ANALYSIS OF ANTIBIOTIC PRESCRIBING PRACTICES IN PRIMARY HEALTH CARE SETTINGS. PART I
Introduction: Antimicrobial resistance (AMR) poses a significant threat to global health, undermining the effectiveness of antibiotics in treating infectious diseases. The increasing prevalence of AMR is driven by various factors, including environmental, drug-related, patient-related, and physician-related causes. Misuse and overuse of antibiotics contribute to the development of resistant bacterial strains, leading to higher morbidity and mortality rates.
Objective: This review aims to analyze antibiotic prescribing practices in primary healthcare settings, identify key contributors to AMR, and propose strategies for improving antibiotic stewardship to mitigate resistance.
Search Strategy: A systematic literature review was conducted using peer-reviewed sources from medical and public health databases, including PubMed, Google Scholar, and EBSCO, WHO reports, epidemiological studies, and recent research on AMR trends and antibiotic prescription behaviors. The focus was on global trends with a specific emphasis on Central Asia, including Kazakhstan and neighboring countries.
Results: The review identified multiple factors contributing to AMR, including inappropriate prescriptions, weak regulatory frameworks, and socioeconomic conditions. Studies indicate that developing countries, particularly in Asia and Africa, experience higher rates of AMR due to poor healthcare policies and excessive antibiotic use in agriculture. In Kazakhstan, AMR was associated with approximately 2,400 deaths in 2019, ranking the country 95th in AMR-related mortality worldwide. The review also highlighted disparities in antibiotic stewardship practices across different regions, with European countries demonstrating lower resistance rates due to stricter regulations.
Conclusion: AMR remains a critical global health issue, exacerbated by inadequate prescription practices and weak enforcement of antibiotic regulations. Addressing this challenge requires coordinated international efforts, including improved antibiotic stewardship, enhanced surveillance systems, and stricter policies on antibiotic use. Raising awareness among healthcare professionals and the general population is essential to combat the growing threat of antibiotic resistance.
Zarpullayev Nyssan Eldosovich – Bachelor of Nursing Science, Master’s Student of Medicine, Department of General practice with a course of evidence-based medicine, NJSC "Astana Medical University", phone: 8 771 796 00 69, e-mail: nyssan.zarpullayev@alumni.nu.edu.kz, https://orcid.org/0009-0000-2276-6937, Astana, Republic of Kazakhstan
Yurkovskaya Oxana Alexandrovna - Candidate of Medical Sciences, Acting Professor of the Department of General medical practice, NJSC "Semey Medical University", phone: 8 702 750 65 21, e-mail: Oksanayrk@mail.ru, https://orcid.org/0000-0002-6251-5574, Semey, Kazakhstan;
Mukanova Dinara Adletovna - Candidate of Medical Sciences, Associate Professor Department of simulation and educational technologies, NJSC "Semey Medical University", phone: 8 701 491 98 29, e-mail: mukanova.dinara@smu.edu.kz, https://orcid.org/0000-0001-5186-2346, Semey, Republic of Kazakhstan;
Kozhakhmetova Dana Kenzhibaevna - аssistant of the Department of Internal Medicine and Rheumatology, NJSC "Semey Medical University", phone: 8 702 705 14 03, e-mail: dana.kozhakhmetova@smu.edu.kz, https://orcid.org/0000 0002-8367-1461, Semey, Republic of Kazakhstan;
Botabayeva Ainur Serikzhanovna - аssistant of the Department of Internal Medicine and Rheumatology, NJSC "Semey Medical University", phone: 8 701 100 20 98, e-mail: ainur.botabayeva@smu.edu.kz, Semey, Republic of Kazakhstan;
Smail Yerbol Muslimovich - Candidate of Medical Sciences, Associate Professor of the Department of Infectious Diseases, Dermatovenerology and Immunology, NJSC "Semey Medical University", phone: 8 705 528 84 09, e-mail: erbis@mail.ru, https://orcid.org/0000-0003-3881-3747, Semey, Kazakhstan;
Shamshudinov Timur Maratovich – PhD, «Medical and diagnostic Center of otorhinolaryngology» PRO-LOR, phone: 8 701 204 10 70, e-mail: dr.shamshudinov@mail.ru, https://orcid.org/0000-0001-5015-871X, Almaty, Kazakhstan;
Kussainova Assiya Abikhasovna - PhD, Acting Associate Professor Department of General practice with a course of evidence-based medicine, NJSC "Astana Medical University", phone: 8 707 498 73 48, e-mail: kuzilas@mail.ru, https://orcid.org/0000 0002-5738-0804, Astana, Republic of Kazakhstan;
Derbissalina Gulmira Azhmadievna - Candidate of Medical Sciences, Head of the Department of General practice with a course of evidence-based medicine, NJSC "Astana Medical University", phone: 8 701 346 93 31, е-mail: derbissalina@gmail.com, https://orcid.org/0000-0003-3704-5061, Astana, Republic of Kazakhstan.
Urazalina Nailya Murathanovna - Candidate of Medical Sciences, Associate Professor of the Department of physiological disciplines named after honored scientist of the republic of Kazakhstan, professor T.A. Nazarova, NJSC "Semey Medical University", Semey, Kazakhstan; phone: 8 777 907 55 89, е-mail: hakim_15@mail.ru, https://orcid.org/0000-0003-0200-1763,
*Correspondence author:
Kassym Laura Talgatkyzy – PhD, Associate Professor Department of General practice with a course of evidence-based medicine, NJSC "Astana Medical University",
Address: Astana Medical University, 49 Abay Street, Astana city, 010000, Republic of Kazakhstan
E-mail: laura.kassym@gmail.com
Phone: 8 777 735 10 62
1. Akram F., Imtiaz M., Haq I.U. Emergent crisis of antibiotic resistance: A silent pandemic threat to 21st century. Microb Pathog. 2022. 174. 105923.
2. Al Rahbi F., Al Salmi I., Khamis F., Al Balushi Z., Pandak N., Petersen E., Hannawi S. Physicians’ attitudes, knowledge, and practices regarding antibiotic prescriptions. J Global Antimicrob Resist. 2023. 32. 58–65.
3. Allel K., García P.C., Labarca J.A., Munita J.M., Rendic M., Undurraga E.A. Socioeconomic factors associated with antimicrobial resistance of Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli in Chilean hospitals (2008–2017). Rev Panam Salud Publica. 2020. 44. e30
4. Amin V.P., Dhanani M., Patel J., Dhawan A., Mahesh G., Chenna V.S.H., Kyada S., Dekhne A., Desai H. D. 2233. Burden of Bacterial Antimicrobial Resistance in United States in 2019: A Systematic Analysis. Open Forum Infect Dis. 2022. 10(Suppl 2). ofad500.1855. https://doi.org/10.1093/ofid/ofad500.1855
5. Ampaire L., Muhindo A., Orikiriza P., Mwanga-Amumpaire J., Bebell L., Boum Y. A review of antimicrobial resistance in East Africa. Afr J Lab Med. 2016. 5(1). e432. https://doi.org/10.4102/ajlm.v5i1.432
6. Arcilla M.S., Van Hattem J.M., Matamoros S., Melles D.C., Penders J., De Jong M.D., Schultsz C. Dissemination of the mcr-1 colistin resistance gene. Lancet Infect Dis. 2015. 16(2). 147–149. https://doi.org/10.1016/s1473-3099(15)00541-1
7. Ardillon A., Ramblière L., Kermorvant-Duchemin E., Sok T., Zo A. Z., Diouf J., Long P., Lach S., et al. Inappropriate antibiotic prescribing and its determinants among outpatient children in 3 low- and middle-income countries: A multicentric community-based cohort study. PLoS Med. 2023. 20(6). e1004211. https://doi.org/10.1371/journal.pmed.1004211
8. Ayukekbong J.A., Ntemgwa M., Atabe A.N. The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrob Resist Infect Control. 2017. 6. 47. doi: 10.1186/s13756-017-0208-x.
9. Baraka M.A., Alboghdadly A., Alshawwa S.Z., Elnour A.A., Alsultan H., Alsalman T., Alaithan H., Islam M.A., El-Fass K.A., Mohamed Y., A. Alasseri A., Salem K.M. The Healthcare Professionals’ Perspectives on Antimicrobial Resistance (AMR) Associated Factors and Their Consequences: A Cross Sectional Study in Eastern Province of Saudi Arabia. Antibiotics (Basel). 2021. 10(7). 878. doi: 10.3390/antibiotics10070878.
10. Bernabé K.J., Langendorf C., Ford N.P., Ronat J., Murphy R.A. Antimicrobial resistance in West Africa: a systematic review and meta-analysis. Int J Antimicrob Agents. 2017. 50 (5). 629-639 .
11. Cassini A., Högberg L.D., Plachouras D., Quattrocchi A., Hoxha A., Simonsen G.S., Colomb-Cotinat M., Kretzschmar M.E. et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis. 2018. 19(1). 56–66. https://doi.org/10.1016/s1473-3099(18)30605-4
12. CDC. COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2022. https://www.cdc.gov/drugresistance/covid19.html
13. Chokshi A., Sifri Z., Cennimo D., Horng H. Global Contributors to Antibiotic Resistance. J Glob Infect Dis. 2019. 11(1). 36-42. doi: 10.4103/jgid.jgid_110_18.
14. Christensen I., Haug J. B., Berild D., Bjørnholt J. V., Skodvin B., Jelsness-Jørgensen, L. Factors Affecting Antibiotic Prescription among Hospital Physicians in a Low-Antimicrobial-Resistance Country: A Qualitative Study. Antibiotics (Basel). 2022. 11(1). 98. https://doi.org/10.3390/antibiotics11010098
15. Dyar O., Tebano G., Pulcini C. Managing responsible antimicrobial use: perspectives across the healthcare system. Clin Microbiol Infect. 2017. 23(7). 441–447. https://doi.org/10.1016/j.cmi.2017.04.016
16. Endale H., Mathewos M., Abdeta D. Potential Causes of Spread of Antimicrobial Resistance and Preventive Measures in One Health Perspective-A Review. Infect Drug Resist. 2023. 16. 7515 - 7545. doi: 10.2147/IDR.S428837.
17. European Food Safety Authority. Plain Language Summary of the European Union summary report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2021-2022. EFSA journal. 2024. 22(2). p220202. https://doi.org/10.2903/j.efsa.2024.p220202
18. Fletcher-Miles H., Gammon J., Williams S., Hunt J. A scoping review to assess the impact of public education campaigns to affect behavior change pertaining to antimicrobial resistance. Am J Infect Control. 2020. 48(4). 433–442. https://doi.org/10.1016/j.ajic.2019.07.011
19. Freeland G., Hettiarachchy N., Atungulu G.G., Apple J., Mukherjee S. Strategies to Combat Antimicrobial Resistance from Farm to Table. Food Reviews International. 2021. 39(1). 27–40. https://doi.org/10.1080/87559129.2021.1893744
20. Giono-Cerezo S., Santos-Preciado J. I., Morfín-Otero M. D. R., Torres-López F. J., & Alcántar-Curiel M. D. Antimicrobial resistance. Its importance and efforts to control it. Resistencia antimicrobiana. Importancia y esfuerzos por contenerla. Gaceta medica de Mexico. 2020. 156(2). 171–178. https://doi.org/10.24875/GMM.M20000358
21. Gulumbe B.H., Haruna U.A., Almazan J., Ibrahim I.H., Faggo A.A., Bazata A.Y. Combating the menace of antimicrobial resistance in Africa: a review on stewardship, surveillance and diagnostic strategies. Biological procedures online. 2022. 24(1). 19. https://doi.org/10.1186/s12575-022-00182-y
22. Hafeez Resham, Mahmood Hina, Raza Fahad, Jabeen Wajeeha, Hyder Pakiza. Factors Influencing the Emergence of Antimicrobial Drug Resistance in Clinical Dental Practice. Journal of the Pakistan Dental Association. 2023. 32. 60-65. 10.25301/JPDA.322.60.
23. Hagedoorn N.N., Borensztajn D.M., Nijman R., Balode A., Von Both U., Carrol E.D., Eleftheriou I., Emonts M., Van Der Flier M., De Groot R., et al. Variation in antibiotic prescription rates in febrile children presenting to emergency departments across Europe (MOFICHE): A multicentre observational study. PLoS Medicine. 2020. 17(8). e1003208. https://doi.org/10.1371/journal.pmed.1003208
24. Holmes A.H., Moore L.S.P., Sundsfjord A., Steinbakk M., Regmi S., Karkey A., Guerin P. J., Piddock L. J.V. Understanding the mechanisms and drivers of antimicrobial resistance. The Lancet. 2015. 387(10014). 176–187. https://doi.org/10.1016/s0140-6736(15)00473-0
25. Huemer M., Mairpady Shambat S., Brugger S.D., Zinkernagel A.S. Antibiotic resistance and persistence-Implications for human health and treatment perspectives. EMBO reports. 2020. 21(12). e51034. https://doi.org/10.15252/embr.202051034
26. Huttner A., Harbarth S., Carlet J., Cosgrove S., Goossens H., Holmes A., Jarlier V., Voss A., Pittet D. Antimicrobial resistance: a global view from the 2013 World Healthcare-Associated Infections Forum. Antimicrobial Resistance and Infection Control. 2014. 2(1). https://doi.org/10.1186/2047-2994-2-31
27. Institute for Health Metrics and Evaluation (IHME). Kazakhstan: Antimicrobial resistance burden 2019. University of Washington. 2023. https://www.healthdata.org/sites/default/files/2023-09/Kazakhstan.pdf
28. Islam M.S., Rahman A.T., Hassan J., Rahman M.T. Extended-spectrum beta-lactamase in Escherichia coli isolated from humans, animals, and environments in Bangladesh: A One Health perspective systematic review and meta-analysis. One Health. 2023. 16. 100526. https://doi.org/10.1016/j.onehlt.2023.100526
29. Jimmy B., Jose J. Patient medication adherence: measures in daily practice. Oman Med J. 2011. 26(3). 155-9. doi: 10.5001/omj.2011.38.
30. Kariuki S.M., Kering K.K., Wairimu C., Onsare R.S., Mbae C.K. Antimicrobial Resistance Rates and Surveillance in Sub-Saharan Africa: Where Are We Now? Infection and Drug Resistance. 2022. 15. 3589 - 3609.
31. Kasse G.E., Cosh S.M., Humphries J., Islam M.S. Antimicrobial prescription pattern and appropriateness for respiratory tract infection in outpatients: a systematic review and meta-analysis. Systematic Reviews. 2024. 13(1). https://doi.org/10.1186/s13643-024-02649-3
32. Kaviani Rad A., Astaykina A., Streletskii R., Afsharyzad Y., Etesami H., Zarei M, Balasundram S.K. An Overview of Antibiotic Resistance and Abiotic Stresses Affecting Antimicrobial Resistance in Agricultural Soils. Int J Environ Res Public Health. 2022. 19(8). 4666. doi: 10.3390/ijerph19084666.
33. Laxminarayan R., Matsoso P., Pant S., Brower C., Røttingen J., Klugman K., Davies S. Access to effective antimicrobials: a worldwide challenge. The Lancet. 2015. 387(10014). 168–175. https://doi.org/10.1016/s0140-6736(15)00474-2
34. Marques A.P., Ramke J., Cairns J., Butt T., Zhang J.H., Jones I., Jovic M. et. al. The economics of vision impairment and its leading causes: A systematic review. EclinicalMedicine. 2022. 46. 101354. https://doi.org/10.1016/j.eclinm.2022.101354
35. Masud A.A., Walpola R.L., Sarker M., Kabir A., Asaduzzaman M., Islam M.S., Mostafa A. T., Akhtar Z., Barua M., Seale H. Understanding antibiotic purchasing practices in community pharmacies: A potential driver of emerging antimicrobial resistance. Exploratory Research in Clinical and Social Pharmacy, 2024. 15. 100485. https://doi.org/10.1016/j.rcsop.2024.100485
36. Maugeri A., Barchitta M., Puglisi F., Agodi A. Socio-economic, governance and health indicators shaping antimicrobial resistance: an ecological analysis of 30 European countries. Globalization and health. 2023. 19(1). 12. https://doi.org/10.116/s12992-023-00913-0
37. McEwen S.A., Collignon P.J. Antimicrobial Resistance: a One Health Perspective. Microbiology spectrum. 2018. 6. P. 210-220.
38. Morrison L., Zembower T.R. Antimicrobial Resistance. Gastrointestinal endoscopy clinics of North America. 2020. 30(4). 619–635. https://doi.org/10.1016/j.giec.2020.06.004
39. Murray C.J.L., Ikuta K.S., Sharara F., Swetschinski L., Aguilar G.R., Gray A., Han C., Bisignano C., Rao P., Wool E., Johnson S.C., Browne A.J., et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet. 2022. 399(10325). 629–655. https://doi.org/10.1016/s0140-6736(21)02724-0
40. Patel J., Sridhar D. The pandemic legacy of antimicrobial resistance in the USA. The Lancet. 2022. Microbe. 3(10). e726–e727. https://doi.org/10.1016/S2666-5247(22)00227-0
41. Pokharel S., Adhikari B., Johnson T., Cheah P.Y. Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low- income and middle-income countries. BMJ global health. 2024. 9(4). e012874. https://doi.org/10.1136/bmjgh-2023-012874
42. Raina S.K. State of the globe: Antimicrobial Resistance: Need for De-compartmentalization of Action. Journal of Global Infectious Diseases. 2019. 11. 133 - 134.
43. Ramamurthy T., Ghosh A., Chowdhury G., Mukhopadhyay A.K., Dutta S., Miyoshi S.I. Deciphering the genetic network and programmed regulation of antimicrobial resistance in bacterial pathogens. Frontiers in cellular and infection microbiology. 2022. 12. 952491. https://doi.org/10.3389/fcimb.2022.952491
44. Sakeena M.H., Bennett A.A., McLachlan A.J. Non-prescription sales of antimicrobial agents at community pharmacies in developing countries: a systematic review. International journal of antimicrobial agents. 2018. 526. 771-782 .
45. Salah F.D., Soubeiga S.T., Ouattara A.K., Sadji A.Y., Metuor-Dabire A., Obiri-Yeboah D., Banla-Kere A., Karou S., Simpore J. Distribution of quinolone resistance gene (qnr) in ESBL-producing Escherichia coli and Klebsiella spp. in Lomé, Togo. Antimicrobial Resistance and Infection Control. 2019. 8(1). https://doi.org/10.1186/s13756-019-0552-0
46. Salam M.A., Al-Amin M.Y., Salam M.T., Pawar J.S., Akhter N., Rabaan A.A., Alqumber M.A. Antimicrobial resistance: a growing serious threat for global public health. Healthcare. 2023. 11(13). 1946. https://doi.org/10.3390/healthcare11131946
47. Samreen Ahmad I., Malak H.A., Abulreesh H.H. Environmental antimicrobial resistance and its drivers: a potential threat to public health. J Glob Antimicrob Resist. 2021. 27. 101-111. doi: 10.1016/j.jgar.2021.08.001. Epub 2021 Aug 25.
48. Schar D., Zhao C., Wang Y., Larsson D.G.J., Gilbert M., Van Boeckel T.P. Twenty-year trends in antimicrobial resistance from aquaculture and fisheries in Asia. Nature communications. 2021. 12(1). 5384. https://doi.org/10.1038/s41467-021-25655-8
49. Semenova Y., Kassym L., Kussainova A., Aimurziyeva A., Makalkina L., Avdeyev A., Yessmagambetova A., Smagul M., Aubakirova B., Akhmetova Z., Yergaliyeva A., Lim L. Knowledge, Attitudes, and Practices towards Antibiotics, Antimicrobial Resistance, and Antibiotic Consumption in the Population of Kazakhstan. Antibiotics. 2024. 13(8). 718. https://doi.org/10.3390/antibiotics13080718
50. Septimus E.J. Antimicrobial Resistance: An Antimicrobial / Diagnostic Stewardship and Infection Prevention Approach. The Medical clinics of North America. 2018. 102(5). 819–829. https://doi.org/10.1016/j.mcna.2018.04.005
51. Shrestha K., Acharya K.P., Shrestha S. One Health:The Interface between Veterinary and Human Health. International Journal of One Health. 2018. 4. 8-14.
52. Shrivastava Saurabh, Ram BihariLal Shrivastava, Prateek Saurabh. The global status of antimicrobial resistance: A long way to go. Environmental Disease. 2020. 5(1). p 23-24. DOI: 10.4103/ed.ed_26_19
53. Sirijatuphat R., Chayangsu S., Srisompong J., Ruangkriengsin D., Thamlikitkul V., et al. Feasibility, Challenges, and Benefits of Global Antimicrobial Resistance Surveillance System Implementation: Results from a Multicenter Quasi-Experimental Study. Antibiotics (Basel, Switzerland). 2022. 11(3). 348. https://doi.org/10.3390/antibiotics11030348
54. Sokolović D., Drakul D., Vujić-Aleksić V., Joksimović B., Marić S., Nežić L. Antibiotic consumption and antimicrobial resistance in the SARS-CoV-2 pandemic: A single-center experience. Front Pharmacol. 2023. 14. 1067973. doi: 10.3389/fphar.2023.1067973.
55. Sridhar et al. emphasize that global travel plays a crucial role in the spread of AMR by facilitating the acquisition, carriage, and transmission of resistant bacteria across. 2021.
56. Sutton K.F., Ashley L.W. Antimicrobial resistance in the United States: Origins and future directions. Epidemiology and infection. 2024. 152. e33. https://doi.org/10.1017/S0950268824000244
57. Tadesse B.T., Ashley E.A., Ongarello S., Havumaki J., Wijegoonewardena M., et al. Antimicrobial resistance in Africa: a systematic review. BMC Infectious Diseases. 2017. 17(1). https://doi.org/10.1186/s12879-017-2713-1
58. Tang K.W.K., Millar B.C., Moore J.E. Antimicrobial resistance (AMR). British Journal of Biomedical Science. 2023. 80. https://doi.org/10.3389/bjbs.2023.11387
59. Van Boeckel T.P., Gandra S., Ashok A., Caudron Q., Grenfell B.T., Levin S.A., Laxminarayan R. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. The Lancet Infectious Diseases. 2014. 14(8). 742–750. https://doi.org/10.1016/s1473-3099(14)70780-7
60. Ventola C.L. The Antibiotic Resistance Crisis: Part 1: Causes and threats. 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/
61. Viderman D., Brotfain E., Khamzina Y., Kapanova G., Zhumadilov A., Poddighe D. Bacterial resistance in the intensive care unit of developing countries: Report from a tertiary hospital in Kazakhstan. Journal of global antimicrobial resistance. 2019. 17. 35–38. https://doi.org/10.1016/j.jgar.2018.11.010
62. WHO. Surveillance of antimicrobial resistance in Europe, 2022 data. European Centre for Disease Prevention and Control. 2023. https://www.ecdc.europa.eu/sites/default/files/documents/Nov2023-ECDC-WHO-Executive-Summary.pdf
63. World Health Organization. Antimicrobial Resistance – Key Facts World Health Organization. 2018Last accessed on 2019 Jun 11 Available from: https://www.who.int/en/news-room/fact-sheets/detail/antimicrobial-resistance.
64. Zellweger R.M., Carrique-Mas J., Limmathurotsakul D., Day N.P.J., Thwaites G.E., Baker S., Southeast Asia Antimicrobial Resistance Network A current perspective on antimicrobial resistance in Southeast Asia. The Journal of antimicrobial chemotherapy. 2017. 72(11). 2963–2972. https://doi.org/10.1093/jac/dkx260
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Zarpullayev N.Ye., Yurkovskaya O.A., Mukanova D.A., Kozhakhmetova D.K., Botabayeva A.S., Smail Ye.M., Shamshudinov T.M., Kussainova A.A., Derbissalina G.A., Urazalina N.M., Kassym L.T. Analysis of antibiotic prescribing practices in primary health care settings. Part I // Nauka i Zdravookhranenie [Science & Healthcare]. 2025. Vol.27 (2), pp. 157-167. doi 10.34689/SH.2024.27.2.016Похожие публикации:
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