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Cao F, Yang F, Li J, Guo W, Zhang C, Gao F, Sun X, Zhou Y, Zhang W. The relationship between diabetes and the dementia risk: a meta-analysis. Diabetol Metab Syndr 2024; 16:101. [PMID: 38745237 PMCID: PMC11092065 DOI: 10.1186/s13098-024-01346-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/04/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The link between diabetes and dementia risk is not well understood. This study evaluates the factors linking diabetes to dementia onset, providing guidance for preventing dementia in diabetic patients. METHODS This analysis utilized databases such as PubMed, Embase, Web of Science, and the Cochrane Library to review literature from January 31, 2012, to March 5, 2023. Articles were rigorously assessed using specific inclusion and exclusion criteria. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the studies. Data analysis was performed with STATA 15.0. RESULTS The study analyzed 15 articles, covering 10,103,868 patients, with 8,821,516 diagnosed with diabetes. The meta-analysis reveals a substantial association between diabetes and an increased risk of dementia [RR: 1.59, 95%CI (1.40-1.80), P < 0.01, I²=96.4%]. A diabetes duration of less than five years is linked to a higher dementia risk [RR: 1.29, 95%CI (1.20-1.39), P < 0.01, I²=92.6%]. Additionally, hypoglycemia significantly raises dementia risk [RR: 1.56, 95%CI (1.13-2.16), P < 0.01, I²=51.5%]. Analyses of blood sugar control, glycated hemoglobin, and fasting blood sugar indicated no significant effects on the onset of dementia. CONCLUSION Diabetes notably increases dementia risk, particularly where diabetes duration is under five years or hypoglycemia is present. REGISTRATION The research protocol was registered with PROSPERO and assigned the registration number CRD42023394942.
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Affiliation(s)
- Fang Cao
- School of Basic Medical Sciences, Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Fushuang Yang
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Jian Li
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Wei Guo
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Chongheng Zhang
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Fa Gao
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Xinxin Sun
- Department of Nutrition, Chinese People's Armed Police Force Medical Characteristic Center, Tianjin, 300162, China
| | - Yi Zhou
- Department of Geriatrics, Baotou Mengshi Hospital of Traditional Chinese Medicine, Baotou, 014000, China
| | - Wenfeng Zhang
- School of Basic Medical Sciences, Changchun University of Chinese Medicine, Changchun, 130117, China.
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Wang Q, Li X, Teng N, Li X. Prediabetes and the incidence of dementia in general population: a systematic review and meta-analysis of prospective studies. Psychogeriatrics 2022; 22:666-678. [PMID: 35777977 DOI: 10.1111/psyg.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Continuous hyperglycaemia has been related with dementia. However, it remains unclear whether prediabetes poses a higher risk of dementia. A meta-analysis was therefore conducted to comprehensively investigate the possible role of prediabetes as a risk factor of dementia. METHODS Prospective cohort studies reporting the association of prediabetes and dementia were identified from PubMed, Web of Science, and Embase databases. A random-effects model was applied to combine the results by incorporating the influence of heterogeneity. Subgroup analyses were also conducted to explore the influences of study features on the relationship. Sensitivity analysis re-estimated the combined effect size after excluding single studies separately to explore the robustness of the results. RESULTS Nine studies involving 29 986 adults from the general population, 6265 (20.9%) of whom had prediabetes, were included. It was shown that prediabetes was not independently associated with a higher incidence of dementia compared with normoglycaemia (adjusted risk ratio (RR): 1.01, 95% confidence interval (CI): 0.85-1.21, P = 0.89, I2 = 39%). Subgroup analyses according to the definitions of prediabetes, follow-up duration, method for diagnosis of dementia, and quality score produced similar findings (P for all subgroup differences >0.05). In addition, prediabetes was not independently associated with the incidence of Alzheimer's disease (RR: 1.24, 95% CI: 0.98-1.56, P = 0.07, I2 = 0%) or vascular dementia (RR: 1.16, 95% CI: 0.70-1.92, P = 0.56, I2 = 0%). Different definitions of prediabetes have the potential to influence the results, as reflected in the subgroup analysis for Alzheimer's disease (RR: 1.30, 95% CI: 1.06-1.60, P = 0.01, I2 = 0%). CONCLUSIONS Prediabetes may not be an independent risk factor of all-cause dementia or vascular dementia in the general adult population. However, changing the definition of prediabetes may have an impact on the outcome for Alzheimer's disease.
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Affiliation(s)
- Qihao Wang
- The Second Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Xinying Li
- The Second Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Nan Teng
- School of Public Health, Dalian Medical University, Dalian, China
| | - Xiaofeng Li
- School of Public Health, Dalian Medical University, Dalian, China
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Yang J, Xu H, Li J, Zhao Y, Guan S, Fu Y, Bao R, Liu Z. The association between undiagnosed diabetes and cognitive function: findings from the China health and retirement longitudinal study. BMC Endocr Disord 2022; 22:151. [PMID: 35658946 PMCID: PMC9167534 DOI: 10.1186/s12902-022-01055-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The cognitive function of people with diabetes has gained an increasing interest in recent years, and this study focuses on exploring the relationship between undiagnosed diabetes and cognitive function among the middle-aged and elderly people in China. METHODS The data came from the China Health and Retirement Longitudinal Study (CHARLS) which was conducted between July and October 2015. 9855 subjects were enrolled in the study. Executive function and episodic memory were used to assess cognitive function. The subjects were divided into three groups: no diabetes, diagnosed diabetes, and undiagnosed diabetes, and weighted multiple linear regression models were established to evaluate the association of undiagnosed diabetes with cognitive function. RESULTS After controlling for covariates, undiagnosed diabetes was statistically associated with executive function (β = -0.215, P < 0.01). In the age group of ≥65 years, undiagnosed diabetes was statistically associated with executive function (β = -0.358, P < 0.01) and episodic memory (β = -0.356, P < 0.01). When adjusting for confounders, no statistically significant associations were found between diagnosed diabetes and cognitive function except in 45-54 age group (β = 0.374, P < 0.05). CONCLUSIONS The cross-sectional study suggested that undiagnosed diabetes was linked to poor cognitive function, especially in the elderly population. Timely diagnosis and active treatment of diabetes are important to reduce the occurrence of cognitive impairment. Further prospective cohort studies are required to articulate the association between undiagnosed diabetes and cognitive function.
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Affiliation(s)
- Jiafei Yang
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
- Research Center of Health Big Data, Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Haiming Xu
- Research Center of Health Big Data, Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
- Department of Occupational and Environmental Health, School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, China
| | - Jiangping Li
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
- Research Center of Health Big Data, Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Yu Zhao
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
- Research Center of Health Big Data, Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Suzhen Guan
- Research Center of Health Big Data, Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
- Department of Occupational and Environmental Health, School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, China
| | - Youjuan Fu
- Department of Occupational and Environmental Health, School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, China
| | - Rui Bao
- Department of Occupational and Environmental Health, School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, China
| | - Zhihong Liu
- Research Center of Health Big Data, Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, 750004, Ningxia Hui Autonomous Region, China.
- Department of Occupational and Environmental Health, School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, China.
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Bello-Chavolla OY, Antonio-Villa NE, Vargas-Vázquez A, Ávila-Funes JA, Aguilar-Salinas CA. Pathophysiological Mechanisms Linking Type 2 Diabetes and Dementia: Review of Evidence from Clinical, Translational and Epidemiological Research. Curr Diabetes Rev 2019; 15:456-470. [PMID: 30648514 DOI: 10.2174/1573399815666190129155654] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/26/2018] [Accepted: 01/08/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Type 2 diabetes represents an increasing health burden world-wide and its prevalence in particularly higher in elderly population. Consistent epidemiological evidence suggests an increased risk of dementia associated to type 2 diabetes; the mechanisms underlying these associations, however, remain unclear. OBJECTIVE The study aims to review epidemiological, clinical and pre-clinical data that weigh on pathophysiological links, mechanisms of disease and associations between type 2 diabetes and dementia to identify areas of opportunity for future research. METHODS We searched the following electronic bibliographic databases: PUBMED, EMBASE, SCIELO, MEDLINE and OVID for clinical, translational and epidemiological research literature that summarize diabetes-related risk factors for dementia, metabolic and neurological changes associated to T2D, evidence of therapeutic approaches in type 2 diabetes and its pathophysiological implications for dementia. RESULTS Type 2 diabetes mellitus increases risk for all-cause dementia, vascular dementia and Alzheimer's disease. The most evaluated mechanisms linking both disorders in pre-clinical studies include an increase in neuronal insulin resistance, impaired insulin signaling, pro-inflammatory state, mitochondrial dysfunction and vascular damage which increase deposition of β-amyloid, tau proteins and GSK3β, leading to an earlier onset of dementia in individuals with impairment in the glucose metabolism. Neuroimaging and neuropathology evidence linking cerebrovascular lesions, neurodegeneration and particularly small-vessel disease in the onset of dementia is consistent with the increased risk of incident dementia in type 2 diabetes, but consistent evidence of AD-related pathology is scarce. Epidemiological data shows increased risk of dementia related to hypoglycemic episodes, glycemic control, metabolic syndrome, insulin resistance and genetic predisposition, but the evidence is not consistent and statistical analysis might be affected by inconsistent covariate controlling. Therapeutic approaches for T2D have shown inconsistent result in relation to dementia prevention and delay of cognitive decline; lifestyle intervention, particularly physical activity, is a promising alternative to ameliorate the impact of disability and frailty on T2D-related dementia. CONCLUSION Vascular disease, inflammation and impaired brain insulin signaling might occur in T2D and contribute to dementia risk. Evidence from epidemiological studies has not consistently reported associations that could integrate a unified mechanism of disease in humans. Evaluation of the effect of antidiabetic medications and non-pharmacological interventions in dementia prevention in type 2 diabetes is promising but has thus far offered inconsistent results.
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Affiliation(s)
- Omar Yaxmehen Bello-Chavolla
- Metabolic Disease Research Unit, National Institute of Medical Sciences and Nutrition, Mexico, United States
- Faculty of Medicine, National Autonomous, University of Mexico, Mexico, United States
| | - Neftali Eduardo Antonio-Villa
- Metabolic Disease Research Unit, National Institute of Medical Sciences and Nutrition, Mexico, United States
- Faculty of Medicine, National Autonomous, University of Mexico, Mexico, United States
| | - Arsenio Vargas-Vázquez
- Metabolic Disease Research Unit, National Institute of Medical Sciences and Nutrition, Mexico, United States
- Faculty of Medicine, National Autonomous, University of Mexico, Mexico, United States
| | - José Alberto Ávila-Funes
- Department of Geriatrics, National Institute of Medical Sciences and Nutrition, Mexico, United States
- University of Bordeaux, Bordeaux Population Health Research Center, 33076 Bordeaux, France
| | - Carlos Alberto Aguilar-Salinas
- Department of Endocrinology and Metabolism, National Institute of Medical Sciences and Nutrition, Mexico, United States
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Sertoma, 64710 Monterrey, N.L., Mexico, United States
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Whitley DM, Fuller-Thomson E. Latino Solo Grandparents Raising Grandchildren: Health Risks and Behaviors. HISPANIC HEALTH CARE INTERNATIONAL 2018; 16:11-19. [PMID: 29493293 DOI: 10.1177/1540415318757219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The purpose of this descriptive report is to provide the first representative information on the sociodemographic profile and the prevalence of mental and physical health conditions of two "at-risk" groups of Latino caregivers: solo grandparent caregivers and single parents. METHODS The 2012 Behavior Risk Factor Surveillance System was used to compare five dimensions of health on a sample of Latino solo grandparents and Latino single parents, raising their grandchildren/children alone. Bivariate and logistic regression comparative analyses were conducted on study measures. RESULTS Latino solo grandparents have a high prevalence of chronic health conditions, including arthritis (51%), depression (40%), diabetes (34%), and asthma (34%). Latino single parents have lower but troubling health risks, including depression (22%), diabetes (14%), and asthma (14%). Differences between the two groups were largely due to the grandparents older age. DISCUSSION Latino solo grandparents have a high prevalence of several chronic medical conditions. The prevalence of disorders is much lower for Latino single parents, although they too have disturbing health risks. CONCLUSION Latino solo grandparents perform their parenting role under intense physical and emotional strain. Health professionals can be instrumental in facilitating interventions that affect the well-being of this expanding family group.
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Li Y, Shang S, Fei Y, Chen C, Jiang Y, Dang L, Liu J, Ma L, Wei M, Qu Q. Interactive relations of type 2 diabetes and abdominal obesity to cognitive impairment: A cross-sectional study in rural area of Xi'an in China. J Diabetes Complications 2018; 32:48-55. [PMID: 29056468 DOI: 10.1016/j.jdiacomp.2017.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 08/26/2017] [Accepted: 09/10/2017] [Indexed: 01/15/2023]
Abstract
AIMS Type 2 diabetes and obesity, which are frequently comorbid, have been associated with cognitive impairment. We aim to examine the potential modulating effect between obesity and diabetes on cognitive impairment. METHODS We recruited 865 adults (aged ≥55years) lived in a village of Xi'an in China from October 2014 to March 2015. All participants underwent biomedical and neuropsychological assessment. Relations of diabetes and abdominal obesity to cognitive impairment were examined in multiple regression models. RESULTS A total of 155 participants (17.9%) presented with the diagnosis of cognitive impairment. Diabetes or obesity alone wasn't significantly associated with cognitive impairment. Interaction analysis showed a significant interaction between abdominal obesity and diabetes on cognitive impairment. Stratified multivariate analysis revealed that the association between diabetes and cognitive impairment was positive in participants with abdominal obesity (OR 2.436, 95% CI 1.345-4.411, p=0.003, in diabetics with high WC, and OR 2.348, 95% CI 1.373-4.014, p=0.002, in diabetics with high WHR), but negative in those without abdominal obesity. CONCLUSIONS Type 2 diabetes interacts with abdominal obesity to be associated with an increased risk of cognitive impairment by more than two times.
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Affiliation(s)
- Yanbo Li
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Suhang Shang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yulang Fei
- The Second Department of Neurology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Chen Chen
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yu Jiang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Liangjun Dang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jie Liu
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Louyan Ma
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; The Second Department of Geriatrics, Xi'an Ninth Hospital, Xi'an, China
| | - Meng Wei
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiumin Qu
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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Acosta I, Borges G, Aguirre-Hernandez R, Sosa AL, Prince M. Neuropsychiatric symptoms as risk factors of dementia in a Mexican population: A 10/66 Dementia Research Group study. Alzheimers Dement 2017; 14:271-279. [PMID: 29028481 PMCID: PMC5869051 DOI: 10.1016/j.jalz.2017.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 08/18/2017] [Accepted: 08/18/2017] [Indexed: 12/23/2022]
Abstract
Introduction Cognitive and/or memory impairment are the main clinical markers currently used to identify subjects at risk of developing dementia. This study aimed to explore the relationship between the presence of neuropsychiatric symptoms and dementia incidence. Methods We analyzed the association between neuropsychiatric symptoms and incident dementia in a cohort of 1355 Mexican older adults from the general population over 3 years of follow-up, modeling cumulative incidence ratios using Poisson models. Results Five neuropsychiatric symptoms were associated with incident dementia: delusions, hallucinations, anxiety, aberrant motor behavior, and depression. The simultaneous presence of two symptoms had a relative risk, adjusted for mild cognitive impairment, diabetes, indicators of cognitive function, and sociodemographic factors, of 1.9 (95% confidence interval, 1.2–2.9), whereas the presence of three to five, similarly adjusted, had a relative risk of 3.0 (95% confidence interval, 1.9–4.8). Discussion Neuropsychiatric symptoms are common in predementia states and may independently contribute as risk factors for developing dementia. Not only cognitive impairment and cognitive features are useful in identifying older adults at risk for developing dementia. Of the 12 neuropsychiatric symptoms evaluated, 5 were associated with incident dementia (delusions, hallucinations, depression, anxiety, and aberrant motor behavior) in a 3-year follow-up. The evaluation of neuropsychiatric symptoms, along with other simple, practical, and inexpensive features, may be useful in identifying subjects at risk of dementia in community health settings and by general practitioners.
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Affiliation(s)
- Isaac Acosta
- Laboratory of Dementias, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Guilherme Borges
- Departament of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramon de la Fuente Muniz, Mexico City, Mexico
| | - Rebeca Aguirre-Hernandez
- Department of Pharmacology, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Ana Luisa Sosa
- Laboratory of Dementias, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
| | - Martin Prince
- Department of Health Service and Population Research, King's College London (Institute of Psychiatry), London, UK
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González-Maciel A, Reynoso-Robles R, Torres-Jardón R, Mukherjee PS, Calderón-Garcidueñas L. Combustion-Derived Nanoparticles in Key Brain Target Cells and Organelles in Young Urbanites: Culprit Hidden in Plain Sight in Alzheimer’s Disease Development. J Alzheimers Dis 2017; 59:189-208. [DOI: 10.3233/jad-170012] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Kawada T. Hypoglycemia and dementia in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2017; 125:65. [PMID: 27855974 DOI: 10.1016/j.diabres.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, Japan.
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