Acupuncture and related techniques for obesity and cardiovascular risk factors: a systematic review and meta-regression analysis

2020 ◽  
Vol 38 (4) ◽  
pp. 227-234
Author(s):  
Jianrong Chen ◽  
Dongping Chen ◽  
Qing Ren ◽  
Weifeng Zhu ◽  
Sheng Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Body Weight ◽  
Cardiovascular Risk ◽  
Blood Glucose ◽  
Cardiovascular Risk Factors ◽  
Density Lipoprotein ◽  
Moderate Quality ◽  
Meta Regression ◽  
Quality Evidence

Objective: To assess how acupuncture and related techniques affect weight-related indicators and cardiovascular risk factors compared with non-acupuncture interventions in overweight and obese patients. Methods: We searched PubMed, Embase and CENTRAL up to 19 April 2018 and included relevant randomised controlled trials (RCTs). Weighted mean differences (WMDs) and 95% confidence intervals (CI) were pooled using the inverse variance method with random-effects model. Prespecified hypotheses were tested in meta-regression to investigate the source of heterogeneity. Statistical software packages used were RevMan 5.3.5 and Stata 14.0. Results: Thirty-three RCTs were included (n=2503 patients). Compared with non-acupuncture interventions, acupuncture produced a greater reduction in body weight (WMD −1.76 kg, 95% CI −2.22 to −1.30, I2=77%; moderate quality), body mass index (WMD −1.13 kg/m2, 95% CI −1.38 to −0.88, I2=85%; low quality) and waist circumference (WMD −2.42 cm, 95% CI −3.22 to −1.62, I2=75%; moderate quality). Acupuncture plus lifestyle intervention resulted in a greater reduction in body weight than acupuncture alone (MD −1.94 kg, 95% CI −3.17 to −0.70). Acupuncture also led to a greater reduction in total cholesterol (WMD −12.87 mg/dL, 95% CI −22.17 to −3.57, I2=87%; very low quality) and low-density lipoprotein cholesterol (WMD −13.52 mg/dL, 95% CI −21.47 to −5.58, I2=74%; low quality). The differences were not statistically significant for blood glucose or blood pressure. Conclusion: In the short term, acupuncture and related techniques may produce a small but statistically significant degree of weight loss based on moderate- to low-quality evidence, and improve serum lipid parameters based on low- to very-low-quality evidence. Their effects on blood glucose and blood pressure remain uncertain.

scholarly journals Characteristics of Cardiovascular Risk Factors and Their Correlation with the Sex and Age of Patients in the Latvian Population

2009 ◽  
Vol 63 (4-5) ◽  
pp. 125-130
Author(s):  
Inga Stuķēna ◽  
Andrejs Kalvelis ◽  
Guntis Bahs ◽  
Uldis Teibe ◽  
Pēteris Tretjakovs ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Blood Glucose ◽  
Cardiovascular Risk Factors ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Age Group ◽  
Reactive Protein

Characteristics of Cardiovascular Risk Factors and Their Correlation with the Sex and Age of Patients in the Latvian Population Various cardiovascular risk factors (RFs) were determined in 773 out-patients (mean age 55.8 ± 14.5 years). Male individuals had a larger waist circumference (WC) than did female patients (99.1 ± 13.6 cm vs 93.3 ± 15.2 cm), higher diastolic blood pressure (DBP) (83.6 ± 9.6 mmHg vs 81.8 ± 9.6 mmHg), and higher levels of blood glucose (5.73 ± 1.4 mmol/L vs 5.49 ± 1.3 mmol/L) and triglycerides (TG) (1.89 ± 1.3 mmol/L vs 1.60 ± 1.0 mmol/L), but lower levels of total cholesterol (TC) (5.54 ± 1.2 mmol/L vs 5.79 ± 1.2 mmol/L) and high-density lipoprotein cholesterol (HDL-C) (1.21 ± 0.4 mmol/L vs 1.44 ± 0.4 mmol/L). Compared with the younger age group (i.e., males, < 7 years; females, < 65 years), patients in the older age group had a larger WC (98.4 ± 14.2 cm vs 92.8 ± 15.1 cm), higher systolic blood pressure (SBP) (144.2 ± 19.2 mmHg vs 131.6 ± 18.5 mmHg), higher DBP (84.5 ± 8.8 mmHg vs 80.9 ± 9.8 mmHg), higher blood glucose level (5.74 ± 1.3 mmol/L vs 5.46 ± 1.3 mmol/L), and higher low-density lipoprotein cholesterol level (LDL-C) (3.68 ± 1.0 mmol/L vs 3.52 ± 1.0 mmol/L), but lower HDL-C level (1.3 ± 0.4 mmol/L vs 1.41 ± 0.4 mmol/L). Age was significantly correlated with all RFs, with the exception of the level of C-reactive protein. In conclusion, analysis of cardiovascular RFs in different age subgroups of both sexes clearly showed individual peculiarities of risk profile. This conclusion challenges the usual way of risk calculation using "universal" markers like adiposity or dyslipidemia in all population. The new approach requires individual attention depending on sex and age also in management of risk.

scholarly journals Examining associations between dietary patterns and metabolic CVD risk factors: a novel use of structural equation modelling

2016 ◽  
Vol 115 (9) ◽  
pp. 1586-1597 ◽  
Author(s):  
Michelle Alessandra Castro ◽  
Valéria Troncoso Baltar ◽  
Dirce Maria Marchioni ◽  
Regina Mara Fisberg
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Body Weight ◽  
Cardiovascular Risk ◽  
Waist Circumference ◽  
Cardiovascular Risk Factors ◽  
Dietary Patterns ◽  
Structural Equation ◽  
Cholesterol Ratio ◽  
Equation Modelling

AbstractThe association between dietary patterns and metabolic cardiovascular risk factors has long been addressed but there is a lack of evidence towards the effects of the overall diet on the complex net of biological inter-relationships between risk factors. This study aimed to derive dietary patterns and examine their associations with metabolic cardiovascular risk factors following a theoretic model for the relationship between them. Participants included 417 adults of both sexes, enrolled to the cross-sectional population-based study performed in Brazil. Body weight, waist circumference, high-sensitivity C-reactive protein, blood pressure, total cholesterol:HDL-cholesterol ratio, TAG:HDL-cholesterol ratio, fasting plasma glucose and serum leptin were evaluated. Food consumption was assessed by two non-consecutive 24-h dietary recalls adjusted for the within-person variation of intake. A total of three dietary patterns were derived by exploratory structural equation modelling: ‘Traditional’, ‘Prudent’ and ‘Modern’. The ‘Traditional’ pattern had a negative and direct effect on obesity indicators (serum LEP, body weight and waist circumference) and negative indirect effects on total cholesterol:HDL-cholesterol ratio, TAG:HDL-cholesterol ratio and fasting plasma glucose. The ‘Prudent’ pattern had a negative and direct effect on systolic blood pressure. No association was observed for the ‘Modern’ pattern and metabolic risk factors. In conclusion, the ‘Traditional’ and ‘Prudent’ dietary patterns were negatively associated with metabolic cardiovascular risk factors among Brazilian adults. Their apparent protective effects against obesity and high blood pressure may be important non-pharmacological strategies for the prevention and control of obesity-related metabolic disorders and CVD.

scholarly journals Gender Difference in Blood Pressure Control and Cardiovascular Risk Factors with Diagnosed Hypertension

2021 ◽  
pp. 275-280
Author(s):  
Tarique Shahzad Chachar ◽  
Ummama Laghari ◽  
Ghullam Mustafa Mangrio ◽  
Abdul Ghaffar Dars ◽  
Ruqayya Farhad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Pressure Control ◽  
Health Sciences ◽  
Low Density Lipoprotein Cholesterol ◽  
Male And Female

Objective: Our study was designed to compare the gender difference in Blood Pressure Control and Cardiovascular Risk Factors in patients of Liaquat University of Medical and Health Sciences Jamshoro Pakistan. Methodology: This cross-sectional study was conducted in  Liaquat University of Medical and Health Sciences Jamshoro Pakistan from December 2019 to December 2020. Blood pressure was measured twice by trained physicians using aneroid sphygmomanometers after a standardized protocol. Patients were asked to sit with both feet on the floor for ≥5 minutes before the first BP measurement. Both the two BP measurements were taken 60 seconds apart.  For this research we defined hypertension as systolic BP ≥140 mm Hg, diastolic BP ≥90 mm Hg. Results:  We conducted a comparison between Hypertensive and nonhypertensive participants of the male and female groups. High blood pressure increased the level of uric acid in both male and female groups (351 ± 92 vs 303 ± 75). We observed that the hypertensive male population reported a high prevalence of cardiovascular risk factors due to  increase amount of total cholesterol level, triglyceride and low-density lipoprotein cholesterol (5.45 ± 1.01, 1.42 ±  0.85,  2.56 ± 0.70) than females (5.15 ± 0.91, 1.29 ± 0.87, 2.30 ± 0.63). Conclusion: Our results concluded that the male hypertensive population is more prone to future cardiovascular risk due to increased amount of total cholesterol levels, triglycerides, and low-density lipoprotein cholesterol, and sex hormones (androgens).

scholarly journals Age at period cessation and trajectories of cardiovascular risk factors across mid and later life

Heart ◽  
2020 ◽  
Vol 106 (7) ◽  
pp. 499-505 ◽  
Author(s):  
Linda Marie O'Keeffe ◽  
Diana Kuh ◽  
Abigail Fraser ◽  
Laura D Howe ◽  
Debbie Lawlor ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Later Life ◽  
Glycated Haemoglobin ◽  
Lipoprotein Cholesterol ◽  
The Impact

ObjectiveTo examine the association between age at period cessation and trajectories of anthropometry, blood pressure, lipids and glycated haemoglobin (HbA1c) from midlife to age 69 years.MethodsWe used data from the UK Medical Research Council National Survey of Health and Development to examine the association between age at period cessation and trajectories of systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI) and waist circumference (WC) from 36 to 69 years and trajectories of triglyceride, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and HbA1c from 53 to 69 years.ResultsWe found no evidence that age at period cessation was associated with trajectories of log triglyceride, LDL-C and HDL-C from 53 to 69 years and trajectories of SBP or DBP from 36 to 69 years, regardless of whether period cessation occurred naturally or due to hysterectomy. While we found some evidence of associations of age at period cessation with log BMI, log WC and log HbA1c, patterns were not consistent and differences were small at age 69 years, with confidence intervals that spanned the null value.ConclusionHow and when women experience period cessation is unlikely to adversely affect conventional cardiovascular risk factors across mid and later life. Women and clinicians concerned about the impact of type and timing of period cessation on conventional cardiovascular intermediates from midlife should be reassured that the impact over the long term is small.

Modification of Cardiovascular Risk Factors during Antihypertensive Treatment: A Multicentre Trial with Quinapril

1993 ◽  
Vol 21 (1) ◽  
pp. 15-25 ◽  
Author(s):  
E Manzato ◽  
A Capurso ◽  
G Crepaldi
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Diastolic Blood Pressure ◽  
Enzyme Inhibitor ◽  
Density Lipoprotein ◽  
Diabetic Patients ◽  
Intent To Treat

A large multicentre study involving 6003 [3044 males, 2959 females; mean (± SD) age 59 ± 11 years] mild-to-severe hypertensive patients was carried out to evaluate the effects of the angiotension converting enzyme inhibitor quinapril on blood pressure and on metabolic cardiovascular risk factors during 3 − 6 months' treatment (mean follow-up 90.4 days). The study population included 551 elderly [mean (± SD) age 71.9 ± 9.3 years] patients, 1314 subjects with diabetes mellitus and 154 non-diabetic patients with hyperlipaemia; 4% of patients were lost to follow-up. Diastolic blood pressure decreased from 102 to 87 mmHg (intent-to-treat analysis) and 62% of patients were normalized (diastolic blood pressure below 90 mmHg) at the last evaluable visit. Overall, serum lipids were favourably affected during quinapril treatment; when corrected for changes in body weight, a significant improvement in total, low- and high-density lipoprotein cholesterol, and triglycerides was detected. Quinapril treatment in elderly patients was efficacious and well tolerated, and quinapril appears to be an effective antihypertensive drug devoid of untoward effects on metabolic risk factors for cardiovascular disease.

scholarly journals Anthropometric, haemodynamic, humoral and hormonal evaluation in patients with incidental adrenocortical adenomas before and after surgery

2003 ◽  
pp. 213-219 ◽  
Author(s):  
G Bernini ◽  
A Moretti ◽  
P Iacconi ◽  
P Miccoli ◽  
R Nami ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Body Weight ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Subclinical Cushing’S Syndrome ◽  
Adrenocortical Adenomas ◽  
Before And After

OBJECTIVE: To compare clinical and humoral parameters before and after surgery in patients with incidental adrenocortical adenomas. DESIGN: Six patients with subclinical Cushing's syndrome and nine with non-functioning adenomas were investigated before and 12 Months after removal of the mass. METHODS: Anthropometric (body weight, body mass index and waist to hip ratio), haemodynamic (blood pressure and heart rate), metabolic (lipids and oral glucose tolerance test (OGTT)), hormonal (cortisol, plasma renin activity, aldosterone, androgens and catecholamines) and bone metabolism (hydroxyproline, parathyroid hormone, osteocalcin and ostase) parameters were evaluated. RESULTS: In the whole group, a significant decrease in body weight (69.7+/-3.5 vs 70.8+/-3.5 kg, P<0.03), in systolic (135.3+/-5.1 vs 145.6+/-4.9 mmHg, P<0.009) and diastolic (83.7+/-1.9 vs 91.0+/-3.5 mmHg, P<0.03) blood pressure and in glucose levels in response to OGTT (106.4+/-9.6 vs 127.5+/-6.5 mg/dl, P<0.05) was observed after surgery. All other parameters examined did not change significantly. This trend was also found in both groups separately. Analytical data showed a high frequency of overweight/obesity (66.6%), hypertension (66.6%) and impaired glucose profile (26.6%) in our patients, with a greater prevalence of these cardiovascular risk factors in the subclinical Cushing's syndrome group. After surgery, values normalized or improved in eight out of ten hypertensive patients and in three out of four patients with impaired glucose profile. CONCLUSIONS: Solid adrenocortical incidentalomas are associated with some cardiovascular risk factors which may be corrected after removal of the mass. Therefore, surgery may be an appropriate choice in patients with subclinical Cushing's syndrome but also in those with solid non-functioning adenomas and coexistent cardiovascular risk factors.

Effects of Long-Acting Somatostatin Analogues on Lipid Metabolism in Patients with Newly Diagnosed Acromegaly: A Retrospective Study of 120 Cases

2022 ◽  
Vol 54 (01) ◽  
pp. 25-32
Author(s):  
Xiao-qing Shao ◽  
Zheng-yuan Chen ◽  
Meng Wang ◽  
Ye-ping Yang ◽  
Yi-fei Yu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Density Lipoprotein ◽  
Somatostatin Analogues ◽  
Lipid Profiles ◽  
Newly Diagnosed ◽  
Short Term ◽  
Long Acting

AbstractThe short-term effects of long-acting somatostatin analogues (SSAs) on lipid profiles in patients with acromegaly are not well studied. We retrospectively analyzed the effects of SSAs on lipid profiles and associated cardiovascular risk factors in a cohort of 120 newly diagnosed acromegaly patients. In this study, 69 females and 51 males were included. These patients were treated with either octreotide LAR (OCT) or lanreotide SR (LAN) for 3 months. After SSAs treatment, both GH and IGF-1 significantly decreased (p<0.001). Triglyceride (TG), total to high-density lipoprotein cholesterol (HDL-C) ratio, and lipoprotein (a) [Lp(a)] levels were significantly decreased, while HDL-C levels were increased (p<0.05). The reduction of mean serum GH (GHm) was positively associated with the decrease of TG (r=0.305, p=0.001) and Lp(a) (r=0.257, p=0.005), as well as the increase of HDL-C (r=−0.355, p<0.001). The changes of lipid profiles were observed only in OCT group, but not in LAN group. In addition, systolic blood pressure (SBP) had significantly declined after SSAs treatment, with an average reduction of 4.4 mmHg (126.7±1.28 vs. 122.3±1.44 mmHg, p=0.003), while no change was observed regarding diastolic blood pressure (DBP) (p>0.05). Fasting insulin, fasting C-peptide, and HOMA-IR were significantly decreased after SSAs treatment. In conclusion, our current study revealed that short-term SSAs treatment improves lipid profiles and other cardiovascular risk factors in patients with acromegaly.

scholarly journals Patterns of Cardiovascular Risk Factors in Old Age and Survival and Health Status at 90

2020 ◽  
Vol 75 (11) ◽  
pp. 2207-2214
Author(s):  
Michelle C Odden ◽  
Andreea M Rawlings ◽  
Alice M Arnold ◽  
Mary Cushman ◽  
Mary L Biggs ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Old Age ◽  
Ldl Cholesterol ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Lower Likelihood

Abstract Background The population age 90 years and older is the fastest growing segment of the U.S. population. Only recently is it possible to study the factors that portend survival to this age. Methods Among participants of the Cardiovascular Health Study, we studied the association of repeated measures of cardiovascular risk factors measured over 15–23 years of follow-up and not only survival to 90 years of age, but also healthy aging outcomes among the population who reached age 90. We included participants aged 67–75 years at baseline (n = 3,613/5,888) to control for birth cohort effects, and followed participants until death or age 90 (median follow-up = 14.7 years). Results Higher systolic blood pressure was associated with a lower likelihood of survival to age 90, although this association was attenuated at older ages (p-value for interaction &lt;.001) and crossed the null for measurements taken in participants’ 80’s. Higher levels of high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and body mass index (BMI) were associated with greater longevity. Among the survivors to age 90, those with worse cardiovascular profile (high blood pressure, LDL cholesterol, glucose, and BMI; low HDL cholesterol) had lower likelihood of remaining free of cardiovascular disease, cognitive impairment, and disability. Conclusion In summary, we observed paradoxical associations between some cardiovascular risk factors and survival to old age; whereas, among those who survive to very old age, these risk factors were associated with higher risk of adverse health outcomes.

scholarly journals Association of serum uric acid, morning home blood pressure and cardiovascular risk factors in a population with previous prehypertension: a cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038046 ◽  
Author(s):  
Lucky Aziza Bawazier ◽  
Mochammad Sja'bani ◽  
Fredie Irijanto ◽  
Zulaela Zulaela ◽  
Agus Widiatmoko ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Uric Acid ◽  
Cardiovascular Risk ◽  
Blood Glucose ◽  
Cardiovascular Risk Factors ◽  
Fasting Blood Glucose ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional

ObjectiveTo observe the changes in blood pressure (BP) over 10 years and to investigate current BP association to serum uric acid (SUA) levels and cardiovascular risk factors in the epidemiological data of a target group of patients with prehypertension in 2007.DesignCross-sectional study.SettingMlati Subdistrict, Sleman District, Yogyakarta Province, Indonesia.ParticipantsA total of 733 patients from ‘Mlati Study Database’ in 2007 were selected by simple random sampling using statistical software. Subjects had both physical and laboratory examinations.Outcome measuresMorning home BP and laboratory examination of urine (uric acid excretion and creatinine) and blood samples (SUA, blood urea nitrogen, creatinine, a lipid profile and fasting blood glucose levels).ResultsAbout 31.1% of 733 subjects with prehypertension became hypertensive after 10 years, 24.6% returned to normal tension and the rest of it remained in prehypertensive state. Mean (SD) of SUA levels in 2017 was significantly higher in men than in women (5.78 (1.25) mg/dL vs 4.52 (1.10) mg/dL, p<0.001). Furthermore, men tended to have high-normal (5–7 mg/dL) or high SUA levels (≥7 mg/dL) compared with women (p<0.001, Relative Risk (RR)=2.60). High-normal and high SUA levels in population with a history of prehypertension were significantly associated with current prehypertension and hypertension only in women (p=0.001, RR=1.21). Age and body mass index was found to be significantly associated with both systolic and diastolic BP in men, but only with systolic BP in women. Fasting blood glucose and SUA levels were significantly associated with systolic and diastolic BP only in women.ConclusionWe concluded that after 10 years, of 733 subjects with prehypertension, 31.1% became hypertensive. The SUA levels in men are significantly higher than those in women. Moreover, high-normal and high SUA levels were significantly associated with prehypertension and hypertension in women but not in men.

scholarly journals Neck circumference as predictor of excess body fat and cardiovascular risk factors in adolescents

2014 ◽  
Vol 27 (2) ◽  
pp. 161-171 ◽  
Author(s):  
Vivian Siqueira Santos Gonçalves ◽  
Eliane Rodrigues De Faria ◽  
Sylvia Do Carmo Castro Franceschini ◽  
Silvia Eloiza Priore
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
High Density Lipoprotein ◽  
Cardiovascular Risk Factors ◽  
Body Fat ◽  
Density Lipoprotein ◽  
Neck Circumference ◽  
High Density ◽  
Fasting Insulin

OBJECTIVE: To verify whether neck circumference can predict cardiovascular risk factors and excess body fat in adolescents. METHODS: This cross-sectional study included male and female adolescents aged 10 to 14 years from Viçosa, Minas Gerais. The following data were collected: anthropometric measurements, blood pressure, percentage of body fat according to dual energy X-ray absorptiometry, and levels of fasting glucose, fasting insulin, triglycerides, total cholesterol, high-density lipoprotein, and low-density lipoprotein. The anthropometric measurements were used for calculating indices and assessing nutritional status. The receiver operating characteristic curve tested whether neck circumference could predict cardiovascular risk. We also investigated how neck circumference related to the study parameters. The significance level was set at 5% (p<0.05). RESULTS: A total of 260 adolescents were assessed of which 50.4% (n=131) were females, 20.4% (n=53) had excess body weight according to the body mass index-for-age index, and 42.7% (n=111) had excess body fat. Blood pressure (3.9%, n=10) and all biochemical parameters were affected, varying from 1.9% (n=5) for glucose to 65% (n=169) for total cholesterol. Neck circumference correlated with body fat, waist circumference, hip circumference, weight, height, body mass index, waist-to-height ratio, homeostasis model of assessment - insulin resistance, fasting insulin, blood pressure, and high-density lipoprotein (<0.05). It predicted excess body fat and changes in fasting insulin and blood pressure in both sexes, blood glucose and high-density lipoprotein in females, and triglycerides in males (area under the curve >0.5; p<0.05, varying from 0.610 for high-density lipoprotein to 0.817 for blood pressure). CONCLUSION: Neck circumference was capable of predicting excess fat and cardiovascular risk factors in adolescents.

Sign in / Sign up

Export Citation Format

Share Document