Gastrointestinal and nutritional issues in children with neurological disability
Neurological disability is often associated with feeding and gastrointestinal disorders leading to malnutrition and growth failure. Assessment of nutritional status represents the first step in the clinical evaluation of children with neurological disability. The European Society of Gastroenterology...
Gespeichert in:
| Veröffentlicht in: | Developmental medicine and child neurology 2018-09, Vol.60 (9), p.892-896 |
|---|---|
| Hauptverfasser: | , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 896 |
|---|---|
| container_issue | 9 |
| container_start_page | 892 |
| container_title | Developmental medicine and child neurology |
| container_volume | 60 |
| creator | Romano, Claudio Dipasquale, Valeria Gottrand, Frederic Sullivan, Peter B |
| description | Neurological disability is often associated with feeding and gastrointestinal disorders leading to malnutrition and growth failure. Assessment of nutritional status represents the first step in the clinical evaluation of children with neurological disability. The European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recently issued a consensus statement on gastrointestinal and nutritional management in children with neurological disability. Here we critically review and address implications of this consensus for clinical practice, including assessment and monitoring of nutritional status, definition of nutritional requirements, diagnosis and treatment of gastro‐oesophageal reflux disease, and indications for and modalities of nutritional support. There is a strong evidence base supporting the ESPGHAN guidelines; their application is expected to lead to better management of this group of children.
What this paper adds
Assessment of nutritional status in children with neurological disability should include the evaluation of body composition.
Standard polymeric formula via gastrostomy tube is an effective, long‐term nutritional intervention.
Tube feeding should be started early, before the development of malnutrition.
Resumen
Problemas gastrointestinales y nutricionales en niños con discapacidad neurológica
La discapacidad neurológica a menudo se asocia con alimentación y trastornos gastrointestinales que conducen a la desnutrición y al retraso del crecimiento. La evaluación del estado nutricional representa el paso inicial en la evaluación clínica de los niños con discapacidad neurológica. La Sociedad Europea de Gastroenterología, Hepatología y Nutrición (ESPGHAN) emitió recientemente unas guías, creadas por consenso, sobre el manejo gastrointestinal y nutricional en niños con discapacidad neurológica. Aquí revisamos críticamente y abordamos las implicaciones de este consenso para la práctica clínica, incluida la evaluación y el control del estado nutricional, la definición de los requisitos nutricionales, el diagnóstico y el tratamiento de la enfermedad por reflujo gastroesofágico y las indicaciones y modalidades de apoyo nutricional. Existe una sólida base de evidencia que respalda las pautas de ESPGHAN; se espera que su aplicación conduzca a un mejor manejo de este grupo de niños.
Resumo
Questões gastrointestinais e nutricionais em crianças com incapacidade neurológica
A incapacidade neurológica é frequentemente associada com desordens |
| doi_str_mv | 10.1111/dmcn.13921 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_04415535v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2046015709</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3991-c86149ce281765b59266312ed12a4fef284a543a8b8474083fd2e0b84767cf133</originalsourceid><addsrcrecordid>eNp9kMtOwzAQRS0EglLY8AEoS0BK8diOEy9RgRapPBawtlzHoUauU-wE1L8nIcCS2Yzu6OhIcxE6ATyBbi7LtfYToILADhoB4yItciZ20QhjIClwQg7QYYxvGGPKM7aPDogoMAeaj9DTTMUm1NY3JjbWK5coXya-bYJtbN1nG2NrYmJ9olfWlcH45NM2q8SbNtSufrW6g0ob1dI622yP0F6lXDTHP3uMXm5vnqfzdPE4u5teLVJNhYBUFxyY0IYUkPNsmQnCOQViSiCKVaYiBVMZo6pYFixnuKBVSQzuA891BZSO0fngXSknN8GuVdjKWlk5v1rI_oYZgyyj2Qd07NnAbkL93j3TyLWN2jinvKnbKAlmHEOWY9GhFwOqQx1jMNWfG7Ds25Z92_K77Q4-_fG2y7Up_9DfejsABuDTOrP9RyWv76cPg_QL4RKJPQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2046015709</pqid></control><display><type>article</type><title>Gastrointestinal and nutritional issues in children with neurological disability</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Wiley Online Library Free Content</source><creator>Romano, Claudio ; Dipasquale, Valeria ; Gottrand, Frederic ; Sullivan, Peter B</creator><creatorcontrib>Romano, Claudio ; Dipasquale, Valeria ; Gottrand, Frederic ; Sullivan, Peter B</creatorcontrib><description>Neurological disability is often associated with feeding and gastrointestinal disorders leading to malnutrition and growth failure. Assessment of nutritional status represents the first step in the clinical evaluation of children with neurological disability. The European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recently issued a consensus statement on gastrointestinal and nutritional management in children with neurological disability. Here we critically review and address implications of this consensus for clinical practice, including assessment and monitoring of nutritional status, definition of nutritional requirements, diagnosis and treatment of gastro‐oesophageal reflux disease, and indications for and modalities of nutritional support. There is a strong evidence base supporting the ESPGHAN guidelines; their application is expected to lead to better management of this group of children.
What this paper adds
Assessment of nutritional status in children with neurological disability should include the evaluation of body composition.
Standard polymeric formula via gastrostomy tube is an effective, long‐term nutritional intervention.
Tube feeding should be started early, before the development of malnutrition.
Resumen
Problemas gastrointestinales y nutricionales en niños con discapacidad neurológica
La discapacidad neurológica a menudo se asocia con alimentación y trastornos gastrointestinales que conducen a la desnutrición y al retraso del crecimiento. La evaluación del estado nutricional representa el paso inicial en la evaluación clínica de los niños con discapacidad neurológica. La Sociedad Europea de Gastroenterología, Hepatología y Nutrición (ESPGHAN) emitió recientemente unas guías, creadas por consenso, sobre el manejo gastrointestinal y nutricional en niños con discapacidad neurológica. Aquí revisamos críticamente y abordamos las implicaciones de este consenso para la práctica clínica, incluida la evaluación y el control del estado nutricional, la definición de los requisitos nutricionales, el diagnóstico y el tratamiento de la enfermedad por reflujo gastroesofágico y las indicaciones y modalidades de apoyo nutricional. Existe una sólida base de evidencia que respalda las pautas de ESPGHAN; se espera que su aplicación conduzca a un mejor manejo de este grupo de niños.
Resumo
Questões gastrointestinais e nutricionais em crianças com incapacidade neurológica
A incapacidade neurológica é frequentemente associada com desordens de alimentação e gastrointestinas, causando malnutrição e falha no crescimento. A avaliação do estado nutricional representa o primeiro passo na avaliação clínica de crianças neurologicamente deficientes. A Sociedade Européia de Gastroenterologia, Hepatologia e Nutrição (ESPGHAN) recentemente emitiu um consenso sobre o manejo gastrointestinal e nutricional de crianças com deficiência neurológica. Aqui, nós revisamos criticamente e abordamos as implicações deste consenso para a prática clinica, incluindo a avaliação e monitoramento do estado nutricional, definição de necessidades nutricionais, diagnóstico e tratamento de refluxo gastroesofágico, e indicações e modalidade de suporte nutricional. Há fortes evidências apoiando as diretrizes da ESPGHAN; espera‐se que sua aplicação melhor o manejo deste grupo de crianças.
What this paper adds
Assessment of nutritional status in children with neurological disability should include the evaluation of body composition.
Standard polymeric formula via gastrostomy tube is an effective, long‐term nutritional intervention.
Tube feeding should be started early, before the development of malnutrition.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.</description><identifier>ISSN: 0012-1622</identifier><identifier>EISSN: 1469-8749</identifier><identifier>DOI: 10.1111/dmcn.13921</identifier><identifier>PMID: 29806137</identifier><language>eng</language><publisher>England: Wiley-Blackwell</publisher><subject>Child ; Gastrointestinal Diseases - diagnosis ; Gastrointestinal Diseases - etiology ; Gastrointestinal Diseases - therapy ; Humans ; Life Sciences ; Malnutrition - diagnosis ; Malnutrition - etiology ; Malnutrition - therapy ; Nervous System Diseases - complications ; Nutritional Requirements ; Nutritional Status ; Nutritional Support</subject><ispartof>Developmental medicine and child neurology, 2018-09, Vol.60 (9), p.892-896</ispartof><rights>2018 Mac Keith Press</rights><rights>2018 Mac Keith Press.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3991-c86149ce281765b59266312ed12a4fef284a543a8b8474083fd2e0b84767cf133</citedby><cites>FETCH-LOGICAL-c3991-c86149ce281765b59266312ed12a4fef284a543a8b8474083fd2e0b84767cf133</cites><orcidid>0000-0001-8827-2091</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fdmcn.13921$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fdmcn.13921$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,1427,27903,27904,45553,45554,46387,46811</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29806137$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.univ-lille.fr/hal-04415535$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Romano, Claudio</creatorcontrib><creatorcontrib>Dipasquale, Valeria</creatorcontrib><creatorcontrib>Gottrand, Frederic</creatorcontrib><creatorcontrib>Sullivan, Peter B</creatorcontrib><title>Gastrointestinal and nutritional issues in children with neurological disability</title><title>Developmental medicine and child neurology</title><addtitle>Dev Med Child Neurol</addtitle><description>Neurological disability is often associated with feeding and gastrointestinal disorders leading to malnutrition and growth failure. Assessment of nutritional status represents the first step in the clinical evaluation of children with neurological disability. The European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recently issued a consensus statement on gastrointestinal and nutritional management in children with neurological disability. Here we critically review and address implications of this consensus for clinical practice, including assessment and monitoring of nutritional status, definition of nutritional requirements, diagnosis and treatment of gastro‐oesophageal reflux disease, and indications for and modalities of nutritional support. There is a strong evidence base supporting the ESPGHAN guidelines; their application is expected to lead to better management of this group of children.
What this paper adds
Assessment of nutritional status in children with neurological disability should include the evaluation of body composition.
Standard polymeric formula via gastrostomy tube is an effective, long‐term nutritional intervention.
Tube feeding should be started early, before the development of malnutrition.
Resumen
Problemas gastrointestinales y nutricionales en niños con discapacidad neurológica
La discapacidad neurológica a menudo se asocia con alimentación y trastornos gastrointestinales que conducen a la desnutrición y al retraso del crecimiento. La evaluación del estado nutricional representa el paso inicial en la evaluación clínica de los niños con discapacidad neurológica. La Sociedad Europea de Gastroenterología, Hepatología y Nutrición (ESPGHAN) emitió recientemente unas guías, creadas por consenso, sobre el manejo gastrointestinal y nutricional en niños con discapacidad neurológica. Aquí revisamos críticamente y abordamos las implicaciones de este consenso para la práctica clínica, incluida la evaluación y el control del estado nutricional, la definición de los requisitos nutricionales, el diagnóstico y el tratamiento de la enfermedad por reflujo gastroesofágico y las indicaciones y modalidades de apoyo nutricional. Existe una sólida base de evidencia que respalda las pautas de ESPGHAN; se espera que su aplicación conduzca a un mejor manejo de este grupo de niños.
Resumo
Questões gastrointestinais e nutricionais em crianças com incapacidade neurológica
A incapacidade neurológica é frequentemente associada com desordens de alimentação e gastrointestinas, causando malnutrição e falha no crescimento. A avaliação do estado nutricional representa o primeiro passo na avaliação clínica de crianças neurologicamente deficientes. A Sociedade Européia de Gastroenterologia, Hepatologia e Nutrição (ESPGHAN) recentemente emitiu um consenso sobre o manejo gastrointestinal e nutricional de crianças com deficiência neurológica. Aqui, nós revisamos criticamente e abordamos as implicações deste consenso para a prática clinica, incluindo a avaliação e monitoramento do estado nutricional, definição de necessidades nutricionais, diagnóstico e tratamento de refluxo gastroesofágico, e indicações e modalidade de suporte nutricional. Há fortes evidências apoiando as diretrizes da ESPGHAN; espera‐se que sua aplicação melhor o manejo deste grupo de crianças.
What this paper adds
Assessment of nutritional status in children with neurological disability should include the evaluation of body composition.
Standard polymeric formula via gastrostomy tube is an effective, long‐term nutritional intervention.
Tube feeding should be started early, before the development of malnutrition.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.</description><subject>Child</subject><subject>Gastrointestinal Diseases - diagnosis</subject><subject>Gastrointestinal Diseases - etiology</subject><subject>Gastrointestinal Diseases - therapy</subject><subject>Humans</subject><subject>Life Sciences</subject><subject>Malnutrition - diagnosis</subject><subject>Malnutrition - etiology</subject><subject>Malnutrition - therapy</subject><subject>Nervous System Diseases - complications</subject><subject>Nutritional Requirements</subject><subject>Nutritional Status</subject><subject>Nutritional Support</subject><issn>0012-1622</issn><issn>1469-8749</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtOwzAQRS0EglLY8AEoS0BK8diOEy9RgRapPBawtlzHoUauU-wE1L8nIcCS2Yzu6OhIcxE6ATyBbi7LtfYToILADhoB4yItciZ20QhjIClwQg7QYYxvGGPKM7aPDogoMAeaj9DTTMUm1NY3JjbWK5coXya-bYJtbN1nG2NrYmJ9olfWlcH45NM2q8SbNtSufrW6g0ob1dI622yP0F6lXDTHP3uMXm5vnqfzdPE4u5teLVJNhYBUFxyY0IYUkPNsmQnCOQViSiCKVaYiBVMZo6pYFixnuKBVSQzuA891BZSO0fngXSknN8GuVdjKWlk5v1rI_oYZgyyj2Qd07NnAbkL93j3TyLWN2jinvKnbKAlmHEOWY9GhFwOqQx1jMNWfG7Ds25Z92_K77Q4-_fG2y7Up_9DfejsABuDTOrP9RyWv76cPg_QL4RKJPQ</recordid><startdate>201809</startdate><enddate>201809</enddate><creator>Romano, Claudio</creator><creator>Dipasquale, Valeria</creator><creator>Gottrand, Frederic</creator><creator>Sullivan, Peter B</creator><general>Wiley-Blackwell</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0001-8827-2091</orcidid></search><sort><creationdate>201809</creationdate><title>Gastrointestinal and nutritional issues in children with neurological disability</title><author>Romano, Claudio ; Dipasquale, Valeria ; Gottrand, Frederic ; Sullivan, Peter B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3991-c86149ce281765b59266312ed12a4fef284a543a8b8474083fd2e0b84767cf133</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Child</topic><topic>Gastrointestinal Diseases - diagnosis</topic><topic>Gastrointestinal Diseases - etiology</topic><topic>Gastrointestinal Diseases - therapy</topic><topic>Humans</topic><topic>Life Sciences</topic><topic>Malnutrition - diagnosis</topic><topic>Malnutrition - etiology</topic><topic>Malnutrition - therapy</topic><topic>Nervous System Diseases - complications</topic><topic>Nutritional Requirements</topic><topic>Nutritional Status</topic><topic>Nutritional Support</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Romano, Claudio</creatorcontrib><creatorcontrib>Dipasquale, Valeria</creatorcontrib><creatorcontrib>Gottrand, Frederic</creatorcontrib><creatorcontrib>Sullivan, Peter B</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Developmental medicine and child neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Romano, Claudio</au><au>Dipasquale, Valeria</au><au>Gottrand, Frederic</au><au>Sullivan, Peter B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Gastrointestinal and nutritional issues in children with neurological disability</atitle><jtitle>Developmental medicine and child neurology</jtitle><addtitle>Dev Med Child Neurol</addtitle><date>2018-09</date><risdate>2018</risdate><volume>60</volume><issue>9</issue><spage>892</spage><epage>896</epage><pages>892-896</pages><issn>0012-1622</issn><eissn>1469-8749</eissn><abstract>Neurological disability is often associated with feeding and gastrointestinal disorders leading to malnutrition and growth failure. Assessment of nutritional status represents the first step in the clinical evaluation of children with neurological disability. The European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recently issued a consensus statement on gastrointestinal and nutritional management in children with neurological disability. Here we critically review and address implications of this consensus for clinical practice, including assessment and monitoring of nutritional status, definition of nutritional requirements, diagnosis and treatment of gastro‐oesophageal reflux disease, and indications for and modalities of nutritional support. There is a strong evidence base supporting the ESPGHAN guidelines; their application is expected to lead to better management of this group of children.
What this paper adds
Assessment of nutritional status in children with neurological disability should include the evaluation of body composition.
Standard polymeric formula via gastrostomy tube is an effective, long‐term nutritional intervention.
Tube feeding should be started early, before the development of malnutrition.
Resumen
Problemas gastrointestinales y nutricionales en niños con discapacidad neurológica
La discapacidad neurológica a menudo se asocia con alimentación y trastornos gastrointestinales que conducen a la desnutrición y al retraso del crecimiento. La evaluación del estado nutricional representa el paso inicial en la evaluación clínica de los niños con discapacidad neurológica. La Sociedad Europea de Gastroenterología, Hepatología y Nutrición (ESPGHAN) emitió recientemente unas guías, creadas por consenso, sobre el manejo gastrointestinal y nutricional en niños con discapacidad neurológica. Aquí revisamos críticamente y abordamos las implicaciones de este consenso para la práctica clínica, incluida la evaluación y el control del estado nutricional, la definición de los requisitos nutricionales, el diagnóstico y el tratamiento de la enfermedad por reflujo gastroesofágico y las indicaciones y modalidades de apoyo nutricional. Existe una sólida base de evidencia que respalda las pautas de ESPGHAN; se espera que su aplicación conduzca a un mejor manejo de este grupo de niños.
Resumo
Questões gastrointestinais e nutricionais em crianças com incapacidade neurológica
A incapacidade neurológica é frequentemente associada com desordens de alimentação e gastrointestinas, causando malnutrição e falha no crescimento. A avaliação do estado nutricional representa o primeiro passo na avaliação clínica de crianças neurologicamente deficientes. A Sociedade Européia de Gastroenterologia, Hepatologia e Nutrição (ESPGHAN) recentemente emitiu um consenso sobre o manejo gastrointestinal e nutricional de crianças com deficiência neurológica. Aqui, nós revisamos criticamente e abordamos as implicações deste consenso para a prática clinica, incluindo a avaliação e monitoramento do estado nutricional, definição de necessidades nutricionais, diagnóstico e tratamento de refluxo gastroesofágico, e indicações e modalidade de suporte nutricional. Há fortes evidências apoiando as diretrizes da ESPGHAN; espera‐se que sua aplicação melhor o manejo deste grupo de crianças.
What this paper adds
Assessment of nutritional status in children with neurological disability should include the evaluation of body composition.
Standard polymeric formula via gastrostomy tube is an effective, long‐term nutritional intervention.
Tube feeding should be started early, before the development of malnutrition.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.</abstract><cop>England</cop><pub>Wiley-Blackwell</pub><pmid>29806137</pmid><doi>10.1111/dmcn.13921</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0001-8827-2091</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0012-1622 |
| ispartof | Developmental medicine and child neurology, 2018-09, Vol.60 (9), p.892-896 |
| issn | 0012-1622 1469-8749 |
| language | eng |
| recordid | cdi_hal_primary_oai_HAL_hal_04415535v1 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Wiley Online Library Free Content |
| subjects | Child Gastrointestinal Diseases - diagnosis Gastrointestinal Diseases - etiology Gastrointestinal Diseases - therapy Humans Life Sciences Malnutrition - diagnosis Malnutrition - etiology Malnutrition - therapy Nervous System Diseases - complications Nutritional Requirements Nutritional Status Nutritional Support |
| title | Gastrointestinal and nutritional issues in children with neurological disability |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-26T13%3A47%3A07IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_hal_p&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Gastrointestinal%20and%20nutritional%20issues%20in%20children%20with%20neurological%20disability&rft.jtitle=Developmental%20medicine%20and%20child%20neurology&rft.au=Romano,%20Claudio&rft.date=2018-09&rft.volume=60&rft.issue=9&rft.spage=892&rft.epage=896&rft.pages=892-896&rft.issn=0012-1622&rft.eissn=1469-8749&rft_id=info:doi/10.1111/dmcn.13921&rft_dat=%3Cproquest_hal_p%3E2046015709%3C/proquest_hal_p%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2046015709&rft_id=info:pmid/29806137&rfr_iscdi=true |