1
|
Zok A, Matecka M, Bienkowski A, Ciesla M. Reduce stress and the risk of burnout by using yoga techniques. Pilot study. Front Public Health 2024; 12:1370399. [PMID: 38699423 PMCID: PMC11064875 DOI: 10.3389/fpubh.2024.1370399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/01/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction This article examines the effectiveness of yoga in managing stress, with a particular focus on work-related stress. Yoga combines physical postures, breath control, and meditation, and has gained recognition for its potential to relieve stress. Purpose This study aimed to investigate the motivating factors behind individuals adopting yoga exercises and to assess the effects of regular yoga practice, with a particular focus on age-related differences. Additionally, we aimed to compare participants' expectations with the actual results of their yoga practice. Methods To achieve this, we conducted a comprehensive survey using an online form, which was completed by 520 yoga practitioners. Participants were surveyed about their motivation, the effects they experienced, and the type of yoga they practiced. Results The results showed that the most common motivation for individuals practicing yoga was stress reduction. Additionally, the analysis of the effects of regular yoga practice demonstrated a significant reduction in stress levels, with experienced practitioners reporting lower stress levels compared to beginners. In conclusion, the study suggests that regular yoga practice can be an effective way to reduce stress levels. Conclusion Dynamic forms of yoga, which incorporate fluid movements and synchronized breathing techniques, are highly effective approaches to stress management and relief. These findings highlight the value of yoga as a tool for individuals of all ages seeking stress relief and overall well-being. Another advantage of yoga practice is its affordability and lack of negative side effects.
Collapse
Affiliation(s)
- Agnieszka Zok
- Department of Philosophy of Medicine and Bioethics, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Matecka
- Department of Occupational Therapy, Poznan University of Medical Sciences, Poznań, Poland
| | - Artur Bienkowski
- Department of Philosophy of Medicine and Bioethics, Poznan University of Medical Sciences, Poznan, Poland
| | - Magdalena Ciesla
- Department of Philosophy of Medicine and Bioethics, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
2
|
Ježková Petrů G, Zychová K, Drahotová K, Kuralová K, Kvasničková Stanislavská L, Pilař L. Identifying the communication of burnout syndrome on the Twitter platform from the individual, organizational, and environmental perspective. Front Psychol 2023; 14:1236491. [PMID: 37928590 PMCID: PMC10621209 DOI: 10.3389/fpsyg.2023.1236491] [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: 06/07/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023] Open
Abstract
Addressing the escalating prevalence of burnout syndrome, which affects individuals across various professions and domains, is becoming increasingly imperative due to its profound impact on personal and professional aspects of employees' lives. This paper explores the intersection of burnout syndrome and human resource management, recognizing employees as the primary assets of organizations. It emphasizes the growing importance of nurturing employee well-being, care, and work-life balance from a human resource management standpoint. Employing social media analysis, this study delves into Twitter-based discourse on burnout syndrome, categorizing communication into three distinct dimensions: individual, organizational, and environmental. This innovative approach provides fresh insights into interpreting burnout syndrome discourse through big data analysis within social network analysis. The methodology deployed in this study was predicated upon the enhanced Social Media Analysis based on Hashtag Research framework and frequency, topic and visual analysis were conducted. The investigation encompasses Twitter communication from January 1st, 2019, to July 31st, 2022, comprising a dataset of 190,770 tweets. Notably, the study identifies the most frequently used hashtags related to burnout syndrome, with #stress and #mentalhealth leading the discussion, followed closely by #selfcare, #wellbeing, and #healthcare. Moreover, a comprehensive analysis unveils seven predominant topics within the discourse on burnout syndrome: organization, healthcare, communication, stress and therapy, time, symptoms, and leadership. This study underscores the evolving landscape of burnout syndrome communication and its multifaceted implications for individuals, organizations, and the broader environment, shedding light on the pressing need for proactive interventions. In organizations at all levels of management, the concept of burnout should be included in the value philosophy of organizations and should focus on organizational aspects, working hours and work-life balance for a healthier working environment and well-being of employees at all levels of management.
Collapse
Affiliation(s)
- Gabriela Ježková Petrů
- Department of Management, Faculty of Economics and Management, Czech University of Life Sciences Prague, Prague, Czechia
| | - Kristýna Zychová
- Department of Management, Faculty of Economics and Management, Czech University of Life Sciences Prague, Prague, Czechia
| | - Kateřina Drahotová
- Department of Management, Faculty of Economics and Management, Czech University of Life Sciences Prague, Prague, Czechia
| | - Kateřina Kuralová
- Department of Management, Faculty of Economics and Management, Czech University of Life Sciences Prague, Prague, Czechia
| | - Lucie Kvasničková Stanislavská
- Department of Management, Faculty of Economics and Management, Czech University of Life Sciences Prague, Prague, Czechia
| | - Ladislav Pilař
- Department of Management, Faculty of Economics and Management, Czech University of Life Sciences Prague, Prague, Czechia
| |
Collapse
|
3
|
Hodkinson A, Zhou A, Johnson J, Geraghty K, Riley R, Zhou A, Panagopoulou E, Chew-Graham CA, Peters D, Esmail A, Panagioti M. Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis. BMJ 2022; 378:e070442. [PMID: 36104064 PMCID: PMC9472104 DOI: 10.1136/bmj-2022-070442] [Citation(s) in RCA: 105] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the association of physician burnout with the career engagement and the quality of patient care globally. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, PsycINFO, Embase, and CINAHL were searched from database inception until May 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Observational studies assessing the association of physician burnout (including a feeling of overwhelming emotional exhaustion, feelings of cynicism and detachment from job defined as depersonalisation, and a sense of ineffectiveness and little personal accomplishment) with career engagement (job satisfaction, career choice regret, turnover intention, career development, and productivity loss) and the quality of patient care (patient safety incidents, low professionalism, and patient satisfaction). Data were double extracted by independent reviewers and checked through contacting all authors, 84 (49%) of 170 of whom confirmed their data. Random-effect models were used to calculate the pooled odds ratio, prediction intervals expressed the amount of heterogeneity, and meta-regressions assessed for potential moderators with significance set using a conservative level of P<0.10. RESULTS 4732 articles were identified, of which 170 observational studies of 239 246 physicians were included in the meta-analysis. Overall burnout in physicians was associated with an almost four times decrease in job satisfaction compared with increased job satisfaction (odds ratio 3.79, 95% confidence interval 3.24 to 4.43, I2=97%, k=73 studies, n=146 980 physicians). Career choice regret increased by more than threefold compared with being satisfied with their career choice (3.49, 2.43 to 5.00, I2=97%, k=16, n=33 871). Turnover intention also increased by more than threefold compared with retention (3.10, 2.30 to 4.17, I2=97%, k=25, n=32 271). Productivity had a small but significant effect (1.82, 1.08 to 3.07, I2=83%, k=7, n=9581) and burnout also affected career development from a pooled association of two studies (3.77, 2.77 to 5.14, I2=0%, n=3411). Overall physician burnout doubled patient safety incidents compared with no patient safety incidents (2.04, 1.69 to 2.45, I2=87%, k=35, n=41 059). Low professionalism was twice as likely compared with maintained professionalism (2.33, 1.96 to 2.70, I2=96%, k=40, n=32 321), as was patient dissatisfaction compared with patient satisfaction (2.22, 1.38 to 3.57, I2=75%, k=8, n=1002). Burnout and poorer job satisfaction was greatest in hospital settings (1.88, 0.91 to 3.86, P=0.09), physicians aged 31-50 years (2.41, 1.02 to 5.64, P=0.04), and working in emergency medicine and intensive care (2.16, 0.98 to 4.76, P=0.06); burnout was lowest in general practitioners (0.16, 0.03 to 0.88, P=0.04). However, these associations did not remain significant in the multivariable regressions. Burnout and patient safety incidents were greatest in physicians aged 20-30 years (1.88, 1.07 to 3.29, P=0.03), and people working in emergency medicine (2.10, 1.09 to 3.56, P=0.02). The association of burnout with low professionalism was smallest in physicians older than 50 years (0.36, 0.19 to 0.69, P=0.003) and greatest in physicians still in training or residency (2.27, 1.45 to 3.60, P=0.001), in those who worked in a hospital (2.16, 1.46 to 3.19, P<0.001), specifically in emergency medicine specialty (1.48, 1.01 to 2.34, P=0.042), or situated in a low to middle income country (1.68, 0.94 to 2.97, P=0.08). CONCLUSIONS This meta-analysis provides compelling evidence that physician burnout is associated with poor function and sustainability of healthcare organisations primarily by contributing to the career disengagement and turnover of physicians and secondarily by reducing the quality of patient care. Healthcare organisations should invest more time and effort in implementing evidence-based strategies to mitigate physician burnout across specialties, and particularly in emergency medicine and for physicians in training or residency. SYSTEMATIC REVIEW REGISTRATION PROSPERO number CRD42021249492.
Collapse
Affiliation(s)
- Alexander Hodkinson
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Anli Zhou
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Keith Geraghty
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Ruth Riley
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Andrew Zhou
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Efharis Panagopoulou
- Laboratory of Hygiene, Aristotle Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - David Peters
- Westminster Centre for Resilience, Faculty of Science and Technology, University of Westminster, London, UK
| | - Aneez Esmail
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Maria Panagioti
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| |
Collapse
|
4
|
The Influence of Work-Family Conflict on Burnout during the COVID-19 Pandemic: The Effect of Teleworking Overload. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910302. [PMID: 34639602 PMCID: PMC8507633 DOI: 10.3390/ijerph181910302] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/01/2022]
Abstract
If there is any field that has experienced changes as a result of the COVID-19 pandemic, it is work, primarily due to the implementation of teleworking and the effort made by workers and families to face new responsibilities. In this context, the study aims to analyze the impact of work–family conflict on burnout, considering work overload, in teleworkers during the COVID-19 pandemic. To evaluate the hypotheses, we used data collected during the last week of July 2020 using an online survey. Work–family conflict and burnout were measured using the Gutek et al. (1991) and Shirom (1989) scales. We tested the hypotheses using a structural equation model (SEM). The results indicated, between other findings, that there was a positive relationship between work–family conflict and family–work conflict and all the dimensions of burnout. However, there was no effect of teleworking overload in the work–family conflict and burnout relationship. This article is innovative because it highlights the importance of the economic and regulatory conditions that have surrounded the modality of teleworking during the pandemic, and their influence on wellbeing and psychosocial risks in workers.
Collapse
|
5
|
Predictors of Occupational Burnout: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179188. [PMID: 34501782 PMCID: PMC8430894 DOI: 10.3390/ijerph18179188] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/16/2022]
Abstract
We aimed to review occupational burnout predictors, considering their type, effect size and role (protective versus harmful), and the overall evidence of their importance. MEDLINE, PsycINFO, and Embase were searched from January 1990 to August 2018 for longitudinal studies examining any predictor of occupational burnout among workers. We arranged predictors in four families and 13 subfamilies of homogenous constructs. The plots of z-scores per predictor type enabled graphical discrimination of the effects. The vote-counting and binomial test enabled discrimination of the effect direction. The size of the effect was estimated using Cohen's formula. The risk of bias and the overall evidence were assessed using the MEVORECH and GRADE methods, respectively. Eighty-five studies examining 261 predictors were included. We found a moderate quality of evidence for the harmful effects of the job demands subfamily (six predictors), and negative job attitudes, with effect sizes from small to medium. We also found a moderate quality of evidence for the protective effect of adaptive coping (small effect sizes) and leisure (small to medium effect sizes). Preventive interventions for occupational burnout might benefit from intervening on the established predictors regarding reducing job demands and negative job attitudes and promoting adaptive coping and leisure.
Collapse
|
6
|
Burnout Among Hospital Non-Healthcare Staff: Influence of Job Demand-Control-Support, and Effort-Reward Imbalance. J Occup Environ Med 2021; 63:e13-e20. [PMID: 33149005 DOI: 10.1097/jom.0000000000002072] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To study the prevalence of burnout among non-health care workers (NHCW), the risk and protective factors and to quantify the risk of burnout. METHOD We conducted a cross-sectional study on the 3142 NHCW of the University Hospital of Clermont-Ferrand. They received a self-assessment questionnaire. RESULTS Four hundred thirty seven (13.9%) NHCW completed the questionnaires. More than three quarter (75.4%) of NHCW was in burnout, with one in five (18.7%) having a severe burnout. Job demand was the main factor explaining the increase in exhaustion and overinvestment was the main factor explaining the increase in cynicism. Effort-reward imbalance (ERI) multiplied the risk of severe burnout by 11.2, job strain by 3.32 and isostrain by 3.74. CONCLUSION NHCW from hospital staff are at high risk of burnout. The two major models of stress at work, the job demand-control-support and the ERI, were highly predictive of burnout, with strong dose-response relationships.
Collapse
|
7
|
Effect of job situational factors on work outcomes of facilities managers. FACILITIES 2021. [DOI: 10.1108/f-08-2020-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to investigate how the situational factors that facilities managers (FMs) in Singapore face in their jobs affect their work outcomes. Job situation factors such as types of tasks, interpersonal relationships in teams, supervisors’ actions and advancements opportunities are classified into job characteristics, social environment characteristics, leadership and organisational practices categories.
Design/methodology/approach
Based on a systematic literature review, a questionnaire was designed to collect data on work outcomes and job situational factors from FMs working in public housing estates in Singapore. Using the Statistical Package for the Social Science software, inferential statistical analyses were carried out.
Findings
FMs reported that they used economical means and resources to carry out their work significantly frequently and achieved significantly high productivity. Complaints are received significantly frequently and maintenance defects are regularly encountered. Many of the job situational factors are present and found to be significantly correlated with work outcomes and some of these may be used to predict FMs’ work outcomes. Based on the correlation results, the frequency of complaints from residents may be reduced through the following ways: make FMs’ work tasks less challenging; reduce the variety of work tasks that FMs need to execute; reduce FMs’ work volume and speed of work.
Research limitations/implications
This study is limited to FMs managing public housing estates in Singapore. The work outcomes are self-reported, and thus susceptible to bias. However, as the respondents reported significantly frequent complaints and defects, this might indicate that the bias is not serious.
Practical implications
FMs’ jobs should be broken down into small parts/tasks and assigned to different FMs to specialise. This makes FMs’ tasks less challenging, and allows them to specialise to increase their productivity, improve their quality of work and overcome the problem of high work volume or demanding work speed. By adopting job specialisation, the frequency of receiving complaints from residents may be reduced.
Originality/value
This study discovered strategies to reduce the number of complaints from residents of public housing about facilities management. The contribution to knowledge is that complaints by residents on facilities management can be reduced by adopting job specialisation but not job enlargement. Decomposing work into different tasks and allowing FMs to focus on a few tasks would lead to a reduction in complaints. It also enables FMs to master the skill and complete the tasks without much oversight or supervision.
Collapse
|
8
|
Sehsah R, Gaballah MH, El-Gilany AH, Albadry AA. Work burnout and coping strategies among Egyptian forensic physicians: a national study. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2021. [DOI: 10.1186/s41935-021-00230-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Forensic physicians are confronted daily with highly stressful and traumatic duties. With repeated exposure, they are at risk of psychological distress, especially burnout. The current study’s objective was to measure the prevalence of burnout and its associated factors among Egyptian forensic physicians, describe their coping strategies, and the correlation between burnout levels and coping strategies. A cross-sectional study on Egyptian forensic physicians was carried out using a self-administered questionnaire. It included personal and occupational data, Maslach Burnout Inventory, and the Brief COPE Inventory. Multivariable logistic regression was performed to identify significant independent predictors of burnout. The correlation between burnout and coping was examined.
Results
Moderate/high levels of burnout were scored by 72.9 %, 51.9%, and 75.9% of forensic physicians in the emotional exhaustion, depersonalization, and personal accomplishment subscales, respectively. The significant independent predictors of high emotional exhaustion were being a forensic examiner (AOR, 3.1; 95% CI, 1.3–7.6) and facing stressful job duties more than five times per month (AOR, 4.4; 95% CI, 1.6–12.3). The predictor of high depersonalization was being a forensic examiner (AOR, 22.8; 95% CI, 8.0–64.8), and for low personal accomplishment was being a female (AOR, 3.0; 95% CI, 1.3–6.8). The most frequent coping strategies adopted by forensic physicians were adaptive coping.
Conclusions
Egyptian forensic physicians have a high prevalence of burnout. Forensic examiners, females with high exposure to stressful duties are more likely to have high burnout levels. Thus, psychoeducation and psychological support services should be applied and made easily accessible to them.
Collapse
|
9
|
Anser MK, Ali M, Anwar F, Usman M. Subjective Age and Job Satisfaction: A Moderated Mediation Model of Job Burnout and Chronological Age. Front Public Health 2020; 8:62. [PMID: 32211366 PMCID: PMC7067820 DOI: 10.3389/fpubh.2020.00062] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/19/2020] [Indexed: 11/13/2022] Open
Abstract
Corresponding to the growing calls for theory-driven research on the age-job satisfaction association, the present study investigated direct and indirect (via job burnout) relationships between subjective age (felt age) and job satisfaction. The study also examined the moderating role of chronological age on both direct and indirect (via job burnout) relationships between subjective age and job satisfaction. Survey data were collected in three waves (2 months apart) from 355 employees in 62 firms operating in various service and manufacturing industry sectors in Pakistan. Data were analyzed using structural equation modeling, PROCESS macro for SPSS, and bootstrapping technique. The results showed subjective age was negatively related to job satisfaction, both directly (β = -0.19, p < 0.001) and indirectly, via job burnout (β = -0.09, bootstrap 95% confidence interval limits did not overlap with zero; lower limit = -0.15, upper limit = -0.04). Interestingly, the interaction term (relative subjective age × chronological age) had a significant negative effect on the direct negative association between subjective age and job satisfaction (B = -0.12, p < 0.05) and a significant positive effect on the direct positive relationship between subjective age and job burnout (B = 0.14, p < 0.01), showing that chronological age moderated the direct relationships of subjective age with job satisfaction and job burnout, respectively. Importantly, the results showed that chronological age moderated the indirect association (via job burnout) between subjective age and job satisfaction [bootstrap estimate = -0.025, bias-corrected confidence interval (-0.06, -0.002)]. The present study contributed to the literature on the age-job satisfaction association by suggesting subjective age as an alternative vantage point to look at this link between age and job satisfaction. The findings carry useful practical implications that can help managers counter age stereotyping, employees' feelings of job burnout, and a low level of employees' job satisfaction.
Collapse
Affiliation(s)
- Muhammad Khalid Anser
- School of Public Administration, Xi'an University of Architecture and Technology, Xi'an, China
| | - Moazzam Ali
- Department of Management Sciences, University of Okara, Okara, Pakistan
| | - Farooq Anwar
- Lahore Business School, The University of Lahore, Lahore, Pakistan
| | - Muhammad Usman
- Department of Management Sciences, COMSATS University Islamabad, Lahore, Pakistan
| |
Collapse
|
10
|
Iskander M. Burnout, Cognitive Overload, and Metacognition in Medicine. MEDICAL SCIENCE EDUCATOR 2019; 29:325-328. [PMID: 34457483 PMCID: PMC8368405 DOI: 10.1007/s40670-018-00654-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Morkos Iskander
- Department of Educational Research, Faculty of Social Sciences, Lancaster University, Lancaster, UK
- Health Education North West, Liverpool, Merseyside UK
| |
Collapse
|