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Alegre V, Álvarez MY, Bianchini A, Buedo P, Campi N, Cristina M, Revaz MDH, Larrán S, Damonte VM, Massaro LA, Gil AM, Morante MC, Moreira G, Díaz GM, Sabio MF, Sipitria R, Luna F. [Digital health in Latin America: current legislation and ethical aspectsSaúde digital na América Latina: legislação atual e aspectos éticos]. Rev Panam Salud Publica 2024; 48:e40. [PMID: 38707778 PMCID: PMC11069326 DOI: 10.26633/rpsp.2024.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/02/2024] [Indexed: 05/07/2024] Open
Abstract
Objectives Describe the current legislation on electronic medical records (EMR) and telehealth in Latin American countries and analyze the treatment of confidentiality and professional secrecy. Methods Between March and September 2022, a survey of the regulations in force in 21 Latin American countries was conducted at two levels: the existence of legislation on EMR and telehealth, and the treatment of confidentiality and professional secrecy in EMR and telehealth. A data extraction form was prepared for each country. Data were collected from official on-line sources. The information was analyzed qualitatively and synthesized in tables when possible. Results The use of EMR is legally regulated in 16 countries. Nineteen countries have legislation on telehealth. All the countries analyzed safeguard confidentiality and professional secrecy through regulations. However, confidentiality and professional secrecy are mentioned in 11 countries in the context of telehealth, and in only nine countries in the context of EMR. Conclusions Since the start of this century, Latin America has made progress in the legislation of digital tools for health care, such as EMR and telehealth. There is also interest in ethical issues related to the use of EMR and telehealth, particularly confidentiality and professional secrecy, aspects that should be strengthened in digital health.
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Affiliation(s)
- Valeria Alegre
- Programa de BioéticaFacultad Latinoamericana de Ciencias Sociales (FLACSO)ArgentinaPrograma de Bioética, Facultad Latinoamericana de Ciencias Sociales (FLACSO), Argentina.
| | | | - Alahí Bianchini
- Instituto de Investigaciones Jurídicas y Sociales Ambrosio L. GiojaFacultad de DerechoUniversidad de Buenos AiresCiudad Autónoma de Buenos AiresArgentinaInstituto de Investigaciones Jurídicas y Sociales Ambrosio L. Gioja, Facultad de Derecho, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Paola Buedo
- Departmento de Filosofía y BioéticaJagiellonian University Medical CollegeCracoviaPoloniaDepartmento de Filosofía y Bioética, Jagiellonian University Medical College, Cracovia, Polonia.
| | - Nicolás Campi
- Hospital Central de San IsidroSan IsidroArgentinaHospital Central de San Isidro, San Isidro, Argentina.
| | - Mariana Cristina
- Programa de BioéticaFacultad Latinoamericana de Ciencias Sociales (FLACSO)ArgentinaPrograma de Bioética, Facultad Latinoamericana de Ciencias Sociales (FLACSO), Argentina.
| | - María Del Huerto Revaz
- Universidad Nacional del NoroesteCiudad Autónoma de Buenos AiresArgentinaUniversidad Nacional del Noroeste, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Sofía Larrán
- Programa de BioéticaFacultad Latinoamericana de Ciencias Sociales (FLACSO)ArgentinaPrograma de Bioética, Facultad Latinoamericana de Ciencias Sociales (FLACSO), Argentina.
| | - Valentina Martínez Damonte
- Universidad de StanfordCaliforniaEstados Unidos de AméricaUniversidad de Stanford, California, Estados Unidos de América.
| | - Laura Andrea Massaro
- Programa de BioéticaFacultad Latinoamericana de Ciencias Sociales (FLACSO)ArgentinaPrograma de Bioética, Facultad Latinoamericana de Ciencias Sociales (FLACSO), Argentina.
| | - Antonella Milano Gil
- Programa de BioéticaFacultad Latinoamericana de Ciencias Sociales (FLACSO)ArgentinaPrograma de Bioética, Facultad Latinoamericana de Ciencias Sociales (FLACSO), Argentina.
| | - María Cecilia Morante
- Programa de BioéticaFacultad Latinoamericana de Ciencias Sociales (FLACSO)ArgentinaPrograma de Bioética, Facultad Latinoamericana de Ciencias Sociales (FLACSO), Argentina.
| | - Gricelda Moreira
- Programa de BioéticaFacultad Latinoamericana de Ciencias Sociales (FLACSO)ArgentinaPrograma de Bioética, Facultad Latinoamericana de Ciencias Sociales (FLACSO), Argentina.
| | - Geovanna Moya Díaz
- Programa de BioéticaFacultad Latinoamericana de Ciencias Sociales (FLACSO)ArgentinaPrograma de Bioética, Facultad Latinoamericana de Ciencias Sociales (FLACSO), Argentina.
| | | | - Rosana Sipitria
- Programa de BioéticaFacultad Latinoamericana de Ciencias Sociales (FLACSO)ArgentinaPrograma de Bioética, Facultad Latinoamericana de Ciencias Sociales (FLACSO), Argentina.
| | - Florencia Luna
- Programa de BioéticaFacultad Latinoamericana de Ciencias Sociales (FLACSO)ArgentinaPrograma de Bioética, Facultad Latinoamericana de Ciencias Sociales (FLACSO), Argentina.
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Harris M, Crone D, Hughes S. Factors That Help and Hinder the Implementation of Community-Wide Behavior Change Programs. Health Promot Pract 2024; 25:428-435. [PMID: 37165856 PMCID: PMC11064465 DOI: 10.1177/15248399231172760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Novel community-wide approaches that gamify physical activity through challenges and competition have become increasingly popular in recent years. However, little is known about the factors that help or hinder their implementation. This qualitative study aimed to address this gap in the literature by systematically investigating the facilitators (organizational and experiential) and barriers to successful implementation of a community-wide intervention delivered in Gloucester, the United Kingdom. A two-phased process evaluation was conducted. Phase 1 involved the thematical analysis of open question feedback from n = 289 adults. Phase 2 included three focus groups conducted with n = 12 participants. This research showed that promoting the initiative through primary education settings was fundamental to enhancing awareness and participation. Social elements of the intervention were identified as a motivating factor for, and a consequential outcome of, participation. A lack of promotion to wider-reaching proportions of the community was perceived to be a significant barrier to implementation, potentially limiting inclusivity and participation in the activity. Game dynamics, timing, and fears regarding sustainability represented further difficulties to implementation.
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Affiliation(s)
- Marc Harris
- Cardiff Metropolitan University, Cardiff, UK
| | - Diane Crone
- Cardiff Metropolitan University, Cardiff, UK
| | - Samantha Hughes
- University of Gloucestershire, Cheltenham, Gloucestershire, UK
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Krukowski RA, Ross KM, Western MJ, Cooper R, Busse H, Forbes C, Kuntsche E, Allmeta A, Silva AM, John-Akinola YO, König LM. Digital health interventions for all? Examining inclusivity across all stages of the digital health intervention research process. Trials 2024; 25:98. [PMID: 38291539 PMCID: PMC10826214 DOI: 10.1186/s13063-024-07937-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024] Open
Abstract
Digital interventions offer many possibilities for improving health, as remote interventions can enhance reach and access to underserved groups of society. However, research evaluating digital health interventions demonstrates that such technologies do not equally benefit all and that some in fact seem to reinforce a "digital health divide." By better understanding these potential pitfalls, we may contribute to narrowing the digital divide in health promotion. The aim of this article is to highlight and reflect upon study design decisions that might unintentionally enhance inequities across key research stages-recruitment, enrollment, engagement, efficacy/effectiveness, and retention. To address the concerns highlighted, we propose strategies including (1) the standard definition of "effectiveness" should be revised to include a measure of inclusivity; (2) studies should report a broad range of potential inequity indicators of participants recruited, randomized, and retained and should conduct sensitivity analyses examining potential sociodemographic differences for both the effect and engagement of the digital interventions; (3) participants from historically marginalized groups should be involved in the design of study procedures, including those related to recruitment, consent, intervention implementation and engagement, assessment, and retention; (4) eligibility criteria should be minimized and carefully selected and the screening process should be streamlined; (5) preregistration of trials should include recruitment benchmarks for sample diversity and comprehensive lists of sociodemographic characteristics assessed; and (6) studies within trials should be embedded to systematically test recruitment and retention strategies to improve inclusivity. The implementation of these strategies would enhance the ability of digital health trials to recruit, randomize, engage, and retain a broader and more representative population in trials, ultimately minimizing the digital divide and broadly improving population health.
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Affiliation(s)
- Rebecca A Krukowski
- Department of Public Health Sciences, School of Medicine, University of Virginia, PO Box 800765, Charlottesville, VA, 22908-0765, USA.
| | - Kathryn M Ross
- Department of Clinical & Health Psychology, College of Public Health & Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610-0165, USA
| | - Max J Western
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Rosie Cooper
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, UK
| | - Heide Busse
- Leibniz Institute for Prevention Research and Epidemiology- BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Cynthia Forbes
- Hull York Medical School, University of Hull, Allam Medical Building, Cottingham Road, Hull, UK
| | - Emmanuel Kuntsche
- Centre for Alcohol Policy Research, La Trobe University, Plenty Road and Kingsbury Drive, Melbourne, 3086 VIC, Australia
| | - Anila Allmeta
- University of Bayreuth, Fritz-Hornschuch-Straße 13, 95326, Kulmbach, Germany
| | - Anabelle Macedo Silva
- Instituto de Estudos Em Saúde Coletiva IESC/ Universidade Federal Do Rio de Janeiro /Leibiniz Science Campus Digital Public Health/Ministério Público Do Estado Do Rio de Janeiro, Rua das Bauhineas 200, Bl B 1602, Península, Barra da Tijuca, Rio de Janeiro, 22776-090, Brazil
| | - Yetunde O John-Akinola
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, College of Medicine, Queen Elizabeth Road, UCH Campus, Ibadan, Nigeria
| | - Laura M König
- University of Bayreuth, Faculty of Life Sciences: Food, Nutrition and Health University of Vienna, Faculty of Psychology, Wächtergasse 1, 1010, Vienna, Austria
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Aschentrup L, Steimer PA, Dadaczynski K, Mc Call T, Fischer F, Wrona KJ. Effectiveness of gamified digital interventions in mental health prevention and health promotion among adults: a scoping review. BMC Public Health 2024; 24:69. [PMID: 38167010 PMCID: PMC10763397 DOI: 10.1186/s12889-023-17517-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Though still a young field of research, gamified digital interventions have demonstrated potential in exerting a favourable impact on health and overall well-being. With the increasing use of the internet and digital devices, the integration of game elements presents novel opportunities for preventing mental disorders and enhancing mental health. Hence, this review aims to assess the effectiveness of gamified interventions focusing on preventing mental disorders or promoting mental health among adults. METHODS Based on a scoping review across four databases (MEDLINE, Embase, PsycInfo and Web of Science), 7,953 studies were initially identified. After removing duplicates and screening titles, abstracts and full texts, 16 studies were identified as suitable for inclusion in a narrative synthesis of findings. We included interventional studies encompassing an intervention and a control group aiming to investigate the effectiveness of the use of gamified digital mental health interventions and the use of gamified digital elements. RESULTS Overall, positive effects of gamified interventions on mental health-related outcomes were identified. In particular, beneficial consequences for psychological well-being and depressive symptoms were observed in all studies. However, further outcomes, such as resilience, anxiety, stress or satisfaction with life, showed heterogenous findings. Most game elements used were reward, sensation and progress, whilst the quantity of elements was not consistent and, therefore, no substantiated conclusion regarding the (optimal) quantity or composition of game elements can be drawn. Further, the outcomes, measurements and analyses differed greatly between the 16 included studies making comparisons difficult. CONCLUSION In summary, this review demonstrates the potential of integrating digital game elements on mental health and well-being with still a great gap of research. A taxonomy is needed to adequately address relevant game elements in the field of mental health promotion and prevention of mental disorders. Therefore, future studies should explicitly focus on the mechanisms of effect and apply rigorous study designs.
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Affiliation(s)
- Leona Aschentrup
- School of Public Health, Bielefeld University, Bielefeld, Germany
- Bielefeld University of Applied Sciences and Arts, Bielefeld, Germany
| | - Pia Anna Steimer
- School of Public Health, Bielefeld University, Bielefeld, Germany
- Department of Global Public Health, Karolinska Institute, Solna, Sweden
| | - Kevin Dadaczynski
- Department of Health Sciences, Fulda University of Applied Sciences, Fulda, Germany
- Centre for Applied Health Sciences, Leuphana University Lueneburg, Lueneburg, Germany
| | - Timothy Mc Call
- School of Public Health, Bielefeld University, Bielefeld, Germany
- Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Bavarian Research Center for Digital Health and Social Care, Kempten University of Applied Sciences, Kempten, Germany.
| | - Kamil J Wrona
- School of Public Health, Bielefeld University, Bielefeld, Germany
- Bielefeld University of Applied Sciences and Arts, Bielefeld, Germany
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König LM, Krukowski RA, Kuntsche E, Busse H, Gumbert L, Gemesi K, Neter E, Mohamed NF, Ross KM, John-Akinola YO, Cooper R, Allmeta A, Silva AM, Forbes CC, Western MJ. Reducing intervention- and research-induced inequalities to tackle the digital divide in health promotion. Int J Equity Health 2023; 22:249. [PMID: 38049789 PMCID: PMC10696856 DOI: 10.1186/s12939-023-02055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/06/2023] [Indexed: 12/06/2023] Open
Abstract
Social inequalities are an important contributor to the global burden of disease within and between countries. Using digital technology in health promotion and healthcare is seen by some as a potential lever to reduce these inequalities; however, research suggests that digital technology risks re-enacting or evening widening disparities. Most research on this digital health divide focuses on a small number of social inequality indicators and stems from Western, educated, industrialized, rich, and democratic (WEIRD) countries. There is a need for systematic, international, and interdisciplinary contextualized research on the impact of social inequality indicators in digital health as well as the underlying mechanisms of this digital divide across the globe to reduce health disparities. In June 2023, eighteen multi-disciplinary researchers representing thirteen countries from six continents came together to discuss current issues in the field of digital health promotion and healthcare contributing to the digital divide. Ways that current practices in research contribute to the digital health divide were explored, including intervention development, testing, and implementation. Based on the dialogue, we provide suggestions for overcoming barriers and improving practices across disciplines, countries, and sectors. The research community must actively advocate for system-level changes regarding policy and research to reduce the digital divide and so improve digital health for all.
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Affiliation(s)
- Laura M König
- Faculty of Life Sciences: Food, Nutrition and Health, University of Bayreuth, Bayreuth, Germany.
- Faculty of Psychology, University of Vienna, Wächtergasse 1/504, 1010, Vienna, Austria.
| | - Rebecca A Krukowski
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, USA
| | - Emmanuel Kuntsche
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Heide Busse
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Leibniz Science Campus Digital Public Health Bremen, Bremen, Germany
| | | | - Kathrin Gemesi
- Institute for Nutritional Medicine, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | | | - Nor Firdous Mohamed
- Department of Psychology, Faculty of Human Development, University Pendidikan Sultan Idris, Tanjong Malim, Malaysia
| | | | - Yetunde O John-Akinola
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rosie Cooper
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anila Allmeta
- Faculty of Life Sciences: Food, Nutrition and Health, University of Bayreuth, Bayreuth, Germany
| | - Anabelle Macedo Silva
- Instituto de Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cynthia C Forbes
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Max J Western
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, UK
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Vidal-Alaball J, Alarcon Belmonte I, Panadés Zafra R, Escalé-Besa A, Acezat Oliva J, Saperas Perez C. [Approach to digital transformation in healthcare to reduce the digital divide]. Aten Primaria 2023; 55:102626. [PMID: 37267831 PMCID: PMC10239691 DOI: 10.1016/j.aprim.2023.102626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 06/04/2023] Open
Abstract
Digital transformation involves the integration of technology into all areas of an organization and a change in the way of operating and providing value. In the healthcare sector, digital transformation should focus on improving health for all by accelerating the development and adoption of digital solutions. The WHO considers digital health as a key factor in ensuring universal health coverage, protection against health emergencies, and better well-being for one billion people worldwide. Digital transformation in healthcare should include digital determinants of health as new factors of inequality alongside classic social determinants. Addressing digital determinants of health and the digital divide is essential to ensure that all people have access to the benefits of digital technology for their health and well-being.
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Affiliation(s)
- Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Barcelona, España; Grup de Recerca Promoció de la Salut en l'Àmbit Rural, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Barcelona, España; Facultat de Medicina, Universitat de Vic-Universitat Central de Catalunya, Vic, Barcelona, España; Grup de Salut Digital CAMFIC, Barcelona, España
| | - Iris Alarcon Belmonte
- Grup de Salut Digital CAMFIC, Barcelona, España; Servei d'Atenció Primària Dreta i Muntanya, Gerència Territorial Barcelona ciutat, Institut Català de la Salut, Barcelona, España.
| | - Robert Panadés Zafra
- Grup de Recerca Promoció de la Salut en l'Àmbit Rural, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Barcelona, España; Grup de Salut Digital CAMFIC, Barcelona, España; Equip d'Atenció Primària d'Anoia Rural, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Jorba i Copons, Barcelona, España
| | - Anna Escalé-Besa
- Grup de Recerca Promoció de la Salut en l'Àmbit Rural, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Barcelona, España; Grup de Salut Digital CAMFIC, Barcelona, España; Equip d'Atenció Primària Navàs-Balsareny, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Navàs, Barcelona, España
| | - Jordi Acezat Oliva
- Grup de Salut Digital CAMFIC, Barcelona, España; Servei d'Atenció Primària Dreta i Muntanya, Gerència Territorial Barcelona ciutat, Institut Català de la Salut, Barcelona, España
| | - Carme Saperas Perez
- Grup de Salut Digital CAMFIC, Barcelona, España; Grupo Inequidades en Salud y Salud Internacional SEMFYC, España; Equipo de Atención Primaria Plana Lledó, Gerencia Metropolina Nord, Mollet del Vallès, Barcelona, España
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Reeves MJ, Boden-Albala B, Cadilhac DA. Care Transition Interventions to Improve Stroke Outcomes: Evidence Gaps in Underserved and Minority Populations. Stroke 2023; 54:386-395. [PMID: 36689590 DOI: 10.1161/strokeaha.122.039565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/09/2022] [Indexed: 01/24/2023]
Abstract
In many countries hospital length of stay after an acute stroke admission is typically just a few days, therefore, most of a person's recovery from stroke occurs in the community. Care transitions, which occur when there is a change in, or handoff between 2 different care settings or providers, represent an especially vulnerable period for patients and caregivers. For some patients with stroke the return home is associated with substantial practical, psychosocial, and health-related challenges leading to substantial burden for the individual and caregiver. Underserved and minority populations, because of their exposure to poor environmental, social, and economic conditions, as well as structural racism and discrimination, are especially vulnerable to the problems of complicated care transitions which in turn, can negatively impact stroke recovery. Overall, there remain significant unanswered questions about how to promote optimal recovery in the post-acute care period, particularly for those from underserved communities. Evidence is limited on how best to support patients after they have returned home where they are required to navigate the chronic stages of stroke with little direct support from health professionals.
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Affiliation(s)
- Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.)
| | - Bernadette Boden-Albala
- Department of Health Society and Behavior, Department of Epidemiology and Biostatistics, Program in Public Health, Department of Neurology, School of Medicine, University of California (B.B.-A.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (D.A.C.)
- Stroke theme, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (D.A.C.)
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