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1.
Nature ; 595(7866): 255-260, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34234336

RESUMEN

The role of subducting topography on the mode of fault slip-particularly whether it hinders or facilitates large megathrust earthquakes-remains a controversial topic in subduction dynamics1-5. Models have illustrated the potential for subducting topography to severely alter the structure, stress state and mechanics of subduction zones4,6; however, direct geophysical imaging of the complex fracture networks proposed and the hydrology of both the subducting topography and the associated upper plate damage zones remains elusive. Here we use passive and controlled-source seafloor electromagnetic data collected at the northern Hikurangi Margin, New Zealand, to constrain electrical resistivity in a region of active seamount subduction. We show that a seamount on the incoming plate contains a thin, low-porosity basaltic cap that traps a conductive matrix of porous volcaniclastics and altered material over a resistive core, which allows 3.2 to 4.7 times more water to subduct, compared with normal, unfaulted oceanic lithosphere. In the forearc, we image a sediment-starved plate interface above a subducting seamount with similar electrical structure to the incoming plate seamount. A sharp resistive peak within the subducting seamount lies directly beneath a prominent upper plate conductive anomaly. The coincidence of this upper plate anomaly with the location of burst-type repeating earthquakes and seismicity associated with a recent slow slip event7 directly links subducting topography to the creation of fluid-rich damage zones in the forearc that alter the effective normal stress at the plate interface by modulating the fluid overpressure. In addition to severely modifying the structure and physical conditions of the upper plate, subducting seamounts represent an underappreciated mechanism for transporting a considerable flux of water to the forearc and deeper mantle.


Asunto(s)
Sedimentos Geológicos , Océanos y Mares , Porosidad , Movimientos del Agua , Terremotos , Campos Electromagnéticos , Nueva Zelanda , Erupciones Volcánicas
2.
Proc Natl Acad Sci U S A ; 121(26): e2321068121, 2024 Jun 25.
Artículo en Inglés | MEDLINE | ID: mdl-38885390

RESUMEN

An often-overlooked question of the biodiversity crisis is how natural hazards contribute to species extinction risk. To address this issue, we explored how four natural hazards, earthquakes, hurricanes, tsunamis, and volcanoes, overlapped with the distribution ranges of amphibians, birds, mammals, and reptiles that have either narrow distributions or populations with few mature individuals. To assess which species are at risk from these natural hazards, we combined the frequency and magnitude of each natural hazard to estimate their impact. We considered species at risk if they overlapped with regions where any of the four natural hazards historically occurred (n = 3,722). Those species with at least a quarter of their range subjected to a high relative impact were considered at high risk (n = 2,001) of extinction due to natural hazards. In total, 834 reptiles, 617 amphibians, 302 birds, and 248 mammals were at high risk and they were mainly distributed on islands and in the tropics. Hurricanes (n = 983) and earthquakes (n = 868) affected most species, while tsunamis (n = 272), and volcanoes (n = 171) affected considerably fewer. The region with the highest number of species at high risk was the Pacific Ring of Fire, especially due to volcanoes, earthquakes, and tsunamis, while hurricane-related high-risk species were concentrated in the Caribbean Sea, Gulf of Mexico, and northwestern Pacific Ocean. Our study provides important information regarding the species at risk due to natural hazards and can help guide conservation attention and efforts to safeguard their survival.


Asunto(s)
Biodiversidad , Extinción Biológica , Animales , Aves , Mamíferos , Reptiles , Terremotos , Tormentas Ciclónicas , Tsunamis , Anfibios , Erupciones Volcánicas , Desastres Naturales
4.
Nature ; 625(7994): 228, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38172311
6.
Cereb Cortex ; 34(7)2024 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-39077917

RESUMEN

Trauma exposure may precipitate a cascade of plastic modifications within the intrinsic activity of brain regions, but it remains unclear which regions could be responsible for the development of post-traumatic stress disorder based on intrinsic activity. To elucidate trauma-related and post-traumatic stress disorder-related alterations in cortical intrinsic activity at the whole-brain level, we recruited 47 survivors diagnosed with post-traumatic stress disorder, 64 trauma-exposed controls from a major earthquake, and 46 age- and sex-matched healthy controls. All subjects were scanned with an echo-planar imaging sequence, and 5 parameters including the amplitude of low-frequency fluctuations, fractional amplitude of low-frequency fluctuations, regional homogeneity, degree centrality, and voxel-mirrored homotopic connectivity were calculated. We found both post-traumatic stress disorder patients and trauma-exposed controls exhibited decreased amplitude of low-frequency fluctuations in the bilateral posterior cerebellum and inferior temporal gyrus, decreased fractional amplitude of low-frequency fluctuation and regional homogeneity in the bilateral anterior cerebellum, and decreased fractional amplitude of low-frequency fluctuation in the middle occipital gyrus and cuneus compared to healthy controls, and these impairments were more severe in post-traumatic stress disorder patients than in trauma-exposed controls. Additionally, fractional amplitude of low-frequency fluctuation in left cerebellum was positively correlated with Clinician-Administered PTSD Scale scores in post-traumatic stress disorder patients. We identified brain regions that might be responsible for the emergence of post-traumatic stress disorder, providing important information for the treatment of this disorder.


Asunto(s)
Trastornos por Estrés Postraumático , Humanos , Trastornos por Estrés Postraumático/fisiopatología , Trastornos por Estrés Postraumático/diagnóstico por imagen , Trastornos por Estrés Postraumático/psicología , Femenino , Masculino , Adulto , Persona de Mediana Edad , Corteza Cerebral/fisiopatología , Corteza Cerebral/diagnóstico por imagen , Imagen Eco-Planar , Terremotos , Imagen por Resonancia Magnética , Adulto Joven , Mapeo Encefálico
7.
Proc Natl Acad Sci U S A ; 119(51): e2216843119, 2022 12 20.
Artículo en Inglés | MEDLINE | ID: mdl-36512498

RESUMEN

So far in this century, six very large-magnitude earthquakes (MW ≥ 7.8) have ruptured separate portions of the subduction zone plate boundary of western South America along Ecuador, Peru, and Chile. Each source region had last experienced a very large earthquake from 74 to 261 y earlier. This history led to their designation in advance as seismic gaps with potential to host future large earthquakes. Deployments of geodetic and seismic monitoring instruments in several of the seismic gaps enhanced resolution of the subsequent faulting processes, revealing preevent patterns of geodetic slip deficit accumulation and heterogeneous coseismic slip on the megathrust fault. Localized regions of large slip, or asperities, appear to have influenced variability in how each source region ruptured relative to prior events, as repeated ruptures have had similar, but not identical slip distributions. We consider updated perspectives of seismic gaps, asperities, and geodetic locking to assess current very large earthquake hazard along the South American subduction zone, noting regions of particular concern in northern Ecuador and Colombia (1958/1906 rupture zone), southeastern Peru (southeasternmost 1868 rupture zone), north Chile (1877 rupture zone), and north-central Chile (1922 rupture zone) that have large geodetic slip deficit measurements and long intervals (from 64 to 154 y) since prior large events have struck those regions. Expanded geophysical measurements onshore and offshore in these seismic gaps may provide critical information about the strain cycle and fault stress buildup late in the seismic cycle in advance of the future great earthquakes that will eventually strike each region.


Asunto(s)
Terremotos , Chile , Ecuador , Perú , Colombia
8.
BMC Cancer ; 24(1): 990, 2024 Aug 10.
Artículo en Inglés | MEDLINE | ID: mdl-39127643

RESUMEN

BACKGROUND: The study aim was to elucidate the effect of the 2024 Noto Peninsula earthquake on outpatient chemotherapy treatment of cancer survivors at Kanazawa Medical University Hospital (KMUH), Japan. METHODS: Medical and nursing records for January 4-31, 2024, from KMUH were retrospectively collected, and data for 286 participants were analyzed. RESULTS: Of the 286 participants, 95.1% were able to attend their first scheduled appointment. Of the 12 (4.2%) who could not attend because of the earthquake, 7 (58.3%) rescheduled their appointments. A total of 8 participants (2.8%) were unable to attend their second scheduled appointment in January, despite being able to attend their first appointment; 3 (37.5%) of these participants reported that they were unable to attend their appointments because of the effect of the earthquake. Chemotherapy was not administered to 53 (18.5%) participants who did attend, mainly owing to neutropenia, progressive disease, rash, and anemia. Evacuation information was available for 25 participants (8.7%); of these, 8 (28.6%) evacuated to their homes, 7 (25.0%) to public shelters, and 4 (14.3%) to apartments near the hospital. Disaster status information was obtained from 62 participants (21.7%), and indicated experiences such as home damage, water outages, and relying on transportation assistance from family to attend appointments. CONCLUSIONS: Most cancer survivors receiving chemotherapy at KMUH were able to maintain outpatient visits. However, a few could not attend because of the earthquake. Further studies are needed to provide more detailed information on the effect of disasters on cancer survivors and the potential factors underlying non-attendance at medical appointments.


Asunto(s)
Supervivientes de Cáncer , Terremotos , Neoplasias , Pacientes Ambulatorios , Humanos , Masculino , Femenino , Japón/epidemiología , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Supervivientes de Cáncer/estadística & datos numéricos , Pacientes Ambulatorios/estadística & datos numéricos , Adulto , Neoplasias/tratamiento farmacológico , Atención Ambulatoria/estadística & datos numéricos , Anciano de 80 o más Años
9.
Nephrol Dial Transplant ; 39(9): 1514-1522, 2024 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-38327222

RESUMEN

BACKGROUND: Two earthquakes on 6 February 2023 destroyed 10 cities in Türkiye. We report our experience with pediatric victims during these catastrophes, with a focus on crush syndrome related-acute kidney injury (Crush-AKI) and death. METHOD: Web-based software was prepared. Patient demographics, time under rubble (TUR), admission laboratory data, dialysis, and kidney and overall outcomes were recorded. RESULTS: A total of 903 injured children (median age 11.62 years) were evaluated. Mean TUR was 13 h (interquartile range 32.5, max 240 h). Thirty-one of 32 patients with a TUR of >120 h survived. The patient who was rescued after 10 days survived. Two-thirds of the patients were given 50 mEq/L sodium bicarbonate in 0.45% sodium chloride solution on admission day. Fifty-eight percent of patients were given intravenous fluid (IVF) at a volume of 2000-3000 mL/m2 body surface area (BSA), 40% at 3000-4000 mL/m2 BSA and only 2% at >4000 mL/m2 BSA. A total of 425 patients had surgeries, and 48 suffered from major bleeding. Amputations were recorded in 96 patients. Eighty-two and 66 patients required ventilator and inotropic support, respectively. Crush-AKI developed in 314 patients (36% of all patients). In all, 189 patients were dialyzed. Age >15 years, creatine phosphokinase (CK) ≥20 950 U/L, TUR ≥10 h and the first-day IVF volume <3000-4000 mL/m2 BSA were associated with Crush-AKI development. Twenty-two deaths were recorded, 20 of 22 occurring in patients with Crush-AKI and within the first 4 days of admission. All patients admitted after 7 days survived. CONCLUSIONS: These are the most extensive pediatric kidney disaster data obtained after an earthquake. Serum CK level was significantly associated with Crush-AKI at the levels of >20 950 U/L, but not with death. Adolescent age and initial IVF of less than 3000-4000 mL/m2 BSA were also associated with Crush-AKI. Given that mildly injured victims can survive longer periods in the disaster field, we suggest uninterrupted rescue activity for at least 10 days.


Asunto(s)
Lesión Renal Aguda , Síndrome de Aplastamiento , Terremotos , Humanos , Niño , Femenino , Masculino , Adolescente , Síndrome de Aplastamiento/terapia , Síndrome de Aplastamiento/complicaciones , Lesión Renal Aguda/terapia , Lesión Renal Aguda/etiología , Preescolar , Pronóstico , Tasa de Supervivencia , Estudios de Seguimiento , Diálisis Renal , Desastres , Lactante , Estudios Retrospectivos
10.
Br J Nutr ; 131(7): 1244-1258, 2024 Apr 14.
Artículo en Inglés | MEDLINE | ID: mdl-37993119

RESUMEN

The Türkiye-Syria earthquake struck eleven provinces directly in Türkiye on 6 February 2023. Emergency nutrition care is indispensable for sustaining the lives of victims and rescue personnel. To optimally support their well-being, emergency food must be both healthy (i.e. aligned with dietary guidelines) and safe. However, globally, there is a dearth of research on the emergency nutrition conditions in shelters in the immediate aftermath of natural disasters. This lack of scientific evidence could limit the extent to which nutritional gaps can be identified and remedied for future relief efforts. Therefore, the aim of this research was to evaluate the nutrition environment and nutritional quality of emergency meals distributed to survivors in Malatya, a heavily affected province in Türkiye. The rapid assessment was conducted in thirteen locations by using an embedded case-study design to evaluate the nutrition environment both quantitatively and qualitatively. Meals served to earthquake victims and volunteers were found to be insufficient in protein, fat, fibre, vitamin C, Ca and Fe, but Na levels were higher than the maximum threshold in many of the centres. The qualitative analysis illustrated insufficiency in three domains of the emergency food and nutrition environment: foods and beverages offered, cooking/food preparation and food safety and dining areas and other facilities. Given the major nutritional gaps identified in this study, future disaster preparations should implement emergency nutrition plans that ensure healthy, nutritious and safe food for survivors. Better coordination and use of technology are necessary for interventions to prevent malnutrition.


Asunto(s)
Planificación en Desastres , Terremotos , Humanos , Siria , Turquía , Comidas
11.
Br J Nutr ; 131(9): 1648-1656, 2024 May 14.
Artículo en Inglés | MEDLINE | ID: mdl-38258409

RESUMEN

Traumatic experiences from disasters have enduring effects on health, both directly and indirectly by influencing health behaviours. Among potential pathways, the impact of disaster-related trauma on dietary patterns has been understudied. This study investigated the relationship between disaster-related trauma and dietary inflammatory index (DII®), and how these relationships differed by gender and whether they prepare meal by themselves or not among older survivors of the 2011 Great East Japan Earthquake and Tsunami (n 1375). Dietary data were collected in 2020 using a brief-type self-administered diet history questionnaire, from which we derived a dietary inflammatory index (DII®) based on twenty-six food/nutrient items, where higher scores indicate pro-inflammatory (i.e. unhealthy) diet. We found that the experience of housing damage due to the earthquake and tsunami was associated with slightly higher DII scores (coef. = 0·38, 95 % CI -0·05, 0·81). Specifically, women who cooked by themselves tended to have higher DII when they experienced housing damage (coef. = 1·33, 95 %CI -0·63, 3·28). On the other hand, loss of friends was associated with a lower DII score (coef. = -0·28, 95 % CI -0·54, -0·01). These findings highlight the importance of providing support to groups who are at increased risk of deterioration in dietary quality in the aftermath of disasters.


Asunto(s)
Dieta , Desastres , Terremotos , Inflamación , Sobrevivientes , Tsunamis , Humanos , Femenino , Japón/epidemiología , Masculino , Anciano , Sobrevivientes/psicología , Dieta/efectos adversos , Persona de Mediana Edad , Anciano de 80 o más Años , Vivienda
12.
Pediatr Nephrol ; 39(7): 2209-2215, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38358551

RESUMEN

BACKGROUND: On February 6th, 2023, two consecutive earthquakes struck southeastern Türkiye with magnitudes of 7.7 and 7.6, respectively. This study aimed to analyze the clinical and laboratory findings, as well as management of pediatric victims with Crush Syndrome (CS) and Acute Kidney Injury (AKI). METHODS: The study included pediatric earthquake victims who were presented to Mersin University Hospital. Clinical and laboratory characteristics of the patients were collected retrospectively. RESULTS: Among 649 patients, Crush injury (CI), CS and AKI was observed in 157, 59, and 17 patients, respectively. White blood cell count (12,870 [IQR: 9910-18700] vs. 10,545 [IQR: 8355-14057] /µL, P < 0.001), C-reactive protein (51.27 [IQR: 14.80-88.78] vs. 4.59 [1.04-18.25] mg/L, P < 0.001) and myoglobin levels (443.00 [IQR: 198.5-1759.35] vs. 17 [11.8-30.43] ng/ml) were higher in patients with CS, while their sodium (IQR: 134 [131-137] vs. 136 [134-138] mEq/L, P < 0.001) levels were lower compared to non-CS patients. An increase in myoglobin levels was identified as an independent risk factor for developing CS (OR = 1.017 [1.006-1.027]). Intravenous fluid replacement was administered to the patients with CS at a dose of 4000 cc/m2/day. Hypokalemia was observed in 51.9% of the CS patients on the third day. All patients with AKI showed improvement and no deaths were reported. CONCLUSIONS: Hyponatremia and increase in inflammation markers associated with CS may be observed. An increase in myoglobin levels was identified as a risk factor for CS. Hypokalemia may be seen as a complication of vigorous fluid therapy during hospitalization.


Asunto(s)
Lesión Renal Aguda , Síndrome de Aplastamiento , Terremotos , Humanos , Síndrome de Aplastamiento/sangre , Síndrome de Aplastamiento/terapia , Síndrome de Aplastamiento/complicaciones , Niño , Lesión Renal Aguda/etiología , Lesión Renal Aguda/terapia , Lesión Renal Aguda/sangre , Lesión Renal Aguda/diagnóstico , Masculino , Femenino , Estudios Retrospectivos , Preescolar , Adolescente , Proteína C-Reactiva/análisis , Mioglobina/sangre , Lactante
13.
14.
Nature ; 615(7952): 388-389, 2023 03.
Artículo en Inglés | MEDLINE | ID: mdl-36878981
17.
J Epidemiol ; 34(4): 164-169, 2024 Apr 05.
Artículo en Inglés | MEDLINE | ID: mdl-37635084

RESUMEN

BACKGROUND: Disaster survivors experience deterioration in lifestyles and an increase in constipation. After the Great East Japan Earthquake in 2011, some survivors were evacuated for a long term, even after moving to temporary housing and public reconstruction housing. However, annual changes in constipation and the association between lifestyles and constipation among the survivors are still unknown. METHODS: Overall, 9,234 survivors aged 18 years or older participated in this 9-year follow-up survey after the disaster. Information about the prevalence of constipation and lifestyle factors (diet, physical activity, and mental health) was collected using a self-reported questionnaire. Their dietary intake was categorized into the following two dietary patterns: prudent (fish and shellfish, soybean products, vegetables, fruits, and dairy products) and meat (meat and eggs). Odds ratios for constipation according to lifestyle factors were calculated using a generalized linear mixed model. RESULTS: In women, the prevalence of constipation was the highest at baseline (8.7%) and remained around 5% afterward. In both men and women, older age, poor mental health, and poor physical activity were significantly associated with higher odds ratios of constipation. Moreover, a lower frequency of meals and a lower prudent dietary score were significantly associated with women's constipation. CONCLUSION: The prevalence of constipation was the highest at baseline and remained around 5% in women. Lifestyle factors, such as poor mental health, physical inactivity, and low frequency of meals were associated with constipation. Our findings suggest continuous support for the survivors with constipation for medium- to long-term after disasters.


Asunto(s)
Terremotos , Masculino , Humanos , Femenino , Estudios de Seguimiento , Japón/epidemiología , Estilo de Vida , Sobrevivientes/psicología , Vivienda Popular
18.
Clin Radiol ; 79(1): 19-24, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37863746

RESUMEN

In the southeastern part of Turkey, two earthquakes measuring 7.7 and 7.8 on the Richter scale occurred within 9 h on 6 February 2023, causing 120,000 injuries and over 50,000 deaths. Evacuees were transferred to various secondary and tertiary hospitals as the health system and hospitals in the affected region were affected by the earthquake. Injuries were mostly caused by blunt trauma and/or prolonged bruising under rubble. The severity and pattern of traumatic injuries in earthquake victims differed from other trauma patients who were not affected by an earthquake. In addition to traumatic injuries that affected multiple body regions and systems, patients who were trapped under debris for long periods of time were also frequently found to have crush syndrome. Pulmonary thromboembolism and hypoxic-ischaemic brain injury were observed in some patients. In this review, we present the imaging findings of traumatic injuries in earthquake victims, emphasising the earthquake-related distinct injury types.


Asunto(s)
Síndrome de Aplastamiento , Terremotos , Heridas no Penetrantes , Humanos , Turquía/epidemiología , Síndrome de Aplastamiento/complicaciones , Sobrevivientes
19.
BMC Psychiatry ; 24(1): 171, 2024 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-38429677

RESUMEN

BACKGROUND: Despite the fact that studies indicate that earthquake trauma is associated with numerous psychological consequences, the mediating mechanisms leading to these outcomes have not been well-studied. Therefore, this study investigates the relationship between trauma exposure with substance use tendency, depression, and suicidal thoughts, with the mediating role of peritraumatic dissociation and experiential avoidance. METHODS: The descriptive-correlational approach was employed in this study. The participants were people who had experienced the Kermanshah earthquake in 2017. A total of 324 people were selected by convenient sampling method. The Traumatic Exposure Severity Scale, the Peritraumatic Dissociative Experiences Questionnaire, the Acceptance and Action Questionnaire, the Iranian Addiction Potential Scale, Beck's Depression Inventory [BDI-II], and Beck's Suicidal Thoughts Scale were used to collect data. The gathered data was analyzed| using structural equation modeling in |SPSS Ver. 24 and LISREL Ver. 24. RESULTS: The study findings indicated that the intensity of the trauma exposure is directly and significantly associated with depression symptoms, peritraumatic dissociation, and experiential avoidance. The severity of exposure to trauma had a significant indirect effect on the tendency to use substances through experiential avoidance. This is while the severity of the trauma experience did not directly correlate with substance use and suicidal thoughts. In addition, peritraumatic dissociation did not act as a mediator in the relationship between the severity of trauma exposure with substance use, depression, and suicidal thoughts. CONCLUSIONS: The severity of exposure to the earthquake was associated with symptoms of depression and these findings indicate the importance of experiential avoidance in predicting the tendency to use drugs. Hence, it is essential to design and implement psychological interventions that target experiential avoidance to prevent drug use tendencies and to establish policies that lower depression symptoms following natural disasters.


Asunto(s)
Terremotos , Trastornos por Estrés Postraumático , Humanos , Trastornos por Estrés Postraumático/psicología , Depresión/etiología , Ideación Suicida , Irán
20.
BMC Psychiatry ; 24(1): 343, 2024 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-38714972

RESUMEN

BACKGROUND: This study aimed to investigate the prevalence and severity of post-traumatic stress disorder (PTSD) and analyze the relationship between PTSD and breastfeeding attitudes and behaviors among breastfeeding mothers and women with children aged 0-24 months, all of whom had experienced the earthquake. METHODS: In this cross-sectional survey, a face-to-face questionnaire was administered to 173 earthquake survivors in Adiyaman, Turkey, during June and July 2023. The PTSD Checklist-Civilian scale was used to assess the presence of PTSD, while the Breastfeeding Attitudes of the Evaluation Scale (BAES) was employed to evaluate breastfeeding behaviors in mothers. RESULTS: Significantly higher PTSD scores (47.6 ± 17.4) were found among women staying in tents, while lower scores (37.0 ± 16.4) were observed in those who continued breastfeeding. 78.6% of women reported decreased breast milk because of the earthquake. Mothers with reduced milk supply had higher PTSD scores (46.1 ± 17.3). Breastfeeding training was associated with higher BAES scores (106.8 ± 56.8) and lower PTSD scores (32.5 ± 11.0). A significant negative correlation was observed between the PTSD score and BAES (r = -0.742; p < 0.001). CONCLUSIONS: The study demonstrated that breastfeeding may protect mothers against PTSD in the aftermath of earthquakes, emphasizing the importance of breastfeeding education. The higher frequency and severity of PTSD observed among earthquake survivor mothers residing in tents underscores the importance of promptly transitioning to permanent housing after the earthquake.


Asunto(s)
Lactancia Materna , Terremotos , Madres , Trastornos por Estrés Postraumático , Humanos , Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/epidemiología , Femenino , Lactancia Materna/psicología , Estudios Transversales , Adulto , Turquía/epidemiología , Madres/psicología , Lactante , Sobrevivientes/psicología , Encuestas y Cuestionarios , Adulto Joven , Recién Nacido , Prevalencia
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