Home About us Contact
|
Home About us Contact | ||
|
|
||
Adult Participants (adult + participant)
Selected AbstractsOutcome Evaluation of ,Sharing the Gift of Life': An Organ and Tissue Donation Educational Program for American IndiansAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2010N. L. Fahrenwald Culturally focused education about deceased donation is needed for American Indians (AIs). This study tested a program designed to impact intention to serve as a deceased donor for reservation dwelling AIs. A pre/posttest design and a community-based participatory research approach were used. The study was based upon the Transtheoretical Model. Adult participants (N = 1580, 58% women) were from four Northern Plains reservations. An outreach coordinator delivered the program using print and video materials. The outcome was stage of motivational readiness (SMR) to serve as a deceased donor. McNemar's test was used to compare pre- to postintervention changes in SMR. At baseline, 55% of participants were not thinking about being a donor (precontemplation stage) and 45% were thinking about it (contemplation stage). Postintervention, 43.1% of participants were unchanged in SMR and 56.9% progressed in SMR. Of those who progressed, 26.5% (n = 418) changed to the contemplation stage, 19.4% (n= 306) changed to the preparation stage (signed a donor card or joined a registry), and 11.1% (n = 175) confirmed a discussion of the decision with family (action stage). Progression in SMR from pre/post was significant, ,2(1) = 18.32, p < 0.05. The intervention resulted in important changes in deceased donor intentions for reservation dwelling AIs. [source] Childhood life events and childhood trauma in adult patients with depressive, anxiety and comorbid disorders vs. controlsACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2010J. G. F. M. Hovens Hovens JGFM, Wiersma JE, Giltay EJ, van Oppen P, Spinhoven P, Penninx BWJH, Zitman FG. Childhood life events and childhood trauma in adult patients with depressive, anxiety and comorbid disorders vs. controls. Objective:, To investigate the association between childhood life events, childhood trauma and the presence of anxiety, depressive or comorbid anxiety and depressive disorders in adulthood. Method:, Data are from 1931 adult participants in the Netherlands Study of Depression and Anxiety (NESDA). Childhood life events included divorce of parents, early parental loss and ,placed in care', whereas childhood trauma was assessed as experienced emotional neglect, psychological, physical and sexual abuse prior to age 16. Results:, Childhood life events were not associated with psychopathology, except for ,placed in care' in the comorbid group. All types of childhood trauma were increasingly prevalent in the following order: controls, anxiety, depression, and comorbid group (P < 0.001). The higher the score was on the childhood trauma index, the stronger the association with psychopathology (P < 0.001). Conclusion:, Childhood trauma rather than childhood life events are related to anxiety and depressive disorders. The strong associations with the comorbid group suggest that childhood trauma contributes to the severity of psychopathology. Our study underscores the importance of heightened awareness of the possible presence of childhood trauma, especially in adult patients with comorbid anxiety and depressive disorders. [source] Congruence between social values and implicit motives: effects on life satisfaction across three culturesEUROPEAN JOURNAL OF PERSONALITY, Issue 4 2006Jan Hofer This study examines the relationship between implicit motives for intimacy-affiliation and power, explicit value orientations, and life satisfaction. The Satisfaction With Life Scale, the Schwartz Value Survey, and a bias-free TAT-type picture-story-test were administered to 319 adult participants in Cameroon, Costa Rica, and Germany. The stories were coded for motive imagery reflecting needs for intimacy-affiliation and power. Based on motives associated with the domain intimacy-affiliation, the results revealed that an alignment of implicit motives and self-attributed values is associated with an enhanced life satisfaction across cultures. In contrast, no such relationship could be found for motives and values associated with the domain of power. Copyright © 2006 John Wiley & Sons, Ltd. [source] Low Plasma Vitamin B12 Is Associated With Lower BMD: The Framingham Osteoporosis StudyJOURNAL OF BONE AND MINERAL RESEARCH, Issue 1 2005Katherine L Tucker Abstract Vitamin B12 is important to DNA synthesis and may affect bone formation. We examined the association between this vitamin and BMD in 2576 adults. Men with plasma B12 < 148 pM had significantly lower BMD at the hip, and women at the spine, relative to those with higher B12, and trends were similar for both at all sites. Low vitamin B12 may be a risk factor for low BMD. Introduction: Vitamin B12 is important to DNA synthesis and may affect bone formation. It has been linked to osteoblastic activity in clinical studies and cell culture. Materials and Methods: We examined the relationship between plasma vitamin B12 status and BMD in 2576 adult participants in the Framingham Offspring Osteoporosis Study (1996,2001). BMD was measured by DXA at the hip and spine. Plasma vitamin B12 was measured by radioassay. Mean BMD measures were estimated for four categories of vitamin B12 concentration, based on commonly used cut-offs, using analysis of covariance, adjusted for age, BMI, physical activity score for the elderly (PASE), alcohol use, smoking status, total calcium and vitamin D intake, season of bone measurement, and for women, menopause status and current estrogen use. Further adjustment for protein intake and total homocysteine concentration was also performed. Results: Both men and women with vitamin B12 concentrations <148 pM had lower average BMD than those with vitamin B12 above this cut-off. These differences were significant (p < 0.05) for men at most hip sites and for women at the spine. Significance remained after further adjustment for protein intake and plasma homocysteine. Conclusions: Vitamin B12 deficiency may be an important modifiable risk factor for osteoporosis. [source] The effects of alcohol and the salience of aggressive cues on triggered displaced aggressionAGGRESSIVE BEHAVIOR, Issue 1 2008Thomas F. Denson Abstract Alcohol increases the aggression-augmenting effects of provocation. Theories of alcohol and aggression suggest that impaired cognitive processing induced by acute intoxication leads individuals to process aggression-inducing social cues differently depending on whether they are high or low in salience. We examined the effects of intoxication and aggressive cue salience within the triggered displaced aggression paradigm. An ethnically diverse sample of 74 primarily young adult participants (40 men and 34 women; M=23.28, SD=3.14 years) were recruited from the university community and surrounding area. All participants were provoked by an experimenter, randomly assigned to a 2 (alcohol condition: alcohol vs. placebo) × 2 (trigger salience: high vs. low salience) between-subjects design, and then given the opportunity to aggress against the undeserving triggering agent. As expected, intoxication combined with a salient triggering cue elicited the most displaced aggression among all conditions. These results provide the first evidence that the effect of alcohol on triggered displaced aggression is moderated by the salience of the triggering event. Aggr. Behav. 34:25,33, 2008. © 2007 Wiley-Liss, Inc. [source] Prevalence of hepatitis B and hepatitis C virus infections in France in 2004: Social factors are important predictors after adjusting for known risk factorsJOURNAL OF MEDICAL VIROLOGY, Issue 4 2010Christine Meffre Abstract To monitor the prevalence of hepatitis B and hepatitis C a cross-sectional survey was conducted in 2004 among French metropolitan residents. A complex sampling design was used to enroll 14,416 adult participants aged 18,80 years. Data collected included demographic and social characteristics and risk factors. Sera were tested for anti-HCV, HCV-RNA, anti-HBc and HBsAg. Data were analyzed with SUDAAN® software to provide weighted estimates for the French metropolitan resident population. The overall anti-HCV prevalence was 0.84% (95% CI: 0.65,1.10). Among anti-HCV positive individuals, 57.4% (95% CI: 43.2,70.5) knew their status. Factors associated independently with positive anti-HCV were drug use (intravenous and nasal), blood transfusion before 1992, a history of tattoos, low socioeconomic status, being born in a country where anti-HCV prevalence >2.5%, and age >29 years. The overall anti-HBc prevalence was 7.3% (95%: 6.5,8.2). Independent risk factors for anti-HBc were intravenous drug use, being a man who has sex with men, low socioeconomic status, a stay in a psychiatric facility or facility for the mentally disabled, <12 years of education, being born in a country where HBsAg prevalence >2%, age >29 and male sex. The HCV RNA and HBsAg prevalence were 0.53% (95% CI: 0.40,0.70) and 0.65% (95% CI: 0.45,0.93), respectively. Among HBsAg positive individuals, 44.8% (95% CI: 22.8,69.1) knew their status. Anti-HCV prevalence was close to the 1990s estimates whereas HBsAg prevalence estimate was greater than expected. Screening of hepatitis B and C should be strengthened and should account for social vulnerability. J. Med. Virol. 82:546,555, 2010. © 2010 Wiley-Liss, Inc. [source] fMRI BOLD Response to the Eyes Task in Offspring From Multiplex Alcohol Dependence FamiliesALCOHOLISM, Issue 12 2007Shirley Y. Hill Background:, Increased susceptibility for developing alcohol dependence (AD) may be related to structural and functional differences in brain circuits that influence social cognition and more specifically, theory of mind (ToM). Alcohol dependent individuals have a greater likelihood of having deficits in social skills and greater social alienation. These characteristics may be related to inherited differences in the neuroanatomical network that comprises the social brain. Methods:, Adolescent/young adult participants from multiplex AD families and controls (n = 16) were matched for gender, age, IQ, education, and handedness and administered the Eyes Task of Baron-Cohen during functional magnetic resonance imaging (fMRI). Results:, High-risk (HR) subjects showed significantly diminished blood oxygen level dependent (BOLD) response in comparison with low-risk control young adults in the right middle temporal gyrus (RMTG) and the left inferior frontal gyrus (LIFG), areas that have previously been implicated in ToM tasks. Conclusions:, Offspring from multiplex families for AD may manifest one aspect of their genetic susceptibility by having a diminished BOLD response in brain regions associated with performance of ToM tasks. These results suggest that those at risk for developing AD may have reduced ability to empathize with others' state of mind, possibly resulting in diminished social skill. [source] Manipulation of glycemic response with isomaltulose in a milk-based drink does not affect cognitive performance in healthy adultsMOLECULAR NUTRITION & FOOD RESEARCH (FORMERLY NAHRUNG/FOOD), Issue 4 2010Louise Dye Abstract Previous research suggests that glucoregulation and nutrient interventions, which alter circulating glucose, impact cognitive function. To examine the effect of modulating glycemic response using isomaltulose on cognitive function 24 healthy male adult participants consumed energy and macronutrient-matched milk-based drinks containing 50,g isomaltulose, 50,g sucrose or a water control in a counterbalanced within-subject design. Interstitial glucose was measured continuously in 12 subjects and all provided 9 capillary measures on each test day. A 30-min cognitive test battery was administered before and twice (+35 and +115,min) after drink ingestion. Immediate, delayed, recognition, verbal and working memory, and psychomotor performance were assessed. Glycemic profiles induced by the drinks differed significantly during the first but not the second post-drink test battery. Neither administration of the sucrose nor isomaltulose drinks produced consistent effects on verbal or working memory, or psychomotor performance. This study used isomaltulose as an investigative tool to lower glycemic response. Importantly, it demonstrates a lack of effect of modulating glucose on cognitive performance based on reliable, continuously measured glycemia. It refutes the hypothesis that glycemia is associated with cognitive performance and questions the suggestion that isomaltulose has an effect on cognitive performance. [source] 35 Electrogastrography in healthy participants: comparison of children and adultsNEUROGASTROENTEROLOGY & MOTILITY, Issue 6 2006CA FRIESEN The current study examined whether electrogastrogram (EGG) patterns differ between children/adolescents and adults, including whether EGG recordings obtained from healthy children would be considered normal by standards established for adults. Twenty-eight healthy children (54% females; ages 8,17, M = 12.4 years) were evaluated and compared to 15 healthy adults. EGGs were recorded for 30 min in the fasting state and for 1 h following a standard meal. For both pediatric and adult participants, there was a significant increase in both the dominant frequency and the dominant power from the pre- to the post , prandial period (p < 0.001 for each). There was a significant post-prandial increase in the %normal slow waves in pediatric participants only (81.5 vs. 89.0% vs. p < 0.001). Children demonstrated a significantly lower mean fasting %normal slow waves (81.5% vs. 94.2%) and a significantly greater fasting % tachygastria (8.9% vs. 2.3%) than did adults. Other parameters did not differ. Using adult standards, the %normal slow waves were ,70% of recording time in 96% children in the fasting state and in 100% in the postprandial period. A postprandial power increase was seen in 89% of the children. In conclusion, while adults should not be used as controls in pediatric studies of EGG, our data would indicate that American Motility Society (AMS) consensus adult criteria for a normal EGG are appropriate to apply to children and adolescents when utilizing methodology and meal challenge similar to that used to establish the adult norms. [source] Prevalence and time trends in obesity among adult West African populations: a meta-analysisOBESITY REVIEWS, Issue 4 2008A. R. Abubakari Summary The objective of this study was to determine the distribution of and trends in obesity in adult West African populations. Between February and March 2007, a comprehensive literature search was conducted using four electronic databases. Journal hand searches, citations and bibliographic snowballing of relevant articles were also undertaken. To be included, studies had to be population-based, use well-defined criteria for measuring obesity, present data that allowed calculation of the prevalence of obesity and sample adult participants. Studies retrieved were critically appraised. Meta-analysis was performed using the DerSimonian-Laird random effect model. Twenty-eight studies were included. Thirteen studies were conducted in urban settings, 13 in mixed urban/rural and one in rural setting. Mean body mass index ranged from 20.1 to 27.0 kg2. Prevalence of obesity in West Africa was estimated at 10.0% (95% CI, 6.0,15.0). Women were more likely to be obese than men, odds ratios 3.16 (95% CI, 2.51,3.98) and 4.79 (95% CI, 3.30,6.95) in urban and rural areas respectively. Urban residents were more likely to be obese than rural residents, odds ratio 2.70 (95% CI, 1.76,4.15). Time trend analyses indicated that prevalence of obesity in urban West Africa more than doubled (114%) over 15 years, accounted for almost entirely in women. Urban residents and women have particularly high risk of overweight/obesity and obesity is rising fast in women. Policymakers, politicians and health promotion experts must urgently help communities control the spread of obesity in West Africa. [source] Obstacles to organ donation in ethnic minoritiesPEDIATRIC TRANSPLANTATION, Issue 6 2001C. O. Callender While the numbers of ethnic minority donors have increased over the last 20 yr, there is still a need for community outreach and education in order to dispel the myths and misperceptions within minority communities so that a greater number of persons will ultimately become donors. While lack of awareness, religious myths and misperceptions, medical distrust, fear of premature death, and racism continue to cause reluctance within ethnic minority communities, the National Minority Organ Tissue Transplant Education Program (National MOTTEP) applies a methodology which has proven successful within various ethnic minority populations. The methodology utilizes ethnically similar and culturally sensitive transplant recipients, candidates and donors or donor families, along with health care providers, as effective messengers who are recognized within the community. In addition, community volunteers are solicited to become involved in hands-on program planning and implementation of activities, which will impact the community regarding their knowledge, attitudes and behaviors. Data collected from 914 consenting adult participants indicated that there were significant increases (p < 0.000) in trust in doctors, future plans to become organ donors, and changes in the participants' spiritual/religious beliefs about organ/tissue donation. The conclusion is that culturally appropriate health education programs targeting ethnic minority populations can effect positive change in knowledge, attitudes, and behavior. [source] Auditory function and hearing loss in children and adults with Williams syndrome: Cochlear impairment in individuals with otherwise normal hearing,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 2 2010Jeffrey A. Marler Abstract Hearing loss is common in school-age individuals with Williams syndrome (WS) and extensive in adults. Prior studies with relatively small sample sizes suggest that hearing loss in WS has an early onset and may be progressive, yet the auditory phenotype and the scope of the hearing loss have not been adequately characterized. We used standard audiometric tools: Otoscopy, tympanometry, air-conduction (bone conduction when available) behavioral testing, and distortion product otoacoustic emissions (DPOAEs) to measure hearing sensitivity and outer hair cell function. We tested 81 individuals with WS aged 5.33,59.50 years. Sixty-three percent of the school-age and 92% of the adult participants had mild to moderately-severe hearing loss. The hearing loss in at least 50% was sensorineural. DPOAE testing corroborated behavioral results. Strikingly, 12 of 14 participants with hearing within normal limits bilaterally had 4,000-Hz DPOAE input/output (DPOAE IO) functions indicative of outer hair cell damage and impaired cochlear compression. Our results indicate that hearing loss is very common in WS. Furthermore, individuals with WS who have "normal" hearing as defined by behavioral thresholds may actually have sub-clinical impairments or undetected cochlear pathology. Our findings suggest outer hair cell dysfunction in otherwise normal hearing individuals. The DPOAE IO in this same group revealed growth functions typically seen in groups with noise-induced damage. Given this pattern of findings, individuals with WS may be at increased risk of noise-induced hearing loss. Recommendations regarding audiological testing for individuals with WS and accommodations for these individuals in both academic and nonacademic settings are provided. © 2010 Wiley-Liss, Inc. [source] The Variety of Ecstasy/MDMA Users: Results from the National Epidemiologic Survey on Alcohol and Related ConditionsTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 6 2009Li-Tzy Wu ScD This study investigates the potential heterogeneity of ecstasy or MDMA (3,4-methylenedioxy-N-methylamphetamine) users. Data came from the 2001,2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Latent class analysis (LCA) and multinomial logistic regression procedures were used to identify subtypes of ecstasy users. Approximately 1.6% (n = 562) of adult participants (N = 43,093) reported lifetime ecstasy use. LCA identified three subtypes of ecstasy users. Class 1 exhibited pervasive use ofmost drug classes (ecstasy-polydrug users, 37%). Class 2 reported a high rate of use of marijuana and cocaine and a moderate use of amphetamines (ecstasy-marijuana-stimulant users, 29%). Class 3 was characterized by a high rate of use of marijuana and a low use ofprimarily prescription-type drugs (ecstasy-marijuana users, 34%). Subtypes were distinguished by family income, history ofsubstance abuse treatment, and familial substance abuse. Class 1 exhibited the highest prevalence of disorders related to the use of marijuana (77%), tobacco (66%), amphetamines (36%), opioids (35%), sedatives (31%), and tranquilizers (30%). The recent resurgence in ecstasy use among adults underscores the need to monitor trends in its use. [source] Incidental Findings in Pediatric ResearchTHE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 2 2008Benjamin S. Wilfond The approach to incidental research fndings in children emerges by considering the child-parent relationship and balancing divergent interests and preferences. Incidental fndings with clear and proximate clinical importance should be disclosed to both. We recommend that particularly sensitive or private information (e.g., pregnancy or drug use) should be disclosed to the adolescent frst, while particularly serious information (e.g., cancer) should frst be disclosed to the parent. These approaches allow the researcher to form an alliance with one party prior to engaging the other. However, unlike clinical settings, where there may be presumptive expectations of confdentiality about sharing information within the family, in most research settings it is reasonable to plan to disclose such information to both parties. It is important to communicate this plan during the informed consent process separately to adolescents to avoid enrolling adolescents when sensitive incidental fndings such as pregnancy and drug use may be detected. The approach to incidental fndings without clear and proximate beneft is challenging. Researchers should plan more limited disclosure of such incidental fndings for pediatric participants than for adult participants. [source] ORIGINAL RESEARCH,INTERSEX AND GENDER IDENTITY DISORDERS: Gender Assignment and Medical History of Individuals with Different Forms of Intersexuality: Evaluation of Medical Records and the Patients' PerspectiveTHE JOURNAL OF SEXUAL MEDICINE, Issue 4i 2007Lisa Brinkmann PhD ABSTRACT Introduction., Until now, there are only few studies that focus on the specific treatment experiences of people with intersexuality and evaluate their outcome in terms of psychological, physical, and social well-being. Further, the presentation of the patients' perspective is often neglected in research. Aim., Overview of preliminary results of the Hamburg-Intersex-Study on gender assignment and medical history of adult subjects with intersexuality (disorders of sex development), as well as the patients retrospectively stated thoughts and feelings regarding these interventions. Main Outcome Measures., Medical records from participants of the study were analyzed. The subjective attitudes and evaluation of the treatment measures were assessed with a self-constructed questionnaire. Data on psychological well-being were measured with the Brief Symptom Inventory. Methods., In total, 37 adult participants (mean age 30.6 years) with following diagnosis were included: congenital adrenal hyperplasia, complete and partial androgen insensitivity syndrome, gonadal dysgenesis and disturbances of the androgen biosynthesis, such as 5 alpha reductase deficiency and 17 beta hydroxysteroid deficiency. Results., The majority of participants had (often multiple) genital surgery to correct the appearance of their genitalia and/or to enable sexual functioning. The diagnostic groups differ not only in amount and invasiveness of experienced surgical and medical treatment but also in the subjective and retrospective evaluation of the treatment measures and in the amount of reported psychological distress. Conclusion., Many subjects stated to have experienced the medical procedures and care very negatively, whereby the aspects of secrecy, untruthfulness, and concealment were stated as most difficult and burdening. Brinkmann L, Schuetzmann K, and Richter-Appelt H. Gender assignment and medical history of individuals with different forms of intersexuality: Evaluation of medical records and the patients' perspective. J Sex Med 2007;4:964,980. [source] Formation and use of covariation assessments in the real worldAPPLIED COGNITIVE PSYCHOLOGY, Issue 1 2002Elliot J. Coups In this study we examined covariation assessments made using real-world information held by individual participants about an important preventive health behaviour: receiving an influenza vaccine (,flu shot'). Four hundred and seventy-seven healthy adult participants completed a questionnaire, indicating both their personal experience and vicarious experience (knowledge of other people's experiences) with the flu shot and the flu. Additionally, participants provided a covariation assessment by indicating how effective they thought the flu shot is in preventing the flu. We examined whether the experience information was related to the covariation assessment, and whether it in turn was related to the decision to receive a flu shot. Our results indicated that people use a simple intuitive strategy to combine their personal experience information. For vicarious experience information, we found evidence for use of a normative strategy, as well as simpler intuitive strategies. Consistent with our hypothesis, both types of experience information were associated with the effectiveness judgement, which was subsequently related to the decision to obtain a flu shot. Practical applications of these findings are discussed. Copyright © 2002 John Wiley & Sons, Ltd. [source] Transfer appropriate processing for prospective memory testsAPPLIED COGNITIVE PSYCHOLOGY, Issue 7 2000Beat Meier Transfer appropriate processing (TAP) is the assumption that retrospective memory test performance reflects the overlap between study and test phase processing. In a task analysis, we identify a similar sequential-type of processing overlap in prospective memory (ProM) situations. In addition, ProM test performance can also involve a concurrent overlap between processes engaged for an ongoing task and those required for recognizing relevant cues. A review of the ProM literature shows consistent TAP effects due to sequential processing overlap manipulations, but inconclusive findings for concurrent processing overlap manipulations. We examined the latter in a new experiment with young adult participants. The ongoing task required either semantic or perceptual processing of words, and the ProM task required either semantic or perceptual processing of words. Consistent with TAP, performance was higher when the ongoing task and the ProM task required the same kind of processing (i.e. semantic,semantic, perceptual,perceptual) rather than different kinds of processing (i.e. semantic,perceptual, perceptual,semantic). Copyright © 2000 John Wiley & Sons, Ltd. [source] Effect of obesity on airway inflammation: a cross-sectional analysis of body mass index and sputum cell countsCLINICAL & EXPERIMENTAL ALLERGY, Issue 7 2007D. C. Todd Summary Background Several observational studies have demonstrated an association between obesity and asthma. Studies evaluating exhaled nitric oxide levels and obesity have revealed that a higher body mass index (BMI) is associated with elevated exhaled nitric oxide levels. Airway inflammation using sputum cell counts has not been assessed in obese patients with airway diseases. Objective The primary aim of this study was to determine whether obesity (based on BMI) is associated with eosinophilic or neutrophilic bronchitis. Methods The results from a database of induced sputum cell counts were compared with BMI and analysed using correlation statistics, regression and parametric and non-parametric analysis. Results Seven-hundred and twenty-seven adult participants with an equal number of sputum samples were included in the analysis. BMI varied from 14.5 to 55 kg/m2. Sputum total cell count (mean±SD: 12.9 × 106 cell/g±21.5), eosinophil percent (median; min to max: 0.3%; 0,89.0), and neutrophil percent (mean±SD: 63.5±26.6%) were within normal limits. Participants with asthma had a higher percentage of sputum eosinophils than those without asthma (P=0.01). However, there was no difference in the total or differential cell counts among the obese and non-obese participants, when the data were analysed according to BMI category, gender, dose of inhaled corticosteroid, and presence or absence of asthma. Conclusion In this large sample of adult asthmatic and non-asthmatic participants, there was no association between BMI and airway inflammation measured by sputum cell counts. Other mechanisms to explain the relationship between obesity and asthma will need to be explored if this association is to be better understood. [source] | |||||||||||||||||||||||||