Three nights leg thermal therapy could improve sleep quality in patients with chronic heart failure

Sleep quality is often impaired in patients with chronic heart failure (HF), which may worsen their quality of life and even prognosis. Leg thermal therapy (LTT), topical leg warming, has been shown to improve endothelial function, oxidative stress, and cardiac function in patients with HF. However,...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Heart and vessels 2018-02, Vol.33 (2), p.155-162
Hauptverfasser: Sawatari, Hiroyuki, Nishizaka, Mari K., Miyazono, Mami, Ando, Shin-ichi, Inoue, Shujiro, Takemoto, Masao, Sakamoto, Takafumi, Goto, Daisuke, Furumoto, Tomoo, Kinugawa, Shintaro, Hashiguchi, Nobuko, Rahmawati, Anita, Chishaki, Hiroaki, Ohkusa, Tomoko, Magota, Chie, Tsutsui, Hiroyuki, Chishaki, Akiko
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 162
container_issue 2
container_start_page 155
container_title Heart and vessels
container_volume 33
creator Sawatari, Hiroyuki
Nishizaka, Mari K.
Miyazono, Mami
Ando, Shin-ichi
Inoue, Shujiro
Takemoto, Masao
Sakamoto, Takafumi
Goto, Daisuke
Furumoto, Tomoo
Kinugawa, Shintaro
Hashiguchi, Nobuko
Rahmawati, Anita
Chishaki, Hiroaki
Ohkusa, Tomoko
Magota, Chie
Tsutsui, Hiroyuki
Chishaki, Akiko
description Sleep quality is often impaired in patients with chronic heart failure (HF), which may worsen their quality of life and even prognosis. Leg thermal therapy (LTT), topical leg warming, has been shown to improve endothelial function, oxidative stress, and cardiac function in patients with HF. However, its short-term influence to sleep quality has not been evaluated in HF patients. Eighteen of 23 patients with stable HF received LTT (15 min of warming at 45 °C and 30 min of insulation) at bedtime for 3 consecutive nights and 5 patients served as control. Subjective sleep quality was evaluated by St. Mary’s Hospital Sleep Questionnaire, Oguri–Shirakawa–Azumi Sleep Inventory, and Epworth sleepiness scale, and also objectively evaluated by polysomnography. LTT significantly improved subjective sleep quality indicated by depth of sleep ( p  
doi_str_mv 10.1007/s00380-017-1047-7
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1938852216</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1938852216</sourcerecordid><originalsourceid>FETCH-LOGICAL-c396t-e4fe13b2fd06f830820d52e7a277d983053f76390545daf4b9168d83f9cc776d3</originalsourceid><addsrcrecordid>eNp1kU9r3DAQxUVJaTZpP0AvRZBLL241km1JxxLaJhDoJT0LrTxaK8h_ItkN--2j7SalBHIa0Pzem4ceIR-BfQHG5NfMmFCsYiArYLWs5BuygRaaijdSnJAN08AqJbg8JWc53zEGjQb9jpxypVnDATbE3fYJkY5h1y-ZRtzRpcc02Ph32nlP3bTGjoZhTtMfpDkizvR-tTEsexpGOtsl4Fi0D2HpqevTNAZHe7Rpod6GuCZ8T956GzN-eJrn5PeP77eXV9XNr5_Xl99uKid0u1RYewSx5b5jrVeCKc66hqO0XMpOl4dGeNmKkrxuOuvrrYZWdUp47ZyUbSfOyeejb4l6v2JezBCywxjtiNOaDWihVMM5tAW9eIHeTWsaS7pCaS51zfmBgiPl0pRzQm_mFAab9gaYOTRgjg2Y0oA5NGBk0Xx6cl63A3b_FM9fXgB-BHJZjTtM_51-1fURTVyQrg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1992794226</pqid></control><display><type>article</type><title>Three nights leg thermal therapy could improve sleep quality in patients with chronic heart failure</title><source>SpringerLink Journals - AutoHoldings</source><creator>Sawatari, Hiroyuki ; Nishizaka, Mari K. ; Miyazono, Mami ; Ando, Shin-ichi ; Inoue, Shujiro ; Takemoto, Masao ; Sakamoto, Takafumi ; Goto, Daisuke ; Furumoto, Tomoo ; Kinugawa, Shintaro ; Hashiguchi, Nobuko ; Rahmawati, Anita ; Chishaki, Hiroaki ; Ohkusa, Tomoko ; Magota, Chie ; Tsutsui, Hiroyuki ; Chishaki, Akiko</creator><creatorcontrib>Sawatari, Hiroyuki ; Nishizaka, Mari K. ; Miyazono, Mami ; Ando, Shin-ichi ; Inoue, Shujiro ; Takemoto, Masao ; Sakamoto, Takafumi ; Goto, Daisuke ; Furumoto, Tomoo ; Kinugawa, Shintaro ; Hashiguchi, Nobuko ; Rahmawati, Anita ; Chishaki, Hiroaki ; Ohkusa, Tomoko ; Magota, Chie ; Tsutsui, Hiroyuki ; Chishaki, Akiko</creatorcontrib><description><![CDATA[Sleep quality is often impaired in patients with chronic heart failure (HF), which may worsen their quality of life and even prognosis. Leg thermal therapy (LTT), topical leg warming, has been shown to improve endothelial function, oxidative stress, and cardiac function in patients with HF. However, its short-term influence to sleep quality has not been evaluated in HF patients. Eighteen of 23 patients with stable HF received LTT (15 min of warming at 45 °C and 30 min of insulation) at bedtime for 3 consecutive nights and 5 patients served as control. Subjective sleep quality was evaluated by St. Mary’s Hospital Sleep Questionnaire, Oguri–Shirakawa–Azumi Sleep Inventory, and Epworth sleepiness scale, and also objectively evaluated by polysomnography. LTT significantly improved subjective sleep quality indicated by depth of sleep ( p  < 0.01), sleep duration ( p  < 0.05), number of awaking ( p  < 0.01), nap duration ( p  < 0.01), sleep quality ( p  < 0.05), and sleep satisfaction ( p  < 0.05). It was also objectively affirmed by a slight but significant decrease of sleep stage N1 ( p  < 0.01), and increase in sleep stage N2 ( p  < 0.05). No significant changes occurred in the controls. Hence, the short-term LTT could improve subjective and objective sleep quality in patients with HF. LTT can be a complimentary therapy to improve sleep quality in these patients.]]></description><identifier>ISSN: 0910-8327</identifier><identifier>EISSN: 1615-2573</identifier><identifier>DOI: 10.1007/s00380-017-1047-7</identifier><identifier>PMID: 28905211</identifier><language>eng</language><publisher>Tokyo: Springer Japan</publisher><subject>Biomedical Engineering and Bioengineering ; Cardiac Surgery ; Cardiology ; Heart ; Heart diseases ; Heart failure ; Insomnia ; Insulation ; Leg ; Medicine ; Medicine &amp; Public Health ; Original Article ; Oxidative stress ; Patients ; Quality ; Quality of life ; Sleep ; Sleep and wakefulness ; Sleepiness ; Therapy ; Vascular Surgery</subject><ispartof>Heart and vessels, 2018-02, Vol.33 (2), p.155-162</ispartof><rights>Springer Japan KK 2017</rights><rights>Heart and Vessels is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-e4fe13b2fd06f830820d52e7a277d983053f76390545daf4b9168d83f9cc776d3</citedby><cites>FETCH-LOGICAL-c396t-e4fe13b2fd06f830820d52e7a277d983053f76390545daf4b9168d83f9cc776d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00380-017-1047-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00380-017-1047-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28905211$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sawatari, Hiroyuki</creatorcontrib><creatorcontrib>Nishizaka, Mari K.</creatorcontrib><creatorcontrib>Miyazono, Mami</creatorcontrib><creatorcontrib>Ando, Shin-ichi</creatorcontrib><creatorcontrib>Inoue, Shujiro</creatorcontrib><creatorcontrib>Takemoto, Masao</creatorcontrib><creatorcontrib>Sakamoto, Takafumi</creatorcontrib><creatorcontrib>Goto, Daisuke</creatorcontrib><creatorcontrib>Furumoto, Tomoo</creatorcontrib><creatorcontrib>Kinugawa, Shintaro</creatorcontrib><creatorcontrib>Hashiguchi, Nobuko</creatorcontrib><creatorcontrib>Rahmawati, Anita</creatorcontrib><creatorcontrib>Chishaki, Hiroaki</creatorcontrib><creatorcontrib>Ohkusa, Tomoko</creatorcontrib><creatorcontrib>Magota, Chie</creatorcontrib><creatorcontrib>Tsutsui, Hiroyuki</creatorcontrib><creatorcontrib>Chishaki, Akiko</creatorcontrib><title>Three nights leg thermal therapy could improve sleep quality in patients with chronic heart failure</title><title>Heart and vessels</title><addtitle>Heart Vessels</addtitle><addtitle>Heart Vessels</addtitle><description><![CDATA[Sleep quality is often impaired in patients with chronic heart failure (HF), which may worsen their quality of life and even prognosis. Leg thermal therapy (LTT), topical leg warming, has been shown to improve endothelial function, oxidative stress, and cardiac function in patients with HF. However, its short-term influence to sleep quality has not been evaluated in HF patients. Eighteen of 23 patients with stable HF received LTT (15 min of warming at 45 °C and 30 min of insulation) at bedtime for 3 consecutive nights and 5 patients served as control. Subjective sleep quality was evaluated by St. Mary’s Hospital Sleep Questionnaire, Oguri–Shirakawa–Azumi Sleep Inventory, and Epworth sleepiness scale, and also objectively evaluated by polysomnography. LTT significantly improved subjective sleep quality indicated by depth of sleep ( p  < 0.01), sleep duration ( p  < 0.05), number of awaking ( p  < 0.01), nap duration ( p  < 0.01), sleep quality ( p  < 0.05), and sleep satisfaction ( p  < 0.05). It was also objectively affirmed by a slight but significant decrease of sleep stage N1 ( p  < 0.01), and increase in sleep stage N2 ( p  < 0.05). No significant changes occurred in the controls. Hence, the short-term LTT could improve subjective and objective sleep quality in patients with HF. LTT can be a complimentary therapy to improve sleep quality in these patients.]]></description><subject>Biomedical Engineering and Bioengineering</subject><subject>Cardiac Surgery</subject><subject>Cardiology</subject><subject>Heart</subject><subject>Heart diseases</subject><subject>Heart failure</subject><subject>Insomnia</subject><subject>Insulation</subject><subject>Leg</subject><subject>Medicine</subject><subject>Medicine &amp; Public Health</subject><subject>Original Article</subject><subject>Oxidative stress</subject><subject>Patients</subject><subject>Quality</subject><subject>Quality of life</subject><subject>Sleep</subject><subject>Sleep and wakefulness</subject><subject>Sleepiness</subject><subject>Therapy</subject><subject>Vascular Surgery</subject><issn>0910-8327</issn><issn>1615-2573</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kU9r3DAQxUVJaTZpP0AvRZBLL241km1JxxLaJhDoJT0LrTxaK8h_ItkN--2j7SalBHIa0Pzem4ceIR-BfQHG5NfMmFCsYiArYLWs5BuygRaaijdSnJAN08AqJbg8JWc53zEGjQb9jpxypVnDATbE3fYJkY5h1y-ZRtzRpcc02Ph32nlP3bTGjoZhTtMfpDkizvR-tTEsexpGOtsl4Fi0D2HpqevTNAZHe7Rpod6GuCZ8T956GzN-eJrn5PeP77eXV9XNr5_Xl99uKid0u1RYewSx5b5jrVeCKc66hqO0XMpOl4dGeNmKkrxuOuvrrYZWdUp47ZyUbSfOyeejb4l6v2JezBCywxjtiNOaDWihVMM5tAW9eIHeTWsaS7pCaS51zfmBgiPl0pRzQm_mFAab9gaYOTRgjg2Y0oA5NGBk0Xx6cl63A3b_FM9fXgB-BHJZjTtM_51-1fURTVyQrg</recordid><startdate>20180201</startdate><enddate>20180201</enddate><creator>Sawatari, Hiroyuki</creator><creator>Nishizaka, Mari K.</creator><creator>Miyazono, Mami</creator><creator>Ando, Shin-ichi</creator><creator>Inoue, Shujiro</creator><creator>Takemoto, Masao</creator><creator>Sakamoto, Takafumi</creator><creator>Goto, Daisuke</creator><creator>Furumoto, Tomoo</creator><creator>Kinugawa, Shintaro</creator><creator>Hashiguchi, Nobuko</creator><creator>Rahmawati, Anita</creator><creator>Chishaki, Hiroaki</creator><creator>Ohkusa, Tomoko</creator><creator>Magota, Chie</creator><creator>Tsutsui, Hiroyuki</creator><creator>Chishaki, Akiko</creator><general>Springer Japan</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20180201</creationdate><title>Three nights leg thermal therapy could improve sleep quality in patients with chronic heart failure</title><author>Sawatari, Hiroyuki ; Nishizaka, Mari K. ; Miyazono, Mami ; Ando, Shin-ichi ; Inoue, Shujiro ; Takemoto, Masao ; Sakamoto, Takafumi ; Goto, Daisuke ; Furumoto, Tomoo ; Kinugawa, Shintaro ; Hashiguchi, Nobuko ; Rahmawati, Anita ; Chishaki, Hiroaki ; Ohkusa, Tomoko ; Magota, Chie ; Tsutsui, Hiroyuki ; Chishaki, Akiko</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-e4fe13b2fd06f830820d52e7a277d983053f76390545daf4b9168d83f9cc776d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Biomedical Engineering and Bioengineering</topic><topic>Cardiac Surgery</topic><topic>Cardiology</topic><topic>Heart</topic><topic>Heart diseases</topic><topic>Heart failure</topic><topic>Insomnia</topic><topic>Insulation</topic><topic>Leg</topic><topic>Medicine</topic><topic>Medicine &amp; Public Health</topic><topic>Original Article</topic><topic>Oxidative stress</topic><topic>Patients</topic><topic>Quality</topic><topic>Quality of life</topic><topic>Sleep</topic><topic>Sleep and wakefulness</topic><topic>Sleepiness</topic><topic>Therapy</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sawatari, Hiroyuki</creatorcontrib><creatorcontrib>Nishizaka, Mari K.</creatorcontrib><creatorcontrib>Miyazono, Mami</creatorcontrib><creatorcontrib>Ando, Shin-ichi</creatorcontrib><creatorcontrib>Inoue, Shujiro</creatorcontrib><creatorcontrib>Takemoto, Masao</creatorcontrib><creatorcontrib>Sakamoto, Takafumi</creatorcontrib><creatorcontrib>Goto, Daisuke</creatorcontrib><creatorcontrib>Furumoto, Tomoo</creatorcontrib><creatorcontrib>Kinugawa, Shintaro</creatorcontrib><creatorcontrib>Hashiguchi, Nobuko</creatorcontrib><creatorcontrib>Rahmawati, Anita</creatorcontrib><creatorcontrib>Chishaki, Hiroaki</creatorcontrib><creatorcontrib>Ohkusa, Tomoko</creatorcontrib><creatorcontrib>Magota, Chie</creatorcontrib><creatorcontrib>Tsutsui, Hiroyuki</creatorcontrib><creatorcontrib>Chishaki, Akiko</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</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>Research Library Prep</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Heart and vessels</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sawatari, Hiroyuki</au><au>Nishizaka, Mari K.</au><au>Miyazono, Mami</au><au>Ando, Shin-ichi</au><au>Inoue, Shujiro</au><au>Takemoto, Masao</au><au>Sakamoto, Takafumi</au><au>Goto, Daisuke</au><au>Furumoto, Tomoo</au><au>Kinugawa, Shintaro</au><au>Hashiguchi, Nobuko</au><au>Rahmawati, Anita</au><au>Chishaki, Hiroaki</au><au>Ohkusa, Tomoko</au><au>Magota, Chie</au><au>Tsutsui, Hiroyuki</au><au>Chishaki, Akiko</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Three nights leg thermal therapy could improve sleep quality in patients with chronic heart failure</atitle><jtitle>Heart and vessels</jtitle><stitle>Heart Vessels</stitle><addtitle>Heart Vessels</addtitle><date>2018-02-01</date><risdate>2018</risdate><volume>33</volume><issue>2</issue><spage>155</spage><epage>162</epage><pages>155-162</pages><issn>0910-8327</issn><eissn>1615-2573</eissn><abstract><![CDATA[Sleep quality is often impaired in patients with chronic heart failure (HF), which may worsen their quality of life and even prognosis. Leg thermal therapy (LTT), topical leg warming, has been shown to improve endothelial function, oxidative stress, and cardiac function in patients with HF. However, its short-term influence to sleep quality has not been evaluated in HF patients. Eighteen of 23 patients with stable HF received LTT (15 min of warming at 45 °C and 30 min of insulation) at bedtime for 3 consecutive nights and 5 patients served as control. Subjective sleep quality was evaluated by St. Mary’s Hospital Sleep Questionnaire, Oguri–Shirakawa–Azumi Sleep Inventory, and Epworth sleepiness scale, and also objectively evaluated by polysomnography. LTT significantly improved subjective sleep quality indicated by depth of sleep ( p  < 0.01), sleep duration ( p  < 0.05), number of awaking ( p  < 0.01), nap duration ( p  < 0.01), sleep quality ( p  < 0.05), and sleep satisfaction ( p  < 0.05). It was also objectively affirmed by a slight but significant decrease of sleep stage N1 ( p  < 0.01), and increase in sleep stage N2 ( p  < 0.05). No significant changes occurred in the controls. Hence, the short-term LTT could improve subjective and objective sleep quality in patients with HF. LTT can be a complimentary therapy to improve sleep quality in these patients.]]></abstract><cop>Tokyo</cop><pub>Springer Japan</pub><pmid>28905211</pmid><doi>10.1007/s00380-017-1047-7</doi><tpages>8</tpages></addata></record>
fulltext fulltext
identifier ISSN: 0910-8327
ispartof Heart and vessels, 2018-02, Vol.33 (2), p.155-162
issn 0910-8327
1615-2573
language eng
recordid cdi_proquest_miscellaneous_1938852216
source SpringerLink Journals - AutoHoldings
subjects Biomedical Engineering and Bioengineering
Cardiac Surgery
Cardiology
Heart
Heart diseases
Heart failure
Insomnia
Insulation
Leg
Medicine
Medicine & Public Health
Original Article
Oxidative stress
Patients
Quality
Quality of life
Sleep
Sleep and wakefulness
Sleepiness
Therapy
Vascular Surgery
title Three nights leg thermal therapy could improve sleep quality in patients with chronic heart failure
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-28T20%3A44%3A01IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Three%20nights%20leg%20thermal%20therapy%20could%20improve%20sleep%20quality%20in%20patients%20with%20chronic%20heart%20failure&rft.jtitle=Heart%20and%20vessels&rft.au=Sawatari,%20Hiroyuki&rft.date=2018-02-01&rft.volume=33&rft.issue=2&rft.spage=155&rft.epage=162&rft.pages=155-162&rft.issn=0910-8327&rft.eissn=1615-2573&rft_id=info:doi/10.1007/s00380-017-1047-7&rft_dat=%3Cproquest_cross%3E1938852216%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1992794226&rft_id=info:pmid/28905211&rfr_iscdi=true