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Edwards N, Walker S, Paddick SM, Prina AM, Chinnasamy M, Reddy N, Mboya IB, Mtei M, Varghese M, Nakkasuja N, Guerra M, Sapkota N, Dotchin C. Prevalence of depression and anxiety in older people in low- and middle- income countries in Africa, Asia and South America: A systematic review and meta-analysis. J Affect Disord 2023; 325:656-674. [PMID: 36681304 DOI: 10.1016/j.jad.2023.01.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND There is rapid growth of older people in Low- and Middle- Income Countries (LMICs). The aim of this review was to assess the literature on prevalence of anxiety and depression in this demographic, which to our knowledge, has not yet been conducted. METHODS Databases including Medline, PsychInfo, Embase, Scielo and African Journals Online were searched for terms including "mental disorders", "neurotic disorders", "mood disorders" and "anxiety disorders". Studies published between 1990 and 2020 providing data on older people (≥50 years) in LMICs (defined by World Bank Criteria) were included and quality-assessed. Meta-analysis was conducted on a subset of higher-quality studies to derive pooled prevalence estimates of depression. RESULTS One hundred and forty relevant studies were identified, of which thirty-two were included in meta-analysis. One hundred and fifteen studies reported depression prevalence only, 19 reported both depression and anxiety, and six reported anxiety only. In all studies identified, depression prevalence ranged from 0.5 % to 62.7 %, and Generalised Anxiety Disorder prevalence ranged from 0.2 % to 32.2 %. The pooled prevalence of depression on meta-analysis was 10.5 % (95 % CI, 8.9 % - 11.2 %). Reported prevalence rates of depression were significantly different in studies using ICD-10 compared with DSM criteria, and between community and clinical settings. LIMITATIONS The search strategy contained bias towards English language papers and high income country (HIC) publications. There is significant heterogeneity within the meta-analysis. DISCUSSION A wide range of methodologies and clinical criteria are used in prevalence studies of depression and anxiety in older people. Studies using screening tools found higher prevalence rates; clinicians and researchers should ensure diagnosis is made with gold-standard clinical criteria. Meta-analysis data suggest that rates of depression are similar in older people in LMICs compared to HICs but mental healthcare resources are limited, suggesting a large potential treatment gap.
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Affiliation(s)
- N Edwards
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle-Upon-Tyne, UK.
| | - S Walker
- Translational and Clinical Research Institute, Newcastle University, Newcastle-Upon-Tyne, UK
| | - S-M Paddick
- Department of Old Age Psychiatry, Gateshead Health NHS Foundation Trust, Tyne and Wear, UK; Population Health Sciences Institute, Newcastle University, Newcastle-Upon-Tyne, UK
| | - A M Prina
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M Chinnasamy
- Bradford Primary Care NHS Foundation Trust, Bradford, UK
| | - N Reddy
- Newcastle University, Newcastle-Upon-Tyne, UK
| | - I B Mboya
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - M Mtei
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - M Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - N Nakkasuja
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - M Guerra
- Memory and Depression Centre, Cayetano Heredia Peruvian University, Peru
| | - N Sapkota
- B.P Koirala Institute of Health Sciences, Dhahran, Eastern Nepal, Nepal
| | - C Dotchin
- Department of Old Age Psychiatry, Gateshead Health NHS Foundation Trust, Tyne and Wear, UK; Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
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Kamoga R, Mubangizi V, Owokuhaisa J, Muwanguzi M, Natakunda S, Rukundo GZ. Behavioral and Psychological Symptoms of Dementia: Prevalence, Symptom Severity, and Caregiver Distress in South-Western Uganda-A Quantitative Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2336. [PMID: 36767708 PMCID: PMC9916294 DOI: 10.3390/ijerph20032336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
The purpose of the study was to investigate behavioral and psychological symptoms (BPSD) prevalence, severity, and distress experienced by caregivers of people living with dementia (PLWD). A cross-sectional, population-based study was conducted in a rural area in southwestern Uganda. A Neuropsychiatric Inventory Questionnaire (NPI-Q) was used to determine the presence of BPSD as perceived by caregivers of PLWD. We carried out both descriptive and inferential data analysis. A total of 175 caregivers of PLWD were enrolled in this study. Among PLWD, 99% had presented BPSD in the past month. Hallucinations (75%) and dysphoria/depression (81%) were the two BPSD that occurred most frequently. Most participants (70%) stated that PLWD experienced hallucinations of significant severity. Aberrant motor activity was reported by 60% of the participants as the type of BPSD that caused severe distress. There was a high positive correlation (0.82) between the total severity score and total distress scores. Interventions aimed at addressing dysphoria and hallucinations may be essential for the reduction of caregiver distress. These findings point to the need for promoting early screening for BPSDs and the provision of support to caregivers.
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Affiliation(s)
- Ronald Kamoga
- Department of Anatomy, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Vincent Mubangizi
- Department of Community Practice and Family Medicine, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Judith Owokuhaisa
- Department of Physiotherapy, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Moses Muwanguzi
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Sylivia Natakunda
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
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Koren T, Fisher E, Webster L, Livingston G, Rapaport P. Prevalence of sleep disturbances in people with dementia living in the community: A systematic review and meta-analysis. Ageing Res Rev 2023; 83:101782. [PMID: 36356799 DOI: 10.1016/j.arr.2022.101782] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 11/01/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
Abstract
This study aimed to systematically review and meta-analyse the prevalence of sleep disturbances in people with dementia and examine demographic predictors and whether overall prevalence has changed over time. We searched Embase, MEDLINE and PsycINFO for studies reporting the prevalence of sleep disturbances in people with dementia living at home. We meta-analysed the data and calculated the pooled prevalence of sleep disturbances in people with dementia overall and in dementia subtypes. We used meta-regressions to investigate the effects of study characteristics, publication dates and participant demographics. Eleven studies fulfilled the inclusion criteria. The pooled prevalence of any symptoms of sleep disturbance was 26 % (95 % confidence intervals, CI: 23-30 %; n = 2719) and of clinically significant sleep disturbance 19 % (13-25 %; n = 2753). The pooled prevalence of sleep disturbance symptoms was significantly lower among people with Alzheimer's disease (24 %; 16-33 %, n = 310) than Lewy body dementia (49 %; 37-61 %, n = 65). Meta-regression analysis did not find that publication year, participant's age, sex and study quality predicted prevalence. Sleep disturbances are common among people with dementia living in the community, especially in Lewy body dementia. There was no change in prevalence according to publication dates, suggesting treatment has not improved over time.
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Affiliation(s)
- Tala Koren
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Emily Fisher
- Division of Psychology and Language Sciences, University College London, 26 Bedford Way, London WC1H 0AP, UK.
| | - Lucy Webster
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Gill Livingston
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Penny Rapaport
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
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Apolipoprotein E ϵ4 allele and neuropsychiatric symptoms among older adults in Central Africa (EPIDEMCA study). Int Psychogeriatr 2021; 33:295-306. [PMID: 33715647 DOI: 10.1017/s1041610220003993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate the association between neuropsychiatric symptoms and apolipoprotein E (APOE) ϵ4 allele among older people in Central African Republic (CAR) and the Republic of Congo (ROC). DESIGN Multicenter population-based study following a two-phase design. SETTING From 2011 to 2012, rural and urban areas of CAR and ROC. PARTICIPANTS People aged 65 and over. MEASUREMENTS Following screening using the Community Screening Interview for Dementia, participants with low cognitive scores (CSI-D ≤ 24.5) underwent clinical assessment. Dementia diagnosis followed the DSM-IV criteria and Peterson's criteria were considered for Mild Cognitive Impairment (MCI). Neuropsychiatric symptoms were evaluated through the brief version of the Neuropsychiatric Inventory (NPI-Q). Blood samples were taken from all consenting participants before APOE genotyping was performed by polymerase chain reaction (PCR). Logistic regression models were used to evaluate the association between the APOE ϵ4 allele and neuropsychiatric symptoms. RESULTS Overall, 322 participants had complete information on both neuropsychiatric symptoms and APOE status. Median age was 75.0 years and 81.1% were female. Neuropsychiatric symptoms were reported by 192 participants (59.8%) and at least 1 APOE ϵ4 allele was present in 135 (41.9%). APOE ϵ4 allele was not significantly associated with neuropsychiatric symptoms but showed a trend toward a protective effect in some models. CONCLUSION This study is the first one investigating the association between APOE ϵ4 and neuropsychiatric symptoms among older people in sub-Saharan Africa (SSA). Preliminary findings indicate that the APOE ϵ4 allele was not associated with neuropsychiatric symptoms. Further research seems, however, needed to investigate the protective trend found in this study.
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Höbler F, McGilton KS, Wittich W, Dupuis K, Reed M, Dumassais S, Mick P, Pichora-Fuller MK. Hearing Screening for Residents in Long-Term Care Homes Who Live with Dementia: A Scoping Review. J Alzheimers Dis 2021; 84:1115-1138. [PMID: 34633326 PMCID: PMC8673512 DOI: 10.3233/jad-215087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hearing loss is highly prevalent in older adults, particularly among those living with dementia and residing in long-term care homes (LTCHs). Sensory declines can have deleterious effects on functioning and contribute to frailty, but the hearing needs of residents are often unrecognized or unaddressed. OBJECTIVE To identify valid and reliable screening measures that are effective for the identification of hearing loss and are suitable for use by nursing staff providing care to residents with dementia in LTCHs. METHODS Electronic databases (Embase, Medline, PsycINFO, CENTRAL, and CINAHL) were searched using comprehensive search strategies, and a stepwise approach based on Arksey & O'Malley's scoping review and appraisal process was followed. RESULTS There were 193 scientific papers included in the review. Pure-tone audiometry was the most frequently reported measure to test hearing in older adults living with dementia. However, measures including self- or other-reports and questionnaires, review of medical records, otoscopy, and the whisper test were found to be most suitable for use by nurses working with older adults living with dementia in LTCHs. CONCLUSION Although frequently used, the suitability of pure-tone audiometry for use by nursing staff in LTCHs is limited, as standardized audiometry presents challenges for many residents, and specific training is needed to successfully adapt test administration procedures and interpret results. The whisper test was considered to be more suitable for use by staff in LTCH; however, it yields a limited characterization of hearing loss. There remains an urgent need to develop new approaches to screen hearing in LTCHs.
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Affiliation(s)
- Fiona Höbler
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katherine S. McGilton
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Walter Wittich
- École d’optométrie, Université de Montréal, Montréal, QC, Canada
- Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, QC, Canada
- Centre de réadaptation Lethbridge-Layton-Mackay du CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, Montréal, QC, Canada
| | - Kate Dupuis
- Sheridan Centre for Elder Research, Sheridan College, Oakville, ON, Canada
| | - Marilyn Reed
- Audiology, Baycrest Health Sciences, Toronto, ON, Canada
| | - Shirley Dumassais
- École d’optométrie, Université de Montréal, Montréal, QC, Canada
- Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, QC, Canada
| | - Paul Mick
- Department of Surgery, Faculty of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Saari T, Koivisto A, Hintsa T, Hänninen T, Hallikainen I. Psychometric Properties of the Neuropsychiatric Inventory: A Review. J Alzheimers Dis 2020; 86:1485-1499. [PMID: 32925068 PMCID: PMC9108559 DOI: 10.3233/jad-200739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neuropsychiatric symptoms cause a significant burden to individuals with neurocognitive disorders and their families. Insights into the clinical associations, neurobiology, and treatment of these symptoms depend on informant questionnaires, such as the commonly used Neuropsychiatric Inventory (NPI). As with any scale, the utility of the NPI relies on its psychometric properties, but the NPI faces unique challenges related to its skip-question and scoring formats. In this narrative review, we examined the psychometric properties of the NPI in a framework including properties pertinent to construct validation, and health-related outcome measurement in general. We found that aspects such as test-retest and inter-rater reliability are major strengths of the NPI in addition to its flexible and relatively quick administration. These properties are desired in clinical trials. However, the reported properties appear to cover only some of the generally examined psychometric properties, representing perhaps necessary but insufficient reliability and validity evidence for the NPI. The psychometric data seem to have significant gaps, in part because small sample sizes in the relevant studies have precluded more comprehensive analyses. Regarding construct validity, only one study has examined structural validity with the NPI subquestions. Measurement error was not assessed in the reviewed studies. For future validation, we recommend using data from all subquestions, collecting larger samples, paying specific attention to construct validity and formulating hypotheses a priori. Because the NPI is an outcome measure of interest in clinical trials, examining measurement error could be of practical importance.
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Affiliation(s)
- Toni Saari
- University of Eastern Finland, Neurology, Kuopio, Finland.,University of Eastern Finland, School of Educational Sciences and Psychology, Joensuu, Finland
| | - Anne Koivisto
- University of Eastern Finland, Neurology, Kuopio, Finland.,Kuopio University Hospital, Neurology, Kuopio, Finland.,University of Helsinki, Department of Neurosciences, Helsinki, Finland.,Helsinki University Hospital, Geriatrics, Department of Internal Medicine and Rehabilitation, Helsinki, Finland
| | - Taina Hintsa
- University of Eastern Finland, Neurology, Kuopio, Finland
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Yoro-Zohoun I, Houinato D, Nubukpo P, Mbelesso P, Ndamba-Bandzouzi B, Clément JP, Dartigues JF, Preux PM, Guerchet M. Severity of Neuropsychiatric Symptoms and Distress in Dementia among Older People in Central Africa (EPIDEMCA Study). J Am Geriatr Soc 2019; 68:180-185. [PMID: 31681982 DOI: 10.1111/jgs.16234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Neuropsychiatric symptoms are common in dementia. Limited data are available concerning their association with dementia in developing countries. Our aim was to describe the severity of neuropsychiatric symptoms among older people, evaluate the distress experienced by caregivers, and assess which neuropsychiatric symptoms were specifically associated with dementia among older adults in Central Africa. DESIGN This study is part of the EPIDEMCA program, a cross-sectional multicenter population-based study. SETTING The EPIDEMCA program was conducted from November 2011 to December 2012 in urban and rural areas of the Central African Republic and the Republic of the Congo. PARTICIPANTS Participants were older people (≥65 y) included in the EPIDEMCA program who underwent a neuropsychiatric evaluation. The sample included overall 532 participants, of whom 130 participants had dementia. MEASUREMENTS Neuropsychiatric symptoms were assessed with the brief version of the Neuropsychiatric Inventory including the evaluation of severity and associated distress. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision, criteria were followed to diagnose dementia. A logistic regression model was used to identify associated neuropsychiatric symptoms. RESULTS The prevalence of neuropsychiatric symptoms was 89.9% (95% confidence interval = 84.6-95.1) among people living with dementia. The overall median severity score for neuropsychiatric symptoms was 9 [interquartile range [IQR] = 6-12], and the overall median distress score was 7 [IQR = 4-10]. Overall median scores of both severity and distress were significantly increased with the number of neuropsychiatric symptoms, the presence of dementia, and dementia severity. Depression, delusions, apathy, disinhibition, and aberrant motor behavior were associated with dementia after multivariate analysis. CONCLUSION This report is one of the few population-based studies on neuropsychiatric symptoms among older people with dementia in Sub-Saharan Africa and the first one evaluating the severity of those symptoms and distress experienced by caregivers. Individual neuropsychiatric symptoms were strongly associated with dementia in older people and require great attention considering their burden on populations. J Am Geriatr Soc 68:180-185, 2019.
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Affiliation(s)
- Inès Yoro-Zohoun
- INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France.,Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, GEIST, Limoges, France.,Laboratory of Chronic Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, School of Health Sciences, University of Abomey-Calavi (UAC), Cotonou, Benin
| | - Dismand Houinato
- INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France.,Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, GEIST, Limoges, France.,Laboratory of Chronic Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, School of Health Sciences, University of Abomey-Calavi (UAC), Cotonou, Benin
| | - Philippe Nubukpo
- INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France.,Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, GEIST, Limoges, France.,CHS Esquirol, Limoges, France
| | - Pascal Mbelesso
- INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France.,Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, GEIST, Limoges, France.,Department of Neurology, Amitié Hospital, Bangui, Central African Republic
| | - Bébène Ndamba-Bandzouzi
- Department of Neurology, Brazzaville University Hospital, Brazzaville, Republic of the Congo
| | - Jean-Pierre Clément
- INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France.,Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, GEIST, Limoges, France.,Hospital and University Federation of Adult and Geriatric Psychiatry, Limoges, France
| | | | - Pierre-Marie Preux
- INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France.,Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, GEIST, Limoges, France.,Department of Medical Information and Evaluation, Clinical Research and Biostatistic Unit, Limoges University Hospital, Limoges, France
| | - Maëlenn Guerchet
- INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France.,Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, GEIST, Limoges, France.,King's College London, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neurosciences, London, United Kingdom
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Brooke J, Ojo O. Contemporary views on dementia as witchcraft in sub‐Saharan Africa: A systematic literature review. J Clin Nurs 2019; 29:20-30. [DOI: 10.1111/jocn.15066] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/12/2019] [Accepted: 08/24/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Joanne Brooke
- Faculty of Health, Education and Life Sciences Birmingham City University Birmingham UK
| | - Omorogieva Ojo
- Faculty of Education and Health University of Greenwich London UK
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