SARS-CoV-2 seroprevalence trends in healthy blood donors during the COVID-19 Milan outbreak

Background&Aims: The Milan metropolitan area in Northern Italy was among the most severely hit by the SARS-CoV-2 outbreak. The aim of this study was to examine the seroprevalence trends of SARS-CoV-2 in healthy asymptomatic adults, the risk factors, and laboratory correlates. Methods: We conducted a cross-sectional study in a random sample of blood donors since the start of the outbreak (February 24th to April 8th 2020, n=789). Presence of IgM/IgG antibodies against the SARS-CoV-2-Nucleocapsid protein was assessed by a lateral flow immunoassay. Results: The test had a 100/98.3 sensitivity/specificity, and for IgG+ was validated in a subset by an independent ELISA against the Spike protein (N=34, P<0.001). At the outbreak start, the overall adjusted seroprevalence of SARS-CoV-2 was 2.7%, 95% c.i. 0.3-6% (P<0.0001 vs. 120 historical controls). During the study period characterized by a gradual implementation of social distancing measures, there was a progressive increase in adjusted seroprevalence to 5.2%, 95% c.i. 2.4-9.0, due to a rise in IgG+ tests to 5%, 95%CI 2.8-8.2 (P=0.004 for trend, adjusted weekly increase 2.7+/-1.3%), but not of IgM+ (P=NS). At multivariate logistic regression analysis, seroconversion to IgG+ was more frequent in younger (P=0.043), while recent infections (IgM+) in older individuals (P=0.002). IgM+ was independently associated with higher triglycerides, eosinophils, and lymphocytes (P<0.05). Conclusions: SARS-CoV-2 infection was already circulating in Milan at the outbreak start. Social distancing may have been more effective in younger individuals, and by the end of April 2.4-9.0% of healthy adults had evidence of seroconversion. Asymptomatic infection may affect lipid profile and blood count.

Download Full-text

Subclinical thyroid dysfunction symptoms in older adults: cross-sectional study in UK primary care

British Journal of General Practice ◽

10.3399/bjgp20x708065 ◽

2020 ◽

Vol 70 (692) ◽

pp. e208-e214

Author(s):

Deborah McCahon ◽

M Sayeed Haque ◽

James Parle ◽

FD Richard Hobbs ◽

Lesley M Roberts

Keyword(s):

Older People ◽

Thyroid Dysfunction ◽

Multivariate Logistic Regression Analysis ◽

Community Setting ◽

Cross Sectional Study ◽

Thyroid Stimulating Hormone ◽

Older Individuals ◽

Sectional Study ◽

Cross Sectional ◽

Symptom Profile

BackgroundSubclinical thyroid dysfunction — abnormal serum thyrotrophin (thyroid-stimulating hormone; TSH) concentrations with normal free thyroxine (FT4) is common in older people. It remains unclear whether individuals with subclinical serum status experience an increased symptom profile.AimTo compare the prevalence of those symptoms typically associated with overt thyroid dysfunction in older individuals with a subclinical and euthyroid serum profile.Design and settingCross-sectional study, nested within the Birmingham Elderly Thyroid Study (BETS); from 19 UK general practices.MethodAdults living in a community setting (aged ≥65 years), without overt thyroid dysfunction or associated treatment, self-reported the presence or absence of 18 symptoms (while serum result naïve). Serum concentrations of TSH and FT4 were measured to establish thyroid status.ResultsA total of 2870 individuals were screened: 2703 (94%) were categorised as euthyroid (normal), 29 (1%) subclinically hyperthyroid, and 138 (5%) subclinically hypothyroid. Symptoms were common in all groups. No significant differences in the prevalence of individual symptoms were observed between the euthyroid and subclinically hypothyroid groups nor in comparison with the subclinically hyperthyroid group. Multivariate logistic regression analysis failed to reveal an association between individual or multiple symptoms and subclinical status.ConclusionFindings suggest that subclinical thyroid dysfunction does not confer a symptom burden in older individuals and support adherence to guidelines in the non-treatment of subclinical thyroid dysfunction. GPs may use the findings to reassure older people presenting with symptoms that subclinical thyroid dysfunction is an unlikely explanation. The presence of persistently abnormal TSH concentrations may be linked to long-term risks of cardiovascular disease, especially atrial fibrillation, but whether this should prompt treatment and whether such treatment alters vascular outcomes is unknown.

Download Full-text

Analisis Faktor Determinan yang berhubungan dengan Kepatuhan Rekomendasi Modifikasi Gaya Hidup Pasien Hipertensi

Jurnal Ners dan Kebidanan (Journal of Ners and Midwifery) ◽

10.26699/jnk.v7i2.art.p256-263 ◽

2020 ◽

Vol 7 (2) ◽

pp. 256-263

Author(s):

Abdul Qodir

Keyword(s):

Blood Pressure ◽

Lifestyle Modification ◽

Multivariate Logistic Regression Analysis ◽

Cross Sectional Study ◽

Lifestyle Modifications ◽

Chi Square ◽

Cross Sectional ◽

Hypertensive Patients ◽

Consecutive Sampling ◽

Knowledge Practice

Penatalaksanaan farmakologis dan non farmakologis dipercaya dapat mengontrol tekanan darah dan mencegah komplikasi, tetapi banyak pasien hipertensi tekanan darahnya tidak terkontrol. Hal tersebut dikarenakan kepatuhan yang buruk dalam melaksanakan rekomendasi gaya hidup. Penelitian ini bertujuan untuk menganalisis determinan faktor yang berhungan dengan kepatuhan melaksanakan rekomendasi modifikasi gaya hidup. Penelitian ini menggunakan metode cross-sectional di pukesmas dinoyo Kota Malang tahun 2019. Teknik pengambilan sampel menggunakan Consecutive Sampling. Kuesioner yang digunakan meliputi : karakteristik demografi, pengetahuan dan rekomendasi mofifikasi gaya hidup pasien hipertensi. Hubungan antara rekomendasi modifikasi gaya hidup dengan variabel independen dianalisis menggunakan uji chi square dan analisis regresi logistik. 140 pasien hipertensi berpartisipasi dalam penelitian ini (60 laki-laki, 80 wanita). Prevalensi kepatuhan adalah 28,6 %. Tingkat pengetahuan berhubungan signifikan dengan kepatuhan melaksanakan rekomendasi gaya hidup (p=0,00). Jenis kelamin, usia, dan tingkat pendidikan tidak mempunyai hubungan signifikan dengan kepatuhan rekomendasi modifikasi gaya hidup (p= 0,06; p=0,21; p=0,87). Pengetahuan mempunyai hubungan yang signifikan dengan kepatuhan rekomendasi modifikasi gaya hidup. Management of pharmacological and non-pharmacological is believed to control blood pressure and prevent complications, but many hypertensive patients have uncontrolled blood pressure. This is due to poor adherence to recommended lifestyle modifications. This study was aimed to determine the factors associated with adherence to recommended lifestyle modifications of hypertensive patients. A cross-sectional study was conducted in Pukesmas Dinoyo Malang in 2019. Consecutive Sampling was used to select study subjects. The questionnaire included information about demographic characteristics, knowledge, practice of lifestyle-modification measures. Associations between adherence to lifestyle modification and independent variables were analyzed using chi square and multivariate logistic regression analysis. 140 hypertensive patients participated in the study (60 men, 80 women). The prevalence of adherence was 28.6%. The level of knowledge was significant associated with adherence to recommended lifestyle modifications (p = 0.00). Genders , age, and educational level were no significant associated with to recommended lifestyle modifications (p= 0.06; p=0.21; p=0.87). Knowledge was significant associated with adherence to recommended lifestyle modifications of hypertensive patients.

Download Full-text

A focus on postpartum depression among Jordanian mothers

International Journal of Social Psychiatry ◽

10.1177/00207640211000100 ◽

2021 ◽

pp. 002076402110001

Author(s):

Esra’ O Taybeh

Keyword(s):

Social Support ◽

Postpartum Depression ◽

Marital Conflict ◽

Multivariate Logistic Regression Analysis ◽

Depression Scale ◽

Negative Attitude ◽

Cross Sectional Study ◽

Cross Sectional ◽

Web Based ◽

Unplanned Pregnancies

Background: The magnitude of postpartum depression in Jordan is under documented, and little is known about its potential sociodemographic and clinical correlates. Purpose: The aim of this study was to explore the prevalence and risk factors associated with postpartum depression among Jordanian mothers in the first 18 months after delivery. Method: This descriptive cross-sectional study was carried out from April to June 2020 in Jordan. A web-based survey was used for recruiting eligible participants. An Arabic version of the validated self-administered Edinburgh Postnatal Depression Scale questionnaire was used to measure postpartum depression with a cut-off score of ⩾12 which indicates probable depression. Results: A total of 1,071 Jordanian women participated in the study. Of those, 567 women had postpartum depression (52.9%). Multivariate logistic regression analysis revealed that postpartum depression was significantly associated with marital conflict (OR: 4.91; 95% CI: 2.36–10.20), negative attitude from the pregnancy (OR: 0.67; 95% CI: 0.45–0.99), unplanned pregnancies (OR: 1.73; 95% CI: 1.16–2.60), lack of social support (OR: 1.93; 95% CI: 1.12–3.32), time from last delivery (OR: 0.99; 95% CI: 0.98–1.00), insomnia (OR: 0.53; 95% CI: 0.35–0.82), and depression during the pregnancy (OR: 0.51; 95% CI: 0.33–0.78). Most of the participants (65.7%) sought social support to avoid, reduce, or treat postpartum depression. Conclusions: Postpartum depression among Jordanian women was the highest in comparison to that of women in other countries in the region. Therefore, screening for the presence of depressive symptoms should be implemented during regular pregnancy care visits. Social support should be encouraged in order to avoid, reduce, or treat postpartum depression.

Download Full-text

Association of breastfeeding and risk of metabolic syndrome and its components in postmenopausal parous women: Korea national health and nutrition examination survey (2010 ~ 2016)

Archives of Public Health ◽

10.1186/s13690-021-00607-2 ◽

2021 ◽

Vol 79 (1) ◽

Author(s):

Jusuk Lee ◽

Taehong Kim

Keyword(s):

Metabolic Syndrome ◽

Laboratory Data ◽

Multivariate Logistic Regression Analysis ◽

Density Lipoprotein ◽

Cross Sectional Study ◽

Korean Women ◽

Cross Sectional ◽

Increased Risk ◽

Nationally Representative ◽

Study Participants

Abstract Background Understanding the relationship between breastfeeding (BF) and metabolic syndrome (Mets) is important for maternal long-term health benefits and disease prevention. This study aimed to examine the association between BF and Mets and its components among postmenopausal parous Korean women. Methods This cross-sectional study on 10,356 Korean women used nationally representative data from the KNHANES from 2010 to 2016. Anthropometric, laboratory data and manual BP were measured. A multivariate logistic regression analysis was conducted to examine the association of BF with Mets and its components after adjusting for potential confounding variables. A p-value < 0.05 was to be considered statistically significant. Results Mets was present in 42% of the study participants. The BF group had low household income and education level. The prevalence of Mets in the BF group was higher than that in the non-BF group (42.69% vs. 34.76%, p < 0.001). BF was associated with increased risk of Mets (odds ratio [OR]: 1.4, 95% confidence interval [CI]: 1.18–1.65, p < 0.001). The BF group was at higher risks for diabetes (OR: 1.5, 95%CI: 1.14–1.98), hypertension (OR: 1.32, 95%CI: 1.03–1.68), hypertriglyceridemia (OR: 1.42, 95%CI: 1.02–1.99) and low high-density lipoprotein cholesterol (OR: 1.32, 95%CI: 1.06–1.65). Conclusion In this study, BF did not affect decreasing the prevalence of Mets and its components.

Download Full-text

From Isolation to Containment: Perceived Fear of Infectivity and Protective Behavioral Changes during the COVID-19 Vaccination Campaign

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126503 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6503

Author(s):

Arielle Kaim ◽

Maya Siman-Tov ◽

Eli Jaffe ◽

Bruria Adini

Keyword(s):

Vaccination Campaign ◽

Cross Sectional Study ◽

Protective Behavior ◽

Cross Sectional ◽

Social Distancing ◽

The Public ◽

The Road ◽

Israeli Population ◽

Study Results ◽

Public Health Officials

In the ongoing COVID-19 pandemic, maintenance of protective behavior is a continued challenge in the effort to contain the spread of the virus. A cross-sectional study via an internet questionnaire was utilized to elucidate changes in compliance to protective behavior among the Israeli population (n = 1120), after the beginning of the vaccination campaign. Comparison was made between individuals who were previously infected with the virus, those who received one dose of inoculation with the vaccine, and individuals that were neither infected or vaccinated. The study results indicate that those who were previously infected with the COVID-19 virus were less careful about mask wearing (18.8%) and social distancing (29.7%), as compared to the other examined groups (regarding mask wearing, 8.2% and 11.6% respectively, and with regard to social distancing 12.8% and 19.2%) and may require targeted risk communication campaigns to address this population. Furthermore, the study revealed that those that were non-Jewish (as compared to Jewish study counterparts) or that were older (19+) were more vigilant in their protective behavior (29.6% vs. 11.2% respectively for social distancing and 29.6% vs. 11.1% respectively for mask wearing). Despite a successful initial vaccination campaign in Israel, public health officials need to engage all members of the public to unremittingly observe compliance to directed health guidelines, to ensure that the results of previous governmental efforts in fighting the pandemic (such as lockdowns) will be effectively sustained, and the road to containment will be hastened.

Download Full-text

Seroprevalence of hepatitis E virus in risk populations and blood donors in a referral hospital in the south of Brazil

Scientific Reports ◽

10.1038/s41598-021-85365-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Marisa Boff Costa ◽

Michele Soares Gomes Gouvêa ◽

Samira Chuffi ◽

Gustavo Hirata Dellavia ◽

Felipe Ornel ◽

...

Keyword(s):

Low Income ◽

Hepatitis E Virus ◽

Blood Donors ◽

Total Sample ◽

Hepatitis E ◽

Cross Sectional Study ◽

Elisa Test ◽

Confirmatory Test ◽

Cross Sectional ◽

Populations At Risk

AbstractThe prevalence of anti-hepatitis E virus (HEV) antibodies has a high heterogeneity worldwide. South American data are still scarce. The aim of this study was to evaluate the prevalence of HEV in populations at risk in comparison to blood donors (BD). A cross-sectional study was carried out in adults of different risk populations including crack users (CK), residents in a low income area (LIA), cirrhotic (CIR) and liver transplant patients (LT) compared with BD. The WANTAI HEV ELISA test was used and real-time PCR (in-house for screening and ALTONA as confirmatory test) for HEV RNA screening. A total of 400 participants were included. Anti-HEV IgG was positive in 19.5% of the total sample, reaching the highest rate in the CIR group, 22.5%, followed by CK, LT, and LIA (20%, 18.7%, and 17.5%, respectively). The prevalence found in BD individuals was of 18.7% (p = NS). Anti-HEV IgM was positive in only 1.5% of the sample (6/400). No blood or stools samples were positive for HEV RNA. The seroprevalence reported is among the highest rates ever found in Brazil. Considering the intense diagnostic investigation, data show that HEV circulation is more common that might be expected in our country.

Download Full-text

Prevalence and factors associated with smoking among Tunisian secondary school-adolescents

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2019-0088 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Houda Ben Ayed ◽

Sourour Yaich ◽

Mariem Ben Hmida ◽

Maissa Ben Jemaa ◽

Maroua Trigui ◽

...

Keyword(s):

Associated Factors ◽

Age Groups ◽

High Stress ◽

Smoking Behavior ◽

Multivariate Logistic Regression Analysis ◽

Cross Sectional Study ◽

Cross Sectional ◽

Current Smoking ◽

Part Time ◽

High Stress Level

AbstractObjectivesThis study aimed to estimate the extent of smoking experience among high and middle school adolescents in Southern Tunisia and to delineate its potential associated factors.MethodsWe conducted a cross-sectional study among middle and high school-adolescents in the governorate of Sfax, South of Tunisia in the 2017–2018 school-years. A questionnaire was anonymously administered to a representative sample of 1,210 school-adolescents randomly drawn.ResultsThe mean age of the school-adolescents was 15.6 ± 4.2 years. The prevalence of lifetime smoking was 16.7% (95% CI=[14.7–18.8%]) (boys 32.6%; girls 5.9%;p<0.001). Among the respondents, 13.9% (95% CI=[11.9–15.8%]) were current smokers. In multivariate logistic regression analysis, independent associated factors of current smoking were male gender (Adjusted (AOR)=10.2; p<0.001), 16–17 and 18–19-year age-groups (AOR=2; p=0.005 and AOR=2.6; p=0.001, respectively), below average academic performance (AOR=5.2; p=0.012), divorced parents (AOR=3.9; p=0.007), family monthly income ≥800 dollars (AOR=2.1; p=0.001), having a part time job (AOR=3.9; p<0.001) and a perceived high stress level (AOR=1.98; p=0.008). Secondhand smoke (AOR=1.8; p=0.011) and concomitant alcohol drink (AOR=14.56; p<0.001) were independent predictors of current smoking, while high education level of the father was independently associated with lower prevalence of current smoking (AOR=0.17; p<0.001).ConclusionThe prevalence of lifetime and current smoking were relatively high in Southern Tunisian middle and high schools. Multilevel influences on youth smoking behavior had been identified, which reflected the need to conceive appropriate school interventions and effective antismoking education program.

Download Full-text

Beijing Friendship Hospital Osteoporosis Self-Assessment Tool for Elderly Male (BFH-OSTM) vs Fracture Risk Assessment Tool (FRAX) for identifying painful new osteoporotic vertebral fractures in older Chinese men: a cross-sectional study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04476-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ning An ◽

Ji Sheng Lin ◽

Qi Fei

Keyword(s):

Assessment Tool ◽

Roc Curves ◽

Cross Sectional Study ◽

Self Assessment ◽

Cross Sectional ◽

Fracture Group ◽

Friendship Hospital ◽

Fracture Risk Assessment Tool ◽

Older Chinese ◽

Sensitivity Specificity

Abstract Background To compare the validation of four tools for identifying painful new osteoporotic vertebral compression fractures (PNOVCFs) in older Chinese men: bone mineral density (BMD), Asian osteoporosis self-assessment tool (OSTA), World Health Organization fracture risk assessment tool (FRAX) (without BMD) and Beijing Friendship Hospital Osteoporosis Self-Assessment Tool (BFH-OSTM). Methods A cross sectional study was conducted from 2013 to 2019. A total of 846 men aged ≥50 were included and were divided into two groups: Fracture Group (patients with PNOVCFs underwent percutaneous vertebroplasty surgery) and Non-Fracture Group (community dwelled subjects for healthy examination). All subjects accepted a dual-energy X-ray BMD test and a structured questionnaire. The results of BMD, OSTA, FRAX and BFH-OSTM scores were assessed and receiver-operating characteristic (ROC) curves were generated to compare the validity of four tools for identifying PNOVCFs. Optimal cutoff points, sensitivity, specificity, and areas under the ROC curves (AUCs) were determined. Results There were significant differences including BMD T score (femoral neck, total hip and L1-L4), OSTA, FRAX and BFH-OSTM scores between Fracture group and Non-fracture group. Compared to BMD and OSTA, BFH-OSTM and FRAX had better predictive value, the sensitivity, specificity and AUC value are 0.841, 81.29%, 70.67% and 0.796, 74.85%, 78.52%, respectively. Compared with FRAX, the BFH-OSTM has a better AUC value. Conclusions Both BFH-OSTM and FRAX can be used to identify POVCFs, However, BFH-OSTM model may be a more simple and effective tool to identify the risk of POVCFs in Chinese elderly men.

Download Full-text

Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients

BMC Infectious Diseases ◽

10.1186/s12879-021-05930-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Carlos Alfonso Romero-Gameros ◽

Tania Colin-Martínez ◽

Salomón Waizel-Haiat ◽

Guadalupe Vargas-Ortega ◽

Eduardo Ferat-Osorio ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Diagnostic Tool ◽

Clinical Decision Making ◽

Multivariate Logistic Regression Analysis ◽

Clinical Decision ◽

Cross Sectional Study ◽

World Health ◽

Likelihood Ratios ◽

Cross Sectional ◽

Health Organization

Abstract Background The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection. Methods An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19. Results A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52–4.17), fever OR 2.98 (95% CI; 2.47–3.58), dyspnea OR 2.9 (95% CI; 2.39–3.51]) and cough OR 2.73 (95% CI: 2.27–3.28). Conclusion The combination of ≥2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation < 93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease. Trial registration Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082.

Download Full-text

Educational programmes for frail older people, their families, carers and healthcare professionals

Wiener klinische Wochenschrift ◽

10.1007/s00508-021-01900-4 ◽

2021 ◽

Author(s):

Rachel J. Viggars ◽

Andrew Finney ◽

Barnabas Panayiotou

Keyword(s):

Health Promotion ◽

Older People ◽

Health Professionals ◽

Data Extraction ◽

Self Care ◽

Cross Sectional Study ◽

Older Individuals ◽

Cross Sectional ◽

Educational Programmes ◽

Quasi Experimental

Summary Background More people are living with frailty and requiring additional health and support services. To improve their management, the “Frailty: Core Capability Framework” in the United Kingdom recommends frailty education for older individuals, their families, carers and health professionals. We performed a systematic review of specific educational programmes for these groups. Methods Electronic databases were searched using dedicated search terms and inclusion criteria. To improve accuracy, two reviewers carried out the screening and selection of research papers. Information from included studies was collected using a tailored data extraction template, and quality appraisal tools were used to assess the rigour of the studies. The findings were analysed to identify key themes. Results A total of 11 studies met the criteria and were included in the review. The study populations ranged from 12 to 603 and the research designs were heterogeneous (6 qualitative; 2 randomised controlled trials; 1 quasi-experimental; 1 mixed methods; 1 cross-sectional study). Whilst some methodological shortcomings were identified, all studies contributed valuable information. The results underwent narrative synthesis, which elucidated four thematic domains: (1) accessibility of educational programmes, (2) empowerment, (3) self-care, and (4) health promotion (especially exercise and nutrition). Conclusion Educational programmes for older people, their carers and health professionals are important for effective frailty prevention and management. To be maximally beneficial, they should be easily accessible to all target populations and include empowerment, self-care and health promotion. Further research should explore the formulation of widely applicable, user-friendly programmes and delivery formats that can be tailored to different client groups.

Download Full-text