Association between Hypertension and the Prevalence of Low Back Pain and Osteoarthritis in Koreans: A Cross-Sectional Study
Hypertension and musculoskeletal disorders are highly prevalent in adult populations. The objective of this study was to investigate the association between hypertension and prevalence of low back pain (LBP) and osteoarthritis in Koreans. A total 17,128 participants (age ≥20 years) who answered low...
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| description | Hypertension and musculoskeletal disorders are highly prevalent in adult populations. The objective of this study was to investigate the association between hypertension and prevalence of low back pain (LBP) and osteoarthritis in Koreans.
A total 17,128 participants (age ≥20 years) who answered low back pain and osteoarthritis items in the 4th Korean National Health and Nutrition Examination Survey (2007-2009) were analyzed. Odds ratios were calculated using logistic regression and were adjusted for age, sex, income level, education, occupation, BMI, smoking status, alcohol consumption, and physical activity.
Lifetime prevalence of LBP in hypertensive subjects was 34.4%, and that of osteoarthritis 26.2%. LBP prevalence was significantly lower in hypertensives (fully adjusted OR 0.79; 95% CI 0.70-0.90), and both LBP and osteoarthritis prevalence was significantly lower in participants with systolic blood pressure ≥140mmHg than those with |
| doi_str_mv | 10.1371/journal.pone.0138790 |
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A total 17,128 participants (age ≥20 years) who answered low back pain and osteoarthritis items in the 4th Korean National Health and Nutrition Examination Survey (2007-2009) were analyzed. Odds ratios were calculated using logistic regression and were adjusted for age, sex, income level, education, occupation, BMI, smoking status, alcohol consumption, and physical activity.
Lifetime prevalence of LBP in hypertensive subjects was 34.4%, and that of osteoarthritis 26.2%. LBP prevalence was significantly lower in hypertensives (fully adjusted OR 0.79; 95% CI 0.70-0.90), and both LBP and osteoarthritis prevalence was significantly lower in participants with systolic blood pressure ≥140mmHg than those with <120mmHg (fully adjusted OR 0.81; 95% CI 0.70-0.94, and 0.81; 95% CI 0.68-0.96, respectively). Prevalence of LBP in subjects with diastolic blood pressure ≥90mmHg was also significantly lower than those with <80mmHg (fully adjusted OR 0.73; 95% CI 0.63-0.85). LBP and osteoarthritis prevalence did not differ by systolic or diastolic blood pressure interval in respondents taking antihypertensive medication. LBP and osteoarthritis prevalence increased with longer hypertension duration (fully adjusted p for trend 0.028, and 0.0008, respectively).
Hypertension showed an inverse relationship with LBP and osteoarthritis prevalence, which may be ascribed to hypertension-associated hypalgesia, and antihypertensive medication intake and longer hypertension duration attenuated this association.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0138790</identifier><identifier>PMID: 26393797</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Alcohol use ; Alcoholic beverages ; Analysis ; Antihypertensive agents ; Antihypertensives ; Arthritis ; Back pain ; Biocompatibility ; Blood ; Blood pressure ; Body mass ; Cross-Sectional Studies ; Drugs ; Exercise ; Female ; Health risk assessment ; Health surveys ; Humans ; Hypertension ; Hypertension - complications ; Hypertension - epidemiology ; Koreans ; Low back pain ; Low Back Pain - complications ; Low Back Pain - epidemiology ; Male ; Medical research ; Middle Aged ; Musculoskeletal diseases ; Nutrition ; Osteoarthritis ; Osteoarthritis - complications ; Osteoarthritis - epidemiology ; Pain ; Physical activity ; Prevalence ; Regression analysis ; Republic of Korea - epidemiology ; Smoking ; Studies ; Surveys</subject><ispartof>PloS one, 2015-09, Vol.10 (9), p.e0138790-e0138790</ispartof><rights>COPYRIGHT 2015 Public Library of Science</rights><rights>2015 Bae et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2015 Bae et al 2015 Bae et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c758t-6797c7d86b4cac09f5e7bb9679763bb94f6877e45ac760a48e3918cb7ee3e0ed3</citedby><cites>FETCH-LOGICAL-c758t-6797c7d86b4cac09f5e7bb9679763bb94f6877e45ac760a48e3918cb7ee3e0ed3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578861/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578861/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26393797$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Fuchs, Flávio Danni</contributor><creatorcontrib>Bae, Young-Hyeon</creatorcontrib><creatorcontrib>Shin, Joon-Shik</creatorcontrib><creatorcontrib>Lee, Jinho</creatorcontrib><creatorcontrib>Kim, Me-riong</creatorcontrib><creatorcontrib>Park, Ki Byung</creatorcontrib><creatorcontrib>Cho, Jae-Heung</creatorcontrib><creatorcontrib>Ha, In-Hyuk</creatorcontrib><title>Association between Hypertension and the Prevalence of Low Back Pain and Osteoarthritis in Koreans: A Cross-Sectional Study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Hypertension and musculoskeletal disorders are highly prevalent in adult populations. The objective of this study was to investigate the association between hypertension and prevalence of low back pain (LBP) and osteoarthritis in Koreans.
A total 17,128 participants (age ≥20 years) who answered low back pain and osteoarthritis items in the 4th Korean National Health and Nutrition Examination Survey (2007-2009) were analyzed. Odds ratios were calculated using logistic regression and were adjusted for age, sex, income level, education, occupation, BMI, smoking status, alcohol consumption, and physical activity.
Lifetime prevalence of LBP in hypertensive subjects was 34.4%, and that of osteoarthritis 26.2%. LBP prevalence was significantly lower in hypertensives (fully adjusted OR 0.79; 95% CI 0.70-0.90), and both LBP and osteoarthritis prevalence was significantly lower in participants with systolic blood pressure ≥140mmHg than those with <120mmHg (fully adjusted OR 0.81; 95% CI 0.70-0.94, and 0.81; 95% CI 0.68-0.96, respectively). Prevalence of LBP in subjects with diastolic blood pressure ≥90mmHg was also significantly lower than those with <80mmHg (fully adjusted OR 0.73; 95% CI 0.63-0.85). LBP and osteoarthritis prevalence did not differ by systolic or diastolic blood pressure interval in respondents taking antihypertensive medication. LBP and osteoarthritis prevalence increased with longer hypertension duration (fully adjusted p for trend 0.028, and 0.0008, respectively).
Hypertension showed an inverse relationship with LBP and osteoarthritis prevalence, which may be ascribed to hypertension-associated hypalgesia, and antihypertensive medication intake and longer hypertension duration attenuated this association.</description><subject>Adult</subject><subject>Alcohol use</subject><subject>Alcoholic beverages</subject><subject>Analysis</subject><subject>Antihypertensive agents</subject><subject>Antihypertensives</subject><subject>Arthritis</subject><subject>Back pain</subject><subject>Biocompatibility</subject><subject>Blood</subject><subject>Blood pressure</subject><subject>Body mass</subject><subject>Cross-Sectional Studies</subject><subject>Drugs</subject><subject>Exercise</subject><subject>Female</subject><subject>Health risk assessment</subject><subject>Health surveys</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension - complications</subject><subject>Hypertension - epidemiology</subject><subject>Koreans</subject><subject>Low back pain</subject><subject>Low Back Pain - complications</subject><subject>Low Back Pain - epidemiology</subject><subject>Male</subject><subject>Medical research</subject><subject>Middle Aged</subject><subject>Musculoskeletal diseases</subject><subject>Nutrition</subject><subject>Osteoarthritis</subject><subject>Osteoarthritis - complications</subject><subject>Osteoarthritis - epidemiology</subject><subject>Pain</subject><subject>Physical activity</subject><subject>Prevalence</subject><subject>Regression analysis</subject><subject>Republic of Korea - epidemiology</subject><subject>Smoking</subject><subject>Studies</subject><subject>Surveys</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk1Fv0zAQxyMEYmPwDRBYQkLw0JLEjp3sAalUwCoqdaLAq-U4l9YltYvtbFR8eZw1mxq0B5SHWH__7n_2-S6KnifxOMEsebcxrdWiGe-MhnGc4JwV8YPoNClwOqJpjB8erU-iJ85t4jjDOaWPo5OU4gKzgp1GfybOGamEV0ajEvw1gEYX-x1YD9p1otAV8mtAlxauRANaAjI1mptr9EHIn-hSqAOzcB6MsH5tlVcOBfWLsSC0O0cTNLXGudESZJdHNGjp22r_NHpUi8bBs_5_Fn3_9PHb9GI0X3yeTSfzkWRZ7kc0HFSyKqclkULGRZ0BK8uikykOC1LTnDEgmZCMxoLkgIsklyUDwBBDhc-ilwffXWMc7-vmeMKSIi1SkhWBmB2IyogN31m1FXbPjVD8RjB2xcPNlGyAU1JJUuG0ECwlUJQ5TWQqcpnRUjKoZPB632dry20QQHsrmoHpcEerNV-ZK04ylge3YPCmN7DmVwvO861yEppGaDDtzbkZyVOckoC--ge9_3Y9tQrvx5WuTcgrO1M-ISwJXUJJHqjxPVT4KtgqGZqsVkEfBLwdBATGw2-_Eq1zfLb8-v_s4seQfX3ErkE0fu1M03at44YgOYCy6y4L9V2Rk5h3M3JbDd7NCO9nJIS9OH6gu6DbocB_AR6JDVM</recordid><startdate>20150922</startdate><enddate>20150922</enddate><creator>Bae, Young-Hyeon</creator><creator>Shin, Joon-Shik</creator><creator>Lee, Jinho</creator><creator>Kim, Me-riong</creator><creator>Park, Ki Byung</creator><creator>Cho, Jae-Heung</creator><creator>Ha, In-Hyuk</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</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>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20150922</creationdate><title>Association between Hypertension and the Prevalence of Low Back Pain and Osteoarthritis in Koreans: A Cross-Sectional Study</title><author>Bae, Young-Hyeon ; Shin, Joon-Shik ; Lee, Jinho ; Kim, Me-riong ; Park, Ki Byung ; Cho, Jae-Heung ; Ha, In-Hyuk</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c758t-6797c7d86b4cac09f5e7bb9679763bb94f6877e45ac760a48e3918cb7ee3e0ed3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Alcohol use</topic><topic>Alcoholic beverages</topic><topic>Analysis</topic><topic>Antihypertensive agents</topic><topic>Antihypertensives</topic><topic>Arthritis</topic><topic>Back pain</topic><topic>Biocompatibility</topic><topic>Blood</topic><topic>Blood pressure</topic><topic>Body mass</topic><topic>Cross-Sectional Studies</topic><topic>Drugs</topic><topic>Exercise</topic><topic>Female</topic><topic>Health risk assessment</topic><topic>Health surveys</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension - complications</topic><topic>Hypertension - epidemiology</topic><topic>Koreans</topic><topic>Low back pain</topic><topic>Low Back Pain - complications</topic><topic>Low Back Pain - epidemiology</topic><topic>Male</topic><topic>Medical research</topic><topic>Middle Aged</topic><topic>Musculoskeletal diseases</topic><topic>Nutrition</topic><topic>Osteoarthritis</topic><topic>Osteoarthritis - complications</topic><topic>Osteoarthritis - epidemiology</topic><topic>Pain</topic><topic>Physical activity</topic><topic>Prevalence</topic><topic>Regression analysis</topic><topic>Republic of Korea - epidemiology</topic><topic>Smoking</topic><topic>Studies</topic><topic>Surveys</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bae, Young-Hyeon</creatorcontrib><creatorcontrib>Shin, Joon-Shik</creatorcontrib><creatorcontrib>Lee, Jinho</creatorcontrib><creatorcontrib>Kim, Me-riong</creatorcontrib><creatorcontrib>Park, Ki Byung</creatorcontrib><creatorcontrib>Cho, Jae-Heung</creatorcontrib><creatorcontrib>Ha, In-Hyuk</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bae, Young-Hyeon</au><au>Shin, Joon-Shik</au><au>Lee, Jinho</au><au>Kim, Me-riong</au><au>Park, Ki Byung</au><au>Cho, Jae-Heung</au><au>Ha, In-Hyuk</au><au>Fuchs, Flávio Danni</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association between Hypertension and the Prevalence of Low Back Pain and Osteoarthritis in Koreans: A Cross-Sectional Study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2015-09-22</date><risdate>2015</risdate><volume>10</volume><issue>9</issue><spage>e0138790</spage><epage>e0138790</epage><pages>e0138790-e0138790</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Hypertension and musculoskeletal disorders are highly prevalent in adult populations. The objective of this study was to investigate the association between hypertension and prevalence of low back pain (LBP) and osteoarthritis in Koreans.
A total 17,128 participants (age ≥20 years) who answered low back pain and osteoarthritis items in the 4th Korean National Health and Nutrition Examination Survey (2007-2009) were analyzed. Odds ratios were calculated using logistic regression and were adjusted for age, sex, income level, education, occupation, BMI, smoking status, alcohol consumption, and physical activity.
Lifetime prevalence of LBP in hypertensive subjects was 34.4%, and that of osteoarthritis 26.2%. LBP prevalence was significantly lower in hypertensives (fully adjusted OR 0.79; 95% CI 0.70-0.90), and both LBP and osteoarthritis prevalence was significantly lower in participants with systolic blood pressure ≥140mmHg than those with <120mmHg (fully adjusted OR 0.81; 95% CI 0.70-0.94, and 0.81; 95% CI 0.68-0.96, respectively). Prevalence of LBP in subjects with diastolic blood pressure ≥90mmHg was also significantly lower than those with <80mmHg (fully adjusted OR 0.73; 95% CI 0.63-0.85). LBP and osteoarthritis prevalence did not differ by systolic or diastolic blood pressure interval in respondents taking antihypertensive medication. LBP and osteoarthritis prevalence increased with longer hypertension duration (fully adjusted p for trend 0.028, and 0.0008, respectively).
Hypertension showed an inverse relationship with LBP and osteoarthritis prevalence, which may be ascribed to hypertension-associated hypalgesia, and antihypertensive medication intake and longer hypertension duration attenuated this association.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26393797</pmid><doi>10.1371/journal.pone.0138790</doi><tpages>e0138790</tpages><oa>free_for_read</oa></addata></record> |
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| issn | 1932-6203 1932-6203 |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Alcohol use Alcoholic beverages Analysis Antihypertensive agents Antihypertensives Arthritis Back pain Biocompatibility Blood Blood pressure Body mass Cross-Sectional Studies Drugs Exercise Female Health risk assessment Health surveys Humans Hypertension Hypertension - complications Hypertension - epidemiology Koreans Low back pain Low Back Pain - complications Low Back Pain - epidemiology Male Medical research Middle Aged Musculoskeletal diseases Nutrition Osteoarthritis Osteoarthritis - complications Osteoarthritis - epidemiology Pain Physical activity Prevalence Regression analysis Republic of Korea - epidemiology Smoking Studies Surveys |
| title | Association between Hypertension and the Prevalence of Low Back Pain and Osteoarthritis in Koreans: A Cross-Sectional Study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-18T20%3A35%3A47IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Association%20between%20Hypertension%20and%20the%20Prevalence%20of%20Low%20Back%20Pain%20and%20Osteoarthritis%20in%20Koreans:%20A%20Cross-Sectional%20Study&rft.jtitle=PloS%20one&rft.au=Bae,%20Young-Hyeon&rft.date=2015-09-22&rft.volume=10&rft.issue=9&rft.spage=e0138790&rft.epage=e0138790&rft.pages=e0138790-e0138790&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0138790&rft_dat=%3Cgale_plos_%3EA471193648%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1719292459&rft_id=info:pmid/26393797&rft_galeid=A471193648&rft_doaj_id=oai_doaj_org_article_64dc4d329a724e9b861c2a8c56bc7edc&rfr_iscdi=true |