Parents report better health-related quality of life for their food-allergic children than children themselves
Summary Background Food allergy affects 5–6% of children and impairs health‐related quality of life (HRQL). Children and parents may differ in their views concerning the child's HRQL. In food allergy, child‐ and parent‐proxy‐reported HRQL have never been compared using valid disease‐specific in...
Gespeichert in:
| Veröffentlicht in: | Clinical and experimental allergy 2011-10, Vol.41 (10), p.1431-1439 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1439 |
|---|---|
| container_issue | 10 |
| container_start_page | 1431 |
| container_title | Clinical and experimental allergy |
| container_volume | 41 |
| creator | van der Velde, J. L. Flokstra-de Blok, B. M. J. DunnGalvin, A. Hourihane, J. O'B. Duiverman, E. J. Dubois, A. E. J. |
| description | Summary
Background Food allergy affects 5–6% of children and impairs health‐related quality of life (HRQL). Children and parents may differ in their views concerning the child's HRQL. In food allergy, child‐ and parent‐proxy‐reported HRQL have never been compared using valid disease‐specific instruments.
Objective The aim of this study was to compare child‐ and parent‐proxy reports on HRQL in food‐allergic children (8–12 years).
Methods The Food Allergy Quality of Life Questionnaire‐Child Form (FAQLQ‐CF), and ‐Parent Form (FAQLQ‐PF) and the Food Allergy Independent Measure‐Child Form and ‐Parent Form (FAIM‐CF and ‐PF) were completed by Dutch food‐allergic child–parent pairs. Child‐ and parent‐proxy reports were correlated and tested for significant differences. Construct validity (Spearman's correlation coefficient between the FAQLQs and FAIMs) and internal consistency (Cronbach's α) were assessed and compared.
Results Seventy‐four child–parent pairs were included. The FAQLQ‐CF score was significantly higher than the FAQLQ‐PF score (3.74 vs. 2.68, P |
| doi_str_mv | 10.1111/j.1365-2222.2011.03753.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_902811473</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1328508109</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4973-c7f31e2cb1f79124d58e3d6952b6dff4759014009a5ff375d94b81df37e93f8d3</originalsourceid><addsrcrecordid>eNqNkU2P0zAQhiMEYsvCX0CREIJLgh3bsX3gsKqWglQWDiCOlhOPqYubdG0X2n-Psy0FcUDMxWPN886H3qIoMapxjlfrGpOWVU2OukEY14hwRur9vWJ2LtwvZkgyWnEh6UXxKMY1QogwKR4WFw1mrcSNmBXDRx1gSLEMsB1DKjtICUK5Au3TqgrgdQJT3u60d-lQjrb0zkJpx1CmFbiQs9FU2nsIX11f9ivnTe6Xi3r48webCP47xMfFA6t9hCen97L4_Ob60_xttfyweDe_WlY9lZxUPbcEQ9N32PK8JzVMADGtZE3XGmspZxJhipDUzNp8upG0E9jkFCSxwpDL4sWx7zaMtzuISW1c7MF7PcC4i0qiRmBMOcnky3-SmDSCIYGRzOizv9D1uAtDvkNhRhkXLcc8U-JI9WGMMYBV2-A2OhwURmpyT63VZJKaTFKTe-rOPbXP0qenAbtuA-Ys_GVXBp6fAB177W3QQ-_ib46y3OmOe33kfjgPh_9eQM2vr6Ys66uj3sUE-7Neh2-q5ZlQX24Wii7ztJv3C0XIT3oFw_I</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1545786717</pqid></control><display><type>article</type><title>Parents report better health-related quality of life for their food-allergic children than children themselves</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><creator>van der Velde, J. L. ; Flokstra-de Blok, B. M. J. ; DunnGalvin, A. ; Hourihane, J. O'B. ; Duiverman, E. J. ; Dubois, A. E. J.</creator><creatorcontrib>van der Velde, J. L. ; Flokstra-de Blok, B. M. J. ; DunnGalvin, A. ; Hourihane, J. O'B. ; Duiverman, E. J. ; Dubois, A. E. J.</creatorcontrib><description><![CDATA[Summary
Background Food allergy affects 5–6% of children and impairs health‐related quality of life (HRQL). Children and parents may differ in their views concerning the child's HRQL. In food allergy, child‐ and parent‐proxy‐reported HRQL have never been compared using valid disease‐specific instruments.
Objective The aim of this study was to compare child‐ and parent‐proxy reports on HRQL in food‐allergic children (8–12 years).
Methods The Food Allergy Quality of Life Questionnaire‐Child Form (FAQLQ‐CF), and ‐Parent Form (FAQLQ‐PF) and the Food Allergy Independent Measure‐Child Form and ‐Parent Form (FAIM‐CF and ‐PF) were completed by Dutch food‐allergic child–parent pairs. Child‐ and parent‐proxy reports were correlated and tested for significant differences. Construct validity (Spearman's correlation coefficient between the FAQLQs and FAIMs) and internal consistency (Cronbach's α) were assessed and compared.
Results Seventy‐four child–parent pairs were included. The FAQLQ‐CF score was significantly higher than the FAQLQ‐PF score (3.74 vs. 2.68, P<0.001, where 1 indicates no impairment and 7 indicates extreme impairment). FAIM‐CF and ‐PF scores were almost identical (3.29 vs. 3.33, P=0.594). There was moderate agreement between the FAQLQ‐CF and ‐PF scores (ICC=0.57 [P<0.001]) and good agreement between the FAIM‐CF and ‐PF scores (ICC=0.80 [P<0.001]). Construct validity was confirmed for the FAQLQ‐CF (ρ=0.60, P<0.001) and ‐PF (ρ=0.58, P<0.001). Internal consistency was excellent for the FAQLQ‐CF (α=0.95) and ‐PF (α=0.95).
Conclusions and Clinical Relevance Parents reported significantly less impact of food allergy on the child's HRQL than children themselves, while reported perceptions of disease severity were nearly identical. This may reflect real differences in perspectives between children and parents and may indicate that parents tend to underestimate their child's HRQL impairment.
It is important for clinicians to include both the child's and their parent's perceptions in order to perform a complete assessment of the impact of food allergy on the child's HRQL and to identify areas of disagreement that need special attention in clinical practice.
Cite this as: J. L. van der Velde, B. M. J. Flokstra‐de Blok, A. DunnGalvin, J. O'B. Hourihane, E. J. Duiverman and A. E. J. Dubois, Clinical & Experimental Allergy, 2011 (41) 1431–1439.]]></description><identifier>ISSN: 0954-7894</identifier><identifier>EISSN: 1365-2222</identifier><identifier>DOI: 10.1111/j.1365-2222.2011.03753.x</identifier><identifier>PMID: 21569128</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adult ; Allergic diseases ; Allergies ; Biological and medical sciences ; Child ; Children ; Digestive allergic diseases ; Female ; Food ; Food allergies ; food allergy ; Food hypersensitivity ; Food Hypersensitivity - etiology ; Food Hypersensitivity - psychology ; Food quality ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Health Status ; Health Status Indicators ; health-related quality of life ; Humans ; Immunopathology ; Male ; Medical sciences ; parent-report ; Parents - psychology ; Peanuts ; Perception ; Psychometrics ; Quality of life ; Quality of Life - psychology ; Self-Assessment ; self-report ; Surveys and Questionnaires</subject><ispartof>Clinical and experimental allergy, 2011-10, Vol.41 (10), p.1431-1439</ispartof><rights>2011 Blackwell Publishing Ltd</rights><rights>2015 INIST-CNRS</rights><rights>2011 Blackwell Publishing Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4973-c7f31e2cb1f79124d58e3d6952b6dff4759014009a5ff375d94b81df37e93f8d3</citedby><cites>FETCH-LOGICAL-c4973-c7f31e2cb1f79124d58e3d6952b6dff4759014009a5ff375d94b81df37e93f8d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1365-2222.2011.03753.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1365-2222.2011.03753.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24537528$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21569128$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van der Velde, J. L.</creatorcontrib><creatorcontrib>Flokstra-de Blok, B. M. J.</creatorcontrib><creatorcontrib>DunnGalvin, A.</creatorcontrib><creatorcontrib>Hourihane, J. O'B.</creatorcontrib><creatorcontrib>Duiverman, E. J.</creatorcontrib><creatorcontrib>Dubois, A. E. J.</creatorcontrib><title>Parents report better health-related quality of life for their food-allergic children than children themselves</title><title>Clinical and experimental allergy</title><addtitle>Clin Exp Allergy</addtitle><description><![CDATA[Summary
Background Food allergy affects 5–6% of children and impairs health‐related quality of life (HRQL). Children and parents may differ in their views concerning the child's HRQL. In food allergy, child‐ and parent‐proxy‐reported HRQL have never been compared using valid disease‐specific instruments.
Objective The aim of this study was to compare child‐ and parent‐proxy reports on HRQL in food‐allergic children (8–12 years).
Methods The Food Allergy Quality of Life Questionnaire‐Child Form (FAQLQ‐CF), and ‐Parent Form (FAQLQ‐PF) and the Food Allergy Independent Measure‐Child Form and ‐Parent Form (FAIM‐CF and ‐PF) were completed by Dutch food‐allergic child–parent pairs. Child‐ and parent‐proxy reports were correlated and tested for significant differences. Construct validity (Spearman's correlation coefficient between the FAQLQs and FAIMs) and internal consistency (Cronbach's α) were assessed and compared.
Results Seventy‐four child–parent pairs were included. The FAQLQ‐CF score was significantly higher than the FAQLQ‐PF score (3.74 vs. 2.68, P<0.001, where 1 indicates no impairment and 7 indicates extreme impairment). FAIM‐CF and ‐PF scores were almost identical (3.29 vs. 3.33, P=0.594). There was moderate agreement between the FAQLQ‐CF and ‐PF scores (ICC=0.57 [P<0.001]) and good agreement between the FAIM‐CF and ‐PF scores (ICC=0.80 [P<0.001]). Construct validity was confirmed for the FAQLQ‐CF (ρ=0.60, P<0.001) and ‐PF (ρ=0.58, P<0.001). Internal consistency was excellent for the FAQLQ‐CF (α=0.95) and ‐PF (α=0.95).
Conclusions and Clinical Relevance Parents reported significantly less impact of food allergy on the child's HRQL than children themselves, while reported perceptions of disease severity were nearly identical. This may reflect real differences in perspectives between children and parents and may indicate that parents tend to underestimate their child's HRQL impairment.
It is important for clinicians to include both the child's and their parent's perceptions in order to perform a complete assessment of the impact of food allergy on the child's HRQL and to identify areas of disagreement that need special attention in clinical practice.
Cite this as: J. L. van der Velde, B. M. J. Flokstra‐de Blok, A. DunnGalvin, J. O'B. Hourihane, E. J. Duiverman and A. E. J. Dubois, Clinical & Experimental Allergy, 2011 (41) 1431–1439.]]></description><subject>Adult</subject><subject>Allergic diseases</subject><subject>Allergies</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Children</subject><subject>Digestive allergic diseases</subject><subject>Female</subject><subject>Food</subject><subject>Food allergies</subject><subject>food allergy</subject><subject>Food hypersensitivity</subject><subject>Food Hypersensitivity - etiology</subject><subject>Food Hypersensitivity - psychology</subject><subject>Food quality</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Health Status</subject><subject>Health Status Indicators</subject><subject>health-related quality of life</subject><subject>Humans</subject><subject>Immunopathology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>parent-report</subject><subject>Parents - psychology</subject><subject>Peanuts</subject><subject>Perception</subject><subject>Psychometrics</subject><subject>Quality of life</subject><subject>Quality of Life - psychology</subject><subject>Self-Assessment</subject><subject>self-report</subject><subject>Surveys and Questionnaires</subject><issn>0954-7894</issn><issn>1365-2222</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU2P0zAQhiMEYsvCX0CREIJLgh3bsX3gsKqWglQWDiCOlhOPqYubdG0X2n-Psy0FcUDMxWPN886H3qIoMapxjlfrGpOWVU2OukEY14hwRur9vWJ2LtwvZkgyWnEh6UXxKMY1QogwKR4WFw1mrcSNmBXDRx1gSLEMsB1DKjtICUK5Au3TqgrgdQJT3u60d-lQjrb0zkJpx1CmFbiQs9FU2nsIX11f9ivnTe6Xi3r48webCP47xMfFA6t9hCen97L4_Ob60_xttfyweDe_WlY9lZxUPbcEQ9N32PK8JzVMADGtZE3XGmspZxJhipDUzNp8upG0E9jkFCSxwpDL4sWx7zaMtzuISW1c7MF7PcC4i0qiRmBMOcnky3-SmDSCIYGRzOizv9D1uAtDvkNhRhkXLcc8U-JI9WGMMYBV2-A2OhwURmpyT63VZJKaTFKTe-rOPbXP0qenAbtuA-Ys_GVXBp6fAB177W3QQ-_ib46y3OmOe33kfjgPh_9eQM2vr6Ys66uj3sUE-7Neh2-q5ZlQX24Wii7ztJv3C0XIT3oFw_I</recordid><startdate>201110</startdate><enddate>201110</enddate><creator>van der Velde, J. L.</creator><creator>Flokstra-de Blok, B. M. J.</creator><creator>DunnGalvin, A.</creator><creator>Hourihane, J. O'B.</creator><creator>Duiverman, E. J.</creator><creator>Dubois, A. E. J.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>IQODW</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>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201110</creationdate><title>Parents report better health-related quality of life for their food-allergic children than children themselves</title><author>van der Velde, J. L. ; Flokstra-de Blok, B. M. J. ; DunnGalvin, A. ; Hourihane, J. O'B. ; Duiverman, E. J. ; Dubois, A. E. J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4973-c7f31e2cb1f79124d58e3d6952b6dff4759014009a5ff375d94b81df37e93f8d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Allergic diseases</topic><topic>Allergies</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Children</topic><topic>Digestive allergic diseases</topic><topic>Female</topic><topic>Food</topic><topic>Food allergies</topic><topic>food allergy</topic><topic>Food hypersensitivity</topic><topic>Food Hypersensitivity - etiology</topic><topic>Food Hypersensitivity - psychology</topic><topic>Food quality</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Fundamental immunology</topic><topic>Health Status</topic><topic>Health Status Indicators</topic><topic>health-related quality of life</topic><topic>Humans</topic><topic>Immunopathology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>parent-report</topic><topic>Parents - psychology</topic><topic>Peanuts</topic><topic>Perception</topic><topic>Psychometrics</topic><topic>Quality of life</topic><topic>Quality of Life - psychology</topic><topic>Self-Assessment</topic><topic>self-report</topic><topic>Surveys and Questionnaires</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van der Velde, J. L.</creatorcontrib><creatorcontrib>Flokstra-de Blok, B. M. J.</creatorcontrib><creatorcontrib>DunnGalvin, A.</creatorcontrib><creatorcontrib>Hourihane, J. O'B.</creatorcontrib><creatorcontrib>Duiverman, E. J.</creatorcontrib><creatorcontrib>Dubois, A. E. J.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical and experimental allergy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van der Velde, J. L.</au><au>Flokstra-de Blok, B. M. J.</au><au>DunnGalvin, A.</au><au>Hourihane, J. O'B.</au><au>Duiverman, E. J.</au><au>Dubois, A. E. J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Parents report better health-related quality of life for their food-allergic children than children themselves</atitle><jtitle>Clinical and experimental allergy</jtitle><addtitle>Clin Exp Allergy</addtitle><date>2011-10</date><risdate>2011</risdate><volume>41</volume><issue>10</issue><spage>1431</spage><epage>1439</epage><pages>1431-1439</pages><issn>0954-7894</issn><eissn>1365-2222</eissn><abstract><![CDATA[Summary
Background Food allergy affects 5–6% of children and impairs health‐related quality of life (HRQL). Children and parents may differ in their views concerning the child's HRQL. In food allergy, child‐ and parent‐proxy‐reported HRQL have never been compared using valid disease‐specific instruments.
Objective The aim of this study was to compare child‐ and parent‐proxy reports on HRQL in food‐allergic children (8–12 years).
Methods The Food Allergy Quality of Life Questionnaire‐Child Form (FAQLQ‐CF), and ‐Parent Form (FAQLQ‐PF) and the Food Allergy Independent Measure‐Child Form and ‐Parent Form (FAIM‐CF and ‐PF) were completed by Dutch food‐allergic child–parent pairs. Child‐ and parent‐proxy reports were correlated and tested for significant differences. Construct validity (Spearman's correlation coefficient between the FAQLQs and FAIMs) and internal consistency (Cronbach's α) were assessed and compared.
Results Seventy‐four child–parent pairs were included. The FAQLQ‐CF score was significantly higher than the FAQLQ‐PF score (3.74 vs. 2.68, P<0.001, where 1 indicates no impairment and 7 indicates extreme impairment). FAIM‐CF and ‐PF scores were almost identical (3.29 vs. 3.33, P=0.594). There was moderate agreement between the FAQLQ‐CF and ‐PF scores (ICC=0.57 [P<0.001]) and good agreement between the FAIM‐CF and ‐PF scores (ICC=0.80 [P<0.001]). Construct validity was confirmed for the FAQLQ‐CF (ρ=0.60, P<0.001) and ‐PF (ρ=0.58, P<0.001). Internal consistency was excellent for the FAQLQ‐CF (α=0.95) and ‐PF (α=0.95).
Conclusions and Clinical Relevance Parents reported significantly less impact of food allergy on the child's HRQL than children themselves, while reported perceptions of disease severity were nearly identical. This may reflect real differences in perspectives between children and parents and may indicate that parents tend to underestimate their child's HRQL impairment.
It is important for clinicians to include both the child's and their parent's perceptions in order to perform a complete assessment of the impact of food allergy on the child's HRQL and to identify areas of disagreement that need special attention in clinical practice.
Cite this as: J. L. van der Velde, B. M. J. Flokstra‐de Blok, A. DunnGalvin, J. O'B. Hourihane, E. J. Duiverman and A. E. J. Dubois, Clinical & Experimental Allergy, 2011 (41) 1431–1439.]]></abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>21569128</pmid><doi>10.1111/j.1365-2222.2011.03753.x</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0954-7894 |
| ispartof | Clinical and experimental allergy, 2011-10, Vol.41 (10), p.1431-1439 |
| issn | 0954-7894 1365-2222 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_902811473 |
| source | MEDLINE; Wiley Online Library All Journals |
| subjects | Adult Allergic diseases Allergies Biological and medical sciences Child Children Digestive allergic diseases Female Food Food allergies food allergy Food hypersensitivity Food Hypersensitivity - etiology Food Hypersensitivity - psychology Food quality Fundamental and applied biological sciences. Psychology Fundamental immunology Health Status Health Status Indicators health-related quality of life Humans Immunopathology Male Medical sciences parent-report Parents - psychology Peanuts Perception Psychometrics Quality of life Quality of Life - psychology Self-Assessment self-report Surveys and Questionnaires |
| title | Parents report better health-related quality of life for their food-allergic children than children themselves |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-05T20%3A50%3A31IST&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=Parents%20report%20better%20health-related%20quality%20of%20life%20for%20their%20food-allergic%20children%20than%20children%20themselves&rft.jtitle=Clinical%20and%20experimental%20allergy&rft.au=van%20der%20Velde,%20J.%20L.&rft.date=2011-10&rft.volume=41&rft.issue=10&rft.spage=1431&rft.epage=1439&rft.pages=1431-1439&rft.issn=0954-7894&rft.eissn=1365-2222&rft_id=info:doi/10.1111/j.1365-2222.2011.03753.x&rft_dat=%3Cproquest_cross%3E1328508109%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=1545786717&rft_id=info:pmid/21569128&rfr_iscdi=true |