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Hudak NM, Akroyd D. Predictors of Physician Assistant Student Mistreatment Reporting. J Physician Assist Educ 2024:01367895-990000000-00153. [PMID: 38874352 DOI: 10.1097/jpa.0000000000000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Many physician assistant (PA) students experience mistreatment by preceptors in clinical settings though most do not report it to their institution. Nonreporting limits an institution's ability to address mistreatment and provide student support. Several reasons for nonreporting have been described in national surveys. The purpose of this study was to identify factors predictive of student reporting behavior. METHODS This study used a nonexperimental, cross-sectional, predictive research design with quantitative analytic methods. Data were from 2 national surveys administered to PA students and programs in 2019. The sample was PA students who experienced mistreatment performed by preceptors. Logistic regression was used to identify which independent variables were predictors of student mistreatment reporting to their institution. RESULTS Students were twice as likely to report mistreatment involving physical or sexual behavior compared with other types. Older students were more likely to report mistreatment than younger students. Policy factors were not significant predictors of student reporting behavior. DISCUSSION Student likelihood to reporting severe forms of mistreatment indicate they recognize those behaviors as mistreatment and believe they are important enough to report. Greater likelihood of reporting by older students indicates the influence of student demographics and life experience. Policy factors and institution characteristics were not significant predictors of student reporting behavior, which suggest the limits of policy as a facilitator of mistreatment reporting. These findings have implications for educational program policy design, implementation, and evaluation, as well as underscore the need for further research to understand factors influencing students' decision to report mistreatment.
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Affiliation(s)
- Nicholas M Hudak
- Nicholas M Hudak, PhD, MPA, MSEd, is an associate professor in the Department of Family Medicine and Community Health at Duke University School of Medicine, Durham, North Carolina
- Duane Akroyd, PhD, is a professor in the North Carolina State University, College of Education, Raleigh, North Carolina
| | - Duane Akroyd
- Nicholas M Hudak, PhD, MPA, MSEd, is an associate professor in the Department of Family Medicine and Community Health at Duke University School of Medicine, Durham, North Carolina
- Duane Akroyd, PhD, is a professor in the North Carolina State University, College of Education, Raleigh, North Carolina
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Walvoord EC, Howenstine MS, Allen BL, Ribera AK, Nabhan ZM, Tori AJ, Eichholtz RD, Dankoski ME. Engaging All Stakeholders to Create a Trusted, Data-Driven, Process Improvement Approach to Addressing Learner Mistreatment. TEACHING AND LEARNING IN MEDICINE 2024; 36:61-71. [PMID: 36106412 DOI: 10.1080/10401334.2022.2122979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
Problem: Learner mistreatment has remained an ongoing challenge in academic medicine despite accreditation requirements mandating that every program has systems in place to prevent and respond to mistreatment. While efforts vary across institutions, much remains unanswered in the literature about best practices. Additionally, for the foreseeable future, challenges in the learning environment will likely continue and potentially worsen, given the confluence of multiple external stressors including the COVID-19 pandemic, faculty burnout and general political divisiveness in the nation. It is essential, therefore, to focus on indicators of improvement via process metrics such as knowledge and awareness of mistreatment policies and procedures, willingness to report, reasons for not reporting, and satisfaction with having made a report, while simultaneously focusing on the more complex challenge of eliminating mistreatment occurrences. Intervention: We describe the aspects of our mistreatment prevention and response system first implemented in 2017 along with process and outcome measures. The interventions included expanding our policy outlining appropriate conduct in the teacher-learner relationship; a graduated response protocol to allegations of mistreatment with a clear escalation approach; an online reporting system; a graduate medical education exit survey which mirrors the AAMC Graduation Questionnaire on mistreatment; a robust communication and professional development campaign; a comprehensive data dashboard; and a comprehensive summary report dissemination plan. Context: The interventions were implemented at the largest allopathic medical school in the U.S., with nine campuses across the state. The system is available to all learners, including medical students, graduate students, residents, and fellows. Impact: Both institutional and national data sources have informed the continuous improvement strategies. Data from internal reporting systems, institutional surveys, and national data are presented from 2017 to 2021. Findings include an increasing number of incidents reported each year, including confidential reports from students who include their contact information rather than report anonymously, which we view as an indicator of learner trust in the system. Our data also show consistent improvements in learners' awareness of the policy and procedures and satisfaction with having made a report. We also include other data such as the nature of complaints submitted and timeliness of our institutional response. Lessons Learned: We present several lessons learned that may guide other institutions looking to similarly improve their mistreatment systems, such as a close partnership between faculty affairs, diversity affairs, and educational affairs leadership; communication, professional development, and training through multiple venues and with all stakeholders; easily accessible reporting with anonymous and confidential options and the ability to report on behalf of others; policy development guidance; data transparency and dissemination; and trust-building activities and ongoing feedback from learners.
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Affiliation(s)
- Emily C Walvoord
- Medical Student Affairs and Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michelle S Howenstine
- Graduate Medical Education, Continuing Medical Education and Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Bradley L Allen
- Medical Student Education and Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy K Ribera
- Research and Evaluation, Faculty Affairs, Professional Development and Diversity, and Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Zeina M Nabhan
- Graduate Medical Education and Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alvaro J Tori
- Diversity Affairs and Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rebekah D Eichholtz
- Faculty Affairs, Professional Development, and Diversity, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mary E Dankoski
- Faculty Affairs, Professional Development, and Diversity and Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Evéquoz Y, Pichonnaz L, Dubois J. Influence of a sexism and sexual harassment prevention course on medical students' perceptions of and responses to problematic situations. BMC MEDICAL EDUCATION 2023; 23:939. [PMID: 38066505 PMCID: PMC10709927 DOI: 10.1186/s12909-023-04902-0] [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: 03/01/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Issues of sexism and sexual harassment within the medical field are widespread. The aim of his study was to describe the influence of a training course on the prevention of sexism and sexual harassment on medical students' perceptions and responses to problematic situations in the workplace. METHODS We performed a secondary analysis of the transcripts of 16 medical students' interviews. The data were initially gathered as part of an external evaluation of the course. We decided to further explore these with a focus on potential changes about sexism and sexual harassment awareness induced by the course. Data were analyzed using qualitative thematic analysis. RESULTS Most medical students were aware of the existence of sexism and sexual harassment in the medical environment before the course but were not always able to delineate what could be considered as such or not. The course allowed them to broaden their ability to identify problematic situations, that were somewhat "trivialized" before, and to set a lower cut-off when judging what constitutes sexism or sexual harassment. It also provided them with tools on how to react when confronted to these situations, as well as resources to seek help. However, students stressed the importance of such courses also being offered to medical staff higher up in the hierarchy, as they are the ones in a position of power. CONCLUSIONS The course helped students to better identify and react to sexism and sexual harassment. However, given students' lack of power within the hierarchy, efforts to prevent sexism and sexual harassment must be undertaken at an institutional level to allow for change in the system as a whole.
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Affiliation(s)
- Yves Evéquoz
- Institute of Family Medicine, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Lauriane Pichonnaz
- Gender and Health Unit, Department of ambulatory care, University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Julie Dubois
- Institute of Family Medicine, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.
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Heath JK, Clancy CB, Pluta W, Weissman GE, Anderson U, Kogan JR, Dine CJ, Shea JA. Natural Language Processing of Learners' Evaluations of Attendings to Identify Professionalism Lapses. Eval Health Prof 2023; 46:225-232. [PMID: 36826805 PMCID: PMC10443919 DOI: 10.1177/01632787231158128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Unprofessional faculty behaviors negatively impact the well-being of trainees yet are infrequently reported through established reporting systems. Manual review of narrative faculty evaluations provides an additional avenue for identifying unprofessional behavior but is time- and resource-intensive, and therefore of limited value for identifying and remediating faculty with professionalism concerns. Natural language processing (NLP) techniques may provide a mechanism for streamlining manual review processes to identify faculty professionalism lapses. In this retrospective cohort study of 15,432 narrative evaluations of medical faculty by medical trainees, we identified professionalism lapses using automated analysis of the text of faculty evaluations. We used multiple NLP approaches to develop and validate several classification models, which were evaluated primarily based on the positive predictive value (PPV) and secondarily by their calibration. A NLP-model using sentiment analysis (quantifying subjectivity of the text) in combination with key words (using the ensemble technique) had the best performance overall with a PPV of 49% (CI 38%-59%). These findings highlight how NLP can be used to screen narrative evaluations of faculty to identify unprofessional faculty behaviors. Incorporation of NLP into faculty review workflows enables a more focused manual review of comments, providing a supplemental mechanism to identify faculty professionalism lapses.
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Affiliation(s)
- Janae K. Heath
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Caitlin B. Clancy
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - William Pluta
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Gary E. Weissman
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ursula Anderson
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jennifer R. Kogan
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - C. Jessica Dine
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Judy A. Shea
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Hayward L, Mott NM, McKean EL, Dossett LA. Survey of student mistreatment experienced during the core clinical clerkships. Am J Surg 2023:S0002-9610(22)00830-3. [PMID: 36669940 DOI: 10.1016/j.amjsurg.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/28/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND The goal of this study was to learn more about the potential impact of medical student mistreatment on patient safety and care. METHODS A web-based survey was sent to members of the class of 2021 and 2022 who have completed their core clerkships at a single academic institution. Descriptive statistics were performed to understand how prior and future mistreatment impacted communication among students and team members. RESULTS We received 290 of 376 responses (77.1%). 26% of respondents indicated that past mistreatment negatively impacted their communication with other team members. 30% of respondents reported that fear of future mistreatment negatively impacted their communication with other team members. CONCLUSION Mistreatment of medical students has many sources and occurs throughout the clinical curriculum. Past and fear of future student mistreatment can negatively impact intrateam communication and therefore negatively impact patient care, with the potential of causing poor patient outcomes.
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Affiliation(s)
- Laura Hayward
- University of Michigan Medical School, Ann Arbor, MI, USA; University of Michigan, Department of Internal Medicine-Pediatrics, Ann Arbor, MI, USA
| | - Nicole M Mott
- University of Michigan Medical School, Ann Arbor, MI, USA; University of Colorado-Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA
| | - Erin L McKean
- University of Michigan Medical School, Ann Arbor, MI, USA; University of Michigan, Department of Otolaryngology-Head and Neck Surgery, Ann Arbor, MI, USA
| | - Lesly A Dossett
- University of Michigan, Department of Surgery, Ann Arbor, MI, USA.
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Hudak NM, Blazar M, Knudsen NW. Physician Assistant Program Policies to Assess and Address Student Reports of Mistreatment During Clinical Training. J Physician Assist Educ 2022; 33:185-191. [PMID: 35917472 DOI: 10.1097/jpa.0000000000000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Many physician assistant (PA) students experience mistreatment in clinical learning environments, and accredited PA programs are required to define, publish, and make readily available policies and procedures for student reports of mistreatment. The purpose of this study is to describe the prevalence, content, and dissemination of program policies to address students' reports of mistreatment involving preceptors during supervised clinical experiences. METHODS To conduct a national policy analysis, the investigators included 10 new survey items in the 2019 Physician Assistant Education Association annual program survey. Deidentified data were analyzed by using descriptive statistics. RESULTS The program response rate to the survey items was 99% (232). Approximately 76% of PA programs reported having a learner mistreatment policy. Policy content across programs varied widely, and several student reporting mechanisms were available. Program directors, clinical faculty, and institutional leadership were most likely to be involved in the management of reports. A majority programs actively assessed for mistreatment and most did so through clinical course evaluations and at the end of each clinical phase course. Most programs disseminated information about policy to faculty, students, and preceptors at least once a year. DISCUSSION The descriptions of policy content, procedures, and dissemination increase educators' understanding of current policies across PA programs in the context of renewed efforts to write or revise policy that is specific to mistreatment. The authors discuss key policy priorities to define mistreatment, offer a range of confidential reporting mechanisms, review the management of reports, and consider how to optimize dissemination strategies.
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Affiliation(s)
- Nicholas M Hudak
- Nicholas M. Hudak, MPA, MSEd,PA-C,is an associate professor in the Department of Family Medicine and Community Health and clinical coordinator for the Division of Physician Assistant Studies at Duke University School of Medicine in Durham, North Carolina
- Melinda Blazar, MHS, PA-C,is an assistant professor in the Department of Family Medicine and Community Health and director of clinical education for the Division of Physician Assistant Studies at Duke University School of Medicine in Durham, North Carolina
- Nancy W. Knudsen, MD,is a professor of anesthesiology and an associate professor in surgery and associate dean for learning environment and well-being at Duke University School of Medicine in Durham, North Carolina
| | - Melinda Blazar
- Nicholas M. Hudak, MPA, MSEd,PA-C,is an associate professor in the Department of Family Medicine and Community Health and clinical coordinator for the Division of Physician Assistant Studies at Duke University School of Medicine in Durham, North Carolina
- Melinda Blazar, MHS, PA-C,is an assistant professor in the Department of Family Medicine and Community Health and director of clinical education for the Division of Physician Assistant Studies at Duke University School of Medicine in Durham, North Carolina
- Nancy W. Knudsen, MD,is a professor of anesthesiology and an associate professor in surgery and associate dean for learning environment and well-being at Duke University School of Medicine in Durham, North Carolina
| | - Nancy W Knudsen
- Nicholas M. Hudak, MPA, MSEd,PA-C,is an associate professor in the Department of Family Medicine and Community Health and clinical coordinator for the Division of Physician Assistant Studies at Duke University School of Medicine in Durham, North Carolina
- Melinda Blazar, MHS, PA-C,is an assistant professor in the Department of Family Medicine and Community Health and director of clinical education for the Division of Physician Assistant Studies at Duke University School of Medicine in Durham, North Carolina
- Nancy W. Knudsen, MD,is a professor of anesthesiology and an associate professor in surgery and associate dean for learning environment and well-being at Duke University School of Medicine in Durham, North Carolina
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Hammoud MM, Appelbaum NP, Wallach PM, Burrows HL, Kochhar K, Hemphill RR, Daniel M, Clery MJ, Santen SA. Incidence of resident mistreatment in the learning environment across three institutions. MEDICAL TEACHER 2021; 43:334-340. [PMID: 33222573 DOI: 10.1080/0142159x.2020.1845306] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Mistreatment in the learning environment is associated with negative outcomes for trainees. While the Association of American Medical Colleges (AAMC) annual Graduation Questionnaire (GQ) has collected medical student reports of mistreatment for a decade, there is not a similar nationally benchmarked survey for residents. The objective of this study is to explore the prevalence of resident experiences with mistreatment. METHODS Residents at three academic institutions were surveyed using questions similar to the GQ in 2018. Quantitative data were analyzed based on frequency and Mann-Whitney U tests to detect gender differences. RESULTS Nine hundred ninety-six of 2682 residents (37.1%) responded to the survey. Thirty-nine percent of residents reported experiencing at least one incident of mistreatment. The highest reported incidents were public humiliation (23.7%) and subject to offensive sexist remarks/comments (16.0%). Female residents indicated experiencing significantly more incidents of public embarrassment, public humiliation, offensive sexist remarks, lower evaluations based on gender, denied opportunities for training or rewards, and unwanted sexual advances. Faculty were the most frequent instigators of mistreatment (66.4%). Of trainees who reported experiencing mistreatment, less than one-quarter reported the behavior. CONCLUSION Mistreatment in the academic learning environment is a concern in residency programs. There is increased frequency among female residents.
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Affiliation(s)
- Maya M Hammoud
- Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nital P Appelbaum
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Paul M Wallach
- Family Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Heather L Burrows
- Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Komal Kochhar
- Family Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robin R Hemphill
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Michelle Daniel
- Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael J Clery
- Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
- Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sally A Santen
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Kisiel MA, Kühner S, Stolare K, Lampa E, Wohlin M, Johnston N, Rask-Andersen A. Medical students' self-reported gender discrimination and sexual harassment over time. BMC MEDICAL EDUCATION 2020; 20:503. [PMID: 33302936 PMCID: PMC7731624 DOI: 10.1186/s12909-020-02422-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/03/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Gender discrimination (GD) and sexual harassment (SH) occur at all academic institutions worldwide. Medical students report high prevalence of GD and SH, which may negatively affect their education and health. There are indications that policies and reforms on reducing GD/SH are insufficient. Swedish medical students' experiences of GD/SH are monitored by course-evaluations and bi-annual student union evaluations; however, the response rate is usually low. The aim of this study was to compare the exposure to and context of self-reported GD/SH over an 11-year period amongst medical students at a Swedish university. METHODS In 2002, a questionnaire (n = 622) was mailed to medical students' home addresses. It was repeated in 2013 and then distributed during mandatory lectures (n = 856). The questions used a behavioristic approach and asked about specific GH/SH experiences. Participation was voluntary and anonymous. The changes in prevalence over time were calculated by sampling weights in order to obtain comparable estimates, representative of both cohorts. RESULTS The response frequency was 55% (62% women) in 2002 and 81% (59% women) in 2013. The prevalence of GD tended to decrease for male and clinical students in comparison to female and pre-clinical peers. However, the prevalence of SH increased for female compared to male students. The ratio of SH for female pre-clinical students doubled in many instances; most often, the mistreatment occurred in the clinic. Medical doctors were indicated as perpetrators up to five times more often by all students in 2013. CONCLUSION Our results show a disproportional change in exposure to GD/SH between female and male medical students, resulting in a widening of the gender gap regarding prevalence of GD and SH between 2002 and 2013. In particular, personal experiences of SH increased for both sexes. It is proof that institutional efforts to fight mistreatment might be ineffective.
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Affiliation(s)
- Marta A Kisiel
- Department of Medical Sciences, Environmental and Occupational Medicine, Uppsala University, Dag Hammarskjölds Väg, 60 751 85, Uppsala, Sweden.
| | - Sofia Kühner
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karin Stolare
- Department of Psychiatry, Uppsala University, Uppsala, Sweden
| | - Erik Lampa
- UCR-Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Martin Wohlin
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Nina Johnston
- UCR-Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Anna Rask-Andersen
- Department of Medical Sciences, Environmental and Occupational Medicine, Uppsala University, Dag Hammarskjölds Väg, 60 751 85, Uppsala, Sweden
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