Loading…

Occurrence of candiduria in a population of chronically catheterized patients with spinal cord injury

Study design: Prospective data collection. Objectives: To evaluate occurrence and characteristics of candiduria in a population of individuals with spinal cord injury (SCI) or multiple sclerosis (MS) and chronic catheter usage. Candiduria, or presence of Candida species in the urine, is a common cli...

Full description

Saved in:
Bibliographic Details
Published in:Spinal cord 2010-01, Vol.48 (1), p.51-54
Main Authors: Goetz, L L, Howard, M, Cipher, D, Revankar, S G
Format: Article
Language:English
Subjects:
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c469t-f1c72c1592483b887924ec4bd0fd28f34c0dc48a38c08a1ec42d31708d7ffedd3
cites cdi_FETCH-LOGICAL-c469t-f1c72c1592483b887924ec4bd0fd28f34c0dc48a38c08a1ec42d31708d7ffedd3
container_end_page 54
container_issue 1
container_start_page 51
container_title Spinal cord
container_volume 48
creator Goetz, L L
Howard, M
Cipher, D
Revankar, S G
description Study design: Prospective data collection. Objectives: To evaluate occurrence and characteristics of candiduria in a population of individuals with spinal cord injury (SCI) or multiple sclerosis (MS) and chronic catheter usage. Candiduria, or presence of Candida species in the urine, is a common clinical problem. It is most frequently seen in patients with indwelling urinary catheters. Many patients have these catheters in place chronically. Previous studies have shown that despite therapy, most patients with candiduria will develop the infection again and that complications such as invasive candidiasis are rare. However, there are no studies that specifically examine the role of candiduria in patients with SCI and long-term catheter use. Setting: Inpatients and outpatients in a US Veterans Affairs spinal cord injury center. Methods: Urinalysis, culture, patient demographic and clinical characteristics through chart review. Results: Of 100 total patients, 52 had paraplegia, 45 tetraplegia and 3 MS. Overall, 17 (17%) patients had candiduria, which was observed in urine culture. Antibiotic use was associated with an increased risk of developing candiduria. Indwelling catheter (urethral or suprapubic) usage was also significantly associated with candiduria; only one person on intermittent catheterization developed candiduria, which was not associated with adverse clinical outcomes. Conclusions: Antibiotic usage and indwelling catheterization were associated with candiduria. No participant in our study population developed invasive candidiasis, and persistence of candiduria was not frequent.
doi_str_mv 10.1038/sc.2009.81
format article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_733694890</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1934583651</sourcerecordid><originalsourceid>FETCH-LOGICAL-c469t-f1c72c1592483b887924ec4bd0fd28f34c0dc48a38c08a1ec42d31708d7ffedd3</originalsourceid><addsrcrecordid>eNp90U1rGzEQBmBRWvJ96Q8ootAEWtbV1-5KxxKStBDIpT0v8kiqZdbSVloR3F9fOTYJ9JCTBubhlUaD0HtKFpRw-TXDghGiFpK-QSdU9F3Tdky8rTXvWCO44sfoNOc1qYgqeYSOqWolVbQ9QfYBoKRkA1gcHQYdjDcleY19wBpPcSqjnn0MT91VisGDHsdtlfPKzjb5v9bgqRIb5owf_bzCefJBjxhiMjVlXdL2HL1zesz24nCeoV-3Nz-vvzf3D3c_rr_dNyA6NTeOQs-AtooJyZdS9rWwIJaGOMOk4wKIASE1l0CkprXFDKc9kaZ3zhrDz9DVPndK8U-xeR42PoMdRx1sLHnoOe-UkIpUefmqZJQz1RNa4cf_4DqWVOerhineyo6Iij7vEaSYc7JumJLf6LQdKBl2OxoyDLsdDXKX-OGQWJYba17oYSkVfDoAnetnu6QD-PzsGBOUEMGq-7J3ubbCb5tenvbatUHPJdnnuAw7UcE_4yyyfQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>229358604</pqid></control><display><type>article</type><title>Occurrence of candiduria in a population of chronically catheterized patients with spinal cord injury</title><source>EBSCOhost SPORTDiscus with Full Text</source><creator>Goetz, L L ; Howard, M ; Cipher, D ; Revankar, S G</creator><creatorcontrib>Goetz, L L ; Howard, M ; Cipher, D ; Revankar, S G</creatorcontrib><description>Study design: Prospective data collection. Objectives: To evaluate occurrence and characteristics of candiduria in a population of individuals with spinal cord injury (SCI) or multiple sclerosis (MS) and chronic catheter usage. Candiduria, or presence of Candida species in the urine, is a common clinical problem. It is most frequently seen in patients with indwelling urinary catheters. Many patients have these catheters in place chronically. Previous studies have shown that despite therapy, most patients with candiduria will develop the infection again and that complications such as invasive candidiasis are rare. However, there are no studies that specifically examine the role of candiduria in patients with SCI and long-term catheter use. Setting: Inpatients and outpatients in a US Veterans Affairs spinal cord injury center. Methods: Urinalysis, culture, patient demographic and clinical characteristics through chart review. Results: Of 100 total patients, 52 had paraplegia, 45 tetraplegia and 3 MS. Overall, 17 (17%) patients had candiduria, which was observed in urine culture. Antibiotic use was associated with an increased risk of developing candiduria. Indwelling catheter (urethral or suprapubic) usage was also significantly associated with candiduria; only one person on intermittent catheterization developed candiduria, which was not associated with adverse clinical outcomes. Conclusions: Antibiotic usage and indwelling catheterization were associated with candiduria. No participant in our study population developed invasive candidiasis, and persistence of candiduria was not frequent.</description><identifier>ISSN: 1362-4393</identifier><identifier>EISSN: 1476-5624</identifier><identifier>DOI: 10.1038/sc.2009.81</identifier><identifier>PMID: 19581915</identifier><identifier>CODEN: SPCOFM</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anatomy ; Biological and medical sciences ; Biomedical and Life Sciences ; Biomedicine ; Candida ; Candidiasis - epidemiology ; Candidiasis - etiology ; Candidiasis - therapy ; Cerebrospinal fluid. Meninges. Spinal cord ; Chi-Square Distribution ; Female ; Human Physiology ; Humans ; Injuries of the nervous system and the skull. Diseases due to physical agents ; Male ; Medical sciences ; Middle Aged ; Nervous system (semeiology, syndromes) ; Neurochemistry ; Neurology ; Neuropsychology ; Neurosciences ; original-article ; Paraplegia - therapy ; Quadriplegia - therapy ; Spinal Cord Injuries - complications ; Spinal Cord Injuries - epidemiology ; Spinal Cord Injuries - therapy ; Traumas. Diseases due to physical agents ; United States - epidemiology ; Urinary Catheterization - adverse effects ; Urinary Tract Infections - etiology ; Urinary Tract Infections - microbiology ; Veterans</subject><ispartof>Spinal cord, 2010-01, Vol.48 (1), p.51-54</ispartof><rights>International Spinal Cord Society 2010</rights><rights>2015 INIST-CNRS</rights><rights>Copyright Nature Publishing Group Jan 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c469t-f1c72c1592483b887924ec4bd0fd28f34c0dc48a38c08a1ec42d31708d7ffedd3</citedby><cites>FETCH-LOGICAL-c469t-f1c72c1592483b887924ec4bd0fd28f34c0dc48a38c08a1ec42d31708d7ffedd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=22410042$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19581915$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Goetz, L L</creatorcontrib><creatorcontrib>Howard, M</creatorcontrib><creatorcontrib>Cipher, D</creatorcontrib><creatorcontrib>Revankar, S G</creatorcontrib><title>Occurrence of candiduria in a population of chronically catheterized patients with spinal cord injury</title><title>Spinal cord</title><addtitle>Spinal Cord</addtitle><addtitle>Spinal Cord</addtitle><description>Study design: Prospective data collection. Objectives: To evaluate occurrence and characteristics of candiduria in a population of individuals with spinal cord injury (SCI) or multiple sclerosis (MS) and chronic catheter usage. Candiduria, or presence of Candida species in the urine, is a common clinical problem. It is most frequently seen in patients with indwelling urinary catheters. Many patients have these catheters in place chronically. Previous studies have shown that despite therapy, most patients with candiduria will develop the infection again and that complications such as invasive candidiasis are rare. However, there are no studies that specifically examine the role of candiduria in patients with SCI and long-term catheter use. Setting: Inpatients and outpatients in a US Veterans Affairs spinal cord injury center. Methods: Urinalysis, culture, patient demographic and clinical characteristics through chart review. Results: Of 100 total patients, 52 had paraplegia, 45 tetraplegia and 3 MS. Overall, 17 (17%) patients had candiduria, which was observed in urine culture. Antibiotic use was associated with an increased risk of developing candiduria. Indwelling catheter (urethral or suprapubic) usage was also significantly associated with candiduria; only one person on intermittent catheterization developed candiduria, which was not associated with adverse clinical outcomes. Conclusions: Antibiotic usage and indwelling catheterization were associated with candiduria. No participant in our study population developed invasive candidiasis, and persistence of candiduria was not frequent.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anatomy</subject><subject>Biological and medical sciences</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Candida</subject><subject>Candidiasis - epidemiology</subject><subject>Candidiasis - etiology</subject><subject>Candidiasis - therapy</subject><subject>Cerebrospinal fluid. Meninges. Spinal cord</subject><subject>Chi-Square Distribution</subject><subject>Female</subject><subject>Human Physiology</subject><subject>Humans</subject><subject>Injuries of the nervous system and the skull. Diseases due to physical agents</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurochemistry</subject><subject>Neurology</subject><subject>Neuropsychology</subject><subject>Neurosciences</subject><subject>original-article</subject><subject>Paraplegia - therapy</subject><subject>Quadriplegia - therapy</subject><subject>Spinal Cord Injuries - complications</subject><subject>Spinal Cord Injuries - epidemiology</subject><subject>Spinal Cord Injuries - therapy</subject><subject>Traumas. Diseases due to physical agents</subject><subject>United States - epidemiology</subject><subject>Urinary Catheterization - adverse effects</subject><subject>Urinary Tract Infections - etiology</subject><subject>Urinary Tract Infections - microbiology</subject><subject>Veterans</subject><issn>1362-4393</issn><issn>1476-5624</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><recordid>eNp90U1rGzEQBmBRWvJ96Q8ootAEWtbV1-5KxxKStBDIpT0v8kiqZdbSVloR3F9fOTYJ9JCTBubhlUaD0HtKFpRw-TXDghGiFpK-QSdU9F3Tdky8rTXvWCO44sfoNOc1qYgqeYSOqWolVbQ9QfYBoKRkA1gcHQYdjDcleY19wBpPcSqjnn0MT91VisGDHsdtlfPKzjb5v9bgqRIb5owf_bzCefJBjxhiMjVlXdL2HL1zesz24nCeoV-3Nz-vvzf3D3c_rr_dNyA6NTeOQs-AtooJyZdS9rWwIJaGOMOk4wKIASE1l0CkprXFDKc9kaZ3zhrDz9DVPndK8U-xeR42PoMdRx1sLHnoOe-UkIpUefmqZJQz1RNa4cf_4DqWVOerhineyo6Iij7vEaSYc7JumJLf6LQdKBl2OxoyDLsdDXKX-OGQWJYba17oYSkVfDoAnetnu6QD-PzsGBOUEMGq-7J3ubbCb5tenvbatUHPJdnnuAw7UcE_4yyyfQ</recordid><startdate>20100101</startdate><enddate>20100101</enddate><creator>Goetz, L L</creator><creator>Howard, M</creator><creator>Cipher, D</creator><creator>Revankar, S G</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</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>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7T7</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20100101</creationdate><title>Occurrence of candiduria in a population of chronically catheterized patients with spinal cord injury</title><author>Goetz, L L ; Howard, M ; Cipher, D ; Revankar, S G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c469t-f1c72c1592483b887924ec4bd0fd28f34c0dc48a38c08a1ec42d31708d7ffedd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anatomy</topic><topic>Biological and medical sciences</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Candida</topic><topic>Candidiasis - epidemiology</topic><topic>Candidiasis - etiology</topic><topic>Candidiasis - therapy</topic><topic>Cerebrospinal fluid. Meninges. Spinal cord</topic><topic>Chi-Square Distribution</topic><topic>Female</topic><topic>Human Physiology</topic><topic>Humans</topic><topic>Injuries of the nervous system and the skull. Diseases due to physical agents</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurochemistry</topic><topic>Neurology</topic><topic>Neuropsychology</topic><topic>Neurosciences</topic><topic>original-article</topic><topic>Paraplegia - therapy</topic><topic>Quadriplegia - therapy</topic><topic>Spinal Cord Injuries - complications</topic><topic>Spinal Cord Injuries - epidemiology</topic><topic>Spinal Cord Injuries - therapy</topic><topic>Traumas. Diseases due to physical agents</topic><topic>United States - epidemiology</topic><topic>Urinary Catheterization - adverse effects</topic><topic>Urinary Tract Infections - etiology</topic><topic>Urinary Tract Infections - microbiology</topic><topic>Veterans</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Goetz, L L</creatorcontrib><creatorcontrib>Howard, M</creatorcontrib><creatorcontrib>Cipher, D</creatorcontrib><creatorcontrib>Revankar, S G</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>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing &amp; Allied Health Database</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</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>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</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>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Nursing &amp; 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>MEDLINE - Academic</collection><jtitle>Spinal cord</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Goetz, L L</au><au>Howard, M</au><au>Cipher, D</au><au>Revankar, S G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Occurrence of candiduria in a population of chronically catheterized patients with spinal cord injury</atitle><jtitle>Spinal cord</jtitle><stitle>Spinal Cord</stitle><addtitle>Spinal Cord</addtitle><date>2010-01-01</date><risdate>2010</risdate><volume>48</volume><issue>1</issue><spage>51</spage><epage>54</epage><pages>51-54</pages><issn>1362-4393</issn><eissn>1476-5624</eissn><coden>SPCOFM</coden><abstract>Study design: Prospective data collection. Objectives: To evaluate occurrence and characteristics of candiduria in a population of individuals with spinal cord injury (SCI) or multiple sclerosis (MS) and chronic catheter usage. Candiduria, or presence of Candida species in the urine, is a common clinical problem. It is most frequently seen in patients with indwelling urinary catheters. Many patients have these catheters in place chronically. Previous studies have shown that despite therapy, most patients with candiduria will develop the infection again and that complications such as invasive candidiasis are rare. However, there are no studies that specifically examine the role of candiduria in patients with SCI and long-term catheter use. Setting: Inpatients and outpatients in a US Veterans Affairs spinal cord injury center. Methods: Urinalysis, culture, patient demographic and clinical characteristics through chart review. Results: Of 100 total patients, 52 had paraplegia, 45 tetraplegia and 3 MS. Overall, 17 (17%) patients had candiduria, which was observed in urine culture. Antibiotic use was associated with an increased risk of developing candiduria. Indwelling catheter (urethral or suprapubic) usage was also significantly associated with candiduria; only one person on intermittent catheterization developed candiduria, which was not associated with adverse clinical outcomes. Conclusions: Antibiotic usage and indwelling catheterization were associated with candiduria. No participant in our study population developed invasive candidiasis, and persistence of candiduria was not frequent.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>19581915</pmid><doi>10.1038/sc.2009.81</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 1362-4393
ispartof Spinal cord, 2010-01, Vol.48 (1), p.51-54
issn 1362-4393
1476-5624
language eng
recordid cdi_proquest_miscellaneous_733694890
source EBSCOhost SPORTDiscus with Full Text
subjects Adult
Aged
Aged, 80 and over
Anatomy
Biological and medical sciences
Biomedical and Life Sciences
Biomedicine
Candida
Candidiasis - epidemiology
Candidiasis - etiology
Candidiasis - therapy
Cerebrospinal fluid. Meninges. Spinal cord
Chi-Square Distribution
Female
Human Physiology
Humans
Injuries of the nervous system and the skull. Diseases due to physical agents
Male
Medical sciences
Middle Aged
Nervous system (semeiology, syndromes)
Neurochemistry
Neurology
Neuropsychology
Neurosciences
original-article
Paraplegia - therapy
Quadriplegia - therapy
Spinal Cord Injuries - complications
Spinal Cord Injuries - epidemiology
Spinal Cord Injuries - therapy
Traumas. Diseases due to physical agents
United States - epidemiology
Urinary Catheterization - adverse effects
Urinary Tract Infections - etiology
Urinary Tract Infections - microbiology
Veterans
title Occurrence of candiduria in a population of chronically catheterized patients with spinal cord injury
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-10T10%3A10%3A27IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Occurrence%20of%20candiduria%20in%20a%20population%20of%20chronically%20catheterized%20patients%20with%20spinal%20cord%20injury&rft.jtitle=Spinal%20cord&rft.au=Goetz,%20L%20L&rft.date=2010-01-01&rft.volume=48&rft.issue=1&rft.spage=51&rft.epage=54&rft.pages=51-54&rft.issn=1362-4393&rft.eissn=1476-5624&rft.coden=SPCOFM&rft_id=info:doi/10.1038/sc.2009.81&rft_dat=%3Cproquest_cross%3E1934583651%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c469t-f1c72c1592483b887924ec4bd0fd28f34c0dc48a38c08a1ec42d31708d7ffedd3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=229358604&rft_id=info:pmid/19581915&rfr_iscdi=true