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Sayeed MSI, Oakman J, Stuckey R. Factors influencing access to and participation in rehabilitation for people with lower limb amputation in East, South, and Southeast Asian developing countries: the perspective of rehabilitation professionals - a qualitative study. Disabil Rehabil 2024; 46:2097-2116. [PMID: 37272783 DOI: 10.1080/09638288.2023.2217383] [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: 07/20/2022] [Accepted: 05/17/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE To identify barriers and enablers for access to and participation in rehabilitation for people with LLA in East, South, and Southeast Asian developing countries from the perspective of rehabilitation professionals. MATERIAL AND METHODS A mixed-method study involving an anonymous cross-sectional screening survey followed by in-depth interviews of rehabilitation professionals in these regions following the COREQ guidelines. Participants were surveyed online using convenience and snowball sampling techniques to inform a purposive heterogenic sample for semi-structured online interviews, between September 2021 to February 2022. Interview transcripts were analysed and thematically coded using the modified Health Care Delivery System Approach (HCDSA) framework. RESULTS A total of 201 quantitative survey responses shaped the interview questions and participation of 28 participants from 13 countries for the qualitative investigation. Important factors at the patient level were sex, economics, health issues, language differences, and lack of awareness; at the care team level, peer and/or family support, referrals, and the gender of the professional; at the organizational level, service availability, resources, and quality; and at the environmental level, policies, supports, and physical and/or social accessibility. CONCLUSIONS Identified interlinked factors at multiple levels of the HCDSA underpin the need for a systems approach to develop and address regional rehabilitation service provision but requires contextually adapted policy.
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Affiliation(s)
- Md Shapin Ibne Sayeed
- Ergonomics, Safety and Health, Department of Public Health, La Trobe University, Melbourne, Australia
| | - Jodi Oakman
- Ergonomics, Safety and Health, Department of Public Health, La Trobe University, Melbourne, Australia
| | - Rwth Stuckey
- Ergonomics, Safety and Health, Department of Public Health, La Trobe University, Melbourne, Australia
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Sayeed MSI, Oakman J, Dillon MP, Stuckey R. Influential factors for access to and participation in rehabilitation for people with lower limb amputation in East, South, and Southeast Asian developing countries: a scoping review. Disabil Rehabil 2022; 44:8094-8109. [PMID: 34719308 DOI: 10.1080/09638288.2021.1994025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To explore factors impacting access to and participation in rehabilitation for people with lower limb amputation (LLA) in East, South, and Southeast Asian developing countries. MATERIALS AND METHODS A scoping review was undertaken following the PRISMA-ScR guidelines. Five electronic databases (PsycINFO (Ovid), Medline (Ovid), CINAHL (EBSCO), AMED, and Proquest Social Sciences) were searched for articles from January 1980 till March 2020. Two authors independently assessed articles for inclusion. Included articles were classified according to the Health Care Delivery System Approach (HCDSA) framework levels. RESULTS Twenty-four studies from 14 countries were identified. At patient level, age, gender, limited rehabilitation awareness, and economic status; at the rehabilitation level, gaps in referrals, family support, and professional skills; at the environmental level, services availability, and location; and, at government level, service costs, income loss, and lack of supporting policies were identified as important influencing factors. CONCLUSIONS Rehabilitation access and participation factors were identified at multiple levels of the HCDSA. Contextually appropriate and accessible services considering individual characteristics and socio-economic status of individuals with LLA are needed, with timely referral to rehabilitation by trained professionals. Improving rehabilitation services for people with LLA in Asian developing countries requires supportive environments, accessible transport, social and financial security, and increased awareness, underpinned by appropriate policy.Implications for rehabilitationProvision of timely referral to rehabilitation by primary/acute health care settings with involvement of family/peer supports.Improved government support systems to facilitate individual access to and participation in rehabilitation with consideration of contextual socio-demographic and economic factors.Prioritisation of adequately resourced and well-designed rehabilitation centres by health care organisations in accessible locations.Implementation by local government of strategies to support development and implementation of well resourced, accessible, equitable, and contextually responsive rehabilitation services.
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Affiliation(s)
- Md Shapin Ibne Sayeed
- Department of Public Health, Ergonomics, Safety and Health, La Trobe University, Melbourne, Australia
| | - Jodi Oakman
- Department of Public Health, Ergonomics, Safety and Health, La Trobe University, Melbourne, Australia
| | - Michael P Dillon
- Department of Physiotherapy, Podiatry, Prosthetics & Orthotics, La Trobe University, Melbourne, Australia
| | - Rwth Stuckey
- Department of Public Health, Ergonomics, Safety and Health, La Trobe University, Melbourne, Australia
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Sayeed SI, Oakman J, Dillon MP, Stuckey R. Disability, economic and work-role status of individuals with unilateral lower-limb amputation and their families in Bangladesh, post-amputation, and pre-rehabilitation: A cross-sectional study. Work 2022; 73:1405-1419. [DOI: 10.3233/wor-211064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Amputation has significant negative impacts on physical, psychological, social and economic wellbeing of individuals and families. This is potentially compounded by significant delays to rehabilitation in Bangladesh. OBJECTIVE: To quantify disability, occupation and socioeconomic status of people with unilateral lower-limb amputation (LLA) and their families in Bangladesh, post-amputation and pre-rehabilitation. METHODS: Between November 2017 and February 2018, people with unilateral LLA attending two locations of Center for the Rehabilitation of the Paralyzed, Bangladesh, for prosthetic rehabilitation were surveyed pre-rehabilitation, using the World Health Organization Disability Assessment Schedule (WHODAS-2.0) with additional socio-economic questions. Data were analysed descriptively, using cross-tabulation with Chi-square and Fisher’s exact tests. RESULTS: Seventy-six individuals participated. The majority had traumatic (64.5%), transtibial amputation (61.8%), were young adults (37.92±12.35 years), in paid work prior to LLA (80%), married (63.2%), male (81.6%), from rural areas (78.9%), with primary/no education (72.4%). After LLA mobility (WHODAS score 74.61±13.19) was their most negatively affected domain. Most (60.5%) did not return to any occupation. Acute healthcare costs negatively impacted most families (89.5%), over 80% becoming impoverished. Nearly 70% of previous income-earners became economically dependent changing traditional family roles. CONCLUSIONS: Following LLA, most participants experienced significant mobility impairment and became economically dependent. The impact of LLA extends beyond the individual, to families who often face challenges to traditional primary earner gendered roles. Improved access to timely and affordable rehabilitation is required to reduce the significant personal and societal costs of disability after LLA.
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Affiliation(s)
- Shapin Ibne Sayeed
- Ergonomics, Safety and Health, Department of Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Jodi Oakman
- Ergonomics, Safety and Health, Department of Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Michael P. Dillon
- Department of Physiotherapy, Podiatry, Prosthetics & Orthotics, La Trobe University, Melbourne, VIC, Australia
| | - Rwth Stuckey
- Ergonomics, Safety and Health, Department of Public Health, La Trobe University, Melbourne, VIC, Australia
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Meshkin DH, Zolper EG, Chang K, Bryant M, Bekeny JC, Evans KK, Attinger CE, Fan KL. Long-term Mortality After Nontraumatic Major Lower Extremity Amputation: A Systematic Review and Meta-analysis. J Foot Ankle Surg 2021; 60:567-576. [PMID: 33509714 DOI: 10.1053/j.jfas.2020.06.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/17/2020] [Accepted: 06/23/2020] [Indexed: 02/03/2023]
Abstract
Chronic wounds that lead to major lower extremity amputation have immense consequences on quality of life, and ultimately, mortality. However, mortality rates after lower extremity amputation for a chronic wound are broad within the literature and have escaped precise definition. This systematic review aims to quantify long-term mortality rates after major lower extremity amputation in the chronic wound population available in the existing literature. Ovid MEDLINE was searched for publications which provided mortality data after major, nontraumatic, primary lower extremity amputations. Lower extremity amputations were defined as below and above the knee amputation. Data from included studies was analyzed to obtain pooled 1-, 2-, 3-, 5- and 10-year mortality rates. Sixty-one studies satisfied inclusion criteria representing 36,037 patients who underwent nontraumatic major lower extremity amputation. Pooled mortality rates were 33.7%, 51.5%, 53%, 64.4%, and 80% at 1-, 2-, 3-, 5- and 10-year follow-up, respectively. Within the 8184 diabetic patients (types 1 and 2), 1- and 5-year mortality was 27.3% and 63.2%. Sources of mortality data were varied and included electronic medical records, national health and insurance registries, and government databases. Mortality after nontraumatic major lower extremity amputation is high, both in patients with diabetes as well as those without. Methods used to measure and report mortality are inconsistent, lack reliability, and may underestimate true mortality rates. These findings illustrate the need for a paradigm shift in wound management and improved outcomes reporting. A focus on amputation prevention and care within a multidisciplinary team is critical for recalcitrant ulcers.
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Affiliation(s)
- Dean H Meshkin
- Medical Student, Georgetown University School of Medicine, Washington, DC
| | - Elizabeth G Zolper
- Medical Student, Department of Plastic and Reconstructive Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, DC
| | - Kevin Chang
- Medical Student, Georgetown University School of Medicine, Washington, DC
| | - Meigan Bryant
- Medical Student, Georgetown University School of Medicine, Washington, DC
| | - Jenna C Bekeny
- Medical Student, Department of Plastic and Reconstructive Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, DC
| | - Karen K Evans
- Professor of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington
| | - Christopher E Attinger
- Professor of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington
| | - Kenneth L Fan
- Assistant Professor Plastic Surgery, Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC.
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Liu R, Petersen BJ, Rothenberg GM, Armstrong DG. Lower extremity reamputation in people with diabetes: a systematic review and meta-analysis. BMJ Open Diabetes Res Care 2021; 9:9/1/e002325. [PMID: 34112651 PMCID: PMC8194332 DOI: 10.1136/bmjdrc-2021-002325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/09/2021] [Indexed: 12/03/2022] Open
Abstract
In this study, we determined the reamputation-free survival to both limbs and to the contralateral limb only following an index amputation of any-level and assessed whether reamputation rates have changed over time. We completed a systematic search using PubMed and screened a total of 205 articles for data on reamputation rates. We reported qualitative characteristics of 56 studies that included data on reamputation rates and completed a meta-analysis on 22 of the studies which enrolled exclusively participants with diabetes. The random-effects meta-analysis fit a parametric survival distribution to the data for reamputations to both limbs and to the contralateral limb only. We assessed whether there was a temporal trend in the reamputation rate using the Mann-Kendall test. Incidence rates were high for reamputation to both limbs and to the contralateral limb only. At 1 year, the reamputation rate for all contralateral and ipsilateral reamputations was found to be 19% (IQR=5.1%-31.6%), and at 5 years, it was found to be 37.1% (IQR=27.0%-47.2%). The contralateral reamputation rate at 5 years was found to be 20.5% (IQR=13.3%-27.2%). We found no evidence of a trend in the reamputation rates over more than two decades of literature analyzed. The incidence of lower extremity reamputation is high among patients with diabetes who have undergone initial amputations secondary to diabetes, and rates of reamputation have not changed over at least two decades.
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Affiliation(s)
- Rongqi Liu
- Podimetrics Inc, Somerville, Massachusetts, USA
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Gary M Rothenberg
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - David G Armstrong
- Department of Surgery, USC Keck School of Medicine, Los Angeles, California, USA
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Hassan Al Imam M, Alamgir H, Jahan Akhtar N, Hossain Z, Islam R, Sohrab Hossain M. Characterisation of persons with lower limb amputation who attended a tertiary rehabilitation centre in Bangladesh. Disabil Rehabil 2019; 42:1995-2001. [DOI: 10.1080/09638288.2018.1544671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mahmudul Hassan Al Imam
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
| | - Hasanat Alamgir
- Department of Public Health, New York Medical College, Valhalla, NY, USA
| | - Noor Jahan Akhtar
- Department of Prosthetics & Orthotics, Centre for the Rehabilitation of the Paralysed (CRP), Dhaka, Bangladesh
| | - Zahid Hossain
- Department of Physiotherapy, Bangladesh Health Professions Institute, Centre for the Rehabilitation of the Paralysed (CRP), Dhaka, Bangladesh
| | - Rangila Islam
- Department of Occupational Therapy, Beautiful Mind, Dhaka, Bangladesh
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Lee DJ, Costello MC. The effect of cognitive impairment on prosthesis use in older adults who underwent amputation due to vascular-related etiology: A systematic review of the literature. Prosthet Orthot Int 2018; 42:144-152. [PMID: 28351207 DOI: 10.1177/0309364617695883] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Older adults with amputations secondary to vascular etiologies may additionally present with cognitive impairment. Cognition plays an important role in the adoption of a prosthetic limb, although the degree and type of impact are debated. Previous literature reviews have not been directed at the specific population of older adults who underwent vascular-related lower limb amputation. OBJECTIVES First, to assess extant literature for relationships between cognitive function and prosthesis-related outcomes in older adults who underwent lower limb amputation for vascular-related etiologies. Second, to perform a critical analysis of prosthesis-related outcomes and cognitive assessments performed in the studies. STUDY DESIGN Systematic literature review. METHODS A systematic review of the literature was performed in databases using keyword combinations. A total of nine articles were selected to be included in this review. RESULTS Seven of the nine included studies found a relationship between decreased cognitive function and reduced performance on a prosthesis-related outcome. There were eight different prosthesis-related outcome measures, with only one study utilizing a comprehensive outcome measure. CONCLUSION Cognitive impairment can negatively impact successful prosthesis use in older adults with lower limb amputation secondary to vascular complications. Future studies should utilize comprehensive outcome measures that represent the multifaceted constructs of cognition and prosthesis use. Clinical relevance Cognitive assessment of older adults who have undergone lower limb amputation secondary to diabetes related complications or vascular disease can be used to inform clinical decision-making. Clinicians should consider selecting prosthesis-related outcome measures that capture the full breadth of prosthesis use when evaluating patients with cognitive impairment.
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Affiliation(s)
- Daniel Joseph Lee
- 1 Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA.,2 Department of Psychology, University of Hartford, West Hartford, CT, USA
| | - Matthew C Costello
- 1 Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA.,2 Department of Psychology, University of Hartford, West Hartford, CT, USA
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Lv F, Tang J, Luo Y, Ban Y, Wu R, Tian J, Yu T, Xie X, Li T. Contrast-enhanced ultrasound assessment of muscle blood perfusion of extremities that underwent crush injury: an animal experiment. J Trauma Acute Care Surg 2013; 74:214-9. [PMID: 23505667 DOI: 10.1097/ta.0b013e3182683498] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This research aimed to study the assessment of local muscle microcirculation perfusion of extremities that underwent crush injuries by using contrast-enhanced ultrasonography (CEUS). METHODS A total of 28 New Zealand rabbits were anesthetized by using intramuscular pentobarbital sodium (30 mg/kg). A balloon cuff device was used to create crush injuries to the left hind leg of each rabbit with a force of 18.6 kPa. CEUS was performed at the 0.5th, 2nd, 6th,24th, and 72nd hour after the release of the crush pressure. Peak intensity (PI) of the crushed regions was compared with those of the uncrushed regions and before the creation of crush injury. Receiver operating characteristic analysis was used to determine the diagnostic value of PI for the crushed region. RESULTS During the 72nd hour after the release of the crush pressure, 5 of the 28 rabbits died, and thus, their statistics were eliminated from the experiment. At different time points after the release of the crush pressure, the crushed regions in all 23 survivals showed quick and high enhancement, and their intensities were higher than those of the un crushed region in the arterial phase. The time-intensity curves of the crushed regions all appeared as rapid lift-gradual drop. PIs were obviously higher in the crushed regions than in the uncrushed regions and than those before the creation of crush injury ( p G 0.001). Receiver operating characteristic curves showed that extremity crush injury was diagnosed by using PI value. CONCLUSION CEUS presents that the microcirculation perfusion of the crushed muscle increased obviously after the release of the crush pressure.PIs evaluated quantitatively the microcirculation perfusion changes. It may suggest a potential alternative for evaluating microcirculation abnormality of the muscle crush injury to the extremities.
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Affiliation(s)
- Faqin Lv
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, 28 Fuxing Rd, Beijing 100853, China.
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Coffey L, O’Keeffe F, Gallagher P, Desmond D, Lombard-Vance R. Cognitive functioning in persons with lower limb amputations: a review. Disabil Rehabil 2012; 34:1950-64. [DOI: 10.3109/09638288.2012.667190] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Amputation is a common surgical procedure in Nigeria but there are no national data on the subject. The objective was to determine the common indications for amputation in Nigeria, mortality rate, and regional differences in indications. Results of studies on amputation in Nigeria over a 15-year period were collated and analysed. The most frequent indications for amputation were trauma (34%); complication of traditional bonesetting (TBS) (23%); malignant tumours (14.5%); diabetic gangrene (12.3%); infections (5.1%); peripheral artery disease (2.1%); and burns (2.1%). In the southern regions, trauma is the most common indication while complications of traditional bonesetting are the most common in the northern and eastern regions. The average age of the Nigerian amputee is 33 years. Hospital mortality after amputation is 10.9%. The estimated prevalence of extremity amputation in Nigeria is 1.6 per 100,000. Peripheral artery disease is an uncommon indication for amputation in Nigeria while trauma, complication of traditional bonesetting, malignant tumours and diabetic gangrene are relatively much more common. The young male is frequently affected.
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Affiliation(s)
- L O A Thanni
- Department of Orthopaedics and Traumatology, College of Health Sciences, Olabisi Onabanjo University, P.M.B.2022, Sagamu, Ogun State, Nigeria.
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Ephraim PL, Dillingham TR, Sector M, Pezzin LE, Mackenzie EJ. Epidemiology of limb loss and congenital limb deficiency: a review of the literature. Arch Phys Med Rehabil 2003; 84:747-61. [PMID: 12736892 DOI: 10.1016/s0003-9993(02)04932-8] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine the state of research on population-based studies of the incidence of limb amputation and birth prevalence of limb deficiency. DATA SOURCES A total of 18 publication databases were searched, including MEDLINE, CINAHL, and the Cochrane Library. STUDY SELECTION The search was performed by using a hierarchical process. Articles were reviewed for inclusion by 3 reviewers. Inclusion criteria included defined catchment area, calculation of population-based incidence rates, defined etiology of limb loss, and English language. Review articles, animal studies, case reports, cohort studies, letters, and editorials were excluded. DATA EXTRACTION Figures on the estimated incidence of amputation and birth prevalence of congenital limb deficiency were gleaned from selected reports and assembled into a table format by etiology. DATA SYNTHESIS The studies varied in scope, quality, and methodology, making comparisons between studies difficult. Incidence rates of acquired amputation varied greatly between and within nations. Rates of all-cause acquired amputation ranged from 1.2 first major amputations per 10,000 women in Japan to 4.4 per 10,000 men in the Navajo Nation in the United States between 1992 and 1997. Consistent among all nations, the risk of amputation was greatest among persons with diabetes mellitus. CONCLUSIONS Surveillance of congenital limb deficiency exists in much of the developed world. Existing studies of acquired amputation suffer from a host of methodologic problems. Future efforts should be directed toward the application of standardized measures and methods to enable trends to be evaluated over time and comparisons to be made within and between countries.
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Affiliation(s)
- Patti L Ephraim
- Center for Injury Research and Policy, Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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