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[Prise en charge de l'iléostomie à haut débit chez les personnes âgées : une revue systématique de cas et de séries de cas]. [老年人高流量回肠造口术的管理:病例和系列病例的系统回顾]。
IF 0.4 4区 医学 Q4 PSYCHIATRY Pub Date : 2024-03-01 DOI: 10.1684/pnv.2024.1150
Romain Hertzog, Moustapha Dramé, Lidvine Godaert

The aim was to perform a systematic review of cases published in the literature to describe the management of high-output ileostomy (HOI) in older adults. A literature search was performed in PubMed©, and Scopus© for all publications up to March 1st, 2023. Case reports and/or case series reporting data from older adults on HOI management were included. Publication year, country, sex, age, aetiology of the stomy, time from ileostomy to HOI, daily volume threshold, Treatment regimen, and effectiveness were extracted. In total, 428 studies were identified, of which 9 (describing 10 cases) were included in this review. The mean age was 69.9 ± 4.7 years. The most frequent aetiology of ileostomy was occlusion. The daily volume considered to be excessive ranged from 1 to 2 litres per 24-hour period. The main side effects of HOI were dehydration, acute renal failure, and weight loss. Loperamide was the most frequently used drug. Most studies reported that non-pharmacological therapies were also used. No death was reported in any of the studies. In all, ileostomy exposes older individuals to complications. Medical therapy with loperamide coupled with rehydration seems to be efficacious in the medium term. Multidisciplinary management is advisable, in order to increase the chances of achieving ostomy reversal as early as possible, when indicated.

目的是对文献中发表的病例进行系统性回顾,以描述老年人高排量回肠造口术(HOI)的治疗方法。我们在 PubMed© 和 Scopus© 上检索了截至 2023 年 3 月 1 日的所有文献。包括病例报告和/或报告老年人高排量回肠造口术管理数据的系列病例。提取了发表年份、国家、性别、年龄、造口病因、从回肠造口术到 HOI 的时间、每日容量阈值、治疗方案和有效性。总共确定了 428 项研究,其中 9 项(描述了 10 个病例)被纳入本综述。平均年龄为 69.9 ± 4.7 岁。回肠造口术最常见的病因是闭塞。每天 24 小时的排便量被认为过多,从 1 升到 2 升不等。回肠造口术的主要副作用是脱水、急性肾功能衰竭和体重下降。洛哌丁胺是最常用的药物。大多数研究报告称也使用了非药物疗法。所有研究均未报告死亡病例。总之,回肠造口术使老年人面临并发症的风险。使用洛哌丁胺配合补液的药物疗法似乎在中期有效。建议采用多学科管理,以增加在有指征时尽早实现造口逆转的机会。
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引用次数: 0
[Cortico-basal syndrome and cortico-basal degeneration: From the clinical diagnosis to the lesional substrate for an adapted care]. [皮质基底综合征和皮质基底变性:从临床诊断到适应护理的病变基础]。
IF 0.6 4区 医学 Q4 PSYCHIATRY Pub Date : 2024-03-01 DOI: 10.1684/pnv.2024.1145
Dario Saracino

Cortico-basal degeneration is a relatively uncommon cause of degenerative parkinsonism in the elderly. From a clinical point of view, it manifests as a cortico-basal syndrome (CBS), featuring a highly asymmetrical akinetic-rigid syndrome, dystonia, myoclonus and cognitive-behavioral impairment with predominant apraxia. Other clinical phenotypes are possible, including variants with mainly language or behavioral impairment, or with axial, symmetrical parkinsonism resembling progressive supranuclear palsy (PSP). Current diagnostic criteria take into account the heterogeneity of clinical presentations. However, a diagnosis of certainty can only be reached by a pathological study, with the evidence of TAU-positive intraneuronal inclusions. Indeed SCB may be underpinned by other lesional substrates, ranging from frontotemporal degeneration to Alzheimer's disease. Symptom management must be early, multidisciplinary and adapted to the progression of the disorder. The identification of the pathological substrate is an essential prerequisite for pathophysiological therapeutic trials.

皮质基底层变性是导致老年退行性帕金森病的一个相对少见的原因。从临床角度来看,它表现为皮质基底综合征(CBS),其特征是高度不对称的动-僵综合征、肌张力障碍、肌阵挛和认知-行为障碍,以肢体瘫痪为主。还可能出现其他临床表型,包括以语言或行为障碍为主的变异型,或类似于进行性核上性麻痹(PSP)的轴向对称性帕金森病。目前的诊断标准考虑到了临床表现的异质性。然而,只有通过病理研究,并有 TAU 阳性的神经元内包涵体的证据,才能得出确定的诊断。事实上,从额颞叶变性到阿尔茨海默病等其他病变基质也可能导致 SCB。症状管理必须是早期的、多学科的,并适应疾病的发展。病理基质的确定是病理生理学治疗试验的重要前提。
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引用次数: 0
[Utilité de la tomographie thoraco-abdomino-pelvienne chez les patients âgés hospitalisés pour altération de l'état général]. [胸腹骨盆断层扫描在因全身状况恶化而住院的老年患者中的实用性]。
IF 0.6 4区 医学 Q4 PSYCHIATRY Pub Date : 2024-03-01 DOI: 10.1684/pnv.2024.1148
Pauline Boussard, Emilie Menand, Estelle Le Pabic, Aline Corvol, Joaquim Prud'homm, Dominique Somme

Alteration of the general state of health is a frequent clinical situation as reason for hospital admission of older adults, although there is no consensus on criteria of the diagnostic approach. Our objective was to study whether thorax, abdomen and pelvis tomography is useful for the diagnosis and determination of a specific care pathway for hospitalized patients over 80 years old with alteration of the general state without identified clinical explanation. retrospective observational monocentric study at a French University Hospital, with the inclusion of all hospitalized patients who had a tomography following for alteration of general state without identified clinical explanation between January 2019 and June 2020. The primary endpoint was the presence of a diagnosis on the tomography report. We studied 48 files of patients (aged 86.2 ± 3.4 years on average). Tomography provided a diagnosis in 60.4% of cases. Factors significantly related to usefulness of tomography were weight loss and duration of weight loss. Among the diagnosed patients, specific actions were taken for 86.2% of them. Our study suggests that thoracic-abdominal-pelvic tomography is useful to examine the alteration of general state in older patients without identified clinical explanation, particularly for those presenting with unintentional weight loss. That suggests that it is probably preferable to use the correct symptoms description instead of alteration of general state.

一般健康状况的改变是老年人入院的常见临床原因,但诊断方法的标准尚未达成共识。我们的目的是研究胸部、腹部和盆腔断层扫描是否有助于诊断和确定80岁以上无明确临床解释的全身状态改变的住院患者的具体护理路径。在法国一所大学医院进行的单中心回顾性观察研究,纳入了2019年1月至2020年6月期间因无明确临床解释的全身状态改变而进行断层扫描的所有住院患者。研究的主要终点是断层扫描报告中的诊断结果。我们研究了 48 份患者档案(平均年龄为 86.2 ± 3.4 岁)。60.4%的病例通过断层扫描确诊。体重减轻和体重减轻的持续时间是与断层扫描是否有用有明显关系的因素。在确诊的患者中,86.2%的患者采取了具体措施。我们的研究表明,胸-腹-盆腔断层扫描对于检查无明确临床解释的老年患者的全身状态改变很有用,尤其是对于那些出现无意性体重减轻的患者。这表明,最好使用正确的症状描述,而不是一般状态的改变。
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引用次数: 0
[Cross-perspectives on telemedicine in nursing homes: a survey of professionals involved in the setting-up of teleconsultations in nursing homes in Rennes area]. [关于疗养院远程医疗的交叉观点:对雷恩地区疗养院中参与建立远程会诊的专业人员的调查]。
IF 0.6 4区 医学 Q4 PSYCHIATRY Pub Date : 2023-12-01 DOI: 10.1684/pnv.2023.1112
Lou Cady, Marie Costes, Emilie Andres, Franck Dillinger, Dominique Somme

The practice of telemedicine in nursing homes is a solution to improve the quality of care for residents. Its application also seems to be beneficial for the professionals involved, but it faces obstacles. The objective of this study is to explore the effects of the implementation of teleconsultations in nursing homes on the professional practices of the stakeholders involved. A qualitative focus group study was conducted with professionals involved in the implementation of teleconsultations. The data was analyzed using an inductive approach similar to grounded theory. The 18 participants included in the study were unanimous and consensual about the benefits of telemedicine. They observed changes in work relationships, particularly the key role of caregivers in coordinating care. However, they feared a deterioration in doctor-patient relationships. The practice of telemedicine was considered time-consuming, which could hinder its dissemination. No general practitioner participated in this study, showing they had reservations about the practice. The Covid-19 pandemic had an impact on the development of teleconsultations within the institutions involved. Telemedicine is acclaimed by the nursing homes teams and the doctors required, particularly through the effects on training and the added value it can bring to their practice. Telemedicine also allows to provide care that is otherwise not available. However, the care process needs to be simplified. In addition, there are obstacles to the involvement of general practitioners, which should be studied in order to optimize the coordination of care for the residents of the nursing homes.

在疗养院开展远程医疗是提高住院患者护理质量的一种解决方案。其应用似乎也对相关专业人员有利,但也面临着障碍。本研究旨在探讨在疗养院实施远程会诊对相关人员专业实践的影响。本研究对参与实施远程会诊的专业人员进行了定性焦点小组研究。采用类似于基础理论的归纳法对数据进行了分析。参与研究的 18 名人员一致认同远程医疗的好处。他们观察到了工作关系的变化,尤其是护理人员在协调护理中的关键作用。不过,他们担心医患关系会恶化。他们认为远程医疗耗费时间,可能会阻碍其推广。没有全科医生参与这项研究,这表明他们对这一做法持保留意见。Covid-19 大流行对相关机构内远程会诊的发展产生了影响。疗养院团队和所需医生对远程医疗赞不绝口,特别是通过远程医疗对培训的影响以及远程医疗为他们的实践带来的附加值。远程医疗还可以提供其他方式无法提供的护理服务。然而,护理过程需要简化。此外,全科医生的参与也存在障碍,应对此进行研究,以优化对疗养院居民的护理协调。
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引用次数: 0
[Vaccination in the elderly in sub-Saharan Africa: Relevance and scheduling model]. [撒哈拉以南非洲老年人的疫苗接种:相关性和时间安排模式]。
IF 0.6 4区 医学 Q4 PSYCHIATRY Pub Date : 2023-12-01 DOI: 10.1684/pnv.2023.1113
Massamba Ba, Assane Sall, Rokhaya Djajhete, Dalahata Ba, Mamadou Coume

According to the World Health Organisation (WHO), recent decades have seen a major increase in the number of elderly people in Africa. Persistent infectious diseases are responsible for high morbidity and mortality in this immuno-senescent population, making vaccination an effective preventive measure. In developed countries, vaccination programs are in place and regularly updated. In sub-Saharan Africa, however, vaccination is still reserved for children, and access for seniors remains limited by a number of factors. The aim of this study was to use a systematic review to demonstrate the relevance of vaccination in this field, and to propose an appropriate vaccination schedule. Ultimately, vaccines against influenza, pneumococcus (23-valent), herpes zoster, diphtheria, pertussis and tetanus should be systematically recommended. Others may be discussed, depending on the fragility of the patient's condition.

世界卫生组织(WHO)指出,近几十年来,非洲老年人的数量大幅增加。持续性传染病是造成这一免疫力低下人群高发病率和高死亡率的原因,因此接种疫苗是一项有效的预防措施。发达国家制定了疫苗接种计划并定期更新。但在撒哈拉以南非洲地区,疫苗接种仍是儿童的专利,老年人接种疫苗仍受到多种因素的限制。本研究的目的是通过系统回顾来证明疫苗接种在这一领域的相关性,并提出适当的疫苗接种计划。最终,流感、肺炎球菌(23 价)、带状疱疹、白喉、百日咳和破伤风疫苗应得到系统推荐。还可以根据患者的病情讨论其他疫苗。
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引用次数: 0
Agenda. 议程
IF 0.6 4区 医学 Q4 PSYCHIATRY Pub Date : 2023-12-01 DOI: 10.1684/pnv.2023.1140
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引用次数: 0
[Evaluation of ophthalmological follow-up of patients over 65 years old in primary care]. [对基层医疗机构 65 岁以上患者眼科随访的评估]。
IF 0.6 4区 医学 Q4 PSYCHIATRY Pub Date : 2023-12-01 DOI: 10.1684/pnv.2023.1115
Clara Burel, Guillaume Chapelet, Gilles Berrut, Michel Weber, Jean-Baptiste Ducloyer

Visual disorders are often under-diagnosed and under-treated in older patients. The main objective was to evaluate the percentage of patients having an ophthalmological follow-up corresponding to the recommendations of the Syndicat national des ophtalmologistes de France (SNOF). This prospective observational multicentre study included all patients aged 65 years or older presenting to their general practitioner in two medical practices from May to October 2021. Of the 113 patients included, 86 (76,1 %) had adequate ophthalmological follow-up, 14 consulted an ophthalmologist, and a therapeutic decision was made for nine patients. Follow-up of patients was generally as recommended. Screening for visual disorders for patients with no recent follow-up was beneficial. This screening must be integrated into a global approach, as the Integrated Care for Older People (ICOPE) of the World Health Organization (WHO), in order to be more relevant and effective.

在老年患者中,视力障碍往往诊断不足、治疗不足。这项研究的主要目的是评估按照法国全国眼科医生协会(SNOF)的建议进行眼科随访的患者比例。这项前瞻性多中心观察研究纳入了 2021 年 5 月至 10 月期间在两家医疗机构向全科医生求诊的所有 65 岁及以上患者。在纳入的113名患者中,86人(76.1%)接受了适当的眼科随访,14人咨询了眼科医生,9人做出了治疗决定。对患者的随访总体上符合建议。对近期没有复诊的患者进行视力障碍筛查是有益的。这种筛查必须纳入全球方法,如世界卫生组织(WHO)的老年人综合护理(ICOPE),这样才能更具针对性和有效性。
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引用次数: 0
[Cognitive functioning in schizophrenia: a lifespan perspective]. [精神分裂症的认知功能:生命周期视角]。
IF 0.6 4区 医学 Q4 PSYCHIATRY Pub Date : 2023-12-01 DOI: 10.1684/pnv.2023.1142
Stephane Raffard

Cognitive disorders are now well known in schizophrenia, but their evolution over time and particularly during aging remains poorly described. Current evidence indicates that cognitive deficits including attention, working memory, verbal learning and memory, and executive functions are present in 80% of individuals with schizophrenia, which, on average, are around two standard deviations below that in healthy controls. Cognitive impairments are important predictors of functioning in daily life, including quality of life, inability to live independently and unemployment. From a lifespan perspective, they are evident in infancy (18 months) and continually increase between infancy and adulthood (20 years) in full-scale IQ and most of cognitive domains, accelerating during the prodromal phase. Cognitive deficits are significant predictor of the psychotic transition, and they stabilize after the first psychotic episode until the age of fifty suggesting that cognitive deficits are mainly established before the prodromal phases of psychosis. Time course of cognitive impairments in elderly patients with schizophrenia appears to be more heterogeneous. While the data suggest that they are stable with advancing age, a subgroup of institutionalized older patients stands out for a significant cognitive decline, without it being possible to determine the causal direction of this association. The twofold increased risk of developing neurodegenerative dementia in this population, combined with institutionalization, could partly explain this cognitive decline in some patients. Long-term longitudinal studies in older adults with schizophrenia are clearly needed, particularly in France. Protective factors such as recovery-focused and psychosocial approaches need to be studied in this population, which has a 15-year shorter life expectancy than the general population.

目前,精神分裂症患者的认知障碍已广为人知,但对其随着时间推移,尤其是在衰老过程中的演变情况却描述不清。目前的证据表明,80% 的精神分裂症患者存在认知功能障碍,包括注意力、工作记忆、言语学习和记忆以及执行功能,平均比健康对照组低两个标准差左右。认知障碍是日常生活功能的重要预测因素,包括生活质量、无法独立生活和失业。从生命周期的角度来看,认知障碍在婴儿期(18 个月)就很明显,从婴儿期到成年期(20 岁),认知障碍在全面智商和大多数认知领域持续增加,并在前驱期加速。认知缺陷是精神病转变的重要预测因素,它们在第一次精神病发作后一直稳定到 50 岁,这表明认知缺陷主要在精神病前驱期之前就已形成。老年精神分裂症患者认知障碍的时间进程似乎更为复杂。虽然数据表明,随着年龄的增长,认知障碍的程度会趋于稳定,但住院的老年患者中,有一个亚群的认知能力明显下降,但无法确定这种关联的因果方向。这一人群患神经退行性痴呆症的风险增加了两倍,再加上被送进养老院,这可能是部分患者认知能力下降的部分原因。显然需要对患有精神分裂症的老年人进行长期纵向研究,尤其是在法国。对这一预期寿命比普通人短 15 年的人群,还需要研究其保护性因素,如注重康复的社会心理疗法。
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引用次数: 0
[How potentially inapropriate are psychotropic drugs prescribing in acute psychiatric unit for the elderly? Results from a large multicentric audit in France]. [急性精神病院为老年人开具的精神药物有多不合适?法国大型多中心审计结果]。
IF 0.6 4区 医学 Q4 PSYCHIATRY Pub Date : 2023-12-01 DOI: 10.1684/pnv.2023.1137
Morgane Houix, Ilia Humbert, Guillaume Mabileau, Guillaume Chapelet, Anne Sauvaget, Bénédicte Gohier, Sophie Armand-Branger, Jean-François Huon, Fanny D'Acremont, Samuel Bulteau

Adverse drug reactions (ADRs) are a major public health issue, especially when it comes to the elderly. Potentially inappropriate prescribing (PIP) are one of the causes of ADRs in older people. A PIP can be defined as a prescription for which the benefit/risk ratio is unfavourable compared to other therapeutic alternatives. Psychotropic drugs are the second highest risk class for ADRs in the elderly. In order to reduce the prevalence of PIP, prescription assistance tools have been created. An inventory of PIP of psychotropic drugs in older patients hospitalized in psychiatry units was carried out in a French regional setting in 2019. A criteria grid was established based on 2 tools: STOPP/START criteria and Laroche's list adapted to French practice. This grid targeted each class of psychotropic drugs, drugs with a high anticholinergic burden and non-recommended combinations of psychotropic drugs. Three hundred forty-seven patients were included. A high prevalence of PPI was found for each class of psychotropic drugs. The highest prevalence of PPI was found among benzodiazepines (90.3%): long-term prescription, long half-life drugs, respiratory insufficiency or cognitive impairment condition. 56.5% of the subjects had a not-recommended combination of psychotropic drugs (prescription of drugs of the same pharmacotherapeutic class), 26% had a PIP of antipsychotics: prescription for insomnia, use of phenothiazine, 11.8% of drugs with anticholinergic properties and 7.4% of antidepressants: especially prescription of tricyclic drugs. These results obtained on a large population underline the interest of considering the specificities of prescriptions in the elderly. It shows both the interest and the limits of the current criteria defining the PIP in the context of a hospitalization in psychiatry for an acute disorder in elderly subjects.

药物不良反应 (ADR) 是一个重大的公共卫生问题,尤其是对老年人而言。潜在的不适当处方(PIP)是造成老年人药物不良反应的原因之一。潜在不适当处方的定义是,与其他治疗方法相比,效益/风险比不利的处方。精神药物是老年人发生药物不良反应的第二大风险类别。为了降低 PIP 的发生率,我们开发了处方辅助工具。2019 年,在法国的一个地区环境中,对在精神病科住院的老年患者进行了精神药物 PIP 普查。根据两种工具建立了一个标准网格:STOPP/START 标准和 Laroche 清单,并根据法国的实际情况进行了调整。该网格针对每一类精神药物、抗胆碱能负荷较高的药物和非推荐的精神药物组合。共纳入 347 名患者。发现每一类精神药物的 PPI 患病率都很高。苯二氮卓类药物的 PPI 发生率最高(90.3%):长期处方、长半衰期药物、呼吸功能不全或认知障碍。56.5%的受试者使用了不推荐的精神药物组合(处方同一药物治疗类别的药物),26%的受试者使用了抗精神病药物 PIP:处方用于失眠、使用吩噻嗪,11.8%的受试者使用了具有抗胆碱能特性的药物,7.4%的受试者使用了抗抑郁药物:尤其是处方三环类药物。这些在大量人口中得出的结果突出表明,考虑老年人处方的特殊性很有意义。这表明,在老年人因急性精神障碍而住院治疗的情况下,目前界定 PIP 的标准既有意义,也有局限性。
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引用次数: 0
[Impact of animal-assisted therapy on well-being in patients with Alzheimer's disease (ELIAUT study)]. [动物辅助疗法对阿尔茨海默病患者幸福感的影响(ELIAUT 研究)]。
IF 0.6 4区 医学 Q4 PSYCHIATRY Pub Date : 2023-12-01 DOI: 10.1684/pnv.2023.1134
Eline Thirion, Solveig Rouissi, Virginie Dauphinot, Antoine Garnier-Crussard, Marie-Hélène Coste, Pierre Krolak-Salmon

The development of non-pharmacological interventions, including animal-assisted therapy (AAT), is an encouraging method for the care of people with Alzheimer's disease (AD). A single-center, randomized, single-blind, controlled intervention study was proposed to compare immediate well-being measured by a visual analog scale (EVIBE) as primary outcome between the intervention group (AAT combined with cognitive stimulation) and the control group (cognitive stimulation only) in AD patients. Secondary outcomes were explored, such as well-being after intervention (also with the EVIBE), cognitive performance (measured by Alzheimer's Disease Assessment Scale, cognitive part GRECO version), behavioral and psychological symptoms of dementia (with the Neuropsychiatric Inventory Behavioral Scale-Nursing Home Version), current depressive symptomatology (with the 30 items Geriatric Depression Scale [GDS 30]) and anxiety (by the State-Trait Anxiety Inventory). Forty-two patients were included, 22 in the intervention group and 20 in the control group. The mean age was 82.5 years and mean MMSE score 19.2 in the control group and 81.4 years and mean MMSE score 18.4 in the TAA group. The results show a significant effect of the intervention on well-being after four weeks (p = 0.048), but no significant effect on cognitive functioning, behavioral and psychological symptoms of dementia. This study shows a small effect of TAA on well-being four weeks after the end of the intervention. The assessment of well-being by another measurement tool and the collection of observations made by the care team could be explored in future studies, which could require a larger sample and a longer follow-up.

开发包括动物辅助疗法(AAT)在内的非药物干预措施是治疗阿尔茨海默病(AD)患者的一种令人鼓舞的方法。我们建议进行一项单中心、随机、单盲、对照干预研究,以比较干预组(AAT 与认知刺激相结合)和对照组(仅认知刺激)之间的主要结果,即通过视觉模拟量表(EVIBE)测量的即时幸福感。研究还探讨了次要结果,如干预后的幸福感(也采用 EVIBE)、认知表现(采用阿尔茨海默病评估量表认知部分 GRECO 版本)、痴呆的行为和心理症状(采用神经精神量表行为量表-疗养院版本)、当前的抑郁症状(采用老年抑郁量表 [GDS 30] 30 个项目)和焦虑(采用状态-特质焦虑量表)。研究共纳入 42 名患者,其中干预组 22 人,对照组 20 人。对照组的平均年龄为 82.5 岁,平均 MMSE 得分为 19.2 分;TAA 组的平均年龄为 81.4 岁,平均 MMSE 得分为 18.4 分。结果显示,干预对四周后的幸福感有明显影响(p = 0.048),但对认知功能、痴呆症的行为和心理症状没有明显影响。这项研究表明,在干预结束四周后,TAA 对幸福感的影响较小。在今后的研究中,可以探索使用另一种测量工具对幸福感进行评估,并收集护理团队的观察结果,这可能需要更大的样本和更长的随访时间。
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引用次数: 0
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Geriatrie et Psychologie Neuropsychiatrie De Vieillissement
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