Self-harm hospitalised morbidity and mortality risk using a matched population-based cohort design

2017 ◽  
Vol 52 (3) ◽  
pp. 262-270 ◽  
Author(s):  
Rebecca J Mitchell ◽  
Cate M Cameron
Keyword(s):  
At Risk ◽  
Confidence Interval ◽  
Mortality Risk ◽  
Service Use ◽  
Population Based ◽  
Mortality Data ◽  
Post Discharge ◽  
Self Harm ◽  
Rate Ratios ◽  
Hospital Use

Objective: Prior and repeated self-harm hospitalisations are common risk factors for suicide. However, few studies have accounted for pre-existing comorbidities and prior hospital use when quantifying the burden of self-harm. The aim is to quantify hospitalisation in the 12 months preceding and re-hospitalisation and mortality risk in the 12 months post a self-harm hospitalisation. Method: A population-based matched cohort using linked hospital and mortality data for individuals ⩾18 years from four Australian jurisdictions. A non-injured comparison cohort was matched on age, gender and residential postcode. Twelve-month pre- and post-index self-harm hospitalisations and mortality were examined. Results: The 11,597 individuals who were hospitalised following self-harm in 2009 experienced 21% higher health service use in the 12 months pre and post the index admission and a higher mortality rate (2.9% vs 0.3%) than their matched counterparts. There were 133 (39.0%) deaths within 2 weeks of hospital discharge and 342 deaths within 12 months of the index hospitalisation in the self-harm cohort. Adjusted rate ratios for hospital readmission were highest for females (2.86; 95% confidence interval: [2.33, 2.52]) and individuals aged 55–64 years (3.96; 95% confidence interval: [2.79, 5.64]). Conclusion: Improved quantification of the burden of self-harm-related hospital use can inform resource allocation for intervention and after-care services for individuals at risk of repeated self-harm. Better assessment of at-risk self-harm behaviour, appropriate referrals and improved post-discharge care, focusing on care continuity, are needed.

scholarly journals Self-harm hospitalised morbidity and mortality risk in Australia using a matched population-based cohort

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Rebecca Mitchell ◽  
Cate Cameron
Keyword(s):  
At Risk ◽  
Health Service ◽  
Mortality Risk ◽  
Service Use ◽  
Negative Binomial ◽  
Population Based ◽  
The Self ◽  
Health Service Use ◽  
Self Harm ◽  
Rate Ratios

IntroductionPrior and repeated self-harm hospitalisations are common risk factors for suicide. However, few studies have accounted for pre-existing comorbidities and prior hospital use when quantifying the burden of self-harm. Objectives and ApproachTo quantify hospitalisation in the 12 months preceding and re-hospitalisation and mortality risk in the 12 months post a self-harm hospitalisation. A population-based matched cohort study of individuals ≥18 years using linked hospitalisation and mortality records from four Australian states. Self-harm was identified using a principal diagnosis of injury (S00-T75 or T79) and an external cause of self-harm (X60-X84). The index self-harm hospitalisation was identified and 12-month pre- and post-index injury health service use was examined. The non-injured comparison cohort was randomly selected from the electoral roll and was matched 1:1 on age, gender, and postcode of residence. Comorbidities were identified using diagnosis classifications with a 1-year lookback. Negative binomial regression was used to quantify associations between self-harm and counts of hospital admissions 12-months post the index hospitalisation using rate ratios and 95%CIs. ResultsThere were 11,597 individuals with a self-harm hospitalisation in New South Wales, South Australia, Queensland or Tasmania with a matched comparison. Mean age was 38.6 years (SD=14.9) and 57.6% were female. The self-harm cohort had a higher proportion of Charlson comorbidities, mental health diagnoses, alcohol misuse and drug-related dependence than their matched counterparts. The self-harm cohort experienced a higher proportion of health service use in the 12-months preceding (20.5% vs 10.1%) and post (21.2% vs 10.6%) the index admission and a higher mortality rate (2.9% vs 0.3%) than their matched counterparts. The adjusted rate ratios (ARR) for hospital readmission were highest for females (ARR: 2.86; 95% CI: 2.33-3.52) and individuals aged 55-64 years (ARR: 3.96; 95%CI: 2.79-5.64). Conclusion/ImplicationsImproved hospitalisation burden quantification for self-harm can inform resource allocation for intervention and after care services for individuals at-risk of repeated self-harm. Better assessment of at-risk self-harm behaviour, appropriate referrals and improved post-discharge care, focusing on care continuity is needed.

Predisposing, enabling and need factors associated with increased use and ongoing increased use of inpatient mental health care: A population-based longitudinal study

2020 ◽  
pp. 000486742097684
Author(s):  
Bianca Suesse ◽  
Luise Lago ◽  
Victoria Westley-Wise ◽  
Jose Cuenca ◽  
Nagesh Pai
Keyword(s):  
Mental Health ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Service Use ◽  
Population Based ◽  
Mental Health Service Use ◽  
History Of ◽  
Self Harm ◽  
History Of Depression ◽  
Hospital Use

Objective: The study investigated factors associated with frequent (admissions), high (total length of stay) or heavy (frequent and high) hospital use, and with ongoing increased hospital use, for mental health conditions in a regional health district. Methods: A retrospective population-based study using longitudinal hospital, emergency department and community service use data for people admitted with a mental health condition between 1 January 2012 and 31 December 2016. Multivariate logistic regression models assessed the association of predisposing, enabling and need factors with increased, and ongoing increased, hospital use. Results: A total of 5,631 people had at least one mental health admission. Frequent admission was associated with not being married (odds ratio = 2.3, 95% confidence interval = [1.5, 3.3]), no private hospital insurance (odds ratio = 2.2, 95% confidence interval = [1.2, 3.8]), previous mental health service use (community, emergency department, lengthy admissions) and a history of a substance use disorder, childhood trauma, self-harm or chronic obstructive pulmonary disease. High and heavy hospital use was associated with marital status, hospital insurance, admission for schizophrenia, previous mental health service use and a history of self-harm. Ongoing frequent use was less likely among those aged 65 and older (odds ratio = 0.2, 95% confidence interval = [0.1, 1.0]) but more likely among those with a history of depression (odds ratio = 2.2, 95% confidence interval = [1.1, 4.4]). Ongoing high use was also associated with admissions for schizophrenia and a history of self-harm. Conclusion: Interventions targeted at younger people hospitalised with schizophrenia, a history of depression or self-harm, particularly with evidence of social and or health disadvantage, should be considered to improve long-term consumer and health system outcomes. These data can support policymakers to better understand the context and need for improvements in stepped or staged care for people frequently using inpatient mental health care.

scholarly journals Poisoning substances taken by young people: a population-based cohort study

2018 ◽  
Vol 68 (675) ◽  
pp. e703-e710 ◽  
Author(s):  
Edward G Tyrrell ◽  
Denise Kendrick ◽  
Kapil Sayal ◽  
Elizabeth Orton
Keyword(s):  
Cohort Study ◽  
Young People ◽  
Population Based ◽  
Incidence Rates ◽  
Practice Research ◽  
Mortality Data ◽  
Clinical Practice Research Datalink ◽  
Self Harm ◽  
Harm Prevention ◽  
Rate Ratios

BackgroundGlobally, poisonings account for most medically-attended self-harm. Recent data on poisoning substances are lacking, but are needed to inform self-harm prevention.AimTo assess poisoning substance patterns and trends among 10–24-year-olds across EnglandDesign and settingOpen cohort study of 1 736 527 young people, using linked Clinical Practice Research Datalink, Hospital Episode Statistics, and Office for National Statistics mortality data, from 1998 to 2014.MethodPoisoning substances were identified by ICD-10 or Read Codes. Incidence rates and adjusted incidence rate ratios (aIRR) were calculated for poisoning substances by age, sex, index of multiple deprivation, and calendar year.ResultsIn total, 40 333 poisoning episodes were identified, with 57.8% specifying the substances involved. The most common substances were paracetamol (39.8%), alcohol (32.7%), non-steroidal anti-inflammatory drugs (NSAIDs) (11.6%), antidepressants (10.2%), and opioids (7.6%). Poisoning rates were highest at ages 16–18 years for females and 19–24 years for males. Opioid poisonings increased fivefold from 1998–2014 (females: aIRR 5.30, 95% confidence interval (CI) = 4.08 to 6.89; males: aIRR 5.11, 95% CI = 3.37 to 7.76), antidepressant poisonings three-to fourfold (females: aIRR 3.91, 95% CI = 3.18 to 4.80, males: aIRR 2.70, 95% CI = 2.04 to 3.58), aspirin/NSAID poisonings threefold (females: aIRR 2.84, 95% CI = 2.40 to 3.36, males: aIRR 2.76, 95% CI = 2.05 to 3.72) and paracetamol poisonings threefold in females (aIRR 2.87, 95% CI = 2.58 to 3.20). Across all substances poisoning incidence was higher in more disadvantaged groups, with the strongest gradient for opioid poisonings among males (aIRR 3.46, 95% CI = 2.24 to 5.36).ConclusionIt is important that GPs raise awareness with families of the substances young people use to self-harm, especially the common use of over-the-counter medications. Quantities of medication prescribed to young people at risk of self-harm and their families should be limited, particularly analgesics and antidepressants.

scholarly journals Mortality Outcomes in People Experiencing Homelessness Across England: a population-based study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Menezes ◽  
D Lewer ◽  
A Yavlinsky ◽  
M Tinelli ◽  
R Aldridge
Keyword(s):  
Hospital Discharge ◽  
Mortality Risk ◽  
Meta Analysis ◽  
Population Based ◽  
Mortality Data ◽  
Additive Interaction ◽  
Population Based Study ◽  
Group A ◽  
Healthcare Interventions ◽  
Discharge From Hospital

Abstract Introduction The number of people experiencing homelessness in England has increased since 2010 and a recent systematic review and meta-analysis demonstrated high levels of mortality in this group across high-income countries. In this study we examine the death rates in people experiencing homelessness after discharge from hospital. Methods This is a study of linked hospital admission records and mortality data for two groups. First, a “Homeless group”: people seen by 17 specialist homeless discharge schemes between 1 November 2013 and 30 November 2016. Second, an “IMD5 group”: A matched group of patients who live in deprived areas and have the same age and sex, and were discharged from the same hospital in the same year as the homeless patient. Our analysis entailed calculating mortality rates across each group and by the number of comorbidities. Results The mortality rate for the IMD5 group was 1,935 deaths per 100,000 person years, compared with 5,691 for the homeless group, giving a rate ratio of 2.9 (95% CI 2.5-3.5). The mortality risk increased with the number of comorbidities. Individuals in the IMD5 group with zero comorbidities had a death rate of 831 per 100,000 person-years, compared with the homeless group for which the corresponding figure was 2,598 and or those with 4+ comorbidities were 7,324 (IMD5) and 12,714 (homeless). This suggests a 'super-additive' interaction in which the effect of morbidity on mortality risk after discharge is greater for homeless patients. Survival at 5 years for the homelessness group was for men 80% (95% CI 77-85) and women 85 (95% CI 81-87). Conclusions This study shows that the well-established inequity in mortality for people experiencing homelessness exists after discharge from hospital and is greatest for the most unwell patients. Our results suggest a need for greater emphasis on prevention of homelessness, early healthcare interventions and improved hospital discharge arrangements for this population. Key messages The well-established inequity in mortality for people experiencing homelessness exists after discharge from hospital and is greatest for the most unwell patients. Our results suggest a need for greater emphasis on prevention of homelessness, early healthcare interventions and improved hospital discharge arrangements for this population.

scholarly journals Association between multimorbidity and socioeconomic deprivation on short-term mortality among patients with diffuse large B-cell or follicular lymphoma in England: a nationwide cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e049087
Author(s):  
Matthew James Smith ◽  
Edmund Njeru Njagi ◽  
Aurelien Belot ◽  
Clémence Leyrat ◽  
Audrey Bonaventure ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
B Cell ◽  
Mortality Risk ◽  
Population Based ◽  
Socioeconomic Deprivation ◽  
Short Term ◽  
English Population ◽  
Short Term Mortality ◽  
Rate Ratios ◽  
Large B Cell

ObjectivesWe aimed to assess the association between multimorbidity and deprivation on short-term mortality among patients with diffuse large B-cell (DLBCL) and follicular lymphoma (FL) in England.SettingThe association of multimorbidity and socioeconomic deprivation on survival among patients diagnosed with DLBCL and FL in England between 2005 and 2013. We linked the English population-based cancer registry with electronic health records databases and estimated adjusted mortality rate ratios by multimorbidity and deprivation status. Using flexible hazard-based regression models, we computed DLBCL and FL standardised mortality risk by deprivation and multimorbidity at 1 year.ResultsOverall, 41 422 patients aged 45–99 years were diagnosed with DLBCL or FL in England during 2005–2015. Most deprived patients with FL with multimorbidities had three times higher hazard of 1-year mortality (HR: 3.3, CI 2.48 to 4.28, p<0.001) than least deprived patients without comorbidity; among DLBCL, there was approximately twice the hazard (HR: 1.9, CI 1.70 to 2.07, p<0.001).ConclusionsMultimorbidity, deprivation and their combination are strong and independent predictors of an increased short-term mortality risk among patients with DLBCL and FL in England. Public health measures targeting the reduction of multimorbidity among most deprived patients with DLBCL and FL are needed to reduce the short-term mortality gap.

scholarly journals Mortality in individuals who have had psychiatric treatment

2005 ◽  
Vol 187 (6) ◽  
pp. 552-558 ◽  
Author(s):  
Stephen Kisely ◽  
Mark Smith ◽  
David Lawrence ◽  
Sarah Maaten
Keyword(s):  
Primary Care ◽  
Mortality Rate ◽  
Mortality Risk ◽  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Population Based ◽  
Patient Treatment ◽  
Male Mortality ◽  
Receive Treatment ◽  
Rate Ratios

BackgroundMost studies of mortality in psychiatric patients have investigated inpatients rather than those attending outpatient clinics or primary care, where most receive treatment.AimsTo evaluate the mortality risk in mental illness for patients in contact with psychiatric services or primary care (n=221 048) across Nova Scotia (population 936 025).MethodA population-based record-linkage analysis was made of the period 1995–2000, using an inception cohortto calculate mortality rate ratios.ResultsThe mortality rate was 1.74, with increased ratios for all major causes of death. Male mortality was almost double that of females after controlling for demographic factors, treatment setting and place of residence. Patients of lower income, in specialist psychiatric settings, and with dementia or psychoses were also at greater risk. However, in absolute numbers, 72% of deaths occurred in patients who had only seen their general practitioner.ConclusionsMortality risk is increased in all psychiatric patients, not just those who have received in-patient treatment.

scholarly journals Trends in occurrence and 30-day mortality of infective endocarditis in adults: population-based registry study in Finland

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026811 ◽  
Author(s):  
Elina Ahtela ◽  
Jarmo Oksi ◽  
Pekka Porela ◽  
Tommi Ekström ◽  
Paivi Rautava ◽  
...  
Keyword(s):  
Sex Differences ◽  
Infective Endocarditis ◽  
Incidence Rate ◽  
Hospital Admissions ◽  
Temporal Trends ◽  
Population Based ◽  
Mortality Data ◽  
Annual Increase ◽  
Rate Ratios ◽  
Age And Sex

ObjectivesInfective endocarditis (IE) is a life-threatening disease associated with significant mortality. We studied recent temporal trends and age and sex differences in the occurrence and short-term mortality of IE.DesignPopulation based retrospective cohort study.SettingData of IE hospital admissions in patients aged ≥18 years in Finland during 2005–2014 and 30-day all-cause mortality data were retrospectively collected from mandatory nationwide registries from 38 hospitals.OutcomesTrends and age and sex differences in occurrence. Thirty-day mortality.ResultsThere were 2611 cases of IE during the study period (68.2% men, mean age 60 years). Female patients were significantly older than males (62.0 vs 59.0 years, p=0.0004). Total standardised annual incidence rate of IE admission was 6.33/100 000 person-years. Men had significantly higher risk of IE compared with women (9.5 vs 3.7/100 000; incidence rate ratios [IRR] 2.49; p<0.0001) and difference was most prominent at age 40–59 years (IRR 4.49; p<0.0001). Incidence rate varied from 5.7/100 000 in 2005 to 7.1/100 000 in 2012 with estimated average 2.1% increase per year (p=0.036) and similar trends in both sexes. Significant increasing trend was observed in patients aged 18–29 years and 30–39 years (estimated annual increase 7.6% and 7.2%, p=0.002) and borderline in patients aged 40–49 years (annual increase 3.8%, p=0.08). In older population, IE incidence rate remained stable. The overall 30-day mortality after IE admission was 11.3%. Mortality was similar between sexes, increased with ageing, and remained similar during the study period.ConclusionsOccurrence of IE is increasing in young adults in Finland. Men, especially middle-aged, are at higher risk for IE compared with women. Thirty-day mortality has remained stable at 11%, increased with ageing, and was similar between sexes.

scholarly journals A video-feedback parenting intervention to prevent enduring behaviour problems in at-risk children aged 12–36 months: the Healthy Start, Happy Start RCT

2021 ◽  
Vol 25 (29) ◽  
pp. 1-84
Author(s):  
Christine O’Farrelly ◽  
Beth Barker ◽  
Hilary Watt ◽  
Daphne Babalis ◽  
Marian Bakermans-Kranenburg ◽  
...  
Keyword(s):  
At Risk ◽  
Confidence Interval ◽  
Usual Care ◽  
Service Use ◽  
Child Behaviour ◽  
Strengths And Difficulties Questionnaire ◽  
Behaviour Problems ◽  
Child Behaviour Checklist ◽  
Strengths And Difficulties

Background Behaviour problems emerge early in childhood and place children at risk for later psychopathology. Objectives To evaluate the clinical effectiveness and cost-effectiveness of a parenting intervention to prevent enduring behaviour problems in young children. Design A pragmatic, assessor-blinded, multisite, two-arm, parallel-group randomised controlled trial. Setting Health visiting services in six NHS trusts in England. Participants A total of 300 at-risk children aged 12–36 months and their parents/caregivers. Interventions Families were allocated in a 1 : 1 ratio to six sessions of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) plus usual care or usual care alone. Main outcome measures The primary outcome was the Preschool Parental Account of Children’s Symptoms, which is a structured interview of behaviour symptoms. Secondary outcomes included caregiver-reported total problems on the Child Behaviour Checklist and the Strengths and Difficulties Questionnaire. The intervention effect was estimated using linear regression. Health and social care service use was recorded using the Child and Adolescent Service Use Schedule and cost-effectiveness was explored using the Preschool Parental Account of Children’s Symptoms. Results In total, 300 families were randomised: 151 to VIPP-SD plus usual care and 149 to usual care alone. Follow-up data were available for 286 (VIPP-SD, n = 140; usual care, n = 146) participants and 282 (VIPP-SD, n = 140; usual care, n = 142) participants at 5 and 24 months, respectively. At the post-treatment (primary outcome) follow-up, a group difference of 2.03 on Preschool Parental Account of Children’s Symptoms (95% confidence interval 0.06 to 4.01; p = 0.04) indicated a positive treatment effect on behaviour problems (Cohen’s d = 0.20, 95% confidence interval 0.01 to 0.40). The effect was strongest for children’s conduct [1.61, 95% confidence interval 0.44 to 2.78; p = 0.007 (d = 0.30, 95% confidence interval 0.08 to 0.51)] versus attention deficit hyperactivity disorder symptoms [0.29, 95% confidence interval –1.06 to 1.65; p = 0.67 (d = 0.05, 95% confidence interval –0.17 to 0.27)]. The Child Behaviour Checklist [3.24, 95% confidence interval –0.06 to 6.54; p = 0.05 (d = 0.15, 95% confidence interval 0.00 to 0.31)] and the Strengths and Difficulties Questionnaire [0.93, 95% confidence interval –0.03 to 1.9; p = 0.06 (d = 0.18, 95% confidence interval –0.01 to 0.36)] demonstrated similar positive treatment effects to those found for the Preschool Parental Account of Children’s Symptoms. At 24 months, the group difference on the Preschool Parental Account of Children’s Symptoms was 1.73 [95% confidence interval –0.24 to 3.71; p = 0.08 (d = 0.17, 95% confidence interval –0.02 to 0.37)]; the effect remained strongest for conduct [1.07, 95% confidence interval –0.06 to 2.20; p = 0.06 (d = 0.20, 95% confidence interval –0.01 to 0.42)] versus attention deficit hyperactivity disorder symptoms [0.62, 95% confidence interval –0.60 to 1.84; p = 0.32 (d = 0.10, 95% confidence interval –0.10 to 0.30)], with little evidence of an effect on the Child Behaviour Checklist and the Strengths and Difficulties Questionnaire. The primary economic analysis showed better outcomes in the VIPP-SD group at 24 months, but also higher costs than the usual-care group (adjusted mean difference £1450, 95% confidence interval £619 to £2281). No treatment- or trial-related adverse events were reported. The probability of VIPP-SD being cost-effective compared with usual care at the 24-month follow-up increased as willingness to pay for improvements on the Preschool Parental Account of Children’s Symptoms increased, with VIPP-SD having the higher probability of being cost-effective at willingness-to-pay values above £800 per 1-point improvement on the Preschool Parental Account of Children’s Symptoms. Limitations The proportion of participants with graduate-level qualifications was higher than among the general public. Conclusions VIPP-SD is effective in reducing behaviour problems in young children when delivered by health visiting teams. Most of the effect of VIPP-SD appears to be retained over 24 months. However, we can be less certain about its value for money. Trial registration Current Controlled Trials ISRCTN58327365. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 29. See the NIHR Journals Library website for further project information.

scholarly journals Algorithms for assessing person-based consistency among linked records for the investigation of maternal use of medications and safety

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Duong Tran ◽  
Alys Havard ◽  
Louisa Jorm
Keyword(s):  
Maternal Age ◽  
Service Use ◽  
Population Based ◽  
Birth Date ◽  
Mortality Data ◽  
South Wales ◽  
The Status ◽  
High Consistency ◽  
Project Data ◽  
Data Collections

ABSTRACTObjectivesPerinatal records linked to pharmaceutical claims and other administrative data provide a powerful resource to investigate maternal use of medications and safety. In this population-based project, data quality assessment was performed on the consistency of linked records brought together from several data collections to ensure reliable links for data analysis. ApproachPerinatal data for the Australian states of New South Wales (NSW) and Western Australia (WA) were linked to pharmaceutical claims by a Commonwealth integrating authority, while linkage to hospital admission, emergency department (ED), mortality and congenital notification data was performed by respective State-based data linkage units. All de-identified records belonging to a unique person ID were sorted chronologically. To assess the consistency of unique persons, both within and across States, algorithms were developed based on pregnancy plurality and birth order, gestation, parity, maternal age and sex, date of delivery, dates of health service use, and State where the claim was made. ResultsThe dataset included 595,456 NSW and 188,014 WA mothers with respectively 937,344 and 295,095 pregnancies delivered between 2003 and 2012. The information brought together through linkage was highly consistent for the majority of mothers and infants. Inconsistencies are identified in 742 cases, including negative inter-pregnancy period, highly illogical parity, highly inconsistent maternal age, maternal gender being systematically recorded as male, use of health services after date of death, and different infants sharing a common ID. These cases will be excluded from analyses. Date of delivery was corrected for 667 pregnancies, using date of birth recorded in the infant’s admission and ED records, and date of the mother’s admissions. Among admission and ED records, over 8000 needed correction in infant age due to typographical errors, 1820 were duplicates, while 1000 had discrepancies between dates of birth, date of admission and separation. There were 455 deaths, mostly neonates, identified by status of admission or ED discharge but not recorded in mortality data. The majority of these deaths were confirmed by the status of neonatal discharge at birth. There were 3404 women who had a single unique ID according to Commonwealth linkage but more than one unique IDs according to State-based linkage. 2827 mothers had births recorded in both NSW and WA. ConclusionQuality assessment indicated high consistency among linked records. The set of algorithms developed in this project can be applied to similar linked perinatal datasets to promote a consistent approach and comparability across studies.

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