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Benzodiazepines and risk of pneumonia in schizophrenia: a nationwide case–control study
Objectives To investigate the relationship between benzodiazepine and risk of developing pneumonia in patients with schizophrenia, whose benzodiazepine dosage and usage frequency was higher than that of the general population. Methods We conducted a nested case–control study to assess the associatio...
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| Published in: | Psychopharmacology 2018-11, Vol.235 (11), p.3329-3338 |
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| container_issue | 11 |
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| container_title | Psychopharmacology |
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| creator | Cheng, Sheng-Yun Chen, Wen-Yin Liu, Hsing-Cheng Yang, Tien-Wei Pan, Chun-Hung Yang, Shu-Yu Kuo, Chian-Jue |
| description | Objectives
To investigate the relationship between benzodiazepine and risk of developing pneumonia in patients with schizophrenia, whose benzodiazepine dosage and usage frequency was higher than that of the general population.
Methods
We conducted a nested case–control study to assess the association between benzodiazepine use and pneumonia among patients with schizophrenia. By using the Taiwan National Health Insurance Research Database, we identified a schizophrenia cohort comprising 34,929 patients during 2000–2010. Within the schizophrenia cohort, 2501 cases of pneumonia and 9961 matched control patients (1:4 ratio) were identified. Benzodiazepine exposure was categorized by drug, treatment duration, and daily dose. Conditional logistic regression models were used to examine the association between benzodiazepine exposure and the risk of pneumonia.
Results
The current use (within 30 days) of midazolam led to the highest pneumonia risk (adjusted risk ratio = 6.56,
P
|
| doi_str_mv | 10.1007/s00213-018-5039-9 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2126918288</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2126918288</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-731e69f5febd7a40e615bd20e39842b4e63f27a735d4e2f86bdebbace00298f13</originalsourceid><addsrcrecordid>eNp1kMtq3TAQhkVoSE4uD9BNEGTTjduR5IucXXJo00Agm3bRlZCtcaPUlhzJJpyz6jv0Dfsk1cFpCoFqMyB984_mI-Qtg_cMoPoQATgTGTCZFSDqrN4jK5YLnnGo-BuyAhAiE6yQh-QoxgdIJ5f5ATkUwAUvBKzItyt0W2-s3uJoHUaqnaHBxh_Ud3R0OA_eWU2to7G9t1s_3gdMFxdUU6cn692TNUhbHfH3z1-td1PwPY3TbDYnZL_TfcTT53pMvn76-GX9Obu9u75ZX95mraj4lFWCYVl3RYeNqXQOWLKiMRxQ1DLnTY6l6HilK1GYHHkny8Zg0-gW0-617Jg4Ju-W3DH4xxnjpAYbW-x77dDPUXHGy5pJLmVCz1-hD34OLv0uUVCDgKrYUWyh2uBjDNipMdhBh41ioHbe1eJdJe9q513VqefsOXluBjQvHX9FJ4AvQExP7juGf6P_n_oHyXiO0A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2109030758</pqid></control><display><type>article</type><title>Benzodiazepines and risk of pneumonia in schizophrenia: a nationwide case–control study</title><source>EBSCOhost SPORTDiscus with Full Text</source><source>Springer Link</source><creator>Cheng, Sheng-Yun ; Chen, Wen-Yin ; Liu, Hsing-Cheng ; Yang, Tien-Wei ; Pan, Chun-Hung ; Yang, Shu-Yu ; Kuo, Chian-Jue</creator><creatorcontrib>Cheng, Sheng-Yun ; Chen, Wen-Yin ; Liu, Hsing-Cheng ; Yang, Tien-Wei ; Pan, Chun-Hung ; Yang, Shu-Yu ; Kuo, Chian-Jue</creatorcontrib><description>Objectives
To investigate the relationship between benzodiazepine and risk of developing pneumonia in patients with schizophrenia, whose benzodiazepine dosage and usage frequency was higher than that of the general population.
Methods
We conducted a nested case–control study to assess the association between benzodiazepine use and pneumonia among patients with schizophrenia. By using the Taiwan National Health Insurance Research Database, we identified a schizophrenia cohort comprising 34,929 patients during 2000–2010. Within the schizophrenia cohort, 2501 cases of pneumonia and 9961 matched control patients (1:4 ratio) were identified. Benzodiazepine exposure was categorized by drug, treatment duration, and daily dose. Conditional logistic regression models were used to examine the association between benzodiazepine exposure and the risk of pneumonia.
Results
The current use (within 30 days) of midazolam led to the highest pneumonia risk (adjusted risk ratio = 6.56,
P
< 0.001), followed by diazepam (3.43,
P
< 0.001), lorazepam (2.16,
P
< 0.001), and triazolam (1.80,
P
= 0.019). Furthermore, nearly all the benzodiazepines under current use had a dose-dependent effect on pneumonia risk. The risk of pneumonia was correlated with the affinities of γ-aminobutyric acid A α1, α2, and α3 receptors.
Conclusions
Benzodiazepines had a dose-dependent relationship with pneumonia in patients with schizophrenia. The differences in risk and mechanism of action of the individual drugs require further investigation. Clinicians should be aware of the early signs of pneumonia in patients with schizophrenia receiving benzodiazepines.</description><identifier>ISSN: 0033-3158</identifier><identifier>EISSN: 1432-2072</identifier><identifier>DOI: 10.1007/s00213-018-5039-9</identifier><identifier>PMID: 30232530</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Benzodiazepines ; Benzodiazepines - administration & dosage ; Benzodiazepines - adverse effects ; Biomedical and Life Sciences ; Biomedicine ; Case-Control Studies ; Cohort Studies ; Databases, Factual - trends ; Diazepam ; Dose-Response Relationship, Drug ; Exposure ; Female ; Health risk assessment ; Humans ; Insurance Claim Reporting - trends ; Lorazepam ; Male ; Mental disorders ; Midazolam ; Middle Aged ; Neurosciences ; Original Investigation ; Patients ; Pharmacology/Toxicology ; Pneumonia ; Pneumonia - chemically induced ; Pneumonia - epidemiology ; Psychiatry ; Regression analysis ; Risk Factors ; Schizophrenia ; Schizophrenia - drug therapy ; Schizophrenia - epidemiology ; Taiwan - epidemiology ; Triazolam</subject><ispartof>Psychopharmacology, 2018-11, Vol.235 (11), p.3329-3338</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018</rights><rights>Psychopharmacology is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-731e69f5febd7a40e615bd20e39842b4e63f27a735d4e2f86bdebbace00298f13</citedby><cites>FETCH-LOGICAL-c372t-731e69f5febd7a40e615bd20e39842b4e63f27a735d4e2f86bdebbace00298f13</cites><orcidid>0000-0002-2773-1335</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30232530$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cheng, Sheng-Yun</creatorcontrib><creatorcontrib>Chen, Wen-Yin</creatorcontrib><creatorcontrib>Liu, Hsing-Cheng</creatorcontrib><creatorcontrib>Yang, Tien-Wei</creatorcontrib><creatorcontrib>Pan, Chun-Hung</creatorcontrib><creatorcontrib>Yang, Shu-Yu</creatorcontrib><creatorcontrib>Kuo, Chian-Jue</creatorcontrib><title>Benzodiazepines and risk of pneumonia in schizophrenia: a nationwide case–control study</title><title>Psychopharmacology</title><addtitle>Psychopharmacology</addtitle><addtitle>Psychopharmacology (Berl)</addtitle><description>Objectives
To investigate the relationship between benzodiazepine and risk of developing pneumonia in patients with schizophrenia, whose benzodiazepine dosage and usage frequency was higher than that of the general population.
Methods
We conducted a nested case–control study to assess the association between benzodiazepine use and pneumonia among patients with schizophrenia. By using the Taiwan National Health Insurance Research Database, we identified a schizophrenia cohort comprising 34,929 patients during 2000–2010. Within the schizophrenia cohort, 2501 cases of pneumonia and 9961 matched control patients (1:4 ratio) were identified. Benzodiazepine exposure was categorized by drug, treatment duration, and daily dose. Conditional logistic regression models were used to examine the association between benzodiazepine exposure and the risk of pneumonia.
Results
The current use (within 30 days) of midazolam led to the highest pneumonia risk (adjusted risk ratio = 6.56,
P
< 0.001), followed by diazepam (3.43,
P
< 0.001), lorazepam (2.16,
P
< 0.001), and triazolam (1.80,
P
= 0.019). Furthermore, nearly all the benzodiazepines under current use had a dose-dependent effect on pneumonia risk. The risk of pneumonia was correlated with the affinities of γ-aminobutyric acid A α1, α2, and α3 receptors.
Conclusions
Benzodiazepines had a dose-dependent relationship with pneumonia in patients with schizophrenia. The differences in risk and mechanism of action of the individual drugs require further investigation. Clinicians should be aware of the early signs of pneumonia in patients with schizophrenia receiving benzodiazepines.</description><subject>Adult</subject><subject>Benzodiazepines</subject><subject>Benzodiazepines - administration & dosage</subject><subject>Benzodiazepines - adverse effects</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Case-Control Studies</subject><subject>Cohort Studies</subject><subject>Databases, Factual - trends</subject><subject>Diazepam</subject><subject>Dose-Response Relationship, Drug</subject><subject>Exposure</subject><subject>Female</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Insurance Claim Reporting - trends</subject><subject>Lorazepam</subject><subject>Male</subject><subject>Mental disorders</subject><subject>Midazolam</subject><subject>Middle Aged</subject><subject>Neurosciences</subject><subject>Original Investigation</subject><subject>Patients</subject><subject>Pharmacology/Toxicology</subject><subject>Pneumonia</subject><subject>Pneumonia - chemically induced</subject><subject>Pneumonia - epidemiology</subject><subject>Psychiatry</subject><subject>Regression analysis</subject><subject>Risk Factors</subject><subject>Schizophrenia</subject><subject>Schizophrenia - drug therapy</subject><subject>Schizophrenia - epidemiology</subject><subject>Taiwan - epidemiology</subject><subject>Triazolam</subject><issn>0033-3158</issn><issn>1432-2072</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp1kMtq3TAQhkVoSE4uD9BNEGTTjduR5IucXXJo00Agm3bRlZCtcaPUlhzJJpyz6jv0Dfsk1cFpCoFqMyB984_mI-Qtg_cMoPoQATgTGTCZFSDqrN4jK5YLnnGo-BuyAhAiE6yQh-QoxgdIJ5f5ATkUwAUvBKzItyt0W2-s3uJoHUaqnaHBxh_Ud3R0OA_eWU2to7G9t1s_3gdMFxdUU6cn692TNUhbHfH3z1-td1PwPY3TbDYnZL_TfcTT53pMvn76-GX9Obu9u75ZX95mraj4lFWCYVl3RYeNqXQOWLKiMRxQ1DLnTY6l6HilK1GYHHkny8Zg0-gW0-617Jg4Ju-W3DH4xxnjpAYbW-x77dDPUXHGy5pJLmVCz1-hD34OLv0uUVCDgKrYUWyh2uBjDNipMdhBh41ioHbe1eJdJe9q513VqefsOXluBjQvHX9FJ4AvQExP7juGf6P_n_oHyXiO0A</recordid><startdate>20181101</startdate><enddate>20181101</enddate><creator>Cheng, Sheng-Yun</creator><creator>Chen, Wen-Yin</creator><creator>Liu, Hsing-Cheng</creator><creator>Yang, Tien-Wei</creator><creator>Pan, Chun-Hung</creator><creator>Yang, Shu-Yu</creator><creator>Kuo, Chian-Jue</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</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>3V.</scope><scope>7QG</scope><scope>7QR</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8AO</scope><scope>8FD</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>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2773-1335</orcidid></search><sort><creationdate>20181101</creationdate><title>Benzodiazepines and risk of pneumonia in schizophrenia: a nationwide case–control study</title><author>Cheng, Sheng-Yun ; Chen, Wen-Yin ; Liu, Hsing-Cheng ; Yang, Tien-Wei ; Pan, Chun-Hung ; Yang, Shu-Yu ; Kuo, Chian-Jue</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-731e69f5febd7a40e615bd20e39842b4e63f27a735d4e2f86bdebbace00298f13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Benzodiazepines</topic><topic>Benzodiazepines - administration & dosage</topic><topic>Benzodiazepines - adverse effects</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Case-Control Studies</topic><topic>Cohort Studies</topic><topic>Databases, Factual - trends</topic><topic>Diazepam</topic><topic>Dose-Response Relationship, Drug</topic><topic>Exposure</topic><topic>Female</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Insurance Claim Reporting - trends</topic><topic>Lorazepam</topic><topic>Male</topic><topic>Mental disorders</topic><topic>Midazolam</topic><topic>Middle Aged</topic><topic>Neurosciences</topic><topic>Original Investigation</topic><topic>Patients</topic><topic>Pharmacology/Toxicology</topic><topic>Pneumonia</topic><topic>Pneumonia - chemically induced</topic><topic>Pneumonia - epidemiology</topic><topic>Psychiatry</topic><topic>Regression analysis</topic><topic>Risk Factors</topic><topic>Schizophrenia</topic><topic>Schizophrenia - drug therapy</topic><topic>Schizophrenia - epidemiology</topic><topic>Taiwan - epidemiology</topic><topic>Triazolam</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cheng, Sheng-Yun</creatorcontrib><creatorcontrib>Chen, Wen-Yin</creatorcontrib><creatorcontrib>Liu, Hsing-Cheng</creatorcontrib><creatorcontrib>Yang, Tien-Wei</creatorcontrib><creatorcontrib>Pan, Chun-Hung</creatorcontrib><creatorcontrib>Yang, Shu-Yu</creatorcontrib><creatorcontrib>Kuo, Chian-Jue</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 Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Chemoreception Abstracts</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research 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)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</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 One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Psychopharmacology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cheng, Sheng-Yun</au><au>Chen, Wen-Yin</au><au>Liu, Hsing-Cheng</au><au>Yang, Tien-Wei</au><au>Pan, Chun-Hung</au><au>Yang, Shu-Yu</au><au>Kuo, Chian-Jue</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Benzodiazepines and risk of pneumonia in schizophrenia: a nationwide case–control study</atitle><jtitle>Psychopharmacology</jtitle><stitle>Psychopharmacology</stitle><addtitle>Psychopharmacology (Berl)</addtitle><date>2018-11-01</date><risdate>2018</risdate><volume>235</volume><issue>11</issue><spage>3329</spage><epage>3338</epage><pages>3329-3338</pages><issn>0033-3158</issn><eissn>1432-2072</eissn><abstract>Objectives
To investigate the relationship between benzodiazepine and risk of developing pneumonia in patients with schizophrenia, whose benzodiazepine dosage and usage frequency was higher than that of the general population.
Methods
We conducted a nested case–control study to assess the association between benzodiazepine use and pneumonia among patients with schizophrenia. By using the Taiwan National Health Insurance Research Database, we identified a schizophrenia cohort comprising 34,929 patients during 2000–2010. Within the schizophrenia cohort, 2501 cases of pneumonia and 9961 matched control patients (1:4 ratio) were identified. Benzodiazepine exposure was categorized by drug, treatment duration, and daily dose. Conditional logistic regression models were used to examine the association between benzodiazepine exposure and the risk of pneumonia.
Results
The current use (within 30 days) of midazolam led to the highest pneumonia risk (adjusted risk ratio = 6.56,
P
< 0.001), followed by diazepam (3.43,
P
< 0.001), lorazepam (2.16,
P
< 0.001), and triazolam (1.80,
P
= 0.019). Furthermore, nearly all the benzodiazepines under current use had a dose-dependent effect on pneumonia risk. The risk of pneumonia was correlated with the affinities of γ-aminobutyric acid A α1, α2, and α3 receptors.
Conclusions
Benzodiazepines had a dose-dependent relationship with pneumonia in patients with schizophrenia. The differences in risk and mechanism of action of the individual drugs require further investigation. Clinicians should be aware of the early signs of pneumonia in patients with schizophrenia receiving benzodiazepines.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30232530</pmid><doi>10.1007/s00213-018-5039-9</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-2773-1335</orcidid></addata></record> |
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| source | EBSCOhost SPORTDiscus with Full Text; Springer Link |
| subjects | Adult Benzodiazepines Benzodiazepines - administration & dosage Benzodiazepines - adverse effects Biomedical and Life Sciences Biomedicine Case-Control Studies Cohort Studies Databases, Factual - trends Diazepam Dose-Response Relationship, Drug Exposure Female Health risk assessment Humans Insurance Claim Reporting - trends Lorazepam Male Mental disorders Midazolam Middle Aged Neurosciences Original Investigation Patients Pharmacology/Toxicology Pneumonia Pneumonia - chemically induced Pneumonia - epidemiology Psychiatry Regression analysis Risk Factors Schizophrenia Schizophrenia - drug therapy Schizophrenia - epidemiology Taiwan - epidemiology Triazolam |
| title | Benzodiazepines and risk of pneumonia in schizophrenia: a nationwide case–control study |
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