Cardiovascular recovery after workload in German shift workers in the hotel and catering industry: results of 24-hour-ambulatory monitoring of heart rate and blood pressure
Purpose Shift work is associated with an impairment of sleep–wake cycles that can affect cardiovascular recovery (CR) negatively. The aim of this study was to examine CR of shift and day workers in the hotel and catering industry (HCI) and identify predictors of CR. Methods The sample consisted of 6...
Gespeichert in:
Veröffentlicht in: | International archives of occupational and environmental health 2019-01, Vol.92 (1), p.81-91 |
---|---|
Hauptverfasser: | , , , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 91 |
---|---|
container_issue | 1 |
container_start_page | 81 |
container_title | International archives of occupational and environmental health |
container_volume | 92 |
creator | Stieler, Lisa Hunger, Bettina Rudolf, Matthias Kreuzfeld, Steffi Stoll, Regina Seibt, Reingard |
description | Purpose
Shift work is associated with an impairment of sleep–wake cycles that can affect cardiovascular recovery (CR) negatively. The aim of this study was to examine CR of shift and day workers in the hotel and catering industry (HCI) and identify predictors of CR.
Methods
The sample consisted of 64 alternating and 96 day workers in the HCI. Monitoring of blood pressure (BP) and heart rate (HR) was conducted for 24 hours per working day during work, leisure and sleep. The CR process was examined for differences between work and leisure, work and sleep regarding a reduction in BP and HR. Lifestyle (physical activity, smoking, drinking) was assessed through questionnaires, BP over a four-day, self-assessment period (38% hypertensives). Participants taking BP medication (
n
= 12) were excluded from analyses.
Results
Shift workers had significantly higher BP (Ø 146/87 vs. Ø 140/84 mmHg;
p
= 0.034–0.044) and HR (Ø 86 vs. 82 bpm;
p
= 0.032) during their work phase verses day workers. There were no differences found for the CR between work and leisure nor work and sleep. As predictors of the CR, classic cardiovascular indicators (blood pressure status, smoking, age, physical activity, sex) were found which explains between 14% (HR) and 30% (BP) of the variance. Shift work was not a predictor for CR.
Conclusions
Employees in the HCI show that their CR is mainly determined by the known cardiovascular indicators and less by shift work. This effect needs to be discussed in relation to the job requirements and the cardiovascular health of the employees. |
doi_str_mv | 10.1007/s00420-018-1357-9 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2102322629</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2102322629</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-5fe858358a67f4a92d1362e7b408cdaeda1841eee93e2e66649786335ef9c2783</originalsourceid><addsrcrecordid>eNp1kc1u1DAUhS0EotPCA7BBltiwMfgvdsIOjaBFqsSmXVue5IakJPFw7bSad-pDYncKSJVY2fL9zjm2DyFvBP8gOLcfI-dacsZFzYSqLGuekY3QSjIhtXlONlzpMlXihJzGeMO5sMaql-REccmVsHxD7rceuzHc-tiuk0eK0IZbwAP1fQKkdwF_TsF3dFzoOeDsFxqHsU8PA8BYztMAdAgJJuqXjrY-68blR550a0x4-JQ94zqlSENPpWZDWJH5eZfjUshBc1jGvCmSDAzgMVHMJg9uuymEju6zQ1wRXpEXvZ8ivH5cz8j11y9X2wt2-f382_bzJWuVlYlVPdRVraraG9tr38hOKCPB7jSv285D50WtBQA0CiQYY3Rja6NUBX3TSlurM_L-6LvH8GuFmNw8xhamyS8Q1uik4FJJaWST0XdP0Jv8viXfrlDC2IpXhRJHqsUQI0Lv9jjOHg9OcFeqdMcqXa7SlSpd0bx9dF53M3R_FX-6y4A8AnFffg_wX_T_XX8DSj2r5g</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2101675059</pqid></control><display><type>article</type><title>Cardiovascular recovery after workload in German shift workers in the hotel and catering industry: results of 24-hour-ambulatory monitoring of heart rate and blood pressure</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Stieler, Lisa ; Hunger, Bettina ; Rudolf, Matthias ; Kreuzfeld, Steffi ; Stoll, Regina ; Seibt, Reingard</creator><creatorcontrib>Stieler, Lisa ; Hunger, Bettina ; Rudolf, Matthias ; Kreuzfeld, Steffi ; Stoll, Regina ; Seibt, Reingard</creatorcontrib><description>Purpose
Shift work is associated with an impairment of sleep–wake cycles that can affect cardiovascular recovery (CR) negatively. The aim of this study was to examine CR of shift and day workers in the hotel and catering industry (HCI) and identify predictors of CR.
Methods
The sample consisted of 64 alternating and 96 day workers in the HCI. Monitoring of blood pressure (BP) and heart rate (HR) was conducted for 24 hours per working day during work, leisure and sleep. The CR process was examined for differences between work and leisure, work and sleep regarding a reduction in BP and HR. Lifestyle (physical activity, smoking, drinking) was assessed through questionnaires, BP over a four-day, self-assessment period (38% hypertensives). Participants taking BP medication (
n
= 12) were excluded from analyses.
Results
Shift workers had significantly higher BP (Ø 146/87 vs. Ø 140/84 mmHg;
p
= 0.034–0.044) and HR (Ø 86 vs. 82 bpm;
p
= 0.032) during their work phase verses day workers. There were no differences found for the CR between work and leisure nor work and sleep. As predictors of the CR, classic cardiovascular indicators (blood pressure status, smoking, age, physical activity, sex) were found which explains between 14% (HR) and 30% (BP) of the variance. Shift work was not a predictor for CR.
Conclusions
Employees in the HCI show that their CR is mainly determined by the known cardiovascular indicators and less by shift work. This effect needs to be discussed in relation to the job requirements and the cardiovascular health of the employees.</description><identifier>ISSN: 0340-0131</identifier><identifier>EISSN: 1432-1246</identifier><identifier>DOI: 10.1007/s00420-018-1357-9</identifier><identifier>PMID: 30203170</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adolescent ; Adult ; Blood pressure ; Blood Pressure - physiology ; Circadian Rhythm ; Earth and Environmental Science ; Environment ; Environmental Health ; Female ; Germany ; Heart rate ; Heart Rate - physiology ; Humans ; Indicators ; Male ; Middle Aged ; Monitoring ; Monitoring, Ambulatory - methods ; Occupational Health ; Occupational Medicine/Industrial Medicine ; Original Article ; Physical activity ; Recovery ; Rehabilitation ; Restaurants ; Self-assessment ; Shift work ; Sleep ; Sleep - physiology ; Sleep and wakefulness ; Smoking ; Surveys and Questionnaires ; Work Schedule Tolerance - physiology ; Working conditions ; Workload</subject><ispartof>International archives of occupational and environmental health, 2019-01, Vol.92 (1), p.81-91</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018</rights><rights>International Archives of Occupational and Environmental Health is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-5fe858358a67f4a92d1362e7b408cdaeda1841eee93e2e66649786335ef9c2783</citedby><cites>FETCH-LOGICAL-c372t-5fe858358a67f4a92d1362e7b408cdaeda1841eee93e2e66649786335ef9c2783</cites><orcidid>0000-0003-2220-0663</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00420-018-1357-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00420-018-1357-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30203170$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stieler, Lisa</creatorcontrib><creatorcontrib>Hunger, Bettina</creatorcontrib><creatorcontrib>Rudolf, Matthias</creatorcontrib><creatorcontrib>Kreuzfeld, Steffi</creatorcontrib><creatorcontrib>Stoll, Regina</creatorcontrib><creatorcontrib>Seibt, Reingard</creatorcontrib><title>Cardiovascular recovery after workload in German shift workers in the hotel and catering industry: results of 24-hour-ambulatory monitoring of heart rate and blood pressure</title><title>International archives of occupational and environmental health</title><addtitle>Int Arch Occup Environ Health</addtitle><addtitle>Int Arch Occup Environ Health</addtitle><description>Purpose
Shift work is associated with an impairment of sleep–wake cycles that can affect cardiovascular recovery (CR) negatively. The aim of this study was to examine CR of shift and day workers in the hotel and catering industry (HCI) and identify predictors of CR.
Methods
The sample consisted of 64 alternating and 96 day workers in the HCI. Monitoring of blood pressure (BP) and heart rate (HR) was conducted for 24 hours per working day during work, leisure and sleep. The CR process was examined for differences between work and leisure, work and sleep regarding a reduction in BP and HR. Lifestyle (physical activity, smoking, drinking) was assessed through questionnaires, BP over a four-day, self-assessment period (38% hypertensives). Participants taking BP medication (
n
= 12) were excluded from analyses.
Results
Shift workers had significantly higher BP (Ø 146/87 vs. Ø 140/84 mmHg;
p
= 0.034–0.044) and HR (Ø 86 vs. 82 bpm;
p
= 0.032) during their work phase verses day workers. There were no differences found for the CR between work and leisure nor work and sleep. As predictors of the CR, classic cardiovascular indicators (blood pressure status, smoking, age, physical activity, sex) were found which explains between 14% (HR) and 30% (BP) of the variance. Shift work was not a predictor for CR.
Conclusions
Employees in the HCI show that their CR is mainly determined by the known cardiovascular indicators and less by shift work. This effect needs to be discussed in relation to the job requirements and the cardiovascular health of the employees.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Blood pressure</subject><subject>Blood Pressure - physiology</subject><subject>Circadian Rhythm</subject><subject>Earth and Environmental Science</subject><subject>Environment</subject><subject>Environmental Health</subject><subject>Female</subject><subject>Germany</subject><subject>Heart rate</subject><subject>Heart Rate - physiology</subject><subject>Humans</subject><subject>Indicators</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Monitoring</subject><subject>Monitoring, Ambulatory - methods</subject><subject>Occupational Health</subject><subject>Occupational Medicine/Industrial Medicine</subject><subject>Original Article</subject><subject>Physical activity</subject><subject>Recovery</subject><subject>Rehabilitation</subject><subject>Restaurants</subject><subject>Self-assessment</subject><subject>Shift work</subject><subject>Sleep</subject><subject>Sleep - physiology</subject><subject>Sleep and wakefulness</subject><subject>Smoking</subject><subject>Surveys and Questionnaires</subject><subject>Work Schedule Tolerance - physiology</subject><subject>Working conditions</subject><subject>Workload</subject><issn>0340-0131</issn><issn>1432-1246</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kc1u1DAUhS0EotPCA7BBltiwMfgvdsIOjaBFqsSmXVue5IakJPFw7bSad-pDYncKSJVY2fL9zjm2DyFvBP8gOLcfI-dacsZFzYSqLGuekY3QSjIhtXlONlzpMlXihJzGeMO5sMaql-REccmVsHxD7rceuzHc-tiuk0eK0IZbwAP1fQKkdwF_TsF3dFzoOeDsFxqHsU8PA8BYztMAdAgJJuqXjrY-68blR550a0x4-JQ94zqlSENPpWZDWJH5eZfjUshBc1jGvCmSDAzgMVHMJg9uuymEju6zQ1wRXpEXvZ8ivH5cz8j11y9X2wt2-f382_bzJWuVlYlVPdRVraraG9tr38hOKCPB7jSv285D50WtBQA0CiQYY3Rja6NUBX3TSlurM_L-6LvH8GuFmNw8xhamyS8Q1uik4FJJaWST0XdP0Jv8viXfrlDC2IpXhRJHqsUQI0Lv9jjOHg9OcFeqdMcqXa7SlSpd0bx9dF53M3R_FX-6y4A8AnFffg_wX_T_XX8DSj2r5g</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Stieler, Lisa</creator><creator>Hunger, Bettina</creator><creator>Rudolf, Matthias</creator><creator>Kreuzfeld, Steffi</creator><creator>Stoll, Regina</creator><creator>Seibt, Reingard</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</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>3V.</scope><scope>7T2</scope><scope>7T5</scope><scope>7TM</scope><scope>7U7</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PATMY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PYCSY</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2220-0663</orcidid></search><sort><creationdate>20190101</creationdate><title>Cardiovascular recovery after workload in German shift workers in the hotel and catering industry: results of 24-hour-ambulatory monitoring of heart rate and blood pressure</title><author>Stieler, Lisa ; Hunger, Bettina ; Rudolf, Matthias ; Kreuzfeld, Steffi ; Stoll, Regina ; Seibt, Reingard</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-5fe858358a67f4a92d1362e7b408cdaeda1841eee93e2e66649786335ef9c2783</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Blood pressure</topic><topic>Blood Pressure - physiology</topic><topic>Circadian Rhythm</topic><topic>Earth and Environmental Science</topic><topic>Environment</topic><topic>Environmental Health</topic><topic>Female</topic><topic>Germany</topic><topic>Heart rate</topic><topic>Heart Rate - physiology</topic><topic>Humans</topic><topic>Indicators</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Monitoring</topic><topic>Monitoring, Ambulatory - methods</topic><topic>Occupational Health</topic><topic>Occupational Medicine/Industrial Medicine</topic><topic>Original Article</topic><topic>Physical activity</topic><topic>Recovery</topic><topic>Rehabilitation</topic><topic>Restaurants</topic><topic>Self-assessment</topic><topic>Shift work</topic><topic>Sleep</topic><topic>Sleep - physiology</topic><topic>Sleep and wakefulness</topic><topic>Smoking</topic><topic>Surveys and Questionnaires</topic><topic>Work Schedule Tolerance - physiology</topic><topic>Working conditions</topic><topic>Workload</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stieler, Lisa</creatorcontrib><creatorcontrib>Hunger, Bettina</creatorcontrib><creatorcontrib>Rudolf, Matthias</creatorcontrib><creatorcontrib>Kreuzfeld, Steffi</creatorcontrib><creatorcontrib>Stoll, Regina</creatorcontrib><creatorcontrib>Seibt, Reingard</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</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>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Environmental Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Environmental Science Collection</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>International archives of occupational and environmental health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stieler, Lisa</au><au>Hunger, Bettina</au><au>Rudolf, Matthias</au><au>Kreuzfeld, Steffi</au><au>Stoll, Regina</au><au>Seibt, Reingard</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiovascular recovery after workload in German shift workers in the hotel and catering industry: results of 24-hour-ambulatory monitoring of heart rate and blood pressure</atitle><jtitle>International archives of occupational and environmental health</jtitle><stitle>Int Arch Occup Environ Health</stitle><addtitle>Int Arch Occup Environ Health</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>92</volume><issue>1</issue><spage>81</spage><epage>91</epage><pages>81-91</pages><issn>0340-0131</issn><eissn>1432-1246</eissn><abstract>Purpose
Shift work is associated with an impairment of sleep–wake cycles that can affect cardiovascular recovery (CR) negatively. The aim of this study was to examine CR of shift and day workers in the hotel and catering industry (HCI) and identify predictors of CR.
Methods
The sample consisted of 64 alternating and 96 day workers in the HCI. Monitoring of blood pressure (BP) and heart rate (HR) was conducted for 24 hours per working day during work, leisure and sleep. The CR process was examined for differences between work and leisure, work and sleep regarding a reduction in BP and HR. Lifestyle (physical activity, smoking, drinking) was assessed through questionnaires, BP over a four-day, self-assessment period (38% hypertensives). Participants taking BP medication (
n
= 12) were excluded from analyses.
Results
Shift workers had significantly higher BP (Ø 146/87 vs. Ø 140/84 mmHg;
p
= 0.034–0.044) and HR (Ø 86 vs. 82 bpm;
p
= 0.032) during their work phase verses day workers. There were no differences found for the CR between work and leisure nor work and sleep. As predictors of the CR, classic cardiovascular indicators (blood pressure status, smoking, age, physical activity, sex) were found which explains between 14% (HR) and 30% (BP) of the variance. Shift work was not a predictor for CR.
Conclusions
Employees in the HCI show that their CR is mainly determined by the known cardiovascular indicators and less by shift work. This effect needs to be discussed in relation to the job requirements and the cardiovascular health of the employees.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30203170</pmid><doi>10.1007/s00420-018-1357-9</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-2220-0663</orcidid></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0340-0131 |
ispartof | International archives of occupational and environmental health, 2019-01, Vol.92 (1), p.81-91 |
issn | 0340-0131 1432-1246 |
language | eng |
recordid | cdi_proquest_miscellaneous_2102322629 |
source | MEDLINE; SpringerLink Journals - AutoHoldings |
subjects | Adolescent Adult Blood pressure Blood Pressure - physiology Circadian Rhythm Earth and Environmental Science Environment Environmental Health Female Germany Heart rate Heart Rate - physiology Humans Indicators Male Middle Aged Monitoring Monitoring, Ambulatory - methods Occupational Health Occupational Medicine/Industrial Medicine Original Article Physical activity Recovery Rehabilitation Restaurants Self-assessment Shift work Sleep Sleep - physiology Sleep and wakefulness Smoking Surveys and Questionnaires Work Schedule Tolerance - physiology Working conditions Workload |
title | Cardiovascular recovery after workload in German shift workers in the hotel and catering industry: results of 24-hour-ambulatory monitoring of heart rate and blood pressure |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-28T01%3A31%3A48IST&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=Cardiovascular%20recovery%20after%20workload%20in%20German%20shift%20workers%20in%20the%20hotel%20and%20catering%20industry:%20results%20of%2024-hour-ambulatory%20monitoring%20of%20heart%20rate%20and%20blood%20pressure&rft.jtitle=International%20archives%20of%20occupational%20and%20environmental%20health&rft.au=Stieler,%20Lisa&rft.date=2019-01-01&rft.volume=92&rft.issue=1&rft.spage=81&rft.epage=91&rft.pages=81-91&rft.issn=0340-0131&rft.eissn=1432-1246&rft_id=info:doi/10.1007/s00420-018-1357-9&rft_dat=%3Cproquest_cross%3E2102322629%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=2101675059&rft_id=info:pmid/30203170&rfr_iscdi=true |