Predictors of survival after acute paraquat poisoning
Acute paraquat poisoning is often fatal. Many studies have investigated successful treatment modalities, but no standard treatment yet exists. The purpose of this study was to determine the predictors of survival after acute paraquat poisoning in 602 patients. The paraquat exposure was assessed base...
Gespeichert in:
Veröffentlicht in: | Toxicology and industrial health 2002-05, Vol.18 (4), p.201-206 |
---|---|
Hauptverfasser: | , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 206 |
---|---|
container_issue | 4 |
container_start_page | 201 |
container_title | Toxicology and industrial health |
container_volume | 18 |
creator | Lee, Eun-Young Hwang, Kyu-Yoon Yang, Jong-Oh Hong, Sae-Yong |
description | Acute paraquat poisoning is often fatal. Many studies have investigated successful treatment modalities, but no standard treatment yet exists. The purpose of this study was to determine the predictors of survival after acute paraquat poisoning in 602 patients. The paraquat exposure was assessed based on the amount of ingested paraquat and a semiquantitative measure of the urine level of paraquat. Initial clinical parameters including vital signs, hemoglobin, white-blood-cell count, pH, PaCO2, PaO2, blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, total bilirubin, amylase, and glucose were obtained at the time of arrival at the emergency room. Outcomes after acute paraquat poisoning were categorized as survivors and nonsurvivors. Multiple logistic regression analysis was applied to assess the predictors of survival after acute paraquat poisoning.
Some patients (55.5%) survived after oral ingestion of paraquat, whereas all those exposed to paraquat percutaneous or inhalational route survived. The amount of paraquat (24.5% concentrate of 1,1′-dimethyl-4,4′-bipyridium dichloride) ingested was 45.69 / 74.1 mL (mean9 / SD). In addition to degree of paraquat exposure, survival after acute paraquat poisoning was associated with age, respiratory rate, pH, PaCO2, hemoglobin, white-blood-cell count, blood urea nitrogen, amylase, and the number of failed organs in multiple logistic regression analysis. In conclusion, young age, percutaneous or inhalational route, exposure to less paraquat, and lesser degrees of leukocytosis, acidosis, and renal, hepatic, and pancreatic failures on admission are good prognostic factors of survival after acute paraquat poisoning. |
doi_str_mv | 10.1191/0748233702th141oa |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_743385839</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1191_0748233702th141oa</sage_id><sourcerecordid>21408619</sourcerecordid><originalsourceid>FETCH-LOGICAL-c457t-f997718d8129d1ef8973e42a3b03f262c74641034fcea1e141c7adcd661128b3</originalsourceid><addsrcrecordid>eNqFkU9LAzEQxYMotlY_gBdZPOhpaybJJtmjFP9BQQ-9L2k2qVu2m22yK_jtzdJCQVFhYA7zmze8eQhdAp4C5HCHBZOEUoFJ9w4MnDpCY2BCpJjm9BiNh3k6ACN0FsIaY8x5Rk7RCEguWMboGGVv3pSV7pwPibNJ6P1H9aHqRNnO-ETpvjNJq7za9qpLWlcF11TN6hydWFUHc7HvE7R4fFjMntP569PL7H6eapaJLrV5LgTIUsZ7JRgrc0ENI4ouMbWEEy0YZ4Aps9ooMNGCFqrUJecARC7pBN3uZFvvtr0JXbGpgjZ1rRrj-lAIRqnMZDQ7QTd_kgQYlhz-B-NbcxkrgtffwLXrfRPdFoRg4CD5oAY7SHsXgje2aH21Uf6zAFwMERU_Ioo7V3vhfrkx5WFjn0kEpjsgqJU5XP1d8QsPV5i7</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>220161869</pqid></control><display><type>article</type><title>Predictors of survival after acute paraquat poisoning</title><source>MEDLINE</source><source>SAGE Complete A-Z List</source><creator>Lee, Eun-Young ; Hwang, Kyu-Yoon ; Yang, Jong-Oh ; Hong, Sae-Yong</creator><creatorcontrib>Lee, Eun-Young ; Hwang, Kyu-Yoon ; Yang, Jong-Oh ; Hong, Sae-Yong</creatorcontrib><description>Acute paraquat poisoning is often fatal. Many studies have investigated successful treatment modalities, but no standard treatment yet exists. The purpose of this study was to determine the predictors of survival after acute paraquat poisoning in 602 patients. The paraquat exposure was assessed based on the amount of ingested paraquat and a semiquantitative measure of the urine level of paraquat. Initial clinical parameters including vital signs, hemoglobin, white-blood-cell count, pH, PaCO2, PaO2, blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, total bilirubin, amylase, and glucose were obtained at the time of arrival at the emergency room. Outcomes after acute paraquat poisoning were categorized as survivors and nonsurvivors. Multiple logistic regression analysis was applied to assess the predictors of survival after acute paraquat poisoning.
Some patients (55.5%) survived after oral ingestion of paraquat, whereas all those exposed to paraquat percutaneous or inhalational route survived. The amount of paraquat (24.5% concentrate of 1,1′-dimethyl-4,4′-bipyridium dichloride) ingested was 45.69 / 74.1 mL (mean9 / SD). In addition to degree of paraquat exposure, survival after acute paraquat poisoning was associated with age, respiratory rate, pH, PaCO2, hemoglobin, white-blood-cell count, blood urea nitrogen, amylase, and the number of failed organs in multiple logistic regression analysis. In conclusion, young age, percutaneous or inhalational route, exposure to less paraquat, and lesser degrees of leukocytosis, acidosis, and renal, hepatic, and pancreatic failures on admission are good prognostic factors of survival after acute paraquat poisoning.</description><identifier>ISSN: 0748-2337</identifier><identifier>EISSN: 1477-0393</identifier><identifier>DOI: 10.1191/0748233702th141oa</identifier><identifier>PMID: 12974543</identifier><language>eng</language><publisher>Thousand Oaks, CA: SAGE Publications</publisher><subject>Administration, Cutaneous ; Adult ; Age Factors ; Cardiovascular disease ; Creatinine ; Dose-Response Relationship, Drug ; Emergency medical care ; Failure ; Female ; Hemoglobin ; Herbicides - administration & dosage ; Herbicides - poisoning ; Hospitals ; Humans ; Inhalation Exposure ; Internal medicine ; Leukocytosis ; Male ; Medical prognosis ; Medicine ; Middle Aged ; Mortality ; Multiple Organ Failure ; Nitrogen ; Paraquat - administration & dosage ; Paraquat - poisoning ; Pesticides ; Poisoning ; Poisons ; Prognosis ; Regression Analysis ; Retrospective Studies ; Survival Analysis ; Toxicology ; Vital signs</subject><ispartof>Toxicology and industrial health, 2002-05, Vol.18 (4), p.201-206</ispartof><rights>Arnold 2002</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c457t-f997718d8129d1ef8973e42a3b03f262c74641034fcea1e141c7adcd661128b3</citedby><cites>FETCH-LOGICAL-c457t-f997718d8129d1ef8973e42a3b03f262c74641034fcea1e141c7adcd661128b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1191/0748233702th141oa$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1191/0748233702th141oa$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12974543$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Eun-Young</creatorcontrib><creatorcontrib>Hwang, Kyu-Yoon</creatorcontrib><creatorcontrib>Yang, Jong-Oh</creatorcontrib><creatorcontrib>Hong, Sae-Yong</creatorcontrib><title>Predictors of survival after acute paraquat poisoning</title><title>Toxicology and industrial health</title><addtitle>Toxicol Ind Health</addtitle><description>Acute paraquat poisoning is often fatal. Many studies have investigated successful treatment modalities, but no standard treatment yet exists. The purpose of this study was to determine the predictors of survival after acute paraquat poisoning in 602 patients. The paraquat exposure was assessed based on the amount of ingested paraquat and a semiquantitative measure of the urine level of paraquat. Initial clinical parameters including vital signs, hemoglobin, white-blood-cell count, pH, PaCO2, PaO2, blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, total bilirubin, amylase, and glucose were obtained at the time of arrival at the emergency room. Outcomes after acute paraquat poisoning were categorized as survivors and nonsurvivors. Multiple logistic regression analysis was applied to assess the predictors of survival after acute paraquat poisoning.
Some patients (55.5%) survived after oral ingestion of paraquat, whereas all those exposed to paraquat percutaneous or inhalational route survived. The amount of paraquat (24.5% concentrate of 1,1′-dimethyl-4,4′-bipyridium dichloride) ingested was 45.69 / 74.1 mL (mean9 / SD). In addition to degree of paraquat exposure, survival after acute paraquat poisoning was associated with age, respiratory rate, pH, PaCO2, hemoglobin, white-blood-cell count, blood urea nitrogen, amylase, and the number of failed organs in multiple logistic regression analysis. In conclusion, young age, percutaneous or inhalational route, exposure to less paraquat, and lesser degrees of leukocytosis, acidosis, and renal, hepatic, and pancreatic failures on admission are good prognostic factors of survival after acute paraquat poisoning.</description><subject>Administration, Cutaneous</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Cardiovascular disease</subject><subject>Creatinine</subject><subject>Dose-Response Relationship, Drug</subject><subject>Emergency medical care</subject><subject>Failure</subject><subject>Female</subject><subject>Hemoglobin</subject><subject>Herbicides - administration & dosage</subject><subject>Herbicides - poisoning</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Inhalation Exposure</subject><subject>Internal medicine</subject><subject>Leukocytosis</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multiple Organ Failure</subject><subject>Nitrogen</subject><subject>Paraquat - administration & dosage</subject><subject>Paraquat - poisoning</subject><subject>Pesticides</subject><subject>Poisoning</subject><subject>Poisons</subject><subject>Prognosis</subject><subject>Regression Analysis</subject><subject>Retrospective Studies</subject><subject>Survival Analysis</subject><subject>Toxicology</subject><subject>Vital signs</subject><issn>0748-2337</issn><issn>1477-0393</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</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>eNqFkU9LAzEQxYMotlY_gBdZPOhpaybJJtmjFP9BQQ-9L2k2qVu2m22yK_jtzdJCQVFhYA7zmze8eQhdAp4C5HCHBZOEUoFJ9w4MnDpCY2BCpJjm9BiNh3k6ACN0FsIaY8x5Rk7RCEguWMboGGVv3pSV7pwPibNJ6P1H9aHqRNnO-ETpvjNJq7za9qpLWlcF11TN6hydWFUHc7HvE7R4fFjMntP569PL7H6eapaJLrV5LgTIUsZ7JRgrc0ENI4ouMbWEEy0YZ4Aps9ooMNGCFqrUJecARC7pBN3uZFvvtr0JXbGpgjZ1rRrj-lAIRqnMZDQ7QTd_kgQYlhz-B-NbcxkrgtffwLXrfRPdFoRg4CD5oAY7SHsXgje2aH21Uf6zAFwMERU_Ioo7V3vhfrkx5WFjn0kEpjsgqJU5XP1d8QsPV5i7</recordid><startdate>200205</startdate><enddate>200205</enddate><creator>Lee, Eun-Young</creator><creator>Hwang, Kyu-Yoon</creator><creator>Yang, Jong-Oh</creator><creator>Hong, Sae-Yong</creator><general>SAGE Publications</general><general>Sage Publications Ltd</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>7QF</scope><scope>7QQ</scope><scope>7SC</scope><scope>7SE</scope><scope>7SP</scope><scope>7SR</scope><scope>7T2</scope><scope>7TA</scope><scope>7TB</scope><scope>7U5</scope><scope>7U7</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8BQ</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>F28</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H8D</scope><scope>H8G</scope><scope>HCIFZ</scope><scope>JG9</scope><scope>JQ2</scope><scope>K9.</scope><scope>KR7</scope><scope>L6V</scope><scope>L7M</scope><scope>L~C</scope><scope>L~D</scope><scope>M0S</scope><scope>M1P</scope><scope>M7S</scope><scope>PATMY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope></search><sort><creationdate>200205</creationdate><title>Predictors of survival after acute paraquat poisoning</title><author>Lee, Eun-Young ; Hwang, Kyu-Yoon ; Yang, Jong-Oh ; Hong, Sae-Yong</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c457t-f997718d8129d1ef8973e42a3b03f262c74641034fcea1e141c7adcd661128b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Administration, Cutaneous</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Cardiovascular disease</topic><topic>Creatinine</topic><topic>Dose-Response Relationship, Drug</topic><topic>Emergency medical care</topic><topic>Failure</topic><topic>Female</topic><topic>Hemoglobin</topic><topic>Herbicides - administration & dosage</topic><topic>Herbicides - poisoning</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Inhalation Exposure</topic><topic>Internal medicine</topic><topic>Leukocytosis</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multiple Organ Failure</topic><topic>Nitrogen</topic><topic>Paraquat - administration & dosage</topic><topic>Paraquat - poisoning</topic><topic>Pesticides</topic><topic>Poisoning</topic><topic>Poisons</topic><topic>Prognosis</topic><topic>Regression Analysis</topic><topic>Retrospective Studies</topic><topic>Survival Analysis</topic><topic>Toxicology</topic><topic>Vital signs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Eun-Young</creatorcontrib><creatorcontrib>Hwang, Kyu-Yoon</creatorcontrib><creatorcontrib>Yang, Jong-Oh</creatorcontrib><creatorcontrib>Hong, Sae-Yong</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>Aluminium Industry Abstracts</collection><collection>Ceramic Abstracts</collection><collection>Computer and Information Systems Abstracts</collection><collection>Corrosion Abstracts</collection><collection>Electronics & Communications Abstracts</collection><collection>Engineered Materials Abstracts</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Materials Business File</collection><collection>Mechanical & Transportation Engineering Abstracts</collection><collection>Solid State and Superconductivity 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>METADEX</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Technology Collection</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>ANTE: Abstracts in New Technology & Engineering</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>Aerospace Database</collection><collection>Copper Technical Reference Library</collection><collection>SciTech Premium Collection</collection><collection>Materials Research Database</collection><collection>ProQuest Computer Science Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Civil Engineering Abstracts</collection><collection>ProQuest Engineering Collection</collection><collection>Advanced Technologies Database with Aerospace</collection><collection>Computer and Information Systems Abstracts Academic</collection><collection>Computer and Information Systems Abstracts Professional</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Engineering 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>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><jtitle>Toxicology and industrial health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Eun-Young</au><au>Hwang, Kyu-Yoon</au><au>Yang, Jong-Oh</au><au>Hong, Sae-Yong</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of survival after acute paraquat poisoning</atitle><jtitle>Toxicology and industrial health</jtitle><addtitle>Toxicol Ind Health</addtitle><date>2002-05</date><risdate>2002</risdate><volume>18</volume><issue>4</issue><spage>201</spage><epage>206</epage><pages>201-206</pages><issn>0748-2337</issn><eissn>1477-0393</eissn><abstract>Acute paraquat poisoning is often fatal. Many studies have investigated successful treatment modalities, but no standard treatment yet exists. The purpose of this study was to determine the predictors of survival after acute paraquat poisoning in 602 patients. The paraquat exposure was assessed based on the amount of ingested paraquat and a semiquantitative measure of the urine level of paraquat. Initial clinical parameters including vital signs, hemoglobin, white-blood-cell count, pH, PaCO2, PaO2, blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, total bilirubin, amylase, and glucose were obtained at the time of arrival at the emergency room. Outcomes after acute paraquat poisoning were categorized as survivors and nonsurvivors. Multiple logistic regression analysis was applied to assess the predictors of survival after acute paraquat poisoning.
Some patients (55.5%) survived after oral ingestion of paraquat, whereas all those exposed to paraquat percutaneous or inhalational route survived. The amount of paraquat (24.5% concentrate of 1,1′-dimethyl-4,4′-bipyridium dichloride) ingested was 45.69 / 74.1 mL (mean9 / SD). In addition to degree of paraquat exposure, survival after acute paraquat poisoning was associated with age, respiratory rate, pH, PaCO2, hemoglobin, white-blood-cell count, blood urea nitrogen, amylase, and the number of failed organs in multiple logistic regression analysis. In conclusion, young age, percutaneous or inhalational route, exposure to less paraquat, and lesser degrees of leukocytosis, acidosis, and renal, hepatic, and pancreatic failures on admission are good prognostic factors of survival after acute paraquat poisoning.</abstract><cop>Thousand Oaks, CA</cop><pub>SAGE Publications</pub><pmid>12974543</pmid><doi>10.1191/0748233702th141oa</doi><tpages>6</tpages></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0748-2337 |
ispartof | Toxicology and industrial health, 2002-05, Vol.18 (4), p.201-206 |
issn | 0748-2337 1477-0393 |
language | eng |
recordid | cdi_proquest_miscellaneous_743385839 |
source | MEDLINE; SAGE Complete A-Z List |
subjects | Administration, Cutaneous Adult Age Factors Cardiovascular disease Creatinine Dose-Response Relationship, Drug Emergency medical care Failure Female Hemoglobin Herbicides - administration & dosage Herbicides - poisoning Hospitals Humans Inhalation Exposure Internal medicine Leukocytosis Male Medical prognosis Medicine Middle Aged Mortality Multiple Organ Failure Nitrogen Paraquat - administration & dosage Paraquat - poisoning Pesticides Poisoning Poisons Prognosis Regression Analysis Retrospective Studies Survival Analysis Toxicology Vital signs |
title | Predictors of survival after acute paraquat poisoning |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-05T13%3A02%3A01IST&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=Predictors%20of%20survival%20after%20acute%20paraquat%20poisoning&rft.jtitle=Toxicology%20and%20industrial%20health&rft.au=Lee,%20Eun-Young&rft.date=2002-05&rft.volume=18&rft.issue=4&rft.spage=201&rft.epage=206&rft.pages=201-206&rft.issn=0748-2337&rft.eissn=1477-0393&rft_id=info:doi/10.1191/0748233702th141oa&rft_dat=%3Cproquest_cross%3E21408619%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=220161869&rft_id=info:pmid/12974543&rft_sage_id=10.1191_0748233702th141oa&rfr_iscdi=true |