Perinatal Stress, Anxiety, and Depression: Effects of a MBCP Intervention on Mother-infant Interaction

2017 ◽  
Vol 41 (S1) ◽  
pp. S30-S31 ◽  
Author(s):  
S.E. Setterberg ◽  
E. Nissen ◽  
W. Jonas ◽  
M. Niemi
Keyword(s):  
Mental Health ◽  
Perceived Stress ◽  
Mental Health Problems ◽  
Intervention Group ◽  
Depression Scale ◽  
Cumulative Effect ◽  
Public Health Issue ◽  
Control Group ◽  
Depression Symptoms ◽  
Mindfulness Intervention

IntroductionTransition into parenthood is a demanding phase in life and exposes the becoming parents to vulnerability for depression, anxiety and stress. Perinatal mental health problems are a major public health issue and many women suffering from depression during their first year after delivery. High levels of stress during pregnancy are associated with adverse psychological and physiological outcomes for the infant and parents. There seems to be an intergenerational transmission of mental health from parent to infant. The current study evaluated the effectiveness of mindfulness intervention during pregnancy in reducing depression symptoms, anxiety and perceived stress in parents-to-be.ObjectivesAssess whether the mindfulness will improve interaction between mother-infant at 12 months.MethodsPerceived stress scale and Edinburgh postnatal depression scale used to measure stress and depression during pregnancy. Parent child early relational assessment assessed mother-infant interaction.ResultsInhibited parent-infant relationships were more common in the control group comparing to the mindfulness intervention group. This is in line with previous research on periantal depression, anxiety, and stress, showing more dysfunctional dyads. A depressed mother has reduced capability to be alert to her baby's signals, which is necessary for appropriate parent-infant relationship to occur. The cumulative effect of impaired parent-infant relationship is a “depressed dyad” of mother and infant.ConclusionMindfulness intervention reduced depressive symptoms, anxiety, and perceived stress in pregnant women. At 12 months mother-infant relationship assessment, the mindfulness intervention group dyads showed a more attuned mother-infant interaction.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Efficacy of ‘Foundations’, a Digital Mental Health App to Improve Mental Well-Being, during COVID-19: A Proof-of-Principle Randomised Controlled Trial (Preprint)

2021 ◽  
Author(s):  
Silvina Catuara-Solarz ◽  
Bartlomiej Skorulski ◽  
Inaki Estella ◽  
Claudia Avella-Garcia ◽  
Sarah Shepherd ◽  
...  
Keyword(s):  
Mental Health ◽  
Perceived Stress ◽  
Intervention Group ◽  
Well Being ◽  
Self Report ◽  
World Health ◽  
Randomised Control Trial ◽  
Control Group ◽  
Mental Well Being ◽  
Proof Of Principle

BACKGROUND Against a long-term trend of increasing demand, the COVID-19 pandemic has led to a global rise in common mental disorders. Now more than ever, there is an urgent need for scalable, evidence-based interventions to support mental well-being. OBJECTIVE The aim of this proof-of-principle study was to evaluate the efficacy of a mobile-based app in adults with self-reported symptoms of anxiety and stress in a randomised control trial that took place during the first wave of the COVID-19 pandemic in the UK. METHODS Adults with mild to severe anxiety and moderate to high levels of perceived stress were randomised to either the intervention or control arm. Participants in the intervention arm were given access to the app, Foundations, for the duration of the 4-week study. All participants were required to self-report a range of validated measures of mental well-being (10-item Connor-Davidson Resilience scale [CD-RISC-10]; 7-item Generalised Anxiety Disorder scale [GAD-7]; Office of National Statistics Four Subjective Well-being Questions [ONS-4]; World Health Organisation-5 Well-Being Index [WHO-5]) and sleep (Minimal Insomnia Scale [MISS]) at baseline and weeks 2 and 4; and, in addition, on perceived stress weekly (10-item Perceived Stress Score [PSS]). RESULTS 136 participants completed the study and were included in the final analysis. The intervention group (n=62) showed significant improvements compared to the control group (n=74) on measures of anxiety (GAD-7 score, delta from baseline to week 2 in the intervention group: -1.35 [SD 4.43]; control group: -0.23 [SD 3.24]; t134= 1.71 , P=.04), resilience (CD-RISC score, delta from baseline to week 2 in the intervention group: 1.79 [± SD 4.08]; control group: -0.31 [± SD 3.16]; t134 -3.37, P<.001), sleep (MISS score, delta from baseline to week 2 in the intervention group: -1.16 [± SD 2.67]; control group: -0.26 [± SD 2.29]; t134= 2.13, P=.01), and mental well-being (WHO-5 score, delta from baseline to week 2 in the intervention group: 1.53 [5.30]; control group: -0.23 [± SD 4.20]; t134= -2.16, P=.02) within 2 weeks of using Foundations, with further improvements emerging at week 4. Perceived stress was also reduced within the intervention group, although the results did not reach statistical significance relative to the control group (PSS score, delta from baseline to week 2 in the intervention group: -2.94 [± SD 6.84]; control group: -2.05 [± SD 5.34]; t134= 0.84, P=.20). CONCLUSIONS This study provides proof-of-principle that the digital mental health app, Foundations, can improve measures of mental well-being, anxiety, resilience, and sleep within 2 weeks of use, with greater effects after 4 weeks. It therefore offers potential as a scalable, cost-effective, and accessible solution to enhance mental well-being, even during times of crisis such as the COVID-19 pandemic.

scholarly journals A Mobile App for Prolonged Grief among Bereaved Parents: Study Protocol for a Randomized Controlled Trial

2021 ◽  
Author(s):  
Rakel Eklund ◽  
Maarten Eisma ◽  
Paul Boelen ◽  
Filip Arnberg ◽  
Josefin Sveen
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Controlled Trial ◽  
Intervention Group ◽  
Mobile App ◽  
Cognitive Behavioral ◽  
Ethical Review ◽  
Depression Symptoms ◽  
Prolonged Grief ◽  
Bereaved Parents

Introduction: Bereaved parents have elevated risk to develop mental health problems, yet, few studies have evaluated the effect of psychosocial interventions developed for bereaved parents. Cognitive behavioral therapy (CBT), both face-to-face or digitally delivered, has shown to be an effective intervention for prolonged grief symptoms. Self-help mobile apps offer various advantages and studies show improved mental health after app interventions. No app has yet been evaluated targeting prolonged grief in bereaved parents. Therefore, the aim of this planned study is to develop and examine the effectiveness of a CBT-based mobile app, called My Grief, in reducing symptoms of prolonged grief, as well as other psychological symptoms, in bereaved parents. Another aim is to assess users experiences and adverse events of My Grief. Methods and analysis: We will conduct a two-armed randomized waitlist-controlled trial. Parents living in Sweden, who lost a child to cancer between one and ten years ago, with elevated symptoms of prolonged grief, will be recruited to participate in the trial. The content of My Grief covers four main domains (Learn: Self-monitoring: Exercises: Get support) and builds on principles of CBT and the proven-effective PTSD Coach app. Participants in the intervention group will fill out online questionnaires at baseline and at 3, 6 and 12-months follow-ups, and the waitlist-controls at baseline and at 3 months. The primary outcome will be prolonged grief symptoms at the 3 months follow-up. Secondary outcomes are posttraumatic stress and depression symptoms, quality of life, and cognitive behavioral variables (i.e., avoidance, rumination, negative cognitions). Ethics and dissemination: Ethical approval has been received from the Swedish Ethical Review Authority (project no. 2021-00770). If the app is shown to be effective, the app will be made publicly accessible on app stores, so that it can benefit other bereaved parents. Trial registration: Clinicaltrials.gov, identifier: NCT04552717.

scholarly journals The Effect of Physiotherapy Group Intervention in Reducing Pain Disorders and Mental Health Symptoms among Syrian Refugees: A Randomized Controlled Trial

2020 ◽  
Vol 17 (24) ◽  
pp. 9468
Author(s):  
Wegdan Hasha ◽  
Jannicke Igland ◽  
Lars T. Fadnes ◽  
Bernadette Kumar ◽  
Jasmin Haj-Younes ◽  
...  
Keyword(s):  
Mental Health ◽  
Chronic Pain ◽  
Mental Health Problems ◽  
Controlled Trial ◽  
General Health Questionnaire ◽  
Intervention Group ◽  
Complex Interventions ◽  
Control Group ◽  
Syrian Refugees ◽  
The Impact

Chronic pain is common among refugees, and often related to mental health problems. Its management, however, is often challenging. A randomized waitlist-controlled trial was designed to study the effect of group physiotherapy activity and awareness intervention (PAAI) on reducing pain disorders, and secondarily improving mental health, among Syrian refugees. A total of 101 adult Syrian refugees suffering from chronic pain were randomized to either the intervention group or the control group, which thereafter also received PAAI after a waiting period. Pain intensity measured by the Brief Pain Inventory (BPI) was the primary outcome. Scores from the Impact of Events Scale-Revised (IES-R 22) and the General Health Questionnaire (GHQ-12) were secondary outcomes. Intention-to-treat analyses (ITT) showed no effect of the intervention on either pain levels (regression coefficient [B {95% CI} of 0.03 {−0.91, 0.96}], IESR scores [4.8 {−3.7, 13.4}] or GHQ-12 scores [−0.4 {−3.1, 2.3}]). Yet, participants highly appreciated the intervention. Despite the negative findings, our study contributes to the evidence base necessary to plan targeted and effective health care services for refugees suffering from chronic pain and highlights the challenge of evaluating complex interventions adapted to a specific group.

scholarly journals Assessment of Anxiety and Depression in Polish Primary Parental Caregivers of Children with Cerebral Palsy Compared to a Control Group, as well as Identification of Selected Predictors

2019 ◽  
Vol 16 (21) ◽  
pp. 4173 ◽  
Author(s):  
Barbara Gugała ◽  
Beata Penar-Zadarko ◽  
Danuta Pięciak-Kotlarz ◽  
Katarzyna Wardak ◽  
Aneta Lewicka-Chomont ◽  
...  
Keyword(s):  
Mental Health ◽  
Cerebral Palsy ◽  
Sense Of Coherence ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Control Group ◽  
Depression Symptoms ◽  
Study Group ◽  
Modifiable Factors ◽  
Taking Care

Background: Taking care of a child with Cerebral Palsy (CP) may be linked with adverse effects in the parents’ physical and mental health. The causes of anxiety and depression symptoms associated with childcare are still not fully understood. Aim: To assess the intensity of anxiety and depression symptoms in parents of children with CP compared to a control group and to identify selected mental health predictors. Design and Methods: Data were collected from 301 respondents, including 190 parents of children with CP (study group) and 111 parents taking care of children developing normally (control group). Intensity of anxiety and depression was rated using the Hospital Anxiety and Depression Scale (HADS) scale. Gross Motor Function Classification System for Cerebral Palsy (GMFCS), Sense of Coherence Scale (SOC-29), Berlin Support Social Scales (BSSS) scales and a specially designed questionnaire were used to assess the predictors. The investigated variables included the children’s and the parents’ characteristics, as well as environmental factors. The analyses applied Spearman’s rank correlation coefficient, M(SD) as well as multiple regression. Results: The level of anxiety and depression was clearly higher in the parents of children with CP–the mean levels of anxiety and depression in the study group and the controls amounted to 8.1 vs. 4.7 and 6.8 vs. 3.7, respectively. The factors associated with intensity of anxiety and depression in the parents of children with CP included lack of social support, mainly perceived and received support, unsatisfying parental health status, poor economic status of the family, as well as difficult living conditions, sense of coherence, loneliness, the parent’s gender, and the child’s intellectual disability. Conclusions: Identification of significant anxiety and depression predictors, understood as modifiable factors, should be considered in determining and planning comprehensive support for a child with CP and his/her primary parental caregiver.

scholarly journals The Effects of a Mindfulness Program on Mental Health in Students at an Undergraduate Program for Teacher Education: A Randomized Controlled Trial in Real-Life

2021 ◽  
Vol 12 ◽  
Author(s):  
Lise Juul ◽  
Eva Brorsen ◽  
Katinka Gøtzsche ◽  
Birgitte Lund Nielsen ◽  
Lone Overby Fjorback
Keyword(s):  
Mental Health ◽  
Teacher Education ◽  
Student Teachers ◽  
Perceived Stress ◽  
Controlled Trial ◽  
Intervention Group ◽  
Real Life ◽  
Well Being ◽  
Control Group ◽  
Undergraduate Program

Background: In this study, we aimed to investigate the effects of a mindfulness program including Mindfulness-Based Stress Reduction (MBSR) on the mental health of student teachers when offered at their educational institution in a real-life context.Methods: A parallel randomized controlled trial (RCT) was conducted among self-selected student teachers at a Danish undergraduate program for teacher education in the autumns of 2019 and 2020. Participation was not recommended in case of (1) clinical depression or a diagnosis of psychosis or schizophrenia, (2) abuse of alcohol, drugs, and/or medicine. Randomization was performed by a Statistician who was blinded to the identity of the students. Data was collected using self-reported questionnaires. The primary outcome was a change in perceived stress 3 months from baseline. Secondary outcome measures were symptoms of anxiety and depression, well-being, resilience, mindfulness, and thoughts and feelings during rest. The effects were analyzed according to the intention-to-treat principle using mixed-effect linear regression models. Mediating effects of mindfulness skills on the mental health outcomes were explored using structural equation modeling.Results: The study group included 67 student teachers with 34 allocated to the intervention group (median age: 25 years; women: n = 24, 71%); and 33 students (median age: 25 years; women: n = 25, 76%) allocated to a waiting list control group. At baseline, mean Perceived Stress Scale (PSS) scores were 18.88 (SD: 5.75) in the intervention group and 17.91 (SD: 6.36) in the waiting list control group. A total of 56 students completed the questionnaire at a 3-month follow-up (28 in both the intervention- and the control group). Statistically significant effects of the intervention were found on perceived stress, symptoms of anxiety and depression, well-being, and on three of seven resting-state dimensions. No effects were found on resilience or mindfulness. Statistically significant mediated effects via resting-state dimensions were found.Conclusion The findings suggested that offering a mindfulness program at an undergraduate program for teacher education could significantly improve the mental health among self-selected students within 3 months. Results of mediation analysis supported the hypothesis that some of the effects might be explained by reduced distracting thoughts.Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT04558099].

scholarly journals Prevalence of Depressive Symptoms and Associated Psychosocial risk Factors among University Students: The Moderating and Mediating Effects of Resilience

2020 ◽  
Author(s):  
Cyrille Kossigan KOKOU KPOLOU ◽  
Askar Jumageldinov ◽  
Sunyoung Park ◽  
Nicolas Nieuviarts ◽  
Pari-Gole Noorishad ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Depressive Symptoms ◽  
University Students ◽  
Perceived Stress ◽  
Mental Health Problems ◽  
Severe Depression ◽  
Cumulative Effect ◽  
Mediation Analyses ◽  
Individual Resilience

<p><i>Background</i>: Previous studies have indicated that university students constitute a higher risk population for mental health problems, especially for depression. Yet, there appears to be a lack of literature addressing a such issues in France. The present study aimed to estimate the prevalence rates of depression, its sociodemographic correlates in French university students (FUS), and to examine whether individual resilience resources moderated and mediated the relationship between perceived stress and depressive symptoms. </p> <p><i>Methods</i>: The data were collected through web-based questionnaires. The sample included 1435 FUS with a mean age of 20.5 (<i>SD </i>= 3.38) years. Participants completed the Beck Depression Inventory (BDI-II), the Perceived Stress Scale, the Brief Resilience Scale, and a sociodemographic questionnaire. Descriptive, multiple logistic regression and mediation analyses were used. </p> <p><i>Results</i>: With respect to the BDI-II’s cutoff scores, 20.3% and 22.8% were positive to moderate and severe depression, respectively (43.1%). Gender and education attainment appeared as moderate risk factors when accounting for cumulative effect of perceived stress and individual resilience. Resilience was found to buffer and mediate partially the perceived stress–depression relationship. </p> <p><i>Conclusion</i>: The prevalence of depression was higher in FUS, as similar to those reported in</p> <p>previous studies. The amount of academic and daily stress explained this prevalence. University students with low resilience level were more at risk. Interventions with aim to improving resilience skills could help to mitigate the negative effects of stress and to promote mental health in this population.</p>

A Prospective Intervention in Patients with Complicated Grief

2017 ◽  
Vol 41 (S1) ◽  
pp. s781-s781
Author(s):  
M. Pinheiro ◽  
N. Carvalho ◽  
D. Mendes ◽  
J. Rocha
Keyword(s):  
Narrative Therapy ◽  
Group Intervention ◽  
Therapy Group ◽  
Intervention Group ◽  
Complicated Grief ◽  
Depression Scale ◽  
Special Treatment ◽  
Control Group ◽  
Depression Symptoms ◽  
Significant Difference

IntroductionMost reactions to grief are adaptive. However, there is the possibility that some individuals present a complicated grief disorder, where there is a pathological intensification of symptoms lasting more than 6 months, deserving special treatment.Objectives/aimsEvaluate the effectiveness of two types of intervention in complicated grief: group intervention (GI) and cognitive-narrative (CN) therapy.MethodsPatients in a complicated grief process were selected (n = 70), and distributed in three groups: cognitive–narrative therapy group (CNTG), group intervention group (GIG) and a control group (CG). Inclusion criteria: adults, with a reference to mourning situation, with personal meaning, for over six months and results in ICG ≥30points (cutoff). The Inventory of Complicated Grief (ICG), the Center for epidemiologic studies depression scale (CES-D) and the trauma questionnaire (ICD-11) were used. Follow-up was performed 3 months after the end of each intervention. Data analysis was performed using the statistical package from social sciences (SPSS 20).ResultsWith respect to complicated grief symptoms (CGx) and depression symptoms (Dx) there were statistically significant differences between the CNTG and the CG, but not with the GIG. There was no statistically significant effect in post-traumatic symptoms (PTx), even though both interventions had a slight decrease. When the CNTG and the GIG were directly compared, there was only a statistically significant difference between PTx.ConclusionsIn our single center cohort, CNTG was a more effective intervention in complicated grief patients for CGx and Dx reduction. For PTx, no intervention was superior. Larger multi-center studies are needed to validate these results.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Prevalence of Depression, Anxiety, and Perceived Stress in Postpartum Mexican Women during the COVID-19 Lockdown

2021 ◽  
Vol 18 (9) ◽  
pp. 4627
Author(s):  
Blanca Vianey Suárez-Rico ◽  
Guadalupe Estrada-Gutierrez ◽  
Maribel Sánchez-Martínez ◽  
Otilia Perichart-Perera ◽  
Carolina Rodríguez-Hernández ◽  
...  
Keyword(s):  
Mental Health ◽  
Postpartum Depression ◽  
Perceived Stress ◽  
Trait Anxiety ◽  
Online Survey ◽  
Depression Scale ◽  
Depression Symptoms ◽  
Mexican Women ◽  
Cross Sectional ◽  
Prevalence Of Depression

The COVID-19 lockdown represents a new challenge for mental health researchers and clinical practitioners. This cross-sectional study aimed to investigate the prevalence of depression, anxiety, and perceived stress in postpartum Mexican women. The study included 293, 4–12-week postpartum women over the age of 18. The Edinburgh Postpartum Depression Scale (EPDS), Trait-State Trait Anxiety Inventory (T-STAI), and Ten Perceived Stress Scale (PSS-10), which are all questionnaires validated for the Mexican population, were applied using a web-based online survey. Prevalence and 95% confidence intervals (CIs) were calculated. The mean ± standard deviation (SD) of the maternal age was 29.9 ± 6.3 years; the EPDS score: 11 ± 6, T-STAI score: 41.7 ± 12.3, and PSS-10 score: 17.1 ± 7. The prevalence (95% CI) of the postpartum depression symptoms was 39.2% (34–45%), trait anxiety symptoms were found among 46.1% (32–43%) of the participants, and moderate and high perceived stress were in 58% (52–64) and 10.9% (7.8–15) of the participants, respectively. The prevalence of depressive symptoms, generalized anxiety, and perceived stress was higher among postpartum Mexican women during the COVID-19 outbreak than before the lockdown. Our findings highlight the importance of monitoring perinatal mental health during pandemics and the need to design effective psychologic interventions for these patients.

scholarly journals Effect of Surya Namaskara on Mental Health, Self-control and Mindfulness of Adolescent School Children.

2021 ◽  
Author(s):  
Niranjan Parajuli ◽  
Mutturaj Shindhe ◽  
Balaram Pradhan
Keyword(s):  
Mental Health ◽  
School Children ◽  
Private School ◽  
Mental Health Problems ◽  
General Health Questionnaire ◽  
Intervention Group ◽  
Self Control ◽  
Control Group ◽  
Large Sample Size ◽  
Significant Difference

Abstract BackgroundA big portion of adolescent school children suffers from mental health problems. Low self-control and mindfulness are positively associated with poor mental health. Therefore, the present study was designed to assess the effect of Surya Namaskara (SN) on mental health, self-control, and mindfulness among school children.Method63(39 female and 24 male) students (mean age = 14.24 years and SD = 0.42 years) studying at 9th grade in a private school in Karnataka, India were recruited as participants of the study. The design of the present study was a non-randomized two arms design. Students in grade 9 section ‘A’ (N= 33) were selected as the intervention group. Whereas, students in grade 9 section ‘B’ (N = 30) were considered as a control group. Students in the intervention group were given SN for 15 days. The participants were administrated the Brief Self-control Scale (BSCS), Mindfulness, Attention and Awareness Scale for Adolescents (MAAS-A), and General Health Questionnaire-12 (GHQ-12) questionnaires on the baseline and after 15 days of intervention. ResultsFindings of the present study showed a significant difference in MAAS-A scores [F (1, 54) = 18.47, p < 0.001, ηp2 = 0.26] in within group comparison. There was also a significant interaction (Times*Groups) for BSCS [F (1, 54) = 4.89, p = 0.031, ηp2 = 0.08] and MAAS-A [F (1, 54) = 6.63, p = 0.013, ηp2 = 0.12] scores. Post-hoc analysis showed SN group has significantly high post BSCS score (p = 0.005) and MAAS-A score (p = 0.005) compared to control group. Similarly, there was a significant high BSCS score (p = 0.003) and MAAS-A score (p < 0.001) after SN intervention compare to their respective pre scores. There was no significant change in the GHQ-12 scores in both groups in pre-post comparison.ConclusionThe finding of the present study showed that SN improves self-control and mindfulness in adolescent school children. However, the results of the current study should be confirmed by future studies with robust research design, a large sample size, and advanced tools.

scholarly journals Mindfulness-Based Intervention for Children with Mental Health Problems: a 2-Year Follow-up Randomized Controlled Study

Mindfulness ◽  
2021 ◽  
Author(s):  
Katarina Laundy ◽  
Peter Friberg ◽  
Walter Osika ◽  
Yun Chen
Keyword(s):  
Mental Health ◽  
Disruptive Behavior ◽  
Mental Health Problems ◽  
Intervention Group ◽  
Health Problems ◽  
Controlled Study ◽  
Control Group ◽  
Registration Number ◽  
Group A

Abstract Objectives Moderate mental health problems are highly prevalent and increasing in Swedish schoolchildren, elevating risk for future mental and somatic disability. The aim of this study was to determine whether an 8-week mindfulness-based intervention, Training for Mindfulness and Resilience (TMR), mitigates mental health symptoms and increases resilience during a 2-year follow-up. Methods Schoolchildren (aged 9–14 years) reporting moderate mental health problems were randomized into either TMR intervention group (N = 22) or control group, receiving best current practice (N = 12). We used validated questionnaires to measure anxiety, depression, anger, disruptive behavior, self-concept, resilience, stress, and mindfulness before treatment with either TMR or control, as well as at 6 months, 1 year, and 2 years follow-up. Results We found a statistically significant effect of TMR intervention vs control, on resilience, anxiety, anger, and disruptive behavior. Compared to baseline, TMR increased the level of resilience at 6 months (p < .001); anxiety at 1 (p <  = .033) and 2 years (p = .04); anger at 6 months (p = .004) and 2 years (p = .039); disruptive behavior at 6 months (p = .006). In the control group, a decrease in resilience between 6 months and 2 years (p = .05) was observed. No other significant effects were found in the control group. Conclusions This study suggested that TMR improved mental health in schoolchildren with effects on anxiety and anger lasting for 2 years, and on resilience and disruptive behavior lasting for 6 months. Trial Registration Number NCT04806542, date of registration 18th of March 2021, retrospectively registered.

Sign in / Sign up

Export Citation Format

Share Document