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1.
Caeymaex L Speranza M Vasilescu C Danan C Bourrat MM Garel M Jousselme C 《PloS one》2011,6(12):e28633
Background
The importance of involving parents in the end-of-life decision-making-process (EOL DMP) for their child in the neonatal intensive care unit (NICU) is recognised by ethical guidelines in numerous countries. However, studies exploring parents'' opinions on the type of involvement report conflicting results. This study sought to explore parents'' experience of the EOL DMP for their child in the NICU.Methods
The study used a retrospective longitudinal design with a qualitative analysis of parental experience 3 years after the death of their child in four NICUs in France. 53 face-to-face interviews and 80 telephone interviews were conducted with 164 individuals. Semi-structured interviews were conducted to explore how parents perceived their role in the decision process, what they valued about physicians'' attitudes in this situation and whether their long-term emotional well being varied according to their perceived role in the EOL DMP.Findings
Qualitative analysis identified four types of perceived role in the DMP: shared, medical, informed parental decision, and no decision. Shared DM was the most appreciated by parents. Medical DM was experienced as positive only when it was associated with communication. Informed parental DM was associated with feelings of anxiousness and abandonment. The physicians'' attitudes that were perceived as helpful in the long term were explicit sharing of responsibility, clear expression of staff preferences, and respectful care and language toward the child.Interpretation
Parents find it valuable to express their opinion in the EOL DMP of their child. Nonetheless, they do need continuous emotional support and an explicit share of the responsibility for the decision. As involvement preferences and associated feelings can vary, parents should be able to decide what role they want to play. However, our study suggests that fully autonomous decisions should be misadvised in these types of tragic choices. 相似文献2.
Background
In species across taxa, offspring have means to influence parental investment (PI). PI thus evolves as an interacting phenotype and indirect genetic effects may strongly affect the co-evolutionary dynamics of offspring and parental behaviors. Evolutionary theory focused on explaining how exaggerated offspring solicitation can be understood as resolution of parent-offspring conflict, but the evolutionary origin and diversification of different forms of family interactions remains unclear.Methodology/Principal Findings
In contrast to previous theory that largely uses a static approach to predict how “offspring individuals” and “parental individuals” should interact given conflict over PI, we present a dynamic theoretical framework of antagonistic selection on the PI individuals obtain/take as offspring and the PI they provide as parents to maximize individual lifetime reproductive success; we analyze a deterministic and a stochastic version of this dynamic framework. We show that a zone for equivalent co-adaptation outcomes exists in which stable levels of PI can evolve and be maintained despite fast strategy transitions and ongoing co-evolutionary dynamics. Under antagonistic co-adaptation, cost-free solicitation can evolve as an adaptation to emerging preferences in parents.Conclusions/Significance
We show that antagonistic selection across the offspring and parental life-stage of individuals favors co-adapted offspring and parental behavior within a zone of equivalent outcomes. This antagonistic parent-offspring co-adaptation does not require solicitation to be costly, allows for rapid divergence and evolutionary novelty and potentially explains the origin and diversification of the observed provisioning forms in family life. 相似文献3.
Background
Theoretical modelling of biparental care suggests that it can be a stable strategy if parents partially compensate for changes in behaviour by their partners. In empirical studies, however, parents occasionally match rather than compensate for the actions of their partners. The recently proposed “information model” adds to the earlier theory by factoring in information on brood value and/or need into parental decision-making. This leads to a variety of predicted parental responses following a change in partner work-rate depending on the information available to parents.Methodology/Principal Findings
We experimentally test predictions of the information model using a population of long-tailed tits. We show that parental information on brood need varies systematically through the nestling period and use this variation to predict parental responses to an experimental increase in partner work-rate via playback of extra chick begging calls. When parental information is relatively high, partial compensation is predicted, whereas when parental information is low, a matching response is predicted.Conclusions/Significance
We find that although some responses are consistent with predictions, parents match a change in their partner''s work-rate more often than expected and we discuss possible explanations for our findings. 相似文献4.
Akira S. Hirao 《Annals of botany》2010,105(4):637-646
Background and Aims
A reduction in offspring fitness resulting from mating between neighbours is interpreted as biparental inbreeding depression. However, little is known about the relationship between the parents'' genetic relatedness and biparental inbreeding depression in their progeny in natural populations. This study assesses the effect of kinship between parents on the fitness of their progeny and the extent of spatial genetic structure in a natural population of Rhododendron brachycarpum.Methods
Kinship coefficients between 11 858 pairs of plants among a natural population of 154 R. brachycarpum plants were estimated a priori using six microsatellite markers. Plants were genotyped, and pairs were selected from among 60 plants to vary the kinship from full-sib to unrelated. After a hand-pollination experiment among the 60 plants, offspring fitness was measured at the stages of seed maturation (i.e. ripening) under natural conditions, and seed germination and seedling survival under greenhouse conditions. In addition, spatial autocorrelation was used to assess the population''s genetic structure.Key Results
Offspring fitness decreased significantly with increasing kinship between parents. However, the magnitude and timing of this effect differed among the life-cycle stages. Measures of inbreeding depression were 0·891 at seed maturation, 0·122 (but not significant) at seed germination and 0·506 at seedling survival. The local population spatial structure was significant, and the physical distance between parents mediated the level of inbreeding between them.Conclusions
The level of inbreeding between individuals determines offspring fitness in R. brachycarpum, especially during seed maturation. Genetic relatedness between parents caused inbreeding depression in their progeny. Therefore, biparental inbreeding contributes little to reproduction and instead acts as a selection force that promotes outcrossing, as offspring of more distant (less related) parents survive better. 相似文献5.
Introduction
Identifying targets to improve parental practices for managing fever in children is the first step to reducing the overloaded healthcare system related to this common symptom. We aimed to study parents'' knowledge and practices and their determinants in managing fever symptoms in children in France as compared with current recommendations.Methods
We conducted an observational national study between 2007 and 2008 of French general practitioners, primary care pediatricians and pharmacists. These healthcare professionals (HPs) were asked to include 5 consecutive patients from 1 month to 12 years old with fever for up to 48 hr who were accompanied by a family member. Parents completed a questionnaire about their knowledge of fever in children and their attitudes about the current fever episode. We used a multilevel logistic regression model to assess the joint effects of patient- and HP-level variables.Results
In all, 1,534 HPs (participation rate 13%) included 6,596 children. Parental concordance with current recommendations for temperature measurement methods, the threshold for defining fever, and physical (oral hydration, undressing, room temperature) and drug treatment was 89%, 61%, 15%, and 23%, respectively. Multivariate multi-level analyses revealed a significant HP effect. In general, high concordance with recommendations was associated with high educational level of parents and the HP consulted being a pediatrician.Conclusions
In France, parents'' knowledge and practices related to managing fever symptoms in children frequently differ from recommendations. Targeted health education interventions are needed to effectively manage fever symptoms in children. 相似文献6.
7.
Camille Ndondoki Hermann Brou Marguerite Timite-Konan Maxime Oga Clarisse Amani-Bosse Hervé Menan Didier Ekouévi Valériane Leroy 《PloS one》2013,8(8)
Background
Universal HIV pediatric screening offered at postnatal points of care (PPOC) is an entry point for early infant diagnosis (EID). We assessed the parents'' acceptability of this approach in Abidjan, Côte d''Ivoire.Methods
In this cross-sectional study, trained counselors offered systematic HIV screening to all children aged 6–26 weeks attending PPOC in three community health centers with existing access to HAART during 2008, as well as their parents/caregivers. HIV-testing acceptability was measured for parents and children; rapid HIV tests were used for parents. Both parents'' consent was required according to the Ivorian Ethical Committee to perform a HIV test on HIV-exposed children. Free HIV care was offered to those who were diagnosed HIV-infected.Findings
We provided 3,013 HIV tests for infants and their 2,986 mothers. While 1,731 mothers (58%) accepted the principle of EID, only 447 infants had formal parental consent 15%; 95% confidence interval (CI): [14%–16%]. Overall, 1,817 mothers (61%) accepted to test for HIV, of whom 81 were HIV-infected (4.5%; 95% CI: [3.5%–5.4%]). Among the 81 HIV-exposed children, 42 (52%) had provided parental consent and were tested: five were HIV-infected (11.9%; 95% CI: [2.1%–21.7%]). Only 46 fathers (2%) came to diagnose their child. Parental acceptance of EID was strongly correlated with prenatal self-reported HIV status: HIV-infected mothers were six times more likely to provide EID parental acceptance than mothers reporting unknown or negative prenatal HIV status (aOR: 5.9; 95% CI: [3.3–10.6], p = 0.0001).Conclusions
Although the principle of EID was moderately accepted by mothers, fathers'' acceptance rate remained very low. Routine HIV screening of all infants was inefficient for EID at a community level in Abidjan in 2008. Our results suggest the need of focusing on increasing the PMTCT coverage, involving fathers and tracing children issued from PMTCT programs in low HIV prevalence countries. 相似文献8.
Objective
What role should minors play in making medical decisions? The authors examined children''s and adolescents'' desire to be involved in serious medical decisions and the emotional consequences associated with them.Methods
Sixty-three children and 76 adolescents were presented with a cover story about a difficult medical choice. Participants were tested in one of four conditions: (1) own informed choice; (2) informed parents'' choice to amputate; (3) informed parents'' choice to continue a treatment; and (4) uninformed parents'' choice to amputate. In a questionnaire, participants were asked about their choices, preference for autonomy, confidence, and emotional reactions when faced with a difficult hypothetical medical choice.Results
Children and adolescents made different choices and participants, especially adolescents, preferred to make the difficult choice themselves, rather than having a parent make it. Children expressed fewer negative emotions than adolescents. Providing information about the alternatives did not affect participants'' responses.Conclusions
Minors, especially adolescents, want to be responsible for their own medical decisions, even when the choice is a difficult one. For the adolescents, results suggest that the decision to be made, instead of the agent making the decision, is the main element influencing their emotional responses and decision confidence. For children, results suggest that they might be less able than adolescents to project how they would feel. The results, overall, draw attention to the need to further investigate how we can better involve minors in the medical decision-making process. 相似文献9.
Mirjam E. J. van Beelen Tinneke M. J. Beirens Paul den Hertog Eduard F. van Beeck Hein Raat 《PloS one》2013,8(3)
Background
Unintentional falls and poisonings are major causes of death and disability among infants. Although guidelines are available to prevent these injuries, safety behaviours are not performed by parents, causing unnecessary risks. Little is known about safety behaviours of first-time parents and whether they behave according to these guidelines.Aims/Objectives/Purpose
The objective of this study was to compare safety behaviours of first-time parents with those of non-first-time parents and to determine correlates of unsafe behaviour of parents of infants. We used self-report questionnaires to assess safety behaviours in a cross-sectional study sample.Methods
A total of 1439 parents visiting a preventive youth healthcare centre in the Netherlands were invited to complete a questionnaire with regard to the prevention of falls and poisonings. Parents were categorized into first-time parents and non-first-time parents. Correlates of parents'' child safety behaviours were determined using multiple logistic regression analyses.Results/Outcome
Most respondents were mothers (93.2%); 48.2% of families were first-time parents. The mean age of the infants was 7.2 months (SD 1.1; range 4–12), 51.8% were boys, and 34.5% of infants could crawl. First-time parents were more likely not to have a stair gate installed (OR 16.46; 95% CI 12.36–21.93); were more likely to store cleaning products unsafely (OR 4.55; 95% CI 3.59–5.76); and were more likely to store medicines unsafely (OR 2.90; 95% CI 2.31–3.63) than non-first-time parents. First-time parents were more likely to not have a window guard installed (OR 1.52; 95% CI 1.08–2.15) (all P<0.05).Discussion/Conclusion
First-time parents are not well prepared for the safety of their infant, causing unnecessary risks. The various parents'' safety behaviours were influenced by different variables, for example, age of the infant, crawling of the infant, mother''s educational level, mother''s ethnicity, self-efficacy, vulnerability, severity. 相似文献10.
Background
In pediatric oncology, effective clinic–based management of acute and long–term distress in families calls for investigation of determinants of parents'' psychological response to the child''s cancer. We examined the relationship between parents'' prior exposure to traumatic life events (TLE) and the occurrence of posttraumatic stress symptoms (PTSS) following their child''s cancer diagnosis. Factors mediating the TLE–PTSS relationship were analyzed.Methodology
The study comprised 169 parents (97 mothers, 72 fathers) of 103 cancer diagnosed children (median age: 5,9 years; range 0.1–19.7 years). Thirty five parents were of immigrant origin (20.7%). Prior TLE were collated using a standardized questionnaire, PTSS was assessed using the Impact of Events–Revised (IES–R) questionnaire covering intrusion, avoidance and hyperarousal symptoms. The predictive significance of prior TLE on PTSS was tested in adjusted regression models.Results
Mothers demonstrated more severe PTSS across all symptom dimensions. TLE were associated with significantly increased hyperarousal symptoms. Parents'' gender, age and immigrant status did not significantly influence the TLE–PTSS relationship.Conclusions
Prior traumatic life–events aggravate posttraumatic hyperarousal symptoms. In clinic–based psychological care of parents of high–risk pediatric patients, attention needs to be paid to life history, and to heightened vulnerability to PTSS associated with female gender. 相似文献11.
Background
The adverse effects of advancing maternal age on offspring''s health and development are well understood. Much less is known about the impact of paternal age.Methods
We explored paternal age-offspring cognition associations in 772 participants from the West of Scotland Twenty-07 study. Offspring cognitive ability was assessed using Part 1 of the Alice Heim 4 (AH4) test of General Intelligence and by reaction time (RT).Results
There was no evidence of a parental age association with offspring RT. However, we observed an inverse U-shaped association between paternal age and offspring AH4 score with the lowest scores observed for the youngest and oldest fathers. Adjustment for parental education and socioeconomic status somewhat attenuated this association. Adjustment for number of, particularly older, siblings further reduced the scores of children of younger fathers and appeared to account for the lower offspring scores in the oldest paternal age group.Conclusion
We observed a paternal age association with AH4 but not RT, a measure of cognition largely independent of social and educational experiences. Factors such as parental education, socioeconomic status and number of, particularly older, siblings may play an important role in accounting for paternal age-AH4 associations. Future studies should include parental intelligence. 相似文献12.
Daniel N?tt Niclas Lindqvist Henrik Stranneheim Joakim Lundeberg Peter A. Torjesen Per Jensen 《PloS one》2009,4(7)
Background
Environmental challenges may affect both the exposed individuals and their offspring. We investigated possible adaptive aspects of such cross-generation transmissions, and hypothesized that chronic unpredictable food access would cause chickens to show a more conservative feeding strategy and to be more dominant, and that these adaptations would be transmitted to the offspring.Methodology/Principal Findings
Parents were raised in an unpredictable (UL) or in predictable diurnal light rhythm (PL, 12∶12 h light∶dark). In a foraging test, UL birds pecked more at freely available, rather than at hidden and more attractive food, compared to birds from the PL group. Female offspring of UL birds, raised in predictable light conditions without parental contact, showed a similar foraging behavior, differing from offspring of PL birds. Furthermore, adult offspring of UL birds performed more food pecks in a dominance test, showed a higher preference for high energy food, survived better, and were heavier than offspring of PL parents. Using cDNA microarrays, we found that the differential brain gene expression caused by the challenge was mirrored in the offspring. In particular, several immunoglobulin genes seemed to be affected similarly in both UL parents and their offspring. Estradiol levels were significantly higher in egg yolk from UL birds, suggesting one possible mechanism for these effects.Conclusions/Significance
Our findings suggest that unpredictable food access caused seemingly adaptive responses in feeding behavior, which may have been transmitted to the offspring by means of epigenetic mechanisms, including regulation of immune genes. This may have prepared the offspring for coping with an unpredictable environment. 相似文献13.
Line Sletner Britt Nakstad Chittaranjan S. Yajnik Kjersti M?rkrid Siri Vangen Mari H. V?rdal Ingar M. Holme K?re I. Birkeland Anne Karen Jenum 《PloS one》2013,8(8)
Background
Neonates from low and middle income countries (LAMIC) tend to have lower birth weight compared with Western European (WE) neonates. Parental height, BMI and maternal parity, age and educational level often differ according to ethnic background, and are associated with offspring birth weight. Less is known about how these factors affect ethnic differences in neonatal body composition.Objectives
To explore differences in neonatal body composition in a multi-ethnic population, and the impact of key parental factors on these differences.Methods
A population-based cohort study of pregnant mothers, fathers and their offspring, living in Oslo, Norway. Gender- and gestational-specific z-scores were calculated for several anthropometric measurements, with the neonates of WE ethnic origin as reference. Mean z-scores for neonates with LAMIC origin, and their parents, are presented as outcome variables.Results
537 singleton, term neonates and their parents were included. All anthropometric measurements were smaller in neonates with LAMIC origin. Abdominal circumference and ponderal index differed the most from WE (mean z-score: −0.57 (95% CI:−0.69 to −0.44) and −0.54 (−0.66 to −0.44), and remained so after adjusting for parental size. Head circumference and skin folds differed less, and length the least (−0.21 (−0.35 to −0.07)). These measures became comparable to WEs when adjusted for parental factors.Conclusions
LAMIC origin neonates were relatively “thin-fat”, as indicated by reduced AC and ponderal index and relatively preserved length and skin folds, compared with neonates with WE origin. This phenotype may predispose to type 2 diabetes. 相似文献14.
Tong Gong Cecilia Lundholm Gustaf Rejn? Carina Mood Niklas L?ngstr?m Catarina Almqvist 《PloS one》2014,9(9)
Background
Little is known about how parental socioeconomic status affects offspring asthma risk in the general population, or its relation to healthcare and medication use among diagnosed children.Methods
This register-based cohort study included 211,520 children born between April 2006 and December 2008 followed until December 2010. Asthma diagnoses were retrieved from the National Patient Register, and dispensed asthma medications from the Prescribed Drug Register. Parental socioeconomic status (income and education) were retrieved from Statistics Sweden. The associations between parental socioeconomic status and outcomes were estimated by Cox proportional hazard regression.Results
Compared to the highest parental income level, children exposed to all other levels had increased risk of asthma during their first year of life (e.g. hazard ratio, HR 1.19, 95% confidence interval, CI 1.09–1.31 for diagnosis and HR 1.17, 95% CI 1.08–1.26 for medications for the lowest quintile) and the risk was decreased after the first year, especially among children from the lowest parental income quintile (HR 0.84, 95% CI 0.77–0.92 for diagnosis, and HR 0.80, 95% CI 0.74–0.86 for medications). Further, compared to children with college-educated parents, those whose parents had lower education had increased risk of childhood asthma regardless of age. Children with the lowest parental education had increased risk of an inpatient (HR 2.07, 95% CI 1.61–2.65) and outpatient (HR 1.32, 95% CI 1.18–1.47) asthma diagnosis. Among diagnosed children, those from families with lower education used fewer controller medications than those whose parents were college graduates.Conclusions
Our findings indicate an age-varying association between parental income and childhood asthma and consistent inverse association regardless of age between parental education and asthma incidence, dispensed controller medications and inpatient care which should be further investigated and remedied. 相似文献15.
Objectives
As more families participate expanded newborn screening for metabolic disorders in China, the overall number of false positives increases. Our goal was to assess the potential impact on parental stress, perceptions of the child''s health, and family relationships.Methods
Parents of 49 infants with false-positive screening results for metabolic disorders in the expanded newborn screening panel were compared with parents of 42 children with normal screening results. Parents first completed structured interview using likert scales, closed and open questions. Parents also completed the parenting stress index.Results
A total of 88 mothers and 41 fathers were interviewed. More mothers in the false-positive group reported that their children required extra parental care (21%), compared with 5% of mothers in the normal-screened group (P<0.001). 39% of mothers in the false-positive group reported that they worry about their child''s future development, compared with 10% of mothers in the normal-screened group (P<0.001). Fathers in the false-positive group did not differ from fathers in the normal-screened group in reporting worry about their child''s extra care requirements, and their child''s future development. Children with false-positive results compared with children with normal results were triple as likely to experience hospitalization (27%vs 9%, respectively; P<0.001).Conclusions
The results showing false-positive screening results may affect parental stress and the parent-child relationship. Parental stress and anxiety can be reduced with improved education and communication to parents about false-positive results. 相似文献16.
Purpose
The aim of the study is to investigate how adolescents'' perception of parents'' and peers'' smoking approval influences adolescent smoking intention, and how age affects this influence in a Swiss sample of adolescents. To know the influence of age can help to develop specific prevention programs tailored to the age groups needs.Method
in a cross sectional survey, students aged between 11 and 14 from public and private middle schools in the Italian region of Switzerland (Ticino) answered questions on smoking habits, parents'' and peers'' approval and intention to smoke.Results
peers'' and parents'' approval significantly influence students'' smoking intention, and students'' age significantly moderates this relation: the effect of parents'' approval decreases for older adolescents, while the effect of peers'' approval increases with age. No difference is found between girls and boys, while non-Swiss are more likely to smoke than Swiss students.Conclusions
as literature suggests, results evidence the role parents play during early adolescence. Prevention programs targeting parent-child communication in early adolescence for preventing children''s tobacco consumption are strongly supported. 相似文献17.
Objective
Newborn bloodspot screening is an internationally established public health measure. Despite this, there is a paucity of information relating to the decision-making process that parents go through when accepting newborn screening. This is important as screening panels are expanding; potentially leading to an increasing amount of complex information. This study sought to understand the factors that influence parental decisions and roles they play in the decision-making process.Patients and Methods
Qualitative thematic evaluation of semi structured interviews with parents whose children had recently undergone newborn screening in the Merseyside and Cheshire region of England, UK.Results
Eighteen interviews with first time parents (n = 12) and those with previous children (n = 6). Seven factors were identified as being either explicitly or implicitly related to parental decision-making: Experience, Attitudes to medicine, Information-seeking behaviour, Perceived knowledge, Attitudes to screening, and Perceived choice, all of which ultimately impact on Perceived decisional quality.Conclusions
These results indicate that while content is important, other contextual factors such as personal experience, perceived choice, and general attitudes toward medicine, are also highly influential. In particular, relationships with key healthcare professionals are central to information collection, attitudes toward screening, and the level of deliberation that is invested in decisions to accept newborn bloodspot screening. 相似文献18.
Background
Research on the temporal relationship of parental risk factors with offspring’s suicide attempt is scarce and a life course approach has not been applied to date. We investigated the temporal relationship of parental morbidity and mortality with offspring’s suicide attempt and whether any such association was modified by offspring’s age at attempt.Methods
We designed a case-control study through linkage of Swedish registers. Cases comprised all individuals in Sweden born 1973–1983 with inpatient care due to suicide attempt (15–31 years of age) and with information on both biological parents (N = 15 193). Ten controls were matched to each case (National Patient register with national complete coverage). Conditional logistic and spline regressions were applied.Results
Particularly for women, most parental markers showed the strongest effect sizes if exposure was short-term (within 2 years after exposure) and related to the mother. Especially short-term exposure to maternal inpatient care due to psychiatric diagnoses had a significantly stronger effect on suicide attempt risk in women compared to men. Regarding exposure to parental inpatient care due to psychiatric diagnoses, short-term as opposed to long-term (exceeding 2 years after exposure) effects were highest during adolescence and decreased significantly with age for female and male offspring, respectively.Conclusions
Although limited by the fact that data on parental morbidity and the outcome of suicidality were based on in-patient data only, the data suggest that the high risks of suicide attempt in case of exposure to parental psychopathology and suicidal behavior particularly during adolescence and the strong short-term effects associated with maternal psychopathology for female offspring are of direct clinical importance. 相似文献19.
Background
As egg production and offspring care are costly, females should invest resources adaptively into their eggs to optimize current offspring quality and their own lifetime reproductive success. Parasite infections can influence maternal investment decisions due to their multiple negative physiological effects. The act of preening – applying oils with anti-microbial properties to feathers – is thought to be a means by which birds combat pathogens and parasites, but little is known of how preening during the reproductive period (and its expected disease-protecting effects) influences maternal investment decisions at the level of the egg.Methodology/Principal Findings
Here, we experimentally prevented female mallards (Anas platyrhynchos) from accessing their preen gland during breeding and monitored female immunoresponsiveness (e.g., plasma lysozyme concentration) as well as some egg traits linked to offspring quality (e.g., egg mass, yolk carotenoid content, and albumen lysozyme levels). Females with no access to their preen gland showed an increase in plasma lysozyme level compared to control, normally preening females. In addition, preen-gland-restricted females laid significantly lighter eggs and deposited higher carotenoid concentrations in the yolk compared to control females. Albumen lysozyme activity did not differ significantly between eggs laid by females with or without preen gland access.Conclusion/Significance
Our results establish a new link between an important avian self-maintenance behaviour and aspects of maternal health and reproduction. We suggest that higher yolk carotenoid levels in eggs laid by preen-gland-restricted females may serve to boost health of offspring that would hatch in a comparatively microbe-rich environment. 相似文献20.