Distal Symmetric and Cardiovascular Autonomic Neuropathies in Brazilian Individuals with Type 2 Diabetes Followed in a Primary Health Care Unit: A Cross-Sectional Study

The paucity of epidemiological data regarding diabetes complications in Brazil motivated us to evaluate the prevalence rates of distal symmetric polyneuropathy (DSP) and of cardiovascular autonomic neuropathy (CAN) in individuals with type 2 diabetes (T2D) followed in a primary care unit. A total of...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:International journal of environmental research and public health 2020-05, Vol.17 (9), p.3232
Hauptverfasser: Reis de Matos, Mozania, Santos-Bezerra, Daniele Pereira, Dias Cavalcante, Cristiane das Graças, Xavier de Carvalho, Jacira, Leite, Juliana, Neves, Jose Antonio Januario, Admoni, Sharon Nina, Passarelli, Marisa, Parisi, Maria Candida, Correa-Giannella, Maria Lucia
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page
container_issue 9
container_start_page 3232
container_title International journal of environmental research and public health
container_volume 17
creator Reis de Matos, Mozania
Santos-Bezerra, Daniele Pereira
Dias Cavalcante, Cristiane das Graças
Xavier de Carvalho, Jacira
Leite, Juliana
Neves, Jose Antonio Januario
Admoni, Sharon Nina
Passarelli, Marisa
Parisi, Maria Candida
Correa-Giannella, Maria Lucia
description The paucity of epidemiological data regarding diabetes complications in Brazil motivated us to evaluate the prevalence rates of distal symmetric polyneuropathy (DSP) and of cardiovascular autonomic neuropathy (CAN) in individuals with type 2 diabetes (T2D) followed in a primary care unit. A total of 551 individuals (59.3% women, 65 years old; diabetes duration of 10 years; HbA1c of 7.2%, medians) were included in this cross-sectional study. DSP was diagnosed by sum of the Neuropathy Symptoms Score (NSS) and Modified Neuropathy Disability Score (NDS) and by the Semmes-Weinstein monofilament. CAN was diagnosed by cardiovascular autonomic reflex tests combined with spectral analysis of heart rate variability. The prevalence rates of DSP were 6.3% and 14.3%, as evaluated by the sum of NSS and NDS and by the Semmes-Weinstein monofilament, respectively. Those with DSP diagnosed by monofilament presented longer diabetes duration, worse glycemic control and a higher stature. The prevalence rates of incipient and definitive CAN were 12.5% and 10%, respectively. Individuals with definitive CAN presented a higher frequency of hypercholesterolemia and of arterial hypertension. The higher prevalence rate of DSP with the use of the monofilament suggests that it may be a more appropriate tool to diagnose DSP in the primary care setting in Brazil.
doi_str_mv 10.3390/ijerph17093232
format Article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7246466</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2400538387</sourcerecordid><originalsourceid>FETCH-LOGICAL-c418t-17d246ad76dc3c070dad039bd0eba476764bb0f0fb2853bd7fc5ad8e9a5043673</originalsourceid><addsrcrecordid>eNpdkk9v3CAQxa2qVZKmufZYIfXSi1NsMNg9VNpu_kpRWynJ2RoD7rLC4ADeaPuJ8jGDtWmU9ATS_Oa9NzBZ9rHAx4Q0-KteKz-uCo4bUpLyTXZQMIZzynDx9sV9P3sfwhpjUlPW7GX7ia0pJ9VB9nCiQwSDrrfDoKLXAoGVaAleareBICYDHi2m6KwbUvGnmrwbIa60Ckhb9MPDX200WHRppd5oOYEJ6F7HFbrZjgqV6ERDp2Kiz5wx7l7JuQ3Qb68H8Ft0ocAkOBkqdGt1_IYWaOldCPm1ElE7O2eLk9x-yN71SVsdPZ2H2e3Z6c3yIr_6dX65XFzlghZ1zAsuS8pAciYFEZhjCRKTppNYdUA544x2He5x35V1RTrJe1GBrFUDFaaEcXKYfd_pjlM3KCmUjR5MO-7ytg50-7pi9ar94zYtT76UsSTw5UnAu7tJhdgOOghlDFjlptCWFOOK1KSevT7_h67d5NPIO4rhitEyUcc7Sszv4lX_HKbA7bwE7eslSA2fXo7wjP_7dfIIteWxxw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2400605642</pqid></control><display><type>article</type><title>Distal Symmetric and Cardiovascular Autonomic Neuropathies in Brazilian Individuals with Type 2 Diabetes Followed in a Primary Health Care Unit: A Cross-Sectional Study</title><source>MDPI - Multidisciplinary Digital Publishing Institute</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>Free Full-Text Journals in Chemistry</source><source>PubMed Central Open Access</source><creator>Reis de Matos, Mozania ; Santos-Bezerra, Daniele Pereira ; Dias Cavalcante, Cristiane das Graças ; Xavier de Carvalho, Jacira ; Leite, Juliana ; Neves, Jose Antonio Januario ; Admoni, Sharon Nina ; Passarelli, Marisa ; Parisi, Maria Candida ; Correa-Giannella, Maria Lucia</creator><creatorcontrib>Reis de Matos, Mozania ; Santos-Bezerra, Daniele Pereira ; Dias Cavalcante, Cristiane das Graças ; Xavier de Carvalho, Jacira ; Leite, Juliana ; Neves, Jose Antonio Januario ; Admoni, Sharon Nina ; Passarelli, Marisa ; Parisi, Maria Candida ; Correa-Giannella, Maria Lucia</creatorcontrib><description>The paucity of epidemiological data regarding diabetes complications in Brazil motivated us to evaluate the prevalence rates of distal symmetric polyneuropathy (DSP) and of cardiovascular autonomic neuropathy (CAN) in individuals with type 2 diabetes (T2D) followed in a primary care unit. A total of 551 individuals (59.3% women, 65 years old; diabetes duration of 10 years; HbA1c of 7.2%, medians) were included in this cross-sectional study. DSP was diagnosed by sum of the Neuropathy Symptoms Score (NSS) and Modified Neuropathy Disability Score (NDS) and by the Semmes-Weinstein monofilament. CAN was diagnosed by cardiovascular autonomic reflex tests combined with spectral analysis of heart rate variability. The prevalence rates of DSP were 6.3% and 14.3%, as evaluated by the sum of NSS and NDS and by the Semmes-Weinstein monofilament, respectively. Those with DSP diagnosed by monofilament presented longer diabetes duration, worse glycemic control and a higher stature. The prevalence rates of incipient and definitive CAN were 12.5% and 10%, respectively. Individuals with definitive CAN presented a higher frequency of hypercholesterolemia and of arterial hypertension. The higher prevalence rate of DSP with the use of the monofilament suggests that it may be a more appropriate tool to diagnose DSP in the primary care setting in Brazil.</description><identifier>ISSN: 1660-4601</identifier><identifier>ISSN: 1661-7827</identifier><identifier>EISSN: 1660-4601</identifier><identifier>DOI: 10.3390/ijerph17093232</identifier><identifier>PMID: 32384735</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Autonomic nervous system ; Blood pressure ; Cholesterol ; Complications ; Cross-sectional studies ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Diabetic neuropathy ; Diabetic retinopathy ; Epidemiology ; Foot diseases ; Health care ; Heart rate ; Hypercholesterolemia ; Hypertension ; Medical personnel ; Polyneuropathy ; Primary care ; Risk factors ; Spectral analysis ; Studies</subject><ispartof>International journal of environmental research and public health, 2020-05, Vol.17 (9), p.3232</ispartof><rights>2020. This work is licensed under http://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 by the authors. 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c418t-17d246ad76dc3c070dad039bd0eba476764bb0f0fb2853bd7fc5ad8e9a5043673</citedby><cites>FETCH-LOGICAL-c418t-17d246ad76dc3c070dad039bd0eba476764bb0f0fb2853bd7fc5ad8e9a5043673</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246466/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246466/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32384735$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Reis de Matos, Mozania</creatorcontrib><creatorcontrib>Santos-Bezerra, Daniele Pereira</creatorcontrib><creatorcontrib>Dias Cavalcante, Cristiane das Graças</creatorcontrib><creatorcontrib>Xavier de Carvalho, Jacira</creatorcontrib><creatorcontrib>Leite, Juliana</creatorcontrib><creatorcontrib>Neves, Jose Antonio Januario</creatorcontrib><creatorcontrib>Admoni, Sharon Nina</creatorcontrib><creatorcontrib>Passarelli, Marisa</creatorcontrib><creatorcontrib>Parisi, Maria Candida</creatorcontrib><creatorcontrib>Correa-Giannella, Maria Lucia</creatorcontrib><title>Distal Symmetric and Cardiovascular Autonomic Neuropathies in Brazilian Individuals with Type 2 Diabetes Followed in a Primary Health Care Unit: A Cross-Sectional Study</title><title>International journal of environmental research and public health</title><addtitle>Int J Environ Res Public Health</addtitle><description>The paucity of epidemiological data regarding diabetes complications in Brazil motivated us to evaluate the prevalence rates of distal symmetric polyneuropathy (DSP) and of cardiovascular autonomic neuropathy (CAN) in individuals with type 2 diabetes (T2D) followed in a primary care unit. A total of 551 individuals (59.3% women, 65 years old; diabetes duration of 10 years; HbA1c of 7.2%, medians) were included in this cross-sectional study. DSP was diagnosed by sum of the Neuropathy Symptoms Score (NSS) and Modified Neuropathy Disability Score (NDS) and by the Semmes-Weinstein monofilament. CAN was diagnosed by cardiovascular autonomic reflex tests combined with spectral analysis of heart rate variability. The prevalence rates of DSP were 6.3% and 14.3%, as evaluated by the sum of NSS and NDS and by the Semmes-Weinstein monofilament, respectively. Those with DSP diagnosed by monofilament presented longer diabetes duration, worse glycemic control and a higher stature. The prevalence rates of incipient and definitive CAN were 12.5% and 10%, respectively. Individuals with definitive CAN presented a higher frequency of hypercholesterolemia and of arterial hypertension. The higher prevalence rate of DSP with the use of the monofilament suggests that it may be a more appropriate tool to diagnose DSP in the primary care setting in Brazil.</description><subject>Autonomic nervous system</subject><subject>Blood pressure</subject><subject>Cholesterol</subject><subject>Complications</subject><subject>Cross-sectional studies</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetic neuropathy</subject><subject>Diabetic retinopathy</subject><subject>Epidemiology</subject><subject>Foot diseases</subject><subject>Health care</subject><subject>Heart rate</subject><subject>Hypercholesterolemia</subject><subject>Hypertension</subject><subject>Medical personnel</subject><subject>Polyneuropathy</subject><subject>Primary care</subject><subject>Risk factors</subject><subject>Spectral analysis</subject><subject>Studies</subject><issn>1660-4601</issn><issn>1661-7827</issn><issn>1660-4601</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNpdkk9v3CAQxa2qVZKmufZYIfXSi1NsMNg9VNpu_kpRWynJ2RoD7rLC4ADeaPuJ8jGDtWmU9ATS_Oa9NzBZ9rHAx4Q0-KteKz-uCo4bUpLyTXZQMIZzynDx9sV9P3sfwhpjUlPW7GX7ia0pJ9VB9nCiQwSDrrfDoKLXAoGVaAleareBICYDHi2m6KwbUvGnmrwbIa60Ckhb9MPDX200WHRppd5oOYEJ6F7HFbrZjgqV6ERDp2Kiz5wx7l7JuQ3Qb68H8Ft0ocAkOBkqdGt1_IYWaOldCPm1ElE7O2eLk9x-yN71SVsdPZ2H2e3Z6c3yIr_6dX65XFzlghZ1zAsuS8pAciYFEZhjCRKTppNYdUA544x2He5x35V1RTrJe1GBrFUDFaaEcXKYfd_pjlM3KCmUjR5MO-7ytg50-7pi9ar94zYtT76UsSTw5UnAu7tJhdgOOghlDFjlptCWFOOK1KSevT7_h67d5NPIO4rhitEyUcc7Sszv4lX_HKbA7bwE7eslSA2fXo7wjP_7dfIIteWxxw</recordid><startdate>20200506</startdate><enddate>20200506</enddate><creator>Reis de Matos, Mozania</creator><creator>Santos-Bezerra, Daniele Pereira</creator><creator>Dias Cavalcante, Cristiane das Graças</creator><creator>Xavier de Carvalho, Jacira</creator><creator>Leite, Juliana</creator><creator>Neves, Jose Antonio Januario</creator><creator>Admoni, Sharon Nina</creator><creator>Passarelli, Marisa</creator><creator>Parisi, Maria Candida</creator><creator>Correa-Giannella, Maria Lucia</creator><general>MDPI AG</general><general>MDPI</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200506</creationdate><title>Distal Symmetric and Cardiovascular Autonomic Neuropathies in Brazilian Individuals with Type 2 Diabetes Followed in a Primary Health Care Unit: A Cross-Sectional Study</title><author>Reis de Matos, Mozania ; Santos-Bezerra, Daniele Pereira ; Dias Cavalcante, Cristiane das Graças ; Xavier de Carvalho, Jacira ; Leite, Juliana ; Neves, Jose Antonio Januario ; Admoni, Sharon Nina ; Passarelli, Marisa ; Parisi, Maria Candida ; Correa-Giannella, Maria Lucia</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c418t-17d246ad76dc3c070dad039bd0eba476764bb0f0fb2853bd7fc5ad8e9a5043673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Autonomic nervous system</topic><topic>Blood pressure</topic><topic>Cholesterol</topic><topic>Complications</topic><topic>Cross-sectional studies</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetic neuropathy</topic><topic>Diabetic retinopathy</topic><topic>Epidemiology</topic><topic>Foot diseases</topic><topic>Health care</topic><topic>Heart rate</topic><topic>Hypercholesterolemia</topic><topic>Hypertension</topic><topic>Medical personnel</topic><topic>Polyneuropathy</topic><topic>Primary care</topic><topic>Risk factors</topic><topic>Spectral analysis</topic><topic>Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Reis de Matos, Mozania</creatorcontrib><creatorcontrib>Santos-Bezerra, Daniele Pereira</creatorcontrib><creatorcontrib>Dias Cavalcante, Cristiane das Graças</creatorcontrib><creatorcontrib>Xavier de Carvalho, Jacira</creatorcontrib><creatorcontrib>Leite, Juliana</creatorcontrib><creatorcontrib>Neves, Jose Antonio Januario</creatorcontrib><creatorcontrib>Admoni, Sharon Nina</creatorcontrib><creatorcontrib>Passarelli, Marisa</creatorcontrib><creatorcontrib>Parisi, Maria Candida</creatorcontrib><creatorcontrib>Correa-Giannella, Maria Lucia</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</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>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of environmental research and public health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Reis de Matos, Mozania</au><au>Santos-Bezerra, Daniele Pereira</au><au>Dias Cavalcante, Cristiane das Graças</au><au>Xavier de Carvalho, Jacira</au><au>Leite, Juliana</au><au>Neves, Jose Antonio Januario</au><au>Admoni, Sharon Nina</au><au>Passarelli, Marisa</au><au>Parisi, Maria Candida</au><au>Correa-Giannella, Maria Lucia</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Distal Symmetric and Cardiovascular Autonomic Neuropathies in Brazilian Individuals with Type 2 Diabetes Followed in a Primary Health Care Unit: A Cross-Sectional Study</atitle><jtitle>International journal of environmental research and public health</jtitle><addtitle>Int J Environ Res Public Health</addtitle><date>2020-05-06</date><risdate>2020</risdate><volume>17</volume><issue>9</issue><spage>3232</spage><pages>3232-</pages><issn>1660-4601</issn><issn>1661-7827</issn><eissn>1660-4601</eissn><abstract>The paucity of epidemiological data regarding diabetes complications in Brazil motivated us to evaluate the prevalence rates of distal symmetric polyneuropathy (DSP) and of cardiovascular autonomic neuropathy (CAN) in individuals with type 2 diabetes (T2D) followed in a primary care unit. A total of 551 individuals (59.3% women, 65 years old; diabetes duration of 10 years; HbA1c of 7.2%, medians) were included in this cross-sectional study. DSP was diagnosed by sum of the Neuropathy Symptoms Score (NSS) and Modified Neuropathy Disability Score (NDS) and by the Semmes-Weinstein monofilament. CAN was diagnosed by cardiovascular autonomic reflex tests combined with spectral analysis of heart rate variability. The prevalence rates of DSP were 6.3% and 14.3%, as evaluated by the sum of NSS and NDS and by the Semmes-Weinstein monofilament, respectively. Those with DSP diagnosed by monofilament presented longer diabetes duration, worse glycemic control and a higher stature. The prevalence rates of incipient and definitive CAN were 12.5% and 10%, respectively. Individuals with definitive CAN presented a higher frequency of hypercholesterolemia and of arterial hypertension. The higher prevalence rate of DSP with the use of the monofilament suggests that it may be a more appropriate tool to diagnose DSP in the primary care setting in Brazil.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>32384735</pmid><doi>10.3390/ijerph17093232</doi><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 1660-4601
ispartof International journal of environmental research and public health, 2020-05, Vol.17 (9), p.3232
issn 1660-4601
1661-7827
1660-4601
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7246466
source MDPI - Multidisciplinary Digital Publishing Institute; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; PubMed Central Open Access
subjects Autonomic nervous system
Blood pressure
Cholesterol
Complications
Cross-sectional studies
Diabetes
Diabetes mellitus
Diabetes mellitus (non-insulin dependent)
Diabetic neuropathy
Diabetic retinopathy
Epidemiology
Foot diseases
Health care
Heart rate
Hypercholesterolemia
Hypertension
Medical personnel
Polyneuropathy
Primary care
Risk factors
Spectral analysis
Studies
title Distal Symmetric and Cardiovascular Autonomic Neuropathies in Brazilian Individuals with Type 2 Diabetes Followed in a Primary Health Care Unit: A Cross-Sectional Study
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-05T07%3A22%3A03IST&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=Distal%20Symmetric%20and%20Cardiovascular%20Autonomic%20Neuropathies%20in%20Brazilian%20Individuals%20with%20Type%202%20Diabetes%20Followed%20in%20a%20Primary%20Health%20Care%20Unit:%20A%20Cross-Sectional%20Study&rft.jtitle=International%20journal%20of%20environmental%20research%20and%20public%20health&rft.au=Reis%20de%20Matos,%20Mozania&rft.date=2020-05-06&rft.volume=17&rft.issue=9&rft.spage=3232&rft.pages=3232-&rft.issn=1660-4601&rft.eissn=1660-4601&rft_id=info:doi/10.3390/ijerph17093232&rft_dat=%3Cproquest_pubme%3E2400538387%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=2400605642&rft_id=info:pmid/32384735&rfr_iscdi=true