What Physical Fitness Component Is Most Closely Associated With Adolescents' Blood Pressure?

2017 ◽  
Vol 124 (6) ◽  
pp. 1107-1120 ◽  
Author(s):  
Heloyse E. G. Nunes ◽  
Carlos A. S. Alves ◽  
Eliane C. A. Gonçalves ◽  
Diego A. S. Silva
Keyword(s):  
Blood Pressure ◽  
Body Composition ◽  
Muscle Strength ◽  
Physical Fitness ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Aerobic Fitness ◽  
Pressure Control ◽  
Cross Sectional ◽  
Digital Pressure

This study aimed to determine which of four selected physical fitness variables, would be most associated with blood pressure changes (systolic and diastolic) in a large sample of adolescents. This was a descriptive and cross-sectional, epidemiological study of 1,117 adolescents aged 14–19 years from southern Brazil. Systolic and diastolic blood pressure were measured by a digital pressure device, and the selected physical fitness variables were body composition (body mass index), flexibility (sit-and-reach test), muscle strength/resistance (manual dynamometer), and aerobic fitness (Modified Canadian Aerobic Fitness Test). Simple and multiple linear regression analyses revealed that aerobic fitness and muscle strength/resistance best explained variations in systolic blood pressure for boys (17.3% and 7.4% of variance) and girls (7.4% of variance). Aerobic fitness, body composition, and muscle strength/resistance are all important indicators of blood pressure control, but aerobic fitness was a stronger predictor of systolic blood pressure in boys and of diastolic blood pressure in both sexes.

The Rate of Increase in Blood Pressure in Children 5 Years of Age Is Related to Changes in Aerobic Fitness and Body Mass Index

PEDIATRICS ◽  
1994 ◽  
Vol 94 (4) ◽  
pp. 465-470
Author(s):  
Steven Shea ◽  
Charles E. Basch ◽  
Bernard Gutin ◽  
Aryeh D. Stein ◽  
Isobel R. Contento ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Body Mass ◽  
Aerobic Fitness ◽  
Medical Center ◽  
Multiple Regression Model ◽  
Age Related ◽  
Rate Of Increase

Objective. To determine whether changes in aerobic fitness and body mass index are related to the age-related rise in blood pressure in healthy preschool children. Study design. Longitudinal analyses of 196 free-living children aged 5 years at baseline who were followed over a mean of 19:7 months. Aerobic fitness was assessed using a treadmill All measures were obtained on multiple occasions at scheduled visits as part of a longitudinal cohort study. Setting. An inner-city medical center. Outcome measures. Blood pressure was measured using an automated Dinamap device. Results. Mean systolic blood pressure was 95.3 mmHg (SD 8.38) at baseline and increased by 4.46 mmHg per year. Mean diastolic blood pressure was 53.9 mmHg (SD 5.81) at baseline and did not change significantly. Children in the highest quintile of increase in fitness had a significantly smaller increase in systolic blood pressure compared to children in the lowest quintile (2.92 vs 5.10 mmHg/year; P = .03). Children in the lowest quintile of increase in body mass index did not differ significantly in rate of increase in systolic blood pressure compared to children in the highest quintile (3.92 vs 4.96 mmHg/year). In a multiple regression model including baseline systolic blood pressure, fitness, height, body mass index, and other covariates, greater increase in fitness (P = .03) and lesser increase in body mass index (P < .01) were associated with lower rates of increase in systolic blood pressure. In a similar multivariate analysis, an increase in fitness was also associated with a lower rate of increase in diastolic blood pressure (P = .02) Conclusion. Young children who increase their aerobic fitness or decrease their body mass index reduce the rate of the age-related increase in blood pressure. These observations may have implications for development of interventions directed at the primary prevention of hypertension.

scholarly journals HUBUNGAN ASUPAN ASAM LEMAK OMEGA-3 DAN OMEGA-6 DENGAN TEKANAN DARAH WANITA USIA 30 – 50 TAHUN

2017 ◽  
Vol 6 (4) ◽  
pp. 313
Author(s):  
Mega Lucyta Sari ◽  
Enny Probosari ◽  
Hartanti Sandi Wijayanti
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Cross Sectional Study ◽  
Observational Research ◽  
Omega 3 ◽  
Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Omega 6

Background: Hypertension is one of the major risk factors for cardiovascular disease. Decreased intake of omega-3 and increased intake of omega-6 can increase the risk of hypertension. Hypertension cases in Indonesia are highest in women especially aged 30 - 50 years. This study aimed to determine correlation of omega-3 and omega-6 intake with blood pressure in women aged 30-50 years.Method : This was an observational research with cross-sectional study design. Fifty four subjects were selecting using consecutive sampling. Intakes were assessed by food recall 2x24 hours. Blood pressure levels were measured by Sphygmomanometer. Data were analyzed by Chi Square and Fisher Exact.Result : Systolic and diastolic blood pressure mean were 115.92 ± 14.5 mmHg and 75 ± 7.45 mmHg, while omega-3 and omega-6 mean were of 3. 1.03 ± 0.52 g and 14.17 ± 5 , 8 g. More than one third of the subjects (37.9%) with pre-hypertension/hypertension had omega-3 intake less than 1.1 g and 52.7% of them had omega-6 intake less than 12 g.There was correlation of omega-6 intake with systolic blood pressure (p <0.05) but there were no correlation between omega-3 intake with systolic blood pressure, omega-3 and omega-6 intake with diastolic blood pressure (p >0,05). Conclusion: There was correlation of omega-6 intake with systolic blood pressure, there were no correlation between omega-3 intake with systolic blood pressure, omega-3 and omega-6 intake with diastolic blood pressure

scholarly journals HUBUNGAN ASUPAN PROTEIN, LEMAK, KALIUM DAN MAGNESIUM DENGAN TEKANAN DARAH SISTOLIK DAN DIASTOLIK LANJUT USIA

2017 ◽  
Vol 6 (4) ◽  
pp. 385
Author(s):  
Aria Menad M ◽  
Aryu Candra Kusumastuti
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Cross Sectional Study ◽  
Bivariate Analysis ◽  
Cross Sectional ◽  
Magnesium Intake ◽  
High Prevalence ◽  
Relationship Of ◽  
Spearman Test

Background : Hypertension is one of the degenerative diseases that has high prevalence an increase. One of the factors that influence blood pressure in hypertensive patients is protein, fat, potassium, and magnesium intake. The purpose of this study was to determine the relationship of protein, fat, potassium, and magnesium intake with blood pressure in elderly.Design : This cross-sectional study was conducted among 42 subjects (aged 60-80 years) of PWRI (Persatuan Wredatama Republik Indonesia) members rating South Semarang, Semarang. Food recall method was used to measure the intake of protein, fat, potassium and magnesium intake. Blood pressure was measured with a mercury sphygmomanometer. Rank- Spearman test was used on bivariate analysis. Results : On the results of this study as many as 83.3% of subjects hypertention. Protein intake (52.4% of subjects), fat intake (100% of subject) potassium intake (54.8%) and magnesium (95.2% of subjects) are lower than needs. Bivariate analysis shows that there were no correlation between protein, fat, potassium, and magnesium intake and systolic blood pressure and diastolic blood pressure. Conclusion : In there were correlation between protein, fat, potassium, and magnesium intake and systolic blood pressure and diastolic blood pressure. 

scholarly journals Effects of Intermittent Compared With Continuous Energy Restriction on Blood Pressure Control in Overweight and Obese Patients With Hypertension

2021 ◽  
Vol 8 ◽  
Author(s):  
Chao-Jie He ◽  
Ye-Ping Fei ◽  
Chun-Yan Zhu ◽  
Ming Yao ◽  
Gang Qian ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Weight Loss ◽  
Body Composition ◽  
Systolic Blood Pressure ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Energy Restriction ◽  
Obese Patients ◽  
Continuous Energy ◽  
The Mean

Background and Aims: Weight-loss diets reduce body weight and improve blood pressure control in hypertensive patients. Intermittent energy restriction (IER) is an alternative to continuous energy restriction (CER) for weight reduction. We aimed to compare the effects of IER with those of CER on blood pressure control and weight loss in overweight and obese patients with hypertension during a 6-month period.Methods: Two hundred and five overweight or obese participants (BMI 28.7 kg/m2) with hypertension were randomized to IER (5:2 diet, a very-low-calorie diet for 2 days per week, 500 kcal/day for women and 600 kcal/day for men, along with 5 days of a habitual diet) compared to a moderate CER diet (1,000 kcal/day for women and 1,200 kcal/day for men) for 6 months. The primary outcomes of this study were changes in blood pressure and weight, and the secondary outcomes were changes in body composition, glycosylated hemoglobin A1c (HbA1c), and blood lipids.Results: Of the 205 randomized participants (118 women and 87 men; mean [SD] age, 50.2 [8.9] years; mean [SD] body mass index, 28.7 [2.6]; mean [SD] systolic blood pressure, 143 [10] mmHg; and mean [SD] diastolic blood pressure, 91 [9] mmHg), 173 completed the study. The intention-to-treat analysis demonstrated that IER and CER are equally effective for weight loss and blood pressure control: the mean (SEM) weight change with IER was −7.0 [0.6] kg vs. −6.8 [0.6] kg with CER, the mean (SEM) systolic blood pressure with IER was −7 [0.7] mmHg vs. −7 [0.6] mmHg with CER, and the mean (SEM) diastolic blood pressure with IER was −6 [0.5] mmHg vs. −5 [0.5] mmHg with CER, (diet by time P = 0.62, 0.39, and 0.41, respectively). There were favorable improvements in body composition, HbA1c, and blood lipid levels, with no differences between groups. Effects did not differ according to completer analysis. No severe hypoglycemia occurred in either group during the trial.Conclusions: Intermittent energy restriction is an effective alternative diet strategy for weight loss and blood pressure control and is comparable to CER in overweight and obese patients with hypertension.Clinical Trial Registration:http://www.chictr.org.cn, identifier: ChiCTR2000040468.

scholarly journals KADAR ASAM URAT SERUM DAN KOMPONEN SINDROM METABOLIK

2016 ◽  
Vol 20 (3) ◽  
pp. 227
Author(s):  
MI Diah P ◽  
Banundari Rachmawati ◽  
Purwanto AP
Keyword(s):  
Blood Pressure ◽  
Waist Circumference ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Elevated Serum ◽  
International Diabetes Federation ◽  
Correlation Coefficients ◽  
Cross Sectional ◽  
Long Term Study ◽  
Student’S T

The incidence of metabolic syndrome (MetS) is significantly increasing. The elevated serum uric acid (SUA) level is correlated with the metabolic risk of cardiovascular. The relationship between SUA levels and components of MetS has been inconsistent. The aim of this study was to know the correlation between SUA level and component of MetS by analyzng. This study was a cross-sectional design conducted on healthy people at the Medical Check Up (MCU) Clinic, Dr. Moewardi Hospital, Surakarta from June 2012 until February 2013. MetS was defined according to the 2005 International Diabetes Federation (IDF) criteria. The statistical analysis was done by Student’s T test, Pearson or Spearman correlation coefficients. The researchers considered p<0.05 as statistically significant with a 95% confidence interval. A total of 80 healthy subjects, (range 19–57 years) were enrolled into this study. MetS was diagnosed in 40 persons where men (62.5%) were more than women and the non-MetS in women (62.5%) were more than men. In this study, a positive correlation was found between SUA and systolic blood pressure, diastolic blood pressure and waist circumference (Pearson r=0.354, 0.495, 0.399, respectively, p<0.05) in women, but not in men. The SUA was positively correlated with systolic blood pressure, diastolic blood pressure and waist circumference, particularly in women. A long term study is needed to investigate the consequence of increasing the SUA level in metabolic disorders and hormonal influences as well.

scholarly journals Controle da Pressão Arterial em Pacientes Idosos de um Ambulatório de Atenção Primária à Saúde

2006 ◽  
Vol 9 ◽  
Author(s):  
Paulo Renato Carvalho Alonso Rays ◽  
Honório Sampaio Menezes
Keyword(s):  
Blood Pressure ◽  
Elderly Patients ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Heart Diseases ◽  
The Elderly ◽  
Cross Sectional ◽  
Diabetes Type Ii ◽  
Hypertensive Therapy ◽  
Elderly Control

Resumo: Hipertensão Arterial é definida como elevação da pressão arterial sistólica e diastólica acima de 140/90mmHg, respectivamente. Estima-se que mais de 50% dos pacientes acima de 60 anos tenham hipertensão, o que deixa essa população sob risco aumentado de doenças em órgãos alvo como coração, rins e cérebro, aumentando também a morbimortalidade desta população. Diversos estudos comprovam que a terapia anti-hipertensiva reduz o risco e a morbimortalidade cardiovascular, cerebral e renal. No presente trabalho foi realizado um estudo transversal, observacional, prospectivo, onde foram avaliadas as medidas da pressão arterial de 24 pacientes idosos do grupo de 70 pacientes hipertensos do ambulatório do Programa Saúde da Família da cidade de Mata, interior do RS. Foi utilizada estatística descritiva e distribuição por freqüência, além do teste “t” de Student para comparação de médias, com nível de significância de 5% para análise dos dados. A pressão sistólica variou entre 120 e 180mmHg, a diastólica entre 60 e 100mmHg. Em 17 (70,83%) dos pacientes não houve associação da hipertensão com outra doença crônica, em quatro (16,22%) havia associado diabete melito tipo II e três (12,50%) tinham dislipidemia. Predominou o sexo feminino em 75% (18) dos pacientes estudados. A pressão sistólica estava acima de 140mmHg em 10 (41,67%) dos pacientes entre os quais havia quatro (16,67%) com a diastólica acima de 90mmHg. Dois quintos dos idosos, mesmo sob tratamento ambulatorial, não apresentava controle da hipertensão arterial adequado. Palavras-chave: Hipertensão. Idoso. Controle. Abstract: Hypertension is defined as an elevation of systolic and diastolic blood pressure above 140/90mmHg. More than 50% of patients over 60 years have hypertension, which increases the risk of cerebrovascular, kidney and heart diseases in this population. The anti-hypertensive therapy reduces risks according several studies. This cross sectional hypertension study of the elderly patients over 60 years old analyzed blood pressure in two opportunities separated by two days. Twenty-four patients had the blood pressure measured among 70 patients. Results: the systolic blood pressure were between 120-190mmHg, the diastolic blood pressure between 60-100mmHg. Eighteen (75%) were women, 17 (70.83%) does not have other chronic diseases, four (16.22%) had diabetes type II, three (12.50%) were dislipidemic. In ten (41.67%) patients the systolic blood pressure was over 140mmHg and four (16.67%) had the diastolic blood pressure over 90mmHg. The hypertension was uncontrolled in two fifty of elderly patients. Keywords: Hypertension. Elderly. Control.

scholarly journals Faktor yang Berhubungan dengan Tekanan Darah pada Petani Penyemprot Tanaman Hortikultura di Desa Trayu Kecamatan Sumowono Kabupaten Semarang

2020 ◽  
Vol 19 (1) ◽  
pp. 38-42
Author(s):  
Latifa Rachmawati ◽  
Suhartono Suhartono ◽  
Budiyono Budiyono
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Random Sampling ◽  
Simple Random Sampling ◽  
P Value ◽  
Cross Sectional ◽  
Pesticide Mixture ◽  
Work Period ◽  
Spearman Test

Latar belakang: Pestisida merupakanxsalahxsatuxbahan kimia yang berbahaya. Adanya kandungan bahan – bahan – bahan aktif pada pestisida yang masuk kedalam tubuh manusia dengan berbagai jalur dapat menganggu proses asetilkolin, yang dapat mengakibatkan gangguan pada tekanan darah. Desa Trayu memiliki pekerjaan dengan mayoritas sebagai petani penyemprot hortikultura denganxjumlah sebanyak 416 orang (41,06%), dimana seluruh petani masih aktif menggunakan pestisida. Tujuan penelitianxinixadalahxuntukxmengetahui beberapaxfaktorxyangxberhubunganxdenganxtekananxdarah petani penyemprot hortikultura dixDesa TrayuxKecamatanxSumowonoxKabupaten Semarang.Metode: Penelitian ini merupakan penelitian analitik observasional dengan pendekatan cross-sectional. Sampel penelitian berjumlah 66 orang diambil dengan menggunakan metode simple random sampling. Pengukuran tekanan darah dilakukan menggunakan tensimeter. Pengumpulan data dilakukan dengan wawancara menggunakan kuesioner. Analisis statistik menggunakan uji korelasi Rank Spearman pada α 95%.  Hasil: Responden rata – rata berumur 50 tahun, dengan tingkat pendidikan didominasi Sekolah Dasar, dimana untuk penggunaan pestisida di Desa Trayu mencapai 100%. Sebanyak 34 responden (51,51%)  memiliki tekanan darah sistolik tinggi dan 46 responden (69,69%) memiliki tekanan darah diastolik tinggi. Hasil menujukkanxbahwa tidakxadaxhubunganxantaraxmasaxkerjaxdenganxtekananxdarahxsistolik (p value = 0,408). Terdapat hubungan pada variabelxmasaxkerjaxdenganxtekananxdarah diastolik (pxvalue = 0,022).xTerdapat hubungan antara jumlah campuran pestisida dengan tekanan darah sistolik (p value = 0,001). Tidak ditemukan adanyaxhubunganxjumlah campuran pestisidaxdenganxtekananxdarahxdiastolik (p value = 0,238). Ada hubungan antara variabel frekuensi penyemprotan dengan tekanan darah sistolik (p value = 0,041) dan tekanan darah diastolik (p value = 0,006).Simpulan: Frekuensi penyemprotan berhubungan dengan tekanan darah petani penyemprot tanaman hortikulturaKata kunci: tekanan darah, pestisida, petani penyemprot, tanaman hortikultura.ABSTRACT Title: The Analysis Factors Related to Blood Pressure on Horticulture Spraying Farmers in Trayu Village, Subdistrict Sumowono, District SemarangBackground: Pesticides are a dangerous chemical. The composition of active ingredients in pesticides that enter the human body with various pathways can interfere with the process of acetylcholine, which can disturbing blood pressure. The highest occupation in Trayu Village is horticulture sprayer, the total is 416 people (41,06%), where all farmers are actively using pesticides. Thexpurposexofxthis research was to determine severalxfactorsxrelated to blood pressure.Method: This research was an observational analytic study with a cross-sectional design. The sample of this study was 66 people taken by simple random sampling method. Blood pressure was measured using tensimeter. Data collection were gathered by interview using a questionnaire. Statistical analysis using Rank Spearman test with α 95%.Result: The average respondent is 50 years, with an education level dominated by elementary school, meanwhile the use of pesticides in Trayu Village reaches 100%. There were 34 respondents (51,51%) had high systolic blood pressure and 46 respondents (69,69%) had high diastolic blood pressure. xThexresultsxshowxthere is no correlation between a work period and systolic pressure (pxvaluex= 0,408). Therexisxaxcorrelation work period with diastolicxbloodxpressurex(pxvaluex=x0,022). Therexisxan associationxbetweenxthexamount of pesticide mixture with systolic blood pressure (p value = 0,001). There was no correlation between the amount of pesticide mixture with diastolic blood pressure (p value = 0,238). There was no association btween the variable frequency of srpaying with systolic blood pressure (p value = 0,041) and diastolic blood pressure (p value = 0,006).Conclusion: The frequency of spraying associated with the blood pressure of horticulture spraying farmers.Keywords: blood pressure, pesticides, spraying farmers, horticulture plants

Correlation between wrist circumference with blood pressure and creatinine level among elderly

2021 ◽  
Vol 9 (2) ◽  
pp. 123-127
Author(s):  
Etisa Adi Murbawani ◽  
Etika Ratna Noer ◽  
Enny Probosari
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Creatinine Level ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Anthropometric Measurement ◽  
Cross Sectional ◽  
High Systolic Blood Pressure ◽  
Wrist Circumference

Background: Hypertension is a highly prevalent health problem which incidence is greatest among the elderly. Hypertension may increase creatinine level and leads to other health problems like diabetes mellitus, kidney damage, and cardiovascular disease. Wrist circumference is a simple anthropometric measurement that can be used to identify hypertension and increasing level of serum creatinine.Objectives: To analyze the correlation of wrist circumference with blood pressure and creatinine level among the elderly.Materials and Methods: This was a cross-sectional study with a purposive sampling method. Subjects of this study were 84 women aged 60 years old or above at Unit Rehabilitasi Sosial Pucang Gading Semarang. The independent variable of this study was wrist circumference, and the dependent variables were systolic blood pressure, diastolic blood pressure, and creatinine level. The result was analyzed using the Spearman-rho test.Results: The participants of this research were 49% women aged 60-65 years old, with an average age was 65.5 years old. The prevalence of hypertension was 61.9%. Most hypertension incidence in this research was caused by high systolic blood pressure (50%), and the rest was caused by high diastolic blood pressure (3.9%) and both (46.1%). The level of creatinine was normal with an average level was 0.75 mg/dL. There was no correlation of wrist circumference with systolic blood pressure systolic (r=0.15; p=0.19), diastolic blood pressure (r=0.1; p=0.38), and creatinine serum (r=0.18; p=0.09) among elderly.Conclusions: There was no correlation of wrist circumference with blood pressure and creatinine level among the elderly.

scholarly journals The Association between Physical Fitness Performance and Subjective Happiness among Taiwanese Adults

2020 ◽  
Vol 17 (11) ◽  
pp. 3774 ◽  
Author(s):  
Hui-Ling Chen ◽  
Po-Fu Lee ◽  
Yun-Chi Chang ◽  
Fu-Shu Hsu ◽  
Ching-Yu Tseng ◽  
...  
Keyword(s):  
Body Composition ◽  
Logistic Regression ◽  
Muscle Strength ◽  
Physical Fitness ◽  
Cross Sectional Study ◽  
Step Test ◽  
Multiple Logistic Regression ◽  
Related Factors ◽  
Cross Sectional ◽  
Logistic Regression Models

The purpose of the present study was to determine the association between health-related physical fitness (HRPF) performance and perceived happiness status among adults in Taiwan. A cross-sectional study was conducted, and data derived from the National Physical Fitness Survey in Taiwan 2014–2015 were reviewed. The participants included 27,930 men and 30,885 women, aged 23 to 64 years. Each participant completed a standardized, structured questionnaire and underwent anthropometric variable and HRPF measurements. The happiness outcome of an individual was obtained using the questionnaire, and the results were stratified into happy (very happy, quite happy, and fair) and unhappy (unhappy and not at all happy) groups for perceived happiness status. HRPF measurements were evaluated using cardiorespiratory endurance (3 min step test), muscle strength and endurance (1 min sit-up test), flexibility (sit-and-reach test), and body composition (body mass index (BMI) and waist-to-hip ratio). To determine the existence of a dose–response relationship between HRPF component levels and happiness status, four quartiles of HRPF components were analyzed using multiple logistic regression models. Multiple logistic regression results indicated that with the worst performance level of HRPF components as a baseline, significant associations were observed for the sit-and-reach test (third level: OR = 1.24, 95% CI: 1.02–1.49) and BMI (second level: OR = 0.78, 95% CI: 0.64–0.95) among men. For women, significant associations were observed for the 1 min sit-up test (second level: OR = 1.28, 95% CI: 1.03–1.60; third level: OR = 1.32, 95% CI: 1.04–1.67; fourth (the best) level: OR = 1.48, 95% CI: 1.12–1.95) and BMI (third level: OR = 0.73, 95% CI: 0.58–0.92). The current study suggested that higher values in flexibility and body composition, happiness-related factors, potentially improve the occurrence of happiness among men. Moreover, this positive effect of higher values of muscle strength, endurance, and BMI was observed for the occurrence of happiness in women. However, the relevant mechanism underlying this phenomenon must be further explored.

Sign in / Sign up

Export Citation Format

Share Document