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Johansson, Bengt
Publications (10 of 97) Show all publications
Chen, H. Y., Cairns, B. J., Small, A. M., Burr, H. A., Ambikkumar, A., Martinsson, A., . . . Thanassoulis, G. (2020). Association of FADS1/2 Locus Variants and Polyunsaturated Fatty Acids With Aortic Stenosis. JAMA cardiology
Open this publication in new window or tab >>Association of FADS1/2 Locus Variants and Polyunsaturated Fatty Acids With Aortic Stenosis
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2020 (English)In: JAMA cardiology, ISSN 2380-6583, E-ISSN 2380-6591Article in journal (Refereed) Epub ahead of print
Abstract [en]

Importance: Aortic stenosis (AS) has no approved medical treatment. Identifying etiological pathways for AS could identify pharmacological targets.

Objective: To identify novel genetic loci and pathways associated with AS.

Design, Setting, and Participants: This genome-wide association study used a case-control design to evaluate 44 703 participants (3469 cases of AS) of self-reported European ancestry from the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort (from January 1, 1996, to December 31, 2015). Replication was performed in 7 other cohorts totaling 256 926 participants (5926 cases of AS), with additional analyses performed in 6942 participants from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium. Follow-up biomarker analyses with aortic valve calcium (AVC) were also performed. Data were analyzed from May 1, 2017, to December 5, 2019.

Exposures: Genetic variants (615 643 variants) and polyunsaturated fatty acids (ω-6 and ω-3) measured in blood samples.

Main Outcomes and Measures: Aortic stenosis and aortic valve replacement defined by electronic health records, surgical records, or echocardiography and the presence of AVC measured by computed tomography.

Results: The mean (SD) age of the 44 703 GERA participants was 69.7 (8.4) years, and 22 019 (49.3%) were men. The rs174547 variant at the FADS1/2 locus was associated with AS (odds ratio [OR] per C allele, 0.88; 95% CI, 0.83-0.93; P = 3.0 × 10-6), with genome-wide significance after meta-analysis with 7 replication cohorts totaling 312 118 individuals (9395 cases of AS) (OR, 0.91; 95% CI, 0.88-0.94; P = 2.5 × 10-8). A consistent association with AVC was also observed (OR, 0.91; 95% CI, 0.83-0.99; P = .03). A higher ratio of arachidonic acid to linoleic acid was associated with AVC (OR per SD of the natural logarithm, 1.19; 95% CI, 1.09-1.30; P = 6.6 × 10-5). In mendelian randomization, increased FADS1 liver expression and arachidonic acid were associated with AS (OR per unit of normalized expression, 1.31 [95% CI, 1.17-1.48; P = 7.4 × 10-6]; OR per 5-percentage point increase in arachidonic acid for AVC, 1.23 [95% CI, 1.01-1.49; P = .04]; OR per 5-percentage point increase in arachidonic acid for AS, 1.08 [95% CI, 1.04-1.13; P = 4.1 × 10-4]).

Conclusions and Relevance: Variation at the FADS1/2 locus was associated with AS and AVC. Findings from biomarker measurements and mendelian randomization appear to link ω-6 fatty acid biosynthesis to AS, which may represent a therapeutic target.

Place, publisher, year, edition, pages
JAMA Network, 2020
National Category
Cardiac and Cardiovascular Systems
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-170494 (URN)10.1001/jamacardio.2020.0246 (DOI)32186652 (PubMedID)
Funder
Västerbotten County Council, VLL-548791Swedish Heart Lung Foundation, 2016-0134Swedish Heart Lung Foundation, 2016-0315Swedish Research Council, 2017-02554Swedish Research Council, 349-2006-237Swedish Research Council, 2009-1039Knut and Alice Wallenberg FoundationSwedish Foundation for Strategic Research , IRC15-0067NIH (National Institute of Health)
Available from: 2020-05-07 Created: 2020-05-07 Last updated: 2020-05-07
Skoglund, K., Heimdahl, J., Mandalenakis, Z., Thilén, U., Johansson, B., Christersson, C., . . . Dellborg, M. (2020). Effect of medical treatment in patients with systemic right ventricle. Scandinavian Cardiovascular Journal, 1-6
Open this publication in new window or tab >>Effect of medical treatment in patients with systemic right ventricle
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2020 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, p. 1-6Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective: Congenitally corrected and surgical atrial redirected transposition of the great arteries (TGA) represents states where the morphological right ventricle serves as a systemic ventricle (S-RV). The S-RV is prone to failure, but data on medical treatment on this problem is limited. The purpose of this study was to evaluate the survival in adults with S-RV, with or without heart failure treatment.

Design: The SWEDCON registry was used to collect data. All adults with S-RV and minimum follow-up of 1 year were included retrospectively. Medical treatment was defined as taking beta-blockers and/or ACE inhibitors and/or ARBs for more than 50% of the time.

Results: We identified 343 patients with S-RV (median age: 21 years). Surgical atrial redirected TGA was present in 58% and congenitally corrected TGA in 42% of patients. The medically treated group (n = 126) had higher rates of impaired S-RV function, use of diuretics, pacemaker and higher NYHA functional class at baseline compared to controls. The proportion of patients with impaired functional class did not change over time in the medically treated group, but increased in controls (21% vs. 30%, p = .015). In Kaplan–Meier analysis, the mean follow-up was 10.3 years, no difference in survival was seen between the groups.

Conclusions: Medical treatment may be beneficial in patients with S-RV and impaired functional class and appears to be safe in the long term. The treatment group had equal survival to controls, despite worse baseline characteristics, which might be a result of slower progression of disease in this group.

Keywords
Systemic right ventricle, heart failure, medical treatment
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology; Cardiology
Identifiers
urn:nbn:se:umu:diva-170493 (URN)10.1080/14017431.2020.1751266 (DOI)32274953 (PubMedID)
Available from: 2020-05-07 Created: 2020-05-07 Last updated: 2020-05-07
Skogby, S., Moons, P., Johansson, B., Sunnegårdh, J., Christersson, C., Nagy, E., . . . Bratt, E.-L. (2020). Outpatient volumes and medical staffing resources as predictors for continuity of follow-up care during transfer of adolescents with congenital heart disease. International Journal of Cardiology, 310, 51-57
Open this publication in new window or tab >>Outpatient volumes and medical staffing resources as predictors for continuity of follow-up care during transfer of adolescents with congenital heart disease
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2020 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 310, p. 51-57Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Providing continuous follow-up care to patients with congenital heart disease (CHD) remains a challenge in many settings. Previous studies highlight that patients with CHD experience discontinuation of follow-up care, but mainly describe a single-centre perspective, neglecting inter-institutional variations. Hospital-related factors above and beyond patient-related factors are believed to affect continuity of care. The present multicentre study therefore investigated (i) proportion of "no follow-up care"; (ii) transfer destinations after leaving paediatric cardiology; (iii) variation in proportions of no follow-up between centres; (iv) the association between no follow-up and outpatient volumes, and (v) its relationship with staffing resources at outpatient clinics.

METHODS: An observational, multicentre study was conducted in seven university hospitals. In total, 654 adolescents with CHD, born between 1991 and 1993, with paediatric outpatient visit at age 14-18 years were included. Transfer status was determined 5 years after the intended transfer to adult care (23y), based on medical files, self-reports and registries.

RESULTS: Overall, 89.7% of patients were receiving adult follow-up care after transfer; 6.6% had no follow-up; and 3.7% were untraceable. Among patients in follow-up care, only one remained in paediatric care and the majority received specialist adult CHD care. Significant variability in proportions of no follow-up were identified across centres. Higher outpatient volumes at paediatric outpatient clinics were associated with better continued follow-up care after transfer (OR = 1.061; 95% CI = 1.001 - 1.124). Medical staffing resources were not found predictive.

CONCLUSION: Our findings support the theory of hospital-related factors influencing continuity of care, above and beyond patient-related characteristics.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Adolescent, Continuity of patient care, Heart defects, congenital, Patient transfer, Transition to adult care, Young adult
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-170495 (URN)10.1016/j.ijcard.2020.01.016 (DOI)31959410 (PubMedID)
Available from: 2020-05-07 Created: 2020-05-07 Last updated: 2020-05-07Bibliographically approved
Sandberg, C., Crenshaw, A. G., Elcadi, G. H., Christersson, C., Hlebowicz, J., Thilen, U. & Johansson, B. (2019). Adults with congenital heart disease have impaired calf muscle oxygenation compared to control subjects. Paper presented at Congress of the European-Society-of-Cardiology (ESC) / World Congress of Cardiology, Paris, FRANCE, AUG 31-SEP 04, 2019.. European Heart Journal, 40, 1091-1091
Open this publication in new window or tab >>Adults with congenital heart disease have impaired calf muscle oxygenation compared to control subjects
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2019 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, p. 1091-1091Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Oxford University Press, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-168199 (URN)10.1093/eurheartj/ehz748.0548 (DOI)000507313001054 ()
Conference
Congress of the European-Society-of-Cardiology (ESC) / World Congress of Cardiology, Paris, FRANCE, AUG 31-SEP 04, 2019.
Note

Supplement: 1. Meeting Abstract: P1796.

Available from: 2020-03-11 Created: 2020-03-11 Last updated: 2020-03-11Bibliographically approved
Larsson, L., Johansson, B., Wadell, K., Thilen, U. & Sandberg, C. (2019). Adults with congenital heart disease overestimate their physical activity level. IJC Heart & Vasculature, 22, 13-17
Open this publication in new window or tab >>Adults with congenital heart disease overestimate their physical activity level
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2019 (English)In: IJC Heart & Vasculature, ISSN 2352-9067, Vol. 22, p. 13-17Article in journal (Refereed) Published
Abstract [en]

Background: Physical activity reduces the risk of acquired cardiovascular disease, which is of great importance in patients with congenital heart disease (CHD). There are diverging data whether physical activity level (PAL) differs between patients with CHD and controls. Furthermore, it is unknown if PAL can be reliably assessed in patients with CHD using self-reported instruments.

Methods: Seventy-five patients with CHD (mean age 37.5 ± 15.5 years, women n = 29 [38.7%]) and 42 age and sex matched controls completed the International Physical Activity Questionnaire (IPAQ) and carried the activity monitor Actiheart over 4 days. Time spent at ≥3 METS ≥21.4 min/day, i.e. reaching the WHO recommendation for PAL to promote health, was used as the outcome measure. Data on PAL obtained from IPAQ were compared with Actiheart.

Results: The proportion of individuals reaching target PAL according to IPAQ was similar in patients with CHD and controls (70.7%vs.76.2%, p = 0.52) as well as between patients with simple and complex lesions. There was an overall difference between IPAQ and Actiheart in detecting recommended PAL (72.6%vs.51.3%, p b 0.001). In a subgroup analysis, this difference was also detected in patients but was borderline for controls. The negative predictive value for IPAQ in detecting insufficient PAL was higher in patients than in controls (73%vs.40%).

Conclusions: The proportion of persons reaching sufficient PAL to promote health was similar in patients and controls. The self-reported instrument overestimated PAL in relation to objective measurements. However, with a high negative predictive value, IPAQ is a potentially useful tool for detecting patients with insufficient PAL.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Adult congenital heart disease, Physical activity level, IPAQ, Actiheart
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-158111 (URN)10.1016/j.ijcha.2018.11.005 (DOI)000462184100003 ()30480085 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20130472Swedish Heart Lung Foundation, 20150579Västerbotten County Council
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2020-05-15Bibliographically approved
Larsson, L., Rinnström, D., Sandberg, C., Högström, G., Thilen, U., Nordström, P. & Johansson, B. (2019). Aerobic capacity in adolescence is associated with time to intervention in adult men with atrial septal defects. International Journal of Cardiology, 280, 57-60
Open this publication in new window or tab >>Aerobic capacity in adolescence is associated with time to intervention in adult men with atrial septal defects
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2019 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 280, p. 57-60Article in journal (Refereed) Published
Abstract [en]

Background: Atrial septal defect (ASD) is a congenital heart lesion that often remains undiagnosed until adulthood. The reasons for this may be multifactorial. It is, however, known that closure of a hemodynamically significant ASD improves exercise capacity. This study aimed to explore whether the aerobic capacity in late adolescence is associated with time to diagnosis and intervention in adult men with late diagnosis of an atrial shunt.

Methods: The Swedish Military Conscription Service Register contains data on exercise tests performed in late adolescence. By linking these data with the National Patient Register, 254 men with a later intervention for an ASD were identified.

Results: Interventions were performed at a mean of 26.5 +/- 7.9 years after the initial exercise tests. The mean absolute workload among those with a later diagnosed ASD was similar to those without a later diagnosed ASD (274 +/- 51W vs. 276 +/- 52 W, p = 0.49). Men with a higher exercise capacity (>= 1 SD) had their intervention earlier (21.9 +/- 8.6 years vs. 27.5 +/- 7.4 years, p < 0.001).

Conclusions: The aerobic exercise capacity was similar in adolescent men with later interventions for ASD compared to the reference population. Furthermore, those with high exercise capacity appeared to be diagnosed earlier. Thus, low exercise capacity may not be a feature of ASD during adolescence, but rather develop later in life as a natural progression of the disease.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Congenital heart disease, Atrial septal defect
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-156856 (URN)10.1016/j.ijcard.2018.12.073 (DOI)000458491600013 ()30651192 (PubMedID)
Available from: 2019-03-13 Created: 2019-03-13 Last updated: 2020-05-15Bibliographically approved
Ljungberg, J., Johansson, B., Engström, K. G., Norberg, M., Bergdahl, I. A. & Söderberg, S. (2019). Arterial hypertension and diastolic blood pressure associate with aortic stenosis. Scandinavian Cardiovascular Journal, 53(2), 91-97
Open this publication in new window or tab >>Arterial hypertension and diastolic blood pressure associate with aortic stenosis
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2019 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 53, no 2, p. 91-97Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Due to age-related differences in aortic valve structure, it is likely that the pathophysiology of aortic stenosis (AS) and associated risk factors differ between age groups. Here we prospectively studied the influence of traditional cardiovascular risk factors on AS development requiring surgery among patients without concomitant coronary artery disease (CAD) and stratified for age.

DESIGN: This study included 322 patients, who had prior to surgery for AS participated in population-based surveys, and 131 of them had no visible CAD upon preoperative coronary angiogram. For each case, we selected four referents matched for age, gender, and geographic area. To identify predictors for surgery, we used multivariable conditional logistic regression with a model including arterial hypertension (or measured blood pressure and antihypertensive medication), cholesterol levels, diabetes, body mass index (BMI), and smoking.

RESULTS: In patients without CAD, future surgery for AS was associated with arterial hypertension and elevated levels of diastolic blood pressure in patients younger than 60 years at surgery (odds ratio [95% confidence interval]), (3.40 [1.45-7.93] and 1.60 [1.09-2.37], respectively), and with only impaired fasting glucose tolerance in patients 60 years or older at surgery (3.22 [1.19-8.76]).

CONCLUSION: Arterial hypertension and elevated diastolic blood pressure are associated with a risk for AS requiring surgery in subjects below 60 years of age. Strict blood pressure control in this group is strongly advocated to avoid other cardiovascular diseases correlated to hypertension. If hypertension and elevated diastolic blood pressure are risk factors for developing AS requiring surgery need further investigations. Notably, elevated fasting glucose levels were related to AS requiring surgery in older adults without concomitant CAD.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
Keywords
Aortic stenosis, bicuspid aortic valve, diabetes, hypertension, valve disease surgery
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-159471 (URN)10.1080/14017431.2019.1605094 (DOI)000469026200007 ()31109205 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20140799Swedish Heart Lung Foundation, 20120631Swedish Heart Lung Foundation, 20100635Västerbotten County Council, VLL-548791
Available from: 2019-05-28 Created: 2019-05-28 Last updated: 2019-06-17Bibliographically approved
Hedlund, M., Lindelöf, N., Johansson, B., Boraxbekk, C.-J. & Rosendahl, E. (2019). Development and Feasibility of a Regulated, Supramaximal High-Intensity Training Program Adapted for Older Individuals. Frontiers in Physiology, 10, Article ID 590.
Open this publication in new window or tab >>Development and Feasibility of a Regulated, Supramaximal High-Intensity Training Program Adapted for Older Individuals
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2019 (English)In: Frontiers in Physiology, ISSN 1664-042X, E-ISSN 1664-042X, Vol. 10, article id 590Article in journal (Refereed) Published
Abstract [en]

Background: High-intensity training (HIT) with extremely short intervals (designated here as supramaximal HIT) is a time-efficient training method for health and performance. However, a protocol for regulation and control of intensity is missing, impeding implementation in various groups, such as older individuals.

Methods: This study presents the development and characteristics of a novel training protocol with regulated and controlled supramaximal intervals adapted for older people. Using both quantitative and qualitative analyses, we explored the feasibility of the program, performed in a group training setting, with physically active older individuals (aged 65–75, n = 7; five women). The developed supramaximal HIT program consisted of 10 × 6 s cycle sprint intervals with ∼1 min of active recovery with the following key characteristics: (1) an individual target power output was reached and maintained during all intervals and regulated and expressed as the percentage of the estimated maximum mean power output for the duration of the interval (i.e., 6 s); (2) pedaling cadence was standardized for all participants, while resistance was individualized; and (3) the protocol enabled controlled and systematic adjustments of training intensity following standardized escalation criteria.

Aim: Our aim was to test the feasibility of a novel training regimen with regulated and controlled supramaximal HIT, adapted for older people. The feasibility criteria for the program were to support participants in reaching a supramaximal intensity (i.e., power output > 100% of estimated VO2 max), avoid inducing a negative affective response, and have participants perceive it as feasible and acceptable.

Results: All feasibility criteria were met. The standardized escalation procedure provided safe escalation of training load up to a supramaximal intensity (around three times the power output at estimated VO2 max). The participants never reported negative affective responses, and they perceived the program as fun and feasible.

Conclusion: This novel program offers a usable methodology for further studies on supramaximal HIT among older individuals with different levels of physical capacity. Future research should explore the effects of the program in various populations of older people and their experiences and long-term adherence compared with other forms of training.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2019
Keywords
sprint interval training, high-intensity interval training, affective state, perceived exertion, training intensity, aging
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:umu:diva-159855 (URN)10.3389/fphys.2019.00590 (DOI)000468572300001 ()
Available from: 2019-06-10 Created: 2019-06-10 Last updated: 2020-05-14Bibliographically approved
Ko, J. M., White, K. S., Kovacs, A. H., Tecson, K. M., Apers, S., Luyckx, K., . . . Cedars, A. M. (2019). Differential impact of physical activity type on depression in adults with congenital heart disease: A multi-center international study. Journal of Psychosomatic Research, 124, Article ID 109762.
Open this publication in new window or tab >>Differential impact of physical activity type on depression in adults with congenital heart disease: A multi-center international study
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2019 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 124, article id 109762Article in journal (Refereed) Published
Abstract [en]

Objective: This study aimed to examine the association between physical activity (PA) and depression in a large international cohort of adults with congenital heart disease (ACHD) as data about the differential impact of PA type on depression in this population are lacking.

Methods: In 2018, we conducted a cross-sectional assessment of 3908 ACHD recruited from 24 ACHD-specialized centers in 15 countries between April 2013 to March 2015. The Hospital Anxiety and Depression Scale was used to assess self-reported depressive symptoms and the Health-Behavior Scale-Congenital Heart Disease was used to collect PA information. Cochran-Armitage tests were performed to assess trends between depressive symptom levels and PA participation. Chi-Square and Wilcoxon Rank Sum tests were utilized to examine relations between depressive symptom levels and patient characteristics. Stepwise multivariable models were then constructed to understand the independent impact of PA on depressive symptoms.

Results: The overall prevalence of elevated depressive symptoms in this sample was 12% with significant differences in rates between countries (p < .001). Physically active individuals were less likely to be depressed than those who were sedentary. Of the 2 PA domains examined, sport participation rather than active commute was significantly associated with reduced symptoms of depression. After adjustment in multivariable analysis, sport participation was still significantly associated with 38% decreased probability of depressive symptoms (p < .001).

Conclusions: Sport participation is independently associated with reduced depressive symptoms. The development and promotion of sport-related exercise prescriptions uniquely designed for ACHD may improve depression status in this unique population.

Place, publisher, year, edition, pages
PERGAMON-ELSEVIER SCIENCE LTD, 2019
Keywords
Physical activity, Depression, Perceived health, Prognosis, Adult congenital heart disease
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
urn:nbn:se:umu:diva-164522 (URN)10.1016/j.jpsychores.2019.109762 (DOI)000483008100018 ()31443808 (PubMedID)
Available from: 2019-11-15 Created: 2019-11-15 Last updated: 2020-05-14Bibliographically approved
Bay, A., Lämås, K., Berghammer, M., Sandberg, C. & Johansson, B. (2019). Enablers and barriers for physical activity in adults with congenital heart disease. In: : . Paper presented at Berzelius symposium 99, The Cardiac Patient from Birth to Adulthood, Stockholm, Sweden, 21-22 February 2019..
Open this publication in new window or tab >>Enablers and barriers for physical activity in adults with congenital heart disease
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2019 (English)Conference paper, Oral presentation only (Refereed)
National Category
Cardiac and Cardiovascular Systems Nursing Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-156923 (URN)
Conference
Berzelius symposium 99, The Cardiac Patient from Birth to Adulthood, Stockholm, Sweden, 21-22 February 2019.
Available from: 2019-03-01 Created: 2019-03-01 Last updated: 2019-03-07Bibliographically approved
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