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Article ; Online: Management of patients with chronic kidney disease: a French medical centre database analysis.

Ariza, Matthieu / Martin, Steven / Dusenne, Mikaël / Darmon, David / Schuers, Matthieu

2023

Abstract: Objective(s): Chronic kidney disease (CKD) is an insidious disease that requires early nephroprotective measures to delay progression to end-stage kidney disease. The objective of this study was to describe the management of patients with CKD in primary ...

Abstract	Objective(s): Chronic kidney disease (CKD) is an insidious disease that requires early nephroprotective measures to delay progression to end-stage kidney disease. The objective of this study was to describe the management of patients with CKD in primary care, including clinical and biological monitoring and prescribed treatments. A retrospective, single-centre study was conducted on adult patients who were treated in the Maison de Neufchâtel (France) between 2012 and 2017 at least once a year. The inclusion criteria were 2 estimated glomerular filtration rate (eGFR) measurements <60 mL/min more than 3 months apart. Two subgroups were constituted according to whether CKD was coded in the electronic medical records (EMRs). Results: A total of 291 (6.7%, CI95% 5.9-7.4) patients with CKD were included. The mean eGFR was 51.0 ± 16.4 mL/min. Hypertension was the most frequent health problem reported (n = 93, 32%). Nephrotective agents were prescribed in 194 (66.7%) patients, non-steroidal anti-inflammatory drugs (NSAIDs) in 22 (8%) patients, and proton-pump inhibitors (PPIs) in 147 (47%) patients. CKD coding in EMRs was associated with dosage of natraemia (n = 34, 100%, P < 0.01), albuminuria (n = 20, 58%, P < 0.01), vitamin D (n = 14, 41%, P < 0.001), and phosphorus (n = 11, 32%, P < 0.001). Eighty-one patients (31.5%) with low eGFR without an entered code for CKD were prescribed an albuminuria dosage. Clinical monitoring could not be analysed due to poor coding. Conclusion: This pilot study reinforces the hypothesis that CKD is underscreened and undermanaged. More systematic coding of medical information in EMRs and further studies on medical centre databases should improve primary care practices.
Language	English
Publishing date	2023-01-27
Publishing country	England
Document type	Journal Article
ZDB-ID	605939-9
ISSN	1460-2229 ; 0263-2136
ISSN (online)	1460-2229
ISSN	0263-2136
DOI	10.1093/fampra/cmad004
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Article ; Online: Guidelines for the management of male urinary tract infections in primary care: a lack of international consensus-a systematic review of the literature.

Soudais, Benjamin / Ribeaucoup, Florian / Schuers, Matthieu

Family practice

2022 Volume 40, Issue 1, Page(s) 152–175

Abstract: Background: The management of adult male urinary tract infections (mUTIs) in primary care lacks international consensus. The main objective of this study was to describe the different guidelines for the diagnosis and management of mUTIs in primary care, ...

Abstract	Background: The management of adult male urinary tract infections (mUTIs) in primary care lacks international consensus. The main objective of this study was to describe the different guidelines for the diagnosis and management of mUTIs in primary care, to assess their methodological quality, and to describe their evidence-based strength of recommendation (SoR). Methods: An international systematic literature review of the electronic databases Medline (PubMed) and EMBASE, and gray-literature guideline-focused databases was performed in 2021. The Appraisal of Guidelines for Research and Evaluation (AGREE II) assessment tool was used by 2 independent reviewers to appraise each guideline. Results: From 1,678 records identified, 1,558 were screened, 134 assessed for eligibility, and 29 updated guidelines met the inclusion criteria (13 from Medline, 0 from EMBASE, and 16 from gray literature). Quality assessment revealed 14 (48%) guidelines with high-quality methodology. A grading system methodology was used in 18 (62%) guidelines. Different classifications of mUTIs are described, underlining a lack of international consensus: an anatomic classification (cystitis, prostatitis, pyelonephritis) and a symptomatic classification (approach based on the intensity and tolerance of symptoms). The duration of antibiotic treatment for febrile mUTIs has been gradually reduced over the last 20 years from 28 days to 10-14 days of fluoroquinolones (FQ), which has become the international gold standard. Guidelines from Scandinavian countries propose short courses (3-5 days) of FQ-sparing treatments: pivmecillinam, nitrofurantoin, or trimethoprim. Guidelines from French-speaking countries use a watchful waiting approach and suggest treating mUTIs with FQ, regardless of fever. Conclusions: This lack of scientific evidence leads to consensus and disagreement: 14 days of FQ for febrile mUTIs is accepted despite a high risk of antimicrobial resistance, but FQ-sparing treatment and/or short treatment for afebrile mUTIs is not. The definition of afebrile UTIs/cystitis is debated and influences the type and duration of antibiotic treatment recommended.
MeSH term(s)	Adult ; Male ; Humans ; Consensus ; Urinary Tract Infections/diagnosis ; Urinary Tract Infections/drug therapy ; Anti-Bacterial Agents/therapeutic use ; Cystitis/drug therapy ; Fluoroquinolones ; Primary Health Care
Chemical Substances	Anti-Bacterial Agents ; Fluoroquinolones
Language	English
Publishing date	2022-07-13
Publishing country	England
Document type	Systematic Review ; Journal Article
ZDB-ID	605939-9
ISSN	1460-2229 ; 0263-2136
ISSN (online)	1460-2229
ISSN	0263-2136
DOI	10.1093/fampra/cmac068
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Article ; Online: General practice-related MeSH terms in main journals: a bibliometric analysis from 2011 to 2021.

Duguet, Théo / Ibanez, Gladys / Schuers, Matthieu / Lebeau, Jean-Pierre / Roser, Kristell / Gomes, Cécilia Saldanha / Cadwallader, Jean-Sébastien

The British journal of general practice : the journal of the Royal College of General Practitioners

2024 Volume 74, Issue 739, Page(s) e120–e125

Abstract: Background: There are various Medical Subject Headings (MeSH) terms used to index general practice research, without consistency.: Aim: To understand how general practice-related research is indexed in the main general practice journals between 2011 ... ...

Abstract	Background: There are various Medical Subject Headings (MeSH) terms used to index general practice research, without consistency. Aim: To understand how general practice-related research is indexed in the main general practice journals between 2011 and 2021, and to analyse the factors that influenced the choice of the general practice-related MeSH. Design and setting: This was a quantitative bibliometric study conducted on MEDLINE. Method: MeSH were selected according to the international definition of General Practice/Family Medicine: 'General Practice', 'Primary Health Care', 'Family Practice', 'General Practitioners', 'Physicians, Primary Care', and 'Physicians, Family'. Their use was studied from 2011 to 2021 on MEDLINE, reviewing the 20 general practice journals with the highest impact factors. A descriptive and analytical approach was used; the association of the country, journal, and year with the choice of general practice-related MeSH terms was analysed. Results: A total of 8514 of 150 286 articles (5.7%) were using one of the general practice-related MeSH terms. The most used were 'Primary Health Care' (4648/9984, 46.6%) and 'General Practice' (2841/9984, 28.5%). A total of 80.0% (6172/7723) of the articles were related to the UK or US and 71.0% (6055/8514) of the articles came from four journals ( Conclusion: Important variations in the indexation of general practice research were found. Researchers should consider combining 'Primary Health Care' and 'General Practice' in their PubMed searches to access all the general practice research, regardless of their country of origin.
MeSH term(s)	Humans ; Medical Subject Headings ; Periodicals as Topic ; Bibliometrics ; Family Practice
Language	English
Publishing date	2024-01-25
Publishing country	England
Document type	Journal Article
ZDB-ID	1043148-2
ISSN	1478-5242 ; 0035-8797 ; 0960-1643
ISSN (online)	1478-5242
ISSN	0035-8797 ; 0960-1643
DOI	10.3399/BJGP.2023.0060
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Article ; Online: Interprofessional clinical decision-making process in health: A scoping review.

Bouchez, Tiphanie / Cagnon, Clémence / Hamouche, Gouraya / Majdoub, Marouan / Charlet, Jean / Schuers, Matthieu

Journal of advanced nursing

2023 Volume 80, Issue 3, Page(s) 884–907

Abstract: Aims: To describe the key elements of the interprofessional decision-making process in health, based on published scientific studies. To describe the authors, reviews and subject matter of those publications.: Design: Scoping review of the literature. ...

Abstract	Aims: To describe the key elements of the interprofessional decision-making process in health, based on published scientific studies. To describe the authors, reviews and subject matter of those publications. Design: Scoping review of the literature. Data sources: MEDLINE, APA Psycinfo OpenGrey, Lissa and Cochrane databases were searched in December 2019 and January 2023. Review methods: References were considered eligible if they (i) were written in French or English, (ii) concerned health, (iii) studied a clinical decision-making process, (iv) were performed in an interprofessional context. 'PRISMA-scoping review' guidelines were respected. The eligible studies were analysed and classified by an inductive approach RESULTS: We identified 1429 sources of information, 145 of which were retained for the analysis. Based on these studies, we identified five key elements of interprofessional decision-making in health. The process was found to be influenced by group dynamics, the available information and consideration of the unique characteristics of the patient. An organizational framework and specific training favoured improvements in the process. Conclusion: Decision-making can be based on a willingness of the healthcare organization to promote models based on more shared leadership and to work on professional roles and values. It also requires healthcare professionals trained in the entire continuum of collaborative practices, to meet the unique needs of each patient. Finally, it appears essential to favour the sharing of multiple sources of accessible and structured information. Tools for knowledge formalization should help to optimize interprofessional decision-making in health. Impact: The quality of a team decision-making is critical to the quality of care. Interprofessional decision-making can be structured and improved through different levels of action. These improvements could benefit to patients and healthcare professionals in every settings of care involving care collaboration. Impact statement: Interprofessional decision-making in health is an essential lever of quality of care, especially for the most complex patients which are a contemporary challenge. This scoping review article offers a synthesis of a large corpus of data published to date about the interprofessional clinical decision-making process in healthcare. It has the potential to provide a global vision, practical data and a list of references to facilitate the work of healthcare teams, organizations and teachers ready to initiate a change.
MeSH term(s)	Humans ; Interprofessional Relations ; Cooperative Behavior ; Delivery of Health Care ; Professional Role ; Clinical Decision-Making
Language	English
Publishing date	2023-09-14
Publishing country	England
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	197634-5
ISSN	1365-2648 ; 0309-2402
ISSN (online)	1365-2648
ISSN	0309-2402
DOI	10.1111/jan.15865
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Article ; Online: A face-to-face national congress experience during the COVID-19 pandemic

Julie Dupouy / Marc Chaneliere / Matthieu Schuers / Catherine Laporte / Marc Bayen / Aurélie Gaultier / Cédric Rat

European Journal of General Practice, Vol 29, Iss

A report focussing on the risk of COVID-19 contamination

2023 Volume 2

Abstract: AbstractBackground The Congress of the National College of Academic General Practitioners took place in France in June 2021. In total, 1300 participants were registered, provoking concerns about the risk of COVID-19 contamination.Objectives The study ... ...

Abstract	AbstractBackground The Congress of the National College of Academic General Practitioners took place in France in June 2021. In total, 1300 participants were registered, provoking concerns about the risk of COVID-19 contamination.Objectives The study objective was to report participation in the first French face-to-face medical congress after restrictions due to COVID-19 and whether it resulted in COVID-19 contamination.Methods We performed two web-based surveys of respectively 46 and 33 questions. The first questionnaire was sent to all congress participants during the congress (and to a panel of non-participants) and investigated demographic characteristics, medical conditions, behaviours related to COVID-19 contamination risk, and the interest of face-to-face congress as compared to virtual congress. Two weeks after the congress, a questionnaire was addressed to the same population and to university General Practice departments to identify incident COVID-19 cases among participants.Results A total of 1001 general practitioners and residents completed the first questionnaire; 752 participated in the congress. The respondents were mainly women (61.3%), with a mean age of 35 (SD 10) years, 96.2% had been vaccinated against SARS-CoV-2, and 11.4% considered themselves at risk for a severe form of COVID-19 for medical reasons. Concerning the interest in attending the congress face-to-face, mean score was 9 over 10 (SD 1.5). No case of COVID-19 was reported among participants according to the second questionnaire (449 respondents).Conclusion During a world pandemic, even participants considering themselves at risk came to a medical congress, highlighting the networking and social aspects of a face-to-face congress.
Keywords	Continuing medical education ; medical congress ; COVID-19 ; health behaviour ; Medicine (General) ; R5-920
Subject code	410
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	Taylor & Francis Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A face-to-face national congress experience during the COVID-19 pandemic: A report focussing on the risk of COVID-19 contamination.

Dupouy, Julie / Chaneliere, Marc / Schuers, Matthieu / Laporte, Catherine / Bayen, Marc / Gaultier, Aurélie / Rat, Cédric

The European journal of general practice

2022 Volume 29, Issue 2, Page(s) 2139825

Abstract: Background: The Congress of the National College of Academic General Practitioners took place in France in June 2021. In total, 1300 participants were registered, provoking concerns about the risk of COVID-19 contamination.: Objectives: The study ... ...

Abstract	Background: The Congress of the National College of Academic General Practitioners took place in France in June 2021. In total, 1300 participants were registered, provoking concerns about the risk of COVID-19 contamination. Objectives: The study objective was to report participation in the first French face-to-face medical congress after restrictions due to COVID-19 and whether it resulted in COVID-19 contamination. Methods: We performed two web-based surveys of respectively 46 and 33 questions. The first questionnaire was sent to all congress participants during the congress (and to a panel of non-participants) and investigated demographic characteristics, medical conditions, behaviours related to COVID-19 contamination risk, and the interest of face-to-face congress as compared to virtual congress. Two weeks after the congress, a questionnaire was addressed to the same population and to university General Practice departments to identify incident COVID-19 cases among participants. Results: A total of 1001 general practitioners and residents completed the first questionnaire; 752 participated in the congress. The respondents were mainly women (61.3%), with a mean age of 35 ( Conclusion: During a world pandemic, even participants considering themselves at risk came to a medical congress, highlighting the networking and social aspects of a face-to-face congress.
MeSH term(s)	Female ; Humans ; Adult ; Male ; COVID-19/epidemiology ; SARS-CoV-2 ; Pandemics/prevention & control ; France/epidemiology
Language	English
Publishing date	2022-11-09
Publishing country	England
Document type	Journal Article
ZDB-ID	1281338-2
ISSN	1751-1402 ; 1381-4788
ISSN (online)	1751-1402
ISSN	1381-4788
DOI	10.1080/13814788.2022.2139825
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Article ; Online: The French ecology of medical care. A nationwide population-based cross sectional study.

Laporte, Catherine / Fortin, Frédéric / Dupouy, Julie / Darmon, David / Pereira, Bruno / Authier, Nicolas / Delorme, Jessica / Chenaf, Chouki / Maisonneuve, Hubert / Schuers, Matthieu

Family practice

2023 Volume 41, Issue 2, Page(s) 92–98

Abstract: Purpose: Studies in the United States, Canada, Belgium, and Switzerland showed that the majority of health problems are managed within primary health care; however, the ecology of French medical care has not yet been described.: Methods: Nationwide, ... ...

Abstract	Purpose: Studies in the United States, Canada, Belgium, and Switzerland showed that the majority of health problems are managed within primary health care; however, the ecology of French medical care has not yet been described. Methods: Nationwide, population-based, cross sectional study. In 2018, we included data from 576,125 beneficiaries from the General Sample of Beneficiaries database. We analysed the reimbursement of consultations with (i) a general practitioner (GP), (ii) an outpatient doctor other than a GP, (iii) a doctor from a university or non-university hospital; and the reimbursement of (iv) hospitalization in a private establishment, (v) general hospital, and (vi) university hospital. For each criterion, we calculated the average monthly number of reimbursements reported on 1,000 beneficiaries. For categorical variables, we used the χ2 test, and to compare means we used the z test. All tests were 2-tailed with a P-value < 5% considered significant. Results: Each month, on average, 454 (out of 1,000) beneficiaries received at least 1 reimbursement, 235 consulted a GP, 74 consulted other outpatient doctors in ambulatory care and 24 in a hospital, 13 were hospitalized in a public non-university hospital and 10 in the private sector, and 5 were admitted to a university hospital. Independently of age, people consulted GPs twice as much as other specialists. The 13-25-year-old group consulted the least. Women consulted more than men. Individuals covered by complementary universal health insurance had more care. Conclusions: Our study on reimbursement data confirmed that, like in other countries, in France the majority of health problems are managed within primary health care.
MeSH term(s)	Male ; Humans ; Female ; Adolescent ; Young Adult ; Adult ; Cross-Sectional Studies ; General Practitioners ; Referral and Consultation ; Hospitalization ; Ambulatory Care
Language	English
Publishing date	2023-11-08
Publishing country	England
Document type	Journal Article
ZDB-ID	605939-9
ISSN	1460-2229 ; 0263-2136
ISSN (online)	1460-2229
ISSN	0263-2136
DOI	10.1093/fampra/cmad098
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Article ; Online: Attitudes of General Practitioners Toward Prescription of Mobile Health Apps: Qualitative Study.

Sarradon-Eck, Aline / Bouchez, Tiphanie / Auroy, Lola / Schuers, Matthieu / Darmon, David

JMIR mHealth and uHealth

2021 Volume 9, Issue 3, Page(s) e21795

Abstract: Background: Mobile health (mHealth) apps are a potential means of empowering patients, especially in the case of multimorbidity, which complicates patients' care needs. Previous studies have shown that general practitioners (GPs) have both expectations ... ...

Abstract	Background: Mobile health (mHealth) apps are a potential means of empowering patients, especially in the case of multimorbidity, which complicates patients' care needs. Previous studies have shown that general practitioners (GPs) have both expectations and concerns regarding patients' use of mHealth apps that could impact their willingness to recommend the apps to patients. Objective: The aim of this qualitative study is to investigate French GPs' attitudes toward the prescription of mHealth apps or devices aimed toward patients by analyzing GPs' perceptions and expectations of mHealth technologies. Methods: A total of 36 GPs were interviewed individually (n=20) or in a discussion group (n=16). All participants were in private practice. A qualitative analysis of each interview and focus group was conducted using grounded theory analysis. Results: Considering the value assigned to mHealth apps by participants and their willingness or resistance to prescribe them, 3 groups were defined based on the attitudes or positions adopted by GPs: digital engagement (favorable attitude; mHealth apps are perceived as additional resources and complementary tools that facilitate the medical work, the follow-up care, and the monitoring of patients; and apps increase patients' compliance and empowerment); patient protection (related to the management of patient care and fear of risks for patients, concerns about patient data privacy and security, doubt about the usefulness for empowering patients, standardization of the medical decision process, overmedicalization, risks for individual freedom, and increasing social inequalities in health); doctor protection (fear of additional tasks and burden, doubt about the actionability of patient-gathered health data, risk for medical liability, dehumanization of the patient-doctor relationship, fear of increased drug prescription, and commodification of patient data). Conclusions: A deep understanding of both the expectations and fears of GPs is essential to motivate them to recommend mHealth apps to their patients. The results of this study show the need to provide appropriate education and training to enhance GPs' digital skills. Certification of the apps by an independent authority should be encouraged to reassure physicians about ethical and data security issues. Our results highlight the need to overcome technical issues such as interoperability between data collection and medical records to limit the disruption of medical work because of data flow.
MeSH term(s)	Attitude ; General Practitioners ; Humans ; Mobile Applications ; Prescriptions ; Telemedicine
Language	English
Publishing date	2021-03-04
Publishing country	Canada
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2719220-9
ISSN	2291-5222 ; 2291-5222
ISSN (online)	2291-5222
ISSN	2291-5222
DOI	10.2196/21795
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Article ; Online: Influence of medical shortage on GP burnout: a cross-sectional study.

Picquendar, Guillaume / Guedon, Antoine / Moulinet, Fanny / Schuers, Matthieu

Family practice

2018 Volume 36, Issue 3, Page(s) 291–296

Abstract: Background: Burnout is a common occurrence among GPs, decreasing quality of and access to care and impacting both physician and patient health. The link between burnout and low medical density has never been studied.: Objectives: This study aimed to ... ...

Abstract	Background: Burnout is a common occurrence among GPs, decreasing quality of and access to care and impacting both physician and patient health. The link between burnout and low medical density has never been studied. Objectives: This study aimed to assess the prevalence of burnout and its related factors, including low medical density, among GPs. Method: We conducted a cross-sectional survey. A self-administered questionnaire was sent to all of the 1632 GPs in Normandy, France, in September 2015. The Maslach Burnout Inventory was used to assess the three burnout dimensions: emotional exhaustion (EE), depersonalization (DP) and low personal accomplishment (PA). Results: In all, 501 GPs sent back their questionnaire (response rate: 30.7%); 487 questionnaires were analysed. Burnout had been experienced by 43.3% of the physicians in the sample. Nearly 24% of the respondents scored high EE, 27.3% scored high DP, and 13.3% scored low PA. Low medical density [odds ratios (OR): 2.16 (1.31-3.54)], and intent to quit [OR: 4.40 (2.59-7.47)] were strongly linked to the three burnout dimensions. Burnout was not linked with quantitative workload. Conclusion: Burnout among GPs was common. Low medical density and intent to quit were strong predictors of burnout. Given the current medical demographic crisis, these results highlight the relationship between burnout and medical shortage. Qualitative workload may have a more significant influence on burnout than quantitative workload. Recruiting more GPs is necessary, but may prove insufficient in fighting burnout. Preventive and curative actions are required, especially in areas with low medical density.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Burnout, Professional/epidemiology ; Cross-Sectional Studies ; Depersonalization/etiology ; Female ; France/epidemiology ; General Practitioners/psychology ; General Practitioners/supply & distribution ; Humans ; Job Satisfaction ; Logistic Models ; Male ; Medically Underserved Area ; Middle Aged ; Multivariate Analysis ; Prevalence ; Psychological Distress ; Self Report ; Surveys and Questionnaires ; Workload/psychology
Language	English
Publishing date	2018-09-05
Publishing country	England
Document type	Journal Article
ZDB-ID	605939-9
ISSN	1460-2229 ; 0263-2136
ISSN (online)	1460-2229
ISSN	0263-2136
DOI	10.1093/fampra/cmy080
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Article ; Online: Positive and negative viral associations in patients with acute respiratory tract infections in primary care: the ECOVIR study.

Petat, Hortense / Schuers, Matthieu / Marguet, Christophe / Humbert, Xavier / Le Bas, François / Rabiaza, Andry / Corbet, Sandrine / Leterrier, Bryce / Vabret, Astrid / Ar Gouilh, Meriadeg

Frontiers in public health

2023 Volume 11, Page(s) 1269805

Abstract: Introduction: Acute respiratory infections (ARIs) are the most common viral infections encountered in primary care settings. The identification of causal viruses is still not available in routine practice. Although new strategies of prevention are being ...

Abstract	Introduction: Acute respiratory infections (ARIs) are the most common viral infections encountered in primary care settings. The identification of causal viruses is still not available in routine practice. Although new strategies of prevention are being identified, knowledge of the relationships between respiratory viruses remains limited. Materials and methods: ECOVIR was a multicentric prospective study in primary care, which took place during two pre-pandemic seasons (2018-2019 and 2019-2020). Patients presenting to their General practitioner (GP) with ARIs were included, without selecting for age or clinical conditions. Viruses were detected on nasal swab samples using a multiplex Polymerase Chain Reaction test focused on 17 viruses [Respiratory Syncytial Virus-A (RSV-A), RSV-B, Rhinovirus/Enterovirus (HRV), human Metapneumovirus (hMPV), Adenovirus (ADV), Coronaviruses (CoV) HKU1, NL63, 229E, OC43, Influenza virus (H1 and H3 subtypes), Influenza virus B, Para-Influenza viruses (PIVs) 1-4, and Bocavirus (BoV)]. Results: Among the 668 analyzed samples, 66% were positive for at least one virus, of which 7.9% were viral codetections. The viral detection was negatively associated with the age of patients. BoV, ADV, and HRV occurred more significantly in younger patients than the other viruses ( Conclusion: Our study provides additional information on the relationships between respiratory viruses, which remains limited in primary care.
MeSH term(s)	Humans ; Prospective Studies ; Respiratory Tract Infections ; Viruses/genetics ; Virus Diseases/epidemiology ; Primary Health Care
Language	English
Publishing date	2023-11-24
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2023.1269805
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