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Rondung, E., Ternström, E., Hildingsson, I., Haines, H. M., Sundin, Ö., Ekdahl, J., . . . Rubertsson, C. (2018). Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial.. JMIR mental health, 5(3), Article ID e10420.
Open this publication in new window or tab >>Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial.
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2018 (English)In: JMIR mental health, ISSN 2368-7959, Vol. 5, no 3, article id e10420Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care.

OBJECTIVE: This randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth.

METHODS: This nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the Unified protocol for transdiagnostic treatment of emotional disorders and consisted of 8 treatment modules and 1 module for postpartum follow-up. The aim was to help participants observe and understand their fear of birth and find new ways of coping with difficult thoughts and emotions. Standard care was offered in the three different study regions. The primary outcome was self-assessed levels of fear of birth, measured using the Fear of Birth Scale.

RESULTS: We included 258 pregnant women reporting clinically significant levels of fear of birth (guided ICBT group, 127; standard care group, 131). Of the 127 women randomized to the guided ICBT group, 103 (81%) commenced treatment, 60 (47%) moved on to the second module, and only 13 (10%) finished ≥4 modules. The levels of fear of birth did not differ between the intervention groups postintervention. At 1-year postpartum follow-up, participants in the guided ICBT group exhibited significantly lower levels of fear of birth (U=3674.00, z=-1.97, P=.049, Cohen d=0.28, 95% CI -0.01 to 0.57). Using the linear mixed models analysis, an overall decrease in the levels of fear of birth over time was found (P≤ .001), along with a significant interaction between time and intervention, showing a larger reduction in fear of birth in the guided ICBT group over time (F1,192.538=4.96, P=.03).

CONCLUSIONS: Fear of birth decreased over time in both intervention groups; while the decrease was slightly larger in the guided ICBT group, the main effect of time alone, regardless of treatment allocation, was most evident. Poor treatment adherence to guided ICBT implies low feasibility and acceptance of this treatment.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02306434; https://clinicaltrials.gov/ct2/show/NCT02306434 (Archived by WebCite at http://www.webcitation.org/70sj83qat).

Keywords
anxiety, cognitive behavioral therapy, fear of birth, internet-based, pregnancy
National Category
Applied Psychology
Identifiers
urn:nbn:se:miun:diva-34318 (URN)10.2196/10420 (DOI)30097422 (PubMedID)
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-09-10Bibliographically approved
Grensman, A., Acharya, B. D., Wändell, P., Nilsson, G. H., Falkenberg, T., Sundin, Ö. & Werner, S. (2018). Effect of traditional yoga, mindfulness-based cognitive therapy, and cognitive behavioral therapy, on health related quality of life: A randomized controlled trial on patients on sick leave because of burnout. BMC Complementary and Alternative Medicine, 18(1), Article ID 80.
Open this publication in new window or tab >>Effect of traditional yoga, mindfulness-based cognitive therapy, and cognitive behavioral therapy, on health related quality of life: A randomized controlled trial on patients on sick leave because of burnout
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2018 (English)In: BMC Complementary and Alternative Medicine, ISSN 1472-6882, E-ISSN 1472-6882, Vol. 18, no 1, article id 80Article in journal (Refereed) Published
Abstract [en]

Background: To explore if health related quality of life(HRQoL) increased after traditional yoga(TY), mindfulness based cognitive therapy(MBCT), or cognitive behavioral therapy(CBT), in patients on sick leave because of burnout. Methods: Randomized controlled trial, blinded, in ninety-four primary health care patients, block randomized to TY, MBCT or CBT (active control) between September 2007 and November 2009. Patients were living in the Stockholm metropolitan area, Sweden, were aged 18-65 years and were on 50%-100% sick leave. A group treatment for 20 weeks, three hours per week, with homework four hours per week. HRQoL was measured by the SWED-QUAL questionnaire, comprising 67 items grouped into 13 subscales, each with a separate index, and scores from 0 (worse) to 100 (best). SWED-QUAL covers aspects of physical and emotional well-being, cognitive function, sleep, general health and social and sexual functioning. Statistics: Wilcoxon's rank sum and Wilcoxon's sign rank tests, Bonett-Price for medians and confidence intervals, and Cohen's D. Results: Twenty-six patients in the TY (21 women), and 27 patients in both the MBCT (24 women) and in the CBT (25 women), were analyzed. Ten subscales in TY and seven subscales in MBCT and CBT showed improvements, p <0.05, in several of the main domains affected in burnout, e.g. emotional well-being, physical well-being, cognitive function and sleep. The median improvement ranged from 0 to 27 points in TY, from 4 to 25 points in CBT and from 0 to 25 points in MBCT. The effect size was mainly medium or large. Comparison of treatments showed no statistical differences, but better effect (small) of both TY and MBCT compared to CBT. When comparing the effect of TY and MBCT, both showed a better effect (small) in two subscales each. Conclusions: A 20 week group treatment with TY, CBT or MBCT had equal effects on HRQoL, and particularly on main domains affected in burnout. This indicates that TY, MBCT and CBT can be used as both treatment and prevention, to improve HRQoL in patients on sick leave because of burnout, reducing the risk of future morbidity. 

Keywords
Burnout, Cognitive behavioral therapy, Exhaustion syndrome, Integrative medicine, Mind-body therapies, Mindfulness-based cognitive therapy, Randomized controlled trial, Stress-related disorder, Traditional yoga, Work-related stress
National Category
Other Health Sciences
Identifiers
urn:nbn:se:miun:diva-33304 (URN)10.1186/s12906-018-2141-9 (DOI)000427044900001 ()29510704 (PubMedID)2-s2.0-85043378898 (Scopus ID)
Available from: 2018-03-19 Created: 2018-03-19 Last updated: 2018-04-03Bibliographically approved
Abbasi, S. H., Sundin, Ö., Jalali, A., Soares, J. & Macassa, G. (2018). Ethnic differences in the risk factors and severity of coronary artery disease: a patient-based study in Iran. Journal of Racial and Ethnic Health Disparities, 5(3), 623-631
Open this publication in new window or tab >>Ethnic differences in the risk factors and severity of coronary artery disease: a patient-based study in Iran
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2018 (English)In: Journal of Racial and Ethnic Health Disparities, ISSN 2197-3792, Vol. 5, no 3, p. 623-631Article in journal (Refereed) Published
Abstract [en]

Background Diverse ethnic groups may differ regarding the risk factors and severity of coronary artery disease (CAD). This study sought to assess the association between ethnicity and CAD risk and severity in six major Iranian ethnic groups.

Methods In this study, 20,165 documented coronary artery disease patients who underwent coronary angiography at a tertiary referral heart center were recruited. The demographic, laboratory, clinical, and risk factor data of all the patients were retrieved. The Gensini score (an indicator of CAD severity) was calculated for all, and the risk factors and severity of CAD were compared between the ethnical groups, using adjusted standardized residuals, Kruskal–Wallis test, and multivariable regression analysis.

Results The mean age of the participants (14,131 [70.1%] men and 6034 [29.9%] women) was 60.7 ± 10.8 years. The Fars (8.7%) and Gilak (8.6%) ethnic groups had the highest prevalence of ≥4 simultaneous risk factors. The mean Gensini score was the highest for the Gilaks (77.1 ± 55.9) and the lowest among the Lors (67.5 ± 52.8). The multivariable regression analysis showed that the Gilaks had the worst severity (β 0.056, 95% CI 0.009 to 0.102; P = 0.018), followed by the Torks (β 0.032, 95% CI 0.005 to 0.059; P = 0.020). Meanwhile, the Lors showed the lowest severity (β −0.087, 95% CI −0.146 to −0.027; P = 0.004).

Conclusions This study found that there was heterogeneity in CAD severity and a diverse distribution in its well-known traditional risk factors among major Iranian ethnic groups.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2018
Keywords
Health status disparities, Ethnicity, Coronary heart disease, Iran
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-31406 (URN)10.1007/s40615-017-0408-3 (DOI)000439352900021 ()28776137 (PubMedID)
Available from: 2017-08-16 Created: 2017-08-16 Last updated: 2018-08-13Bibliographically approved
Rondung, E., Ekdahl, J., Hildingsson, I., Rubertsson, C. & Sundin, Ö. (2018). Heterogeneity in childbirth related fear or anxiety. Scandinavian Journal of Psychology
Open this publication in new window or tab >>Heterogeneity in childbirth related fear or anxiety
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2018 (English)In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450Article in journal (Refereed) Epub ahead of print
Abstract [en]

Many pregnant women experience fear, worry or anxiety relating to the upcoming childbirth. The aim of this cross-sectional study was to investigate possible subgroups in a sample of 206 pregnant women (mean age 29.4 years), reporting fear of birth in mid-pregnancy. Comparisons were made between nulliparous and parous women. In a series of cluster analyses, validated psychological instruments were used to cluster women based on their psychological profiles. A five-cluster solution was suggested, with the clusters characterized by: overall low symptom load, general high symptom load, medium symptom load with high performance-based self-esteem, blood- and injection phobic anxiety, and specific anxiety symptoms. Nulliparous women were more likely to report clinically relevant levels of blood- and injection phobia (OR = 2.57, 95% CI 1.09–6.01), while parous women more often reported previous negative experiences in health care (OR 1.93, 95% CI 1.09–3.39) or previous trauma (OR 2.90, 95% CI 1.58–5.32). The results indicate that women reporting fear of birth are a heterogeneous group. In order to individualize treatment, psychological characteristics may be of greater importance than parity in identifying relevant subgroups. 

Keywords
anxiety, fear, childbirth, pregnancy, cluster analysis, blood- and injection phobia
National Category
Applied Psychology
Identifiers
urn:nbn:se:miun:diva-34320 (URN)10.1111/sjop.12481 (DOI)
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-09-10Bibliographically approved
Rondung, E., Ekdahl, J. & Sundin, Ö. (2018). Potential mechanisms in fear of birth: The role of pain catastrophizing and intolerance of uncertainty.. Birth
Open this publication in new window or tab >>Potential mechanisms in fear of birth: The role of pain catastrophizing and intolerance of uncertainty.
2018 (English)In: Birth, ISSN 0730-7659, E-ISSN 1523-536XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Although many pregnant women experience fear, worry, or anxiety relating to the upcoming birth, little is known regarding the psychological mechanisms contributing to these experiences. In this study, we wanted to take a first step in trying to identify mechanisms of potential interest. The objective of this cross-sectional study was thus to investigate pain catastrophizing, intolerance of uncertainty, positive worry beliefs, and cognitive avoidance as potential mechanisms predicting fear of birth among pregnant women.

METHODS: A sample of 499 pregnant women, recruited in antenatal health care settings in 2 Swedish regions, completed the Fear of Birth Scale, along with measurements of the mechanisms of interest. Linear and logistic hierarchical regression analyses were used to investigate the extent to which pain catastrophizing, intolerance of uncertainty, positive worry beliefs, and cognitive avoidance predicted fear of birth, both as a continuous and a dichotomous measure.

RESULTS: Logistic regression analysis showed high levels of pain catastrophizing and intolerance of uncertainty to be the best predictors of fear of birth, OR 3.49 (95% CI 2.17-5.61) and OR 3.25 (95% CI 2.00-5.27), respectively. Positive beliefs about worry and cognitive avoidance were both correlated with fear of birth as a continuous measure, but did not contribute to the logistic regression model.

CONCLUSIONS: Pain catastrophizing and intolerance of uncertainty were the most evident predictors of fear of birth. Although preliminary, the findings suggest that interventions targeting catastrophic cognitions and intolerance of uncertainty might be relevant to psychological treatment for fear, worry, or anxiety relating to giving birth.

Keywords
fear of birth, intolerance of uncertainty, pain catastrophizing
National Category
Applied Psychology
Identifiers
urn:nbn:se:miun:diva-34319 (URN)10.1111/birt.12368 (DOI)29954044 (PubMedID)
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-09-10Bibliographically approved
Daniel, M., Agewall, S., Berglund, F., Caidahl, K., Collste, O., Ekenbäck, C., . . . Tornvall, P. (2018). Prevalence of Anxiety and Depression Symptoms in Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries. American Journal of Medicine, 131(9), 1118-1124
Open this publication in new window or tab >>Prevalence of Anxiety and Depression Symptoms in Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries
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2018 (English)In: American Journal of Medicine, ISSN 0002-9343, E-ISSN 1555-7162, Vol. 131, no 9, p. 1118-1124Article in journal (Refereed) Published
Abstract [en]

Background: Myocardial infarction with non-obstructive coronary arteries is a working diagnosis for several heart disorders. Previous studies on anxiety and depression in patients with myocardial infarction with non-obstructive coronary arteries are lacking. Our aim was to investigate the prevalence of anxiety and depression among patients with myocardial infarction with non-obstructive coronary arteries. Methods: We included 99 patients with myocardial infarction with non-obstructive coronary arteries together with age- and sex-matched control groups who completed the Beck Depression Inventory and the Hospital Anxiety and Depression Scale (HADS) 3 months after the acute event. Results: Using the Beck Depression Inventory, we found that the prevalence of depression in patients with myocardial infarction with non-obstructive coronary arteries (35%) was higher than in healthy controls (9%; P =.006) and similar to that of patients with coronary heart disease (30%; P =.954). Using the HADS anxiety subscale, we found that the prevalence of anxiety in patients with myocardial infarction with non-obstructive coronary arteries (27%) was higher than in healthy controls (9%; P =.002) and similar to that of patients with coronary heart disease (21%; P =.409). Using the HADS depression subscale, we found that the prevalence of depression in patients with myocardial infarction with non-obstructive coronary arteries (17%) was higher than in healthy controls (4%; P =.003) and similar to that of patients with coronary heart disease (13%; P =.466). Patients with myocardial infarction with non-obstructive coronary arteries and takotsubo syndrome scored higher on the HADS anxiety subscale than those without (P =.028). Conclusions: This is the first study on the mental health of patients with myocardial infarction with non-obstructive coronary arteries to show that prevalence rates of anxiety and depression are similar to those in patients with coronary heart disease. 

Keywords
Beck Depression Inventory, Hospital Anxiety and Depression Scale, Myocardial infarction, Myocardial infarction with non-obstructive coronary arteries, Takotsubo syndrome
National Category
Psychology
Identifiers
urn:nbn:se:miun:diva-34559 (URN)10.1016/j.amjmed.2018.04.040 (DOI)000445642300044 ()29859805 (PubMedID)
Available from: 2018-09-28 Created: 2018-09-28 Last updated: 2018-10-16Bibliographically approved
Dias, N., Costa, D., Soares, J., Hatzidimitriadou, E., Ioannidi-Kapolou, E., Lindert, J., . . . Fraga, S. (2018). Social support and the intimate partner violence victimization among adults from six European countries.
Open this publication in new window or tab >>Social support and the intimate partner violence victimization among adults from six European countries
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2018 (English)In: Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background

Social support may buffer the negative effects of violence on physical and mental health. Family medicine providers play an essential role in identifying the available social support and intervening in intimate partner violence (IPV).

Objective

This study aimed at assessing the association between social support and the IPV victimization among adults from six European countries.

Methods

This is a cross-sectional multi-centre study that included individuals from Athens (Greece), Budapest (Hungary), London (UK), Östersund (Sweden), Porto (Portugal) and Stuttgart (Germany). Data collection was carried out between September 2010 and May 2011. The sample consisted of 3496 adults aged 18–64 years randomly selected from the general population in each city. The revised Conflict Tactics Scales was used to assess IPV victimization. Social support was assessed with the Multidimensional Scale of Perceived Social Support.

Results

Participants reporting physical assault victimization experienced lower social support (mean ± SD) than their counterparts, 66.1 ± 13.96 versus 71.7 ± 12.90, P< 0.001, for women; and 67.1 ± 13.69 versus 69.5 ± 13.52, P = 0.002 for men. Similar results were found regarding sexual coercion victimization, 69.1 ± 14.03 versus 71.3 ± 12.97, P = 0.005 for women and 68.0 ± 13.29 versus 69.3 ± 13.62, P= 0.021 for men. This study revealed lower levels of social support among participants reporting lifetime and past year victimization, independent of demographic, social and health-related factors.

Conclusion

Results showed a statistically significant association between low social support and IPV victimization. Although the specific mechanisms linking social support with experiences of violence need further investigation, it seems that both informal and formal networks may be associated with lower levels of abusive situations.

Keywords
Adult, cross-sectional studies, Europe, intimate partner violence, social networking, social support
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-34349 (URN)10.1093/fampra/cmy042 (DOI)
Available from: 2018-09-07 Created: 2018-09-07 Last updated: 2018-09-19Bibliographically approved
Costa, D., Hatzidimitriadou, E., Ioannidi-Kapolo, E., Lindert, J., Soares, J., Sundin, Ö., . . . Barros, H. (2018). The impact of intimate partner violence on forgone healthcare: a population-based, multicentre European study. European Journal of Public Health
Open this publication in new window or tab >>The impact of intimate partner violence on forgone healthcare: a population-based, multicentre European study
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2018 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND:

To examine the relationship between forgone healthcare and involvement in intimate partner violence (IPV) as victims, perpetrators or both.

METHODS:

This cross-sectional multicentre study assessed community non-institutionalized residents (n = 3496, aged 18-64) randomly selected from six European cities: Athens, Budapest, London, Östersund, Porto, Stuttgart. A common questionnaire was used, including self-reports of IPV and forgone healthcare ('Have you been in need of a certain care service in the past year, but did not seek any help?'). Odds ratios (ORs), 95% confidence intervals (CIs) were computed fitting logistic regression models adjusted for city, chronic disease, self-assessed health status and financial strain.

RESULTS:

Participants experiencing past year IPV (vs. no violence) reported more often to forgone healthcare (n = 3279, 18.6% vs. 15.3%, P = 0.016). IPV experienced as both a victim and perpetrator was associated with forgone healthcare (adjusted OR, 95%CI: 1.32, 1.02-1.70).

CONCLUSION:

IPV was associated with forgone healthcare, particularly for those experiencing violence as both victims and perpetrators. Results suggest that preventing IPV among adults may improve timely healthcare uptake.

Keywords
domestic violence, adult, chronic disease, health status, internship and residency, multicenter studies, violence, medical residencies, community, perpetrator of child and adult abuse
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-34350 (URN)10.1093/eurpub/cky167 (DOI)
Available from: 2018-09-07 Created: 2018-09-07 Last updated: 2018-10-04Bibliographically approved
Almén, N., Lundberg, H., Sundin, Ö. & Jansson, B. (2018). The reliability and factorial validity of the Swedish version of the Recovery Experience Questionnaire. Nordic Psychology, 1-10
Open this publication in new window or tab >>The reliability and factorial validity of the Swedish version of the Recovery Experience Questionnaire
2018 (English)In: Nordic Psychology, ISSN 1901-2276, E-ISSN 1904-0016, p. 1-10Article in journal (Refereed) Epub ahead of print
Abstract [en]

Recent research has indicated that recovery from work stress and effort might be crucial for health and well-being. Thus, a valid measurement of recovery becomes important. The main purpose of the present study was to empirically evaluate and seeking support for the hypothesized four-factor model of the Swedish version of Recovery Experience Questionnaire (REQ). The total sample (N = 680) was randomly split into two subsamples. The first subsample was used for finding the best-fitting model using an exploratory factor analysis and the second subsample was used to test the a priori model using confirmatory factor analysis. The results support the proposed four-factor structure of the scale for both males and females. Additionally, apart from high reliability estimates, this instrument proved to have good convergent and discriminant validity for all four factors. Implications for the use of the REQ in conjunction with recovery-focused interventions were discussed, as were limitations such as low response rate. 

Keywords
assessement, factor analysis, job stress recovery, psychophysiological deactivation, questionnaire, recovery experiences
National Category
Psychology
Identifiers
urn:nbn:se:miun:diva-33303 (URN)10.1080/19012276.2018.1443280 (DOI)
Available from: 2018-03-19 Created: 2018-03-19 Last updated: 2018-03-19Bibliographically approved
Ternström, E., Hildingsson, I., Haines, H., Karlström, A., Sundin, Ö., Ekdahl, J., . . . Rubertsson, C. (2017). A randomized controlled study comparing internet-based cognitive behavioral therapy and counselling by standard care for fear of birth – A study protocol. Sexual & Reproductive HealthCare, 13, 75-82
Open this publication in new window or tab >>A randomized controlled study comparing internet-based cognitive behavioral therapy and counselling by standard care for fear of birth – A study protocol
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2017 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 13, p. 75-82Article in journal (Refereed) Published
Abstract [en]

Fear of birth is a concern that requires evidence based treatment. The aim of this study is to present the protocol of a randomized controlled multi-center trial to compare internet-based cognitive therapy with counseling as standard care for pregnant women reporting fear of birth. Participants will be recruited in mid-pregnancy. Women who score 60 or above on the Fear of Birth Scale will be offered to participate in this study. Data will be collected by questionnaires including validated instruments at baseline and follow-ups at gestational weeks 30 and 36, two months and one year after birth. The primary outcome will be level of fear of birth measured with the Fear of Birth Scale at 36 weeks of gestation. Secondary outcome measures are level of fear of birth at two months and one year after giving birth, preferences for mode of birth, requests for elective cesarean section, compliance and satisfaction with treatment and birth outcomes. A power calculation based on a 20% reduction of fear implies that approximately 200 will be included in the trial. The study outlined in this protocol will be the first randomized controlled trial comparing internet-based cognitive therapy with counseling for women reporting fear of birth. An effective treatment may result in better overall health for women with fear of birth and a reduction in cesarean sections for non-medical reasons. Evidence regarding treatment options of fear of birth will also provide a greater choice for women.

National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-31379 (URN)10.1016/j.srhc.2017.06.001 (DOI)000411305800011 ()28844361 (PubMedID)2-s2.0-85021645169 (Scopus ID)
Note

Available online 15 June 2017

Available from: 2017-08-11 Created: 2017-08-11 Last updated: 2017-10-18Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4116-5501

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