Extensive Phenotyping for Potential Weight-Inducing Factors in an Outpatient Population with Obesity
Background: Obesity has been associated with miscellaneous weight-inducing determinants. A comprehensive assessment of known obesity-related factors other than diet and physical activity within one cohort is currently lacking. Objectives: To assess the prevalence of potential contributors to obesity...
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| Veröffentlicht in: | Obesity Facts 2019-09, Vol.12 (4), p.369-384 |
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| creator | Savas, Mesut Wester, Vincent L. Visser, Jenny A. Kleinendorst, Lotte van der Zwaag, Bert van Haelst, Mieke M. van den Akker, Erica L.T. van Rossum, Elisabeth F.C. |
| description | Background: Obesity has been associated with miscellaneous weight-inducing determinants. A comprehensive assessment of known obesity-related factors other than diet and physical activity within one cohort is currently lacking. Objectives: To assess the prevalence of potential contributors to obesity and self-reported triggers for marked weight gain in an adult population with obesity and between obesity classes. Methods: In this observational cohort study, we assessed 408 persons with obesity (aged 41.3 ± 14.2 years, BMI 40.5 ± 6.2) visiting our obesity clinic. They were evaluated for use of weight-inducing drugs, hormonal abnormalities, menarcheal age, (high) birth weight, sleep deprivation, and obstructive sleep apnea syndrome (OSAS). We additionally assessed self-reported triggers for marked weight gain and performed genetic testing in patients suspected of genetic obesity. Results: Nearly half of the patients were using a potentially weight-inducing drug, which was also the most reported trigger for marked weight gain. For the assessed hormonal conditions, a relatively high prevalence was found for hypothyroidism (14.1%), polycystic ovary syndrome (12.0%), and male hypogonadism (41.7%). A relatively low average menarcheal age (12.6 ± 1.8 years) was reported, whereas there was a high prevalence of a high birth weight (19.5%). Sleep deprivation and OSAS were reported in, respectively, 14.5 and 13.7% of the examined patients. Obesity class appeared to have no influence on the majority of the assessed factors. Of the genetically analyzed patients, a definitive genetic diagnosis was made in 3 patients (1.9%). Conclusions: A thorough evaluation of patients with obesity yields a relatively high prevalence of various potentially weight-inducing factors. Diagnostic screening of patients with obesity could therefore benefit these patients by potentially reducing the social stigma and improving the outcomes of obesity treatment programs by tackling, where possible, the weight-inducing factors in advance. |
| doi_str_mv | 10.1159/000499978 |
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A comprehensive assessment of known obesity-related factors other than diet and physical activity within one cohort is currently lacking. Objectives: To assess the prevalence of potential contributors to obesity and self-reported triggers for marked weight gain in an adult population with obesity and between obesity classes. Methods: In this observational cohort study, we assessed 408 persons with obesity (aged 41.3 ± 14.2 years, BMI 40.5 ± 6.2) visiting our obesity clinic. They were evaluated for use of weight-inducing drugs, hormonal abnormalities, menarcheal age, (high) birth weight, sleep deprivation, and obstructive sleep apnea syndrome (OSAS). We additionally assessed self-reported triggers for marked weight gain and performed genetic testing in patients suspected of genetic obesity. Results: Nearly half of the patients were using a potentially weight-inducing drug, which was also the most reported trigger for marked weight gain. For the assessed hormonal conditions, a relatively high prevalence was found for hypothyroidism (14.1%), polycystic ovary syndrome (12.0%), and male hypogonadism (41.7%). A relatively low average menarcheal age (12.6 ± 1.8 years) was reported, whereas there was a high prevalence of a high birth weight (19.5%). Sleep deprivation and OSAS were reported in, respectively, 14.5 and 13.7% of the examined patients. Obesity class appeared to have no influence on the majority of the assessed factors. Of the genetically analyzed patients, a definitive genetic diagnosis was made in 3 patients (1.9%). Conclusions: A thorough evaluation of patients with obesity yields a relatively high prevalence of various potentially weight-inducing factors. Diagnostic screening of patients with obesity could therefore benefit these patients by potentially reducing the social stigma and improving the outcomes of obesity treatment programs by tackling, where possible, the weight-inducing factors in advance.</description><identifier>ISSN: 1662-4025</identifier><identifier>EISSN: 1662-4033</identifier><identifier>DOI: 10.1159/000499978</identifier><identifier>PMID: 31216558</identifier><language>eng</language><publisher>Basel, Switzerland: S. Karger AG</publisher><subject>Adolescent ; Adult ; Adverse drug reactions ; Age ; Apnea ; Birth weight ; Body Mass Index ; Causality ; Cohort Studies ; Demographic aspects ; Diagnosis ; Diet - adverse effects ; Drug use ; Drug-Related Side Effects and Adverse Reactions - complications ; Drug-Related Side Effects and Adverse Reactions - epidemiology ; Drugs ; Education ; Endocrine System Diseases - complications ; Endocrine System Diseases - epidemiology ; Exercise ; Exercise - physiology ; Family medical history ; Female ; Genes ; Genetic aspects ; Genetic testing ; Genetics ; Humans ; Hypogonadism ; Hypothyroidism ; Male ; Medical History Taking - statistics & numerical data ; Metabolism ; Middle Aged ; Obesity ; Obesity - epidemiology ; Obesity - etiology ; Outpatient care facilities ; Outpatients ; Phenotype ; Physical fitness ; Polycystic ovary syndrome ; Population ; Prevalence ; Research Article ; Risk Factors ; Secondary causes ; Self report ; Sleep ; Sleep apnea ; Sleep Apnea, Obstructive - complications ; Sleep Apnea, Obstructive - epidemiology ; Sleep deprivation ; Testosterone ; Thyroid gland ; Thyroid hormones ; Trends ; Type 2 diabetes ; Weight control ; Weight gain ; Weight Gain - physiology ; Young Adult</subject><ispartof>Obesity Facts, 2019-09, Vol.12 (4), p.369-384</ispartof><rights>2019 The Author(s) Published by S. Karger AG, Basel</rights><rights>2019 The Author(s) Published by S. Karger AG, Basel.</rights><rights>COPYRIGHT 2019 S. Karger AG</rights><rights>Copyright © 2019 by S. Karger AG, Basel 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c585t-537a70ba6d98e43b9adb6acd87772193630f9729752ae864f3c32dccf6fa536b3</citedby><cites>FETCH-LOGICAL-c585t-537a70ba6d98e43b9adb6acd87772193630f9729752ae864f3c32dccf6fa536b3</cites><orcidid>0000-0001-5223-1140 ; 0000-0001-5352-9328</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6758708/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6758708/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2095,27614,27903,27904,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31216558$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Savas, Mesut</creatorcontrib><creatorcontrib>Wester, Vincent L.</creatorcontrib><creatorcontrib>Visser, Jenny A.</creatorcontrib><creatorcontrib>Kleinendorst, Lotte</creatorcontrib><creatorcontrib>van der Zwaag, Bert</creatorcontrib><creatorcontrib>van Haelst, Mieke M.</creatorcontrib><creatorcontrib>van den Akker, Erica L.T.</creatorcontrib><creatorcontrib>van Rossum, Elisabeth F.C.</creatorcontrib><title>Extensive Phenotyping for Potential Weight-Inducing Factors in an Outpatient Population with Obesity</title><title>Obesity Facts</title><addtitle>Obes Facts</addtitle><description>Background: Obesity has been associated with miscellaneous weight-inducing determinants. A comprehensive assessment of known obesity-related factors other than diet and physical activity within one cohort is currently lacking. Objectives: To assess the prevalence of potential contributors to obesity and self-reported triggers for marked weight gain in an adult population with obesity and between obesity classes. Methods: In this observational cohort study, we assessed 408 persons with obesity (aged 41.3 ± 14.2 years, BMI 40.5 ± 6.2) visiting our obesity clinic. They were evaluated for use of weight-inducing drugs, hormonal abnormalities, menarcheal age, (high) birth weight, sleep deprivation, and obstructive sleep apnea syndrome (OSAS). We additionally assessed self-reported triggers for marked weight gain and performed genetic testing in patients suspected of genetic obesity. Results: Nearly half of the patients were using a potentially weight-inducing drug, which was also the most reported trigger for marked weight gain. For the assessed hormonal conditions, a relatively high prevalence was found for hypothyroidism (14.1%), polycystic ovary syndrome (12.0%), and male hypogonadism (41.7%). A relatively low average menarcheal age (12.6 ± 1.8 years) was reported, whereas there was a high prevalence of a high birth weight (19.5%). Sleep deprivation and OSAS were reported in, respectively, 14.5 and 13.7% of the examined patients. Obesity class appeared to have no influence on the majority of the assessed factors. Of the genetically analyzed patients, a definitive genetic diagnosis was made in 3 patients (1.9%). Conclusions: A thorough evaluation of patients with obesity yields a relatively high prevalence of various potentially weight-inducing factors. Diagnostic screening of patients with obesity could therefore benefit these patients by potentially reducing the social stigma and improving the outcomes of obesity treatment programs by tackling, where possible, the weight-inducing factors in advance.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Adverse drug reactions</subject><subject>Age</subject><subject>Apnea</subject><subject>Birth weight</subject><subject>Body Mass Index</subject><subject>Causality</subject><subject>Cohort Studies</subject><subject>Demographic aspects</subject><subject>Diagnosis</subject><subject>Diet - adverse effects</subject><subject>Drug use</subject><subject>Drug-Related Side Effects and Adverse Reactions - complications</subject><subject>Drug-Related Side Effects and Adverse Reactions - epidemiology</subject><subject>Drugs</subject><subject>Education</subject><subject>Endocrine System Diseases - complications</subject><subject>Endocrine System Diseases - epidemiology</subject><subject>Exercise</subject><subject>Exercise - physiology</subject><subject>Family medical history</subject><subject>Female</subject><subject>Genes</subject><subject>Genetic aspects</subject><subject>Genetic testing</subject><subject>Genetics</subject><subject>Humans</subject><subject>Hypogonadism</subject><subject>Hypothyroidism</subject><subject>Male</subject><subject>Medical History Taking - statistics & numerical data</subject><subject>Metabolism</subject><subject>Middle Aged</subject><subject>Obesity</subject><subject>Obesity - epidemiology</subject><subject>Obesity - etiology</subject><subject>Outpatient care facilities</subject><subject>Outpatients</subject><subject>Phenotype</subject><subject>Physical fitness</subject><subject>Polycystic ovary syndrome</subject><subject>Population</subject><subject>Prevalence</subject><subject>Research Article</subject><subject>Risk Factors</subject><subject>Secondary causes</subject><subject>Self report</subject><subject>Sleep</subject><subject>Sleep apnea</subject><subject>Sleep Apnea, Obstructive - complications</subject><subject>Sleep Apnea, Obstructive - epidemiology</subject><subject>Sleep deprivation</subject><subject>Testosterone</subject><subject>Thyroid gland</subject><subject>Thyroid hormones</subject><subject>Trends</subject><subject>Type 2 diabetes</subject><subject>Weight control</subject><subject>Weight gain</subject><subject>Weight Gain - physiology</subject><subject>Young Adult</subject><issn>1662-4025</issn><issn>1662-4033</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>M--</sourceid><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><sourceid>DOA</sourceid><recordid>eNptkk1v1DAQhiMEomXhwB2hSL3AYYs_4o9cKq2qLqxUaXsAcbQcx856ydrBdgr77_GSElGEfPBo3mdee0ZTFK8huISQ1B8AAFVd14w_Kc4hpWhZAYyfzjEiZ8WLGPcAUFgx-Lw4wxBBSgg_L9qbn0m7aO91ebfTzqfjYF1XGh_KO5-VZGVfftW226XlxrWjOqlrqZIPsbSulK7cjmmQyWY2lwxjn2Pvyh827cpto6NNx5fFMyP7qF893Iviy_rm8_Wn5e324-Z6dbtUhJO0JJhJBhpJ25rrCje1bBsqVcsZYwjWmGJgaoZqRpDUnFYGK4xapQw1kmDa4EWxmXxbL_diCPYgw1F4acXvhA-dkCFZ1WuBoTRNRWulka4qwzk2iGLNIGC45eTkdTV5DWNz0K3K7QXZPzJ9rDi7E52_F5QRzgDPBu8eDIL_PuqYxMFGpfteOu3HKBCqKohhxUFGL_5B934MLo9KIAwA4ZwjlKnLiepkbsA64_O7Kp9WH6zyThub8ysKUI0ozfNaFO-nAhV8jEGb-fcQiNPiiHlxMvv273Zn8s-mZODNBHyTodNhBub6i__K2_VqIsTQGvwLeenS_Q</recordid><startdate>20190901</startdate><enddate>20190901</enddate><creator>Savas, Mesut</creator><creator>Wester, Vincent L.</creator><creator>Visser, Jenny A.</creator><creator>Kleinendorst, Lotte</creator><creator>van der Zwaag, Bert</creator><creator>van Haelst, Mieke M.</creator><creator>van den Akker, Erica L.T.</creator><creator>van Rossum, Elisabeth F.C.</creator><general>S. 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adverse effects</topic><topic>Drug use</topic><topic>Drug-Related Side Effects and Adverse Reactions - complications</topic><topic>Drug-Related Side Effects and Adverse Reactions - epidemiology</topic><topic>Drugs</topic><topic>Education</topic><topic>Endocrine System Diseases - complications</topic><topic>Endocrine System Diseases - epidemiology</topic><topic>Exercise</topic><topic>Exercise - physiology</topic><topic>Family medical history</topic><topic>Female</topic><topic>Genes</topic><topic>Genetic aspects</topic><topic>Genetic testing</topic><topic>Genetics</topic><topic>Humans</topic><topic>Hypogonadism</topic><topic>Hypothyroidism</topic><topic>Male</topic><topic>Medical History Taking - statistics & numerical data</topic><topic>Metabolism</topic><topic>Middle Aged</topic><topic>Obesity</topic><topic>Obesity - epidemiology</topic><topic>Obesity - etiology</topic><topic>Outpatient care facilities</topic><topic>Outpatients</topic><topic>Phenotype</topic><topic>Physical fitness</topic><topic>Polycystic ovary syndrome</topic><topic>Population</topic><topic>Prevalence</topic><topic>Research Article</topic><topic>Risk Factors</topic><topic>Secondary causes</topic><topic>Self report</topic><topic>Sleep</topic><topic>Sleep apnea</topic><topic>Sleep Apnea, Obstructive - complications</topic><topic>Sleep Apnea, Obstructive - epidemiology</topic><topic>Sleep deprivation</topic><topic>Testosterone</topic><topic>Thyroid gland</topic><topic>Thyroid hormones</topic><topic>Trends</topic><topic>Type 2 diabetes</topic><topic>Weight control</topic><topic>Weight gain</topic><topic>Weight Gain - physiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Savas, Mesut</creatorcontrib><creatorcontrib>Wester, Vincent L.</creatorcontrib><creatorcontrib>Visser, Jenny A.</creatorcontrib><creatorcontrib>Kleinendorst, Lotte</creatorcontrib><creatorcontrib>van der Zwaag, Bert</creatorcontrib><creatorcontrib>van Haelst, Mieke M.</creatorcontrib><creatorcontrib>van den Akker, Erica L.T.</creatorcontrib><creatorcontrib>van Rossum, Elisabeth F.C.</creatorcontrib><collection>Karger 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>Gale Academic OneFile</collection><collection>ProQuest Central (Corporate)</collection><collection>ABI/INFORM Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ABI/INFORM Trade & Industry (Alumni Edition)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ABI/INFORM Collection (Alumni Edition)</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>Business Premium Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Business Premium Collection (Alumni)</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 Business Collection (Alumni Edition)</collection><collection>ProQuest Business Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ABI/INFORM Trade & Industry</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Research Library China</collection><collection>ProQuest One Business</collection><collection>ProQuest One Business (Alumni)</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>ABI/INFORM Collection China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Obesity Facts</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Savas, Mesut</au><au>Wester, Vincent L.</au><au>Visser, Jenny A.</au><au>Kleinendorst, Lotte</au><au>van der Zwaag, Bert</au><au>van Haelst, Mieke M.</au><au>van den Akker, Erica L.T.</au><au>van Rossum, Elisabeth F.C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Extensive Phenotyping for Potential Weight-Inducing Factors in an Outpatient Population with Obesity</atitle><jtitle>Obesity Facts</jtitle><addtitle>Obes Facts</addtitle><date>2019-09-01</date><risdate>2019</risdate><volume>12</volume><issue>4</issue><spage>369</spage><epage>384</epage><pages>369-384</pages><issn>1662-4025</issn><eissn>1662-4033</eissn><abstract>Background: Obesity has been associated with miscellaneous weight-inducing determinants. A comprehensive assessment of known obesity-related factors other than diet and physical activity within one cohort is currently lacking. Objectives: To assess the prevalence of potential contributors to obesity and self-reported triggers for marked weight gain in an adult population with obesity and between obesity classes. Methods: In this observational cohort study, we assessed 408 persons with obesity (aged 41.3 ± 14.2 years, BMI 40.5 ± 6.2) visiting our obesity clinic. They were evaluated for use of weight-inducing drugs, hormonal abnormalities, menarcheal age, (high) birth weight, sleep deprivation, and obstructive sleep apnea syndrome (OSAS). We additionally assessed self-reported triggers for marked weight gain and performed genetic testing in patients suspected of genetic obesity. Results: Nearly half of the patients were using a potentially weight-inducing drug, which was also the most reported trigger for marked weight gain. For the assessed hormonal conditions, a relatively high prevalence was found for hypothyroidism (14.1%), polycystic ovary syndrome (12.0%), and male hypogonadism (41.7%). A relatively low average menarcheal age (12.6 ± 1.8 years) was reported, whereas there was a high prevalence of a high birth weight (19.5%). Sleep deprivation and OSAS were reported in, respectively, 14.5 and 13.7% of the examined patients. Obesity class appeared to have no influence on the majority of the assessed factors. Of the genetically analyzed patients, a definitive genetic diagnosis was made in 3 patients (1.9%). Conclusions: A thorough evaluation of patients with obesity yields a relatively high prevalence of various potentially weight-inducing factors. Diagnostic screening of patients with obesity could therefore benefit these patients by potentially reducing the social stigma and improving the outcomes of obesity treatment programs by tackling, where possible, the weight-inducing factors in advance.</abstract><cop>Basel, Switzerland</cop><pub>S. Karger AG</pub><pmid>31216558</pmid><doi>10.1159/000499978</doi><tpages>16</tpages><orcidid>https://orcid.org/0000-0001-5223-1140</orcidid><orcidid>https://orcid.org/0000-0001-5352-9328</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1662-4025 |
| ispartof | Obesity Facts, 2019-09, Vol.12 (4), p.369-384 |
| issn | 1662-4025 1662-4033 |
| language | eng |
| recordid | cdi_pubmed_primary_31216558 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Karger Open Access; PubMed Central |
| subjects | Adolescent Adult Adverse drug reactions Age Apnea Birth weight Body Mass Index Causality Cohort Studies Demographic aspects Diagnosis Diet - adverse effects Drug use Drug-Related Side Effects and Adverse Reactions - complications Drug-Related Side Effects and Adverse Reactions - epidemiology Drugs Education Endocrine System Diseases - complications Endocrine System Diseases - epidemiology Exercise Exercise - physiology Family medical history Female Genes Genetic aspects Genetic testing Genetics Humans Hypogonadism Hypothyroidism Male Medical History Taking - statistics & numerical data Metabolism Middle Aged Obesity Obesity - epidemiology Obesity - etiology Outpatient care facilities Outpatients Phenotype Physical fitness Polycystic ovary syndrome Population Prevalence Research Article Risk Factors Secondary causes Self report Sleep Sleep apnea Sleep Apnea, Obstructive - complications Sleep Apnea, Obstructive - epidemiology Sleep deprivation Testosterone Thyroid gland Thyroid hormones Trends Type 2 diabetes Weight control Weight gain Weight Gain - physiology Young Adult |
| title | Extensive Phenotyping for Potential Weight-Inducing Factors in an Outpatient Population with Obesity |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-25T20%3A05%3A16IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Extensive%20Phenotyping%20for%20Potential%20Weight-Inducing%20Factors%20in%20an%20Outpatient%20Population%20with%20Obesity&rft.jtitle=Obesity%20Facts&rft.au=Savas,%20Mesut&rft.date=2019-09-01&rft.volume=12&rft.issue=4&rft.spage=369&rft.epage=384&rft.pages=369-384&rft.issn=1662-4025&rft.eissn=1662-4033&rft_id=info:doi/10.1159/000499978&rft_dat=%3Cgale_pubme%3EA602926619%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2300588822&rft_id=info:pmid/31216558&rft_galeid=A602926619&rft_doaj_id=oai_doaj_org_article_31afb469ce2e44f883f263e71073d85b&rfr_iscdi=true |