Yukti pramana

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The Sanskrit word ‘Yukti’ means a rationally designed protocol to manage a condition or situation. ‘Yukti pramana’ is included as a source of valid knowledge in Ayurveda.[Cha.Sa.Sutra Sthana 11/17] It is the intellectual perception resulting from the analysis of varied causative factors. It represents the logical reasoning and interpretation constructed to gain knowledge regarding any phenomena. It is knowledge of pure intellect due to multifactorial, multi-dimensional thinking relevant in the past, present, and future. Yukti can also be understood as planning, applying, and executing knowledge using one's intellectual and reasoning abilities. It is the knowledge arising out of multiple things occurring or operating together. Hence, it provides a practical approach to the rest of the pramana, enhancing their utility. Some Ayurveda scholars and philosophers considered yukti ancillary to anumana pramana (inferential knowledge). It is compared to conjecture or probability (uha) and invariable concomitance (avinabhava) similar to vyapti (invariable relationship) of nyaya (nyaya philosophy).[Chakrapani on Cha.Sa.Sutra Sthana 11/25] This article describes the concept and practical applications of yukti pramana in medical science.

Contributors
Section/Chapter/topic Concepts/Pramana/Yukti pramana
Authors Bhojani M. K. 1, Joglekar A. A.2
Reviewer Basisht G.3
Editors Deole Y.S.4, Basisht G.3
Affiliations

1 Department of Sharira Kriya, All India Institute of Ayurveda, New Delhi

2Department of Samhita Siddhant, All India Institute of Ayurveda, New Delhi

3 Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India

4 Department of Kayachikitsa, G.J.Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
Correspondence emails

meera.samhita@aiia.gov.in,

carakasamhita@gmail.com
Date of first publication: March 24, 2022
DOI under process

Etymology and derivation

Yukti is derived from the verb ‘yuja’ meaning to connect, join, arrange, and prepare. [Monnier Williams dictionary definition of yukti][1] Yukti means union, junction, connection, combination, preparation, application, practice, trick, contrivance means, reasoning, arguments, induction or deduction from circumstances, intellectual weighing of circumstances.[Monnier Williams dictionary definition of yukti].

Definition of yukti

Yukti is the outcome of a combination of causative factors based on past, present, and future knowledge. It helps in the fulfillment of all the three aspects of human life i.e. duties (dharma), wealth (artha), and desires (kama). The following examples explain this method of acquiring knowledge.[Cha.Sa.Sutra Sthana 11/23-25]

1) Plant grows as a cumulative result of watering, plowing, sowing the seed in the field in an ideal season. These four factors are indispensable for the cultivation of any crop.

2) The fetus is formed after the union of factors like five fundamental elements (panchamahabhuta) and soul (atma).

3) The synergistic action of object, the churning rod and act of churning bring results in the thermogenic reaction or formation of heat or fire.

4) Treatment is successful when all the components like the physician, patient, paramedical staff and intervention act in synergy.

The role of yukti pramana in reincarnation is explained based on cause and effect theory (karyakarana bhava).[Cha.Sa.Sutra Sthana 11/32] Logical reasoning is essential to establish the link between the action and result.

Yukti is included in ten qualities (paradiguna) that are considered to be pivotal for excellence and success in treatment. It is rational planning of the treatment rendered. [Cha.Sa.Sutra Sthana 26/29-31]

Yukti is included under the heading of anumana pramana. It is not an actual source of knowledge but a way to proceed towards a source of knowledge. It involves foreseeing the cause-effect relationship and application of theory in a practical scenarios.[Cha.Sa.Vimana Sthana 8/40]

Yukti is imagination or prediction done in a proper or appropriate manner. However, intellectual cognition is similar to logical interpretation (uhya). It acts as an ally to other means of knowledge (pramana). It is homologous with inferential knowledge (anumana pramana), doubting its utility in gathering present knowledge.[Chakrapani on Cha.Sa.Sutra Sthana 11/25] Yukti is the correlation between two aspects and considers it as the initiation of treatment modality.[Chakrapani on Cha.Sa.Sutra Sthana 10/3] Yukti is implied as proper medication planning as per the state of dosha vitiation.[Chakrapani on Cha.Sa.Sutra Sthana 26/31]

Yukti is proper thinking or applying unknown factors after getting the complete knowledge of various elements in the manifestation of a known product.[Gangadhar on Cha.Sa.Sutra Sthana 11/25]

Yukti is defined as the process of assessing the knowledge regarding unknown phenomena using established principles of the cause-effect relationship. [Charakospaskara on Cha.Sa.Sutra Sthana 11]

Synonyms of Yukti

  1. Yojana [Cha.Sa.Sutra Sthana 26], [Chakrapani on Cha. Sa.Sutra Sthana 1/58], [Cha.Sa.Sutra Sthana 2/16], [Cha.Sa.Sutra Sthana 26/31]
  2. Yoga [Cha.Sa.Sutra Sthana 25]
  3. Pravritti [Chakrapani on Cha.Sa.Sutra Sthana 10/1]
  4. Upaya [Chakrapani on Cha.Sa.Sutra Sthana 26/12]

Importance of Yukti pramana

Yukti pramana is extensively used in all contexts. It is simultaneous application of textual knowledge, practical experience and logical reasoning. It provides ability to treat range of disorders with confidence and precision. It is thus, the most important skill to be acquired for every physician to succeed in disease diagnosis and treatment. It is applied widely in all domains of healthcare.

Importance of yukti in the prevention of disease

The prevention and management of disease involves many aspects like diet and lifestyle interventions (aahara-vihara), mental wellbeing (manas swasthya), moral conduct (sadvritta), rightful behaviour (aachara) and knowledge (dnyana-vidnyana).[Cha.Sa.Sharira Sthana 2/46-47] The benefits of three pillars of life i.e., dietary habits (aahaara), sleeping habits (nidra), and sexual life and moral conducts (bramhacharya) largely depend upon one’s intellect and conduct.[Cha.Sa.Sutra Sthana 11/35] The three types of bala (strength and vitality) includes a type of acquired form (yuktikrita). This is achieved through dietetic and lifestyle measures.[Cha.Sa.Sutra Sthana 11/36] It is opined that even the diet that is a daily necessity can cause different disease manifestations when not consumed in an appropriate manner, and its rightful consumption can prove to be the cause of wellness and vitality.[Cha.Sa.Chikitsa Sthana 24/59-60] The same principle can be applied for the usage of alcohol (madya) in the treatment of diseases, which can prove to be beneficial if consumed in proper dose and time.[Cha.Sa.Chikitsa Sthana 24/60] Aachara rasayana also mentions one who is blessed with yukti (yuktignya), as an optimum factor for the practice of rasayana and maintenance of wellbeing. [Cha.Sa.Chikitsa Sthana 1/ 33]

Yukti as most pivotal characteristic of any physician

Yuktignyata, or the ability to think logically and rationally, is an important physician characteristic. It enables him to make the proper selection of drugs or treatment modality to treat any disease successfully.[Cha.Sa.Sutra Sthana 2/36][Cha.Sa.Chikitsa Sthana 1/4/51] A sensible man should not take medicine from a physician who is devoid of yukti or reasoning ability. Because no drug can be administered without the discretion of the physician’s intellect.[Cha.Sa.Sutra Sthana 1/127] This makes yukti the most important skill or attribute of the physician.[Cha.Sa.Sutra Sthana 25/41] Yukti is compared with the managerial skills of a physician in the management of the patient condition.[Cha.Sa.Sutra Sthana 9/10] The vitarka, or the ability of a physician to make logical, planned decisions, is also amongst the six attributes of a successful physician.[Cha.Sa.Sutra Sthana 9/21] The physician has been given the liberty to design and use the different surgical instruments and tools like yantra and shastra based on his expertise. The usage of the tools and surgical management is in turn, dependent on the rationale of the surgeon or physician.[Su.Sa.Sutra Sthana 7/19,21][2]

Importance of yukti pramana in the selection of drugs

Nothing in the universe exists that has no medicinal or therapeutic value. Hence with the help of yukti or the rationale of the physician, medicinal properties of every drug can be explored.[Cha.Sa.Sutra Sthana 26/12] After explanation of different classes of medicine (mahakashaya), it is stated that the drugs mentioned are exemplary, and physicians can make use of other herbs depending on their own intellect and reasoning.[Cha.Sa.Sutra Sthana 4/20] The arrangement of mahakashaya is made for understanding and application for those with low intellect, while those with higher aptitude can implement other herbs than those mentioned in the chapter.[Cha.Sa.Sutra Sthana 4/27] The physician is free to use different modalities like poison (visha) in the treatment due to the wide and wise applicability of yukti pramana.[Cha.Sa.Sutra Sthana 1/124-125] The poison (visha) can provide healing properties when used in an appropriate manner. While the same, when used non-judiciously, can lead to unwanted consequences.[Cha.Sa.Sutra Sthana 1/126] The treatment is only effective when it is based on scientific and logical reasoning directed towards the wellbeing of the sufferer thus underlining the importance of yukti.[Cha.Sa.Sutra Sthana 1/134] The potency of the drugs administered can be modified or even improved by the application of the yukti (proper planning) by the physician. [Cha.Sa.Kalpa Sthana 12/48] By applying one’s intellect and reasoning, thousands and millions of combinations of the medications can be administered. There is no limit to invention of formulation or treatment modalities as there exists wide scope for the development of multidrug regimes.[Cha.Sa.Kalpa Sthana 12/49-50] Accordingly, the wise physician should exclude the drugs if it is not appropriate, irrespective of their mention in the text. He can also make additions to the list indicated for the treatment. With the help of reasoning, one can make innumerable combinations of drugs. The texts provide examples to inspire the intellectual and guide those with dull intellect. The physician following the said course succeeds in his endeavor or causes little risk because the illustration is not too brief.[Cha.Sa.Vimana Sthana 8/149]

Importance of yukti pramana in the diagnosis of diseases

Yukti pramana forms the basis for diagnosing unknown diseases (anukta vyadhi) or those conditions not mentioned in the texts.[Cha.Sa.Sutra Sthana 18/44] It can also prove a diagnostic tool for evolving and novel disease conditions. By understanding the nature of disease (prakriti), site of disease occurrence and manifestation (adhishthana) and etiological factors (samutthana), one can diagnose the disease condition and plan appropriate management of the condition.[Cha.Sa.Sutra Sthana 18/45-46] While justifying the different ways of classification of disease, the physician has been given the liberty to classify and name the condition based on his intellect and reasoning.[Cha.Sa.Vimana Sthana 6/4] The knowledge of prognostic signs (arishta) is also based mainly on the yukti of physician.[Cha.Sa. Indriya Sthana 1/3, 12/89]

Importance of yukti pramana in treatment of diseases

Yukti is the rational application of knowledge in the treatment of diseases.Successful treatment is done by yukti or rational application based on dose (matra) and time (kala).[Cha.Sa.Sutra Sthana 2/16] The yukti pramana is most important while selecting any drug for treatment. It is the planned investigations undertaken by the physician to reach an accurate diagnosis and appropriate treatment. The physician's skill is largely dependent on logical analysis and clinical knowledge, and success in treatment if not based on logical and rational principles is termed a success by chance.[Cha.Sa.Siddhi Sthana 2/29] It is included in the three types of treatment modalities. Under the heading of yuktivyapashraya, rational management using diet, lifestyle, and drug interventions is done. [Cha.Sa.Sutra Sthana 11/54] It involves pacifying (shamana), purifying (shodhana), psychological interventions (manas cheshta) which can be observed or demonstrable.[Cha.Sa.Vimana Sthana 8/87] Yuktivyapashrayac hikitsa [using medications or interventions] includes psychotherapy [sattvavajayachikitsa], material therapy [dravyabhoota] and drug less therapy [adravyabhoota chikitsa] as well. While describing the indications and contra-indications for purification (shodhana) therapy, it is mentioned that a wise physician should not blindly follow the instructions mentioned in the chapter and make rational decisions based on one’s own intellect and discretion, considering the factors like habitat (desha) , time (kala), strength (bala), stage of vyadhi (avastha).[Cha.Sa,Siddhi Sthana2/25-26] One can even administer the contraindicated modalities in the patient for relieving the conditions. For instance, based on logic and condition of the patient, emesis can be prescribed in certain stages of vomiting, heart-disease and abdominal lump (gulma) and even therapeutic enema (bastikarma) is advised for the treatment of skin disorders (kushtha).(Cha.Sa.Siddhi Sthana 2/27) The purification to be administered in any patient should also be based entirely upon yukti. Because the stage of disease is affected by multiple factors like dosha vitiation, administered medication (bheshaja), place and geographical condition (desha), time and climatic condition (kala), strength of individual (bala), dietary habits (aahara), habits (satmya), mental state (sattva), phenotype (prakriti), age (vaya) etc. [Cha.Sa.Sutra Sthana 16/19], [Cha.Sa.Sutra Sthana 15/5] This underlines the importance of individual-based treatment and the outlook of physician towards imparting the treatment strategy. Yukti is thus important in the management of all kinds of diseases according to the principles of Ayurveda. For instance, in the treatment of alcohol abuse/alcoholism (madatyaya), eight different components are mentioned under the umbrella term for yukti that are necessary for proper management.[Cha.Sa.Chikitsa Sthana 24/69] This principle can thus be applied to all other diseases.

Importance of yukti pramana in teaching and learning methodology

The theoretical knowledge or aaptopadesha illuminates the mind, while one’s intellect is the means to analyze the knowledge acquired. Suppose the physician is able to balance the two components properly. In that case, they can succeed in treatment. [Cha.Sa.Sutra Sthana 9/24] Yukti is thus this factor that helps analyze the facts to provide proper treatment. According to pedagogy, yukti can therefore be compared to the imaginative and logical skills of the individual to help analyzing and rationalizing the facts and knowledge obtained. It is required to establish the cause-effect relationship by analyzing multiple points related to the phenomena. It is thus vital for practice-based teaching and learning to form a foundation for critical thinking.[3] It is advised to carefully examine the texts and available knowledge based on yukti before learning or adapting new theory. [Cha.Sa.Vimana Sthana 8/3] It is also an essential attribute of both the teacher and learner. [Cha.Sa.Vimana Sthana 8/7,8] The different tantrayukti, vaadamarga, sambhasha explained in the text highlight the importance of yukti in understanding the different types of texts. [Cha.Sa.Sutra Sthana 30/69][Cha.Sa.Siddhi Sthana 12/47]

Importance of yukti pramana in research

Yukti pramana is amalgamation of aaptopadesha pramana, pratyaksha pramana and anumana pramana coupled with logical and creative thinking to reach a fruitful conclusion. Any research work commences after deriving the previously gained knowledge through aaptopadesha pramana, perceiving the available information through the pratyaksha pramana, deriving the logical inferences using the anumana pramana and analysis, interpreting and presenting the findings through the means of yukti pramana.[4] It can thus help to establish the facts put forth by anumana pramana or inference. It involves utilizing permutations and combinations of available data or knowledge to derive a logical interpretation. It literally means to test or experiment, which forms the basis for all the research works. Thus it can be compared with experimental evidence. Yukti is an invariable combination of things to be proven and its rationale. It is pivotal in various research steps, including the selection of topic, selection of drug, and selection of assessment criteria. It thus forms a basis to define multiple factors in the occurrence of disease conditions and structuring a clinical trial, an epidemiological or observational study for the assessment.

Related Chapters

Tistrainshaniya Adhyaya, Atreyabhadrakapyiya Adhyaya, Deerghamjivitiya Adhyaya, Rogabhishakjitiya vimana Adhayaya, Khuddakchatushpada Adhyaya.

Recent research and articles referred

  1. H.K.Shriwas et.al have explained the applied aspect of Yukti Pramana along with its application in the diagnostics and therapeutics.[5]
  2. Manjula K. et al. have explained the importance of different pramana including yukti pramana in research and clinical diagnosis.[6]
  3. Pratap Chauhan explained the importance of yukti pramana in clinical decision making on the part of physician establishing it as an important diagnostic tool.[7]
  4. Vinodkumar M.V described the yukti pramana as multifactorial analysis in an article comparing the of ‘classical’ and ‘contemporary’ research methods in the context of Ayurveda.[8]
  5. Athira P. et.al. elaborated the concept of paradiguna in the purview of clinical knowledge compared the yukti with the application of therapeutic principles in the patient management and prescription.[9]
  6. Rathi P, Rathi R. discussed the importance of yukti as rational diagnostic and treatment methodology exploring its utility in prescribing the treatment protocol.[10]
  7. Author Roddam Narsimha in the book “Pramanas, Proofs, and the Yukti of Classical Indic Science” has explained the Yukti as an instrument of useful knowledge in the purview of both Ayurveda and other Indian sciences.[11]
  8. Barkha C et.al have explained the different vyadhi-avastha or clinical presentation of Acne Vulgaris (Mukhadushika) using the concept of yukti pramana. They have explored the utility of Yukti pramana in understanding the disease manifestation according to contemporary and classical sciences.[12]
  9. Patil S. et. al. have explained scope of yuktipareeksha in treatment and diagnosis establishing it as an important tool of epistemology.[13]
  10. Singh R.H. described yukti pramana as an important tool in developing the research methodology according to Ayurveda.[14]
  11. Vyas H. and Kalpana P. have applied the concept of yukti in determination of pharmacological characteristics of the herbs not mentioned in the Ayurveda. It thus gives guidelines to develop the methodology to drug research.[15]
  12. Dornala S. et. al. have compared yukti pramana as concept of deductive reasoning to understand the concepts of Ayurveda.[16]
  13. Suma P. et. al. have explored the potential of yukti pramana in the field of bhaishajyakalpana in ayurveda pharmaceuticals and developed the methodology to develop the drug manufacturing.[17]
  14. Bagali S. et. al. has explained the importance of yuktivyapashraya chikitsa with special reference to yukti pramana in management of psychological disorders.[18]
  15. Gowtham S. et. al. have elaborated the concept of yukti and yuktivyapashraya and its importance in literature considering the concept of Ashta-trika.[19]
  16. Bhalerao S. et. al. in their letter to editor have compared the yukti as an intellectual ability that involves applying the fresh, analytical, rational and imaginative thinking to the problem or situation on hand.[20]
  17. Panda A et. al. explored the role of yukti pramana in understanding the Ayurveda approach to Covid-19. They have explored different methodologies to understand the novel diseases like Covid-19.[21]
  18. Nath R., Mandal S. have explained the concept of yukti pramana while treating a case of Diabetes Mellitus.[22]
  19. Bagali S. et. al. have considered yukti as a new approach of understanding examination, process, technology, methodology of Ayurveda medicine and research.[23]
  20. Patel S. et. al. have explained the yukti pramana or yukti guna as method of fixation of dose and administration of medicine.[24]
  21. Jaiswal R. and Amit Kumar have explained the utility of Yukti in every field of Ayurveda.[25]
  22. Unnikrishnana P. and Padma V. have explained the yukti as logical interpretation in understanding the concepts of Ayurveda and method for ontology and trans-disciplinary research in novel fields like food technology.[26]
  23. Vaidya N. et. al. have highlighted the importance of yukti pramana in drug selection and usage considering the example of Mutravirachaniya mahakashaya.

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References

  1. ↑ MW Cologne Scan [Internet]. [cited 2022 Feb 16]. Available from:https://www.sanskrit –lexicon.uni-koeln.de/scans/csl-apidev/servepdf.php?dict=MW&page=853
  2. ↑ Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.
  3. ↑ Kavanagh SS, Conrad J, Dagogo-Jack S. From rote to reasoned: Examining the role of pedagogical reasoning in practice-based teacher education. Teach Teach Educ. 2020;89:102991. doi:10.1016/j.tate.2019.102991
  4. ↑ P.V.Sharma , Six decades of Ayurveda , Epistemology in Ayurveda , Maulika siddhanta, Dwitiya Khanda, First edition 2005 , Chaukhamba Sanskrit Pratisthana , Delhi, Page no. 364
  5. ↑ Shriwas DHK. Yukti Pramana and its Applied aspect in Ayurveda: a Review. World Journal of Pharmaceutical Research. 8(7):6.
  6. ↑ Manjula K, Vaidya VA, Asokan V, Vyas TK. Utility of Pramana in Ayurveda – A Review. Journal of Pharmaceutical Research International. 2021 Sep 1;153–7.
  7. ↑ The Diagnostic Tools of Ayurveda [Internet]. [cited 2022 Feb 16]. Available from: https://www.manyzone.com/article/11143/the-diagnostic-tools-of-ayurveda
  8. ↑ Vinodkumar MV, Anoop AK. Review on comparability of ‘classical’ and ‘contemporary’ research methods in the context of Ayurveda. Journal of Ayurveda and Integrative Medicine. 2020 Oct;11(4):539–46.
  9. ↑ Athira P, Nair L, Ushakumari C, Irshad H. Relevance of paradi guna as a chikitsasiddhi upaya. Journal of Ayurveda. 2021 Apr 1;15(2):117–117.
  10. ↑ Rathi. Principals of ethical ayurveda prescription writing in clinical practice: A literature review [Internet]. [cited 2022 Feb 16]. Available from:http://www.journaldmims.com=/article.asp?issn=0974-3901;year=2019;volume =14;issue=6;spage=97;epage=102;aulast=Rathi
  11. ↑ Narasimha R. Pramanas, Proofs, and the Yukti of Classical Indic Science. In: Bala A, editor. Asia, Europe, and the Emergence of Modern Science: Knowledge Crossing Boundaries [Internet]. New York: Palgrave Macmillan US; 2012 [cited 2022 Feb 14]. p. 93–109. Available from: https://doi.org/10.1057/9781137031730_6
  12. ↑ Ravalani VBC, Purohit VHJ, Mishra VB. Panchakarma procedures according to Vyadhi Avastha in Mukhdushika w.s.r. to Acne Vulgaris. Journal of Ayurveda and Integrated Medical Sciences. 2019 Dec 31;4(06):157–61.
  13. ↑ Patil SC, Baghel A, Dwivedi RR. Methods of Examination and Investigation in Ayurveda : A review in reference to Pramana Vijnana ( Epistemology). Annals of Ayurvedic Medicine [Internet]. 0 [cited 2022 Feb 16];0(0). Available from: https://www.aamjournal.in/index.php?mno=150592
  14. ↑ Singh RH. Exploring issues in the development of Ayurvedic research methodology. J Ayurveda Integr Med. 2010;1(2):91–5.
  15. ↑ Vyas H, Panara KB. Determination of anukta dravya through classical ayurvedic principles :7.
  16. ↑ Dornala SN, Reddy RG, Annambhotla S. Contermporary perspectives on Ayurveda and changing paradigms. 2015;2(1):5.
  17. ↑ Suma P, Vasudev C, Anand K. Concepts of Bhaishajya Kalpana in Charak Samhita PIJAR/VOLUME-I/ISSUE –III/January-February-2017
  18. ↑ Bagali DSS, Baragi DUC, Deshmukh DRA. Concept of Satwavajaya Chikitsa (Psychotherapy). Journal of Ayurveda and Integrated Medical Sciences. 2016 Jun 30;1(01):56–63.
  19. ↑ Gowtham DS, Gautham M, Sivudu KV, Krishnaiah VG. Concept of ashta trika in Charak Samhita. 2019;5(6):12.
  20. ↑ Bhalerao S, Ranade A, Vaidya ADB. Bloom’s taxonomy reiterates Pramana. J Ayurveda Integr Med. 2017;8(1):56–7.
  21. ↑ Panda AK, Palei DT, Rout S, Kar S. Ayurveda approaches to COVID-19 in 2 wave: Lessons learned from practice. Journal of Preventive Medicine and Holistic Health. 2021 Nov 15;7(2):104–8.
  22. ↑ Nath R, Mandal SK. An analytical study of different clinical presentation of Diabetes mellitus: Ayurveda perspective: Journal of Scientific and Innovative Research 2017; 6(2): 44-49:6.
  23. ↑ Bagali DS, Baragi U, Sajjanshetti MR. A view on Practical Utility of Paradi Gunas. Journal of Ayurveda and Integrated Medical Sciences. 2017 Apr 30;2(02):147–59.
  24. ↑ Patel S.A comprehensive and comparative view of gunas in ayurveda and vaisheshika philosophy. IJAR. 2019 Jul 31;7(7):576–87.
  25. ↑ Ramnihor Tapsi Jaiswal, Amit Kumar Yukti Pramana and its Utility: A Review. Indian J Ancien Med Yog. 2020;13(4): 175–177
  26. ↑ Payyappallimana U, Venkatasubramanian P. Exploring Ayurvedic Knowledge on Food and Health for Providing Innovative Solutions to Contemporary Healthcare. Frontiers in Public Health [Internet]. 2016 [cited 2022 Feb 16];4. Available from: https://www.frontiersin.org/article/10.3389/fpubh.2016.00057
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