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O’Donnell A, Anderson P, Schmidt C, Braddick F, Lopez-Pelayo H, Mejía-Trujillo J, Natera G, Arroyo M, Bautista N, Piazza M, Bustamante IV, Kokole D, Jackson K, Jane-Llopis E, Gual A, Schulte B. Tailoring an evidence-based clinical intervention and training package for the treatment and prevention of comorbid heavy drinking and depression in middle-income country settings: the development of the SCALA toolkit in Latin America. Glob Health Action 2022; 15:2080344. [PMID: 35867541 PMCID: PMC9310809 DOI: 10.1080/16549716.2022.2080344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/16/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Effective interventions exist for heavy drinking and depression but to date there has been limited translation into routine practice in global health systems. This evidence-to-practice gap is particularly evident in low- and middle-income countries. The international SCALA project (Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America) sought to test the impact of multilevel implementation strategies on rates of primary health care-based measurement of alcohol consumption and identification of depression in Colombia, Mexico, and Peru. OBJECTIVE To describe the process of development and cultural adaptation of the clinical intervention and training package. METHODS We drew on Barrero and Castro's four-stage cultural adaption model: 1) information gathering, 2) preliminary adaption, 3) preliminary adaption tests, and 4) adaption refinement. The Tailored Implementation in Chronic Diseases checklist helped us identify potential factors that could affect implementation, with local stakeholder groups established to support the tailoring process, as per the Institute for Healthcare Improvement's Going to Scale Framework. RESULTS In Stage 1, international best practice guidelines for preventing heavy drinking and depression, and intelligence on the local implementation context, were synthesised to provide an outline clinical intervention and training package. In Stage 2, feedback was gathered from local stakeholders and materials refined accordingly. These materials were piloted with local trainers in Stage 3, leading to further refinements including developing additional tools to support delivery in busy primary care settings. Stage 4 comprised further adaptions in response to real-world implementation, a period that coincided with the onset of the COVID-19 pandemic, including translating the intervention and training package for online delivery, and higher priority for depression screening in the clinical pathway. CONCLUSION Our experience highlights the importance of meaningful engagement with local communities, alongside the need for continuous tailoring and adaptation, and collaborative decision-making.
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Affiliation(s)
- Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Anderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Christiane Schmidt
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fleur Braddick
- Addictions Unit, Psychiatry Department, Hospital Clínic, Barcelona, Spain
| | - Hugo Lopez-Pelayo
- Addictions Unit, Psychiatry Department, Hospital Clínic, Barcelona, Spain
- Red de Trastornos Adictivos, Instituto Carlos III. Sinesio Delgado, Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS); Rosselló, Barcelona, Spain
| | | | - Guillermina Natera
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Miriam Arroyo
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Natalia Bautista
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martin de Porres, Peru
| | - Ines V. Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martin de Porres, Peru
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Katherine Jackson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eva Jane-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Univ. Ramon Llull, ESADE, Barcelona, Spain
| | - Antoni Gual
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS); Rosselló, Barcelona, Spain
| | - Bernd Schulte
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Pefaur J, Toro L, Lorca E, Torres R. Impact of a National Multicentric Strategy to Support Kidney Transplant Patients During the COVID-19 Pandemic in Latin America: FUTAC Team Creation and Activities. Transplantation 2022; 106:680-684. [PMID: 34759256 PMCID: PMC8942594 DOI: 10.1097/tp.0000000000004001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jacqueline Pefaur
- Chilean Society of Nephrology, Providencia, Chile
- Division of Nephrology, Department of Medicine, Hospital Barros Luco Trudeau, Santiago, Chile
- Division of Nephrology, Clinica Santa Maria, Santiago, Chile
| | - Luis Toro
- Chilean Society of Nephrology, Providencia, Chile
- Division of Nephrology, Department of Medicine, Hospital Clinico Universidad de Chile, Santiago, Chile
- Centro de Investigacion Clinica Avanzada, Hospital Clinico Universidad de Chile, Santiago, Chile
- Critical Care Center, Clinica Las Condes, Santiago, Chile
| | - Eduardo Lorca
- Chilean Society of Nephrology, Providencia, Chile
- Departamento de Medicina Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Division of Nephrology, Hospital del Salvador, Servicio de Salud Metropolitano Oriente, Santiago, Chile
| | - Ruben Torres
- Chilean Society of Nephrology, Providencia, Chile
- Division of Nephrology, Department of Medicine, Hospital Clinico Universidad de Chile, Santiago, Chile
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Solovei A, Manthey J, Anderson P, Mercken L, Jané Llopis E, Natera Rey G, Pérez Gómez A, Mejía Trujillo J, Bustamante I, Piazza M, Pérez de León A, Arroyo M, de Vries H, Rehm J, Evers S. Costs of an Alcohol Measurement Intervention in Three Latin American Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:700. [PMID: 35055522 PMCID: PMC8776036 DOI: 10.3390/ijerph19020700] [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: 10/31/2021] [Revised: 12/26/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022]
Abstract
Alcohol measurement in health care settings is an effective intervention for reducing alcohol-related harm. However, in many countries, costs related to alcohol measurement have not yet been transparently assessed, which may hinder its adoption and implementation. Costs of an alcohol measurement programme in three upper-middle-income Latin American countries were assessed via questionnaires and compared, as part of the quasi-experimental SCALA study. Additional to the intervention costs, the costs of three implementation strategies: standard training and clinical package, intensive training and clinical package, and community support, were assessed and subsequently translated into costs per additional alcohol measurement session. Results demonstrated that costs for one alcohol measurement session ranged between Int$ 0.67 and Int$ 1.23 in Colombia, Int$ 1.19 and Int$ 2.57 in Mexico, and Int$ 1.11 and Int$ 2.14 in Peru. Costs were mainly driven by the salaries of the health professionals. Implementation strategies costs per additional alcohol measurement session ranged between Int$ 1.24 and Int$ 6.17. In all three countries, standard training and a clinical package may be a promising implementation strategy with a relatively low cost per additional alcohol measurement session.
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Affiliation(s)
- Adriana Solovei
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229HA Maastricht, The Netherlands; (P.A.); (L.M.); (E.J.L.); (H.d.V.)
| | - Jakob Manthey
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; (J.M.); (J.R.)
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
- Department of Psychiatry, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229HA Maastricht, The Netherlands; (P.A.); (L.M.); (E.J.L.); (H.d.V.)
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229HA Maastricht, The Netherlands; (P.A.); (L.M.); (E.J.L.); (H.d.V.)
- Department of Health Psychology, Faculty of Psychology and Educational Sciences, Open University Postbus 2960, 6401DL Heerlen, The Netherlands
| | - Eva Jané Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229HA Maastricht, The Netherlands; (P.A.); (L.M.); (E.J.L.); (H.d.V.)
- ESADE Business School, University Ramon Llull, Av. de Pedralbes, 60, 62, 08034 Barcelona, Spain
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
| | - Guillermina Natera Rey
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, Mexico City 14370, Mexico; (G.N.R.); (A.P.d.L.); (M.A.)
| | - Augusto Pérez Gómez
- Corporación Nuevos Rumbos, Calle 108 A # 4-15, Bogota 110111, Colombia; (A.P.G.); (J.M.T.)
| | - Juliana Mejía Trujillo
- Corporación Nuevos Rumbos, Calle 108 A # 4-15, Bogota 110111, Colombia; (A.P.G.); (J.M.T.)
| | - Inés Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb Ingeniería, Lima 15102, Peru; (I.B.); (M.P.)
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb Ingeniería, Lima 15102, Peru; (I.B.); (M.P.)
| | - Alejandra Pérez de León
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, Mexico City 14370, Mexico; (G.N.R.); (A.P.d.L.); (M.A.)
| | - Miriam Arroyo
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, Mexico City 14370, Mexico; (G.N.R.); (A.P.d.L.); (M.A.)
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229HA Maastricht, The Netherlands; (P.A.); (L.M.); (E.J.L.); (H.d.V.)
| | - Jürgen Rehm
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; (J.M.); (J.R.)
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya Str., 8, b. 2, 119992 Moscow, Russia
| | - Silvia Evers
- Department of Health Services Research CAPHRI Care, Public Health Research Institute, Maastricht University, POB 616, 6200MD Maastricht, The Netherlands;
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Wu H, Xu L, Zheng Y, Shi L, Zhai L, Xu F. Application of the Delphi Method in the Study of Depressive Disorder. Front Psychiatry 2022; 13:925610. [PMID: 35873226 PMCID: PMC9301200 DOI: 10.3389/fpsyt.2022.925610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Depressive disorder is a common mental disorder that has a high prevalence and low visiting rate, which caused patients years lived with disability. Due to the complexity of the depressive disorder, the Delphi method is a better choice compared with other commonly used methods, which provides a new perspective for the prevention and treatment of depression. This article will summarize the clinical studies of depressive disorders using the Delphi method from four perspectives, and summarize the advantages and disadvantages of the Delphi method in depressive disorders research, arguing that the Delphi method can cross the gap between clinical research and clinical practice, and is a highly practical part of the research process.
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Affiliation(s)
- Hengjin Wu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School of Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Linjie Xu
- Graduate School of Beijing University of Traditional Chinese Medicine, Beijing, China.,Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu Zheng
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lei Shi
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liangfan Zhai
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - FengQuan Xu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Kokole D, Jané-Llopis E, Natera Rey G, Aguilar NB, Medina Aguilar PS, Mejía-Trujillo J, Mora K, Restrepo N, Bustamante I, Piazza M, O’Donnell A, Solovei A, Mercken L, Schmidt CS, Lopez-Pelayo H, Matrai S, Braddick F, Gual A, Rehm J, Anderson P, de Vries H. Training primary health care providers in Colombia, Mexico and Peru to increase alcohol screening: Mixed-methods process evaluation of implementation strategy. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221112693. [PMID: 37091075 PMCID: PMC9924276 DOI: 10.1177/26334895221112693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Initial results from the SCALA study demonstrated that training primary health care providers is an effective implementation strategy to increase alcohol screening in Colombia, Mexico and Peru, but did not show evidence of superior performance for the standard compared to the shorter training arm. This paper elaborates on those outcomes by examining the relationship of training-related process evaluation indicators with the alcohol screening practice. Methods A mix of convergent and exploratory mixed-methods design was employed. Data sources included training documentation, post-training questionnaires, observation forms, self-report forms and interviews. Available quantitative data were compared on outcome measure - providers' alcohol screening. Results Training reach was high: three hundred fifty-two providers (72.3% of all eligible) participated in one or more training or booster sessions. Country differences in session length reflected adaptation to previous topic knowledge and experience of the providers. Overall, 49% of attendees conducted alcohol screening in practice. A higher dose received was positively associated with screening, but there was no difference between standard and short training arms. Although the training sessions were well received by participants, satisfaction with training and perceived utility for practice were not associated with screening. Profession, but not age or gender, was associated with screening: in Colombia and Mexico, doctors and psychologists were more likely to screen (although the latter represented only a small proportion of the sample) and in Peru, only psychologists. Conclusions The SCALA training programme was well received by the participants and led to half of the participating providers conducting alcohol screening in their primary health care practice. The dose received and the professional role were the key factors associated with conducting the alcohol screening in practice.Plain Language Summary: Primary health care providers can play an important role in detecting heavy drinkers among their consulting patients, and training can be an effective implementation strategy to increase alcohol screening and detection. Existing training literature predominantly focuses on evaluating trainings in high-income countries, or evaluating their effectiveness rather than implementation. As part of SCALA (Scale-up of Prevention and Management of Alcohol Use Disorders in Latin America) study, we evaluated training as implementation strategy to increase alcohol screening in primary health care in a middle-income context. Overall, 72.3% of eligible providers attended the training and 49% of training attendees conducted alcohol screening in practice after attending the training. Our process evaluation suggests that simple intervention with sufficient time to practice, adapted to limited provider availability, is optimal to balance training feasibility and effectiveness; that booster sessions are especially important in context with lower organizational or structural support; and that ongoing training refinement during the implementation period is necessary.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
- Univ. Ramon Llull, ESADE, Avenida de Pedralbes, 60, 62, 08034 Barcelona, Spain
- Institute for Mental Health Policy
Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
| | - Guillermina Natera Rey
- Instituto Nacional de Psiquiatría Ramón
de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, 14370 Ciudad de México,
CDMX, Mexico
| | - Natalia Bautista Aguilar
- Instituto Nacional de Psiquiatría Ramón
de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, 14370 Ciudad de México,
CDMX, Mexico
| | - Perla Sonia Medina Aguilar
- Instituto Nacional de Psiquiatría Ramón
de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, 14370 Ciudad de México,
CDMX, Mexico
| | | | - Katherine Mora
- Corporación Nuevos Rumbos, Calle 108 A # 4-15, Bogotá,
Colombia
| | | | - Ines Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano
Heredia, Ave. Honorio Delgado 430, Urb. Ingeniería, S.M.P. Lima -
Perú
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano
Heredia, Ave. Honorio Delgado 430, Urb. Ingeniería, S.M.P. Lima -
Perú
| | - Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne
NE2 4AX, UK
| | - Adriana Solovei
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
- Department of Health Psychology, Open University, Valkenburgerweg 177, 6419 AT Heerlen, the Netherlands
| | - Christiane Sybille Schmidt
- Centre for Interdisciplinary Addiction Research (ZIS), Department of
Psychiatry and Psychotherapy, University Medical Centre
Hamburg-Eppendorf, Hamburg, Germany
| | - Hugo Lopez-Pelayo
- Addictions Unit, Psychiatry Dept, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
- Red de Trastornos Adictivos, Instituto Carlos III, Sinesio Delgado, 4, 28029 – Madrid, Spain
- Institut d’Investigacions Biomèdiques
August Pi Sunyer (IDIBAPS), Rosselló, 149-153, 08036 Barcelona, Spain
| | - Silvia Matrai
- Addictions Unit, Psychiatry Dept, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
| | - Fleur Braddick
- Addictions Unit, Psychiatry Dept, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
| | - Antoni Gual
- Addictions Unit, Psychiatry Dept, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
- Red de Trastornos Adictivos, Instituto Carlos III, Sinesio Delgado, 4, 28029 – Madrid, Spain
- Institut d’Investigacions Biomèdiques
August Pi Sunyer (IDIBAPS), Rosselló, 149-153, 08036 Barcelona, Spain
| | - Jürgen Rehm
- Institute for Mental Health Policy
Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
- Dalla Lana School of Public
Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7,
Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8,
Canada
- Department of International Health Projects, Institute for
Leadership and Health Management, I.M. Sechenov First Moscow State Medical
University, Trubetskaya str., 8, b. 2, 119992, Moscow, Russian Federation
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne
NE2 4AX, UK
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health
Research Institute, Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
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