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Akselsson, A., Lindgren, H., Georgsson, S., Pettersson, K., Steineck, G., Skokic, V. & Rådestad, I. (2020). Mindfetalness to increase women's awareness of fetal movements and pregnancy outcomes: a cluster-randomised controlled trial including 39 865 women. British Journal of Obstetrics and Gynecology
Open this publication in new window or tab >>Mindfetalness to increase women's awareness of fetal movements and pregnancy outcomes: a cluster-randomised controlled trial including 39 865 women
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2020 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: To examine whether a method for raising women's awareness of fetal movements, Mindfetalness, can affect pregnancy outcomes.

DESIGN: Cluster-randomised controlled trial.

SETTING: Sixty-seven maternity clinics in Stockholm, Sweden.

POPULATION: Women with singleton pregnancy with birth from 32 weeks' gestation.

METHODS: Women registered at a clinic randomised to Mindfetalness were assigned to receive a leaflet about Mindfetalness (n = 19 639) in comparison with routine care (n = 20 226). Data were collected from a population-based register.

MAIN OUTCOME MEASURES: Apgar score <7 at 5 minutes after birth, visit to healthcare due to decrease in fetal movements. Other outcomes: Apgar score <4 at 5 minutes after birth, small-for-gestational-age and mode of delivery.

RESULTS: No difference (1.1 versus 1.1%, relative risk [RR] 1.0; 95% CI 0.8-1.2) was found between the Mindfetalness group and the Routine care group for a 5-minute Apgar score <7. Women in the Mindfetalness group contacted healthcare more often due to decreased fetal movements (6.6 versus 3.8%, RR 1.72; 95% CI 1.57-1.87). Mindfetalness was associated with a reduction of babies born small-for-gestational-age (RR 0.95, 95% CI 0.90-1.00), babies born after gestational week 41+6 (RR 0.91, 95% CI 0.83-0.98) and caesarean sections (19.0 versus 20.0%, RR 0.95; 95% CI 0.91-0.99).

CONCLUSIONS: Mindfetalness did not reduce the number of babies born with an Apgar score <7. However, Mindfetalness was associated with the health benefits of decreased incidence of caesarean section and fewer children born small-for-gestational-age.

TWEETABLE ABSTRACT: Introducing Mindfetalness in maternity care decreased caesarean sections but had no effect on the occurrence of Apgar scores <7.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2020
Keywords
Apgar score, awareness, decreased fetal movements, reduced fetal movements
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:rkh:diva-3134 (URN)10.1111/1471-0528.16104 (DOI)31971325 (PubMedID)
Funder
Swedish Research Council
Available from: 2020-02-14 Created: 2020-02-14 Last updated: 2020-02-14Bibliographically approved
Georgsson, S., Krautmeyer, S., Sundqvist, E. & Carlsson, T. (2019). Abortion-related worries, fears and preparedness: a Swedish Web-based exploratory and retrospective qualitative study. European journal of contraception & reproductive health care, 24(5), 380-389
Open this publication in new window or tab >>Abortion-related worries, fears and preparedness: a Swedish Web-based exploratory and retrospective qualitative study
2019 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 24, no 5, p. 380-389Article in journal (Refereed) Published
Abstract [en]

Objective: A survey was conducted to explore worries, fears and preparedness relating to the recollected experience of having an induced abortion. Methods: The Web-based survey was carried out in Sweden among 185 women. Respondents answered open-ended questions and gave retrospective self-reported ratings about their abortion-related worries, fears, preparedness and satisfaction with information obtained from health professionals and the Web. Data were analysed using qualitative content analysis and descriptive statistics. Results: Worries and fears included the abortion process, physical reactions and psychosocial aspects. The abortion was associated with unexpected events, including the abortion process, poor health professional treatment and support, and side effects and complications. Respondents described a lack of preparatory information, leading to uncertainties due to insufficient information. Many searched for Web-based information, but respondents experienced difficulties finding high-quality sources. Respondents also recounted that the preparatory information received did not reflect the actual abortion experience. Conclusion: There is room for improvement with regard to informing, preparing and supporting women who seek an abortion. The results emphasise the importance of health professionals' giving sufficient preparatory information to enable preparedness and lessen the impact of possible unexpected events. There is a need for the development of a trustworthy Web-based service that contains honest and high-quality information.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
preparedness, Consumer health information, fear, induced abortion, worry
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-3010 (URN)10.1080/13625187.2019.1647334 (DOI)31368829 (PubMedID)
Available from: 2019-08-08 Created: 2019-08-08 Last updated: 2019-12-09Bibliographically approved
Akselsson, A., Lindgren, H., Georgsson, S., Warland, J., Pettersson, K. & Rådestad, I. (2019). Daily structured approach to awareness of fetal movements and pregnancy outcome - a prospective study. Sexual & Reproductive HealthCare, 20, 32-37
Open this publication in new window or tab >>Daily structured approach to awareness of fetal movements and pregnancy outcome - a prospective study
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2019 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, p. 32-37Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: We investigated how women, seeking care due to decreased movements, had paid attention to fetal movements and if the method of monitoring was associated with pregnancy outcome.

METHODS: A questionnaire was distributed to women from gestational week 28, who had sought care due to decreased fetal movements in Stockholm between January 1st and December 31st, 2014. Women were included in the study if the examination did not reveal any signs of a compromised fetus requiring immediate intervention. Birth outcome and sociodemographic data were collected from the obstetric record register.

RESULTS: There were 29166 births in Stockholm in 2014, we have information from 2683 women who sought care for decreased fetal movements. The majority (96.6%) of the women stated that they paid attention to fetal movements. Some women observed fetal movements weekly (17.2%) and 69.5% concentrated on fetal movements daily (non-structured group). One in ten (9.9%) used counting methods daily for observing fetal movements (structured group). Women in the structured group more often had caesarean section before onset of labor (RR 1.6, 95% CI 1.2-2.2) and a lower risk of their baby being transferred to neonatal nursery (RR 0.25, 95% CI 0.03-0.94) compared to women in the non-structured group.

CONCLUSIONS: Women, who had a daily and structured approach to awareness of fetal movements, were more likely to have a caesarean section but their babies were less likely to be transferred to a neonatal nursery as compared with women who used a non-structured method daily.

Keywords
Awareness, Decreased fetal movements, Pregnancy, Pregnancy outcome, Reduced fetal movements
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:rkh:diva-2878 (URN)10.1016/j.srhc.2019.02.002 (DOI)31084815 (PubMedID)
Available from: 2019-05-22 Created: 2019-06-14 Last updated: 2019-06-18Bibliographically approved
Akselsson, A., Lindgren, H., Georgsson, S., Pettersson, K. & Rådestad, I. (2019). Increased labor induction and women presenting with decreased or altered fetal movements - a population-based survey.. PLoS ONE, 14(5), Article ID e0216216.
Open this publication in new window or tab >>Increased labor induction and women presenting with decreased or altered fetal movements - a population-based survey.
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2019 (English)In: PLoS ONE, E-ISSN 1932-6203, Vol. 14, no 5, article id e0216216Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Women's awareness of fetal movements is important as perception of decreased fetal movements can be a sign of a compromised fetus. We aimed to study rate of labor induction in relation to number of times women seek care due to decreased or altered fetal movements during their pregnancy compared to women not seeking such care. Further, we investigated the indication of induction.

MATERIAL AND METHODS: A prospective population-based cohort study including all obstetric clinics in Stockholm, Sweden. Questionnaires were distributed to women who sought care due to decreased or altered fetal movements ≥ 28 week's gestation in 2014, women for whom an examination did not indicate a compromised fetus that required induction of labor or cesarean section when they sought care. Women who gave birth at ≥ 28 weeks' gestation in 2014 in Stockholm comprises the reference group.

RESULTS: Labor was induced more often among the 2683 women who had sought care due to decreased or altered fetal movements (RR 1.4, 95% CI 1.3-1.5). In women who presented with decreased or altered fetal movements induction of labor occurred more frequently for fetal indication than those with induction of labor and no prior fetal movement presentation (RR 1.6, 95% CI 1.4-1.8). The rate of induction increased with number of times a woman sought care, RR 1.3 for single presentation to 3.2 for five or more.

CONCLUSIONS: We studied women seeking care for decreased or altered fetal movements and for whom pregnancy was not terminated with induction or caesarean section. Subsequent (median 20 days), induction of labor and induction for fetal indications were more frequent in this group compared to the group of women with no fetal movement presentations. Among women seeking care for altered or decreased fetal movements, the likelihood of induction of labor increased with frequency of presentation.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:rkh:diva-2808 (URN)10.1371/journal.pone.0216216 (DOI)31048896 (PubMedID)
Available from: 2019-05-09 Created: 2019-05-09 Last updated: 2020-02-28Bibliographically approved
Georgsson, S. & Carlsson, T. (2019). Pain and pain management during induced abortions: a web-based exploratory study of recollections from previous patients. Journal of Advanced Nursing, 75(11), 3006-3017
Open this publication in new window or tab >>Pain and pain management during induced abortions: a web-based exploratory study of recollections from previous patients
2019 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 11, p. 3006-3017Article in journal (Refereed) Published
Abstract [en]

AIMS: To explore recollections of pain and pain management during induced abortions.

DESIGN: Mixed-methods exploratory study in Sweden.

METHODS: A web-based survey was distributed between October 2017 - July 2018 via Swedish discussion boards and social media. Open-ended questions were asked about recollection of pain and pain management, followed by self-report ratings. The survey was answered by 185 participants, responses analyzed with qualitative content analysis.

FINDINGS: Recollections of pain intensity illustrated considerable pain and a traumatic event, described in temporal aspects and likened to other painful conditions such as dysmenorrhea and childbirth. Recollections of pain management illustrated experiences of insufficient treatment of pain and dissatisfaction with pain management, including inefficient treatment and lack of professional attendance. Psychological aspects and consequences illustrated that participants related psychological distress to physical pain, felt unprepared for the physical pain and emphasized the importance of psychological support. Those who experienced intense pain described long-term psychological consequences, including fear of childbirth.

CONCLUSION: Physical pain and psychological distress can manifest as considerable challenges during induced abortion. Abortion-related pain is a multidimensional phenomenon involving physical and psychological components that needs to be rigorously treated. When physical pain is unsuccessfully treated, women may experience long-term psychological consequences after an abortion.

IMPACT: The results illustrate the importance of holistic abortion care where the multidimensional components of abortion-related pain are considered. Patients need to be offered sufficient preparatory information about potential physical pain and psychological distress. This study indicates that there is room for improvement in pain management. Larger studies are needed.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
induced abortion, midwifery, nursing, pain, pain management
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2999 (URN)10.1111/jan.14132 (DOI)31237008 (PubMedID)
Available from: 2019-06-27 Created: 2019-06-27 Last updated: 2019-12-09Bibliographically approved
Vass, C. M., Georgsson, S., Ulph, F. & Payne, K. (2019). Preferences for aspects of antenatal and newborn screening: a systematic review. BMC Pregnancy and Childbirth, 19(1), Article ID 131.
Open this publication in new window or tab >>Preferences for aspects of antenatal and newborn screening: a systematic review
2019 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, no 1, article id 131Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Many countries offer screening programmes to unborn and newborn babies (antenatal and newborn screening) to identify those at risk of certain conditions to aid earlier diagnosis and treatment. Technological advances have stimulated the development of screening programmes to include more conditions, subsequently changing the information required and potential benefit-risk trade-offs driving participation. Quantifying preferences for screening programmes can provide programme commissioners with data to understand potential demand, the drivers of this demand, information provision required to support the programmes and the extent to which preferences differ in a population. This study aimed to identify published studies eliciting preferences for antenatal and newborn screening programmes and provide an overview of key methods and findings.

METHODS: A systematic search of electronic databases for key terms identified eligible studies (discrete choice experiments (DCEs) or best-worst scaling (BWS) studies related to antenatal/newborn testing/screening published between 1990 and October 2018). Data were systematically extracted, tabulated and summarised in a narrative review.

RESULTS: A total of 19 studies using a DCE or BWS to elicit preferences for antenatal (n = 15; 79%) and newborn screening (n = 4; 21%) programmes were identified. Most of the studies were conducted in Europe (n = 12; 63%) but there were some examples from North America (n = 2; 11%) and Australia (n = 2; 11%). Attributes most commonly included were accuracy of screening (n = 15; 79%) and when screening occurred (n = 13; 68%). Other commonly occurring attributes included information content (n = 11; 58%) and risk of miscarriage (n = 10; 53%). Pregnant women (n = 11; 58%) and healthcare professionals (n = 11; 58%) were the most common study samples. Ten studies (53%) compared preferences across different respondents. Two studies (11%) made comparisons between countries. The most popular analytical model was a standard conditional logit model (n = 11; 58%) and one study investigated preference heterogeneity with latent class analysis.

CONCLUSION: There is an existing literature identifying stated preferences for antenatal and newborn screening but the incorporation of more sophisticated design and analytical methods to investigate preference heterogeneity could extend the relevance of the findings to inform commissioning of new screening programmes.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Antenatal, Best-worst scaling, Discrete choice experiment, Newborn, Preferences, Screening, Systematic review
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-2802 (URN)10.1186/s12884-019-2278-7 (DOI)30991967 (PubMedID)
Available from: 2019-04-25 Created: 2019-04-25 Last updated: 2019-09-26Bibliographically approved
Georgsson, S., van der Spoel, L., Ferm, J. & Carlsson, T. (2019). Quality of web pages about second-trimester medical abortion: A cross-sectional study of readability, comprehensiveness, and transparency. Journal of Advanced Nursing, 75(11), 2683-2691
Open this publication in new window or tab >>Quality of web pages about second-trimester medical abortion: A cross-sectional study of readability, comprehensiveness, and transparency
2019 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 11, p. 2683-2691Article in journal (Refereed) Published
Abstract [en]

AIMS: To investigate the readability, comprehensiveness and transparency of web pages about medical abortion in the second trimester of pregnancy.

DESIGN: A cross-sectional descriptive study of Swedish web pages.

METHODS: Six systematic searches were performed in Google during January 2017. The first 10 hits of each search were screened, resulting in 46 included Swedish web pages. The web pages were analyzed with readability index (LIX) to investigate readability, inductive manifest content analysis to investigate comprehensiveness, and Journal of the Medical Association benchmarks to investigate transparency.

RESULTS: Median LIX was 29.0 and the largest proportion had LIX 31-40 (N = 17), indicating moderate readability. Visual components were observed in 13 websites. Content analysis resulted in 12 categories illustrating comprehensiveness, but eight of these were only included in ≤50% web pages. With regard to transparency, 29 (63%) adhered to no benchmark, 15 (33%) adhered to one benchmark, and 2 (4%) adhered to two benchmarks. Most web pages were written or reviewed by laypersons (N = 25) and health professionals (N = 11).

CONCLUSION: The results indicate that web pages about medical abortion have moderate readability, varied comprehensiveness and poor transparency.

IMPACT: Health professionals need to acknowledge the risk of contact with web-based information about poor quality. There is a need for research that aims to increase the chances that patients encounter high-quality web-based information about medical abortion in the second trimester of pregnancy.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2019
Keywords
Comprehensiveness, Induced Abortion, Information Science, Internet, Nursing, Popular Works, Readability, Transparency
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-2947 (URN)10.1111/jan.14080 (DOI)31206760 (PubMedID)
Available from: 2019-06-24 Created: 2019-06-24 Last updated: 2019-12-09Bibliographically approved
Eriksson, C., Skinstad, M., Georgsson, S. & Carlsson, T. (2019). Quality of websites about long-acting reversible contraception: a descriptive cross-sectional study. Reproductive Health, 16(1), Article ID 172.
Open this publication in new window or tab >>Quality of websites about long-acting reversible contraception: a descriptive cross-sectional study
2019 (English)In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 16, no 1, article id 172Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Today, there are various short- and long-acting contraceptive alternatives available for those who wish to prevent unintended pregnancy. Long-acting reversible contraception are considered effective methods with a high user satisfaction. High-quality information about contraception is essential in order to empower individuals to reach informed decisions based on sufficient knowledge. Use of the Web for information about contraception is widespread, and there is a risk that those who use it for this purpose could come in contact with sources of low quality.

OBJECTIVE: The overarching aim was to investigate the quality of websites about long-acting reversible contraception.

METHODS: Swedish client-oriented websites were identified through searches in Google (n = 46 included websites). Reliability and information about long-acting reversible contraceptive choices were assessed by two assessors with the DISCERN instrument, transparency was analyzed with the Journal of the American Medical Association benchmarks, completeness was assessed with inductive content analysis and readability was analyzed with Readability Index.

RESULTS: The mean DISCERN was 44.1/80 (SD 7.7) for total score, 19.7/40 (SD 3.7) for reliability, 22.1/35 (SD 4.1) for information about long-acting reversible contraceptive choices, and 2.3/5 (SD 1.1) for overall quality. A majority of the included websites had low quality with regard to what sources were used to compile the information (n = 41/46, 89%), when the information was produced (n = 40/46, 87%), and if it provided additional sources of support and information (n = 30/46, 65%). Less than half of the websites adhered to any of the JAMA benchmarks. We identified 23 categories of comprehensiveness. The most frequent was contraceptive mechanism (n = 39/46, 85%) and the least frequent was when contraception may be initiated following an abortion (n = 3/46, 7%). The mean Readability Index was 42.5 (SD 6.3, Range 29-55) indicating moderate to difficult readability levels, corresponding to a grade level of 9.

CONCLUSIONS: The quality of client-oriented websites about long-acting reversible contraception is poor. There is an undeniable need to support and guide laypersons that intend to use web-based sources about contraceptive alternatives, so that they may reach informed decisions based on sufficient knowledge.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Consumer health information, Long-acting reversible contraception, World wide web
National Category
Other Health Sciences Information Studies
Identifiers
urn:nbn:se:rkh:diva-3093 (URN)10.1186/s12978-019-0835-1 (DOI)31775765 (PubMedID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-09Bibliographically approved
Ulfsdottir, H., Saltvedt, S. & Georgsson, S. (2019). Women's experiences of waterbirth compared with conventional uncomplicated births. Midwifery, 79, Article ID 102547.
Open this publication in new window or tab >>Women's experiences of waterbirth compared with conventional uncomplicated births
2019 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 79, article id 102547Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To compare childbirth experiences between women having a waterbirth and women having an uncomplicated conventional birth.

DESIGN: A prospective cohort study using the validated Childbirth Experience Questionnaire (CEQ) six weeks postpartum. The 22-item questionnaire assesses four domains of the childbirth experience; Own capacity, Professional support, Perceived safety and Participation. These four domains constituted the main outcome of the study. Further, supplementary questions about the second stage of labour were added to the web-questionnaire.

SETTING: One city-located hospital in Stockholm and one small-town hospital in Southern Sweden offering waterbirth to low risk women.

PARTICIPANTS: 215 women; 99 nulli- and 116 multiparas. 111 gave birth in water and 104 had an uncomplicated conventional birth.

MEASUREMENTS AND FINDINGS: The total CEQ score did not differ between the groups, while women having a waterbirth scored significantly higher in the domain, "Own capacity" and lower in the domain, "Professional support". Women having a waterbirth rated less pain and higher scores of being in control in the second stage of labour.

KEY CONCLUSIONS: A waterbirth seems to empower and enhance women's capacity for those who choose this alternative. Waterbirth can improve their birth experience and can possibly make women less dependent on the midwife.

IMPLICATIONS FOR PRACTICE: To provide waterbirth could be a way of empowering women and giving them a positive birth experience.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Childbirth Experience Questionnaire (CEQ), Experience of childbirth, Water immersion, Waterbirth
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:rkh:diva-3060 (URN)10.1016/j.midw.2019.102547 (DOI)31610362 (PubMedID)
Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-05Bibliographically approved
Ulfsdottir, H., Saltvedt, S., Ekborn, M. & Georgsson, S. (2018). Like an empowering micro-home: A qualitative study of women's experience of giving birth in water. Midwifery, 67, 26-31
Open this publication in new window or tab >>Like an empowering micro-home: A qualitative study of women's experience of giving birth in water
2018 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 67, p. 26-31Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To describe women´s experiences and perceptions of giving birth in water.

DESIGN: A qualitative study with in-depth interviews three to five months after the birth. A content analysis of the interviews was made.

SETTING: One city-located hospital in Stockholm, offering waterbirth to low risk women.

PARTICIPANTS: 20 women, 12 primiparas and 8 multiparas, aged 27-39.

MEASUREMENTS AND FINDINGS: The overall theme emerging from the analysis was, "Like an empowering micro-home", which describes the effect of being strengthened, enabled and authorized in the birth process. Three categories were found: "Synergy between body and mind", "Privacy and discretion", and "Natural and pleasant".

KEY CONCLUSIONS: The immersion in warm water provided the women with conditions that helped them to cope and feel confident during labour and birth. The homelike and limited space of a bathtub helped give a relaxed feeling of privacy, safety, control and focus for the women.

IMPLICATIONS FOR PRACTICE: This study contributes to a deeper understanding of what waterbirth offers to women. For some women, waterbirth may be a way to accomplish an empowering and positive birth experience, and could work as a tool that preserves the normality of, and increases self-efficacy in, childbirth.

Keywords
Birth, Content Analyses, Empowerment, Experience of childbirth, Water immersion, Waterbirth
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:rkh:diva-2894 (URN)10.1016/j.midw.2018.09.004 (DOI)30223104 (PubMedID)
Available from: 2019-06-14 Created: 2019-06-14 Last updated: 2019-06-18Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0003-2626-2335

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