Undernutrition Severity Is Associated With Worse Outcomes in Patients With Acute Myocardial Infarction
Malnutrition has been associated with inferior outcomes in patients admitted with acute myocardial infarction (AMI). However, there is a lack of data to assess if the degree of malnutrition correlates with outcome severity. We used the Nationwide Readmission Database for 2016 to 2019 in our cross-se...
Gespeichert in:
| Veröffentlicht in: | The American journal of cardiology 2023-08, Vol.201, p.42-49 |
|---|---|
| Hauptverfasser: | , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 49 |
|---|---|
| container_issue | |
| container_start_page | 42 |
| container_title | The American journal of cardiology |
| container_volume | 201 |
| creator | Mohamad Alahmad, Mohamad Alhoda Gupta, Kamal |
| description | Malnutrition has been associated with inferior outcomes in patients admitted with acute myocardial infarction (AMI). However, there is a lack of data to assess if the degree of malnutrition correlates with outcome severity. We used the Nationwide Readmission Database for 2016 to 2019 in our cross-sectional study. First, we extracted all cases older than 18 years that include a primary diagnosis of AMI. Appropriate survey and domain analyses were applied to obtain the national estimates using Statistical Analysis Software 9.4. We identified 2,280,393 discharges for AMI. Malnutrition was present in 4% of the study cohort (or 89,490 cases). Half of the patients with malnutrition (or 44,919) had moderate-to-severe malnutrition. The other 44,371 (or 50%) had a milder degree of malnutrition. Patients with malnutrition were younger than those without malnutrition (mean age 72 vs 75 years, p |
| doi_str_mv | 10.1016/j.amjcard.2023.05.046 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2829425331</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0002914923003405</els_id><sourcerecordid>2829425331</sourcerecordid><originalsourceid>FETCH-LOGICAL-c440t-b1810dcdd71f1826698827571d431a1914c416062cb714537b1fab121177301c3</originalsourceid><addsrcrecordid>eNqFkUuLFDEUhYMoTs_oT1ACbtxUmZtHPVbSDOo0jIygwyxDKrmFKboqY5Ia6H9vmm5duHGVhHz35OQcQt4Aq4FB82GqzTxZE13NGRc1UzWTzTOyga7tK-hBPCcbxhivepD9BblMaSpHANW8JBeiFYo3jdiQ8X5xGJc1R599WOh3fMKyPdBdotuUgvUmo6MPPv-kDyEmpHdrtmHGRP1Cv5nsccnpdL-1a0b69RCOtrzZ090ymmiPuq_Ii9HsE74-r1fk_vOnH9c31e3dl9319rayUrJcDdABc9a5FkboisO-63irWnBSgCm_klZCwxpuhxakEu0AoxmAA7StYGDFFXl_0n2M4deKKevZJ4v7vVkwrEnzjveSKyGgoO_-QaewxqW4K5QE0feKy0KpE2VjSCniqB-jn008aGD6WISe9LkIfSxCM6VLEWXu7Vl9HWZ0f6f-JF-AjycASxxPHqNOtmRp0fmINmsX_H-e-A2dnJqb</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2841399524</pqid></control><display><type>article</type><title>Undernutrition Severity Is Associated With Worse Outcomes in Patients With Acute Myocardial Infarction</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Mohamad Alahmad, Mohamad Alhoda ; Gupta, Kamal</creator><creatorcontrib>Mohamad Alahmad, Mohamad Alhoda ; Gupta, Kamal</creatorcontrib><description><![CDATA[Malnutrition has been associated with inferior outcomes in patients admitted with acute myocardial infarction (AMI). However, there is a lack of data to assess if the degree of malnutrition correlates with outcome severity. We used the Nationwide Readmission Database for 2016 to 2019 in our cross-sectional study. First, we extracted all cases older than 18 years that include a primary diagnosis of AMI. Appropriate survey and domain analyses were applied to obtain the national estimates using Statistical Analysis Software 9.4. We identified 2,280,393 discharges for AMI. Malnutrition was present in 4% of the study cohort (or 89,490 cases). Half of the patients with malnutrition (or 44,919) had moderate-to-severe malnutrition. The other 44,371 (or 50%) had a milder degree of malnutrition. Patients with malnutrition were younger than those without malnutrition (mean age 72 vs 75 years, p <0.001) and were more often women (48% vs 37%, p <0.001). Patients with malnutrition had a higher prevalence of underlying heart failure, dementia, coagulopathy, and chronic (liver, renal, and lung) diseases (p <0.001). Patients with malnutrition also had a significantly higher inpatient mortality (12.5% vs 4.6%, p <0.001), length of stay (mean of 13 vs 7 days, p <0.001), and 30-day all-cause readmission rates (19% vs 13%, p <0.001). Inpatient mortality on readmission was also higher in those with malnutrition (2% vs 0.6%, p <0.001). The univariate analysis showed that the severity of malnutrition also correlated with a higher inpatient mortality (odds ratio [OR] 2.34 [2.24 to 2.46] for mild malnutrition and 3.65 [3.49 to 3.82] for advanced malnutrition). After adjusting for age, gender, heart failure, dementia, coagulopathy, chronic (liver, renal, and lung) diseases, and history of cardiovascular revascularization, the presence of malnutrition and the severity of malnutrition continued to be associated with a higher inpatient mortality than those without malnutrition (OR 1.20 [1.14 to 1.26] for mild malnutrition and OR 1.69 [1.61 to 1.78] for more severe malnutrition). In conclusion, underlying malnutrition is associated with worse outcomes in patients hospitalized with AMI. The severity of malnutrition also correlates with worse outcomes.]]></description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2023.05.046</identifier><identifier>PMID: 37352663</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Blood Coagulation Disorders - complications ; Body mass index ; Cardiovascular disease ; Congestive heart failure ; Coronary vessels ; Cross-Sectional Studies ; Dementia ; Dementia disorders ; Diabetes ; Female ; Geriatrics ; Heart attacks ; Heart failure ; Heart Failure - complications ; Heart surgery ; Hospital Mortality ; Hospitalization ; Hospitals ; Humans ; Length of stay ; Liver ; Liver diseases ; Lung diseases ; Lungs ; Malnutrition ; Malnutrition - complications ; Malnutrition - epidemiology ; Medical prognosis ; Mortality ; Myocardial infarction ; Myocardial Infarction - complications ; Nutritional status ; Obesity ; Physiology ; Regression analysis ; Statistical analysis ; Undernutrition</subject><ispartof>The American journal of cardiology, 2023-08, Vol.201, p.42-49</ispartof><rights>2023 The Author(s)</rights><rights>Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.</rights><rights>2023. The Author(s)</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c440t-b1810dcdd71f1826698827571d431a1914c416062cb714537b1fab121177301c3</citedby><cites>FETCH-LOGICAL-c440t-b1810dcdd71f1826698827571d431a1914c416062cb714537b1fab121177301c3</cites><orcidid>0000-0003-2103-8975</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914923003405$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37352663$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mohamad Alahmad, Mohamad Alhoda</creatorcontrib><creatorcontrib>Gupta, Kamal</creatorcontrib><title>Undernutrition Severity Is Associated With Worse Outcomes in Patients With Acute Myocardial Infarction</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description><![CDATA[Malnutrition has been associated with inferior outcomes in patients admitted with acute myocardial infarction (AMI). However, there is a lack of data to assess if the degree of malnutrition correlates with outcome severity. We used the Nationwide Readmission Database for 2016 to 2019 in our cross-sectional study. First, we extracted all cases older than 18 years that include a primary diagnosis of AMI. Appropriate survey and domain analyses were applied to obtain the national estimates using Statistical Analysis Software 9.4. We identified 2,280,393 discharges for AMI. Malnutrition was present in 4% of the study cohort (or 89,490 cases). Half of the patients with malnutrition (or 44,919) had moderate-to-severe malnutrition. The other 44,371 (or 50%) had a milder degree of malnutrition. Patients with malnutrition were younger than those without malnutrition (mean age 72 vs 75 years, p <0.001) and were more often women (48% vs 37%, p <0.001). Patients with malnutrition had a higher prevalence of underlying heart failure, dementia, coagulopathy, and chronic (liver, renal, and lung) diseases (p <0.001). Patients with malnutrition also had a significantly higher inpatient mortality (12.5% vs 4.6%, p <0.001), length of stay (mean of 13 vs 7 days, p <0.001), and 30-day all-cause readmission rates (19% vs 13%, p <0.001). Inpatient mortality on readmission was also higher in those with malnutrition (2% vs 0.6%, p <0.001). The univariate analysis showed that the severity of malnutrition also correlated with a higher inpatient mortality (odds ratio [OR] 2.34 [2.24 to 2.46] for mild malnutrition and 3.65 [3.49 to 3.82] for advanced malnutrition). After adjusting for age, gender, heart failure, dementia, coagulopathy, chronic (liver, renal, and lung) diseases, and history of cardiovascular revascularization, the presence of malnutrition and the severity of malnutrition continued to be associated with a higher inpatient mortality than those without malnutrition (OR 1.20 [1.14 to 1.26] for mild malnutrition and OR 1.69 [1.61 to 1.78] for more severe malnutrition). In conclusion, underlying malnutrition is associated with worse outcomes in patients hospitalized with AMI. The severity of malnutrition also correlates with worse outcomes.]]></description><subject>Aged</subject><subject>Blood Coagulation Disorders - complications</subject><subject>Body mass index</subject><subject>Cardiovascular disease</subject><subject>Congestive heart failure</subject><subject>Coronary vessels</subject><subject>Cross-Sectional Studies</subject><subject>Dementia</subject><subject>Dementia disorders</subject><subject>Diabetes</subject><subject>Female</subject><subject>Geriatrics</subject><subject>Heart attacks</subject><subject>Heart failure</subject><subject>Heart Failure - complications</subject><subject>Heart surgery</subject><subject>Hospital Mortality</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Length of stay</subject><subject>Liver</subject><subject>Liver diseases</subject><subject>Lung diseases</subject><subject>Lungs</subject><subject>Malnutrition</subject><subject>Malnutrition - complications</subject><subject>Malnutrition - epidemiology</subject><subject>Medical prognosis</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Myocardial Infarction - complications</subject><subject>Nutritional status</subject><subject>Obesity</subject><subject>Physiology</subject><subject>Regression analysis</subject><subject>Statistical analysis</subject><subject>Undernutrition</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkUuLFDEUhYMoTs_oT1ACbtxUmZtHPVbSDOo0jIygwyxDKrmFKboqY5Ia6H9vmm5duHGVhHz35OQcQt4Aq4FB82GqzTxZE13NGRc1UzWTzTOyga7tK-hBPCcbxhivepD9BblMaSpHANW8JBeiFYo3jdiQ8X5xGJc1R599WOh3fMKyPdBdotuUgvUmo6MPPv-kDyEmpHdrtmHGRP1Cv5nsccnpdL-1a0b69RCOtrzZ090ymmiPuq_Ii9HsE74-r1fk_vOnH9c31e3dl9319rayUrJcDdABc9a5FkboisO-63irWnBSgCm_klZCwxpuhxakEu0AoxmAA7StYGDFFXl_0n2M4deKKevZJ4v7vVkwrEnzjveSKyGgoO_-QaewxqW4K5QE0feKy0KpE2VjSCniqB-jn008aGD6WISe9LkIfSxCM6VLEWXu7Vl9HWZ0f6f-JF-AjycASxxPHqNOtmRp0fmINmsX_H-e-A2dnJqb</recordid><startdate>20230815</startdate><enddate>20230815</enddate><creator>Mohamad Alahmad, Mohamad Alhoda</creator><creator>Gupta, Kamal</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</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>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</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>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2103-8975</orcidid></search><sort><creationdate>20230815</creationdate><title>Undernutrition Severity Is Associated With Worse Outcomes in Patients With Acute Myocardial Infarction</title><author>Mohamad Alahmad, Mohamad Alhoda ; Gupta, Kamal</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c440t-b1810dcdd71f1826698827571d431a1914c416062cb714537b1fab121177301c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Aged</topic><topic>Blood Coagulation Disorders - complications</topic><topic>Body mass index</topic><topic>Cardiovascular disease</topic><topic>Congestive heart failure</topic><topic>Coronary vessels</topic><topic>Cross-Sectional Studies</topic><topic>Dementia</topic><topic>Dementia disorders</topic><topic>Diabetes</topic><topic>Female</topic><topic>Geriatrics</topic><topic>Heart attacks</topic><topic>Heart failure</topic><topic>Heart Failure - complications</topic><topic>Heart surgery</topic><topic>Hospital Mortality</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Length of stay</topic><topic>Liver</topic><topic>Liver diseases</topic><topic>Lung diseases</topic><topic>Lungs</topic><topic>Malnutrition</topic><topic>Malnutrition - complications</topic><topic>Malnutrition - epidemiology</topic><topic>Medical prognosis</topic><topic>Mortality</topic><topic>Myocardial infarction</topic><topic>Myocardial Infarction - complications</topic><topic>Nutritional status</topic><topic>Obesity</topic><topic>Physiology</topic><topic>Regression analysis</topic><topic>Statistical analysis</topic><topic>Undernutrition</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mohamad Alahmad, Mohamad Alhoda</creatorcontrib><creatorcontrib>Gupta, Kamal</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</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 Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</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 & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biochemistry Abstracts 1</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</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 Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mohamad Alahmad, Mohamad Alhoda</au><au>Gupta, Kamal</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Undernutrition Severity Is Associated With Worse Outcomes in Patients With Acute Myocardial Infarction</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2023-08-15</date><risdate>2023</risdate><volume>201</volume><spage>42</spage><epage>49</epage><pages>42-49</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><abstract><![CDATA[Malnutrition has been associated with inferior outcomes in patients admitted with acute myocardial infarction (AMI). However, there is a lack of data to assess if the degree of malnutrition correlates with outcome severity. We used the Nationwide Readmission Database for 2016 to 2019 in our cross-sectional study. First, we extracted all cases older than 18 years that include a primary diagnosis of AMI. Appropriate survey and domain analyses were applied to obtain the national estimates using Statistical Analysis Software 9.4. We identified 2,280,393 discharges for AMI. Malnutrition was present in 4% of the study cohort (or 89,490 cases). Half of the patients with malnutrition (or 44,919) had moderate-to-severe malnutrition. The other 44,371 (or 50%) had a milder degree of malnutrition. Patients with malnutrition were younger than those without malnutrition (mean age 72 vs 75 years, p <0.001) and were more often women (48% vs 37%, p <0.001). Patients with malnutrition had a higher prevalence of underlying heart failure, dementia, coagulopathy, and chronic (liver, renal, and lung) diseases (p <0.001). Patients with malnutrition also had a significantly higher inpatient mortality (12.5% vs 4.6%, p <0.001), length of stay (mean of 13 vs 7 days, p <0.001), and 30-day all-cause readmission rates (19% vs 13%, p <0.001). Inpatient mortality on readmission was also higher in those with malnutrition (2% vs 0.6%, p <0.001). The univariate analysis showed that the severity of malnutrition also correlated with a higher inpatient mortality (odds ratio [OR] 2.34 [2.24 to 2.46] for mild malnutrition and 3.65 [3.49 to 3.82] for advanced malnutrition). After adjusting for age, gender, heart failure, dementia, coagulopathy, chronic (liver, renal, and lung) diseases, and history of cardiovascular revascularization, the presence of malnutrition and the severity of malnutrition continued to be associated with a higher inpatient mortality than those without malnutrition (OR 1.20 [1.14 to 1.26] for mild malnutrition and OR 1.69 [1.61 to 1.78] for more severe malnutrition). In conclusion, underlying malnutrition is associated with worse outcomes in patients hospitalized with AMI. The severity of malnutrition also correlates with worse outcomes.]]></abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>37352663</pmid><doi>10.1016/j.amjcard.2023.05.046</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-2103-8975</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9149 |
| ispartof | The American journal of cardiology, 2023-08, Vol.201, p.42-49 |
| issn | 0002-9149 1879-1913 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2829425331 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aged Blood Coagulation Disorders - complications Body mass index Cardiovascular disease Congestive heart failure Coronary vessels Cross-Sectional Studies Dementia Dementia disorders Diabetes Female Geriatrics Heart attacks Heart failure Heart Failure - complications Heart surgery Hospital Mortality Hospitalization Hospitals Humans Length of stay Liver Liver diseases Lung diseases Lungs Malnutrition Malnutrition - complications Malnutrition - epidemiology Medical prognosis Mortality Myocardial infarction Myocardial Infarction - complications Nutritional status Obesity Physiology Regression analysis Statistical analysis Undernutrition |
| title | Undernutrition Severity Is Associated With Worse Outcomes in Patients With Acute Myocardial Infarction |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-08T01%3A19%3A06IST&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=Undernutrition%20Severity%20Is%20Associated%20With%20Worse%20Outcomes%20in%20Patients%20With%20Acute%20Myocardial%20Infarction&rft.jtitle=The%20American%20journal%20of%20cardiology&rft.au=Mohamad%20Alahmad,%20Mohamad%20Alhoda&rft.date=2023-08-15&rft.volume=201&rft.spage=42&rft.epage=49&rft.pages=42-49&rft.issn=0002-9149&rft.eissn=1879-1913&rft_id=info:doi/10.1016/j.amjcard.2023.05.046&rft_dat=%3Cproquest_cross%3E2829425331%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=2841399524&rft_id=info:pmid/37352663&rft_els_id=S0002914923003405&rfr_iscdi=true |