Epidermolysis bullosa (EB) is a accumulation of attenuate abiogenetic derma altitude that could could could could could could could could could could could could could could could could could could could could could cause the derma to abscess in acknowledgment to accessory injury, heat, or abrasion from abrading or scratching. Abiogenetic altitude are inherited. They are acquired by adulterated genes that run in the family.

Most types of epidermolysis bullosa initially affect breed and adolescent children. Some humans with balmy forms of the action do not advance signs and affection until boyhood or aboriginal adulthood. Balmy forms of EB may advance with age, but astringent forms may could could could could could could could could could could could could could could could could could could could could could cause austere complications and can be fatal. Some breed are built-in with blisters. Accouchement with EB are sometimes alleged butterfly accouchement because their derma is said to be as brittle as a butterfly’s wing.

EB affects boys and girls equally, and can affect any indigenous group. In attenuate cases, EB can aswell affect adults, but the action tends to be mild.

There is no cure for EB. Analysis depends on the severity, but it is about aimed at preventing pain, infection and added complications.

There are three capital types of EB:

Epidermolysis Bullosa simplex. This is the a lot of accepted blazon of EB, 70 percent of EB cases.

Dystrophic Epidermolysis Bullosa affects about 25 percent of humans with EB.

Junctional Epidermolysis Bullosa affects about 5 percent of humans with EB.

Within anniversary blazon of EB, there are several adapted forms and affection and causes can vary. Currently, there are added than 25 accepted forms of EB.

If a adolescent has EB, adulterated genes in their derma beef could could could could could could could could could could could could could could could could could could could could could cause blisters to form. Their derma is aswell actual fragile. Even the aboriginal rubbing, abrasion or accessory abrasion can could could could could could could could could could could could could could could could could could could could could could cause their derma to abscess and tear.

Blisters can aswell advance on their own, even if the derma is not damaged. Blisters and derma accident can leave accessible wounds and raw patches on the skin.

Some forms of EB can accomplish accustomed activities, such as acquirements to clamber and walk, difficult for both babies and earlier children.

According to Medilexicon’s medical dictionary, Epidermolysis bullosa is:

“a accumulation of affiliated abiding noninflammatory derma diseases in which ample bullae and erosions aftereffect from slight automated trauma; a anatomy localized to the calmly and anxiety is alleged Weber-Cockayne syndrome, of autosomal ascendant bequest acquired by alteration in either the gene encoding keratin-5 (KRT5) on chromosome 12q or the gene for keratin-14 (KRT14) on 17q.”

Mild or astringent forms of EB

Some forms of EB can be mild. Affection may affect alone localized locations of the body, such as the anxiety and hands. The affection of some forms can aswell advance as a adolescent grows older.

In added forms of EB, blisters and derma accident can be added widespread. Blisters may anatomy in the mouth, eyes, nose, stomach, airways and genitals.

Some forms of EB can be severe, and the action can be action threatening.

EB acquisita.

A attenuate derma action that mainly affects adults. EB acquisita aswell causes blistering. However, EB acquisita is not a abiogenetic disease; it is an autoimmune condition. The allowed arrangement produces antibodies, which frequently advance adopted beef such as bacteria. In an autoimmune condition, the antibodies advance the body’s own advantageous beef and tissue. In EB acquisita, antibodies advance and abort derma cells, causing blisters to form. It is sometimes affiliated with added altitude such as Crohn’s disease, diabetes, systemic lupus erythematosus which is an deepening of tissues affecting the accomplished body.

What are the signs and affection of epidermolysis bullosa?

A evidence is something the accommodating feels and reports, while a assurance is something added people, such as the doctor notice. For example, affliction may be a evidence while a adventurous may be a sign.

The primary adumbration of epidermolysis bullosa is the access of fluid-filled blisters (bullae) on the skin. They a lot of frequently arise on the calmly and anxiety in acknowledgment to friction. In balmy cases, blisters alleviate afterwards scarring.

The affection of EB usually advance in babies. They can be present at bearing or advance anon after. Affection tend to advance after in action with milder forms of EB, for example, if the action affects adults. EB in adults is rare. Signs and affection of epidermolysis bullosa may include:

Blisters basic in the skin

Deformity or accident of fingernails and toenails

Dental abnormalities, such as tooth adulteration from ailing formed tooth enamel

Difficulty swallowing

Excessive sweating

Internal blistering, including on the throat, esophagus, top airway, stomach, belly and urinary tract

Peeling of the skin

Scalp blistering, scarring and hair loss

Skin falling off

Skin agglomeration on award and soles of the anxiety (hyperkeratosis)

Tearing of the skin

Thin-appearing skin

Tiny white derma bumps or pimples (milia)

In EB, the derma is brittle and can calmly be damaged by:

the aboriginal abrading or friction

minor injuries, including knocks and bumps

clothing that touches or rubs the skin

In some forms of EB, blisters can affect the eyes and the body’s centralized linings, such as the membranes central the mouth, nose, airways, esophagus, abdomen and genitals.

Seek alert medical absorption if a babyish or adolescent develops blisters, and there is no credible acumen for them. In some cases of epidermolysis bullosa, baking may not arise until a toddler aboriginal begins to walk, or until an earlier adolescent begins new concrete activities that activate added acute abrasion on the feet.

If a adolescent has been diagnosed with epidermolysis bullosa and develops signs of an infection about an accessible breadth of skin, seek medical attention. Such signs can include:

Redness, calefaction or pain

Pus or a chicken discharge

Crusting

Red band or band beneath the skin, addition abroad from the wound

A anguish that does not heal

Fever or chills

Blisters can advance to infection and deformity. Proper affliction is essential.

Seek medical absorption for individuals of all ages experiencing problems burning or breathing.

There are adapted types of EB. The capital types of EB include:

EB simplex

dystrophic EB

junctional EB

Kindler syndrome

Within these types, there are adapted forms of EB, and the affection can ambit from balmy to severe.

EB canker (localized and generalized)

This a lot of accepted and about mildest anatomy usually begins at bearing or in aboriginal infancy. The adulterated genes are circuitous in the assembly of keratin. If one ancestor has the individual adulterated gene, there is a 50 percent adventitious his or her babyish will accept the defect.

Blisters advance mainly on a child’s calmly (on the palms) and anxiety (on the soles). Affection may cover boundless afraid on the calmly and anxiety (hyperhidrosis). This anatomy of EB is alleged localized EB simplex, or Weber-Cockayne EB simplex.

There may aswell be blisters central the mouth. This anatomy of EB is alleged ambiguous EB simplex, or Köbner (or Koebner) EB simplex.

In these forms of EB simplex, the blisters usually alleviate afterwards abrogation scars. Balmy weather, calefaction and clamminess can accomplish the baking worse.

EB canker (Dowling Meara)

The Dowling Meara anatomy of EB canker is added severe. The blisters arise in clusters. Baking or derma accident may be widespread.

The babyish may accept blisters on their articulation box (larynx), which can could could could could could could could could could could could could could could could could could could could could could cause a blatant cry. Also, they may accept blisters in their mouth, which can could could could could could could could could could could could could could could could could could could could could could cause agriculture problems. In this blazon of EB simplex, the baking about improves as the adolescent gets older. Afterwards blisters heal, they may leave the derma discolored.

Dystrophic EB (DEB)

The affection of DEB can alter widely. They can be balmy to severe. In some forms of DEB, blisters may alone affect allotment of the physique (localized) or can be abundant added boundless (generalized). Afterwards the blisters heal, they usually leave scars and small, aloft white spots on the skin.

If DEB is affiliated from one ancestor (dominant inheritance), the affection are usually milder. This anatomy is alleged ascendant dystrophic EB (DDEB).

If DEB is affiliated from both parents (recessive inheritance), the action tends to be added severe. This anatomy is alleged backward dystrophic EB (RDEB). The affection can be actual severe. There can be all-encompassing baking and scarring, as able-bodied as problems with the digestive arrangement and the kidneys. This anatomy is alleged astringent ambiguous RDEB, or Hallopeau-Siemens RDEB.

Junctional EB (JEB)

The ataxia about begins at birth. As with DEB, the affection of JEB can alter and can be balmy or severe. Blisters and brittle derma can affect alone allotment of the body, or they can be actual widespread.

Herlitz JEB is a severe, life-threatening anatomy of the condition. Herlitz JEB causes abounding complications, including all-encompassing accident of skin, breath difficulties and anemia (iron deficiency).

Kindler affection

In Kindler syndrome, baking mainly affects the calmly and feet. Added affection that can aswell affect the derma are bit-by-bit crumbling abroad (atrophy), acuteness to ablaze (photosensitivity) and derma blush or colorant aberration (poikiloderma).

What are the causes of Epidermolysis bullosa?

In a lot of cases, epidermolysis bullosa is inherited. It is acquired by adulterated genes in derma cells. These genes ascendancy the way the physique produces skin. It is aswell accessible to advance EB as a aftereffect of a accidental alteration in a gene.

Blisters

The derma is fabricated up of adapted layers including the top band (epidermis) and the lower layers (dermis).

Because of the adulterated genes the adapted derma layers cannot authority or stick together, and they separate. Breadth the layers of derma accept separated, aqueous gathers in the amplitude to anatomy a blister. The derma is brittle and calmly damaged.

Currently, there are added than 25 accepted forms of EB and three capital types. Anniversary blazon is acquired by adapted genes and adapted faults. Researchers accept articular the abiogenetic mutations that could could could could could could could could could could could could could could could could could could could could could cause a lot of forms of EB.

Where and if blisters advance depends on the blazon of epidermolysis bullosa. The adulterated genes could could could could could could could could could could could could could could could could could could could could could cause blisters to anatomy in adapted layers of the skin, depending on the blazon of EB. For example:

In dystrophic EB: blisters anatomy in the lower layers and tissues of the skin.

In EB simplex: blisters anatomy aural the top band of the derma (epidermis).

In junctional EB: blisters anatomy breadth the top and lower layers meet.

In Kindler syndrome: the layers of derma breadth blisters anatomy can vary.

In some forms of EB, the adulterated genes can aswell could could could could could could could could could could could could could could could could could could could could could cause blisters to anatomy central the body, central the mouth, nose, esophagus, stomach, airways and genitals.

Genetic altitude

All animal beings accede two genes for anniversary appropriate (eye color, acme and derma color). One gene comes from anniversary parent.

A adolescent can accede a abiogenetic action in several ways. For example:

Dominant inheritance: One ancestor can canyon on a adulterated gene to their child. In this case, the ancestor will aswell accept the condition.

Recessive inheritance: Both parents canyon on adulterated genes to the child. In these cases, the parents will not accept the condition, and may not be acquainted that they are carriers.

How is EB inherited?

EB can be affiliated in adapted ways. The forms affiliated from both parents (recessive) tend to be added severe.

EB canker is usually affiliated from one ancestor who has the adulterated gene. The ancestor aswell has the condition.

In attenuate cases, a adolescent can accept EB canker breadth there is no ancestors history of the condition. A gene can mutate, even admitting neither ancestor has the condition. What causes the genes to adapt is unknown.

Dystrophic EB can be affiliated from both parents, or from one parent. Junctional EB and Kindler affection are affiliated from both parents. Junctional epidermolysis bullosa is the aftereffect of both parents accustomed and casual on the aberrant gene, although neither ancestor may clinically accept the ataxia (silent mutation). If both parents accept the adulterated gene, there is a 25 percent adventitious that one of their babyish will accept the birthmark and advance the disorder.

What are the accident factors of epidermolysis bullosa?

A accident agency is something which increases the likelihood of developing a action or disease. For example, blubber decidedly raises the accident of developing diabetes blazon 2. Therefore, blubber is a accident agency for diabetes blazon 2.

The above accident agency for developing the ataxia is to accept a ancestors history of epidermolysis bullosa.

How is epidermolysis bullosa diagnosed?

During medical appraisal the derma will be advised to assess:

size of the blisters

how calmly the derma is damaged

how abundant of the physique is affected

what causes the blisters

where the blisters are on the body

The mouth, eyes, nails, teeth, and hair will be examined. There will be a analysis of the parents’ ancestors history of EB.

Testing is all-important to affirm analysis of EB and to analyze the blazon of EB and how it was inherited.

A biopsy may be agitated out, breadth a sample of the derma tissue is taken for testing. In some cases, claret samples may be taken from the adolescent and their parents. The samples can be acclimated for abiogenetic tests in adjustment to affirm whether the action has been affiliated from one or both parents.
 


After the analysis

If a adolescent is diagnosed with EB, they will be referred to a specialist EB centre.

What is the analysis for epidermolysis bullosa?

There is currently no cure for epidermolysis bullosa (EB). Analysis of EB aims mainly at preventing complications, abatement ache from baking and authoritative the condition’s symptoms.

Skin care


Blisters may be large. Once broken, they are afflicted to infection and aqueous loss. They may be punctured with a antiseptic needle. Abrogation the roof of the abscess complete allows for arising of the abscess while attention the basal skin. Antibacterial ointment, petroleum clabber or added moisturizing actuality may be recommended afore applying a non-sticking bandage. In some cases, there may be no charge for a bathrobe and it is best to ‘dust’ the abscess with blah flour, which helps to dry it and abate added friction.

In the case of wounds that do not alleviate over time, derma grafts may be recommended, application either the parents’ or the child’s own skin, or bogus skin. Covering the anguish with derma can admonition activate healing.

Surgery


Repeated baking and scarring can could could could could could could could could could could could could could could could could could could could could could cause deformities. Surgery may be recommended to actual these deformities, decidedly if they baffle with accustomed activity.

Blistering and scarring of the esophagus may advance to esophageal narrowing, authoritative bistro difficult. Surgery to widen the esophagus may be needed. Application ablaze sedation, a babyish airship is aggrandized in the esophagus to amplify the area.

If agriculture is impossible, a tube may be built-in to bear aliment anon to the stomach.

Physical therapy


It can admonition affluence the limitations on motion acquired by scarring and contracture.

Specialist centers for EB

Children with EB can accept circuitous needs, decidedly if they accept a astringent anatomy of EB. Their affliction may absorb abounding adapted healthcare professionals. Specialist centers alike affliction for accouchement and adults with EB.

Avoiding accident to child’s derma

Advice about how to abstain accident to a child’s derma may vary, depending on the anatomy of EB and the severity of their symptoms. This may include:

Avoid accustomed knocks, bumps and scratches.

Avoid abrading their derma in adjustment to admonition abstain blisters and derma damage. Be added affable if acrimonious them up.

Avoiding clothes that fit deeply or rub the skin.

Choosing able shoes that fit well. Accustomed bolt like covering may admonition to accumulate their anxiety cool.

Keep the adolescent from bistro harder or aciculate foods that can could  cause blisters in the mouth.

Keeping your adolescent as air-conditioned as accessible in balmy weather.

Wearing clothes fabricated from accustomed fabrics, such as cotton, to admonition the adolescent to accumulate cool.

Infections

Open wounds and raw patches of derma can about become infected. An antibacterial chrism may be prescribed.

Pain abatement

The charge for affliction abatement anesthetic will vary, depending on the severity of the child’s symptoms. The blisters and the wounds can be actual painful. Simple activities, such as affective and walking can be difficult.

Dental affliction

Good dental hygiene and approved visits to a dentist are important. Soreness acquired by blisters central the child’s aperture can accomplish charwoman their teeth difficult.

Feeding

If the babyish has blisters in the mouth, it can could cause problems with feeding. Get medical admonition on how to cope with these problems, whether breastfeeding or canteen feeding.

Child’s diet and diet

Ask for medical admonition about the child’s diet. A advantageous diet is actual important back the healing action makes abundant demands on the body. Acceptable diet is capital to admonition alleviate the wounds on the child’s skin.

A diet top in calories and protein can be recommended. Aswell supplements, such as vitamins or adamant if they accept anemia (iron deficiency).

Genetic counseling

Treatment for EB may cover abiogenetic counseling, to accommodate abutment and advice, as able-bodied as admonition about how it is affiliated and which ancestors associates may be affected.

Gene analysis

Research into convalescent treatments for EB is ongoing. It focuses on managing abiding affliction and gene therapy, which involves replacing adulterated genes with accustomed genes, or genes that accept been altered.

What are the complications of epidermolysis bullosa (EB)?

There are currently added than 25 accepted forms of epidermolysis bullosa (EB). Anniversary has adapted complications.

Complications acquired by scarring

In some forms of EB, blisters and accessible wounds can alleviate slowly, abrogation blister tissue that builds up over time. In EB simplex, blister tissue can thicken and amalgamate derma on the award of the calmly and soles of the anxiety (hyperkeratosis).

In added forms of EB, the accession of blister tissue can could cause disability, and adversity with movement. In astringent backward dystrophic EB, blister tissue can physique up amid fingers or toes so that they accompany together. Surgery may be bare in adjustment to accredit the adolescent to move their fingers again.

Blisters can could  cause problems with chewing, burning aliment and authoritative bistro actual painful.

Scarring can aswell accomplish the esophagus narrower, or could  cause blockages in it. Surgery may be bare to accredit burning again. Nutrients may be fed anon to the abdomen through a tube.

Blistering and scarring about the anus can accomplish casual stools (faeces) aching and could  cause constipation.

Secondary derma infection. Baking can leave derma accessible to bacterial infection, decidedly staph infection, and access affairs for sepsis.

Sepsis. It occurs if bacilli from a massive infection access the bloodstream and advance throughout the body. Sepsis is a rapidly progressing, life-threatening condition. It can could  cause shock and agency failure.

Deformities. Astringent forms of epidermolysis bullosa can  cause admixture of fingers or toes and aberrant angle of joints, such as fingers, knees and elbows.

Malnutrition. Some forms of epidermolysis bullosa could  cause baking of the aperture and added close membranes, bistro may be difficult. The consistent malnutrition can apathetic down accustomed growth.

Anemia. Continuous accident of claret from accessible sores and possibly disability to yield in able diet may accord to adamant absence anemia.

Complications affecting the eyes

Eye complications are added accepted in the added astringent forms of EB. The a lot of accepted aggravation that affects the eyes is tearing, baking or scarring of the cornea which is the bright alien band at the foreground of the eye. Added eye complications can include:

blistering of the conjunctiva (the cellophane film that covers the white allotment of the eye and the close eyelid surfaces)

blisters on the eyelids

inflamed eyelids

the eyelid axis outwards (ectropion)

Treatment for eye complications may cover lubricating the eye application drops and ointments to admonition accumulate it moist.

Dehydration

Skin holds baptize and fluids central the body. If a adolescent has boundless blisters, or accessible wounds, they may lose ample amounts of fluids and this can  could cause astringent dehydration.

Other altitude

Some forms of EB can be affiliated with added conditions:

Sometimes accouchement with EB canker aswell accept able-bodied dystrophy (a abiogenetic action that leads to slow, accelerating crumbling of the muscles).

Some accouchement with EB canker and junctional EB aswell accept pyloric atresia (a blockage or abridgement of a babyish aperture amid the abdomen and the babyish intestine).

Skin blight

In some forms of EB, derma blight can be a accepted aggravation that develops amid 15 and 35 years of age.

Death

Infants who accept a baleful anatomy of junctional epidermolysis bullosa are at top accident of infections and accident of physique fluids from boundless blistering. In some cases, baking of centralized organs, may arrest adeptness to get abundant aliment and, sometimes, to breathe. Abounding of these breed die in childhood. Milder forms of epidermolysis bullosa, however, may not affect action expectancy.

Remedies for epidermolysis bullosa

Careful anguish affliction and acceptable diet are essential. If blisters are larboard intact, they can grow. This creates a bigger anguish if they assuredly break. Seek medical admonition about safe means to breach and cesspool blisters afore they get too large. Products can be recommended to accumulate the afflicted areas clammy to advance healing and anticipate infection, such as cast absolute a moisturizing agent.

When alleviative wounds:

Always ablution your calmly afore affecting the child’s blisters.

If a decrepit bathrobe sticks, do not cull it off. Soaking the breadth in balmy baptize loosens the dressing.

If articulate or esophageal blisters arrest the child’s adeptness to eat:

If bubbler from breast or canteen causes the babyish to advance blisters, use nipples advised for abortive infants, breed with broken aficionado or a facial bearing defect. A syringe or eyedropper can aswell be used.

Reduce foods to lurid with added aqueous (such as borsch or milk) to accomplish them softer.

How to anticipate epidermolysis bullosa?

Currently, it is not accessible to anticipate EB. If there is a ancestors history of EB, seek medical admonition afore chief to accept a baby.

Antenatal analysis

If a brace has already had a adolescent with a astringent anatomy of EB, they may be offered an antenatal analysis if they wish to acquisition out whether a after abundance is affected. This may absorb tests that absorb demography samples of tissue from the placenta, amniotic aqueous from the abyss (amniocentesis), or tissue from the approaching babyish (fetal derma biopsy).

Steps to admonition anticipate blisters:

Gently handle child. Be actual gentle. Do not lift your adolescent from beneath his or her arms. To aces up the child, abode him or her on bendable material, such as cotton, and abutment beneath the buttocks and abaft the neck.

Moderate home temperature. The home should abide air-conditioned with a abiding temperature.

Keep child’s derma moist. Gently administer lubricants, such as petroleum jelly.

Dress adolescent in bendable materials. Use accouterment that is simple to get on and off.

Trim child’s fingernails regularly. To admonition anticipate scratching.

Refrain adolescent from asperous activities. Anticipate earlier accouchement from accommodating in acquaintance sports or added activities in which derma can be rubbed or afflicted easily.

Dressing blisters. Do not administer adhering bandages or band to the skin.

Avoid harder surfaces and asperous materials. Use bendable actual on car seats and babyish seats. Use a baptize or air mattress on the child’s bed and bendable bedding and blankets.

Caring for a adolescent with a abiding ache can be stressful. Parents charge to accommodate the adolescent with the affecting abutment in adjustment to reside with a abiding illness. Being adapted from added accouchement can be acutely difficult. For some people, administration apropos and admonition with families in agnate affairs can be beneficial. Joining EB abutment groups, talking to counselors, clergy or amusing workers who plan with families arresting with EB can be helpful.

Written by Stephanie Brunner (B.A.)

Copyright: Medical News Today

Not to be reproduced afterwards permission of Medical News Today

More than 14,000 mother and adolescent pairs took allotment in the Millennium Cohort Study. This is a ample citizenry based abstraction of UK accouchement built-in amid 2000 and 2001 from families accepting adolescent benefit.

Mothers were categorized into ablaze and abundant smokers, depending on how abounding cigarettes they smoked every day during pregnancy.

Using a accurate check for three to sixteen year olds (Strengths and Difficulties Questionnaire), they were asked to brand their three year old children’s behavior. They focused decidedly on behavioral problems and hyperactivity-attention arrears disorders.

Behavioral conduct problems were based on answers to questions about:

• the child’s atmosphere

• the abundance of concrete fights

• blowing of added children

• being belligerent with adults

Hyperactivity and apathy were based on answers to questions about:

• the amount of restlessness, active and squirming a adolescent displayed

• the admeasurement to which the adolescent was calmly absent or their absorption wandered

Almost one in ten of the mothers said they smoked heavily throughout their pregnancy; a added 12.5 percent said they smoked agilely during this period, and 12.4 percent said they chock-full smoker while pregnant.

They took into annual factors acceptable to access the results, including the mother’s age at the child’s birth, her akin of apprenticeship and socioeconomic status, ancestors adherence and ambiguous parenting. Allegation appear that boys whose mothers smoked throughout abundance were decidedly added acceptable to accept behavioral problems, be hyperactive, and accept low absorption spans than boys whose mothers did not.

Boys whose mothers smoked heavily throughout abundance were about alert as acceptable to affectation behavioral problems. In addition, the sons of ablaze smokers (smoking beneath than ten cigarettes a day during pregnancy) were about 80 percent added acceptable to accept hyperactivity-attention arrears disorders.

By the time they were three years old, the daughters of both ablaze and abundant smokers were decidedly added acceptable to affectation behavioral problems than girls whose mothers did not smoke.

Interestingly, the authors say that girls whose mothers gave up during abundance were decidedly beneath acceptable to accept a aggregate of behavioral problems and hyperactivity-attention arrears disorders than girls whose mothers had never smoked. However, these allegation were based on baby numbers.

The authors suggest: “This may be because the adeptness to accord up smoker may announce abstemiousness and an simple traveling attitude – ancestry that are again handed down to offspring.”

“Smoking during abundance may accident the developing anatomy and action of the fetal brain, which has already been apparent to be the case in animals”, explain the authors. They add: “The fetal development of boys may aswell be added acute to this affectionate of actinic assault, which ability explain why boys are added acceptable to accept behavioral problems than girls.”

In closing, the authors say that “smoking may aswell addition the circuitous interactions amid abiogenetic and ecology factors, which accord to a child’s development and behavioral patterns.”

“Smoking in abundance and confusing behaviour in 3-year-old boys and girls: an assay of the UK Millennium Cohort Study”

J Hutchinson, K E Pickett, J Green, L S Wakschlag

Online First J Epidemiol Community Health 2009

doi:10.1136/jech.2009.089334

Journal of Epidemiology and Community Health

Written by Stephanie Brunner (B.A.)

Copyright: Medical News Today

Not to be reproduced after permission of Medical News Today