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CPM Certified Professional Midwife

Exam Details:
- Number of Questions: The number of questions in the CPM (Certified Professional Midwife) exam may vary depending on the certifying organization. Typically, the exam consists of multiple-choice questions, and the exact number can range from 150 to 250 questions.

- Time: The duration of the exam can also vary depending on the organization. Generally, candidates are given a set time limit to complete the exam, which can range from 3 to 5 hours. It is advisable to refer to the specific guidelines provided by the certifying organization for accurate information regarding the exam duration.

Course Outline:
The CPM certification program is designed to assess the knowledge and skills required to practice as a professional midwife. While the specific course outline may vary depending on the certifying organization, the following courses are typically covered:

1. Midwifery Philosophy and Principles:
- History and philosophy of midwifery
- The role and responsibilities of a certified professional midwife
- Legal and ethical considerations in midwifery practice

2. Pregnancy and Prenatal Care:
- Anatomy and physiology of pregnancy
- Prenatal assessments and screenings
- Antenatal care and education for expectant parents

3. Intrapartum Care and Delivery:
- Stages of labor and childbirth
- Monitoring maternal and fetal well-being during labor
- Techniques for supporting natural childbirth and managing complications

4. Postpartum Care:
- Postpartum physiological changes and recovery
- Breastfeeding support and education
- Newborn care and assessments

5. Newborn Care and Neonatal Resuscitation:
- Neonatal assessment and resuscitation techniques
- Newborn screening and immunizations
- Common newborn conditions and interventions

6. Complications and Emergency Situations:
- Recognition and management of obstetric emergencies
- Complications during labor and birth
- Communication and collaboration with healthcare professionals in emergency situations

7. Professional Practice and Ethics:
- Professional standards and guidelines for midwifery practice
- Business and legal aspects of a midwifery practice
- Cultural competency and sensitivity in providing care

Exam Objectives:
The objectives of the CPM exam typically include:

1. Assessing Knowledge: Evaluate the candidate's understanding of midwifery principles, practices, and essential knowledge areas.

2. Testing Clinical Skills: Assess the candidate's ability to apply theoretical knowledge to clinical scenarios and make appropriate decisions in various aspects of midwifery care.

3. Evaluating Critical Thinking: Assess the candidate's critical thinking skills in evaluating evidence, problem-solving, and making sound clinical judgments in midwifery practice.

4. Certifying Midwifery Competencies: Provide a recognized certification for individuals who demonstrate the knowledge, skills, and competencies required to practice as a certified professional midwife.

Exam Syllabus:
The specific exam syllabus for the CPM may vary depending on the certifying organization. However, the following courses are typically included:

1. Midwifery Philosophy and Principles:
- History and philosophy of midwifery
- Midwifery models of care
- Legal and ethical considerations in midwifery practice

2. Anatomy and Physiology:
- Female reproductive system
- Fetal development and physiology
- Physiological changes during pregnancy, labor, and postpartum

3. Prenatal Care:
- Prenatal assessments and screenings
- Nutrition and exercise during pregnancy
- Education and counseling for expectant parents

4. Intrapartum Care:
- Stages of labor and childbirth
- Comfort measures and pain management techniques
- Monitoring maternal

and fetal well-being during labor

5. Postpartum Care:
- Postpartum physiological changes and recovery
- Breastfeeding support and education
- Newborn care and assessments

6. Newborn Care:
- Newborn assessment and examinations
- Common newborn conditions and interventions
- Neonatal resuscitation techniques

7. Complications and Emergency Situations:
- Obstetric emergencies and management
- Complications during labor and birth
- Communication and collaboration with healthcare professionals in emergency situations

8. Professional Practice:
- Professional standards and guidelines for midwifery practice
- Business aspects of a midwifery practice
- Cultural competency and sensitivity in providing care
Certified Professional Midwife
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Certified Professional Midwife
Question: 36
A client in labor is administered with an anesthetic through the spinal
subarachnoid space. Which of the following actions by the nurse is the least
appropriate when managing the client?
A. The midwife maintains the client flat on bed for 8 to 12 hours.
B. Inform the client that headaches may occur.
C. Monitor the client for hypertension.
D. Administer IV fluids.
Answer: C
The midwife should monitor the client for hypotension, not hypertension
Subarachnoid or spinal block relieves uterine and perineal pain and numbs the
lower extremities, vagina and perineum. The anesthetic may cause headaches.
The client should be flat on the bed for 8 to 12 hours. Administration of IV fluids
is also appropriate.
Question: 37
A midwife is teaching a 14-year-old girl about contraceptives. The client gave
birth to a healthy baby girl three days ago. The midwife is correct when she says
that the most effective way to protect against conception is through:
A. Natural family planning.
B. Abstinence.
C. Oral contraception.
D. Surgical methods.
Answer: B
Abstinence is the most effective way to protect against conception. Natural family
planning has a failure rate of about 20%. Oral contraception has a failure rate of
about 3%. If used correctly, oral contraceptives are 99.5% effective. Surgical
methods have a failure rate between 0.1 and 0.4%.
Question: 38
A midwife is assessing four female clients with signs and symptoms involving the
reproductive system. All clients are engaging in heterosexual sexual relationships.
The midwife requires identification and treatment of sexual partners of all of the
following clients except:
A. A client diagnosed with genital herpes.
B. A client diagnosed with chlamydia.
C. A client diagnosed with bacterial vaginosis.
D. A client with hepatitis B.
Answer: C
A client diagnosed with bacterial vaginosis is not required to identify her sexual
partners for treatment. Engaging in unprotected sex increases the risk for bacterial
vaginosis for women only, and it is believed that bacterial vaginosis can be
transmitted between women. Therefore, only women who engage in sexual
relationships with other women need to identify their sexual partners for treatment
of bacterial vaginosis.
Question: 39
A midwife is assessing the fertility of couples who have been trying to conceive
for a period of time without success. Which of the following couples has primary
A. A couple engaging in unprotected sex for half a year. No previous conceptions
are reported.
B. A couple engaging in unprotected sex for one year. A previous conception is
C. A couple engaging in unprotected sex for one year. No previous conceptions
are reported.
D. A couple engaging in unprotected sex for half a year. A previous conception is
Answer: C
Infertility is engaging in unprotected sex for one year without an occurring
pregnancy. If the couple has no previous conceptions, it is called primary
infertility. If the couple reported a previous conception, it is called secondary
Question: 40
A couple is considering artificial insemination after the man fails to respond to
medications that intend to increase his sperm count. Which of the following
statements about artificial insemination is false?
A. A donors sperm can be used.
B. The sperm is instilled into the female reproductive tract one day after
C. It involves selective termination of gestational sacs.
D. The sperm is instilled into the cervix or uterus.
Answer: C
Artificial insemination does not involve selective termination of gestational sacs.
Selective termination is performed in in vitro fertilization. Artificial insemination
may be considered if the man has inadequate sperm count or if the woman has a
condition that interferes with sperm motility.
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Medical Professional information - BingNews https://killexams.com/pass4sure/exam-detail/CPM Search results Medical Professional information - BingNews https://killexams.com/pass4sure/exam-detail/CPM https://killexams.com/exam_list/Medical Medical Professionals Are Sharing The Weirdest Thing A Patient Lied To Them About

Sharing deeply personal or embarrassing info with medical professionals can be nerve-wracking, but it's so important to tell them the truth. After all, it can be incredibly hard for doctors to do their jobs without having all the information they need to make a true diagnosis.

Recently, u/pleasedvenison5 asked doctors and other medical professionals on Reddit to share their stories about patients not being truthful with them, and their responses range from truly baffling to downright shocking. Here are some of the wildest stories:

1."I’m a hospital dietitian. One time I had a patient who always had very high blood sugar and needed tons of insulin to make it go down. This was a daily thing and several certified even came in to consult to try to figure out why this person wasn’t responding to meds. After a few days, a nurse caught the patient EATING CANDY from a bag they had stashed somewhere in the room. This person laid in bed for days eating candy and said NOTHING while all of us were trying to control his glucose!"

Betsie Van Der Meer / Getty Images

2."This is a med school story. During ER rotation, a guy came in with a banana up his butt. It went in too far and he needed medical attention. He swore up and down that he tripped, fell on the stairs, and accidentally sat on the banana. After we fished the banana out my attending at the time came over said to me, 'Just before he accidentally fell onto the banana, a condom magically got in the way.'"


3."I'm a nurse. Men constantly lie about their height to us when we're trying to fill out their charts. Even to the male doctors and nurses! I'm pretty tall, so I can tell immediately when the person who's saying they're 5'11" is actually 5'8"."

4."There was a guy who came in for a broken bone who failed to tell the people caring for him that there was a Gatorade bottle stuck on his penis."


5."I can literally smell the smoke on your clothes and breath, see the nicotine stains on your fingers, and you're trying to tell me you quit smoking 10 years ago?"

Krisanapong Detraphiphat / Getty Images

6."The number of virgins that I have diagnosed with STI’s and/or pregnancy is astounding."


7."When I was an optician, we had a patient come in that was having trouble with dry eyes. That's okay, it happens. We asked several times if she wore contacts and she swore up and down she didn't (she got contacts from us, which is how we knew), so we went through as normal. Doctor took her back and what do you know, she's wearing contacts. Even after he took them out himself and showed her, she refused to acknowledge those were hers. As she left, she asked for a new contact prescription."

Christian Feldhaar / Getty Images/iStockphoto

8."Once had a woman come in for a 'possible yeast infection.' On exam, she had a glass bottle stuck in her vaginal filled with urine. Totally wouldn’t admit it was hers or explain how it got there even after we removed it. Just kept saying 'I think this is all a joke and you put it up there.'"


9."One thing I noticed a LOT when I worked in allergy was patients lying about taking allergy pills. First off, if you take an allergy pill before an appointment that's scheduled for allergen testing, CANCEL the appointment. We're testing for up to 113 things at once. It takes a long time to set up, and you have to sit for the next 20 minutes and watch for a reaction. It's a colossal waste of time for everyone involved."

10."A patient with a specific type of eczema that looked clearly filler-related swore on her life she had never had fillers done. Awkward silence when the pathologist could see the material they use in fillers under the microscope."

11."I was working in Trauma ICU. We had this idiot that clearly shot himself in the hip while putting a gun in his pocket/side. He claimed someone came from behind and shot him. That's the story he gave the cop too."


12."I have a slightly related story; the patient did admit to me but had been lying to other doctors for years. I was seeing a patient for follow up after a heart attack. This was the patient's third heart attack and he had problems from blockages in all his arteries. He had already had a few strokes, stents in his legs, previous bypass from his first heart attack. I felt a bit bad for the guy; from the medication list he brought in he was on really good medication which should be preventing these things."

13."In general, all drug users are pretty transparent with us, they understand we’re not cops. Heroin to coke, fentanyl or what have you. Except meth. Probably the paranoia. But meth users almost always lie. As just one example: I have heard, 'My partner must have sprinkled a bit into my coffee/breakfast,' minimum three times!"


14."Friend of mine is a doctor and used to work in ER during his training. He told me they kept a box around with the objects that they pulled out of people's asses, like toy cars, light bulbs and what not. And they had a jar that they would always put €1 into whenever someone claimed 'I fell on it' or some BS. The first person to just openly admit, 'Yeah, I put that in there for pleasure' was to get all that money — but it never happened before my friend moved on to the next station of his training."


15."One lady came in with a bowel obstruction saying that the only previous surgery she had had was some bowel removal from a previous obstruction. Her abdomen was COVERED in surgical scars, but she was insistent that that was the only surgery she’d ever had. Read her notes and came back and got her to admit she’d had her gallbladder, appendix, ovaries, AND uterus removed. She was missing basically half of her abdominal contents but refused to admit it?? Patients are weird sometimes."


16."Woman came into the OB ER in labor. We asked her if she had had any prenatal checks and she said she went to all of them. Asked her if she did an ultrasound and she said yes but left the results at home. We proceeded with vaginal delivery since the baby was already crowning. Once the baby was out, we proceeded with caring for the baby and preparing for the placenta to come out. I put my fingers inside and felt… a foot near the opening. Turns out she was having twins, and the second one was breech (feet as the presenting part). Good thing we managed to deliver the second one vaginally and there were no complications, but soon we found out that the mother lied about having any prenatal checks and ultrasound done. She didn’t even know she was having twins."

Borupfoto / Getty Images/iStockphoto

17."Had a case in residency where a woman came in with her family, swore her water broke at home, and she was going into labor. The nurse couldn't find heart beats, so was low key freaking out, put out a call for a bedside ultrasound to confirm an intrauterine demise (still birth). Well, they put the ultrasound probe on and there's no baby. Family all at the bedside asking, 'What's going on?' And this lady still wouldn't say anything. We were all looking at each other in this silent stand off. We just said, 'Sorry, there's no baby.' And the family was all sorts of confused, 'What do you mean no baby? Like the baby is dead?' She didn't say anything so we left the room and discharged her. Pretty sure we checked and she had a negative pregnancy test too."


18."Patient came in saying they thought they had a UTI and wanted to be tested. I said okay please provide a urine sample. They came back out with a urine cup filled with clear liquid. Like, completely clear. Not pale pale yellow, like crystal clear. Clearly water. I said, 'Is this water or urine?' They just shrugged. I said, 'Can you please go back in and bring back urine instead?' And they came back with urine. They had a UTI, and we gave them antibiotics."


19."I’ve had many discussions with hearing aid patients that the hearing aids they are wearing are in fact the existing aids and not 20 years old. Since I issue aids and don’t sell them, people try and tell me I’ve never given them anything even though I can show them serial numbers that match their records. Less frequently, they claim the aids as lost but I can hear them whistling in their pockets."

20."He wouldn't admit to being shot. Came in with leg pain and a hole. X-ray confirmed bullet in leg. He stated he was bitten. After he was taken to OT and had the bullet removed, he still says he was bitten."


21.And finally, "I do medical massage and it’s always baffling when people don’t provide me very major parts of their health history. One of my patients had a pretty clean health history on paper, nothing listed under surgeries, medications, or cardiovascular issues. Get the massage started, asking follow up questions as I go, and suddenly he remembers that he’s on blood thinners and he’s had a pace maker put in about two years ago. Cool, cool. Continue working… Oh yeah, and he also had a hip replacement and arthritis in the left knee."


22.If you work in the medical field, have you ever had a patient lie to you like this? Or have you ever lied to your doctor? Tell us your story in the comments.

Wed, 15 Nov 2023 15:32:00 -0600 en-US text/html https://www.yahoo.com/lifestyle/medical-professionals-sharing-weirdest-thing-053102951.html
Health professionals need to collaborate. Changing how they’re taught helps build that skill No result found, try new keyword!It’s all too common for health professionals and departments to slip into silo mentalities. The post Health professionals need to collaborate. Changing how they’re taught helps build that skill ... Tue, 14 Nov 2023 20:49:25 -0600 en-us text/html https://www.msn.com/ The Missing Piece That Can Help Solve the Mental Health Crisis No result found, try new keyword!However, many people have already discovered that physical activities such as walking, running, or working out have positive impact on their mental outlook, reduction of anger or anxiety reactions and ... Wed, 15 Nov 2023 23:02:05 -0600 en-us text/html https://www.msn.com/ Health professionals played 'central role' in Nazi crimes: study

Medical professionals played a "central role" in the crimes committed by the Nazis, according to a new study published Thursday, which aims to debunk "long-held misconceptions" about the scale of their involvement.

Medical atrocities during the Nazi era were not solely carried out by "a few extremist doctors" or perpetrators that acted "under coercion", according to a report published in The Lancet journal, described by its authors as the most comprehensive of its kind to date.

By 1945, between 50 to 65 percent of non-Jewish German doctors had joined the Nazi party, which represents a "much higher proportion than in any other academic profession," said the 73-page report.

The abhorrent eugenics and euphemistically termed "euthanasia" murder programs of the Nazis during World War II resulted in "at least 230 000" deaths, including 7,000 to 10,000 children.

Over 300,000 forced sterilizations were also performed on victims, who were labeled "genetically inferior".

Despite ample evidence to the contrary, "common misconceptions" that medicine in Nazi Germany merely amounted to "pseudoscience" still remain, the study shows.

In fact, German scientists were "part of broader international networks exploring and promoting eugenics and developing racist medical rationales" and Nazi research was sometimes integrated into the "canon of medical knowledge".

Today's understanding of ", hypothermia, and even the effects of tobacco and on the body" is in part based on Nazi research, while "awareness of how the research was obtained is scarce".

As "coerced contributions to medicine", the bodies of Nazi victims were used for research and teaching, and sometimes kept in scientific collections "for decades after the war" without revealing the crimes involved.

Scientists such as the Austrian anatomist Eduard Pernkopf achieved lasting fame after the war even though their research derived from the "bodies of victims of the Nazi regime".

The Pernkopf anatomy atlas was widely published and used until the 1990s without any reference to the origins of the images in the atlas that "very likely" depict murdered Nazi victims.

Long praised as the founder of juvenile psychiatry in Germany and awarded the Cross of Merit in 1979, Elisabeth Hecker's past remained unknown to the public until a 1995 documentary revealed that she ordered transfers of children to local killing units.

"Methods first developed" between 1939 and 1941 in an effort to kill tens of thousands of institutionalized patients by gas were later "applied to the extermination camps in Poland," according to a press release accompanying the report

The authors recommend that the study of medicine under Nazism and the Holocaust should be incorporated in health care curricula, as the lack of knowledge "apart from a vague notion of Josef Mengele's experiments in Auschwitz" today is "often surprising".

Through studying the past, will be better equipped to "face moral and ethical medical dilemmas and their own biases, stand up to power, and protect vulnerable populations".

As examples, the report cites can be confronted with, such as performing triage or determining "the beginning and the end of life".

The report was carried out as part of a Lancet Commission that brought together a group of 20 international experts for the first time to examine the history of medicine.

More information: The Lancet Commission on medicine, Nazism, and the Holocaust: historical evidence, implications for today, teaching for tomorrow, The Lancet (2023). www.thelancet.com/commissions/ … ne-and-the-holocaust

© 2023 AFP

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Wed, 08 Nov 2023 19:38:00 -0600 en text/html https://phys.org/news/2023-11-health-professionals-played-central-role.html
How information technology and medical studies are converging Sun, 12 Nov 2023 19:01:00 -0600 en-US text/html https://njbiz.com/how-information-technology-and-medical-studies-are-converging/ Best Medical Billing Software Of 2023

DrChrono is a cloud-based medical billing software solution that serves as a patient management portal. Anyone in the office can access patient data easily online or via an iPad or iPhone app. The system helps medical providers manage patient intake, care, clinical charting and billing.

Intake nurses can enter patient vitals data, while doctors can leave patient notes regarding patient visits. Doctors can prescribe controlled substances using the Electronic Prescribing Controlled Substances feature, making it quick and easy to remain compliant. The system also allows you to order lab tests from among 45,000 U.S. labs, making it convenient for patients to get doctors the right health details and results.

Doctors are further able to annotate records and use an iPad to upload instant photographs to embed in the patient record. When it comes to billing, billing codes can be pre-populated, making it easy to complete any task. The system integrates with the HIPAA-compliant cloud storage system, Box, along with a host of other partner apps.

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Medical providers of all sizes and billing offices will appreciate the simplicity of DrChrono and be able to streamline their patient management tasks.

Tue, 07 Nov 2023 04:34:00 -0600 Kimberlee Leonard en-US text/html https://www.forbes.com/advisor/business/software/best-medical-billing-software/
The Mental Health Benefits Of Gratitude

While several studies link gratitude to enhanced physical health—reduced stress, a stronger immune system, improved sleep quality and lower blood pressure, to name a few benefits—practicing gratitude can also Improve mental health in some pretty meaningful ways.

Gratitude Can Help Regulate Your Emotions

Research suggests gratitude plays a role in a person’s ability to identify and regulate emotions, with some studies pointing to a possible relationship between gratitude and emotional intelligence.

“When we focus our attention on the good in our lives, the components that are making us feel sad or panic are minimized,” says Dr. Moye. “This [perspective] can provide us a sense of emotional freedom and serenity, regardless of what we face.”

Gratitude Can Elevate Your Mindset

When someone feels grateful—which can be described as a positive emotion in itself—research shows they tend to experience more positive feelings overall. Some studies also find that building gratitude practices into psychotherapy sessions can actually help promote a positive cognitive mindset because the focus shifts from negative experiences to more positive ones.

Reaping the benefits of thinking positively can take time, but with practice, the pursuit of happiness can be a worthwhile and effective one. “As we develop a relationship with gratitude, it [can] become easier to reframe our thinking in difficult moments of life,” says Dr. Moye.

Gratitude Can Help You Feel More Connected to Others

“Gratitude may help people feel more connected to others and the world around them, which can lead to increased happiness and decreased loneliness,” says Dr. Brandon.

Research backs that point, with studies finding that gratitude can help promote emotional closeness and the maintenance of strong bonds in intimate and non-intimate relationships. Additional studies suggest the expression of gratitude—and the coinciding ability to strengthen social bonds— may help reduce feelings of loneliness and disconnectedness.

Gratitude Can Motivate You Toward Better Outcomes

When you’re grateful for something, that gratitude is often reflected by and aligned with your outcomes, says Dr. Moye. “For example,” she says, “When we hold gratitude for our endurance, it will be reflected in our eating habits and physical activity.”

Research suggests gratitude exercises may, in fact, lead to more positive outcomes. Not only can they encourage health-promoting behaviors (like healthier eating), but they’ve also been found to inspire prosocial behavior (helping others). As an added benefit, Dr. Brandon says prosocial behavior may lead to increased social support (i.e friends and acquaintances who are available and able to help you), which is another factor linked to improved mental health.

Gratitude Can Help Protect You From the Effects of Stress

The connection between gratitude and improved mental health in the face of stress has been recognized by researchers for quite some time. One study found feeling more gratitude to be associated with less stress during the height of the COVID-19 pandemic, a time marked by a significant uptick in stress and anxiety levels for many people .

“Gratitude anchors us back toward our inner knowing that we are in control of our peace by how we choose to respond to stress,” says Dr. Moye.

You Deserve To Feel Better

BetterHelp match you with a dedicated licensed therapists who will help you work through difficult feelings and achieve your goals.

Thu, 09 Nov 2023 18:38:00 -0600 en-US text/html https://www.forbes.com/health/mind/mental-health-benefits-of-gratitude/
Medical Board Reprimands Doctor Who Worked While COVID-Positive

A physician in Rhode Island was given a formal reprimand by the state's medical board for performing a procedure after testing positive for COVID-19.

According to the letter, Malcolm Kirk, MD, found out he was positive for COVID-19 the evening before the scheduled procedure. "Despite the positive test results, Respondent proceeded to conduct the procedure on the following morning of January 12, 2023, at Rhode Island Hospital," the consent order states.

The Rhode Island Department of Health license database lists Kirk's specialties as cardiac electrophysiology and cardiovascular disease.

Kirk admitted that he conducted a procedure on that day while COVID-19 positive, the letter said. An investigation was conducted after a complaint was filed, and it determined Kirk had engaged in "unprofessional conduct" by violating "both federal and state quarantine guidelines applicable to COVID-19." The board also fined Kirk $1,100.

Kirk and Rhode Island Hospital in Providence (the facility where the procedure took place), did not return requests for comment from MedPage Today.

"I'm a big believer that hospital spread is a big deal," said Jeremy Faust, MD, of Brigham and Women's Hospital and Harvard Medical School in Boston, who is also the editor-in-chief of MedPage Today. "There are people who say hospitals are no worse for spread than schools or other places, but the implications are different."

"If I spread it to a group of school kids, they lose a week of school; if I spread it to a group of people in the hospital, they die," he said.

Yet there hasn't been strong endorsement from medical leadership on COVID-19 infection control policies for the healthcare workforce.

A representative from the American Medical Association said in an email to MedPage Today: "The AMA is not the author of clinical guidelines. The AMA defers to the national medical specialty societies to establish clinical guidelines and best practices." The representative referred MedPage to the American College of Surgeons, which declined to comment on clinical guidelines or the reprimand. The American Hospital Association also declined to comment.

The Rhode Island Department of Health website's "Information For Healthcare Professionals" related to COVID-19 links out to the CDC interim guidance.

According to that CDC document (last updated in September 2022), healthcare workers with mild-to-moderate COVID-19 may return to work 7 days after symptoms appeared, as long as they obtain a negative COVID test result within 48 hours of work, that it's been at least 24 hours since they had a fever, and that their symptoms have improved.

For asymptomatic COVID-19 infection, healthcare workers can return to work after it has been at least 7 days since their first positive test and if they have a negative test within 48 hours of returning to work (or 10 days if testing is not performed or if they had a positive test at day 5-7).

The CDC is currently in the process of updating its 2007 isolation precaution guidelines, which many healthcare facilities follow; COVID-19 specific precautions have not yet been drafted.

Rhode Island regulations for healthcare workers under which Kirk would have been operating also require either up-to-date COVID-19 vaccination or wearing an N95 mask when working in a healthcare facility during times when the COVID-19 prevalence rate is at or above 50 cases per 100,000 people.

However, Rhode Island Department of Health's COVID-19 Data Hub says that it is not currently tracking prevalence. "Community Levels have been replaced by Hospital Admission Levels because the widespread change in testing, such as the use of at-home tests, has made Community Levels less reliable," it noted. There were 248 reported COVID-19 hospital admissions in the state in October, less than half what was seen in October of last year.

  • Sophie Putka is an enterprise and investigative writer for MedPage Today. Her work has appeared in the Wall Street Journal, Discover, Business Insider, Inverse, Cannabis Wire, and more. She joined MedPage Today in August of 2021. Follow

Thu, 16 Nov 2023 05:34:00 -0600 en text/html https://www.medpagetoday.com/special-reports/features/107405
Flint grapples with the mental health fallout from the water disaster

On a Saturday in May in Flint, Mich., residents took seats in one of three rings of chairs at a local food bank. The 50 or so participants, spanning three generations, would spend time that morning sharing stories and practicing deep listening as part of a healing circle. It’s one component of a wider community-based movement to build relationships and challenge racist beliefs and systems.

In one circle, healing practitioner Todd Womack asked participants to introduce themselves and describe their favorite desserts. Fingers snapped softly to signal mutual enjoyment. Next, participants paired off, with instructions to take turns asking about something that recently made them smile or laugh — and to listen without interruption. From there, new pairs moved to other topics, such as an accomplishment they were proud of.

Healing circles are a space to foster community, says Lynn Williams, the director of equity and community engagement at the Community Foundation of Greater Flint, who helped organize the event that morning. The circles allow room for “healing of trauma from systems, from oppression, from negativity,” she says. And they provide a place to tell a community’s full story, to “highlight the assets and the cultural contributions.”

The circles are one way to let people know they matter when society keeps telling them they don’t.

Three healing practitioners from Flint, Michigan, stand outside on a fall day.
Healing practitioners Kristin Stevenson, Lynn Williams and Todd Womack, from left, lead healing circles in Flint to bring people together to share their stories and build relationships.JENIFER VELOSO

The residents of Flint — a city with a majority Black population and many people experiencing poverty — know this disregard well. In April 2014, to cut costs, state officials switched the city’s water source from Lake Huron to the Flint River without an adequate treatment plan. The public health catastrophe that has followed “is a story of government failure, intransigence, unpreparedness, delay, inaction and environmental injustice,” according to the final report from the Flint Water Advisory Task Force, commissioned to find the causes of the water disaster. The human-made crisis turned a necessity into a hazard for the residents of the city, which had a population of around 99,000 at the time. The lack of proper treatment exposed people to bacteria, excessive disinfection chemicals and lead.

Residents reported that their physical health suffered. People broke out in rashes, lost hair and had gastrointestinal illnesses. Researchers found an association between a local, deadly Legionnaires’ disease outbreak in 2014–15 and insufficient disinfection in the water system. Many children have developed health and behavioral problems from lead poisoning. “I am so upset,” says Bishop Bernadel Jefferson of Faith Deliverance Center in Flint, speaking of her grandson’s lead exposure and subsequent learning difficulties. “The system failed him.”

Mental health has suffered, too. Residents have reported experiencing depression, anxiety and post-traumatic stress disorder. With disasters, especially those that involve toxic exposures, “the emotional consequences are long-term, because they’re fueled by this concern [that] health or cognitive functioning has been forever adversely affected,” says Evelyn Bromet, a psychiatric epidemiologist at the Renaissance School of Medicine at Stony Brook University in New York who has studied the Chernobyl nuclear power plant disaster.

For a year and a half, officials dismissed residents’ concerns about the safety of the water. “It was horrifying, because not only were they not believed, but they weren’t taken seriously,” Bromet says. The anger that goes along with that “is of course a detrimental emotional state to be in for a long period of time.”

Other difficult experiences compounded the anguish that came with the water disaster. “This community has been exposed to multiple traumas,” says Womack, a social worker at the University of Michigan–Flint. When the disaster began, Flint was still struggling with the loss of tens of thousands of jobs due to General Motors’ layoffs and plant closures from the 1970s to the 1990s. The COVID-19 pandemic began as the water disaster continued.

Mental health remains a pressing concern for the community. But there aren’t enough mental health providers to meet the need, says Barbara Wolf, a clinical health psychologist at McLaren Health Care in Flint. Genesee County, which includes Flint, is among the areas in the United States with a shortage of mental health professionals, according to the U.S. Department of Health and Human Services.

A person stands with two others in a room and paintings, one of a snowman, surround them.
Youth Arts: Unlocked provides art workshops to young people at the Genesee County Juvenile Justice Center. Visual arts teacher Sharlene L. Howe (center), who works with the organization, discusses some of the young artists’ work at an art walk event in October. Youth Arts: Unlocked is one of several local organizations funded by ReCAST, which seeks to address trauma and stress in the community.JENIFER VELOSO

So, as they’ve done before, Flint residents are finding a way. It was the community’s organizing and activism that brought attention to the water disaster. And as Flint approaches 10 years since the disaster began, local organizations continue to help the community heal. There are mental health and resiliency trainings, mindfulness meditation and community conversations about mental health. “There’s not just one approach,” says Kristin Stevenson, project manager for the Flint Resiliency in Communities After Stress and Trauma, or ReCAST, program at the Greater Flint Health Coalition, and a healing practitioner. “All of these things combined are what create the impact.”

What has happened in Flint — and what continues there — illustrates a community’s activism and perseverance, as well as the mental health fallout of a disaster. But this story won’t end in Flint. Communities across the country could find themselves part of the next chapter, their lives upended by catastrophe. The United States’ aging water infrastructure has led to other water crises and could trigger more. Wildfires, hurricanes and floods, fueled by climate change and other human-caused environmental changes, are increasing in frequency and destructiveness. Mental health will suffer in the aftermath of these traumatic events. The water disaster in Flint can be seen as both a warning and a model of community response.

“We recognize that our struggle, if not now, will become yours,” Womack says.

The making of the water disaster in Flint

A decorative archway spanning one of downtown Flint’s main thoroughfares reads “Flint: Vehicle City.” The city was home to a booming carriage business before General Motors was founded there in 1908. Residents look back with pride on the community’s activism during GM workers’ famous sit-down strike for better pay and recognition of their union, the United Auto Workers. For around six weeks in 1936–37, striking workers occupied factories to stop production. Family and community members provided supplies and support from the outside. The strike heralded the rise of the labor movement in the automotive industry.

Workers sit  studying papers on couches in a factory setting with partially built automobiles in the background.
Flint residents have a long history of activism, including the sit-down strike of 1936–37 by General Motors workers, who remained in the plants to stop production (Fisher body plant factory No. 3 is shown).SHELDON DICK/LIBRARY OF CONGRESS

As in other cities, Flint’s industrial growth was detrimental to its river, as factories would discharge waste directly into the water. The Clean Water Act of 1972, which regulates pollution from industrial and municipal sources, has improved the health of U.S. waterways, including Flint’s. In 1974, the Safe Drinking Water Act was enacted to safeguard the country’s drinking water. The law sets standards for levels of contaminants, including microorganisms, chemicals and metals such as lead.

In 2014, Flint’s water treatment plant hadn’t been fully operational for almost 50 years. Instead, the city had been purchasing treated Lake Huron water from Detroit’s water utility. But an unelected emergency manager, placed in charge of Flint’s finances by Michigan’s then-Governor Rick Snyder, had authorized a switch to the Flint River as a cost-saving measure. Water treatment is a complex process, and the Flint River water was more corrosive than other water sources. But the Flint plant didn’t test its treatment procedures sufficiently, according to an analysis by water treatment experts. In violation of federal requirements, there was no corrosion control treatment, which helps prevent lead from leaching into the water as it moves through the distribution system’s pipes.

When residents turned on their faucets in the weeks after the switch on April 25, they were unsettled by what came out. “I used to love tap water, just to run it and let it get cold,” Jefferson says. But after the switch, the water left a film in her mouth. Flint resident Gina Luster liked to chew ice, but it started to taste “like metal, like I’m chewing steel.” Cynthia Watkins, apostle at the Well International Church Ministries in Flint, remembers the water “just smelling, it was horrible.” For Roshanda Womack, a professional storyteller and spouse of Todd Womack, the water had a strong odor and was sometimes cloudy or had a slight brown tinge to it.

People in the community spoke out about the poor water quality, with some reporting rashes from exposure to the water. But officials maintained that the water was safe for use.

Warning signs mounted in the following months. The water in the distribution system tested positive in August for E. coli, which can indicate fecal contamination and inadequate disinfection. This prompted a boil water advisory. In October, General Motors announced that it would stop using the city’s water at an engine plant over concerns about corrosion. While the company switched to a different water supply for manufacturing, officials still claimed Flint’s water met safety standards for people. Throughout 2014, church leaders and other community members worked to elevate people’s concerns about the water.

At the end of 2014, the city was served with a Safe Drinking Water Act violation, having exceeded allowable levels of trihalomethanes, disinfection by-products tied to an increased risk of cancer. These chemicals form when disinfectant added during treatment reacts with naturally occurring materials in river and lake water. One of the challenges of water treatment is maintaining proper disinfection while limiting by-product chemicals.

After the public notice of the violation in January 2015, Flint resident LeeAnne Walters asked the city to test her water. Samples from February and March revealed lead levels around seven and 27 times what spurs regulatory action. Walters’ home plumbing was plastic. An analysis of the city service line to the house revealed it was the source of the lead. When Walters’ 4-year-old son was tested for lead in March, his level was 6.5 micrograms per deciliter. No amount of lead is considered safe. At the time, the U.S. Centers for Disease Control and Prevention used a reference value of 5 µg/dL, developed based on national surveys, to identify kids with the highest lead levels. In 2021, the CDC lowered that reference value to 3.5 µg/dL.

A person holds a jug of brown water with a pink "Safe Water" sign in the background.
Community activism was instrumental in bringing attention to the Flint water crisis. Here, Gladyes Williamson and others protest in April 2015 in downtown Flint.SAM OWENS/THE FLINT JOURNAL-MLIVE.COM/ASSOCIATED PRESS

As the year continued, local organizations and churches formed the Coalition for Clean Water, which passed out flyers to inform residents of the water safety issues and collected water samples for testing. People protested, with rallies in Flint, Detroit and Lansing, the state capital. In August, organizers delivered to the mayor a petition, with more than 26,000 signatures, demanding to switch back to water from the Detroit system.

Then, at a September news conference, local researchers announced an alarming rise in the percentage of Flint children with lead levels of 5 µg/dL or higher. The analysis included children younger than age 5 who had had their levels checked as part of routine lead screening — 736 children in 2013, before the water source changed, and 737 after, in 2015. The percentage of kids considered to have high lead levels increased from 2.4 percent in 2013 to 4.9 percent in 2015, the researchers reported in 2016 in the American Journal of Public Health. In neighborhoods with the most lead in the water, the jump was from 4.0 to 10.6 percent. A similar change was not seen in 2,202 children who lived outside of the city and had a different water source.

Lead harms children’s developing brains and nervous systems. Studies have found that the metal disrupts communication between nerve cells and impairs the hippocampus, a brain region important in learning and memory. Children exposed to lead can develop learning disabilities, speech and hearing disorders, and behavioral problems. The damage can shape the rest of their lives.

Officials ultimately couldn’t brush aside the evidence of poisoned children. The city reconnected to the Detroit water system on October 16, 2015. But that water still had to flow through Flint’s pipes, which had become corroded. The city has been replacing its lead service lines but has repeatedly missed court-ordered deadlines and still isn’t finished. Lead levels have been in compliance with federal regulations since 2016 but have fluctuated recently. In 2022, lead levels rose to the highest seen in six years.

“We’re still not fixed,” says Kent Key, a health disparities researcher at the Flint campus of Michigan State University’s College of Human Medicine.

The Flint Water Advisory Task Force reported that the state government was primarily responsible for the water disaster.

The anguish Flint residents have felt

The Flint community organized, rallied and distributed testing kits and bottled water while people there lived through a disaster. “The water disaster was a traumatic experience,” Todd Womack says. “At the time, I don’t think people were saying it was traumatic. I think they were saying, ‘How do we get this basic need?’”

Eventually, the trauma rose to the surface. There had been so much worry, stress, anger and grief. Parents who had cajoled their kids to choose water over soda and juice were distraught. “I feel so guilty now,” Luster says. “I was poisoning my kid.” Pets died unexpectedly, which seemed to be tied to drinking the water. “I ended up losing both my dogs,” Watkins says. “That was just devastating.” Getting enough bottled water was a financial hardship for many. “I watched people, low-income families or on a fixed income … take half of their money to buy water every month,” Jefferson says.

And for so long, residents were told, “ ‘You’re paranoid, you’re crazy, the water is fine,’ ” Roshanda Womack says, “when you can see it’s not fine.” Jennifer Carrera, an environmental sociologist at Michigan State University in East Lansing, says there were “so many ways in which the treatment of the residents minimized their experiences…. Gaslighting is a very fair way of characterizing what happened to Flint residents.”

Yet General Motors got a different water supply for its plant. “For parts, for automobile parts,” Jefferson says, but not for people. “It was all right for us to be poisoned. It was all right to be sick. It was all right to die.”

Dionna Brown, a sociology graduate student at Wayne State University in Detroit, grew up in Flint and was a teenager during the water disaster. Brown felt “like the government is trying to poison a Black city.” She realized, “Black children, we can’t have a childhood. We have to grow up fast.”

“To live with that level of betrayal,” says Bromet, the Stony Brook psychiatric epidemiologist, “of course it takes its toll.”

As does the lack of justice. “The perpetrator, in a just and fair society, is held accountable,” Key says. “In the Flint water crisis, that still hasn’t happened.” The city has been “forced to work with the perpetrator, the state, to work towards recovery.”

The experience has left many unconvinced that the city’s water is safe. “I think you’re just going to have a large portion of the population that is never going to drink the water again,” says social epidemiologist Jerel Ezell of the University of California, Berkeley, who grew up in the Flint suburbs.

Worrying about water “puts a strain on you,” says Flint resident Tyshae Brady. “I don’t want to always go over to a friend’s house and go, ‘Hey, is your water safe to drink?’ ” The unease extends beyond Flint, too. Flint church elder Sarah Bailey, who has worked on stroke prevention in the community and other projects, recalls being at a Boston restaurant with colleagues. “The waitress brings some water to the table in glasses, and I reach over and say, ‘Do you happen to have any bottled water?’ ” One of her colleagues told Bailey the water was safe. “I said, ‘For you…. The water was not safe for me.’ ”

People stand singing in a big room with white walls.
People sing together at a community celebration on January 20, 2020, Martin Luther King Jr. Day, at the Flint Institute of Arts.SARAHBETH MANEY/THE FLINT JOURNAL-MLIVE.COM/ASSOCIATED PRESS

The mental health aftermath of the water crisis

The disaster has weighed heavily on the mental health of residents, both children and adults. From December 2018 to March 2020, researchers surveyed the caregivers of 1,203 children, ages 3 to 17. The caregiver-reported rates of anxiety and depression among the children were 13 percent for anxiety and 8 percent for depression, higher than the national rates of 9 and 4 percent for that age group, the researchers reported in September in the American Journal of Public Health.

A different research team surveyed 1,970 adult residents from August 2019 to April 2020 — around that time, Flint’s total population was just over 81,000. Twenty-two percent of the respondents had experienced symptoms of depression in the past year, while 24 percent met criteria for post-traumatic stress disorder. That’s higher than the estimated past-year rates, 8 percent for depression and 5 percent for PTSD, for the U.S. population. Extending the findings to Flint’s population suggests that around 13,600 adults may have experienced depression and around 15,000 may have had PTSD, the researchers reported in 2022 in JAMA Network Open.

People who were panic the water had harmed their or their family’s health were more than twice as likely to meet the criteria for depression and about 1.7 times as likely for PTSD, compared with people without this concern.

Past tragedies, such as a serious accident, physical abuse, sexual assault or a previous environmental calamity, can increase mental health risks when disaster strikes. “Your cumulative exposure to potentially traumatic events drives a lot of the risk for either developing or maintaining PTSD or depression,” says Dean Kilpatrick, a clinical psychologist at the Medical University of South Carolina in Charleston and one of the authors of the study in adults. Kilpatrick and colleagues found that the risk of developing symptoms of depression increased by a factor of close to three, and for PTSD symptoms by a factor of 4.6, for Flint residents with past exposure to a potentially traumatic event, compared with those without.

For some, mental health issues from disasters may persist for years. Researchers followed mothers who experienced Hurricane Katrina and had incomes less than twice the federal poverty line. The women were surveyed at three points after August of 2005, when the storm hit the U.S. Gulf Coast. Although rates of post-traumatic stress symptoms declined over time among the women, 1 in 6 still had symptoms 12 years after the hurricane, researchers reported in 2019 in Social Science & Medicine. Mothers with young children who were evacuees after the Chernobyl disaster and Chernobyl cleanup workers have had long-lasting mental health consequences.

Despite the potential impacts, only 35 percent of respondents in the study in JAMA Network Open reported that they had ever been offered mental health care to attend to issues that arose from the water disaster. If offered, most people — 79 percent — took advantage.

The COVID-19 pandemic, another traumatic experience, hit the community while they were still dealing with the water disaster. In the most accurate Community Health Needs Assessment for Flint and surrounding Genesee County, from 2022, 45 percent of respondents to the assessment’s resident survey indicated that they were dealing with stress, and 33 percent said they had mental health problems such as depression or anxiety.

How the community is helping and healing

Having too few mental health care practitioners is not an issue unique to Flint. Nearly 166 million people in the United States, about half the population, live in areas with a shortage of mental health professionals. The COVID-19 pandemic has only exacerbated the problem.

Treatment options did recently expand somewhat in Flint. In May, local mental health services provider Genesee Health System opened a new outpatient clinic that serves uninsured county residents. The treatment facility is funded in part by a recently passed property tax increase to support mental health in the county.

Beyond that, Flint organizations are taking community-based approaches to help residents cope. The Flint ReCAST program, supported with a grant from the federal Substance Abuse and Mental Health Services Administration, funds local organizations seeking to address trauma and stress in the community. ReCAST has supported art, music and dance programs for young people and an initiative to build mindfulness skills among the police and community members.

ReCAST also funds Genesee Health System to offer free community mental health and resiliency trainings, on courses ranging from recognizing suicidal ideation to learning about mental health and stigma to building resiliency. ReCAST and Genesee mental health professionals have teamed up for virtual conversations about mental health called Talk About It Tuesdays.

The Flint Public Health Youth Academy, which Key began developing in 2014, is a homegrown initiative to inspire Flint’s young people to pursue careers in public health. “I wanted to create a youth group that did not allow the water crisis to be a sentence of doom and gloom,” he says, but rather a jumping-off point to create the next generation of public health professionals. Among the academy’s activities is an annual summer camp that centers on a public health topic, such as environmental justice.

Looking to the future, Stevenson, the project manager for ReCAST, is interested in bringing training of mental health ambassadors to Flint. The idea is to train trusted community members to be a source of mental health information for their neighborhoods. Stevenson is also a big proponent of healing circles as a way to help people heal and build resilience.

A person plays the cello on a chair outside a brick building.
The Flint Farmers’ Market, which dates back to the early 1900s, is a popular community spot in downtown Flint. Here, Joe Snider plays the cello outside of the market in October.JENIFER VELOSO

At the close of one healing circle on that Saturday in May, Todd Womack took out a skein of moss green yarn. Womack asked the participants to be ready to share something they appreciate about themselves. Womack went first, then tossed the skein to another participant while holding on to a piece of the yarn. As each person took a turn, the skein zigzagged across the space, unwinding along the way. In the end, everyone in the circle was holding on to the web of yarn, a physical reminder of the community and connections created that morning.

That afternoon, three different groups formed to discuss changes residents would like to see in Flint. People responded on sticky notes to different questions, such as what Flint would look like without gun violence. People talked about the city’s history, GM’s layoffs and the abandoned homes that still dot many neighborhoods, the result of years of population loss. After a peak of nearly 197,000 in 1960, the latest population estimate, from 2022, is under 80,000.

The people gathered that Saturday are among those who have stayed. They are Flintstones, as residents call themselves. While brainstorming about Flint’s future, playful chants broke out between the groups, each of which had taken on a Flint-related name. “Flintstones!” one group cried. “810!” another responded, referring to the local area code. “Bedrock!” boomed the third, naming the town from the old The Flintstones cartoon.

When residents reflect on Flint, the strong sense of community comes up again and again. It’s how residents have stood up for their health and safety during a disaster, and it’s how they continue to care for each other.

“There’s really this unity and connectedness with anyone who has lived here,” Todd Womack says.

“We’re a loving city,” Dionna Brown says, “and we’re going to be OK.”

“There are amazing, deeply committed people that live here … there’s a lot of commitment, there’s a lot of passion,” Lynn Williams says. “And that’s why we stay.”

Wed, 15 Nov 2023 23:00:00 -0600 Aimee Cunningham en-US text/html https://www.sciencenews.org/article/flint-water-crisis-mental-health-community
Survey of 34,000 health care professionals indicates higher bias against transgender people

By analyzing data from the Harvard Implicit Association Test—a widely accepted measure of a person's attitudes toward people based on characteristics like race, gender, and sexuality—researchers find that health care professionals, and in particular nurses, are more biased against transgender people than are people who are not health care professionals.

A administered before and after the test shows that health care professionals are less likely to know personally and that nurses are more likely to conflate sex and . These results are reported in the journal Heliyon.

The Implicit Association Test works by asking participants to categorize groups of people with "good" words like "nice" or "laughter" and "bad" words like "nasty" or "rotten." Its results are collected by a team of scientists as a part of Project Implicit since 1998 and are made available for use by the public and other researchers.

To specifically assess the attitudes of health care professionals towards people, the researchers focused on a subset of the respondents from 2020 to 2022, including 11,996 nursing health care professionals and 22,443 non-nursing health care professionals. These responses were compared to 177,810 responses of non-health care professionals.

A person's is reported as their "D-score," which can range from -2 to 2, with higher scores indicating more anti-transgender views. The standard classification for this test lists values over 0.15 as "slightly biased," and over 0.35 and 0.65 as "moderately" and "strongly" biased, respectively.

Non-health care professionals on average reported a D-score of 0.116, which is considered to mean that they have little to no bias. However, health care professionals (non-nursing), reported an elevated score of 0.149, which is on the edge of what is considered to be "slightly biased." The average D-score for nursing health care professionals was 0.176, which falls clearly within the range of "slightly biased."

The participants' D-score assesses their implicit bias—their true beliefs which they may be too reluctant to share—but their explicit bias, or their self-reported views, were assessed by a questionnaire.

Nursing health care professionals were significantly more likely to agree with statements like "I believe a person can never change their " or "I think there is something wrong with a person who says they are neither a man nor a woman" compared to other health care professionals and non-health care professionals.

"Our finding that nurses have higher levels of implicit bias towards transgender people may be related to a tendency to conflate sex and gender identity, as shown by higher levels of agreement with transphobic statements that conflate these two distinct concepts," write authors Daniel W. Derbyshire of the University of Exeter and Tamsin Keay of Coventry University.

The questionnaire also asked about the participants' relationships with transgender people in their daily lives. While health care professionals—including nurses and non-nurses—were more likely to have met a transgender person than non-health care professionals, they reported that they were less likely to have a transgender friend or family member.

"This suggests that ' (both nurses and non-) experience of interacting with transgender people may be largely confined to a work context," write the authors.

The authors note that the participants in this test are limited to those who visited the Project Implicit website and chose to complete the test. "As such, the trial may be subject to trial selection bias in terms of the demographics and Implicit Association Test (IAT) results of participants," write the authors.

"However, it may be anticipated that people with particularly negative attitudes towards transgender people would avoid taking the Transgender IAT and the results presented here may therefore under-represent the extent of towards transgender people."

More information: Daniel W. Derbyshire et al, Nurses' implicit and explicit attitudes towards transgender people and the need for trans-affirming care, Heliyon (2023). DOI: 10.1016/j.heliyon.2023.e20762

Citation: Survey of 34,000 health care professionals indicates higher bias against transgender people (2023, November 3) retrieved 17 November 2023 from https://medicalxpress.com/news/2023-11-survey-health-professionals-higher-bias.html

This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

Fri, 03 Nov 2023 03:00:00 -0500 en text/html https://medicalxpress.com/news/2023-11-survey-health-professionals-higher-bias.html

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