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...
Saved in:
Published in: | Spinal cord 2010-01, Vol.48 (1), p.51-54 |
---|---|
Main Authors: | , , , |
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&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 & 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 & 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 & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & 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 & 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 |