<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1683-9803</journal-id>
<journal-title><![CDATA[Pediatría (Asunción)]]></journal-title>
<abbrev-journal-title><![CDATA[Pediatr. (Asunción)]]></abbrev-journal-title>
<issn>1683-9803</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Paraguaya de Pediatría]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1683-98032023000100048</article-id>
<article-id pub-id-type="doi">10.31698/ped.50012023009</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Frecuencia de consumo de drogas adictivas ilícitas en gestantes o puérperas y su detección en recién nacidos en un hospital materno-infantil de Asunción]]></article-title>
<article-title xml:lang="en"><![CDATA[Frequency of consumption of illicit addictive drugs in pregnant or postpartum women and their detection in newborns in a maternal and infant hospital in Asunción]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Samudio Domínguez]]></surname>
<given-names><![CDATA[Gloria Celeste]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Correa]]></surname>
<given-names><![CDATA[Angélica]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Brítez Martínez]]></surname>
<given-names><![CDATA[Ils Carolina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Vera Quintana]]></surname>
<given-names><![CDATA[Luis María]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ortiz Cuquejo]]></surname>
<given-names><![CDATA[Lidia María]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Nacional de Itauguá  ]]></institution>
<addr-line><![CDATA[Itauguá ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>04</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>04</month>
<year>2023</year>
</pub-date>
<volume>50</volume>
<numero>1</numero>
<fpage>48</fpage>
<lpage>57</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S1683-98032023000100048&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S1683-98032023000100048&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S1683-98032023000100048&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción:  la adicción a sustancias ilícitas constituye un problema de salud pública, del cual no están exentas las embarazadas. Los efectos deletéreos sobre el feto pueden tener consecuencias catastróficas.  Objetivo:  Determinar la frecuencia de uso de drogas ilícitas en mujeres gestantes y caracterizar a estas mujeres y sus recién nacidos de julio de 2020 a julio de 2021.  Material y método:  Estudio transversal, descriptivo, observacional con madres con sospecha de uso de drogas y sus recién nacidos (RN). Se buscó asociación entre variables estudiadas. Se utilizó escala de Finnegan para síndrome de abstinencia neonatal (SAN) y se determinó presencia de drogas en orina.  Resultados:  Fueron incluidos 107 binomios madres -hijos. Prevalencia de madres adictas de 11,42%. Edad promedio de madres 24,5 años y 29,9% en situación calle. 70% fueron partos vaginales, 90,5% con APGAR de 7-10. 26,1% fueron RN prematuros. RCIU 34,5%, PEG 35,5%. 93,3% mujeres se autorreportó como consumidora, 57,9% tuvo control prenatal nulo. 56% de gestantes presentó signos evidentes de ser consumidora de drogas ilícitas al ingreso. La droga más consumida fue la cocaína (COC) 85%. Detección de cocaína en RN fue 81,3%. SAN en 24,2% RN. Se encontró Cocaína en la orina de 18/26 de los pacientes con SAN, y en 64/77 de los pacientes sin síndrome de abstinencia. Tuvo Lues el 25,9%. Se encontró asociación de SAN con la presencia de COC en el RN.  Conclusiones:  el consumo de drogas en la embarazada expone al RN a drogas deletéreas, siendo la droga más frecuentemente consumida la COC. La prevalencia de SAN fue baja, encontrándose asociación entre esta entidad y la presencia de COC en RN.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction:  Addiction to illicit substances constitutes a public health problem, from which pregnant women are not exempt. The deleterious effects on the fetus can have catastrophic consequences.  Objective: To determine the frequency of illicit drug use in pregnant women and to characterize these women and their newborns during the time period from July 2020 to July 2021.  Materials and methods:  this was a cross-sectional, descriptive, observational study with mothers suspected of drug use and their newborns (NBs). An association was sought between the studied variables. The Finnegan scale for neonatal abstinence syndrome (NAS) was used and the presence of drugs in urine was determined.  Results: 107 mother-child pairs were included. The prevalence of addicted mothers was 11.42%. Average age of mothers was 24.5 years and 29.9% were living on the street. 70% were vaginal deliveries, 90.5% with an APGAR score of 7-10. 26.1% were premature newborns. IUGR 34.5%, SGA 35.5%. 93.3% women self-reported as drug consumers, 57.9% had zero prenatal control. 56% of pregnant women presented obvious signs of being an illicit drug user upon admission. The most consumed drug was cocaine (COC), 85%. Detection of cocaine in newborns was 81.3%. NAS was diagnosed in 24.2% NB. Cocaine was found in the urine of 18/26 of the patients with NAS, and in 64/77 of the patients without withdrawal syndrome. 25.9% had Lues. An association of NAS with the presence of COC in the newborn was found.  Conclusions:  drug use in pregnant women exposes the newborn to deleterious drugs, COC being the most frequently used drug. The prevalence of NAS was low, although we found an association between NAS and the presence of COC in newborns.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Drogas]]></kwd>
<kwd lng="es"><![CDATA[adicción]]></kwd>
<kwd lng="es"><![CDATA[recién nacidos]]></kwd>
<kwd lng="es"><![CDATA[síndrome de abstinencia neonatal]]></kwd>
<kwd lng="en"><![CDATA[Drugs]]></kwd>
<kwd lng="en"><![CDATA[addiction]]></kwd>
<kwd lng="en"><![CDATA[newborns]]></kwd>
<kwd lng="en"><![CDATA[neonatal abstinence syndrome]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="book">
<collab>Organización de los Estados Americanos</collab>
<collab>Secretaría de Seguridad Multidimensional Comisión Interamericana para el Control del Abuso de Drogas</collab>
<collab>Observatorio Interamericano de Drogas</collab>
<source><![CDATA[Report on drug use in the Americas]]></source>
<year>2019</year>
<publisher-name><![CDATA[OEA]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Oliveira]]></surname>
<given-names><![CDATA[TA]]></given-names>
</name>
<name>
<surname><![CDATA[Sanchez]]></surname>
<given-names><![CDATA[BAA]]></given-names>
</name>
<name>
<surname><![CDATA[Dos Santos]]></surname>
<given-names><![CDATA[TM]]></given-names>
</name>
<name>
<surname><![CDATA[de Aquino]]></surname>
<given-names><![CDATA[MMA]]></given-names>
</name>
<name>
<surname><![CDATA[Neto]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Resultados perinatais em gestantes usuárias de drogas ilícitas]]></article-title>
<source><![CDATA[Rev Bras Ginecol Obstet]]></source>
<year>2016</year>
<volume>38</volume>
<page-range>183-8</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pérez López]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Embarazo y drogodependencia Actuación en atención primaria]]></article-title>
<source><![CDATA[Medicina Integral]]></source>
<year>2022</year>
<volume>39</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>110-20</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Aguilar Cisneros]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
</person-group>
<source><![CDATA[Morbilidad neonatal por drogadicción de la mujer embarazada]]></source>
<year>2005</year>
<publisher-loc><![CDATA[México DF ]]></publisher-loc>
<publisher-name><![CDATA[México]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[López-Granados]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
<name>
<surname><![CDATA[Cruz-Cortés C de]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Factores psicosociales y sociodemográficos vinculados al uso de sustancias psicoactivas en mujeres durante el embarazo. Una revisión narrativa]]></article-title>
<source><![CDATA[RIIAD]]></source>
<year>2017</year>
<volume>3</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>45-56</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Narkowicz]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Plotka]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Polkowska]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
<name>
<surname><![CDATA[Biziuk]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Namiesnik]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prenatal exposure to substance of abuse a worldwide problem]]></article-title>
<source><![CDATA[Environ Int]]></source>
<year>2013</year>
<volume>54</volume>
<page-range>141-63</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Huestis]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Choo]]></surname>
<given-names><![CDATA[RE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Drug abuse&amp;apos;s smallest victims in utero drug exposure]]></article-title>
<source><![CDATA[Forensic Sci Int]]></source>
<year>2002</year>
<volume>128</volume>
<numero>1-2</numero>
<issue>1-2</issue>
<page-range>20-30</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Porcel]]></surname>
<given-names><![CDATA[GAM]]></given-names>
</name>
<name>
<surname><![CDATA[Ortega]]></surname>
<given-names><![CDATA[MSM]]></given-names>
</name>
<name>
<surname><![CDATA[Barrrientos]]></surname>
<given-names><![CDATA[TS]]></given-names>
</name>
<name>
<surname><![CDATA[Ferreira]]></surname>
<given-names><![CDATA[RF]]></given-names>
</name>
<name>
<surname><![CDATA[Martínez]]></surname>
<given-names><![CDATA[LC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Síndrome de abstinencia neonatal evolución en los últimos diez años]]></article-title>
<source><![CDATA[Enferm. glob]]></source>
<year>2014</year>
<volume>13</volume>
<numero>36</numero>
<issue>36</issue>
<page-range>337-51</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mur Sierra]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Lopez-Vilchez]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Abuso de tóxicos y gestación]]></article-title>
<source><![CDATA[Academia Española de Pediatría. Protocolos Diagnóstico Terapeúticos de la AEP: Neonatología]]></source>
<year>2008</year>
<page-range>145-58</page-range><publisher-name><![CDATA[Paya Panadès]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sublett]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Neonatal Abstinence Syndrome therapeutic nterventions]]></article-title>
<source><![CDATA[American Journal of Maternal/Child Nursing]]></source>
<year>2013</year>
<volume>38</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>102-7</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Correa Reinoso]]></surname>
<given-names><![CDATA[PC]]></given-names>
</name>
<name>
<surname><![CDATA[Solórzano Pérez]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evaluación de la severidad del síndrome de abstinencia neonatal mediante la escala de finnegan según el tipo de droga consumida por las gestantes]]></article-title>
<source><![CDATA[The ecuador j of medicine]]></source>
<year>2018</year>
<page-range>14-20</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="book">
<collab>Secretaría Nacional Antidrogas</collab>
<source><![CDATA[Informe Nacional: situación de drogas en Paraguay 2017]]></source>
<year>2018</year>
<publisher-name><![CDATA[SENAD]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Samudio Domínguez]]></surname>
<given-names><![CDATA[GC]]></given-names>
</name>
<name>
<surname><![CDATA[Ortiz Cuquejo]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
<name>
<surname><![CDATA[Soto Meza]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Samudio Genes]]></surname>
<given-names><![CDATA[CR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Factores asociados al consumo de drogas ilícitas en una población adolescente encuesta en zonas marginales de área urbana]]></article-title>
<source><![CDATA[Pediatr. (Asunción)]]></source>
<year>2021</year>
<volume>48</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>107-12</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Homsup]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Phaloprakarn]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Tangjitgamol]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Manusirivithaya]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Maternal characteristics and pregnancy outcomes among illicit drug-using women in an urban setting]]></article-title>
<source><![CDATA[Taiwan J Obstet Gynecol]]></source>
<year>2018</year>
<volume>57</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>83-8</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Villarreal]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Ré]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Detection of illicit drugs in urine in the Division of Neonatology, Hospital Molas in La Pampa]]></article-title>
<source><![CDATA[Arch Argent Pediatr]]></source>
<year>2013</year>
<volume>111</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>232-6</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<collab>Comisión de Monitorización de Fármacos y Toxicología Clínica de la Sociedad Española de Química Clínica y Patología Molecular</collab>
<article-title xml:lang=""><![CDATA[Importancia del laboratorio clínico en el análisis de drogas de abuso Educación continuada en el laboratorio clínico 2012-2013]]></article-title>
<source><![CDATA[Ed Cont Lab Clín]]></source>
<year>2013</year>
<volume>16</volume>
<page-range>109-18</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Flores-Ramos]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Uso de sustancias adictivas durante el embarazo]]></article-title>
<source><![CDATA[Perinatol. Reprod. Hum.]]></source>
<year>2012</year>
<volume>26</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>169-71</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Santana Ênale]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Illicit and licit drugs and their consequences during pregnancy a literature review]]></article-title>
<collab>Nunes Y de S.Ibiapina DFN.Landim LA dos SR</collab>
<source><![CDATA[RSD]]></source>
<year>2021</year>
<volume>10</volume>
<numero>13</numero>
<issue>13</issue>
</nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Silva-M]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Ponce-A]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Sampedro-M]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Síndrome de abstinencia neonatal: una problemática actual en la unidad de neonatología]]></article-title>
<source><![CDATA[Ciencia Latina Revista Científica Multidisciplinar]]></source>
<year>2022</year>
<volume>6</volume>
<numero>2</numero>
<issue>2</issue>
</nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Morano Amado]]></surname>
<given-names><![CDATA[LE]]></given-names>
</name>
<name>
<surname><![CDATA[Vázquez Álvarez]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Patología orgánica en adicciones otras infecciones asociadas al consumo de drogas]]></article-title>
<source><![CDATA[Adicciones]]></source>
<year>2006</year>
<volume>18</volume>
<numero>Suppl 1</numero>
<issue>Suppl 1</issue>
<page-range>137-59</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Briones Bermeo]]></surname>
<given-names><![CDATA[NP]]></given-names>
</name>
<name>
<surname><![CDATA[Briones Mera]]></surname>
<given-names><![CDATA[AR]]></given-names>
</name>
<name>
<surname><![CDATA[Barreto Rosado]]></surname>
<given-names><![CDATA[ME]]></given-names>
</name>
<name>
<surname><![CDATA[Zambrano Loor]]></surname>
<given-names><![CDATA[LY]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Relación entre Consumo de Drogas con Conductas Sexuales de Riesgo y ETS]]></article-title>
<source><![CDATA[Polo del Conocimiento]]></source>
<year>2021</year>
<volume>6</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>323-34</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gutiérrez-Padilla]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Padilla-Muñoz]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[GutiérrezGonzález]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Barrera-de León]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Aguirre-Jáuregui]]></surname>
<given-names><![CDATA[OM]]></given-names>
</name>
<name>
<surname><![CDATA[Martínez-Verónica]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evolución clínica de hijos de madres con adicciones internados en una unidad de terapia intensiva neonatal del Occidente de México]]></article-title>
<source><![CDATA[Ginecol Obstet Mex]]></source>
<year>2014</year>
<volume>81</volume>
<page-range>441-7</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
