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Moncer R, Feni N, Houssem G, Loubiri I, Mtaouaa S, Jemni S, Abdelaziz AB. Unmet needs to admission in physical and rehabilitation inpatient department in Low and Middle Income Countries in 2023. PLoS One 2024; 19:e0309349. [PMID: 39418265 PMCID: PMC11486359 DOI: 10.1371/journal.pone.0309349] [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: 06/19/2024] [Accepted: 08/10/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND Determining the needs to access to rehabilitation structures is essential for developing effective improvement strategies. The objective of this study was to determine the percentage of unmet needs to admission to rehabilitation and their associated factors. METHODS It is a cross sectional study in the inpatient rehabilitation department Sahloul Hospital of Sousse, tertiary care center including all requests to admission. Patient demographics, diagnoses, admission decisions, and post-decision outcomes were collected for each request. RESULTS Of 329 admission requests, 316 were eligible. The mean patient age was 45 years, with a male-to-female ratio of 0.84. Most requests originated from the hospital's outpatient department, neurology, and orthopedics. Among all requests, 40.5% were not admitted. Non-neurological diagnoses and patient residency were associated with non-admission. Patients with non-neurological conditions and those residing outside the city had twice the risk of non-admission. At one month, 63% of non-admitted patients experienced functional decline, and 18% were lost to follow-up. CONCLUSION Unmet needs to admission in rehabilitation structures is high due to lack of beds. This is leading of inequity of access to such important phase of care more. This study highlighted throwing the example of physical and rehabilitation department the gap of needs and the capacity of inpatient rehabilitation facilities. Healthcare policies should prioritize increasing rehabilitation bed availability in all regions of the country.
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Affiliation(s)
- Rihab Moncer
- Physical and Rehabilitation Department Sahloul Hospital of Sousse, Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Research Laboratory LR19SP01, Tunisia
| | - Nedra Feni
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Physical and Rehabilitation Department Kairouan, Kairouan, Tunisia
| | - Ghorbel Houssem
- Physical and Rehabilitation Department Sahloul Hospital of Sousse, Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Ines Loubiri
- Physical and Rehabilitation Department Sahloul Hospital of Sousse, Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Sahbi Mtaouaa
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Physical and Rehabilitation Department Kairouan, Kairouan, Tunisia
| | - Sonia Jemni
- Physical and Rehabilitation Department Sahloul Hospital of Sousse, Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Ahmed Ben Abdelaziz
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Research Laboratory LR19SP01, Tunisia
- Information System Department, Sahloul Hospital of Sousse, Sousse, Tunisia
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Moncer R, Loubiri I, Melki S, Frigui S, Ouannes W, Ben Abdelaziz A, Jemni S. An update on the access to inpatient rehabilitation facilities across Tunisia in 2023. LA TUNISIE MEDICALE 2024; 102:83-86. [PMID: 38567473 PMCID: PMC11358814 DOI: 10.62438/tunismed.v102i2.4679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/27/2023] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Considering the growing global need and the complexity of health conditions, an intensive rehabilitation in inpatient departments is fundamental. Yet, in Tunisia, the distribution of Inpatient Rehabilitation Facilities is not illustrated. AIM To perform an update concerning the rehabilitation's beds-ratio /1000 Tunisian-inhabitants in 2023. METHODS Data were collected from the Tunisian Ministry of Health, the Eastern Mediterranean Regional Office, and the National Institute of Statistics websites. RESULTS The findings revealed a total number of rehabilitations' beds 132 among a total of 20000 hospital beds with a rehabilitations' beds-ratio equal to 0.01/1000 inhabitants. Only three Inpatient Rehabilitation Facilities were identified in Tunisia covering the Greater Tunis, North East, and Center east districts. There was inequity of distribution since the beds ratio is 1.07/1000 in the North east, 0.02/1000 in the Greater Tunis and 0 in the North West and the South of Tunisia. CONCLUSION This update highlighted the alarmingly low rehabilitation's beds-ratio in Tunisia, coupled to a significant regional disparity. Increasing beds in the existing Inpatient Rehabilitation Facilities and extending outpatient rehabilitation departments with inpatient units might be considered urgent solutions.
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Affiliation(s)
- Rihab Moncer
- Department of physical medicine, Sahloul hospital Sousse
- Faculty of medicine, University of Sousse, Sousse, Tunisia
| | - Ines Loubiri
- Department of physical medicine, Sahloul hospital Sousse
- Faculty of medicine, University of Sousse, Sousse, Tunisia
| | - Sarra Melki
- Faculty of medicine, University of Sousse, Sousse, Tunisia
- Information systems department, Sahloul hospital Sousse
- Research laboratory LR19SP01, Sousse
| | - Sinene Frigui
- Department of physical medicine, Sahloul hospital Sousse
- Faculty of medicine, University of Sousse, Sousse, Tunisia
| | - Walid Ouannes
- Department of physical medicine, Sahloul hospital Sousse
- Faculty of medicine, University of Sousse, Sousse, Tunisia
| | - Ahmed Ben Abdelaziz
- Faculty of medicine, University of Sousse, Sousse, Tunisia
- Information systems department, Sahloul hospital Sousse
- Research laboratory LR19SP01, Sousse
| | - Sonia Jemni
- Department of physical medicine, Sahloul hospital Sousse
- Faculty of medicine, University of Sousse, Sousse, Tunisia
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Kokorelias KM, Lee TSJ, Bayley M, Seto E, Toulany A, Nelson MLA, Dimitropoulos G, Penner M, Simpson R, Munce SEP. "I Have Eight Different Files at Eight Different Places": Perspectives of Youths and Their Family Caregivers on Transitioning from Pediatric to Adult Rehabilitation and Community Services. J Clin Med 2023; 12:jcm12041693. [PMID: 36836228 PMCID: PMC9960001 DOI: 10.3390/jcm12041693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION The number of young adults (youth) living with childhood-onset disabilities, and requiring transitional support to adult community and rehabilitation services, is increasing. We explored facilitators and barriers to accessing and sustaining community and rehabilitation services during the transition from pediatric to adult care. METHODS A qualitative descriptive study was conducted in Ontario, Canada. Data were collected through interviews with youth (n = 11) and family caregivers (n = 7). The data were coded and analyzed using thematic analysis. RESULTS Youth and caregivers face many types of transitions from pediatric to adult community and rehabilitation services, e.g., those related to education, living arrangements, and employment. This transition is marked by feelings of isolation. Supportive social networks, continuity of care (i.e., same care providers), and advocacy all contribute to positive experiences. Lack of knowledge about resources, changing parental involvement without preparation, and a lack of system responses to evolving needs were barriers to positive transitions. Financial circumstances were described as either a barrier or facilitator to service access. CONCLUSIONS This study demonstrated that continuity of care, support from providers, and social networks all contribute markedly to the positive experience of transitioning from pediatric to adult services for individuals with childhood-onset disabilities and family caregivers. Future transitional interventions should incorporate these considerations.
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Affiliation(s)
- Kristina M. Kokorelias
- Department of Medicine, Sinai Health System and University Health Network, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON M5G 2A2, Canada
- Department of Occupational Sciences and Occupational Therapy, Temetry Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Tin-Suet Joan Lee
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON M5G 2A2, Canada
| | - Mark Bayley
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON M5G 2A2, Canada
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Center for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Alene Toulany
- Department of Adolescent Medicine, the Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle L. A. Nelson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Melanie Penner
- Department of Pediatrics, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada
| | - Robert Simpson
- St. John’s Rehab Research Program at Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, North York, ON M2M 2G1, Canada
| | - Sarah E. P. Munce
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON M5G 2A2, Canada
- Department of Occupational Sciences and Occupational Therapy, Temetry Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Correspondence:
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Renard M, Gaboury I, Michaud F, Tousignant M. The acceptability of two remote monitoring modalities for patients waiting for services in a physiotherapy outpatient clinic. Musculoskeletal Care 2022; 20:616-624. [PMID: 35142425 DOI: 10.1002/msc.1622] [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: 09/14/2021] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Access to public rehabilitation services for patients with non-urgent conditions - which suffer mainly from musculoskeletal disorders - is problematic around the world. Remote rehabilitation services are recognized as effective means to increase accessibility. Patient acceptability is an important element in the successful implementation of such clinical innovations and has not yet been studied thoroughly in this context. Thus, the aim of this study was to evaluate and compare the acceptability of two remote consultation modalities - phone and teleconsultation - for patients waiting for public outpatient non-urgent rehabilitation services. METHODS We conducted a qualitative descriptive study nested within a randomized clinical trial in which participants received either phone or teleconsultation follow-ups with a physiotherapist after a first systematic face-to-face evaluation. Semi-structured interviews were conducted with participants of both groups selected with purposive sampling. Sekhon's acceptability metaframework was used and interviews were transcribed and coded with thematic analysis. ETHIC APPROVAL The research protocol was approved by the Research Ethics Board of the Centre intégré universitaire de santé et de services sociaux - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS) (#2019-2919). RESULTS Twenty participants were recruited. Results show both follow-up modalities have a good level of acceptability for participants; however, teleconsultation stands out because its visual dimension offers higher quality human contact and satisfactorily meets greater needs for support. CONCLUSION Systematic in-person assessment and advice combined with telephone or teleconsultation follow-up can contribute to diversifying the services offered in physiotherapy outpatient clinics. Offering a range of service modalities with different resource requirements may shorten wait times. Such an approach seems to be well accepted by patients, especially with teleconsultation. CLINICALTRIALS gov ID: NCT03991858.
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Affiliation(s)
- Marianne Renard
- Research Centre on Aging, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke (CIUSSS de l'Estrie CHUS), Sherbrooke, Quebec, Canada
| | - Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Faculty of Medecine and Health Sciences, Université de Sherbrooke, Longueuil, Quebec, Canada
| | - François Michaud
- Department of Electrical Engineering and Computer Engineering, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Michel Tousignant
- Research Centre on Aging, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke (CIUSSS de l'Estrie CHUS), Sherbrooke, Quebec, Canada
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Lundy DW, Harvey EJ, Jahangir AA, Leighton RK. Trauma systems in North America. OTA Int 2019; 2:e013. [PMID: 37681214 PMCID: PMC10481315 DOI: 10.1097/oi9.0000000000000013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/03/2018] [Indexed: 09/09/2023]
Abstract
North American trauma systems are well developed yet vary widely in form across the continent. Comparatively, the Canadian trauma system is more unified, and approximately 80% of Canadians live within 1 hour of a level I or II center. In the United States, trauma centers are specifically verified by the individual states and thus there tends to be more variability across the country. Although many states use the criteria developed by the American College of Surgeons Committee on Trauma, the individual agencies are free to utilize their own verification standards. Both Canada and the United States utilize efficient prehospital care, and both countries recognize that postdischarge care is a financial challenge to the system. Population dense areas offer rapid admission to well-developed trauma centers, but injured patients in remote areas may have challenges regarding access. Trauma centers are classified according to their capabilities from level I (highest ability) to level IV. Although each trauma system has opportunities for improvement, they both provide effective access and quality care to the vast majority of injured patients.
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Deslauriers S, Raymond MH, Laliberté M, Lavoie A, Desmeules F, Feldman DE, Perreault K. Access to publicly funded outpatient physiotherapy services in Quebec: waiting lists and management strategies. Disabil Rehabil 2016; 39:2648-2656. [PMID: 27758150 DOI: 10.1080/09638288.2016.1238967] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Problems with access to outpatient physiotherapy services have been reported in publicly funded healthcare systems worldwide. A few studies have reported management strategies aimed at reducing extensive waiting lists, but their association with waiting times is not fully understood. The purpose of this study was to document access to public outpatient physiotherapy services for persons with musculoskeletal disorders in hospitals and explore organizational factors associated with waiting time. METHODS We surveyed outpatient physiotherapy services in publicly funded hospitals in the province of Quebec (Canada). RESULTS A total of 97 sites responded (99%) to the survey. The median waiting time was more than six months for 41% of outpatient physiotherapy services. The waiting time management strategies most frequently used were attendance and cancelation policies (99.0%) and referral prioritization (95.9%). Based on multivariate analyses, the use of a prioritization process with an initial evaluation and intervention was associated with shorter waiting times (p = 0.008). CONCLUSIONS Our findings provide evidence that a large number of persons wait a long time for publicly funded physiotherapy services in Quebec. Based on our results, implementation of a prioritization process with an initial evaluation and intervention could help improve timely access to outpatient physiotherapy services. Implications for Rehabilitation Access to publicly funded outpatient physiotherapy services is limited by long waiting times in a great proportion of Quebec's hospitals. The use of a specific prioritization process that combines an evaluation and an intervention could possibly help improve timely access to services. Policy-makers, managers, and other stakeholders should work together to address the issue of limited access to publicly funded outpatient physiotherapy services.
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Affiliation(s)
- Simon Deslauriers
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Quebec City , Quebec , Canada.,b Department of Rehabilitation, Faculty of Medicine , Université Laval , Quebec City , Quebec , Canada
| | - Marie-Hélène Raymond
- c School of Rehabilitation, Faculty of Medicine , Université de Montréal , Montreal , Quebec , Canada.,d Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Quebec , Canada
| | - Maude Laliberté
- c School of Rehabilitation, Faculty of Medicine , Université de Montréal , Montreal , Quebec , Canada.,d Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Quebec , Canada
| | - Amélie Lavoie
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Quebec City , Quebec , Canada.,b Department of Rehabilitation, Faculty of Medicine , Université Laval , Quebec City , Quebec , Canada
| | - François Desmeules
- c School of Rehabilitation, Faculty of Medicine , Université de Montréal , Montreal , Quebec , Canada.,e Maisonneuve-Rosemont Hospital Research Centre , Montreal , Quebec , Canada
| | - Debbie E Feldman
- c School of Rehabilitation, Faculty of Medicine , Université de Montréal , Montreal , Quebec , Canada.,d Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Quebec , Canada.,f Direction of Public Health of the Centre intégré universitaire de santé et de services sociaux du Centre-Est-de-l'ḽle-de-Montréal , Montreal , Quebec , Canada
| | - Kadija Perreault
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Quebec City , Quebec , Canada.,b Department of Rehabilitation, Faculty of Medicine , Université Laval , Quebec City , Quebec , Canada
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Paquin K, Ali S, Carr K, Crawley J, McGowan C, Horton S. Effectiveness of commercial video gaming on fine motor control in chronic stroke within community-level rehabilitation. Disabil Rehabil 2015; 37:2184-91. [PMID: 25586794 DOI: 10.3109/09638288.2014.1002574] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effectiveness of commercial gaming as an intervention for fine motor recovery in chronic stroke. METHODS Ten chronic phase post-stroke participants (mean time since CVA = 39 mos; mean age = 72 yrs) completed a 16-session program using the Nintendo Wii for 15 min two times per week with their more affected hand (10 right handed). Functional recovery (Jebsen Hand Function Test (JHFT), Box and Block Test (BBT), Nine Hole Peg Test (NHPT)), and quality of life (QOL; Stroke Impact Scale (SIS)) were measured at baseline (pre-testing), after 8 sessions (mid-testing) and after 16 sessions (post-testing). RESULTS Significant improvements were found with the JHFT, BBT and NHPT from pre-testing to post-testing (p = 0.03, p = 0.03, p = 0.01, respectively). As well, there was an increase in perceived QOL from pre-testing to post-testing, as determined by the SIS (p = 0.009). CONCLUSION Commercial gaming may be a viable resource for those with chronic stroke. Future research should examine the feasibility of this as a rehabilitation tool for this population. IMPLICATIONS FOR REHABILITATION Stroke survivors often live with lasting effects from their injury, however, those with chronic stroke generally receive little to no rehabilitation due to a perceived motor recovery plateau. Virtual reality in the form of commercial gaming is a novel and motivating way for clients to complete rehabilitation. The Nintendo Wii may be a feasible device to improve both functional ability and perceived quality of life in chronic stroke survivors.
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Affiliation(s)
| | | | | | - Jamie Crawley
- b Faculty of Nursing , University of Windsor , Windsor , Ontario , Canada
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Teasell R, Meyer MJ, Foley N, Salter K, Willems D. Stroke rehabilitation in Canada: a work in progress. Top Stroke Rehabil 2009; 16:11-9. [PMID: 19443343 DOI: 10.1310/tsr1601-11] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Stroke rehabilitation in Canada continues to function under models and practices that have changed little in the last four decades and struggles to implement new evidence-based or best practices. Ontario, Canada's largest province, has had a coordinated stroke strategy since 2000. The Ontario Stroke System has developed an extensive infrastructure of research syntheses, consensus panel recommendations, practice guidelines, standards of care, and centralized data collection across the continuum of stroke care. This has produced a solid foundation upon which an evidence-based stroke rehabilitation system can be developed. However, failure to invest in stroke rehabilitation or provide incentives to implement change has resulted in the stroke rehabilitation system and critical outcomes remaining largely unchanged. Improvements in time to admission have been countered by rising admission FIM scores such that severe stroke patients often cannot access the stroke rehabilitation system. Many stroke patients are still rehabilitated on general rehabilitation units, therapy intensities remain unacceptably low, and many outpatient programs are being reduced or even closed. Although there are pockets of innovation, the stroke rehabilitation system continues to function more according to traditional ways of practicing. The hope is that with appropriate investments and incentives, Canadians and Ontarians can build upon the existing infrastructure to ensure stroke patients receive optimal rehabilitative care based on best evidence. In the meantime, stroke rehabilitation in Canada remains a work in progress.
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Affiliation(s)
- Robert Teasell
- Department of Physical Medicine and Rehabilitation, St. Joseph's Health Care, Schulich School of Medicine, University of Western Ontario, Aging, Rehabilitation and Geriatric Care Program, Lawson Health Reserach Institute, London, Ontario, Canada
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