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Sanchez K, Eghaneyan BH, Killian MO, Cabassa LJ, Trivedi MH. Depression education fotonovela for engagement of Hispanic patients in treatment: a randomized clinical trial. BMC Psychiatry 2021; 21:635. [PMID: 34949169 PMCID: PMC8705454 DOI: 10.1186/s12888-021-03641-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/06/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We report the primary outcomes from a randomized clinical trial testing a novel culturally-adapted patient education intervention to increase engagement of Hispanic patients in depression treatment. The Depression Education Fotonovela (DEF), Secret Feelings, incorporates popular images, cultural norms, and vivid pictures embedded within a soap opera narrative to increase depression knowledge and dispel myths about treatment. We then assessed engagement in a integrated care treatment model in response to the education intervention and subsequent changes in depression symptoms in a large community-based clinic whose patient population is majority Hispanic. METHOD The sample included 150 adult Hispanic patients with a confirmed diagnosis of depression who were randomly assigned to either: [1] integrated care + fotonovela; or [2] integrated care + standard education. Differences between treatment groups were examined as were changes in depression, anxiety, depression knowledge, and stigma scores over time and engagement in treatment. RESULTS Results indicated that while depression scores significantly decreased over time for participants (F [2.811, 416.054] = 197.69, p < .001, η2 = .572), no differences between the two education groups were found (F [1, 148] = 0.70, p = .403, η2 = .005). At 12-month follow-up, 101 patients (80.8%) reported a 50% of greater reduction in depression scores from baseline. CONCLUSIONS We found little difference between the two education groups, suggesting that either may helpful for engaging Hispanic patients into care. Better tailoring of patient education, with the fotonovela or similarly adapted tools, will require more directly addressing the stigma associated with antidepressant medication. TRIAL REGISTRATION The study was registered with www.clinicaltrials.gov : NCT02702596 , on 03/20/2016. Retrospectively registered.
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Affiliation(s)
- Katherine Sanchez
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, Texas, 76019, USA. .,Department of Psychiatry, UT Southwestern Medical Center, 6363 Forest Park Rd, Dallas, TX, 75235, USA.
| | - Brittany H. Eghaneyan
- grid.253559.d0000 0001 2292 8158Department of Social Work, California State University, Fullerton, USA
| | - Michael O. Killian
- grid.255986.50000 0004 0472 0419College of Social Work, Florida State University, 296 Champions Way, UCC 2500, Tallahassee, FL 32306 USA
| | - Leopoldo J. Cabassa
- grid.4367.60000 0001 2355 7002George Warren Brown School of Social Work, Washington University in St. Louis, Goldfarb Hall, Room 358, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130 USA
| | - Madhukar H. Trivedi
- grid.267313.20000 0000 9482 7121Department of Psychiatry, UT Southwestern Medical Center, 6363 Forest Park Rd, Dallas, TX 75235 USA
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Tan SL, Whittal A, Lippke S. Testing a Photo Story Intervention in Paper Versus Electronic Tablet Format Compared to a Traditional Brochure Among Older Adults in Germany: Randomized Controlled Trial. JMIR Aging 2018; 1:e12145. [PMID: 31518254 PMCID: PMC6715415 DOI: 10.2196/12145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/26/2018] [Accepted: 11/16/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To increase effective communication in primary care consultations among older adults in Germany, the photo story is considered to be a useful tool based on Bandura's social cognitive theory. With information technology helping to increase effective communication, the use of tablets is gaining attention in health care settings, especially with older adults. However, the effectiveness of tablet technology and photo stories has rarely been tested. OBJECTIVE The aim is to compare the effectiveness of a photo story intervention to a traditional brochure. Both were delivered either in paper or tablet format. METHODS A trial was conducted with 126 older adults, aged 50 years and older, who were approached and recruited by researchers and administrative staff from senior day care, doctors in rehabilitation centers, and trainers in sports clubs in Germany. Open and face-to-face assessment methodologies were used. Participants were randomly assigned to one of four intervention conditions: traditional brochure in paper format (condition 1) and tablet format (condition 2), and photo story in paper format (condition 3) and tablet format (condition 4). Each participant received a questionnaire and either the traditional brochure or photo story in a paper or tablet version. To evaluate the effectiveness of each intervention, participants completed evaluation questionnaires before and after each intervention. The second part of the questionnaire measured different indicators of health literacy, communication skills, health measurements, and possible underlying mechanisms. RESULTS Compared to the traditional brochure, participants considered the photo story easier to understand (t124=2.62, P=.01) and more informative (t124=-2.17, P=.03). Participants preferred the paper format because they found it less monotonous (t124=-3.05, P=.003), less boring (t124=-2.65, P=.009), and not too long (t124=-2.26, P=.03) compared to the tablet format. Among all conditions, the traditional brochure with a tablet (condition 2) was also perceived as more monotonous (mean 3.07, SD 1.08), boring (mean 2.77, SD 1.19), and too long to read (mean 2.50, SD 1.33) in comparison to the traditional brochure in paper format (condition 1). Moreover, the participants scored significantly higher on self-referencing on the traditional brochure in paper format (condition 1) than tablet format for both types of the brochure (conditions 2 and 4). CONCLUSIONS Traditional brochures on a tablet seem to be the least effective communication option in primary care consultations among all conditions for older adults. The findings might be specific for the current generation of older adults in Germany and need to be replicated in other countries with larger sample sizes. Although information technology brings advantages, such as effective interventions in different fields and settings, it may also come with several disadvantages, such as technical requirements of the users and devices. These should be considered when integrating information technology into wider situations and populations. TRIAL REGISTRATION ClinicalTrials.gov NCT02502292; https://clinicaltrials.gov/ct2/show/NCT02502292 (Archived by Webcite at http://www.webcitation.org/747jdJ8pU).
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Affiliation(s)
- Shu Ling Tan
- Institute of Sport and Exercise Sciences, Department of Social Sciences of Sports, University of Münster, Münster, Germany
| | - Amanda Whittal
- Health Psychology and Behavioral Medicine, Department of Psychology and Methods, Jacobs University Bremen, Bremen, Germany
| | - Sonia Lippke
- Health Psychology and Behavioral Medicine, Department of Psychology and Methods, Jacobs University Bremen, Bremen, Germany.,Bremen International Graduate School of Social Sciences, Jacobs University Bremen, Bremen, Germany
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Sanchez K, Eghaneyan BH, Killian MO, Cabassa L, Trivedi MH. Measurement, Education and Tracking in Integrated Care (METRIC): use of a culturally adapted education tool versus standard education to increase engagement in depression treatment among Hispanic patients: study protocol for a randomized control trial. Trials 2017; 18:363. [PMID: 28774339 PMCID: PMC5543442 DOI: 10.1186/s13063-017-2109-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/15/2017] [Indexed: 12/02/2022] Open
Abstract
Background Significant mental health disparities exist for Hispanic populations, especially with regard to depression treatment. Stigma and poor communication between patients and their providers result in low use of antidepressant medications and early treatment withdrawal. Cultural factors which influence treatment decisions among Hispanics include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking medications. Primary care settings often are the gateway to identifying undiagnosed or untreated mental health disorders, particularly for people with co-morbid physical health conditions. Hispanics, in particular, are more likely to receive mental healthcare in primary care settings. Recent recommendations from the U.S. Preventive Services Task Force are that primary care providers screen adult patients for depression only if systems are in place to ensure adequate treatment and follow-up. Methods We are conducting a randomized controlled trial among 150 depressed adult Hispanics in a primary care safety net setting, testing the effectiveness of a culturally appropriate depression education intervention to reduce stigma and increase uptake in depression treatment among Hispanics, and implement a Measurement-Based Integrated Care (MBIC) model with collaborative, multidisciplinary treatment and culturally tailored care management strategies. Discussion This study protocol represents the first randomized control trial of the culturally adapted depression education fotonovela, Secret Feelings, among Hispanics in a primary care setting. The education intervention will be implemented after diagnosis using an innovative screening technology and enrolled in measurement-based integrated care for the treatment of depression, which will help build the evidence around cultural adaptations in treatment to reduce mental health disparities. Trial registration ClinicalTrials.gov, NCT02702596. Registered on 20 March 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2109-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katherine Sanchez
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA. .,Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA.
| | - Brittany H Eghaneyan
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA
| | - Michael O Killian
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA
| | - Leopoldo Cabassa
- George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130-4899, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA
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A qualitative study of the emotional and spiritual needs of Hispanic families in hospice. Palliat Support Care 2017; 17:150-158. [DOI: 10.1017/s1478951517000190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTBackground:As the older U.S. population becomes more ethnically diverse, there will be an increased need for culturally sensitive hospice care services. Hispanics often experience multiple barriers to quality end-of-life care services.Objective:To address the underlying disparities in the cultural, emotional, and spiritual aspects of hospice care, the objective of the present qualitative study was to examine the emotional and spiritual needs of Hispanic patients' families while in hospice.Method:Semistructured in-person interviews were conducted with 29 Hispanic patients' families regarding their perceived experience of the hospice-based emotional and spiritual support received. Demographic information was collected on both the family member and the patient. Interviews were digitally recorded, transcribed, and analyzed using thematic content analysis.Results:Participant narratives fell into five main themes: (1) the influence of Hispanic culture in the relationship with hospice care providers; (2) types of social support received from hospice; (3) barriers to receiving support; (4) lack of health literacy regarding hospice care; and (5) cultural preferences for religious/spiritual support in hospice.Significance of Results:Our results provide insight into the specific emotional and spiritual needs of Hispanic families receiving hospice services. Our findings highlight that cultural values play an important role in the hospice care experiences of Hispanic families.
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Sanchez K, Eghaneyan BH, Trivedi MH. Depression Screening and Education: Options to Reduce Barriers to Treatment (DESEO): protocol for an educational intervention study. BMC Health Serv Res 2016; 16:322. [PMID: 27473569 PMCID: PMC4966863 DOI: 10.1186/s12913-016-1575-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 07/21/2016] [Indexed: 11/14/2022] Open
Abstract
Background Barriers to depression treatment among Hispanic populations include persistent stigma, inadequate doctor patient communication (DPC) and resultant sub-optimal use of anti-depressant medications. Stigma is primarily perpetuated due to inadequate disease literacy and cultural factors. Common concerns about depression treatments among Hispanics include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking psychotropic medications. The current manuscript presents the study protocol for the Depression Screening and Education: Options to Reduce Barriers to Treatment (DESEO) study funded by the Center for Medicare and Medicaid Services (CMS) Grants to Support the Hispanic Health Services Research Grant Program. Methods/Design DESEO will implement universal screening with a self-report depression screening tool (the 9-item Patient Health Questionnaire (PHQ-9)) that is presented through a customized web application and a Depression Education Intervention (DEI) designed to increase disease literacy, and dispel myths about depression and its treatment among Hispanic patients thus reducing stigma and increasing treatment engagement. This project will be conducted at one community health center whose patient population is majority Hispanic. The target enrollment for recruitment is 350 patients over the 24-month study period. A one-group, pretest-posttest design will be used to asses knowledge of depression and its treatment and related stigma before, immediately after, and one month post intervention. Discussion Primary care settings often are the gateway to identifying undiagnosed mental health disorders, particularly for people with comorbid physical health conditions. This study is unique in that it aims to examine the specific role of patient education as an intervention to increase engagement in depression treatment. By participating in the DEI, it is expected that patients will have time to understand treatment options, participate in shared decision-making with their provider, and increase engagement in treatment of depression which might lead to improved overall health. It is also expected that implementation of the iPad Depression Screening application will increase provider awareness of the incidence and prevalence of depression in their own practice and improve the performance and care the clinic provides. Trial registration The study was registered with: NCT02491034 July 2, 2015.
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Affiliation(s)
- Katherine Sanchez
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA. .,Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA.
| | - Brittany H Eghaneyan
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA
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Reyes-Rodríguez ML, García M, Silva Y, Sala M, Quaranta M, Bulik CM. [Development of fotonovelas to raise awareness of eating disorders in Latinos in the United States]. ACTA ACUST UNITED AC 2016; 7:17-23. [PMID: 27313838 DOI: 10.1016/j.rmta.2016.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to develop fotonovelas, a popular type of graphic novel in the Latino population, to raise awareness and educate about eating disorders (EDs). Four illustrated cartoons and scripts tailored for adults and adolescents of both sexes were presented in focus groups and an in-depth interview. Seventeen Latino adults (14 females; 3 males) and 10 adolescents (9 females; 1 male) participated in the study. Participants found the fotonovelas interesting, and eye-catching than traditional brochures. The use of Spanglish and clarification of differences across EDs were suggested by adolescent females. Male adults suggested changing the title to focus on the health consequences of EDs in order to catch the male attention in reading the story. Based on the receptivity we found in this study, fotonovela could be a promising avenue to raise awareness and to educate the Latino community in the United States about EDs.
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Affiliation(s)
| | - Marissa García
- Department of Psychology, University of North Carolina, Chapel Hill, NC
| | - Yormeri Silva
- Department of Psychology, North Carolina State University, Raleigh, NC
| | - Margarita Sala
- Department of Psychology, University of North Carolina, Chapel Hill, NC
| | - Michela Quaranta
- Department of Neuroscience, AOU San Giovanni Battista, Turin, Italy
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC; Department of Nutrition, University of North Carolina, Chapel Hill, NC; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Jimenez DE, Reynolds CF, Alegría M, Harvey P, Bartels SJ. The Happy Older Latinos are Active (HOLA) health promotion and prevention study: study protocol for a pilot randomized controlled trial. Trials 2015; 16:579. [PMID: 26683695 PMCID: PMC4683729 DOI: 10.1186/s13063-015-1113-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/09/2015] [Indexed: 11/25/2022] Open
Abstract
Background Results of previous studies attest to the greater illness burden of common mental disorders (anxiety and depression) in older Latinos and the need for developing preventive interventions that are effective, acceptable, and scalable. Happy Older Latinos are Active (HOLA) is a newly developed intervention that uses a community health worker (CHW) to lead a health promotion program in order to prevent common mental disorders among at-risk older Latinos. This pilot study tests the feasibility and acceptability of delivering HOLA to older, at-risk Latinos. Methods/Design HOLA is a multi-component, health promotion intervention funded by the National Institute of Mental Health (NIMH). This prevention approach will be tested against a fotonovela, an enhanced psychoeducation control condition, in a sample of Latino elderly with minor or subthreshold depression or anxiety. A total of 60 older Latinos (aged 60+) will be randomized to receive HOLA or the fotonovela. The primary outcomes of interest are recruitment, adherence, retention, and acceptability. Data will also be collected on: preemption of incident and recurrent major depression, generalized anxiety, and social phobia; reduction in depression and anxiety symptom severity; physical functioning; sedentary behaviors; social engagement; and self-efficacy. Discussion The results of this study could have implications for other high-risk, highly disadvantaged populations. The development of a health promotion intervention designed to prevent common mental disorders could be a means of addressing multiple disparities (for example, mental health outcomes, mental health service use, stigma) among racial/ethnic minority elderly. ClinicalTrials.gov Identifier NCT02371954. Date of registration: 21 January 2015.
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Affiliation(s)
- Daniel E Jimenez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1695 NW 9th Ave., Suite 3208, Miami, FL, 33136, USA.
| | - Charles F Reynolds
- NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, PA, USA.
| | - Margarita Alegría
- Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA.
| | - Philip Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1695 NW 9th Ave., Suite 3208, Miami, FL, 33136, USA.
| | - Stephen J Bartels
- Dartmouth Centers for Health and Aging, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. Stephen.j.bartels.@dartmouth.edu
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Chan A, Brown B, Sepulveda E, Teran-Clayton L. Evaluation of fotonovela to increase human papillomavirus vaccine knowledge, attitudes, and intentions in a low-income Hispanic community. BMC Res Notes 2015; 8:615. [PMID: 26514184 PMCID: PMC4625467 DOI: 10.1186/s13104-015-1609-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 10/19/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND It has nearly been a decade since the introduction of the vaccine against human papillomavirus (HPV), yet vaccination rates in the United States have remained suboptimal, particularly among Hispanics. Culturally and linguistically relevant health education tools targeting Hispanics are needed to increase the current rate of HPV vaccination. This article evaluates a theory-informed, evidence-guided fotonovela (photographic short story) intervention to improve HPV vaccination knowledge, attitudes, and intention among young adults. METHODS Young adults (N = 41, aged 18-26 years) in a low-income primary care clinic in Southern California were administered pre- and post-intervention surveys to measure changes in perceived susceptibility to HPV, perceived benefit of vaccination in committed relationship, intention to vaccinate, intention to encourage social networks to vaccinate, and attitude towards vaccination. Post-intervention survey also examined attitudes towards fotonovela. Relationships between attitudes towards fotonovela and demographic characteristics were assessed with Fisher's exact test. Self-reported gains in knowledge were categorized and tabulated. Changes in perceptions and intentions were analyzed with the marginal homogeneity test. RESULTS The majority of participants were female (78.0%), Latino/Hispanic (92.7%), single (70.7%), and had at least a college education (61.0%). The mean age was 21.9 years (SD 0.4). The fotonovela was viewed as entertaining (95.1%), educational (97.6%), and easy to read (100 %). Following the intervention, Hispanic participants improved in all five variables of interest measured in the survey, including perceived susceptibility (+10.5%, p = 0.03), benefit of vaccination (+7.8%, p = 0.25), intent to vaccinate (+18.4%, p = 0.06), intent to encourage others to vaccinate (+10.5%, p = 0.14) and attitude towards vaccination (+13.1%, p = 0.05). Improvements in perceived susceptibility and attitude towards vaccination reached statistical significance (p < 0.05). The most frequent gains in knowledge were the risk of HPV infection despite condom use (N = 16) and relationship status (N = 8), three-dose vaccine administration schedule (N = 13), and burden of HPV infection among males (N = 9). CONCLUSION Results are promising because they demonstrate that health messages delivered through a narrative format can promote positive changes in knowledge, attitudes, and intentions. The fotonovela may be a powerful vehicle for HPV education, particularly among Hispanics.
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Affiliation(s)
- Alvin Chan
- School of Medicine, University of California, Irvine, Irvine, CA, USA.
| | - Brandon Brown
- Center for Healthy Communities, School of Medicine, University of California, Riverside, Riverside, CA, USA.
| | - Enedina Sepulveda
- Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, Irvine, CA, USA.
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Macario E, Matiella AC. A bilingual webnovela on the human papillomavirus: Will Latinas and health professionals use it? ACTA ACUST UNITED AC 2015. [DOI: 10.1179/1753807615y.0000000004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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