Long-Term Treatment of Intestinal Helminths Increases Mite Skin-Test Reactivity in Gabonese Schoolchildren
Background. Several studies have shown an inverse association between helminth infections and atopy, but none have clearly established that the pathogens themselves, rather than other associated factors, cause the suppression of atopy. To show a direct link, prospective intervention studies are requ...
Gespeichert in:
| Veröffentlicht in: | The Journal of infectious diseases 2004-03, Vol.189 (5), p.892-900 |
|---|---|
| Hauptverfasser: | , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 900 |
|---|---|
| container_issue | 5 |
| container_start_page | 892 |
| container_title | The Journal of infectious diseases |
| container_volume | 189 |
| creator | van den Biggelaar, Anita H. J. Rodrigues, Laura C. van Ree, Ronald van der Zee, Jaring S. Hoeksma-Kruize, Yvonne C. M. Souverijn, John H. M. Missinou, Michel A. Borrmann, Steffen Kremsner, Peter G. Yazdanbakhsh, Maria |
| description | Background. Several studies have shown an inverse association between helminth infections and atopy, but none have clearly established that the pathogens themselves, rather than other associated factors, cause the suppression of atopy. To show a direct link, prospective intervention studies are required. Methods. A randomized, controlled trial was performed to study whether repeated anthelminthic treatment results in increased allergic sensitivity to house dust mites (HDMs) in chronically infected children. The trial population consisted of 317 Gabonese schoolchildren with a high prevalence of intestinal helminths. Intervention consisted of treatment every 3 months with praziquantel and mebendazole and with placebo in the control group. Follow-up lasted 30 months: at 6-month intervals, skin-test sensitivity to mites, helminth infection status, and levels of total IgE were determined. Results. Treatment resulted in a significant increase in the rate of developing skin sensitivity to HDMs (hazard ratio, 2.51; 95% confidence interval, 1.85–3.41), which was mediated, in part, by reductions in Ascaris and/or Trichuris infections. Levels of total IgE were reduced, but this did not mediate the effect of treatment on skin-test reactivity. Conclusions. Anthelminthic treatment of chronically infected children results in increased atopic reactivity, which indicates that helminths directly suppress allergic reactions. |
| doi_str_mv | 10.1086/381767 |
| format | Article |
| fullrecord | <record><control><sourceid>jstor_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_19770273</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><jstor_id>30075909</jstor_id><oup_id>10.1086/381767</oup_id><sourcerecordid>30075909</sourcerecordid><originalsourceid>FETCH-LOGICAL-c549t-aca098d7dea6ebf8c8fa209063b080e1401d17ccc2110f404abb474d3590c67a3</originalsourceid><addsrcrecordid>eNp10F1rFDEUBuAgil2r_gNlFPRu9GSSSSaXUm23sKVQ1w96EzKZjJvtTLImGbH_vimzdEHwKpDznJOTF6GXGD5gaNhH0mDO-CO0wDXhJWOYPEYLgKoqcSPEEXoW4xYAKGH8KTrCVHDGgC_QduXdr3Jtwlisg1FpNC4Vvi_OXTIxWaeGYmmG0bq0iflSZxNNLC5sMsXXG-tya0zFlVE62T823RbWFWeq9c7EDPTG-0Fv7NAF456jJ70aonmxP4_Rt9Mv65Nlubo8Oz_5tCp1TUUqlVYgmo53RjHT9o1uelWBAEZaaMBgCrjDXGtdYQw9BaralnLakVqAZlyRY_R-nrsL_veU15OjjdoMg3LGT1FiwTlUnGT49h-49VPIX46yqogAIZr6ME0HH2MwvdwFO6pwKzHI--jlHH2Gr_fTpnY03YHts87g3R6oqNXQB-W0jQdXc0ZFU2X3ZnZ-2v3_sVez2cbkw4MiADzHIHK9nOs2JvP3oa7CjczdvJbLn9fyxxX9vrrGp_IzuQMsuK2e</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>223909985</pqid></control><display><type>article</type><title>Long-Term Treatment of Intestinal Helminths Increases Mite Skin-Test Reactivity in Gabonese Schoolchildren</title><source>Jstor Complete Legacy</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>van den Biggelaar, Anita H. J. ; Rodrigues, Laura C. ; van Ree, Ronald ; van der Zee, Jaring S. ; Hoeksma-Kruize, Yvonne C. M. ; Souverijn, John H. M. ; Missinou, Michel A. ; Borrmann, Steffen ; Kremsner, Peter G. ; Yazdanbakhsh, Maria</creator><creatorcontrib>van den Biggelaar, Anita H. J. ; Rodrigues, Laura C. ; van Ree, Ronald ; van der Zee, Jaring S. ; Hoeksma-Kruize, Yvonne C. M. ; Souverijn, John H. M. ; Missinou, Michel A. ; Borrmann, Steffen ; Kremsner, Peter G. ; Yazdanbakhsh, Maria</creatorcontrib><description>Background. Several studies have shown an inverse association between helminth infections and atopy, but none have clearly established that the pathogens themselves, rather than other associated factors, cause the suppression of atopy. To show a direct link, prospective intervention studies are required. Methods. A randomized, controlled trial was performed to study whether repeated anthelminthic treatment results in increased allergic sensitivity to house dust mites (HDMs) in chronically infected children. The trial population consisted of 317 Gabonese schoolchildren with a high prevalence of intestinal helminths. Intervention consisted of treatment every 3 months with praziquantel and mebendazole and with placebo in the control group. Follow-up lasted 30 months: at 6-month intervals, skin-test sensitivity to mites, helminth infection status, and levels of total IgE were determined. Results. Treatment resulted in a significant increase in the rate of developing skin sensitivity to HDMs (hazard ratio, 2.51; 95% confidence interval, 1.85–3.41), which was mediated, in part, by reductions in Ascaris and/or Trichuris infections. Levels of total IgE were reduced, but this did not mediate the effect of treatment on skin-test reactivity. Conclusions. Anthelminthic treatment of chronically infected children results in increased atopic reactivity, which indicates that helminths directly suppress allergic reactions.</description><identifier>ISSN: 0022-1899</identifier><identifier>EISSN: 1537-6613</identifier><identifier>DOI: 10.1086/381767</identifier><identifier>PMID: 14976607</identifier><identifier>CODEN: JIDIAQ</identifier><language>eng</language><publisher>Chicago, IL: The University of Chicago Press</publisher><subject>Adolescent ; Allergens ; Allergic diseases ; Allergies ; Animals ; Anthelmintics - adverse effects ; Anthelmintics - therapeutic use ; Antibodies ; Ascariasis - drug therapy ; Ascariasis - epidemiology ; Ascaris ; Biological and medical sciences ; Child ; Child, Preschool ; Control groups ; Dermatophagoides pteronyssinus ; Drug Hypersensitivity - epidemiology ; Experimentation ; Follow-Up Studies ; Food allergies ; Fundamental and applied biological sciences. Psychology ; Gabon - epidemiology ; Helminthiasis - drug therapy ; Helminthiasis - epidemiology ; Histamines ; Humans ; Infections ; Infectious diseases ; Insect Vectors ; Intestinal Diseases, Parasitic - drug therapy ; Intestinal Diseases, Parasitic - epidemiology ; Medical sciences ; Microbiology ; Mites - immunology ; Parasites ; Prevalence ; Proportional Hazards Models ; Reactivity ; Regression Analysis ; Research Design ; Skin Tests ; Time Factors ; Trichuriasis - drug therapy ; Trichuriasis - epidemiology</subject><ispartof>The Journal of infectious diseases, 2004-03, Vol.189 (5), p.892-900</ispartof><rights>Copyright 2003 Infectious Diseases Society of America</rights><rights>2004 by the Infectious Diseases Society of America 2004</rights><rights>2004 INIST-CNRS</rights><rights>Copyright University of Chicago, acting through its Press Mar 1 2004</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c549t-aca098d7dea6ebf8c8fa209063b080e1401d17ccc2110f404abb474d3590c67a3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/30075909$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/30075909$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,776,780,799,27903,27904,57995,58228</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15764982$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14976607$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van den Biggelaar, Anita H. J.</creatorcontrib><creatorcontrib>Rodrigues, Laura C.</creatorcontrib><creatorcontrib>van Ree, Ronald</creatorcontrib><creatorcontrib>van der Zee, Jaring S.</creatorcontrib><creatorcontrib>Hoeksma-Kruize, Yvonne C. M.</creatorcontrib><creatorcontrib>Souverijn, John H. M.</creatorcontrib><creatorcontrib>Missinou, Michel A.</creatorcontrib><creatorcontrib>Borrmann, Steffen</creatorcontrib><creatorcontrib>Kremsner, Peter G.</creatorcontrib><creatorcontrib>Yazdanbakhsh, Maria</creatorcontrib><title>Long-Term Treatment of Intestinal Helminths Increases Mite Skin-Test Reactivity in Gabonese Schoolchildren</title><title>The Journal of infectious diseases</title><addtitle>J Infect Dis</addtitle><addtitle>J Infect Dis</addtitle><description>Background. Several studies have shown an inverse association between helminth infections and atopy, but none have clearly established that the pathogens themselves, rather than other associated factors, cause the suppression of atopy. To show a direct link, prospective intervention studies are required. Methods. A randomized, controlled trial was performed to study whether repeated anthelminthic treatment results in increased allergic sensitivity to house dust mites (HDMs) in chronically infected children. The trial population consisted of 317 Gabonese schoolchildren with a high prevalence of intestinal helminths. Intervention consisted of treatment every 3 months with praziquantel and mebendazole and with placebo in the control group. Follow-up lasted 30 months: at 6-month intervals, skin-test sensitivity to mites, helminth infection status, and levels of total IgE were determined. Results. Treatment resulted in a significant increase in the rate of developing skin sensitivity to HDMs (hazard ratio, 2.51; 95% confidence interval, 1.85–3.41), which was mediated, in part, by reductions in Ascaris and/or Trichuris infections. Levels of total IgE were reduced, but this did not mediate the effect of treatment on skin-test reactivity. Conclusions. Anthelminthic treatment of chronically infected children results in increased atopic reactivity, which indicates that helminths directly suppress allergic reactions.</description><subject>Adolescent</subject><subject>Allergens</subject><subject>Allergic diseases</subject><subject>Allergies</subject><subject>Animals</subject><subject>Anthelmintics - adverse effects</subject><subject>Anthelmintics - therapeutic use</subject><subject>Antibodies</subject><subject>Ascariasis - drug therapy</subject><subject>Ascariasis - epidemiology</subject><subject>Ascaris</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Control groups</subject><subject>Dermatophagoides pteronyssinus</subject><subject>Drug Hypersensitivity - epidemiology</subject><subject>Experimentation</subject><subject>Follow-Up Studies</subject><subject>Food allergies</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Gabon - epidemiology</subject><subject>Helminthiasis - drug therapy</subject><subject>Helminthiasis - epidemiology</subject><subject>Histamines</subject><subject>Humans</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Insect Vectors</subject><subject>Intestinal Diseases, Parasitic - drug therapy</subject><subject>Intestinal Diseases, Parasitic - epidemiology</subject><subject>Medical sciences</subject><subject>Microbiology</subject><subject>Mites - immunology</subject><subject>Parasites</subject><subject>Prevalence</subject><subject>Proportional Hazards Models</subject><subject>Reactivity</subject><subject>Regression Analysis</subject><subject>Research Design</subject><subject>Skin Tests</subject><subject>Time Factors</subject><subject>Trichuriasis - drug therapy</subject><subject>Trichuriasis - epidemiology</subject><issn>0022-1899</issn><issn>1537-6613</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10F1rFDEUBuAgil2r_gNlFPRu9GSSSSaXUm23sKVQ1w96EzKZjJvtTLImGbH_vimzdEHwKpDznJOTF6GXGD5gaNhH0mDO-CO0wDXhJWOYPEYLgKoqcSPEEXoW4xYAKGH8KTrCVHDGgC_QduXdr3Jtwlisg1FpNC4Vvi_OXTIxWaeGYmmG0bq0iflSZxNNLC5sMsXXG-tya0zFlVE62T823RbWFWeq9c7EDPTG-0Fv7NAF456jJ70aonmxP4_Rt9Mv65Nlubo8Oz_5tCp1TUUqlVYgmo53RjHT9o1uelWBAEZaaMBgCrjDXGtdYQw9BaralnLakVqAZlyRY_R-nrsL_veU15OjjdoMg3LGT1FiwTlUnGT49h-49VPIX46yqogAIZr6ME0HH2MwvdwFO6pwKzHI--jlHH2Gr_fTpnY03YHts87g3R6oqNXQB-W0jQdXc0ZFU2X3ZnZ-2v3_sVez2cbkw4MiADzHIHK9nOs2JvP3oa7CjczdvJbLn9fyxxX9vrrGp_IzuQMsuK2e</recordid><startdate>20040301</startdate><enddate>20040301</enddate><creator>van den Biggelaar, Anita H. J.</creator><creator>Rodrigues, Laura C.</creator><creator>van Ree, Ronald</creator><creator>van der Zee, Jaring S.</creator><creator>Hoeksma-Kruize, Yvonne C. M.</creator><creator>Souverijn, John H. M.</creator><creator>Missinou, Michel A.</creator><creator>Borrmann, Steffen</creator><creator>Kremsner, Peter G.</creator><creator>Yazdanbakhsh, Maria</creator><general>The University of Chicago Press</general><general>University of Chicago Press</general><general>Oxford University Press</general><scope>BSCLL</scope><scope>IQODW</scope><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>K9.</scope><scope>NAPCQ</scope><scope>7SS</scope></search><sort><creationdate>20040301</creationdate><title>Long-Term Treatment of Intestinal Helminths Increases Mite Skin-Test Reactivity in Gabonese Schoolchildren</title><author>van den Biggelaar, Anita H. J. ; Rodrigues, Laura C. ; van Ree, Ronald ; van der Zee, Jaring S. ; Hoeksma-Kruize, Yvonne C. M. ; Souverijn, John H. M. ; Missinou, Michel A. ; Borrmann, Steffen ; Kremsner, Peter G. ; Yazdanbakhsh, Maria</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c549t-aca098d7dea6ebf8c8fa209063b080e1401d17ccc2110f404abb474d3590c67a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adolescent</topic><topic>Allergens</topic><topic>Allergic diseases</topic><topic>Allergies</topic><topic>Animals</topic><topic>Anthelmintics - adverse effects</topic><topic>Anthelmintics - therapeutic use</topic><topic>Antibodies</topic><topic>Ascariasis - drug therapy</topic><topic>Ascariasis - epidemiology</topic><topic>Ascaris</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Control groups</topic><topic>Dermatophagoides pteronyssinus</topic><topic>Drug Hypersensitivity - epidemiology</topic><topic>Experimentation</topic><topic>Follow-Up Studies</topic><topic>Food allergies</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Gabon - epidemiology</topic><topic>Helminthiasis - drug therapy</topic><topic>Helminthiasis - epidemiology</topic><topic>Histamines</topic><topic>Humans</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Insect Vectors</topic><topic>Intestinal Diseases, Parasitic - drug therapy</topic><topic>Intestinal Diseases, Parasitic - epidemiology</topic><topic>Medical sciences</topic><topic>Microbiology</topic><topic>Mites - immunology</topic><topic>Parasites</topic><topic>Prevalence</topic><topic>Proportional Hazards Models</topic><topic>Reactivity</topic><topic>Regression Analysis</topic><topic>Research Design</topic><topic>Skin Tests</topic><topic>Time Factors</topic><topic>Trichuriasis - drug therapy</topic><topic>Trichuriasis - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van den Biggelaar, Anita H. J.</creatorcontrib><creatorcontrib>Rodrigues, Laura C.</creatorcontrib><creatorcontrib>van Ree, Ronald</creatorcontrib><creatorcontrib>van der Zee, Jaring S.</creatorcontrib><creatorcontrib>Hoeksma-Kruize, Yvonne C. M.</creatorcontrib><creatorcontrib>Souverijn, John H. M.</creatorcontrib><creatorcontrib>Missinou, Michel A.</creatorcontrib><creatorcontrib>Borrmann, Steffen</creatorcontrib><creatorcontrib>Kremsner, Peter G.</creatorcontrib><creatorcontrib>Yazdanbakhsh, Maria</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Entomology Abstracts (Full archive)</collection><jtitle>The Journal of infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van den Biggelaar, Anita H. J.</au><au>Rodrigues, Laura C.</au><au>van Ree, Ronald</au><au>van der Zee, Jaring S.</au><au>Hoeksma-Kruize, Yvonne C. M.</au><au>Souverijn, John H. M.</au><au>Missinou, Michel A.</au><au>Borrmann, Steffen</au><au>Kremsner, Peter G.</au><au>Yazdanbakhsh, Maria</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-Term Treatment of Intestinal Helminths Increases Mite Skin-Test Reactivity in Gabonese Schoolchildren</atitle><jtitle>The Journal of infectious diseases</jtitle><stitle>J Infect Dis</stitle><addtitle>J Infect Dis</addtitle><date>2004-03-01</date><risdate>2004</risdate><volume>189</volume><issue>5</issue><spage>892</spage><epage>900</epage><pages>892-900</pages><issn>0022-1899</issn><eissn>1537-6613</eissn><coden>JIDIAQ</coden><abstract>Background. Several studies have shown an inverse association between helminth infections and atopy, but none have clearly established that the pathogens themselves, rather than other associated factors, cause the suppression of atopy. To show a direct link, prospective intervention studies are required. Methods. A randomized, controlled trial was performed to study whether repeated anthelminthic treatment results in increased allergic sensitivity to house dust mites (HDMs) in chronically infected children. The trial population consisted of 317 Gabonese schoolchildren with a high prevalence of intestinal helminths. Intervention consisted of treatment every 3 months with praziquantel and mebendazole and with placebo in the control group. Follow-up lasted 30 months: at 6-month intervals, skin-test sensitivity to mites, helminth infection status, and levels of total IgE were determined. Results. Treatment resulted in a significant increase in the rate of developing skin sensitivity to HDMs (hazard ratio, 2.51; 95% confidence interval, 1.85–3.41), which was mediated, in part, by reductions in Ascaris and/or Trichuris infections. Levels of total IgE were reduced, but this did not mediate the effect of treatment on skin-test reactivity. Conclusions. Anthelminthic treatment of chronically infected children results in increased atopic reactivity, which indicates that helminths directly suppress allergic reactions.</abstract><cop>Chicago, IL</cop><pub>The University of Chicago Press</pub><pmid>14976607</pmid><doi>10.1086/381767</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0022-1899 |
| ispartof | The Journal of infectious diseases, 2004-03, Vol.189 (5), p.892-900 |
| issn | 0022-1899 1537-6613 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_19770273 |
| source | Jstor Complete Legacy; Oxford University Press Journals All Titles (1996-Current); MEDLINE; Alma/SFX Local Collection |
| subjects | Adolescent Allergens Allergic diseases Allergies Animals Anthelmintics - adverse effects Anthelmintics - therapeutic use Antibodies Ascariasis - drug therapy Ascariasis - epidemiology Ascaris Biological and medical sciences Child Child, Preschool Control groups Dermatophagoides pteronyssinus Drug Hypersensitivity - epidemiology Experimentation Follow-Up Studies Food allergies Fundamental and applied biological sciences. Psychology Gabon - epidemiology Helminthiasis - drug therapy Helminthiasis - epidemiology Histamines Humans Infections Infectious diseases Insect Vectors Intestinal Diseases, Parasitic - drug therapy Intestinal Diseases, Parasitic - epidemiology Medical sciences Microbiology Mites - immunology Parasites Prevalence Proportional Hazards Models Reactivity Regression Analysis Research Design Skin Tests Time Factors Trichuriasis - drug therapy Trichuriasis - epidemiology |
| title | Long-Term Treatment of Intestinal Helminths Increases Mite Skin-Test Reactivity in Gabonese Schoolchildren |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-28T05%3A13%3A09IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-jstor_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Long-Term%20Treatment%20of%20Intestinal%20Helminths%20Increases%20Mite%20Skin-Test%20Reactivity%20in%20Gabonese%20Schoolchildren&rft.jtitle=The%20Journal%20of%20infectious%20diseases&rft.au=van%20den%20Biggelaar,%20Anita%20H.%20J.&rft.date=2004-03-01&rft.volume=189&rft.issue=5&rft.spage=892&rft.epage=900&rft.pages=892-900&rft.issn=0022-1899&rft.eissn=1537-6613&rft.coden=JIDIAQ&rft_id=info:doi/10.1086/381767&rft_dat=%3Cjstor_proqu%3E30075909%3C/jstor_proqu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=223909985&rft_id=info:pmid/14976607&rft_jstor_id=30075909&rft_oup_id=10.1086/381767&rfr_iscdi=true |