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Norman, Å., Zeebari, Z., Nyberg, G. & Elinder, L. S. (2019). Parental support in promoting children's health behaviours and preventing overweight and obesity - a long-term follow-up of the cluster-randomised healthy school start study II trial.. BMC Pediatrics, 19(1), Article ID 104.
Open this publication in new window or tab >>Parental support in promoting children's health behaviours and preventing overweight and obesity - a long-term follow-up of the cluster-randomised healthy school start study II trial.
2019 (English)In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 19, no 1, article id 104Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Effects of obesity prevention interventions in early childhood are only meaningful if they are sustained over time, but long-term follow-up studies are rare. The school-based cluster-randomised Healthy School Start (HSS) trial aimed at child health promotion and obesity prevention through parental support was carried out in 31 pre-school classes (378 families) in disadvantaged areas in Sweden during 2012-2013. Post-intervention results showed intervention effects on intake of unhealthy foods and drinks, and lower BMI-sds in children with obesity at baseline. This study aimed to evaluate the long-term effectiveness 4 years post-intervention.

METHODS: Data were collected from 215 children in March-June 2017. Child dietary intake, screen time, and physical activity were measured through parental-proxy questionnaires. Child height and weight were measured by the research group. Group effects were examined using Poisson, linear, logistic, and quantile regression for data on different levels. Analyses were done by intention to treat, per protocol, and sensitivity analyses using multiple imputation.

RESULTS: No between-group effects on dietary intake, screen time, physical activity, or BMI-sds were found for the entire group at the four-year follow-up. In girls, a significant subgroup-effect was found favouring intervention compared to controls with a lower intake of unhealthy foods, but this was not sustained in the sensitivity analysis. In boys, a significant sub-group effect was found where the boys in the intervention group beyond the 95th percentile had significantly higher BMI-sds compared to boys in the control group. This effect was sustained in the sensitivity analysis. Analyses per protocol showed significant intervention effects regarding a lower intake of unhealthy foods and drinks in the children with a high intervention dose compared to controls.

CONCLUSIONS: Four years after the intervention, only sub-group effects were found, and it is unlikely that the HSS intervention had clinically meaningful effects on the children. These results suggest that school-based prevention programmes need to be extended for greater long-term effectiveness by e.g. integration into school routine practice. In addition, results showed that children with a high intervention dose had better long-term outcomes compared to controls, which emphasises the need for further work to increase family engagement in interventions.

TRIAL REGISTRATION: ISRCTN, ISRCTN39690370, retrospectively registered March 1, 2013, http://www.isrctn.com/ISRCTN39690370 .

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
BMI-sds, Diet, Intervention, Motivational interviewing, Physical activity, Quantile regression, School, Screen time, Sedentary behaviour, Socio-economic position
National Category
Pediatrics
Identifiers
urn:nbn:se:hj:diva-43573 (URN)10.1186/s12887-019-1467-x (DOI)000464863900001 ()30975106 (PubMedID)2-s2.0-85064209327 (Scopus ID)GOA JIBS 2019 (Local ID)GOA JIBS 2019 (Archive number)GOA JIBS 2019 (OAI)
Available from: 2019-05-07 Created: 2019-05-07 Last updated: 2019-05-07Bibliographically approved
Hallgren, M., Lundin, A., Zeebari, Z. & Rehm, J. (2018). Collectivity of drinking or collective thinking?: Policy implications of polarised alcohol consumption trends [Letter to the editor]. Drug and Alcohol Review, 37, S470-S471
Open this publication in new window or tab >>Collectivity of drinking or collective thinking?: Policy implications of polarised alcohol consumption trends
2018 (English)In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 37, p. S470-S471Article in journal, Letter (Other (popular science, discussion, etc.)) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Substance Abuse
Identifiers
urn:nbn:se:hj:diva-39959 (URN)10.1111/dar.12621 (DOI)000431986800059 ()29105182 (PubMedID)2-s2.0-85032908137 (Scopus ID)
Available from: 2018-06-07 Created: 2018-06-07 Last updated: 2018-06-07Bibliographically approved
Elinder, L. S., Sundblom, E., Zeebari, Z. & Bergström, H. (2018). Effect and process evaluation of a structural health intervention in community residences for adults with intellectual disabilities. Journal of Policy and Practice in Intellectual Disabilities, 15(4), 319-328
Open this publication in new window or tab >>Effect and process evaluation of a structural health intervention in community residences for adults with intellectual disabilities
2018 (English)In: Journal of Policy and Practice in Intellectual Disabilities, ISSN 1741-1122, E-ISSN 1741-1130, Vol. 15, no 4, p. 319-328Article in journal (Refereed) Published
Abstract [en]

Interventions to improve health among adults with intellectual disabilities (ID) living in community residences are needed as unhealthy behaviors, obesity, and chronic diseases are more common in this group than in the general population. This study evaluated effectiveness of a structural health intervention, a study circle for paid carers aiming to improve health promotion work routines for residents, and explored barriers and facilitators in the implementation process. A quasi-experimental design was used. Eight municipalities with 84 community residences agreed to participate with 70 of these completing the study. A 26-item questionnaire was used regarding staff work routines in three domains (general health promotion, food and meals, physical activity) and a total score to evaluate effectiveness. An inductive qualitative method was used to explore barriers and facilitators in the implementation process. The intervention group (n = 42 residences) improved their health promoting work routines significantly more than the comparison group (n = 28 residences) in the domains of general health promotion (p =.05), physical activity (p =.02), and for the total score (p =.002), but no significant change was found in the food and meal domain (p =.11). Regarding barriers and facilitators in the implementation process, a “Need for a supportive structure and key persons with a mandate to act,” was identified as an overarching theme. Barriers and facilitators were identified within four categories: (1) characteristics of the study circle, (2) staff capacity, (3) organizational capacity, and (4) external support. This study provides evidence that a structural intervention targeting staff in community residences for people with ID can improve health promoting work routines and that the results might be generalizable. If disseminated on a wider scale, this intervention has the potential of improving health and preventing obesity and other chronic diseases in adults with ID. 

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
developmental disability, diet, implementation, physical activity
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hj:diva-42601 (URN)10.1111/jppi.12262 (DOI)000453739400006 ()2-s2.0-85056628331 (Scopus ID)
Funder
Stockholm County Council, HSN 0802-0339
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-01-11Bibliographically approved
Hallgren, M., Owen, N., Stubbs, B., Zeebari, Z., Vancampfort, D., Schuch, F., . . . Trolle Lagerros, Y. (2018). Passive and mentally-active sedentary behaviors and incident major depressive disorder: A 13-year cohort study. Journal of Affective Disorders, 241, 579-585
Open this publication in new window or tab >>Passive and mentally-active sedentary behaviors and incident major depressive disorder: A 13-year cohort study
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2018 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 241, p. 579-585Article in journal (Refereed) Published
Abstract [en]

Background: Regular physical activity reduces the risk of depression onset and is an effective treatment for mood disorders. Recent studies have reported that sedentary behavior (SB) increases the risk of depression in adults, but relationships of different types of SBs with depression have not been examined systematically. We explored longitudinal relationships of passive (e.g. watching TV) and mentally-active (e.g. office-work) SBs with incident major depressive disorder (MDD).

Methods: Self-report questionnaires were completed by 40,569 Swedish adults in 1997; responses were linked to clinician-diagnosed MDD obtained from medical registers until 2010. Relationships between passive, mentally-active and total SBs with incident MDD were explored using survival analysis with Cox proportional hazards regression. Models controlled for leisure time moderate-vigorous physical activity and occupational physical activity. Moderating effects of gender were examined.

Results: In fully-adjusted models, including only non-depressed adults at baseline, those reporting ≥ 3 h of mentally-active SBs on a typical day (versus < 3 h) had significant lower hazards of incident MDD at follow-up (HR = 0.74, 95% CI = 0.58–0.94, p = 0.018). There was a non-significant positive relationship of passive SBs with incident MDD (HR = 1.20, 95% CI = 0.96–1.52, p = 0.106). The association between total SBs (passive and mentally-active combined) was not significant (HR = 0.91, 95% CI = 0.75–1.10, p = 0.36). Gender did not moderate these associations.

Limitations: Physical activity and SBs were self-reported.

Conclusion: Mentally-active SBs may have beneficial effects on adults’ mental well-being. These effects are largely independent of habitual physical activity levels. 

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Depression, Mentally-active, Passive, Physical activity, Sedentary behavior, Sitting, adult, Article, cohort analysis, female, follow up, human, incidence, major clinical study, major depression, male, middle aged, office worker, priority journal, questionnaire, risk assessment, sedentary lifestyle, self report, television viewing
National Category
Psychiatry
Identifiers
urn:nbn:se:hj:diva-42602 (URN)10.1016/j.jad.2018.08.020 (DOI)000443816800076 ()30170310 (PubMedID)2-s2.0-85052326517 (Scopus ID)IHHÖvrigtIS (Local ID)IHHÖvrigtIS (Archive number)IHHÖvrigtIS (OAI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, DELG-2016/0028
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-01-11Bibliographically approved
Winters, M., Jalloh, M. F., Sengeh, P., Jalloh, M. B., Conteh, L., Bunnell, R., . . . Nordenstedt, H. (2018). Risk communication and Ebola-Specific knowledge and behavior during 2014-2015 outbreak, Sierra Leone. Emerging Infectious Diseases, 24(2), 336-344
Open this publication in new window or tab >>Risk communication and Ebola-Specific knowledge and behavior during 2014-2015 outbreak, Sierra Leone
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2018 (English)In: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 24, no 2, p. 336-344Article in journal (Refereed) Published
Abstract [en]

We assessed the effect of information sources on Ebola-specific knowledge and behavior during the 2014-2015 Ebola virus disease outbreak in Sierra Leone. We pooled data from 4 population-based knowledge, attitude, and practice surveys (August, October, and December 2014 and July 2015), with a total of 10,604 respondents. We created composite variables for exposures (information sources: electronic, print, new media, government, community) and outcomes (knowledge and misconceptions, protective and risk behavior) and tested associations by using logistic regression within multilevel modeling. Exposure to information sources was associated with higher knowledge and protective behaviors. However, apart from print media, exposure to information sources was also linked to misconceptions and risk behavior, but with weaker associations observed. Knowledge and protective behavior were associated with the outbreak level, most strongly after the peak, whereas risk behavior was seen at all levels of the outbreak. In future outbreaks, close attention should be paid to dissemination of information.

Place, publisher, year, edition, pages
Centers for Disease Control and Prevention (CDC), 2018
National Category
Immunology in the medical area
Identifiers
urn:nbn:se:hj:diva-39961 (URN)10.3201/eid2402.171028 (DOI)000423966800018 ()29350151 (PubMedID)2-s2.0-85040917308 (Scopus ID)
Available from: 2018-06-07 Created: 2018-06-07 Last updated: 2018-06-07Bibliographically approved
Zeebari, Z., Kibria, B. M. & Shukur, G. (2018). Seemingly unrelated regressions with covariance matrix of cross-equation ridge regression residuals. Communications in Statistics - Theory and Methods, 47(20), 5029-5053
Open this publication in new window or tab >>Seemingly unrelated regressions with covariance matrix of cross-equation ridge regression residuals
2018 (English)In: Communications in Statistics - Theory and Methods, ISSN 0361-0926, E-ISSN 1532-415X, Vol. 47, no 20, p. 5029-5053Article in journal (Refereed) Published
Abstract [en]

Generalized least squares estimation of a system of seemingly unrelated regressions is usually a two-stage method: (1) estimation of cross-equation covariance matrix from ordinary least squares residuals for transforming data, and (2) application of least squares on transformed data. In presence of multicollinearity problem, conventionally ridge regression is applied at stage 2. We investigate the usage of ridge residuals at stage 1, and show analytically that the covariance matrix based on the least squares residuals does not always result in more efficient estimator. A simulation study and an application to a system of firms' gross investment support our finding.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Multicollinearity, Ridge regression, Seemingly unrelated regressions
National Category
Probability Theory and Statistics
Identifiers
urn:nbn:se:hj:diva-37275 (URN)10.1080/03610926.2017.1383431 (DOI)000440044100008 ()2-s2.0-85033673015 (Scopus ID)IHHÖvrigtIS (Local ID)IHHÖvrigtIS (Archive number)IHHÖvrigtIS (OAI)
Available from: 2017-09-13 Created: 2017-09-13 Last updated: 2019-01-03Bibliographically approved
Sörberg Wallin, A., Zeebari, Z., Lager, A., Gunnell, D., Allebeck, P. & Falkstedt, D. (2018). Suicide attempt predicted by academic performance and childhood IQ: a cohort study of 26 000 children. Acta Psychiatrica Scandinavica, 137(4), 277-286
Open this publication in new window or tab >>Suicide attempt predicted by academic performance and childhood IQ: a cohort study of 26 000 children
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2018 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 137, no 4, p. 277-286Article in journal (Refereed) Published
Abstract [en]

Objective: Academic performance in youth, measured by grade point average (GPA), predicts suicide attempt, but the mechanisms are not known. It has been suggested that general intelligence might underlie the association.

Methods: We followed 26 315 Swedish girls and boys in population-representative cohorts, up to maximum 46 years of age, for the first suicide attempt in hospital records. Associations between GPA at age 16, IQ measured in school at age 13 and suicide attempt were investigated in Cox regressions and mediation analyses.

Results: There was a clear graded association between lower GPA and subsequent suicide attempt. With control for potential confounders, those in the lowest GPA quartile had a near five-fold risk (HR 4.9, 95% CI 3.7–6.7) compared to those in the highest quartile. In a mediation analysis, the association between GPA and suicide attempt was robust, while the association between IQ and suicide attempt was fully mediated by GPA.

Conclusions: Poor academic performance in compulsory school, at age 16, was a robust predictor of suicide attempt past young adulthood and seemed to account for the association between lower childhood IQ and suicide attempt. 

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
educational status, intelligence, self-injurious behaviour, suicide attempted
National Category
Psychiatry
Identifiers
urn:nbn:se:hj:diva-39960 (URN)10.1111/acps.12817 (DOI)000427001000002 ()29114860 (PubMedID)2-s2.0-85033219379 (Scopus ID)
Available from: 2018-06-07 Created: 2018-06-07 Last updated: 2018-06-07Bibliographically approved
Zeebari, Z., Lundin, A., Dickman, P. W. & Hallgren, M. (2017). Are changes in alcohol consumption among swedish youth really occurring 'in concert'?: A new perspective using quantile regression. Alcohol and Alcoholism, 52(4), 487-495
Open this publication in new window or tab >>Are changes in alcohol consumption among swedish youth really occurring 'in concert'?: A new perspective using quantile regression
2017 (English)In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 52, no 4, p. 487-495Article in journal (Refereed) Published
Abstract [en]

Aims: Recent studies of youth alcohol consumption indicate a collective downward drinking trend at all levels of consumption, i.e. reductions occurring 'in concert'. We re-examine the collectivity of drinking theory by applying quantile regression methods to the analysis and interpretation of Swedish youth alcohol consumption.

Method: Changes in youth alcohol consumption between 2000 and 2014 were assessed using a school-based survey conducted in Stockholm (n = 86,402). Participants were Swedish youth aged 15-18 years. The rate of change in consumption was examined using quantile regression, and compared to Ordinary Least Squares modelling. The hypothesis of parallelism or 'in concert' changes in consumption was assessed using the test of the equality of linear regression slopes corresponding to different quantiles of log consumption.

Results: In both models, changes in consumption over time did not occur in parallel, contrary to the collectivity of drinking theory. Instead, a clear divergence in the rate of drinking was observed, with most adolescent quantiles reducing consumption, while heavy consuming remained stable.

Conclusions: Contrary to previous studies, our findings do not support a collectivity of drinking behaviour among Swedish youth. Quantile regression is a robust and appropriate method for analysing temporal changes in alcohol consumption data.

Place, publisher, year, edition, pages
Oxford University Press, 2017
Keywords
adolescent, adult, alcohol consumption, Article, drinking behavior, female, human, human experiment, juvenile, least square analysis, linear regression analysis, male, priority journal, regression analysis, Swedish citizen, adolescent behavior, comparative study, epidemiology, psychological theory, Sweden, trends, underage drinking, Humans, Least-Squares Analysis
National Category
Substance Abuse
Identifiers
urn:nbn:se:hj:diva-39963 (URN)10.1093/alcalc/agx020 (DOI)000404607500013 ()28379324 (PubMedID)2-s2.0-85021724048 (Scopus ID)
Available from: 2018-06-07 Created: 2018-06-07 Last updated: 2018-06-07Bibliographically approved
Rahman, M. S., Millischer, V., Zeebari, Z., Forsell, Y. & Lavebratt, C. (2017). BDNF Val66Met and childhood adversity on response to physical exercise and internet-based cognitive behavioural therapy in depressed Swedish adults. Journal of Psychiatric Research, 93, 50-58
Open this publication in new window or tab >>BDNF Val66Met and childhood adversity on response to physical exercise and internet-based cognitive behavioural therapy in depressed Swedish adults
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2017 (English)In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 93, p. 50-58Article in journal (Refereed) Published
Abstract [en]

The genetic effect of Brain-derived neurotrophic factor (BDNF) on treatment response in depression is not consistent in the literature. Childhood adversity is a known risk factor for depression which has been reported to increase depression susceptibility by interacting with BDNF genetic variation. We aimed to explore whether the BDNF variation Val66Met and childhood adversity (CA) predicted the treatment response to a 12-week intervention with physical exercise (PE) or internet-based cognitive behavioural therapy (ICBT) when compared with treatment as usual (TAU). A prospective cohort study nested within a randomised control trial was conducted using data from 547 participants with mild to moderate depression. Depression severity at baseline and follow-up was measured using the Montgomery-Åsberg Depression Rating Scale. Met allele carriers without exposure to CA and current antidepressant use showed higher treatment response to PE than Val homozygotes. There was no evidence to support that BDNF Val66Met or CA alone predicted treatment response to PE and ICBT. The Met carriers had higher serum mature BDNF level. These data suggest that Met allele carriers benefit more from PE treatment but only if they are not exposed to early adversity. 

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Childhood adversity, Cognitive therapy, Depression, Exercise, Gene-environment interactions, Neurotrophic factor, antidepressant agent, brain derived neurotrophic factor, methionine, valine, adult, allele, Article, childhood disease, cognitive behavioral therapy, cohort analysis, comparative study, controlled study, disease severity, female, follow up, genotype, homozygote, human, Internet, major clinical study, male, Montgomery Asberg Depression Rating Scale, outcome assessment, priority journal, prospective study, randomized controlled trial, Swedish citizen, treatment response, adolescent, child abuse, epidemiology, genetic polymorphism, genetics, metabolism, middle aged, nonparametric test, physiology, procedures, psychology, statistical model, Sweden, Brain-Derived Neurotrophic Factor, Cohort Studies, Humans, Logistic Models, Polymorphism, Genetic, Statistics, Nonparametric
National Category
Psychiatry
Identifiers
urn:nbn:se:hj:diva-39962 (URN)10.1016/j.jpsychires.2017.05.007 (DOI)000404708900006 ()28578208 (PubMedID)2-s2.0-85020001135 (Scopus ID)
Available from: 2018-06-07 Created: 2018-06-07 Last updated: 2018-06-07Bibliographically approved
Nyberg, G., Norman, Å., Sundblom, E., Zeebari, Z. & Elinder, L. S. (2016). Effectiveness of a universal parental support programme to promote health behaviours and prevent overweight and obesity in 6-year-old children in disadvantaged areas, the Healthy School Start Study II, a cluster-randomised controlled trial. International Journal of Behavioral Nutrition and Physical Activity, 13(1), Article ID 4.
Open this publication in new window or tab >>Effectiveness of a universal parental support programme to promote health behaviours and prevent overweight and obesity in 6-year-old children in disadvantaged areas, the Healthy School Start Study II, a cluster-randomised controlled trial
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2016 (English)In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 13, no 1, article id 4Article in journal (Refereed) Published
Abstract [en]

Background: There is increasing evidence for the effectiveness of parental support programmes to promote healthy behaviours and prevent obesity in children, but only few studies have been conducted among groups with low socio-economic status. The aim of this study was to develop and evaluate the effectiveness of a parental support programme to promote healthy dietary and physical activity habits and to prevent overweight and obesity in six-year-old children in disadvantaged areas.

Methods: A cluster-randomised controlled trial was carried out in disadvantaged areas in Stockholm. Participants were six-year-old children (n = 378) and their parents. Thirty-one school classes from 13 schools were randomly assigned to intervention (n = 16) and control groups (n = 15). The intervention lasted for 6 months and included: 1) Health information for parents, 2) Motivational Interviewing with parents and 3) Teacher-led classroom activities with children. Physical activity was measured by accelerometry, dietary intake and screen time with a questionnaire, body weight and height were measured and BMI standard deviation score was calculated. Measurements were conducted at baseline, post-intervention and at 5months follow-up. Group effects were examined using Mixed-effect Regression analyses adjusted for sex, parental education and baseline values.

Results: Fidelity to all three intervention components was satisfactory. Significant intervention effects were found regarding consumption of unhealthy foods (p = 0.01) and unhealthy drinks (p = 0.01). At follow-up, the effect on intake of unhealthy foods was sustained for boys (p = 0.03). There was no intervention effect on physical activity. Further, the intervention had no apparent effect on BMI sds for the whole sample, but a significant difference between groups was detected among children who were obese at baseline (p = 0.03) which was not sustained at follow-up.

Conclusions: The Healthy School Start study shows that it is possible to influence intake of unhealthy foods and drinks and weight development in obese children by providing individual parental support in a school context. However, the effects were short-lived. Therefore, the programme needs to be prolonged and/or intensified in order to obtain stronger and sustainable effects. This study is an important contribution to the further development of evidence-based parental support programmes to prevent overweight and obesity in children in disadvantaged areas.

Place, publisher, year, edition, pages
BioMed Central, 2016
Keywords
Accelerometer, BMI, Diet, Intervention, Motivational interviewing, Parental education, Physical activity, Pre-school class, Sedentary behaviour, Socio-economic status, accelerometry, Article, behavior assessment, body height, body mass, body weight, child, clinical article, clinical effectiveness, controlled study, dietary intake, disease control, female, follow up, health behavior, health education, health program, health promotion, human, male, measurement, medical information, obesity, outcome assessment, parental support program, preschool child, randomized controlled trial, social status, controlled clinical trial, exercise, Overweight, parent, Pediatric Obesity, poverty, procedures, questionnaire, school, school health service, Sweden, treatment outcome, vulnerable population, Humans, Parents, School Health Services, Schools, Surveys and Questionnaires, Vulnerable Populations
National Category
Physiology
Identifiers
urn:nbn:se:hj:diva-39966 (URN)10.1186/s12966-016-0327-4 (DOI)000368976700001 ()26795378 (PubMedID)2-s2.0-84955478230 (Scopus ID)
Available from: 2018-06-07 Created: 2018-06-07 Last updated: 2018-06-07Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-2733-4441

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