Skip to main content
Download PDF

Inter-agency collaboration factors affecting multidisciplinary workers’ ability to identify child maltreatment

BMC Research Notes volume 13, Article number: 323 (2020) Cite this article

Abstract

Objectives

This study aimed to clarify the factors of successful inter-agency collaboration that affect multidisciplinary workers’ abilities to identify child maltreatment. A questionnaire-based survey was conducted; the contents of the questionnaire included the Collaboration Evaluation Scale we developed and the workers’ abilities to identify child maltreatment. In total, 277 individuals from various agencies in Japan participated in this study. To examine the factors of successful inter-agency collaboration affecting workers’ awareness of child maltreatment, we used hierarchical multiple regression analysis.

Results

The analysis showed the positive effect of “commitment with loyalty” on the workers’ awareness of child maltreatment-related information in all fields (β = .18–.31, p < .05), the effect of “strong leadership” on information about maltreated children and the home environment (β = .18, p < .05; β = .16, p < .05, respectively), and the effect of “resources” on the information about mothers’ information during pregnancy and of fathers’ feelings towards their children during the perinatal period (β = .17, p < .05; β = .22, p < .01, respectively). In conclusion, commitment with loyalty, strong leadership, and resources are factors of successful inter-agency collaboration that affects the ability of multidisciplinary workers to recognize signs of child maltreatment.

Introduction

Child maltreatment is an extremely serious issue worldwide [1]. In Japan, the number of reported cases of child maltreatment was 133,778 in 2017, presenting a threefold increase from the previous decade [2]. Child maltreatment has negative consequences, such as physical injuries that can result in death; impairments of physical, socioemotional, and cognitive development; and various mental health problems, including not only diagnosable diseases but also serious behavioral issues [3,4,5].

A multidisciplinary approach from multi-agency partnerships is a standard in the prevention of child maltreatment [6, 7]. Given that early interventions, such as those conducted by nurses visiting new parents and pregnant women at risk of child maltreatment, are effective methods for preventing child maltreatment [8], it is important that multidisciplinary workers who belong to the agencies involved with families and pregnant women at risk of child maltreatment are aware of the early signs of child maltreatment [5, 9]. Therefore, the evaluation and improvement of the ability of such workers’ awareness of the signs of child maltreatment is needed in inter-agency collaboration practices.

In Japan, child protection services (CPS), in which child guidance centers located in each administrative jurisdiction play a central role, deal with suspected child maltreatment cases. To prevent child maltreatment, the CPS collaborates with various agencies, such as hospitals, schools, educational boards, municipal offices, police, and public health centers. However, there are many issues regarding functional practices in multidisciplinary collaboration among agencies. Several studies have discussed the barriers to, and factors for, successful collaboration in child protection [10,11,12]. Johnson et al. investigated the seven factors of successful inter-agency collaboration: (1) commitment, (2) communication, (3) strong leadership provided by key decision-makers, (4) an understanding of the collaborating agencies’ cultures, (5) engagement in serious preplanning, (6) provision of adequate resources for collaboration, and (7) turf issues [12].

We hypothesize that the above-mentioned factors of successful inter-agency collaboration could affect the ability of workers involved with families and pregnant women at risk of child maltreatment to recognize signs of child maltreatment. This study aims to clarify the effects of these factors of successful inter-agency collaboration on multidisciplinary workers’ abilities to recognize signs of child maltreatment. Specifically, the following research questions were examined: (1) What are the pivotal factors of successful inter-agency collaboration?; (2) Which of these factors affect the ability of workers involved with children, families, and pregnant women at risk of child maltreatment to recognize signs of child maltreatment?

Main text

Methods

Participants and data collection

The survey was conducted based on the data collected from August to September 2018. Participants were anonymous multidisciplinary workers who were involved with children and families at risk of child maltreatment. The questionnaire sheet was mailed to the following institutions: 36 hospitals with pediatric emergency departments; 119 child protection-related departments of all municipal offices in Chiba Prefecture, such as the department of children’s health, family care, and prenatal care; seven child guidance centers; 19 public health centers; 54 local boards of education; and one district public prosecutor’s office in Chiba Prefecture (i.e. 236 facilities in total).

Measures

Collaboration evaluation scale

We developed a Collaboration Evaluation Scale based on the seven factors related to successful inter-agency collaboration regarding Johnson’s study [12]. It contained 24 items, and participants rated each item using a four-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree).

Assessment of workers’ abilities to recognize child maltreatment

We developed the questionnaire sheet with reference to the previously reported risk factors of child maltreatment [13, 14]. The questionnaire consisted of 41 items related to maltreatment to assess responders’ abilities to recognize signs of child maltreatment (see Additional file 1). Participants rated each item using a six-point Likert scale, ranging from 1 (not important at all) to 6 (very important).

Data analysis

Statistical analysis was performed using the SPSS 19.0J software package (SPSS, Inc., Chicago, IL). Before performing hierarchical multiple regression analysis to reveal the factors of successful inter-agency collaboration affecting multidisciplinary workers’ awareness of child maltreatment, data screening was conducted to confirm that the assumptions of multivariate analysis were satisfied. We used Cronbach’s α to analyze the internal consistency of the Collaboration evaluation scale and the questions for information to assess the risk of child maltreatment. After that, we calculated the correlations between factors of the Collaboration Evaluation scale and categories of items of information for assessing the risk of child maltreatment and then conducted a hierarchical multiple regression analysis of factors of the Collaboration Evaluation scale and the categories of items for assessing the risk of child maltreatment. For all statistical tests, we used a significance level of .05.

Results

The completed questionnaires were returned by 277 individuals from 114 facilities (48.3%). A total of 277 individuals, comprising 67 men, 207 women, and 3 individuals who did not report their sex, participated in this study. Participants ranged from 22 to 68 years old (mean = 43.6, standard deviation (SD) = 10.8). Table 1 displays the participants’ sex, age, agency, profession, and years of child protection experience.

Table 1 Social and Demographic Characteristics
Full size table

Table 2 shows that the result of the exploratory factor analysis (EFA) on the Collaboration Evaluation Scale. We found four factors as a result of EFA of the 24 item: “commitment with loyalty” (10 items; α = .84), “strong leadership” (6 items; α = .87), “resources” (4 items; α = .62), and “turf issues” (4 items; α = .63).

Table 2 Factor loadings of the items of the collaboration evaluation scale
Full size table

Regarding the assessment of workers’ abilities to recognize child maltreatment, we categorized 41 items into seven fields and performed principal component analysis for each field: (1) maltreated children (10 items, α = .90), including whether they had any physical injuries, their developmental state, and the degree of their affection towards their guardians; (2) mothers’ information, including their child-rearing ability (9 items, α = .91), such as the mother’s age, intellectual ability, and mental disorder; (3) mothers’ information during pregnancy (4 items, α = .88), including whether the mother was socially isolated during pregnancy and whether the pregnancy was unexpected; (4) mothers’ information after childbirth (6 items, α = .91), including whether the mother was socially isolated after childbirth and the mother’s feelings towards her child after childbirth; (5) fathers’ information, including their child-rearing ability (5 items, α = .85), such as the father’s age, intellectual ability, and mental disorder; (6) fathers’ feelings towards his children during pregnancy and after childbirth (2 items, α = .94), including what types of feelings the father had towards his child during pregnancy and after childbirth; and (7) the home environment (5 items, α = .88), including each home’s economic situation, whether there was a supporter, and whether there was a record of child maltreatment.

We analyzed the correlations between the Collaboration Evaluation Scale’s four factors and the seven categories of items of information for assessing the risk of child maltreatment. Commitment with loyalty factor had a significant positive correlation with all the seven categories (r = .23–.40, p < .01). Further, the strong leadership factor was significantly positively correlated with mothers’ information, including their child-rearing ability (r = .21, p < .01); fathers’ information, including their child-rearing ability (r = .13, p < .05); the home environment (r = .24, p < .01); and maltreated children (r = .22, p < .01). Resources were significantly positively correlated with mothers’ information during pregnancy and fathers’ feelings towards their children during pregnancy and after childbirth (r = .19, p < .01; r = .24, p < .01, respectively).

A hierarchical multiple regression analysis was conducted using the four factors of the Collaboration Evaluation scale and the scores of the seven categories of items for assessing the risk of child maltreatment as objective variables. In Step 1, we entered the years of child protection experience, sex, and age as basic attributes, and in Step 2, we entered the scale’s four factors. The forced entry method was adopted to perform all the steps. Significant differences were found in the increase in the coefficient of determination between the steps. In the second model, which was the final step, the value of the partial regression coefficient (β) for each variable indicated commitment with loyalty, strong leadership, resources, and turf issues. There were positive influences of (1) commitment with loyalty on all the categories, (2) strong leadership on maltreated children and the home environment, and (3) recourses on mothers’ information during pregnancy and fathers’ feelings towards their children during pregnancy and after childbirth (Table 3).

Table 3 Hierarchical regression models explaining the multidisciplinary workers’ ability to identify child maltreatment
Full size table

Discussion

We determined that (i) commitment with loyalty, (ii) strong leadership, (iii) resources, and (iv) turf issues were key factors for inter-agency collaboration among multidisciplinary workers involved with children, families, and pregnant women at risk of child maltreatment. Our results show how these four factors affect workers’ ability to recognize signs of child maltreatment.

This study showed that the commitment with loyalty factor had a positive influence on all the areas of information that workers considered important signs of child maltreatment. This supports the idea that commitment factor is a basic, essential, and pivotal element in the provision of children and family support services through inter-agency collaboration [15, 16].

We found that strong leadership also is a factor of successful inter-agency collaboration affecting multidisciplinary workers’ ability to identify “maltreated children” and “home environment problems” in addition to commitment with loyalty. This finding is consistent with that of previous studies on the provision of services for maltreated or disabled children [12, 15, 17]. If upper management does not provide leadership, the efficiency of inter-agency collaboration will decrease [18]. Our study provides a new finding that strong leadership affects workers’ awareness of “maltreated children” and “home environment problems.” To improve workers’ awareness of signs of child maltreatment, people who excel in management and leadership should be assigned to each agency involved in child maltreatment, such as schools, nursery schools, child guidance centers, and municipal offices.

The present study demonstrates that resources affect multidisciplinary workers’ abilities to respond to “mothers’ information during pregnancy” and “fathers’ feelings towards their children during pregnancy and after childbirth,” in addition to commitment with loyalty. Much previous research has emphasized the importance of allocating sufficient resources for inter-agency collaboration within CPS [19, 20]. Johnson et al. found that stable funding is vital and individual staff members should not engage in inter-agency collaboration without funding [12]. Fifty percent of women with postpartum depression suffer from depression during pregnancy [21]. The Edinburgh Postnatal Depression Scale’s scores are significantly positively correlated with neglectful or aggressive parenting behavior of mothers with a child below 1 year old [22]. Further, fathers’ positive attitudes towards their children can reduce the maternal risk for physical child abuse [23]. The improvement of resources for inter-agency collaboration to prevent child maltreatment may improve multidisciplinary workers’ abilities to identify pregnant women and their partners who are at risk of child maltreatment before birth. Further studies are required to clarify the relationships between relevant resources.

The results showed that turf issues as a factor of inter-agency collaboration do not affect workers’ ability to recognize child maltreatment. Since many reports mention that turf issues or the division of roles hinder good inter-agency collaboration [12, 24], these results were unexpected. One potential reason is that a bias in the recruitment of participants may have influenced the results. Only those who were interested in this study’s purpose responded to the questions. Those who did not respond might have been inactive or uncooperative.

Conclusion

This study identified three factors—commitment with loyalty, strong leadership, and resources—as successful inter-agency collaboration practices to prevent child maltreatment. Furthermore, these factors affect the ability of multidisciplinary workers to recognize signs of child maltreatment. To improve abilities to prevent child maltreatment in inter-agency collaboration practices, the present findings could be useful.

Limitations

This study has several limitations. First, as participants could choose whether or not to answer the survey questions, their answers may have been biased since only those who were interested in the study’s purpose responded to the questions. Second, regional characteristics may have affected the answers, since our survey was only conducted in Chiba Prefecture in the Tokyo Metropolitan Area. However, Chiba Prefecture, which is inhabited by more than 600 million people, has a balanced number of rural and urban regions. Finally, we did not enquire about the details of cases handled by individual participants, such as the seriousness of the abuse, which would require the separation of children from their parents. Further research that overcomes the above problems should be conducted on this topic.

Availability of data and materials

The datasets supporting the conclusions drawn in this article are available upon reasonable request.

Abbreviations

CPS:

Child protection services

CGCs:

Child guidance centers

EFA:

Exploratory factor analysis

References

  1. Butchart A, Mikton C. Global status report on violence prevention; 2014. https://www.who.int/violence_injury_prevention/violence/status_report/2014/en/. Accessed 17 Sept 2020.

  2. Ministry of Health, Labour and Welfare, Japan. The number of consultations about child abuse; 2018. https://www.mhlw.go.jp/content/11901000/000533886.pdf. Accessed 17 Sept 2020.

  3. Eigsti IM, Cicchetti D. The impact of child maltreatment on expressive syntax at 60 months. Dev Sci. 2004;7(1):88–102.

    Article  Google Scholar 

  4. English DJ, Thompson R, Graham JC, Briggs EC. Toward a definition of neglect in young children. Child Maltreat. 2005;10(2):190–206.

    Article  Google Scholar 

  5. Levey EJ, Gelaye B, Bain P, Rondon MB, Borba CP, Henderson DC, et al. A systematic review of randomized controlled trials of interventions designed to decrease child abuse in high-risk families. Child Abuse Negl. 2017;65:48–57.

    Article  Google Scholar 

  6. Okato A, Hashimoto T, Tanaka M, Tachibana M, Machizawa A, Okayama J, et al. Hospital-based child protection teams that care for parents who abuse or neglect their children recognize the need for multidisciplinary collaborative practice involving perinatal care and mental health professionals: a questionnaire survey conducted in Japan. J Multidiscip Healthcare. 2018;11:121.

    Article  Google Scholar 

  7. Tachibana Y, Koizumi N, Akanuma C, Tarui H, Ishii E, Hoshina T, et al. Integrated mental health care in a multidisciplinary maternal and child health service in the community: the findings from the Suzaka trial. BMC Pregnancy Childbirth. 2019;19(1):58.

    Article  Google Scholar 

  8. Olds DL, Sadler L, Kitzman H. Programs for parents of infants and toddlers: recent evidence from randomized trials. J Child Psychol Psychiatry. 2007;48(3–4):355–91.

    Article  Google Scholar 

  9. van der Put CE, Bouwmeester-Landweer MBR, Landsmeer-Beker EA, Wit JM, Dekker FW, Kousemaker NPJ, et al. Screening for potential child maltreatment in parents of a newborn baby: the predictive validity of an Instrument for early identification of Parents At Risk for child Abuse and Neglect (IPARAN). Child Abuse Negl. 2017;70:160–8.

    Article  Google Scholar 

  10. Scott D. Inter-agency conflict: an ethnographic study. Child Fam Soc Work. 1997;2:73–80.

    Article  Google Scholar 

  11. Hudson B. Interprofessionality in health and social care: the Achilles’ heel of partnership? J Interprof Care. 2002;16(1):7–17.

    Article  Google Scholar 

  12. Johnson LJ, Zorn D, Tam BY, Lamontagne M, Johnson S. Stakeholders’ views of factors that impact successful interagency collaboration. Council Except Child. 2003;69(2):195–209.

    Article  Google Scholar 

  13. United States Department of Health and Human Services. Child maltreatment; 2018. https://www.acf.hhs.gov/cb/research-data-technology/statistics-research/child-maltreatment. Accessed 17 Sept 2020.

  14. Doidge JC, Higgins DJ, Delfabbro P, Segal L. Risk factors for child maltreatment in an Australian population-based birth cohort. Child Abuse Negl. 2017;64:47–60.

    Article  Google Scholar 

  15. Harker RM, Dobel-Ober D, Berridge D, Sinclair R. More than the sum of its parts? inter-professional working in the education of looked after children. Child Soc. 2004;18(3):179–93.

    Article  Google Scholar 

  16. Schmied V, Mills A, Kruske S, Kemp L, Fowler C, Homer C. The nature and impact of collaboration and integrated service delivery for pregnant women, children and families. J Clin Nurs. 2010;19(23–24):3516–26.

    Article  Google Scholar 

  17. Mulroy EA. Building a neighborhood network: interorganizational collaboration to prevent child abuse and neglect. J Social Work. 1997;42(3):255–64.

    Article  CAS  Google Scholar 

  18. Salmon G, Rapport F. Multi-agency voices: a thematic analysis of multi-agency working practices within the setting of a Child and Adolescent Mental Health Service. J Interprof Care. 2005;19(5):429–43.

    Article  Google Scholar 

  19. Cicchetti D. An odyssey of discovery: lessons learned through three decades of research on child maltreatment. J Am Psychol. 2004;59(8):731.

    Article  Google Scholar 

  20. Darlington Y, Feeney JA, Rixon K. Interagency collaboration between child protection and mental health services: practices, attitudes and barriers. Child Abuse Negl. 2005;29(10):1085–98.

    Article  Google Scholar 

  21. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Arlington: American Psychiatric Association; 2013.

    Book  Google Scholar 

  22. Sagami A, Kayama M, Senoo E. The relationship between postpartum depression and abusive parenting behavior of Japanese mothers: a survey of mothers with a child less than one year old. Bull Menninger Clin. 2004;68(2):174–87.

    Article  Google Scholar 

  23. Guterman NB, Lee Y, Lee SJ, Waldfogel J, Rathouz PJ. Fathers and maternal risk for physical child abuse. Child Maltreat. 2009;14(3):277–90.

    Article  Google Scholar 

  24. Robinson M, Cottrell D. Health professionals in multi-disciplinary and multi-agency teams: changing professional practice. J Interprof Care. 2005;19(6):547–60.

    Article  Google Scholar 

Download references

Acknowledgements

The authors wish to thank the study participants for their contribution to this research. We would like to thank Editage (http://www.editage.jp) for English language editing.

Funding

This study was supported by the Mitsubishi Foundation for Social Welfare Activities (ID 30325).

Author information

Authors and Affiliations

  1. Department of Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba, Chiba, 260-8670, Japan

    Ayumi Okato, Tasuku Hashimoto & Masaomi Iyo

  2. Department of Psychiatry, Sodegaura Satsukidai Hospital, 5-21 Nagauraekimae, Sodegaura, Chiba, 299-0246, Japan

    Tasuku Hashimoto

  3. Division of Clinical Study on Juvenile Delinquency, Center for Forensic Mental Health, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba, Chiba, 260-8670, Japan

    Mami Tanaka

  4. Department of Pediatrics, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba, Chiba, 260-8670, Japan

    Naoki Saito & Mamiko Endo

  5. Division of Clinical Forensic Medicine, Education and Research Center of Legal Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba, Chiba, 260-8670, Japan

    Naoki Saito & Masayoshi Senda

  6. Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba, Chiba, 260-8670, Japan

    Jun Okayama

  7. Welfare and Medical Intelligence, Chiba University Hospital, 1-8-1 Inohana, Chuou-ku, Chiba, Chiba, 260-8677, Japan

    Akiko Ichihara & Saki Eshima

  8. Department of Psychiatry, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan

    Satoshi Handa & Michiko Nakazato

  9. Department of Pediatrics, Asahi General Hospital, I-1326, Asahi, Chiba, 289-2511, Japan

    Masayoshi Senda

  10. Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinju-ku, Tokyo, 160-8582, Japan

    Yasunori Sato

  11. Division of Medical Treatment and Rehabilitation, Center for Forensic Mental Health, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba, Chiba, 260-8677, Japan

    Hiroyuki Watanabe

  12. Gakuji-Kai Kimura Hospital, 6-19, Higashi-Honcho, Chuou-ku, Chiba, Chiba, 260-0004, Japan

    Hiroyuki Watanabe

Authors
  1. Ayumi Okato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tasuku Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mami Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naoki Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mamiko Endo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jun Okayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akiko Ichihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Saki Eshima
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Satoshi Handa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Masayoshi Senda
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yasunori Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hiroyuki Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Michiko Nakazato
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Masaomi Iyo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AO, TH, MT, and YS designed this study. AO, TH, MT, NS, ME, JO, AI, SE, and MS developed the contents of the questionnaire. AO, TH, and MT analyzed the data, and AO, TH, MT, YS, and SH interpreted the results. AO, TH, and MT drafted the manuscript, and YS, SH, HW, MN, and MI revised it. MI supervised the study. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tasuku Hashimoto.

Ethics declarations

Ethics approval and consent to participate

The protocol of this study was reviewed and approved by the Institutional Review Board of the Chiba University School of Medicine (ID, 3129). We provided participants with a letter of informed consent that detailed the study’s purpose and assured confidentiality concerning any personal information, and informed participants that completing and mailing back the questionnaire were considered to reflect written informed consent regarding participation in this study.

Consent for publication

Not applicable.

Competing interests

TH has received research support from Bracket global company. MI received consultant fees from Janssen, Eli Lilly, Otsuka, and Meiji Seika Pharma and honoraria from Janssen Pharmaceutical, Eli Lilly, Otsuka, Meiji Seika Pharma, Astellas, Dainippon Sumitomo, Ono, Mochida, MSD, Eisai, Daiichi-Sankyo, Novartis, Teijin, Shionogi, Hisamitsu, and Asahi Kasei. No potential conflict of interest was reported by the other authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Additional file 1.

The self-assessment sheet for workers’ abilities to recognize child maltreatment.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Okato, A., Hashimoto, T., Tanaka, M. et al. Inter-agency collaboration factors affecting multidisciplinary workers’ ability to identify child maltreatment. BMC Res Notes 13, 323 (2020). https://doi.org/10.1186/s13104-020-05162-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13104-020-05162-7

Keywords

BMC Research Notes

ISSN: 1756-0500

Contact us