TUBERCULOSIS MORTALITY, DRUG RESISTANCE, AND INFECTIOUSNESS IN PATIENTS WITH AND WITHOUT HIV INFECTION IN PERU
The effects of HIV co-infection and multi-drug resistant tuberculosis (MDRTB) on tuberculosis prognosis are poorly defined. Therefore, we studied infectiousness and mortality of 287 tuberculosis patients treated with standard, directly observed, short-course therapy in the Peruvian community. During...
Gespeichert in:
| Veröffentlicht in: | The American journal of tropical medicine and hygiene 2006-12, Vol.75 (6), p.1027-1033 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1033 |
|---|---|
| container_issue | 6 |
| container_start_page | 1027 |
| container_title | The American journal of tropical medicine and hygiene |
| container_volume | 75 |
| creator | KAWAI, VIVIAN SOTO, GISELLE GILMAN, ROBERT H BAUTISTA, CHRISTIAN T CAVIEDES, LUZ HUAROTO, LUZ TICONA, EDUARDO ORTIZ, JAIME TOVAR, MARCO CHAVEZ, VICTOR RODRIGUEZ, RICHARD ESCOMBE, A. RODERICK EVANS, CARLTON A |
| description | The effects of HIV co-infection and multi-drug resistant tuberculosis (MDRTB) on tuberculosis prognosis are poorly defined. Therefore, we studied infectiousness and mortality of 287 tuberculosis patients treated with standard, directly observed, short-course therapy in the Peruvian community. During 6-17 months of treatment, 49 (18%) of patients died, of whom 48 (98%) had AIDS and 28 (57%) had MDRTB; 17/31 (55%) of MDRTB-patients with AIDS died within 2 months of diagnosis, before traditional susceptibility testing would have identified their MDRTB. Most non-MDRTB became smear- and culture-negative within 6 weeks of therapy, whereas most MDRTB remained sputum-culture-positive until death or treatment completion. HIV-negative patients with non-MDRTB had good outcomes. However, MDRTB was associated with prolonged infectiousness and HIV co-infection with early mortality, indicating a need for greater access to anti-retroviral therapy. Furthermore, early and rapid tuberculosis drug-susceptibility testing and infection control are required so that MDRTB can be appropriately treated early enough to reduce mortality and transmission. |
| doi_str_mv | 10.4269/ajtmh.2006.75.1027 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_2912515</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>20389451</sourcerecordid><originalsourceid>FETCH-LOGICAL-c461t-89a5e2da99875fa918246d695232e302eb5a14c9727c657a42837364956a5b1b3</originalsourceid><addsrcrecordid>eNpVkVtvmzAcxa1pU5u1_QJ7mHjZnkpmG1_wyyRKaYOUQQVm054shzgNFZcOJ4v27QcJarcn337_c451APiA4JxgJr7op12znWMI2ZzTOYKYvwEzRDhzESP0LZhBCLErmMfPwXtrnyBEPkboDJwjjjj2GJqBVhY3URYWyzSPc-dbmslgGcuf185tVtw7WTTcyiAJo2snSG6dOLmLQhmnRZ5EeT4cnYdAxlEic-dHLBdHZtykhXQW8fcXPjmiUVZcgncbXVtzNa0XoLiLZLhwl-l9HAZLtyQM7VxfaGrwWgvhc7rRYshN2JoJij1sPIjNimpESsExLxnlmmDf4x4jgjJNV2jlXYCvJ93n_aox69K0u17X6rmvGt3_UZ2u1P8vbbVVj91vhQXCFNFB4PMk0He_9sbuVFPZ0tS1bk23twpDzxeEogHEJ7DsO2t7s3kxQVCNNaljTWqsSXGqxpqGoY__xnsdmXoZgE8ToG2p602v27Kyr9z4XXp0n2Juq8ftoeqNso2u60EWqcPhMPixk-NfJ9qgOQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>20389451</pqid></control><display><type>article</type><title>TUBERCULOSIS MORTALITY, DRUG RESISTANCE, AND INFECTIOUSNESS IN PATIENTS WITH AND WITHOUT HIV INFECTION IN PERU</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>KAWAI, VIVIAN ; SOTO, GISELLE ; GILMAN, ROBERT H ; BAUTISTA, CHRISTIAN T ; CAVIEDES, LUZ ; HUAROTO, LUZ ; TICONA, EDUARDO ; ORTIZ, JAIME ; TOVAR, MARCO ; CHAVEZ, VICTOR ; RODRIGUEZ, RICHARD ; ESCOMBE, A. RODERICK ; EVANS, CARLTON A</creator><creatorcontrib>KAWAI, VIVIAN ; SOTO, GISELLE ; GILMAN, ROBERT H ; BAUTISTA, CHRISTIAN T ; CAVIEDES, LUZ ; HUAROTO, LUZ ; TICONA, EDUARDO ; ORTIZ, JAIME ; TOVAR, MARCO ; CHAVEZ, VICTOR ; RODRIGUEZ, RICHARD ; ESCOMBE, A. RODERICK ; EVANS, CARLTON A</creatorcontrib><description>The effects of HIV co-infection and multi-drug resistant tuberculosis (MDRTB) on tuberculosis prognosis are poorly defined. Therefore, we studied infectiousness and mortality of 287 tuberculosis patients treated with standard, directly observed, short-course therapy in the Peruvian community. During 6-17 months of treatment, 49 (18%) of patients died, of whom 48 (98%) had AIDS and 28 (57%) had MDRTB; 17/31 (55%) of MDRTB-patients with AIDS died within 2 months of diagnosis, before traditional susceptibility testing would have identified their MDRTB. Most non-MDRTB became smear- and culture-negative within 6 weeks of therapy, whereas most MDRTB remained sputum-culture-positive until death or treatment completion. HIV-negative patients with non-MDRTB had good outcomes. However, MDRTB was associated with prolonged infectiousness and HIV co-infection with early mortality, indicating a need for greater access to anti-retroviral therapy. Furthermore, early and rapid tuberculosis drug-susceptibility testing and infection control are required so that MDRTB can be appropriately treated early enough to reduce mortality and transmission.</description><identifier>ISSN: 0002-9637</identifier><identifier>EISSN: 1476-1645</identifier><identifier>DOI: 10.4269/ajtmh.2006.75.1027</identifier><identifier>PMID: 17172361</identifier><identifier>CODEN: AJTHAB</identifier><language>eng</language><publisher>Lawrence, KS: ASTMH</publisher><subject>Acquired Immunodeficiency Syndrome - complications ; Acquired Immunodeficiency Syndrome - epidemiology ; Acquired Immunodeficiency Syndrome - mortality ; Adult ; Bacterial diseases ; Biological and medical sciences ; Drug Resistance, Multiple ; Epidemiology ; Female ; General aspects ; HIV Infections - complications ; HIV Infections - epidemiology ; HIV Infections - mortality ; HIV Seropositivity - epidemiology ; Human bacterial diseases ; Human immunodeficiency virus ; Human viral diseases ; Humans ; Incidence ; Infectious diseases ; Male ; Medical sciences ; Peru - epidemiology ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Sputum - parasitology ; Sputum - virology ; Tuberculosis and atypical mycobacterial infections ; Tuberculosis, Pulmonary - epidemiology ; Tuberculosis, Pulmonary - mortality ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids</subject><ispartof>The American journal of tropical medicine and hygiene, 2006-12, Vol.75 (6), p.1027-1033</ispartof><rights>2007 INIST-CNRS</rights><rights>Copyright © 2006 by The American Society of Tropical Medicine and Hygiene 2006</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c461t-89a5e2da99875fa918246d695232e302eb5a14c9727c657a42837364956a5b1b3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18373551$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17172361$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>KAWAI, VIVIAN</creatorcontrib><creatorcontrib>SOTO, GISELLE</creatorcontrib><creatorcontrib>GILMAN, ROBERT H</creatorcontrib><creatorcontrib>BAUTISTA, CHRISTIAN T</creatorcontrib><creatorcontrib>CAVIEDES, LUZ</creatorcontrib><creatorcontrib>HUAROTO, LUZ</creatorcontrib><creatorcontrib>TICONA, EDUARDO</creatorcontrib><creatorcontrib>ORTIZ, JAIME</creatorcontrib><creatorcontrib>TOVAR, MARCO</creatorcontrib><creatorcontrib>CHAVEZ, VICTOR</creatorcontrib><creatorcontrib>RODRIGUEZ, RICHARD</creatorcontrib><creatorcontrib>ESCOMBE, A. RODERICK</creatorcontrib><creatorcontrib>EVANS, CARLTON A</creatorcontrib><title>TUBERCULOSIS MORTALITY, DRUG RESISTANCE, AND INFECTIOUSNESS IN PATIENTS WITH AND WITHOUT HIV INFECTION IN PERU</title><title>The American journal of tropical medicine and hygiene</title><addtitle>Am J Trop Med Hyg</addtitle><description>The effects of HIV co-infection and multi-drug resistant tuberculosis (MDRTB) on tuberculosis prognosis are poorly defined. Therefore, we studied infectiousness and mortality of 287 tuberculosis patients treated with standard, directly observed, short-course therapy in the Peruvian community. During 6-17 months of treatment, 49 (18%) of patients died, of whom 48 (98%) had AIDS and 28 (57%) had MDRTB; 17/31 (55%) of MDRTB-patients with AIDS died within 2 months of diagnosis, before traditional susceptibility testing would have identified their MDRTB. Most non-MDRTB became smear- and culture-negative within 6 weeks of therapy, whereas most MDRTB remained sputum-culture-positive until death or treatment completion. HIV-negative patients with non-MDRTB had good outcomes. However, MDRTB was associated with prolonged infectiousness and HIV co-infection with early mortality, indicating a need for greater access to anti-retroviral therapy. Furthermore, early and rapid tuberculosis drug-susceptibility testing and infection control are required so that MDRTB can be appropriately treated early enough to reduce mortality and transmission.</description><subject>Acquired Immunodeficiency Syndrome - complications</subject><subject>Acquired Immunodeficiency Syndrome - epidemiology</subject><subject>Acquired Immunodeficiency Syndrome - mortality</subject><subject>Adult</subject><subject>Bacterial diseases</subject><subject>Biological and medical sciences</subject><subject>Drug Resistance, Multiple</subject><subject>Epidemiology</subject><subject>Female</subject><subject>General aspects</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - mortality</subject><subject>HIV Seropositivity - epidemiology</subject><subject>Human bacterial diseases</subject><subject>Human immunodeficiency virus</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infectious diseases</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Peru - epidemiology</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Sputum - parasitology</subject><subject>Sputum - virology</subject><subject>Tuberculosis and atypical mycobacterial infections</subject><subject>Tuberculosis, Pulmonary - epidemiology</subject><subject>Tuberculosis, Pulmonary - mortality</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. Aids</subject><issn>0002-9637</issn><issn>1476-1645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkVtvmzAcxa1pU5u1_QJ7mHjZnkpmG1_wyyRKaYOUQQVm054shzgNFZcOJ4v27QcJarcn337_c451APiA4JxgJr7op12znWMI2ZzTOYKYvwEzRDhzESP0LZhBCLErmMfPwXtrnyBEPkboDJwjjjj2GJqBVhY3URYWyzSPc-dbmslgGcuf185tVtw7WTTcyiAJo2snSG6dOLmLQhmnRZ5EeT4cnYdAxlEic-dHLBdHZtykhXQW8fcXPjmiUVZcgncbXVtzNa0XoLiLZLhwl-l9HAZLtyQM7VxfaGrwWgvhc7rRYshN2JoJij1sPIjNimpESsExLxnlmmDf4x4jgjJNV2jlXYCvJ93n_aox69K0u17X6rmvGt3_UZ2u1P8vbbVVj91vhQXCFNFB4PMk0He_9sbuVFPZ0tS1bk23twpDzxeEogHEJ7DsO2t7s3kxQVCNNaljTWqsSXGqxpqGoY__xnsdmXoZgE8ToG2p602v27Kyr9z4XXp0n2Juq8ftoeqNso2u60EWqcPhMPixk-NfJ9qgOQ</recordid><startdate>20061201</startdate><enddate>20061201</enddate><creator>KAWAI, VIVIAN</creator><creator>SOTO, GISELLE</creator><creator>GILMAN, ROBERT H</creator><creator>BAUTISTA, CHRISTIAN T</creator><creator>CAVIEDES, LUZ</creator><creator>HUAROTO, LUZ</creator><creator>TICONA, EDUARDO</creator><creator>ORTIZ, JAIME</creator><creator>TOVAR, MARCO</creator><creator>CHAVEZ, VICTOR</creator><creator>RODRIGUEZ, RICHARD</creator><creator>ESCOMBE, A. RODERICK</creator><creator>EVANS, CARLTON A</creator><general>ASTMH</general><general>Allen Press</general><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>7QL</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>5PM</scope></search><sort><creationdate>20061201</creationdate><title>TUBERCULOSIS MORTALITY, DRUG RESISTANCE, AND INFECTIOUSNESS IN PATIENTS WITH AND WITHOUT HIV INFECTION IN PERU</title><author>KAWAI, VIVIAN ; SOTO, GISELLE ; GILMAN, ROBERT H ; BAUTISTA, CHRISTIAN T ; CAVIEDES, LUZ ; HUAROTO, LUZ ; TICONA, EDUARDO ; ORTIZ, JAIME ; TOVAR, MARCO ; CHAVEZ, VICTOR ; RODRIGUEZ, RICHARD ; ESCOMBE, A. RODERICK ; EVANS, CARLTON A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c461t-89a5e2da99875fa918246d695232e302eb5a14c9727c657a42837364956a5b1b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Acquired Immunodeficiency Syndrome - complications</topic><topic>Acquired Immunodeficiency Syndrome - epidemiology</topic><topic>Acquired Immunodeficiency Syndrome - mortality</topic><topic>Adult</topic><topic>Bacterial diseases</topic><topic>Biological and medical sciences</topic><topic>Drug Resistance, Multiple</topic><topic>Epidemiology</topic><topic>Female</topic><topic>General aspects</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - epidemiology</topic><topic>HIV Infections - mortality</topic><topic>HIV Seropositivity - epidemiology</topic><topic>Human bacterial diseases</topic><topic>Human immunodeficiency virus</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infectious diseases</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Peru - epidemiology</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Sputum - parasitology</topic><topic>Sputum - virology</topic><topic>Tuberculosis and atypical mycobacterial infections</topic><topic>Tuberculosis, Pulmonary - epidemiology</topic><topic>Tuberculosis, Pulmonary - mortality</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. Aids</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>KAWAI, VIVIAN</creatorcontrib><creatorcontrib>SOTO, GISELLE</creatorcontrib><creatorcontrib>GILMAN, ROBERT H</creatorcontrib><creatorcontrib>BAUTISTA, CHRISTIAN T</creatorcontrib><creatorcontrib>CAVIEDES, LUZ</creatorcontrib><creatorcontrib>HUAROTO, LUZ</creatorcontrib><creatorcontrib>TICONA, EDUARDO</creatorcontrib><creatorcontrib>ORTIZ, JAIME</creatorcontrib><creatorcontrib>TOVAR, MARCO</creatorcontrib><creatorcontrib>CHAVEZ, VICTOR</creatorcontrib><creatorcontrib>RODRIGUEZ, RICHARD</creatorcontrib><creatorcontrib>ESCOMBE, A. RODERICK</creatorcontrib><creatorcontrib>EVANS, CARLTON A</creatorcontrib><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>Bacteriology Abstracts (Microbiology B)</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The American journal of tropical medicine and hygiene</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>KAWAI, VIVIAN</au><au>SOTO, GISELLE</au><au>GILMAN, ROBERT H</au><au>BAUTISTA, CHRISTIAN T</au><au>CAVIEDES, LUZ</au><au>HUAROTO, LUZ</au><au>TICONA, EDUARDO</au><au>ORTIZ, JAIME</au><au>TOVAR, MARCO</au><au>CHAVEZ, VICTOR</au><au>RODRIGUEZ, RICHARD</au><au>ESCOMBE, A. RODERICK</au><au>EVANS, CARLTON A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>TUBERCULOSIS MORTALITY, DRUG RESISTANCE, AND INFECTIOUSNESS IN PATIENTS WITH AND WITHOUT HIV INFECTION IN PERU</atitle><jtitle>The American journal of tropical medicine and hygiene</jtitle><addtitle>Am J Trop Med Hyg</addtitle><date>2006-12-01</date><risdate>2006</risdate><volume>75</volume><issue>6</issue><spage>1027</spage><epage>1033</epage><pages>1027-1033</pages><issn>0002-9637</issn><eissn>1476-1645</eissn><coden>AJTHAB</coden><abstract>The effects of HIV co-infection and multi-drug resistant tuberculosis (MDRTB) on tuberculosis prognosis are poorly defined. Therefore, we studied infectiousness and mortality of 287 tuberculosis patients treated with standard, directly observed, short-course therapy in the Peruvian community. During 6-17 months of treatment, 49 (18%) of patients died, of whom 48 (98%) had AIDS and 28 (57%) had MDRTB; 17/31 (55%) of MDRTB-patients with AIDS died within 2 months of diagnosis, before traditional susceptibility testing would have identified their MDRTB. Most non-MDRTB became smear- and culture-negative within 6 weeks of therapy, whereas most MDRTB remained sputum-culture-positive until death or treatment completion. HIV-negative patients with non-MDRTB had good outcomes. However, MDRTB was associated with prolonged infectiousness and HIV co-infection with early mortality, indicating a need for greater access to anti-retroviral therapy. Furthermore, early and rapid tuberculosis drug-susceptibility testing and infection control are required so that MDRTB can be appropriately treated early enough to reduce mortality and transmission.</abstract><cop>Lawrence, KS</cop><pub>ASTMH</pub><pmid>17172361</pmid><doi>10.4269/ajtmh.2006.75.1027</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9637 |
| ispartof | The American journal of tropical medicine and hygiene, 2006-12, Vol.75 (6), p.1027-1033 |
| issn | 0002-9637 1476-1645 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_2912515 |
| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Acquired Immunodeficiency Syndrome - complications Acquired Immunodeficiency Syndrome - epidemiology Acquired Immunodeficiency Syndrome - mortality Adult Bacterial diseases Biological and medical sciences Drug Resistance, Multiple Epidemiology Female General aspects HIV Infections - complications HIV Infections - epidemiology HIV Infections - mortality HIV Seropositivity - epidemiology Human bacterial diseases Human immunodeficiency virus Human viral diseases Humans Incidence Infectious diseases Male Medical sciences Peru - epidemiology Public health. Hygiene Public health. Hygiene-occupational medicine Sputum - parasitology Sputum - virology Tuberculosis and atypical mycobacterial infections Tuberculosis, Pulmonary - epidemiology Tuberculosis, Pulmonary - mortality Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids |
| title | TUBERCULOSIS MORTALITY, DRUG RESISTANCE, AND INFECTIOUSNESS IN PATIENTS WITH AND WITHOUT HIV INFECTION IN PERU |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-05T01%3A05%3A30IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=TUBERCULOSIS%20MORTALITY,%20DRUG%20RESISTANCE,%20AND%20INFECTIOUSNESS%20IN%20PATIENTS%20WITH%20AND%20WITHOUT%20HIV%20INFECTION%20IN%20PERU&rft.jtitle=The%20American%20journal%20of%20tropical%20medicine%20and%20hygiene&rft.au=KAWAI,%20VIVIAN&rft.date=2006-12-01&rft.volume=75&rft.issue=6&rft.spage=1027&rft.epage=1033&rft.pages=1027-1033&rft.issn=0002-9637&rft.eissn=1476-1645&rft.coden=AJTHAB&rft_id=info:doi/10.4269/ajtmh.2006.75.1027&rft_dat=%3Cproquest_pubme%3E20389451%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=20389451&rft_id=info:pmid/17172361&rfr_iscdi=true |