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ORIGINAL ARTICLE
Year : 2019  |  Volume : 17  |  Issue : 2  |  Page : 130-135

Knowledge and perceptions about dental health insurance among dental practitioners of Jaipur City


1 Department of Public Health Dentistry, Rajasthan Dental College and Hospital, Jaipur, Rajasthan, India
2 Department of Public Health Dentistry, Daswani Dental College and Research Centre, Kota, Rajasthan, India
3 Research Fellow, National Academy of Sciences - Indian Council of Medical Research, Chair on Public Health Research at Rajasthan University of Health Sciences, Jaipur, Rajasthan, India

Date of Submission01-Oct-2018
Date of Acceptance04-Apr-2019
Date of Web Publication20-Jun-2019

Correspondence Address:
Dr. Preyas Joshi
F-76, 6-D Engineers Colony, New Sanganer Road, Jaipur - 302 020, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_193_18

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  Abstract 


Background: The general health insurance plans merely cover the hospitalization and medicinal costs. Dental insurance is meant to insure people against the dental disease and their expense of treatment. Aim: The aim of the study is to assess the knowledge and perceptions regarding dental health insurance among private dental practitioners of Jaipur city. Material and Methods: A cross-sectional study was conducted among private dental practitioners aged 25–59 years in Jaipur city, a 20-item self-designed questionnaire was used to assess the knowledge and perceptions regarding dental health insurance. Data were analyzed using MedCalc software version 14.2.1.0. Chi-square test was applied for analyzing the categorical data. The confidence interval and level of significance were set at 95% and P ≤ 0.05, respectively. Results: The dental practitioners were aware of dental insurance, and the Internet was found to be the major source of knowledge (57.00%) regarding dental health insurance, and there was statistically significant (P = 0.026) difference between male and female dental practitioners (39 males and 18 females). Overall, 80% of the dental practitioners felt that individuals with numerous or ongoing oral health problems are more likely to purchase dental insurance. Cashless treatment facility was found to be the biggest (62.00%) influencing factor affecting the health insurance subscriptions; also, there was a statistically significant difference (P = 0.001) between male and female dental practitioners about the same. Conclusion: In the present study, dental insurance has been found to be associated with higher rates of visiting for a checkup and regular dental visiting and was correlated with patient acceptance of prescribed dental treatment, which suggests that insured individuals may face fewer financial barriers to comprehensive dental care.

Keywords: Dentist, disease, insurance, knowledge, medical


How to cite this article:
Joshi P, Solanki J, Chaudhary P, Jadoun DS, Mishra P, Sharma P. Knowledge and perceptions about dental health insurance among dental practitioners of Jaipur City. J Indian Assoc Public Health Dent 2019;17:130-5

How to cite this URL:
Joshi P, Solanki J, Chaudhary P, Jadoun DS, Mishra P, Sharma P. Knowledge and perceptions about dental health insurance among dental practitioners of Jaipur City. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2019 Jul 23];17:130-5. Available from: http://www.jiaphd.org/text.asp?2019/17/2/130/260871




  Introduction Top


The Insurance Regulatory and Development Authority of India defines “health insurance” as the insurance contract which provides for sickness benefits or medical, surgical, or hospital expense benefits, including assured benefits and long-term care, travel insurance, and personal accident cover.[1]

Dental insurance is an insurance to protect people against dental costs. It insures against the expense of treatment, care of dental disease, and accident to teeth. It has been found to be associated with higher rates of visiting for a checkup and regular dental visiting and was correlated with patient acceptance of prescribed dental treatment, which suggests that insured individuals may face lesser financial barriers to comprehensive dental care.[2],[3]

In India, dental insurance is mostly clubbed with health insurance and available under the general health insurance plans. These plans do not cover dental ailments exclusively and mainly the hospitalization and medicinal costs arising due to a dental emergency are covered. There are two kinds of dental insurance plans available in India: exclusive dental health insurance plans and dental coverage under various policies of general, health, and life insurance companies. Apart from these, there are some employers, namely, Indian Army and Public Sector Undertakings banks which provide reimbursement for dental treatments.[4]

With only 2% of the current Indian population going to a dental clinic for treatment, the possibility of being able to attract a large customer base is bleak. This coupled with the slow penetration of medical insurance and the insufficient medical infrastructure to provide quality treatment has played a further deterrent toward people accepting health-care insurance as a boon and not a bane.[2],[5]

Most of the studies in the past have focused on dentists' knowledge, attitude, and practices regarding the various aspects of dentistry, but very few studies were conducted to explore dentist's knowledge, awareness, and perceptions regarding dental health insurance.[6],[7],[8],[9] Those available, stress more on professional indemnity insurance rather than comprehensively covering all the aspects related to dental health insurance. There is a paucity of dentist-centered studies related to this very issue in the Indian scenario. Hence, the aim of the present study was to assess dentists' knowledge and perceptions about dental health insurance among dental practitioners of Jaipur city.


  Material and Methods Top


Study setting

The present cross-sectional study was conducted to assess the knowledge and perceptions about dental health insurance among dental practitioners of Jaipur city, Rajasthan state, India.

Study population

A detailed list of the Indian Dental Association (IDA)-registered dental practitioners of Jaipur city was procured from the Jaipur branch of the association and was used as the sampling frame. It constituted of 580 dental professionals practicing dentistry in Jaipur city.

Inclusion criteria

  • Dentists practicing in Jaipur city and registered with the Jaipur branch of IDA were included in the study.


Exclusion criteria

The exclusion criteria were as follows:

  • The dentist who refused to participate in the study
  • The dentist whose IDA registration was lapsed
  • The dentist who was not doing clinical practice
  • The dentist who was no longer a resident of Jaipur city.


Sample size

All the 580 dental professionals practicing dentistry in Jaipur city were approached to participate in the study, and out of them, only 100 dental practitioners who fulfilled the abovementioned inclusion and exclusion criteria were included in the study.

Ethical approval

Ethical approval was obtained from a Private Institute Research Ethical Committee RDCH/PHD/16-3 dated 16/01/2014. Before the administration of the questionnaire, the aim and the potential benefits of the present study were clearly explained to all the study participants. An informed consent certificate was obtained from the participating dentists, after they thoroughly understood the contents of the information sheet.

4;To the best of our knowledge, this study is a pioneer work in this region, therefore, a self-designed paper-and-pencil self-administered questionnaire considering English language, and cultural practicing was introduced. During the questionnaire designing process, various questions were adopted from different articles and research studies which were done with similar study design.[10],[11],[12],[13],[14] After thorough examination of all of these questions, 20 items were finally selected. The questions were then modified and certain changes were made based on the needs of the target sample. The questionnaire was pretested and prevalidated by conducting a pilot study on ten practitioners to ensure its reliability, and these practitioners were not included in the study. One part of the questionnaire included the demographic characteristics and personal information of the dental practitioners (dentists' name, age, gender, IDA registration number, postqualification experience, and practice address). The second part included 20 questions on insurance schemes, adverse selection, equity, influencing factors, advertising, and about promotional costs in the insurance market. The dental practitioners were visited by a single examiner, and all the available and willing participants were given the questionnaire on the day of visit. The examiner was calibrated before data collection, and the intra-examiner reliability was measured using kappa statistics (κ = 0.86; almost perfect agreement).[15] The practitioners were requested to fill it either at once or later at their leisure time, whichever was convenient to them. All the dental practitioners were asked to respond to each item in the questionnaire by choosing the most appropriate alternative. The examiner revisited the respondents in person after 3 days to collect the filled questionnaires. Confidentiality and anonymity of the respondents were assured.

Statistical analysis

Data thus collected were entered into Microsoft Excel sheet 2007 to prepare master chart and then analyzed using MedCalc for Windows, version 14.2.1.0 (MedCalc Software, Ostend, Belgium). Chi-square test was applied for analyzing the categorical data. The confidence interval and level of significance were set at 95% and P ≤ 0.05, respectively.


  Results Top


The present study was conducted to assess the knowledge and perceptions about dental health insurance among the dental practitioners of Jaipur city. The study included a total of 100 dental practitioners whose age(s) ranged from 25 to 59 years. In the study, the knowledge among the dentists regarding the history of dental health insurance and various dental health insurance schemes currently being implemented in the country along with the perceptions of adverse selection, equity, influencing factors, advertising, promotional costs, and potential elements were studied. Fifty-eight male and 42 female private dental practitioners completed the questionnaire for an overall response rate of 100%.

Sources of knowledge regarding dental health insurance

Maximum number of dentists (57%) reported Internet communications on E-mail and websites to be the major source of knowledge about dental insurance, followed by interactions with colleagues (49%), articles published in academic journals (46%), newspapers, magazines and community newsletters (31.00%), radio and television broadcasting (10%), and any other (06%). There was, however, a difference in sources of knowledge between male and female dentists with Internet communications on E-mail and websites being the source of knowledge for 67.24% of the male dentists as compared to 42.86% of the female dentists, and this was also statistically significant [P = 0.026; [Table 1].
Table 1: Different sources of knowledge about dental health insurance

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Knowledge about companies offering dental insurance plans in India

ICICI Lombard dental insurance was correctly identified as an offer or of standalone dental insurance in the Indian market by almost half (46.00%) of the study participants. However, very few respondents (03.00%) were able to correctly identify Apollo DKV health insurance as another such insurer. There was, however, statistically significant differences between knowledge of male and female dentists with incorrect responses such as Max Bupa health insurance (P = 0.031) and Birla Sun life insurance (P = 0.033); [Table 2]. The data shows that female dental practitioners had more positive knowledge than their male counterparts.
Table 2: Knowledge about companies in India offering the standalone insurance plans for dental treatment (multiple response questions)

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Importance of dental health insurance for oral health protection

A positive attitude was found regarding dental health insurance among the private dental practitioners of Jaipur city as 100 (100%) of the dentists reported that dental health insurance is an important element for family's oral health protection. However, no significant difference was observed among the perceptions of male and female dentists.

Adverse selection within dental insurance markets

Overall, 80% of the dentists felt that individuals with numerous or ongoing oral health problems are more likely to purchase dental insurance. A total of 9% dentists were found not in agreement with the given statement, whereas 11% of them appeared impartial by means of choosing the “can't say anything” option. There was, however, no significant difference observed in perceptions of male and female dentists.

Influencing factors which affect health insurance subscriptions the most

Sixty-two percent of the private dental practitioners felt that cashless treatment facility is the biggest influencing factor (62%) affecting the purchase of health insurance subscriptions in the Indian market. Furthermore, there was a significant difference (P = 0.001) in perceptions of male (79.31%) and female (38.1%) dentists over identification of cashless treatment facility as an influencing factor [Table 3].
Table 3: Influencing factors which affects health insurance subscriptions the most (multiple response questions)

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Perception of respondents over reasons responsible for the absence of an all-inclusive standalone insurance plan in Indian market

A whopping 42% (n = 42) of the dental practitioners pick out “denial of claims” as the biggest reason for the absence of a comprehensive dental insurance plan in India. Dental practitioners also identified high premium (39%), complicated paperwork (27%), and slow payments (27%) as some other factors responsible for the same. Furthermore, a significant difference [P = 0.043; [Table 4] was observed between the perception of male and female dental practitioners about high premium being responsible for the absence of any such insurance plan.
Table 4: What are the reasons you feel are responsible for the absence of an all.inclusive standalone insurance plan in the Indian market (multiple response questions)

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Perception of respondents over what prompts an Indian customer to buy a health insurance policy from an insurance company

Company's ads and promotion campaign (52%) were identified as the biggest factor influencing the insurance purchases made by Indian customers. Furthermore, a significant gender difference [P = 0.022; [Table 5] was found between the perceptions of dental practitioners about “smart marketing by company's sales department” as an influencing factor persuading the purchase.
Table 5: What prompts an Indian customer to buy a health insurance policy from an insurance company (multiple response articles)

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  Discussion Top


Preventive care for oral health is very important for living a long and healthy life, for which oral health care should begin very early. Oral health is an integral part of general health and most of the oral diseases require professional dental care; however, owing to limited availability to accessibility and awareness, the oral health is markedly poor among people with low income and without a health insurance.[16]

Dental insurance has been found to be associated with higher rates of visiting for a checkup and regular dental visiting and was correlated with patient acceptance of prescribed dental treatment, which suggests that insured individuals may face fewer financial barriers to comprehensive dental care. In addition, it has been found that while most individuals obtain basic dental care regardless of their insurance status, dental insurance is associated with the use of more expensive dental services, further indicating the capacity of insurance to reduce financial barriers.[3]

In the present study, an overall response rate of 100% (n = 100) was achieved. This findingR is inconsistent with the previous online surveys conducted by Shulman et al.[6] and Nebeker et al.[7] to evaluate dentist's attitudes toward Medicaid government insurance program where the response rates achieved were 23% and 50%, respectively. In general, online surveys are much less likely to achieve response rates as high as surveys administered on paper; as stated by Nulty [17] on the basis of comparison among response rates of various online and paper-based surveys.

Awareness level regarding dental health insurance

In the present study, awareness regarding dental health insurance among dental practitioners was 100%. All the dental practitioners, both males (n = 58) and females (n = 42), demonstrated a high level of awareness possibly because “dental insurance” is a part of the subject of Public health dentistry, decided by the Dental Council of India. This is not in agreement with a study done by Gupta et al.[9] among graduated and postgraduated dental surgeons in Mumbai city, India, where only 55.2% of dental practitioners were aware of “dental indemnity insurance,” thus demonstrating a low level of awareness. This might be because of Rajasthan state government's Bhamashah health insurance, Yojna, in which dental clinics can also be enrolled. Hence, the dentists are familiar to the process of dental insurance.

Dentists' source of knowledge about dental insurance

Internet communications and websites were cited as the main source of knowledge about dental insurance among the dentists practicing in Jaipur. This could be due to the easy access of Internet facilities to the dentists. This finding is similar to that of a previous study done by Khare et al.[18] where significantly higher proportion of pure practitioners (51.5%) used Internet to get access to the knowledge about forensic odontology. In the present study, there was also a statistically significant difference (P = 0.026) among the gender and source of knowledge about dental insurance which is similar to the study done by Johansson et al.[19] where gender was significantly correlated (P < 0.001), with the source of knowledge about eating disorders among the dentists.

Dentists' perceptions about importance of dental health insurance for oral health protection

The results of this study showed that there was a positive attitude regarding dental health insurance among the dental practitioners of Jaipur city, as 100% of the dental practitioners reported dental health insurance to be a must element for family's oral health protection. The finding is similar to that of Louisiana dentists' survey conducted by Shulman et al.[6] which revealed that almost two-thirds (64%) dental practitioners believed Medicaid government insurance program to be taking care of individuals who have difficulty obtaining dental care. It could be due to the common belief that the individuals with dental insurance are more likely than their uninsured counterparts to make regular dentist visits and to receive preventive care. However, this finding is not consistent with that reported in a previous survey at Mumbai, India, by Gupta et al.,[9] whereas 35.6% of the dental practitioners felt that it was not mandatory to have professional liability insurance. This might be because a majority of Indian clients still hesitate to use their professional advisers for negligence.

Dentists' perceptions of adverse selection within dental insurance markets

This survey showed that the majority of dental practitioners (80%) in Jaipur felt that individuals with numerous or ongoing oral health problems are more likely to purchase dental insurance, a process known as adverse selection. This finding is consistent with that reported in a Netherlands study by Godfried et al.[20] which showed that high-risk customers are more inclined to buy dental insurance. This conclusion differs from the conclusion that would be drawn from the results of the study by Geurts and Rutten [21] who concluded that adverse selection in dental insurance is not an issue since customers' insurance choice is unrelated to their teeth condition. A study conducted in the region of Lucknow, India, by Mathur et al.[22] also showed that respondents who perceived to have fair health possess a health insurance plan, while the respondents with poor health status displayed lower subscription to the health insurance plan. The lower participation of respondents could be due to the suppliers' deterrence to cover people having poor health status and thus overcoming the issue of adverse selection.

Dentists' perceptions of influencing factors affecting health insurance subscriptions

In the present study, cheaper plans, cashless treatment facility, coverage of all illnesses, and coverage of all services were identified as possible influencing factors affecting health insurance subscriptions. In contrast to the study conducted by Mathur et al.,[22] age, dependent family members, medical expenditure, health status, and individual's product perception were found to be significantly associated with health insurance subscription in the region. A study conducted in Jalandhar, India, by Kansra and Pathania [23] also showed that income, age, knowledge about insurance, perception regarding future health-care expenditure, and number of children in a family were the factors which were found to affect the purchase of health insurance scheme.

Dentists' perceptions of reasons responsible for the absence of an all-inclusive standalone insurance plan in Indian market

In the present study, denial of claims was identified as the biggest possible reason responsible for the absence of an all-inclusive standalone insurance plan in the Indian market. This is in agreement with a study conducted by Mathur [24] who reviewed the ethical issues of comprehensiveness and inclusion in insurance and revealed that insurance companies are large monopolies, where the consumer is treated as secondary and does not have an opportunity to negotiate the terms and conditions of a contract. Insurance claims are frequently rejected due to various reasons such as minor transcription errors, noncovered charges, out-of-network provider, and referral or preauthorization required. Furthermore, fraud and manipulation by clients and providers of care had resulted in several exclusions. In our study, high premium 39.00% was the second most frequent option in its row, which is dissimilar to a Lucknow study by Mathur et al.[22] where 46.00% of the respondents disagreed and opposed the statement “premium is too high, so health insurance products are not affordable.” A significant difference (P = 0.043) was observed between the perception of male and female dental practitioners about high premium being the reason for the absence of a comprehensive dental insurance plan in the Indian market, it might be because out of the many aspects that can influence a buyer's decision-making behavior, one of the major factors is gender. Male's and female's purchase with different motives, prospective, rationales, and considerations.

Dentists' perceptions of factors affecting Indian consumer's buying behavior for health insurance

The impression created by the company's ads and promotion campaign was found to be what prompts an Indian customer the most to buy a health insurance policy from an insurance company. This is in agreement with a previous study conducted by Sivanesan [25] in Kanyakumari, India, which showed that advertisement had a strong positive influence and significant relationship with consumer buying behavior. Advertising helps in that it carries the message far and wide to a scattered target audience that the advertiser or producer could not have reached it at once so easily. This finding of our study is in contrast with an Ajmer city study done by Mathur and Tripathi [26] which revealed that according to the ranks given the most important factors that influence customers for selecting an insurance company was computerization and online transactions. Furthermore, a significant difference (P = 0.022) was observed among both the genders regarding the perceptions of dental practitioners about consideration of “smart marketing by company's sales department” as an influencing factor.


  Conclusion Top


Dental insurance has been found to be associated with higher rates of visiting for a checkup and regular dental visiting and was correlated with patient acceptance of prescribed dental treatment, which suggests that insured individuals may face fewer financial barriers to comprehensive dental care. More of the dentist awareness programs through seminars, lectures or forums, educational articles, and debates are needed to increase dentist's knowledge about dental health insurance. The insurance companies should focus more on factors such as cheaper plans, cashless treatment facility, coverage of all illnesses, and coverage of all services, which the dentists perceive as most important factors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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The Gazette of India: Extraordinary. Insurance Regulatory and Development Authority (Health insurance) Regulations. Part III. Sec. 4. Hyderabad: The Gazette of India: Extraordinary; 2013. p. 76.  Back to cited text no. 1
    
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McHugh ML. Interrater reliability: The kappa statistic. Biochem Med (Zagreb) 2012;22:276-82.  Back to cited text no. 15
    
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Singh A, Purohit BM, Masih N, Kahndelwal PK. Risk factors for oral diseases among workers with and without dental insurance in a national social security scheme in India. Int Dent J 2014;64:89-95.  Back to cited text no. 16
    
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Khare P, Chandra S, Raj V, Verma P, Subha G, Khare A, et al. Status of forensic odontology in metro and in tier 2 city in Urban India. J Forensic Dent Sci 2013;5:134-7.  Back to cited text no. 18
[PUBMED]  [Full text]  
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Introduction
Material and Methods
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