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Preventive health services and lifestyle practices in cancer survivors: a population health investigation

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Abstract

Introduction

Long term health in cancer survivors require both preventive health services and certain health behavior practices in order to prevent the major chronic diseases that can occur for any adult in the general population. Despite this we currently do not know the pattern of clinical preventive services and health behaviors of cancer survivors in the US population. The present study examines the patterns of preventive health activities in two domains: clinical preventive services and healthy lifestyle practices in a heterogeneous population of cancer survivors.

Methods

Longitudinal analyses of Medical Expenditure Panel Survey (MEPS) data, a nationally representative health survey, for the calendar years 2000 through 2004 were conducted. Cancer survivors were defined as individuals diagnosed with cancer in the baseline year and alive in the subsequent year. To address both provider based and behavioral health activities, two categories of care were included: clinical preventive services consisting of influenza immunization, routine physical examination, and a dental check up within the last year using the follow-up year data and healthy lifestyle practices including engaging in moderate/vigorous exercise three times per week, maintaining a body mass index (BMI) within normal range, and not currently smoking. Chi-square tests and Poisson regressions were performed to identify factors that were associated with these preventive health activities.

Results

Unadjusted rates of preventive health activities were as follows: 78% had a routine physical check up, 66% visited the dentist at least annually, and 54% received an influenza immunization. Across healthy lifestyle practices, 80% did not smoke, 52% engaged in regular exercise, and 37% maintained their BMI within normal range. Only 31% received all three clinical preventive services and only 16.5% engaged in all three healthy lifestyle practices. Across both domains of preventive health activities, age, marital status, and education were positively associated with the number of services. Presence of diabetes and poorer mental health were associated with greater number of clinical preventive services and lower number of healthy lifestyle practices. Cancer survivors with fair/poor perception of their mental health had lower number of clinical preventive services and those with fair/poor perception of physical health engaged in lower number of healthy lifestyle practices. Demographic and health status factors impacted the two domains differentially.

Discussion/Conclusions

The rates and predictors of preventive care varied by type of service/domain suggesting that individualization is needed in creating a comprehensive preventive service and lifestyle activity plan that accounts for the survivor’s specific total care needs, including all comorbidities. However, it was also found that cancer survivors are less likely to engage in all types of preventive activities; a one-size-fit-all approach is not recommended for preventive health education and planning for this population.

Implications for cancer survivors

Our study findings suggest the need to address the overall long term healthcare of cancer survivors by prioritizing and developing individualized preventive plans to optimize care that emphasize education, self care perceptions, and incorporate other comorbidities.

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Notes

  1. Academy of Healthcare Quality and Research, MEPS HC-087 2004 Medical Conditions (2006) http://www.meps.ahrq.gov/mepsweb/data_stats/download_data/pufs/h87/h87doc.pdf, accessed August 12, 2008.

References

  1. Beyer DA. Cancer is a chronic disease. Nurse Pract Forum 1995;6(4):201–6.

    PubMed  CAS  Google Scholar 

  2. Hewitt M, Greenfield S, Stovall E, editors. From cancer patient to cancer survivor: lost in transition. Washington, DC: Institute of Medicine and National Research Council; 2006.

  3. Deimling GT, Sterns S, Bowman KF, Kahana B. The health of older-adult, long-term cancer survivors. Cancer Nurs. 2005;28(6):415–24. doi:10.1097/00002820-200511000-00002.

    Article  PubMed  Google Scholar 

  4. Extermann M. Interaction between comorbidity and cancer. Cancer Control 2007;14(1):13–22.

    PubMed  Google Scholar 

  5. Rogers LQ, Courneya KS, Paragi-Gururaja R, Markwell SJ, Imeokparia R. Lifestyle behaviors, obesity, and perceived health among men with and without a diagnosis of prostate cancer: a population-based, cross-sectional study. BMC Public Health 2008;8:23. doi:10.1186/1471-2458-8-23.

    Article  PubMed  Google Scholar 

  6. Richardson LC, Wingo PA, Zack MM, Zahran HS, King JB. Health-related quality of life in cancer survivors between ages 20 and 64 years: population-based estimates from the behavioral risk factor surveillance system. Cancer 2008;112(6):1380–9. doi:10.1002/cncr.23291.

    Article  PubMed  Google Scholar 

  7. Enger SM, Greif JM, Polikoff J, Press M. Body weight correlates with mortality in early-stage breast cancer. Archives of surgery 2004 discussion 958–60; Sep;139(9):954–8.

  8. Meyerhardt JA, Catalano PJ, Haller DG, Mayer RJ, Macdonald JS, Benson AB 3rd, et al. Impact of diabetes mellitus on outcomes in patients with colon cancer. J Clin Oncol 2003;21(3):433–40. doi:10.1200/JCO.2003.07.125.

    Article  PubMed  Google Scholar 

  9. Snyder CF, Earle CC, Herbert RJ, Neville BA, Blackford AL, Frick KD. Trends in follow-up and preventive care for colorectal cancer survivors. J Gen Intern Med 2008;23(3):254–9. doi:10.1007/s11606-007-0497-5.

    Article  PubMed  Google Scholar 

  10. Snyder CF, Earle CC, Herbert RJ, Neville BA, Blackford AL, Frick KD. Preventive care for colorectal cancer survivors: a 5-year longitudinal study. J Clin Oncol 2008;26(7):1073–9. doi:10.1200/JCO.2007.11.9859.

    Article  PubMed  Google Scholar 

  11. Hewitt M, Rowland JH, Yancik R. Cancer survivors in the United States: age, health, and disability. J Gerontol, Ser A, Biol Sci Med Sci 2003;58(1):82–91.

    Google Scholar 

  12. Bellizzi KM, Rowland JH, Jeffery DD, McNeel T. Health behaviors of cancer survivors: examining opportunities for cancer control intervention. J Clin Oncol 2005;23(34):8884–93. doi:10.1200/JCO.2005.02.2343.

    Article  PubMed  Google Scholar 

  13. McBean AM, Yu X, Virnig BA. The use of preventive health services among elderly uterine cancer survivors. Am J Obstet Gynecol 2008;198(1):86.e1–e8. Jan.

    Article  Google Scholar 

  14. Coups EJ, Ostroff JS. A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and noncancer controls. Prev Med 2005;40(6):702–11. doi:10.1016/j.ypmed.2004.09.011.

    Article  PubMed  Google Scholar 

  15. Stephenson GD, Rose DP. Breast cancer and obesity: an update. Nutr Cancer 2003;45(1):1–16. doi:10.1207/S15327914NC4501_1.

    Article  PubMed  CAS  Google Scholar 

  16. Demark-Wahnefried W, Winer EP, Rimer BK. Why women gain weight with adjuvant chemotherapy for breast cancer. J Clin Oncol 1993;11(7):1418–29.

    PubMed  CAS  Google Scholar 

  17. Earle CC, Neville BA. Under use of necessary care among cancer survivors. Cancer 2004;101(8):1712–9. doi:10.1002/cncr.20560.

    Article  PubMed  Google Scholar 

  18. Agency for Healthcare Research and Quality. U.S. Preventive Services Task Force. Rockville, MD.; January 2003.

  19. Michaud DS, Liu Y, Meyer M, Giovannucci E, Joshipura K. Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study. Lancet Oncol 2008;9(6):550–8. doi:10.1016/S1470-2045(08)70106-2.

    Article  PubMed  Google Scholar 

  20. Bertakis KD, Azari R. Determinants of physician discussion regarding tobacco and alcohol abuse. J Health Commun 2007;12(6):513–25. doi:10.1080/10810730701508187.

    Google Scholar 

  21. Agency for Healthcare Research and Quality.Medical Expenditure Panel Survey, Household Component, 2000.

  22. Agency for Healthcare Research and Quality.Medical Expenditure Panel Survey, Household Component, 2001.

  23. Agency for Healthcare Research and Quality.Medical Expenditure Panel Survey, Household Component, 2002.

  24. Agency for Healthcare Research and Quality.Medical Expenditure Panel Survey, Household Component, 2003.

  25. Agency for Healthcare Research and Quality.Medical Expenditure Panel Survey, Household Component, 2004.

  26. Cohen J. Methodology Report #1: Design and Methods of the Medical Expenditure Panel Survey Household Component. July 1997.

  27. Bertakis KD, Azari R. Determinants of physician discussion regarding tobacco and alcohol abuse. J Health Commun. 2007;12(6):513–25. doi:10.1080/10810730701508187.

    Article  PubMed  Google Scholar 

  28. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity. Available at: http://www.cdc.gov/nccdphp/dnpa/. Accessed September 1, 2008.

  29. Earle CC, Burstein HJ, Winer EP, Weeks JC. Quality of non-breast cancer health maintenance among elderly breast cancer survivors. J Clin Oncol 2003;21(8):1447–51. doi:10.1200/JCO.2003.03.060.

    Article  PubMed  Google Scholar 

  30. Slymen DJ, Drew JA, Elder JP, Williams SJ. Determinants of non-compliance and attrition in the elderly. Int J Epidemiol 1996;25(2):411–9. doi:10.1093/ije/25.2.411.

    Article  PubMed  CAS  Google Scholar 

  31. Green CA, Polen MR, Brody KK. Depression, functional status, treatment for psychiatric problems, and the health-related practices of elderly HMO members. Am J Health Promot 2003;17(4):269–75.

    PubMed  Google Scholar 

  32. Cryer PC, Jenkins LM, Cook AC, Ditchburn JS, Harris CK, Davis AR, et al. The use of acute and preventative medical services by a general population: relationship to alcohol consumption. Addiction (Abingd, Engl) 1999;94(10):1523–32. doi:10.1046/j.1360-0443.1999.941015238.x.

    Article  CAS  Google Scholar 

  33. American Society of Clinical Oncology. Recommended breast cancer surveillance guidelines. J Clin Oncol 1997;15(5):2149–56.

    Google Scholar 

  34. Emmons KM, Puleo E, Park E, Gritz ER, Butterfield RM, Weeks JC, et al. Peer-delivered smoking counseling for childhood cancer survivors increases rate of cessation: the partnership for health study. J Clinic Oncol 2005;23(27):6516–23. doi:10.1200/JCO.2005.07.048.

    Article  Google Scholar 

  35. Centers for Disease Control and Prevention (CDC). Cigarette smoking among adults—United States, 2006. MMWR 2007;56(44):1157–61.

    Google Scholar 

  36. Klosky JL, Tyc VL, Garces-Webb DM, Buscemi J, Klesges RC, Hudson MM. Emerging issues in smoking among adolescent and adult cancer survivors: a comprehensive review. Cancer 2007;110(11):2408–19. doi:10.1002/cncr.23061.

    Article  PubMed  Google Scholar 

  37. Blanchard CM, Denniston MM, Baker F, Ainsworth SR, Courneya KS, Hann DM, et al. Do adults change their lifestyle behaviors after a cancer diagnosis? Am J Health Behav 2003;27(3):246–56.

    PubMed  Google Scholar 

  38. Sabatino SA, Coates RJ, Uhler RJ, Pollack LA, Alley LG, Zauderer LJ. Provider counseling about health behaviors among cancer survivors in the United States. J Clin Oncol 2007;25(15):2100–6. doi:10.1200/JCO.2006.06.6340.

    Article  PubMed  Google Scholar 

  39. Kiyak HA, Reichmuth M. xBarriers to and enablers of older adults’ use of dental services. J Dent Educ 2005;69(9):975–86.

    PubMed  Google Scholar 

  40. Manski RJ, Cooper PF. Dental care use: does dental insurance truly make a difference in the US? Community Dent Health 2007;24(4):205–12.

    PubMed  CAS  Google Scholar 

  41. Jones JA, Kressin NR, Spiro A 3rd, Randall CW, Miller DR, Hayes C, et al. Self-reported and clinical oral health in users of VA health care. J Gerontol, Ser A, Biol Sci Med Sci 2001;56(1):M55–62.

    CAS  Google Scholar 

  42. Morrow GR. Cancer-related fatigue: causes, consequences, and management. The Oncologist 2007;12(Suppl 1):1–3. doi:10.1634/theoncologist.12-S1-1.

    Article  PubMed  Google Scholar 

  43. Helgeson VS, Cohen S. Social support and adjustment to cancer: reconciling descriptive, correlational, and intervention research. Health Psychol 1996;15(2):135–48. doi:10.1037/0278-6133.15.2.135.

    Article  PubMed  CAS  Google Scholar 

  44. Calfas KJ, Long BJ, Sallis JF, Wooten WJ, Pratt M, Patrick K. A controlled trial of physician counseling to promote the adoption of physical activity. Prev Med 1996;25(3):225–33. doi:10.1006/pmed.1996.0050.

    Article  PubMed  CAS  Google Scholar 

  45. Fiscella K, Holt K. Impact of primary care patient visits on racial and ethnic disparities in preventive care in the United States. JABFM 2007;20(6):587–97. doi:10.3122/jabfm.2007.06.070053.

    Article  PubMed  Google Scholar 

  46. Wei W, Findley PA, Sambamoorthi U. Disability and receipt of clinical preventive services among women. Women’s Health Issues 2006;16(6):286–96. doi:10.1016/j.whi.2006.09.002.

    Article  PubMed  Google Scholar 

  47. Corbie-Smith G, Flagg EW, Doyle JP, O, Brien MA. Influence of usual source of care on differences by race/ethnicity in receipt of preventive services. J Gen Intern Med 2002;17(6):458–64. doi:10.1046/j.1525-1497.2002.10733.x.

    Article  PubMed  Google Scholar 

  48. DeVoe JE, Fryer GE, Phillips R, Green L. Receipt of preventive care among adults: insurance status and usual source of care. Am J Public Health 2003;93(5):786–91.

    Article  PubMed  Google Scholar 

  49. Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services. Healthy people 2010. Available at: http://www.healthypeople.gov/default.htm. Accessed September 1, 2008.

  50. Earle CC. Failing to plan is planning to fail: improving the quality of care with survivorship care plans. J Clin Oncol 2006;24(32):5112–6. doi:10.1200/JCO.2006.06.5284.

    Article  PubMed  Google Scholar 

  51. Lafata JE, Martin S, Morlock R, Divine G, Xi H. Provider type and the receipt of general and diabetes-related preventive health services among patients with diabetes. Med Care 2001;39(5):491–9. doi:10.1097/00005650-200105000-00009.

    Article  PubMed  CAS  Google Scholar 

  52. Starfield B, Lemke KW, Bernhardt T, Foldes SS, Forrest CB, Weiner JP. Comorbidity: implications for the importance of primary care in ‘case’ management. Ann Fam Med 2003;1(1):8–14. doi:10.1370/afm.1.

    Article  PubMed  Google Scholar 

  53. Herman DR, Ganz PA, Petersen L, Greendale GA. Obesity and cardiovascular risk factors in younger breast cancer survivors: the Cancer and Menopause Study (CAMS). Breast Cancer Res Treat 2005;93(1):13–23. doi:10.1007/s10549-005-2418-9.

    Article  PubMed  Google Scholar 

  54. Parikh-Patel A, Allen M, Wright WE, California Teachers Study Steering, Committee. Validation of self-reported cancers in the California teachers study. Am J Epidemiol 2003;157(6):539–45. doi:10.1093/aje/kwg006.

    Article  PubMed  Google Scholar 

  55. Yeazel MW, Gurney JG, Oeffinger KC, Mitby PA, Mertens AC, Hudson MM, et al. An examination of the dental utilization practices of adult survivors of childhood cancer: a report from the childhood cancer survivor study. J Public Health Dent 2004;64(1):50–4. doi:10.1111/j.1752-7325.2004.tb02726.x.

    Article  PubMed  Google Scholar 

  56. Yarnall KS, Pollak KI, Ostbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am J Public Health 2003;93(4):635–41.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Patricia A. Findley.

Additional information

The findings and opinions reported here are those of the authors and do not necessarily represent the views of any other individuals or organizations. Work for this grant was partially supported by Dr. Findley’s K23 Award under the National Institute of Child Health and Human Development

Appendix

Appendix

Clinical classification code to ICD-9-CM code crosswalk for cancer diagnosesFootnote 1

Cancer of head and neck

1400 1401 1403 1404 1405 1406 1408 1409 1410 1411 1412 1413

1414 1415 1416 1418 1419 1420 1421 1422 1428 1429 1430 1431

1438 1439 1440 1441 1448 1449 1450 1451 1452 1453 1454 1455

1456 1458 1459 1460 1461 1462 1463 1464 1465 1466 1467 1468

1469 1470 1471 1472 1473 1478 1479 1480 1481 1482 1483 1488

1489 1490 1491 1498 1499 1600 1601 1602 1603 1604 1605 1608

1609 1610 1611 1612 1613 1618 1619 1950 2300 2310 V1001 V1002

V1021

Cancer of esophagus

1500 1501 1502 1503 1504 1505 1508 1509 2301 V1003

Cancer of stomach

1510 1511 1512 1513 1514 1515 1516 1518 1519 2302 V1004

Cancer of colon

1530 1531 1532 1533 1534 1535 1536 1537 1538 1539 1590 2303

V1005

Cancer of rectum and anus

1540 1541 1542 1543 1548 2304 2305 2306 V1006

Cancer of liver and intrahepatic bile duct

1550 1551 1552 2308 V1007

Cancer of pancreas

1570 1571 1572 1573 1574 1578 1579

Cancer of other GI organs; peritoneum

1520 1521 1522 1523 1528 1529 1560 1561 1562 1568 1569 1580

1588 1589 1591 1598 1599 2307 2309 V1000 V1009

Cancer of bronchus; lung

1622 1623 1624 1625 1628 1629 2312 V1011

Cancer; other respiratory and intrathoracic

1620 1630 1631 1638 1639 1650 1658 1659 2311 2318 2319 V1012

V1020 V1022

Cancer of bone and connective tissue

1700 1701 1702 1703 1704 1705 1706 1707 1708 1709 1710 1712

1713 1714 1715 1716 1717 1718 1719

Melanomas of skin

1720 1721 1722 1723 1724 1725 1726 1727 1728 1729 V1082

Other non-epithelial cancer of skin

1730 1731 1732 1733 1734 1735 1736 1737 1738 1739 2320 2321

2322 2323 2324 2325 2326 2327 2328 2329 V1083

Cancer of breast

1740 1741 1742 1743 1744 1745 1746 1748 1749 1750 1759 2330

V103

Cancer of uterus

179 1820 1821 1828 2332 V1042

Cancer of cervix

1800 1801 1808 1809 2331 7950 V1041

Cancer of ovary

1830 V1043

Cancer of other female genital organs

181 1832 1833 1834 1835 1838 1839 1840 1841 1842 1843 1844

1848 1849 2333 V1040 V1044

Cancer of prostate

185 2334 V1046

Cancer of testis

1860 1869 V1047

Cancer of other male genital organs

1871 1872 1873 1874 1875 1876 1877 1878 1879 2335 2336 V1045

V1048 V1049

Cancer of bladder

1880 1881 1882 1883 1884 1885 1886 1887 1888 1889 2337 V1051

Cancer of kidney and renal pelvis

1890 1891 V1052

Cancer of other urinary organs

1892 1893 1894 1898 1899 2339 V1050 V1059

Cancer of brain and nervous system

1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921

1922 1923 1928 1929 V1085 V1086

Cancer of thyroid

193 V1087

Hodgkin’s disease

20100 20101 20102 20103 20104 20105 20106 20107 20108 20110 20111 20112

20113 20114 20115 20116 20117 20118 20120 20121 20122 20123 20124 20125

20126 20127 20128 20140 20141 20142 20143 20144 20145 20146 20147 20148

20150 20151 20152 20153 20154 20155 20156 20157 20158 20160 20161 20162

20163 20164 20165 20166 20167 20168 20170 20171 20172 20173 20174 20175

20176 20177 20178 20190 20191 20192 20193 20194 20195 20196 20197 20198

V1072

Non-Hodgkin’s lymphoma

20000 20001 20002 20003 20004 20005 20006 20007 20008 20010 20011 20012

20013 20014 20015 20016 20017 20018 20020 20021 20022 20023 20024 20025

20026 20027 20028 20080 20081 20082 20083 20084 20085 20086 20087 20088

20200 20201 20202 20203 20204 20205 20206 20207 20208 20210 20211 20212

20213 20214 20215 20216 20217 20218 20220 20221 20222 20223 20224 20225

20226 20227 20228 20280 20281 20282 20283 20284 20285 20286 20287 20288

20290 20291 20292 20293 20294 20295 20296 20297 20298 V1071 V1079

Leukemias

20240 20241 20242 20243 20244 20245 20246 20247 20248 2031 20310 20311

2040 20400 20401 2041 20410 20411 2042 20420 20421 2048 20480 20481

2049 20490 20491 2050 20500 20501 2051 20510 20511 2052 20520 20521

2053 20530 20531 2058 20580 20581 2059 20590 20591 2060 20600 20601

2061 20610 20611 2062 20620 20621 2068 20680 20681 2069 20690 20691

2070 20700 20701 2071 20710 20711 2072 20720 20721 2078 20780 20781

2080 20800 20801 2081 20810 20811 2082 20820 20821 2088 20880 20881

2089 20890 20891 V1060 V1061 V1062 V1063 V1069

Multiple myeloma

2030 20300 20301 2038 20380 20381

41 Cancer; other and unspecified primary

1640 1641 1642 1643 1648 1649 1760 1761 1762 1763 1764 1765

1768 1769 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909

1940 1941 1943 1944 1945 1946 1948 1949 1951 1952 1953 1954

1955 1958 20230 20231 20232 20233 20234 20235 20236 20237 20238 20250

20251 20252 20253 20254 20255 20256 20257 20258 20260 20261 20262 20263

20264 20265 20266 20267 20268 2340 2348 2349 7951 V1029 V1081 V1084

V1088 V1089 V109 V711

Secondary malignancies

1960 1961 1962 1963 1965 1966 1968 1969 1970 1971 1972 1973

1974 1975 1976 1977 1978 1980 1981 1982 1983 1984 1985 1986

1987 19881 19882 19889

Malignant neoplasm without specification of site

1990 1991

Neoplasms of unspecified nature or uncertain behavior

2350 2351 2352 2353 2354 2355 2356 2357 2358 2359 2360 2361

2362 2363 2364 2365 2366 2367 23690 23691 23699 2370 2371 2372

2373 2374 2375 2376 2377 23770 23771 23772 2379 2380 2381 2382

2383 2384 2385 2386 2387 2388 2389 2390 2391 2392 2393 2394

2395 2396 2397 2398 2399

Maintenance chemotherapy; radiotherapy

V580 V581 V5811 V5812 V661 V662 V671 V672

Benign neoplasm of uterus

2180 2181 2182 2189 2190 2191 2198 2199

Other and unspecified benign neoplasm

2100 2101 2102 2103 2104 2105 2106 2107 2108 2109 2110 2111

2112 2113 2114 2115 2116 2117 2118 2119 2120 2121 2122 2123

2124 2125 2126 2127 2128 2129 2130 2131 2132 2133 2134 2135

2136 2137 2138 2139 2140 2141 2142 2143 2144 2148 2149 2150

2152 2153 2154 2155 2156 2157 2158 2159 2160 2161 2162 2163

2164 2165 2166 2167 2168 2169 217 220 2210 2211 2212 2218

2219 2220 2221 2222 2223 2224 2228 2229 2230 2231 2232 2233

22381 22389 2239 2240 2241 2242 2243 2244 2245 2246 2247 2248

2249 2250 2251 2252 2253 2254 2258 2259 226 2270 2271 2273

2274 2275 2276 2278 2279 22800 22801 22802 22803 22804 22809 2281

2290 2298 2299 V1272

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Findley, P.A., Sambamoorthi, U. Preventive health services and lifestyle practices in cancer survivors: a population health investigation. J Cancer Surviv 3, 43–58 (2009). https://doi.org/10.1007/s11764-008-0074-x

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