Nutritional status in chronic spinal cord injury: a systematic review and meta-analysis
Study design Systematic review and meta-analysis. Objectives The objective was to investigate nutritional status in chronic spinal cord injury (SCI), and compare macronutrient and micronutrient intake to the recommended values by the United States Department of Agriculture (USDA) 2015–2020 Dietary G...
Gespeichert in:
| Veröffentlicht in: | Spinal cord 2019-01, Vol.57 (1), p.3-17 |
|---|---|
| Hauptverfasser: | , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 17 |
|---|---|
| container_issue | 1 |
| container_start_page | 3 |
| container_title | Spinal cord |
| container_volume | 57 |
| creator | Farkas, Gary J. Pitot, Marika A. Berg, Arthur S. Gater, David R. |
| description | Study design
Systematic review and meta-analysis.
Objectives
The objective was to investigate nutritional status in chronic spinal cord injury (SCI), and compare macronutrient and micronutrient intake to the recommended values by the United States Department of Agriculture (USDA) 2015–2020 Dietary Guidelines for Americans.
Setting
United States of America.
Methods
A MEDLINE/PubMed, Google Scholar, Scopus, and Web of Science search was performed, identifying 268 papers. All papers included were English-language papers examining adults with chronic SCI. A meta-analysis was performed to produce weighted averages and 95% confidence intervals (CI) when summary statistics were provided.
Results
The systematic review included 15 articles, while the meta-analysis included 12. Resting metabolic rate (1492 kcal/day; CI: 1414–1569) fell below the able-bodied average, and total energy (1876 kcal/day; CI: 1694–2059) and fiber (17 g/day; CI: 14–20) intake were below USDA guidelines. Protein (319 kcal/day; CI: 294–345) and carbohydrate (969 kcal/day; CI: 851–1087) intake were above guidelines. Fat intake (663 kcal/day; CI: 590–736) was within USDA guidelines. Vitamins A, B5, B7, B9, D, E, potassium, and calcium were deficient, while vitamins B1, B2, B3, B12, C, K, sodium, phosphorus, copper, and zinc were in excess according to USDA guidelines. Vitamin B6, iron, and magnesium were within USDA guidelines.
Conclusion
Findings indicate greater energy intake relative to energy needs in those with chronic SCI, and an imbalance in fiber intake and micronutrients compared to the USDA guidelines. Future research examining nutritional health status is needed in order to establish evidence-based, SCI-specific dietary guidelines. |
| doi_str_mv | 10.1038/s41393-018-0218-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2132735916</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2132735916</sourcerecordid><originalsourceid>FETCH-LOGICAL-c481t-12826e4fd975298cd87be1f2680dc4a2129334de46f1616370e9123979d32e8f3</originalsourceid><addsrcrecordid>eNp1kEtLxDAUhYMozjj6A9xIwY2bal6TJu5k8AWDbhSXIdOmmqGPMTdV-u9N6agguLm53Pudc8NB6Jjgc4KZvABOmGIpJjLFNBa-g6aEZyKdC8p3Y88ETXlEJugAYI0xVkTJfTRhmFMspJyil4cueBdc25gqgWBCB4lrkvzNt43LE9i4YZG3vojjdef7y8Qk0EOwtQkR8PbD2c_ENEVS22BSE_EeHByivdJUYI-27ww931w_Le7S5ePt_eJqmeZckpASKqmwvCxUNqdK5oXMVpaUVEhc5NxQQhVjvLBclEQQwTJsFaFMZapg1MqSzdDZ6Lvx7XtnIejaQW6ryjS27UBTwmjG5ipqZ-j0D7puOx__O1AinuGM4UiRkcp9C-BtqTfe1cb3mmA9pK7H1HVMXQ-pax41J1vnblXb4kfxHXME6AhAXDWv1v-e_t_1C-Qui6U</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2163344330</pqid></control><display><type>article</type><title>Nutritional status in chronic spinal cord injury: a systematic review and meta-analysis</title><source>SpringerLink Journals</source><creator>Farkas, Gary J. ; Pitot, Marika A. ; Berg, Arthur S. ; Gater, David R.</creator><creatorcontrib>Farkas, Gary J. ; Pitot, Marika A. ; Berg, Arthur S. ; Gater, David R.</creatorcontrib><description>Study design
Systematic review and meta-analysis.
Objectives
The objective was to investigate nutritional status in chronic spinal cord injury (SCI), and compare macronutrient and micronutrient intake to the recommended values by the United States Department of Agriculture (USDA) 2015–2020 Dietary Guidelines for Americans.
Setting
United States of America.
Methods
A MEDLINE/PubMed, Google Scholar, Scopus, and Web of Science search was performed, identifying 268 papers. All papers included were English-language papers examining adults with chronic SCI. A meta-analysis was performed to produce weighted averages and 95% confidence intervals (CI) when summary statistics were provided.
Results
The systematic review included 15 articles, while the meta-analysis included 12. Resting metabolic rate (1492 kcal/day; CI: 1414–1569) fell below the able-bodied average, and total energy (1876 kcal/day; CI: 1694–2059) and fiber (17 g/day; CI: 14–20) intake were below USDA guidelines. Protein (319 kcal/day; CI: 294–345) and carbohydrate (969 kcal/day; CI: 851–1087) intake were above guidelines. Fat intake (663 kcal/day; CI: 590–736) was within USDA guidelines. Vitamins A, B5, B7, B9, D, E, potassium, and calcium were deficient, while vitamins B1, B2, B3, B12, C, K, sodium, phosphorus, copper, and zinc were in excess according to USDA guidelines. Vitamin B6, iron, and magnesium were within USDA guidelines.
Conclusion
Findings indicate greater energy intake relative to energy needs in those with chronic SCI, and an imbalance in fiber intake and micronutrients compared to the USDA guidelines. Future research examining nutritional health status is needed in order to establish evidence-based, SCI-specific dietary guidelines.</description><identifier>ISSN: 1362-4393</identifier><identifier>EISSN: 1476-5624</identifier><identifier>DOI: 10.1038/s41393-018-0218-4</identifier><identifier>PMID: 30420688</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>692/308/409 ; 692/700/2814 ; Adults ; Anatomy ; B7 antigen ; Biomedical and Life Sciences ; Biomedicine ; Calcium ; Carbohydrates ; Confidence intervals ; Diet ; Energy intake ; Government agencies ; Guidelines ; Human Physiology ; Injury analysis ; Iron ; Magnesium ; Meta-analysis ; Metabolic rate ; Micronutrients ; Neurochemistry ; Neuropsychology ; Neurosciences ; Nutritional status ; Phosphorus ; Potassium ; Proteins ; Review Article ; Reviews ; Scientific papers ; Search engines ; Sodium ; Spinal cord injuries ; Statistical analysis ; Systematic review ; Vitamin B12 ; Vitamin B6 ; Vitamins ; Zinc</subject><ispartof>Spinal cord, 2019-01, Vol.57 (1), p.3-17</ispartof><rights>International Spinal Cord Society 2018</rights><rights>Copyright Nature Publishing Group Jan 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c481t-12826e4fd975298cd87be1f2680dc4a2129334de46f1616370e9123979d32e8f3</citedby><cites>FETCH-LOGICAL-c481t-12826e4fd975298cd87be1f2680dc4a2129334de46f1616370e9123979d32e8f3</cites><orcidid>0000-0002-5482-6049</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/s41393-018-0218-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/s41393-018-0218-4$$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/30420688$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Farkas, Gary J.</creatorcontrib><creatorcontrib>Pitot, Marika A.</creatorcontrib><creatorcontrib>Berg, Arthur S.</creatorcontrib><creatorcontrib>Gater, David R.</creatorcontrib><title>Nutritional status in chronic spinal cord injury: a systematic review and meta-analysis</title><title>Spinal cord</title><addtitle>Spinal Cord</addtitle><addtitle>Spinal Cord</addtitle><description>Study design
Systematic review and meta-analysis.
Objectives
The objective was to investigate nutritional status in chronic spinal cord injury (SCI), and compare macronutrient and micronutrient intake to the recommended values by the United States Department of Agriculture (USDA) 2015–2020 Dietary Guidelines for Americans.
Setting
United States of America.
Methods
A MEDLINE/PubMed, Google Scholar, Scopus, and Web of Science search was performed, identifying 268 papers. All papers included were English-language papers examining adults with chronic SCI. A meta-analysis was performed to produce weighted averages and 95% confidence intervals (CI) when summary statistics were provided.
Results
The systematic review included 15 articles, while the meta-analysis included 12. Resting metabolic rate (1492 kcal/day; CI: 1414–1569) fell below the able-bodied average, and total energy (1876 kcal/day; CI: 1694–2059) and fiber (17 g/day; CI: 14–20) intake were below USDA guidelines. Protein (319 kcal/day; CI: 294–345) and carbohydrate (969 kcal/day; CI: 851–1087) intake were above guidelines. Fat intake (663 kcal/day; CI: 590–736) was within USDA guidelines. Vitamins A, B5, B7, B9, D, E, potassium, and calcium were deficient, while vitamins B1, B2, B3, B12, C, K, sodium, phosphorus, copper, and zinc were in excess according to USDA guidelines. Vitamin B6, iron, and magnesium were within USDA guidelines.
Conclusion
Findings indicate greater energy intake relative to energy needs in those with chronic SCI, and an imbalance in fiber intake and micronutrients compared to the USDA guidelines. Future research examining nutritional health status is needed in order to establish evidence-based, SCI-specific dietary guidelines.</description><subject>692/308/409</subject><subject>692/700/2814</subject><subject>Adults</subject><subject>Anatomy</subject><subject>B7 antigen</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Calcium</subject><subject>Carbohydrates</subject><subject>Confidence intervals</subject><subject>Diet</subject><subject>Energy intake</subject><subject>Government agencies</subject><subject>Guidelines</subject><subject>Human Physiology</subject><subject>Injury analysis</subject><subject>Iron</subject><subject>Magnesium</subject><subject>Meta-analysis</subject><subject>Metabolic rate</subject><subject>Micronutrients</subject><subject>Neurochemistry</subject><subject>Neuropsychology</subject><subject>Neurosciences</subject><subject>Nutritional status</subject><subject>Phosphorus</subject><subject>Potassium</subject><subject>Proteins</subject><subject>Review Article</subject><subject>Reviews</subject><subject>Scientific papers</subject><subject>Search engines</subject><subject>Sodium</subject><subject>Spinal cord injuries</subject><subject>Statistical analysis</subject><subject>Systematic review</subject><subject>Vitamin B12</subject><subject>Vitamin B6</subject><subject>Vitamins</subject><subject>Zinc</subject><issn>1362-4393</issn><issn>1476-5624</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp1kEtLxDAUhYMozjj6A9xIwY2bal6TJu5k8AWDbhSXIdOmmqGPMTdV-u9N6agguLm53Pudc8NB6Jjgc4KZvABOmGIpJjLFNBa-g6aEZyKdC8p3Y88ETXlEJugAYI0xVkTJfTRhmFMspJyil4cueBdc25gqgWBCB4lrkvzNt43LE9i4YZG3vojjdef7y8Qk0EOwtQkR8PbD2c_ENEVS22BSE_EeHByivdJUYI-27ww931w_Le7S5ePt_eJqmeZckpASKqmwvCxUNqdK5oXMVpaUVEhc5NxQQhVjvLBclEQQwTJsFaFMZapg1MqSzdDZ6Lvx7XtnIejaQW6ryjS27UBTwmjG5ipqZ-j0D7puOx__O1AinuGM4UiRkcp9C-BtqTfe1cb3mmA9pK7H1HVMXQ-pax41J1vnblXb4kfxHXME6AhAXDWv1v-e_t_1C-Qui6U</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Farkas, Gary J.</creator><creator>Pitot, Marika A.</creator><creator>Berg, Arthur S.</creator><creator>Gater, David R.</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7T7</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</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>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQGLB</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5482-6049</orcidid></search><sort><creationdate>20190101</creationdate><title>Nutritional status in chronic spinal cord injury: a systematic review and meta-analysis</title><author>Farkas, Gary J. ; Pitot, Marika A. ; Berg, Arthur S. ; Gater, David R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c481t-12826e4fd975298cd87be1f2680dc4a2129334de46f1616370e9123979d32e8f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>692/308/409</topic><topic>692/700/2814</topic><topic>Adults</topic><topic>Anatomy</topic><topic>B7 antigen</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Calcium</topic><topic>Carbohydrates</topic><topic>Confidence intervals</topic><topic>Diet</topic><topic>Energy intake</topic><topic>Government agencies</topic><topic>Guidelines</topic><topic>Human Physiology</topic><topic>Injury analysis</topic><topic>Iron</topic><topic>Magnesium</topic><topic>Meta-analysis</topic><topic>Metabolic rate</topic><topic>Micronutrients</topic><topic>Neurochemistry</topic><topic>Neuropsychology</topic><topic>Neurosciences</topic><topic>Nutritional status</topic><topic>Phosphorus</topic><topic>Potassium</topic><topic>Proteins</topic><topic>Review Article</topic><topic>Reviews</topic><topic>Scientific papers</topic><topic>Search engines</topic><topic>Sodium</topic><topic>Spinal cord injuries</topic><topic>Statistical analysis</topic><topic>Systematic review</topic><topic>Vitamin B12</topic><topic>Vitamin B6</topic><topic>Vitamins</topic><topic>Zinc</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Farkas, Gary J.</creatorcontrib><creatorcontrib>Pitot, Marika A.</creatorcontrib><creatorcontrib>Berg, Arthur S.</creatorcontrib><creatorcontrib>Gater, David R.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</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>Technology Research Database</collection><collection>ProQuest SciTech 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>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection (ProQuest)</collection><collection>Environmental Sciences and Pollution Management</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>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Applied & Life Sciences</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Spinal cord</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Farkas, Gary J.</au><au>Pitot, Marika A.</au><au>Berg, Arthur S.</au><au>Gater, David R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nutritional status in chronic spinal cord injury: a systematic review and meta-analysis</atitle><jtitle>Spinal cord</jtitle><stitle>Spinal Cord</stitle><addtitle>Spinal Cord</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>57</volume><issue>1</issue><spage>3</spage><epage>17</epage><pages>3-17</pages><issn>1362-4393</issn><eissn>1476-5624</eissn><abstract>Study design
Systematic review and meta-analysis.
Objectives
The objective was to investigate nutritional status in chronic spinal cord injury (SCI), and compare macronutrient and micronutrient intake to the recommended values by the United States Department of Agriculture (USDA) 2015–2020 Dietary Guidelines for Americans.
Setting
United States of America.
Methods
A MEDLINE/PubMed, Google Scholar, Scopus, and Web of Science search was performed, identifying 268 papers. All papers included were English-language papers examining adults with chronic SCI. A meta-analysis was performed to produce weighted averages and 95% confidence intervals (CI) when summary statistics were provided.
Results
The systematic review included 15 articles, while the meta-analysis included 12. Resting metabolic rate (1492 kcal/day; CI: 1414–1569) fell below the able-bodied average, and total energy (1876 kcal/day; CI: 1694–2059) and fiber (17 g/day; CI: 14–20) intake were below USDA guidelines. Protein (319 kcal/day; CI: 294–345) and carbohydrate (969 kcal/day; CI: 851–1087) intake were above guidelines. Fat intake (663 kcal/day; CI: 590–736) was within USDA guidelines. Vitamins A, B5, B7, B9, D, E, potassium, and calcium were deficient, while vitamins B1, B2, B3, B12, C, K, sodium, phosphorus, copper, and zinc were in excess according to USDA guidelines. Vitamin B6, iron, and magnesium were within USDA guidelines.
Conclusion
Findings indicate greater energy intake relative to energy needs in those with chronic SCI, and an imbalance in fiber intake and micronutrients compared to the USDA guidelines. Future research examining nutritional health status is needed in order to establish evidence-based, SCI-specific dietary guidelines.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>30420688</pmid><doi>10.1038/s41393-018-0218-4</doi><tpages>15</tpages><orcidid>https://orcid.org/0000-0002-5482-6049</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1362-4393 |
| ispartof | Spinal cord, 2019-01, Vol.57 (1), p.3-17 |
| issn | 1362-4393 1476-5624 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2132735916 |
| source | SpringerLink Journals |
| subjects | 692/308/409 692/700/2814 Adults Anatomy B7 antigen Biomedical and Life Sciences Biomedicine Calcium Carbohydrates Confidence intervals Diet Energy intake Government agencies Guidelines Human Physiology Injury analysis Iron Magnesium Meta-analysis Metabolic rate Micronutrients Neurochemistry Neuropsychology Neurosciences Nutritional status Phosphorus Potassium Proteins Review Article Reviews Scientific papers Search engines Sodium Spinal cord injuries Statistical analysis Systematic review Vitamin B12 Vitamin B6 Vitamins Zinc |
| title | Nutritional status in chronic spinal cord injury: a systematic review and meta-analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-19T00%3A49%3A36IST&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=Nutritional%20status%20in%20chronic%20spinal%20cord%20injury:%20a%20systematic%20review%20and%20meta-analysis&rft.jtitle=Spinal%20cord&rft.au=Farkas,%20Gary%20J.&rft.date=2019-01-01&rft.volume=57&rft.issue=1&rft.spage=3&rft.epage=17&rft.pages=3-17&rft.issn=1362-4393&rft.eissn=1476-5624&rft_id=info:doi/10.1038/s41393-018-0218-4&rft_dat=%3Cproquest_cross%3E2132735916%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=2163344330&rft_id=info:pmid/30420688&rfr_iscdi=true |