The Frequency and Clinical Significance of Twin Gestations According to Zygosity and Chorionicity
Background: Although the clinical importance of chorionicity in twin pregnancies has been studied widely, the significance of perinatal determination of zygosity using molecular genetic analyses remains controversial. The purpose of this study was to determine the frequency and clinical significance...
Gespeichert in:
| Veröffentlicht in: | Twin research and human genetics 2010-12, Vol.13 (6), p.609-619 |
|---|---|
| Hauptverfasser: | , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 619 |
|---|---|
| container_issue | 6 |
| container_start_page | 609 |
| container_title | Twin research and human genetics |
| container_volume | 13 |
| creator | Lee, Kyung A. Oh, Kyung Joon Lee, Seung Mi Kim, Ahm Jun, Jong Kwan |
| description | Background: Although the clinical importance of chorionicity in twin pregnancies has been studied widely, the significance of perinatal determination of zygosity using molecular genetic analyses remains controversial. The purpose of this study was to determine the frequency and clinical significance of twin gestations according to zygosity and chorionicity in a Korean population. Methods: We enrolled 569 women who delivered twin newborns (> 24 weeks) at Seoul National University Hospital between 1999 and 2008. Chorionicity was established by histologic examination of placentae. Zygosity was determined with sex of neonates, chorionicity, and DNA analysis of umbilical cord blood. Results: The frequency of dizygotic (DZ) twins was 71.0% (404/569 pairs) based on the opposite sex (238/404 [58.9%]) and DNA analyses (166/404 [41.1%]); that of monozygotic (MZ) twins was 29.0% (165/569), including monochorionic (MC) (72.1% [119/165]) and dichorionic (DC) twins (27.9% [46/165]), which was confirmed by DNA analyses. Among spontaneously conceived twins, the frequency of MZ twins was more than twice that of DZ twins. The risk of low birth weight was 1.8-fold higher among MZDC twins and 1.9-fold higher among MZMC twins than among DZDC twins (p < .05). Bronchopulmonary dysplasia occurred more frequently among MZMC twins than among DZDC twins (adjusted OR 8.42, 95% CI 1.82–39.08, p < .01). However, the frequencies of other neonatal morbidities were not significantly higher in the MZMC group than in the MZDC and DZDC groups. The perinatal mortality rate was 15 per 1000 total births in the DZDC twins, 20 per 1000 total births in the MZDC and 56 per 1000 total births in the MZMC (p < .01). Conclusions: Although monozygosity was shown to be a risk factor for perinatal death and accurate determination of zygosity plays a great role in the future consideration of organ transplantation and twin studies, the value of zygosity determination along with chorionicity in relation to overall neonatal morbidity was not definite. |
| doi_str_mv | 10.1375/twin.13.6.609 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_822543802</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><cupid>10_1375_twin_13_6_609</cupid><informt_id>10.3316/informit.597336774209396</informt_id><sourcerecordid>822543802</sourcerecordid><originalsourceid>FETCH-LOGICAL-c518t-6eb04bb1a4d8bc81956561168b578255b3643911d0871bc9b2a6a3a4e4f15d8b3</originalsourceid><addsrcrecordid>eNptkM1vEzEQxVcIREvhyBWtxIHTpmt7_XWsojYtakGoASEulu31bhx27WI7ovnv8SahkRAnP3l-M2_mFcVbUM8Aovg8_bYuqxmZkZo_K04BQ7yCBLLnOw2rBtLmpHgV47quEQW8flmcQAAayBE7LeRyZcqrYH5tjNPbUrq2nA_WWS2H8t72znZZOm1K35XLbFUuTEwyWe9ieaG1D611fZl8-WPb-2jTYcTKh4xYnT9eFy86OUTz5vCeFV-vLpfz6-r28-JmfnFbaQxYqohRdaMUkE3LlGaAY4IJAIQpTBnEWCHSIA5AWzMKlOYKSiKRbEzTAZxb0FnxYT_3Ifh8TUxitFGbYZDO-E0UDELcIFbDTL7_h1z7TXB5OQEpm4wBxZmq9pQOPsZgOvEQ7CjDVoBaTNGLKfqsBBE5-sy_O0zdqNG0T_TfrDPwfQ-E0Sah_TAYvQtyLVMU0cigV8K6zu_qPvSi9VZIFSdDhAA5FjGnCBFKG5iNOTnuamMyj0_WMvwUhE6rksUXAfmnu_u7j9fiW-bPD7fJUQXb9uYYwf-v-wPvI71G</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2789565175</pqid></control><display><type>article</type><title>The Frequency and Clinical Significance of Twin Gestations According to Zygosity and Chorionicity</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Lee, Kyung A. ; Oh, Kyung Joon ; Lee, Seung Mi ; Kim, Ahm ; Jun, Jong Kwan</creator><creatorcontrib>Lee, Kyung A. ; Oh, Kyung Joon ; Lee, Seung Mi ; Kim, Ahm ; Jun, Jong Kwan</creatorcontrib><description>Background: Although the clinical importance of chorionicity in twin pregnancies has been studied widely, the significance of perinatal determination of zygosity using molecular genetic analyses remains controversial. The purpose of this study was to determine the frequency and clinical significance of twin gestations according to zygosity and chorionicity in a Korean population. Methods: We enrolled 569 women who delivered twin newborns (> 24 weeks) at Seoul National University Hospital between 1999 and 2008. Chorionicity was established by histologic examination of placentae. Zygosity was determined with sex of neonates, chorionicity, and DNA analysis of umbilical cord blood. Results: The frequency of dizygotic (DZ) twins was 71.0% (404/569 pairs) based on the opposite sex (238/404 [58.9%]) and DNA analyses (166/404 [41.1%]); that of monozygotic (MZ) twins was 29.0% (165/569), including monochorionic (MC) (72.1% [119/165]) and dichorionic (DC) twins (27.9% [46/165]), which was confirmed by DNA analyses. Among spontaneously conceived twins, the frequency of MZ twins was more than twice that of DZ twins. The risk of low birth weight was 1.8-fold higher among MZDC twins and 1.9-fold higher among MZMC twins than among DZDC twins (p < .05). Bronchopulmonary dysplasia occurred more frequently among MZMC twins than among DZDC twins (adjusted OR 8.42, 95% CI 1.82–39.08, p < .01). However, the frequencies of other neonatal morbidities were not significantly higher in the MZMC group than in the MZDC and DZDC groups. The perinatal mortality rate was 15 per 1000 total births in the DZDC twins, 20 per 1000 total births in the MZDC and 56 per 1000 total births in the MZMC (p < .01). Conclusions: Although monozygosity was shown to be a risk factor for perinatal death and accurate determination of zygosity plays a great role in the future consideration of organ transplantation and twin studies, the value of zygosity determination along with chorionicity in relation to overall neonatal morbidity was not definite.</description><identifier>ISSN: 1832-4274</identifier><identifier>EISSN: 1839-2628</identifier><identifier>DOI: 10.1375/twin.13.6.609</identifier><identifier>PMID: 21142938</identifier><language>eng</language><publisher>Cambridge, UK: Cambridge University Press</publisher><subject>Adult ; Analysis ; Birth weight ; Births ; Chorion - pathology ; chorionicity ; Clinical significance ; Cohort Studies ; Cord blood ; Deoxyribonucleic acid ; Diseases in Twins - etiology ; DNA ; DNA - genetics ; DNA analysis ; Dysplasia ; Embryology ; Female ; Genetic analysis ; Gestational Age ; Human genetics ; Humans ; Infant Mortality ; Infant, Newborn ; Low-birth-weight ; Male ; Morbidity ; Mortality ; Neonates ; Newborn infants ; placenta ; Pregnancy ; Pregnancy Outcome ; Prognosis ; Retrospective Studies ; Risk factors ; Transplantation ; twin ; Twins ; Twins, Dizygotic - genetics ; Twins, Monozygotic - genetics ; Umbilical cord ; Zygosity ; Zygote - pathology</subject><ispartof>Twin research and human genetics, 2010-12, Vol.13 (6), p.609-619</ispartof><rights>Copyright © Cambridge University Press 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c518t-6eb04bb1a4d8bc81956561168b578255b3643911d0871bc9b2a6a3a4e4f15d8b3</citedby><cites>FETCH-LOGICAL-c518t-6eb04bb1a4d8bc81956561168b578255b3643911d0871bc9b2a6a3a4e4f15d8b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21142938$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Kyung A.</creatorcontrib><creatorcontrib>Oh, Kyung Joon</creatorcontrib><creatorcontrib>Lee, Seung Mi</creatorcontrib><creatorcontrib>Kim, Ahm</creatorcontrib><creatorcontrib>Jun, Jong Kwan</creatorcontrib><title>The Frequency and Clinical Significance of Twin Gestations According to Zygosity and Chorionicity</title><title>Twin research and human genetics</title><addtitle>Twin Res Hum Genet</addtitle><description>Background: Although the clinical importance of chorionicity in twin pregnancies has been studied widely, the significance of perinatal determination of zygosity using molecular genetic analyses remains controversial. The purpose of this study was to determine the frequency and clinical significance of twin gestations according to zygosity and chorionicity in a Korean population. Methods: We enrolled 569 women who delivered twin newborns (> 24 weeks) at Seoul National University Hospital between 1999 and 2008. Chorionicity was established by histologic examination of placentae. Zygosity was determined with sex of neonates, chorionicity, and DNA analysis of umbilical cord blood. Results: The frequency of dizygotic (DZ) twins was 71.0% (404/569 pairs) based on the opposite sex (238/404 [58.9%]) and DNA analyses (166/404 [41.1%]); that of monozygotic (MZ) twins was 29.0% (165/569), including monochorionic (MC) (72.1% [119/165]) and dichorionic (DC) twins (27.9% [46/165]), which was confirmed by DNA analyses. Among spontaneously conceived twins, the frequency of MZ twins was more than twice that of DZ twins. The risk of low birth weight was 1.8-fold higher among MZDC twins and 1.9-fold higher among MZMC twins than among DZDC twins (p < .05). Bronchopulmonary dysplasia occurred more frequently among MZMC twins than among DZDC twins (adjusted OR 8.42, 95% CI 1.82–39.08, p < .01). However, the frequencies of other neonatal morbidities were not significantly higher in the MZMC group than in the MZDC and DZDC groups. The perinatal mortality rate was 15 per 1000 total births in the DZDC twins, 20 per 1000 total births in the MZDC and 56 per 1000 total births in the MZMC (p < .01). Conclusions: Although monozygosity was shown to be a risk factor for perinatal death and accurate determination of zygosity plays a great role in the future consideration of organ transplantation and twin studies, the value of zygosity determination along with chorionicity in relation to overall neonatal morbidity was not definite.</description><subject>Adult</subject><subject>Analysis</subject><subject>Birth weight</subject><subject>Births</subject><subject>Chorion - pathology</subject><subject>chorionicity</subject><subject>Clinical significance</subject><subject>Cohort Studies</subject><subject>Cord blood</subject><subject>Deoxyribonucleic acid</subject><subject>Diseases in Twins - etiology</subject><subject>DNA</subject><subject>DNA - genetics</subject><subject>DNA analysis</subject><subject>Dysplasia</subject><subject>Embryology</subject><subject>Female</subject><subject>Genetic analysis</subject><subject>Gestational Age</subject><subject>Human genetics</subject><subject>Humans</subject><subject>Infant Mortality</subject><subject>Infant, Newborn</subject><subject>Low-birth-weight</subject><subject>Male</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Neonates</subject><subject>Newborn infants</subject><subject>placenta</subject><subject>Pregnancy</subject><subject>Pregnancy Outcome</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Transplantation</subject><subject>twin</subject><subject>Twins</subject><subject>Twins, Dizygotic - genetics</subject><subject>Twins, Monozygotic - genetics</subject><subject>Umbilical cord</subject><subject>Zygosity</subject><subject>Zygote - pathology</subject><issn>1832-4274</issn><issn>1839-2628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNptkM1vEzEQxVcIREvhyBWtxIHTpmt7_XWsojYtakGoASEulu31bhx27WI7ovnv8SahkRAnP3l-M2_mFcVbUM8Aovg8_bYuqxmZkZo_K04BQ7yCBLLnOw2rBtLmpHgV47quEQW8flmcQAAayBE7LeRyZcqrYH5tjNPbUrq2nA_WWS2H8t72znZZOm1K35XLbFUuTEwyWe9ieaG1D611fZl8-WPb-2jTYcTKh4xYnT9eFy86OUTz5vCeFV-vLpfz6-r28-JmfnFbaQxYqohRdaMUkE3LlGaAY4IJAIQpTBnEWCHSIA5AWzMKlOYKSiKRbEzTAZxb0FnxYT_3Ifh8TUxitFGbYZDO-E0UDELcIFbDTL7_h1z7TXB5OQEpm4wBxZmq9pQOPsZgOvEQ7CjDVoBaTNGLKfqsBBE5-sy_O0zdqNG0T_TfrDPwfQ-E0Sah_TAYvQtyLVMU0cigV8K6zu_qPvSi9VZIFSdDhAA5FjGnCBFKG5iNOTnuamMyj0_WMvwUhE6rksUXAfmnu_u7j9fiW-bPD7fJUQXb9uYYwf-v-wPvI71G</recordid><startdate>20101201</startdate><enddate>20101201</enddate><creator>Lee, Kyung A.</creator><creator>Oh, Kyung Joon</creator><creator>Lee, Seung Mi</creator><creator>Kim, Ahm</creator><creator>Jun, Jong Kwan</creator><general>Cambridge University Press</general><scope>BSCLL</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>8FD</scope><scope>8FE</scope><scope>8FH</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>LK8</scope><scope>M7P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>20101201</creationdate><title>The Frequency and Clinical Significance of Twin Gestations According to Zygosity and Chorionicity</title><author>Lee, Kyung A. ; Oh, Kyung Joon ; Lee, Seung Mi ; Kim, Ahm ; Jun, Jong Kwan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c518t-6eb04bb1a4d8bc81956561168b578255b3643911d0871bc9b2a6a3a4e4f15d8b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Analysis</topic><topic>Birth weight</topic><topic>Births</topic><topic>Chorion - pathology</topic><topic>chorionicity</topic><topic>Clinical significance</topic><topic>Cohort Studies</topic><topic>Cord blood</topic><topic>Deoxyribonucleic acid</topic><topic>Diseases in Twins - etiology</topic><topic>DNA</topic><topic>DNA - genetics</topic><topic>DNA analysis</topic><topic>Dysplasia</topic><topic>Embryology</topic><topic>Female</topic><topic>Genetic analysis</topic><topic>Gestational Age</topic><topic>Human genetics</topic><topic>Humans</topic><topic>Infant Mortality</topic><topic>Infant, Newborn</topic><topic>Low-birth-weight</topic><topic>Male</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Neonates</topic><topic>Newborn infants</topic><topic>placenta</topic><topic>Pregnancy</topic><topic>Pregnancy Outcome</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Transplantation</topic><topic>twin</topic><topic>Twins</topic><topic>Twins, Dizygotic - genetics</topic><topic>Twins, Monozygotic - genetics</topic><topic>Umbilical cord</topic><topic>Zygosity</topic><topic>Zygote - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Kyung A.</creatorcontrib><creatorcontrib>Oh, Kyung Joon</creatorcontrib><creatorcontrib>Lee, Seung Mi</creatorcontrib><creatorcontrib>Kim, Ahm</creatorcontrib><creatorcontrib>Jun, Jong Kwan</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</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</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Biological Science Database</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>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Twin research and human genetics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Kyung A.</au><au>Oh, Kyung Joon</au><au>Lee, Seung Mi</au><au>Kim, Ahm</au><au>Jun, Jong Kwan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Frequency and Clinical Significance of Twin Gestations According to Zygosity and Chorionicity</atitle><jtitle>Twin research and human genetics</jtitle><addtitle>Twin Res Hum Genet</addtitle><date>2010-12-01</date><risdate>2010</risdate><volume>13</volume><issue>6</issue><spage>609</spage><epage>619</epage><pages>609-619</pages><issn>1832-4274</issn><eissn>1839-2628</eissn><abstract>Background: Although the clinical importance of chorionicity in twin pregnancies has been studied widely, the significance of perinatal determination of zygosity using molecular genetic analyses remains controversial. The purpose of this study was to determine the frequency and clinical significance of twin gestations according to zygosity and chorionicity in a Korean population. Methods: We enrolled 569 women who delivered twin newborns (> 24 weeks) at Seoul National University Hospital between 1999 and 2008. Chorionicity was established by histologic examination of placentae. Zygosity was determined with sex of neonates, chorionicity, and DNA analysis of umbilical cord blood. Results: The frequency of dizygotic (DZ) twins was 71.0% (404/569 pairs) based on the opposite sex (238/404 [58.9%]) and DNA analyses (166/404 [41.1%]); that of monozygotic (MZ) twins was 29.0% (165/569), including monochorionic (MC) (72.1% [119/165]) and dichorionic (DC) twins (27.9% [46/165]), which was confirmed by DNA analyses. Among spontaneously conceived twins, the frequency of MZ twins was more than twice that of DZ twins. The risk of low birth weight was 1.8-fold higher among MZDC twins and 1.9-fold higher among MZMC twins than among DZDC twins (p < .05). Bronchopulmonary dysplasia occurred more frequently among MZMC twins than among DZDC twins (adjusted OR 8.42, 95% CI 1.82–39.08, p < .01). However, the frequencies of other neonatal morbidities were not significantly higher in the MZMC group than in the MZDC and DZDC groups. The perinatal mortality rate was 15 per 1000 total births in the DZDC twins, 20 per 1000 total births in the MZDC and 56 per 1000 total births in the MZMC (p < .01). Conclusions: Although monozygosity was shown to be a risk factor for perinatal death and accurate determination of zygosity plays a great role in the future consideration of organ transplantation and twin studies, the value of zygosity determination along with chorionicity in relation to overall neonatal morbidity was not definite.</abstract><cop>Cambridge, UK</cop><pub>Cambridge University Press</pub><pmid>21142938</pmid><doi>10.1375/twin.13.6.609</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1832-4274 |
| ispartof | Twin research and human genetics, 2010-12, Vol.13 (6), p.609-619 |
| issn | 1832-4274 1839-2628 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_822543802 |
| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Adult Analysis Birth weight Births Chorion - pathology chorionicity Clinical significance Cohort Studies Cord blood Deoxyribonucleic acid Diseases in Twins - etiology DNA DNA - genetics DNA analysis Dysplasia Embryology Female Genetic analysis Gestational Age Human genetics Humans Infant Mortality Infant, Newborn Low-birth-weight Male Morbidity Mortality Neonates Newborn infants placenta Pregnancy Pregnancy Outcome Prognosis Retrospective Studies Risk factors Transplantation twin Twins Twins, Dizygotic - genetics Twins, Monozygotic - genetics Umbilical cord Zygosity Zygote - pathology |
| title | The Frequency and Clinical Significance of Twin Gestations According to Zygosity and Chorionicity |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-31T10%3A30%3A19IST&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=The%20Frequency%20and%20Clinical%20Significance%20of%20Twin%20Gestations%20According%20to%20Zygosity%20and%20Chorionicity&rft.jtitle=Twin%20research%20and%20human%20genetics&rft.au=Lee,%20Kyung%20A.&rft.date=2010-12-01&rft.volume=13&rft.issue=6&rft.spage=609&rft.epage=619&rft.pages=609-619&rft.issn=1832-4274&rft.eissn=1839-2628&rft_id=info:doi/10.1375/twin.13.6.609&rft_dat=%3Cproquest_cross%3E822543802%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=2789565175&rft_id=info:pmid/21142938&rft_cupid=10_1375_twin_13_6_609&rft_informt_id=10.3316/informit.597336774209396&rfr_iscdi=true |