Prevalence of Cognitive Frailty Phenotypes and Associated Factors in a Community-Dwelling Elderly Population
Objectives Cognitive frailty was notable target for the prevention of adverse health outcomes in future. The goal of this study was to use a population-based survey to investigate cognitive frailty phenotypes and potentially sociodemographic factors in elderly Chinese individuals. Design Cross-secti...
Gespeichert in:
| Veröffentlicht in: | The Journal of nutrition, health & aging health & aging, 2020-02, Vol.24 (2), p.172-180 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 180 |
|---|---|
| container_issue | 2 |
| container_start_page | 172 |
| container_title | The Journal of nutrition, health & aging |
| container_volume | 24 |
| creator | Ruan, Q. Xiao, F. Gong, K. Zhang, W. Zhang, M. Ruan, J. Zhang, X. Chen, Q. Yu, Zhuowei |
| description | Objectives
Cognitive frailty was notable target for the prevention of adverse health outcomes in future. The goal of this study was to use a population-based survey to investigate cognitive frailty phenotypes and potentially sociodemographic factors in elderly Chinese individuals.
Design
Cross-sectional study.
Setting
General community.
Participants
A total of 5328 elderly adults (aged 60 years or older, mean age 71.36 years) enrolled in the Shanghai study of health promotion for elderly individuals with frailty.
Measurements
The 5-item FRAIL scale and the 3-item Rapid Cognitive Screen tools were used to assess physical frailty and cognitive impairment, including dementia or mild cognitive impairment (MCI). Physical frailty was diagnosed by limitations in 3 or more of the FRAIL scale domains and pre-physical frailty by 1–2 limitations. Subjective cognitive decline (SCD) and pre-MCI SCD, was diagnosed with two self-report measures based on memory and other cognitive domains in elderly adults.
Results
Of the participating individuals, 97.17% (n= 5177, female 53.4%) were eligible. Notably, 9.67%, 41.61% and 35.20% of participants were MCI, SCD and pre-MCI SCD; 35.86% and 4.41% exhibited physical pre-frailty and frailty; and 19.86% and 6.30% exhibited reversible and potential reversible cognitive frailty. Logistic regression analyses indicated that physical frailty phenotypes were significantly associated with MCI with SCD, and pre-MCI with SCD. Older single females with a high education level were more likely to exhibit the reversible cognitive frailty; and younger elderly individuals with a middle education level were at lower risk for potentially reversible cognitive frailty.
Conclusions
The prevalence of pre-physical and reversible cognitive frailty was high in elderly individuals and age was the most significant risk factor for all types of frailty phenotypes. To promote the rapid screening protocol of cognitive frailty in community-dwelling elderly is important to find high-risk population, implement effective intervention, and decrease adverse prognosis. |
| doi_str_mv | 10.1007/s12603-019-1286-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2350087519</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2350087519</sourcerecordid><originalsourceid>FETCH-LOGICAL-c415t-1f4365236fde55096a1afea231bafcb0401daab3ed21b8ae7e3b5306d27466d43</originalsourceid><addsrcrecordid>eNp1kU9v1DAQxS0EoqXwAbggS1y4GMZ_YifHatsFpErtoT1HTjxZXDn2YidF--1xtQUkpJ5mpPm9N6N5hLzn8JkDmC-FCw2SAe8YF61m5gU55UYDU6ZtX9ZemI4ZA-aEvCnlHkA1XatfkxMpAKQCc0rCTcYHGzCOSNNEN2kX_eIfkG6z9WE50JsfGNNy2GOhNjp6XkoavV3Q0a0dl5QL9ZHaKpzntUoP7OIXhuDjjl4GhzlUh7Rfg118im_Jq8mGgu-e6hm5217ebr6xq-uv3zfnV2xUvFkYn5TUjZB6ctg00GnL7YRWSD7YaRxAAXfWDhKd4ENr0aAcGgnaCaO0dkqekU9H331OP1csSz_7MtazbMS0ll7IBqA1De8q-vE_9D6tOdbrKqXa-l-jZaX4kRpzKiXj1O-zn20-9Bz6xyj6YxR9jaJ_jKI3VfPhyXkdZnR_FX9-XwFxBEodxR3mf6ufd_0NyZ6Ujg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2348260763</pqid></control><display><type>article</type><title>Prevalence of Cognitive Frailty Phenotypes and Associated Factors in a Community-Dwelling Elderly Population</title><source>MEDLINE</source><source>Springer Online Journals Complete</source><source>Alma/SFX Local Collection</source><creator>Ruan, Q. ; Xiao, F. ; Gong, K. ; Zhang, W. ; Zhang, M. ; Ruan, J. ; Zhang, X. ; Chen, Q. ; Yu, Zhuowei</creator><creatorcontrib>Ruan, Q. ; Xiao, F. ; Gong, K. ; Zhang, W. ; Zhang, M. ; Ruan, J. ; Zhang, X. ; Chen, Q. ; Yu, Zhuowei</creatorcontrib><description>Objectives
Cognitive frailty was notable target for the prevention of adverse health outcomes in future. The goal of this study was to use a population-based survey to investigate cognitive frailty phenotypes and potentially sociodemographic factors in elderly Chinese individuals.
Design
Cross-sectional study.
Setting
General community.
Participants
A total of 5328 elderly adults (aged 60 years or older, mean age 71.36 years) enrolled in the Shanghai study of health promotion for elderly individuals with frailty.
Measurements
The 5-item FRAIL scale and the 3-item Rapid Cognitive Screen tools were used to assess physical frailty and cognitive impairment, including dementia or mild cognitive impairment (MCI). Physical frailty was diagnosed by limitations in 3 or more of the FRAIL scale domains and pre-physical frailty by 1–2 limitations. Subjective cognitive decline (SCD) and pre-MCI SCD, was diagnosed with two self-report measures based on memory and other cognitive domains in elderly adults.
Results
Of the participating individuals, 97.17% (n= 5177, female 53.4%) were eligible. Notably, 9.67%, 41.61% and 35.20% of participants were MCI, SCD and pre-MCI SCD; 35.86% and 4.41% exhibited physical pre-frailty and frailty; and 19.86% and 6.30% exhibited reversible and potential reversible cognitive frailty. Logistic regression analyses indicated that physical frailty phenotypes were significantly associated with MCI with SCD, and pre-MCI with SCD. Older single females with a high education level were more likely to exhibit the reversible cognitive frailty; and younger elderly individuals with a middle education level were at lower risk for potentially reversible cognitive frailty.
Conclusions
The prevalence of pre-physical and reversible cognitive frailty was high in elderly individuals and age was the most significant risk factor for all types of frailty phenotypes. To promote the rapid screening protocol of cognitive frailty in community-dwelling elderly is important to find high-risk population, implement effective intervention, and decrease adverse prognosis.</description><identifier>ISSN: 1279-7707</identifier><identifier>EISSN: 1760-4788</identifier><identifier>DOI: 10.1007/s12603-019-1286-7</identifier><identifier>PMID: 32003407</identifier><language>eng</language><publisher>Paris: Springer Paris</publisher><subject>Aged ; Aged, 80 and over ; Aging ; China ; Cognitive ability ; Cognitive Dysfunction - epidemiology ; Cross-Sectional Studies ; Dementia ; Female ; Frailty ; Genotype & phenotype ; Geriatrics/Gerontology ; Humans ; Independent Living ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neurosciences ; Nutrition ; Older people ; Prevalence ; Primary Care Medicine ; Quality of Life Research</subject><ispartof>The Journal of nutrition, health & aging, 2020-02, Vol.24 (2), p.172-180</ispartof><rights>Serdi and Springer-Verlag International SAS, part of Springer Nature 2019</rights><rights>The journal of nutrition, health & aging is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c415t-1f4365236fde55096a1afea231bafcb0401daab3ed21b8ae7e3b5306d27466d43</citedby><cites>FETCH-LOGICAL-c415t-1f4365236fde55096a1afea231bafcb0401daab3ed21b8ae7e3b5306d27466d43</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/s12603-019-1286-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12603-019-1286-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32003407$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ruan, Q.</creatorcontrib><creatorcontrib>Xiao, F.</creatorcontrib><creatorcontrib>Gong, K.</creatorcontrib><creatorcontrib>Zhang, W.</creatorcontrib><creatorcontrib>Zhang, M.</creatorcontrib><creatorcontrib>Ruan, J.</creatorcontrib><creatorcontrib>Zhang, X.</creatorcontrib><creatorcontrib>Chen, Q.</creatorcontrib><creatorcontrib>Yu, Zhuowei</creatorcontrib><title>Prevalence of Cognitive Frailty Phenotypes and Associated Factors in a Community-Dwelling Elderly Population</title><title>The Journal of nutrition, health & aging</title><addtitle>J Nutr Health Aging</addtitle><addtitle>J Nutr Health Aging</addtitle><description>Objectives
Cognitive frailty was notable target for the prevention of adverse health outcomes in future. The goal of this study was to use a population-based survey to investigate cognitive frailty phenotypes and potentially sociodemographic factors in elderly Chinese individuals.
Design
Cross-sectional study.
Setting
General community.
Participants
A total of 5328 elderly adults (aged 60 years or older, mean age 71.36 years) enrolled in the Shanghai study of health promotion for elderly individuals with frailty.
Measurements
The 5-item FRAIL scale and the 3-item Rapid Cognitive Screen tools were used to assess physical frailty and cognitive impairment, including dementia or mild cognitive impairment (MCI). Physical frailty was diagnosed by limitations in 3 or more of the FRAIL scale domains and pre-physical frailty by 1–2 limitations. Subjective cognitive decline (SCD) and pre-MCI SCD, was diagnosed with two self-report measures based on memory and other cognitive domains in elderly adults.
Results
Of the participating individuals, 97.17% (n= 5177, female 53.4%) were eligible. Notably, 9.67%, 41.61% and 35.20% of participants were MCI, SCD and pre-MCI SCD; 35.86% and 4.41% exhibited physical pre-frailty and frailty; and 19.86% and 6.30% exhibited reversible and potential reversible cognitive frailty. Logistic regression analyses indicated that physical frailty phenotypes were significantly associated with MCI with SCD, and pre-MCI with SCD. Older single females with a high education level were more likely to exhibit the reversible cognitive frailty; and younger elderly individuals with a middle education level were at lower risk for potentially reversible cognitive frailty.
Conclusions
The prevalence of pre-physical and reversible cognitive frailty was high in elderly individuals and age was the most significant risk factor for all types of frailty phenotypes. To promote the rapid screening protocol of cognitive frailty in community-dwelling elderly is important to find high-risk population, implement effective intervention, and decrease adverse prognosis.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aging</subject><subject>China</subject><subject>Cognitive ability</subject><subject>Cognitive Dysfunction - epidemiology</subject><subject>Cross-Sectional Studies</subject><subject>Dementia</subject><subject>Female</subject><subject>Frailty</subject><subject>Genotype & phenotype</subject><subject>Geriatrics/Gerontology</subject><subject>Humans</subject><subject>Independent Living</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neurosciences</subject><subject>Nutrition</subject><subject>Older people</subject><subject>Prevalence</subject><subject>Primary Care Medicine</subject><subject>Quality of Life Research</subject><issn>1279-7707</issn><issn>1760-4788</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</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><recordid>eNp1kU9v1DAQxS0EoqXwAbggS1y4GMZ_YifHatsFpErtoT1HTjxZXDn2YidF--1xtQUkpJ5mpPm9N6N5hLzn8JkDmC-FCw2SAe8YF61m5gU55UYDU6ZtX9ZemI4ZA-aEvCnlHkA1XatfkxMpAKQCc0rCTcYHGzCOSNNEN2kX_eIfkG6z9WE50JsfGNNy2GOhNjp6XkoavV3Q0a0dl5QL9ZHaKpzntUoP7OIXhuDjjl4GhzlUh7Rfg118im_Jq8mGgu-e6hm5217ebr6xq-uv3zfnV2xUvFkYn5TUjZB6ctg00GnL7YRWSD7YaRxAAXfWDhKd4ENr0aAcGgnaCaO0dkqekU9H331OP1csSz_7MtazbMS0ll7IBqA1De8q-vE_9D6tOdbrKqXa-l-jZaX4kRpzKiXj1O-zn20-9Bz6xyj6YxR9jaJ_jKI3VfPhyXkdZnR_FX9-XwFxBEodxR3mf6ufd_0NyZ6Ujg</recordid><startdate>20200201</startdate><enddate>20200201</enddate><creator>Ruan, Q.</creator><creator>Xiao, F.</creator><creator>Gong, K.</creator><creator>Zhang, W.</creator><creator>Zhang, M.</creator><creator>Ruan, J.</creator><creator>Zhang, X.</creator><creator>Chen, Q.</creator><creator>Yu, Zhuowei</creator><general>Springer Paris</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>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20200201</creationdate><title>Prevalence of Cognitive Frailty Phenotypes and Associated Factors in a Community-Dwelling Elderly Population</title><author>Ruan, Q. ; Xiao, F. ; Gong, K. ; Zhang, W. ; Zhang, M. ; Ruan, J. ; Zhang, X. ; Chen, Q. ; Yu, Zhuowei</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c415t-1f4365236fde55096a1afea231bafcb0401daab3ed21b8ae7e3b5306d27466d43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aging</topic><topic>China</topic><topic>Cognitive ability</topic><topic>Cognitive Dysfunction - epidemiology</topic><topic>Cross-Sectional Studies</topic><topic>Dementia</topic><topic>Female</topic><topic>Frailty</topic><topic>Genotype & phenotype</topic><topic>Geriatrics/Gerontology</topic><topic>Humans</topic><topic>Independent Living</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neurosciences</topic><topic>Nutrition</topic><topic>Older people</topic><topic>Prevalence</topic><topic>Primary Care Medicine</topic><topic>Quality of Life Research</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ruan, Q.</creatorcontrib><creatorcontrib>Xiao, F.</creatorcontrib><creatorcontrib>Gong, K.</creatorcontrib><creatorcontrib>Zhang, W.</creatorcontrib><creatorcontrib>Zhang, M.</creatorcontrib><creatorcontrib>Ruan, J.</creatorcontrib><creatorcontrib>Zhang, X.</creatorcontrib><creatorcontrib>Chen, Q.</creatorcontrib><creatorcontrib>Yu, Zhuowei</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 & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</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 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>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology 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>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of nutrition, health & aging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ruan, Q.</au><au>Xiao, F.</au><au>Gong, K.</au><au>Zhang, W.</au><au>Zhang, M.</au><au>Ruan, J.</au><au>Zhang, X.</au><au>Chen, Q.</au><au>Yu, Zhuowei</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence of Cognitive Frailty Phenotypes and Associated Factors in a Community-Dwelling Elderly Population</atitle><jtitle>The Journal of nutrition, health & aging</jtitle><stitle>J Nutr Health Aging</stitle><addtitle>J Nutr Health Aging</addtitle><date>2020-02-01</date><risdate>2020</risdate><volume>24</volume><issue>2</issue><spage>172</spage><epage>180</epage><pages>172-180</pages><issn>1279-7707</issn><eissn>1760-4788</eissn><abstract>Objectives
Cognitive frailty was notable target for the prevention of adverse health outcomes in future. The goal of this study was to use a population-based survey to investigate cognitive frailty phenotypes and potentially sociodemographic factors in elderly Chinese individuals.
Design
Cross-sectional study.
Setting
General community.
Participants
A total of 5328 elderly adults (aged 60 years or older, mean age 71.36 years) enrolled in the Shanghai study of health promotion for elderly individuals with frailty.
Measurements
The 5-item FRAIL scale and the 3-item Rapid Cognitive Screen tools were used to assess physical frailty and cognitive impairment, including dementia or mild cognitive impairment (MCI). Physical frailty was diagnosed by limitations in 3 or more of the FRAIL scale domains and pre-physical frailty by 1–2 limitations. Subjective cognitive decline (SCD) and pre-MCI SCD, was diagnosed with two self-report measures based on memory and other cognitive domains in elderly adults.
Results
Of the participating individuals, 97.17% (n= 5177, female 53.4%) were eligible. Notably, 9.67%, 41.61% and 35.20% of participants were MCI, SCD and pre-MCI SCD; 35.86% and 4.41% exhibited physical pre-frailty and frailty; and 19.86% and 6.30% exhibited reversible and potential reversible cognitive frailty. Logistic regression analyses indicated that physical frailty phenotypes were significantly associated with MCI with SCD, and pre-MCI with SCD. Older single females with a high education level were more likely to exhibit the reversible cognitive frailty; and younger elderly individuals with a middle education level were at lower risk for potentially reversible cognitive frailty.
Conclusions
The prevalence of pre-physical and reversible cognitive frailty was high in elderly individuals and age was the most significant risk factor for all types of frailty phenotypes. To promote the rapid screening protocol of cognitive frailty in community-dwelling elderly is important to find high-risk population, implement effective intervention, and decrease adverse prognosis.</abstract><cop>Paris</cop><pub>Springer Paris</pub><pmid>32003407</pmid><doi>10.1007/s12603-019-1286-7</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1279-7707 |
| ispartof | The Journal of nutrition, health & aging, 2020-02, Vol.24 (2), p.172-180 |
| issn | 1279-7707 1760-4788 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2350087519 |
| source | MEDLINE; Springer Online Journals Complete; Alma/SFX Local Collection |
| subjects | Aged Aged, 80 and over Aging China Cognitive ability Cognitive Dysfunction - epidemiology Cross-Sectional Studies Dementia Female Frailty Genotype & phenotype Geriatrics/Gerontology Humans Independent Living Male Medicine Medicine & Public Health Middle Aged Neurosciences Nutrition Older people Prevalence Primary Care Medicine Quality of Life Research |
| title | Prevalence of Cognitive Frailty Phenotypes and Associated Factors in a Community-Dwelling Elderly Population |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-21T01%3A33%3A56IST&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=Prevalence%20of%20Cognitive%20Frailty%20Phenotypes%20and%20Associated%20Factors%20in%20a%20Community-Dwelling%20Elderly%20Population&rft.jtitle=The%20Journal%20of%20nutrition,%20health%20&%20aging&rft.au=Ruan,%20Q.&rft.date=2020-02-01&rft.volume=24&rft.issue=2&rft.spage=172&rft.epage=180&rft.pages=172-180&rft.issn=1279-7707&rft.eissn=1760-4788&rft_id=info:doi/10.1007/s12603-019-1286-7&rft_dat=%3Cproquest_cross%3E2350087519%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=2348260763&rft_id=info:pmid/32003407&rfr_iscdi=true |