Abstracts

Introduction

In the largest forced migration in recent Latin American history, 6.9 million Venezuelans emigrated from 2017 to October 2023 due to the political and socioeconomic crisis in their home country, and Brazil was one of the main host countries, especially in the Global South ¹1. United Nations High Commissioner for Refugees. Refugee data finder: forced displacement flow dataset. https://www.unhcr.org/refugee-statistics/insights/explainers/forcibly-displaced-flow-data.html (accessed on 13/Feb/2024).
https://www.unhcr.org/refugee-statistics... . By November 2023, 510,100 Venezuelans were living in Brazil ²2. Regional Inter-Agency Coordination Platform for Refugees and Migrants from Venezuela. R4V Latin America and the Caribbean, Venezuelan refugees and migrants in the region - Nov 2023. https://www.r4v.info/en/document/r4v-latin-america-and-caribbean-venezuelan-refugees-and-migrants-region-nov-2023 (accessed on 16/Feb/2024).
https://www.r4v.info/en/document/r4v-lat... .

Forced migration is any situation in which individuals are forced to leave their usual place of residence due to reasons beyond their desire or interest ³3. Pereira GL. Direitos humanos e migrações forçadas: introdução ao direito migratório e ao direito dos refugiados no Brasil e no mundo. Porto Alegre: EDIPUCRS; 2019.. Although the United Nations High Commissioner for Refugees (UNHCR) considers that the reasons for the Venezuelan exodus do not fit the definition of refugees in the Refugee Statute ⁴4. United Nations High Commissioner for Refugees. Global trends: forced displacement in 2019. Geneva: United Nations High Commissioner for Refugees; 2020.. That agency argues that the circumstances that led to the outflow would fit the broader definition of a refugee in the Cartagena Declaration, with an irrefutable need for international protection ⁵5. United Nations High Commissioner for Refugees. Guidelines on International Protection n. 12. Claims for refugee status related to situations of armed conflict and violence under Article 1A(2) of the 1951 Convention and/or 1967 Protocol relating to the status of refugees and the regional refugee definitions. Geneva: United Nations High Commissioner for Refugees; 2016.^,66. United Nations High Commissioner for Refugees. Nota de orientação sobre considerações de proteção internacional para venezuelanos. Geneva: United Nations High Commissioner for Refugees; 2019.. In Brazil, Venezuelan visas were validated temporarily for humanitarian reception ⁷7. Ministério da Justiça; Ministério Extraordinário da Segurança Pública; Ministério das Relações Exteriores; Ministério do Trabalho. Portaria Interministerial nº 9, de 14 de março de 2018. Dispõe sobre a concessão de autorização de residência ao imigrante que esteja em território brasileiro e seja nacional de país fronteiriço, onde não esteja em vigor o Acordo de Residência para Nacionais dos Estados Partes do MERCOSUL e países associados, a fim de atender a interesses da política migratória nacional. Diário Oficial da União 2018; 15 mar.^,88. Brasil. Lei nº 13.445, de 24 de maio de 2017. Institui a Lei de Migração. Diário Oficial da União 2017; 25 may..

Quality of life can be understood as an important indicator of migrants’ integration in the host country, with several physical, psychological, social, and environmental predictors that can negatively affect their perception, such as feeling discriminated, difficulty in accessing health services, unemployment, and weak social network ⁹9. Organization for Economic Cooperation and Development. How's life? 2017: measuring well-being. Paris: Organization for Economic Cooperation and Development; 2017.^,1010. van der Boor CF, Amos R, Nevitt S, Dowrick C, White RG. Systematic review of factors associated with quality of life of asylum seekers and refugees in high-income countries. Confl Health 2020; 14:48.. The quality of life of forced migrants is generally lower than that of the overall population in host countries ¹¹11. Correa-Velez I, Green A, Murray K, Schweitzer RD, Vromans L, Lenette C, et al. Social context matters: predictors of quality of life among recently arrived refugee women-at-risk living in Australia. J Immigr Refug Stud 2020; 18:498-514.. They tend to be more satisfied with their lives in host countries that have lower levels of economic inequality, good public services, and a safer, more welcoming social environment ¹²12. Kogan I, Shen J, Siegert M. What makes a satisfied immigrant? Host-country characteristics and immigrants' life satisfaction in eighteen European countries. Journal of Happiness Studies 2017; 19:1783-809.. The support of organizations and institutions for access to services relevant to their reception and stay also contributes to the integration process ¹³13. Pereira JCA. Migração, saúde e acolhimento: intersecções políticas, sociais e culturais. Travessia - Revista do Migrante 2018; XXXI:3-12.. Furthermore, the time spent living in the host country tends to improve the socioeconomic condition and quality of life of migrants due to their gradual integration ¹⁰10. van der Boor CF, Amos R, Nevitt S, Dowrick C, White RG. Systematic review of factors associated with quality of life of asylum seekers and refugees in high-income countries. Confl Health 2020; 14:48.^,1414. Martine G. Adaptation of migrants or survival of the fittest? A Brazilian case. J Dev Areas 1979; 14:23-41..

The World Health Organization (WHO) defines quality of life as a broad, multidimensional concept that includes an individual’s subjective assessment of their physical health, psychological state, level of independence, social relationships, personal beliefs, and their relationship with the environment ¹⁵15. Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med 1998; 28:551-8.. Thus, quality of life reflects the perception of individuals that their needs are being satisfied or that they are being denied opportunities to achieve happiness and self-realization, regardless of their physical state of health or social and economic conditions ¹⁶16. The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties. Soc Sci Med 1998; 46:1569-85.. Although the concept of quality of life is complex and subjective, different tools were created to quantify it ¹⁷17. Fleck MPA. O instrumento de avaliação de qualidade de vida da Organização Mundial da Saúde (WHOQOL-100): características e perspectivas. Ciênc Saúde Colet 2000; 5:33-8., e.g., the WHOQOL instruments, to allow comparison and progression of some specific aspects of quality of life.

The COVID-19 pandemic has amplified the inequalities and vulnerabilities of migrants worldwide, favoring processes of social exclusion, also noted in the South America and the Southern Cone ¹⁸18. Regional Inter-Agency Coordination Platform for Refugees and Migrants from Venezuela. Plan de respuesta para migrantes y refugiados 2021 - Southern Cone. [s.l.]: Regional Inter-Agency Coordination Platform for Refugees and Migrants from Venezuela; 2020.^,1919. Zapata GP, Prieto Rosas V. Structural and contingent inequalities: the impact of COVID-19 on migrant and refugee populations in South America. Bull Lat Am Res 2020; 39(S1):16-22.. In Brazil, where migrants may transit or stay, the pandemic created severe work, income, education, and health difficulties ²⁰20. Alto Comissariado das Nações Unidas para Refugiados. Pesquisa aponta que refugiados e migrantes venezuelanos têm maior acesso a emprego após interiorização. https://www.acnur.org/portugues/2021/12/08/pesquisa-realizada-por-agencias-da-onu-demonstra-que-pessoas-refugiadas-e-migrantes-vindas-da-venezuela-tem-maior-acesso-a-emprego-e-renda-apos-adesao-a-estrategia-de-interiorizacao/ (accessed on 01/Mar/2023).
https://www.acnur.org/portugues/2021/12/... , resulting from an increase in unemployment and informal jobs, income shortage, and lack of knowledge regarding access to education and health institutions ²¹21. Fernandes D, Baeninger R, Demétrio N. Resultados da pesquisa: impactos da pandemia de Covid-19 nas migrações internacionais no Brasil. In: Fernandes D, Baeninger R, Castro MCG, Balieiro HG, Rocha J, Borges F, et al., editors. Impactos da pandemia de Covid-19 nas migrações internacionais no Brasil - resultados de pesquisa. Campinas: Núcleo de Estudos de População "Elza Berquó", Universidade Estadual de Campinas; 2020. p. 35-79..

To the best of our knowledge, no studies have been conducted on the quality of life of Venezuelan migrants in Brazil. We hypothesized that the adverse circumstances faced by Venezuelan migrants during the COVID-19 pandemic have deepened their vulnerability, which may have negatively influenced their perception of quality of life. This study aims to evaluate the quality of life of Venezuelan migrants in Brazil during the COVID-19 pandemic.

Methods

This study was approved by the Research Ethics Committee of the State University of Rio de Janeiro (UERJ; CAAE: 31909220.1.0000.5260); WHO authorized the use of the WHOQOL-BREF (identification: 361703); and participants signed an online consent form.

This is a cross-sectional study that used an online self-administered questionnaire via the REDCap platform (https://redcapbrasil.com.br/). Venezuelans aged 18 years or older living in Brazil and who answered at least 80% of the quality of life questionnaire were included. Recruitment strategies included: invitation participants of an online Portuguese course administered by UERJ and Cáritas-RJ; referral from the Sérgio Vieira de Mello Academic Chairs of Brazilian universities; and snowball sampling on Facebook, Instagram, Telegram, and WhatsApp. Invitations reached 577,247 individuals. Among 327 respondents, 18 years or older, 15 were excluded, based on: failure to sign the consent form, limited understanding of the questionnaire, illiteracy, or answering fewer than 80% of the items in the questionnaire.

After a pilot study conducted in 2020, the questionnaire in Spanish was applied from October 20, 2020, to May 10, 2021, addressing three modules: sociodemographic characteristics, migration aspects, and quality of life. The first module included 17 questions and the second 13 questions, both of which could be redirected to complementary questions. To evaluate the qualty of life, the Spanish version of the WHOQOL-BREF ²²22. Lucas-Carrasco R. Spanish version of the WHOQOL. Madrid: Ergón; 1998. was adopted, with 26 questions: two extra-domain items (health and overall quality of life) and 24 facets subdivided into four domains (physical, psychological, social relations, and environment).

The WHOQOL-BREF instrument is a shorter version of the WHOQOL-100, both created by the WHO in a multicenter field work ¹⁵15. Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med 1998; 28:551-8.. Although Brazil was one of the centers where the instrument was created and tested, studies conducted with people from or living in Spanish-speaking countries, without their own version of the WHOQOL-BREF, opted to use the Spanish version ²³23. Benítez-Borrego S, Mancho-Fora N, Farràs-Permanyer L, Urzúa-Morales A, Guàrdia-Olmos J. Differential item functioning of WHOQOL-BREF in nine Iberoamerican countries. Revista Iberoamericana de Psicología y Salud 2016; 7:51-9.^,2424. Urzúa A, Ferrer R, Canales Gaete V, Núñez Aragón D, Ravanal Labraña I, Tabilo Poblete B. The influence of acculturation strategies in quality of life by immigrants in Northern Chile. Qual Life Res 2017; 26:717-26.. Each item of the WHOQOL-BREF is rated by a Likert scale ranging from 1 (very dissatisfied) to 5 (very satisfied). Following recommendations by the WHO, this study analyzed the answers to the WHOQOL-BREF with scores converted to a scale from 0 to 100 (worst and best possible scores, respectively).

The frequencies and 95% confidence intervals (95%CI) of variables related to sociodemographic and migration profile were estimated, as well as mean scores and standard deviations of overall quality of life, facets, domains, and Cronbach’s α, standardized for each domain. Missing data were not included in the calculation of relative frequencies. Multiple linear regression models were estimated for the analyses of the associations of overall quality of life and its domains (dependent variables) with the profile (independent variables) of the respondents. The independent variables initially selected were those reported in the literature and that presented p-values < 0.20 in the bivariate analyses of the quality of life scores. Independent variables with p-values < 0.05 remained in the models, using the backward stepwise strategy. The studentized residuals of the models confirmed most linear regression assumptions such as normality, absence of outliers, multicollinearity, and homoscedasticity. The R software version 3.4.2 (http://www.r-project.org) was used.

Results

Among the 312 Venezuelan migrants included, 65.7% were women, median age was 36 years (interquartile range - IQR: 29-44), 54.2% had 15 to 19 years of schooling, and 52.4% were married or living in a stable union. In total, 58% of the participants had no paid activity, 14.8% reported no household income, and 27.2% received up to USD 92 of monthly household income. Moreover, 34% of the Venezuelans participating in the study had experienced nationality-based discrimination, 38.1% had a fixed-term residence permit, and 37.5% lived in Northern Brazil (Table 1).

Overall quality of life showed a mean score of 44.7 (standard deviation - SD = 21.8) on the 0-100 scale. The facets with the highest mean scores were “mobility” (87.7) and “body image and appearance” (75.1). The lowest were “financial resources” (24.8) and “recreation/leisure” (33.8) (Figure 1). The physical domain presented the best mean assessment, with 66.2 points (SD = 17.8; α = 0.78), followed by the psychological (65.0 points; SD = 17.4; α = 0.78), social relations (58.1 points; SD = 24.2; α = 0.69), and environmental (51.1 points; SD = 14.6; α = 0.77) domains. The overall quality of life and domains variables were considered to have a normal distribution.

Low family income and having experienced discrimination reduced the overall quality of life score (reduction of up to 23.7 and 6.7 points, respectively). Among the quality of life domains, being a woman decreased the physical and psychological domains by 6.2 points, and the latter also scored 7.3 points lower among those who had experienced some episode of discrimination. In the social relations domain, lower score was also associated with discrimination, female sex, and not living with a partner. Finally, experience of discrimination resulted in a 4-point decrease in the score in the environment domain (Table 2). Variations in totals are due to missing data.

Discussion

The overall quality of life of Venezuelan migrants in Brazil included in our study during the COVID-19 pandemic was perceived as lower than half of the maximum score on the multidimensional WHOQOL-BREF instrument. Physical domain scored the best; while the environment worst. Poorer quality of life (overall and in specific domains) was associated with female sex, living without a partner, low household income, and having experienced discrimination due to nationality.

The methodological approach adopted snowball sampling, as well as the use of social networks to recruit study participants. We highlight that other studies with migrant populations during the COVID-19 pandemic have also used this approach ²⁵25. Baeninger R, Demétrio N, Domeniconi J, Ribeiro J. Observatório das migrações em São Paulo: desafios das pesquisas de campo no contexto pandêmico. Travessia - Revista do Migrante 2022; XXXV:127-44.. Limitations for participation included limited access to the internet and possibly a lack of a relationship of trust ²⁶26. Ribeiro JC. Migrações bolivianas. Campinas: Núcleo de Estudos de População "Elza Berquó", Universidade Estadual de Campinas; 2021.^,2727. Baeninger R, Fernandes D. Aspectos metodológicos da pesquisa "Impactos da pandemia de Covid-19 nas migrações internacionais no Brasil". In: Fernandes D , Baeninger R , Castro MCG, Balieiro HG, Rocha J, Borges F, et al., editors. Impactos da pandemia de Covid-19 nas migrações internacionais no Brasil - resultados de pesquisa. Campinas: Núcleo de Estudos de População "Elza Berquó" , Universidade Estadual de Campinas; 2020. p.13-9..

The higher proportion of women in the study was consistent with the higher female presence in Venezuelan migration to Brazil. Monthly income of less than USD 93, or less than half of the Brazilian minimum wage (value in 2022: USD 224) was reported by 42% of participants; about 15% mentioned no income. The high proportion of migrants with higher education contrasts with the high frequency of very low income. In another sample of Venezuelans who entered Brazil via Roraima - a state that has common border with Venezuela - there were also reports of about half the income of Brazilians ²⁰20. Alto Comissariado das Nações Unidas para Refugiados. Pesquisa aponta que refugiados e migrantes venezuelanos têm maior acesso a emprego após interiorização. https://www.acnur.org/portugues/2021/12/08/pesquisa-realizada-por-agencias-da-onu-demonstra-que-pessoas-refugiadas-e-migrantes-vindas-da-venezuela-tem-maior-acesso-a-emprego-e-renda-apos-adesao-a-estrategia-de-interiorizacao/ (accessed on 01/Mar/2023).
https://www.acnur.org/portugues/2021/12/... . Their apparently more severe economic vulnerability may be partly explained by the higher rate of unpaid activity. The negative impact of low income on quality of life was expected and has been reported in other migratory groups in Latin America ¹⁹19. Zapata GP, Prieto Rosas V. Structural and contingent inequalities: the impact of COVID-19 on migrant and refugee populations in South America. Bull Lat Am Res 2020; 39(S1):16-22.^,2424. Urzúa A, Ferrer R, Canales Gaete V, Núñez Aragón D, Ravanal Labraña I, Tabilo Poblete B. The influence of acculturation strategies in quality of life by immigrants in Northern Chile. Qual Life Res 2017; 26:717-26..

More than one third of the respondents mentioned discrimination due to their nationality, not a surprising nor recent fact in Brazil. The country’s migration policy privileged white European migrants, with a subsequent attempt to assimilate them and their descendants to consolidate a national unity in cultural, religious, and ethnic patterns ²⁸28. Seyferth G. A assimilação dos imigrantes como questão nacional. Mana 1997; 3:95-131.^,2929. Seyferth G. Colonização, imigração e questão racial no Brasil. Rev USP 2002; (53):117-49.. This intention of “whitening” the Brazilian population is well-known and manifests itself in various ways ³⁰30. Seyferth G. A invenção da raça e o poder discricionário dos estereótipos. Anuário Antropológico 1995; 18:175-203.. The several reported episodes of xenophobia also contributed to the breakdown of “Brazilian cordiality” mith ³¹31. Mina RV, Lima JRT. A "cordialidade" do povo brasileiro frente à imigração de venezuelanos em Roraima: uma discussão sobre a xenofobia. Revista del CESLA 2018; 22:327-46.. Discrimination has already been mentioned as an obstacle to integration in Brazil: among nearly 500 refugees from other countries, 41% had suffered some kind of discrimination based on their foreign nationality, race/skin color, or sexual orientation ³²32. Alto Comissariado das Nações Unidas para Refugiados. Perfil socioeconômico dos refugiados no Brasil. Brasília: Alto Comissariado das Nações Unidas para Refugiados; 2019.. Notably, quality of life is worse in those who experienced discrimination, having also been reported in other forced migrant groups ³³33. Slonim-Nevo V, Regev S, Millo Y. The psycho-social conditions of asylum-seekers from Darfur in Israel. Refuge: Canada's Journal on Refugees 2015; 31:25-38..

Data collection occurred at the beginning of the COVID-19 pandemic, in which high mortality, severe insecurity, and an intense economic crisis occurred in Brazil, which may have worsened the quality of life of Venezuelan participants in this study, especially during the period of social isolation, due either to decreased or lost income, difficulties in securing healthcare, and postponement of decisions on their migration status ¹⁹19. Zapata GP, Prieto Rosas V. Structural and contingent inequalities: the impact of COVID-19 on migrant and refugee populations in South America. Bull Lat Am Res 2020; 39(S1):16-22.^,3434. Kluge HHP, Jakab Z, Bartovic J, D'Anna V, Severoni S. Refugee and migrant health in the COVID-19 response. Lancet 2020; 395:1237-9.. Thus, during the advance of COVID-19, comprehensive healthcare for migrants was further limited due to the lack of information about their rights and language difficulties ³⁵35. Martino AA. Migração, saúde e pandemia: reflexões acerca do atendimento de saúde às pessoas migrantes. In: Magalhães LF, von Zuben C, Parise P, Demétrio NB, Domeniconi J, editors. Migrações internacionais e a pandemia de COVID-19. Campinas: Núcleo de Estudos de População "Elza Berquó", Universidade Estadual de Campinas; 2020. p. 550-9.. Regarding exposure to coronavirus, along with no equitable access to COVID-19 vaccines, migrants reported difficulty in adhering to social distancing measures since they had to leave home in search of financial resources. Moreover, the sometimes restricted housing structure hindered in-home isolation when necessary ²¹21. Fernandes D, Baeninger R, Demétrio N. Resultados da pesquisa: impactos da pandemia de Covid-19 nas migrações internacionais no Brasil. In: Fernandes D, Baeninger R, Castro MCG, Balieiro HG, Rocha J, Borges F, et al., editors. Impactos da pandemia de Covid-19 nas migrações internacionais no Brasil - resultados de pesquisa. Campinas: Núcleo de Estudos de População "Elza Berquó", Universidade Estadual de Campinas; 2020. p. 35-79..

Over the last few years, Brazil has experienced a change in the origin of migrants arriving in the country - no longer predominantly from the Global North ³⁶36. Cavalcanti L, Oliveira T, Silva SL. Relatório anual OBMigra 2023 - OBMigra 10 anos: pesquisa, dados e contribuições para políticas. https://portaldeimigracao.mj.gov.br/pt/dados/relatorios-a (accessed on 28/Jan/2024).
https://portaldeimigracao.mj.gov.br/pt/d... . In the context of South-South migration, the predominantly regional flow of Venezuelans highlights this reconfiguration and indicates the need to prepare for the increase in migrants from the Global South ³⁷37. Jarochinski-Silva JC, Baeninger R. O êxodo venezuelano como fenômeno da migração Sul-Sul. REMHU (Online) 2022; 29:123-39.. However, at the beginning of the pandemic, migratory flows to Brazil were negatively impacted by laws that restricted access to the country with closed borders, thus undermining the right to reception provided for in national laws and treaties to which Brazil is a signatory ³⁸38. Ramos AC. Construindo muralhas: o fechamento de fronteiras na pandemia de COVID-19. In: Magalhães LF, von Zuben C, Parise P, Demétrio NB, Domeniconi J, editors. Migrações internacionais e a pandemia de COVID-19. Campinas: Núcleo de Estudos de População "Elza Berquó", Universidade Estadual de Campinas; 2020. p. 109-18..

The circumstances in the host country influence migrants’ self-perception of quality of life. The COVID-19 pandemic has exacerbated socioeconomic and health problems, which may have led to a worsening of quality of life among the Venezuelans who participated in the study. Factors associated with overall quality of life and its domains, especially income and discrimination, were also observed in other studies as obstacles to Venezuelans and their effective integration ²¹21. Fernandes D, Baeninger R, Demétrio N. Resultados da pesquisa: impactos da pandemia de Covid-19 nas migrações internacionais no Brasil. In: Fernandes D, Baeninger R, Castro MCG, Balieiro HG, Rocha J, Borges F, et al., editors. Impactos da pandemia de Covid-19 nas migrações internacionais no Brasil - resultados de pesquisa. Campinas: Núcleo de Estudos de População "Elza Berquó", Universidade Estadual de Campinas; 2020. p. 35-79.^,3939. Agência da ONU para Refugiados; ONU Mulheres; Fundo de População das Nações Unidas. Oportunidades e desafios à integração local de pessoas de origem venezuelana interiorizadas no Brasil durante a pandemia de COVID-19. https://www.onumulheres.org.br/pesquisa-moverse/ (accessed on 06/Feb/2024).
https://www.onumulheres.org.br/pesquisa-... . Therefore, considering not only the implementation of intersectoral public policies, but also the Global Health scenario, the assessment of quality of life can aid monitoring progress toward achieving the Sustainable Development Goals outlined in the United Nations 2030 Agenda ⁴⁰40. Skevington SM, Epton T. How will the sustainable development goals deliver changes in well-being? A systematic review and meta-analysis to investigate whether WHOQOL-BREF scores respond to change. BMJ Glob Health 2018; 3(Suppl 1):e000609..

This study presents some limitations, including: uneven representation of Brazil’s states; potential recall and/or censoring biases affecting reported data; the sample not being representative of the quality of life of Venezuelans throughout the country; and the exclusion of Venezuelan migrants without internet access and/or basic computer skills.

Despite the common language, the cultural, historical, and social differences in Spanish-speaking countries can influence an individual perception of quality of life ²³23. Benítez-Borrego S, Mancho-Fora N, Farràs-Permanyer L, Urzúa-Morales A, Guàrdia-Olmos J. Differential item functioning of WHOQOL-BREF in nine Iberoamerican countries. Revista Iberoamericana de Psicología y Salud 2016; 7:51-9.. We highlight that the Spanish-language version of the WHOQOL-BREF did not undergo cross-cultural adaptation to the specific Venezuelan context. Thus, its application in this population may not have fully captured subjective aspects of self-assessed quality of life. Additional studies, such as those employing qualitative techniques, may capture perceptions beyond what a closed questionnaire can reflect.

Contributions to the literature

This study explores the gap in Venezuelans’ self-perception of quality of life in Brazil and the contexts that substantially reduce such quality. The findings can support the development of specific and intersectoral strategies directed to Venezuelans in Brazil.

Acknowledgments

The authors wish to thank the Cáritas-RJ Refugee Care Program, the Sérgio Vieira de Mello Academic Chairs, and the fellows from the Institute of Social Medicine at the State University of Rio de Janeiro for their support in conducting the research. Supported by a Master’s scholarship from Brazilian Coordination for the Improvement of Higher Education Personnel (CAPES) of the Brazilian Ministry of Education.

References

Publication Dates

History