Obesity Pillars最新文献

{"title":"Healthcare professionals’ perspectives on the current state of obesity management training: A mix methods study","authors":"Francisca Contreras,&nbsp;Tak Ying Louise Ko,&nbsp;Carel W. le Roux,&nbsp;Werd Al-Najim","doi":"10.1016/j.obpill.2025.100202","DOIUrl":"10.1016/j.obpill.2025.100202","url":null,"abstract":"<div><h3>Introduction</h3><div>Obesity is a disease that represents a major global health problem, affecting over a quarter of European adults and straining healthcare systems. Despite its multifactorial causes, many healthcare professionals lack adequate training and confidence in delivering effective, person-centered obesity care. Weight stigma and misconceptions further impair outcomes. Thus, improved education and interprofessional training are essential to support healthcare professionals in delivering optimal obesity care. The aim of this study is to explore the current state of obesity management training among healthcare professionals working in obesity management services by identifying perceived training gaps, confidence levels and impact on clinical practice.</div></div><div><h3>Methodology</h3><div>This study employed a mixed-methods design by combining a cross-sectional survey of 100 healthcare professionals with semi-structured interviews of 20 professionals who work in obesity management. Survey data were analyzed descriptively, and interview transcripts underwent thematic analysis using Braun and Clarke's framework.</div></div><div><h3>Results</h3><div>Of the 100 healthcare professionals surveyed, 88 % reported actively working in obesity management and completed the full survey. Undergraduate training in obesity care was limited, with only 44 % receiving any, and only 12 % rated it as good or excellent. Postgraduate training was pursued by 51 %, with only 6 % completing formal advanced education. Participant perceptions of obesity training were organized in 5 domains: a) Current state of obesity management training, b) Confidence level, c) Gaps in training, d) Impact on clinical practice and d) Recommendation for obesity training curriculum.</div></div><div><h3>Conclusion</h3><div>Healthcare professionals report significant gaps in obesity management training that impact their confidence and clinical practice. The key recommendations made by participants in this study reflect both the perceived deficits and a clear demand for more structured and comprehensive training in obesity management. Integrating structured, evidence-based obesity education into healthcare training programs is essential to reduce stigma, build competence, and improve obesity care.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"16 ","pages":"Article 100202"},"PeriodicalIF":0.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144902894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of physical activity and BMI on health-related quality of life in overweight Indian adolescents: A randomized controlled study","authors":"Prateek Srivastav ,&nbsp;K. Vaishali ,&nbsp;H. Vinod Bhat ,&nbsp;Suzanne Broadbent","doi":"10.1016/j.obpill.2025.100201","DOIUrl":"10.1016/j.obpill.2025.100201","url":null,"abstract":"<div><h3>Background</h3><div>Health-related quality of life (HRQOL) is a critical yet often overlooked component of adolescent obesity management. While physical activity (PA) and body mass index (BMI) are established markers of health, their combined influence on HRQOL in Indian adolescents remains underexplored.</div></div><div><h3>Objective</h3><div>To examine how PA and BMI influence overall and domain-specific HRQOL in overweight and adolescents with obesity following a structured lifestyle program.</div></div><div><h3>Methods</h3><div>In this randomized controlled study, 604 adolescents (aged 11–16 years) with BMI above the 85th percentile were recruited from schools in Udupi, India. Individuals were randomized into three groups: multifactorial strategy (MFI: exercise, lifestyle education, behavioral counseling), exercise-only (EX), and Control group (CON). PA was measured using the Physical Activity Questionnaire for Adolescents (PAQ-A), and HRQOL was measured via the Pediatric Quality of Life Inventory (PedsQL 4.0). Linear mixed-effects models evaluated associations between PA, BMI, and HRQOL over a 12-month period, which included a 12-week intervention followed by 9 months of follow-up.</div></div><div><h3>Results</h3><div>PA was linked with better HRQOL in the MFI (β = 9.30, p &lt; 0.001) and EX (β = 4.47, p &lt; 0.001) groups. Interestingly, higher BMI correlated with better HRQOL scores in both program arms. The CON group showed no meaningful association between PA and HRQOL. The domain-level analysis found that PA and BMI were positively linked to physical, emotional, social, and school functioning in both program groups, with more pronounced effects in the MFI group. The CON group showed improvement only in emotional functioning related to BMI.</div></div><div><h3>Conclusion</h3><div>Structured PA programs, especially those combining education and behavioral support, notably enhance the quality of life among overweight Indian adolescents. These findings reinforce the importance of focusing not solely on weight loss, but on holistic, behavior-driven health outcomes in adolescent obesity care.</div></div><div><h3>Clinical trial registration</h3><div>CTRI/2019/04/018,834.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"16 ","pages":"Article 100201"},"PeriodicalIF":0.0,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity Medicine Association statement regarding online pharmacologic management of obesity","authors":"Leslie Golden,&nbsp;Harold Edward Bays","doi":"10.1016/j.obpill.2025.100200","DOIUrl":"10.1016/j.obpill.2025.100200","url":null,"abstract":"","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"16 ","pages":"Article 100200"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity treatment as a bridge to solid organ transplantation: A comparison of bariatric surgery to medical therapy","authors":"Kevin L. Roddy,&nbsp;Matthew R. Greenwald,&nbsp;Nicholas Hollman,&nbsp;Madisen F. Dorand,&nbsp;Jesse R. Richards","doi":"10.1016/j.obpill.2025.100199","DOIUrl":"10.1016/j.obpill.2025.100199","url":null,"abstract":"<div><h3>Background</h3><div>Organ transplant is a rapidly growing area of medicine, with over 42,800 organ transplants occurring in 2022.[1] Obesity complicates the transplant surgery process; historically, the only available treatment for patients with both severe obesity and end-organ damage requiring transplant was bariatric surgery. Glucagon-like peptide-1 (GLP-1) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) agonists (such as semaglutide and tirzepatide, respectively) may offer a non-surgical alternative to weight management prior to transplant surgery.</div></div><div><h3>Methods</h3><div>This descriptive case series utilized retrospective chart review to compare peri-transplant weight loss in individuals treated with bariatric surgery alone, GLP-1 or GLP-1/GIP medication without surgical intervention, and GLP-1 or GLP-1/GIP medication with surgical intervention. Nineteen (N = 19) patients pursuing kidney transplant met inclusion criteria. Primary outcomes of interest in each group were median weight loss, total weight loss percent, and portion of individuals who met the BMI cut-off for transplantation following the intervention.</div></div><div><h3>Results</h3><div>Individuals treated with tirzepatide (n = 9) demonstrated 8 % less weight loss than the surgical-intervention group, and 77.8 % (n = 7) met BMI cutoff for transplant after treatment. Among patients treated with semaglutide (n = 4), 50 % (n = 2) met BMI cutoff for transplant. In the bariatric-surgery only group, 66.7 % (n = 2) met the BMI cutoff for transplant. Among those who received both bariatric surgery and GLP-1 medication (n = 3), all met the BMI cutoff for transplant.</div></div><div><h3>Conclusions</h3><div>This descriptive case series demonstrates that the current generation of weight loss medications produce a degree of weight loss comparable to bariatric surgery; this is particularly relevant to individuals with obesity who are pursuing organ transplant. Conclusions are limited due to the small, retrospective, and observational nature of this study; however, the results support the hypothesis that medications could revolutionize the organ transplant process by providing a reasonable non-surgical weight loss option for individuals with obesity. Further study with a larger, prospective randomized trial is needed to fully evaluate the viability of utilizing anti-obesity medications for this unique clinical indication.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"16 ","pages":"Article 100199"},"PeriodicalIF":0.0,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144902395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving screening for disordered eating behaviors in pediatric weight management using quality improvement methodology","authors":"Roohi Y. Kharofa ,&nbsp;Sanita L. Ley ,&nbsp;Kristin M. Stackpole ,&nbsp;Jessica A. Lin ,&nbsp;Carolina M. Bejarano ,&nbsp;Katelyn Gordon ,&nbsp;Shelley Kirk ,&nbsp;Melissa Burbrink ,&nbsp;Robert M. Siegel","doi":"10.1016/j.obpill.2025.100198","DOIUrl":"10.1016/j.obpill.2025.100198","url":null,"abstract":"<div><h3>Background</h3><div>Adolescents with obesity are at increased risk for disordered eating behaviors (DEBs). Despite screening being recommended, identification of DEBs in pediatric weight management (PWM) remains inadequate.</div></div><div><h3>Methods</h3><div>The aim of this quality improvement project was to increase provider documentation of screening for DEBs from 44 % to 80 % for new patients, age ≥12, seen at a PWM program over a 10-month period. Interventions were grouped into four PDSA cycles: 1. Provider education, 2. Screening tool implementation, 3. Systematic use of screening tool, and 4. Implementation of an electronic screener. The primary outcome was the percent of patients with documentation of DEB screening. Data was plotted on a p-chart. Standard statistical process control methods were used.</div></div><div><h3>Results</h3><div>Mean documentation rates for DEBs increased from a baseline of 44 %–85 %, with special cause analysis demonstrating improvement. Referrals for DEBs increased from 13 % at baseline to 19 %.</div></div><div><h3>Conclusion</h3><div>Consistently screening for disordered eating behaviors in pediatric weight management is feasible. Quality improvement methodology can be utilized to help identify and act on facilitators and barriers to screening. Improved screening may lead to earlier identification of high-risk patients and prompt referral to mental health practitioners.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"16 ","pages":"Article 100198"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-sectional associations between intrinsic and extrinsic motivation for physical activity and body composition in adolescents with obesity","authors":"Fábio de Freitas ,&nbsp;Mariana R. Zago ,&nbsp;Maria Ângela Antônio ,&nbsp;António Videira-Silva ,&nbsp;Maria Ângela Bellomo Brandão","doi":"10.1016/j.obpill.2025.100197","DOIUrl":"10.1016/j.obpill.2025.100197","url":null,"abstract":"<div><h3>Background</h3><div>Motivation is essential in turning the intention to engage in physical activity (PA) into consistent action, promoting healthier and more sustainable habits. This study aimed to identify the motivational factors associated with engagement in a PA program and examine the relationship between motivation and body composition in adolescents with obesity.</div></div><div><h3>Methods</h3><div>Fifty adolescents (60.0 % boys); Median age of 13.6 years (IQR: 2.4); Median BMI z-score of 3.42 (IQR: 1.55) recruited for a PA program were included in this cross-sectional study. All participants completed standardized body composition assessments and an online questionnaire assessing five motivational domains: enjoyment and competence (intrinsic), and appearance, fitness, and social (extrinsic domains).</div></div><div><h3>Results</h3><div>Fitness emerged as the main reason for engaging in the PA program (6.41 ± 0.81), followed by appearance (5.64 ± 1.43), enjoyment (4.98 ± 1.47), competence (4.55 ± 1.99), and social (3.79 ± 1.85). Enjoyment and competence showed significant negative associations with body weight. (<em>r</em>_<em>p</em> = −0.29, p = 0.045; <em>r</em>_<em>p</em> = −0.32, p = 0.027). Regression analysis identified fitness as a significant predictor for BMI z-score (β = 0.4, p = 0.027).</div></div><div><h3>Conclusion</h3><div>Extrinsic motives, such as fitness and appearance may drive PA engagement in treatment-seeking adolescents with obesity. However, intrinsic motives, such as enjoyment and competence, may be inversely associated with BMI z-score. Thus, targeting both extrinsic and intrinsic motivation may help to improve adherence and weight outcomes in obesity care. More studies with larger samples are needed to confirm these findings.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"16 ","pages":"Article 100197"},"PeriodicalIF":0.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diet quality and nutrient distribution while using glucagon-like-peptide-1 receptor agonist: A secondary cross-sectional analysis","authors":"Brittany V.B. Johnson,&nbsp;Mary Milstead,&nbsp;Lauren Green,&nbsp;Rachel Kreider,&nbsp;Rachel Jones","doi":"10.1016/j.obpill.2025.100195","DOIUrl":"10.1016/j.obpill.2025.100195","url":null,"abstract":"<div><h3>Background</h3><div>With the rise of glucagon-like-peptide-1 receptor agonist medications (GLP-1RA) for obesity treatment, understanding diet quality can be a valuable tool for providing evidence-based nutrition guidance. However, there is limited data on dietary intake during GLP-1RA treatment. Thus, we analyzed diet quality and nutrient timing while using GLP-1RA.</div></div><div><h3>Methods</h3><div>This was a secondary analysis from a previous cross-sectional online survey questionnaire study involving adults currently using GLP-1RA for weight reduction (N = 69, 49.6 ± 12.3 years old, 35.9 ± 9.1 kg/m2). Three-day food records were analyzed using the Healthy Eating Index (HEI), a validated score that indicates overall diet quality. The 13 HEI components were scored from average 3-day food records and calculated using 95 % confidence intervals (CI). A Bonferroni correction applied significance accepted at p = 0.0038. Additionally, 95 % CI were calculated for calories, macronutrients, and fiber intake reported for breakfast, lunch, dinner, and snacks.</div></div><div><h3>Results</h3><div>A 95 % CI revealed a total HEI score of 54 ± 12 (51.4, 57.3), significantly below the HEI goal (p &lt; 0.0038). All components, except added sugars, were significantly under the max score. There was no significant difference for HEI scores based on duration of GLP-1RA use. The largest number of calories were consumed at dinner, averaging 649 compared to 538, 392, and 391 calories at lunch, breakfast, and snacks, respectively. Further, 40 % of the total daily protein intake occurred at dinnertime.</div></div><div><h3>Conclusion</h3><div>Within the sample of patients using GLP-1RAs, dietary quality was suboptimal for fruits, vegetables, whole grains, seafood and plant proteins, dairy and fatty acids. Future research is needed to determine if HEI scores change before, during, and after GLP-1RA treatments and nutrient timing.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"16 ","pages":"Article 100195"},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum regarding missing clinical trial registration numbers in previously published articles","authors":"","doi":"10.1016/j.obpill.2025.100193","DOIUrl":"10.1016/j.obpill.2025.100193","url":null,"abstract":"","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"15 ","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Creating an adolescent intensive health behavior and lifestyle treatment for type 1 diabetes: Feedback from the target population","authors":"Jennifer L. Warnick ,&nbsp;Katherine E. Darling ,&nbsp;Smriti Maskey ,&nbsp;Lisa Swartz Topor ,&nbsp;Katelyn Fox ,&nbsp;KayLoni Olson ,&nbsp;Elissa Jelalian","doi":"10.1016/j.obpill.2025.100194","DOIUrl":"10.1016/j.obpill.2025.100194","url":null,"abstract":"<div><h3>Background</h3><div>The prevalence of obesity among youth with type 1 diabetes (T1D) has significantly increased over the past few decades, leading to increased risks for morbidity and early mortality. Despite this growing need, there is a dearth of evidence-based intensive health behavior and lifestyle treatments (IHBLT) for youth with T1D. This study collected qualitative data from adolescents with T1D and with comorbid overweight/obesity and their caregivers to inform the refinement of an IHBLT specific to adolescents with T1D.</div></div><div><h3>Methods</h3><div>This is an original clinical research study. Participants completed individual semi-structured interviews to provide feedback on planned session topics, handouts, and activities for a modified IHBLT for T1D. A deductive framework matrix analysis approach was used to analyze data. All data were analyzed by two independent coders who met to discuss divergence in coding and came to 100 % agreement. Codes were iteratively reduced and organized into themes.</div></div><div><h3>Results</h3><div>Sixteen participants (<em>n</em> = 8 adolescents, <em>n</em> = 8 caregivers) completed qualitative interviews. Three main themes emerged from the data: (1) satisfaction with the proposed program, (2) program structure preferences, and (3) suggested adaptations.</div></div><div><h3>Conclusions</h3><div>The adapted IHBLT for adolescents with T1D seems to be initially acceptable to the target population. Results provide suggestions for the continued refinement of an IHBLT specific to adolescents with T1D.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"16 ","pages":"Article 100194"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving obesity treatment through online motivational support in primary care","authors":"Jessica Stockham ,&nbsp;Shannon Harris ,&nbsp;William Berard","doi":"10.1016/j.obpill.2025.100191","DOIUrl":"10.1016/j.obpill.2025.100191","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a complex, chronic disease requiring time-intensive, multifaceted management strategies that are often difficult to implement in primary care. This quality improvement project aimed to evaluate whether the integration of an online motivational support group via Facebook, in addition to routine monthly office visits, could enhance obesity treatment outcomes and patient motivation in a primary care setting. As a nurse practitioner driven project, nurse practitioners have the training to make significant improvements in the area of obesity treatment. Nurse practitioners are key in providing patients with education and tools to help patients lose weight and maintain successful weight loss (Fruh, 2017) [1].</div></div><div><h3>Methods</h3><div>This was a quality improvement project using a pre-post design conducted at a private outpatient internal medicine clinic. Adult patients (n = 68) with a BMI ≥30 or ≥25 with comorbidities were enrolled. Participants joined a Facebook-based support group and received standardized education and monthly in-person follow-up for 12 weeks. Outcomes measured before and after the intervention included weight, BMI, waist circumference, and responses to the Weight Efficacy Lifestyle Questionnaire-Short Form (WEL-SF). Paired t-tests were used for statistical analysis.</div></div><div><h3>Results</h3><div>Statistically significant improvements were observed in weight (−9.46 lbs, <em>p</em> &lt; 0.0001), BMI (−1.91, <em>p</em> &lt; 0.0001), and waist circumference (−1.87 inches, <em>p</em> &lt; 0.0001). WEL-SF scores improved significantly in 7 of 8 domains, with an average increase of 11.8 %, indicating enhanced self-efficacy and motivation for healthy eating behaviors.</div></div><div><h3>Conclusion</h3><div>The integration of an online motivational support platform with monthly in-office visits significantly improved physiologic outcomes and patient self-efficacy in managing obesity. These findings support the feasibility and potential benefit of low-cost digital support tools in augmenting outpatient obesity care, particularly in settings with limited resources. Further research should explore the impact of engagement level and long-term outcomes.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"16 ","pages":"Article 100191"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}