Early Detection and Treatment of Type 2 Diabetes Reduce Cardiovascular Morbidity and Mortality: A Simulation of the Results of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Europe)
To estimate the benefits of screening and early treatment of type 2 diabetes compared with no screening and late treatment using a simulation model with data from the ADDITION-Europe study. We used the Michigan Model, a validated computer simulation model, and data from the ADDITION-Europe study to...
Gespeichert in:
| Veröffentlicht in: | Diabetes care 2015-08, Vol.38 (8), p.1449-1455 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1455 |
|---|---|
| container_issue | 8 |
| container_start_page | 1449 |
| container_title | Diabetes care |
| container_volume | 38 |
| creator | Herman, William H Ye, Wen Griffin, Simon J Simmons, Rebecca K Davies, Melanie J Khunti, Kamlesh Rutten, Guy E H M Sandbaek, Annelli Lauritzen, Torsten Borch-Johnsen, Knut Brown, Morton B Wareham, Nicholas J |
| description | To estimate the benefits of screening and early treatment of type 2 diabetes compared with no screening and late treatment using a simulation model with data from the ADDITION-Europe study.
We used the Michigan Model, a validated computer simulation model, and data from the ADDITION-Europe study to estimate the absolute risk of cardiovascular outcomes and the relative risk reduction associated with screening and intensive treatment, screening and routine treatment, and no screening with a 3- or 6-year delay in the diagnosis and routine treatment of diabetes and cardiovascular risk factors.
When the computer simulation model was programmed with the baseline demographic and clinical characteristics of the ADDITION-Europe population, it accurately predicted the empiric results of the trial. The simulated absolute risk reduction and relative risk reduction were substantially greater at 5 years with screening, early diagnosis, and routine treatment compared with scenarios in which there was a 3-year (3.3% absolute risk reduction [ARR], 29% relative risk reduction [RRR]) or a 6-year (4.9% ARR, 38% RRR) delay in diagnosis and routine treatment of diabetes and cardiovascular risk factors.
Major benefits are likely to accrue from the early diagnosis and treatment of glycemia and cardiovascular risk factors in type 2 diabetes. The intensity of glucose, blood pressure, and cholesterol treatment after diagnosis is less important than the time of its initiation. Screening for type 2 diabetes to reduce the lead time between diabetes onset and clinical diagnosis and to allow for prompt multifactorial treatment is warranted. |
| doi_str_mv | 10.2337/dc14-2459 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4512138</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1698956507</sourcerecordid><originalsourceid>FETCH-LOGICAL-c403t-15e1165aa344d59c89c854cc1b884218101709d2d19f551d113667cd55f99afb3</originalsourceid><addsrcrecordid>eNpdktFq2zAUhs3YWLNuF3uBIdhNe-HNsiTH2kUhxGkX6NaxZuzSyNJxo-JIniQH_O67mNy0XTcQiMP5-PgP_EnyFmcfckLmH5XENM0p48-SGeaEpYzR8nkyyzDlKeM8P0peeX-bZRmlZfkyOcoZL4uiwLPk90q4bkQVBJBBW4OEUWjjQIQdmIBsizZjDyhHlRZNhDz6DmqQgJbCKW33wsuhEw59sa7RSofxThCnILo4fUILdK13EbmTR13YQlT4oQv-YVyYm86mlTDab9NqCHKLrsOgxmm_NgGM13t4Ekob9A1s3wH6qUNkpQMw6eEEUH-TTpzTO-HGKS2gk0VVrTfrq6_panC2h9PXyYtWdB7e3P_HyY_z1Wb5Ob28ulgvF5eppBkJKWaAccGEIJQqxmUZH6NS4qYsaY5LnOF5xlWuMG8ZwwpjUhRzqRhrORdtQ46Ts4O3H5odKBmPcKKr-0O42gpd_7sxelvf2H1NGc4xKaPg5F7g7K8BfKh32kvoOmHADr7GBS85K1g2j-j7_9BbOzgTz5sons8JKXikTg-UdNZ7B-1jGJzVU6fqqVP11KnIvnua_pF8KBH5A6T5yeQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1699273369</pqid></control><display><type>article</type><title>Early Detection and Treatment of Type 2 Diabetes Reduce Cardiovascular Morbidity and Mortality: A Simulation of the Results of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Europe)</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><source>EZB Electronic Journals Library</source><creator>Herman, William H ; Ye, Wen ; Griffin, Simon J ; Simmons, Rebecca K ; Davies, Melanie J ; Khunti, Kamlesh ; Rutten, Guy E H M ; Sandbaek, Annelli ; Lauritzen, Torsten ; Borch-Johnsen, Knut ; Brown, Morton B ; Wareham, Nicholas J</creator><creatorcontrib>Herman, William H ; Ye, Wen ; Griffin, Simon J ; Simmons, Rebecca K ; Davies, Melanie J ; Khunti, Kamlesh ; Rutten, Guy E H M ; Sandbaek, Annelli ; Lauritzen, Torsten ; Borch-Johnsen, Knut ; Brown, Morton B ; Wareham, Nicholas J</creatorcontrib><description>To estimate the benefits of screening and early treatment of type 2 diabetes compared with no screening and late treatment using a simulation model with data from the ADDITION-Europe study.
We used the Michigan Model, a validated computer simulation model, and data from the ADDITION-Europe study to estimate the absolute risk of cardiovascular outcomes and the relative risk reduction associated with screening and intensive treatment, screening and routine treatment, and no screening with a 3- or 6-year delay in the diagnosis and routine treatment of diabetes and cardiovascular risk factors.
When the computer simulation model was programmed with the baseline demographic and clinical characteristics of the ADDITION-Europe population, it accurately predicted the empiric results of the trial. The simulated absolute risk reduction and relative risk reduction were substantially greater at 5 years with screening, early diagnosis, and routine treatment compared with scenarios in which there was a 3-year (3.3% absolute risk reduction [ARR], 29% relative risk reduction [RRR]) or a 6-year (4.9% ARR, 38% RRR) delay in diagnosis and routine treatment of diabetes and cardiovascular risk factors.
Major benefits are likely to accrue from the early diagnosis and treatment of glycemia and cardiovascular risk factors in type 2 diabetes. The intensity of glucose, blood pressure, and cholesterol treatment after diagnosis is less important than the time of its initiation. Screening for type 2 diabetes to reduce the lead time between diabetes onset and clinical diagnosis and to allow for prompt multifactorial treatment is warranted.</description><identifier>ISSN: 0149-5992</identifier><identifier>EISSN: 1935-5548</identifier><identifier>DOI: 10.2337/dc14-2459</identifier><identifier>PMID: 25986661</identifier><identifier>CODEN: DICAD2</identifier><language>eng</language><publisher>United States: American Diabetes Association</publisher><subject>Adult ; Aged ; Blood Glucose - metabolism ; Blood Pressure - physiology ; Cardiovascular disease ; Cholesterol - blood ; Computer Simulation ; Critical Care ; Denmark - epidemiology ; Diabetes ; Diabetes Mellitus, Type 2 - mortality ; Diabetes Mellitus, Type 2 - prevention & control ; Diabetic Angiopathies - mortality ; Diabetic Angiopathies - prevention & control ; Early Diagnosis ; Epidemiology/Health Services Research ; Female ; Humans ; Mass Screening - methods ; Medical screening ; Medical treatment ; Middle Aged ; Morbidity ; Mortality ; Netherlands - epidemiology ; Primary Health Care ; Risk Factors ; Simulation ; United Kingdom - epidemiology</subject><ispartof>Diabetes care, 2015-08, Vol.38 (8), p.1449-1455</ispartof><rights>2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.</rights><rights>Copyright American Diabetes Association Aug 2015</rights><rights>2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c403t-15e1165aa344d59c89c854cc1b884218101709d2d19f551d113667cd55f99afb3</citedby><cites>FETCH-LOGICAL-c403t-15e1165aa344d59c89c854cc1b884218101709d2d19f551d113667cd55f99afb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25986661$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Herman, William H</creatorcontrib><creatorcontrib>Ye, Wen</creatorcontrib><creatorcontrib>Griffin, Simon J</creatorcontrib><creatorcontrib>Simmons, Rebecca K</creatorcontrib><creatorcontrib>Davies, Melanie J</creatorcontrib><creatorcontrib>Khunti, Kamlesh</creatorcontrib><creatorcontrib>Rutten, Guy E H M</creatorcontrib><creatorcontrib>Sandbaek, Annelli</creatorcontrib><creatorcontrib>Lauritzen, Torsten</creatorcontrib><creatorcontrib>Borch-Johnsen, Knut</creatorcontrib><creatorcontrib>Brown, Morton B</creatorcontrib><creatorcontrib>Wareham, Nicholas J</creatorcontrib><title>Early Detection and Treatment of Type 2 Diabetes Reduce Cardiovascular Morbidity and Mortality: A Simulation of the Results of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Europe)</title><title>Diabetes care</title><addtitle>Diabetes Care</addtitle><description>To estimate the benefits of screening and early treatment of type 2 diabetes compared with no screening and late treatment using a simulation model with data from the ADDITION-Europe study.
We used the Michigan Model, a validated computer simulation model, and data from the ADDITION-Europe study to estimate the absolute risk of cardiovascular outcomes and the relative risk reduction associated with screening and intensive treatment, screening and routine treatment, and no screening with a 3- or 6-year delay in the diagnosis and routine treatment of diabetes and cardiovascular risk factors.
When the computer simulation model was programmed with the baseline demographic and clinical characteristics of the ADDITION-Europe population, it accurately predicted the empiric results of the trial. The simulated absolute risk reduction and relative risk reduction were substantially greater at 5 years with screening, early diagnosis, and routine treatment compared with scenarios in which there was a 3-year (3.3% absolute risk reduction [ARR], 29% relative risk reduction [RRR]) or a 6-year (4.9% ARR, 38% RRR) delay in diagnosis and routine treatment of diabetes and cardiovascular risk factors.
Major benefits are likely to accrue from the early diagnosis and treatment of glycemia and cardiovascular risk factors in type 2 diabetes. The intensity of glucose, blood pressure, and cholesterol treatment after diagnosis is less important than the time of its initiation. Screening for type 2 diabetes to reduce the lead time between diabetes onset and clinical diagnosis and to allow for prompt multifactorial treatment is warranted.</description><subject>Adult</subject><subject>Aged</subject><subject>Blood Glucose - metabolism</subject><subject>Blood Pressure - physiology</subject><subject>Cardiovascular disease</subject><subject>Cholesterol - blood</subject><subject>Computer Simulation</subject><subject>Critical Care</subject><subject>Denmark - epidemiology</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 2 - mortality</subject><subject>Diabetes Mellitus, Type 2 - prevention & control</subject><subject>Diabetic Angiopathies - mortality</subject><subject>Diabetic Angiopathies - prevention & control</subject><subject>Early Diagnosis</subject><subject>Epidemiology/Health Services Research</subject><subject>Female</subject><subject>Humans</subject><subject>Mass Screening - methods</subject><subject>Medical screening</subject><subject>Medical treatment</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Netherlands - epidemiology</subject><subject>Primary Health Care</subject><subject>Risk Factors</subject><subject>Simulation</subject><subject>United Kingdom - epidemiology</subject><issn>0149-5992</issn><issn>1935-5548</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdktFq2zAUhs3YWLNuF3uBIdhNe-HNsiTH2kUhxGkX6NaxZuzSyNJxo-JIniQH_O67mNy0XTcQiMP5-PgP_EnyFmcfckLmH5XENM0p48-SGeaEpYzR8nkyyzDlKeM8P0peeX-bZRmlZfkyOcoZL4uiwLPk90q4bkQVBJBBW4OEUWjjQIQdmIBsizZjDyhHlRZNhDz6DmqQgJbCKW33wsuhEw59sa7RSofxThCnILo4fUILdK13EbmTR13YQlT4oQv-YVyYm86mlTDab9NqCHKLrsOgxmm_NgGM13t4Ekob9A1s3wH6qUNkpQMw6eEEUH-TTpzTO-HGKS2gk0VVrTfrq6_panC2h9PXyYtWdB7e3P_HyY_z1Wb5Ob28ulgvF5eppBkJKWaAccGEIJQqxmUZH6NS4qYsaY5LnOF5xlWuMG8ZwwpjUhRzqRhrORdtQ46Ts4O3H5odKBmPcKKr-0O42gpd_7sxelvf2H1NGc4xKaPg5F7g7K8BfKh32kvoOmHADr7GBS85K1g2j-j7_9BbOzgTz5sons8JKXikTg-UdNZ7B-1jGJzVU6fqqVP11KnIvnua_pF8KBH5A6T5yeQ</recordid><startdate>20150801</startdate><enddate>20150801</enddate><creator>Herman, William H</creator><creator>Ye, Wen</creator><creator>Griffin, Simon J</creator><creator>Simmons, Rebecca K</creator><creator>Davies, Melanie J</creator><creator>Khunti, Kamlesh</creator><creator>Rutten, Guy E H M</creator><creator>Sandbaek, Annelli</creator><creator>Lauritzen, Torsten</creator><creator>Borch-Johnsen, Knut</creator><creator>Brown, Morton B</creator><creator>Wareham, Nicholas J</creator><general>American Diabetes Association</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>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20150801</creationdate><title>Early Detection and Treatment of Type 2 Diabetes Reduce Cardiovascular Morbidity and Mortality: A Simulation of the Results of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Europe)</title><author>Herman, William H ; Ye, Wen ; Griffin, Simon J ; Simmons, Rebecca K ; Davies, Melanie J ; Khunti, Kamlesh ; Rutten, Guy E H M ; Sandbaek, Annelli ; Lauritzen, Torsten ; Borch-Johnsen, Knut ; Brown, Morton B ; Wareham, Nicholas J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c403t-15e1165aa344d59c89c854cc1b884218101709d2d19f551d113667cd55f99afb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Blood Glucose - metabolism</topic><topic>Blood Pressure - physiology</topic><topic>Cardiovascular disease</topic><topic>Cholesterol - blood</topic><topic>Computer Simulation</topic><topic>Critical Care</topic><topic>Denmark - epidemiology</topic><topic>Diabetes</topic><topic>Diabetes Mellitus, Type 2 - mortality</topic><topic>Diabetes Mellitus, Type 2 - prevention & control</topic><topic>Diabetic Angiopathies - mortality</topic><topic>Diabetic Angiopathies - prevention & control</topic><topic>Early Diagnosis</topic><topic>Epidemiology/Health Services Research</topic><topic>Female</topic><topic>Humans</topic><topic>Mass Screening - methods</topic><topic>Medical screening</topic><topic>Medical treatment</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Netherlands - epidemiology</topic><topic>Primary Health Care</topic><topic>Risk Factors</topic><topic>Simulation</topic><topic>United Kingdom - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Herman, William H</creatorcontrib><creatorcontrib>Ye, Wen</creatorcontrib><creatorcontrib>Griffin, Simon J</creatorcontrib><creatorcontrib>Simmons, Rebecca K</creatorcontrib><creatorcontrib>Davies, Melanie J</creatorcontrib><creatorcontrib>Khunti, Kamlesh</creatorcontrib><creatorcontrib>Rutten, Guy E H M</creatorcontrib><creatorcontrib>Sandbaek, Annelli</creatorcontrib><creatorcontrib>Lauritzen, Torsten</creatorcontrib><creatorcontrib>Borch-Johnsen, Knut</creatorcontrib><creatorcontrib>Brown, Morton B</creatorcontrib><creatorcontrib>Wareham, Nicholas J</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 Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Diabetes care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Herman, William H</au><au>Ye, Wen</au><au>Griffin, Simon J</au><au>Simmons, Rebecca K</au><au>Davies, Melanie J</au><au>Khunti, Kamlesh</au><au>Rutten, Guy E H M</au><au>Sandbaek, Annelli</au><au>Lauritzen, Torsten</au><au>Borch-Johnsen, Knut</au><au>Brown, Morton B</au><au>Wareham, Nicholas J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early Detection and Treatment of Type 2 Diabetes Reduce Cardiovascular Morbidity and Mortality: A Simulation of the Results of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Europe)</atitle><jtitle>Diabetes care</jtitle><addtitle>Diabetes Care</addtitle><date>2015-08-01</date><risdate>2015</risdate><volume>38</volume><issue>8</issue><spage>1449</spage><epage>1455</epage><pages>1449-1455</pages><issn>0149-5992</issn><eissn>1935-5548</eissn><coden>DICAD2</coden><abstract>To estimate the benefits of screening and early treatment of type 2 diabetes compared with no screening and late treatment using a simulation model with data from the ADDITION-Europe study.
We used the Michigan Model, a validated computer simulation model, and data from the ADDITION-Europe study to estimate the absolute risk of cardiovascular outcomes and the relative risk reduction associated with screening and intensive treatment, screening and routine treatment, and no screening with a 3- or 6-year delay in the diagnosis and routine treatment of diabetes and cardiovascular risk factors.
When the computer simulation model was programmed with the baseline demographic and clinical characteristics of the ADDITION-Europe population, it accurately predicted the empiric results of the trial. The simulated absolute risk reduction and relative risk reduction were substantially greater at 5 years with screening, early diagnosis, and routine treatment compared with scenarios in which there was a 3-year (3.3% absolute risk reduction [ARR], 29% relative risk reduction [RRR]) or a 6-year (4.9% ARR, 38% RRR) delay in diagnosis and routine treatment of diabetes and cardiovascular risk factors.
Major benefits are likely to accrue from the early diagnosis and treatment of glycemia and cardiovascular risk factors in type 2 diabetes. The intensity of glucose, blood pressure, and cholesterol treatment after diagnosis is less important than the time of its initiation. Screening for type 2 diabetes to reduce the lead time between diabetes onset and clinical diagnosis and to allow for prompt multifactorial treatment is warranted.</abstract><cop>United States</cop><pub>American Diabetes Association</pub><pmid>25986661</pmid><doi>10.2337/dc14-2459</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0149-5992 |
| ispartof | Diabetes care, 2015-08, Vol.38 (8), p.1449-1455 |
| issn | 0149-5992 1935-5548 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4512138 |
| source | MEDLINE; Journals@Ovid Complete; EZB Electronic Journals Library |
| subjects | Adult Aged Blood Glucose - metabolism Blood Pressure - physiology Cardiovascular disease Cholesterol - blood Computer Simulation Critical Care Denmark - epidemiology Diabetes Diabetes Mellitus, Type 2 - mortality Diabetes Mellitus, Type 2 - prevention & control Diabetic Angiopathies - mortality Diabetic Angiopathies - prevention & control Early Diagnosis Epidemiology/Health Services Research Female Humans Mass Screening - methods Medical screening Medical treatment Middle Aged Morbidity Mortality Netherlands - epidemiology Primary Health Care Risk Factors Simulation United Kingdom - epidemiology |
| title | Early Detection and Treatment of Type 2 Diabetes Reduce Cardiovascular Morbidity and Mortality: A Simulation of the Results of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Europe) |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-24T20%3A44%3A49IST&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=Early%20Detection%20and%20Treatment%20of%20Type%202%20Diabetes%20Reduce%20Cardiovascular%20Morbidity%20and%20Mortality:%20A%20Simulation%20of%20the%20Results%20of%20the%20Anglo-Danish-Dutch%20Study%20of%20Intensive%20Treatment%20in%20People%20With%20Screen-Detected%20Diabetes%20in%20Primary%20Care%20(ADDITION-Europe)&rft.jtitle=Diabetes%20care&rft.au=Herman,%20William%20H&rft.date=2015-08-01&rft.volume=38&rft.issue=8&rft.spage=1449&rft.epage=1455&rft.pages=1449-1455&rft.issn=0149-5992&rft.eissn=1935-5548&rft.coden=DICAD2&rft_id=info:doi/10.2337/dc14-2459&rft_dat=%3Cproquest_pubme%3E1698956507%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=1699273369&rft_id=info:pmid/25986661&rfr_iscdi=true |