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Chong GY, Kaur S, Ruzita AT, Wilfred Mok KH, Tan HY, Loy SL, Chen LW, Siah WY, Lim GP, Chee YY, June Lem EM, Koo HC. Scoping review: Exploring the relationship between chrononutrition and glycemic responses in the adult population. Chronobiol Int 2024; 41:904-923. [PMID: 38832541 DOI: 10.1080/07420528.2024.2360742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 05/21/2024] [Indexed: 06/05/2024]
Abstract
Chrononutrition, an emerging body of evidence on the relationship between biological rhythms and metabolism, has been established to be associated with glycemic responses. However, the available evidence is inconsistent, due to protocol variations. Therefore, this review aims to summarize the findings on chrononutrition characteristics and their association with glycemic responses among adults. Systematic searches were conducted across six databases (PubMed, EBSCO Host, ProQuest Central, MEDLINE & Ovid, Scopus and Web of Science) to identify all relevant studies published from January 2012. Two reviewers independently screened the abstracts and full-text articles based on the inclusion and exclusion criteria. Details about population characteristics, study methods and key findings were extracted following the PRISMA-ScR guideline. The quality of selected studies was evaluated using the mixed methods appraisal tool. The searchers identified 49 studies eligible for analysis. The results showed that meal timing, particularly night-time eating and snacking were associated with glycemic responses. Regarding meal regularity, skipping breakfast may affect glycemic responses, but no clear conclusion was drawn about its effect on insulin. The association between meal frequency and glycemic responses was inconclusive. Night fasting duration and restricted eating window are potentially associated with glycemic responses. The current review extensively investigates the association between chrononutrition factors and glycemic responses in adults. However, more prospective cohort and interventional studies are needed to better understand this causal-effect relationship.
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Affiliation(s)
- Guey Yong Chong
- Faculty of Applied Sciences, Tunku Abdul Rahman University of Management and Technology, Kuala Lumpur, Malaysia
| | - Satvinder Kaur
- Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Abd Talib Ruzita
- Nutritional Sciences Program, Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Kok Hoe Wilfred Mok
- Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Hui Yin Tan
- Faculty of Applied Sciences, Tunku Abdul Rahman University of Management and Technology, Kuala Lumpur, Malaysia
| | - See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Obstetrics & Gynecology Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Ling-Wei Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Master of Public Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Woan Yie Siah
- Klinik Kesihatan Batu Berendam, Pejabat Kesihatan Daerah Melaka Tengah, Melaka, Malaysia
| | - Geok Pei Lim
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Yin Yin Chee
- Faculty of Applied Sciences, Tunku Abdul Rahman University of Management and Technology, Kuala Lumpur, Malaysia
| | - Ee Mun June Lem
- Faculty of Applied Sciences, Tunku Abdul Rahman University of Management and Technology, Kuala Lumpur, Malaysia
| | - Hui Chin Koo
- Faculty of Applied Sciences, Tunku Abdul Rahman University of Management and Technology, Kuala Lumpur, Malaysia
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Kok EY, Kaur S, Mohd Shukri NH, Abdul Razak N, Takahashi M. Development, validation, and reliability of the Chrononutrition Profile Questionnaire-Pregnancy (CPQ-P). BMC Pregnancy Childbirth 2024; 24:217. [PMID: 38521925 PMCID: PMC10960373 DOI: 10.1186/s12884-024-06403-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND During pregnancy, physiological changes can affect eating and sleeping habits, which may eventually have negative consequences for maternal and foetal health. To better understand these changes, it is essential to develop a reliable questionnaire that addresses lifestyle habits such as snacking and daytime napping. This study aimed to determine the validity and reliability of the Chrononutrition Profile Questionnaire-Pregnancy (CPQ-P). METHODS A total of 399 women in their second and third trimester of pregnancy were recruited from government maternal and child health clinics in Kuala Lumpur and Putrajaya and completed a self-administered online questionnaire. Content validity was conducted with an expert panel consisting of 4 members. Confirmatory factor analysis (CFA) using maximum likelihood was conducted to determine the construct validity. Internal consistency was determined by Cronbach's alpha coefficient (CAC), while the test-retest reliability was conducted using intraclass correlation coefficient (ICC). RESULTS The questionnaire had an appropriate content validity index of 0.91. The CPQ-P consists of 22 items, measuring 5 constructs, including morning chrono-habits, sleeping habits, evening eating, temporal eating, and pregnancy symptoms. The factor model showed good fit with χ2/df = 2.486, GFI = 0.893, CFI = 0.912, and RMSEA = 0.065. The 22 items in CPQ-P showed fair to excellent test-retest reliability (ICC: 0.42 to 0.98). The 5 constructs in CPQ-P were found to have a good to excellent internal consistency (α = 0.612-0.963). CONCLUSIONS The CPQ-P is a valid and reliable tool for assessing lifestyle habits during pregnancy. The questionnaire can be used to identify areas where pregnant women may need additional support or intervention to adopt healthy behaviours and reduce the risk of adverse maternal and foetal outcomes. TRIAL REGISTRATION NCT05700136 (clinicaltrials.gov). Trial registration date: 26/01/2023.
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Affiliation(s)
- Ee Yin Kok
- Department of Food Science and Nutrition, Faculty of Applied Sciences, UCSI University, Cheras, Wilayah Persekutuan Kuala Lumpur, 56000, Malaysia
| | - Satvinder Kaur
- Department of Food Science and Nutrition, Faculty of Applied Sciences, UCSI University, Cheras, Wilayah Persekutuan Kuala Lumpur, 56000, Malaysia.
| | - Nurul Husna Mohd Shukri
- Department of Nutrition, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
| | - Nurliyana Abdul Razak
- Department of Food Science and Nutrition, Faculty of Applied Sciences, UCSI University, Cheras, Wilayah Persekutuan Kuala Lumpur, 56000, Malaysia
| | - Masaki Takahashi
- Institute for Liberal Arts, Tokyo Institute of Technology, Tokyo, Japan
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Roberto DMT, Pereira LJ, Vieira FGK, Di Pietro PF, de Assis MAA, Hinnig PDF. Association between Sleep Timing, Being Overweight and Meal and Snack Consumption in Children and Adolescents in Southern Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6791. [PMID: 37754650 PMCID: PMC10531239 DOI: 10.3390/ijerph20186791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023]
Abstract
Sleep timing is one of the dimensions of sleep that refers to the time of day when sleep occurs. It has been included in sleep-related research because of the potential associations between being overweight and the consumption of meals and snacks. This cross-sectional study aimed to investigate associations between sleep timing, meal and snack consumption and weight status in 1333 schoolchildren aged 7-14 years. The midpoint of sleep was used as a sleep timing measure obtained by the midpoint between bedtime and wake-up time, classified as Early, Intermediate, and Late. Schoolchildren in the Early group were less likely to be overweight (OR: 0.83, 95% CI 0.69; 0.99), and had higher odds of mid-morning snack consumption (OR: 1.95, 95% CI 1.56; 2.44) and lower probability to consume an evening snack (OR: 0.75, 95% CI 0.59; 0.94) compared with the Intermediate group. The Late group had lower odds of mid-morning snack consumption (OR: 0.67, 95% CI 0.55, 0.80) than the Intermediate group. The consumption of mid-morning and evening snacks was associated with the Early and Late midpoints of sleep. These results suggest that bedtime and wake-up time are relevant to consuming meals and snacks and may also be related to a greater probability of being overweight in children and adolescents.
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Affiliation(s)
| | | | | | | | | | - Patrícia de Fragas Hinnig
- Post-Graduation Program in Nutrition, Health Sciences Center, Federal University of Santa Catarina, Florianópolis 88040-900, Brazil
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BaHammam AS, Pirzada A. Timing Matters: The Interplay between Early Mealtime, Circadian Rhythms, Gene Expression, Circadian Hormones, and Metabolism-A Narrative Review. Clocks Sleep 2023; 5:507-535. [PMID: 37754352 PMCID: PMC10528427 DOI: 10.3390/clockssleep5030034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/24/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023] Open
Abstract
Achieving synchronization between the central and peripheral body clocks is essential for ensuring optimal metabolic function. Meal timing is an emerging field of research that investigates the influence of eating patterns on our circadian rhythm, metabolism, and overall health. This narrative review examines the relationship between meal timing, circadian rhythm, clock genes, circadian hormones, and metabolic function. It analyzes the existing literature and experimental data to explore the connection between mealtime, circadian rhythms, and metabolic processes. The available evidence highlights the importance of aligning mealtime with the body's natural rhythms to promote metabolic health and prevent metabolic disorders. Specifically, studies show that consuming meals later in the day is associated with an elevated prevalence of metabolic disorders, while early time-restricted eating, such as having an early breakfast and an earlier dinner, improves levels of glucose in the blood and substrate oxidation. Circadian hormones, including cortisol and melatonin, interact with mealtimes and play vital roles in regulating metabolic processes. Cortisol, aligned with dawn in diurnal mammals, activates energy reserves, stimulates appetite, influences clock gene expression, and synchronizes peripheral clocks. Consuming meals during periods of elevated melatonin levels, specifically during the circadian night, has been correlated with potential implications for glucose tolerance. Understanding the mechanisms of central and peripheral clock synchronization, including genetics, interactions with chronotype, sleep duration, and hormonal changes, provides valuable insights for optimizing dietary strategies and timing. This knowledge contributes to improved overall health and well-being by aligning mealtime with the body's natural circadian rhythm.
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Affiliation(s)
- Ahmed S. BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh 11324, Saudi Arabia
| | - Abdulrouf Pirzada
- North Cumbria Integrated Care (NCIC), National Health Service (NHS), Carlisle CA2 7HY, UK;
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Chrono-Nutrition: Circadian Rhythm and Personalized Nutrition. Int J Mol Sci 2023; 24:ijms24032571. [PMID: 36768893 PMCID: PMC9916946 DOI: 10.3390/ijms24032571] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
The human circadian system has a period of approximately 24 h and studies on the consequences of "chornodisruption" have greatly expanded. Lifestyle and environmental factors of modern societies (i.e., artificial lighting, jetlag, shift work, and around-the-clock access to energy-dense food) can induce disruptions of the circadian system and thereby adversely affect individual health. Growing evidence demonstrates a complex reciprocal relationship between metabolism and the circadian system, in which perturbations in one system affect the other one. From a nutritional genomics perspective, genetic variants in clock genes can both influence metabolic health and modify the individual response to diet. Moreover, an interplay between the circadian rhythm, gut microbiome, and epigenome has been demonstrated, with the diet in turn able to modulate this complex link suggesting a remarkable plasticity of the underlying mechanisms. In this view, the study of the impact of the timing of eating by matching elements from nutritional research with chrono-biology, that is, chrono-nutrition, could have significant implications for personalized nutrition in terms of reducing the prevalence and burden of chronic diseases. This review provides an overview of the current evidence on the interactions between the circadian system and nutrition, highlighting how this link could in turn influence the epigenome and microbiome. In addition, possible nutritional strategies to manage circadian-aligned feeding are suggested.
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Mazri FH, Manaf ZA, Shahar S, Mat Ludin AF, Abdul Basir SM. Development and Evaluation of Integrated Chrono-Nutrition Weight Reduction Program among Overweight/Obese with Morning and Evening Chronotypes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084469. [PMID: 35457337 PMCID: PMC9029858 DOI: 10.3390/ijerph19084469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/07/2022]
Abstract
This paper describes the development of an integrated chrono-nutrition weight reduction program and the evaluation of the attendance, retention, satisfaction and compliance towards the chrono-nutrition components among morning and evening chronotypes for overweight/obese non-shift workers. The present study was conducted in two phases: Phase I was composed of needs assessments on the chronotypes’ dietary patterns and chrono-nutrition through a scoping review and integrating the chrono-nutrition components (temporal eating pattern, meal timing and sleeping habits) alongside the existing weight reduction module, SLIMSHAPE™. Phase II consisted of a feasibility study to evaluate the integrated chrono-nutrition weight reduction program (SLIMSHAPE™ Chrono). A total of 91 overweight/obese non-shift workers participated in the 12-week weight reduction program (Age: 39.6 ± 6.3 years; 74.7% women; BMI: 31.2 ± 4.5 kg/m2). Low attrition rate was recorded, with 85 participants (93.4%) completing the pre- and post-intervention assessments. Overall, morning and evening chronotypes had increased their % energy intake in the early eating window (MT: 64.8 vs. 67.2%, ET: 62.7 vs. 65.6%, Mean difference (MD): 2.8, 95%CI: 0.3, 5.1, p = 0.028) and reduced their intake in the late eating window (MT: 35.2 vs. 32.8%, ET: 37.3 vs. 34.4%, MD: −2.8, 95%CI: −5.1, −0.3, p = 0.028) and earlier midpoint of eating (MT: 14:02 vs. 13:49; ET: 14:27 vs. 14:18, 95%CI: −0.4, −0.02, p = 0.029) and had a reduced night eating syndrome score (MT: 10.0 vs. 8.9; ET: 10.7 vs. 8.9, MD: −1.5, 95%CI: −2.5, −0.5, p = 0.004). There was no significant change in the first (MT: 08:12 vs. 08:04, ET: 08:24 vs. 08:22, MD: −0.1, 95%CI: −0.2, 0.03, p = 0.170) and last mealtime (MT: 19:52 vs. 19:33, ET: 20:29 vs. 20:14, MD: −0.3, 95%CI: −0.6, −0.04, p = 0.081), eating duration (MT: 11.7 vs. 11.5 h, ET: 12.1 vs. 11.9 h, MD: −0.2, 95%CI: −0.6, 0.2, p = 0.251) and the elapse time between sleep onset and last meal (MT: 3.1 vs. 3.5 h, ET: 3.5 vs. 3.2 h, MD: 0.1, 95%CI: −0.3, 0.4, p = 0.678). In terms of sleep, evening chronotypes increased their sleep duration (MD: 0.8 h, 95% CI: 0.4, 1.2, p < 0.001) and reduced social jetlag (MD: 19 min, 95% CI: 1.7, 36.3, p = 0.031) post-intervention compared to morning chronotypes. The integrated chrono-nutrition weight reduction program among morning and evening chronotypes improved the temporal pattern of energy intake, meal timing, night eating syndrome and sleep habits post-intervention. The chrono-nutrition practice could be a potentially modifiable behavior as an adjunct strategy in weight management.
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Affiliation(s)
- Fatin Hanani Mazri
- Dietetic Program and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (F.H.M.); (S.S.); (S.M.A.B.)
| | - Zahara Abdul Manaf
- Dietetic Program and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (F.H.M.); (S.S.); (S.M.A.B.)
- Correspondence:
| | - Suzana Shahar
- Dietetic Program and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (F.H.M.); (S.S.); (S.M.A.B.)
| | - Arimi Fitri Mat Ludin
- Biomedical Science Program and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Siti Munirah Abdul Basir
- Dietetic Program and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (F.H.M.); (S.S.); (S.M.A.B.)
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Mazri FH, Manaf ZA, Shahar S, Mat Ludin AF, Karim NA, Hazwari NDD, Kek QW, Abdul Basir SM, Arifin A. Do Temporal Eating Patterns Differ in Healthy versus Unhealthy Overweight/Obese Individuals? Nutrients 2021; 13:nu13114121. [PMID: 34836375 PMCID: PMC8618797 DOI: 10.3390/nu13114121] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 01/29/2023] Open
Abstract
This study examined whether the temporal patterns of energy and macronutrient intake in early and late eating windows were associated with metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) among non-shift workers. A total of 299 overweight/obese non-shift workers (Age: 40.3 ± 6.9 years; 73.6% women; BMI: 31.7 ± 5.0 kg/m2) were recruited in the Klang Valley area of Malaysia. The biochemical parameters were determined from fasting blood samples, whereas information on dietary intake and timing was obtained from a 7-day diet history questionnaire. The midpoint of eating was used to determine the early and late windows. Compared to MHO non-shift workers (n = 173), MUO non-shift workers (n = 126) had lower energy intake from carbohydrates and protein during the early window. In contrast, MUO participants had greater energy intake from carbohydrates and fat during the late window. Participants with unhealthy metabolic status (regardless of their chronotypes) had similar temporal patterns of energy intake characterized by smaller energy intake during the early window and greater energy intake during the late window compared with participants with healthier metabolic status. Overall, the lowest percentile of energy intake during the early window was associated with an increased risk of MUO, after adjustment for potential confounders [odds ratio (OR) = 4.30, 95% confidence interval (CI) 1.41-13.11]. The greater the energy intake during the late window, the greater the risk of MUO (OR = 2.38, 95% CI 1.11-5.13) (OR = 2.33, 95% CI 1.03-5.32) (OR = 4.45, 95% CI 1.71-11.56). In summary, consuming less energy earlier in the day and more energy and carbohydrate later in the day was associated with a greater risk of MUO. Thus, a prospective study is needed to explore the potential role of chrono-nutrition practices in modifying risk factors to delay the transition of MHO to MUO.
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Affiliation(s)
- Fatin Hanani Mazri
- Dietetic Program and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (F.H.M.); (S.S.); (N.D.D.H.); (Q.W.K.); (S.M.A.B.)
| | - Zahara Abdul Manaf
- Dietetic Program and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (F.H.M.); (S.S.); (N.D.D.H.); (Q.W.K.); (S.M.A.B.)
- Correspondence:
| | - Suzana Shahar
- Dietetic Program and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (F.H.M.); (S.S.); (N.D.D.H.); (Q.W.K.); (S.M.A.B.)
| | - Arimi Fitri Mat Ludin
- Biomedical Science Program and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Norwahidah Abdul Karim
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur 56000, Malaysia;
| | - Nur Diyana Dalila Hazwari
- Dietetic Program and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (F.H.M.); (S.S.); (N.D.D.H.); (Q.W.K.); (S.M.A.B.)
| | - Qi Wen Kek
- Dietetic Program and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (F.H.M.); (S.S.); (N.D.D.H.); (Q.W.K.); (S.M.A.B.)
| | - Siti Munirah Abdul Basir
- Dietetic Program and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (F.H.M.); (S.S.); (N.D.D.H.); (Q.W.K.); (S.M.A.B.)
| | - Asnida Arifin
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
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de la Hunty A, Gallagher AM, Buttriss JL. Nutrition Bulletin
recognised with Impact Factor™. NUTR BULL 2021. [DOI: 10.1111/nbu.12520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Alison M. Gallagher
- Ulster University Doctoral College, Ulster University Coleraine Co. Londonderry UK
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