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Article: Pathogenesis of Olfactory Disorders in COVID-19.

Ziuzia-Januszewska, Laura / Januszewski, Marcin

2022 Volume 12, Issue 4

Abstract: Since the outbreak of the SARS-CoV-2 pandemic, olfactory disorders have been reported as a frequent symptom of COVID-19; however, its pathogenesis is still debated. The aim of this review is to summarize the current understanding of the pathogenesis of ... ...

Abstract	Since the outbreak of the SARS-CoV-2 pandemic, olfactory disorders have been reported as a frequent symptom of COVID-19; however, its pathogenesis is still debated. The aim of this review is to summarize the current understanding of the pathogenesis of smell impairment in the course of COVID-19 and to highlight potential avenues for future research on this issue. Several theories have been proposed to explain the pathogenesis of COVID-19-related anosmia, including nasal obstruction and rhinorrhea, oedema of the olfactory cleft mucosa, olfactory epithelial damage either within the olfactory receptor cells or the supporting non-neural cells (either direct or immune-mediated), damage to the olfactory bulb, and impairment of the central olfactory pathways. Although the pathogenesis of COVID-19-related anosmia is still not fully elucidated, it appears to be mainly due to sensorineural damage, with infection of the olfactory epithelium support cells via the ACE1 receptor and disruption of the OE caused by immense inflammatory reaction, and possibly with direct olfactory sensory neurons infection mediated by the NRP-1 receptor. Involvement of the higher olfactory pathways and a conductive component of olfactory disorders, as well as genetic factors, may also be considered.
Language	English
Publishing date	2022-03-27
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2651993-8
ISSN	2076-3425
ISSN	2076-3425
DOI	10.3390/brainsci12040449
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: sFlT-1/PlGF ratio as a predictor of preeclampsia in COVID-19 pregnant patients.

Pluta, Kamil / Januszewski, Marcin / Ziuzia-Januszewska, Laura / Kudan, Michał / Suchocka, Maria / Kuśmierczuk, Kinga / Issat, Tadeusz / Jakimiuk, Artur J

BMC pregnancy and childbirth

2024 Volume 24, Issue 1, Page(s) 94

Abstract: The association between SARS-CoV-2 infection in pregnancy and preeclampsia is widely debated in numerous studies. The aim of our study was to investigate whether an increased sFlt-1/PlGF ratio is a good marker of preeclampsia in pregnant patients with ... ...

Abstract	The association between SARS-CoV-2 infection in pregnancy and preeclampsia is widely debated in numerous studies. The aim of our study was to investigate whether an increased sFlt-1/PlGF ratio is a good marker of preeclampsia in pregnant patients with COVID-19 infection. This single centre prospective study was conducted in the Department of Obstetrics and Gynaecology, at the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw. The study group consisted of 68 COVID-19 pregnant patients and 57 SARS-CoV-2 negative pregnant controls. Serum sFlt-1/PlGF ratio was assessed. The two groups did not differ in terms of the frequency of IVF, nulliparity, history of hypertension, pre-gestational diabetes and chronic kidney disease. The primary outcome was the diagnosis of preeclampsia. Preeclampsia was diagnosed in 10 patients in both groups. The sFlt-1/PlGF ratio higher than 38, considered highly suggestive of developing preeclampsia, was found in 20 patients in the COVID-19 group and 15 patients in the control group. The odds of developing preeclampsia in patients with sFlt-1/PlGF ratio > 38 was approximately 4-fold higher in COVID-19 group and 11-fold higher in controls. Sflt-1/PlGF ratio does not differ significantly between the SARS-CoV-2-positive and SARS-COV-2-negative pregnant patients. The sFlt-1/PlGF ratio > 38 is associated with higher odds of the diagnosis of preeclampsia in both of these groups, and therefore may serve as its marker regardless of COVID-19 infection status.
MeSH term(s)	Pregnancy ; Female ; Humans ; Pre-Eclampsia/diagnosis ; Prospective Studies ; COVID-19/diagnosis ; SARS-CoV-2 ; Placenta Growth Factor ; Parity ; Vascular Endothelial Growth Factor Receptor-1 ; Biomarkers
Chemical Substances	Placenta Growth Factor (144589-93-5) ; Vascular Endothelial Growth Factor Receptor-1 (EC 2.7.10.1) ; Biomarkers
Language	English
Publishing date	2024-01-31
Publishing country	England
Document type	Journal Article
ZDB-ID	2059869-5
ISSN	1471-2393 ; 1471-2393
ISSN (online)	1471-2393
ISSN	1471-2393
DOI	10.1186/s12884-024-06263-y
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Article ; Online: Liver damage profile in COVID-19 pregnant patients.

Januszewski, Marcin / Ziuzia-Januszewska, Laura / Kudan, Michal / Pluta, Kamil / Klapaczyński, Jakub / Wierzba, Waldemar / Maciejewski, Tomasz / Jakimiuk, Alicja A / Jakimiuk, Artur J

Cell communication and signaling : CCS

2024 Volume 22, Issue 1, Page(s) 5

Abstract: Introduction: SARS-CoV-2 unsparingly impacts all areas of medicine. Pregnant women are particularly affected by the pandemic and COVID-19 related liver damage seems to be another threat to maternal and fetal health. The aim of this study is to define ... ...

Abstract	Introduction: SARS-CoV-2 unsparingly impacts all areas of medicine. Pregnant women are particularly affected by the pandemic and COVID-19 related liver damage seems to be another threat to maternal and fetal health. The aim of this study is to define liver damage profile including bile acids serum levels in COVID-19 pregnant patients and to determine predictors of disease aggravation and poor obstetrics outcomes. Methods: This study has been carried out in the Obstetrics and Gynecology Department, at the National Medical Institute in Warsaw, Poland between 01.02.2021 and 01.11.2022 The study cohort comprises 148 pregnant patients with COVID-19 and 102 pregnant controls who has been tested negative for SARS-CoV-2. Results: COVID-19 pregnant patients presented liver involvement at admission in 41,9%. Hepatotoxic damage accounted for 27 (19.85%), cholestatic type was diagnosed in 11 (8.09%) and mixed type of liver injury was presented in 19 (13.97%) of patients. Higher serum levels of AST, ALT, GGT, total bilirubin and bile acids as well as mixed type of liver injury at admission were correlated with severe form of an illness. AST and ALT above upper reference limit as well as hepatotoxic type of liver damage predisposed pregnant patients with COVID-19 to poor obstetrics outcomes. Conclusion: Hepatic damage in pregnant women with COVID-19 is a common, mild, transaminase-dominant, or mixed type of injury, and often correlates with elevated inflammatory markers. SARS-CoV-2 test should be performed as a part of differential diagnosis in elevated liver function tests. Although bile acids serum levels were commonly elevated they seems to be clinically irrelevant in terms of pregnancy outcomes. Video Abstract.
MeSH term(s)	Humans ; Female ; Pregnancy ; COVID-19 ; SARS-CoV-2 ; Liver Diseases ; Liver ; Bile Acids and Salts
Chemical Substances	Bile Acids and Salts
Language	English
Publishing date	2024-01-02
Publishing country	England
Document type	Video-Audio Media ; Journal Article
ZDB-ID	2126315-2
ISSN	1478-811X ; 1478-811X
ISSN (online)	1478-811X
ISSN	1478-811X
DOI	10.1186/s12964-023-01285-z
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Article: Postpartum Blood Loss in COVID-19 Patients-Propensity Score Matched Analysis.

Januszewski, Marcin / Santor-Zaczyńska, Małgorzata / Ziuzia-Januszewska, Laura / Kudan, Michał / Jakimiuk, Alicja A / Wierzba, Waldemar / Jakimiuk, Artur J

Biomedicines

2022 Volume 10, Issue 10

Abstract: The aim of this study was to compare the estimated blood loss and the frequency of obstetric hemorrhage among pregnant women with and without COVID-19 infection. The study was carried out in the Department of Obstetrics and Gynecology, at the Central ... ...

Abstract	The aim of this study was to compare the estimated blood loss and the frequency of obstetric hemorrhage among pregnant women with and without COVID-19 infection. The study was carried out in the Department of Obstetrics and Gynecology, at the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Poland. From 15 May 2020 to 26 April 2021, a total of 224 parturients with COVID-19 infection were admitted for labor. The control group consisted of 300 randomly recruited pre-pandemic deliveries that took place between 15 May 2019 and 26 April 2020 at the Department. The primary outcome was the presence of postpartum hemorrhage, defined as an estimated blood loss of ≥500 mL within 24 h after birth or the need to transfuse 2 or more units of packed red blood cells (pRBCs). Secondary outcomes were the difference between hemoglobin and hematocrit levels at 24 h postpartum, the number of pRBCs units transfused, and the need for transperitoneal drainage. After applying the propensity-score-matching procedure for postpartum bleeding risk factors, 325 eligible patients were included in the final analysis, divided into 203 COVID-19 positive and 122 COVID-19 negative prepandemic deliveries. SARS-CoV-2 infected patients were characterized by a longer activated partial thromboplastin time (APTT), a reduced prothrombin time (PT), and lower platelet count at initial presentation. COVID-19 deliveries were found to be associated with a higher frequency of postpartum hemorrhage, an increased estimated blood loss, the more frequent use of peritoneal drainage, and more pRBCs units transfused. During the pandemic, an increased risk of postpartum hemorrhage posed another threat to SARS-CoV-2 infected pregnant women. It is essential to be aware of this when approaching COVID-19 delivery and to implement efficient preventative methods.
Language	English
Publishing date	2022-10-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2720867-9
ISSN	2227-9059
ISSN	2227-9059
DOI	10.3390/biomedicines10102517
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Article ; Online: Predictors of COVID-19 severity among pregnant patients.

Januszewski, Marcin / Ziuzia-Januszewska, Laura / Jakimiuk, Alicja A / Oleksik, Tomasz / Pokulniewicz, Marek / Wierzba, Waldemar / Kozlowski, Krzysztof / Jakimiuk, Artur J

Bosnian journal of basic medical sciences

2022 Volume 22, Issue 6, Page(s) 1005–1015

Abstract: Coronavirus disease 2019 (COVID-19) was declared a pandemic and has spread around the globe, unsparingly affecting vulnerable populations. Effective prevention measures for pregnant women, who are particularly affected, include early identification of ... ...

Abstract	Coronavirus disease 2019 (COVID-19) was declared a pandemic and has spread around the globe, unsparingly affecting vulnerable populations. Effective prevention measures for pregnant women, who are particularly affected, include early identification of those patients at risk of developing in-hospital complications, and the continuous improvement of maternal-fetal treatment strategies to ensure the efficient use of health resources. The objective of our retrospective study was to determine which patient biomarkers on hospital admission correlate with disease severity as measured by disease course classification, the need for oxygen supplementation and higher demand for oxygen, the need for mechanical ventilation, intensive care unit admission, and length of hospital stay. Analysis of 52 PCR SARS-CoV-2 positive pregnant women revealed that the median date of hospital admission was the 30th gestational week, with dyspnoea, cough, and fever as the leading symptoms. The presence of diabetes and hypertension predisposed pregnant women to the severe course of illness. Lung involvement shown by CT scans on admission correlated with the greater clinical severity. The main laboratory predictors of disease progression were lymphocytopenia, hypocalcemia, low total cholesterol, low total protein levels, and high serum levels of C-reactive protein, ferritin, interleukin-6, glucose, lactate dehydrogenase, procalcitonin, and troponin I. Further research with a larger cohort of pregnant women is needed to determine the utility of these results for everyday practice.
MeSH term(s)	Humans ; Female ; Pregnancy ; COVID-19 ; SARS-CoV-2 ; C-Reactive Protein ; Retrospective Studies ; Procalcitonin ; Troponin I ; Interleukin-6 ; L-Lactate Dehydrogenase ; Ferritins ; Oxygen ; Glucose ; Cholesterol
Chemical Substances	C-Reactive Protein (9007-41-4) ; Procalcitonin ; Troponin I ; Interleukin-6 ; L-Lactate Dehydrogenase (EC 1.1.1.27) ; Ferritins (9007-73-2) ; Oxygen (S88TT14065) ; Glucose (IY9XDZ35W2) ; Cholesterol (97C5T2UQ7J)
Language	English
Publishing date	2022-10-23
Publishing country	Bosnia and Herzegovina
Document type	Journal Article
ZDB-ID	2240029-1
ISSN	1840-4812 ; 1512-8601
ISSN (online)	1840-4812
ISSN	1512-8601
DOI	10.17305/bjbms.2022.7181
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Article ; Online: COVID-19 Severity and Mortality in Two Pandemic Waves in Poland and Predictors of Poor Outcomes of SARS-CoV-2 Infection in Hospitalized Young Adults.

Ziuzia-Januszewska, Laura / Januszewski, Marcin / Sosnowska-Nowak, Joanna / Janiszewski, Mariusz / Dobrzyński, Paweł / Jakimiuk, Alicja A / Jakimiuk, Artur J

Viruses

2022 Volume 14, Issue 8

Abstract: SARS-CoV-2 variants pose a significant threat to global public health. However, their influence on disease severity, especially among young adults who may exhibit different clinical characteristics, is debatable. In this retrospective study of 229 young ... ...

Abstract	SARS-CoV-2 variants pose a significant threat to global public health. However, their influence on disease severity, especially among young adults who may exhibit different clinical characteristics, is debatable. In this retrospective study of 229 young adults hospitalized with COVID-19, we investigated the differences between Poland's second and third waves of the pandemic. To identify potential predictors of severe COVID-19 in young adults, we analyzed patient characteristics and laboratory findings between survivors and non-survivors and we performed logistic regression to assess the risk of death, mechanical ventilation, and intensive care unit treatment. We found no increase in COVID-19 severity comparing the third and second waves of the pandemic, indicating that the alpha variant had no influence on disease severity. In addition, we found that factors, such as obesity, comorbidities, lung involvement, leukocytosis, neutrophilia, lymphopenia, higher IG count, the neutrophil-to-lymphocyte ratio, C-reactive protein, procalcitonin, interleukin-6, D-Dimer, lactate dehydrogenase, high-sensitive troponin I, creatine kinase-myocardial band, myoglobin, N-terminal-pro-B-type natriuretic peptide, creatinine, urea and gamma-glutamyl transferase, lower estimated glomerular filtration rate, albumin, calcium and vitamin D3, possibly a decrease in red blood cell counts, hemoglobin and hematocrit, and an increase in creatine kinase during hospitalization may be associated with poor outcomes of COVID-19.
MeSH term(s)	COVID-19/epidemiology ; Creatine Kinase ; Hospitalization ; Humans ; Pandemics ; Poland/epidemiology ; Retrospective Studies ; SARS-CoV-2 ; Young Adult
Chemical Substances	Creatine Kinase (EC 2.7.3.2)
Language	English
Publishing date	2022-07-31
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2516098-9
ISSN	1999-4915 ; 1999-4915
ISSN (online)	1999-4915
ISSN	1999-4915
DOI	10.3390/v14081700
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Article: COVID-19 Severity and Mortality in Two Pandemic Waves in Poland and Predictors of Poor Outcomes of SARS-CoV-2 Infection in Hospitalized Young Adults

Ziuzia-Januszewska, Laura / Januszewski, Marcin / Sosnowska-Nowak, Joanna / Janiszewski, Mariusz / Dobrzyński, Paweł / Jakimiuk, Alicja A. / Jakimiuk, Artur J.

Viruses. 2022 July 31, v. 14, no. 8

2022

Abstract	SARS-CoV-2 variants pose a significant threat to global public health. However, their influence on disease severity, especially among young adults who may exhibit different clinical characteristics, is debatable. In this retrospective study of 229 young adults hospitalized with COVID-19, we investigated the differences between Poland’s second and third waves of the pandemic. To identify potential predictors of severe COVID-19 in young adults, we analyzed patient characteristics and laboratory findings between survivors and non-survivors and we performed logistic regression to assess the risk of death, mechanical ventilation, and intensive care unit treatment. We found no increase in COVID-19 severity comparing the third and second waves of the pandemic, indicating that the alpha variant had no influence on disease severity. In addition, we found that factors, such as obesity, comorbidities, lung involvement, leukocytosis, neutrophilia, lymphopenia, higher IG count, the neutrophil-to-lymphocyte ratio, C-reactive protein, procalcitonin, interleukin-6, D-Dimer, lactate dehydrogenase, high-sensitive troponin I, creatine kinase-myocardial band, myoglobin, N-terminal-pro-B-type natriuretic peptide, creatinine, urea and gamma-glutamyl transferase, lower estimated glomerular filtration rate, albumin, calcium and vitamin D3, possibly a decrease in red blood cell counts, hemoglobin and hematocrit, and an increase in creatine kinase during hospitalization may be associated with poor outcomes of COVID-19.
Keywords	C-reactive protein ; COVID-19 infection ; Severe acute respiratory syndrome coronavirus 2 ; albumins ; calcium ; cholecalciferol ; creatine ; creatine kinase ; creatinine ; death ; disease severity ; gamma-glutamyltransferase ; glomerular filtration rate ; hematocrit ; hemoglobin ; interleukin-6 ; lactate dehydrogenase ; lungs ; mortality ; myoglobin ; natriuretic peptides ; obesity ; pandemic ; patients ; public health ; regression analysis ; retrospective studies ; risk assessment ; urea ; Poland
Language	English
Dates of publication	2022-0731
Publishing place	Multidisciplinary Digital Publishing Institute
Document type	Article
ZDB-ID	2516098-9
ISSN	1999-4915
ISSN	1999-4915
DOI	10.3390/v14081700
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Liver damage profile in COVID-19 pregnant patients

Marcin Januszewski / Laura Ziuzia-Januszewska / Michal Kudan / Kamil Pluta / Jakub Klapaczyński / Waldemar Wierzba / Tomasz Maciejewski / Alicja A. Jakimiuk / Artur J. Jakimiuk

Cell Communication and Signaling, Vol 22, Iss 1, Pp 1-

2024 Volume 11

Abstract: Abstract Introduction SARS-CoV-2 unsparingly impacts all areas of medicine. Pregnant women are particularly affected by the pandemic and COVID-19 related liver damage seems to be another threat to maternal and fetal health. The aim of this study is to ... ...

Abstract	Abstract Introduction SARS-CoV-2 unsparingly impacts all areas of medicine. Pregnant women are particularly affected by the pandemic and COVID-19 related liver damage seems to be another threat to maternal and fetal health. The aim of this study is to define liver damage profile including bile acids serum levels in COVID-19 pregnant patients and to determine predictors of disease aggravation and poor obstetrics outcomes. Methods This study has been carried out in the Obstetrics and Gynecology Department, at the National Medical Institute in Warsaw, Poland between 01.02.2021 and 01.11.2022 The study cohort comprises 148 pregnant patients with COVID-19 and 102 pregnant controls who has been tested negative for SARS-CoV-2. Results COVID-19 pregnant patients presented liver involvement at admission in 41,9%. Hepatotoxic damage accounted for 27 (19.85%), cholestatic type was diagnosed in 11 (8.09%) and mixed type of liver injury was presented in 19 (13.97%) of patients. Higher serum levels of AST, ALT, GGT, total bilirubin and bile acids as well as mixed type of liver injury at admission were correlated with severe form of an illness. AST and ALT above upper reference limit as well as hepatotoxic type of liver damage predisposed pregnant patients with COVID-19 to poor obstetrics outcomes. Conclusion Hepatic damage in pregnant women with COVID-19 is a common, mild, transaminase-dominant, or mixed type of injury, and often correlates with elevated inflammatory markers. SARS-CoV-2 test should be performed as a part of differential diagnosis in elevated liver function tests. Although bile acids serum levels were commonly elevated they seems to be clinically irrelevant in terms of pregnancy outcomes. Video Abstract
Keywords	COVID-19 ; Liver damage ; Pregnancy ; Bile acids ; SARS-CoV-2 ; Medicine ; R ; Cytology ; QH573-671
Subject code	610
Language	English
Publishing date	2024-01-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
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Article ; Online: Is the Course of COVID-19 Different during Pregnancy? A Retrospective Comparative Study.

Januszewski, Marcin / Ziuzia-Januszewska, Laura / Jakimiuk, Alicja A / Wierzba, Waldemar / Gluszko, Anna / Zytynska-Daniluk, Joanna / Jakimiuk, Artur J

International journal of environmental research and public health

2021 Volume 18, Issue 22

Abstract: The COVID-19 pandemic has challenged health systems around the world. Maternal-foetal medicine, which has been particularly affected, must consider scientific data on the physiological processes occurring in the pregnant woman's body to develop relevant ... ...

Abstract	The COVID-19 pandemic has challenged health systems around the world. Maternal-foetal medicine, which has been particularly affected, must consider scientific data on the physiological processes occurring in the pregnant woman's body to develop relevant standards of care. Our study retrospectively compared the clinical and laboratory characteristics of 52 COVID-19 pregnant patients with 53 controls. Most of the pregnant patients required medical attention during the third trimester and therefore we propose that vaccination is needed prior to the 30th week of pregnancy. We found no differences between the 2 groups in the course of illness classification system, days of hospital stay, need for oxygen supplementation, need for mechanical ventilation, and ICU admission. Moreover, clinical manifestations and imaging findings were comparable. Pregnant patients needed a greater oxygen flow rate and required high flow oxygen therapy more frequently. Considering pregnancy-related physiological adaptations, we found that COVID-19 infection in pregnant patients is associated with higher levels of inflammatory markers, apart from serum ferritin, than in non-pregnant women, and concluded that biomarkers of cardiac and muscle injury, as well as kidney function, may not be good predictors of COVID-19 clinical course in pregnant patients at the time of admission, but more research needs to be conducted on this topic.
MeSH term(s)	COVID-19 ; Female ; Humans ; Pandemics ; Pregnancy ; Pregnancy Complications, Infectious ; Respiration, Artificial ; Retrospective Studies ; SARS-CoV-2
Language	English
Publishing date	2021-11-16
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph182212011
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Article ; Online: Simple Disposable Odor Identification Tests for Predicting SARS-CoV-2 Positivity.

Ziuzia-Januszewska, Laura / Dobrzyński, Paweł / Ślączka, Krzysztof / Ciszek, Jaromir / Krawiec, Łukasz / Wierzba, Waldemar / Zaczyński, Artur

International journal of environmental research and public health

2021 Volume 18, Issue 19

Abstract: Olfactory dysfunction (OD) is a common manifestation of COVID-19 and may be useful for screening. Survey-based olfactory evaluation tends to underestimate the prevalence of OD, while psychophysical olfactory testing during a pandemic has the disadvantage ...

Abstract	Olfactory dysfunction (OD) is a common manifestation of COVID-19 and may be useful for screening. Survey-based olfactory evaluation tends to underestimate the prevalence of OD, while psychophysical olfactory testing during a pandemic has the disadvantage of being time consuming, expensive, and requiring standardized laboratory settings. We aimed to develop a quick, simple, affordable, and reliable test to objectively assess the prevalence and diagnostic accuracy of OD in COVID-19. The olfactory function of 64 COVID-19 inpatients and 34 controls was evaluated using a questionnaire and a simple disposable odor identification test (SDOIT) developed for this study. Four SDOIT models were assessed: 10-SDOIT, 9-SDOIT, 8-SDOIT, and 4-SDOIT, with 10, 9, 8 and 4 samples, respectively. We found a high frequency of self-reported OD in COVID-19 patients, with 32.8% and 42.2% reporting current and recent OD, respectively. Different SDOIT models revealed smell impairment in 54.7-64.1% of COVID-19 patients. The combination of either 10-SDOIT results and self-reported OD, or 8-SDOIT results and self-reported OD, were the best predictors of COVID-19, both with an AUC value of 0.87 (0.85 and 0.86 for the age-matched subjects). OD is a common symptom of COVID-19. A combination of self-reported smell deterioration and OD psychophysically evaluated using SDOIT appears to be a good predictor of COVID-19.
MeSH term(s)	COVID-19 ; Humans ; Odorants ; Olfaction Disorders/diagnosis ; Olfaction Disorders/epidemiology ; Pandemics ; SARS-CoV-2 ; Smell
Language	English
Publishing date	2021-09-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph181910185
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