1.Safety of an inactivated 2019-nCoV vaccine (Vero) in adults aged 60 years and older.
Bi Hua HAN ; Zhi Wei WU ; Min Jie LI ; Fei JIN ; Zhao GAO ; Lu Lu PAN ; Jing Chen MA ; Hui JIN ; Yu Liang ZHAO ; Qi LI
Chinese Journal of Preventive Medicine 2022;56(9):1295-1301
		                        		
		                        			
		                        			Objective: To analyze the safety of an inactivated 2019-nCoV vaccine (Vero cell) in adults aged 60 years and older. Methods: A randomized, double-blind, placebo-controlled clinical study was conducted in May 2020 The eligible residents aged 60 and above were recruited in Renqiu city, Hebei Province. A total of 422 subjects (phase Ⅰ/Ⅱ:72/350) were enrolled. Two doses of the trial vaccine or placebo were randomly administered according to a 0 and 28-day immunization schedule. Subjects were randomly divided into two groups in Phase Ⅰ. Within each group, participants received vaccine or placebo in a ratio of 2∶1. Subjects were randomly divided into four groups in phase Ⅱ to receive low-dose, medium-dose, high-dose vaccine and placebo, respectively, in a ratio of 2∶2∶2∶1. A combination of regular follow-up and active reporting was used to observe adverse reactions within 28 days after vaccination, and compare the incidence rate of adverse reactions in the trial and control groups. Results: 422 subjects were (66.45±4.70) years old, and 48.82% were male (206/422). There were 100, 124, 124 and 74 patients enrolled into the low-dose, medium-dose, high-dose vaccine groups and the placebo group, respectively. One person without the vaccination was removed, and 421 participants who received at least one dose of vaccine were included in the safety analysis. Within 28 days after the first or second dose, a total of 20.67% (87/421) subjects had adverse reactions (both solicitation and non-solicitation). About 76 patients suffered grade 1 adverse reactions [18.05% (76/421)] and 22 patients suffered grade 2 adverse reactions [5.23% (22/421)]. No grade 3 or above adverse reactions occurred. A total of 19.71% (83/421) subjects had solicited adverse reactions. The most common grade 1 adverse reaction was injection site pain, followed by fever and fatigue. The most common grade 2 adverse reactions were fever and fatigue, followed by muscle pain and injection site redness. A total of 2.61% (11/421) subjects had unsolicited adverse reactions. A total of 1.66% (7/421) subjects had serious adverse events after vaccination, and no serious vaccine-related adverse events were reported. Conclusions: The inactivated SARS-CoV-2 vaccine is safe for people aged 60 years and above.
		                        		
		                        		
		                        		
		                        			Adult
		                        			;
		                        		
		                        			Aged
		                        			;
		                        		
		                        			Antibodies, Viral
		                        			;
		                        		
		                        			COVID-19/prevention & control*
		                        			;
		                        		
		                        			COVID-19 Vaccines
		                        			;
		                        		
		                        			Fatigue
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Middle Aged
		                        			;
		                        		
		                        			SARS-CoV-2
		                        			;
		                        		
		                        			Vaccination
		                        			
		                        		
		                        	
2.The effectiveness of psychological intervention on nursing staff' compassion fatigue: a meta-analysis.
Wan Qing XIE ; Jia Lin WANG ; Xia LUO ; Ping TANG ; Li ZENG ; Man JIN
Chinese Journal of Industrial Hygiene and Occupational Diseases 2022;40(1):39-45
		                        		
		                        			
		                        			Objective: To systematically evaluate the impact of psychological intervention on nursing staff' compassion fatigue. Methods: From March to May 2020, PubMed, Cochrane Library, EMbase, Web of Science, CNKI, VIP, Wanfang and other databases were electronically searched to collect randomized controlled trials (RCTs) on the influence of psychological intervention on nursing staff' compassion fatigue with the main search terms including compassion fatigue, nurs*, psychological intervention, mental intervention, RCT and so on from inception to March 31, 2020. Screened literature, extracted data and assessed the risk of bias of included studies. The Stata 16.0 software was used to calculate the pooled effectiveness of psychological intervention on nursing staff' compassion fatigue. Results: All 13 RCTs were enrolled, including 940 nursing staff. Meta-analysis results demonstrated that the psychological intervention group was superior to the control group in the improvement of the compassion fatigue score (SMD=-0.96, 95%CI: -1.17-0.74, P=0.001) , compassion satisfaction score (SMD=0.61, 95%CI: 0.45-0.77, P=0.002) , burnout score (SMD=-0.46, 95%CI: -0.62-0.29, P=0.006) , secondary trauma score (SMD=-0.40, 95%CI: -0.68-0.12, P=0.020) , and the difference was statistically significant. Subgroup analysis found that the psychological intervention group was more effective than the control group in improving compassion satisfaction score, reducing burnout score and secondary trauma score, and the differences were statistically significant (P<0.05) in different intervention time (<8 weeks and ≥8 weeks) and intervention methods. Conclusion: The psychological intervention can improve the level of compassion satisfaction, and reduce the compassion fatigue among nursing staff, and have a certain preventive effect on compassion fatigue.
		                        		
		                        		
		                        		
		                        			Burnout, Professional/prevention & control*
		                        			;
		                        		
		                        			Compassion Fatigue/prevention & control*
		                        			;
		                        		
		                        			Empathy
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Nursing Staff
		                        			;
		                        		
		                        			Psychosocial Intervention
		                        			;
		                        		
		                        			Quality of Life
		                        			
		                        		
		                        	
3.Protective effects of 7-hydroxyethyl chrysin on rats with exercise-induced fatigue in hypobaric hypoxia environment.
Luwei MIAO ; Tong ZHAO ; Yingchun GAO ; Linlin JING ; Qiong HUANG ; Huiping MA
Journal of Zhejiang University. Medical sciences 2021;50(5):575-581
		                        		
		                        			
		                        			To investigate the protective effect of 7-hydroxyethyl chrysin (7-HEC) on rats with exercise-induced fatigue in hypobaric hypoxic condition.Forty healthy male Wistar rats were randomly divided into four groups with 10 rats in each group: control group, model group, chrysin group and 7-HEC group. The rats in control group were raised at local altitude but other three groups were raised in a simulating altitude of for hypobaric hypoxia treatment. The chrysin group and 7-HEC group were given chrysin or 7-HEC by gavage for respectively; while the control group and model group were given the same amount of sterilized water. The weight-bearing swimming tests were performed 3 d later, and the weight-bearing swimming time was documented. After rats were sacrificed, the liver and skeletal muscle tissue samples were taken for pathological examination and determination of lactate, malondialdehyde (MDA), total superoxide dismutase (T-SOD) and glycogen levels. Blood urea nitrogen was also determined. Compared with the model group, weight-bearing swimming times were significantly prolonged in 7-HEC group [ vs. (4.04±1.30) min, <0.01]; pathological changes in liver and skeletal muscle tissue were attenuated; generation rate of blood urea nitrogen vs. 0.60) mmol·L·min, <0.05], lactate [liver: (0.14±0.05) vs. (0.10±0.03) mg·g·min, skeletal muscle: vs. (0.18±] and MDA [liver: (0.48) vs. (0.78±0.28) nmol·mg·min, skeletal muscle: (0.87±0.19) vs. (0.63±0.11) nmol·mg·min] were significantly reduced (all < 0.05); glycogen content [liver: (15.16±2.69) vs. skeletal muscle: (1.46±0.49) vs.0.48) mg/g] and T-SOD [liver: (1.87±0.01) vs. (2.68±0.12) U/mL, skeletal muscle: 0.42) vs. 0.96) U/mL] were significantly improved (all <0.05). 7-HEC has significant protective effect on the rats with exercise-induced fatigue in hypobaric hypoxia condition.
		                        		
		                        		
		                        		
		                        			Altitude
		                        			;
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Fatigue/prevention & control*
		                        			;
		                        		
		                        			Flavonoids
		                        			;
		                        		
		                        			Hypoxia
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Rats
		                        			;
		                        		
		                        			Rats, Wistar
		                        			
		                        		
		                        	
4.Mental health of front-line staff in prevention of coronavirus disease 2019.
Ziwei TENG ; Jing HUANG ; Yan QIU ; Yuxi TAN ; Qiuping ZHONG ; Hui TANG ; Haishan WU ; Ying WU ; Jindong CHEN
Journal of Central South University(Medical Sciences) 2020;45(6):613-619
		                        		
		                        			OBJECTIVES:
		                        			The coronavirus disease 2019 (COVID-19) pandemic is a global public health crisis, which elicits psychological problems in different population This study is to investigate the impact of COVID-19 on mental health in the front-line staff.
		                        		
		                        			METHODS:
		                        			Patient Health Questionnare-9 (PHQ-9), Self-Rating Anxiety Scale (SAS), and Fatigue Self-assessment Scale (FSAS) were used to assess the depression, anxiety, and fatigue in front-line staff.
		                        		
		                        			RESULTS:
		                        			The detection rates of depression, anxiety, and fatigue were 49.1%, 21.8%, and 76.0% among the front-line staff. The rates of depression, anxiety, and fatigue in community workers were higher than those in medical workers and other occupational staff (<0.01). The PHQ-9 of front-line staffs was negatively correlated with age, family income, family members' support, satisfaction of service objects, and sleep quality (all <0.01), while positively correlated with education level, fatigue, fear of pneumonia, and the duration of daily attention to the COVID-19 (all <0.01). SAS was negatively correlated with age, family income, family support, satisfaction of objects service, and sleep quality (all <0.01), while positively correlated with gender, fatigue, fear of pneumonia, and duration of daily attention to the COVID-19 (all <0.01).
		                        		
		                        			CONCLUSIONS
		                        			The front-line workers should manage work and rest time reasonably to adjust their negative mood and fatigue. The government and the society should pay more attention to the psychological state of the front-line staff, particularly for the staff working in the community or villages and towns in preventing the COVID-19 pandemic. Thus, front-line staff can be obtained mental intervention or be taken a rest from the high-intensive work.
		                        		
		                        		
		                        		
		                        			Anxiety
		                        			;
		                        		
		                        			diagnosis
		                        			;
		                        		
		                        			Betacoronavirus
		                        			;
		                        		
		                        			Coronavirus Infections
		                        			;
		                        		
		                        			prevention & control
		                        			;
		                        		
		                        			psychology
		                        			;
		                        		
		                        			Depression
		                        			;
		                        		
		                        			diagnosis
		                        			;
		                        		
		                        			Fatigue
		                        			;
		                        		
		                        			diagnosis
		                        			;
		                        		
		                        			Health Personnel
		                        			;
		                        		
		                        			psychology
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Mental Health
		                        			;
		                        		
		                        			Pandemics
		                        			;
		                        		
		                        			prevention & control
		                        			;
		                        		
		                        			Pneumonia, Viral
		                        			;
		                        		
		                        			prevention & control
		                        			;
		                        		
		                        			psychology
		                        			
		                        		
		                        	
5.Research of Methods to Reduce Alarm Fatigue of Monitoring System.
Mengxing LIU ; Zehui SUN ; Wenyu YE ; Sanchao LIU ; Xianliang HE ; Cheng WANG ; Ye LI
Chinese Journal of Medical Instrumentation 2020;44(6):481-486
		                        		
		                        			OBJECTIVE:
		                        			In order to solve alarm fatigue, the algorithm optimization strategies were researched to reduce false and worthless alarms.
		                        		
		                        			METHODS:
		                        			A four-lead arrhythmia analysis algorithm, a multiparameter fusion analysis algorithm, an intelligent threshold reminder, a refractory period delay technique were proposed and tested with collected 28 679 alarms in multi-center study.
		                        		
		                        			RESULTS:
		                        			The sampling survey indicate that the 80.8% of arrhythmia false alarms were reduced by the four-lead analysis, the 55.9% of arrhythmia and pulse false alarms were reduced by the multi-parameter fusion analysis, the 28.0% and 29.8% of clinical worthless alarms were reduced by the intelligent threshold and refractory period delay techniques respectively. Finally, the total quantity of alarms decreased to 12 724.
		                        		
		                        			CONCLUSIONS
		                        			To increase the dimensionality of parametric analysis and control the alarm limits and delay time are conducive to reduce alarm fatigue in intensive care units.
		                        		
		                        		
		                        		
		                        			Alert Fatigue, Health Personnel/prevention & control*
		                        			;
		                        		
		                        			Arrhythmias, Cardiac/diagnosis*
		                        			;
		                        		
		                        			Clinical Alarms
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Intensive Care Units
		                        			;
		                        		
		                        			Monitoring, Physiologic
		                        			
		                        		
		                        	
6.Analysis of anti-fatigue mechanism and potential targets of ginseng.
Fei-Xiang LIU ; Zi-Xuan LIN ; Huai-Liang ZHANG ; Zhen-Qiang ZHANG ; Ke-Qin YANG ; Xiao-Fei FAN ; Jin XU ; Yong-Tao WANG ; Yu-Nan ZHAO
China Journal of Chinese Materia Medica 2019;44(24):5479-5487
		                        		
		                        			
		                        			Ginseng has effects in reinforcing vital energy,invigorating health effectively and relieving fatigue symptoms,and ginsenoside( GS) is the main component of its anti-fatigue effect. Totally 17 active components and 92 drug targets of ginseng compounds were screened from Traditional Chinese Medicine Systems Pharmacology; and 78 intersecting genes of diseases and drug targets were obtained based on R Language Technology. The protein-protein interaction( PPI) network was constructed by STRING 11. 0 software,and Matthews Correlation Coefficient( MCC) algorithm was used to screen core target genes. Gene ontology enrichment analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis were used to analyze the major genes and their roles in regulatory networks. The results indicated that ginseng could regulate the core target genes,including AKT serine/threonine kinase( AKT1),interleukin-1β,Toll-like receptor binding molecule 1( ICAM1),mitogen-activated protein kinase 8( MAPK8),AP-1 transcription factor subunit( JUN),transducer and activator of transcription 1( STAT1) and prostaglandin peroxidase synthase 2( PTGS2). It could participate in the functions of cytokine receptor binding,cell adhesion molecule binding and tumor necrosis factor receptor superfamily binding,and also regulate the signal pathways of tumor necrosis factor,interleukin 17 and c-type lectin receptor,so as to exert an anti-fatigue effect. Based on the results of network analysis,32 four-week-old male SPFACR mice were randomly divided into control group,low-dose ginsenoside group,middle-dose ginsenoside group and high-dose ginsenoside group. The corresponding drugs were administrated for 3 weeks. The results showed that GS could significantly up-regulate the expressions of STAT1 and AKT1( P<0. 01,P<0. 05),and downregulate the expressions of PTGS2 and JUN( P<0. 01). However,there was no significant effect on MAPK8,IL-1β and ICAM1. Ginseng's anti-fatigue regulation network was constructed through network pharmacology,and the results were verified by experiments,in order to reveal the anti-fatigue mechanism of ginseng and provide scientific basis for its clinical application.
		                        		
		                        		
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Fatigue/prevention & control*
		                        			;
		                        		
		                        			Gene Expression Regulation
		                        			;
		                        		
		                        			Gene Ontology
		                        			;
		                        		
		                        			Ginsenosides/pharmacology*
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Mice
		                        			;
		                        		
		                        			Panax/chemistry*
		                        			;
		                        		
		                        			Plant Extracts/pharmacology*
		                        			;
		                        		
		                        			Random Allocation
		                        			
		                        		
		                        	
7.Predicting needlestick and sharps injuries and determining preventive strategies using a Bayesian network approach in Tehran, Iran.
Hamed AKBARI ; Fakhradin GHASEMI ; Hesam AKBARI ; Amir ADIBZADEH
Epidemiology and Health 2018;40(1):e2018042-
		                        		
		                        			
		                        			OBJECTIVES: Recent studies have shown that the rate of needlestick and sharps injuries (NSIs) is unacceptably high in Iranian hospitals. The aim of the present study was to use a systematic approach to predict and reduce these injuries. METHODS: This cross-sectional study was conducted in 5 hospitals in Tehran, Iran. Eleven variables thought to affect NSIs were categorized based on the Human Factors Analysis and Classification System (HFACS) framework and modeled using a Bayesian network. A self-administered validated questionnaire was used to collect the required data. In total, 343 cases were used to train the model and 50 cases were used to test the model. Model performance was assessed using various indices. Finally, using predictive reasoning, several intervention strategies for reducing NSIs were recommended. RESULTS: The Bayesian network HFACS model was able to predict 86% of new cases correctly. The analyses showed that safety motivation and fatigue were the most important contributors to NSIs. Supervisors' attitude toward safety and working hours per week were the most important factors in the unsafe supervision category. Management commitment and staffing were the most important organizational-level factors affecting NSIs. Finally, promising intervention strategies for reducing NSIs were identified and discussed. CONCLUSIONS: To reduce NSIs, both management commitment and sufficient staffing are necessary. Supervisors should encourage nurses to engage in safe behavior. Excessive working hours result in fatigue and increase the risk of NSIs.
		                        		
		                        		
		                        		
		                        			Accident Prevention
		                        			;
		                        		
		                        			Bayes Theorem
		                        			;
		                        		
		                        			Classification
		                        			;
		                        		
		                        			Cross-Sectional Studies
		                        			;
		                        		
		                        			Fatigue
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Iran*
		                        			;
		                        		
		                        			Motivation
		                        			;
		                        		
		                        			Needlestick Injuries*
		                        			;
		                        		
		                        			Organization and Administration
		                        			
		                        		
		                        	
8.Predicting needlestick and sharps injuries and determining preventive strategies using a Bayesian network approach in Tehran, Iran
Hamed AKBARI ; Fakhradin GHASEMI ; Hesam AKBARI ; Amir ADIBZADEH
Epidemiology and Health 2018;40(1):2018042-
		                        		
		                        			
		                        			OBJECTIVES: Recent studies have shown that the rate of needlestick and sharps injuries (NSIs) is unacceptably high in Iranian hospitals. The aim of the present study was to use a systematic approach to predict and reduce these injuries.METHODS: This cross-sectional study was conducted in 5 hospitals in Tehran, Iran. Eleven variables thought to affect NSIs were categorized based on the Human Factors Analysis and Classification System (HFACS) framework and modeled using a Bayesian network. A self-administered validated questionnaire was used to collect the required data. In total, 343 cases were used to train the model and 50 cases were used to test the model. Model performance was assessed using various indices. Finally, using predictive reasoning, several intervention strategies for reducing NSIs were recommended.RESULTS: The Bayesian network HFACS model was able to predict 86% of new cases correctly. The analyses showed that safety motivation and fatigue were the most important contributors to NSIs. Supervisors' attitude toward safety and working hours per week were the most important factors in the unsafe supervision category. Management commitment and staffing were the most important organizational-level factors affecting NSIs. Finally, promising intervention strategies for reducing NSIs were identified and discussed.CONCLUSIONS: To reduce NSIs, both management commitment and sufficient staffing are necessary. Supervisors should encourage nurses to engage in safe behavior. Excessive working hours result in fatigue and increase the risk of NSIs.
		                        		
		                        		
		                        		
		                        			Accident Prevention
		                        			;
		                        		
		                        			Bayes Theorem
		                        			;
		                        		
		                        			Classification
		                        			;
		                        		
		                        			Cross-Sectional Studies
		                        			;
		                        		
		                        			Fatigue
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Iran
		                        			;
		                        		
		                        			Motivation
		                        			;
		                        		
		                        			Needlestick Injuries
		                        			;
		                        		
		                        			Organization and Administration
		                        			
		                        		
		                        	
9.Effects of Foot-Reflexology Massage on Fatigue, Stress and Postpartum Depression in Postpartum Women.
Journal of Korean Academy of Nursing 2015;45(4):587-594
		                        		
		                        			
		                        			PURPOSE: To identify the effects of foot reflexology massage on fatigue, stress and depression of postpartum women. METHODS: A nonequivalent control group pre-post design was used. A total of 70 women in a postpartum care center were recruited and were assigned to the experimental group (35) or control group (35). Foot reflexology massage was provided to the experimental group once a day for three days. Data were collected before and after the intervention program which was carried out from December, 2013 to February, 2014. Data were analyzed using Chi-square test, Fisher's exact test, and t-test. RESULTS: The level of fatigue in the experimental group was significantly lower than the control group (t= - 2.74, p =.008). The level of cortisol in the urine of women in the experimental group was significantly lower than the control group (t= - 2.19, p =.032). The level of depression in the experimental group was significantly lower than the control group (t= - 3.00, p =.004). CONCLUSION: The results show that the foot reflexology massage is an effective nursing intervention to relieve fatigue, stress, and depression for postpartum women.
		                        		
		                        		
		                        		
		                        			Adult
		                        			;
		                        		
		                        			Depression, Postpartum/*prevention & control
		                        			;
		                        		
		                        			*Fatigue
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Foot
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Hydrocortisone/blood
		                        			;
		                        		
		                        			Infant, Newborn
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			*Massage
		                        			;
		                        		
		                        			Postpartum Period/*psychology
		                        			;
		                        		
		                        			*Stress, Psychological
		                        			;
		                        		
		                        			Surveys and Questionnaires
		                        			
		                        		
		                        	
10.Efficacy of Hemocontrol Biofeedback System in Intradialytic Hypotension-Prone Hemodialysis Patients.
Hyo Wook GIL ; Kitae BANG ; So Young LEE ; Byoung Geun HAN ; Jin Kuk KIM ; Young Ok KIM ; Ho Cheol SONG ; Young Joo KWON ; Yong Soo KIM
Journal of Korean Medical Science 2014;29(6):805-810
		                        		
		                        			
		                        			We conducted a study to determine whether the hemocontrol biofeedback system (HBS) can improve intradialytic hypotension (IDH) in hypotension-prone hemodialysis (HD) patients compared with conventional HD. In this multicenter prospective crossover study, 60 hypotension-prone patients were serially treated by conventional HD for 8 weeks (period A), by HD with hemoscan blood volume monitoring for 2 weeks (period B0), and by HBS HD for 8 weeks (period B1). The number of sessions complicated by symptomatic IDH during 24 HD sessions (14.9+/-5.8 sessions, 62.1% in period A vs 9.2+/-7.2 sessions, 38.4% in period B1, P<0.001) and the number of IDH-related nursing interventions in a session (0.96+/-0.66 in period A vs 0.56+/-0.54 in period B1, P<0.001) significantly decreased in period B1 than in period A. Recovery time from fatigue after dialysis was significantly shorter in period B1 than in period A. The patients with higher post-dialysis blood pressure, lower difference between pre- and post-dialysis blood pressure, less frequent IDH, and higher pre- and post-dialysis body weight in period A responded better to HBS in period B1 in regard to the reduction of IDH. In conclusion, HBS may improve the patient tolerability to HD by reducing the IDH frequency and promoting faster recovery from fatigue after dialysis.
		                        		
		                        		
		                        		
		                        			Adolescent
		                        			;
		                        		
		                        			Adult
		                        			;
		                        		
		                        			Aged
		                        			;
		                        		
		                        			*Biofeedback, Psychology
		                        			;
		                        		
		                        			Blood Pressure
		                        			;
		                        		
		                        			Blood Volume
		                        			;
		                        		
		                        			Body Weight
		                        			;
		                        		
		                        			Cross-Over Studies
		                        			;
		                        		
		                        			Fatigue
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Hypotension/etiology/*prevention & control
		                        			;
		                        		
		                        			Kidney Failure, Chronic/*therapy
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Middle Aged
		                        			;
		                        		
		                        			Prone Position
		                        			;
		                        		
		                        			Prospective Studies
		                        			;
		                        		
		                        			Renal Dialysis/adverse effects
		                        			;
		                        		
		                        			Young Adult
		                        			
		                        		
		                        	
            
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