility India Rehabilitation Research and Training Centre, 1st and 1st A Cross, Phase II, J.P. Nagar, Bangalore, Karnataka e-560078 India
| | - Katrine Randbøll Jensen
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00 Lund, Sweden
| | - Katharina Göbel
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00 Lund, Sweden
| | - Jenny Wågberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00 Lund, Sweden
| | - Sofia Wallén
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00 Lund, Sweden
| | - Alma Svensson
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00 Lund, Sweden
| | - Rebecka Stavenheim
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00 Lund, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00 Lund, Sweden
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