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Published in: Health and Quality of Life Outcomes 1/2019

Open Access 01-12-2019 | Pruritus | Research

Psychometric properties of the portuguese version of the chronic urticaria quality of life questionnaire (CU-Q2oL)

Authors: Pedro Lopes Ferreira, Margarida Gonçalo, José Alberto Ferreira, Ana Célia Costa, Ana Todo-Bom, Cristina Lopes Abreu, Ana Rita Travassos, Pedro Andrade, Ilaria Baiardini, Giorgio Walter Canonica

Published in: Health and Quality of Life Outcomes | Issue 1/2019

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Abstract

Background

Chronic urticaria is defined as the appearance of urticarial lesions and/or angioedema during a period of more than six weeks. We aimed at developing the Portuguese version of the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) and at testing its reliability and the content, construct and criterion validity.

Methods

The forward-backward approach to a linguistic equivalence was followed, after which a clinical review and a cognitive debriefing with patients were performed. The intraclass correlation coefficient checked test-retest reliability with patients filling the same questionnaire with one week apart and the Cronbach’s alpha indicator assessed the internal consistency. Construct validity was tested by an exploratory factor analysis and by hypothesis tests involving sociodemographic and clinical patient characteristics, including the urticaria control test (UCT). On the other hand, criterion validity was tested through correlations with the Short-Form Health Survey SF-36, EQ-5D-5 L, and the Dermatology Quality of Life Index (DLQI).

Results

A total of 162 patients from seven hospital units were included. The mean (standard deviation) age was 42.6 (13.3) and 81.6% were female. CU-Q2oL was entirely filled by all respondents. Internal consistency was 0.947 for the overall score, ranging from 0.661 (limits) to 0.899 (sleep problems) and the corresponding reproducibility indicator was 0.910, based on 23 patients and ranging from 0.711 (swelling) and 0.957 (looks). Exploratory factor analysis in general confirmed the original structure originally obtained by the authors. All CU-Q2oL dimensions were highly correlated with DLQI Index and differentiated well between males and females, and between different levels of wheals and pruritus. In addition, moderate negative correlations were found between Cu-Q2oL scores and the dimensions from SF-36 and EQ-5D-5 L.

Conclusions

The satisfactory metric properties confirmed the cultural adaptation and validity of CU-Q2oL into Portuguese population, providing the clinicians with a valid tool to evaluate the impact of chronic urticaria on patient’s QoL and therefore adjust their treatment.

Trial registration number

Not applicable.
Literature
1.
go back to reference Baiardini I, Pasquali M, Braido F, Fumagalli F, Guerra L, Compalati E, Braga M, Lombardi C, Fassio O, Canonica GW. A new tool to evaluate the impact of chronic urticaria on quality of life: chronic urticaria quality of life questionnaire (CU-QoL). Allergy. 2005 Aug;60(8):1073–8.CrossRef Baiardini I, Pasquali M, Braido F, Fumagalli F, Guerra L, Compalati E, Braga M, Lombardi C, Fassio O, Canonica GW. A new tool to evaluate the impact of chronic urticaria on quality of life: chronic urticaria quality of life questionnaire (CU-QoL). Allergy. 2005 Aug;60(8):1073–8.CrossRef
2.
go back to reference Greaves M. Chronic urticaria. J Allergy Clin Immunol. 2000 Apr;105(4):664–72.CrossRef Greaves M. Chronic urticaria. J Allergy Clin Immunol. 2000 Apr;105(4):664–72.CrossRef
3.
go back to reference Magerl M, Altrichter S, Borzova E, Giménez-Arnau A, Grattan CE, Lawlor F, Mathelier-Fusade P, Meshkova RY, Zuberbier T, Metz M, Maurer M. The definition, diagnostic testing, and management of chronic inducible urticarias - the EAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision. Allergy. 2016;71:780–802.CrossRef Magerl M, Altrichter S, Borzova E, Giménez-Arnau A, Grattan CE, Lawlor F, Mathelier-Fusade P, Meshkova RY, Zuberbier T, Metz M, Maurer M. The definition, diagnostic testing, and management of chronic inducible urticarias - the EAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision. Allergy. 2016;71:780–802.CrossRef
5.
go back to reference Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, Bernstein JA, Bindslev-Jensen C, Brzoza Z, Buense Bedrikow R, Canonica GW, Church MK, Craig T, Danilycheva IV, Dressler C, Ensina LF, Giménez-Arnau A, Godse K, Gonçalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Katelaris CH, Kocatürk E, Kulthanan K, Larenas-Linnemann D, Leslie TA, Magerl M, Mathelier-Fusade P, Meshkova RY, Metz M, Nast A, Nettis E, Oude-Elberink H, Rosumeck S, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Staubach P, Sussman G, Toubi E, Vena GA, Vestergaard C, Wedi B, Werner RN, Zhao Z, Maurer M. The EAACI/GA2LEN/EDF/WAO Guideline for the Definition, Classification, Diagnosis and Management of Urticaria. The 2017 Revision and Update. Allergy. 2018 Jul;73(7):1393–1414 Jan 15. doi: https://doi.org/10.1111/all.13397.CrossRef Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, Bernstein JA, Bindslev-Jensen C, Brzoza Z, Buense Bedrikow R, Canonica GW, Church MK, Craig T, Danilycheva IV, Dressler C, Ensina LF, Giménez-Arnau A, Godse K, Gonçalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Katelaris CH, Kocatürk E, Kulthanan K, Larenas-Linnemann D, Leslie TA, Magerl M, Mathelier-Fusade P, Meshkova RY, Metz M, Nast A, Nettis E, Oude-Elberink H, Rosumeck S, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Staubach P, Sussman G, Toubi E, Vena GA, Vestergaard C, Wedi B, Werner RN, Zhao Z, Maurer M. The EAACI/GA2LEN/EDF/WAO Guideline for the Definition, Classification, Diagnosis and Management of Urticaria. The 2017 Revision and Update. Allergy. 2018 Jul;73(7):1393–1414 Jan 15. doi: https://​doi.​org/​10.​1111/​all.​13397.CrossRef
6.
go back to reference Costa C, Gonçalo M. Abordagem diagnóstica e terapêutica da urticária crónica espontânea: recomendações em Portugal. Acta Medica Port. 2016 Nov;29(11):763–81.CrossRef Costa C, Gonçalo M. Abordagem diagnóstica e terapêutica da urticária crónica espontânea: recomendações em Portugal. Acta Medica Port. 2016 Nov;29(11):763–81.CrossRef
7.
go back to reference Wedi B, Wieczorek D, Raap U, Kapp A. Urticaria. J Dtsch Dermatol Ges. 2014;12:997–1007.PubMed Wedi B, Wieczorek D, Raap U, Kapp A. Urticaria. J Dtsch Dermatol Ges. 2014;12:997–1007.PubMed
8.
go back to reference Baiardini I, Giardini A, Pasquali M, Dignetti P, Guerra L, Specchia C, Braido F, Majani G, Canonica GW. Quality of life and patients' satisfaction in chronic urticaria and respiratory allergy. Allergy. 2003 Jul;58(7):621–3.CrossRef Baiardini I, Giardini A, Pasquali M, Dignetti P, Guerra L, Specchia C, Braido F, Majani G, Canonica GW. Quality of life and patients' satisfaction in chronic urticaria and respiratory allergy. Allergy. 2003 Jul;58(7):621–3.CrossRef
9.
go back to reference O'Donnell BF, Lawlor F, Simpson J, Morgan M, Greaves MW. The impact of chronic urticaria on the quality of life. Br J Dermatol. 1997 Feb;136(2):197–201.CrossRef O'Donnell BF, Lawlor F, Simpson J, Morgan M, Greaves MW. The impact of chronic urticaria on the quality of life. Br J Dermatol. 1997 Feb;136(2):197–201.CrossRef
10.
go back to reference Gaig P, Olona M, Muñoz Lejarazu D, Caballero MT, Domínguez FJ, Echechipia S, García Abujeta JL, Gonzalo MA, Lleonart R, Martínez Cócera C, Rodríguez A, Ferrer M. Epidemiology of urticaria in Spain. J Investig Allergol Clin Immunol. 2004;14:214–20.PubMed Gaig P, Olona M, Muñoz Lejarazu D, Caballero MT, Domínguez FJ, Echechipia S, García Abujeta JL, Gonzalo MA, Lleonart R, Martínez Cócera C, Rodríguez A, Ferrer M. Epidemiology of urticaria in Spain. J Investig Allergol Clin Immunol. 2004;14:214–20.PubMed
11.
go back to reference Zuberbier T, Balke M, Worm M, Edenharter G, Maurer M. Epidemiology of urticaria: a representative cross-sectional population survey. Clin Exp Dermatol. 2010;35:869–73.CrossRef Zuberbier T, Balke M, Worm M, Edenharter G, Maurer M. Epidemiology of urticaria: a representative cross-sectional population survey. Clin Exp Dermatol. 2010;35:869–73.CrossRef
12.
go back to reference Carrasco J, Costa C, Gonçalo M, Guilherme M, Martins AR. Qual é o impacto económico da urticária crónica espontânea grave em Portugal? A perspetiva do Serviço Nacional de Saúde e da Sociedade Portuguesa. Coimbra: SPAIC; 2015. Carrasco J, Costa C, Gonçalo M, Guilherme M, Martins AR. Qual é o impacto económico da urticária crónica espontânea grave em Portugal? A perspetiva do Serviço Nacional de Saúde e da Sociedade Portuguesa. Coimbra: SPAIC; 2015.
13.
go back to reference Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HCW. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010 May;19(4):539–49.CrossRef Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HCW. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010 May;19(4):539–49.CrossRef
14.
go back to reference Acquadro C, Conway K, Hareendran A, Aaronson N. European regulatory issues and quality of life assessment (ERIQA) group. Literature review of methods to translate health-related quality of life questionnaires for use in multinational clinical trials. Value Health. 2008;11(3):509–21.CrossRef Acquadro C, Conway K, Hareendran A, Aaronson N. European regulatory issues and quality of life assessment (ERIQA) group. Literature review of methods to translate health-related quality of life questionnaires for use in multinational clinical trials. Value Health. 2008;11(3):509–21.CrossRef
15.
go back to reference Dias GA, Pires GV, Valle SO, França AT, Papi JA, Dortas SD Jr, Levy SA, Baiardini I, Canonica GW. Cross-cultural adaptation of the Brazilian-Portuguese version of the chronic urticaria quality-of-life questionnaire - CU-Q2oL. Allergy. 2011 Nov;66(11):1487–93.CrossRef Dias GA, Pires GV, Valle SO, França AT, Papi JA, Dortas SD Jr, Levy SA, Baiardini I, Canonica GW. Cross-cultural adaptation of the Brazilian-Portuguese version of the chronic urticaria quality-of-life questionnaire - CU-Q2oL. Allergy. 2011 Nov;66(11):1487–93.CrossRef
16.
go back to reference Młynek A, Magerl M, Hanna M, Lhachimi S, Baiardini I, Canonica GW, Brzoza Z, Kasperska-Zajac A, Rogala B, Zalewska-Janowska A, Zuberbier T, Maurer M. The German version of the chronic Urticaria quality-of-life questionnaire: factor analysis, validation, and initial clinical findings. Allergy. 2009 Jun;64(6):927–36.CrossRef Młynek A, Magerl M, Hanna M, Lhachimi S, Baiardini I, Canonica GW, Brzoza Z, Kasperska-Zajac A, Rogala B, Zalewska-Janowska A, Zuberbier T, Maurer M. The German version of the chronic Urticaria quality-of-life questionnaire: factor analysis, validation, and initial clinical findings. Allergy. 2009 Jun;64(6):927–36.CrossRef
17.
go back to reference Koti I, Weller K, Makris M, Tiligada E, Psaltopoulou T, Papageorgiou C, Baiardini I, Panagiotakos D, Braido F, Maurer M. Disease activity only moderately correlates with quality of life impairment in patients with chronic spontaneous urticaria. Dermatol. 2013;226(4):371–9.CrossRef Koti I, Weller K, Makris M, Tiligada E, Psaltopoulou T, Papageorgiou C, Baiardini I, Panagiotakos D, Braido F, Maurer M. Disease activity only moderately correlates with quality of life impairment in patients with chronic spontaneous urticaria. Dermatol. 2013;226(4):371–9.CrossRef
18.
go back to reference Kessel A, Graif Y, Vadasz Z, Schichter-Konfino V, Almog M, Cohen S, Teplitski V, Stein N, Baiardini I, Maurer M, Toubi E. Adaptation and validation of the Israeli version of the chronic Urticaria quality of life questionnaire (CU-Q2oL). Isr Med Assoc J. 2016 Aug;18(8):461–5.PubMed Kessel A, Graif Y, Vadasz Z, Schichter-Konfino V, Almog M, Cohen S, Teplitski V, Stein N, Baiardini I, Maurer M, Toubi E. Adaptation and validation of the Israeli version of the chronic Urticaria quality of life questionnaire (CU-Q2oL). Isr Med Assoc J. 2016 Aug;18(8):461–5.PubMed
19.
go back to reference Tavakol M, Mohammadinejad P, Baiardini I, Braido F, Gharagozlou M, Aghamohammadi A, Nabavi M, Dabbaghzade A, Tavakol Z, Afarideh M, Rezaei N. The Persian version of the chronic urticaria quality of life questionnaire: factor analysis, validation, and initial clinical findings. Iran J Allergy Asthma Immunol. 2014 Aug;13(4):278–85.PubMed Tavakol M, Mohammadinejad P, Baiardini I, Braido F, Gharagozlou M, Aghamohammadi A, Nabavi M, Dabbaghzade A, Tavakol Z, Afarideh M, Rezaei N. The Persian version of the chronic urticaria quality of life questionnaire: factor analysis, validation, and initial clinical findings. Iran J Allergy Asthma Immunol. 2014 Aug;13(4):278–85.PubMed
20.
go back to reference Brzoza Z, Badura-Brzoza K, Młynek A, Magerl M, Baiardini I, Canonica GW, Weller K, Kocatürk E, Kalogeromitros D, Zalewska-Janowska A, Zuberbier T, Maurer M. Adaptation and initial results of the polish version of the GA(2)LEN chronic urticaria quality of life questionnaire (CU-Q(2)oL). J Dermatol Sci. 2011 Apr;62(1):36–41.PubMed Brzoza Z, Badura-Brzoza K, Młynek A, Magerl M, Baiardini I, Canonica GW, Weller K, Kocatürk E, Kalogeromitros D, Zalewska-Janowska A, Zuberbier T, Maurer M. Adaptation and initial results of the polish version of the GA(2)LEN chronic urticaria quality of life questionnaire (CU-Q(2)oL). J Dermatol Sci. 2011 Apr;62(1):36–41.PubMed
21.
go back to reference Valero A, Herdman M, Bartra J, Ferrer M, Jáuregui I, Dávila I, del Cuvillo A, Montoro J, Mullol J, Sastre J, Canonica GW, Baiardini I. Adaptation and validation of the Spanish version of the chronic Urticaria quality of life questionnaire (CU-Q2oL). J Investig Allergol Clin Immunol. 2008;18(6):426–32.PubMed Valero A, Herdman M, Bartra J, Ferrer M, Jáuregui I, Dávila I, del Cuvillo A, Montoro J, Mullol J, Sastre J, Canonica GW, Baiardini I. Adaptation and validation of the Spanish version of the chronic Urticaria quality of life questionnaire (CU-Q2oL). J Investig Allergol Clin Immunol. 2008;18(6):426–32.PubMed
22.
go back to reference Kulthanan K, Chularojanamontri L, Tuchinda P, Rujitharanawong C, Baiardini I, Braido F. Minimal clinical important difference (MCID) of the Thai chronic Urticaria quality of life questionnaire (CU-Q2oL). Asian Pac J Allergy Immunol. 2016 Jun;34(2):137–45.PubMed Kulthanan K, Chularojanamontri L, Tuchinda P, Rujitharanawong C, Baiardini I, Braido F. Minimal clinical important difference (MCID) of the Thai chronic Urticaria quality of life questionnaire (CU-Q2oL). Asian Pac J Allergy Immunol. 2016 Jun;34(2):137–45.PubMed
23.
go back to reference Kocatürk E, Weller K, Martus P, Aktas S, Kavala M, Sarigul S, Baiardini I, Canonica GW, Brzoza Z, Kalogeromitros D, Maurer M. Turkish version of the chronic urticaria quality of life questionnaire: cultural adaptation, assessment of reliability and validity. Acta Derm Venereol. 2012 Jul;92(4):419–25.CrossRef Kocatürk E, Weller K, Martus P, Aktas S, Kavala M, Sarigul S, Baiardini I, Canonica GW, Brzoza Z, Kalogeromitros D, Maurer M. Turkish version of the chronic urticaria quality of life questionnaire: cultural adaptation, assessment of reliability and validity. Acta Derm Venereol. 2012 Jul;92(4):419–25.CrossRef
24.
go back to reference Finlay AY, Khan GK. Dermatology life quality index (DLQI)--a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994 May;19(3):210–6.CrossRef Finlay AY, Khan GK. Dermatology life quality index (DLQI)--a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994 May;19(3):210–6.CrossRef
25.
go back to reference Ferreira P. Creation of the Portuguese version of the MOS SF-36. Part I—linguistic and cultural adaptation. Acta Medica Port. 2000;13:55–66. Ferreira P. Creation of the Portuguese version of the MOS SF-36. Part I—linguistic and cultural adaptation. Acta Medica Port. 2000;13:55–66.
26.
go back to reference Ware J, Sherbourne C. The MOS 36-item short-form health survey (SF-36). Conceptual framework and item selection. Med Care. 1992;30:473–83.CrossRef Ware J, Sherbourne C. The MOS 36-item short-form health survey (SF-36). Conceptual framework and item selection. Med Care. 1992;30:473–83.CrossRef
27.
go back to reference Devlin N, Shah K, Feng Y, Mulhern B, van Hout B. Valuing health-related quality of life: an EQ-5D-5L value set for England. Health Econ. 2017:1–16. Devlin N, Shah K, Feng Y, Mulhern B, van Hout B. Valuing health-related quality of life: an EQ-5D-5L value set for England. Health Econ. 2017:1–16.
28.
go back to reference Ferreira PL, Antunes P, Ferreira LN, Pereira LN, Ramos-Goñi LM. A hybrid modelling approach for eliciting health states preferences: the Portuguese EQ-5D-5L value set. Qual Life Res: 14 June 2019. Ferreira PL, Antunes P, Ferreira LN, Pereira LN, Ramos-Goñi LM. A hybrid modelling approach for eliciting health states preferences: the Portuguese EQ-5D-5L value set. Qual Life Res: 14 June 2019.
29.
go back to reference Weller K, Groffik A, Church MK, Hawro T, Krause K, Metz M, Martus P, Casale TB, Staubach P, Maurer M. Development and validation of the Urticaria Control Test: a patient-reported outcome instrument for assessing urticaria control. J Allergy Clin Immunol. 2014 May;133(5):1365–1372, 1372.e1–6.CrossRef Weller K, Groffik A, Church MK, Hawro T, Krause K, Metz M, Martus P, Casale TB, Staubach P, Maurer M. Development and validation of the Urticaria Control Test: a patient-reported outcome instrument for assessing urticaria control. J Allergy Clin Immunol. 2014 May;133(5):1365–1372, 1372.e1–6.CrossRef
30.
go back to reference Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016 Jun;15(2):155–63.CrossRef Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016 Jun;15(2):155–63.CrossRef
31.
go back to reference Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, de Vet HC. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007 Jan;60(1):34–42.CrossRef Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, de Vet HC. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007 Jan;60(1):34–42.CrossRef
32.
go back to reference de Vet HC, Terwee CB, Mokkink LB, Knol DL. Measurement in medicine. Cambridge: Cambridge University Press; 2011.CrossRef de Vet HC, Terwee CB, Mokkink LB, Knol DL. Measurement in medicine. Cambridge: Cambridge University Press; 2011.CrossRef
33.
go back to reference Cohen J. Statistical power analysis for the behavioural sciences. New York: Lawrence Erlbaum Associates; 1988. Cohen J. Statistical power analysis for the behavioural sciences. New York: Lawrence Erlbaum Associates; 1988.
34.
go back to reference Costa C, Rosmaninho I, Guilherme A, Ferreira J, Antunes J, Pina A, Prates S, Marques JG, Azevedo F, Cunha AP, Brito C, Massa A, Sousa JT, Velho GC, Raposo I, Pinto GM, Sousa V, Martins AR. Chronic Urticaria in the real-life clinical practice setting in Portugal: baseline results from the non-interventional multicentre AWARE study. Acta Medica Port. 2019 Feb 28;32(2):133–40.CrossRef Costa C, Rosmaninho I, Guilherme A, Ferreira J, Antunes J, Pina A, Prates S, Marques JG, Azevedo F, Cunha AP, Brito C, Massa A, Sousa JT, Velho GC, Raposo I, Pinto GM, Sousa V, Martins AR. Chronic Urticaria in the real-life clinical practice setting in Portugal: baseline results from the non-interventional multicentre AWARE study. Acta Medica Port. 2019 Feb 28;32(2):133–40.CrossRef
35.
go back to reference Maurer M, Houghton K, Costa C, Dabove F, Ensina LF, Giménez-Arnau A, Guillet G, Konstantinou GN, Labrador-Horrillo M, Lapeere H, Meshkova R, Pastorello EA, Velásquez-Lopera M, Tamayo Quijano LM, Vestergaard C, Chapman-Rothe N. Differences in chronic spontaneous urticaria between Europe and Central/South America: results of the multi-center real world AWARE study. World Allergy Organ J. 2018 Nov 16;11(1):32. https://doi.org/10.1186/s40413-018-0216-1.CrossRefPubMedPubMedCentral Maurer M, Houghton K, Costa C, Dabove F, Ensina LF, Giménez-Arnau A, Guillet G, Konstantinou GN, Labrador-Horrillo M, Lapeere H, Meshkova R, Pastorello EA, Velásquez-Lopera M, Tamayo Quijano LM, Vestergaard C, Chapman-Rothe N. Differences in chronic spontaneous urticaria between Europe and Central/South America: results of the multi-center real world AWARE study. World Allergy Organ J. 2018 Nov 16;11(1):32. https://​doi.​org/​10.​1186/​s40413-018-0216-1.CrossRefPubMedPubMedCentral
Metadata
Title
Psychometric properties of the portuguese version of the chronic urticaria quality of life questionnaire (CU-Q2oL)
Authors
Pedro Lopes Ferreira
Margarida Gonçalo
José Alberto Ferreira
Ana Célia Costa
Ana Todo-Bom
Cristina Lopes Abreu
Ana Rita Travassos
Pedro Andrade
Ilaria Baiardini
Giorgio Walter Canonica
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2019
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-019-1266-y

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