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A mindful approach to physician self-care. 医生自我保健的注意方法。
IF 1 Q3 Medicine Pub Date : 2024-01-30 DOI: 10.4102/safp.v66i1.5836
Janine M Kirby, Peter D Milligan, Hofmeyr H Conradie, Belinda M McIntosh

There has been an increasing awareness of the importance of physician mental health. Several South African studies show a high prevalence of burnout among doctors. Burnout is characterised by three components: exhaustion, depersonalisation, and a sense of a lack of efficacy. Burnout is a result of both external and internal pressures. While lifestyle modification is essential, mindfulness-informed programmes promote self-regulation and resilience. Mindfulness programmes comprise three components: present moment awareness, perspective-taking and wisdom, and compassion. Physician wellness begins with individuals recognising the need of self-care and giving themselves permission to prioritise this. Ongoing identification of self-care needs and acting compassionately to address these needs is essential.

人们越来越意识到医生心理健康的重要性。南非的几项研究表明,医生的职业倦怠发生率很高。职业倦怠有三个特征:精疲力竭、人格解体和缺乏效率感。职业倦怠是外部和内部压力共同作用的结果。改变生活方式至关重要,而正念计划则能促进自我调节和恢复能力。正念计划包括三个组成部分:当下意识、透视和智慧以及同情心。内科医生的健康始于个人认识到自我保健的必要性,并允许自己优先考虑这一点。持续识别自我保健需求并以同情之心满足这些需求至关重要。
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引用次数: 0
Diet and exercise knowledge and practices for diabetes care within families in Senwabarwana. 森瓦巴瓦纳(Senwabarwana)家庭的饮食和运动知识以及糖尿病护理实践。
IF 1 Q3 Medicine Pub Date : 2024-01-30 DOI: 10.4102/safp.v66i1.5767
Mabitsela H Mphasha, Linda Skaal, Tebogo Mothibal

Background:  Family members (FMs) are a valuable source of support, as the bulk of daily diabetes treatment occurs at home. Family members' insufficient understanding of patient support can lead to poor diabetes outcomes. Lack of knowledge about good diet and exercise can lead to unhealthy food preparation and sedentary lifestyles, affecting patients and increasing the risk of diabetes. This study aims to fill the gap in the level of knowledge of FMs relating to appropriate care for diabetic patients under their care. This will relate specifically to diet and exercise.

Methods:  A cross-sectional survey conducted in Senwabarwana, Limpopo province, involved 200 FMs caring for diabetic patients for at least 6 months. Their experience could offer valuable insights into the competence of their care. Data were collected regarding knowledge and practice using a close-ended questionnaire, with Likert scale responses and SPSS analysis, including descriptive statistics and chi-squared tests. Knowledge was assessed on a scale ranging from poor to excellent: poor (0% - 50%), fair (51% - 60%), good (61% - 74%) and excellent ( 75%). Practice was assessed as poor (0% - 50%), fair (51% - 69%) and good (70% - 100%).

Results:  Thirty-one percent of participants demonstrated excellent knowledge and only 9% demonstrated good practice. Unfortunately, 53% stated that obese patients with diabetes should skip meals to lose weight. Only 3.5% and 19%, respectively, are familiar with recommendations for exercise and glucose monitoring. Barely 35.5% of FMs eat breakfast every day, while 87.5% report exercising.

Conclusion:  Few FMs possess excellent diabetes management knowledge but still indulge in bad practices, increasing their risk of developing diabetes. Additionally, they may potentially cause health problems for patients.Contribution: Family-centred behaviour change intervention is recommended.

背景: 家庭成员(FMs)是一个宝贵的支持来源,因为糖尿病的日常治疗大部分是在家中进行的。家庭成员对患者支持的理解不足会导致糖尿病治疗效果不佳。缺乏有关良好饮食和运动的知识会导致不健康的食物烹饪和久坐不动的生活方式,从而影响患者并增加患糖尿病的风险。本研究旨在填补家庭医生在为其护理的糖尿病患者提供适当护理方面的知识空白。具体涉及饮食和运动: 方法:在林波波省森瓦巴瓦纳市进行了一项横断面调查,调查对象为 200 名护理糖尿病患者至少 6 个月的家庭医生。他们的经验可为了解其护理能力提供宝贵的信息。我们通过利克特量表和 SPSS 分析(包括描述性统计和卡方检验)收集了有关知识和实践的数据。知识评估从差到优秀:差(0% - 50%)、一般(51% - 60%)、好(61% - 74%)和优秀(75%)。实践的评估结果为差(0% - 50%)、一般(51% - 69%)和好(70% - 100%): 31%的参与者表现出了卓越的知识水平,只有 9% 的参与者表现出了良好的实践能力。遗憾的是,53% 的参与者表示肥胖的糖尿病患者应该不吃饭来减肥。分别只有 3.5% 和 19% 的人熟悉运动和血糖监测的建议。仅有 35.5% 的家庭医生每天吃早餐,而 87.5% 的家庭医生表示会锻炼身体: 结论:少数家庭主妇拥有丰富的糖尿病管理知识,但仍然沉溺于不良的生活习惯,增加了患糖尿病的风险。此外,他们还可能给患者带来潜在的健康问题:贡献:建议采取以家庭为中心的行为改变干预措施。
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引用次数: 0
Diabetes Knowledge, Attitudes, and Practices in adults with type 2 diabetes at primary health care clinics in Kimberley South Africa. 南非金伯利初级保健诊所 2 型糖尿病成人患者的糖尿病知识、态度和做法。
IF 1 Q3 Medicine Pub Date : 2024-01-29 DOI: 10.4102/safp.v66i1.5838
Moses Alenbalu, Chika K Egenasi, Wilhelm J Steinberg, Omololu Aluko

Background:  Diabetes mellitus (DM) is a common non-communicable disease associated with significant morbidity and mortality globally. It poses a huge public health and economic challenge. People with diabetes need to have adequate knowledge, attitudes and practice (KAP) to prevent complications from diabetes. This study aims to evaluate the KAP towards diabetes among type 2 diabetes mellitus (T2DM) patients attending primary healthcare clinics in Kimberley.

Methods:  A cross-sectional analytical, quantitative questionnaire-based study was done using a convenient sampling method in Sol Plaatje Municipality, Kimberley, Northern Cape.

Results:  A total of 363 type 2 diabetic patients took part in the study. Most of the participants (62.0%) were females. Most had good knowledge (67.5%), while 64.5% of the participants showed good attitudes towards diabetes. However, only 35.8% of the participants had good practices towards diabetes. There was a significant association between the participant's level of education and (1) knowledge and (2) practice, with p-values of 0.002 and 0.0075, respectively. No significant association was found between the participant's level of education and attitudes towards diabetes (p = 0.2416).

Conclusion:  This study demonstrated good diabetes-related knowledge and attitudes but inadequate practices among participants. Educational programmes to assist patients with diabetes to improve their practice towards diabetes should be encouraged and implemented.Contribution: This study will help to create awareness of the need for people with diabetes to improve their practices towards diabetes.

背景: 糖尿病(DM)是一种常见的非传染性疾病,在全球范围内具有显著的发病率和死亡率。它带来了巨大的公共卫生和经济挑战。糖尿病患者需要有足够的知识、态度和实践(KAP)来预防糖尿病并发症。本研究旨在评估在金伯利初级保健诊所就诊的 2 型糖尿病(T2DM)患者对糖尿病的 KAP: 方法:在北开普省金伯利市 Sol Plaatje 镇采用方便抽样的方法进行了一项横断面定量问卷分析研究: 共有 363 名 2 型糖尿病患者参与了研究。大多数参与者(62.0%)为女性。大多数人对糖尿病有良好的认识(67.5%),64.5%的参与者对糖尿病表现出良好的态度。然而,只有 35.8% 的参与者对糖尿病有良好的实践。参与者的教育水平与(1)知识和(2)实践之间有明显的联系,P 值分别为 0.002 和 0.0075。受试者的教育水平与对糖尿病的态度之间无明显关联(p = 0.2416): 本研究表明,参与者对糖尿病的相关知识和态度良好,但实践不足。应鼓励并实施教育计划,以帮助糖尿病患者改善其对糖尿病的态度:贡献:这项研究将有助于提高糖尿病患者的意识,使他们认识到需要改进自己的糖尿病治疗方法。
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引用次数: 0
Forensic evidence preservation following an incident of rape: The role of the victim 强奸事件后的法医证据保存:受害者的作用
IF 1 Q3 Medicine Pub Date : 2024-01-25 DOI: 10.4102/safp.v66i1.5776
A. Adefuye, C. Egenasi, Moa Benedict
Background: Rape has a high prevalence in South Africa. The collection of credible and valid forensic evidence is a key legal factor that impacts case trial outcomes. Victim behaviour around the time of the rape can impact the collection and the integrity of forensic evidence, and can have a direct effect on case progression and conviction. Despite the importance of victim behaviour, few studies have been done on the role of victims in preserving forensic evidence. This article discusses how common personal hygiene practices undertaken by rape victims after being raped can impact the quality and validity of forensic evidence. This investigation was done with the aim of elucidating the role of victims in preserving forensic evidence post rape.Methods: This was a descriptive, retrospective clinical audit of all rape victims managed at Robert Mangaliso Sobukwe Hospital forensic unit in South Africa from 01 January 2020 to 31 March 2022.Results: A total of 192 rape cases over the study period were included in this review. The median age of rape victims was 20 years (minimum 2 years; maximum 76 years). The majority (n = 178; 92.7%) of the victims were female. About 44.8% (n = 86) of the victims reported that they had urinated post-rape and prior to forensic examination, 20.8% (n = 40) had changed their clothing, 8.3% (n = 16) had showered, 6.8% (n = 13) had bathed, 4.2% (n = 8) had douched, and only 1.0% (n = 2) had defecated. Only 44 (22.9%) of the victims reported to have ingested alcohol or spiked drinks before the rape.Conclusion: These findings suggest that some rape victims engaged in personal hygiene practices that could militate against forensic evidence preservation. This finding, therefore, indicates the need for public awareness about ways to preserve evidence to the greatest extent possible after an incident of rape.Contribution: We provide simple guidelines for victims on the preservation of forensic evidence following rape and before detailed forensic medical examination and evidence collection.
背景:强奸案在南非的发生率很高。收集可信和有效的法医证据是影响案件审判结果的关键法律因素。受害者在强奸案发生前后的行为会影响法医证据的收集和完整性,并对案件的进展和定罪产生直接影响。尽管受害者的行为很重要,但有关受害者在保存法医证据方面的作用的研究却很少。本文讨论了强奸受害者在被强奸后的常见个人卫生习惯会如何影响法医证据的质量和有效性。这项调查旨在阐明受害者在强奸后保存法医证据中的作用:这是对南非罗伯特-曼加利索-索布奎医院(Robert Mangaliso Sobukwe Hospital)法医部门在 2020 年 1 月 1 日至 2022 年 3 月 31 日期间处理的所有强奸受害者进行的一次描述性、回顾性临床审计:在研究期间,共有 192 例强奸案被纳入本次审查。强奸受害者的年龄中位数为 20 岁(最小 2 岁,最大 76 岁)。大多数受害者(n = 178;92.7%)为女性。约44.8%(n = 86)的受害者表示在强奸后和法医检查前小便过,20.8%(n = 40)的受害者换过衣服,8.3%(n = 16)的受害者洗过澡,6.8%(n = 13)的受害者洗过澡,4.2%(n = 8)的受害者冲洗过身体,只有1.0%(n = 2)的受害者排便过。只有 44 名受害者(22.9%)称在被强奸前喝过酒或加了料的饮料:这些发现表明,一些强奸受害者的个人卫生习惯可能不利于法医证据的保存。因此,这一发现表明,有必要提高公众对强奸事件发生后如何最大限度地保存证据的认识:贡献:我们为受害者提供了在强奸后、详细法医检查和证据收集前保存法医证据的简单指南。
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引用次数: 0
Assessing index CD4 and associated outcomes at 1-year in a tertiary HIV clinic, KwaZulu-Natal 评估夸祖鲁-纳塔尔省一家三级艾滋病毒诊所的 CD4 指数和 1 年后的相关结果
IF 1 Q3 Medicine Pub Date : 2024-01-25 DOI: 10.4102/safp.v66i1.5803
Zanele R. Moya, S. Pillay, N. Magula
Background: Human immunodeficiency virus (HIV) management guidelines have evolved from initiating therapy at CD4 counts of ≤ 200 cells/m3 to implementing universal test and treat (UTT). This study aimed to assess whether in clinical practice, patients are presenting with higher baseline CD4 counts, describe the incidence of opportunistic infections and the proportion that achieved viral suppression.Methods: A retrospective cohort design with convenience sampling was conducted. Cohort 1 included patients initiated on antiretroviral therapy (ART) between 01 January 2014 and 31 December 2014, when criteria were set at CD4 count ≤ 350 cells/mm3. Cohort 2 included patients initiated on ART between 01 January 2019 and 31 December 2019, during the UTT era.Results: At ART initiation, the median CD4 cell was 170 cells/mm3 (interquartile range [IQR]: 85.5–287) in Cohort 1 cells/mm3 and 243 cells/mm3 (IQR: 120–411) in Cohort 2. Tuberculosis was the predominant OI in the group with CD4 cell count ≤ 200 cells/m3 in both Cohort 1 (26.8%) and Cohort 2 (27.9%), p = 0.039. At 1 year, virological suppression was achieved in only 77.7% and 84.7% of Cohorts 1 and 2 patients.Conclusion: A notable portion of patients at King Edward VIII Hospital’s HIV clinic commenced ART with CD4 counts significantly below the recommended guideline thresholds.Contribution: The research revealed a delay in initiating ART. A comprehensive reevaluation is essential to pinpoint the factors contributing to this delay and to devise customised interventions.
背景:人类免疫缺陷病毒(HIV)管理指南已从 CD4 细胞数≤ 200 cells/m3 开始治疗发展到实施普遍检测和治疗(UTT)。本研究旨在评估在临床实践中,患者的基线CD4细胞数是否更高,描述机会性感染的发生率以及达到病毒抑制的比例:方法: 采用方便抽样的回顾性队列设计。队列 1 包括 2014 年 1 月 1 日至 2014 年 12 月 31 日期间开始接受抗逆转录病毒疗法(ART)的患者,当时的标准是 CD4 细胞数≤ 350 cells/mm3。队列2包括2019年1月1日至2019年12月31日期间开始接受抗逆转录病毒疗法的患者,当时正值UTT时代:在开始接受抗逆转录病毒疗法时,队列 1 的 CD4 细胞中位数为 170 cells/mm3(四分位数间距 [IQR]:85.5-287),队列 2 的 CD4 细胞中位数为 243 cells/mm3(四分位数间距 [IQR]:120-411)。在 CD4 细胞计数≤ 200 cells/m3 的人群 1(26.8%)和人群 2(27.9%)中,结核是最主要的 OI,p = 0.039。1年后,只有77.7%和84.7%的第1组和第2组患者实现了病毒抑制:结论:在爱德华八世国王医院的艾滋病诊所,有相当一部分患者在开始接受抗逆转录病毒疗法时,CD4 细胞计数明显低于推荐的指导阈值:贡献:这项研究揭示了抗逆转录病毒疗法启动的延迟。有必要进行全面的重新评估,以找出导致这一延迟的因素,并制定个性化的干预措施。
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引用次数: 0
Mental illness attitudes, service provision interest and further training preferences of clinical associates 临床助理人员对精神疾病的态度、提供服务的兴趣和进修偏好
IF 1 Q3 Medicine Pub Date : 2024-01-23 DOI: 10.4102/safp.v66i1.5808
S. Moodley, J. Wolvaardt, C. Grobler
Background: Non-specialist health professionals are required to provide mental health services given the burden of disease due to mental illness. The study aimed to explore the attitudes of clinical associates towards those with mental illness as well as their interest in mental health work and additional mental health training.Methods: A cross-sectional study design was utilised. The study population consisted of clinical associates based in South Africa. An electronic questionnaire was developed that incorporated the 16-item Mental Illness Clinicians’ Attitudes version 4 scale (MICA-4), which is scored out of 96 with higher scores indicating more stigmatising attitudes. Multivariate linear regression was used to determine factors associated with the MICA-4 score.Results: The mean MICA-4 score for the 166 participants who completed all 16 questions was 37.55 (standard deviation 7.33). In multivariate analysis, the factors associated with significantly lower MICA-4 scores were falling in the 25- to 29-year-old age category and indicating that a mental health rotation formed part of the undergraduate degree. More than 80% of the participants (140/167, 83.8%) indicated an interest in mental health work. Two-thirds of the participants (111/167, 66.5%) indicated an interest in a specialisation in mental health.Conclusion: The mean MICA-4 score recorded for clinical associates indicates low stigma levels towards those with mental illness. Additionally, there is significant interest in working and training in mental health.Contribution: Training programmes should take note of the contribution of a mental health rotation to a positive attitude to mental health patients. Clinical associates’ attitudes towards mental illness together with their interest in working and training in mental health suggest that they could be more widely utilised in mental health service provision.
背景:鉴于精神疾病造成的疾病负担,需要非专业的卫生专业人员提供精神健康服务。本研究旨在探讨临床助理人员对精神病患者的态度,以及他们对精神健康工作和额外精神健康培训的兴趣:研究采用横断面研究设计。研究对象包括南非的临床医生。该量表满分为 96 分,分数越高,表明对精神疾病的态度越轻蔑。多变量线性回归用于确定与 MICA-4 评分相关的因素:结果:在完成全部 16 个问题的 166 名参与者中,MICA-4 的平均得分为 37.55(标准偏差为 7.33)。在多变量分析中,与 MICA-4 得分明显较低相关的因素是年龄在 25-29 岁之间,以及本科学位中包含心理健康轮换课程。超过 80% 的参与者(140/167,83.8%)表示对心理健康工作感兴趣。三分之二的参与者(111/167,66.5%)表示对心理健康专业感兴趣:结论:临床助理人员的 MICA-4 平均得分表明,他们对精神病患者的成见程度较低。结论:临床助理医师的 MICA-4 平均得分表明,他们对精神病患者的成见程度较低,此外,他们对精神健康方面的工作和培训也很感兴趣:贡献:培训计划应注意到心理健康轮转对心理健康患者积极态度的促进作用。临床助理对精神疾病的态度以及他们对精神健康工作和培训的兴趣表明,他们可以在精神健康服务中得到更广泛的利用。
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引用次数: 0
Enhancing sexual health in primary care: Guidance for practitioners 加强初级保健中的性健康:从业人员指南
IF 1 Q3 Medicine Pub Date : 2024-01-19 DOI: 10.4102/safp.v66i1.5822
P. Ramlachan, K. Naidoo
Sexual health is an integral aspect of overall health and well-being and is fundamental to the sustainable development of societies worldwide. The World Health Organization (WHO) defines sexual health as ‘a state of physical, emotional, mental, and social well-being in relation to sexuality’. However, addressing sexual health has been afforded low priority in primary healthcare systems. Primary care practitioners (PCPs), who play a crucial role in providing comprehensive care to communities, receive little training on screening and managing individuals with sexual health problems. The scope of services ranges from education, prevention and screening, to management of sexual health matters. Patients with noncommunicable diseases (NCDs), such as stroke, cancer, heart disease and diabetes, are at increased risk for sexual dysfunction, possibly because of common pathogenetic mechanisms, such as inflammation. This is of considerable importance in the sub-Saharan African context where there is a rapidly increasing prevalence of NCDs, as well as a high burden of HIV. Strategies to improve the quality of sexual health services in primary care include creating a safe and non-judgemental practice environment for history-taking among gender-diverse populations, utilising effective screening tools aligned with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for sexual dysfunctions. In particular, the International Consultation on Sexual Medicine (ICSM -5) diagnostic and treatment algorithm can empower primary care providers to effectively address sexual dysfunctions among patients and improve the quality of care provided to communities regarding sexual and reproductive health.
性健康是整体健康和福祉不可或缺的一个方面,也是全世界社会可持续发展的基础。世界卫生组织(WHO)将性健康定义为 "与性有关的身体、情感、精神和社会福祉状态"。然而,在初级保健系统中,解决性健康问题的优先级一直很低。初级保健从业人员(PCPs)在为社区提供全面保健方面发挥着至关重要的作用,但他们几乎没有接受过关于筛查和管理有性健康问题的个人的培训。服务范围包括教育、预防和筛查,以及性健康问题的管理。中风、癌症、心脏病和糖尿病等非传染性疾病(NCDs)患者发生性功能障碍的风险增加,这可能是因为炎症等共同的致病机制。这在撒哈拉以南非洲地区相当重要,因为那里的非传染性疾病发病率迅速上升,而且艾滋病毒感染率很高。提高初级保健中性健康服务质量的策略包括:为不同性别人群的病史采集创造一个安全、非评判性的实践环境,利用符合《精神疾病诊断与统计手册》(DSM-5)性功能障碍标准的有效筛查工具。特别是,国际性医学咨询会(ICSM-5)的诊断和治疗算法可以增强初级保健提供者的能力,有效解决患者的性功能障碍问题,提高为社区提供的性健康和生殖健康保健的质量。
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引用次数: 0
Mastering your fellowship: Part 1, 2024 掌握你的奖学金第 1 部分,2024 年
IF 1 Q3 Medicine Pub Date : 2024-01-04 DOI: 10.4102/safp.v66i1.5829
K. V. von Pressentin, Mergan Naidoo, F. Mayanja, S. Rangiah, Ramprakash Kaswa
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引用次数: 0
Brain drain in South Africa is affecting health care 南非人才外流影响医疗保健
IF 1 Q3 Medicine Pub Date : 2024-01-03 DOI: 10.4102/safp.v66i1.5830
Indiran Govender
No abstract available.
无摘要。
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引用次数: 0
The support group impact on enhancing the self-worth of women who terminated a pregnancy in adolescence. 支持小组对提升青春期终止妊娠妇女自我价值的影响。
IF 1 Q3 Medicine Pub Date : 2023-12-27 DOI: 10.4102/safp.v65i1.5707
Botshelo R Sebola, Patrone R Risenga

Background:  Terminating a pregnancy can be a traumatic life event, resulting in negative emotions that can diminish women's self-worth. Support from different sources, including health support groups, could be beneficial in restoring a woman's self-worth. This article aimed to present findings on the impact of a support group intervention on the self-worth of women who terminated a pregnancy in adolescence.

Methods:  A qualitative, exploratory and descriptive approach, using in-depth, semi-structured interviews, was used to collect data. Thematic analysis guided the data analysis.

Results:  Five themes emerged from the data: reasons for joining the support group; enhanced emotional and physical wellbeing; self-forgiveness; spiritual growth and participants' voices.

Conclusion:  Participants described why they needed to join the support group. It became clear that the intercession was effective in the short term as it enhanced participants' self-worth by encouraging them to accept themselves thereby altering their self-condemning emotions, replacing them with self-love.Contribution: The study recommends that a support group should be considered as a backup for women who terminated a pregnancy and have lost their self-worth.

背景: 终止妊娠可能是一个创伤性的人生事件,会导致负面情绪,从而降低女性的自我价值。来自不同方面的支持,包括健康支持小组,可以帮助妇女恢复自我价值。本文旨在介绍支持小组干预对青春期终止妊娠女性自我价值的影响: 采用定性、探索性和描述性的方法,通过深入的半结构化访谈收集数据。结果:从数据中得出了五个主题:终止妊娠的原因、终止妊娠的动机、终止妊娠的方式和终止妊娠的后果: 结果:数据中出现了五个主题:加入支持小组的原因;增强情感和身体健康;自我宽恕;精神成长和参与者的声音: 结论:参与者描述了他们需要加入支持小组的原因。很明显,干预在短期内是有效的,因为它通过鼓励参与者接受自己,从而改变他们自我谴责的情绪,用自爱取代自我谴责的情绪,提高了参与者的自我价值:本研究建议,应考虑将支持小组作为终止妊娠并失去自我价值的妇女的后备力量。
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引用次数: 0
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South African Family Practice
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