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Airaksinen, J., Pentti, J., Suominen, S., Vahtera, J. & Kivimäki, M. (2020). An Example of How Immortal Time Bias Can Reverse the Results of an Observational Study [Letter to the editor]. Epidemiology, 31(2), e19-e20
Open this publication in new window or tab >>An Example of How Immortal Time Bias Can Reverse the Results of an Observational Study
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2020 (English)In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 31, no 2, p. e19-e20Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Wolters Kluwer, 2020
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-18205 (URN)10.1097/EDE.0000000000001103 (DOI)31567749 (PubMedID)2-s2.0-85078869541 (Scopus ID)
Note

Export Date: 17 February 2020; Article

Available from: 2020-02-17 Created: 2020-02-17 Last updated: 2020-02-20Bibliographically approved
Simonsen, N., Lahti, A., Suominen, S., Välimaa, R., Tynjälä, J., Roos, E. & Kannas, L. (2020). Empowerment-enabling home and school environments and self-rated health among Finnish adolescents. Health Promotion International, 35(1), 82-92
Open this publication in new window or tab >>Empowerment-enabling home and school environments and self-rated health among Finnish adolescents
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2020 (English)In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 35, no 1, p. 82-92Article in journal (Refereed) Published
Abstract [en]

Perceived health during adolescence has not only immediate consequences for individuals and for society, but also long-term. We need to understand better the health development in this period of the lifespan. Empowerment may be one pathway through which social factors and conditions translate into health effects. This study aimed to examine whether empowerment-enabling home and school environments are associated with self-rated health among adolescents, and whether the associations differ between genders, age or majority/minority language groups. Anonymous questionnaire data from respondents aged 11, 13 and 15 years were obtained from the Health Behaviour in School-aged Children study, conducted in Finland in 2014 in Finnish- and Swedish-speaking schools (n = 5925/1877). The proportion rating their health as excellent varied between 33.6 (11-year-olds) and 23.1% (15-year-olds), boys rating their health as excellent more often than girls in all age groups. Findings showed that indicators of both empowerment-enabling home and school environments were independently and positively related to adolescents' self-rated health. Whereas a respectful, accepting, kind and helpful attitude among classmates and a good home atmosphere were quite consistently associated with excellent health, there were gender and age differences with concern to the other empowerment-enabling indicators. Moreover, there were gender-, age- and language-related differences regarding adolescents' perceptions of how empowerment enabling their environments were. Home and school environments that create opportunities through encouragement and care, and through strengthening feelings of being secure, accepted and respected are potentially empowerment enabling. This study suggests that such environmental qualities are important for the perceived health of young people. 

Place, publisher, year, edition, pages
Oxford University Press, 2020
Keywords
adolescents, empowerment-enabling environment, family, school, self-rated health, adolescent, anonymised data, article, atmosphere, child, empowerment, female, Finland, Finn (citizen), gender, health behavior, human, human experiment, language, major clinical study, male, perception, respect, school child, speech
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-18163 (URN)10.1093/heapro/day104 (DOI)30590462 (PubMedID)2-s2.0-85077702101 (Scopus ID)
Available from: 2020-01-24 Created: 2020-01-24 Last updated: 2020-02-06Bibliographically approved
Volanen, S.-M., Lassander, M., Hankonen, N., Santalahti, P., Hintsanen, M., Simonsen, N., . . . Suominen, S. (2020). Healthy learning mind – Effectiveness of a mindfulness program on mental health compared to a relaxation program and teaching as usual in schools: A cluster-randomised controlled trial. Journal of Affective Disorders, 260, 660-669
Open this publication in new window or tab >>Healthy learning mind – Effectiveness of a mindfulness program on mental health compared to a relaxation program and teaching as usual in schools: A cluster-randomised controlled trial
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2020 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 260, p. 660-669Article in journal (Refereed) Published
Abstract [en]

Background: Mindfulness-Based Interventions (MBIs) have shown promising effects on mental health among children and adolescents, but high-quality studies examining the topic are lacking. The present study assessed the effects of MBI on mental health in school-setting in an extensive randomised controlled trial. Methods: Finnish school children and adolescents (N = 3519), aged 12–15 years (6th to 8th graders), from 56 schools were randomized into a 9 week MBI group, and control groups with a relaxation program or teaching as usual. The primary outcomes were resilience, socio-emotional functioning, and depressive symptoms at baseline, at completion of the programs at 9 weeks (T9), and at follow-up at 26 weeks (T26). Results: Overall, mindfulness did not show more beneficial effects on the primary outcomes compared to the controls except for resilience for which a positive intervention effect was found at T9 in all participants (β=1.18, SE 0.57, p = 0.04) as compared to the relaxation group. In addition, in gender and grade related analyses, MBI lowered depressive symptoms in girls at T26 (β=−0.49, SE 0.21, p = 0.02) and improved socio-emotional functioning at T9 (β=−1.37, SE 0.69, p = 0.049) and at T26 (β=−1.71, SE 0.73, p = 0.02) among 7th graders as compared to relaxation. Limitations: The inactive control group was smaller than the intervention and active control groups, reducing statistical power. Conclusions: A short 9-week MBI in school-setting provides slight benefits over a relaxation program and teaching as usual. Future research should investigate whether embedding regular mindfulness-based practice in curriculums could intensify the effects. 

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Mental health promotion, Mindfulness, Randomized controlled trial, School-based intervention
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-17756 (URN)10.1016/j.jad.2019.08.087 (DOI)000490428300083 ()31546105 (PubMedID)2-s2.0-85072510110 (Scopus ID)
Available from: 2019-10-04 Created: 2019-10-04 Last updated: 2020-01-29Bibliographically approved
Vuorio, T., Suominen, S., Kautiainen, H. & Korhonen, P. (2019). Determinants of sickness absence rate among Finnish municipal employees. Scandinavian Journal of Primary Health Care, 37(1), 3-9
Open this publication in new window or tab >>Determinants of sickness absence rate among Finnish municipal employees
2019 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 37, no 1, p. 3-9Article in journal (Refereed) Published
Abstract [en]

Objective: In addition to acute health problems, various aspects of health behavior, work-related and sociodemographic factors have been shown to influence the rate of sickness absence. The aim of this study was to concomitantly examine factors known to have an association with absenteeism. We hypothesized the prevalence of chronic diseases being the most important factor associated with sickness absence. Design: A cross-sectional study. Setting: Occupational health care in the region of Pori, Finland. Subjects: 671 municipal employees (89% females) with a mean age of 49 (SD 10) years. Information about the study subjects was gathered from medical records, by physical examination and questionnaires containing information about physical and mental health, health behavior, work-related and sociodemographic factors. The number of sickness absence days was obtained from the records of the city of Pori. Main outcome measures: The relationship of absenteeism rate with sociodemographic, health- and work-related risk factors. Results: In the multivariate analysis, the mean number of chronic diseases (IRR 1.24, 95% CI 1.13 to 1.36), work ability (IRR 0.83, 95% CI 0.76 to 0.91), and length of years in education (IRR 0.90, 95% CI 0.85 to 0.95) remained as independent factors associated with absenteeism. Conclusion: According to our results, chronic diseases, self-perceived work ability and length of years in education are the most important determinants of the rate of sickness absence. This implies that among working-aged people the treatment of chronic medical conditions is also worth prioritizing, not only to prevent complications, but also to avoid sickness absences. KEY POINTS Various sociodemographic, health- and work- related risk factors have been shown to influence sickness absence. The study aimed to find the most important determinants of absenteeism among several known risk factors in Finnish municipal employees. Chronic diseases, self-perceived work ability and education years remained as the most important determinants of sickness absence rates. Treatment of chronic medical conditions should be prioritized in order to reduce sickness absence rate. © 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
chronic disease, health behavior, occupational health care, sickness absence, sociodemographic factor, work ability, work-related factor
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-16630 (URN)10.1080/02813432.2019.1568710 (DOI)000463364700008 ()30689483 (PubMedID)2-s2.0-85060928514 (Scopus ID)
Available from: 2019-02-15 Created: 2019-02-15 Last updated: 2019-05-09
Ervasti, J., Airaksinen, J., Pentti, J., Vahtera, J., Suominen, S., Virtanen, M. & Kivimaki, M. (2019). Does increasing physical activity reduce the excess risk of work disability among overweight individuals?. Scandinavian Journal of Work, Environment and Health, 45(4), 376-385
Open this publication in new window or tab >>Does increasing physical activity reduce the excess risk of work disability among overweight individuals?
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2019 (English)In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 45, no 4, p. 376-385Article in journal (Refereed) Published
Abstract [en]

Objectives We examined the extent to which an increase in physical activity would reduce the excess risk of work disability among overweight and obese people (body mass index >= 25kg/m(2)).

Methods We used counterfactual modelling approaches to analyze longitudinal data from two Finnish prospective cohort studies (total N=38 744). Weight, height and physical activity were obtained from surveys and assessed twice and linked to electronic records of two indicators of long-term work disability (>= 90-day sickness absence and disability pension) for a 7-year follow-up after the latter survey. The models were adjusted for age, sex, socioeconomic status, smoking, and alcohol consumption.

Results The confounder-adjusted hazard ratio (HR) of long-term sickness absence for overweight compared to normal-weight participants was 1.43 [95% confidence interval (CI) 1.35-1.53]. An increase in physical activity among overweight compared to normal-weight individuals was estimated to reduce this HR to 1.40 (95% CI 1.31-1.48). In pseudo-trial analysis including only the persistently overweight, initially physically inactive participants, the HR for long-term sickness absence was 0.82 (95% CI 0.70-0.94) for individuals with increased physical activity compared to those who remained physically inactive. The results for disability pension as an outcome were similar.

Conclusions These findings suggest that the excess risk of work disability among overweight individuals would drop by 3-4% if they increased their average physical activity to the average level of normal-weight people. However, overweight individuals who are physically inactive would reduce their risk of work disability by about 20% by becoming physically active.

Place, publisher, year, edition, pages
Nordic Association of Occupational Safety and Health (NOROSH), 2019
Keywords
counterfactual analysis, mediation, normal weight; obesity, sickness absence, weight
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-17464 (URN)10.5271/sjweh.3799 (DOI)000473173000007 ()30640978 (PubMedID)
Available from: 2019-07-22 Created: 2019-07-22 Last updated: 2019-11-13
Koponen, A. M., Simonsen, N. & Suominen, S. (2019). How to promote fruits, vegetables, and berries intake among patients with type 2 diabetes in primary care?: A self-determination theory perspective. Health Psychology Open, 6(1)
Open this publication in new window or tab >>How to promote fruits, vegetables, and berries intake among patients with type 2 diabetes in primary care?: A self-determination theory perspective
2019 (English)In: Health Psychology Open, E-ISSN 2055-1029, Vol. 6, no 1Article in journal (Refereed) Published
Abstract [en]

The results of this study showed the importance of autonomous motivation for healthy eating. Autonomous motivation and female gender were the determinants most strongly associated with fruits, vegetables, and berries intake among patients with type 2 diabetes. Other determinants of fruits, vegetables, and berries intake were high education, high social support, high age, and a strong sense of coherence. Autonomous motivation and self-care competence mediated the effect of perceived autonomy support from a physician on fruits, vegetables, and berries intake. Thus, physicians can promote patients’ fruits, vegetables, and berries intake by supporting their autonomous motivation and self-care competence. The results are in line with self-determination theory.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
adherence, diabetes, diet, fruit and vegetable intake, self-determination theory
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-17320 (URN)10.1177/2055102919854977 (DOI)000471634900001 ()31218074 (PubMedID)2-s2.0-85067349786 (Scopus ID)
Available from: 2019-06-27 Created: 2019-06-27 Last updated: 2019-08-06Bibliographically approved
Virtanen, M., Jokela, M., Lallukka, T., Magnusson Hanson, L., Pentti, J., Nyberg, S. T., . . . Kivimäki, M. (2019). Long working hours and change in body weight: analysis of individual-participant data from 19 cohort studies. International Journal of Obesity
Open this publication in new window or tab >>Long working hours and change in body weight: analysis of individual-participant data from 19 cohort studies
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2019 (English)In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective: To examine the relation between long working hours and change in body mass index (BMI). Methods: We performed random effects meta-analyses using individual-participant data from 19 cohort studies from Europe, US and Australia (n = 122,078), with a mean of 4.4-year follow-up. Working hours were measured at baseline and categorised as part time (<35 h/week), standard weekly hours (35–40 h, reference), 41–48 h, 49–54 h and ≥55 h/week (long working hours). There were four outcomes at follow-up: (1) overweight/obesity (BMI ≥ 25 kg/m2) or (2) overweight (BMI 25–29.9 kg/m2) among participants without overweight/obesity at baseline; (3) obesity (BMI ≥ 30 kg/m2) among participants with overweight at baseline, and (4) weight loss among participants with obesity at baseline. Results: Of the 61,143 participants without overweight/obesity at baseline, 20.2% had overweight/obesity at follow-up. Compared with standard weekly working hours, the age-, sex- and socioeconomic status-adjusted relative risk (RR) of overweight/obesity was 0.95 (95% CI 0.90–1.00) for part-time work, 1.07 (1.02–1.12) for 41–48 weekly working hours, 1.09 (1.03–1.16) for 49–54 h and 1.17 (1.08–1.27) for long working hours (P for trend <0.0001). The findings were similar after multivariable adjustment and in subgroup analyses. Long working hours were associated with an excess risk of shift from normal weight to overweight rather than from overweight to obesity. Long working hours were not associated with weight loss among participants with obesity. Conclusions: This analysis of large individual-participant data suggests a small excess risk of overweight among the healthy-weight people who work long hours. 

Place, publisher, year, edition, pages
Springer, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-17995 (URN)10.1038/s41366-019-0480-3 (DOI)31767974 (PubMedID)2-s2.0-85075470775 (Scopus ID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2020-01-29Bibliographically approved
Magnusson Hanson, L. L., Rod, N. H., Vahtera, J., Peristera, P., Pentti, J., Rugulies, R., . . . Westerlund, H. (2019). Multicohort study of change in job strain, poor mental health and incident cardiometabolic disease. Occupational and Environmental Medicine, 76, 785-792
Open this publication in new window or tab >>Multicohort study of change in job strain, poor mental health and incident cardiometabolic disease
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2019 (English)In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 76, p. 785-792Article in journal (Refereed) Published
Abstract [en]

Objectives: Several recent large-scale studies have indicated a prospective association between job strain and coronary heart disease, stroke and diabetes. Job strain is also associated with poorer mental health, a risk factor for cardiometabolic disease. This study investigates the prospective relationships between change in job strain, poor mental health and cardiometabolic disease, and whether poor mental health is a potential mediator of the relationship between job strain and cardiometabolic disease. Methods: We used data from five cohort studies from Australia, Finland, Sweden and UK, including 47 757 men and women. Data on job strain across two measurements 1-5 years apart (time 1 (T1)-time 2 (T2)) were used to define increase or decrease in job strain. Poor mental health (symptoms in the top 25% of the distribution of the scales) at T2 was considered a potential mediator in relation to incident cardiometabolic disease, including cardiovascular disease and diabetes, following T2 for a mean of 5-18 years. Results: An increase in job strain was associated with poor mental health (HR 1.56, 95% CI 1.38 to 1.76), and a decrease in job strain was associated with lower risk in women (HR 0.70, 95% CI 0.60-0.84). However, no clear association was observed between poor mental health and incident cardiometabolic disease (HR 1.08, 95% CI 0.96-1.23), nor between increase (HR 1.01, 95% CI 0.90-1.14) and decrease (HR 1.08, 95% CI 0.96-1.22) in job strain and cardiometabolic disease. Conclusions: The results did not support that change in job strain is a risk factor for cardiometabolic disease and yielded no support for poor mental health as a mediator.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
Keywords
cardiovascular, diabetes mellitus, mental health, meta-analysis, stress
National Category
Public Health, Global Health, Social Medicine and Epidemiology Occupational Health and Environmental Health General Practice
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-17718 (URN)10.1136/oemed-2018-105595 (DOI)000497712200002 ()31488605 (PubMedID)2-s2.0-85072081458 (Scopus ID)
Available from: 2019-09-23 Created: 2019-09-23 Last updated: 2019-12-06Bibliographically approved
Lagström, H., Halonen, J. I., Kawachi, I., Stenholm, S., Pentti, J., Suominen, S., . . . Vahtera, J. (2019). Neighborhood socioeconomic status and adherence to dietary recommendations among Finnish adults: A retrospective follow-up study. Health and Place, 55, 43-50
Open this publication in new window or tab >>Neighborhood socioeconomic status and adherence to dietary recommendations among Finnish adults: A retrospective follow-up study
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2019 (English)In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 55, p. 43-50Article in journal (Refereed) Published
Abstract [en]

Neighborhood socioeconomic status (SES) is associated with dietary habits among the residents, but few studies have examined this association separately among long-term residents and movers. We calculated cumulative neighborhood SES score weighted by residential time in each address over 6 years for non-movers (n = 7704) and movers (n = 8818) using national grid database. Increase in average neighborhood SES was associated with higher adherence to dietary recommendations in both groups. Among the movers, an upward trajectory from low to high neighborhood SES was also associated with better adherence. Our findings suggest high SES areas might offer healthier food environments than low SES areas.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
dietary habits, dietary recommendations, neighborhood socioeconomic status, adult, article, controlled study, diet, female, Finn (citizen), follow up, habit, human, major clinical study, male, neighborhood, resident, retrospective study, social status
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-16474 (URN)10.1016/j.healthplace.2018.10.007 (DOI)000456089600006 ()30470615 (PubMedID)2-s2.0-85056901266 (Scopus ID)
Available from: 2018-12-06 Created: 2018-12-06 Last updated: 2019-02-06Bibliographically approved
Kivimäki, M., Singh-Manoux, A., Pentti, J., Sabia, S., Nyberg, S. T., Alfredsson, L., . . . Jokela, M. (2019). Physical inactivity, cardiometabolic disease, and risk of dementia: an individual-participant meta-analysis. BMJ. British Medical Journal, 365, Article ID l1495.
Open this publication in new window or tab >>Physical inactivity, cardiometabolic disease, and risk of dementia: an individual-participant meta-analysis
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2019 (English)In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 365, article id l1495Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE To examine whether physical inactivity is a risk factor for dementia, with attention to the role of cardiometabolic disease in this association and reverse causation bias that arises from changes in physical activity in the preclinical (prodromal) phase of dementia. DESIGN Meta-analysis of 19 prospective observational cohort studies. DATA SOURCES The Individual-Participant-Data Meta-analysis in Working Populations Consortium, the Inter-University Consortium for Political and Social Research, and the UK Data Service, including a total of 19 of a potential 9741 studies. REVIEW METHOD The search strategy was designed to retrieve individual-participant data from prospective cohort studies. Exposure was physical inactivity; primary outcomes were incident all-cause dementia and Alzheimer's disease; and the secondary outcome was incident cardiometabolic disease (that is, diabetes, coronary heart disease, and stroke). Summary estimates were obtained using random effects meta-analysis. RESULTS Study population included 404 840 people (mean age 45.5 years, 57.7% women) who were initially free of dementia, had a measurement of physical inactivity at study entry, and were linked to electronic health records. In 6.0 million person-years at risk, we recorded 2044 incident cases of all-cause dementia. In studies with data on dementia subtype, the number of incident cases of Alzheimer's disease was 1602 in 5.2 million person-years. When measured < 10 years before dementia diagnosis (that is, the preclinical stage of dementia), physical inactivity was associated with increased incidence of all-cause dementia (hazard ratio 1.40, 95% confidence interval 1.23 to 1.71) and Alzheimer's disease (1.36, 1.12 to 1.65). When reverse causation was minimised by assessing physical activity >= 10 years before dementia onset, no difference in dementia risk between physically active and inactive participants was observed (hazard ratios 1.01 (0.89 to 1.14) and 0.96 (0.85 to 1.08) for the two outcomes). Physical inactivity was consistently associated with increased risk of incident diabetes (hazard ratio 1.42, 1.25 to 1.61), coronary heart disease (1.24, 1.13 to 1.36), and stroke (1.16, 1.05 to 1.27). Among people in whom cardiometabolic disease preceded dementia, physical inactivity was non-significantly associated with dementia (hazard ratio for physical activity assessed > 10 before dementia onset 1.30, 0.79 to 2.14). CONCLUSIONS In analyses that addressed bias due to reverse causation, physical inactivity was not associated with all-cause dementia or Alzheimer's disease, although an indication of excess dementia risk was observed in a subgroup of physically inactive individuals who developed cardiometabolic disease.

Place, publisher, year, edition, pages
ENGLAND: BMJ Publishing Group Ltd, 2019
Keywords
JOB STRAIN, PROPORTIONAL-HAZARDS, HEART-DISEASE, LIFE-STYLE, FOLLOW-UP, COHORT, TIME, MEN, ASSOCIATION, MORTALITY
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-16879 (URN)10.1136/bmj.l1495 (DOI)000465550000004 ()30995986 (PubMedID)2-s2.0-85064695071 (Scopus ID)
Available from: 2019-05-10 Created: 2019-05-10 Last updated: 2019-08-06Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6648-603X

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