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Broström, Anders
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Publications (10 of 101) Show all publications
Broström, A., Fridlund, B., Hedberg, B., Nilsen, P. & Ulander, M. (2017). Communication between patients with obstructive sleep apnoea syndrome and healthcare personnel during the initial visit to a continuous positive airway pressure clinic. Journal of Clinical Nursing, 26(3-4), 568-577
Open this publication in new window or tab >>Communication between patients with obstructive sleep apnoea syndrome and healthcare personnel during the initial visit to a continuous positive airway pressure clinic
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2017 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 3-4, p. 568-577Article in journal (Refereed) Published
Abstract [en]

Aims and objectives. To describe facilitators and barriers from a patient perspective in communications between patients with obstructive sleep apnoea syndrome and healthcare personnel during the first meeting when continuous positive airway pressure is initiated. Background. Adherence to continuous positive airway pressure treatment tends to be poor, especially at the initial phase of treatment. Communication between the patient and healthcare personnel has not been studied from the patient perspective, as either a barrier or facilitator for adherence. Methods. A descriptive design using qualitative content analysis was used. Interviews with 25 patients with obstructive sleep apnoea syndrome took place after their initial visit at four continuous positive airway pressure clinics. A deductive analysis based on The 4 Habits Model (i.e. emphasise the importance of investing in the beginning of the consultation, elicit the patients perspective, demonstrate empathy and invest in the end of the consultation) was conducted. Results. Building confidence (i.e. structure building, information transfer, commitment) or hindering confidence (i.e. organisational insufficiency, stress behaviour, interaction deficit) was associated with investing in the beginning. Motivating (i.e. situational insight, knowledge transfer, practical training) or demotivating (i.e. expectations, dominance and power asymmetry, barriers) was associated with eliciting the patients perspective. Building hope (i.e. awareness, sensitivity, demonstration of understanding) or hindering hope (i.e. unprepared, uncommitted, incomprehension) was associated with showing empathy. Agreement (i.e. confirmation, responsibilities, comprehensive information) or disagreement (i.e. structural obscurity, irresponsibility, absent-mindedness) was associated with investing in the end. Conclusions. Understanding of facilitators and barriers, as described by patients, can be used to improve contextual conditions and communication skills among healthcare personnel. Relevance to clinical practice. A patient-centred communication technique should be used in relation to all stages of The 4 Habits Model to facilitate shared decision-making and improve adherence to continuous positive airway pressure treatment.

Place, publisher, year, edition, pages
WILEY, 2017
Keywords
communication; continuous positive airway pressure; obstructive sleep apnoea; shared decision-making
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-136331 (URN)10.1111/jocn.13592 (DOI)000396479700026 ()27685080 (PubMedID)
Note

Funding Agencies|FORSS (Medical Research Council of Southeast Sweden) [DNR.566401, 376541]

Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2018-05-03
Steinke, E., Palm Johansen, P., Fridlund, B. & Broström, A. (2016). Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea: a systematic review. International journal of clinical practice (Esher), 70(1), 5-19
Open this publication in new window or tab >>Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea: a systematic review
2016 (English)In: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 70, no 1, p. 5-19Article, review/survey (Refereed) Published
Abstract [en]

Aims: Obstructive sleep apnoea (OSA) may negatively affect a couples sexual relationship. This systematic review evaluated what characteristics are determinants of sexual function and dysfunction in women and men with OSA, and what interventions are shown to be effective. Methods: A systematic literature review was conducted using PubMed, CINAHL, Cochrane and TRIP, and articles published between January 2004 and December 2014 in English; original research; adults >= 18 years; and both experimental and non-experimental designs. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was used to assess study quality. Of 21 studies, six studies (no randomised control trials, RCTs) included women and 15 (with six RCTs) studies included men. Extracted data were scrutinised and adjusted until consensus was reached; suitable quantitative data were pooled in statistical meta-analysis. Results: Sexual function was affected similarly in both genders, but effective interventions were reported only for men. In some studies, OSA severity and medications contributed to greater sexual dysfunction. In women, menopausal status, hormone levels and SaO(2) < 90% were determinants of sexual dysfunction, while for men factors included BMI, hormonal status and inflammatory markers. Continuous positive airway pressure (CPAP) not only improved clinical measures such as excessive daytime sleepiness but also the erectile and orgasmic function. Nevertheless, sildenafil was superior CPAP with regard to erectile dysfunction. Conclusions: The findings illustrate important contributors to sexual dysfunction; however, firm generalisations cannot be made. There were limited RCTs and none for women, indicating further RCTs are needed to determine how OSA affects sexual function.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2016
National Category
General Practice Psychiatry
Identifiers
urn:nbn:se:liu:diva-126859 (URN)10.1111/ijcp.12751 (DOI)000371231100002 ()26620672 (PubMedID)
Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2018-01-10
Eriksson, K., Wikström, L., Fridlund, B., Årestedt, K. & Broström, A. (2016). Patients experiences and actions when describing pain after surgery - A critical incident technique analysis. International Journal of Nursing Studies, 56, 27-36
Open this publication in new window or tab >>Patients experiences and actions when describing pain after surgery - A critical incident technique analysis
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2016 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 56, p. 27-36Article in journal (Refereed) Published
Abstract [en]

Background: Postoperative pain assessment remains a significant problem in clinical care despite patients wanting to describe their pain and be treated as unique individuals. Deeper knowledge about variations in patients experiences and actions could help healthcare professionals to improve pain management and could increase patients participation in pain assessments. Objective: The aim of this study was, through an examination of critical incidents, to describe patients experiences and actions when needing to describe pain after surgery. Methods: An explorative design involving the critical incident technique was used. Patients from one university and three county hospitals in both urban and rural areas were included. To ensure variation of patients a strategic sampling was made according to age, gender, education and surgery. A total of 25 patients who had undergone orthopaedic or general surgery was asked to participate in an interview, of whom three declined. Findings: Pain experiences were described according to two main areas: "Patients resources when in need of pain assessment" and "Ward resources for performing pain assessments". Patients were affected by their expectations and tolerance for pain. Ability to describe pain could be limited by a fear of coming into conflict with healthcare professionals or being perceived as whining. Furthermore, attitudes from healthcare professionals and their lack of adherence to procedures affected patients ability to describe pain. Two main areas regarding actions emerged: "Patients used active strategies when needing to describe pain" and "Patients used passive strategies when needing to describe pain". Patients informed healthcare professionals about their pain and asked questions in order to make decisions about their pain situation. Selfcare was performed by distraction and avoiding pain or treating pain by themselves, while others were passive and endured pain or refrained from contact with healthcare professionals due to healthcare professionals large work load. (C) 2015 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
PERGAMON-ELSEVIER SCIENCE LTD, 2016
Keywords
Critical incident technique; Pain assessment; Patients experiences; Postoperative pain
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-126797 (URN)10.1016/j.ijnurstu.2015.12.008 (DOI)000371844700004 ()26772655 (PubMedID)
Note

Funding Agencies|Futurum, the Academy for Health and Care, County Council of Jonkoping, Sweden; FORSS, Medical Research Council of Southeast Sweden

Available from: 2016-04-07 Created: 2016-04-05 Last updated: 2017-11-30
Andersen Amofah, H., Broström, A., Fridlund, B., Bjorvatn, B., Haaverstad, R., Ove Hufthammer, K., . . . Norekval, T. M. (2016). Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement. European Journal of Cardiovascular Nursing, 15(2), 168-177
Open this publication in new window or tab >>Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement
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2016 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 2, p. 168-177Article in journal (Refereed) Published
Abstract [en]

Background: Octogenarians with aortic stenosis are an increasing population of patients admitted for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Although adequate sleep is important after illness and surgery, it has scarcely been studied in the immediate postoperative phase. Aims: To determine and compare the nature of self-reported sleep and insomnia, and recorded sleep-wake patterns in octogenarians during the in-hospital postoperative phase after SAVR or TAVI. Methods: A prospective cohort design was used that included octogenarian patients undergoing SAVR or TAVI at a regional university hospital. Self-reports were used to document sleep and insomnia, and actigraphy was used to record sleep-wake patterns. Data were collected at baseline preoperatively, and then daily for the first five postoperative days. Results: SAVR patients experienced the most insomnia on postoperative nights later in recovery, while TAVI patients experienced the most insomnia on postoperative nights early in recovery. The median total sleep time, as measured by actigraphy, was 6.4 h, and the median sleep efficiency was 79% for the five postoperative nights, but no differences were found between SAVR and TAVI patients on this parameter. All patients slept more during daytime than at night, with SAVR patients having significantly more total sleep hours for all five days than TAVI patients (p < 0.01). Conclusion: Octogenarians with aortic stenosis had disturbed self-reported sleep, increased insomnia, and disturbed sleep-wake patterns postoperatively, resulting in more daytime sleep and inactivity. In patients undergoing SAVR or TAVI, sleep evolves differently during the in-hospital postoperative phase.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2016
Keywords
Aortic stenosis; SAVR; TAVI; in-hospital sleep; octogenarian
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-127419 (URN)10.1177/1474515115620992 (DOI)000373286900009 ()26635329 (PubMedID)
Note

Funding Agencies|Kavli Research Center for Aging and Dementia; University of Bergen; Bergen University College; Norwegian Nurses Association

Available from: 2016-05-01 Created: 2016-04-26 Last updated: 2017-11-30
Ulander, M. & Broström, A. (2015). Letter: Response to Akar et al., regarding our study "Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea" in SLEEP AND BREATHING, vol 19, issue 4, pp 1345-1345 [Letter to the editor]. Sleep and Breathing, 19(4), 1345-1345
Open this publication in new window or tab >>Letter: Response to Akar et al., regarding our study "Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea" in SLEEP AND BREATHING, vol 19, issue 4, pp 1345-1345
2015 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 19, no 4, p. 1345-1345Article in journal, Letter (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
SPRINGER HEIDELBERG, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-123792 (URN)10.1007/s11325-015-1169-z (DOI)000365744500032 ()25893321 (PubMedID)
Available from: 2016-01-11 Created: 2016-01-11 Last updated: 2017-11-30
Gustafsson, G., Broström, A., Ulander, M., Vrethem, M. & Svanborg, E. (2015). Occurrence of epileptiform discharges and sleep during EEG recordings in children after melatonin intake versus sleep-deprivation. Clinical Neurophysiology, 126(8), 1493-1497
Open this publication in new window or tab >>Occurrence of epileptiform discharges and sleep during EEG recordings in children after melatonin intake versus sleep-deprivation
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2015 (English)In: Clinical Neurophysiology, ISSN 1388-2457, E-ISSN 1872-8952, Vol. 126, no 8, p. 1493-1497Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

To determine if melatonin is equally efficient as partial sleep deprivation in inducing sleep without interfering with epileptiform discharges in EEG recordings in children 1-16years old.

METHODS:

We retrospectively analysed 129 EEGs recorded after melatonin intake and 113 EEGs recorded after partial sleep deprivation. Comparisons were made concerning occurrence of epileptiform discharges, the number of children who fell asleep and the technical quality of EEG recordings. Comparison between different age groups was also made.

RESULTS:

No significant differences were found regarding occurrence of epileptiform discharges (33% after melatonin intake, 36% after sleep deprivation), or proportion of unsuccessful EEGs (8% and 10%, respectively). Melatonin and sleep deprivation were equally efficient in inducing sleep (70% in both groups). Significantly more children aged 1-4years obtained sleep after melatonin intake in comparison to sleep deprivation (82% vs. 58%, p⩽0.01), and in comparison to older children with melatonin induced sleep (58-67%, p⩽0.05). Sleep deprived children 9-12years old had higher percentage of epileptiform discharges (62%, p⩽0.05) compared to younger sleep deprived children.

CONCLUSION:

Melatonin is equally efficient as partial sleep deprivation to induce sleep and does not affect the occurrence of epileptiform discharges in the EEG recording. Sleep deprivation could still be preferable in older children as melatonin probably has less sleep inducing effect.

SIGNIFICANCE:

Melatonin induced sleep have advantages, especially in younger children as they fall asleep easier than after sleep deprivation. The procedure is easier for the parents than keeping a young child awake for half the night.

Place, publisher, year, edition, pages
Elsevier, 2015
National Category
Pediatrics Neurology
Identifiers
urn:nbn:se:liu:diva-115914 (URN)10.1016/j.clinph.2014.10.015 (DOI)000357488800008 ()25453612 (PubMedID)
Available from: 2015-03-23 Created: 2015-03-23 Last updated: 2017-12-04
Johansson, P., Svensson, E., Alehagen, U., Dahlström, U., Jaarsma, T. & Broström, A. (2015). Sleep disordered breathing, hypoxia and inflammation: associations with sickness behaviour in community dwelling elderly with and without cardiovascular disease. Sleep and Breathing, 19(1), 263-271
Open this publication in new window or tab >>Sleep disordered breathing, hypoxia and inflammation: associations with sickness behaviour in community dwelling elderly with and without cardiovascular disease
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2015 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 19, no 1, p. 263-271Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Inflammation can induce a cluster of symptoms, referred to as sickness behaviour (e.g., depressive symptoms, sleep disturbances, pain and fatigue). Cardiovascular disease (CVD) and sleep disordered breathing (SDB) are common in older adults. CVD is associated with an increased inflammatory activity and in SDB, hypoxia can also increase inflammation. The purpose of this study is to explore if SDB-related hypoxia is associated differently with inflammation and the presence of sickness behaviour in older adults with and without CVD.

METHODS: Three hundred and thirty-one older adults, whose mean age is 78 years, underwent one-night polygraphic recording to measure SDB and hypoxia. CVD was established by a clinical investigation. Questionnaires were used to measure sickness behaviour and depressive symptoms. High sensitivity C-reactive protein was used as a marker of inflammation.

RESULTS: Structural Equation Modelling showed that SDB-related hypoxia was associated with inflammation (β > 0.40) which mediated indirect associations with sickness behaviour (β = 0.19) and depressive symptoms (β = 0.11), but only in those with CVD (n = 119). In this model, inflammation had a direct effect on sickness behaviour (β = 0.43) and an indirect effect on depressive symptoms (β = 0.24). Hypoxia had the strongest effect (i.e., β = 0.41; significant) on inflammation, whereas the AHI or ODI had weak and non-significant effects (β = 0.03 and β = 0.15).

CONCLUSIONS: Older adults with CVD and SDB are at a particular risk of developing sickness behaviour and depressive symptoms. The effect of SDB was mainly caused by hypoxia, suggesting that hypoxia is an important marker of SDB severity in older adults with CVD.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2015
Keywords
Sleep disordered breathing, Hypoxia, Inflammation, Cardiovascular disease, Sickness behaviour
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-108602 (URN)10.1007/s11325-014-1006-9 (DOI)000349983900044 ()24859483 (PubMedID)
Available from: 2014-07-01 Created: 2014-07-01 Last updated: 2017-12-05
Hjelm, C., Broström, A., Riegel, B., Årestedt, K. & Strömberg, A. (2015). The association between self-care and cognitive dysfunction in patients with chronic heart failure. Heart & Lung, 44(4), 113-119
Open this publication in new window or tab >>The association between self-care and cognitive dysfunction in patients with chronic heart failure
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2015 (English)In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 44, no 4, p. 113-119Article in journal (Refereed) Published
Abstract [en]

Aim: To test the relationship between cognitive function and self-care in patients with heart failure after adjusting for the contribution of age, education, functional status, myocardial stress, sleep and depression. Further, the relationship between cognitive function and self-care was explored with depression and sleep as moderators.

Background: Self-care can significantly impact functional capacity, well-being, morbidity, and prognosis in patients with heart failure (HF). However, self-care requires the cognitive ability to learn, perceive, interpret and respond. The influence of demographics and clinical symptoms on the relationship between cognition and self-care needs to be further understood.

Design: Descriptive, cross-sectional study.

Methods: The study included 142 patients with chronic HF (68% male, median age 72 years, 61% in NYHA II). Self-care was measured with the European Heart Failure Self-Care Behavior Scale. Cognitive function was evaluated with neuropsychological tests measuring global cognitive dysfunction, psychomotor speed, executive function, visual-spatial perception/construct, spatial performance, semantic and episodic memory.

Findings: Psychomotor function (speed and attention) measured with the Trail Making A was the only dimension of cognitive function significantly associated with self-care. Neither depressive symptoms, nor sleep disturbances  moderated the relation between cognitive function and selfcare.

Conclusion: Deficits in psychomotor speed have implications for how patients should be educated and supported to perform self-care. A decrease in sustained attention and ability to carry out more than one task at a same time could lead to difficulties in self-care. Screening for psychomotor speed is therefore advocated for patients with HF.

Place, publisher, year, edition, pages
New York: Elsevier, 2015
Keywords
Aging, Brain natriuretic peptides, Cognitive function, Depression, Heart failure, Nursing, Psychomotor speed, Patient education, Self-care, Sleep disordered breathing, Trail-making test
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-96805 (URN)10.1016/j.hrtlng.2014.12.003 (DOI)000351027400007 ()
Available from: 2013-08-27 Created: 2013-08-27 Last updated: 2018-02-28Bibliographically approved
Johansson, P., Svensson, E., Alehagen, U., Jaarsma, T. & Broström, A. (2015). The contribution of hypoxia to the association between sleep apnoea, insomnia, and cardiovascular mortality in community-dwelling elderly with and without cardiovascular disease. European Journal of Cardiovascular Nursing, 14(3), 222-231
Open this publication in new window or tab >>The contribution of hypoxia to the association between sleep apnoea, insomnia, and cardiovascular mortality in community-dwelling elderly with and without cardiovascular disease
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2015 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, no 3, p. 222-231Article in journal (Refereed) Published
Abstract [en]

Aims:

This study explores if nightly hypoxia (i.e. percentage of sleep time with oxygen saturation lower than 90% (SaO2<90%)) contributed to the association between sleep-disordered breathing (SDB) and insomnia in community-dwelling elderly with and without cardiovascular disease (CVD). A second aim was to explore a potential cut-off score for hypoxia to predict insomnia and the association of the cut-off with clinical characteristics and cardiovascular mortality.

Method:

A total of 331 community-dwelling elderly aged 71–87 years underwent one-night polygraphic recordings. The presence of insomnia was recorded by a self-report questionnaire. The presence of CVD was objectively established and mortality data were collected after three and six years.

Results:

In both patients with CVD (n=119) or without CVD (n=212) SDB was associated with hypoxia (p<0.005). Only in the patients with CVD was hypoxia associated with insomnia (p<0.001) which mediated an indirect effect (p<0.05) between SDB and insomnia. Hypoxia of more than 1.5% of sleep time with SaO2<90% was found to be a critical level for causing insomnia. According to this criterion 32% (n=39) and 26% (n=55) of those with and without CVD had hypoxia, respectively. These groups did not differ with respect to age, gender, body mass index, diabetes, hypertension, respiratory disease or levels of SDB. However, in the CVD group, hypoxia was associated with cardiovascular mortality at the three-year follow-up (p=0.008) and higher levels of insomnia (p=0.002).

Conclusion:

In the elderly with CVD, SDB mediated by hypoxia can be associated with more insomnia and a worse prognosis.

Place, publisher, year, edition, pages
Sage Publications, 2015
Keywords
Elderly, cardiovascular disease, sleep-disordered breathing, hypoxia, insomnia
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-107677 (URN)10.1177/1474515114524072 (DOI)000354116400006 ()24509843 (PubMedID)
Available from: 2014-06-18 Created: 2014-06-18 Last updated: 2017-12-05
Johansson, P., Broström, A., Sanderman, R. & Jaarsma, T. (2015). The Course of Sleep Problems in Patients With Heart Failure and Associations to Rehospitalizations.. Journal of Cardiovascular Nursing, 30(5), 403-410
Open this publication in new window or tab >>The Course of Sleep Problems in Patients With Heart Failure and Associations to Rehospitalizations.
2015 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 30, no 5, p. 403-410Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Sleep problems are common in patients with heart failure (HF) and might be associated with patient outcomes.

AIMS: The aim of this study was to describe the course of sleep problems in HF patients over 1 year and the association between sleep problems and rehospitalization.

METHODS: Data from 499 HF patients (mean age, 70 years) were used in this analysis. Sleep problems were assessed with the item "Was your sleep restless" from the Center for Epidemiological Studies Depression Scale during hospitalization for HF (baseline) and after 1 year.

RESULTS: A total of 43% of patients (n = 215) reported sleep problems at baseline, and 21% of patients (n = 105), after 1 year. Among the 215 patients with problems with sleep at baseline, 30% (n = 65) continued to have sleep problems over time. Among the 284 patients without sleep problems at baseline, 14% (n = 40) reported sleep problems after 1 year. After adjustments for potential cofounders, patients with continued sleep problems had an almost 2-fold increased risk for all-cause hospitalizations (hazard ratio, 2.1; P = .002) and cardiovascular hospitalizations (hazard ratio, 2.2; P = .004).

CONCLUSION: One-third of HF patients with sleep problems at discharge experienced persistent sleep problems at follow-up. Continued sleep problems were associated with all-cause and cardiovascular rehospitalizations.

Place, publisher, year, edition, pages
Wolters Kluwer, 2015
National Category
Neurology
Identifiers
urn:nbn:se:liu:diva-115774 (URN)10.1097/JCN.0000000000000176 (DOI)000360496800005 ()24978159 (PubMedID)
Available from: 2015-03-19 Created: 2015-03-19 Last updated: 2017-12-04Bibliographically approved
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