Skip to main content

Advertisement

SpringerLink
Log in

PTSD and Physical Health

  • Disaster Psychiatry: Trauma, PTSD, and Related Disorders (MJ Friedman, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We review evidence linking PTSD to physical health symptoms and specific disorders, highlighting areas with multiple studies and objective measures of disease states when available. We also examine evidence for biological, behavioral, and psychosocial mechanisms underlying these associations and discuss the clinical implications of recent research.

Recent Findings

Recent meta-analyses have found that evidence is particularly strong for increased risk of cardiovascular, metabolic, and musculoskeletal disorders among patients with PTSD. Numerous studies have found alterations in the hypothalamic-pituitary-adrenal axis, sympathetic nervous system, inflammation, and health behaviors that could increase risk of illness, but few studies have simultaneously incorporated measures of mechanisms and disease outcomes.

Summary

Future research should focus on expanding the diversity of populations studied, particularly with respect to underrepresented racial and ethnic groups. Longitudinal studies that incorporate repeated measures of PTSD, pathogenic mechanisms of disease, and physical health outcomes and the addition of physical health outcomes to PTSD treatment trials will be most informative for the field.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005;62(6):593–602.

    Article  PubMed  Google Scholar 

  2. Kessler RC. Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry. 2000;61(Suppl 5):4.

    PubMed  Google Scholar 

  3. Pietrzak RH, Goldstein RB, Southwick SM, Grant BF. Prevalence and axis I comorbidity of full and partial posttraumatic stress disorder in the united states: results from wave 2 of the national epidemiologic survey on alcohol and related conditions. J Anxiety Disord. 2011;25(3):456–65.

    Article  PubMed  Google Scholar 

  4. Bedi US, Arora R. Cardiovascular manifestations of posttraumatic stress disorder. J Natl Med Assoc. 2007;99(6):642–9.

    PubMed  PubMed Central  Google Scholar 

  5. Boscarino JA. Posttraumatic stress disorder and mortality among U.S. army veterans 30 years after military service. Ann Epidemiol. 2006;16(4):248–56.

    Article  PubMed  Google Scholar 

  6. Dohrenwend BP, Turner JB, Turse NA, Adams BG, Koenen KC, Marshall R. Continuing controversy over the psychological risks of vietnam for U.S. veterans. J Trauma Stress. 2007;20(4):449–65.

    Article  PubMed  Google Scholar 

  7. Fulton JJ, Calhoun PS, Wagner HR, Schry AR, Hair LP, Feeling N, et al. The prevalence of posttraumatic stress disorder in operation enduring freedom/operation iraqi freedom (OEF/OIF) veterans: a meta-analysis. J Anxiety Disord. 2015;31:98–107.

    Article  PubMed  Google Scholar 

  8. Schnurr PP, Friedman MJ, Foy DW, Shea MT, Hsieh FY, Lavori PW, et al. Randomized trial of trauma-focused group therapy for posttraumatic stress disorder: Results from a department of veterans affairs cooperative study. Arch Gen Psychiatry. 2003;60(5):481–9.

    Article  PubMed  Google Scholar 

  9. Pacella ML, Hruska B, Delahanty DL. The physical health consequences of PTSD and PTSD symptoms: a meta-analytic review. J Anxiety Disord. 2013;27(1):33–46.

    Article  PubMed  Google Scholar 

  10. • Schry AR, Rissling MB, Gentes EL, Beckham JC, Kudler HS, Straits-Tröster K, et al. The relationship between post-traumatic stress symptoms and physical health in a survey of U.S. iraq and afghanistan era veterans. Psychosomatics. 2015;56(6):674–84 This is one of the first studies to examine the association between PTSD and physical health in a cohort of relatively younger veterans.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wachen JS, Shipherd JC, Michael S, Dawne V, King LA, King DW. Posttraumatic stress symptomatology as a mediator of the relationship between warzone exposure and physical health symptoms in men and women. J Trauma Stress. 2013;26(3):319–28.

    Article  PubMed  Google Scholar 

  12. Qureshi SU, Pyne JM, Magruder KM, Schulz PE, Kunik ME. The link between post-traumatic stress disorder and physical comorbidities: a systematic review. Psychiatr Q. 2009;80(2):87–97.

    Article  PubMed  Google Scholar 

  13. • El-Gabalawy R, Blaney C, Tsai J, Sumner JA, Pietrzak RH. Physical health conditions associated with full and subthreshold PTSD in U.S. military veterans: Results from the national health and resilience in veterans study. J Affect Disord. 2018;227:849–53 This is the most recent study to examine the association between PTSD and physical health in U.S. military veterans.

    Article  PubMed  Google Scholar 

  14. Levine AB, Levine LM, Levine TB. Posttraumatic stress disorder and cardiometabolic disease. Cardiology. 2014;127(1):1–19.

    Article  PubMed  Google Scholar 

  15. Cohen BE, Edmondson D, Kronish IM. State of the art review: depression, stress, anxiety, and cardiovascular disease. Am J Hypertens. 2015;28(11):1295–302.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Suglia SF, Sapra KJ, Koenen KC. Violence and cardiovascular health: a systematic review. Am J Prev Med. 2015;48(2):205–12.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Burg MM, Soufer R. Post-traumatic stress disorder and cardiovascular disease. Curr Cardiol Rep. 2016;18(10):94.

    Article  PubMed  Google Scholar 

  18. • Edmondson D, von Känel R. Post-traumatic stress disorder and cardiovascular disease. Lancet Psychiatry. 2017;4(4):320–9 Recent review of PTSD and cardiovascular disease and evidence for underlying mechanisms of association.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Edmondson D, Kronish IM, Shaffer JA, Falzon L, Burg MM. Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review. Am Heart J. 2013;166(5):806–14.

    Article  PubMed  Google Scholar 

  20. Gradus JL, Farkas D, Svensson E, Ehrenstein V, Lash TL, Milstein A, et al. Associations between stress disorders and cardiovascular disease events in the Danish population. BMJ Open. 2015;5(12):e009334.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sumner JA, Kubzansky LD, Elkind MSV, Roberts AL, Agnew-Blais J, Chen Q, et al. Trauma exposure and posttraumatic stress disorder symptoms predict onset of cardiovascular events in women. Circulation. 2015;132(4):251–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gilsanz P, Winning A, Koenen KC, Roberts AL, Sumner JA, Chen Q, et al. Posttraumatic stress disorder symptom duration and remission in relation to cardiovascular disease risk among a large cohort of women. Psychol Med. 2017;47(8):1370–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Vidal C, Polo R, Alvarez K, Falgas-Bague I, Wang Y, Lê Cook B, et al. Co-occurrence of posttraumatic stress disorder and cardiovascular disease among ethnic/racial groups in the United States. Psychosom Med. 2018;80(7):680–688.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Turner JH, Neylan TC, Schiller NB, Li Y, Cohen BE. Objective evidence of myocardial ischemia in patients with posttraumatic stress disorder. Biol Psychiatry. 2013;74(11):861–6.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Vaccarino V, Goldberg J, Rooks C, Shah AJ, Veledar E, Faber TL, et al. Post-traumatic stress disorder and incidence of coronary heart disease. J Am Coll Cardiol. 2013;62(11):970.

    Article  PubMed  Google Scholar 

  26. Ahmadi N, Hajsadeghi F, Mirshkarlo HB, Budoff M, Yehuda R, Ebrahimi R. Post-traumatic stress disorder, coronary atherosclerosis, and mortality. Am J Cardiol. 2011;108(1):29–33.

    Article  PubMed  Google Scholar 

  27. • Vancampfort D, Rosenbaum S, Ward PB, Steel Z, Lederman O, Lamwaka AV, et al. Type 2 diabetes among people with posttraumatic stress disorder: Systematic review and meta-analysis. Psychosom Med. 2016;78(4):465–73 Systematic review of PTSD and risk of diabetes.

    Article  PubMed  Google Scholar 

  28. Roberts NP, Roberts PA, Jones N, Bisson JI. Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: a systematic review and meta-analysis. Clin Psychol Rev. 2015;38:25–38.

    Article  PubMed  Google Scholar 

  29. Kubzansky LD, Bordelois P, Jun HJ, Roberts AL, Cerda M, Bluestone N, et al. The weight of traumatic stress: a prospective study of posttraumatic stress disorder symptoms and weight status in women. JAMA Psychiatry. 2014;71(1):44–51.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Scherrer JF, Salas J, Lustman PJ, van den Berk-Clark C, Schnurr PP, Tuerk P, et al. The role of obesity in the association between posttraumatic stress disorder and incident diabetes. JAMA Psychiatry. 2018.

  31. • O'Doherty DC, Chitty KM, Saddiqui S, Bennett MR, Lagopoulos J. A systematic review and meta-analysis of magnetic resonance imaging measurement of structural volumes in posttraumatic stress disorder. Psychiatry Res. 2015;232(1):1–33 Recent systematic review and meta-analysis of structural brain changes in PTSD.

    Article  PubMed  Google Scholar 

  32. Vasterling JJ, Duke LM, Brailey K, Constans JI, Allain AN Jr, Sutker PB. Attention, learning, and memory performances and intellectual resources in vietnam veterans: PTSD and no disorder comparisons. Neuropsychology. 2002;16(1):5–14.

    Article  PubMed  Google Scholar 

  33. Vasterling JJ, Brailey K. Neuropsychological findings in adults with PTSD. In J. J. Vasterling & C. R. Brewin (Eds.), Neuropsychology of PTSD: Biological, cognitive, and clinical perspectives. New York, NY, US: Guilford Press; 2005. p.178–207.

  34. Boccia M, D'Amico S, Bianchini F, Marano A, Giannini AM, Piccardi L. Different neural modifications underpin PTSD after different traumatic events: an fMRI meta-analytic study. Brain Imaging Behav. 2016;10(1):226–37.

    Article  PubMed  Google Scholar 

  35. Vermetten E, Vythilingam M, Southwick SM, Charney DS, Bremner JD. Long-term treatment with paroxetine increases verbal declarative memory and hippocampal volume in posttraumatic stress disorder. Biol Psychiatry. 2003;54(7):693–702.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Thomaes K, Dorrepaal E, Draijer N, Jansma EP, Veltman DJ, van Balkom AJ. Can pharmacological and psychological treatment change brain structure and function in PTSD? A systematic review. J Psychiatr Res. 2014;50:1–15.

    Article  PubMed  Google Scholar 

  37. O’Donovan A. PTSD is associated with elevated inflammation. any impact on clinical practice? Evid Based Ment Health. 2016;19(4):102376.

    Google Scholar 

  38. Song H, Fang F, Tomasson G, Arnberg FK, Mataix-Cols D, Fernandez de la Cruz L, et al. Association of stress-related disorders with subsequent autoimmune disease. JAMA. 2018;319(23):2388–400.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Cohen BE, Maguen S, Bertenthal D, Shi Y, Jacoby V, Seal KH. Reproductive and other health outcomes in iraq and afghanistan women veterans using VA health care: association with mental health diagnoses. Womens Health Issues. 2012;22(5):461.

    Article  Google Scholar 

  40. Bradley CS, Nygaard IE, Hillis SL, Torner JC, Sadler AG. Longitudinal associations between mental health conditions and overactive bladder in women veterans. Am J Obstet Gynecol. 2017;217(4):430.e8.

    Article  Google Scholar 

  41. • Shaw JG, Asch SM, Katon JG, Shaw KA, Kimerling R, Frayne SM, et al. Post-traumatic stress disorder and antepartum complications: a novel risk factor for gestational diabetes and preeclampsia. Paediatr Perinat Epidemiol. 2017;31(3):185–94 This study examines the association between antenatal PTSD and spontaneous pre-term birth in an unprecedented number of deliveries covered by the Veterans Health Administration.

    Article  PubMed  Google Scholar 

  42. Shaw JG, Asch SM, Kimerling R, Frayne SM, Shaw KA, Phibbs CS. Posttraumatic stress disorder and risk of spontaneous preterm birth. Obstet Gynecol. 2014;124(6):1111–9.

    Article  PubMed  Google Scholar 

  43. Krulewitch CJ. Reproductive health of active duty women in medically austere environments. Mil Med. 2016;181(suppl_1):63–9.

    Article  PubMed  Google Scholar 

  44. Kang HK, Mahan CM, Lee KY, Magee CA, Mather SH, Matanoski G. Pregnancy outcomes among U.S. women Vietnam veterans. Am J Ind Med. 2000;38(4):447–54.

    Article  CAS  PubMed  Google Scholar 

  45. Schnurr PP, Wachen JS, Green BL, Kaltman S. Trauma exposure, PTSD, and physical health. In M. J. Friedman, T. M. Keane, & P. A. Resick (Eds.), Handbook of PTSD: Science and practice. New York, NY, US: Guilford Press; 2014. p. 502–21.

  46. Morris MC, Compas BE, Garber J. Relations among posttraumatic stress disorder, comorbid major depression, and HPA function: a systematic review and meta-analysis. Clin Psychol Rev. 2012;32(4):301–15.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Yehuda R, McFarlane AC, Shalev AY. Predicting the development of posttraumatic stress disorder from the acute response to a traumatic event. Biol Psychiatry. 1998;44(12):1305–13.

    Article  CAS  PubMed  Google Scholar 

  48. Young EA, Breslau N. Cortisol and catecholamines in posttraumatic stress disorder: an epidemiologic community study. Arch Gen Psychiatry. 2004;61(4):394–401.

    Article  CAS  PubMed  Google Scholar 

  49. Wingenfeld K, Wolf OT. Effects of cortisol on cognition in major depressive disorder, posttraumatic stress disorder and borderline personality disorder—2014 curt richter award winner. Psychoneuroendocrinology. 2015;51:282–95.

    Article  CAS  PubMed  Google Scholar 

  50. Rogers KM, Bonar CA, Estrella JL, Yang S. Inhibitory effect of glucocorticoid on coronary artery endothelial function. Am J Physiol Heart Circ Physiol. 2002;283(5):1922.

    Article  Google Scholar 

  51. Esler M. The 2009 Carl Ludwig lecture: Pathophysiology of the human sympathetic nervous system in cardiovascular diseases: the transition from mechanisms to medical management. J Appl Physiol (1985). 2010;108(2):227–37.

    Article  CAS  Google Scholar 

  52. Jones KB, Mollano AV, Morcuende JA, Cooper RR, Saltzman CL. Bone and brain: a review of neural, hormonal, and musculoskeletal connections. Iowa Orthop J. 2004;24:123–32.

    PubMed  PubMed Central  Google Scholar 

  53. Morale C, Brouwer J, Testa N, Tirolo C, Barden N, Dijkstra CD, et al. Stress, glucocorticoids and the susceptibility to develop autoimmune disorders of the central nervous system. Neurol Sci. 2001;22(2):159–62.

    Article  CAS  PubMed  Google Scholar 

  54. Cole SW, Nagaraja AS, Lutgendorf SK, Green PA, Sood AK. Sympathetic nervous system regulation of the tumour microenvironment. Nat Rev Cancer. 2015;15(9):563–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Carpenter LL, Shattuck TT, Tyrka AR, Geracioti TD, Price LH. Effect of childhood physical abuse on cortisol stress response. Psychopharmacology. 2011;214(1):367–75.

    Article  CAS  PubMed  Google Scholar 

  56. Kiecolt-Glaser JK, Gouin JP, Weng NP, Malarkey WB, Beversdorf DQ, Glaser R. Childhood adversity heightens the impact of later-life caregiving stress on telomere length and inflammation. Psychosom Med. 2011;73(1):16–22.

    Article  PubMed  Google Scholar 

  57. Fagundes CP, Glaser R, Kiecolt-Glaser JK. Stressful early life experiences and immune dysregulation across the lifespan. Brain Behav Immun. 2013;27C:8–12.

    Article  CAS  Google Scholar 

  58. Baker DG, Nievergelt CM, O'Connor DT. Biomarkers of PTSD: neuropeptides and immune signaling. Neuropharmacology. 2012;62(2):663–73.

    Article  CAS  PubMed  Google Scholar 

  59. Miller AM. Role of IL-33 in inflammation and disease. J Inflamm (Lond). 2011;8(1):22.

    Article  CAS  Google Scholar 

  60. Gill JM, Saligan L, Woods S, Page G. PTSD is associated with an excess of inflammatory immune activities. Perspect Psychiatr Care. 2009;45(4):262–77.

    Article  PubMed  Google Scholar 

  61. Gill J, Vythilingam M, Page GG. Low cortisol, high DHEA, and high levels of stimulated TNF-alpha, and IL-6 in women with PTSD. J Trauma Stress. 2008;21(6):530–9.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Altemus M, Dhabhar FS, Yang R. Immune function in PTSD. Ann N Y Acad Sci. 2006;1071:167–83.

    Article  CAS  PubMed  Google Scholar 

  63. Fu SS, McFall M, Saxon AJ, Beckham JC, Carmody TP, Baker DG, et al. Post-traumatic stress disorder and smoking: a systematic review. Nicotine Tob Res. 2007;9(11):1071–84.

    Article  PubMed  Google Scholar 

  64. Debell F, Fear NT, Head M, Batt-Rawden S, Greenberg N, Wessely S, et al. A systematic review of the comorbidity between PTSD and alcohol misuse. Soc Psychiatry Psychiatr Epidemiol. 2014;49(9):1401–25.

    Article  PubMed  Google Scholar 

  65. Norman SB, Allard CB, Trim RS, Thorp SR, Behrooznia M, Masino TT, et al. Psychometrics of the overall anxiety severity and impairment scale (OASIS) in a sample of women with and without trauma histories. Arch Womens Ment Health. 2013;16(2):123–9.

    Article  PubMed  Google Scholar 

  66. Hall KS, Hoerster KD, Yancy WS Jr. Post-traumatic stress disorder, physical activity, and eating behaviors. Epidemiol Rev. 2015;37:103–15.

    Article  PubMed  Google Scholar 

  67. • van den Berk-Clark C, Secrest S, Walls J, Hallberg E, Lustman PJ, Schneider FD, et al. Association between posttraumatic stress disorder and lack of exercise, poor diet, obesity, and co-occuring smoking: a systematic review and meta-analysis. Health Psychol. 2018;37(5):407–16 Recent meta-analysis of PTSD and behavioral risk factors for cardiovascular disease.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Kronish IM, Edmondson D, Li Y, Cohen BE. Post-traumatic stress disorder and medication adherence: Results from the mind your heart study. J Psychiatr Res. 2012;46(12):1595–9.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Kronish IM, Lin JJ, Cohen BE, Voils CI, Edmondson D. Posttraumatic stress disorder and medication nonadherence in patients with uncontrolled hypertension. JAMA Intern Med. 2014;174(3):468–70.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Akosile W, Young R, Lawford B, Voisey J, Colquhoun D. PTSD symptoms associated with myocardial infarction: practical clinical implications. Australas Psychiatry. 2018;26(1):60–4.

    Article  PubMed  Google Scholar 

  71. Jain KM, Davey-Rothwell M, Crossnohere NL, Latkin CA. Post-traumatic stress disorder, neighborhood residency and satisfaction, and social network characteristics among underserved women in Baltimore, Maryland. Womens Health Issues. 2018;28(3):273–80.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Cohen BE, Gima K, Bertenthal D, Kim S, Marmar CR, Seal KH. Mental health diagnoses and utilization of VA non-mental health medical services among returning Iraq and Afghanistan veterans. J Gen Intern Med. 2010;25(1):18–24.

    Article  PubMed  Google Scholar 

  73. Schlenger WE, Mulvaney-Day N, Williams CS, Kulka RA, Corry NH, Mauch D, et al. PTSD and use of outpatient general medical services among veterans of the Vietnam war. Psychiatr Serv. 2016;67(5):543–50.

    Article  PubMed  Google Scholar 

  74. Weitlauf JC, Finney JW, Ruzek JI, Lee TT, Thrailkill A, Jones S, et al. Distress and pain during pelvic examinations: effect of sexual violence. Obstet Gynecol. 2008;112(6):1343–50.

    Article  PubMed  Google Scholar 

  75. Nicolai MP, Keller JJ, de Vries L, van der Meulen-de Jong AE, Nicolai JJ, Hardwick JC, et al. The impact of sexual abuse in patients undergoing colonoscopy. PLoS One. 2014;9(1):e85034.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  76. Weitlauf JC, Jones S, Xu X, Finney JW, Moos RH, Sawaya GF, et al. Receipt of cervical cancer screening in female veterans: impact of posttraumatic stress disorder and depression. Womens Health Issues. 2013;23(3):153.

    Article  Google Scholar 

  77. Prins A, Bovin MJ, Smolenski DJ, Marx BP, Kimerling R, Jenkins-Guarnieri MA, et al. The primary care PTSD screen for DSM-5 (PC-PTSD-5): development and evaluation within a veteran primary care sample. J Gen Intern Med. 2016;31(10):1206–11.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Manser SS, Houck K, Kramer MD, Tabas IA, Brown CVR, Coopwood B. Do screening and a randomized brief intervention at a level 1 trauma center impact acute stress reactions to prevent later development of post traumatic stress disorder? J Trauma Acute Care Surg. 2018;85(3):466-475.

  79. Bates CK, Carroll N, Potter J. The challenging pelvic examination. J Gen Intern Med. 2011;26(6):651–7.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. San Francisco Veterans Affairs Health Care System, 4150 Clement Street, San Francisco, CA, 94121, USA

    Annie L. Ryder & Beth E. Cohen

  2. Department of Internal Medicine, University of California San Francisco, San Francisco, CA, USA

    Annie L. Ryder, Patrick M. Azcarate & Beth E. Cohen

Authors
  1. Annie L. Ryder
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick M. Azcarate
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Beth E. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Beth E. Cohen.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Disaster Psychiatry: Trauma, PTSD, and Related Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ryder, A.L., Azcarate, P.M. & Cohen, B.E. PTSD and Physical Health. Curr Psychiatry Rep 20, 116 (2018). https://doi.org/10.1007/s11920-018-0977-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-018-0977-9

Keywords

Search

Navigation